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BACKGROUND: High normal resting pCO2 is a risk factor for salt sensitivity of blood pressure (BP) in normotensive humans and has been associated with higher resting systolic BP in postmenopausal women. To date, however, no known studies have investigated the effects of regular practice of voluntary mild hypocapnic breathing on BP in hypertensive patients. The objective of the present research was to test the hypothesis that capnometric feedback training can decrease both resting pCO2 and 24-h BP in a series of mildly hypertensive postmenopausal women. METHODS: A small portable end tidal CO2 (etCO2) monitor was constructed and equipped with software that determined the difference between the momentary etCO2 and a pre-programmed criterion range. The monitor enabled auditory feedback for variations in CO2 outside the criterion range. 16 mildly hypertensive postmenopausal women were individually trained to sustain small decreases in etCO2 during six weekly sessions in the clinic and daily sessions at home. 24-h BP monitoring was conducted before and after the intervention, and in 16 prehypertensive postmenopausal women in a control group who did not engage in the capnometric training. RESULTS: Following the intervention, all 16 capnometric training participants showed decreases in resting etCO2 (- 4.3 ± 0.4 mmHg; p

BackgroundThe Neonatal Resuscitation Program (NRP) recommends using 100% O2 during chest compressions and adjusting FiO2 based on SpO2 after return of spontaneous circulation (ROSC). The optimal strategy for adjusting FiO2 is not known.MethodsTwenty-five near-term lambs asphyxiated by umbilical cord occlusion to cardiac arrest were resuscitated per NRP. Following ROSC, lambs were randomized to gradual decrease versus abrupt wean to 21% O2 followed by FiO2 titration to achieve NRP SpO2 targets. Carotid blood flow and blood gases were monitored.ResultsThree minutes after ROSC, PaO2 was 229 ± 32 mmHg in gradual wean group compared to 57 ± 13 following abrupt wean to 21% O2 (p

Objective: To determine whether there is racial/ethnical discrepancy between pulse oximetry (SpO2) and oxygen saturation (SaO2) in patients receiving extracorporeal membrane oxygenation (ECMO). Methods: This was a retrospective observational study at a tertiary academic ECMO center with adults (>18 years) on venoarterial (VA) or venovenous (VV) ECMO. Datapoints were excluded if oxygen saturation ≤70% or SpO2–SaO2 pairs were not measured within 10 minutes. The primary outcome was the presence of a SpO2–SaO2 discrepancy between different races/ethnicities. Bland–Altman analyses and linear mixed-effects modeling, adjusting for prespecified covariates, were used to assess the SpO2–SaO2 discrepancy between races/ethnicities. Occult hypoxemia was defined as SaO2

Purpose: Purpose of this study is to reveal the relationship between optic nerve sheath diameter (ONSD) and the etiology of brain death and to investigate whether there is a correlation between ONSD and blood gas parameters before and after the apnea test in patients diagnosed with brain death. Materıals and Methods: The data of 92 patients with brain death diagnoses were retrospectively analyzed for ONSD measurements for each eye, partial carbon dioxide pressure (pCO2), and blood gas parameters before and after the apnea test. Results: Subarachnoidal and intracerebral hemorrhages were the two most common brain death etiology. The mean ONSD for the right eye was 6.37±1.03 mm. The mean ONSD for the left eye was 6.43±1.02 mm. Only 8 patients had ONSD below 5.00 mm. There was no statistically significant correlation between the percent change of pCO2 and ONSD change (p>0.05). Conclusion: The present study shows that ONSD values are very high regardless of the partial pressure of carbon dioxide in patients with brain death diagnoses. We can suggest that ONSD can find a place for evaluating comatose patients for brain death diagnosis.

Most prediction models, like return of spontaneous circulation (ROSC) after cardiac arrest (RACA) or Utstein-based (UB)-ROSC score, were developed for prehospital settings to predict the probability of ROSC in patients with out-of-hospital cardiac arrest (OHCA). A prediction model has been lacking for the probability of ROSC in patients with OHCA at emergency departments (EDs). In the present study, a point-of-care (POC) testing-based model, POC-ED-ROSC, was developed and validated for predicting ROSC of OHCA at EDs. Prospectively collected data for adult OHCA patients between 2015 and 2020 were analysed. POC blood gas analysis obtained within 5 min of ED arrival was used. The primary outcome was ROSC. In the derivation cohort, multivariable logistic regression was used to develop the POC-ED-ROSC model. In the temporally split validation cohort, the discriminative performance of the POC-ED-ROSC model was assessed using the area under the receiver operating characteristic (ROC) curve (AUC) and compared with RACA or UB-ROSC score using DeLong test. The study included 606 and 270 patients in the derivation and validation cohorts, respectively. In the total cohort, 471 patients achieved ROSC. Age, initial cardiac rhythm at ED, pre-hospital resuscitation duration, and POC testing-measured blood levels of lactate, potassium and glucose were significant predictors included in the POC-ED-ROSC model. The model was validated with fair discriminative performance (AUC: 0.75, 95% confidence interval [CI]: 0.69–0.81) with no significant differences from RACA (AUC: 0.68, 95% CI: 0.62–0.74) or UB-ROSC score (AUC: 0.74, 95% CI: 0.68–0.79). Using only six easily accessible variables, the POC-ED-ROSC model can predict ROSC for OHCA resuscitated at ED with fair accuracy. [ABSTRACT FROM AUTHOR]

Background: Enterprise Point‐of‐Care (EPOC) blood analysis is used routinely in wildlife veterinary practice to monitor blood oxygenation, but the reliability of the EPOC calculated arterial oxygen‐hemoglobin saturation (cSaO2) has never been validated in the white rhinoceros (Ceratotherium simum), despite their susceptibility to hypoxemia during chemical immobilization. Objectives: We aimed to evaluate the reliability of the EPOC cSaO2 by comparing it against arterial oxygen‐hemoglobin saturation (SaO2) measured by a co‐oximeter reference method in immobilized white rhinoceroses. Methods: Male white rhinoceroses in two studies (both n = 8) were immobilized by darting with different etorphine‐based drug combinations, followed by butorphanol or saline (administered intravenously). Animals in both studies received oxygen via intranasal insufflation after 60 min. Blood samples were drawn, at predetermined time points, from a catheter inserted into the auricular artery and analyzed using the EPOC and a co‐oximeter. Bland–Altman (to estimate bias and precision) and area root mean squares (ARMS) plots were used to determine the reliability of the EPOC cSaO2 compared with simultaneous co‐oximeter SaO2 readings. Results: The rhinoceros were acidotic (pH of 7.3 ± 0.1 [mean ± standard deviation]), hypercapnic (PaCO2 of 73.7 ± 10.5 mmHg), and normothermic (body temperature of 37.4 ± 1.8°C). In total, 389 paired cSaO2‐SaO2 measurements were recorded (the cSaO2 ranged between 13.2% and 99.0%, and the SaO2 ranged between 11.8% and 99.9%). The EPOC cSaO2 readings were unreliable (inaccurate, imprecise, and poor ARMS) across the entire saturation range (bias −6%, precision 5%, and ARMS 8%). Conclusions: The EPOC cSaO2 is unreliable and should not be used to monitor blood oxygenation in immobilized white rhinoceroses. [ABSTRACT FROM AUTHOR]

Simple Summary: Mastitis is one of the most common diseases of the dairy industry and with it brings important economic losses. The most prevalent form of the disease is subclinical mastitis, which leads, in the absence of clinical signs, to decreased milk production, increased somatic cell count, and an increased risk of clinical mastitis during lactation. With the increasing public health concerns for antimicrobial use and its relationship with the development of antimicrobial resistance, nation-specific regulations and general pressure to reduce group-level prophylactic use of antimicrobials have been established. Selective dry therapy reserves antimicrobial treatment for cows or quarters suspected of having an intramammary infection. The treatment is administered after the last milking, while uninfected cows or quarters do not receive antibiotherapy. Since selective dry cow therapy was introduced, different methods of selecting infected cows or quarters have been reported. The aim of this article is to describe the management of mastitis in dairy cows and the main tools for its diagnosis, with a specific focus on on-farm instruments. Mastitis is one of the most important diseases in dairy cattle farms, and it can affect the health status of the udder and the quantity and quality of milk yielded. The correct management of mastitis is based both on preventive and treatment action. With the increasing concern for antimicrobial resistance, it is strongly recommended to treat only the mammary quarters presenting intramammary infection. For this reason, a timely and accurate diagnosis is fundamental. The possibility to detect and characterize mastitis directly on farm would be very useful to choose the correct management protocol. Some on-field diagnostic tools are already routinely applied to detect mastitis, such as the California Mastitis Test and on-farm culture. Other instruments are emerging to perform a timely diagnosis and to characterize mastitis, such as Infra-Red Thermography, mammary ultrasound evaluation and blood gas analysis, even if their application still needs to be improved. The main purpose of this article is to present an overview of the methods currently used to control, detect, and characterize mastitis in dairy cows, in order to perform a timely diagnosis and to choose the most appropriate management protocol, with a specific focus on on-farm diagnostic tools. [ABSTRACT FROM AUTHOR]

Arterial blood gas analysis (ABGA) is one of the few tests performed during cardiopulmonary resuscitation (CPR). There have been some studies on the prediction of survival outcomes in adult out-of-hospital cardiac arrest (OHCA) patients during CPR using ABGA results. However, in pediatric OHCA patients, the prognosis of survival outcome based on ABGA results during CPR remains unclear. We retrospectively analyzed prospectively collected data from the Korean Cardiac Arrest Resuscitation Consortium (KoCARC) registry, a multicenter OHCA registry of Republic of Korea. We analyzed 108 pediatric (age < 19 years) OHCA patients between October 2015 and June 2022. Using multivariable logistic regression, an adjusted odds ratio (aOR) was obtained to validate the ABGA results of survival to hospital admission and survival to discharge. The variables associated with survival to hospital admission were non-comorbidities (aOR 3.03, 95% confidence interval (CI) 1.22–7.53, p = 0.017) and PaO2 > 45.750 mmHg (aOR 2.69, 95% CI 1.13–6.42, p = 0.026). There was no variable that was statistically significant association with survival to discharge. PaO2 > 47.750 mmHg and non-comorbidities may serve as an independent prognostic factor for survival to hospital admission in pediatric OHCA patients. However, the number of cases analyzed in our study was relatively small, and there have been few studies investigating the association between ABGA results during CPR and the survival outcome of pediatric OHCA patients. Therefore, further large-scale studies are needed. [ABSTRACT FROM AUTHOR]

Purpose: In this study, we investigated the relationship between integrated pulmonary index and patients' demographic data, surgical characteristics, postoperative complications, blood gas analysis, and hemodynamic values after thoracic surgery. Materials and Methods: A total of 97 patients scheduled for elective thoracic surgery were included in this study. After surgery, integrated pulmonary index monitoring was performed for all patients in the post-anesthetic care unit. Patients' characteristics, postoperative hemodynamic values, arterial blood gas analysis, length of hospital stay, postoperative complications, duration of anesthesia, and duration of surgery were recorded. Their correlations with postoperative integrated pulmonary index scores at 30 minutes, 1 hour, and 2 hours were investigated. Results: Patients' demographic data and surgical characteristics did not affect integrated pulmonary index scores. No significant correlation was found between integrated pulmonary index scores and duration of anesthesia, duration of surgery, postoperative complications, or length of hospital stay. However, there was a correlation between postoperative hemodynamic values, arterial blood gas analysis and integrated pulmonary index score. Conclusion: Integrated pulmonary index monitoring is a bedside and non-invasive method that displays multiple parameters on a single screen, corraletes with arterial blood gas analysis and hemodynamic values. Therefore, it may provide advantages in early follow-up of thoracic surgery patients. However, multicenter, randomized controlled studies with a larger number of patients are needed to investigate the efficacy of integrated pulmonary index in patients undergoing thoracic surgery. [ABSTRACT FROM AUTHOR]

Traumatic brain injury (TBI) is often accompanied by hemorrhage, and treatment of hemorrhagic shock (HS) after TBI is particularly challenging because the two therapeutic treatment strategies for TBI and HS often conflict. Ischemia/reperfusion injury from HS resuscitation can be exaggerated by TBI-induced loss of autoregulation. In HS resuscitation, the goal is to restore lost blood volume, while in the treatment of TBI the priority is focused on maintenance of adequate cerebral perfusion pressure and avoidance of secondary bleeding. In this study, we investigate the responses to resuscitation from severe HS after TBI in rats, using fresh blood, polymerized human hemoglobin (PolyhHb), and lactated Ringer's (LR). Rats were subjected to TBI by pneumatic controlled cortical impact. Shortly after TBI, HS was induced by blood withdrawal to reduce mean arterial pressure (MAP) to 35-40 mmHg for 90 min before resuscitation. Resuscitation fluids were delivered to restore MAP to ~ 65 mmHg and animals were monitored for 120 min. Increased systolic blood pressure variability (SBPV) confirmed TBI-induced loss of autoregulation. MAP after resuscitation was significantly higher in the blood and PolyhHb groups compared to the LR group. Furthermore, blood and PolyhHb restored diastolic pressure, while this remained depressed for the LR group, indicating a loss of vascular tone. Lactate increased in all groups during HS, and only returned to baseline level in the blood reperfused group. The PolyhHb group possessed lower SBPV compared to LR and blood groups. Finally, sympathetic nervous system (SNS) modulation was higher for the LR group and lower for the PolyhHb group compared to the blood group after reperfusion. In conclusion, our results suggest that PolyhHb could be an alternative to blood for resuscitation from HS after TBI when blood is not available, assuming additional testing demonstrate similar favorable results. PolyhHb restored hemodynamics and oxygen delivery, without the logistical constraints of refrigerated blood.

Background and Objective: In order to determine the Hypoxemia and prognosis of patients with covid-19 hospitalized in the intensive care unit, reliable oxygen supply indicators are needed. In this situation, the examination of the percentage of arterial oxygen saturation (SaO2) and arterial oxygen pressure (PaO2), as well as their relationship, may be helpful. Materials and Methods: This descriptive-cross-sectional study examined 1,121 patients with covid-19 hospitalized in the intensive care unit of hospitals affiliated with Hamadan University of Medical Sciences. Data were collected through a researcher-made checklist, including age, gender, history of smoking and drug use, underlying disease, duration of hospitalization, the outcome of hospitalization, and hemoglobin listed in the patient's medical records. Moreover, SaO2 and PaO2 were examined in the first arterial blood analysis report after admission to the hospital. Results: A positive and significant correlation was observed between SaO2 and PaO2 (r=0.733 and P

Abstract Background Blood gas analysis is integral to assessing emergency department (ED) patients with acute respiratory or metabolic disease. Arterial blood gas (ABG) is the gold standard for oxygenation, ventilation, and acid–base status but is painful to obtain. Peripheral venous blood gas (VBG) is a valuable alternative as it is less painful and easy to collect. The comparability of ABG and VBG was studied in various conditions. But in hypotension, previous findings were inconsistent. So, we studied the correlation and agreement between ABG and VBG in hypotensive patients. Methodology The study was conducted at the emergency department of a tertiary healthcare center in Northern India. Patients with hypotension above 18 years who satisfied the inclusion criteria were clinically evaluated. Patients who require ABG as a part of routine care were sampled. ABG was collected from the radial artery. VBG was obtained from the cubital or dorsal hand veins. Both samples were collected within 10 min and were analyzed. All ABG and VBG variables were entered in premade proforma. The patient was then treated and disposed of according to institutional protocol. Results A total of 250 patients were enrolled. The mean age was 53.25 ± 15.71 years. 56.8% were male. The study included 45.6% septic, 34.4% hypovolemic, 18% cardiogenic, and 2% obstructive shock patients. The study found a strong correlation and agreement for ABG and VBG pH, pCO2, HCO3, lactate, sodium, potassium, chloride, ionized calcium, blood urea nitrogen, base excess, and arterial/alveolar oxygen ratio. Hence, regression equations were made for the aforementioned. There was no correlation observed between ABG and VBG pO2 and SpO2. Our study concluded that VBG could be a reasonable alternative for ABG in hypotensive patients. We can also mathematically predict values of ABG from VBG using regression equations derived. Conclusions ABG sampling causes most unpleasant experiences to patients and is associated with complications like arterial injury, thrombosis, air or clotted-blood embolism, arterial occlusion, hematoma, aneurysm formation, and reflex sympathetic dystrophy. The study has shown strong correlations and agreements for most ABG and VBG parameters and can predict ABG mathematically using regression formulas formulated from VBG. This will decrease needle stick injury, consume less time, and make blood gas evaluation easy in hypotensive settings.

Background Noninvasive positive pressure ventilation (NPPV) is a major respiratory support technique for patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) and carbon dioxide (CO2) retention. However, the obvious dead space in available masks used for NPPV could easily lead to repeated CO2 inhalation, which affects the correction of CO2 retention. Objective To develop a face mask with two channel and constant leakage (TCCL) used for NPPV, and to examine its value in NPPV treatment of AECOPD patients with CO2 retention. Methods Thirty patients with AECOPD and typeⅡ respiratory failure treated with NPPV were recruited from the ICU, the First Affiliated Hospital of Chongqing Medical University from 2020 to 2021, and equally randomized into an experimental group (using the TCCL mask) and an control group (using the traditional mask with an exhalation valve on the side for NPPV) . Treatment effectiveness was assessed using arterial partial pressure of oxygen (PaO2) and partial pressure of carbon dioxide (PaCO2) monitored at baseline, and at the end of 4, 8, 24, and 48 hours of NPPV treatment as well as 24 hours after NPPV cessation. Results The two-way repeated measures ANOVA indicated that treatment time and treatment approach had no interactive effects on PaO2 (P>0.05) . Treatment time produced significant main effects on PaO2 (P0.05) . Treatment time and treatment approach had no interactive effects on PaCO2 (P>0.05) . Treatment time produced significant main effect on PaCO2 (P

Highlights Brain hypoxia may be the key point of pathological link between PFO and migraine. NBO may be a feasible promising method on PFO–migraine control. The size of PFO aperture may be not very matched with the severity and the incidence of migraine.

Polyoxotungstate nanoclusters have recently emerged as promising contrast agents for computed tomography (CT). In order to evaluate their clinical potential, in this study, we evaluated the in vitro CT imaging properties, potential toxic effects in vivo, and tissue distribution of monolacunary Wells–Dawson polyoxometalate, α2-K10P2W17O61.20H2O (mono-WD POM). Mono-WD POM showed superior X-ray attenuation compared to other tungsten-containing nanoclusters (its parent WD-POM and Keggin POM) and the standard iodine-based contrast agent (iohexol). The calculated X-ray attenuation linear slope for mono-WD POM was significantly higher compared to parent WD-POM, Keggin POM, and iohexol (5.97 ± 0.14 vs. 4.84 ± 0.05, 4.55 ± 0.16, and 4.30 ± 0.09, respectively). Acute oral (maximum-administered dose (MAD) = 960 mg/kg) and intravenous administration (1/10, 1/5, and 1/3 MAD) of mono-WD POM did not induce unexpected changes in rats’ general habits or mortality. Results of blood gas analysis, CO-oximetry status, and the levels of electrolytes, glucose, lactate, creatinine, and BUN demonstrated a dose-dependent tendency 14 days after intravenous administration of mono-WD POM. The most significant differences compared to the control were observed for 1/3 MAD, being approximately seventy times higher than the typically used dose (0.015 mmol W/kg) of tungsten-based contrast agents. The highest tungsten deposition was found in the kidney (1/3 MAD—0.67 ± 0.12; 1/5 MAD—0.59 ± 0.07; 1/10 MAD—0.54 ± 0.05), which corresponded to detected morphological irregularities, electrolyte imbalance, and increased BUN levels.

This study aimed to investigate the association of respiratory rate (RR), oxygen saturation (SpO2), and blood findings with respiratory disease in dogs and to compare the examination findings in the chronic and acute phases. Dogs that visited a veterinary referral hospital with respiratory symptoms were classified into the chronic disease group (GC), and those that visited the emergency veterinary hospital were classified into the acute disease group (GA). In total, 704 and 682 dogs were included in GC and GA, respectively. The RR and SpO2 were significantly higher and lower, respectively, in patients with lung disease compared to other disease sites in both groups. White blood cell counts were significantly increased in patients with lung and pleural diseases in both groups. Respiratory alkalosis and respiratory acidosis were most common in GC and GA, respectively. The C-reactive protein levels were elevated in both groups, primarily in patients with lung disease. Associations between the results of several tests for understanding and diagnosing respiratory conditions and diseases were recognized, and differences in the trends of the chronic and acute phases were clarified. These tools may be used as adjuncts to other tests for the diagnosis and monitoring of treatment responses.

Background: The altering effects of hypoxia on aerobic/anaerobic performance are well documented and form the basis of this study. Application of hyperoxic gases (inspiratory fraction of oxygen [FiO2] > 0.2095) prior to competition or training (hyperoxic preconditioning) can compensate for the negative influence of acute hypoxia. Purpose: To investigate whether oxygen supplementation immediately prior to exercise (FiO2 = 1.0) improves all-out exercise performance in normobaric hypoxia (3500 m) in highly skilled skiers. Methods: In this single-blind, randomized, crossover study, 17 subjects performed a 60-second constant-load, all-out test in a normobaric hypoxic chamber. After a short period of adaptation to hypoxia (60 min), they received either pure oxygen or chamber air for 5 minutes prior to the all-out test (hyperoxic preconditioning vs nonhyperoxic preconditioning). Capillary blood was collected 3 times, and muscle oxygenation was assessed with near-infrared spectroscopy. Results: Absolute and relative peak power (P =.073 vs P =.103) as well as mean power (P =.330 vs P =.569) did not significantly differ after the hyperoxic preconditioning phase. PaO2 increased from 51.3 (3) to 451.9 (89.0) mm Hg, and SaO2 increased from 88.2% (1.7%) to 100% (0.2%) and dropped to 83.8% (4.2%) after the all-out test. Deoxygenation (P =.700) and reoxygenation rates (P =.185) did not significantly differ for both preconditioned settings. Conclusions: Therefore, the authors conclude that hyperoxic preconditioning did not enhance 60-second all-out exercise performance in acute hypoxia (3500 m). [ABSTRACT FROM AUTHOR]

Background: The current paradigms in arterial blood gas analysis are based on mathematical or physicochemical models that require complex algorithms for interpretation. This leads to avoidance or dislike from health care professionals. Purpose: To formulate a new approach to the analysis and classification of acid base disturbances. Methodology: we conducted a systematic review of the related literature and a paradigm shift for data interpretation. Results: Acid-base disorders can be grouped and managed according to the underlying biochemical processes. Conclusions: This proposal represents a new classification, which groups acid base disorders according to the underlying causal biochemical process. Disorders with an elevated anion gap relate to alterations in cellular respiration (energy/ATP production)- All disturbances with normal anion gap relate to transmembrane ion exchange.

Accurate reporting of blood gas samples is dependent upon following proper preanalytical sample handling requirements though there is variation for sample acceptability criteria across institutions. We examined five common sample types (arterial, venous, umbilical arterial, umbilical venous and capillary) stored at either room temperature or on crushed ice in a time series (0, 15, 30, 45, 60, 90, 180, 240 min) and applied local regulatory and/or institutional allowable performance limits to determine the need for cold preservation and/or maximum stability time for pH, pO 2 , pCO 2 , glucose, lactate, sodium, potassium, chloride, and ionized calcium where applicable in each sample type. Although changes in sample pO 2 and/or lactate values were responsible, in part or in whole, for surpassing the allowable limits in nearly all sample types analyzed, this was not uniformly observed across sample types within the typical time limits that are referenced in literature. Furthermore, we demonstrated that cold preservation may not ubiquitously provide longer stability for blood gas specimens and this is dependent on the sample type and analyte in question. Nevertheless, these results demonstrate the known instability of pO 2 and lactate and suggest that it may be possible to simplify the monitoring of preanalytical conditions by first evaluating pO 2 and lactate in patient blood gas samples if applicable. [ABSTRACT FROM AUTHOR]

Purpose: To showcase results of arterial blood gases' analysis in elite breath-hold divers sampled at depths where their total lung capacities are below their residual lung volume on surface. Methods: Three male elite breath-hold divers performed body plethysmographies to determine their lung volumes. Two dives were performed, one on normal inhalation to 60 m of depth and the second on complete exhalation to 10 m of depth. Blood samples were taken on five occasions; before the first dive, at 60 and 10 m of depth and immediately after resurfacing after both dives. Results: Arterial blood gases' analysis at 60 m of depth showed an increase in partial pressures of oxygen and carbon dioxide, a consequent decrease in pH and an increase in concentration of HCO3−. After resurfacing, in two divers, values mostly returned to normal; hypoxemia was observed in one diver. At 10 m of depth, all values showed similar variation, and hypoxemia was observed in the same diver but at depth. Upon resurfacing, all values returned to normal. Conclusion: This is the first study performed at depths where the total lung capacities of participants are below their residual lung volumes at the surface. Partial pressure of carbon dioxide increases at depth to higher than normal values causing pH to decrease thus exceeding the buffering potential of the blood. In addition, previous assumptions that maximum depth in breath-hold divers is where total lung capacity is reduced to their residual volume proved wrong as our group of divers had no symptoms after resurfacing. [ABSTRACT FROM AUTHOR]

Introduction: We evaluated the effects of pre‐analytical care on total carbon dioxide (tCO2) in hemodialysis patients, as calculated by blood gas analysis (ctCO2) or measured by an enzymatic assay (mtCO2). Methods: Blood samples were collected via vascular access before dialysis sessions. For blood gas analysis, eight aliquots were collected, refrigerated or non‐refrigerated, and analyzed at 0, 4, 8, and 24 h after collection. A blood sample was then collected for the enzymatic method and distributed into 14 aliquots. Half of the aliquots were refrigerated. The samples analyzed at time point 0 were centrifuged immediately. The remaining aliquots of both the refrigerated and non‐refrigerated clusters were centrifuged before storage. Samples were analyzed at 4, 8, and 24 h post‐collection. Findings: By blood gas analysis, no significant change was found in bicarbonate values over time, either in the non‐refrigerated or refrigerated samples. ctCO2 values during the experiment showed a minor but statistically significant increase of questionable clinical relevance in both non‐refrigerated and refrigerated aliquots. In the enzymatic assay, the reduction in mtCO2 levels during the experiment was negligible. The median absolute reductions at the end of the experiment were 1.77, 1.21, 1.04, and 1.12 mmol/L for the non‐centrifuged/non‐refrigerated, centrifuged/non‐refrigerated, non‐centrifuged/refrigerated, and centrifuged/refrigerated aliquots, respectively. Discussion: Our results suggest that measured or calculated tCO2 levels of capped and cooled samples are adequate for analyzing the acid–base status of hemodialysis patients, even when such determination is not performed immediately after collection. [ABSTRACT FROM AUTHOR]

Since usability is considered a significant success factor for Clinical decision support systems (CDSSs), this study seeks to assess the usability of an electronic medical records-embedded CDSS for arterial blood gas (ABG) interpretation and ordering. The current study was conducted in the general ICU of a teaching hospital, using the System Usability Scale (SUS) and interviews with all anesthesiology residents and intensive care fellows in two rounds of CDSS usability testing. The feedback from the participants was discussed with the research team across a series of meetings, and the second version of CDSS was designed and tailored to participants' feedbacks. Subsequently, the CDSS usability score increased from 67.22±4.58 to 80.00±4.84 (P-value<0.001) through participatory, iterative design and the users' usability testing feedbacks. [ABSTRACT FROM AUTHOR]

Purpose: Severe haemorrhage is a leading cause of early mortality following major trauma. By early identification of patients at risk, blood transfusion could already be initiated in the prehospital period. Aim of the study was to evaluate the extent to which prehospital lactate and base excess, which are known to be associated with trauma-induced coagulopathy, and additional clinical parameters are associated with the need for early transfusion. Methods: In this prospective, single-centre observational study, trauma patients treated by a helicopter emergency medical service were included, regardless of the injury severity. Patients with coagulation-influencing drugs in long-term therapy were excluded. Blood samples obtained at the beginning of the prehospital treatment were analysed. Primary outcome was the association of lactate and base excess with the need for early transfusion (resuscitation room or immediate surgery). Receiver operating characteristic curves were created, and the area under the curve (AUROC) was calculated. Results: Between 2015 and 2018, 21 out of 130 adult trauma patients received blood products during the early in-hospital treatment. Both prehospital lactate and base excess were associated with the transfusion (AUROC 0.731 and 0.798, respectively). The optimal calculated cut-off values were 4 mmol/l (lactate) and − 2.5 mmol/l (base excess). When circulatory instability and suspected relevant bleeding were included, the association further improved (AUROC 0.871 and 0.866, respectively). Conclusion: Prehospital lactate and base excess could be used in combination with other clinical parameters as indicators of the need for early transfusion. This relationship has yet to be confirmed in the current validation study. Trial registration: German Clinical Trials Register, www.drks.de (No. DRKS 00009559). [ABSTRACT FROM AUTHOR]

Medical devices for cell therapy can be improved through prevascularization. In this work we study the vascularization of a porous polymer device, previously used by our group for pancreatic islet transplantation with results indicating improved glycemic control. Oxygen partial pressure within such devices was monitored non-invasively using an optical technique. Oxygen-sensitive tubes were fabricated and placed inside devices prior to subcutaneous implantation in nude mice. We tested the hypothesis that vascularization will be enhanced by administration of the pro-angiogenic factor hydrogen sulfide (H2S). We found that oxygen dynamics were unique to each implant and that the administration of H2S does not result in significant changes in perfusion of the devices as compared with control. These observations suggest that vascular perfusion and density are not necessarily correlated, and that the rate of vascularization was not enhanced by the pro-angiogenic agent.

Objective To observe the effects of different sedatives on hemodynamics and blood gas analysis in patients with heart failure with noninvasive positive pressure ventilation (NPPV) .Methods A total of 90 patients with heart failure diagnosed and treated with NPPV in this hospital from January 2020 to January 2022 were selected as research objects, and randomly divided into groups A,B and C, with 30 patients in each group.The group A was given dexmedetomidine, the group B was given midazolam, and the group C was given propofol. The NPPV time, ICU treatment time, endotracheal intubation rate, mortality within 28 days, incidence of adverse reactions, central venous pressure (CVP),changes of heart rate (HR),N-terminal B-type natriuretic peptide (Nt-proBNP),mean arterial pressure (MAP),arterial oxygen partial oxygen saturation (SpO2),and arterial partial carbon dioxide pressure (PaCO2) at 6,24 and 48 hours after sedation were observed and recorded in each group. Results The NIPPV time, endotracheal intubation rate, ICU treatment time and wake time after drug withdrawal in the group A were significantly shorter than those in groups B and C, the differences were statistically significant (P<0.05),but there were no statistical significances in NIPPV time, endotracheal intubation rate, ICU treatment time and wake time after drug withdrawal between groups B and C (P>0.05) .The levels of HR, CVP, Nt-proBNP and MAP in group A were significantly lower than those in groups B and C at 6,24 and 48 hours after sedation, the differences were statistically significant (P<0.05) .However, there were no statistical significances in the levels of HR, CVP, Nt-proBNP and MAP between groups B and C at 6,24 and 48 hours after sedation (P>0.05) .SpO2,PaO2 in the group A were significantly higher than those in groups B and C at 6,24 and 48 hours after sedation, and PaCO2 was significantly lower than those in groups B and C, the differences were statistically significant (P<0.05),but there were no statistical significances in SpO2,PaO2 and PaCO2 between groups B and C at 6,24 and 48 hours after sedation (P>0.05) .There was no significant difference in the incidence of complications between the group A (16.67%),group B (26.67%) and group C (30.00%) (P>0.05) .Conclusion Dexmedetomidine, midazolam and propofol have the same incidence of adverse reactions during sedation in patients with NPPV heart failure, but dexmedetomidine is more effective in reducing the duration of NPPV, endotracheal intubation rate, ICU treatment time and wake time after drug withdrawal, and can improve hemodynamic status and cardiac function faster, and correct hypoxemia more significantly. [ABSTRACT FROM AUTHOR]

Background: Blood gas analysis is integral to assessing emergency department (ED) patients with acute respiratory or metabolic disease. Arterial blood gas (ABG) is the gold standard for oxygenation, ventilation, and acid–base status but is painful to obtain. Peripheral venous blood gas (VBG) is a valuable alternative as it is less painful and easy to collect. The comparability of ABG and VBG was studied in various conditions. But in hypotension, previous findings were inconsistent. So, we studied the correlation and agreement between ABG and VBG in hypotensive patients. Methodology: The study was conducted at the emergency department of a tertiary healthcare center in Northern India. Patients with hypotension above 18 years who satisfied the inclusion criteria were clinically evaluated. Patients who require ABG as a part of routine care were sampled. ABG was collected from the radial artery. VBG was obtained from the cubital or dorsal hand veins. Both samples were collected within 10 min and were analyzed. All ABG and VBG variables were entered in premade proforma. The patient was then treated and disposed of according to institutional protocol. Results: A total of 250 patients were enrolled. The mean age was 53.25 ± 15.71 years. 56.8% were male. The study included 45.6% septic, 34.4% hypovolemic, 18% cardiogenic, and 2% obstructive shock patients. The study found a strong correlation and agreement for ABG and VBG pH, pCO2, HCO3, lactate, sodium, potassium, chloride, ionized calcium, blood urea nitrogen, base excess, and arterial/alveolar oxygen ratio. Hence, regression equations were made for the aforementioned. There was no correlation observed between ABG and VBG pO2 and SpO2. Our study concluded that VBG could be a reasonable alternative for ABG in hypotensive patients. We can also mathematically predict values of ABG from VBG using regression equations derived. Conclusions: ABG sampling causes most unpleasant experiences to patients and is associated with complications like arterial injury, thrombosis, air or clotted-blood embolism, arterial occlusion, hematoma, aneurysm formation, and reflex sympathetic dystrophy. The study has shown strong correlations and agreements for most ABG and VBG parameters and can predict ABG mathematically using regression formulas formulated from VBG. This will decrease needle stick injury, consume less time, and make blood gas evaluation easy in hypotensive settings. [ABSTRACT FROM AUTHOR]

Interpreting blood gas analysis results can be challenging for the clinician, especially in stressful situations under time pressure. To foster fast and correct interpretation of blood gas results, we developed Visual Blood. This computer-based, multicentre, noninferiority study compared Visual Blood and conventional arterial blood gas (ABG) printouts. We presented six scenarios to anaesthesiologists, once with Visual Blood and once with the conventional ABG printout. The primary outcome was ABG parameter perception. The secondary outcomes included correct clinical diagnoses, perceived diagnostic confidence, and perceived workload. To analyse the results, we used mixed models and matched odds ratios. Analysing 300 within-subject cases, we showed noninferiority of Visual Blood compared to ABG printouts concerning the rate of correctly perceived ABG parameters (rate ratio, 0.96; 95% CI, 0.92–1.00; p = 0.06). Additionally, the study revealed two times higher odds of making the correct clinical diagnosis using Visual Blood (OR, 2.16; 95% CI, 1.42–3.29; p < 0.001) than using ABG printouts. There was no or, respectively, weak evidence for a difference in diagnostic confidence (OR, 0.84; 95% CI, 0.58–1.21; p = 0.34) and perceived workload (Coefficient, 2.44; 95% CI, −0.09–4.98; p = 0.06). This study showed that participants did not perceive the ABG parameters better, but using Visual Blood resulted in more correct clinical diagnoses than using conventional ABG printouts. This suggests that Visual Blood allows for a higher level of situation awareness beyond individual parameters' perception. However, the study also highlighted the limitations of today's virtual reality headsets and Visual Blood. [ABSTRACT FROM AUTHOR]

Acid–base homeostasis is crucial for all physiological processes in the body and is evaluated using arterial blood gas (ABG) analysis. Screens or printouts of ABG results require the interpretation of many textual elements and numbers, which may delay intuitive comprehension. To optimise the presentation of the results for the specific strengths of human perception, we developed Visual Blood, an animated virtual model of ABG results. In this study, we compared its performance with a conventional result printout. Seventy physicians from three European university hospitals participated in a computer-based simulation study. Initially, after an educational video, we tested the participants' ability to assign individual Visual Blood visualisations to their corresponding ABG parameters. As the primary outcome, we tested caregivers' ability to correctly diagnose simulated clinical ABG scenarios with Visual Blood or conventional ABG printouts. For user feedback, participants rated their agreement with statements at the end of the study. Physicians correctly assigned 90% of the individual Visual Blood visualisations. Regarding the primary outcome, the participants made the correct diagnosis 86% of the time when using Visual Blood, compared to 68% when using the conventional ABG printout. A mixed logistic regression model showed an odds ratio for correct diagnosis of 3.4 (95%CI 2.00–5.79, p < 0.001) and an odds ratio for perceived diagnostic confidence of 1.88 (95%CI 1.67–2.11, p < 0.001) in favour of Visual Blood. A linear mixed model showed a coefficient for perceived workload of −3.2 (95%CI −3.77 to −2.64) in favour of Visual Blood. Fifty-one of seventy (73%) participants agreed or strongly agreed that Visual Blood was easy to use, and fifty-five of seventy (79%) agreed that it was fun to use. In conclusion, Visual Blood improved physicians' ability to diagnose ABG results. It also increased perceived diagnostic confidence and reduced perceived workload. This study adds to the growing body of research showing that decision-support tools developed around human cognitive abilities can streamline caregivers' decision-making and may improve patient care. [ABSTRACT FROM AUTHOR]

This study aimed to evaluate the association between prehospital airway type and oxygenation and ventilation in out-of-hospital cardiac arrest (OHCA). This retrospective observational study included OHCA patients who visited the emergency departments (EDs) between October 2015 and June 2021. The study groups were categorized according to the prehospital airway type: endotracheal intubation (ETI), supraglottic airway (SGA), or bag-valve-mask ventilation (BVM). The primary outcome was good oxygenation: partial pressure of oxygen (PaO2) ≥ 60 mmHg on the first arterial blood gas (ABG) test. The secondary outcome was good ventilation: partial pressure of carbon dioxide (PaCO2) ≤ 45 mmHg. Multivariate logistic regression was conducted to calculate the adjusted odds ratio (AOR) and 95% confidence interval (CI). A total of 7,372 patients were enrolled during the study period: 1,819 patients treated with BVM, 706 with ETI, and 4,847 who underwent SGA. In multivariable logistic regression analysis for good oxygenation outcomes, the ETI group showed a higher AOR than the BVM group (AOR [95% CIs]: 1.30 [1.06–1.59] in ETI and 1.05 [0.93–1.20] in SGA groups). Regarding good ventilation, the ETI group showed a higher AOR, and the SGA group showed a lower AOR compared to the BVM group (AOR [95% CIs] 1.33 [1.02–1.74] in the ETI and 0.83 (0.70–0.99) in the SGA groups). There was no significant difference in survival to discharge. ETI was significantly associated with good oxygenation and good ventilation compared to BVM in patients with OHCA, particularly during longer transports. This should be taken into consideration when deciding the prehospital advanced airway management in patients with OHCA. [ABSTRACT FROM AUTHOR]

Asphyxia during birth is one of the three leading causes of neonatal morbidity and mortality among newborns carried to term. The objective of this study was to evaluate the measurement of the foetal scalp blood pH as a measure of foetal status, evaluating: cord gases, meconium-stained fluid, APGAR score or the need for neonatal resuscitation in pregnant women undergoing caesarean sections. A cross-sectional study was carried out over a period of 5 years (2017–2021) at the Hospital de Poniente (southern Spain). A total of 127 pregnant women participated from whom a foetal scalp blood pH sample was taken and used to indicate the need for an urgent caesarean section. The results showed a correlation between the pH of the scalp blood and the pH of the umbilical cord artery, umbilical cord vein (Rho of Spearman arterial pH: 0.64, p < 0.001; Rho of Spearman venous pH: 0.58, p < 0.001) and the APGAR test one minute after delivery (Spearman's Rho coefficient of 0.33, p < 0.01). These results suggest that the foetal scalp pH should not be considered a foolproof method to indicate an urgent caesarean section. Foetal scalp pH sampling can be used as a complementary test, in conjunction with cardiotocography, to indicate whether an emergency caesarean section is necessary due to loss of foetal well-being. [ABSTRACT FROM AUTHOR]

Background: Methemoglobinemia (MetHb) is a rare and potentially severe dyshemoglobinemia that can be induced by exposure to oxidizing agents, decreasing the functional capacity of the hemoglobin molecule to transport and release oxygen into the tissues. MetHb can originate from gases with oxidizing capacity generated by internal combustion engines, although since the universalization of catalyst converters in automobiles, a tiny proportion of MetHb poisoning is due to exposure to engine gases and fumes. Within this group, only two cases due to suicidal motivations have been reported in the last 30 years. Case presentation: Here, we expose the case of a patient with MetHb levels of 25.2% (normal 0–1.5%) who with suicidal motivations had attached and locked a hose to the exhaust pipe of her vehicle with electrical tape, becoming exposed to a sustained concentration of the vehicle's exhaust. Upon her arrival at the emergency department, the presence of generalized greyish cyanosis with alterations of the sensorium, dissociation between saturation measured by arterial blood gas analysis and pulse oximetry (98% vs. 85%), no response to high-flow oxygen therapy, and an excellent response to intravenous methylene blue treatment were highlighted. Conclusions: This report illustrates an original case of acute toxic acquired MetHb due to inhalation of oxidizing substances originating from the bad ignition of an internal combustion engine. When evaluating a patient with suspected gas intoxication, we usually consider poisoning by the most common toxins, such as carbon monoxide or cyanide. In this context, we propose an algorithm to assist in the suspicion of this entity in patients with cyanosis in the emergency department. MetHb poisoning should be suspected, and urgent co-oximetry should be requested when there is no congruence between cyanosis intensity and oxygen saturation measured by pulse oximetry, if there is discordance between the results of oxygen saturation measured by arterial blood gas and pulse oximeter, and if there is no response to oxygen treatment. This algorithm could be useful to not delay diagnosis, improve prognosis, and limit potential sequelae. [ABSTRACT FROM AUTHOR]

Simple Summary: Apennine chamois (Rupicapra pyrenaica ornata) is a vulnerable subspecies, and creation of new colonies is required for its conservation. Capturing mountain ungulates is not only logistically challenging, but also requires careful planning and clinical monitoring in order to ensure animal welfare and survival. This study reports collective physical capture followed by anesthesia of 21 Apennine chamois for translocation with conservation purposes. The chamois were captured with up-net® (Fondazione Universitaria "Centro Ricerche sulla Gestione della fauna selvatica"—CE.RI.GE.FA.S., Sampeyre—CN) or box-traps, then anesthetized with medetomidine–ketamine–acepromazine and monitored with advanced field techniques, including venous blood gas analysis, which was used for the first time on mountain ungulates in Europe. Despite the risk of metabolic acidosis and catching myopathy, 19 chamois survived and adapted to the new environment to found new colonies, which were monitored through GPS radiocollar data of all released chamois. The Apennine chamois (Rupicapra pyrenaica ornata) is one of the rarest subspecies in Italy, listed in Annexes II and IV of the Habitats Directive and currently included as a vulnerable subspecies in the International Union for Conservation of Nature (IUCN) Red List. The Maiella National Park population has recently been defined as a source population for reintroduction into other parks. Since collective captures allow for better selection of target animals for the establishment of new colonies, the aim of this study is to evaluate the physiological conditions and animal welfare in free-ranging Apennine chamois after collective physical capture followed by chemical immobilization with medetomidine 0.054 mg ± 0.007, ketamine 2.14 mg ± 0.28, and acepromazine 0.043 mg ± 0.006. Twenty-one Apennine chamois (18 females and 3 males) were captured and translocated for conservation purposes. The effects of capture and anesthesia were evaluated using clinical variables, hematology, serum biochemistry, and venous blood gas analysis, the latter being used in the field for the first time in chamois capture. A risk of metabolic acidosis and capture myopathy was identified, although it did not compromise the survival of 19 chamois, which adapted to novel environments and founded new colonies, as verified through GPS radiocollars. The protocol applied in this study represents an innovative approach to assessing animal physiology and welfare in collective mountain ungulate captures, useful for improving management activities for conservation purposes. [ABSTRACT FROM AUTHOR]

Introduction: We aimed to evaluate the interchangeability of sodium, potassium, hemoglobin, and hematocrit measurement between the blood gas analyzers and laboratory automatic analyzers results. Methods: This was a retrospective cross‐sectional study. The results of 1927 paired samples analyzed simultaneously with the blood gas analyzer and the laboratory automatic analyzer were compared. The Bland–Altman and Cohen's kappa statistic detected the agreement between the two analyses. Results: The limits of agreement (±1.96 standard deviation of the mean difference) were −11.1 to 20.3 for sodium, −1.9 to 0.5 for potassium, −16.1 to 12.9 for hematocrit, and −5.0 to 4.0 for hemoglobin. Agreement between the two analyses was not acceptable within the defined clinically acceptable limits. In addition, none of the kappa values were higher than 0.60, which highlights the lack of agreement between the two analyzers. Conclusion: The blood gas analyzers and laboratory automatic analyzers results cannot be used interchangeably. [ABSTRACT FROM AUTHOR]

Simple Summary: Blood gas analyzers are stationary or hand-held machines used to measure blood gases and electrolytes in a blood sample taken from a patient. No machine has been specifically designed for use in horses, and therefore every machine needs to be validated before being used in equine practice. The aim of this study was to compare the newly marketed GEM5000 machine to the formerly validated epoc machine for blood gas analysis in horses. Blood samples taken from healthy and sick horses were run on both machines in alternate order, and various statistical tests were used to analyze if the two machines give similar results. Although the precision of the GEM5000 is good for most parameters, the agreement with the epoc machine is not always satisfactory. Therefore, data from different blood gas machines should not be used interchangeably. Different blood gas analyzers are used in equine practice. Every machine needs to be validated, as they have not been designed for use in horses. The aim of this study was to compare the newly marketed GEM5000 machine to the formerly validated epoc machine for blood gas analysis in horses. In this prospective, non-blinded, comparative laboratory analyzer study, 43 equine blood samples were analyzed on both analyzers and values were compared between the two machines via Lin's concordance analysis, Passing–Bablok regression analysis and Bland–Altman plots. Duplicate measurements were conducted on the GEM5000 machine to evaluate precision. The GEM5000 failed to achieve the required precision for tHb, Hct and iCa2+, but achieved acceptable precision for all other parameters. Concordance correlation analysis revealed poor correlation for Na+, Cl−, iCa2+, K+, Hct and tHb, while there was an at least moderate agreement for all other parameters. Passing–Bablok regression revealed significant constant bias for pCO2, pO2, Cl−, and iCa2+ and significant proportional bias for pCO2, iCa2+ and SO2. Bland–Altman analysis revealed significant systematic bias for Na+, Cl−, iCa2+, K+, Hct, tHb and SO2. This study shows that while precision of the GEM5000 is good, values should not be used interchangeably with data obtained from other blood gas analyzers. [ABSTRACT FROM AUTHOR]

Purpose : This study aimed to compare peripheral pulse oxygen saturation (SpO2) values, measured at different monitoring sites, and arterial oxygen saturation (SaO2) of neurocritical patients. Methods : The study included 110 patients admitted to the neurosurgical intensive care unit of a university hospital. The patients' SpO2 values were measured in their index fingers, both second toes, both earlobes, and foreheads, using the patient monitoring system. These values were compared with the standard value of SaO2 measured using a blood gas analyzer. Data were analyzed using descriptive values, Pearson's correlation coefficients, Lin's concordance correlation coefficients (CCC), and Bland-Altman plots. Result : Regardless of the measuring site, SpO2 was correlated with the paired measurements of SaO2 (r=.40~.60, p<.001, CCC range=.40~.58). No significant bias in paired measurements of SpO2 and SaO2 was observed at all sites (-0.06~0.19%, p>.05). SpO2 values at the left finger and right earlobe had the narrowest range, with a 95% limits of agreement (LOA) (left finger -3.04~2.93% and right earlobe -3.18~2.79%). SpO2 at the index finger, on the side without an arterial catheter, had a narrower range of 95% LOA than that of the opposing finger (-3.00~2.97% vs. -3.73~3.26%). Conclusion : SpO2 at the finger without an arterial catheter had the highest level of precision. This study suggests using the index finger, on the side without an arterial catheter, for pulse oximetry in neurocritical patients. [ABSTRACT FROM AUTHOR]

Background and purposes: There has been both great interest in and skepticism about the strategies for headache inhibition in patients with patent foramen ovale and migraines (PFO-migraine). Furthermore, many questions remain about the fundamental pathophysiology of PFO-migraines. Herein, the inhibiting effect of normobaric oxygenation (NBO) on PFO-migraine was analyzed. Methods: This real-world self-control study consecutively enrolled patients during the ictal phase of migraines who had patent foramen ovale (PFO) confirmed by Trans esophageal Ultrasound(TEE). After comparing the baseline arterial oxygen partial pressure (PaO2) in their blood gas with that of healthy volunteers, all the patients with PFO-migraine underwent treatment with NBO (8 L/min. for 1 h/q8h) inhalation through a mask. Their clinical symptoms, blood gas, and electroencephalograph (EEG) prior to and post-NBO were compared. Results: A total of 39 cases with PFO-migraine (in which 36% of participants only had a small-aperture of PFO) and 20 non-PFO volunteers entered the final analysis. Baseline blood gas analysis results showed that the PaO2 in patients with PFO-migraine were noticeably lower than PaO2 levels in non-PFO volunteers. After all patients with PFO-migraines underwent NBO treatment, 29(74.4%) of them demonstrated dramatic headache attenuation and a remarkable increase in their arterial PaO2 levels after one time treatment of NBO inhalation (p < 0.01). The arterial PaO2 levels in these patients gradually went down during the following 4 h after treatment. 5 patients finished their EEG scans prior to and post-NBO, and 4(80%) were found to have more abnormal slow waves in their baseline EEG maps. In the follow up EEG maps post-NBO treatment for these same 4 patients, the abnormal slow waves disappeared remarkably. Conclusions: Patients with PFO–migraine may derive benefit from NBO treatment. PFOs result in arterial hypoxemia due to mixing of venous blood, which ultimately results in brain hypoxia and migraines. This series of events may be the key pathologic link explaining how PFOs lead to migraines. NBO use may attenuate the headaches from migraines by correcting the hypoxemia. Highlights: Brain hypoxia may be the key point of pathological link between PFO and migraine. NBO may be a feasible promising method on PFO–migraine control. The size of PFO aperture may be not very matched with the severity and the incidence of migraine. [ABSTRACT FROM AUTHOR]

Background: Pyometra is a bacterial and hormone-induced reproductive disease that occurs in the post-estrus luteal phase in intact queens. Pyometra is more common in the diestrus period due to the high progesterone concentration (in queens that mated, spontaneously ovulated, or were induced to ovulate). However, it can also be seen due to the use of exogenous hormones such as progesterone for the suppression of estrus. More research is needed in cases of pyometra in queens, as well as in bitches. Because, considering that the pathogenesis and characteristics of feline pyometra is similar to bitches, studies on pyometra-affected bitches are taken as reference in studies and applications on queens. From this point of view, the aims of this study were to reveal the changes in complete blood count, blood gas, and serum biochemistry parameters in feline pyometra cases and to determine the correlation between the mentioned parameters. Materials, Methods & Results: In the study, a total of 25 female cats of different breeds were used, between the ages of 6 months and 7 years, 15 were diagnosed with pyometra, and 10 healthy. Anamnesis, clinical findings, and ultrasonographic examinations were used in the diagnosis of pyometra. Abdominal ultrasonography was performed on queens brought to the clinic with complaints such as anorexia, polydipsia, polyuria, abdominal tension, and fever. The control group (n =10) consisted of queens that were introduced to the clinic and were reproductively healthy. Before any treatment in queens with pyometra and the control group, 1 mL blood samples were taken from v. cephalica to evaluate complete blood count, blood gases and serum biochemistry parameters. In complete WBC, Lym, Mon, Gra, RBC, Hb, HCT, MCV, MCH and PLT parameters and, blood gas parameters such as pH, pCO2, pO2, sO2, Na, K, Cl, lactate, glucose, HCO3, and BE were also evaluated in taken blood samples. Biochemical parameters BUN, creatinine, ALT, AST, ALP, amylase, T.BIL, D.BIL, P, CHOL, TG, LDH, TP, CPK, ALP, Ca, GGT were measured in serum samples. After examination and laboratory analysis, ovariohysterectomy was performed on queens as a treatment. Granulocyte, WBC, HCT and MCH levels of the pyometra group were higher (P < 0.05) and Lym levels were lower (P < 0.05) compared to the control group. According to these results, pH, HCO3, and BE were lower (P < 0.05) in queens with pyometra than those in the control group, while Na and lactate parameters were higher (P < 0.05). According to the results of biochemical analysis, it was determined that BUN, creatinine levels, GGT, and LDH enzyme activities were found to be higher in the pyometra group compared to the control group, while the Ca level was found to be low (P < 0.05). A positive correlation was observed between BUN and creatinine and LDH, WBC, granulocyte, HCT, and lactate, and a negative correlation between lymphocytes, pH, and BE in the correlation analysis performed on queens with pyometra and control group. However, a positive correlation was observed between creatinine and LDH and HCT, and a negative correlation between lymphocyte, pH and BE. Discussion: There is not enough information about pyometra in queens. As a result, it was determined that there were significant changes in complete blood count, blood gases and serum biochemical parameters in queens with pyometra in this study. These changes were generally thought to be related to dehydration and sepsis or endotoxemia. In addition, it was evaluated that prerenal azotemia occurring in pyometra affected queens may cause renal dysfunction. For this reason, it is thought that the results obtained in the presented study may contribute to the diagnosis, treatment, and prognosis of pyometra cases in queens. [ABSTRACT FROM AUTHOR]

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Copyright of Ahi Evran Medical Journal is the property of Ahi Evran University and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Hip dysplasia is an alteration with a high incidence in large dogs. The aim of the study was to compare the association of xylazine or dexmedetomidine with fentanyl for radiography with joint distractor for the diagnosis of hip dysplasia. Fifteen healthy dogs, German Shepherd and Belgian Shepherd, were randomly submitted to treatments 0.2 mg/kg xylazine + 2.5 µg/kg fentanyl (XF) or 2 µg/kg dexmedetomidine + 2.5 µg/kg fentanyl (DF), intravenously. HR, f, SAP, MAP, DAP and TR were evaluated at intervals of 5 min before and after the administration of treatments; pH, PaCO2, PaO2, BE, HCO3−, SaO2, Na+, K+ and Hb at 5 and 15 min after treatment administration; and the quality of sedation at intervals of 5 min after administration of treatments. Latency, duration, and recovery times were also compared. The HR values showed a significant reduction in both groups, as well as pH, PaCO2, PaO2 and SaO2. Latency, duration and recovery times, and quality of sedation did not differ statistically between groups. Xylazine and fentanyl or dexmedetomidine and fentanyl combinations provide adequate sedation and analgesia for performing diagnostic radiographic procedures for hip dysplasia. However, oxygen supplementation is recommended to increase protocol safety.

Sodium bicarbonate (SB) is an ergogenic supplement shown to improve high-intensity exercise via increased blood bicarbonate buffering. Substantial amounts of the ingested bicarbonate are neutralized in the stomach. Bariatric surgery results in a small gastric pouch which dramatically reduces exposure time of any ingested food in the stomach. The aim of this study was to examine the pharmacokinetics of orally ingested SB in a postgastric bypass individual to determine the magnitude of changes in blood bicarbonate and associated side effects. We hypothesized that SB supplementation in a gastric bypass model would result in greater blood bicarbonate increases and fewer side effects than in healthy individuals due to minimal bicarbonate losses in the stomach. One postbariatric male ingested 0.3 g/kg·body mass of SB on three occasions (SB1, SB2, and SB3) and 0.3 g/kg·body mass of placebo on a further occasion. Blood bicarbonate was determined before and every 10 min following supplement ingestion for 3 hr and then every 20 min for a further 1 hr. Side effects were reported using an adapted questionnaire at identical time points. Maximal increases in blood bicarbonate with SB were +20.0, +15.2, and +12.6 mM, resulting in maximal bicarbonate concentrations of 42.8, 39.3, and 36.2 mM. Area under the curve was SB1: 8,328 mM/min; SB2: 7,747 mM/min; SB3: 7,627 mM/min, and 6,436 mM/min for placebo. Side effects with SB were scarce. Maximal bicarbonate increases were well above those shown previously, with minimal side effects, indicative of minimal neutralization of bicarbonate in the stomach. The large increases in circulating bicarbonate and minimal side effects experienced by our postgastric surgery bypass patient are indicative that minimizing neutralization of bicarbonate in the stomach, as would occur with enteric coated capsules, may optimize SB supplementation and thus warrants investigation. [ABSTRACT FROM AUTHOR]

ObjectivesTherapeutic hypothermia is standard of care in management of moderate/severe hypoxic-ischemic encephalopathy. Persistent pulmonary hypertension of the newborn is associated with hypoxic-ischemic encephalopathy and is exacerbated by hypoxemia and hypercarbia. Gas exchange is assessed by arterial blood gas analysis (with/without correction for body temperature), pulse oximetry, and end-tidal CO2.DesignA retrospective chart review.SettingsRegional perinatal center in Western New York.PatientsFifty-eight ventilated neonates with indwelling arterial catheter on therapeutic hypothermia.InterventionNone.Measurement and main resultsWe compared pulse oximetry, PaO2, end-tidal CO2, and PaCO2 during hypothermia and normothermia in neonates with hypoxic-ischemic encephalopathy using 1,240 arterial blood gases with simultaneously documented pulse oximetry. During hypothermia, pulse oximetry 92-98% was associated with significantly lower temperature-corrected PaO2 (51 mmHg; interquartile range, 43-51) compared with normothermia (71 mmHg; interquartile range, 61-85). Throughout the range of pulse oximetry values, geometric mean PaO2 was about 23% (95% CI, 19-27%) lower during hypothermia compared with normothermia. In contrast, end-tidal CO2 accurately assessed temperature-corrected PaCO2 during normothermia and hypothermia.ConclusionsHypothermia shifts oxygen-hemoglobin dissociation curve to the left resulting in lower PaO2 for pulse oximetry. Monitoring oxygenation with arterial blood gas uncorrected for body temperature and pulse oximetry may underestimate hypoxemia in hypoxic-ischemic encephalopathy infants during whole-body hypothermia, while end-tidal CO2 reliably correlates with temperature-corrected PaCO2.

Abstract Background To investigate the impact of hyperoxia that developed immediately after extracorporeal membrane oxygenation (ECMO)-assisted cardiopulmonary resuscitation (ECPR) on patients’ short-term neurological outcomes after out-of-hospital cardiac arrest (OHCA). Methods This study retrospectively analyzed data from the Japanese OHCA registry from June 2014 to December 2017. We analyzed adult patients (≥ 18 years) who had undergone ECPR. Eligible patients were divided into the following three groups based on their initial partial pressure of oxygen in arterial blood (PaO2) levels after ECMO pump-on: normoxia group, PaO2 ≤ 200 mm Hg; moderate hyperoxia group, 200 mm Hg 400 mm Hg. The primary and secondary outcomes were 30-day favorable neurological outcomes. Logistic regression statistical analysis model of 30-day favorable neurological outcomes was performed after adjusting for multiple propensity scores calculated using pre-ECPR covariates and for confounding factors post-ECPR. Results Of the 34,754 patients with OHCA enrolled in the registry, 847 were included. The median PaO2 level was 300 mm Hg (interquartile range: 148–427 mm Hg). Among the eligible patients, 277, 313, and 257 were categorized as normoxic, moderately hyperoxic, and extremely hyperoxic, respectively. Moderate hyperoxia was not significantly associated with 30-day neurologically favorable outcomes compared with normoxia as a reference (adjusted odds ratio, 0.86; 95% confidence interval: 0.55–1.35; p = 0.51). However, extreme hyperoxia was associated with less 30-day neurologically favorable outcomes when compared with normoxia (adjusted odds ratio, 0.48; 95% confidence interval: 0.29–0.82; p = 0.007). Conclusions For patients with OHCA who received ECPR, extreme hyperoxia (PaO2 > 400 mm Hg) was associated with 30-day poor neurological outcomes. Avoidance of extreme hyperoxia may improve neurological outcomes in patients with OHCA treated with ECPR.

BackgroundThe Neonatal Resuscitation Program recommends initial resuscitation of preterm infants with low oxygen (O2) followed by titration to target preductal saturations (SpO2). We studied the effect of resuscitation with titrated O2 on gas exchange, pulmonary, and systemic hemodynamics.MethodologyTwenty-nine preterm lambs (127 d gestation) were randomized to resuscitation with 21% O2 (n = 7), 100% O2 (n = 6), or initiation at 21% and titrated to target SpO2 (n = 16). Seven healthy term control lambs were ventilated with 21% O2.ResultsPreductal SpO2 achieved by titrating O2 was within the desired range similar to term lambs in 21% O2. Resuscitation of preterm lambs with 21% and 100% O2 resulted in SpO2 below and above the target, respectively. Ventilation of preterm lambs with 100% O2 and term lambs with 21% O2 effectively decreased pulmonary vascular resistance (PVR). In contrast, preterm lambs with 21% O2 and titrated O2 demonstrated significantly higher PVR than term lambs on 21% O2.Conclusion(s)Initial resuscitation with 21% O2 followed by titration of O2 led to suboptimal pulmonary vascular transition at birth in preterm lambs. Ventilation with 100% O2 in preterm lambs caused hyperoxia but reduced PVR similar to term lambs on 21% O2. Studies evaluating the initiation of resuscitation at a higher O2 concentration followed by titration based on SpO2 in preterm neonates are needed.

This study aimed to evaluate the effect of the exercise performed under the semi-arid weather on horses submitted to a Rodeo-style Sport (Vaquejada) through hemogasometric, clinical, and thermographic variables. To conduct this study, a Vaquejada simulation test (VST) was conducted in agreement with the rules of the Brazilian Association of Vaquejada. Physiological, thermographic, hemogasometry, and biochemistry data were collected before and after a single race. After it, significant changes were observed for thermographic, physiological, hemogasometric, and biochemical variables. The general surface temperature (ST) and those by body region differed (P < 0.01) between pre- and post-exercise conditions. The RR, HR, CK, Lactate, K+, and AG increased (P < 0.01) after the exercise. A negative correlation between the maximum lactate concentration and the reduction (P < 0.01) of pH, HCO3-, TCO2, and EB was also observed after the exercise. No significant changes were observed in PO2, PCO2, SO2, and other serum electrolytes after the exercise. The thermographic profile evidences the environment of thermal, critical, and dangerous discomfort to which the animals are exposed. Thus, we believe horses used in this activity should not be submitted to consecutive and immediate exercises so that pathological complications from repetitive exertion are avoided.

IntroductionVomiting is a common sign in dogs presenting to emergency services. It can be self-limiting, a sign of a life-threatening extraintestinal, or intestinal disorder. Reasonable diagnostics should be performed to determine the underlying cause. This study aimed to assess the utility of diagnostic tests in vomiting dogs, and its correlation with patient history, and physical examination results. Additionally, parameters to differentiate uncomplicated vomiting from complicated vomiting were investigated.MethodsIn this prospective, observational, clinical study, data from 99 client-owned dogs with vomiting, presenting as first opinion cases, were evaluated. History, physical examination, duration of clinical signs, overall number of episodes of vomiting, appetite, and additional clinical signs were recorded. The standardized diagnostic evaluation of all patients included venous blood gas analysis, complete blood count, serum biochemistry profile, canine pancreatic lipase, abdominal radiographs, ultrasound, and urinalysis. Follow-up was performed 4–5 days later. Based on severity of disease and clinical course, dogs were categorized to “uncomplicated vomiting” (UN), or “complicated vomiting” (COM). The utility of each test for diagnosing the cause of vomiting was evaluated. Spearman correlation coefficient, Chi-squared-, unpaired t-, and Mann–Whitney U-test were used. Statistical significance was defined as p ≤ 0.05.ResultsOut of the 99 dogs, 34 had uncomplicated courses of disease (UN). In 60/99 cases, a diagnosis was obtained, and in 39/99 cases, the cause for vomiting remained unknown. Longer duration of clinical signs, and reduced appetite were associated with higher utility of abdominal ultrasound. A poor mentation was associated with a higher utility of blood examinations and abdominal radiographs. Dogs presenting with an impaired mentation or with additional clinical signs other than diarrhea, were more likely to be in the COM group.DiscussionBased on this investigation, general recommendations concerning the diagnostic approach for patients with vomiting could not be provided. For dogs who have exclusively vomiting as a clinical sign, and present in good mentation, further investigations might not be beneficial, and these dogs may recover with symptomatic treatment alone. Additional diagnostics could be indicated in dogs with additional clinical signs other than diarrhea.

Hospital-acquired anemia is common in patients hospitalized in the intensive care unit (ICU). A major source of iatrogenic blood loss in the ICU is the withdrawal of blood for laboratory testing. The aim of our study was to analyze the feasibility and accuracy of non-invasive spot-check pulse co-oximetry (SpHb), and a reduced-volume blood gas analysis (ABG Hb) for the determination of Hb concentration in critically ill patients. Comparisons between Hb determined with test devices and the gold standard—complete blood count (CBC)—were performed using Bland–Altman analysis and concordance correlation coefficient (CCC). The limits of agreement between SpHb and CBC Hb were –2.0 [95%CI −2.3–(−1.7)] to 3.6 (95%CI 3.3–3.9) g/dL. The limits of agreement between ABG Hb and CBC Hb were −0.6 [95%CI −0.7–(−0.4)] to 2.0 (95%CI 1.9–2.2) g/dL. Spearman's coefficient and CCC between ABG Hb and CBC Hb were 0.96 (95%CI 0.95–0.97, p < 0.001) and 0.91 (95%CI 0.88–0.92), respectively. Non-invasive spot-check Hb co-oximetry is not sufficiently accurate for the monitoring of hemoglobin concentration in critically ill patients. Reduced volume arterial blood gas analysis has acceptable accuracy and could replace complete blood count for the monitoring of Hb concentration in critically ill patients, leading to a significant reduction in blood volume lost for anemia diagnostics. [ABSTRACT FROM AUTHOR]

Background: An association between post-arrest hyperoxaemia and worse outcomes has been reported for out-of-hospital cardiac arrest (OHCA) patients, but little is known about the relationship between intra-arrest hyperoxaemia and clinically relevant outcomes. This study aimed to investigate the association between intra-arrest hyperoxaemia and outcomes for OHCA patients.Methods: This was an observational study using a registry database of OHCA cases that occurred between 2014 and 2017 in Japan. We included adult, non-traumatic OHCA patients who were in cardiac arrest at the time of hospital arrival and for whom partial pressure of arterial oxygen (PaO2) levels was measured during resuscitation. Main exposure was intra-arrest PaO2 level, which was divided into three categories: hypoxaemia, PaO2 <60 mmHg; normoxaemia, 60-300; or hyperoxaemia, ≥300. Primary outcome was favourable functional survival at one month or at hospital discharge. Multivariable logistic regression was performed to adjust for clinically relevant variables.Results: Among 16,013 patients who met the eligibility criteria, the proportion of favourable functional survival increased as the PaO2 categories became higher: 0.5% (57/11,484) in hypoxaemia, 1.1% (48/4243) in normoxaemia, and 5.2% (15/286) in hyperoxaemia (p-value for trend <0.001). Higher PaO2 categories were associated with favourable functional survival and the adjusted odds ratios increased as the PaO2 categories became higher: 2.09 (95% CI: 1.39-3.14) in normoxaemia and 5.04 (95% CI: 2.62-9.70) in hyperoxaemia when compared to hypoxaemia as a reference.Conclusion: In this observational study of adult OHCA patients, intra-arrest normoxaemia and hyperoxaemia were associated with better functional survival, compared to hypoxaemia. [ABSTRACT FROM AUTHOR]

Our objective was to evaluate the effects of time and temperature on umbilical-cord blood analysis. This prospective study included the term spontaneous vaginal deliveries. One venous and seven arterial samples were drawn from each umbilical cord within 5 min from delivery. Three samples were immediately refrigerated (3 °C), while all other samples were stored at room temperature (23–26 °C). Samples were analyzed in pairs (refrigerated and room-temperature samples) at 0, 20, 40, and 60 min after delivery for pH and lactate levels. Repeated-measures analysis using a generalized linear model was used to compare the change in pH and lactate values over time. 518 samples from 74 women were analyzed. The mean gestational age was 39.1 ± 1.1 weeks. All neonates had an Apgar score of ≥9 in the 1st and 5th minutes. Mean arterial pH and lactate levels at delivery (time 0) were 7.32 ± 0.07 and 4.00 ± 1.36 mmol/L, respectively. Over time, a statistically significant decrease in pH and a reciprocal increase in lactate levels were observed. The mean change in arterial pH following 60 min was 0.021 ± 0.028 (room-temperature) and 0.016 ± 0.023 (refrigerated); p < 0.001. Compared to pH, a greater change was demonstrated in lactate levels over time; the mean change in lactate following 60 min was −0.896 ± 0.535 (room temperature) and −0.512 ± 0.450 mmol/L (refrigerated). Temperature significantly altered both pH and lactate levels, but lactate levels were altered at earlier time points. Both time and temperature have significant effects on cord blood analysis. Yet, these changes are minor and may not have any clinical significance unless in extreme cases in which medicolegal aspects emerge. [ABSTRACT FROM AUTHOR]