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Abstract Objectives Hypoxia is a known feature of sickle cell anaemia (SCA) which results from chronic anaemia and recurrent vaso-occlusive crisis (VOC) which can cause tissue ischaemia that leads to an end organ damage. The hallmark of SCA is chronic anaemia and recurrent vaso-occlusive crisis. The aim of this study is to compare the oxygen saturation of sickle cell anaemic individuals with the normal haemoglobin type (Hb AA) control and also to determine the prevalence of hypoxemia among SCA. Results Two-hundred and twenty-two (136 Hb SS and 86 Hb AA) participated in the study. The mean ± SD of age (years), oxygen saturation (%) and pulse rate (bpm) of participants with sickle cell anaemia and Hb AA control were 21.85 ± 3.04 and 22.14 ± 3.18 (t = 0.701, p = 0.436), 95.21 ± 3.02 and 98.07 ± 0.81 (t=-8.598, p

Introduction: Paediatric Acute Respiratory Distress Syndrome (PARDS) remains a major cause of mortality and morbidity in Paediatric Intensive Care Units (PICU) despite various advanced management strategies. The management and outcome of PARDS depend on the severity of the disease. Aim: To study the clinical profile in terms of aetiology and outcome of paediatric patients with moderate to severe Acute Respiratory Distress Syndrome (ARDS) in the PICU. Materials and Methods: A prospective cohort study was conducted at the PICU in Dr. BC Roy Postgraduate Institute of Paediatric Sciences, Kolkata, West Bengal, India, from July 2018 to June 2019. A total of 120 children aged between two months and 12 years who developed moderate to severe ARDS according to Paediatric Acute Lung Injury Consensus Conference (PALICC) criteria were included. Demographic details, different risk factors, morbidity patterns, and outcomes were recorded. Patients were categorised into three groups based on Positive End Expiratory Pressure (PEEP): 5-8 cm of H2O, 9-12 cm of H2O, and >12 cm of H2O. Based on Peak Inspiratory Pressure (PIP), patients were divided into two groups: 12 cm of H2O group and 84.4% in the PIP 30-35 cm of H2O group. Conclusion: The majority of ARDS cases are due to direct lung injury caused by pneumonia, and the outcome is better than in cases of indirect lung injury. Mortality is nearly twice as high in severe ARDS as in moderate ARDS.

Introduction: Acute respiratory failure is the most common clinical feature in patients with severe Coronavirus Disease -2019 (COVID-19) who are admitted to an Intensive Care Unit (ICU) and may require invasive mechanical ventilation, which is generally linked with a high fatality rate. Patients with established co-morbidities, such as diabetes, invariably fall into the category of patients with severe disease presentation and rapid disease progression. Aim: To study the clinical outcomes of COVID-19 diabetic patients after sequential oxygen therapy using a reservoir bag mask, High Frequency Nasal Oxygen (HFNO), and Non-invasive Ventilation (NIV). Materials and Methods: In this retrospective cohort study, adhering to the STROBE statement criteria, the authors included 150 patients suffering from COVID-19 acute respiratory failure, who were known diabetics, divided into three groups based on admission oxygen saturation and Respiratory Rate (RR) for Non-Rebreather Bag-Mask (NRBM) therapy, HFNO, and NIV. For two weeks, all patients were monitored, and measures such as Saturation of peripheral Oxygen (SpO2), Respiratory Rate (RR) escalation of oxygen requirement, glycaemic management, compliance and problems with continued oxygen therapy, the need for invasive mechanical ventilation, and mortality were recorded. The recorded parameters among the three groups were compared using Analysis of Variance (ANOVA) test. Results: Among the demographic parameters recorded, the authors noted that individuals older than 50-55 years of either sex were admitted for HFNO (56.02±11.71 years) and NIV (54.28±14.67 years) therapy, whereas no such preponderance was noted among the two genders. Significant results were noted in all three groups in terms of the escalation of oxygen fraction (FiO2) requirements on the 10th day of observation (NRBM 12.63±2.48%, HFNO 37.74±13.56%, NIV 82.44±11.11%). The need for tracheal intubation was higher in patients in the NIV group (10) compared to the HFNO (9) and NRBM (1) groups. Patients whose blood sugar levels remained uncontrolled throughout the course of observation in the study were disparagingly seen to have been a part of the HFNO and NIV groups, and hence the subsequent mortality. Conclusion: There was a steady escalation of mean oxygen requirements in all three groups of oxygen therapy over the course of two weeks, coinciding with the ensuing ‘cytokine storm’ associated with Severe Acute Respiratory Syndrome- Coronavirus- 2 (SARS-CoV-2) infection. This trend of escalation of oxygen requirement also in turn coincided with the raised glycaemic charting trends of the patients over the same course of two weeks, delineating those individuals with diabetes mellitus, in view of their compromised immunity and innate pro -inflammatory state, are more prone to develop severe form of the disease with more serious complications, which may even lead to mortality. With regards to the compliance, NRBM & HFNO provided best results in comparison to NIV. The rates of complications were also noted to be higher with the use of NIV in this instance.

Objective·To investigate the anesthetic effect of PetCO2 monitoring nasopharyngeal airway on preventing hypoxia in patients with obstructive sleep apnea syndrome (OSAS) during magnifying endoscopy.Methods·Eighty OSAS patients who underwent magnifying endoscopy anesthesia in Xuchang Central Hospital of Henan Province from February to June 2023 were randomly divided into PetCO2 monitoring nasopharyngeal airway group (group T) and traditional nasopharyngeal airway group (group B), with 40 cases in each group. General information, perioperative data and total anesthetic dosage of the two groups of patients were collected and compared. The systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR) and pulse oxygen saturation (SpO2) of the two groups of patients before anesthesia (T0), at the time of entering the endoscopy (T1), 3 min after entering the endoscopy (T2), 10 min after entering the endoscopy (T3) and at the end of endoscopy (T4) were observed and recorded, respectively. The incidence of body movement and hypoxemia, and the effects of preventing hypoxia (including mask ventilation, jaw-lift support and chest compressions to assist breath) of the two groups of patients were recorded.Results·There were no significant differences in general information, perioperative data and total anesthetic dosage between the two groups. At T1 and T2, SpO2 in group T was higher than that in group B (T1: P=0.041,T2: P=0.012), and there was no statistically significant difference in SBP, DBP and HR between the groups; at other time points, there was no statistically significant difference in the four indicators between the two groups. Compared with group B, the incidences of body movement, hypoxemia, mask ventilation, jaw-lift support and chest compressions to assist breath in group T were all decreased (all P=0.000).Conclusion·PetCO2 monitoring nasopharyngeal airway can reduce the incidence of hypoxia during magnifying endoscopy in patients with OSAS, with minimal adverse events. Also, it can detect the status of lung ventilation in time, guide clinical intervention, reduce complications and improve the safety of magnifying endoscopy anesthesia.

AbstractBackground Hypoxemia often occurs in outpatients undergoing anesthesia-assisted esophagogastroduodenoscopy (EGD). However, there is a scarcity in tools to predict the hypoxemia risk. We aimed to solve this problem by developing and validating machine learning (ML) models based on preoperative and intraoperative features.Methods All data were retrospectively collected from June 2021 to February 2022. The most appropriate predictive features were selected by the least absolute shrinkage and selection operator, which were incorporated and modelled by 4 ML algorithms. The area under the precision-recall curve (AUPRC) was used as the main evaluation metric to select the best models, and the selected models were compared with the STOP-BANG score. Their predictive performance was visually interpreted by SHapley Additive exPlanations. The primary endpoint of this study was hypoxemia during the procedure, defined as at least one reading of pulse oximetry < 90% without probes misplacement from the anesthesia induction beginning to the end of EGD, while the secondary endpoint was hypoxemia during induction, from the induction beginning to the start of endoscopic intubation.Results Of 1160 patients in the derivation cohort, 112 patients (9.6%) developed intraoperative hypoxemia, of which 102 (8.8%) occurred during the induction period. In temporal and external validation, no matter whether based on preoperative variables or still based on preoperative plus intraoperative variables, our models showed excellent predictive performance for the two endpoints, significantly better than STOP-BANG score. In the model interpretation section, preoperative variables (airway assessment indicators, pulse oximeter oxygen saturation and BMI) and intraoperative variables (the induced propofol dose) made the highest contribution to the predictions.Conclusions To our knowledge, our ML models were the first to predict hypoxemia risk, which achieved excellent overall predictive ability integrating various clinical indicators. These models have the potential to become an effective tool for adjusting sedation strategies flexibly and reducing the workload of anesthesiologists.KEY MESSAGESThis study is the first model employing ML methods based on preoperative and preoperative plus intraoperative variables for predicting the risk of hypoxemia during induction and the whole EGD procedure respectively.Our four models achieved satisfactory predictive performance and outperformed STOP-BANG score in terms of AUPRC in the temporal and external validation cohorts respectively.We found that the relevant variables of airway assessment should be fully taken into account when analyzing the risk factor of hypoxemia, and the effect of patients’ age on their hypoxemia risk should be considered in conjunction with the propofol dose.

Background: Organophosphorus insecticides are considered one of the commonest causes of morbidity and mortality due to poisoning worldwide. Severe organophosphorus poisoning can lead to multiple sometimes lethal metabolic and haematological abnormalities. METHODS: A total of 141 OP poisoning patients were admitted during the study period and their blood samples were collected on admission and analysed for the biochemical abnormalities. RESULTS: Out of 141 patients 76 were males (53.9%) and 65 were females (46.1%). Bradycardia with Pulse rate of less than 60 was seen in in 21 patients (14.7). Hypoxemia with oxygen saturation of less than 94% was seen in 32 (22.7%). leucocytosis with TLC o 11000 or more was seen in 19 patients (13.5%).101 patients (83.5%) had low serum choline esterase levels less than 1.5kU/L. Hypokalaemia with K+ of less than 3.5 was seen in 16 patients (9.9%). Five patients died out of 141 (3.5%). Hypoxemia Spo2 of less than 90% was seen in 3 (60%) patients who died and hypoglycaemia with blood glucose of less than 70mg/dl was seen in 2 out of 5 Patients (40%) CONCLUSIONS: low choline esterase levels less than 1.5kU/L was the most common abnormality indicating severe poisoning followed by hypoxemia. Both Hypoxemia and low acetylcholine esterase levels are bad prognostic signs and result in high mortality in organophosphorus poisoning. Keywords: Organophosphorus Poisoning, Hypoxemia, choline esterase, Hypokalaemia, Hypoglycaemia.

Abstract Pulmonary arteriovenous malformations (PAVMs), particularly where feeding artery/arteries to PAVMs ≥ 3 mm can be treated with embolization. The treatment for hypoxemia resulting from multiple small or diffuse PAVMs remains unclear. We report a girl aged 5 years and 10 months presented with cyanosis and decreased activity after exercise (83–85% of pulse oxygen saturation, SpO2). She had 1 skin lesion on her face and 1 suspected hemangioma on her left upper extremity at birth and that gradually disappeared spontaneously. Physical examination revealed clubbed fingers, and abundant vascular networks on her back. Contrast-enhanced lung CT (slice thickness:1.25 mm) with vascular three-dimensional reconstruction and abdominal CT revealed increased bronchovascular bundles, increased diameter of the pulmonary artery and ascending aorta, and intrahepatic portosystemic venous shunts due to patent ductus venosus. Echocardiography revealed increased diameter of aortic and pulmonary artery. Transthoracic contrast echocardiography was highly positive (bubble appearing in the left ventricle after 5 cardiac cycles). Abdominal doppler ultrasound revealed hepatic-portal venous shunt. Magnetic resonance imaging, artery and vein of the brain revealed multiple malformations of venous sinuses. The patient received sirolimus for 2 years and 4 months. Her condition improved significantly. SpO2 gradually increased to 98%. Her finger clubbing gradually normalized. Our report implicates sirolimus might be a potential treatment option in persistent hypoxemia mainly due to intrapulmonary right-to-left shunt even small multiple or diffusive PAVMs in pediatric patients with multiple cutaneous and visceral vascular anomalies.

Background and Objective: In order to determine the Hypoxemia and prognosis of patients with covid-19 hospitalized in the intensive care unit, reliable oxygen supply indicators are needed. In this situation, the examination of the percentage of arterial oxygen saturation (SaO2) and arterial oxygen pressure (PaO2), as well as their relationship, may be helpful. Materials and Methods: This descriptive-cross-sectional study examined 1,121 patients with covid-19 hospitalized in the intensive care unit of hospitals affiliated with Hamadan University of Medical Sciences. Data were collected through a researcher-made checklist, including age, gender, history of smoking and drug use, underlying disease, duration of hospitalization, the outcome of hospitalization, and hemoglobin listed in the patient's medical records. Moreover, SaO2 and PaO2 were examined in the first arterial blood analysis report after admission to the hospital. Results: A positive and significant correlation was observed between SaO2 and PaO2 (r=0.733 and P

Introduction: Most common complication encountered while intubating critically ill patients in intensive care unit (ICU) is hypoxemia. Acute physiological abnormalities and poor pulmonary reserve render preoxygenation less effective or insufficient to avoid desaturation even for short duration of apnea in these patients. Measures to oxygenate the patient even during the period of apnea should be considered. Objective: To compare Continuous Positive Airway Pressure (CPAP) administered through nasopharyngeal airway and traditional apneic oxygenation administered through nasal prongs, in reducing the drop in oxygen saturation (SpO2) while intubating critically ill patients in ICU. Methodology: In this randomized controlled study, 50 patients with type I respiratory failure requiring mechanical ventilation, were randomized into 2 groups of 25 each. After 5 min of NIV preoxygenation, in Group NPA – patients received apneic oxygenation through a nasopharyngeal airway connected to ventilator circuit and CPAP of 10 cmH2O Group NC – patients received oxygen via nasal prongs at 15 l/min during intubation. The SpO2 levels at various time intervals of per-intubation period were recorded. Results: Significant difference was observed in degree of desaturation between the 2 groups (2.1 ± 3.5 in group NPA versus 4.24 ± 3.67 in group NC, P value 0.007). The mean tracheal intubation time (44.93 ± 19.66 vs 46.79 ± 18, P value 0.739) and mean intubation difficulty scores (IDS) (1.67 ± 1.39 vs 1.47 ± 1.35, P value 0.464) were comparable in both the groups. Conclusion: The degree of desaturation while intubating hypoxemic patients in ICU is similar with both the techniques of peri-intubation oxygenation, i.e., Oxygen administered though nasal Prongs at 15 L/min and CPAP of 10 cmH2O administered through nasopharyngeal airway. Cinical Trial Registration No. CTRI/2018/09/015747 Registered at www.ctri.gov.in.

Methemoglobinemia is a potentially life-threatening disease resulting from high blood levels of methemoglobin resulting in failure of binding and delivery of oxygen to tissues. The most common causes of methemoglobinemia are oxidizing toxins, such as butamirate citrate, which is a commonly used liquid antitussive, especially in pediatric patients. Herein, we present the case of a 3-year-old girl who accidentally ingested excessive amounts of butamirate citrate. She presented with mild lip cyanosis with high methemoglobin levels (6.5%) and normal oxygen saturation (98%), and was managed by prompt gut decontamination with activated charcoal, followed by monitoring and intravenous glucose administration. Therefore, methemoglobinemia should be considered a differential diagnosis in a patient presenting with cyanosis without any underlying lung or heart disease.

Abstract A complex interrelation between lung and brain in patients with acute lung injury (ALI) has been established by experimental and clinical studies during the last decades. Although, acute brain injury represents one of the most common insufficiencies in patients with ALI and acute respiratory distress syndrome (ARDS), the underlying pathophysiology of the observed crosstalk remains poorly understood due to its complexity. Specifically, it involves numerous pathophysiological parameters such as hypoxemia, neurological adverse events of lung protective ventilation, hypotension, disruption of the BBB, and neuroinflammation in such a manner that the brain of ARDS patients—especially hippocampus—becomes very vulnerable to develop secondary lung-mediated acute brain injury. A protective ventilator strategy could reduce or even minimize further systemic release of inflammatory mediators and thus maintain brain homeostasis. On the other hand, mechanical ventilation with low tidal volumes may lead to self-inflicted lung injury, hypercapnia and subsequent cerebral vasodilatation, increased cerebral blood flow, and intracranial hypertension. Therefore, by describing the pathophysiology of ARDS-associated acute brain injury we aim to highlight and discuss the possible influence of mechanical ventilation on ALI-associated acute brain injury.

Abstract Hypoxic pulmonary vasoconstriction (HPV) is a major physiological mechanism that prevents the development of hypoxemia secondary to a regional decrease in the ventilation–perfusion ratio (the intrapulmonary shunt effect). Calcium plays a critical role in the cellular response to hypoxia and the regulation of the pulmonary vascular tone. Therefore, calcium channel antagonists such as nicardipine have the potential to interfere with the pulmonary response to hypoxia, increasing intrapulmonary blood shunt and thus worsening underlying hypoxemia. This article reports the case of a 40‐year‐old man suffering from lobar pneumonia, who developed a rapidly progressing hypoxemia after starting nicardipine infusion for blood pressure control. After ruling out all major causes of hypoxemic respiratory failure, the involvement of the calcium channel antagonist was strongly suspected. Hypoxemia caused by HPV release is an underreported side effect of calcium channel blockers. There are few clinical reports that describe the occurrence of this adverse event, and to our knowledge, only one other publication describes a patient suffering from infectious pneumopathy. In this article, we discuss the cellular mechanisms behind the HPV, as well as the pharmacology of calcium channel antagonists and their involvement in the development of acute respiratory failure. The purpose of this report is to remind clinicians dealing with patients affected by acute hypoxemia that pharmacologic HPV inhibition should be considered as part of the differential diagnosis, thus avoiding unnecessary costly and time‐consuming assessments.

Obstructive sleep apnea hypopnea syndrome (OSAHS), which is a common childhood disease, is a trending topic in clinical multidisciplinary research due to its detriment to the growth and development of children. Due to the wide variety and specificity of pathogenesis and clinical manifestations, the clinical diagnosis of OSAHS is sophisticated and difficult and remains controversial in the field. This review summarizes the common diagnostic methods in OSAHS for children, including polysomnography,which is known as the current “gold standard”, pulse oximetry, fiberoptic nasopharyngoscopy, nasopharyngeal lateral X-ray, CT, and magnetic resonance imaging (MRI). Furthermore, it emphasizes the new diagnostic critical value from Chinese guidelines for the diagnosis and treatment of obstructive sleep apnea in children (2020) for children with OSAHS released by China in 2020: the obstructive apnea hypopnea index (OAHI) is ≥ 1 time/h; it also emphasizes the importance of history and physical examination to contribute to clinical diagnosis and treatment for children with OSAHS.

Abstract Background Studies evaluating the role of high-flow nasal cannula (HFNC) in sedated digestive endoscopy have reported conflicting results. This meta-analysis evaluates the effectiveness of HFNC in patients undergoing digestive endoscopy procedures under sedation. Methods PubMed, Medline, EMBASE, Cochrane Central Register of Controlled Trials and Web of Science, were searched from inception to 31 July 2021. Only randomized clinical trials comparing HFNC with standard nasal cannula oxygen (SNC) during sedated digestive endoscopy were included. The incidence of hypoxemia was the primary outcome, and the secondary outcome was the percentage of patients who needed airway interventions. Results Seven studies that enrolled 2998 patients were included. When compared to SNC, HFNC was associated with a significant reduction in hypoxemia incidence (OR 0.24, 95% CI 0.09 to 0.64) and airway intervention requirements (OR 0.15, 95% CI 0.03 to 0.69), with both high heterogeneity (I2 = 81% and 94%). In subgroup analysis, when hypoxemia was defined as pulse oxygen saturation (SpO2)

Background Early detection of arterial gas abnormalities and acid–base disturbances in patients with chronic liver disease is essential to improve prognosis on the basis of pulmonary and liver diseases. The aim of the current study was to detect arterial blood gas changes, acid–base disturbances, and prevalence of hepatopulmonary syndrome (HPS) in different classes of severity of chronic hepatic disease for achieving a higher survival rate. Results Patients with hypoxemia represented 38 (33.6%) cases: three (15.7%) of 19 patients in group A, 16 (33.3%) of 48 patients in group B, 12 (34.2%) of 35 patients in group C, and seven (63.6%) of 11 patients with encephalopathy. Highly statistically significant decreases in arterial blood partial pressure of O2 and oxygen saturation were found with the increase in the severity of the hepatic disease and cirrhosis as assessed using the Child–Pugh score. Moreover, partial pressure of O2 was lowest in patients with encephalopathy. HPS was present in 22 (19.4%) patients with hypoxemia. A total of 12 patients were Child class C, eight patients were Child class B, and two patients were Child class A. Acid–base disturbances were observed in 82 (72.6%) patients, respiratory alkalosis in 49 (43.4%) patients, metabolic alkalosis in 10 (8.8%) patients, metabolic acidosis in seven (6.2%) patients, respiratory acidosis in eight (7.1%) patients, and mixed disturbances in eight (7.1%) patients. Conclusions Patients with hypoxemia were found to have a higher score of Child–Pugh than patients not having hypoxemia. HPS was found in all three Child–Pugh classes but mostly in Class C, so it is recommended that every patient with chronic liver disease should be evaluated and assessed for therapeutic decision, control of symptoms, improving survival, and quality of life.

Abstract Background In patients receiving single lung transplantation for idiopathic pulmonary fibrosis, worsening of fibrosis of the native lung is usually progressive over time, with no significant effects on gas exchange. Case presentation Here, we describe the cases of two Caucasian male recipients of single lung transplants for idiopathic pulmonary fibrosis, 65 and 62 years of age, who exhibited acute worsening of lung fibrosis after an episode of serious viral infection (cytomegalovirus primo-infection in one case and COVID-19 in the other). In both cases, along with opacification of the native lung over several days, the patients presented acute respiratory failure that required the use of high-flow nasal oxygen therapy. Eventually, hypoxemic respiratory failure resolved, but with rapid progression of fibrosis of the native lung. Conclusion We conclude that acute worsening of fibrosis on the native lung secondary to a severe viral infection should be added to the list of potential complications developing on the native lung after single lung transplantation for idiopathic pulmonary fibrosis.

Pulmonary arteriovenous malformations after the Kawashima procedure causing severe hypoxemia are treated by Fontan surgery that redirects hepatic venous blood to the pulmonary circulation. Alignment of the hepatic venous conduit toward both pulmonary arteries is crucial for their regression. Persistent hypoxemia due to nonregressed malformations in one lung often warrants a repeat surgery to redirect hepatic venous flows. Catheter-based redirection of Fontan flows is not commonly performed as metallic stents and devices may predispose to thrombus formation in the circuit. This report highlights a patient with persistent arteriovenous malformations in the left lung leading to severe disabling hypoxemia that was managed in the catheterization laboratory with an innovative strategy to redirect Fontan flows toward the affected left lung.

Abstract Background Supplemental oxygen during exercise training is used to increase the training effect of an exercise program in patients with chronic obstructive pulmonary disease (COPD) who show exercise-induced desaturation. Exercise-induced desaturation is not clearly defined in the guidelines; however, it is generally defined in clinical studies as a decrease in SpO2 of more than 4% from rest or a decrease to less than 88% during exercise. Although some meta-analyses examined the effectiveness of supplemental oxygen during exercise training, these studies concluded that it does not further improve exercise tolerance compared to exercise training alone. However, supplemental oxygen during exercise training may be effective in improving exercise tolerance in COPD patients with severe exercise-induced desaturation. Therefore, this study will be performed to elucidate the effectiveness of supplemental oxygen during exercise training and the relationship between its effectiveness and severity of exercise-induced desaturation at baseline. Methods We will first assess the effectiveness of supplemental oxygen during exercise training in COPD. The main outcome is the change in exercise tolerance before and after the intervention, indicated by the 6-min walking distance, the walking distance, or the walking time in incremental shuttle walking test, and analyzed as the standardized mean difference (SMD). The quality and risk of bias in individual studies will be assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system and risk-of-bias tool (RoB ver.2). If statistical heterogeneity in terms of the effectiveness of exercise tolerance is shown, we will conduct meta-regression analyses to examine the association between the effectiveness of exercise training with supplemental oxygen and severity of exercise-induced desaturation at baseline. Discussion One strength of this study is that it is a systematic review with meta-regression analysis to elucidate the effectiveness of supplemental oxygen during exercise training in patients with COPD who show severe exercise-induced desaturation. Furthermore, we will assess the severity of exercise-induced desaturation for which exercise training with supplemental oxygen is effective, the influence of acute effects at baseline, and the effect of supplemental oxygen on adverse events. Systematic review registration Registration number, UMIN000039960.

Abstract PBMT using 630 + 660 nm wavelengths transcutaneously at 7 cm above chest area irradiating lungs and heart regions of patients with acute, infectious respiratory syndrome alleviated their respiratory symptoms, mitigated pulmonary inflammation and hypoxia. PBMT could prevent more severe respiratory distress requiring emergency care and reduce the strain on healthcare. This case report's clinical experience can be the basis of future research evaluating oxygen saturation levels pre‐ and post‐PBMT.

Hereditary methemoglobinemia is one of the rare causes of hypoxemia. Mutations in the CYB5R3 gene cause autosomal recessive hereditary methemoglobinemia. Mostly, symptoms such as shortness of breath, bruise and and fatique occur. It may not display any symptoms until adult ages. Our case was at the age of 18 and had sometimes recurring bruise in hands and lips, shortness of breath, palpitations and oxygen saturation (SaO2) was 85%. Methemoglobin (Methb) level was %20 (N;0-1.5) No cardiac or pulmonary cause could be detected, which could account for dyspnea and cyanosis, and due to low saturation and high Methb. levels, metheglobinemia was considered and high dose IV ascorbic acid was administered. In follow up period, saturation increased and Methb. level gradually decreased and with genetic tests, homozygous missense c.136C gt; T (p.R46W) mutation was detected with CYB5R3 gene sequence analysis. Patient was diagnosed with autosomal recessive hereditary methemoglobinemia type 1. This case is presented ın order to emphasize that hereditary methemoglobinemia should be kept in mind when shortness of breath, hypoxia and cyanosis, occur together and can not be attributed to pulmonary and cardiovascular causes.

Objective To investigate the incidence and potential risk factors of postoperative hypoxemia in a post-anesthesia care unit (PACU). Methods The retrospective cohort assessed 14 604 postoperative patients who were admitted to PACU in a period of one year. Clinical data were collected, the incidence and potential risk factors for postoperative hypoxemia were statistically analyzed. Results The incidence of hypoxemia was 2.79%. Multiple regression analysis indicated that the risk factors were age (≥65-year old), body mass index (BMI≥25), American Society of Anesthesiologists (ASA ≥Ⅱ), limb surgery, and thoracic surgery. Conclusions Hypoxemia is common in postoperative patients in PACU. Age, BMI, ASA classification, and surgical site are associated with postoperative hypoxemia. Doctors should pay attention and give timely treatment to high-risk patients to prevent hypoxemia in PACU.

Abstract Background The current target oxygen saturation range for patients with COVID-19 recommended by the National Institutes of Health is 92–96%. Main body This article critically examines the evidence guiding current target oxygen saturation recommendation for COVID-19 patients, and raises important concerns in the extrapolation of data from the two studies stated to be guiding the recommendation. Next, it examines the influence of hypoxia on upregulation of ACE2 (target receptor for SARS-CoV-2 entry) expression, with supporting transcriptomic analysis of a publicly available gene expression profile dataset of human renal proximal tubular epithelial cells cultured in normoxic or hypoxic conditions. Finally, it discusses potential implications of specific clinical observations and considerations in COVID-19 patients on target oxygen saturation, such as diffuse systemic endothelitis and microthrombi playing an important pathogenic role in the wide range of systemic manifestations, exacerbation of hypoxic pulmonary vasoconstriction in the setting of pulmonary vascular endothelitis/microthrombi, the phenomenon of “silent hypoxemia” with some patients presenting to the hospital with severe hypoxemia disproportional to symptoms, and overburdened health systems and public health resources in many parts of the world with adverse implications on outpatient monitoring and early institution of oxygen supplementation. Conclusions The above factors and analyses, put together, call for an urgent exploration and re-evaluation of target oxygen saturation in COVID-19 patients, both in the inpatient and outpatient settings. Until data from such trials become available, where possible, it may be prudent to target an oxygen saturation at least at the upper end of the recommended 92–96% range in COVID-19 patients both in the inpatient and outpatient settings (in patients that are normoxemic at pre-COVID baseline). Home pulse oximetry, tele-monitoring, and earlier institution of oxygen supplementation for hypoxemic COVID-19 outpatients could be beneficial, where public health resources allow for their implementation.

Abstract Background Hypoxemia is a severe condition associated with high rates of mortality, particularly in low- and middle-income countries (LMICs) with poor access to oxygen therapy. Despite its clinical significance, there have been few studies to describe the burden of hypoxemia. Thus, the primary objective of this study is to systematically describe the prevalence of hypoxemia among pediatric and adult patients in low- and middle-income countries. Methods/design Standard systematic review methods will be used. Bibliographic databases (MEDLINE, EMBASE, CINAHL) will be searched from 1998 onwards. The search strategy aims to identify studies that have measured peripheral blood oxygen saturation (SpO2) in children and adults presenting to health facilities in LMICs. Studies will be included if oxygen saturation measurements by pulse oximetry were measured. No studies will be excluded based on study design though patients recruited from intensive care units and post-operative care will be excluded. The primary outcome is the prevalence of hypoxemia on presentation to the healthcare facility. We define hypoxemia on the basis of SpO2 measurements, and use a threshold of SpO2 less than 90% at sea level though allow for a lower threshold for studies conducted at higher altitude and where justified. Standardized tools will be used to extract data on number of patients with SpO2 measurements, number of patients with hypoxemia, patient population characteristics, and study characteristics. Quality of the included studies will be assessed using the “Checklist for Prevalence Studies” developed by the Joanna Briggs Institute. If there are enough studies to do so, we will conduct meta-analysis using a random effects model to estimate prevalence of hypoxemia and conduct subgroup analyses by age and disease groups. Discussion Hypoxemia is a critical condition and understanding the burden of hypoxemia may support decision-making in LMICs to deploy pulse oximeters and oxygen treatments more efficiently to address diseases and patient populations with the highest burden. Previous studies on hypoxemia prevalence have focused too narrowly on a few diseases or specific patient populations (e.g., pneumonia in children under five) whereas any effort to improve access to oxygen requires understanding of the potential demand for oxygen for all diseases and population groups. Governments, UN agencies, donors, and NGOs are investing strongly to improve oxygen systems in LMICs. Effective oxygen system planning requires estimation of oxygen need, informed by robust data on hypoxemia prevalence and admission patterns at all the levels of the health system. This study aims to fill that gap by providing comprehensive estimates of hypoxemia prevalence. Systematic review registration PROSPERO CRD42019136622 .

Background:Laparoscopic cholecystectomy is a commonly performed surgery that is associated with pneumoperitoneum‑induced respiratory compromise and altered pulmonary mechanics strategies have been investigated for use during laparoscopic cholecystectomy. The Objectives: to study the effects of low tidal volume with positive end-expiratory pressure (PEEP) on arterialblood gases of patients undergoing laparoscopic cholecystectomy. Patients and Methods: This is a prospective study that included 60 adult patients undergoing elective laparoscopic cholecystectomywith BMI< 30at general surgery department in Qena university hospital “between October 2016to April 2018”, the Sixty patients were assigned to two groups:group Athe tidal volume was 6 mL/kg, with PEEP of 5 cm of H2O(n = 30), group < br />B received the tidal volume was 10 mL/kg, and the PEEP was set at 0 cm of H2O (n = 30). Patient hemodynamics, pulmonarymechanics, and arterial blood gases were measuredpreoperative, intraoperative and post-operative. Results:All cases were completed successfully.Study showed significance between oxygenation in both groups. Post-operative oxygenation in protective ventilation (group < br />A)Mean Post P aO2 in group A was 91.1(± 5.1)mmHg, while in group B was 80.2(±4.2) mmHg, p value (0.001). Conclusion:Study found that protective ventilation was superior to conventional ventilation as it was associated with better oxygenation in the post-operative in laparoscopic cholecystectomy

Background: One-lung ventilation (OLV) is a common practice during thoracic surgery involving pulmonary resection to facilitate surgical exposure. For long time, arterial hypoxemia during OLV was is the most important problem for the anesthesiologist. At present, there is increasing concern about the effects of ventilator settings on acute lung injury. Objectives: The aim of this study is to compare the effect of different levels of Positive end expiratory pressure (PEEP) on hemodynamics in thoracic surgeries in adult patients. Patients and Methods: This is a prospective study that included 60 adult patients undergoing elective thoracic procedures requiring one-lung ventilation through a posterio-lateral thoracotomy at cardio-thoracic surgery department in Qena university hospital “between October 2017 to April 2019”, the Sixty patients were assigned to three groups: group I received no PEEP (n = 20),group II received a PEEP (5 cmH2O) (n = 20),and group III received a PEEP (10 cmH2O) (n = 20). Patient hemodynamics, pulmonary mechanics, and arterial blood gases were measured just after OLV(T1) and 20 (T2), 40 (T3), and 60 min(T4) after OLV. Results: All cases were completed successfully. The heart rate and mean arterial blood pressure showed no significant changes between all groups. Conclusion: During OLV, mechanical ventilation with PEEP 0, 5 or 10 cmH2O has no effect on hemodynamics in thoracic surgeries in adult patients.

Abstract Hypoxia and hypoxemia are two different entities. Correcting hypoxemia without hypoxia tends to have disastrous effects and delays lung healing. In this study, we share a case of an elderly man with moderate COVID‐19 who never received any form of supplemental oxygen as compared to other patients with similar presentation.

Platypnea-orthodeoxia Syndrome is characterized by clinically significant postural hypoxia. The full spectrum of the syndrome includes intracardial and extracardial abnormalities with R->L shunt. Various concurrent underlying physiological abnormalities are usually encountered that require thorough clinical and laboratory evaluation. A high clinical suspicion in patients with unexplained dyspnea is also required to reach a firm diagnosis. We herein present a rare case of an 82-years-old patient with episodic unexplained dyspnea, patent foramen ovale with normal pulmonary pressures and we review the underlying physiologic mechanisms.

Persistent changes on chest x-ray and hypoxemia in arterial blood gas analyses have been described in several cases in novel CoV-19 virus (nCoV-19) patients. These changes are usually not expressed to a large extent. Our goal was not only to present a patient with comorbidities in whom residual pulmonary infiltrates remained with consequent hypoxemia after extubation, but also to show that these changes do not always correlate with the clinical condition. In summary, despite chest x-ray changes and hypoxemia, with appropriate respiratory physiotherapy, the patient had a satisfactory clinical status.

Abstract In presence of tachypnea, digital clubbing and cyanosis in a patient with the hallmarks of chronic liver disease, hepatopulmonary syndrome should be suspected and investigated.

Diseases of the respiratory system (both acute and exacerbations of chronic ones) remain the most frequent non-surgical complications after surgical interventions of various sizes, increasing the duration of the patient»s hospital stay, increasing economic costs and the percentage of deaths. It was shown that respiratory complications developed after abdominal operations increased the risk of 30-day mortality by 10 times. The most common complications include: reintubation, acute respiratory failure, pulmonary edema, atelectasis and pneumonia. The development of respiratory complications is due to the pathology of the respiratory system and respiratory muscles. It is proved that the use of drugs that inhibit neuromuscular conduction in 75 % of cases provokes the development of atelectasis, respiratory muscle dysfunction and reduces respiratory volumes. Respiratory complications are most often caused by hypoxia or hypercapnia. Hypoxia is characterized by a decrease in the partial pressure of oxygen and is well corrected by additional oxygenation. In the first hours after surgery hypoxemia occurs in 50—55 % of cases with a decrease in saturation up to 80 %. Complete normalization of respiratory dysfunction usually occurs 4—6 hours after extubation. Hypercapnia, on the contrary, is characterized by an increase in the partial pressure of oxygen, the phenomena of hyperkalemia and respiratory acidosis. Correction of electrolyte and buffer disturbances is necessary. It is important for the Clinician to remember the need to identify possible risk factors for respiratory complications (modifiable and unmodified) and ways to correct them. Examination of the patient by a therapist before the planned operation, including possible preoperative preparation in the therapeutic departments of a multidisciplinary hospital helps to reduce the frequency of postoperative complications. In this article the authors describe recommendations for evaluation, prevention and diagnosis of respiratory complications in the perioperative period in patients with comorbid pathology.

High flow nasal cannula (HFNC) oxygen therapy devices are used on a daily-basis in many intensive care units and postoperative wards. Such a device deliver a mixture of air and oxygen, warmed, humidifi ed, with gas flow between 20-60 L/min, and inspired oxygen fraction between 0.21-1. Therefore, it improves oxygenation, decreases dead space, washes out the carbon dioxide (CO2) from patients’ airways, improves thoraco-abdominal synchrony and decreases the work of breathing. Studies have shown effi cacy of HFNC oxygen therapy use for acute hypoxemic respiratory failure, for patients with exacerbations of chronic pulmonary diseases, after extubation in order reduce the need for mechanical ventilation, in perioperative period to prevent atelectasis and in palliative care, in order to reduce breathlessness. It isn`t feasible for patients with severe altered neurological status, facial trauma, basal skull fracture, complete airway obstruction or epistaxis. There are no standardized recommendation for the use or contraindication of HFCN oxygen therapy. The weaning is realised according with patients’ tolerance, oxygen saturation, respiratory and heart rates.

Perinatal asphyxia is the most common cause of either death or severely handicapped survivors. Perinatal asphyxia can be identified by one, five, ten minutes APGAR scores less than 7. Prolonged asphyxia produce hypoxemia, acidosis, hypercapnia, thus diminishing cerebral blood flow, which in turn results in clinical patterns of Hypoxic - Ischemic Encephalopathy (HIE). The atm of this study was to evaluate the accuracy of clinical observation on newborn asphyxia to predict the presence of neurological deficits connected with blood gas analysts investigation. Thirty eight newborn babies who bad APGAR scores of less than 7 as an asphyctic newborn baby group compared with an equal number of normal babies as control group. Physical and neurological examinations were performed immediately after birth and at six months of age. Two of the 38 infants who bad perinatal asphyxia died several hours after birth. Two of the 31 of the surviving infants with a historical of perinatal asphyxia bad cerebral palsy. One of the two babies with cerebral palsy bad epilepsy. Twenty nine of the 31 of the surviving infants with a history of perinatal asphyxia with or without mild HIE showed normal neurological outcomes. All of the normal newborn babies as control showed normal neurological outcome. One infant with cerebral palsy and one infant who bad cerebral palsy with epilepsy bad a history of a severe degree of HIE and moderate degree of Hm with neonatal convulsion respectively. One of the 2 infants with cerebral palsy bad severe hypoxia and none on the infants with normal neurological outcome exhibited Pa02 less than 50 mmHg. There were no significant differences ( p > 0.05) of the Pa02 PH and base deficit between the infants with a history of asphyxia and with a history of a vigorous baby, who bad a normal outcome. We concluded that postasphyxia encephalopathy was more accurate than a low APGAR score in predicting an adverse outcome, and the value of the Pa02 very important in predicting an encephalopathy.

Objectives: To determine the Clinical Predictors of Hypoxemia in Acute respiratory tract infections ( ARI) in children aged 6 to 60 months and to study the incidence of ARI with Hypoxemia. Materials & Methods: A Prospective observational study carried on 138 children between the age of 6 to 60 months presenting with a complaint of cough or difficulty in breathing were assessed between September 2016-February 2017. Hypoxemia is defined as arterial saturation of oxygen less than 90% (SPO2

Resumen: Presentamos el caso de un varón de 15 años que padeció un cuadro de insuficiencia respiratoria grave con hipoxemia marcada e inestabilidad hemodinámica, atendido en un Centro de Salud de una estación de esquí, denominado edema pulmonar de gran altitud (EPGA), que implica la acumulación anormal de líquido en los pulmones y, de hecho, es la manifestación mortal más común de la enfermedad grave de gran altitud. Una actuación rápida con reducción de la presión arterial pulmonar son claves en el pronóstico. Abstract: We present the case of 15-years-old man who suffered from severe respiratory failure with marked hypoxemia and hemodynamic instability, treated in a Health Center of a ski resort, called high-altitude pulmonary edema (HAPE), which implies accumulation abnormal fluid in the lungs and, in fact, is the most common fatal manifestation of severe high-altitude illness. A rapid action with reduction of pulmonary arterial pressure are key in the prognosis.

Introduction: Cobalt (II) chloride hexahydrate (CoCl2) is a material that frequently used as hypoxia mimicking agent (HMA) to induce hypoxia condition in the cell culture. CoCl2 may stimulate the adaptive state and maintain the stemness of mesenchymal stem cells (MSCs). Even though CoCl2 commonly administered for cell culture, the biocompabilty of this material should be examined before use on Gingival Mesenchymal Stem Cells (GMSCs). Purpose: the purpose of this study is to examine the biocompability of CoCl2 as HMA on Rabbit's (Oryctolagus cuniculus GMSCs by using cytotoxicity assay. Materials and Methods: Rabbit's GMSCs at fourth subculture obtained from cell stock was used in this study. CoCl2 with the concentration as much as 200 θM, 150 θM, 100 θM, 75 θM, 50 θM, 25θM was used to be compared in this study. Cytotoxicity test of CoCl2 on GMSCs was conducted by means of 3-(4,5-Dimethylthiazol-2-yl) 2,5-diphenyltetrazolium bromide (MTT) assay. The formazan crystal was observed in the viable cells. The data were analyzed using one-way Analysis of Variance (ANOVA) with p<0.05 considered as significant. Results: The formazan crystals were found in the GMSCs co-cultured with various doses of CoCl2. There was no significant difference in the cell viability percentage of GMSCs between groups treated with CoCl2 with various concentration (p>0.05). Conclusion: CoCl2 as hypoxia mimicking agent are biocompatible to be used on rabbit's (O. cuniculus) gingival mesenchymal stem cells. [ABSTRACT FROM AUTHOR]

We explored the metabolic makeup of urine in prescreened healthy male participants within the PlanHab experiment. The run-in (5 day) and the following three 21-day interventions [normoxic bedrest (NBR), hypoxic bedrest (HBR), and hypoxic ambulation (HAmb)] were executed in a crossover manner within a controlled laboratory setup (medical oversight, fluid and dietary intakes, microbial bioburden, circadian rhythm, and oxygen level). The inspired O2 (FiO2) fraction next to inspired O2 (PiO2) partial pressure were 0.209 and 133.1 ± 0.3 mmHg for the NBR variant in contrast to 0.141 ± 0.004 and 90.0 ± 0.4 mmHg (approx. 4,000 m of simulated altitude) for HBR and HAmb interventions, respectively. 1H-NMR metabolomes were processed using standard quantitative approaches. A consensus of ensemble of multivariate analyses showed that the metabolic makeup at the start of the experiment and at HAmb endpoint differed significantly from the NBR and HBR endpoints. Inactivity alone or combined with hypoxia resulted in a significant reduction of metabolic diversity and increasing number of affected metabolic pathways. Sliding window analysis (3 + 1) unraveled that metabolic changes in the NBR lagged behind those observed in the HBR. These results show that the negative effects of cessation of activity on systemic metabolism are further aggravated by additional hypoxia. The PlanHab HAmb variant that enabled ambulation, maintained vertical posture, and controlled but limited activity levels apparently prevented the development of negative physiological symptoms such as insulin resistance, low-level systemic inflammation, constipation, and depression. This indicates that exercise apparently prevented the negative spiral between the host's metabolism, intestinal environment, microbiome physiology, and proinflammatory immune activities in the host. [ABSTRACT FROM AUTHOR]

Italy is currently experiencing an epidemic of coronavirus disease 2019 (Covid-19). Aim of our study is to identify the best predictors of Intensive Care Unit (ICU) admission in patients with Covid-19. We examined 28 patients admitted to the Emergency Department (ED) and subsequently confirmed as cases of Covid-19. Patients received, at the admission to the ED, a diagnostic work-up including: patient history, clinical examination, an arterial blood gas analysis (whenever possible performed on room air), laboratory blood tests, including serum concentrations of interleukin-6 (IL-6), lung ultrasound examination and a computed tomography (CT) scan of the thorax. For each patient, as gas exchange index through the alveolocapillary membrane, we determined the alveolar-arterial oxygen gradient (AaDO⁠2) and the alveolar-arterial oxygen gradient augmentation (AaDO⁠2 augmentation). For each patient, as measurement of hypoxemia, we determined oxygen saturation (SpO2), partial pressure of oxygen in arterial blood (PaO⁠2), PaO⁠2 deficit and the ratio between arterial partial pressure of oxygen by blood gas analysis and fraction of inspired oxygen (P/F). Patients were assigned to ICU Group or to Non-ICU Group basing on the decision to intubate. Areas under the curve (AUC) and receiver operating characteristic (ROC) curve were used to compare the performance of each test in relation to prediction of ICU admission. Comparing patients of ICU Group (10 patients) with patients of Non-ICU Group (18 patients), we found that the first were older, they had more frequently a medical history of malignancy and they were more frequently admitted to ED for dyspnea. Patients of ICU Group had lower oxygen saturation, PaO⁠2, P/F and higher heart rate, respiratory rate, AaDO⁠2, AaDO⁠2 augmentation and lactate than patients of Non-ICU Group. ROC curves demonstrate that age, heart rate, respiratory rate, dyspnea, lactate, AaDO2, AaDO2 augmentation, white blood cell count, neutrophil count and percentage, fibrinogen, C-reactive protein, lactate dehydrogenase, glucose level, international normalized ratio (INR), blood urea and IL-6 are useful predictors of ICU admission. We identified several predictors of ICU admission in patients with Covid-19. They can act as fast tools for the early identification and timely treatment of critical cases since their arrival in the ED.

Background: Sleep Disordered Breathing (SDB) is associated with a wide range of pathophysiological changes due, in part, to hypoxemia during sleep. We sought to identify gene transcription associations with measures of SDB and hypoxemia during sleep, and study their response to treatment. Methods: In two discovery cohorts, Framingham Offspring Study (FOS; N = 571) and the Multi-Ethnic Study of Atherosclerosis (MESA; N = 580), we studied gene expression in peripheral blood mononuclear cells in association with three measures of SDB: Apnea Hypopnea Index (AHI); average oxyhemoglobin saturation (avgO2) during sleep; and minimum oxyhemoglobin saturation (minO2) during sleep. Associated genes were used for analysis of gene expression in the blood of 15 participants with moderate or severe obstructive sleep apnea (OSA) from the Heart Biomarkers In Apnea Treatment (HeartBEAT) trial. These genes were studied pre- and post-treatment (three months) with continuous positive airway pressure (CPAP). We also performed Gene Set Enrichment Analysis (GSEA) on all traits and cohort analyses. Findings: Twenty-two genes were associated with SDB traits in both MESA and FOS. Of these, lower expression of CD1D and RAB20 was associated with lower avgO2 in MESA and FOS. CPAP treatment increased the expression of these genes in HeartBEAT participants. Immunity and inflammation pathways were up-regulated in subjects with lower avgO2; i.e., in those with a more severe SDB phenotype (MESA), whereas immuno-inflammatory processes were down-regulated following CPAP treatment (HeartBEAT). Interpretation: Low oxygen saturation during sleep is associated with alterations in gene expression and transcriptional programs that are partially reversed by CPAP treatment.

Objective To investigate the effects of inverse ratio ventilation combined with lung-protective ventilation on pulmonary function and inflammatory factors in severe burn patients undergoing surgery. Populations and Methods: Eighty patients with severe burns undergoing elective surgery were divided randomly into two groups: control (CG, n = 40) and experiment (EG, n = 40). The CG had conventional ventilation, whereas the EG were ventilated with tidal volume (TV) of 6–8 ml/kg, I (inspiration): E (expiration) of 2:1, and positive end-expiratory pressure (PEEP) 5 cm H2O. The following variables were evaluated before (T0), 1 h after start of surgery (T1) and after surgery (T2): oxygenation index (OI), partial pressure of carbon dioxide (PaCO2), TV, peak airway pressure (Ppeak), mean airway pressure (Pmean), PEEP, pulmonary dynamic compliance (Cdyn), alveolar–arterial difference of oxygen partial pressure D(A-a)O2, lactic acid (Lac), interleukin (IL)-6 and IL-10, and lung complications. Results: At T1 and T2 time points, the OI, Pmean and Cdyn were significantly greater in the EG than in the CG while the TV, Ppeak, D(A-a)O2, IL-6 and IL-10 were significantly smaller in the EG than in the CG. At the end of the surgery, the Lac was significantly smaller in the EG than in the CG (1.28 ± 0.19 vs. 1.40 ± 0.23 mmol/L). Twenty-four hours after the surgery, significantly more patients had hypoxemia (27.5 vs. 10.0%), increased expectoration (45.0 vs. 22.5%), increased lung texture or exudation (37.5 vs. 17.5%) in the CG than in the EG. Conclusions: Inverse ratio ventilation combined with lung-protective ventilation can reduce Ppeak, increase Pmean and Cdyn, improve the pulmonary oxygenation function, and decrease ILs in severe burn surgery patients.

Acute respiratory distress syndrome (ARDS) is a syndrome, a combination of clinical and physiological observations that describe a pathological state. The pathogenesis of ARDS is not completely clear and there is no gold standard for diagnosis. ARDS is characterized by non-cardiogenic pulmonary edema, inflammation of the lungs, hypoxemia, and decreased lung compliance. Acute is defined as a symptom that occurs within one week of a known risk factor. Early clinical manifestations are shortness of breath (dyspneu and tachypneu) which then quickly develop into respiratory failure. ARDS was first described in 1967 by Asbaugh, et al., then the AECC made a definition that was finally refined by Berlin's criteria. Berlin's criteria divided the degree of hypoxemia into 3, namely mild, moderate, and severe, based on the arterial PO2 / FiO2 ratio and the need for PEEP (5 cm H2O or more) which can be given via endotracheal tube or non-invasive ventilation. Sepsis, aspiration of fluid or gastric contents, and multipe transfusion (>15 units/24 hours) are associated with a high risk of ARDS. Cases of ARDS related to pulmonary sepsis, such as pneumonia, inhalational trauma, and pulmonary contusions are as much as 46% or non-pulmonary sepsis as much as 33%. ARDS management includes oxygen therapy and supportive therapy, such as hemodynamics, pharmacotherapy, and nutrition. Further studies are still needed to get a good outcome for ARDS patients.

The pregnancy physiologically navigates, sort of speaking, the hematopoietic system in the direction of hypercoagulabile state, which grows stronger throughout the pregnancy and reaches its maximum at the time of the delivery. These changes are considered to be the protection of the pregnant woman during puerperium, but if over-emphasized, they could lead to complications in both mother and the fetus. The main hypothesis of pathophysiology of these problems, during pregnancy, is based on the events of forming the blood vessels between the placenta and the uterus. During the forming of placental circulation, as a result of non-adequate placentation and placental vascular thrombosis, certain secondary reactions may be manifested, such as: placental abruption, hypoxia and hypoxemia of the fetus, which result as fetal growth restriction. These states may be consequences of congenital or acquired thrombophilia. The therapy advised to these women varies, but there are no absolute evidences that it is obligatory. Clinical experience suggests that the use of aspirin, in the state of antiphospholipid syndrome, leads to better results, considering both the mother and the fetus.

Increased prevalence of obesity poses a challenge due to the altered physiologic and pharmacokinetic state which renders the patient under general anesthesia susceptible to delayed recovery, increased incidence of hypoxemia, and delayed healing. Smooth conduct of anaesthesia in a differently abled child with morbid obesity demands meticulous preoperative preparation to ward off separation anxiety from the parents as well as the anxiousness related to the unfamiliar environment.

We report a case of hypothyroidism, obstructive sleep apnea (OSA) with persistent daytime hypoxemia. Cause of hypoxemia was two arteriovenous (AV) malformations in the lower lobe of the lung. We must be alert to other causes of hypoxemia in patients of OSA with persistent daytime hypoxemia.

This is a case report showing acute hypoxemia during anesthesia. Immediate differentiation using lung POCUS (point-of-care ultrasound), in addition to physical examination and portable chest radiography, was made. This is the first case report of sputum impaction due to pneumonia causing hypoxemia that has been detected by lung POCUS during anesthesia.

Resting hypoxemia is the most severe stage of Chronic Obstructive Pulmonary Disease (COPD). Due to their impairments during the exacerbation, these patients are limited to traditional exercise rehabilitation and are excluded from the majority of the studies. The aim of this study was to assess the feasibility and the efficacy of two exercise programs in Acute Exacerbation of COPD (AECOPD) patients with resting hypoxemia. In this randomized clinical trial, patients hospitalized due to an acute exacerbation of COPD with hypoxemia at rest were included. Patients were randomly assigned into three groups. A Control Group (pharmacological treatment), a Global Exercise Group (GEG), and a Functional Electrostimulation Group (FEG). Patients were treated during the hospitalization period. The main outcomes were lower limb strength (assessed by a dynamometer), balance (assessed by the one leg standing balance test), health related quality of life (assessed by the EQ-5D), adverse events and adherence. At the end of the intervention, there were significant differences in all the variables in favour of the experimental groups (p < 0.05). We concluded that conducting an exercise program is feasible and improves lower limb strength, balance, and health related quality of life in AECOPD patients with resting hypoxemia.

Background: Cardiovascular disease is a major cause of mortality in chronic obstructive pulmonary disease (COPD), particularly in patients with mild to moderate severity. Microalbuminuria (MAB) has a strong association with cardiovascular events and death, and it reflects generalized endothelial dysfunction. There is evidence of vascular dysfunction in patients with COPD. Objectives: (a) To study the prevalence of MAB in stable COPD patients. (b) To determine the relationship of MAB with clinical and physiological descriptors of COPD severity and cardiovascular risk factors. Materials and Methods: A cross-sectional study in 150 COPD patients over a period of 1 year. Lung function, 6-min walk distance, smoking history, arterial blood pressure (BP), BODE index, and arterial blood gases were measured. Screening for MAB was done by measuring urinary albumin-to-creatinine ratio in a random spot urine collection. Stepwise logistic regression was performed using MAB as the dependent variable. P < 0.05 was taken as statistically significant. Results: Forty-six patients (30.0%) had MAB. There was negative association between hypoxemia and MAB. Stepwise logistic regression analysis with MAB as the dependent variable showed smoking (odds ratio [OR]: 2.29; 95% confidence interval [CI]: 1.54-3.41), lower forced expiratory volume in 1 s % (OR: 1.04; 95% CI: 0.98-1.10), and PaO2 (OR: 0.68; 95% CI: 0.57-0.83) as independent predictors of MAB. Conclusions: MAB in severe COPD patients should be examined in regular periods for risk of cardiovascular morbidity or mortality.

Pulmonary arteriovenous malformations (PAVMs) are abnormal communications between pulmonary arteries and veins. The clinical features suggestive of PAVMs are stigmata of right-to-left shunting (dyspnea, hypoxemia, cyanosis, cerebral embolism, brain abscess), unexplained hemoptysis, or hemothorax. We present a case of young man presented to Emergency Department complaining dyspnea, polycythemia and persistent hypoxemia. Angio-CT scan of the chest detected multiple PAVMs. PAVMs are uncommon in the general population, but they are an important consideration in the differential diagnosis of common pulmonary problems, including hypoxemia, pulmonary nodules, and hemoptysis