Arterial Blood Gases In Patients Research Articles

Effect of standard feeding with a high-protein diet on arterial blood gases in patients admitted to the intensive care units: A study protocol for a double-blinded, randomized controlled clinical trial

Critically ill patients admitted to the intensive care units (ICUs) often face numerous challenges, including severe metabolic stress, systemic inflammation, and compromised immune function. Studies have suggested that critically ill patients frequently experience a negative nitrogen balance due to a hypercatabolic state, leading to impaired organ function and muscle wasting, which can cause severe muscle weakness and physical disability for years after discharge. Arterial blood gases (ABG) reflect patients' oxygenation and acid-base status and are crucial indicators of respiratory and metabolic function in critically ill individuals. We aim to address this by conducting a double-blinded, randomized controlled clinical trial to compare the effects of standard feeding with a high-protein diet on ABG in ICU patients. In this double-blinded, randomized controlled clinical trial, we will use block randomization of 80 patients aged between 18 to 65 years old and Patients expected to be hospitalized in the ICU for at least 3 days from Kosar Hospital, Kurdistan, Iran. The intervention group (n=40) will receive a protein diet (consisting of 18.7% protein, 45% carbohydrates, and 35% fat per 1000cc). A control group (n=40) will receive a standard diet (14.4% protein, 54% carbohydrates, and 32.4% fat per 1000cc) for the same duration in addition to usual care. The caloric requirements of each patient will be determined by a nutritionist based on their nutritional status, height, weight, age, and initial diagnosis, utilizing the Harris-Benedict formula. The parameters of ABG, including PO2, PCO2, SAO2, HCO3, BE, and pH, will be assessed. By optimizing protein intake through a high-protein diet, we aim to improve the nutritional status of patients and enhance their overall clinical outcomes. This reassures us of the potential benefits of our study.

Hypercapnia is not excluded by normoxia in neuromuscular disease patients: implications for oximetry.

Pulse oximetry is widely used in the assessment of chronic respiratory failure in neuromuscular disease (NMD) patients. Chronic respiratory failure is the major cause of morbidity and mortality, necessitating early diagnosis and intervention. Guidelines suggest that an arterial blood gas (ABG) measurement is indicated if oxygen saturation (S pO2 ) is ≤94% in the absence of lung disease. However, hypercapnia with normoxia (S pO2 ≥95%) has been observed on ABGs of patients with NMD, in particular those with motor neurone disease. A single-centre retrospective audit of room-air ABGs in stable hypercapnic chronic respiratory failure patients from 1990 to 2020 was performed. Patients with parenchymal lung disease were excluded. Patients were grouped into three main categories: non-NMD, other NMD and motor neurone disease. 297 ABGs with hypercapnia from 180 patients with extrinsic restrictive lung disease were analysed. No patients with non-NMD, 54% of patients with other NMD and 36% of motor neurone disease patients demonstrated hypercapnia with normoxia (Chi-squared 61.33; p<0.001). The potential mechanism is proposed to be a difference in calculated respiratory quotient. If the alveolar-arterial gradient is assumed to be normal, the calculated respiratory quotient was significantly higher in motor neurone disease patients and other NMD patients compared with non-NMD patients (estimated marginal mean 0.99, 95% CI 0.94-1.03; 0.86 0.76-0.96; 0.73, 0.63-0.83, respectively; p<0.001) by mixed-model analysis. Hypercapnia is not excluded with normal oximetry in NMD patients and may be due to an elevated respiratory quotient. This has implications in the diagnosis and monitoring of respiratory insufficiency in NMD patients with oximetry alone.

Characteristics of pulse oximetry and arterial blood gas in patients with fibrotic interstitial lung disease

BackgroundFibrotic interstitial lung disease (ILD) is frequently associated with abnormal oxygenation; however, little is known about the accuracy of oxygen saturation by pulse oximetry (SpO2) compared with arterial blood gas...

Arterial Blood Gas Analysis in Patients with Stridor, and the Impact of Emergency Tracheostomy on It: A Tertiary Care Center Experience.

Comparative evaluation of arterial blood gas in patients with stridor, before and after emergency tracheostomy. The present prospective study was conducted in tertiary care Centre from February 2022 to June 2023 on 42 patients who presented with stridor and underwent emergency tracheostomy in our department. After proper history taking and clinical examination, nonsurgical cause of stridor was ruled out. Patients were then classified on the basis of location of cause of stridor (whether oropharyngeal, hypo-pharyngeal, supra-glottic, glottic or sub-glottic). Immediately an arterial blood gas (ABG) analysis was done, and emergency tracheostomy was performed. Following tracheostomy, ABG analysis was done immediately, after 12h and after 24h. The mean age of presentation of stridor in our study was 65.02 ± 3.23years, with male preponderance (Male: female ratio being 3.66:1). Most common etiology of stridor in our study was glottic carcinoma comprising 50%, and least common etiology of stridor was hypopharyngeal carcinoma, and subglottic stenosis comprising 2.4% each. There was statistically significant normalization of ABG in terms of pH, PO2, PCO2, HCO3. Mean pH, PO2, PCO2, and HCO3 before tracheostomy were 7.31, 74.8, 60.6, and 29.8 respectively. Mean pH, PO2, PCO2, HCO3, immediately after tracheostomy were7.38, 91.3, 48.4, and 27.4 respectively. After 12h of tracheostomy, mean pH, PO2, PCO2, HCO3 were 7.41, 95.4, 42.7, 25.3 respectively. Mean pH, PO2, PCO2, HCO3 24h after emergency tracheostomy were 7.441, 95.5, 42.8, 24.6 respectively. Emergency tracheostomy in stridor patients improves the acid base and ventilatory status, by relieving the obstruction as evidenced by statistically significant improvement in arterial blood gas values, and can be used as a diagnostic tool in upper airway obstruction.

Can venous blood gas be used instead of arterial blood gas in emergency department?

Objective: In our study, we aimed to evaluate the usability of venous blood gas (VBG) in substitution for arterial blood gas (ABG).&#x0D; &#x0D; Methods: In this study, 110 patients with respiratory complaints, who were brought intubated were evaluated prospectively. Arterial and venous blood gases were taken simultaneously shortly before the initiation of oxygen therapy in the emergency department. PH, pO2, pCO2, SaO2, HCO3, lactate (Lac) and BEecf values were recorded.&#x0D; &#x0D; Results: Of the 110 patients included in the study, 75 were male (68.2%), 35 were female (31.8%), and they had a mean age of 53.7 ± 23.1 years. A strong positive correlation between PH, PCO2, HCO3-, BEecf, Lac values (p=0.001) and positive correlation between PO2 and SaO2 values (p= 0.002) were detected.&#x0D; &#x0D; Conclusion: We can conclude that venous blood gas be used in substitution for arterial blood gas in patients who are presented to emergency service and it may reduce the need for arterial blood gas sampling.

Role of Arterial versus Venous Lactate and Base Deficit in Assessing Prognosis of Septic Patients

Abstract Background Septic shock is a syndrome of pathologic, physiologic, and biochemical disturbances caused by infection, and it is a major public health concern worldwide. Many techniques have been developed for the early detection of septic shock and prompt resuscitation. Lactate-guided resuscitation decreased mortality in patients with septic shock compared to that of resuscitation without lactate monitoring. In 2016, the international consensus launched a new sepsis definition (Sepsis-3), which is composed of the sepsis condition, the need for a vasopressor to maintain a mean arterial pressure of ≥ 65 mmHg and a serum lactate level rising to be ≥ 2 mmol/L in the absence of hypovolemia. Aim of the Work The aims of the study are to determine if lactate and standard base deficit can be used interchangeably in patients with septic shock in the emergency setting and to demonstrate whether venous blood gases could act as a surrogate for arterial blood gases in patients with sepsis syndrome. Patients and Methods This prospective observational study was conducted on 35 patients admitted to the ICU with a diagnosis of sepsis or septic shock in the Intensive Care Units at Ain Shams University Hospitals through 6 months. Results Our study found a significant correlation and high levels of agreement between arterial lactate and peripheral venous lactate in patients admitted to ICU with sepsis indicating the possibility of their interchangeable use. Our data also demonstrated strong correlations across lactate and base excess but not between lactate and anion gap in patients with septic syndrome. The results of our study indicate that base deficit is superior to lactate level as a predictor of mortality. Only, the 2nd arterial and venous base deficit at 24-hours revealed highly significant differences between both survivors and non-survivors. Conclusion Our study demonstrated a high level of agreement in the lactate levels as measured on venous samples and arterial samples in patients with septic syndrome; we also demonstrated that lactate and base excess showed a strong correlation with each other, but not with anion gap. Thus, these biomarkers can be used interchangeably to help in the early determination of septic shock, and also venous lactate levels are reliable in the resuscitation of patients with sepsis. A larger multicenter study may be required to confirm the generalizability of our results.

The effect of rewarming on hemodynamic parameters and arterial blood gases of patients after open-heart surgery: A randomized controlled trial

Hypothermia after open-heart surgery can have potential side effects for patients. This study aimed to examine the effects of rewarming on patients' hemodynamic and arterial blood gases parameters after open-heart surgery. This randomized controlled trial was performed in 2019 on 80 patients undergoing open-heart surgery at Tehran Heart Center, Iran. The subjects were consecutively recruited and randomly assigned to an intervention group (n=40) and a control group (n=40). After the surgery, the intervention group was warmed with an electric warming mattress while the control group warmed using a simple hospital blanket. The hemodynamic parameters of the two groups were measured 6 times and arterial blood gas was measured 3 times. Data were analyzed by independent samples t and Chi-squared tests, and repeated measures analysis. Before the intervention, the two groups did not significantly differ in terms of hemodynamic and blood gas parameters. However, the two groups were significantly different in the mean heart rate, systolic blood pressure, diastolic blood pressure, mean arterial blood pressure, temperature, right and left lung drainage in the first half-hour, and the first to fourth hours after the intervention (p < 0.05). Furthermore, there was a significant difference between the mean arterial oxygen pressure of the two groups during and after rewarming (P <0.05). Rewarming of patients after open-heart surgery can significantly affect hemodynamic and arterial blood gas parameters. Therefore, rewarming methods can be used safely to improve the patients' hemodynamic parameters after open-heart surgery.

Effect of visual endotracheal tube combined with bronchial occluder on pulmonary ventilation and arterial blood gas in patients undergoing thoracic surgery.

To investigate the effect of visual endotracheal tube combined with bronchial occluder on pulmonary ventilation and arterial blood gas in patients undergoing thoracic surgery. Ninety patients who underwent thoracic surgery under anesthesia and required pulmonary ventilation at our hospital from May 2020 to December 2021 were collected. The patients were divided into three groups according to different intubation methods: visual double-lumen endotracheal tube group (VDLT group), bronchial occluder group (BO group), and VDLT + BO group. Clinical data and laboratory test data were collected from the three groups. Additionally, the three groups were compared in terms of peak airway pressure, time to correct positioning, pulmonary ventilation time, hemodynamics before and after intubation, intubation success rate, and postoperative recovery. The VDLT + BO group was superior to the BO group or VDLT group in airway peak pressure, time to correct positioning, pulmonary ventilation time, intubation success rate, and hemodynamics after intubation (P < 0.05). In the comparison of postoperative recovery, the postoperative pain score, white blood cell level, incidence rate of pneumonia, hospital stay and hospitalization costs in the VDLT + BO group were significantly lower than those in the BO group or VDLT group (P < 0.05). The visual endotracheal tube combined with bronchial occluder is effective in pulmonary ventilation during thoracic surgery under anesthesia, and can improve arterial blood gas in patients.

Assessment of the Utility of Point-of-Care Testing Incorporating Ultrasound and Arterial Blood Gas in Patients with Acute Febrile Illness in the Emergency Department to Determine Disease Severity, Disposition, Need for Ventilation and Renal Replacement Therapy.

Acute febrile illness (AFI) patients present to the emergency department (ED), with fever to multi-organ dysfunction. There is a lack of early point-of-care-based disposition criteria in AFI patients regarding the need for intensive care unit (ICU) or high dependency unit (HDU) care. We enrolled 100 patients with AFI presenting to the ED and evaluated using point-of-care ultrasound with two-dimensional echocardiography (ECHO), lung ultrasound score (LUS), renal arterial resistive index (RRI), and arterial blood gas. The need for ICU/HDU admission, ventilation (either noninvasive or invasive), and renal-replacement therapy (RRT) within 48 h of hospitalization was noted. Ninety-five patients were included in the analysis. 72 (75.8%) patients required either ICU or HDU admission, 45 (47.4%) required ventilatory support (either noninvasive or invasive), and 32 (33.7%) required RRT. After logistic regression, LUS ≥16, and arterial lactate ≥12 mg/dL were independent predictors of the need for ICU or HDU admission. The respiratory rate (RR) ≥28/minute, LUS ≥16 and RRI ≥61 were the independent predictors of the need for ventilation. The MAP ≤73 mmHg, LUS (≥16), and RRI (≥67) were the predictors of the need for RRT. In AFI patients presenting to the ED, the MAP, LUS, and lactate are predictors of the need for ICU/HDU admission. The LUS and RRI were predictors of the need for RRT whereas the RR, LUS, and RRI were the predictors of the need for ventilation.

Changes of blood gas analysis in moderate-to-severe acute respiratory distress syndrome patients during long-term prone position ventilation: a retrospective cohort study.

Prone position ventilation (PPV) has been recommended for patients with acute respiratory distress syndrome (ARDS) to improve oxygenation. However, whether prolonged prone ventilation will aggravate hyperoxia and whether abdominal compression will aggravate permissive hypercapnia acidosis are topics of concern. We carried out a retrospective analysis to investigate the issues above. Clinical data were collected from 97 moderate-to-severe ARDS patients who received PPV as part of their treatment in the intensive care unit (ICU) of the First Affiliated Hospital of Guangzhou Medical University from November 2015 to May 2021. We collected arterial blood gas of patients according to the 3 periods: supine position ventilation (SPV), PPV early stage (within 4 hours), and PPV middle and late stage (6 hours or later). We established a linear mixed-effects models with "body position changes, times of PPV, gender, age, baseline SOFA, and baseline APACHE II" as fixed effects, and individual and the number of prone positions as random intercept and random slope to investigate the effect of body position changes on blood gas analysis. Among the 97 patients received PPV included, 51 were ICU survivors. Arterial partial pressure of oxygen (PaO2) and PaO2/fraction of inspired oxygen (FiO2) ratio were significantly higher at the early, middle and late stages of PPV than those in SPV [PFR (mmHg): 158 (118.00, 203.00) vs. 161 (129.00, 202.75) vs. 123 (91.75, 163.00), P<0.05]. Despite the synchronized reduction of FiO2, the incidence of hyperoxia in the prone position was still significantly higher than that in the supine position [hyperoxia (%):33.33 vs. 33.56 vs. 12.42, P<0.05]; there was no significant change in arterial carbon dioxide partial pressure (PaCO2) at each stage of PPV, but there was a significant increase in PH at PPV middle and late stages than those at early stage [PH: 7.39 (7.34, 7.42) vs. 7.37 (7.31, 7.41), P<0.05]. Although PPV improves the patients' oxygenation, the associated incidence of hyperoxia exceeds 33%. Down-regulate FiO2 more sharply after PPV is necessary, if oxygenation conditions permit. PPV may alleviate the acidosis associated with permissive hypercapnia in ARDS patients treated with lung protective ventilation strategy (LPVS).

211.7: Is Pulse Oximetry a Good Screening Test for Hepatopulmonary Syndrome in Liver Transplant Candidates?

Background: Pulse oximetry with oxygen saturation (SpO2) ≤96% is recommended as a screening test to identify patients (pts) with severe hepatopulmonary syndrome (HPS) to be eligible for MELD exceptions. However, diagnosis of milder forms requires contrast-enhanced echocardiography (CE-TTE) and arterial blood gas (ABG). Goals: 1) To investigate the prevalence of intrapulmonary vascular dilatations (IPVD) and HPS in pts with cirrhosis evaluated for liver transplantation (OLT) and 2) To compare the results of SpO2 with ABG measurements. Methods: The study included 972 consecutive pts (2013-2021) who completed pre-OLT evaluation including CE-TTE, SpO2 and ABG. IPVD was defined as the appearance of microbubbles in the left heart within 3-5 cardiac cycles and HPS by an alveolar arterial O2 gradient ≥ 15 mm Hg or ≥ 20 if age > 64 and absence of pulmonary chronic diseases. HPS was considered as mild, moderate or severe according to PaO2 (>80, 60-80 and <60 respectively). Results: The prevalence of IPVD was 15.4% (150/972) and of HPS 7.8% (76/972). Age of pts with HPS was 47±3 years (57% males) and MELD-Na 17± 1.HCV, alcoholism and autoimmune hepatitis were the most frequent etiologies of cirrhosis (22% each). Among pts with HPS 59 (78%) were mild (PaO2 108 ±22), 13 (17%) moderate (73 ±4) and 4 severe (55.5±3). SpO2 was ≤96% in 26% (20/76), 15% in mild (9/59), 54% in moderate (8/13) and 100% in severe (4/4) HPS. Unexpectedly, of 20 pts with Spo2 ≤96% only 4 had PaO2 <60 mmHg. Conclusions: Universal testing with CE-TTE followed by ABG in patients with cirrhosis evaluated for OLT resulted in a lower prevalence than reported of HPS, most likely due to the preponderance of mild clinical forms with normal SpO2. Using the recommended cut-off value of Spo2 ≤96% we found a poor correlation between pulse oximetry and ABG measurement.

Base excess, bicarbonate, and lactate levels predict 28-day mortality in patients with COVID-19: a retrospective study

Aim: It is critical to categorize the risk factors that could disclose the severity of COVID-19. This study aimed to determine the effects of arterial blood gases on hospital mortality by examining the results retrospectively measured at the first admission to the emergency department of cases diagnosed with COVID-19.&#x0D; Material and Method: In this retrospective study, arterial blood gases of patients with COVID-19 were analyzed using univariate analysis to identify factors linked to 28-day all-cause in-hospital mortality. The patients were divided into two groups survivors and nonsurvivors.&#x0D; Results: The study included 159 survivors and 33 nonsurvivors with COVID-19. Serum levels of lactate, D-dimer, troponin, and CRP were higher and serum levels of base excess, bicarbonate, and albumin to creatinine ratio were lower in nonsurvivor patients than in survivors. The highest AUC was found for lactate and base excess.&#x0D; Conclusion: The arterial blood gases performed during the first admission to the emergency department are linked with disease severity and can be used to predict disease progression and mortality. Furthermore, patients with higher levels of lactate and lower levels of base excess and bicarbonate should be monitored closely and treated early.

Evaluation of arterial blood gases of patients with type 1-2 respiratory failure diagnosed in intensive care using the quantitative Stewart method

Introduction: Arterial blood gases are tests that provide reliable information about the metabolic and respiratory status of patients. In traditional methods, arterial blood gases are evaluated by calculating the bicarbonate concentration and anion gap in the plasma. Since ICU patients almost always have protein and electrolyte disorders, a different method has been suggested instead of the traditional method that neglects electrolyte and protein in the evaluation. In the mathematical model described by Stewart and modified by Figge et al., 4 types of respiratory failure were defined according to their pathophysiology: hypoxemic (type 1), hypercapnic (type 2), perioperative (type 3), and hypoperfusion-induced respiratory failure in shock patients (type 4). The study aims to evaluate the arterial blood gases of intensive care patients with type 1 and type 2 respiratory failure with the Stewart method and compare them with the traditional method.&#x0D; Material and Method: In the study, serum BUN (blood urea nitrogen), creatinine, glucose, sodium, chlorine, serum BUN (blood urea nitrogen) of 106 patients diagnosed with type 1-2 respiratory failure. Together with potassium, magnesium, albumin values, pH, pCO2, pO2, HCO3, base deficit, and lactate values studied in arterial blood gas sample were determined and evaluated according to the Stewart method.&#x0D; Results: The length of stay of the patients in the intensive care unit was determined as 17.48±10.58 (minimum 6-maximum 68) days. It was determined that 74 (69.8%) of the patients were discharged and 32 (30.2%) died. When the blood gases and laboratory values of the patients were compared according to the clinical outcomes of the patients, no statistically significant correlation was found between the patients’ mean pH, pCO2, HCO3, base deficit, pO2, albumin, lactate, creatinine, glucose, potassium, and chlorine values and the patients’ discharge or death. BUN values of patients who died were found to be higher than those who were discharged. A statistically significant difference was found between the development of hypoalbuminemia and the length of stay in the intensive care unit. It has been determined that the treatment costs of patients with severe hypoalbuminemia are higher than other patients. The length of stay in the intensive care unit of the patients who did not develop acidosis was found to be statistically significantly lower than the patients who developed metabolic and respiratory acidosis.&#x0D; Conclusion: While a significant relationship was found between albumin levels, which has an important place in the Stewart method, and the length of stay in the intensive care unit, no relationship was found between albumin levels or lactate levels and mortality. However, increased BUN values were associated with mortality. As the albumin value decreases in patients with hypoalbuminemia, treatment costs increase. There is a need for larger multicenter studies with a larger sample group that will evaluate metabolic status with the Stewart method and investigate its relationship with mortality.

Is pulse oximeter a reliable tool for non-critically ill patients with COVID-19?

IntroductionGuidelines recommend using a pulse oximeter rather than arterial blood gas (ABG) for COVID‐19 patients. However, significant differences can be observed between oxygen saturation measured by pulse oximetry (SpO2) and arterial oxygen saturation (SaO2) in some clinical conditions. We aimed to assess the reliability of the pulse oximeter in patients with COVID‐19.MethodsWe retrospectively reviewed ABG analyses and SpO2 levels measured simultaneously with ABG in patients hospitalised in COVID‐19 wards.ResultsWe categorised total 117 patients into two groups, in whom the difference between SpO2 and SaO2 was ≤4% (acceptable difference) and >4% (large difference). A large difference group exhibited higher neutrophil count, C‐reactive protein, ferritin, fibrinogen, D‐dimer and lower lymphocyte count. Multivariate analyses revealed that increased fibrinogen, increased ferritin and decreased lymphocyte count were independent risk factors for a large difference between SpO2 and SaO2. The total study group demonstrated the negative bias of 4.02% with the limits of agreement of −9.22% to 1.17%. The bias became significantly higher in patients with higher ferritin, fibrinogen levels and lower lymphocyte count.ConclusionPulse oximeters may not be sufficient to assess actual oxygen saturation, especially in COVID‐19 patients with high ferritin and fibrinogen levels and low lymphocyte count with low SpO2 measurements.

Impact of inspiratory muscle training on diaphragmatic mobility and arterial blood gases in patients undergoing haemodialysis

Background/aims Impairment of respiratory muscle function is common in patients with chronic kidney disease undergoing haemodialysis, and is manifested by decreased oxygenation and physical function. The purpose of this study was to analyse the impact of training with incentive spirometer on mobility of the diaphragm, arterial blood gases and functional capacity in patients with chronic kidney disease undergoing haemodialysis. Methods A pre–post research design was implemented. A total of 30 patients undergoing haemodialysis for chronic kidney disease received incentive spirometer training intradialysis three sessions a week for 8 weeks. Outcome measures were the amount of diaphragmatic mobility measured by ultrasonography, the levels of arterial partial pressure of oxygen, arterial partial pressure of carbon dioxide, oxygen saturation percentages and the distance walked in 6 minutes. Results Significant improvement from pre-treatment to post-treatment measurements occurred in all outcome measures, with P&lt;0.05. Conclusions Incentive spirometer training should be recommended to be a part of daily routine of patients with chronic kidney disease who are undergoing haemodialysis to decrease respiratory and physical function impairments.

Evaluation of the relationship between pump duration and arterial blood gases in patients undergoing on-pump CABG

Introduction: Arterial blood gas (ABG) is one of the most important laboratory tests to determine the pH status, oxygen and carbon dioxide levels of the blood and bicarbonate levels. Lactate, hemoglobin and electrolyte levels can also be obtained from this test. Changes in these items can be important steps in determining the relationship between these changes and the complications of various organs. so, the aim of this study was to investigate the relationship between pump duration and arterial blood gases in patients undergoing on-pump CABG. Material and Methods: During the surgery, the exact time of the pump time, patients' cross-clamping and questionnaires were recorded by the responsible resident. Arterial blood samples were taken from all patients before and 45 minutes after anesthesia, after removal of the cardiopulmonary pump, one hour after admission to the ICU, 1 hour and 6 hours after extubation, and three days after admission to open heart ICU. ABG parameters including PO2, PCO2, PH and HCO3 were measured each time. Finally, the relationship between pump time and ABG parameters was assessed using the obtained data and designed questionnaire. Data were analyzed by IBM SPSS Statistics V22.0. Results: ABG parameters in the two pump time groups were not statistically significant before anesthesia, during surgery, ICU admission time, one hour after open heart ICU admission and one hour after patient extubation (P> 0.05). PCO2 in the long pump time group was relatively decreased 6 hours and 3 days after admission to the open heart ICU and patients showed some degree of respiratory alkalosis (P = 0.04). Conclusion: Our findings show that preoperative and postoperative ABG analysis is an important factor in patients undergoing CABG and its correct interpretation can manage postoperative complications.

Transport of awake hypoxemic probable COVID 19 patients in the prone position.

ObjectiveWe aimed to investigate the effects of transport with prone position on hypoxemia in hypoxemic and awake probable COVID 19 pneumonia patients.MethodsHypoxic and awake patients with probable COVID 19 pneumonia who were referred to the Ankara City Hospital Emergency Department from 1 April to 31 May 2020 were included in this prospective study. Patients were transported in prone position and fixed on the stretcher. During the transport, patients continued receiving 2 l per minute oxygen with nasal cannula. Arterial blood gases were obtained from the patients before and after transport. The transport time was recorded as minutes. The primary outcome of the study is the increase of partial oxygen value in the arterial blood gas of patients after transport.ResultsIt was found that pO2 and SpO2 end values were statistically significantly higher in the patient group compared to the initial values. In the group with transport duration of more than 15 min, a difference was found between the initial and end values in pO2 and SpO2 parameters similar to the whole group. However, there was no statistically significant difference between the initial and end values in the group with transport duration of 15 min or below.ConclusionsAwake hypoxemic patients can be transported without complications in prone position during transport. Transports more than 15 min, prone position may be recommended because the partial oxygen pressure of the patients increases.

Efficacy of manual hyperinflation on arterial blood gases in patients with ventilator-associated pneumonia

BackgroundTracheal 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).ResultsAfter 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).ConclusionIt 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 registrationPACTR, PACTR201909817075549. Registered October 21, 2018—retrospectively registeredhttps://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=4655

Effect of Different Levels of Positive End-Expiratory Pressure (PEEP) on Respiratory Status during Gynecologic Laparoscopy.

BackgroundDuring gynecologic laparoscopy, pneumoperitoneum, and the position of the patient's head can lead to pathophysiologic changes in cardiovascular and respiratory systems, complicating the management of anesthesia in these patients. One of the strategies for improving the respiratory status of patients undergoing laparoscopy is the use of Positive End-Expiratory Pressure (PEEP).ObjectivesThis study aimed to evaluate the effect of different levels of PEEP on the respiratory status of patients undergoing gynecologic laparoscopy.MethodsIn this clinical trial, 60 patients with ASA I were randomly assigned to three groups to control anesthesia: ZEEP (PEEP 0 cmH2O; 20 cases), PEEP5 (PEEP 5 cmH2O; 20 cases), and PEEP10 (PEEP 10 cmH2O; 20 cases). Respiratory and hemodynamic variables of patients were compared before general anesthetic induction and immediately after CO2 insufflation at intervals of 5, 10, 20, 30, and 60 min and the end of the operation in the three study groups.ResultsThe PEEP application improved pH, PaCO2, and PaO2 levels at the end of pneumoperitoneum compared to baseline when compared with the non-use of PEEP (ZEEP group). Also, the frequency of dysrhythmia in the use of PEEP in controlled ventilation was significantly lower in patients with PEEP10 (P < 0.05). The application of PEEP5 resulted in similar effects to PEEP10 in the levels of respiratory variables.ConclusionsThe PEEP application is associated with improved arterial blood gas in patients with gynecologic laparoscopy. The use of PEEP10 has a greater effect on the improvement of respiratory parameters and complications of pneumoperitoneum.

Upoređivanje efekata heparina od 1000 jedinica i 5000 jedinica na gasove arterijske krvi

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 &lt; 0.001), and HCO3, BEe and K were observed between the two groups (p &lt; 0.01). No statistically significant difference between the values of PaCO2, PH and PaO2 in the two groups were reported (p &gt; 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.