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journal mamata bista (1) (1).pptx
1. Journal Club Presentation
Dr. Mamata Bista
1st Year Resident
Department of critical care and anesthesiology
BPKIHS, Dharan , Nepal
Moderator:Additonal professor Dr. Ashish Subedi
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3. Title
Supranormal arterial oxygen tension only during the first six
hours after cardiac arrest is associated with unfavourable
outcomes
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4. Authors
Hyoung Youn Lee:
Trauma Centre, Chonnam National University Hospital, Gwangju, Republic of
Korea
Yong Hun Jung and Jiho Lee:
Department of Emergency Medicine, Chonnam National University Hospital,
Gwangju, Republic of Korea
Byung Kook Lee , Tag Heo ,Yong Il Min and Kyung Woon Jeung:
Department of Emergency Medicine, Chonnam National University Medical
School,Gwangju, Republic of Korea
Eul Noh:
Department of Emergency Medicine, Chonnam National University Hwasun
Hospital, Hwasun-gun, Jeollanam-do, Republic of Korea
Jung Chul Kim:
Division of Trauma Surgery, Department of Surgery, Chonnam National
University Hospital, Gwangju,Republic of Korea
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5. Details
• Published in: ACTA, Anaesthesiologica Scandinavica
Foundation
• Date of accepted:
8 August 2022
• Duration of study:
March 2010 and June 2020
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6. Place of study
• Chonnam National University Hospital, Gwangju,
Republic of Korea.
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7. Critical appraisal of Journal
• An, ACTA, Anaesthesiologica Scandinavica journal,
charge free
• Open access, peer-reviewed journal
• Citable by the digital object identifier (DOI)
• Inclusion in Pubmed.
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8. Critical analysis of Topic
• Time frame is short and first 6 hour of study also divided
further into first 2 hour so patient may not receive
appropriate intervention within this frame of time
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10. Introduction
• Hyperoxia has been considered a potential risk
factor for unfavourable outcomes following cardiac
arrest (CA).
• The relationship between hyperoxaemia and
outcomes may differ depending on timing and
duration.
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11. • They performed a detailed analysis of the relationship
between PaO2 at specific time intervals within 24 h after
CA and unfavourable outcomes to gain a deeper
understanding of this association.
• The author hypothesised that the relationship between
supranormal PaO2 and unfavourable outcomes would
vary depending on time-related factor.
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12. Materials and Methods
• Study design: Retrospective observational study
• Study population: 838 adult non-traumatic patients with
Cardiac Arrest.
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13. Inclusion Criteria
Adult (aged ≥ 18 years) patients resuscitated
following out-of-hospital or in-hospital CA were
included in the study
Exclusion criteria
• Cardiac arrest related to trauma.
• Haemorrhagic or ischemic stroke indicated on
brain imaging after the restoration of
spontaneous circulation (ROSC)
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14. • Pre-arrest cerebral performance category (CPC) 3 or 4.
• Glasgow coma scale score ≥ 9 on admission.
• Lack of PaO2 data within 24 h after ROSC.
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15. Variables
• Electronic medical records.
• Demographic data.
• Preexisting illnesses.
• CA-related variables.
• Illness severity variables
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16. • Laboratory variables
• Hospital treatment-related variables,
• Outcomes at hospital discharge,
• PaO2 results within 24 h after ROSC.
• The first 24 h were divided into four 6-h time intervals,
and the highest PaO2 and the number of PaO2
measurements for each time interval were determined
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17. • The author calculated time-weighted average PaO2
(TWA-PaO2) for each time interval and used it to
measure cumulative oxygen exposure over time.
• To calculate TWA-PaO2, we considered the first
measured PaO2 levels as the PaO2 level in the period
from the ROSC to the first PaO2 measurement, and for
subsequent PaO2 measurements, the PaO2 level
observed in the earlier measurement was considered the
PaO2 level between two PaO2 measurements
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18. Analysis
• Continuous variables were compared using the Mann–
Whitney U test, while categorical variables were
compared using Fisher's exact test or the chi-square
test.
• Propensity score was calculated using Multivariable
logistic regression analyses were conducted.
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28. Critical appraisal of Results
• Result should be started with word not with number
• Result is presented in logical and comprehensible
manner, according to aims and objective
• All data are performed in tabular form and tables are
explained
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29. Critical appraisal of Discussion
• Is meaningful and has highlighted the important
findings of study
• Comparison and contrast with other study is
mentioned
• Limitation of study is mentioned
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30. Limitation
• The study was a retrospective observational study, no causal
relationship between exposure to supranormal PaO2 and
unfavourable outcomes could be established.
• A single-centre study, which limited the generalisability of the
findings.
• Most patients were treated with TTM. Therefore, results may not be
applicable to patients not treated with TTM.
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31. • Despite efforts to adjust for illness severity and care
processes, residual confounding by these factors may
have been in effect.
• The primary outcome measure was CPC upon hospital
discharge; no data were available on longer-term
outcomes. Our primary outcome measure might not
have accurately captured the long-term neurological
consequences of CA.
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32. • Ventilator settings and derived parameters such as positive
end expiratory pressure and plateau pressure were not
included in our study.
• A preplanned analysis of the TTM2 trial, evaluating ventilator
settings and gas exchange parameters and their association
with outcomes at 6 months, is currently ongoing and is likely
to provide valuable information on optimal ventilation
strategies for patients resuscitated after CA.
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33. Conclusion
• Results suggest that even a mildly elevated PaO2 level
(>150 mmHg) may be harmful.
• Mild hyperoxaemia may cause oxidative injury to the
brain because of increased prooxidant and decreased
antioxidant capacities following ROSC.
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34. • Supranormal PaO2 in the first 6 h but not later
was independently associated with unfavourable
outcomes.
• The association between supranormal PaO2 in
the first 2 h and unfavourable outcomes was
even stronger and emerged at PaO2 levels ≥
150 mmHg.
• Length of time spent with PaO2 ≥ 150 mmHg
was associated with an increased risk of
unfavourable outcomes
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35. Strength
• Sample size is large
• All SSI categoried by attending physician and expert
team (decreasing observer biasness)
• Useful research study
• Ethical clearance
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The abstract of the article is structured
The abstract is informative and meaningful
It is comprehensive in its content
Hyperoxia exacerbates reperfusion injury by enhancing oxidative stress.
A number of clinical studies have evaluated the effect of hyperoxaemia on post-CA outcomes; however, they have yielded inconsistent results.
The introduction is meaningful and built in existing literature
Introduction is logically presented with opening, body and termination like need for the study
Done by standard and appropriate statistical tests
Outcome compared in percentage
the curve for the 0–6-h time interval was linear, while the results for the succeeding time intervals were non-linear and U-shaped
The shape of the relationship between supranormal PaO2 and unfavourable outcomes after CA differed among studies
An intervention to prevent hyperoxaemia exposure may be most effective when a normal PaO2 level is achieved within the first 2 h
Conclusion is meaningful
Supported by the result drawn
