Blood Gas Levels Research Articles

Influence of study design on effects of mask wearing on fMRI BOLD contrast and systemic physiology — A comment on Law et al. (2021)

In a study by Law and colleagues recently published in Neuroimage, the authors reported that wearing a surgical mask during an fMRI scan leads to a statistically significant subject-specific change (30%) in the baseline BOLD level in gray matter, although the response to a sensory-motor task was unaffected. An average increase in end-tidal CO2 of 7.4% was found when wearing a mask, despite little support in the literature for major effects of mask wearing on blood gas levels. We comment on these findings, point out a several relevant limitations of the study design and provide alternative interpretations of these data.

Acute Ischemic Priapism: An AUA/SMSNA Guideline.

Priapism is a persistent penile erection that continues hours beyond, or is unrelated to, sexual stimulation and results in a prolonged and uncontrolled erection. Given its time-dependent and progressive nature, priapism is a situation that both urologists and emergency medicine practitioners must be familiar with and comfortable managing. Acute ischemic priapism, characterized by little or no cavernous blood flow and abnormal cavernous blood gases (ie, hypoxic, hypercarbic, acidotic) represents a medical emergency and may lead to cavernosal fibrosis and subsequent erectile dysfunction. A comprehensive search of the literature was performed by Emergency Care Research Institute for articles published between January 1, 1960 and May 1, 2020. Searches identified 2948 potentially relevant articles, and 2516 of these were excluded at the title or abstract level for not meeting inclusion criteria for any key question. Full texts for the remaining 432 articles were reviewed, and ultimately 137 unique articles were included in the report. This Guideline was developed to inform clinicians on the proper diagnosis and surgical and non-surgical treatment of patients with acute ischemic priapism. This Guideline addresses the role of imaging, adjunctive laboratory testing, early involvement of urologists when presenting to the emergency room, discussion of conservative therapies, enhanced data for patient counseling on risks of erectile dysfunction and surgical complications, specific recommendations on intracavernosal phenylephrine with or without irrigation, the inclusion of novel surgical techniques (eg, tunneling), and early penile prosthesis placement. All patients with priapism should be evaluated emergently to identify the sub-type of priapism (acute ischemic versus non-ischemic) and those with an acute ischemic event should be provided early intervention. Treatment of the acute ischemic patient must be based on patient objectives, available resources, and clinician experience. As such, a single pathway for managing the condition is oversimplified and no longer appropriate. Using a diversified approach, some men may be treated with intracavernosal injections of phenylephrine alone, others with aspiration/irrigation or distal shunting, and some may undergo non-emergent placement of a penile prosthesis.

High flow versus conventional nasal cannula for oxygenation and ventilation maintenance during surgery with intravenous deep sedation by propofol: a randomized controlled study

BackgroundThe dead space washout and provision of some level of positive airway pressure by nasal high-flow (NHF) cannula could improve the efficiency of ventilation, oxygenation and maintenance of the upper airway in patients undergoing deep sedation. This study aimed to compare the incidences of events represented oxygenation and ventilation, i.e. desaturation and upper airway obstruction, and arterial blood gas (ABG) levels between using NHF cannula and conventional nasal cannula (NC2) during deep sedation of adult surgical patients.MethodsIn this prospective randomized single-blinded study, the patients who were 20–80 years old, ASA physical status of 1 to 3, scheduled for surgery under intravenous sedation (IVS) were included. The patients were randomly divided into two groups, i.e., NC2 or NHF groups. Propofol infusion was given to maintain deep sedation. The desaturation (SpO2 < 92%) and upper airway obstruction events (presence of snoring with paradoxical breathing) after application of NC2 or NHF were observed and collected. Other outcomes included interventions during IVS, such as jaw lifting or airway instrument insertion, mouth dryness, and post- ABG analyses were also collected and compared.ResultsThirty-six patients undergoing endovascular surgery were randomized into NC2 or NHF groups (18 in each group). No patients dropped out of the study. There were no significant differences in age, sex, ASA physical status, pre-sedation and pre-application of NC2 and NHF ABG analyses (PaO2, SaO2, pH, PaCO2, and PaO2/FiO2). NHF group had significantly lower in the incidence of desaturation [5 (27.78%) vs 13 (72.22%), p = 0.008], upper airway obstruction [4 (22.22%) vs 13 (72.22%), p = 0.003], and airway maneuver [6 (33.33%) vs 13 (72.22%), p = 0.019] than NC2 group. There were no differences in the ABG analyses after oxygen supplementation and no significant differences in mouth dryness between groups.ConclusionThe use of NHF cannula in patients undergoing endovascular surgery under deep sedation reduced desaturation events and required fewer airway interventions than NC2 with no difference in arterial blood gas analyses and mouth dryness.

PD41-10 EVALUATION OF DIFFERENT PNEUMOPERITONEAL PRESSURES WITH RESPECT TO TECHNICAL FEASIBILITY AND PHYSIOLOGICAL PARAMETERS IN LAPAROSCOPIC RENAL SURGERY–A PROSPECTIVE AND RANDOMIZED STUDY

You have accessJournal of UrologySurgical Technology & Simulation: Instrumentation & Technology II (PD41)1 Sep 2021PD41-10 EVALUATION OF DIFFERENT PNEUMOPERITONEAL PRESSURES WITH RESPECT TO TECHNICAL FEASIBILITY AND PHYSIOLOGICAL PARAMETERS IN LAPAROSCOPIC RENAL SURGERY–A PROSPECTIVE AND RANDOMIZED STUDY Sanjoy Kumar Sureka, Utsav Shah, Abhay Kumar G, Uday Pratap Singh, and Aneesh Srivastava Sanjoy Kumar SurekaSanjoy Kumar Sureka More articles by this author , Utsav ShahUtsav Shah More articles by this author , Abhay Kumar GAbhay Kumar G More articles by this author , Uday Pratap SinghUday Pratap Singh More articles by this author , and Aneesh SrivastavaAneesh Srivastava More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002051.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: There are no well validated studies to define safe and ergonomically efficient pneumoperitoneal pressures (PP) for transperitoneal laparoscopic renal surgeries (LRS). Though the impact of PP on intraoperative physiological parameters have been evaluated widely, it’s effect on postoperative recovery is not well studied. This study aims to determine safe and optimal pneumoperitoneal pressures during transperitoneal LRS while evaluating its impact on intraoperative parameters and post-operative recovery. METHODS: In a prospective, randomized setting (April 2019-March 2020), 78 adults undergoing LRS were randomized equally into 3 groups based on pneumoperitoneal pressures (Group I, 8-10 mmHg; Group II, 11-13 mmHg and Group III, 14-16 mmHg). Hemodynamic parameters and blood gas levels were measured: before CO2-insufflation (T0), 10 min after insufflation (T1), before desufflation (T2) and 10 min after desufflation (T3). Postoperative pain at 1, 6, and 12 hours and time to start oral feeds as well as hospital stay were noted. Technical feasibility was evaluated based on successful surgery completion, duration and intraoperative complications. RESULTS: Group I and II showed similar hemodynamic and ventilatory parameters at T1 and T2. In Group III the hemodynamic and respiratory changes (p value for EtCO2 & pH; 0.01 & 0.03 respectively) were more pronounced at T1 and T2. At T3, most parameters were statistically restored to baseline in Group I and II but not uniformly in Group III. Mean postoperative pain at 1 hour was least in group I, but comparable between group I and II at 6 and 12 hours. Postoperative pain and time to start oral feeds was significantly greater in Group III. In group I, 5 patients were excluded from analysis as they crossed over to group II due to technical operative difficulties. Intraoperative and post-operative complications were similar among groups and no statistically significant difference in hospital stay among groups. CONCLUSIONS: Pneumoperitoneal pressures of 10 mm Hg or less cause least disturbance in intra- and postoperative homeostasis and is ideal for LRS. However, technical difficulty may be encountered in obese patients, requiring higher pressures. Pressures above 13 mmHg should be avoided. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e684-e685 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Sanjoy Kumar Sureka More articles by this author Utsav Shah More articles by this author Abhay Kumar G More articles by this author Uday Pratap Singh More articles by this author Aneesh Srivastava More articles by this author Expand All Advertisement Loading ...

Ventilation via nose cone results in similar hemodynamic parameters and blood gas levels as endotracheal intubation during open chest surgery in rats.

Open chest surgery in rodents requires assisted breathing and the most common approach for ventilation is via an endotracheal tube. Even with well-trained operators the endotracheal intubation is technically challenging and may lead to prolonged procedures and endotracheal intubation complications. Nose cone ventilation is a simpler procedure compared to endotracheal intubation and has the potential to improve animal welfare by reducing procedure time and endotracheal intubation associated complications. Rats are obligate nose breathers, and therefore replacing intubation with air supply from a nose cone would be an advantage and a more natural way of breathing. Here, we compared the values for several blood gases, blood pressure and heart rate from rats that were nose cone ventilated with rats that underwent endotracheal intubation at 12 timepoints equally distributed across three surgical stages: baseline, open chest and closed chest. Throughout the monitoring period the hemodynamic and blood gas values for both methods of ventilation were within published, normal ranges for the rat and were biologically equivalent (equivalence test p value ≤ 0.05). Our data showed that nose cone ventilation-maintained blood gases and hemodynamic homeostasis equivalent to endotracheal intubation. Nose cone ventilation can be recommended as an alternative to endotracheal intubation in rat experiments where investigators require airway control.

Case series of the first three severe COVID-19 patients treated with the secretome of hypoxia-mesenchymal stem cells in Indonesia

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is responsible for the outbreak of coronavirus disease 2019 (COVID-19), which has been rapidly spreading. Several guideline therapies have been proposed as a possible treatment for SARS-CoV-2, however, these therapies are not sufficient to treat a severe condition of SARS-CoV-2 infection characterised by the increase of D-dimer and C-reactive protein (CRP) levels, and patchy ground-glass opacities (GGOs). Secretome-mesenchymal stem cells (S-MSCs) produced by MSCs under hypoxia could excessively release several anti-inflammatory cytokines and growth factors to control the COVID-19 cytokine storm and accelerate lung injury improvement. This is the first study investigating the clinical outcomes of three severe COVID-19 patients admitted to the intensive care unit of three different hospitals in Indonesia treated with S-MSCs. The decrease of D-dimer and CRP level was reported for all patients treated with S-MSCs. This was in line with improvement of pulmonary radiology, blood gas level, and hematologic assessment. In conclusion, these cases suggest that S-MSCs could effectively control D-dimer, CRP level and GGOs of severe COVID-19 patients associated with recovered pulmonary function.

A comparative study on the effects of fentanyl and dexmedetomidine on hemodynamic changes in patients undergoing brain tumor surgery in Al-Zahra Hospital in 2017

Background: Considering the importance of maintaining hemodynamic stability in the patient undergoing brain tumor surgery, this study aimed to compare the effects of fentanyl and dexmedetomidine on hemodynamic changes in patients undergoing brain tumor surgery. Methods: In a clinical trial study, 70 patients undergoing brain surgery were distributed in two groups of 35. The first group received 5 mg / kg fentanyl, and the second group received 1 mg / kg dexmedetomidine immediately after induction of anesthesia. During the operation, the patients were evaluated for hemodynamic parameters, blood gas levels and coagulation profile during operation and recovery and compared between the two groups. Findings: The mean changes of hemodynamic parameters was not differ between the two groups. Among blood gases HCO3had a higher level of in the dexmedotomidine group before, during and after surgery, and its changes during the study period were significant between the two groups (P &lt;0.001). Also, PT level was higher in the dexmedmotidine group before surgery (P = 0.007), but its change was not significantly different during the study period (P = 0.14). Discussion: Our findings showed that the use of dexmeditomidine with more favorable hemodynamic stability, shorter hemodynamic presentation, and shorter duration of stay of patients undergoing cerebral surgery. Considering the serious side effects of doxedetomidine administration, it seems that the use of Dexmedetomidine is preferred in patients undergoing brain surgery than fentanyl. Keywords: Brain tumor, Dexmedmotidine, Fentanyl, Hemodynamic

Comparison of minimal-flow sevoflurane versus desflurane anesthesia: randomized clinical trial

Background and objectivesMinimal-flow anesthesia provides various advantages, such as reduced environmental pollution, proper humidification and warming of anesthetic gases, and reduced costs. The aim of this study was to compare the cost-effectiveness of minimal-flow sevoflurane and desflurane anesthesia and their effects on hemodynamics, postoperative recovery, respiratory parameters, and liver and kidney functions. MethodsA total of 60 ASA I–II patients aged 18–70 years who underwent posterior spinal instrumentation were included in the study. The patients were divided into Group S (sevoflurane) and Group D (desflurane). After anesthesia induction, the gas flow was initiated at a rate of 4 L.min-1 using a concentration of 8% in Group D and 3.5% in Group S, and the time to reach 0.8 MAC was recorded. The gas flow was then switched to minimal flow. Patient hemodynamic and respiratory parameters, body temperatures and arterial blood gas levels were recorded. The integrated pulmonary index (IPI) was monitored postoperatively. Biochemical findings were recorded 12 hours after the operation. The amount of bleeding and blood transfused, and the costs involved were calculated. ResultsThe patients’ demographic characteristics, duration of surgery, hemodynamic parameters, IPI values, body temperatures, and arterial blood gas levels were similar at all time points. Biochemical findings, amount of bleeding and amount of blood transfused were similar between the two groups. The mean cost was lower in Group S than in Group D (p = 0.007). ConclusionThe study found no significant difference in terms of reliability between minimal-flow sevoflurane and desflurane anesthesia. Furthermore, the procedure was found to be more cost-effective for Group S than for Group D.

The Reign of the Ventilator: Acute Respiratory Distress Syndrome, COVID-19, and Technological Imperatives in Intensive Care.

In the early phase of the COVID-19 pandemic, a dispute arose as to whether the disease caused a typical or atypical version of acute respiratory distress syndrome (ARDS). This essay recounts the emergence of ARDS and places it in the context of the technological transformation of modern hospital care-particularly the emergence of intensive care after the 1952 Copenhagen polio epidemic. The polio epidemic seemed to show the value of manual positive-pressure ventilation, leading to the proliferation of mechanical ventilators and the expansion of intensive care units in the 1960s. This created the conditions of possibility for ARDS to be described and institutionalized within modern intensive care. Yet the centrality of the ventilator to descriptions and definitions of ARDS quickly made it difficult to conceive of the disorder outside the framework of mechanical ventilation and blood gas levels, or to acknowledge the degree to which the ventilator was a source of iatrogenic injury and complications. Moreover, the imperative to understand and treat ARDS with mechanical ventilation set the stage for the early confusion about whether patients with COVID-19 should receive mechanical ventilation. This history offers many crucial lessons about how new technologies can lead to new and valuable therapies but can also subtly shape and constrain medical thinking. Moreover, ventilators not only changed how respiratory disorders were conceived; they also brought new forms of respiratory illness into existence.

Relationship between vitamin D levels and mortality rates of critically ill patients in intensive care unit

Introduction: Vitamin D have a pivotal role in bone metabolism. It regulates immunity and inflammation. In this current research, it was aimed to determine whether there is an association between the mortality rate and the vitamin D level of critically ill patients who were followed in intensive care unit (ICU).&#x0D; Material and Methods: Fifty two patients (30 (58%) female and 22 (42%) male) admitted to ICU with the diagnosis of respiratory failure, sepsis, acute renal failure, multiple organ failure, GIS bleeding were included in the study. During the admission to the ICU, all of the patients’ complete blood count, C-reactive protein, serum calcium, albumin, urea, creatinine, 25-OH vitamin D, potassium, and arterial/venous blood gas levels were measured. Their acceptable mortality risk was calculated according to the APACHE II scoring system.&#x0D; Results: The level of vitamin D was found at least 1 up to 78.6 range, and the average was 19.61 ng/dl. Eighteen (35%) patients were discharged and 34 (65%) of the ICU patients were died. Vitamin D deficiency was observed to be a very common issue in our critically ill patients (65.4%). The difference between the two groups of age, accepted mortality and urea levels were found to be statistically significant (p

Pediatric Obstructive Sleep Apnea Syndrome: Emerging Evidence and Treatment Approach.

OSA pediatric subjects suffer from episodes of upper airway obstruction that can be partial or complete, with atypical sleep patterns and blood-gas level alteration. If poor treated and/or diagnosed, it can cause cardiovascular disease, learning difficulties, behavioural issues, and retardation of growth. In the literature, there are conflicting evidence about OSA assessment and treatment in pediatric age, so the aim of this paper is to highlight the multidisciplinary approach in the management of sleep disorders, stressing the role of the pediatric dentist in both diagnosing and treating the OSAS in children, according to the current evidence of the treatment options effectiveness of the syndrome itself. Conclusions. Scientific evidence shows that OSAS management requires a multidisciplinary approach in order to make an early diagnosis and a correct treatment plan. The orthodontic treatment approach includes orthopedic maxillary expansion and mandibular advancement using intraoral appliances. Hence, the orthodontist and the pediatric dentist play an important role not only in early diagnosis but also in the treatment of pediatric OSAS.

Silent hypoxia in COVID-19: pathomechanism and possible management strategy.

The novel coronavirus disease 2019 (COVID-19) has become a severe health issue, especially to the patients who develop silent hypoxia condition after SARS-CoV-2 infection. Due to the lack of dyspnoea and extremely low oxygen saturation level, these patients are at exceptionally higher risk. Although the prevalence of silent hypoxia in COVID-19 patients has been evident in several cases, the underlying pathomechanism behind this condition is still unclear. Silent hypoxia in SARS-CoV-2 infected patients can be diagnosed with the help of a pulse oximeter, blood gas levels, and a 6-min walking test. While the clinicians and researchers figure out the exact reason for this phenomenon, the patients must be under strict day-to-day monitoring. In this article, we aim to provide comprehensive insights into the underlying symptoms, mechanism, and possible factors behind the occurrence of silent hypoxia among COVID-19 patients.

The Impact of COVID-19 Pandemic Lockdown on the Incidence of New-Onset Type 1 Diabetes and Ketoacidosis Among Saudi Children.

BackgroundOverburdened healthcare systems during the coronavirus disease (COVID-19) pandemic led to suboptimal chronic disease management, including that of pediatric type 1 diabetes mellitus (T1DM). The pandemic also caused delayed detection of new-onset diabetes in children; this increased the risk and severity of diabetic ketoacidosis (DKA). We therefore investigated the frequency of new-onset pediatric T1DM and DKA in Saudi Arabia during the COVID-19 pandemic and compared it to the same period in 2019.MethodsWe conducted a multicenter retrospective cohort study, including patients aged 1–14 years admitted with new-onset T1DM or DKA during the COVID-19 pandemic (March–June 2020) and the same period in 2019. We assessed factors including age, sex, anthropometric measures, nationality, duration of diabetes, diabetes management, HbA1c levels, glycemic control, cause of admission, blood gas levels, etiology of DKA, DKA complications, length of hospital stay, and COVID-19 test status.ResultDuring the lockdown, 106 children, compared with 154 in 2019, were admitted to 6 pediatric diabetes centers. Among the admissions, DKA was higher in 2020 than in 2019 (83% vs. 73%; P=0.05; risk ratio=1.15; 95% confidence interval, 1.04–1.26), after adjusting for age and sex. DKA frequency among new-onset T1DM and HbA1c levels at diagnosis were higher in 2020 than in 2019 (26% vs. 13.4% [P=<0.001] and 12.1 ± 0.2 vs. 10.8 ± 0.25 [P<0.001], respectively). Females and older patients had a higher risk of DKA.ConclusionThe lockdown implemented in Saudi Arabia has significantly impacted children with T1DM and led to an increased DKA frequency, including children with new-onset T1DM, potentially owing to delayed presentation.

Prognostic role of perioperative acid-base disturbances on the risk of Clostridioides difficile infection in patients undergoing cardiac surgery.

It is unclear whether acid-base balance disturbances during the perioperative period may impact Clostridium difficile infection (CDI), which is the third most common major infection following cardiac surgery. We hypothesized that perioperative acid-base abnormalities including lactate disturbances may predict the probability of incidence of CDI in patients after cardiac procedures. Of the 12,235 analyzed patients following cardiac surgery, 143 (1.2%) developed CDI. The control group included 200 consecutive patients without diarrhea, who underwent cardiac procedure within the same period of observation. Pre-, intra and post-operative levels of blood gases, as well as lactate and glucose concentrations were determined. Postoperatively, arterial blood was drawn four times: immediately after surgery and successively; 4, 8 and 12 h following the procedure. Baseline pH was lower and PaO2 was higher in CDI patients (p < 0.001 and p = 0.001, respectively). Additionally, these patients had greater base deficiency at each of the analyzed time points (p < 0.001, p = 0.004, p = 0.012, p = 0.001, p = 0.016 and p = 0.001, respectively). Severe hyperlactatemia was also more common in CDI patients; during the cardiac procedure, 4 h and 12 h after surgery (p = 0.027, p = 0.004 and p = 0.001, respectively). Multivariate logistic regression analysis revealed that independent risk factors for CDI following cardiac surgery were as follows: intraoperative severe hyperlactatemia (OR 2.387, 95% CI 1.155-4.933, p = 0.019), decreased lactate clearance between values immediately and 12 h after procedure (OR 0.996, 95% CI 0.994-0.999, p = 0.013), increased age (OR 1.045, 95% CI 1.020-1.070, p < 0.001), emergent surgery (OR 2.755, 95% CI 1.565-4.848, p < 0.001) and use of antibiotics other than periprocedural prophylaxis (OR 2.778, 95% CI 1.690-4.565, p < 0.001). This study is the first to show that perioperative hyperlactatemia and decreased lactate clearance may be predictors for occurrence of CDI after cardiac surgery.

Blood pressure in the chronically hypoxaemic fetus is regulated by α-adrenergic receptors on the peripheral vasculature.

Blood pressure in the chronically hypoxaemic fetus is regulated by α-adrenergic receptors on the peripheral vasculature.

Evaluation of percutaneous transcatheter embolization for pulmonary arteriovenous malformations

BackgroundThe purpose of this study was to assess the safety and efficacy of percutaneous transcatheter embolization (TCE) for the treatment of pulmonary arteriovenous malformations (PAVMs).MethodsForty-three consecutive patients (n = 17 males; n = 26 females) with 72 untreated PAVMs underwent coil and/or plug embolization between January 2010 and February 2018. The mean patient age was 42 ± 14 years (range 19–71 years). The median size of the feeding artery was 7.9 ± 2.9 mm (range 3.5–14.0 mm). The arterial blood gas level and cardiac function of all patients were analysed. The technical success rate, recanalization rate, and complications were evaluated. Computed tomography angiography (CTA) examinations were scheduled for 12 months after treatment and every 2–4 years thereafter.ResultsTwenty-five PAVMs were treated with coils alone, twenty-one were treated with plugs alone, and twenty-six were treated with both coils and plugs. The technical success rate was 100%. There were no complications during operation. However, one patient (2.3%) had pulmonary thrombosis and embolism post-operation. The patients’ pre-operative and post-operative PaO2 and SaO2 levels were significantly different (p < 0.01). A comparison of the New York Heart Association (NYHA) grade before and after embolization in all patients showed a significant decrease in the post-operative grade (p < 0.01). The 72 PAVMs were divided into three groups (coils only group [n = 25], plugs only group [n = 21], and coils/plugs combined group [n = 26]). After 12 months of follow-up, there were seven reperfusion PAVMs in the coil group, seven reperfusion PAVMs in the plug group, and 1 reperfusion PAVM in the combined group. There were significant differences between the two groups and the combined group.ConclusionPercutaneous TCE is safe and effective for the treatment of PAVMs. A combination of coils and vascular plugs may be useful for preventing recanalization after the embolization of PAVMs.

Incidence and Associated Risk Factors for Lactic Acidosis Induced by Linezolid Therapy in a Case-Control Study in Patients Older Than 85 Years.

Background: Serum lactic acid is considered a prognostic indicator in critically ill patients. However, studies on linezolid-induced lactic acidosis (LILA) are still limited. Individuals older than 85 years old (very elderly) have limited capacity for organ compensation, and LILA data from these patients are lacking. In this study, we evaluated the risk factors for LILA in patients older than 85 years and established a risk prediction model for geriatric practice.Methods: In this retrospective cohort study, blood gas analysis data and arterial lactate levels were monitored in patients older than 85 years during the use of teicoplanin or linezolid. After propensity score matching analyses, we compared the incidence of lactic acidosis between the teicoplanin and linezolid therapy groups and identified the risk factors of LILA.Results: The incidence of lactic acidosis was found to be much lower in the group receiving teicoplanin than those receiving linezolid therapy (0 vs. 35.7%; p < 0.0001). A duration of linezolid therapy ≥ 9 days [odds ratio (OR), 3.541; 95% confidence interval (CI), 1.161–10.793; p = 0.026], an arterial blood glucose level ≥ 8 mmol/L (OR, 4.548; 95% CI, 1.507–13.725; p = 0.007), and a high sequential organ failure assessment score (OR, 1.429; 95% CI, 1.213–1.685; p < 0.0001) were risk factors for LILA. The constructed risk model could be used to predict LILA (area under the curve, 0.849; specificity, 65.1%; sensitivity, 91.4%, with a negative predictive value of 93.2% and a positive predictive value of 59.3%).Conclusions: LILA can occur in patients older than 85 years after a relatively shorter duration of linezolid therapy. Therefore, close monitoring of blood gas and arterial lactate levels during linezolid therapy in the very elderly population is necessary.

Postcovid Multisystemic Inflammatory Syndrome in a Child with Acute Obstructive Pneumonia

Abstract Childhood inflammatory multisystemic syndrome (CIS-C) is a serious late complication of SARS-CoV-2 infection that can develop in some children and young adults. Criteria for defining SIM-C in children include fever≥ 38.0°C, laboratory findings suggestive of an inflammatory process increased - C-reactive protein, D-dimer, VSH, ferritin, LDH, IL-6, neutrophils, procalcitonin, venous blood gas and lactate levels, brain natriuretic peptide; decreased - lymphocytes, platelets, serum albumin, serum sodium, manifestations of multisystem involvement with &gt;2 organs/systems (cardiac, renal, respiratory, haematological, gastrointestinal, dermatological or neurological), absence of plausible alternative diagnosis, recent or currently positive COVID-19 infection, or contact with confirmed COVID-19 case within 4 weeks prior to onset of symptoms. The authors present the case of a 3-year-old girl aged 3 years and 5 months, admitted to the Pediatric Clinic of the Hospital Clinic Judetean de Urgenta Constanta in January 2022, for fever (39.5°C), microerythematous rash, semi-productive cough. and dyspnea. Investigations detected anticovid antibodies present, with no SARS cov2 infection diagnosed in the personal pathological history.

CO2 artificial pneumothorax on coagulation and fibrinolysis during thoracoscopic esophagectomy.

Background:CO2 artificial pneumothorax creates a sufficient operative field for thoracoscopic esophagectomy. However, it has potential complications and continuous CO2 insufflation may impede coagulation and fibrinolysis. We sought to compare the effects of CO2 artificial pneumothorax on perioperative coagulation and fibrinolysis during thoracoscopic esophagectomy.Methods:We investigated patients who underwent thoracoscopic esophagectomy with (group P, n = 24) or without CO2 artificial pneumothorax (group N, n = 24). The following parameters of coagulation–fibrinolysis function: intraoperative bleeding volume; serum levels of tissue plasminogen activator (t-PA), plasminogen activator inhibitor (PAI-1), thromboelastogram (TEG), D-Dimer; and arterial blood gas levels were compared with two groups.Results:Group P showed higher levels of PaCO2, reaction time (R) value and kinetics (K) value, but significantly lower pH value, alpha (α) angle and Maximum Amplitude (MA) value at 60 minutes after the initiation of CO2 artificial pneumothorax than group N ((P < .05, all). The t-PA level after CO2 insufflation for 60 minutes was significantly higher in group P than in group N (P < .05), but preoperative levels were gradually restored on cessation of CO2 insufflation for 30 min (P > .05). There was no significant difference in D-dimer.Conclusion:CO2 artificial pneumothorax during thoracoscopic esophagectomy had a substantial impact on coagulation and fibrinolysis, inducing significant derangements in pH and PaCO2.Trial registration:The study was registered at the Chinese clinical trial registry (ChiCTR1800019004)

Noninvasive ventilatory support in morbid obesity

BackgroundIn the conventional management of the morbidly obese that normalizes the apnea-hypopnea index (AHI), CO2 levels often remain elevated. MethodsA retrospective review of morbidly obese patients using volume preset settings up to 1800ml to positive inspiratory pressures (PIPs) of 25–55cm H2O, or pressure control at 25–50cm H2O pressure via noninvasive interfaces up to continuously (CNVS). ResultsTwenty-six patients, mean 55.6±14.8 years of age, weight 108–229kg, mean BMI 56.1 (35.5–77)kg/m2, mean AHI 69.0±24.9, depended on up to CNVS for 3 weeks to up to 66 years. There were eleven extubations and seven decannulations to CNVS despite failure to pass spontaneous breathing trials. Thirteen were CNVS dependent for 92.2 patient-years with little to no ventilator free breathing ability (VFBA). Six used NVS from 10 to 23h a day, and others only for sleep. Fifteen patients with cough peak flows (CPF) less than 270L/m had access to mechanical insufflation-exsufflation (MIE) in the peri-extubation/decannulation period and long-term. The daytime end-tidal (Et)CO2 of 14 who were placed on sleep NVS without extubation or decannulation to it decreased from mean EtCO2 61.0±9.3–38.5±3.6mm Hg and AHI normalized to 2.2. Blood gas levels were normal while using NVS/CNVS. Pre-intubation PaCO2 levels, when measured, were as high as 183mm Hg before extubation to CNVS. ConclusionsVentilator unweanable morbidly obese patients can be safely extubated/decannulated and maintained indefinitely using up to CNVS rather than resort to tracheotomies.