Value of short-time transcutaneous carbon dioxide and oxygen pressure monitoring in critically ill preterm infants / 中华围产医学杂志

Objective:To investigate the value of short-time transcutaneous carbon dioxide pressure (TcPCO 2) and transcutaneous oxygen pressure (TcPO 2) monitoring in critically ill preterm infants. Methods:From January to December 2018, 62 critically ill neonates receiving respiratory support at Guangzhou Women and Children's Medical Center were retrospectively enrolled. A total of 348 sets of paired data including TcPCO 2/TcPO 2 and arterial carbon dioxide pressure (PaCO 2)/arterial oxygen partial pressure (PaO 2) were analyzed. The patients were divided into different groups based upon birth weight (23 cases>1 000 g-≤1 500 g, 129 sets of paired data; 18 cases≤1 000 g, 130 sets of paired data) and gestational age (16 cases born at ≤28 gestational weeks, 127 sets of paired data; 29 cases born at 28-34 gestational weeks, 159 sets of paired data) and the differences between groups were compared. The correlation and consistency of TcPCO 2/TcPO 2 and PaCO 2/PaO 2 were evaluated using Pearson's correlation and Blan-Altman scatter plots. Receiver operating characteristic (ROC) curve was drawn to analyze the diagnostic efficacy of TcPCO 2 in neonates with hypercapnia. Results:There was a positive correlation between TcPCO 2 and PaCO 2 in all patients ( r=0.913, 95% CI:0.894-0.929, P<0.05). In patients whose birth weight was>1 000 g-≤1 500 g or≤1 000 g, TcPCO 2 and PaCO 2 were positively correlated and the consistency were good ( r=0.909, 95% CI:0.874-0.935; r=0.934, 95% CI:0.908-0.953; both P<0.05), and the same finding was also observed in patients born at≤28 gestational weeks or 28-34 weeks of gestation ( r=0.938, 95% CI:0.913-0.956; r=0.871, 95% CI: 0.827-0.904; both P<0.05). The sensitivity, specificity and area under curve of TcPCO 2 in the diagnosis of hypercapnia were 90.91%, 85.85%, and 0.942, respectively. There was a poor correlation between TcPO 2 and PaO 2 in all patients and those with birth weight >1 000 g-≤1 500 g or gestational age 28-34 weeks (all r<0.75, all P<0.05). There was no correlation between TcPO 2 and PaO 2 in the birth weight ≤1 000 g and gestational age ≤28 weeks groups (both P>0.05). Conclusions:Short-time TcPCO 2 monitoring can accurately assess PaCO 2 in critically ill neonates requiring respiratory support and is of high diagnostic value for hypercapnia. However, TcPO 2 has limitation in evaluating PaO 2 and other indicators may need to be involved.

Clinical efficacy of acupoint application therapy combined with pressing needle in the treatment of acute exacerbation of chronic obstructive pulmonary disease / 中国基层医药

Objective:To investigate the clinical efficacy of acupoint application therapy combined with pressing needle therapy in the treatment of acute exacerbation of chronic obstructive pulmonary disease.Methods:Eighty-six patients with acute exacerbation of chronic obstructive pulmonary disease who received treatment at Lishui Hospital of Traditional Chinese Medicine from February 2022 to August 2022 were retrospectively included in this study. They were randomly divided into Group A ( n = 29), group B ( n = 29), and the combined treatment group ( n = 28) according to different treatment methods. All three groups were treated with conventional Western medicine. Based on this, group A was treated with acupoint application therapy, group B was treated with pressing needle therapy and the combined treatment group with treated with acupoint application therapy and pressing needle therapy. Clinical efficacy was compared among the three groups. Traditional Chinese medicine symptom score, pulmonary function index, blood gas index, and quality of life score pre- and post-treatment were compared among the three groups. Results:There was a significant difference in total response rate among group A [75.86% (22/29)], group B [79.31% (23/29)], and the combined treatment group [96.43% (27/28), H = 6.15, P < 0.05]. After treatment, the scores of cough, expectoration, and dyspnea in the three groups were significantly decreased compared with those before treatment (all P < 0.05). After treatment, the scores of cough, expectoration, and dyspnea in the combined treatment group were (1.79 ± 0.48) points, (2.30 ± 0.32) points, and (1.96 ± 0.43) points, respectively, which were significantly lower than those in (2.32 ± 0.41) points, (2.68 ± 0.42) points, and (2.27 ± 0.36) points in group A and (2.17 ± 0.50) points, (2.91 ± 0.43) points, and (2.33 ± 0.43) points in group B ( F = 9.81, 17.38, 6.72, all P < 0.05). After treatment, forced vital capacity (FVC), forced expiratory volume in the first second (FEV 1), and FEV 1/FVC were increased in each group compared with those before treatment (all P < 0.05). After treatment, FVC, FEV 1, and FEV 1/FVC in the combined treatment group were (3.95 ± 0.47) L, (2.01 ± 0.36) L, and (82.91 ± 13.35)%, respectively, which were significantly higher than (3.63 ± 0.59) L, (1.76 ± 0.21) L, and (73.23 ± 10.85)% in group A and (3.89 ± 0.38) L, (1.64 ± 0.37) L and (73.91 ± 7.62)% in group B ( F = 3.49, 9.80, 7.05, all P < 0.05). After treatment, blood gas indicators in each group were significantly increased compared with those before treatment (all P < 0.05). After treatment, blood oxygen partial pressure in the combined treatment group, group A and group B was (85.76 ± 3.21) mmHg, (81.05 ± 4.23) mmHg, and (80.62 ± 4.03) mmHg, respectively. The partial pressure of carbon dioxide in the three groups was (37.74 ± 5.88) mmHg, (44.32 ± 5.59) mmHg, and (43.22 ± 6.41) mmHg, respectively. There were significant differences in blood oxygen partial pressure and partial pressure of carbon dioxide among the three groups ( F = 15.50, 9.88, all P < 0.05). After treatment, the quality of life score in each group was significantly increased compared with that before treatment (all P < 0.05). After treatment, the quality of life score in the combined treatment group, group B, and group A was (43.97 ± 6.34) points, (39.16 ± 4.45) points, and (40.19 ± 4.67) points, respectively, and there was significant difference among the three groups ( F = 4.12, P < 0.001). Conclusion:In the treatment of acute exacerbation of chronic obstructive pulmonary disease, acupoint application therapy combined with pressing needle therapy is highly effective than monotherapy. The combined therapy can better improve traditional Chinese medicine symptoms and blood gas indicators, effectively enhance pulmonary function, and improve quality of life than monotherapy.

Clinical efficacy of ateplase combined with heparin in the treatment of acute moderate- and high-risk pulmonary thromboembolism and its effects on arterial blood gas analysis and myocardial enzyme level / 中国基层医药

Objective:To investigate the clinical efficacy of alteplase combined with heparin in the treatment of acute moderate- and high-risk pulmonary thromboembolism and its effects on arterial blood gas analysis and myocardial enzyme level.Methods:Seventy-eight patients with acute moderate- and high-risk pulmonary thromboembolism who received treatment in Dongyang People's Hospital from January 2015 to January 2022 were retrospectively included in this study. They were divided into observation ( n = 39) and control ( n = 39) groups according to different treatment methods. The control group was treated with heparin, while the observation group was treated with alteplase based on heparin. All patients were treated for 7 days. Clinical efficacy as well as arterial blood gas analysis, myocardial enzymes, pulmonary artery pressure, and tricuspid annular plane systolic excursion pre- and post-treatment were compared between the two groups. Results:The total response rate in the observation group was significantly higher than that in the control group (94.87% vs. 76.92%, χ2 = 5.18, P < 0.05). After treatment, the partial pressure of carbon dioxide in the observation group was significantly lower than that in the control group [(36.24 ± 5.12) mmHg vs. (44.25 ± 3.78) mmHg, 1 mmHg = 0.133 kPa, t = 7.86, P < 0.05]. After treatment, the partial pressure of oxygen in the observation group was significantly higher than that in the control group [(78.82 ± 5.1) mmHg vs. (71.23 ± 4.89) mmHg, t = 6.66, P < 0.05]. After treatment, lactate dehydrogenase, creatine kinase, and creatine kinase isoenzyme in the observation group were (107.42 ± 15.45) U/L, (37.21 ± 10.84) U/L, and (12.28 ± 3.54) U/L, respectively, which were significantly lower than (189.94 ± 21.20) U/L, (65.42 ± 6.57) U/L, and (19.29 ± 3.08) U/L in the control group ( t = 19.64, 13.89, 9.33, all P < 0.001). After treatment, the pulmonary arterial pressure in the observation group was significantly lower than that in the control group [(32.24 ± 3.86) mmHg vs. (37.79 ± 5.17) mmHg, t = 5.37, P < 0.001]. Tricuspid annular plane systolic excursion in the observation group was significantly higher than that in the control group [(14.07 ± 1.27) mm vs. (12.63 ± 1.16) mm, t = 5.22, P < 0.001]. Conclusion:Ateplase combined with heparin has an obvious effect on acute moderate- and high-risk pulmonary thromboembolism. It can improve arterial blood gas analysis and reduce myocardial enzyme levels.

Application value of monitoring of percutaneous partial pressure of carbon dioxide/oxygen for patients in ICU after general anesthesia

For patients in ICU under mechanical ventilation, monitoring of percutaneous partial pressure of CO2 and O2 after general anesthesia is crucial as excessive or insufficient ventilation may prove to be fatal. However, the correlation between percutaneous monitoring and arterial blood gas analysis still remains unclear. Here, we studied the application value of monitoring of PtcCO2/PtcO2 for patients in ICU after general anesthesia for better management of patients in ICU on ventilation. A total of 195 eligible patients were selected. After transfer, when PtcCO2 and PtcO2 were stable (10-15 min), they were recorded as transfer-in values. Partial pressure of carbon dioxide (PaCO2), partial pressure of oxygen (PaO2), lactate, PtcO2 and PtcCO2 were recorded. Vital signs and hemodynamics data were also recorded. There were significant positive correlations between PtcCO2 and PtcO2 (r = 0.876), and between PtcO2 and PaCO2 (r = 0.817) (P <0.01). PaO2 was higher than PtcO2 (P <0.01). There were significant positive correlations between PtcCO2/PtcO2 and PaCO2/PaO2 at different time points (T0: upon transfer-in; T1: before extubation; T2: upon transfer-out, P <0.01). At different oxygen inhalation concentrations (21, 40 and 50%), PtcCO2 and PtcO2 were all well linearly correlated. The overall PtcO2/PaO2 was (0.75±0.12). When FIO2 values were 21, 40 and 50%, PtcO2/PaO2 values were similar (P >0.05). PtcCO2 and PtcO2 or PtcO2 and PaCO2 are significantly positively correlated, without significant differences between different time periods or oxygen concentrations. PtcCO2 and PtcO2 can predict the changes of PtcO2 and PaCO2, which is of great significance to the early observation of oxygenation changes, adjustment of ventilator parameters and improvement of prognosis. PtcCO2/PaO2 values are similar at different oxygen concentrations, as an eligible index for the postoperative evaluation of tissue perfusion status and hemodynamic level.

Justificativa e limitações da SpO2/FiO2 como possível substituta da PaO2/FiO2 em diferentes cenários pré-clínicos e clínicos / Rationale and limitations of the SpO2/FiO2 as a possible substitute for PaO2/FiO2 in different preclinical and clinical scenarios

RESUMO Embora a PaO2/FiO2 derivada da gasometria arterial continue sendo o padrão-ouro do diagnóstico de insuficiência respiratória aguda, a SpO2/FiO2 tem sido investigada como potencial substituta. Esta revisão narrativa apresenta o estado da literatura pré-clínica e clínica sobre a SpO2/FiO2 como possível substituta da PaO2/FiO2 e para uso como marcador diagnóstico e prognóstico; ainda, é fornecida uma visão geral da oximetria de pulso e suas limitações, além da avaliação da utilidade da SpO2/ FiO2 como substituta da PaO2/FiO2 em pacientes com COVID-19. Ao todo, foram encontrados 49 estudos comparando SpO2/FiO2 e PaO2/ FiO2 com base em uma estratégia de pesquisa mínima. A maioria dos estudos foi realizada em recémnascidos, alguns foram realizados em adultos com síndrome do desconforto respiratório agudo, e outros foram realizados em outros cenários clínicos (incluindo poucos em pacientes com COVID-19). Há certa evidência de que os critérios de SpO2/FiO2 podem substituir a PaO2/FiO2 em diferentes cenários clínicos. Isso é reforçado pelo fato de que devem ser evitados procedimentos invasivos desnecessários em pacientes com insuficiência respiratória aguda. É inegável que os oxímetros de pulso estão cada vez mais difundidos e podem proporcionar um monitoramento sem custos. Portanto, substituir a PaO2/FiO2 pela SpO2/FiO2 pode permitir que instalações com recursos limitados diagnostiquem a insuficiência respiratória aguda de maneira objetiva.

ABSTRACT Although the PaO 2/FiO 2 derived from arterial blood gas analysis remains the gold standard for the diagnosis of acute respiratory failure, the SpO2/FiO2 has been investigated as a potential substitute. The current narrative review presents the state of the preclinical and clinical literature on the SpO2/FiO2 as a possible substitute for PaO2/FiO2 and for use as a diagnostic and prognostic marker; provides an overview of pulse oximetry and its limitations, and assesses the utility of SpO2/ FiO2 as a surrogate for PaO2/FiO2 in COVID-19 patients. Overall, 49 studies comparing SpO2/FiO2 and PaO2/FiO2 were found according to a minimal search strategy. Most were conducted on neonates, some were conducted on adults with acute respiratory distress syndrome, and a few were conducted in other clinical scenarios (including a very few on COVID-19 patients). There is some evidence that the SpO2/ FiO2 criteria can be a surrogate for PaO2/FiO2 in different clinical scenarios. This is reinforced by the fact that unnecessary invasive procedures should be avoided in patients with acute respiratory failure. It is undeniable that pulse oximeters are becoming increasingly widespread and can provide costless monitoring. Hence, replacing PaO2/FiO2 with SpO2/FiO2may allow resourcelimited facilities to objectively diagnose acute respiratory failure.

Clinical efficacy of sequential invasive-noninvasive mechanical ventilation for chronic obstructive pulmonary disease complicated by type II respiratory failure / 中国基层医药

Objective:To investigate the clinical efficacy of sequential invasive-noninvasive mechanical ventilation for chronic obstructive pulmonary disease complicated by type II respiratory failure.Methods:Eighty-four patients with chronic obstructive pulmonary disease complicated by type II respiratory failure who received treatment in The First Affiliated Hospital of University of Science and Technology of China from January 2017 to December 2019 were included in this study. Patients were selected to withdraw the ventilator for performing a spontaneous breathing test according to recovery status. Patients who underwent invasive mechanical ventilation were included in the control group ( n = 42). Patients who underwent sequential invasive-noninvasive mechanical ventilation based on the pulmonary infection control window were included in the observation group. Mortality rate, reintubation rate, total ventilation time, length of hospital stay, heart rate, and blood gas analysis were compared between the two groups. Results:The length of hospital stay and total ventilation time in the observation group were (9.69 ± 1.94) days and (7.49 ± 1.53) days, respectively, which were significantly shorter than those in the control group ( t = 8.87, 5.10, both P < 0.05). Reintubation rate and mortality rate in the observation group were 4.76% (2/42) and 2.38% (1/42), respectively, which were significantly lower than those in the control group ( χ2 = 5.13, 3.90, both P < 0.05). In each group, heart rate, partial pressure of carbon dioxide and partial pressure of oxygen measured after treatment were superior to those measured before treatment (all P < 0.05). Conclusion:Based on pulmonary infection control window, invasive-noninvasive sequential ventilation for chronic obstructive pulmonary disease complicated by type II respiratory failure can not only reduce total ventilation time and length of hospital stay, remarkably improve clinical manifestations, but also effectively reduce reintubation rate and mortality rate.

Efficacy of Kechuanning combined with western medicine in the treatment of phlegm-heat obstructing lung syndrome AECOPD and its effects on inflammatory factors / 中国基层医药

Objective:To investigate the efficacy of Kechuanning combined with western medicine on acute exacerbation of chronic obstructive pulmonary disease (AECOPD) and its effects on serum amyloid A, interleukin 1β and procalcitonin levels. Methods:A total of 104 patients with AECOPD who received treatment in Yongkang Hospital of Traditional Chinese Medicine from January 2019 to December 2020 were included in this study. They were randomly assigned to receive either symptomatic treatment with western medicine alone ( n = 52, control group) or symptomatic treatment with western medicine combined with Kechuanning ( n = 52, observation group). Therapeutic effects, latency to clinical symptom relief, pre- and post-treatment pulmonary function, serum inflammatory factor levels, and blood gas analysis indexes were compared between the two groups. Results:Total response rate in the observation group was significantly higher than that in the control group [86.54% (45/52) vs. 67.31%(35/52), χ2 = 4.99, P < 0.05]. Latency to rale disappearance, latency to cough disappearance, length of hospital stay in the observation group were (8.25 ± 1.38) days, (10.05 ± 1.53) days, and (12.65 ± 2.28) days, which were significantly shorter than those in the control group [(9.41 ± 1.46) days, (12.19 ± 1.61) days, (14.36 ± 2.14) days, t = 4.16, 6.98, 3.61, all P < 0.05]. After treatment, forced vital capacity (FVC), forced expiratory volume in the first second (FEV 1), and FEV 1/FVC value in the observation group were (1.88 ± 0.5) L, (64.13 ± 5.72)%pred, (59.43 ± 5.57)%, respectively, which were significantly higher than those in the control group [(1.65 ± 0.51) L, (60.22 ± 5.60)% pred, (54.16 ± 5.19)%, t = 2.17, 3.52, 4.99, all P < 0.05]. Arterial partial pressure of oxygen (PaO 2) and blood oxygen saturation (SpO 2) in the observation group were (9.18 ± 0.89) kPa and (96.26 ± 2.13)%, respectively, which were significantly higher than those in the control group [(8.74 ± 0.76) kPa, (94.07 ± 2.08)%, t = 2.71, 5.305, both P < 0.05]. Partial pressure of carbon dioxide (PaCO 2) in the observation group was significantly lower than that in the control group [(7.32 ± 0.27) kPa vs. (7.63 ± 0.32) kPa, t = 5.34, P < 0.05]. Serum amyloid protein, interleukin-1β and procalcitonin levels in the observation group were (43.84 ± 6.15) mg/L, (3.24 ± 0.51) μg/L, (1.55 ± 0.37) ng/L, respectively, which were significantly lower than those in the control group [(55.26 ± 3.46) mg/L, (4.19 ± 0.56) μg/L, (2.03 ± 0.46) ng/L, t = 9.23, 9.04, 5.86, all P < 0.05]. Conclusion:Kechuanning as an adjuvant therapy for AECOPD can greatly improve lung function and hypoxia, alleviate clinical symptoms, reduce inflammatory reactions, and have a definite clinical effect. The study is innovative and scientific and is worthy of clinical reference.

Observation of the clinical efficacy of sacubitril-valsartan combined with Haikun Shenxi in the treatment of chronic left heart failure with renal insufficiency / 中国医师进修杂志

Objective:To observe the clinical efficacy of sacubitril-valsartan combined with Haikun Shenxi in the treatment of chronic left heart failure with renal insufficiency.Methods:A total of 80 patients with chronic left heart failure and renal insufficiency who were admitted to Dalian Municipal Central Hospital from October 2019 to October 2020 were selected as the research objects. They were divided into two groups by random digits table method, 40 cases in each group. The control group was treated with sacubitril-valsartan. The observation group was based on the control group plus Haikun Shenxi Capsule, and N-terminal pro-brain natriuretic peptide (NT-proBNP), heart function indexes, kidney function indexes, blood gas indexes and quality of life in two groups were compared.Results:NT-proBNP, serum creatinine and blood urea nitrogen in the observation group were significantly lower than those in the control group after treatment: (1 034.27 ± 87.33) μg/L vs. (1 421.46 ± 105.54) μg/L, (240.53 ± 45.26) μmol/L vs. (284.52 ± 52.47) μmol/L, (12.05 ± 1.87) mmol/L vs. (15.79 ± 1.87) mmol/L, the difference was statistically significant ( t = 17.88, 4.01 and 8.62; P<0.01); left ventricular end-diastolic dimension (LVEDD) after treatment in the observation group was significantly lower than that in the control group: (46.12 ± 1.05) mm vs. (48.81 ± 1.74) mm, left ventricular ejection fraction (LVEF) and cardiac index (CI) were significantly higher than those in the control group: (49.95 ± 2.17)% vs. (45.24 ± 3.22)%, (2.98 ± 0.55) L/(min·m 2) vs. (2.45 ± 0.73) L/(min·m 2), the difference was statistically significant ( t = 7.67, 8.38 and 3.66; P<0.01); the blood gas index arterial partial pressure of carbon dioxide (PaCO 2) in the observation group after treatment was significantly lower than that in the control group: (46.34 ± 3.52) mmHg (1 mmHg = 0.133 kPa) vs. (51.63 ± 4.25) mmHg, arterial partial pressure of oxygen (PaO 2), oxygen saturation of haemoglobin (SO 2), pH, HCO 3-, base excess (BE) were significantly higher than the control group: (69.35 ± 5.12) mmHg vs. (62.45 ± 4.86) mmHg, (90.46 ± 4.02)% vs. (85.36 ± 4.32)%, 7.32 ± 0.12 vs. 7.22 ± 0.15, (23.1 ± 2.0) mmol/L vs. (21.5 ± 1.9) mmol/L, (-1.57 ± 0.67) mmol/L vs. (-2.15 ± 0.85) mmol/ L, the differences were statistically significant ( t = 6.06, 6.18, 5.47, 3.33, 3.67 and 3.39; P<0.01); the quality of life scores PD, ED, OD and TS in the observation group after treatment were lower than those in the control group: (17.80 ± 3.11) scores vs. (22.35 ± 2.72) scores, (12.28 ± 2.10) scores vs. (15.74 ± 1.73) scores, (18.27 ± 1.69) scores vs. (25.54 ± 2.33) scores, (46.68 ± 3.15) scores vs. (62.17 ± 3.63) scores, the differences was statistically significant ( t = 6.97, 8.05, 15.30 and 20.38; P<0.01). Conclusions:The sacubitril-valsartan combined with Haikun Shenxi in the treatment of chronic left heart failure with renal insufficiency has a significant clinical effect. It could effectively improve the patient's heart and kidney function and blood gas indicators, and further improve the patient's quality of life.

Design and application of arterial blood gas analysis assisted by electronic computation: analysis of two cases attached / 中国小儿急救医学

Objective:To make Excel spreadsheet of arterial blood gas analysis to judge the types of acid-base imbalance quickly and accurately, and guide the clinical treatment of acid-base disorders.Methods:According to the Henderson-Hasselbalch equation, the compensation formula of acid-base imbalance prediction, the theory of acid-base balance and the related research progress, the analysis process of acid-base balance disorder was settled, and the IF function in Microsoft Office Excel 2003 was used to edit the formula to make Excel spreadsheet for arterial blood gas analysis.Once the pH value, artery blood carbon dioxide pressure (PaCO 2), actual bicarbonate (HCO 3-), sodiumion (Na + ), chlorineion (Cl -) and compensatory time-limited parameters were input, the types of acid-base imbalance can be shown.Arterial blood gas analysis of 185 cases from intensive care unit at Xuzhou Central Hospital was determined by Excel spreadsheet group and manual group respectively, the results and time of judging the type of acid-base imbalance were compared between two groups for statistical analysis. Results:The results of acid-base imbalance between two groups were compared, and 42 cases were normal and simple acid-base and the consistent rate was 100%, double acid-base imbalances of 107 cases with the consistent rate of 97.20%, triple acid-base imbalances of 36 cases with the consistent rate of 91.67%.After Kappa consistency test (Kappa value=0.944) and Pair chi-square Test (McNemar-Bowker Test)( P=0.223), the results of two groups were consistent.It took less time to judge the results of normal or simple acid-base imbalance[(32.32±4.26)s vs.(75.88±19.22)s], double acid-base imbalance[(31.28±5.31)s vs.(137.56±37.64)s] and triple acid-base imbalance[(32.98±4.23)s vs.(315.09±89.37)s] by the Excel spreadsheet group compared with the manual group, and the differences were statistically significant ( P<0.01). Conclusion:The automatic judging of Excel spreadsheet for arterial blood gas analysis can quickly and accurately determine the types of acid-base imbalance in arterial blood gas analysis and has more advantages for triple acid and base imbalance especially with simple interface and simple operation.And it can avoid the missing judgment of acid and base imbalance when pH is 7.35 to 7.45.

Fisiología respiratoria: relación ventilación/perfusión / Respiratory fisiology: ventilation/perfusion relationship

Las alteraciones de la relación entre la ventilación y el flujo sanguíneo (V/Q) en diversas regiones del pulmón alteran el aporte de oxígeno (O2) y remoción del dióxido de carbono (CO2) al organismo. Fisiológicamente existen diferencias regionales en la relación V/Q. Determinadas patologías pueden alterar esta relación, produciendo tres escenarios distintos: Cortocircuito (Shunt), Alteración V/Q y aumento del espacio muerto. Para evaluar estos escenarios y realizar una aproximación diagnostica son de utilidad el estudio de los gases arteriales y venosos, la diferencia alveolo arterial y la respuesta al suministrar O2

Alterations in the ventilation perfusion relationship (V/Q) in various lung regions alter the supply of oxygen (O2) and the removal of carbon dioxide (CO2) in the body. Physiologically, there are regional differences in the V/Q ratio. Certain pathologies can alter this relationship, producing three different scenarios: Shunt, V/Q mismach and dead space increased. To evaluate these scenarios and carry out a diagnostic approach, it is useful to study arterial and venous gasometry, the alveolar arterial difference and the response to oxygen supplying.

Clinical efficacy of Qianjin Weijing Decoction in the treatment of severe pneumonia with accumulation of phlegm and heat in the lung / 中国基层医药

Objective:To investigate the clinical efficacy of Qianjin Weijing Decoction in the treatment of severe pneumonia with the accumulation of phlegm and heat in the lung. Methods:Eighty patients with severe pneumonia with the accumulation of phlegm and heat in the lung received treatment in Wenzhou Hospital of Traditional Chinese Medicine from December 2018 to December 2020. They were randomly allocated to undergo routine treatments (control group, n = 40) or routine treatments combined with Qianjin Weijing Decoction (observation group, n = 40) for 7 days. Clinical efficacy, blood gas analysis, oxygenation index, inflammatory factors (C-reactive protein and procalcitonin), and sequential organ failure score were compared between the two groups. Results:Total response rate in the observation group was significantly higher than that in the control group [87.50% (35/40) vs. 65.00% (26/40), χ2 = 5.59, P < 0.05]. Partial pressure of carbon dioxide (PaCO 2) post-treatment was significantly lower in the observation group than that in the control group [(30.24 ± 2.68) mmHg vs. (39.95 ± 3.27) mmHg, t = 14.52, P < 0.05]. The partial pressure of blood oxygen (PaO 2) and oxygenation index (PaO 2/FiO 2) in the observation group were (76.85 ± 4.56) mmHg and (326.84 ± 8.49) mmHg, respectively, which were significantly higher than those in the control group [(68.39 ± 4.12) mmHg, (284.16 ± 15.56) mmHg, t = -8.70, -15.22, both P < 0.05). Serum levels of C-reactive protein and procalcitonin post-treatment in the observation group were (23.12 ± 6.56) mg/L and (0.31 ± 0.08) μg/L, respectively, which were significantly lower than those in the control group [(38.92 ± 5.62) mg/L, (0.78 ± 0.20) μg/L, t = 11.56, 13.80, both P < 0.05]. Sequential organ failure score was significantly lower in the observation group than in the control group [(2.31 ± 0.46) points vs. (5.12 ± 1.25) points, t = 13.34, P < 0.05)]. Conclusion:Qianjin Weijing Decoction has a good therapeutic effect on severe pneumonia with the accumulation of phlegm and heat in the lung. The treatment can improve blood gas analysis and decrease inflammatory factor levels with a good prognosis.

Factors influencing pH value of umbilical arterial blood gas analysis in preterm infants / 中华围产医学杂志

Objective:To analyze the factors influencing pH value in umbilical arterial blood gas (UABG) analysis in preterm infants.Methods:A retrospective study was conducted on live singleton preterm infants ( n=573) who received UABG analysis in Peking University Third Hospital from January 2017 to February 2019. Analysis of variance, independent sample t-test, Spearman's or Pearson's correlation analysis, or linear regression analysis was used to analyze the influencing factors. Results:There was no significant difference in UABG pH value between preterm infants of different gestational ages (F=1.74, P=0.077). Spearman's correlation analysis found no correlation between gestational age and UABG pH value in premature infants ( r=0.003, P=0.940), and neither did Pearson's correlation between birth weight and pH value ( r=0.025, P=0.548). UABG pH value in preterm infants was linearly correlated with vaginal delivery ( t=－5.72, P<0.001), gestational hypertension ( t=－3.99, P<0.001) and placental abruption ( t=－4.52, P<0.001). Conclusions:Preterm infants at different gestational ages show a similar pH value in UABG. For those born to mothers with gestational hypertension or placental abruption, when vaginal delivery is pending, close monitoring and full preparation for resuscitation are necessary.

Adding autogenic drainage to chest physiotherapy after upper abdominal surgery: effect on blood gases and pulmonary complications prevention. Randomized controlled trial

ABSTRACT BACKGROUND: Hypoxemia and pulmonary complications are common after upper abdominal surgery (UAS). OBJECTIVE: To examine whether inclusion of autogenic drainage (AD) in chest physiotherapy after UAS confers additional benefits in improving blood gases and reducing postoperative pulmonary complications (PPCs). DESIGN AND SETTING: Randomized controlled study conducted at Kasr Al-Ainy teaching hospital, Egypt. METHODS: A randomized controlled trial was conducted on 48 subjects undergoing elective UAS with high risk of developing PPCs. The study group received AD plus routine chest physiotherapy (deep diaphragmatic breathing, localized breathing and splinted coughing) and the control group received routine chest physiotherapy only. The outcomes included arterial blood gases measured at the first and seventh postoperative days, incidence of PPCs within the first seven days and length of hospital stay. RESULTS: Baseline characteristics were similar between groups. In the AD group, SaO2, PaO2, PaCO2 and HCO3 significantly improved (P < 0.05) while in the physiotherapy group, only SaO2 and PaO2 significantly improved (P < 0.05). Nonetheless, significant differences in post-treatment SaO2 and PaO2 between the groups were observed. The overall incidence of PPCs was 16.66% (12.5% in the AD group and 20.8% in the physiotherapy group) (absolute risk reduction -8.3%; 95% confidence interval, CI, -13.5 to 29.6%), with no significant difference between the groups. The AD group had a significantly shorter hospital stay (P = 0.0001). CONCLUSION: Adding AD to routine chest physiotherapy after UAS provided a favorable blood gas outcome and reduced the length of hospital stay. It tended to reduce the incidence of PPCs. TRIAL REGISTRATION: ClinicalTrials.gov: NCT04446520.

Caracterización de parámetros del intercambio gaseoso en la Ciudad de México / Characterization of gas exchange parameters in Mexico City

Introducción: en las grandes altitudes, el intercambio gaseoso suele estar deteriorado; en la altitud moderada de la Ciudad de México esto no está aún plenamente definido. Objetivo: caracterizar el intercambio gaseoso en la altitud moderada de la Ciudad de México. Material y métodos: mediante un estudio transversal analítico se estudiaron sujetos nacidos y habitantes de la Ciudad de México, de ambos géneros, con edades de 20 a 59 años sin enfermedad cardiopulmonar. Se registraron sus variables demográficas, espirometría simple y de gasometría arterial. Las diferencias en las variables se calcularon con ANOVA de una vía para grupos independientes y ajuste de Bonferroni. Una p < 0.05 se aceptó como significativa. Resultados: se estudiaron 335 sujetos, de los cuales 168 (50.15%) fueron hombres, la edad grupal fue de 45 ± 11 años, con índice de masa corporal 22.97 ± 1.54 Kg/m2. La relación volumen espiratorio forzado en el primer segundo/Capacidad vital forzada (VEF1/CVF) de 91.58 ± 12.86%. La presión arterial de oxígeno fue de 66 ± 5.02 mmHg, el bióxido de carbono: 32.07 ± 2.66 mmHg, la saturación arterial de oxígeno: 93.03 ± 1.80% y la hemoglobina: 14.07 ± 1.52 gr/dL. Conclusiones: la presión arterial de oxígeno y del bióxido de carbono están disminuidos a la altura de la Ciudad de México.

Background: At high altitude the gas exchange is impaired, in the moderate altitude of Mexico City they are not yet defined. Objective: To characterize the gas exchange in the moderate altitude of Mexico City. Material and methods: Through an analytical cross-sectional study, subjects born and inhabitants of Mexico City, both genders, aged 20 to 59 years without cardiopulmonary disease, were studied. Their demographic variables, simple spirometry and arterial blood gas were recorded. Differences in variables were calculated with one-way ANOVA for independent groups and Bonferroni adjustment. p < 0.05 was accepted as significant. Results: 335 subjects were studied, 168 (50.15%) men. Group age 45 ± 11 years old, body mass index 22.97 ± 1.54 Kg/m2. Forced expiratory volume ratio in the first second / Forced vital capacity (FEV1/FVC) 91.58 ± 12.86%. The arterial oxygen pressure was: 66 ± 5.02 mmHg, carbon dioxide: 32.07 ± 2.66 mmHg, arterial oxygen saturation: 93.0 3 ± 1.80%, and hemoglobin: 14.07 ± 1.52 gr/dL. Conclusions: The arterial oxygen pressure and carbon dioxide are lowered at the Mexico City altitude.

Uso de los gases arteriales en trauma / Blood gas use in trauma

El trauma continúa siendo una de las primeras causas de muertes prevenibles en nuestro país. A pesar de la disminución del trauma militar, la incidencia que abarca todas las formas de trauma continúa siendo alta y congestiona los servicios de urgencias, por eso es fundamental el adecuado enfoque inicial para disminuir la mortalidad. Tradicionalmente, se han utilizado marcadores, como los signos vitales, para la identificación del choque hemorrágico, pero estudios observacionales de gran escala han demostrado cómo estos muchas veces no logran identificar a los pacientes con choque hemorrágico, haciendo necesario usar marcadores más objetivos, como los gases arteriales, con la medición del lactato y el déficit de base, que según literatura tienen mejor predicción de mortalidad, identificación temprana del choque y activación temprana de protocolos transfusionales

Trauma continues to be one of the lead causes of preventable deaths in our country. Even with the decrease of military trauma, the incidence of trauma remains high, dominating the emergency room. The initial approach is fundamental to decrease mortality. Traditionally, vital signs have been used as a marker of hemorrhage shock, but observational studies of high volumes of patients showed how those often can't identify patients with hemorrhage shock, which makes necessary more objective markers such as the blood gas with the measure of lactate and base deficit, which has proven useful in the prediction of mortality, early identification of shock and a faster activation of transfusion protocols

Glicose 25% no alívio da dor de recém-nascidos durante punção arterial e venosa: uma revisão de escopo / Glucosa 25% en el alivio del dolor del recién nacido durante la punción arterial y venosa: una revisión del alcance / 25% glucose in pain relief in newborns during arterial and venous puncture: a scoping review

RESUMO O objetivo foi mapear o conhecimento sobre o uso da solução de glicose 25% no alívio da dor de recém-nascidos durante a punção arterial e venosa. Trata-se de uma revisão de escopo. Realizada busca em oito fontes de dados (Cumulative Index to Nursing and Allied Health Literature, Literatura Latino-Americana e do Caribe em Ciências da Saúde, Medical Literature Analysis and Retrieval System Online, SciVerse Scopus, Web of Science, Scientific Electronic Library Online, Cochrane Library, Catálogo de Teses e Dissertações) e em buscador eletrônico no mês de agosto de 2020. Foram selecionados 11 estudos, que corroboram a utilização da glicose 25% como medida não farmacológica para redução da dor em Recém-nascidos, evidenciando seu efeito analgésico a partir da redução da pontuação nas escalas que avaliam a dor. Quanto à utilização, notou-se que a maioria utilizou 2 mL dessa solução, por via oral, dois minutos antes do procedimento. As medidas não farmacológicas são de fácil uso e baixo custo. A glicose 25% é vista como um método padrão-ouro para o alívio da dor de Recém-nascidos. Este estudo possibilitou mais embasamento científico ao mostrar que o uso da solução de glicose 25% é benéfico no alívio da dor de recém-nascidos durante a punção arterial e venosa, principalmente quando associada a outras técnicas. O estudo elucida as ações de saúde para o manejo da dor neonatal e contribui para o fomento da visibilidade e relevância científica ao tema.

RESUMEN El objetivo fue mapear el conocimiento sobre el uso de una solución de glucosa al 25% para el alivio del dolor en recién nacidos durante la punción arterial y venosa. Esta es una revisión del alcance. Se buscaron ocho fuentes de datos (Cumulative Index to Nursing and Allied Health Literature, Latin American and Caribbean Literature in Health Sciences, Medical Literature Analysis and Retrieval System Online, SciVerse Scopus, Web of Science, Scientific Electronic Library Online, Cochrane Library, Tesis y disertaciones Catálogo) y en un buscador electrónico en agosto de 2020. Se seleccionaron once estudios, que corroboran el uso de glucosa al 25% como medida no farmacológica para reducir el dolor en Recién Nacido, mostrando su efecto analgésico a partir de la reducción de puntuaciones en escalas que evalúan el dolor. En cuanto al uso, se notó que la mayoría utilizó 2 mL de esta solución, por vía oral, dos minutos antes del procedimiento. Las medidas no farmacológicas son fáciles de usar y económicas. La glucosa al 25% se considera un método de referencia para el alivio del dolor Recién Nacido. Este estudio proporcionó una base más científica al demostrar que el uso de una solución de glucosa al 25% es beneficioso para aliviar el dolor de los recién nacidos durante la punción arterial y venosa, especialmente cuando se asocia con otras técnicas. El estudio dilucida acciones de salud para el manejo del dolor neonatal y contribuye a promover la visibilidad y relevancia científica del tema.

ABSTRACT The objective was to map knowledge about the use of a 25% glucose solution in pain relief in newborns during arterial and venous puncture. This is a scoping review. It was conducted during August 2020 in eight data sources (Cumulative Index to Nursing and Allied Health Literature, Literatura Latino-Americana e do Caribe em Ciências da Saúde, Medical Literature Analysis and Retrieval System Online, SciVerse Scopus, Web of Science, Scientific Electronic Library Online, Cochrane Library, and Theses and Dissertations Catalog), as well as in an electronic search engine. Eleven studies were selected, which corroborate the use of 25% glucose as a non-pharmacological measure to reduce pain in Newborns, evidencing its analgesic effect from the reduction of the scores in the scales that assess pain. Regarding use, it was noticed that most employed 2 mL of this solution, via oral route, two minutes before the procedure. The non-pharmacological measures are low-cost and easy to use. The 25% glucose solution is seen as a gold-standard method for pain relief in Newborns. This study provided additional scientific basis by showing that the use of a 25% glucose solution is beneficial in relieving pain in newborns during arterial and venous puncture, especially when associated with other techniques. The study elucidates the health actions for the management of neonatal pain and contributes to fostering scientific visibility and relevance regarding the theme.

Correlation between venous blood gas indices and radiological involvements of COVID-19 patients at first admission to emergency department

SUMMARY The purpose of this study was to investigate the relation between venous blood gas and chest computerized tomography findings and the clinical conditions of COVID-19 pneumonia. METHODS: A total of 309 patients admitted to the emergency department and subsequently confirmed COVID-19 cases was examined. Patients with pneumonia symptoms, chest computerized tomography scan, venous blood gas findings, and confirmed COVID-19 on reverse transcription-polymerase chain reaction (PCR) were consecutively enrolled. Multiple linear regression was used to predict computerized tomography and blood gas findings by clinical/laboratory data. RESULTS: The median age of patients was 51 (interquartile range 39-66), and 51.5% were male. The mortality rate at the end of follow-up was 18.8%. With respect to survival status of patients pCO2 and HCO3 levels and total computerized tomography score values were found to be higher in the surviving patients (p<0.001 and p=0.003, respectively), whereas pH and lactate levels were higher in patients who died (p=0.022 and p=0.001, respectively). With logistic regression analysis, total tomography score was found to be significantly effective on mortality (p<0.001). The diffuse and random involvement of the lungs had a significant effect on mortality (p<0.001, 95%CI 3.853-38.769, OR 12.222 and p=0.027; 95%CI 1.155-11.640, OR 3.667, respectively). With linear regression analysis, the effect of pH and lactate results were found to have a positive effect on total tomography score (p=0.003 and p<0.001, respectively), whereas pCO2 was found to have a negative effect (p=0.029). CONCLUSION: There was correlation between venous blood gas indices and radiologic scores in COVID-19 patients. Venous blood gas taken in emergency department can be a fast, applicable, minor-invasive, and complementary test in terms of diagnosing COVID-19 pneumonia and predicting the prognosis of disease.

Protective effect of Renqing Changjue on acute respiratory distress syndrome in rabbits / 中国药理学与毒理学杂志

OBJECTIVE To investigate whether Renqing Changjue has a protective effect on acute respiratory dis?tress syndrome (ARDS) induced by endotoxin lipopolysaccharide (LPS) in rabbits. METHODS Thirty-six healthy male New Zealand white rabbits were randomly divided into six groups: normal control group, model group, dexamethasone group, Renqing Changjue high, middle and low dose group, with six rabbits in each group. LPS was used to replicate the ARDS model after five consecutive days of gavage. Arterial pressure, respiratory rate and anal temperature blood were recorded for arterial blood gas analysis at 0, 0.5, 1, 2 and 4 h, respectively. At the end of the four-hour experiment, rab?bits were killed by bloodletting, and the lung tissue was quickly removed to determine the cytokines, SOD, MDA and pathological examination of rabbit lung. RESULTS Renqing Changjue can significantly reduce the pathological changes of lung in ARDS model group. The expression of AQP1 and MPO in rabbit lung was significantly decreased by immuno?histochemistry (P<0.05) ,reduce the lung wet/dry weight ratio, increase the ratio of PaO2/FiO2, inhibit the release of inflammatory factors and scavenge free radicals and antioxidant effects. CONCLUSION Renqing Changjue can effec?tively protect rabbits with acute respiratory distress syndrome induced by LPS, and may protect the lung by inhibiting the release of cytokines and anti-oxidation.

Comparison of the efficacy of different venous intubation in venous-arterial extracorporeal membrane oxygenation assisted lung transplantation / 中华危重病急救医学

Objective:To compare the curative effects of different venous cannulas and drainage to improve patient's whole body oxygenation during the auxiliary process of venous-arterial extracorporeal membrane oxygenation (VA-ECMO) in lung transplantation.Methods:From December 2016 to December 2019, 12 patients who were assisted by VA-ECMO in one lung transplantation in People's Hospital of Henan Province were selected as the research objects. According to the number of side holes of venous cannulas, they were divided into two groups: one group with few side holes and other group with multiple side holes. The differences in blood gas indexes among the right radial artery, left radial artery, and right internal jugular vein before and after assistance were compared, and the assistance effect was evaluated.Results:The arterial partial pressure of oxygen (PaO 2) of blood gas indexes of the right and left radial arteries in both groups were significantly higher than that before assistance [mmHg (1 mmHg = 0.133 kPa): right and left radial artery in few side holes group: 79.5±4.2 vs. 48.3±3.8 and 88.1±3.5 vs. 48.3±3.8; right and left radial artery in multiple side holes group: 67.7±5.9 vs. 48.7±3.2 and 84.0±3.8 vs. 48.7±3.2, all P < 0.05]. The arterial partial pressure of carbon dioxide (PaCO 2) of blood gas index was significantly lower than that before assistance (mmHg: 44.2±2.6 vs. 71.7±4.4 for the right radial artery and 44.7±1.4 vs. 71.7±4.4 for the left radial artery in the group with few side holes; 46.2±2.1 vs. 71.2±3.5 for the right radial artery and 44.1±1.9 vs. 71.2±3.5 for the left radial artery in the group with multiple side holes, all P < 0.05). The partial pressure of oxygen in venous blood (PvO 2) of blood gas index of ECMO system in the group with few side holes was significantly lower than that of the multiport side holes group (mmHg: 56.4±3.2 vs. 88.7±1.5, P < 0.01), and the partial pressure of carbon dioxide in venous blood (PvCO 2) was significantly higher than that of multiport side holes group (mmHg: 63.6±3.7 vs. 44.2±1.7, P < 0.01). Conclusions:When VA-ECMO is used in lung transplantation, the superior vena cava blood flow can be fully drained by using intravenous cannula with few side holes. It can effectively improve the oxygenation of the upper body of lung transplant patients, avoid the dilemma of hypoxemia in the upper body and hyperxemia in the lower body, provide more effective assistance to patients undergoing single lung transplantation, and is more meaningful for improving the oxygenation status of the whole body in patients undergoing single lung transplantation.