Intraosseous Blood Samples Are Predictive for Central Venous Acid-Base Status and Oxygenation

Background and Objectives: In severe circulatory failure agreement between arterial and mixed venous or central venous values is poor; venous values are more reflective of tissue acid–base imbalance. No prior study has examined the relationship between peripheral venous blood gas (VBG) values and arterial blood gas (ABG) values in hemodynamic compromise. The objective of this study was to examine the correlation between hemodynamic parameters, specifically systolic blood pressure (SBP) and the arterial–peripheral venous (A-PV) difference for all commonly used acid–base parameters (pH, Pco 2, and bicarbonate). Design, Setting, Participants, and Measurements: Data were obtained prospectively from adult patients with trauma. When an ABG was obtained for clinical purposes, a VBG was drawn as soon as possible. Patients were excluded if the ABG and VBG were drawn >10 minutes apart. Results: The correlations between A-PV pH, A-PV Pco 2, and A-PV bicarbonate and SBP were not statistically significant ( P = .55, .17, and .09, respectively). Although patients with hypotension had a lower mean arterial and peripheral venous pH and bicarbonate compared to hemodynamically stable patients, mean A-PV differences for pH and Pco 2 were not statistically different ( P = .24 and .16, respectively) between hypotensive and normotensive groups. Conclusions: In hypovolemic shock, the peripheral VBG does not demonstrate a higher CO2 concentration and lower pH compared to arterial blood. Therefore, the peripheral VBG is not a surrogate for the tissue acid–base status in hypovolemic shock, likely due to peripheral vasoconstriction and central shunting of blood to essential organs. This contrasts with the selective venous respiratory acidosis previously demonstrated in central venous and mixed venous measurements in circulatory failure, which is more reflective of acid–base imbalance at the tissue level than arterial blood. Further work needs to be done to better define the relationship between ABG and both central and peripheral VBG values in various types of shock.

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Comparison of two methods for converting central venous values of acid-base status to arterial values in critically ill patients

Computer Methods and Programs in Biomedicine ◽

10.1016/j.cmpb.2021.106022 ◽

2021 ◽

Vol 203 ◽

pp. 106022

Author(s):

Lisha Shastri ◽

Thierry Boulain ◽

Stephen Edward Rees ◽

Lars Pilegaard Thomsen

Keyword(s):

Critically Ill ◽

Critically Ill Patients ◽

Central Venous ◽

Acid Base ◽

Acid Base Status

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Function of oxygen transport in the blood of patients in a state of alcohol deprivation in blood in vitro incubation with ethanol solution

Health and Ecology Issues ◽

10.51523/2708-6011.2021-18-4-14 ◽

2021 ◽

Vol 18 (4) ◽

pp. 108-113

Author(s):

H. V. Lelevich

Keyword(s):

Oxygen Transport ◽

Ethanol Solution ◽

Final Concentration ◽

Acid Base ◽

Blood Samples ◽

Healthy Donors ◽

Chronic Ethanol Consumption ◽

Acid Base Status ◽

Male Patients

Objective. To estimate the in vitro effect of ethanol on the function of oxygen transport in the blood of patients in a state of alcohol deprivation and in healthy donors.Materials and methods. We analyzed blood samples from 13 male patients aged 22–56 in a state of alcohol deprivation and 11 males aged 20-45 in whom this diagnosis was excluded. The blood was incubated with ethanol solution at a final concentration of 50 μmol/L. The parameters of the function of oxygen transport (р50, рО2, рСО2, рН, АВЕ, НСО3-, ТСО2,SВЕ, SBC) of the blood taken from the cubital vein using an ABL-330 “Radiometr” microgas analyzer were determined.Results. The patients in a state of alcohol deprivation reveal increased affinity of hemoglobin for oxygen, and their acid-base status of the blood becomes alkaline. When ethanol is added in vitro to the blood of patients, the affinity of hemoglobin for oxygen decreases.Conclusion. Decreased affinity of hemoglobin for oxygen upon the in vitro addition of ethanol in the examined patients indicates compensatory and adaptive changes in the oxygen transport of the blood in response to chronic ethanol consumption.

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To Manage Infantile Hypertrophic Pyloric Stenosis by "Double-Y Pyloromyotomy" is a better Surgical Approach

Journal of Paediatric Surgeons of Bangladesh ◽

10.3329/jpsb.v1i2.19532 ◽

2014 ◽

Vol 1 (2) ◽

pp. 143-147

Author(s):

Md. Ansar Ali ◽

Kaniz Hasina ◽

Shahnoor Islam ◽

Md. Ashraf Ul Huq ◽

Md. Mahbub-Ul Alam ◽

...

Keyword(s):

Weight Gain ◽

Pyloric Stenosis ◽

Hypertrophic Pyloric Stenosis ◽

Treatment Modalities ◽

Infantile Hypertrophic Pyloric Stenosis ◽

Postoperative Vomiting ◽

Acid Base ◽

Feeding Regimes ◽

Acid Base Status ◽

Postoperative Feeding

Background: Different treatment modalities and procedures have been tried for the management of infantile hypertrophic pyloric stenosis. But surgery remains the mainstay for management of IHPS. Ramstedts pyloromyotomy was described almost over a hundred years ago and to date remains the surgical technique of choice. An alternative and better technique is the double-Y pyloromyotomy, which offer better results for management of this common condition.Methods: A prospective comparative interventional study of 40 patients with IHPS was carried out over a period of 2 years from July 2008 to July 2010. The patients were divided into 2 equal groups of 20 patients in each. The study was designed that all patients selected for study were optimized preoperatively regarding to hydration, acid-base status and electrolytes imbalance. All surgeries were performed after obtaining informed consent. Standard preoperative preparation and postoperative feeding regimes were used. The patients were operated on an alternate basis, i.e., one patient by Double-Y Pyloromyotomy(DY) and the next by aRamstedts Pyloromyotomy (RP). Data on patient demographics, operative time, anesthesia complications, postoperative complications including vomiting and weight gain were collected. Patients were followed up for a period of 3 months postoperatively. Statistical assessments were done by using t test.Results: From July 2008 through July 2010, fourty patients were finally analyzed for this study. Any statistical differences were observed in patient population regarding age, sex, weight at presentation, symptoms and clinical condition including electrolytes imbalance and acid-base status were recorded. Significant differences were found in postoperative vomiting and weight gain. Data of post operative vomiting and weight gain in both groups were collected. Vomiting in double-Y(DY) pyloromyotomy group (1.21 ± 0.45days) vs Ramstedts pyloromyotomy (RP) group(3.03 ± 0.37days) p= 0.0001.Weight gain after 1st 10 days DY vs RP is ( 298 ± 57.94 gm vs193±19.8 gm p=0.0014), after 1 month (676.67±149.84 gm vs 466.67 ± 127.71 gm, p=0.0001), after 2months (741.33± 278.74 gm vs 490±80.62 gm, p=0.002) and after 3 months (582±36.01gm vs 453.33±51.64 gm, p=0.0001).No long-term complications were reported and no re-do yloromyotomy was needed.Conclusion: The double-Y pyloromyotomy seems to be a better technique for the surgical management of IHPS. It may offer a better functional outcome in term of postoperative vomiting and weight gain.DOI: http://dx.doi.org/10.3329/jpsb.v1i2.19532

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