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Randomized Trial of 21% versus 100% Oxygen during Chest Compressions Followed by Gradual versus Abrupt Oxygen Titration after Return of Spontaneous Circulation in Neonatal Lambs

The combination of perinatal acidemia with postnatal hyperoxia is associated with a higher incidence of hypoxic-ischemic encephalopathy (HIE) in newborn infants. In neonatal cardiac arrest, current International Liaison Committee on Resuscitation (ILCOR) and Neonatal Resuscitation Program (NRP) guid...

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Autores principales: Sankaran, Deepika, Giusto, Evan M., Lesneski, Amy L., Hardie, Morgan E., Joudi, Houssam M., Lane, Emily C. A., Hammitt, Victoria L., Tully, Kirstie C., Vali, Payam, Lakshminrusimha, Satyan
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10047452/
https://www.ncbi.nlm.nih.gov/pubmed/36980132
http://dx.doi.org/10.3390/children10030575
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author Sankaran, Deepika
Giusto, Evan M.
Lesneski, Amy L.
Hardie, Morgan E.
Joudi, Houssam M.
Lane, Emily C. A.
Hammitt, Victoria L.
Tully, Kirstie C.
Vali, Payam
Lakshminrusimha, Satyan
author_facet Sankaran, Deepika
Giusto, Evan M.
Lesneski, Amy L.
Hardie, Morgan E.
Joudi, Houssam M.
Lane, Emily C. A.
Hammitt, Victoria L.
Tully, Kirstie C.
Vali, Payam
Lakshminrusimha, Satyan
author_sort Sankaran, Deepika
collection PubMed
description The combination of perinatal acidemia with postnatal hyperoxia is associated with a higher incidence of hypoxic-ischemic encephalopathy (HIE) in newborn infants. In neonatal cardiac arrest, current International Liaison Committee on Resuscitation (ILCOR) and Neonatal Resuscitation Program (NRP) guidelines recommend increasing inspired O(2) to 100% during chest compressions (CC). Following the return of spontaneous circulation (ROSC), gradual weaning from 100% O(2) based on pulse oximetry (SpO(2)) can be associated with hyperoxia and risk for cerebral tissue injury owing to oxidative stress. We hypothesize that compared to gradual weaning from 100% O(2) with titration based on preductal SpO(2), abrupt or rapid weaning of inspired O(2) to 21% after ROSC or use of 21% O(2) during CC followed by upward titration of inspired O(2) to achieve target SpO(2) after ROSC will limit hyperoxia after ROSC. Nineteen lambs were randomized before delivery and asphyxial arrest was induced by umbilical cord occlusion. There was no difference in oxygenation during chest compressions between the three groups. Gradual weaning of inspired O(2) from 100% O(2) after ROSC resulted in supraphysiological PaO(2) and higher cerebral oxygen delivery compared to 21% O(2) during CC or 100% O(2) during CC followed by abrupt weaning to 21% O(2) after ROSC. The use of 21% O(2) during CC was associated with very low PaO(2) after ROSC and higher brain tissue lactic acid compared to other groups. Our findings support the current recommendations to use 100% O(2) during CC and additionally suggest the benefit of abrupt decrease in inspired oxygen to 21% O(2) after ROSC. Clinical studies are warranted to investigate optimal oxygen titration after chest compressions and ROSC during neonatal resuscitation.
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spelling pubmed-100474522023-03-29 Randomized Trial of 21% versus 100% Oxygen during Chest Compressions Followed by Gradual versus Abrupt Oxygen Titration after Return of Spontaneous Circulation in Neonatal Lambs Sankaran, Deepika Giusto, Evan M. Lesneski, Amy L. Hardie, Morgan E. Joudi, Houssam M. Lane, Emily C. A. Hammitt, Victoria L. Tully, Kirstie C. Vali, Payam Lakshminrusimha, Satyan Children (Basel) Article The combination of perinatal acidemia with postnatal hyperoxia is associated with a higher incidence of hypoxic-ischemic encephalopathy (HIE) in newborn infants. In neonatal cardiac arrest, current International Liaison Committee on Resuscitation (ILCOR) and Neonatal Resuscitation Program (NRP) guidelines recommend increasing inspired O(2) to 100% during chest compressions (CC). Following the return of spontaneous circulation (ROSC), gradual weaning from 100% O(2) based on pulse oximetry (SpO(2)) can be associated with hyperoxia and risk for cerebral tissue injury owing to oxidative stress. We hypothesize that compared to gradual weaning from 100% O(2) with titration based on preductal SpO(2), abrupt or rapid weaning of inspired O(2) to 21% after ROSC or use of 21% O(2) during CC followed by upward titration of inspired O(2) to achieve target SpO(2) after ROSC will limit hyperoxia after ROSC. Nineteen lambs were randomized before delivery and asphyxial arrest was induced by umbilical cord occlusion. There was no difference in oxygenation during chest compressions between the three groups. Gradual weaning of inspired O(2) from 100% O(2) after ROSC resulted in supraphysiological PaO(2) and higher cerebral oxygen delivery compared to 21% O(2) during CC or 100% O(2) during CC followed by abrupt weaning to 21% O(2) after ROSC. The use of 21% O(2) during CC was associated with very low PaO(2) after ROSC and higher brain tissue lactic acid compared to other groups. Our findings support the current recommendations to use 100% O(2) during CC and additionally suggest the benefit of abrupt decrease in inspired oxygen to 21% O(2) after ROSC. Clinical studies are warranted to investigate optimal oxygen titration after chest compressions and ROSC during neonatal resuscitation. MDPI 2023-03-17 /pmc/articles/PMC10047452/ /pubmed/36980132 http://dx.doi.org/10.3390/children10030575 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Sankaran, Deepika
Giusto, Evan M.
Lesneski, Amy L.
Hardie, Morgan E.
Joudi, Houssam M.
Lane, Emily C. A.
Hammitt, Victoria L.
Tully, Kirstie C.
Vali, Payam
Lakshminrusimha, Satyan
Randomized Trial of 21% versus 100% Oxygen during Chest Compressions Followed by Gradual versus Abrupt Oxygen Titration after Return of Spontaneous Circulation in Neonatal Lambs
title Randomized Trial of 21% versus 100% Oxygen during Chest Compressions Followed by Gradual versus Abrupt Oxygen Titration after Return of Spontaneous Circulation in Neonatal Lambs
title_full Randomized Trial of 21% versus 100% Oxygen during Chest Compressions Followed by Gradual versus Abrupt Oxygen Titration after Return of Spontaneous Circulation in Neonatal Lambs
title_fullStr Randomized Trial of 21% versus 100% Oxygen during Chest Compressions Followed by Gradual versus Abrupt Oxygen Titration after Return of Spontaneous Circulation in Neonatal Lambs
title_full_unstemmed Randomized Trial of 21% versus 100% Oxygen during Chest Compressions Followed by Gradual versus Abrupt Oxygen Titration after Return of Spontaneous Circulation in Neonatal Lambs
title_short Randomized Trial of 21% versus 100% Oxygen during Chest Compressions Followed by Gradual versus Abrupt Oxygen Titration after Return of Spontaneous Circulation in Neonatal Lambs
title_sort randomized trial of 21% versus 100% oxygen during chest compressions followed by gradual versus abrupt oxygen titration after return of spontaneous circulation in neonatal lambs
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10047452/
https://www.ncbi.nlm.nih.gov/pubmed/36980132
http://dx.doi.org/10.3390/children10030575
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