Hyperoxemia in mechanically ventilated, critically ill subjects: incidence and related factors.

BACKGROUND: Excessive supplemental oxygen causes injurious hyperoxemia. Before establishing the best P(aO2) targets for mechanically ventilated patients, it is important to understand the incidence of hyperoxemia and related factors. We investigated oxygenation in mechanically ventilated subjects in our ICU and evaluated factors related to hyperoxemia (P(aO2) > 120 mm Hg) at 48 h after initiation of mechanical ventilation. METHODS: We retrospectively reviewed the medical records of patients admitted to our ICU from January 2010 to May 2013. Inclusion criteria were 15 y of age or older and administration of mechanical ventilation for > 48 h. Patients at risk of imminent death on admission or who had received noninvasive ventilation were excluded. We collected subject demographics, reasons for mechanical ventilation, and during mechanical ventilation, we collected arterial blood gas data and ventilator settings on the first day of intubation (T1), 48 h after initiation of mechanical ventilation (T2), and on the day of extubation (T3). Multivariable logistic regression analysis was performed to clarify independent variables related to hyperoxemia at T2. RESULTS: For the study period, data for 328 subjects were analyzed. P(aO2) statistically significantly increased over time to 90 (interquartile range of 74-109) mm Hg at T1, 105 (89-120) mm Hg at T2, and 103 (91-119) mm Hg at T3 (P < .001), coincident with decreases in F(IO2) of 0.4 (0.3-0.5) at T1, 0.3 (0.3-0.4) at T2, and 0.3 (0.3-0.35) at T3 (P < .001). Hyperoxemia occurred in 15.6% (T1), 25.3% (T2), and 22.4% (T3) of subjects. Multivariable logistic regression analysis revealed that hyperoxemia was independently associated with age of < 40 y (odds ratio 2.6, 95% CI 1.1-6.0), Acute Physiology and Chronic Health Evaluation II scores of ≥ 30 (odds ratio 0.53, 95% CI 0.3-1.0), and decompensated heart failure (odds ratio 1.9, 95% CI 1.1 to 3.5). CONCLUSIONS: During mechanical ventilation of critically ill subjects, P(aO2) increased, and F(IO2) decreased. One in 4 subjects were hyperoxemic at T2, and hyperoxemia persisted until T3.

Synthesis of conjugated oligomers having aromatic and enediyne units alternately in the backbone that show intense fluorescence emission.

[structure: see text] Synthesis and fluorescence properties of pi-conjugated compounds having alternately an aromatic ring such as benzene, pyridine, and thiophene and an enediyne unit in the backbone are described.

Role of Rho-associated protein kinase and histamine in lysophosphatidic acid-induced airway hyperresponsiveness in guinea pigs.

Inhalation of oleoyl lysophosphatidic acid (LPA) induced airway hyperresponsiveness to acetylcholine (ACh). In contrast, palmitoyl and stearoyl LPA exerted minimal effects. Airway hyperresponsiveness was inhibited by inhalation of Y-27632, an inhibitor of Rho-associated protein kinase (ROCK). Mepyramine, an H1 histamine receptor antagonist and ketotifen, an inhibitor of histamine release and H1 histamine receptor antagonist, also inhibited airway hyperresponsiveness induced by LPA; however, aspirin failed to attenuate this response. The incubation of lung fragments with LPA gave rise to releases in histamine. On the other hand, LPA produced no significant changes on the smooth muscle contraction evoked by ACh. These findings suggest that LPA-induced airway hyperresponsiveness is attributable to activation of the Rho/ROCK-mediated pathway via endothelial cell differentiation gene (EDG) receptors, probably EDG 7. Moreover, histamine release may be involved.