Anesthesiology
Thushara Madathil; Cassie Carvalho; Sunil Rajan
Volume 10, Issue 1 , January 2024, , Pages 22-26
Abstract
Objective: Fluids are administered to optimize hemodynamics during off-pump coronary artery bypass grafting (CABG), which may lead to a positive fluid balance and increased lung water, lung congestion, hypoxemia, prolonged mechanical ventilation, and longer hospital stays. Lung ultrasound can assess ...
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Objective: Fluids are administered to optimize hemodynamics during off-pump coronary artery bypass grafting (CABG), which may lead to a positive fluid balance and increased lung water, lung congestion, hypoxemia, prolonged mechanical ventilation, and longer hospital stays. Lung ultrasound can assess extravascular lung water and help titrate diuretics and fluids, thus preventing hypoxemia. The primary objective of this study was to study the correlation between B-line scores measured by lung ultrasound and the PaO2/FiO2 ratio (the ratio of arterial partial pressure of oxygen to fractional inspired oxygen) after off-pump CABG.Methods: Forty off-pump CABG patients were included in this prospective observational study in a tertiary care center from 2022 to 2023. The correlation coefficient from an earlier study was used and a sample size of 9 was calculated. Random sampling technique was used. A four-sector lung ultrasound was utilized for B-line scoring. B-line scores and PaO2/FiO2 ratios were recorded at three time points: before the surgery commenced and at 24 and 48 hours post-operation. The fluid balance was calculated at 24 and 48 hours post-operation. Pearson correlation coefficient was used to evaluate the correlation between B-line scores and fluid balance with oxygenation, and its significance was assessed through a linear regression test.Results: The PaO2/FiO2 ratio and B-line scores exhibited a statistically significant moderate negative correlation at 24 hours post-surgery (r = -0.44; SD = -0.66, 95% CI = -0.66, -0.15; P = 0.004) and a B-line score exceeding 8 was associated with the lowest PaO2/FiO2 ratio. However, fluid balance and PaO2/FiO2 ratios revealed no correlation at 24 or 48 hours post-surgery. Additionally, fluid balance and B-line scores demonstrated a moderate positive correlation after 48 hours but no correlation at 24 hours post-surgery.Conclusion: B-line scores always negatively correlated with PaO2/FiO2 ratios, and scores greater than eight corresponded to the lowest ratio.
Infectious disease
Farhad Heydari; Majid Zamani; Mohammad Nasr-Esfahani; Fatemehsadat Mirmohammad Sadeghi; Faezeh Hedayati
Volume 9, Issue 2 , July 2023, , Pages 114-119
Abstract
Objective: Recently, high-flow nasal cannula (HFNC) oxygen therapy has been implicated in the treatment of patients with acute respiratory failure. In this study, the effect of this treatment on COVID-19 patients was investigated.Methods : This was a prospective, randomized, single-blind clinical trial ...
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Objective: Recently, high-flow nasal cannula (HFNC) oxygen therapy has been implicated in the treatment of patients with acute respiratory failure. In this study, the effect of this treatment on COVID-19 patients was investigated.Methods : This was a prospective, randomized, single-blind clinical trial on patients with COVID-19 referred to the emergency department. COVID-19 patients who had peripheral oxygen saturation (SpO2) ≤90% despite receiving nasal oxygen (up to 6 L/min) were included in the study and randomized to HFNC or conventional oxygen therapy (COT). Then the patients were compared in terms of vital signs, SpO2, need for endotracheal intubation, and need for intensive care unit admission. The sample size was calculated at 35 patients in each group. Variables were compared using the chi-square test, Student’s t-test, or the Mann-Whitney U test.Results: 87 patients with a mean age of 65.3±14.8 (62.1% male) were included. The two groups were similar in terms of age, sex, time interval from onset to diagnosis, and underlying diseases (hypertension, diabetes, coronary artery disease, etc.) (P<0.05). No statistically significant difference was reported between SpO2 and PaO2/FiO2 vital signs at the beginning of treatment between the two groups. One hour after treatment, respiratory rate, SpO2, and PaO2/FiO2 were better in the HFNC group compared to the COT group (P<0.05). Also, there was no significant difference between the two groups in terms of the need for endotracheal intubation, the need for ICU admission, and in-hospital mortality.Conclusion: Early use of HFNC oxygen therapy in patients with COVID-19 can improve SpO2, respiratory rate, and PaO2/FiO2 levels. Therefore, it has high clinical value.