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The immune and lymphatic systems, infection and sepsis
Published in Peate Ian, Dutton Helen, Acute Nursing Care, 2020
Michelle Treacy, Caroline Smales, Helen Dutton
Arterial blood gas analysis will not only help evaluate respiratory status, but give information on the metabolic problems as a result of sepsis. Abnormalities in tissue perfusion quickly give rise to a metabolic acidosis, evidenced by a lowered arterial pH and BE/Bicarbonate. In health, aerobic respiration meets oxygen demands, when the body has an increased demand for oxygen, such as in sepsis, the body switches to anaerobic respiration. Elevated serum lactate (the bi-product of anaerobic respiration) of more than 2mmol/L, due to ongoing tissue ischaemia, is the hallmark of sepsis. The increased acid load generated by anaerobic metabolism causes hyperventilation, with a rise in respiratory rate as the body increases carbon dioxide excretion. A chest x-ray will aid medical diagnosis and may reveal areas of patchy consolidation consistent with infection/deteriorating lung function.
Fetal and neonatal medicine
Published in Jagdish M. Gupta, John Beveridge, MCQs in Paediatrics, 2020
Jagdish M. Gupta, John Beveridge
4.38. A newborn infant is cyanosed. The respiratory rate is 30/min. There are no cardiac murmurs or evidence of congestive cardiac failure. When given 100% oxygen the cyanosis remains unchanged. Blood gas analysis shows Po2 70 mmHg in air and 450 mmHg in 100% oxygen. The pH and Pco2 are normal. Which of the following statements is/are true?It is likely that the infant does not have congenital heart disease.The infant will benefit from oxygen therapy.The infant has normal lungs.The infant should be commenced on prostaglandin to prevent closure of the ductus arteriosus.The infant should be given methylene blue.
The Lung and the Pleura
Published in E. George Elias, CRC Handbook of Surgical Oncology, 2020
Preoperative evaluation of the patient is of utmost importance and should include pulmonary function tests. Pulmonary function tests are utilized as screening for chronic lung diseases that predict postoperative complications. A 50% reduction in the predicted vital capacity, 1-sec forced expiratory volume, maximum voluntary ventilation, and diffusing capacity are indicators for more extensive testing. Arterial blood gas analysis that reveals a PO2 under 65 mm Hg and an elevated PCO2 are predictors of increased risk. In such cases, radionuclide scanning of the lung can be helpful in evaluating the function of the involved lung and in the assessment of operability. This is not a routine screening procedure, but it is indicated when pneumonectomy is contemplated and the pulmonary function tests are marginal. Table 3 lists the absolute contraindications to thoracotomy.
Hemolysis and blood gas analysis: it’s time for a change!
Published in Scandinavian Journal of Clinical and Laboratory Investigation, 2022
Marco Casati, Jari Intra, Wendy Rossi, Chiara Giacobone, Rinaldo Brivio
CLSI guidelines recommend that hemolyzed, lipemic or icteric samples are considered unsuitable for laboratory testing [10]. Consequently, blood gas specimens are also potentially characterized by the presence of interfering substances, cell-free hemoglobin, triglycerides and bilirubin, a risk that might make them inappropriate for testing, as previously reported [6,9,13]. Moreover, the inability of actual blood gas analyzers to identify hemolysis, lipemia and icterus can lead to relevant clinical misinterpretations [6]. A limited number of reliable studies about the bias introduced by interfering molecules in blood gas analysis have been published, and the matter is under debate [6–9,13]. Our study confirms that a significant number of blood gas samples presented elevated values of the serum indices, particularly hemolysis, and that several parameters of blood gas analysis are therefore strongly affected. Thus, it is the time to introduce automated processing of serum indices in blood gas analyzers.
PDE3-inhibitor enoximone prevented mechanical ventilation in patients with SARS-CoV-2 pneumonia
Published in Experimental Lung Research, 2021
Jan Beute, Pieter Boermans, Bart Benraad, Jan Telman, Zuzana Diamant, Alex KleinJan
This report includes four cases with severe SARS-CoV-2 pneumonia in whom early intervention (i.e., before intubation) with the selective PDE3-inhibitor enoximone, yielded symptomatic relief, helped to revert respiratory failure and thus prevented mechanical ventilation, while, compared to controls, accelerating recovery and shortening the overall ICU/hospital stay. In the context of the clinical (observational) setting, it should be noted that blood gas samples may not have been obtained at the most representative timepoints and may thus not be fully informative. Blood gas analysis (Supplementary Table 1) and oxygen saturation did not reflect patients’ clinical status accurately; despite an apparent improvement in pO2 approximately 1 h post-treatment they were still severely dyspnoeic. The ability to speak (nodding yes/shaking no, monosyllabic speech, short sentences or complete sentences) seems to be a more adequate marker of the physical status and respiratory function of very severe COVID-19 patients.
Lipoxin A4 attenuates the lung ischaemia reperfusion injury in rats after lung transplantation
Published in Annals of Medicine, 2021
Lijuan Zhang, Qihang Tai, Guangxiao Xu, Wei Gao
After 24 h of reperfusion, all the rats were anaesthetised with intraperitoneal injection of 3% pentobarbital sodium (30 mg/kg body weight) and cannulated. The arterial blood gas analysis was performed, and the peripheral blood was collected. After sacrificing the rats with overdose of anaesthetic, the left lungs were collected and divided into 3 parts. Upper part of the graft (the LIRI and LA4 groups) or control lung (the sham group) was stored at liquid nitrogen for further analysis of protein expression; the middle part was prepared for the histological and apoptotic evaluation; the lower part was homogenised with 0.9% saline (1: 9 weight) for testing the cytokines levels in the 10% homogenate. The peripheral blood and homogenate were centrifuged at 4 °C, 1000 g/min for 10 min, and the supernatant was collected for further analysis.