Background Serum lactate and central venous oxygen saturation (ScvO 2 ) are commonly used and commonly recommended as markers of tissue oxygenation in shock states. Medical literature has both explicitly stated and implied that the two biomarkers are interchangeable in the management of patients with shock. However, there have been relatively few direct comparisons of these tests in clinical circumstances, and the relationship between them is uncertain. The objective of our study was to evaluate whether simultaneous or near-simultaneous measurements of lactate and ScvO 2 reveal a consistent relationship between these two biomarkers. Methods A retrospective cohort study was conducted in an urban, academic US hospital. All adults in ICUs between March 2007 and March 2017 who had a lactate measurement and ScvO 2 or mixed venous oxygen saturation (SvO 2 ) measurement made +/− 1 h from the lactate were included. Linear and non-linear correlations of ScvO 2 and lactate were assessed in a variety of shock states. Results Two thousand sixty-two patients were included. Lactate and ScvO 2 correlated poorly ( r 2 = 0.0041, p = 0.0019). This was true for patients with ScvO 2 ≤ 65% ( r 2 = 0.0431, p < 0.001), patients with normal kidney and liver function ( r 2 = 0.0517, p < 0.001), and septic shock patients ( r 2 = 0.0037, p = 0.17). For patients with an O 2 extraction ratio ≥ 50%, lactate and ScvO 2 were strongly correlated ( r 2 = 0.93, p = 0.0019), but these patients represented only 2.8% of patients in whom the ratio could be calculated. Conclusions Lactate can predict ScvO 2 when patients are at or below the critical oxygen delivery threshold, but relatively few shock patients meet this criterion. In the overall population of critically ill patients, serum lactate predicts ScvO 2 poorly, even after controlling for factors that may affect lactate production. Lactate and ScvO 2 should not be assumed to be interchangeable markers of tissue oxygenation/perfusion. Electronic supplementary material The online version of this article (10.1186/s40560-019-0401-5) contains supplementary material, which is available to authorized users.
Background: Specific antibody deficiency is a primary immunodeficiency characterized by normal immunoglobulins with an inadequate response to polysaccharide antigen vaccination. This disease can result in recurrent infections, the most common being sinopulmonary infections. Treatment options include clinical observation, prophylactic antibiotic therapy, and immunoglobulin supplementation therapy, each with limited clinical data about their efficacy. Objective: This study aimed to identify whether there was a statistically significant difference in the rate of infections for patients who were managed with clinical observation, prophylactic antibiotics, or immunoglobulin supplementation therapy. Methods: A retrospective chart review was conducted. Patients were eligible for the study if they had normal immunoglobulin levels, an inadequate antibody response to polysaccharide antigen‐based vaccination, and no other known causes of immunodeficiency. Results: A total of 26 patients with specific antibody deficiency were identified. Eleven patients were managed with immunoglobulin supplementation, ten with clinical observation, and five with prophylactic antibiotic therapy. The frequency of antibiotic prescriptions was assessed for the first year after intervention. A statistically significant rate of decreased antibiotic prescriptions after intervention was found for patients treated with immunoglobulin supplementation (n = 11; p = 0.0004) and for patients on prophylactic antibiotics (n = 5; p = 0.01). There was no statistical difference in antibiotic prescriptions for those patients treated with immunoglobulin supplementation versus prophylactic antibiotics (p = 0.21). Conclusion: Prophylactic antibiotics seemed to be equally effective as immunoglobin supplementation therapy for the treatment of specific antibody deficiency. Further studies are needed in this area.
RATIONALE: Small airway (bronchioles less than 2 mm in diameter) means less than 10% of total airway resistance. In despite of it is not commonly used at clinical practice because its variability, its dysfunction has been closely linked with severity of asthma (both with symptoms and with respiratory tests). METHODS: We have done an observational retrospective study to evaluate the relationship between small airways dysfunction and bronchial hyperresponsiveness (BHR). We studied the small airway in 70 spirometries and the presence or not of BHR through methacholine provocations. We analyzed them with Student T-Test. RESULTS: There was no difference in sex or age. The patients without BHR have a forced expiratory volume in one-second (FEV1) value statistically superior to patients with BHR (3.35vs2.93, p50.02). In the same way, the values of forced expiratory flow at 75% (FEF75%) and at 50% (FEF50%) of the vital capacity, are statistically lower in patients with BHR: FEF 75% 6.93vs5.51, p50.004; FEF 50% 4.18vs3.25, p50.00. The smallest airway, FEF25% has not shown difference statistically significant between the groups: 1.890vs1.385, p50.09. No correlation was found between the patients who also have rhinitis symptoms, p 5 0.88. Neither it was a difference with other markers, such as fraction of exhaled nitric oxide, FENO (p50.15). CONCLUSIONS: Increasing evidence shows the relationship between the small airways and the clinical expression and severity of asthma. This study concludes the importance of small airway to predict bronchial hyperresponsiveness especially FEF75% and FEF50%. A better understanding of the role small airways is playing in asthma is needed.
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