Results Of Blood Gas Analysis Research Articles

Intravenous initial bolus during prophylactic norepinephrine infusion to prevent spinal hypotension for cesarean delivery: A randomized controlled, dose-finding trial

BackgroundPrevious studies have shown that a 0.05 μg/kg/min of norepinephrine infusion in combination with an initial bolus reduces the incidence of spinal hypotension during cesarean delivery. The initial norepinephrine bolus influences the incidence of spinal hypotension during continuous norepinephrine infusion; however, the ideal initial bolus dose for 0.05 μg/kg/min of continuous infusion remains unknown. MethodsThis randomized, controlled, dose-finding study randomly allocated 120 parturients scheduled for elective cesarean delivery to receive initial bolus doses of 0, 0.05, 0.10, and 0.15 μg/kg of norepinephrine, followed by continuous infusion at a rate of 0.05 μg/kg/min. The primary outcome was the dose-response relationship of the initial norepinephrine bolus in preventing the incidence of spinal hypotension. Spinal hypotension was defined as systolic blood pressure (SBP) decreased to <80% of the baseline value or to an absolute value of <90 mmHg from intrathecal injection to delivery, and severe spinal hypotension was defined as SBP decreased to <60% of the baseline value. The secondary outcomes included the incidence of nausea and/or vomiting, hypertension, and bradycardia, as well as the Apgar scores and results of the umbilical arterial blood gas analysis. The effective dose (ED) 90 and ED95 were estimated using probit regression. ResultsThe per-protocol analysis included 117 patients. The incidence of spinal hypotension varied significantly among the groups: Group 0 (51.7%), Group 0.05 (44.8%), Group 0.10 (23.3%), and Group 0.15 (6.9%). The ED90 and ED95 values were 0.150 μg/kg (95% confidence interval [CI], 0.114–0.241 μg/kg) and 0.187 μg/kg (95% CI, 0.141–0.313 μg/kg), respectively. However, the ED95 value fell outside the dose range examined in this study. The incidence of severe spinal hypotension differed significantly (P = 0.02) among Groups 0 (17.2%), 0.05 (10.3%), 0.10 (3.3%), and 0.15 (0.0%); however, the incidence of hypertension and bradycardia did not. The incidence of nausea and/or vomiting decreased with an increase in the initial bolus dose (P = 0.03). The fetal outcomes were comparable among the groups. ConclusionsAn initial bolus of 0.150 μg/kg of norepinephrine may be the optimal dose for preventing spinal hypotension during cesarean delivery with a continuous infusion rate of 0.05 μg/kg/min, and does not significantly increase the incidence of hypertension but substantially reduces the risk of nausea and/or vomiting.

Study on comparison of electrolytes in hospitalized patients of critical care medicine by automated biochemistry analyzer and arterial blood gas analyzer

Critical care medicine department has to assess electrolytes accurately and quickly to initiate the treatment. Blood samples are analyzed in a matter of seconds by arterial blood gas analyzers (ABG), albeit their accuracy is still up for debate. The current study objectives were to estimate and compare the levels of electrolytes (sodium, potassium, and chloride) in hospitalized critical care patients as determined by automated biochemistry analysis and blood gas analyzer and to assess the degree of agreement between the two instruments and obtain information on whether these values can be interchanged. A prospective hospital based observational study was undertaken after obtaining institutional ethical committee clearance. The study included a total of 195 paired venous and arterial samples from the patients admitted to Critical Care Medicine Unit of NIMS Hospital, Jaipur, India in whom electrolytes were analysed on Arterial Blood Gas (ABG) analyzer and Automated Biochemistry Analyzer (ABA). Analysis was done on ABL555 blood gas analyzer located in the critical care medicine unit and vitros 5600, located in Clinical Biochemistry. Statistical analysis was done using Student’s t test and Pearson’s correlation coefficient test.A total of 195 samples were analyzed. The mean levels of sodium, potassium and chloride were 136.64 ± 5.44 mmol/L, 3.87 ± 0.523 mmol/L and 100.79 ± 6.65 mmol/L respectively analyzed by ABG analyzer. The mean levels of sodium, potassium and chloride were 136.65 ± 5.81mmol/L, 88 ± 0.543 mmol/L and 100.47 ± 6.41 mmol/L respectively analyzed by ABA. Student’s t test comparison p values for sodium, potassium and chloride were 0.458 (Not Significant), 0.1867 (Not Significant) and 0.0438 (Significant) between the two instruments. The strength of agreement between the two instruments for sodium, potassium and chloride were analyzed using pearsons correlation coefficient. There was strong agreement for all the three parameters between the two instruments and the p value was 0.00001 (highly significant) for all the three parameters.The results of this investigation showed no discernible differences between the automated biochemistry analyzer and arterial blood gas analyzer measurements of sodium, potassium, and chloride. Clinicians can make critically important decisions by relying on the results of arterial blood gas analysis.

Comparison of Blood Gas Analysis and Auto-Analyzer Results for Sodium and Potassium Levels in Elderly and Non-elderly Adult Emergency Department Patients.

Objectives This study aims to evaluate the concordance between blood gas and biochemical measurement methods for sodium and potassium levels in elderly and non-elderly patients within an emergency department (ED) setting. Methods A retrospective method comparison study was conducted at an ED from February 1, 2023, to March 1, 2023. The study included 414 patients, categorized into "elderly" (aged 65 and above; n = 138, 33.3%) and "non-elderly" (aged 18 to 64; n = 276, 66.7%) groups. Concordance was assessed using Bland-Altman, Passing-Bablok, and Lin's concordance correlation methods. Results In sodium measurements, the elderly group exhibited an average bias of -1.52 mEq/L (95% confidence interval [CI] -2.12 to -0.92), with lower and upper limits of agreement (LoA) at -8.46 and 5.42 mEq/L, respectively, indicating a broader variance than non-elderly patients, who showed an average bias of -0.82 mEq/L with limits of -4.97 to 3.32 mEq/L. For potassium, the elderly group's average bias was -0.46 mEq/L (95% CI -0.36 to -0.57), with limits of agreement from -1.68 to 0.75 mEq/L, compared to non-elderly patients with a bias of -0.29 mEq/L and limits of -0.71 to 0.13 mEq/L. Furthermore, concordance correlation coefficients revealed a reduced agreement in the elderly for both sodium (r ccc = 0.799) and potassium (r ccc = 0.529) compared to the non-elderly cohort (sodium r ccc = 0.821, potassium r ccc = 0.715). Conclusion The study identifies significant discrepancies in sodium and potassium levels between elderly and non-elderly patients, suggesting a need for diagnostic precision. It emphasizes the importance of customizing diagnostic approaches to better serve the elderly population in EDs.

Exploring the Prevalence of Respiratory Failure in Adults Presenting With Acute Exacerbations of Chronic Obstructive Pulmonary Disease.

Chronic obstructive pulmonary disease (COPD) poses a significant global health burden and is a leading cause of morbidity and mortality. Acute exacerbations of COPD often lead to respiratory failure, necessitating a thorough understanding of its prevalence. This study aimed to investigate the prevalence of respiratory failure among adult patients experiencing acute exacerbations of COPD. A descriptive, cross-sectional study was conducted over a span of seven months at the internal medicine department of Hayatabad Medical Complex, Peshawar. A total of 255 adult patients with acute exacerbations of COPD were included, and their demographic data, as well as arterial blood gas (ABG) analysis results, were collected. The prevalence of respiratory failure was defined by specific arterial blood gas criteria. The study revealed a notable prevalence of respiratory failure (41.18%) among COPD patients presenting with acute exacerbations. Factors such as older age and male gender were identified as being associated with a heightened risk of respiratory failure. In conclusion, acute exacerbations of COPD predominantly affect middle-aged males (65.5%), with the 51-60 age group being the most impacted. Respiratory failure was present in over 41% of cases. ABG analysis indicated significant acid-base imbalances, hypoxemia, and hypercapnia, with compensatory chronic respiratory acidosis. These findings highlight the need for targeted interventions to manage and prevent COPD exacerbations, especially in middle-aged men.

Case Report: Managing the Coinfection of Cerebral Malaria and Dengue in the Intensive Care Unit

Background: Dengue and malaria are the two most common arthropod-borne illnesses, but cases of multiple infections are extremely uncommon. The mortality rate for individuals with dengue and malaria was higher than the death rate for those with malaria alone.Case: An intubated 53-year-old male was referred from a class B hospital because of severe malaria with suspected cerebral malaria, dengue fever (day-11), septic shock and acute kidney injury. His initial laboratory investigation showed increasing pattern of WBC, thrombocyte, anemia, peripheral blood smear normochromic normocytic erythrocyte, poikilocytosis (ovalocytes (+), teardrop cells (+)), normoblasts (+), presence of Plasmodium malariae trophozoite and schizont stage parasites, positive result of IgM and IgG anti dengue, increased liver function test, increased BUN and creatinine serum levels, hyperbilirubinemia, hypoalbuminemia, and normal result of blood gas analysis. On the sixth day of ICU admission, the patient gradually regained consciousness with appropriate responsiveness and showed clinical improvement. The patient was discharged after one month of hospital care with the last peripheral blood smear showing no parasites detected.Discussion: Mono-infection with malaria and dengue, two mosquito-borne diseases endemic to tropical and subtropical regions, often carries a high risk of fatality. The risk becomes even more pronounced when co-infection occurs. The early diagnosis and management in the ICU are crucial for cases of coinfection involving cerebral malaria and dengue. The primary focus is on both definitive and supportive therapies.Conclusion: The prognosis for coinfection of cerebral malaria and dengue is generally poor, but in this case, the patient showed improvement and was able to be discharged without any sequelae.

The establishment of diseased human whole organ model by normothermic machine perfusion technique: Principle of concept.

The global incidence of liver diseases is rising, yet there remains a dearth of precise research models to mimic these diseases. The use of normothermic machine perfusion (NMP) to study diseased livers recovered from liver transplantation (LT) recipients presents a promising avenue. Accordingly, we have developed a machine perfusion system tailored specifically for the human whole diseased livers and present our experience from the NMP of diseased livers. Six diseased livers recovered from LT recipients with different diagnoses were collected. The diseased livers were connected to the machine perfusion system that circulated tailored perfusate, providing oxygen and nutrients. The pressure and flow of the system were recorded, and blood gas analysis and laboratory tests of perfusate and bile were examined to analyze the function of the diseased livers. Liver tissues before and after NMP were collected for histological analysis. Experiments showed that the system maintained the diseased livers in a physiological state, ensuring stable hemodynamics and a suitable partial pressure of oxygen and carbon dioxide. The results of blood gas analysis and laboratory tests demonstrated a restoration and sustenance of metabolism with minimal damage. Notably, a majority of the diseased livers exhibited bile production continuously, signifying their vivid functional integrity. The pathological characteristics remained stable before and after NMP. We successfully established the machine perfusion system tailored specifically for diseased human whole livers. Through the application of this system, we have developed a novel invitro model that faithfully recapitulates the main features of human liver disease. This model holds immense promise as an advanced disease modeling platform, offering profound insights into liver diseases and potential implications for research and therapeutic development.

Exploiting the Features of Clinical Judgment to Improve Assessment of Disease Severity in the Emergency Department: An Acutelines Study.

Clinical judgment, also known as gestalt or gut feeling, can predict deterioration and can be easily and rapidly obtained. To date, it is unknown what clinical judgement precisely entails. The aim of this study was to elucidate which features define the clinical impression of health care professionals in the ED. A nominal group technique (NGT) was used to develop a consensus-based instrument to measure the clinical impression score (CIS, scale 1-10) and to identify features associated with either a more severe or less severe estimated disease severity. This single-center observational cohort study included 517 medical patients visiting the ED. The instrument was prospectively validated.. The predictive value of each feature for the clinical impression was assessed using multivariate linear regression analyses to adjust for potential confounders and validated in the infection group. The CIS at the ED was associated with ICU admission (OR 1.67 [1.37-2.03], p < 0.001), in-hospital mortality (OR 2.25 [1.33-3.81], p < 0.001), and 28-day mortality (OR 1.33 [1.07-1.65], <0.001). Dry mucous membranes, eye glance, red flags during physical examination, results of arterial blood gas analysis, heart and respiratory rate, oxygen modality, triage urgency, and increased age were associated with a higher estimated disease severity (CIS). On the other hand, behavior of family, self-estimation of the patient, systolic blood pressure, and Glascow Coma Scale were associated with a lower estimated disease severity (CIS). We identified several features that were associated with the clinical impression of health care professionals in the ED. Translating the subjective features and objective measurements into quantifiable parameters may aid the development of a novel triage tool to identify patients at risk of deterioration in the ED.

Monolacunary Wells-Dawson Polyoxometalate as a Novel Contrast Agent for Computed Tomography: A Comprehensive Study on In Vivo Toxicity and Biodistribution.

Polyoxotungstate nanoclusters have recently emerged as promising contrast agents for computed tomography (CT). In order to evaluate their clinical potential, in this study, we evaluated the in vitro CT imaging properties, potential toxic effects in vivo, and tissue distribution of monolacunary Wells-Dawson polyoxometalate, α2-K10P2W17O61.20H2O (mono-WD POM). Mono-WD POM showed superior X-ray attenuation compared to other tungsten-containing nanoclusters (its parent WD-POM and Keggin POM) and the standard iodine-based contrast agent (iohexol). The calculated X-ray attenuation linear slope for mono-WD POM was significantly higher compared to parent WD-POM, Keggin POM, and iohexol (5.97 ± 0.14 vs. 4.84 ± 0.05, 4.55 ± 0.16, and 4.30 ± 0.09, respectively). Acute oral (maximum-administered dose (MAD) = 960 mg/kg) and intravenous administration (1/10, 1/5, and 1/3 MAD) of mono-WD POM did not induce unexpected changes in rats' general habits or mortality. Results of blood gas analysis, CO-oximetry status, and the levels of electrolytes, glucose, lactate, creatinine, and BUN demonstrated a dose-dependent tendency 14 days after intravenous administration of mono-WD POM. The most significant differences compared to the control were observed for 1/3 MAD, being approximately seventy times higher than the typically used dose (0.015 mmol W/kg) of tungsten-based contrast agents. The highest tungsten deposition was found in the kidney (1/3 MAD-0.67 ± 0.12; 1/5 MAD-0.59 ± 0.07; 1/10 MAD-0.54 ± 0.05), which corresponded to detected morphological irregularities, electrolyte imbalance, and increased BUN levels.

Effects of small-dose S-ketamine on anesthesia-induced atelectasis in patients undergoing general anesthesia accessed by lung ultrasound: study protocol for a randomized, double-blinded controlled trial.

Atelectasis after anesthesia induction in most patients undergoing general anesthesia may lead to postoperative pulmonary complications (PPCs) and affect postoperative outcomes. However, there is still no existing effective method used for the prevention of perioperative atelectasis. S-ketamine may prevent atelectasis due to airway smooth muscle relaxation and anti-inflammatory effects. Lung ultrasound is a portable and reliable bedside imaging technology for diagnosing anesthesia-induced atelectasis. The primary objective of this study is to assess whether a small dose of S-ketamine can reduce the incidence of atelectasis after intubation, and further investigate the effects of preventing the early formation of perioperative atelectasis and PPCs. This is a single-institution, prospective, randomized controlled, parallel grouping, and double-blind study. From October 2020 to March 2022, 100 patients (18-60 years old) scheduled for elective surgery will be recruited from Beijing Tiantan Hospital, Capital Medical University, and randomly assigned to the S-ketamine group (group 1) and the normal saline group (group 2) at a ratio of 1:1. The label-masked agents will be administered 5 min before induction, and all patients will undergo a standardized general anesthesia protocol. Related data will be collected at three time points: after radial artery puncture (T1), 15 min after tracheal intubation (T2), and before extubation (T3). The primary outcome will be the total lung ultrasound scores (LUS) at T2. Secondary outcomes will include LUS in six chest regions at T2, total LUS at T3, arterial blood gas analysis results (PaCO2, PaO2) and PaO2/FiO2 at T2 and T3, and plateau pressure (Pplat) and dynamic lung compliance (Cdyn) at T2 and T3. The incidence of postoperative complications associated with S-ketamine and PPCs at 2 h and 24 h after surgery will be recorded. This trial aims to explore whether a simple and feasible application of S-ketamine before the induction of general anesthesia can prevent atelectasis. The results of this study may provide new ideas and direct clinical evidence for the prevention and treatment of perioperative pulmonary complications during anesthesia. ClinicalTrials.gov NCT04745286. Registered onFebruary 9, 2021.

Analysis of risk factors for acute attacks complicated by respiratory failure in children with asthma.

To describe the proportion and clinical characteristics of hospitalized children with acute asthma attacks complicated by respiratory failure and to analyze the risk factors. This retrospective study analyzed hospital admissions of children and adolescents with acute asthma attacks between January 2016 and December 2021. Inclusion criteria were used to identify eligible cases, and demographic information and disease characteristics were collected. Patients were categorized into respiratory failure group and the other group based on the result of artery blood gas analysis. Multivariate logistic regression was utilized to investigate the risk factors associated with respiratory failure resulting from acute asthma attacks. The data were analyzed using SPSS 22.0, and significance was considered at P < 0.05. Our research involved 225 participants, with 18.7% diagnosed with respiratory failure. The respiratory failure group was found to be younger and have higher percentage of male, while birth weight, nationality, and type of residence did not differ between the two groups. In the respiratory failure group, a significant difference was observed in emergency hospitalization, ICU treatment, severe to critical attack, dyspnea and allergy history. The two groups did not differ in admission season, first asthma diagnosis, respiratory infection and comorbidity. The respiratory failure group exhibited a higher proportion of atopy-only asthma and a lower proportion of T2-high asthma. The eosinophil count, and eosinophil percentage were lower in the respiratory failure group, while neutrophil count was higher. Having a history of allergies (OR = 2.46, 95% CI: 1.08-5.59) and neutrophil count (OR = 1.10, 95% CI: 1.00-1.21) were the risk factors for respiratory failure in children with asthma. There also existed that the risk of respiratory failure increases with decreasing age of the children (OR = 0.85, 95% CI: 0.73-0.99). Notably, risk factors for respiratory failure in hospitalized asthma children include age, having a history of allergies, and neutrophil count. The identification of the above factors and the implementation of timely intervention can optimize the treatment of asthma in children.

Hemostatic effect of fibrinogen concentrate on traumatic massive hemorrhage: a propensity score matching study

BackgroundFibrinogen concentrate (FC) can be administered during massive transfusions to manage trauma-induced coagulopathy. However, its effectiveness in survival remains inconclusive due to scarce high-level evidence. This study aimed to investigate...

How Did the COVID-19 Pandemic Affect Maternal and Neonatal Health?

The aim of this study was to investigate the effects of the coronavirus disease 2019 (COVID-19) pandemic on the proportional growth of the fetus, maternal health, and neonatal outcomes. The study group (Group 1) included pregnant women with a history of COVID-19. Pregnant women who were hospitalized during the same period without COVID-19 were the control group (Group 2). Maternal and neonatal outcomes were compared between the groups. A total of 230 pregnant women and their infants were assessed. Group 1 (n = 74) had significantly higher rates of diabetes mellitus and hypertension than Group 2 (n = 156; p = 0.015 and 0.014, respectively). Premature birth and cesarean section rates were also significantly higher in Group 1 than in Group 2 (p = 0.001 and 0.040, respectively). While the rate of iatrogenic preterm birth was significantly higher in Group 1, the rate of spontaneous preterm birth was significantly higher in Group 2 (p = 0.049). Infants born to COVID-19-positive mothers had lower median gestational age, birth weight, and Apgar scores (p < 0.01). There was no significant difference between the groups in terms of the results of cord blood gas analysis (p > 0.05). The rate of admission to the neonatal intensive care unit (NICU) and need for mechanical ventilation was significantly higher in infants of COVID-19-positive mothers (p < 0.05 for both). The length of stay in the NICU was also significantly longer for the infants of COVID-19-positive mothers (p < 0.05). Birth weights decreased due to increased cases of iatrogenic preterm births (p < 0.05). However, ponderal indices (PIs) of newborns of pregnant COVID-19 mothers did not differ at birth (p > 0.05). COVID-19 is associated with low Apgar scores, increased risk of premature birth complications, and maternal comorbidities, with no effect on the PI and proportionate growth of the infant at birth. · No difference in ponderal indices.. · No difference in postnatal cardiovascular adaptation.. · COVID-19 is frequent in pregnant women with comorbidities like diabetes mellitus and hypertension..

Effect of cord blood double collection method on cord blood hematopoietic stem cell transplantation-related indices and blood gas analysis.

Umbilical cord blood has been widely used in clinical transplantation. Blood gas analysis of umbilical cord blood is routinely used to evaluate neonatal asphyxia. This study aimed to evaluate an improved umbilical cord blood collection method that does not affect the results of umbilical cord blood gas analysis and hematopoietic stem cell transplantation-related indices. Three hundred pregnant women were recruited between December 2019 and August 2022. In total, 270 umbilical cord blood samples were included and randomly divided into 3 groups. Group A was defined as the group in which both umbilical cord blood samples for hematopoietic stem cell transplantation and blood gas analysis were collected. Group B was defined as the group from which umbilical cord blood was collected for hematopoietic stem cell transplantation. Group C was defined as that wherein umbilical cord blood was collected only for blood gas analysis. Hematopoietic stem cell transplantation-related indices were detected in groups A and B, and blood gas analysis was performed in groups A and C. Hematopoietic stem cell transplantation-related indices were not significantly different between groups A and B. The pH, base excess, and lactic acid values were not significantly different between groups A and C. The cord blood double collection method would not affect the results of umbilical cord blood gas analysis and hematopoietic stem cell transplantation-related indices. It is suitable for cord blood collection when preparing for hematopoietic stem cell transplantation and blood gas analysis.

Long-term neurodevelopmental effects of exclusively high cord lactate levels in term newborn

Introduction Cord arterial blood gas analysis (ABGA) results are used as diagnostic criteria for hypoxic-ischemic encephalopathy in newborns with suspected perinatal asphyxia. This study evaluated the effect of cord ABGA lactate level on the long-term neurodevelopment of newborns without any clinical signs of perinatal asphyxia. Methods This clinical observation study was designed among term babies born between 2018 and 2019 in our unit. Cases with a 5-min Apgar score <7 and signs of fetal distress in their antenatal follow-up were excluded. The cases (n = 1438) were divided into two groups those with high cord lactate levels (above 5 mmol/L, n = 92) and those with low lactate levels (below 2 mmol/L, n = 255). An Ages and Stages Questionnaire, Third Edition (ASQ-3) developmental screening questionnaire was sent to all parents. Patients with a chronological age between 24 and 42 months and for whom the parents fulfilled the questionnaire (low lactate group, n = 29, and high lactate group, n = 45) were evaluated. Results No difference was observed between the two groups in terms of demographic characteristics such as age (p = .1669), male gender (p = .906), mother’s working situation (p = .948), mother’s education level (p = .828), father’s education level (p = .507), and family’s total income (p = .642). Mean ACQ-3 developmental screening test scores were significantly lower in the high lactate group compared to the low lactate group concerning; fine motor (40 vs. 60, p = .001), problem-solving (50 vs. 60, p = .002), and personal social development (45 vs. 60, p = .003). No difference was observed in terms of communication and gross motor total scores. Discussion In general practice, routine cord ABGA is not generally recommended for patients with normal Apgar scores and no suspected hypoxia. However, in this study, we observed that cases with a normal 5-min Apgar score, no suspected perinatal asphyxia, and a cord lactate value of ≥5 fell behind their peers when evaluated with the ACQ-3 developmental screening questionnaire.

User Perceptions of Visual Blood: An International Mixed Methods Study on Novel Blood Gas Analysis Visualization.

Blood gas analysis plays a central role in modern medicine. Advances in technology have expanded the range of available parameters and increased the complexity of their interpretation. By applying user-centered design principles, it is possible to reduce the cognitive load associated with interpreting blood gas analysis. In this international, multicenter study, we explored anesthesiologists' perspectives on Visual Blood, a novel visualization technique for presenting blood gas analysis results. We conducted interviews with participants following two computer-based simulation studies, the first utilizing virtual reality (VR) (50 participants) and the second without VR (70 participants). Employing the template approach, we identified key themes in the interview responses and formulated six statements, which were rated using Likert scales from 1 (strongly disagree) to 5 (strongly agree) in an online questionnaire. The most frequently mentioned theme was the positive usability features of Visual Blood. The online survey revealed that participants found Visual Blood to be an intuitive method for interpreting blood gas analysis (median 4, interquartile range (IQR) 4-4, p < 0.001). Participants noted that minimal training was required to effectively learn how to interpret Visual Blood (median 4, IQR 4-4, p < 0.001). However, adjustments are necessary to reduce visual overload (median 4, IQR 2-4, p < 0.001). Overall, Visual Blood received a favorable response. The strengths and weaknesses derived from these data will help optimize future versions of Visual Blood to improve the presentation of blood gas analysis results.

Effect of syringe underfilling on the quality of venous blood gas analysis.

There is limited information on the influence of collecting small amounts of blood on the quality of blood gas analysis. Therefore, the purpose of this study was to investigate the effects of different degrees of underfilling of syringes on test results of venous blood gas analysis. Venous blood was collected by venipuncture from 19 healthcare workers in three 1.0 mL syringes for blood gas analysis, by manually aspirating different volumes of blood (i.e.,1.0, 0.5 and 0.25 mL). Routine blood gas analysis was then immediately performed with GEM Premier 5,000. The results of the two underfilled syringes were compared with those of the reference syringe filled with appropriate blood volume. The values of most assayed parameters did not differ significantly in the two underfilled syringes. Statistically significant variations were found for lactate, hematocrit and total hemoglobin, the values of which gradually increased as the fill volume diminished, as well as for sodium concentration, which decreased in both insufficiently filled blood gas syringes. The bias was clinically meaningful for lactate in syringe filled with 0.25 mL of blood, and for hematocrit, total hemoglobin and sodium in both syringes containing 0.5 and 0.25 mL of blood. Collection of smaller volumes of venous blood than the specified filling volume in blood gas syringes may have an effect on the quality of some test results, namely lactate, hematocrit, total hemoglobin and sodium. Specific indications must be given for standardizing the volume of blood to be collected within these syringes.

The Relationship between Blood Gas Analysis Profile and the Outcome of Severe COVID-19 Patients

Coronaviruses commonly infect the respiratory tract, leading to severe pneumonia. Respiratory problems cause numerous acid-base disorders in 2019 Coronavirus Disease (COVID-19) patients. Several studies have explored laboratory biomarkers used in the management and prognosis of COVID-19 patients during this pandemic; however, only a few focused on blood gas analysis. Determine the blood gas analysis pattern and its association with the outcome of severe COVID-19 patients treated in the Intensive Care Unit (ICU). This retrospective cohort study used secondary data from patients with severe COVID-19 treated in the ICU of Hasanuddin University Hospital between January and December 2021. There was a higher number of male (58.8%) compared to female patients (41.5%), with a mean age of 62 years. Respiratory alkalosis was the most prevalent blood gas disorder (24.4%). Metabolic alkalosis was a blood gas disorder with the highest number of recovery/improvement outcomes (8 patients). There was no significant relationship between blood gas analysis results and the outcome of severe COVID-19. In addition, no specific pattern was found in the results of blood gas analysis. Respiratory alkalosis was the most frequent blood gas disorder detected in these patients.

Comparison of the Arterial PaCO 2 Values and ETCO 2 Values Measured with Sidestream Capnography in Patients with a Prediagnosis of COPD Exacerbation.

Background Aim of this study is to investigate whether end-tidal carbon dioxide (ETCO 2 ) values can be used instead of partial pressure of carbon dioxide (PaCO 2 ) values in guiding treatment, and determining treatment benefits in patients that received a pre-diagnosis of chronic obstructive pulmonary disease (COPD) exacerbation at the emergency department. Methods This observational prospective study was conducted with patients who presented to the emergency department with the complaint of shortness of breath and were diagnosed with COPD exacerbation. ETCO 2 was measured with the sidestream method during blood gas analysis in patients with indications for this analysis. Measurements were repeated at hour 1 after treatment. Results The study included a total of 121 cases. There was a positive correlation between the PaCO 2 and ETCO 2 values measured before and after treatment ( r = 0.736, p < 0.01 and r = 0.883, p < 0.01, respectively). High ETCO 2 values were accompanied by high PaCO 2 values. When the measurements before and after treatment were evaluated using the Bland-Altman method, most of the result were within the limits of agreement (-4.9 and +31.4/- 2.6 and +9.4), with mean differences being calculated as 13.2 and 8.4, respectively. Conclusions Although ETCO 2 and PaCO 2 were statistically consistent according to the results of our study, due to the high averages of differences between these two parameters, the ETCO 2 value has limited clinical use in COPD cases compared to PaCO 2 . However, high ETCO 2 values may indicate that noninvasive mechanical ventilation should be included in the treatment of COPD cases without waiting for the results of blood gas analysis, and they can also be when needed for inpatient treatment.

Prognostic role of intermountain risk score (IMRS) in intensive care unit patients with a diagnosis of COVID-19.

In this study, we aimed to assess the predictive value of Intermountain Risk Score (IMRS) in intensive care unit (ICU) patients with COVID-19. Our retrospective study included the data of 194 patients who were admitted to the COVID-19 ICU of a tertiary care center. COVID-19 diagnoses were made by a positive result from a real-time reverse-transcriptase (RT) polymerase chain reaction (PCR) assay of nasal and pharyngeal swab specimens. Patients who had negative RT-PCR results or who were not admitted to ICU and patients under 18 years old were excluded from the study. Complete blood count, biochemistry panel, and blood gas analysis results were gathered and compiled. 194 ICU patients with COVID-19 (PCR positive) were included in the study. The patients were divided into two groups according to IMRS (if IMRS was <15 in women and <17 in men, patients were included in the non-high-risk group, while patients with IMRS ≥15 in women and ≥17 in men were defined as a high-risk group). Multivariate regression analysis was performed to predict in-hospital mortality. The IMRS [OR: 1.17 (1.08-1.27) p<0.001)] was found to predict in-hospital mortality. In this study, we showed that the IMRS score at admission can predict in-hospital mortality in intensive care unit patients with a diagnosis of COVID-19.

Improving Clinical Decision-Making: A Focus on Early Warning Systems and Scoring Methods

Dear Editor, Examinations, laboratory tests, radiology, and clinical experience are required to make the most appropriate clinical decisions. There is no single universal clinical decision-making method advocated in routine medical literature. Often, this process is driven by experience, exploration, and clinical gestalt. Clinician management serves as a subjective decision tool in disease management. It has been extensively studied in the literature, particularly in entities such as pulmonary embolism, difficult airway prediction, and severe COVID-19 (1). By combining parameters such as laboratory-vital parameters and combined hematological parameters, clinical decision-making tools have been developed (2-3). Early warning systems (EWS) help predict which patients will require critical care by evaluating physiological parameters in busy and crowded workspaces. These scores, which can be measured through vital parameters and a simple physical examination, ensure the effective use of resources (4). In intensive care units (ICUs), complex systems are used to predict mortality. APACHE II is the most well-known score used in intensive care, consisting of many parameters that are computationally difficult. Vital parameters, biochemical tests, and blood gas analysis results are used when calculating APACHE II (5). On the other hand, important features of scores used in the emergency department are their quick and easy calculation, requiring no professional knowledge. The VitalPAC Early Warning Score (ViEWS), developed by Prytherch et al. in 2010, is an EWS that includes six physiological parameters. This score records the pulse rate, systolic blood pressure, respiratory minute rate, body temperature, level of consciousness (assessed by AVPU), and peripheral oxygen saturation (SpO2) parameters. ViEWS is created based on the degree of deviation of these six parameters from their normal ranges. Additional points are given if the patient receives oxygen support. The total ViEWS value, calculated by considering each parameter, provides information about the patient's prognosis (6). By adding the rapid lactate level to ViEWS (ViEWS-L), a score that better predicts outcomes in the geriatric population was developed (7). The Modified Early Warning Score (MEWS) is one of the triage scoring methods used to identify patients in need of intensive and critical care, and to expedite their transfer to the intensive care unit. It evaluates systolic blood pressure, heart rate, respiratory rate, body temperature, and neurological status. MEWS is included in routine nursing care procedures in some countries and is routinely assessed by nurses. ICU admission rates and mortality rates increase for those who score 5 or more on this scale, although this threshold may vary in different populations or clinical situations. In a Korean study analyzing sepsis patients, combining lactate with the MEWS score improved the prediction of the need for intensive care (8). The National Early Warning Score (NEWS) is another scoring system used to determine clinical deterioration and follow-up level for all hospitalized patients, as well as to predict clinically high-risk patients. It is calculated by evaluating respiratory rate, oxygen saturation, oxygen support status, blood pressure, body temperature, and neurological status. The NEWS-L score, obtained by combining NEWS with lactate, has been reported to be superior to NEWS alone in geriatric critically ill patients (9). However, contrary to the geriatric patient study, Özkan's study reported that NEWS-L was not superior to NEWS and that they exhibited similar predictive abilities (10). As a result, researchers are actively working on new parameters and scoring systems to optimize resource utilization and predict critical illness. Researchers should be encouraged to investigate studies on EWS lactate combinations or other combinations.