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Background: Clearance of tissue carbon dioxide by circulation is measured by venous to arterial carbon dioxide partial pressure difference (AVCO2 ) and is correlated with cardiac output (CO) in critically ill adult patients. This study aimed to correlate AVCO2 with other CO indices like arteriovenous oxygen saturation difference (AVO2 ), central venous oxygen saturation (ScVO2 ), and serum lactate in pediatric patients undergoing intracardiac repair (ICR) for tetralogy of Fallot (TOF). Methods: We conducted a prospective observational study in 50 patients, of age 5months to 5 years, undergoing ICR for TOF and analyzed AVO2 , AVCO2 , ScVO2 , and lactate from arterial and venous blood gas pairs obtained at different time intervals from admission to pediatric intensive care unit(PICU)(T0 ), at 6 h (T1 ), 12 h (T2 ), 24 h (T3 ), and 48 h (T4 ) postoperatively. Bivariate correlations were analyzed using Pearson for parametric variables. Results: Admission AVCO2 was not correlated with AVO2 (R2 = 0.166, P = 0.246), ScVO2 (R2 = ?2.2, P = 0.124), and lactate (R2 = ?0.07, P = 0.624). At T1 , AVCO2 was correlated with AVO2 (R2 = 0.283, P = 0.0464) but not with ScVO2 (R2 = ? 0.25, P = 0.079) and lactate (R2 = ?0.07, P = 0.623). At T2 , T3 and T4 , AVCO2 was correlated with AVO2 (R2 = 0.338,0.440 & 0.318, P = 0.0162, 0.0013, and 0.024), ScVO2 (R2 = ? 0.344, ? 0.488, and ?0.366; P = 0.0143, <0.0001, and 0.017), and lactate (R2 = 0.305, 0.467 and 0.607; P = 0.0314, 0.00062 and <0.0001). AVCO2 was negatively correlated with ScVO2 . No correlation observed between admission AVCO2 and mechanical ventilation duration. Two nonsurvivors had higher value of admission AVCO2 compared to survivors. Conclusion: AVCO2 is correlated with other CO surrogates like AVO2 , ScVO2 , and lactate in pediatric patients undergoing ICR for TOF.
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Aims: To evaluate the effectiveness of low pressure carbon dioxide as a hurdle in raw milk storage. Study Design: Milk samples were stored at under low pressure carbon dioxide at 29°C for 6 hours and the microbial quality of milk was compared with control milk. Place and Duration of Study: Department of Dairy Microbiology, Verghese Kurien Institute of Dairy and Food Technology (VKIDFT), Kerala Veterinary and Animal Sciences University, Mannuthy between January 2020 and December 2020. Methodology: Milk samples were collected from an organized farm. The initial microbial quality of milk was determined and samples were carbonated to a pressure of 20 psi and stored for six hours 29°C, uncarbonated milk sample kept at 29°C acted as the control. The microbial quality of the carbonated milk and uncarbonated milk was determined after storage in terms of total viable count, coliform count and gram negative organism count. Results: Significant growth suppression (P=0.05) of bacteria was observed in the carbonated milk. Total Viable count showed a suppression of 1.05 log cfu/ml while coliforms showed a suppression of 1.3 log cfu/ml. The greatest log reduction was observed in gram negative organisms with a difference of 2.2 log cfu/ml and psychrotrophic organisms with 1.54 log cfu/ml. Conclusion: Carbon dioxide was found to be an effective bacteriostatic agent which could be used for extending the keeping quality of raw milk. The bacteriostatic action could be due to anaerobic conditions developed by carbon dioxide and also due to the increased acidity of the medium.
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Objective:Extracorporeal carbon dioxide removal(ECCO 2R) is a technique that aims to decarboxylate the blood and thus to correct hypercapnia and respiratory acidosis in acute respiratory failure, but is rarely used in children.We successfully completed the ECCO 2R treatment for a pediatric case with adenovirus pneumonia, severe acute respiratory distress syndrome(ARDS) and hypercapnia in PICU, which provided clinical references for the use of ECCO 2R in acute respiratory failure for children. Methods:A patient with adenovirus pneumonia and severe ARDS was successfully treated with ECCO 2R-continuous renal replacement therapy(CRRT)combined system after weaning from extracorporeal membrane oxygenation(ECMO). We reported the treatment process, ECCO 2R treatment effect and side effects, so as to provide clinical reference for ECCO 2R treatment of children with ARDS. Results:One-year and four-month-old boy was treated with mechanical ventilation and venous-arterial ECMO due to adenovirus pneumonia and severe ARDS.After ECMO treatment for 25 days, he developed severe hypercapnia after weaning from ECMO.ECCO 2R was initiated.The pH value increased by 11.2%(from 7.222 to 7.303) 1 hour after ECCO 2R treatment, partial pressure of blood carbon dioxide(PCO 2)decreased by 29.1%(from 72.6 mmHg to 51.5 mmHg, 1 mmHg=0.133 kPa) and the average airway pressure of high-frequency ventilation decreased by 5 cmH 2O(from 20 cmH 2O to 15 cmH 2O, 1 cmH 2O=0.098 kPa) after 6 hours of ECCO 2R.The CO 2 removal rate of ECCO 2R system was 29.1 mL/min.It was stopped because of ECCO 2R-membrane clotting after 72 h. There was no increase of PCO 2.Extubation was successfully after undergoing invasive mechanical ventilation for 39 days and with noninvasive ventilation for 5 days.The boy was hospitalized in PICU for 54 days, improved and discharged from the hospital.Followed up for 2 years after discharge, the growth and development were good, but the strenuous exercise endurance was still poor. Conclusion:ECCO 2R is effective in improving gas exchange, reducing PCO 2 and lowering ventilator pressure in children with ARDS and hypercapnia, which allow more protective ventilation.ECCO 2R provide transitional treatment for ECMO weaning and provide meaningful clinical reference for the use of ECCO 2R as part of respiratory support in children with respiratory failure.
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Objective:To explore the role of continuous renal replacement therapy (CRRT) combined with extracorporeal carbon dioxide removal (ECCO 2R) in the treatment of children with respiratory failure. Methods:The clinical data of 12 children with respiratory failure who were treated with CRRT+ECCO 2R in PICU of Jinan Children's Hospital from July 2020 to August 2022 were collected and analyzed retrospectively. The outcomes and the external pipeline usage of the patients were observed, and the blood gas analysis and ventilator parameters before 1 h and after 1, 6, 12 and 24 h of the treatment were compared by one-way ANOVA with LSD post hoc correction. Results:Six patients successfully withdrew from CRRT+ECCO 2R and mechanical ventilation, three patients were transferred to ECMO treatment. Three cases died after voluntary withdrawal of treatment, and two cases died due to treatment failure. The mortality rate was 41.7%. After continuous treatment of CRRT+ECCO 2R for 15 to 112 h, two cases experienced extracorporeal circuit obstruction. After 1 h of treatment, PaCO 2 decreased from (64.67±24.4) mmHg to (49.42±15.54) mmHg, pH increased from (7.28±0.20) to (7.38±0.11), FiO 2 decreased from (0.85±0.13) to (0.78±0.15), PC decreased from (19.42±4.34) cmH 2O to (17.75±4.00) cmH 2O. After 24 h of treatment, PaCO 2 decreased to (39.2±5.55) mmHg, pH increased to (7.41±0.04), FiO 2 decreased to (0.46±0.11), and PC decreased to (13.8±3.36) cmH 2O, and the differences were statistically significant compared with before treatment ( P < 0.05). Conclusions:The combination of CRRT and ECCO 2R therapy can safely substitute for partial lung ventilation/perfusion function, and play a role in protecting right heart function and improving lung-kidney interaction. It can be considered as an option for extracorporeal respiratory, circulatory, and renal support, and consequently has broad prospects.
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Objective:To investigate the relationship between central venous-arterial blood carbon dioxide partial pressure difference (Pcv-aCO 2) and left ventricular ejection fraction(LVEF) in acute myocardial infarction. Methods:Clinical data of patients with acute myocardial infarction admitted to the Intensive Care Unit of Fujian Provincial Hospital from November 2019 to October 2021 were retrospectively analyzed. LVEF was measured by bedside echocardiogram. The patients were divided into the normal LVEF group (LVEF ≥ 52%) and decreased LVEF group (LVEF < 52%) according to LVEF. The differences in general information and hemodynamic parameters between the two groups were compared. The normality of the above data was tested by the Jarque-Bera test. Correlation analysis of hemodynamic indices with LVEF was performed. Binary logistic regression was used to analyze the risk factors associated with the decrease in LVEF. The feasibility of diagnosing LVEF decline with Pcv-aCO 2 was assessed using receiver operating characteristic (ROC) curve. Results:Seventy-two patients with acute myocardial infarction were included for analysis, including 25 patients in the normal LVEF group and 47 patients in the decreased LVEF group. Pcv-aCO 2 was significantly higher in the decreased LVEF group than that in the normal LVEF group [(7.13±1.19) mmHg vs. (5.41±1.23) mmHg, P<0.01]. There was a negative correlation between LVEF and Pcv-aCO 2 ( rs= -0.740, P<0.01). The area under the ROC curve for Pcv-aCO 2 was 0.849 (95% CI: 0.758-0.939, P<0.01). The binary logistic regression analysis showed that Pcv-aCO 2 was an independent risk factor for decreased LVEF ( OR=2.251, 95% CI: 1.326-3.820). Conclusions:To a certain extent, the increase of Pcv-aCO 2 can predict the decrease of LVEF in acute myocardial infarction.
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Objective:To investigate the value of the venous-to-arterial CO 2 gap (Δ CO 2 gap) before and after the fluid challenge (FC) in determining the fluid responsivenessin septic shock patients. Methods:A total of 104 septic shock patients admitted to the Medical Intensive Care Unit (MICU) of Peking Union Medical College Hospital were included in the retrospective study. All patients were monitored by Swan Ganz floating catheter during the FC. Hemodynamics and blood gas indices were collected before FC (T0) and immediately (T1), 10 min (T2), 30 min (T3) and 60 min (T4) after FC. Responders were defined as patients with a > 10% increase in cardiac output (CO) after FC. Spearman correlation analysis was used to evaluate the correlation between CO 2 gap and CO. The value of ΔCO2 gap were calculated by the area under the receiver operating characteristic (AUROC) curve in the whole population. Results:Among 104 patients, the effective rates of FC at T1, T2, T3 and T4 were 59% (61/104), 72% (75/104), 73% (76/104), and 77% (80/104), respectively. CO of patients in the reactive group was lower than that in the non-reactive group at T2 [6.0 (4.7, 7.5) vs. 7.2 (6.4, 8.5) L/min, P=0.019], and there was no significant difference in CO 2 gap between the two groups before FC. Spearman correlation analysis showed that CO 2 gap was negatively correlated with CO, and the correlations between CO 2 content gap and CO was -0.34, and -0.33 of CO 2 pressure gap and CO, respectively (both P <0.05). ROC curve analysis showed that the ΔCO 2 gap at T1 could weakly judge the reactivity at T2, T3 and T4, but could not judge the reactivity at T1. The AUROC at T2 was 0.669 of ΔCO 2 content gap and 0.684 of ΔCO 2 pressure gap (both P <0.05). Conclusions:The evaluate time judging the effect of FC should be appropriately extended. The change value of CO 2 gap before and immediately after volume expansion in septic shock patients can judge the fluid responsiveness within 10 min after FC.
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Carbon dioxide is a simple asphyxial gas, with low concentrations having an excitatory effect on the respiratory center, while high concentrations have an inhibitory effect on the respiratory center. Simple carbon dioxide poisoning is rarely seen clinically. This article reviews and analyzes the treatment process of 9 cases of acute inhalation carbon dioxide poisoning in a cargo ship carbon dioxide leakage accident in May 2019, summarizes clinical treatment experience, and provides timely and effective treatment for acute pulmonary edema caused by acute inhalation carbon dioxide poisoning. In particular, the application of hormones has a good prognosis, improving clinicians' understanding of the disease.
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Humans , Carbon Dioxide , Ships , Accidents , Pulmonary Edema , Treatment Outcome , Poisoning , Accidents, OccupationalABSTRACT
To comprehensively evaluate the human body's respiratory, circular metabolism and other functions, and to diagnose lung disease, an accurate and reliable pulmonary function test (PFT) is developed. The system is divided into two parts:hardware and software. It realizes the collection of respiratory, pulse oxygen, carbon dioxide, oxygen and other signals, and draws flow-volume curve (FV curve), volume-time curve (VT curve), respiratory waveform, pulse wave, carbon dioxide and oxygen waveform in real time on the upper computer of the PFT system, and conducts signal processing and parameter calculation for each signal. The experimental results prove that the system is safe and reliable, it can accurately measure the basic functions of human body, and provide reliable parameters, and has good application prospects.
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Humans , Carbon Dioxide , Respiratory Function Tests , Oxygen , Heart RateABSTRACT
Extracorporeal carbon dioxide removal is an artificial lung auxiliary technique based on extrapulmonary gas exchange and can effectively remove carbon dioxide and provide oxygenation to a certain extent, and it is one of the effective treatment techniques for hypercapnia developed after mechanical ventilation and extracorporeal membrane oxygenation in recent years and has wide application prospect. This article elaborates on the development, working principle, advantages, classification, complications, and clinical application of extracorporeal carbon dioxide removal, so as to provide a new choice for extracorporeal carbon dioxide removal in clinical practice.
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Humans , Carbon Dioxide , Extracorporeal Membrane Oxygenation , Renal Dialysis , Respiration, ArtificialABSTRACT
ABSTRACT We report the long-term outcomes of a case of prenatal gastroschisis repair using a fully percutaneous fetoscopic approach with partial carbon dioxide insufflation. Surgery was performed as an experimental procedure before the scheduled elective birth. The fetal intestines were successfully returned to the abdominal cavity without any fetal or maternal complications. Ultrasonography performed 24 hours later revealed bowel peristalsis and no signs of fetal distress. After 48 hours, partial extrusion of the small bowel was observed, and the fetus was delivered. Gastroschisis repair was immediately performed upon delivery using the EXIT-like procedure as per our institutional protocol. The newborn did not require assisted mechanical ventilation, was discharged at 14 days of age and was then exclusively breastfed. At 3-year follow-up, the patient had no associated gastroschisis-related complications. This is the first case of prenatal repair of gastroschisis, which provides baseline knowledge for future researchers on the potential hurdles and management of prenatal repair.
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Abstract Introduction: Arterial lactate, mixed venous O2 saturation, venous minus arterial CO2 partial pressure (Pv-aCO2) and the ratio between this gradient and the arterial minus venous oxygen content (Pv-aCO2/Ca-vO2) were proposed as markers of tissue hypoperfusion and oxygenation. The main goals were to characterize the determinants of Pv-aCO2 and Pv-aCO2/Ca-vO2, and the interchangeability of the variables calculated from mixed and central venous samples. Methods: 35 cardiac surgery patients were included. Variables were measured or calculated: after anesthesia induction (T1), end of surgery (T2), and at 6-8 hours intervals after ICU admission (T3 and T4). Results: Macrohemodynamics was characterized by increased cardiac index and low systemic vascular resistances after surgery (p < 0.05). Hemoglobin, arterial-pH, lactate, and systemic O2 metabolism showed significant changes during the study (p < 0.05). Pv-aCO2 remained high and without changes, Pv-aCO2/Ca-vO2 was also high and decreased at T4 (p < 0.05). A significant correlation was observed globally and at each time interval, between Pv-aCO2 or Pv-aCO2/Ca-vO2 with factors that may affect the CO2 hemoglobin dissociation. A multilevel linear regression model with Pv-aCO2 and Pv-aCO2/Ca-vO2 as outcome variables showed a significant association for Pv-aCO2 with SvO2, and BE (p < 0.05), while Pv-aCO2/Ca-vO2 was significantly associated with Hb, SvO2, and BE (p < 0.05) but not with cardiac output. Measurements and calculations from mixed and central venous blood were not interchangeable. Conclusions: Pv-aCO2 and Pv-aCO2/Ca-vO2 could be influenced by different factors that affect the CO2 dissociation curve, these variables should be considered with caution in cardiac surgery patients. Finally, central venous and mixed values were not interchangeable.
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Cardiac Surgical Procedures , Perfusion , Carbon Dioxide , AnaerobiosisABSTRACT
Abstract Background Cardiopulmonary Exercise Testing (CPX) is essential for the assessment of exercise capacity for patients with Chronic Heart Failure (CHF). Respiratory gas and hemodynamic parameters such as Ventilatory Efficiency (VE/VCO2 slope), peak oxygen uptake (peak VO2), and heart rate recovery are established diagnostic and prognostic markers for clinical populations. Previous studies have suggested the clinical value of metrics related to respiratory gas collected during recovery from peak exercise, particularly recovery time to 50% (T1/2) of peak VO2. The current study explores these metrics in detail during recovery from peak exercise in CHF. Methods Patients with CHF who were referred for CPX and healthy individuals without formal diagnoses were assessed for inclusion. All subjects performed CPX on cycle ergometers to volitional exhaustion and were monitored for at least five minutes of recovery. CPX data were analyzed for overshoot of respiratory exchange ratio (RER=VCO2/VO2), ventilatory equivalent for oxygen (VE/VO2), end-tidal partial pressure of oxygen (PETO2), and T1/2 of peak VO2 and VCO2. Results Thirty-two patients with CHF and 30 controls were included. Peak VO2 differed significantly between patients and controls (13.5 ± 3.8 vs. 32.5 ± 9.8 mL/Kg*min−1, p < 0.001). Mean Left Ventricular Ejection Fraction (LVEF) was 35.9 ± 9.8% for patients with CHF compared to 61.1 ± 8.2% in the control group. The T1/2 of VO2, VCO2 and VE was significantly higher in patients (111.3 ± 51.0, 132.0 ± 38.8 and 155.6 ± 45.5s) than in controls (58.08 ± 13.2, 74.3 ± 21.1, 96.7 ± 36.8s; p < 0.001) while the overshoot of PETO2, VE/VO2 and RER was significantly lower in patients (7.2 ± 3.3, 41.9 ± 29.1 and 25.0 ± 13.6%) than in controls (10.1 ± 4.6, 62.1 ± 17.7 and 38.7 ± 15.1%; all p < 0.01). Most of the recovery metrics were significantly correlated with peak VO2 in CHF patients, but not with LVEF. Conclusions Patients with CHF have a significantly blunted recovery from peak exercise. This is reflected in delays of VO2, VCO2, VE, PETO2, RER and VE/VO2, reflecting a greater energy required to return to baseline. Abnormal respiratory gas kinetics in CHF was negatively correlated with peak VO2 but not baseline LVEF.
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Objective:To investigate the prognostic value of the ratio of veno-arterial carbon dioxide partial pressure difference to arterio-venous oxygen content difference (Pv-aCO 2/Ca-vO 2) in children with primary peritonitis-related septic shock. Methods:A retrospective study was conducted. Sixty-three children with primary peritonitis-related septic shock admitted to department of intensive care unit of the Children's Hospital Affiliated to Xi'an Jiaotong University from December 2016 to December 2021 were enrolled. The 28-day all-cause mortality was the primary endpoint event. The children were divided into survival group and death group according to the prognosis. The baseline data, blood gas analysis, blood routine, coagulation, inflammatory status, critical score and other related clinical data of the two groups were statistics. The factors affecting the prognosis were analyzed by binary Logistic regression, and the predictability of risk factors were tested by the receiver operator characteristic curve (ROC curve). The risk factors were stratified according to the cut-off, Kaplan-Meier survival curve analysis compared the prognostic differences between the groups.Results:A total of 63 children were enrolled, including 30 males and 33 females, the average age (5.6±4.0) years old, 16 cases died in 28 days, with mortality was 25.4%. There were no significant differences in gender, age, body weight and pathogen distribution between the two groups. The proportion of mechanical ventilation, surgical intervention, vasoactive drug application, and procalcitonin, C-reactive protein, activated partial thromboplastin time, serum lactate (Lac), Pv-aCO 2/Ca-vO 2, pediatric sequential organ failure assessment, pediatric risk of mortality Ⅲ in the death group were higher than those in the survival group. Platelet count, fibrinogen, mean arterial pressure were lower than those in the survival group, and the differences were statistically significant. Binary Logistic regression analysis showed that Lac and Pv-aCO 2/Ca-vO 2 were independent risk factors affecting the prognosis of children [odds ratio ( OR) and 95% confidence interval (95% CI) were 2.01 (1.15-3.21), 2.37 (1.41-3.22), respectively, both P < 0.01]. ROC curve analysis showed that the area under curve (AUC) of Lac, Pv-aCO 2/Ca-vO 2 and their combination were 0.745, 0.876 and 0.923, the sensitivity were 75%, 85% and 88%, and the specificity were 71%, 87% and 91%, respectively. Risk factors were stratified according to cut-off, and Kaplan-Meier survival curve analysis showed that the 28-day cumulative probability of survival of Lac ≥ 4 mmol/L group was lower than that in Lac < 4 mmol/L group [64.29% (18/28) vs. 82.86% (29/35), P < 0.05]. Pv-aCO 2/Ca-vO 2 ≥ 1.6 group 28-day cumulative probability of survival was less than Pv-aCO 2/Ca-vO 2 < 1.6 group [62.07% (18/29) vs. 85.29% (29/34), P < 0.01]. After a hierarchical combination of the two sets of indicator variables, the 28-day cumulative probability of survival of Pv-aCO 2/Ca-vO 2 ≥ 1.6 and Lac ≥ 4 mmol/L group significantly lower than that of the other three groups (Log-rank test, χ2 = 7.910, P = 0.017). Conclusion:Pv-aCO 2/Ca-vO 2 combined with Lac has a good predictive value for the prognosis of children with peritonitis-related septic shock.
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Objective:To investigate the relationship between arterial blood partial pressure of carbon dioxide and neurological outcome after cardiopulmonary resuscitation.Methods:The clinical data of 116 patients who underwent cardiopulmonary resuscitation admitted to the Intensive Care Unit and Emergency Department of the Second People's Hospital of Hefei from January 2018 to January 2020 were retrospectively analyzed. According to the average arterial blood partial pressure of carbon dioxide within 24 hours after admission, patients were divided into normal (35 mmHg ≤ PaCO 2 ≤ 55 mmHg, 1 mmHg = 0.133 kPa, n = 44), hypercapnia (PaCO 2 > 55 mmHg, n = 51), and hypocapnia (PaCO 2 < 35 mmHg, n = 21) groups. ICU stay, in-hospital mortality, and neurological outcome at discharge were compared among groups. A logistic regression analysis model was established. The relationship between PaCO 2 and neurological outcome was determined. Results:There were no significant differences in age, sex, cardiac arrest time, acute physiological and chronic health evaluation II score at admission, 1-hour mean arterial pressure, location of cardiac arrest, and initial heart rhythm among the three groups (all P > 0.05). ICU stay in the normal group [(7.23 ± 2.55) days] was significantly higher than that in the hypercapnia [(12.21 ± 4.12) days] and hypocapnia [(11.78 ± 4.72) days] groups ( t = 6.48, 4.59, both P < 0.01). In-hospital mortality in the normal group was 38.6% (17/44), which was significantly lower than 60.8% (31/51) in the hypercapnia group and 66.7% (14/21) in the hypocapnia group ( χ2 = 4.63, 4.47, both P < 0.05). The good neurological outcome rate in the normal group was 55.6% (15/44), which was significantly higher than 25.0% (5/51) in the hypercapnia group and 28.6% (2/21) in the hypocapnia group ( χ2 = 8.38, 5.14, both P < 0.05). Multivariate logistic regression analysis showed that cardiac arrest time, 1-hour mean arterial pressure, acute physiological and chronic health evaluation II score, and PaCO 2 are important factors for neurological outcomes of resuscitated patients at discharge (all P < 0.01). Conclusion:Within 24 hours after cardiopulmonary resuscitation, maintaining a normal PaCO 2 level can help improve the neurological outcome of patients at discharge.
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Objective:To investigate the effects of aerosol therapy with budesonide suspension combined with compound ipratropium bromide on partial pressure of carbon dioxide (PaCO 2) and tumor necrosis factor α (TNF-α) in children with bronchiolitis. Methods:A total of 124 children with bronchiolitis admitted to Gujiao Central Hospital from January 2019 to December 2021 were included in this study. These children were randomly divided into two groups using the coin-tossing method. The control group ( n = 62) was treated with routine symptomatic treatment, and the study group ( n = 62) was treated with aerosol therapy of budesonide suspension combined with compound ipratropium bromide based on routine symptomatic treatment. The time at which clinical symptoms disappear, clinical efficacy, inflammatory reaction, and blood gas index were determined in each group. Results:After treatment, the time at which asthma, cough, pulmonary rales, and fever in the study group were (2.28 ± 0.71) days, (3.30 ± 0.82) days, (5.25 ± 1.03) days, and (19.01 ± 2.65) hours, respectively, which were significantly shorter than (2.71 ± 0.89) days, (3.81 ± 0.98) days, (5.72 ± 1.37) days, and (20.76 ± 3.12) hours in the control group ( t = 2.97, 3.14, 2.15, 3.36, all P < 0.05). Total response rate and PaO 2 in the study group were 91.94% and (83.94 ± 4.02) mmHg, respectively, which were significantly higher than 77.42% and (81.25 ± 5.53) mmHg in the control group ( χ2 = 5.03, t = 3.09, both P < 0.05). Interleukin-18, interleukin-33, TNF-α, and PaCO 2 in the study group were (141.03 ± 34.69) ng/L, (143.87 ± 38.43) ng/L, (75.49 ± 18.43) ng/L, and (41.85 ± 3.31) mmHg, respectively, which were significantly lower than (158.64 ± 47.92) ng/L, (162.75 ± 50.32) ng/L, (83.22 ± 21.75) ng/L, and (43.58 ± 4.46) mmHg in the control group ( t = -2.34, -2.34, -3.23, -2.45, all P < 0.05). Conclusion:Aerosol therapy with budesonide suspension combined with compound ipratropium bromide based on routine symptomatic treatment is more effective on bronchiolitis than routine symptomatic treatment alone. The combined therapy can effectively decrease PaCO 2 and TNF-α levels.
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Abstract: Introduction: Inducing hypocapnia is a common practice during pediatric general anesthesia, even though it has not shown clear benefits. Objective: To compare the impact of carbon dioxide values after aortic impingement (< 32.7 vs ≥ 32.7 mmHg) on postoperative morbimortality among pediatric patients undergoing cardiac surgery. Material and methods: A case-control study included 90 pediatric patients undergoing cardiac surgery with cardiopulmonary bypass. The study cases consisted of 45 patients who died within 30 days of the postoperative period. Cases and controls were individually matched (1:1 ratio). Descriptive and inferential statistics (Mann-Whitney's U, Student's t and χ2 tests) were used to analyze the results. A p < 0.05 was considered significant. A univariate analysis was also carried out. The strength of association between morbimortality and carbon dioxide values after aortic impingement was determined using the odds ratio. The data were processed using SPSS v-24.0. Results: The group with carbon dioxide values of < 32.7 mmHg after aortic impingement was associated with greater morbidity (OR 24.75; 95% CI 4.92-124.32) and mortality (OR 22.47; 95% CI 4.85-10.17) at 30 days. Conclusion: Pediatric patients undergoing cardiac surgery with carbon dioxide values of < 32.7 mmHg after aortic impingement showed higher postoperative morbimortality than those with carbon dioxide values of ≥ 32.7 mmHg.
Resumen: Introducción: La hipocapnia es una práctica común durante la anestesia general pediátrica; sin embargo, a lo largo del tiempo no ha mostrado beneficios bien definidos. Objetivo: Comparar el impacto del bióxido de carbono post-pinzamiento aórtico (< 32.7 vs ≥ 32.7 mmHg) sobre la morbimortalidad postoperatoria en los pacientes pediátricos sometidos a cirugía cardíaca. Material y métodos: Se realizó un estudio de casos y controles que incluyó 90 pacientes pediátricos sometidos a cirugía cardíaca con derivación cardiopulmonar. Se consideraron casos 45 pacientes que fallecieron dentro de los 30 días del postoperatorio. Los controles fueron pareados en relación 1:1. Para su análisis se realizó estadística descriptiva e inferencial con U de Mann-Whitney, t de Student y χ2 según fue el caso. Una p < 0.05 fue significativa. Se realizó un análisis univariado. La fuerza de asociación entre la morbimortalidad y los valores de bióxido de carbono post-pinzamiento aórtico se obtuvo mediante el odds ratio. Los datos fueron procesados mediante SPSS v-24.0. Resultados: El grupo con valores de bióxido de carbono post-pinzamiento aórtico < 32.7 mmHg se asoció con una mayor morbilidad a los 30 días (OR 24.75; IC del 95% 4.92-124.32) y mortalidad (OR 22.47; IC del 95% 4.85-10.17). Conclusión: Los pacientes pediátricos sometidos a cirugía cardíaca con valores de bióxido de carbono post-pinzamiento aórtico < 32.7 mmHg tienen mayor morbimortalidad postoperatoria que los que tienen valores ≥ 32.7 mmHg.
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ABSTRACT Background: Capnography and carbon dioxide (CO2) insufflation during gastrointestinal endoscopy under sedation are associated with safety and comfort improvements, respectively. Capnography can provide early detection of apnea and hypoxemia, whereas CO2 insufflation causes lower periprocedural discomfort. This is the first study to report the application of volumetric capnography in colonoscopy. Objective: This study aimed to evaluate the use of volumetric capnography with room air (RA) and CO2 insufflation during routine colonoscopy. Methods: In this prospective cohort study, 101 patients who underwent routine colonoscopy under sedation with volumetric capnography monitoring were included. Insufflation with RA was used to distend the intestinal lumen in group 1 (n=51), while group 2 (n=50) used CO2 insufflation. The primary endpoints were episodes of hypoxia, alveolar hypoventilation, and end-tidal CO2 (EtCO2). The secondary endpoints were tidal volume per minute, consumption of sedation medications, and post-procedure pain using the Gloucester modified pain scale. Results: The number of episodes of hypoxia (SpO2<90%) was similar between the groups: four episodes in Group 1 and two episodes in Group 2. The duration of hypoxia was significantly longer in group 2 (P=0.02). Hypoalveolar ventilation (EtCO2) occurred more frequently in Group 2 than in Group 1 (27 vs 18 episodes, P=0.05). Regarding EtCO2, Group 2 showed higher values in cecal evaluation (28.94±4.68 mmHg vs 26.65±6.12 mmHg, P=0.04). Regarding tidal volume per minute, Group 2 had significantly lower values at the cecal interval compared to Group 1 (2027.53±2818.89 vs 970.88±1840.25 L/min, P=0.009). No episodes of hypercapnia (EtCO2 > 60 mmHg) occurred during the study. There was no difference in the consumption of sedation medications between the groups. Immediately after colonoscopy, Group 2 reported significantly less pain than Group 1 (P=0.05). Conclusion: In our study, volumetric capnography during colonoscopy was feasible and effective for monitoring ventilatory parameters and detecting respiratory complications. CO2 insufflation was safe and associated with less pain immediately after colonoscopy.
RESUMO Contexto: A capnografia e a insuflação de gás carbônico (CO2) durante endoscopia digestiva sob sedação são associados à maior segurança e conforto do paciente, respectivamente. A capnografia pode detectar precocemente a apneia e hipoxemia, enquanto a insuflação de CO2 causa menor desconforto periprocedimento. Relatos da aplicação da capnografia volumétrica em colonoscopias são escassos. Objetivo: Avaliar o uso de capnograifa volumétrica durante colonoscopia diagnóstica com insuflação de ar comprimido e CO2. Métodos: Em estudo prospectivo de coorte, foram incluídos um total de 101 pacientes submetidos a colonoscopia diagnóstica sob sedação com monitoração respiratória por meio de capnografia volumétrica. Insuflação com ar comprimido foi usado para distender o lúmen intestinal no Grupo 1 (n=51), enquanto o Grupo 2 (n=50) utilizou CO2 para insuflação. Objetivos primários foram avaliar episódios de hipóxia, hipoventilação alveolar e CO2 expirado (EtCO2). Objetivos secundários foram avaliar o volume alveolar por minuto, consumo de sedativos e a dor pós-colonoscopia por meio da Escala de Dor Modificada de Gloucester. Resultados: O número de episódios de hipóxia (SpO2 <90%) foi semelhante entre os grupos: quatro episódios no Grupo 1 e dois episódios no Grupo 2. A duração da hipóxia foi significativamente maior no Grupo 2 (P=0,02). A hipoventilação alveolar (EtCO2 ≥25% do valor basal) ocorreu mais frequentemente no Grupo 2 quando comparado ao Grupo 1 (27 vs 18 episódios, P=0,05). Em relação ao EtCO2, o Grupo 2 apresentou valores maiores no momento de aferição cecal (28.94±4.68 vs 26.65±6.12 mmHg, P=0,04). Quanto ao volume alveolar por minuto, o Grupo 2 apresentou valores significativamente menores no momento de aferição cecal quando comparado ao Grupo 1 (2027.53±2818.89 vs 970.88±1840.25 L/min, P=0,009). Não houve ocorrência de hipercapnia durante o estudo (EtCO2 >60 mmHg). Não houve diferença em relação ao consumo de sedativos entre os dois grupos. Imediatamente após a colonoscopia, o Grupo 2 apresentou significativamente menos dor que o Grupo 1 (P=0,05). Conclusão: Em nosso estudo, a capnografia volumétrica durante colonoscopia foi factível e eficaz para monitorar parâmetros ventilatórios e detectar complicações respiratórias, e a insuflação com CO2 foi segura e associada a menor dor imediatamente pós-colonoscopia.
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RESUMO Objetivo: A proporção entre pressão venosa central menos arterial de dióxido de carbono e conteúdo de oxigênio arterial menos venoso central (Pcv-aCO2/Ca-cvO2) é frequentemente usada como substituta para a oxigenação tecidual. O objetivo deste estudo foi identificar e sintetizar a literatura e a qualidade das evidências que suportam a Pcv-aCO2/Ca-cvO2 como um preditor de mortalidade em comparação com o lactato em pacientes críticos. Métodos: Pesquisamos vários bancos de dados procurando estudos que tivessem medido a Pcv-aCO2/Ca-cvO2 em pacientes críticos. Pesquisadores independentes realizaram a triagem dos artigos e a extração de dados. Uma metanálise de efeitos aleatórios foi realizada. Diferenças médias padronizadas agrupadas foram usadas para comparar a capacidade prognóstica da Pcv-aCO2/Ca-cvO2 e do lactato. Resultados: Inicialmente, obtivemos 172 estudos; 17 foram incluídos para descrição qualitativa, e dez foram incluídos para síntese quantitativa. A média de Pcv-aCO2/Ca-cvO2 foi maior nos não sobreviventes do que nos sobreviventes (diferença média padronizada agrupada de 0,75; IC95% 0,34 - 1,17; I2 = 83%), assim como os níveis de lactato (diferença média padronizada agrupada = 0,94; IC95% 0,34 - 1,54; I2 = 92%). Ambos os testes foram preditores estatisticamente significativos de mortalidade, embora com sobreposição de IC95% entre eles. Conclusão: Evidências de qualidade moderada mostraram pouca ou nenhuma diferença na capacidade da Pcv-aCO2/Ca-cvO2, em comparação com o lactato, em predizer mortalidade. No entanto, nossas conclusões são limitadas pela considerável heterogeneidade entre os estudos. Registro no PROSPERO:CRD42019130387
ABSTRACT Objective: The central venousarterial carbon dioxide pressure to arterial-central venous oxygen content ratio (Pcv-aCO2/Ca-cvO2) is frequently used as a surrogate for tissue oxygenation. We aimed to identify and synthesize literature and quality of evidence supporting Pcv-aCO2/Ca-cvO2 as a predictor of mortality in critically ill patients compared with lactate. Methods: We searched several databases for studies measuring Pcv-aCO2/Ca-cvO2 in critically ill patients. Independent investigators performed the article screening and data extraction. A random-effects metaanalysis was performed. Pooled standardized mean differences (SMD) were used to compare the prognostic ability of Pcv-aCO2/Ca-cvO2 and lactate. Results: We initially retrieved 172 studies; 17 were included for qualitative description, and 10 were included for quantitative synthesis. The mean Pcv-aCO2/Ca-cvO2 was higher in nonsurvivors than in survivors (pooled SMD = 0.75; 95%CI 0.34 - 1.17; I2 = 83%), as was the case with lactate levels (pooled SMD = 0.94; 95%CI 0.34 - 1.54; I2 = 92%). Both tests were statistically significant predictors of mortality, albeit with overlapping 95%CIs between them. Conclusion: Moderate-quality evidence showed little or no difference in the ability of Pcv-aCO2/Ca-cvO2, compared with lactate, to predict mortality. Nevertheless, our conclusions are limited by the considerable heterogeneity among the studies. PROSPERO registration:CRD42019130387
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Plastic pyrolysis oil blended with diesel was tested in a single cylinder diesel engine in an experimental study. Waste plastic is used to make plastic pyrolysis oil. Various blends of PPO-DIESEL are tested for engine exhaust emission at various loads in this study. Nitrogen oxide (NOx), carbon monoxide (CO), carbon dioxide (CO2), and hydro carbon (HC) are all measured in engine exhaust emissions. According to the results, D80PPO20 blend is best compared to other fuels for NOx, CO in all blends has no difference at full load, D60PPO40 blend is best compared to other fuels for CO2, and D80PPO20 blend is best compared to other fuels for HC. PPO-DIESEL blends can be used without modification in CI engines.
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Resumen A pesar de las referencias que advierten sobre los efectos adversos de la utilización de O2 suplementario sin asistencia ventilatoria en pacientes con enfermedades neuromusculares (ENM), aún hoy continúan ingresando pacientes en unidades de cuidados intensivos con hipercapnia grave y narcosis por CO2. Parecería que el problema es redescubierto según pasan los años y las generaciones. Muchos pacientes y su red de cuidadores formales e informales no son conscientes de este riesgo que puede llevar a un empeoramiento significativo de los síntomas, eventos agudos, ingresos hospitalarios y, en algunos casos, causar la muerte. Este artículo está centrado en los riesgos de la administración de O2, así como en sus indicaciones puntuales en personas con ENM. El problema central es que la administración de O2 puede quitar el impulso hipóxico para ventilar, aunque otros mecanismos podrían estar involucrados. El retiro completo de la oxigenoterapia sin apoyo de asistencia ventilatoria, es un error aún mayor. Es posible administrar O2 y controlar el CO2 de forma segura. Nunca se debe administrar O2 sin monitorear constantemente el nivel de CO2. La ventilación no invasiva binivelada (BiPAP) mediante interfaz nasal, bucal o boquilla, es la principal medida para revertir la hipoventilación y lograr el descenso de la PaCO2. Las indicaciones de oxigenoterapia en personas con ENM han sido consensuadas y están reservadas a situaciones específicas. Para mejorar la atención de aquellos enfermos con ENM y evitar intervenciones iatrogénicas, se requiere educación al equipo de salud y contención en el entorno del paciente.
Abstract Although the references warn about the adverse effects of adding O2 without ventilatory assistance in patients with neuromuscular diseases (NMD), patients are still to be admitted to intensive care units with severe hypercapnia and CO2 narcosis. It seems that the problem is rediscovered as the years and generations go by. Unfortunately, many patients and their network of formal and informal caregivers are unaware of this risk, leading to significant worsening of symptoms, acute events, hospital admissions, and, in some cases, cause death. This article focuses on the dangers of O2 administration as well as its precise indications in people with NMD. The central problem is that the administration of O2 can remove the hypoxic impulse to ventilate, however, other mechanisms could be involved, but. The complete withdrawal of oxygen therapy is an even greater mistake if it is not supported by ventilatory assistance. It is possible to supply O2 and control CO2 safely. Oxygen should never be administered without constantly monitoring the CO2 level. Bi-level non-invasive ventilation (BiPAP) through a buccal, nasal interface or mouthpiece is the primary measure to reverse hypoventilation and achieve a decrease in PaCO2. The indications for oxygen therapy in people with NMD have been agreed upon and are reserved for specific situations. To improve the care of those with NMD and avoid iatrogenic interventions, education of the health team and support in the patient's environment is required.