Prognostic Value of Arterial/Alveolar Oxygen Tension Ratio (a/APO2) in Acute Pulmonary Embolism

Hsu, Jen Te; Chu, Chi Ming; Chang, Shih Tai; Cheng, Hui; Lin, Pi Chi; Hsu, Tsu Shiu; Hsiao, Ju Feng; Ho, Wan Ching; Chung, Chang Min

doi:10.1253/circj.71.1560

Cited by 12 publications

(5 citation statements)

References 33 publications

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“…PaO 2 values have been demonstrated to be linearly associated to CTPA parameters such as proximal extension of pulmonary clots and RV/LV diameter 41. Parameters derived from BGA, such as alveolar-arterial oxygen gradient (values > 50 mmHg) and arterial–alveolar oxygen tension ratio (values < 0.50) have been demonstrated to be associated to poor prognosis in nonelderly patients with PE 51,52. Moreover, alveolar dead space measured from volumetric capnography and BGA seems to correlate with embolic burden of PE 53.…”

Section: Risk Evaluation and Prognostic Stratificationmentioning

confidence: 99%

Prognostic stratification of acute pulmonary embolism: Focus on clinical aspects, imaging, and biomarkers

Masotti¹,

Righini²,

Vuilleumier³

et al. 2009

VHRM

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Pulmonary embolism (PE) represents a common disease in emergency medicine and guidelines for diagnosis and treatment have had wide diffusion. However, PE morbidity and mortality remain high, especially when associated to hemodynamic instability or right ventricular dysfunction. Prognostic stratification to identify high risk patients needing to receive more aggressive pharmacological and closer monitoring is of utmost importance. Modern guidelines for management of acute PE are based on risk stratification using either clinical, radiological, or laboratory findings. This article reviews the modern treatment of acute PE, which is customized upon patient prognosis. Accordingly the current risk stratification tools described in the literature such as clinical scores, echocardiography, helical computer tomography, and biomarkers will be reviewed.

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Section: Risk Evaluation and Prognostic Stratificationmentioning

confidence: 99%

Prognostic stratification of acute pulmonary embolism: Focus on clinical aspects, imaging, and biomarkers

Masotti¹,

Righini²,

Vuilleumier³

et al. 2009

VHRM

View full text Add to dashboard Cite

show abstract

“…The degree of hypoxemia is known to be directly proportional to the extent of thromboembolic occlusion 52 . Two recent publications have suggested that humans with confirmed PTE who have an A‐a gradient >53 mm Hg or an arterial:alveolar oxygen tension ratio <0.49 have a poor prognosis 53,54 . It is unknown whether similar relationships exist in small animals.…”

Section: Diagnosismentioning

confidence: 99%

Pulmonary thromboembolism

Goggs

Benigni

Fuentes

et al. 2009

J Vet Emergen Crit Care

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Objective -To review the pathophysiology, clinical signs, diagnosis, and treatment of pulmonary thromboembolism (PTE) in small animals. Data Sources -Human and veterinary clinical studies, reviews, texts, and recent research in canine and feline PTE diagnosis and thromboembolic therapeutics. Human Data Synthesis -In humans, clinical probability assessment and point-of-care D-dimer-based algorithms are widely used. Computed tomography pulmonary angiography is the gold standard for PTE diagnosis in humans. Echocardiography is increasingly used for bedside assessment of affected patients. In low-risk human patients anticoagulants alone are recommended while patients with cardiogenic shock are treated with thrombolytics followed by anticoagulation. Veterinary Data Synthesis -PTE is associated with numerous predisposing conditions causing hypercoagulability, blood flow stasis, or endothelial injury. Identifying at-risk patients is key to diagnosis in small animals. Thromboelastography provides a method for identifying hypercoagulable patients. Computed tomography pulmonary angiography may replace selective pulmonary angiography as the imaging technique of choice for PTE diagnosis. PTE therapy consists of supportive treatment combined with appropriate, individualized thromboembolic pharmacotherapy for acute treatment and chronic management. Thrombolytic therapy for PTE remains controversial but may be indicated in hemodynamically unstable acute PTE. Thromboprophylaxis in specific conditions is rational although evidence of efficacy is limited. Prognosis depends upon degree of cardiopulmonary compromise and patient response to therapy. Mortality rates in small animals are unknown. Conclusions -New diagnostic techniques and advances in therapy offer significant potential for improvements in the identification and treatment of PTE in small animals. Further study must be directed to validating new diagnostic modalities and evaluating therapeutic regimes.

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“…The a/APO 2 has been found to be a reliable and consistent index of respiratory impairment over the range of FiO 2 from 0.21 to 1.0. Its constancy depends on the amount of ventilation/perfusion mismatch and of shunting being its greater constancy found in patients with large shunts 34 . Therefore, this index is of particular interest in preterm infants who are often affected by both ventilation/perfusion mismatch (i.e., severe RDS, PPH) and shunts (i.e., hemodynamic significant PDA).…”

Section: Discussionmentioning

confidence: 99%

Measurement of lung oxygenation by near‐infrared spectroscopy in preterm infants with respiratory distress syndrome: A proof‐of‐concept study

Dani

Ciarcià

Miselli

et al. 2022

Pediatric Pulmonology

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Introduction: Noninvasive markers more accurate than FiO 2 would be useful to assess the severity of RDS and guide its treatment. Our aim was to assess for the first time the possibility of continuously monitoring lung oxygenation (rSO 2 L) by near-infrared spectroscopy (NIRS) and to evaluate whether rSO 2 L correlates with other oxygenation indices and RDS severity. Methods:We carried out this proof-of-concept study on 20 preterm infants with RDS requiring noninvasive respiratory support. Patients were continuously studied for 24 h by NIRS and rSO 2 L was correlated with SpO 2 /FiO 2 ratio, a/APO 2 , and O.I. Results:The overall value of rSO 2 L was 80.1 ± 6.2%, without significant differences between the right and left hemithorax (80.2 ± 6.7 vs. 80.0 ± 5.7%; p = 0.869). Mean values of total, right, and left rSO 2 L did not significantly change during the 24-h study period. Linear regression analysis demonstrated a significant positive relationship between total rSO 2 L and SpO 2 /FiO 2 ratio (p < 0.001) and a/APO 2 (p = 0.040), and a negative relationship between total rSO 2 L and O.I. (r = −0.309; p = 0.022).Conclusions: Continuous monitoring of rSO 2 L by NIRS in preterm infants with RDS is feasible and safe. The correlation of rSO 2 L with other indices of oxygenation and RDS severity supports the accuracy and reliability of this measurement.

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Prognostic Value of Arterial/Alveolar Oxygen Tension Ratio (a/APO2) in Acute Pulmonary Embolism

Cited by 12 publications

References 33 publications

Prognostic stratification of acute pulmonary embolism: Focus on clinical aspects, imaging, and biomarkers

Prognostic stratification of acute pulmonary embolism: Focus on clinical aspects, imaging, and biomarkers

Pulmonary thromboembolism

Measurement of lung oxygenation by near‐infrared spectroscopy in preterm infants with respiratory distress syndrome: A proof‐of‐concept study

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