Relationship between the alveolar-arterial oxygen gradient and PaO2/FiO2—Introducing peep into the model

Casado, Marcelino Sánchez; Díaz, Manuel Quintana; Palacios, D.; Hortigüela, V.; Schülke, Christoph; Garcia, João Márcio; Canabal, Alfonso; Pedrero, Mercedes; Ramos, A. Velasco; Arrese, Marco

doi:10.1016/j.medine.2012.07.001

Cited by 6 publications

(2 citation statements)

References 17 publications

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“…We noted that the persistent lung aeration improvement in the PPE group was not reflected in the A-a O 2 gradient. This could be due to external oxygen supplementation within the first half hour after extubation in certain patients [17][18][19][20][21]. This could have led to an insignificant difference in the variation in A-a O 2 gradient between the two groups as the measurement of the A-a O 2 gradient was done when the patients were on supplemental oxygen for an initial half hour after extubation, despite the constant FiO 2 .…”

Section: Discussionmentioning

confidence: 99%

Comparison of positive pressure extubation with traditional extubation in critically ill patients – a randomised control study

Prabhakaran¹,

Vanalal²,

Soni³

et al. 2023

ait

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Orotracheal extubation is a standard procedure in the intensive care unit (ICU). It can be associated with various complications in the critically ill population, notably bronchospasm, severe cough, hypertension, tachycardia, tachypnoea, poor respiratory mechanics, and major complications such as upper airway obstruction and stridor, desaturation, etc. [1]. The incidence of complications following extubation has been reported between 6 to 100% in the same population [2][3][4]. Multiple risk factors, for instance, hemodynamic lability, increased secretions, weakness, malnutrition, etc., play a significant role in complicating routine extubation. The incidence of aspiration pneumonitis in the ICU

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Section: Discussionmentioning

confidence: 99%

Comparison of positive pressure extubation with traditional extubation in critically ill patients – a randomised control study

Prabhakaran¹,

Vanalal²,

Soni³

et al. 2023

ait

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“…P(A-a)O 2 is simple and reliable indicator of physiological shunt al-terations in cardiorespiratory stable patients on constant FiO 2 . PaO 2 /FiO 2 has been widely used to evaluate oxygen exchange and it is modified with PEEP and respiratory condition of the patient (15). Due to simplicity of bedside calculation of both parameters, absence of cardiorespiratory comorbidity in study population and ventilation with constant FiO 2 , we used those parameters to evaluate PEEP titration effect.…”

Section: Discussionmentioning

confidence: 99%

Slow PEEP Titration During General Anesthesia with Muscle Paralysis Improves Lung Function Without Compromising Hemodynamic Stability in Preschool Children: A Randomized Control Clinical Trial

et al. 2019

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Background: Mechanical ventilation impairs oxygenation and increases intrapulmonary shunt. Positive end-expiratory pressure (PEEP) slows derecruitment, improves lung function but can compromise hemodynamics. Objectives: To asses slow PEEP titration effect on intrapulmonary shunt, oxygenation and hemodynamics in preschool children on mechanical ventilation under general anesthesia. Methods: This was a single tertiary care center an open-label, randomized parallel group controlled clinical trial. Study included 70 children, 3-7 years, ASA I and II, under general anesthesia for non-cardiothoracic surgery. Children were randomly allocated either to receive PEEP titration 5-11 cmH2O 20 minutes before the end of anesthesia (intervention group) or to be ventilated until the end of anesthesia with constant positive end-expiratory pressure of 3 cmH2O (control group). Main outcome measures were changes in oxygenation index (PaO2/FiO2) and alveolar-arterial gradient (P(A-a)O2) between and within groups and changes in systolic blood pressure (SBP), mean arterial pressure (MAP) and heart rate (HR) in interventional group during PEEP trial. Results: Seventy children were recruited and analyzed. P(A-a)O2 and PaO2/FiO2 improved in interventional group comparing to control as consequence of PEEP titration (∆PaO2/FiO2-30.3 vs. 0.52; P < 0.001; ∆P(A-a)O2 6.7 vs.-1.0; P < 0.001) and within interventional group before and after PEEP titration (PaO2/FiO2 522.0 vs. 552.3; P < 0.01; P(A-a)O2 20.1 vs. 13.3; P < 0.001). Hypotension and bradycardia were not documented. Conclusions: Slow PEEP titration up to 11 cmH2O improves oxygenation, reduces intrapulmonary shunt without causing hemodynamic instability in preschool children during general anesthesia.

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Evaluation of some new parameters predicting outcome of patients with acute respiratory failure needing invasive mechanical ventilation due to CAP

El-Shafey

El-Bedewy

2014

Egyptian Journal of Chest Diseases and Tuberculosis

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Many traditional scores such as sequential organ failure assessment score (SOFA score) are used in the ICU to predict outcome and mortality in mechanically ventilated patients with acute respiratory failure. But new simplified parameter now, is used such as oxygen index (OI). Other authors add PEEP to the PaO 2 /FiO 2 ratio called PaFip which is calculated according to the equation = Ln [(PaO 2 /FiO 2 )/(PEEP + 12)] (Ln is the natural logarithm) and used it as an outcome predictor. Aim of the work: is to evaluate the values of oxygen index, PaFip and SOFA score as early predictors of outcome of patients with acute respiratory failure caused by severe CAP who underwent invasive mechanical ventilation. Subjects and methods: this study was carried out on 40 patients with acute respiratory failure due to severe community acquired pneumonia (CAP) who were mechanically ventilated and divided into 2 groups, GI: included 18 non-survivors and GII: included 22 survivors. All patients were subjected to full history and clinical examination, plain X-ray chest and culture and sensitivity of tracheal aspirate. 4 hours after the onset of mechanical ventilation: ABG, measurement of mean airway pressure, calculation of oxygen index, measurement of extrinsic PEEP and calculation of PaFip were done. Results: The SOFA score, PaFip, OI, PaO 2 /FiO 2 and PaO 2 were related to mortality in patients on mechanical ventilation due to acute respiratory failure caused by severe community acquired pneumonia. The SOFA score was the parameter most closely related to mortality (P = 0.00I) followed by PaFip (P = 0.006) and PaO 2 /FiO 2 (P = 0.008) while PaO 2 and OI were the parameters detecting mortality the least (P = 0.020 & 0.025, respectively). Conclusion: PaFip is nearly equal to the SOFA score as an early outcome predictor for mechanically ventilated patients while the value of oxygen index as early outcome predictor is less than the above 2 parameters.

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Relationship between the alveolar-arterial oxygen gradient and PaO2/FiO2—Introducing peep into the model

Cited by 6 publications

References 17 publications

Comparison of positive pressure extubation with traditional extubation in critically ill patients – a randomised control study

Comparison of positive pressure extubation with traditional extubation in critically ill patients – a randomised control study

Slow PEEP Titration During General Anesthesia with Muscle Paralysis Improves Lung Function Without Compromising Hemodynamic Stability in Preschool Children: A Randomized Control Clinical Trial

Evaluation of some new parameters predicting outcome of patients with acute respiratory failure needing invasive mechanical ventilation due to CAP

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