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Zhou D, Lv Y, Wang C, Li D. The early change in pH values after out-of-hospital cardiac arrest is not associated with neurological outcome at hospital discharge. Resusc Plus 2024; 18:100650. [PMID: 38711912 PMCID: PMC11070929 DOI: 10.1016/j.resplu.2024.100650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 04/10/2024] [Accepted: 04/19/2024] [Indexed: 05/08/2024] Open
Abstract
Background The association between pH values and outcome for patients after out-of-hospital cardiac arrest (OHCA) was not fully elucidated; besides, the relationship of change in pH values and neurological outcome was unknown. The aim was to explore the association of pH values as well as change in pH values and neurological outcome for OHCA cardiac patients. Methods The adult patients with non-traumatic out-of-hospital cardiac arrest, shock-refractory ventricular fibrillation or pulseless ventricular tachycardia, and at least two arterial blood gases analysis recorded after admission were included. The change in pH values is calculated as the difference between the second and first pH value, and divided by time interval got the rate of change in pH values. The primary outcome was modified Rankin Score (mRS), dichotomized to good (mRS 0-3) and poor (mRS 4-6) outcomes at hospital discharge. The independent relationship of the first pH value, second pH value, and changes in pH values with neurological outcome was investigated with multivariable logistic regression models, respectively. Results A total of 1388 adult patients were included for analysis, of which 514 (37%) had good neurological outcome. The median first pH value and second pH value after admission were 7.21 (interquartile range [IQR] 7.09-7.29) and 7.28 (IQR 7.20-7.36), respectively. The median absolute, relative change, and rate of changes in pH values were 0.08 (IQR 0.01-0.16), 1.10% (IQR 0.11-2.22%), and 0.02 (IQR 0-0.06) per hour, respectively. After adjusting for confounders, the higher first pH value (odds ratio [OR] 3.81, confidence interval [CI] 1.60-9.24, P = 0.003) and higher second pH value (OR 9.54, CI 3.45-26.87, P < 0.001) after admission were associated with good neurological outcome, respectively. The absolute (OR 1.58, CI 0.58-4.30, P = 0.368) and relative (OR 1.03, CI 0.96-1.11, P = 0.399) change as well as the rate of change (OR 0.98, CI 0.33-2.71, P = 974) in pH values were not associated with neurological outcome. Conclusions For OHCA patients, abnormality in pH values was very common, with a more acidic pH value indicating poor neurological outcome. However, the change in pH values was not associated with outcomes.
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Affiliation(s)
- Dawei Zhou
- Department of Critical Care Medicine, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Yi Lv
- Department of Critical Care Medicine, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Chao Wang
- Department of Critical Care Medicine, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Dan Li
- Department of Critical Care Medicine, Beijing Tongren Hospital, Capital Medical University, Beijing, China
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2
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Pelletier JH, Rakkar J, Au AK, Fuhrman DY, Clark RSB, Kochanek PM, Horvat CM. Retrospective Validation of a Computerized Physiologic Equation to Predict Minute Ventilation Needs in Critically Ill Children. Pediatr Crit Care Med 2024; 25:390-395. [PMID: 38329377 PMCID: PMC11065608 DOI: 10.1097/pcc.0000000000003462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2024]
Abstract
OBJECTIVES Mechanical ventilation (MV) is pervasive among critically ill children. We sought to validate a computerized physiologic equation to predict minute ventilation requirements in children and test its performance against clinician actions in an in silico trial. DESIGN Retrospective, electronic medical record linkage, cohort study. SETTING Quaternary PICU. PATIENTS Patients undergoing invasive MV, serial arterial blood gas (ABG) analysis within 1-6 hours, and pharmacologic neuromuscular blockade (NMB). MEASUREMENTS AND MAIN RESULTS ABG values were filtered to those occurring during periods of NMB. Simultaneous ABG and minute ventilation data were linked to predict serial Pa co2 and pH values using previously published physiologic equations. There were 15,121 included ABGs across 500 encounters among 484 patients, with a median (interquartile range [IQR]) of 20 (10-43) ABGs per encounter at a duration of 3.6 (2.1-4.2) hours. The median (IQR) Pa co2 prediction error was 0.00 (-3.07 to 3.00) mm Hg. In Bland-Altman analysis, the mean error was -0.10 mm Hg (95% CI, -0.21 to 0.01 mm Hg). A nested, in silico trial of ABGs meeting criteria for weaning (respiratory alkalosis) or escalation (respiratory acidosis), compared the performance of recommended ventilator changes versus clinician decisions. There were 1,499 of 15,121 ABGs (9.9%) among 278 of 644 (43.2%) encounters included in the trial. Calculated predictions were favorable to clinician actions in 1124 of 1499 ABGs (75.0%), equivalent to clinician choices in 26 of 1499 ABGs (1.7%), and worse than clinician decisions in 349 of 1499 ABGs (23.3%). Calculated recommendations were favorable to clinician decisions in sensitivity analyses limiting respiratory rate, analyzing only when clinicians made changes, excluding asthma, and excluding acute respiratory distress syndrome. CONCLUSIONS A computerized equation to predict minute ventilation requirements outperformed clinicians' ventilator adjustments in 75% of ABGs from critically ill children in this retrospective analysis. Prospective validation studies are needed.
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Affiliation(s)
- Jonathan H Pelletier
- Division of Critical Care, Department of Pediatrics, Akron Children's Hospital, Akron, OH
| | - Jaskaran Rakkar
- Division of Critical Care, Department of Pediatrics, Phoenix Children's Hospital, Phoenix, AZ
| | - Alicia K Au
- Division of Critical Care, Department of Pediatrics, Akron Children's Hospital, Akron, OH
- Division of Critical Care, Department of Pediatrics, Phoenix Children's Hospital, Phoenix, AZ
- Department Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA
- Brain Care Institute, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA
- Safar Center for Resuscitation Research, University of Pittsburgh School of Medicine, Pittsburgh, PA
- Division of Health Informatics, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA
| | - Dana Y Fuhrman
- Department Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Robert S B Clark
- Division of Critical Care, Department of Pediatrics, Akron Children's Hospital, Akron, OH
- Division of Critical Care, Department of Pediatrics, Phoenix Children's Hospital, Phoenix, AZ
- Department Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA
- Brain Care Institute, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA
- Safar Center for Resuscitation Research, University of Pittsburgh School of Medicine, Pittsburgh, PA
- Division of Health Informatics, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA
| | - Patrick M Kochanek
- Division of Critical Care, Department of Pediatrics, Akron Children's Hospital, Akron, OH
- Division of Critical Care, Department of Pediatrics, Phoenix Children's Hospital, Phoenix, AZ
- Department Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA
- Brain Care Institute, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA
- Safar Center for Resuscitation Research, University of Pittsburgh School of Medicine, Pittsburgh, PA
- Division of Health Informatics, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA
| | - Christopher M Horvat
- Division of Critical Care, Department of Pediatrics, Akron Children's Hospital, Akron, OH
- Division of Critical Care, Department of Pediatrics, Phoenix Children's Hospital, Phoenix, AZ
- Department Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA
- Brain Care Institute, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA
- Safar Center for Resuscitation Research, University of Pittsburgh School of Medicine, Pittsburgh, PA
- Division of Health Informatics, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA
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3
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O'Brolchain A, Maletsky J, Mian I, Edwards S. Does Treatment with Sodium-Glucose Cotransporter-2 Inhibitors Affect Adherence to International Society Criteria for Diabetic Ketoacidosis in Adult Patients with Type 2 Diabetes? A Retrospective Cohort Analysis. J Diabetes Res 2024; 2024:1849522. [PMID: 38516324 PMCID: PMC10957251 DOI: 10.1155/2024/1849522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 01/17/2024] [Accepted: 01/19/2024] [Indexed: 03/23/2024] Open
Abstract
Design Retrospective observational study. Setting. Inpatients at two teaching hospitals in Queensland, Australia. Primary Outcome Measure(s). The number of patients meeting the Joint British Diabetes Society (JBDS) and American Association of Clinical Endocrinology/American College of Endocrinology (AACE/ACE) diagnostic criteria for DKA. Patients were divided into two groups by treatment with SGLT2i at the time of diagnosis. Participants. Adult patients (>18 years old) with type 2 diabetes diagnosed with DKA from April 2015 to January 2022. Patients without type 2 diabetes were excluded. Results One hundred and sixty-five patients were included in this study-comprising 94 patients in the SGLT2i cohort and 70 in the non-SGLT2i cohort. A significantly smaller proportion of patients in the SGLT2i vs. non-SGLT2i cohorts met both JBDS (56% vs. 72%, p = 0.035) and AACE/ACE (63% vs. 82%, p = 0.009) criteria for diagnosis of DKA. Conclusion Patients with type 2 diabetes treated with SGLT2i may be more likely to be diagnosed with DKA despite not meeting the criteria. Despite recent adjustments to account the physiological effects of SGLT2i, significant variation in criteria between major society guidelines presents ongoing challenges to clinicians. The proportion of patients diagnosed using both JDBS and AACE/ACE were comparable, suggesting a reasonable degree of agreement.
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Affiliation(s)
- Aongus O'Brolchain
- Department of Medicine, Gold Coast Health, Gold Coast, Queensland, Australia
- Griffith University, Queensland, Australia
| | - Joshua Maletsky
- Department of Medicine, Gold Coast Health, Gold Coast, Queensland, Australia
| | - Ibrahim Mian
- Department of Medicine, Gold Coast Health, Gold Coast, Queensland, Australia
| | - Serena Edwards
- Department of Medicine, Gold Coast Health, Gold Coast, Queensland, Australia
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4
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Story DA. Respiratory Changes and Acid-Base Compensation: Watch the Salt. Anesthesiology 2024; 140:1-3. [PMID: 38085159 DOI: 10.1097/aln.0000000000004762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Affiliation(s)
- David A Story
- Department of Critical Care; Melbourne Medical School, The University of Melbourne, Melbourne, Australia
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5
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Zadek F, Danieli A, Brusatori S, Giosa L, Krbec M, Antolini L, Fumagalli R, Langer T. Combining the Physical-Chemical Approach with Standard Base Excess to Understand the Compensation of Respiratory Acid-Base Derangements: An Individual Participant Meta-analysis Approach to Data from Multiple Canine and Human Experiments. Anesthesiology 2024; 140:116-125. [PMID: 37616330 DOI: 10.1097/aln.0000000000004751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/26/2023]
Abstract
BACKGROUND Several studies explored the interdependence between Paco2 and bicarbonate during respiratory acid-base derangements. The authors aimed to reframe the bicarbonate adaptation to respiratory disorders according to the physical-chemical approach, hypothesizing that (1) bicarbonate concentration during respiratory derangements is associated with strong ion difference; and (2) during acute respiratory disorders, strong ion difference changes are not associated with standard base excess. METHODS This is an individual participant data meta-analysis from multiple canine and human experiments published up to April 29, 2021. Studies testing the effect of acute or chronic respiratory derangements and reporting the variations of Paco2, bicarbonate, and electrolytes were analyzed. Strong ion difference and standard base excess were calculated. RESULTS Eleven studies were included. Paco2 ranged between 21 and 142 mmHg, while bicarbonate and strong ion difference ranged between 12.3 and 43.8 mM, and 32.6 and 60.0 mEq/l, respectively. Bicarbonate changes were linearly associated with the strong ion difference variation in acute and chronic respiratory derangement (β-coefficient, 1.2; 95% CI, 1.2 to 1.3; P < 0.001). In the acute setting, sodium variations justified approximately 80% of strong ion difference change, while a similar percentage of chloride variation was responsible for chronic adaptations. In the acute setting, strong ion difference variation was not associated with standard base excess changes (β-coefficient, -0.02; 95% CI, -0.11 to 0.07; P = 0.719), while a positive linear association was present in chronic studies (β-coefficient, 1.04; 95% CI, 0.84 to 1.24; P < 0.001). CONCLUSIONS The bicarbonate adaptation that follows primary respiratory alterations is associated with variations of strong ion difference. In the acute phase, the variation in strong ion difference is mainly due to sodium variations and is not paralleled by modifications of standard base excess. In the chronic setting, strong ion difference changes are due to chloride variations and are mirrored by standard base excess. EDITOR’S PERSPECTIVE
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Affiliation(s)
- Francesco Zadek
- Department of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy
| | - Andrea Danieli
- Department of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy
| | - Serena Brusatori
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Lorenzo Giosa
- Department of Surgical Sciences, University of Turin, Turin, Italy; Centre for Human and Applied Physiological Sciences, King's College London, London, United Kingdom
| | - Martin Krbec
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy; Department of Anaesthesia and Intensive Care Medicine, Third Faculty of Medicine, Charles University and Královské Vinohrady University Hospital, Prague, Czechia
| | - Laura Antolini
- Department of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy
| | - Roberto Fumagalli
- Department of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy; Department of Anesthesia and Intensive Care Medicine, Niguarda Ca' Granda, Milan, Italy
| | - Thomas Langer
- Department of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy; Department of Anesthesia and Intensive Care Medicine, Niguarda Ca' Granda, Milan, Italy
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Abstract
The bedside Stewart approach to acid–base disorders is a simple, pragmatic tool that can assist anesthesiologists in analyzing and managing acid–base changes in the operating room, particularly metabolic acidosis.
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Affiliation(s)
- David A Story
- Department of Critical Care, Melbourne Medical School, University of Melbourne, Melbourne, Australia
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Bonatto NCM, Alves LSS, Silva LE, Milhorine CA, de Barros LD, Santos JA, de Almeida BFM, da Costa Flaiban KKM. Does postprandial lipemia interfere with blood gas analysis and assessment of acid-base status in dogs? Res Vet Sci 2023; 154:52-58. [PMID: 36459719 DOI: 10.1016/j.rvsc.2022.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 10/30/2022] [Accepted: 11/14/2022] [Indexed: 11/18/2022]
Abstract
To evaluate the interference of postprandial lipemia on blood gas parameters and to assess the acid-base status by the quantitative approach of the strong ion model blood samples of 15 healthy dogs were collected during fasting (0 h) and at one (1 h), three (3 h) and five (5 h) hours after the induction of lipemia with a hypercaloric diet. Total cholesterol (TC) and triglyceride (TG) levels were used to assess lipemia and these were correlated with the parameters evaluated accordingly. Anion gap decreased at 5 h without correlation with TC and TG, whereas other parameters measured by the blood gasometer did not change. In the evaluation of the acid base state, the apparent strong ion difference (SIDa) and the strong ion gap (SIG) showed a decrease at 5 h without correlation with lipemia. Lipid levels correlated with the effective strong ion difference (SIDe), the concentration of total non-volatile weak acids (Atot), albumin, phosphate, and magnesium. The SIDe increased at 1 h and at 3 h; the Atot at 1 h, 3 h, and 5 h; albumin increased at 1 h and 3 h; phosphate increased at 1 h, 3 h and 5 h; and magnesium decreased at 5 h. Though postprandial lipemia does not interfere with blood gas analysis, it can cause errors in the variables used to assess the acid-base status, which are dependent on biochemical analytes. Therefore, caution is required when interpreting electrolyte disturbances that result from the postprandial state.
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Affiliation(s)
| | - Laís Sodré Santana Alves
- Department of Preventive Veterinary Medicine, State University of Londrina - (UEL), Londrina, PR, Brazil
| | - Luara Evangelista Silva
- Department of Preventive Veterinary Medicine, State University of Londrina - (UEL), Londrina, PR, Brazil
| | | | - Luiz Daniel de Barros
- Department of Preventive Veterinary Medicine, State University of Londrina - (UEL), Londrina, PR, Brazil
| | - Julian Andrade Santos
- Department of Preventive Veterinary Medicine, State University of Londrina - (UEL), Londrina, PR, Brazil
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Setoguchi M, Muto M, Ohata T, Fukuoka R, Ikeda H, Aki H, Haraguchi M, Hanjo S, Arima J, Ibara S. Syringe‐dispensed omega‐3 lipid injectable emulsions should be stored under airtight refrigeration: a proposal for the efficient supply of unapproved precious lipid resources. JPEN J Parenter Enteral Nutr 2022; 46:1923-1931. [DOI: 10.1002/jpen.2443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 08/10/2022] [Accepted: 08/16/2022] [Indexed: 11/05/2022]
Affiliation(s)
- Makoto Setoguchi
- Department of PharmacyKagoshima City HospitalKagoshimaJapan
- Working group for Inflammatory bowel disease and Intestinal failure providing Supportive and Hearty care (WISH)
| | - Mitsuru Muto
- Working group for Inflammatory bowel disease and Intestinal failure providing Supportive and Hearty care (WISH)
- Department of Pediatric Surgery, Research Field in Medical and Health Sciences, Medical and Dental Area, Research and Education AssemblyKagoshima UniversityKagoshimaJapan
| | - Tomonori Ohata
- Faculty of Pharmaceutical SciencesFukuoka UniversityFukuokaJapan
| | - Ryuichi Fukuoka
- Working group for Inflammatory bowel disease and Intestinal failure providing Supportive and Hearty care (WISH)
- Department of PharmacyHakuyukai Onsen HospitalKagoshimaJapan
| | - Hirohito Ikeda
- Faculty of Pharmaceutical SciencesFukuoka UniversityFukuokaJapan
| | - Hatsumi Aki
- Faculty of Pharmaceutical SciencesFukuoka UniversityFukuokaJapan
| | - Masaomi Haraguchi
- Department of Clinical laboratoryKagoshima City HospitalKagoshimaJapan
| | - Shota Hanjo
- Department of PharmacyKagoshima City HospitalKagoshimaJapan
| | - Junko Arima
- Department of PharmacyKagoshima City HospitalKagoshimaJapan
| | - Satoshi Ibara
- Working group for Inflammatory bowel disease and Intestinal failure providing Supportive and Hearty care (WISH)
- Department of NeonatologyKagoshima City HospitalKagoshimaJapan
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9
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Four Acid-Base Disturbances in a Critically-Ill Patient Undergoing Emergent Abdominal Surgery. Case Rep Crit Care 2022; 2022:1285598. [PMID: 35836728 PMCID: PMC9273465 DOI: 10.1155/2022/1285598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 06/23/2022] [Indexed: 11/30/2022] Open
Abstract
Lactic acidosis is common in critically-ill surgical patients, but not all perioperative acid-base imbalances are attributable to tissue hypoperfusion. Other causes of acid-base abnormalities can be missed when focused on acute resuscitation of a surgical pathology. This report presents the case of a 60-year-old woman with no past medical history who underwent exploratory laparotomy for umbilical hernia with incarcerated and perforated bowel whose perioperative management was complicated by four acid-base disturbances, including starvation ketosis. This case highlights the importance of early recognition of acid-base imbalances to explain concurrent medical pathology and accurately predict a patient's expected post-operative course.
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10
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Roberts DM, Hoffman RS, Brent J, Lavergne V, Hovda KE, Porter WH, McMartin KE, Ghannoum M. The serum glycolate concentration: its prognostic value and its correlation to surrogate markers in ethylene glycol exposures. Clin Toxicol (Phila) 2022; 60:798-807. [PMID: 35323087 DOI: 10.1080/15563650.2022.2049811] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
CONTEXT Ethylene glycol poisoning manifests as metabolic acidemia, acute kidney injury and death. The diagnosis and treatment depend on history and biochemical tests. Glycolate is a key toxic metabolite that impacts prognosis, but assay results are not widely available in a clinically useful timeframe. We quantitated the impact of serum glycolate concentration for prognostication and evaluated whether more readily available biochemical tests are acceptable surrogates for the glycolate concentration. OBJECTIVES The objectives of this study are to 1) assess the prognostic value of the initial glycolate concentration on the occurrence of AKI or mortality in patients with ethylene glycol exposure (prognostic study); 2) identify surrogate markers that correlate best with glycolate concentrations (surrogate study). METHODS A systematic review of the literature was performed using Medline/PubMed, EMBASE, Cochrane library, conference proceedings and reference lists. Human studies reporting measured glycolate concentrations were eligible. Glycolate concentrations were related to categorical clinical outcomes (acute kidney injury, mortality), and correlated with continuous surrogate biochemical measurements (anion gap, base excess, bicarbonate concentration and pH). Receiver operating characteristic curves were constructed to calculate the positive predictive values and the negative predictive values of the threshold glycolate concentrations that predict acute kidney injury and mortality. Further, glycolate concentrations corresponding to 100% negative predictive value for mortality and 95% negative predictive value for acute kidney injury were determined. RESULTS Of 1,531 articles identified, 655 were potentially eligible and 32 were included, reflecting 137 cases from 133 patients for the prognostic study and 154 cases from 150 patients for the surrogate study. The median glycolate concentration was 11.2 mmol/L (85.1 mg/dL, range 0-38.0 mmol/L, 0-288.8 mg/dL), 93% of patients were treated with antidotes, 80% received extracorporeal treatments, 49% developed acute kidney injury and 13% died. The glycolate concentration best predicting acute kidney injury was 12.9 mmol/L (98.0 mg/dL, sensitivity 78.5%, specificity 88.1%, positive predictive value 86.4%, negative predictive value 80.9%). The glycolate concentration threshold for a 95% negative predictive value for acute kidney injury was 6.6 mmol/L (50.2 mg/dL, sensitivity 96.9%, specificity 62.7%). The glycolate concentration best predicting mortality was 19.6 mmol/L (149.0 mg/dL, sensitivity 61.1%, specificity 81.4%, positive predictive value 33.3%, negative predictive value 93.2%). The glycolate concentration threshold for a 100% negative predictive value for mortality was 8.3 mmol/L (63.1 mg/dL, sensitivity 100.0%, specificity 35.6%). The glycolate concentration correlated best with the anion gap (R2 = 0.73), followed by bicarbonate (R2 = 0.57), pH (R2 = 0.50) and then base excess (R2 = 0.25), while there was no correlation between the glycolate and ethylene glycol concentration (R2 = 0.00). These data can assist clinicians in planning treatments such as extracorporeal treatments and prognostication. Potentially, they may also provide some reassurance regarding when extracorporeal treatments can be delayed while awaiting the results of further testing in patients in whom ethylene glycol poisoning is suspected but not yet confirmed. CONCLUSIONS This systematic review demonstrates that the glycolate concentration predicts mortality (unlikely if <8 mmol/L [61 mg/dL]). The anion gap is a reasonable surrogate measurement for glycolate concentration in the context of ethylene glycol poisoning. The findings are mainly based on published retrospective data which have various limitations. Further prospective validation studies are of interest.
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Affiliation(s)
- Darren M Roberts
- Department of Clinical Pharmacology and Toxicology, St Vincent's Hospital, Sydney, NSW, Australia.,St Vincent's Clinical School, University of New South Wales, Sydney, NSW, Australia.,Drug Health Clinical Services, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Robert S Hoffman
- Division of Medical Toxicology, Ronald O. Perelman Department of Emergency Medicine, NYU Grossman School of Medicine, NY, USA
| | - Jeffrey Brent
- Departments of Medicine and Emergency Medicine, University of Colorado, School of Medicine and Colorado School of Public Health, Aurora, CO, USA
| | - Valéry Lavergne
- Research Center, CIUSSS du Nord-de-l'île-de-Montréal, University of Montreal, Montreal, QC, Canada
| | - Knut Erik Hovda
- The Norwegian CBRNE Centre of Medicine, Department of Acute Medicine, Oslo University Hospital, Oslo, Norway
| | - William H Porter
- Department of Pathology and Laboratory Medicine, University of Kentucky Medical Center Lexington, KY, USA
| | | | - Marc Ghannoum
- Research Center, CIUSSS du Nord-de-l'île-de-Montréal, University of Montreal, Montreal, QC, Canada
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11
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Clinical Use of Lactate Measurements: Reply. Anesthesiology 2021; 135:766-767. [PMID: 34388819 DOI: 10.1097/aln.0000000000003906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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12
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Gucyetmez B, Tuzuner F, Atalan HK, Sezerman U, Gucyetmez K, Telci L. Base-excess chloride; the best approach to evaluate the effect of chloride on the acid-base status: A retrospective study. PLoS One 2021; 16:e0250274. [PMID: 33914794 PMCID: PMC8084199 DOI: 10.1371/journal.pone.0250274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 04/01/2021] [Indexed: 11/18/2022] Open
Abstract
To practically determine the effect of chloride (Cl) on the acid-base status, four approaches are currently used: accepted ranges of serum Cl values; Cl corrections; the serum Cl/Na ratio; and the serum Na-Cl difference. However, these approaches are governed by different concepts. Our aim is to investigate which approach to the evaluation of the effect of Cl is the best. In this retrospective cohort study, 2529 critically ill patients who were admitted to the tertiary care unit between 2011 and 2018 were retrospectively evaluated. The effects of Cl on the acid-base status according to each evaluative approach were validated by the standard base excess (SBE) and apparent strong ion difference (SIDa). To clearly demonstrate only the effects of Cl on the acid-base status, a subgroup that included patients with normal lactate, albumin and SIG values was created. To compare approaches, kappa and a linear regression model for all patients and Bland-Altman test for a subgroup were used. In both the entire cohort and the subgroup, correlations among BECl, SIDa and SBE were stronger than those for other approaches (r = 0.94 r = 0.98 and r = 0.96 respectively). Only BECl had acceptable limits of agreement with SBE in the subgroup (bias: 0.5 mmol L-1) In the linear regression model, only BECl in all the Cl evaluation approaches was significantly related to the SBE. For the evaluation of the effect of chloride on the acid-base status, BECl is a better approach than accepted ranges of serum Cl values, Cl corrections and the Cl/Na ratio.
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Affiliation(s)
- Bulent Gucyetmez
- Department of Anaesthesiology and Reanimation, Acıbadem Mehmet Ali Aydınlar University School of Medicine, Istanbul, Turkey
- General Intensive Care Unit, Acıbadem International Hospital, Istanbul, Turkey
| | - Filiz Tuzuner
- General Intensive Care Unit, Acıbadem Taksim Hospital, Istanbul, Turkey
| | | | - Uğur Sezerman
- Department of Biostatistics, Acıbadem Mehmet Ali Aydınlar University, Istanbul, Turkey
| | | | - Lutfi Telci
- General Intensive Care Unit, Acıbadem International Hospital, Istanbul, Turkey
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13
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Umbilical Cord Unmeasured Anions and Tissue Acid Levels According to Stewart’s Method in Term Newborn Infants and the Impact of Delivery Mode on these parameters. JOURNAL OF CONTEMPORARY MEDICINE 2020. [DOI: 10.16899/jcm.763338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Madotto F, Rezoagli E, McNicholas BA, Pham T, Slutsky AS, Bellani G, Laffey JG. Patterns and Impact of Arterial CO 2 Management in Patients With Acute Respiratory Distress Syndrome: Insights From the LUNG SAFE Study. Chest 2020; 158:1967-1982. [PMID: 32589951 DOI: 10.1016/j.chest.2020.05.605] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 04/08/2020] [Accepted: 05/29/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Considerable variability exists regarding CO2 management in early ARDS, with the impact of arterial CO2 tension on management and outcomes poorly understood. RESEARCH QUESTION To determine the prevalence and impact of hypocapnia and hypercapnia on the management and outcomes of patients with early ARDS enrolled in the Large Observational Study to Understand the Global Impact of Severe Acute Respiratory Failure (LUNG SAFE) study, an international multicenter observational study. STUDY DESIGN AND METHODS Our primary objective was to examine the prevalence of day 1 and sustained (day 1 and 2) hypocapnia (Paco2 < 35 mm Hg), normocapnia (Paco2 35-45 mm Hg), and hypercapnia (Paco2 > 45 mm Hg) in patients with ARDS. Secondary objectives included elucidating the effect of CO2 tension on ventilatory management and examining the relationship with ARDS outcome. RESULTS Of 2,813 patients analyzed, 551 (19.6%; 95%CI, 18.1-21.1) were hypocapnic, 1,018 (36.2%; 95% CI, 34.4-38.0) were normocapnic, and 1,214 (43.2%; 95% CI, 41.3-45.0) were hypercapnic, on day 1. Sustained hypocapnia was seen in 252 (9.3%; 95% CI, 8.2-10.4), sustained normocapnia in 544 (19.3%; 95% CI, 17.9-20.8), and sustained hypercapnia in 654 (24.1%; 95% CI, 22.5-25.7) patients. Hypocapnia was more frequent and severe in patients receiving noninvasive ventilation but also was observed in patients on controlled mechanical ventilation. Sustained hypocapnia was more frequent in middle-income countries, whereas sustained hypercapnia was more frequent in Europe. ARDS severity profile was highest in sustained hypercapnia, and these patients received more protective ventilation. No independent association was seen between arterial CO2 and outcome. In propensity-matched analyses, the hospital mortality rate was 36% in both sustained normocapnic and hypercapnic patients (P = 1.0). ICU mortality was higher in patients with mild to moderate ARDS receiving sustained hypocapnia (38.1%) compared with normocapnia (27.1%). INTERPRETATION No evidence was found for benefit or harm with hypercapnia. Of concern, ICU mortality was higher with sustained hypocapnia in mild to moderate ARDS.
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Affiliation(s)
- Fabiana Madotto
- IRCCS MultiMedica, Value-based healthcare unit, Sesto San Giovanni (Milan), Italy
| | - Emanuele Rezoagli
- School of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy; Department of Emergency and Intensive Care, San Gerardo Hospital, Monza, Italy
| | - Bairbre A McNicholas
- School of Medicine, National University of Ireland Galway, Galway, Ireland; Department of Anaesthesia and Intensive Care Medicine, Galway University Hospitals, Galway, Ireland
| | - Tài Pham
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada; Service de médecine intensive-réanimation, AP-HP, Hôpital de Bicêtre, Hôpitaux Universitaires Paris-Saclay, Le Kremlin-Bicêtre, France; Keenan Research Center at the Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, ON, Canada
| | - Arthur S Slutsky
- Keenan Research Center at the Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, ON, Canada; Interdepartmental Division of Critical Care Medicine, and the Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Giacomo Bellani
- School of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy; Department of Emergency and Intensive Care, San Gerardo Hospital, Monza, Italy
| | - John G Laffey
- School of Medicine, National University of Ireland Galway, Galway, Ireland; Department of Anaesthesia and Intensive Care Medicine, Galway University Hospitals, Galway, Ireland; Lung Biology Group, Regenerative Medicine Institute (REMEDI) at CÚRAM Centre for Research in Medical Devices, Biomedical Sciences Building, National University of Ireland Galway, Galway, Ireland.
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Haines RW, Kirwan CJ, Prowle JR. Managing Chloride and Bicarbonate in the Prevention and Treatment of Acute Kidney Injury. Semin Nephrol 2020; 39:473-483. [PMID: 31514911 DOI: 10.1016/j.semnephrol.2019.06.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Intravenous crystalloid therapy is one of the most ubiquitous aspects of hospital and critical care medicine. In recent years, there has been increasing focus on the electrolyte composition, and particularly chloride content, of crystalloid solutions. This has led to increasing clinical adoption of balanced solutions, containing substrates for bicarbonate generation and consequently a lower chloride content, in place of 0.9% saline. In this article we review the physiochemical rationale for avoidance of 0.9% saline and the effects of hyperchloremic acidosis on renal physiology. Finally, we review the current evidence and rationale for use of balanced solutions greater than 0.9% saline in acutely ill patients in a variety of clinical settings, as well as considering the role for sodium bicarbonate in preventing or correcting metabolic acidosis. In conclusion, there is a strong physiological rationale for avoidance of iatrogenic hyperchloremic acidosis from 0.9% saline administration in acutely unwell patients and an association with adverse renal outcomes in several studies. However, evidence from large definitive multicenter randomized trials is not yet available to establish the dose-relationship between 0.9% saline administration and potential harm and inform us if some 0.9% saline use is acceptable or if any exposure confers harm.
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Affiliation(s)
- Ryan W Haines
- Adult Critical Care Unit, The Royal London Hospital, Barts Health NHS Trust, London, United Kingdom; William Harvey Research Institute, Queen Mary University of London, London, United Kingdom
| | - Christopher J Kirwan
- Adult Critical Care Unit, The Royal London Hospital, Barts Health NHS Trust, London, United Kingdom; William Harvey Research Institute, Queen Mary University of London, London, United Kingdom; Department of Renal Medicine and Transplantation, The Royal London Hospital, Barts Health NHS Trust, London, United Kingdom
| | - John R Prowle
- Adult Critical Care Unit, The Royal London Hospital, Barts Health NHS Trust, London, United Kingdom; William Harvey Research Institute, Queen Mary University of London, London, United Kingdom; Department of Renal Medicine and Transplantation, The Royal London Hospital, Barts Health NHS Trust, London, United Kingdom.
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Acid-base effects of continuous infusion furosemide in clinically stable surgical ICU patients: an analysis based on the Stewart model. Clin Exp Nephrol 2020; 24:541-546. [PMID: 32152833 DOI: 10.1007/s10157-020-01867-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 02/25/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVES We sought to test the strength of correlation between predicted and observed systemic acid-base status based on the Stewart model equations during continuous infusion (CI) furosemide therapy. DESIGN, SETTING AND PARTICIPANTS This was a prospective, single-center, observational study conducted in the Surgical ICU of a large academic medical center. Ten critically ill patients who received CI furosemide were included. MAIN OUTCOMES AND MEASURES The primary purpose was to characterize the relationship between changes in serum electrolyte and acid-base status and the excretion of electrolytes in the urine during infusion of CI furosemide in critically ill patients. As a secondary endpoint, we sought to evaluate the predictive application of the Stewart model. Over 72-h, intake and output volumes, electrolyte content of fluids administered, plasma and urine electrolytes, urine pH, and venous blood gases were collected. Predicted and observed changes in acid-based status were compared for each day of diuretic therapy using Spearman's correlation coefficient. RESULTS The mean (SD) strong ion difference (SID) increased from 45.2 (3.2) at baseline to 49.6 (4.0) after 72 h of continuous infusion furosemide. At Day 1, the mean SID (observed) (SD) was 47.5 (3.5) and the predicted SID was 49.5 (5.8). Day 1 observed plasma SID was positively correlated with the predicted SID (rs = 0.80, p = 0.01). By Days 2 and 3, the correlations of observed and predicted SID were no longer statistically significant. CONCLUSIONS AND RELEVANCE Using the Stewart model, increases in SID as an indicator of metabolic alkalosis due to the chloruretic effects of furosemide were observed. Predicted and observed SID correlated well over the first 24 h of treatment.
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Hasuda A, Flaiban K, Lisbôa J, Gomes L, Polizelli I, Santana L. Identifying hydric, electrolytic and acid-base imbalances through traditional and quantitative approaches in dogs with hemorrhagic gastroenteritis. ARQ BRAS MED VET ZOO 2020. [DOI: 10.1590/1678-4162-11017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Vomiting and diarrhea are two important clinical signs that can cause significant electrolytic and acid-base imbalances. The purposes of this study were to characterize hydric, electrolytic and acid-base disorders presented by puppies with hemorrhagic gastroenteritis and to compare the traditional and quantitative approaches to acid-base status interpretation. Sixty-one animals with a history of vomiting and/or diarrhea were used in this study and the following tests were performed: complete blood count, total plasma protein concentration and hemogasometry. Mean, standard deviation and Kappa values were calculated. The imbalances characterized by both approaches were: 42 (69%) animals without imbalance, 17 (28%) with metabolic alkalosis and 2 (3%) with metabolic acidosis by the traditional approach and 17 (28%) dogs without imbalance, 26 (43%) with metabolic alkalosis and 18 (29%) with metabolic acidosis by the quantitative approach. The agreement calculated between two approaches coincide in 28 cases, with a moderate Kappa value equivalent to 0.459. The most found imbalances were metabolic alkalosis, hypokalemia, and mild dehydration. Most of acid-base disturbances were not identified by the traditional approach, whereas by the quantitative approach, they were easily determined. Thus quantitative approach proved to be superior in identification of possible acid-base imbalances.
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Affiliation(s)
- A.L. Hasuda
- Universidade Estadual de Londrina, Brazil; Universidade Estadual de Londrina, Brazil
| | | | | | - L.A. Gomes
- Universidade Estadual de Londrina, Brazil
| | - I.G. Polizelli
- Universidade Estadual de Londrina, Brazil; Universidade Estadual de Londrina, Brazil
| | - L.S. Santana
- Universidade Estadual de Londrina, Brazil; Universidade Estadual de Londrina, Brazil
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Diaztagle-Fernández JD, Moreno-Ladino IJ, Morcillo-Muñoz JA, Morcillo-Muñoz AF, Marcelo-Pinilla LA, Cruz-Martínez LE. Comparative analysis of acid-base balance in patients with severe sepsis and septic shock: traditional approach vs. physicochemical approach. REVISTA DE LA FACULTAD DE MEDICINA 2019. [DOI: 10.15446/revfacmed.v67n4.65448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Introduction: The evaluation of metabolism and the diagnostic classification of acid-base disorders has generated great controversy. Acid-base balance (ABB) is approached by means of the physicochemical and Henderson’s models.Objective: To compare two diagnostic approaches to ABB in patients with severe sepsis.Materials and methods: Prospective, descriptive study conducted in patients with severe sepsis. ABB was analyzed within the first 24 hours. The diagnosis was compared according to each model and the causes of the disorders were compared according to the physicochemical model.Results: 38 patients were included in the study, of which 21 (55%) were women; the mean age was 49 years, the median APACHE II, 13.28, and the mortality at 28 days, 24.3%. The traditional approach identified 8 patients with normal ABB, 20 with metabolic acidosis, and 10 with other disorders. Based on the physicochemical model, all subjects had acidosis and metabolic alkalosis. Increased strong ion difference (SID) was the most frequently observed disorder.Conclusion: The physicochemical model was useful to diagnose more patients with acid-base disorders. According to these results, all cases presented with acidosis and metabolic alkalosis; the most frequent proposed mechanism of acidosis was elevated SID. The nature of these disorders and their clinical relevance is yet to be established.
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Zhang TQ, Huang SM, Gu YK, Gao F, Huang ZM, Jiang XY, Liu DX, Huang JH. Safety and effect on ablation size of hydrochloric acid-perfused radiofrequency ablation in animal livers. Int J Hyperthermia 2018; 34:925-933. [PMID: 29457524 DOI: 10.1080/02656736.2018.1442588] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
PURPOSE Our objective was to determine the safety and ablation size of hydrochloric acid-perfused radiofrequency ablation (HCl-RFA) in liver tissues, prospectively using in vivo rabbit and ex vivo porcine liver models. MATERIALS AND METHODS The livers in 30 rabbits were treated in vivo with perfusions of normal saline (controls) and HCl concentrations of 5%, 10%, 15%, and 20%, during RFA at 103 °C and 30 W for 3 min. For each experimental setting, six ablations were created. Safety was assessed by comparing baseline weight and selected laboratory values with those at 2, 7, and 14 days' post-ablation, and by histopathological analysis. The livers in 25 pigs were treated ex vivo with the same five perfusions during RFA at 103 °C, at both 30 W and 60 W, for 30 min. Ablation diameters and volumes were measured by two examiners. RESULTS Rabbit weights and selected laboratory values did not differ significantly from baseline to 7 and 14 days' post-ablation, liver tissues outside the ablation zones were normal histologically, and adjacent organs showed no macroscopic damage. The mean ablation volumes in the porcine livers treated with HCl-RFA were all larger than those treated with normal saline perfusion during RFA (NS-RFA), at both 30 W and 60 W (p < 0.001). The largest ablation volume and transverse diameter were observed in the porcine livers during 10% HCl-RFA at 60 W, measuring 179.22 (SD = 24.79) cm3 and 6.84 (SD = 0.36) cm, respectively. CONCLUSIONS Based on our experiments, HCl-RFA in the liver appears to be as safe as NS-RFA while also resulting in larger ablation zones.
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Affiliation(s)
- Tian-Qi Zhang
- a Department of Minimally Invasive Interventional Radiology , Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine , Guangzhou , P.R. China
| | - Sen-Miao Huang
- b Department of Oncology , Panyu Central Hospital , Guangzhou , P.R. China
| | - Yang-Kui Gu
- a Department of Minimally Invasive Interventional Radiology , Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine , Guangzhou , P.R. China
| | - Fei Gao
- a Department of Minimally Invasive Interventional Radiology , Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine , Guangzhou , P.R. China
| | - Zhi-Mei Huang
- a Department of Minimally Invasive Interventional Radiology , Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine , Guangzhou , P.R. China
| | - Xiong-Ying Jiang
- c Department of Interventional Radiology , Sun Yat-sen Memorial Hospital, Sun Yat-sen University , Guangzhou , P.R. China
| | - Ding-Xin Liu
- d Department of Colorectal Surgery , Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine , Guangzhou , P.R. China
| | - Jin-Hua Huang
- a Department of Minimally Invasive Interventional Radiology , Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine , Guangzhou , P.R. China
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Özdemir Z, Törer B, Hanta D, Cetinkaya B, Gulcan H, Tarcan A. Determination of tissue hypoxia by physicochemical approach in premature anemia. Pediatr Neonatol 2017; 58:425-429. [PMID: 28395879 DOI: 10.1016/j.pedneo.2016.09.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Revised: 07/10/2016] [Accepted: 09/14/2016] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND Anemia is a common problem in premature infants and its most rapid and effective therapy is erythrocyte transfusion. However, owing to inherent risks of transfusion in this population, transfusions should be administered only when adequate oxygen delivery to tissues is impaired. The aim of this study was to determine tissue acid levels using Stewart method in an attempt to evaluate the tissue oxygenation level and thereby the accuracy of transfusion timing. METHODS This study included 47 infants delivered at gestational age below 34 weeks who required erythrocyte transfusion for premature anemia. Strong ion gap (SIG), unmeasurable anions (UMA), tissue acid levels (TA), and Cl/Na ratios were calculated before and after transfusion. RESULTS The mean birth weight and gestational age of the study population were 1210 ± 365 g and 29.2 ± 2.7 weeks, respectively. Tissue acid levels were increased (TA ≥ 4) and tissue hypoxia developed in 10 (16.6%) of 60 erythrocyte transfusions administered according to the restrictive transfusion approach. The patients were divided into two groups according to tissue acid levels as low (<4) and high (≥4) tissue acid groups. The group with tissue hypoxia (TA ≥ 4) had significantly higher UMA levels but a significantly lower Cl/Na ratio; and UMA levels decreased and Cl/Na ratio increased after transfusion in this group. Tissue hypoxia secondary to anemia was shown to be improved by erythrocyte transfusion. CONCLUSION The results of the present study suggest that the determination of the level of tissue hypoxia by the Stewart approach may be an alternative to restrictive transfusion guidelines for timing of transfusion in premature anemia. It also showed that a low Cl/Na ratio can be used as a simple marker of tissue hypoxia.
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Affiliation(s)
- Zeliha Özdemir
- Baskent University Faculty of Medicine, Department of Neonatology, Seyhan, Adana, Turkey
| | - Birgin Törer
- Baskent University Faculty of Medicine, Department of Neonatology, Seyhan, Adana, Turkey.
| | - Deniz Hanta
- Baskent University Faculty of Medicine, Department of Neonatology, Seyhan, Adana, Turkey
| | - Bilin Cetinkaya
- Baskent University Faculty of Medicine, Department of Neonatology, Seyhan, Adana, Turkey
| | - Hande Gulcan
- Baskent University Faculty of Medicine, Department of Neonatology, Seyhan, Adana, Turkey
| | - Aylin Tarcan
- Baskent University Faculty of Medicine, Department of Neonatology, Seyhan, Adana, Turkey
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