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Low‐load blood‐flow‐restriction resistance training (LL‐BFR‐RT) is gaining popularity, but its physiological effects remain unclear. This study aimed to compare LL‐BFR‐RT with low‐load resistance exercise (LL‐RT) and high‐load resistance exercise (HL‐RT) on metabolism, electrolytes, and ions in the lower extremities by invasive catheter measurements, which are crucial for risk assessment. Ten healthy men (27.6 ± 6.4 years) completed three trials of knee‐extensor exercises with LL‐RT (30% 1RM), LL‐BFR‐RT (30% 1RM, 50% limb occlusion pressure), and HL‐RT (75% 1RM). The exercise protocol consisted of four sets to voluntary muscle failure with 1 min of rest between sets. Blood gas analysis was collected before, during, and after each trial through intravenous catheters at the exercising leg. LL‐BFR‐RT had lower total workload (1274 ± 237 kg, mean ± SD) compared to LL‐RT (1745 ± 604 kg), and HL‐RT (1847 ± 367 kg, p < 0.01), with no difference between LL‐RT and HL‐RT. Pain perception did not differ significantly. Exercise‐induced drop in oxygen partial pressure, lactate accumulation and electrolyte shifts (with increased [K+]) occurred during under all conditions (p < 0.001). Creatine kinase and lactate dehydrogenase increased significantly 24‐ and 48‐h postexercise under all three conditions (p < 0.001). This study, using invasive catheter measurements, found no significant differences in metabolic, ionic, and electrolyte responses among LL‐BFR‐RT, LL‐RT, and HL‐RT when exercised to voluntary muscular failure. LL‐BFR‐RT reduced time to failure without specific physiological responses. [ABSTRACT FROM AUTHOR]

Background: Identification of hypoxaemia and hypercapnia is essential for the diagnosis and treatment of acute respiratory failure. While arterial blood gas (ABG) analysis is standard for PO2 and PCO2 measurement, venous blood gas (VBG) analysis is increasingly used as an alternative. Previous systematic reviews established that VBG reporting of PO2 and PCO2 is less accurate, but the impacts on clinical management and patient outcomes are unknown. Aims: This study aimed to systematically review available evidence of the clinical impacts of using ABGs or VBGs and examine the arteriovenous difference in blood gas parameters. Methods: A comprehensive search of the MEDLINE, Embase and Cochrane Library databases since inception was conducted. Included studies were prospective or cross‐sectional studies comparing peripheral ABG to peripheral VBG in adult non‐critical care inpatients presenting with respiratory symptoms. Results: Of 15 119 articles screened, 15 were included. No studies were found that examined clinical impacts resulting from using VBG compared to ABG. Included studies focused on the agreement between ABG and VBG measurements of pH, PO2, PCO2 and HCO3−. Due to the heterogeneity of the included studies, qualitative evidence synthesis was performed. While the arteriovenous difference in pH and HCO3− was generally predictable, the difference in PO2 and PCO2 was more significant and less predictable. Conclusions: Our study reinforces the notion that VBG is not comparable to ABG for physiological measurements. However, a key revelation from our research is the significant lack of data regarding the clinical implications of using VBG instead of ABG, a common scenario in clinical practice. This highlights a critical knowledge gap. [ABSTRACT FROM AUTHOR]

The assessment of gas exchange under varying ambient and metabolic conditions is an important and fundamental investigation of respiratory function. The gold standard is an arterial blood gas (ABG) sample; however, the procedure is not universally performed by medical scientists, is not standardised, and is typically taught by a subjective Halsted 'see one, do one' approach. The Australian and New Zealand Society of Respiratory Science recognised the need to create an ABG position statement that includes the required pre‐requisite education, an evidence‐based procedure and the minimum reporting and competency assessment requirements. This position statement aims to minimise patient discomfort, to improve puncture success rate and reduce the potential for sample handling and analysis error. Importantly, this position statement translates to all relevant health professionals, including medical officers, scientists, nursing staff and allied health. [ABSTRACT FROM AUTHOR]

Aims: The aim of this study is to measure staff compliance with the local umbilical cord lactate (UCL) sampling guideline and investigate the quality of paired UCG samples at a tertiary maternity unit. Methods: We performed a retrospective consecutive sampling of 100 babies delivered via emergency caesarean section and 50 babies with each of all other guideline‐based indications for UCL sampling born on and before 31 December 2021. Data were extracted from physical and electronic records. Compliance with guideline‐based indications for UCL at birth was measured. The proportion of valid UCG samples was calculated. Samples were considered invalid under the following cases: (i) inadvertently collecting from the same vessel, (ii) switching arterial and venous samples, (iii) collecting from only one vessel or (iv) committing errors during sample collection and handling. Results: Of the samples collected at birth from 321 babies, 280 (87%) had UCL. Small for gestational age and concerns about fetal well‐being in labour were indications associated with poorer compliance, 66% and 78%, respectively. About 99 (44%) babies of 226 babies with UCG performed had valid UCG samples. The most common reasons for invalid samples were collection and handling errors (22%) and inadvertent collection from the same vessel (15%). Conclusions: Generally, compliance with the guidelines is good. However, invalid UCG samples were more frequent than expected. [ABSTRACT FROM AUTHOR]

Introduction: Respiratory distress is the leading cause of admission to neonatal units and is a common indication for medical retrieval. Whilst approximately 25% of births in NSW occur in regional centres, there is a paucity of neonatal research in these settings. Objective: To describe the characteristics and outcomes of term neonates admitted with respiratory distress to two regional special care nurseries (SCNs) and identify variables associated with the need for medical retrieval. Design: We describe a cohort of 629 term infants admitted to the SCN in two regional hospitals, 2015–2019. We describe the admission characteristics, level of respiratory support, biochemical investigations, diagnosis and outcomes. Findings: During the study period, 629 eligible term infants were admitted, retrieval occurred in 29 (4.6%). Those admitted were more often male (66.5%), with a mean gestational age of 39 + 1 weeks (±9 days) and birth weight of 3470 g (±500 g). Infants requiring medical retrieval had higher PaCO2 on blood gas analysis (59.8 mmHg vs. 53.3 mmHg, OR 1.03, p = 0.02). There was no association between maternal GBS status, meconium‐stained liquor, gestational age, or raised inflammatory markers and medical retrieval. Transient tachypnoea of the newborn was the most common diagnosis of neonates admitted to SCN with respiratory distress. Discussion: Among term infants admitted to a SCN for respiratory distress most were male, of a normal birthweight and born in good condition. Within our cohort there was no association between retrieval and maternal GBS colonisation, meconium‐stained liquor or raised infectious biomarkers. Medical retrieval was infrequent and was associated with higher PaCO2 on initial blood gas analysis. Conclusion: We present a large cohort of term newborn infants managed for respiratory distress in a regional setting over a five‐year period. Retrieval was infrequent, and outcomes for the cohort were excellent with no deaths during the study period. [ABSTRACT FROM AUTHOR]

Background: Prone positioning has been widely used to improve oxygenation and reduce ventilator‐induced lung injury in patients with severe COVID‐19 acute respiratory distress syndrome (ARDS). One major complication associated with prone positioning is the development of pressure ulcers (PUs). Aim: This study aimed to determine the impact of a prevention care bundle on the incidence of PUs in patients with COVID‐19 ARDS undergoing prone positioning in the intensive care unit. Study Design: This was a single‐centre pre and post‐test intervention study which adheres to the Standards for Reporting Implementation Studies (StaRI) guidelines. The intervention included a care bundle addressing the following: increasing frequency of head turns, use of an open gel head ring, application of prophylactic dressings to bony prominences, use of a pressure redistribution air mattress, education of staff in the early identification of evolving PUs through regular and rigorous skin inspection and engaging in bedside training sessions with nursing and medical staff. The primary outcome of interest was the incidence of PU development. The secondary outcomes of interest were severity of PU development and the anatomical location of the PUs. Results: In the pre‐intervention study, 20 patients were included and 80% (n = 16) of these patients developed PUs, comprising 34 ulcers in total. In the post‐intervention study, a further 20 patients were included and 60% (n = 12) of these patients developed PUs, comprising 32 ulcers in total. This marks a 25% reduction in the number of patients developing a PU, and a 6% decrease in the total number of PUs observed. Grade II PUs were the most prevalent in both study groups (65%, n = 22; 88%, n = 28, respectively). In the post‐intervention study, there was a reduction in the incidence of grade III and deep tissue injuries (pre‐intervention 6%, n = 2 grade III, 6% n = 2 deep tissue injuries; post‐intervention no grade III ulcers, grade IV ulcers, or deep tissues injuries were recorded). However, there was an increase in the number of unstageable PUs in the post‐intervention group with 6% (n = 2) of PUs being classified as unstageable, meanwhile there were no unstageable PUs in the pre‐intervention group. This is an important finding to consider as unstageable PUs can indicate deep tissue damage and therefore need to be considered alongside PUs of a more severe grade (grade III, grade IV, and deep tissue injuries). Conclusion: The use of a new evidence‐based care bundle for the prevention of PUs in the management of patients in the prone position has the potential to reduce the incidence of PU development. Although improvements were observed following alterations to standard practice, further research is needed to validate these findings. Relevance to Clinical Practice: The use of a new, evidence‐based care bundle in the management of patients in the prone position has the potential to reduce the incidence of PUs. [ABSTRACT FROM AUTHOR]

Background: Hyperkalaemia is managed in the emergency department (ED) following measurement of potassium results by blood gas analysers (BGA) or laboratory analysers (LAB). Aims: To determine the prevalence of clinically significant differences between BGA and LAB potassium results and the impact on ED hyperkalaemia management. Methods: Retrospective analysis of time‐matched ED BGA and LAB potassium samples from 2019 to 2020 (taken within 15 min, one or both results ≥6.0 mmol/L). Mean differences and 95% limits of agreement (LoA) were determined for pairs with one or both results ≥6.0 mmol/L and a separate 500 consecutive sample pairs. Results: Four hundred eighty‐eight matched BGA and LAB samples met the inclusion criteria. Of these, 201 (41.2%) differed by ≤0.5 mmol/L, 169 (34.6%) included a haemolysed LAB sample, and 12 (2.5%) had an unreportable BGA sample. One hundred six (21.7%) pairs differed by >0.5 mmol/L, and 60/106 (57%) had normal LAB potassium results, but BGA indicated moderate/severe hyperkalaemia (two of these pairs received hyperkalaemia treatment). Of patients with a haemolysed LAB sample, or where pairs differed by >0.5 mmol, 48 were treated with insulin and five (10.4%) experienced hypoglycaemia. Mean differences and LoA for pairs with LAB results <6.0 mmol/L but BGA ≥6.0 mmol/L demonstrated unacceptable agreement, with 18 (25.7%) BGA results exceeding 8.0 mmol/L. Conclusions: Potentially significant discordance may occur between BGA and LAB potassium results. Clinicians need to be aware of factors impacting both analytical methods' accuracy (such as poor venepuncture or sample handling, (K) EDTA interference) and undetectable haemolysis with BGA measurements. We recommend BGA hyperkalaemia be confirmed with LAB results using a non‐haemolysed sample where time permits. [ABSTRACT FROM AUTHOR]

Aims: It is widely held that heart failure (HF) does not cause exertional hypoxaemia, based upon studies in HF with reduced ejection fraction, but this may not apply to patients with HF and preserved ejection fraction (HFpEF). Here, we characterize the prevalence, pathophysiology, and clinical implications of exertional arterial hypoxaemia in HFpEF. Methods and results: Patients with HFpEF (n = 539) and no coexisting lung disease underwent invasive cardiopulmonary exercise testing with simultaneous blood and expired gas analysis. Exertional hypoxaemia (oxyhaemoglobin saturation <94%) was observed in 136 patients (25%). As compared to those without hypoxaemia (n = 403), patients with hypoxaemia were older and more obese. Patients with HFpEF and hypoxaemia had higher cardiac filling pressures, higher pulmonary vascular pressures, greater alveolar–arterial oxygen difference, increased dead space fraction, and greater physiologic shunt compared to those without hypoxaemia. These differences were replicated in a sensitivity analysis where patients with spirometric abnormalities were excluded. Regression analyses revealed that increases in pulmonary arterial and pulmonary capillary pressures were related to lower arterial oxygen tension (PaO2), especially during exercise. Body mass index (BMI) was not correlated with the arterial PaO2, and hypoxaemia was associated with increased risk for death over 2.8 (interquartile range 0.7–5.5) years of follow‐up, even after adjusting for age, sex, and BMI (hazard ratio 2.00, 95% confidence interval 1.01–3.96; p = 0.046). Conclusion: Between 10% and 25% of patients with HFpEF display arterial desaturation during exercise that is not ascribable to lung disease. Exertional hypoxaemia is associated with more severe haemodynamic abnormalities and increased mortality. Further study is required to better understand the mechanisms and treatment of gas exchange abnormalities in HFpEF. [ABSTRACT FROM AUTHOR]

Purpose: To investigate whether 4 weeks of normobaric "live high–train low and high" (LHTLH) causes different hematological, cardiorespiratory, and sea‐level performance changes compared to living and training in normoxia during a preparation season. Methods: Nineteen (13 women, 6 men) cross‐country skiers competing at the national or international level completed a 28‐day period (∼18 h day−1) of LHTLH in normobaric hypoxia of ∼2400 m (LHTLH group) including two 1 h low‐intensity training sessions per week in normobaric hypoxia of 2500 m while continuing their normal training program in normoxia. Hemoglobin mass (Hbmass) was assessed using a carbon monoxide rebreathing method. Time to exhaustion (TTE) and maximal oxygen uptake (VO2max) were measured using an incremental treadmill test. Measurements were completed at baseline and within 3 days after LHTLH. The control group skiers (CON) (seven women, eight men) performed the same tests while living and training in normoxia with ∼4 weeks between the tests. Results: Hbmass in LHTLH increased 4.2 ± 1.7% from 772 ± 213 g (11.7 ± 1.4 g kg−1) to 805 ± 226 g (12.5 ± 1.6 g kg−1) (p < 0.001) while it was unchanged in CON (p = 0.21). TTE improved during the study regardless of the group (3.3 ± 3.4% in LHTLH; 4.3 ± 4.8% in CON, p < 0.001). VO2max did not increase in LHTLH (61.2 ± 8.7 mL kg−1 min−1 vs. 62.1 ± 7.6 mL kg−1 min−1, p = 0.36) while a significant increase was detected in CON (61.3 ± 8.0–64.0 ± 8.1 mL kg−1 min−1, p < 0.001). Conclusions: Four‐week normobaric LHTLH was beneficial for increasing Hbmass but did not support the short‐term development of maximal endurance performance and VO2max when compared to the athletes who lived and trained in normoxia. [ABSTRACT FROM AUTHOR]

The article presents the discussion on improve favourable functional outcomes at 6 months compared to placebo. Topics include Tranexamic acid (TXA) becoming the standard of care for potentially exsanguinating trauma patients to prevent trauma coagulopathy; and patients with acute neck or back pain without identified severe underlying pathology.

Objective: To identify PaCO2 trajectories and assess their associations with mortality in critically ill patients with coronavirus disease 2019 (COVID‐19) during the first and second waves of the pandemic in Denmark. Design: A population‐based cohort study with retrospective data collection. Patients: All COVID‐19 patients were treated in eight intensive care units (ICUs) in the Capital Region of Copenhagen, Denmark, between March 1, 2020 and March 31, 2021. Measurements: Data from the electronic health records were extracted, and latent class analyses were computed based on up to the first 3 weeks of mechanical ventilation to depict trajectories of PaCO2 levels. Multivariable Cox regression analyses were used to calculate adjusted hazard ratios (aHRs) for Simplified Acute Physiology Score 3, sex and age with 95% confidence intervals (CIs) for death according to PaCO2 trajectories. Main results: In latent class trajectory models, including 25,318 PaCO2 measurements from 244 patients, three PaCO2 latent class trajectories were identified: a low isocapnic (Class I; n = 130), a high isocapnic (Class II; n = 80), as well as a progressively hypercapnic (Class III; n = 34) trajectory. Mortality was higher in Class II [aHR: 2.16 {1.26–3.68}] and Class III [aHR: 2.97 {1.63–5.40}]) compared to Class I (reference). Conclusion: Latent class analysis of arterial blood gases in mechanically ventilated COVID‐19 patients identified distinct PaCO2 trajectories, which were independently associated with mortality. [ABSTRACT FROM AUTHOR]

Background: Whether subcutaneous continuous glucose monitoring (CGM) can safely replace intermittent arterial blood gas glucose analyses in intensive care unit (ICU) patients remains uncertain. We aimed to compare CGM to blood gas glucose values and assess whether CGM use reduces blood gas sampling frequency and glucose variability in ICU patients with type 2 diabetes managed with liberal glucose control. Methods: We used the FreeStyle Libre CGM in 15 ICU patients and compared their blood glucose metrics with a pre‐CGM control population of 105 ICU patients with type 2 diabetes. Both groups received insulin to target glucose range of 10–14 mmol/L. We used linear regression analysis adjusted for illness severity to assess the association of CGM use with blood gas sampling frequency and glucose variability. We used mean absolute relative difference (MARD) and Clarke error grid analysis to assess accuracy of matched CGM‐blood glucose values overall, across glucose stata (<10, 10–14, >14 mmol/L), and over time (≤48, 48–96, >96 h). Results: We analyzed 483 matched glucose values. Overall MARD was 11.5 (95% CI, 10.7–12.3)% with 99% of readings in Clarke zones A and B. MARD was 15.5% for glucose values <10 mmol/L, 11.1% at 10–14 mmol/L, and 11.4% >14 mmol/L. MARD was 13.8% in the first 48 h, 10.9% at 48–96 h, and 8.9% beyond 96 h. CGM use was associated with 30% reduction in blood gas sampling frequency. CGM use was not associated with glucose variability as determined by glycemic lability index or standard deviation of blood glucose. Conclusions: In our cohort of ICU patients with type 2 diabetes receiving liberal glycemic control, CGM showed acceptable accuracy and was associated with a reduction in blood gas sampling frequency without compromising glucose control. Lowest accuracy was observed at glucose values below 10 mmol/L and during the first 48 h of CGM use. [ABSTRACT FROM AUTHOR]

Background: To assess the effectiveness and safety of laryngeal mask anesthesia (LMA) in thoracoscopic pulmonary wedge resection based on patient‐reported outcomes (PROs). Methods: This randomized controlled trial included 107 patients who underwent thoracoscopic pulmonary wedge resection between June 2017 and December 2021 for pulmonary nodule or pulmonary bullae. In one group, LMA was applied for general anesthesia, and in the other group, endotracheal intubation (ETT) was used. Results: A total of 107 patients were included in the study. The symptom assessment based on PROs showed that the incidence of pharyngodynia, trachyphonia, and cough were lower in the LMA group, while the postoperative gastrointestinal reaction did not significantly differ between the two groups. The pain score and global satisfaction score were significantly better in the LMA group. The satisfaction degree of anesthesia and the surgical field did not significantly differ between the two groups. The anesthesia recovery time, indwelling days of chest catheter, and postoperative hospital stay of the LMA group were all shorter, while the operation time, intraoperative blood loss and lowest intraoperative oxygen saturation did not significantly differ between the two groups. The highest intraoperative partial pressure of CO2 was significantly higher in the LMA group. The artery blood gas analysis after the operation did not significantly differ between the two groups. Conclusion: Compared with ETT, the application of LMA may demonstrate promising advantages in airway management for thoracoscopic pulmonary wedge resection. Registration No. of clinical trial (ChiCTR2000034905). [ABSTRACT FROM AUTHOR]

Pulmonary hypertension can be very difficult to identify and patients often experience a long delay before diagnosis. This article aims to raise awareness of pulmonary hypertension in the primary care setting, and discusses the role of the GP in diagnosis and management, with a focus on pulmonary arterial hypertension. [ABSTRACT FROM AUTHOR]

Objective: Acidosis decreases myocardial contractile and myofibrillar responsiveness by reducing the calcium sensitivity of contractile proteins, which could reduce the effectiveness of pimobendan. We aimed to assess the cardiovascular effects of pimobendan in dogs subjected to acute respiratory acidosis. Design: Randomized crossover study with a 2‐week washout period. Setting: University Laboratory. Animals: Six healthy research Beagle dogs. Interventions: Anesthetized dogs were administered 2 doses of IV pimobendan during conditions of eucapnia (Paco2 35–40 mm Hg) and hypercapnia (Paco2 90–110 mm Hg). Eucapnia was maintained by positive pressure ventilation and hypercapnia was induced by adding exogenous CO2 to the anesthesia circuit. Heart rate (HR), systemic arterial blood pressure, cardiac output (CO), systemic and pulmonary vascular resistance (SVR and PVR, respectively), and pulmonary arterial pressure (PAP) were measured at baseline and 60 min after administering 0.125 mg/kg (low) and 0.25 mg/kg (high) pimobendan intravenously. Blood gas and biochemical analyses were performed at baseline and at the end of the experiment. Measurements and Main Results: The median baseline blood pH was 7.41 (range: 7.33–7.45) and 7.03 (range: 6.98–7.09) under conditions of eucapnia and hypercapnia, respectively. The serum concentrations of epinephrine and norepinephrine and the HR, CO, and PAP were higher, and SVR was lower at baseline in hypercapnic dogs. Pimobendan dose‐dependently increased CO in eucapnia (baseline: 3.6 ± 0.2 L/kg/m2 [mean ± SE], low: 5.0 ± 0.4 L/kg/m2, high: 5.8 ± 0.5 L/kg/m2, P < 0.001) and hypercapnia (baseline: 4.9 ± 0.5 L/kg/m2, low: 5.8 ± 0.5 L/kg/m2, high: 6.2 ± 0.5 L/kg/m2, P < 0.001), and increased HR and decreased SVR and PVR under both conditions (P < 0.001). In hypercapnia, the degree of increase or decrease of these cardiovascular measurements (except for PAP) by pimobendan was less than that in the eucapnic dogs. Conclusions: Pimobendan maintains function as an inodilator in anesthetized dogs with induced respiratory acidosis. [ABSTRACT FROM AUTHOR]

A 43‐year‐old Caucasian man was admitted to hospital due to shortness of breath, right lumbar pain and lower left limb swelling. Arterial blood gas sample showed mild hypoxemia and respiratory alkalosis. CT scan confirmed pulmonary embolism, splenic and bilateral renal ischemic lesions. Echocardiography showed right ventricular and coronary sinus (CS) dilatation. Using contrast echocardiography, a superior sinus venous atrial septal defect and persistent left superior vena cava (PLSVC) draining in CS were suspected. Cardiac CT confirmed the diagnosis and showed overriding right superior vena cava (RSVC) draining in both atria. The patient underwent successful surgical correction. [ABSTRACT FROM AUTHOR]

Both delayed cord clamping (DCC) and cord blood gas (CBG) analysis are recommended practices for preterm births. However, the compliance rates remain lower than expected, with a DCC rate of only 48.9% and CBG sampling of 66.6% in the preterm cohort. DCC was associated with a significant reduction in success rate of paired CBG analysis in both the term and preterm cohort of 8.3% and 7.7% respectively. Our study highlights the difficulty in achieving both recommendations. [ABSTRACT FROM AUTHOR]

Background and Aim: Laparoscopic hysterectomy (LH) have been frequently used because of low complication rates and short duration of hospital stay. Elevated intracranial pressure (ICP), a disadvantage of laparoscopic surgery, is caused by the Trendelenburg position (TP) and CO2 pneumoperitoneum (PP). This study aimed to evaluate TP and PP associated changes in ICP by ONSD measurements during LH. The intra‐and inter‐observer consistency and reliability of ONSD measurements were also investigated. Methods: Sixty patients with were enrolled into this prospective study. ONSD for each patient was measured by three anesthesiologists at T0, T1, T2, and T3 time points. ONSD, mean arterial pressure (MAP), end tidal CO2 (EtCO2), and arterial blood CO2 partial pressure values (PaCO2) were measured at T0: baseline, T1: 10 min after introducing 20 mmHg PP, T2: 10 min after placing the patient in TP and 15 mmHg PP and, T3: 10 min after PP deflation. Results: The ONSD measured at T1 (5.97 ± 0.49 cm) and T2 (5.95 ± 0.57 cm) were higher than T0 (5.63 ± 0.53 cm) and T3 (5.72 ± 0.47 cm) (p < 0.05). There were no correlations between MAP and ONSD, and also between PaCO2, EtCO2, and ONSD measurements at any time points. Inter‐observer intraclass correlation coefficient (ICC) values of ONSD measurements by all examiners had moderate (at T1) to good (at T0, T2, T3) reliability. Intra‐observer agreements were reasonable for each observer. Conclusion: ONSD measurements increase with CO2PP and TP in patients undergoing LH. Transorbital sonography is a reliable method to monitor intraoperative changes in ONSDs. This study underlines the need for careful training and the importance of standardization in order to obtain reliable results in the examination technique of ONSD measurements. [ABSTRACT FROM AUTHOR]

The article presents a case study of an 11-year-old boy with autosomal dominant hypocalcemia (ADH) treated with vitamin D and thiazide, who experienced a severe hypercalcemic episode. Topics discussed include the patient's treatment history, the development of hypercalcemia, and the potential association with a milk-alkali syndrome-like syndrome triggered by increased dietary calcium intake.

Since the accuracy of headspace gas chromatographic analysis of blood for ethanol concentration has been so well established over the past several decades, it has become commonplace in court proceedings to attack preanalytical handling of the blood samples including the lack of measuring sample temperature prior to sample preparation. The impact on measured ethanol concentration of allowing refrigerated (~4℃) samples varying amounts of time to equilibrate with room temperature, 24, 4, 3, 2, and 1 h, prior to sample preparation was evaluated. Samples were diluted 1:10 with an internal standard using a diluter/dispenser and analyzed using headspace gas chromatography. The mean ethanol concentration measured for the sixteen samples at each of the five equilibration times was 0.153 g/dl. The F‐critical from the one‐way ANOVA was 2.4937. The calculated F value was 0.4209. Additionally, the effect on measured ethanol concentration of having calibrators at different temperatures than case samples was investigated. Three groups were analyzed: all calibrators, controls, and samples given 24 h to equilibrate with room temperature, all calibrators, controls, and samples prepared immediately after removal from refrigeration, and calibrators sampled immediately after removal from refrigerator with samples and controls allowed 24 h to equilibrate with room temperature. The mean ethanol concentration measured for the thirty blood samples in each of the three groups was 0.197 g/dl. The F‐critical from the one‐way ANOVA was 3.1013. The calculated F value was 0.0188. Measured ethanol concentrations were insensitive to the variations in preanalytical conditions evaluated in this study. [ABSTRACT FROM AUTHOR]

Although sodium bicarbonate can be a life‐saving antidote for patients with overdoses resulting in sodium channel blockade, there has been a concerning rise in cases referred to the Poisons Information Centre where inappropriately large doses of bicarbonate have been used resulting in iatrogenic harm. We present a series of three clinical cases where excessive bicarbonate was used to treat poisonings and discuss our approach to managing cardiotoxicity secondary to sodium channel blockade. Serial blood gas analysis should be performed when using bicarbonate to ensure pH targets are met and severe alkalaemia, hypernatraemia and hypokalaemia are avoided. We encourage clinicians to contact the Poisons Information Centre (13 11 26) or their local clinical toxicologist when managing patients with life‐threatening sodium channel blockade. [ABSTRACT FROM AUTHOR]

Background: During thoracoscopic segmentectomy, accurately and rapidly identifying the intersegmental plane (ISP) is of great importance. This study aimed to investigate the effect and safety of a nitrous oxide (N2O)/oxygen (O2) inspired mixture on the appearance time of the ISP (TISP) via the modified inflation‐deflation method. Methods: A total of 65 participants who underwent segmentectomy were randomized into three groups: 75% N2O (n = 24), 50% N2O (n = 23) or 0% N2O (n = 18). The 75% N2O group received a gas mixture of N2O/O2 (Fio2 = 0.25), the 50% N2O group received N2O/O2 (Fio2 = 0.5), and the 0% N2O group received 100% oxygen during lung expansion. The appearance time of satisfactory and ideal planes was recorded. Furthermore, arterial blood gas at breathing room air, one‐lung ventilation (OLV) before lung expansion, 5 and 15 min after lung expansion were also recorded. Results: TISP was significantly shorter in the 75% N2O group (320.2 ± 65.9 s) compared with that of the 50% N2O group (552.4 ± 88.9 s, p < 0.001) and the 0% N2O group (968.3 ± 85.5 s, p < 0.001), while the 50% N2O group was shorter than that of the 0% N2O group (p < 0.001). Arterial oxygenation was significantly improved in the 0% N2O group only after lung expansion, before which there were no differences in mean PaO2 values among groups. Conclusions: The use of N2O in the inspired gas mixture during lung expansion is an applicable strategy to rapidly identify the ISP via the modified inflation‐deflation method without any adverse effect on OLV related arterial oxygenation during segmentectomy. [ABSTRACT FROM AUTHOR]

Objective: To determine the relationship between arterial and venous acid–base status in a model of septic shock. Methods: Paired samples (n = 435) of arterial and femoral venous blood from 57 sheep (47 septic, 10 non‐septic) managed with protocol‐guided ventilation, sedation, parenteral fluids and inotropic support. Results: The arterial‐venous difference in acid–base parameters was similar with and without sepsis. There was a consistent arterio‐venous relationship for metabolic (pH, lactate, bicarbonate, base excess), but not respiratory parameters (partial pressures of oxygen, carbon dioxide, and haemoglobin‐oxygen saturation), independent of sepsis. Conclusions: Venous blood provides a reliable measure of metabolic but not respiratory disturbance. [ABSTRACT FROM AUTHOR]

Aim: To evaluate whether there is a statistically significant difference between the cord blood gas parameters of pregnancies complicated with preeclampsia and uncomplicated pregnancies and to show whether the amount of proteinuria affects fetal cord blood gas parameters in pregnancies complicated with preeclampsia. Methods: The study was designed retrospectively. Between 2016 and 2019, the neonatal results and cord blood gas results of 109 pregnant women who were diagnosed with preeclampsia and 75 nonpreeclamptic randomly selected pregnant women were compared. The preeclampsia group was divided into groups according to amount of proteinuria. SPSS 21.0 statistics program was used, and comparative analysis was carried out. Results: The data of the 109 preeclampsia cases and 75 control groups included in the study were compared, and there was no statistical difference between the fetal cord blood gas parameters between the groups (p > 0.05). The median first and fifth minute Apgar scores were found significantly lower in the preeclampsia group compared to the control group (6, 8 and 8, 9, respectively; p < 0.001). Also, the amount of proteinuria does not alter cord blood gas parameters (p > 0.05). Conclusion: Preeclampsia poses a risk for the neonatal period as it reduces the neonatal Apgar scores due to the chronic hypoxic process it creates. However, it was observed that the amount of proteinuria, which is one of the diagnostic criteria, did not affect neonatal results on Apgar scores or fetal cord blood gas parameters. [ABSTRACT FROM AUTHOR]

Aim: To investigate intrapartum fetal heart rate (FHR) patterns in women with chorioamnionitis at or beyond 34 weeks of gestation in relation to neonatal outcome and to compare clinical and subclinical chorioamnionitis. Methods: A retrospective questionnaire survey on deliveries during 2015 was conducted by the Perinatology Committee of the Japan Society of Obstetrics and Gynecology from 2016 to 2018. A total of 498 singleton births complicated by chorioamnionitis delivered at ≥34 weeks of gestation without major congenital malformations were included. The subjects were divided into clinical and subclinical chorioamnionitis groups based on Lencki's criteria. Poor perinatal outcome was defined as death or brain damage. We analyzed clinical features, FHR patterns in the last 2 h before delivery, gestational age, birthweight, Apgar score, umbilical arterial blood gas analysis, and infant's outcome. Results: Incidence of chorioamnionitis at ≥34 weeks of gestation was 0.59% (522/87827). Clinical and subclinical chorioamnionitis comprised 240 and 258 cases, respectively. Abnormal FHR patterns (late deceleration or decreased baseline variability) were significantly associated with poor perinatal outcome. Combined late deceleration and decreased variability showed low positive predictive value (12.8%) and high negative predictive value (99.5%), and was significantly associated with long‐term poor outcome in clinical chorioamnionitis only (odds ratio: 29.4, p < 0.01). Poor perinatal outcome showed no significant difference between the clinical and subclinical chorioamnionitis groups. Conclusions: Combined late deceleration and decreased variability could predict poor perinatal outcome in clinical chorioamnionitis. Poor perinatal outcome occurred in infants born to mothers with clinical and subclinical chorioamnionitis. [ABSTRACT FROM AUTHOR]

Trampolining has become a popular recreational activity, but currently no method exists by which energy expenditure can be indirectly measured while bouncing. Therefore, the aim of this study was to produce a model to measure energy expenditure while bouncing on a trampoline. To achieve this, the study was completed in two stages. First, a model was developed which calculated the energy absorbed by the trampoline for a known weight. This was achieved using drop tests on a trampoline. Second, the efficiency of energy conversion while trampolining was measured. This involved healthy adults bouncing on a trampoline while energy expenditure was recorded using a gas analyser. The combined datasets from the two parts allowed the formation of a model which can predict energy expenditure while bouncing on a trampoline using only the user's weight as an input. This model can now be used with an on-trampoline measurement method to track energy expenditure while jumping, thereby facilitating the use of trampolines for health and fitness. [ABSTRACT FROM AUTHOR]

Objective: Our aim was to reduce unnecessary blood gases to improve patient flow, reduce false positives and reduce unnecessary treatments. Methods: This was a retrospective, single‐centre audit of 100 patients in June 2022. Results: There were approximately 45 blood gases per 100 ED presentations. Following education and poster reminders, a re‐audit was undertaken in October 2022, resulting in a reduction of 33% of blood gases ordered. Conclusion: We have found that many blood gases are ordered for patients who are not critically unwell, and whose disposition was not affected by their result. [ABSTRACT FROM AUTHOR]

Aim: Angong Niuhuang pill (ANP) is a traditional Chinese medicine (TCM) drug widely used for treating stroke. This study aimed to investigate the effect of ANP on respiratory nursing outcomes in chronic obstructive pulmonary disease (COPD) patients following cardiac surgery. Methods: A total of 80 COPD patients following cardiac surgery were enrolled and randomized into the control group receiving routine postoperative nursing and ANP group additionally receiving ANP treatment for 3 days (n = 40 for both group). The frequency of back percussion, time of back percussion, amount of expectoration, arterial blood gas levels were compared between groups. Results: Compared to the control group, the ANP group had a significantly shorter daily mean time of back percussion at day 3 (p =.036) and day 7 (p =.014). The daily mean amount of expectoration was higher at day3 (p =.018) but lower at day 7 (p =.043) in the ANP group than in the control group. In addition, the ANP group had significantly higher hemoglobin saturation (SpO2) and partial pressure of oxygen (PaO2) but lower partial pressure of carbon dioxide (PaCO2) at both day 3 and day 7 than the control group (all p <.05). Furthermore, the time of postoperative aerosol inhalations (p =.041), pulmonary infection rate (p =.025) and postoperative hospital stay (p =.036) were significantly reduced in the ANP group. The ANP group had significantly lower TCM symptom scores at day 3 and day 7 after surgery. Conclusion: These results suggested that ANP treatment can effectively promote the postoperative recovery and respiratory nursing outcomes in COPD patients following cardiac surgery. [ABSTRACT FROM AUTHOR]

Aim: Oxygen saturation is frequently monitored with pulse oximetry to assess vital signs in critically ill patients. Optimally, pulse oximetry closely tracks arterial oxygen tension (PaO2 ), which provides guidance in oxygen titration. We investigated whether monitoring peripheral oxygen saturation (SpO2 ) could accurately guide oxygen titration in newborn infants.Methods: Twenty seven thousand two hundred thirty seven SpO2 readings were retrospectively paired with arterial oxygen saturation (SaO2 ) and PaO2 results from blood gas analyses performed in infants with arterial catheters in place.Results: SpO2 overestimated SaO2 readings by 2.9 ± 5.8%. When pulse oximetry readings were within the defined oxygen saturation target range, 7809 (20.9%) SaO2 values were below and 2830 (7.6%) exceeded the target range. In 57% of patients, PaO2 levels < 6 kPa was diagnosed while SpO2 readings were > 90%. PaO2  > 11 kPa was recorded in 19% of cases, when SpO2 readings were < 95%. Infants treated with supplemental oxygen showed a threefold increased risk of hypoxaemia compared to infants breathing room air. Sensitivity and specificity for detecting upper and lower target range limits were fair to good. For SpO2 values below 91%, ISO quality criteria were no longer fulfilled.Conclusions: Based on arterial blood gas analyses as reference, pulse oximetry readings did not fulfil the performance requirements for titrating oxygen in neonatal patients. [ABSTRACT FROM AUTHOR]

The article presents case study of male infant. in which gastric residual volume of mild of more than 50% from the previous feed persisted without abdominal distension, and loose to watery stool was sometimes observed. It mentions diagnosis of Food protein-induced enterocolitis syndrome; and also mentions focus on the histopathological findings of FPIES, even in surgical cases.

Introduction: Pulmonary Hypertension (PH) is a frequent comorbidity in Obesity Hypoventilation Syndrome (OHS). Objective: We investigated long‐term outcome of OHS with a particular emphasis on PH. Methods: In a prospective design, 64 patients with OHS and established noninvasive positive pressure ventilation (NPPV), were assessed by serum biomarkers, right heart catheterization, blood gases analysis, lung function, Epworth‐Sleepiness Scale (ESS), Pittsburgh Sleep Quality Index (PSQI), World Health Organization‐functional class (WHO‐FC) and health‐related quality of life (HRQL) via the Severe Respiratory Insufficiency (SRI) questionnaire. After a planned follow‐up of 5 years patients were reassessed regarding vital status, WHO‐FC, ESS, SRI, PSQI, body mass index (BMI) and NPPV use. Prognostic markers were explored using univariate and multivariate Cox regression analyses. Results: At the 5‐year follow‐up, BMI tended to decrease (P = 0.05), while WHO‐FC, ESS and PSQI remained unchanged. HRQL deteriorated in terms of SRI summary score and most subdomains (P <.05 each). NPPV adherence still was high (89%), while daily NPPV use increased from 6.7 (5.1; 8.0) h/d to 8.2 (7.4; 9.0) h/d (P <.05). After a 5‐year follow‐up, mortality was 25.8%. In univariate regression analyses only age > 69.5 years (HR = 4.145, 95%‐CI = 1.180‐14.565, P = 0.016), NT‐proBNP > 1256 pg/mL (HR = 5.162, 95%‐CI = 1.136‐23.467, P = 0.018), diffusion capacity for carbon monoxide (DLCO, %pred) (HR = 0.341, 95%‐CI = 0.114‐1.019, P = 0.043) and higher oxygen use during daytime (HR = 5.236, 95%‐CI = 1.489‐18.406, P = 0.004) predicted mortality. No independent factor predicting mortality was detected in multivariate analysis. Conclusion: Despite a high long‐term NPPV use HRQL worsened. Age, oxygen use at baseline, DLCO (%pred) and NT‐proBNP, as a surrogate parameter for PH, were related to long‐term survival. [ABSTRACT FROM AUTHOR]

Objective: To characterise intramuscular ketamine‐medetomidine‐tramadol anaesthesia in hatchling green sea turtles (Chelonia mydas). Study design Prospective clinical trial. Animals Ten hatchling green sea turtles. Materials and methods: Prior to anaesthesia, cardiopulmonary parameters, cloacal temperature, and venous blood gas and biochemistry were obtained from hatchling green sea turtles while they were being gently restrained. Animals were then anaesthetised with ketamine (5 mg kg−1), medetomidine (0.05 mg kg−1) and tramadol (5 mg kg−1) via intramuscular injection. Turtles were checked for the depth of anaesthesia at five‐min intervals by recording reflexes (righting, palpebral, pinch, cloacal) and measuring heart rate, respiratory rate and cloacal temperature. After 20 min, a second venous blood sample was obtained for further blood gas and biochemical analysis and the medetomidine was antagonised using atipamezole (5:1 medetomidine, 0.25 mg kg−1). Results: All turtles were successfully anaesthetised with a mean time to induction of 3.4 min (±1). In all animals, a loss of reflexes (except for palpebral reflex) and voluntary movement was observed for the entire 20 min. Anaesthesia resulted in marked apnoea for the duration of the procedure. Venous blood gas and biochemistry analysis indicated that a 20 min period of apnoea had no measurable effects on venous blood gas results. All turtles recovered uneventfully after atipamazole antagonisation, with a mean time to first breath 4.5 min (±3.7), and mean recovery time 15.5 min (±15.4). Conclusions and clinical relevance: Intramuscular ketamine‐medetomidine‐tramadol, antagonised with atipamazole appears to be an effective anaesthetic protocol in hatchling green sea turtles for short procedures with no deleterious effects on venous blood gases or biochemistry. [ABSTRACT FROM AUTHOR]

Background: Risks of neonatal and long-term neurological outcomes are influenced by metabolic acidosis at birth and by reduced Apgar scores, even within the normal range (7-10).Objective: To analyse associations between metabolic acidosis at birth and risks of reduced Apgar scores within the normal range.Methods: In a Swedish cohort of term non-malformed infants born between 2008 and 2013, we included 81 861 infants with information from cord blood gas analyses and Apgar score values of 7-10 at 1, 5, and 10 minutes. Poisson log-linear regression analyses were used to examine associations between metabolic acidosis at birth (defined as pH <7.05 or <7.10 and base deficit ≥12) and Apgar scores of 7, 8, and 9. Adjusted risk ratio (RR) and 95% confidence intervals (C). were calculated.Results: Compared with infants without metabolic acidosis, the adjusted RR of an Apgar score of 9 at 5 minutes was 3.14 (95% CI 2.57, 3.84) in infants with metabolic acidosis (pH <7.05 as cut-off), and 10.13 (95% CI 7.63, 13.45) and 7.60 (95% CI 3.54, 16.33) for Apgar scores of 8 and 7, respectively. Corresponding RRs of Apgar scores at 10 minutes were also substantially increased. The magnitude of RDs varied, but was consistently increased. Both reduced Apgar scores and metabolic acidosis (pH <7.10) influenced neonatal morbidity.Conclusions: Metabolic acidosis is associated with increased risks of reduced Apgar scores within the normal range. Due to international variations in the assessment of Apgar score, our findings need to be confirmed in other populations. [ABSTRACT FROM AUTHOR]

An 82‐year‐old man was treated with neo‐adjuvant nivolumab (programmed cell death protein 1 or PD‐1 inhibitor) for local recurrence of melanoma developed myositis, myocarditis and a myasthenic‐like syndrome with a fatal outcome. The occurrence of these three conditions may constitute a new immune checkpoint‐induced syndrome. The relevance of the clinical features and the immunology is discussed. This case highlights the special role of anti‐striated muscle antibodies as a predictor of mortality. [ABSTRACT FROM AUTHOR]

Laryngeal surgery requires a shared airway and close collaboration between surgeon and anaesthetist in order to optimise operating conditions. Apnoeic oxygenation uses the principle of aventilatory mass flow to maintain oxygenation of pulmonary capillary blood under apnoeic conditions while minimising laryngeal movement. Concerns regarding accumulation of carbon dioxide and resultant acidaemia have limited the use of the technique. We performed a prospective study of low-flow apnoeic oxygenation for patients undergoing microlaryngoscopy under general anaesthesia in order to evaluate the ability of the technique to maintain oxygenation and determine the resultant rate of carbon dioxide accumulation. Sixty-four patients undergoing microlaryngoscopy under general anaesthesia were studied between November 2016 and December 2018. Intra-operative oxygenation was provided via a 10-French oxygen catheter placed into the trachea delivering oxygen at 0.5-1.0 l.min-1 . Data regarding apnoea time, peripheral oxygen saturation and venous blood gas concentrations were recorded. The mean (SD) duration of apnoea was 18.7 (7.2) min. Apnoeic oxygenation allowed successful completion of the surgical procedure in 62/64 patients. Mean (SD) rate of rise of the venous partial pressure of carbon dioxide was 0.15 (0.10) kPa.min-1 . Operating conditions were recorded qualitatively as being adequate in all cases. No adverse effects were reported. Low-flow intra-tracheal apnoeic oxygenation is a simple, effective and inexpensive technique to maintain oxygenation for laryngeal surgery. [ABSTRACT FROM AUTHOR]

Introduction: This study aimed to determine whether predialysis blood gases is affected by altitude differences in hemodialysis patients with arteriovenous fistulas living in Turkey at three different altitudes. Methods: Patients' predialysis blood gases were compared by standardizing both arterial blood gases collections and working methods for patients undergoing hemodialysis using a dialysate with the same properties at altitudes of 30 m (sea level), 1020 m (moderate altitude), and 1951 m (high altitude). Findings Blood gases disorders were detected in 32 (82.1%) high altitude group patients, whereas 49 (74.2%) sea level group patients had no blood gases disorders (P < 0.001). pH values in the high altitude group were significantly lower than those in the other groups, and the pH increased as altitude decreased (P < 0.001). The partial pressure of carbon dioxide (PaCO2) values was higher in the sea level group than in the other groups and increased at lower sea levels (P < 0.001). Bicarbonate values were significantly higher in the sea level group than in the other groups and increased at lower sea levels, similar to PaCO2 values (P < 0.001). The partial pressure of oxygen (PaO2) values in the high altitude and sea level groups were significantly higher and increased at lower sea levels (P < 0.001). The oxygen saturation (SaO2) values were significantly lower in the high altitude group than in the other groups and increased gradually at lower sea levels (P < 0.001). Discussion Predialysis metabolic acidosis was more pronounced in patients undergoing hemodialysis at high altitudes, whereas PaCO2, PaO2, and SaO2 values were lower. [ABSTRACT FROM AUTHOR]

Background: This study evaluated blood components processed by the platelet rich plasma (PRP) method from fresh whole blood (FWB) treated with a pathogen reduction technology (PRT). The effects of storage temperature on PRT treated platelet concentrates (PCs) were also examined.Study Design and Methods: PRT was performed using riboflavin and ultraviolet light on FWB in citrate phosphate dextrose anticoagulant. Following PRT, red blood cells (RBCs), PCs, and plasma for fresh frozen plasma (FFP), were isolated by sequential centrifugation. RBCs were stored at 4°C, FFP at -80°C, and PC at 22°C or at 4°C. Components were assayed throughout their storage times for blood gases, chemistry and CBC, hemostatic function as well as platelet (PLT) and RBC integrity.Results: Component processing following PRT resulted in a significant drop in platelet recovery. Most PRT-PC bags fell below AABB guidelines for platelet count. PRT-PC also showed a decrease in clot strength and decreased aggregometry response. Platelet caspases were activated by PRT. Storage at 4°C improved platelet function. In PRT-FFP, prothrombin time and partial thromboplastin time (PT and aPTT) were prolonged; factors V, VII, VIII, and XI, protein C, and fibrinogen were significantly decreased. Free hemoglobin was elevated two-fold in PRT-RBC.Conclusion: Blood components isolated by the PRP method from PRT-treated WB result in a high percentage of PC that fail to meet AABB guidelines. FFP also shows diminished coagulation capacity. However, PRT-RBC are comparable to control-RBC. PRT-WB retains acceptable hemostatic function but alternatives to the PRP method of component separation may be more suitable. [ABSTRACT FROM AUTHOR]

Background: Optimal management of exacerbations of chronic obstructive pulmonary disease (COPD) reduces patient morbidity and healthcare system burden. COPD guidelines, including the Global Initiative for Chronic Obstructive Lung Disease (GOLD) and the COPD‐X Plan, provide evidence‐based recommendations, but adherence in hospital practice is variable. Aims: To examine current practice in management of COPD exacerbations at an Australian teaching hospital and to compare with COPD‐X Plan recommendations. Methods: Data were collected retrospectively from electronic medical records for admissions occurring during 1 May to 31 August 2016, and compared with recommendations from the COPD‐X Plan. Results: A total of 134 patients (n = 68 females) was admitted for a COPD exacerbation during the study period. Mean age was 75.4 ± 10.2 years and 33.6% were current smokers. Airflow obstruction on spirometry was confirmed in 67.2% (mean forced expiratory volume in 1 s was 53 ± 22% predicted (1.2 ± 0.5 L)). Excellent adherence to the COPD‐X Plan was demonstrated in the ordering of chest radiographs (97%) and electrocardiograms (94%). Supplemental oxygen was appropriately provided to all patients with oxygen saturation of <88%. All patients with confirmed hypercapnic respiratory failure were managed with non‐invasive ventilation. Corticosteroids and bronchodilators were prescribed for the majority of patients. Areas of suboptimal practice included inadequate usage of arterial blood gases, excess supplemental oxygen in the absence of hypoxaemia, over‐prescription of intravenous antimicrobials, low referral rates to pulmonary rehabilitation and insufficient smoking cessation counselling. Conclusions: Level of adherence to guideline recommendations in the management of COPD exacerbations is inadequate and further strategies are required to elevate standards of practice. [ABSTRACT FROM AUTHOR]

Objective: To determine variations in cord blood gas (CBG) parameters after 3-minute delayed cord clamping (DCC) in vaginal deliveries (VDs) and caesarean deliveries (CDs) at term without fetal distress.Design: Prospective observational study.Setting: University hospital.Sample: CBG from 97 VDs and 124 CDs without fetal distress.Methods: Comparison of paired arterial-venous CBG parameters drawn at birth from the unclamped cord and after 3-minutes DCC for VDs and CDs.Main Outcome Measures: Base excess, bicarbonate, haematocrit and haemoglobin from both arterial and venous cord blood, lactate, neonatal outcomes, partial pressure of oxygen (pO2 ), partial pressure of carbon dioxide (pCO2 ), pH, and postpartum haemorrhage.Results: Arterial cord blood pH, bicarbonate ( HCO3- , mmol/l), and base excess (BE, mmol/l) decreased significantly after 3-minute DCC both in VDs (pH = 7.23 versus 7.27; P < 0.001; HCO3-  = 23.3 versus 24.3; P = 0.004; BE = -5.1 versus -2.9; P < 0.001) and CDs (pH = 7.28 versus 7.34; P < 0.001; HCO3-  = 26.2 versus 27.2; P < 0.001; BE = -1.5 versus 0.7; P < 0.001). After 3-minute DCC, pCO2 increased in CDs only (57 versus 51; P < 0.001), whereas lactate increased more in CDs compared with VDs (lactate, +1.1 [0.9, 1.45] versus +0.5 [-0.65, 2.35]; P = 0.01). Postpartum maternal haemorrhage, neonatal maximum bilirubin concentration, and need for phototherapy were similar between the two groups. Newborns born by CD more frequently required postnatal clinical monitoring or admission to a neonatal intensive care unit.Conclusions: After 3-minute DCC, the acid-base status shifted towards mixed acidosis in CDs and prevalent metabolic acidosis in VDs. CDs were associated with a more pronounced increase in arterial lactate, compared with VDs.Tweetable Abstract: By 3-minute DCC, acid-base status shifts towards mixed and metabolic acidosis in caesarean and vaginal delivery, respectively. [ABSTRACT FROM AUTHOR]

Aim: It is not clear whether perinatal acidosis can predict poor outcomes in extremely preterm infants and we investigated associations between intrapartum hypoxia and mortality and neurodevelopmental outcomes.Methods: We used nationwide data on 705 infants from the Extremely Preterm Infants in Sweden Study, delivered at 22-26 weeks of gestation during 2004-2007. Comprehensive neurodevelopmental assessments were performed on survivors at 2.5 (n = 456) and 6.5 (n = 441) years of corrected age. Gestational age-related changes in umbilical cord arterial pH were compared with reference values for term newborn infants, and base excess was also calculated. Associations between low blood gas values (<10th percentile) and mortality and neurodevelopmental outcome were estimated.Results: Cord blood determination was more common in surviving infants (P < .001), with pH determined in 322/705 (46%) and base excess in 311/705 (44%). Extremely preterm infants had higher pH values than term infants (P < .0001), with no change from 22 to 26 weeks of gestation (P = .61, r2  = .001). Multiple logistic regression showed no association between low blood gas values and risk of death or neurodevelopmental impairment at 6.5 years (P ≥ .17).Conclusion: Hypoxia with acidosis at birth was not associated with an increased risk of death or impaired neurodevelopmental in extremely preterm born children at 6.5 years. [ABSTRACT FROM AUTHOR]

Aim: To study analgesic effects of dexmedetomidine or sufentanil, both combined with ropivacaine, in epidural analgesia during labor. Methods: We recruited 160 primigravidae with full‐term pregnancy who received epidural anesthesia during labor and randomized them into four groups to receive epidural administration of ropivacaine combined with sufentanil (RS1 and RS2 groups) or with dexmedetomidine (RD1 and RD2 groups). Systolic blood pressure, diastolic blood pressure and heart rate before anesthesia (T1), 15 min after anesthesia induction (T2), on delivery (T3) and 2 h postpartum (T4), together with visual analogue scale scores, Bromage scores, Ramsay scores, adverse reactions during analgesia and urinary retention at 6 and 24 h postpartum were recorded; the pH, PCO2 and PO2 of umbilical cord arterial blood and Apgar scores at 1, 5 and 10 min after childbirth were assessed. Results: RS1 group had significantly lower systolic blood pressure, diastolic blood pressure and heart rate than RD1 group at T2 and T3 (all P < 0.05), but not at T1. At T2 and T3, the other three groups were lower than RS2 group in visual analogue scale and Ramsay scores (all P < 0.05). After childbirth, RD2 group had significantly higher PO2 result than other three groups (P < 0.05). At 6 h postpartum, RD2 group had significantly fewer cases of urinary retention than RD1 and RS1 groups (both P < 0.05). Conclusion: A relatively low concentration of ropivacaine, combined with dexmedetomidine, is better in analgesia during labor. [ABSTRACT FROM AUTHOR]

Background: The critical care experience is particularly stressful for patients, which can result in a number of physiological and psychological consequences, including haemodynamic instability, increased pain, agitation and delirium, leading to prolonged mechanical ventilation, length of stay and subsequent complications. Massage therapy encompasses different techniques to promote relaxation and to counter stress, therefore potentially affecting several patients' outcomes. Aims: To systematically review evidence on the effects of massage on outcomes of adult critically ill patients. The outcome measures included pain, vital signs (VS), haemodynamic measurements, level of consciousness, sleep quality, muscle tension, anxiety, feelings of calm and relaxation, coping, arterial blood gases and serum biomarkers. Method: This was a systematic review based on focused literature searches (PubMed, CINAHL, Scopus, EMBASE‐Ovid databases, Google Scholar). The Cochrane Collaboration's tool was used to assess the risk of bias. Eligibility criteria included published experimental and quasi‐experimental studies reporting on the physiological and psychological outcomes of critically ill patients. Results: Based on the selection criteria, 12 studies were included in the review. The main findings are as follows: 8 of 12 studies used randomized control designs with high internal validity, and there was a high level of evidence of favourable effects with respect to improvements in VS and a reduction in pain and anxiety. Outcomes that need to be more rigorously pursued include quality of sleep, analgesic and sedative dosages and level of consciousness. Conclusion: The results suggest that massage interventions can have positive effects on critically ill patients' outcomes. However, there are several gaps in the literature, along with methodological limitations, that require further consideration in critical care settings. Relevance to clinical practice: The results of this systematic review can inform implementation of massage interventions in critical care, which can be challenging as a result of several barriers. [ABSTRACT FROM AUTHOR]

The interpretation of umbilical cord gases may not be straightforward following shoulder dystocia. We reviewed Perinatal and Maternal Mortality Review Committee data from New Zealand infants with moderate and severe neonatal encephalopathy (NE) for 2010–2017 inclusive. If one or more of: pH of ≤7.1; base excess of ≤–12 mmol/L; or lactate of ≥6 mmol/L were present it was considered an abnormal result. One‐third (12/36) of infants born following shoulder dystocia had documented umbilical cord gases within the normal range. It is important for clinicians to be aware of this possibility when assessing newborn infants with NE. [ABSTRACT FROM AUTHOR]

Background: This study evaluated potential risk factors associated with acute kidney injury (AKI) in infants undergoing bedside open laparotomy in the neonatal intensive care unit (NICU), and analyzed the association between postoperative AKI and outcomes. Methods: Retrospective data, including neonatal characteristics, perioperative findings (i.e. vital signs and fluid status), postoperative AKI incidence, and postoperative mortality rate of infants who underwent bedside open laparotomy in the NICU between May 2013 and May 2018 were collected and analyzed. Results: A total of 53 cases (26 in AKI group vs 27 in non‐AKI group) were analyzed. On univariable analysis, transfusion, pre‐ and postoperative blood gas analysis and number of inotropic agents, cumulative postoperative percentage fluid overload (48 h), and preoperative hourly urine output were associated with the development of postoperative AKI. On multivariable logistic regression analysis, preoperative acidosis (pH <7.15 or base deficit >10; P = 0.002; OR, 11.067; 95%CI: 2.499–49.017) and preoperative urine output (P = 0.035; OR, 0.548; 95%CI: 0.314–0.959) were significant factors associated with postoperative AKI. Postoperative mortality rate 30 days after surgery was higher in the AKI group, but the difference was not significant. Conclusions: Preoperative metabolic acidosis and urine output are important factors potentially associated with the development of postoperative AKI in neonates undergoing bedside open laparotomy. Strategies such as alkali therapy, which protect the kidney from further injury, should be validated in future studies. A decreasing urine output may suggest deteriorating kidney function prior to surgery, potentially amplifying the risk of postoperative AKI. [ABSTRACT FROM AUTHOR]

Background: Many patients with acute exacerbations of chronic obstructive pulmonary disease (AECOPD) have type 2 respiratory failure (T2RF). Often arterial blood gases are not performed and correlation with venous blood gases (VBG) is controversial. The venous pH and bicarbonate (HCO3) are useful, but VBG pCO2 (PvCO2) is considered too unpredictable. Aim: To examine the utility of VBG in this cohort of patients. Methods: A prospective study of AECOPD patients with T2RF presenting to the emergency department was performed. Patients being considered for non‐invasive ventilation and who required an arterial blood gas were invited to participate. A subsequent VBG was also taken, and Bland–Altman plots were used for analysis. Results: Sixty‐three patients were included in this study. The limits of agreement for pH and HCO3 were narrow. Wider limits of agreement with a systematic bias of 7.7 mmHg were noted with pCO2. Conclusions: The utility of VBG pH and HCO3 was again demonstrated. VBG pCO2 in this cohort of patients may have a role in the assessment of patients with AECOPD. Further study is needed on the possible role of VBG in the management of such patients with T2RF particularly those using non‐invasive ventilation. [ABSTRACT FROM AUTHOR]

Background: Near‐infrared spectroscopy (NIRS) is a noninvasive method to measure regional tissue oxygenation (rSO2). In patients with atrial fibrillation (AF), cardiac output and endothelial function are altered. Peripheral tissue oxygenation may therefore be reduced. This study aims to describe the peripheral tissue oxygenation of the feet before and after synchronized electrical cardioversion (CV) of patients with AF using NIRS. Methods: Patients with AF undergoing CV were included and screened for peripheral arterial disease (PAD), diabetes mellitus (DM), and peripheral neuropathy (PN). NIRS was performed before and after CV under continuous ECG and monitoring of peripheral oxygen saturation. NIRS was registered on the dorsoplantar and plantar area of both feet. Capillary blood gas analysis was performed and left ventricular ejection fraction (LVEF) was determined. Results: Twelve patients (five women, seven men, age 70.8 ± 10.8 years) participated. None had history of PAD. DM was present in three (25%) patients. Two patients (16.7%) had PN. CV was successful in 11 patients. Overall, rSO2 improved significantly in all patients after CV (P = .0003). Mean improvement was 7.17%. There were no significant changes in body temperature, ankle‐brachial index, sO2, pO2, pCO2, pH, or lactate after CV. Heart rate was significantly lower (P < .0001) and LVEF significantly higher (P = .0123) after CV. Conclusions: In patients with AF, peripheral tissue oxygen saturation improves significantly after successful CV. This suggests that patients with PAD may not only benefit from interventional or surgical improvement of arterial vascularization, but also from CV in case of AF. [ABSTRACT FROM AUTHOR]

Objective: The aims of this study were to establish the bias (mean difference) and 95% limits of agreement (LoA) between electrolyte values (sodium and potassium) and haemoglobin between whole blood analysed by the ED resuscitation room blood gas analyser and specimens analysed using standard techniques in the central hospital laboratory and to determine the proportion of analyses falling outside defined clinically acceptable LoA and pathology expert defined standards. Methods: Prospective cohort study. Paired blood gas analyser and laboratory samples taken no more than 10 min apart were included. The primary outcome of interest was bias and 95% LoA by Bland–Altman analysis. Subgroup analyses for values outside the normal range were also conducted. Results: Three hundred and fifty‐two sample pairs were included in the analysis. For sodium concentration the bias was 0.6 mmol/L (95% LoA −3.3 to 4.6 mmol/L). For potassium concentration the bias was 0.21 mmol/L (95% LoA −0.36 to 0.79 mmol/L). For haemoglobin concentration the bias was −1.6 g/dL (95% LoA −10.2 to 6.9 g/dL). For sodium and haemoglobin concentrations, >95% of results fell within the defined clinically acceptable limits. For potassium concentration, >90% of results fell within the defined clinically acceptable limits. In general, serum sodium and potassium concentrations were slightly higher than blood gas levels and for haemoglobin serum levels were slightly lower. Conclusion: Agreement between blood gas analysis and laboratory analysis for sodium, potassium and haemoglobin concentrations shows acceptable agreement for use in time critical clinical decision‐making in ED. [ABSTRACT FROM AUTHOR]

Aim: To investigate whether unnecessary harm could be avoided in children admitted to paediatric intensive care (PICU), we analysed the impact of arterial blood gas on the paediatric index of mortality score2 (PIM2) and the derived predicted death rate (PDR).Methods: From January 1, 2008 to December 31, 2010, 1793 consecutive admissions, newborn infants to 16 years of age (median 0.71 years) from a single, tertiary PICU in Gothenburg Sweden, were collected. Admission information on arterial oxygen tension (PaO2 ) and fraction of inspired oxygen (FiO2 ) was extracted from 990 admissions.Results: There was close agreement between PIM2 score and PDR regardless of whether the PaO2 /FiO2 ratio was omitted or not. In the subgroup of admissions with a respiratory admission diagnosis, the inclusion of the PaO2 /FiO2 ratio increased the accuracy of the PIM2 score as well as the PDR. The standard mortality ratio was slightly but not significantly overestimated by excluding the PaO2 /FiO2 ratio.Conclusion: To avoid unnecessary harm to children admitted to PICU, an arterial blood gas analysis should only be performed if clinically indicated or if the child has a respiratory admission diagnosis. Estimation of the PIM2 score and PDR will not be less accurate by this approach. [ABSTRACT FROM AUTHOR]