scholarly journals Effect of changes in inspired oxygen fraction on oxygen delivery during cardiac surgery: a substudy of the CARROT trial

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Karam Nam ◽  
Hye-Bin Kim ◽  
Young-Lan Kwak ◽  
Young Hyun Jeong ◽  
Jae-Woo Ju ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Cardiac Surgery ◽  
Kidney Disease ◽  
Oxygen Delivery ◽  
Artery Bypass ◽  
Blood Gas Analysis ◽  
Gas Analysis ◽  
Off Pump ◽  
Hb Concentration ◽  
Inspired Oxygen

AbstractWhen hemoglobin (Hb) is fully saturated with oxygen, the additional gain in oxygen delivery (DO2) achieved by increasing the fraction of inspired oxygen (FiO2) is often considered clinically insignificant. In this study, we evaluated the change in DO2, interrogated by mixed venous oxygen saturation (SvO2), in response to a change in FiO2 of 0.5 during cardiac surgery. When patients were hemodynamically stable, FiO2 was alternated between 0.5 and 1.0 in on-pump cardiac surgery patients (pilot study), and between 0.3 and 0.8 in off-pump coronary artery bypass grafting patients (substudy of the CARROT trial). After the patient had stabilized, a blood gas analysis was performed to measure SvO2. The observed change in SvO2 (ΔSvO2) was compared to the expected ΔSvO2 calculated using Fick’s equation. A total 106 changes in FiO2 (two changes per patient; total 53 patients; on-pump, n = 36; off-pump, n = 17) were finally analyzed. While Hb saturation remained near 100% (on-pump, 100%; off-pump, mean [SD] = 98.1% [1.5] when FiO2 was 0.3 and 99.9% [0.2] when FiO2 was 0.8), SvO2 changed significantly as FiO2 was changed (the first and second changes in on-pump, 7.7%p [3.8] and 7.6%p [3.5], respectively; off-pump, 7.9%p [4.9] and 6.2%p [3.9]; all P < 0.001). As a total, regardless of the surgery type, the observed ΔSvO2 after the FiO2 change of 0.5 was ≥ 5%p in 82 (77.4%) changes and ≥ 10%p in 31 (29.2%) changes (mean [SD], 7.5%p [3.9]). Hb concentration was not correlated with the observed ΔSvO2 (the first changes, r =  − 0.06, P = 0.677; the second changes, r =  − 0.21, P = 0.138). The mean (SD) residual ΔSvO2 (observed − expected ΔSvO2) was 0%p (4). Residual ΔSvO2 was more than 5%p in 14 (13.2%) changes and exceeded 10%p in 2 (1.9%) changes. Residual ΔSvO2 was greater in patients with chronic kidney disease than in those without (median [IQR], 5%p [0 to 7] vs. 0%p [− 3 to 2]; P = 0.049). DO2, interrogated by SvO2, may increase to a clinically significant degree as FiO2 is increased during cardiac surgery, and the increase of SvO2 is not related to Hb concentration. SvO2 increases more than expected in patients with chronic kidney disease. Increasing FiO2 can be used to increase DO2 during cardiac surgery.

Comparison of Blood Gas Analysis on Hemodialysis in Patients with Chronic Kidney Diseases

2021 ◽  
Vol 28 (1) ◽  
pp. 55
Author(s):  
Nenden Senina Rindaha ◽  
Sulina Yanti Wibawa ◽  
Yuyun Widaningsih ◽  
Rachmawati A. Muhiddin
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Kidney Diseases ◽  
Blood Gas Analysis ◽  
Gas Analysis ◽  
Rank Test ◽  
Blood Gas ◽  
Metabolic Conditions ◽  
Sigmoid Curve ◽  
Signed Rank Test

Chronic Kidney Disease (CKD) is defined as a renal failure that has lasted for more than three months. Hemodialysis is thetype of kidney replacement therapy that is mostly used, and blood gas analysis can be used to identify this condition. Thisstudy is to compare the blood gas analysis on pre-and post-dialysis in patients with CKD using pH, PaCO , PaO , HCO , SO , 2 2 3 2and BE as markers of improvement in the patients'condition. The population was all patients diagnosed with CKD andhemodialysis at Wahidin Sudirohusodo Hospital, and eligible according to the criteria in this study. The sample size wasdetermined using Federer's calculation, and the statistical analysis using paired T-test and Wilcoxon signed-rank test withα=0.05. Subjects were 34 patients, consisting of 18 females (52.9%) and 16 males (47.1%). Hemodialysis had the mostsignificant impact on the PaO and SaO variables. Relation between PaO and SaO was illustrated in a sigmoid curve. 2 2 2 2Oxygen-bound hemoglobin increased after the first molecule was bound. An almost full PaO pressure will cause a slight 2increase in SaO . Whereas at <90% saturation, a slight decrease in PaO will cause a large decrease in SaO . PaO and SaO 2 2 2 2 2determine cardiac efficiency and the markers for assessing the metabolic conditions of the lungs and heart that correlatewith oxygen. Chronic kidney disease patients experienced improved conditions after undergoing hemodialysis withincreased blood gas values, especially in PaO and SaO .

scholarly journals Management of severe baclofen toxicosis using hemodialysis in conjunction with mechanical ventilation in a cat with chronic kidney disease

2021 ◽  
Vol 7 (2) ◽  
pp. 205511692110337
Author(s):  
Levi Hoffman ◽  
Leonel A Londoño ◽  
Jenifer Martinez
Keyword(s):  
Chronic Kidney Disease ◽  
Mechanical Ventilation ◽  
Kidney Disease ◽  
Venous Blood ◽  
Clinical Signs ◽  
Blood Gas Analysis ◽  
Gas Analysis ◽  
Dialysis Session ◽  
History Of ◽  
Venous Blood Gas

Case summary A 2-year-old castrated male domestic shorthair cat was presented for evaluation of acute and progressive neurologic signs 2–4 h after exposure to baclofen. The suspected ingested dose was 2.1 mg/kg. On admission, the cat was tetraplegic with stuporous mentation, and venous blood gas analysis showed mild hypercapnia (PvCO2 43.4 mmHg) raising concern for hypoventilation. Owing to the acute nature of the ingestion, severity of the clinical signs and reported history of chronic kidney disease, hemodialysis was recommended to remove the toxin. A 5 h hemodialysis session was performed using an intermittent platform without hemoperfusion. At the beginning of hemodialysis, worsening hypoventilation and hypercapnia (PvCO2 88.6 mmHg) required endotracheal intubation and manual ventilation initially, followed by mechanical ventilation. At the end of the dialysis session, the cat was breathing spontaneously and disconnected from the ventilator. The cat was ambulatory and alert 1 h after the end of dialysis. After an additional 12 h of monitoring, the cat had full return of neurologic function and was discharged from hospital. Serum baclofen concentration measured prior to, during and after hemodialysis showed a 77.7% reduction in baclofen levels immediately after hemodialysis. Relevance and novel information This is the first report of baclofen toxicity in a cat successfully treated with hemodialysis and mechanical ventilation simultaneously. Treatment with hemodialysis therapy and mechanical ventilation could be considered in cases of acute baclofen toxicosis to improve outcome and reduce the length of the hospital stay.

scholarly journals Assessment of Acid Base and Electrolyte Status in Patients with Chronic Kidney Disease

JMS SKIMS ◽  
2013 ◽  
Vol 16 (2) ◽  
pp. 86-89
Author(s):  
Mahrukh Hameed ◽  
Syed Mudassar ◽  
Mosin S Khan ◽  
Nisar Ahmad Wani
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Blood Gas Analysis ◽  
Gas Analysis ◽  
Electrolyte Imbalance ◽  
Common Finding ◽  
Blood Gas ◽  
Acid Base ◽  
Glomerular Diseases ◽  
Nephritic Syndrome

Background: Blood gas measurements are being used to evaluate oxygenation and acid/base status. They are typically ordered if a patient has worsening symptoms of an acid/base imbalance, difficulty in breathing or shortness of breath. Blood gas analysis has been a cornerstone in the management of acutely ill patients with presumed acid/base and electrolyte imbalance. Objective: The aim of this study was to study the blood gases and electrolyte status in patients with chronic kidney disorder. Methods: A prospective study was conducted in the department of Clinical Biochemistry, Sher-I Kashmir Institute of Medical Sciences (SKIMS) Srinagar. A total of 171 patients were included in the study of which 91 were males and 80 were females. The age of the patients ranged between 4 - 80 years. These patients were admitted in the Nephrology ward of SKIMS. Out of these 171 patients included in the study 99 had CKD, 42 had ARF, 11 had metabolic acidosis, 6 had nephritic syndrome, 2 had lupus nephritis and 11 had complications like dysuria, HTN, glomerular diseases etc. The medical history of the patients with CKD was recorded and Samples were obtained for blood gas analysis. Venous samples were obtained for VBG analysis and arterial samples were obtained for ABG analysis. These samples were analysed for determining the blood gas status. Hemoglobin levels and kidney function test were performed manually. Hemoglobin was estimated by cyanmet-hemoglobin method. Urea was estimated by Diacetyl monoxime (DAM) method. Creatinine was estimated by Jaffe’s reaction. Results: CKD patients showed acidosis, hypocapnia and hypoxia. Among electrolytes almost all the patients with CKD had hyponatremia and increased anion gap. Conclusion: It was concluded from the observation that male predominance was seen in chronic kidney disease. Blood gas parameters including pH, PCO2, PO2, HCO3 were found to be deranged in most of the patients with CKD. Among electrolytes sodium was found to be mostly deranged in patients with CKD and Anemia was the most common finding in patients with this disorder. JMS 2013; 16(2):86-89

scholarly journals Long-Term Follow-Up Evaluation of Renal Function in Patients with Chronic Kidney Disease Undergoing Cardiac Surgery

2016 ◽  
Vol 2016 ◽  
pp. 1-4 ◽  
Author(s):  
Eduesley Santana-Santos ◽  
Felipe Kenji Oshiro Kamei ◽  
Tarcísia Karoline do Nascimento ◽  
Anas Abou Ismail ◽  
Jurema da Silva Herbas Palomo ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Renal Function ◽  
Cardiac Surgery ◽  
Kidney Disease ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Kidney Injury ◽  
Perioperative Period

Background. Acute kidney injury (AKI) is a common complication of cardiac surgery but its long-term consequences, in patients with chronic kidney disease (CKD), are not known.Methods. We compared the long-term prognoses of CKD patients who developed (n=23) and did not develop (n=35) AKI during the period of hospitalization after undergoing coronary artery bypass graft (CABG). Fifty-eight patients who survived (69.6±8.4years old, 72% males, 83% Whites, 52% diabetics, baseline GFR:46±16 mL/min) were followed up for47.8±16.4months and treated for secondary prevention of events.Results. There were 6 deaths, 4 in the AKI+ and 2 in the AKI− group (Log-rank = 0.218), two attributed to CV causes. At the end of the study, renal function was similar in the two groups. One AKI− patient was started on dialysis. Only 4 patients had an increase in serum creatinine ≥ 0.5 mg/dL during follow-up.Conclusion. CKD patients developing AKI that survived the early perioperative period of coronary intervention present good renal and nonrenal long-term prognosis, compared to patients who did not develop AKI.

scholarly journals Influence of chronic kidney disease on early clinical outcomes after off-pump coronary artery bypass grafting

2020 ◽  
Author(s):  
Xihui Li ◽  
Siyu Zhang ◽  
Feng Xiao
Keyword(s):  
Chronic Kidney Disease ◽  
Renal Function ◽  
Coronary Artery ◽  
Kidney Disease ◽  
Artery Bypass ◽  
Complication Rates ◽  
Bypass Grafting ◽  
Off Pump ◽  
Pump Cabg ◽  
Pump Coronary Artery Bypass

Abstract Backgroud: Patients with chronic kidney disease (CKD) have a high incidence of coronary heart disease, which is the leading cause of death in these patients. CABG significantly decreases short-term and long-term mortality in patients with CKD compared with PCI. The effect of CKD on the early outcomes of off-pump CABG has been studied less often. We aimed to investigate the effect of CKD on early postoperative mortality and complications following off-pump coronary artery bypass grafting (CABG). Methods: We retrospectively analyzed preoperative baseline and surgery data for 1173 patients undergoing off-pump CABG from January 2010 to December 2017 in the Department of Cardiac Surgery, Peking University First Hospital. Outpatient follow-up was performed until 30 days postoperatively. Patients with estimated glomerular filtration rates calculated according to the Chronic Kidney Disease Epidemiology Collaboration equation ≥ 60 mL/min/1.73 m2 were assigned to the normal renal function group (normal group, n = 924), and those with a rate < 60 mL/min/1.73 m2 were assigned to the CKD group (CKD group, n = 249). Results: Patients in the CKD group were seriously ill with multiple complications, and postoperative 30-day mortality and complication rates were significantly higher than those in the normal group. In the logistic regression analysis, after correcting for common confounding factors, namely, sex, age, and left ventricular ejection fraction, preoperative CKD was a risk factor for postoperative acute kidney injury, perioperative myocardial infarction, gastrointestinal bleeding, secondary tracheal intubation, stroke, chest wound infection, prolonged mechanical ventilation (≥ 24 h), prolonged intensive care unit stay (≥ 72 h), prolonged length of stay (≥ 14d), dialysis requirement, and postoperative death within 30 days. Conclusions: Patients with CKD had more preoperative complications, and their postoperative 30-day mortality and complication rates after off-pump CABG were significantly higher than those of patients with normal renal function. For CABG patients with CKD, the risk of surgery should be assessed carefully, and comprehensive measures should be taken to strengthen perioperative management, with an aim to reduce complications and mortality and improve surgical outcomes.

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