Gas Analysis Parameters Research Articles

Exploratory analysis of serum Krebs von den Lungen-6, blood gas analysis & Brixia score in determining COVID-19 severity & mortality.

Background & objectives Krebs von den Lungen-6 (KL-6) is primarily expressed by the damaged type II pneumocytes. In this context, the relationship of KL-6 with blood gas analysis (BGA) parameters and Brixia score is still limitedly discussed. This study aims to analyze the correlation of KL-6, BGA and Brixia scores to the severity and mortality of COVID-19. Methods A cross-sectional study was conducted in adult COVID-19 positive individuals at Universitas Airlangga Hospital, Surabaya, East Java, Indonesia, from March to August 2021. KL-6, BGA, and Brixia scores were compared according to severity (severe vs. non-severe) and mortality (non-survivor vs. survivor). The receiver operating characteristic (ROC) analysis was also performed to define the optimal cut-off, sensitivity, as well as the specificity of KL-6, BGA and Brixia scores to determine the COVID-19 severity and mortality. Results Total 35 severe and 20 non-severe COVID-19 positive individuals were enrolled in this study. Of those, there were 22 non-survivors. No significant difference in serum KL-6 levels was observed in the severity and mortality groups. KL-6 and HCO3- had positive correlation in the severe group (r=0.37). KL-6 and Brixia scores showed a significant negative correlation among COVID-19 positive individuals (r=-0.283; P=0.036). KL-6 and Brixia scores together served as the best severity markers in the current study [AUC 0.809 (0.697-0.920); Sn/Sp=0.686/0.900)], followed by KL-6 and P/F ratio [AUC 0.800 (0.637-0.963); Sn/Sp=0.971/0.750]. Interpretation & conclusions The findings of this study suggest that KL-6 has the potential to be a useful adjunct laboratory parameter to the BGA and Brixia score representing COVID-19 severity and mortality.

Negative impact of face masks in patients with interstitial lung disease: A prospective study.

Face masks increase airway resistance, data on the actual extent of this effect are scarce. The aim of this study was to assess the effect of different mask types on clinical parameters during moderate exercise in healthy non-smokers, active smokers and patients with interstitial lung disease (ILD) without the need of oxygen therapy. In a prospective observational pilot study participants performed a six-minute walk test without mask, with a surgical mask, a well-fitted FFP2 mask and with a valved FFP3 mask. Respiratory rate, blood pressure, heart rate, blood gas analysis parameters, dyspnoea and six-minute walk distance were measured. Data were analysed in an ANOVA model. 21 healthy participants, 17 active smokers without known pulmonary disease and 15 patients with interstitial lung disease were included. Participants with ILD had a significant lower walking distance, a higher respiratory rate and a lower pO2 when using FFP2 masks, but not with valved FFP3 masks or surgical masks compared to not wearing a mask. For patients with ILD without the need of oxygen therapy wearing an FFP2 mask had a negative impact on pO2, respiratory rate and walking distance in the six-minute walk test. This effect was not seen with valved FFP3 masks or surgical masks.

Carbon and graphene based nanocomposites for gas sensors—Current state and advances

After the discovery of carbon nanoforms, carbon nanotube (one dimensional) and tube like nanostructure and graphene (two dimensional) nanosheets have gained immense research curiosity. Further nanotechnological developments have moved towards the formation of carbon nanotube nanocomposites and graphene nanocomposites. For the purpose, various matrices including thermoplastic polymers and conjugated polymers have been used. Methodology is the systematic gathering of the literature and development of a novel review outline, theme, and discussions regarding the discussed topics. Hence, varying conjugated polymers such as polyaniline, polythiophene, poly(3,4-ethylenedioxythiophene), and nonconjugated nylon, poly(ethylene glycol), etc. have been processed using techniques like in situ, solution, electropolymerization, spin coating, etc. In sensors, the nanocomposites need to develop fine nanoparticle dispersion, network formation, and interfacial interactions ultimately supporting the electron or charge transfer in these nanomaterials desirable for the recognition of the gaseous species. Moreover, interactions of the nanocomposite with the analyte molecules define the sensing capabilities of the nanomaterials. Consequently, nanocarbon nanocomposite based gas sensors have been analyzed for conductivity, change in resistance, sensitivity, selectivity, response time, detection limit, and other desirable properties. For future designs, it is recommended to develop high-tech combinations of conjugated polymers like polythiophene derivatives using functional forms of graphene and carbon nanotube. In addition, use of advanced manufacturing techniques like 3D/4D printing and spin coating must be applied to form efficient sensors. In conclusions, this manuscript presents not only comprehensive but also comparative analysis on different gas analysis parameters such as detection limit, concentration, response time, etc. for various nanocomposite sensors. Lastly, the encounters in preparing and applying graphene/carbon nanotube sensors, associated utilizations, and possible future prospects have been discussed.

Predictive values of ultrasonic diaphragm thickening fraction combined with integrative weaning index in weaning patients with mechanical ventilation: a retrospective study

ObjectiveWe aimed to explore the predictive values of ultrasonic diaphragm thickening fraction (DTF) combined with integrative weaning index (IWI) in weaning patients with mechanical ventilation.MethodsPatients with mechanical ventilation who received oral endotracheal intubation from September 2020 to September 2021 were included in this retrospective study. Before the start of the spontaneous breathing test (SBT), IWI was calculated according to the blood gas analysis parameters and parameters read in volume control mode. After the start of SBT, DTF was calculated according to the end-expiratory thickness and end-inspiratory thickness of the right diaphragm. The receiver operating curve (ROC) was used to evaluate the predictive value of DTF and IWI for successful weaning, and the sensitivity and specificity were calculated according to the best critical value.ResultsThe sensitivity, specificity, and best cutoff value of DTF to predict successful weaning was 0.772, 0.727, and 0.293, respectively, and the area under the curve (AUC) was 0.72 (95%CI 0.59–0.86, p = 0.003). The sensitivity, specificity, and best cutoff value of IWI to predict successful weaning was 0.614, 0.909, 53.00, respectively, and AUC was 0.82 (95%CI 0.72–0.91, p < 0.001). The sensitivity, specificity, and best cutoff value of the combination of DTF and IWI to predict successful weaning was 0.614, 0.909, 17.848, respectively, and AUC was 0.84 (95%CI 0.75–0.93, p < 0.001).ConclusionDTF and IWI can guide the selection of weaning, while DTF combined with IWI can improve the effect of weaning prediction and provide support for patients’ weaning safety.

Effects of N-Acetylcysteine combined with Ambroxol Hydrochloride on clinical symptoms, CRP, and PCT in children with pneumonia

ObjectiveThis study investigated the effects of N-Acetylcysteine (NAC) combined with Ambroxol Hydrochloride (AH) on clinical symptoms, C-Reactive Protein (CRP), and Procalcitonin (PCT) levels in children with pneumonia. MethodsA total of 98 children with pneumonia were assigned to the control group and observation group by random number table method. NAC was administered to the observation group and AH was given to the control group. The therapeutic effect was observed, the disappearance time of clinical symptoms and levels of inflammatory factors, lung function parameters, blood gas analysis parameters, and immunoglobulin were measured. The incidence of adverse reactions was statistically analyzed. ResultsA higher effective rate was observed in the observation group than in the control group (p < 0.05). Antipyretic time, cough disappearance time, and lung rale disappearance time in the observation group were shorter than those in the control group (p < 0.05). After treatment, CRP and PCT were lower (p < 0.05), FVC, FEV1, and FEV1/FVC were higher, PaCO2 was lower, PaO2 and SaO2 were higher, and IgA, IgG, IgM, and C3 were higher in the observation group than those in the control group (p < 0.05). The incidence of adverse reactions between the two groups was not significantly different (p > 0.05). ConclusionNAC combined with AH is effective in the treatment of pediatric pneumonia by effectively alleviating clinical symptoms, reducing inflammatory factors, and improving lung function and immune function.

Weather VBG Analysis can Replace ABG Analysis in DKA Patients

Introduction: Endocrinological emergencies such as DKA are known for hyperglycemia, ketone bodies, and metabolic acidosis in the blood and urine. It rarely occurs in type 2 DM patients. ABG and VBG are biochemical parameters used in its research. Objective: To evaluate the efficacy of VBG against ABG in DKA patients. Methodology: Details on DM type, duration, antidiabetic drug and insulin usage, and past DKA hospitalizations were collected. A complete blood count, ESR, RFT, electrolyte levels (sodium, potassium, calcium, and phosphate), LFT, RBS, UT, ABG, VBGA, microscopy, chest X-ray, ECG, abdominal and pelvic ultrasound are recommended. Result and Conclusion: We discovered that the majority of patients pH levels were in the 7.00-7.25 range in both AB and VB (48.7% and 46.1%, respectively) and that the majority of patients' levels were above 15 in both AB and VB (56.6% and 64.5%, respectively). Thus, we found that VBG analysis parameters were similar to ABG analysis parameters. The blood gas analysis parameters pH and exhibited the strongest linear correlation when comparing arterial and venous samples.

Clinical Variables Specific to Timing of Tracheal Extubation Following Pediatric Cardiac Surgery.

The primary objective of this study was to identify specific factors in pediatric cardiac surgical patients when tracheal extubation was performed on the operating table after completion of open-heart surgery (Group-1), postoperatively in the intensive care unit within 6 h (Group-II) or after 6 h (Group-III). The causes of failed extubation, the presence of chromosomal disorders in addition to arterial blood gas analysis parameters at the time of tracheal extubation, and the duration of intensive care unit stay were also evaluated in each group. In addition to the three groups, Groups I and II were combined as a "fast-track" extubation group. The demographic data, Risk Adjustment for Congenital Heart Surgery (RACHS-1) score, the Society of Thoracic Surgeons - European Association for Cardio-Thoracic Surgery Congenital Heart Surgery Mortality Category (STAT Mortality Category), cardiopulmonary bypass (CPB) time, aortic cross-clamp (ACC) time, and vasoactive-inotropic score (VIS) at the time of tracheal extubation along with data related to secondary objectives were recorded for each patient. A significant association was found by bivariate analysis between clinical variables and for both operating table and fast-track extubation in terms of age, weight, RACHS-1 score, STAT category, CPB and ACC time, and VIS. A multivariate-adjusted analysis showed weight, lower STAT category, CPB time, and VIS were independent predictors for operating table and fast-track extubation. Younger age, lower weight, higher RACHS-1, STAT category, and VIS, along with longer CPB and ACC, are associated with delay in the timing of tracheal extubation in pediatric cardiac surgical patients.

The physiological effect of prone positioning and lateral decubitus in non-intubated patients with severe COVID-19: a prospective cohort study

Introduction: Prone positioning is one type of postural lung recruitment manoeuvre that has been widely studied regarding the benefits and physiological changes of the cardiorespiratory system. However, prone positioning is not very comfortable for the patients because they have to lie on their stomachs for a while when the oxygen therapy and other monitoring devices are still attached. Based on patient observations, some patients will change to more comfortable positions, namely using the right/left lateral decubitus position. The purpose of this research was to examine the physiological impact of prone and lateral decubitus position in non-intubated patients who were diagnosed with severe COVID-19. Methods: It was a prospective cohort study in subsequent people with severe COVID-19 who obtained a non-rebreathing mask or high-flow nasal cannula at a University Hospital between 1 June and 10 September 2021. The study lasted for a total of 2021 days and involved 48 patients. The patients assumed the prone positioning or lateral decubitus every morning and afternoon for 4 h and were measured for cardiorespiratory parameters and blood gas analysis. It has been reported in line with the STROCSS criteria. Results: Dynamic changes based on cardiorespiratory parameters and blood gas analysis parameters in patients with prone and lateral decubitus position in patients with severe COVID-19 receiving conventional oxygen therapy (via non-rebreathing mask) or high-flow nasal cannula did not show any significant difference. Conclusion: The physiological effect of prone positioning and lateral decubitus in non-intubated patients with severe COVID-19 are similar. Accordingly, lateral decubitus can be an alternative for postural lung recruitment manoeuvres and warrants further randomized trials.

Long-COVID is Associated with Impaired Red Blood Cell Function.

COVID-19 disease, caused by the severe acute respiratory syndrome virus 2 (SARS-CoV-2), induces a broad spectrum of clinical symptoms ranging from asymptomatic cases to fatal outcomes. About 10-35% of all COVID-19 patients, even those with mild COVID-19 symptoms, continue to show symptoms, i. e., fatigue, shortness of breath, cough, and cognitive dysfunction, after initial recovery. Previously, we and others identified red blood cell precursors as a direct target of SARS-CoV-2 and suggested that SARS-CoV-2 induces dysregulation in hemoglobin- and iron-metabolism contributing to the severe systemic course of COVID-19. Here, we put particular emphasis on differences in parameters of clinical blood gas analysis and hematological parameters of more than 20 healthy and Long-COVID patients, respectively. Long-COVID patients showed impaired oxygen binding to hemoglobin with concomitant increase in carbon monoxide binding. Hand in hand with decreased plasma iron concentration and transferrin saturation, mean corpuscular hemoglobin was elevated in Long-COVID patients compared to healthy donors suggesting a potential compensatory mechanism. Although blood pH was within the physiological range in both groups, base excess- and bicarbonate values were significantly lower in Long-COVID patients. Furthermore, Long-COVID patients displayed reduced lymphocyte levels. The clinical relevance of these findings, e. g., as a cause of chronic immunodeficiency, remains to be investigated in future studies. In conclusion, our data suggest impaired erythrocyte functionality in Long-COVID patients, leading to diminished oxygen supply. This in turn could be an explanation for the CFS, dyspnea and anemia. Further investigations are necessary to identify the underlying pathomechanisms.

Effect of Nasal Continuous Airway Pressure With and Without Surfactant Administration for the Treatment of Respiratory Distress Syndrome in Preterm Neonates.

Background Neonatal respiratory distress syndrome is a common cause of respiratory distress in newborns, often resulting from a lack of surfactant production or premature lung breakdown. The objective of this study was to compare the effect of nasal continuous airway pressure with and without surfactant administration for the treatment of respiratory distress syndrome in preterm neonates. Methodology A comparative analytical study was conducted on 100 neonates (group A continuous positive airway pressure (CPAP) with surfactant = 50 vs. group B CPAP only= 50 ). The group was allocated to the patient according to sequence. In group A, the neonates were given surfactant by the INSURE (intubation, surfactant, extubation) technique via an endotracheal tube with a single dose of 100 mg/kg/dose within the first hours of life followed by CPAP. In group B, the neonates were given only CPAP after birth. At follow-up after 24 hours, pH, pCO2, pO2, positive end-expiratory pressure (PEEP), and FiO2 were documented. All information was recorded on a predesigned questionnaire and results were subjected to statistical analysis to determine the significance of observed differences. Collected data were entered and analyzed using SPSS version 22 (IBM Corp., Armonk, NY, USA). Both groups were compared for mean pH, pCO2, pO2, PEEP, and FiO2 using an independent-sample t-test and effectiveness using a chi-square test. A significant difference was considered when the p-value was ≤0.05. Results Group A had a mean age of 4.84 ± 0.95 hours, while group B had a mean age of 5.5 ± 1.26 hours (p = 0.04). Gender distribution was similar in both groups, with 46.0% males and 54.0% females in group A, and 48.0% males and 52.0% females in group B (p = 0.841). Regarding post-treatment blood gas analysis, group A had a mean pH of 7.30 ± 0.05, and group B had a mean pH of 7.302 ± 0.07. While there was no significant difference in pO2 levels (p = 0.38), there was a substantial difference in pCO2 levels, with group A at 38.26 ± 4.35 and group B at 35.45 ± 4.36 (p = 0.02).CPAP parameters also showed a statistically significant difference in PEEP pCO2, with group A at 4.5 ± 0.73 and group B at 4.16 ± 0.37 (p = 0.004). After treatment, group A exhibited significant improvements in blood gas analysis and CPAP parameters compared to group B. Conclusions The study revealed that both CPAP with and without surfactant treatment effectively treat respiratory distress syndrome in preterm infants, with both being safe, effective, secure, and reducing side effects. However, CPAP treatment without surfactant is a non-invasive and cost-effective option.

Markers of inflammasome activation in Coronavirus disease 2019 (COVID-19) Egyptian patients: Impact on disease severity

There are conflicting data regarding the relationship between coronavirus disease 2019 (COVID-19) severity and Caspase-1 (Casp-1), interleukin-1ß (IL-1β), and IL-18. Our study sought to quantify the levels of IL-18, IL-1ß, and Casp-1 as indicators for inflammasome activation in COVID-19 patients at Assiut University Hospitals and to correlate their levels with parameters of disease severity in COVID-19 patients. Serum levels of Casp-1, IL-1β and IL-18 were measured in 63 COVID-19 patients and 26 normal controls by an enzyme linked immunosorbent assay (ELISA). Also, arterial blood gas analysis and laboratory parameters including hemoglobin, platelets, lymphocyte count, liver function test, kidney function test, C-reactive protein (CRP), D-dimer, ferritin and LDH were estimated. Serum levels of Casp-1, IL-1β and IL-18 were significantly higher in the COVID-19 group as compared to controls (p= 0.04, p=0.001 and p=0.03, respectively). Although the three markers were higher in the severe group, yet only IL-1ß showed a significant difference as compared to the non-severe group (p=0.04). IL-18 had significant positive correlations with CRP and ferritin (p = 0.04 and p = 0.02, respectively). IL-1β was positively correlated with alanine aminotransferase. Casp-1 had significant positive correlations with CRP and lactate dehydrogenase (p=0.045 and p=0.001, respectively). Patients showed weak positive correlations between serum level of Casp-1 and each of IL-1β and IL-18. Also, a strong positive correlation was found between IL-1β and IL-18 (p < 0.0001). In conclusion, inflammasome activation was a hallmark in COVID-19 patients. The markers of activation were positively correlated with many parameters of inflammation, may suggest their important roles in the pathophysiology of the disease and its progression. IL-1β was the only marker to be correlated with disease severity and therefore may be suggested as a potential marker for identifying severe COVID-19 patients.

Acid base disturbances in leptospirosis patients: Comparison of conventional and Stewart method

Background: The Henderson-Hasselbalch equation is used in the conventional assessment of acid-base status. In 1983, P. Stewart put up an alternate strategy. The Henderson-Hasselbalch equation uses variations in PCO2 and bicarbonate to explain the acid-base state. On the other hand, the Stewart theory states that albumin, inorganic phosphate, PCO2, Strong Ion Difference (SID), and SID dictate acid-base status. Therefore, these variables have an important role in clinical management. The metabolic acidosis caused by unmeasured anions is accurately identified by the Stewart physiochemical approach, and it is a predictor of mortality in patients with leptospirosis. Aims and Objectives: Comparison of the leptospirosis patient’s S. albumin (requiring ABG analysis) and arterial blood gas (ABG) analysis parameters (pH, PO2, PCO2, HCO3-, BE, SaO2, S.Na+, S.K+, S.Cl, S.PO43-, and anion gap) to compare the conventional and Stewart methods and determine the type of acid-base disturbances present in leptospirosis patients in the intensive care unit. Materials and Methods: Following approval by the ethics committee, ABG and S. Albumin were taken from the clinical notes of fifty patients. The Henderson-Hasselbalch equation, in its conventional form, was unable to identify complex acid-base problems. Thus, we integrated this with the Stewart method. Results: The majority of leptospirosis patients had a mixed disorder characterized by respiratory alkalosis, metabolic acidosis, and metabolic alkalosis. The most prevalent conditions were metabolic acidosis, respiratory alkalosis, and metabolic alkalosis. Stewart’s method can help explain the cause of metabolic disorders. Stewart’s approach also made occult acid-base disorders visible. Conclusion: Stewart’s approach emphasizes the significance of Na+, K+, Cl-, Alb, and PO43- and clarifies their part in the development of metabolic abnormalities, particularly those involving Alb and PO43-. This demonstrates unequivocally that the cause of the metabolic abnormalities can be explained by Stewart’s method, which is highly helpful in planning the management.

Integrated lung ultrasound score for early clinical decision-making in patients with COVID-19: results and implications

Background and objectivesLung Ultrasound Score (LUS) identifies and monitors pneumonia by assigning increasing scores. However, it does not include parameters, such as inferior vena cava (IVC) diameter and index of collapse, diaphragmatic excursions and search for pleural and pericardial effusions. Therefore, we propose a new improved scoring system, termed “integrated” lung ultrasound score (i-LUS) which incorporates previously mentioned parameters that can help in prediction of disease severity and survival, choice of oxygenation mode/ventilation and assignment to subsequent areas of care in patients with COVID-19 pneumonia.MethodsUpon admission at the sub-intensive section of the emergency medical department (SEMD), 143 consecutively examined COVID-19 patients underwent i-LUS together with all other routine analysis. A database for anamnestic information, laboratory data, gas analysis and i-LUS parameters was created and analyzed.ResultsOf 143 enrolled patients, 59.4% were male (mean age 71 years) and 40.6% female. (mean age 79 years: p = 0.005). Patients that survived at 1 month had i-LUS score of 16, which was lower than that of non-survivors (median 20; p = 0.005). Survivors had a higher PaO2/FiO2 (median 321.5) compared to non-survivors (median 229, p < 0.001). There was a correlation between i-LUS and PaO2/FiO2 ratio (rho:-0.4452; p < 0.001), PaO2/FiO2 and survival status (rho:-0.3452; p < 0.001), as well as i-LUS score and disease outcome (rho:0.24; p = 0.005). In non-survivors, the serum values of different significant COVID indicators were severely expressed. The i-LUS score was higher (median 20) in patients who required non-invasive ventilation (NIV) than in those treated only by oxygen therapy (median 15.42; p = 0.003). The odds ratio for death outcome was 1.08 (confidence interval 1.02–1.15) for each point increased. At 1-month follow-up, 65 patients (45.5%) died and 78 (54.5%) survived. Patients admitted to the high critical ward had higher i-LUS score than those admitted to the low critical one (p < 0.003).Conclusionsi-LUS could be used as a helpful clinical tool for early decision-making in patients with COVID-19 pneumonia.

P274 GUESS WHO‘S COMING TO REANIMATION? ANALYSIS OF THE ELDERLY PATIENT WITH EMBOLISM IN NEED OF HOSPITALIZATION IN INTENSIVE CARE: REAL LIFE IN THE EMERGENCY ROOM

Abstract Premise Pulmonary embolism is a disease still characterized by high mortality and which may require hospitalization in intensive care. Purpose Evaluate which parameters, in the real life of an Emergency Department, correlate with the need and the duration of hospitalization in intensive care. Methods Single–center retrospective observational study, on all geriatric patients (&amp;gt; 75) who refer to our ED, where they were diagnosed with acute PE. Enrollment began in 2015 and ended in 2019. We collected data from medical history, physical examination, laboratory tests, imaging, outcomes. Results We enrolled 247 patients, with a mean age of 83 years and female prevalence (F = 63%). Of these 12 (14 %) required hospitalization in intensive care from the emergency room. Regarding the need for hospitalization in resuscitation, age and vital parameters (arterial pressure, respiratory rate, heart rate), as well as derived shock indices are not correlated (p &amp;gt; 0.05). Only the systolic blood pressure values and it show a trend which however does not reach statistical significance (p = 0.06). Among the blood gas analysis parameters, only low pCO2 has a slight correlation (p &amp;lt; 0.05). The D–Dimer (p &amp;lt; 0.01) and creatinine values (p &amp;lt; 0.05) show correlation between the blood chemistry tests. Regarding the length of stay in resuscitation, age and vital parameters (blood pressure, respiratory rate, heart rate), as well as derived shock indices, do not show any correlation (rho∼0; p &amp;gt; 0.05). A weak correlation is instead present with high values of D–Dimer (rho∼0.25; p &amp;lt; 0.005) and creatinine (rho∼0.33; p &amp;lt; 0.0005). The presence of massive pulmonary embolism shows no correlation (p &amp;gt; 0.5). The presence of organ damage, on the other hand, correlates in a statistically significant manner (p &amp;lt; 0.0005). Excellent correlation is shown by the sPESI index (p &amp;lt; 0.0001). Discrete correlation showed the alteration in pH (rho∼0.61; p &amp;lt; 0.0001). Correlation for the blood gas analysis parameters taken into consideration (pH; pO2; pCO2; lactates). Conclusions The study suggests a reduced significance of vital parameters and indices derived from them for the need and duration of hospitalization in resuscitation. Presence of organ damage, low pCO2 values and high D–Dimer and creatinine values are associated with both the need for hospitalization in resuscitation and duration.

P270 TELL ME HOW LONG WILL YOU STAY … TELL ME HOW LONG HOW LONG … ANALYSIS OF THE DURATION OF HOSPITAL STAY (HOSPITAL LENGTH OF STAY) OF ELDERLY PATIENTS WITH EMBOLISM: EXPERIENCE OF 4 YEARS IN FIRST AID

Abstract Premise Pulmonary embolism is a disease still characterized by high mortality. It requires emergency department resources to be diagnosed promptly and can require lengthy hospital care. Purpose to assess which parameters, in the real life of an Emergency Department, correlate with the duration of a hospitalization for pulmonary embolism (hospital LOS). Methods Single–center retrospective observational study, on all geriatric patients (&amp;gt; 75) who entered our ED, where they were diagnosed with acute PE. Enrollment began in 2016 and ended in 2019. We collected data from medical history, physical examination, laboratory tests, imaging; we calculated the characteristic scores from the diagnostic / therapeutic algorithm, both for the risk of PE (Wells, Geneva and Years), and for the presentation of the risk of mortality at 30 days (sPESI). We analyzed all the blood chemistry and blood gas analyzes performed upon access to the emergency room. We then had all chest CTs retested by an experienced radiologist. We also analyzed vital parameters and the various shock indexes from these derivatives. We then analyzed whether patients had massive pulmonary embolism or the presence of organ damage (right ventricular dilation, pulmonary artery dilation and presence of pulmonary infarction). Results We enrolled 247 patients, all in need of hospitalization for acute pulmonary embolism. The average age is 83 with female precalence (F = 63%). Regarding the length of hospital stay, the presence of massive embolism shows a good statistical correlation (p &amp;lt; 0.01), while the presence of organ damage seems irrelevant (p &amp;gt; 0.05). The need for resuscitation care and the high sPESI index also show no correlation (p &amp;gt; 0.05). Age and vital signs (blood pressure, respiratory rate, heart rate) as well as derived shock indices are unrelated (rho∼0; p &amp;gt; 0.05). A weak correlation is instead present with high D–Dimer values (rho∼0.20; p &amp;lt; 0.005) while the other blood samples do not show correlation (rho∼0; p &amp;gt; 0.05). No correlation for the blood gas analysis parameters taken into consideration (pH; pO2; pCO2; lactates). Conclusions The study suggests that the presence of massive pulmonary embolism and to a lesser extent high D–Dimer values correlates with a long hospital stay.

Analysis of the overshoot of the respiratory exchange ratio during recovery from maximal exercise testing in patients with heart failure with reduced ejection fraction

Abstract Funding Acknowledgements Type of funding sources: None. Background Transient increases (overshoot) in respiratory gas analysis parameters have been observed during recovery after maximal cardiopulmonary exercise testing (CPET), but their clinical significance is not clearly understood.(1) Respiratory exchange ratio (RER) at peak exercise (RER peak) is an objective index to evaluate exercise effort.(2) Moreover, overshoot phenomenon of the RER is commonly observed during recovery from CPET.(3) On the other hand, the overshoot of some CPET parameters during recovery has been found reduced in magnitude in patients with heart failure with reduced ejection fraction (HFrEF).(4) Purpose We aimed to examine the clinical significance of RER behaviour after a maximal effort and to understand if this could help in the classification of specific subpopulations of patients. Methods In this cross-sectional study patients with HFrEF who underwent functional evaluation with CPET between 2017 and 2020 were included. A maximal CPET with at least two minute of recorded recovery was performed and always RER achieved at peak of exercise was higher than 1.10. RER behaviour during recovery has been evaluated, assessing its maximal value (RER max), the magnitude of the RER overshoot (RER mag), the time to reach RER max during recovery and the linear slope of increase of the RER from peak exercise to RER max (RER slope). Additionally, subgroup analyses were performed. Results 80 patients with HFrEF were included. Figure 1 shows an example of analyzed RER overshoot parameters. Principal clinical characteristics, CPET parameters and recovery metrics are shown in Table I. Significant correlations between RER recovery parameters and prognostically relevant CPET indices of cardiorespiratory fitness and efficiency were found, especially between RER mag and VO2peak (r=0.333; p=0.03), and RER mag and VE/VCO2slope (r= - 0.494; p&amp;lt;0.01). At multiple linear regression, VE/VCO2slope was the only determinant of RER mag. Patients in a more severe disease state (Ventilatory class III/IV and Weber’s classes C/D) present RER overshoot parameters significantly reduced compared with those in a light/moderate disease state (Ventilatory class I/II and Weber’s classes A/B), (all p=0.01). Conclusions The overshoots phenomena of RER during recovery from maximal exercise were associated with patients’ cardiopulmonary function, and their magnitudes were less prominent in HFrEF patients with a lower cardiorespiratory efficiency. Thus, the evaluation of the overshoot during recovery from CPET might represent an interesting clinical and prognostic tool in patients with HFrEF.

Fever and sepsis - dangerous controversies

Introduction. Sepsis is the body?s response to infection, leading to tissue and organ damage. Although fever was considered to be an important sign of sepsis, it has been shown that half of the critically ill patients with sepsis do not have fever at the time of diagnosis. Absence of high body temperature may be a serious disruption of the thermoregulatory response to infection and therefore a reflection of the disease severity. The aim of this study was to determine the percentage of patients with sepsis without fever, and to compare the clinical presentation and outcome of the disease in febrile and afebrile patients. Material and Methods. A retrospective study included 597 patients with sepsis who were divided into two groups: the first included patients with elevated body temperature (? 37.7 ?) and the second included patients who were afebrile (&lt; 37.7 ?). Demographic data, clinical, laboratory and microbiological data, gas analysis parameters, length of hospitalization, and data on the disease outcome were collected and analyzed for all patients. Results. The results show that 41.9% of patients with sepsis did not have fever in the first 24 hours of hospitalization. In the group of afebrile patients, the average age was higher (67.38 ? 14.63 vs. 61.38 ? 18.96 years; p &lt; 0.001) and comorbidities were more common. Patients with elevated body temperature had a significantly lower degree of organ dysfunction measured by the Sequential Organ Failure Assessment score compared to afebrile patients. There were 29.2% of patients with lethal outcome in the group of afebrile patients compared to 18.4% of deceased febrile patients. Conclusion. We conclude that the absence of fever does not rule out the diagnosis of sepsis, but on the contrary, it is associated with greater organ dysfunction and higher mortality, while the elderly are a particularly vulnerable group.

Diagnostic value of mechanical power in patients with moderate to severe acute respiratory distress syndrome: an analysis using the data from MIMIC-III

To explore the diagnostic value of mechanical power (MP) in patients with moderate to severe acute respiratory distress syndrome (ARDS) based on the Medical Information Mart for Intensive Care-IIIv1.4 (MIMIC-III v1.4). The information of ARDS patients undergoing invasive mechanical ventilation for no less than 48 hours who were hospitalized at Beth Israel Deaconess Medical Center in Boston, Massachusetts from June 2001 to October 2012 in the MIMIC-III v1.4 were collected. The demographics of patients, disease severity scores, ARDS etiology, prognostic indicators, pre-ventilation arterial blood gas analysis and respiratory parameters within 48 hours of ventilation were extracted. According to the lowest oxygenation index (PaO2/FiO2) before ventilation, the patients were divided into mild to moderate ARDS group (> 150 mmHg, 1 mmHg≈0.133 kPa) and moderate to severe ARDS group (≤ 150 mmHg), and the differences in baseline characteristics between the two groups were compared. The independent predictors associated with the severity of ARDS were analyzed using Logistic regression. The receiver operator characteristic curve (ROC curve) was plotted. The area under ROC curve (AUC) was calculated to evaluate the diagnostic value of MP for moderate to severe ARDS. The Youden index was used to determine the diagnostic threshold of MP for moderate to severe ARDS. According to the cut-off value of MP based on Youden index, all ARDS patients were divided into high and low MP groups. Kaplan-Meier survival curve was used to analyze the 28-day survival status of patients. A total of 403 ARDS patients were enrolled in the study, including 107 subjects with mild to moderate ARDS and 296 with moderate to severe ARDS. There were significant differences in age, sequential organ failure assessment (SOFA) score, the lowest PaO2/FiO2 before ventilation, the last PaO2/FiO2 before ventilation, 28-day mortality, the length of intensive care unit (ICU) stay, duration of mechanical ventilation, lung dynamic compliance (Cdyn) in the second 24 hours of ventilation and positive end-expiratory pressure (PEEP), plateau pressure (Pplat), driving pressure (ΔP), respiratory rate (RR), lung static compliance (Cst), MP, inspired fraction of oxygen (FiO2) within 48 hours of ventilation between the two groups. After adjusting variables such as age, SOFA score, the last PaO2/FiO2 before ventilation, and related respiratory mechanics parameters, multivariate Logistic regression analysis showed that higher ΔP, PEEP and MP, and lower last PaO2/FiO2 before ventilation were independently associated with moderate to severe ARDS [odds ratio (OR) and 95% confidence interval (95%CI) was 1.137 (1.032-1.252), 1.333 (1.139-1.561), 1.102 (1.030-1.179), and 0.996 (0.993-0.998), respectively, all P < 0.01]. The ROC curve analysis showed that the best cut-off value of MP for the diagnosis of moderate to severe ARDS was 18.1 J/min with sensitivity of 81.42% and specificity of 60.75%, and the AUC was 0.745 (95%CI was 0.690-0.799). According to the cut-off value of MP obtained by ROC curve, all ARDS patients were divided into high MP group (> 18.1 J/min) and low MP group (≤ 18.1 J/min). The Kaplan-Meier survival curve showed that the 28-day cumulative survival rate in the high MP group was significantly lower than that in the low MP group (73.8% vs. 85.1%; Log-Rank test: χ2 = 5.660, P = 0.017). MP is an independent predictor of the severity of ARDS, and it can be used to diagnose moderate to severe ARDS.

Development of ex vivo normothermic perfusion as an innovative method to assess pancreases after preservation

Ann Ogbemudia, Julien Branchereau (Joint first authors), Gabriella Hakim, Fungai Dengu, FaysalEl-Gilani, John Mulvey, Kaithlyn Rozenberg, Thomas Prudhomme, Letizia Lo Faro, James Hunter,Paul Johnson, Rutger Ploeg and Peter Friend&#x0D; &#x0D; Objective Static cold storage (SCS) is the standard method for pancreas preservation but does not facilitate objective organ assessment prior to transplantation. Normothermic machine perfusion (NMP) has been used to test other abdominal and thoracic organs’ function and viability in transplantation settings. Our aim was to develop a NMP protocol specific for pancreases and then investigate its potential as an organ assessment strategy.&#x0D; Method 8 porcine pancreases were procured in conditions replicating donation after circulatory death with warm ischaemia time of 25 minutes. After 3 hours of static cold storage (SCS) the pancreases were divided into 3 experimental groups 1) the feasibility group (n=2) that underwent 2.5 hours of NMP 2) the SCS group (n = 2) that underwent an additional 6 hours of SCS prior to assessment on NMP for an hour and 3) the Oxygenated Hypothermic Machine Perfusion (oxyHMP) group (n = 4) that underwent 6 hours of oxyHMP followed by 1-hour assessment on NMP. The NMP protocol used autologous, leucodepleted blood delivered at a mean arterial pressure of 40mmHg with a temperature of 37oC. At timed intervals during NMP, perfusate samples were collected for gas analysis and perfusion parameters were recorded.&#x0D; Results The feasibility group was used to develop the NMP protocol and demonstrated stable perfusion parameters throughout NMP. Compared to the SCS group the oxyHMP group demonstrated better average perfusion characteristics with lower resistances, higher flow rates, lower mean lactate levels and physiological pH. The oxyHMP group maintained normal macroscopic appearances during NMP. At the end of NMP the SCS group had an average 32% weight increase compared to the oxyHMP group that were found to have a 17% weight reduction.&#x0D; Conclusion Normothermic machine perfusion of whole pancreases is feasible after cold preservation and potentially useful as an assessment strategy. Furthermore, it demonstrated that oxygenated HMP may be beneficial for pancreas preservation compared to SCS.

Arterial blood gas analysis: base excess and carbonate are predictive of noninvasive ventilation adaptation and survival in amyotrophic lateral sclerosis

Objective: To investigate the role of arterial blood gas (ABG) analysis parameters (blood carbon dioxide, pCO2; oxygen, pO2; carbonate, HCO3−; standard base excess, SBE) in monitoring respiratory function and ventilation compliance after noninvasive mechanical ventilation (NIV) adaptation, predicting survival in ALS patients. Methods: We selected the first ABG performed after NIV start in ALS patients followed from 2000 to 2015 in Turin ALS Center. Correlations between ABG parameters and survival were calculated. Risk for death/tracheostomy was computed at modifying ABG parameters by using Cox regression models, adjusted for the main prognostic factors. Kaplan–Meier curves were then performed and compared. Results: A total of 186 post-NIV ABGs were included. HCO3− and SBE showed a significant correlation with survival after NIV (respectively, R = −0.183, p = 0.018 and R = −0.200, p = 0.010). Risk for death/tracheostomy after NIV was significantly higher at increasing HCO3− and SBE blood levels, especially when HCO3− was >29 mmol/L and SBE >4 mmol/L (respectively, HR 1.466, 95% CI 1.068–2.011, p = 0.018 and HR = 1.411, 95% CI 1.030–1.32, p = 0.032). Survival in NIV was higher in patients with HCO3− < 29.0 mmol/L and SBE < 4.0 mmol/L. Conclusions: HCO3− and SBE blood levels are markers of ventilation compliance, tolerance and efficacy, being able to predict survival after NIV start in ALS.