High-Flow Oxygen through Nasal Cannula vs. Non-Invasive Ventilation in Hypercapnic Respiratory Failure: A Randomized Clinical Trial

High-flow oxygen through nasal cannula (HFNC) provides adequate oxygenation and can be an alternative to noninvasive ventilation (NIV) for patients with hypoxemic respiratory failure. The aim of the present study was to assess the efficacy of HFNC versus NIV in hypercapnic respiratory failure. Patients (n = 40) who were admitted to the Emergency Department of Alexandra Hospital due to hypercapnic respiratory failure (PaCO2 ≥ 45 mmHg) were randomized assigned into two groups, i.e., an intervention group (use of HFNC, n = 20) and a control group (use of NIV, n = 20). During their hospitalization in the Intensive Care Unit, vital signs (respiratory and heart rate, arterial blood pressure) and arterial blood gases (ABG) were closely monitored on admission, after 24 h and at discharge. No difference between the two groups regarding the duration of hospitalization and the use of HFNC or NIV was observed (p > 0.05). On admission, the two groups did not differ in terms of gender, age, body mass index, APACHE score, predicted death rate, heart rate, arterial blood pressure and arterial blood gases (p > 0.05). Respiratory rate in the HFNC group was lower than in the NIV group (p = 0.023). At discharge, partial carbon dioxide arterial pressure (PaCO2) in the HFNC group was lower than in the NIV group (50.8 ± 9.4 mmHg versus 59.6 ± 13.9 mmHg, p = 0.024). The lowerPaCO2 in the HFNC group than in the NIV group indicated that HFNC was superior to NIV in the management of hypercapnic respiratory failure.

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Rhythmic Breath Holding and Its Effect on Arterial Blood Pressure and Its Correlation With Blood Gases

ACTA MEDICA IRANICA ◽

10.18502/acta.v57i8.2425 ◽

2020 ◽

Author(s):

Bharti Bhandari ◽

Manisha Mavai ◽

Yogendra Raj Singh ◽

Bharati Mehta ◽

Omlata Bhagat

Keyword(s):

Blood Pressure ◽

Heart Rate ◽

Cardiovascular System ◽

Arterial Blood Pressure ◽

Blood Gases ◽

Total Power ◽

Breath Holding ◽

Single Episode ◽

Arterial Blood ◽

Maximum Inspiration

A single episode of breath-holding (BH) is known to elevate the blood pressure, and regular breathing exercise lowers the blood pressure. This prompted us to investigate how a series of BH epochs would affect the cardiovascular system. To observe arterial blood pressure (ABP) and heart rate (HR) changes associated with a series of “BH epochs” following maximum inspiration and maximum expiration and find the underlying mechanisms for the change by autonomic activity. Thirty-five healthy young adults were instructed to hold their breath repetitively, for 5 minutes, in two patterns, one following maximum inspiration and other following maximum expiration. ABP and ECG (for Heart Rate Variability) were continuously recorded at rest and during both the maneuvers. Capillary blood gases (BG) were zanalyzed at baseline and at the breakpoint of the last epoch of BH. ABP rose significantly at the breakpoint during both the maneuvers. No change in HR was observed. There was significant fall in PO2 from 94.7 (4.1) mmHg at baseline to 79.1 (9.0) mmHg during inspiratory and 76.90 (12.1) mmHg during expiratory BH. Similarly, SPO2 decreased from 96.3 (1.9) % at baseline to 95.4 (1.5) % and 94.5 (2.7) % during inspiratory and expiratory BH, respectively. Rise in PCO2 from 39.5(3.1) mmHg at baseline to 42.9 (2.7) mmHg and 42.1 (2.8) mmHg during inspiratory and expiratory BH respectively was observed. There was no significant correlation between blood gases and arterial blood pressure. Among HRV parameters, a significant decrease in SDNN, RMSSD, HFnu, total power and SD1/SD2 and the significant increase in LFnu, LF/HF and SD2 were observed during both BH patterns. Rhythmic BH patterns affect the cardiovascular system in similar way as a single episode of BH. Sympathetic overactivity could be the postulated mechanism for the same. © 2019 Tehran University of Medical Sciences. All rights reserved. Acta Med Iran 2019;57(8):492-498.

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Impact of high-flow oxygen therapy delivered through a tracheostomy on arterial blood gases and endotracheal pressure

Critical Care ◽

10.1186/cc13511 ◽

2014 ◽

Vol 18 (Suppl 1) ◽

pp. P321 ◽

Cited By ~ 4

Author(s):

D Natalini ◽

FA Idone ◽

DL Grieco ◽

L Spaziani ◽

MT Santantonio ◽

...

Keyword(s):

Oxygen Therapy ◽

Blood Gases ◽

High Flow ◽

Arterial Blood Gases ◽

Arterial Blood ◽

High Flow Oxygen

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Cardiovascular response to arousal from sleep under controlled conditions of central and peripheral chemoreceptor stimulation in humans

Journal of Applied Physiology ◽

10.1152/japplphysiol.00749.2003 ◽

2004 ◽

Vol 96 (3) ◽

pp. 865-870 ◽

Cited By ~ 17

Author(s):

Denise M. O'Driscoll ◽

Guy E. Meadows ◽

Douglas R. Corfield ◽

Anita K. Simonds ◽

Mary J. Morrell

Keyword(s):

Blood Pressure ◽

Arterial Blood Pressure ◽

Mean Arterial Blood Pressure ◽

Cardiovascular Response ◽

Blood Gases ◽

Arterial Blood Gases ◽

Peripheral Chemoreceptor ◽

Healthy Men ◽

Arterial Blood ◽

Hypercapnic Hypoxia

The cardiovascular response to an arousal occurring at the termination of an obstructive apnea is almost double that to a spontaneous arousal. We investigated the hypothesis that central plus peripheral chemoreceptor stimulation, induced by hypercapnic hypoxia (HH), augments the cardiovascular response to arousal from sleep. Auditory-induced arousals during normoxia and HH (>10-s duration) were analyzed in 13 healthy men [age 24 ± 1 (SE) yr]. Subjects breathed on a respiratory circuit that held arterial blood gases constant, despite the increased ventilation associated with arousal. Arousals were associated with a significant increase in mean arterial blood pressure at 5 s ( P < 0.001) and with a significant decrease in the R-R interval at 3 s ( P < 0.001); however, the magnitude of the changes was not significantly different during normoxia compared with HH (mean arterial blood pressure: normoxia, 91 ± 4 to 106 ± 4 mmHg; HH, 91 ± 4 to 109 ± 5 mmHg; P = 0.32; R-R interval: normoxia, 1.12 ± 0.04 to 1.02 ± 0.05 s; HH, 1.09 ± 0.05 to 0.92 ± 0.04 s; P = 0.78). Mean ventilation increased significantly at the second breath postarousal for both conditions ( P < 0.001), but the increase was not significantly different between the two conditions (normoxia, 5.35 ± 0.40 to 9.57 ± 1.69 l/min; HH, 8.57 ± 0.63 to 11.98 ± 0.70 l/min; P = 0.71). We conclude that combined central and peripheral chemoreceptor stimulation with the use of HH does not interact with the autonomic outflow associated with arousal from sleep to augment the cardiovascular response.

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Relative latency of responses of chemoreceptor afferents from aortic and carotid bodies

Journal of Applied Physiology ◽

10.1152/jappl.1980.48.2.362 ◽

1980 ◽

Vol 48 (2) ◽

pp. 362-369 ◽

Cited By ~ 11

Author(s):

S. Lahiri ◽

T. Nishino ◽

E. Mulligan ◽

A. Mokashi

Keyword(s):

Blood Pressure ◽

Arterial Blood Pressure ◽

Carotid Body ◽

Blood Gases ◽

Unexpected Result ◽

Blood Gas ◽

Arterial Blood Gases ◽

Carotid Chemoreceptors ◽

Arterial Blood ◽

Carotid Bodies

Discharges from aortic and carotid body chemoreceptor afferents were simultaneously recorded in 18 anesthetized cats to test the hypothesis that aortic chemoreceptors, because of their proximity to the heart, respond to changes in arterial blood gases before carotid chemoreceptors. We found that carotid chemoreceptor responses to the onset of hypoxia and hypercapnia, and to the intravenously administered excitatory drugs (cyanide, nicotine, and doxapram), preceded those of aortic chemoreceptors. Postulating that this unexpected result was due to differences in microcirculation and mass transport, we also investigated their relative speed of responses to changes in arterial blood pressure. The aortic chemoreceptors responded to decreases in arterial blood pressure before the carotid chemoreceptors, supporting the idea that the aortic body has microcirculatory impediments not generally present in the carotid body. These findings strengthened the concept that carotid bodies are more suited for monitoring blood gas changes due to respiration, whereas aortic bodies are for monitoring circulation.

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Depressed ventilatory response to hypoxia in hypothermic newborn piglets: role of glutamate

Journal of Applied Physiology ◽

10.1152/jappl.1998.84.3.830 ◽

1998 ◽

Vol 84 (3) ◽

pp. 830-836 ◽

Cited By ~ 11

Author(s):

Annette McCormick ◽

Cleide Suguihara ◽

Jian Huang ◽

Carlos Devia ◽

Dorothy Hehre ◽

...

Keyword(s):

Blood Pressure ◽

Heart Rate ◽

Arterial Blood Pressure ◽

Nucleus Tractus Solitarius ◽

Ventilatory Response ◽

Blood Gases ◽

Arterial Blood ◽

Significant Linear Correlation ◽

The Central Nervous System ◽

Ventilatory Response To Hypoxia

To evaluate whether changes in extracellular glutamate (Glu) levels in the central nervous system could explain the depressed hypoxic ventilatory response in hypothermic neonates, 12 anesthetized, paralyzed, and mechanically ventilated piglets <7 days old were studied. The Glu levels in the nucleus tractus solitarius obtained by microdialysis, minute phrenic output (MPO), O2 consumption, arterial blood pressure, heart rate, and arterial blood gases were measured in room air and during 15 min of isocapnic hypoxia (inspired O2 fraction = 0.10) at brain temperatures of 39.0 ± 0.5°C [normothermia (NT)] and 35.0 ± 0.5°C [hypothermia (HT)]. During NT, MPO increased significantly during hypoxia and remained above baseline. However, during HT, there was a marked decrease in MPO during hypoxia (NT vs. HT, P < 0.03). Glu levels increased significantly in hypoxia during NT; however, this increase was eliminated during HT ( P < 0.02). A significant linear correlation was observed between the changes in MPO and Glu levels during hypoxia ( r = 0.61, P < 0.0001). Changes in pH, arterial[Formula: see text], O2 consumption, arterial blood pressure, and heart rate during hypoxia were not different between the NT and HT groups. These results suggest that the depressed ventilatory response to hypoxia observed during HT is centrally mediated and in part related to a decrease in Glu concentration in the nucleus tractus solitarius.

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Changes in Arterial Blood Gases during and after a Period of Oxygen Breathing in Patients with Chronic Hypercapnic Respiratory Failure and in Patients with Asthma

Clinical Science ◽

10.1042/cs0570389 ◽

1979 ◽

Vol 57 (5) ◽

pp. 389-396 ◽

Cited By ~ 13

Author(s):

M. Rudolf ◽

J. A. McM. Turner ◽

B. D. W. Harrison ◽

J. F. Riordan ◽

K. B. Saunders

Keyword(s):

Respiratory Failure ◽

Blood Gases ◽

Arterial Blood Gases ◽

Hypercapnic Respiratory Failure ◽

Failure Group ◽

Oxygen Breathing ◽

Arterial Blood ◽

Group 2 ◽

Asthma Group ◽

Group 1

1. Ten patients with chronic hypercapnic respiratory failure (group 1) and eight patients with asthma (group 2) breathed pure O2 from an MC mask for 60 min. Blood gases were measured during this period and for the subsequent 45 min. 2. In nine of ten patients in group 1 and in all eight patients in group 2 arterial O2 tension (Pa,o2) fell to values lower than had been obtained before O2 was given. 3. These undershoots in Pa,o2 are unrelated to changing CO2 stores or to hypoventilation, and are more likely due to persistence of altered ventilation-perfusion ratios associated with O2 breathing. 4. Magnitude of the undershoots is usually small, and periods of less than 15 min off O2 are unlikely to be harmful.

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Sustained Arterial Blood Pressure Elevation Associated with Pneumothoraces: Early Detection via Continuous Monitoring

PEDIATRICS ◽

10.1542/peds.68.6.775 ◽

1981 ◽

Vol 68 (6) ◽

pp. 775-777

Author(s):

Ronald N. Goldberg

Keyword(s):

Blood Pressure ◽

Heart Rate ◽

Arterial Blood Pressure ◽

Continuous Monitoring ◽

Clinical Signs ◽

Vital Signs ◽

Blood Gases ◽

Base Line ◽

Blood Pressure Elevation ◽

Arterial Blood

The diagnosis of pneumothorax in the neonate is often heralded by such signs as deterioration of arterial blood gases, arterial hypotension, and cardiac arrest. An awareness of more subtle clinical signs of accumulating extra-alveolar gas may lead to earlier intervention and a decrease in morbidity. Fourteen episodes of pneumothorax developed in seven of 69 neonates who received ventilatory assistance (mean birth weight 1,828 ± 295 gm), of whom six were ventilated for hyaline membrane disease and one for pneumonia. Instantaneous heart rate and arterial blood pressure (ABP) were monitored continuously in all patients. Changes in vital signs were noted at a mean of 48 minutes (range 12 to 116 minutes) prior to thoracentesis. There was an increase in systolic ABP (7 to 26 mm Hg) associated with 70% of the episodes, and an increase in heart rate and pulse pressure associated with 57% of the episodes. By 20 minutes after thoracentesis there was a rapid decrease in ABP values toward levels not significantly different from base line. A sustained increase in ABP may be an early sign of accumulating extra-alveolar gas. Continuous monitoring and graphic representation of vital signs in the ventilated neonate may suggest the diagnosis of pneumothorax before clinical decompensation occurs.

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Some Cardio-Pulmonary Effects of Infra-Renal Clamping of the Abdominal Aorta

Anaesthesia and Intensive Care ◽

10.1177/0310057x7800600106 ◽

1978 ◽

Vol 6 (1) ◽

pp. 44-48 ◽

Cited By ~ 5

Author(s):

H. Askitopolou ◽

C. A. Young ◽

M. Morgan ◽

M. K. Sykes

Keyword(s):

Blood Pressure ◽

Heart Rate ◽

Abdominal Aorta ◽

Volume Ratio ◽

Blood Gases ◽

Arterial Blood Gases ◽

Circulating Blood Volume ◽

Arterial Blood ◽

Renal Vessels ◽

Before And After

No significant changes were found in heart rate, blood pressure, cardiac output, arterial blood gases or physiological deadspace: tidal volume ratio before and after clamping and unclamping the abdominal aorta below the renal vessels. Nevertheless, drugs should be available to reduce the afterload on the heart if any evidence of myocardial ischaemia appears during the period of aortic clamping. The importance of maintaining an adequate circulating blood volume at all times is stressed.

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