Índice de PaO2/FAO2: ¿un mejor indicador de oxigenación para valorar la hipoxemia? Resultados de un análisis de concordancia con el índice de PaO2/FiO2 / PaO2/FAO2 index: a better oxygenation indicator to assess hypoxemia? Results of an analysis of agreement with the PaO2/FiO2 index / Índice PaO2/FAO2: melhor indicador de oxigenação para avaliar hipoxemia? Resultados de uma análise de concordância com o índice de PaO2/FiO2

Resumen: Introducción: el cociente PaO2/FiO2 ajustado a la presión barométrica se utiliza para evaluar la oxigenación en la falla respiratoria; sin embargo, no toma en cuenta la PaCO2, a diferencia del índice PaO2/FAO2 (PaO2 dividida entre la fracción alveolar de oxígeno). Objetivo: evaluar la concordancia entre PaO2/FiO2 y PaO2/FAO2. Material y métodos: estudio observacional, ambispectivo, transversal y analítico en pacientes mayores de 18 años, bajo ventilación mecánica invasiva, con falla respiratoria hipoxémica y con diferentes valores de PaCO2. Resultados: se analizó la concordancia en 64 mediciones gasométricas tomadas al ingreso y cuando se documentó la mayor PaCO2 de 32 enfermos. El análisis de Bland y Altman mostró una media de las diferencias (bias) de 13 y un límite de concordancia de 95%, entre 54 y -24. La concordancia es mejor cuando la PaO2/FiO2 es menor de 150. Veintidós por ciento de las mediciones no concordaron en la asignación a grupos con hipoxemia leve, moderada o grave. Conclusiones: existe una moderada concordancia entre la PaO2/FAO2 y la PaO2/FiO2; sin embargo, en los enfermos con hipoxemia severa la concordancia es mejor. En los pacientes con PaO2/FiO2 ≥ 150, la hipercapnia explica en parte la baja concordancia. Posiblemente la PaO2/FAO2 es una mejor forma de evaluar el grado del trastorno en la oxigenación.

Abstract: Introduction: the PaO2/FiO2 ratio adjusted to barometric pressure is used to assess oxygenation in respiratory failure; however, it does not take PaCO2 into account, unlike the PaO2/FAO2 ratio (PaO2 divided by the alveolar fraction of oxygen). Objective: to evaluate the agreement between PaO2/FiO2 and PaO2/FAO2. Material and methods: observational, ambispective, cross-sectional and analytical study in patients older than 18 years, under invasive mechanical ventilation with respiratory failure and with different PaCO2 values. Results: agreement was analyzed in 64 gasometric measurements taken at admission and when the highest PaCO2 was documented, of 32 patients. The Bland and Altman analysis showed a mean of the differences (bias) of 13 and a 95% limit of agreement, between 54 and -24. Agreement is better when PaO2/FiO2 is greater than 150. Twenty two percent of the measurements did not agree in the assignment to groups with mild, moderate, or severe hypoxemia. Conclusions: there is moderate agreement between PaO2/FAO2 and PaO2/FiO2; however, in patients with severe hypoxemia, agreement is better. In patients with PaO2/FiO2 ≥ 150, hypercapnia partly explains the low agreement. PaO2/FAO2 is possibly a better way to assess the degree of oxygenation disturbance.

Resumo: Introdução: o cociente PaO2/FiO2 ajustado à pressão barométrica é utilizada para avaliar a oxigenação na insuficiência respiratória; entretanto, não considera a PaCO2, ao contrário da relação PaO2/FAO2 (PaO2 dividida pela fração alveolar de oxigênio). Objetivo: Avaliar a concordância entre PaO2/FiO2 e PaO2/FAO2. Material e métodos: estudo observacional, ambispectivo, transversal e analítico em pacientes maiores de 18 anos, sob ventilação mecânica invasiva com insuficiência respiratória hipoxêmica e com diferentes valores de PaCO2. Resultados: analisou-se a concordância em 64 gasometrias feitas na admissão e quando documentou-se a maior PaCO2, de 32 pacientes. A análise de Bland e Altman mostrou uma média das diferenças (bias) de 13 e limite de concordância de 95%, entre 54 e -24. A concordância é melhor quando a PaO2/FiO2 é maior que 150. 22% das medidas não concordaram na alocação dos grupos com hipoxemia leve, moderada ou grave. Conclusões: existe uma concordância moderada entre PaO2/FAO2 e a PaO2/FiO2; no entanto, em pacientes com hipoxemia grave a concordância é melhor. Em pacientes com PaO2/FiO2 ≥ 150, a hipercapnia explica em parte a baixa concordância. Possivelmente a PaO2/FAO2 seja a melhor forma de avaliar o grau de distúrbio da oxigenação.

Ajuste de la relación o cociente PaO2 /Fio2 a la presión barométrica en la ciudad de La Paz 3600 msnm / Adjustment of the PaO2 /fio2 ratio or ratio to barometric pressure in the city of La Paz 3600 masl

La hipoxemia es común en los pacientes en estado crítico, la misma que puede ser causada por hipoventilación, trastornos en la ventilación/perfusión, los cortocircuitos de derecha-izquierda, o en la limitación de la difusión a través de la membrana alvéolo-capilar. Otra de las causas puede ser como resultado de las bajas presiones inspiradas de O2 como sucede en grandes alturas. La hipoxemia es uno de los parámetros importantes para la definición del síndrome de dificultad respiratoria aguda (SDRA). La relación PaO2/FiO2 se incluye en la definición de la conferencia del Consenso AmericanoEuropeo (lesión pulmonar aguda ≤ 300 y SIRA si es ≤ a 200). La hipoxia hipobárica es una manifestación que existe y que no se ha tomado en cuenta para la definición de LPA/SIRA. Cuando disminuye la presión barométrica (PB) como consecuencia de la disminución de la presión atmosférica (P atm), disminuye la presión parcial de oxígeno (PO2). Una de las formas para determinar la PaO2/FiO2 en relación a la presión barométrica es: PB ajustada: PAO2 x PaO2/FiO2/100, una fórmula similar a la publicada por West JB y utilizada en el estudio Alveoli: PaO2/FiO2 ajustada = PO2/FIO2 x (PB/760). La relación PO2/FIO2 debe ajustarse dependiendo de la presión barométrica.

Evidencia que tres ciclos de prono aumentan la PaO2/FiO2 en el enfermo de neumonía por COVID-19 / Evidence that three prone cycles increase PaO2/FiO2 in patients with COVID-19 pneumonia

Introducción: Es posible deducir la mejoría o empeoramiento del intercambio gaseoso en el paciente con COVID-19 en ventilación mecánica invasiva mediante el índice PaO2/FiO2 tras el uso de la posición prono. Objetivos: Identificar los cambios en el índice PaO2/FiO2 tras el uso de tres ciclos de prono, y detallar las características sociodemográficas de los pacientes. Material y métodos: En este estudio descriptivo y retrospectivo se analizaron los expedientes clínicos de 60 pacientes con COVID-19, se tomaron en cuenta valores de PaO2/FiO2, saturación de oxígeno y datos sociodemográficos. Resultados: Con el uso de tres ciclos de posición prono de 24 horas cada uno, en promedio la PaO2/FiO2 aumentó 26.38 mmHg (20%) y la saturación de oxígeno aumentó un 6.3%. 66.7% de la población eran hombres, y el promedio de edad fue de 67.10 años. Limitación: Hubo limitaciones de carácter retrospectivo debido al contexto de la pandemia de COVID-19 y la alta carga de trabajo que imposibilitó la adecuada recolección de información relevante, como los tipos de tratamiento farmacológico y de soporte vital empleados. Conclusiones: El uso de la posición prono en el paciente orointubado con COVID-19 constituye una estrategia de primera línea, pues ha demostrado un aumento en la PaO2/FiO2, que resulta en una mejoría en la oxigenación/perfusión.

Introduction: The improvement or worsening of gas exchange in patients with COVID-19 on invasive mechanical ventilation can be determined through the PaO2/FiO2 index after using the prone position. Objectives: To identify changes in the PaO2/FiO2 index after three prone cycles, and to describe the sociodemographic characteristics of the patients. Material and methods: In this descriptive and retrospective study, the clinical records of 60 patients with COVID-19 were analyzed, PaO2/FiO2 oxygen saturation values and sociodemographic data were considered. Results: With the use of three prone position cycles of 24 hours each, on average, the PaO2/FiO2increased by 26.38 mmHg (20.09%) and oxygen saturation increased by 6.3%. Male population represented 66.7%, and the average age was 67.10 years. Limitation: There was retrospective limitations due to the COVID-19 pandemic context and high workload, which made difficult to adequately record relevant information, including types of pharmacological and life support treatments used. Conclusions: The prone position used on orointubated patient with COVID-19 constitutes a first-line strategy; it has shown an increase in PaO2/FiO2 values, which leads to an improvement in oxygenation/perfusion.

Acupuncture during convalescent period from SARS-CoV-2 (COVID-19) infection: A case report / 全日本鍼灸学会雑誌

[Introduction] There is as yet no clear medical treatment for acute phase COVID-19, and treatment of some cases using drugs alone have proved challenging. We report on a severely ill COVID-19 patient whose symptoms improved after receiving acupuncture during recovery from COVID-19.[Case] The patient was a 53-year-old man whose chief complaint was dyspnea. He developed dyspnea and fever on August 24 (20XX) and became aware of taste disturbances on August 27. His respiratory symptoms worsened during the evening of August 29, and he was transported to hospital via ambulance on August 31. He tested positive on a PCR test, and widespread pneumonia was observed, so he was hospitalized following a diagnosis of severe COVID-19.[Treatment] To improve the patient's breathing, acupuncture was used in combination with Chinese medicine (Kampo) to treat lung qi deficiency and kidney failing to receive qi. Chest pain which appeared during the treatment period and low back pain due to long-term bed rest were also treated. At the first acupuncture intervention, the fraction of inspiratory oxygen (FiO2) was 80% with high-flow oxygen therapy, and body movement was difficult. Following treatment, oxygen therapy became unnecessary (FiO2: 21%), and the patient was subsequently discharged from the hospital.[Discussion and Conclustion] This case indicates that acupuncture may be effective for improving respiratory symptoms during the acute phase of COVID-19. In this case, oxygen demand was improved by treatment of relevant acupoints based on Kampo diagnosis. However, one symptom which remained was that the chest did not expand upon inspiration. The relevant locale of this symptom was detected on the kidney meridian. The movement of the thorax was visually improved after performing thoracic acupoint, and oxygen saturation was also improved. In conclusion, it appears that acupuncture is effective for both the acute and chronic phases of COVID-19, and can be applicable for active intervention.

Correlación de índice PO2/FiO2 con parámetros inflamatorios y de coagulación en pacientes críticos con covid-19. Lombardía, 2020 / PO2/FiO2 index correlation with inflammatory and coagulation parameters in critically-ill patients with COVID-19 in Lombardy, 2020

RESUMEN Introducción: el conocimiento de la fisiopatología de la enfermedad ha revolucionado el enfoque tradicional en el tratamiento de las enfermedades causadas por virus respiratorios. Actualmente, se utilizan marcadores de la respuesta inflamatoria para diagnosticar, estratificar y predecir en muchos casos el comportamiento futuro del enfermo de covid-19. Objetivo: caracterizar la naturaleza de la relación entre el índice PO2/FiO2 y los parámetros inflamatorios y de coagulación en pacientes graves por la covid-19, en la región de Lombardía, Italia. Materiales y métodos: se realizó un estudio analítico, longitudinal, retrospectivo con 191 pacientes graves y críticos, que ingresaron con diagnóstico de covid-19 del 1 de abril al 20 mayo de 2020, en el Hospital Mayor de Crema, en la región de Lombardía, Italia. Resultados: las correlaciones evidenciadas fueron las siguientes: proteína C reactiva (-0,417) p = 0; procalcitonina (-0,152) p = 0,018; dímero D (-0,112) p = 0,061; fibrinógeno (-0,272) p = 0,000; creatinina plasmática (-0,320) p = 0,000; conteo de linfocitos (0,028) p = 0,000; troponina (-0,028) p = 0,142, y lactato (-0,191) p = 0,288. Conclusiones: los marcadores inflamatorios en la patogenia de la enfermedad juegan un rol capital, y el enfoque hacia este renglón del tratamiento médico antiinflamatorio de cualquier tipo es mandatorio. Se debe realizar un correcto monitoreo de la coagulación, usar heparinas de bajo peso molecular, así como mantener un adecuado soporte hemodinámico capaz de evitar las disoxias celulares que progresen al fallo multiorgánico (AU).

ABSTRACT Introduction: the knowledge of disease physiopathology has revolutionized the traditional approach in the treatment of diseases caused by respiratory viruses. Currently, the markers of inflammatory answer are used to diagnose, stratify and predict in many cases the future behavior of COVID-19 patients. Objective: to characterize the nature of the relationship between PO2/FiO2 (PAFI, Spanish acronym of PA= presión arterial [arterial pressure], FI=fracción inspirada [inspired fraction]) and coagulation and inflammatory parameters in seriously-ill patients with COVID-19, in the region of Lombardy, Italy. Materials and methods: a retrospective, longitudinal, analytic study was carried out in 191 severe and critical patients who were admitted in Hospadale Maggiori di Crema, in the region of Lombardy, Italy, with the diagnosis of COVID-19, in the period April 1st-May 20, 2020. Results: the evidenced correlations were the following: reactive C protein (-0.417) p=0; procalcitonin (PCT) (-0.152) p=0.018. D dimer (-0.112) p=0.061; Fibrinogen (-0.272) p=0.000; Plasma creatinine (-0.320) p=0.000; lymphocytes count (0,028) p=0,000; troponin (-0.028) p=0.142; and lactate (-0.191) p=0.288. Conclusions: inflammatory markers play a capital role in the disease pathogenesis, and approaching this item of the medical anti-inflammatory treatment is mandatory. It is useful to keep a correct coagulation screening, using low molecular weight heparins, and also keeping an adequate hemodynamic support able to avoid cell dysoxia progressing to multiorgan failure (AU).

Modelo temporal del comportamiento de pacientes críticos con covid-19 durante su estadía en cuidados intensivos. Lombardía, Italia / Temporal model of the behavior of critically ill patients with COVID-19 during their staying in intensive care. Lombardy, Italy

RESUMEN Introducción: una serie temporal es el producto de la observación de una variable en el tiempo. Es una herramienta matemática que se aplica con frecuencia en la salud. No se han elaborado modelos temporales que predigan el comportamiento de los pacientes durante su ingreso en la Unidad de Cuidados Intensivos. Objetivos: crear una serie temporal que permita predecir el comportamiento, durante su ingreso en la Unidad de Cuidados Intensivos, de pacientes graves producto de la covid-19 en la región de Lombardía, Italia. Materiales y métodos: analítico, longitudinal prospectivo con un grupo de pacientes críticos que ingresaron del 1 de abril al 1 de mayo de 2020, con diagnóstico de covid-19, en el Hospital Mayor de Crema, en la región de Lombardía, Italia. El universo estuvo constituido por 28 pacientes y se trabajó con el total de ellos. Resultados: composición por sexo: 48 % masculino. Media de edad: 83 años. Serie temporal: Modelo 1 que ajusta (Hold) PO2/FiO2 p = 0,251; Modelo 2 (ARIMA) SatO2/FiO2 p = 0,674 (en los dos primeros modelos el resultado se incrementó con los días, siguiendo un comportamiento predecible); Modelo 3 (ARIMA) p = 0,406 (en este caso, el resultado esperado decreció a medida que transcurrió el tiempo). Las funciones obtenidas permiten calcular el valor esperado según el día desde el ingreso. Conclusiones: predecir la evolución del paciente en la Unidad de Cuidados Intensivos permitió detectar tempranamente aquellos con una curva inesperada y dirigir hacia a ellos las terapéuticas más agresivas (AU).

ABSTRACT Introduction: a time series is the product of the observation of a variable in time. It is a mathematical tool frequently applied in health. No temporal models have been developed to predict patients' behavior during their staying in the Intensive Care Unit. Objectives: to create a time series allowing to predict the behavior of seriously-ill patients due to COVID-19, during their staying in the Intensive Care Unit in the region of Lombardy, Italy. Materials and methods: analytic, longitudinal prospective study with a group of critical patients who were admitted from April 1st to May 1st, with COVID-19 diagnosis, to Ospedale Maggiore di Crema, in the Lombardy region, Italy. The universe was formed by 28 patients and all of them were worked on. Results: 48% of patients were male. Average age: 83 years; Time series: Model 1 holding PO2/FiO2 p = 0.251; Model 2 (ARIMA) SatO2/FiO2 p = 0.674 (in the two first models the result increased with the days, following a predictable behavior=; Model 3 (ARIMA) p = 0.406 (in this case the expected result decreased as time passed). The obtained functions allow to calculate the expected value according to the day from the admission. Conclusions: predicting patient's evolution in the Intensive Care Unit allowed early detecting those with unexpected curves and targeting more aggressive therapies toward them (AU).

Impacto del decúbito prono en el síndrome de insuficiencia respiratoria aguda en pacientes con COVID-19 bajo ventilación mecánica invasiva / Impact of prone position on acute respiratory distress syndrome in patients with COVID-19 under invasive mechanical ventilation / Impacto de la posição prona na síndrome da insuficiência respiratória aguda em pacientes com COVID-19 sob ventilação mecânica invasiva

Resumen: A finales del año 2019 surgió una nueva especie de coronavirus con la capacidad de producir enfermedad en humanos, conocida como SARS-CoV-2 y definiéndose la enfermedad como COVID-19. A partir de marzo del 2020 se comenzaron a presentar casos de neumonía por SARS-CoV-2 en el Hospital Español de México, algunos de estos pacientes desarrollaron la enfermedad grave requiriendo ventilación mecánica invasiva. Se realizó el estudio de una serie de casos, de tipo descriptivo, transversal, retrolectivo y analítico, desde mayo de 2020 hasta agosto de 2020, en pacientes ingresados en el área de terapia intensiva COVID en dicho hospital. Se obtuvo una muestra de 42 pacientes, 32 (76%) hombres y 10 (24%) mujeres, con neumonía severa por SARS-CoV-2 e hipoxemia refractaria con un cuadro de síndrome de insuficiencia respiratoria aguda (SIRA) moderado (PaO2/FiO2 < 200) a severo (PaO2/FiO2 < 100), los cuales necesitaron ventilación mecánica invasiva y por hipoxemia refractaria al menos un evento de decúbito prono. La duración mínima de cada episodio de prono fue al menos de 24 horas, teniendo como mínimo un evento de decúbito prono y como máximo siete eventos, con un promedio global de 2.7 eventos de decúbito prono. El tiempo máximo prono por evento fue de 36 horas continuas, teniendo un promedio de 30.1 horas en decúbito prono. Se logró establecer que los pacientes en decúbito prono presentaron una mejoría respecto al índice de oxigenación (PaO2/FiO2) con una p < 0.01, a diferencia de otros indicadores de oxigenación tales como PaO2 y PaCO2, donde no se encontró suficiente evidencia respecto a ser predictor sobre mortalidad y gravedad.

Abstract: At the end of 2019, a new species of coronavirus identified as SARS-CoV-2 emerged, with the ability to cause disease in humans, defined as COVID-19. As of March 2020, cases of SARS-CoV-2 pneumonia began to appear at the Hospital Español de México, some of these patients developed severe disease requiring invasive mechanical ventilation. A descriptive, cross-sectional, retrolective and analytical study of cases was conducted from May to August 2020, in patients admitted to the COVID intensive care area at said hospital. A sample of 42 patients was obtained, 32 (76%) men and 10 (24%) women, with severe pneumonia due to SARS-CoV-2 and refractory hypoxemia with a picture of acute respiratory insufficiency syndrome (SIRA) from moderate (PaO2/FiO2 < 200) to severe (PaO2/FiO2 < 100), which required invasive mechanical ventilation and for refractory hypoxemia at least one event in the prone position. The minimum duration of each prone episode was at least 24 hours, with a minimum of one decubitus and prone events and a maximum of seven events, with a global average of 2.7 prone events. The maximum prone time per event was 36 continuous hours, with an average of 30.1 hours in the prone position. It was possible to establish that patients in the prone position presented an improvement regarding the oxygenation index (PaO2/FiO2) with a p < 0.01, unlike other characteristics such as PaO2 and PaCO2, where not enough evidence was found with regard to being a predictor of mortality and gravity.

Resumo: No final de 2019, surgiu uma nova espécie de Coronavírus com capacidade de causar doença em humanos, identificando-se como COVID-19 e definindo a doença como SARS-CoV-2. Em março de 2020, casos de pneumonia por SARS-CoV-2 começaram a aparecer no Hospital Español de México, alguns desses pacientes desenvolveram doença grave que requereram ventilação mecânica invasiva. Uma série de casos descritivos, transversais, retroletivos e analíticos foi realizada de maio de 2020 a agosto de 2020 em pacientes internados na área de terapia intensiva COVID do Hospital Español de México. Uma amostra de 42 pacientes, 32 (76%) homens e 10 (24%) mulheres, com pneumonia grave por SARS-CoV-2 e hipoxemia refratária com síndrome de insuficiência respiratória aguda (SIRA) moderada (PaO2/FiO2 < 200) a grave (PaO2/FiO2 < 100), que exigiu ventilação mecânica invasiva e devido à hipoxemia refratária pelo menos um evento em decúbito prono. A duração mínima de cada episódio na posição prona foi menor a 24 horas, tendo como mínimo de 1 evento decúbito e prona e como máximo de 7 eventos, com uma média global de 2.7 eventos em decúbito prona. O tempo máximo em prona por evento foi de 36 horas contínuas, com média de 30.1 horas na posição prona. Foi possível estabelecer que os pacientes em decúbito prona apresentaram melhora em relação ao índice de oxigenação (PaO2/FiO2) com p < 0.01, ao contrário de outros indicadores de oxigenação como PaO2 e PaCO2, não foram encontradas evidências suficientes de ser um preditor de mortalidade e gravidade.

A study to validate thoracic trauma severity score in chest trauma patients

Background: Aim of this study was to validate thoracic trauma severity score (TTSS) in assessing the requirement of mechanical ventilation, mortality, and predicting prognosis in chest injury patients.Methods: This study was conducted in department of general surgery, Dr. S. N. Medical College, Jodhpur, Rajasthan, from December 2018 to September 2019. This was a single centred, prospective, observational study, conducted in 110 patients, aged >18 years, of isolated chest injury, excluding polytrauma patients. Data was summarized in the form of proportions, histograms and tables to show relationships of parameters with results. Data was presented as mean±SD and proportions as appropriate. Chi square test, z test or t tests were used wherever necessary for association analysis between categorical variables. Diagnostic test characteristics for mortality and complications was calculated from the ROC curves. A two sided of p values of less than 0.05 was considered statistically significant.Results: Most common mode of chest injury was blunt trauma and most common age group affected was 42-54 years. Maximum mortality was seen in TTSS between 16-20, shows higher the TTSS more the mortality. Ventilator requirement was more in high TTSS. Patients with higher TTSS had longer hospital stay as compared to patients with lower TTSS.Conclusions: On application of TTSS on admission, TTSS had direct correlation with need for oxygenation, ventilator need, duration of hospital stay, mortality or outcome in chest trauma patients. Thus we recommend TTSS as a good useful score for evaluation of prognosis, outcome and mortality in chest trauma patients.

Correlación de SpO2/FiO2 versus PaO2/FiO2 para monitoreo de la oxigenación en pacientes con trauma de tórax / Correlation of SPO2/FiO2 versus PaO2/FiO2 for oxigenation monitoring in patients with thorax trauma / Correlação de SPO2/FiO2 versus PaO2/FiO2 para monitoração de oxigenação em pacientes com trauma tórax

Resumen: Introducción: La monitorización de la oxigenación se ha realizado tradicionalmente mediante índices como PaO2/FiO2, que requieren de toma de gasometrías para su determinación. La tendencia de una monitorización mínimamente invasiva propone utilizar la saturación de pulso en el índice SpO2/FiO2 con el mismo fin. El índice SpO2/FiO2 tiene ventajas: obtención rápida y no requiere de gasometría. Rice y cols. hicieron la comparación SpO2/FiO2 y PaO2/FiO2, demostrando la validación del índice Patrick y cols. lo incorporaron a la escala SOFA, Kigali mostró la importancia de monitoreo mínimamente invasivo con SpO2/FiO2 y USG pulmonar en SDRA, proponiendo una clasificación comparable con la de Berlín. Objetivos: Demostrar que existe correlación entre SpO2/FiO2 versus PaO2/FiO2 para monitoreo de la oxigenación en los pacientes con trauma de tórax. Material y métodos: Se realizó un estudio observacional, descriptivo, longitudinal y ambispectivo en 25 pacientes ingresados con diagnóstico de trauma de tórax entre enero de 2016 y abril de 2017 en el servicio de cuidados intensivos, de los cuales se excluyeron cinco pacientes. Se realizó un análisis estadístico utilizando correlación bivariada de Pearson y, si ésta fuera significativa, una correlación lineal para determinar el grado de la misma. Se realizó determinación de medias de edad, género, tipo de trauma, días de ventilación mecánica y defunción. Los resultados se analizaron con el programa estadístico SPSS versión 21.0. Conclusiones: Existe desde el ingreso una correlación lineal significativa entre ambos índices, dicha correlación es mayor de 60% desde el ingreso; sin embargo, adquiere mayor significancia estadística con un grado de correlación hasta de 90% a partir de las 24 horas y hasta el fin del estudio. Consideramos, por tanto, una prueba útil y significativa para valorar la oxigenación en pacientes con trauma de tórax.

Abstract: Introduction: Traditionally, oxygenation monitoring has been performed using indices such as PaO2/FiO2, which requires the determination of gasometry. The trend of minimally invasive monitoring proposes to use pulse saturation in the SpO2/FiO2 index for the same purpose. The SpO2/FiO2 index has advantages: rapid obtaining and not requiring gasometry. Rice performed the SpO2/FiO2 and PaO2/FiO2 comparison demonstrating index validation, Patrick incorporates it into the SOFA scale, Kigali shows the importance of minimally invasive monitoring with SpO2/FiO2 and pulmonary USG in ARDS by proposing a comparable classification with that of Berlin. Objectives: To demonstrate that there is a correlation between SpO2/FiO2 vs PaO2/FiO2 for monitoring of oxygenation in patients with chest trauma. Material and methods: An observational, descriptive, longitudinal, ambispective study was performed in 25 patients admitted with a diagnosis of chest trauma between January, 2016 and April, 2017, in the Intensive Care service, of which 5 patients were excluded. A statistical analysis was performed using Pearson's bivariate correlation, and if a linear correlation was significant to determine the degree of correlation. Determination of means of age, gender, type of trauma, mechanical ventilation and death were determined. The results were analyzed with the statistical program SPSS version 21.0. Conclusions: There is a significant linear correlation between the two indexes, a correlation that is greater than 60% from the time of admission, but it acquires the highest statistical significance with a degree of correlation up to 90% from 24 hours to the end Of the study. We therefore consider a useful and significant test to assess oxygenation in patients with chest trauma.

Resumo: Introdução: Tradicionalmente, o monitoramento da oxigenação tem sido realizado por meio de índices como PaO2/FiO2, que exigem o uso de gasometrias para sua determinação. A tendência do monitoramento minimamente invasivo propõe o uso da saturação de pulso no índice SpO2/FiO2 para o mesmo fim. O índice SpO2/FiO2 apresenta vantagens: obtenção rápida e não requerer gasometria. Rice fez a comparação SpO2/FiO2 e PaO2/FiO2 demonstrando a validação do índice, Patrick incorpora na escala SOFA, Kigali mostra a importância da monitorização minimamente invasiva com SpO2/FiO2 e USG pulmonar na SDRA, propondo uma classificação comparável à de Berlim. Objetivos: Demonstrar que há correlação entre a SpO2/FiO2 e a PaO2/FiO2 no monitoramento da oxigenação em pacientes com trauma torácico. Material e métodos: Estudo observacional, descritivo, longitudinal, ambispectivo, realizado em 25 pacientes admitidos com diagnóstico de trauma torácico, entre janeiro de 2016 e abril de 2017, na Unidade de Terapia Intensiva, dos quais 5 pacientes foram excluídos. Uma análise estatística foi realizada usando a correlação bivariada de Pearson, e se esta fosse significativa, uma correlação linear para determinar o grau de correlação da mesma. Determinamos as médias de idade, sexo, tipo de trauma, dias de ventilação mecânica e morte. Os resultados foram analisados com o programa estatístico SPSS versão 21.0. Conclusões: Existe uma correlação linear significativa entre os dois índices, tal correlação é maior que 60% desde a internação, mas adquire a maior significância estatística com um grau de correlação de até 90% a partir das 24 horas e até final do estudo. Portanto, consideramos um teste útil e significativo para avaliar a oxigenação em pacientes com trauma torácico.

ARDS severity identification based on noninvasive parameter SpO2/FiO2 / 医疗卫生装备

Objective To explore the relationship between SpO2/FiO2(S/F) and PaO2/FiO2(P/F) so as to determine the possibility of ARDS severity identification based on noninvasive parameters. Methods The physiological parameters of corresponding patients were acquired from Medical Information Mart for Intensive Care (MIMIC-Ⅲ),and then divided into a training set and a test set randomly.In the training set the linear relationship between lg(S/F)and lg(P/F)was established with generalized linear regression model,and a log linear regression model was formed with the optimal regression equation;the linear relationship between lg(S/F)and lg(P/F)was compared with that between S/F and P/F.In the test set,the two models were compared on the identification of ARDS in case P/F values were 100(mild ARDS),200(moderate ARDS)and 300(severe ARDS)respectively.Results In the training set(n=61 634)the linear relationship between lg(S/F)and lg(P/F)was deduced as lg(S/F)=1.277+0.437×lg(P/F) (r=0.66,P<0.000 1),and the S/F thresholds in case P/F values were 100,200 and 300 respectively were 131,201 and 271.In the test set (n=26 758)the identification effect was verified with the acquired S/F thresholds,which proved better than that of traditional regression model.Conclusion Noninvasive parameter SpO2/FiO2can replace PaO2/FiO2for the auxiliary diagnosis of ARDS in case the result of blood gas analysis is absent.

Efecto de la aspirina en la mortalidad del síndrome de distrés respiratorio agudo en pacientes internados en la Unidad de Cuidados Intensivos del Hospital Juárez de México / Effect of aspirin on the mortality of acute respiratory distress syndrome in patients admitted to the Intensive Care Unit of the Juarez hospital in Mexico / Efeito da aspirina sobre a mortalidade na síndrome da angústia respiratória aguda em pacientes internados na unidade de terapia intensiva do Hospital Juárez de México

Resumen: Objetivo: Determinar el efecto en la morbimortalidad del uso de la aspirina después de 28 días en pacientes con SDRA. Material y métodos: Se realizó un ensayo clínico experimental, prospectivo aleatorizado simple durante el periodo comprendido del 01 diciembre de 2015 al 30 de junio de 2016 en la UCI del Hospital Juárez de México. Se incluyeron todos los pacientes que ingresaron a la UCI durante el periodo de estudio con diagnóstico de SDRA y se dividieron en dos grupos de manera aleatoria. Al grupo A se le administraron 100 mg de aspirina además del tratamiento estándar para SDRA y el grupo B sólo recibió tratamiento médico estándar para SDRA. Se cuantificaron los cambios en los valores de PaO2/FiO2, los valores de DA-aO2 y de Cstat, días de ventilación mecánica, así como la asociación de los valores del score APACHE II y su relación con la morbimortalidad en ambos grupos. Se utilizó la prueba estadística T de Student para variables independientes. Resultados: La mortalidad en el grupo A fue de 60% versus 80% en el grupo B. No se evidenció diferencia entre ambos grupos en la PaO2/FiO2 (p = 0.097). En el grupo A se observó una media de días de ventilación mecánica de 15.8 días versus 16.8 en el grupo B (p = 0.860, IC 95%), respecto a los días de estancia en la UCI y estancia intrahospitalaria no hubo diferencia estadísticamente significativa. Conclusiones: El uso de aspirina en pacientes con SDRA establecido, independientemente de su gravedad, no disminuye la mortalidad, ni acorta los días de estancia en la UCI o de estancia hospitalaria, como tampoco reduce los días de ventilación mecánica, ni mejora la PaO2/FiO2, la DAaO2 o la Cstat.

Abstract: Objective: To determine the effect on morbidity and mortality at 28 days with the use of aspirin in patients with ARDS. Material and methods: An experimental, prospective randomized clinical trial simply was conducted during the period from December 1, 2015 to June 30, 2016 in the ICU of Hospital Juarez of Mexico. all patients admitted to the ICU during the study period with a diagnosis of ARDS and were divided into two groups randomly included. Group A received 100 mg of aspirin in addition to standard treatment for ARDS, group B received only standard medical treatment for ARDS. changes in the values of PaO2/FiO2, the values of the DA-aO2 and CESTAT, days of mechanical ventilation, as well as the association of the values of APACHE II score and its relationship with morbidity and mortality in both groups were quantified. Statistical T Student test was used for independent variables. Results: Mortality in group A was 60% versus 80% in group B. No difference was observed in both groups in the PaO2/FiO2 (p = 0.097). In group A, an average of days of mechanical ventilation of 15.8 days versus 16.8 in group B (p = 0.860, 95%) compared to the days of stay in the ICU and hospital stay was found no statistically significant difference was observed. Conclusions: The use of aspirin in patients with ARDS established, regardless of severity; it does not decrease mortality, days of stay in the ICU or Hospital, nor diminish the days of mechanical ventilation, or improve PaO2/FiO2, the DAaO2, and CESTAT.

Resumo: Objetivo: Para determinar o efeito sobre a morbimortalidade aos 28 dias com o uso da aspirina em pacientes com SARA. Material e métodos: Realizou-se um ensaio clínico experimental, prospectivo randomizado simples, durante o período compreendido de 01 de dezembro de 2015 a 30 de junho de 2016 na UTI do Hospital Juárez do México. Foram incluídos todos os pacientes admitidos na UTI durante o período do estudo com um diagnóstico de SARA e foram divididos em dois grupos aleatoriamente. O Grupo A recebeu 100 mg de aspirina ademais do tratamento padrão para a SARA, o grupo B recebeu apenas o tratamento médico padrão para a SARA. Foram quantificados as alterações nos valores da PaO2/FiO2, valores DA-aO2 e Cestat, dias de ventilação mecânica, associação dos valores da pontuação APACHE II e a sua relação com a morbimortalidade em ambos os grupos. Se utilizou a prova estatística teste T Student para variáveis independentes. Resultados: A mortalidade no grupo A foi de 60% versus 80% no grupo B. Não se evidenciou diferença em ambos grupos na PaO2/FiO2 (p = 0.097). No Grupo A encontramos uma média de dias de ventilação mecânica de 15.8 dias versus 16.8 no grupo B (p = 0.860, IC 95%), com respeito aos dias de permanência na UTI e estadia hospitalar não observamos nenhuma diferença estatisticamente significativa. Conclusões: O uso da aspirina em pacientes com SARA estabelecido, independentemente da gravidade, não diminui a mortalidade, os dias de estadia na UTI e a estância hospitalar, assim como não diminui os dias de ventilação mecânica e não melhora a PaO2/FiO2, a DAaO2, e a Cestat.

The early diagnosis value of the serum surfactant protein a in critically ill acute lung injury of HFMD / 重庆医学

Objective To explore the early diagnosis clinical value of the serum surfactant protein-A (SP-A) against acute lung injury on HFMD (hand ,foot and mouth disease) in critically ill .Methods 60 cases of HFMD were selected in Xingtai People′s Hospital from August 2010 to December 2011 ,and they were divided into three groups .20 were ordinary cases ,28 were severe cases and 12 were critical cases(4 cases dead) .According to PaO2/FiO2 of ALI ,3 of critical cases (PaO2/FiO2 >300 mm Hg) were put into the non lung injury group and 9 (PaO2/FiO2 ≤300 mm Hg) were put into the lung injury group .Besides ,15 cases of healthy children were selected as the control group .The changes of the serum SP-A levels in these children were detected through ELISA methods after 24 h and 72 h .Results Contrasting the serum SP-A levels in the ordinary and severe groups separately with the ones in control group ,there was no statistical significance(P>0 .05) and so was contrasting the serum SP-A levels in the ordinary group with the ones in the severe group ,and the serum SP-A levels in the critical group after 24 h was significantly higher than the ordina-ry and severe groups (P0 .05) ,con-trasting with ones in the control group ;but the serum SP-A levels in the lung injury group after 24 h were significantly higher than ones in the control group and in the non lung injury group (P<0 .05) .Conclusion Detection of the serum SP A has clinical value of the early diagnosis of acute lung injury on HFMD in critically ill ,which is beneficial to guide the clinical treatment .Meanwhile , it can reduce the mortality rate and the sequela ,and help to diagnose the condition of acute lung injury and treat it .

The Effect of Prone Position on Fio2 Level in Premature Baby Who Received Ventilator

Literature study about the position of infant who has respiratory problem indicates that Prone Position (PP) is more beneficial compared to Supine Position (SP). One of monitoring action done by nurse while baby is receiving mechanical ventilator is baby’s need monitoring of concentration of inspired oxygen (FiO2). The purpose of this study is to identify the effect of Prone Position to oxygenation status (FiO2) of baby who received mechanical ventilation at NICU RSUPN dr. Cipto Mangunkusumo. The research design is pre experimental one group pretest posttest. Sample of this research is 18 babies. FiO2 level in this research was measured before PP, 30 minutes after PP, 1 hour after PP, and 2 hours after PP. Sample of this research is 18 babies by characteristics; age of 44,78±25,06 days; boys 61%; girls 39%; birth weight: 2008,33±977,84; mode of ventilator: pressure support; used synchronized intermittent mandatory ventilation and assist control; and length of use ventilator: 36,67±19,57 days. Babies’ birth weight who received mechanical ventilation and PP is 2008,33 grams on average and the standard deviation is 977,84 grams. There are no significance difference between birth weight and FiO2. The result shows that there are no significance differences of Fi02 in babies who received mechanical ventilation before and after receiving prone position. There is a significant difference in measurement before and 2 hours after PP. Moreover, there is a tendency that the more of baby’s weight, the lower of the FiO2. From that research, the recommendation of nursing implication is to improving PP intervention to babies who are in stable condition and weaning process. It is needed to conduct an advanced research with a big amount of sample, conducted by quasi experiment or true experiment method with custody variable controlling. It is also needed more analyzes for the correct PP time.

Evaluación de la ventilación mecánica no invasiva en pacientes con insuficiencia respiratoria aguda / Evaluation of non-invasive ventilation in patients with acute respiratory failure

Antecedentes: Existe evidencia que avala la utilidad de la ventilación mecánica no invasiva (VMNI) en el manejo de la insuficiencia respiratoria aguda (IRA), no obstante, la definición de variables que permitan predecir el éxito o fracaso de este recurso terapéutico es controversial. Objetivo: Evaluar el comportamiento de parámetros clínicos y de laboratorio en relación con el éxito o fracaso de la VMNI en pacientes con IRA. Metodología: Estudio prospectivo de cohorte descriptivo que incluye pacientes consecutivos que cumplieron con criterios de conexión a VMNI e ingresaron a la UPC de Clínica Alemana de Santiago entre marzo de 2005 y julio de 2007. Los pacientes se dividieron en dos grupos, aquellos que fracasan con VMNI y requirieron intubación, grupo fracaso (GF) y los que no la requirieron, grupo éxito (GE). Se registraron variables demográficas, APACHE II, diagnóstico de ingreso. La mecánica respiratoria, gasometría arterial y hemodinámica se obtuvieron en tres momentos de la evolución evolución: previo a la conexión, a las dos horas y al término del uso de VMNI (preintubación y destete de VMNI). Resultados: De los 132 pacientes incluidos se logró evitar la intubación en 99 de ellos (75 por ciento), 33 fueron intubados (25 por ciento), de los cuales 1 falleció. El pH fue menor en el GF (7,42+/-0,06 v/s 7,39+/-0,08; p =0,04). La saturación de oxígeno por pulsioximetría (SpO2) también fue menor en el GF tanto a las dos horas (96+/-2 v/s 95+/-3; p=0,01) como al final del uso de VMNI (96+/-2 v/s 95+/-3; p =0,04). La PaO2/FiO2 fue menor en el mismo grupo, en los tres momentos de medición: previo a la conexión (196+/-66 v/s 144+/-59; p =0,001), a las dos horas (223+/-92 v/s 179+/-88;p =0,022) y al término del uso de VMNI (252+/-78 v/s 208+/-104; p =0,021). Al final del uso de VMNI, tanto la frecuencia cardiaca (FC) (86+/-16 v/s 94+/-20; p =0,03) como el nivel de IPAP (12+/-2 v/s 13+/-3; p =0,02) fueron mayores en el GF. Conclusiones: El GF muestra..

Background: There is evidence supporting the benefits of non-invasive ventilation (NIV) in the treatment of acute respiratory failure (ARF), however, the role of different variables in the evaluation of this technique’s success are controversial. Objective: To evaluate the performance of the different clinical parameters and relate them with the success and failure of NIV in patients with ARF. Methodology: Prospective study of descriptive cohort that includes consecutive patients who fulfilled criteria of connection to NIV and entered to the ICU (Intensive Care Unit)of Clínica Alemana de Santiago between March of 2005 to July 2007. These patients were divided into two groups, those presenting failure with NIV and required intubation, failure group (GF) and those that did not require it, success sgroup (GE). The demographic registered variables measured were APACHE II, diagnosis of entrance were registered. The respiratory mechanics, arterial gasometry and haemodynamics were obtained at three moments of the evolution: previous to the connection, the two hours and at the end of the use of NIV (pre-intubation and weaning of NIV). Results: From the 132 patients included, intubation was avoided in 99 of them (75 percent) 33 percent were entubated from which only 1 died. The pH was lower in the FG (7.42 +/- 0.06v/s 7.39 +/- 0.08; p = 0.04). The oxygen saturation by pulsometry (SpO2), was also lower in the GF after two hours (96+/-2 v/s 95+/-3; p =0.01) and at the end of NIV use (96+/-2 v/s 95+/-3; p =0.04). The PaO2/FiO2 was lower in the same group, at the three moments of measurement: previous to the connection (196+/-66 v/s 144+/-59; p =0.001), two hours post connection (223+/-92 v/s 179+/-88; p =0.022) and at the end of the NIV use (252+/-78 v/s 208+/-104; p =0.021). At the end of the NIV use both, the cardiac frequency (FC) (86+/-16 v/s94+/-20; p =0.03) and the IPAP level (12+/-2 v/s 13+/-3; p=0.02)...

Correlation between Changes of Intrapulmonary Right to Left Shunt and Improvements in Oxygenation after Exogenous Surfactant Administration in Preterm Respiratory Distress Syndrome

PURPOSE: This study was aimed to investigate the relationship between changes in intrapulmonary right to left shunt(QSP/QT) and improvements in oxygenation during the 2-hr study period after Surfactant-TA(S-TA) administration. METHODS: Umbilical arterial blood gases and corresponding respiratory indexes of 27 preterm neonates with respiratory distress syndrome were studied. The neonates were separated into group A(n=20) and group B(n=7) according to whether their initial QSP/QT was above or below 30 %, respectively. And the patients were studied immediately before and after endotracheal single- dose S-TA administration within 6 hours after birth. RESULTS: In the case of P(a/A)O2, group A showed a significant increase throughout the study period(P<0.01, P<0.001), whereas group B showed an initial significant increase at 2 hr(P<0.05). Significant correlations between changes in QSP/QT and improvements in P(a/A)O2 were seen in both groups(P<0.001, P<0.05). Moreover in the case of PaO2/FIO2, group A showed a significant increase throughout the study period(P<0.01, P<0.001), whereas group B showed an initial significant increase at 30 min(P<0.05). Significant correlations between changes in QSP/QT and improvements in PaO2/FIO2 were also seen in both groups(P<0.01, P<0.05). And at 2 hr, VEI and VA showed a significant increase in both groups(P<0.05, P<0.01), whereas PaCO2 showed a significant decrease in both groups(P<0.001, P<0.05). CONCLUSION: Irrespective of initial QSP/QT, immediate improvements in oxygenation following surfactant replacement were accomplished by recruiting atelectatic alveoli and stablizing underventilated alveoli(namely by decreasing QSP/QT). Moreover, the patients with more severe respiratory failure had a more rapid and sustained improvement in oxygenation.

Evaluation of Weaning Criteria from Mechanical Ventilatory Support / 대한구급학회지

Introduction: A number of indices have been proposed as accurate predictors of weaning, but several studies have questioned the accuracy of these weaning indices in predicting the capability of independent breathing. The purpose of the study was to assess six standard bedside weaning criteria of mechanically ventilated patients in Surgical intensive care unit (SICM). METHOD: : The study was performed on 72 SICU patients who were mechanically ventilated. According to the outcome of weaning, they were divided into two groups, weaning success (n=62) and weaning failure (n=10) group. All subjects should have PaO2 above 60 mm Hg at an FIO2 of 0.4 and PEEP of 3~5 cm H2O in the extubated patients and no PEEP in the tracheostomy patients. Six bedside weaning criteria were tidal volume above 5 ml/kg, respiratory rate below 25/min, vital capacity above 10 ml/kg, maximum inspiratory pressure below -20 cm H2O, minute volume below 10 L/min and PaO2/FIO2 above 200. Weaning failure was regarded as follows; changes of systolic blood pressure 20 mm Hg or diastolic pressure 10 mm Hg, changes of pulse rate 20 beat per minute, respiratory rate above 30 per minute or increased respiratory rate above 10 per minute, PaO2 below 60 mm Hg or PaCO2 above 55 mm Hg, and presence of paradoxical respiratory pattern. RESULTS: PaO2/FIO2 and minute volume (VE) were showed statistically significant difference between two groups (P=0.048, P=0.003 respectively). Linear discriminant function was D=-1.422-0.005-xPaO2/FIO2+0.336xVE. CONCLUSION: Our study demonstrates that PaO2/FIO2 and minute volume accurately predicts the weaning outcome in the surgical patients with mechanical support.

The Study of the Effect of Maternal FiO2 on the Umbilical Blood Gas Analysis and Maternal Awareness in Cesarean Section under General Anesthesia / 대한마취과학회지

General anesthesia for cesarean section usually includes 50% oxygen and nitrous oxide, supplemented by a low concentration of a volatile agent. This is based upon data demonstrating that an increase in maternal FiO2(inspired oxygen concentration) to more than 0.6 did not improve fetal oxygenation, But the use of 100% oxygen supplemented only by volatile anesthetics probably is safe in the case of emergency operation or fetal distress and advantageous in prevention of maternal awareness during cesarean section. The present study was designed to compare the effect of increasing FiO2 upon fetal oxygenation. It was also proposed to determine awareness, by questioning patients as well about dreams or other manifestations of inadequate depth of anesthesia. 30 patients undergoing cesarean section under general anesthesia were selected and they were allocated randomly into three groups according to FiO2 as follows; Group 1(n=10): FiO2 0.33 with 0.75 vo1% isoflurane, Group 2(n=10): FiO2 0.66 with 0.75vo1% isoflurane, Group 3(n= 10): FiO2 1.0 with 0.75 vo1% isoflurane. For the induction of anesthesia, thiopental 4 mg/kg was administered, followed by succinylcholine 1.5 mg/kg. After intubation, the lung was ventilated with different FiO2 and maternal arterial blood was sampled just before delivery and umbilical arterial and venous blood were sampled immediately after delivery. Induction to delivery time(IDT), uterine incision to delivery time(IDT), neonatal birth weight and Apgar score were measured. The patient was interviewed to evaluate the incidence of awareness three days after operation. Our results were as follows; There were statistically significant differences between three groups in maternal PaO2, but there were no statistically significant differences between three groups in umbilical arterial and venous oxygenation. Induction to delivery time(IDT) in group 1 was significantly short, compared to group 2 and 3, but uterine incision to delivery time(UDT) was not statistically difference between three groups. The condition of the neonates at birth was generally good except one in group 2. But, this neonate recovered as 5-min Apgar score of 9 after aspiration of amnionic fluid and oxygen administration. Two patients reported dreaming, pain recall or fact recall and one of them refused to be administrated the same anesthesia once again, respectively in three groups. In conclusion, the use of FiO2 0.33 is probably safe in no fetal distress while the use of FiO2 1.0 results in no increase of oxygen partial pressure of umbilical artery and vein, but it guarantees the safe method in the case of suspecting fetal depression. Our anesthetic method was not enough to prevent the awareness. So, further study about not only deep, but also safe anesthetic method is justified.

The Study of Oxygen Therapy with Modified T - piece in Pediatric Patients after Open Heart Surgery / 대한마취과학회지

Oxygen therapy is the important method of critical care especially to pediatric patients of post-open heart surgery. The purpose of this study is to investigate the effect of oxygen therspy with modified T-piece in pediatric patients. We supply oxygen via modified T-piece after ventilatory weaning as following rates in turn : group 1; 0.05L/min/kg, group 2; 0.1L /min/kg, group 3; 0.3L/nun/kg, group 4; 0.5L/min/kg. Arterial blood gas analysis was done and heart rate, systolic and diastolic blood pressure, body temperature and oxygen sat uration were recorded. We defined absolute oxygen flow as oxygen flow/weight x weight. The relationshiop between oxygen flow/weight or absolute oxygen flow and PaO2 SaO2, was statistically significant. We got the regression equation as following : PaO2,=119.7xoxygen flow/weight+132.7 (R2=0.13), SaO2=3.2xoxygen flow/weight+97.9 (R2=0.11), PaO2=6.7Xabsolute oxygen flow+141.6 (R2=0.11), SaO2=0.16Xabsolute oxygen flow+96.2 (R2= 0.1). There were significant factors, by which PaO2, was influenced, such as oxygen flow/ weight(Pearson correlation coefficient, r=0.34), absolute oxygen flow(r=0.37), SaO2(r= 0.57), heart rate(r=-0.35), body temperature(r=0.21). As the result of mutiple regression analysis of these factors, we got the regression equation as following : PaO2=-1254.8+67.1Xoxygen flow/weight+14.5XSa0-1.6XPaCO2-0.5XheartXrate+ 2.7Xbody tempersture (R2= 0.44), PaO2=-1240+5.4Xabsolute oxygen flow+14.0XSaO2-1.4 PaCO2-0.6Xheart rate+4.0 body temperature-2.1Xweight (R2=0.46) It were group 1; 0.66, group 2; 0.69, group 3; 0.71, group 4; 0.75 that were calculated FIO2 using AaDO2 in case of FIO2=1.0 and increased significantly. However, because R2 that we got in the regression equation is too small, even though there is statistical significance, we think that clinical application of the result of our study is difficult.

The Study of Oxygen Therapy with Modified T - piece in Pediatric Patients after Open Heart Surgery / 대한마취과학회지

Oxygen therapy is the important method of critical care especially to pediatric patients of post-open heart surgery. The purpose of this study is to investigate the effect of oxygen therspy with modified T-piece in pediatric patients. We supply oxygen via modified T-piece after ventilatory weaning as following rates in turn : group 1; 0.05L/min/kg, group 2; 0.1L /min/kg, group 3; 0.3L/nun/kg, group 4; 0.5L/min/kg. Arterial blood gas analysis was done and heart rate, systolic and diastolic blood pressure, body temperature and oxygen sat uration were recorded. We defined absolute oxygen flow as oxygen flow/weight x weight. The relationshiop between oxygen flow/weight or absolute oxygen flow and PaO2 SaO2, was statistically significant. We got the regression equation as following : PaO2,=119.7xoxygen flow/weight+132.7 (R2=0.13), SaO2=3.2xoxygen flow/weight+97.9 (R2=0.11), PaO2=6.7Xabsolute oxygen flow+141.6 (R2=0.11), SaO2=0.16Xabsolute oxygen flow+96.2 (R2= 0.1). There were significant factors, by which PaO2, was influenced, such as oxygen flow/ weight(Pearson correlation coefficient, r=0.34), absolute oxygen flow(r=0.37), SaO2(r= 0.57), heart rate(r=-0.35), body temperature(r=0.21). As the result of mutiple regression analysis of these factors, we got the regression equation as following : PaO2=-1254.8+67.1Xoxygen flow/weight+14.5XSa0-1.6XPaCO2-0.5XheartXrate+ 2.7Xbody tempersture (R2= 0.44), PaO2=-1240+5.4Xabsolute oxygen flow+14.0XSaO2-1.4 PaCO2-0.6Xheart rate+4.0 body temperature-2.1Xweight (R2=0.46) It were group 1; 0.66, group 2; 0.69, group 3; 0.71, group 4; 0.75 that were calculated FIO2 using AaDO2 in case of FIO2=1.0 and increased significantly. However, because R2 that we got in the regression equation is too small, even though there is statistical significance, we think that clinical application of the result of our study is difficult.