在二氧化碳分析用的材料利用过期的CO 2监测的障碍之一，居住在急诊医师所用的材料悬殊。为了澄清这种情况下，重要的是要区分患者是否是人为的通风，或自主呼吸。至于其余的，不再进行分析使用了不同的技术的临床效果和效率的含义。 本声明，主张在支流和主流二氧化碳分析之间的传统区别的情况下。这两种技术措施的CO 2使用红外波;侧流系统使用一个抽吸泵从口位于显示器探测器运输的CO 2，而主流的制度措施CO 2在一个小室直接在口中病人和电缆连接到显示器。传统，侧流系统是用于病人自发呼吸的系统重量更轻，和主流系统，有点笨重，是直接连接到气管内管插管患者。在过去几年的技术进步，从根本上降低了主流和支流系统之间的差异。新技术是指向microstream系统，这是一种“增强支流系统”，其中二氧化碳沿着旅行才到达探测器位于室的细管，使较小的过渡期之间的口和检测室和因此，二氧化碳分析曲线几乎是同步机票的嘴。因此，让我们看看有什么区别材料的选择，在下半年的视频序列作为解释： <ul><li>如果医生希望监察在自主呼吸的病人，以precocely检测呼吸暂停（程序镇静期间，或医疗中毒后），那么只有曲线的形式是必不可少的，ETCO 2不太重要的实际价值。在这种情况下，他的医生可以选择鼻塞或capnomask氧气和二氧化碳的愿望相结合，或薄的CO 2可以放在一个经典的面具下的愿望管之间。 </li><li>如果医生希望能够精确地分析ETCO 2，为了适应呼吸器参数，以验证气管插管的正确定位，或在心脏骤停患者的预后评估，他必须使用比可以适应使用的材料气管插管（总是放在后面的过滤器，以便从病人的分泌物不阻塞管）。 </li></ul>二氧化碳分析曲线在图1给出一个典型的二氧化碳分析曲线，在三个到期。曲线恢复在每一个灵感的X轴（0值），因为几乎没有吸入空气中的CO 2。 <img src="/files/ftp_upload/2508/2508fig1.jpg" alt="图1" /> 图1：alternance灵感过期 PACO 2和ETCO 2之间的差异这将是在位相信过期的CO 2，非侵入性的监测，在任何情况下都可以取代需要动脉血气（ABG）的措施，认为是黄金标准测量 PACO 2。一切都取决于过期的CO 2和患者的心肺状况测量的迹象。如果指示的呼吸活动的监控，以防止在低通气和呼吸暂停镇静，一个简单的曲线分析就足够了，无论ETCO 2的值。另一方面，如果指示监察足够的通风与头部外伤患者无心肺疾病史，我们可以预期ETCO值2氧分压值接近，但一个精确的必要性PACO 2值规定至少有一个ABG样品，这也使我们能够证实，确实ETCO 2 PACO 2，在本案中。 最后，如果我们面对的是一个病人插管和通风，因呼吸窘迫的情况下，ETCO 2值显然不是一个很好的近似PACO 2。原因很简单，只要有一个通气-灌注比例的干扰，不论什么心肺疾病目前，创建正确的CO 2由肺消除障碍。因此，CO 2在血液中积聚，鼻颊消除减少，创建PACO 2 - ETCO 2梯度。在这种情况下，关键是知道PACO 2的值之前任何解释ETCO值2。 视频序列的第一部分介绍了要遵循的程序解释PACO 2和ETCO 2之间的差异。我们看到，ETCO 2的措施是立即和在非侵入性的方式获得，但在这个阶段，不能让适应呼吸机的参数。这意味着有来衡量的，然后可以用比2的ETCO PACO 2。 PACO 2的值仍然是转介病人通风升值价值。 <ul><li>如果柏高2测量高于所需的值，例如60mmHg，40mmHg的，而不是，这意味着病人hypoventilated。呼吸机的参数，然后可以适应;呼吸频率或潮气量可以增加，以增加通风，从而减少PACO 2 。我们的目标包括减少20mmHg ETCO 2，无论初始ETCO值2。例如，它才能成为可能，ETCO值2 50mmHg时PACO 2 60mmHg测量，由于一个PACO 2 ETCO 2梯度创建一个心肺疾病的存在。适应呼吸机的参数，允许ETCO 2下降至50mmHg至30mmHg时，我们可以放心地假设一个PACO 2 60mmHg至40mmHg的下降值，病人有足够的通风。 </li><li>反之，如果PACO 2低于目标值时，病人是hyperventilated因此呼吸频率或潮气量必须减少，以达到目标值。如果PACO 2比目标值低20毫米汞柱，人们通过呼吸机的参数修改20mmHg增加ETCO 2。 </li></ul>文物和二氧化碳分析的陷阱。 如果CO 2测量技术已经成为可靠的精密度，重现性，响应时间和曲线质量方面，它仍存在，任何监视的参数，一定限度： <ul><li>第一个限制是由于缺乏有关的医生，谁不愿意使用技术的CO 2病理生理学的正确知识。我们希望这样的解释和随行的视频序列，将有助于解决这个限制。 </li><li>在自主呼吸的病人情况下，通过面罩oxygenotherapy附益会冲淡过期的CO 2，这将大大修改capnogram ETCO 2将下降。视频序列中演示了这种现象。 </li><li>如果一个人希望低通气或呼吸暂停事件监测程序镇静期间，我们预计ETCO 2，在相关PACO 2，增加平行病人通气不足。 Paradoxally，自发地在病人呼吸低通气事件是翻译ETCO 2下降，因为病人则只有一个非常小的潮气量，基本上相当于气管bronchal空间的死体积呼吸;和我们知道，这个空间不参与气体交换，从而包含很少的CO 2。 </li><li>机械通气期间，缺陷是忘记ETCO 2并不一定反映PACO 2（见前一章）。 </li></ul>

<ol>
	<li>Gravenstein, J. S., Jaffe, M. B., Paulus, D. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=.">.</a> Capnography, Clinical aspects. , (2004).</li><li>Kupnik, D., Skok, P. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Capnometry+in+the+prehospital+setting:+are+we+using+its+potential.">Capnometry in the prehospital setting: are we using its potential.</a> Emerg Med J. 24, 614-617 (2007).</li><li>Delorio, N. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Continuous+end-tidal+carbon+dioxide+monitoring+for+confirmation+of+endotracheal+tube+placement+is+neither+widely+available+nor+consistently+applied+by+emergency+physicians.">Continuous end-tidal carbon dioxide monitoring for confirmation of endotracheal tube placement is neither widely available nor consistently applied by emergency physicians.</a> Emerg Med J. 22, 490-493 (2005).</li><li>Burton, J. H., Harrah, J. D., Germann, C. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Does+end-tidal+carbon+dioxide+monitoring+detect+respiratory+events+prior+to+current+sedation+monitoring+practices?.">Does end-tidal carbon dioxide monitoring detect respiratory events prior to current sedation monitoring practices?.</a> Acad Emerg Med. 13, 500-504 (2006).</li><li>Fletcher, R., Jonson, B., Cumming, G., Brew, J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+concept+of+deadspace+with+special+reference+to+the+single+breath+test+for+carbon+dioxide.">The concept of deadspace with special reference to the single breath test for carbon dioxide.</a> Br J Anaesth. 53, 77-78 (1981).</li></ol>

有机体的CO 2的重要性在探索过期的CO 2监测，它是必不可少的角度把二氧化碳在人体发挥的作用一般。 CO 2是在大约每分钟200毫升的速度生产，不只是一个细胞的新陈代谢的副产品浪费。如果我们medullar的化学感受器维持动脉二氧化碳分压在40mmHg的（PACO 2）的作用，这是因为 CO 2已在机体的其他功能，急诊医师每天遇到： <ul><li> CO 2...

expired co2 measurement in intubated or spontaneously breathing patients from the emergency department

二氧化碳（CO 2）与氧气（O 2）的份额，在人体中最重要的气体的作用。过期的CO 2口的测量征求越来越多的各种迹象在急诊科医师的临床利益：（1）监测等监测插管病人气管插管的正确定位（2）核查; （3 ）在心脏骤停病人的监测;（4）实现normocapnia插管头部外伤患者;（​​5）在程序镇静监测通风。视频允许医生熟悉自己使用的二氧化碳分析和文本提供了理论和校长参与审查。特别是，生物体的重要性的CO 2，过期的CO 2测量的相关性，动脉和过期的CO 2，其文物和陷阱二氧化碳分析所用的材料之间的差异将予以审查。由于不愿意使用过期的CO 2测量的主要是由于缺乏正确的有关医师的 CO 2病理生理学知识，我们希望这个解释和随行的视频序列，将有助于解决这一限制。

Watch this Scientific Journal Video about Expired CO2 Measurement in Intubated or Spontaneously Breathing Patients from the Emergency Department at JoVE.com

Expired CO2 Measurement in Intubated or Spontaneously Breathing Patients from the Emergency Department

本视频介绍了如何执行CO<sub&gt; 2</sub&gt;测量气管插管以及自主呼吸的病人。主要临床指征的紧急情况是指：（1）核实足够的定位气管插管;（2）实现normocapnia外伤患者;（​​3）监测程序镇静的情况下通风。

过期的CO 2测量气管插管或自主呼吸的病人从急诊科

Carbon dioxide (CO2) along with oxygen (O2) share the role of being the most important gases in the human body. The measuring of expired CO2 at the mouth ...

expired-co2-measurement-intubated-or-spontaneously-breathing-patients

Research

JoVE Journal

Medicine

Expired CO2 Measurement in Intubated or Spontaneously Breathing Patients from the Emergency Department

16.1K 次观看.  Universit Catholique de Louvain Cliniques Universitaires Saint-Luc. 本视频介绍了如何执行CO 2测量气管插管以及自主呼吸的病人。主要临床指征的紧急情况是指：（1）核实足够的定位气管插管;（2）实现normocapnia外伤患者;（​​3）监测程序镇静的情况下通风。

视频: Expired CO2 Measurement in Intubated or Spontaneously Breathing Patients from the Emergency Department

Scleral Cross-linking Using Riboflavin and Ultraviolet-A Radiation for Prevention of Axial Myopia in a Rabbit Model

Myopic individuals, especially those with severe myopia, are at higher-than-normal risk of cataract, glaucoma, retinal detachment and chorioretinal abnormalities. In addition, pathological myopia is a common irreversible cause of visual impairment and blindness1-3. Our study demonstrates the effect of scleral crosslinking using riboflavin and ultraviolet-A radiation on the development of axial myopia in a rabbit model. The axial length of the eyeball was measured by A-scan ultrasound in New Zealand white rabbits aged 13 days (male and female). The eye then underwent 360&#176; conjunctival peritomy with scleral crosslinking, followed by tarsorrhaphy. Axial elongation was induced in 13 day-old New Zealand rabbits by suturing their right eye eyelids (tarsorrhaphy). The eyes were divided into quadrants, and every quadrant had two scleral irradiation zones, each with an area of 0.2 cm&#178; and a radius of 4 mm. Crosslinking was performed by dropping 0.1% dextran-free riboflavin-5-phosphate onto the irradiation zones 20 sec before ultraviolet-A irradiation and every 20 sec during the 200 sec irradiation time. UVA radiation (370 nm) was applied perpendicular to the sclera at 57 mW/cm&#178; (total UVA light dose, 57 J/cm&#178;). Tarsorrhaphies were removed on day 55, followed by repeated axial length measurements. This study demonstrates that scleral crosslinking with riboflavin and ultraviolet-A radiation effectively prevents occlusion-induced axial elongation in a rabbit model.

We demonstrate the effect of scleral crosslinking with riboflavin and UVA on an axial elongation rabbit eye. Axial elongation was induced in 13 day-old New Zealand rabbits (male and female) by suturing their right eye eyelids (tarsorrhaphy).

巩膜交联兔模型使用核黄素和紫外辐射的轴性近视防治

Myopic individuals, especially those with severe myopia, are at higher-than-normal risk of cataract, glaucoma, retinal detachment and chorioretinal ...

科研

医学

A Novel Approach for the Administration of Medications and Fluids in Emergency Scenarios and Settings

The available routes of administration commonly used for medications and fluids in the acute care setting are generally limited to oral, intravenous, or intraosseous routes, but in many patients, particularly in the emergency or critical care settings, these routes are often unavailable or time-consuming to access. A novel device is now available that offers an easy route for administration of medications or fluids via rectal mucosal absorption (also referred to as proctoclysis in the case of fluid administration and subsequent absorption). Although originally intended for the palliative care market, the utility of this device in the emergency setting has recently been described. Specifically, reports of patients being treated for dehydration, alcohol withdrawal, vomiting, fever, myocardial infarction, hyperthyroidism, and cardiac arrest have shown success with administration of a wide variety of medications or fluids (including water, aspirin, lorazepam, ondansetron, acetaminophen, methimazole, and buspirone). Device placement is straightforward, and based on the observation of expected effects from the medication administrations, absorption is rapid. The rapidity of absorption kinetics are further demonstrated in a recent report of the measurement of phenobarbital pharmacokinetics. We describe here the placement and use of this device, and demonstrate methods of pharmacokinetic measurements of medications administered by this method.

This study presents a novel device that offers an easy route to quickly provide medications and fluids in patients with limited or difficult IV access. This small-diameter device is placed in the distal third of the rectum, allowing for ongoing medication and fluids administration.

应急方案和设置药物和液体管理的新方法

The available routes of administration commonly used for medications and fluids in the acute care setting are generally limited to oral, intravenous, or ...

Setting Up a Stroke Team Algorithm and Conducting Simulation-based Training in the Emergency Department - A Practical Guide

Time is of the essence when caring for an acute stroke patient. The ultimate goal is to restore blood flow to the ischemic brain. This can be&#160;achieved by either&#160;thrombolysis with recombinant tissue-plasminogen activator (rt-PA), the standard therapy for stroke patients who present within the first hours of symptom onset without contraindications, or by an endovascular approach, if a proximal brain vessel occlusion is detected. As the efficacy of both therapies declines over time, every minute saved along the way will improve the patient&#39;s outcome.
This critical situation requires thorough work and precise communication with the patient, the family and colleagues from different professions to acquire all relevant information and reach the right decision while carefully monitoring the patient. This is a high fidelity situation. In nonmedical high-fidelity environments such as aviation, Crew Resource Management (CRM) is used to enhance safety and team efficiency.
This guide shows how a Stroke Team algorithm, which is transferable to other hospital settings, was established and how regular simulation-based trainings were performed. It requires determination and endurance to maintain these time-consuming simulation trainings on a regular basis over the course of time. However, the resulting improvement of team spirit and excellent door-to-needle times will benefit both the patients and the work environment in any hospital.
A dedicated Stroke Team of 7 persons who are notified 24/7 by a collective call via speed dial and run a binding algorithm that takes approximately 20 min, was established. To train everybody involved in this algorithm, a simulation-based team training for all new Stroke Team members was conceived and conducted at monthly intervals. This led to a relevant and sustained reduction of the mean door-to-needle time to 25 min, and enhanced the feeling of stroke readiness especially in junior doctors and nurses.

Every min counts in acute stroke care. This guide shows how to establish a Stroke Team algorithm and enhance its performance with regular simulation training. The principles of Crew Resource Management (CRM) facilitate a straight workflow, reduce door-to-needle times and increase staff satisfaction.

建立中风病研究小组算法并进行急诊科基于仿真的培训 - 实用指南

Time is of the essence when caring for an acute stroke patient. The ultimate goal is to restore blood flow to the ischemic brain. This can ...

Emergency Undocking in Robotic Surgery: A Simulation Curriculum

The following is a training platform to allow robotic surgeons to develop the skills necessary to lead an interprofessional team in emergency undocking of a robotic system. In traditional robotic training for surgeons, a brief web based overview of performing an emergency undocking is provided during initial introductory training to the robotics system. During such a process, there is no training in delineation of interdisciplinary roles for operating room (OR) personnel. The training presented here uses formative simulation and debriefing followed by a lecture. For the simulation, a modified gynecologic simulator is draped in a steep trendelenburg position consistent with most gynecologic laparoscopic surgery. The training torso is modified using tubing hooked to pressure bags of red food colored IV fluid used to simulate a catastrophic vessel injury on demand. Positioned throughout the operating room setting is an interprofessional team consisting of embedded standardized persons (ESPs) to fulfill the roles of a circulating nurse, scrub nurse, anesthesiologist, and bedside assist surgeon. Robotic surgeons are presented a case scenario necessitating emergency undocking, and given control of the robotic instruments. The scenario is terminated following either successful completion of an emergency undock, or at five minutes due to the emergent nature of the case. A debriefing session with hands on training of the steps to emergency undocking, necessary equipment, troubleshooting techniques, and operating room personnel roles follows the simulation. The learners are presented with a short lecture reemphasizing the material presented in the debriefing for their own self-study. This training results in improved time accessing the patient, improved knowledge, confidence, and completion of critical actions, and can be replicated in most institutions. All robotic surgeons should be able to demonstrate competence in this crucial intervention. A limitation of the curriculum is ability to access the in-situ environment for training purposes.

This training platform is designed to allow robotic surgeons to develop the skills necessary to lead an interprofessional team in emergency undocking of the robotic system. Training includes the utilization of the technology and equipment to perform an emergency undocking, as well as delineation of roles for such a scenario.

机器人手术中的紧急脱位: 一个模拟课程

The following is a training platform to allow robotic surgeons to develop the skills necessary to lead an interprofessional team in emergency undocking of ...

Setup and Execution Of the Blindfolded Code Training Exercise

Miscommunication is the most common cause of preventable patient harm in medicine. Currently, there is limited knowledge of innovative techniques to improve resident physician communication and leadership strategies in high-acuity situations. The blindfolded code training exercise removes visual stimuli from the team leader, forcing the team leader to effectively utilize closed-loop communication. The simple act of blindfolding the team leader creates a learning environment where the leader must utilize a conceptual framework and critical thinking strategies to organize the team and manage the resuscitation. An advantage to this teaching technique is that it does not require any special simulation equipment, making it a low-cost approach. The blindfolded code training exercise can be applied to the management of any critically ill patient where the primary objective is to focus on developing communication skills in acute resuscitations. The purpose of the description of the blindfolded code training exercise is to provide guidance on how to perform this innovative teaching technique to force effective closed-loop communication.

The blindfolded code training exercise, which blindfolds the team leader in a code resuscitation simulation, is an advanced teaching technique to improve closed-loop communication, organizational skills, and critical thinking.&#160;

盲民代码训练练习的设置和执行

Miscommunication is the most common cause of preventable patient harm in medicine. Currently, there is limited knowledge of innovative techniques to ...

CO2-Lasertonsillotomy Under Local Anesthesia in Adults

Tonsil-related complaints are very common among the adult population. Tonsillectomy under general anesthesia is currently the most performed surgical treatment in adults for such complaints. Unfortunately, tonsillectomy is an invasive treatment associated with a high complication rate and a long recovery time. Complications and a long recovery time are mostly related to removing the vascular and densely innervated capsule of the tonsils. Recently, CO2-lasertonsillotomy under local anesthesia has been demonstrated to be a viable alternative treatment for tonsil-related disease with a significantly shorter and less painful recovery period. The milder side-effect profile of CO2-lasertonsillotomy is likely related to leaving the tonsil capsule intact. The aim of the current report is to present a concise protocol detailing the execution of CO2-lasertonsillotomy under local anesthesia. This intervention has been performed successfully in our hospital in more than 1,000 patients and has been found to be safe and to be associated with a steep learning curve.

CO2-Lasertonsillotomy Under Local Anesthesia in Adults

CO2-lasertonsillotomy under local anesthesia is an interesting alternative treatment method for tonsillectomy under general anesthesia for tonsil-related complaints in adults. This report presents a step-by-step protocol detailing the execution of CO2-lasertonsillotomy under local anesthesia.

CO2- 成人局部麻醉下的激光切除术

Tonsil-related complaints are very common among the adult population. Tonsillectomy under general anesthesia is currently the most performed surgical ...

Cooling or Warming the Esophagus to Reduce Esophageal Injury During Left Atrial Ablation in the Treatment of Atrial Fibrillation

Ablation of the left atrium using either radiofrequency (RF) or cryothermal energy is an effective treatment for atrial fibrillation (AF) and is the most frequent type of cardiac ablation procedure performed. Although generally safe, collateral injury to surrounding structures, particularly the esophagus, remains a concern. Cooling or warming the esophagus to counteract the heat from RF ablation, or the cold from cryoablation, is a method that is used to reduce thermal esophageal injury, and there are increasing data to support this approach. This protocol describes the use of a commercially available esophageal temperature management device to cool or warm the esophagus to reduce esophageal injury during left atrial ablation. The temperature management device is powered by standard water-blanket heat exchangers, and is shaped like a standard orogastric tube placed for gastric suctioning and decompression. Water circulates through the device in a closed-loop circuit, transferring heat across the silicone walls of the device, through the esophageal wall. Placement of the device is analogous to the placement of a typical orogastric tube, and temperature is adjusted via the external heat-exchanger console.

The goal of this protocol is to describe the use of esophageal temperature modulation to counteract esophageal thermal injury from left atrial ablation for the treatment of atrial fibrillation.

在心房颤动治疗中，为食道冷却或加热，以减少左心房消融期间的食管损伤

Ablation of the left atrium using either radiofrequency (RF) or cryothermal energy is an effective treatment for atrial fibrillation (AF) and is the most ...

Measurement of Tissue Oxygenation Using Near-Infrared Spectroscopy in Patients Undergoing Hemodialysis

Near-infrared spectroscopy (NIRS) has recently been applied as a tool to measure regional oxygen saturation (rSO2), a marker of tissue oxygenation, in clinical settings including cardiovascular and brain surgery, neonatal monitoring and prehospital medicine. The NIRS monitoring devices are real-time and noninvasive, and have mainly been used for evaluating cerebral oxygenation in critically ill patients during an operation or intensive care. Thus far, the use of NIRS monitoring in patients with chronic kidney disease (CKD) including hemodialysis (HD) has been limited; therefore, we investigated rSO2 values in some organs during HD. We monitored rSO2 values using a NIRS device transmitting near-infrared light at 2 wavelengths of attachment. The HD patients were placed in a supine position, with rSO2 measurement sensors attached to the foreheads, the right hypochondrium and the lower legs to evaluate rSO2 in the brain, liver and lower leg muscles, respectively. NIRS monitoring could be a new approach to clarify changes in organ oxygenation during HD or factors affecting tissue oxygenation in CKD patients. This article describes a protocol to measure tissue oxygenation represented by rSO2 as applied in HD patients.

We present a protocol to measure regional oxygen saturation (rSO2) in hemodialysis (HD) patients by using a near-infrared spectroscopy monitor. The rSO2 value is an index of tissue oxygenation. This noninvasive and real-time monitoring could be useful for confirming changes in organ oxygenation during HD.

使用近红外光谱测量血液透析患者的组织氧合

Near-infrared spectroscopy (NIRS) has recently been applied as a tool to measure regional oxygen saturation (rSO2), a marker of tissue oxygenation, in ...

A Novel Inhalation Mask System to Deliver High Concentrations of Nitric Oxide Gas in Spontaneously Breathing Subjects

Nitric Oxide (NO) is administered as gas for inhalation to induce selective pulmonary vasodilation. It is a safe therapy, with few potential risks even if administered at high concentration. Inhaled NO gas is routinely used to increase systemic oxygenation in different disease conditions. The administration of high concentrations of NO also exerts a virucidal effect in vitro. Owing to its favorable pharmacodynamic and safety profiles, the familiarity in its use by critical care providers, and the potential for a direct virucidal effect, NO is clinically used in patients with coronavirus disease-2019 (COVID-19). Nevertheless, no device is currently available to easily administer inhaled NO at concentrations higher than 80 parts per million (ppm) at various inspired oxygen fractions, without the need for dedicated, heavy, and costly equipment. The development of a reliable, safe, inexpensive, lightweight, and ventilator-free solution is crucial, particularly for the early treatment of non-intubated patients outside of the intensive care unit (ICU) and in a limited-resource scenario. To overcome such a barrier, a simple system for the non-invasive NO gas administration up to 250 ppm was developed using standard consumables and a scavenging chamber. The method has been proven safe and reliable in delivering a specified NO concentration while limiting nitrogen dioxide levels. This paper aims to provide clinicians and researchers with the necessary information on how to assemble or adapt such a system for research purposes or clinical use in COVID-19 or other diseases in which NO administration might be beneficial.

This simple and highly adaptable system device for the inhalation of high-concentration nitric oxide (NO) gas does not require mechanical ventilators, positive pressure, or high gas flows. Standard medical consumables and a snug-fitting mask are used to safely deliver NO gas to spontaneously breathing subjects.

一种新型吸入面膜系统，可在自发呼吸受试者中提供高浓度的一氧化氮气体

Nitric Oxide (NO) is administered as gas for inhalation to induce selective pulmonary vasodilation. It is a safe therapy, with few potential risks even if ...

使用相位角和BIVA Z-Scores预测急性心力衰竭的预后

Clinical Application of Phase Angle and BIVA Z-Score Analyses in Patients Admitted to an Emergency Department with Acute Heart Failure

Acute heart failure is characterized by neurohormonal activation, which leads to sodium and water retention and causes alterations in body composition, such as increased body fluid congestion or systemic congestion. This condition is one of the most common reasons for hospital admission and has been associated with poor outcomes. The phase angle indirectly measures intracellular status, cellular integrity, vitality, and the distribution of spaces between intracellular and extracellular body water. This parameter has been found to be a predictor of health status and an indicator of survival and other clinical outcomes. In addition, phase angle values of &lt;4.8&#176; upon admission were associated with higher mortality in patients with acute heart failure. However, low phase angle values may be due to alterations-such as the shifting of fluids from an intracellular body water (ICW) compartment to an ECW (extracellular body water) compartment and a concurrent decrease in body-cell mass (which can reflect malnutrition)-that are present in heart failure. Thus, a low phase angle may be due to overhydration and/or malnutrition. BIVA provides additional information about the body-cell mass and congestion status with a graphical vector (R-Xc graph). In addition, a BIVA Z-score analysis (the number of standard deviations from the mean value of the reference group) that has the same pattern as that of the ellipses for the percentiles on the original R-Xc graph can be used to detect changes in soft-tissue mass or tissue hydration and can help researchers compare changes in different study populations. This protocol explains how to obtain and interpret phase angle values and BIVA Z-score analyses, their clinical applicability, and their usefulness as a predictive marker for the prognosis of a 90-day event in patients admitted to an emergency department with acute heart failure.

作者聚焦：揭示心力衰竭的预后指标 - 相位角和生物电阻抗分析的作用 

In this protocol, we explain how to obtain and interpret phase angle values and bioelectrical impedance vectorial analysis (BIVA) Z-score obtained by bioelectrical impedance in patients with acute heart failure admitted to the Emergency Department and their clinical applicability as a predictive marker for the prognosis of a 90-day event.

相位角和BIVA Z评分分析在急诊科急性心力衰竭患者中的临床应用

Acute heart failure is characterized by neurohormonal activation, which leads to sodium and water retention and causes alterations in body composition, ...