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1.
Neurol Sci ; 41(10): 2671-2674, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32734396

RESUMO

INTRODUCTION: The relationship between dyspnea and COVID-19 is unknown. In COVID-19 patients, the higher prevalence of neurological symptoms and the lack of dyspnea may suggest common underlying pathogenetic mechanisms. The aim of this preliminary study is to address whether there is a lack of dyspnea in COVID-19 patients and if there is a relationship between neurological symptoms and the perception of dyspnea. METHODS: A structured interview regarding the occurrence of subjective neurological symptoms was performed and coupled with a questionnaire about the intensity and qualities of dyspnea. Respiratory rate (RR) and an arterial blood gas on room air were concurrently evaluated. RESULTS: Twenty-two patients (age 68.4 ± 13.9 years, 13 males and 9 females) were included and divided into two groups according to the Borg dyspnea scale: dyspneic patients BU ≥ 1(DYSP) and non-dyspneic patients BU < 1 (NDYSP). The prevalence of dyspnea overall was 31.8%. The prevalence of neurological symptoms, dyspnea descriptors, RR, pH, PaCO2, PaO2, or lactate was similar between groups. CONCLUSION: This study confirms that the prevalence of dyspnea is low in non-severe COVID-19 patients, but contrary to our hypothesis of a relationship between shortness of breath and neurological symptoms, we have not been able to find any evidence of an impairment in dyspnea perception, either in the DYSP or NDYSP group.


Assuntos
Betacoronavirus , Infecções por Coronavirus/diagnóstico , Autoavaliação Diagnóstica , Dispneia/diagnóstico , Doenças do Sistema Nervoso/diagnóstico , Percepção , Pneumonia Viral/diagnóstico , Idoso , Idoso de 80 Anos ou mais , Gasometria/métodos , Gasometria/psicologia , Infecções por Coronavirus/complicações , Infecções por Coronavirus/psicologia , Dispneia/etiologia , Dispneia/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doenças do Sistema Nervoso/etiologia , Doenças do Sistema Nervoso/psicologia , Pandemias , Pneumonia Viral/complicações , Pneumonia Viral/psicologia
3.
Medicine (Baltimore) ; 99(17): e19810, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32332623

RESUMO

INTRODUCTION: Hepatic portal venous gas (HPVG) is a rare imaging finding. When HPVG is accompanied with pneumatosis intestinalis (PI), the underlying cause is usually mesenteric ischemia with consequent intestinal necrosis. This combination of clinical conditions is associated with a poor prognosis. In this study, we present the cases of 2 elderly patients with HPVG and PI secondary to mesenteric ischemia. PATIENT CONCERNS: In case 1, a 89-year-old male patient was admitted to intensive care unit with respiratory failure, On the fifth day of admission, he developed a high fever (39.5°C) and abdominal distension. In case 2, a 92-year-old male patient admitted to our intensive care unit and received mechanical ventilation due to acute respiratory failure. During the treatment, the patient developed gastrointestinal bleeding. On physical examination, abdominal bulging and tense abdominal walls were detected. Both patients underwent abdominal contrast-enhanced computed tomography, showed abundant HPVG with PI. DIAGNOSES: The patients were diagnosed as acute mesenteric ischemia, bowel necrosis, septic shock, multiple organ dysfunction syndrome based on computed tomography scan, abdominal signs, and laboratory tests. INTERVENTIONS: Fluid resuscitation, high-dose vasopressors, and intravenous antibiotic therapy were given. OUTCOMES: Despite prompt treatment, the condition of both patients rapidly deteriorated, and the patients died shortly thereafter. CONCLUSION: Mesenteric ischemia is a clinical emergency. In patients with risk factors and abdominal signs, the clinical suspicion for this condition should be high. Although rare, both HPVG and PI are important radiological clues that usually indicate the presence of mesenteric ischemia with consequent intestinal necrosis.


Assuntos
Gasometria/métodos , Fígado/fisiopatologia , Isquemia Mesentérica/sangue , Veia Porta/fisiopatologia , Insuficiência Respiratória/sangue , Idoso de 80 Anos ou mais , Gasometria/estatística & dados numéricos , Humanos , Unidades de Terapia Intensiva/organização & administração , Unidades de Terapia Intensiva/estatística & dados numéricos , Masculino , Isquemia Mesentérica/etiologia , Isquemia Mesentérica/fisiopatologia , Insuficiência Respiratória/complicações , Insuficiência Respiratória/fisiopatologia , Tomografia Computadorizada por Raios X/métodos
5.
J Vet Emerg Crit Care (San Antonio) ; 30(3): 279-285, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32187439

RESUMO

OBJECTIVE: To compare the Element point-of-care (POC) portable blood gas analyzer with a laboratory-based bench-top reference analyzer using whole blood samples obtained from horses presenting to a referral center with various disorders in order to determine agreement between these analyzers. DESIGN: Prospective clinical study. SETTING: The study was conducted at a university teaching hospital at moderate altitude. ANIMALS: One hundred paired samples from 80 horses >1 year of age were collected after obtaining informed client consent. Fifty paired samples were from patients admitted for elective procedures and considered to be healthy, and 50 paired samples were emergency admissions and considered to be critically ill. MEASUREMENTS AND MAIN RESULTS: Paired whole blood samples were evaluated on both the Element POC and Radiometer ABL 800 FLEX analyzers simultaneously, and results were compared. Pearson correlation coefficients between analyzers were calculated. To assess agreement, scatter and Bland-Altman plots were evaluated, and mean difference and 95% limits of agreement were calculated for each analyte. Correlation was either good (0.8-0.92) or excellent (>0.93) for the majority of analytes. All analytes apart from hemoglobin had acceptable agreement, with ≥80% of individual results within agreement targets. Precision targets were acceptable for most analytes, with partial pressure of carbon dioxide (pCO2 ) and calcium (Ca2+ ) exceeding precision targets. CONCLUSIONS: The portable Element POC system had acceptable agreement with the ABL 800 FLEX bench-top analyzer currently in use at the study center when evaluating the majority of analytes from equine whole blood samples.


Assuntos
Gasometria/veterinária , Cavalos/sangue , Sistemas Automatizados de Assistência Junto ao Leito , Animais , Gasometria/instrumentação , Gasometria/métodos , Cálcio , Dióxido de Carbono/sangue , Hemoglobinas , Pressão Parcial , Estudos Prospectivos
6.
J Clin Neurosci ; 72: 50-56, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31982274

RESUMO

In this study, we correlate single breath count (SBC) with arterial blood gas (ABG) parameters to derive a cutoff point for intubation and mechanical ventilation (MV) in Guillain-Barré Syndrome (GBS). Ninety-four GBS patients underwent serial SBC at 2 Hz using an audio program. ABG was done at admission, and repeated if SBC declined. The patients were intubated based on "the modified intubation criteria" as follows (a + b or c): (a) hypoxia (PaO2 < 60 mm of Hg on ventimask); (b) hypercarbia (PaCO2 > 50 mm of Hg); (c) acidosis (pH < 7.3). The primary outcome was the absolute SBC at which patients had ABG alteration needing intubation. All the patients maintained a desired ABG without respiratory distress till SBC 7. At SBC 5, need for MV could be predicted with a sensitivity of 90.6% and specificity of 95.2%. Admission SBC cut-off of 13 and relative delta SBC at 24 h cut-off of > 20% had a negative predictive value of 88.5% (95% CI 77.0%-96.0%) and 80.8% (95% CI 60.7%-93.4%) respectively for ruling out need of MV. SBC is a useful non-invasive measure for monitoring respiratory function and guiding ABG analysis. Till SBC 7, repeated ABG may be avoided in GBS.


Assuntos
Gasometria/métodos , Síndrome de Guillain-Barré/diagnóstico , Hipóxia/diagnóstico , Espirometria/métodos , Gasometria/instrumentação , Gasometria/normas , Feminino , Síndrome de Guillain-Barré/complicações , Síndrome de Guillain-Barré/terapia , Humanos , Hipóxia/etiologia , Hipóxia/terapia , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Respiração Artificial/métodos , Espirometria/instrumentação , Espirometria/normas
7.
Respir Res ; 21(1): 27, 2020 Jan 20.
Artigo em Inglês | MEDLINE | ID: mdl-31959169

RESUMO

BACKGROUND AND OBJECTIVE: Reduced physical capacity (PC) and physical activity (PA) are common in COPD patients and associated with poor outcome. However, they represent different aspects of physical functioning and interventions do not affect them in the same manner. To address this, a new PC-PA quadrant concept was recently generated to identify clinical characteristics of sub-groups of physical functioning. The objective of this study was to I) proof the new concept and to verify their differentiating clinical characteristics, II) evaluate the consistency of the concept over time, III) assess whether patients changed their quadrant affiliation over time, IV) and to test if changes in quadrant affiliations are associated with changes in clinical characteristics. METHODS: In a longitudinal, prospective, non-interventional cohort with mild to very severe COPD patients, PC and PA as well as respiratory variables, COPD-specific health status, comorbidities, survival, and exacerbations were yearly assessed. RESULTS: Data from 283 patients were analysed at baseline. Mean (min/max) follow-up time was 2.4 (0.5/6.8) years. The PC-PA quadrants could be characterized as follows: I) "can't do, don't do": most severe and symptomatic, several comorbidities II) "can do, don't do": severe but less symptomatic, several comorbidities III) "can't do, do do": few patients, severe and symptomatic, less comorbidities IV) "can do, do do": mildest and less symptomatic, less comorbidities, lowest exacerbation frequency. Of the 172 patients with at least one follow-up, 58% patients never changed their quadrant affiliation, while 17% declined either PC, PA or both, 11% improved their PC, PA or both, and 14% showed improvement and decline in PC, PA or both during study period. None of the clinical characteristics or their annual changes showed consistent significant and relevant differences between all individual sub-groups. CONCLUSION: Our findings suggest that there are no clinical characteristics allowing to distinguish between the PC-PA quadrants and the concept seems not able to illustrate disease process. However, the already low PA but preserved PC in the "can do, don't do" quadrant raises the question if regularly assessment of PA in clinical practice would be more sensitive to detect progressive deterioration of COPD compared to the commonly used PC. CLINICAL TRIAL REGISTRATION: www.ClinicalTrials.gov, NCT01527773.


Assuntos
Atitude Frente a Saúde , Exercício Físico/fisiologia , Exercício Físico/psicologia , Doença Pulmonar Obstrutiva Crônica/metabolismo , Doença Pulmonar Obstrutiva Crônica/psicologia , Idoso , Gasometria/métodos , Estudos de Coortes , Feminino , Seguimentos , Humanos , Estudos Longitudinais , Medidas de Volume Pulmonar/métodos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Doença Pulmonar Obstrutiva Crônica/terapia
8.
Chin Med J (Engl) ; 133(2): 229-234, 2020 Jan 20.
Artigo em Inglês | MEDLINE | ID: mdl-31904726

RESUMO

The oxygen reserve index (ORI) is a new technology that provides real-time, non-invasive, and continuous monitoring of patients' oxygenation status. This review aimed to discuss its clinical utility, prospect and limitations. A systematic literature search of PubMed, MEDLINE, Google Scholar, and ScienceDirect was performed with the keywords of "oxygen reserve index," "ORI," "oxygenation," "pulse oximetry," "monitoring," and "hyperoxia." Original articles, reviews, case reports, and other relevant articles were reviewed. All articles on ORI were selected. ORI can provide an early warning before saturation begins to decrease and expands the ability to monitor the human body's oxygenation status noninvasively and continuously with the combination of pulse oximetry so as to avoid unnecessary hyperoxia or unanticipated hypoxia. Although the technology is so new that it is rarely known and has not been applied to routine practices in hospitals, it shows good prospects for critical care, oxygen therapy, and intraoperative monitoring.


Assuntos
Oxigenoterapia/métodos , Gasometria/métodos , Humanos , Monitorização Fisiológica/métodos , Oximetria/métodos
9.
BJOG ; 127(3): 405-413, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31762140

RESUMO

OBJECTIVE: To determine variations in cord blood gas (CBG) parameters after 3-minute delayed cord clamping (DCC) in vaginal deliveries (VDs) and caesarean deliveries (CDs) at term without fetal distress. DESIGN: Prospective observational study. SETTING: University hospital. SAMPLE: CBG from 97 VDs and 124 CDs without fetal distress. METHODS: Comparison of paired arterial-venous CBG parameters drawn at birth from the unclamped cord and after 3-minutes DCC for VDs and CDs. MAIN OUTCOME MEASURES: Base excess, bicarbonate, haematocrit and haemoglobin from both arterial and venous cord blood, lactate, neonatal outcomes, partial pressure of oxygen (pO2 ), partial pressure of carbon dioxide (pCO2 ), pH, and postpartum haemorrhage. RESULTS: Arterial cord blood pH, bicarbonate ( HCO 3 - , mmol/l), and base excess (BE, mmol/l) decreased significantly after 3-minute DCC both in VDs (pH = 7.23 versus 7.27; P < 0.001; HCO 3 -  = 23.3 versus 24.3; P = 0.004; BE = -5.1 versus -2.9; P < 0.001) and CDs (pH = 7.28 versus 7.34; P < 0.001; HCO 3 -  = 26.2 versus 27.2; P < 0.001; BE = -1.5 versus 0.7; P < 0.001). After 3-minute DCC, pCO2 increased in CDs only (57 versus 51; P < 0.001), whereas lactate increased more in CDs compared with VDs (lactate, +1.1 [0.9, 1.45] versus +0.5 [-0.65, 2.35]; P = 0.01). Postpartum maternal haemorrhage, neonatal maximum bilirubin concentration, and need for phototherapy were similar between the two groups. Newborns born by CD more frequently required postnatal clinical monitoring or admission to a neonatal intensive care unit. CONCLUSIONS: After 3-minute DCC, the acid-base status shifted towards mixed acidosis in CDs and prevalent metabolic acidosis in VDs. CDs were associated with a more pronounced increase in arterial lactate, compared with VDs. TWEETABLE ABSTRACT: By 3-minute DCC, acid-base status shifts towards mixed and metabolic acidosis in caesarean and vaginal delivery, respectively.


Assuntos
Acidose , Cesárea , Parto Obstétrico , Sangue Fetal/metabolismo , Complicações do Trabalho de Parto , Cordão Umbilical/cirurgia , Acidose/sangue , Acidose/diagnóstico , Acidose/etiologia , Gasometria/métodos , Cesárea/efeitos adversos , Cesárea/métodos , Cesárea/estatística & dados numéricos , Constrição , Parto Obstétrico/efeitos adversos , Parto Obstétrico/métodos , Parto Obstétrico/estatística & dados numéricos , Feminino , Humanos , Recém-Nascido , Itália/epidemiologia , Masculino , Complicações do Trabalho de Parto/diagnóstico , Complicações do Trabalho de Parto/epidemiologia , Complicações do Trabalho de Parto/etiologia , Gravidez , Resultado da Gravidez/epidemiologia , Tempo para o Tratamento
10.
J Matern Fetal Neonatal Med ; 33(2): 283-288, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29898632

RESUMO

Objective: This study used near-infrared spectroscopy (NIRS) to detect the pulmonary regional oxygen saturation (rSO2) of premature infants. The oxygenation state of the lung tissue was also evaluated, which provided preliminary evidence regarding the application of NIRS in oxygen therapy for premature infants.Methods: NIRS was used to measure the pulmonary rSO2 of 26 premature infants (gestational age <32 weeks). The correlations between pulmonary rSO2 and the arterial partial pressure of oxygen (PaO2), arterial oxygen saturation (SaO2), and pulse oxygen saturation (SpO2) were analyzed. The diagnostic value of NIRS was evaluated via both Pearson's correlation and receiver operating characteristic (ROC) curve analyses.Results: Pulmonary rSO2 was positively correlated with both PO2 and SaO2; the linear correlation coefficients (r) were 0.544 (p = .004) and 0.515 (p = .007), respectively. No significant correlation was found between rSO2 and SpO2 (p = .098). SpO2 was positively correlated with PO2 (r = 0.402, p = .042) and SaO2 (r = 0.625, p = .001). NIRS could be used to predict hypoxemia (area under the curve [AUC] = 0.843; Youden's index =0.654) when the pulmonary rSO2 was 62.39%, the sensitivity was 88.9%, and the specificity was 23.5% (p = .005) as well as predict hyperoxemia (AUC = 0.775; Youden's index = 0.65) when the pulmonary rSO2 was 61.99%, the sensitivity was 100%, and the specificity was 35% (p = .045). SpO2 predicted hypoxemia (AUC = 0.784, p = .019) but not hyperoxemia (AUC = 0.7, p = .144).Conclusion: NIRS objectively reflects the changes in oxygenation in the lung tissue. This study provides evidence for the clinical application of NIRS.


Assuntos
Oxigênio/sangue , Espectroscopia de Luz Próxima ao Infravermelho/métodos , Gasometria/métodos , Feminino , Idade Gestacional , Humanos , Hipóxia/prevenção & controle , Recém-Nascido , Recém-Nascido Prematuro , Doenças do Prematuro/prevenção & controle , Pulmão/irrigação sanguínea , Masculino , Oxigenoterapia/métodos , Fluxo Sanguíneo Regional
11.
J Clin Neurosci ; 71: 213-216, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31864831

RESUMO

Transcranial Doppler sonography (TCD) assayed cerebral blood flow (CBF) may vary between different intracranial pathologies. Blood gas analysis of the jugular bulb provides a novel way to estimate the global relationship between CBF and oxygen metabolism. In this study, 25 patients with brain trauma, spontaneous intracerebral hemorrhage, and acute cerebral infarction were recruited. Jugular venous oxygen saturation (SjvO2) increased significantly at different time points after hyperventilation (p < 0.05). A negative correlation between the partial pressure of CO2 between jugular venous bulb and radial artery blood (P(jv-a)CO2) and CBF could be observed in acute brain injury and spontaneous intracerebral hemorrhage groups, while P(jv-a)CO2 and CBF show positive correlation in acute cerebral infarction group. Our results suggest that serial P(jv-a)CO2 analysis combing with SjvO2 can be utilized to monitor the change of CBF for patients undergoing craniocerebral surgery.


Assuntos
Lesões Encefálicas Traumáticas/sangue , Dióxido de Carbono/sangue , Hemorragia Cerebral/sangue , Infarto Cerebral/sangue , Monitorização Fisiológica/métodos , Oxigênio/sangue , Adulto , Gasometria/métodos , Encéfalo/irrigação sanguínea , Circulação Cerebrovascular/fisiologia , Feminino , Humanos , Veias Jugulares , Masculino , Pessoa de Meia-Idade , Oximetria/métodos , Ultrassonografia Doppler Transcraniana
12.
PLoS One ; 14(12): e0226851, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31887165

RESUMO

BACKGROUND: Due to the current poaching crisis in Africa, increasing numbers of white rhinoceroses (Ceratotherium simum) require opioid immobilisation for medical interventions or management procedures. Alarmingly, the results of both blood gas analysis and pulse oximetry regularly indicate severe hypoxaemia. Yet, the recovery of the animals is uneventful. Thus, neither of the techniques seems to represent the real oxygenation level. We hypothesized that unusual haemoglobin characteristics of this species interfere with the techniques developed and calibrated for the use in human patients. METHODS: Haemoglobin was isolated from blood samples of four adult, white rhinoceroses. Oxygen dissociation curves at pH 7.2 and 7.4 (37°C) were determined based on the absorbance change of haemoglobin in the Soret-region (around 420 nm). Absorbance spectra of oxy- and deoxyhaemoglobin extending into the infrared region were measured. RESULTS: Oxygen dissociation curves of rhinoceros haemoglobin showed the typical high oxygen affinity (p50 of 2.75 ± 0.07 and 2.00 ± 0.04 kPa for pH 7.2 and 7.4, respectively) under near-physiological conditions with respect to pH, temperature and DPG. The infrared absorbance spectra of oxy- and deoxyhaemoglobin showed only marginal deviations from standard human spectra, possibly due to the presence of a few percent of methaemoglobin in vitro. CONCLUSIONS: Our data enables the development of a rhinoceros-specific blood gas analysis algorithm, which allows for species-specific calculation of SaO2 levels in anaesthetized animals. The inconspicuous absorbance spectra do not contribute to the systematic underestimation of SpO2 by pulse-oximetry.


Assuntos
Hemoglobinas/metabolismo , Oxigênio/sangue , Perissodáctilos/sangue , África , Algoritmos , Analgésicos Opioides , Animais , Gasometria/métodos , Gasometria/normas , Hemoglobinas/química , Humanos , Concentração de Íons de Hidrogênio , Oximetria/normas , Espectrofotometria/métodos
13.
Med. intensiva (Madr., Ed. impr.) ; 43(9): 521-527, dic. 2019. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-185898

RESUMO

Objetivo: Evaluar las diferencias observadas en la determinación de los iones y del anión GAP obtenidos por gasometría (POC) y por bioquímica de laboratorio, y analizar los posibles errores en función de los límites de normalidad. Material y métodos: Estudio descriptivo transversal retrospectivo para valorar la concordancia entre dos pruebas diagnósticas de los pacientes ingresados en la Unidad de Reanimación del Complexo Hospitalario Universitario de Ourense, entre julio y noviembre de 2015, con al menos una determinación coincidente de bioquímica y POC. Se excluyeron pacientes menores de 18años. Resultados: Se analizaron 1.073 muestras. Coeficientes de correlación de concordancia de Lin en sodio, potasio y cloro de 0,87, 0,84 y 0,72, respectivamente. Concordancia kappa de los límites de normalidad para sodio, potasio y cloro de 0,63, 0,74 y 0,32. Pobre correlación del anión GAP y nula concordancia entre el POC y el calculado por la bioquímica, incluido el corregido por albúmina. Conclusiones: Concordancia pobre entre los iones de la bioquímica y la gasometría, por lo que no son intercambiables. Concordancia kappa con los límites de normalidad buena para el sodio y potasio, y débil para el cloro. Posible validez para una orientación en la clasificación dentro de los límites de los iones, excepto para el cloro. Nula concordancia para el anión GAP, incluso el corregido por albúmina


Objective: To evaluate the differences observed in ion and GAP anion determinations obtained by point-of-care (POC) blood gas versus laboratory biochemical testing, and to analyze the possible errors according to the limits of normality. Material and methods: A descriptive, cross-sectional retrospective study was made to assess concordance between two diagnostic tests in patients admitted to the Critical Care Unit of Ourense University Hospital Complex (Spain), between July and November 2015, involving at least one coinciding biochemical test and POC determination. Patients under 18years of age were excluded. Results: A total of 1,073 samples were analyzed. Lin's concordance correlation coefficients for sodium, potassium and chlorine were 0.87, 0.84 and 0.72, respectively. Kappa concordance of the normality limits for sodium, potassium and chlorine was 0.63, 0.74 and 0.32. The results indicated poor correlation of the anion GAP and null concordance between POC and biochemical testing, including the value corrected for albumin. Conclusions: Poor concordance was observed between the ion values as determined by biochemistry and blood gases; the two methods are therefore not interchangeable. Kappa agreement with normality limits was good for sodium and potassium, and weak for chlorine. Possible validity was noted in orienting the classification within the ion limits, with the exception of chlorine. No agreement was recorded in relation to the anion GAP, even that corrected for albumin


Assuntos
Humanos , Equilíbrio Ácido-Base , Gasometria/métodos , Cuidados Críticos , Desequilíbrio Ácido-Base/sangue , Íons/análise , Sistemas Automatizados de Assistência Junto ao Leito , Estudos Transversais , Estudos Retrospectivos , Manejo de Espécimes/estatística & dados numéricos , Sódio/análise
14.
Rev. lab. clín ; 12(4): e66-e74, oct.-dic. 2019.
Artigo em Espanhol | IBECS | ID: ibc-187312

RESUMO

El análisis de gases en sangre es una prueba frecuentemente solicitada en diferentes ámbitos hospitalarios. La medida de los parámetros incluidos en este análisis puede verse afectada por un elevado número de condiciones preanalíticas y es responsabilidad del laboratorio garantizar que los resultados reflejan de forma segura el equilibrio ácido-base y el estado de oxigenación del paciente. Aunque muchas de estas condiciones son comunes al resto de las magnitudes del laboratorio, como la identificación correcta del espécimen, algunas son propias del análisis de gases debido a la estabilidad de las magnitudes incluidas en él. Este documento establece recomendaciones para el control de las condiciones preanalíticas y otras fuentes de error relacionadas con el análisis de gases en sangre, tales como las características de los materiales empleados para la toma de muestra (jeringas, agujas y anticoagulantes), tipo de muestra (sangre arterial, venosa y capilar «arterializada») y las condiciones para el manejo y transporte de la muestra, incluyendo la influencia del tiempo transcurrido entre la extracción y el análisis, la temperatura de la muestra durante el transporte y el transporte en sí


Blood gas analysis is a commonly ordered test in different hospital settings. The measurement of the parameters included in this analysis is vulnerable to a huge number of pre-analytical conditions. Laboratory staff are responsible for ensuring that these results accurately reflect the acid-base and oxygenation status of the patient. Despite many pre-analytical steps in blood gas testing being common to other laboratory tests, such as proper sample identification, others are particular for this determination, such as the stability of the analytes measured. The aim of this document is to provide recommendations for the control of the pre-analytical variables and other error sources related to blood gas analysis. These include the characteristics of the materials used to collect the blood samples (syringes, needles and anticoagulants), the sample types (arterial, venous and «arterialised» capillary blood), as well as the conditions for sample handling and transport, including the effect of the time between sampling and analysis, the temperature during transport, and the type of transport


Assuntos
Humanos , Fase Pré-Analítica/métodos , Desequilíbrio Ácido-Base/diagnóstico , Gasometria/métodos , Equilíbrio Ácido-Base/fisiologia , Guias como Assunto , Ácido Carbônico/análise , Bicarbonatos/análise , Dióxido de Carbono/análise , Oximetria/métodos , Manejo de Espécimes/métodos , Anticoagulantes/uso terapêutico
16.
Physiol Int ; 106(3): 261-271, 2019 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-31602997

RESUMO

It has been shown that the tissue oxygen index (TOI) measured by near-infrared spectroscopy oscillates at very low frequencies during recovery after exercise and that this oscillation is derived from interactions among biochemical substances involved in oxidative metabolism in skeletal muscle. As a further step, we examined whether TOI in muscle interacts through oscillation with factors related to oxygen in the cardiorespiratory system. For this examination, coherence and phase difference between the TOI in the vastus lateralis and heart rate (HR) and between TOI and arterial oxygen saturation (SpO2) were sequentially determined during recovery (2-60 min) after severe cycle exercise with a workload of 7.5% of body weight for 20 s. Significant coherence between TOI and HR was obtained in the very low-frequency band (approximate range: 0.002-0.03 Hz) and in the low-frequency band (approximate range: 0.06-0.12 Hz). The phase difference was negative in the low-frequency band and positive in the very low-frequency band. The coherence between TOI and SpO2 was significant in the very low-frequency band. The phase difference was negative. There were no sequential changes in these coherences and phase differences. The results suggest that TOI in skeletal muscle interrelates with factors related to the heart and lungs.


Assuntos
Exercício Físico/fisiologia , Coração/fisiologia , Pulmão/fisiologia , Músculo Esquelético/fisiologia , Consumo de Oxigênio/fisiologia , Oxigênio/metabolismo , Adulto , Gasometria/métodos , Teste de Esforço/métodos , Frequência Cardíaca/fisiologia , Humanos , Pulmão/metabolismo , Masculino , Contração Muscular/fisiologia , Músculo Esquelético/metabolismo , Músculo Quadríceps/metabolismo , Músculo Quadríceps/fisiologia , Adulto Jovem
17.
Clin Respir J ; 13(12): 795-799, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31559694

RESUMO

Williams-Campbell syndrome, is a rare disorder characterized by a deficiency of cartilage in subsegmental bronchi, leading to distal airway collapse and bronchiectasis, which typically affects the fourth- to sixth-order bronchi. This article reported a 31-year-old female patient who was diagnosed with Williams-Campbell syndrome with pulmonary hypertension and Type 2 respiratory failure due to extensive cystic bronchiectasis. CT of the thorax showed the affected bronchi had characteristic ballooning on inspiration and collapse on expiration.


Assuntos
Brônquios/diagnóstico por imagem , Hipertensão Pulmonar/etiologia , Insuficiência Respiratória/etiologia , Traqueobroncomalácia/complicações , Adulto , Antibacterianos/uso terapêutico , Gasometria/métodos , Brônquios/patologia , Bronquiectasia/complicações , Broncodilatadores/uso terapêutico , Broncoscopia/métodos , Erros de Diagnóstico , Diuréticos/uso terapêutico , Ecocardiografia/métodos , Feminino , Humanos , Oxigenoterapia/métodos , Pressão , Artéria Pulmonar/diagnóstico por imagem , Testes de Função Respiratória/métodos , Testes de Função Respiratória/estatística & dados numéricos , Insuficiência Respiratória/sangue , Insuficiência Respiratória/classificação , Tomografia Computadorizada por Raios X/métodos , Traqueobroncomalácia/diagnóstico por imagem , Traqueobroncomalácia/fisiopatologia , Traqueobroncomalácia/terapia , Resultado do Tratamento
19.
Clin Lab ; 65(8)2019 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-31414738

RESUMO

BACKGROUND: Accurate chloride measurement is important in critically ill patients. METHODS: Chloride concentration measured simultaneously between the central laboratory (indirect ion-selective electrode) and blood gas analysis (direct ion-selective electrode) were compared. RESULTS: We report a discrepancy with chloride measurement between the central laboratory and blood gas analysis at low bicarbonate levels. CONCLUSIONS: Caution should be applied while interpreting the chloride concentration when indirect ion-selective electrode methodology is used, especially in the setting of low serum bicarbonate levels.


Assuntos
Bicarbonatos/análise , Gasometria/métodos , Cloretos/análise , Estado Terminal , Bicarbonatos/sangue , Gasometria/instrumentação , Cloretos/sangue , Eletrodos , Humanos , Concentração de Íons de Hidrogênio , Potássio/análise , Potássio/sangue , Sódio/análise , Sódio/sangue
20.
Intensive Care Med ; 45(9): 1219-1230, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31432216

RESUMO

PURPOSE: To describe the variability and determinants of the effect of extracorporeal CO2 removal (ECCO2R) on tidal volume (Vt), driving pressure (ΔP), and mechanical power (PowerRS) and to determine whether highly responsive patients can be identified for the purpose of predictive enrichment in ECCO2R trial design. METHODS: Using data from the SUPERNOVA trial (95 patients with early moderate acute respiratory distress syndrome), the independent effects of alveolar dead space fraction (ADF), respiratory system compliance (Crs), hypoxemia (PaO2/FiO2), and device performance (higher vs lower CO2 extraction) on the magnitude of reduction in Vt, ΔP, and PowerRS permitted by ECCO2R were assessed by linear regression. Predicted and observed changes in ΔP were compared by Bland-Altman analysis. Hypothetical trials of ECCO2R, incorporating predictive enrichment and different target CO2 removal rates, were simulated in the SUPERNOVA study population. RESULTS: Changes in Vt permitted by ECCO2R were independently associated with ADF and device performance but not PaO2/FiO2. Changes in ΔP and PowerRS were independently associated with ADF, Crs, and device performance but not PaO2/FiO2. The change in ΔP predicted from ADF and Crs was moderately correlated with observed change in ΔP (R2 0.32, p < 0.001); limits of agreement between observed and predicted changes in ΔP were ± 3.9 cmH2O. In simulated trials, restricting enrollment to patients with a larger predicted decrease in ΔP enhanced the average reduction in ΔP, increased predicted mortality benefit, and reduced sample size and screening size requirements. The increase in statistical power obtained by restricting enrollment based on predicted ΔP response varied according to device performance as specified by the target CO2 removal rate. CONCLUSIONS: The lung-protective benefits of ECCO2R increase with higher alveolar dead space fraction, lower respiratory system compliance, and higher device performance. ADF and Crs, rather than severity of hypoxemia, should be the primary factors determining whether to enroll patients in clinical trials of ECCO2R.


Assuntos
Dióxido de Carbono/sangue , Circulação Extracorpórea/normas , Oxigenação por Membrana Extracorpórea/métodos , Resultado do Tratamento , Adulto , Idoso , Gasometria/métodos , Circulação Extracorpórea/métodos , Circulação Extracorpórea/estatística & dados numéricos , Oxigenação por Membrana Extracorpórea/tendências , Feminino , Humanos , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Escores de Disfunção Orgânica , Projetos Piloto , Curva ROC , Escala Psicológica Aguda Simplificada
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