17 results on '"Keenaghan M"'
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2. CSD: An Innovative Style of Service Delivery
- Author
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Forrest, J., primary, Hinnigan, L., additional, Keenaghan, M., additional, and Owen, A., additional
- Published
- 1992
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3. Multisystem Inflammatory Syndrome in Children -- Initial Therapy and Outcomes.
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Son, M. B. F., Murray, N., Friedman, K., Young, C. C., Newhams, M. M., Feldstein, L. R., Loftis, L. L., Tarquinio, K. M., Singh, A. R., Heidemann, S. M., Soma, V. L., Riggs, B. J., Fitzgerald, J. C., Kong, M., Doymaz, S., Giuliano Jr., J. S., Keenaghan, M. A., Hume, J. R., Hobbs, C. V., and Schuster, J. E.
- Subjects
- *
SYNDROMES in children , *LEFT ventricular dysfunction , *INTRAVENOUS immunoglobulins , *DEMOGRAPHIC characteristics , *TEENAGERS - Abstract
BACKGROUND The assessment of real-world effectiveness of immunomodulatory medications for multisystem inflammatory syndrome in children (MIS-C) may guide therapy. METHODS We analyzed surveillance data on inpatients younger than 21 years of age who had MIS-C and were admitted to 1 of 58 US. hospitals between March 15 and October 31, 2020. The effectiveness ofinitial immunomodulatory therapy (day 0, indicating the first day any such therapy for MIS-C was given) with intravenous immune globulin (IVIG) plus glucocorticoids, as compared with IVIG alone, was evaluated with propensity-score matching and inverse probability weighting, with adjustment for baseline MIS-C severity and demographic characteristics. The primary outcome was cardiovascular dysfunction (a composite of left ventricular dysfunction or shock resulting in the use ofvasopressors) on or after day 2. Secondary outcomes included the components of the primary outcome, the receipt of adjunctive treatment (glucocorticoids in patients not already receiving glucocorticoids on day 0, a biologic, or a second dose of IVIG) on or after day 1, and persistent or recurrent fever on or after day 2. RESULTS A total of 518 patients with MIS-C (median age, 8.7 years) received at least one immunomodulatory therapy; 75°6 had been previously healthy, and 9 died. In the propensity-score-matched analysis, initial treatment with IVIG plus glucocorticoids (103 patients) was associated with a lower risk of cardiovascular dysfunction on or after day 2 than IVIG alone (103 patients) (17% vs. 31%; risk ratio, 0.56; 95% confidence interval [CI], 0.34 to 0.94). The risks of the components of the composite outcome were also lower among those who received IVIG plus glucocorticoids: left ventricular dysfunction occurred in 8% and 17% of the patients, respectively (risk ratio, 0.46; 95% CI, 0.19 to 1.15), and shock resulting in vasopressor use in 13% and 24% (risk ratio, 0.54; 95% CI, 0.29 to 1.00). The use of adjunctive therapy was lower among patients who received IVIG plus glucocorticoids than among those who received IVIG alone (34% vs. 70%; risk ratio, 0.49; 95% CI, 0.36 to 0.65), but the risk of fever was unaffected (31% and 40%, respectively; risk ratio, 0.78; 95% CI, 0.53 to 1.13). The inverse-probabilityweighted analysis confirmed the results of the propensity-score-matched analysis. CONCLUSIONS Among children and adolescents with MIS-C, initial treatment with IVIG plus glucocorticoids was associated with a lower risk of new or persistent cardiovascular dysfunction than IVIG alone. (Funded by the Centers for Disease Control and Prevention.) [ABSTRACT FROM AUTHOR]
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- 2021
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4. Ohms Law
- Author
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Tenny KM and Keenaghan M
- Abstract
Ohm law is a relationship between three physical phenomena: current, voltage, and resistance. Current is defined as the flow of positive charge from a source to a negative charge source. The units for current are C/s for the amount of charge (C) that travels per unit time (s). The ampere (A) is the common unit of current equal to 1 C/s and the symbol for current is I. Current is an intrinsic property, as it depends on other aspects, such as the size of the system. To aptly compare the amount of current for different systems, the current is normalized per area or mass of the system. This is described as the following: J = I/A. J = I/m. Where J is the current density in I/(m·m) or I/g depending on how the systems are compared, I is the current (A), A is the cross-sectional area (m·m), and m is the mass (g). Note that often j is used for current instead of I to prevent confusion with imaginary numbers. Therefore, one should pay attention to the symbols’ definitions, as they can vary case-by-case. The voltage is another piece of Ohm law that states the amount of work needed to move a charge. The unit for voltage is J/C, which is equal to the ubiquitous unit the Volt (V). The voltage measures the electric potential an object possesses in reference to a charge. By applying a voltage, work is done on the charge which enables the movement of the charge. The amount of charge compared to an individual charge, known as a point charge, can be determined by the following: V = kq/(r·r). Where V is the electric potential (V), k is the constant 8.99 E 9 N·m·m/(C·C), q is the charge of the point (C), and r is the distance from the point charge (m). The resistance is the opposition to the movement of charge. The resistance is similar to friction effects in flowing water or a sliding object. The units for resistance are Ohms, which is denoted with the capital Greek letter Omega. To calculate the amount of resistance in an object, the following equation can be used: R = Rho·l/A. Where R is the resistance (Omega), Rho is the resistivity of the object (Omega·m), l is the length of the object (m), and A is the cross-sectional area of the object (m·m). The resistivity is different for every object and is based on the structure of the material. The calculation for resistivity is outside the scope of this article. The resistance can also be normalized to provide an apt, case-by-case comparison. The normalized resistance is given by: R’ = R·A. Where R is the normalized resistance (Omega·m·m). The resistance, which impedes the flow of charge, is inversely proportional to the current. As the current normalization is per units of area, the resistance normalization is multiplied by units of the cross-sectional area due to the inverse relationship. The inverse of resistance (1/R) is known as the conductance, which measures the ability of an object to conduct charge given in units of Siemens (S). Further discussion of conductance is outside the scope of this article; however, it is worth noting the inverse relationship conductance has with resistance. Given the current, voltage, and resistance, Ohm law is defined as: V = I·R. Dimensional analysis is needed to ensure consistent units., (Copyright © 2022, StatPearls Publishing LLC.)
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- 2022
5. Febrile Seizure
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Xixis KL, Samanta D, and Keenaghan M
- Abstract
Febrile seizures are seizures that are caused by a sudden spike in body temperature with fevers greater than 38C or 100.4F, with no other underlying seizure-provoking causes or diseases such as the central nervous system (CNS) infections, electrolyte abnormalities, drug withdrawal, trauma, genetic predisposition or known epilepsy. Febrile seizures categorize as either simple febrile seizures or complex febrile seizures. Differentiation between simple and complex febrile seizures is important as the approach and workup for each is different., (Copyright © 2022, StatPearls Publishing LLC.)
- Published
- 2022
6. Arterial Lines
- Author
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Pierre L, Pasrija D, and Keenaghan M
- Abstract
Arterial catheterization is a procedure that is common to the intensive care settings and the operating room. It involves placement of a catheter into the lumen of an artery to provide at least a continuous display blood pressure with access to frequent arterial blood sampling. The discovery of the arterial waveform by insertion of a catheter into an artery dates to 1847 by the German Physiologist Carl Ludwig. More recently, the widely known Seldinger technique has been adopted by guiding catheter into a vessel over a wire previously inserted into the lumen or the artery. With knowledge of anatomy, various sites of insertion are available. However, practitioners must be mindful of indications and contraindications, proper preparation of equipment and personnel as well as the technique of insertion. As all invasive procedures, the placement of arterial catheters may present complications, with an advised operator who must be ready to intervene promptly to prevent unnecessary harm to the patient., (Copyright © 2022, StatPearls Publishing LLC.)
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- 2022
7. Sturge-Weber Syndrome
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Singh AK and Keenaghan M
- Abstract
Sturge-Weber syndrome (SWS) is a neurocutaneous syndrome characterized by angiomas involving the face, choroid, and leptomeninges. The facial capillary vascular malformation is also known as "port-wine stain" or "nevus flammeus" and usually is seen in the territory of the trigeminal nerve. Sturge-Weber syndrome is also called encephalotrigeminal angiomatosis. It is the third most common neurocutaneous syndrome after neurofibromatosis and tuberous sclerosis. The neurologic manifestations of SWS include atonic, tonic, or myoclonic seizures., (Copyright © 2022, StatPearls Publishing LLC.)
- Published
- 2022
8. Aspiration Risk
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Kollmeier BR and Keenaghan M
- Abstract
Aspiration is common, even in healthy patients. Aspiration can have significant morbidity and mortality in certain circumstances. It is categorized based on the predominant material in the aspirate. If oropharyngeal secretions, orally ingested material, or partially digested gastric contents are aspirated, one would expect infectious pneumonia to develop. However, if pure gastric secretions are aspirated, then chemical pneumonitis is the result. If partially digested gastric contents are aspirated along with some gastric acid, a mixture of chemical pneumonitis and inoculation of the lungs with potentially pathogenic organisms can occur. In practice, it is prudent to treat chemical pneumonitis with prophylactic antibiotics because a superimposed infection occurs in over 25% of cases. It is difficult to determine the quality of the aspirate in most cases, and a combination of bacterial and chemical injury is common., (Copyright © 2022, StatPearls Publishing LLC.)
- Published
- 2022
9. Serotonin Syndrome
- Author
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Simon LV and Keenaghan M
- Abstract
Serotonin syndrome is a potentially life-threatening condition precipitated by the use of serotonergic drugs. It may be a consequence of therapeutic medication use, accidental interactions between medications or recreational drugs, or intentional overdose. Symptoms can range from mild to fatal and classically include altered mental status, autonomic dysfunction, and neuromuscular excitation. Several criteria exist for making this clinical diagnosis, but the Hunter criteria are generally accepted as the most accurate. The diagnosis can be made in patients with a history of exposure to a serotonergic drug plus one or more of the following: spontaneous clonus, inducible clonus with agitation and diaphoresis, ocular clonus with agitation and diaphoresis, tremor and hyperreflexia, hypertonia, temperature over 38 C with ocular or inducible clonus. Management consists of immediate discontinuation of serotonergic agents, hydration, and supportive care to manage blood pressure, hyperpyrexia, and respiratory and cardiac complications. Sedation is best facilitated with benzodiazepines. Refractory cases may respond to the antidote, cyproheptadine, which must be given orally or via gastric tube. The effectiveness of cyproheptadine is unproven, but multiple case reports support its use in patients who do not respond to sedation and supportive care., (Copyright © 2022, StatPearls Publishing LLC.)
- Published
- 2022
10. Arterial Blood Gas
- Author
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Castro D, Patil SM, and Keenaghan M
- Abstract
Blood gas analysis is a commonly used diagnostic tool to evaluate the partial pressures of gas in blood and acid-base content. Understanding and use of blood gas analysis enable providers to interpret respiratory, circulatory, and metabolic disorders. [1] A "blood gas analysis" can be performed on blood obtained from anywhere in the circulatory system (artery, vein, or capillary). An arterial blood gas (ABG) tests explicitly blood taken from an artery. ABG analysis assesses a patient's partial pressure of oxygen (PaO2) and carbon dioxide (PaCO2). PaO2 provides information on the oxygenation status, and PaCO2 offers information on the ventilation status (chronic or acute respiratory failure). PaCO2 is affected by hyperventilation (rapid or deep breathing), hypoventilation (slow or shallow breathing), and acid-base status. Although oxygenation and ventilation can be assessed non-invasively via pulse oximetry and end-tidal carbon dioxide monitoring, respectively, ABG analysis is the standard. When assessing the acid-base balance, most ABG analyzers measure the pH and PaCO2 directly. A derivative of the Hasselbach equation calculates the serum bicarbonate (HCO3) and base deficit or excess. This calculation frequently results in a discrepancy from the measured due to the blood CO2 unaccounted for by the equation. The measured HCO3 uses a strong alkali that liberates all CO2 in serum, including dissolved CO2, carbamino compounds, and carbonic acid. The calculation only accounts for dissolved CO2; this measurement using a standard chemistry analysis will likely be called a "total CO2". For that reason, the difference will amount to around 1.2 mmol/L. However, a larger difference may be seen on the ABG, compared to the measured value, especially in critically ill patients. [2] The calculation has been disputed as both accurate and inaccurate based on the study, machine, or calibration used and must be interpreted appropriately based on your institutional standards.[3] Arterial blood gases are frequently ordered by emergency medicine, intensivist, anesthesiology, and pulmonology clinicians but may also be needed in other clinical settings. Many diseases are evaluated using an ABG, including acute respiratory distress syndrome (ARDS), severe sepsis, septic shock, hypovolemic shock, diabetic ketoacidosis, renal tubular acidosis, acute respiratory failure, heart failure, cardiac arrest, asthma, and inborn errors of metabolism., (Copyright © 2022, StatPearls Publishing LLC.)
- Published
- 2022
11. Febrile Seizure (Nursing)
- Author
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Xixis KL, Samanta D, Keenaghan M, and Vernon NT
- Abstract
Febrile seizures are seizures that are caused by a sudden spike in body temperature with fevers greater than 38C or 100.4F, with no other underlying seizure-provoking causes or diseases such as central nervous system (CNS) infections, electrolyte abnormalities, drug withdrawal, trauma, genetic predisposition or known epilepsy. Febrile seizures categorize as either simple febrile seizures or complex febrile seizures. Differentiation between simple and complex febrile seizures is important as the approach and workup for each is different.[1][2][3], (Copyright © 2022, StatPearls Publishing LLC.)
- Published
- 2022
12. Aspiration Risk (Nursing)
- Author
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Kollmeier BR, Keenaghan M, and Doerr C
- Abstract
Aspiration is common, even in healthy patients. Aspiration can have a significant morbidity and mortality in certain circumstances. It is categorized based on the predominant material in the aspirate. If oropharyngeal secretions, orally ingested material, or partially digested gastric contents are aspirated, one would expect infectious pneumonia to develop. However, if pure gastric secretions are aspirated, then a chemical pneumonitis is the result. If partially digested gastric contents are aspirated along with some gastric acid, a mixture of chemical pneumonitis and inoculation of the lungs with potentially pathogenic organisms can occur. In practice, it is prudent to treat a chemical pneumonitis with prophylactic antibiotics because a superimposed infection occurs in over 25% of cases. It is difficult to determine the quality of the aspirate in most cases, and a combination of bacterial and chemical injury is common.[1][2], (Copyright © 2022, StatPearls Publishing LLC.)
- Published
- 2022
13. Intravenous methylprednisolone versus intravenous methylprednisolone combined with inhaled budesonide in acute severe pediatric asthma.
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Gummalla P, Weaver D, Ahmed Y, Shah V, Keenaghan M, and Doymaz S
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- Acute Disease, Administration, Inhalation, Administration, Intravenous, Adolescent, Child, Child, Preschool, Drug Combinations, Female, Humans, Infant, Male, Severity of Illness Index, Young Adult, Bronchodilator Agents administration & dosage, Budesonide administration & dosage, Glucocorticoids administration & dosage, Methylprednisolone administration & dosage, Status Asthmaticus drug therapy
- Abstract
Introduction: Corticosteroids are important part of acute severe asthma (ASA) management in pediatric intensive care units. Few studies look at the efficacy of inhaled corticosteroids (ICS) in critical care settings. We aimed to investigate the potential beneficial effects of ICS when added to intravenous corticosteroids in pediatric patients with ASA admitted to the pediatric intensive care unit (PICU)., Methods: This was a randomized controlled trial involving pediatric patients aged 1-21 years admitted to PICU with ASA. Patients were randomized into 2 groups using block randomization. Patients in Group A received intravenous methylprednisolone (2 mg/kg/day) alone and patients in Group B received intravenous methylprednisolone (2 mg/kg/day) plus budesonide nebulization (0.5 mg every 12 h). Main outcomes were duration of continuous albuterol treatment, PICU and hospital length of stay (LOS), and need and duration of respiratory support. Kruskal-Wallis and Chi-square tests were used for statistical analysis, in which a p-value < 0.05 was considered statistically significant., Results: Duration of continuous albuterol treatment was not different between the 2 groups median/(QR), 30/(18-51) vs. 25/(14-49). ( p = 0.38) PICU and hospital LOS between the 2 groups was similar, median/(QR), 44/(30-64) vs. 46/(30-62), ( p = 0.75) and 78/(65-95) vs.72/(58-92), ( p = 0.19). Number of patients requiring respiratory support was 22(58%) in Group A and 25(64%) in Group B ( p = 0.19)., Conclusions: In critically ill children with ASA, intravenous methylprednisolone combined with inhaled budesonide did not shorten the duration of continuous albuterol inhalation treatment, the PICU and hospital LOS, and the need for respiratory support.
- Published
- 2021
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14. It Is Not Always Sepsis: Fatal Tachypnea in a Newborn.
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Levene R, Pollak-Christian E, Garg A, and Keenaghan M
- Abstract
Coarctation of the aorta (CoA) is a congenital cardiac malformation that is well understood. Despite being well characterized, CoA is a commonly missed congenital heart disease (CHD) during the newborn period. We report a full-term nine-day-old male who presented to the pediatric emergency department (ED) with isolated tachypnea. After an initial sepsis workup, subsequent investigations revealed critical CoA. Because the primary workup focused on sepsis, there was a significant delay in prostaglandin E1 (PGE
1 ) initiation. This case illustrates the importance of early CoA recognition and timely initiation of PGE1 in newborns who present with suspected sepsis along with tachypnea.- Published
- 2018
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15. Pulmonary air leak syndrome associated with traumatic nasopharyngeal suctioning.
- Author
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Chitty Lopez M, Pollak-Christian E, and Keenaghan M
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- Bronchiolitis therapy, Bronchiolitis virology, Female, Humans, Infant, Respiratory Syncytial Virus Infections complications, Respiratory Syncytial Viruses, Mediastinal Emphysema etiology, Nasopharynx injuries, Subcutaneous Emphysema etiology, Suction adverse effects
- Abstract
We describe a healthy 7-month-old female infant who developed spontaneous pneumomediastinum (PM) and subcutaneous emphysema after traumatic nasopharyngeal suctioning (NPS) while hospitalised for respiratory syncytial virus bronchiolitis. To the best of our knowledge, this is the first reported case of pulmonary air leak syndrome associated with traumatic NPS in a healthy infant affected by bronchiolitis. Although NPS is currently the mainstay of treatment in patients admitted with bronchiolitis in the USA, currently there are minimal data regarding the safety and effectiveness of the procedure in patients with bronchiolitis. Physicians should consider the possibility of pulmonary air leak as a complication of NPS and have high suspicion in a decompensating infant after suctioning who is afflicted with bronchiolitis., Competing Interests: Conflicts of Interest: None declared., (2016 BMJ Publishing Group Ltd.)
- Published
- 2016
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16. Intrauterine growth restriction impairs right ventricular response to hypoxia in adult male rats.
- Author
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Keenaghan M, Sun L, Wang A, Hyodo E, Homma S, and Ten VS
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- Animals, Animals, Newborn, Disease Models, Animal, Echocardiography, Female, Litter Size, Male, Mitochondria metabolism, Oxygen Consumption, Pregnancy, Prenatal Exposure Delayed Effects physiopathology, Rats, Rats, Sprague-Dawley, Time Factors, Fetal Growth Retardation physiopathology, Heart Ventricles physiopathology, Hypoxia physiopathology, Ventricular Dysfunction, Right
- Abstract
Background: Intrauterine growth restriction (IUGR) predisposes to cardiovascular diseases in adulthood. The mechanisms of this phenomenon remain cryptic. We hypothesized that heart mitochondria in IUGR-born adult rats are more sensitive to acute hypoxia which translates into dysfunctional cardiac response to hypoxic stress., Methods: Adult IUGR-born male rats (the offspring of dams fed with calories-restricted diet during pregnancy) were exposed to acute hypoxic stress with echocardiographic assessment of cardiac function. In parallel, mitochondrial respiration in organelles isolated from left ventricle (LV) and right ventricle (RV) was tested in normoxic and anoxic conditions. The extent of post-anoxic inhibition of mitochondrial respiration and cardiac function was compared with controls, non-IUGR rats., Results: Compared with controls, in the IUGR rats hypoxia significantly reduced only RV contractility, evidenced by decreased fractional shortening, functional area of contraction, and tricuspid annular plane systolic excursion. In isolated mitochondria, anoxic challenge inhibited respiratory chain in both groups of rats. However, compared with controls, the extent of anoxic mitochondrial depression was significantly greater in IUGR-born rats, but only in the organelles isolated from RV., Conclusions: In adult IUGR-born rats, mitochondria from RV are hypersensitive to oxygen deprivation and this translates into maladaptive RV cardiac response to acute hypoxia.
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- 2016
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17. Response of vascular endothelial growth factor and angiogenesis-related genes to stepwise increases in inspired oxygen in neonatal rat lungs.
- Author
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Keenaghan M, Cai CL, Kumar D, Valencia GB, Rao M, Aranda JV, and Beharry KD
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- Animals, Animals, Newborn, Female, Male, RNA, Messenger genetics, Rats, Vascular Endothelial Growth Factor Receptor-1 genetics, Neovascularization, Pathologic genetics, Oxygen administration & dosage, Vascular Endothelial Growth Factor A genetics
- Abstract
Background: Bronchopulmonary dysplasia is an inflammatory lung disease that afflicts preterm infants requiring supplemental oxygen and is associated with impaired pulmonary angiogenesis. We tested the hypothesis that there is a critical threshold of inspired O2 (FiO2) that alters pulmonary angiogenesis., Methods: Within 2-6 h of birth, rat pups were exposed to 10%, 21%, 30%, 40%, 50%, 60%, 70%, 80%, 90%, or 100% FiO2 for 2 h. Mixed arterial-venous blood gases, serum and pulmonary levels of vascular endothelial growth factor (VEGF) and soluble VEGF receptor-1, and pulmonary angiogenesis gene profiles were determined., Results: PO2 increased with hyperoxia from 35.6 ± 5.0 (range: 31.5-39.8) at 10% O2 to 108.5 ± 25.0 (range: 82.2-134.8) at 100% O2. PO2 at 21% O2 was 42.4 ± 7.3 (range: 36.8-48.1). Lung VEGF levels declined at 40%-100%. The critical PO2 associated with decreased lung VEGF was 66 mm Hg, achieved with a FiO2 of 0.4. PO2 was inversely correlated with VEGF levels in the lungs (R = -0.377; P < 0.008). Antiangiogenesis genes were robustly upregulated at 70%, predominantly in males. Data are reported as mean ± SD., Conclusions: A critical threshold of FiO2 affecting angiogenesis exists in immature lungs. Exposure of preterm lungs to >40% inspired O2, even for 2 h, may result in abnormal expression of biomarkers regulating lung angiogenesis.
- Published
- 2013
- Full Text
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