scholarly journals Efficacy of manual hyperinflation on arterial blood gases in patients with ventilator-associated pneumonia

2020 ◽  
Vol 25 (1) ◽  
Author(s):  
Basant H. Elrefaey ◽  
Mohamed S. Zidan
Keyword(s):  
Supine Position ◽  
Blood Gases ◽  
Lateral Decubitus Position ◽  
Ventilator Associated Pneumonia ◽  
Arterial Blood Gases ◽  
Post Intervention ◽  
Arterial Blood ◽  
Significant Difference ◽  
Lateral Decubitus ◽  
Group B

Abstract Background Tracheal intubation exposes mechanically ventilated patients to serious pulmonary complications such as ventilator-associated pneumonia (VAP). This study was conducted to compare the efficacy of manual hyperinflation in supine versus lateral decubitus position on arterial blood gases (ABG) in patients with VAP. Forty-two patients with ventilator-associated pneumonia with age range from 40 to 60 years were selected. They were randomly divided into two equal groups: group A who received manual hyperinflation from supine position and group B who received manual hyperinflation from lateral decubitus position (upper most affected). Both groups received respiratory physiotherapy. The patients received 2 sessions per day for 6 days. Outcome measures were arterial blood gases (PaO2, PaCO2, PaO2/FiO2, and SaO2). They were assessed before the 1st morning session (pre), at day 3 (post 1), and at day 6 (post 2). Results After sessions, significant changes of measured variables (PaO2, PaCO2, PaO2/FiO2, and SaO2) were obtained in both groups (P < 0.05, in all variables) and by comparison between groups post-intervention; a significant difference was observed between both groups in measures of oxygenation in favor of group B (P < 0.05), whereas there was a non-significant difference in the PaC02 between both groups (post 1 P = 0.52 and post 2 P = 0.33). Conclusion It was concluded that effect of the bag squeezing on arterial blood gases in patients with ventilator-associated pneumonia from lateral decubitus position was more effective than from supine position. Trial registration PACTR, PACTR201909817075549. Registered October 21, 2018—retrospectively registered https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=4655

scholarly journals Interpleural Bupivacaine Infusion Compared with Intravenous Pethidine Infusion after Cholecystectomy

1991 ◽  
Vol 19 (4) ◽  
pp. 539-545 ◽  
Author(s):  
H. Kastrissios ◽  
G. A. G. Mogg ◽  
E. J. Triggs ◽  
J. W. Higbie
Keyword(s):  
Side Effects ◽  
Postoperative Pain ◽  
Postoperative Period ◽  
Intravenous Infusion ◽  
Blood Gases ◽  
Arterial Blood Gases ◽  
Pain Scores ◽  
Arterial Blood ◽  
Vas Scores ◽  
Group B

Twenty-six cholecystectomy patients received either an interpleural infusion of bupivacaine (Group B, n = 12) or an intravenous infusion of pethidine (Group P, n = 14) for management of postoperative pain over a three-day period. Patients in Group P experienced a significantly (P < 0.05) greater incidence of total side-effects (146) than patients in Group B (66). Pain scores (VAS) and responses to a pain questionnaire were similar for both groups; however, within Group B improvement in mean VAS scores at rest with time were more sustained. Similar reductions in FEV, and FVC from preoperative values occurred for both groups, while for Group P there were significant (P < 0.05) changes in arterial blood gases (increase in Pco2, decrease in Po2) over two days postoperatively. Patients in Group P recorded longer times to passing flatus and unaided mobilisation (P < 0.05), and required a significantly greater number of additional medications (anti-emetics and analgesics) over the postoperative period (41 vs 29, P < 0.05).

Reliability of Cup Position in Navigated Tha in the Lateral Decubitus Position Using the ‘Flip Technique’

2011 ◽  
Vol 21 (6) ◽  
pp. 700-705 ◽  
Author(s):  
Alessandro Carcangiu ◽  
Carmelo D'Arrigo ◽  
Domenico Topa ◽  
Raffaella Alonzo ◽  
Attilio Speranza ◽  
...  
Keyword(s):  
Supine Position ◽  
Lateral Decubitus Position ◽  
Computer Assisted ◽  
Orientation Data ◽  
Assisted Navigation ◽  
Imageless Navigation ◽  
Significant Difference ◽  
Lateral Decubitus ◽  
The Mean ◽  
Navigation Software

Malpositioning of the acetabular component in total hip arthroplasty (THA) increases the risk of dislocation, reduces the range of motion and may contribute to bearing surface wear. During computer assisted navigation, the anterior pelvic plane is registered intraoperatively by percutaneous palpation, but this may be unreliable. The aim of our study was to evaluate the reliability of imageless navigation in acetabular positioning employing data acquisition in the supine position and surgery in the lateral position (‘flip technique’). We report 24 patients affected by primary osteoarthritis undergoing THA in which implants were placed with a conventional free-hand technique using the acetabular transverse ligament for cup orientation. For imageless navigation we used Orthopilot-Aesculap software. All patients had a postoperative computed tomography (CT) scan at three months, using previously validated dedicated software for cup orientation. Data collected using navigation software were compared with CT measurements. The mean acetabular inclination and anteversion recorded intra-operatively using navigation software were respectively 41°5’ (SD: 9.61) and 9°5’ (SD: 4.01) respectively. The mean inclination and anteversion calculated post-operatively by the CT based image software were 44°2’ (SD 5.83) and 14°4’ (SD 6.42) respectively. There was a statistically significant difference between the anteversion values (p=0.04). Therefore, the acquisition of parameters in the supine position with surgery performed in the lateral decubitus position creates unreliable data concerning cup anteversion using an imageless navigation system, and therefore the ‘flip technique’ cannot be recommended.

scholarly journals Comparison of the effects of heparin 1000 and 5000 units on arterial blood gases

2020 ◽  
Vol 37 (3) ◽  
pp. 267-273
Author(s):  
Reza Borabadi ◽  
Mostafa Rad ◽  
Mohammad Rakhshani ◽  
Mojtaba Rad
Keyword(s):  
Clinical Trial ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Blood Gases ◽  
Metabolic Parameters ◽  
Arterial Blood Gases ◽  
R Software ◽  
Arterial Blood ◽  
Respiratory Parameters ◽  
Significant Difference

Analysis of arterial blood gases is necessary for managing the respiratory and metabolic parameters of patients in the intensive care unit. The aim of this study was to compare the effects of heparin 1000 and heparin 5000 units on arterial blood gases in patients admitted to the intensive care unit. This study was a triple-blinded clinical trial. A total of 78 patients with head injury were randomly selected from the emergency department of a hospital in an urban area of Iran in 2017. Data was collected using a questionnaire and a checklist of laboratory parameters. Data was analyzed using descriptive and inferential statistical methods via the R software. Statistically significant differences in Na, SaO2, Ca, BEecf (p < 0.001), and HCO3, BEe and K were observed between the two groups (p < 0.01). No statistically significant difference between the values of PaCO2, PH and PaO2 in the two groups were reported (p > 0.05). The results of this study confirmed that heparin 1000 and heparin 5000 units had no effects on respiratory parameters in analyzing arterial blood gases. However, the concentration of heparin had a significant effect on metabolic parameters for the analysis of arterial blood gases and electrolytes.

scholarly journals ARE THE SPIDER ANGIOMAS SKIN MARKERS OF HEPATOPULMONARY SYNDROME?

2013 ◽  
Vol 50 (3) ◽  
pp. 175-179 ◽  
Author(s):  
Americo de Oliveira SILVERIO ◽  
Dayanne Cintra GUIMARAES ◽  
Larissa Fernanda Queiroz ELIAS ◽  
Erika Oliveira MILANEZ ◽  
Silvano NAVES
Keyword(s):  
Liver Cirrhosis ◽  
Liver Disease ◽  
Contrast Echocardiography ◽  
Laboratory Data ◽  
Hepatopulmonary Syndrome ◽  
Blood Gases ◽  
Vascular Changes ◽  
Arterial Blood Gases ◽  
Arterial Blood ◽  
Significant Difference

Context Hepatopathies can significantly influence both veins and arteries, these changes may cause some cutaneous stigmas, such as spider angioma (SA) and some systemic vascular changes, such as those observed in hepatopulmonary syndrome (HPS). Based on this common pathophysiological root we can assume that the SA can be skin markers of HPS. Objective The objective of this study is to assess whether there is a relationship between the presence of SA and HPS. Methods Records of 40 patients with liver cirrhosis who underwent contrast echocardiography were evaluated, in which we researched the description of SA, physical examination, and other clinical and laboratory data. For diagnosis of HPS we use these signs of the disease: presence of liver disease (cirrhosis in the case), abnormalities in gas exchange by arterial blood gases, and evidence of pulmonary vasodilations by the contrast echocardiography. Results The SA were found in 21/40 (52.5%) patients and hepatopulmonary syndrome in 9/40 (22.5%). The HPS was observed in 8/21 (38.1%) of patients with SA and 1/19 (5.3%) patients were without this sign (P<0.01). We found no statistically significant difference between the SA and the presence of HPS with sex or age. Patients with SA had a higher hypoxemia [PaO2 84.8 ± 11.5 mmHg and 19.8 ± 14.7 mmHg alveolar-arterial gradient of oxygen (AAG)] than those without SA (PaO2 90.8 ± 10.7 mmHg and 10.9 ± 11.7 AAG mmHg) (P<0.05). Conclusion Our findings show a correlation between the presence of SA and HPS, suggesting that the SA may be cutaneous markers of HPS.

scholarly journals ECCO2R in 12 COVID-19 ARDS Patients With Extremely Low Compliance and Refractory Hypercapnia

2021 ◽  
Vol 8 ◽  
Author(s):  
Xin Ding ◽  
Huan Chen ◽  
Hua Zhao ◽  
Hongmin Zhang ◽  
Huaiwu He ◽  
...  
Keyword(s):  
Blood Gases ◽  
Low Flow ◽  
Respiratory System Compliance ◽  
Arterial Blood Gases ◽  
Extracorporeal Carbon Dioxide Removal ◽  
Clinical Trial Registration ◽  
Arterial Blood ◽  
Significant Difference ◽  
Pros And Cons ◽  
System Characteristics

Purpose: A phenotype of COVID-19 ARDS patients with extremely low compliance and refractory hypercapnia was found in our ICU. In the context of limited number of ECMO machines, feasibility of a low-flow extracorporeal carbon dioxide removal (ECCO2R) based on the renal replacement therapy (RRT) platform in these patients was assessed.Methods: Single-center, prospective study. Refractory hypercapnia patients with COVID-19-associated ARDS were included and divided into the adjusted group and unadjusted group according to the level of PaCO2 after the application of the ECCO2R system. Ventilation parameters [tidal volume (VT), respiratory rate, and PEEP], platform pressure (Pplat) and driving pressure (DP), respiratory system compliance, arterial blood gases, and ECCO2R system characteristics were collected.Results: Twelve patients with refractory hypercapnia were enrolled, and the PaCO2 was 64.5 [56-88.75] mmHg. In the adjusted group, VT was significantly reduced from 5.90 ± 0.16 to 5.08 ± 0.43 ml/kg PBW; DP and Pplat were also significantly reduced from 23.5 ± 2.72 mmHg and 29.88 ± 3.04 mmHg to 18.5 ± 2.62 mmHg and 24.75 ± 3.41 mmHg, respectively. In the unadjusted group, PaCO2 decreased from 94 [86.25, 100.3] mmHg to 80 [67.50, 85.25] mmHg but with no significant difference, and the DP and Pplat were not decreased after weighing the pros and cons.Conclusions: A low-flow ECCO2R system based on the RRT platform enabled CO2 removal and could also decrease the DP and Pplat significantly, which provided a new way to treat these COVID-19 ARDS patients with refractory hypercapnia and extremely low compliance.Clinical Trial Registration:https://www.clinicaltrials.gov/, identifier NCT04340414.

Vasopressor Effect of Epinephrine with and without Dopamine during Cardiopulmonary Resuscitation

1988 ◽  
Vol 22 (11) ◽  
pp. 868-872 ◽  
Author(s):  
Edgar R. Gonzalez ◽  
Joseph P. Ornato ◽  
Ronald L. Levine
Keyword(s):  
Cardiopulmonary Resuscitation ◽  
Radial Artery ◽  
Life Support ◽  
Blood Gases ◽  
High Dose ◽  
Arterial Blood ◽  
Significant Difference ◽  
Group A ◽  
Group B ◽  
Dose Dependent

We prospectively studied nine prehospital cardiac arrest patients (six M, three F; aged 60 ± 8 yr) to determine the vasopressor response following incremental (1, 3, and 5 mg) doses of intravenous epinephrine given 5 minutes apart with or without dopamine 15 μg/kg/min. All patients were in ventricular fibrillation on arrival of the paramedics and were not resuscitated with standard advanced cardiac life support therapy. Cardiopulmonary resuscitation (CPR) was performed with a computerized Thumper at 60 compressions/min with a 50:50 downstroke-to-upstroke ratio. All patients were intubated and received 12 ventilations/min at a fraction of inspired oxygen of 80 percent. Radial artery pressure was monitored through a #20 gauge radial artery catheter inserted by cutdown within ten minutes after arrival at the emergency room. Five patients received epinephrine alone (group A) and four received epinephrine plus dopamine (group B). The patient's age, paramedic response time, arterial blood gases, and initial diastolic blood pressure (BP) did not differ significantly between treatment groups. Baseline systolic BP was significantly higher (p < 0.01) in group B (68 ± 10 mm Hg) than in group A (35 ± 5 mm Hg). Epinephrine produced a dose-dependent vasopressor response in group A, but not in group B. In group A, peak systolic BP following epinephrine 1, 3, and 5 mg was 57 ± 20, 69 ± 23, and 76 ± 27 mm Hg, respectively (p < 0.05 for 5 mg vs. baseline). No statistically significant difference was observed among the respective values in group B (81 ± 13, 80 ± 18, and 78 ± 19 mm Hg). In group A, peak diastolic BP following epinephrine 1, 3, and 5 mg was 24 ± 8, 28 ± 16, and 31 ± 6 mm Hg, respectively (p < 0.05 for epinephrine 5 mg vs. baseline). No statistically significant difference was observed among the respective values in group B (33 ± 10, 33 ± 11, and 34 ± 13 mm Hg). Epinephrine produces a dose-dependent vasopressor response during CPR in humans. The administration of high doses of epinephrine to patients receiving high-dose dopamine does not produce an additive vasopressor response.

scholarly journals Pathophysiology and clinical consequences of arterial blood gases and pH after cardiac arrest

2020 ◽  
Vol 8 (S1) ◽  
Author(s):  
Chiara Robba ◽  
Dorota Siwicka-Gieroba ◽  
Andras Sikter ◽  
Denise Battaglini ◽  
Wojciech Dąbrowski ◽  
...  
Keyword(s):  
Carbon Dioxide ◽  
Mechanical Ventilation ◽  
Cardiac Arrest ◽  
Oxygen Demand ◽  
Blood Gases ◽  
Metabolic Energy ◽  
High Morbidity ◽  
Arterial Blood Gases ◽  
Arterial Blood ◽  
Clinical Consequences

AbstractPost cardiac arrest syndrome is associated with high morbidity and mortality, which is related not only to a poor neurological outcome but also to respiratory and cardiovascular dysfunctions. The control of gas exchange, and in particular oxygenation and carbon dioxide levels, is fundamental in mechanically ventilated patients after resuscitation, as arterial blood gases derangement might have important effects on the cerebral blood flow and systemic physiology.In particular, the pathophysiological role of carbon dioxide (CO2) levels is strongly underestimated, as its alterations quickly affect also the changes of intracellular pH, and consequently influence metabolic energy and oxygen demand. Hypo/hypercapnia, as well as mechanical ventilation during and after resuscitation, can affect CO2 levels and trigger a dangerous pathophysiological vicious circle related to the relationship between pH, cellular demand, and catecholamine levels. The developing hypocapnia can nullify the beneficial effects of the hypothermia. The aim of this review was to describe the pathophysiology and clinical consequences of arterial blood gases and pH after cardiac arrest.According to our findings, the optimal ventilator strategies in post cardiac arrest patients are not fully understood, and oxygen and carbon dioxide targets should take in consideration a complex pattern of pathophysiological factors. Further studies are warranted to define the optimal settings of mechanical ventilation in patients after cardiac arrest.

Arterial Blood Gases in Pranayama Practice

1978 ◽  
Vol 46 (1) ◽  
pp. 171-174 ◽  
Author(s):  
V. Pratap ◽  
W. H. Berrettini ◽  
C. Smith
Keyword(s):  
Blood Gases ◽  
Neural Mechanism ◽  
Arterial Blood Gases ◽  
Arterial Blood ◽  
Yogic Breathing ◽  
The Mind ◽  
Calming Effect

Pranayama is a Yogic breathing practice which is known experientially to produce a profound calming effect on the mind. In an experiment designed to determine whether the mental effects of this practice were accompanied by changes in the arterial blood gases, arterial blood was drawn from 10 trained individuals prior to and immediately after Pranayama practice. No significant changes in arterial blood gases were noted after Pranayama. A neural mechanism for the mental effects of this practice is proposed.

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