OBJECTIVE: To explore the effects of veno-venous extra corporeal carbon dioxide removal (V-V ECCO₂R) on local mechanical power and gas distribution in the lungs of patients with mild to moderate acute respiratory distress syndrome (ARDS) receiving non-invasive ventilation. METHODS: Retrospective research methods were conducted. Sixty patients with mild to moderate ARDS complicated with renal insufficiency who were transferred to the respiratory intensive care unit (RICU) through the 96195 platform critical care transport green channel from January 2018 to January 2020 at the collaborative hospitals of Henan Provincial People's Hospital were enrolled. According to different treatment methods, they were divided into a conventional treatment group and an ECCO₂R group, with 30 patients in each group. Both groups received standard treatments including primary disease treatment, airway management, and non-invasive ventilation. The conventional treatment group received bedside continuous renal replacement therapy (CRRT), and the ECCO₂R group received V-V ECCO₂R treatment. General information of patient such as gender, age, cause of disease, and acute physiology and chronic health evaluation II (APACHE II) were recorded; arterial blood gas analysis was performed before treatment and at 12 hours and 24 hours during treatment, recording arterial partial pressure of oxygen (PaO₂), arterial partial pressure of carbon dioxide (PaCO₂), and oxygenation index (PaO₂/FiO₂). Respiratory mechanics parameters [tidal volume, respiratory rate, maximal inspiratory pressure (MIP), and maximal expiratory pressure (MEP)] were recorded, and the rapid shallow breathing index (RSBI) was calculated; electrical impedance tomography (EIT) was used to measure regional of interest (ROI) values in different lung areas at 12 hours and 24 hours of treatment, and the pulmonary mechanical energy was calculated. RESULTS: The arterial blood gas analysis indicators, respiratory mechanics parameters, and pulmonary mechanical energy of patients in the conventional treatment group and ECCO₂R group improved significantly after 24 hours of treatment compared to 12 hours of treatment (all P < 0.05). The levels of PaCO₂, RSBI, total mechanical power, and non-dependent zone mechanical power in the ECCO₂R group were significantly lower than those in the conventional treatment group at both 12 hours and 24 hours during the treatment [PaCO₂ (mmHg, 1 mmHg ≈ 0.133 kPa): 44.03±2.96 vs. 49.96±2.50 at 12 hours, 41.65±3.21 vs. 48.53±2.33 at 24 hours; RSBI (times×min^-1×L^-1): 88.67±4.05 vs. 92.35±4.03 at 12 hours, 77.66±4.64 vs. 90.98±4.21 at 24 hours; total mechanical power (mJ): 10.40±1.15 vs. 12.93±1.68 at 12 hours, 11.13±1.18 vs. 14.05±1.69 at 24 hours; non-dependent zone mechanical power (mJ): 7.15±0.84 vs. 7.98±0.75 at 12 hours, 7.77±0.93 vs. 9.13±1.10 at 24 hours], and MEP and MIP in the ECCO₂R group were significantly higher than those in the conventional treatment group at both 12 hours and 24 hours during the treatment [MEP (cmH₂O, 1 cmH₂O ≈ 0.098 kPa): 89.88±5.04 vs. 86.09±5.57 at 12 hours, 96.57±2.59 vs. 88.66±2.98 at 24 hours; MIP (cmH₂O): 47.64±2.82 vs. 41.93±2.44 at 12 hours, 60.11±6.53 vs. 43.63±2.80 at 24 hours], the differences were statistically significant (all P < 0.05). CONCLUSIONS V-V ECCO₂R combined with non-invasive ventilation can effectively reduce the regional tidal volume, mechanical power, and respiratory rate in the non-gravitational dependent zones of patients with mild to moderate ARDS, and improve respiratory distress and oxygenation status.
Humans ; Respiratory Distress Syndrome/physiopathology* ; Retrospective Studies ; Carbon Dioxide ; Blood Gas Analysis ; Lung/physiopathology* ; Intensive Care Units ; Male ; Female ; Noninvasive Ventilation/methods* ; Continuous Renal Replacement Therapy/methods* ; APACHE ; Middle Aged

Acute respiratory distress syndrome (ARDS) is a serious threat to human life and health disease, with acute onset and high mortality. The current diagnosis of the disease depends on blood gas analysis results, while calculating the oxygenation index. However, blood gas analysis is an invasive operation, and can't continuously monitor the development of the disease. In response to the above problems, in this study, we proposed a new algorithm for identifying the severity of ARDS disease. Based on a variety of non-invasive physiological parameters of patients, combined with feature selection techniques, this paper sorts the importance of various physiological parameters. The cross-validation technique was used to evaluate the identification performance. The classification results of four supervised learning algorithms using neural network, logistic regression, AdaBoost and Bagging were compared under different feature subsets. The optimal feature subset and classification algorithm are comprehensively selected by the sensitivity, specificity, accuracy and area under curve (AUC) of different algorithms under different feature subsets. We use four supervised learning algorithms to distinguish the severity of ARDS (P/F ≤ 300). The performance of the algorithm is evaluated according to AUC. When AdaBoost uses 20 features, AUC = 0.832 1, the accuracy is 74.82%, and the optimal AUC is obtained. The performance of the algorithm is evaluated according to the number of features. When using 2 features, Bagging has AUC = 0.819 4 and the accuracy is 73.01%. Compared with traditional methods, this method has the advantage of continuously monitoring the development of patients with ARDS and providing medical staff with auxiliary diagnosis suggestions.
Algorithms ; Area Under Curve ; Blood Gas Analysis ; Humans ; Machine Learning ; Monitoring, Physiologic ; methods ; ROC Curve ; Respiratory Distress Syndrome, Adult ; diagnosis ; Sensitivity and Specificity

BACKGROUND: Over the past few decades, the Japanese Ministry of the Environment has been biomonitoring dioxins in the general Japanese population and, in response to public concerns, has taken measures to reduce dioxin exposure. The objectives of this study were to assess the current dioxin dietary intake and corresponding body burden in the Japanese and compare Japanese dioxin data from 2011 to 2016 and 2002-2010 surveys. We also examined the relationship between blood dioxins and health parameters/clinical biomarkers. METHODS: From 2011 to 2016, cross-sectional dioxin surveys were conducted on 490 Japanese (242 males and 248 females, aged 49.9 ± 7.6 years) from 15 Japanese prefectures. Blood (n = 490) and food samples (n = 90) were measured for 29 dioxin congeners including polychlorinated dibenzo-para-dioxins (PCDDs), polychlorinated dibenzofurans (PCDFs), and coplanar polychlorinated biphenyls (Co-PCBs) using gas chromatography coupled with high-resolution mass spectrometry. Using the 2006 World Health Organization toxic equivalence factors, the toxic equivalents (TEQs) were calculated. Clinical biomarkers and anthropometric parameters were also measured and information on lifestyle behaviours collected. Data imputations were applied to account for blood dioxins below the detection limit. RESULTS: The median (95% confidence interval or CI) blood levels and dioxin dietary intake was respectively 9.4 (8.8-9.9) pg TEQ/g lipid and 0.3 (0.2-0.4) pg TEQ/kg body weight/day. The median blood dioxin level in the 2011-2016 survey was found to have decreased by 41.3% compared to the 2002-2010 surveys. Participants who were older were found to be more likely to have higher dioxin levels. Blood dioxins were also significantly associated with body mass index, triglycerides, docosahexaenoic acid, eicosapentaenoic acid, and dihomo-gamma-linoleic acid levels in blood. Furthermore, associations between blood dioxin and dietary dioxin intake were evident in the unadjusted models. However, after adjusting for confounders, blood dioxins were not found to be associated with dietary dioxin intake. CONCLUSIONS Blood dioxin levels declined over the past decade. This study showed that the measures and actions undertaken in Japan have possibly contributed to these reductions in the body burden of dioxins in the Japanese population.
Adult ; Aged ; Analysis of Variance ; Biomarkers ; blood ; Body Mass Index ; Cross-Sectional Studies ; Diet ; Dioxins ; analysis ; Environmental Exposure ; analysis ; Environmental Monitoring ; methods ; Female ; Food ; Food Analysis ; Food Contamination ; analysis ; Gas Chromatography-Mass Spectrometry ; Humans ; Japan ; Male ; Middle Aged ; Surveys and Questionnaires ; Young Adult

OBJECTIVETo study the clinical effect and safety of bubble nasal continuous positive airway pressure (BNCPAP) versus conventional nasal continuous positive airway pressure (nCPAP) in respiratory support for preterm infants with neonatal respiratory distress syndrome (NRDS).

METHODSA retrospective analysis was performed for the clinical data of 130 preterm infants with NRDS. Among them, 69 underwent BNCPAP and 61 underwent nCPAP. The two groups were compared in terms of mortality rate, duration of respiratory support, use of pulmonary surfactant (PS), and treatment failure rate, and the incidence rates of bronchopulmonary dysplasia (BPD) and retinopathy of prematurity (ROP), as well as the changes in blood gas pH, partial pressure of oxygen, and partial pressure of carbon dioxide. The safety was evaluated for both groups.

RESULTSThere were no significant differences between the BNCPAP group and the nCPAP group in sex distribution, gestational age, birth weight, Apgar score at 1 and 5 minutes after birth, delivery mode, and the severity of NRDS (P>0.05). No infants in the BNCPAP group died, and one infant in the nCPAP group died; there was no significant difference in the mortality rate between the two groups (P>0.05). There were also no significant differences between the two groups in the duration of noninvasive ventilation, treatment failure rate, the incidence rates of BPD and ROP, and the percentage of infants with a need for use or reuse of PS (P>0.05). After 8-12 hours of ventilation, there were no significant differences between the two groups in the changes in blood gas pH and oxygenation index (P>0.05), while the BNCPAP group had a significantly greater reduction in partial pressure of carbon dioxide than the nCPAP group (P<0.05). There were no significant differences between the two groups in the incidence rates of pneumothorax, nasal septal injury, and nasal mucosal injury (P>0.05).

CONCLUSIONSBNCPAP and nCPAP have similar clinical effect and safety in respiratory support for preterm infants with NRDS.

Blood Gas Analysis ; Carbon Dioxide ; analysis ; blood ; Continuous Positive Airway Pressure ; methods ; Female ; Gestational Age ; Humans ; Infant, Newborn ; Infant, Premature ; blood ; Male ; Oxygen ; analysis ; blood ; Pneumothorax ; therapy ; Respiratory Distress Syndrome, Newborn ; blood ; therapy ; Retrospective Studies ; Treatment Failure

BACKGROUND: Point-of-care (POC) arterial blood gas analysis (ABGA) is widely used for checking hemoglobin (Hb) level. However, there is the tendency of downward bias of conductivity-based POC ABGA Hb measurement compared with optical methods. Authors tried to correct that bias by linear regression equation. METHODS: We retrospectively collected a total of 86 Hb result pairs during surgeries. Hb measured by the Sysmex XE-2100 in the laboratory was set as the gold standard and was compared with that measured by the GEM Premier 3500. Data were compared using the Bland-Altman analysis, the reliability of transfusion decision was assessed using three-zone error grid. The linear regression analysis was performed to find out the relation between the Hb results of POC ABGA and those of laboratory based test. RESULTS: The bias of the Hb measured between Sysmex XE-2100 and GEM Premier 3500 was −0.9 g/dl (P < 0.001, 95% confidence interval, −1.038 to −0.665 g/dl). The percentage error was 16.4%. According to error grid methodology, zone A, B and C encompassed 89.5%, 10.5% and 0% of data pairs. After adjusting the POC ABGA Hb values, the bias of the Hb measured by two methods was 0 g/dl (P = 0.991). The percentage error was 18.2%. The zone A, B and C encompassed 91.9%, 8.1% and 0% of data pairs. CONCLUSIONS: Hb measurements obtained with reference to conductivity via a POC ABGA were significantly lower than those obtained via optical methods. This bias may deserve attention of anesthesiologists when POC ABGA Hb level is used as a transfusion guideline.
Bias (Epidemiology)* ; Blood Gas Analysis ; Linear Models ; Methods* ; Point-of-Care Systems* ; Point-of-Care Testing ; Retrospective Studies

High oxygen-affinity hemoglobin (Hb) variants and a 2,3-diphosphoglycerate (2,3-DPG) deficiency could cause congenital (familial) erythrocytosis. High oxygen-affinity Hb variants and a 2,3-DPG deficiency might result in low tissue oxygen tension left-shifted oxygen dissociation curves and reduction in the standard P₅₀ value (P(50,std), oxygen tension at which haemoglobin is 50% saturated). Hence, the P(50,std) value is considered while formulating diagnostic strategies for erythrocytosis. In this study, we established a reference range for P(50,std) using an International Federation of Clinical Chemistry and Laboratory Medicine-approved equation (Hill's equation) for individual single venous/arterial blood samples. Blood gas analysis results of 243 samples with oxygen saturation ranging from 40%–90% (Hb < 16 mg/dL) were selected. The reference range of P(50,std) was in the 2.5th–97.5th percentile, and was 25.9–27.3 mm Hg. Hill's equation is a simple approved method for evaluating the P(50,std) values. Only a single sample of venous or arterial blood and a blood gas analyser are required to obtain the P(50,std). Our study provides a useful tool for the diagnostic work-up of patients with erythrocytosis.
2,3-Diphosphoglycerate ; Blood Gas Analysis ; Chemistry, Clinical ; Humans ; Methods ; Oxygen ; Polycythemia* ; Reference Values

PURPOSE: Extracorporeal treatment has been used increasingly to treat patients with acute ethylene glycol poisoning. We analyzed all patients with acute poisoning of ethylene glycol during a recent 10-year period to provide clinical recommendations for adequate application of continuous renal replacement therapy for these patients. METHODS: A retrospective chart review study was conducted for patients whose final diagnosis were “toxic effects of glycols or other alcohols,” between October 2006 and September 2016. The basal characteristics of patients, suspected amount of ingestion, intention of poisoning, concomitant alcohol ingestion, mental state at admission, time from exposure to admission, chief complaint, length of hospital stay, method of treatments, laboratory results including acute kidney injury and urine oxalate crystal, as well as treatment results were examined. RESULTS: A total number of 14 patients were included in this study. Nine patients (64.3%) underwent continuous renal replacement therapy; 5 patients (35.7%) underwent ethanol mono-therapy. Between the antidote therapy group and the extracorporeal treatment group, there was a significant difference in the levels of plasma bicarbonate, chloride, anion gap, pH, and base excess in arterial blood gas analysis, as well as the calculated osmolar gap. One patient expired due to multi-organ failure, while the others recovered completely. CONCLUSION: Continuous renal replacement therapy was most frequently chosen as a treatment method in patients with acute ethylene glycol poisoning. Further research regarding indication of continuous renal replacement therapy and combing therapy with other treatment will be necessary to determine the best treatment method.
Acid-Base Equilibrium ; Acute Kidney Injury ; Animals ; Blood Gas Analysis ; Comb and Wattles ; Diagnosis ; Eating ; Ethanol ; Ethylene Glycol* ; Glycols ; Humans ; Hydrogen-Ion Concentration ; Intention ; Length of Stay ; Methods* ; Plasma ; Poisoning* ; Renal Replacement Therapy ; Retrospective Studies

OBJECTIVETo investigate the underlying metabolomic profifiling of coronary heart disease (CHD) with blood stasis syndrome (BSS).

METHODSCHD model was induced by a nameroid constrictor in Chinese miniature swine. Fifteen miniature swine were randomly divided into a model group (n=9) and a control group (n=6), respectively according to arandom number table. After 4 weeks, plasma hemorheology was detected by automatic hemorheological analyzer, indices including hematocrit, plasma viscosity, blood viscosity, rigidity index and erythrocyte sedimentation rate; cardiac function was assessed by echocardiograph to detect left ventricular end-systolic diameter (LVED), left ventricular end-diastolic diameter (LVEDd), ejection fraction (EF), fractional shortening (FS) and other indicators. Gas chromatography coupled with mass spectrometry (GC-MS) and bioinformatics were applied to analyze spectra of CHD plasma with BSS.

RESULTSThe results of hemorheology analysis showed signifificant changes in viscosity, with low shear whole blood viscosity being lower and plasma viscosity higher in the model group compared with the control group. Moreover, whole blood reduction viscosity at high shear rate and whole blood reduction viscosity at low shear rate increased signifificantly (P <0.05). The echocardiograph results demonstrated that cardiac EF and FS showed signifificant difference (P <0.05), with EF values being decreased to 50% or less. The GC-MS data showed that principal component analysis can clearly separate the animals with BSS from those in the control group. The enriched Kyoto Encyclopedia of Genes and Genomes biological pathways results suggested that the patterns involved were associated with dysfunction of energy metabolism including glucose and lipid disorders, especially in glycolysis/gluconeogenesis, galactose metabolism and adenosine-triphosphate-binding cassette transporters.

CONCLUSIONSGlucose metabolism and lipid metabolism disorders were the major contributors to the syndrome classifification of CHD with BSS.

Animals ; Coronary Angiography ; Coronary Disease ; blood ; diagnostic imaging ; metabolism ; surgery ; Disease Models, Animal ; Electrocardiography ; Gas Chromatography-Mass Spectrometry ; Hemorheology ; Metabolome ; Metabolomics ; methods ; Principal Component Analysis ; Sus scrofa ; Tricarboxylic Acids ; metabolism

BACKGROUNDThe optimal ventilated status under total intravenous or inhalation anesthesia in neurosurgical patients with a supratentorial tumor has not been ascertained. The purpose of this study was to intraoperatively compare the effects of moderate hyperventilation on the jugular bulb oxygen saturation (SjO 2 ), cerebral oxygen extraction ratio (O 2 ER), mean arterial blood pressure (MAP), and heart rate (HR) in patients with a supratentorial tumor under different anesthetic regimens.

METHODSTwenty adult patients suffered from supratentorial tumors were randomly assigned to receive a propofol infusion followed by isoflurane anesthesia after a 30-min stabilization period or isoflurane followed by propofol. The patients were randomized to one of the following two treatment sequences: hyperventilation followed by normoventilation or normoventilation followed by hyperventilation during isoflurane or propofol anesthesia, respectively. The ventilation and end-tidal CO 2 tension were maintained at a constant level for 20 min. Radial arterial and jugular bulb catheters were inserted for the blood gas sampling. At the end of each study period, we measured the change in the arterial and jugular bulb blood gases.

RESULTSThe mean value of the jugular bulb oxygen saturation (SjO 2 ) significantly decreased, and the oxygen extraction ratio (O 2 ER) significantly increased under isoflurane or propofol anesthesia during hyperventilation compared with those during normoventilation (SjO 2 : t = -2.728, P = 0.011 or t = -3.504, P = 0.001; O 2 ER: t = 2.484, P = 0.020 or t = 2.892, P = 0.009). The SjO 2 significantly decreased, and the O 2 ER significantly increased under propofol anesthesia compared with those values under isoflurane anesthesia during moderate hyperventilation (SjO 2 : t = -2.769, P = 0.012; O 2 ER: t = 2.719, P = 0.013). In the study, no significant changes in the SjO 2 and the O 2 ER were observed under propofol compared with those values under isoflurane during normoventilation.

CONCLUSIONSOur results suggest that the optimal ventilated status under propofol or isoflurane anesthesia in neurosurgical patients varies. Hyperventilation under propofol anesthesia should be cautiously performed in neurosurgery to maintain an improved balance between the cerebral oxygen supply and demand.

Adolescent ; Adult ; Aged ; Anesthetics, Inhalation ; Anesthetics, Intravenous ; Arterial Pressure ; physiology ; Blood Gas Analysis ; Craniotomy ; methods ; Female ; Heart Rate ; physiology ; Humans ; Hyperventilation ; chemically induced ; physiopathology ; Isoflurane ; administration & dosage ; therapeutic use ; Male ; Middle Aged ; Propofol ; administration & dosage ; therapeutic use ; Young Adult

OBJECTIVEWe investigate the magnitudes of waveform changes of arterial blood gas (ABG) in patients with heart failure.

METHODSFive patients with heart failure were selected, continuous collecting radial artery blood and measured PaO2, PaCO2, pHa and Sao2. We selected two typical breaths cycles of waveform changes of ABG from each patient for data analysis. Comparison of the adjacent highest and lowest values to verify the presence of a periodic waveform changes of ABG, and in addition, we used t test to analysis the range of waveform changes of ABG in patients with heart failure and patients with normal cardiac function and compared whether the difference between them.

RESULTSThe 5 patients (2 surgical and 3 ICU) with heart failure, were 4 male and 1 female, (69 ± 7)year, (169 ± 10) cm, (75 ± 19)kg, LVEF = (38 ± 3)%. The heart beat numbers for full blood into the blood sampling pipe were 17 ± 2, and all covered more than 2 breath cycles. There were significant changes of PaO2, PaCO2, [H+]a and SaO2 (P < 0.05). The magnitudes of changing PaO2, PaCO2, [H+]a and Sao2 were (7.94 ± 2.02)mmHg, (1.18 ± 0.56)mmHg, (0.54 ± 0.17)nmol/L and (0.21 ± 0.07)%, and they were (6.1 ± 1.5)%, (3.2 ± 1.5)%, (1.5 ± 0.5)% and (0.2 ± 0.1)% from their mean respectively. Even these magnitudes fo all ABG parameters were trendily lower than those of patients with normal cardiac function, but only PaO2 and [H+]a were significant (P < 0.05).

CONCLUSIONUsing this simple continuous beat-by-beat arterial blood sampling method, we obtained a clear evidence of periodic waveform of ABG parameters following by breath cycle in patients with heart failure, but the magnitude trendily be decreased.

Aged ; Blood Gas Analysis ; Cardiovascular Diseases ; Female ; Heart Failure ; Heart Rate ; Humans ; Male ; Middle Aged ; Monitoring, Physiologic ; methods