Blood Gas Measurements Research Articles

Cerebral O2 and CO2 transport in isovolumic haemodilution: Compensation of cerebral delivery of O2 and maintenance of cerebrovascular reactivity to CO2

This study investigated the influence of acute reductions in arterial O2 content (CaO2) via isovolumic haemodilution on global cerebral blood flow (gCBF) and cerebrovascular CO2 reactivity (CVR) in 11 healthy males (age; 28 ± 7 years: body mass index; 23 ± 2 kg/m2). Radial artery and internal jugular vein catheters provided measurement of blood pressure and gases, quantification of cerebral metabolism, cerebral CO2 washout, and trans-cerebral nitrite exchange (ozone based chemiluminescence). Prior to and following haemodilution, the partial pressure of arterial CO2 (PaCO2) was elevated with dynamic end-tidal forcing while gCBF was measured with duplex ultrasound. CVR was determined as the slope of the gCBF response and PaCO2. Replacement of ∼20% of blood volume with an equal volume of 5% human serum albumin (Alburex® 5%) reduced haemoglobin (13.8 ± 0.8 vs. 11.3 ± 0.6 g/dL; P < 0.001) and CaO2 (18.9 ± 1.0 vs 15.0 ± 0.8 mL/dL P < 0.001), elevated gCBF (+18 ± 11%; P = 0.002), preserved cerebral oxygen delivery (P = 0.49), and elevated CO2 washout (+11%; P = 0.01). The net cerebral uptake of nitrite (11.6 ± 14.0 nmol/min; P = 0.027) at baseline was abolished following haemodilution (−3.6 ± 17.9 nmol/min; P = 0.54), perhaps underpinning the conservation of CVR (61.7 ± 19.0 vs. 69.0 ± 19.2 mL/min/mmHg; P = 0.23). These findings demonstrate that the cerebrovascular responses to acute anaemia in healthy humans are sufficient to support the maintenance of CVR.

AARC Clinical Practice Guidelines: Capillary Blood Gas Sampling for Neonatal and Pediatric Patients.

In the absence of an indwelling arterial catheter, capillary blood gas sampling may be used to evaluate the acid/base and ventilation status of neonatal and pediatric patients with cardiorespiratory conditions. These guidelines were developed from a comprehensive review of the literature to provide guidance for the collection, handling, and interpretation of blood obtained from an arterialized capillary sample. Capillary and venous blood gas measurements are a useful alternative to arterial blood gas measurements for neonatal and pediatric patients who do not require close monitoring of [Formula: see text] In the presence of alterations in body temperature, blood pressure, or peripheral perfusion, agreement between a capillary blood gas with an arterial sample is recommended to determine whether changes in these physiologic conditions reduce reliability. Perfusion to the sample site should be assessed and preference given to blood sampling from a well perfused site, and blood should be analyzed within 15 min of sampling to minimize the propensity for pre-analytical errors. Clinicians should consider re-collecting a blood sample, obtained from an artery, vein, or capillary, when the blood gas or analyte result interpretation does not align with the patient's clinical presentation. A pneumatic tube system can be reliably used to transport blood gas samples collected in a syringe and capillary tube to a clinical laboratory for analysis. To reduce the cumulative pain effect and risk of complications, the capillary puncture procedure should be minimized when possible. Non-pharmacologic interventions should be used to reduce pain associated with capillary blood gas sampling. Automatic lancets are preferred to puncture the skin for capillary blood gas collection.

The Effect of Mild Hypocapnia on Postoperative Ecchymosis in Rhinoplasty.

Ecchymosis and edema are the most common complications in patients following rhinoplasty in the early postoperative period. Vasoconstriction created by hypocarbia may have a positive effect on postoperative ecchymosis. The aim of this study was to evaluate the effect of mild hypocapnia induced in rhinoplasty on the severity of periorbital ecchymosis. The study was carried out retrospectively in the digital photographs (control group and study group) of 31 participants who underwent open technical rhinoplasty between January and March 2019. During the operation, partial carbon dioxide pressure in the study group was kept in the range of 32 to 38 mmHg and in the control group between 42 and 46 mmHg and this was confirmed by arterial blood gas measurements taken during the operation. Measuring the brightness and shadows of digital photos Digital color meter was used in MacOS X as a computer software. The mean ratio of periorbital ecchymosis to forehead brightness was 0.84 ± 0.05 in the study group and 0.81 ± 0.03 in the control group. There was no significant difference between the study and control groups (P > .05). This study investigates the potential role of hypocapnia on postoperative ecchymosis during rhinoplasty. The severity of ecchymosis was less in the patients with induced mild hypocapnia regarding both subjective and objective evaluations, but this difference didn't reach statistical significance compared to the normocapnic control group.

Effects of detomidine or romifidine during maintenance and recovery from isoflurane anaesthesia in horses

ObjectiveTo evaluate the effects of detomidine or romifidine on cardiovascular function, isoflurane requirements and recovery quality in horses undergoing isoflurane anaesthesia. Study designProspective, randomized, blinded, clinical study. AnimalsA total of 63 healthy horses undergoing elective surgery during general anaesthesia. MethodsHorses were randomly allocated to three groups of 21 animals each. In group R, horses were given romifidine intravenously (IV) for premedication (80 μg kg–1), maintenance (40 μg kg–1 hour–1) and before recovery (20 μg kg–1). In group D2.5, horses were given detomidine IV for premedication (15 μg kg–1), maintenance (5 μg kg–1 hour–1) and before recovery (2.5 μg kg–1). In group D5, horses were given the same doses of detomidine IV for premedication and maintenance but 5 μg kg–1 prior to recovery. Premedication was combined with morphine IV (0.1 mg kg–1) in all groups. Cardiovascular and blood gas variables, expired fraction of isoflurane (Fe′Iso), dobutamine or ketamine requirements, recovery times, recovery events scores (from sternal to standing position) and visual analogue scale (VAS) were compared between groups using either anova followed by Tukey, Kruskal-Wallis followed by Bonferroni or chi-square tests, as appropriate (p < 0.05). ResultsNo significant differences were observed between groups for Fe′Iso, dobutamine or ketamine requirements and recovery times. Cardiovascular and blood gas measurements remained within physiological ranges for all groups. Group D5 horses had significantly worse scores for balance and coordination (p = 0.002), overall impression (p = 0.021) and final score (p = 0.008) than group R horses and significantly worse mean scores for VAS than the other groups (p = 0.002). Conclusions and clinical relevanceDetomidine or romifidine constant rate infusion provided similar conditions for maintenance of anaesthesia. Higher doses of detomidine at the end of anaesthesia might decrease the recovery quality.

Performance Evaluation of the i-SmartCare 10 Analyzer and Method Comparison of Six Point-of-Care Blood Gas Analyzers.

Blood gas, electrolyte, glucose, and lactate level measurement have an immediate and critical impact on patient care. We evaluated the performance of i-SmartCare 10 (i-SENS Inc., Seoul, Korea) and conducted a method comparison study of five point-of-care (POC) analyzers with i-SmartCare 10 as the comparator, according to the CLSI guidelines. Ten analytes (pH, pCO2, pO2, Na+, K+, Cl-, iCa2+, glucose, lactate, and Hct) were tested on six analyzers: i-SmartCare 10, ABL90 FLEX PLUS (Radiometer Medical ApS, Copenhagen, Denmark), i-Stat (Abbott Point of Care Inc., Princeton, NJ, USA), RapidLab 1265 (Siemens Healthcare Diagnostics Inc., Tarrytown, NY, USA), Stat Profile pHOx Ultra (Nova Biomedical, Waltham, MA, USA), and Gem Premier 5000 (Instrumentation Laboratory, Bedford, MA, USA). The total imprecision and linearity (r2>0.99) were excellent, except for a few analytes that narrowly escaped the preset criteria. Interference was noted for Na+ in the presence of a high K+ level and for iCa2+ in the presence of high K+ and Mg2+ levels. Forty of 48 items demonstrated either a proportional or systematic difference in regression analysis; the relative mean difference (%) of 14/48 items escaped the allowable total error in the difference plot analysis. i-SmartCare 10 shows acceptable performance, and using a single POC blood gas analyzer is recommended for monitoring.

Polycythemia in dogs with chronic hypoxic pulmonary disease.

BackgroundProlonged tissue hypoxia caused by chronic pulmonary disease is commonly regarded as an important mechanism in the development of secondary polycythemia, but little clinical data are available to support this hypothesis.ObjectiveTo study the prevalence and severity of erythrocytosis accompanying chronic hypoxic pulmonary disease in dogs.AnimalsForty‐seven dogs with hypoxic chronic pulmonary disease, 27 dogs with nonhypoxic chronic pulmonary disease, and 60 healthy controls.MethodsDogs with chronic pulmonary disease and chronic hypoxemia (partial pressure of arterial oxygen [PaO2] < 80 mm Hg on at least 2 arterial blood gas measurements a minimum of 1 month apart) were identified retrospectively from patient records. Association between arterial oxygen and red blood cell parameters was analyzed using Pearson's correlation coefficients and multivariable linear regression analysis.ResultsRed blood cell parameters measured at the end of the hypoxemia period were within the laboratory reference range in most dogs. In chronically hypoxemic dogs, hematocrit (Hct) was increased in 4/47 (8.5%; 95% confidence interval [CI], 0‐17) dogs, erythrocyte count (Erytr) was increased in 12/47 (26%; 95%CI, 13‐38) dogs and hemoglobin concentration (Hb) was increased in 3/47 (6.4%; 95%CI, 0‐14) dogs. No marked polycythemia (Hct ≥65%) was noted in any of the dogs. Red blood cell parameters were not associated with the severity of hypoxemia (correlation to PaO2: Erytr, r = −.14; Hb, r = −.21; Hct, r = −.14; P > .05 for all).Conclusions and Clinical ImportancePolycythemia is uncommon, and usually mild if present, in dogs with chronic hypoxia caused by pulmonary disease.

Evaluation of Functional Operability Prior to Lung Surgery

Cardiac and pulmonary physiologic assessment is necessary for risk stratification before any lung resection. It may uncover hidden health issues, which can be addressed first to make patients fit for surgery. It allows for the surgeon to estimate the patient's risk for major complications and at the same time for the patient to understand the procedural risks and give informed consent or even reject surgery. Recommended work-up for both to cardiac risk evaluation and preoperative pulmonary function test algorithms are based on guidelines formulated by the ERS/ESTS and ACCP 1 3 4.Basic pulmonary function tests consist of spirometry, blood gas analysis and measurement of diffusion capacity (DLCO); followed by cardiopulmonary exercise testing (CPET) which estimates or measures the patient's oxygen consumption, and split function tests such as perfusion scintigraphy. Clinical assessment of both the patient's overall status and pulmonary function allows for an adequate assessment of overall operative risk. Pulmonary function tests are affected by multiple variables and as such prone to error. It is advisable to always question the validity of every work-up and to repeat any test if necessary.

A Term Neonate with Multiorgan Dysfunction, Severe Metabolic Acidosis, and Hyperkalemia.

A Term Neonate with Multiorgan Dysfunction, Severe Metabolic Acidosis, and Hyperkalemia.

Magnesium sulfate for acute exacerbations of chronic obstructive pulmonary disease.

Magnesium sulfate for acute exacerbations of chronic obstructive pulmonary disease.

Acid base and blood gas analysis in term neonates immediately after birth with uncomplicated neonatal transition

BackgroundAcid base and blood gas measurements provide essential information, especially in critically ill neonates. After birth, rapidly changing physiology and difficulty to obtain blood samples represent unique challenges.ObjectivesThe aim of the present study was to establish normal values of capillary acid base and blood gas analysis immediately after birth in term neonates after uncomplicated neonatal transition.MethodThis is a post-hoc-analysis of ancillary outcome parameter of a prospective observational study in term neonates immediately after caesarean section. Neonates were included after immediate neonatal transition without need of medical support and a capillary blood sample was taken by a heel-stick within 15–20 minutes after birth.ResultOne hundred thirty-two term neonates were included with mean (SD) gestational age of 38.7 ± 0.7 weeks. The blood was drawn mean (SD) 16 ± 1.7 minutes after birth. The mean (SD) values of the analyses were: pH 7.30 ± 0.04, pCO2 52.6 ± 6.4, base excess − 0.9 ± 1.7 and bicarbonate 24.8 ± 1.6.ConclusionThis is the first study describing acid base and blood gas analyses in term neonates immediately after birth with uncomplicated neonatal transition.

Capnography and Pulse Oximetry Improve Fast Track Extubation in Patients Undergoing Coronary Artery Bypass Graft Surgery: A Randomized Clinical Trial.

BackgroundUse of capnography as a non-invasive method during the weaning process for fast track extubation (FTE) is controversial. We conducted the present study to determine whether pulse oximetry and capnography could be utilized as alternatives to arterial blood gas (ABG) measurements in patients under mechanical ventilation (MV) following coronary artery bypass graft (CABG) surgery.MethodsIn this randomized clinical trial, 70 patients, who were candidates for CABG surgery, were randomly assigned into two equal groups (n = 35), intervention and control group. In the intervention group, the ventilator management and weaning from MV was done using Etco2 from capnography and SpO2 from pulse oximetry. Meanwhile, in the control group, weaning was done based on ABG analysis. The length of intensive care unit (ICU) stay, time to extubation, number of manual ventilators setting changes, and alarms were compared between the groups.ResultsThe end-tidal carbon dioxide (ETCO2) levels in the intervention group were completely similar to the partial pressure of carbon dioxide (PaCo2) in the control group (39.5 ± 3.1 vs. 39.4 ± 4.32, p > 0.05). The mean extubation times were significantly shorter in the intervention group compared to those in the control patients (212.2 ± 80.6 vs. 342.7 ± 110.7, p < 0.001). Moreover, the number of changes in the manual ventilator setting and the number of alarms were significantly lower in the intervention group. However, the differences in the length of stay in ICU between the two groups were not significant (p = 0.219).ConclusionOur results suggests that capnography can be used as an alternative to ABG. Furthermore, it is a safe and valuable monitor that could be a good alternative for ABG in this population. Further studies with larger sample sizes and on different disease states and populations are required to assess the accuracy of our findings.Clinical Trial RegistrationCurrent Controlled Trials, IRCT, IRCT201701016778N6, Registered 3 March 2017, https://www.irct.ir/trial/7192.

MO002: Are there Differences in the Results of the Venous Blood Gas Test According to the Origin of the Sample?

Abstract BACKGROUND AND AIMS Currently, hospital haemodialysis units present a high percentage of patients with central venous catheters as the preferred access for haemodialysis treatment, compared with arteriovenous fistula. In most cases, this situation is derived from the characteristics of the patients in these units: patients with high comorbidity, vascular exhaustion and age, among others. For this reason, in the face of a large population with these characteristics, we decided to assess whether there were differences in the blood gas values obtained depending on the place of origin of the sample extraction: from the catheter itself or from the peripheral line. OBJECTIVES Estimate if there are differences in the results obtained in venous blood gases extracted from a venous catheter compared with those obtained through peripheral venipuncture. METHOD Two simultaneous cohort studies were carried out to assess the analytical results of venous blood gas according to whether the origin of the sample was from a central venous catheter or fistula, and a second study that compared the results of patients with central venous catheters to those obtained peripherally on the same day and time. The sample consisted of 104 patients undergoing renal replacement treatment in the Haemodialysis Unit of Torrecardenas Hospital in Almería. Hypothesis: (1) There are differences between blood gases obtained from patients with AVF and vascular catheter. (2) There are differences between the blood gases of the patients depending on whether they are extracted from a vascular catheter or peripheral venipuncture. In the first case, a hypothesis contrast test was carried out to compare the means in independent samples. To verify the second hypothesis, a comparison of means for paired samples was made, for the gasometric results depending on whether they came from a catheter or peripheral puncture. IBM's SPSS software was used to manage these data. RESULTS Of the 104 patients, there were 68 men (65.38%) and 36 women (34.62%) with a mean age of 63.83 years. Permanent catheter bearers in 49.03% of cases (51 patients). Six patients were excluded from whom no valid sample was obtained. The test carried out did not show significance for the first hypothesis raised, and differences in blood gas measurements between patients with AVF and vascular catheter could not be accepted. The difference between the pH, pHCO3 and pCO2 of the blood gases was significant depending on whether they came from a vascular catheter or peripheral venipuncture. CONCLUSION Given the data obtained, we can conclude that there are no differences in the analytical results of the samples obtained from the catheter or from the fistula, which both represent a reliable method when obtaining the samples in these patients, eliminating traumatic venipuncture. However, significant differences were found within the same subjects depending on whether the sample was obtained.

Peripartum Severe COVID-19 Pneumonia: Fetal and Neonatal Implications.

Peripartum Severe COVID-19 Pneumonia: Fetal and Neonatal Implications.

Is Continuous Noninvasive Hemoglobin Monitoring Estimates Timing for Detection of Anemia During Operation better than Clinicians

Blood loss is a common surgical complication, but patient complications and healthcare costscan be exacerbated by needless blood transfusions. Non-invasive and continuous monitoring ofhemoglobin concentrations is possible with the Radical-7 Pulse CO- Oximeter. These determinedvalues are identical to those obtained by blood sampling for hemoglobin concentrations, andthe technique enables continuous monitoring over time of changes in Hemoglobin levels. Aims ofStudy: to investigate whether noninvasive, continuous, and real-time monitoring of Hemoglobincould estimate the timing for further Hemoglobin measurements more accurately than clinicians’discretion during surgery. Patients and Methods: 54 Patients eligible for the study wereunderwent different surgeries with planned invasive venous blood gas sampling for bloodHemoglobin for hemoglobin measurement while Radical-7 Pulse CO-Oximeter continuouslyreading Hemoglobin noninvasively during each surgery. Blood samples were obtained 5 minafter induction of anesthesia (other samples was taken multiple time during operations accordingto time of operation). The Conventional venous blood gas measurements were compared with radical7 co-oximeter obtained at the time of the blood sampling. Results: In our study There was nostatistically significant differences (p&gt;0.05) in mean hemoglobin level, whether measured by SpHbor by conventional laboratory. in addition, Bland–Altman plot was utilized and show no markeddifference between invasive and noninvasive method. All these factors signify a good compatibilitybetween the two methods. Conclusions: The radical 7 satisfactorily follows hemoglobin shifts andmore reliably predicts the required timing for early Hemoglobin management decisions throughoutsurgery.

This Month in Anesthesiology

This Month in Anesthesiology

Implementation and challenges of portable blood gas measurements in air medical transport.

Ventilator management in prehospital settings using end-tidal CO2 can lead to inappropriate ventilation in the absence of point of care blood gas (POCBG) measurements. Implementation of POCBG testing in helicopter Emergency Medical Services (HEMS) is limited in part because of concern for preanalytical and analytical errors due to altitude, vibration, and other associated environmental factors and due to insufficient documentation of implementation challenges. We performed accuracy and precision verification studies using standard materials tested pre-, in-, and post-flight (n=10) in a large HEMS agency. Quality assurance error log data were extracted and summarized for common POCBG errors during the first 31months of use and air medical transport personnel were surveyed regarding POCBG use (n=63). No clinically significant differences were found between pre-, in-, and post-flight blood gas measurements. Error log data demonstrated a reduction in device errors over time. Survey participants found troubleshooting device errors and learning new clinical processes to be the largest barriers to implementation. Continued challenges for participants coincided with error log data including temperature and sampling difficulties. Survey participants indicated that POCBG testing improved patient management. POCBG testing does not appear to be compromised by the HEMS environment. Temperature excursions can be reduced by use of insulated transport bags with heating and cooling packs. Availability of POCBG resultsin air medical transport appeared to improve ventilator management, increase recognition of ventilation-perfusion mismatch, and improve patient tolerance of ventilation.

Novel Portable Hypothermic Cardiac Preservation Device Extends Cardiac Viability and Function Beyond the Standard of Care Using Isolated Porcine Hearts

<h3>Purpose</h3> The standard of care: cold static storage (CSS), limits the time a heart can be preserved to 4-6 hours. Machine perfusion preservation has been shown to improve organ viability. However, current machine perfusion technology is complex and requires the use of blood or blood products. The purpose of this study was to test the efficacy of a portable hypothermic oxygenated and acellular perfusion machine device, in preserving cardiac viability and function in comparison to CSS for 4 hours at different perfusion times using an isolated heart porcine model. <h3>Methods</h3> Isolated porcine hearts (N=17) were recovered under anesthesia and by inducing cardiac arrest through cardioplegia administration. Experimental hearts were perfused using a novel cardiac preservation device with an acellular perfusate at 4-8°C for 4 hours(n=3), 8 hours(n=4), and 24 hours(n=3). In addition, 3 hearts were perfused for 2 hours and then kept inside the perfusor at 4-8°C for an additional 4 hours without perfusion (extended mode), to determine efficacy during inoperable conditions. Controls (n=4) were hearts kept in CSS for 4 hours. Hourly flow, pressure, temperature, and blood gas measurements were taken from perfused hearts. After preservation, the hearts were placed in a Langendorff for functional recovery determined by +/- dP/dT and maximum pressure. Biopsy samples were taken before and at the end of either preservation method for histological and gene expression analyses. <h3>Results</h3> Control hearts weight gain (%) was -3.4 ± 4.9 and perfused hearts was 1.52 ± 7.6. Venous and arterial lactate concentrations were less than 2.5 mmol/L across all experiments. Perfused hearts at 4 hours, 8 hours, and extended mode had significantly increased contractility (p<0.05) than CSS demonstrated by +dP/dT and peak pressure. Gene expression showed a significant reduction (p<0.005) of inflammation (IL-6, IL-8, TNFα) and cell death markers (p53,cTnI) in perfused hearts compared to control hearts. Furthermore, histological assessment confirmed greater myocardium damage in CSS hearts. <h3>Conclusion</h3> This novel cardiac preservation device enhances cardiac viability and function compared to CSS. Furthermore, it allows for 4 hours of CSS after 2 hours of perfusion in case of cessation of perfusion. Animal transplant studies will be conducted to verify these results.

Invasive And Non-invasive Assessment Of Arterial Blood Oxygen Saturation In Patients With Continuous Flow LVADs: Is There A Correlation?

<h3>Background</h3> Patients with continuous flow left ventricular assist devices (CF-LVAD) typically have a narrow pulse pressure. This may pose a challenge for transcutaneous automated pulse oximeter devices to accurately measure arterial blood saturation. This study aimed to assess their accuracy in a CF-LVAD population by comparing pulse oximetry readings to invasive arterial blood gas (ABG) measurements. <h3>Methods</h3> A total of eighteen patients with a CF-LVAD were identified using chart review at the University of Minnesota and Minneapolis Heart Institute. All, except one patient were implanted with a HeartMate III device (Abbott Laboratories, Minneapolis, MN). Non-invasively assessed oxygen saturation was compared to simultaneously obtained arterial blood oxygen saturation. Two patients were receiving mechanical ventilation, one received BiPAP support, and 15 patients were either breathing room air or receiving supplemental oxygen by nasal cannula. <h3>Results</h3> A non-invasive pulse oximeter read was obtained on every patient. There was a moderate correlation between the invasively and non-invasively obtained oxygen saturation values as shown in Figure 1 (R²=0.624). Waveform quality, as assessed by the treating physician, qualified as good or acceptable in 16 cases and as poor for 2 patients. Data points for these 2 patients are marked in red in Figure 1. <h3>Conclusion</h3> Despite a narrow pulse pressure in patients with CF-LVAD, non-invasive pulse oximetry provided a reliable assessment of arterial blood saturation when compared to the gold standard ABG measurement. This finding presents an opportunity to conduct future studies in this patient population in which continuous monitoring of oxygen saturation may be necessary, such as evaluation for obstructive sleep apnea.

Evaluation of diagnostic and treatment approaches to acute dyspnea in a palliative care setting among medical doctors with different educational levels

SummaryBackgroundDyspnea is common in patients with advanced cancer. Diagnostic procedures in patients with dyspnea are mandatory but often time-consuming and hamper rapid treatment of the underlying refractory symptoms. Opioids are the first-line drugs for the treatment of refractory dyspnea in palliative care patients with advanced lung cancer.MethodsTo evaluate the knowledge levels of medical doctors with different educational levels on the diagnosis of and treatment options for dyspnea in patients with advanced lung cancer in a palliative care setting, a case report and survey were distributed to physicians at the University Hospital Krems, describing acute dyspnea in a 64-year-old stage IV lung cancer patient. A total of 18 diagnostic and 22 therapeutic options were included in the survey. The physicians were asked to suggest and rank in order of preference their diagnosis and treatment options. Statistical analyses of the data were performed, including comparison of the responses of the senior doctors and the physicians in training.ResultsA total of 106 surveys were completed. The respondents were 82 senior physicians and 24 physicians in training (response rates of 86% and 80%, respectively). Regarding diagnostic investigations, inspection and reading the patient’s chart were the most important diagnostic tools chosen by the respondents. The choices of performing blood gas analysis (p = 0.01) and measurement of oxygen saturation (p = 0.048) revealed a significant difference between the groups, both investigations performed more frequently by the physicians in training. As for non-pharmacological treatment options, providing psychological support was one of the most relevant options selected. A significant difference was seen in choosing the option of improving a patient’s position in relation to level of training (65.9% senior physicians vs. 30.4% physicians in training, p = 0.04). Regarding pharmacological treatment options, oxygen application was the most chosen approach. The second most frequent drug chosen was a ß-2 agonist. Only 9.8% of the senior physicians and 8.7% of the physicians in training suggested oral opioids as a treatment option, whereas intravenous opioids were suggested by 43.9% of the senior physicians and 21.7% of the physicians in training (p = 0.089). For subcutaneous application of opioids, the percentage of usage was significantly higher for the physicians in training than for the senior physicians (78.3% vs. 48.8%, p = 0.017, respectively).ConclusionThe gold standard treatment for treating refractory dyspnea in patients with advanced lung cancer is opioids. Nevertheless, this pharmacological treatment option was not ranked as the most important. Discussing hypothetical cases of patients with advanced lung cancer and refractory dyspnea with experienced doctors as well as doctors at the beginning of their training may help improve symptom control for these patients.

The Corevent 2020: An Open-source, Rapid Design-build-Test Emergency Ventilator Developed for Covid-19

In the first quarter of 2020, SARs-CoV-2 (COVID-19) infections began to grow at an alarming rate despite drastic measures to reduce infection rates. Severe COVID-19 cases required mechanical ventilation, resulting in ventilator shortages worldwide. To address the ventilator shortages, the authors developed the CoreVent 2020, an emergency-use ventilator for adult patients that was designed, built, and tested in ten days. The CoreVent 2020 is a pressure-cycled, time-limited ventilator with a breath-assist mode that operates on standard pressurized oxygen and medical air. It provides adjustable peak inspiratory pressure (PIP) and positive end-expiratory pressure (PEEP). A medical-grade commercially available breathing circuit is used to minimize non-medical component requirements. The CoreVent 2020 was fabricated in-house at Stony Brook University Hospital and tested on three mechanical lung simulators in which the operating modes and alarm features were demonstrated. Animal studies were also performed in both normal breathing mode and breath-assisted modes. Arterial blood gas measurements confirmed that the ventilator provided satisfactory ventilation for the test subjects. The COVID-19 pandemic presented unique constraints on the design and innovation process not normally encountered in typical practice. Design decisions such as component choice, delivery time, and ease of high-volume, rapid manufacturing influenced all aspects of the design process. This aspect of the design/innovation process is also discussed, as well as an introductory discussion on how training and simulations can be developed so that innovation can occur efficiently in future crises situations.