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

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.

Download Full-text

Relationship of Respiratory Symptoms and Signs with Hypoxemia in Infants Under 2 months of Age

Journal of Nepal Paediatric Society ◽

10.3126/jnps.v31i3.5359 ◽

1970 ◽

Vol 31 (3) ◽

pp. 202-208

Author(s):

K Agrawal ◽

C Mahaseth ◽

A Rayamajhi

Keyword(s):

Respiratory Rate ◽

Clinical Signs ◽

High Specificity ◽

Signs And Symptoms ◽

Acute Illness ◽

Gas Analysis ◽

Cross Sectional ◽

Arterial Blood Gas ◽

Arterial Blood ◽

Head Nodding

Introduction: Hypoxemia is the most serious manifestation of any acute illness in infants less than two months and has shown to be a risk factor for mortality. Hypoxia can be detected using a pulse oxymeter or arterial blood gas analysis. However this facility is not available in most centers of Nepal. This study has correlated different signs and symptoms to predict hypoxia. Methodology: This hospital based prospective cross sectional study included 160 infant < 2 months, presenting to OPD or Emergency department with any acute illness A complete history was taken and weight, temperature, respiratory rate, heart rate and oxygen saturation was recorded. Presence or absence of nasal flaring, cyanosis, chest indrawing, head nodding, grunting, wheezing and crepitations on auscultation was recorded subsequently. Clinical signs of hypoxemic and non hypoxemic infants were compared and then analyzed. Results: 160 infants, 95 (59.4%) were male and 65 (40.6%) were female. Of the total population, 56(35%) were hypoxic where as 104(65%) were non hypoxic. Infants who presented with more than 3 symptoms, were lethargic, tachypneic or had chest indrawing had higher sensitivity(92.8%, 75%, 75% and 89.3 % respectively) where as infants with nasal flaring, grunting, head nodding or central cyanosis had high specificity (91.3%, 87.5%, 98% and 100%) respectively. Conclusion: Infants presenting with ≥ 3 symptoms, lethargy, respiratory rate of ≥ 70/minute or chest indrawing can be used for screening purpose to detect hypoxia and infants showing signs like grunting, head nodding, nasal flaring or central cyanosis should be considered hypoxic and treated with supplemental oxygen. Key words: Hypoxia; Respiratory rate; Chest indrawing; Nasal flaring DOI: http://dx.doi.org/10.3126/jnps.v31i3.5359 J Nep Paedtr Soc 2011;31(3): 202-208

Download Full-text

Electrocardiographic findings of methanol toxicity: A cross-sectional study of 356 cases in Iran.

10.21203/rs.3.rs-34297/v1 ◽

2020 ◽

Author(s):

Mohammad Hossein Nikoo ◽

Alireza Arjangzadeh ◽

Maryam Pakfetrat ◽

Shahrokh Sadeghi Boogar ◽

Vahid Mohammadkarimi ◽

...

Keyword(s):

Myocardial Infarction ◽

Case Reports ◽

Medical Science ◽

Alcoholic Beverages ◽

Common Finding ◽

Blood Gas ◽

Cross Sectional ◽

Arterial Blood Gas ◽

Arterial Blood ◽

Electrocardiographic Findings

Abstract Bakground: Methanol is used widely in industry but methanol poisoning is not common; however, a number of outbreaks have been recently reported due to inappropriate processing of alcoholic beverages. Shiraz which is located in the southern part of Iran faced one of these in 2020 during COVID-19 pandemic. There is scarce literature on the electrocardiographic findings in methanol toxicity. The aim of this study is to address this gap in the literature. Method: A total of 356 cases with methanol toxicity were referred to Shiraz University of Medical Science Tertiary Hospitals (Faghihi and Namazi) in March and April 2020. The clinical findings such as blindness and impaired level of consciousness, lab data such as arterial blood gas, electrolytes, and creatinine, and the most common findings from ECGs were collected. Results: The most common ECG findings were J point elevation (68.8%), presence of U wave (59.2%), QTc prolongation (53.2% in males and 28.6% in females), and fragmented QRS (33.7%). An outstanding finding in this study was the presence of myocardial infarction in 5.3% of the cases, a finding which, to our knowledge, has only been reported in in a few case reports. Brugada pattern (8.1%) and Osborn wave (3.7%) were other interesting findings. In multivariate analysis, when confounding factors faded, myocardial infarction, atrioventricular conduction disturbances, sinus tachycardia and a prolonged QTC of more than 500 msecond were four independent correlates of methanol toxicity severity measured with arterial blood PH on arterial blood gas measurements, with p values and odds ratios of < 0.001 (12.386), 0.012 (5.981), 0.018(2.262) and 0.001(3.247), respectively. Conclusion: Electrocardiographic changes during methanol intoxication are remarkable and correlate well with the severity of poisoning. Myocardial infarction was an egregious yet concerningly common finding in this sample, which need to be ruled out in methanol toxicity.

Download Full-text

Causes, Effects and Methods of Monitoring Gas Exchange Disturbances during Equine General Anaesthesia

Animals ◽

10.3390/ani11072049 ◽

2021 ◽

Vol 11 (7) ◽

pp. 2049

Author(s):

Elżbieta Stefanik ◽

Olga Drewnowska ◽

Barbara Lisowska ◽

Bernard Turek

Keyword(s):

Gas Exchange ◽

General Anaesthesia ◽

Near Infrared ◽

Respiratory Acidosis ◽

Monitoring Methods ◽

Arterial Blood Gas ◽

Complementary Method ◽

Arterial Blood ◽

Operative Complications ◽

Post Operative Complications

Horses, due to their unique anatomy and physiology, are particularly prone to intraoperative cardiopulmonary disorders. In dorsally recumbent horses, chest wall movement is restricted and the lungs are compressed by the abdominal organs, leading to the collapse of the alveoli. This results in hypoventilation, leading to hypercapnia and respiratory acidosis as well as impaired tissue oxygen supply (hypoxia). The most common mechanisms disturbing gas exchange are hypoventilation, atelectasis, ventilation–perfusion (V/Q) mismatch and shunt. Gas exchange disturbances are considered to be an important factor contributing to the high anaesthetic mortality rate and numerous post-anaesthetic side effects. Current monitoring methods, such as a pulse oximetry, capnography, arterial blood gas measurements and spirometry, may not be sufficient by themselves, and only in combination with each other can they provide extensive information about the condition of the patient. A new, promising, complementary method is near-infrared spectroscopy (NIRS). The purpose of this article is to review the negative effect of general anaesthesia on the gas exchange in horses and describe the post-operative complications resulting from it. Understanding the changes that occur during general anaesthesia and the factors that affect them, as well as improving gas monitoring techniques, can improve the post-aesthetic survival rate and minimize post-operative complications.

Download Full-text

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

PEDIATRICS ◽

10.1542/peds.42.2.238 ◽

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.

Download Full-text

A Prospective Observational Study of the Change in Systemic Ionised Calcium following 4% Citrate Locking of Venous Haemodialysis Catheters in Intensive Care Patients

Anaesthesia and Intensive Care ◽

10.1177/0310057x1804600406 ◽

2018 ◽

Vol 46 (4) ◽

pp. 381-385

Author(s):

S. Shewdin ◽

Y. C. Bong ◽

S. Okano ◽

M. D. Chatfield ◽

J. Walsham

Keyword(s):

Intensive Care ◽

Observational Study ◽

Prospective Observational Study ◽

Clinical Signs ◽

Dialysis Catheter ◽

Citrate Solution ◽

Arterial Blood Gas ◽

Intensive Care Patients ◽

Arterial Blood ◽

Ionised Calcium

Traditionally heparin has been the anticoagulant of choice for venous dialysis catheter locking. There is systemic leakage of heparin catheter locking solutions at the time of injection. Alternative agents, such as citrate, are increasingly being used. We are not aware of any data in the critical care literature on the effect of citrate locking of venous dialysis catheters on systemic ionised calcium (iCa2+). To assess the effect of 4% citrate locking of venous dialysis catheters on systemic iCa2+ in intensive care patients we performed a prospective observational study of 50 paired samples in 26 intensive care patients receiving 4% citrate dialysis catheter locking in an adult tertiary intensive care unit between May 2016 and December 2016. Arterial blood gas (ABG) analysis was performed prior to venous dialysis catheter locking and a baseline iCa2+ result obtained. The catheter was locked with 4% citrate solution. A further ABG was sampled between 30 and 120 seconds later and the iCa2+ results were compared. Patients were observed for clinical signs of hypocalcaemia. On average, there was little difference between the pre- and post-catheter locking iCa2+ (median pre-locking iCa2+ 1.19 mmol/l, mean change of +0.004 mmol/l, 95% confidence interval [CI] −0.004 to 0.013, P=0.34). There was no evidence this difference differed by length of catheter (P=0.26) or site of catheter (P=0.85) insertion, but there was some evidence that this differed by receipt of citrate dialysis circuit anticoagulation (P=0.013). Patients who received citrate dialysis circuit anticoagulation had an increase in catheter locking iCa2+ by 0.017 mmol/l (95% CI 0.005 to 0.028). Locking of venous dialysis catheters with 4% citrate solution has no clinically significant effect on systemic iCa2+ in intensive care patients with indwelling venous dialysis catheters.

Download Full-text

Thoracoabdominal restriction in supine men: CT and lung function measurements

Journal of Applied Physiology ◽

10.1152/jappl.1988.64.2.599 ◽

1988 ◽

Vol 64 (2) ◽

pp. 599-604 ◽

Cited By ~ 20

Author(s):

L. Tokics ◽

G. Hedenstierna ◽

B. Brismar ◽

A. Strandberg ◽

H. Lundquist

Keyword(s):

Lung Function ◽

Lung Tissue ◽

Total Lung Capacity ◽

Blood Gas Analysis ◽

Gas Analysis ◽

Cross Sectional ◽

Arterial Blood Gas ◽

Lung Capacity ◽

Arterial Blood ◽

Volume Curve

Thoracoabdominal restriction was brought on by means of a corset, and the subsequent effects on thoracic dimensions and lung tissue were studied by computerized tomography (CT) and by various lung function tests in supine healthy volunteers (mean age 30 yr). Restriction caused reductions in total lung capacity (helium equilibration) from mean 6.84 to 4.80 liters, in functional residual capacity (FRC) from 2.65 to 2.08 liters, and in vital capacity from 5.16 to 3.45 liters. Closing capacity (single-breath N2 washout) fell from 2.42 to 1.88 liters, thus matching the reduction in FRC. The static pressure-lung volume curve was shifted to the right by 1.5 cmH2O at 50% of total lung capacity. However, no change in the slope of the curve was observed. The diaphragm was moved cranially by 1.2 cm, and the thoracic cross-sectional area was reduced by a mean 32 cm2 at a level just above the diaphragm. No changes in the lung tissue were seen on CT scanning. Gas exchange, as assessed by multiple inert gas elimination technique and arterial blood gas analysis, was unaffected by restriction. It is concluded that in supine subjects, thoracoabdominal restriction that reduces FRC by 0.6 liter is not accompanied by atelectasis (normal CT scan). In this respect the result differs from that found in anesthetized supine subjects who show the same fall in FRC and atelectasis in dependent lung regions.

Download Full-text

The Role of Pulse Oximetry in the Initial Airway Management of Helicopter Transported, Trauma Victims

Prehospital and Disaster Medicine ◽

10.1017/s1049023x00039625 ◽

1992 ◽

Vol 7 (3) ◽

pp. 277-278

Author(s):

Ross S. Carol ◽

Francis P. Renzi

Keyword(s):

Airway Management ◽

Pulse Oximetry ◽

Clinical Signs ◽

Management Decision ◽

Trauma Patients ◽

Arterial Blood Gas ◽

Arterial Blood ◽

Prehospital Management ◽

A Prospective Study

AbstractIntroduction:Circumstances surrounding the prehospital management of trauma patients may mask clinical signs of inadequate oxygenation. Pulse oximetry (PO) may influence airway management prior to helicopter transport by helping to identify patients with occult hypoxemia.Methods:Patients were enrolled in a prospective study. Initially, the flight physician clinically decided how best to manage the patient's airway prior to helicopter transport. The patient's oxygenation saturation (O2at), was determined by PO. Then, the physician reassessed the initial airway management decision based on clinical assessment and knowledge of the O2Sat. All patients had an arterial blood gas (ABG) measurement taken after completion of transport.Results:Sixty patients were enrolled. Knowledge of the O2Sat, as determined by pulse oximetry, did not influence airway management. No patients with occult hypoxemia were identified.Conclusion:The use of PO in the initial evaluation of trauma patients prior to helicopter transport did not influence the flight physician's initial management of the airway.

Download Full-text

Investigation of Frequency of the Lethal Triad and Its 24 Hours Prognostic Value among Patients with Multiple Traumas

Open Access Macedonian Journal of Medical Sciences ◽

10.3889/oamjms.2019.217 ◽

2019 ◽

Vol 7 (6) ◽

pp. 962-966 ◽

Cited By ~ 4

Author(s):

Iraj Goli Khatir ◽

Farzad Bozorgi ◽

Hesam Ghanbari ◽

Fatemeh Jahanian ◽

Mohsen Arabi ◽

...

Keyword(s):

Logistic Regression ◽

Predictive Value ◽

Coagulation Factors ◽

Cross Sectional Study ◽

Care Plan ◽

Cross Sectional ◽

Arterial Blood Gas ◽

Arterial Blood ◽

Lethal Triad ◽

Multiple Traumas

BACKGROUND: Death in multiple trauma (MT) patients is one of the serious concerns of the medical service provider. Any prediction of the likelihood of death on the assessment of the patient's condition is performed using different variables, one of the tools in the triage of patients to determine their condition. AIM: We aimed to investigate the frequency and the predictive value of death in 24 hours triad of death in patients qualified with multiple traumas admitted to Imam Khomeini hospital. METHODS: This was a prospective cross-sectional study to determine the prevalence and predictive value of 24-hour triad of death among patients with MT referred to an emergency department. Three factors including acidosis, hypothermia and coagulopathy and predictive value of 24-hour death were evaluated. Arterial blood gas, oral temperature and blood samples for coagulation factors were analysed. Data were analysed using SPSS version 19. Multivariate analysis (logistic regression) was used to determine the predictive value of the triad of death. RESULTS: A group of 199 MT patients referring to Imam Khomeini hospital during the first 6 months of 2015 were evaluated for the first 24 hours of admission. Logistic regression analysis showed that using the following formula based on the triad of death can predict death in 96% of cases can be based on the triad of a death foretold death upon admission to the emergency room. It should be noted that this prediction tool as 173 people left alive after 24 hours as live predicts (100% correct). CONCLUSION: The triad of death is one of the tools in the triage of patients to determine their condition and care plan to be used, provided valuable information to predict the prognosis of patients with a medical team.

Download Full-text

Apnoeic oxygenation using transnasal humidified rapid-insufflation ventilatory exchange during rigid bronchoscopy: a report of four cases

Journal of International Medical Research ◽

10.1177/03000605211068309 ◽

2022 ◽

Vol 50 (1) ◽

pp. 030006052110683

Author(s):

Jaewoong Jung ◽

Juhui Park ◽

Misoon Lee ◽

Yang-Hoon Chung

Keyword(s):

General Anaesthesia ◽

Flow Rate ◽

Outlet Obstruction ◽

Respiratory Acidosis ◽

Bronchial Tube ◽

Rigid Bronchoscopy ◽

Gas Analysis ◽

Arterial Blood Gas ◽

Arterial Blood ◽

Apnoeic Oxygenation

General anaesthesia with a muscle relaxant is usually performed for rigid bronchoscopy (RB), but ventilation is challenging due to large amounts of leakage. Optiflow™ supplies 100% humidified, warmed oxygen at a rate of up to 70 l/min and this high flow rate may overcome the leakage problem. This case report describes four patients that were scheduled for RB. The lung lesions were all located below the carina, so a bronchial tube was inserted under general anaesthesia. Once a large amount of leakage was confirmed by manual ventilation, Optiflow™ was connected to the bronchial tube (flow rate, 70 l/min). All of the ports of the bronchoscopy were left open to prevent the risk of outlet obstruction. Oxygenation was well maintained with stable vital signs throughout the procedures, which took up to 34 min without airway intervention. There were no occurrences of cardiac arrhythmia or changes in the electrocardiograms. Respiratory acidosis recovered after emergence, which was confirmed by arterial blood gas analysis in all cases. Apnoeic oxygenation using Optiflow™ was applied successfully during RB. Applying Optiflow™ could make cases of difficult ventilation during RB much easier for the anaesthetist. Larger studies need to demonstrate the efficacy and safety of this technique.

Download Full-text

Beyond PaO2: Relationships between Indices of Pulmonary Oxygen Transfer in Hospitalized Adults Undergoing Blood Gas Testing

International Journal of Innovative Research in Medical Science ◽

10.23958/ijirms/vol04-i03/600 ◽

2019 ◽

Vol 4 (03) ◽

Author(s):

Mark Feldman, MD ◽

Denise Rebel, BS, RRT

Keyword(s):

Oxygen Transfer ◽

Supplemental Oxygen ◽

Blood Gas ◽

Limited Information ◽

Partial Pressure Of Oxygen ◽

Arterial Blood Gas ◽

Arterial Blood ◽

Wide Range ◽

Breathing Room ◽

Supplemental Oxygen Therapy

The arterial partial pressure of oxygen in the arterial blood reveals limited information about pulmonary oxygen transfer. In 989 hospitalized patients undergoing arterial blood gas testing, we compared conventional indices of oxygen transfer: (1) P(A-a) O2 (A-a); (2) PaO2/PAO2 (a/A); and (3) the P/F ratio Nine hundred twenty-five of the patients were receiving supplemental oxygen therapy (FIO2 .24-1.00) and 65 were breathing room air. In patients receiving supplemental O2, the a/A ratio closely correlated with the P/F ratio (r = .98 to .99); the A-a O2 difference did not correlate as closely with the a/A ratio (r = -.77 to -.85) or with the P/F ratio (r = -.72 to -.80). In those breathing room air (FIO2 .21), the a/A ratio was closely and inversely correlated with the A-a difference (r= -.97 to -.98); correlations between the a/A and P/F ratios (r=.88 to .89) and between the P/F ratio and A-a O2 difference (r = -.78 to -.79) were less robust. We conclude that the a/A ratio is the preferred oxygen transfer parameter over the wide range of FIO2 levels encountered clinically.

Download Full-text