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Cui Z, Liu X, Qu H, Wang H. Technical Principles and Clinical Applications of Electrical Impedance Tomography in Pulmonary Monitoring. SENSORS (BASEL, SWITZERLAND) 2024; 24:4539. [PMID: 39065936 PMCID: PMC11281055 DOI: 10.3390/s24144539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Revised: 06/11/2024] [Accepted: 07/10/2024] [Indexed: 07/28/2024]
Abstract
Pulmonary monitoring is crucial for the diagnosis and management of respiratory conditions, especially after the epidemic of coronavirus disease. Electrical impedance tomography (EIT) is an alternative non-radioactive tomographic imaging tool for monitoring pulmonary conditions. This review proffers the current EIT technical principles and applications on pulmonary monitoring, which gives a comprehensive summary of EIT applied on the chest and encourages its extensive usage to clinical physicians. The technical principles involving EIT instrumentations and image reconstruction algorithms are explained in detail, and the conditional selection is recommended based on clinical application scenarios. For applications, specifically, the monitoring of ventilation/perfusion (V/Q) is one of the most developed EIT applications. The matching correlation of V/Q could indicate many pulmonary diseases, e.g., the acute respiratory distress syndrome, pneumothorax, pulmonary embolism, and pulmonary edema. Several recently emerging applications like lung transplantation are also briefly introduced as supplementary applications that have potential and are about to be developed in the future. In addition, the limitations, disadvantages, and developing trends of EIT are discussed, indicating that EIT will still be in a long-term development stage before large-scale clinical applications.
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Affiliation(s)
- Ziqiang Cui
- School of Electrical and Information Engineering, Tianjin University, Tianjin 300072, China; (X.L.); (H.Q.); (H.W.)
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Maeda A, Chaba A, Inokuchi R, Pandey D, Spano S, Phongphithakchai A, Hikasa Y, Pattamin N, Eastwood G, Jahanabadi H, Seevanayagam S, Motley A, Bellomo R. Carboxyhemoglobin as Potential Biomarker for Cardiac Surgery Associated Acute Kidney Injury. J Cardiothorac Vasc Anesth 2024:S1053-0770(24)00455-5. [PMID: 39084930 DOI: 10.1053/j.jvca.2024.07.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Revised: 06/13/2024] [Accepted: 07/08/2024] [Indexed: 08/02/2024]
Abstract
OBJECTIVES Carboxyhemoglobin (CO-Hb) is a marker of hemolysis and inflammation, both risk factors for cardiac surgery-associated AKI (CSA-AKI). However, the association between CO-Hb and CSA-AKI remains unknown. DESIGN A retrospective cohort study. SETTING Tertiary university-affiliated metropolitan hospital: single center. PARTICIPANTS Adult on-pump cardiac surgery patients from July 2014 to June 2022 (N = 1,698). INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Patients were stratified into quartiles based on CO-Hb levels at intensive care unit (ICU) admission. A progressive increased risk of CSA-AKI was observed with higher CO-Hb levels at ICU admission. On multivariable logistic regression analysis, the highest quartile (CO-Hb ≥ 1.4%) showed an independent association with the occurrence of CSA-AKI (odds ratio 1.45 compared to the lowest quartile [CO-Hb < 1.0%], 95% CI 1.023-2.071; p = 0.038). Compared to patients with CO-Hb <1.4%, patients with CO-Hb ≥ 1.4% at ICU admission had significantly higher postoperative creatinine (135 vs 116 μmol/L, p < 0.001), higher rates of postoperative RRT (6.7% vs 2.3%, p < 0.001) and AKI (p < 0.001) on univariable analysis and shorter time to event for AKI or death (p < 0.001). CONCLUSIONS CO-Hb ≥ 1.4% at ICU admission is an independent risk factor for CSA-AKI, which is easily obtainable and available on routine arterial blood gas measurements. Thus, CO-Hb may serve as a practical and biologically logical biomarker for risk stratification and population enrichment in trials of CSA-AKI prevention.
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Affiliation(s)
- Akinori Maeda
- Department of Intensive Care, Austin Hospital, Melbourne, VIC, Australia; Department of Emergency and Critical Care Medicine, The University of Tokyo, Tokyo, Japan
| | - Anis Chaba
- Department of Intensive Care, Austin Hospital, Melbourne, VIC, Australia
| | - Ryota Inokuchi
- Department of Emergency and Critical Care Medicine, The University of Tokyo, Tokyo, Japan; Department of Clinical Engineering, The University of Tokyo, Tokyo, Japan
| | - Dinesh Pandey
- Data Analytics Research and Evaluation Centre, The University of Melbourne and Austin Hospital, Melbourne, VIC, Australia; Clinical Analytics and Reporting, Austin Hospital, Melbourne, VIC, Australia
| | - Sofia Spano
- Department of Intensive Care, Austin Hospital, Melbourne, VIC, Australia
| | | | - Yukiko Hikasa
- Department of Intensive Care, Austin Hospital, Melbourne, VIC, Australia
| | - Nuttapol Pattamin
- Department of Intensive Care, Austin Hospital, Melbourne, VIC, Australia
| | - Glenn Eastwood
- Department of Intensive Care, Austin Hospital, Melbourne, VIC, Australia
| | - Hossein Jahanabadi
- Data Analytics Research and Evaluation Centre, The University of Melbourne and Austin Hospital, Melbourne, VIC, Australia; Clinical Analytics and Reporting, Austin Hospital, Melbourne, VIC, Australia
| | - Siven Seevanayagam
- Department of Cardiac Surgery, Austin Hospital, Melbourne, VIC, Australia
| | - Andrew Motley
- Department of Haematology and Blood Bank, Austin Hospital, Melbourne, Australia
| | - Rinaldo Bellomo
- Department of Intensive Care, Austin Hospital, Melbourne, VIC, Australia; Department of Clinical Engineering, The University of Tokyo, Tokyo, Japan; Department of Critical Care, The University of Melbourne, Melbourne, VIC, Australia; Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia.
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Zhang X, Zhang Y, Yuan S, Zhang J. The potential immunological mechanisms of sepsis. Front Immunol 2024; 15:1434688. [PMID: 39040114 PMCID: PMC11260823 DOI: 10.3389/fimmu.2024.1434688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2024] [Accepted: 06/25/2024] [Indexed: 07/24/2024] Open
Abstract
Sepsis is described as a life-threatening organ dysfunction and a heterogeneous syndrome that is a leading cause of morbidity and mortality in intensive care settings. Severe sepsis could incite an uncontrollable surge of inflammatory cytokines, and the host immune system's immunosuppression could respond to counter excessive inflammatory responses, characterized by the accumulated anti-inflammatory cytokines, impaired function of immune cells, over-proliferation of myeloid-derived suppressor cells and regulatory T cells, depletion of immune effector cells by different means of death, etc. In this review, we delve into the underlying pathological mechanisms of sepsis, emphasizing both the hyperinflammatory phase and the associated immunosuppression. We offer an in-depth exploration of the critical mechanisms underlying sepsis, spanning from individual immune cells to a holistic organ perspective, and further down to the epigenetic and metabolic reprogramming. Furthermore, we outline the strengths of artificial intelligence in analyzing extensive datasets pertaining to septic patients, showcasing how classifiers trained on various clinical data sources can identify distinct sepsis phenotypes and thus to guide personalized therapy strategies for the management of sepsis. Additionally, we provide a comprehensive summary of recent, reliable biomarkers for hyperinflammatory and immunosuppressive states, facilitating more precise and expedited diagnosis of sepsis.
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Affiliation(s)
- Xinyu Zhang
- Department of Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Institute of Anesthesia and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yujing Zhang
- Department of Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Institute of Anesthesia and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shiying Yuan
- Department of Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Institute of Anesthesia and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jiancheng Zhang
- Department of Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Institute of Anesthesia and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Gevaerd Martins J, Saad A, Saade G, Pacheco LD. The role of point-of-care ultrasound to monitor response of fluid replacement therapy in pregnancy. Am J Obstet Gynecol 2024:S0002-9378(24)00730-0. [PMID: 38969197 DOI: 10.1016/j.ajog.2024.06.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Revised: 05/05/2024] [Accepted: 06/15/2024] [Indexed: 07/07/2024]
Abstract
Fluid management in obstetrical care is crucial because of the complex physiological conditions of pregnancy, which complicate clinical manifestations and fluid balance management. This expert review examined the use of point-of-care ultrasound to evaluate and monitor the response to fluid therapy in pregnant patients. Pregnancy induces substantial physiological changes, including increased cardiac output and glomerular filtration rate, decreased systemic vascular resistance, and decreased plasma oncotic pressure. Conditions, such as preeclampsia, further complicate fluid management because of decreased intravascular volume and increased capillary permeability. Traditional methods for assessing fluid volume status, such as physical examination and invasive monitoring, are often unreliable or inappropriate. Point-of-care ultrasound provides a noninvasive, rapid, and reliable means to assess fluid responsiveness, which is essential for managing fluid therapy in pregnant patients. This review details the various point-of-care ultrasound modalities used to measure dynamic changes in fluid status, focusing on the evaluation of the inferior vena cava, lung ultrasound, and left ventricular outflow tract. Inferior vena cava ultrasound in spontaneously breathing patients determines diameter variability, predicts fluid responsiveness, and is feasible even late in pregnancy. Lung ultrasound is crucial for detecting early signs of pulmonary edema before clinical symptoms arise and is more accurate than traditional radiography. The left ventricular outflow tract velocity time integral assesses stroke volume response to fluid challenges, providing a quantifiable measure of cardiac function, which is particularly beneficial in critical care settings where rapid and accurate fluid management is essential. This expert review synthesizes current evidence and practice guidelines, suggesting the integration of point-of-care ultrasound as a fundamental aspect of fluid management in obstetrics. It calls for ongoing research to enhance techniques and validate their use in broader clinical settings, aiming to improve outcomes for pregnant patients and their babies by preventing complications associated with both under- and overresuscitation.
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Affiliation(s)
| | - Antonio Saad
- Department of Obstetrics and Gynecology, Inova Maternal-Fetal Medicine, Fairfax, VA
| | - George Saade
- Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, VA
| | - Luis D Pacheco
- Departments of Obstetrics and Gynecology and Anesthesiology, The University of Texas Medical Branch, Galveston, TX
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Mathur P, Halvorson S, Cywinski JB, Machado S, Khatib R, Kurz AM, Galway U, Mascha EJ. Timing of Intraoperative Transitions of Care Among Anesthesiologists Is Not Associated With Postoperative Adverse Outcomes: Retrospective Cohort Study. Anesth Analg 2024; 139:186-194. [PMID: 38885400 DOI: 10.1213/ane.0000000000006853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/20/2024]
Abstract
BACKGROUND The majority of published research suggests that anesthesia handovers during major surgical procedures are associated with unintended harmful consequences. It is still unclear if the number or quality of the transition of care is the main driver of the adverse outcomes. There is even less data if the timing of the anesthesiologist handovers during the critical portion of the anesthetic continuum (induction or emergence versus surgical period) plays a role in patient outcomes. Therefore, we investigated if the anesthesiologist handovers during induction and emergence are associated with adverse patient outcomes. METHODS This retrospective investigation included noncardiac surgical procedures occurring between January 1, 2012 and December 31, 2019 that had exactly 1 attending anesthesiologist handover. We categorized transitions of care between attending anesthesiologists as being before incision, between incision and closing, and after closing. Our primary outcome was a composite of 6 categories of surgical complications and in-hospital mortality. We created logistic generalized estimating equation models to estimate the average relative effect odds ratio between each pair of the 3 transition timing groups across the components of the composite outcome. Inverse probability of treatment weights were used to mitigate confounding on a host of baseline variables. We used Bonferroni correction to adjust for multiple comparisons between the transition groups. RESULTS In total, we studied 36,937 procedures with exactly 1 attending anesthesiologist handover. Of these records, 4370 had the transition during induction, 24,999 between incision and closure, and 7568 during emergence. No differences were found between the transition periods and the composite outcome. The estimated average relative effect odds ratio (98.3% confidence interval [CI]) across the components of the composite outcome was as follows: (1.0002 [0.81-1.24], P = .99) between the induction and surgical period; (1.10 [0.87-1.40], P = .32) between the induction and emergence periods; and (0.91 [0.79-1.04], P = .08) between the emergence and surgical periods. CONCLUSIONS Timing of intraoperative handover among attending anesthesiologists during noncardiac surgery is not associated with adverse patient outcomes.
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Affiliation(s)
- Piyush Mathur
- From the Department of General Anesthesiology, Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio
| | - Sven Halvorson
- Prevention Science Institute, University of Oregon, Oregon
| | - Jacek B Cywinski
- From the Department of General Anesthesiology, Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio
- Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio
| | - Sandra Machado
- From the Department of General Anesthesiology, Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio
| | - Reem Khatib
- From the Department of General Anesthesiology, Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio
| | - Andrea M Kurz
- From the Department of General Anesthesiology, Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio
- Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio
- Division of General Anaesthesiology, Emergency- and Intensive Care Medicine, University of Graz, Graz, Austria
| | - Ursula Galway
- From the Department of General Anesthesiology, Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio
| | - Edward J Mascha
- Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio
- Departments of Quantitative Health Sciences and Outcomes Research, Cleveland Clinic, Cleveland, Ohio
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Scavello F, Brunetta E, Mapelli SN, Nappi E, García Martín ID, Sironi M, Leone R, Solano S, Angelotti G, Supino D, Carnevale S, Zhong H, Magrini E, Stravalaci M, Protti A, Santini A, Costantini E, Savevski V, Voza A, Bottazzi B, Bartoletti M, Cecconi M, Mantovani A, Morelli P, Tordato F, Garlanda C. The long Pentraxin PTX3 serves as an early predictive biomarker of co-infections in COVID-19. EBioMedicine 2024; 105:105213. [PMID: 38908098 PMCID: PMC11245991 DOI: 10.1016/j.ebiom.2024.105213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 05/27/2024] [Accepted: 06/07/2024] [Indexed: 06/24/2024] Open
Abstract
BACKGROUND COVID-19 clinical course is highly variable and secondary infections contribute to COVID-19 complexity. Early detection of secondary infections is clinically relevant for patient outcome. Procalcitonin (PCT) and C-reactive protein (CRP) are the most used biomarkers of infections. Pentraxin 3 (PTX3) is an acute phase protein with promising performance as early biomarker in infections. In patients with COVID-19, PTX3 plasma concentrations at hospital admission are independent predictor of poor outcome. In this study, we assessed whether PTX3 contributes to early identification of co-infections during the course of COVID-19. METHODS We analyzed PTX3 levels in patients affected by COVID-19 with (n = 101) or without (n = 179) community or hospital-acquired fungal or bacterial secondary infections (CAIs or HAIs). FINDINGS PTX3 plasma concentrations at diagnosis of CAI or HAI were significantly higher than those in patients without secondary infections. Compared to PCT and CRP, the increase of PTX3 plasma levels was associated with the highest hazard ratio for CAIs and HAIs (aHR 11.68 and 24.90). In multivariable Cox regression analysis, PTX3 was also the most significant predictor of 28-days mortality or intensive care unit admission of patients with potential co-infections, faring more pronounced than CRP and PCT. INTERPRETATION PTX3 is a promising predictive biomarker for early identification and risk stratification of patients with COVID-19 and co-infections. FUNDING Dolce & Gabbana fashion house donation; Ministero della Salute for COVID-19; EU funding within the MUR PNRR Extended Partnership initiative on Emerging Infectious Diseases (Project no. PE00000007, INF-ACT) and MUR PNRR Italian network of excellence for advanced diagnosis (Project no. PNC-E3-2022-23683266 PNC-HLS-DA); EU MSCA (project CORVOS 860044).
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Affiliation(s)
| | - Enrico Brunetta
- Infectious Diseases Unit, Hospital Health Direction, IRCCS Humanitas Research Hospital, 20089, Rozzano, Milan, Italy
| | - Sarah N Mapelli
- IRCCS Humanitas Research Hospital, 20089, Rozzano, Milan, Italy
| | - Emanuele Nappi
- IRCCS Humanitas Research Hospital, 20089, Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, 20072, Pieve Emanuele, Milan, Italy
| | - Ian David García Martín
- Department of Biomedical Sciences, Humanitas University, 20072, Pieve Emanuele, Milan, Italy
| | - Marina Sironi
- IRCCS Humanitas Research Hospital, 20089, Rozzano, Milan, Italy
| | - Roberto Leone
- IRCCS Humanitas Research Hospital, 20089, Rozzano, Milan, Italy
| | - Simone Solano
- IRCCS Humanitas Research Hospital, 20089, Rozzano, Milan, Italy
| | - Giovanni Angelotti
- Artificial Intelligence Center, IRCCS Humanitas Research Hospital, 20089, Rozzano, Milan, Italy
| | - Domenico Supino
- IRCCS Humanitas Research Hospital, 20089, Rozzano, Milan, Italy
| | | | - Hang Zhong
- IRCCS Humanitas Research Hospital, 20089, Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, 20072, Pieve Emanuele, Milan, Italy
| | - Elena Magrini
- IRCCS Humanitas Research Hospital, 20089, Rozzano, Milan, Italy
| | | | - Alessandro Protti
- Department of Biomedical Sciences, Humanitas University, 20072, Pieve Emanuele, Milan, Italy; Department of Anesthesia and Intensive Care, IRCCS Humanitas Research Hospital, 20089, Rozzano, Milan, Italy
| | - Alessandro Santini
- Department of Biomedical Sciences, Humanitas University, 20072, Pieve Emanuele, Milan, Italy; Department of Anesthesia and Intensive Care, IRCCS Humanitas Research Hospital, 20089, Rozzano, Milan, Italy
| | - Elena Costantini
- Department of Anesthesia and Intensive Care, IRCCS Humanitas Research Hospital, 20089, Rozzano, Milan, Italy
| | - Victor Savevski
- Artificial Intelligence Center, IRCCS Humanitas Research Hospital, 20089, Rozzano, Milan, Italy
| | - Antonio Voza
- Department of Biomedical Sciences, Humanitas University, 20072, Pieve Emanuele, Milan, Italy; Emergency Department, IRCCS Humanitas Research Hospital, 20089, Rozzano, Milan, Italy
| | | | - Michele Bartoletti
- Infectious Diseases Unit, Hospital Health Direction, IRCCS Humanitas Research Hospital, 20089, Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, 20072, Pieve Emanuele, Milan, Italy
| | - Maurizio Cecconi
- Department of Biomedical Sciences, Humanitas University, 20072, Pieve Emanuele, Milan, Italy; Department of Anesthesia and Intensive Care, IRCCS Humanitas Research Hospital, 20089, Rozzano, Milan, Italy
| | - Alberto Mantovani
- IRCCS Humanitas Research Hospital, 20089, Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, 20072, Pieve Emanuele, Milan, Italy; The William Harvey Research Institute, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK
| | - Paola Morelli
- Infectious Diseases Unit, Hospital Health Direction, IRCCS Humanitas Research Hospital, 20089, Rozzano, Milan, Italy
| | - Federica Tordato
- Infectious Diseases Unit, Hospital Health Direction, IRCCS Humanitas Research Hospital, 20089, Rozzano, Milan, Italy
| | - Cecilia Garlanda
- IRCCS Humanitas Research Hospital, 20089, Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, 20072, Pieve Emanuele, Milan, Italy.
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Hudkins M, Hamilton H, Underwood SJ, Kazmierczak DE, Dewey EN, Kazmierczak SC, Messer WB, Khan A, Schreiber MA, Farrell DH. Extreme γ' fibrinogen levels in COVID-19 patients. Blood Cells Mol Dis 2024; 107:102856. [PMID: 38762921 DOI: 10.1016/j.bcmd.2024.102856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 04/24/2024] [Accepted: 04/25/2024] [Indexed: 05/21/2024]
Abstract
COVID-19 disease progression can be accompanied by a "cytokine storm" that leads to secondary sequelae such as acute respiratory distress syndrome. Several inflammatory cytokines have been associated with COVID-19 disease progression, but have high daily intra-individual variability. In contrast, we have shown that the inflammatory biomarker γ' fibrinogen (GPF) has a 6-fold lower coefficient of variability compared to other inflammatory markers such as hs-CRP. The aims of the study were to measure GPF in serial blood samples from COVID-19 patients at a tertiary care medical center in order to investigate its association with clinical measures of disease progression. COVID-19 patients were retrospectively enrolled between 3/16/2020 and 8/1/2020. GPF was measured using a commercial ELISA. We found that COVID-19 patients can develop extraordinarily high levels of GPF. Our results showed that ten out of the eighteen patients with COVID-19 had the highest levels of GPF ever recorded. The previous highest GPF level of 80.3 mg/dL was found in a study of 10,601 participants in the ARIC study. GPF levels were significantly associated with the need for ECMO and mortality. These findings have potential implications regarding prophylactic anticoagulation of COVID-19 patients.
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Affiliation(s)
- Matthew Hudkins
- Department of Pediatrics, Oregon Health & Science University, Portland, OR 97239, USA
| | - Heather Hamilton
- Department of Surgery, Oregon Health & Science University, Portland, OR 97239, USA
| | - Samantha J Underwood
- Department of Surgery, Oregon Health & Science University, Portland, OR 97239, USA
| | - Diana E Kazmierczak
- Department of Pathology, Oregon Health & Science University, Portland, OR 97239, USA
| | - Elizabeth N Dewey
- Department of Surgery, Oregon Health & Science University, Portland, OR 97239, USA
| | - Steven C Kazmierczak
- Department of Pathology, Oregon Health & Science University, Portland, OR 97239, USA
| | - William B Messer
- Department of Molecular Microbiology and Immunology, Oregon Health & Science University, Portland, OR 97239, USA
| | - Akram Khan
- Department of Medicine, Oregon Health & Science University, Portland, OR 97239, USA
| | - Martin A Schreiber
- Department of Surgery, Oregon Health & Science University, Portland, OR 97239, USA
| | - David H Farrell
- Department of Surgery, Oregon Health & Science University, Portland, OR 97239, USA.
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Sharma S, Ramachandran R, Rewari V, Trikha A. Evaluation of Electrical Cardiometry to Assess Fluid Responsiveness in Patients with Acute Circulatory Failure: A Comparative Study with Transthoracic Echocardiography. Indian J Crit Care Med 2024; 28:650-656. [PMID: 38994256 PMCID: PMC11234120 DOI: 10.5005/jp-journals-10071-24753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Accepted: 06/03/2024] [Indexed: 07/13/2024] Open
Abstract
Aim Acute circulatory failure is commonly encountered in critically ill patients, that requires fluid administration as the first line of treatment. However, only 50% of patients are fluid-responsive. Identification of fluid responders is essential to avoid the harmful effects of overzealous fluid therapy. Electrical cardiometry (EC) is a non-invasive bedside tool and has proven to be as good as transthoracic echocardiography (TTE) to track changes in cardiac output. We aimed to look for an agreement between EC and TTE for tracking changes in cardiac output in adult patients with acute circulatory failure before and after the passive leg-raising maneuver. Materials and methods Prospective comparative study, conducted at a Tertiary Care Teaching Hospital. Results We recruited 125 patients with acute circulatory failure and found 42.4% (53 out of 125) to be fluid-responsive. The Bland-Altman plot analysis showed a mean difference of 2.08 L/min between EC and TTE, with a precision of 3.8 L/min. The limits of agreement (defined as bias ± 1.96SD), were -1.7 L/min and 5.8 L/min, respectively. The percentage of error between EC and TTE was 56% with acceptable limits of 30%. Conclusion The percentage error beyond the acceptable limit suggests the non-interchangeability of the two techniques. More studies with larger sample sizes are required to establish the interchangeability of EC with TTE for tracking changes in cardiac output in critically ill patients with acute circulatory failure. How to cite this article Sharma S, Ramachandran R, Rewari V, Trikha A. Evaluation of Electrical Cardiometry to Assess Fluid Responsiveness in Patients with Acute Circulatory Failure: A Comparative Study with Transthoracic Echocardiography. Indian J Crit Care Med 2024;28(7):650-656.
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Affiliation(s)
- Shashikant Sharma
- Department of Critical Care Medicine, Jay Prabha Medanta Hospital, Patna, Bihar, India
| | - Rashmi Ramachandran
- Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Vimi Rewari
- Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Anjan Trikha
- Department of Anesthesiology and Perioperative Medicine, Penn State College of Medicine, Hershey, Pennsylvania, United States
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Alwakeel M, Wang Y, Torbic H, Sacha GL, Wang X, Abi Fadel F, Duggal A. Impact of Sedation Practices on Mortality in COVID-19-Associated Adult Respiratory Distress Syndrome Patients: A Multicenter Retrospective Descriptive Study. J Intensive Care Med 2024; 39:646-654. [PMID: 38193291 DOI: 10.1177/08850666231224395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2024]
Abstract
Background: Reduction in sedation exposure is an important metric in intensive care unit (ICU) patients. However, challenges arose during the coronavirus disease-2019 (COVID-19) pandemic in adhering to this practice, driven by concerns on transmission and disease severity issues. Accordingly, diverse sedation approaches emerged, although the effect on mortality has not been studied thoroughly. Methods: Retrospective cohort study in the medical ICU of seven hospitals within a major Health System in Northeast Ohio. We included all adult patients admitted with COVID-19 requiring invasive mechanical ventilation (IMV) from March 2020 to December 2021. Results: Study included 2394 COVID-19 patients requiring IMV. Across waves, sample included 55-63% male subjects, with an average age of 61-68 years (P < 0.001), Acute Physiologic and Chronic Health Evaluation (APACHE)-III score 65.8-68.9 (P = 0.37), median IMV duration 8-10 days (P = 0.14), and median ICU duration 9.8-11.6 days (P = 0.084). Propofol remained the primary sedative (84-92%; P = 0.089). Ketamine use increased from the first (9.7%) to fourth (19%) wave (P = 0.002). Midazolam use decreased from the first (27.4%) to third (9.4%) wave (P = 0.001). Dexmedetomidine use declined from 35% to 27-28% (P = 0.002) after the first wave. A multivariable regression analysis indicated clinical variables explained 34% of the variation in hospital mortality (R2). Factors associated with higher mortality included age [aOR = 1.059 (95% CI 1.049-1.069); P < 0.001], COVID-19 wave, especially fourth wave [aOR = 2.147, (95% CI 1.370-3.365); P = 0.001], and higher number of vasopressors [aOR = 31.636, (95% CI 17.603-56.856); P < 0.001]. Addition of sedative medications to a second model led to an increase in the R2 by only 1.6% to 35.6% [aOR = 1 (95% CI 1-1); P > 0.05] for propofol, ketamine, and midazolam. Dexmedetomidine demonstrated a decrease in the odds of mortality [aOR = 0.96 (95% CI 0.94-0.97); P < 0.001]. Conclusion: Mortality in critical COVID-19 patients was mostly driven by illness severity, and the choice of sedation might have minimal impact when other factors are controlled.
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Affiliation(s)
- Mahmoud Alwakeel
- Department of Pulmonary and Critical Care Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Yan Wang
- Department of Anesthesiology, Boston Medical Center, Boston, Massachusetts, USA
| | - Heather Torbic
- Department of Pharmacy, Cleveland Clinic, Cleveland, Ohio, USA
| | | | - Xiaofeng Wang
- Qualitative Health Sciences, Cleveland Clinic, Cleveland, Ohio, USA
| | - Francois Abi Fadel
- Department of Pulmonary and Critical Care Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Abhijit Duggal
- Department of Pulmonary and Critical Care Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, Ohio, USA
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Siddiqui KM, Farooqui MH, Yousuf MS, Ali MA. ARISCAT and LAS VEGAS risk scores for predicting postoperative pulmonary complications after cardiac surgery: a cohort study. Ann Med Surg (Lond) 2024; 86:3873-3879. [PMID: 38989237 PMCID: PMC11230767 DOI: 10.1097/ms9.0000000000002191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 05/08/2024] [Indexed: 07/12/2024] Open
Abstract
Background Postoperative pulmonary complications (PPCs) could lead to morbidity, mortality, and prolonged hospital stay. Different risk-scoring systems are used to predict the identification of patients at risk of developing PPCs. The diagnostic accuracies of the Assess Respiratory Risk in Surgical Patients in Catalonia (ARISCAT) and Local Assessment of Ventilatory Management During General Anaesthesia for Surgery (LAS VEGAS) risk scores are compared in prediction of PPCs taking pulmonary complication as the gold standard in cardiac surgery. Materials and methods A prospective cohort study with consecutive sampling technique. A total of 181 patients were included. Quantitative data is presented as simple descriptive statistics giving mean and standard deviation, and qualitative variables are presented as frequency and percentages. Sensitivity, specificity, positive and negative predictive values, and diagnostic accuracies are also calculated. Results Total 181 post-cardiac surgery patients were analyzed. The median [interquartile range] of age, height, weight, and BMI were 60.0 [52.0-67.0] years, 163.0 [156.0-168.0] cm, 71.0 [65.0-80.0] kg and 27.3 [24.2-30.4] kg/m2. 127 (70.2%) were male, and 54 (29.8%) were female. Sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of ARISCAT for the prediction of PPCs were (94.9%, 4.65%, 76.1%, 22.9% and 73.4%), whereas LAS VEGAS were (97.1%, 4.65%, 76.5%, 33.3% and 75.1%), respectively. Conclusion Both the ARISCAT and LAS VEGAS risk scores are of limited value in cardiac surgery patients for the prediction of postoperative pulmonary complications, based on the predicted scores in this study.
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Affiliation(s)
- Khalid M. Siddiqui
- Department of Anaesthesiology, Aga Khan University Hospital, Karachi, Pakistan
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Shapiro JN, Mian SI. Nontraditional approaches to sedation for anterior segment surgery: a narrative review. Curr Opin Ophthalmol 2024; 35:298-303. [PMID: 38704652 DOI: 10.1097/icu.0000000000001051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2024]
Abstract
PURPOSE OF REVIEW Surgical and anesthetic technological advancement have made both cataract and noncataract anterior segment surgery significantly less invasive and time-intensive, facilitating the transition of some of these procedures from the operating room under monitored anesthesia care (MAC) to the office-based setting without MAC. This transition has been aided by the popularization of nonintravenous approaches to achieving patient sedation for these procedures. In this review, we discuss the literature surrounding traditional and nontraditional methods of achieving patient sedation for anterior segment surgery. RECENT FINDINGS Our survey of the literature suggests that nonintravenous (IV) approaches to sedation for these procedures may be just as safe, effective, and satisfactory to patients as traditional IV approaches. SUMMARY As anterior segment surgery becomes less invasive and less time-intensive, providers considering transitioning their cataract and anterior segment surgery out of the operating room and into the office-based setting without MAC anesthesia should consider the non-IV sedation options outlined in this review to achieve adequate patient sedation and comfort.
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Affiliation(s)
- Jeremy N Shapiro
- Department of Ophthalmology and Visual Sciences, University of Michigan Kellogg Eye Center
- University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Shahzad I Mian
- Department of Ophthalmology and Visual Sciences, University of Michigan Kellogg Eye Center
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Sataloff RT, Ranjbar PA, Balouch B, Barna A, Al Omari AI, Martha V, Alnouri G. Overlapping otolaryngologic surgery: Safety and efficacy. Am J Otolaryngol 2024; 45:104292. [PMID: 38640813 DOI: 10.1016/j.amjoto.2024.104292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 04/14/2024] [Indexed: 04/21/2024]
Abstract
BACKGROUND Surgical procedures scheduled staggered between two operating rooms increase efficiency by eliminating turnover time. However, the practice might increase the surgeon's fatigue. Overlapping surgery has been assumed to be safe because no critical portions of procedures are performed simultaneously in two rooms, but there is little evidence in the literature to support that assumption for otolaryngologic surgery, and there is no evidence comparing non-overlapping and overlapping surgical outcomes for a single surgeon with all confounding factors controlled. METHODS Retrospective cohort study that included a consecutive sample of adult subjects who underwent otolaryngologic laryngeal or otologic surgery between June 2013 and March 2016. All procedures were performed by the same surgical team and surgeon who had block time with 2-rooms every other week and 1-room on alternate weeks. The incidence of surgical complications was assessed in the perioperative period. Duration of surgery and time-in-room also were evaluated, as were surgical outcomes. RESULTS A total of 496 surgeries were assigned to either overlapping-surgery (n = 346) or non-overlapping-surgery (n = 150) cohorts. Overlapping-surgery was a significant predictor for increased time-in-room on multivariate analysis but was not a significant predictor for surgery duration. Rate of complications, hospital readmission, emergency department visit, reoperation, mortality, and patient satisfaction did not differ significantly between cohorts. CONCLUSIONS Overlapping surgery does not hinder patient safety or functional outcomes in patients undergoing otolaryngologic operations such as voice or ear surgery.
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Affiliation(s)
- Robert T Sataloff
- Department of Otolaryngology - Head and Neck Surgery, Senior Associate Dean for Clinical Academic Specialties, Drexel University College of Medicine, Philadelphia, PA, United States.
| | - Parastou Azadeh Ranjbar
- Department of Otolaryngology - Head and Neck Surgery, Tulane University, New Orleans, LA, United States
| | - Bailey Balouch
- Division of Otolaryngology - Head and Neck Surgery, Cooper University Health Care, Camden NJ, Cooper Medical School of Rowan University, Camden, NJ, United States
| | - Alexander Barna
- Medical Student, Drexel University College of Medicine, United States
| | - Ahmad Issa Al Omari
- Department of Otolaryngology - Head and Neck Surgery, UPMC Memorial Hospital, York, PA, United States; Department of Special Surgery, Jordan University of Science and Technology, Irbid, Jordan
| | - Vishnu Martha
- Department of Otolaryngology-Head & Neck Surgery, Malla Reddy Institute of Medical Sciences, Hyderabad, Telangana, India; Department of Otolaryngology - Head and Neck Surgery, Drexel University College of Medicine, United States
| | - Ghiath Alnouri
- Department of Otolaryngology - Head and Neck Surgery, Ohio University Heritage Collage of Osteopathic Medicine, Athens, OH, United States
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Kaye AD, Dufrene K, Cooley J, Walker M, Shah S, Hollander A, Shekoohi S, Robinson CL. Neuropsychiatric Effects Associated with Opioid-Based Management for Palliative Care Patients. Curr Pain Headache Rep 2024; 28:587-594. [PMID: 38564124 DOI: 10.1007/s11916-024-01248-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/19/2024] [Indexed: 04/04/2024]
Abstract
PURPOSE OF REVIEW The abundance of opioids administered in the palliative care setting that was once considered a standard of care is at present necessitating that providers evaluate patients for unintentional and deleterious symptomology related to aberrant opioid use and addiction. Polypharmacy with opioids is dynamic in affecting patients neurologically, and increased amounts of prescriptions have had inimical effects, not only for the individual, but also for their families and healthcare providers. The purpose of this review is to widen the perspective of opioid consequences and bring awareness to the numerous neuropsychiatric effects associated with the most commonly prescribed opioids for patients receiving palliative care. RECENT FINDINGS Numerous clinical and research studies have found evidence in support for increased incidence of opioid usage and abuse as well as undesirable neurological outcomes. The most common and concerning effects of opioid usage in this setting are delirium and problematic drug-related behavioral changes such as deceitful behavior towards family and physicians, anger outbursts, overtaking of medications, and early prescription refill requests. Other neuropsychiatric effects detailed by recent studies include drug-seeking behavior, tolerance, dependence, addictive disorder, anxiety, substance use disorder, emotional distress, continuation of opioids to avoid opioid withdrawal syndrome, depression, and suicidal ideation. Opioid usage has detrimental and confounding effects that have been overlooked for many years by palliative care providers and patients receiving palliative care. It is necessary, even lifesaving, to be cognizant of potential neuropsychiatric effects that opioids can have on an individual, especially for those under palliative care. By having an increased understanding and awareness of potential opioid neuropsychiatric effects, patient quality of life can be improved, healthcare system costs can be decreased, and patient outcomes can be met and exceeded.
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Affiliation(s)
- Alan D Kaye
- Department of Anesthesiology, Louisiana State University Health Sciences Center at Shreveport, 1501 Kings Highway, Shreveport, LA, 71103, USA
- Department of Pharmacology, Louisiana State University Health Sciences Center at Shreveport, Toxicology, and Neurosciences, Shreveport, LA, 71103, USA
| | - Kylie Dufrene
- School of Medicine, Louisiana State University Health Sciences Center Shreveport, Shreveport, LA, 71103, USA
| | - Jada Cooley
- School of Medicine, Louisiana State University Health Sciences Center Shreveport, Shreveport, LA, 71103, USA
| | - Madeline Walker
- School of Medicine, Louisiana State University Health Sciences Center Shreveport, Shreveport, LA, 71103, USA
| | - Shivam Shah
- School of Medicine, Louisiana State University Health Sciences Center Shreveport, Shreveport, LA, 71103, USA
| | - Alex Hollander
- School of Medicine, Louisiana State University Health Sciences Center Shreveport, Shreveport, LA, 71103, USA
| | - Sahar Shekoohi
- Department of Anesthesiology, Louisiana State University Health Sciences Center at Shreveport, 1501 Kings Highway, Shreveport, LA, 71103, USA.
| | - Christopher L Robinson
- Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, 02215, USA
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Minic J, Vigato E, Shoham Y, Lavagnolo U, Governa M. Selective enzymatic debridement and modified Meek technique in the treatment of extensive burns: Preliminary observations. Health Sci Rep 2024; 7:e1829. [PMID: 39040879 PMCID: PMC11260873 DOI: 10.1002/hsr2.1829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 10/31/2023] [Accepted: 01/03/2024] [Indexed: 07/24/2024] Open
Abstract
Background Selective bromelain-based enzymatic debridement (BED) has emerged as a valid alternative for the treatment of extensive burns, with Total Body Surface Area (TBSA) > 20%. Autologous skin grafting represents the procedure of choice but the scarcity of donor sites remains the main reconstructive challenge. The modified Meek micro-grafting technique may represent a valid strategy to optimize the final outcome. Methods A single-cohort retrospective analysis was performed, involving nine burn patients (TBSA > 20%) who underwent both BED and subsequently modified Meek technique. Demographic and clinical data (mechanism of injury, surgical treatment, complications, necessity of re-grafting, further surgery and esthetic outcome) were collected. Results All patients had large burns of mixed and deep dermal thickness (first, second, and third degree). All burns were enzymatically debrided postadmission and covered by the modified Meek technique. Local infection due to poor general conditions was the main complication for all patients. All but two patients survived. The selectiveness of the enzymatic debridement and dermal preservation seemed to improve the quality of scars resulting from micro-grafting. Evaluations performed at 12 ± 2 months postburn showed superior scar quality compared to areas treated with traditional (sheet/mesh) grafts. Conclusion Combined BED and Meek techniques may provide an effective synergic combination for the treatment of extensive burns.
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Affiliation(s)
| | | | - Yaron Shoham
- Burn Unit, Soroka University Medical Center, Faculty of Health SciencesBen‐Gurion University of the NegevBeer ShebaIsrael
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Liu T, Qu Y, Chai J, Liu X, Hu F, Zhang D, Duan H, Chi Y. Epidemiology and first aid measures in pediatric burn patients in northern China during 2016-2020: A single-center retrospective study. Health Sci Rep 2024; 7:e2218. [PMID: 39072351 PMCID: PMC11273291 DOI: 10.1002/hsr2.2218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 06/02/2024] [Accepted: 06/13/2024] [Indexed: 07/30/2024] Open
Abstract
Background and Aims Burn and scald injuries are the fourth most common type of trauma. Pediatric burns account for a high proportion of the total number of burn patients and impose a high burden on public health. Understanding the epidemiology of pediatric burns can help improve science education and reduce the incidence of burn injuries. Methods This study is a single-center retrospective study. One thousand five hundred and twenty-seven pediatric burn patients admitted to our burn center from January 2016 to December 2020 were included. Demographic and epidemiological data of included patients were extracted and analyzed. The correlations of categorical data were tested by the Chi-square tests, and differences of continuous data were tested by the Kruskal-Wallis tests. A p-value of less than 0.05 was considered to be statistically significant. Results The results showed that children under 3 years of age were most susceptible to burn and scald injuries. Burn injuries were most likely to occur in the season of winter and at the place of home. 56.6% of included patients did receive first aid measures, while 1.8% received gold-standard first aid. Clinical variables related to the severity of injuries were statistically different between patients with and without cooling measures in first aid. Linear regression models showed that emergency treatment of burns in children and adolescents was associated with outcome indicators, including number of operations, total operation duration per total burn surface area (TBSA), cost per TBSA, and length of stay per TBSA. Conclusions This study summarized the epidemiology and outcomes of pediatric burn patients admitted to a burn center in northern China. Adopting cooling measures in first aid can reduce the severity of injuries and reduce the burden on the medical system. Education on burn prevention and first aid measures to caregivers of children, especially preschool children, should be strengthened.
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Affiliation(s)
- Tian Liu
- Senior Department of Burns & Plastic SurgeryThe Fourth Medical Center of PLA General HospitalBeijingChina
- Department of Burn and Plastic SurgeryGeneral Hospital of Southern Theater Command, PLAGuangzhouChina
| | - Yirui Qu
- Chinese PLA General Hospital & Chinese PLA Medical SchoolBeijingChina
| | - Jiake Chai
- Senior Department of Burns & Plastic SurgeryThe Fourth Medical Center of PLA General HospitalBeijingChina
| | - Xiangyu Liu
- Chinese PLA General Hospital & Chinese PLA Medical SchoolBeijingChina
| | - Fangchao Hu
- Chinese PLA General Hospital & Chinese PLA Medical SchoolBeijingChina
| | - Dongliang Zhang
- Department of Burns and Cutaneous Surgery, Xijing HospitalFourth Military Medical UniversityXi'anChina
| | - Hongjie Duan
- Senior Department of Burns & Plastic SurgeryThe Fourth Medical Center of PLA General HospitalBeijingChina
| | - Yunfei Chi
- Senior Department of Burns & Plastic SurgeryThe Fourth Medical Center of PLA General HospitalBeijingChina
- Chinese PLA General Hospital & Chinese PLA Medical SchoolBeijingChina
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Barchick SR, Masada KM, Fryhofer GW, Alqazzaz A, Donegan DJ, Mehta S. The hip fracture assessment tool: A scoring system to assess high risk geriatric hip fracture patients for post-operative critical care monitoring. Injury 2024; 55:111584. [PMID: 38762944 DOI: 10.1016/j.injury.2024.111584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 04/16/2024] [Accepted: 04/17/2024] [Indexed: 05/21/2024]
Abstract
INTRODUCTION Intensive care unit risk stratification models have been utilized in elective joint arthroplasty; however, hip fracture patients are fundamentally different in their clinical course. Having a critical care risk calculator utilizing pre-operative risk factors can improve resourcing for hip fracture patients in the peri‑operative period. METHODS A cohort of geriatric hip fracture patients at a single institution were reviewed over a three-year period. Non-operative patients, peri‑implant fractures, additional procedures performed under the same anesthesia period, and patients admitted to the intensive care unit (ICU) prior to surgery were excluded. Pre-operative laboratory values, Revised Cardiac Risk Index (RCRI), and American Society of Anesthesiologists (ASA) scores were calculated. Pre-operative ambulatory status was determined. The primary outcome measure was ICU admission in the post-operative period. Outcomes were assessed with Fisher's exact test, Kruskal-Wallis test, logistic regression, and ROC curve. RESULTS 315 patient charts were analyzed with 262 patients meeting inclusion criteria. Age ≥ 80 years, ASA ≥ 4, pre-operative hemoglobin < 10 g/dL, and a history of CVA/TIA were found to be significant factors and utilized within a "training" data set to create a 4-point scoring system after reverse stepwise elimination. The 4-point scoring system was then assessed within a separate "validation" data set to yield an ROC area under the curve (AUC) of 0.747. Score ≥ 3 was associated with 96.8 % specificity and 14.2 % sensitivity for predicting post-op ICU admission. Score ≥ 3 was associated with a 50 % positive predictive value and 83 % negative predictive value. CONCLUSION A hip fracture risk stratification scoring system utilizing pre-operative patient specific values to stratify geriatric hip patients to the ICU post-operatively can improve the pre-operative decision-making of surgical and critical care teams. This has important implications for triaging vital hospital resources. LEVEL OF EVIDENCE III (retrospective study).
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Affiliation(s)
- Stephen R Barchick
- Department of Orthopaedic Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
| | - Kendall M Masada
- Department of Orthopaedic Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - George W Fryhofer
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Aymen Alqazzaz
- Department of Orthopaedic Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Derek J Donegan
- Department of Orthopaedic Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Samir Mehta
- Department of Orthopaedic Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
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Tsumura H, Brandon D, Vacchiano C, Krishnamoorthy V, Bartz R, Pan W. Exploring phenotype-based ventilator parameter optimization to mitigate postoperative pulmonary complications: a retrospective observational cohort study. Surg Today 2024; 54:722-733. [PMID: 38095709 PMCID: PMC11176264 DOI: 10.1007/s00595-023-02785-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 11/01/2023] [Indexed: 06/15/2024]
Abstract
PURPOSE To identify tidal volume (VT) and positive end-expiratory pressure (PEEP) associated with the lowest incidence and severity of postoperative pulmonary complications (PPCs) for each phenotype based on preoperative characteristics. METHODS The subjects of this retrospective observational cohort study were 34,910 adults who underwent surgery, using general anesthesia with mechanical ventilation. Initially, the least absolute shrinkage and selection operator regression was employed to select relevant preoperative characteristics. Then, the classification and regression tree (CART) was built to identify phenotypes. Finally, we computed the area under the receiver operating characteristic curves from logistic regressions to identify VT and PEEP associated with the lowest incidence and severity of PPCs for each phenotype. RESULTS CARTs classified seven phenotypes for each outcome. A probability of the development of PPCs ranged from the lowest (3.51%) to the highest (68.57%), whereas the probability of the development of the highest level of PPC severity ranged from 3.3% to 91.0%. Across all phenotypes, the VT and PEEP associated with the most desirable outcomes were within a small range of VT 7-8 ml/kg predicted body weight with PEEP of between 6 and 8 cmH2O. CONCLUSIONS The ranges of optimal VT and PEEP were small, regardless of the phenotypes, which had a wide range of risk profiles.
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Affiliation(s)
- Hideyo Tsumura
- Duke University School of Nursing, 307 Trent Drive, Durham, NC, 27710, USA.
- Duke University Health System, 2301 Erwin Road, Durham, NC, 27710, USA.
| | - Debra Brandon
- Duke University School of Nursing, 307 Trent Drive, Durham, NC, 27710, USA
- Department of Pediatrics, Duke University School of Medicine, DUMC 3352, Durham, NC, 27710, USA
| | - Charles Vacchiano
- Duke University School of Nursing, 307 Trent Drive, Durham, NC, 27710, USA
| | - Vijay Krishnamoorthy
- Department of Anesthesiology, Duke University School of Medicine, Durham, NC, DUMC 309427710, USA
- Department of Population Health Sciences Duke University School of Medicine, 215 Morris Street, Durham, NC, 27701, USA
| | - Raquel Bartz
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA
| | - Wei Pan
- Duke University School of Nursing, 307 Trent Drive, Durham, NC, 27710, USA
- Department of Population Health Sciences Duke University School of Medicine, 215 Morris Street, Durham, NC, 27701, USA
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Alessandri Bonetti M, Egro FM. The Role of Microsurgery in Burn Surgery. Clin Plast Surg 2024; 51:399-408. [PMID: 38789149 DOI: 10.1016/j.cps.2024.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2024]
Abstract
Acute burn reconstruction involves intricate strategies such as skin grafting and innovative technologies, addressing challenges in coverage and minimizing donor site morbidity. Despite being rarely used, flap reconstruction becomes necessary when critical structures are exposed, offering robust coverage and reducing complications. However, free flaps in acute burns face challenges, including a higher failure rate attributed to hyperinflammatory states and hypercoagulability. Surgical optimization strategies involve careful timing, patient preparation, and meticulous postoperative care. In delayed burn reconstruction, free flaps proved effective in functional and aesthetic restoration, with low flap loss rates and minimal contracture recurrence. Prefabricated and prelaminated flaps emerged as a solution for complex cases, ensuring the best functional and aesthetic possible outcomes in challenging facial burn reconstructions.
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Affiliation(s)
| | - Francesco M Egro
- Department of Plastic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA; Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
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Matsuura H, Matsui Y, Okuda K, Kishimoto M. Isolated Lung Ventilation With Tracheostomy Using Two Intubation Tubes for Severe Endotracheal Hemorrhage Due to Pulmonary Contusion. Cureus 2024; 16:e64443. [PMID: 39135810 PMCID: PMC11317845 DOI: 10.7759/cureus.64443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/12/2024] [Indexed: 08/15/2024] Open
Abstract
A 72-year-old man presented with severe pulmonary contusions and multiple traumas, including aortic injury, pelvic fracture, and renal injury. The patient required multidisciplinary treatment, including transcatheter arterial embolization, thoracic endovascular aortic repair, right lung upper lobe partial resection, and massive transfusion. During the initial treatment, the patient experienced respiratory failure due to endotracheal bleeding, and we attempted isolated lung ventilation with a 37 Fr double-lumen endotracheal intubation tube. Although drainage by suction and protection of the healthy lung was vital, the patient was unable to maintain ventilation volume because of poor drainage. Additionally, the respiratory status deteriorated. To resolve the situation, a tracheotomy was performed and two endotracheal intubation tubes (6.0 mm inner diameter, and 9.0 mm outer diameter) were inserted through a large U-shaped tracheal hole 18 hours after admission. The respiratory status of the patient gradually improved after the procedure. There were two advantages of this method of respiratory management. Firstly, each of the two endotracheal tubes had a separate cuff, allowing more reliable separation of the healthy lung from the injured lung. Secondly, bronchoscopes of sufficient diameter (4.9 mm outer diameter ) were used bilaterally, allowing sufficient drainage of viscous airway secretions mixed with hematoma and improving atelectasis. Although venovenous extracorporeal membrane oxygenation is a crucial support tool when the respiratory status deteriorates due to severe pulmonary contusions, our method of airway management may be attempted in patients with multiple traumatic injuries with coagulopathy.
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Affiliation(s)
- Hiroshi Matsuura
- Emergency and Critical Care, Osaka Prefectural Nakakawachi Emergency and Critical Care Center, Osaka, JPN
| | - Yuki Matsui
- Emergency and Critical Care, Osaka Prefectural Nakakawachi Emergency and Critical Care Center, Osaka, JPN
| | - Kazunori Okuda
- Emergency and Critical Care, Osaka Prefectural Nakakawachi Emergency and Critical Care Center, Osaka, JPN
| | - Masafumi Kishimoto
- Emergency and Critical Care, Osaka Prefectural Nakakawachi Emergency and Critical Care Center, Osaka, JPN
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Ruiz Colón GD, Prolo LM. In Reply to the Letter to the Editor Regarding "Neurosurgical Outcomes Among Non-English Speakers: A Systematic Review and a Framework for Future Research". World Neurosurg 2024; 187:273. [PMID: 38970193 DOI: 10.1016/j.wneu.2024.04.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Accepted: 04/06/2024] [Indexed: 07/08/2024]
Affiliation(s)
- Gabriela D Ruiz Colón
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, USA
| | - Laura M Prolo
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, USA; Division of Pediatric Neurosurgery, Lucile Packard Children's Hospital, Stanford, California, USA.
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Tanaka N, Kadoya Y, Suzuka T, Yamanaka T, Ida M, Naito Y, Ozu N, Hori S, Kawaguchi M. Effect of nociception level-directed analgesic management on opioid usage in robot-assisted laparoscopic radical prostatectomy: a single-center, single-blinded, randomized controlled trial. J Anesth 2024:10.1007/s00540-024-03365-x. [PMID: 38935172 DOI: 10.1007/s00540-024-03365-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Accepted: 06/14/2024] [Indexed: 06/28/2024]
Abstract
PURPOSE To assess the importance of appropriate opioid administration methods according to nociceptive monitoring. METHODS We conducted a randomized controlled trial involving 54 patients who underwent robot-assisted laparoscopic radical prostatectomy at our hospital. Patients were randomly allocated to either receive nociception level (NOL)-directed intraoperative opioid management with a minimum flow of remifentanil (NOL group) or conventional intraoperative analgesic management (control group). The primary outcome was the mean intraoperative remifentanil infusion flow rate (intraoperative remifentanil usage [μg]/ideal body weight [kg]/operation time [min]). The main secondary outcomes were plasma concentrations of three perioperative inflammatory biomarkers (interleukin-6, C-reactive protein [CRP], and cortisol levels) and postoperative pain (Numeric Rating Scale [NRS]) scores 2 h postoperatively and on postoperative days 1, 2, 3, and 7. RESULTS Compared with standard analgesia management, NOL-directed analgesic management reduced remifentanil consumption by 20% ( - 0.038; 95% confidence interval, - 0.059 to - 0.017; p = 0.0007). NOL-directed management did not lead to an increase in IL-6, CRP, or cortisol levels compared with conventional analgesic management. Furthermore, this protocol led to improvements in the NRS scores at rest 2 h postoperatively and upon movement up to postoperative day 3. CONCLUSION NOL-directed analgesic management reduced remifentanil consumption by 20% and the NRS scores at rest 2 h postoperatively and upon movement up to postoperative day 3 without an increase in inflammatory marker levels. REGISTRY NUMBER Japan Registry of Clinical Trials, JRCTs052220034.
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Affiliation(s)
- Nobuhiro Tanaka
- Department of Anesthesiology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, Japan.
| | - Yuma Kadoya
- Department of Anesthesiology, Ikeda City Hospital, Ikeda, Osaka, Japan
| | - Takanori Suzuka
- Department of Anesthesiology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, Japan
| | - Takayuki Yamanaka
- Department of Anesthesiology, Nara Prefecture General Medical Center, Nara, Nara, Japan
| | - Mitsuru Ida
- Department of Anesthesiology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, Japan
| | - Yusuke Naito
- Department of Anesthesiology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, Japan
| | - Naoki Ozu
- Institute for Clinical and Translational Science, Nara Medical University Hospital, Kashihara, Nara, Japan
| | - Shunta Hori
- Department of Urology, Nara Medical University, Kashihara, Nara, Japan
| | - Masahiko Kawaguchi
- Department of Anesthesiology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, Japan
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Hernandez J, Demiranda L, Perisetla P, Andrews L, Zhang K, Henderson R, Mittal A, Norton HF, Hagen MG. A systematic review and narrative synthesis of health literacy interventions among Spanish speaking populations in the United States. BMC Public Health 2024; 24:1713. [PMID: 38926697 PMCID: PMC11210103 DOI: 10.1186/s12889-024-19166-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 06/14/2024] [Indexed: 06/28/2024] Open
Abstract
BACKGROUND While many populations struggle with health literacy, those who speak Spanish preferentially or exclusively, including Hispanic, immigrant, or migrant populations, may face particular barriers, as they navigate a predominantly English-language healthcare system. This population also faces greater morbidity and mortality from treatable chronic diseases, such as hypertension and diabetes. The aim of this systematic review was to describe existing health literacy interventions for patients with a Spanish-language preference and present their effectiveness. METHODS We carried out a systematic review where Web of Science, EMBASE, and PubMed were queried using MeSH terms to identify relevant literature. Included articles described patients with a Spanish-language preference participating in interventions to improve health literacy levels in the United States. Screening and data abstraction were conducted independently and in pairs. Risk of bias assessments were conducted using validated appraisal tools. RESULTS A total of 2823 studies were identified, of which 62 met our eligibility criteria. The studies took place in a variety of community and clinical settings and used varied tools for measuring health literacy. Of the interventions, 28 consisted of in-person education and 27 implemented multimedia education, with 89% of studies in each category finding significant results. The remaining seven studies featured multimodal interventions, all of which achieved significant results. CONCLUSION Successful strategies included the addition of liaison roles, such as promotores (Hispanic community health workers), and the use of multimedia fotonovelas (photo comics) with linguistic and cultural adaptations. In some cases, the external validity of the results was limited. Improving low health literacy in patients with a Spanish-language preference, a population with existing barriers to high quality of care, may help them better navigate health infrastructure and make informed decisions regarding their health. REGISTRATION PROSPERO (available at https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021257655.t ).
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Affiliation(s)
- Joel Hernandez
- University of Central Florida College of Medicine, University of Central Florida, Orlando, USA
| | - Liliana Demiranda
- Equal Access Research, College of Medicine, University of Florida, 1549 Gale Lemerand Drive, 4 Floor, Suite 4592, Gainesville, FL, 32610-3008, USA
| | - Priyanka Perisetla
- Equal Access Research, College of Medicine, University of Florida, 1549 Gale Lemerand Drive, 4 Floor, Suite 4592, Gainesville, FL, 32610-3008, USA
| | - Lauren Andrews
- Equal Access Research, College of Medicine, University of Florida, 1549 Gale Lemerand Drive, 4 Floor, Suite 4592, Gainesville, FL, 32610-3008, USA
| | - Keer Zhang
- Equal Access Research, College of Medicine, University of Florida, 1549 Gale Lemerand Drive, 4 Floor, Suite 4592, Gainesville, FL, 32610-3008, USA
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, USA
| | - Rebecca Henderson
- College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Ajay Mittal
- Equal Access Research, College of Medicine, University of Florida, 1549 Gale Lemerand Drive, 4 Floor, Suite 4592, Gainesville, FL, 32610-3008, USA
| | - Hannah F Norton
- University of Florida Health Science Center Libraries, Gainesville, FL, USA
| | - Melanie G Hagen
- Equal Access Research, College of Medicine, University of Florida, 1549 Gale Lemerand Drive, 4 Floor, Suite 4592, Gainesville, FL, 32610-3008, USA.
- Department of Internal Medicine, College of Medicine, University of Florida, Gainesville, FL, USA.
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Ilg AM, Beltran CP, Shih JA, Yankama TT, Hayes MM, Moskowitz AL. Experiential Learning with Ketamine: A Mixed-Methods Exploratory Study on Prescription and Perception. Ther Clin Risk Manag 2024; 20:381-390. [PMID: 38934016 PMCID: PMC11199167 DOI: 10.2147/tcrm.s462760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2024] [Accepted: 06/09/2024] [Indexed: 06/28/2024] Open
Abstract
Background Incorporating unfamiliar therapies into practice requires effective longitudinal learning and the optimal way to achieve this is debated. Though not a novel therapy, ketamine in critical care has a paucity of data and variable acceptance, with limited research describing intensivist perceptions and utilization. The Coronavirus-19 pandemic presented a particular crisis where providers rapidly adapted analgosedation strategies to achieve prolonged, deep sedation due to a surge of severe acute respiratory distress syndrome (ARDS). Question How does clinical experience with ketamine impact the perception and attitude of clinicians toward this therapy? Methods We conducted a mixed-methods study using quantitative ketamine prescription data and qualitative focus group data. We analyzed prescription patterns of ketamine in a tertiary academic ICU during two different time points: pre-COVID-19 (March 1-June 30, 2019) and during the COVID-19 surge (March 1-June 30, 2020). Two focus groups (FG) of critical care attendings were held, and data were analyzed using the Framework Method for content analysis. Results Four-hundred forty-six medical ICU patients were mechanically ventilated (195 pre-COVID-19 and 251 during COVID-19). The COVID-19 population was more likely to receive ketamine (81[32.3%] vs 4 [2.1%], p < 0.001). Thirteen respondents participated across two FG sessions (Pre-COVID = 8, Post-COVID=5). The most prevalent attitude among our respondents was discomfort, with three key themes identified as follows: 1) lack of evidence regarding ketamine, 2) lack of personal experience, and 3) desire for more education and protocols. Conclusion Despite a substantial increase in ketamine prescription during COVID-19, intensivists continued to feel discomfort with utilization. Factors contributing to this discomfort include a lack of evidence, a lack of experience, and a desire for more education and protocols. Increase in experience with ketamine alone was not sufficient to minimize provider discomfort. These findings should inform future curricula and call for process improvement to optimize continuing education.
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Affiliation(s)
- Annette M Ilg
- Division of Emergency Critical Care, Department of Emergency Medicine, Mass General Brigham, Boston, MA, USA
| | - Christine P Beltran
- Carl J, Shapiro Institute for Education and Research, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Jenny A Shih
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Department of Pulmonary and Critical Care, Brigham and Women’s Hospital, Boston, MA, USA
| | - Tuyen T Yankama
- Department of Pharmacy, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Margaret M Hayes
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Ari L Moskowitz
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Division of Critical Care Medicine, Department of Medicine, Montefiore Medical Center, Bronx, New York, NY, USA
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Zhu X, Jia Z, Zhou Y, Wu J, Cao M, Hu C, Yu L, Chen Z. Current advances in the pain treatment and mechanisms of Traditional Chinese Medicine. Phytother Res 2024. [PMID: 39031847 DOI: 10.1002/ptr.8259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 05/20/2024] [Accepted: 05/20/2024] [Indexed: 07/22/2024]
Abstract
Traditional Chinese Medicine (TCM), as a unique medical model in China, has been shown to be effective in the treatment of many diseases. It has been proven that TCM can increase the pain threshold, increase the level of endorphins and enkephalins in the body, and reduce the body's response to adverse stimuli. In recent years, TCM scholars have made valuable explorations in the field of pain treatment, using methods such as internal and external application of TCM and acupuncture to carry out research on pain treatment and have achieved more satisfactory results. TCM treats pain in a variety of ways, and with the discovery of a variety of potential bioactive substances for pain treatment. With the new progress in the research of other TCM treatment methods for pain, TCM will have greater potential in the clinical application of pain.
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Affiliation(s)
- Xiaoli Zhu
- State Key Laboratory of Southwestern Chinese Medicine Resources, School of Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Zhuolin Jia
- State Key Laboratory of Southwestern Chinese Medicine Resources, School of Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Ye Zhou
- State Key Laboratory of Southwestern Chinese Medicine Resources, School of Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Jie Wu
- State Key Laboratory of Southwestern Chinese Medicine Resources, School of Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Mayijie Cao
- State Key Laboratory of Southwestern Chinese Medicine Resources, School of Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Changjiang Hu
- State Key Laboratory of Southwestern Chinese Medicine Resources, School of Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Lingying Yu
- State Key Laboratory of Southwestern Chinese Medicine Resources, School of Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Zhimin Chen
- State Key Laboratory of Southwestern Chinese Medicine Resources, School of Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu, China
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Salehi Z, Askari M, Jafari A, Ghosn B, Surkan PJ, Hosseinzadeh-Attar MJ, Pouraram H, Azadbakht L. Dietary patterns and micronutrients in respiratory infections including COVID-19: a narrative review. BMC Public Health 2024; 24:1661. [PMID: 38907196 PMCID: PMC11193220 DOI: 10.1186/s12889-024-18760-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Accepted: 05/02/2024] [Indexed: 06/23/2024] Open
Abstract
BACKGROUND COVID-19 is a pandemic caused by nCoV-2019, a new beta-coronavirus from Wuhan, China, that mainly affects the respiratory system and can be modulated by nutrition. METHODS This review aims to summarize the current literature on the association between dietary intake and serum levels of micronutrients, malnutrition, and dietary patterns and respiratory infections, including flu, pneumonia, and acute respiratory syndrome, with a focus on COVID-19. We searched for relevant articles in various databases and selected those that met our inclusion criteria. RESULTS Some studies suggest that dietary patterns, malnutrition, and certain nutrients such as vitamins D, E, A, iron, zinc, selenium, magnesium, omega-3 fatty acids, and fiber may have a significant role in preventing respiratory diseases, alleviating symptoms, and lowering mortality rates. However, the evidence is not consistent and conclusive, and more research is needed to clarify the mechanisms and the optimal doses of these dietary components. The impact of omega-3 and fiber on respiratory diseases has been mainly studied in children and adults, respectively, and few studies have examined the effect of dietary components on COVID-19 prevention, with a greater focus on vitamin D. CONCLUSION This review highlights the potential of nutrition as a modifiable factor in the prevention and management of respiratory infections and suggests some directions for future research. However, it also acknowledges the limitations of the existing literature, such as the heterogeneity of the study designs, populations, interventions, and outcomes, and the difficulty of isolating the effects of single nutrients from the complex interactions of the whole diet.
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Affiliation(s)
- Zahra Salehi
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, IR, Iran
| | - Mohammadreza Askari
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, IR, Iran
| | - Alireza Jafari
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, IR, Iran
| | - Batoul Ghosn
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, IR, Iran
| | - Pamela J Surkan
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Mohammad Javad Hosseinzadeh-Attar
- Department of Clinical Nutrition, School of Nutritional Sciences and Dietetic, Tehran University of Medical Sciences, Tehran, Iran
- Department of Nutrition and Biochemistry, School of Public Health, Tehran University of Medical Sciences, Tehran, IR, Iran
| | - Hamed Pouraram
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, IR, Iran
| | - Leila Azadbakht
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, IR, Iran.
- Diabetes Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, IR, Iran.
- Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, IR, Iran.
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Park H, Ko E, Lim CH, Lee J, Kim D, Yeom G, Lee K. Effects of video-assisted preanesthetic patient education on preanesthetic interview time; A prospective, single-blinded, randomized controlled trial. Medicine (Baltimore) 2024; 103:e38577. [PMID: 38905399 PMCID: PMC11191935 DOI: 10.1097/md.0000000000038577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 05/23/2024] [Indexed: 06/23/2024] Open
Abstract
BACKGROUND A preanesthetic evaluation interview with an anesthesiologist is essential for patient safety, however, it is not performed adequately owing to the excessive workload of doctors. This study aimed to determine whether video-assisted preanesthetic patient education can reduce patient interview time and solve the problem of excessive labor at a relatively low cost. METHODS This study considered relatively healthy patients aged 19 to 65 years who were scheduled for elective surgery under general anesthesia. None of the patients had history of general anesthesia. Patients were randomly assigned 1:1 to Groups V and C. Group V watched the preanesthetic education video, while Group C did not. The duration of the preanesthetic evaluation interview was measured for all participants. The satisfaction of the anesthesiologist and patient with the preanesthetic evaluation procedure, anxiety of the patient, and vital signs during surgery were collected. RESULTS A total of 33 patients in Group V watched the preanesthetic education video, while 31 patients in Group C did not. Group V spent significantly less time on the preanesthetic evaluation interview with an anesthesiologist than that of Group C (172.42 vs 196.68 seconds; P = .005). There was no difference in patient and anesthesiologist satisfaction between the 2 groups (P = .861 and P = .849, respectively). Patients' anxiety (P = .474), intraoperative mean blood pressure (P = .168), and heart rate (P = .934) did not differ between Groups V and C. CONCLUSION Watching the informational video about anesthesia before preanesthetic evaluation could reduce the interview time by an average of 24 seconds, with no difference in patients' or doctors' satisfaction or anxiety compared to patients who did not watch it. Video-assisted preanesthetic patient education indicates that the load on anesthesiologists can be reduced.
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Affiliation(s)
- Heechan Park
- Department of Anesthesiology and Pain Medicine, Korea University Anam Hospital, Seoul, South Korea
| | - Eunji Ko
- Department of Anesthesiology and Pain Medicine, Korea University Anam Hospital, Seoul, South Korea
| | - Choon Hak Lim
- Department of Anesthesiology and Pain Medicine, College of Medicine, Korea University, Seoul, South Korea
| | - Jeonghoon Lee
- Department of Anesthesiology and Pain Medicine, Korea University Anam Hospital, Seoul, South Korea
| | - Dongil Kim
- Korea University Anam Hospital, Seoul, South Korea
| | | | - Kyungmin Lee
- Korea Univiersity Guro Hospital, Seoul, South Korea
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Güzel N, Yava A, Koyuncu A. The Effects of Preoperative Video-Assisted Education on Anxiety and Comfort After Breast Cancer Surgery: Nonrandomized Controlled Study. J Perianesth Nurs 2024:S1089-9472(24)00035-2. [PMID: 38904603 DOI: 10.1016/j.jopan.2024.01.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 01/21/2024] [Accepted: 01/21/2024] [Indexed: 06/22/2024]
Abstract
PURPOSE This study aimed to determine the effects of video-assisted education given before breast cancer surgery on patients' anxiety and comfort. DESIGN A nonrandomized, controlled, quasi-experimental model was used. METHODS The study was conducted in the general surgery clinic of a public hospital. Seventy patients voluntarily participated in the study, 35 of them were in the Control (CG) and 35 of them were in the Experimental Group (EG). While routine treatment and care were given to CG, a video-assisted education was also provided to EG. The data were collected using the Personal Information Form, State-Trait Anxiety Inventory (STAI), and General Comfort Questionnaire (GCQ). The patients in both groups filled in the STAI and GCQ on the first day preoperatively, STAI-S and GCS on the second postoperative day and STAI-S on the tenth day after surgery. P < .05 was accepted as a statistical significance value. FINDINGS The groups were similar in terms of descriptive features and preoperative anxiety scores (P > .05). Postoperative second and tenth-day anxiety scores were significantly higher in CG (43.97 ± 9.42 and 39.45 ± 3.88) compared to EG (33.29 ± 4.94 and 33.31 ± 3.01) (P < .05). In terms of the mean scores of the GCQ and its subscales of comfort, preoperative comfort was found to be lower than postoperative comfort level (P < .05). CONCLUSIONS Preoperative video-assisted education decreased the anxiety level and increased the comfort level in EG. We conclude that the use of video-assisted education in reducing anxiety and increasing the perception of comfort in breast cancer surgery patients would be beneficial.
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Affiliation(s)
- Neriman Güzel
- Hamidiye Etfal Vocational and Technical Anatolian High School Sisli, Istanbul, Turkey.
| | - Ayla Yava
- Nursing Department, Faculty of Health Sciences, Gaziantep Hasan Kalyoncu University, Gaziantep, Turkey
| | - Aynur Koyuncu
- Nursing Department, Faculty of Health Sciences, Gaziantep Hasan Kalyoncu University, Gaziantep, Turkey
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Joo Y, Jang Y, Kwon OY. Contents and effectiveness of patient- and family-centred care interventions in adult intensive care units: A systematic review. Nurs Crit Care 2024. [PMID: 38899600 DOI: 10.1111/nicc.13105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 04/16/2024] [Accepted: 05/28/2024] [Indexed: 06/21/2024]
Abstract
BACKGROUND The need and values of patient- and family-centred care (PFCC) have been globally increasing in the health care landscape. However, the concept of PFCC and the components in adult intensive care units (ICUs) remain wide-ranging. AIM To elucidate the core concepts of PFCC interventions and evaluate the effects of the interventions in adult ICUs. STUDY DESIGN We searched electronic databases (PubMed, Cochrane Central, CINAHL, EMBASE, PsycINFO, RISS, KMbase and KoreaMed) from inception to 20 June 2022, for all studies on PFCC interventions. Three authors independently conducted data screening and extraction. The core concepts and the effects of PFCC interventions in adult ICUs were examined. The effects of patient- and family-centred care interventions in adult ICUs were examined. The quality of the included studies was evaluated using the Mixed Methods Appraisal Tool. RESULTS Overall, 3507 records were identified, and 14 full-text articles were assessed. Participants in the included studies were patients and/or their family members in adult ICUs. The main concepts of the studies were participation and information-sharing. Only two studies used collaboration as the main concept of intervention. PFCC interventions have shown positive outcomes for patients, including increased satisfaction, improvement of patient health status and reduced incidence of complications. They have also been beneficial for families, leading to higher satisfaction levels and decreased anxiety. Additionally, these interventions have positively impacted health care providers by enhancing satisfaction and improving rounding efficiency. Moreover, they have influenced health care utilization by decreasing hospital costs and length of stay. CONCLUSIONS This review highlights the advantages of PFCC interventions for patients, families and health care providers in adult ICUs. Future research should focus on developing strategies to incorporate collaboration more comprehensively as a core concept in the implementation of PFCC interventions. RELEVANCE TO CLINICAL PRACTICE Future research endeavours must prioritize collaborative efforts involving health care providers, patients and their families by deploying an array of strategies within the intensive care unit setting.
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Affiliation(s)
- Youngshin Joo
- College of Nursing and Brain Korea 21 FOUR Project, Yonsei University, Seoul, Republic of Korea
| | - Yeonsoo Jang
- College of Nursing and Mo-Im Kim Nursing Research Institute, Yonsei University, Seoul, Republic of Korea
| | - Oh Young Kwon
- College of Nursing and Brain Korea 21 FOUR Project, Yonsei University, Seoul, Republic of Korea
- College of Nursing and Mo-Im Kim Nursing Research Institute, Yonsei University, Seoul, Republic of Korea
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Chau SWH, Chue TM, Chan RNY, Lai YL, Wong PWC, Li SX, Liu Y, Chan JWY, Chan PKS, Lai CKC, Leung TWH, Wing YK. Chronic post-COVID neuropsychiatric symptoms persisting beyond one year from infection: a case-control study and network analysis. Transl Psychiatry 2024; 14:261. [PMID: 38898009 PMCID: PMC11187160 DOI: 10.1038/s41398-024-02978-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 05/18/2024] [Accepted: 06/10/2024] [Indexed: 06/21/2024] Open
Abstract
Our study aims to delineate the phenotypes of chronic neuropsychiatric symptoms among adult subjects recovering from their first COVID that occurred more than one year ago. We also aim to explore the clinical and socioeconomic risk factors of having a high loading of chronic neuropsychiatric symptoms. We recruited a post-COVID group who suffered from their first pre-Omicron COVID more than a year ago, and a control group who had never had COVID. The subjects completed app-based questionnaires on demographic, socioeconomic and health status, a COVID symptoms checklist, mental and sleep health measures, and neurocognitive tests. The post-COVID group has a statistically significantly higher level of fatigue compared to the control group (p < 0.001). Among the post-COVID group, the lack of any COVID vaccination before the first COVID and a higher level of material deprivation before the COVID pandemic predicts a higher load of chronic post-COVID neuropsychiatric symptoms. Partial correlation network analysis suggests that the chronic post-COVID neuropsychiatric symptoms can be clustered into two major (cognitive complaints -fatigue and anxiety-depression) and one minor (headache-dizziness) cluster. A higher level of material deprivation predicts a higher number of symptoms in both major clusters, but the lack of any COVID vaccination before the first COVID only predicts a higher number of symptoms in the cognitive complaints-fatigue cluster. Our result suggests heterogeneity among chronic post-COVID neuropsychiatric symptoms, which are associated with the complex interplay of biological and socioeconomic factors.
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Affiliation(s)
- Steven Wai Ho Chau
- Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.
| | - Timothy Mitchell Chue
- Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Rachel Ngan Yin Chan
- Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Yee Lok Lai
- Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Paul W C Wong
- Department of Social Work and Social Administration, Faculty of Social Science, The University of Hong Kong, Hong Kong, China
| | - Shirley Xin Li
- Department of Psychology, Faculty of Social Science, The University of Hong Kong, Hong Kong, China
| | - Yaping Liu
- Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
- Center for Sleep and Circadian Medicine, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Joey Wing Yan Chan
- Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Paul Kay-Sheung Chan
- Department of Microbiology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Christopher K C Lai
- Department of Microbiology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Thomas W H Leung
- Division of Neurology, Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Yun Kwok Wing
- Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
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Yang Y, Liao B, Deng R, Ren L, Sun Y, Xiong S, Wu X. Comparison of anaesthesia strategies on postoperative nausea and vomiting in laparoscopic sleeve gastrectomy: a randomised controlled trial. BMC Anesthesiol 2024; 24:207. [PMID: 38872117 PMCID: PMC11170773 DOI: 10.1186/s12871-024-02577-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Accepted: 05/24/2024] [Indexed: 06/15/2024] Open
Abstract
BACKGROUND Intra-operative anaesthesia management should be optimised to reduce the occurrence of postoperative nausea and vomiting in high-risk patients; however, a single intervention may not effectively reduce postoperative nausea and vomiting in such patients. This study assessed the effect of an optimised anaesthetic protocol versus a conventional one on postoperative nausea and vomiting in patients who underwent laparoscopic sleeve gastrectomy. METHODS A single-centre randomised trial was conducted at Peking University Shenzhen Hospital from June 2021 to December 2022. Among 168 patients who underwent laparoscopic sleeve gastrectomy, 116 qualified, and 103 completed the study with available data. Patients were categorized into the conventional group (received sevoflurane and standard fluids) and the optimised group (underwent propofol-based anaesthesia and was administered goal-directed fluids). The primary endpoints were postoperative nausea and vomiting incidence and severity within 24 h. RESULTS Postoperative nausea and vomiting assessment at 0-3 h post-surgery revealed no significant differences between groups. However, at 3-24 h, the optimised anaesthetic protocol group showed lower postoperative nausea and vomiting incidence and severity than those of the conventional group (P = 0.005). In the conventional group, 20 (37.04%) patients experienced moderate-to-severe postoperative nausea and vomiting, compared to six (12.25%) patients in the optimised group (odds ratio = 0.237; 95% CI = 0.086, 0.656; P = 0.006). No significant differences were noted in antiemetic treatment, moderate-to-severe pain incidence, anaesthesia recovery, post-anaesthetic care unit stay, or postoperative duration between the groups. While the total intra-operative infusion volumes were comparable, the optimised group had a significantly higher colloidal infusion volume (500 mL vs. 0 mL, P = 0.014) than that of the conventional group. CONCLUSIONS The incidence and severity of postoperative nausea and vomiting 3-24 h postoperatively in patients who underwent laparoscopic sleeve gastrectomy were significantly lower with propofol-based total intravenous anaesthesia and goal-directed fluid therapy than with sevoflurane anaesthesia and traditional fluid management. Total intravenous anaesthesia is an effective multimodal antiemetic strategy for bariatric surgery. TRIAL REGISTRATION This trial was registered with the Chinese Clinical Trial Registry (ChiCTR-TRC- 2,100,046,534, registration date: 21 May 2021).
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Affiliation(s)
- Ying Yang
- Department of Anesthesiology, Peking University Shenzhen Hospital, No. 1200 Lianhua Street, Futian District, Shenzhen, Guangdong, 518036, China
| | - Bucheng Liao
- Department of Anesthesiology, Peking University Shenzhen Hospital, No. 1200 Lianhua Street, Futian District, Shenzhen, Guangdong, 518036, China
| | - Ruoxi Deng
- Department of Anesthesiology, Peking University Shenzhen Hospital, No. 1200 Lianhua Street, Futian District, Shenzhen, Guangdong, 518036, China
| | - Liwei Ren
- Hubei University of Medicine, Shiyan, Shenzhen, China
| | - Yongjie Sun
- Hubei University of Medicine, Shiyan, Shenzhen, China
| | - Shaowei Xiong
- Department of Gastrointestinal Surgery, Peking University Shenzhen Hospital, Shenzhen, China
| | - Xinhai Wu
- Department of Anesthesiology, Peking University Shenzhen Hospital, No. 1200 Lianhua Street, Futian District, Shenzhen, Guangdong, 518036, China.
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Kamenshchikov NO, Podoksenov YK, Kozlov BN, Maslov LN, Mukhomedzyanov AV, Tyo MA, Boiko AM, Margolis NY, Boshchenko AA, Serebryakova ON, Dzyuman AN, Shirshin AS, Buranov SN, Selemir VD. The Nephroprotective Effect of Nitric Oxide during Extracorporeal Circulation: An Experimental Study. Biomedicines 2024; 12:1298. [PMID: 38927505 PMCID: PMC11201384 DOI: 10.3390/biomedicines12061298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Revised: 05/24/2024] [Accepted: 06/06/2024] [Indexed: 06/28/2024] Open
Abstract
This study aims to determine the effectiveness of administering 80 ppm nitric oxide in reducing kidney injury, mitochondrial dysfunction and regulated cell death in kidneys during experimental perfusion. Twenty-four sheep were randomized into four groups: two groups received 80 ppm NO conditioning with 90 min of cardiopulmonary bypass (CPB + NO) or 90 min of CPB and hypothermic circulatory arrest (CPB + CA + NO), while two groups received sham protocols (CPB and CPB + CA). Kidney injury was assessed using laboratory (neutrophil gelatinase-associated lipocalin, an acute kidney injury biomarker) and morphological methods (morphometric histological changes in kidney biopsy specimens). A kidney biopsy was performed 60 min after weaning from mechanical perfusion. NO did not increase the concentrations of inhaled NO2 and methemoglobin significantly. The NO-conditioning groups showed less severe kidney injury and mitochondrial dysfunction, with statistical significance in the CPB + NO group and reduced tumor necrosis factor-α expression as a trigger of apoptosis and necroptosis in renal tissue in the CPB + CA + NO group compared to the CPB + CA group. The severity of mitochondrial dysfunction in renal tissue was insignificantly lower in the NO-conditioning groups. We conclude that NO administration is safe and effective at reducing kidney injury, mitochondrial dysfunction and regulated cell death in kidneys during experimental CPB.
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Affiliation(s)
- Nikolay O. Kamenshchikov
- Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, 111a Kievskaya St., Tomsk 634012, Russia; (Y.K.P.); (B.N.K.); (L.N.M.); (A.V.M.); (M.A.T.); (A.M.B.); (N.Y.M.); (A.A.B.)
| | - Yuri K. Podoksenov
- Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, 111a Kievskaya St., Tomsk 634012, Russia; (Y.K.P.); (B.N.K.); (L.N.M.); (A.V.M.); (M.A.T.); (A.M.B.); (N.Y.M.); (A.A.B.)
| | - Boris N. Kozlov
- Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, 111a Kievskaya St., Tomsk 634012, Russia; (Y.K.P.); (B.N.K.); (L.N.M.); (A.V.M.); (M.A.T.); (A.M.B.); (N.Y.M.); (A.A.B.)
| | - Leonid N. Maslov
- Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, 111a Kievskaya St., Tomsk 634012, Russia; (Y.K.P.); (B.N.K.); (L.N.M.); (A.V.M.); (M.A.T.); (A.M.B.); (N.Y.M.); (A.A.B.)
| | - Alexander V. Mukhomedzyanov
- Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, 111a Kievskaya St., Tomsk 634012, Russia; (Y.K.P.); (B.N.K.); (L.N.M.); (A.V.M.); (M.A.T.); (A.M.B.); (N.Y.M.); (A.A.B.)
| | - Mark A. Tyo
- Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, 111a Kievskaya St., Tomsk 634012, Russia; (Y.K.P.); (B.N.K.); (L.N.M.); (A.V.M.); (M.A.T.); (A.M.B.); (N.Y.M.); (A.A.B.)
| | - Alexander M. Boiko
- Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, 111a Kievskaya St., Tomsk 634012, Russia; (Y.K.P.); (B.N.K.); (L.N.M.); (A.V.M.); (M.A.T.); (A.M.B.); (N.Y.M.); (A.A.B.)
| | - Natalya Yu. Margolis
- Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, 111a Kievskaya St., Tomsk 634012, Russia; (Y.K.P.); (B.N.K.); (L.N.M.); (A.V.M.); (M.A.T.); (A.M.B.); (N.Y.M.); (A.A.B.)
| | - Alla A. Boshchenko
- Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, 111a Kievskaya St., Tomsk 634012, Russia; (Y.K.P.); (B.N.K.); (L.N.M.); (A.V.M.); (M.A.T.); (A.M.B.); (N.Y.M.); (A.A.B.)
| | - Olga N. Serebryakova
- Department of Morphology and General Pathology, Siberian State Medical University, 2 Moskovsky trakt, Tomsk 634050, Russia; (O.N.S.); (A.N.D.)
| | - Anna N. Dzyuman
- Department of Morphology and General Pathology, Siberian State Medical University, 2 Moskovsky trakt, Tomsk 634050, Russia; (O.N.S.); (A.N.D.)
| | - Alexander S. Shirshin
- Federal State Unitary Enterprise “Russian Federal Nuclear Center—All-Russian Research Institute of Experimental Physics”, 37, Mira Ave., Nizhny Novgorod Region, Sarov 607190, Russia; (A.S.S.); (S.N.B.); (V.D.S.)
| | - Sergey N. Buranov
- Federal State Unitary Enterprise “Russian Federal Nuclear Center—All-Russian Research Institute of Experimental Physics”, 37, Mira Ave., Nizhny Novgorod Region, Sarov 607190, Russia; (A.S.S.); (S.N.B.); (V.D.S.)
| | - Victor D. Selemir
- Federal State Unitary Enterprise “Russian Federal Nuclear Center—All-Russian Research Institute of Experimental Physics”, 37, Mira Ave., Nizhny Novgorod Region, Sarov 607190, Russia; (A.S.S.); (S.N.B.); (V.D.S.)
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82
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Labay LM, Kacinko SL, Casey BK, Brower JO. Tolerant or Intolerant? Learning From Studying Drug Concentrations in the Living and the Dead. Am J Forensic Med Pathol 2024:00000433-990000000-00196. [PMID: 39018464 DOI: 10.1097/paf.0000000000000962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/19/2024]
Abstract
ABSTRACT Tolerance is the diminished response to a drug that occurs when that drug is repeatedly used, and the body adapts to its continued presence. This means that greater blood concentrations are required to achieve desired effects, produce impairment, or cause death. Without case-specific information, the pharmacodynamic impacts of a drug on an individual are difficult to ascertain based on its concentration alone. One starting point, however, is to compare reported findings with reference ranges associated with therapeutic, toxic, and lethal outcomes. Toxicologists have observed concentrations dramatically increase over time in the living population for some drugs to concentrations that can easily be associated with impairment and lethal outcomes. It is, therefore, important to continually monitor and be familiar with drug concentrations found in the living to interpret postmortem concentrations. To emphasize this approach, we compared fentanyl concentrations from JAN 2010 to OCT 2023 in individuals investigated for driving under the influence of drugs to postmortem cases. This comparison highlights the changing nature of tolerance, stresses the importance of not relying solely on reference ranges for result interpretations, and discusses the importance of the autopsy in identifying or ruling out other potential causes of death.
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83
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Chauhan MZ, Soliman MK, Pace NL, Mathis MR, Schonberger RB, Sallam AB. Anesthesia Techniques for Vitreoretinal Surgery in the United States: A Report from the Multicenter Perioperative Outcomes Group Research Consortium. Am J Ophthalmol 2024; 267:30-40. [PMID: 38871268 DOI: 10.1016/j.ajo.2024.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Revised: 05/28/2024] [Accepted: 06/07/2024] [Indexed: 06/15/2024]
Abstract
PURPOSE To explore the patterns of anesthesia use and their determinants during vitreoretinal (VR) surgeries in academic and community hospitals across the US, using data from the Multicenter Perioperative Outcomes Group (MPOG). DESIGN A retrospective, multicenter, cohort study. METHODS We queried the MPOG database of 107,066 patients undergoing VR surgeries. Patients (≥18 years) undergoing VR surgery with monitored anesthesia care (MAC) or general anesthesia (GA) from January 1, 2015 to December 31, 2021 were included. Patient-level, case-based, and institutional-level covariates were collected. We performed multivariable mixed-effects models to determine predictors of anesthesia type use. The primary outcome was the type of anesthesia (MAC or GA) used during VR surgeries. As a secondary outcome, MAC cases were further classified based on the additional use of sedation into MAC with or without sedation. RESULTS We found that 67.45% of VR surgery cases received MAC, and 73.63% of institutions administered MAC to more than half of cases. Random effect modeling revealed that 47.76% of the variation in MAC use was attributed to institutions. A trend toward increased use of MAC with increasing age was observed. Patients diagnosed with chronic pulmonary disease, liver disease, or a history of drug abuse were less likely to receive MAC. Conversely, we found that patients with reported alcohol abuse disorder, diabetes with complications, and those with American Society of Anesthesiologists (ASA) physical status of 4 (vs. 1, 2, or 3) were more likely to use MAC. Compared to non-complex VR surgeries, there was a notably decreased likelihood of MAC use in complex PPV (P = .004), PPV + scleral buckle (SB) for retinal detachment (P < .0001), and primary SB surgery (P < .0001). CONCLUSIONS Approximately 2/3 of VR anesthesia is under MAC, but GA is still preferred for SBs, complex vitrectomy, and younger patients. We show that large interinstitutional variation for using MAC in practice exists.
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Affiliation(s)
- Muhammad Z Chauhan
- From the Department of Ophthalmology, University of Arkansas for Medical Sciences (M.Z.C., A.B.S.), Little Rock, Arkansas, USA.
| | - Mohamed K Soliman
- Department of Ophthalmology and Visual Sciences, University Hospitals Eye Institute, Case Western Reserve University (M.K.S.), Cleveland, Ohio, USA; Department of Ophthalmology, Faculty of Medicine, Assiut University Hospitals (M.K.S.), Assiut, Egypt
| | - Nathan L Pace
- Department of Anesthesiology, University of Utah (N.L.P.), Salt Lake City, Utah, USA
| | - Michael R Mathis
- Department of Anesthesiology, University of Michigan (M.R.M.), Ann Arbor, Michigan, USA
| | - Robert B Schonberger
- Department of Anesthesiology, Yale School of Medicine (R.B.S.), New Haven, Connecticut, USA
| | - Ahmed B Sallam
- From the Department of Ophthalmology, University of Arkansas for Medical Sciences (M.Z.C., A.B.S.), Little Rock, Arkansas, USA.
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84
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Del Castillo C, Verdugo F, Appiani F, Yáñez F, Bontá C, Torres-Herrera C, Garcia A, Blázquez-Bermejo Z, Castrodeza J, Requena D, Rodríguez A, Silvio A, Gatica A, Begazo A, Alfaro M. Echocardiogram by apical-subcostal protocol in prone position during invasive mechanical ventilation in cardiovascular intensive care unit. Cardiovasc Ultrasound 2024; 22:7. [PMID: 38858752 PMCID: PMC11163713 DOI: 10.1186/s12947-024-00326-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Accepted: 05/31/2024] [Indexed: 06/12/2024] Open
Abstract
AIMS To evaluate the feasibility of a transthoracic echocardiogram using an apical-subcostal protocol in invasive mechanical ventilation (IMV) and prone position. METHODS Prospective study of adults who required a prone position during IMV. A pillow was placed only under the left hemithorax in the prone position to elevate and ease the apical and subcostal windows. A critical care cardiologist (prone group) acquired and evaluated the images using the apical-subcostal protocol. Besides, we used ambulatory echocardiograms performed as a comparative group (supine group). RESULTS 86 patients were included, 43 in the prone and 43 in the supine. In the prone group, the indication to perform an echocardiogram was hemodynamic monitoring. All patients were ventilated with protective parameters, and the mean end-expiratory pressure was 10.6 cmH2O. The protocol was performed entirely in 42 of 43 patients in the prone group because one patient did not have any acoustic window. In the 43 patients in the prone group analyzed and compared to the supine group, global biventricular function was assessed in 97.7% (p = 1.0), severe heart valve disease in 88.4% (p = 0.055), ruled out of the presence of pulmonary hypertension in 76.7% (p = 0.80), pericardial effusion in 93% (p = 0.12), and volume status by inferior vena cava in 93% (p = 0.48). Comparing prone versus supine position, a statistical difference was found when evaluating the left ventricle apical 2-chamber view (65.1 versus 100%, p < 0.01) and its segmental function (53.4 versus 100%, p < 0.01). CONCLUSION The echocardiogram using an apical-subcostal protocol is feasible in patients in the IMV and prone position.
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Affiliation(s)
- César Del Castillo
- Cardiovascular department, Hospital DIPRECA, Santiago, Chile.
- Postgraduate Department, Faculty of Medicine, Universidad Diego Portales, Santiago, Chile.
| | | | - Franco Appiani
- Cardiovascular department, Hospital DIPRECA, Santiago, Chile
- Postgraduate Department, Faculty of Medicine, Universidad Diego Portales, Santiago, Chile
| | - Francisca Yáñez
- Cardiovascular department, Hospital Clínico San Borja Arriarán, Santiago, Chile
| | - Camila Bontá
- Cardiovascular department, Hospital Clínico San Borja Arriarán, Santiago, Chile
| | - Carlos Torres-Herrera
- Postgraduate Department, Faculty of Medicine, Universidad Diego Portales, Santiago, Chile
| | - Angela Garcia
- Intensive Care Unit, Hospital DIPRECA, Santiago, Chile
| | - Zorba Blázquez-Bermejo
- Cardiovascular department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Javier Castrodeza
- Cardiovascular department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Daniel Requena
- Cardiovascular department, Hospital DIPRECA, Santiago, Chile
| | | | - Arquimedes Silvio
- Cardiovascular department, Hospital DIPRECA, Santiago, Chile
- Postgraduate Department, Faculty of Medicine, Universidad Diego Portales, Santiago, Chile
| | - Agustín Gatica
- Cardiovascular department, Hospital DIPRECA, Santiago, Chile
| | - Arnulfo Begazo
- Cardiovascular department, Hospital DIPRECA, Santiago, Chile
- Postgraduate Department, Faculty of Medicine, Universidad Diego Portales, Santiago, Chile
| | - Mario Alfaro
- Cardiovascular department, Hospital Clínico San Borja Arriarán, Santiago, Chile
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85
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Costa ELV, Alcala GC, Tucci MR, Goligher E, Morais CC, Dianti J, Nakamura MAP, Oliveira LB, Pereira SM, Toufen C, Barbas CSV, Carvalho CRR, Amato MBP. Impact of extended lung protection during mechanical ventilation on lung recovery in patients with COVID-19 ARDS: a phase II randomized controlled trial. Ann Intensive Care 2024; 14:85. [PMID: 38849605 PMCID: PMC11161454 DOI: 10.1186/s13613-024-01297-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 04/15/2024] [Indexed: 06/09/2024] Open
Abstract
BACKGROUND Protective ventilation seems crucial during early Acute Respiratory Distress Syndrome (ARDS), but the optimal duration of lung protection remains undefined. High driving pressures (ΔP) and excessive patient ventilatory drive may hinder lung recovery, resulting in self-inflicted lung injury. The hidden nature of the ΔP generated by patient effort complicates the situation further. Our study aimed to assess the feasibility of an extended lung protection strategy that includes a stepwise protocol to control the patient ventilatory drive, assessing its impact on lung recovery. METHODS We conducted a single-center randomized study on patients with moderate/severe COVID-19-ARDS with low respiratory system compliance (CRS < 0.6 (mL/Kg)/cmH2O). The intervention group received a ventilation strategy guided by Electrical Impedance Tomography aimed at minimizing ΔP and patient ventilatory drive. The control group received the ARDSNet low-PEEP strategy. The primary outcome was the modified lung injury score (mLIS), a composite measure that integrated daily measurements of CRS, along with oxygen requirements, oxygenation, and X-rays up to day 28. The mLIS score was also hierarchically adjusted for survival and extubation rates. RESULTS The study ended prematurely after three consecutive months without patient enrollment, attributed to the pandemic subsiding. The intention-to-treat analysis included 76 patients, with 37 randomized to the intervention group. The average mLIS score up to 28 days was not different between groups (P = 0.95, primary outcome). However, the intervention group showed a faster improvement in the mLIS (1.4 vs. 7.2 days to reach 63% of maximum improvement; P < 0.001), driven by oxygenation and sustained improvement of X-ray (P = 0.001). The intervention group demonstrated a sustained increase in CRS up to day 28 (P = 0.009) and also experienced a shorter time from randomization to room-air breathing (P = 0.02). Survival at 28 days and time until liberation from the ventilator were not different between groups. CONCLUSIONS The implementation of an individualized PEEP strategy alongside extended lung protection appears viable. Promising secondary outcomes suggested a faster lung recovery, endorsing further examination of this strategy in a larger trial. Clinical trial registration This trial was registered with ClinicalTrials.gov (number NCT04497454) on August 04, 2020.
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Affiliation(s)
- Eduardo L V Costa
- Laboratório de Pneumologia LIM-09, Faculdade de Medicina, Hospital das Clinicas HCFMUSP, Universidade de Sao Paulo, 455 Dr Arnaldo Ave, Room 2144, São Paulo, SP, Brazil
- Research and Education Institute, Hospital Sírio-Libanes, Sao Paulo, Brazil
- Divisao de Pneumologia, Faculdade de Medicina, Instituto do Coracao, Hospital das Clinicas HCFMUSP, Universidade de Sao Paulo, São Paulo, SP, Brasil
| | - Glasiele C Alcala
- Laboratório de Pneumologia LIM-09, Faculdade de Medicina, Hospital das Clinicas HCFMUSP, Universidade de Sao Paulo, 455 Dr Arnaldo Ave, Room 2144, São Paulo, SP, Brazil
- Divisao de Pneumologia, Faculdade de Medicina, Instituto do Coracao, Hospital das Clinicas HCFMUSP, Universidade de Sao Paulo, São Paulo, SP, Brasil
| | - Mauro R Tucci
- Divisao de Pneumologia, Faculdade de Medicina, Instituto do Coracao, Hospital das Clinicas HCFMUSP, Universidade de Sao Paulo, São Paulo, SP, Brasil
| | - Ewan Goligher
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada
- Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada
- Toronto General Hospital Research Institute, Toronto, Canada
| | - Caio C Morais
- Laboratório de Pneumologia LIM-09, Faculdade de Medicina, Hospital das Clinicas HCFMUSP, Universidade de Sao Paulo, 455 Dr Arnaldo Ave, Room 2144, São Paulo, SP, Brazil
- Departamento de Fisioterapia, Universidade Federal de Pernambuco, Recife, PE, Brazil
| | - Jose Dianti
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada
- Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada
- Toronto General Hospital Research Institute, Toronto, Canada
| | - Miyuki A P Nakamura
- Laboratório de Pneumologia LIM-09, Faculdade de Medicina, Hospital das Clinicas HCFMUSP, Universidade de Sao Paulo, 455 Dr Arnaldo Ave, Room 2144, São Paulo, SP, Brazil
| | - Larissa B Oliveira
- Divisao de Pneumologia, Faculdade de Medicina, Instituto do Coracao, Hospital das Clinicas HCFMUSP, Universidade de Sao Paulo, São Paulo, SP, Brasil
| | - Sérgio M Pereira
- Laboratório de Pneumologia LIM-09, Faculdade de Medicina, Hospital das Clinicas HCFMUSP, Universidade de Sao Paulo, 455 Dr Arnaldo Ave, Room 2144, São Paulo, SP, Brazil
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada
- Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada
| | - Carlos Toufen
- Divisao de Pneumologia, Faculdade de Medicina, Instituto do Coracao, Hospital das Clinicas HCFMUSP, Universidade de Sao Paulo, São Paulo, SP, Brasil
| | - Carmen S V Barbas
- Divisao de Pneumologia, Faculdade de Medicina, Instituto do Coracao, Hospital das Clinicas HCFMUSP, Universidade de Sao Paulo, São Paulo, SP, Brasil
- Adult ICU Albert Einstein Hospital, São Paulo, Brazil
| | - Carlos R R Carvalho
- Laboratório de Pneumologia LIM-09, Faculdade de Medicina, Hospital das Clinicas HCFMUSP, Universidade de Sao Paulo, 455 Dr Arnaldo Ave, Room 2144, São Paulo, SP, Brazil
- Divisao de Pneumologia, Faculdade de Medicina, Instituto do Coracao, Hospital das Clinicas HCFMUSP, Universidade de Sao Paulo, São Paulo, SP, Brasil
| | - Marcelo B P Amato
- Laboratório de Pneumologia LIM-09, Faculdade de Medicina, Hospital das Clinicas HCFMUSP, Universidade de Sao Paulo, 455 Dr Arnaldo Ave, Room 2144, São Paulo, SP, Brazil.
- Divisao de Pneumologia, Faculdade de Medicina, Instituto do Coracao, Hospital das Clinicas HCFMUSP, Universidade de Sao Paulo, São Paulo, SP, Brasil.
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Weimer AM, Weimer JM, Jonck C, Müller L, Stäuber M, Chrissostomou CD, Buggenhagen H, Klöckner R, Pirlich N, Künzel J, Rink M. [Ultrasound supported identification of the ligamentum conicum in teaching head and neck sonography]. Laryngorhinootologie 2024. [PMID: 38830381 DOI: 10.1055/a-2311-4389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2024]
Abstract
OBJECTIVE Upper airway obstructions are usually acute emergencies. Coniotomy is the last option to secure the airway and can be supported by sonography. The aim of this study was to establish a training program to teach these skills. MATERIAL AND METHODS The training consisted of theoretical training with an additional video presentation (10 minutes each) and practical training (45 minutes). Evaluations were completed before (T1) and after (T2) the training to measure prior experience and satisfaction with the training as well as subjective and objective competence levels. At T2, a practical test was also completed by n=113 participants. A standardized evaluation form was used to document the results of the practical test. RESULTS A large proportion of the participants had neither seen a coniotomy (64.6%) nor performed one independently (79.6%). Significant improvement (T1 to T2) was measured with regard to the subjective assessment of competence (p<0.001). The training received positive ratings for all items tested (scale ranges 1-2). During practical tests, the participants achieved an average of 89.2% of the possible points and needed a mean of 101 ±23 seconds to identify the conic ligament. CONCLUSION Structured training for sonographic identification of the conic ligament leads to significant improvement in the subjective assessment of competence and a high objective competence level in a short period of time. This type of training should be standardized in head and neck ultrasound training in the future.
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Affiliation(s)
- Andreas Michael Weimer
- Zentrum für Orthopädie, Unfallchirurgie und Paraplegiologie, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - Johannes Matthias Weimer
- Rudolf Frey Lernklinik, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Mainz, Germany
| | - Christopher Jonck
- Rudolf Frey Lernklinik, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Mainz, Germany
| | - Lukas Müller
- Klinik und Poliklinik für Diagnostische und Interventionelle Radiologie, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Mainz, Germany
| | - Marie Stäuber
- Rudolf Frey Lernklinik, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Mainz, Germany
| | | | - Holger Buggenhagen
- Rudolf Frey Lernklinik, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Mainz, Germany
| | - Roman Klöckner
- Institut für Interventionelle Radiologie, Universitätsklinikum Schleswig-Holstein Campus Lübeck, Lubeck, Germany
| | - Nina Pirlich
- Klinik für Anästhesiologie, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Mainz, Germany
| | - Julian Künzel
- Klinik und Poliklinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Regensburg, Regensburg, Germany
| | - Maximilian Rink
- Klinik und Poliklinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Regensburg, Regensburg, Germany
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87
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Adhikari S, Gurung R, Bastakoti S, Alrasheedy AA, KC B. Burn pain management in a female patient with severe burn injuries in Nepal: a case study and review. Pain Manag 2024; 14:323-329. [PMID: 39101437 PMCID: PMC11340753 DOI: 10.1080/17581869.2024.2382072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Accepted: 07/16/2024] [Indexed: 08/06/2024] Open
Abstract
Burn injuries in low-resource settings like Nepal present significant public health challenges, leading to substantial morbidity, mortality and severe pain. This paper assesses burn pain management in Nepal, emphasizing the need for enhanced strategies. A case study of a female patient with severe burn injuries from a rural village in Western Nepal illustrates current challenges. Reviewing studies on burn pain management in Nepal shows limited access to specialized facilities, inadequate palliative care, medication shortages and insufficient healthcare professionals. Pharmacological interventions are impacted by financial constraints and a lack of protocols, while nonpharmacological approaches have not been explored and contextualized for the Nepalese context due to similar financial issues. Comprehensive burn pain management requires addressing resource constraints through collaborative health-aid partnerships.
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Affiliation(s)
- Sundar Adhikari
- Department of Pharmacy, Fishtail Hospital and Research Center, Pvt. Ltd., Gairapatan-4, Pokhara, Nepal
| | | | - Suresh Bastakoti
- Nepalese Army Institute of Health Sciences, Shree Birendra Hospital, Kathmandu, Nepal
| | | | - Bhuvan KC
- Discipline of Pharmacy, School of Clinical Sciences, Queensland University of Technology, Brisbane, Australia
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Tang J, Wu C, Zhong Z. Group-Based Trajectory Modeling of Fluid Balance in Elderly Patients with Acute Ischemic Stroke: Analysis from Multicenter ICUs. Neurol Ther 2024; 13:749-761. [PMID: 38635141 PMCID: PMC11136917 DOI: 10.1007/s40120-024-00612-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Accepted: 03/21/2024] [Indexed: 04/19/2024] Open
Abstract
INTRODUCTION Acute ischemic stroke (AIS) significantly contributes to severe disability and mortality among the elderly. This study aims to explore the association between longitudinal fluid balance (FB) trajectories and clinical outcomes in elderly patients with AIS. Our hypothesis posits the existence of multiple latent trajectories of FB in patients with AIS during the initial 7 days following ICU admission. METHODS Patients (age ≥ 65 years) with AIS and continuous FB records were identified from two large databases. Group-based trajectory modeling identified latent groups with similar 7-day FB trajectories. Subsequently, multivariable logistic and quasi-Poisson regression were employed to evaluate the relationship between trajectory groups and outcomes. Additionally, nonlinear associations between maximum fluid overload (FO) and outcomes were analyzed using restricted cubic spline models. To further validate our findings, subgroup and sensitivity analysis were conducted. RESULTS A total of 1146 eligible patients were included in this study, revealing three trajectory patterns were identified: low FB (84.8%), decreasing FB (7.2%), and high FB (7.9%). High FB emerged as an independent risk factor for in-hospital mortality. Compared with those without FO, patients with FO had a 1.57-fold increased risk of hospital mortality (adjusted odd ratio (OR) 1.57, 95% confidence interval (CI) 1.08-2.27), 2.37-fold increased risk of adverse kidney event (adjusted OR 2.37, 95% CI 1.56-3.59), and 1.33-fold increased risk of prolonged ICU stay (adjusted incidence rate ratio (IRR) 1.33, 95% CI 1.19-1.48). The risk of hospital mortality and adverse kidney event increased linearly with rising maximum FO (P for non-linearity = 0.263 and 0.563, respectively). CONCLUSION Daily FB trajectories were associated with adverse outcomes in elderly patients with AIS. Regular assessment of daily fluid status and restriction of FO are crucial for the recovery of critically ill patients.
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Affiliation(s)
- Jia Tang
- Graduate School of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Changdong Wu
- Xinjiang Emergency Center, People's Hospital of Xinjiang Uygur Autonomous Region, No. 91, Tian-Chi Road, Tianshan District, Urumqi, 830001, Xinjiang, China.
| | - Zhenguang Zhong
- Department of Bioengineering, Imperial College London, London, UK
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89
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Rali AS, Tran L, Balakrishna A, Senussi M, Kapur NK, Metkus T, Tedford RJ, Lindenfeld J. Guide to Lung-Protective Ventilation in Cardiac Patients. J Card Fail 2024; 30:829-837. [PMID: 38513887 DOI: 10.1016/j.cardfail.2024.01.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 01/12/2024] [Accepted: 01/16/2024] [Indexed: 03/23/2024]
Abstract
The incidence of acute respiratory insufficiency has continued to increase among patients admitted to modern-day cardiovascular intensive care units. Positive pressure ventilation (PPV) remains the mainstay of treatment for these patients. Alterations in intrathoracic pressure during PPV has distinct effects on both the right and left ventricles, affecting cardiovascular performance. Lung-protective ventilation (LPV) minimizes the risk of further lung injury through ventilator-induced lung injury and, hence, an understanding of LPV and its cardiopulmonary interactions is beneficial for cardiologists.
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Affiliation(s)
- Aniket S Rali
- Division of Cardiovascular Diseases, Vanderbilt University Medical Center, Nashville, TN.
| | - Lena Tran
- Division of Cardiovascular Diseases, Vanderbilt University Medical Center, Nashville, TN
| | - Aditi Balakrishna
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN
| | - Mourad Senussi
- Department of Medicine, Baylor St. Luke's Medical Center, Houston, TX
| | - Navin K Kapur
- Division of Cardiovascular Diseases, Tufts Medical Center, Boston, MA
| | - Thomas Metkus
- Departments of Medicine and Surgery, Divisions of Cardiology and Cardiac Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Ryan J Tedford
- Department of Medicine, Division of Cardiology, Medical University of South Carolina, Charleston, SC
| | - Joann Lindenfeld
- Division of Cardiovascular Diseases, Vanderbilt University Medical Center, Nashville, TN
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90
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Ward B. Association Between Intraoperative Opioid Administration and Postoperative Opioid Use. J Perianesth Nurs 2024; 39:493-494. [PMID: 38823966 DOI: 10.1016/j.jopan.2024.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 03/25/2024] [Indexed: 06/03/2024]
Affiliation(s)
- Blake Ward
- Department of Anesthesiology, University of Mississippi Medical Center, Jackson, MS.
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91
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Park SY. Multimodal analgesia for postoperative pain: pursuing liberation from pain, not redemption. Ann Coloproctol 2024; 40:189-190. [PMID: 38946090 DOI: 10.3393/ac.2024.00304.0043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2024] [Accepted: 06/03/2024] [Indexed: 07/02/2024] Open
Affiliation(s)
- Soo Yeun Park
- Colorectal Cancer Center, Kyungpook National University Chilgok Hospital, Kyungpook National University School of Medicine, Daegu, Korea
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92
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Pereira D, Pereira S, Neves C, Segura E, Assunção JP. Bedside ultrasound in post-anaesthetic care unit for the diagnosis of post-extubation negative pressure pulmonary oedema: A paediatric case. J Perioper Pract 2024; 34:195-198. [PMID: 37886901 DOI: 10.1177/17504589231193553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
BACKGROUND Post-extubation negative pressure pulmonary oedema is a rare, potentially life-threatening complication associated with general anaesthesia. Chest radiography is used as a diagnostic tool, but it implies a non-negligible radiation exposure, a very important consideration, especially for the paediatric population. However, lung ultrasound can overcome this problem and can be used to detect postoperative pulmonary complications. CASE REPORT A 16-year-old male was scheduled for tympanoplasty. General anaesthesia was conducted, and after extubation, the patient developed a laryngospasm. On arrival at the post-anaesthetic care unit, the patient started to cough, a pink frothy sputum and hypoxemia were noticed, and auscultation revealed crepitations. A bedside lung ultrasound showed more than three B-lines per intercostal window, suggesting an alveolar-interstitial syndrome. DISCUSSION With this case report, we would like to raise awareness to this clinical entity and demonstrate bedside ultrasound has an important role in the diagnostic and therapeutic assessment during the perioperative period.
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Affiliation(s)
- Dulce Pereira
- Anaesthesiology Department, Centro Hospitalar Tondela Viseu, Viseu, Portugal
| | - Sofia Pereira
- Anaesthesiology Department, Centro Hospitalar Tondela Viseu, Viseu, Portugal
| | - Clarinda Neves
- Anaesthesiology Department, Centro Hospitalar Tondela Viseu, Viseu, Portugal
| | - Elena Segura
- Anaesthesiology Department, Centro Hospitalar Tondela Viseu, Viseu, Portugal
| | - José Pedro Assunção
- Anaesthesiology Department, Centro Hospitalar Tondela Viseu, Viseu, Portugal
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93
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Bessas NC, Christine de Souza Arantes E, Cassani NM, Aquino Ruiz UE, Santos IA, Silva Martins DO, Costa Oliveira AL, Antoniucci GA, de Oliveira AHC, DeFreitas-Silva G, Gomes Jardim AC, Galvão de Lima R. Influence of diimine bidentate ligand in the nitrosyl and nitro terpyridine ruthenium complex on the HSA/DNA interaction and antiviral activity. Nitric Oxide 2024; 147:26-41. [PMID: 38614230 DOI: 10.1016/j.niox.2024.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 12/05/2023] [Accepted: 04/09/2024] [Indexed: 04/15/2024]
Abstract
Nitric oxide (NO) acts in different physiological processes, such as blood pressure control, antiparasitic activities, neurotransmission, and antitumor action. Among the exogenous NO donors, ruthenium nitrosyl/nitro complexes are potential candidates for prodrugs, due to their physicochemical properties, such as thermal and physiological pH stability. In this work, we proposed the synthesis and physical characterization of the new nitro terpyridine ruthenium (II) complexes of the type [RuII(L)(NO2)(tpy)]PF6 where tpy = 2,2':6',2″-terpyridine; L = 3,4-diaminobenzoic acid (bdq) or o-phenylenediamine (bd) and evaluation of influence of diimine bidentate ligand NH.NHq-R (R = H or COOH) in the HSA/DNA interaction as well as antiviral activity. The interactions between HSA and new nitro complexes [RuII(L)(NO2)(tpy)]+ were evaluated. The Ka values for the HSA-[RuII(bdq)(NO2)(tpy)]+ is 10 times bigger than HSA-[RuII(bd)(NO2)(tpy)]+. The sites of interaction between HSA and the complexes via synchronous fluorescence suppression indicate that the [RuII(bdq)(NO2)(tpy)]+ is found close to the Trp-241 residue, while the [RuII(bd)(NO2)(tpy)]+ complex is close to Tyr residues. The interaction with fish sperm fs-DNA using direct spectrophotometric titration (Kb) and ethidium bromide replacement (KSV and Kapp) showed weak interaction in the system fs-DNA-[RuII(bdq)(NO)(tpy)]+. Furthermore, fs-DNA-[RuII(bd)(NO2)(tpy)]+ and fs-DNA-[RuII(bd)(NO)(tpy)]3+ system showed higher intercalation constant. Circular dichroism spectra for fs-DNA-[RuII(bd)(NO2)(tpy)]+ and fs-DNA-[RuII(bd)(NO)(tpy)]3+, suggest semi-intercalative accompanied by major groove binding interaction modes. The [RuII(bd)(NO2)(tpy)]+ and [RuII(bd)(NO)(tpy)]3+ inhibit replication of Zika and Chikungunya viruses based in the nitric oxide release under S-nitrosylation reaction with cysteine viral.
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Affiliation(s)
- Naiara Cristina Bessas
- Instituto de Química, Universidade Federal de Uberlândia, Avenida João Naves de Avila, 2121, 38400-902, Uberlândia, MG, Brazil
| | | | - Natasha Marques Cassani
- Laboratory of Antiviral Research, Institute of Biomedical Sciences, Federal University of Uberlândia, Uberlândia, MG, Brazil
| | - Uriel Enrique Aquino Ruiz
- Laboratory of Antiviral Research, Institute of Biomedical Sciences, Federal University of Uberlândia, Uberlândia, MG, Brazil
| | - Igor Andrade Santos
- Laboratory of Antiviral Research, Institute of Biomedical Sciences, Federal University of Uberlândia, Uberlândia, MG, Brazil
| | - Daniel Oliveira Silva Martins
- Laboratory of Antiviral Research, Institute of Biomedical Sciences, Federal University of Uberlândia, Uberlândia, MG, Brazil; Instituto de Ciências Exatas e Naturais Do Pontal, ICENP, Universidade Federal de Uberlândia, Rua Vinte, 1600, 38304-402, Tupã, Ituiutaba, MG, Brazil
| | - Ana Laura Costa Oliveira
- Laboratory of Antiviral Research, Institute of Biomedical Sciences, Federal University of Uberlândia, Uberlândia, MG, Brazil
| | - Giovanna André Antoniucci
- Laboratory of Antiviral Research, Institute of Biomedical Sciences, Federal University of Uberlândia, Uberlândia, MG, Brazil
| | - Arthur Henrique Cavalcante de Oliveira
- Departamento de Química, Faculdade de Filosofia, Ciências e Letras de Ribeirão Preto, Universidade de São Paulo, CEP 14040-901, Ribeirão Preto, SP, Brazil
| | - Gilson DeFreitas-Silva
- Departamento de Química, Instituto de Ciências Exatas, Universidade Federal de Minas Gerais, 31.270-901, Belo Horizonte, MG, Brazil
| | - Ana Carolina Gomes Jardim
- Laboratory of Antiviral Research, Institute of Biomedical Sciences, Federal University of Uberlândia, Uberlândia, MG, Brazil
| | - Renata Galvão de Lima
- Instituto de Química, Universidade Federal de Uberlândia, Avenida João Naves de Avila, 2121, 38400-902, Uberlândia, MG, Brazil; Instituto de Ciências Exatas e Naturais Do Pontal, ICENP, Universidade Federal de Uberlândia, Rua Vinte, 1600, 38304-402, Tupã, Ituiutaba, MG, Brazil.
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94
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Iwata H, Yoshida T, Hoshino T, Aiyama Y, Maezawa T, Hashimoto H, Koyama Y, Yamada T, Fujino Y. Electrical Impedance Tomography-based Ventilation Patterns in Patients after Major Surgery. Am J Respir Crit Care Med 2024; 209:1328-1337. [PMID: 38346178 DOI: 10.1164/rccm.202309-1658oc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 02/12/2024] [Indexed: 06/01/2024] Open
Abstract
Rationale: General anesthesia and mechanical ventilation have negative impacts on the respiratory system, causing heterogeneous distribution of lung aeration, but little is known about the ventilation patterns of postoperative patients and their association with clinical outcomes. Objectives: To clarify the phenotypes of ventilation patterns along a gravitational direction after surgery by using electrical impedance tomography (EIT) and to evaluate their association with postoperative pulmonary complications (PPCs) and other relevant clinical outcomes. Methods: Adult postoperative patients at high risk for PPCs, receiving mechanical ventilation on ICU admission (N = 128), were prospectively enrolled between November 18, 2021 and July 18, 2022. PPCs were prospectively scored until hospital discharge, and their association with phenotypes of ventilation patterns was studied. The secondary outcomes were the times to wean from mechanical ventilation and oxygen use and the length of ICU stay. Measurements and Main Results: Three phenotypes of ventilation patterns were revealed by EIT: phenotype 1 (32% [n = 41], a predominance of ventral ventilation), phenotype 2 (41% [n = 52], homogeneous ventilation), and phenotype 3 (27% [n = 35], a predominance of dorsal ventilation). The median PPC score was higher in phenotype 1 and phenotype 3 than in phenotype 2. The median time to wean from mechanical ventilation was longer in phenotype 1 versus phenotype 2. The median duration of ICU stay was longer in phenotype 1 versus phenotype 2. The median time to wean from oxygen use was longer in phenotype 1 and phenotype 3 than in phenotype 2. Conclusions: Inhomogeneous ventilation patterns revealed by EIT on ICU admission were associated with PPCs, delayed weaning from mechanical ventilation and oxygen use, and a longer ICU stay.
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Affiliation(s)
- Hirofumi Iwata
- Department of Anesthesiology and Intensive Care Medicine, Osaka University Graduate School of Medicine, Suita, Japan; and
| | - Takeshi Yoshida
- Department of Anesthesiology and Intensive Care Medicine, Osaka University Graduate School of Medicine, Suita, Japan; and
| | - Taiki Hoshino
- Department of Anesthesiology and Intensive Care Medicine, Osaka University Graduate School of Medicine, Suita, Japan; and
| | - Yuki Aiyama
- Department of Anesthesiology and Intensive Care Medicine, Osaka University Graduate School of Medicine, Suita, Japan; and
| | - Takashi Maezawa
- Department of Anesthesiology and Intensive Care Medicine, Osaka University Graduate School of Medicine, Suita, Japan; and
| | - Haruka Hashimoto
- Department of Anesthesiology and Intensive Care Medicine, Osaka University Graduate School of Medicine, Suita, Japan; and
| | - Yukiko Koyama
- Department of Anesthesiology and Intensive Care Medicine, Osaka University Graduate School of Medicine, Suita, Japan; and
| | - Tomomi Yamada
- The Department of Medical Innovation Data Coordinating Center, Osaka University Hospital, Suita, Japan
| | - Yuji Fujino
- Department of Anesthesiology and Intensive Care Medicine, Osaka University Graduate School of Medicine, Suita, Japan; and
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95
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Yi R, Cheng S, Zhong F, Luo D, You Y, Yu T, Wang H, Zhou L, Zhang Y. GABAergic neurons of anterior thalamic reticular nucleus regulate states of consciousness in propofol- and isoflurane-mediated general anesthesia. CNS Neurosci Ther 2024; 30:e14782. [PMID: 38828651 PMCID: PMC11145368 DOI: 10.1111/cns.14782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Revised: 04/22/2024] [Accepted: 05/13/2024] [Indexed: 06/05/2024] Open
Abstract
BACKGROUND The thalamus system plays critical roles in the regulation of reversible unconsciousness induced by general anesthetics, especially the arousal stage of general anesthesia (GA). But the function of thalamus in GA-induced loss of consciousness (LOC) is little known. The thalamic reticular nucleus (TRN) is the only GABAergic neurons-composed nucleus in the thalamus, which is composed of parvalbumin (PV) and somatostatin (SST)-expressing GABAergic neurons. The anterior sector of TRN (aTRN) is indicated to participate in the induction of anesthesia, but the roles remain unclear. This study aimed to reveal the role of the aTRN in propofol and isoflurane anesthesia. METHODS We first set up c-Fos straining to monitor the activity variation of aTRNPV and aTRNSST neurons during propofol and isoflurane anesthesia. Subsequently, optogenetic tools were utilized to activate aTRNPV and aTRNSST neurons to elucidate the roles of aTRNPV and aTRNSST neurons in propofol and isoflurane anesthesia. Electroencephalogram (EEG) recordings and behavioral tests were recorded and analyzed. Lastly, chemogenetic activation of the aTRNPV neurons was applied to confirm the function of the aTRN neurons in propofol and isoflurane anesthesia. RESULTS c-Fos straining showed that both aTRNPV and aTRNSST neurons are activated during the LOC period of propofol and isoflurane anesthesia. Optogenetic activation of aTRNPV and aTRNSST neurons promoted isoflurane induction and delayed the recovery of consciousness (ROC) after propofol and isoflurane anesthesia, meanwhile chemogenetic activation of the aTRNPV neurons displayed the similar effects. Moreover, optogenetic and chemogenetic activation of the aTRN neurons resulted in the accumulated burst suppression ratio (BSR) during propofol and isoflurane GA, although they represented different effects on the power distribution of EEG frequency. CONCLUSION Our findings reveal that the aTRN GABAergic neurons play a critical role in promoting the induction of propofol- and isoflurane-mediated GA.
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Affiliation(s)
- Rulan Yi
- Department of AnesthesiologyAffiliated Hospital of Zunyi Medical UniversityZunyiChina
- Key Laboratory of Anesthesia and Organ Protection (Zunyi Medical University), Ministry of EducationZunyi Medical UniversityZunyiChina
- Key Laboratory of Brain ScienceZunyi Medical UniversityZunyiChina
- Guizhou Key Laboratory of Anesthesia and Organ ProtectionZunyi Medical UniversityZunyiChina
| | - Shiyu Cheng
- Key Laboratory of Anesthesia and Organ Protection (Zunyi Medical University), Ministry of EducationZunyi Medical UniversityZunyiChina
- Key Laboratory of Brain ScienceZunyi Medical UniversityZunyiChina
- Guizhou Key Laboratory of Anesthesia and Organ ProtectionZunyi Medical UniversityZunyiChina
| | - Fuwang Zhong
- Key Laboratory of Anesthesia and Organ Protection (Zunyi Medical University), Ministry of EducationZunyi Medical UniversityZunyiChina
- Key Laboratory of Brain ScienceZunyi Medical UniversityZunyiChina
- Guizhou Key Laboratory of Anesthesia and Organ ProtectionZunyi Medical UniversityZunyiChina
| | - Dan Luo
- Key Laboratory of Anesthesia and Organ Protection (Zunyi Medical University), Ministry of EducationZunyi Medical UniversityZunyiChina
- Key Laboratory of Brain ScienceZunyi Medical UniversityZunyiChina
- Guizhou Key Laboratory of Anesthesia and Organ ProtectionZunyi Medical UniversityZunyiChina
| | - Ying You
- Key Laboratory of Anesthesia and Organ Protection (Zunyi Medical University), Ministry of EducationZunyi Medical UniversityZunyiChina
- Key Laboratory of Brain ScienceZunyi Medical UniversityZunyiChina
- Guizhou Key Laboratory of Anesthesia and Organ ProtectionZunyi Medical UniversityZunyiChina
| | - Tian Yu
- Department of AnesthesiologyAffiliated Hospital of Zunyi Medical UniversityZunyiChina
- Key Laboratory of Anesthesia and Organ Protection (Zunyi Medical University), Ministry of EducationZunyi Medical UniversityZunyiChina
- Key Laboratory of Brain ScienceZunyi Medical UniversityZunyiChina
- Guizhou Key Laboratory of Anesthesia and Organ ProtectionZunyi Medical UniversityZunyiChina
| | - Haiying Wang
- Department of AnesthesiologyAffiliated Hospital of Zunyi Medical UniversityZunyiChina
- Key Laboratory of Anesthesia and Organ Protection (Zunyi Medical University), Ministry of EducationZunyi Medical UniversityZunyiChina
- Key Laboratory of Brain ScienceZunyi Medical UniversityZunyiChina
- Guizhou Key Laboratory of Anesthesia and Organ ProtectionZunyi Medical UniversityZunyiChina
| | - Liang Zhou
- Department of AnesthesiologyAffiliated Hospital of Zunyi Medical UniversityZunyiChina
- Key Laboratory of Anesthesia and Organ Protection (Zunyi Medical University), Ministry of EducationZunyi Medical UniversityZunyiChina
- Key Laboratory of Brain ScienceZunyi Medical UniversityZunyiChina
- Guizhou Key Laboratory of Anesthesia and Organ ProtectionZunyi Medical UniversityZunyiChina
| | - Yu Zhang
- Department of AnesthesiologyAffiliated Hospital of Zunyi Medical UniversityZunyiChina
- Key Laboratory of Anesthesia and Organ Protection (Zunyi Medical University), Ministry of EducationZunyi Medical UniversityZunyiChina
- Key Laboratory of Brain ScienceZunyi Medical UniversityZunyiChina
- Guizhou Key Laboratory of Anesthesia and Organ ProtectionZunyi Medical UniversityZunyiChina
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96
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Bünger V, Hunsicker O, Krannich A, Balzer F, Spies CD, Kuebler WM, Weber-Carstens S, Menk M, Graw JA. HAPTOGLOBIN DEPLETION DURING THE FIRST 7 DAYS OF VENO-VENOUS EXTRACORPOREAL MEMBRANE OXYGENATION THERAPY IS ASSOCIATED WITH INCREASED MORTALITY AND ADVERSE OUTCOMES IN PATIENTS WITH ACUTE RESPIRATORY DISTRESS SYNDROME. Shock 2024; 61:828-835. [PMID: 38661177 DOI: 10.1097/shk.0000000000002352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
ABSTRACT Background: Hemolysis is a frequent complication in patients with sepsis, ARDS, or extracorporeal membrane oxygenation (ECMO). Haptoglobin (Hp) can scavenge released cell-free hemoglobin (CFH). Hemolysis and low plasma concentrations of Hp may be independently associated with mortality in critically ill patients. Methods: This study used a retrospective analysis of 435 patients with ARDS and veno-venous ECMO therapy, admitted to a tertiary ARDS referral center (01/2007-12/2018). Hp depletion was defined as decrease in plasma Hp concentration <0.39 g/L within the first week after ECMO initiation. Patients with Hp depletion were compared to patients without Hp depletion. The primary endpoint was 28-day mortality. Secondary endpoints included organ dysfunction-free, renal replacement therapy-free, vasopressor-free, and ECMO-free composites. Results: Patients with Hp depletion (n = 269) had a significantly higher mortality 28 days after ECMO initiation compared to patients without Hp depletion (43.5% [95% CI 37.52-49.66] vs. 25.3% [19.03-32.74], P < 0.001). Furthermore, patients with Hp depletion had fewer organ dysfunction-free days (subdistribution hazard ratio [SHR] 0.35 [95% CI 0.25-0.50], P < 0.001), lower chances for successful weaning from renal replacement therapy (SHR 0.50 [0.32-0.79], P < 0.001), vasopressor therapy (SHR 0.39 [0.28-0.54], P < 0.001), and ECMO therapy (SHR 0.41 [0.30-0.57], P < 0.001) within 28 days after ECMO initiation. Patients with initial Hp <0.66 g/L had higher risks for Hp depletion than patients with initial Hp ≥0.66 g/L. Conclusion: Patients with Hp depletion within the first week of ECMO therapy might benefit from close monitoring of hemolysis with early detection and elimination of the underlying cause. They might be potential candidates for future Hp supplementation therapy to prevent overload of the CFH-scavenger system.
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Affiliation(s)
| | | | | | - Felix Balzer
- Institute of Medical Informatics, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | | | - Wolfgang M Kuebler
- Institute of Physiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
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97
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Khatib H, Edwin SB, Paxton R, Hughes C, Hartner C, Al-Samman S, Giuliano C. Enteral Sedation in Patients Requiring Mechanical Ventilation During an Intravenous Analgesic and Sedative Shortage. J Pharm Pract 2024; 37:696-702. [PMID: 37173117 DOI: 10.1177/08971900231175934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
Background: There is a paucity of data evaluating the use of enteral sedation in mechanical ventilation. A sedative shortage resulted in the use of this approach. Purpose: To evaluate the feasibility of using enteral sedatives to decrease intravenous (IV) analgesia and sedative requirements. Materials/Methods: This single-center, retrospective, observational study compared two groups of patients admitted to the ICU who were mechanically ventilated. One group received a combination of enteral and IV sedatives and the second group received IV monotherapy. Linear mixed model (LMM) analyses were performed to assess the impact of enteral sedatives on IV fentanyl equivalents, IV midazolam equivalents, and propofol. Mann-Whitney U tests were performed on percent of days at goal for Richmond Agitation and Sedation Scale (RASS) and critical care pain observation tool (CPOT) scores. Results: One hundred and four patients were included. The average cohort age was 62 years and 58.7% were male. The median length of mechanical ventilation was 7.1 days and the median length of stay was 11.9 days. The LMM estimated that enteral sedatives reduced IV fentanyl equivalents received per patient by an average of 305.6 mcg/day (P = .04), although did not significantly decrease midazolam equivalents or propofol. There was no statistically significant difference in CPOT scores (P = .57 and P = .46 respectively), however RASS scores in the enteral sedation group were more often at goal (P = .03); oversedation occurred more in the non-enteral sedation group (P = .018). Conclusion: Enteral sedation may be a possible way to decrease IV analgesia requirements during periods of shortage.
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Affiliation(s)
- Hassan Khatib
- Eugene Applebaum College of Pharmacy & Health Sciences, Wayne State University, Detroit, MI, USA
| | - Stephanie B Edwin
- Department of Pharmacy, Ascension St John Hospital, Detroit, MI, USA
| | - Renee Paxton
- Department of Pharmacy, Ascension St John Hospital, Detroit, MI, USA
| | - Christopher Hughes
- Department of Pulmonary and Critical Care Medicine, Ascension St John Hospital, Detroit, MI, USA
| | - Carrie Hartner
- Department of Pharmacy, Ascension St John Hospital, Detroit, MI, USA
| | - Samer Al-Samman
- Department of Pulmonary and Critical Care Medicine, Ascension St John Hospital, Detroit, MI, USA
| | - Christopher Giuliano
- Eugene Applebaum College of Pharmacy & Health Sciences, Wayne State University, Detroit, MI, USA
- Department of Pharmacy, Ascension St John Hospital, Detroit, MI, USA
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98
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Edwards JN, Whitney MA, Smith BB, Fah MK, Buckner Petty SA, Durra O, Sell-Dottin KA, Portner E, Wittwer ED, Milam AJ. The role of methadone in cardiac surgery for management of postoperative pain. BJA OPEN 2024; 10:100270. [PMID: 38560623 PMCID: PMC10978480 DOI: 10.1016/j.bjao.2024.100270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 02/27/2024] [Indexed: 04/04/2024]
Abstract
Background This retrospective study evaluated the efficacy and safety of intraoperative methadone compared with short-acting opioids. Methods Patients undergoing cardiac surgery with cardiopulmonary bypass (n=11 967) from 2018 to 2023 from a single health system were categorised into groups based on intraoperative opioid administration: no methadone (Group O), methadone plus other opioids (Group M+O), and methadone only (Group M). Results Patients in Groups M and M+O had lower mean pain scores until postoperative day (POD) 7 compared with Group O after adjusting for covariates (P<0.01). Both Groups M and M+O had lower total opioid administered compared with Group O for all days POD0-POD6 (all P<0.001). The median number of hours until initial postoperative opioid after surgery was 2.55 (inter-quartile range [IQR]=1.07-5.12), 6.82 (IQR=3.52-12.98), and 7.0 (IQR=3.82-12.95) for Group O, Group M+O, and Group M, respectively. The incidence of postoperative complications did not differ between groups. Conclusions Intraoperative administration of methadone was associated with better pain control without significant side-effects after cardiac surgery.
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Affiliation(s)
- Jordan N. Edwards
- Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA
| | | | - Bradford B. Smith
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Phoenix, AZ, USA
| | - Megan K. Fah
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Phoenix, AZ, USA
| | | | - Omar Durra
- Keck School of Medicine of USC, Los Angeles, CA, USA
| | | | - Erica Portner
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
| | - Erica D. Wittwer
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
| | - Adam J. Milam
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Phoenix, AZ, USA
- Department of Quantitative Health Sciences, Mayo Clinic, Phoenix, AZ, USA
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99
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Farid M, Zohny E, Ismail A, Ateya M, Abdel-Razek A, Hamed N, Elmarakby A, Hassanin A, Ismail A, Mansour O, Roshdy H, Ahmed Y, Ismail M, Amin HAA. Bone marrow embolism: should it result from traumatic bone lesions? A histopathological human autopsy study. Forensic Sci Med Pathol 2024; 20:387-399. [PMID: 37133760 PMCID: PMC11297083 DOI: 10.1007/s12024-023-00609-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/27/2023] [Indexed: 05/04/2023]
Abstract
Bone marrow embolism (BME) is likely a consequence of fractures in which pulmonary vessels are the most affected. However, some cases of BME were reported in the absence of trauma. Thus, a traumatic injury might not be necessary for developing BME. This study discusses BME cases in patients without signs of fractures or blunt trauma. The discussion addresses various possible mechanisms for the appearance of BME. Options include cancer in which bone marrow metastasis is a suggestive cause. Another proposal is the chemical theory where bone marrow fats are released via lipoprotein lipase in a pro-inflammatory state, resulting in vascular/pulmonary obstruction. Other cases discussed in this study are hypovolemic shock and drug-abuse related BME. All autopsy cases with BME were included regardless of the cause of death for a period of 2 years. Autopsies involved complete dissection with the macroscopic evaluation of the affected organs, including the heart, lungs, and brain. Tissues were also prepared for microscopic examination. Of the 11 cases, eight showed non-traumatic BME (72%). These findings conflict with theories in the literature that BME most commonly occurs after fractures or trauma. One of the eight cases exhibited mucinous carcinoma; one is presented with hepatocellular carcinoma; and two cases showed severe congestion. Lastly, one case was found to be associated with each of the following conditions: liposuction, drug abuse, pulmonary hypertension, and heart failure. Each case suggests a different pathophysiology for developing BME, yet the exact mechanisms are not fully understood. Further study of non-traumatic associated BME is recommended.
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Affiliation(s)
- Maha Farid
- Department of Forensic Medicine and Clinical Toxicology, Faculty of Medicine, Helwan University, Cairo, Egypt.
| | - Esraa Zohny
- Faculty of Medicine, Helwan University, Cairo, Egypt
| | - Alaa Ismail
- Faculty of Medicine, Helwan University, Cairo, Egypt
| | - Mariem Ateya
- Faculty of Medicine, Helwan University, Cairo, Egypt
| | | | - Nermien Hamed
- Faculty of Medicine, Helwan University, Cairo, Egypt
| | | | - Arwa Hassanin
- Faculty of Medicine, Helwan University, Cairo, Egypt
| | - Ahmed Ismail
- Faculty of Medicine, Helwan University, Cairo, Egypt
| | - Omar Mansour
- Faculty of Medicine, Helwan University, Cairo, Egypt
| | - Hossam Roshdy
- Faculty of Medicine, Helwan University, Cairo, Egypt
| | - Yehia Ahmed
- Faculty of Medicine, Helwan University, Cairo, Egypt
| | - Mariam Ismail
- Faculty of Medicine, Helwan University, Cairo, Egypt
| | - Hebat Allah A Amin
- Department of Pathology, Faculty of Medicine, Helwan University, Cairo, Egypt
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Casper E, El Wakeel L, Sabri N, Khorshid R, Fahmy SF. Melatonin: A potential protective multifaceted force for sepsis-induced cardiomyopathy. Life Sci 2024; 346:122611. [PMID: 38580195 DOI: 10.1016/j.lfs.2024.122611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 03/19/2024] [Accepted: 04/02/2024] [Indexed: 04/07/2024]
Abstract
Sepsis is a life-threatening condition manifested by organ dysfunction caused by a dysregulated host response to infection. Lung, brain, liver, kidney, and heart are among the affected organs. Sepsis-induced cardiomyopathy is a common cause of death among septic patients. Sepsis-induced cardiomyopathy is characterized by an acute and reversible significant decline in biventricular both systolic and diastolic function. This is accompanied by left ventricular dilatation. The pathogenesis underlying sepsis-induced cardiomyopathy is multifactorial. Hence, targeting an individual pathway may not be effective in halting the extensive dysregulated immune response. Despite major advances in sepsis management strategies, no effective pharmacological strategies have been shown to treat or even reverse sepsis-induced cardiomyopathy. Melatonin, namely, N-acetyl-5-methoxytryptamine, is synthesized in the pineal gland of mammals and can also be produced in many cells and tissues. Melatonin has cardioprotective, neuroprotective, and anti-tumor activity. Several literature reviews have explored the role of melatonin in preventing sepsis-induced organ failure. Melatonin was found to act on different pathways that are involved in the pathogenesis of sepsis-induced cardiomyopathy. Through its antimicrobial, anti-inflammatory, and antioxidant activity, it offers a potential role in sepsis-induced cardiomyopathy. Its antioxidant activity is through free radical scavenging against reactive oxygen and nitrogen species and modulating the expression and activity of antioxidant enzymes. Melatonin anti-inflammatory activities control the overactive immune system and mitigate cytokine storm. Also, it mitigates mitochondrial dysfunction, a major mechanism involved in sepsis-induced cardiomyopathy, and thus controls apoptosis. Therefore, this review discusses melatonin as a promising drug for the management of sepsis-induced cardiomyopathy.
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Affiliation(s)
- Eman Casper
- Department of Clinical Pharmacy, Faculty of Pharmacy, Ain Shams University, Cairo, Egypt.
| | - Lamia El Wakeel
- Department of Clinical Pharmacy, Faculty of Pharmacy, Ain Shams University, Cairo, Egypt.
| | - Nagwa Sabri
- Department of Clinical Pharmacy, Faculty of Pharmacy, Ain Shams University, Cairo, Egypt.
| | - Ramy Khorshid
- Department of Cardiovascular and Thoracic Surgery, Ain Shams University Hospital, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
| | - Sarah F Fahmy
- Department of Clinical Pharmacy, Faculty of Pharmacy, Ain Shams University, Cairo, Egypt.
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