ARTERIAL BLOOD GAS AND ACID-BASE DISORDERS IN INFANTS AND CHILDREN WITH STATUS ASTHMATICUS

PEDIATRICS ◽  
1968 ◽  
Vol 42 (2) ◽  
pp. 238-249
Author(s):  
John J. Downes ◽  
David W. Wood ◽  
Theodore W. Striker ◽  
Joffie C. Pittman
Keyword(s):  
Status Asthmaticus ◽  
Clinical Signs ◽  
Arterial Oxygen Tension ◽  
Base Deficit ◽  
Infants And Children ◽  
Clinical Severity ◽  
Arterial Oxygen ◽  
Acid Base ◽  
Arterial Blood ◽  
Arterial Ph

The course of arterial oxygen tension (Pao2), pH, carbon dioxide tension (Paco2) and base deficit (negative base excess) was studied in 45 episodes of status asthmaticus occurring in 32 infants and children. The data indicate that arterial hypoxemia occurs in these patients due to alveolar hypoventilation and pulmonary arterial-venous shunts. Three fourths of the patients tested demonstrated a base deficit which was related in part to ketonemia. The Paco2 varied from below normal to 168 mm Hg, and arterial pH varied from 6.89 to 7.41 at the time of peak clinical severity. Clinical signs of respiratory failure associated with a Paco2 above 65 mm Hg occurred in 13 patients (18 episodes), all of whom were successfully managed by mechanical ventilation. These studies indicate the variability in alveolar ventilation and acid-base balance during an asthmatic episode and the need for repeated assessment of arterial pH and blood gases if one is to provide optimal management.

Continuous Monitoring of Arterial Oxygen Tension Using a Catheter-Tip Polarographic Electrode in Infants

PEDIATRICS ◽  
1976 ◽  
Vol 57 (2) ◽  
pp. 244-250
Author(s):  
M. Conway ◽  
G. M. Durbin ◽  
D. Ingram ◽  
N. McIntosh ◽  
D. Parker ◽  
...  
Keyword(s):  
Oxygen Tension ◽  
Continuous Monitoring ◽  
Newborn Infants ◽  
Arterial Oxygen Tension ◽  
Oxygen Electrode ◽  
Arterial Oxygen ◽  
Respiratory Illnesses ◽  
Arterial Blood ◽  
Reliable Instrument ◽  
Catheter Tip

An oxygen electrode mounted in the tip of an umbilical artery catheter was used in 36 newborn infants with severe respiratory illnesses, 28 of whom survived. Thirty-seven electrodes were used. The median age at insertion was 4 hours (range, 30 minutes to 122 hours). Three electrodes failed to work and they were removed or replaced, and two could not be properly evaluated. Thirty-two electrodes functioned satisfactorily for 10 to 190 hours (mean, 75 hours) after a one-point calibration against blood sampled through the catheter. Twenty-two did not need recalibrating before they were removed after 10 to 190 hours (mean, 88 hours). Four of the remaining ten electrodes were recalibrated once after 33 to 97 hours and then functioned until removed 15 to 55 hours later. The other six electrodes failed after 32 to 105 hours (mean, 49 hours). Complications were few. A total of 356 arterial blood samples, obtained after the initial calibration and before any recalibration was necessary, gave a correlation coefficient of 0.93 (P < .0001) against an independent system for measuring arterial oxygen tension (Pao2) (Radiometer Type E.5046 oxygen electrode). We conclude that the catheter-tip electrode is a safe and reliable instrument for continuously recording Pao2 in newborn infants which much simplifies the management of serious respiratory illnesses.

scholarly journals Bidirectional Ductal Shunting and Preductal to Postductal Oxygenation Gradient in Persistent Pulmonary Hypertension of the Newborn

Children ◽  
2020 ◽  
Vol 7 (9) ◽  
pp. 137
Author(s):  
Amy Lesneski ◽  
Morgan Hardie ◽  
William Ferrier ◽  
Satyan Lakshminrusimha ◽  
Payam Vali
Keyword(s):  
Blood Flow ◽  
Pulmonary Hypertension ◽  
Pulmonary Blood Flow ◽  
Ductus Arteriosus ◽  
Arterial Oxygen Tension ◽  
Persistent Pulmonary Hypertension ◽  
Arterial Oxygen ◽  
Meconium Aspiration ◽  
Arterial Blood Gas ◽  
Arterial Blood

Background: The aim was to evaluate the relationship between the direction of the patent ductus arteriosus (PDA) shunt and the pre- and postductal gradient for arterial blood gas (ABG) parameters in a lamb model of meconium aspiration syndrome (MAS) with persistent pulmonary hypertension of the newborn (PPHN). Methods: PPHN was induced by intermittent umbilical cord occlusion and the aspiration of meconium through the tracheal tube. After delivery, 13 lambs were ventilated and simultaneous 129 pairs of pre- and postductal ABG were drawn (right carotid and umbilical artery, respectively) while recording the PDA and the carotid and pulmonary blood flow. Results: Meconium aspiration resulted in hypoxemia. The bidirectional ductal shunt had a lower postductal partial arterial oxygen tension ([PaO2] with lower PaO2/FiO2 ratio—97 ± 36 vs. 130 ± 65 mmHg) and left pulmonary flow (81 ± 52 vs. 133 ± 82 mL/kg/min). However, 56% of the samples with a bidirectional shunt had a pre- and postductal saturation gradient of < 3%. Conclusions: The presence of a bidirectional ductal shunt is associated with hypoxemia and low pulmonary blood flow. The absence of a pre- and postductal saturation difference is frequently observed with bidirectional right-to-left shunting through the PDA, and does not exclude a diagnosis of PPHN in this model.

Effect of Intraoperative PEEP Application on Colonic Anastomoses Healing: An Experimental Animal Study

2016 ◽  
Vol 101 (1-2) ◽  
pp. 24-34 ◽  
Author(s):  
Mehmet Akif Turkoglu ◽  
Erdal Birol Bostancı ◽  
Hasan Bilgili ◽  
Yıldız Turkoglu ◽  
Ümit Karadeniz ◽  
...  
Keyword(s):  
Oxygen Saturation ◽  
Healing Process ◽  
Peep Level ◽  
Arterial Oxygen Tension ◽  
Arterial Oxygen ◽  
Colonic Anastomoses ◽  
Arterial Blood Gas ◽  
Arterial Blood ◽  
Bursting Pressures ◽  
Group 2

This study aimed to assess the effect of intraoperative positive end–expiratory pressure (PEEP) intervention on the healing of colonic anastomoses in rabbits. A total of 32 New Zealand type male rabbits were divided into 2 groups of 16 animals each. Following ventilation with tracheostomy, colonic resection and anastomosis were performed in both groups. Although 10 cm of H2O PEEP level was applied in group 1 (PEEP), group 2 [zero end-expiratory pressure (ZEEP)] was ventilated without PEEP throughout the surgery. Half of both the PEEP and ZEEP group animals were killed on the third postoperative day, whereas the remaining half were killed on the seventh. Anastomotic bursting pressures, the tissue concentrations in hydroxyproline, and histologic assessments were performed. Intraoperative oxygen saturation and postoperative arterial blood gas parameters were also compared. On the first postoperative day, both arterial oxygen tension (PO2) and oxygen saturation (SO2) in the PEEP group were significantly higher than in the ZEEP group. On the seventh postoperative day, the bursting pressures of the anastomoses were significantly higher in the PEEP group; however, the hydroxyproline content was significantly lower in the PEEP group than in the ZEEP group. At day 7, the PEEP group was significantly associated with increased neoangiogenesis compared with the ZEEP group. The anastomotic healing process is positively influenced by the intraoperative PEEP application.

scholarly journals Intubation prognosis in COVID-19 patients and associated factors: a cross-sectional study

2020 ◽  
Author(s):  
Mostafa Mohammadi ◽  
Hesam Aldin Varpaei ◽  
Majid Amini
Keyword(s):  
Clinical Signs ◽  
Respiratory Acidosis ◽  
Absolute Lymphocyte Count ◽  
Clinical Severity ◽  
Common Finding ◽  
Cross Sectional ◽  
Arterial Blood Gas ◽  
Laboratory Parameters ◽  
Arterial Blood ◽  
Wide Range

Abstract Background: In December 2019, a new pathogen, HCoV, or New Corona Virus 2019 (2019-nCoV), was recognized in Wuhan, China, causing a pandemic. COVID-19 has a wide range of clinical severity. Approximately 3.2% of patients within some periods of the disease require intubation and invasive ventilation. Methods: This study was descriptive-analytical and was conducted in the Imam Khomeini Hospital. Patients with Covid-19 who required endotracheal intubation were identified and their clinical signs and laboratory parameters were recorded. SPSS23 software was used for statistical analysis. Results: 120 patients with coronavirus with different conditions were evaluated. The mean age was 55±14. 30 patients had cardiovascular disease (hypertension) and 20 endocrine disease(diabetes). Respiratory acidosis, decreased oxygen saturation, lymphopenia, and increased CRP were the most common finding before intubation. 31 patients had no comorbidity conditions. However, 27 patients had more than one comorbidity condition, and 23 experienced acute respiratory distress syndrome. The mortality rate was 49.2%. Discussion: Although all laboratory parameters and patients symptoms can affect the treatment outcome, it was found that WBC and absolute lymphocyte count, BUN, SOFA and APACHE scores, inflammatory index ratio CRP / LDH % CRP / ESR% and ESR / LDH%, arterial blood gas indices, pulse rate, and patient temperature before intubation are among the parameters that can affect the patient's 14-day prognosis. Conclusion: Except for the mentioned items, CRP / LDH% ratio seems to be a good indicator for checking the prognosis of discharge or death of patients within 14 days, However, CRP / ESR% and ESR / LDH% are appropriate criteria for determining the prognosis for discharge or stay in the ICU for more than 14 days.

Blood gas analysis in the critically ill

2016 ◽  
Author(s):  
Gavin M. Joynt ◽  
Gordon Y. S. Choi
Keyword(s):  
Haemoglobin Concentration ◽  
Respiratory Acidosis ◽  
Blood Oxygenation ◽  
Arterial Oxygen ◽  
Buffer System ◽  
Blood Gas ◽  
Acid Base ◽  
Bicarbonate Buffer ◽  
Arterial Blood ◽  
Alveolar Hypoventilation

Arterial blood gases allow the assessment of patient oxygenation, ventilation, and acid-base status. Blood gas machines directly measure pH, and the partial pressures of carbon dioxide (PaCO2) and oxygen (PaO2) dissolved in arterial blood. Oxygenation is assessed by measuring PaO2 and arterial blood oxygen saturation (SaO2) in the context of the inspired oxygen and haemoglobin concentration, and the oxyhaemoglobin dissociation curve. Causes of arterial hypoxaemia may often be elucidated by determining the alveolar–arterial oxygen gradient. Ventilation is assessed by measuring the PaCO2 in the context of systemic acid-base balance. A rise in PaCO2 indicates alveolar hypoventilation, while a decrease indicates alveolar hyperventilation. Given the requirement to maintain a normal pH, functioning homeostatic mechanisms result in metabolic acidosis, triggering a compensatory hyperventilation, while metabolic alkalosis triggers a compensatory reduction in ventilation. Similarly, when primary alveolar hypoventilation generates a respiratory acidosis, it results in a compensatory increase in serum bicarbonate that is achieved in part by kidney bicarbonate retention. In the same way, respiratory alkalosis induces kidney bicarbonate loss. Acid-base assessment requires the integration of clinical findings and a systematic interpretation of arterial blood gas parameters. In clinical use, traditional acid-base interpretation rules based on the bicarbonate buffer system or standard base excess estimations and the interpretation of the anion gap, are substantially equivalent to the physicochemical method of Stewart, and are generally easier to use at the bedside. The Stewart method may have advantages in accurately explaining certain physiological and pathological acid base problems.

scholarly journals The Effect of Halothane-Nitrous Oxide Anaesthesia and Spontaneous Ventilation on Arterial Blood Oxygenation and Physiological Deadspace

1976 ◽  
Vol 4 (1) ◽  
pp. 41-45
Author(s):  
M. Morgan ◽  
J. Norman
Keyword(s):  
Nitrous Oxide ◽  
Oxygen Tension ◽  
Arterial Oxygen Tension ◽  
Volume Ratio ◽  
Carbon Dioxide Tension ◽  
Blood Oxygenation ◽  
Arterial Oxygen ◽  
Significant Deterioration ◽  
Arterial Blood ◽  
Oxide Anaesthesia

Arterial blood, inspired and expired gas samples were taken from seven patients anaesthetized with halothane (1–2 per cent) and nitrous oxide in oxygen and who breathed spontaneously. Over a two hour period, the average arterial oxygen tension was 75 mm Hg and carbon dioxide tension 49 mm Hg. No significant deterioration of either blood gas value occurred during the two hours. The dead-space/tidal volume ratio and alveolar-arterial oxygen tension difference did not alter significantly during the period of the study.

OXYGEN THERAPY IN THE NEWBORN INFANT

PEDIATRICS ◽  
1971 ◽  
Vol 47 (6) ◽  
pp. 1086-1087
Author(s):  
Jerold F. Lucey ◽  
Marvin Cornblath ◽  
Stanley N. Graven ◽  
Sheldon B. Korones ◽  
L. Stanley James ◽  
...  
Keyword(s):  
Oxygen Concentration ◽  
Oxygen Tension ◽  
Newborn Infant ◽  
Newborn Infants ◽  
Arterial Oxygen Tension ◽  
Arterial Oxygen ◽  
Retrolental Fibroplasia ◽  
Arterial Blood ◽  
Increased Risk ◽  
Inspired Oxygen

The following recommendations will appear in the revision of the manual, Standards and Recommendations for Hospital Care of Newborn Infants, scheduled for publication early in 1971. Because the Committee felt a sense of urgency to provide these recommendations to pediatricians, family physicians, and other health professionals caring for newborn infants, they are being published prior to appearance of the manual. The statement has had extensive review by a large number of experts not on the Committee, and their comments and suggestions have been followed in the preparation of the final draft. It was also reviewed and approved by the Committee on Drugs of the Academy at their meeting in San Francisco October 24, 1970. When a newborn infant needs extra oxygen, it must be administered with great care because there is a causal relationship between a higher than normal oxygen tension in arterial blood (60 to 100 mm Hg) and retrolental fibroplasia (retinopathy of prematurity). When the normal O2 tension is exceeded, there is an increased risk of retrolental fibroplasia. The upper limit of arterial oxygen tension and its duration which are safe for these infants is not known. It is probable that even concentrations of 40% of inspired oxygen (formerly considered safe) could be dangerous for some infants. An inspired oxygen concentration of 40% may be insufficient for infants with cardiorespiratory disease to raise the oxygen tension of arterial blood to a normal level. In such instances, an inspired oxygen concentration of 60%, 80%, or higher may be necessary.

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