Arterial Gas Research Articles

Validation of exhaled volatile organic compounds analysis using electronic nose as index of COPD severity.

AimSix-minute walking test distance (6MWD) and body mass index, obstruction, dyspnea and exercise (BODE) index are measures of functional status in COPD patients, but require space, time and patient’s compliance. Exhaled volatile organic compounds (VOCs) analysis via electronic nose is a quick and easy method that has already been used to discriminate COPD phenotypes. The aim of this study is to evaluate whether VOCs analysis can predict functional status and its variation over time in COPD patients.MethodsA monocentric prospective study with 1 year of follow-up was carried out. All patients underwent pulmonary function tests, arterial gas analysis, bioimpedance analysis, 6-minute walking test, and VOCs collection. Exhaled breath was collected with Pneumopipe® and analyzed using BIONOTE electronic nose. Outcomes prediction was performed by k-fold cross-validated partial least square discriminant analysis: accuracy, sensitivity and specificity as well as Cohen’s kappa for agreement were calculated.ResultsWe enrolled 63 patients, 60.3% men, with a mean age of 71 (SD: 8) years, median BODE index of 1 (interquartile range: 0–3) and mean 6MWD normalized by squared height (n6MWD) of 133.5 (SD: 42) m/m2. The BIONOTE predicted baseline BODE score (dichotomized as BODE score <3 or ≥3) with an accuracy of 86% and quartiles of n6MWD with an accuracy of 79%. n6MWD decline more than the median value after 1 year was predicted with an accuracy of 86% by BIONOTE, 52% by Global Initiative for Chronic Obstructive Lung Disease (GOLD) class and 78% by combined BIONOTE and GOLD class.ConclusionExhaled VOCs analysis identifies classes of BODE and n6MWD quartiles, and outperforms GOLD classification in predicting n6MWD variation.

Relación del buen control oximétrico mantenido con la situación clínica, gasométrica y el pronóstico de los pacientes con ventilación mecánica no invasiva domiciliaria

Introduction and objectiveThe effectiveness of home non-invasive mechanical ventilation (NIMV) is assessed by determining blood gas values in wakefulness, the evolution of their symptoms, and the monitoring of ventilation at night. The aim of our study is to evaluate whether defined values reached with outpatient monitoring by oximetry is related to the clinical, arterial gases and survival of a sample of patients with home NIMV. Material and methodRetrospective observational cohort study of a series of patients receiving home NIMV treatment for different causes. Patients with amyotrophic lateral sclerosis and less than 3 months of follow-up were excluded. The evolution of the patient's symptoms, their baseline arterial blood gases in wakefulness, and home nocturnal oximetry records, are evaluated at each outpatient visit. Good maintained oximetry control (MOC) was defined when mean O2 saturation values were reached and maintained until the last revision. Patient groups were considered, according to whether or not a good MOC was achieved during follow-up. ResultFour hundred patients were evaluated. Three hundred and sixty four (91%) were included in the study; their median age was 68 years, 51% were male. 37.6% had a good MOC during follow-up. Compared to patients with not good MOC, a better long-term mortality was obtained (16.8% vs 28.2%, P=.013), and an improvement in symptoms (33.8% vs 18.6%, P=.002) and a lower proportion of patients with persistently>50mmHg PaCO2 (14.2% vs. 33.9%, P<.001) was observed. ConclusionIn the follow-up of patients with home NIMV in our context, values defined in home nocturnal oximetry (good MOC) are positively associated with clinical, gasometric and longer-term survival.

An opportunity to improve pulmonary capillary circulation in patients with chronic obstructive pulmonary disease and comorbidity

This study was aimed at investigating pathogenesis of pulmonary vascular abnormalities in COPD with systemic features, and ways to treat these circulatory disorders. Methods. We analyzed pulmonary vascular parameters, molecular markers of endothelial dysfunction, pulmonary artery pressure (PAP) and gas exchange in patients with moderate (n = 64) and severe (n = 70) COPD treated with basic therapy with or without an endothelial protector. Results. The results showed that perfusion disorders could appear in different parts of the lungs, probably, due to different mechanisms of these abnormalities. Localization of perfusion disorders was related to blood levels of molecular markers of endothelial dysfunction: adhesion molecules sP-selectin and sVCAM-1 were related to perfusion abnormalities in the upper lobes, VEGF-A was related to perfusion abnormalities in the lower lobes, and diffuse perfusion abnormalities were related to endothelin-1. Additional treatment with sulodexide improved endothelial function and pulmonary circulation, decreased PAP and blood concentrations of molecular markers of endothelial dysfunction. Conclusion. Predominant localization of microcirculatory abnormalities in COPD patients, especially in the lower lobes, is related to ventilation abnormalities, could predict clinical course of the disease and indicates the need in endotheliotropic therapy.

Diagnosis of arterial gas embolism in SCUBA diving: modification suggestion of autopsy techniques and experience in eight cases

The purpose of this study was to suggest modifications of autopsy techniques in order to improve post-mortem diagnosis of arterial gas embolism (AGE) based on multidisciplinary investigation of SCUBA diving fatalities. Five adult human cadavers from the voluntary donation program of the Human Anatomy Laboratory, and eight judicial autopsied bodies of SCUBA divers from the Forensic Pathology Service were assessed. Before performing any autopsies, we accessed the diving plan and the divers' profiles for each case. We then introduced a new dissection procedure that included identification, isolation, and manipulation of carotid, vertebral and thoracic arterial systems. The dissected vascular structures that allowed optimall isolation of the systemic arterial circulation were identified and ligated. In three of the eight judicial cases, we had a strongly suggestive history of arterial gas embolism following pulmonary barotrauma (PBt/AGE). In these cases, the additional arterial dissection allowed us to clearly diagnose AGE in one of them. The autopsy of the rest of the cases showed other causes of death such as asphyxia by drowning and heart attack. In all cases we were able to reject decompression sickness, and in some of them we showed the presence of artefacts secondary to decomposition and resuscitation maneuvers. These results allow us to suggest a specific autopsy technique divided into four steps, aimed at confirming or excluding some evidence of dysbaric disorders according to a re-enactment of the incident. We have demonstrated the presence of large volumes of intravascular air, which is typical of PBt/AGE.

Ventilatory response to exercise in cardiopulmonary disease: the role of chemosensitivity and dead space.

The lungs and heart are irrevocably linked in their oxygen (O2) and carbon dioxide (CO2) transport functions. Functional impairment of the lungs often affects heart function and vice versa The steepness with which ventilation (V'E) rises with respect to CO2 production (V'CO2 ) (i.e. the V'E/V'CO2 slope) is a measure of ventilatory efficiency and can be used to identify an abnormal ventilatory response to exercise. The V'E/V'CO2 slope is a prognostic marker in several chronic cardiopulmonary diseases independent of other exercise-related variables such as peak O2 uptake (V'O2 ). The V'E/V'CO2 slope is determined by two factors: 1) the arterial CO2 partial pressure (PaCO2 ) during exercise and 2) the fraction of the tidal volume (VT) that goes to dead space (VD) (i.e. the physiological dead space ratio (VD/VT)). An altered PaCO2 set-point and chemosensitivity are present in many cardiopulmonary diseases, which influence V'E/V'CO2 by affecting PaCO2 Increased ventilation-perfusion heterogeneity, causing inefficient gas exchange, also contributes to the abnormal V'E/V'CO2 observed in cardiopulmonary diseases by increasing VD/VT During cardiopulmonary exercise testing, the PaCO2 during exercise is often not measured and VD/VT is only estimated by taking into account the end-tidal CO2 partial pressure (PETCO2 ); however, PaCO2 is not accurately estimated from PETCO2 in patients with cardiopulmonary disease. Measuring arterial gases (PaO2 and PaCO2 ) before and during exercise provides information on the real (and not "estimated") VD/VT coupled with a true measure of gas exchange efficiency such as the difference between alveolar and arterial O2 partial pressure and the difference between arterial and end-tidal CO2 partial pressure during exercise.

Strip of the Month: Marked Variability: To Worry or Not?

Electronic fetal monitoring is a popular technology used to establish fetal well-being. Despite its widespread use, the terminology used to describe patterns seen on the monitor has not been consistent until recently. In 1997, the National Institute of Child Health and Human Development (NICHD) Research Planning Workshop published guidelines for interpretation of fetal tracings. This publication was the culmination of 2 years of work by a panel of experts in the field of fetal monitoring and was endorsed in 2005 by both the American College of Obstetricians and Gynecologists (ACOG) and the Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN). In 2008, ACOG, NICHD, and the Society for Maternal-Fetal Medicine reviewed and updated the definitions for fetal heart rate (FHR) patterns, interpretation, and research recommendations. Following is a summary of the terminology definitions and assumptions found in the 2008 NICHD workshop report. Normal values for arterial umbilical cord gas values and indications of acidosis are defined in Table 1. View this table: Table 1. Arterial Umbilical Cord Gas Values ### Assumptions from the NICHD Workshop ### Baseline FHR

Hyperbaric Oxygen Therapy in Liver Diseases.

Hyperbaric oxygen therapy (HBOT) is an efficient therapeutic option to improve progress of lots of diseases especially hypoxia-related injuries, and has been clinically established as a wide-used therapy for patients with carbon monoxide poisoning, decompression sickness, arterial gas embolism, problematic wound, and so on. In the liver, most studies positively evaluated HBOT as a potential therapeutic option for liver transplantation, acute liver injury, nonalcoholic steatohepatitis, fibrosis and cancer, especially for hepatic artery thrombosis. This might mainly attribute to the anti-oxidation and anti-inflammation of HBOT. However, some controversies are existed, possibly due to hyperbaric oxygen toxicity. This review summarizes the current understandings of the role of HBOT in liver diseases and hepatic regeneration. Future understanding of HBOT in clinical trials and its in-depth mechanisms may contribute to the development of this novel adjuvant strategy for clinical therapy of liver diseases.

Mucine-1 Is Related to Cell-Mediated Immunoexpression and Blood Pressure in Pulmonary Artery in Pulmonary Arterial Hypertension (PAH): Preliminary Results.

Mucine-1 (MUC1) increases in primary lung disease; however, no data are available on pulmonary arterial hypertension (PAH). Our aim was to analyze MUC1 in PAH and a possible link with pulmonary artery pressure (PAPs), PaO2, PaCO2 and cell-mediated immunity. We studied nine PAH patients (four males and five females, aged 52 ± 21years). The control groups were nine patients with pulmonary hypertensions due to lung disease (PPH; five males and four females, aged 63 ± 18years) and 14 patients with left heart disease (HPH; four males and ten females, aged 73 ± 13years). All underwent arterial gas analysis and echocardiography. A serum sample was collected to determine MUC1 and CD40L values on ELISA. No differences were found for PAPs and CD40L. MUC1 resulted in comparable values between PAH and HPH but decreased when compared to PPH (16.46 ± 4.12 vs 116.6 ± 47.08U/ml, p=0.049). pO2 was higher in PAH (PAH 83.18 ± 1.77 vs PPH 62.75 ± 3.23mmHg, p=0.003; vs HPH 65.83 ± 6.94mmHg, p=0.036). pCO2 was lower compared to PPH (36.15 ± 2.19 vs 45.83 ± 3.00mmHg, p=0.026) but not compared to HPH. In PAH patients the MUC1 correlated with pO2 (r=-0.91), pCO2 (r=0.80), PAPs (r=0.82) and CD40L (r=0.72) while it did not in PPH and HPH. These preliminary data show a possible mechanism of immune stimulation in PAH patients. This may imply an association between lung parenchyma, immunity and increase in vascular resistance. Additional studies are required to confirm these findings.

Relationship between fetal heart rate patterns and a time course for evaluation of fetal well-being: “the 30 minutes rule” for decision of mechanical delivery

ObjectiveTo predict acidosis in fetus showing deceleration associated with non-reassuring fetal status during delivery, we examined the relationship between duration of the deceleration and umbilical arterial pH. Materials and methodsA total of 19,907 deliveries in eight facilities of the Juntendo Perinatal Care Group, 895 cases of vaginal deliveries with level 3 decelerations were selected for the subjects of this study. The cut-off point of time when the umbilical arterial pH fell below 7.20 in all cases of level 3 and for each deceleration type were examined. The explanatory variables were the pH and pO2 of umbilical arterial gas and the time from onset of the level 3 pattern to delivery. From receiver operating characteristic (ROC) analysis using these variables, the critical point indicating low Apgar score was set at an umbilical arterial pH < 7.20. ResultsThe cut-off point of time when the umbilical arterial pH fell below 7.2 was 33.5 min for all cases of level 3, and 604 cases of severe variable decelerations with normal baseline variability and normal baseline heart rates, the cut-off point was 33.5 min as well. For 108 cases of late decelerations, there was no significant cut-off point for either the mild or severe cases. Mild prolonged deceleration showed the cut-off point of 34.5 min. ConclusionsWe confirmed the time indices for predicting and preventing acidosis in fetuses showing decelerations. To prevent fetal acidosis, the decision related to proper timing for performing assisted delivery by considering the time course is important.

Maternal and Neonatal Outcomes in Indicated Preterm Births Based on the Intended Mode of Delivery

To compare maternal and neonatal outcomes in women who underwent induction of labor or planned cesarean delivery in indicated preterm births before 34 weeks of gestation. We conducted a retrospective cohort study of all indicated singleton preterm births (23-34 weeks of gestation) in a tertiary center from 2011 to 2014. The primary maternal outcome was a composite of early postpartum hemorrhage, blood transfusion, operative complications, postpartum complications, and clinical chorioamnionitis. The primary neonatal outcome was a composite of neonatal death, cardiopulmonary resuscitation in the delivery room, grade 3 or 4 intraventricular hemorrhage, necrotizing enterocolitis, culture-proven sepsis, birth trauma, arterial cord gas pH less than 7 or base excess less than -12, and 5-minute Apgar score 3 or less. Outcomes were compared by intended mode of delivery (induction of labor compared with cesarean) and adjusted for confounders. In secondary analyses, maternal and neonatal outcomes based on the intended mode of delivery were stratified by gestational age (23-27 6/7, 28-31 6/7, and 32-33 6/7 weeks of gestation). Of 629 patients with indicated early preterm births during the study period, 331 (53%) underwent induction of labor, of whom 208 (63%) delivered vaginally. Induction of labor was not associated with an increased risk of the primary maternal (16.3% compared with 19.5%, adjusted odds ratio [OR] 0.8, 95% CI 0.5-1.3) or neonatal composite outcome (14.5% compared with 35.9%, adjusted OR 0.7, 95% CI 0.4-1.1). Analyses stratified by gestational age were consistent with the overall analysis. Maternal and neonatal outcomes do not differ based on the intended mode of delivery. Induction of labor should be considered when early preterm birth is indicated.

Delayed cord clamping and cord gas analysis at birth.

Delayed cord clamping for at least 60s in both term and preterm babies is a major recent change in clinical care. Delayed cord clamping has several effects on other possible interventions. One of these is the effect of delayed cord clamping on umbilical artery gas analysis. When indicated, umbilical artery gas analysis can safely be done either with early cord clamping or, probably most of the times it is necessary, during delayed cord clamping with the cord still unclamped. Paired blood samples (one from the umbilical artery and one from the umbilical vein) can be taken from the pulsating and unclamped cord, immediately after birth, during delayed cord clamping, without any effect on either the accuracy of umbilical artery gas analysis or the transfusion of blood through delayed cord clamping. Umbilical artery gas analysis should instead not be done after delayed cord clamping, since delayed cord clamping alters several acid-based parameters and lactate values.

Two Cases of Platypnoea-Orthodexia.

Platypnoea-orthodexia syndrome is a rare cause of dyspnoea when hypoxaemia is induced by the upright position and relieved by recumbency. We report two cases in which platypnoea-orthodexia syndrome was present and caused by two different mechanisms: intracardiac shunt and intrapulmonary shunt.LEARNING POINTSPlatypnoea-orthodexia syndrome should be considered in the differential diagnosis of unexplained hypoxia.A high degree of suspicion is required to instigate initial investigations with either postural pulse oximetry or arterial gas analysis.The diagnosis must be based on the presence of both an anatomical and a functional component.

Acute effects of repeated cycling sprints in hypoxia induced by voluntary hypoventilation.

This study aimed to investigate the acute responses to repeated-sprint exercise (RSE) in hypoxia induced by voluntary hypoventilation at low lung volume (VHL). Nine well-trained subjects performed two sets of eight 6-s sprints on a cycle ergometer followed by 24s of inactive recovery. RSE was randomly carried out either with normal breathing (RSN) or with VHL (RSH-VHL). Peak (PPO) and mean power output (MPO) of each sprint were measured. Arterial oxygen saturation, heart rate (HR), gas exchange and muscle concentrations of oxy-([O2Hb]) and deoxyhaemoglobin/myoglobin ([HHb]) were continuously recorded throughout exercise. Blood lactate concentration ([La]) was measured at the end of the first (S1) and second set (S2). There was no difference in PPO and MPO between conditions in all sprints. Arterial oxygen saturation (87.7 ± 3.6 vs 96.9 ± 1.8% at the last sprint) and HR were lower in RSH-VHL than in RSN during most part of exercise. The changes in [O2Hb] and [HHb] were greater in RSH-VHL at S2. Oxygen uptake was significantly higher in RSH-VHL than in RSN during the recovery periods following sprints at S2 (3.02 ± 0.4 vs 2.67 ± 0.5L min-1 on average) whereas [La] was lower in RSH-VHL at the end of exercise (10.3 ± 2.9 vs 13.8 ± 3.5mmol.L-1; p < 0.01). This study shows that performing RSE with VHL led to larger arterial and muscle deoxygenation than with normal breathing while maintaining similar power output. This kind of exercise may be worth using for performing repeated sprint training in hypoxia.

Scuba diving death: Always due to drowning? Two forensic cases and a review of the literature.

Scuba diving is an increasingly common recreational activity. We describe the physiopathology of barotrauma in two cases where death was caused by pulmonary barotrauma while diving. An inspection and autopsy were carried out in both cases. The autopsy data were supported by post-mortem radiological investigation. Histological and toxicological analyses were also carried out, and dive computer and tank manometer analysis performed. In both cases, the cause of death was attributable to arterial gas embolism, resulting from pulmonary barotrauma subsequent to pulmonary over-distension. The dive computer analysis and the tank manometer allowed us to understand what happened underwater. In our opinion, a multidisciplinary approach is crucial in order to clarify the cause of death. Some pathological conditions and risk factors should be considered before diving.

Implementation of the International Myeloma Working Group reccomendations on renal impairment in multiple myeloma patients in routine clinical practice

Background: Renal impairment (RI), is one of the most common complications of multiple myeloma (MM), and it is associated with an increased risk of early death. The incidence of RI at MM diagnosis ranges from 20% to 50%, while its comparison occurred in 60% MM patients (pts). In this scenario tempestive diagnosis of RI in MM pts and exclusion of possible alternative causes of RI are essential.We applied the diagnostic algorithmproposed by the International Myeloma Working Group in pts admittedto our Hospital for RI (with known and unknown MM, or suspected cast nephropathy, CN), in order to verify the possible positive impact of this diagnostic workflow on MM-related RI management. Patients and methods: We collected data of adult pts, with known or unknown MM, with or withouth monoclonal component (MC). We performed complete blood analysis, with eGFR (CKD-EPI and MDRD methods), serum and urine electrolites, bicarbonatemia, serum and urine immunofixation, fraction 3 and 4 of complement, crioglobulinemia, HbA1c, arterial gas analysis, evaluation of urine rate every 6 hours, daily urine collection. We investigated eventual nephrotoxic concomitant therapies, clinical parameters and objectives signs of RI (edema, symptomatic disionia). In the second day of hospitalization we tested protein electrophoresis on serum and urine, chest X-ray, ultrasonography of abdomen, ecocardiography and electrocardiography. In the third day we evaluated results of previous exams and we decided, if necessary, eventual biopsies (bone marrow in unknown MM pts, renalin suspected CNpts, umbilical fat for amyloidosis). Results: From March to December 2016 we admitted 89 pts with RI and MC (51 F, 38 M, 41-83 yrs range), 25 are knownMM pts with newly diagnosed RI. Among RI cases, we diagnosed 22 de novo MM, 26 diabetes related RI, 5 amyloidosis, 11 other causes. We obtained diagnosis of RI within 4 days, both in known and in de novo MM pts. Conclusions: The implementation of the International Myeloma Working Group Reccomendations on RIin a routine clinical practice confirmed its feasibility and utility in the optimal workout of MM pts, with a positive impact on reduced hospitalization, uncessary dyalisis and steroids overtreatment.

Acute kidney injury caused by decompression illness successfully treated with hyperbaric oxygen therapy and temporary dialysis.

A 52-year-old Japanese male professional diver was referred to our hospital for decompression illness (DCI). After 1h of diving operation at 20m below sea level, he complained of dyspnea, chest pain, and abdominal pain. He dove again, intending to ease the symptoms, but the symptoms were never relieved. He dove for a total of 4h. No neurological abnormalities were observed. Computed tomography images revealed portal venous gas and mesenteric venous gas, in addition to bubbles in the femoral veins, pelvis, lumbar canal, intracranial sinuses, and joints. Hyperbaric oxygen therapy (HBOT) was immediately administered. His symptoms improved after the first course of HBOT, however, the patient had anuria for almost 36h after admission and exhibited acute kidney injury (AKI). Serum creatinine and creatine kinase (CK) levels were increased to maximal values of 6.16 mg/dL and 18,963 U/L, respectively. Blood flow signals were not detected on kidney Doppler ultrasound. We considered that AKI was caused by blood flow impairment and capillary leak syndrome due to DCI in addition to rhabdomyolysis secondary to arterial gas embolism in the skeletal muscles. Temporary dialysis was required to correct the acidemia and electrolyte disturbance. Diuretic phase was initiated, and the patient was put off dialysis on day 3. Serum creatinine and CK levels returned to normal on day 11. He was successfully treated without any complications. Although AKI is a rare manifestation, we should consider AKI risk in patients with severe DCI.

The Relationship between Cerebral Vasoreactivity and Post-Concussive Symptom Severity.

While pathophysiology underlying post-concussion symptom burden is unknown, data suggest that cerebrovascular dysfunction may be among the culprits. We sought to determine whether the degree of impairment in the ability of cerebrovasculature to buffer against changes in arterial gases (vasoreactivity) is associated with concussion symptoms. In 15 participants (19 ± 5 years, 1 week to 1 year post-injury) diagnosed with concussion, we assessed vasoreactivity from the slope of the linear relationship of beat-by-beat middle cerebral artery blood flow velocity (transcranial Doppler ultrasound) to end-tidal CO2 during progressive increases in end-tidal CO2 (air rebreathing). Symptom burden was assessed using the Post-Concussion Symptom Scale. Subsequently, we explored the relationship between vasoreactivity and the severity of post-concussion headache and cognitive difficulties by linear models. During rebreathing, CO2 increased from 32.6 ± 1.6 to 46.8 ± 1.8 mmHg and cerebrovascular conductance (i.e., flow velocity over pressure) increased from 0.48 ± 0.04 to 0.74 ± 0.06 cms-1 mmHg-1. There was a strong linear relationship between the increase in CO2 and in conductance (R2 = 0.81 ± 0.05; p < 0.05). On average, cerebral vasoreactivity was 0.018 ± 0.003 cm-1 s-1 mmHg CO2-1. Although vasoreactivity tended to be somewhat higher in the asymptotic participants (0.019 ± 0.003 vs. 0.015 ± 0.005 cm-1 s-1 mmHg CO2-1), this difference was not statistically significant (p = 0.48). Higher vasoreactivity was strongly associated with more severe headaches (R2 = 0.57; p < 0.01) and worse cognitive symptoms (R2 = 0.71; p < 0.01). Thus, cerebral vasoreactivity relates strongly to post-concussive headache and cognitive symptom burden. This has significant implications for understanding the pathophysiology underlying post-concussive symptom burden and for devising effective treatment options.

¿Los gases venosos periféricos pueden reemplazar a los gases arteriales en la evaluación de pacientes críticos?

Arterial blood gas analysis is a routine study for ill patients, and provides a lot of information when it comes to making decisions. For a long time arterial blood gases have been used as reference for these decisions, which are often difficult. Arterial blood gases are often painful and technically demanding, often resulting in damage to the arterial wall, especially when repeated measurements are required. Pulse oximetry is a non-invasive alternative to arterial blood gases, but does not allow assessment of partial pressure of carbon dioxide (pCO2). Taking into account routine sampling in hospitals, and that it is often easier to take a sample of venous blood in which measurements can be made of the pH, pCO2, pO2, and bicarbonate and lactate levels, a review is presented of different studies that compare arterial and venous gases in multiple scenarios and determine the importance of these, as well as if peripheral venous gases could at some point replace the arterial gases, and showing that these are only comparable in the estimates of pH. For the time being, and until larger studies show otherwise, venous gases cannot replace arterial gases in acid-base and oxygenation analysis in critically ill patients.

Case 2: Beware of Lumps and Bumps after Cooling!

The infant is born to a 31-year-old primigravida mother by cesarean delivery due to nonreassuring fetal heart rate and chorioamnionitis. Rupture of membranes is prolonged at 47 hours with meconium-stained amniotic fluid. At birth, the newborn is noted to have poor tone and respiratory effort. He undergoes intubation and is admitted to the NICU for further observation and management. Apgar scores are 2, 5, and 7 at 1, 5, and 10 minutes, respectively. Arterial cord gas has a pH of 6.8 and a base deficit of 24 mEq/L (24 mmol/L). The patient demonstrates signs and symptoms of moderate hypoxic-ischemic encephalopathy and meets the criteria for whole body hypothermia therapy. He is started on parental nutrition. He has evidence of pulmonary hypertension on echocardiography and requires inhaled nitric oxide for 2 days while undergoing hypothermia treatment. He maintains adequate blood pressures and does not have any hemodynamic decompensation. He receives 2 doses of fresh frozen plasma to correct laboratory indices that demonstrate abnormal coagulation profiles. Following rewarming and after obtaining a brain magnetic resonance imaging scan (which is unremarkable) he undergoes successful extubation on the 4th postnatal day. His respiratory support is gradually weaned and he remains in room air from day 6 of age onwards. He is slowly introduced to enteral feeds and reaches full oral feeds by 9 days of age. His neurologic examination findings are normal. Erythematous, indurated plaques are noted over the upper back, …

Asociación entre los niveles de déficit de base y la aparición de disfunción orgánica múltiple en pacientes con preeclampsia severa admitidas en la clínica gestión salud s.a.s (Cartagena) entre el 1 de enero de 2014 hasta 31 diciembre 2016

&#x0D; Objetivo: Determinar la asociación entre los niveles de déficit de base y la aparición de disfunción orgánica en pacientes con preeclampsia severa admitidas en la Clínica Gestión salud S.A.S (Cartagena) entre el 1 de enero de 2014 hasta 31 Dic 2016. Método: La Pseudomonas Aerugiosa es una bacilo gramnegativos, con diámetros de 1 - 3 mm de longitud, aerobio obligado, oxidasa positiva que crece a 37-42 °C, de habita variable (tierra, agua, plantas y animales). Se caracteriza por formar colonias redondeadas, lisas con olor a uvas y de variable color según el pimento producidos por la cepa color verde-azulado (piocinina y pioverdina), rojo oscuro (piorrubina) y negro (piomelanina). Resultados: Mediante un análisis de regresión logística se exploró la fuerza de asociación entre tener un déficit de base menor o igual a -5 y el desarrollo de DOM encontrándose una asociación estadísticamente significativa. Tener un déficit de base menor o igual a -5 aumentaba la probabilidad de desarrollar DOM con una OR de 3,73 (IC 95% 1,28 a 12,05 p=0,0197). Conclusión: Valores de DB menores a -5, es decir, tener un mayor DB se asocia a un aumento en la probabilidad de tener DOM. En este grupo de pacientes también son más frecuentes la disfunción hepática, la disfunción de la coagulación y el síndrome de HELLP.&#x0D;