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Ritz T, Kroll JL, Khan DA, Yezhuvath US, Aslan S, Pinkham A, Rosenfield D, Brown ES. fMRI BOLD responses to film stimuli and their association with exhaled nitric oxide in asthma and health. Psychophysiology 2024; 61:e14513. [PMID: 38339852 DOI: 10.1111/psyp.14513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 09/02/2023] [Accepted: 10/03/2023] [Indexed: 02/12/2024]
Abstract
Little is known about central nervous system (CNS) responses to emotional stimuli in asthma. Nitric oxide in exhaled breath (FENO) is elevated in asthma due to allergic immune processes, but endogenous nitric oxide is also known to modulate CNS activity. We measured fMRI blood oxygen-dependent (BOLD) brain activation to negative (blood-injection-injury themes) and neutral films in 31 participants (15 with asthma). Regions-of-interest analysis was performed on key areas relevant to central adaptive control, threat processing, or salience networks, with dorsolateral prefrontal cortex (PFC), anterior insula, dorsal anterior cingulate cortex (dACC), amygdala, ventral striatum, ventral tegmentum, and periaqueductal gray, as well as top-down modulation of emotion, with ventrolateral and ventromedial PFC. Both groups showed less BOLD deactivation from fixation cross-baseline in the left anterior insula and bilateral ventromedial PFC for negative than neutral films, and for an additional number of areas, including the fusiform gyrus, for film versus recovery phases. Less deactivation during films followed by less recovery from deactivation was found in asthma compared to healthy controls. Changes in PCO2 did not explain these findings. FENO was positively related to BOLD activation in general, but more pronounced in healthy controls and more likely in neutral film processing. Thus, asthma is associated with altered processing of film stimuli across brain regions not limited to central adaptive control, threat processing, or salience networks. Higher levels of NO appear to facilitate CNS activity, but only in healthy controls, possibly due to allergy's masking effects on FENO.
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Affiliation(s)
- Thomas Ritz
- Department of Psychology, Southern Methodist University, Dallas, Texas, USA
| | - Juliet L Kroll
- Department of Psychology, Southern Methodist University, Dallas, Texas, USA
- Department of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - David A Khan
- Department of Internal Medicine, Division of Allergy and Immunology, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | | | - Sina Aslan
- Department of Internal Medicine, Division of Allergy and Immunology, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Advance MRI LLC, Frisco, Texas, USA
- Department of Psychology, University of Texas at Dallas, Dallas, Texas, USA
| | - Amy Pinkham
- Department of Psychology, University of Texas at Dallas, Dallas, Texas, USA
| | - David Rosenfield
- Department of Psychology, Southern Methodist University, Dallas, Texas, USA
| | - E Sherwood Brown
- Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
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Aetou M, Wahab L, Dreher M, Daher A. Significance of Hypocapnia in the Risk Assessment of Patients with Pulmonary Hypertension. J Clin Med 2023; 12:6307. [PMID: 37834951 PMCID: PMC10573368 DOI: 10.3390/jcm12196307] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 09/21/2023] [Accepted: 09/29/2023] [Indexed: 10/15/2023] Open
Abstract
Blood gas analysis is part of the diagnostic work-up for pulmonary hypertension (PH). Although some studies have found that the partial pressure of carbon dioxide (PaCO2) is an independent marker of mortality in individuals with pulmonary arterial hypertension (PH Group 1), there is a lack of data regarding the significance of PaCO2 in individuals with different types of PH based on the new 2022 definitions. Therefore, this study analyzed data from 157 individuals who were undergoing PH work-up, including right heart catheterization, using PH definitions from the 2022 European Society of Cardiology/European Respiratory Society guidelines. At diagnosis, N-terminal pro-B-type natriuretic peptide (NT-pro-BNP) levels were significantly higher, but the time-course of NT-pro-BNP levels during treatment was significantly more favorable in individuals with pulmonary arterial hypertension (PH Group 1) who did versus did not have hypocapnia (p = 0.026 and p = 0.017, respectively). These differences based on the presence of hypocapnia were not seen in individuals with PH Groups 2, 3, or 4. In conclusion, using the new definition of PH, hypocapnia may correlate with worse risk stratification at diagnosis in individuals with pulmonary arterial hypertension. However, hypocapnic individuals with pulmonary arterial hypertension may benefit more from disease-specific therapy than those without hypocapnia.
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Affiliation(s)
| | | | - Michael Dreher
- Department of Pneumology and Intensive Care Medicine, University Hospital RWTH Aachen, 52074 Aachen, Germany; (M.A.); (L.W.); (A.D.)
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Scudellari A, Dudek P, Marino L, Badenes R, Bilotta F. Ventilation Targets for Patients Undergoing Mechanical Thrombectomy for Acute Ischemic Stroke: A Systematic Review. J Clin Med 2023; 12:4925. [PMID: 37568327 PMCID: PMC10420130 DOI: 10.3390/jcm12154925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Revised: 06/30/2023] [Accepted: 07/24/2023] [Indexed: 08/13/2023] Open
Abstract
Mechanical thrombectomy (MT) has become a standard treatment for acute ischemic stroke (AIS) caused by large vessel occlusion (LVO). Recent evidence suggests that general anesthesia (GA) and mechanical ventilation do not lead to inferior neurologic outcomes if compared to non-GA. However, the guidelines lack specific recommendations for ventilation targets during MT under GA. This systematic review aims to identify ventilation strategies correlating with better neurological outcomes in AIS patients undergoing MT, particularly focusing on oxygenation and carbon dioxide (CO2) targets. A systematic search of multiple databases was conducted to identify human studies reporting the correlation between ventilation strategies and neurological outcomes in MT for AIS. Eligible studies included clinical trials, observational studies, and case-control studies. Out of 157 studies assessed, 11 met the inclusion criteria. Five studies investigated oxygenation targets, while six studies explored CO2 targets. The published studies highlighted the controversial role of supplemental normobaric oxygen therapy and its potential association with worse outcomes. Regarding CO2 targets, the studies identified a potential association between end tidal CO2 levels and functional outcomes, with hypocapnia being unfavorable. This systematic review demonstrates that the current available evidence still lacks strength to suggest specific ventilation targets, but it highlights the potential risks of hyperoxia and hypocapnia in this specific cohort of patients.
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Affiliation(s)
| | - Paula Dudek
- 2nd Department of Anesthesiology and Intensive Care, Medical University of Warsaw, 02-097 Warsaw, Poland;
| | - Luca Marino
- Department of Mechanical and Aerospace Engineering, “Sapienza” University of Rome, 00184 Rome, Italy
| | - Rafael Badenes
- Department of Anesthesiology and Surgical-Trauma Intensive Care, Hospital Clínic Universitari de Valencia, University of Valencia, 46010 Valencia, Spain
| | - Federico Bilotta
- Department of Anesthesiology, Critical Care and Pain Medicine, Policlinico Umberto I, “Sapienza” University of Rome, 00185 Rome, Italy;
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Zhao Y, Jia L, Jia R, Han H, Feng C, Li X, Wei Z, Wang H, Zhang H, Pan S, Wang J, Guo X, Yu Z, Li X, Wang Z, Chen W, Li J, Li T. A New Time-Window Prediction Model For Traumatic Hemorrhagic Shock Based on Interpretable Machine Learning. Shock 2022; 57:48-56. [PMID: 34905530 PMCID: PMC8663521 DOI: 10.1097/shk.0000000000001842] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 07/26/2021] [Indexed: 12/29/2022]
Abstract
ABSTRACT Early warning prediction of traumatic hemorrhagic shock (THS) can greatly reduce patient mortality and morbidity. We aimed to develop and validate models with different stepped feature sets to predict THS in advance. From the PLA General Hospital Emergency Rescue Database and Medical Information Mart for Intensive Care III, we identified 604 and 1,614 patients, respectively. Two popular machine learning algorithms (i.e., extreme gradient boosting [XGBoost] and logistic regression) were applied. The area under the receiver operating characteristic curve (AUROC) was used to evaluate the performance of the models. By analyzing the feature importance based on XGBoost, we found that features in vital signs (VS), routine blood (RB), and blood gas analysis (BG) were the most relevant to THS (0.292, 0.249, and 0.225, respectively). Thus, the stepped relationships existing in them were revealed. Furthermore, the three stepped feature sets (i.e., VS, VS + RB, and VS + RB + sBG) were passed to the two machine learning algorithms to predict THS in the subsequent T hours (where T = 3, 2, 1, or 0.5), respectively. Results showed that the XGBoost model performance was significantly better than the logistic regression. The model using vital signs alone achieved good performance at the half-hour time window (AUROC = 0.935), and the performance was increased when laboratory results were added, especially when the time window was 1 h (AUROC = 0.950 and 0.968, respectively). These good-performing interpretable models demonstrated acceptable generalization ability in external validation, which could flexibly and rollingly predict THS T hours (where T = 0.5, 1) prior to clinical recognition. A prospective study is necessary to determine the clinical utility of the proposed THS prediction models.
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Affiliation(s)
- Yuzhuo Zhao
- Department of Emergency, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Lijing Jia
- Department of Emergency, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Ruiqi Jia
- School of Economics and Management, Beijing Jiaotong University, Beijing, China
| | - Hui Han
- Department of Emergency, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Cong Feng
- Department of Emergency, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Xueyan Li
- Management School, Beijing Union University, Beijing, China
| | | | - Hongxin Wang
- Department of Emergency, Armed Police Characteristic Medical Center, Tianjin, China
| | - Heng Zhang
- Department of Emergency, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Shuxiao Pan
- College of Computer Science and Artificial Intelligence, Wenzhou University
| | - Jiaming Wang
- School of Economics and Management, Beijing Jiaotong University, Beijing, China
| | - Xin Guo
- Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Zheyuan Yu
- School of Economics and Management, Beijing Jiaotong University, Beijing, China
| | - Xiucheng Li
- School of Economics and Management, Beijing Jiaotong University, Beijing, China
| | - Zhaohong Wang
- School of Economics and Management, Beijing Jiaotong University, Beijing, China
| | - Wei Chen
- Department of Emergency, The Third Medical Center of Chinese PLA General Hospital, Beijing, China
- Hainan Hospital of Chinese PLA General Hospital, Sanya, China
| | - Jing Li
- School of Economics and Management, Beijing Jiaotong University, Beijing, China
| | - Tanshi Li
- Department of Emergency, The First Medical Center of Chinese PLA General Hospital, Beijing, China
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Itonaga M, Okanari K, Maeda T, Yoshiura KI, Ihara K. Simultaneous monitoring of oxygen and carbon dioxide for Pitt-Hopkins syndrome. Pediatr Int 2022; 64:e15180. [PMID: 35438213 DOI: 10.1111/ped.15180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 02/04/2022] [Accepted: 02/21/2022] [Indexed: 01/05/2023]
Affiliation(s)
- Masahiko Itonaga
- Department of Pediatrics, Oita University Faculty of Medicine, Yufu, Japan
| | - Kazuo Okanari
- Department of Pediatrics, Oita University Faculty of Medicine, Yufu, Japan
| | - Tomoki Maeda
- Department of Pediatrics, Oita University Faculty of Medicine, Yufu, Japan
| | - Koh-Ichiro Yoshiura
- Department of Human Genetics, Atomic Bomb Disease Institute, Nagasaki University, Nagasaki, Japan
| | - Kenji Ihara
- Department of Pediatrics, Oita University Faculty of Medicine, Yufu, Japan
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Li L, Qin A, Yang X, Zhou S, Luo Y, Zhu F, Hu B, Li J, Cai S, Peng Z. Findings and Prognostic Value of Lung Ultrasonography in Coronal Virus Disease 2019 (COVID-19) Pneumonia. Shock 2021; 56:200-205. [PMID: 33234837 PMCID: PMC8284347 DOI: 10.1097/shk.0000000000001700] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Revised: 10/01/2020] [Accepted: 11/18/2020] [Indexed: 12/20/2022]
Abstract
PURPOSE We used lung ultrasonography to identify features of COVID-19 pneumonia and to evaluate the prognostic value. PATIENTS AND METHODS We performed lung ultrasonography on 48 COVID-19 patients in an intensive care unit (ICU) (Wuhan, China) using a 12-zone method. The associations between lung ultrasonography score, PaO2/FiO2, APACHE II, SOFA, and PaCO2 with 28-day mortality were analyzed and the receiver operator characteristic curve was plotted. RESULTS 25.9% areas in all scanning zones presented with B7 lines and 23.5% with B3 lines (B-pattern) on lung ultrasonography; 13% areas with confluent B lines (B-pattern), 24.9% in areas with consolidations, and 9.9% in areas with A lines. Pleural effusion was observed in 2.8% of areas. Lung ultrasonography score was negatively correlated with PaO2/FiO2 (n = 48, r = -0.498, P < 0.05) and positively correlated with APACHE II (n = 48, r = 0.435, P < 0.05). Lung ultrasonography score was independently associated with 28-day mortality. The areas under receiver operator characteristic curves of lung ultrasonography score were 0.735 (95% CI: 0.586-0.844). The sensitivity, specificity, and cutoff values were 0.833, 0.722, and 22.5, respectively. CONCLUSIONS Lung ultrasonography could be used to assess the severity of COVID-19 pneumonia, and it could also reveal the pathological signs of the disease. The lung ultrasonography score on ICU admission was independently related to the ICU 28-day mortality.
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Affiliation(s)
- Lu Li
- Department of Critical Care Medicine, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
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Duan L, Xie C, Zhao N. Effect of high-flow nasal cannula oxygen therapy in patients with chronic obstructive pulmonary disease: A meta-analysis. J Clin Nurs 2021; 31:87-98. [PMID: 34245049 DOI: 10.1111/jocn.15957] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/03/2021] [Indexed: 12/22/2022]
Abstract
BACKGROUND High-flow nasal cannula oxygen therapy reduces the arterial partial pressure of carbon dioxide and acute exacerbation but does not increase exercise capacity or decrease hospitalisation or mortality. The study aimed to test the hypothesis that in chronic obstructive pulmonary disease patients, the use of high-flow nasal cannula decreases arterial partial pressure of carbon dioxide and increases the partial pressure of oxygen and 6-min walking distance. METHODS PubMed, Embase and the Cochrane library were searched for eligible studies published from database inception to November 2020 (Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist). The primary outcomes were partial pressure of carbon dioxide and partial pressure of oxygen, and the secondary outcomes were transcutaneous partial pressure of carbon dioxide and 6-min walking distance. RESULTS Nine studies (680 patients) were included. high-flow nasal cannula did not decrease partial pressure of carbon dioxide compared with the control interventions (mean difference = -0.81, 95% confidence interval: -2.68 to 1.06, p = .395; I2 = 42.9%, pheterogeneity = .105). high-flow nasal cannula decreased partial pressure of carbon dioxide compared with long-term oxygen therapy (mean difference = -3.25, 95% confidence interval: -5.65 to -0.85, p = .008; I2 = 0%, pheterogeneity = .375); no difference was observed for the control modalities. high-flow nasal cannula resulted in better partial pressure of carbon dioxide compared with control interventions in hypoxemic patients (mean difference = -2.59, 95% confidence interval: -4.82 to -0.35, p = .023; I2 = 32.5%, pheterogeneity = .224), but not in other types of patients. high-flow nasal cannula did not increase partial pressure of oxygen compared with the control interventions (mean difference = 1.17, 95% confidence interval: -1.50 to 3.83, p = .390; I2 = 0%, pheterogeneity = .660). high-flow nasal cannula decreased transcutaneous carbon dioxide tension (transcutaneous partial pressure of carbon dioxide) compared with the control interventions (mean difference = 2.37, 95% confidence interval: 0.07-4.68, p = .044; I2 = 8.7%, pheterogeneity = .295). high-flow nasal cannula increased 6-min walking distance compared with the control interventions (mean difference = 18.22, 95% confidence interval: 0.86-,35.57, p = .040; I2 = 0%, pheterogeneity = .918). The sensitivity analyses showed that the results were robust. CONCLUSIONS High-flow nasal cannula did not significantly decrease partial pressure of carbon dioxide or increase partial pressure of oxygen in chronic obstructive pulmonary disease patients, which is different from the previous meta-analysis, but it decreases transcutaneous partial pressure of carbon dioxide and increased 6-min walking distance. RELEVANCE TO CLINICAL PRACTICE This meta-analysis shows that in patients with chronic obstructive pulmonary disease, high-flow nasal cannula improves both transcutaneous partial pressure of carbon dioxide and 6-min walking distance, suggesting the high-flow nasal cannula has benefits in the management of chronic obstructive pulmonary disease. Considering that the literature suggests no impact of high-flow nasal cannula on hospitalisation and mortality, the benefits of high-flow nasal cannula might be limited to the patients who survive the chronic obstructive pulmonary disease events. Still, the global impact of high-flow nasal cannula on the quality of life of patients with chronic obstructive pulmonary disease should be examined.
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Affiliation(s)
- Li Duan
- Department of Respiratory and Critical Care Medicine, The Ninth People's Hospital of Chongqing, Chongqing, China
| | - Caide Xie
- Department of Respiratory and Critical Care Medicine, The Ninth People's Hospital of Chongqing, Chongqing, China
| | - Na Zhao
- Department of Respiratory and Critical Care Medicine, The Ninth People's Hospital of Chongqing, Chongqing, China
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Wang J, Shang H, Yang X, Guo S, Cui Z. Procalcitonin, C-reactive protein, PaCO2, and noninvasive mechanical ventilation failure in chronic obstructive pulmonary disease exacerbation. Medicine (Baltimore) 2019; 98:e15171. [PMID: 31027061 PMCID: PMC6831316 DOI: 10.1097/md.0000000000015171] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
It is unclear whether procalcitonin (PCT) is correlated with noninvasive ventilation (NIV) failure. This retrospective case-control study aimed to compare PCT levels, C-reactive protein (CRP) levels, and PaCO2 in patients (05/2014-03/2015 at the Harrison International Peace Hospital, China) with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) and NIV failure/success.This was a retrospective case-control study of patients with AECOPD who required NIV between May 2014 and March 2015. All consecutive patients with AECOPD admitted at the Department of Critical Care Medicine and transferred from the general ward were included in the study. Hemogram, PCT, erythrocyte sedimentation rate (ESR), arterial blood gas (ABG), and CRP levels were measured ≤1 hour before NIV was used. NIV was considered to have failed if at least one of the following criteria was met: cardiac arrest or severe hemodynamic instability; respiratory arrest or gasping; mask intolerance; difficulty in clearing bronchial secretions; or worsening of ABGs or sensorium level during NIV. The factors associated with NIV failure were determined.A total of 376 patients were included: 286 with successful NIV and 90 wither NIV failure. The multivariate analysis showed that PCT (OR = 2.0, 95%CI: 1.2-3.2, P = .006), CRP (OR = 1.2, 95%CI: 1.1-1.3, P < .001), and PaCO2 (OR = 1.1, 95%CI: 1.1-1.2, P < .001) ≤1 hour before NIV were independently associated with NIV failure. The optimal cutoff were 0.31 ng/mL for PCT (sensitivity, 83.3%; specificity, 83.7%), 15.0 mg/mL for CRP (sensitivity, 75.6%; specificity, 93.0%), and 73.5 mm Hg for PaCO2 (sensitivity, 71.1%; specificity, 100%). The area under the curve (AUC) was 0.854 for PCT, 0.849 for CRP, and 0.828 for PaCO2. PCT, CRP, and PaCO2 were used to obtain a combined prediction factor, which achieved an AUC of 0.978 (95%CI: 0.961-0.995).High serum PCT, CRP, and PaCO2 levels predict NIV failure for patients with AECOPD. The combination of these three parameters might enable even more accurate prediction.
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Schwarz SB, Windisch W, Magnet FS, Schmoor C, Karagiannidis C, Callegari J, Huttmann SE, Storre JH. Continuous non-invasive PCO 2 monitoring in weaning patients: Transcutaneous is advantageous over end-tidal PCO 2. Respirology 2017; 22:1579-1584. [PMID: 28613389 DOI: 10.1111/resp.13095] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Revised: 04/21/2017] [Accepted: 04/21/2017] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND OBJECTIVE Continuous partial pressure of carbon dioxide (PCO2 ) assessment is essential for the success of mechanical ventilation (MV). Non-invasive end-tidal PCO2 (PetCO2 ) and transcutaneous PCO2 (PtcCO2 ) measurements serve as alternatives to the gold standard arterial PCO2 (PaCO2 ) method, but their eligibility in critical care is unclear. METHODS The present study therefore performed methodological comparisons of PaCO2 versus PetCO2 and PtcCO2 , respectively, in weaning patients receiving invasive MV via tracheal cannulas. PetCO2 and PtcCO2 were recorded continuously, while PaCO2 was analysed at baseline, and after 30 and 60 min. Using the Bland-Altman analysis, a clinically acceptable range was defined as a mean difference of ±4 mm Hg between PaCO2 and non-invasive strategies. RESULTS A total of 60 patients (COPD (n = 30) and non-COPD (n = 30)) completed the protocol. Mean PCO2 values were 42.4 ± 8.6 mm Hg (PaCO2 ), 36.5 ± 7.5 mm Hg (PetCO2 ) and 41.7 ± 8.7 mm Hg (PtcCO2 ). Mean differences between PtcCO2 and PaCO2 were -0.7 ± 3.6 mm Hg (95% CI: -1.6/0.3 mm Hg; 95% limits of agreement: -7.8 to 6.4 mm Hg), and between PetCO2 and PaCO2 -5.9 ± 5.3 mm Hg (95% CI: -7.2/-4.5 mm Hg; 95% limits of agreement: -16.2 to 4.5 mm Hg). Underestimation of PaCO2 by PetCO2 was most pronounced in COPD patients. CONCLUSION Our data therefore support PtcCO2 as a suitable means for monitoring PCO2 in patients undergoing invasive MV. This is in contrast to PetCO2 , which clearly underestimated PaCO2 , especially in patients with COPD.
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Affiliation(s)
- Sarah B Schwarz
- Department of Pneumology, Cologne-Merheim Hospital, Kliniken der Stadt Köln gGmbH, Witten/Herdecke University Hospital, Cologne, Germany
| | - Wolfram Windisch
- Department of Pneumology, Cologne-Merheim Hospital, Kliniken der Stadt Köln gGmbH, Witten/Herdecke University Hospital, Cologne, Germany
| | - Friederike S Magnet
- Department of Pneumology, Cologne-Merheim Hospital, Kliniken der Stadt Köln gGmbH, Witten/Herdecke University Hospital, Cologne, Germany
| | - Claudia Schmoor
- Clinical Trials Unit, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg im Breisgau, Germany
| | - Christian Karagiannidis
- Department of Pneumology, Cologne-Merheim Hospital, Kliniken der Stadt Köln gGmbH, Witten/Herdecke University Hospital, Cologne, Germany
| | - Jens Callegari
- Department of Pneumology, Cologne-Merheim Hospital, Kliniken der Stadt Köln gGmbH, Witten/Herdecke University Hospital, Cologne, Germany
| | - Sophie E Huttmann
- Department of Pneumology, Cologne-Merheim Hospital, Kliniken der Stadt Köln gGmbH, Witten/Herdecke University Hospital, Cologne, Germany
| | - Jan H Storre
- Department of Intensive Care, Sleep Medicine and Mechanical Ventilation, Asklepios Hospital München-Gauting, Gauting, Germany.,Department of Pneumology, University Medical Hospital, Freiburg, Germany
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Shadnia S, Rahimi M, Soltaninejad K, Nilli A. Role of clinical and paraclinical manifestations of methanol poisoning in outcome prediction. J Res Med Sci 2013; 18:865-9. [PMID: 24497857 PMCID: PMC3897070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/20/2013] [Revised: 02/10/2013] [Accepted: 04/23/2013] [Indexed: 11/02/2022]
Abstract
BACKGROUND Methanol poisoning is one of the most important poisoning due to drinking of illegal and non-standard alcoholic beverage in some countries. Relatively limited studies have been carried out to identify the prognostic factors in methanol poisoning. MATERIALS AND METHODS We performed a retrospective study on acute methanol-intoxicated patients, which were admitted on the Loghman Hakim Hospital Poison Center (Tehran, Iran) over a 24-month period. The demographic data, clinical manifestations and paraclinical findings, therapeutic interventions and outcome (survivors with or without complications and non-survivors) were extracted. RESULTS We evaluated 30 patients with methanol poisoning during 2 years. All of the patients were male; with the median age of 25.5 years. Visual disturbances, respiratory manifestations, and loss of consciousness were the most common clinical manifestations on admission time. The results of paraclinical manifestations on admission time were as following: The median of blood methanol level was 20 mg/dL. The median of pH, PaCO2 and HCO3 was 7.15, 22.35 mmHg and 7.2 mEq/L, respectively. Hyperglycemia was observed in 70% of the patients and the median of blood glucose was 184.5 mg/dL. In fourteen of the patients hemodialysis was performed. Median duration of hospitalization was 48 h. Nine of the patients died. There was a significant difference between survivors and non-survivors with regard to coma, blood methanol level, and PaCO2 and blood glucose. Furthermore, we did not observe a significant difference between these two groups regarding to pH, HCO3 level, and time interval between alcohol ingestion to hospital admission and beginning of hemodialysis. CONCLUSION Regarding the results of this study, it can be suggested that coma, PaCO2 and hyperglycemia on admission time could be used as strong predictors of poor outcome.
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Affiliation(s)
- Shahin Shadnia
- Excellent Center of Clinical Toxicology, Toxicological Research Center, Clinical Toxicology Department, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mojgan Rahimi
- Excellent Center of Clinical Toxicology, Toxicological Research Center, Clinical Toxicology Department, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Kambiz Soltaninejad
- Legal Medicine Research Center, Legal Medicine Organization, Tehran, Iran,Address for correspondence: Dr. Kambiz Soltaninejad, Department of Forensic Toxicology, Legal Medicine Research Center, Legal Medicine Organization of Iran, Behesht Street, Khayyam Avenue, Tehran, Iran. E-mail:
| | - Amir Nilli
- Department of Toxicology and Pharmacology, Faculty of Pharmacy, Pharmaceutical Sciences Research Center, Tehran University of Medical Sciences, Tehran, Iran
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Harilall Y, Adam JK, Biccard BM, Reddi A. The effect of optimising cerebral tissue oxygen saturation on markers of neurological injury during coronary artery bypass graft surgery. Heart Lung Circ 2013; 23:68-74. [PMID: 23911209 DOI: 10.1016/j.hlc.2013.07.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Revised: 06/29/2013] [Accepted: 07/02/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Surgical revascularisation of the coronary arteries is a cornerstone of cardiothoracic surgery. Advanced age and the incidence of preoperative co-morbidity in patients presenting for coronary artery bypass graft surgery increases the potential for stroke and other perioperative outcomes. It is hypothesised that by using interventions during cardiac surgery to improve cerebral oxygenation, the risk of patients enduring adverse neurological outcomes would be reduced. METHODS Forty patients (mean age 55.3, standard deviation 9.74 and range from 39 to 72 years) undergoing on-pump coronary artery bypass graft surgery were recruited at Inkosi Albert Luthuli Central Hospital, South Africa. Patients were randomised into a control group (n=20) and interventional group (n=20). Intraoperative regional cerebral oxygen saturation (rSO2) monitoring with active display and Murkin treatment intervention protocol was administered for the interventional group. Arterial blood samples for the measurement of serum S100B were taken pre and postoperatively. An enzyme immunoassay (ELISA) was used for the quantitative and comparative measurement of human S100B concentrations for both groups. A prioritised intraoperative management protocol to maintain rSO2 values above 75% of the baseline threshold during cardiopulmonary bypass was followed. RESULTS There was a highly significant difference in the change in S100B concentrations post surgery between the interventional (37.3picograms per millilitre) and control groups (139.3pg/ml). The control group showed a significantly higher increase in S100B concentration over time than the intervention group (p<0.001). There was a significant difference in cerebral desaturation time (p<0.001) between the groups. The mean desaturation time for the control group was 63.85min as compared to 24.7min in the interventional group. Cerebral desaturation occurred predominantly during aortic cross clamping, distal anastomosis of coronary arteries and aortic cross clamp release. Predictors of cerebral oxygen desaturation included, partial pressure of carbon dioxide (pCO2), temperature, pump flow rate (LMP), mean arterial pressure (MAP), haematocrit, heart rate (HR) and patient oxygen saturation (SpO2). CONCLUSION Monitoring brain oxygen saturation during on-pump CABG together with an effective treatment protocol to deal with cerebral desaturation must be advocated.
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Affiliation(s)
- Yakeen Harilall
- Dept of Cardiothoracic Surgery, Inkosi Albert Luthuli Central Hospital, KZN, South Africa
| | - Jamila Kathoon Adam
- Department of Biomedical and Clinical Technology, Durban University of Technology, South Africa.
| | - Bruce McLure Biccard
- College of Health Sciences, University of Kwazulu Natal, South Africa; Department of Anaesthesia, Inkosi Albert Luthuli Central Hospital, South Africa
| | - Anu Reddi
- Dept of Cardiothoracic Surgery, Inkosi Albert Luthuli Central Hospital, KZN, South Africa
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Al Jaaly E, Fiorentino F, Reeves BC, Ind PW, Angelini GD, Kemp S, Shiner RJ. Effect of adding postoperative noninvasive ventilation to usual care to prevent pulmonary complications in patients undergoing coronary artery bypass grafting: a randomized controlled trial. J Thorac Cardiovasc Surg 2013; 146:912-8. [PMID: 23582830 DOI: 10.1016/j.jtcvs.2013.03.014] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2012] [Revised: 02/19/2013] [Accepted: 03/06/2013] [Indexed: 11/16/2022]
Abstract
OBJECTIVE We compared the efficacy of noninvasive ventilation with bilevel positive airway pressure added to usual care versus usual care alone in patients undergoing coronary artery bypass grafting. METHODS We performed a 2-group, parallel, randomized controlled trial. The primary outcome was time until fit for discharge. Secondary outcomes were partial pressure of carbon dioxide, forced expiratory volume in 1 second, atelectasis, adverse events, duration of intensive care stay, and actual postoperative stay. RESULTS A total of 129 patients were randomly allocated to bilevel positive airway pressure (66) or usual care (63). Three patients allocated to bilevel positive airway pressure withdrew. The median duration of bilevel positive airway pressure was 16 hours (interquartile range, 11-19). The median duration of hospital stay until fit for discharge was 5 days for the bilevel positive airway pressure group (interquartile range, 4-6) and 6 days for the usual care group (interquartile range, 5-7; hazard ratio, 1.68; 95% confidence interval, 1.08-2.31; P = .019). There was no significant difference in duration of intensive care, actual postoperative stay, and mean percentage of predicted forced expiratory volume in 1 second on day 3. Mean partial pressure of carbon dioxide was significantly reduced 1 hour after bilevel positive airway pressure application, but there was no overall difference between the groups up to 24 hours. Basal atelectasis occurred in 15 patients (24%) in the usual care group and 2 patients (3%) in the bilevel positive airway pressure group. Overall, 30% of patients in the bilevel positive airway pressure group experienced an adverse event compared with 59% in the usual care group. CONCLUSIONS Among patients undergoing elective coronary artery bypass grafting, the use of bilevel positive airway pressure at extubation reduced the recovery time. Supported by trained staff, more than 75% of all patients allocated to bilevel positive airway pressure tolerated it for more than 10 hours.
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Affiliation(s)
- Emad Al Jaaly
- Cardiothoracic Surgery, Hammersmith Hospital, Imperial College NHS Trust, London, United Kingdom
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Rubortone SA, De Carolis MP, Lacerenza S, Bersani I, Occhipinti F, Romagnoli C. Use of a combined SpO₂/PtcCO₂ sensor in the delivery room. Sensors (Basel) 2012; 12:10980-9. [PMID: 23112642 PMCID: PMC3472870 DOI: 10.3390/s120810980] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/12/2012] [Revised: 07/16/2012] [Accepted: 07/31/2012] [Indexed: 11/16/2022]
Abstract
Arterial oxygen saturation (SaO2) and partial arterial pressure of carbon dioxide (PaCO2) are important respiratory parameters in critically ill neonates. A sensor combining a pulse oximeter with the Stow-Severinghaus electrode, required for the measurement of peripheral oxygen saturation (SpO2) and transcutaneous partial pressure of carbon dioxide (PtcCO2), respectively, has been recently used in neonatal clinical practice (TOSCA500ÒRadiometer). We evaluated TOSCA usability and reliability in the delivery room (DR), throughout three different periods, on term, late-preterm, and preterm neonates. During the first period (period A), 30 healthy term neonates were simultaneously monitored with both TOSCA and a MASIMO pulse oximeter. During the second period (period B), 10 healthy late-preterm neonates were monitored with both TOSCA and a transcutaneous device measuring PtcCO2 (TINAÒ TCM3, Radiometer). During the third period (period C), 15 preterm neonates were monitored with TOSCA and MASIMO after birth, during stabilization, and during transport to the neonatal intensive care unit (NICU). Blood gas analyses were performed to compare transcutaneous and blood gas values. TOSCA resulted easily and safely usable in the DR, allowing reliable noninvasive SaO2 estimation. Since PtcCO2 measurements with TOSCA required at least 10 min to be stable and reliable, this parameter was not useful during the early resuscitation immediately after birth. Moreover, PtcCO2 levels were less precise if compared to the conventional transcutaneous monitoring. However, PtcCO2 measurement by TOSCA was useful as trend-monitoring after stabilization and during transport to NICU.
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Affiliation(s)
- Serena Antonia Rubortone
- Division of Neonatology, Department of Paediatrics, Catholic University of Sacred Heart, Largo Gemelli 8, I-00168 Rome, Italy.
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