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To investigate the effect of prolonged time before analysis and mechanical manipulation on pre-analytical stability of biomarkers and the validity of blood gas analysis results. We collected blood samples from 240 ICU patients from May 18, 2022 to March 31, 2023. Samples were analyzed immediately per standard operating procedure, then the syringes were kept at room temperature for 60 min, subjected to standardized mechanical forces (repeated drops) and analyzed again. Thirteen typical blood gas analytes were measured. Bland-Altman plots were prepared to assess differences between initial and delayed analyses. Differences were compared against official accuracy limits specified in German quality assurance guidelines (Rili-BAEK). For hemoglobin, creatinine, glucose, and electrolytes (calcium, sodium, chloride, bicarbonate), agreement between immediate and post-delay analyses remained within the official acceptable ranges. For pH and potassium, deviations exceeded the Rili-BAEK accuracy limits but remained clinically acceptable. Only oxygen partial pressure and lactate levels changed so markedly that they would no longer be reliable for clinical interpretation. Even after a 60-min delay and excessive mechanical stress, selected blood gas analytes such as hemoglobin, glucose, and electrolytes can be considered valid. Potassium and carbon dioxide partial pressure were altered but might be suitable for approximation purposes. Findings for oxygen partial pressure and lactate were generally invalid. In the future, these findings can aid in reducing unnecessary blood sampling. These findings may guide clinicians in deciding whether repeat sampling is necessary, potentially reducing unnecessary blood draws, while reinforcing that critical parameter (pO₂, pCO₂, pH) still require prompt analysis.

Background Renin-angiotensin system (RAS) signaling and angiotensin-converting enzyme 2 (ACE2) have been implicated in the pathogenesis of acute respiratory distress syndrome (ARDS). We postulated that repleting ACE2 using GSK2586881, a recombinant form of human angiotensin-converting enzyme 2 (rhACE2), could attenuate acute lung injury. Methods We conducted a two-part phase II trial comprising an open-label intrapatient dose escalation and a randomized, double-blind, placebo-controlled phase in ten intensive care units in North America. Patients were between the ages of 18 and 80 years, had an American-European Consensus Criteria consensus diagnosis of ARDS, and had been mechanically ventilated for less than 72 h. In part A, open-label GSK2586881 was administered at doses from 0.1 mg/kg to 0.8 mg/kg to assess safety, pharmacokinetics, and pharmacodynamics. Following review of data from part A, a randomized, double-blind, placebo-controlled investigation of twice-daily doses of GSK2586881 (0.4 mg/kg) for 3 days was conducted (part B). Biomarkers, physiological assessments, and clinical endpoints were collected over the dosing period and during follow-up. Results Dose escalation in part A was well-tolerated without clinically significant hemodynamic changes. Part B was terminated after 39 of the planned 60 patients following a planned futility analysis. Angiotensin II levels decreased rapidly following infusion of GSK2586881, whereas angiotensin-(1–7) and angiotensin-(1–5) levels increased and remained elevated for 48 h. Surfactant protein D concentrations were increased, whereas there was a trend for a decrease in interleukin-6 concentrations in rhACE2-treated subjects compared with placebo. No significant differences were noted in ratio of partial pressure of arterial oxygen to fraction of inspired oxygen, oxygenation index, or Sequential Organ Failure Assessment score. Conclusions GSK2586881 was well-tolerated in patients with ARDS, and the rapid modulation of RAS peptides suggests target engagement, although the study was not powered to detect changes in acute physiology or clinical outcomes. Trial registration ClinicalTrials.gov, NCT01597635 . Registered on 26 January 2012.

Background Point‐of‐care testing of blood gases plays a critical role in patient management. The aim of this study was to verify the manufacturer's specifications of the Nova Stat Profile Prime Plus Analyser, along with a comparison study with the GEM Premier 4000 Blood Gas Analyser. Methods Parameters analysed were pH, pCO2, pO2, Na+, Cl−, K+, iCa, lactate, and glucose. Data for the precision and bias study were generated using control samples in a 5 × 5 study design. Linearity was checked using a five‐level Linearity Control Set, while comparison was done between the Nova and GEM analysers using whole blood samples (N = 103). Acceptance was based on the CLIA TEa for all analytes except for lactate, for which the TEa defined by CAP and AAB was used. Results The within‐run and between‐run CVR% precision were all lower than the claimed CVs%, except for pCO2 control level 2 within run (CV% 1.5 [claim CV% 1.1]) and iCa control level 5 between run (CV% 1.42 [claim 1.12]). The observed bias for all parameters was within the calculated lower and upper bias limits. Linearity was verified for all analytes except for Na+. Upon comparison of the Nova and GEM analysers, a correlation coefficient above 0.95 was observed for most parameters. Conclusion The Nova Stat Profile Prime Plus analyser meets the manufacturer's precision and bias claims. Linearity was confirmed for most analytes. There was a good correlation between the Nova and GEM Blood Gas analyser at concentrations within the reference range intervals for all investigated parameters. Point‐of‐care (POC) testing of blood gases plays a critical role in the management of patients both in the emergency department and in a critical care setting. Findings from this study confirm that the Nova Stat Profile Prime Plus analyser meets the manufacturer's precision and bias claims. Linearity was confirmed for pCO2, pO2, K+, Cl‐ and iCa. A good correlation was found between the Nova Stat Profile Prime Plus and GEM Premier Blood Gas analysers at concentrations within the reference range intervals for all the investigated parameters.

Background Continuous blood gas monitoring (CBGM) during cardiopulmonary bypass (CPB) is essential for maintaining optimal patient outcomes, enabling rapid responses to critical fluctuations in blood gas parameters. This non-inferiority study evaluates the Quantum Perfusion System by Spectrum Medical, which features continuous online blood gas monitoring through Quantum workstation (QWS) and Quantum ventilation module (QVM) without the use of cuvettes, against the standard blood gas analysis (BGA) analyzer to assess real-time clinical accuracy. Methods This retrospective study included a sample of 40 patients, monitored continuously with the QPS and compared at intervals against standard BGA measurements. The patients undergoing on elective CPB procedures, specifically for coronary artery bypass grafting (CABG), mitral valve replacement (MVR), and aortic valve replacement (AVR). Results Pre-alignment deviations for all parameters were within CLIA thresholds, confirming baseline reliability. For hemoglobin, the pre-alignment deviation was 1.9%, which decreased to 0.7% post-alignment, both within the CLIA threshold of ± 5%, with a Bland-Altman mean difference of 0.0988 g/dL (limits: 0.0963 to 0.1012 g/dL). Hematocrit showed a pre-alignment deviation of 2.1%, reduced to 0.2% post-alignment, both within the CLIA threshold of ± 5%, with a Bland-Altman mean difference of 0.3009% (limits: 0.2956 to 0.3063%). For PaO₂, the pre-alignment deviation was 3.9%, reduced to 0.4% post-alignment, both within the CLIA threshold of ± 10%, with a Bland-Altman mean difference of 4.0490 mmHg (limits: 3.9976 to 4.1004 mmHg). PCO₂ demonstrated a pre-alignment deviation of 4.2%, reduced to 0.19% post-alignment, both within the CLIA threshold of ± 10%, with a Bland-Altman mean difference of 0.3790 mmHg (limits: 0.3751 to 0.3829 mmHg). SvO₂ showed a pre-alignment deviation of 3%, which decreased to 0.8% post-alignment, both within the CLIA threshold of ± 5%, with a Bland-Altman mean difference of 0.7782% (limits: 0.7706 to 0.7858%). Finally, for SaO₂, the pre-alignment deviation was 2.6%, reduced to 0.1% post-alignment, both within the CLIA threshold of ± 5%, with a Bland-Altman mean difference of 0.9614% (limits: 0.9594 to 0.9634%). The Passing-Bablok regression analysis confirmed strong agreement, with slopes close to 1.0100 and intercepts near zero for all parameters. These results validate the QPS as a reliable and non-inferior tool for real-time blood gas monitoring during cardiopulmonary bypass, adhering to CLIA standards and ensuring clinical accuracy. Conclusions The findings support the accuracy of the Quantum Perfusion System compared to the BGA standard, demonstrating the system’s capability to provide accurate, continuous blood gas monitoring during CPB. However, further studies are necessary to strengthen and confirm these results across broader and more varied clinical scenarios, for these reason as recommended by the manufacturers, the quantum monitoring system should only be used as a trending device.

Portable blood gas analyzers are used to facilitate diagnosis and treatment of disorders related to disturbances of acid-base and electrolyte balance in the ambulatory care of equine patients. The aim of this study was to determine whether 2 portable analyzers produce results in agreement with a stationary analyzer. Blood samples from 23 horses hospitalized for various medical reasons were included in this prospective study. Blood gas analysis and electrolyte concentrations measured by the portable analyzers VetStat and epoc were compared to those produced by the cobas b 123 analyzer via concordance analysis, Passing-Bablok regression and Bland-Altman analysis. Limits of agreement indicated relevant bias between the VetStat and cobas b 123 for partial pressure of oxygen (pO2; 27.5-33.8 mmHg), sodium ([Na+]; 4.3-21.6 mmol/L) and chloride concentration ([Cl-]; 0.3-7.9 mmol/L) and between the epoc and cobas b 123 for pH (0.070-0.022), partial pressure of carbon dioxide (pCO2; 3.6-7.3 mmHg), pO2 (36.2-32.7 mmHg) and [Na+] (0.38.1 mmol/L). The VetStat analyzer yielded results that were in agreement with the cobas b 123 analyzer for determination of pH, pCO2, bicarbonate ([HCO3-]) and potassium concentration [K+], while the epoc analyzer achieved acceptable agreement for [HCO3-] and [K+]. The VetStat analyzer may be useful in performing blood gas analysis in equine samples but analysis of [Na+], [Cl-] and pO2 should be interpreted with caution. The epoc delivered reliable results for [HCO3-] and [K+], while results for pH, pCO2, pO2 and [Na+] should be interpreted with caution.

Background Authors of recent meta-analyses have reported that prolonged glucocorticoid treatment is associated with significant improvements in patients with severe pneumonia or acute respiratory distress syndrome (ARDS) of multifactorial etiology. A prospective randomized trial limited to patients with sepsis-associated ARDS is lacking. The objective of our study was to evaluate the efficacy of hydrocortisone treatment in sepsis-associated ARDS. Methods In this double-blind, single-center (Siriraj Hospital, Bangkok), randomized, placebo-controlled trial, we recruited adult patients with severe sepsis within 12 h of their meeting ARDS criteria. Patients were randomly assigned (1:1 ratio) to receive either hydrocortisone 50 mg every 6 h or placebo. The primary endpoint was 28-day all-cause mortality; secondary endpoints included survival without organ support on day 28. Results Over the course of 4 years, 197 patients were randomized to either hydrocortisone ( n  = 98) or placebo ( n  = 99) and were included in this intention-to-treat analysis. The treatment group had significant improvement in the ratio of partial pressure of oxygen in arterial blood to fraction of inspired oxygen and lung injury score ( p  = 0.01), and similar timing to removal of vital organ support (HR 0.74, 95 % CI 0.51–1.07; p  = 0.107). After adjustment for significant covariates, day 28 survival was similar for the whole group (HR 0.80, 95 % CI 0.46–1.41; p  = 0.44) and for the larger subgroup ( n  = 126) with Acute Physiology and Chronic Health Evaluation II score <25 (HR 0.57, 95 % CI 0.24–1.36; p  = 0.20). With the exception of hyperglycemia (80.6 % vs. 67.7 %; p  = 0.04), the rate of adverse events was similar. Hyperglycemia had no impact on outcome. Conclusions In sepsis-associated ARDS, hydrocortisone treatment was associated with a significant improvement in pulmonary physiology, but without a significant survival benefit. Trial registration ClinicalTrials.gov identifier NCT01284452 . Registered on 18 January 2011.

Elevated D-dimer is known as predictor for severity of SARS-CoV2-infection. Increased D-dimer is associated with thromboembolic complications, but it is also a direct consequence of the acute lung injury seen in COVID-19 pneumonia. To evaluate the rate of persistent elevated D-dimer and its association with thromboembolic complications and persistent ground glass opacities (GGO) after recovery from COVID-19. In this post hoc analysis of a prospective multicenter trial, patients underwent blood sampling, measurement of diffusion capacity, blood gas analysis, and multidetector computed tomography (MDCT) scan following COVID-19. In case of increased D-dimer (>0,5 [mu]g/ml), an additional contrast medium-enhanced CT was performed in absence of contraindications. Results were compared between patients with persistent D-dimer elevation and patients with normal D-dimer level. 129 patients (median age 48.8 years; range 19-91 years) underwent D-Dimer assessment after a median (IQR) of 94 days (64-130) following COVID-19. D-dimer elevation was found in 15% (19/129) and was significantly more common in patients who had experienced a severe SARS-CoV2 infection that had required hospitalisation compared to patients with mild disease (p = 0.049). Contrast-medium CT (n = 15) revealed an acute pulmonary embolism in one patient and CTEPH in another patient. A significant lower mean pO2 (p = 0.015) and AaDO2 (p = 0.043) were observed in patients with persistent D-Dimer elevation, but the rate of GGO were similar in both patient groups (p = 0.33). In 15% of the patients recovered from COVID-19, persistent D-dimer elevation was observed after a median of 3 months following COVID-19. These patients had experienced a more severe COVID and still presented more frequently a lower mean pO2 and AaDO2.

PurposeTo describe the variability and determinants of the effect of extracorporeal CO2 removal (ECCO2R) on tidal volume (Vt), driving pressure (ΔP), and mechanical power (PowerRS) and to determine whether highly responsive patients can be identified for the purpose of predictive enrichment in ECCO2R trial design.MethodsUsing data from the SUPERNOVA trial (95 patients with early moderate acute respiratory distress syndrome), the independent effects of alveolar dead space fraction (ADF), respiratory system compliance (Crs), hypoxemia (PaO2/FiO2), and device performance (higher vs lower CO2 extraction) on the magnitude of reduction in Vt, ΔP, and PowerRS permitted by ECCO2R were assessed by linear regression. Predicted and observed changes in ΔP were compared by Bland–Altman analysis. Hypothetical trials of ECCO2R, incorporating predictive enrichment and different target CO2 removal rates, were simulated in the SUPERNOVA study population.ResultsChanges in Vt permitted by ECCO2R were independently associated with ADF and device performance but not PaO2/FiO2. Changes in ΔP and PowerRS were independently associated with ADF, Crs, and device performance but not PaO2/FiO2. The change in ΔP predicted from ADF and Crs was moderately correlated with observed change in ΔP (R2 0.32, p < 0.001); limits of agreement between observed and predicted changes in ΔP were ± 3.9 cmH2O. In simulated trials, restricting enrollment to patients with a larger predicted decrease in ΔP enhanced the average reduction in ΔP, increased predicted mortality benefit, and reduced sample size and screening size requirements. The increase in statistical power obtained by restricting enrollment based on predicted ΔP response varied according to device performance as specified by the target CO2 removal rate.ConclusionsThe lung-protective benefits of ECCO2R increase with higher alveolar dead space fraction, lower respiratory system compliance, and higher device performance. ADF and Crs, rather than severity of hypoxemia, should be the primary factors determining whether to enroll patients in clinical trials of ECCO2R.

This book is a comprehensive guide that includes information on the origin and analysis of natural gas, the standard test methods, and procedures that help with the predictability of gas composition and behavior during gas cleaning operations and use. The author-a noted expert on the topic-also explores the properties and behavior of the various components of natural gas and gas condensate. All chapters are written as stand-alone chapters and they cover a wealth of topics including history and uses; origin and production; composition and properties; recovery, storage, and transportation; properties and analysis of gas stream and gas condensate. The text is designed to help with the identification of quality criteria appropriate analysis and testing that fall under the umbrella of ASTM International. ASTM is an organization that is recognized globally across borders, disciplines and industries and works to improve performance in manufacturing and materials and products.