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Demetz M, Krigers A, Uribe-Pacheco R, Pinggera D, Klingenschmid J, Thomé C, Freyschlag CF, Kerschbaumer J. The role of postoperative blood pressure management in early postoperative hemorrhage in awake craniotomy glioma patients. Neurosurg Rev 2024; 47:452. [PMID: 39168945 PMCID: PMC11339099 DOI: 10.1007/s10143-024-02661-0] [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: 06/19/2024] [Revised: 07/30/2024] [Accepted: 08/05/2024] [Indexed: 08/23/2024]
Abstract
Postoperative hemorrhage can severely affect the patients' neurological outcome after awake craniotomy. Higher postoperative blood pressure can increase the risk of postoperative hemorrhage. The aim of this study was to investigate the role of postoperative blood pressure and other common radiological and epidemiological features with the incidence of postoperative hemorrhage. In this retrospective analysis, we included patients who underwent awake surgery at our institution. We assessed the blood pressure both intra- and postoperatively as well as the heart rate for the first 12 h. We compared a cohort with postoperative hemorrhage, who required further treatment (surgical revision or intravenous antihypertensive therapy), with a cohort with no postoperative hemorrhage. We included 48 patients with a median age of 39 years. 9 patients (19%) required further treatment due to postoperative hemorrhage, which was surgery in 2 cases and intensive blood pressure measurements in 7 cases. However, with early treatment, no significant difference in Performance scores at follow-up could be found. Patients with postoperative hemorrhage showed significantly higher postoperative systolic blood pressure during the hours 3-12 (p < 0.05) as well as intraoperatively throughout the procedure (p < 0.05). In ROC and Youden Test, a strong impact of systolic blood pressure over 140mmHg during the early postoperative course could be shown. Postoperative hemorrhage is a rare but possible complication in awake surgery glioma patients. To avoid postoperative hemorrhage, treating physicians should aim strictly on systolic blood pressure of under 140mmHg for the postoperative course.
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Affiliation(s)
- Matthias Demetz
- Department of Neurosurgery, Medical University of Innsbruck, Anichstr. 35, Innsbruck, AT-6020, Austria
| | - Aleksandrs Krigers
- Department of Neurosurgery, Medical University of Innsbruck, Anichstr. 35, Innsbruck, AT-6020, Austria
| | - Rodrigo Uribe-Pacheco
- Department of Neurosurgery, Medical University of Innsbruck, Anichstr. 35, Innsbruck, AT-6020, Austria
| | - Daniel Pinggera
- Department of Neurosurgery, Medical University of Innsbruck, Anichstr. 35, Innsbruck, AT-6020, Austria
| | - Julia Klingenschmid
- Department of Neurosurgery, Medical University of Innsbruck, Anichstr. 35, Innsbruck, AT-6020, Austria
| | - Claudius Thomé
- Department of Neurosurgery, Medical University of Innsbruck, Anichstr. 35, Innsbruck, AT-6020, Austria
| | - Christian F Freyschlag
- Department of Neurosurgery, Medical University of Innsbruck, Anichstr. 35, Innsbruck, AT-6020, Austria.
| | - Johannes Kerschbaumer
- Department of Neurosurgery, Medical University of Innsbruck, Anichstr. 35, Innsbruck, AT-6020, Austria
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Lin Y, Teixeira-Pinto A, Craig JC, Opdam H, Chapman JC, Pleass H, Carter A, Rogers NM, Davies CE, McDonald S, Yang J, Lim WH, Wong G. Trajectories of systolic blood pressure decline in kidney transplant donors prior to circulatory death and delayed graft function. Clin Kidney J 2023; 16:1170-1179. [PMID: 37398694 PMCID: PMC10310517 DOI: 10.1093/ckj/sfad047] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Indexed: 07/28/2024] Open
Abstract
BACKGROUND Kidneys donated after circulatory death suffer a period of functional warm ischaemia before death, which may lead to early ischaemic injury. Effects of haemodynamic trajectories during the agonal phase on delayed graft function (DGF) is unknown. We aimed to predict the risk of DGF using patterns of trajectories of systolic blood pressure (SBP) declines in Maastricht category 3 kidney donors. METHODS We conducted a cohort study of all kidney transplant recipients in Australia who received kidneys from donation after circulatory death donors, divided into a derivation cohort (transplants between 9 April 2014 and 2 January 2018 [462 donors]) and a validation cohort (transplants between 6 January 2018 and 24 December 2019 [324 donors]). Patterns of SBP decline using latent class models were evaluated against the odds of DGF using a two-stage linear mixed effects model. RESULTS In the derivation cohort, 462 donors were included in the latent class analyses and 379 donors in the mixed effects model. Of the 696 eligible transplant recipients, 380 (54.6%) experienced DGF. Ten different trajectories, with distinct patterns of SBP decline were identified. Compared with recipients from donors with the slowest decline in SBP after withdrawal of cardiorespiratory support, the adjusted odds ratio (aOR) for DGF was 5.5 [95% confidence interval (CI) 1.38-28.0] for recipients from donors with a steeper decline and lowest SBP [mean 49.5 mmHg (standard deviation 12.5)] at the time of withdrawal. For every 1 mmHg/min reduction in the rate of decline of SBP, the respective aORs for DGF were 0.95 (95% CI 0.91-0.99) and 0.98 (95% CI 0.93-1.0) in the random forest and least absolute shrinkage and selection operator models. In the validation cohort, the respective aORs were 0.95 (95% CI 0.91-1.0) and 0.99 (95% CI 0.94-1.0). CONCLUSION Trajectories of SBP decline and their determinants are predictive of DGF. These results support a trajectory-based assessment of haemodynamic changes in donors after circulatory death during the agonal phase for donor suitability and post-transplant outcomes.
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Affiliation(s)
- Yingxin Lin
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
- Faculty of Science, School of Mathematics and Science, University of Sydney, Sydney, NSW, Australia
| | - Armando Teixeira-Pinto
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
- Centre for Kidney Research, Kids Research Institute, Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Jonathan C Craig
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Helen Opdam
- Department of Surgery, DonateLife, Organ and Tissue Authority, Canberra, ACT, Australia
| | - Jeremy C Chapman
- Centre for Transplant and Renal Research, Westmead Hospital, Sydney, NSW, Australia
| | - Henry Pleass
- Centre for Transplant and Renal Research, Westmead Hospital, Sydney, NSW, Australia
- Specialty of Surgery, University of Sydney, Sydney, NSW, Australia
| | - Angus Carter
- Intensive Care Unit, Cairns Hospital, Cairns, QLD, Australia
| | - Natasha M Rogers
- Centre for Transplant and Renal Research, Westmead Hospital, Sydney, NSW, Australia
| | - Christopher E Davies
- Department of Renal Medicine, Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, South Australian Health and Medical Research Institute, Adelaide, SA, Australia
- Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
| | - Stephen McDonald
- Department of Renal Medicine, Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, South Australian Health and Medical Research Institute, Adelaide, SA, Australia
- Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
| | - Jean Yang
- Faculty of Science, School of Mathematics and Science, University of Sydney, Sydney, NSW, Australia
| | - Wai H Lim
- Faculty of Health and Medical Science, University of Western Australia, Perth, WA, Australia
- Department of Renal Medicine, Sir Charles Gairdner Hospital, Perth, WA, Australia
| | - Germaine Wong
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
- Centre for Kidney Research, Kids Research Institute, Children's Hospital at Westmead, Sydney, NSW, Australia
- Centre for Transplant and Renal Research, Westmead Hospital, Sydney, NSW, Australia
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Abugomaa A, Elbadawy M. Olive leaf extract modulates glycerol-induced kidney and liver damage in rats. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2020; 27:22100-22111. [PMID: 32291641 DOI: 10.1007/s11356-020-08371-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Accepted: 03/09/2020] [Indexed: 06/11/2023]
Abstract
The present study was conducted to examine the protective effect of olive leaf extract (OLE) against glycerol-induced oxidative stress in rats. Sixty male albino rats were used and allocated randomly into four groups, each of 15 rats. Groups (1) and (2) were administered intraperitoneally (i.p.) a single dose of 500 μL normal saline and hypertonic glycerol solution (10 mL/kg b.wt., 50% v/v, in sterile saline), respectively, followed by a 24-h period of water deprivation. Group (3) was orally given OLE (500 mg/kg b.wt.) for 22 days and glycerol as mentioned above on the 14th day of OLE administration followed by a 24-h period of water deprivation. Group (4) was administered OLE alone. Five rats from each group were sacrificed and samples were collected 1, 5, and 8 days after water deprivation. Alterations in hematobiochemical parameters, renal and hepatic oxidative stress markers, as well as histopathology of the kidney and liver, were evaluated. Glycerol treatment resulted in significant hematological and biochemical alterations as well as significant renal and hepatic oxidative stress. Administration of OLE has significantly ameliorated renal dysfunction, morphological alterations of kidney and liver, and relieved the oxidative stress. These findings show obviously the role of oxidative stress and its relevance to renal dysfunction and suggest the ameliorative impact of OLE in glycerol-induced acute kidney damage in rats, possibly due to its antioxidant properties.
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Affiliation(s)
- Amira Abugomaa
- Faculty of Veterinary Medicine|, Mansoura University, Mansoura, Dakahliya, 35516, Egypt
| | - Mohamed Elbadawy
- Department of Pharmacology, Faculty of Veterinary Medicine, Benha University, Moshtohor, Toukh, Elqaliobiya, 13736, Egypt.
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Smischney NJ, Seisa MO, Cambest J, Wiegand RA, Busack KD, Loftsgard TO, Schroeder DR, Diedrich DA. The Incidence of and Risk Factors for Postintubation Hypotension in the Immunocompromised Critically Ill Adult. J Intensive Care Med 2017; 34:578-586. [PMID: 28425335 DOI: 10.1177/0885066617704844] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVES Our primary aim was to ascertain the frequency of postintubation hypotension in immunocompromised critically ill adults with secondary aims of arriving at potential risk factors for the development of postintubation hypotension and its impact on patient-related outcomes. METHODS Critically ill adult patients (≥18 years) were included from January 1, 2010, to December 31, 2014. We defined immunocompromised as patients with any solid organ or nonsolid organ malignancy or transplant, whether solid organ or not, requiring current chemotherapy. Postintubation hypotension was defined as a decrease in systolic blood pressure to less than 90 mm Hg or a decrease in mean arterial pressure to less than 65 mm Hg or the initiation of any vasopressor medication. Patients were then stratified based on development of postintubation hypotension. Potential risk factors and intensive care unit (ICU) outcome metrics were electronically captured by a validated data mart system. RESULTS The final cohort included 269 patients. Postintubation hypotension occurred in 141 (52%; 95% confidence interval: 46-58) patients. Several risk factors predicted postintubation hypotension on univariate analysis; however, only Acute Physiology and Chronic Health Evaluation III score in the first 24 hours, preintubation shock status, and preintubation hemodynamic instability remained significant on all 4 multivariate analyses. Patients developing postintubation hypotension had higher ICU and hospital mortality (54 [38%] vs 31 [24%], P = .01; 69 [49%] vs 47 [37%], P = .04). CONCLUSION Based on previous literature, we found a higher frequency of postintubation hypotension in the immunocompromised than in the nonimmunocompromised critically ill adult patients. Acute Physiology and Chronic Health Evaluation III score in the first 24 hours, preintubation shock status, and preintubation hemodynamic instability were significant predictors on multivariate analyses. Postintubation hypotension led to higher ICU and hospital mortality in those experiencing this complication.
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Affiliation(s)
- Nathan J Smischney
- 1 Department of Anesthesiology, Mayo Clinic, Rochester, MN, USA.,2 Hemodynamic and Airway Management Group (HEMAIR), Mayo Clinic, Rochester, MN, USA
| | - Mohamed O Seisa
- 1 Department of Anesthesiology, Mayo Clinic, Rochester, MN, USA.,2 Hemodynamic and Airway Management Group (HEMAIR), Mayo Clinic, Rochester, MN, USA
| | - John Cambest
- 1 Department of Anesthesiology, Mayo Clinic, Rochester, MN, USA
| | | | - Kyle D Busack
- 1 Department of Anesthesiology, Mayo Clinic, Rochester, MN, USA
| | | | | | - Daniel A Diedrich
- 1 Department of Anesthesiology, Mayo Clinic, Rochester, MN, USA.,2 Hemodynamic and Airway Management Group (HEMAIR), Mayo Clinic, Rochester, MN, USA
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Calvert J, Mao Q, Rogers AJ, Barton C, Jay M, Desautels T, Mohamadlou H, Jan J, Das R. A computational approach to mortality prediction of alcohol use disorder inpatients. Comput Biol Med 2016; 75:74-9. [PMID: 27253619 DOI: 10.1016/j.compbiomed.2016.05.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Revised: 05/17/2016] [Accepted: 05/22/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND Health information technologies can assist clinicians in the Intensive Care Unit (ICU) by providing additional analysis of patient stability. However, because patient diagnoses can be confounded by chronic alcohol use, the predictive value of existing systems is suboptimal. Through the use of Electronic Health Records (EHR), we have developed computer software called AutoTriage to generate accurate predictions through multi-dimensional analysis of clinical variables. We analyze the performance of AutoTriage on the Alcohol Use Disorder (AUD) subpopulation in this study, and build on results we reported for AutoTriage performance on the general population in previous work. METHODS AUD-related ICD-9 codes were used to obtain a patient population from MIMIC III ICU dataset for a retrospective study. Patient mortality risk score is generated through analysis of eight EHR-based clinical variables. The score is determined by combining weighted subscores, each of which are obtained from singlets, doublets or triplets of one or more of the eight continuous-valued clinical variable inputs. A temporally updating risk score is computed with a continuously revised 12-hour mortality prediction. RESULTS Among AUD patients, in a non-overlapping test set, AutoTriage outperforms existing systems with an Area Under Receiver Operating Characteristic (AUROC) value of 0.934 for 12-h mortality prediction. At a sensitivity of 90%, AutoTriage achieves a specificity of 80%, positive predictive value of 40%, negative predictive value of 89%, and an Odds Ratio of 36. CONCLUSIONS For mortality prediction, AutoTriage demonstrates improvements in both the accuracy and the Odds Ratio over current systems among the AUD patient population.
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Affiliation(s)
| | | | | | - Christopher Barton
- Department of Emergency Medicine, University of California, San Francisco, United States
| | | | | | | | - Jasmine Jan
- Department of Bioengineering, University of California, Berkeley, United States
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Panwar R, Lanyon N, Davies AR, Bailey M, Pilcher D, Bellomo R. Mean perfusion pressure deficit during the initial management of shock--an observational cohort study. J Crit Care 2013; 28:816-24. [PMID: 23849541 DOI: 10.1016/j.jcrc.2013.05.009] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2013] [Revised: 04/09/2013] [Accepted: 05/15/2013] [Indexed: 01/20/2023]
Abstract
PURPOSE It is unclear if blood pressure targets for patients with shock should be adjusted to pre-morbid levels. We aimed to investigate mean deficit between the achieved mean perfusion pressure (MPP) in vasopressor-treated patients and their estimated basal (resting) MPP, and assess whether MPP deficit has any association with subsequent acute kidney injury (AKI). MATERIALS AND METHODS Fifty-one consecutive, non-trauma patients, aged ≥40 years, with ≥2 organ dysfunction and requiring vasopressor≥4 hours were observed at an academic intensive care unit. Mean MPP deficit [=%(basal MPP-achieved MPP)/basal MPP] and % time spent with >20% MPP deficit were assessed during initial 72 vasopressor hours (T0-T72) for each patient. RESULTS Achieved MPP was unrelated to basal MPP (P=.99). Mean MPP deficit was 18% (95% CI 15-21). Patients spent 48% (95% CI 39-57) time with >20% MPP deficit. Despite similar risk scores at T0, subsequent AKI (≥2 RIFLE class increase from T0) occurred more frequently in patients with higher (>median) MPP deficit compared to patients with lower MPP deficit (56% vs 28%; P=.045). Incidence of subsequent AKI was also higher among patients who spent greater % time with >20% MPP deficit (P=.04). CONCLUSIONS Achieved blood pressure during vasopressor therapy had no relationship to the pre-morbid basal level. This resulted in significant and varying degree of relative hypotension (MPP deficit), which could be a modifiable risk factor for AKI in patients with shock.
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Affiliation(s)
- Rakshit Panwar
- Department of Anaesthesia, Intensive Care and Pain Medicine, John Hunter Hospital, Newcastle 2305, Australia.
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