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Reintam Blaser A, Mändul M, Björck M, Acosta S, Bala M, Bodnar Z, Casian D, Demetrashvili Z, D'Oria M, Durán Muñoz-Cruzado V, Forbes A, Fuglseth H, Hellerman Itzhaki M, Hess B, Kase K, Kirov M, Lein K, Lindner M, Loudet CI, Mole DJ, Murruste M, Nuzzo A, Saar S, Scheiterle M, Starkopf J, Talving P, Voomets AL, Voon KKT, Yunus MA, Tamme K. Incidence, diagnosis, management and outcome of acute mesenteric ischaemia: a prospective, multicentre observational study (AMESI Study). Crit Care 2024; 28:32. [PMID: 38263058 PMCID: PMC10807222 DOI: 10.1186/s13054-024-04807-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Accepted: 01/12/2024] [Indexed: 01/25/2024] Open
Abstract
BACKGROUND The aim of this multicentre prospective observational study was to identify the incidence, patient characteristics, diagnostic pathway, management and outcome of acute mesenteric ischaemia (AMI). METHODS All adult patients with clinical suspicion of AMI admitted or transferred to 32 participating hospitals from 06.06.2022 to 05.04.2023 were included. Participants who were subsequently shown not to have AMI or had localized intestinal gangrene due to strangulating bowel obstruction had only baseline and outcome data collected. RESULTS AMI occurred in 0.038% of adult admissions in participating acute care hospitals worldwide. From a total of 705 included patients, 418 patients had confirmed AMI. In 69% AMI was the primary reason for admission, while in 31% AMI occurred after having been admitted with another diagnosis. Median time from onset of symptoms to hospital admission in patients admitted due to AMI was 24 h (interquartile range 9-48h) and time from admission to diagnosis was 6h (1-12 h). Occlusive arterial AMI was diagnosed in 231 (55.3%), venous in 73 (17.5%), non-occlusive (NOMI) in 55 (13.2%), other type in 11 (2.6%) and the subtype could not be classified in 48 (11.5%) patients. Surgery was the initial management in 242 (58%) patients, of which 59 (24.4%) underwent revascularization. Endovascular revascularization alone was carried out in 54 (13%), conservative treatment in 76 (18%) and palliative care in 46 (11%) patients. From patients with occlusive arterial AMI, revascularization was undertaken in 104 (45%), with 40 (38%) of them in one site admitting selected patients. Overall in-hospital and 90-day mortality of AMI was 49% and 53.3%, respectively, and among subtypes was lowest for venous AMI (13.7% and 16.4%) and highest for NOMI (72.7% and 74.5%). There was a high variability between participating sites for most variables studied. CONCLUSIONS The overall incidence of AMI and AMI subtypes varies worldwide, and case ascertainment is challenging. Pre-hospital delay in presentation was greater than delays after arriving at hospital. Surgery without revascularization was the most common management approach. Nearly half of the patients with AMI died during their index hospitalization. Together, these findings suggest a need for greater awareness of AMI, and better guidance in diagnosis and management. TRIAL REGISTRATION NCT05218863 (registered 19.01.2022).
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Affiliation(s)
- Annika Reintam Blaser
- Institute of Clinical Medicine, University of Tartu, Puusepa 8, 50406, Tartu, Estonia.
- Department of Intensive Care Medicine, Lucerne Cantonal Hospital, Lucerne, Switzerland.
| | - Merli Mändul
- Institute of Mathematics and Statistics, University of Tartu, Tartu, Estonia
- Estonian Genome Center, Institute of Genomics, University of Tartu, Tartu, Estonia
| | - Martin Björck
- Institute of Clinical Medicine, University of Tartu, Puusepa 8, 50406, Tartu, Estonia
- Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, Sweden
| | - Stefan Acosta
- Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Miklosh Bala
- Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Zsolt Bodnar
- Letterkenny University Hospital, Letterkenny, Ireland
| | - Dumitru Casian
- University Clinic of Vascular Surgery, "Nicolae Testemitanu" State University of Medicine and Pharmacy of the Republic of Moldova, Chişinău, Moldova
| | | | - Mario D'Oria
- University Hospital of Trieste ASUGI, Trieste, Italy
| | | | - Alastair Forbes
- Institute of Clinical Medicine, University of Tartu, Puusepa 8, 50406, Tartu, Estonia
| | - Hanne Fuglseth
- Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway
| | - Moran Hellerman Itzhaki
- Intensive Care Unit and Institute for Nutrition Research, Rabin Medical Center, University of Tel Aviv, Petah Tikva, Israel
| | - Benjamin Hess
- Department of Intensive Care Medicine, Lucerne Cantonal Hospital, Lucerne, Switzerland
| | - Karri Kase
- Institute of Clinical Medicine, University of Tartu, Puusepa 8, 50406, Tartu, Estonia
- Tartu University Hospital, Puusepa 8, Tartu, Estonia
| | - Mikhail Kirov
- Department of Anesthesiology and Intensive Care Medicine, Northern State Medical University and City Hospital #1, Arkhangelsk, Russia
| | - Kristoffer Lein
- University Hospital North Norway and UiT The Arctic University of Norway, Tromsö, Norway
| | - Matthias Lindner
- Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | | | - Damian J Mole
- Chair of Surgery, University of Edinburgh Centre for Inflammation Research, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Marko Murruste
- Institute of Clinical Medicine, University of Tartu, Puusepa 8, 50406, Tartu, Estonia
- Tartu University Hospital, Puusepa 8, Tartu, Estonia
| | - Alexandre Nuzzo
- Intestinal Stroke Center, Department of Gastroenterology, IBD and Intestinal Failure, AP-HP. Nord, Beaujon Hospital, Paris Cité University, Paris, France
| | - Sten Saar
- Division of Acute Care Surgery, North Estonia Medical Centre, Tallinn, Estonia
| | | | - Joel Starkopf
- Institute of Clinical Medicine, University of Tartu, Puusepa 8, 50406, Tartu, Estonia
- Tartu University Hospital, Puusepa 8, Tartu, Estonia
| | - Peep Talving
- Institute of Clinical Medicine, University of Tartu, Puusepa 8, 50406, Tartu, Estonia
- Division of Acute Care Surgery, North Estonia Medical Centre, Tallinn, Estonia
| | | | | | - Mohammad Alif Yunus
- General Surgeon of General Surgery Department, Hospital Melaka, Malacca, Malaysia
| | - Kadri Tamme
- Institute of Clinical Medicine, University of Tartu, Puusepa 8, 50406, Tartu, Estonia
- Tartu University Hospital, Puusepa 8, Tartu, Estonia
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Marcucci M, Painter TW, Conen D, Lomivorotov V, Sessler DI, Chan MTV, Borges FK, Leslie K, Duceppe E, Martínez-Zapata MJ, Wang CY, Xavier D, Ofori SN, Wang MK, Efremov S, Landoni G, Kleinlugtenbelt YV, Szczeklik W, Schmartz D, Garg AX, Short TG, Wittmann M, Meyhoff CS, Amir M, Torres D, Patel A, Ruetzler K, Parlow JL, Tandon V, Fleischmann E, Polanczyk CA, Lamy A, Jayaram R, Astrakov SV, Wu WKK, Cheong CC, Ayad S, Kirov M, de Nadal M, Likhvantsev VV, Paniagua P, Aguado HJ, Maheshwari K, Whitlock RP, McGillion MH, Vincent J, Copland I, Balasubramanian K, Biccard BM, Srinathan S, Ismoilov S, Pettit S, Stillo D, Kurz A, Belley-Côté EP, Spence J, McIntyre WF, Bangdiwala SI, Guyatt G, Yusuf S, Devereaux PJ. Hypotension-Avoidance Versus Hypertension-Avoidance Strategies in Noncardiac Surgery : An International Randomized Controlled Trial. Ann Intern Med 2023; 176:605-614. [PMID: 37094336 DOI: 10.7326/m22-3157] [Citation(s) in RCA: 21] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/26/2023] Open
Abstract
BACKGROUND Among patients having noncardiac surgery, perioperative hemodynamic abnormalities are associated with vascular complications. Uncertainty remains about what intraoperative blood pressure to target and how to manage long-term antihypertensive medications perioperatively. OBJECTIVE To compare the effects of a hypotension-avoidance and a hypertension-avoidance strategy on major vascular complications after noncardiac surgery. DESIGN Partial factorial randomized trial of 2 perioperative blood pressure management strategies (reported here) and tranexamic acid versus placebo. (ClinicalTrials.gov: NCT03505723). SETTING 110 hospitals in 22 countries. PATIENTS 7490 patients having noncardiac surgery who were at risk for vascular complications and were receiving 1 or more long-term antihypertensive medications. INTERVENTION In the hypotension-avoidance strategy group, the intraoperative mean arterial pressure target was 80 mm Hg or greater; before and for 2 days after surgery, renin-angiotensin-aldosterone system inhibitors were withheld and the other long-term antihypertensive medications were administered only for systolic blood pressures 130 mm Hg or greater, following an algorithm. In the hypertension-avoidance strategy group, the intraoperative mean arterial pressure target was 60 mm Hg or greater; all antihypertensive medications were continued before and after surgery. MEASUREMENTS The primary outcome was a composite of vascular death and nonfatal myocardial injury after noncardiac surgery, stroke, and cardiac arrest at 30 days. Outcome adjudicators were masked to treatment assignment. RESULTS The primary outcome occurred in 520 of 3742 patients (13.9%) in the hypotension-avoidance group and in 524 of 3748 patients (14.0%) in the hypertension-avoidance group (hazard ratio, 0.99 [95% CI, 0.88 to 1.12]; P = 0.92). Results were consistent for patients who used 1 or more than 1 antihypertensive medication in the long term. LIMITATION Adherence to the assigned strategies was suboptimal; however, results were consistent across different adherence levels. CONCLUSION In patients having noncardiac surgery, our hypotension-avoidance and hypertension-avoidance strategies resulted in a similar incidence of major vascular complications. PRIMARY FUNDING SOURCE Canadian Institutes of Health Research, National Health and Medical Research Council (Australia), and Research Grant Council of Hong Kong.
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Affiliation(s)
- Maura Marcucci
- Population Health Research Institute, Hamilton, Ontario, Canada (M.M., D.C., F.K.B., S.N.O., M.K.W., A.L., R.P.W., M.H.M., J.V., I.C., K.B., S.P., D.S., E.P.B., J.S., W.F.M., S.I.B., S.Y., P.J.D.)
| | - Thomas W Painter
- Acute Care Medicine, University of Adelaide, Adelaide, South Australia, Australia (T.W.P.)
| | - David Conen
- Population Health Research Institute, Hamilton, Ontario, Canada (M.M., D.C., F.K.B., S.N.O., M.K.W., A.L., R.P.W., M.H.M., J.V., I.C., K.B., S.P., D.S., E.P.B., J.S., W.F.M., S.I.B., S.Y., P.J.D.)
| | - Vladimir Lomivorotov
- Department of Anesthesiology and Intensive Care, E. Meshalkin National Medical Research Centre, Novosibirsk, Russia (V.L., S.I.)
| | - Daniel I Sessler
- Anesthesiology Institute, Department of Outcomes Research, Cleveland Clinic, Cleveland, Ohio (D.I.S., K.R., S.A., K.M., A.K.)
| | - Matthew T V Chan
- The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China (M.T.V.C., W.K.K.W.)
| | - Flavia K Borges
- Population Health Research Institute, Hamilton, Ontario, Canada (M.M., D.C., F.K.B., S.N.O., M.K.W., A.L., R.P.W., M.H.M., J.V., I.C., K.B., S.P., D.S., E.P.B., J.S., W.F.M., S.I.B., S.Y., P.J.D.)
| | - Kate Leslie
- Department of Critical Care Medicine, Melbourne Medical School, University of Melbourne, Melbourne, Victoria, Australia (K.L.)
| | - Emmanuelle Duceppe
- Department of Medicine, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada (E.D.)
| | - María José Martínez-Zapata
- Iberoamerican Cochrane Centre, Public Health and Clinical Epidemiology Service, IIB Sant Pau, CIBERESP, Barcelona, Spain (M.J.M.)
| | - Chew Yin Wang
- Department of Anesthesiology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia (C.Y.W., C.C.C.)
| | - Denis Xavier
- St. John's Medical College, Bangalore, India (D.X.)
| | - Sandra N Ofori
- Population Health Research Institute, Hamilton, Ontario, Canada (M.M., D.C., F.K.B., S.N.O., M.K.W., A.L., R.P.W., M.H.M., J.V., I.C., K.B., S.P., D.S., E.P.B., J.S., W.F.M., S.I.B., S.Y., P.J.D.)
| | - Michael Ke Wang
- Population Health Research Institute, Hamilton, Ontario, Canada (M.M., D.C., F.K.B., S.N.O., M.K.W., A.L., R.P.W., M.H.M., J.V., I.C., K.B., S.P., D.S., E.P.B., J.S., W.F.M., S.I.B., S.Y., P.J.D.)
| | - Sergey Efremov
- Saint Petersburg State University Hospital, Saint Petersburg, Russia (S.E.)
| | - Giovanni Landoni
- Department of Anesthesiology and Intensive Care, IRCCS San Raffaele Scientific Institute, Vita Salute San Raffaele University, Milan, Italy (G.L.)
| | - Ydo V Kleinlugtenbelt
- Department of Orthopedic and Trauma Surgery, Deventer Ziekenhuis, Deventer, the Netherlands (Y.V.K.)
| | - Wojciech Szczeklik
- Centre for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Krakow, Poland (W.S.)
| | - Denis Schmartz
- CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium (D.S.)
| | - Amit X Garg
- Department of Medicine, Western University, London, Ontario, Canada (A.X.G.)
| | - Timothy G Short
- Department of Anaesthesia, Auckland City Hospital, Auckland, New Zealand (T.G.S.)
| | - Maria Wittmann
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany (M.W.)
| | - Christian S Meyhoff
- Department of Anesthesia and Intensive Care, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark (C.S.M.)
| | - Mohammed Amir
- Department of Surgery, Shifa International Hospital and Shifa Tameer-e-Millat University, Islamabad, Pakistan (M.A.)
| | - David Torres
- Departamento de Epidemiología y Estudios en Salud, Universidad de Los Andes, Santiago, Chile (D.T.)
| | - Ameen Patel
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada (A.P., V.T.)
| | - Kurt Ruetzler
- Anesthesiology Institute, Department of Outcomes Research, Cleveland Clinic, Cleveland, Ohio (D.I.S., K.R., S.A., K.M., A.K.)
| | - Joel L Parlow
- Department of Anesthesiology and Perioperative Medicine, Queen's University, and Kingston Health Sciences Centre, Kingston, Ontario, Canada (J.L.P.)
| | - Vikas Tandon
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada (A.P., V.T.)
| | - Edith Fleischmann
- Department of Anesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Vienna, Austria (E.F.)
| | - Carisi A Polanczyk
- UFRGS, Hospital de Clínicas de Porto Alegre, National Institute for Health Technology Assessment, IATS; Hospital Moinhos de Vento, Porto Alegre, Brazil (C.A.P.)
| | - Andre Lamy
- Population Health Research Institute, Hamilton, Ontario, Canada (M.M., D.C., F.K.B., S.N.O., M.K.W., A.L., R.P.W., M.H.M., J.V., I.C., K.B., S.P., D.S., E.P.B., J.S., W.F.M., S.I.B., S.Y., P.J.D.)
| | - Raja Jayaram
- Department of Anaesthetics, Clinical Neurosciences, University of Oxford, Oxford University Hospitals NHS Trust, Oxford, United Kingdom (R.J.)
| | - Sergey V Astrakov
- Department of Anesthesiology, Novosibirsk State University, Novosibirsk, Russia (S.V.A.)
| | - William Ka Kei Wu
- The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China (M.T.V.C., W.K.K.W.)
| | - Chao Chia Cheong
- Department of Anesthesiology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia (C.Y.W., C.C.C.)
| | - Sabry Ayad
- Anesthesiology Institute, Department of Outcomes Research, Cleveland Clinic, Cleveland, Ohio (D.I.S., K.R., S.A., K.M., A.K.)
| | - Mikhail Kirov
- Department of Anesthesiology and Intensive Care Medicine, Northern State Medical University, Arkhangelsk, Russia (M.K.)
| | - Miriam de Nadal
- Department of Anesthesiology and Intensive Care, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain (M. de N.)
| | | | - Pilar Paniagua
- Anesthesiology Department, Santa Creu i Sant Pau University Hospital, Barcelona, Spain (P.P.)
| | - Hector J Aguado
- Trauma & Orthopaedic Surgery Department, Hospital Clínico Universitario de Valladolid, Valladolid, Spain (H.J.A.)
| | - Kamal Maheshwari
- Anesthesiology Institute, Department of Outcomes Research, Cleveland Clinic, Cleveland, Ohio (D.I.S., K.R., S.A., K.M., A.K.)
| | - Richard P Whitlock
- Population Health Research Institute, Hamilton, Ontario, Canada (M.M., D.C., F.K.B., S.N.O., M.K.W., A.L., R.P.W., M.H.M., J.V., I.C., K.B., S.P., D.S., E.P.B., J.S., W.F.M., S.I.B., S.Y., P.J.D.)
| | - Michael H McGillion
- Population Health Research Institute, Hamilton, Ontario, Canada (M.M., D.C., F.K.B., S.N.O., M.K.W., A.L., R.P.W., M.H.M., J.V., I.C., K.B., S.P., D.S., E.P.B., J.S., W.F.M., S.I.B., S.Y., P.J.D.)
| | - Jessica Vincent
- Population Health Research Institute, Hamilton, Ontario, Canada (M.M., D.C., F.K.B., S.N.O., M.K.W., A.L., R.P.W., M.H.M., J.V., I.C., K.B., S.P., D.S., E.P.B., J.S., W.F.M., S.I.B., S.Y., P.J.D.)
| | - Ingrid Copland
- Population Health Research Institute, Hamilton, Ontario, Canada (M.M., D.C., F.K.B., S.N.O., M.K.W., A.L., R.P.W., M.H.M., J.V., I.C., K.B., S.P., D.S., E.P.B., J.S., W.F.M., S.I.B., S.Y., P.J.D.)
| | - Kumar Balasubramanian
- Population Health Research Institute, Hamilton, Ontario, Canada (M.M., D.C., F.K.B., S.N.O., M.K.W., A.L., R.P.W., M.H.M., J.V., I.C., K.B., S.P., D.S., E.P.B., J.S., W.F.M., S.I.B., S.Y., P.J.D.)
| | - Bruce M Biccard
- Department of Anesthesia and Perioperative Medicine, Groote Schuur Hospital, and University of Cape Town, Cape Town, South Africa (B.M.B.)
| | - Sadeesh Srinathan
- Section of Thoracic Surgery, Department of Surgery, University of Manitoba, Winnipeg, Manitoba, Canada (S.S.)
| | - Samandar Ismoilov
- Department of Anesthesiology and Intensive Care, E. Meshalkin National Medical Research Centre, Novosibirsk, Russia (V.L., S.I.)
| | - Shirley Pettit
- Population Health Research Institute, Hamilton, Ontario, Canada (M.M., D.C., F.K.B., S.N.O., M.K.W., A.L., R.P.W., M.H.M., J.V., I.C., K.B., S.P., D.S., E.P.B., J.S., W.F.M., S.I.B., S.Y., P.J.D.)
| | - David Stillo
- Population Health Research Institute, Hamilton, Ontario, Canada (M.M., D.C., F.K.B., S.N.O., M.K.W., A.L., R.P.W., M.H.M., J.V., I.C., K.B., S.P., D.S., E.P.B., J.S., W.F.M., S.I.B., S.Y., P.J.D.)
| | - Andrea Kurz
- Anesthesiology Institute, Department of Outcomes Research, Cleveland Clinic, Cleveland, Ohio (D.I.S., K.R., S.A., K.M., A.K.)
| | - Emilie P Belley-Côté
- Population Health Research Institute, Hamilton, Ontario, Canada (M.M., D.C., F.K.B., S.N.O., M.K.W., A.L., R.P.W., M.H.M., J.V., I.C., K.B., S.P., D.S., E.P.B., J.S., W.F.M., S.I.B., S.Y., P.J.D.)
| | - Jessica Spence
- Population Health Research Institute, Hamilton, Ontario, Canada (M.M., D.C., F.K.B., S.N.O., M.K.W., A.L., R.P.W., M.H.M., J.V., I.C., K.B., S.P., D.S., E.P.B., J.S., W.F.M., S.I.B., S.Y., P.J.D.)
| | - William F McIntyre
- Population Health Research Institute, Hamilton, Ontario, Canada (M.M., D.C., F.K.B., S.N.O., M.K.W., A.L., R.P.W., M.H.M., J.V., I.C., K.B., S.P., D.S., E.P.B., J.S., W.F.M., S.I.B., S.Y., P.J.D.)
| | - Shrikant I Bangdiwala
- Population Health Research Institute, Hamilton, Ontario, Canada (M.M., D.C., F.K.B., S.N.O., M.K.W., A.L., R.P.W., M.H.M., J.V., I.C., K.B., S.P., D.S., E.P.B., J.S., W.F.M., S.I.B., S.Y., P.J.D.)
| | - Gordon Guyatt
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada (G.G.)
| | - Salim Yusuf
- Population Health Research Institute, Hamilton, Ontario, Canada (M.M., D.C., F.K.B., S.N.O., M.K.W., A.L., R.P.W., M.H.M., J.V., I.C., K.B., S.P., D.S., E.P.B., J.S., W.F.M., S.I.B., S.Y., P.J.D.)
| | - P J Devereaux
- Population Health Research Institute, Hamilton, Ontario, Canada (M.M., D.C., F.K.B., S.N.O., M.K.W., A.L., R.P.W., M.H.M., J.V., I.C., K.B., S.P., D.S., E.P.B., J.S., W.F.M., S.I.B., S.Y., P.J.D.)
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Ilyina Y, Fot E, Kuzkov V, Kirov M. The Glycocalyx Shedding Influences Hemodynamic and Metabolic Response to Fluid Load in Septic Shock. Turk J Anaesthesiol Reanim 2022; 50:94-100. [PMID: 35544247 PMCID: PMC9361336 DOI: 10.5152/tjar.2021.21224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Objective: Sepsis-associated endothelial dysfunction and degradation result in release of inflammatory mediators, compromise endothelial permeability, and impair alveolar fluid clearance leading to pulmonary edema. Excessive fluid therapy in septic shock damage the endothelial glycocalyx which will increase capillary leakage. The aim of our study was to assess the relationship of endothelial glycocalyx shedding with hemodynamic and metabolic response to fluid load in patients with septic shock. Methods: Eighteen adult patients were included in prospective observational study. To predict the response to infusion, we performed fluid load test by using crystalloids 7 mL kg−1 for 10 minutes. The plasma concentrations of endothelial glycocalyx components including heparan sulfate proteoglycan and syndecan 1 were measured at baseline, 2, 24 hours after fluid load test. Results: We observed associations of syndecan 1 with extravascular lung water index (rho = 0.48, P = .04) at baseline and of heparan sulfate proteoglycan with extravascular lung water index (rho = −0.56, P = .03) and pulse pressure variation (rho = 0.53, P = .04) at 24 hours after fluid load test. The plasma concentration of syndecan 1 correlated with lactate at baseline (rho = 0.51, P = .02) and at 24 hours after fluid load test (rho = 0.76, P = .009). At 2 hours after fluid load test, the concentration of syndecan 1 correlated with global end-diastolic volume index (rho= 0.93, P = .001) in normovolemic patients. Conclusions: The shedding of endothelial glycocalyx after fluid load test in septic shock is associated with hemodynamic and metabolic responses and related with the severity of pulmonary edema.
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Affiliation(s)
- Yana Ilyina
- Department of Anaesthesiology and Intensive Care, Northern State Medical University, Arkhangelsk, Russian Federation
- Department of Anesthesiology and Intensive Care, City Hospital # 1, Arkhangelsk, Russian Federation
- Corresponding author: Yana Ilyina, e-mail:
| | - Eugenia Fot
- Department of Anaesthesiology and Intensive Care, Northern State Medical University, Arkhangelsk, Russian Federation
- Department of Anesthesiology and Intensive Care, City Hospital # 1, Arkhangelsk, Russian Federation
| | - Vsevolod Kuzkov
- Department of Anaesthesiology and Intensive Care, Northern State Medical University, Arkhangelsk, Russian Federation
- Department of Anesthesiology and Intensive Care, City Hospital # 1, Arkhangelsk, Russian Federation
| | - Mikhail Kirov
- Department of Anaesthesiology and Intensive Care, Northern State Medical University, Arkhangelsk, Russian Federation
- Department of Anesthesiology and Intensive Care, City Hospital # 1, Arkhangelsk, Russian Federation
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Marcucci M, Painter TW, Conen D, Leslie K, Lomivorotov VV, Sessler D, Chan MTV, Borges FK, Martínez Zapata MJ, Wang CY, Xavier D, Ofori SN, Landoni G, Efremov S, Kleinlugtenbelt YV, Szczeklik W, Schmartz D, Garg AX, Short TG, Wittmann M, Meyhoff CS, Amir M, Torres D, Patel A, Duceppe E, Ruetzler K, Parlow JL, Tandon V, Wang MK, Fleischmann E, Polanczyk CA, Jayaram R, Astrakov SV, Rao M, VanHelder T, Wu WKK, Cheong CC, Ayad S, Abubakirov M, Kirov M, Bhatt K, de Nadal M, Likhvantsev V, Iglesisas PP, Aguado HJ, McGillion M, Lamy A, Whitlock RP, Roshanov P, Stillo D, Copland I, Vincent J, Balasubramanian K, Bangdiwala SI, Biccard B, Kurz A, Srinathan S, Petit S, Eikelboom J, Richards T, Gross PL, Alfonsi P, Guyatt G, Belley-Cote E, Spence J, McIntyre W, Yusuf S, Devereaux PJ. Rationale and design of the PeriOperative ISchemic Evaluation-3 (POISE-3): a randomized controlled trial evaluating tranexamic acid and a strategy to minimize hypotension in noncardiac surgery. Trials 2022; 23:101. [PMID: 35101083 PMCID: PMC8805242 DOI: 10.1186/s13063-021-05992-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 12/29/2021] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
For patients undergoing noncardiac surgery, bleeding and hypotension are frequent and associated with increased mortality and cardiovascular complications. Tranexamic acid (TXA) is an antifibrinolytic agent with the potential to reduce surgical bleeding; however, there is uncertainty about its efficacy and safety in noncardiac surgery. Although usual perioperative care is commonly consistent with a hypertension-avoidance strategy (i.e., most patients continue their antihypertensive medications throughout the perioperative period and intraoperative mean arterial pressures of 60 mmHg are commonly accepted), a hypotension-avoidance strategy may improve perioperative outcomes.
Methods
The PeriOperative Ischemic Evaluation (POISE)-3 Trial is a large international randomized controlled trial designed to determine if TXA is superior to placebo for the composite outcome of life-threatening, major, and critical organ bleeding, and non-inferior to placebo for the occurrence of major arterial and venous thrombotic events, at 30 days after randomization. Using a partial factorial design, POISE-3 will additionally determine the effect of a hypotension-avoidance strategy versus a hypertension-avoidance strategy on the risk of major cardiovascular events, at 30 days after randomization. The target sample size is 10,000 participants. Patients ≥45 years of age undergoing noncardiac surgery, with or at risk of cardiovascular and bleeding complications, are randomized to receive a TXA 1 g intravenous bolus or matching placebo at the start and at the end of surgery. Patients, health care providers, data collectors, outcome adjudicators, and investigators are blinded to the treatment allocation. Patients on ≥ 1 chronic antihypertensive medication are also randomized to either of the two blood pressure management strategies, which differ in the management of patient antihypertensive medications on the morning of surgery and on the first 2 days after surgery, and in the target mean arterial pressure during surgery. Outcome adjudicators are blinded to the blood pressure treatment allocation. Patients are followed up at 30 days and 1 year after randomization.
Discussion
Bleeding and hypotension in noncardiac surgery are common and have a substantial impact on patient prognosis. The POISE-3 trial will evaluate two interventions to determine their impact on bleeding, cardiovascular complications, and mortality.
Trial registration
ClinicalTrials.gov NCT03505723. Registered on 23 April 2018.
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Garg AX, Cuerden M, Aguado H, Amir M, Belley-Cote EP, Bhatt K, Biccard BM, Borges FK, Chan M, Conen D, Duceppe E, Efremov S, Eikelboom J, Fleischmann E, Giovanni L, Gross P, Jayaram R, Kirov M, Kleinlugtenbelt Y, Kurz A, Lamy A, Leslie K, Likhvantsev V, Lomivorotov V, Marcucci M, Martínez-Zapata MJ, McGillion M, McIntyre W, Meyhoff C, Ofori S, Painter T, Paniagua P, Parikh C, Parlow J, Patel A, Polanczyk C, Richards T, Roshanov P, Schmartz D, Sessler D, Short T, Sontrop JM, Spence J, Srinathan S, Stillo D, Szczeklik W, Tandon V, Torres D, Van Helder T, Vincent J, Wang CY, Wang M, Whitlock R, Wittmann M, Xavier D, Devereaux PJ. Effect of a Perioperative Hypotension-Avoidance Strategy Versus a Hypertension-Avoidance Strategy on the Risk of Acute Kidney Injury: A Clinical Research Protocol for a Substudy of the POISE-3 Randomized Clinical Trial. Can J Kidney Health Dis 2022; 9:20543581211069225. [PMID: 35024154 PMCID: PMC8744204 DOI: 10.1177/20543581211069225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 11/30/2021] [Indexed: 11/24/2022] Open
Abstract
Background: Most patients who take antihypertensive medications continue taking them on
the morning of surgery and during the perioperative period. However, growing
evidence suggests this practice may contribute to perioperative hypotension
and a higher risk of complications. This protocol describes an acute kidney
injury substudy of the Perioperative Ischemic Evaluation-3 (POISE-3) trial,
which is testing the effect of a perioperative hypotension-avoidance
strategy versus a hypertension-avoidance strategy in patients undergoing
noncardiac surgery. Objective: To conduct a substudy of POISE-3 to determine whether a perioperative
hypotension-avoidance strategy reduces the risk of acute kidney injury
compared with a hypertension-avoidance strategy. Design: Randomized clinical trial with 1:1 randomization to the intervention (a
perioperative hypotension-avoidance strategy) or control (a
hypertension-avoidance strategy). Intervention: If the presurgery systolic blood pressure (SBP) is <130 mmHg, all
antihypertensive medications are withheld on the morning of surgery. If the
SBP is ≥130 mmHg, some medications (but not angiotensin receptor blockers
[ACEIs], angiotensin receptor blockers [ARBs], or renin inhibitors) may be
continued in a stepwise manner. During surgery, the patients’ mean arterial
pressure (MAP) is maintained at ≥80 mmHg. During the first 48 hours after
surgery, some antihypertensive medications (but not ACEIs, ARBs, or renin
inhibitors) may be restarted in a stepwise manner if the SBP is ≥130
mmHg. Control: Patients receive their usual antihypertensive medications before and after
surgery. The patients’ MAP is maintained at ≥60 mmHg from anesthetic
induction until the end of surgery. Setting: Recruitment from 108 centers in 22 countries from 2018 to 2021. Patients: Patients (~6800) aged ≥45 years having noncardiac surgery who have or are at
risk of atherosclerotic disease and who routinely take antihypertensive
medications. Measurements: The primary outcome of the substudy is postoperative acute kidney injury,
defined as an increase in serum creatinine concentration of either ≥26.5
μmol/L (≥0.3 mg/dL) within 48 hours of randomization or ≥50% within 7 days
of randomization. Methods: The primary analysis (intention-to-treat) will examine the relative risk and
95% confidence interval of acute kidney injury in the intervention versus
control group. We will repeat the primary analysis using alternative
definitions of acute kidney injury and examine effect modification by
preexisting chronic kidney disease, defined as a prerandomization estimated
glomerular filtration rate <60 mL/min/1.73 m2. Results: Substudy results will be analyzed in 2022. Limitations: It is not possible to mask patients or providers to the intervention;
however, objective measures will be used to assess acute kidney injury. Conclusions: This substudy will provide generalizable estimates of the effect of a
perioperative hypotension-avoidance strategy on the risk of acute kidney
injury.
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Affiliation(s)
| | | | | | - Mohammed Amir
- Shifa International Hospital (STMU), Islamabad, Pakistan
| | | | - Keyur Bhatt
- SIDS Hospital & Research Centre, Guntur, India
| | | | | | - Matthew Chan
- The Chinese University of Hong Kong, Shatin, Hong Kong
| | - David Conen
- Population Health Research Institute, Hamilton, ON, Canada
| | | | | | | | | | | | | | | | - Mikhail Kirov
- Northern State Medical University of the Ministry of Healthcare of the Russian Federation, Arkhangelsk, Russia
| | | | | | - Andre Lamy
- Population Health Research Institute, Hamilton, ON, Canada
| | | | | | | | | | | | | | | | | | - Sandra Ofori
- Population Health Research Institute, Hamilton, ON, Canada
| | | | | | | | | | | | | | - Toby Richards
- The University of Western Australia, Perth, Australia
| | | | | | | | - Tim Short
- Auckland District Health Board, New Zealand
| | | | | | | | - David Stillo
- Population Health Research Institute, Hamilton, ON, Canada
| | | | | | | | | | | | - C Y Wang
- University of Malaya, Kuala Lumpur, Malaysia
| | | | | | | | - Denis Xavier
- St. John's National Academy of Health Sciences, Bangalore, India
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Korehova M, Kirov M, Novikova I, Soloviev A, Golubeva E. Features of Anesthesiologists-Reanimatologists’ Emotional States in Different COVID-19 Pandemic Periods in Russia. EJMH 2022. [DOI: 10.5708/ejmh.17.2022.2.9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Introduction: The COVID-19 pandemic is one of the most stressful events in recent times. Medical professionals, including anesthesiologists-reanimatologists, suffered the main blow in this difficult and stressful environment. Aims: This study aimed at identifying the features of anesthesiologists-reanimatologists’ emotional states in different COVID-19 pandemic periods. Methods: The study was conducted through an anonymous questionnaire among anesthesiologists-reanimatologists in two periods. In the First stage – which was carried out in May 2020 (during the first COVID-19 pan¬demic wave) – 58 anesthesiologists-reanimatologists in the Arkhangelsk region took part. During the Second segment – which took place in October 2020 (in the second COVID-19 pandemic wave) – 43 anesthesiologists-reanimatologists were examined. Repeated questioning was carried out among the same participants. Results: In October 2020, compared to May, the number of doctors who noted a high intensity of professional activity increased. Regardless of the study period, one-third of the subjects experienced constant pronounced anxiety. Anesthesiologists-reanimatologists, whose professional activity was directly related to the patients in COVID-19 care, noted a poorer emo¬tional state more frequently in October, accompanied by anxiety, depressed mood, irritability and a high burnout level, which may indicate a depletion of internal resources in this group. Conclusions: The study results showed that for anesthesiologists-reanimatologists, a further depletion of emotional resources accompanied the second pandemic wave. The anesthesiologists-reanimatologists’ emotional state was mediated by a number of social and gender factors, as well as specific labor organization features.
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Regli A, Reintam Blaser A, De Keulenaer B, Starkopf J, Kimball E, Malbrain MLNG, Van Heerden PV, Davis WA, Palermo A, Dabrowski W, Siwicka-Gieroba D, Barud M, Grigoras I, Ristescu AI, Blejusca A, Tamme K, Maddison L, Kirsimägi Ü, Litvin A, Kazlova A, Filatau A, Pracca F, Sosa G, Santos MD, Kirov M, Smetkin A, Ilyina Y, Gilsdorf D, Ordoñez CA, Caicedo Y, Greiffenstein P, Morgan MM, Bodnar Z, Tidrenczel E, Oliveira G, Albuquerque A, Pereira BM. Intra-abdominal hypertension and hypoxic respiratory failure together predict adverse outcome - A sub-analysis of a prospective cohort. J Crit Care 2021; 64:165-172. [PMID: 33906106 DOI: 10.1016/j.jcrc.2021.04.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 04/14/2021] [Accepted: 04/14/2021] [Indexed: 12/23/2022]
Abstract
PURPOSE To assess whether the combination of intra-abdominal hypertension (IAH, intra-abdominal pressure ≥ 12 mmHg) and hypoxic respiratory failure (HRF, PaO2/FiO2 ratio < 300 mmHg) in patients receiving invasive ventilation is an independent risk factor for 90- and 28-day mortality as well as ICU- and ventilation-free days. METHODS Mechanically ventilated patients who had blood gas analyses performed and intra-abdominal pressure measured, were included from a prospective cohort. Subgroups were defined by the absence (Group 1) or the presence of either IAH (Group 2) or HRF (Group 3) or both (Group 4). Mixed-effects regression analysis was performed. RESULTS Ninety-day mortality increased from 16% (Group 1, n = 50) to 30% (Group 2, n = 20) and 27% (Group 3, n = 100) to 49% (Group 4, n = 142), log-rank test p < 0.001. The combination of IAH and HRF was associated with increased 90- and 28-day mortality as well as with fewer ICU- and ventilation-free days. The association with 90-day mortality was no longer present after adjustment for independent variables. However, the association with 28-day mortality, ICU- and ventilation-free days persisted after adjusting for independent variables. CONCLUSIONS In our sub-analysis, the combination of IAH and HRF was not independently associated with 90-day mortality but independently increased the odds of 28-day mortality, and reduced the number of ICU- and ventilation-free days.
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Affiliation(s)
- Adrian Regli
- Department of Intensive Care, Fiona Stanley Hospital, Perth, WA, Australia; Medical School, The Notre Dame University, Fremantle, WA, Australia; Medical School, The University of Western Australia, Perth, WA, Australia.
| | - Annika Reintam Blaser
- Department of Anaesthesiology and Intensive Care, University of Tartu, Tartu, Estonia; Department of Intensive Care Medicine, Lucerne Cantonal Hospital, Lucerne, Switzerland
| | - Bart De Keulenaer
- Department of Intensive Care, Fiona Stanley Hospital, Perth, WA, Australia; School of Surgery, The University of Western Australia, Perth, WA, Australia
| | - Joel Starkopf
- Department of Anaesthesiology and Intensive Care, University of Tartu, Tartu, Estonia; Department of Anaesthesiology and Intensive Care, Tartu University Hospital, Tartu, Estonia
| | - Edward Kimball
- Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT, United States
| | - Manu L N G Malbrain
- Faculty of Engineering, Department of Electronics and Informatics (ETRO), Vrije Universiteit Brussel (VUB), Brussels, Belgium; International Fluid Academy, Lovenjoel, Belgium
| | | | - Wendy A Davis
- Medical School, The University of Western Australia, Perth, WA, Australia
| | | | - Annamaria Palermo
- Department of Intensive Care, Fiona Stanley Hospital, Perth, WA, Australia
| | - Wojciech Dabrowski
- First Department of Anaesthesiology and Intensive Care, Medical University of Lublin, Lublin, Poland
| | - Dorota Siwicka-Gieroba
- First Department of Anaesthesiology and Intensive Care, Medical University of Lublin, Lublin, Poland
| | - Malgorzata Barud
- First Department of Anaesthesiology and Intensive Care, Medical University of Lublin, Lublin, Poland
| | - Ioana Grigoras
- Grigore T. Popa, University of Medicine and Pharmacy, Iasi, Romania; Regional Institute of Oncology, Iasi, Romania
| | - Anca Irina Ristescu
- Grigore T. Popa, University of Medicine and Pharmacy, Iasi, Romania; Regional Institute of Oncology, Iasi, Romania
| | | | - Kadri Tamme
- Department of Anaesthesiology and Intensive Care, University of Tartu, Tartu, Estonia; Department of Anaesthesiology and Intensive Care, Tartu University Hospital, Tartu, Estonia
| | - Liivi Maddison
- Department of Anaesthesiology and Intensive Care, Tartu University Hospital, Tartu, Estonia
| | - Ülle Kirsimägi
- Department of Surgery, Tartu University Hospital, Tartu, Estonia
| | - Andrey Litvin
- Department of Surgical Disciplines, Immanuel Kant Baltic Federal University, Regional Clinical Hospital, Kaliningrad, Russia
| | - Anastasiya Kazlova
- Department of Intensive Care Medicine, Regional Clinical Hospital, Gomel, Belarus
| | - Aliaksandr Filatau
- Department of Intensive Care Medicine, Regional Clinical Hospital, Gomel, Belarus
| | - Francisco Pracca
- Department of Intensive Care Unit, Clinics University Hospital, UDELAR, Montevideo, Uruguay
| | - Gustavo Sosa
- Department of Intensive Care Unit, Clinics University Hospital, UDELAR, Montevideo, Uruguay
| | - Maicol Dos Santos
- Department of Intensive Care Unit, Clinics University Hospital, UDELAR, Montevideo, Uruguay
| | - Mikhail Kirov
- Department of Anesthesiology and Intensive Care Medicine, Northern State Medical University, Arkhangelsk, Russia
| | - Alexey Smetkin
- Department of Anesthesiology and Intensive Care Medicine, Northern State Medical University, Arkhangelsk, Russia
| | - Yana Ilyina
- Department of Anesthesiology and Intensive Care Medicine, Northern State Medical University, Arkhangelsk, Russia
| | - Daniel Gilsdorf
- Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT, United States
| | - Carlos A Ordoñez
- Division of Trauma and Acute Care Surgery, Department of Surgery, Fundación Valle del Lili - Universidad del Valle, Cali, Colombia
| | - Yaset Caicedo
- Centro de Investigaciones Clínicas (CIC), Fundacion Valle del Lili, Cali, Colombia
| | | | - Margaret M Morgan
- Louisiana State University Health Sciences Center, New Orleans, United States; UC Health Memorial Hospital Central, Colorado Springs, California, United States
| | - Zsolt Bodnar
- University Hospital of Torrevieja, Torrevieja, Spain; Letterkenny University Hospital, Letterkenny, Ireland
| | - Edit Tidrenczel
- University Hospital of Torrevieja, Torrevieja, Spain; Killybegs Family Health Centre, Killybegs, Ireland
| | - Gina Oliveira
- Polyvalent Intensive Care Unit, Hospitalar Center Tondela-Viseu, Tondela-Viseu, Portugal
| | - Ana Albuquerque
- Polyvalent Intensive Care Unit, Hospitalar Center Tondela-Viseu, Tondela-Viseu, Portugal
| | - Bruno M Pereira
- Postgraduate and Research Division, Masters Program in Health Applied Sciences, Vassouras University, Vassouras, RJ, Brazil; Grupo Surgical, Campinas, SP, Brazil; Terzius Institute of Education, Campinas, SP, Brazil
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8
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Sakka SG, Tagami T, Kirov M, Perel A. Letter to: acute respiratory distress syndrome in traumatic brain injury: how do we manage it? J Thorac Dis 2018; 10:E221-E223. [PMID: 29708169 DOI: 10.21037/jtd.2018.02.45] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Samir G Sakka
- Department of Anesthesiology and Operative Intensive Care Medicine, University of Witten/Herdecke, Cologne Merheim Medical Center, Cologne, Germany
| | - Takashi Tagami
- Department of Emergency and Critical Care Medicine, Nippon Medical School Tama Nagayama Hospital, Tokyo, Japan.,Health Services and Systems Research, Duke-NUS Medical School, Singapore
| | - Mikhail Kirov
- Department of Anesthesiology and Intensive Care Medicine, Northern State Medical University, Arkhangelsk, Russia
| | - Azriel Perel
- Department of Anesthesiology and Intensive Care, Sheba Medical Center, Tel Aviv University, Tel Aviv, Israel
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Perel A, Saugel B, Teboul JL, Malbrain MLNG, Belda FJ, Fernández-Mondéjar E, Kirov M, Wendon J, Lussmann R, Maggiorini M. The effects of advanced monitoring on hemodynamic management in critically ill patients: a pre and post questionnaire study. J Clin Monit Comput 2015; 30:511-8. [DOI: 10.1007/s10877-015-9811-7] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Accepted: 11/26/2015] [Indexed: 11/28/2022]
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11
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Huber W, Minning A, Sakka S, Monnet X, Kirov M, Fernández Mondejar E, Wendon J, Maggiorini M, Putensen C, Belda J, Faltlhauser A, Eyer F, Polderman K. Is magnetic resonance imaging (MRI) feasible with an indwelling transpulmonary thermodilution catheter: data from an observational analysis and from a survey. Intensive Care Med Exp 2015. [PMCID: PMC4796144 DOI: 10.1186/2197-425x-3-s1-a612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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12
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Belda FJ, Aguilar G, Teboul JL, Pestaña D, Redondo FJ, Malbrain M, Luis JC, Ramasco F, Umgelter A, Wendon J, Kirov M, Fernández-Mondéjar E. Complications related to less-invasive haemodynamic monitoring. Br J Anaesth 2010; 106:482-6. [PMID: 21205627 DOI: 10.1093/bja/aeq377] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND The aim of this study was to evaluate the type and incidence of complications during insertion, maintenance, and withdrawal of central arterial catheters used for transpulmonary thermodilution haemodynamic monitoring (PiCCO™). METHODS We conducted a prospective, observational, multicentre study in 14 European intensive care units (six countries). A total of 514 consecutive patients in whom haemodynamic monitoring by PiCCO™ was indicated were studied. RESULTS Five hundred and fourteen PiCCO catheters (475 in femoral, 26 in radial, nine in axillary, and four in brachial arteries) were inserted. Arterial access was obtained on the first attempt in 86.4% of the patients. Minor problems such as oozing after insertion (3.3%) or removal of the catheter (3.5%) were observed, but no episodes of serious bleeding (more than 50 ml) were recorded. Small local haematomas were observed after insertion (4.5%) and after removal (1.2%) of the catheter. These complications were not more frequent in patients with coagulation abnormalities. The incidence of site inflammation and catheter-related infection was 2% and 0.78%, respectively. Other complications such as ischaemia (0.4%), pulse loss (0.4%), or femoral artery thrombosis (0.2%) were rare, transient, and all resolved with catheter removal or embolectomy, respectively. CONCLUSIONS In this series of patients, central arterial catheters used for PiCCO™ monitoring were demonstrated to be a safe alternative for advanced haemodynamic monitoring.
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Affiliation(s)
- F J Belda
- Anesthesiology and Intensive Care Department, Hospital Clínico Universitario de Valencia, Valencia, Spain.
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Perel A, Maggiorini M, Malbrain M, Teboul JL, Belda J, Mond�jar EF, Kirov M, Wendon J. Optimal hemodynamic management according to the Surviving Sepsis Guidelines is not applicable to all ICU patients. Crit Care 2008. [PMCID: PMC4088769 DOI: 10.1186/cc6619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Perel A, Maggiorini M, Malbrain M, Teboul J, Belda J, Mondéjar EF, Kirov M, Wendon J. Change of therapeutic plan following advanced cardiopulmonary monitoring in critically ill patients: a multicenter study. Crit Care 2007. [PMCID: PMC4095338 DOI: 10.1186/cc5445] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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15
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Perel A, Maggiorini M, Malbrain M, Teboul J, Belda J, Mondéjar EF, Kirov M, Wendon J. Clinicians' prediction of advanced cardiopulmonary variables in critically ill patients: a multicenter study. Crit Care 2007. [PMCID: PMC4095337 DOI: 10.1186/cc5444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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16
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Kuklin V, Kirov M, Sovershaev M, Andreasen T, Ingebretsen OC, Ytrehus K, Bjertnaes L. Tezosentan-induced attenuation of lung injury in endotoxemic sheep is associated with reduced activation of protein kinase C. Crit Care 2005; 9:R211-7. [PMID: 15987392 PMCID: PMC1175881 DOI: 10.1186/cc3497] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/24/2004] [Revised: 01/27/2005] [Accepted: 02/16/2005] [Indexed: 11/10/2022]
Abstract
INTRODUCTION Studies in vitro reveal that endothelin-1 (ET-1) activates the alpha isoform of protein kinase C (PKC-alpha) in cultures of endothelial cells, thereby deranging cellular integrity. Sepsis and endotoxemia are associated with increased plasma concentrations of ET-1 that induce acute lung injury (ALI). We recently reported that non-selective ET-1 receptor blockade attenuates ALI in sheep by reducing the endotoxin-induced increase in extravascular lung water index (EVLWI). The aim of this study was to find out whether this attenuation is associated with reduced translocation of PKC-alpha from the cytosolic to the membrane fraction of lung tissue homogenate. METHODS Seventeen awake, instrumented sheep were randomly assigned to a sham-operated group (n = 3), a lipopolysaccharide (LPS) group (n = 7) receiving an intravenous infusion of Escherichia coli 15 ng/kg per min for 24 hours, and a tezosentan group (n = 7) subjected to LPS and, from 4 hours, an intravenous injection of tezosentan 3 mg/kg followed by infusion at 1 mg/kg per hour for the reminder of the experiment. Pulmonary micro-occlusion pressure (Pmo), EVLWI, plasma concentrations of ET-1, tumor necrosis factor-a (TNF-a), and interleukin-8 (IL-8) were determined every 4 hours. Western blotting was used to assess PKC-alpha. RESULTS In non-treated sheep a positive correlation was found between the plasma concentration of ET-1 and Pmo in the late phase of endotoxemia (12 to 24 hours). A positive correlation was also noticed between Pmo and EVLWI in the LPS and the LPS plus tezosentan groups, although the latter was significantly reduced in comparison with LPS alone. In both endotoxemic groups, plasma concentrations of ET-1, TNF-alpha, and IL-8 increased. In the LPS group, the cytosolic fraction of PKC-alpha decreased by 75% whereas the membrane fraction increased by 40% in comparison with the sham-operated animals. Tezosentan completely prevented the changes in PKC-alpha in both the cytosolic and the membrane fractions, concomitantly causing a further increase in the plasma concentrations of ET-1, TNF-alpha, and IL-8. CONCLUSION In endotoxemic sheep, ET-1 receptor blockade alleviates lung injury as assessed by a decrease in EVLWI paralleled by a reduction in Pmo and the prevention of activation of PKC-alpha.
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Affiliation(s)
- Vladimir Kuklin
- Research Fellow, Department of Anesthesiology, Faculty of Medicine, University of Tromsø, Norway
| | - Mikhail Kirov
- Research Fellow, Department of Anesthesiology, Faculty of Medicine, University of Tromsø, Norway
| | - Mikhail Sovershaev
- Research Fellow, Department of Physiology, Faculty of Medicine, University of Tromsø, Norway
| | - Thomas Andreasen
- Departmental engineer, Department of Physiology, Faculty of Medicine, University of Tromsø, Norway
| | - Ole C Ingebretsen
- Professor, Department of Clinical Chemistry, University Hospital of Tromsø, Norway
| | - Kirsti Ytrehus
- Professor, Department of Physiology, Faculty of Medicine, University of Tromsø, Norway
| | - Lars Bjertnaes
- Professor, Chairman of the Department of Anesthesiology, Faculty of Medicine, University of Tromsø, Norway
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Borisov D, Kirov M, Kuzkov V, Uvarov D, Nedashkovsky E. Crit Care 2005; 9:P224. [DOI: 10.1186/cc3287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Gatev S, Kirov M, Gigov K, Matveeva R, Mitseva R. [Clinical and experimental research on a massage cream in physiotherapeutic practice]. Vopr Kurortol Fizioter Lech Fiz Kult 1991:39-41. [PMID: 1887623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
New Bulgarian preparations from mioton series (A, B and C) have of late attracted the attention of clinicians. Of a special interest for physiotherapists is mioton B. Broad-scale clinical and experimental trials (41 patients and 75 animals) demonstrated high clinical efficacy of the cream mioton B (Extr. caps. spis. 1.01% 01. bergamotae u ol. lavandulae) induced by ultraphonophoresis. No side effects were registered.
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Svrakov D, Nikolov S, Kirov M. [Ways of lowering toxicity of novocaine-adrenaline solutions in infiltration anesthesia]. Farmatsiia 1971; 20:53-7. [PMID: 5093357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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20
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Bachev S, Kirov M. [Results of experimental and clinical use of vulnuzan in wound treatment]. Khirurgiia (Mosk) 1971; 47:67-70. [PMID: 5576374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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