Inhaled nitric oxide as temporary respiratory stabilization in patients with COVID-19 related respiratory failure (INOCOV): Study protocol for a randomized controlled trial

Background In March 2020, WHO announced the COVID-19 a pandemic and a major global public health emergency. Mortality from COVID-19 is rapidly increasing globally, with acute respiratory failure as the predominant cause of death. Many patients experience severe hypoxia and life-threatening respiratory failure often requiring mechanical ventilation. To increase safety margins during emergency anaesthesia and rapid sequence intubation (RSI), patients are preoxygenated with a closed facemask with high-flow oxygen and positive end-expiratory pressure (PEEP). Due to the high shunt fraction of deoxygenated blood through the lungs frequently described in COVID-19 however, these measures may be insufficient to avoid harmful hypoxemia. Preoxygenation with inhaled nitric oxide (iNO) potentially reduces the shunt fraction and may thus allow for the necessary margins of safety during RSI. Methods and design The INOCOV protocol describes a phase II pharmacological trial of inhaled nitric oxide (iNO) as an adjunct to standard of care with medical oxygen in initial airway and ventilation management of patients with known or suspected COVID-19 in acute respiratory failure. The trial is parallel two-arm, randomized, controlled, blinded trial. The primary outcome measure is the change in oxygen saturation (SpO2), and the null hypothesis is that there is no difference in the change in SpO2 following initiation of iNO.publishedVersio

Flicker VEPs reflecting multiple rod and cone pathways

AbstractIn an attempt to determine whether the relative contributions of magno-mediated and parvo-mediated inputs to the cortex are significantly altered in the transition from cone to rod vision, VEPs were recorded at different luminance levels (photopic to scotopic) for 2Hz square-wave, isochromatic flicker. The VEP mass response appears capable of reflecting major parvo-mediated contributions even at luminance levels for which responses from individual cells in the parvocellular pathway are reported to be weak. Our findings suggest that parvo-mediated responses are the dominant source of high-contrast isochromatic flicker VEPs at all light levels

Surround-induced foveal afterimage pulsation: Evidence for a long-range neural effect

AbstractWe demonstrate that an afterimage resulting from a strong foveal light flash can be made to pulsate by luminance modulation of a surrounding annulus as far as 8deg away. Afterimage pulsation persists even if all artifacts due to pupil size, stray light and simultaneous contrast are ruled out. This suggests an origin by a long-range neural process acting from the remote surround. The effect is interpreted in terms of an adaptive gain control optimizing the responses of visual cells