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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.
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Objective To investigate the improvement of oxygenation after the treatment of prone position in patients with severe acute respiratory distress syndrome (ARDS) caused by pneumocystis jirovecii pneumonia (PJP) after kidney transplantation. Methods Clinical data of 5 cases of moderate and severe ARDS caused by PJP after kidney transplantation were analyzed retrospectively, and clinical characteristics, treatment regimen and prognosis were summarized. Results Clinical manifestations of 5 patients were fever, dry cough, chest tightness, shortness ofbreath,sweating and fatigue, and body temperature fluctuated between 38 ℃ and 39 ℃, percutaneous arterial oxygen saturation(SpO2) was gradually decreased, and respiratory distress symptoms were worsened. Pulmonary CT scan showed diffuse ground-glass shadow. After transfer to intensive care unit (ICU), immunosuppressive drugs were terminated, and all patients were given with compound sulfamethoxazole, caspofungin, low-dose glucocorticoids against pneumocystis jirovecii (PJ), oxygen therapy and other symptomatic supportive treatments. Four patients diagnosed with severe ARDS upon admission to ICU were treated in a prone position. One patient with moderate ARDS was not kept in a prone position. At 1 d after treatment in a prone position, partial pressure of arterial oxygen (PaO2) and oxygenation index were increased, whereas alveolar-arterial oxygen difference (A-aDO2) was decreased compared with before treatment (allP<0.05). Compared with 1 d after treatment, SpO2, PaO2 and oxygenation index were all increased, while A-aDO2 was decreased at 4 d after treatment (all P<0.05). Box diagram showed that oxygenation index showed an overall upward trend after prone-position treatment, whereas A-aDO2 showed an overall downward trend. The length of ICU stay of 5 patients was 14 (8, 29) d. All patients in a prone position did not develop complications, such as skin pressure sore, tube detachment and tube displacement, etc. Among 5 patients, 4 patients were mitigated, and 1 patient died of septic shock and multiple organ failure. Conclusions For both conscious and intubated patients, a prone position may significantly improve oxygenation and prognosis of patients with severe ARDS caused by PJP after kidney transplantation. Early diagnosis and accurate and standardized treatment play a pivotal role in enhancing cure rate.
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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.
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Oxygen , Partial Pressure , Atmospheric Pressure , Acute Lung Injury , HypoxiaABSTRACT
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.
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Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , COVID-19 , Pulmonary Gas Exchange , Prone PositionABSTRACT
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.
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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.
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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.
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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.
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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.
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OBJECTIVE:To investigate the effect of preoperative use of high-dose simvastatin on the pulmonary artery pres-sure in congenital heart disease with left-to-right shunt. METHODS:86 patients with left-to-right shunt congenital heart disease who were planned to implement interventional occlusion therapy were randomly divided into control group(43 cases)and observa-tion group(43 cases). Patients in both groups were given digitalis,diuretics,anticoagulants and other basic treatments;On this basis, control group received Sildenafil citrate tablet,25 mg,3 times a day,orally given 1 h before a meal;observation group received Simvastatin tablet 80 mg,once every evening,orally. The treatment course for both groups was 7 d. Mean pulmonary hypertension (mPAP),N terminal prohormone brain natriuretic peptide (NT-proBNP),arterial oxygen saturation (SaO2),arterial oxygen ten-sion(PaO2),pulmonary blood circulation ratio(Qq/Qs),pulmonary pressure variation(Rp/Rs),pulmonary vascular resistance in-dex(PVRi)before and after treatment in 2 groups were observed,and related indicators of liver functions [alanine aminotransfer-ase (ALT),aspartate aminotransferase(AST)] and myocardial enzymes [lactate dehydrogenase (LDH),creatine kinase MB(CK-MB)] were detected. The incidence of adverse reactions were deteted. RESULTS:Before treatment,there were no significant differ-ences in mPAP,NT-proBNP,SaO2,PaO2,Qq/Qs,Rp/Rs,PVRi,ALT,AST,LDH and CKMB levels in 2 groups(P>0.05). Af-ter treatment,mPAP,NT-proBNP,Rp/Rs and PVRi levels were significantly lower than before,SaO2,PaO2,and Qq/Qs levels were significantly higher than before and Qq/Qs level in observation group was higher than these in control group.The difference was statistically significant(P<0.05). There was 1 patient showed severe liver injury in observation group and exited the test;the other 85 patients showed no obvious adverse reactions,with successful surgery and good prognosis. CONCLUSIONS:The preoper-ative use of high-dose simvastatin shows obvious effect on controlling mean pulmonary hypertension,reducing mPAP,NT-proB-NP,Rp/Rs and PVRi levels and increasing SaO2,PaO2,and Qq/Qs levels before operation,with good safety.
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Background: The valley of Kashmir lies at an average height of 1730 m above the sea level with a barometric pressure of 624 mmHg. The fall in atmospheric pressure at higher altitude decreases the partial pressure of inspired oxygen and hence the driving pressure for gas exchange in the lungs. At sea level the normal range of PaCO2 is 35 mmHg to 45 mmHg and at 1500m above sea level (barometric pressure 634 mmHg), the predicted normal PaO2 in a healthy young adult is approximately 80 mmHg; this contrasts with a value close to 95 mmHg at sea level. On these grounds this study was undertaken to formulate normal ABG values for this place as it lies at a higher altitude. Methods: The study was undertaken to measure "arterial blood gases" (ABG) in ethnic Kashmiri population and consisted of a sample of one hundred healthy Kashmiri subjects of either sex after proper inclusion and exclusion by spirometrically measuring Vital Capacity and Forced expiratory volume in one second/Forced vital capacity (Fev1/FVC). A modified Allen's test was performed to check for adequate collateral circulation ruling out Ischemia. Results: The average mean PaO2 of 78.51 ± 4.40 mmHg and the average mean PaCO2 of 33.37 ± 2.38 mmHg was obtained of the volunteers of both the sexes. The average mean pH of males (7.43 ± 0.02) was significantly lower than the mean pH of females (7.45 ± 0.021). Conclusions: The present study might provide useful base line normal values of Arterial Blood Gases for the local population and will be beneficial to the clinicians.
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Objective To investigate clinical effect of Danhong injection combined with edaravone in patients with idiopathic pulmonary fibrosis (IPF) and influence on TNF-αand TGF-β1 in serum.Methods 67 patients were randomly divided into Treatment Group (n=35) and Control Group (n=32) in Xuanwu hospital of Nanjing from March 2011 to December 2014.All the patients were treated by comprehensive conventional treatment, and then control group was treated by edaravone, treatment group were treated by Danhong injection on the basis of control group.The clinical efficiency, PaO2 , carbon monoxide diffusing capacity (Dlco) and the levels of inflammatory factors between two groups were compared.Results After treatment, the clinical total effective rate(97.14%) of treatment group was statistically higher than that of control group (75.00%, Z=-2.035,P=0.042).After treatment, partial pressure of oxygen(PaO2) and Dlco in treatment group were increased significantly(all P<0.05);and it was statistically higher then control group (all P<0.05).TNF-αand TGF-β1 in treatment group were decreased significantly (all P<0.05);and it was also statistically higher then control group (all P<0.05).Conclusion Danhong injection combined with edaravone is effective in treatment of IPF, which can significantly improve the pulmonary function and levels of inflammatory factors.
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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 .
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@#BACKGROUND: High-volume hemofiltration (HVHF) is technically possible in severe acute pancreatitis (SAP) patients complicated with multiple organ dysfunction syndrome (MODS). Continuous HVHF is expected to become a beneficial adjunct therapy for SAP complicated with MODS. In this study, we aimed to explore the effects of fluid resuscitation and HVHF on alveolar-arterial oxygen exchange, the Acute Physiology and Chronic Health Evaluation II (APACHE II) score in patients with refractory septic shock. METHODS: A total of 89 refractory septic shock patients, who were admitted to ICU, the Provincial Hospital affiliated to Shandong University from August 2006 to December 2009, were enrolled in this retrospective study. The patients were randomly divided into two groups: fluid resuscitation (group A, n=41), and fluid resuscitation plus high-volume hemofiltration (group B, n=48). The levels of O2 content of central venous blood (CcvO2), arterial oxygen content (CaO2), alveolar-arterial oxygen pressure difference P(A-a)DO2, ratio of arterial oxygen pressure/alveolar oxygen pressure (PaO2/PAO2), respiratory index (RI) and oxygenation index (OI) were determined. The oxygen exchange levels of the two groups were examined based on the arterial blood gas analysis at different times (0, 24, 72 hours and 7 days of treatment) in the two groups. The APACHE II score was calculated before and after 7-day treatment in the two groups. RESULTS: The levels of CcvO2, CaO2 on day 7 in group A were significantly lower than those in group B (CcvO2: 0.60±0.24 vs. 0.72±0.28, P<0.05; CaO2: 0.84±0.43 vs. 0.94±0.46, P<0.05). The level of oxygen extraction rate (O2ER) in group A on the 7th day was significantly higher than that in group B ( 28.7±2.4 vs. 21.7±3.4, P<0.01). The levels of P(A-a)DO2 and RI in group B on the 7th day were significantly lower than those in group A. The levels of PaO2/PAO2 and OI in group B on 7th day were significantly higher than those in group A (P<0.05 or P<0.01). The APACHE II score in the two groups reduced gradually after 7-day treatment, and the APACHE II score on the 7th day in group B was significantly lower than that in group A (8.2±3.8 vs. 17.2±6.8, P<0.01). CONCLUSION: HVHF combined with fluid resuscitation can improve alveolar- arterial-oxygen exchange, decrease the APACHE II score in patients with refractory septic shock, and thus it increases the survival rate of patients.
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Objective To evaluate the effects of fluid resuscitation and large-volume hemofiltration (HVHF) on the Alveolar-arterial oxygen exchange in patients with refractory septic shock. Method A total of 89 intensive care patients with refractory septic shock treated with fluid resuscitation and/or HVHF were enrolled between August 2006 and December 2009. All the patients were randomly divided into two groups. In group A, patients were treated with fluid resuscitation, n = 41 cases) and in group B, patients were treated with large-volume hemofiltration and fluid resuscitation, n =48). The O2 content of central venous blood(CcvO2), arterial oxygen content (CaO2), Alveolar-arterial oxygen pressure difference (P(A-a)DO2), the ratio of arterial oxygen pressure/alveolar oxygen pressure (PaO2/PAO2), respiratory index (RI) and oxygenation index (OI) were checked. The levels of oxygen exchange in two groups were detected by arterial blood gas analysis before treatnent, 24 hour, 72 hour and 7 days after treatment. The APACHE Ⅱ scores in patients with refractory septic shock were measured before and the 7th day after treatment with HVHF and/or fluid resuscitation respectively. Data were analyzed by using t -test and chi-square test to compare the differences and ratio between two groups and were expressed in mean ± standard deviation, and the analysis of variance was done with SPSS version 12.0 software. Results ① The differences in CcvO2 and CaO2 between two groups were[(0.60±0.24) vs. (0.72±-0.28), P ＜0.05 and (0.84±0.43) vs. (0.94±0.46), P ＜0.05]; and the oxygen extraction rates (O2ER) were significantly different between two groups [(28.7±2.4) vs. (21.7±3.4), P<0.01];② The levels of P(A-a)DO2、ratio of PaO2/PAO2、RI and OI in group B were reduced more significantly than in group A (P<0.05 or P<0.01);③The APACHE Ⅱ scores in both groups were gradually reduced after treatment for 7 days, and the APACHE Ⅱscore in group B on the 7th day of treatment were lower than that in group A[(17.2 ± 6.8) vs. (8.2 ± 3.8), P ＜ 0.01]. Conclusions Fluid resuscitation and HVHF could improve alveolar-arterial-oxygen exchange in patients with refractory septic shock, and at the same time decreased the APACHE Ⅱ scores, improving the survival rate of patients.
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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 techniques 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)...
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Humans , Respiratory Insufficiency/therapy , Respiration, Artificial/methods , Acute Disease , Blood Gas Analysis , Intensive Care Units , Oxygen/analysis , Prospective Studies , Reference ValuesABSTRACT
BACKGROUND/AIMS: Ventilating patients with acute respiratory distress syndrome (ARDS) in the prone position has been shown to improve arterial oxygenation, but prolonged prone positioning frequently requires continuous deep sedation, which may be harmful to patients. We evaluated the meaning of early gas exchange in patients with severe ARDS under prolonged (> or = 12 hours) prone positioning. METHODS: We retrospectively studied 96 patients (mean age, 60.1 +/- 15.6 years; 75% men) with severe ARDS (PaO2/FiO2 or = 20 mmHg and decreases in PaCO2 of > or = 1 mmHg, respectively, 8 to 12 hours after first placement in the prone position. RESULTS: The mean duration of prone positioning was 78.5 +/- 61.2 hours, and the 28-day mortality rate after MICU admission was 56.3%. No significant difference in clinical characteristics was observed between PaO2 and PaCO2 responders and non-responders. The PaO2 responders after prone positioning showed an improved 28-day outcome, compared with non-responders by Kaplan-Meier survival estimates (p < 0.05 by the log-rank test), but the PaCO2 responders did not. CONCLUSIONS: Our results suggest that the early oxygenation improvement after prone positioning might be associated with an improved 28-day outcome and may be an indicator to maintain prolonged prone positioning in patients with severe ARDS.
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Adult , Aged , Female , Humans , Male , Middle Aged , Carbon Dioxide/blood , Critical Care/methods , Oxygen/blood , Positive-Pressure Respiration , Posture , Pulmonary Gas Exchange , Respiratory Distress Syndrome/blood , Retrospective Studies , Severity of Illness Index , Tidal VolumeABSTRACT
Objective To explore the changes of finger artery hemodynamics of patients with pulmonary heart disease, at the same time to search for the relationship with PaO_2.Methods We used American ACUSON128/xp10 and ATL5000 color Doppler ultrasound diagnostic instrument to detect double middle - finger artery hymodynamics items; VSMANX, VDMIN,TAMX , PI and RI. We used Danish ABL5 artery blood gas analysis to monitor PaO_2 and SaO_2.Results PaO_2 ,SaO_2, VSMAX,VDMIN ,TAMX,and PI in control group,pulmonary heart disease remission stage, active attack stage had significant difference (P
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Objective To investigate the relationship between CRP and CK-MB among acute and stable patients with COPD in Nanjing city. Methods Using case-control design, 81 COPD patients and 71 normal controls were selected. Both fasting venous and arterial blood samples were collected for COPD patients at the acute and the stable stage separately, while fasting venous blood samples were collected for controls during medical examination. The concentrations of CRP, CK-MB or PaO2 of all blood samples were examined. Results The concentration of CRP and CK-MB were significantly higher among stable COPD patients (7.18?5.62, 10.92?5.33; respectively) than those among controls(3.00?0.91, 3.11?1.46; respectively), while acute patients (51.22?24.53,30.06?16.68; respectively) got much higher concentration of CRP and CK-MB than stable patients did. However, PaO2 was significantly higher among stable COPD patients than that among acute patients. For acute COPD patients, the concentration of CK-MB positively correlated with CRP, while PaO2 negatively correlated with CRP and CK-MB separately. Conclusions CRP and CK-MB were sensitive predictors of COPD status to the transition from stable to acute stage of COPD, and both negatively correlated with PaO2 among these sample COPD patients.
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BACKGROUND: One-lung ventilation (OLV) is commonly used in the majority of thoracotomies and thoracoscopic surgeries. During OLV, a decrease in partial pressure of arterial oxygen (PaO2) occurs due to the right-to-left transpulmonary shunt that develops in the non-dependent lung, and is aggravated just after pleural opening. Here, we examined the occurrence, cause, and means of preventing drops in PaO2 caused by pleural opening. METHODS: Seventy patients, ASA PS I or II, who were scheduled for elective thoracotomy or thoracoscopic surgery, were prospectively examined. After OLV, patients were randomly allocated to one of four groups. In the Control group (n = 10), pleurae were not opened during studies. In the Open group (n = 20), pleurae were opened with the plug of the double-lumen endobronchial tube of the non-dependent lung opened. In the Closure group (n = 20), the plug was closed just before pleural opening. And in the continuous positive airway pressure (CPAP) group (n = 20), pleurae were opened after applying 5 cmH2O CPAP of medical air to the non-dependent lung. Arterial blood gas analyses, hemodynamics, end-tidal CO2, peak inspiratory airway pressure, lung compliance, and airway resistance were recorded 15 min after two-lung ventilation, 20 min after transition to OLV, just before pleural opening, and 1, 3, and 20 min after pleural opening. In the control group, data were recorded 15 min after two-lung ventilation and in seven intervals after transition to OLV (1, 3, 5, 10, 20, 25, and 45 min). RESULTS: A significant decrease in PaO2 was detected just after pleural opening in the Open and Closure groups. PaO2 decreased in the Open group more than in the Closure group. However, in the CPAP group, no significant PaO2 reduction was detected after pleural opening. CONCLUSIONS: We found that PaO2 decreased when pleurae were opened during OLV. This may be due to the sudden development of atelectasis in the non-dependent lung by exposure to atmospheric pressure. This decrease in PaO2 can be relieved by closing the double-lumen endobronchial tube's plug of the non-dependent lung or by applying CPAP to the non-dependent lung when pleurae are opened.