Effect of high‐flow oxygen therapy on regional oxygen saturation during vaso‐occlusive pain crisis: An observational study

医学 缺氧(环境) 血管闭塞危象 微循环 麻醉 氧饱和度 氧气 内科学 心脏病学 疾病 化学 镰状细胞性贫血 有机化学
作者
Ségolène Gendreau,Jérôme Cecchini,François Perier,Keyvan Razazi,Guillaume Carteaux,Nicolas de Prost,Pablo Bartolucci,Anoosha Habibi,Armand Mekontso Dessap
出处
期刊:British Journal of Haematology [Wiley]
卷期号:201 (6)
标识
DOI:10.1111/bjh.18812
摘要

The vaso-occlusive pain crisis (VOC) is the hallmark manifestation of sickle cell disease (SCD). Hypoxia-induced polymerization of haemoglobin S, red blood cell sickling and microvascular occlusion accounts for the main disease process underlying VOC. Hypoxia seems to be a critical factor inducing the polymerization of deoxygenated sickle haemoglobin, resulting in multicellular adhesion, vascular obstruction and ischaemia–reperfusion injury.1 High-flow nasal oxygen (HFNO) therapy, by inducing arterial hyperoxemia, may mitigate the postcapillary venules desaturation and the associated polymerization. By measuring regional oxygen saturation within a sampled volume mixing arterioles, capillaries and venules, near-infrared spectroscopy (NIRS) allows a non-invasive monitoring of the microcirculation. Patients with SCD exhibit lower values of muscular and cerebral regional oxygen saturation at steady state.2, 3 The effects of oxygen therapy on microcirculation are unknown during VOC. We aimed at describing these effects using NIRS. The study was conducted in an intensive care unit within a university hospital during a two-year period. Adult patients with SCD admitted for VOC were eligible for inclusion if: (1) the painful site of the VOC included at least one limb; (2) the physician in charge of the patient decided to deliver oxygen therapy by using HFNO. This study was approved by an external review board (‘Comité de Protection des Personnes Ile-de-France V’). The requirement for informed consent was waived because of the observational nature of the study, as per French law. All patients received written and oral information about the study. After a 5-min period with standard oxygen therapy (i.e. targeting a pulsed oxygen saturation of 95%), HFNO was delivered by using cannulas (Optiflow™ or Airvo-2™, Fisher-Payckel), during 1 h, at flows of 30–60 L/min and fraction of inspired oxygen (FiO2) of 100%. We recorded baseline characteristics including the type of haemoglobinopathy, the steady-state haemoglobin value and the history and long-term treatment of SCD. Pain and regional oxygen saturation (rSO2) were assessed for each limb site with a categorical pain score (CPS, ranging from 0 to 3 points) and a NIRS monitor (INVOS™ 5100C; Medtronic), respectively.4 Biological data were measured before the HFNO. Three sensors were positioned simultaneously on the forehead (cerebral rSO2) and symmetrically on two limbs (on the flexor digitorum superficialis muscle at the proximal third of the forearm or on the rectus femoris muscle at the middle third of the thigh) above a muscle area (muscular-rSO2). For the peripheral measurement, most painful and less painful limbs referred to the most and the less severe painful side of the limb studied (as assessed by CPS), respectively. rSO2 values were recorded every 30 s and then averaged over 3 min before administering HFNO (T0) and 60 min after HFNO at 100% FiO2 (T60). Sample size calculation and statistical methods are reported in Data S1. Ten patients were included. Patients' characteristics are provided in Table S1. Two patients received red blood cell transfusion before inclusion, and no patient had a cerebral vasculopathy. At baseline, the CPS of the most painful limb was higher as compared to that of the less painful limb: 2.5 (2.0–3.0) vs. 1.0 (0.0–2.0), p = 0.008. Standard oxygen therapy consisted of HFNO at FiO2 between 21% and 40% (nine patients) and low-flow nasal oxygen at 5 L/min (one patient). There were no significant differences in rSO2 measured on the most painful limb, the less painful limb and the forehead at baseline (Figure S1). During HFNO, a within-subject increase for rSO2 was observed, both at cerebral and muscular sites, with no significant change in clinical parameters except for an increase in pulsed oxygen saturation (Table 1 and Figure 1). These results persisted after exclusion of patients receiving transfusion before inclusion (Figure S2). In this exploratory study, we observed an increase in rSO2 in limbs and cerebral areas during HFNO in SCD patients with VOC. This observation could be relevant, as enhanced rSO2 may increase microvascular oxygen tension and favour the process of red blood cell unsickling.5 At baseline, there was a trend towards lower rSO2 in the most painful limb as compared to the less painful limb, but this difference did not reach statistical significance. A previous study found normal sublingual microcirculation during painful crisis in SCD.6 Another study evidenced a 30% reduction in microvascular blood flow during pain crisis as compared to steady state.7 However, no comparison between most painful and less painful limbs was performed in these studies. Values of rSO2 we observed in less painful limbs are in accordance with values of muscle tissue oxygen index previously reported in SCD patients.2 Previous studies evidenced that cerebral rSO2 was significantly lower in patients with SCD as compared to those without,8 but no such difference was evidenced for quadriceps.9 We found slightly lower values of cerebral rSO2 (41%) than previously reported in patients with SCD (48%),3 and there was a trend towards lower values of cerebral rSO2 as compared to limb values. Cerebral and muscle oxygen saturation were reported to be similar amongst patients with SCD2 but not in neonates10 nor adults11 without SCD. Lower values and/or decline of cerebral rSO2 have been associated with cognitive impairment after cardiac surgery.12 In line with our hypothesis, rSO2 increased during HFNO both in limbs and cerebral areas. A previous case report of a child without SCD evidenced improvement in cerebral oxygenation (measured by NIRS) with HFNO.13 The optimal oxygen support for patients with SCD is still controversial: an excessive oxygen supplementation could enhance oxidative stress and inflammation,14 whereas hypoxia could trigger sickling and VOC and enhance pulmonary vasoconstriction and acute chest syndrome.15 Although prolonged continuous oxygen delivery in patients with SCD was associated with a decrease in erythropoietin levels,16 a correlation between erythropoietin levels and haemoglobin is not consistently observed17 and whether hyperoxia could be detrimental in this population is still uncertain. The main strength of our study is that, to the best of our knowledge, it is the first to report rSO2 during HFNO in several patients. The improvement of tissue oxygenation and microcirculation driven by HFNO may improve unsickling during SCD, but further studies are needed to assess the needed value or change in rSO2 to improve clinical outcomes like the pain score. Whether longer exposition to HFNO will be needed to achieve these goals warrants further research. Other limitations of our study include its small sample size and the lack of a direct biological surrogate of sickling. In conclusion, a 1-h session of HFNO at FiO2 1 in SCD patients with vaso-occlusive painful crisis improved regional oxygen saturation both at muscular and cerebral sites but with no change in the pain score. JC, SG, AH, PB, KR, NDP, GC and AMD contributed to the study design, data analysis, interpretation and drafting of the manuscript. JC and FP contributed to data acquisition. All authors revised the article and gave approval for the submitted version. Medtronic provided the monitor for clinical measurements. The authors have no competing interests. The study data (protocol, patients' characteristics and measures, and statistical analysis) are available upon request. Appendix S1. Figure S1. Figure S2. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

科研通智能强力驱动
Strongly Powered by AbleSci AI
科研通是完全免费的文献互助平台,具备全网最快的应助速度,最高的求助完成率。 对每一个文献求助,科研通都将尽心尽力,给求助人一个满意的交代。
实时播报
Jocd完成签到,获得积分10
刚刚
Akim应助孙二二采纳,获得10
1秒前
优雅的千凝完成签到,获得积分10
1秒前
Time完成签到,获得积分10
2秒前
格拉希尔完成签到 ,获得积分10
3秒前
Yzh完成签到,获得积分10
4秒前
shuke完成签到,获得积分10
5秒前
啊七飞完成签到,获得积分10
5秒前
琦琦国王完成签到,获得积分10
6秒前
务实的绝悟完成签到,获得积分10
9秒前
经纲完成签到 ,获得积分0
9秒前
我说苏卡你说不列完成签到,获得积分10
11秒前
CipherSage应助科研通管家采纳,获得10
13秒前
13秒前
顾矜应助科研通管家采纳,获得10
13秒前
13秒前
劲秉应助科研通管家采纳,获得10
13秒前
sun应助科研通管家采纳,获得20
13秒前
苗条绝义应助科研通管家采纳,获得10
14秒前
隐形曼青应助科研通管家采纳,获得10
14秒前
科研通AI5应助科研通管家采纳,获得10
14秒前
蔡从安完成签到,获得积分20
14秒前
劲秉应助科研通管家采纳,获得10
14秒前
CipherSage应助科研通管家采纳,获得10
14秒前
NexusExplorer应助科研通管家采纳,获得10
14秒前
黑囡应助科研通管家采纳,获得10
14秒前
14秒前
科研通AI5应助科研通管家采纳,获得10
14秒前
科研通AI2S应助科研通管家采纳,获得10
14秒前
5165asd完成签到 ,获得积分10
15秒前
ritata完成签到 ,获得积分10
16秒前
小彤完成签到 ,获得积分10
17秒前
17秒前
ll应助蔡从安采纳,获得10
18秒前
boltos完成签到,获得积分20
19秒前
善学以致用应助橙猫猫采纳,获得10
20秒前
GEZIKU完成签到 ,获得积分10
22秒前
23秒前
陈文学完成签到,获得积分10
24秒前
LL关注了科研通微信公众号
25秒前
高分求助中
Continuum Thermodynamics and Material Modelling 3000
Production Logging: Theoretical and Interpretive Elements 2700
Mechanistic Modeling of Gas-Liquid Two-Phase Flow in Pipes 2500
Structural Load Modelling and Combination for Performance and Safety Evaluation 1000
Conference Record, IAS Annual Meeting 1977 720
電気学会論文誌D(産業応用部門誌), 141 巻, 11 号 510
Typology of Conditional Constructions 500
热门求助领域 (近24小时)
化学 材料科学 生物 医学 工程类 有机化学 生物化学 物理 纳米技术 计算机科学 内科学 化学工程 复合材料 基因 遗传学 物理化学 催化作用 量子力学 光电子学 冶金
热门帖子
关注 科研通微信公众号,转发送积分 3566811
求助须知:如何正确求助?哪些是违规求助? 3139560
关于积分的说明 9431989
捐赠科研通 2840353
什么是DOI,文献DOI怎么找? 1560990
邀请新用户注册赠送积分活动 730141
科研通“疑难数据库(出版商)”最低求助积分说明 717855