Arterial Blood Gas Parameters Research Articles

Effects of supplementation with low-dose group B vitamins on clinical and biochemical parameters in critically ill patients with COVID-19: a randomized clinical trial

ABSTRACT Background : This study aimed to check the effect of supplementation with low-dose group B vitamins on clinical and biochemical parameters on patients with coronavirus disease 2019 (COVID-19). Research design and method : This double-blind, randomized clinical trial was carried out on 85 critically ill patients with COVID-19. All patients received high protein prescriptions of 30 kcal/kg/d by enteral nutrition. The intervention group (n = 40) received vitamin B complex, including thiamine (10 mg), riboflavin (4 mg), nicotinamide (40 mg), and dexpanthenol (6 mg). The control group received similar nutritional supports, except for group B vitamins. Assessments were carried out at baseline and after 2 weeks of intervention. Results : Vitamin B supplementation had no effects on the biochemical and pathological parameters including kidney function, arterial blood gas parameters, Glasgow coma scale, cell blood count, and serum electrolytes of the intervention group compared with the control group. The 30-day mortality was insignificantly lower in the intervention group than in the control group (83.3% against 96.1%, P = 0.07). Conclusions The mortality rate of patients with COVID-19 might be improved by low-dose vitamin B supplementation.

A PRELIMINARY STUDY TO EVALUATE THE EFFECTIVENESS OF LARYNGEAL MASK AIRWAYS IN ANESTHETIZED BIGHORN SHEEP (OVIS CANADENSIS) LAMBS.

Chemical immobilization of wildlife, required for many biological studies and management events, often induces hypoxemia and respiratory depression. Laryngeal mask airways (LMAs) have shown promise as an efficient method of airway protection during anesthesia. Nineteen wild bighorn sheep (Ovis canadensis) lambs were immobilized using an IM combination of medetomidine (0.16 ± 0.062 mg/kg), azaperone (0.20 ± 0.058 mg/kg), and alfaxalone (0.54 ± 0.21 mg/kg) via remote injection. Upon recumbency, arterial blood gas parameters, minute ventilation (VE), tidal volume (VT), and respiratory rate were measured before and after LMA placement. The VE and VT were measured via respirometer. Time to LMA placement, cuff pressure, cuff volume, and ease of placement were measured. Medetomidine was reversed with IM atipamezole at five times the medetomidine dose upon completion of procedures. Pre- and post-LMA measurements were compared using a t test or a Wilcoxon signed-rank test based on normality of the data. The LMA provided a patent airway in all lambs with a significant (P < 0.0001) increase in VE (mean [95% CI]; pre-LMA: VE = 17.3 [16.2-18.5] L/min, post-LMA: VE = 19.8 [18.6-21.0] L/min) but did not have a significant impact on partial pressure of oxygen (PaO2; pre-LMA: corrected PaO2 = 45.2 [41.2-49.2] mm Hg, post-LMA: corrected PaO2 = 47.5 [43.3-51.7] mm Hg; P = 0.19) or partial pressure of carbon dioxide (PaCO2; pre-LMA: PaCO2 = 50.4 [46.6-53.2] mm Hg, post-LMA: PaCO2 = 51.6 [48.8-55.7] mm Hg; P = 0.035) following placement. This study demonstrated that the LMA is a viable option for airway protection in wild bighorn sheep.

Hastaneden taburculuk sırasında yüksek PaCO2 seviyeleri, evde non-invaziv mekanik ventilatörü olmayan kronik solunum yetmezliği hastalarında orta vadeli mortaliteyi öngörüyor mu?

Aim: Long-term domiciliary use of a non-invasive mechanical ventilator (NIV) is a controversial form of therapy for patients with chronic obstructive pulmonary disease (COPD) and moderate hypercapnia. The present research attempted to examine hospital admissions, hospitalizations, and medium-term (6-8 months) mortality in a group of patients with compensated but moderate hypercapnia who were discharged from our clinic without a domiciliary NIV. Material and Method: The sample of this retrospective, observation-based cohort study consisted of compensated hypercapnic cases that were hospitalized in our Pulmonology Intensive Care Unit (ICU) between 01.01.2019 and 12.31.2020. Results: A total of 245 patients discharged with high partial pressure of carbon dioxide (PaCO2) levels between 01.01.2019 and 12.31.2020 were included in the study. While 58% of the cases were males (n=142), we found the mean age of the patients to be 71.89±12.63 years. The findings yielded no significant differences between the groups by sex, use of NIV during hospitalization, number of days of NIV use during hospitalization, use of LTOT or Oxygen tube at home, and intubation history before ICU admission (p&amp;gt;0.05). Similarly, we could not conclude significant differences between the groups by hospitalization, discharge, and follow-up arterial blood gas (ABG) parameters. Yet, the rates of congestive heart failure, coronary artery disease, and atrial fibrillation were significantly higher in the mortality group (p=0.017, p=0.032, and p=0.002, respectively). Besides, high PaCO2 levels versus mortality rates at 1, 3, 6, 8, and 12 months and in the entire follow-up period were subjected to the ROC analysis. Accordingly, when accepting 50.25 mmHg as the cut-off value for determining the 8-month mortality for discharge PaCO2 levels, we calculated the sensitivity to be 78.6% and the specificity to be 43%. Conclusion: Overall, it is highly convenient to consider the possible positive effects of NIV therapy on mortality among patients with heart-related diseases and with moderate hypercapnia (PaCO2&amp;gt;50 mmHg) at discharge.

The Use of High-Flow Nasal Oxygen Therapy in the Management of Severe Acute Exacerbation of Chronic Obstructive Pulmonary Disease: A Feasibility Study.

OBJECTIVE:This study investigated the efficacy of high-flow nasal oxygen therapy in patients with severe acute exacerbation of chronic obstructive pulmonary disease admitted to the intensive care unit.MATERIAL AND METHODS:Totally, 23 patients were enrolled in the study. High-flow nasal oxygen therapy was administered with a predefined protocol. Vital signs, Visual Analog Scale for dyspnea, and arterial blood gas parameters were recorded at the beginning under low-flow oxygen support therapy and the 1st, 6th, 12th, and 24th hours of high-flow nasal oxygen therapy. High-flow nasal oxygen therapy duration, intensive care unit length of stay, and intensive care unit, in-hospital, and 60-day mortality were recorded as outcomes and compared according to the presence of pneumonia upon admission.Results:In 12 patients (52.2%), pneumonia was present. High-flow nasal oxygen therapy was applied for a median of 57 hours [49.2-104.5]. Overall decreases were detected in heart rate (P = .001), respiratory rate (P < .001), and Visual Analog Scale for dyspnea (P = .001) during the first 24 hours of the therapy. Although there was an increase in PaCO2 (P = .001), pH increased (P < .001) over time too. No change in partial arterial oxygen pressure (P = .63) and partial arterial oxygen pressure/fraction of inspired oxygen ratio (P = .22) was noted. Nineteen patients (77%) were successfully weaned from high-flow nasal oxygen therapy. While the high-flow nasal oxygen therapy failure rate was 23%, the in-hospital and 60-day mortality rates were 8.6%. Outcomes were not different between patients with and without pneumonia.Conclusion:High-flow nasal oxygen therapy was efficient in relieving respiratory distress and well-tolerated with no adverse outcome in severe acute exacerbation of chronic obstructive pulmonary disease patients admitted to the intensive care unit.

Validity of the ROX index in predicting invasive mechanical ventilation requirement in pneumonia

BackgroundThe ROX index (Respiratory rate-OXygenation) has been described as a prediction tool to identify the need for invasive mechanical ventilation (IMV) in community-acquired pneumonia (CAP) with acute hypoxaemic respiratory failure...

Utility of Initial Arterial Blood Gas in Neuromuscular versus Non-Neuromuscular Acute Respiratory Failure in Intensive Care Unit Patients.

Background: The arterial blood gas (ABG) parameters of patients admitted to intensive care units (ICUs) with acute neuromuscular respiratory failure (NMRF) and non-NMRF have not been defined or compared in the literature. Methods: We retrospectively collected the initial ABG parameters (pH, PaCO2, PaO2, and HCO3) of patients admitted to ICUs with acute respiratory failure. We compared ABG parameter ranges and the prevalence of abnormalities in NMRF versus non-NMRF and its categories, including primary pulmonary disease (PPD) (chronic obstructive pulmonary disease, asthma, and bronchiectasis), pneumonia, and pulmonary edema. Results: We included 287 patients (NMRF, n = 69; non-NMRF, n = 218). The difference between NMRF and non-NMRF included the median (interquartile range (IQR)) of pH (7.39 (7.32–7.43), 7.33 (7.22–7.39), p < 0.001), PaO2 (86.9 (71.4–123), 79.6 (64.6–99.1) mmHg, p = 0.02), and HCO3 (24.85 (22.9–27.8), 23.4 (19.4–26.8) mmol/L, p = 0.006). We found differences in the median of PaCO2 in NMRF (41.5 mmHg) versus PPD (63.3 mmHg), PaO2 in NMRF (86.9 mmHg) versus pneumonia (74.3 mmHg), and HCO3 in NMRF (24.8 mmol/L) versus pulmonary edema (20.9 mmol/L) (all p < 0.01). NMRF compared to non-NMRF patients had a lower frequency of hypercarbia (24.6% versus 39.9%) and hypoxia (33.8% versus 50.5%) (all p < 0.05). NMRF compared to PPD patients had lower frequency of combined hypoxia and hypercarbia (13.2% versus 37.8%) but more frequently isolated high bicarbonate (33.8% versus 8.9%) (all p < 0.001). Conclusions: The ranges of ABG changes in NMRF patients differed from those of non-NMRF patients, with a greater reduction in PaO2 in non-NMRF than in NMRF patients. Combined hypoxemia and hypercarbia were most frequent in PPD patients, whereas isolated high bicarbonate was most frequent in NMRF patients.

Effect of Nebulized Eucalyptus on Arterial Blood Gases and Physiologic Indexes of Mechanical Ventilated Patients: A Randomized Clinical Trial.

Introduction: Arterial hypoxia is one of the most common findings in critically ill patients. Inhaled medications in ventilated patients can reduce airway resistance, facilitate dilution, and prevent airway infections. This study aimed to examine the effects of nebulized Eucalyptus (NE) on arterial blood gases (ABG) and physiologic indexes of patients receiving mechanical ventilation (MV). Methods: The current randomized clinical trial was performed in three intensive care units (ICUs) of Al-Zahra Hospital in Isfahan, Iran. Using purposive sampling method, 70 intubated patients were selected and randomly divided into NE (n=35) and control (n=35) groups. NE group received 4 ml (5%) Eucalyptus in 6 mL normal saline (NS) every 8 hours since intubation to 3 days by a nebulizer. Control group received 10 mL NS in the same way. Glasgow Coma Scale (GCS) and ABG parameters (pH, BE, HCO3, PCO2, SaO2, and PaO2), and the peak inspiratory pressure (PIP) and tidal volume (TV) were equally assessed in both intervention and control groups. Data were analyzed using SPSS software version 13. Results: There was no significant difference between the patients of both groups in terms of vital signs (blood pressure, temperature, respiratory rate, and pulse rate), GCS, pH, BE, HCO3, PCO2, SaO2, PaO2, PIP, and TV before the study. Amongst the parameters of ABG, there was a significant difference between PaO2 and SaO2 and PIP in the intervention and control groups 3 days after intervention. Conclusion: Inhaled Eucalyptus can improve oxygenation and reduce airway pressure in patients undergoing MV.

Accuracy of Oxygen Saturation Measurements in Patients with Obesity Undergoing Bariatric Surgery.

We aimed to determine the magnitude, direction, and influencing factors of the concordance between arterial oxygen saturation (SaO2) and peripheral capillary oxygen saturation (SpO2) in patients with obesity undergoing bariatric surgery, supporting the measurement of SaO2 and SpO2 in key populations. Patients with obesity undergoing bariatric surgery from 2017 to 2020 were included. Preoperative SpO2 and SaO2 were collected. Linear correlation and multiple linear regression analyses were performed to characterize the relationships between body mass index (BMI), age, and sex with pulse oximetry and arterial blood gas (ABG) parameters. Bland-Altman analysis was applied to determine the concordance between SpO2 and SaO2 and the limits of this concordance. A total of 134 patients with obesity undergoing bariatric surgery were enrolled. SaO2 was negatively associated with BMI (p < 0.0001) and age (p = 0.006), and SpO2 was negatively associated with BMI (p = 0.021) but not with age. SpO2 overestimated SaO2 in 91% of patients with a bias of 2.05%. This bias increased by 203% in hypoxemic patients compared with nonhypoxemic patients (p < 0.0001). The bias was 1.3-fold higher (p = 0.023) in patients with a high obesity surgery mortality risk score (OS-MRS) than in those with low or intermediate scores. Compared with SpO2, preoperative SaO2 can more accurately reflect the real oxygen saturation in patients with obesity undergoing bariatric surgery, especially for those with BMI ≥ 40kg/m2, age ≥ 40years, and high OS-MRS. ABG analysis can provide a more reliable basis for accurate and timely monitoring, ensuring the perioperative safety of susceptible patients.

Study of Utility of Basic Arterial Blood Gas Parameters and Lactate as Prognostic Markers in Patients With Severe Dengue

BackgroundThe importance of prognostication in critical care cannot be over-emphasized, especially in the context of diseases like dengue, as their presentation may vary from mild fever to critical life-threatening illness. With the help of prognostic markers, it is possible to identify patients at higher risk and thus improve their outcome with timely intervention. Basic arterial blood gas (ABG) parameters, i.e., potential of hydrogen (pH), partial pressure of oxygen (PO2), partial pressure of carbon dioxide (PCO2) and bicarbonate are useful parameters, especially in critical care medicine as they are known to vary with the severity of illness. Hyperlactatemia is often referred to as a “powerful predictor of mortality”. Basic ABG parameters and lactate have been used as an essential prognostic modality in critically ill patients for decades; however, the evidence remains limited for their role as prognostic markers in patients with severe dengue.MethodWe carried out an observational retrospective cohort study comprising 163 patients with severe dengue, admitted between July 2021 and November 2021 at Medical Intensive Care Unit (MICU) of Shri Ram Murti Smarak Institute of Medical Sciences (SRMS IMS), Bareilly, Uttar Pradesh, India. Basic ABG parameters and lactate levels at the time of admission to MICU were compared between survivor and non-survivor groups of patients with severe dengue in order to evaluate their prognostic utility as predictors of mortality.ResultspH (p<0.0001), PO2 (p=0.01) and bicarbonate (<0.0001) levels were significantly lower, while PCO2 (p=0.002) and lactate (p<0.0001) levels were significantly higher in non-survivor group as compared to survivor group. Lactate was found to be the best prognostic marker with Area Under the Curve (AUC) of 88.7% on Receiver Operating Characteristics (ROC) analysis.ConclusionBasic arterial blood gas parameters and lactate can be used as feasible prognostic markers in patients with severe dengue.

Risk prediction model for 24-hour mortality in preterm infants using lactate and blood gas analysis: A machine learning approach and retrospective cohort study

Background: This study aimed to evaluate the performance of machine learning algorithms using lactate and arterial blood gas parameters to predict the imminent risk of death in extremely low birth weight infants. Methods: A retrospective cohort study analyzing preterm infants with birth weight less than 1000 grams in a single-center tertiary neonatal intensive care unit in São Paulo, Brazil, between 2012 and 2017 was carried out. We included all infants with at least one arterial blood gas analysis with paired serum lactate. To assess 24-hour mortality risk, we conducted three machine learning algorithms (Logistic Regression, Extreme Gradient Boosting, and AutoML Tables). Results: We analyzed 1932 blood gas samples with matched lactate measurements. Our study population had a median gestational age of 27.1 (26 – 29.1) weeks and a median birth weight of 746 (600 – 880) grams. The Extreme Gradient Boosting model with lactate achieved the highest area under the receiver operating characteristic (AUROC) of 0.898. Base excess, lactate, and pH were, in order of importance, the most important features associated with 24-hour mortality. Conclusions: Incorporating lactate and blood gas samples into real-time mortality predictive models may aid to identify those preterm infants with a higher risk of death.

ASSESSMENT OF ARTERIAL BLOOD GAS COMPOSITION DEPENDING ON THE DEGREE OF MORBID OBESITY IN PATIENTS IN BARIATRIC SURGERY

Abstract. The work is devoted to the study of arterial blood gas parameters and comparison of capnographic determination of carbon dioxide at the end of exhalation (EtCO2) and the real pressure of carbon dioxide in arterial blood (paCO2) depending on the degree of morbid obesity in patients who were to undergo surgical bariatric interventions in 2012-2021. The study included 61 patients, whose age ranged from 22 to 69 years, body mass index from 40 to 91 kg/m2. The patients were divided into 3 groups depending on the degree of morbid obesity: group 1 - 20 patients with body mass index ≥ 40 (grade 3); group 2 - 25 patients with body mass index ≥ 50 (grade 4); group 3 - 16 patients with body mass index ≥ 60 (grade 5). Based on the data obtained, it was found that the state of the arterial blood gas composition indicates the presence of respiratory function disorders in patients with morbid obesity, which significantly reduce the compensatory capabilities of the body. Arterial hemoglobin saturation with oxygen (SaO2) tended to decrease, reaching a minimum in patients of the 1st group. The studied parameters of the arterial blood gas composition in patients of group 1 tended to worsen, and in patients of groups 2 and 3 they significantly worsened with an increase in the degree of morbid obesity. The maximum disruption of arterial blood gases was found in patients with a body mass index ≥ 60. The partial pressure of carbon dioxide at the end of exhalation (EtCO2) in patients with morbid obesity does not correspond to the partial pressure of carbon dioxide in arterial blood (paCO2).

How Important Are Arterial Blood Gas Parameters for Severe Head Trauma in Children?

Aim: Our aim in this study is to consider the relationship between arterial blood gas (ABG) parameters and prognosis in severe head trauma in children.&#x0D; Material and Methods: Patients younger than 17 years of age with a Glasgow Coma Scale (GCS) of 8 and below with a history of head trauma were retrospectively analyzed. The relation of ABG parameters taken at the time of admission with mortality was examined. Independent sample T-test was used for pH, PCO2 and base extract (BE) parameters in ABG, and Mann Whitney U test was used for PO2 and lactate parameters.&#x0D; Results: 48 patients were included in the study. Gender, age, admission blood pressure arterial values, GCS and Abbreviated Injury Scale (AIS) scores, length of stay in intensive care, and the surgical application did not differ statistically between the patient groups who died and survived (p&gt; 0.05). Ph and PO2 values were lower, PCO2, lactate and BE values were found to be higher in the deceased patient group compared to the living patient group (p˂0.05). The presence of acidosis, hypercapnia, or hyperlactatemia according to ABG values in the patient group who died was statistically significantly higher (p˂0.05).&#x0D; Conclusion: In our study, we found that the presence of acidosis, hypercapnia, and hyperlactatemia in patients according to ABG values increased mortality. In addition, according to the results of ROC analysis, we found that high PCO2 and lactate values could be specific indicators indicating poor prognosis. We think that PCO2 and lactate measured in arterial blood may be biomarkers that can determine the prognosis.

The activation of SIRT3 by dexmedetomidine mitigates limb ischemia-reperfusion-induced lung injury.

BackgroundThe lung is one of the most sensitive organs, and is vulnerable to injury caused by limb ischemia-reperfusion (LIR). Dexmedetomidine, an anesthetic adjunct, has been shown to have therapeutic effects on lung injury secondary to LIR. This study aimed to investigate the role of dexmedetomidine in ameliorating LIR-induced lung injury in a mouse model of bilateral hind LIR.MethodsIn this study, 75 mice were randomly divided into 5 groups to prepare the LIR model. After the model was established, arterial blood was extracted for blood gas analysis. The pathological changes of lung tissue, lung wet/dry weight ratio, arterial blood gas analysis, detection of myeloperoxidase (MPO) activity, the content of reactive oxygen species (ROS), superoxide dismutase (SOD), glutathione peroxidase (GSH-Px) and malondialdehyde (MDA) in oxidative stress indexes, mitochondrial membrane potential (MMP), adenosine triphosphate (ATP) content and cytochrome c content were measured, and the relative protein expression levels of sirtuin-3 (SIRT3) and apoptosis factor Bcl-2 related X protein (Bax), B-cell Lymphoma 2 (Bcl-2), cleaved caspase 3, and nuclear factor erythroid 2-related factor 2 (Nrf2) and cytoplasmic heme oxygenase-1 (HO-1).ResultsPretreatment with dexmedetomidine dramatically ameliorated LIR-induced lung injury, the wet/dry weight ratio, the arterial blood gas parameters, and enhanced SIRT3 expression. Moreover, dexmedetomidine significantly inhibits ROS and MDA level and restores antioxidant enzyme activities (SOD, GSH-Px). Of note, dexmedetomidine suppressed LIR-induced lung tissue apoptosis by modulating apoptosis-associated protein such as Bax, Bcl-2, and cleaved caspase 3. Moreover, dexmedetomidine inhibited the LIR-induced decreases in MMP, ATP levels, and the release of cytochrome c of LIR to maintain mitochondrial function. Latest study has shown that activating Nrf2 could promote SIRT3 expression to alleviate IR injury. Intriguingly, dexmedetomidine could facilitate nuclear Nrf2 and cytoplasmic HO-1 expression.ConclusionsOur findings suggest that dexmedetomidine protects against LIR-induced lung injury by inhibiting the oxidative response, mitochondrial dysfunction and apoptosis. The mechanism appears to be at least partly mediated through the upregulation of SIRT3 expression.

Arterial Blood Gas and Rotational Thromboelastometry Parameters in Healthy Rescuers Incidentally Exposed to Nitroglycerin, Nitrogen Compounds, and Combustion Products.

Acute exposure to nitrogen compounds combined with a massive inhalation of air pollutants can influence respiratory and cardiovascular symptoms and coagulation abnormalities in accidentally exposed healthy adults during cave detonation operations. Italian alpine and cave rescuers widened a cave in the Abisso Luca Kralj in Trieste, Italy. Volunteers inside the cave were accidentally exposed to the fumes from an uncontrolled detonation of blasting gelatin microcharges. We performed a retrospective cohort study on the clinical data, arterial blood gas analysis, and rotational thromboelastometry parameters from the rescuers involved in the accident. Ninety-three healthy rescuers were involved in the uncontrolled detonation: 47 volunteers handled a mixture of nitrogen compounds (blaster group), and 46 volunteers did not (nonblaster group). After the accident, statistically significant differences (P<0.05) in arterial blood gas values were observed between the groups, with a pattern of mild respiratory acidosis with hypercapnia in the nonblaster group and severe mixed acid-base disorder with hypoxia and hypercapnia in the blaster group. Mild hyperfibrinolysis was observed in 44 volunteers in the blaster group, as were associated bleeding symptoms in 34 volunteers; no significant coagulation modifications were recorded in the nonblaster group. Respiratory acidosis with hypoxia, hypercapnia, a compensatory metabolic response, and mild hyperfibrinolysis were probably related to the combined effect of nitrogen compounds and the inhaled toxic products of detonation. Therefore, each element exerts a determinant effect on promoting the biological toxicity of the others.

Effect of later cord clamping on umbilical cord blood gas in term neonates of diabetic mothers: a randomized clinical trial

ObjectiveTo evaluate the effect of later cord clamping (LCC) on umbilical arterial blood gas in neonates of diabetic mothers.MethodsThis prospective study included a group of 160 diabetic mothers (DM) whose neonates were randomized to immediate cord clamping (ICC) (≤ 15 s after birth) or LCC (≥ 30 s after birth), and a group of 208 non-diabetic mothers (NDM) whose neonates were randomized to ICC or LCC as a reference. Cord arterial pH, base excess (BE), bicarbonate (HCO3−), partial pressure of carbon dioxide (pCO2), partial pressure of oxygen (pO2), lactate, hemoglobin, hematocrit and glucose were compared among groups.ResultsIn neonates of DM, there was no significant difference in cord arterial pH between the ICC and LCC group. LCC of ≥ 30 s decreased umbilical arterial HCO3− and BE and increased lactate (ICC versus LCC, HCO3−: 24.3 (22.7, 25.8) versus 23.7 (22.3, 24.7) mmol/L, P = 0.01; BE: -2.70 (-4.80, -1.50) versus − 3.72 (-5.66, -2.36) mmol/L, P = 0.006; lactate: 2.1 (1.6, 3.7) versus 2.7 (2.1, 4.3) mmol/L, P = 0.005), without the alterations of pCO2, pO2, hemoglobin, hematocrit and glucose. Similar results were found in neonates of NDM (ICC versus LCC, HCO3−: 24.3 (23.1, 25.7) versus 23.5 (22.3, 24.8) mmol/L, P = 0.01; BE: -2.39 (-3.73, -1.51) versus − 3.40 (-4.73, -1.91) mmol/L, P = 0.001; lactate: 2.2 (1.9, 3.3) versus 2.5 (2.0, 4.3) mmol/L, P = 0.01), except for the higher level of hemoglobin in the LCC group. The majority of diabetic mothers (ICC: 92.0%; LCC: 91.8%) had good blood glucose control. No differences were observed in acid-base status and glucose between neonates of DM and neonates of NDM in both ICC and LCC, but hemoglobin and hematocrit were elevated after ICC in neonates of DM compared to neonates of NDM.ConclusionsLater cord clamping of ≥ 30 s resulted in a tendency towards metabolic acidosis of umbilical arterial blood in neonates of DM and NDM. Umbilical arterial blood gas parameters at birth were similar in neonates of DM and NDM.Trial registrationClinicalTrials.gov: NCT04369313; date of registration: 30/04/2020 (retrospectively registered).

Effect of post-operative goal-directed fluid therapy (GDFT) on organ function after orthotopic liver transplantation: Secondary outcome analysis of the COLT randomised control trial

BackgroundGoal-directed fluid therapy (GDFT) has been shown to reduce the complications following a variety of major surgical procedures, possibly mediated by improved organ perfusion and function. We have shown that it is feasible to randomise patients to GDFT or standard fluid management following liver transplant in the cardiac-output optimisation following liver transplantation (COLT) trial. The current study compares end organ function in patients from the COLT trial who received GDFT in comparison to those receiving standard care (SC) following liver transplant. MethodsAdult patients with liver cirrhosis undergoing liver transplantation were randomised to GDFT or SC for the first 12 h following surgery as detailed in a published trial protocol. GDFT protocol was based on stroke volume (SV) optimisation using 250 ml crystalloid boluses. Total fluid administration and time to extubation were recorded. Hourly SV and cardiac output (CO) readings were recorded from the non-invasive cardiac output monitoring (NICOM) device in both groups. Pulmonary function was assessed by arterial blood gas (ABG) and ventilatory parameters. Lung injury was assessed using PaO2:FiO2 ratios and calculated pulmonary compliance. The KDIGO score was used for determining acute kidney injury. Renal and liver graft function were assessed during the post-operative period and at 3 months and 1-year. Results60 patients were randomised to GDFT (n = 30) or SC (n = 30). All patients completed the 12 h intervention period. GDFT group received a significantly higher total volume of fluid during the 12 h trial intervention period (GDFT 5317 (2335) vs. SC 3807 (1345) ml, p = 0.003); in particular crystalloids (GDFT 3968 (2073) vs. SC 2510 (1027) ml, p = 0.002). There was no evidence of significant difference between the groups in SV or CO during the assessment periods. Time to extubation, PaO2: FIO2 ratios, pulmonary compliance, ventilatory or blood gas measurements were similar in both groups. There was a significant rise in serum creatinine from baseline (77 μmol/L) compared to first (87 μmol/L, p = 0.039) and second (107 μmol/L, p = 0.001) post-operative days. There was no difference between GDFT and SC in the highest KDIGO scores for the first 7 days post-LT. At 1-year follow-up, there was no difference in need for renal replacement therapy or graft function. ConclusionsIn this randomised trial of fluid therapy post liver transplant, GDFT was associated with an increased volume of crystalloids administered but did not alter early post-operative pulmonary or renal function when compared with standard care.

Arterial partial pressure of oxygen and procalcitonin levels correlate with pulmonary artery systolic pressure in patients with active pulmonary tuberculosis

ObjectWe aimed to study whether arterial blood gas parameters, inflammatory markers, and coagulation indicators correlate with pulmonary artery systolic pressure (PASP) values in patients with active pulmonary tuberculosis (PTB). MethodsA total of 121 patients with PTB who had a measurement of PASP by Doppler echocardiography in the active phase of tuberculosis were included in this study. We carried out univariate and multivariate linear regression analyses to determine factors correlated with PASP values. We excluded patients with other diseases or conditions that might lead to increased PASP. ResultsUnivariate linear regression analysis revealed positive correlations of age, white blood cell count, neutrophils ratio, Log procalcitonin, erythrocyte sedimentation rate, Log C-reactive protein, fibrinogen, Log D-dimer with PASP and showed an inverse correlation of arterial partial pressure of oxygen (PaO2) and arterial oxygen saturation (SaO2) with PASP. Multiple linear regression analysis demonstrated that PaO2 and Log procalcitonin remained correlated with PASP values. ConclusionPaO2 and procalcitonin were strongly correlated with PASP values in patients with active PTB. The degree of hypoxia and severity of secondary respiratory bacterial infection may influence PASP value in active PTB.

Early Predictors of Success of Non-invasive Positive Pressure Ventilation in Hypercapnic Respiratory Failure

Objectives: To study the indication of NIPPV in patients with hypercapnic respiratory failure. To evaluate the clinical, laboratory and ventilatory parameters with respect to improvement or deterioration in general condition of the patient. To predict the outcome in the form of weaning from NIPPV or requirement of invasive ventilation. To compare APACHE II score with outcome. Background: Non-invasive ventilation (NIV) is now being considered more as the respiratory support of choice for acute respiratory failure. In some patients, with acute hypercapnic respiratory failure, NIV is inadequate and invasive ventilation is required for the management of respiratory failure. Thus, the determination of early predictors of the success of non-invasive positive pressure ventilation (NIPPV) is important to identify the patients who are likely to benefit from it. This study was done to determine the early predictors of the success of NIPPV in hypercapnic respiratory failure. Material and Methods: In the current hospital-based prospective observational study, 100 patients admitted with hypercapnic respiratory failure requiring ventilation therapy are included in the study. Baseline clinical (heart rate [HR] and respiratory rate [RR]), arterial blood gas (ABG) parameters (pH, pO2, and pCO2), and ventilatory parameters were recorded before the initiation of NIPPV. The above parameters were re-evaluated at 1, 4, and 24 h after initiation of NIPPV. Acute Physiology and Chronic Health Evaluation II (APACHE II) score was also calculated on admission and at the end of 24 h to compare with the outcome. Results: Of the 100 patients, 73% of patients showed improvement in clinical and laboratory parameters. There was an improvement in HR, RR, pH, pCO2, and pO2 within the 1st hour and continued to improve even after 1 h, 4 h, and 24 h of NIPPV in the success group. About 27% of patients who failed to improve required intubation. The optimum cutoff value for APACHE II score on admission for predicting the outcome of NIPPV was found to be 33 in this study. Therefore, a score above 33 predicts failure of NIV. Conclusion: This study demonstrated that the clinical and laboratory parameters predict the success of NIPPV in patients with hypercapnic respiratory failure averting the need for mechanical ventilation.

Comparison of adaptive support ventilation and synchronized intermittent mandatory ventilation in patients with acute respiratory distress syndrome: A randomized clinical trial

Background:Suitable mechanical ventilation strategies can reduce the incidence and severity of ventilator-associated lung injury in patients with acute respiratory distress syndrome (ARDS). In this study, the effects of adaptive support ventilation (ASV) and synchronized intermittent mandatory ventilation (SIMV) on respiratory parameters and arterial blood gases (ABGs) parameters were compared in ARDS patients.Materials and Methods:Twenty-four patients were randomly divided into two groups of ASV and SIMV. Patients were followed up for 3 days, and respiratory parameters including rapid shallow breathing index (RSBI), spontaneous breathing rate (SBR), minute volume, and peak inspiratory pressure (PIP) as the primary outcomes and ABG parameters including PaO2, FiO2, PaCO2, HCO3, and PaO2/FiO2 ratio as the secondary outcomes were measured.Results:PIP in patients in the SIMV group on the 1st day (P = 0.013), 2nd day (P = 0.001), and 3rd day (P = 0.004) was statistically significantly more compared to those in patients in the ASV group. RSBI, SBR, and minute volume between the ASV and SIMV groups during the 3 days were not statistically significantly different (P > 0.05). The mean arterial blood pressure, heart rate, PaO2, and PH between both groups were similar (P > 0.05). At the end of the 2nd and 3rd days, the level of FiO2 and PaCO2 in ASV was significantly lower than those in ASV group. HCO3 in each of the 3 days in the ASV group was statistically significantly lower than that in the SIMV group (P < 0.050). PaO2/FiO2 ratio in patients in the ASV group in the 3 days was statistically significantly higher than that in the SIMV group (P < 0.050).Conclusion:By reducing PIP and improving oxygenation and ABG parameters, ASV mode may be a safe and feasible mode during mechanical ventilation in patients with ARDS.

Correlation of the end-tidal CO2 value with arterial blood gas parameters – evaluation of the treatment efficacy of COPD exacerbation in the emergency department

Introduction and aim. Painful, invasive, and expensive arterial blood gas (ABG) analysis is required in the diagnosis, follow-up, treatment, and even discharge of patients with chronic obstructive pulmonary disease (COPD). This study aimed to compare the end-tidal carbon dioxide (ETCO2) value, which allows non-invasive, painless, low-cost, and continuous monitoring, with ABG parameters, in the evaluation of the treatment efficacy of COPD exacerbation. Material and methods. The study was prospectively conducted with patients who presented to the emergency department with COPD exacerbation. ABG analysis and ETCO2 measurement were simultaneously performed in patients with COPD exacerbation at the time of arrival and after treatment, and were statistically compared. Results. The study included a total of 216 patients, of whom 57.4% were male. The mean age of the patients was 67.3±13.9 years. The ETCO2 values of the patients at arrival and after COPD exacerbation treatment were 39.2±10 and 37.3±9, respectively, and a statistically significant difference was determined (p=0.001). The partial pressure of pCO2 values measured at arrival and after treatment were 40.85±10.54 and 38.74±9.25, respectively, and it was statistically significant (p=0.001). A strong positive and statistically significant correlation was found between the ETCO2 and pCO2 values both at arrival and after COPD exacerbation treatment (r=0.840; p&lt;0.001 and r=0.872; p&lt;0.001, respectively). The Bland-Altman plot was constructed for the agreement between ETCO2 and pCO2 at both evaluation times. Conclusion. ETCO2 measurement could accurately predict the pCO2 of patients with COPD at arrival and after COPD exacerbation treatment. Also, ETCO2 may be useful in cases where pCO2 cannot be used.