Venous pH Values Research Articles

Exploring the Feasibility of Calculating Expected pCO2 From Venous Blood Gas Samples Alone in Intensive Care Patients.

Introduction This study highlights the significance of assessing acid-base balance and gas exchange in intensive care patients. The research investigates the applicability of using the "expected (pCO2 = HCO3 + 15)" formula, derived from venous blood gas samples, as an alternative to Winter's formula and practical formula. The study emphasizes the importance of identifying the primary acid-base abnormality accurately and efficiently for appropriate clinical intervention in critically ill patients. Methods This study included 400 adult patients admitted to the Anesthesia Clinic in the Third Stage Anesthesia and Reanimation Intensive Care Unit at Hitit University Erol Olçok Training and Research Hospital between April 2020 and July 2023. Blood gas samples were collected simultaneously from both arterial lines and venous catheters. Patients under 18 years, pregnant women, hemodialysis patients, and those with missing data were excluded. The study aimed to calculate the expected partial pressure of carbon dioxide (pCO2) values using Winter's formula and simple formulafor both arterial and venous blood gas samples and assess potential correlations between them. Results The results showed a narrow range for arterial pH values (7.12-7.72), a wider distribution for pCO2 values (17.90-81.30 mmHg), and a moderate dispersion for HCO3values (12.80-44.33 mmol/L). Both Winter's and simple formulas were applied to estimate the expected pCO2 values, showing strong positive correlations between arterial and venous pH, pCO2, and HCO3 values. The scatterplot illustrated a very high level of association (Pearson's correlation coefficient, r = 1) between the expected pCO2 values derived from both formulas using arterial and venous blood gas samples. Conclusion The clinical study demonstrates that estimating expected pCO2 values in mixed acid-base disorders can be achieved using a simple and convenient formulation, eliminating the need for arterial blood gas sampling and its associated complications.

Correlation of Arterial and Venous pH and Bicarbonate in Patients With Renal Failure.

Background and objectiveBlood gas analysis plays a pivotal role in the management of various respiratory and metabolic disorders. Both arterial and venous samples can be used for blood gas analysis. Arterial blood sampling is technically difficult and is associated with more complications as compared to venous sampling. Many studies have shown the correlation of arterial and venous pH and bicarbonate levels in sepsis, diabetic ketoacidosis (DKA), chronic obstructive pulmonary disease (COPD), and circulatory failure. But, there is a paucity of data, pertaining specifically to the correlation of arterial blood gas (ABG) analysis and venous blood gas (VBG) analysis in patients with renal failure. The objective of this study was to look for any possible correlation between arterial and venous pH and bicarbonate values in patients with renal failure.MethodsThis cross-sectional study was carried out at a large tertiary care hospital in Rawalpindi, Pakistan. Over a period of eight months, 101 patients with renal failure were enrolled after obtaining informed consent. Arterial and venous samples from the patients were obtained, analyzed, and compared.ResultsOut of the total 101 patients, 53 (52.5%) were male while 48 (47.5%) were female. The mean age of the patients was 46.23 ±15.54 years. Mean arterial pH and venous pH were 7.35 and 7.28 respectively. The Pearson correlation coefficient between arterial and venous pH was found to be 0.857 (p<0.001). The mean arterial and venous bicarbonate values were 14.47 mEq/L and 15.51 mEq/L respectively. And the Pearson correlation coefficient between arterial and venous bicarbonate was found to be 0.842 (p<0.001). ConclusionVenous pH and bicarbonate levels correlate strongly with arterial pH and bicarbonate levels, respectively, in patients with renal failure.

Clinical Phenotypes of Hypoxia in Patients with COVID-19

The aim of the studywas to examine the clinical phenotypes of hypoxia in patients with COVID-19 in relation to the severity of acute respiratory failure (ARF).Material and methods. Sixty patients with severe COVID-19 and manifestations of acute respiratory failure admitted to the infectious disease hospitals of Nizhny Novgorod were enrolled in the study.The study included patients with transcutaneous saturation (SpO2) below 93% on spontaneous breathing, who required correction of respiratory alterations according to the Interim Clinical Guidelines for the Treatment of Patients with COVID-19. All patients were divided into 2 groups of 30 patients each according to the nature of respiratory impairment. Group 1 included patients without breathing difficulties who had respiratory rate up to 25 per minute. Group 2 patients had breathing difficulties and respiratory rate over 25 per minute.In addition to SpO2, severity of respiratory difficulties, respiratory rate (RR), forced breathing (FB), heart rate (HR), acid-base balance (ABB) and arterial and venous blood gases, capillary refill time, blood lactate level were assessed. The severity of lung involvement was determined using chest computed tomography, and severity of disease was assessed using the NEWS score. Respiratory treatment required for ARF correction and the outcome of hospitalization were also considered.Results. In group 1, the mean age was 66 (56; 67) years and the disease severity was 8 (7; 10) points. Group 1 patients had minor tachycardia and tachypnoea, there were no lactate elevation or prolonged capillary refill time. Mean SpO2was as low as 86 (83; 89)%. Venous blood pH and pCO2 values were within normal reference intervals, mean BE was 6 (4; 9) mmol/l, pO2was 42 (41; 44) mm Hg, and SO2was 67 (65; 70)%. Mean arterial blood pO2was 73 (69; 75) mm Hg, SO2was 86 (83; 90)%, and O2was 37 (35; 39) mm Hg. Oxygen therapy with the flow rate of 5-15 l/min in prone position helped correct ARF. All patients of this group were discharged from hospital.In group 2, the mean age was 76 (70;79) years and the disease severity was 14 (12; 18) points. Anxiety was observed in 15 patients, prolonged capillary refill time was seen in 13 patients, and increased lactate level in 18 patients. Mean RR was 34 (30; 37) per minute, HR was 110 (103; 121) per minute, and SpO2was 76 (69; 83)%. Mean venous blood pH was 7.21 (7.18; 7.27), pCO2was 69 (61; 77) mm Hg, BE was -5 (-7; 2) mmol/l, pO2was 25 (22; 28) mm Hg, SO2was 47 (43; 55)%. Mean arterial blood pO2was 57 (50; 65) mm Hg, SO2was 74 (69; 80)%, and pCO2was 67 (58; 74) mm Hg. In the group 2 patients, the standard oxygen therapy in prone position failed to correct ARF, and high flow oxygen therapy, noninvasive CPAP with FiO2of 50-90% or noninvasive CPAP+PS were administered. Fourteen patients were started on invasive lung ventilation. There were 10 fatal outcomes (33%) in this group.Conclusion. Two clinical phenotypes of hypoxia in patients with COVID-19 can be distinguished. The first pattern is characterized by reduced SpO2(80-93%), no tachypnoea (RR &gt;25 per minute) and moderate arterial hypoxemia without tissue hypoxia and acidosis («silent hypoxia»). It is typical for younger patients and associates with less lung damage and disease severity than in patients with severe ARF. Hypoxemia can be corrected by prone position and oxygen therapy and does not require switching to mechanical ventilation. The second pattern of hypoxia is characterized by significant arterial hypoxemia and hypercapnia with tissue hypoxia and acidosis. Its correction requires the use of noninvasive or invasive mechanical ventilation.

Predictors of successful discontinuation from renal replacement therapy during AKI: A meta-analysis.

The predictors of weaning time of renal replacement therapy (RRT) remain controversial for special patients suffering from acute kidney injury (AKI). The present work aims to perform a meta-analysis to evaluate proper predictors of RRT weaning in AKI patients. We systematically searched EMBASE, PubMed, and Cochrane Central Register of Controlled trials for literatures between 1984 and June 2019. Studies evaluating predictors of weaning success of RRT in patients of AKI were included. Random-effects model or fixed-effects model meta-analyses were performed to compute a standard mean difference (SMD). Newcastle-Ottawa Scale was employed to assess the risk of bias. We included 10 observational trials including 1453 patients. Twelve predictors including urine output, serum creatinine, serum urea, mean arterial pressure, central venous pressure, lactate, serum potassium, serum bicarbonate, pH value, SOFA score, urinary urea, and urinary creatinine were identified, showing urine output (p=0.0000), serum creatinine (p=0.008), serum potassium (p=0.02), serum bicarbonate (p=0.01), pH value (p=0.03), urinary urea (p=0.002), and urinary creatinine (p=0.02) were significantly associated with weaning success. With the limited evidence, we speculate that urine output, serum creatinine, serum potassium, serum bicarbonate, pH value, urinary urea, and urinary creatinine might be associated with successful weaning.

Maternal arterial blood gas values during delivery: Effect of mode of delivery, maternal characteristics, obstetric interventions and correlation to fetal umbilical cord blood

Obstetricians routinely use biochemical parameters from non-pregnant women to assess the condition of the laboring mother. However, it is well known that pregnancy leads to significant physiological changes in most organ systems. The aim of this study was to determine normal values for maternal arterial blood gases during vaginal deliveries as compared with control values from planned cesarean sections. We also wanted to elucidate the effect of various maternal characteristics, mode of delivery and obstetric interventions on blood gas values. We carried out a randomly selected, prospective-observational cohort study of 250 women undergoing vaginal delivery and 58 women undergoing planned cesarean section at the Department of Obstetrics and Gynecology, Skåne University Hospital, Malmö, Sweden. We found significant differences for gestational age, parity, umbilical venous blood pH, pCO2 and lactate values between the two study groups (P<.005). Significantly lower pH, pCO2 , pO2 and sO2 were found in mothers delivering vaginally. Higher base deficit, hemoglobin, bilirubin, potassium, glucose and lactate were found in vaginal deliveries than in planned cesarean sections (P<.02). Maternal body mass index (BMI), smoking and hypertension were not significantly correlated to acid base parameters in women with vaginal deliveries. On the other hand, multiple regression showed significant associations for the use of epidural anesthesia on maternal pH (P<.05) and pO2 (P<.01); and synthetic oxytocin on pCO2 (P=.08), glucose (P<.00) and lactate (P<.02) levels in maternal arterial blood. Maternal arterial pH, pCO2 and lactate values correlated significantly to values in venous umbilical cord blood (P<.000). Maternal arterial blood gas parameters varied significantly according to mode of delivery, the use of epidural anesthesia and synthetic oxytocin.

Gestational age-related reference values for Apgar score and umbilical cord arterial and venous pH in preterm and term newborns.

Despite much literature on reference values of acid-base status in umbilical cord blood at birth, there are as yet no studies performed to determine gestational age-dependent references in cord venous blood and no studies on preterm acid-base standards. Similarly, the normal reference range of Apgar scores for term and preterm infants has not yet been determined. Data were obtained from the maternity units of Skåne University Hospital, Malmö and Lund, Sweden, from 2001 to 2010. Validated paired arterial and venous cord pH values were obtained from 27175 newborns, of whom 18584 had spontaneous, non-instrumental vaginal deliveries and a 5-minute Apgar score equal to or greater than the median value for the individual gestational week. Simple linear and polynomial regression analyses were performed. Values were reported as mean±standard deviation and median with 2.5th and 97.5th percentiles. Median 5-minute Apgar score was 7 for gestations shorter than 28weeks, 8 for 28weeks, 9 for 29-30weeks, and 10 from 31weeks onwards. A linear decline in pH for both cord arterial and venous blood was seen with advancing gestational age (P<0.001). Median 5-minute Apgar scores were <10 before 31weeks of gestation. Both umbilical cord arterial and venous pH decreased linearly with increasing gestational age. Further studies are needed to show whether gestational age-related pH reference ranges might be preferred to fixed cut-offs in the estimation of umbilical cord acidemia at birth.

Arterio-VENouS Intra Subject agreement for blood gases within intensive care: The AVENSIS study.

In critically ill patients, who require multiple blood gas assessments, agreement between arterial and venous blood gas values for pH and partial pressure of carbon dioxide, is not clear. Good agreement would mean that venous values could be used to assess ventilation and metabolic status of patients in intensive care unit. All adult patients admitted to Alfred intensive care unit, Melbourne, from February 2013 to January 2014, who were likely to have arterial and central venous lines for three days, were enrolled. Patients on extra-corporeal life support and pregnant women were excluded. After enrolment, near simultaneous arterial and central venous sampling and analysis were performed at least once per nursing shift till the lines were removed or the patient died. Bland-Altman analysis for repeated measures was performed to assess the agreement between arterio-venous pH and partial pressure of carbon dioxide. A total of 394 paired blood gas analyses were performed from 59 participants. The median (IQR) number of samples per patient was 6 (5-9) with the median (IQR) sampling interval 9.4 (5.2-18.5) h. The mean bias for pH was + 0.036 with 95% limits of agreement ranging from - 0.005 to + 0.078. For partial pressure of carbon dioxide, the values were -2.58 and -10.43 to + 5.27 mmHg, respectively. The arterio-venous agreement for pH in intensive care unit patients appears to be acceptable. However, the agreement for partial pressure of carbon dioxide was poor.

The relationship between serum bicarbonate, pH level and sleep quality in haemodialysis patients: A cross-sectional study from Turkey.

To investigate the relationship of blood pH and bicarbonate levels with sleep disorders in patients with end-stage renal disease. The cross-sectional study was conducted at Kocaeli Derince Health Practice and Research Center, Kocaeli, Turkey, in July 2015, and comprised stable haemodialysis patients aged over 18 years who had undergone at least 3 months of treatment. The Pittsburgh sleep quality index was used to assess sleep quality, and the Epworth sleepiness scale was used to assess sleepiness. Blood urea nitrogen levels were measured to determine dialysis success. SPSS 17 was used for data analysis. Of the 62 patients, 22(35.4%) were good sleepers, while 40(65.6%) were bad sleepers, and 11(17.7%) had excessive daytime sleepiness. There was no significant difference between poor and good sleepers with respect to venous pH (p=0.197) and bicarbonate (p=0.305) levels. Also, the two levels did not differ significantly between patients with routine or excessive daytime sleepiness (p>0.05). Patients with excessive daytime sleepiness had significantly lower calcium (p=0.046) and higher creatinine (p-0.014) levels and were older (p=0.01). Age was the only independent predictor of both the index and the scale scores (p<0.05 each). Sleep disorders and sleepiness were found to be high in haemodialysis patients and there was a strong correlation between sleep disturbance and age. There was no correlation of either state with patients' bicarbonate or venous pH values.

Central Venous Blood Gas Analysis: An Alternative to Arterial Blood Gas Analysis for pH, PCO2, Bicarbonate, Sodium, Potassium and Chloride in the Intensive Care Unit Patients.

ABSTRACTAimsArterial blood gas (ABG) analysis is a frequently ordered test in intensive care unit (ICU) and can analyze electrolyte in addition to pH and blood gases. Venous blood gas (VBG) analysis is a safer procedure and may be an alternative for ABG. Electrolyte estimation by auto analyzer usually takes 20–30 minutes. This study was aimed to investigate the correlation of pH, PCO2, bicarbonate, sodium, potassium, and chloride (electrolytes) between ABG and central VBG in ICU patients.Materials and methodsThis was a prospective observational study conducted in medical college hospital ICU. Adult patients requiring ABG and electrolyte estimation as a part of their clinical care were consecutively included in the study. Patients having any intravenous infusion or who were pregnant were excluded. Venous samples were taken within 2 minutes of arterial sampling from in situ central line. Data were analyzed using Bland-Altman methods.ResultsA total of 110 patients' paired blood samples were analyzed. The mean difference between arterial and central venous values of pH, PCO2, bicarbonate, sodium, potassium, and chloride was 0.04 units, –5.84 mm Hg, 0.89 mmol/L, –1.8 mEq/L, –0.04 mEq/L, and –0.89 mEq/L, respectively. The correlation coefficients for pH, PCO2, HCO3−, sodium, potassium, and chloride were 0.799, 0.831, 0.892, 0.652, 0.599 and 0.730, respectively. Limits of agreement (95%) were within acceptable limits.ConclusionCentral venous pH, PCO2, and bicarbonate may be an acceptable substitute for ABG in patients admitted in the ICU. However caution should be exercised while applying electrolyte measurements.How to cite this articleBijapur MB, Kudligi NA, Asma S. Central Venous Blood Gas Analysis: An Alternative to Arterial Blood Gas Analysis for pH, PCO2, Bicarbonate, Sodium, Potassium and Chloride in the Intensive Care Unit Patients. Indian J Crit Care Med 2019;23(6):258–262.

Comparison of arterial and venous blood gases in patients with obesity hypoventilation syndrome and neuromuscular disease.

OBJECTIVES:Obesity hypoventilation syndrome (OHS) and some neuromuscular diseases (NMD) present with hypercapnic respiratory failure. Arterial blood gas (ABG) analysis is important in the diagnosis, follow-up, and treatment response of these diseases. However, ABG sampling is difficult in these patients because of excessive subcutaneous fat tissue, muscle atrophy, or contracture. The aim of this study is to investigate the value of venous blood gas (VBG), which is an easier and less complicated method, among stable patients with OHS and NMD.METHODS:The study included stable OHS and NMD patients who had been previously diagnosed and followed up between March 2017 and May 2017 in the outpatient clinic. ABG was taken from all patients in room air, and peripheral VBG was taken within 5 min after ABG sampling.RESULTS:Thirty-six patients with OHS and 46 patients with NMD were included in the study. There was a moderate positive correlation between arterial and venous pH values for all patients (rs = 0.590, P < 0.001). There were a strong and very strong positive correlations between arterial and venous pCO2 and HCO3 values (rs = 0.725 and rs = 0.934, respectively) (P < 0.001). There was no correlation between arterial and venous pO2 and saturation values. There was an agreement in Bland–Altman method for the values of ABG and VBG (pH, pCO2, and HCO3).CONCLUSIONS:There was a correlation between ABG and VBG values (pH, pCO2, and HCO3). VBG parameters (pH, pCO2, and HCO3) can be used safely instead of ABG parameters which have many risks, during treatment and follow-up of patients with OHS and NMD.

The Relationship between Arterial and Central Venous Blood Gases Values in Patients Undergoing Mechanical Ventilation after Cardiac Surgery

Background: The most straightforward method of ascertaining arterial PO2, PCO2, and other components of blood gas is to measure them directly from a blood sample. In situations in which arterial puncture cannot be achieved or may be technically difficult, the venous blood sample can be used. Methods: In a prospective analytical study, 80 patients undergoing mechanical ventilation after open-heart surgery in the intensive care unit were evaluated. Simultaneous, matched arterial and central venous blood gas samples were taken from radial artery line and central vein, respectively, when the ABG (arterial blood gases) assessment was needed. Arterial and central venous blood samples were analyzed and data were expressed as mean and ± SD. Results: The Pearson correlation coefficient for pH, PCO2, HCO3, and SatO2 was 0.898, 0.940, 0.840, and 0.567, respectively. There was a significant correlation between arterial and central venous values of pH, PCO2, and HCO3 (P < 0.0001). The mean difference between arterial and central venous PCO2 was -2.44 ± 2.6 mmHg, and the mean venous pH value was only 0.021 ± 0.037 units lower than the mean arterial value. In addition, the calculated mean bicarbonate concentration in venous blood was only about 0.06 ± 1.5 mEq.L higher than the mean arterial value. Conclusions: The central venous PCO2, pH, and HCO3 measured during mechanical ventilation in the intensive care unit approximate arterial values closely enough to permit the estimation of the adequacy of ventilation and acid-base status. The central venous Sat O2 does not reliably parallel the arterial Sat O2. In conclusion, venous blood sampling can potentially reduce the requirement for ABG sampling in special situations.

The Relationship between Arterial and Central Venous Blood Gases Values in Patients Undergoing Mechanical Ventilation after Cardiac Surgery.

BackgroundThe most straightforward method of ascertaining arterial PO2, PCO2, and other components of blood gas is to measure them directly from a blood sample. In situations in which arterial puncture cannot be achieved or may be technically difficult, the venous blood sample can be used.MethodsIn a prospective analytical study, 80 patients undergoing mechanical ventilation after open-heart surgery in the intensive care unit were evaluated. Simultaneous, matched arterial and central venous blood gas samples were taken from radial artery line and central vein, respectively, when the ABG (arterial blood gases) assessment was needed. Arterial and central venous blood samples were analyzed and data were expressed as mean and ± SD.ResultsThe Pearson correlation coefficient for pH, PCO2, HCO3, and SatO2 was 0.898, 0.940, 0.840, and 0.567, respectively. There was a significant correlation between arterial and central venous values of pH, PCO2, and HCO3 (P < 0.0001). The mean difference between arterial and central venous PCO2 was -2.44 ± 2.6 mmHg, and the mean venous pH value was only 0.021 ± 0.037 units lower than the mean arterial value. In addition, the calculated mean bicarbonate concentration in venous blood was only about 0.06 ± 1.5 mEq.L higher than the mean arterial value.ConclusionsThe central venous PCO2, pH, and HCO3 measured during mechanical ventilation in the intensive care unit approximate arterial values closely enough to permit the estimation of the adequacy of ventilation and acid-base status. The central venous Sat O2 does not reliably parallel the arterial Sat O2. In conclusion, venous blood sampling can potentially reduce the requirement for ABG sampling in special situations.

Accuracy of Peripheral and Central Venous Blood Gas Analysis in Evaluating Patients with Respiratory Failure

Objectives: Arterial blood samples are the gold standard test but these are more difficult to get than venous samples. In this study we assessed the possibility of utilization of venous (peripheral and central) blood gas samples in evaluation of subjects with respiratory failure instead of arterial samples. Methods: critically ill subjects with respiratory failure had paired venous (peripheral and central) and arterial samples taken. Assessment of agreement between blood gas samples (arterial and venous) as regard PH, Pco2 and HCO3 was done using Bland–Altman analyses. The spearmen correlation and linear regression tests were also performed to assess the degree of association between arterial and venous samples. Results: 100subjects were included. A good agreement was found between venous (peripheral and central) and arterial values of pHand HCO3.The agreements between peripheral venous and arterial PH and HCO3 values is higher than agreements between arterial and central venous measures. Conclusions: venous blood gas analysis (mainly peripheral samples) could replace arterial blood gas analysis in the evaluation of acid base balance in subjects with respiratory failure

Comparison and Agreement between Venous and Arterial Blood Gas Values for pH, pCO2, pO2, Bicarbonate and Oxygen Saturation in Patients with Acute Respiratory Illnesses

Comparison and Agreement between Venous and Arterial Blood Gas Values for pH, pCO2, pO2, Bicarbonate and Oxygen Saturation in Patients with Acute Respiratory Illnesses

Correlation of arterial blood gas measurement with peripheral venous blood gas values in adults patients admitted in ICU

Arterial blood gas (ABG) sampling is an essential investigation for assessment of acid-base status, oxygenation and ventilation in critical care practice. Arterial puncture to obtain arterial blood is more invasive procedure than venous and has more potential complications. To find out the correlation between arterial and peripheral venous blood gas values for pH, PCO2 and bicarbonate. Patients admitted in ICU requiring arterial blood gas analysis to determine their acid-base status or ventilatory status was included in the study. One milliliter of venous blood was obtained in a heparin flushed syringe within 5 minutes of getting arterial blood sample. Both labeled samples were processed immediately. Data were analyzed by student’s t-test. A total of 50 paired samples from 36 patients were evaluated. The mean differences between arterial and venous blood gas values for pH, PCO2 and bicarbonate were 0.02 units, -2.37 mmHg and -0.45 mEq/L respectively. Similarly, the correlation coefficients between arterial and venous parameters were 0.964, 0.881 and 0.906 for pH, PCO2 and bicarbonate respectively, which were statistically significant (p&lt;0.001). Venous pH, PCO2 and bicarbonate showed a very high level of correlation with the respective arterial values.

Predictors of Mortality in Patients With Cirrhosis Admitted at Intensive Care Unit at Cardinal Santos Medical Center

Cirrhotic patients who need critical care support show high morbidity and mortality rates compared with other critically ill patients. Their prognosis is, in fact, influenced by both the severity of the underlying hepatic disease and the worsening of extrahepatic organ function. Patients with cirrhosis are admitted to intensive care units (ICUs) for complications of portal hypertension such as variceal bleeding, hepatic encephalopathy or sepsis culminating in multiple organ failure in a large portion of patients. The objective of the study is to identify predictors of mortality in a retrospective analysis of patients with cirrhosis admitted to ICU of Cardinal Santos Medical Center and to compare these predictors to that established liver specific (Child-Pugh Score, Model for End-Stage Liver Disease (MELD) and MELD-Na) prognostic models. A total of 51 cirrhotic patients were admitted at the Cardinal Santos Medical Center Medical Intensive Care Unit between June 1, 2009 to June 30, 2015. The results are presented as means with ± standard deviations and confidence intervals of 95% for quantitative variables and as percentages for categorical variables. It was found that cirrhosis is more frequent in males and usually at their fifth and sixth decades of life and Hepatits B is the most common cause of cirrhosis. Although Child-Pugh score indicates the severity of underlying liver disease it cannot be considered as the best tool for predicting mortality in cirrhotic patients. Among patients admitted in the ICU, encephalopathy is a complication involving low survival. Among the clinical parameters, the use of mechanical ventilator, the need for inotropic support, the need for renal replacement therapy are associated with increased mortality rate. Among the laboratory parameters, lower venous pH and bicarbonate values in cirrhotic patients are significantly associated with mortality. The prognosis for cirrhotic patients admitted to the ICU is poor.

Comparison of Arterial and Venous Blood Gas Measurements in Non-Respiratory Diseases Patients Admitted in Intensive Care Unit (ICU)

The aim is to study the relationship between arterial and venous blood gas measurements of pH, HCO3 - & pCO2 in patients of non-respiratory diseases admitted in ICU in PCMS&RC, Bhopal. Enrollment of non-respiratory disease patients admitted in ICU reporting in our hospital to evaluate the relationship between arterial and venous blood gas parameters through Cross-sectional Study. The data we reviewed revealed us that venous blood gas analysis has the potential to be of great importance in the ICU setting in general as well as for patients presenting with different diagnosis. The association between Arterial and venous pH in which p-value of 0.85 which is not significant. The association between Arterial and venous pO2 in which the p-value of 0.001 which is highly significant. The association between Arterial and venous pCO2 in which p-value of 0.001 which is highly significant. The association between Arterial and venous HCO3 - in which p-value of 0.056 which is not significant. Correlation between arterial and venous parameters reveals all the correlation coefficient (r) is positive and only pH, pCO2 and HCO3 - are highly significant. The use of venous blood gas values has shown to be cost-effective and implementation of this procedure in the routine venous blood sampling will prove to be time and money saving as well, as it will reduce the risk factors for the patient and the health care worker. The venous blood gas values for pH and HCO3 - showed excellent association and correlation and can

Cardiac biomarkers in premature calves with respiratory distress syndrome.

The aim of this study was to determine the clinical relevance of cardiac biomarkers [troponin I and T, creatine kinase-MB fraction (CK-MB) and lactate dehydrogenase (LDH)] in premature calves with respiratory distress syndrome. Seventy premature calves were admitted to the clinic within 24 h after birth. Respiratory distress syndrome was diagnosed in premature calves by clinical examination and venous blood gas analysis. Ten healthy calves, aged 5 days, were used as control. Cardiac troponin I and T were analysed using ELISA and ELFA, respectively. Serum CK-MB and LDH were also analysed in an automatic analyser. The calves had low venous pH, pO2, O2 saturation and high pCO2 values consistent with dyspnoea, hypoxaemia, and inadequate oxygen delivery. Mean serum troponin I, troponin T, CK-MB and LDH levels were increased in the premature calves compared to the control group. In conclusion, the results in this study demonstrated that serum CK-MB, troponin I and troponin T concentrations could be used for evaluating myocardial injury in premature calves with respiratory distress syndrome.

Neonatal Acid-Base Status in Fetuses with Abnormal Vertebro- and Cerebro-Placental Ratios

Objective: A low cerebro-placental ratio (CPR) at term suggests the existence of failure to reach growth potential (FRGP) with a higher risk of poor neonatal acid-base status. This study aimed to evaluate whether similar findings were also seen in the vertebral artery (vertebro-placental ratio, VPR), supplying 30% of the cerebral flow. Methods: We studied term fetuses classified into groups according to birth weight (BW), CPR and VPR. BW was expressed in centiles and ratios in multiples of the median (MoM). Subsequently, associations with neonatal pH values were evaluated by means of regression curves and Mann-Whitney tests. Results: VPR MoM correlated with BW centiles (p < 0.0001, R² = 0.042) and its distribution resembled that of CPR MoM (p < 0.001). When both arteries were compared, adequate-for-gestational-age (AGA) fetuses with either low CPR or low VPR had lower neonatal venous pH values (p < 0.05, p < 0.01, respectively). However, in case of small-for-gestational-age (SGA) fetuses, only those with low VPR had significantly lower neonatal arterial and venous pH values (p < 0.05). Conclusions: Blood flow in the vertebral artery mimics that in the middle cerebral artery supporting the FRGP model. Both CPR and VPR identify AGA fetuses with lower neonatal pH values, but only VPR identifies SGA with lower pH values. Hypoxemia might be reflected as a generalized cerebral vasodilation demonstrated as low CPR and VPR.

Risk factors for the development of hypokalemia in neonatal diarrheic calves.

BackgroundNeonatal diarrheic calves have a clear negative potassium balance because of intestinal losses and decreased milk intake but in the presence of acidemia, they usually show normokalemic or hyperkalemic plasma concentrations.ObjectivesTo assess whether marked hypokalemia occurs in response to the correction of acidemia and dehydration and to identify factors that are associated with this condition.AnimalsEighty‐three calves with a clinical diagnosis of neonatal diarrhea.MethodsProspective cohort study. Calves were treated according to a clinical protocol using an oral electrolyte solution and commercially available packages of 8.4% sodium bicarbonate, 0.9% saline and 40% dextrose infusion solutions.ResultsThe proportion of hypokalemic calves after 24 hours of treatment (19.3%) was twice as great as it was on admission to the hospital. Plasma K+ after 24 hours of treatment was not significantly correlated to venous blood pH values at the same time but positively correlated to venous blood pH values on admission (r = 0.51, P < .001). Base excess on admission (Odds ratio [OR] = 0.81, 95% confidence interval [CI] = 0.70–0.94), duration of diarrhea (OR = 1.37, 95% CI = 1.05–1.80), milk intake during hospitalization (OR = 0.54, 95% CI = 0.37–0.79) and plasma sodium concentrations after 24 hours (OR = 1.12, 95% CI = 1.01–1.25) were identified to be independently associated (P < .05) with a hypokalemic state after 24 hours of treatment.Conclusions and Clinical ImportanceFindings of this study suggest that marked depletion of body potassium stores is evident in diarrheic calves that suffered from marked metabolic acidosis, have a low milk intake and a long history of diarrhea.