Determining oxygenation targets in acute respiratory distress syndrome(ARDS)remains a challenge.Althoughoxygenation targets have been used since ARDS was first described,they have not been investigated in detail.Howev...Determining oxygenation targets in acute respiratory distress syndrome(ARDS)remains a challenge.Althoughoxygenation targets have been used since ARDS was first described,they have not been investigated in detail.However,recent retrospective and prospective trials have evaluated the optimal oxygenation threshold in patientsadmitted to the general intensive care unit.In view of the lack of prospective data,clinicians continue to relyon data from the few available trials to identify the optimal oxygenation strategy.Assessment of the cost-benefitratio of the fraction of inspired oxygen(FiO_(2))to the partial pressure of oxygen in the arterial blood(PaO_(2))is an additional challenge.A high FiO_(2) has been found to be responsible for respiratory failure and deaths innumerous animal models.Low and high PaO_(2) values have also been demonstrated to be potential risk factors inexperimental and clinical situations.The findings from this literature review suggest that PaO_(2) values rangingbetween 80 mmHg and 90 mmHg are acceptable in patients with ARDS.The costs of rescue maneuvers needed toreach these targets have been discussed.Several recent papers have highlighted the risk of disagreement betweenarterial oxygen saturation(SaO_(2))and peripheral oxygen saturation(SpO_(2))values.In order to avoid discrepanciesand hidden hypoxemia,SpO_(2) readings need to be compared with those of SaO_(2).Higher SpO_(2) values may beneeded to achieve the recommended PaO_(2) and SaO_(2) values.展开更多
Extreme preterm infants(<28 weeks'gestation)often require positive pressure ventilation with oxygen during postnatal stabilization in the delivery room.To date,optimal inspired fraction of oxygen(FiO_(2))still ...Extreme preterm infants(<28 weeks'gestation)often require positive pressure ventilation with oxygen during postnatal stabilization in the delivery room.To date,optimal inspired fraction of oxygen(FiO_(2))still represents a conundrum in newborn care oscillating between higher(>60%)and lower(<30%)initial FiO_(2).Recent evidence and meta-analyses have underscored the predictive value for survival and/or relevant clinical outcomes of the Apgar score and the achievement of arterial oxygen saturation measured by pulse oximetry≥85%at 5 minutes after birth.New clinical trials comparing higher versus lower initial FiO_(2)have been launched aiming to optimize postnatal stabilization of extreme preterm while avoiding adverse effects of hypoxemia or hyperoxemia.展开更多
文摘Determining oxygenation targets in acute respiratory distress syndrome(ARDS)remains a challenge.Althoughoxygenation targets have been used since ARDS was first described,they have not been investigated in detail.However,recent retrospective and prospective trials have evaluated the optimal oxygenation threshold in patientsadmitted to the general intensive care unit.In view of the lack of prospective data,clinicians continue to relyon data from the few available trials to identify the optimal oxygenation strategy.Assessment of the cost-benefitratio of the fraction of inspired oxygen(FiO_(2))to the partial pressure of oxygen in the arterial blood(PaO_(2))is an additional challenge.A high FiO_(2) has been found to be responsible for respiratory failure and deaths innumerous animal models.Low and high PaO_(2) values have also been demonstrated to be potential risk factors inexperimental and clinical situations.The findings from this literature review suggest that PaO_(2) values rangingbetween 80 mmHg and 90 mmHg are acceptable in patients with ARDS.The costs of rescue maneuvers needed toreach these targets have been discussed.Several recent papers have highlighted the risk of disagreement betweenarterial oxygen saturation(SaO_(2))and peripheral oxygen saturation(SpO_(2))values.In order to avoid discrepanciesand hidden hypoxemia,SpO_(2) readings need to be compared with those of SaO_(2).Higher SpO_(2) values may beneeded to achieve the recommended PaO_(2) and SaO_(2) values.
基金L.T.-R.enjoys a“Post-MIR”predoctoral research grant from the Health Research Institute La Fe(IISLAFE).I.L.-C.and A.P.-G.enjoy Rio Hortega predoctoral grants from the Instituto de Investigación en Salud Carlos III(Ministry of Science,Spain).
文摘Extreme preterm infants(<28 weeks'gestation)often require positive pressure ventilation with oxygen during postnatal stabilization in the delivery room.To date,optimal inspired fraction of oxygen(FiO_(2))still represents a conundrum in newborn care oscillating between higher(>60%)and lower(<30%)initial FiO_(2).Recent evidence and meta-analyses have underscored the predictive value for survival and/or relevant clinical outcomes of the Apgar score and the achievement of arterial oxygen saturation measured by pulse oximetry≥85%at 5 minutes after birth.New clinical trials comparing higher versus lower initial FiO_(2)have been launched aiming to optimize postnatal stabilization of extreme preterm while avoiding adverse effects of hypoxemia or hyperoxemia.
