Short term non-invasive ventilation post-surgery improves arterial blood-gases in obese subjects compared to supplemental oxygen delivery - a randomized controlled trial

<p>Abstract</p> <p>Background</p> <p>In the immediate postoperative period, obese patients are more likely to exhibit hypoxaemia due to atelectasis and impaired respiratory mechanics, changes which can be attenuated by non-invasive ventilation (NIV). The aim of the study was to evaluate the duration of any effects of early initiation of short term pressure support NIV vs. traditional oxygen delivery via venturi mask in obese patients during their stay in the PACU.</p> <p>Methods</p> <p>After ethics committee approval and informed consent, we prospectively studied 60 obese patients (BMI 30-45) undergoing minor peripheral surgery. Half were randomly assigned to receive short term NIV during their PACU stay, while the others received routine treatment (supplemental oxygen via venturi mask). Premedication, general anaesthesia and respiratory settings were standardized. We measured arterial oxygen saturation by pulse oximetry and blood gas analysis on air breathing. Inspiratory and expiratory lung function was measured preoperatively (baseline) and at 10 min, 1 h, 2 h, 6 h and 24 h after extubation, with the patient supine, in a 30 degrees head-up position. The two groups were compared using repeated-measure analysis of variance (ANOVA) and t-test analysis. Statistical significance was considered to be P < 0.05.</p> <p>Results</p> <p>There were no differences at the first assessment. During the PACU stay, pulmonary function in the NIV group was significantly better than in the controls (p < 0.0001). Blood gases and the alveolar to arterial oxygen partial pressure difference were also better (p < 0.03), but with the addition that overall improvements are of questionable clinical relevance. These effects persisted for at least 24 hours after surgery (p < 0.05).</p> <p>Conclusion</p> <p>Early initiation of short term NIV during in the PACU promotes more rapid recovery of postoperative lung function and oxygenation in the obese. The effect lasted 24 hours after discontinuation of NIV. Patient selection is necessary in order to establish clinically relevant improvements.</p> <p>Trial Registration#</p> <p>DRKS00000751; <url>http://www.germanctr.de</url></p

A ius talionis és az asylum városok jogi, vallási és kultúratörténeti jelentősége a tanakban

The cultural and legal goal of the cities of refuge was to prevent as many kinds of murder as possible and also to curtail the possibilities of blood feuds. The cities of refuge were solely for inadvertent murderers (slayers). The cities of refuge were tied to exile as a form of punishment. It meant the murderers had to leave the territory of their tribes, their families and their homes, to live in the city of refuge. The time period of the punishment was, in all cases, correlated with life of the chief prelate of the city of refuge. As long as the chief prelate lived, the punishment continued. When the chief prelate died, the punishment ended. Leaving home was a serious punishment itself for the fleeing slayer and at the same time it was an obvious legal restriction for those seeking revenge (revenges), as the slayer was separated from the “revenges” by the scope of authority of the cities of refuge. If the inadvertent murderer could not be accused of any form of willfulness in relation to causality regarding the crime, then the court acting in the cities of refuge acquitted the defender and ensured refuge for him, in other words, he had to be accepted by the „goel”. Acquittal meant that the slayer could stay in the cities of refuge and the avengers could not kill him. The legal regulation invoking the cities of refuge stopped all kinds of abuse in relation to vendettas (blood feuds). At the same time we can remark here that the slayer could continue his life with the possibility of this legal defense; if he physically got into one of the cities of refuge in an acceptable manner. However, if he was overtaken or caught during his flight to safety the avengers could kill him, due to the ancient law, which was the “blood for blood” approach. We point out, reflecting upon the connection through the later administration of Roman law, that the witness was very important in the Israeli adjudication, and also in relation to the cities of refuge. The scope of Deut 19:15-21 definitely talks about inquisition to prove out witnesses who bear false witness and who mislead the judges in trial procedure. In the case of two or three concordant serious testimonies, even a death penalty could be brought. That’s why a false witness could throw off the safeguards of the whole adjudication, and the judge could have no other possibility but to bring the most serious verdict. The Bible asks for a thorough inquiry out of Leviticus, requiring inquisition from the ministers in the case of witnesses. The fundamental principal of the Israeli criminal law was the “ius talionis”, which meant, in practice, that whosoever committed a crime in something, he was likewise punished by that crime in some way. The severe consequences and deliberative judicial process in relation to the asylum law eliminated all kinds of abuse. However, the cities of refuge could not be a refuge place for willful murderers. In all other ways the cities of refuge belonged to the cities of Leviticus in religious, legal and cultural aspects. The shelter provided by the cities of refuge can be understood as a personal captivity, not outside Israel, but inside the country. As in the “galut” (exile), the Jews always longed for the homes they left behind, and so likewise, the inadvertent murderers yearned for their own homes. The final close (judgment) of a matter of refuge was based not only on the decision of the judges but also upon the person of the prelate. Israel had already passed on certain principals of “mispat” (equity) to the Romans, prior to its complete devastation by the Romans in AD 135. The Roman Empire readily absorbed the concept of refuge and subsequently spread it to the entire human intellectual world through the jurisdiction of the continental (Roman) law. It is perhaps more realistic today than ever before to consider the thought of the cities of refuge, as in our world violent death is taking its victims all the time. In our time, hundreds and millions of people flee from civil wars and humanitarian catastrophes. Without any place of refuge, these masses of human beings would die. The Biblical concept of the cities of refuge is also about mankind’s ever present minorities; the fugitives of our kind have fundamental human rights. The concept of refuge was familiar to the tribes of the Near East, but Israel excelled among them, as Israel’s solution differed in many ways from the solutions of other tribes. Its importance cannot be taken away because it can be seen that it is still practiced and known in the modern world. Consulates, embassies, churches and other sacred places acting under international law are places of refuge based upon this concept. What can we – 21st century people – do in relation to this old Jewish Biblical Law? At least we can assure the rights of minorities in their environments, or in other words, not being fully persuaded by the majority alone, we try to assure our personal influence by using Biblical principles to assure the fundamental rights of the oppressed and the disadvantaged