Effect of Endotracheal Suction with and Without Instillation of Normal Saline on Oxygenation, Hemodynamic and Arterial Blood Gases in Adult Mechanically Ventilated Patients

Abstract Objectives: Arterial blood gas measurements are not always immediately available despite their potential relevance to management of mechanically ventilated patients. Retrospective and prospective studies have validated the non-linear imputation of PaO2/FIO2 from SpO2/FIO2, predominantly in USA. In this study, the objective was to validate the non-linear imputation algorithm among mechanically ventilated patients in the Chinese population. Method: Mechanically ventilated patients admitted to the emergency departments or ICUs at two participating hospitals in China were enrolled prospectively. At the time of a clinical arterial blood gas being drawn, SpO2, oximeter waveform characteristics, receipt of vasopressor, and skin pigmentation were simultaneously recorded. For the various imputation methods, we calculated both imputation error and the area under the curve for patients meeting criteria for acute respiratory distress syndrome (PaO2/FIO2 ≤ 300) and moderate-severe acute respiratory distress syndrome (PaO2/FIO2 ≤ 150). Result: We studied 663 arterial blood gases from 646 patients; 177 (26%) arterial blood gases were associated with SpO2 less than or equal to 96%. Non-linear imputation had lower mean absolute error than linear imputation method when SpO2 was less than or equal to 96% (p<0.001). At the PaO2/FiO2 threshold of 300 or less, non-linear imputation AUC (0.90 95% CI 0.85-0/95) was not significantly higher than the AUCs of linear and log-linear imputation methods (0.88 95% CI 0.82-0.94). The same result was shown at the PaO2 /FiO2 threshold of 150 or less. For patients with a threshold SpO2 of 96% or less, AUC analysis yielded similar results between non-linear vs. linear and log-linear imputations. Conclusions: In this cohort of mechanically ventilated patients, non-linear imputation was not superior to linear and log-linear imputations for patients with SpO2 of 96% or less. All strategies performed similarly in estimating PaO2/FIO2 from SpO2/FIO2.

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Auto-PEEP effects on respiratory mechanics and blood gases in mechanically ventilated patients

Jornal de Pediatria ◽

10.2223/jped.442 ◽

1998 ◽

Vol 74 (4) ◽

pp. 275-83

Author(s):

Antônio C. P. Ferreira ◽

Benjamin I. Kopelman ◽

Werther Brunow de Carvalho ◽

Jorge Bonassa

Keyword(s):

Respiratory Mechanics ◽

Blood Gases ◽

Mechanically Ventilated ◽

Mechanically Ventilated Patients ◽

Ventilated Patients

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Accuracy of two pulse-oximetry measurements for INTELLiVENT-ASV in mechanically ventilated patients: a prospective observational study

Scientific Reports ◽

10.1038/s41598-021-88608-7 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Shinshu Katayama ◽

Jun Shima ◽

Ken Tonai ◽

Kansuke Koyama ◽

Shin Nunomiya

Keyword(s):

Oxygen Saturation ◽

Pulse Oximetry ◽

Prospective Observational Study ◽

Arterial Oxygen Saturation ◽

Arterial Oxygen ◽

Arterial Blood Gas ◽

Mechanically Ventilated ◽

Mechanically Ventilated Patients ◽

Arterial Blood ◽

Ventilated Patients

AbstractRecently, maintaining a certain oxygen saturation measured by pulse oximetry (SpO2) range in mechanically ventilated patients was recommended; attaching the INTELLiVENT-ASV to ventilators might be beneficial. We evaluated the SpO2 measurement accuracy of a Nihon Kohden and a Masimo monitor compared to actual arterial oxygen saturation (SaO2). SpO2 was simultaneously measured by a Nihon Kohden and Masimo monitor in patients consecutively admitted to a general intensive care unit and mechanically ventilated. Bland–Altman plots were used to compare measured SpO2 with actual SaO2. One hundred mechanically ventilated patients and 1497 arterial blood gas results were reviewed. Mean SaO2 values, Nihon Kohden SpO2 measurements, and Masimo SpO2 measurements were 95.7%, 96.4%, and 96.9%, respectively. The Nihon Kohden SpO2 measurements were less biased than Masimo measurements; their precision was not significantly different. Nihon Kohden and Masimo SpO2 measurements were not significantly different in the “SaO2 < 94%” group (P = 0.083). In the “94% ≤ SaO2 < 98%” and “SaO2 ≥ 98%” groups, there were significant differences between the Nihon Kohden and Masimo SpO2 measurements (P < 0.0001; P = 0.006; respectively). Therefore, when using automatically controlling oxygenation with INTELLiVENT-ASV in mechanically ventilated patients, the Nihon Kohden SpO2 sensor is preferable.Trial registration UMIN000027671. Registered 7 June 2017.

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Safety in intrahospital transportation: evaluation of respiratory and hemodynamic parameters. A prospective cohort study

Sao Paulo Medical Journal ◽

10.1590/s1516-31802008000600005 ◽

2008 ◽

Vol 126 (6) ◽

pp. 319-322 ◽

Cited By ~ 12

Author(s):

Bruno Franco Mazza ◽

José Luiz Gomes do Amaral ◽

Heloisa Rosseti ◽

Rosana Borges Carvalho ◽

Ana Paula Resque Senna ◽

...

Keyword(s):

Cohort Study ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Mechanically Ventilated ◽

Mechanically Ventilated Patients ◽

Arterial Blood ◽

Before And After ◽

High Risk Situation ◽

Change In Mean ◽

Ventilated Patients

CONTEXT AND OBJECTIVE: Intrahospital transportation of mechanically ventilated patients is a high-risk situation. We aimed to determine whether transfers could be safely performed by using a transportation routine. DESIGN AND SETTING: Prospective cohort study with "before and after" evaluation. METHODS: Mechanically ventilated patients who needed transportation were included. Hemodynamic and respiratory parameters were measured before and after transportation. Statistical analysis consisted of variance analysis and paired Student's t test. Results were considered significant if P < 0.05. RESULTS: We studied 37 transfers of 26 patients (12 female) of mean age 46.6 ± 15.7. Patients with pulmonary diseases, positive end expiratory pressure > 5, FiO2 > 0.4 and vasoactive drug use comprised 42.4%, 24.3%, 21.6% and 33.0% of cases, respectively. Mean duration of transportation was 43.4 ± 18.9 minutes. Complications occurred in 32.4%. There was a significant increase in CO2 (before transportation, 29.6 ± 7.3 and after transportation, 34.9 ± 7.0; P = 0.000); a trend towards improved PO2/FiO2 ratio (before transportation, 318.0 ± 137.0 and after transportation, 356.8 ± 119.9; P = 0.053); increased heart rate (before transportation, 80.9 ± 18.7 and after transportation, 85.5 ± 17.6; P = 0.08); and no significant change in mean arterial blood pressure (P = 0.93). CONCLUSION: These results suggest that intrahospital transportation can be safely performed. Our low incidence of complications was possibly related to both the presence of a multidisciplinary transportation team and proper equipment.

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