ABSTRACT
OBJECTIVE@#To investigate the efficacy of arterial partial pressure of oxygen (PaO2), procalcitonin (PCT) combined with ROX index in predicting the timing of tracheal intubation in patients with acute severe pancreatitis (SAP).@*METHODS@#A case-control study was conducted. A total of 148 patients with SAP admitted to Hunan Provincial People's Hospital from January 2019 to December 2022 were selected as the research objects. According to whether endotracheal intubation was used after admission during hospitalization, the patients were divided into the intubation group (102 cases) and non-intubation group (46 cases). Gender, age, white blood cell count (WBC), lymphocyte count (LYM), platelet count (PLT), C-reactive protein (CRP), hemoglobin (Hb), PCT, PaO2, arterial partial pressure of carbon dioxide (PaCO2), arterial bicarbonate ion (HCO3-) 1 day after admission, arterial lactic acid (Lac), lactate dehydrogenase (LDH), heart rate (HR), respiratory rate (RR), pulse oxygen saturation (SpO2), oxygenation index (PaO2/FiO2), blood pressure, worst ROX index (ROX index = SpO2/FiO2/RR) within 30 minutes of admission and 30 minutes before intubation of the two groups were measured. Multivariate Logistic regression was used to analyze the independent risk factors for the timing of endotracheal intubation in patients with SAP. The receiver operator characteristic curve (ROC curve) was used to determine the optimal predictive cut-off value for endotracheal intubation.@*RESULTS@#There were no significant differences in age, gender, WBC, LYM, CRP, Hb, LDH, HR and blood pressure at admission between the two groups. The PLT, Lac, PCT and RR in the intubation group were significantly higher than those in the un-intubation group, and HCO3-, PaO2, SpO2, PaO2/FiO2, the worst ROX index within 30 minutes after admission and 30 minutes before intubation were significantly lower than those in the non-intubation group (all P < 0.05). Logistic regression analysis showed that the worst ROX index within 30 minutes before intubation was the largest negative influencing factor for the timing of tracheal intubation in SAP patients [odds ratio (OR) = 0.723, 95% confidence interval (95%CI) was 0.568-0.896, P = 0.000], followed by PaO2 (OR = 0.872, 95%CI was 0.677-1.105, P < 0.001). PCT was the positive influencing factor (OR = 1.605, 95%CI was 1.240-2.089, P < 0.001). ROC curve analysis showed that the area under the ROC curve (AUC) of PaO2, PCT, the worst ROX index within 30 minutes before intubation and the combination to evaluate the tracheal intubation time of patients with SAP were 0.715, 0.702, 0.722 and 0.808, the sensitivity was 78.1%, 75.0%, 81.5% and 89.3%, the specificity was 66.7%, 59.0%, 73.2% and 86.4%, and the best cut-off value was 60.23 mmHg (1 mmHg ≈ 0.133 kPa), 2.72 μg/L, 4.85, and 0.58, respectively. The AUC of the combination of PaO2, PCT and the worst ROX index within 30 minutes before intubation predicted the timing of tracheal intubation in patients with SAP was significantly greater than using each index alone (all P < 0.01).@*CONCLUSIONS@#The worst ROX index within 30 minutes before intubation combined with PaO2 and PCT is helpful for clinicians to make a decision for tracheal intubation in patients with SAP.
Subject(s)
Humans , Procalcitonin , Oxygen , Case-Control Studies , Partial Pressure , Retrospective Studies , Pancreatitis/therapy , Intubation, Intratracheal , Prognosis , ROC CurveABSTRACT
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.
Subject(s)
Oxygen , Partial Pressure , Atmospheric Pressure , Acute Lung Injury , HypoxiaABSTRACT
OBJECTIVE@#To evaluate the safety of preoxygenation with high-flow nasal oxygenation in elderly patients during induction of general anesthesia with endotracheal intubation.@*METHODS@#Fifty-six elderly patients without difficult airway were randomized equally into high-flow nasal oxygen group (HF group) and conventional mask oxygen group (M group). Preoxygenation was performed for 5 min before induction of general anesthesia and endotracheal intubation. Oxygenation was maintained during laryngoscopy in HF group, and ventilation lasted until laryngoscopy in M group. For all the patients, the general data, cross-sectional area (CSA) of the gastric antrum measured by ultrasonography, arterial partial pressure of oxygen (PaO2), arterial partial pressure of carbon dioxide (PaCO2) and arterial oxygen saturation (cSO2) were recorded before preoxygenation (T1), at 5 min of preoxygenation (T2) and immediately after intubation (T3). The safety time of asphyxia, intubation time, times of mask ventilation and postoperative complications were compared between the two groups.@*RESULTS@#The general data were comparable between the two groups. After 5 min of preoxygenation, PaO2 and cSO2 were significantly increased in both groups, and PaO2 was significantly higher in HF group than in M group (F=118.108 vs 9.511, P < 0.05). Both PaO2 and cSO2 decreased after intubation, but PaO2 decreased more slowly in HF group and still remained higher than that at T1; cSO2 decreased significantly in M group to a lower level than that at T1. Compared with those in M group, the patients in HF group showed a significantly longer safety time of asphyxia (t=5.305, P < 0.05) with fewer times of mask ventilation (χ2= 6.720, P < 0.05). PaCO2 increased after intubation in both groups but was comparable between the two groups (F=3.138, P > 0.05).@*CONCLUSION@#High-flow nasal oxygen is safe, simple and effective for pre-oxygenation, which, as compared with the conventional oxygen mask, improves arterial oxygen partial pressure and prolongs the safety time of asphyxia to ensure the safety of airway management during induction of general anesthesia in elderly patients with endotracheal intubation.
Subject(s)
Aged , Humans , Anesthesia, General , Asphyxia , Intubation, Intratracheal , Oxygen , Partial PressureABSTRACT
OBJECTIVES@#To evaluate the accuracy and safety of measurements of transcutaneous carbon dioxide partial pressure (TcPCO@*METHODS@#A total of 45 very low birth weight infants were enrolled. TcPCO@*RESULTS@#There was no significant difference in TcPCO@*CONCLUSIONS@#Lower electrode temperatures (38-41℃) can accurately measure blood carbon dioxide partial pressure in very low birth weight infants, and thus can be used to replace the electrode temperature of 42°C. Transcutaneous measurements at the lower electrode temperatures may be helpful for understanding the changing trend of blood oxygen partial pressure.
Subject(s)
Humans , Infant , Infant, Newborn , Blood Gas Monitoring, Transcutaneous , Carbon Dioxide , Electrodes , Infant, Very Low Birth Weight , Oxygen , Partial Pressure , TemperatureABSTRACT
RESUMO O teste de apneia com desconexão do ventilador mecânico representa riscos durante a determinação da morte encefálica, especialmente em pacientes hipoxêmicos. Descrevemos a realização do teste de apneia sem desconexão do ventilador mecânico em dois pacientes. O primeiro caso é o de um menino de 8 anos, admitido com hipoxemia grave por pneumonia. Apresentou parada cardiorrespiratória, seguida de coma não responsivo por encefalopatia hipóxico-isquêmica. Dois exames clínicos constataram ausência de reflexos de tronco, e o Doppler transcraniano revelou parada circulatória encefálica. Realizaram-se três tentativas de teste de apneia, que foram interrompidas por hipoxemia, sendo então realizado teste de apneia sem desconexão do ventilador mecânico, ajustando a pressão contínua nas vias aéreas em 10cmH2O e fração inspirada de oxigênio em 100%. A saturação de oxigênio manteve-se em 100% por 10 minutos. A gasometria pós-teste foi a seguinte: pH de 6,90, pressão parcial de oxigênio em 284,0mmHg, pressão parcial de dióxido de carbono em 94,0mmHg e saturação de oxigênio em 100%. O segundo caso é de uma mulher de 43 anos, admitida com hemorragia subaracnóidea (Hunt-Hess V e Fisher IV). Dois exames clínicos constataram coma não responsivo e ausência de todos os reflexos de tronco. A cintilografia cerebral evidenciou ausência de captação de radioisótopos no parênquima cerebral. A primeira tentativa do teste de apneia foi interrompida após 5 minutos por hipotermia (34,9oC). Após reaquecimento, o teste de apneia foi repetido sem desconexão do ventilador mecânico, evidenciando-se manutenção do volume residual funcional com tomografia de bioimpedância elétrica. Gasometria pós-teste de apneia apresentava pH em 7,01, pressão parcial de oxigênio em 232,0mmHg, pressão parcial de dióxido de carbono 66,9mmHg e saturação de oxigênio em 99,0%. O teste de apneia sem desconexão do ventilador mecânico permitiu a preservação da oxigenação em ambos os casos. O uso de pressão contínua nas vias aéreas durante o teste de apneia parece ser uma alternativa segura para manter o recrutamento alveolar e a oxigenação durante determinação da morte encefálica.
ABSTRACT The apnea test, which involves disconnection from the mechanical ventilator, presents risks during the determination of brain death, especially in hypoxemic patients. We describe the performance of the apnea test without disconnection from the mechanical ventilator in two patients. The first case involved an 8-year-old boy admitted with severe hypoxemia due to pneumonia. He presented with cardiorespiratory arrest, followed by unresponsive coma due to hypoxic-ischemic encephalopathy. Two clinical exams revealed the absence of brainstem reflexes, and transcranial Doppler ultrasound revealed brain circulatory arrest. Three attempts were made to perform the apnea test, which were interrupted by hypoxemia; therefore, the apnea test was performed without disconnection from the mechanical ventilator, adjusting the continuous airway pressure to 10cmH2O and the inspired fraction of oxygen to 100%. The oxygen saturation was maintained at 100% for 10 minutes. Posttest blood gas analysis results were as follows: pH, 6.90; partial pressure of oxygen, 284.0mmHg; partial pressure of carbon dioxide, 94.0mmHg; and oxygen saturation, 100%. The second case involved a 43-year-old woman admitted with subarachnoid hemorrhage (Hunt-Hess V and Fisher IV). Two clinical exams revealed unresponsive coma and absence of all brainstem reflexes. Brain scintigraphy showed no radioisotope uptake into the brain parenchyma. The first attempt at the apnea test was stopped after 5 minutes due to hypothermia (34.9°C). After rewarming, the apnea test was repeated without disconnection from the mechanical ventilator, showing maintenance of the functional residual volume with electrical bioimpedance. Posttest blood gas analysis results were as follows: pH, 7.01; partial pressure of oxygen, 232.0mmHg; partial pressure of carbon dioxide, 66.9mmHg; and oxygen saturation, 99.0%. The apnea test without disconnection from the mechanical ventilator allowed the preservation of oxygenation in both cases. The use of continuous airway pressure during the apnea test seems to be a safe alternative in order to maintain alveolar recruitment and oxygenation during brain death determination.
Subject(s)
Humans , Male , Female , Child , Adult , Apnea/diagnosis , Brain Death/diagnosis , Continuous Positive Airway Pressure/methods , Oxygen/blood , Partial Pressure , Respiration, Artificial , Blood Gas Analysis/methods , Carbon Dioxide/blood , Hypoxia/diagnosisABSTRACT
RESUMO Entre as potenciais complicações da oxigenação por membrana extracorpórea, as disfunções neurológicas, incluindo morte encefálica, não são desprezíveis. No Brasil, o processo diagnóstico é regulamentado pela resolução 2.173 de 2017 do Conselho Federal de Medicina. Entre os testes diagnósticos, está o de apneia, que objetiva verificar se existe resposta ventilatória ao estímulo hipercápnico. Contudo, trocas gasosas, incluindo a remoção de dióxido de carbono, são mantidas sob oxigenação por membrana extracorpórea, tornando o teste desafiador. Somado ao fato de que a citada resolução não contempla as especificidades do processo diagnóstico sob oxigenação por membrana extracorpórea, publicações sobre o tema são escassas. Esta revisão objetivou identificar estudos de casos (e/ou séries de casos) publicados nas bases PubMed® e Cochrane que descrevessem o processo. Foram identificadas 17 publicações (2011 - 2019). As estratégias práticas descritas foram: prover oxigenação suplementar pré-teste, via ventilador mecânico e oxigenação por membrana extracorpórea (fração inspirada de oxigênio = 1,0), e, ao início do teste, titular o sweep flow (0,5 - 1,0L/minuto), a fim de minimizar a remoção de dióxido de carbono. Recomenda-se também incrementar o fluxo sanguíneo e/ou do sweep ante hipoxemia e/ou hipotensão, podendo associar à infusão de fluidos e/ou ao escalonamento de drogas inotrópicas/vasoativas. Se o limiar da pressão parcial de dióxido de carbono não for alcançado, repetir o teste sob suplementação de dióxido de carbono exógeno ao circuito é uma alternativa. Finalmente, nos casos de oxigenação por membrana extracorpórea venoarterial, para mensurar a variação de gases e excluir hipóxia diferencial, recomenda-se coletar amostras sanguíneas provenientes das circulações nativa e extracorpórea (pós-oxigenador).
Abstract Among the potential complications of extracorporeal membrane oxygenation, neurological dysfunctions, including brain death, are not negligible. In Brazil, the diagnostic process of brain death is regulated by Federal Council of Medicine resolution 2,173 of 2017. Diagnostic tests for brain death include the apnea test, which assesses the presence of a ventilatory response to hypercapnic stimulus. However, gas exchange, including carbon dioxide removal, is maintained under extracorporeal membrane oxygenation, making the test challenging. In addition to the fact that the aforementioned resolution does not consider the specificities of the diagnostic process under extracorporeal membrane oxygenation, studies on the subject are scarce. This review aims to identify case studies (and/or case series) published in the PubMed® and Cochrane databases describing the process of brain death diagnosis. A total of 17 publications (2011 - 2019) were identified. The practical strategies described were to provide pretest supplemental oxygenation via mechanical ventilation and extracorporeal membrane oxygenation (fraction of inspired oxygen = 1.0) and, at the beginning of the test, titrate the sweep flow (0.5 - 1.0L/minute) to minimize carbon dioxide removal. It is also recommended to increase blood flow and/or sweep flow in the presence of hypoxemia and/or hypotension, which may be combined with fluid infusion and/or the escalation of inotropic/vasoactive drugs. If the partial pressure of carbon dioxide threshold is not reached, repeating the test under supplementation of carbon dioxide exogenous to the circuit is an alternative. Last, in cases of venoarterial extracorporeal membrane oxygenation, to measure gas variation and exclude differential hypoxia, blood samples of the native and extracorporeal (post-oxygenator) circulations are recommended.
Subject(s)
Humans , Adult , Apnea/diagnosis , Brain Death/diagnosis , Extracorporeal Membrane Oxygenation , Partial Pressure , Brazil , Carbon Dioxide/metabolismABSTRACT
El nitrito de amilo, conocida como "poppers", se ha masificado como droga recreacional en parte por sus efectos con objetivos sexuales. Su consumo se asocia a complicaciones psiquiátricas y médicas. Reportamos el caso de un paciente que se presenta con metahemog-lobinemia moderada secundaria a la inhalación de nitrito de amilo asociado a alcohol. Al ingreso presenta cianosis peribucal y en extremidades, disociación entre oximetría de pulso y presión parcial de oxígeno en gases arteriales, además de metahemoglobinemia 29,9%. Se descartan otras intoxicaciones y causas primarias de metahemoglobinemia. Se maneja con oxigenoterapia, hidratación y ácido ascórbico, presentando una evolución favorable. Presentamos el primer caso en Chile de metahemoglobinemia secundaria al consumo de nitrito de amilo con fines recreativos.
Amyl nitrite, known as "poppers", has become popular as a recreational drug for sexual purposes. Its consumption is associated with psychiatric and medical complications. We report the case of a patient presenting with moderate methemoglobinemia secondary to amyl nitrite inhalation associated with alcohol. At admission, perioral and extremities cyanosis, a dissociation between pulse oximetry and partial pressure of oxygen in arterial gases, and methemoglobinemia 29.9% were present. Other intoxications and primary causes of methemoglobinemia were ruled out. The patient receives oxygen therapy, hydration, and ascorbic acid, presenting a favorable evolution. We report the first Chilean's case of methemoglobinemia secondary to amyl nitrite consumption for recreational purposes
Subject(s)
Humans , Male , Adult , Amyl Nitrite , Recreational Drug Use , Methemoglobinemia , Partial Pressure , Patients , Oximetry , HIV , Cyanosis , Clinical StudyABSTRACT
RESUMO Relatamos o caso de um paciente que evoluiu com suspeita de morte encefálica associada à atelectasia e à hipoxemia moderada a grave, apesar de instituídos ventilação protetora, sistema de aspiração traqueal fechado, pressão positiva ao final da expiração moderada e manobra de recrutamento. Diante da não obtenção de pressão parcial de oxigênio adequada para o teste de apneia, optamos por pronar o paciente, utilizar pressão positiva expiratória final mais elevada, realizar nova manobra de recrutamento e ventilar com volume corrente mais elevado (8mL/kg), sem ultrapassar pressão de platô de 30cmH2O. O teste de apneia foi realizado em posição prona, com válvula de pressão positiva contínua nas vias aéreas acoplada em tubo T. O atraso no diagnóstico foi de 10 horas; a doação de órgãos não foi possível devido à parada circulatória. Este relato demonstra as dificuldades para obtenção de níveis de pressão parcial de oxigênio mais altos para a realização do teste de apneia. Os atrasos que isso pode acarretar ao diagnóstico de morte encefálica e ao processo de doação de órgãos são discutidos, além de potenciais estratégias de otimização da pressão parcial de oxigênio para realização do teste, conforme as recomendações atuais.
ABSTRACT We report the case of a patient in whom brain death was suspected and associated with atelectasis and moderate to severe hypoxemia even though the patient was subjected to protective ventilation, a closed tracheal suction system, positive end-expiratory pressure, and recruitment maneuvers. Faced with the failure to obtain an adequate partial pressure of oxygen for the apnea test, we elected to place the patient in a prone position, use higher positive end-expiratory pressure, perform a new recruitment maneuver, and ventilate with a higher tidal volume (8mL/kg) without exceeding the plateau pressure of 30cmH2O. The apnea test was performed with the patient in a prone position, with continuous positive airway pressure coupled with a T-piece. The delay in diagnosis was 10 hours, and organ donation was not possible due to circulatory arrest. This report demonstrates the difficulties in obtaining higher levels of the partial pressure of oxygen for the apnea test. The delays in the diagnosis of brain death and in the organ donation process are discussed, as well as potential strategies to optimize the partial pressure of oxygen to perform the apnea test according to the current recommendations.
Subject(s)
Humans , Male , Apnea/diagnosis , Pulmonary Atelectasis/complications , Brain Death/diagnosis , Hypoxia/complications , Oxygen/blood , Partial Pressure , Tidal Volume , Prone Position , Continuous Positive Airway Pressure , Delayed Diagnosis , Middle AgedABSTRACT
BACKGROUND: Postoperative desaturation in older individuals is rarely addressed in the literature. The objective of this retrospective study was to investigate whether a preoperative spirometric test and arterial blood gas analysis (ABGA) might predict postoperative desaturation after spinal anesthesia in extreme older patients.METHODS: The medical records of 399 patients (age ≥ 80 yrs) who were administered spinal anesthesia for a femur neck fracture surgery were retrospectively reviewed. Early postoperative desaturation was defined as a reduction of oxygen saturation (SpO₂) below 90% within 3 days of surgery, despite O₂ supply via a nasal prong. Binary logistic regression analysis was used to identify predictors of early postoperative desaturation.RESULTS: The incidence of postoperative desaturation was 12.5%. Major morbidity rate was significantly higher in the desaturation group (n = 50) than that in the non-desaturation group (n = 349) (14% vs. 3.2%, P = 0.001) with more frequent postoperative stays in the intensive care unit (22% vs. 12%, P = 0.004). In a binary logistic regression analysis, preoperative ratio of arterial oxygen partial pressure to fractional inspired oxygen (PaO₂/FiO₂ ratio) (OR, 0.972; 95% CI 0.952–0.993; P = 0.010) and history of cardiovascular disease (OR, 2.127; 95% CI 1.004–4.507; P = 0.049) predicted postoperative desaturation.CONCLUSIONS: Preoperative PaO₂/FiO₂ ratio, but not preoperative spirometry, was predictive of the postoperative desaturation in older patients after being administered spinal anesthesia for femur fracture surgery. Based on our results, preoperative ABGA may be helpful in predicting early postoperative desaturation in these patients.
Subject(s)
Humans , Anesthesia, Spinal , Blood Gas Analysis , Cardiovascular Diseases , Femoral Neck Fractures , Femur , Incidence , Intensive Care Units , Logistic Models , Medical Records , Oxygen , Partial Pressure , Retrospective Studies , SpirometryABSTRACT
PURPOSE: Comparison between lung ultrasound (LUS) score and indices of respiratory severity in very preterm infants born at 28 to 31 weeks' gestation. METHODS: We retrospectively reviewed medical records of 32 very preterm infants born at 28 to 31 weeks' gestation at Keimyung University Dongsan Medical Center. Before surfactant administration, bedside LUS in the neonatal intensive care unit was recorded within the first hour of life. Partial pressure of capillary oxygen to fraction of inspired oxygen ratio (PcO2)/FiO2, alveolar-arterial gradient (A-aO2), modified oxygenation index (OI), and arterial to alveolar ratio were calculated. Correlation between LUS score and indices of respiratory severity were analyzed between the intubation and nasal continuous positive airway pressure (NCPAP) groups depending on the presence or absence of endotracheal intubation. RESULTS: Mean LUS scores, A-aO2, and modified OI in the intubation group were significantly higher than those in the NCPAP group. Conversely, PcO2/FiO2 and arterial to alveolar ratios in the intubation group were significantly lower than those in the NCPAP group. LUS score was found to be significantly correlated with A-aO2 (r=0.448, P>0.05) and modified OI (r=0.453, P>0.05), but not with PcO2/FiO2 ratio (r=−0.205, P0.05). CONCLUSION: The LUS score is well correlated with indices of respiratory severity in very preterm infants born at 28 to 31 weeks' gestation. Further investigation is needed to use LUS as an alternative tool in infants with respiratory distress.
Subject(s)
Humans , Infant , Infant, Newborn , Pregnancy , Capillaries , Continuous Positive Airway Pressure , Infant, Premature , Intensive Care, Neonatal , Intubation , Intubation, Intratracheal , Lung , Medical Records , Oxygen , Partial Pressure , Respiratory Distress Syndrome, Newborn , Retrospective Studies , UltrasonographyABSTRACT
PURPOSE: We investigated the characteristics of lung allocation and outcomes of lung transplant (LTx) according to the Korean urgency status. MATERIALS AND METHODS: LTx registration in the Korean Organ Transplantation Registry (KOTRY) began in 2015. From 2015 to June 2017, 86 patients who received LTx were enrolled in KOTRY. After excluding one patient who received a heart-lung transplant, 85 were included. Subjects were analyzed according to the Korean urgency status. RESULTS: Except for Status 0, urgency status was classified based on partial pressure of oxygen in arterial blood gas analysis and functional status in 52 patients (93%). The wait time for lung allograft was well-stratified by urgency (Status 0, 46.5±59.2 days; Status 1, 104.4±98.2 days; Status 2 or 3, 132.2±118.4 days, p=0.009). Status 0 was associated with increased operative times and higher intraoperative blood transfusion. Status 0 was associated with prolonged extracorporeal membrane oxygenation use, postoperative bleeding, and longer mechanical ventilation after operation. Survival of Status 0 patients seemed worse than that of non-Status 0 patients, although differences were not significant. CONCLUSION: The Korean urgency classification for LTx is determined by using very limited parameters and may not be a true reflection of urgency. Status 0 patients seem to have poor outcomes compared to the other urgency status patients, despite having the highest priority for donor lungs. Further multi-center and nationwide studies are needed to revise the lung allocation system to reflect true urgency and provide the best benefit of lung transplantation.
Subject(s)
Humans , Allografts , Blood Gas Analysis , Blood Transfusion , Classification , Extracorporeal Membrane Oxygenation , Hemorrhage , Lung Transplantation , Lung , Operative Time , Organ Transplantation , Oxygen , Partial Pressure , Respiration, Artificial , Tissue Donors , TransplantsABSTRACT
The randomized controlled trials about modified Sangbaipi Decoction in the treatment of acute exacerbation of chronic obstructive pulmonary disease( AECOPD) patients were collected from 7 databases( PubMed,CNKI,et al) from the establishment to December 5,2018. All the studies searched were strictly evaluated. Literatures were independently screened by two researchers according to the inclusion and exclusion criteria,and the methodological quality of included studies was evaluated. To systematically review the efficacy of modified Sangbaipi Decoction in treating AECOPD,the Meta-analysis and trial sequential analysis were conducted by using Stata/SE 14. 0 and TSA 0. 9. 5. 10 Beta,respectively. A total of 25 RCTs involving 1 784 patients were included. According to the results of Meta-analysis,compared with the control groups,the trial group had a higher clinical efficacy in AECOPD patients( RR =1. 18,95%CI[1. 13,1. 22],P = 0),improved pulmonary functions including forced expiratory volume in one second( FEV1,WMD =0. 44,95%CI[0. 01,0. 87],P = 0. 046),and the forced vital capacity( FVC,WMD = 0. 42,95%CI[0. 07,0. 22],P = 0),but no statistical significance in the percentage of forced expiratory volume in one second( FEV1%,P = 0. 067) and the first seconds breathing volume percentage of forced vital capacity( FEV1/FVC,P = 0. 238); it improved the arterial oxygen partial pressure( PaO2,SMD =0. 85,95%CI[0. 41,1. 30],P = 0) and decreased the arterial partial pressure of carbon dioxide( PaCO2,SMD =-0. 94,95% CI[-1. 70,-0. 18],P= 0. 016); and in terms of inflammatory markers,it improved the white blood cell count( WBC,WMD=-0. 94,95%CI[-1. 17,-0. 70],P = 0). The trial sequential analysis showed that the studies included with the improvement of clinical efficacy had passed the conventional and TSA threshold,so as to further confirm the evidence. According to the findings,in addition to conventional Western medicine treatment,modified Sangbaipi Decoction could improve the efficiency in treating acute exacerbation patients with chronic obstructive pulmonary disease,increase PaO2,and decrease PaCO2,with a high safety but no effect on pulmonary function. However,restricted by the low quality of studies included,this conclusion shall be further verified by more high-quality clinical trials.
Subject(s)
Humans , Arterial Pressure , Drugs, Chinese Herbal , Therapeutic Uses , Forced Expiratory Volume , Lung , Partial Pressure , Pulmonary Disease, Chronic Obstructive , Drug Therapy , Randomized Controlled Trials as Topic , Vital CapacityABSTRACT
PURPOSE: Improvements in surgical techniques and a better understanding of the unique anesthetic requirements in neonates undergoing laparoscopy have suggested that laparoscopic surgery may be effective in newborns. This study therefore evaluated the safety and feasibility of laparoscopic excision of the cyst (LEC) in neonates. METHODS: This retrospective study included 43 neonates who underwent excision of choledochal cysts between November, 2001, and January, 2018, including 21 who underwent open excision and 22 who underwent LEC. Their perioperative and surgical outcomes were reviewed. The patients were followed up for a median 37 months (range, 3–141 months). RESULTS: Baseline characteristics did not differ significantly in the open and LEC groups. Mean intraoperative peak partial pressure of arterial CO2 (PaCO2) (45.5 mmHg vs. 48.0 mmHg) and total operation time (208.3 ± 71.0 minutes vs. 235.0 ± 47.2 minutes) were similar in both groups. Parents of the patients in the LEC group provided a more positive evaluation of scar scale and greater satisfaction with wound. No patient in either group experienced any critical complications. Three patients in the open excision group required readmission for cholangitis and 2 patients had ileus. No patient in the laparoscopic excision group experienced any postoperative complications during follow-up. CONCLUSION: Despite difficulties performing laparoscopic surgery in neonates, LEC was safe and feasible when intraperitoneal peak pressure was maintained under 10 mmHg and PaCO₂ was closely monitored by a pediatric anesthesiologist. Compared with open excision, LEC provided improved cosmetic outcomes without severe complications. Prospective randomized studies with large numbers of patients are warranted.
Subject(s)
Humans , Infant , Infant, Newborn , Cholangitis , Choledochal Cyst , Cicatrix , Follow-Up Studies , Ileus , Laparoscopy , Minimally Invasive Surgical Procedures , Parents , Partial Pressure , Postoperative Complications , Prospective Studies , Retrospective Studies , Wounds and InjuriesABSTRACT
The objective of this study was to evaluate the analytical performance of the Stat Profile pHOx Ultra Blood Gas Analyzer (Nova Biomedical, USA), a new blood gas/chemistry analyser, including its precision and linearity, comparison studies, and the carry-over effect of commercial reagents and patient specimens. We assessed all the results on the basis of the Clinical and Laboratory Standards Institute guidelines. The following parameters were assessed: pH, partial pressure of carbon dioxide, partial pressure of oxygen, ionized calcium, ionized magnesium (iMg), and lactate concentration The total imprecision had a coefficient of variation of 0.0%–1.8%, and the linear measurement ranges for each parameter were all acceptable. In comparison with the Nova Critical Care Xpress Analyzer (Nova Biomedical, USA), the results indicated a good agreement, except for iMg. All carry-over ranges were between −0.5% and −1.4%. The Stat Profile pHOx Ultra Blood Gas Analyzer showed good analytical performance in terms of precision, linearity, comparison studies, and carry-over effect. The Stat Profile pHOx Ultra Blood Gas Analyzer can provide reliable measurements across a clinically relevant range and has potential use in laboratory tests.
Subject(s)
Humans , Calcium , Carbon Dioxide , Critical Care , Hydrogen-Ion Concentration , Indicators and Reagents , Lactic Acid , Magnesium , Oxygen , Partial PressureABSTRACT
PURPOSE: Recent basic life support (BLS) guidelines recommend a 30:2 compression-to-ventilation ratio (CV2) or chest compression-only cardiopulmonary resuscitation (CC); however, there are inevitable risks of interruption of high-quality cardiopulmonary resuscitation (CPR) in CV2 and hypoxemia in CC. In this study, we compared the short-term outcomes among CC, CV2, and 30:1 CV ratio (CV1). MATERIALS AND METHODS: In total, 42 pigs were randomly assigned to CC, CV1, or CV2 groups. After induction of ventricular fibrillation (VF), we observed pigs for 2 minutes without any intervention. Thereafter, BLS was started according to the assigned method and performed for 8 minutes. Defibrillation was performed after BLS and repeated every 2 minutes, followed by rhythm analysis. Advanced cardiac life support, including continuous chest compression with ventilation every 6 seconds and intravenous injection of 1 mg epinephrine every 4 minutes, was performed until the return of spontaneous circulation (ROSC) or 22 minutes after VF induction. Hemodynamic parameters and arterial blood gas profiles were compared among groups. ROSC, 24-hour survival, and neurologic outcomes were evaluated at 24 hours. RESULTS: The hemodynamic parameters during CPR did not differ among the study groups. Partial pressure of oxygen in arterial blood and arterial oxygen saturation were lowest in the CC group, compared to those in the other groups, during the BLS period (p=0.002 and p < 0.001, respectively). The CV1 groups showed a significantly higher rate of favorable neurologic outcome (swine CPC 1 or 2) than the other groups (p=0.044). CONCLUSION: CPR with CV1 could promote better neurologic outcome than CV2 and CC.
Subject(s)
Advanced Cardiac Life Support , Hypoxia , Cardiopulmonary Resuscitation , Epinephrine , Heart Arrest , Hemodynamics , Injections, Intravenous , Methods , Oxygen , Partial Pressure , Swine , Thorax , Treatment Outcome , Ventilation , Ventricular FibrillationABSTRACT
OBJECTIVE: This study examined the initial partial pressure of carbon dioxide (PCO₂) as a possible indicator of prehospital ventilation and its association with prehospital i-gel in out-of-hospital cardiac arrest (OHCA) patients. METHODS: The demographics and arrest parameters, including i-gel insertion and initial arterial blood gas analysis, of OHCA patients who visited the emergency department were analyzed retrospectively. Linear regression analysis was performed to examine the association between i-gel insertion and the initial PCO₂. RESULTS: A total of 106 patients were investigated. Fifty-six patients had prehospital i-gel insertion and 50 patients did not have a prehospital advanced airway. The initial PCO₂ was higher in the i-gel group than the no advanced airway group (105.2 mmHg [77.5–134.9] vs. 87.5 mmHg [56.8–115.3], P=0.03). Prehospital i-gel insertion was associated with a higher initial PCO₂ level (βcoefficient, 20.3; 95% confidence interval, 2.6–37.9; P=0.03). CONCLUSION: Prehospital insertion of i-gel was associated with higher initial PCO₂ values in OHCA patients compared to no advanced airway.
Subject(s)
Humans , Airway Management , Blood Gas Analysis , Carbon Dioxide , Cardiopulmonary Resuscitation , Demography , Emergency Medical Services , Emergency Service, Hospital , Heart Arrest , Linear Models , Out-of-Hospital Cardiac Arrest , Partial Pressure , Retrospective Studies , VentilationABSTRACT
BACKGROUND: Patients with acute respiratory failure secondary to tuberculous destroyed lung (TDL) have a poor prognosis. The aim of the present retrospective study was to develop a mortality prediction model for TDL patients who require mechanical ventilation. METHODS: Data from consecutive TDL patients who had received mechanical ventilation at a single university-affiliated tertiary care hospital in Korea were reviewed. Binary logistic regression was used to identify factors predicting intensive care unit (ICU) mortality. A TDL on mechanical Ventilation (TDL-Vent) score was calculated by assigning points to variables according to β coefficient values. RESULTS: Data from 125 patients were reviewed. A total of 36 patients (29%) died during ICU admission. On the basis of multivariate analysis, the following factors were included in the TDL-Vent score: age ≥65 years, vasopressor use, and arterial partial pressure of oxygen/fraction of inspired oxygen ratio <180. In a second regression model, a modified score was then calculated by adding brain natriuretic peptide. For TDL-Vent scores 0 to 3, the 60-day mortality rates were 11%, 27%, 30%, and 77%, respectively (p<0.001). For modified TDL-Vent scores 0 to ≥3, the 60-day mortality rates were 0%, 21%, 33%, and 57%, respectively (p=0.001). For both the TDL-Vent score and the modified TDL-Vent score, the areas under the receiver operating characteristic curve were larger than that of other illness severity scores. CONCLUSION: The TDL-Vent model identifies TDL patients on mechanical ventilation with a high risk of mortality. Prospective validation studies in larger cohorts are now warranted.
Subject(s)
Humans , Cohort Studies , Intensive Care Units , Korea , Logistic Models , Lung , Mortality , Multivariate Analysis , Natriuretic Peptide, Brain , Oxygen , Partial Pressure , Prognosis , Prospective Studies , Respiration, Artificial , Respiratory Insufficiency , Retrospective Studies , ROC Curve , Tertiary Healthcare , TuberculosisABSTRACT
BACKGROUND: Bronchoalveolar lavage (BAL) is a necessary procedure for diagnosis of various lung diseases. High-flow nasal cannula (HFNC) oxygen delivery was recently introduced. This study aimed to investigate the safety and effectiveness of HFNC oxygen supply during BAL procedure in patients with acute respiratory failure (ARF). METHODS: Patients who underwent BAL while using HFNC at a partial pressure of oxygen in arterial blood/fraction of inspired oxygen (PaO2/FiO2; PF) ratio of 300 or below among patients who had been admitted from March 2013 to May 2017 were retrospectively investigated. RESULTS: Thirty-three BAL procedures were confirmed. Their baseline PF ratio was 166.1±46.7. FiO2 values before, during, and after BAL were 0.45±0.12, 0.74±0.19, and 0.57±0.14, respectively. Flow (L/min) values before, during, and after BAL were 26.5±20.3, 49.0±7.2, and 40.8±14.2, respectively. Both FiO2 and flow during and after the procedure were significantly different from those before the procedure (both p < 0.001). Oxygen saturation levels before, during, and after BAL measured by pulse oximeter were 94.8±2.9, 94.6±3.5, and 95.2±2.8%, respectively. There were no significant differences in oxygen saturation among the three groups. Complications of BAL procedure included transient hypoxemia, hypotension, and fever. However, there was no endotracheal intubation within 24 hours. Baseline PF ratio in “without HFNC” group was significantly higher than that in “with HFNC” group. There were no differences in complications between the two groups. CONCLUSION: The use of HFNC during BAL procedure in ARF patients was effective and safe. However, there were no significant differences in oxygen saturation level and complications comparing “without HFNC” group in mild ARF. More studies are needed for moderate to severe ARF patients.
Subject(s)
Humans , Hypoxia , Bronchoalveolar Lavage , Bronchoscopy , Catheters , Diagnosis , Fever , Hypotension , Intubation, Intratracheal , Lung Diseases , Oxygen , Partial Pressure , Respiratory Insufficiency , Retrospective StudiesABSTRACT
OBJECTIVE: This study aimed to identify the effects of serum potassium and lactate on neurologic outcomes in out-of-hospital post-cardiac arrest adult patients. METHODS: This study was a single center, retrospective observational study. We recruited out-of-hospital post-cardiac arrest adult patients admitted to an intensive care unit from 2011 to 2017. Primary outcome was good neurologic outcome at discharge. To evaluate the prognostic impact of serum potassium and lactate, univariate and multivariate logistic regression analyses were performed. RESULTS: A total of 57 patients were included in this study. The number of patients with good neurologic outcome was 19 (33.3%). In the univariate analysis, good neurologic outcome patients showed a higher smoking rate, shorter pre-hospital transportation time, higher rate of percutaneous coronary intervention, and lower severity score (all p < 0.05). The good neurologic outcome patients also presented higher pH, lower partial pressure of carbon dioxide, and lower potassium regarding laboratory findings on the first hospital day (all p < 0.05). In the multivariate analysis, the independent factors favoring good neurologic outcome were pre-hospital transportation time (adjusted odds ratio [aOR], 0.82; 95% confidence interval [CI], 0.69–0.97; P=0.019) and lower partial pressure of carbon dioxide on the first hospital day (aOR, 0.95; 95% CI, 0.91–0.99; P=0.034). CONCLUSION: Serum potassium and lactate were not significantly associated with good neurologic outcome in out-of-hospital post-cardiac arrest adult patients. The prognostic factors for good neurologic outcome were pre-hospital transportation time and initial partial pressure of carbon dioxide.
Subject(s)
Adult , Humans , Carbon Dioxide , Cardiopulmonary Resuscitation , Heart Arrest , Hydrogen-Ion Concentration , Intensive Care Units , Lactic Acid , Logistic Models , Multivariate Analysis , Observational Study , Odds Ratio , Partial Pressure , Percutaneous Coronary Intervention , Potassium , Prognosis , Retrospective Studies , Smoke , Smoking , TransportationABSTRACT
Severe eating disorders characterized by repetitive episodes of purging and vomiting can occasionally trigger acute kidney injury. However, interstitial nephritis induced by episodes of repeated vomiting has rarely been reported, and the pathophysiology of this entity remains unknown. A 26-year-old man was admitted to our hospital because of known hypokalemia. His serum electrolyte profile showed: sodium 133 mEq/L, potassium 2.6 mEq/L, chloride 72 mEq/L, total carbon dioxide 50 mEq/L, blood urea nitrogen/creatinine ratio (BUN/Cr) 21.9/1.98 mg/dL, and magnesium 2.0 mg/dL. Arterial blood gas analysis showed: pH 7.557, partial pressure of carbon dioxide 65.8 mmHg, and bicarbonate 58.5 mEq/L. His urinary potassium concentration was 73.2 mEq/L, and Cr was 111 mg/dL. Renal biopsy revealed acute tubular necrosis and tubulointerstitial nephritis with a few shrunken glomeruli. Repeated psychogenic vomiting may precipitate acute kidney injury and interstitial nephritis secondary to volume depletion and hypokalemia. Serum electrolyte levels and renal function should be carefully monitored in patients diagnosed with eating disorders to prevent tubular ischemia and interstitial nephritis.