scholarly journals Shedding Light Into The Black Box of Out-of-Hospital Respiratory Emergencies – A Retrospective Cohort Analysis of Discharge Diagnoses, Prehospital Diagnostic Accuracy, And Predictors of Mortality

2021 ◽  
Author(s):  
Patrick Spörl ◽  
Stefan K. Beckers ◽  
Rolf Rossaint ◽  
Marc Felzen ◽  
Hanna Schröder
Keyword(s):  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Hospital Mortality ◽  
Blood Gas Analysis ◽  
Mortality Rates ◽  
Gas Analysis ◽  
Discharge Diagnosis ◽  
Blood Gas ◽  
Low Oxygen ◽  
Hospital Emergency

Abstract Background: Respiratory distress is one of the most common complaints of patients requiring out-of-hospital emergency services. Determining the precise discharge diagnosis in these circumstances can be challenging due to the wide range of suspected diagnoses. Moreover, these patients appear to have particularly high mortality, but little is currently known about the exact mortality rates associated with specific discharge diagnoses. Our study, therefore, aimed to determine how accurately correct diagnoses are made by EMS physicians in the out-of-hospital setting, identify examination findings that correlate with discharge diagnoses, investigate hospital mortality, and identify mortality-associated predictors.Methods: This retrospective observational study examined emergency medical service (EMS) encounters between December 2015 and May 2016 in the city of Aachen, Germany, in which an EMS physician was present at the scene. Adult patients were included if the EMS physician initially detected dyspnea, low oxygen saturation, or pathological auscultation findings at the scene (n = 719). By linking out-of-hospital data to hospital records, including initial blood gas analysis, a discharge diagnosis was assigned to each EMS encounter, and the outcome was analyzed. Binary logistic regressions were used to search for associations between pathological findings and discharge diagnoses, as well as predictors of hospital mortality.Results: The overall diagnostic accuracy was 69.9% (485/694). The highest diagnostic accuracies were observed in asthma (15/15 ≙ 100%), hypertensive crisis (28/33 ≙ 84.4%), and COPD exacerbation (114/138 ≙ 82.6%), and the lowest accuracies were observed in urinary tract infection (14/35 ≙ 40%), pulmonary embolism (8/18 ≙ 44.4%), and pneumonia (70/142 ≙ 49.3%). The overall hospital mortality rate was 13.8% (99/719). The highest hospital mortality rates were seen in pneumonia (44/142 ≙ 31%) and urinary tract infection (7/35 ≙ 20%). Potential risk factors for hospital mortality identified in this study were reduced vigilance, low oxygen saturation, increasing age, blood gas analysis (BGA) results associated with metabolic acidosis, and an incorrect out-of-hospital diagnosis by the EMS physician.Conclusions: Our data highlight the diagnostic uncertainties and high mortality in out-of-hospital emergency patients presenting with respiratory distress. The identified predictors could help in early detection of patients at risk in the future.

scholarly journals Incidence of hyperoxia in trauma patients receiving pre-hospital emergency anaesthesia: results of a 5-year retrospective analysis

2021 ◽  
Vol 29 (1) ◽  
Author(s):  
P. Leitch ◽  
A. L. Hudson ◽  
J. E. Griggs ◽  
R. Stolmeijer ◽  
R. M. Lyon ◽  
...  
Keyword(s):  
Major Trauma ◽  
Hospital Setting ◽  
Blood Gas Analysis ◽  
Gas Analysis ◽  
Trauma Patients ◽  
Blood Gas ◽  
Hospital Emergency ◽  
Arterial Blood Gas ◽  
Arterial Blood ◽  
Arterial Blood Gas Analysis

Abstract Background Previous studies have demonstrated an association between hyperoxia and increased mortality in various patient groups. Critically unwell and injured patients are routinely given high concentration oxygen in the pre-hospital phase of care. We aim to investigate the incidence of hyperoxia in major trauma patients receiving pre-hospital emergency anesthesia (PHEA) in the pre-hospital setting and determine factors that may help guide clinicians with pre-hospital oxygen administration in these patients. Methods A retrospective cohort study was performed of all patients who received PHEA by a single helicopter emergency medical service (HEMS) between 1 October 2014 and 1 May 2019 and who were subsequently transferred to one major trauma centre (MTC). Patient and treatment factors were collected from the electronic patient records of the HEMS service and the MTC. Hyperoxia was defined as a PaO2 > 16 kPA on the first arterial blood gas analysis upon arrival in the MTC. Results On arrival in the MTC, the majority of the patients (90/147, 61.2%) had severe hyperoxia, whereas 30 patients (20.4%) had mild hyperoxia and 26 patients (19.7%) had normoxia. Only 1 patient (0.7%) had hypoxia. The median PaO2 on the first arterial blood gas analysis (ABGA) after HEMS handover was 36.7 [IQR 18.5–52.2] kPa, with a range of 7.0–86.0 kPa. SpO2 pulse oximetry readings before handover were independently associated with the presence of hyperoxia. An SpO2 ≥ 97% was associated with a significantly increased odds of hyperoxia (OR 3.99 [1.58–10.08]), and had a sensitivity of 86.7% [79.1–92.4], a specificity of 37.9% [20.7–57.8], a positive predictive value of 84.5% [70.2–87.9] and a negative predictive value of 42.3% [27.4–58.7] for the presence of hyperoxemia. Conclusion Trauma patients who have undergone PHEA often have profound hyperoxemia upon arrival at hospital. In the pre-hospital setting, where arterial blood gas analysis is not readily available a titrated approach to oxygen therapy should be considered to reduce the incidence of potentially harmful tissue hyperoxia.

Does Catheter-Associated Urinary Tract Infection Increase Mortality in Critically Ill Patients?

2007 ◽  
Vol 28 (12) ◽  
pp. 1367-1373 ◽  
Author(s):  
Christophe Clec'h ◽  
Carole Schwebel ◽  
Adrien Français ◽  
Dany Toledano ◽  
Jean-Philippe Fosse ◽  
...  
Keyword(s):  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Tract Infection ◽  
Hospital Mortality ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Urinary Catheter ◽  
Mortality Rates ◽  
Confounding Factors ◽  
Icu Mortality

Objective.To produce an accurate estimate of the association between catheter-associated urinary tract infection (UTI) and intensive care unit (ICU) and hospital mortality, controlling for major confounding factors.Design.Nested case-control study in a multicenter cohort (the OutcomeRea database).Setting.Twelve French medical or surgical ICUs.Methods.All patients admitted between January 1997 and August 2005 who required the insertion of an indwelling urinary catheter. Patients who developed catheter-associated UTI (ie, case patients) were matched to control patients on the basis of the following criteria: sex, age ( ± 10 years), SAPS (Simplified Acute Physiology Score) II score ( ± 10 points), duration of urinary tract catheterization, and presence or absence of diabetes mellitus. The association of catheter-associated UTI with ICU and hospital mortality was assessed by use of conditional logistic regression.Results.Of the 3,281 patients who had an indwelling urinary catheter, 298 (9%) developed at least 1 episode of catheter-associated UTI. The incidence density of catheter-associated UTI was 12.9 infections per 1,000 catheterization-days. Crude ICU mortality rates were higher among patients with catheter-associated UTI, compared with those without catheter-associated UTI (32% vs 25%, P = .02); the same was true for crude hospital mortality rates (43% vs 30%, P>.01). After matching and adjustment, catheter-associated UTI was no longer associated with increased mortality (ICU mortality: odds ratio [OR], 0.846 [95% confidence interval {CI}, 0.659-1.086]; P = .19 and hospital mortality: OR, 0.949 [95% CI, 0.763-1.181]; P = .64).Conclusion.After carefully controlling for confounding factors, catheter-associated UTI was not found to be associated with excess mortality among our population of critically ill patients in either the ICU or the hospital.

Blood gas analysis in newborns with low cardiac output syndrome after cardiac surgery.

2018 ◽  
Vol 19 (5) ◽  
pp. 676-687
Author(s):  
G.G. Khubulava ◽  
A.B. Naumov ◽  
S.P. Marchenko ◽  
O.Yu. Chupaeva ◽  
A.A. Seliverstova ◽  
...  
Keyword(s):  
Cardiac Output ◽  
Cardiac Surgery ◽  
Blood Gas Analysis ◽  
Gas Analysis ◽  
Blood Gas ◽  
Low Cardiac Output Syndrome ◽  
Low Cardiac Output

scholarly journals The effect of clamped and unclamped umbilical cord samples on blood gas analysis

2021 ◽  
Author(s):  
Elisabetta Colciago ◽  
Simona Fumagalli ◽  
Elena Ciarmoli ◽  
Laura Antolini ◽  
Antonella Nespoli ◽  
...  
Keyword(s):  
Blood Gas Analysis ◽  
Cross Sectional Study ◽  
Gas Analysis ◽  
Blood Collection ◽  
Large Sample Size ◽  
Blood Gas ◽  
Delayed Cord Clamping ◽  
Cross Sectional ◽  
High Risk Women ◽  
Significant Difference

Abstract Purpose Delayed cord clamping for at least 60 s is recommended to improve neonatal outcomes. The aim of this study is to evaluate whether there are differences in cord BGA between samples collected after double clamping the cord or without clamping the cord, when blood collection occurs within 60 s from birth in both groups. Methods A cross-sectional study was carried out, collecting data from 6884 high-risk women who were divided into two groups based on the method of cord sampling (clamped vs unclamped). Results There were significant decrease in pH and BE values into unclamped group compared with the clamped group. This difference remained significant when considering pathological blood gas analysis parameters, with a higher percentage of pathological pH or BE values in the unclamped group. Conclusion Samples from the unclamped cord alter the acid–base parameters compared to collection from the clamped cord; however, this difference does not appear to be of clinical relevance. Findings could be due to the large sample size, which allowed to achieve a high power and to investigate very small numerical changes between groups, leading to a statistically significant difference in pH and BE between samples even when we could not appreciate any clinical relevant difference of pH or BE between groups. When blood gas analysis is indicated, the priority should be given to the timing of blood collection to allow reliable results, to assess newborns status at birth and intervene when needed.

scholarly journals AN IMPROVEMENT IN THE VAN SLYKE METHOD FOR BLOOD GAS ANALYSIS

1934 ◽  
Vol 104 (1) ◽  
pp. 29-31
Author(s):  
Friedrich Rappaport ◽  
Klara Köck-Molnar
Keyword(s):  
Blood Gas Analysis ◽  
Gas Analysis ◽  
Blood Gas

Validation of transcutaneous carbon dioxide monitoring using an artificial lung during adult pulsatile cardiopulmonary bypass

2021 ◽  
pp. 039139882098785
Author(s):  
Lawrence Garrison ◽  
Jeffrey B Riley ◽  
Steve Wysocki ◽  
Jennifer Souai ◽  
Hali Julick
Keyword(s):  
Carbon Dioxide ◽  
Cardiopulmonary Bypass ◽  
Gold Standard ◽  
Blood Gas Analysis ◽  
Gas Analysis ◽  
Artificial Lung ◽  
Blood Gas ◽  
Median Difference ◽  
Transcutaneous Carbon Dioxide ◽  
Arterial Blood

Measurements of transcutaneous carbon dioxide (tcCO2) have been used in multiple venues, such as during procedures utilizing jet ventilation, hyperbaric oxygen therapy, as well as both the adult and neo-natal ICUs. However, tcCO2 measurements have not been validated under conditions which utilize an artificial lung, such cardiopulmonary bypass (CPB). The purpose of this study was to (1) validate the use of tcCO2 using an artificial lung during CPB and (2) identify a location for the sensor that would optimize estimation of PaCO2 when compared to the gold standard of blood gas analysis. tcCO2 measurements ( N = 185) were collected every 30 min during 54 pulsatile CPB procedures. The agreement/differences between the tcCO2 and the PaCO2 were compared by three sensor locations. Compared to the earlobe or the forehead, the submandibular PtcCO2 values agreed best with the PaCO2 and with a median difference of –.03 mmHg (IQR = 5.4, p < 0.001). The small median difference and acceptable IQR support the validity of the tcCO2 measurement. The multiple linear regression model for predicting the agreement between the submandibular tcCO2 and PaCO2 included the SvO2, the oxygenator gas to blood flow ratio, and the native perfusion index ( R2 = 0.699, df = 1, 60; F = 19.1, p < 0.001). Our experience in utilizing tcCO2 during CPB has demonstrated accuracy in estimating PaCO2 when compared to the gold standard arterial blood gas analysis, even during CO2 flooding of the surgical field.

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