scholarly journals Pathophysiology and clinical consequences of arterial blood gases and pH after cardiac arrest

2020 ◽  
Vol 8 (S1) ◽  
Author(s):  
Chiara Robba ◽  
Dorota Siwicka-Gieroba ◽  
Andras Sikter ◽  
Denise Battaglini ◽  
Wojciech Dąbrowski ◽  
...  
Keyword(s):  
Carbon Dioxide ◽  
Mechanical Ventilation ◽  
Cardiac Arrest ◽  
Oxygen Demand ◽  
Blood Gases ◽  
Metabolic Energy ◽  
High Morbidity ◽  
Arterial Blood Gases ◽  
Arterial Blood ◽  
Clinical Consequences

AbstractPost cardiac arrest syndrome is associated with high morbidity and mortality, which is related not only to a poor neurological outcome but also to respiratory and cardiovascular dysfunctions. The control of gas exchange, and in particular oxygenation and carbon dioxide levels, is fundamental in mechanically ventilated patients after resuscitation, as arterial blood gases derangement might have important effects on the cerebral blood flow and systemic physiology.In particular, the pathophysiological role of carbon dioxide (CO2) levels is strongly underestimated, as its alterations quickly affect also the changes of intracellular pH, and consequently influence metabolic energy and oxygen demand. Hypo/hypercapnia, as well as mechanical ventilation during and after resuscitation, can affect CO2 levels and trigger a dangerous pathophysiological vicious circle related to the relationship between pH, cellular demand, and catecholamine levels. The developing hypocapnia can nullify the beneficial effects of the hypothermia. The aim of this review was to describe the pathophysiology and clinical consequences of arterial blood gases and pH after cardiac arrest.According to our findings, the optimal ventilator strategies in post cardiac arrest patients are not fully understood, and oxygen and carbon dioxide targets should take in consideration a complex pattern of pathophysiological factors. Further studies are warranted to define the optimal settings of mechanical ventilation in patients after cardiac arrest.

Arterial blood gases during cardiac arrest: markers of blood flow in a canine model

Resuscitation ◽  
1992 ◽  
Vol 23 (2) ◽  
pp. 101-111 ◽  
Author(s):  
Mark G. Angelos ◽  
Daniel J. DeBehnke ◽  
James E. Leasure
Keyword(s):  
Blood Flow ◽  
Cardiac Arrest ◽  
Blood Gases ◽  
Canine Model ◽  
Arterial Blood Gases ◽  
Arterial Blood

Lack of Degradation of Sevoflurane by a New Carbon Dioxide Absorbent in Humans

2001 ◽  
Vol 94 (6) ◽  
pp. 1007-1009 ◽  
Author(s):  
Ali Mchaourab ◽  
Shahbaz R. Arain ◽  
Thomas J. Ebert
Keyword(s):  
Carbon Dioxide ◽  
Gas Flow ◽  
Blood Gases ◽  
Soda Lime ◽  
Barium Hydroxide ◽  
Arterial Blood Gases ◽  
Compound A ◽  
Arterial Blood ◽  
Co2 Absorbent ◽  
End Tidal

Background Potent inhaled anesthetics degrade in the presence of the strong bases (sodium hydroxide or potassium hydroxide) in carbon dioxide (CO2) absorbents. A new absorbent, Amsorb (Armstrong Medical Ltd., Coleraine, Northern Ireland), does not employ these strong bases. This study compared the scavenging efficacy and compound A production of two commercially available absorbents (soda lime and barium hydroxide lime) with Amsorb in humans undergoing general anesthesia. Methods Four healthy volunteers were anesthetized on different days with desflurane, sevoflurane, enflurane, and isoflurane. End-tidal carbon dioxide (ETCO2) and anesthetic concentrations were measured with infrared spectroscopy; blood pressure and arterial blood gases were obtained from a radial artery catheter. Each anesthetic exposure lasted 3 h, during which the three fresh (normally hydrated) CO2 absorbents were used for a period of 1 h each. Anesthesia was administered with a fresh gas flow rate of 2 l/min of air:oxygen (50:50). Tidal volume was 10 ml/kg; respiratory rate was 8 breaths/min. Arterial blood gases were obtained at baseline and after each hour. Inspired concentrations of compound A were measured after 15, 30, and 60 min of anesthetic administration for each CO2 absorbent. Results Arterial blood gases and ETCO2 were not different among three CO2 absorbents. During sevoflurane, compound A formed with barium hydroxide lime and soda lime, but not with Amsorb. Conclusions This new CO2 absorbent effectively scavenged CO2 and was not associated with compound A production.

scholarly journals Ultrasound-guided assessment of diaphragmatic thickness as an indicator of successful extubation in mechanically ventilated cancer patients

2019 ◽  
pp. 175-185
Author(s):  
Ahmed M. Soliman ◽  
Mohga A. Samy ◽  
Ashraf M. Heikal ◽  
Mohamed A. El Ramely ◽  
Tamer A. Kotb
Keyword(s):  
Mechanical Ventilation ◽  
Blood Gases ◽  
Arterial Blood Gases ◽  
Ultrasound Guided ◽  
Diaphragm Thickness ◽  
Percent Change ◽  
Rapid Shallow Breathing Index ◽  
Arterial Blood ◽  
Shallow Breathing ◽  
Successful Extubation

Objective: The study aimed to assess diaphragmatic thickness measurement by B-mode ultrasound for prediction of extubation and proper timing of weaning from mechanical ventilation in cancer patients admitted to the intensive care unit after major surgery.Methodology: A prospective, longitudinal study conducted at Surgical ICU, National Cancer Institute, Cairo University, Cairo. Fifty patients were recruited during the immediate postoperative period after major elective cancer surgery who needed mechanical ventilation (MV). Patients were enrolled when judged to be eligible for a test of weaning from MV according to clinical and arterial blood gases (ABG) criteria. The patient was assessed for weaning according to rapid shallow breathing index (RSBI) and ultrasound guided measurements of diaphragmatic thickness (tdi) during inspiration and expiration. The percent change in tdi between end-expiration and end-inspiration (Δtdi%) was calculated. The primary outcome measure was diagnostic accuracy of tdi and Δtdi% to predict weaning compared to ABG analysis (the gold standard for weaning).Results: After 48 hours, 13 patients were weaned according to ABG criteria. Kappa value (agreement) between RSBI and ABG was 0.974. Kappa between both tdi and Δtdi% and the ABG criteria was 0.891. The values differed slightly in patients tested after 72 hours. Sensitivity of a cut off level of tdi of 2 mm was 84.6% and 83.3% after 48 and 72 hours of MV, respectively. Sensitivity of Δtdi% of 20% was clearly higher after 72 hours (95.8%). Using ROC curves, Δtdi% of > 29.5% was also more sensitive after 72 hours.Conclusion: Ultrasound estimation of diaphragm function is a promising tool to help clinicians to judge weaning readiness in patients on mechanical ventilation following major cancer surgery. Diaphragm thickness and its change between end-expiration and end-inspiration showed high degree of agreement with arterial blood gases for predicting weaning readiness.Abbreviations: RSBI: Rapid shallow breathing index, MV: mechanical ventilation, tdi: diaphragm thickness, Δtdi%: percent change in tdi between end-expiration and end-inspiration, PPV: positive predictive value, NPV: negative predictive value, kappa: measure of agreement, NCI: National Cancer Institute, VIDD: ventilator-induced diaphragmatic dysfunctionCitation: Soliman AM, Samy MA, Heikal AM, El Ramely MA, Kotb TA. Ultrasoundguidedassessment of diaphragmatic thickness as an indicator of successful extubation. Anaesth pain & intensive care 2019;23(2):178-185

scholarly journals The Effect of Endotracheal Suctioning on Arterial Blood Gases in Patients Receiving Mechanical Ventilation: A Before-After Open Clinical Trial

2008 ◽  
Vol 6 (1) ◽  
pp. 19-26
Author(s):  
Mahmood Kohan ◽  
Ebrahim Rahimi ◽  
Hamid Mommtahan ◽  
Nahid Mohammad Taheri ◽  
Saeed Sobhanian ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Mechanical Ventilation ◽  
Blood Gases ◽  
Arterial Blood Gases ◽  
Endotracheal Suctioning ◽  
Arterial Blood

Acute lung injury from mechanical ventilation at moderately high airway pressures

1990 ◽  
Vol 69 (3) ◽  
pp. 956-961 ◽  
Author(s):  
K. Tsuno ◽  
P. Prato ◽  
T. Kolobow
Keyword(s):  
Mechanical Ventilation ◽  
Peak Inspiratory Pressure ◽  
Blood Gases ◽  
Inspiratory Pressure ◽  
Control Group ◽  
Arterial Blood Gases ◽  
Lung Weight ◽  
Pulmonary Atelectasis ◽  
Arterial Pco2 ◽  
Arterial Blood

We have explored adverse pulmonary effects of mechanical ventilation at a peak inspiratory pressure of 30 cmH2O in paralyzed and anesthetized healthy sheep. A control group of eight sheep (group A) was mechanically ventilated with 40% oxygen at a tidal volume of 10 ml/kg, a frequency of 15 breaths/min, a peak inspiratory pressure less than 18 cmH2O, and a positive end-expiratory pressure of 3-5 cmH2O. During the ensuing 48 h, there were no measurable deleterious changes in lung function or arterial blood gases. Another 19 sheep were ventilated with 40% oxygen at a peak inspiratory pressure of 30 cmH2O under a different set of conditions and were randomly assigned to two groups. In group B, the respiratory rate was kept near 4 breaths/min to keep arterial PCO2 in the normal range; in group C, the frequency was kept near 15 breaths/min by including a variable dead space in the ventilator circuit to keep arterial PCO2 near baseline values. There was a progressive deterioration in total static lung compliance, functional residual capacity, and arterial blood gases. After some hours, there were abnormal chest roentgenographic changes. At time of death we found severe pulmonary atelectasis, increased wet lung weight, and an increase in the minimum surface tension of saline lung lavage fluid.

Effects of expiratory ribcage compression before endotracheal suctioning on arterial blood gases in patients receiving mechanical ventilation

2014 ◽  
Vol 19 (5) ◽  
pp. 255-261 ◽  
Author(s):  
Mahmoud Kohan ◽  
Morteza Rezaei-Adaryani ◽  
Akram Najaf-Yarandi ◽  
Fatemeh Hoseini ◽  
Nahid Mohammad-Taheri
Keyword(s):  
Mechanical Ventilation ◽  
Blood Gases ◽  
Arterial Blood Gases ◽  
Endotracheal Suctioning ◽  
Arterial Blood

Extracorporeal cardiopulmonary resuscitation for post-operative cardiac arrest: indications, techniques, controversies, and early results – what is known (and unknown)

2011 ◽  
Vol 21 (S2) ◽  
pp. 109-117 ◽  
Author(s):  
Paul J. Chai ◽  
Jeffrey P. Jacobs ◽  
Heidi J. Dalton ◽  
John M. Costello ◽  
David S. Cooper ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Extracorporeal Membrane Oxygenation ◽  
Cardiac Disease ◽  
Blood Gases ◽  
Arterial Blood Gases ◽  
Extracorporeal Cardiopulmonary Resuscitation ◽  
Arterial Blood ◽  
Selection Of Patients ◽  
Selection Of

AbstractExtracorporeal cardiopulmonary resuscitation may be defined as the use of extracorporeal membrane oxygenation for the support of patients who do not respond to conventional cardiopulmonary resuscitation. Data from national and international paediatric databases indicate that the use of extracorporeal cardiopulmonary resuscitation is increasing. Guidelines from the American Heart Association suggest that any patient with refractory cardiopulmonary resuscitation and potentially reversible causes of cardiac arrest is a candidate for extracorporeal cardiopulmonary resuscitation. One possible framework for selection of patients for extracorporeal cardiopulmonary resuscitation includes dividing patients on the basis of favourable or unfavourable characteristics. Favourable characteristics include cardiac disease, witnessed event in the intensive care unit, ability to deliver effective cardiopulmonary resuscitation, active patient monitoring present, favourable arterial blood gases, and early institution of extracorporeal membrane oxygenation. Unfavourable characteristics potentially include non-cardiac disease, an unwitnessed cardiac arrest, ineffective cardiopulmonary resuscitation, and severely acidotic arterial blood gases. Considering the significant resources and cost involved in the use of extracorporeal cardiopulmonary resuscitation, its use needs to be critically examined to improve outcomes, assess neurological recovery and quality of life, and help identify populations and other factors that may help guide in the selection of patients for successful extracorporeal cardiopulmonary resuscitation.

scholarly journals Rapid Onset of Specific Diaphragm Weakness in a Healthy Murine Model of Ventilator-induced Diaphragmatic Dysfunction

2012 ◽  
Vol 117 (3) ◽  
pp. 560-567 ◽  
Author(s):  
Segolene Mrozek ◽  
Boris Jung ◽  
Basil J. Petrof ◽  
Marion Pauly ◽  
Stephanie Roberge ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Airway Pressure ◽  
Positive Airway Pressure ◽  
Blood Gases ◽  
Hemodynamic Parameters ◽  
Arterial Blood Gases ◽  
Diaphragmatic Dysfunction ◽  
Arterial Blood ◽  
Controlled Mechanical Ventilation ◽  
Mechanical Ventilation Group

Background Controlled mechanical ventilation is associated with ventilator-induced diaphragmatic dysfunction, which impedes weaning from mechanical ventilation. To design future clinical trials in humans, a better understanding of the molecular mechanisms using knockout models, which exist only in the mouse, is needed. The aims of this study were to ascertain the feasibility of developing a murine model of ventilator-induced diaphragmatic dysfunction and to determine whether atrophy, sarcolemmal injury, and the main proteolysis systems are activated under these conditions. Methods Healthy adult male C57/BL6 mice were assigned to three groups: (1) mechanical ventilation with end-expiratory positive pressure of 2-4 cm H2O for 6 h (n=6), (2) spontaneous breathing with continuous positive airway pressure of 2-4 cm H2O for 6 h (n=6), and (3) controls with no specific intervention (n=6). Airway pressure and hemodynamic parameters were monitored. Upon euthanasia, arterial blood gases and isometric contractile properties of the diaphragm and extensor digitorum longus were evaluated. Histology and immunoblotting for the main proteolysis pathways were performed. Results Hemodynamic parameters and arterial blood gases were comparable between groups and within normal physiologic ranges. Diaphragmatic but not extensor digitorum longus force production declined in the mechanical ventilation group (maximal force decreased by approximately 40%) compared with the control and continuous positive airway pressure groups. No histologic difference was found between groups. In opposition with the calpains, caspase 3 was activated in the mechanical ventilation group. Conclusion Controlled mechanical ventilation for 6 h in the mouse is associated with significant diaphragmatic but not limb muscle weakness without atrophy or sarcolemmal injury and activates proteolysis.

scholarly journals The effects of graded changes in oxygen and carbon dioxide tension on coronary blood velocity independent of myocardial energy demand

2016 ◽  
Vol 311 (2) ◽  
pp. H326-H336 ◽  
Author(s):  
Lindsey M. Boulet ◽  
Mike Stembridge ◽  
Michael M. Tymko ◽  
Joshua C. Tremblay ◽  
Glen E. Foster
Keyword(s):  
Carbon Dioxide ◽  
Energy Demand ◽  
Cardiovascular Response ◽  
Mechanical Energy ◽  
Blood Gases ◽  
Blood Velocity ◽  
Left Ventricular ◽  
Arterial Blood Gases ◽  
Transthoracic Doppler Echocardiography ◽  
Arterial Blood

In humans, coronary blood flow is tightly regulated by microvessels within the myocardium to match myocardial energy demand. However, evidence regarding inherent sensitivity of the microvessels to changes in arterial partial pressure of carbon dioxide and oxygen is conflicting because of the accompanied changes in myocardial energy requirements. This study aimed to investigate the changes in coronary blood velocity while manipulating partial pressures of end-tidal CO2 (Petco2) and O2 (Peto2). It was hypothesized that an increase in Petco2 (hypercapnia) or decrease in Peto2 (hypoxia) would result in a significant increase in mean blood velocity in the left anterior descending artery (LADVmean) due to an increase in both blood gases and energy demand associated with the concomitant cardiovascular response. Cardiac energy demand was assessed through noninvasive measurement of the total left ventricular mechanical energy. Healthy subjects ( n = 13) underwent a euoxic CO2 test (Petco2 = −8, −4, 0, +4, and +8 mmHg from baseline) and an isocapnic hypoxia test (Peto2 = 64, 52, and 45 mmHg). LADVmean was assessed using transthoracic Doppler echocardiography. Hypercapnia evoked a 34.6 ± 8.5% (mean ± SE; P < 0.01) increase in mean LADVmean, whereas hypoxia increased LADVmean by 51.4 ± 8.8% ( P < 0.05). Multiple stepwise regressions revealed that both mechanical energy and changes in arterial blood gases are important contributors to the observed changes in LADVmean ( P < 0.01). In summary, regulation of the coronary vasculature in humans is mediated by metabolic changes within the heart and an inherent sensitivity to arterial blood gases.

Abstract 275: Arterial Hyperoxia Exposure and Survival Among Resuscitated Patients With Out-of-Hospital Cardiac Arrest. Jaam-ohca Registry in Japan

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_2) ◽  
Author(s):  
Takeyuki Kiguchi ◽  
Tetsuhisa Kitamura ◽  
Daisuke Kobayashi ◽  
Chika Nishiyama ◽  
Satoshi Fujimi ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Blood Gases ◽  
Temperature Management ◽  
Arterial Blood Gases ◽  
Extracorporeal Cardiopulmonary Resuscitation ◽  
Hospital Arrival ◽  
Arterial Blood ◽  
Hyperoxia Exposure ◽  
Resuscitated Patients ◽  
Hospital Cardiac Arrest

Background: The effect of hyperoxia for outcomes in resuscitated patients with out-of-hospital cardiac arrest (OHCA) is still controversial. Objective: To assess the relationship between the post-ROSC hyperoxia exposure volume (HEV) and survival among resuscitated OHCA patients. Methods: The JAAM-OHCA Registry was a multicenter prospective observation using the OHCA database obtained from 73 critical care medical centers in Japan, and the study period were between June 2014 and December 2015. In this study, patients who sustained a cardiac arrest in a prehospital setting, for whom resuscitation was attempted, and who were then transported to participating institutions were included. Patients receiving extracorporeal cardiopulmonary resuscitation and who was dead in emergency room were excluded. Arterial blood gases were sampled on hospital arrival, ROSC, ICU admission, and at least 24-hours post-ROSC. In addition to the 4 sampling times mentioned above, arterial blood gases were sampled, as and when required. Hyperoxia was defined as a PaO2 value of >=300 mm Hg. Hyperoxia exposure time (HET) was defined as the time of a sustained PaO2 value of >=300 mmHg, and hyperoxia excess level (HEL) was defined as the highest PaO2 level from hospital arrival to 24-hours post-ROSC. HEV was calculated by HET*HEV/2. Primary outcome was one-month survival. Multivariable logistic regression adjusting for age, sex, initial shockable rhythm, bystander witness, bystander CPR, time from call to hospital arrival, tracheal intubation, and targeted temperature management was performed to assess the association between HEV and survival. Results: A total of 1751 patients were included and 414 (23.6%) had hyperoxia. Among the hyperoxia patients, survival gradually decreased from 50.0% to 44.2% as HEV increased. The adjusted odds ratio of minimum HEV groups or maximum HEV groups for one-month survival compared with non-hyperoxia group was 2.50 (95% confidence interval [CI], 1.33-4.70) and 1.16 (95% CI, 0.62-2.18), respectively. Conclusions: Among resuscitated OHCA patients, excessive amounts of HEV was associated with decreased one-month survival.

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