Comparison of Pulse and Arterial Oxygen Saturation Changes in Endotracheal Suction Opening with Two Sizes of 12 and 14: A Randomised Controlled Trial

BackgroundAs part of a randomised controlled trial of treatment with placebo versus 3 days of amoxicillin for nonsevere fast-breathing pneumonia among Malawian children aged 2–59 months, a subset of children was hospitalised for observation. We sought to characterise the progression of fast-breathing pneumonia among children undergoing repeat assessments to better understand which children do and do not deteriorate.MethodsVital signs and physical examination findings, including respiratory rate, arterial oxygen saturation measured by pulse oximetry (SpO2), chest indrawing and temperature were assessed every 3 h for the duration of hospitalisation. Children were assessed for treatment failure during study visits on days 1, 2, 3 and 4.ResultsHospital monitoring data from 436 children were included. While no children had SpO2 90–93% at baseline, 7.4% (16 of 215) of children receiving amoxicillin and 9.5% (21 of 221) receiving placebo developed SpO2 90–93% during monitoring. Similarly, no children had chest indrawing at enrolment, but 6.6% (14 of 215) in the amoxicillin group and 7.2% (16 of 221) in the placebo group went on to develop chest indrawing during hospitalisation.ConclusionRepeat monitoring of children with fast-breathing pneumonia identified vital and physical examination signs not present at baseline, including SpO2 90–93% and chest indrawing. This information may support providers and policymakers in developing guidance for care of children with nonsevere pneumonia.

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Evaluation of the efficacy and safety of inhaled magnesium sulphate in combination with standard treatment in patients with moderate or severe COVID-19: A structured summary of a study protocol for a randomised controlled trial

Trials ◽

10.1186/s13063-021-05032-y ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Guitti Pourdowlat ◽

Seyed Ruhollah Mousavinasab ◽

Behrooz Farzanegan ◽

Alireza Kashefizadeh ◽

Zohreh Akhoundi Meybodi ◽

...

Keyword(s):

Oxygen Saturation ◽

Magnesium Sulphate ◽

Standard Treatment ◽

Controlled Trial ◽

Arterial Oxygen Saturation ◽

Arterial Oxygen ◽

Open Label ◽

Arterial Blood ◽

Full Protocol ◽

Randomised Controlled

Abstract Objectives Basic and clinical studies have shown that magnesium sulphate ameliorates lung injury and controls asthma attacks by anti-inflammatory and bronchodilatory effects. Both intravenous and inhaled magnesium sulphate have a clinical impact on acute severe asthma by inhibition of airway smooth muscle contraction. Besides, magnesium sulphate can dilate constricted pulmonary arteries and reduce pulmonary artery resistance. However, it may affect systemic arteries when administered intravenously. A large number of patients with covid-19 admitted to the hospital suffer from pulmonary involvement. COVID-19 can cause hypoxia due to the involvement of the respiratory airways and parenchyma along with circulatory impairment, which induce ventilation-perfusion mismatch. This condition may result in hypoxemia and low arterial blood oxygen pressure and saturation presented with some degree of dyspnoea and shortness of breath. Inhaled magnesium sulphate as a smooth muscle relaxant (natural calcium antagonist) can cause both bronchodilator and consequently vasodilator effects (via a direct effect on alveolar arterioles in well-ventilated areas) in the respiratory tract. We aim to investigate if inhaled magnesium sulphate as adjuvant therapy to standard treatment can reduce ventilation-perfusion mismatch in the respiratory tract and subsequently improve arterial oxygen saturation in hospitalized patients with COVID-19. Trial design A multi-centre, open-label, randomised controlled trial (RCT) with two parallel arms design (1:1 ratio) Participants Patients aged 18-80 years hospitalized at Masih Daneshvari Hospital and Shahid Dr. Labbafinejad hospital in Tehran and Shahid Sadoughi Hospital in Yazd will be included if they meet the inclusion criteria of the study. Inclusion criteria are defined as 1. Confirmed diagnosis of SARS-CoV-2 infection based on polymerase chain reaction (PCR) of nasopharyngeal secretions or clinical manifestations along with chest computed tomography (chest CT) scan 2. Presenting with moderate or severe COVID-19 lung involvement confirmed with chest CT scan and arterial oxygen saturation below 93% 3. Length of hospital stay ≤48 hours. Patients with underlying cardiovascular diseases including congestive heart failure, bradyarrhythmia, heart block, the myocardial injury will be excluded from the study. Intervention and comparator Participants will be randomly divided into two arms. Patients in the intervention arm will be given both standard treatment for COVID-19 (according to the national guideline) and magnesium sulphate (5 cc of a 20% injectable vial or 2 cc of a 50% injectable vial will be diluted by 50 cc distilled water and nebulized via a mask) every eight hours for five days. Patients in the control (comparator) arm will only receive standard treatment for COVID-19. Main outcomes Improvement of respiratory function and symptoms including arterial blood oxygen saturation, dyspnoea (according to NYHA functional classification), and cough within the first five days of randomization. Randomisation Block randomisation will be used to allocate eligible patients to the study arms (in a 1:1 ratio). Computer software will be applied to randomly select the blocks. Blinding (masking) The study is an open-label RCT without blinding. Numbers to be randomised (sample size) The trial will be performed on 100 patients who will be randomly divided into two arms of control (50) and intervention (50). Trial Status The protocol is Version 5.0, January 05, 2021. Recruitment of the participants started on July 30, 2020, and it is anticipated to be completed by February 28, 2021. Trial registration The trial was registered in the Iranian Registry of Clinical Trials (IRCT) on July 28, 2020. It is available on https://en.irct.ir/trial/49879. The registration number is IRCT20191211045691N1. Full protocol The full protocol is attached as an additional file, accessible from the Trials website (Additional file 1). In the interest of expediting the dissemination of this material, the familiar formatting has been eliminated; this Letter serves as a summary of the key elements of the full protocol.

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Controlled Trial of Nebulized Albuterol in Children Younger Than 2 Years of Age With Acute Asthma

PEDIATRICS ◽

10.1542/peds.89.1.133 ◽

1992 ◽

Vol 89 (1) ◽

pp. 133-137 ◽

Cited By ~ 1

Author(s):

Lea Bentur ◽

Gerard J. Canny ◽

Michael D. Shields ◽

Eitan Kerem ◽

Joseph J. Reisman ◽

...

Keyword(s):

Oxygen Saturation ◽

Acute Asthma ◽

Controlled Trial ◽

Arterial Oxygen Saturation ◽

Clinical Status ◽

Previous History ◽

Clinical Score ◽

Arterial Oxygen ◽

Recurrent Wheezing ◽

History Of

To determine the response to nebulized β2 agonist, 28 children younger than 2 years of age who visited the emergency department during an episode of acute asthma were studied. Each subject had a previous history of recurrent wheezing episodes. They were randomly assigned to receive two administrations of either nebulized albuterol (0.15 mg/kg per dose) or placebo (normal saline) with oxygen, 1 hour apart. After two nebulizations, the albuterol-treated patients had a greater improvement in clinical status (respiratory rate, degree of wheezing and accessory muscle use, total clinical score, and arterial oxygen saturation) than the placebo group. None of the patients in the albuterol group experienced a decrease of arterial oxygen saturation of ≥2%. It is conduded that a trial of nebulized β2 agonists is warranted in the treatment of acute asthma in infants and young children.

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Which oxygen saturation level should we use for very premature infants? A randomised controlled trial

http://isrctn.org/> ◽

10.1186/isrctn00842661 ◽

2012 ◽

Author(s):

Peter Brocklehurst

Keyword(s):

Randomised Controlled Trial ◽

Oxygen Saturation ◽

Premature Infants ◽

Controlled Trial ◽

Saturation Level ◽

Oxygen Saturation Level ◽

Randomised Controlled ◽

Very Premature Infants

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A recruitment manoeuvre performed after endotracheal suction does not increase dynamic compliance in ventilated paediatric patients: a randomised controlled trial

Australian Journal of Physiotherapy ◽

10.1016/s0004-9514(07)70023-5 ◽

2007 ◽

Vol 53 (3) ◽

pp. 163-169 ◽

Cited By ~ 21

Author(s):

Brenda Morrow ◽

Merle Futter ◽

Andrew Argent

Keyword(s):

Randomised Controlled Trial ◽

Controlled Trial ◽

Dynamic Compliance ◽

Recruitment Manoeuvre ◽

Endotracheal Suction ◽

Paediatric Patients ◽

Randomised Controlled

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The Effect of the Duration of Pre-Oxygenation before Endotracheal Suction on Hemodynamic Symptoms

Global Journal of Health Science ◽

10.5539/gjhs.v9n2p127 ◽

2016 ◽

Vol 9 (2) ◽

pp. 127

Author(s):

Hossein Tavangar ◽

Mostafa Javadi ◽

Saeed Sobhanian ◽

Fatemeh Forozan Jahromi

Keyword(s):

Heart Rate ◽

Oxygen Saturation ◽

Arterial Oxygen Saturation ◽

Repeated Measure ◽

Arterial Oxygen ◽

Endotracheal Suctioning ◽

Endotracheal Suction ◽

The Mean ◽

The One ◽

Clinical Conditions

BACKGROUND: Hypoxia and hypoxemia are among the most common complications of endotracheal suctioning. These complications are often mitigated by the administration of oxygen 100% prior to endotracheal suction. Although several studies have supported the application of this method, none have yet specified the exact duration of pre-oxygenation required to be performed before endotracheal suction. The present study was therefore conducted to determine the effect of the duration of pre-oxygenation before endotracheal suction on heart rate and arterial oxygen saturation in patients in intensive care units.OBJECTIVES: This prospective clinical trial conducted on 63 eligible ICU patients under mechanical ventilator. Subjects randomly divided into three groups. Pre-oxygenation was carried out for 30 seconds in the first group, for one minute in the second group and for two minutes in the third group. All three groups were then hyper-oxygenated for one minute. Arterial oxygen saturation and heart rate were recorded on different occasions in the three groups. The data obtained were analyzed using the ANOVA, the one-way ANOVA, the post-hoc test and the repeated measure ANOVA.RESULTS: The results obtained showed a greater reduction in the mean O2sat during the suctioning episodes in the 30-second pre-oxygenation group compared to in the one-minute (P=0.046) and two-minute (P=0.001) pre-oxygenation groups. This mean reduction was also observed immediately after suctioning (P=0.001). The mean O2sat was lower in the 30-second pre-oxygenation group than in the one-minute pre-oxygenation group in minutes 5 (P=0.002) and 20 (P=0.001) of the suctioning. Similarly, the mean O2sat was lower in the 30-second pre-oxygenation group than in the two-minute pre-oxygenation group in minutes 5 (P=0.001) and 20 (P=0.001) of the suctioning. The results obtained through the ANOVA showed the lack of significant differences between the three groups in the mean variation in heart rate in the different stages of suctioning.CONCLUSIONS: According to the results obtained, one-minute and two-minute pre-oxygenations cause less disruption in arterial oxygen saturation compared to a 30-second pre-oxygenation. To achieve stability in arterial oxygen saturation and avoid hypoxemia caused by endotracheal suctioning, one-minute or two-minute pre-oxygenation is recommended in ICUs depending on the patient’s clinical conditions.

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Physiological stability in an indigenous sleep device: a randomised controlled trial

Archives of Disease in Childhood ◽

10.1136/archdischild-2017-313512 ◽

2017 ◽

Vol 103 (4) ◽

pp. 377-382 ◽

Cited By ~ 5

Author(s):

Sally A Baddock ◽

David Tipene-Leach ◽

Sheila M Williams ◽

Angeline Tangiora ◽

Raymond Jones ◽

...

Keyword(s):

Heart Rate ◽

New Zealand ◽

Randomised Controlled Trial ◽

Oxygen Saturation ◽

Outcome Measures ◽

Thermal Environment ◽

Controlled Trial ◽

Intention To Treat ◽

The Mean ◽

Randomised Controlled

ObjectiveTo compare overnight oxygen saturation, heart rate and the thermal environment of infants sleeping in an indigenous sleep device (wahakura) or bassinet to identify potential risks and benefits.DesignRandomised controlled trial.SettingFamily homes in low socio-economic areas in New Zealand.Patients200 mainly Māori mothers and their infants.InterventionsParticipants received a wahakura or bassinet from birth.Main outcome measuresOvernight oximetry, heart rate and temperature at 1 month.ResultsIntention-to-treat analysis for 83 bassinet and 84 wahakura infants showed no significant differences between groups for the mean time oxygen saturation (SpO2) was less than 94% (0.54 min, 95% CI -1.36 to 2.45) or less than 90% (0.22 min, 95% CI -0.56 to 1.00), the mean number of SpO2 dips per hour >5% (-0.19, 95% CI -3.07 to 2.69) or >10% (-0.41, 95% CI -1.63 to 0.81), mean heart rate (1.99 beats/min, 95% CI -1.02 to 4.99), or time shin temperature >36°C (risk ratio (RR): 0.63, 95% CI 0.13 to 2.99) or <34°C (RR: 0.89, 95% CI 0.61 to 1.30). A per-protocol analysis of 45 bassinet and 26 wahakura infants and an as-used analysis of 104 infants in a bassinet and 48 in a wahakura found no significant differences between groups for all outcome measures.ConclusionsThis indigenous sleep device is at least as safe as the currently recommended bassinet, which supports its use as a sleep environment that offers an alternative way of bed-sharing.Trial registration numberAustralian New Zealand Clinical Trials Registry: ACTRN12610000993099.

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Systemic Oxygen Delivery during One-Lung Ventilation: Comparison between Propofol and Sevoflurane Anaesthesia in a Randomised Controlled Trial

Journal of Clinical Medicine ◽

10.3390/jcm8091438 ◽

2019 ◽

Vol 8 (9) ◽

pp. 1438

Author(s):

Tae Soo Hahm ◽

Heejoon Jeong ◽

Hyun Joo Ahn

Keyword(s):

Randomised Controlled Trial ◽

Oxygen Delivery ◽

Controlled Trial ◽

Lung Ventilation ◽

Arterial Oxygen ◽

One Lung Ventilation ◽

Systemic Oxygen Delivery ◽

Patient Status ◽

Systemic Oxygen ◽

Randomised Controlled

Systemic oxygen delivery (DO2) is a more comprehensive marker of patient status than arterial oxygen saturation (SaO2), and DO2 in the range of 330–500 mL min−1 is reportedly adequate during anaesthesia. We measured DO2 during one-lung ventilation (OLV) for thoracic surgery—where the risk of pulmonary shunt is significant, and hypoxia occurs frequently—and compared sevoflurane and propofol, the two most commonly used anaesthetics in terms of DO2. Sevoflurane impairs hypoxic pulmonary vasoconstriction. Thus, our hypothesis was that propofol-based anaesthesia would show a higher DO2 value than sevoflurane-based anaesthesia. This was a double-blinded randomised controlled trial conducted at a university hospital from 2017 to 2018. The study population consisted of patients scheduled for lobectomy under OLV (N = 120). Sevoflurane or propofol was titrated to a bispectral index of 40–50. Haemodynamic variables were measured during two-lung ventilation (TLV) and OLV at 15 and 45 min (OLV15 and OLV45, respectively) using oesophageal Doppler monitoring. The mean DO2 (mL min−1) was not different between the sevoflurane and propofol anaesthesia groups (TLV: 680 vs. 706; OLV15: 685 vs. 703; OLV45: 759 vs. 782, respectively). SaO2 was not correlated with DO2 (r = 0.09, p = 0.100). Patients with SaO2 < 94% showed adequate DO2 (641 ± 203 mL min−1), and patients with high SaO2 (> 97%) showed inadequate DO2 (14% of measurements < 500 mL min−1). In conclusion, DO2 did not significantly differ between sevoflurane and propofol. SaO2 was not correlated with DO2 and was not informative regarding whether the patients were receiving an adequate oxygen supply. DO2 may provide additional information on patient status, which may be especially important when patients show a low SaO2.

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