Mean Respiratory Rate Research Articles

Abstract P705: Lesion Symptom Mapping of Cardiac Autonomic Dysfunction in Patients With Acute Ischaemic Stroke: A Prospective Cohort Study

Introduction: About 15% of patients with stroke show elevated Troponin T levels without presenting an acute coronary syndrome. Dysbalance in the autonomous nervous system is discussed as a possible reason. However, it remains unknown which brain regions affect specific autonomous biosignals. Methods: Prospectively from July 2018 to May 2019 we performed simultaneous non-invasive 30-min recordings of autonomous biosignals with all patients at our centre suffering from an ischaemic stroke within the last 7 days. Previously described autonomous risk factors were investigated and a lesion symptom mapping based on MRI was done. Results: In total, 100 patients with ischaemic stroke were measured. Subsequently 10 patients had to be excluded because of atrial fibrillation during recording, resulting in a study population of 90 patients. Mean age was 64.9 years, 38 patients (42.2%) were female. Mean NIHSS-Score at first admission was 3.7 points. The five parameters baroreflex sensitivity (BRS), deceleration capacity of the heart rate, expiration-triggered sinus arrhythmia, mean heart rate and average respiration rate were analysed for their association with ischaemic lesion location. Using established dichotomy limits in the lesion symptom mapping we could find risk factor related overlaps in different brain regions, such as an association of disturbed BRS with pontine strokes. Conclusion: Previous studies show that patients with abnormalities in autonomous parameters have higher cardiovascular risk. Identifying brain regions that affect the cardiac autonomous system is relevant for better understanding the underlying pathophysiology as well as early identification of these patients at risk. It is interesting to speculate if patients with lesions in these brain regions could benefit from early cardiologic surveillance. We are currently validating our findings with a higher sample size and follow up data.

Opioid requirements after locoregional anaesthesia in dogs undergoing tibial plateau levelling osteotomy: a pilot study

ObjectiveTo determine the intraoperative and early postoperative opioid requirement after ultrasound-guided sciatic and/or femoral nerve block or epidural anaesthesia in dogs undergoing tibial plateau levelling osteotomy (TPLO). Study designProspective, masked, pilot, randomized, clinical trial. AnimalsA total of 40 client-owned dogs undergoing TPLO. MethodsEach dog was randomly assigned to group SF (combined sciatic and femoral nerve block), group S (sciatic nerve block), group F (femoral nerve block) or group E (epidural anaesthesia). A total of 0.3 mL kg–1 of ropivacaine 0.5% was administered to each nerve or in the epidural space. Intraoperatively, fentanyl (2 μg kg–1) was administered intravenously when heart rate, mean arterial pressure or respiratory rate increased by >30% compared with baseline values. Postoperatively, a visual analogue scale (VAS) and a modified German version of the French pain scale (4AVet) were used to assess pain every 30 minutes for 150 minutes and again once the morning after surgery. Methadone (0.1 mg kg–1) was administered intravenously if the VAS was ≥ 4 cm [maximal value 10 cm; median (interquartile range)] or the composite pain score was ≥5 [maximal value 15; median (interquartile range)]. Significance was defined as p ≤ 0.05. ResultsGroups SF and E required less total intraoperative and early postoperative opioid doses compared with groups S and F (p = 0.031). No dogs in group SF had a block failure or required postoperative methadone. A reduced methadone requirement was found in group SF compared with all the other groups up to 150 minutes after recovery (p = 0.041). Conclusions and clinical relevanceCombined sciatic and femoral nerve block and epidural anaesthesia lead to less cumulative consumption of perioperative opioids than single nerve blockade. Sciatic or femoral nerve block alone might be insufficient to control nociception and early postoperative pain in dogs undergoing TPLO.

Initial Prehospital Rapid Emergency Medicine Score (REMS) as a Predictor of Patient Outcomes

Background: A standardized objective measure of prehospital patient risk of hospitalization or death is needed. The Rapid Emergency Medicine Score (REMS), a validated risk-stratification tool, has not been widely tested for prehospital use. This study’s objective was to assess predictive characteristics of initial prehospital REMS for ED disposition and overall patient mortality. Methods: This retrospective analysis used linked prehospital and hospital data from the national ESO Data Collaborative. All 911 responses from 1/1/2019–12/31/2019 were included. REMS (0–26) was calculated using age and first prehospital values for: pulse rate, mean arterial pressure, respiratory rate, oxygen saturation, and Glasgow Coma Scale. Non-transports, patients <18 and cardiac arrests prior to EMS arrival were excluded. The primary outcome was ED disposition, dichotomized to discharge versus admission, transfer, or death. The secondary outcome was overall survival to discharge (ED or inpatient). Transfers and records without inpatient disposition were excluded from the secondary analysis. Predictive ability was assessed using area under the receiver operating curve (AUROC). Optimal REMS cut points were determined using test characteristic curves. Univariable logistic regression modeling was used to quantify the association between initial prehospital REMS and each outcome. Results: Of 579,505 eligible records, 94,640 (16%) were excluded due to missing data needed to calculate REMS. Overall, 62% (n = 298,223) of patients were discharged from the ED, 36% (n = 175,212) were admitted, 2% (n = 10,499) were transferred, and 0.2% (n = 931) died in the ED. A REMS of 5 or lower demonstrated optimal statistical prediction for ED discharge versus not discharged (admission/transfer/death) (AUROC: 0.68). Patients with initial prehospital REMS of 5 or lower showed a three-fold increase in odds of ED discharge (OR: 3.28, 95%CI: 3.24–3.32). Of the 457,226 patients included in overall mortality analysis, >98% (n = 450,112) survived. AUROC of initial prehospital REMS for overall mortality was 0.79. A score 7 or lower was statistically optimal for predicting survival. Initial prehospital REMS of 7 or lower was associated with a five-fold increase in odds of overall survival (OR:5.41, 95%CI:5.15–5.69). Conclusion: Initial prehospital REMS was predictive of ED disposition and overall patient mortality, suggesting value as a risk-stratification measure for EMS agencies, systems and researchers.

Butorphanol in combination with dexmedetomidine provides efficient pain management in adult burn patients

ObjectiveThis study aimed to compare the sedation and analgesic effects of butorphanol alone and butorphanol in combination with dexmedetomidine on dressing changes in adult burn patients. MethodFrom June 2016 to May 2019, 44 adult burn patients from our department were enrolled in this prospective, double-blinded study. Their total burn surface area (TBSA) varied from 10% to 30%; and the depth of burn injury ranged from second degree to third degree. The patients were randomized into two groups. In the control group, butorphanol combined with saline was injected into the body via venous route during dressing change. In the observation group, butorphanol in combination with dexmedetomidine was injected. The variation in mean blood pressure, heart rate, respiratory rate, and peripheral oxygen saturation were recorded at various time-points of the procedure. Visual Analogue Scale (VAS) of pain and Ramsay Sedation Scores (RSS) were also recorded at different time points. Consumption of butorphanol and adverse events in these two groups were compared. ResultsThe mean blood pressure and heart rate were significantly decreased in the observation group before butorphanol injection (P < 0.05) and before the dressing change (P < 0.05). The respiratory rates and peripheral oxygen saturation of these two groups showed no significant differences at all time points (P > 0.05). Patients in the observation group had lower VAS scores during dressing change (P < 0.05). The RSS Scores in the observation group were higher than those in the control group during (P < 0.05) and after the dressing change (P < 0.05). The consumption of butorphanol was more in the control group (P < 0.05), and the adverse events recorded in the control group were higher (P < 0.05). ConclusionButorphanol combined with dexmedetomidine can reduce analgesic use of butorphanol during dressing change. This combination resulted in a higher sedation score and fewer adverse effects.

Salbutamol nebulization for management of transient tachypnea of newborn (TTN).

Objective: To compare the mean change in respiratory rate with salbutamol nebulization versus placebo for treatment of transient tacyopnea of newborn. Study Design: Randomized Control Trial. Setting: Department of Neonatology, Federal Government Polyclinic (PGMI), Islamabad. Period: 8th August 2017 to 7th February 2018. Material &amp; Methods: 100 neonates fulfilling selection criteria were enrolled in the study. Informed consent was obtained from parents. Demographic information was also noted. All baseline respiratory rate were noted. Neonates were divided into two groups by lottery method. Neonates in Treatment group were nebulized with Salbutamol. Placebo group was nebulized with Normal Saline. Then neonates were followed-up in N.I.C.U after 4 hours of second nebulization. After 4 hours, respiratory rates were assessed and change in respiratory rate was noted. Both groups were compared for mean reduction in respiratory rate by using independent sample t-test. Results: In nebulized salbutamol, group, mean respiratory rate was changed from 79.62±8.18bpm to 52.06±4.96bpm. This was a significant decrease (p&lt;0.05). In placebo group, mean respiratory rate was changed from 81.88±8.86bpm to 62.50±6.75bpm. This was significant decrease (p&lt;0.05). The difference between both groups at baseline was insignificant while after 4 hours was significant. The mean changed in respiratory rate with nebulized salbutamol was 27.56±6.83bpm while with placebo was 19.35±9.83bpm. There was significant difference in mean reduction in respiratory rate (p&lt;0.05). Conclusion: It has been proved that nebulized salbutamol can be helpful in reducing respiratory rate significantly in neonates with TTN as compared to placebo.

Comparison of the Effect of Lullaby and Kangaroo Care on Physiological Criteria during Heel Lance in Preterm Neonates at the Neonatal Intensive Care Unit

Background The painful procedure of drawing blood from the heel (heel lance) in the neonatal intensive care unit (NICU) is necessary for some diagnostic tests. However, it can have negative effects on the physiological criteria of preterm neonates. This study aimed to compare the effect of lullaby and kangaroo care on the physiological criteria of preterm neonates admitted to the NICU during heel lance.Methods This clinical trial study was conducted with a crossover design on 60 preterm newborns (30-36 weeks of gestation) admitted to the NICU at Ali ibn Abi Taleb Hospital, Zahedan, Iran, 2019. The neonates were randomly divided into two groups of lullaby and kangaroo care (n=30 each). In the former group, a lullaby was played for the neonates through headphones for 30 min, and in the latter group, the naked neonate was placed in the mother's arms for the same duration. Physiological criteria were recorded before (0 min), during (15 min), and after the procedure (30 min). The collected data were analyzed in SPSS software (version 22) using independent t-tests and Chi-square test.Results There was no statistically significant difference between the mean scores of gestation age of neonates in the lullaby (32.63±1.92) and kangaroo care (32.69±1.92) group (P=1.000). The results of the independent sample t-test showed that during the intervention, there was a difference between the mean pulse rate (P=0.015), respiration rate (P=0.003), and arterial oxygen saturation percentage (P<0.01) in preterm neonates. The two groups were significantly different in this regard. However, in the post-intervention stage, no statistically significant difference was observed between the mean pulse rate and respiration rate (P=0.60 and P=0.614, respectively).Conclusion Given the positive effect of kangaroo care on the physiological criteria of preterm newborns during heel lance, this non-pharmacological, low-cost, and available method could help nurses working in the NICU improve physiological criteria during heel lance.

Evaluation of Cardiopulmonary, Blood Gases and Clinical Effects of Dexmedetomidine-Ketamine and Midazolam-Ketamine Anesthesia in New Zealand White Rabbits

This study aimed to investigate the effects of dexmedetomidine-ketamine and midazolam-ketamine combinations on cardiopulmonary and clinical parameters in New Zealand white rabbits. The DXK group (n=8) received dexmedetomidine (50 µg/kg) and ketamine (20 mg/kg), and the MDK group (n=8) received midazolam (0.6 mg/kg) and ketamine (20 mg/kg) in the same syringe through the intramuscular (IM) route. Before anaesthesia and for 120 minutes, reflexes, haemodynamic values and blood gas changes were monitored. It was determined that anaesthesia was induced within a shorter time and lasted longer in DXK. The difference between the groups in terms of the time of loss of the pedal reflex (2.0 min in DXK, 7.5 min in MDK) was statistically significant (p&lt;0.05). It was observed that, in both groups, the heart rate (HR), mean arterial pressure (MAP), respiratory rate (RR) and oxy-haemoglobin saturation (SpO2) values decreased, and the end-tidal CO2 (EtCO2) values increased, but these changes were greater in DXK. With regard to arterial blood gasses, a reduction in pH and pO2 and an increase in pCO2 were also more noticeable in DXK. Consequently, at the doses applied, dexmedetomidine-ketamine caused more noticeable changes in the haemodynamic values and blood gasses in comparison to midazolam-ketamine. High-dose dexmedetomidine (50 µg/kg) and low-dose ketamine (20 mg/kg) achieved induction in a shorter time but led to a significant reduction in RR. It was concluded that the combination of midazolam (0.6 mg/kg) and ketamine (20 mg/kg) could be regarded as appropriate for the anaesthesia of New Zealand white rabbits.

Patient vital signs in relation to ICU admission in treatment of acute leukemia: a retrospective chart review

ABSTRACT Objectives The objective of the current study was to investigate the relationship between changes in vital signs and intensive care unit (ICU) admission. Windsor Regional Hospital treats 15–20 new patients a year with acute leukemia. These patients are at increased risk of neutropenic fevers and admission to the ICU following induction chemotherapy. Methods Retrospective review examined the correlation between acute leukemia patient vitals and ICU admission. The analysis included 37 patients: 7 ICU versus 30 controls. Changes were compared to baseline over 24 hours prior to ICU admission or 5 days after the initiation of induction chemotherapy in the following vital signs: heart rate (HR), mean arterial pressure (MAP), temperature (T), respiratory rate (RR), and fraction of inspired oxygen (FiO2) required to maintain a stable oxygen saturation. Results RR and FiO2 demonstrated significant change over baseline leading up to ICU admission within the ICU group. T, HR and MAP did not demonstrate significant changes over time in either group. RR, FiO2 and HR were significantly higher in the ICU group at time zero compared with the control group. RR was recorded least frequently in the 24 hours leading up to ICU admission. Discussion Changes in RR and FiO2 predicted clinical deterioration requiring ICU admission in acute leukemia patients. This is consistent with the predominant reason for ICU admission which was respiratory failure. Conclusion We present preliminary evidence to support enhanced monitoring of RR and FiO2 in acute leukemia patients following induction chemotherapy with early intervention if identified.

Effect of different doses of topical ketamine on hemodynamics in patients undergoing modified radical mastectomy

BackgroundKetamine has been administered by many routes with different adverse effects according to the selected route of administration and the given doses.ObjectivesWe investigated the effect of three different doses of topical ketamine on hemodynamics and adverse effects. We aimed to find the most effective dose with the least hemodynamic derangements and minimal adverse effects.Study designA prospective, double-blind randomized dose finding study was conducted.SettingThe study was done at the Cancer Institute.Patients and methodsPatients scheduled for modified radical mastectomy were enrolled into three groups (n=30) to receive ketamine hydrochloride topical instillation. The study drug was diluted by 20-ml normal saline (0.9%) and instilled before wound closure by anesthesia assistant as follows: groups A, B, and C: in which patients received 1 mg, 2 mg, and 3 mg/kg ketamine, respectively. Hemodynamic assessments included the mean arterial blood pressure, heart rate, and respiratory rate recorded at baseline and 2, 4, 6, 12, 24, 36, and 48 h postoperatively.ResultsIntergroup comparison showed that the three doses of ketamine instillation (1, 2, and 3 mg/kg), showed no difference in the mean arterial blood pressure, either in the heart rate or respiratory rate at any time point during the study (P>0.05). Five patients versus 2 and 4 experienced postoperative nausea and two patients versus 6 and 6 vomited in groups A, B, and C, respectively.LimitationsSmall sample size was a limitation.ConclusionTopical instillation of ketamine in patients undergoing modified radical mastectomy is a safe technique. The three doses investigated were comparable regarding the hemodynamics with no significant adverse effects.

Determining the effect of time dependent and time independent factors on pneumonia of children under five in North west Ethiopia.

Lower Respiratory Tract Infections including pneumonia are the fourth cause of death globally. In Ethiopia, pneumonia is the leading cause of death for children under five. However, so far, only a few studies that used longitudinal design and time dependent covariates determined the significant factors of pneumonia. This study sought to determine whether respiratory rate changes differed for under five-year-old pneumonia patients who had been receiving different treatments over time and whether the change was effected by time dependent and independent covariates. A longitudinal study design involving marginal Poisson regression models and conditional Poisson regression models was used. After comparing the two, the final interpretation was made using a conditional Poisson regression model owing to its relative powerfulness. Four hundred and fifty-three under five pneumonia patients were included, of which 44.37% were female. It is found that, compared to rural children, urban children had an estimated mean respiratory rate decrease of 3%. It is also found that, compared to children whose mother practiced only exclusive breastfeeding in the first six months, children whose mother practiced both breastfed and complementary were more likely to be exposed to pneumonia. The estimated mean respiratory rate of children having asthma was 1.073 times that of children who had diarrhea. In northwest Ethiopia, weight, residence, previous disease history, breastfeeding and temperature are significant factors of pneumonia among children under five. The effectiveness of treatments was dependent on the number of times children visited the hospital. A significant variation of baseline pneumonia status among under five pneumonia patient children was noted in the hospital.

Clinical Characteristics and main presentation of the COVID19 among Iraqi people

The COVId19 pandemic is a newly emerging infectious disease that needs to be understood thoroughly in order to be controlled. This study aimed to study the clinical and laboratory characteristics of the COVID19 patient . Patient and methods: A cross-sectional study was done in Iraq, at Salahadeen general hospital from the period 1st March to the end of May 2020 on patients diagnosed with COVID 19. A total of 75 COVID19 patients enrolled in the study. a full history was taken, a full physical examination was done, computerized tomography, and laboratory tests. Results: The age distribution of the COVID19 patient were commonly aged (30-50 years) 37(49.3%), and those aged &lt;30 years represented about 6(8%) of the sample. The dominant gender was male 43(57.3%). About 58 (77.3%) of the patient had comorbid disease, coronary vascular disease was 49(65.3%), hypertension was found among 47(62.7%), DM was found among 40(53.3%). Smoking found among 35(46.7%) of the patients . The commonest symptoms were dyspnea 63(84%), fever 51(68%), Myalgia 46(61.3%), loss of smell 8(10.7%), vomiting 8(10.7%), sputum 8(10.7%), loss of taste 6(8%), diarrhea 6(8%), dry mouth found among 6(8%), cough 6(8%), fatigue 5(6.7%)followed by arthralgia 4(5.3%), and chest pain 3(4%). The mean Spo2% was (88±6.6), heart rate was (103±23.3), the mean respiratory rate was (17.7±4.1), the mean temperature value was (38.1±1.1), and the mean C - reactive protein rate was (49.8±41.2). The CBC shows that Lymphopenia was reported among 34(45.3%) of the patient, leukocytosis reported among 19 (25.3%) of the patient. Chest CT revealed that mean lung involvement was (16.6±14.7%). Conclusion: The commonest presentation of the patient was dyspnea, followed by fever. Digestive symptoms and myalgia were common. COVID19 maybe became a stigma in our community and educational programs were needed to overcome this problem.

Comparison of Various Techniques of Anesthesia for Surgical Management of Diabetic Foot

Background: Diabetes mellitus is a multisystem disease caused by an absolute or relative deficiency of insulin secretion or resistance or a combination of both. Anesthesia in them is of special concern because of complex polypharmacy, an inappropriate dose of oral hypoglycemic agents or insulin and errors in converting IV insulin to usual medication. The objective is to compare the various techniques of anesthesia for surgical management of diabetic foot in terms of intraoperative hemodynamic stability, perioperative problems related to anesthesia techniques, postoperative analgesia. Subjects and Methods: Sixty adult diabetic patients of both gender of ASA grade II-III, aged 35years undergoing surgical management of diabetic foot were elected and separated into three groups, Group A: general anesthesia with tracheal intubation, Group B: unilateral spinal anesthesia with injection 0.5% bupivacaine heavy 1.5ml (7.5mg), Group C: popliteal nerve block via lateral approach by injecting 30 ml 0.5% bupivacaine. Parameters like pulse rate, mean arterial blood pressure, respiratory rate and SpO2 were recorded at regular intervals. Postoperative pain, perioperative side effects, complications and problems related to anesthetic techniques were noted. The analysis is done by unpaired t-test and chi-square test. Results: Group C patients were hemodynamic stable than Group A and B. Post-op analgesia was prolonged in Group C. Perioperative side effects were more found in Group A. Conclusion: Popliteal nerve block and unilateral spinal anesthesia provide better hemodynamic stability and postoperative analgesia with negligible side effects as compared to general anesthesia for surgical management of diabetic foot.

Role of intravenous paracetamol as an adjunct to epidural analgesia in immediate postoperative period in abdominal cancer surgeries

Aims and Objectives: To evaluate analgesic efficacy and side effects of intravenous paracetamol, also assess IV-PCA morphine consumption in patients undertaken abdominal cancer surgery. Materials and Methods: Total 160 ASA grade I and II patients of both the sex, between age 18-70 years were randomly divided in two equal groups to receive either IV paracetamol 1gm or no paracetamol after surgery. Hemodynamic parameters, pain intensity scores, amount of morphine consumption and side effects were recorded. Results: The control group had higher mean heart rate, mean arterial blood pressures, mean respiratory rate than paracetamol group. Pain intensity score was much higher in control group at any time which needed considerably higher dose of rescue analgesic (IV morphine) for pain control than paracetamol group. We found no significant difference statistically in sedation scores in patients using patient controlled analgesia in either group. Side effects were found to be lower in paracetamol group compared to control group but difference was not significant statistically. Conclusion: Paracetamol is safe and effective drug for postoperative analgesia with negligible side effects. Keywords: IV paracetamol, IV-PCA morphine, Abdominal cancer surgery, Epidural Analgesia, Pain scores, Sedation score.

Nebulized epinephrine versus salbutamol for the management of children presenting with bronchiolitis: Single Center Study.

Objectives: To compare the outcome of nebulized epinephrine versus salbutamol for the management of children presenting with bronchiolitis. Study Design: Randomized Controlled Trial. Setting: Department of Pediatrics, Federal Government Polyclinic Hospital, Islamabad. Period: 6 month (1st October, 2016 to 1st April, 2017). Material &amp; Methods: Children fulfilled selection criteria were enrolled. Then patients were randomly divided in two groups by using lottery method. In Group A, children received salbutamol. In group B, children received nebulized adrenaline. After 48 hours, children were evaluated for heart rate, respiratory rates, oxygen saturation and Respiratory Distress Assessment Index (RDAI) score. All the information was collected using proforma. Data was analyzed using SPSS version 21. Results: The mean age of children was 10.45±6.70 months in epinephrine group and13.07±6.28 months in salbutamol group. There were 29 (52.7%) males &amp; 26 (47.3%) females in both groups. After 48 hours, mean heart rate was 122.58±4.75bpm with epinephrine while 127.87±4.4.44bpm with salbutamol. Mean respiratory rate was 35.16±3.29bpm with epinephrine while 39.84±3.32bpm with salbutamol. Mean RDAI score was 8.35±1.36 with epinephrine while 10.07±1.37 with salbutamol. Mean oxygen saturation was 85.24±2.74% with epinephrine while 80.38±3.26% with salbutamol. The difference was significant (P&lt;0.05). Conclusion: Thus the nebulized epinephrine was found to be more effective in maintaining heart rate, respiratory rate, oxygen saturation and RDAI score of children as compared to salbutamol.

Physiological and biochemical responses and hydration status in equines after two barrel racing courses

ABSTRACT: Studies on biochemical constituents and hydration of horses in training or competitions are essential for the knowledge of their adaptive physiological and metabolic responses to the type of exercise inherent to the sport. The present research evaluated the effects of exercise on hydric status and physiologic and biochemical profiles in Quarter Horses during a barrel race training session. The design consisted of three evaluation times (T): at rest, before the start of physical activity (T0); immediately after a 10-minute warm-up trot and then running the barrel race courses twice with a 10-minute interval (T1); and after one hour’s rest after the second course (T2). The parameters analyzed were: heart rate (HR), respiratory rate (RR), body temperature (BT) and mucose color; the capillary refill time (CRT), packed cell volume (PCV), total plasma proteins (TPP), serum creatinine (CRE) and blood urea nitrogen (BUN) were evaluated and used to infer water status; plasma osmolarity (Osm) was measured; the electrolytes sodium (Na), potassium (K), chloride (Cl), total calcium (tCa), total magnesium (tMg) and phosphorus (P), plasma glucose (Glu) and lactate (Lac) and the muscle enzymes creattine kinase (CK) and aspartate aminotransferase (AST) completed the evaluated parameters. The data for the variables studied were submitted to ANOVA and the Tukey test at 5% probability. After exercise (in T1), HR, RR, BT, PCV, TPP, Glu, Lac, Cre increased (P&lt;0.05), there was also increase in phosphorus and decrease in K (P&lt;0.05), but there was no hypophosphatemia and hipokalemia, respectively. After rest (in T2), only glucose returned to baseline levels (T0) and, with lower mean values, HR, RR, BT, PCV, K and Lac did not return to baseline levels (T0), while P decreased (P&lt;0.05). Osm, BUN, Na, Cl, tCa, tMg, CK and AST did not change between times (P&gt;0.05). It was concluded that the maximum intensity exercise performed on two barrel race courses caused mild hemoconcentration, did not changed plasma osmolality or concentrations of important electrolytes and muscle enzymes of horses, but caused hyperlactatemia without the plasma lactate concentrations being fully recomposed after resting.

The The Correlation of Hemodynamic Status and Oxygen Saturation with The Level of Consciousness in Head Injury Patients

Introduction: Head injury is a traumatic disorder caused by the mechanical strength of a blunt object or penetration that can cause temporary or permanent changes in tissue function and structure. The latest developing concept on poor prognosis among head injury patients was occur related to the secondary injuries, where there was an increase in intracranial, cerebral ischemia, and decreased consciousness. The important thing in the management of head injuries is to maintain hemodynamic stability and to prevent hypoxia by maintaining oxygen saturation &gt;95%. The purpose of this study was to analyze the correlation of hemodynamic status and oxygen saturation with the level of consciousness in head injury patients at RSUD Mardi Waluyo, Blitar.&#x0D; Methods: The research used correlational analytical with a cross-sectional design. The sampling technique used consecutive sampling within a total sample of 30 respondents. Spearman's test was used for data analysis.&#x0D; Results: The results showed a correlation between mean arterial pressure (p-value = .004), respiratory rate (p-value = .000), body temperature (p-value = .017), and oxygen saturation (p-value = .000) with level of consciousness (GCS) respectively.&#x0D; Conclusion: It can be concluded that mean arterial pressure, respiratory rate, body temperature, and oxygen saturation can affect the level of consciousness (GCS). There was a need to improve hemodynamic and oxygen saturation monitoring to prevent the bad prognosis in head injury patients at RSUD Mardi Waluyo, Blitar.

Starvation of the Respiratory Metabolism and Locomotion of Aurelia aurita s.l. Ephyrae

Blooms of the scyphozoan jellyfish Aurelia aurita are greatly regulated by the survival rate of planktonic ephyrae. The ecophysiology of ephyrae is poorly studied compared with polyps and medusae. As extremely strong starvation resistance and recovery capability of A. aurita ephyrae may due to its low metabolic rate as well as starvation may reduce the swimming ability of ephyrae which may lead to the higher predation loss, the effects of temperature and starvation on their respiration and pulsation rates were examined. In this study, ephyrae under different starvation conditions were measured by a fluorescence-based DO meter after 72 h incubation. And the pulsation rates were measured at every 10-d interval in 1-liter plastic bottle by a hand-held counter. The results showed that the mean respiration rates of newly released ephyrae were 0.24, 0.24 and 0.19 μl O2 ephyra-1 d-1 at 15°C, 12°C and 9°C, respectively, and the rates tended to decrease with increasing starvation duration. Carbon weight-specific respiration rates did not change significantly with starvation duration. The dry weight-specific respiration rates of newly released A. aurita ephyrae (i.e., 11.7-14.6 μl O2 mg DW-1 d-1) were nearly one order of magnitude lower than the rates for planktonic larvae of other taxa (e.g., molluscs, crustaceans and fish). The maximum pulsation rate taken by A. aurita ephyrae was 49.2 beats min-1, which represents the maximum swimming velocity to be 8.87 cm·min-1. The pulsation rates were not affected by temperature over the range between 9°C and 15°C. However, they were influenced by starvation duration. Starvation-derived decrease in pulsation together with associated body shrinkage may lead to lower encounter rate of prey and lower escaping ability from predators, which may lead to higher predation loss in the field.

Impact of Using Active Locomotion Interfaces for Gameplay: A Study on Exertion Levels and Presence

Active video games have proven to be an effective means of coupling gaming and exercise, while also providing a more enjoyable experience. In this article, we investigate two elliptical walker-based exertion systems for active video game locomotion. The impacts on heart rate, respiratory rate, and sense of presence were investigated as a result of using different locomotion systems by employing 20 subjects. Four configurations of elliptical walker-based exertion systems were compared with two commonly used sedentary game controllers. The results showed that participants’ mean heart and respiratory rate were significantly increased as a result of using the active locomotion systems. Seventy percent of participants stated they would likely use the exertion systems at home, with a mean estimated weekly use time of 4.2 h. It is expected that the ongoing use of the exertion systems would exceed the physical activity guidelines recommended by the World Health Organisation. While participants subjectively did not feel more present, they were more involved with the virtual experience when using the exertion systems compared to the sedentary configurations. It was found that familiarity with the controls, and weekly time spent playing video games both had a significant impact on player exertion and subjective presence.

Abstract 205: Effect of Prehospital Noninvasive Positive Pressure Ventilation for Rescue of Acute Respiratory Distress

Background: Emergency medical services (EMS) patients in respiratory distress require prompt rescue treatment. Only limited data describe the outcomes of prehospital rescue treatment with non-invasive positive pressure ventilation (NIPPV), including continuous positive airway pressure (CPAP) or bilevel positive air pressure (BiPAP). We sought to characterize the outcomes of prehospital CPAP/BiPAP in a national EMS cohort. Methods: We analyzed 2018 cross-sectional data on 1289 EMS agencies from ESO Solutions, Inc. (Austin, Texas). We included adult (age ≥18 years) patients with respiratory distress (respiratory rate (RR) ≥30 breaths/min. We divided the patients between those receiving NIPPV and standard care (SC). The primary outcome was change in RR during EMS care. We censored the analysis at 40 minutes of treatment. We compared baseline characteristics between NIPPV and SC. Using mixed linear, fractional polynomial and multiple spline models, we determined the associations of prehospital NIPPV with changes in RR. Results: Of the 6,156,846 adult 911 cases, we included 87,219 with respiratory distress, including 11,271 (12.9%) NIPPV (11,206 CPAP and 65 BiPAP) and 75,948 (87.1%) SC. Median treatment duration were: NIPPV 20.0 minutes (IQR 13.5-29.2 minutes), SC 18.5 minutes (IQR 11.1-27.6 minutes). Common concurrent treatments for NIPPV and SC included: Albuterol (48.6%, 20.9%), Ipratropium (27.9%, 11.2%) and Methylprednisolone (23.7%, 7.8%). At 20 minutes, mean RR change was greater for SC than NIPPV; SC -7.8 breaths/min vs. NIPPV -6.0 breaths/min, difference 2.3 (95% CI 1.9-2.6), p&lt;0.001. At 40 minutes, mean RR change was greater for SC than NIPPV; SC -9.5 breaths/min vs. NIPPV -8.2 breaths/min, difference 1.6 (95% CI 0.8 - 2.5), p&lt;0.001. On linear mixed modeling adjusted for age, sex, incident location, race, ethnicity, agency type, initial RR, and medication use, SC was associated with a larger decrease in respiratory rate across time than NIPPV; [NIPPV X time] interaction p&lt;0.001. Conclusions: In this multicenter series of prehospital respiratory distress, SC was associated with greater reductions in RR than NIPPV.

ANESTHESIA WITH MEDETOMIDINE-KETAMINE AND DEXMEDETOMIDINE-KETAMINE IN MOUNTAIN GORILLAS (GORILLA BERINGEI BERINGEI).

Between December 2002 and September 2017, 125 anesthetic procedures involving free-living and orphaned captive mountain gorillas (Gorilla beringei beringei) were performed in the Virunga Massif and Bwindi Impenetrable Forest in East-Central Africa. Of these 125 immobilizations, 114 records were complete enough for inclusion into this study. Anesthetic and physiologic data from these 114 cases were analyzed, of which 57 used medetomidine-ketamine and 57 used dexmedetomidine-ketamine administered intramuscularly. With the use of estimated weights, the mean induction dosage (mg/kg ± SD) for medetomidine was 0.033 ± 0.003 (n = 42), for dexmedetomidine 0.018 ± 0.005 (n = 53), and for ketamine 3.66 ± 0.95 (n = 95). Mean time from injection of induction dose to recumbency was 6.8 ± 3.1 min (n = 74). Atipamezole was administered intramuscularly to reverse anesthesia. First signs of recovery occurred at 5.0 ± 4.0 min, and full recovery was 19.0 ± 17.0 min after administration of the reversal agent. No significant differences in physiologic parameters or anesthetic time variables were noted between healthy and unhealthy individuals. Mean heart rate was 72.0 ± 17.6 beats/min (n = 83) and mean oxygen saturation was 96.5% ± 4.2 (n = 62). Mean respiratory rate was 27 ± 9 breaths/min (n = 84) and mean body temperature 36.6°C ± 1.2 (n = 61). The current protocol has several advantages for field use in this species given its quick induction, few observed side effects, and ability to reverse so that the animal can return more quickly to its social group.