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alveolar arterial oxygen gradient

J G Toffaletti, C R Rackley
Although part of a common "blood gas" test panel with pH and pCO2, the pO2, %O2Hb, and related parameters are independently used to detect and monitor oxygen deficits from a variety of causes. Measurement of blood gases and cooximetry may be done by laboratory analyzers, point of care testing, noninvasive pulse oximetry, and transcutaneous blood gases. The specimen type and mode of monitoring oxygenation that are chosen may be based on a combination of urgency, practicality, clinical need, and therapeutic objectives...
2016: Advances in Clinical Chemistry
Israel Grilo-Bensusan, Juan Manuel Pascasio-Acevedo
Hepatopulmonary syndrome (HPS) is characterized by abnormalities in blood oxygenation caused by the presence of intrapulmonary vascular dilations (IPVD) in the context of liver disease, generally at a cirrhotic stage. Knowledge about the subject is still only partial. The majority of the information about the etiopathogenesis of HPS has been obtained through experiments on animals. Reported prevalence in patients who are candidates for a liver transplantation (LT) varies between 4% and 32%, with a predominance of mild or moderate cases...
July 7, 2016: World Journal of Gastroenterology: WJG
Yingming Amy Chen, Vikramaditya Prabhudesai, Helene Castel, Samir Gupta
BACKGROUND: Hepatopulmonary syndrome (HPS) is defined by liver dysfunction, intrapulmonary vascular dilatations, and impaired oxygenation. The gold standard for detection of intrapulmonary vascular dilatations in HPS is contrast echocardiography. However, two small studies have suggested that patients with HPS have larger segmental pulmonary arterial diameters than both normal subjects and normoxemic subjects with cirrhosis, when measured by CT. We sought to compare CT imaging-based pulmonary vasodilatation in patients with HPS, patients with liver dysfunction without HPS, and matching controls on CT imaging...
2016: PloS One
X Li, Y Chen, L Wang, G Shang, C Zhang, Z Zhao, H Zhang, A Liu
Quercetin shows protective effects against hepatopulmonary syndrome (HPS), as demonstrated in a rat model. However, whether these effects involve pulmonary vascular angiogenesis in HPS remains unclear. Therefore, this study aimed to assess the effect of quercetin on pulmonary vascular angiogenesis and explore the underlying mechanisms. Male Sprague-Dawley rats weighing 200-250 g underwent sham operation or common bile duct ligation (CBDL). Two weeks after surgery, HIF-1α and NFκB levels were assessed in rat lung tissue by immunohistochemistry and western blot...
July 4, 2016: Brazilian Journal of Medical and Biological Research, Revista Brasileira de Pesquisas Médicas e Biológicas
Marco Morosin, Carlo Vignati, Angela Novi, Elisabetta Salvioni, Fabrizio Veglia, Marina Alimento, Guido Merli, Susanna Sciomer, Gianfranco Sinagra, Piergiuseppe Agostoni
In chronic heart failure (HF), the alveolar-capillary membrane undergoes a remodeling process that negatively affects gas exchange. In case of alveolar-capillary gas diffusion impairment, arterial desaturation (SaO2) is rarely observed in HF patients. At play are 3 factors: overall pulmonary diffusing capacity (assessed as lung diffusion for CO, DLCO), global O2 consumption (VO2) and alveolar (A) to arterial (a) pO2 gradient (AaDO2). In 100 consecutive stable HF patients, DLCO, resting respiratory gases and arterial blood gases were measured to determine VO2, paO2, pAO2 and AaDO2...
July 1, 2016: Respiratory Physiology & Neurobiology
Matthias Held, Philipp Kolb, Maria Grün, Berthold Jany, Gudrun Hübner, Aleksandar Grgic, Regina Holl, Hans-Joachim Schaefers, Heinrike Wilkens
BACKGROUND: Patients with chronic thromboembolic pulmonary disease (CTED) have persistent pulmonary vascular obstruction and exercise intolerance without pulmonary hypertension at rest and may benefit from pulmonary endarterectomy. However, up to now, CTED has been poorly characterized. OBJECTIVES: This study aimed to analyze the exercise capacity and limiting factors in CTED. METHODS: We compared right heart catheterization and cardiopulmonary exercise test results of patients with CTED [mean pulmonary artery pressure (mPAP) at rest <25 mm Hg, n = 10], chronic thromboembolic pulmonary hypertension (CTEPH, n = 31) and a control group (n = 41) presenting with dyspnea but normal pulmonary vascular imaging and excluded pulmonary hypertension...
2016: Respiration; International Review of Thoracic Diseases
Caglar Cosarderelioglu, Arif M Cosar, Merve Gurakar, Nabil N Dagher, Ahmet Gurakar
A severe and common pulmonary vascular complication of liver disease is hepatopulmonary syndrome (HPS). It is a triad of liver dysfunction and/or portal hypertension, intrapulmonary vascular dilatations, and increased alveolar-arterial oxygen gradient. Prevalence varies according to various study groups from 4%-47%. While the most common presenting symptom of HPS is dyspnea, it is usually asymptomatic, and thus all liver transplant candidates should be screened for its presence. Pulse oximetry is a useful screening method, but arterial blood gas examination is the gold standard...
March 28, 2016: Journal of Clinical and Translational Hepatology
Wei Wu, Junlan Zhang, Wenli Yang, Bingqian Hu, Michael B Fallon
BACKGROUND AND AIM: Pulmonary monocyte infiltration plays a significant role in the development of angiogenesis in experimental hepatopulmonary syndrome (HPS) after common bile duct ligation (CBDL). Hepatic monocytes are also increased after CBDL but the origins remain unclear. Splenic reservoir monocytes have been identified as a major source of monocytes that accumulate in injured tissues. Whether splenic monocytes contribute to monocyte alterations after CBDL is unknown. This study evaluates monocyte distributions and assesses effects of splenectomy on monocyte levels and pulmonary vascular and hepatic abnormalities in experimental HPS...
March 31, 2016: Journal of Gastroenterology and Hepatology
Thierry Thévenot, Delphine Weil, Armand Garioud, Hortensia Lison, Jean-François Cadranel, Bruno Degano
Hepatopulmonary syndrome (HPS) is defined by the association of portal hypertension, increased alveolar-arterial oxygen gradient and intrapulmonary vascular dilations. Pathophysiological mechanisms of hypoxemia are characterized by ventilation-perfusion mismatch, oxygen diffusion limitation between alveolus and the centre of the dilated capillary, and right-to-left shunting. An excess of vasodilator molecules (like nitric monoxide) and proangiogenic factors (like VEGF) play an important role in the occurrence of HPS...
May 2016: La Presse Médicale
Abdullah Al-Harbi, Khalid Abdullah, Abdulmajeed Al-Abdulkareem, Ali Alghamdi, Hamdan Al-Jahdali
BACKGROUND: Hepatopulmonary syndrome (HPS) is commonly encountered in the setting of end-stage liver disease (ESLD). Past studies have reported conflicting results in terms of demonstrating an association between HPS and mortality. The aim of this study was to determine the prevalence of HPS in patients with ESLD referred for assessment of transplantation suitability. In addition, we investigated survival rates in the setting of HPS, with and without liver transplantation. MATERIAL AND METHODS: The medical records of 524 consecutive patients with ESLD evaluated for potential liver transplantation were retrospectively reviewed...
2016: Annals of Transplantation: Quarterly of the Polish Transplantation Society
Junichi Okamoto, Hirotoshi Kubokura, Jitsuo Usuda
BACKGROUND: In the elderly patients, optimal surgical treatment can be difficult to achieve, because of comorbidity. Therefore, we aimed to clarify the preferred surgical management in this patient group. METHODS: A retrospective study was conducted between April 2008 and March 2015 that included patients with non-small cell lung cancer (NSCLC) aged ≥ 75 years. RESULTS: We included 44 patients who underwent partial resection (n = 20) or lobectomy (n = 24)...
June 20, 2016: Annals of Thoracic and Cardiovascular Surgery
Gerwin E Engels, Jan van Klarenbosch, Y John Gu, Willem van Oeveren, Adrianus J de Vries
OBJECTIVES: In addition to its blood-sparing effects, intraoperative cell salvage may reduce lung injury following cardiac surgery by removing cytokines, neutrophilic proteases and lipids that are present in cardiotomy suction blood. To test this hypothesis, we performed serial measurements of biomarkers of the integrity of the alveolar-capillary membrane, leucocyte activation and general inflammation. We assessed lung injury clinically by the duration of postoperative mechanical ventilation and the alveolar arterial oxygen gradient...
March 2016: Interactive Cardiovascular and Thoracic Surgery
Toshihiro Okamoto, David Wheeler, Qiang Liu, Cristiano Quintini, J Steven Hata, Kenneth R McCurry
BACKGROUND: The pressure of arterial oxygen to fractional inspired oxygen concentration (PaO2/FiO2, P/F) ratio has been the gold standard in the assessment of transplant suitability in ex vivo lung perfusion (EVLP) with red blood cells. However, several reports using mathematical models and clinical data analysis suggest that the P/F ratio fluctuates at different FiO2. The purpose of this study was to examine the variations in P/F ratio at different FiO2 during EVLP and develop a practicable decision making algorithm in the EVLP...
December 2015: Transplantation
Yasuyuki Kaneko, Shidow Torisu, Mitsuyoshi Hagio, Ryoji Yamaguchi, Shinya Mizutani, Kiyokazu Naganobu
Hepatopulmonary syndrome (HPS) is a respiratory complication of hepatic disease, that is well recognized in humans and defined by the presence of 1) liver disease, 2) hypoxemia and/or high alveolar-arterial oxygen gradient (AaDO2) and 3) intrapulmonary vasodilatation. The present report describes a similar case of HPS in a dog. A six-month-old Papillon was diagnosed with ductal plate malformation with chronic active hepatitis and showed progressive increases in AaDO2 over the course of the following six months...
March 2016: Journal of Veterinary Medical Science
Masako Terao, Akinobu Takaki, Takayuki Maruyama, Hiroki Oe, Tetsuya Yasunaka, Naofumi Tamaki, Kazufumi Nakamura, Takaaki Tomofuji, Takahito Yagi, Hiroshi Sadamori, Yuzo Umeda, Susumu Shinoura, Ryuichi Yoshida, Kazuhiro Nouso, Daisuke Ekuni, Kazuko Koike, Fusao Ikeda, Hidenori Shiraha, Manabu Morita, Hiroshi Ito, Toshiyoshi Fujiwara, Kazuhide Yamamoto
OBJECTIVE: Hepatopulmonary syndrome (HPS) is characterized by vascular dilatation and hyperdynamic circulation, while portopulmonary hypertension (POPH) is characterized by vasoconstriction with fibrous obliteration of the vascular bed. Vasoactive molecules such as nitric oxide (NO) are candidate factors for cirrhotic complications associated with these diseases. However, oxidative stress balance is not well characterized in HPS and POPH. The present objective is to investigate the oxidative stress and anti-oxidative stress balance and NO pathway balance in patients with potential HPS and POPH...
2015: Internal Medicine
Roselyne Brat, Nadya Yousef, Roman Klifa, Stephanie Reynaud, Shivani Shankar Aguilera, Daniele De Luca
IMPORTANCE: Lung ultrasonography (LUS) is a bedside technique useful to diagnose neonatal respiratory problems, but, to our knowledge, no data are available about its use for monitoring lung function or eventually guiding surfactant therapy. OBJECTIVE: To determine the diagnostic accuracy of a neonatal-adapted LUS score to evaluate oxygenation and predict need for surfactant administration. DESIGN, SETTING, AND PARTICIPANTS: Prospective diagnostic accuracy study following STARD (Standards for the Reporting of Diagnostic Accuracy Studies) guidelines at a tertiary level academic neonatal intensive care unit in 2014...
August 2015: JAMA Pediatrics
Youn Yi Jo, Ji Young Kim, Chun Kon Park, Young Jin Chang, Hyun Jeong Kwak
BACKGROUND: We investigated the effect of prolonged inspiratory to expiratory (I/E) ratio ventilation on respiratory mechanics, gas exchange, and regional cerebral oxygen saturation (rSO2) in obese patients undergoing laparoscopic bariatric surgery in the reverse Trendelenburg position. METHODS: Twenty-eight adult patients scheduled for laparoscopic sleeve gastrectomy were enrolled in this prospective observational study. After anesthesia induction, pressure-controlled ventilation was conducted initially at a conventional I/E ratio of 1:2 and a positive end-expiratory pressure of 5 cmH2O...
February 2016: Obesity Surgery
Satoshi Watanabe, Yuko Waseda, Hazuki Takato, Ryo Matsunuma, Takeshi Johkoh, Ryoko Egashira, Yoshinori Kawabata, Hiroko Ikeda, Masahide Yasui, Masaki Fujimura, Kazuo Kasahara
BACKGROUND: Pleuroparenchymal fibroelastosis (PPFE) is a rare idiopathic interstitial pneumonia defined by pleural and subpleural parenchymal fibrosis predominantly in the upper lobes. Although the radiological and pathological characteristics of PPFE have become increasingly recognized, its pulmonary physiological features are not well understood. METHODS: We reviewed nine patients with radiologically and histologically proven PPFE, and evaluated pulmonary physiological data...
July 2015: Respiratory Investigation
Lynn A Fussner, Vivek N Iyer, Rodrigo Cartin-Ceba, Grace Lin, Kymberly D Watt, Michael J Krowka
Hepatopulmonary syndrome (HPS) and portopulmonary hypertension (POPH) are pulmonary vascular complications of portal hypertension with divergent clinicopathologic features and management. The presence of intrapulmonary vascular dilatations (IPVDs), detected by agitated saline contrast-enhanced transthoracic echocardiography (cTTE), is an essential feature of HPS but is not typically characteristic of POPH. Although IPVDs have been reported rarely in POPH, the prevalence and significance of this finding have not been systematically studied...
November 2015: Liver Transplantation
Peter Buss, Francisco Olea-Popelka, Leith Meyer, Jennifer Hofmeyr, Nomkhosi Mathebula, Marius Kruger, Angela Brüns, Laura Martin, Michele Miller
Ten white rhinoceros (Ceratotherium simum) were immobilized for a total of 13 procedures in holding facilities in Kruger National Park using etorphine, azaperone, and hyaluronidase to assess the effect of extended immobilization on serial cardiorespiratory, blood gas, and lactate values. Butorphanol was administered intravenously following initial blood collection and physiologic assessment (t=0). Respiratory and cardiovascular parameters, body temperature, and arterial blood gases were monitored at 10-min intervals for a total of 100 min...
June 2015: Journal of Zoo and Wildlife Medicine: Official Publication of the American Association of Zoo Veterinarians
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