Title |
Effects of short-term hyperoxia on erythropoietin levels and microcirculation in critically Ill patients: a prospective observational pilot study
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Published in |
BMC Anesthesiology, March 2017
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DOI | 10.1186/s12871-017-0342-2 |
Pubmed ID | |
Authors |
Abele Donati, Elisa Damiani, Samuele Zuccari, Roberta Domizi, Claudia Scorcella, Massimo Girardis, Alessia Giulietti, Arianna Vignini, Erica Adrario, Rocco Romano, Laura Mazzanti, Paolo Pelaia, Mervyn Singer |
Abstract |
The normobaric oxygen paradox states that a short exposure to normobaric hyperoxia followed by rapid return to normoxia creates a condition of 'relative hypoxia' which stimulates erythropoietin (EPO) production. Alterations in glutathione and reactive oxygen species (ROS) may be involved in this process. We tested the effects of short-term hyperoxia on EPO levels and the microcirculation in critically ill patients. In this prospective, observational study, 20 hemodynamically stable, mechanically ventilated patients with inspired oxygen concentration (FiO2) ≤0.5 and PaO2/FiO2 ≥ 200 mmHg underwent a 2-hour exposure to hyperoxia (FiO2 1.0). A further 20 patients acted as controls. Serum EPO was measured at baseline, 24 h and 48 h. Serum glutathione (antioxidant) and ROS levels were assessed at baseline (t0), after 2 h of hyperoxia (t1) and 2 h after returning to their baseline FiO2 (t2). The microvascular response to hyperoxia was assessed using sublingual sidestream dark field videomicroscopy and thenar near-infrared spectroscopy with a vascular occlusion test. EPO increased within 48 h in patients exposed to hyperoxia from 16.1 [7.4-20.2] to 22.9 [14.1-37.2] IU/L (p = 0.022). Serum ROS transiently increased at t1, and glutathione increased at t2. Early reductions in microvascular density and perfusion were seen during hyperoxia (perfused small vessel density: 85% [95% confidence interval 79-90] of baseline). The response after 2 h of hyperoxia exposure was heterogeneous. Microvascular perfusion/density normalized upon returning to baseline FiO2. A two-hour exposure to hyperoxia in critically ill patients was associated with a slight increase in EPO levels within 48 h. Adequately controlled studies are needed to confirm the effect of short-term hyperoxia on erythropoiesis. ClinicalTrials.gov ( www.clinicaltrials.gov ), NCT02481843 , registered 15th June 2015, retrospectively registered. |
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Unknown | 4 | 67% |
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Mendeley readers
Geographical breakdown
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Unknown | 49 | 98% |
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Student > Master | 6 | 12% |
Student > Ph. D. Student | 6 | 12% |
Student > Bachelor | 5 | 10% |
Other | 4 | 8% |
Other | 10 | 20% |
Unknown | 12 | 24% |
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Agricultural and Biological Sciences | 2 | 4% |
Other | 2 | 4% |
Unknown | 14 | 28% |