Blood Gas Analysis among COVID-19  Patients: A Single Centre Retrospective  Observational Study

Mondal, Soumitra; Das, Tarun; Bhattacharya, Saikat; Banerjee, Shibasish; Hazra, Debopam

doi:10.7860/jcdr/2021/49835.15185

Cited by 6 publications

(12 citation statements)

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“…The prevalence of inappropriate responders is consistent with estimates of respiratory alkalosis in 28.7–55.4% from other studies that investigated blood gas analysis in hospitalized COVID-19 patients [( 5 ) (55.4%); ( 6 ) (28.7%); ( 7 ) (30.3%); ( 8 ) (40.4%)]. Wu et al ( 6 ) found higher inflammatory markers in respiratory alkalosis group, and other studies corroborate admission hypocapnia as a marker of severe disease ( 17 , 18 ).…”

Section: Discussionsupporting

confidence: 88%

“…Of the total cohort, 38% (74/194), had a 6-week follow-up after hospital discharge, of which 34 (17.5%) were face-to-face consultations which allowed full clinical assessment. A new diagnosis of breathing pattern disorder (BPD) was made in 23.5% (8/34), with a BPAT score of 6 ( 5 – 7 ). None had a past medical history of respiratory, neurological or psychiatric disorder.…”

Section: Resultsmentioning

confidence: 99%

“…62.5% (5/8) were in the inappropriate responders group. All eight patients with BPD had 6-month follow-up, of which three still had BPD, with a BPAT score of 2.5 ( 3 – 5 ). Five of the eight patients attended 12-month follow-up, of which one had BPD, with a BPAT score of 2 ( 2 , 3 ) ( Figure 2 ).…”

Section: Resultsmentioning

confidence: 99%

“…However, data on the nature of breathing control in COVID-19 are lacking. A few previous studies investigated blood gas analysis in hospitalized COVID-19 patients ( 5 – 8 ), but none concurrently assessed arterial blood gases (ABG), respiratory rate and perception of dyspnoea, and therefore could not directly comment on appropriateness of physiological and breathing perception responses, which we attempt to do here.…”

Section: Introductionmentioning

confidence: 99%

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Inappropriate Ventilatory Homeostatic Responses in Hospitalized COVID-19 Patients

et al. 2022

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BackgroundThe clinical presentation of COVID-19 suggests altered breathing control - tachypnoea, relative lack of dyspnoea, and often a discrepancy between severity of clinical and radiological findings. Few studies characterize and analyse the contribution of breathing drivers and their ventilatory and perceptual responses.AimTo establish the prevalence of inappropriate ventilatory and perceptual response in COVID-19, by characterizing the relationships between respiratory rate (RR), dyspnoea and arterial blood gas (ABG) in a cohort of COVID-19 patients at presentation to hospital, and their post-Covid respiratory sequelae at follow-up.MethodsWe conducted a retrospective cohort study including consecutive adult patients admitted to hospital with confirmed COVID-19 between 1st March 2020 and 30th April 2020. In those with concurrent ABG, RR and documented dyspnoea status on presentation, we documented patient characteristics, disease severity, and outcomes at hospital and 6-week post-discharge.ResultsOf 492 admissions, 194 patients met the inclusion criteria. Tachypnoea was present in 75% pronounced (RR>30) in 36%, and persisted during sleep. RR correlated with heart rate (HR) (r = 0.2674), temperature (r = 0.2824), CRP (r = 0.2561), Alveolar-arterial (A-a) gradient (r = 0.4189), and lower PaO2/FiO2 (PF) ratio (r = −0.3636). RR was not correlated with any neurological symptoms. Dyspnoea was correlated with RR (r = 0.2932), A-a gradient (r = 0.1723), and lower PF ratio (r = −0.1914), but not correlated with PaO2 (r = −0.1095), PaCO2 (r = −0.0598) or any recorded neurological symptom except for altered consciousness. Impaired ventilatory homeostatic control of pH/PaCO2 [tachypnoea (RR>20), hypocapnia (PaCO2 <4.6 kPa), and alkalosis (pH>7.45)] was observed in 29%. This group, of which 37% reported no dyspnoea, had more severe respiratory disease (A-a gradient 38.9 vs. 12.4 mmHg; PF ratio 120 vs. 238), and higher prevalence of anosmia (21 vs. 15%), dysgeusia (25 vs. 12%), headache (33 vs. 23%) and nausea (33 vs. 14%) with similar rates of new anxiety/depression (26 vs. 23%), but lower incidence of past neurological or psychiatric diagnoses (5 vs. 21%) compared to appropriate responders. Only 5% had hypoxia sufficiently severe to drive breathing (i.e. PaO2 <6.6 kPa). At 6 weeks post-discharge, 24% (8/34) showed a new breathing pattern disorder with no other neurological findings, nor previous respiratory, neurological, or psychiatric disorder diagnoses.ConclusionsImpaired homeostatic control of ventilation i.e., tachypnoea, despite hypocapnia to the point of alkalosis appears prevalent in patients admitted to hospital with COVID-19, a finding typically accompanying more severe disease. Tachypnoea prevalence was between 12 and 29%. Data suggest that excessive tachypnoea is driven by both peripheral and central mechanisms, but not hypoxia. Over a third of patients with impaired homeostatic ventilatory control did not experience dyspnoea despite tachypnoea. A subset of followed-up patients developed post-covid breathing pattern disorder.

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Section: Discussionsupporting

confidence: 88%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Inappropriate Ventilatory Homeostatic Responses in Hospitalized COVID-19 Patients

et al. 2022

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“…In clinical practice, the use of corticosteroids in the past, whether at home or in any other hospital environment, may also cause metabolic alkalosis by activating the mineralocorticoid system, but it cannot be connected directly to respiratory alkalosis [8]. In this study, 15 (5.6%) patients also presented with metabolic alkalosis.…”

Section: Discussionmentioning

confidence: 55%

Study of Arterial Blood Gas Analysis in Moderate-to-Severe COVID-19 Patients

Sanghani¹,

Bansal²,

Parmar³

et al. 2022

Cureus

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BackgroundThe high prevalence of pneumonia and renal involvement in coronavirus disease 2019 leads to frequent acid-base abnormalities in serious patients and affects prognosis. In this study, we aimed to assess the arterial blood gas (ABG) and acid-base patterns in COVID-19 patients admitted to a tertiary care hospital. MethodologyA retrospective observational study was conducted in a designated COVID-19 hospital involving 267 reverse transcription-polymerase chain reaction-positive COVID-19 patients. Demographic and laboratory data including ABG data within the first day after admission and in patients with multiple ABG analyses, only the first measurement was collected and analyzed statistically, including its association with comorbidities. ResultsThe most common age group of the patients was 51-60 years (30.8%), with a male predominance (male:female = 2.7:1). The most common comorbidities were hypertension, diabetes mellitus, and chronic obstructive pulmonary disease found in 147 (55%) COVID-19 patients. Alkalosis and acidosis were observed in 145 (54.3%) and 50 (18.7%) patients, respectively. The most common ABG abnormality observed was primary respiratory alkalosis with secondary metabolic acidosis in 67 (25.1%) patients, followed by primary respiratory alkalosis with secondary metabolic alkalosis in 54 (20.2%) patients. Statistically significant negative correlation was found with PaCO 2 and pH (r = -0.530, p < 0.0001), statistically significant positive correlation was found between pH and base (r = 0.533, p < 0.0001), pH and TCO 2 (r = 0.260, p < 0.0001), and pH and HCO 3 (r = 0.354, p < 0.0001). ConclusionsAcid-base abnormalities are commonly encountered in COVID-19 patients. Respiratory alkalosis as a part of a single or mixed pattern on ABG was the most common pattern found in critically ill COVID-19 patients. ABG on admission in moderate-to-severe COVID-19 patients can help in the early correction of metabolic abnormalities leading to improved patient outcomes.

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Longitudinal analysis of electrolyte prolife in intensive care COVID-19 patients

Abosamak

Szergyuk

Oliveira

et al. 2023

Egyptian Journal of Anaesthesia

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Blood Gas Analysis among COVID-19 Patients: A Single Centre Retrospective Observational Study

Cited by 6 publications

References 0 publications

Inappropriate Ventilatory Homeostatic Responses in Hospitalized COVID-19 Patients

Inappropriate Ventilatory Homeostatic Responses in Hospitalized COVID-19 Patients

Study of Arterial Blood Gas Analysis in Moderate-to-Severe COVID-19 Patients

Longitudinal analysis of electrolyte prolife in intensive care COVID-19 patients

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