Blood gas analysis as a surrogate for microhemodynamic monitoring in sepsis

BACKGROUND:Emergency patients with sepsis or septic shock are at high risk of death.Despite increasing attention to microhemodynamics,the clinical use of advanced microcirculatory assessment is limited due to its shortcomings.Since blood gas analysis is a widely used technique reflecting global oxygen supply and consumption,it may serve as a surrogate for microcirculation monitoring in septic treatment.METHODS:We performed a search using PubMed,Web of Science,and Google scholar.The studies and reviews that were most relevant to septic microcirculatory dysfunctions and blood gas parameters were identified and included.RESULTS:Based on the pathophysiology of oxygen metabolism,the included articles provided a general overview of employing blood gas analysis and its derived set of indicators for microhemodynamic monitoring in septic care.Notwithstanding flaws,several parameters are linked to changes in the microcirculation.A comprehensive interpretation of blood gas parameters can be used in order to achieve hemodynamic optimization in septic patients.CONCLUSION:Blood gas analysis in combination with clinical performance is a reliable alternative for microcirculatory assessments.A deep understanding of oxygen metabolism in septic settings may help emergency physicians to better use blood gas analysis in the evaluation and treatment of sepsis and septic shock.

An investigation of the effects of dust storms on rat lung using HRCT and blood gas analysis

The increasing intensity and frequency of sand-dust storms in China has led to greater prominence of associated environmentaland health issues. Many studies have focused on the health effects of air particulate contaminants, but fewformal investigations have studied the effects of sand-dust storms on human and animal health. The aim of this study wasto investigate the effects of dust storms on rat lung by using high resolution computed tomography （HRCT） and blood gasanalysis through a wind tunnel simulating. We found that the rat lung damage effects can be detected by the HRCT imagingafter exposure to sand-dust storm environments, but had no obvious result through blood gas analysis. Exposure durationspositively correlated with the damage degree to lung tissue. These will provide some evidence for clinical diagnosis ofnon-occupational pneumoconiosis.

Effect of blood gas analysis in patients with bed rest and blood sampling through the dorsal artery:A meta-analysis

Objective:To systematic evaluation by the dorsalis pedis artery puncture for bed patients blood gas analysis of application effect of impact.Methods:A randomized controlled trial of the effect of arterial blood extraction on blood gas analysis in PubMed,CNKI,Wanfang database and VIP database.After selecting the literature,extracting the data and evaluating the quality of the literature.Meta- analysis was carried out by RevMan 5.3 software.Results:Twelve randomized controlled trials were included and 1696 patients were enrolled.After meta-analysis,the arterial puncture can effectively improve the success of arterial puncture in patients with bed [Z = 5.78,95%CI(1.90,3.66),P<0.001],reduce the occurrence of hematoma [Z = 4.27,95%CI(0.19,0.54),P<0.001],reduce the mistaken into the vein [Z = 4.60,95%CI(0.08,0.36),P<0.001],reduce cyanosis [Z = 2.84,95%CI(0.23,0.81),P<0.008],the difference was statistically significant.Conclusion:Dorsalis pedis artery puncture can improve the success rate of blood gas analysis in bedridden patients,reduce the incidence of hematoma and the incidence of venous leakage,and can be widely used in clinical practice.

Lung ultrasound score evaluation of the effect of pressure-controlled ventilation volume-guaranteed on patients undergoing laparoscopicassisted radical gastrectomy

BACKGROUND Laparoscopic-assisted radical gastrectomy(LARG)is the standard treatment for early-stage gastric carcinoma(GC).However,the negative impact of this proce-dure on respiratory function requires the optimized intraoperative management of patients in terms of ventilation.AIM To investigate the influence of pressure-controlled ventilation volume-guaranteed(PCV-VG)and volume-controlled ventilation(VCV)on blood gas analysis and pulmonary ventilation in patients undergoing LARG for GC based on the lung ultrasound score(LUS).METHODS The study included 103 patients with GC undergoing LARG from May 2020 to May 2023,with 52 cases undergoing PCV-VG(research group)and 51 cases undergoing VCV(control group).LUS were recorded at the time of entering the operating room(T0),20 minutes after anesthesia with endotracheal intubation(T1),30 minutes after artificial pneumoperitoneum(PP)establishment(T2),and 15 minutes after endotracheal tube removal(T5).For blood gas analysis,arterial partial pressure of oxygen(PaO_(2))and partial pressure of carbon dioxide(PaCO_(2))were observed.Peak airway pressure(P_(peak)),plateau pressure(Pplat),mean airway pressure(P_(mean)),and dynamic pulmonary compliance(C_(dyn))were recorded at T1 and T2,1 hour after PP establishment(T3),and at the end of the operation(T4).Postoperative pulmonary complications(PPCs)were recorded.Pre-and postoperative serum interleukin(IL)-1β,IL-6,and tumor necrosis factor-α(TNF-α)were measured by enzyme-linked immunosorbent assay.RESULTS Compared with those at T0,the whole,anterior,lateral,posterior,upper,lower,left,and right lung LUS of the research group were significantly reduced at T1,T2,and T5;in the control group,the LUS of the whole and partial lung regions(posterior,lower,and right lung)decreased significantly at T2,while at T5,the LUS of the whole and some regions(lateral,lower,and left lung)increased significantly.In comparison with the control group,the whole and regional LUS of the research group were reduced at T1,T2,and T5,with an increase in PaO_(2),decrease in PaCO_(2),reduction in P_(peak) at T1 to T4,increase in P_(mean) and C_(dyn),and decrease in Pplat at T4,all significant.The research group showed a significantly lower incidence of PPCs than the control group within 3 days postoperatively.Postoperative IL-1β,IL-6,and TNF-αsignificantly increased in both groups,with even higher levels in the control group.CONCLUSION LUS can indicate intraoperative non-uniformity and postural changes in pulmonary ventilation under PCV-VG and VCV.Under the lung protective ventilation strategy,the PCV-VG mode more significantly improved intraop-erative lung ventilation in patients undergoing LARG for GC and reduced lung injury-related cytokine production,thereby alleviating lung injury.

A retrospective analysis of the relationship between dermatomyositis-associated interstitial lung disease and disease duration,age,arterial blood gas pH,and serum Cl^(-)levels

Background:Dermatomyositis-associated interstitial lung disease(DM-ILD)represents a severe and insidious complication of dermatomyositis(DM).The study aimed to investigate the association between DM-ILD and arterial blood gas indices,serum ion levels,and the timing of interstitial lung disease onset,with the goal of identifying potential predictors for DM-ILD.Methods:The investigation involved the collection of basic data from 89 patients with DM hospitalized at the Chinese PLA General Hospital between January 2019 and April 2022,and 43 normal control patients hospitalized for physical examinations during the same period.Analyses were conducted to explore the relationship between DM-ILD,arterial blood gas indices,disease duration,and serum ions.A regression model to predict DM-ILD was developed using these indices,and a receiver operating characteristic curve was generated.Results:Significant differences were observed in pH and PaO2 between the control group and the disease group(p<0.05).The DM group exhibited higher levels of pH,actual bicarbonate,and base excess(BE)compared with the control group.In contrast,pH and BE levels were lower in the DM-ILD group than in the DM group,with these differences being statistically significant(p<0.05).Interstitial lung disease was correlated with the duration of the disease and pH levels(p<0.05).The cutoff values for age,disease duration,pH,and Cl^(-)were 55.5 years,5.5 years,7.432,and 101.5 mmol/L,respectively.The model demonstrated a prediction sensitivity and specificity for DM-ILD of 0.809 and 0.722,respectively,with an area under the curve of 0.809.Conclusion:Arterial blood gas analysis and serum Cl^(-)levels may assist in predicting DM-ILD.A combined monitoring approach involving arterial blood gas pH,disease duration,age,and serum Cl^(-)levels could enhance the accuracy of DM-ILD predictions and hold significant clinical evaluation potential.

Effects of nursing team communication and collaboration on treatment outcomes in intensive care unit patients with severe pneumonia

BACKGROUND Severe pneumonia is a common severe respiratory infection worldwide,and its treatment is challenging,especially for patients in the intensive care unit(ICU).AIM To explore the effect of communication and collaboration between nursing teams on the treatment outcomes of patients with severe pneumonia in ICU.METHODS We retrospectively analyzed 60 patients with severe pneumonia who were treated at the ICU of the hospital between January 1,2021 and December 31,2023.We compared and analyzed the respiratory mechanical indexes[airway resistance(Raw),mean airway pressure(mPaw),peak pressure(PIP)],blood gas analysis indexes(arterial oxygen saturation,arterial oxygen partial pressure,and oxygenation index),and serum inflammatory factor levels[C-reactive protein(CRP),procalcitonin(PCT),cortisol(COR),and high mobility group protein B1(HMGB1)]of all patients before and after treatment.RESULTS Before treatment,there was no significant difference in respiratory mechanics index and blood gas analysis index between 2 groups(P>0.05).However,after treatment,the respiratory mechanical indexes of patients in both groups were significantly improved,and the improvement of Raw,mPaw,plateau pressure,PIP and other indexes in the combined group after communication and collaboration with the nursing team was significantly better than that in the single care group(P<0.05).The serum CRP and PCT levels of patients were significantly decreased,and the difference was statistically significant compared with that of nursing group alone(P<0.05).The levels of serum COR and HMGB1 before and after treatment were also significantly decreased between the two groups.CONCLUSION The communication and collaboration of the nursing team have a significant positive impact on respiratory mechanics indicators,blood gas analysis indicators and serum inflammatory factor levels in the treatment of severe pneumonia patients in ICU.

Experimental study on therapy of ultraviolet blood irradiation and oxygenation in acute soman intoxication in rabbits

Objective:To study the therapy effect of ultraviolet blood irradiation and oxygenation （UBIO） on blood AChe activity and lung injury due to acute soman intoxication in rabbits. Methods:Forty rabbits were randomly divided into 4 groups: normal control group, intoxication group, routine therapy group and UBIO therapy group. Blood AChe activity and artery blood gas were analyzed 2 h after intoxication. ACP and AKP activities in BALF were determined respectively. Results:Blood AChe activity in intoxication group was lower than that in normal control group （P<0.05）. BALF ACP and AKP activities in intoxication group were higher than that in normal control group. Blood AChe activities in UBIO therapy group increased and were higher than that in intoxication and routine therapy groups. Compared with intoxication group, BALF ACP and AKP activities were decreased （P<0.05） in UBIO therapy group, while artery blood pH, PaO2 and SaO2 increased （P<0.05）. Conclusion: UBIO therapy can elevate blood AChe activity and alleviate lung injury induced by soman intoxication. So it may be a new way to treat acute soman intoxication.

Algorithm-based arterial blood sampling recognition increasing safety in point-of-care diagnostics

AIM To detect blood withdrawal for patients with arterial blood pressure monitoring to increase patient safety and provide better sample dating.METHODS Blood pressure information obtained from a patient monitor was fed as a real-time data stream to an experimental medical framework. This framework was connected to an analytical application which observes changes in systolic, diastolic and mean pressure to determine anomalies in the continuous data stream. Detection was based on an increased mean blood pressure caused by the closing of the withdrawal three-way tap and an absence of systolic and diastolic measurements during this manipulation. For evaluation of the proposed algorithm, measured data from animal studies in healthy pigs were used.RESULTS Using this novel approach for processing real-time measurement data of arterial pressure monitoring, the exact time of blood withdrawal could be successfully detected retrospectively and in real-time. The algorithm was able to detect 422 of 434(97%) blood withdrawals for blood gas analysis in the retrospective analysis of 7 study trials. Additionally, 64 sampling events for other procedures like laboratory and activated clotting time analyses were detected. The proposed algorithm achieved a sensitivity of 0.97, a precision of 0.96 and an F1 score of 0.97.CONCLUSION Arterial blood pressure monitoring data can be used toperform an accurate identification of individual blood samplings in order to reduce sample mix-ups and thereby increase patient safety.

Neuroprotection of hyperbaric oxygen therapy in sub-acute traumatic brain injury:not by immediately improving cerebral oxygen saturation and oxygen partial pressure

Although hyperbaric oxygen （HBO） therapy can promote the recovery of neural function in patients who have suffered traumatic brain injury （TBI）, the underlying mechanism is unclear. We hypothesized that hyperbaric oxygen treatment plays a neuroprotective role in TBI by increasing regional transcranial oxygen saturation （rSO2） and oxygen partial pressure （PaO2）. To test this idea, we compared two groups： a control group with 20 healthy people and a treatment group with 40 TBI patients. The 40 patients were given 100% oxygen of HBO for 90 minutes. Changes in rSO2 were measured. The controls were also examined for rSO2 and PaO2, but received no treatment, rSO2 levels in the patients did not differ significantly after treatment, but levels before and after treatment were significantly lower than those in the control group. PaO2 levels were significantly decreased after the 30-minute HBO treatment. Our findings suggest that there is a disorder of oxygen metabolism in patients with sub-acute TBI. HBO does not immediately affect cerebral oxygen metabolism, and the underlying mechanism still needs to be studied in depth.

THE CHANGE OF ARTERIOVENOUS CARBON DIOXIDE AND pH GRADIENTS DURING SEVERE HEMORRHAGIC SHOCK AND RESUSCITATION

Objective. To investigate clinically useful markers for determining the seventy of hemorrhagic shock and adequacy of resuscitation Methods. Prospective study was undertaken in 12 dogs, using an established model for hemorrhagic shock. The anesthetized dogs were bled to a mean arterial pressure of 40 mmHg which was maintained for 3 hours. Then each animal was resuscitated with heperinized whole blood followed by intravenous infusion of dobutamine at a rate of 5 ug. kg-1. min-1 for 10 minutes. Arterial and mixed venous blood gases, arterial lactate concentrations and hemodynamic Parameters were measured throughout the study. Results. A difference in the PCO2 and pH values between arterial and mixed venous blood was observed. Arterial-venous PCO2 and pH difference increased significantly after sustained shock. The arteriovenous carbon dioxide and pH gradients recovered more rapidly than arterial lactate levels after successful resuscitation with blood and dobutamine. Conclusion. Arterial blood gases fail to reflect the acid-base status of tissues during hemorrhagic shock. The differences in PCO2 and pH values between arterial and mixed venous blood could be used as clinical in- dicators for assessing the seventy of shock and efficacy of resuscitation.

Effect of endobronchial blocker tube in the pulmonary carcinoma with video-assisted thoracic surgery

Objective:The aim of this study was to observe the effect of endobronchial blocker tube in the pulmonary carcinoma with video-assisted thoracic surgery.Methods:Forty patients of pulmonary carcinoma with video-assisted thoracic surgery were randomly assigned into two groups with twenty cases each:endobronchial blocker tube group(group 1) and double-lumen endobronchial tube group(group 2).After anesthesia was induced,in group 1,single lumen tube was intubated at first,and then endobronchial blocker tube intubated to left or right primary bronchus under the guidance of fiber-optic bronchoscope according to operational necessary,injected 2-4 mL air to blocker balloon and blocker one lateral primary bronchus for one-lung ventilation necessarily;while in group 2,the position of double-lumen endobronchial tube was confirmed with fiber-optic bronchoscope after intubation.Blood samples were collected before anesthesia induction,double lumen ventilation,at the one-lung ventilation of 5 min,30 min,60 min,120 min and 180 min,SBP,DBP,HR,SpO2,partial pressure of end tidal carbon dioxide(PetCO2),pH,PaO2,PaCO2,PaO2/FiO2 were recorded.Results:Forty cases' intubations were all successful.There were no differences in SBP,DBP,HR,SpO2,PetCO2,pH,PaCO2 between two groups in different points(P > 0.05).Paw in group 1 was lower than group 2,PaO2 and PaO2/FiO2 in group 1 was higher than group 2 in the one lung ventilation of 5 min,30 min,60 min,120 min and 180 min.Conclusion:The endobronchial blocker tube can meet the request of video-assisted thoracic surgery,with the special advantages of simple insertion,lower airway and better oxygenation.Endobronchial blocker tube offer a new way for one-lung ventilation in the pulmonary carcinoma with video-assisted thoracic surgery.

Roles of preoperative arterial blood gas tests in the surgical treatment of scoliosis with moderate or severe pulmonary dysfunction

Background It has been stated that preoperative pulmonary function tests are essential to assess the surgical risk in patients with scoliosis.Arterial blood gas tests have also been used to evaluate pulmonary function before scoliotic surgery.However,few studies have been reported.The aim of this study was to investigate the roles of preoperative arterial blood gas tests in the surgical treatment of scoliosis with moderate or severe pulmonary dysfunction.Methods This study involved scoliotic patients with moderate or severe pulmonary dysfunction （forced vital capacity 〈60%） who underwent surgical treatment between January 2002 and April 2010.A total of 73 scoliotic patients （23 males and 50 females） with moderate or severe pulmonary dysfunction were included.The average age of the patients was 16.53 years （ranged 10-44）.The demographic distribution,medical records,and radiographs of all patients were collected.All patients received arterial blood gas tests and pulmonary function tests before surgery.The arterial blood gas tests included five parameters：partial pressure of arterial oxygen,partial pressure of arterial carbon dioxide,alveolar-arterial oxygen tension gradient,pH,and standard bases excess.The pulmonary function tests included three parameters：forced expiratory volume in 1 second ratio,forced vital capacity ratio,and peak expiratory flow ratio.All five parameters of the arterial blood gas tests were compared between the two groups with or without postoperative pulmonary complications by variance analysis.Similarly,all three parameters of the pulmonary function tests were compared.Results The average coronal Cobb angle before surgery was 97.42° （range,50°-180°）.A total of 15 （20.5%） patients had postoperative pulmonary complications,including hypoxemia in 5 cases （33.3%）,increased requirement for postoperative ventilatory support in 4 （26.7%）,pneumonia in 2 （13.3%）,atelectasis in 2 （13.3%）,pneumothorax in 1 （6.7%）,and hydrothorax in 1 （6.7%）.No significant differences in demographic characteristics or perioperative factors （P 〉0.05） existed between the two groups with or without postoperative pulmonary complications.According to the variance analysis,there were no statistically significant differences in any parameter of the arterial blood gas tests between the two groups.Conclusions No significant correlation between the results of the preoperative arterial blood gas tests and postoperative pulmonary complications existed in scoliotic patients with moderate or severe pulmonary dysfunction.However,the postoperative complications tended to increase with the decrease of partial pressure of arterial oxygen in the arterial blood gas tests.

Protective effect of Renqing Changjue on acute respiratory distress syndrome in rabbits

OBJECTIVE To investigate whether Renqing Changjue has a protective effect on acute respiratory distress syndrome(ARDS)induced by endotoxin lipopolysaccharide(LPS)in rabbits.METHODS Thirty-six healthy male New Zealand white rabbits were randomly divided into six groups:normal control group,model group,dexamethasone group,Renqing Changjue high,middle and low dose group,with six rabbits in each group.LPS was used to replicate the ARDS model after five consecutive days of gavage.Arterial pressure,respiratory rate and anal temperature blood were recorded for arterial blood gas analysis at 0,0.5,1,2 and 4 h,respectively.At the end of the four-hour experiment,rabbits were killed by bloodletting,and the lung tissue was quickly removed to determine the cytokines,SOD,MDA and pathological examination of rabbit lung.RESULTS Renqing Changjue can significantly reduce the pathological changes of lung in ARDS model group.The expression of AQP1 and MPO in rabbit lung was significantly decreased by immunohistochemistry(P<0.05),reduce the lung wet/dry weight ratio,increase the ratio of PaO_(2)/FiO_(2),inhibit the release of inflammatory factors and scavenge free radicals and antioxidant effects.CONCLUSION Renqing Changjue can effectively protect rabbits with acute respiratory distress syndrome induced by LPS,and may protect the lung by inhibiting the release of cytokines and anti-oxidation.

Proportional assist ventilation: methodology and therapeutics on COPD patients compared with pressure support ventilation

OBJECTIVE: To investigate the impact of proportional assist ventilation (PAV) on tolerance and breathlessness in ventilated chronic obstructive pulmonary disease (COPD), and to describe the patient-ventilator interaction, hemodynamic state, breathing pattern and work of breath during PAV and pressure support ventilation (PSV). METHODS: Ten intubated COPD patients on weaning from mechanical ventilation were studied. Elastance and resistance were measured by both the inspiratory-hold technique during a brief period of volume control ventilation and runaway technique during PAV. Each assistance level of PAV (80%, 60% and 40%) and PSV was selected randomly. Patients' response, hemodynamics, blood gas and lung mechanics were monitored. RESULTS: Tidal volume and respiratory rate didn't change in a consistent manner as the level of assist was decreased (P > 0.05). With the level of assist increasing, peak inspiratory pressure was increasing significantly (P

Study on changes of partial pressure of brain tissue oxygen and brain temperature in acute phase of severe head injury during mild hypothermia therapy

Objective: To study the changes of partial pressure of brain tissue oxygen (PbtO 2) and brain temperature in acute phase of severe head injury during mild hypothermia therapy and the clinical significance. Methods: One hundred and sixteen patients with severe head injury were selected and divided into a mild hypothermia group (n=58), and a control group (n=58) according to odd and even numbers of hospitalization. While mild hypothermia therapy was performed PbtO 2 and brain temperature were monitored for 1 7 days (mean=86 hours), simultaneously, the intracranial pressure, rectum temperature, cerebral perfusion pressure, PaO 2 and PaCO 2 were also monitored. The patients were followed up for 6 months and the prognosis was evaluated with GOS (Glasgow outcome scale). Results: The mean value of PbtO 2 within 24 hour monitoring in the 116 patients was 13.7 mm Hg ± 4.94 mm Hg , lower than the normal value (16 mm Hg ± 40 mm Hg ) The time of PbtO 2 recovering to the normal value in the mild hypothermia group was shortened by 10± 4.15 hours compared with the control group (P< 0.05 ). The survival rate of the mild hypothermia group was 60.43 %, higher than that of the control group ( 46.55 %). After the recovery of the brain temperature, PbtO 2 increased with the rise of the brain temperature. Conclusions: Mild hypothermia can improve the survival rate of severe head injury. The technique of monitoring PbtO 2 and the brain temperature is safe and reliable, and has important clinical significance in judging disease condition and instructing clinical therapy.

Study on acid base disturbance in patients with post traumatic multiple organ dysfunction syndrome

Objective: To investigate the classification and incidence of acid base disturbance (ABD) in the patients with post traumatic multiple organ dysfunction syndrome (MODS). Methods: A total of 119 patients with MODS were examined with arterial blood gas analysis and serum electrolytes detection for 675 times in this study. Results: Different types of ABD existed in 647 times out of 675 times ( 95.9 %) of blood gas analyses. There were 270 times ( 41.7 %) of simple ABD, 271 times ( 41.9 %) of double ABD and 106 times ( 16.4 %) of triple ABD. Among which, 404 times ( 62.4 %) were in respiratory alkalosis (RAL), 332 times ( 51.3 %) in metabolic acidosis (MA), 227 times ( 35.1 %) in metabolic alkalosis (MAL) and 167 times ( 25.8 %) in respiratory acidosis (RA). In this study, 79 cases ( 66.4 %) out of 119 cases with MODS died from these kinds of ABD. Conclusions: It suggests that in the early stage of MODS, RAL with or without hypoxemia may exist, and later on, MA or even triple ABD may occur. In order to detect and correct the primary disorders as early as possible, it is important to keep the balance of hydrolyte. The treatment of primary diseases is also important. Disorders of acid base balance were corrected according to pH standard values, anion gap (AG) and the potential [HCO 3 -] were also calculated simultaneously. When pH was more than 7.50 or lower than 7.20 , it is necessary to give drugs of acidity or alkalinity to the patients with ABD to maintain pH value within a normal range.

Establishment of an animal model of non-transthoracic cardiopulmonary bypass in rats

Objective: To establish an animal model of non-transthoracic cardiopulmonary bypass (CPB) in rats. Methods: Ten adult male Sprague-Dawlay rats, weighing 350-500 g, were used in this study. CPB was established in these animals through cannulating the left carotid and right jugular vein for arterial perfusion and venous return. The components of perfusion circuit, especially the miniature oxygenator and cannula, were specially designed and improved. The mean arterial pressure was measured with a blood pressure meter through cannulating the left femoral artery. The hemodynamic and blood gas parameters were also monitored. Results: The rat model of non-transthoracic CPB was established successfully. The hemodynamical parameters were changed within an acceptable region during CPB. The miniature oxygenator was sufficient to meet the standard of satisfactory CPB. Conclusions: The rat model of non-transthoracic CPB established through the carotid and jugular cannulation is feasible, easily operated, safe, reliable, and economic. It is an ideal model for the pathophysiological research of CPB.