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Hong A, Boukthir S, Levé C, Joachim J, Mateo J, Le Gall A, Mebazaa A, Gayat E, Cartailler J, Vallée F. "Association of velocity-pressure loop-derived values recorded during neurosurgical procedures with postoperative organ failure biomarkers: a retrospective single-center study". Anaesth Crit Care Pain Med 2024:101405. [PMID: 38997007 DOI: 10.1016/j.accpm.2024.101405] [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: 10/17/2023] [Revised: 05/24/2024] [Accepted: 06/02/2024] [Indexed: 07/14/2024]
Abstract
BACKGROUND Perioperative renal and myocardial protection primarily depends on preoperative prediction tools, along with intraoperative optimization of cardiac output (CO) and mean arterial pressure (MAP). We hypothesise that monitoring the intraoperative global afterload angle (GALA), a proxy of ventricular afterload derived from the velocity pressure (VP) loop, could better predict changes in postoperative biomarkers than the recommended traditional MAP and CO. METHOD This retrospective monocentric study included patients programmed for neurosurgery with continuous VP loop monitoring. Patients with hemodynamic instability were excluded. Those presenting a 1-day post-surgery increase in creatinine, B-type natriuretic peptide, or troponin Ic us were labelled Bio+, Bio- otherwise. Demographics, intra-operative data and comorbidities were considered as covariates. The study aimed to determine if intraoperative GALA monitoring could predict early postoperative biomarker disruption. RESULT From November 2018 to November 2020, 86 patients were analysed (Bio+/Bio- = 47/39). Bio + patients were significantly older (62[54-69] versus 42[34-57] years, p < 0.0001), More often hypertensive (25% vs. 9%, p = 0.009), and more frequently treated with antihypertensive drugs (31.9% vs. 7.7%, p = 0.013). GALA was significantly larger in Bio+ patients (40[31-56] vs. 23[19-29] °, p < 0.0001), while CO, MAP, and cumulative time spent <65mmHg were similar between groups. GALA exhibited strong predictive performances for postoperative biological deterioration (AUC=0.88[0.80-0.95]), significantly outperforming MAP (MAP AUC=0.55[0.43-0.68], p < 0.0001). CONCLUSION GALA under general anaesthesia prove more effective in detecting patients at risk of early cardiac or renal biological deterioration, compared to classical hemodynamic parameters.
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Affiliation(s)
- Alex Hong
- Department of Anaesthesiology, Burn and Critical Care. Saint-Louis-Lariboisière University Hospital, Assistance Publique Hôpitaux de Paris, Paris, France; Cambodia China friendship preah kossamak hospital 316d St 150, Phnom Penh, Cambodia
| | - Sonia Boukthir
- Department of Anaesthesiology, Burn and Critical Care. Saint-Louis-Lariboisière University Hospital, Assistance Publique Hôpitaux de Paris, Paris, France.
| | - Charlotte Levé
- Department of Anaesthesiology, Burn and Critical Care. Saint-Louis-Lariboisière University Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Jona Joachim
- Department of Anaesthesiology, Burn and Critical Care. Saint-Louis-Lariboisière University Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Joaquim Mateo
- Department of Anaesthesiology, Burn and Critical Care. Saint-Louis-Lariboisière University Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Arthur Le Gall
- Department of Anaesthesiology, Burn and Critical Care. Saint-Louis-Lariboisière University Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Alexandre Mebazaa
- Department of Anaesthesiology, Burn and Critical Care. Saint-Louis-Lariboisière University Hospital, Assistance Publique Hôpitaux de Paris, Paris, France; Inserm, UMRS-942, Paris. France
| | - Etienne Gayat
- Department of Anaesthesiology, Burn and Critical Care. Saint-Louis-Lariboisière University Hospital, Assistance Publique Hôpitaux de Paris, Paris, France; Inserm, UMRS-942, Paris. France
| | - Jérôme Cartailler
- Department of Anaesthesiology, Burn and Critical Care. Saint-Louis-Lariboisière University Hospital, Assistance Publique Hôpitaux de Paris, Paris, France; Inserm, UMRS-942, Paris. France
| | - Fabrice Vallée
- Department of Anaesthesiology, Burn and Critical Care. Saint-Louis-Lariboisière University Hospital, Assistance Publique Hôpitaux de Paris, Paris, France; Inserm, UMRS-942, Paris. France; Laboratoire de Mécanique des Solides (LMS), Ecole Polytechnique, CNRS, Palaiseau, France
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Al-Hchaimi HA, Alhamaidah MF, Alkhfaji H, Qasim MT, Al-Nussairi AH, Abd-Alzahra HS. Intraoperative Fluid Management for Major Neurosurgery: Narrative study. 2022 INTERNATIONAL SYMPOSIUM ON MULTIDISCIPLINARY STUDIES AND INNOVATIVE TECHNOLOGIES (ISMSIT) 2022. [DOI: 10.1109/ismsit56059.2022.9932659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Affiliation(s)
- Hussein Ali Al-Hchaimi
- College of Health and Medical Technology, Al-Ayen University Nasiriya heart center,Department of Anesthesia,Thi-Qar,Iraq
| | - Majid Fakhir Alhamaidah
- College of Health and Medical Technology, Al-Ayen University AL-Rifaei General Hospital,Department of Anesthesia,Thi-Qar,Iraq
| | - Hussein Alkhfaji
- College of Health and Medical Technology, Al-Ayen University Bent AL Huda hospital,Department of Anesthesia,Thi-Qar,Iraq
| | - Maytham T. Qasim
- College of Health and Medical Technology, Al-Ayen University,Department of Anesthesia,Thi-Qar,Iraq
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Schierbauer JR, Günther S, Haupt S, Zimmer RT, Zunner BEM, Zimmermann P, Wachsmuth NB, Eckstein ML, Aberer F, Sourij H, Moser O. Accuracy of Real Time Continuous Glucose Monitoring during Different Liquid Solution Challenges in Healthy Adults: A Randomized Controlled Cross-Over Trial. SENSORS 2022; 22:s22093104. [PMID: 35590794 PMCID: PMC9105614 DOI: 10.3390/s22093104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 04/12/2022] [Accepted: 04/13/2022] [Indexed: 01/02/2023]
Abstract
Continuous glucose monitoring (CGM) represents an integral of modern diabetes management, however, there is still a lack of sensor performance data when rapidly consuming different liquids and thus changing total body water. 18 healthy adults (ten females, age: 23.1 ± 1.8 years, BMI 22.2 ± 2.1 kg·m−2) performed four trial visits consisting of oral ingestion (12 mL per kg body mass) of either a 0.9% sodium chloride, 5% glucose or Ringer’s solution and a control visit, in which no liquid was administered (control). Sensor glucose levels (Dexcom G6, Dexcom Inc., San Diego, CA, USA) were obtained at rest and in 10-min intervals for a period of 120 min after solution consumption and compared against reference capillary blood glucose measurements. The overall MedARD [IQR] was 7.1% [3.3−10.8]; during control 5.9% [2.7−10.8], sodium chloride 5.0% [2.7−10.2], 5% glucose 11.0% [5.3−21.6] and Ringer’s 7.5% [3.1−13.2] (p < 0.0001). The overall bias [95% LoA] was 4.3 mg·dL−1 [−19 to 28]; during control 3.9 mg·dL−1 [−11 to 18], sodium chloride 4.8 mg·dL−1 [−9 to 19], 5% glucose 3.6 mg·dL−1 [−33 to 41] and Ringer’s solution 4.9 mg·dL−1 [−13 to 23]. The Dexcom G6 CGM system detects glucose with very good accuracy during liquid solution challenges in normoglycemic individuals, however, our data suggest that in people without diabetes, sensor performance is influenced by different solutions.
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Affiliation(s)
- Janis R. Schierbauer
- Division of Exercise Physiology and Metabolism, Department of Sport Science, University of Bayreuth, 95440 Bayreuth, Germany; (J.R.S.); (S.G.); (S.H.); (R.T.Z.); (B.E.M.Z.); (P.Z.); (N.B.W.); (M.L.E.); (F.A.)
| | - Svenja Günther
- Division of Exercise Physiology and Metabolism, Department of Sport Science, University of Bayreuth, 95440 Bayreuth, Germany; (J.R.S.); (S.G.); (S.H.); (R.T.Z.); (B.E.M.Z.); (P.Z.); (N.B.W.); (M.L.E.); (F.A.)
| | - Sandra Haupt
- Division of Exercise Physiology and Metabolism, Department of Sport Science, University of Bayreuth, 95440 Bayreuth, Germany; (J.R.S.); (S.G.); (S.H.); (R.T.Z.); (B.E.M.Z.); (P.Z.); (N.B.W.); (M.L.E.); (F.A.)
| | - Rebecca T. Zimmer
- Division of Exercise Physiology and Metabolism, Department of Sport Science, University of Bayreuth, 95440 Bayreuth, Germany; (J.R.S.); (S.G.); (S.H.); (R.T.Z.); (B.E.M.Z.); (P.Z.); (N.B.W.); (M.L.E.); (F.A.)
| | - Beate E. M. Zunner
- Division of Exercise Physiology and Metabolism, Department of Sport Science, University of Bayreuth, 95440 Bayreuth, Germany; (J.R.S.); (S.G.); (S.H.); (R.T.Z.); (B.E.M.Z.); (P.Z.); (N.B.W.); (M.L.E.); (F.A.)
| | - Paul Zimmermann
- Division of Exercise Physiology and Metabolism, Department of Sport Science, University of Bayreuth, 95440 Bayreuth, Germany; (J.R.S.); (S.G.); (S.H.); (R.T.Z.); (B.E.M.Z.); (P.Z.); (N.B.W.); (M.L.E.); (F.A.)
| | - Nadine B. Wachsmuth
- Division of Exercise Physiology and Metabolism, Department of Sport Science, University of Bayreuth, 95440 Bayreuth, Germany; (J.R.S.); (S.G.); (S.H.); (R.T.Z.); (B.E.M.Z.); (P.Z.); (N.B.W.); (M.L.E.); (F.A.)
| | - Max L. Eckstein
- Division of Exercise Physiology and Metabolism, Department of Sport Science, University of Bayreuth, 95440 Bayreuth, Germany; (J.R.S.); (S.G.); (S.H.); (R.T.Z.); (B.E.M.Z.); (P.Z.); (N.B.W.); (M.L.E.); (F.A.)
| | - Felix Aberer
- Division of Exercise Physiology and Metabolism, Department of Sport Science, University of Bayreuth, 95440 Bayreuth, Germany; (J.R.S.); (S.G.); (S.H.); (R.T.Z.); (B.E.M.Z.); (P.Z.); (N.B.W.); (M.L.E.); (F.A.)
- Interdisciplinary Metabolic Medicine Trials Unit, Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, 8036 Graz, Austria;
| | - Harald Sourij
- Interdisciplinary Metabolic Medicine Trials Unit, Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, 8036 Graz, Austria;
| | - Othmar Moser
- Division of Exercise Physiology and Metabolism, Department of Sport Science, University of Bayreuth, 95440 Bayreuth, Germany; (J.R.S.); (S.G.); (S.H.); (R.T.Z.); (B.E.M.Z.); (P.Z.); (N.B.W.); (M.L.E.); (F.A.)
- Interdisciplinary Metabolic Medicine Trials Unit, Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, 8036 Graz, Austria;
- Correspondence: ; Tel.: +49-(0)921-55-3465
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