scholarly journals Blood Purification in Severe and Critical COVID-19 Patients: A Case Series of 5 Patients

2021 ◽  
Vol 9 ◽  
Author(s):  
Hongjun Chen ◽  
Leisheng Zhang ◽  
Wei Zhang ◽  
Lili Liu ◽  
Zhihua Dai ◽  
...  
Keyword(s):  
Inflammatory Cytokine ◽  
Troponin T ◽  
Early Stage ◽  
Fluid Management ◽  
Case Series ◽  
Oxygenation Index ◽  
Blood Gas Analysis ◽  
Blood Purification ◽  
Gas Analysis ◽  
Blood Purification Therapy

Objective: The ongoing coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has led to a worldwide pandemic. Currently, supportive care measures remain the standard of care for severe and critical COVID-19 patients, such as ventilation oxygenation, fluid management and blood purification. In this study, we aimed to evaluate the effects of early blood purification therapy upon severe and/or critical COVID-19 patients.Patients and Methods: From January 31, 2020 to March 1, 2020, a total 5 patients with COVID-19 (3 critical type cases and 2 severe type cases) received early blood purification treatment in the intensive care unit (ICU) of Affiliated Hospital of Zunyi Medical University. Clinical indexes, including oxygen concentration, blood gas analysis, oxygenation index, and laboratory test as well as disease scores were recorded and analyzed before and after the treatment with blood purification.Results: Among the 5 patients, 4 were males ranging from 35 to 80 year old (Mean age = 63 ± 17.87). All cases with characteristics of OI <300 mm Hg, decline in lymphocyte (LYMPH)%, boost in lactate dehydrogenase (LDH), troponin T (TNT), B-type brain natriuretic peptide (BNP), interleukin-6 (IL-6) and interferon-alpha (IFN-a), three with high flow nasal cannula (HFNC), two with non-invasive ventilation (NIV) and acute kidney injury (AKI), and one with shock and IV. Blood purification therapy significantly decreased the serum levels of inflammatory cytokine, ameliorated the concomitant symptoms and complications. Finally, one case was discharged from the hospital, 4 cases were transferred to the general ward, and all the 5 cases survived.Conclusion: Continuous blood purification therapy held promising prospects for alleviating the deteriorative progression of severe and critical types of COVID-19 in the early stage, together with ameliorating the accumulation of inflammatory cytokine and the concomitant symptoms and complications by efficacious immunoadsorption.Trial Registration:www.chictr.org.cn, Identifier (ChiCTR2000031930).

Ultrasound-guided vascular access in intensive/acute cardiac care

2021 ◽  
pp. 314-322
Author(s):  
Richard Paul
Keyword(s):  
Ph Value ◽  
Fluid Management ◽  
Disease Process ◽  
Blood Gas Analysis ◽  
Underlying Disease ◽  
Gas Analysis ◽  
Cardiac Care ◽  
Acid Base ◽  
Electrolyte Disorders ◽  
Arterial Blood Gas

Acid-base homeostasis is vital for the maintenance of normal tissue and organ function, as both acidosis and alkalosis can have harmful and potentially life-threatening effects on the human body. Arterial blood gas analysis, combined with routine clinical history and examination, can provide useful information for the management of the critically ill cardiac patient. Most acid-base derangements are reversed by treatment of the underlying disease process, rather than simple correction of the abnormal pH, and prognosis is determined by the nature of the underlying disease, rather than the extent of pH value deviation. Within this chapter, an approach is presented for prompt and accurate acid-base interpretation. Water and electrolyte disorders are common in the intensive cardiac care unit, particularly in patients with cardiac failure. Prompt recognition and treatment is required to prevent cardiovascular and neurological compromise. Therapeutic strategies range from simple electrolyte substitution and fluid management to extracorporeal filtration of excess fluid and electrolytes. These are discussed within this chapter.

Erector spine plane block as postoperative rescue analgesia in thoracic surgery

2020 ◽  
Vol 106 (5) ◽  
pp. 388-391
Author(s):  
Marco Rispoli ◽  
Roberta Tamburri ◽  
Moana Rossella Nespoli ◽  
Marianna Esposito ◽  
Dario Maria Mattiacci ◽  
...  
Keyword(s):  
Thoracic Surgery ◽  
Rating Scale ◽  
Dynamic Assessment ◽  
Case Series ◽  
Blood Gas Analysis ◽  
Numeric Rating Scale ◽  
Forced Expiratory Volume ◽  
Gas Analysis ◽  
Rescue Analgesia ◽  
Surgical Ward

Objective: Erector spine plane block (ESPB) is a newly defined regional anesthesia technique performed by injection of local anesthetic beneath the erector spine muscle. We tested ESPB as a regional rescue analgesia bedside technique to be performed in the thoracic surgical ward, reporting a 7-patient case series. Methods: We report our experience in rescue analgesia after thoracic surgery. During the postoperative stay, numeric rating scale (NRS) score >3 and inability to perform physiotherapy or effective cough due to postoperative pain represented the criteria for proposing rescue analgesia with ESPB. NRS at rest and during movements was recorded; blood gas analysis and spirometry were performed to evaluate PaO2/FiO2 (P/F), forced vital capacity (FVC), and forced expiratory volume in 1 second (FEV1) before ESPB execution. After performing the ESPB, static and dynamic NRS, P/F, and FVC and FEV1 were recorded at 40 minutes and 80 minutes. Results: NRS had a reduction at rest and in dynamic assessment. The P/F did not improve but spirometric measures improved. FVC had a relevant improvement only after 80 minutes; FEV1 was increased after 40 minutes. Conclusion: The use of ESPB as postoperative rescue analgesia can offer several advantages due to effective rescue analgesia and safety that makes it easy to perform in the thoracic surgical ward or in an outpatient clinic setting.

Blood gas analysis

2018 ◽  
Author(s):  
Richard Paul ◽  
Paul Grant
Keyword(s):  
Ph Value ◽  
Fluid Management ◽  
Disease Process ◽  
Blood Gas Analysis ◽  
Underlying Disease ◽  
Gas Analysis ◽  
Blood Gas ◽  
Acid Base ◽  
Electrolyte Disorders ◽  
Arterial Blood

Acid-base homeostasis is vital for the maintenance of normal tissue and organ function, as both acidosis and alkalosis can have harmful and potentially life-threatening effects. Arterial blood gas analysis, combined with routine clinical history and examination, can provide useful information for the management of the critically ill cardiac patient. Most acid-base derangements are reversed by treatment of the underlying disease process, rather than simple correction of the abnormal pH, and prognosis is determined by the nature of the underlying disease, rather than the extent of pH value deviation. Within this chapter, a six-step approach is presented for prompt and accurate acid-base interpretation. Water and electrolyte disorders are common in the intensive cardiac care unit, particularly in patients with cardiac failure. Prompt recognition and treatment is required to prevent cardiovascular and neurological compromise. Therapeutic strategies range from simple electrolyte substitution and fluid management to extracorporeal filtration of excess fluid and electrolytes. These are discussed within this chapter.

Blood gas analysis: acid–base, fluid, and electrolyte disorders

2015 ◽  
Author(s):  
Richard Paul ◽  
Pavlos Myrianthefs ◽  
George Baltopoulos ◽  
Shaun McMaster
Keyword(s):  
Ph Value ◽  
Fluid Management ◽  
Disease Process ◽  
Blood Gas Analysis ◽  
Underlying Disease ◽  
Gas Analysis ◽  
Blood Gas ◽  
Acid Base ◽  
Electrolyte Disorders ◽  
Arterial Blood

Acid-base homeostasis is vital for the maintenance of normal tissue and organ function, as both acidosis and alkalosis can have harmful and potentially life-threatening effects. Arterial blood gas analysis, combined with routine clinical history and examination, can provide useful information for the management of the critically ill cardiac patient. Most acid-base derangements are reversed by treatment of the underlying disease process, rather than simple correction of the abnormal pH, and prognosis is determined by the nature of the underlying disease, rather than the extent of pH value deviation. Within this chapter, a six-step approach is presented for prompt and accurate acid-base interpretation. Water and electrolyte disorders are common in the intensive cardiac care unit, particularly in patients with cardiac failure. Prompt recognition and treatment is required to prevent cardiovascular and neurological compromise. Therapeutic strategies range from simple electrolyte substitution and fluid management to extracorporeal filtration of excess fluid and electrolytes. These are discussed within this chapter.

scholarly journals Screening Children with a Family History of Central Congenital Hypoventilation Syndrome

2020 ◽  
Vol 2020 ◽  
pp. 1-4
Author(s):  
Hina Emanuel ◽  
Kimberly Rennie ◽  
Kelly Macdonald ◽  
Aravind Yadav ◽  
Ricardo A. Mosquera
Keyword(s):  
Family History ◽  
Genetic Disorder ◽  
Neuropsychological Testing ◽  
Clinical Manifestations ◽  
Case Series ◽  
Blood Gas Analysis ◽  
Cor Pulmonale ◽  
Gas Analysis ◽  
Neuropsychological Evaluations ◽  
Hypoventilation Syndrome

Congenital central hypoventilation syndrome (CCHS) is a rare genetic disorder of an autonomic nervous disorder that affects breathing. It is characterized by respiratory insufficiency secondary to insensitivity to hypoxemia and hypercarbia, particularly during sleep leading to persistent apnea. We report four individuals across two generations harboring heterozygous 25 polyalanine repeats mutations (PARMs) in PHOX2B with a varying degree of phenotypic clinical manifestations. Two family members who reported to be “asymptomatic” were subsequently diagnosed with CCHS, based on genetic testing, obtained because of their family history. Genetic studies in the family including a mother and three offsprings revealed in-frame five amino acid PARMs of PHOX2B consistent with CCHS in addition to full clinical assessment. All affected individuals had evidence of hypercapnia on blood gas analysis with PCO2 in the range of 32–70 (mean; 61). Nocturnal polysomnogram revealed evidence of hypoventilation in two individuals (1 offspring and mother) with the end-tidal CO2 median of 54. Magnetic resonance imaging of brain revealed no abnormalities in the brain stem. There was no evidence of cor pulmonale on echocardiograms in all individuals. Neuropsychological testing was conducted on all four patients; two patients (mother and 1 offspring) had normal results, while the other two offspring exhibited some impairments on neuropsychological testing. This case series emphasizes the importance of screening first-degree relatives of individuals with confirmed CCHS to minimize complications associated with long-term ventilatory impairment. It also suggests that some patients with CCHS should undergo neuropsychological evaluations to assess for cognitive weaknesses secondary to their CCHS.

scholarly journals Metformin poisoning treated with high dose insulin dextrose therapy: a case series

2019 ◽  
Vol 26 (1) ◽  
pp. 72-78
Author(s):  
Theodore Young ◽  
Joaquim Cevallos ◽  
James Napier ◽  
Juan Martin-Lazaro
Keyword(s):  
Lactic Acidosis ◽  
Case Series ◽  
Blood Gas Analysis ◽  
Gas Analysis ◽  
Independent Effect ◽  
High Dose ◽  
Blood Gas ◽  
Compassionate Use ◽  
Life Threatening ◽  
Dextrose Infusion

Purpose. We describe the compassionate use of high dose insulin dextrose (HID) for life threatening metformin associated lactic acidosis (MALA) in four patients admitted to intensive care. Methods. Patients presenting with refractory lactic acidosis believed to be secondary to metformin poisoning were included. High dose insulin dextrose at 0.5units/kg/hour was infused in 50% dextrose. Frequent blood gas analysis allowed titration of therapy. All patients also received continuous veno-venous haemofiltration. Results. All four patients recovered to normal or near normal lactate and pH between 10 and 24 hours of therapy. Two patients had significant separation in time between initiation of HID and haemofiltration to suggest an independent effect of HID on improving pH and lactate. All patients had at least one episode of hypoglycaemia below 4.0 mmol/L with the lowest glucose in any patient during therapy being 3.0 mmol/L. All episodes were corrected with a dextrose infusion without sequelae. Conclusions. Our study demonstrates that HID therapy appears to be safe in patients with suspected metformin poisoning. It also appears to work to drive down lactate, improve pH and patients’ clinical condition. Further evidence is required to assess the effectiveness of HID therapy in the context of MALA.

scholarly journals A Retrospective Study on the Efficacy of PAH-targeted Therapy in Patients with Severe Pulmonary Hypertension in Chronic Lung Disease

2020 ◽  
Author(s):  
li jieying ◽  
sun zhang ◽  
haiming Chen ◽  
wenliang Guo ◽  
chunli Liu ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Targeted Therapy ◽  
Lung Disease ◽  
Chronic Lung Disease ◽  
Survival Rates ◽  
Oxygenation Index ◽  
Blood Gas Analysis ◽  
Gas Analysis ◽  
Right Atrial ◽  
Severe Pulmonary Hypertension

Abstract Background Using PAH-targeted therapy in severe pulmonary hypertension (PH) patients with chronic lung disease (CLD) is controversial as the pulmonary vasodilation could worsen hypoxemia. Objective To investigate the efficacy of patients with severe PH-CLD to PAH targeted therapy. Methods We retrospectively enrolled patients with severe PH-CLD in our study. Each patient underwent laboratory indicators and transthoracic echocardiography at baseline and after the therapy, and survival after therapy were also evaluated. Results After PAH targeted therapy, NT - proBNP significantly decreased (1043.10(236.75-2697.50) pg/ml vs 287.10(21.00-555.90) pg/ml, p=0.035), whereas PaO2 and the oxygenation index in blood gas analysis significantly increased(59.18± 30.12 mmHg vs 74.35(61.63-163.95)mmHg, p=0.010 and 177.21± 84.38 mmHg vs 286.22± 165.13 mmHg, p=0.035, respectively). But the difference at 1-,3- years survival rates between the two groups was not statistically significant (82.82% and 66.26% vs 75.87% and 20.23%, respectively, p=0.094). Multivariate regression analysis identified baseline mean right atrial pressure values and cardiac index as significant predictors of survival of patients with severe PH-CLD. Conclusions PAH targeted therapy may have benefit in patients with severe PH-CLD and didn’t worsen their hypoxemia. Right ventricular function might have an important impact on the survival of patients.

scholarly journals Trajectories of Hypoxemia & Respiratory System Mechanics of COVID-19 ARDS in the NorthCARDS dataset

2021 ◽  
Author(s):  
Daniel Jafari ◽  
Amir Gandomi ◽  
Alex Makhnevich ◽  
Michael Qiu ◽  
Daniel M Rolston ◽  
...  
Keyword(s):  
Hospital Admissions ◽  
Oxygenation Index ◽  
Blood Gas Analysis ◽  
Lung Compliance ◽  
Gas Analysis ◽  
Non Invasive ◽  
Level Data ◽  
Patient Heterogeneity ◽  
Trajectories Of Change ◽  
Post Intubation

AbstractRationaleThe preliminary reports of COVID Acute Respiratory Distress Syndrome (COVIDARDS) suggest the existence of a subset of patients with higher lung compliance despite profound hypoxemia. Understanding heterogeneity seen in patients with COVIDARDS and comparing to non-COVIDARDS may inform tailored treatments.ObjectivesTo describe the trajectories of hypoxemia and respiratory compliance in COVIDARDS and associations with outcomes.MethodsA multidisciplinary team of frontline clinicians and data scientists created the Northwell COVIDARDS dataset (NorthCARDS) leveraging over 11,542 COVID-19 hospital admissions. Data was summarized to describe differences based on clinically meaningful categories of lung compliance, and compared to non-COVIDARDS reports. A sophisticated method of extrapolating PaO2 from SpO2, as well estimating FiO2 from non invasive oxygen delivery devices were utilized to create meaningful trends of derived PaO2 to FiO2 (P/F).Measurements and Main ResultsOf the 1595 COVIDARDS patients in the NorthCARDS dataset, there were 538 (34·6%) who had very low lung compliance (<20ml/cmH2O), 982 (63·2%) with low-normal compliance (20-50ml/cmH2O), and 34 (2·2%) with high lung compliance (>50ml/cmH2O). The very low compliance group had double the median time to intubation compared to the low-normal group (107 hours(IQR 26·3, 238·3) vs. 37·9 hours(IQR 4·8, 90·7)). Oxygenation trends have improved in all groups after a nadir immediately post intubation. The P/F ratio improved from a mean of 109 to 155, with the very low compliance group showing a smaller improvement compared to low compliance group. The derived P/F trends closely correlated with blood gas analysis driven P/F trends, except immediately post intubation were the trends diverge as illustrated in the image. Overall, 67·5% (n=1049) of the patients died during the hospitalization. In comparison to non-COVIDARDS reports, there were less patients in the high compliance category (2.2%vs.12%, compliance ≥50mL/cmH20), and more patients with P/F ≤ 150 (57·8% vs. 45.6%). No correlation was apparent between lung compliance and P/F ratio. The Oxygenation Index was similar, (11·12(SD 5·67)vs.12·8(SD 10·8)).ConclusionsHeterogeneity in lung compliance is seen in COVIDARDS, without apparent correlation to degree of hypoxemia. Notably, time to intubation was greater in the very low lung compliance category. Understanding ARDS patient heterogeneity must include consideration of treatment patterns in addition to trajectories of change in patient-level data and demographics.

scholarly journals Equine multinodular pulmonary fibrosis (EMPF): Five case reports

2013 ◽  
Vol 61 (3) ◽  
pp. 319-332 ◽  
Author(s):  
Bianca Schwarz ◽  
Andrea Klang ◽  
Barbora Bezdekova ◽  
Sára Sárdi ◽  
Orsolya Kutasi ◽  
...  
Keyword(s):  
Pulmonary Fibrosis ◽  
Bronchoalveolar Lavage ◽  
Case Reports ◽  
Clinical Signs ◽  
Case Series ◽  
Blood Gas Analysis ◽  
Endoscopic Examination ◽  
Gas Analysis ◽  
Arterial Blood Gas ◽  
Arterial Blood

Equine multinodular pulmonary fibrosis (EMPF), a progressive fibrosing interstitial lung disease has been associated with gammaherpesviruses. This case series describes five horses with EMPF. Three of the horses (two in Hungary, one in the Czech Republic) were diagnosed with EMPF ante mortem. They presented with typical clinical signs of EMPF including dyspnoea and weight loss. Arterial blood gas analysis revealed hypoxaemia. Blood work showed signs of inflammation like neutrophilia and hyperfibrinogenaemia. An endoscopic examination of the respiratory tract including cytology and culture of tracheobronchial secretion and bronchoalveolar lavage were performed, revealing secondary bacterial infection in one case. A suspected diagnosis of EMPF was made on the basis of a positive EHV-5 PCR from bronchoalveolar lavage and the findings of thoracic radiographs and ultrasound examination. In one case the diagnosis was confirmed by lung biopsy. All horses died or had to be euthanised despite treatment. Two horses (from Austria) were diagnosed with EMPF post mortem. They not only had EMPF but also concurrent other diseases which seemed to be associated with immunosuppression. Three horses showed the discrete form and two horses the diffuse form of EMPF. EHV-5 DNA was identified in lung tissue of all horses by PCR.

Blood gas analysis: acid–base, fluid, and electrolyte disorders

2021 ◽  
pp. 165-180
Author(s):  
Farah Shariff ◽  
Richard Paul
Keyword(s):  
Ph Value ◽  
Fluid Management ◽  
Disease Process ◽  
Blood Gas Analysis ◽  
Underlying Disease ◽  
Gas Analysis ◽  
Blood Gas ◽  
Acid Base ◽  
Electrolyte Disorders ◽  
Arterial Blood Gas

Acid-base homeostasis is vital for the maintenance of normal tissue and organ function, as both acidosis and alkalosis can have harmful and potentially life-threatening effects on the human body. Arterial blood gas analysis, combined with routine clinical history and examination, can provide useful information for the management of the critically ill cardiac patient. Most acid–base derangements are reversed by treatment of the underlying disease process, rather than by simple correction of the abnormal pH, and prognosis is determined by the nature of the underlying disease, rather than by the extent of pH value deviation. In this chapter, an approach is presented for prompt and accurate acid–base interpretation. Water and electrolyte disorders are common in the intensive cardiac care unit, particularly in patients with cardiac failure. Prompt recognition and treatment are required to prevent cardiovascular and neurological compromise. Therapeutic strategies range from simple electrolyte substitution and fluid management to extracorporeal filtration of excess fluid and electrolytes. These are discussed in this chapter.

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