To determine the feasibility on maintaining oxygenation of high-flow nasal oxygenation (HFNO) with bispectral index-guided intravenous anesthesia for nonintubated interventional bronchoscopy (NIIB). If desaturation happens, the factors influencing intraprocedural desaturation were also analyzed.This is a single-center retrospective study on patients receiving NIIB with HFNO and intravenous anesthesia guided by bispectral index levels to the depth of general anesthesia, which were between 40 and 60. Intraprocedural desaturation (SPO 2 < 90%) and complications (bleeding, delayed discharge, unexpected admission) were collected. Factors affecting desaturation and complications were analyzed including patients' factors (age, American Society of Anesthesiologists classification, body mass index [BMI]), procedural factors (procedural time, with or without use of cryoprobe), and setting (outpatient or hospitalized).Records of 223 patients receiving NIIB were collected. The NIIB procedures time was 56.1 ± 26.8 minute. Sixty patients (26.9%) presented desaturation events. Higher BMI, but not procedure time or setting, was significantly associated with desaturation. The desaturation were resolved after relieving upper airway obstruction but 1 patient required bag-valve-mask ventilation to restore oxygenation. Accidental massive bleeding and intraprocedural desaturation during tracheal and bronchial recannulation with cryoprobes happened in 2 patients and 1 of them was admitted to intensive care unit.HFNO is feasible to maintain oxygenation during NIIB only if there is effective upper airway management especially for patients with higher BMI. Longer procedural time and different setting did not affect the desaturation rate. Complications and unexpected admission were associated with the use of cryoprobes.Abbreviations: ASA = American Society of Anesthesiologists, BIS = bispectral index, BMI = body mass index, HFNO = highflow nasal oxygenation, IB = interventional bronchoscopy, NIIB = nonintubated interventional bronchoscopy, PACU = postanesthesia care unit, TBC = transbronchial cryobiopsy.
The association of IL-15 with a range of inflammatory disorders has implicated its function in innate immune response. Several isoforms of IL-15 mRNA generated by alternative splicing have been found constitutively expressed in normal mouse tissues at low level. An ENU mutagenized mouse (pedigree 191) bears a mutation in the exon 7 of IL-15 mRNA. Although the transcriptional level of the canonical IL-15 mRNA in P191 was comparable with B6 wild type skin, a transcript generated from alternatively spliced exon 7 of IL-15 mRNA (IL-15_ASE7) was increased by 8 folds in the epidermis of mutant mice. Mechanical stimulation induced downregulation of IL-15 mRNA in B6 but less reduced in P191 abraded skin which also exhibited attenuated dermal cellular infiltration and reduced expression of IL-1β, TNF-α and IL-6 transcripts. Moreover, genome-wide transcriptional profiling of B6 and P191 abraded skin by DNA microarray analysis showed that genes involved in oxidative phosphorylation and glutathione metabolism were distinguishably expressed between B6 and P191 abraded skin. Particularly, transcriptional levels of Uqcrb gene encoding components of the mitochondrial respiratory chain complex III and anti-oxidant Sod-1 gene were significantly reduced in P191 skin at 48 hours after abrasion. Detailed mechanisms by which IL-15 controls the redox state in epidermal keratinocytes as well as the regulatory role of IL-15_ASE7 on IL-15 action will be elucidated.
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