Published ahead of print on September 1, 2005, doi:10.1164/rccm.200412-1740OC
American Journal of Respiratory and Critical Care Medicine Vol 172. pp. 1393-1398, (2005)
© 2005 American Thoracic Society
doi: 10.1164/rccm.200412-1740OC
Room-Air Resuscitation Causes Less Damage to Heart and Kidney than 100% Oxygen
Máximo Vento,
Juan Sastre,
Miguel A. Asensi and
José Viña
Servicio de Neonatología, Hospital Universitario Materno-Infantil La Fe; and Departamento de Fisiología, Faculty of Medicine, University of Valencia, Valencia, Spain
Correspondence and requests for reprints should be addressed to Máximo Vento, Ph.D., M.D., Associate Professor of Pediatrics, Neonatal Research Unit, Servicio de Neonatología, Hospital Universitario Materno-Infantil La Fe, Avenida de Campanar 21, 46009 Valencia, Spain. E-mail: maximo.vento{at}uv.es or maximovento@telefonica.net
Rationale: Pure oxygen causes more oxidative stress than room air in resuscitation of asphyctic neonates, and consequently could be associated with increased tissue damage.
Objectives: To compare damage caused to heart and kidneys on reoxygenation in severely asphyctic term neonates resuscitated with room air (RAR) or 100% oxygen (OxR). Nonasphyctic term newborn infants served as a control group.
Methods and Measurements: This is a prospective randomized clinical trial masked for the gas mixture. Reduced glutathione (GSH), oxidized glutathione (GSSG), and superoxide dismutase (SOD) activity were measured to assess oxidative stress. Plasma cardiac troponin T (cTnT) and urinary N-acetyl-glucosaminidase (NAG) assessed cardiac and renal damage, respectively. Daily determinations of NAG for a 2-wk period were performed to monitor postasphyctic renal damage.
Main Results: Both asphyctic groups showed oxidative stress when compared with the control group as evidenced by diminished GSH/GSSG ratios, adaptive increases in SOD activity, and higher values of NAG and cTnT (markers of tissue damage). However, the OxR group showed significantly higher values of NAG and cTnT, lower GSH/GSSG ratios, and higher SOD activity than the RAR group. Moreover, NAG values persisted in being higher than normal in the OxR group for 2 wk after birth, whereas NAG in the RAR group dropped to normal within the first week. A linear correlation between cTnT or NAG and GSSG was found.
Conclusions: The use of room air on resuscitation causes less oxidative stress and damage to heart and kidney than pure oxygen.
Key Words: birth asphyxia • glutathione • oxidative stress • room-air resuscitation
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