P18 Plasma-lyte 148 vs 0.9% saline for fluid resuscition in children: electrolytic and clinical outcomes

AimsCrystalloid fluid boluses are a mainstay of treatment in unwell children, with the traditional fluid of choice being 0.9% saline (NS). However, the use of NS has been associated with an increase in plasma chloride levels and acidosis, leading to kidney injury and other detrimental clinical effects. Plasma-Lyte 148 (PLA) is a balanced, physiological, crystalloid intravenous fluid, which is both calcium-free and isotonic. Its use in place of NS for fluid resuscitation may circumvent hyperchloraemic metabolic acidosis. In May 2015 our hospital altered its standard resuscitation fluid from NS to PLA. We aimed to compare the effect of fluid boluses of NS to those of PLA in children.MethodsAll patients admitted in the 18 month periods before and after the change from NS to PLA, and receiving a fluid bolus in the first 24 hours of admission, were included. Post-surgical patients and those who had undergone haemofiltration were excluded. Arterial blood gas and creatinine values for up to 5 days after bolus fluid administration were examined. Patients were stratified according to the total resuscitation volume (ml/kg), then split into categories determined by the balance of PLA vs. NS.The primary outcome was plasma chloride. Secondary outcomes included blood pH and percentage change in creatinine. Clinical outcomes were length of ventilation and length of PICU stay.Results126 patients were included in the analysis. Patients receiving NS boluses tended to have a higher maximum chloride, higher average chloride, lower pH and higher percentage creatinine increase than those given PLA. Subgroup analysis showed a statistically significant difference in average serum chloride for the 61–90 ml/kg group {PLA 105.59±1.29 vs NS 111.29±2.1 mmol/L; difference: −6.21 [95% confidence interval (CI)−9.55,–2.87]}. Patients who received PLA tended to have a higher pH than those receiving NS. A statistically significant difference was seen in the 10–30 ml/kg group [PLA 7.42±0.49 vs NS 7.33±0.65; difference: 0.0913 (95% CI: −0.18 to −0.02)].Significant differences were not seen in the clinical outcomes of length of stay or ventilationConclusionPLA as a resuscitation fluid is significantly associated with a more physiological plasma chloride and pH across several resuscitation fluid volume categories, when compared to NS. The trends in the other fluid volume categories are in line with these findings, but are not statistically significant. There was also a trend towards patients receiving PLA having a lower percentage rise in creatinine than those who received saline. These results were consistent over all weight and age categories.

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P0290THERAPEUTIC PLASMAPHERESIS EXPERIENCE DUE TO NEPHROLOGICAL INDICATIONS

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa142.p0290 ◽

2020 ◽

Vol 35 (Supplement_3) ◽

Author(s):

İsmail Baloglu ◽

Hatice Ozge Serin ◽

Halil Zeki Tonbul ◽

Nedim Yılmaz Selcuk ◽

Kultigin Turkmen

Keyword(s):

Serum Creatinine ◽

Thrombotic Microangiopathy ◽

Clinical Effects ◽

Humoral Rejection ◽

Mortality And Morbidity ◽

Arterial Blood Gas ◽

Arterial Blood ◽

Significant Difference ◽

Life Threatening ◽

Clinical Responses

Abstract Background and Aims Therapeutic plasma exchange (PEX) has an increasingly long list of indications in recent years, in addition to immunosuppressive therapies in many life-threatening immune activations, it provides significant improvements in mortality and morbidity. In this study, we aimed to investigate the laboratory and clinical effects of PEX performed with nephrologic indication in our clinic. Method The records of 67 patients (36 females, 31 males; mean age, 45.7±15.8 years) who underwent PEX with nephrological indication between 2012 and 2017 in our clinic were retrospectively reviewed. Characteristics of the patients such as, indications of PEX, laboratory values and number of PEX sessions were recorded. In addition, clinical responses were also evaluated. Results When a total 398 PEX sessions were examined, the most common indication (40.3%) was acute humoral rejection after renal transplantation, followed by granulomatosis with polyangiitis (19.4%) and thrombotic microangiopathy (9%), respectively. The average of the PEX sessions was 5.94. There was a statistically significant increase in the bicarbonate value when the arterial blood gas of the patients was evaluated after PEX (p=0.002). However, no significant difference was observed in the pH and ionized calcium values (p=0.135, p=0.969, respectively) (Table 1). When all the patients were evaluated, there was no significant change in hemoglobin values (p=0.174), but platelet values decreased significantly (p=0.011) after PEX. However, when the patient group admitted with thrombotic microangiopathy was examined, it was observed that platelet count increased and LDH level decreased significantly (p=0.063, p=0.028, respectively). When the serum creatinine values of all patients were evaluated, a significant decrease was observed in the serum creatinine values after PEX (p=0.001). In addition, after 2 years following PEX treatment, 70.1% of patients were still alive and 12.5% of patients undergoing PEX for acute humoral rejection were undergoing on hemodialysis treatment. Conclusion According to the results of our study, patients should be followed up especially for acid-base and electrolyte changes after PEX. In addition, therapeutic PEX might be effective in terms of improving morbidity and 2 year-mortality of these patients.

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Severe Decompression Illness: Case Report, Prehospital Recognition, and Regional Transport Considerations

Case Reports in Emergency Medicine ◽

10.1155/2017/7203085 ◽

2017 ◽

Vol 2017 ◽

pp. 1-4

Author(s):

Julie Estrada ◽

David Meurer ◽

Kevin De Boer ◽

Karl Huesgen

Keyword(s):

Early Recognition ◽

Multiorgan Failure ◽

Tertiary Care ◽

Pulmonary Arteries ◽

Kidney Injury ◽

Decompression Illness ◽

Arterial Blood Gas ◽

Head Ct ◽

Arterial Blood ◽

Prehospital Emergency

A 46-year-old male presented to our tertiary care emergency department (ED) with shortness of breath and chest pain following an uneventful four-hour SCUBA dive at 100 feet. His prehospital emergency medical services (EMS) assessment revealed transient hypotension and hypoxia. He later developed progressive skin mottling. Serology was significant for acute kidney injury, transaminitis, hemoconcentration, and hypoxia on an arterial blood gas. Computed tomography (CT) angiography demonstrated intravascular gas throughout the mesenteric and pulmonary arteries as well as the portal venous system. No abnormality was seen on head CT and the patient had normal mental status. Prehospital nonrebreather oxygen therapy was changed to continuous positive airway pressure (CPAP) upon ED arrival, and the patient was intubated prior to transfer to a hyperbaric facility. However, within 24 hours the patient was found to have multiorgan failure, diffuse cerebral edema, and brain death despite no further episodes of hypotension or hypoxia. No intracranial gas was seen on repeat head CT. Our case demonstrates the importance of early recognition of decompression illness by EMS personnel, consideration of ground versus flight transportation of these patients to the nearest hyperbaric center, and the possible use of prehospital CPAP as an alternative to enhance oxygenation.

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COVID-19 and Multiorgan Dysfunction Syndrome

10.5772/intechopen.99676 ◽

2021 ◽

Author(s):

Jitendra D. Lakhani ◽

Sajni Kapadia ◽

Rohit Choradiya ◽

Roop Preet Gill ◽

Som J. Lakhani

Keyword(s):

Organ Failure ◽

Kidney Injury ◽

Glycemic Variability ◽

Multiple Organ ◽

Organ Support ◽

Arterial Blood Gas ◽

Arterial Blood ◽

Treatment Support ◽

Laboratory Investigations ◽

Hospital Acquired

Severe acute respiratory syndrome (SARS) is the leading cause of death in COVID-19 infection, however, multi-organ dysfunction due to COVID-19 and/or because of co-morbidities is a usual accompaniment causing unfavorable outcome. Early detection of organ failure and giving appropriate organ support may improve the chances of survival. Arterial Blood Gas (ABG) analysis; electrolytes coupled with clinical picture and with organ related laboratory investigations may help in diagnosis of MODS and sepsis in COVID-19 SEVERE SYNDROME. Acute kidney injury (AKI), myocarditis, thromboembolism, acute liver de-compensation, hospital acquired infections, cardiac arrest, glycemic variability, thyroid dysfunction and other organ failure may lead to MODS.As patients having multiple organ syndrome requires ICU admission and interventions like intubation, hemodialysis and other extracorporeal treatment support knowing holistically about “COVID-19 MODS” is important for treating physicians.

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Feasıbılıty of Transcutaneous Method for Carbon Dıoxıde Monıtorıng in an Intensive Care Unıt

Current Respiratory Medicine Reviews ◽

10.2174/1573398x18666220103113003 ◽

2022 ◽

Vol 18 ◽

Author(s):

Nazlıhan Boyacı ◽

Sariyya Mammadova ◽

Nurgül Naurizbay ◽

Merve Güleryüz ◽

Kamil İnci ◽

...

Keyword(s):

Carbon Dioxide ◽

Intensive Care Unit ◽

Intensive Care ◽

Partial Pressure ◽

Blood Gas ◽

Peripheral Oxygen Saturation ◽

Arterial Blood Gas ◽

Arterial Blood ◽

Randomized Controlled Studies ◽

Significant Difference

Background: Transcutaneous partial pressure of carbon dioxide (PtCO2) monitorization provides a continuous and non-invasive measurement of partial pressure of carbon dioxide (pCO2). In addition, peripheral oxygen saturation (SpO2) can also be measured and followed by this method. However, data regarding the correlation between PtCO2 and arterial pCO2 (PaCO2) measurements acquired from peripheric arterial blood gas is controversial. Objective: We aimed to determine the reliability of PtCO2 with PaCO2 based on its advantages, like non-invasiveness and continuous applicability. Methods: Thirty-five adult patients with hypercapnic respiratory failure admitted to our tertiary medical intensive care unit (ICU) were included. Then we compared PtCO2 and PaCO2 and both SpO2 measurements simultaneously. Thirty measurements from the deltoid zone and 26 measurements from the cheek zone were applied. Results: PtCO2 could not be measured from the deltoid region in 5 (14%) patients. SpO2 and pulse rate could not be detected at 8 (26.7%) of the deltoid zone measurements. Correlation coefficients between PtCO2 and PaCO2 from deltoid and the cheek region were r: 0,915 and r: 0,946 (p = 0,0001). In comparison with the Bland-Altman test, difference in deltoid measurements was -1,38 ± 1,18 mmHg (p = 0.252) and in cheek measurements it was -5,12 ± 0,92 mmHg (p = 0,0001). There was no statistically significant difference between SpO2 measurements in each region. Conclusion: Our results suggest that PtCO2 and SpO2 measurements from the deltoid region are reliable compared to the arterial blood gas analysis in hypercapnic ICU patients. More randomized controlled studies investigating the effects of different measurement areas, hemodynamic parameters, and hemoglobin levels are needed.

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Furosemide in Hyaline Membrane Disease

PEDIATRICS ◽

10.1542/peds.62.5.785 ◽

1978 ◽

Vol 62 (5) ◽

pp. 785-788

Author(s):

Keith H. Marks ◽

William Berman ◽

Zvi Friedman ◽

Victor Whitman ◽

Cheryl Lee ◽

...

Keyword(s):

Interstitial Fluid ◽

Hyaline Membrane Disease ◽

Skinfold Thickness ◽

Acute Stage ◽

Control Group ◽

Arterial Blood Gas ◽

Cardiorespiratory Function ◽

Arterial Blood ◽

Significant Difference ◽

Hyaline Membrane

In a randomized clinical trial designed to evaluate the effect of diuresis on infants with hyaline membrane disease, seven infants were treated with furosemide (2 mg/kg intravenously) and five received 5% dextrose water in 0.225% sodium chloride (control group). Arterial blood gas analyses performed before and during the six hours after treatment showed no significant difference between control and treated infants. Urine output and urine sodium and calcium loss were significantly increased (P < .05) in the infants receiving furosemide. The diuresis seemed to have no effect on left atrial size determined echocardiographically, whereas measurements of dynamic skinfold thickness suggested mobilization of subcutaneous water. One infant became seriously dehydrated and hypotensive secondary to a massive diuresis. We concluded that furosemide had a potent diuretic effect in infants with hyaline membrane disease but does not improve cardiorespiratory function acutely. This may be because of failure to mobilize pulmonary interstitial fluid in the time period tested. It may also be possible that the presence of pulmonary interstitial fluid does not play an important role in the impairment of gas exchange in the acute stage of hyaline membrane disease.

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Acute kidney injury and major outcomes in cancer patients with no history of chronic kidney disease (CKD) with coronavirus 2019 (COVID-19) infection.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.e18816 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. e18816-e18816

Author(s):

Cesar Simbaqueba ◽

Omar Mamlouk ◽

Kodwo Dickson ◽

Josiah Halm ◽

Sreedhar Mandayam ◽

...

Keyword(s):

Mechanical Ventilation ◽

Acute Kidney Injury ◽

Cancer Patients ◽

Clinical Outcomes ◽

Kidney Injury ◽

Hazard Model ◽

Cancer Center ◽

Icu Admission ◽

Significant Difference ◽

History Of

e18816 Background: Acute Kidney Injury (AKI) in patients with COVID-19 infection is associated with poor clinical outcomes. We examined outcomes (hemodialysis, mechanical ventilation, ICU admission and death) in cancer patients with normal estimated glomerular filtration rate (eGFR) treated in a tertiary referral center with COVID-19 infection, who developed AKI within 30 days of diagnosis. Methods: All patient data — demographics, labs, comorbidities and outcomes — were aggregated and analyzed in the Syntropy platform, Palantir Foundry (“Foundry”), as part of the Data-Driven Determinants of COVID-19 Oncology Discovery Effort (D3CODE) protocol at MD Anderson. The cohort was defined by the following: (1) positive COVID-19 test; (2) baseline eGFR >60 ml/min/1.73m2most temporally proximal lab results within 30 days prior to the patient’s infection. AKI was defined by an absolute change of creatinine ≥0.3 within 30 days after the positive COVID-19 test. Kaplan-Meier analysis was used for survival estimates at specific time periods and multivariate Cox Proportional cause-specific Hazard model regression to determine hazard ratios with 95% confidence intervals for major outcomes. Results: 635 patients with Covid-19 infection had a baseline eGFR >60 ml/min/1.73m2. Of these patients, 124 (19.5%) developed AKI. Patients with AKI were older, mean age of 61+/-13.2 vs 56.9+/- 14.3 years (p=0.002) and more Hypertensive (69.4% vs 56.4%, p=0.011). AKI patients were more likely to have pneumonia (63.7% vs 37%, p<0.001), cardiac arrhythmias (39.5% vs 20.7%, p<0.001) and myocardial infarction (15.3% vs 8.8%, p=0.046). These patients had more hematologic malignancies (35.1% vs 19%, p=0.005), with no difference between non metastatic vs metastatic disease (p=0.284). There was no significant difference in other comorbidities including smoking, diabetes, hypothyroidism and liver disease. AKI patients were more likely to require dialysis (2.4% vs 0.2%, p=0.025), mechanical ventilation (16.1% vs 1.8%, p<0.001), ICU admission (43.5% vs 11.5%, p<0.001) within 30 days, and had a higher mortality at 90 days of admission (20.2% vs 3.7%, p<0.001). Multivariate Cox Proportional cause-specific Hazard model regression analysis identified history of Diabetes Mellitus (HR 10.8, CI 2.42 - 48.4, p=0.001) as an independent risk factor associated with worse outcomes. Mortality was higher in patients with COVID-19 infection that developed AKI compared with those who did not developed AKI (survival estimate 150 days vs 240 days, p=0.0076). Conclusions: In cancer patients treated at a tertiary cancer center with COVID-19 infection and no history of CKD, the presence of AKI is associated with worse outcomes including higher 90 day mortality, ICU stay and mechanical ventilation. Older age and hypertension are major risk factors, where being diabetic was associated with worse clinical outcomes.

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Platypnoea–orthodeoxia after left total knee replacement

BMJ Case Reports ◽

10.1136/bcr-2019-230771 ◽

2019 ◽

Vol 12 (10) ◽

pp. e230771

Author(s):

Taha Almufti ◽

Franz Eversheim ◽

Brett Johnson ◽

Gabriel Ayonmigbesimi Akra

Keyword(s):

Total Knee Replacement ◽

Knee Replacement ◽

Unusual Case ◽

Medical Intervention ◽

Colour Doppler ◽

Arterial Blood Gas ◽

Arterial Blood ◽

Significant Difference ◽

Severe Hypoxaemia ◽

Total Knee

Platypnoea–orthodeoxia syndrome (POS) is a rare disorder characterised by both dyspnoea (platypnoea) and arterial desaturation (orthodeoxia) in the upright position, with improvement in the supine position. We report an unusual case in which an 82-year-old woman developed severe hypoxaemia with POS after left total knee replacement. A significant difference in alveolar–arterial blood gas oxygen tension was demonstrated, and hypoxaemia failed to respond to 100% oxygen supply. A patent foramen ovale with a right-to-left shunt was evident on transoesophageal echocardiogram employing colour Doppler and agitated normal saline studies. Interestingly, the patient’s symptoms resolved within 6 months with ongoing chest physiotherapy, without surgical or medical intervention.

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Electrocardiographic features of hyperkalemia during acute kidney injury in a patient with pacemaker

Italian Journal of Medicine ◽

10.4081/itjm.2018.986 ◽

2018 ◽

Vol 12 (2) ◽

pp. 145

Author(s):

Alfonso Sforza ◽

Federica De Pisapia ◽

Giuliano De Stefano ◽

Antonio Gaspardini ◽

Maria Immacolata Arnone ◽

...

Keyword(s):

Cardiac Activity ◽

Kidney Injury ◽

Blood Gas Analysis ◽

Sine Wave ◽

Gas Analysis ◽

Acute Confusional State ◽

Arterial Blood Gas ◽

Arterial Blood ◽

Arterial Blood Gas Analysis ◽

History Of

We describe a case of a 79-year-old man with pacemaker who presented to the Emergency Department due to asthenia and acute confusional state. He had a history of atrial fibrillation, anemia and colostomy and he was on treatment with diuretics. The electrocardiogram (ECG) showed pacemaker-induced ventricular activity, QRS complexes excessively wide with sine-wave appearance, tall and peaked T waves, without electrically evident atrial activity. Potassium concentration on arterial blood gas analysis was 8.8 mmol/L. ECG abnormalities disappeared after therapy with calcium chloride and spontaneous cardiac activity reappeared.

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EFFECTS OF APROTININ ON PULMONARY FUNCTIONS IN EXPERIMENTAL FAT EMBOLISM: CHANGES IN ARTERIAL BLOOD GAS LEVELS AND SCINTIGRAPHIC FINDINGS

Journal of Musculoskeletal Research ◽

10.1142/s0218957700000197 ◽

2000 ◽

Vol 04 (03) ◽

pp. 189-198

Author(s):

Mustafa Yel ◽

Hülya Dalgiç ◽

Güngör Taştekin ◽

Mehmet Arazi ◽

Abdurrahman Kutlu

Keyword(s):

Fat Embolism ◽

Control Group ◽

Blood Gas ◽

Arterial Blood Gas ◽

Arterial Blood ◽

Significant Difference ◽

Intravenous Saline ◽

Group 2 ◽

Embolization Procedure ◽

Control Group Group

Purpose: To assess the effects of aprotinin on the formation and resolution of fat embolism of the lungs. Methods: The changes in arterial blood gas levels and perfusion scintigraphy were studied by forming experimental standardized fat embolism in rabbits with autogenous fat obtained from their femur medullas. Two groups, each consisting of 14 albino rabbits, were used in this study. Group 1, which received intravenous saline solution, was the control group. Group 2, which received aprotinin, was referred to as the aprotinin group. Autogenous femoral medullary content was used for embolization procedures. Arterial blood gas levels were recorded 72 hours before and 1, 24, 72 hours and 10 days following the embolization procedure. Pulmonary perfusion scintigraphies were performed 72 hours before the embolization procedure and on the first and 72nd hours, and the 10th day. Results: Fat embolism was achieved in all rabbits. Seven rabbits in the control group and one rabbit in the aprotinin group died within an hour after the embolization procedure. According to blood gas levels and perfusion scintigraphic findings, the aprotinin group significantly had less pulmonary fat embolism and recovered faster than the control group, especially during the first 24 hours. There was no significant difference in regression of pulmonary dysfunction between the two groups. Conclusion: The correlation between the blood gas levels and scintigraphic findings suggested that the administration of aprotinin for prophylactic purposes had favorable effects on the development of pulmonary gas exchange disturbance and perfusion defect in fat embolism.

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Physiological Effects of Different Recruitment Maneuvers in a Pig Model of ARDS

10.21203/rs.2.21361/v3 ◽

2020 ◽

Author(s):

Feiping Xia ◽

Chun Pan ◽

Lihui Wang ◽

Ling Liu ◽

Songqiao Liu ◽

...

Keyword(s):

Random Order ◽

Pig Model ◽

Physiological Effects ◽

Impedance Tomography ◽

Arterial Blood Gas ◽

Arterial Blood ◽

Recruitment Maneuvers ◽

Sustained Inflation ◽

Significant Difference ◽

Before And After

Abstract Background: In acute respiratory distress syndrome (ARDS), lung recruitment maneuvers can recruit collapsed alveoli in gravity-dependent lung regions, improving the homogeneity of ventilation distribution. This study used electrical impedance tomography (EIT) to investigate the physiological effects of different recruitment maneuvers for alveolar recruitment in a pig model of ARDS. Methods: ARDS was induced in ten healthy male pigs with repeated bronchoalveolar lavage until the arterial partial pressure of oxygen (PaO2)/fraction of inspired oxygen (FiO2) (P/F ratio) was < 100 mmHg and remained stable for 30 minutes (TARDS). ARDS pigs underwent three sequential recruitment maneuvers, including sustained inflation (SI), increments of positive end-expiratory pressure (PEEP) (IP), and pressure-controlled ventilation (PCV) applied in random order, with 30 mins at a PEEP of 5 cmH2O between maneuvers. Respiratory mechanics, hemodynamics, arterial blood gas, and EIT were recorded at baseline, TARDS, and before and after each recruitment maneuver.Results: In all ten pigs, ARDS was successfully induced with a mean 2.8±1.03L (2800±1032.80ml) bronchoalveolar lavages. PaO2, SO2, P/F, and compliance were significantly improved after recruitment with SI, IP or PCV (all p<0.05), and there were no significant differences between maneuvers. Global inhomogeneity (GI) was significantly decreased after recruitment with SI, IP, or PCV. There were no significant differences in GI before or after recruitment with the different maneuvers. The decrease in GI (ΔGI) was significantly greater after recruitment with IP compared to SI (p=0.023), but there was no significant difference in ΔGI between IP and PCV.Conclusion: SI, IP, and PCV increased oxygenation, and regional and global compliance of the respiratory system, and decreased inhomogeneous gas distribution in ARDS pigs. IP significantly improved inhomogeneity of the lung compared to SI.

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