The effects of lung volume reduction treatment on diffusing capacity and gas exchange

Lung volume reduction (LVR) treatment in patients with severe emphysema has been shown to have a positive effect on hyperinflation, expiratory flow, exercise capacity and quality of life. However, the effects on diffusing capacity of the lungs and gas exchange are less clear. In this review, the possible mechanisms by which LVR treatment can affect diffusing capacity of the lung for carbon monoxide (DLCO) and arterial gas parameters are discussed, the use of DLCO in LVR treatment is evaluated and other diagnostic techniques reflecting diffusing capacity and regional ventilation (V′)/perfusion (Q′) mismatch are considered.A systematic review of the literature was performed for studies reporting on DLCO and arterial blood gas parameters before and after LVR surgery or endoscopic LVR with endobronchial valves (EBV). DLCO after these LVR treatments improved (40 studies, n=1855) and the mean absolute change from baseline in % predicted DLCO was +5.7% (range −4.6% to +29%), with no real change in blood gas parameters. Improvement in V′ inhomogeneity and V′/Q′ mismatch are plausible explanations for the improvement in DLCO after LVR treatment.

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d-Cystine di(m)ethyl ester reverses the deleterious effects of morphine on ventilation and arterial blood gas chemistry while promoting antinociception

Scientific Reports ◽

10.1038/s41598-021-89455-2 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Benjamin Gaston ◽

Santhosh M. Baby ◽

Walter J. May ◽

Alex P. Young ◽

Alan Grossfield ◽

...

Keyword(s):

Gas Exchange ◽

Intracellular Signaling ◽

Dimethyl Ester ◽

Diethyl Ester ◽

Blood Gas ◽

Negative Effects ◽

Arterial Blood Gas ◽

Arterial Blood ◽

Gas Chemistry ◽

Ventilatory Drive

AbstractWe have identified thiolesters that reverse the negative effects of opioids on breathing without compromising antinociception. Here we report the effects of d-cystine diethyl ester (d-cystine diEE) or d-cystine dimethyl ester (d-cystine diME) on morphine-induced changes in ventilation, arterial-blood gas chemistry, A-a gradient (index of gas-exchange in the lungs) and antinociception in freely moving rats. Injection of morphine (10 mg/kg, IV) elicited negative effects on breathing (e.g., depression of tidal volume, minute ventilation, peak inspiratory flow, and inspiratory drive). Subsequent injection of d-cystine diEE (500 μmol/kg, IV) elicited an immediate and sustained reversal of these effects of morphine. Injection of morphine (10 mg/kg, IV) also elicited pronounced decreases in arterial blood pH, pO2 and sO2 accompanied by pronounced increases in pCO2 (all indicative of a decrease in ventilatory drive) and A-a gradient (mismatch in ventilation-perfusion in the lungs). These effects of morphine were reversed in an immediate and sustained fashion by d-cystine diME (500 μmol/kg, IV). Finally, the duration of morphine (5 and 10 mg/kg, IV) antinociception was augmented by d-cystine diEE. d-cystine diEE and d-cystine diME may be clinically useful agents that can effectively reverse the negative effects of morphine on breathing and gas-exchange in the lungs while promoting antinociception. Our study suggests that the d-cystine thiolesters are able to differentially modulate the intracellular signaling cascades that mediate morphine-induced ventilatory depression as opposed to those that mediate morphine-induced antinociception and sedation.

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The utility of arterial blood gas parameters and chest radiography in predicting appropriate intubations in burn patients with suspected inhalation injury- a retrospective cohort study

Burns ◽

10.1016/j.burns.2021.02.018 ◽

2021 ◽

Author(s):

Minesh Chotalia ◽

Christine Pirrone ◽

Muzzammil Ali ◽

Randeep Mullhi ◽

Barbara Torlinska ◽

...

Keyword(s):

Cohort Study ◽

Retrospective Cohort Study ◽

Chest Radiography ◽

Retrospective Cohort ◽

Inhalation Injury ◽

Burn Patients ◽

Blood Gas ◽

Arterial Blood Gas ◽

Arterial Blood ◽

Blood Gas Parameters

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Sedative and cardiopulmonary effects of acepromazine, midazolam, butorphanol, acepromazine-butorphanol and midazolam-butorphanol on propofol anaesthesia in goats

Journal of the South African Veterinary Association ◽

10.4102/jsava.v80i1.162 ◽

2009 ◽

Vol 80 (1) ◽

Author(s):

T.B. Dzikitia ◽

G.F. Stegmanna ◽

L.J. Hellebrekers ◽

R.E.J. Auer ◽

L.N. Dzikiti

Keyword(s):

Saline Group ◽

Control Group ◽

Blood Gas ◽

Arterial Blood Gas ◽

Induction Dose ◽

Normal Limits ◽

Arterial Blood ◽

Blood Gas Parameters ◽

Induction Of Anaesthesia

The sedative, propofol-sparing and cardiopulmonary effects of acepromazine, midazolam, butorphanol and combinations of butorphanol with acepromazine or midazolam in goats were evaluated. Six healthy Boer - Indigenous African crossbreed goats were by randomised cross-over designated to 6 groups: Group SAL that received saline, Group ACE that received acepromazine, Group MID that received midazolam, Group BUT that received butorphanol, Group ACEBUT that received acepromazine and butorphanol and Group MIDBUT that received midazolam and butorphanol as premedication agents intramuscularly on different occasions at least 3 weeks apart. The degree of sedation was assessed 20 minutes after administration of the premedication agents. Thirty minutes after premedication, the dose of propofol required for induction of anaesthesia adequate to allow placement of an endotracheal tube was determined. Cardiovascular, respiratory and arterial blood-gas parameters were assessed up to 30 minutes after induction of general anaesthesia. Acepromazine and midazolam produced significant sedation when administered alone, but premedication regimens incorporating butorphanol produced inconsistent results. The dose of propofol required for induction of anaesthesia was significantly reduced in goats that received midazolam alone, or midazolam combined with either acepromazine or butorphanol. The quality of induction of anaesthesia was good in all groups, including the control group. Cardiovascular, respiratory and blood-gas parameters were within normal limits in all groups and not significantly different between or within all groups. In conclusion: sedation with midazolam alone, or midazolam combined with either acepromazine or butorphanol significantly reduces the induction dose of propofol with minimal cardiopulmonary effects in goats.

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Delayed results of lung volume reduction surgery in heterogeneous lung emphysema

Russian Pulmonology ◽

10.18093/0869-0189-2005-0-1-84-86 ◽

2005 ◽

pp. 84-86

Author(s):

P. Wex ◽

V. Haas ◽

E. Utta

Keyword(s):

Lung Volume ◽

Oxygen Therapy ◽

Postoperative Mortality ◽

Volume Reduction ◽

Lung Volume Reduction Surgery ◽

Lung Volume Reduction ◽

Walk Distance ◽

Lung Emphysema ◽

Blood Gas Parameters

The aim of the study was to search delayed results and to characterize patients with heterogeneous emphysema which do not improve their quality of life after lung volume reduction surgery. Retrospective analysis was done based on medical history reports from July, 1994, to January, 1998. The surgical lung volume reduction was performed in 81 patients (45 males and 13 females, the average age was 61.9 yrs). Postoperative mortality was 6.9 % (4 patients). Twenty-three patients died within 5 yrs after the intervention; their mean follow-up period was 33.3 months. The average follow-up period was 54.3 months. Functional parameters for patients survived 3 to 5 yrs were: FEV1 50 ± 23.8 %, RV 35.6 ± 29.1 %, RV / TLC 12.3 ± 12 %, the 6-min walk distance was 96.7 ± 62 m. The total 5-year survival was 63.8 %, the survival for the patients having FEV1> 30 % was 83.8 % and that for the patients with FEV1 < 30 % was 50 %. Age and lung function parameters did not differ in survivors and died patients. On the contrary, differences in the blood gas parameters, oxygen therapy time and 6-min walk distance were significant between these groups. Some negative factors were revealed: predominant injury of the lower lung fields, FEV1 < 30 % pred., respiratory failure (PaCO2 ≥ 48 mm Hg), oxygen therapy longer than 6 months, the 6-min walk distance shorter than 80 m.

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An update report on the harmonization of adult reference intervals in Australasia

Clinical Chemistry and Laboratory Medicine (CCLM) ◽

10.1515/cclm-2017-0920 ◽

2018 ◽

Vol 0 (0) ◽

Cited By ~ 1

Author(s):

Gus Koerbin ◽

Ken Sikaris ◽

Graham R.D. Jones ◽

Robert Flatman ◽

Jillian R. Tate

Keyword(s):

Royal College ◽

Clinical Chemistry ◽

Metrological Traceability ◽

Reference Intervals ◽

Evidence Based ◽

Blood Gas ◽

Arterial Blood Gas ◽

The Past ◽

Arterial Blood ◽

Blood Gas Parameters

Abstract The Australasian Association of Clinical Biochemists (AACB) has over the past 5 years been actively working to achieve harmonized reference intervals (RIs) for common clinical chemistry analytes using an evidence-based checklist approach where there is sound calibration and metrological traceability. It has now recommended harmonized RIs for 18 common clinical chemistry analytes which are performed in most routine laboratories and these have been endorsed by the Royal College of Pathologists of Australasia (RCPA). In 2017 another group of analytes including urea, albumin and arterial blood gas parameters were considered and suggested harmonized RIs proposed. This report provides an update of those harmonization efforts.

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