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Treff G, Treff F, Sareban M, Schiefer LM, Schäfer L, Schmidt P, Niebauer J, Steinacker JM, Swenson ER, Swenson KE, Mayer B, Berger MM. Performance and reliability of two frequently used point-of-care blood gas analyzers at 423 and 4,559 m. Clin Biochem 2023; 116:38-41. [PMID: 36935067 DOI: 10.1016/j.clinbiochem.2023.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 03/10/2023] [Accepted: 03/14/2023] [Indexed: 03/19/2023]
Abstract
BACKGROUND AND OBJECTIVES Blood gas analyzers (BGA) aid medical decision-making. Their specified performance criteria are based on sea level conditions. However, millions of people are living at high altitude (HA) where the performance of BGAs is poorly characterized. We investigated the effect of exposure to 4,559 m on the reliability and robustness of two BGAs widely used at HA. METHODS In this prospective study arterial blood samples from 13 volunteers (2 female) with susceptibility to the development of high-altitude pulmonary edema were collected once near sea level at 423 m (nSL423) and three times at high altitude (HA4,559). Samples were measured in triplicate with the cartridge BGAs Rapidpoint 500 (SIE; Siemens Healthcare) and the ABL90 (RAD; Radiometer) to calculate coefficients of variation (CV) and intraclass correlation coefficients (ICC) within a mixed model. RESULTS At nSL423 and HA4,559, 3% and 17% of all data were not reported with SIE, mainly due to clotting of the sample caused by delays because of the frequent automated calibration routines. No data were missing with RAD. ICCs were not significantly lower (mean (min-max) 0.87 (0.68-0.98) vs. 0.94 (0.84-1.00); p = 0.217) with SIE at nSL423, but significantly lower at HA4,559 (0.87 (0.49-1.00) vs. 0.99 (0.96-1.00); p = 0.025). All CVs, except that for arterial oxygen saturation at HA4,559,were higher with SIE . CONCLUSION In this study, the reliability of RAD was superior to SIE at nSL423 and HA4,559. In contrast to RAD, the performance of SIE declined at HA4,559. SIE was more prone to not reporting all variables, especially at HA4559.
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Affiliation(s)
- Gunnar Treff
- Division of Sports and Rehabilitation Medicine, University Hospital Ulm, Leimgrubenweg 14, 89075 Ulm, Germany; University Institute of Sports Medicine, Prevention and Rehabilitation, Research Institute of Molecular Sports Medicine and Rehabilitation, Paracelsus Medical University, Lindhofstraße 20, 5020 Salzburg, Austria.
| | - Franziska Treff
- Department of Anesthesiology, Critical Care and Pain Medicine, Paracelsus Medical University, Müllner Hauptstraße 48, 5020 Salzburg, Austria
| | - Mahdi Sareban
- University Institute of Sports Medicine, Prevention and Rehabilitation, Research Institute of Molecular Sports Medicine and Rehabilitation, Paracelsus Medical University, Lindhofstraße 20, 5020 Salzburg, Austria
| | - Lisa M Schiefer
- Department of Anesthesiology, Critical Care and Pain Medicine, Paracelsus Medical University, Müllner Hauptstraße 48, 5020 Salzburg, Austria
| | - Larissa Schäfer
- Department of Anesthesiology, Critical Care and Pain Medicine, Paracelsus Medical University, Müllner Hauptstraße 48, 5020 Salzburg, Austria
| | - Peter Schmidt
- Department of Anesthesiology, Critical Care and Pain Medicine, Paracelsus Medical University, Müllner Hauptstraße 48, 5020 Salzburg, Austria
| | - Josef Niebauer
- University Institute of Sports Medicine, Prevention and Rehabilitation, Research Institute of Molecular Sports Medicine and Rehabilitation, Paracelsus Medical University, Lindhofstraße 20, 5020 Salzburg, Austria
| | - Jürgen M Steinacker
- Division of Sports and Rehabilitation Medicine, University Hospital Ulm, Leimgrubenweg 14, 89075 Ulm, Germany
| | - Erik R Swenson
- Pulmonary, Critical Care and Sleep Medicine, VA Puget Sound Health Care System, University of Washington, 1660 S Columbian Way, Seattle, WA 98108, United States of America
| | - Kai E Swenson
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114, United States of America
| | - Benjamin Mayer
- Institute of Epidemiology and Medical Biometry, Ulm University, Schwabstr. 13, 89075 Ulm, Germany
| | - Marc M Berger
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Essen, Hufelandstr. 55, 45147 Essen, Germany
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Berger MM, Sareban M, Schiefer LM, Swenson KE, Treff F, Schäfer L, Schmidt P, Schimke MM, Paar M, Niebauer J, Cogo A, Kriemler S, Schwery S, Pickerodt PA, Mayer B, Bärtsch P, Swenson ER. Effects of acetazolamide on pulmonary artery pressure and prevention of high altitude pulmonary edema after rapid active ascent to 4,559 m. J Appl Physiol (1985) 2022; 132:1361-1369. [PMID: 35511718 DOI: 10.1152/japplphysiol.00806.2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Acetazolamide prevents acute mountain sickness (AMS) by inhibition of carbonic anhydrase. Since it reduces acute hypoxic pulmonary vasoconstriction (HPV), it may also prevent high-altitude pulmonary edema (HAPE) by lowering pulmonary artery pressure. We tested this hypothesis in a randomized, placebo-controlled, double-blind study. Thirteen healthy, non-acclimatized lowlanders with a history of HAPE ascended (<22h) from 1,130 to 4,559m with one overnight stay at 3,611m. Medications started 48h before ascent (acetazolamide: n=7, 250mg 3x/d; placebo: n=6, 3x/d). HAPE was diagnosed by chest radiography, and pulmonary artery pressure by measurement of right ventricular to atrial pressure gradient (RVPG) by transthoracic echocardiography. AMS was evaluated with the Lake Louise Score (LLS) and AMS-C Score. Incidence of HAPE was 43% vs. 67% (acetazolamide vs. placebo, p=0.39). Ascent to altitude increased RVPG from 20±5 to 43±10mmHg (p<0.001) without a group difference (p=0.68). Arterial PO2 fell to 36±9mmHg (p<0.001) and was 8.5mmHg higher with acetazolamide at high altitude (p=0.025). At high altitude, the LLS and AMS-C score remained lower in those taking acetazolamide (both p<0.05). Although acetazolamide reduced HAPE incidence by 35%, this effect was not statistically significant, and considerably less than reductions of about 70-100% with prophylactic dexamethasone, tadalafil, and nifedipine performed with the same ascent profile at the same location. We could not demonstrate a reduction in RVPG compared to placebo treatment despite reductions in AMS severity and better arterial oxygenation. Limited by a small sample size, our data do not support recommending acetazolamide for prevention of HAPE in mountaineers ascending rapidly to over 4,500m.
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Affiliation(s)
- Marc Moritz Berger
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Mahdi Sareban
- University Institute of Sports Medicine, Prevention and Rehabilitation, Paracelsus Medical University, Salzburg, Austria; Research Institute of Molecular Sports Medicine and Rehabilitation, Paracelsus Medical University, Salzburg, Austria
| | - Lisa Maria Schiefer
- Department of Anesthesiology, Critical Care and Pain Medicine, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Kai Erik Swenson
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston, MA, United States
| | - Franziska Treff
- Department of Anesthesiology, Critical Care and Pain Medicine, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Larissa Schäfer
- Department of Anesthesiology, Critical Care and Pain Medicine, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Peter Schmidt
- Department of Anesthesiology, Critical Care and Pain Medicine, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Magdalena M Schimke
- Department of Anesthesiology, Critical Care and Pain Medicine, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Michael Paar
- Department of Radiology, Paracelsus Medical University, Salzburg, Austria
| | - Josef Niebauer
- University Institute of Sports Medicine, Prevention and Rehabilitation, Paracelsus Medical University, Salzburg, Austria; Research Institute of Molecular Sports Medicine and Rehabilitation, Paracelsus Medical University, Salzburg, Austria
| | - Annalisa Cogo
- Biomedical Sport Studies Center, University of Ferrara, Ferrara, Italy
| | - Susi Kriemler
- Epidemiology, Biostatistics and Public Health Institute, University of Zürich, Zurich, Switzerland
| | | | - Philipp Andreas Pickerodt
- Department of Anesthesiology and Operative Intensive Care Medicine, Campus Charité Mitte and Virchow-Klinikum, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Benjamin Mayer
- Institute for Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Peter Bärtsch
- Department of Internal Medicine, University of Heidelberg, Heidelberg, Germany
| | - Erik R Swenson
- Pulmonary, Critical Care and Sleep Medicine, VA Puget Sound Health Care System, University of Washington, Seattle, WA, United States
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Ziegler B, Ofner S, Lischent J, Perndorfer J, Diem A, Laimer M, Prodinger C, Treff F. [Anesthesiological aspects in patients with epidermolysis bullosa]. Anaesthesist 2022; 71:467-474. [PMID: 35175387 DOI: 10.1007/s00101-022-01096-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/20/2022] [Indexed: 11/25/2022]
Abstract
Epidermolysis bullosa causes blistering due to altered structural proteins of the dermoepidermal junction, resulting in scarring and strictures of the skin and mucous membranes. Affected individuals typically require frequent surgical interventions due to burdensome symptoms and complications of the disease. The anesthesiological management of these patients is inherently challenging. This review article summarizes the relevant features of this patient cohort and provides practical recommendations for care.
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Affiliation(s)
- B Ziegler
- Univ.Klinik f. Anästhesiologie, perioperative Medizin und allgemeine Intensivmedizin, LKH Salzburg, Müllner Hauptstr. 48, 5020, Salzburg, Österreich.
| | - S Ofner
- Univ.Klinik f. Anästhesiologie, perioperative Medizin und allgemeine Intensivmedizin, LKH Salzburg, Müllner Hauptstr. 48, 5020, Salzburg, Österreich
| | - J Lischent
- Univ.Klinik f. Anästhesiologie, perioperative Medizin und allgemeine Intensivmedizin, LKH Salzburg, Müllner Hauptstr. 48, 5020, Salzburg, Österreich
| | - J Perndorfer
- Univ.Klinik f. Anästhesiologie, perioperative Medizin und allgemeine Intensivmedizin, LKH Salzburg, Müllner Hauptstr. 48, 5020, Salzburg, Österreich
| | - A Diem
- Univ. Klinik f. Dermatologie und Allergologie, LKH Salzburg, Müllner Hauptstr. 48, 5020, Salzburg, Österreich.,EB Haus Austria, LKH Salzburg, Müllner Hauptstr. 48, 5020, Salzburg, Österreich
| | - M Laimer
- Univ. Klinik f. Dermatologie und Allergologie, LKH Salzburg, Müllner Hauptstr. 48, 5020, Salzburg, Österreich.,EB Haus Austria, LKH Salzburg, Müllner Hauptstr. 48, 5020, Salzburg, Österreich
| | - C Prodinger
- Univ. Klinik f. Dermatologie und Allergologie, LKH Salzburg, Müllner Hauptstr. 48, 5020, Salzburg, Österreich
| | - F Treff
- Univ.Klinik f. Anästhesiologie, perioperative Medizin und allgemeine Intensivmedizin, LKH Salzburg, Müllner Hauptstr. 48, 5020, Salzburg, Österreich
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Schiefer LM, Treff G, Treff F, Schmidt P, Schäfer L, Niebauer J, Swenson KE, Swenson ER, Berger MM, Sareban M. Validity of Peripheral Oxygen Saturation Measurements with the Garmin Fēnix ® 5X Plus Wearable Device at 4559 m. Sensors (Basel) 2021; 21:s21196363. [PMID: 34640680 PMCID: PMC8513012 DOI: 10.3390/s21196363] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Revised: 09/11/2021] [Accepted: 09/18/2021] [Indexed: 11/30/2022]
Abstract
Decreased oxygen saturation (SO2) at high altitude is associated with potentially life-threatening diseases, e.g., high-altitude pulmonary edema. Wearable devices that allow continuous monitoring of peripheral oxygen saturation (SpO2), such as the Garmin Fēnix® 5X Plus (GAR), might provide early detection to prevent hypoxia-induced diseases. We therefore aimed to validate GAR-derived SpO2 readings at 4559 m. SpO2 was measured with GAR and the medically certified Covidien Nellcor SpO2 monitor (COV) at six time points in 13 healthy lowlanders after a rapid ascent from 1130 m to 4559 m. Arterial blood gas (ABG) analysis served as the criterion measure and was conducted at four of the six time points with the Radiometer ABL 90 Flex. Validity was assessed by intraclass correlation coefficients (ICCs), mean absolute percentage error (MAPE), and Bland–Altman plots. Mean (±SD) SO2, including all time points at 4559 m, was 85.2 ± 6.2% with GAR, 81.0 ± 9.4% with COV, and 75.0 ± 9.5% with ABG. Validity of GAR was low, as indicated by the ICC (0.549), the MAPE (9.77%), the mean SO2 difference (7.0%), and the wide limits of agreement (−6.5; 20.5%) vs. ABG. Validity of COV was good, as indicated by the ICC (0.883), the MAPE (6.15%), and the mean SO2 difference (0.1%) vs. ABG. The GAR device demonstrated poor validity and cannot be recommended for monitoring SpO2 at high altitude.
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Affiliation(s)
- Lisa M. Schiefer
- Department of Anesthesiology, Critical Care and Pain Medicine, Paracelsus Medical University, 5020 Salzburg, Austria; (L.M.S.); (F.T.); (P.S.); (L.S.)
- Ludwig Boltzmann Institute for Digital Health and Prevention, 5020 Salzburg, Austria;
| | - Gunnar Treff
- Division of Sports and Rehabilitation Medicine, University of Ulm, 89075 Ulm, Germany;
| | - Franziska Treff
- Department of Anesthesiology, Critical Care and Pain Medicine, Paracelsus Medical University, 5020 Salzburg, Austria; (L.M.S.); (F.T.); (P.S.); (L.S.)
| | - Peter Schmidt
- Department of Anesthesiology, Critical Care and Pain Medicine, Paracelsus Medical University, 5020 Salzburg, Austria; (L.M.S.); (F.T.); (P.S.); (L.S.)
| | - Larissa Schäfer
- Department of Anesthesiology, Critical Care and Pain Medicine, Paracelsus Medical University, 5020 Salzburg, Austria; (L.M.S.); (F.T.); (P.S.); (L.S.)
| | - Josef Niebauer
- Ludwig Boltzmann Institute for Digital Health and Prevention, 5020 Salzburg, Austria;
- University Institute of Sports Medicine, Prevention and Rehabilitation and Research Institute of Molecular Sports Medicine and Rehabilitation, Paracelsus Medical University, 5020 Salzburg, Austria
| | - Kai E. Swenson
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston, MA 02114, USA;
- Division of Pulmonary, Critical Care, and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA
| | - Erik R. Swenson
- Division of Pulmonary, Critical Care and Sleep Medicine, VA Puget Sound Health Care System, University of Washington, Seattle, WA 98108, USA;
| | - Marc M. Berger
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Essen, University Duisburg Essen, 45147 Essen, Germany;
| | - Mahdi Sareban
- Ludwig Boltzmann Institute for Digital Health and Prevention, 5020 Salzburg, Austria;
- University Institute of Sports Medicine, Prevention and Rehabilitation and Research Institute of Molecular Sports Medicine and Rehabilitation, Paracelsus Medical University, 5020 Salzburg, Austria
- Correspondence: ; Tel.: +43-57-255-23200
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