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.

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 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 VOX Index– A New Parameter Using Ultrasound to Predict Time of Applying Noninvasive Ventilation

2020 ◽  
Author(s):  
Ruoxuan Wen ◽  
Xingshuo Hu ◽  
Zhimei Duan ◽  
Han Fu ◽  
Hongjun Gu ◽  
...  
Keyword(s):  
Noninvasive Ventilation ◽  
Assessment Tool ◽  
Medical Center ◽  
Oxygenation Index ◽  
Blood Gases ◽  
Low Flow ◽  
Arterial Blood Gases ◽  
Icu Patients ◽  
Arterial Blood ◽  
Movement Distance

Abstract Background: Physicians have been utilizing respiratory status and arterial blood gases measurements of the patient for determining the need of noninvasive ventilation (NIV). There is actually no clear and accurate index to assess the appropriate time of using NIV. We hypothesized that diaphragmatic ultrasound in combination with arterial blood gases test can accurately predict when the patients require sequential NIV.Objective: To investigate the feasibility of using the new VOX (velocity oxygenation) index, combining the diaphragmatic ultrasound and oxygen pressure analyses, as a reliable assessment tool for sequential NIV in intensive care unit (ICU) patients. Method: A prospective study including patients admitted to ICU of People’s Liberation Army General Hospital First Medical Center Respiratory Department between August 1st 2018 and March 31st 2020. Patients received either continuous low-flow oxygen therapy or sequential NIV based on the physician judgement. The diaphragm movement distance, contraction time, and velocity were recorded and the E-T (excursion-time) index, VOX index, and arterial blood gases were compared. Result: The velocity of the diaphragmatic contraction (VD) was higher (3.29 vs. 1.89, P< 0.001) and P/F ratio was lower (161 vs. 264, P< 0.001) in patients receiving NIV. In predicting the need of utilizing NIV, VOX index showed the largest area under curve of ROC (AUC= 0.97) which was significantly greater than the AUC of VD and P/F ratio.Conclusion: VOX index serves as an accurate indicator of predicting the time of using NIV for ICU patients. It is recommended to switch from invasive ventilation to NIV when VOX< 109.89.

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.

Respiratory syncytial virus infection in anesthetized weanling rather than adult rats prolongs the apneic responses to right atrial injection of capsaicin

2007 ◽  
Vol 102 (6) ◽  
pp. 2201-2206 ◽  
Author(s):  
Wenhong Peng ◽  
Jianguo Zhuang ◽  
Kevin S. Harrod ◽  
Fadi Xu
Keyword(s):  
Respiratory Syncytial Virus ◽  
Blood Gases ◽  
Respiratory Frequency ◽  
Right Atrial ◽  
Arterial Blood Gases ◽  
Adult Rats ◽  
Intranasal Inoculation ◽  
Arterial Blood ◽  
Rsv Infection ◽  
Syncytial Virus

Apnea is a common complication in infants infected by respiratory syncytial virus (RSV). A recent study has shown that intranasal inoculation of RSV in conscious weanling rats strengthens the apneic responses to right atrial injection of capsaicin (CAP), leading to 66% mortality. The objectives of the present study were to determine 1) whether RSV infection changes baseline minute ventilation (V̇e) and arterial blood gases in anesthetized rats; 2) what the effects of RSV infection are on the respiratory responses to CAP; and 3) whether the RSV-strengthened apneic responses are age dependent. Our experiments were conducted in anesthetized and spontaneously breathing rats divided into four groups of weanling and adult rats that received either intranasal inoculation of RSV or virus-free medium. Two days after RSV infection (0.7 ml/kg), animal blood gases, baseline V̇e, and V̇e responses to right atrial injection of three doses of CAP (4, 16, and 64 μg/kg) were measured and compared among the four groups. Our results showed that RSV infection increased respiratory frequency (∼25%, P < 0.05) in weanling but not adult rats, with little effect on arterial blood gases. RSV infection amplified the apneic responses to CAP in weanling but not adult rats, characterized by increases in the initial (40%) and the longest apneic duration (650%), the number of apneic episodes (139%), and the total duration of apneas (60%). These amplifications led to 50% mortality ( P < 0.05). We conclude that RSV infection increases respiratory frequency and strengthens the apneic responses to CAP only in anesthetized weanling but not adult rats.

Fetal cardiac bypass alters regional blood flows, arterial blood gases, and hemodynamics in sheep

1992 ◽  
Vol 263 (3) ◽  
pp. H919-H928 ◽  
Author(s):  
S. M. Bradley ◽  
F. L. Hanley ◽  
B. W. Duncan ◽  
R. W. Jennings ◽  
J. A. Jester ◽  
...  
Keyword(s):  
Blood Flow ◽  
Blood Gases ◽  
Arterial Blood Gases ◽  
Blood Flows ◽  
Arterial Blood ◽  
Cardiac Bypass ◽  
Regional Blood Flows ◽  
Placental Blood ◽  
Fetal Organs ◽  
Placental Blood Flow

Successful fetal cardiac bypass might allow prenatal correction of some congenital heart defects. However, previous studies have shown that fetal cardiac bypass may result in impaired fetal gas exchange after bypass. To investigate the etiology of this impairment, we determined whether fetal cardiac bypass causes a redistribution of fetal regional blood flows and, if so, whether a vasodilator (sodium nitroprusside) can prevent this redistribution. We also determined the effects of fetal cardiac bypass with and without nitroprusside on fetal arterial blood gases and hemodynamics. Eighteen fetal sheep were studied in utero under general anesthesia. Seven fetuses underwent bypass without nitroprusside, six underwent bypass with nitroprusside, and five were no-bypass controls. Blood flows were determined using radionuclide-labeled microspheres. After bypass without nitroprusside, placental blood flow decreased by 25–60%, whereas cardiac output increased by 15–25%. Flow to all other fetal organs increased or remained unchanged. Decreased placental blood flow after bypass was accompanied by a fall in PO2 and a rise in PCO2. Nitroprusside improved placental blood flow, cardiac output, and arterial blood gases after bypass. Thus fetal cardiac bypass causes a redistribution of regional blood flow away from the placenta and toward the other fetal organs. Nitroprusside partially prevents this redistribution. Methods of improving placental blood flow in the postbypass period may prove critical to the success of fetal cardiac bypass.

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