TY - JOUR
T1 - Haemodynamic effects of a 10-min treatment with a high inspired oxygen concentration in the emergency department
T2 - A prospective observational study
AU - Stolmeijer, Renate
AU - van Ieperen, Ellen
AU - Lameijer, Heleen
AU - van Beest, Paul
AU - ter Maaten, Jan Cornelis
AU - ter Avest, Ewoud
N1 - Funding Information:
This work was financially supported by the MCL Research academy (purchase of the finger cuffs). The ClearSight® system was made available at no costs by Edward Lifesciences (reference number NL2018.051). Funding institutions had no role in conception, design, or conduct of the study; collection, management, analysis, interpretation, or presentation of the data; or preparation, review, or approval of the manuscript.
Publisher Copyright:
©
PY - 2022/9/1
Y1 - 2022/9/1
N2 - Previous studies show that prolonged exposure to a high inspired oxygen concentration (FiO 2) is associated with unfavourable haemodynamic effects. Until now, it is unknown if similar effects also occur after oxygen therapy of limited duration in the emergency department (ED). Objectives To investigate the haemodynamic effects of a high FiO 2 administered for a limited duration of time in patients who receive preoxygenation for procedural sedation and analgesia (PSA) in the ED. Design, settings and participants In a prospective cohort study, cardiac output (CO), stroke volume (SV) and systemic vascular resistance (SVR) were measured using the Clearsight non-invasive CO monitoring system in patients who received preoxygenation for PSA in the ED. Measurements were performed at baseline, after 5 min of preoxygenation via a non-rebreathing mask at 15 /L min and after 5 min of flush rate oxygen administration. Outcomes measures The primary outcome was defined as the change in CO (L/min) from baseline after subsequent preoxygenation with 15 L/min and flush rate. Results Sixty patients were included. Mean CO at baseline was 6.5 (6.0-6.9) L/min and decreased to 6.3 (5.8-6.8) L/min after 5 min of oxygen administration at a rate of 15 L/min, and to 6.2 (5.7-6.70) L/min after another 5 min at flush rate (p=0.037). Mean SV remained relatively constant during this period, whereas mean SVR increased markedly (from 781 (649-1067), to 1244 (936-1695) to 1337 (988-1738) dyn/s/cm -5, p<0.001. Sixteen (27%) patients experienced a>10% decrease in CO. Conclusion Exposure of patients to a high FiO 2 for 5-10 min results in a significant drop in CO in one out of four patients. Therefore, even in the ED and in prehospital care, where oxygen is administered for a limited amount of time, FiO 2 should be titrated based on deficit whenever this is feasible and high flow oxygen should not be given as a routine treatment.
AB - Previous studies show that prolonged exposure to a high inspired oxygen concentration (FiO 2) is associated with unfavourable haemodynamic effects. Until now, it is unknown if similar effects also occur after oxygen therapy of limited duration in the emergency department (ED). Objectives To investigate the haemodynamic effects of a high FiO 2 administered for a limited duration of time in patients who receive preoxygenation for procedural sedation and analgesia (PSA) in the ED. Design, settings and participants In a prospective cohort study, cardiac output (CO), stroke volume (SV) and systemic vascular resistance (SVR) were measured using the Clearsight non-invasive CO monitoring system in patients who received preoxygenation for PSA in the ED. Measurements were performed at baseline, after 5 min of preoxygenation via a non-rebreathing mask at 15 /L min and after 5 min of flush rate oxygen administration. Outcomes measures The primary outcome was defined as the change in CO (L/min) from baseline after subsequent preoxygenation with 15 L/min and flush rate. Results Sixty patients were included. Mean CO at baseline was 6.5 (6.0-6.9) L/min and decreased to 6.3 (5.8-6.8) L/min after 5 min of oxygen administration at a rate of 15 L/min, and to 6.2 (5.7-6.70) L/min after another 5 min at flush rate (p=0.037). Mean SV remained relatively constant during this period, whereas mean SVR increased markedly (from 781 (649-1067), to 1244 (936-1695) to 1337 (988-1738) dyn/s/cm -5, p<0.001. Sixteen (27%) patients experienced a>10% decrease in CO. Conclusion Exposure of patients to a high FiO 2 for 5-10 min results in a significant drop in CO in one out of four patients. Therefore, even in the ED and in prehospital care, where oxygen is administered for a limited amount of time, FiO 2 should be titrated based on deficit whenever this is feasible and high flow oxygen should not be given as a routine treatment.
KW - ACCIDENT & EMERGENCY MEDICINE
KW - Adult intensive & critical care
KW - INTENSIVE & CRITICAL CARE
U2 - 10.1136/bmjopen-2021-059848
DO - 10.1136/bmjopen-2021-059848
M3 - Article
AN - SCOPUS:85137875833
SN - 2044-6055
VL - 12
JO - BMJ Open
JF - BMJ Open
IS - 9
M1 - e059848
ER -