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Laou E, Papagiannakis N, Sarchosi S, Kleisiaris K, Apostolopoulou A, Syngelou V, Kakagianni M, Christopoulos A, Ntalarizou N, Chalkias A. The use of mean circulatory filling pressure analogue for monitoring hemodynamic coherence: A post-hoc analysis of the SPARSE data and proof-of-concept study. Clin Hemorheol Microcirc 2023:CH221563. [PMID: 36846992 DOI: 10.3233/ch-221563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
BACKGROUND Dissociation between macrocirculation and microcirculation is often observed in surgical patients. OBJECTIVE To test the hypothesis that the analogue of mean circulatory filling pressure (Pmca) can monitor hemodynamic coherence during major non-cardiac surgery. METHODS In this post-hoc analysis and proof-of-concept study, we used the central venous pressure (CVP), mean arterial pressure (MAP), and cardiac output (CO) to calculate Pmca. Efficiency of the heart (Eh), arterial resistance (Rart), effective arterial elastance (Ea), venous compartment resistance (Rven), oxygen delivery (DO2), and oxygen extraction ratio (O2ER) were also calculated. Sublingual microcirculation was assessed using SDF + imaging, and the De Backer score, Consensus Proportion of Perfused Vessels (Consensus PPV), and Consensus PPV (small) were determined. RESULTS Thirteen patients were included, with a median age of 66 years. Median Pmca was 16 (14.9-18) mmHg and was positively associated with CO [p < 0.001; a 1 mmHg increase in Pmca increases CO by 0.73 L min - 1 (p < 0.001)], Eh (p < 0.001), Rart (p = 0.01), Ea (p = 0.03), Rven (p = 0.005), DO2 (p = 0.03), and O2ER (p = 0.02). A significant correlation was observed between Pmca and Consensus PPV (p = 0.02), but not with De Backer Score (p = 0.34) or Consensus PPV (small) (p = 0.1). CONCLUSION Significant associations exist between Pmca and several hemodynamic and metabolic variables including Consensus PPV. Adequately powered studies should determine whether Pmca can provide real-time information on hemodynamic coherence.
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Affiliation(s)
- Eleni Laou
- Department of Anesthesiology, Faculty of Medicine, University of Thessaly, Larisa, Greece
| | - Nikolaos Papagiannakis
- First Department of Neurology, Eginition University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Smaragdi Sarchosi
- Department of Anesthesiology, Faculty of Medicine, University of Thessaly, Larisa, Greece
| | - Konstantinos Kleisiaris
- Intermediate Care Unit, Cardiovascular Center, University Hospital of Bern, Bern, Switzerland
| | | | - Vasiliki Syngelou
- Department of Anesthesiology, Faculty of Medicine, University of Thessaly, Larisa, Greece
| | - Maria Kakagianni
- Department of Anesthesiology, Faculty of Medicine, University of Thessaly, Larisa, Greece
| | | | - Nicoleta Ntalarizou
- Department of Anesthesiology, Faculty of Medicine, University of Thessaly, Larisa, Greece
| | - Athanasios Chalkias
- Department of Anesthesiology, Faculty of Medicine, University of Thessaly, Larisa, Greece.,Outcomes Research Consortium, Cleveland, OH, USA
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Hamada M, Takeuchi I, Muramatsu KI, Nagasawa H, Ohsaka H, Ishikawa K, Yanagawa Y. Relationship between Incontinence and Disease Severity in Patients Transported by Ambulance. J Emerg Trauma Shock 2023; 16:13-16. [PMID: 37181745 PMCID: PMC10167822 DOI: 10.4103/jets.jets_122_22] [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: 09/28/2022] [Revised: 10/24/2022] [Accepted: 11/25/2022] [Indexed: 03/29/2023] Open
Abstract
Introduction Retrospectively investigated this relationship using data from Shimoda Fire Department. Methods We investigated patients who were transported by Shimoda Fire Department from January 2019 to December 2021. The participants were divided into groups based on the existence of incontinence at the scene or not (Incontinence [+] and Incontinence [-]). We compared the variables mentioned above between these groups. Results There were 499 cases with incontinence and 8241 cases without incontinence. There were no significant differences between the two groups with respect to weather and wind speed. The average age, percentage of male patients, percentage of cases in the winter season, rate of collapse at home, scene time, rate of endogenous disease, disease severity, and mortality rate in the incontinence (+) group were significantly greater in comparison to the incontinence (-) group, whereas the average temperature in the incontinence (+) group was significantly lower than that in the incontinence (-) group. Regarding the rates of incontinence of each disease, neurologic, infectious, endocrinal disease, dehydration, suffocation, and cardiac arrest at the scene had more than twice the rate of incontinence in other conditions. Conclusions This is the first study to report that patients with incontinence at the scene tended to be older, showed a male predominance, severe disease, high mortality, and required a long scene time in comparison to patients without incontinence. Prehospital care providers should therefore check for incontinence when evaluating patients.
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Affiliation(s)
- Michika Hamada
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Izunokuni, Japan
| | - Ikuto Takeuchi
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Izunokuni, Japan
| | - Ken-Ichi Muramatsu
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Izunokuni, Japan
| | - Hiroki Nagasawa
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Izunokuni, Japan
| | - Hiromichi Ohsaka
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Izunokuni, Japan
| | - Kouhei Ishikawa
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Izunokuni, Japan
| | - Youichi Yanagawa
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Izunokuni, Japan
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Association of Preoperative Basal Inflammatory State, Measured by Plasma suPAR Levels, with Intraoperative Sublingual Microvascular Perfusion in Patients Undergoing Major Non-Cardiac Surgery. J Clin Med 2022; 11:jcm11123326. [PMID: 35743397 PMCID: PMC9225100 DOI: 10.3390/jcm11123326] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Revised: 06/02/2022] [Accepted: 06/08/2022] [Indexed: 02/04/2023] Open
Abstract
It remains unknown whether chronic systemic inflammation is associated with impaired microvascular perfusion during surgery. We evaluated the association between the preoperative basal inflammatory state, measured by plasma soluble urokinase-type plasminogen activator receptor (suPAR) levels, and intraoperative sublingual microcirculatory variables in patients undergoing major non-cardiac surgery. Plasma suPAR levels were determined in 100 non-cardiac surgery patients using the suPARnostic® quick triage lateral flow assay. We assessed sublingual microcirculation before surgical incision and every 30 min during surgery using Sidestream Darkfield (SDF+) imaging and determined the De Backer score, the Consensus Proportion of Perfused Vessels (Consensus PPV), and the Consensus PPV (small). Elevated suPAR levels were associated with lower intraoperative De Backer score, Consensus PPV, and Consensus PPV (small). For each ng mL−1 increase in suPAR, De Backer score, Consensus PPV, and Consensus PPV (small) decreased by 0.7 mm−1, 2.5%, and 2.8%, respectively, compared to baseline. In contrast, CRP was not significantly correlated with De Backer score (r = −0.034, p = 0.36), Consensus PPV (r = −0.014, p = 0.72) or Consensus PPV Small (r = −0.037, p = 0.32). Postoperative De Backer score did not change significantly from baseline (5.95 ± 3.21 vs. 5.89 ± 3.36, p = 0.404), while postoperative Consensus PPV (83.49 ± 11.5 vs. 81.15 ± 11.8, p < 0.001) and Consensus PPV (small) (80.87 ± 13.4 vs. 78.72 ± 13, p < 0.001) decreased significantly from baseline. In conclusion, elevated preoperative suPAR levels were associated with intraoperative impairment of sublingual microvascular perfusion in patients undergoing elective major non-cardiac surgery.
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Bose R, Singh G, Singh P, Sampath A, Singh R, Patel B, Pakhare AP, Joshi R, Khadanga S. Predictors of Requirement of Inotrope Among Patients With Early Sepsis: Special Reference to Microcirculatory Parameters. Cureus 2022; 14:e24762. [PMID: 35686248 PMCID: PMC9170368 DOI: 10.7759/cureus.24762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/04/2022] [Indexed: 11/05/2022] Open
Abstract
Introduction The management of septic shock and refractory septic shock is essential in preventing sepsis-related death. The handheld vital microscope is a new modality of investigation for sepsis for microcirculatory assessment. This study aimed to identify predictors of inotrope requirements among patients with early sepsis and impending septic shock with particular reference to sublingual microcirculation assessment parameters. Methodology We conducted an observational cross-sectional hospital-based study in central India. The formal sample size was calculated to be 52 patients using a convenient sampling technique. The study was initiated with ethics approval (IHEC-LOP/2019/ MD0090) with consent from the patients. We used the MicroScan (MicroVision Medical, Netherlands) Video Microscope System (No.16A00102) to obtain sidestream dark-field imaging along with the AVA 4.3C software (MicroVision Medical). Results Of 51 cases, 60.8% were women, and 39.2% were men, and the study population had a mean age of 41.0 ± 14.9 years. Patients were recruited from medical wards (64.7%) and emergency departments (35.3%). The most common site of infection was gastrointestinal (33.3%), followed by respiratory infections (25.5%) and genitourinary infections (11.8%). The quick sequential organ failure assessment score was 2.0 ± 0.1. Eight patients required inotropes, and six patients died. High respiratory rates and lactate levels were important predictors of inotrope requirements in patients with early sepsis. Sublingual microcirculatory parameters at baseline did not significantly affect the requirement of inotropes consequently. Conclusions Sublingual microscopy is a suggested tool for the management of sepsis. However, without clearly defined cut-off values, handheld vital microscopy could not predict fluid responsiveness among patients with early sepsis. Also, it would be difficult to incorporate this technology into regular practice without equipment upgrades and image acquisition software.
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Bruno RR, Wernly B, Hornemann J, Flaatten H, FjØlner J, Artigas A, Bollen Pinto B, Schefold JC, Wolff G, Baldia PH, Binneboessel S, Kelm M, Beil M, Sviri S, van Heerden PV, Szczeklik W, Elhadi M, Joannidis M, Oeyen S, Kondili E, Wollborn J, Marsh B, Andersen FH, Moreno R, Leaver S, Boumendil A, De Lange DW, Guidet B, Jung C. Early evaluation of organ failure using MELD-XI in critically ill elderly COVID-19 patients. Clin Hemorheol Microcirc 2021; 79:109-120. [PMID: 34487039 DOI: 10.3233/ch-219202] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSECritically ill elderly patients who suffer from Sars-CoV-2 disease are at high risk for organ failure. The modified MELD-XI score has not been evaluated for outcome prediction in these most vulnerable patients.METHODSThe Corona Virus disease (COVID19) in Very Elderly Intensive Care Patients study (COVIP, NCT04321265) prospectively recruited patients on intensive care units (ICU), who were = 70 years. Data were collected from March 2020 to February 2021. The MELD-XI score was calculated using the highest serum bilirubin and creatinine on ICU admission. Univariate and multivariable logistic regression analyses were performed to assess associations between the MELD-XI score and mortality. The primary outcome was 30-day-mortality, the secondary outcomes were ICU- and 3-month-mortality.RESULTSIn total, data from 2,993 patients were analyzed. Most patients had a MELD-XI <12 on admission (76%). The patients with MELD-XI = 12 had a significantly higher 30-day-, ICU- and 3-month-mortality (44%vs 64%, and 42%vs. 59%, and 57%vs. 76%, p < 0.001). After adjustment for multiple confounders, MELD-XI = 12 remained significantly associated with 30-day- (aOR 1.572, CI 1.268-1.949, p < 0.001), ICU-, and 3-month-mortality.CONCLUSIONIn critically ill elderly intensive care patients with COVID-19, the MELD-XI score constitutes a valuable tool for an early outcome prediction.
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Affiliation(s)
- Raphael Romano Bruno
- Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - Bernhard Wernly
- Department of Department of Anaesthesiology, Perioperative Medicine and Intensive Care Medicine, Paracelsus Medical University, Salzburg, Austria
| | - Johanna Hornemann
- Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - Hans Flaatten
- Department of Clinical Medicine, University of Bergen, Department of Anaestesia and Intensive Care, Haukeland University Hospital, Bergen, Norway
| | - Jesper FjØlner
- Department of Intensive Care, Aarhus University Hospital, Aarhus, Denmark
| | - Antonio Artigas
- Department of Intensive Care Medicine, CIBER Enfermedades Respiratorias, Corporacion Sanitaria Universitaria Parc Tauli, Autonomous University of Barcelona, Sabadell, Spain
| | | | - Joerg C Schefold
- Department of Intensive Care Medicine, Inselspital, Universitätsspital, University of Bern, Bern, Switzerland
| | - Georg Wolff
- Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - Philipp Heinrich Baldia
- Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - Stephan Binneboessel
- Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - Malte Kelm
- Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - Michael Beil
- Department of Medical Intensive Care, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Sigal Sviri
- Department of Medical Intensive Care, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Peter Vernon van Heerden
- General Intensive Care Unit, Dept. of Anesthesiology, Critical Care and Pain Medicine, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Wojciech Szczeklik
- Center for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Krakow, Poland
| | | | - Michael Joannidis
- Division of Intensive Care and Emergency Medicine, Department of Internal Medicine, Medical University Innsbruck, Innsbruck, Austria
| | - Sandra Oeyen
- Department of Intensive Care 1K12IC Ghent University Hospital, Ghent, Belgium
| | - Eumorfia Kondili
- Intensive Care Unit, University Hospital of Heraklion, Heraklion, Greece
| | - Jakob Wollborn
- Department of Anesthesiolgy, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Brian Marsh
- Mater Misericordiae University Hospital, Dublin, Ireland
| | - Finn H Andersen
- Department of Anaesthesia and Intensive Care, Ålesund Hospital, Ålesund, Norway.,Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
| | - Rui Moreno
- Unidade de Cuidados Intensivos Neurocríticos e Trauma. Hospital de São José, Centro Hospitalar Universitário de Lisboa Central, Faculdade de Ciências Médicas de Lisboa, Nova Médical School, Lisbon, Portugal
| | - Susannah Leaver
- General Intensive care, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Ariane Boumendil
- Sorbonne Universités, UPMC Univ Paris, INSERM, UMR S, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Equipe: Épidémiologie Hospitaliére Qualité et Organisation des Soins, Paris, France.,Assistance Publique - Hôpitaux de Paris, Hôpital Saint-Antoine, Service De Réanimation Médicale, Paris, France
| | - Dylan W De Lange
- Department of Intensive Care Medicine, University Medical Center, University Utrecht, Utrecht, The Netherlands
| | - Bertrand Guidet
- Sorbonne Universités, UPMC Univ Paris, INSERM, UMR S, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Equipe: Épidémiologie Hospitaliére Qualité et Organisation des Soins, Paris, France.,Assistance Publique - Hôpitaux de Paris, Hôpital Saint-Antoine, Service De Réanimation Médicale, Paris, France
| | - Christian Jung
- Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
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Pillai S, Davies G, Lawrence M, Whitley J, Stephens J, Williams PR, Morris K, Evans PA. The effect of diabetic ketoacidosis (DKA) and its treatment on clot microstructure: Are they thrombogenic? Clin Hemorheol Microcirc 2021; 77:183-194. [PMID: 32925001 DOI: 10.3233/ch-200957] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Diabetic ketoacidosis (DKA) is a medical emergency with a high mortality rate and is associated with severe metabolic acidosis and dehydration. DKA patients have an increased risk of arterial and venous thromboembolism, however little is known about this metabolic derangement in the first 24 hours of admission and to assess its effect on coagulation. We therefore utilised a novel functional marker of clot microstructure (fractal dimension - df) to assess these changes within the first 24 hours. METHODS Prospective single centre observational study to demonstrate whether the tendency of blood clot formation differs in DKA patients. RESULTS 15 DKA patients and 15 healthy matched controls were recruited. Mean df in the healthy control group was 1.74±0.03. An elevated df of 1.78±0.07 was observed in patients with DKA on admission. The mean pH on admission was 7.14±0.13 and the lactate was 3.6±2.0. df changed significantly in response to standard treatment and was significantly reduced to 1.68±0.09 (2-6& h) and to 1.66±0.08 at 24& h (p < 0.01 One-way ANOVA). df also correlated significantly with lactate and pH (Pearson correlation coefficient 0.479 and -0.675 respectively, p < 0.05). CONCLUSIONS DKA patients at presentation have a densely organising less permeable thrombogenic clot microstructure as evidenced by high df. These structural changes are due to a combination of dehydration and a profound metabolic acidosis, which was reversed with treatment. These changes were not mirrored in standard clinical markers of thromboge-nicity.
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Affiliation(s)
- Suresh Pillai
- Welsh Centre for Emergency Medicine Research, Emergency Department, Morriston Hospital, Swansea, UK.,Morriston Hospital, Swansea, UK.,Swansea University, Swansea, UK
| | - Gareth Davies
- Welsh Centre for Emergency Medicine Research, Emergency Department, Morriston Hospital, Swansea, UK
| | - Matthew Lawrence
- Welsh Centre for Emergency Medicine Research, Emergency Department, Morriston Hospital, Swansea, UK.,Swansea University, Swansea, UK
| | - Janet Whitley
- Welsh Centre for Emergency Medicine Research, Emergency Department, Morriston Hospital, Swansea, UK.,Swansea University, Swansea, UK
| | - Jeffrey Stephens
- Morriston Hospital, Swansea, UK.,Swansea University, Swansea, UK
| | | | | | - Phillip Adrian Evans
- Welsh Centre for Emergency Medicine Research, Emergency Department, Morriston Hospital, Swansea, UK.,Morriston Hospital, Swansea, UK.,Swansea University, Swansea, UK
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