Effect of exogenous lipids contamination on blood gas analysis.

Objectives: The purpose of this study was to investigate the effects of contamination of venous blood with a lipid-containing solution on parameters measured by a modern blood gas analyzer. Methods: We collected venous blood from 17 healthcare workers (46 ± 11 years; 53 % women) into three blood gas syringes containing 0 , 5 and 10 % lipid-containing solution. Blood gas analysis was performed within 15 min from sample collection on GEM Premier 5000, while triglycerides and serum indices were assays on Roche COBAS C702. Results: Triglycerides concentration increased from 1.0 ± 0.3 mmol/L in the uncontaminated blood gas syringe, to 39.4 ± 7.8 and 65.3 ± 14.4 mmol/L (both p<0.001) in syringes with 5 and 10 % final lipid contamination. The lipemic and hemolysis indices increased accordingly. Statistically significant variation was noted for all analytes except hematocrit and COHb in the syringe with 5 % lipids, while only COHb did not vary in the syringe with 10 % lipids. Significant increases were observed from 5 % lipid contamination for pO2, SO2 and lactate, while the values of pH, pCO2, sodium, potassium, chloride, ionized calcium, glucose, hematocrit (10 % contamination), hemoglobin and MetHB decreased. All these changes except lactate and CoHb exceeded their relative performance specifications. Conclusions: Artifactual hyperlipidemia caused by contamination with exogenous lipids can have a clinically significant impact on blood gas analysis. Manufacturers of blood gas analyzers must be persuaded to develop new instruments equipped with serum indices.

Differences in Exercise Capacity, Ventilatory Efficiency, and Gas Exchange between Patients with Pulmonary Arterial Hypertension and Chronic Thromboembolic Pulmonary Hypertension Residing at High Altitude.

Background: Cardiopulmonary exercise testing (CPET) assesses exercise capacity and causes of exercise limitation in patients with pulmonary hypertension (PH). At altitude, changes occur in the ventilatory pattern and a decrease in arterial oxygen pressure in healthy; these changes are increased in patients with cardiopulmonary disease. Our objective was to compare the response to exercise and gas exchange between patients with pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH) residing at the altitude of Bogotá (2640 m). Methods: All patients performed an incremental CPET with measurement of oxygen consumption ( VO 2 ), dead space (VD/VT), ventilatory equivalents (VE/ VCO 2 ), and alveolar-arterial oxygen gradient ( PA-aO 2 ). X 2 test and one-way analysis of variance were used for comparisons between PAH and CTEPH. Results: We included 53 patients, 29 with PAH, 24 with CTEPH, and 102 controls as a reference of the normal response to exercise at altitude. CTEPH patients had a higher New York Health Association (NYHA) functional class than PAH (p = 0.037). There were no differences between patients with PAH and CTEPH in hemodynamics and VO 2 % of predicted (67.8 ± 18.7 vs. 66.0 ± 19.8, p < 0.05), but those with CTEPH had higher dyspnea, VD/VT (0.36 ± 0.09 vs. 0.23 ± 0.9, p < 0.001), VE/ VCO 2 (45.8 ± 7.1 vs. 39.3 ± 5.6, p < 0.001), and PA-aO 2 (19.9 ± 7.6 vs. 13.5 ± 7.6, p < 0.001) than PAH patients. Conclusions: At altitude, patients with PH present severe alterations in gas exchange during exercise. There were no differences in exercise capacity between PAH and CTEPH, but patients with CTEPH had more dyspnea and greater alterations in gas exchange during exercise. CPET made it possible to identify alterations related to the pathophysiology of CTEPH that could explain the functional class and dyspnea in these patients.

Short-Term Effects of Heat Stress on Cow Behavior, Registered by Innovative Technologies and Blood Gas Parameters.

Heat stress (HS) is one of the key factors affecting an animal's immune system and productivity, as a result of a physiological reaction combined with environmental factors. This study examined the short-term effects of heat stress on cow behavior, as recorded by innovative technologies, and its impact on blood gas parameters, using 56 of the 1070 cows clinically evaluated during the second and subsequent lactations within the first 30 days postpartum. Throughout the experiment (from 4 June 2024 until 1 July 2024), cow behavior parameters (rumination time min/d. (RT), body temperature (°C), reticulorumen pH, water consumption (L/day), cow activity (h/day)) were monitored using specialized SmaXtec boluses and employing a blood gas analyzer (Siemens Healthineers, 1200 Courtneypark Dr E Mississauga, L5T 1P2, Canada). During the study period, the temperature-humidity index (THI), based on ambient temperature and humidity, was recorded and used to calculate THI and to categorize the data into four THI classes as follows: 1-THI 60-63 (4 June 2024-12 June 2024); 2-THI 65-69 (13 June 2024-18 June 2024); 3-THI 73-75 (19 June 2024-25 June 2024); and 4-THI 73-78 (26 June 2024-1 July 2024). The results showed that heat stress significantly reduced rumination time by up to 70% in cows within the highest THI class (73 to 78) and increased body temperature by 2%. It also caused a 12.6% decrease in partial carbon dioxide pressure (pCO2) and a 32% increase in partial oxygen pressure (pO2), also decreasing plasma sodium by 1.36% and potassium by 6%, while increasing chloride by 3%. The findings underscore the critical need for continuous monitoring, early detection, and proactive management to mitigate the adverse impacts of heat stress on dairy cow health and productivity. Recommendations include the use of advanced monitoring technologies and specific blood gas parameter tracking to detect the early signs of heat stress and implement more timely interventions.

An Assessment of the Relationships Between Umbilical Cord Blood Gas Analysis, APGAR (Appearance, Pulse, Grimace, Activity, and Respiration) Scores, and Neonatal Outcomes.

Introduction Intrapartum hypoxic-ischemic injury is a condition that significantly affects neonatal health and, therefore, needs to be attended to urgently. Umbilical cord blood gas analysis (BGA) results and APGAR (appearance, pulse, grimace, activity, and respiration) scores are commonly used to assess birth asphyxia and the severity of neonatal acidemia. In this context, this study was conducted to investigate the correlations of BGA results and APGAR scores with neonatal outcomes to determine the combined value of BGA results and APGAR scores in neonatal health assessment. Methods The sample of this retrospective cohort study consisted of 593 consecutive-term newborns delivered in a tertiary referral center in Turkey between January 2020 and December 2022. All newborns' maternal, delivery, and neonatal characteristics, BGA results, and APGAR scores were analyzed to determine correlations with composite adverse neonatal outcomes. The study's primary outcome was defined as the rate of the composite adverse neonatal outcomes, whereas the secondary outcomes were determined as the impact of maternal and neonatal characteristics on composite neonatal morbidity and the correlation between the one- and five-minute APGAR scores and umbilical cord BGA parameters. Results Of the 593 infants included in the study, 191 (32.2%) infants experienced composite adverse neonatal outcomes, primarily mechanical ventilation (47.7%), followed by respiratory distress/syndrome (35.6%). Significant correlations were detected between composite adverse neonatal outcomes and advanced maternal age (p = 0.025), cesarean section history (p < 0.001), preterm delivery (p < 0.001), lower one- and five-minute APGAR scores (p < 0.001 for both cases), and acidemia severity (p = 0.007). However, the correlations between BGA parameters and APGAR scores were weak (r < 0.2). Conclusion This study investigated the correlations between neonatal mortality and morbidity and maternal factors, delivery characteristics, and fetal features, including one- and five-minute APGAR scores and BGA parameters. Nevertheless, weak correlations between BGA parameters and APGAR scores warrant further comprehensive prospective studies.

Effects of nursing team communication and collaboration on treatment outcomes in intensive care unit patients with severe pneumonia.

BACKGROUND: Severe pneumonia is a common severe respiratory infection worldwide, and its treatment is challenging, especially for patients in the intensive care unit (ICU). AIM: To explore the effect of communication and collaboration between nursing teams on the treatment outcomes of patients with severe pneumonia in ICU. METHODS: We retrospectively analyzed 60 patients with severe pneumonia who were treated at the ICU of the hospital between January 1, 2021 and December 31, 2023. We compared and analyzed the respiratory mechanical indexes [airway resistance (Raw), mean airway pressure (mPaw), peak pressure (PIP)], blood gas analysis indexes (arterial oxygen saturation, arterial oxygen partial pressure, and oxygenation index), and serum inflammatory factor levels [C-reactive protein (CRP), procalcitonin (PCT), cortisol (COR), and high mobility group protein B1 (HMGB1)] of all patients before and after treatment. RESULTS: Before treatment, there was no significant difference in respiratory mechanics index and blood gas analysis index between 2 groups (P > 0.05). However, after treatment, the respiratory mechanical indexes of patients in both groups were significantly improved, and the improvement of Raw, mPaw, plateau pressure, PIP and other indexes in the combined group after communication and collaboration with the nursing team was significantly better than that in the single care group (P < 0.05). The serum CRP and PCT levels of patients were significantly decreased, and the difference was statistically significant compared with that of nursing group alone (P < 0.05). The levels of serum COR and HMGB1 before and after treatment were also significantly decreased between the two groups. CONCLUSION: The communication and collaboration of the nursing team have a significant positive impact on respiratory mechanics indicators, blood gas analysis indicators and serum inflammatory factor levels in the treatment of severe pneumonia patients in ICU.

Reference limits for blood gas analysis performed from coccygeal vessels of multiparous Holstein dairy cows: Effects of stage of lactation and season of sampling.

Blood gas analysis is a great support to the diagnostic process of critically ill patients. Its correct application to the medicine of dairy cows depends on the availability of specific reference intervals that are still difficult to find in the literature. They may vary according to the type of blood sampled, animals' age and production stage, and climatic conditions. This study aimed at calculating the reference limits for some blood gas parameters in the blood collected from the coccygeal vessels of multiparous Holstein dairy cows. This site of sampling implies the risk of withdrawing blood of unknown origin (venous, arterial, or mixed), but has a high practical interest for the easy and quick performance and the minimal animal restraint required. Data from 379 cows were used, and reference limits were produced for pH, partial pressure of carbon dioxide (pCO2), bicarbonate concentration (HCO3), total carbon dioxide concentration (tCO2), oxygen saturation (sO2), hemoglobin (Hb), hematocrit (Hct), base excess (BE), glucose, Na, K, and ionized calcium (iCa). The effects of stage of lactation (5 to 60 vs. > 60 DIM) and season of sampling (cold vs. hot) were investigated, and specific reference limits were produced for each variable and each level of the factors whenever a significant effect was detected. The pH, sO2, K, and iCa were not influenced by season or stage of lactation. All the other blood gas parameters were significantly affected by season of sampling, and Hb, Hct, glucose, and Na were also affected by stage of lactation. Reference limits provided in this study are specific to the site of sampling (coccygeal vessels) and the animal category considered. Further studies are needed to produce reference intervals for other blood gas parameters, cow categories, and blood types.

Lung ultrasound score evaluation of the effect of pressure-controlled ventilation volume-guaranteed on patients undergoing laparoscopic-assisted radical gastrectomy.

BACKGROUND: Laparoscopic-assisted radical gastrectomy (LARG) is the standard treatment for early-stage gastric carcinoma (GC). However, the negative impact of this procedure on respiratory function requires the optimized intraoperative management of patients in terms of ventilation. AIM: To investigate the influence of pressure-controlled ventilation volume-guaranteed (PCV-VG) and volume-controlled ventilation (VCV) on blood gas analysis and pulmonary ventilation in patients undergoing LARG for GC based on the lung ultrasound score (LUS). METHODS: The study included 103 patients with GC undergoing LARG from May 2020 to May 2023, with 52 cases undergoing PCV-VG (research group) and 51 cases undergoing VCV (control group). LUS were recorded at the time of entering the operating room (T0), 20 minutes after anesthesia with endotracheal intubation (T1), 30 minutes after artificial pneumoperitoneum (PP) establishment (T2), and 15 minutes after endotracheal tube removal (T5). For blood gas analysis, arterial partial pressure of oxygen (PaO2) and partial pressure of carbon dioxide (PaCO2) were observed. Peak airway pressure (Ppeak), plateau pressure (Pplat), mean airway pressure (Pmean), and dynamic pulmonary compliance (Cdyn) were recorded at T1 and T2, 1 hour after PP establishment (T3), and at the end of the operation (T4). Postoperative pulmonary complications (PPCs) were recorded. Pre- and postoperative serum interleukin (IL)-1ß, IL-6, and tumor necrosis factor-α (TNF-α) were measured by enzyme-linked immunosorbent assay. RESULTS: Compared with those at T0, the whole, anterior, lateral, posterior, upper, lower, left, and right lung LUS of the research group were significantly reduced at T1, T2, and T5; in the control group, the LUS of the whole and partial lung regions (posterior, lower, and right lung) decreased significantly at T2, while at T5, the LUS of the whole and some regions (lateral, lower, and left lung) increased significantly. In comparison with the control group, the whole and regional LUS of the research group were reduced at T1, T2, and T5, with an increase in PaO2, decrease in PaCO2, reduction in Ppeak at T1 to T4, increase in Pmean and Cdyn, and decrease in Pplat at T4, all significant. The research group showed a significantly lower incidence of PPCs than the control group within 3 days postoperatively. Postoperative IL-1ß, IL-6, and TNF-α significantly increased in both groups, with even higher levels in the control group. CONCLUSION: LUS can indicate intraoperative non-uniformity and postural changes in pulmonary ventilation under PCV-VG and VCV. Under the lung protective ventilation strategy, the PCV-VG mode more significantly improved intraoperative lung ventilation in patients undergoing LARG for GC and reduced lung injury-related cytokine production, thereby alleviating lung injury.

Preadmission metformin use increased the incidence of hyperlactatemia at admission and 30-day in-hospital mortality among T2D patients with heart disease at high risk of hypoxia.

BACKGROUND: Surprisingly, despite the high prevalence of metformin use in type 2 diabetes (T2D) patients with heart disease, limited safety data is available regarding metformin use in patients with acute and critical heart disease. METHODS: In this single-center retrospective study, patients admitted to the cardiology department for heart failure (HF) or acute coronary syndrome (ACS) between December 2013 and December 2021 and who underwent arterial blood gas analysis at admission with an estimated glomerular clearance rate of ≥45 ml/min/1.73 m2 were identified. The incidences of hyperlactatemia, acidosis, and 30-day in-hospital mortality were compared between preadmission metformin users and nonusers. RESULTS: Of 526 admissions, 193/193 metformin users/nonusers were selected in a propensity score-matched model. Metformin users had greater lactate levels (2.55 ± 2.07 mmol/l vs. 2.00 ± 1.80 mmol/l P < 0.01), a greater incidence of hyperlactatemia [odds ratio (OR) = 2.55; 95% confidence interval (CI), 1.63-3.98; P < 0.01] and acidosis (OR = 1.78; 95% CI, 1.00-3.16; P < 0.05) at admission and a greater incidence of in-hospital mortality (OR = 3.83; 95% CI, 1.05-13.94; P < 0.05), especially those with HF/acute myocardial infarction, elderly age, or without preadmission insulin use. CONCLUSIONS: Our results suggest that, compared to metformin nonusers, preadmission use of metformin may be associated with a greater incidence of hyperlactatemia and acidosis at admission and greater 30-day in-hospital mortality among T2D patients with HF or ACS at high risk of hypoxia, particularly those without preadmission insulin use. The safety of metformin in this population needs to be confirmed in prospective controlled trials.

FFP2 induced breathing resistance does not affect metabolism and well-being during brisk walking and stair climbing - a randomized controlled trial.

OBJECTIVES: N95 or Type II filtering face pieces (FFP2) are often worn during work hours or on public transportation to prevent airborne infection. The aim of this randomized controlled crossover study is to assess the impact of FFP2 induced breathing resistance on pulmonary function, blood gas values and discomfort during walking and stair climbing. METHODS: N = 16 healthy adults (24.8 ± 2.2 years; 10 females, ) participated. Interventions included (1) six minutes of walking in a 16-meter-long hallway (612 m) and (2) eight minutes of stair climbing in a two-story staircase (420 stairs), both with and without a FFP2 (> 48 h wash-out). Spiroergometric data (Ventilation, breathing frequency, tidal volume, oxygen uptake and carbon dioxide exhalation (primary outcome), end tidal carbon dioxide- and oxygen pressure) and self-reported response (Perceived exertion, dyspnoea and pain) were assessed during activities. Blood gas analysis (capillary carbon dioxide- (pCO2) (primary outcome) and oxygen partial pressure (pO2), pH, lactate and base excess) was measured immediately after cessation of activities. Manipulation effects (FFP2 versus no mask) were tested using repeated measures analyses of variance. RESULTS: Analysis showed no effect of FFP2 on pCO2 or other blood-gas parameters but on carbon dioxide exhalation during walking: (mean 1067, SD 209 ml/min) (mean 1908, SD 426 ml/min) (F(15) = 19.5; p < 0.001; ηp2 = 0.566) compared to no mask wearing (mean 1237, SD 173 ml/min; mean 1908, SD 426 ml/min). Ventilation was decreased and dyspnoea was increased by FFP2 during activities. FFP2 led to lower oxygen uptake and lower end tidal oxygen but higher end tidal carbon dioxide during stair climbing. CONCLUSIONS: FFP2 decreased ventilation based on slower breathing patterns and led to limitations in pulmonary gas exchange and increased subjective dyspnoea. However, invasive diagnostics revealed no signs of clinically relevant metabolic effects immediately after everyday physical activities.

Utilization of Multi-Parameter Blood Gas Analysis in Prehospital Emergency Medicine-A Scoping Review.

BACKGROUND: Prehospital blood gas analysis (BGA) is an evolving field that offers the potential for early identification and management of critically ill patients. However, the utility and accuracy of prehospital BGA are subjects of ongoing debate. OBJECTIVES: We aimed to provide a comprehensive summary of the current literature on prehospital BGA, including its indications, methods, and feasibility. METHODS: We performed a scoping review of prehospital BGA. A thorough search of the PubMed, Embase, and Web of Science databases was conducted to identify relevant studies focusing on prehospital BGA in adult patients. RESULTS: Fifteen studies met the inclusion criteria. Prehospital BGA was most frequently performed in patients in out-of-hospital cardiac arrest, followed by traumatic and nontraumatic cases. The parameters most commonly analyzed were pH, pCO2, pO2, and lactate. Various sampling methods, including arterial, venous, and intraosseous, were reported for prehospital BGA. While prehospital BGA shows promise in facilitating early identification of critical patients and guiding resuscitation efforts, logistical challenges are to be considered. The handling of preclinical BGA is described as feasible and useful in most of the included studies. CONCLUSION: Prehospital BGA holds significant potential for enhancing patient care in the prehospital setting, though technical challenges need to be considered. However, further research is required to establish optimal indications and demonstrate the benefits for prehospital BGA in specific clinical contexts.