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Calculated PaCO2

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1. Calculated PaCO2

Calculated PaCO2 Calculated PaCO2 Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Calculated PaCO2 Calculated PaCO2 Aka: Calculated (...) PaCO2 , Winter's Formula II. Calculation: Calculated PaCO2 in Respiratory Conditions Increase by 10 mmHg Acute : decreases pH 0.08 Chronic : decreases pH 0.03 Decrease by 10 mmHg Acute : increases pH 0.08 Chronic : increases pH 0.03 III. Calculation: Calculated PaCO2 in Metabolic Conditions with expected compensation = 1.5 x HCO3 + 8 (+/- 2) Delta = 1.2 x BicarbDelta will not typically drop below 10 mmHg in respiratory compensation with expected compensation = 0.7 x HCO3 + 20 (+/- 1.5) IV

2018 FP Notebook

2. Calculated arterial blood gas values from a venous sample and pulse oximetry: Clinical validation. Full Text available with Trip Pro

Calculated arterial blood gas values from a venous sample and pulse oximetry: Clinical validation. Arterial blood gases (ABG) are essential for assessment of patients with severe illness, but sampling is difficult in some settings and more painful than for peripheral venous blood gas (VBG). Venous to Arterial Conversion (v-TAC; OBIMedical ApS, Denmark) is a method to calculate ABG values from a VBG and pulse oximetry (SpO2). The aim was to validate v-TAC against ABG for measuring pH, carbon (...) dioxide (pCO2) and oxygenation (pO2).Of 103 sample sets, 87 paired ABGs and VBGs with SpO2 from 46 inpatients eligible for ABG met strict sampling criteria. Agreement was evaluated using mean difference with 95% limits of agreement (LoA) and Bland-Altman plots.v-TAC had very high agreement with ABG for pH (mean diff(ABG-v-TAC) -0.001; 95% LoA -0.017 to 0.016), pCO2 (-0.14 kPa; 95% LoA -0.46 to 0.19) and moderate to high for pO2 (-0.28 kPa; 95% LoA -1.31 to 0.76). For detecting hypercapnia (PaCO2>6.0

2019 PLoS ONE

3. Calculated PaCO2

Calculated PaCO2 Calculated PaCO2 Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Calculated PaCO2 Calculated PaCO2 Aka: Calculated (...) PaCO2 , Winter's Formula II. Calculation: Calculated PaCO2 in Respiratory Conditions Increase by 10 mmHg Acute : decreases pH 0.08 Chronic : decreases pH 0.03 Decrease by 10 mmHg Acute : increases pH 0.08 Chronic : increases pH 0.03 III. Calculation: Calculated PaCO2 in Metabolic Conditions with expected compensation = 1.5 x HCO3 + 8 (+/- 2) Delta = 1.2 x BicarbDelta will not typically drop below 10 mmHg in respiratory compensation with expected compensation = 0.7 x HCO3 + 20 (+/- 1.5) IV

2015 FP Notebook

4. The Effect of Position on PaCO2 and PETCO2 in Patients Undergoing Cervical Spine Surgery in Supine and Prone Position. (Abstract)

arterial cannula was placed. General anesthesia administered and oral endotracheal intubation done. Baseline values of systolic blood pressure, diastolic blood pressure, mean arterial pressure, heart rate, temperature, SpO2, Ppeak, Pmean, and Pplateau were measured in supine position. For each patient the capnometer was calibrated before use. The P(a-ET)CO2 was calculated in supine position (S1). The PaCO2 and ETCO2 were measured after prone positioning P1, at each subsequent hour (P2, P3, P4 (...) The Effect of Position on PaCO2 and PETCO2 in Patients Undergoing Cervical Spine Surgery in Supine and Prone Position. As per American Society of Anesthesiologists guidelines, continuous monitoring of end tidal carbon dioxide (PETCO2) is recommended as standard II basics of anesthetic monitoring especially to ensure adequate ventilation during all anesthetics. Continuous monitoring of PETCO2 can also be used as a guide to maintain the partial pressure of carbon dioxide in arterial blood (PaCO2

2016 Journal of neurosurgical anesthesiology

5. Can Transcutaneous CO2 Tension Be Used to Calculate Ventilatory Dead Space? A Pilot Study Full Text available with Trip Pro

Can Transcutaneous CO2 Tension Be Used to Calculate Ventilatory Dead Space? A Pilot Study Dead space fraction (V d/V t) measurement performed using volumetric capnography requires arterial blood gas (ABG) sampling to estimate the partial pressure of carbon dioxide (PaCO2). In recent years, transcutaneous capnography (PtcCO2) has emerged as a noninvasive method of estimating PaCO2. We hypothesized that PtcCO2 can be used as a substitute for PaCO2 in the calculation of V d/V t (...) . In this prospective pilot comparison study, 30 consecutive postcardiac surgery mechanically ventilated patients had V d/V t calculated separately using volumetric capnography by substituting PtcCO2 for PaCO2. The mean V d/V t calculated using PaCO2 and PtcCO2 was 0.48 ± 0.09 and 0.53 ± 0.08, respectively, with a strong positive correlation between the two methods of calculation (Pearson's correlation = 0.87, p < 0.05). Bland-Altman analysis showed a mean difference of -0.05 (95% CI: -0.01 to -0.09) between

2016 Critical care research and practice

6. British guideline on the management of asthma

with diurnal variation was more accurate than calculating the mean variation. Strategies for detecting eosinophilic inflammation or atopy FeNO Adults: Regard a FeNO level of 40 ppb or more as a positive test Children 5?16yrs: regard a FeNO level of 35 ppb or more as a positive test. FeNO in adults FeNO in schoolchildren 43–88% 57% 60–92% 87% 54–95% 90% 65–93% 49% These studies are all in secondary care populations. Approximately one in five adults with a positive FeNO test will not have asthma (ie false

2019 SIGN

7. Sleep Disorder Management

Med. 2011;183(9):1238-1244. 6. Levendowski D, Steward D, Woodson BT, et al. The impact of obstructive sleep apnea variability measured in-lab versus in- home on sample size calculations. Int Arch Med. 2009;2(1):2. 7. Mulgrew AT, Fox N, Ayas NT, Ryan CF. Diagnosis and initial management of obstructive sleep apnea without polysomnography a randomized validation study. Ann Intern Med. 2007;146:157-166. 8. Rosen CL, Auckley D, Benca R, et al. A multisite randomized trial of portable sleep studies

2020 AIM Specialty Health

8. BTS/SIGN British Guideline on the Management of Asthma

with diurnal variation was more accurate than calculating the mean variation. Strategies for detecting eosinophilic inflammation or atopy FeNO Adults: Regard a FeNO level of 40 ppb or more as a positive test Children 5?16yrs: regard a FeNO level of 35 ppb or more as a positive test. FeNO in adults FeNO in schoolchildren 43–88% 57% 60–92% 87% 54–95% 90% 65–93% 49% These studies are all in secondary care populations. Approximately one in five adults with a positive FeNO test will not have asthma (ie false

2019 British Thoracic Society

9. AIM Clinical Appropriateness Guidelines for Sleep Disorder Management

, Woodson BT, et al. The impact of obstructive sleep apnea variability measured in-lab versus in-home on sample size calculations. Int Arch Med. 2009;2(1):2. 7. Mulgrew AT, Fox N, Ayas NT, Ryan CF. Diagnosis and initial management of obstructive sleep apnea without polysomnography a randomized validation study. Ann Intern Med. 2007;146:157-166. 8. Rosen CL, Auckley D, Benca R, et al. A multisite randomized trial of portable sleep studies and positive airway pressure autotitration versus laboratory-based

2019 AIM Specialty Health

10. CRACKCast E144 – High Altitude Medicine

not result in similar problems. [4] How do you calculate the alveolar partial pressure of oxygen? As described by the alveolar gas equation, for any given inspired oxygen tension, the level of ventilation determines alveolar oxygen: as the Paco2 decreases, Pao2 correspondingly increases. The factors that determine the values for pO 2 and are: The pressure of outside air The partial pressures of inspired oxygen and carbon dioxide The rates of total body oxygen consumption and carbon dioxide production

2018 CandiEM

11. Neonatal stabilisation for retrieval

work of breathing · Respiratory acidosis (e.g. pH less than 7.25 or partial pressure of carbon dioxide (PaCO2) greater than 60 mmHg) · Increasing apnoeic episodes · Increasing bradycardic episodes · Refer to Table 10. Intermittent positive pressure ventilation Care 33 · Observe nares and nasal septum for redness · If CPAP or bubble not being maintained: o Check circuit—set up, patency o Reposition CPAP delivery device o Reposition the baby o Maintain seal o Reassess prong size o Place chin strap (...) Sternal recession o Nasal flaring o Audible expiratory grunt o Apnoea not responding to treatment · Poor gas exchange evident by blood gas pH less than 7.25 and PaCO2 greater that 60 mmHg Intubation · Consider sedation [refer to Section 9.1.1 Morphine sulphate] · Use size and insertion length/depth according to baby’s weight 35 · Assess position o Condensation on inside of ETT during exhalation o Equal chest wall movement o Symmetrical air entry over lung fields o Colour change on a colorimetric end

2018 Clinical Practice Guidelines Portal

12. CRACKCast E124 – Acid-Base Disorders

of bicarbonate (HCO3) and carbon dioxide (Paco2) = [1.5 × serum HCO3 − ] + [8 ± 2]; when two of these variables are known, the third may be calculated. Most blood gas analyzers measure pH and Paco2 and report a calculated [HCO3 − ]. When only a primary disturbance and its corresponding compensation are present, it is described as a simple acid-base disorder. A mixed acid-base disorder exists when more than one primary disturbance occurs simultaneously. Key thought process: Is this a simple ABD or a mixed ABD (...) by adding 150 mEq sodium bicarbonate (three crash cart ampules, which are usually 50 mL of 8.4% solution) to 1 L of 5% D5W, infusing as slowly as the clinical situation permits (eg, 75–200 mL/hr). Sodium bicarbonate should generally not be added to normal saline because of concern of hypertonicity. Winter’s equation (Paco2 = [1.5 × serum HCO3] + [8 ± 2]) can be used to calculate the expected arterial Pco2 for the serum bicarbonate level. If the Pco2 is higher than expected, the patient may be fatiguing

2017 CandiEM

13. Sleep Disorder Management Diagnostic & Treatment Guidelines

, Woodson BT, et al. The impact of obstructive sleep apnea variability measured in-lab versus in-home on sample size calculations. Int Arch Med. 2009;2(1):2. 7. Mulgrew AT, Fox N, Ayas NT, Ryan CF. Diagnosis and initial management of obstructive sleep apnea without polysomnography a randomized validation study. Ann Intern Med. 2007;146:157-166. 8. Rosen CL, Auckley D, Benca R, et al. A multisite randomized trial of portable sleep studies and positive airway pressure autotitration versus laboratory-based

2017 AIM Specialty Health

14. Post-Resuscitation Therapy in Adult Advanced Life Support

maintaining PaCO2 within a normal physiological range as part of a post-ROSC bundle of care. 6. ANZCOR suggests no modification of standard glucose management protocols for adults with ROSC after cardiac arrest. 7. Providers should monitor blood glucose frequently after cardiac arrest and should treat hyperglycemia (>10 mmol/l) with insulin but avoid hypoglycemia. 8. It may be reasonable to continue an infusion of an antiarrhythmic drug that successfully restored a stable rhythm during resuscitation (e.g (...) opinion]. See also Guideline 11.6.1. 1.3 Control of arterial carbon dioxide Five studies in adults and numerous animal studies documented harmful effects of hypocapnia (cerebral ischemia) after cardiac arrest. Two studies provide neutral evidence. ANZCOR Guideline 11.7 January 2016 Page 8 of 17 There are no data to support the targeting of a specific PaCO2 after resuscitation from cardiac arrest. Data extrapolated from patients with brain injury however, imply that ventilation to normocarbia (e.g

2016 Australian Resuscitation Council

15. The Early Change in Pa<sub>CO<sub>2</sub></sub> after Extracorporeal Membrane Oxygenation Initiation Is Associated with Neurological Complications. (Abstract)

of neurological complications in patients with respiratory failure.Methods: We conducted a multicenter, international, retrospective cohort study using the Extracorporeal Life Support Organization Registry, including adults with respiratory failure receiving ECMO via any mode between 2012 and 2017. The relative change in PaCO2 in the first 24 hours was calculated as (24-h post-ECMO PaCO2 - pre-ECMO PaCO2)/pre-ECMO PaCO2. The primary outcome was the occurrence of neurological complications, defined as seizures (...) The Early Change in PaCO2 after Extracorporeal Membrane Oxygenation Initiation Is Associated with Neurological Complications. Rationale: Large decreases in PaCO2 that occur when initiating extracorporeal membrane oxygenation (ECMO) in patients with respiratory failure may cause cerebral vasoconstriction and compromise brain tissue perfusion.Objectives: To determine if the magnitude of PaCO2 correction upon ECMO initiation is associated with an increased incidence

2020 American journal of respiratory and critical care medicine

16. Effects of high-flow nasal cannula in patients with persistent hypercapnia after an acute COPD exacerbation: a prospective pilot study. Full Text available with Trip Pro

the level of PaCO2 after 72 h only in "pure" COPD patients, recovering from AHRF. No effects in terms of CO2 reduction were found in those with overlap syndrome. The present findings will help guide selection of the best target population and allow a sample size calculation for future long-term randomized control trials of HFNC vs NIV.This study is registered with www. clinicaltrials.gov with identifier number NCT03759457. (...) Effects of high-flow nasal cannula in patients with persistent hypercapnia after an acute COPD exacerbation: a prospective pilot study. Persistent hypercapnia after COPD exacerbation is associated with excess mortality and early rehospitalization. High Flow Nasal cannula (HFNC), may be theoretically an alternative to long-term noninvasive ventilation (NIV), since physiological studies have shown a reduction in PaCO2 level after few hours of treatment. In this clinical study we assessed

2020 BMC pulmonary medicine

17. Evaluating a novel formula for noninvasive estimation of arterial carbon dioxide during postresuscitation care. (Abstract)

arrest patients.A total of 4,741 data sets were collected retrospectively from 233 resuscitated patients undergoing therapeutic hypothermia. The original formula used to analyze the data is PaCO2 -est1= PETCO2 +k[(PIO2 -PETCO2 ) -PaO2 ]. To achieve better accuracy, we further modified the formula to PaCO2 -est2= k1 *PETCO2 + k2 *(PIO2 -PETCO2 )+k3 *(100-SpO2 ). The coefficients were determined by identifying the minimal difference between the measured and calculated arterial carbon dioxide values (...) in a development set. The accuracy of these two methods was compared with the estimation of the partial pressure of carbon dioxide using end-tidal carbon dioxide.With PaCO2 -est1, the mean difference between the partial pressure of carbon dioxide, and the estimated carbon dioxide was 0.08 kPa (SE ± 0.003); with PaCO2 -est2 the difference was 0.036 kPa (SE ± 0.009). The mean difference between the partial pressure of carbon dioxide and end-tidal carbon dioxide was 0.72 kPa (SE ± 0.01). In a mixed linear model

2020 Acta Anaesthesiologica Scandinavica

18. CRACKCast E008 – Brain Resuscitation

is imminently herniating PaCO2 = 35-45 avoid hypoxia and hyperoxia PaO2: 80-120 (18% higher mortality when PaO2 =300 for long periods) Maintenance of body temperature fever is damaging to the brain (increases metabolic demand 10% per degree C) monitor core body temp: rectal, esophageal, bladder or vaginal temp managed with antipyretics, cooling with fans +/- misting, commercial cooling devices What about resuscitative mild hypothermia? stay tuned for question 3 but no clear mechanism Treatment (...) support a CPP of 50-70mmHg in patients with severe traumatic brain injury (this is usually calculated for patients once in the neuro-ICU) Note: this is a gross oversimplification of a complicated fellowship topic. The key take home point is that we need to do whatever we can to protect the injured brain because it does a finite ability to auto-regulate! 2) Wisecracks Essential Evidence: Target Temperature Management at 330C versus 360C after Cardiac Arrest (Nielsen et al. 2013) 1 Worldwide, Nielsen et

2016 CandiEM

19. Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient

predictive equation or a simplistic weight-based equation (25–30 kcal/kg/day) be used to determine energy requirements. (See section Q for obesity recommendations.) Rationale: Clinicians should determine energy requirements in order to establish the goals of nutrition therapy. Energy requirements may be calculated either through simplistic formulas (25–30 kcal/kg/day), published predictive equations, or IC. The applicability of IC may be limited at most institutions by availability and cost. Variables (...) should be advanced toward goal as quickly as tolerated over 24–48 hours while monitoring for refeeding syndrome. Efforts to provide > 80% of estimated or calculated goal energy and protein within 48–72 hours should be made in order to achieve the clinical benefit of EN over the first week of hospitalization. Rationale: Trophic feeds (usually defined as 10–20 mL/hr or 10–20 kcal/hr) may be sufficient to prevent mucosal atrophy and maintain gut integrity in low- to moderate-risk patients, but may

2016 Society of Critical Care Medicine

20. Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient

based on the top guidelines (as voted on by the committee) for the bedside practitioner is presented in . Table 2. Bundle Statements. • Assess patients on admission to the intensive care unit (ICU) for nutrition risk, and calculate both energy and protein requirements to determine goals of nutrition therapy. • Initiate enteral nutrition (EN) within 24−48 hours following the onset of critical illness and admission to the ICU, and increase to goals over the first week of ICU stay. • Take steps (...) . (See section Q for obesity recommendations.) Rationale: Clinicians should determine energy requirements to establish the goals of nutrition therapy. Energy requirements may be calculated through simplistic formulas (25–30 kcal/kg/d), published predictive equations, or IC. The applicability of IC may be limited at most institutions by availability and cost. Variables in the ICU that affect the timing and accuracy of IC measurements include the presence of air leaks or chest tubes, supplemental

2016 American Society for Parenteral and Enteral Nutrition

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