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Rossetti E, Eandi Eberle S, Aguirre F, Pepe C, Díaz L, Harris V, Ávalos V. Hemoglobin Denver, a cause of desaturated pulse oximetry. A pediatric case report. ARCH ARGENT PEDIATR 2023; 121:e202202801. [PMID: 36857142 DOI: 10.5546/aap.2022-02801.eng] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
Hemoglobinopathies are genetic disorders that affect the hemoglobin (Hb) molecule. Mutations in the alpha or beta chains altering the Hb tetramer may modify the molecule's oxygen-binding capacity. Hemoglobinopathies with low oxygen affinity may occur with cyanosis and an altered pulse oximetry reading, leading to unnecessary and sometimes invasive tests to rule out cardiovascular and respiratory conditions. In the case report described here, we present an asymptomatic pediatric patient who consulted for desaturated pulse oximetry. Her initial laboratory tests showed normocytic, normochromic anemia. Venous blood gas samples showed an elevated p50. After using extensive diagnostic tools, a variant of Hb with low oxygen affinity was diagnosed: Hb Denver.
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Affiliation(s)
- Estefanía Rossetti
- Department of Hematology and Oncology; Hospital de Pediatría S.A.M.I.C. Prof. Dr. Juan P. Garrahan, City of Buenos Aires, Argentina
| | - Silvia Eandi Eberle
- Laboratory of Hematology; Hospital de Pediatría S.A.M.I.C. Prof. Dr. Juan P. Garrahan, City of Buenos Aires, Argentina
| | - Fernando Aguirre
- Laboratory of Hematology; Hospital de Pediatría S.A.M.I.C. Prof. Dr. Juan P. Garrahan, City of Buenos Aires, Argentina
| | - Carolina Pepe
- Laboratory of Molecular Biology; Hospital de Pediatría S.A.M.I.C. Prof. Dr. Juan P. Garrahan, City of Buenos Aires, Argentina
| | - Lilian Díaz
- Department of Hematology and Oncology; Hospital de Pediatría S.A.M.I.C. Prof. Dr. Juan P. Garrahan, City of Buenos Aires, Argentina
| | - Verónica Harris
- Clinic of Intermediate and Medium Care; Hospital de Pediatría S.A.M.I.C. Prof. Dr. Juan P. Garrahan, City of Buenos Aires, Argentina
| | - Vanesa Ávalos
- Department of Hematology and Oncology; Hospital de Pediatría S.A.M.I.C. Prof. Dr. Juan P. Garrahan, City of Buenos Aires, Argentina
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Sørensen KM, Leicht RV, Carlsson CJ, Elvekjaer M, Porsbjerg C, Aasvang EK, Meyhoff CS. Agreement Between Transcutaneous Monitoring and Arterial Blood Gases During COPD Exacerbation. Respir Care 2021; 66:1560-1566. [PMID: 34074743 PMCID: PMC9993557 DOI: 10.4187/respcare.08510] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Transcutaneous measurements of CO2 and O2 ([Formula: see text], [Formula: see text]) are noninvasive and allow for continuous monitoring in adults with exacerbation of COPD, but substantial accuracy issues may exist. We investigated agreement between results of arterial blood gas analysis and transcutaneous measurements of CO2 and O2 in patients with COPD. METHODS Adult subjects were monitored after acute admission to a respiratory intermediate care unit or ICU due to exacerbation of COPD and with ongoing noninvasive ventilation or immediately following extubation. Monitored variables were continuous transcutaneous measurement and simultaneous routine arterial blood gas analysis. Agreement between measurements was assessed by calculating bias with 95% limits of agreement for single-point estimates of [Formula: see text] versus [Formula: see text] and versus [Formula: see text], and for changes in transcutaneous measurements between 2 time points ([Formula: see text] and [Formula: see text]). We considered limits of agreement within ± 7.5 mm Hg to be acceptable. RESULTS A total of 57 transcutaneous measurements were made in 20 subjects for comparison with concurrent arterial blood gas analysis at 36 time points. The bias (limits of agreement) for [Formula: see text] and [Formula: see text] was 2.5 mm Hg (-10.6 to 15.6 mm Hg) and 11.2 mm Hg (-28.2 to 50.6 mm Hg), respectively. The bias for [Formula: see text] and [Formula: see text] was 2.3 mm Hg (-3.8 to 8.3 mm Hg) and -5.3 mm Hg (-37.5 to 27 mm Hg), respectively. CONCLUSIONS [Formula: see text] and [Formula: see text] did not accurately reflect results from arterial blood gas analyses in this study of mostly hypercapnic subjects. Agreement between changes in CO2 during the monitoring period was acceptable, however, and transcutaneous monitoring may be used for continuous monitoring of [Formula: see text] in conjunction with arterial blood gas analysis for reference.
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Affiliation(s)
- Kasper M Sørensen
- Department of Anaesthesia and Intensive Care, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
- Copenhagen Center for Translational Research, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Rebecca V Leicht
- Department of Anaesthesia and Intensive Care, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
- Copenhagen Center for Translational Research, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Christian J Carlsson
- Department of Anaesthesia and Intensive Care, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
- Copenhagen Center for Translational Research, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Mikkel Elvekjaer
- Department of Anaesthesia and Intensive Care, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
- Copenhagen Center for Translational Research, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Celeste Porsbjerg
- Copenhagen Center for Translational Research, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
- Department of Respiratory Medicine, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Eske K Aasvang
- Department of Anesthesiology, Centre for Cancer and Organ Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Christian S Meyhoff
- Department of Anaesthesia and Intensive Care, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark.
- Copenhagen Center for Translational Research, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Frérou A, Maamar A, Rafi S, Lhommet C, Phelouzat P, Pontis E, Reizine F, Lesouhaitier M, Camus C, Le Tulzo Y, Tadié JM, Gacouin A. Monitoring Transcutaneously Measured Partial Pressure of CO 2 During Intubation in Critically Ill Subjects. Respir Care 2021; 66:1004-1015. [PMID: 33824171 DOI: 10.4187/respcare.08009] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND The risk for severe hypoxemia during endotracheal intubation is a major concern in the ICU, but little attention has been paid to CO2 variability. The objective of this study was to assess transcutaneously measured partial pressure of CO2 ([Formula: see text]) throughout intubation in subjects in the ICU who received standard oxygen therapy, high-flow nasal cannula oxygen therapy, or noninvasive ventilation for preoxygenation. We hypothesized that the 3 methods differ in terms of ventilation and CO2 removal. METHODS In this single-center, prospective, observational study, we recorded [Formula: see text] from preoxygenation to 3 h after the initiation of mechanical ventilation among subjects requiring endotracheal intubation. Subjects were sorted into 3 groups according to the preoxygenation method. We then assessed the link between [Formula: see text] variability and the development of postintubation hypotension. RESULTS A total of 202 subjects were included in the study. The [Formula: see text] values recorded at endotracheal intubation, at the initiation of mechanical ventilation, and after 30 min and 1 h of mechanical ventilation were significantly higher than those recorded during preoxygenation (P < .05). [Formula: see text] variability differed significantly according to the preoxygenation method (P < .001, linear mixed model). A decrease in [Formula: see text] by > 5 mm Hg within 30 min after the start of mechanical ventilation was independently associated with postintubation hypotension (odds ratio = 2.14 [95% CI 1.03-4.44], P = .039) after adjustments for age, Simplified Acute Physiology Score II, COPD, cardiac comorbidity, the use of propofol for anesthetic induction, and minute ventilation at the start of mechanical ventilation. CONCLUSIONS [Formula: see text] variability during intubation is significant and differs with the method of preoxygenation. A decrease in [Formula: see text] after the beginning of mechanical ventilation was associated with postintubation hypotension. (ClinicalTrials.gov registration NCT0388430.).
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Affiliation(s)
- Aurélien Frérou
- Service de Maladies Infectieuses et Réanimation Médicale, CHU de Rennes, Rennes, France
- Faculté de Médecine, Université de Rennes 1, Rennes, France
| | - Adel Maamar
- Service de Maladies Infectieuses et Réanimation Médicale, CHU de Rennes, Rennes, France
- Faculté de Médecine, Université de Rennes 1, Rennes, France
| | - Sonia Rafi
- Service de Maladies Infectieuses et Réanimation Médicale, CHU de Rennes, Rennes, France
- Faculté de Médecine, Université de Rennes 1, Rennes, France
| | - Claire Lhommet
- Service de Maladies Infectieuses et Réanimation Médicale, CHU de Rennes, Rennes, France
- Faculté de Médecine, Université de Rennes 1, Rennes, France
| | - Pierre Phelouzat
- Service de Maladies Infectieuses et Réanimation Médicale, CHU de Rennes, Rennes, France
- Faculté de Médecine, Université de Rennes 1, Rennes, France
| | - Emmanuel Pontis
- Service de Maladies Infectieuses et Réanimation Médicale, CHU de Rennes, Rennes, France
- Faculté de Médecine, Université de Rennes 1, Rennes, France
| | - Florian Reizine
- Service de Maladies Infectieuses et Réanimation Médicale, CHU de Rennes, Rennes, France
- Faculté de Médecine, Université de Rennes 1, Rennes, France
| | - Mathieu Lesouhaitier
- Service de Maladies Infectieuses et Réanimation Médicale, CHU de Rennes, Rennes, France
- Faculté de Médecine, Université de Rennes 1, Rennes, France
| | - Christophe Camus
- Service de Maladies Infectieuses et Réanimation Médicale, CHU de Rennes, Rennes, France
- Faculté de Médecine, Université de Rennes 1, Rennes, France
| | - Yves Le Tulzo
- Service de Maladies Infectieuses et Réanimation Médicale, CHU de Rennes, Rennes, France
- Faculté de Médecine, Université de Rennes 1, Rennes, France
| | - Jean-Marc Tadié
- Service de Maladies Infectieuses et Réanimation Médicale, CHU de Rennes, Rennes, France
- Faculté de Médecine, Université de Rennes 1, Rennes, France
| | - Arnaud Gacouin
- Service de Maladies Infectieuses et Réanimation Médicale, CHU de Rennes, Rennes, France
- Faculté de Médecine, Université de Rennes 1, Rennes, France
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Martins IPM, Nakato AM, Hembecker PK, Ioshii SO, Nohama P. Correlation of End-Tidal Carbon Dioxide with Arterial Carbon Dioxide in Mechanically Ventilated Neonates: A Scoping Review. Glob Pediatr Health 2021; 8:2333794X211016790. [PMID: 34036124 PMCID: PMC8132087 DOI: 10.1177/2333794x211016790] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 04/21/2021] [Indexed: 12/03/2022] Open
Abstract
Monitoring CO2 levels in intubated neonates is highly relevant in the face of complications associated with altered CO2 levels. Thus, this review aims to present the scientific evidence in the literature regarding the correlation between arterial carbon dioxide measured by non-invasive methods in newborns submitted to invasive mechanical ventilation. The search was carried out from January 2020 to January 2021, in the Scopus, Medline, The Cochrane Library, Web of Science, CINAHL and Embase databases. Also, a manual search of the references of included studies was performed. The main descriptors used were: "capnography," "premature infant," "blood gas analysis," and "mechanical ventilation." As a result, 221 articles were identified, and 18 were included in this review. A total of 789 newborns were evaluated, with gestational age between 22.8 and 42.2 weeks and birth weight between 332 and 4790 g. Capnometry was the most widely used non-invasive method. In general, the correlation and agreement between the methods evaluated in the studies were strong/high. The birth weight did not influence the results. The gestational age of fewer than 37 weeks implied, in its majority, a moderate correlation and agreement. Therefore, we can conclude that there was a predominance of a strong correlation between arterial blood gases and non-invasive methods, although there are variations found in the literature. Even so, the results were promising and may provide valuable data for future studies, which are necessary to consolidate non-invasive methods as a reliable and viable alternative to arterial blood gasometry.
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Affiliation(s)
| | - Adriane Muller Nakato
- Graduate Program on Health Technology, Pontifícia Universidade Católica do Paraná (PUCPR), Curitiba, Paraná, Brazil
| | - Paula Karina Hembecker
- Graduate Program on Health Technology, Pontifícia Universidade Católica do Paraná (PUCPR), Curitiba, Paraná, Brazil
| | - Sérgio Ossamu Ioshii
- Graduate Program on Health Technology, Pontifícia Universidade Católica do Paraná (PUCPR), Curitiba, Paraná, Brazil
| | - Percy Nohama
- Graduate Program on Health Technology, Pontifícia Universidade Católica do Paraná (PUCPR), Curitiba, Paraná, Brazil
- Graduate Program on Biomedical Engineering, Universidade Tecnológica Federal do Paraná, Curitiba, Paraná, Brazil
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Ruiz Y, Farrero E, Córdoba A, González N, Dorca J, Prats E. Transcutaneous Carbon Dioxide Monitoring in Subjects With Acute Respiratory Failure and Severe Hypercapnia. Respir Care 2016; 61:428-33. [PMID: 26786741 DOI: 10.4187/respcare.04283] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Transcutaneous carbon dioxide (P(tcCO2)) monitoring is being used increasingly to assess acute respiratory failure. However, there are conflicting findings concerning its reliability when evaluating patients with high levels of P(aCO2). Our study evaluates the accuracy of this method in subjects with respiratory failure according to the severity of hypercapnia. METHODS We included subjects with respiratory failure, admitted to a respiratory intermediate care unit, who required arterial blood gas analysis. Simultaneously, P(tcCO2) was measured using a digital monitor. Relations between P(aCO2) and P(tcCO2) were assessed by the Pearson correlation coefficient. Bland-Altman analysis was used to test data dispersion, and an analysis of variance test was used to compare the differences between P(aCO2) and the corresponding P(tcCO2) at different levels (level 1, <50 mm Hg; level 2, 50-60 mm Hg; level 3, >60 mm Hg). RESULTS Eighty-one subjects were analyzed. The main diagnosis was COPD exacerbation (45%). P(tcCO2) correlated well with P(aCO2) (r2 = 0.93, P < .001). Bland-Altman analysis showed a mean P(aCO2) - P(tcCO2) difference of 4.9 ± 4.4 with 95% limits of agreement ranging from -3.6 to 13.4. The difference between variables increased in line with P(aCO2) severity: level 1, 1.7 ± 3.2 mm Hg; level 2, 3.7 ± 2.8; level 3, 6.8 ± 4.7 (analysis of variance, P < .001). CONCLUSIONS Our study showed an acceptable agreement of P(tcCO2) monitoring with arterial blood gas analysis. However, we should consider that P(tcCO2) underestimates P(aCO2) levels, and its accuracy depends on the level of hypercapnia, so this method would not be suitable for acute patients with severe hypercapnia.
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Affiliation(s)
- Yolanda Ruiz
- Respiratory Department, Hospital Universitario de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain.
| | - Eva Farrero
- Respiratory Department, Hospital Universitario de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
| | - Ana Córdoba
- Respiratory Department, Hospital Universitario de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
| | - Nuria González
- Respiratory Department, Hospital Universitario de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
| | - Jordi Dorca
- Respiratory Department, Hospital Universitario de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
| | - Enric Prats
- Respiratory Department, Hospital Universitario de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
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Mueggler T, Baumann D, Rausch M, Staufenbiel M, Rudin M. Age-dependent impairment of somatosensory response in the amyloid precursor protein 23 transgenic mouse model of Alzheimer's disease. J Neurosci 2003; 23:8231-6. [PMID: 12967984 PMCID: PMC6740698] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023] Open
Abstract
Quantitative functional magnetic resonance imaging was applied to characterize brain function in amyloid precursor protein 23 (APP23) transgenic mice, which reproduce the neuropathological alterations associated with Alzheimer's disease. Electrical stimulation of the paw led to cerebral blood volume increases in the contralateral somatosensory cortex. In APP23 mice this hemodynamic response decreased with increasing age of the animal and with increasing stimulus amplitude as compared with wild-type animals. The age-dependent dysfunction in APP23 mice may be attributed in part to a compromised cerebrovascular reactivity. Quantitative functional brain mapping that uses standardized sensory inputs should allow for assessment of disease progression and therapy response (e.g., passive immunization against beta-amyloid) in patients also.
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Affiliation(s)
- Thomas Mueggler
- Analytical and Imaging Sciences, Novartis Institute for Biomedical Research, CH-4002 Basel, Switzerland
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