Skip to main content

Oxygen Injection...Will we forget anoxia?

Dr. Kheir was involved in an incident with a critically ill 9 month old patient who sustained brain injury after prolonged hypoxemia. She was put on bypass, but it was too late to save her brain. After that, Kheir started dreaming of a syringe with intravenous oxygen they could’ve given her. And went to work on it.


hey now seem to have a working prototype of a lipid emulsion that contains oxygen and can be injected into the blood stream, release the oxygen and thereby reoxygenate the blood. Their findings are published in Science Translational Medicine. Actually we have only the Abstract to this article..



Intravenous Oxygen
Intravenous administration of oxygen was tried in the early 1900s, but these attempts failed to oxygenate the blood and often caused dangerous gas embolisms as free oxygen oxygen in blood spontaneously formed larger gas bubbles.
Dr Kheir and his Harvard Team has engineered around this problem by packaging the gas into small, deformable lipid particles. They also increase the surface area for gas exchange and are able to squeeze through capillaries where free gas bubbles would get stuck.
Mixing the solution with human blood in a lab glass immediately turned the dark blood bright red, and measurements showed the oxygen was available for gas exchange. They have also injected the solution into hypoxemic rabbits. Arterial saturation was near normal after a few seconds. And fell again when they stopped the infusion.
Current Limitations and Obstacles
There still seems to be a few problems. The solution carrying the oxygen isn’t too healthy for you in large quanteties. They have managed to concentrate a lot of oxygen into a small amount of liquid, but apparently you can only infuse this agent for 15-30 mins before you start to reach maximum safe levels.
And it might not be working as well as one would hope, just yet. Reading the abstract, the outcome of the next experiment was a little more worrying:
“The particles were also infused into rabbits undergoing 15 min of complete tracheal occlusion. The oxygen microparticles significantly decreased the degree of hypoxemia in these rabbits, and the incidence of cardiac arrest and organ injury was reduced compared to controls.”
Hypoxemia was significantly decreased? The incidence of cardiac arrrest was reduced? The incidence of cardiac arrest should be gone, if this really worked. So this doesn’t sound like the pocketable pre-drawn i.v. oxygen syringe I was hoping for. In any case, this is an exciting sic-fi innovation.
In a later iteration, it could save difficult intubation scenarios, can’t intubate can’t ventilate, or other forms of acute and critical airways, lung injuries or other events leading to severe hypoxemia. It would buy us time to intervene to establish an airway, or put the patient on ECMO.
                                                 Click here for Abstract

Comments

  1. Well, this is my first visit to your blog! But I admire the precious time and effort you put into it, especially into interesting articles you share here!
    anaesthesia Machine

    ReplyDelete

Post a Comment

Popular posts from this blog

Driving Pressure in ARDS: A new concept!

Driving Pressure and Survival in the Acute Respiratory Distress Syndrome Marcelo B.P. Amato, M.D., Maureen O. Meade, M.D., Arthur S. Slutsky, M.D., Laurent Brochard, M.D., Eduardo L.V. Costa, M.D., David A. Schoenfeld, Ph.D., Thomas E. Stewart, M.D., Matthias Briel, M.D., Daniel Talmor, M.D., M.P.H., Alain Mercat, M.D., Jean-Christophe M. Richard, M.D., Carlos R.R. Carvalho, M.D., and Roy G. Brower, M.D. N Engl J Med 2015; 372:747-755 February 19, 2015 DOI: 10.1056/NEJMsa1410639 BACKGROUND Mechanical-ventilation strategies that use lower end-inspiratory (plateau) airway pressures, lower tidal volumes (V T ), and higher positive end-expiratory pressures (PEEPs) can improve survival in patients with the acute respiratory distress syndrome (ARDS), but the relative importance of each of these components is uncertain. Because respiratory-system compliance (C RS ) is strongly related to the volume of aerated remaining functional lung during disease (termed functional lung size)...

Anaphylaxis updates part 2- Empty Ventricle Syndrome

Patients with anaphylaxis should not suddenly sit, stand, or be placed in the upright position. Instead, they should be placed on the back with their lower extremities elevated or, if they are experiencing respiratory distress or vomiting, they should be placed in a position of comfort with their lower extremities elevated. This accomplishes 2 therapeutic goals: 1) preservation of fluid in the circulation (the central vascular compartment), an important step in managing distributive shock; and 2) prevention of the empty vena cava/empty ventricle syndrome, which can occur within seconds when patients with anaphylaxis suddenly assume or are placed in an upright position. Patients with this syndrome are at high risk for sudden death. They are unlikely to respond to epinephrine regardless of route of administration, because it does not reach the heart and therefore cannot be circulated throughout the body

Epidural catheter tests...not only the test dose

Siphon test The catheter is held upright and a fluid level sought. If the catheter is then elevated, the fluid level should fall (see inset) as the fluid siphons in to the epidural space, which is usually under negative pressure compared with atmospheric. If the fluid column continues to rise, this may suggest subarachnoid placement. The siphon test can be reassuring, but is not mandatory. Aspiration  This should be considered mandatory. The Luer connector is attached to the catheter and a syringe is used to apply negative pressure. Free and continued aspiration of clear fluid can indicate subarachnoid placement of the catheter. However, if saline has been used for loss of resistance, it is not unusual for a small amount of this to be aspirated. If there is doubt, the aspirated fluid can be tested for glucose (cerebrospinal fluid will generally test positive) or mixed with thiopentone (cerebrospinal fluid forms a precipitate). If blood is freely and continuously aspirated, this sug...