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PubMed1999

A new measuring device for non-invasive determination of oxygen partial pressure and oxygen conductance of the skin and other tissues.

About fifty percent of the oxygen consumption of the skin is supplied by diffusion through the surface. This portion of the skin oxygen supply becomes of high importance in case of arterial occlusion. The oxygen permeation coefficient (P) of the upper layers and the oxygen pressure field within the skin determine the diffusive oxygen uptake from the outside. To our knowledge, the permeation coefficient (P) until now was only estimated by indirect methods of little practicability (Baumberger et al., 1951; Eberhard et al., 1978). An oxygen partial pressure of the skin is conventionally measured by modified CLARK type electrodes. A disadvantage of this so-called transcutaneous electrode is its oxygen consumption and the fixed coupling of the consumption with the oxygen pressure to be determined. Therefore the measurement always induces a systematic error (the so-called stirring effect) which depends, among other factors, on the oxygen availability of the skin under the electrode. The new device combines a consumption-free oxygen partial pressure detector on the basis of luminescence quenching by oxygen with an independently working specific oxygen consumer realized by an active galvanic chain (silver-lead element). The chain permits setting any oxygen mass flow (mO2) in a certain range by varying the electrode current choosing different resistors within the electrical circuit. According to the diffusion law, the surface oxygen pressure (ePO2) being measured is a linear function of the oxygen flow (mO2) directed to the cathode: ePO2 identical to -(1/P).(mO2/A) + icPO2; A: area under the cathode. The intracutaneous oxygen partial pressure (icPO2) is a virtual quantity defined by the equation given. Only by using an active electrode different oxygen mass flows can be set and so the oxygen conductance of the upper skin layers can be assessed. First experiments on human skin in the gluteal region of an adult delivered an estimated value of the permeation coefficient (P): 2.2.10(-5) ml O2 (STPD)/(atm.s.cm2) at 42 degrees C skin surface temperature; the intracutaneous partial pressure obtained was 5.5 kPa (41 mmHg) (STPD: "standard temperature pressure dry" conditions of the gas). At 42 degrees C skin temperature no burning occurs. The determined O2-conductance is in the same range as estimated formerly (see above). The intracutaneous oxygen partial pressure determined seems to be a realistic value of the tissue at 42 degrees C. By in vitro measurements with technical membranes the new device and procedure was validated giving precise values of the oxygen conductance. Hence the new method may be used for calibration of the oxygen flux optode (Holst et al., 1993). The O2-permeation coefficient (P) could be an important parameter for evaluating dermatological applications (which attempt to increase P) in the treatment of local dermal oxygen deficiency. The intracutaneous oxygen partial pressure found is a reasonable value for a surface temperature of 42 degrees. Because of the independence of the O2-partial pressure determined and the O2-consumption the new device exhibits no stirring effect and it provides more insight into the limitations of conventional transcutaneous oxygen measurement.

Adult↗
PubMed1993

Cerebral blood flow and oxygen consumption in acute brain injury with acute anemia: an alternative for the cerebral metabolic rate of oxygen consumption?

OBJECTIVE: To comparatively evaluate cerebral metabolic rate of oxygen consumption and a modification of it, cerebral consumption of oxygen, in patients with acute brain injury with acute anemia. DESIGN: Prospective, observational study. SETTING: Neuroscience intensive care unit (ICU) of a university hospital. PATIENTS: Adults (n = 62) with acute brain trauma, undergoing serial 133xenon studies of regional cerebral blood flow and global cerebral oxygen metabolism, along with other routine monitoring techniques. MEASUREMENTS AND MAIN RESULTS: In 173 combined studies of blood flow and oxygen metabolism, in the presence of spontaneous decreases in hemoglobin, cerebral metabolic rate of oxygen consumption and cerebral consumption of oxygen were comparatively evaluated in three groups with different hemoglobin levels. Cerebral metabolic rate of oxygen consumption was calculated as the product of averaged regional cerebral blood flow and arterio-jugular oxygen content difference, while cerebral consumption of oxygen was calculated as the product of averaged regional cerebral blood flow and the arterio-jugular oxyhemoglobin saturation difference, i.e., cerebral extraction of oxygen. Results indicated that a decrease of hemoglobin content is paralleled by a decrease in cerebral metabolic rate of oxygen consumption, even though the level of consciousness (coma score) is essentially unchanged across three hemoglobin groups. On the other hand, cerebral consumption of oxygen does not follow the decrease in hemoglobin and cerebral metabolic rate of oxygen consumption, thus demonstrating better stability to changing hemoglobin content. The low cerebral metabolic rate of oxygen consumption is due to a decrease in arterio-jugular oxygen content difference in anemia, while the cerebral extraction of oxygen does not follow the trend of the arterio-jugular oxygen content difference. CONCLUSIONS: In acute brain trauma with acute anemia, calculated arterio-jugular oxygen content difference and cerebral metabolic rate of oxygen consumption tend to be progressively lower, depending on the extent of anemia, which is in disagreement with coma scores. These changes in hemoglobin tend to have an inverse influence on cerebral consumption of oxygen, which, therefore, constitutes an alternative and independent measure of cerebral oxygen and independent measure of cerebral oxygen consumption under these limiting circumstances.

Acute Disease↗
PubMed1993

The effect on fetal arteriolar oxygen saturation resulting from giving oxygen to the mother measured by pulse oximetry.

OBJECTIVE: To determine if pulse oximetry could detect any changes in fetal arteriolar oxygen saturation resulting from maternal administration of oxygen. DESIGN: A prospective study comparing study comparing the fetal pulse oximetry reading before and after giving 27% and 100% oxygen to the mother. The data were collected using an experimental pulse oximeter and a sensor specifically adapted to cope with the problems of fetal pulse oximetry. SETTING: Labour ward, St. Jame's University Hospital, Leeds University, UK. SUBJECTS: Twelve fetuses presenting by the vertex in normal uncomplicated labour. MAIN OUTCOME MEASURES: The change in fetal arteriolar oxygen saturation recorded by the pulse oximeter in response to oxygen administration to the mother. RESULTS: Twenty-seven percent oxygen increased the average fetal arteriolar oxygen saturation by 7.5%, the effect being reversed when the oxygen was withdrawn. One hundred percent oxygen increased fetal arteriolar oxygen saturation by 11% and when the oxygen was withdrawn oxygen saturation dropped by 10%. One hundred percent inspired maternal oxygen was more effective than 27%. The gradient of the fetal oxygen regression slope is steeper with 100% oxygen than 27% and it is steeper when oxygen is given compared to when it is withdrawn. This suggests that the fetus responds to the new placental oxygen gradient by accepting oxygen more rapidly than it gives it up. Using a quadratic regression model, it took 9 min for fetal oxygen saturation to reach its maximum value after giving the mother oxygen. CONCLUSION: This study confirms that a pulse oximeter is able to measure an increase in fetal arteriolar oxygen saturation when oxygen is administered to the mother.

Arterioles↗
PubMed1999

Oxygen deficit and slow oxygen component relationships between intermittent and continuous exercise.

Above the lactate/ventilatory threshold, prolonged steady-state exercise produces a secondary rise in oxygen uptake, the slow oxygen component. The slow oxygen component 'represents an additional energetic requirement' above steady state; however, a lack of consensus on how to measure anaerobic energy expenditure makes it difficult to ascertain how or if anaerobic metabolism also contributes to energy expenditure. The aim of this study was to establish if the slow oxygen component is the sole source of 'additional energetic requirements' during steady-state exercise above the lactate/ventilatory threshold. Ten participants completed an 8 min continuous treadmill run and four 2 min intermittent runs at a speed of 2.67 m x s(-1) and a grade located halfway between the ventilatory threshold and maximum oxygen uptake. Each participant performed five submaximal runs below the ventilatory threshold to estimate energy expenditure at this exercise intensity. Both the oxygen deficit and the slow oxygen component were derived from this estimated energy expenditure. Oxygen equivalent units (ml O2) were used for comparison. The slow oxygen component for the 8 min continuous run began 2-4 min into exercise (73 ml O2), rose quickly at 4 6 min (178 ml O2) and declined at 6-8 min (96 ml O2). For the intermittent 2 min runs, a decrease in the oxygen deficit was seen between the first and second trial (-273 ml O2), indicating a larger aerobic energy expenditure contribution. The oxygen deficit began to increase when the third and fourth trials (+62 ml O2) were compared, suggesting a larger contribution to anaerobic energy expenditure. At the end of exercise, the intermittent oxygen deficit and continuous slow oxygen component revealed inverse associations; that is, in participants with large slow oxygen component contributions, the oxygen deficit was minimal; participants who had an increased oxygen deficit had smaller slow oxygen component contributions. The results suggest larger aerobic contributions to 'additional energetic requirements' when the slow oxygen component itself is large; however, smaller slow oxygen components do not necessarily indicate a lower energy expenditure. Individuals with smaller slow oxygen components during continuous exercise have larger oxygen deficits during intermittent exercise; thus an anaerobic contribution to the 'additional energetic requirement' may exist.

Adult↗
PubMed1995

Tissue oxygenation with graded dissolved oxygen delivery during cardiopulmonary bypass.

BACKGROUND: Intravascular perfluorochemical emulsions together with a high oxygen tension may increase the delivery of dissolved oxygen to useful levels. The hypothesis of this study is that increasing the dissolved oxygen content of blood with incremental doses of a perfluorochemical emulsion improves tissue oxygenation during cardiopulmonary bypass in a dose-related fashion. METHODS AND RESULTS: Oxygen utilization was studied in a profoundly anemic canine model of hypothermic cardiopulmonary bypass. Forty-two dogs underwent normovolemic hemodilution to a hematocrit of 15.8% +/- 0.6% (mean +/- standard error of the mean). Cardiopulmonary bypass was begun and resulted in a hematocrit of 9.4% +/- 0.6%. A standard priming solution was used in the control group (n = 12), and the test groups received 1.35 gm perfluorochemical.kg-1 (n = 10 dogs), 2.7 gm perfluorochemical.kg-1 (n = 10 dogs), or 5.4 gm perfluorochemical.kg-1 (n = 10 dogs) through the venous return cannula. Each animal underwent a series of randomized pump flows (0.25, 0.5, 1.0, 1.5, 2.0, and 3.0 L.min-1.m-2) at 32 degrees C. After the randomized flows were completed at 32 degrees C, the temperature was raised to 38 degrees C and cardiopulmonary bypass was discontinued. Mortality from cardiac failure on separation from cardiopulmonary bypass was 42% in the control group and 20% in perfluorochemical-treated groups. The mean perfluorochemical dose was higher in survivors than in nonsurvivors (2.9 +/- 0.4 versus 1.3 +/- 0.5 gm perfluorochemical.kg-1; p < 0.05). No differences in oxygen consumption or transbody lactate gradient were found between groups during cardiopulmonary bypass. Analysis of mixed venous oxygen tension (a surrogate measure for tissue oxygenation) as a function of cardiopulmonary bypass flow normalized to body surface area showed that the control group had significantly lower mixed venous oxygen tension (p < 0.05) than the perfluorochemical emulsion-treated groups. Furthermore, the differences were related to the perfluorochemical emulsion dose. These differences in mixed venous oxygen tension continued after termination of cardiopulmonary bypass. The coronary sinus oxygen tension and cardiac arterial-venous oxygen content differences during and after cardiopulmonary bypass were similar among the control and perfluorochemical emulsion-treated animals. Dissolved oxygen consumption during and after cardiopulmonary bypass was calculated. Dissolved oxygen consumption increased in the perfluorochemical-treated animals in a perfluorochemical dose-related manner and was significantly higher in perfluorochemical-treated animals than in the control animals (p < 0.05). CONCLUSIONS: Graded increases in mixed venous oxygen tension during cardiopulmonary bypass were observed in response to graded increases in the dissolved oxygen delivery. These data suggest that enhancing oxygenation with perfluorochemical-dissolved oxygen is an effective temporary substitute for the use of hemoglobin-bound oxygen during cardiopulmonary bypass. Perfluorochemical-dissolved oxygen may be particularly beneficial in the setting of multiple hypoxic stresses.

Analysis of Variance↗
PubMed1996

Cardiac oxygenation by extracorporeal membrane oxygenation in exteriorized fetal lambs.

OBJECTIVE: The purpose of this study was to determine the degree of cardiac oxygenation produced by different routes of extracorporeal membrane oxygenation in fetal lambs submerged in warm saline solution. STUDY DESIGN: Seven fetal lambs ranging in age from 113 to 133 days of gestation were delivered by cesarean section and oxygenated with extracorporeal membrane oxygenation. To maintain the patency of the ductus arteriosus, prostaglandin E1 was continuously infused intravenously to the fetus. Initially the extracorporeal membrane oxygenation route was from the right atrium to the carotid artery. Then the extracorporeal membrane oxygenation route was changed to flow from the right atrium to the umbilical vein. The fetus was kept in a warm saline solution bath, and the fetal circulation was maintained. Extracorporeal membrane oxygenation flow ranged between 100 and 200 ml/min throughout the experiment. Simultaneous blood samples were taken during both types of extracorporeal membrane oxygenation from the following points in the fetal circulation: premembrane (least oxygenated blood leaving the fetus from the right atrium), postmembrane (oxygenated blood returning to the fetus), the carotid artery, and the left ventricle. The respiratory gases and pH of each sample were measured. Six fetuses received nonradioactive colored microspheres injected into the oxygenated blood returning to the fetus flow before returning to the fetuses during both types of extracorporeal membrane oxygenation. After the animals were killed, microspheres were counted in the myocardium separately taken from the right and left atria and the right and left ventricles to determine cardiac blood flow. RESULTS: During right atrium to carotid artery extracorporeal membrane oxygenation, left ventricle PO2 remained low as postmembrane PO2 increased; these values were not significantly correlated (r = 0.234, p = 0.61). During right atrium to umbilical vein extracorporeal membrane oxygenation, left ventricle and postmembrane PO2 exhibited a significant positive correlation (r = 0.855, p = 0.014). When the extracorporeal membrane oxygenation route was switched from the right atrium to carotid artery to the right atrium to umbilical vein, there was a significant increase in left ventricle PO2 and a decrease in left ventricle PCO2, whereas the respiratory gases and pH remained unchanged at other sites in the circulation. Microsphere counts were consistently higher during right atrium to umbilical vein extracorporeal membrane oxygenation than during right atrium to carotid artery extracorporeal membrane oxygenation in all four samples from different parts of myocardium (p < 0.001 by paired t test). CONCLUSION: More effective cardiac oxygenation is provided by right atrium to umbilical vein extracorporeal membrane oxygenation than by right atrium to carotid artery extracorporeal membrane oxygenation.

Animals↗
PubMed2007

A novel method to oxygenate intraocular irrigation fluids with an in-line oxygenator.

PURPOSE: We describe a novel method to oxygenate intraocular irrigation solutions involving an in-line oxygenator. METHODS: Either lactated Ringer (LR) solution or balanced salt solution (BSS) was oxygenated with the FE390 Stainless In-line Oxygenation Assembly (Beer, Beer, and More Beer, Concord, CA). After running a 100-mL of solution through the in-line oxygenator, oxygen saturation was measured with a dissolved oxygen meter. A control experiment involving the oxygenator without oxygen perfusion was performed. Paired t-tests were used to compare oxygen saturation changes before and after oxygenation. RESULTS: In comparison with the original BSS, there was an increase in oxygen saturation of 162 +/- 47% (n = 40; P < 0.05). Without oxygenation perfusion, there was only a 24 +/- 14% (n = 40) increase in oxygen levels in BSS, which was significantly lower than that in treated BSS (P < 0.05). In comparison with the original LR solution, there was an increase in oxygen saturation of 208 +/- 21% (n = 40; P < 0.05). Without oxygenation perfusion, there was only a 21 +/- 9% (n = 40) gain in oxygen saturation in the control LR solution, which was statistically lower as well (P < 0.05). CONCLUSION: The in-line oxygenator is an efficient tool for oxygenating BSS and LR solution. It represents a potential efficient and convenient method to oxygenate irrigating solutions for vitreoretinal surgeries.

Acetates↗
PubMed1997

The S factor--a new derived hemodynamic oxygenation parameter--a useful tool for simplified mathematical modeling of global problems of oxygen transport.

We describe a new derived hemodynamic oxygenation parameter, the S factor (S). The factor is based on oxygen delivery and oxygen consumption and can range from -3 to 1. It allows simplified mathematical modeling of clinical problems of oxygen transport and can be applied to many clinical situations. A new hemodynamic oxygenation parameter, the S factor (S), is introduced as an aid to mathematical modeling. It is defined as follows: [formula: see text] (DO2 = oxygen delivery, VO2 = oxygen consumption) S can theoretically vary from -3 (DO2 = VO2) to +1 (VO2 = 0). When DO2/VO2 = 4 (ie. OER = 0.25), S = 0. An S < 0 implies utilization of reserve oxygen transport capacity. An S > 0 implies increased oxygen delivery in relation to oxygen consumption (ie. "shunted oxygen delivery"). By algebraic manipulation and substitution of the components of DO2 into Equation 1: DO2 = Q x Ca x 10 DO2 = Q [(Hb)(Sat)(1.36) + PaO2(.0031)] 10 (2) the following equations can be derived: [formula: see text] [formula: see text] Ca - Cv (Ca = arterial content, Cv = venous content) can be determined by substituting components of oxygen consumption: VO2 = Q (Ca - Cv) x 10 (5) into equation 1 and solving for Ca - Cv. [formula: see text] Equation 6 can be simplified to: [formula: see text] A previously defined relationship between mixed venous PO2 (PvO2) and DO2/VO2 (where calculated P50 is 26.6 +/- 1.0) can be used to modify S in a clinically relevant manner. PvO2 = 5.44D O2/VO2 + 18.16 (8) The relationship between S and PvO2 can be defined by substituting Equation 4 into Equation 1 and solving for PvO2 PvO2 = [21.76/(1-S)] + 18.16 (9) As an example, at a PvO2 of 28 torr (anaerobic threshold), S = -1.2. The relationship between PvO2 and S is shown in Figure 1. S, which can also be defined as 1-4(VO2/DO2) or 1-4(OER), is a useful tool for mathematical modeling of global problems of oxygen transport because the previously derived equations with the S value allow the components of oxygen transport to be interrelated in a clinically relevant manner. Additional advantages of using S in mathematical modeling are: 1. Conceptually it 'fits' in that in regards to the sign (+ or -), as a -S implies utilization of reserve oxygen transport capacity and a +S implies wasted or excess oxygen delivery (shunted). 2. These concepts are easily quantified using the S factor. 3. It 'spreads out' the difference between values for parameters (OER or S) integrating components of oxygen transport, ie. in the 'normal state' regarding oxygen transport, OER = 0.25 and S = 0. At the anaerobic threshold (PvO2 = 28 torr), OER = 0.55 and S = -1.2. Thus, the change in OER from 'normal state' to anaerobic threshold is 0.3 (0.55-0.25) and the change in S is 1.2. This represents a four-fold increase. Four examples of mathematical modeling of global problems of oxygen transport using the S factor are described below.

Anaerobiosis↗
PubMed1996

Effects of oxygen, positive end-expiratory pressure, and carbon dioxide on oxygen delivery in an animal model of the univentricular heart.

OBJECTIVE: Respiratory manipulations are a mainstay of therapy for infants with a univentricular heart, but until recently little experimental information has been available to guide their use. We used an animal model of a univentricular heart to characterize the physiologic effects of a number of commonly used ventilatory treatments, including altering inspired oxygen tension, adding positive end-expiratory pressure, and adding supplemental carbon dioxide to the ventilator circuit. RESULTS: Lowering inspired oxygen tension decreased the ratio of pulmonary to systemic flow. This ratio was 1.29 +/- 0.08 at an inspired oxygen tension of 100%, 0.61 +/- 0.09 at an inspired oxygen tension of 21%, and 0.42 +/- 0.09 at an inspired oxygen tension of 15% (p < 0.05 compared with an inspired oxygen tension of 100% and a positive end-expiratory pressure of 0 cm H2O). High-concentration supplemental carbon dioxide (carbon dioxide tension of 80 to 90 mm Hg) added to the ventilator circuit decreased inspired oxygen tension from 1.29 +/- 0.11 to 0.42 +/- 0.12 (p < 0.05 compared with baseline). A mixture of 95% oxygen and 5% carbon dioxide (carbon dioxide tension of 50 to 60 mm Hg) did not decrease the pulmonary/systemic flow ratio significantly. All three types of interventions influenced systemic oxygen delivery, which was a function of the pulmonary/systemic flow ratio. As the pulmonary/systemic flow ratio decreased from initially high levels (greater than 1), oxygen delivery first increased and reached an optimum at a flow ratio slightly less than 1. As the pulmonary/systemic flow ratio decreased further, below 0.7, oxygen delivery decreased. The ability of systemic arterial and venous oxygen saturations to predict the pulmonary/systemic flow ratio was examined. Venous oxygen saturation correlated well with both pulmonary/systemic flow ratio and systemic oxygen delivery, whereas arterial oxygen saturation did not accurately predict either pulmonary/systemic flow ratio or oxygen delivery. CONCLUSION: This model demonstrated the value of estimating the pulmonary/systemic flow ratio before initiating therapy. When the initial ratio was greater than about 0.7, interventions that decreased the ratio increased oxygen delivery and were beneficial. When the initial pulmonary/systemic flow ratio was below 0.7, interventions that decreased the ratio decreased oxygen delivery and were detrimental. We conclude by presenting a framework to guide therapy based on the combination of arterial and venous oxygen saturations and the estimate of the pulmonary/systemic flow ratio that they provide.

Animals↗
PubMed2003

Impact of oxygen addition during enological fermentation on sterol contents in yeast lees and their reactivity towards oxygen.

During enological fermentations, superfluous oxygen consumption by yeast cells is observed. The superfluous oxygen consumed by the yeast cells is mainly related to the operation of non-respiratory oxygen consumption pathways resulting in an overall decrease in the total sterol fraction in yeast. On the other hand, yeast lees remaining at the end of alcoholic fermentations exhibit specific oxygen utilization rates ranging from 1 to 4 micromol O2 h- 10(-10) cells from the second to the thirteenth month of wine aging. This oxygen consumption capacity of yeast lees was independent of residual cell viability. In this study, we investigated the potential relationship between the oxygen added to commercial yeast strains during enological fermentation and the capacity of the corresponding yeast lees to interact with oxygen. Additions of low (7 mg l(-)) and excess (37 mg l(-1)) amounts of oxygen at the end of the cell growth phase were compared in terms of repercussions on the oxygen consumption activity of the corresponding yeast lees. As expected, the superfluous oxygen consumption by yeast cells during fermentation had a positive influence on the fermentation kinetics and increased cell biomass formation. Oxygen consumption rates and the total capacity of oxygen consumption by the corresponding yeast lees clearly decreased when oxygen was added during fermentation. This marked decrease in yeast lees reactivity towards oxygen was concomitantly related to an increase in ergosterol synthesis and to oxygen-dependent sterol degradation. Such degradation occurred when oxygen was added in excess. Therefore, oxygenation control during fermentation appears to be a potential way to optimize both the fermentation kinetics and control yeast lees reactivity towards oxygen. For practical applications, oxygenation control during alcoholic fermentation may be considered as a general tool for decreasing the highly reductive effect of yeast lees during wine aging.

Journal Article↗
PubMed1996

Oxygenation in fetal lambs supported by extrauterine right atrium to artery extracorporeal membrane oxygenation.

OBJECTIVE: Our purpose was to determine the adequacy of oxygenation, particularly cranial and cardiac oxygenation, in exteriorized fetal lambs on right atrium to artery extracorporeal membrane oxygenation. STUDY DESIGN: Thirteen fetal lambs were placed on right atrium to artery extracorporeal membrane oxygenation between the gestational ages of 113 and 133 days. Various PO2 and oxygen saturation (SO2) values were obtained by varying the oxygen concentrations at the oxygenator membrane. Blood gases, pH, and SO2 were observed on samples taken before and after membrane oxygenation from the left ventricle and through the cranial carotid arterial catheter. These were compared with control values obtained before the cessation of umbilical circulation. Fetal coronary oxygenation was represented by left ventricle PO2 and SO2 and cranial oxygen by carotid artery PO2 and SO2. RESULTS: We classified oxygen saturation as low, medium, and high on the basis of the level of postmembrane SO2. Carotid artery cranial oxygenation in the low SO2 group was equivalent to control values, but that in the medium and high SO2 groups was significantly higher than in the control group. Left ventricle oxygenation was consistently lower than cranial oxygenation in any SO2 group. In the low group left ventricle oxygenation was significantly lower than the control values. CONCLUSIONS: Right atrium to artery extracorporeal membrane oxygenation appears sufficient to oxygenate the fetal cranial circulation but may be inadequate for the efficient distribution of oxygenated blood into the left ventricle and thus the coronary circulation.

Animals↗
PubMed1998

Do patients using long-term liquid oxygen differ from those on traditional treatment with oxygen concentrators and/or compressed gas cylinders? A comparison of two national registers.

Long-term oxygen therapy (LTOT) in patients with chronic hypoxaemia is an expanding field. Traditional stationary oxygen, with and without portable compressed gas cylinders, and portable liquid oxygen equipment is available today. No official guidelines exist for the prescription of liquid oxygen vs traditional oxygen supply in LTOT, although it is generally though that patients receiving liquid oxygen are younger and less seriously affected. The authors tested this hypothesis by comparing register data from two national Scandinavian registers of patients on LTOT in the same time period; one including all the patients on traditional oxygen treatment alone, e.g. concentrators and compressed gas cylinders (n = 1039), the other including all the patients using portable liquid oxygen alone (n = 117). About 80% of the patients in both groups suffered from chrome obstructive pulmonary disease. Younger patients were found in the liquid oxygen group (P < 0.004), but with clinically slightly worse blood gas derangement (mostly statistically significant). They had higher frequency of previous or present oedema (P < 0.0001), and there were more smokers in this group (P < 0.0001). No significant differences were seen with respect to sex distribution or oxygen delivery systems. Higher oxygen dose and longer daily oxygen treatment (P < 0.0001) were prescribed for the liquid oxygen patients compared with the patients on traditional oxygen with statistically higher oxygen tension during the prescribed treatment. A slight further increase in PaCO2 was seen in both groups during oxygen treatment, of doubtful significance. Compared with patients on traditional oxygen, liquid oxygen thus appears to be prescribed for younger patients, independent of clinical status or blood gas levels.

Age Distribution↗
PubMed2004

Assessments for oxygen therapy in COPD: are we under correcting arterial oxygen tensions?

There is little data about the use of different oxygen sources during assessment for long-term oxygen therapy (LTOT) and how this impacts upon blood oxygen tensions and prescribed flow rates. Patients with chronic obstructive pulmonary disease (COPD), n=30, had assessments for LTOT using both an oxygen-concentrator and piped hospital oxygen (wall-oxygen) as supply sources. In addition, a random survey of 64 hospitals was conducted to determine what source of oxygen supply was used during assessments. Wall-oxygen was used by 89% of hospitals to perform assessments. During assessments, the median oxygen flow required to achieve an arterial oxygen tension (Pa,O2) >8 kPa was significantly greater for an oxygen-concentrator than for wall-oxygen, with a median difference (range) in flow of 1 (0-3) L. This difference was most likely in those with an forced expiratory volume <30% of predicted. At an oxygen flow of 1 L.min(-1), the mean P(a,O2) using an oxygen-concentrator was significantly lower than that of the wall-oxygen value, with a difference of 1.32+/-1.19 kPa (mean+/-SD). The common practice of using wall-oxygen to perform assessments significantly underestimates the required oxygen-concentrator flow rate. This may have implications for the long-term effect of domiciliary oxygen therapy.

Blood Gas Analysis↗
PubMed2002

Supplemental oxygen use in ischemic stroke patients: does utilization correspond to need for oxygen therapy?

BACKGROUND: In 1994, the American Heart Association Stroke Council concluded that there were no data to support the routine use of supplemental oxygen in patients who had a stroke. More recently, supplemental oxygen has been suggested to be potentially detrimental. The purpose of this study was to determine the extent of oxygen use in ischemic stroke patients and whether patients receiving oxygen had indications for its use. METHODS: A literature search was performed to generate a comprehensive list of explicit criteria for supplemental oxygen use. When the literature disagreed, the criteria were included in the list to overestimate rather than underestimate the justification for oxygen use. A retrospective chart review of consecutive, nonintubated, ischemic stroke patients admitted to a university hospital was performed. Statistical tests and logistic regression models were constructed to identify the presence of unjustified oxygen use within the sample. Hospital charges were used to quantify opportunities for resource conservation. RESULTS: A total of 167 patient charts were reviewed yielding a total of 600 inpatient days abstracted. One hundred two patients (61.1%) received oxygen during some portion of their hospitalization. Of the 322 days that patients received oxygen, 147 (45.6%) met at least 1 criterion for oxygen use. Of the 278 days that patients did not receive oxygen, 69 (24.8%) met at least 1 of the criteria for oxygen use. There were 384 days for which no criteria were met. Of these, a patient still received oxygen 45.6% of the time (175 days). Factors associated with oxygen use included the presence of at least 1 justifying criteria as well as increasing age and male sex. Withholding oxygen from those not medically justified by the criteria could produce resource savings of roughly 45%. CONCLUSIONS: Using a literature-based list of criteria for supplemental oxygen use, only 45.6% of days of oxygen use were justified in our ischemic stroke population. This study demonstrates that oxygen therapy is commonly given to ischemic stroke patients without clear indication, and opportunities exist for substantial resource conservation.

Age Factors↗
PubMed1981

Oxygen delivery in acute exacerbation of chronic obstructive pulmonary disease. Effects of controlled oxygen therapy.

The hemodynamic response to controlled oxygen administration was investigated in 35 patients who presented with acute decompensation of chronic obstructive pulmonary disease. Gasometric and hemodynamic data were successively measured under inspiratory fractions in oxygen of 0.21 (room air) and 0.28. Response to oxygen therapy was characterized by a decrease in cardiac output and an increase in oxygen delivery because of a sharp increase in arterial oxygen content. The coefficient of oxygen delivery (oxygen delivery/oxygen consumption) increased in each patient. All these changes were highly significant (p les than 0.001). Somewhat unexpectedly, there was no change in pulmonary artery pressures, so that pulmonary arteriolar resistance even increased (p less than 0.05). Further analysis individualized 2 types of hemodynamic response to oxygen therapy. In 15 patients who presented with severe hypoxemia, oxygen therapy resulted in a significant increase in oxygen delivery without change in cardiac output. By contrast, in 20 patients with moderate hypoxemia, oxygen therapy induced a significant decrease in cardiac output (p less than 0.001) without change in oxygen delivery. Patients in whom cardiac output was unaffected by oxygen administration presented with a lower mixed venous oxygen tension (less than 35 mmHg) and a lower coefficient of oxygen delivery (less than 3.5). This study demonstrated that oxygen therapy does not always increase oxygen delivery in acute decompensation of chronic obstructive pulmonary disease.

Adult↗
PubMed1987

Theory and development of fluorescence-based optochemical oxygen sensors: oxygen optodes.

As the preceding considerations concerning the physical and technical features of oxygen optodes have demonstrated, fluorescence-based optochemical oxygen sensors possess certain advantages and peculiarities compared to conventionally applied electrochemical sensors such as polarographic oxygen electrodes. First, in contrast to oxygen electrodes, oxygen measurements with oxygen optodes do not suffer from distortions caused by the reference electrodes. In addition, because of the polarographic process, platinum electrodes continuously consume oxygen, which falsifies the results, especially when small sample volumes or long-term measurements, or both, are involved, whereas the sensor layer of oxygen optodes must only be equilibrated. Moreover, the surface of the platinum wire has to be catalytically clean in order to obtain a plateau of the polarogram and, consequently, to achieve a low rest current at zero PO2. Unfortunately, the demand for catalytically clean platinum surfaces turns out to be rather critical, since surface contamination occurs even with membranized electrodes, resulting in the well-known phenomenon of "electrode poisoning." The question of the specificity of oxygen electrodes also must be considered. In this context, CO2 and halothane may interfere with oxygen measurements, whereas fluorescence quenching is unaffected by CO2 and halothane affects the measurements only slightly, depending on the special indicator used. Furthermore, because of the flow dependence, oxygen measurements with the oxygen electrode show a distinct "stirring effect" caused by the turbulence in front of the electrode, which disturbs the diffusion field. Because of the completely different physical principle of fluorescence optical sensors, such influences are not observed with oxygen optodes. In addition, isolation and shielding of electrical circuits found in electrodes are not necessary for optodes. Furthermore, the sensitivity of oxygen optodes can be tuned to the desired range of PO2 values, resulting in a higher resolution. Use of suitable polymer alloys as indicator matrices can even enhance oxygen sensitivity; therefore, the application of optodes for trace analysis of oxygen might be possible, especially with regard to the application of highly oxygen-sensitive phosphorescent indicators. Finally, owing to the reversibility of fluorescence quenching, monitoring of oxygen by fluorescence optical sensors allows a continuous and remote control of biomedical parameters as well as regulation of biotechnological processes.(ABSTRACT TRUNCATED AT 400 WORDS)

Blood Gas Analysis↗
PubMed1989

Independent measurement of oxygen consumption and oxygen delivery.

This experiment investigated the relationship between oxygen consumption and oxygen delivery (cardiac output X arterial oxygen content) in an acute canine model. Previous studies investigating this relationship have largely utilized methods in which oxygen consumption and oxygen delivery were each calculated using the same measured variables resulting in mathematical coupling of variables. In this study, oxygen consumption was measured directly by closed-circuit spirometry. Oxygen delivery was independently controlled using right atrial bypass. These techniques assured that the values for oxygen consumption and oxygen delivery were derived entirely independently. In our study using 11 dogs, we found that oxygen consumption was constant and independent of oxygen delivery at oxygen delivery levels greater than 8.0 cc/kg/min (normal canine oxygen delivery 20-25 cc/kg/min). Oxygen consumption was linearly related to oxygen delivery at oxygen delivery levels less than or equal to 8.0 cc/kg/min. Below this critical level of oxygen delivery, animals were more acidotic and hypotensive than at higher delivery levels.

Animals↗
PubMed2000

Incidence of nocturnal desaturation while breathing oxygen in COPD patients undergoing long-term oxygen therapy.

STUDY OBJECTIVE: It is suggested that oxygen flow be increased by 1 L/min during sleep in COPD patients undergoing long-term oxygen therapy (LTOT) in order to avoid nocturnal desaturations. The purpose of this study was to investigate the occurrence of nocturnal desaturations while breathing oxygen in COPD patients receiving LTOT. SETTING: Inpatient/university hospital. PATIENTS: We studied 82 consecutive COPD patients. Their functional characteristics were as follows (mean +/- SD): FVC, 2.15 +/- 0.69 L; FEV(1), 0.87 +/- 0.33 L; PaO(2), 51.6 +/- 5 mm Hg; and PaCO(2), 47 +/- 8 mm Hg. MEASUREMENTS: Overnight pulse oximetry (PO) was performed twice: (1) while breathing air and (2) while breathing supplemental oxygen assuring satisfactory diurnal resting oxygenation (mean PaO(2) during oxygen breathing, 67 +/- 6 mm Hg; mean arterial oxygen saturation [SaO(2)] during oxygen breathing, 93%). RESULTS: PO performed while patients were breathing air showed a mean overnight SaO(2) of 82.7 +/- 6.7%. Patients spent 90% of the recording time with an SaO(2) of < 90%. While breathing oxygen, 43 patients (52.4%) remained well oxygenated. Their mean overnight SaO(2) while breathing oxygen was 94.4 +/- 2.1%, and time spent with saturation < 90% was 6.9 +/- 8.6%. Thirty-nine patients (47.6%) spent > 30% of the night with an SaO(2) of < 90% while breathing supplemental oxygen. Their mean overnight SaO(2) while breathing oxygen was 87.1 +/- 4.5%, and time spent with an SaO(2) of < 90% was 66.1 +/- 24.7% of the recording time. Comparison of ventilatory variables and daytime blood gases between both groups revealed statistically significantly higher PaCO(2) on air (p < 0.001) and on oxygen (p < 0. 05), and lower PaO(2) on oxygen (p < 0.05) in the group of patients demonstrating significant nocturnal desaturation. CONCLUSIONS: We conclude that about half of COPD patients undergoing LTOT need increased oxygen flow during sleep. Patients with both hypercapnia (PaCO(2) > or = 45 mm Hg) and PaO(2) < 65 mm Hg while breathing oxygen are most likely to desaturate during sleep.

Circadian Rhythm↗