Severe Acidosis Research Articles

Resolution of Complete AV block to Normal Sinus Rhythm without Cardiac Pacemaker in a Patient with Severe Acidosis: A Case Report

Resolution of Complete AV block to Normal Sinus Rhythm without Cardiac Pacemaker in a Patient with Severe Acidosis: A Case Report

Investigating the Risk Factors Associated With Acute Neurologic Dysfunction in Pediatric Hyperglycemic Emergencies on Transport.

This study aims to identify key characteristics of hyperglycemic emergencies in pediatric patients and those at risk for acute neurologic dysfunction during transport. We conducted a retrospective chart review of pediatric patients during interfacility transport by Ornge, Ontario's critical care transport service, from January 1, 2009, to December 31, 2019. Data were extracted from electronic patient care records and included demographic, clinical, and transport-specific variables. Two multiple logistic regression models were utilized to analyze associations between predictor variables and neurologic dysfunction (GCS, <14). Of the 399 patients included, 24% (n = 95) had a GCS score of <14. Patients with a GCS score of <14 were more acidotic compared with those with a GCS score of ≥14 (median pH, 6.9 [IQR, 6.8-7.1] vs median, pH 7.0 [IQR, 1.0-7.2]; P < 0.001). Higher median corrected sodium for glucose values were observed in patients with a GCS score of <14 compared to those with a GCS score of ≥14 (145.7 mmol/L [IQR, 140.6-149.9 mmol/L] vs 141.7 mmol/L [IQR, 138.3-146.4 mmol/L]; P < 0.001). Multiple logistic regression identified younger age (aOR, 0.91; 95% CI, 0.84-0.98; P = 0.01), severe acidosis (pH <7.10; aOR, 3.56; 95% CI, 1.33-11.62; P = 0.02), and higher creatinine (aOR, 1.01; 95% CI, 1.01-1.02; P < 0.001) as risk factors for acute neurologic dysfunction. Our findings reveal associations between acute neurologic dysfunction, younger age, severe acidosis, and elevated corrected sodium for glucose values in pediatric hyperglycemic emergencies during transport. Education and adherence to guidelines are recommended to improve outcomes in this population.

Severe Respiratory Acidosis in Acute Exacerbation COPD, Is that Possible to Treat?

Introduction: Chronic obstructive pulmonary disease (COPD), currently the third leading cause of death worldwide, is a common condition characterized by progressive airflow limitation and tissue destruction. Patients with COPD may present to the Emergency Room (ER) with severe acute exacerbations (AECOPD), which can be associated with acute respiratory failure—a life-threatening condition with a mortality rate approaching 50% in Indonesia—requiring rapid intervention and ICU admission. In this report, we present a severe respiratory acidosis in AECOPD case with successful emergency followed by ICU management and the frequent pitfalls. Case Illustration: In this report we present a-67 years old male, pedicab driver and smoker came to the ER with acute onset shortness of breath and decrease of consciousness with history of shortness of breath in last 10 years. In primary survey we found clear wheezing sound, tachypnea, intercostal retraction, decrease of peripheral oxygen saturation, tachycardia and verbal respond of consciousness. Blood gas analysis result interpreted severe respiratory acidosis with pH 6.90 and pCO2 128.5 mmHg. Chest radiograph showed infiltrate that became the cause of exacerbation. Endotracheal intubation was performed due to decreased consciousness, persistent tachypnea and pCO2 over 100 mmHg. This patient was hospitalized for 12 days including 9 days in ICU followed by 3 days in regular ward. Conclusion: The goal for AECOPD management is to minimize and prevent the negative effects of the exacerbation.

Risk Factors and Outcome of Acute Kidney Injury in Children with Diabetic Ketoacidosis

Background: Children with diabetic ketoacidosis (DKA) suffer from several complications. Among them acute kidney injury (AKI) is one of the grave complications. Objectives: To determine the risk factors for development of AKI in children (age &lt;15 years) with DKA and observe the outcome of these children. Method: An observational study was done in Department of Paediatrics, BIRDEM General Hospital, Dhaka, Bangladesh from January 2019 to December 2020. During study period, we observed all children with DKA who developed AKI. Data of clinical and biological variables were taken from hospital records and analysed. The parameters of children with AKI were compared with children with DKA who did not develop AKI. Then outcome of the children with AKI were measured. Statistical analysis was done by using SPSS version 23. Results: Among 73 children with DKA, 16 (21.9%) children developed AKI. Children were divided into two groups, DKA with AKI and DKA without AKI. No statistically significant differences were found in demographic features of children in both groups. We observed that, delay in initiation of treatment, low Glasgow Coma Scale (score- &lt;8), haemodynamic failure, severe acidosis and sepsis were significant risk factors of developing AKI. Out of 16 children with AKI, 9(56.2%) patients needed peritoneal dialysis and 7(43.7%) responded to fluid resuscitation. Complete resolution occurred in 13(81.2%). Total mortality in DKA children was 13(17.8%). Among them 84.6% children died due to AKI. Conclusions: This study documented that 21.9% of children with DKA developed AKI. Among them mortality was 84.5%. BANGLADESH J CHILD HEALTH 2023; VOL 47 (1) : 30-33

Health disparities in the risk of severe acidosis: real-world evidence from the All of Us cohort.

To assess the health disparities across social determinants of health (SDoH) domains for the risk of severe acidosis independent of demographical and clinical factors. A retrospective case-control study (n = 13310, 1:4 matching) is performed using electronic health records (EHRs), SDoH surveys, and genomics data from the All of Us participants. The propensity score matching controls confounding effects due to EHR data availability. Conditional logistic regressions are used to estimate odds ratios describing associations between SDoHs and the risk of acidosis events, adjusted for demographic features, and clinical conditions. Those with employer-provided insurance and those with Medicaid plans show dramatically different risks [adjusted odds ratio (AOR): 0.761 vs 1.41]. Low-income groups demonstrate higher risk (household income less than $25k, AOR: 1.3-1.57) than high-income groups ($100-$200k, AOR: 0.597-0.867). Other high-risk factors include impaired mobility (AOR: 1.32), unemployment (AOR: 1.32), renters (AOR: 1.41), other non-house-owners (AOR: 1.7), and house instability (AOR: 1.25). Education was negatively associated with acidosis risk. Our work provides real-world evidence of the comprehensive health disparities due to socioeconomic and behavioral contributors in a cohort enriched in minority groups or underrepresented populations. SDoHs are strongly associated with systematic health disparities in the risk of severe metabolic acidosis. Types of health insurance, household income levels, housing status and stability, employment status, educational level, and mobility disability play significant roles after being adjusted for demographic features and clinical conditions. Comprehensive solutions are needed to improve equity in healthcare and reduce the risk of severe acidosis.

Electrocardiographic Changes, Mortality, and Late Period Findings in Methyl Alcohol Poisoning

Background: Methyl alcohol poisoning (MAP) is a common commercial compound that can lead to significant morbidity and mortality when exposed to high levels. This study aims to describe MAP-related electrocardiography (ECG) changes and post-acute late complications. Materials and Methods: The study was conducted through a retrospective data review between 2017 and 2023. Patient data were recorded, including demographic information, medication use, and laboratory results. Twelve-lead ECG recordings were evaluated and the results were recorded. The cases included in the study were grouped according to QTc distance, ECG findings, late-term complications, treatment status, and mortality. Results: The mean age of all cases included in the study (n = 227) was 43.23 ± 11.11 years, 8 (3.5%) cases were female, and the age distribution was between 19 and 68 years (p = 0.792). The age distribution of QTc groups was not significant (p = 0.792). The mean QTc distance was 442.7 ± 60.1 ms in all cases (n = 227) and 514.08 ± 5.45 ms in cases with mortality (n = 49) (p &lt; 0.001). The mean time to application of the patients to the hospital (n = 227) was 19.1 ± 4.61 h, and blood sugar was 130.7 ± 32.09 mg/dL (p &lt; 0.001). In addition, the mean pH of the cases (n = 227) was 7.14 ± 0.2, bicarbonate was 17.17 ± 4.86 mmol/L, the base deficit was −6.21 ± 3.18 mmol/L, the anion gap was 19.36 ± 7.31 mmol/L, and lactate was 4.82 ± 2.45 mmol/L (p &lt; 0.001). Mortality occurred in 49 (21.6%) of the patients, and all of them were in-hospital deaths. In all cases where mortality occurred, pH was below 6.93 ± 0.22 and severe acidosis was directly related to death. MAP, sinus tachycardia in 31 (13.7%) cases, bradycardia in 8 (3.5%), atrial fibrillation in 5 (2.2%), accelerated idioventricular rhythm in 3 (1.3%), and 11 (4.8%), left bundle branch block, and right bundle branch block were detected in 22 (9.7%). All of these ECG findings were newly developed conditions with no previous history. In the 6-month follow-up after discharge, 4 (1.8%) of the cases developed neurological deficit, 15 (6.6%) had acute coronary syndrome and severe heart failure, 23 (10.1%) had permanent blindness, 6 (2.7%) had renal failure, and 6 (2.7%) had pancreatitis. Conclusion: Methyl alcohol poisoning can cause various ECG changes; sinus tachycardia, nonspecific changes, and QTc prolongation are the most common findings. These changes are more pronounced in cases of severe acidosis. Patients should be warned of late signs of MAP.

8227 Complex Case of Myxedema Coma Complicated by Cardiac Arrest in a Geriatric Patient with Multiple Comorbidities

Abstract Disclosure: M. Parvez: None. L. Makahleh: None. S. Nagpal: None. A. Kavarthapu: None. V. Vedantam: None. Introduction: This case report details a rare instance of cardiac arrest in a patient with myxedema coma, a severe form of hypothyroidism. It highlights the diagnostic and therapeutic challenges in managing such complex endocrine emergencies. Case Presentation: A 70-year-old female with a history of hypothyroidism, type 2 diabetes, atrial fibrillation, pacemaker implantation, and COPD presented with a 3 day history of progressive lethargy and weakness. EMS found her with critically low blood glucose level of 20. History and Examination revealed non-compliance with thyroid medication and myxedematous features including moon-like facies, periorbital edema, generalized edema, elevated JVP, and cold extremities with sluggish capillary refill. In the ER, she was hypotensive, labs showed a significantly elevated TSH level of 30.55 (0.45-4.5), free T3 level of 1.2 (2.3-4.2), free T4 level of 1.12 (0.93-1.70), high lactate, metabolic acidosis, renal impairment, and liver enzyme elevation. These findings, coupled with the clinical presentation, led to the diagnosis of myxedema coma. The patient's critical state was further complicated by distributive shock, shock liver and oliguric AKI. Management included sodium bicarbonate infusion for severe acidosis, IV hydrocortisone, IV levothyroxine, and broad-spectrum antibiotics. Amiodarone was discontinued due to its potential contribution to acute liver injury and hypothyroidism. Despite interventions, she developed acute respiratory failure, requiring intubation and norepinephrine for low mean arterial pressure. Her renal function improved with pressor support, and her lactic acidosis resolved. She recovered quickly and was subsequently extubated. After stabilization, she was switched to oral levothyroxine and discharged. Shortly after discharge, she returned again with generalized weakness, confusion, and dysuria. ER evaluation revealed lethargy, hypotension, hypoglycemia, severe metabolic acidosis, and a UTI. She tested positive for Influenza. While in the ER, she had cardiac arrest, presenting with agonal breathing and PEA. CPR was initiated, achieving ROSC after two rounds and one dose of epinephrine. She was treated again with IV levothyroxine, and IV antibiotics. She recovered well and was discharged to rehab facility with re-education on compliance. Conclusion: This case exemplifies the complexity and challenges in managing a geriatric patient with multiple comorbidities, particularly in the context of myxedema coma. The intricate interplay of endocrine, cardiovascular, respiratory, and infectious complications necessitated a multifaceted and dynamic therapeutic approach. This case underscores the importance of compliance, vigilant monitoring, prompt recognition of complicating factors, and the need for a coordinated multidisciplinary approach in managing similar cases. Presentation: 6/2/2024

The Effect of Lactic Acidosis on Neonatal Outcomes in Premature Infants

The aim of the study was to evaluate neonatal outcomes in preterm infants.Materials and methods. The study included 58 premature neonates divided into 2 groups: «A» (N=34) with an adverse neonatal period ending in death and «B» (N=24) who survived. Clinical assessment of the infant, measurement of blood gases, acid-base balance (ABB) and lactate, recording of lung ventilation parameters, calculation of mean airway pressure, oxygenation index (OI) and ventilation efficiency index (VEI), neurosonography and, in case of death, pathological and histological examination of the brain were performed.Results. Elevated lactate was found in 24 patients (70.5%) in group A and in 12 patients (50%) in group B. The mean lactate levels in groups A and B were 8.1±3.3 and 6.3±2.8 mmol/L, respectively. In group A, 19 (55.9%) infants had severe acidosis, corresponding to a pH of 7.19 to 6.80. In group B, only 8 (33.3%) infants had a pH between 7.0 and 7.19. At birth, neonates in both groups were found to have a base deficit (BD), which was significantly lower in group A than in group B (P=0.004). There were no trends toward reduction of acidosis or normalization of ABB in infants in group A. Plasma BE levels in group B had returned to normal by 96 hours postpartum. The frequency of grade II, III peri/intraventricular hemorrhage (PIVH) and hemorrhage of other localization in group A were 8 (23.5%), 9 (26.5%), and 3 (8.8%), respectively. In group B, grade I PIVH and hemorrhage of other localization occurred in 5 (20.8%) and 1 (4.2%) cases, respectively. In neonates with grade II PIVH, severe lactic acidosis was diagnosed at birth: venous blood pH was 6.97 [6.8; 7.22], BE was (–21.6) [–30; –7.2] mmol/L, lactate level was 8.5 [6.3; 12.9] mmol/L, and pO₂ was 50.5 [20.5; 64] mm Hg. In infants with grade III PIVH, pH was –7.26 [7.12; 7.28], BE was (–8.1) [–8.9; –7] mmol/L, lactate was 7.6 [4.8; 8.9] mmol/L, and pO₂ was 33 [30; 50] mm Hg. Cell damage of varying severity affected all brain structures, as evidenced by absence or deformation of nuclei and nucleoli, and peripheral chromatin condensation. Morphological immaturity of brain structures was another negative factor.Conclusion. Lactic acidosis diagnosed at birth in premature infants is one of the indicators of perinatal hypoxia severity. Critical pH, BE, and lactate levels, as well as lack of response to treatment, contribute to structural brain damage and worsen prognosis. Severe changes in oxygen and lactate levels that persist for two days after birth lead to severe PIVH and irreversible brain changes.

Exploring Therapeutic Effects of Continuous Kidney Replacement Therapy in Patients with Severe Acidosis Using Deep Learning-Based Causal Inference

Exploring Therapeutic Effects of Continuous Kidney Replacement Therapy in Patients with Severe Acidosis Using Deep Learning-Based Causal Inference

The Warburg Effect: A Case of Severe Lactic Acidosis and Hypoglycemia

The Warburg Effect: A Case of Severe Lactic Acidosis and Hypoglycemia

Sodium Bicarbonate Supplementation May Be Harmful in Septic Patients with Severe Lactic Acidosis: A Retrospective Analysis

Sodium Bicarbonate Supplementation May Be Harmful in Septic Patients with Severe Lactic Acidosis: A Retrospective Analysis

Results of the RE-DINO multicenter randomized trial on the repeated use of vaginal dinoprostone (Propess®) for labor induction in patients at term

BackgroundLabor is induced in over 25% of women in France. Prostaglandins, especially intravaginal dinoprostone (Propess®), are widely used to initiate cervical ripening. If labor does not start within 24 hours, there is uncertainty about whether to administer a second dinoprostone pessary or to use oxytocin to induce labor in order to achieve a vaginal delivery. ObjectivesOur principal objective was to determine whether placement of a second Propess®, followed by oxytocin (Syntocinon®) if necessary, in pregnant women for whom the first Propess® failed to induce cervical ripening increases the vaginal delivery rate compared to direct oxytocin injection. The vaginal delivery rate was therefore the primary outcome. The secondary outcomes were the cervical ripening failure rate and maternal and fetal morbidity and mortality. Study DesignRE-DINO is a prospective, open-label, multicenter, randomized superiority trial with 2 parallel arms running in 7 French hospitals. Patients at > 37 weeks of gestation who had unfavorable cervical conditions (Bishop score < 6) 24 hours after placement of the first Propess® (vaginal patch featuring progressive continuous diffusion of 10 mg dinoprostone), with fetuses in cephalic presentation, were included. Results160 pregnant women were randomized, 80 patients in each group, from December 2016 through April 2022. Baseline characteristics such as age, BMI, maternal age at induction and Bishop score at induction were similar between both groups. Vaginal delivery occurred in 76.3% of cases in the 2nd Propess® group and 73.8% of cases in the Syntocinon® group (RR=1.03 [0.86; 1.24], p=.715). Although the cesarean section rate was similar in each group, there were significantly more cesarean sections for arrest of dilatation (52.6% vs 19%; p=.0262) in the Propess® group and a larger, borderline-significant difference in patients having operative vaginal delivery (24.6% vs 11.9%; p=.07) for abnormal fetal heart rate (80% vs 29%; p=.05). There was significantly more failure of cervical ripening in the Propess® group (57.1% vs 19%; RR=2.59 ; 95% CI [1.64; 4.11]; p<.0001) and the interval between study treatment and delivery was also significantly longer (28.1h vs 9,7h; p<.0001). There was a higher incidence of postpartum hemorrhage in the Propess® group, although this was not significant (11.3% vs 5% ; p=,15), but also more newborns with acidosis (39.3% vs 27.9% ; p=.18) or severe acidosis (8,6% vs 3.4% ; p=.27), more meconium fluid (11.3% vs 6.3% ; p=.26) and transferred to intensive care (5% vs 2.5% ; p=.68). ConclusionOur data showed no superiority of a second dinoprostone pessary over oxytocin in patients not responding to initial prostaglandins E2 maturation for labor induction. Repeated use of Propess® is not useful for induction of labor.

Drug-Related Pyroglutamic Acidosis: Systematic Literature Review.

Background: Inborn errors of glutathione metabolism may cause high anion gap metabolic acidosis due to pyroglutamic acid accumulation. Since 1988, cases of this acidosis have been reported in individuals without these defects. Methods: Given the poorly characterized predisposing factors, presentation, management, and prognosis of acquired pyroglutamic acidosis, we conducted a systematic review using the National Library of Medicine, Excerpta Medica, Web of Science, and Google Scholar databases. Results: A total of 131 cases were found. Most patients were females (79%), adults (92%) aged 51 years or older (66%) with pre-existing conditions (74%) such as undernutrition, alcohol-use disorder, or kidney disease, and had an ongoing infection (69%). The clinical features included diminished consciousness (60%), Kussmaul breathing (56%), and nausea or vomiting (27%). At least 92% of patients were on paracetamol therapy for >10 days at an appropriate dose, 32% on a β-lactamase-resistant penicillin, and 2.3% on vigabatrin. Besides severe anion gap acidosis, patients also presented with hypokalemia (24%) and kidney function deterioration (41%). Management involved discontinuing the offending drug (100%), bicarbonate (63%), acetylcysteine (42%), and acute kidney replacement therapy (18%). The fatality rate was 18%, which was higher without acetylcysteine (24%) compared to with it (11%). Conclusions: Acquired pyroglutamic acidosis is a rare, potentially fatal metabolic derangement, which usually occurs after paracetamol use, frequently combined with a β-lactamase-resistant penicillin or vigabatrin. This condition predominantly affects adults, especially women with factors like undernutrition, alcohol-use disorder, or kidney disease, often during infection. Increased awareness of this rare condition is necessary.

Deciphering the role of lactate as aprognostic indicator in pediatric diabetic ketoacidosis.

Serum lactate levels have been recognized as arobust marker for predicting disease severity and survival in many critically ill children but consensus is lacking regarding its utility in diabetic ketoacidosis. This study aimed to investigate the relationship between initial lactate levels and disease severity in pediatric patients presenting with diabetic ketoacidosis. This single-center retrospective descriptive study involved pediatric patients with diabetic ketoacidosis in the pediatric emergency department between January 2022 and April 2023. Patients were diagnosed using the International Society for Pediatric and Adolescent Diabetes 2022 guidelines. Among the 112 patients included in the study, 41 (36.6%) were classified as mild, 42 (34.8%) as moderate and 32 (28.6%) as severe acidosis. Astatistically significant difference was observed between the time to resolution and clinical severity of diabetic ketoacidosis (p < 0.001). Elevated lactate levels of 2.5 mmol/L or above were detected in 37.5% (42/112) of our patients and asignificant increase in clinical severity was observed as lactate levels increased (p < 0.001). Correlation analysis revealed no significant relationship between lactate levels and time to resolution of diabetic ketoacidosis or length of intensive care unit stay. Multivariate analysis demonstrated asignificant association between lactate levels and severity of acidosis (p: 0.046). Although there is an association between the severity of acidosis and lactate levels in diabetic ketoacidosis, contrary to expectations, this relationship was not found to be associated with adverse outcomes. An important point not to be overlooked by pediatricians is that elevated lactate levels in diabetic ketoacidosis may not always herald poor outcomes.

107 Severe acidosis during airway procedure under Transnasal high-flow oxygenation

107 Severe acidosis during airway procedure under Transnasal high-flow oxygenation

Novel phenotype of COASY deficiency is characterized by fatal neonatal hepathopathy with severe hypoglycaemia, hyperammonaemia and lactic acidosis

Novel phenotype of COASY deficiency is characterized by fatal neonatal hepathopathy with severe hypoglycaemia, hyperammonaemia and lactic acidosis

A Multi-Target Pharmacological Correction of a Lipoyltransferase LIPT1 Gene Mutation in Patient-Derived Cellular Models.

Mutations in the lipoyltransferase 1 (LIPT1) gene are rare inborn errors of metabolism leading to a fatal condition characterized by lipoylation defects of the 2-ketoacid dehydrogenase complexes causing early-onset seizures, psychomotor retardation, abnormal muscle tone, severe lactic acidosis, and increased urine lactate, ketoglutarate, and 2-oxoacid levels. In this article, we characterized the disease pathophysiology using fibroblasts and induced neurons derived from a patient bearing a compound heterozygous mutation in LIPT1. A Western blot analysis revealed a reduced expression of LIPT1 and absent expression of lipoylated pyruvate dehydrogenase E2 (PDH E2) and alpha-ketoglutarate dehydrogenase E2 (α-KGDH E2) subunits. Accordingly, activities of PDH and α-KGDH were markedly reduced, associated with cell bioenergetics failure, iron accumulation, and lipid peroxidation. In addition, using a pharmacological screening, we identified a cocktail of antioxidants and mitochondrial boosting agents consisting of pantothenate, nicotinamide, vitamin E, thiamine, biotin, and α-lipoic acid, which is capable of rescuing LIPT1 pathophysiology, increasing the LIPT1 expression and lipoylation of mitochondrial proteins, improving cell bioenergetics, and eliminating iron overload and lipid peroxidation. Furthermore, our data suggest that the beneficial effect of the treatment is mainly mediated by SIRT3 activation. In conclusion, we have identified a promising therapeutic approach for correcting LIPT1 mutations.

Umbilical Cord pH Levels and Neonatal Morbidity and Mortality

Umbilical cord pH (UC-pH) level is an important objective indicator of intrapartum fetal hypoxia and is used to predict neonatal morbidity and mortality. A UC-pH value of less than 7.00 is often defined as a threshold for severe acidosis, but existing evidence is divergent and largely based on UC-pH measurements from selected populations; consequently, the results are challenging to interpret. To investigate the association between UC-pH levels and the risk of adverse neonatal outcomes in a national setting with universal UC-pH measurement. This national, population-based cohort study included all liveborn, singleton, full-term infants without malformations born in Denmark from January 1, 2012, to December 31, 2018. Data were analyzed from January 1, 2023, to March 1, 2024. Umbilical cord pH level categorized as less than 7.00, 7.00 to 7.09, 7.10 to 7.19 and 7.20 to 7.50 (reference group). The primary outcome was a composite of severe adverse neonatal outcomes: neonatal death, therapeutic hypothermia, mechanical ventilation, treatment with inhaled nitric oxide, or seizures. Secondary outcomes were individual components of the primary outcome, Apgar score, respiratory outcomes, and hypoglycemia. Data are presented as adjusted risk ratios (ARRs) with 95% CIs. Among the 340 431 infants included, mean (SD) gestational age was 39.9 (1.6) weeks; mean (SD) birth weight was 3561 (480) g; and 51.3% were male. Umbilical cord pH of less than 7.20 was observed more often among infants with a gestational age of 40 or 41 weeks (31.6%-33.6% compared with 18.2%-20.2% at a gestational age of 39 weeks) and among male infants (53.9%-55.4% vs 44.6%-46.1% among female infants). Compared with the pH reference group (576 of 253 540 [0.2%]), the risk for the primary outcome was increased for the groups with UC-pH levels of less than 7.00 (171 of 1743 [9.8%]), 7.00 to 7.09 (101 of 11 904 [0.8%]), and 7.10 to 7.19 (259 of 73 244 [0.4%]). Comparable patterns were observed for the individual outcomes, except for neonatal death, which was only increased in the group with UC-pH levels of less than 7.10. The risk of treatment with continuous positive airway pressure was increased when UC-pH levels were less than 7.20, and the risk of hypoglycemia was 21.5% if UC-pH levels were less than 7.10. In this cohort study of 340 431 newborn infants, results support and extend previous studies indicating a higher risk of adverse outcomes even at UC-pH levels above 7.00. The threshold for more intensive observation and treatment may be reconsidered.

When Is Laparotomy for Mesenteric Ischemia After Aortic Dissection Futile?

BackgroundTissue necrosis from persistent mesenteric ischemia after aortic dissection may progress to sepsis and death without emergency laparotomy. However, the signs of mesenteric necrosis are common in patients experiencing nonsurvivable multisystem failure after aortic catastrophe. This study examined when and whether laparotomy offers a chance for meaningful survival in these patients. MethodsA total of 145 patients treated for acute type A or type B aortic dissection with mesenteric ischemia were identified from a single institution from 2006 to 2022. Of those patients, 29 underwent laparotomy, all for compelling clinical indications. Detailed clinical characteristics were studied with respect to short- and long-term outcomes in these patients. ResultsAmong the patients who underwent laparotomy, 45% (13 of 29) survived to discharge compared with 71% (103 of 145) of all patients with mesenteric malperfusion. Serum lactate and arterial pH were both very strongly associated with survival after laparotomy. Among survivors and nonsurvivors, the mean lactate level before laparotomy was 6.3 mmol/L vs 13.4 mmol/L (P = .024), and the mean pH was 7.39 vs 7.20 (P < .001). In particular, a lactate value higher than 8 mmol/L (odd ratio, 16.5; 95% CI, 2.0-192; P = .003) and a pH lower than 7.30 (odds ratio, 14.4; 95% CI, 1.87-128; P = .003) were highly predictive of mortality. Survival to discharge after laparotomy for patients with both severe lactatemia and severe acidosis (defined earlier) was 9% (1 of 11) compared with 90% (9 of 10) for patients with neither severe lactatemia nor acidosis. ConclusionsThe degree of lactic acidosis can effectively identify patients for whom laparotomy is futile and those for whom it is not after aortic dissection with mesenteric ischemia.

Venovenous extracorporeal membrane oxygenation (VV-ECMO) for severe acute respiratory distress syndrome (ARDS) in adults—a single-center experience

BackgroundThe survival benefit of venovenous extracorporeal membrane oxygenation (VV-ECMO) in adult patients with severe acute respiratory distress syndrome (ARDS) remains controversial. This study aimed to investigate the efficiency and potential prognostic factors of VV-ECMO for severe ARDS in adults by evaluating our institutional experience and results.Materials and methodsThis research studied ARDS patients receiving VV-ECMO between June 2011 and May 2023. The inclusion criteria were PaO2/FiO2 < 100 mmHg at FiO2 of 1.0. Retrospective data was analyzed to identify factors associated with successful ECMO weaning and hospital discharge survival.ResultsA total of 18 patients were included in this study, with 7 cases (38.9%) successfully weaned from ECMO and 5 cases (27.8%) surviving hospital discharge. The overall complication rate was 77.8%. After treatment with VV ECMO, there were statistically significant improvements in both PaO2 and PaCO2 (P < 0.05). Patients in the successful weaning group had a lower pTB value, less accumulative volume of sodium bicarbonate during ECMO, and lower accumulative volume of intravenous immunoglobulin in the hospital compared to the unsuccessful weaning group (all P < 0.05). Furthermore, compared to the non-survivors, the survivors had less severe acidosis, higher mean arterial pressure before ECMO, a lower level of pCr, and a lower pTB value during ECMO (all P < 0.05).ConclusionECMO can effectively promote oxygenation and carbon dioxide (CO2) removal in patients with severe ARDS. Early initiation of ECMO with appropriate management could benefit in reducing comorbidities and mortality.