Air versus oxygen for resuscitation of infants at birth

Tan, Anton; Schulze, Andreas; O'Donnell, CPF; Davis, PG

doi:10.1002/14651858.cd002273.pub2

Cited by 47 publications

(27 citation statements)

References 16 publications

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“…Although these recommendations are not evidence-based, it is unlikely that controlled trials would ever be undertaken using different levels of oxygen therapy in these emergencies and it seems intuitive to maximise oxygen delivery for critically ill patients with circulatory collapse. However, randomised trials have been undertaken of resuscitation of neonates breathing room air or oxygen and the unexpected outcome of a Cochrane review was that the outcome was possibly better when room air was used 76. This surprising finding cannot be extrapolated to adult patients, but it does emphasise the need for clinical trials even in areas where one might intuitively believe that oxygen would be beneficial.…”

Section: Section 6: Hypoxia Hyperoxia Hypercapnia and The Rationalementioning

confidence: 99%

BTS guideline for emergency oxygen use in adult patients

O’Driscoll

Howard

Davison³

2008

Thorax

533

535

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Section: Section 6: Hypoxia Hyperoxia Hypercapnia and The Rationalementioning

confidence: 99%

BTS guideline for emergency oxygen use in adult patients

O’Driscoll

Howard

Davison³

2008

Thorax

533

535

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“…The biochemical processes associated with tissue injury in oxygen stress have been well-outlined [50,51], as have interventions to prevent such injury [52]. CO 2 supplementation for neonatal resuscitation is indicated by suggestions that room air may be at least as effective as 100% O 2 in infants subjected to asphyxia [53,54] and that biochemical correlates of oxygen stress are diminished [55]. Room air resuscitation results in less injury to the heart and kidney [56]; injury to the heart is especially apparent after hyperoxic exposure [57].…”

Section: Discussionmentioning

confidence: 99%

Hyperoxic Brain Effects Are Normalized by Addition of CO2

2007

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BackgroundHyperoxic ventilation (>21% O2) is widely used in medical practice for resuscitation, stroke intervention, and chronic supplementation. However, despite the objective of improving tissue oxygen delivery, hyperoxic ventilation can accentuate ischemia and impair that outcome. Hyperoxia results in, paradoxically, increased ventilation, which leads to hypocapnia, diminishing cerebral blood flow and hindering oxygen delivery. Hyperoxic delivery induces other systemic changes, including increased plasma insulin and glucagon levels and reduced myocardial contractility and relaxation, which may derive partially from neurally mediated hormonal and sympathetic outflow. Several cortical, limbic, and cerebellar brain areas regulate these autonomic processes. The aim of this study was to assess recruitment of these regions in response to hyperoxia and to determine whether any response would be countered by addition of CO2 to the hyperoxic gas mixture.Methods and FindingsWe studied 14 children (mean age 11 y, range 8–15 y). We found, using functional magnetic resonance imaging, that 2 min of hyperoxic ventilation (100% O2) following a room air baseline elicited pronounced responses in autonomic and hormonal control areas, including the hypothalamus, insula, and hippocampus, throughout the challenge. The addition of 5% CO2 to 95% O2 abolished responses in the hypothalamus and lingual gyrus, substantially reduced insular, hippocampal, thalamic, and cerebellar patterns in the first 48 s, and abolished signals in those sites thereafter. Only the dorsal midbrain responded to hypercapnia, but not hyperoxia.ConclusionsIn this group of children, hyperoxic ventilation led to responses in brain areas that modify hypothalamus-mediated sympathetic and hormonal outflow; these responses were diminished by addition of CO2 to the gas mixture. This study in healthy children suggests that supplementing hyperoxic administration with CO2 may mitigate central and peripheral consequences of hyperoxia.

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“…Although these recommendations are not evidence-based, it is unlikely that controlled trials would ever be undertaken using different levels of oxygen therapy in these emergencies and it seems intuitive to maximise oxygen delivery for critically ill patients with circulatory collapse and respiratory failure. However, randomised trials have been undertaken of resuscitation of neonates breathing room air or oxygen and the unexpected outcome of a Cochrane review was that the survival was better when room air was used 97. This surprising finding cannot be extrapolated to adult patients, but it does emphasise the need for clinical trials even in areas where one might intuitively believe that oxygen would be beneficial.…”

Section: Section 6: Hypoxia Hypoxaemia Hyperoxaemia Hypercapnia Anmentioning

confidence: 99%