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Arterial Blood Gas Analysis (arterial + blood_gas_analysis)

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Medical Sciences	100%

Selected Abstracts

Cost-effectiveness of screening for hepatopulmonary syndrome in liver transplant candidates,

LIVER TRANSPLANTATION, Issue 2 2007
D. Neil Roberts
The hepatopulmonary syndrome (HPS) is present in 15,20% of patients with cirrhosis undergoing orthotopic liver transplantation (OLT) evaluation. Both preoperative and post-OLT mortality is increased in HPS patients particularly when hypoxemia is severe. Screening for HPS could enhance detection of OLT candidates with sufficient hypoxemia to merit higher priority for transplant and thereby decrease mortality. However, the cost-effectiveness of such an approach has not been assessed. Our objective was to perform a cost-effectiveness analysis from a third-party payer's perspective of screening for HPS in liver OLT candidates. The costs and outcomes of 3 different strategies were compared: (1) no screening, (2) screening patients with a validated dyspnea questionnaire, and (3) screening all patients with pulse oximetry. Arterial blood gas analyses and contrast echocardiography were performed in patients with dyspnea or a pulse oximetry (SpO2) ,97% to define the presence of HPS. A Markov model was constructed simulating the natural history of cirrhosis in a cohort of patients 50 years old over a time horizon of their remaining life expectancy. Transition probabilities were obtained from published data available through Medline and U.S. vital statistics. Costs represented Medicare reimbursement data at our institution. Costs and health effects were discounted at a 3% annual rate. No screening was associated with a total cost of $291,898 and a life expectancy of 11.131 years. Screening with pulse oximetry was associated with a cost of $299,719 and a life expectancy of 12.27 years. Screening patients with the dyspnea-fatigue index was associated with a cost and life expectancy of $300,278 and 12.28 years, respectively. The incremental cost-effectiveness ratio of screening with pulse oximetry (compared to no screening) was $6,867 per life year gained, whereas that of the dyspnea-fatigue index (compared to pulse oximetry) was $55,900 per life year gained. The cost-effectiveness of screening depended on the prevalence and severity of HPS, and the choice of screening strategy was dependent on the sensitivity of the screening modality. In conclusion, screening for HPS, especially with pulse oximetry, is a cost-effective strategy that improves survival in transplant candidates predominantly by targeting the transplant to the subgroup of patients most likely to benefit. The utility of screening depends on the prevalence and severity of HPS in the target population. Liver Transpl, 2006. © 2006 AASLD. [source]

Arterial blood gas parameters of normal foals born at 1500 metres elevation

EQUINE VETERINARY JOURNAL, Issue 1 2010
E. S. HACKETT
Summary Reasons for performing study: Arterial blood gas analysis is widely accepted as a diagnostic tool to assess respiratory function in neonates. To the authors' knowledge, there are no published reports of arterial blood gas parameters in normal neonatal foals at altitude. Objective: To provide information on arterial blood gas parameters of normal foals born at 1500 m elevation (Fort Collins, Colorado) in the first 48 h post partum. Hypothesis: Foals born at 1500 m will have lower PaO2 and PaCO2 than foals born at sea level due to low inspired oxygen and compensatory hyperventilation occurring at altitude. Methods: Sixteen foals were studied. Arterial blood gas analysis was performed within 1 h of foaling and subsequent samples were evaluated at 3, 6, 12, 24 and 48 h post partum. Data were compared to those previously reported in healthy foals born near sea level. Results: Mean PaO2 was 53.0 mmHg (7.06 kPa) within 1 h of foaling, rising to 67.5 mmHg (9.00 kPa) at 48 h post partum. PaCO2 was 44.1 mmHg (5.88 kPa) within one hour of foaling, falling to 38.3 mmHg (5.11 kPa) at 48 h. Both PaO2 and PaCO2 were significantly lower in foals born at 1500 m elevation than those near sea level at several time points during the first 48 h. Conclusions and potential relevance: Foals at 1500 m elevation undergo hypobaric hypoxia and compensatory hyperventilation in the first 48 h. Altitude specific normal arterial blood values are an important reference for veterinarians providing critical care to equine neonates. [source]

Childhood cirrhosis, hepatopulmonary syndrome and liver transplantation

PEDIATRIC TRANSPLANTATION, Issue 3 2008
Gokhan Tumgor
Abstract:, Objectives:, The hepatopulmonary syndrome (HPS) is characterized as a triad: liver disease, intrapulmonary vascular dilatatiton, and arterial hypoxemia. The aim of this study is to analyze outcome of children with HPS in liver transplant era. Methods:, Between September 1996 and November 2006, 172 cirrhotic patients (median age 5 years; range 0.2,22 years, M/F; 97/75) were followed at Ege University Pediatric Gastroenterology, Hepatology and Nutrition Unit. All patients were evaluated by chest radiography, arterial blood gas analysis, and alveolar-arterial oxygen tension difference, contrast echocardiography (CEE) after and before the liver transplantation. Results:, HPS was diagnosed in 33 patients (19%) by CEE. None of them had pulmonary hypertension. HPS was not found related to etiology of the liver disease. Portal hypertension was found related to the development of HPS (75.7% in patients with HPS and 54.6% in others, p = 0.02). 17 of 33 patients with HPS underwent liver transplantation. Preoperative and postoperative period of these patients was uneventful. Patients were extubated in the operating room except for two. Median follow up of transplanted children was 1.9 year (range; 0.75,10 years). Arterial blood gas analysis and CEE positivity regressed in all of them by postoperative 6th month. Conclusions:, HPS is a serious and important complication of cirrhotic children that leads to tissue hypoxia and central cyanosis. HPS seems reversible after liver transplantation in all patients. [source]

Agreement between bicarbonate measured on arterial and venous blood gases

EMERGENCY MEDICINE AUSTRALASIA, Issue 5-6 2004
Anne-Maree Kelly
Abstract Objective:, This study aims to determine the extent of agreement between venous and arterial bicarbonate for a group of emergency department patients with respiratory or metabolic illness requiring blood gas analysis as part of their evaluation. Methods:, This prospective study of patients who were deemed by their treating doctor to require an arterial blood gas analysis to determine their ventilatory or acid-base status, compared bicarbonate on an arterial and a venous sample taken as close to simultaneously as possible. Data were analysed using bias (Bland-Altman) methods. Subgroup analyses were performed for the metabolic, respiratory, chronic obstructive airways disease and acidotic subgroups. Results:, Two hundred and forty-six patients were entered into the study; 195 with acute respiratory disease and 51 with suspected metabolic derangement. The values of bicarbonate on arterial and venous samples showed close agreement with an average difference between the samples of 1.20 mmol/L (95% limits of agreement being ,2.73 to +5.13 mmol/L). Similar agreement was found for all subgroups. Conclusion:, Venous bicarbonate estimation shows a high level of agreement with the arterial value, with acceptably narrow 95% limits of agreement. These results suggest that venous bicarbonate estimation may be an acceptable substitute for arterial measurement. [source]

Evaluation of a score designed to predict sepsis in foals

JOURNAL OF VETERINARY EMERGENCY AND CRITICAL CARE, Issue 3 2003
DACVECC, DACVIM, Kevin T. T. Corley BSc, MRCVS
Abstract Objective: To evaluate the accuracy of a published score designed to predict sepsis in foals in a clinical setting and to evaluate the association of clinical and clinicopathological variables with sepsis. Design: Observational study. Retrospective for data from 1998. Prospective in 1999,2001. Setting: Foal intensive care unit of a university hospital. Animals: Client-owned foals of less than 10 days of age, presenting from 1998 to 2001. Interventions: None. Measurements and main results: Data from the history and physical examination, together with admission hematology, biochemistry and arterial blood gas analysis were used to generate the published sepsis scores. The same data were investigated for their statistical relationship with sepsis. The presence or absence of sepsis was determined from blood culture, culture of sites of suspected local infection, clinical course and/or post-mortem examination. The modified sepsis score was calculated for 168 foals, which were classified as septic (86), non-septic (45) or not possible to classify (37). The modified sepsis score correctly predicted sepsis in 58 out of 86 foals and non-sepsis in 34 out of 45 foals, resulting in a sensitivity of 67%, a specificity of 76%, a positive predictive value of 84% and a negative predictive value of 55%. Abnormal neutrophil cytology, an immunoglobulin concentration of less than 400 mg/dl, and low blood glucose concentration had the strongest association with sepsis. Conclusions: The low negative predictive value of the sepsis score limited its clinical utility. The sepsis score should not be used to define sepsis in clinical studies, unless previously validated in the study center. [source]

Longtime performance and reliability of two different PtcCO2 and SpO2 sensors in neonates

PEDIATRIC ANESTHESIA, Issue 9 2008
VERA BERNET
Summary Objectives:, Blood gas monitoring is necessary in treatment of critically ill neonates. Whereas SaO2 can be estimated by pulse oximetry, PaCO2 is still most often assessed from blood samples. Aim:, To compare long time performance of an ear sensor for combined assessment of transcutaneous carbon dioxide (PtcCO2) and oxygen saturation (SpO2) (TOSCA Monitor; Radiometer, Switzerland) with a conventional PtcCO2 monitor (MicroGas 7650-500 rapid, Radiometer, Switzerland) in critically ill neonates. Methods:, Prospective, observational study. Twenty critically ill neonates were monitored for PtcCO2 and SpO2 using the Tosca and the MicroGas monitor for 24 h. TOSCA ear sensor was changed to the other ear lobe after 12 h and the MicroGas sensor four hourly on the trunk. Values obtained were compared with SaO2 and PaCO2 from arterial blood gas analysis using Bland,Altman analysis. Data are presented as median (range). Results:, Eighty-two paired measurements were obtained. Median age of the 20 patients was 4.5 days (1,26 days) and weight was 3.05 kg (0.98,3.95 kg). Bias and precision between PaCO2 and PtcCO2 were 0.14 and 1.45 kPa for the Tosca monitor and ,0.08 and 1.2 kPa for the MicroGas monitor, respectively. The two biases were significantly different (P = 0.0036). SpO2 assessment by TOSCA was comparable to SaO2 values (bias 0.26% and precision 4.14%). Conclusion:, The TOSCA monitor allows safe estimation of PtcCO2 and SaO2 in neonates. Measurements of PtcCO2 were less reliable with TOSCA compared with conventional monitoring but still allow assessing a trend of ventilation status in newborn patients. [source]

Childhood cirrhosis, hepatopulmonary syndrome and liver transplantation

Cross-sectional and longitudinal construct validity of the Saint George's Respiratory Questionnaire in patients with IPF

RESPIROLOGY, Issue 6 2008
Shouchun PENG
Background and objective: This study was performed to confirm the cross-sectional and longitudinal construct validity of the Saint George's Respiratory Questionnaire (SGRQ) for the measurement of health-related quality of life (HRQoL) in patients with IPF. Methods: Sixty-eight patients with IPF responded to the SGRQ and pulmonary function tests (PFT), dyspnoea testing, arterial blood gas analysis, 6-min walk tests (6MWT) and high-resolution computed tomography were performed in a baseline study. A follow-up study was performed on 45 of these patients. Results: In the baseline study HRQoL as measured by the SGRQ was substantially impaired in IPF patients, especially in symptoms and activity domains. A significant decline in HRQoL was observed in the activity domain during follow up. TLC and changes in TLC showed the most significant inverse correlations with each SGRQ domain (r < ,0.3, P < 0.05). In a stepwise multiple regression analysis, TLC contributed most significantly to each SGRQ component baseline score. Similar results were also observed during follow up. There was a significant correlation between total CT scores and each component of the SGRQ (r > 0.3, P , 0.001). Changes in ground-glass opacity on CT (CT-alv) were also correlated with changes in each SGRQ domain (r > 0.3, P , 0.001). Stepwise multiple regression analysis showed that interstitial opacity on CT (CT-fib) contributed to variation in the baseline activity score, and that changes in CT-alv independently contributed to overall changes in the SGRQ domains during follow up. The dyspnoea score, and changes in the dyspnoea score, correlated significantly with the SGRQ sores, with the exception of the symptoms score, in both the baseline and follow-up studies. Conclusions: HRQoL as assessed by the SGRQ showed good cross-sectional and longitudinal construct validity in patients with IPF. However, additional studies are required to analyse the reliability and responsiveness so that the SGRQ can be used in patients with IPF. [source]