THE STUDY ON ARTERIAL BLOOD GAS IN PATIENTS WITH ACUTE STROKE

2017 ◽  
pp. 37-45
Author(s):  
Xuan Tai Nguyen ◽  
Dinh Toan Nguyen

Objectives: 1) To investigate the variation in arterial blood gas in patients with acute stroke according to ischemic stroke and hemorrhagic stroke. 2) To determine the correlation and relevance between arterial blood gas and Glasgow scale score, NIHSS, volume of brain damage on computed tomography imaging. Subjects and methods: A cross-sectional study was done in 70 patients with acute stroke. Results: Reduced rates of PCO2, PO2, SaO2 at the time of admission were 56.2%, 25%, 18.8% in ischemic stroke and 44.4%, 72.2%, 63% in hemorrhagic stroke. At the time of 24 hours, these rates were 75%, 56.2%, 50% in ischemic stroke and 50%, 79.6%, 70.4% in hemorrhagic stroke. At the time of 48 hours, these rates were 68.7%, 50%, 18.8% in ischemic stroke and 53.7%, 59.3%, 44.4% in hemorrhagic stroke. Respiratory acidosis was only present at hemorrhagic stroke. Respiratory alkalosis was in both stroke style and had the highest proportion. At the time of admission, SaO2 was negatively correlated with damage volume (r=- 0.264, p<0.05). HCO3- correlated with Glasgow (r=0.323; p<0.01) and NIHSS (r=-0.274; p<0.05). At the time of 24 hours, there was a negative correlation between PO2 (r=-0.375, p=0.001) and SaO2 (r =-0.39, p<0.01) with NIHSS. There was a negative correlation between PO2 (r=-0.435) and SaO2 (r=-0.457) with damage volume (p <0.0001). At the time of 48 hours, there was a negative correlation between PCO2, PO2 and SaO2 with NIHSS (r=-0.312, p<0.01, r=-0.35, p=0.01 and r=-0.0270, p<0.05). PCO2 was positively correlated with Glasgow (r = 0.260, p <0.05). There was a negative correlation between PO2 (r = - 0.391, p = 0.001) and SaO2 (r = - 0.421, p <0.001) with damage volume. Conclusions: In stroke patients, disturbances on ABG they are surfered from (acid-base disorders, hypoxemia) affect directly or indirectly on brain cells. Secondary brain damages could be well prevented if these disturbances is diagnosed and treated promptly. Key words: Stroke, arterial blood gas, Glasgow scale score, NIHSS

Author(s):  
Jyot Amrita

Summary   Background: COVID-19 is caused by a novel coronavirus, named severe acute respiratory syndrome coronavirus2 (SARS-CoV-2). The foremost predominant complication of SARS-CoV-2 is arterial hypoxemia thereby disturbing lung compliance, requiring mechanical ventilation. The aim of the current research study is to analyze role of ABG as a valuable assessment tool of disease severity in SARS-CoV-2 patients. Methods: 170 arterial blood samples were collected from patients admitted in Intensive Care Unit (ICU) of Sri Guru Ram Das Charitable Hospital, Amritsar. They were analyzed for arterial blood gas using ABG analyzer. Parameters of ABG such as pH, pCo2, HCO3, O2 saturation, ionized calcium (iCa) and calculated ionized calcium (at pH 7.4) was calculated for all the samples. Results: Continuous variables were described as medians with interquartile ranges (IQRs) and categorical variables as percentages and frequencies. Spearman correlation test was done for calculation of correlation between pH and other ABG parameters. Analysis of arterial blood gas revealed significant negative correlation (p<0.05) between pH and pCO2 and significant positive correlation (p<0.05) between pH and HCO3 and between pH and delta ionized calcium. Low levels (98.2%) of ionized calcium were observed while monitoring the ABG findings though weak negative correlation (p<0.05) was observed between pH and iCa. Conclusion: Our study suggests that ABG analysis acts as a momentous indicator for critically ill patients admitted in Intensive Care Unit (ICU). Estimation of iCa in this critical care setting acts as a distinctive biochemical feature of SARS-CoV-2 disease, as an initial assessment tool, for hypocalcemia. Keywords:  Arterial Blood Gas, SARS-CoV-2, Ionized Calcium, Hypocalcemia


PLoS ONE ◽  
2021 ◽  
Vol 16 (3) ◽  
pp. e0248264
Author(s):  
Sancho Rodríguez-Villar ◽  
Paloma Poza-Hernández ◽  
Sascha Freigang ◽  
Idoia Zubizarreta-Ormazabal ◽  
Daniel Paz-Martín ◽  
...  

Background Point-of-care arterial blood gas (ABG) is a blood measurement test and a useful diagnostic tool that assists with treatment and therefore improves clinical outcomes. However, numerically reported test results make rapid interpretation difficult or open to interpretation. The arterial blood gas algorithm (ABG-a) is a new digital diagnostics solution that can provide clinicians with real-time interpretation of preliminary data on safety features, oxygenation, acid-base disturbances and renal profile. The main aim of this study was to clinically validate the algorithm against senior experienced clinicians, for acid-base interpretation, in a clinical context. Methods We conducted a prospective international multicentre observational cross-sectional study. 346 sample sets and 64 inpatients eligible for ABG met strict sampling criteria. Agreement was evaluated using Cohen’s kappa index, diagnostic accuracy was evaluated with sensitivity, specificity, efficiency or global accuracy and positive predictive values (PPV) and negative predictive values (NPV) for the prevalence in the study population. Results The concordance rates between the interpretations of the clinicians and the ABG-a for acid-base disorders were an observed global agreement of 84,3% with a Cohen’s kappa coefficient 0.81; 95% CI 0.77 to 0.86; p < 0.001. For detecting accuracy normal acid-base status the algorithm has a sensitivity of 90.0% (95% CI 79.9 to 95.3), a specificity 97.2% (95% CI 94.5 to 98.6) and a global accuracy of 95.9% (95% CI 93.3 to 97.6). For the four simple acid-base disorders, respiratory alkalosis: sensitivity of 91.2 (77.0 to 97.0), a specificity 100.0 (98.8 to 100.0) and global accuracy of 99.1 (97.5 to 99.7); respiratory acidosis: sensitivity of 61.1 (38.6 to 79.7), a specificity of 100.0 (98.8 to 100.0) and global accuracy of 98.0 (95.9 to 99.0); metabolic acidosis: sensitivity of 75.8 (59.0 to 87.2), a specificity of 99.7 (98.2 to 99.9) and a global accuracy of 97.4 (95.1 to 98.6); metabolic alkalosis sensitivity of 72.2 (56.0 to 84.2), a specificity of 95.5 (92.5 to 97.3) and a global accuracy of 93.0 (88.8 to 95.3); the four complex acid-base disorders, respiratory and metabolic alkalosis, respiratory and metabolic acidosis, respiratory alkalosis and metabolic acidosis, respiratory acidosis and metabolic alkalosis, the sensitivity, specificity and global accuracy was also high. For normal acid-base status the algorithm has PPV 87.1 (95% CI 76.6 to 93.3) %, and NPV 97.9 (95% CI 95.4 to 99.0) for a prevalence of 17.4 (95% CI 13.8 to 21.8). For the four-simple acid-base disorders and the four complex acid-base disorders the PPV and NPV were also statistically significant. Conclusions The ABG-a showed very high agreement and diagnostic accuracy with experienced senior clinicians in the acid-base disorders in a clinical context. The method also provides refinement and deep complex analysis at the point-of-care that a clinician could have at the bedside on a day-to-day basis. The ABG-a method could also have the potential to reduce human errors by checking for imminent life-threatening situations, analysing the internal consistency of the results, the oxygenation and renal status of the patient.


Author(s):  
Jitendra Lakhani ◽  
Sajani Kapadia ◽  
Hetal Pandya ◽  
Roop Gill ◽  
Rohit Chordiya ◽  
...  

Background/Aims: The aim of present study was to find out profile and sequential pattern of Arterial Blood Gas (ABG) in critically ill Corona Virus Disease 2019 (COVID-19) patients. Study Design: Observational prospective study. Methodology: A total of 80 Reverse Transcription Polymerase Chain Reaction (RT PCR) positive cases; that needed ICU admission for their life-threatening conditions were included in this study done at teaching hospital of Gujarat, India. Non consenting patients and patients who could not be followed up as per protocol were excluded. Data of Arterial Blood Gas (ABG), performed on admission, day 5 and day 10 were taken for the analysis. Patients were followed up till they remained in ICU. Results: Of 80 patients, 3 patients had normal, 24 patients (30%) had primary disorder on ABG while 53 patients (66.25%) had mixed disorders. The most common ABG abnormality observed was respiratory alkalosis with metabolic acidosis in 16 patients (20%) while respiratory alkalosis with metabolic alkalosis in 15 patients (18.75%). There was difference in ABG pattern observed among survivors and non-survivors (P=.04); of which conspicuous was presence of “respiratory acidosis with metabolic acidosis” in 5 non-survivors (15.63%), which was not seen in survivors. Of 80 patients admitted in COVID ICU; 2 improved after day 1; 6 after day 5; 40 after day 10, making total of 48 patients surviving COVID critical condition. Of 32 non-survivors, 14 died within twenty-four hours of admission, 14 within first 5 days and 04 after 10 days of ICU stay. Conclusion: ABG done on admission and serially in severe COVID-19 patients gives useful information on underlying pathophysiology. Mixed ABG pattern was more common than single disorder which can be sign of multi-organ involvement.  Respiratory acidosis with metabolic acidosis was observed significantly higher in non-survivors. Respiratory alkalosis as a part of single or mixed pattern on ABG was the most common pattern found in critically ill COVID patients.


2022 ◽  
Vol 52 (4) ◽  
Author(s):  
Simone Marques Caramalac ◽  
Andreza Futado de Souza ◽  
Silvana Marques Caramalac ◽  
Verônica Batista de Albuquerque ◽  
Lucas Bezerra da Silva Azuaga ◽  
...  

ABSTRACT: Anesthetic protocols have been developed to obtain the most effective and safe association in wildlife. This study compared the anesthetic effects and cardiorespiratory parameters of ketamine-S (+) (10 mg/kg)/dexmedetomidine (0.020 mg/kg) (KD ) and ketamine-S (+) (10 mg/kg)/midazolam (0.5 mg/kg)/methadone (1.0 mg/kg) (KMM ) in capuchin monkeys (Sapajus apella). Eight capuchin monkeys were randomly assigned to KD (n = 4) or KMM (n = 4) to evaluate induction, immobilization, and recovery scores, heart and respiratory rate parameters, besides systolic, mean, diastolic arterial pressure and arterial blood gas. There was no difference (P = 0.56) in the quality of induction, immobilization, and anesthetic recovery between the protocols. The time for anesthetic induction was 4 ± 1 min in the KD group and 5 ± 1 min in the KMM group, and these values were statistically equal (P = 0.28). The mean immobilization time in the KD and KMM groups were 35 ± 13 and 33 ± 15 min, respectively. Heart rate was lower in animals in the KD group (P < 0.001), while respiratory rate (P = 0.03), and mean blood pressure (P = 0.046) were higher than that of the animals in the KMM group. Respiratory acidosis occurred in the KMM group, with lower pH (7.25±0.047; P = 0.0055) and higher pCO2 (51 ± 6;mmHg; P = 0.008). Both protocols exhibited good induction quality, immobilization, and anesthetic recovery, despite cardiorespiratory and blood gas alterations observed, which warrants monitoring of cardiorespiratory variables during KD or KMM chemical restraint.


2003 ◽  
Vol 10 (6) ◽  
pp. 311-315 ◽  
Author(s):  
Tereza Martinu ◽  
Dick Menzies ◽  
Sandra Dial

RATIONALE: The prediction rules for the evaluation of the acid-base status in patients with chronic respiratory acidosis, derived primarily from an experimental canine model, suggest that complete compensation should not occur. This appears to contradict frequent observations of normal or near-normal pH levels in patients with chronic hypercapnia.METHODS: Linear regression analysis was used to estimate the relationships between arterial pH, bicarbonate and partial pressure of carbon dioxide (PCO2) from 18 separate arterial blood gas measurements in 18 clinically stable outpatients with chronic hypercapnic respiratory failure from chronic obstructive lung disease, and without clinical conditions or medications likely to cause a primary metabolic alkalosis.RESULTS: The PCO2ranged from 45 mmHg to 77 mmHg, and pH ranged from 7.37 to 7.44. In only three of the arterial blood gas measurements were the pH values lower than 7.38. From the regression equations derived from these measurements, the pH decreased by 0.014 for each 10 mmHg increase in the PCO2, and the bicarbonate level increased by 5.1 mmol/L. These values are quite different from a decrease in pH of 0.03 and an increase in bicarbonate of 3.5 mmol/L predicted using the rules derived from the canine model.CONCLUSIONS: In patients with chronic stable hypercapnia, acid-base compensatory mechanisms appear to be more effective than would be predicted using the classic rules.


2019 ◽  
pp. 203-206
Author(s):  
Mevlut Demir ◽  
◽  
Muslum Sahin ◽  
Ahmet Korkmaz ◽  
◽  
...  

Carbon monoxide intoxication occurs usually via inhalation of carbon monoxide that is emitted as a result of a fire, furnace, space heater, generator, motor vehicle. A 37-year-old male patient was admitted to the emergency department at about 5:00 a.m., with complaints of nausea, vomiting and headache. He was accompanied by his wife and children. His venous blood gas measures were: pH was 7.29, partial pressure of carbon dioxide (pCO2) was 42 mmHg, partial pressure of oxygen (pO2) was 28 mmHg, carboxyhemoglobin (COHb) was 12.7% (reference interval: 0.5%-2.5%) and oxygen saturation was 52.4%. Electrocardiogram (ECG) examination showed that the patient was not in sinus rhythm but had atrial fibrillation. After three hours the laboratory examination was repeated: Troponin was 1.2 pg/ml and in the arterial blood gas COHb was 3%. The examination of the findings on the monitor showed that the sinus rhythm was re-established. The repeated ECG examination confirmed the conversion to the sinus rhythm. He was monitored with the normobaric oxygen administration.


2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Benjamin Gaston ◽  
Santhosh M. Baby ◽  
Walter J. May ◽  
Alex P. Young ◽  
Alan Grossfield ◽  
...  

AbstractWe have identified thiolesters that reverse the negative effects of opioids on breathing without compromising antinociception. Here we report the effects of d-cystine diethyl ester (d-cystine diEE) or d-cystine dimethyl ester (d-cystine diME) on morphine-induced changes in ventilation, arterial-blood gas chemistry, A-a gradient (index of gas-exchange in the lungs) and antinociception in freely moving rats. Injection of morphine (10 mg/kg, IV) elicited negative effects on breathing (e.g., depression of tidal volume, minute ventilation, peak inspiratory flow, and inspiratory drive). Subsequent injection of d-cystine diEE (500 μmol/kg, IV) elicited an immediate and sustained reversal of these effects of morphine. Injection of morphine (10 mg/kg, IV) also elicited pronounced decreases in arterial blood pH, pO2 and sO2 accompanied by pronounced increases in pCO2 (all indicative of a decrease in ventilatory drive) and A-a gradient (mismatch in ventilation-perfusion in the lungs). These effects of morphine were reversed in an immediate and sustained fashion by d-cystine diME (500 μmol/kg, IV). Finally, the duration of morphine (5 and 10 mg/kg, IV) antinociception was augmented by d-cystine diEE. d-cystine diEE and d-cystine diME may be clinically useful agents that can effectively reverse the negative effects of morphine on breathing and gas-exchange in the lungs while promoting antinociception. Our study suggests that the d-cystine thiolesters are able to differentially modulate the intracellular signaling cascades that mediate morphine-induced ventilatory depression as opposed to those that mediate morphine-induced antinociception and sedation.


2021 ◽  
Vol 11 (3) ◽  
pp. 517-521
Author(s):  
Alejandro Montero-Salinas ◽  
Marta Pérez-Ramos ◽  
Fernando Toba-Alonso ◽  
Leticia Quintana-DelRío ◽  
Jorge Suanzes-Hernández ◽  
...  

Aim. To evaluate the influence of time on arterial blood gas values after artery puncture is performed. Method. Prospective longitudinal observational study carried out with gasometric samples from 86 patients, taken at different time intervals (0 (T0), 15 (T15), 30 (T30) and 60 (T60) min), from 21 October 2019 to 21 October 2020. The study variables were: partial pressure of carbon dioxide, bicarbonate, hematocrit, hemoglobin, potassium, lactic acid, pH, partial pressure of oxygen, saturation of oxygen, sodium and glucose. Results. The initial sample consisted of a total of 90 patients. Out of all the participants, four were discarded as they did not understand the purpose of the study; therefore, the total number of participants was 86, 51% of whom were men aged 72.59 on average (SD: 16.23). In the intra-group analysis, differences in PCO2, HCO3, hematocrit, Hb, K+ and and lactic acid were observed between the initial time of the test and the 15, 30 and 60 min intervals. In addition, changes in pH, pO2, SO2, Na and glucose were noted 30 min after the initial sample had been taken. Conclusions. The variation in the values, despite being significant, has no clinical relevance. Consequently, the recommendation continues to be the analysis of the GSA at the earliest point to ensure the highest reliability of the data and to provide the patient with the most appropriate treatment based on those results.


Animals ◽  
2021 ◽  
Vol 11 (7) ◽  
pp. 2049
Author(s):  
Elżbieta Stefanik ◽  
Olga Drewnowska ◽  
Barbara Lisowska ◽  
Bernard Turek

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.


Author(s):  
Kirsty L. Ress ◽  
Gus Koerbin ◽  
Ling Li ◽  
Douglas Chesher ◽  
Phillip Bwititi ◽  
...  

AbstractObjectivesVenous blood gas (VBG) analysis is becoming a popular alternative to arterial blood gas (ABG) analysis due to reduced risk of complications at phlebotomy and ease of draw. In lack of published data, this study aimed to establish reference intervals (RI) for correct interpretation of VBG results.MethodsOne hundred and 51 adult volunteers (101 females, 50 males 18–70 y), were enrolled after completion of a health questionnaire. Venous blood was drawn into safePICO syringes and analysed on ABL827 blood gas analyser (Radiometer Pacific Pty. Ltd.). A non-parametric approach was used to directly establish the VBG RI which was compared to a calculated VBG RI based on a meta-analysis of differences between ABG and VBGResultsAfter exclusions, 134 results were used to derive VBG RI: pH 7.30–7.43, partial pressure of carbon dioxide (pCO2) 38–58 mmHg, partial pressure of oxygen (pO2) 19–65 mmHg, bicarbonate (HCO3−) 22–30 mmol/L, sodium 135–143 mmol/L, potassium 3.6–4.5 mmol/L, chloride 101–110 mmol/L, ionised calcium 1.14–1.29 mmol/L, lactate 0.4–2.2 mmol/L, base excess (BE) −1.9–4.5 mmol/L, saturated oxygen (sO2) 23–93%, carboxyhaemoglobin 0.4–1.4% and methaemoglobin 0.3–0.9%. The meta-analysis revealed differences between ABG and VBG for pH, HCO3−, pCO2 and pO2 of 0.032, −1.0 mmol/L, −4.2 and 39.9 mmHg, respectively. Using this data along with established ABG RI, calculated VBG RI of pH 7.32–7.42, HCO3− 23 – 27 mmol/L, pCO2 36–49 mmHg (Female), pCO2 39–52 mmHg (Male) and pO2 43–68 mmHg were formulated and compared to the VBG RI of this study.ConclusionsAn adult reference interval has been established to assist interpretation of VBG results.


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