Hyperoxemia and excess oxygen use in early acute respiratory distress syndrome : Insights from the LUNG SAFE study

Publisher Copyright: © 2020 The Author(s). Copyright: Copyright 2020 Elsevier B.V., All rights reserved.Background: Concerns exist regarding the prevalence and impact of unnecessary oxygen use in patients with acute respiratory distress syndrome (ARDS). We examined this issue in patients with ARDS enrolled in the Large observational study to UNderstand the Global impact of Severe Acute respiratory FailurE (LUNG SAFE) study. Methods: In this secondary analysis of the LUNG SAFE study, we wished to determine the prevalence and the outcomes associated with hyperoxemia on day 1, sustained hyperoxemia, and excessive oxygen use in patients with early ARDS. Patients who fulfilled criteria of ARDS on day 1 and day 2 of acute hypoxemic respiratory failure were categorized based on the presence of hyperoxemia (PaO2 > 100 mmHg) on day 1, sustained (i.e., present on day 1 and day 2) hyperoxemia, or excessive oxygen use (FIO2 ≥ 0.60 during hyperoxemia). Results: Of 2005 patients that met the inclusion criteria, 131 (6.5%) were hypoxemic (PaO2 < 55 mmHg), 607 (30%) had hyperoxemia on day 1, and 250 (12%) had sustained hyperoxemia. Excess FIO2 use occurred in 400 (66%) out of 607 patients with hyperoxemia. Excess FIO2 use decreased from day 1 to day 2 of ARDS, with most hyperoxemic patients on day 2 receiving relatively low FIO2. Multivariate analyses found no independent relationship between day 1 hyperoxemia, sustained hyperoxemia, or excess FIO2 use and adverse clinical outcomes. Mortality was 42% in patients with excess FIO2 use, compared to 39% in a propensity-matched sample of normoxemic (PaO2 55-100 mmHg) patients (P = 0.47). Conclusions: Hyperoxemia and excess oxygen use are both prevalent in early ARDS but are most often non-sustained. No relationship was found between hyperoxemia or excessive oxygen use and patient outcome in this cohort. Trial registration: LUNG-SAFE is registered with ClinicalTrials.gov, NCT02010073publishersversionPeer reviewe

Study of formation of green eggshell color in ducks through global gene expression - Fig 5

<p><b>A. ABC transporter of DEGs.</b> Note: red represents the up-regulated DEGs, green represents the down-regulated DEGs. <b>B. ABC transporter of the target genes.</b> Note: blue represents that the target genes of miRNAs are enriched in this pathway.</p

Distribution of sRNA sequence length.

<p>Distribution of sRNA sequence length.</p

Experimental preparation of shell gland from ducks laying green and white eggs.

<p>Note: 1–6 represent D1-D3 and W1-W3 samples; D1-D3 and W1-W3 correspond to samples of three green egg shell glands and white egg shell glands, respectively. M: Trans 2K Plus.</p

Study of formation of green eggshell color in ducks through global gene expression - Fig 4

<p><b>A. Scatterplot of KEGG enrichment for differentially expressed genes. B. Scatterplot of top 20 KEGG enrichment for target genes.</b> Note: Rich factor is the ratio of the differentially expressed gene number or target number to the total gene number in certain pathway. The size and color of the dots represent the gene number and the range of the q value, respectively.</p

Functional regulation networks of five differentially expressed miRNAs and respective target genes.

<p>Note: yellow represents core differentially expressed miRNAs; blue represents target genes. (Several important genes: <i>ENSAPLG00000014523</i>: <i>FABP7</i>, <i>ENSAPLG00000004563</i>: <i>CD36</i>, <i>ENSAPLG00000008520</i>: <i>SLC12A8</i>, <i>ENSAPLG00000002382</i>: <i>ABCG2</i>).</p

Hierarchical clustering analysis of differentially expressed miRNA.

<p>Note: Row: different samples; red and blue represent high expression miRNAs and low expression miRNAs, respectively.</p