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To assess whether, in a lung resection cohort with a low probability of confounding by indication, higher FiO2 is associated with an increased risk of impaired postoperative oxygenation – a clinical manifestation of lung injury/dysfunction. Pre-specified registry-based retrospective cohort study. Two large academic hospitals in the United States. 2936 lung resection patients with an overall good intraoperative oxygenation (median intraoperative SpO2 ≥ 95 %). We compared patients with a higher (≥0.8) and lower (<0.8) median intraoperative FiO2 after propensity score-weighting for 75 perioperative variables based on a causal inference framework. The primary outcome of impaired oxygenation was defined as at least one of the following within seven postoperative days: (1) SpO2 < 92 %; (2) imputed PaO2/FiO2 < 300 mmHg [(1) or (2) at least twice within 24 h]; (3) intensive oxygen therapy (mechanical ventilation or > 50 % oxygen or high-flow oxygen). Among the 2936 included patients, 2171 (73.8 %) received median intraoperative FiO2 ≥ 0.8. Impaired postoperative oxygenation occurred in 1627 (74.9 %) and 422 (55.2 %) patients in the higher and lower FiO2 groups, respectively. In a propensity score-weighted analysis, higher intraoperative FiO2 was associated with an 84 % increase in the likelihood of impaired postoperative oxygenation (OR 1.84; 95 % CI 1.60 to 2.12; P < 0.001). Despite plausible harm from hyperoxia, high intraoperative FiO2 is extremely common during lung resection. Nearly three-quarters of lung resection patients with acceptable oxygenation received median intraoperative FiO2 ≥ 0.8. Such higher FiO2 was associated with an increased risk of impaired postoperative oxygenation – a clinically relevant manifestation of lung injury or dysfunction. This observation supports the administration of a lower (< 0.8) intraoperative FiO2 and its further assessment in clinical trials. •FiO2 as a component of protective ventilation received minimal attention in lung resection•We assessed the effects of intraoperative FiO2 on postoperative oxygenation in lung resection patients•To address confounding by indication, we studied only patients who had an overall good intraoperative oxygenation•After adjusting for over 70 variables, higher intraoperative FiO2 was associated with worse postoperative oxygenation

BackgroundDespite patients with severe coronavirus disease (COVID-19) receiving standard triple therapy, including steroids, antiviral agents, and anticytokine therapy, health condition of certain patients continue to deteriorate. In Taiwan, the COVID-19 mortality has been high since the emergence of previous variants of this disease (such as alpha, beta, or delta). We aimed to evaluate whether adjunctive infusion of human umbilical cord mesenchymal stem cells (MSCs) (hUC-MSCs) on top of dexamethasone, remdesivir, and tocilizumab improves pulmonary oxygenation and suppresses inflammatory cytokines in patients with severe COVID-19.MethodsHospitalized patients with severe or critical COVID-19 pneumonia under standard triple therapy were separated into adjuvant hUC-MSC and non-hUC-MSC groups to compare the changes in the arterial partial pressure of oxygen (PaO2)/fraction of inspired oxygen (FiO2) ratio and biological variables.ResultsFour out of eight patients with severe or critical COVID-19 received either one ( n = 2) or two ( n = 2) doses of intravenous infusions of hUC-MSCs using a uniform cell dose of 1.0 × 108. Both high-sensitivity C-reactive protein (hs-CRP) level and monocyte distribution width (MDW) were significantly reduced, with a reduction in the levels of interleukin (IL)-6, IL-13, IL-12p70 and vascular endothelial growth factor following hUC-MSC transplantation. The PaO2/FiO2 ratio increased from 83.68 (64.34–126.75) to 227.50 (185.25–237.50) and then 349.56 (293.03–367.92) within 7 days after hUC-MSC infusion ( P < 0.001), while the change of PaO2/FiO2 ratio was insignificant in non-hUC-MSC patients (admission day: 165.00 [102.50–237.61]; day 3: 100.00 [72.00–232.68]; day 7: 250.00 [71.00–251.43], P = 0.923).ConclusionTransplantation of hUC-MSCs as adjunctive therapy improves pulmonary oxygenation in patients with severe or critical COVID-19. The beneficial effects of hUC-MSCs were presumably mediated by the mitigation of inflammatory cytokines, characterized by the reduction in both hs-CRP and MDW.

To determine whether individualized fraction of inspired oxygen (iFiO2) improves pulmonary atelectasis after elective laparoscopic colorectal surgery relative to 60 % FiO2. This was a single-center, prospective, randomized study. This study was conducted in a single tertiary care hospital in China. A total of 84 eligible inpatients who underwent elective laparoscopic colorectal surgery between August 2021 and May 2022 were included in the study. The patients were randomly assigned to receive either a fixed fraction of inspiration oxygen (fFiO2 group) or individualized FiO2 based on physiological SpO2 (iFiO2 group). The primary outcome was the lung ultrasound score (LUS) at 30 min after extubation. Secondary outcomes included the length of hospital stay, admission to the intensive care unit, the length of post-anesthetic care unit stay, the ratio of lung capacity on the third day after surgery compared with before surgery, the incidence of nausea and vomiting, and surgical site infections after surgery. Additionally, the airway plate pressure, airway peak pressure, pulmonary dynamic compliance, PaO2, oxygenation index, alveolar–arterial oxygen tension gradient (A-aDO2), and pulmonary shunt fraction (Qs/Qt) were considered. The LUS was significantly lowered in the iFiO2 group (5 [4, 7]) compared with the fFiO2 group (8 [4, 10]) (P = 0.03). Based on the criterion for determining atelectasis, 25 patients (62.5 %) in the fFiO2 group experienced significant atelectasis compared with 15 patients (37.5 %) in the iFiO2 group (P = 0.025). At the end of surgery, PaO2, A-aDO2, and Qs/Qt were significantly reduced in patients in the iFiO2 group compared with those in the fFiO2 group. The use of iFiO2 during operation significantly reduces the LUS and pulmonary atelectasis in patients undergoing laparoscopic colorectal surgery under general anesthesia. Clinical trial registration: ChiCTRT2100049615. •Using iFiO2 reduced LUS and atelectasis in patients undergoing laparoscopic colorectal surgery under general anesthesia.•The iFiO2 titrated by SpO2 was lower than 60 % FiO2, providing adequate oxygenation and efficiently preventing hyperoxia.•The use of iFiO2 during operation significantly reduced A-aDO2 and Qs/Qt.

To determine the early factors associated with continuous positive airway pressure (CPAP) failure in moderate-to-late preterm infants (32 + 0/7 to 36 + 6/7 weeks’ gestation) from the NEOBS cohort study. The NEOBS study was a multi-center, prospective, observational study in 46 neonatal intensive care units in France, which included preterm and late preterm infants with early neonatal respiratory distress. This analysis included a subset of the NEOBS population who had respiratory distress and required ventilatory support with CPAP within the first 24  of life. CPAP failure was defined as the need for tracheal intubation within 72  of CPAP initiation. Maternal and neonatal clinical parameters in the delivery room and clinical data at 3  of life were analyzed. CPAP failure occurred in 45/375 infants (12%), and compared with infants with CPAP success, they were mostly singletons (82.2% vs. 62.1%; p < 0.01), had a lower Apgar score at 10 min of life (9.1 ± 1.3 vs. 9.6 ± 0.8; p = 0.02), and required a higher fraction of inspired oxygen (FiO 2 ; 34.4 ± 15.9% vs. 22.8 ± 4.1%; p < 0.0001) and a higher FiO 2 *positive end-expiratory pressure (PEEP) (1.8 ± 0.9 vs. 1.1 ± 0.3; p < 0.0001) at 3 . FiO 2 value of 0.23 ( R 2 = 0.73) and FiO 2 *PEEP of 1.50 ( R 2 = 0.75) best predicted CPAP failure. The risk of respiratory distress and early CPAP failure decreased 0.7 times per 1-week increase in gestational age and increased 1.7 times with every one-point decrease in Apgar score at 10 min and 19 times with FiO 2 *PEEP > 1.50 (vs. ≤ 1.50) at 3  ( R 2 of the overall model = 0.83). Conclusion : In moderate-to-late preterm infants, the combination of singleton pregnancy, lower Apgar score at 10 min, and FiO 2 *PEEP > 1.50 at 3  can predict early CPAP failure with increased accuracy. What is Known: • Respiratory distress syndrome (RSD) represents an unmet medical need in moderate-to-late preterm births and is commonly treated with continuous positive airway pressure (CPAP) to reduce mortality and the need for additional ventilatory support. • Optimal management of RSD is yet to be established, with several studies suggesting that identification of predictive factors for CPAP failure can aid in the prompt treatment of infants likely to experience this failure. What is New: • Secondary analysis of the observational NEOBS study indicated that oxygen requirements during CPAP therapy, especially the product of fraction of inspired oxygen (FiO2) and positive end-expiratory pressure (PEEP), are important factors associated with early CPAP failure in moderate-to-late term preterm infants. • The combination of a singleton pregnancy, low Apgar score at 10 minutes, and high FiO2*PEEP at 3 hours can predict early CPAP failure with increased accuracy, highlighting important areas for future research into the prevention of CPAP failure.

Respiratory diseases are one of the most common causes of death in the world and this recent COVID-19 pandemic is a key example. Problems such as infections, in general, affect many people and depending on the form of transmission they can spread throughout the world and weaken thousands of people. Two examples are severe acute respiratory syndrome and the recent coronavirus disease. These diseases have mild and severe forms, in which patients gravely affected need ventilatory support. The equipment that serves as a basis for operation of the mechanical ventilator is the air–oxygen blender, responsible for carrying out the air–oxygen mixture in the proper proportions ensuring constant supply. New blender models are described in the literature together with applications of control techniques, such as Proportional, Integrative and Derivative (PID); Fuzzy; and Adaptive. The results obtained from the literature show a significant improvement in patient care when using automatic controls instead of manual adjustment, increasing the safety and accuracy of the treatment. This study presents a deep review of the state of the art in air–oxygen benders, identifies the most relevant characteristics, performs a comparison study considering the most relevant available solutions, and identifies open research directions in the topic.

Objective Cerebral hypoxia and hypoperfusion are key pathophysiological contributors to postoperative delirium (POD). This study evaluated the impact of 40% versus 100% inspired oxygen (FiO₂) on POD incidence, neuroinflammation, and clinical outcomes in elderly patients undergoing major abdominal surgery. Methods In this trial, 160 elderly patients scheduled for major abdominal surgery under general anesthesia from 2022 to September 2023 were randomly assigned to receive 40% FiO₂ ( n  = 80) or 100% FiO₂ ( n  = 80). The primary outcome was POD incidence within 3 postoperative days. Secondary outcomes included perioperative oxygenation parameters, plasma neuroinflammatory markers, pulmonary infections, pain scores, and hospitalization duration. Blood samples were collected preoperatively and postoperatively for biomarker analysis. Results Among 154 analyzed patients, POD incidence was 5.2% (8/154), with no significant difference between 40% FiO₂ (6.4%, 5/78) and 100% FiO₂ (3.9%, 3/76) groups ( P  = 0.72). The 40% FiO₂ group exhibited lower saturation of pulse oxygen, regional cerebral oxygen saturation, and arterial partial pressure of oxygen from 1 h post-anesthesia (T2) to anesthesia end (T5) ( P  < 0.05). No intergroup differences in interleukin-6, tumor necrosis factor alpha, neuron-specific enolase, or neurofilament light chain levels were observed postoperatively ( P  > 0.05). FiO₂ levels did not influence pulmonary infection rates, postoperative VAS scores, or hospital stay ( P  > 0.05). Conclusions While 100% FiO₂ enhances cerebral oxygenation, it does not reduce POD incidence or neuroinflammatory markers compared to 40% FiO₂. High-concentration oxygen did not increase pulmonary complications but offered no clinical benefits in this cohort. Intraoperative FiO₂ should be titrated based on individualized patient needs.

Oxygen (O2) is the most common therapy in mechanically ventilated patients, but targets and dose are poorly understood. We aimed to describe current O2 administration and titration in such patients in an academic intensive care unit. In consecutive ventilated (>48 hours) patients we prospectively obtained fraction of inspired O2 (Fio2), pulse oximetry O2 saturation (Spo2) and arterial O2 tension (Pao2) every 6 hours. We calculated the amount of excess O2 delivery and the intensivists’ response to hyperoxemia (Spo2 >98%). During 358 mechanical ventilation days in 51 critically ill patients, median calculated excess O2 delivery was 3472 L per patient. Patients spent most of their time with their Spo2 >98% (59% [29-83]) and Pao2 between 80 and 120 mm Hg (59% [38–72]). In addition, 50% of all observations showed hyperoxemia and 4% severe hyperoxemia (Pao2 >202.5 mm Hg). Moreover, 71% of the calculated total excess 263,841 L of O2 was delivered when the Fio2 was 0.3 to 0.5. When hyperoxemia occurred with an Fio2 between 0.3 and 0.4, for 88% of episodes, no Fio2 adjustments were made. Excess O2 delivery and liberal O2 therapy were common in mechanically ventilated patients. Current O2 therapy practice may be suboptimal and further investigations are warranted.

Background The nasal cannula is considered a trusted and effective means of administering low-flow oxygen and is widely used for neonates and infants requiring oxygen therapy, despite an understanding that oxygen concentrations delivered to patients are variable. Methods In the present study, realistic nasal airway replicas derived from medical scans of children less than 3 months old were used to measure the fraction of oxygen inhaled (FiO 2 ) through nasal cannulas during low-flow oxygen delivery. Parameters influencing variability in FiO 2 were evaluated, as was the hypothesis that measured FiO 2 values could be predicted using a simple, flow-weighted calculation that assumes ideal mixing of oxygen with entrained room air. Tidal breathing through neonatal and infant nasal airway replicas was controlled using a lung simulator. Parameters for nasal cannula oxygen flow rate, nasal airway geometry, tidal volume, respiratory rate, inhalation/exhalation, or I:E ratio (t i /t e ), breath waveform, and cannula prong insertion position were varied to determine their effect on measured FiO 2 . In total, FiO 2 was measured for 384 different parameter combinations, with each combination repeated in triplicate. Analysis of variance (ANOVA) was used to assess the influence of parameters on measured FiO 2 . Results Measured FiO 2 was not appreciably affected by the breath waveform shape, the replica geometry, or the cannula position but was significantly influenced by the tidal volume, the inhalation time, and the nasal cannula flow rate. Conclusions The flow-weighted calculation overpredicted FiO 2 for measured values above 60%, but an empirical correction to the calculation provided good agreement with measured FiO 2 across the full range of experimental data.

Background Postoperative pulmonary complications (PPCs) are severe and are of particular concern in older adult patients undergoing laparoscopic gastrointestinal surgery. Both 40% and 80% fraction of inspired oxygen (FiO 2 ) are commonly used for anesthesia. Presently, whether 40% FiO 2 can increase the oxygenation index of patients 48 h postoperatively and reduce PPCs remains controversial. Moreover, no clear consensus exists for older adult patients. Therefore, this study aims to compare the effects of low FiO 2 (40%) and high FiO 2 (80%) levels on postoperative pulmonary function in older adult study participants undergoing laparoscopic gastrointestinal surgery. Methods This multicenter, prospective, parallel-cohort, randomized controlled clinical trial will include 1098 older adult participants aged ≥ 65 years old undergoing laparoscopic gastrointestinal surgery, from 16 clinical trial sites across China. Participants will be randomized, as per a 1:1 ratio to two cohorts, the “L” and “H” cohorts, to receive low FiO 2 (40%) and high FiO 2 (80%) levels, respectively. The primary outcome measure is the 48-h postoperative oxygenation index between the two cohorts. The secondary outcome measures include the other blood gas analysis results, PPCs within 7 days, and 30-day mortality rate. Discussion This study of elderly patients undergoing laparoscopic gastrointestinal surgery with different intraoperative oxygen concentrations at high risk for pulmonary complications. All subjects were followed up for up to 30 days for pulmonary function, postoperative complications, etc. Randomization was performed separately at 16 sites. Trial registration ClinicalTrials.gov NCT06359106. Registered and posted on April 11, 2024.

The blow-by method using a pediatric non-rebreathing mask (PNRM) is commonly employed to maintain oxygenation during transport of pediatric patients after general anesthesia. This study aimed to evaluate the performance of the blow-by method using a PNRM with an oxygen flow rate of 10 liters per minute (LPM) during simulated transport of pediatric patients. This laboratory study was simulated along a 32-meter corridor from the pediatric operating room to the post-anesthesia care unit at Srinagarind Hospital. A pediatric mannequin was positioned laterally on a transport trolley. A PNRM delivering oxygen at 10 LPM was placed at distances of 0, 5, and 10 cm from the mannequin's nose. The fraction of inspired oxygen (FiO ) at the mannequin's nose was measured every 2 meters along the corridor. Each distance condition was tested 10 times. The primary outcome was whether the blow-by method could maintain FiO above 40% at all measurement points during simulated patient transport. Oxygen delivery was adequate only when the PNRM was placed at 0 cm from the nose, with a mean FiO of 86.9 ± 0.3%, In contrast the mean FiO values at 5 and 10 cm was 28.5 ± 0.3%, and 24.1 ± 0.1%, respectively. The mean FiO difference between 0 and 5 cm was 58.4% (95% CI: 56.8-60.1; p < 0.001), and between 0 and 10 cm was 62.8% (95% CI: 61.5-64.1; p < 0.001). The blow-by method using PNRM positioned at 0 cm from pediatric mannequin's nose provided adequate oxygenation throughout transport. Clinically, therefore, maintaining a close PNRM position is essential.