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1.
Artigo em Chinês | MEDLINE | ID: mdl-32074756

RESUMO

Objective: To observe the efficacy of continuous positive airway pressure (CPAP) in the treatment of obstructive sleep apnea hypopnea syndrome (OSAHS) and its affection on patients' blood gas analysis, C reactive protein(CRP) levels. Methods: This prospective study was performed from October 2016 to July 2017. Fifty hospitalized adult patients with medium or severe OSAHS, who were diagnosed by polysomnography (PSG) in Department of Otorhinolaryngology, Affiliated Hospital of Inner Mongolia Medical University, were collected as a case group. Those patients met the standards of medium or severe OSAHS, among whom 40 were male, 10 were female, the age was between 30 and 65, with a mean age of (47.24±10.28) years, and BMI was (27.94±3.43) kg/m(2). Meanwhile, 50 healthy individuals were chose in the same term as a control group, among whom 37 were male, 13 were female, the age was between 29 and 69, with a mean age of (51.28±10.58) years, body mass index(BMI) was (26.98±2.70) kg/m(2), and apnea-hypopnea index (AHI) was<5/h. The differences of blood gas analysis pH, arterial oxygen saturation (SaO(2)), arterial partial pressure of carbon dioxide (PaCO(2)), arterial partial pressure of oxygen (PaO(2)), CRP before and after the treatment of CPAP in case group and in the control group were compared. The choosing data were disposed and analyzed with statistics software of SPSS 20.0. Among which t test was adopted for measurement data, χ(2) test was adopted for enumeration data, and nonparametric rank sum test was adopted for other measurement data. Results: Before the CPAP treatment, pH, PaO(2) and SaO(2) levels in case group were lower than that in control group, respectively [7.34±0.03 vs. 7.37±0.04, (75.93±9.08) mmHg vs. (80.07±10.94) mmHg (1 mmHg=0.133 kPa), (89.71±6.09) mmHg vs.(93.29±5.36) mmHg, all P<0.05]. Both PaCO(2) level and CRP were higher than that in control group [(43.02±8.43) mmHg vs.(39.26±8.20) mmHg, 1.28[0.27,5.83] mg/L(Median[P(25),P(75)]) vs. 0.51[0.21,2.13] mg/L, both P<0.05]. After the CPAP treatment, pH(7.36±0.04), PaO(2) [(80.28±9.96) mmHg] and SaO(2) [(92.94±4.01) mmHg] level in case group were increased than pretreatment, respectively. Moreover, PaCO(2) level [(39.46±8.36) mmHg] and CRP(0.44[0.21,3.40] mg/L) are decreased than pretreatment (P<0.05), respectively. Conclusion: The CRP and blood gas analyses are significant index to evaluate the state of an illness and to estimate the prognosis of disease of OSAHS, which is deserved to generalize.


Assuntos
Dióxido de Carbono/sangue , Pressão Positiva Contínua nas Vias Aéreas , Oxigênio/sangue , Apneia Obstrutiva do Sono/sangue , Apneia Obstrutiva do Sono/terapia , Adulto , Idoso , Pressão Arterial , Proteína C-Reativa/análise , Estudos de Casos e Controles , China , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pressão Parcial , Estudos Prospectivos
2.
J Zoo Wildl Med ; 50(4): 1026-1030, 2020 Jan 09.
Artigo em Inglês | MEDLINE | ID: mdl-31926542

RESUMO

The Galápagos shearwater, Puffinus subalaris, is a seabird endemic to the Galápagos archipelago. Hematology, blood chemistry, and general health parameters have not been published for this species. Analyses were run on blood samples drawn from 20 clinically healthy Galápagos shearwaters captured by hand at their nests at Islote Pitt on San Cristóbal Island in July 2016. A portable blood analyzer (iSTAT) was used to obtain near immediate field results for pH, pO2, pCO2, TCO2, HCO3 -, hematocrit, hemoglobin, sodium, potassium, chloride, ionized calcium, creatinine, urea nitrogen, anion gap, and glucose. Blood lactate was measured using a portable Lactate Plus analyzer. The reported results provide baseline data that can be used for comparisons among populations and in detecting changes in health status among Galápagos shearwaters.


Assuntos
Bicarbonatos/sangue , Aves/sangue , Dióxido de Carbono/sangue , Hematócrito/veterinária , Oxigênio/sangue , Equilíbrio Ácido-Base , Animais , Glicemia , Cálcio/sangue , Cloretos/sangue , Creatinina/sangue , Hemoglobinas , Concentração de Íons de Hidrogênio , Lactatos/sangue , Potássio/sangue , Sódio/sangue
3.
Anaesthesia ; 75(3): 338-347, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31420989

RESUMO

Obstructive sleep apnoea and residual neuromuscular blockade are, independently, known to be risk factors for respiratory complications after major surgery. Residual effects of neuromuscular blocking agents are known to reduce the hypoxic ventilatory response in healthy volunteers. Patients with obstructive sleep apnoea have impaired control of breathing, but it is not known to what extent neuromuscular blocking agents interfere with the regulation of breathing in such patients. In a physiological study in 10 unsedated men with untreated obstructive sleep apnoea, we wished to examine if partial neuromuscular blockade had an effect on hypoxic ventilatory response (isocapnic hypoxia to oxygen saturation of 80%) and hypercapnic ventilatory response (normoxic inspired carbon dioxide 5%). The hypoxic ventilatory response was reduced by 32% (p = 0.016) during residual neuromuscular block (rocuronium to train-of-four ratio 0.7), but the hypercapnic ventilatory response was unaffected. We conclude that neuromuscular blockade specifically depresses peripheral chemosensitivity, and not respiratory muscle function since the hypercapnic ventilatory response was unaffected.


Assuntos
Hipóxia/induzido quimicamente , Hipóxia/fisiopatologia , Bloqueio Neuromuscular/efeitos adversos , Fármacos Neuromusculares não Despolarizantes/efeitos adversos , Ventilação Pulmonar , Rocurônio/efeitos adversos , Apneia Obstrutiva do Sono/fisiopatologia , Adolescente , Adulto , Idoso , Dióxido de Carbono/sangue , Humanos , Hipercapnia/fisiopatologia , Masculino , Pessoa de Meia-Idade , Oxigênio/sangue , Estudos Prospectivos , Músculos Respiratórios/efeitos dos fármacos , Músculos Respiratórios/fisiopatologia , Fatores de Risco , Adulto Jovem
4.
Arch Dis Child Fetal Neonatal Ed ; 105(1): 87-93, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31123057

RESUMO

OBJECTIVE: High-flow nasal cannula (HFNC) therapy is increasingly used in preterm infants despite a paucity of physiological studies. We aimed to investigate the effects of HFNC on respiratory physiology. STUDY DESIGN: A prospective randomised crossover study was performed enrolling clinically stable preterm infants receiving either HFNC or nasal continuous positive airway pressure (nCPAP). Infants in three current weight groups were studied: <1000 g, 1000-1500 g and >1500 g. Infants were randomised to either first receive HFNC flows 8-2 L/min and then nCPAP 6 cm H2O or nCPAP first and then HFNC flows 8-2 L/min. Nasopharyngeal end-expiratory airway pressure (pEEP), tidal volume, dead space washout by nasopharyngeal end-expiratory CO2 (pEECO2), oxygen saturation and vital signs were measured. RESULTS: A total of 44 preterm infants, birth weights 500-1900 g, were studied. Increasing flows from 2 to 8 L/min significantly increased pEEP (mean 2.3-6.1 cm H2O) and reduced pEECO2 (mean 2.3%-0.9%). Tidal volume and transcutaneous CO2 were unchanged. Significant differences were seen between pEEP generated in open and closed mouth states across all HFNC flows (difference 0.6-2.3 cm H2O). Infants weighing <1000 g received higher pEEP at the same HFNC flow than infants weighing >1000 g. Variability of pEEP generated at HFNC flows of 6-8 L/min was greater than nCPAP (2.4-13.5 vs 3.5-9.9 cm H2O). CONCLUSIONS: HFNC therapy produces clinically significant pEEP with large variability at higher flow rates. Highest pressures were observed in infants weighing <1000 g. Flow, weight and mouth position are all important determinants of pressures generated. Reductions in pEECO2 support HFNC's role in dead space washout.


Assuntos
Oxigenoterapia/métodos , Respiração com Pressão Positiva , Síndrome do Desconforto Respiratório do Recém-Nascido/terapia , Peso Corporal , Dióxido de Carbono/sangue , Pressão Positiva Contínua nas Vias Aéreas , Estudos Cross-Over , Feminino , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Masculino , Oxigênio/sangue , Estudos Prospectivos , Volume de Ventilação Pulmonar , Sinais Vitais
5.
Life Sci ; 240: 117081, 2020 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-31756342

RESUMO

BACKGROUND AND GOAL OF THE STUDY: Pulmonary inflammation, increased vascular permeability, and pulmonary edema, occur in response to primary pulmonary infections like pneumonia but are also evident in endotoxemia or sepsis. Mechanical ventilation augments pre-existing lung injury and inflammation resulting from exposure to microbial products. The objective of this study was to test the hypothesis that low-tidal-volume prevent ventilation induced lung injury in sepsis. MATERIALS AND METHODS: 10-12-week-old male C57BL/6N-mice received an intraperitoneal (i.p.) injection with equipotent dosages of LPS, 1668-thioate, 1612-thioate, or PBS. 120 min after injection, mice were randomized to low- (LV, 7 ± 1 ml/kg) or high-tidal-volume (HV, 25 ± 1 ml/kg) ventilation. Hemodynamic and ventilatory parameters were recorded and inflammatory markers were analyzed form BAL that was generated after 90 minute ventilation. RESULTS AND DISCUSSION: Arterial blood pressures declined during mechanical ventilation in all groups. pO2 decreased in LPS injected and CO2 increased in sham, LPS, and 1612-thioate administered mice at 45 min and in 1668-thioate injected mice after 90 minute LV ventilation compared to respective HV groups. BAL protein concentrations increased in HV ventilated and 1668- or 1612-thioat pre-treated mice. BAL TNF-α protein concentrations increased in both LPS- and 1668-thioate-injected and IL-1ß protein concentrations only in LPS-injected and HV ventilated mice. Most notably, no increased protein concentrations were observed in any of the LV ventilated groups. CONCLUSION: We conclude that low-tidal-volume ventilation may be a potential strategy for the prevention of ventilator induced lung injury in a murine model of systemic TLR agonist induced lung injury.


Assuntos
Inflamação/terapia , Sepse/terapia , Volume de Ventilação Pulmonar , Lesão Pulmonar Induzida por Ventilação Mecânica/prevenção & controle , Animais , Pressão Arterial , Líquido da Lavagem Broncoalveolar , Dióxido de Carbono/sangue , Hemodinâmica , Inflamação/complicações , Inflamação/patologia , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Oxigênio/sangue , Mecânica Respiratória , Sepse/complicações , Sepse/patologia , Lesão Pulmonar Induzida por Ventilação Mecânica/patologia
6.
Medicine (Baltimore) ; 98(46): e17957, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31725655

RESUMO

BACKGROUND: Although surgical field visualization is important in functional endoscopic sinus surgery (FESS), the complications associated with controlled hypotension for surgery should be considered. Intraoperative hypotension is associated with postoperative stroke, leading to subsequent hypoxia with potential neurologic injury. We investigated the effect of propofol and desflurane anesthesia on S-100ß and glial fibrillary acidic protein (GFAP) levels which are early biomarkers for cerebral ischemic change during controlled hypotension for FESS. METHODS: For controlled hypotension during FESS, anesthesia was maintained with propofol/remifentanil in propofol group (n = 30) and with desflurane/remifentanil in desflurane group (n = 30). For S-100ß and GFAP assay, blood samples were taken at base, 20 and 60 minutes after achieving the target range of mean arterial pressure, and at 60 minutes after surgery. RESULTS: The base levels of S-100ß were 98.04 ±â€Š78.57 and 112.61 ±â€Š66.38 pg/mL in the propofol and desflurane groups, respectively. The base levels of GFAP were 0.997 ±â€Š0.486 and 0.898 ±â€Š0.472 ng/mL in the propofol and desflurane groups, respectively. The S-100ß and GFAP levels were significantly increased in the study period compared to the base levels in both groups (P ≤ .001). There was no significant difference at each time point between the 2 groups. CONCLUSION: On comparing the effects of propofol and desflurane anesthesia for controlled hypotension on the levels of S-100ß and GFAP, we noted that there was no significant difference in S-100ß and GFAP levels between the 2 study groups. CLINICAL TRIAL REGISTRATION: Available at: http://cris.nih.go.kr, KCT0002698.


Assuntos
Proteína Glial Fibrilar Ácida/sangue , Hipotensão Controlada/métodos , Propofol/uso terapêutico , Subunidade beta da Proteína Ligante de Cálcio S100/sangue , Sinusite/cirurgia , Adulto , Anestésicos Intravenosos , Pressão Arterial/efeitos dos fármacos , Dióxido de Carbono/sangue , Doença Crônica , Desflurano/administração & dosagem , Desflurano/efeitos adversos , Desflurano/uso terapêutico , Endoscopia , Feminino , Proteína Glial Fibrilar Ácida/biossíntese , Humanos , Hipotensão Controlada/efeitos adversos , Masculino , Pessoa de Meia-Idade , Propofol/administração & dosagem , Propofol/efeitos adversos , Estudos Prospectivos , Remifentanil/administração & dosagem , Subunidade beta da Proteína Ligante de Cálcio S100/biossíntese , Fatores de Tempo
8.
Pak J Pharm Sci ; 32(3 Special): 1375-1380, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31551218

RESUMO

To explore efficacy of acupoint massage combined with acupoint application on arterial blood gas and postoperative complications for patients undergoing laparoscopic cholecystectomy. Patients undergoing laparoscopic cholecystectomy (LC) in general anesthesia condition were randomly enrolled from local hospital into control group and experimental group. Four acupuncture points were prepared for acupoint massage and acupoint application, including bilateral Hegu acupoint (LI4), Neiguan Point (PC6), Zusanli Point (ST36) and Tanzhong acupoint (CV17). All patients in experimental group were treated with point acupressure treatment combined with acupoint application before LC, while control group directly receive LC surgery. The peak inspiratory pressure (PIP), end-tidal CO2 pressure (PETCO2), oxygen saturation (SpO2) and pH were examined at multiple time points during LC surgery. Related postoperative complications were documented for further analysis. All data were analyzed to assess efficacy of acupoint massage combined with acupoint application on arterial blood gas. There is no difference in baseline condition between experimental group and control group. Compared with control group, PetCO2 and SpO2 in experimental group were significantly increased while PIP was decreased. PH in experimental group ranged in a more stable domain. Hypercapnia and deep venous thrombosis were mitigated in experimental group compared with control group. Moreover, multiple pneumoperitoneum-related complications were alleviated after combined treatment, including pain and frequency of nausea and vomiting. Acupoint massage combined with acupoint application ameliorated related postoperative complications, and reduced side events of LC surgery via improving carbon dioxide metabolism.


Assuntos
Terapia por Acupuntura/métodos , Colecistectomia Laparoscópica/efeitos adversos , Complicações Pós-Operatórias/prevenção & controle , Pontos de Acupuntura , Adulto , Gasometria , Dióxido de Carbono/sangue , Feminino , Humanos , Masculino , Massagem , Pessoa de Meia-Idade , Cuidados Pré-Operatórios , Prognóstico , Resultado do Tratamento
9.
Dan Med J ; 66(9)2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31495370

RESUMO

INTRODUCTION: An indication of the adequacy of the intra-vascular volume is of importance in critically ill patients. The status of the intravascular volume can be determined from a fluid challenge test. Most tests involve invasive monitoring. An exception is the capnographic measurement of changes in end-tidal (ET) CO2 after a fluid challenge. The method is appealing as it rests on solid physiological ground - the Fick principle and the Frank-Starling mechanism. Furthermore, it is non-invasive and convenient. We report the results of a systematic review of the merits of this method. METHODS: After a registration with PROSPERO, we searched MEDLINE, EMBASE, the Cochrane Library database and trial registers for studies on the diagnostic accuracy of changes in ET-CO2 in fluid responsiveness testing. Test sensitivity, specificity and area under the receiver operating charac-teristics curve (AUROC) were the primary outcome meas-ures. RESULTS: Seven papers met the inclusion criteria. The test was found to have a median sensitivity of 0.75 (range: 0.60-0.91) and a median specificity of 0.94 (range: 0.70-1.00). The median AUROC was 0.82 (range: 0.67-0.94); the diagnostic threshold was an increase in ET-CO2 of 2 mmHg/5%. CONCLUSIONS: Monitoring of ET-CO2 during fluid responsiveness testing provides good diagnostic value with few false negative tests and fewer false positive tests. The included studies have important methodological flaws. It must therefore be acknowledged that the diagnostic value of ET-CO2 monitoring found in the review is overrated and overrated to an unknown degree. Therefore, at the present state of affairs, implementation of the test cannot be considered evidence-based.


Assuntos
Dióxido de Carbono/sangue , Hidratação , Volume de Ventilação Pulmonar/fisiologia , Capnografia , Estado Terminal/terapia , Humanos , Estudos Observacionais como Assunto , Valor Preditivo dos Testes , Volume Sistólico/fisiologia , Resultado do Tratamento
10.
Clin Biochem ; 74: 69-72, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31473201

RESUMO

BACKGROUND: S100B protein is one of the most accurate biomarkers for diagnosis of neuroapoptosis and brain damage. The aim was to evaluate the lactate concentration and acid-base balance (pH, pCO2, pO2, HCO3c and BEb) in umbilical cord blood to predict high risk of neuroapoptosis and analyze the relationship between the levels of these biomarkers and umbilical cord blood S100B protein concentration at birth. METHODS: Apparently healthy newborns were included. S100B protein and blood gas test (lactate and acid-base balance) were determined in umbilical cord blood at birth. Newborns were classified into two groups: with and without high risk of neuroapoptosis. Newborns with high umbilical cord blood S100B protein concentration were considered newborns at high risk of neuroapoptosis. RESULTS: Sixty-one newborns were included, 12 had high risk of neuroapoptosis and 49 did not. S100B protein concentration correlate directly with pCO2 levels (Rho: 0.286, p = .0321) and lactate concentration (Rho: 0.278, p = .0315); and indirectly with pH (Rho: -0.332, p = .01). The analysis of the ROC curves yielded significant curves for pH and pCO2 to predict high risk of neuroapoptosis, pH optimal cutoff value was 7.19 (sensitivity: 50%, specificity: 83.7%, AUC: 0.708); and pCO2 optimal cutoff value was 60 mmHg (sensitivity: 30%, specificity: 85.4%, AUC: 0.705). CONCLUSIONS: Respiratory acidosis is associated to high concentrations of S100B protein in umbilical cord blood at birth. Umbilical cord blood pH and pCO2 may be useful in differentiating newborns at high risk of neuroapoptosis. Umbilical cord blood gas test may be valuable as risk indicator for neuroapoptosis at birth.


Assuntos
Acidose Respiratória/sangue , Acidose Respiratória/patologia , Apoptose , Encéfalo/patologia , Sangue Fetal/química , Adolescente , Adulto , Biomarcadores/sangue , Gasometria , Dióxido de Carbono/sangue , Estudos Transversais , Feminino , Hipóxia Fetal/sangue , Humanos , Concentração de Íons de Hidrogênio , Recém-Nascido , Ácido Láctico/sangue , Masculino , Neurônios/patologia , Curva ROC , Subunidade beta da Proteína Ligante de Cálcio S100/sangue , Sensibilidade e Especificidade , Adulto Jovem
11.
Clin Biochem ; 74: 47-53, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31533025

RESUMO

BACKGROUND: Blood gas analyzers are frequently installed as point of care devices and thus allow rapid decision making. Few data are available regarding analytical performance of large sets of BGA. We aimed at evaluating 22 ABL 90 Flex Plus analyzers intended to be deployed. The evaluation was performed at the device level and at the entire set level to characterize the quality of measurements but also to ensure consistency across the devices deployed in the hospital. METHODS: Imprecision and total error were assessed for pH, pCO2, pO2, sodium, potassium, ionized calcium, glucose, lactate and oximetry parameters. Imprecision at the hospital level including between device variability was also evaluated. One of the two analyzers used in the central laboratory was correlated with a GEM Premier 4000 and a Cobas b221 analyzers. Thereafter, we tested sequentially the 20 instruments intended to be deployed in care service in comparison with the reference device. RESULTS: Heterogeneity of analytical performance across the different analyzers was low, allowing to consider the whole set as a unique analyzer. The total error was in line with performance goals. Analytical performance of the analyzers was found suitable for use in clinical practice. CONCLUSIONS: Our study is an example of the qualification of a set of point and underscores 1)The need for a unified qualification scheme when multiple analyzers are deployed simultaneously 2) analytical performance goals compatible with clinical use and the state of the art for all parameters.


Assuntos
Gasometria/instrumentação , Sistemas Automatizados de Assistência Junto ao Leito , Glicemia , Cálcio/sangue , Dióxido de Carbono/sangue , Tomada de Decisão Clínica , Equipamentos e Provisões Hospitalares , Humanos , Concentração de Íons de Hidrogênio , Laboratórios Hospitalares , Ácido Láctico/sangue , Oxigênio/sangue , Potássio/sangue , Reprodutibilidade dos Testes , Sódio/sangue
12.
Trials ; 20(1): 465, 2019 Jul 30.
Artigo em Inglês | MEDLINE | ID: mdl-31362776

RESUMO

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is a common cause of chronic respiratory failure and its course is punctuated by a series of acute exacerbations which commonly lead to hospital admission. Exacerbations are managed through the application of non-invasive ventilation and, when this fails, tracheal intubation and mechanical ventilation. The need for mechanical ventilation significantly increases the risk of death. An alternative therapy, extracorporeal carbon dioxide removal (ECCO2R), has been shown to be efficacious in removing carbon dioxide from the blood; however, its impact on respiratory physiology and patient outcomes has not been explored. METHODS/DESIGN: A randomised controlled open label trial of patients (12 in each arm) with acute exacerbations of COPD at risk of failing conventional therapy (NIV) randomised to either remaining on NIV or having ECCO2R added to NIV with a primary endpoint of time to cessation of NIV. The change in respiratory physiology following the application of ECCO2R and/or NIV will be measured using electrical impedance tomography, oesophageal pressure and parasternal electromyography. Additional outcomes, including patient tolerance, outcomes, need for readmission, changes in blood gases and biochemistry and procedural complications, will be measured. Physiological changes will be compared within one patient over time and between the two groups. Healthcare costs in the UK system will also be compared between the two groups. DISCUSSION: COPD is a common disease and exacerbations are a leading cause of hospital admission in the UK and worldwide, with a sizeable mortality. The management of patients with COPD consumes significant hospital and financial resources. This study seeks to understand the feasibility of a novel approach to the management of patients with acute exacerbations of COPD as well as to understand the underlying physiological changes to explain why the approach does or does not assist this patient cohort. Detailed respiratory physiology has not been previously undertaken using this technique and there are no other randomised controlled trials currently in the literature. TRIAL REGISTRATION: ClinicalTrials.gov, NCT02086084.


Assuntos
Dióxido de Carbono/sangue , Circulação Extracorpórea , Hipercapnia/terapia , Pulmão/fisiopatologia , Doença Pulmonar Obstrutiva Crônica/terapia , Respiração , Biomarcadores/sangue , Terapia Combinada , Progressão da Doença , Circulação Extracorpórea/efeitos adversos , Humanos , Hipercapnia/sangue , Hipercapnia/diagnóstico , Hipercapnia/fisiopatologia , Londres , Ventilação não Invasiva , Estudos Prospectivos , Doença Pulmonar Obstrutiva Crônica/sangue , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Recuperação de Função Fisiológica , Fatores de Tempo , Resultado do Tratamento
13.
Am J Cardiol ; 124(4): 499-504, 2019 08 15.
Artigo em Inglês | MEDLINE | ID: mdl-31262498

RESUMO

The Impella (Abiomed, Danvers, Massachusetts) device is increasingly used for mechanical circulatory support (MCS) to treat acute severe cardiogenic shock (CS). Initial and continued determination of the appropriate degree of MCS is challenging. This study evaluates predictors of mortality in patients treated with the Impella for acute severe CS and outcomes associated with prolonged Impella use. This retrospective single-center study included 204 patients treated with the Impella 2.5, Impella CP, or Impella 5.0 from 2011 to 2018 for acute severe CS. The primary end point was all-cause in-hospital mortality. All-cause in-hospital mortality was 45.1%. Nonsurvivors had a lower initial pH (7.24 vs 7.32, hazard ratio [HR] 1.03, p <0.0001), lower serum CO2 (19.1 vs 21.3 mmol/L, HR 1.08, p = 0.002), higher lactate (6.8 vs 3.3 mmol/L, HR 1.17, p <0.0001), and used a greater number of vasopressors and inotropes (4.3 vs 2.6, HR 1.44, p <0.0001). Patients with the Impella >4 days (n = 45) had a longer intensive care unit stay (12.6 vs 6.9 days, p <0.001), longer total hospital stay (16.4 vs 11.6 days, p = 0.03), longer mechanical ventilation use (7.8 vs 4.4 days, p = 0.002), and trend toward increased mortality (57.8 vs 41.5%, p = 0.051). In conclusion, in patients treated with the Impella for acute severe CS, initial biochemical parameters and need for vasopressors and inotropes are significant predictors of mortality that can serve as valuable indicators of whether the Impella or higher level of MCS is more appropriate. Patients treated with the Impella beyond 4 days have poorer outcomes and may benefit from escalation of care.


Assuntos
Circulação Assistida/métodos , Cardiotônicos/uso terapêutico , Coração Auxiliar , Mortalidade Hospitalar , Choque Cardiogênico/terapia , Vasoconstritores/uso terapêutico , Idoso , Circulação Assistida/instrumentação , Dióxido de Carbono/sangue , Feminino , Parada Cardíaca/complicações , Humanos , Concentração de Íons de Hidrogênio , Ácido Láctico/sangue , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio sem Supradesnível do Segmento ST/complicações , Prognóstico , Modelos de Riscos Proporcionais , Respiração Artificial/estatística & dados numéricos , Estudos Retrospectivos , Infarto do Miocárdio com Supradesnível do Segmento ST/complicações , Choque Cardiogênico/sangue , Choque Cardiogênico/etiologia
14.
Emerg Med Clin North Am ; 37(3): 395-408, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31262411

RESUMO

Patients in shock present frequently to the emergency department. The emergency physician must be skilled in the resuscitation of both differentiated and undifferentiated shock. Early, aggressive resuscitation of patients in shock is essential, using macrocirculatory, microcirculatory, and clinical end points to guide interventions. Therapy should focus on the restoration of oxygen delivery to match tissue demand. This article reviews the evidence supporting common end points of resuscitation for common etiologies of shock and limitations to their use.


Assuntos
Ressuscitação , Choque/terapia , Lesão Renal Aguda/diagnóstico , Lesão Renal Aguda/prevenção & controle , Pressão Arterial/fisiologia , Biomarcadores , Circulação Sanguínea/fisiologia , Dióxido de Carbono/sangue , Débito Cardíaco/fisiologia , Medicina de Emergência , Homeostase/fisiologia , Humanos , Hipotensão/prevenção & controle , Ácido Láctico/sangue , Oxigênio/sangue , Sepse/fisiopatologia , Choque/sangue , Urina
15.
Curr Opin Anaesthesiol ; 32(5): 568-573, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31211719

RESUMO

PURPOSE OF REVIEW: Hyperventilation is commonly used in neurological patients to decrease elevated intracranial pressure (ICP) or relax a tense brain. However, the potentially deleterious effects of hyperventilation may limit its clinical application. The aim of this review is to summarize the physiological and outcome evidence related to hyperventilation in neurological patients. RECENT FINDINGS: Physiologically, hyperventilation may adversely decrease cerebral blood flow (CBF) and the match between the cerebral metabolic rate and CBF. In patients with severe traumatic brain injury (TBI), prolonged prophylactic hyperventilation with arterial carbon dioxide tension (PaCO2) less than 25 mmHg or during the first 24 h after injury is not recommended. Most patients (>90%) with an aneurysmal subarachnoid hemorrhage undergo hyperventilation (PaCO2 <35 mmHg); however, whether hyperventilation is associated with poor outcomes in this patient population is controversial. Hyperventilation is effective for brain relaxation during craniotomy; however, this practice is not based on robust outcome evidence. SUMMARY: Although hyperventilation is commonly applied in patients with TBI or intracranial hemorrhage or in those undergoing craniotomy, its effects on patient outcomes have not been proven by quality research. Hyperventilation should be used as a temporary measure when treating elevated ICP or to relax a tense brain. Outcome research is needed to better guide the clinical use of hyperventilation in neurological patients.


Assuntos
Lesões Encefálicas Traumáticas/terapia , Craniotomia/efeitos adversos , Hipertensão Intracraniana/terapia , Respiração Artificial/métodos , Hemorragia Subaracnóidea/terapia , Encéfalo/irrigação sanguínea , Encéfalo/metabolismo , Lesões Encefálicas Traumáticas/complicações , Lesões Encefálicas Traumáticas/diagnóstico , Dióxido de Carbono/sangue , Dióxido de Carbono/metabolismo , Craniotomia/normas , Medicina Baseada em Evidências/métodos , Medicina Baseada em Evidências/normas , Humanos , Hipertensão Intracraniana/etiologia , Oxigênio/metabolismo , Guias de Prática Clínica como Assunto , Respiração Artificial/efeitos adversos , Hemorragia Subaracnóidea/etiologia , Índices de Gravidade do Trauma , Resultado do Tratamento
16.
Pediatrics ; 144(1)2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31248940

RESUMO

Ventilatory support may affect the short- and long-term neurologic and respiratory morbidities of preterm infants. Ongoing monitoring of oxygenation and ventilation and control of adequate levels of oxygen, pressures, and volumes can decrease the incidence of such adverse outcomes. Use of pulse oximetry became a standard of care for titrating oxygen delivery, but continuous noninvasive monitoring of carbon dioxide (CO2) is not routinely used in NICUs. Continuous monitoring of CO2 level may be crucial because hypocarbia and hypercarbia in extremely preterm infants are associated with lung and brain morbidities, specifically bronchopulmonary dysplasia, intraventricular hemorrhage, and cystic periventricular leukomalacia. It is shown that continuous monitoring of CO2 levels helps in maintaining stable CO2 values within an accepted target range. Continuous monitoring of CO2 levels can be used in the delivery room, during transport, and in infants receiving invasive or noninvasive respiratory support in the NICU. It is logical to hypothesize that this will result in better outcome for extremely preterm infants. In this article, we review the different noninvasive CO2 monitoring alternatives and devices, their advantages and disadvantages, and the available clinical data supporting or negating their use as a standard of care in NICUs.


Assuntos
Dióxido de Carbono/sangue , Terapia Intensiva Neonatal/métodos , Monitorização Fisiológica/métodos , Biomarcadores/sangue , Gasometria/instrumentação , Gasometria/métodos , Gasometria/normas , Humanos , Recém-Nascido , Unidades de Terapia Intensiva Neonatal , Terapia Intensiva Neonatal/normas , Monitorização Fisiológica/instrumentação , Monitorização Fisiológica/normas , Respiração Artificial , Padrão de Cuidado
17.
J Avian Med Surg ; 33(2): 123-132, 2019 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-31251499

RESUMO

Venous blood samples were collected from 129 apparently healthy, rehabilitated juvenile black-bellied whistling ducks (Dendrocygna autumnalis) immediately before release from rehabilitation. Blood gas, electrolyte, and select biochemical and hematologic values were analyzed by using a point-of-care analyzer, and complete blood cell counts and osmolality were determined. Most biochemical analyte values were distributed parametrically, while most hematologic values were nonparametrically distributed. Calculated osmolality values were in poor agreement with measured osmolality values, and values of packed cell volume had poor agreement with hematocrit values determined with the i-STAT 1. The physiologic values reported provide vital information to assess individual duck health and guide fluid therapy in captivity and may prove useful to assess free-living population health of this duck species.


Assuntos
Patos/sangue , Animais , Glicemia , Temperatura Corporal , Dióxido de Carbono/sangue , Eletrólitos/sangue , Hematócrito/veterinária , Hemoglobinas , Concentração de Íons de Hidrogênio , Ácido Láctico/sangue , Contagem de Leucócitos/veterinária , Minerais/sangue , Concentração Osmolar , Valores de Referência
18.
Fish Shellfish Immunol ; 93: 752-762, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31163297

RESUMO

The West Coast rock lobster (WCRL), Jasus lalandii, inhabits highly variable environments frequented by upwelling events, episodes of hypercapnia and large temperature variations. Coupled with the predicted threat of ocean acidification and temperature change for the coming centuries, the immune response in this crustacean will most likely be affected. We therefore tested the hypothesis that chronic exposure to hypercapnia and elevated seawater temperature will alter immune function of the WCRL. The chronic effects of four combinations of two stressors (seawater pCO2 and temperature) on the total number of circulating haemocytes (THC) as well as on the lobsters' ability to clear (inactivate) an injected dose of Vibrio anguillarum from haemolymph circulation were assessed. Juvenile lobsters were held in normocapnic (pH 8.01) or hypercapnic (pH 7.34) conditions at two temperatures (15.6 and 18.9 °C) for 48 weeks (n = 30 lobster per treatment), after which a subsample of lobsters (n = 8/treatment), all at a similar moult stage, were selected from each treatment for the immune challenge. Baseline levels of haemocytes (THC ml-1) and bacteria (CFU ml-1) in their haemolymph were quantified 24 h prior to bacterial challenge. Lobsters were then challenged by injecting 4 × 104V. anguillarum per g body weight directly into the cardiac region of each lobster and circulating haemocyte and culturable bacteria were measured at 20 min post challenge. No significant differences in THC ml-1 (p < 0.05) were observed between any of the treatment groups prior to the bacterial challenge. However lobsters chronically exposed to a combination of hypercapnia and low temperature had significantly higher (p < 0.05) THCs post-challenge in comparison with lobsters chronically exposed to hypercapnia and high temperature. A significant interactive effect was recorded between temperature and pH for the post-challenge THC data (two-way ANOVA, p = 0.0025). Lobster were very efficient at rendering an injected dose of bacteria non-culturable, with more than 83% of the theoretical challenge dose (∼1.7 × 105Vibrio ml-1 haemolymph) inactivated within the first 10 min following injection. Although differences in the inactivation of V. anguillarum were observed between treatment groups, none of these differences were significant. Clearance efficiency was in the following order: Hypercapnia/low temperature > normocapnia/high temperature > normocapnia/low temperature > hypercapnia/high temperature. This study demonstrated that despite chronic exposure to combinations of reduced seawater pH and high temperature, the WCRL was still capable of rapidly rendering an injected dose of bacteria non-culturable.


Assuntos
Dióxido de Carbono/sangue , Hemolinfa/química , Imunidade Inata/fisiologia , Palinuridae/imunologia , Animais , Temperatura Alta/efeitos adversos , Concentração de Íons de Hidrogênio , Palinuridae/química , Palinuridae/fisiologia , Água do Mar/química
19.
Vet Anaesth Analg ; 46(4): 483-487, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31178411

RESUMO

OBJECTIVE: To describe clinically relevant, physiological measurements collected during a 3 hour duration of alfaxalone total intravenous anaesthesia. STUDY DESIGN: Case series. ANIMALS: A total of 112 client-owned middle-aged or older dogs. METHODS: Dogs were premedicated with intramuscular acepromazine (0.03 mg kg-1). Anaesthesia was induced and subsequently maintained for up to 3 hours with alfaxalone administered intravenously. Dogs breathed 100% oxygen via an endotracheal tube. Heart rate, respiratory rate and blood pressure were evaluated 30 minutes after administration of acepromazine and used as baseline values for comparisons of intra-anaesthetic data. Blood glucose was measured 1 week prior to anaesthesia and every hour during alfaxalone anaesthesia. Quality and duration of recovery were recorded. Mean data for physiological variables were compared over three time points-before induction of anaesthesia, for the first hour of anaesthesia and from 60 minutes to discontinuation of anaesthesia. RESULTS: Mean induction dose of alfaxalone was 1.4 mg kg-1 [95% confidence interval (CI) 1.3-1.5). Post induction apnoea for >60 seconds occurred in 13 (11.6%) dogs. Mean alfaxalone infusion rate during the first 60 minutes of anaesthesia was 0.099 mg kg-1 minute-1; mean infusion rate was 0.092 mg kg-1 minute-1 from 60 minutes until discontinuation of anaesthesia. Heart rate was well maintained; hypotension (mean arterial blood pressure < 60 mmHg) was encountered in 23 (21%) dogs. Blood glucose levels did not alter during anaesthesia. Median time between discontinuation of alfaxalone infusion and extubation was 17 (7-35 minutes), time to assuming sternal recumbency was 75 (58-110 minutes), and time to standing was 109 (88-140 minutes). CONCLUSIONS AND CLINICAL RELEVANCE: Alfaxalone infusion provided effective anaesthesia in this population. In a minority of cases, respiratory and haemodynamic support of the patient was required.


Assuntos
Anestesia Intravenosa/veterinária , Anestésicos/farmacologia , Doenças do Cão/diagnóstico por imagem , Osteoartrite/veterinária , Pregnanodionas/farmacologia , Radiografia/veterinária , Anestésicos/administração & dosagem , Anestésicos/efeitos adversos , Animais , Apneia/induzido quimicamente , Apneia/veterinária , Glicemia , Pressão Sanguínea/efeitos dos fármacos , Dióxido de Carbono/sangue , Estudos de Casos e Controles , Cães , Feminino , Frequência Cardíaca/efeitos dos fármacos , Masculino , Osteoartrite/diagnóstico por imagem , Oxigênio/sangue , Pregnanodionas/administração & dosagem , Pregnanodionas/efeitos adversos , Respiração/efeitos dos fármacos
20.
Nutr. hosp ; 36(3): 517-525, mayo-jun. 2019. tab, graf
Artigo em Inglês | IBECS | ID: ibc-184547

RESUMO

Introduction: children with cerebral palsy (CP) have multiple risk factors for low bone mineral density or osteoporosis. Objective: to explore the association between bone mineral density (BMD) and biochemical and hormonal indicators of bone metabolism in children with quadriplegic cerebral palsy (CP). Methods: a cross-sectional analytical study included 59 participants from six to 18 years of age with quadriplegic CP. Serum concentrations of calcium, phosphorus, 25OHD metabolite, parathyroid hormone (PTH), alkaline phosphatase, and thyroid hormones were determined using standardized methods. The BMD measurement was obtained from the lumbar spine expressed in g/cm2 and Z-score. Unpaired Student's t-test, Chi-square test, odds ratio and Pearson's correlation were performed. Results: participants with CP and malnutrition had lower serum concentrations of calcium, phosphorus and alkaline phosphatase. Those who had low BMD showed lower serum concentrations of calcium, phosphorus and alkaline phosphatase. Most participants with low and normal BMD had vitamin D deficiency (27.1% and 10%) and insufficiency (35.4% and 30%), respectively. There was a significant correlation between BMD and serum concentrations of calcium, phosphorus, alkaline phosphatase, vitamin D and thyroid-stimulating hormone (TSH). There were no differences in the biochemical and hormonal indicators by level of gross motor function, use of anticonvulsants and oral versus enteral feeding method. Conclusion: malnutrition and alteration of vitamin D nutritional status were associated with low BMD and alterations of biochemical indicators of bone metabolism in pediatric patients with quadriplegic CP. The relationship between BMD and biochemical indicators of bone metabolism in children with quadriplegic CP was also demonstrated


Introducción: los niños con parálisis cerebral (PC) presentan múltiples factores de riesgo de densidad mineral ósea baja u osteoporosis. Objetivo: explorar la asociación entre la baja densidad mineral ósea (DMO) e indicadores bioquímicos y hormonales del metabolismo óseo en niños con PC cuadripléjica. Métodos: un estudio transversal analítico incluyó a 59 participantes de entre seis y 18 años de edad con PC cuadripléjica. Las concentraciones séricas de calcio, fósforo, metabolito 25OHD, hormona paratiroidea (PTH), fosfatasa alcalina y hormonas tiroideas se determinaron utilizando métodos estandarizados. La medición de DMO se obtuvo de la columna lumbar expresada en g/cm2 y puntaje Z. Se realizaron pruebas t de Student no pareada, Chi-cuadrado, razón de momios y correlación de Pearson. Resultados: los participantes con PC y desnutrición tenían concentraciones séricas más bajas de calcio, fósforo y fosfatasa alcalina. Los participantes con DMO baja tuvieron menor concentración sérica de calcio, fósforo y fosfatasa alcalina. Los participantes con DMO baja y normal tenían deficiencia de vitamina D (27.1% y 10%) e insuficiencia (35.4% y 30%), respectivamente. Hubo una correlación significativa entre DMO y las concentraciones séricas de calcio, fósforo, fosfatasa alcalina, vitamina D y hormona estimulante de la tiroides. Conclusión: la desnutrición y la alteración del estado nutricio de la vitamina D se asociaron con DMO baja y alteraciones de los indicadores bioquímicos del metabolismo óseo. Se demostró una asociación entre DMO e indicadores bioquímicos y hormonales del metabolismo óseo en niños con PC cuadripléjica


Assuntos
Humanos , Criança , Adolescente , Densidade Óssea , Paralisia Cerebral/dietoterapia , Paralisia Cerebral/diagnóstico , Quadriplegia/complicações , Estado Nutricional , Vitamina D/sangue , Cálcio/sangue , Quadriplegia/dietoterapia , Quadriplegia/diagnóstico , Estudos Transversais , Osso e Ossos/metabolismo , Fosfatase Alcalina/análise , Fosfatase Alcalina/sangue , Dióxido de Carbono/sangue
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