High-flow oxygen, a therapeutic bridge while awaiting thrombolysis in pulmonary embolism?

Lacroix, Guillaume; Pons, Frédéric; D'Aranda, Erwan; Legodec, J.; Romanat, Pierre-Emmanuel; Goutorbe, Philippe

doi:10.1016/j.ajem.2012.08.030

Cited by 16 publications

(5 citation statements)

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“…We found the lowest oxygen supply similar to a nasal cannula (F io 2 40%) sufficient to normalize saturation and Pa o 2 /Pa co 2 ratio. Retrospective studies indicate that low saturation or low Pa o 2 /Pa co 2 or saturation/F io 2 ratios are associated with adverse outcome (34–37) and that supplemental oxygen improves respiratory status in acute PE (14, 38). We have now shown the efficacy of oxygen on cardiopulmonary hemodynamics.…”

Section: Discussionmentioning

confidence: 99%

Oxygen Therapy Lowers Right Ventricular Afterload in Experimental Acute Pulmonary Embolism

Lyhne

Hansen

Dragsbæk

et al. 2021

Critical Care Medicine

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OBJECTIVES: To investigate if oxygen could unload the right ventricle and improve right ventricle function in a porcine model mimicking intermediate-high risk acute pulmonary embolism. DESIGN: Controlled, blinded, animal study. SETTING: Tertiary university hospital, animal research laboratory. SUBJECTS: Female, Danish pigs (n = 16, approximately 60 kg). INTERVENTIONS: Acute autologous pulmonary embolism was induced until doubling of baseline mean pulmonary arterial pressure. Group 1 animals (n = 8) received increasing Fio 2 (40%, 60%, and 100%) for time intervals of 15 minutes returning to atmospheric air between each level of Fio 2. In group 2 (n = 8), the effects of Fio 2 40% maintained over 75 minutes were studied. In both groups, pulmonary vasodilatation from inhaled nitric oxide (40 parts per million) was used as a positive control. MEASUREMENTS AND MAIN RESULTS: Effects were evaluated by biventricular pressure-volume loop recordings, right heart catheterization, and arterial and mixed venous blood gasses. Pulmonary embolism increased mean pulmonary arterial pressure from 15 ± 4 to 33 ± 6 mm Hg (p = 0.0002) and caused right ventricle dysfunction (p < 0.05) with troponin release (p < 0.0001). In group 1, increasing Fio 2 lowered mean pulmonary arterial pressure (p < 0.0001) and pulmonary vascular resistance (p = 0.0056) and decreased right ventricle volumes (p = 0.0018) and right ventricle mechanical work (p = 0.034). Oxygenation was improved and pulmonary shunt was lowered (p < 0.0001). Maximal hemodynamic effects were seen at Fio 2 40% with no additional benefit from higher fractions of oxygen. In group 2, the effects of Fio 2 40% were persistent over 75 minutes. Supplemental oxygen showed the same pulmonary vasodilator efficacy as inhaled nitric oxide (40 parts per million). No adverse effects were observed. CONCLUSIONS: In a porcine model mimicking intermediate-high risk pulmonary embolism, oxygen therapy reduced right ventricle afterload and lowered right ventricle mechanical work. The effects were immediately present and persistent and were similar to inhaled nitric oxide. The intervention is easy and safe. The study motivates extended clinical evaluation of supplemental oxygen in acute pulmonary embolism.

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Section: Discussionmentioning

confidence: 99%

Oxygen Therapy Lowers Right Ventricular Afterload in Experimental Acute Pulmonary Embolism

Lyhne

Hansen

Dragsbæk

et al. 2021

Critical Care Medicine

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“…67 Further oxygenation techniques should also be considered, including high-flow oxygen (i.e. a high-flow nasal cannula) 236,237 and mechanical ventilation (non-invasive or invasive) in cases of extreme instability (i.e. cardiac arrest), taking into consideration that correction of hypoxaemia will not be possible without simultaneous pulmonary reperfusion.…”

Section: Prognostic Assessment Strategymentioning

confidence: 99%

2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS)

Konstantinides¹,

Meyer²,

Belle³

et al. 2019

European Heart Journal

3,082

2,739

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Disclaimer. The ESC Guidelines represent the views of the ESC and were produced after careful consideration of the scientific and medical knowledge, and the evidence available at the time of their publication. The ESC is not responsible in the event of any contradiction, discrepancy, and/or ambiguity between the ESC Guidelines and any other official recommendations or guidelines issued by the relevant public health authorities, in particular in relation to good use of healthcare or therapeutic strategies. Health professionals are encouraged to take the ESC Guidelines fully into account when exercising their clinical judgment, as well as in the determination and the implementation of preventive, diagnostic, or therapeutic medical strategies; however, the ESC Guidelines do not override, in any way whatsoever, the individual responsibility of health professionals to make appropriate and accurate decisions in consideration of each patient's health condition and in consultation with that patient and, where appropriate and/or necessary, the patient's caregiver. Nor do the ESC Guidelines exempt health professionals from taking into full and careful consideration the relevant official updated recommendations or guidelines issued by the competent public health authorities, in order to manage each patient's case in light of the scientifically accepted data pursuant to their respective ethical and professional obligations. It is also the health professional's responsibility to verify the applicable rules and regulations relating to drugs and medical devices at the time of prescription.

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“…Further oxygenation techniques should also be considered, including high-flow oxygen (i.e. a high-flow nasal cannula) [236,237] and mechanical ventilation (non-invasive or invasive) in cases of extreme instability (i.e. cardiac arrest), taking into consideration that correction of hypoxaemia will not be possible without simultaneous pulmonary reperfusion.…”

Section: Iibmentioning

confidence: 99%

2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS)

et al. 2019

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High-flow oxygen, a therapeutic bridge while awaiting thrombolysis in pulmonary embolism?

Cited by 16 publications

References 1 publication

Oxygen Therapy Lowers Right Ventricular Afterload in Experimental Acute Pulmonary Embolism

Oxygen Therapy Lowers Right Ventricular Afterload in Experimental Acute Pulmonary Embolism

2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS)

2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS)

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