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Pubblicazioni recenti - cardiopulmonary
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Basic Life Support: an accessible tool in layperson training.
Rev Assoc Med Bras (1992)2019 ;65(10):1300-1307. doi: S0104-42302019001001300.
Bonizzio Carolina Reis, Nagao Christopher K, Polho Gabriel B, Paes Vitor R,
Abstract
OBJECTIVES:
1) To evaluate the efficiency of a new method of training laypeople on cardiopulmonary resuscitation (CPR). 2) To assess previous knowledge of the participants.
METHODS:
Instructors were trained according to the 2015 American Heart Association Guidelines, with emphasis on CPR. Dummies made with PET bottles were used, and a questionnaire was applied to the participants before and after training. Statistical analysis was performed in the R commander program. Participants with incomplete documents were excluded from the study.
RESULTS:
Out of 101 participants, 96 were included: 69 lay people, 17 health professionals, and ten health students. There was an improvement in the overall performance after training (mean pre: 62.7%, mean post: 75.8%, p <0.01), also present in the following main concepts: "mouth-to-mouth breathing is not necessary" (p <0.01), "risk of contamination" (p <0.01), "compression technique" (p <0.01). The concepts "recognition of severity" and "what is chest compression" did not improve, but had good pre-test means, 96.8% and 81.2%. There was no statistical difference in the knowledge between the groups (laypeople vs. health professionals and students, pre=0,06 e post=0,33).
CONCLUSION:
The tools used in training were efficient. However, further studies are necessary to assess the long-term impact of this intervention.
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Measuring cardiopulmonary complications of carfilzomib treatment and associated risk factors using the SEER-Medicare database.
Cancer2019 Nov;():. doi: 10.1002/cncr.32601.
Fakhri Bita, Fiala Mark A, Shah Nina, Vij Ravi, Wildes Tanya M,
Abstract
BACKGROUND:
Carfilzomib improves survival in patients with recurrent myeloma. Given the strict eligibility criteria in clinical trials, the actual frequency of cardiac adverse events (CAEs) and pulmonary adverse events (PAEs) and the risk factors associated with these AEs in the general population need to be established.
METHODS:
The authors extracted myeloma cases in the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database from 2000 through 2013 and corresponding claims through 2014. They then identified patients who received carfilzomib during their disease course. Subsequently, the International Classification of Diseases, Ninth Revision (ICD-9) was used to identify all the codes for CAEs, PAEs, and respiratory infections associated with carfilzomib use. Preexisting diagnoses corresponding to the CAEs and PAEs of interest were excluded to distinguish toxicity from comorbidity. Multivariate Cox regression was performed to determine those variables independently associated with the development of CAEs and PAEs.
RESULTS:
Of the 635 patients analyzed, the median age was 72 years (range, 36-94 years); 55% of the patients were male and 79% were white. The median duration of carfilzomib treatment was 58 days (range, 1-716 days). Overall, approximately 66% of the patients had codes for either CAEs or PAEs. In terms of CAEs, approximately 22% of patients developed hypertension, 15% developed peripheral edema, and 14% experienced heart failure. With regard to PAEs, approximately 28% of patients developed dyspnea, 15% developed cough, and 15% developed pneumonia. Only chronic obstructive pulmonary disease (COPD) was found to be independently associated with the development of CAEs. Patients with preexisting COPD were found to have a 40% increase in their hazard of developing CAEs (adjusted hazard ratio, 1.40; 95% CI, 1.03-1.90).
CONCLUSIONS:
In older adults with myeloma who are undergoing treatment with carfilzomib, new cardiac and pulmonary diagnoses were common. Patients with preexisting COPD were found to be at an increased risk of developing CAEs.
© 2019 American Cancer Society.
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Prognostic value of the preoperative prognostic nutritional index in oldest-old patients with colorectal cancer.
Surg Today2019 Nov;():. doi: 10.1007/s00595-019-01910-w.
Tominaga Tetsuro, Nonaka Takashi, Hisanaga Makoto, Fukuda Akiko, Tanoue Yukinori, Yoshimoto Takafumi, Hidaka Shigekazu, Sawai Terumitsu, Nagayasu Takeshi,
Abstract
BACKGROUND:
The prognostic nutritional index (PNI), which is calculated using serum albumin and the peripheral lymphocyte count, is a simple and useful score for predicting the prognosis in patients with various cancers. The correlation between the preoperative PNI and long-term outcomes is unclear in oldest-old patients with colorectal cancer.
METHODS:
A total of 84 consecutive patients???85 years old who underwent resection for primary colon adenocarcinoma at our institution between April 2008 and March 2017 were retrospectively reviewed. The cut-off value of the PNI for predicting the relapse-free survival (RFS) was 42.4 on a receiver operating characteristic curve analysis. The clinical characteristics and markers of systemic inflammation were then compared between patients with a low PNI (PNI?
RESULTS:
A low PNI was associated with systemic inflammation marker levels, including a low neutrophil-to-lymphocyte ratio (p?=?0.048), a low platelet-to-lymphocyte ratio (p?=?0.006), and a high lymphocyte-to-monocyte ratio (p?
CONCLUSIONS:
A low-preoperative PNI was significantly associated with a poor prognosis in oldest-old colorectal cancer patients. Perioperative nutritional support may be important for prolonging the survival.
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Comparison of targeted next-generation sequencing for whole-genome sequencing of Hantaan orthohantavirus in Apodemus agrarius lung tissues.
Sci Rep2019 Nov;9(1):16631. doi: 10.1038/s41598-019-53043-2.
No Jin Sun, Kim Won-Keun, Cho Seungchan, Lee Seung-Ho, Kim Jeong-Ah, Lee Daesang, Song Dong Hyun, Gu Se Hun, Jeong Seong Tae, Wiley Michael R, Palacios Gustavo, Song Jin-Won,
Abstract
Orthohantaviruses, negative-sense single-strand tripartite RNA viruses, are a global public health threat. In humans, orthohantavirus infection causes hemorrhagic fever with renal syndrome or hantavirus cardiopulmonary syndrome. Whole-genome sequencing of the virus helps in identification and characterization of emerging or re-emerging viruses. Next-generation sequencing (NGS) is a potent method to sequence the viral genome, using molecular enrichment methods, from clinical specimens containing low virus titers. Hence, a comparative study on the target enrichment NGS methods is required for whole-genome sequencing of orthohantavirus in clinical samples. In this study, we used the sequence-independent, single-primer amplification, target capture, and amplicon NGS for whole-genome sequencing of Hantaan orthohantavirus (HTNV) from rodent specimens. We analyzed the coverage of the HTNV genome based on the viral RNA copy number, which is quantified by real-time quantitative PCR. Target capture and amplicon NGS demonstrated a high coverage rate of HTNV in Apodemus agrarius lung tissues containing up to 10-10 copies/?L of HTNV RNA. Furthermore, the amplicon NGS showed a 10-fold (10 copies/?L) higher sensitivity than the target capture NGS. This report provides useful insights into target enrichment NGS for whole-genome sequencing of orthohantaviruses without cultivating the viruses.
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Takotsubo syndrome and cardiac implantable electronic device therapy.
Sci Rep2019 Nov;9(1):16559. doi: 10.1038/s41598-019-52929-5.
El-Battrawy Ibrahim, Erath Julia W, Lang Siegfried, Ansari Uzair, Behnes Michael, Gietzen Thorsten, Zhou Xiaobo, Borggrefe Martin, Akin Ibrahim,
Abstract
Recent studies have reported that takotsubo syndrome (TTS) patients are suffering from life-threatening arrhythmias. The aim of our study was to understand the short and long-term usefulness of cardiac implantable electronic devices in TTS patients.We constituted a collective of 142 patients in a bi-centric study diagnosed with TTS between 2003 and 2017. The patient groups, divided according to the treatment with (n?=?9, 6.3%) or without cardiac devices (n?=?133, 93.7%), were followed-up to determine the importance of devices and its complications. One patient was treated with a permanent pacemaker, five patients with a wearable cardioverter defibrillator, two patients with a subcutaneous defibrillator and one patient with a transvenous defibrillator. Regular device check-up was documented in all patients, presenting an ongoing high-degree AV-block. Neither device complications nor life-threatening tachyarrhythmias were documented after acute TTS event. However, patients comprising the device group suffered significantly more often from a highly reduced EF (30?±?7.7% versus 39.1?±?9.7%; p?
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The therapeutic effect of controlled reoxygenation on chronic hypoxia-associated brain injury.
Biol Open2019 Nov;():. doi: bio.039370.
Tu Zhenzhen, Tan Xingqin, Li Shangyingying, Cui Jie, Tu Shengfen, Jiang Li,
Abstract
Cardiopulmonary bypass (CPB) is the most general technique applied in congenital heart disease (CHD). However, standard CPB poses a specific pathologic condition for patients during surgery: exposure to reoxygenation. When surgery is performed on cyanotic infants, standard CPB is usually initiated at a high concentration of oxygen without consideration of cytotoxic effects. Controlled reoxygenation is defined as using normoxic CPB with a pump prime the PO2 (oxygen tension in the blood) of which is matched to the patient's preoperative saturation. The aim of this study is to determine whether controlled reoxygenation could avoid standard reoxygenation injury and to clarify the molecular signaling pathways during hypoxia. We successfully established the reproducing abnormal brain observed in mice, of chronic hypoxia during the period of early postnatal development, which is equivalent to the third trimester in humans. Mice were treated with standard reoxygenation and controlled reoxygenation after hypoxia for 24 h. We then assessed the brain tissue of these mice. In standard reoxygenation treated hypoxia mice, the caspase-3-dependent neuronal apoptosis was enhanced by increasing concentration of oxygen. Interestingly, controlled reoxygenation inhibited neurons and glial cells apoptosis through suppressing cleavage of caspase-3 and PARP. We also found that controlled reoxygenation suppressed LCN2 expression and inflammatory cytokines (including TNF-?, IL-6, and CXCL10) production, in which JAK2/STAT3 signaling pathway might participate. In conclusion, our findings propose a novel therapeutic potential of controlled reoxygenation on cardiopulmonary bypass during congenital heart disease.
© 2019. Published by The Company of Biologists Ltd.
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Effect of Using Triclosan-Impregnated Polyglactin Suture to Prevent Infection of Saphenectomy Wounds in CABG: A Prospective, Double-Blind, Randomized Clinical Trial.
Braz J Cardiovasc Surg2019 12;34(5):588-595. doi: 10.21470/1678-9741-2019-0048.
Santos Paulo Samuel, Santos Marisa, Colafranceschi Alexandre Siciliano, Pragana Andrea Nunes de Souza, Correia Marcelo Goulart, Simões Heloisa Helena, Rocha Fernando Alves, Soggia Maria Eduarda de Vasconcelos, Santos Ana Paula Malta Samuel, Coutinho Annie de Azeredo, Figueira Matheus Swarovsky, Tura Bernardo Rangel,
Abstract
OBJECTIVE:
To evaluate the efficacy of triclosan-coated suture for the reduction of infection in saphenectomy wounds of patients undergoing coronary artery bypass graft (CABG) surgery.
METHODS:
A total of 508 patients who underwent saphenectomy in CABG surgery were included in a prospective, randomized, double-blind trial from February/2011 to June/2014. Patients were randomized into the triclosan-coated suture group (n= 251) and the conventional non-antibiotic suture group (n=257). Demographic (gender and age), clinical (body mass index, diabetes, and use of analgesics), and intraoperative (cardiopulmonary bypass and cross-clamp times) variables and those related to the saphenectomy wound (pain, dehiscence, erythema, infection, necrosis, and hyperthermia) were measured and analyzed.
RESULTS:
Of the 508 patients who underwent saphenectomy, 69.9% were males and 40.2% were diabetic. Thirty-three (6.5%) patients presented infection: 13 (5.3%) with triclosan and 20 (7.9%) with conventional suture (P=0.281). Among diabetic patients (n=204), triclosan suture was used in 45.1% with four cases of infection; conventional suture was used in 54.9% of them, with 11 cases of infection. Most patients (94.3%) underwent on-pump CABG. Wound pain was observed in 9.9% of patients with triclosan-coated suture and in 17.9% with conventional suture (P=0.011). Wound hyperthermia was found in 1.6% of patients with triclosan-coated suture and in 5.4% of those with conventional suture (P=0.028).
CONCLUSION:
Triclosan-coated suture shows lower infection rate in saphenectomy of patients undergoing CABG, although the differences were not statistically significant. Pain and wound hyperthermia were less frequent in patients with triclosan-coated sutures compared with conventional sutures.
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Commentary: Preprocedural diagnostic imaging for transcatheter aortic valve implantation-Videri quam esse.
J Thorac Cardiovasc Surg -
Incidence Trends and Predictors of In-Hospital Mortality in Drowning in Children and Adolescents in the United States: A National Inpatient Database Analysis.
Clin Pediatr (Phila)2019 Nov;():9922819886871. doi: 10.1177/0009922819886871.
Umapathi Krishna Kishore, Thavamani Aravind, Dhanpalreddy Harshitha, Khatana Jasmine, Roy Aparna,
Abstract
We sought to examine incidence and mortality trends of drowning-related hospitalizations in children aged <20 years and to study the presence of risk factors associated with in-hospital mortality. Retrospective analysis of the 2003-2016 Health Care Cost and Utilization Project National Inpatient Sample and Kids' Inpatient Database was performed. The estimated annual incidence rate of drowning hospitalizations declined 31.5% from 2.73 to 1.87 per 100?000 population. Most drowning-related hospitalizations were seen in <5-year-old children (66.4%) and in males (65.3%), Caucasians (41.7%), and public insurance (46%). In-hospital mortality declined 46% from an estimated 290 deaths in 2003 to 156 deaths in 2016. On multivariate analysis, age <5 years, Caucasian ethnicity, uninsured status, pool/bathtub or undetermined location, arrhythmia (adjusted odds ratio [aOR] = 1.3, = .001), acute kidney injury (aOR = 3.4, < .001), cerebral edema (aOR = 2.8, < .001), cardiopulmonary resuscitation (aOR = 12.1, < .001), and invasive mechanical ventilation (aOR = 28.4, < .001) were found to be independent predictors of mortality.
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Wearable Cardiopulmonary Function Evaluation System for Six-Minute Walking Test.
Sensors (Basel)2019 Oct;19(21):. doi: E4656.
Lin Bor-Shing, Jhang Ruei-Jie, Lin Bor-Shyh,
Abstract
As a submaximal exercise test, a 6-min walking test (6MWT) can be considered a suitable index for the exercise capacity of patients with a respiratory problem. Traditionally, medical staff manually collect cardiopulmonary information using different devices. However, no integrated monitoring system is currently available to simultaneously record the real-time breathing sound, heart rhythm, and precise walking information (i.e., walking distance, speed, and acceleration) during the 6MWT. In this study, a wearable and wireless multiparameter monitoring system is proposed to simultaneously monitor the breathing sound, oxygen saturation (SpO2), electrocardiograph (ECG) signals, and precise walking information during the 6MWT. Here, a wearable mechanical design was successfully used to reduce the effect of motion artifacts on the breathing sound and ECG signal. A multiparameter detection algorithm was designed to effectively estimate heart and breathing rates. Finally, the cardiopulmonary function of smokers was evaluated using the proposed system. The evaluation indicated that this system could reveal dynamic changes and differences in the breathing rate, heart rate, SpO2, walking speed, and acceleration during the 6MWT. The proposed system can serve as a more integrated approach to monitor cardiopulmonary parameters and obtain precise walking information simultaneously during the 6MWT.
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International Society of Cardiovascular Infectious Diseases Guidelines for the Diagnosis, Treatment and Prevention of Disseminated Mycobacterium chimaera Infection Following Cardiac Surgery with Cardiopulmonary Bypass.
J Hosp Infect2019 Nov;():. doi: S0195-6701(19)30444-X.
Hasse Barbara, Hannan Margaret, Keller Peter M, Maurer Florian P, Sommerstein Rami, Mertz Dominik, Wagner Dirk, Fernández-Hidalgo Nuria, Nomura Jim, Manfrin Vinicio, Bettex Dominique, Conte Antonio Hernandez, Durante-Mangoni Emanuele, Hing-Cheung Tang Tommy, Stuart Rhonda L, Lundgren Jens, Gordon Steve, Jarashow M Claire, Schreiber Peter W, Niemann Stefan, Kohl Thomas A, Daley Charles, Stewardson Andrew J, Whitener Cynthia J, Perkins Kiran, Plachouras Diamantis, Lamagni Theresa, Chand Meera, Freiberger Tomas, Zweifel Sandrine, Sander Peter, Schulthess Bettina, Scriven James, Sax Hugo, van Ingen Jakko, Mestres Carlos A, Diekema Daniel, Brown-Elliott Barbara A, Wallace Richard J, Baddour Larry M, Miro Jose M, Hoen Bruno, , , , , , , , ,
Abstract
Mycobacterial infection-related morbidity and mortality in patients following cardiopulmonary bypass surgery is high and and there is a growing need for a consensus-based expert opinion to provide international guidance for diagnosing, preventing and treating in these patients. In this document the International Society for Cardiovascular Infectious Diseases (ISCVID) covers aspects of prevention (field of hospital epidemiology), clinical management (infectious disease specialists, cardiac surgeons, ophthalmologists, others), laboratory diagnostics (microbiologists, molecular diagnostics), device management (perfusionists, cardiac surgeons) and public health aspects.
Copyright © 2019 The Author(s). Published by Elsevier Ltd.. All rights reserved.
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Plasmapharesis in Patients with Heparin-Induced Thrombocytopenia Requiring Ventricular Assist Device.
Ann Thorac Surg2019 Nov;():. doi: S0003-4975(19)31679-0.
Maffei Salvador R, Lamba Harveen K, Mensah Cassius Kwasi, Bracey Arthur, Civitello Andrew, Delgado Reynolds, Simpson Leo, Nair Ajith, Frazier O H, Morgan Jeffrey A,
Abstract
Anticoagulation with unfractionated heparin is vital to reduce the risk of thromboembolic events during cardiopulmonary bypass and left ventricular assist device (LVAD) placement. However, patients with heparin-induced thrombocytopenia (HIT) are at risk of developing immune-mediated thrombotic events. We describe two patients with HIT confirmed via serotonin release assay who were successfully treated with plasmapheresis exchange before LVAD placement.
Copyright © 2019. Published by Elsevier Inc.
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Veterans with Gulf War Illness exhibit distinct respiratory patterns during maximal cardiopulmonary exercise.
PLoS One2019 ;14(11):e0224833. doi: 10.1371/journal.pone.0224833.
Lindheimer Jacob B, Cook Dane B, Klein-Adams Jacquelyn C, Qian Wei, Hill Helene Z, Lange Gudrun, Ndirangu Duncan S, Wylie Glenn R, Falvo Michael J,
Abstract
INTRODUCTION:
The components of minute ventilation, respiratory frequency and tidal volume, appear differentially regulated and thereby afford unique insight into the ventilatory response to exercise. However, respiratory frequency and tidal volume are infrequently reported, and have not previously been considered among military veterans with Gulf War Illness. Our purpose was to evaluate respiratory frequency and tidal volume in response to a maximal cardiopulmonary exercise test in individuals with and without Gulf War Illness.
MATERIALS AND METHODS:
20 cases with Gulf War Illness and 14 controls participated in this study and performed maximal cardiopulmonary exercise test on a cycle ergometer. Ventilatory variables (minute ventilation, respiratory frequency and tidal volume) were obtained and normalized to peak exercise capacity. Using mixed-design analysis of variance models, with group and time as factors, we analyzed exercise ventilatory patterns for the entire sample and for 11 subjects from each group matched for race, age, sex, and height.
RESULTS:
Despite similar minute ventilation (p = 0.57, ?2p = 0.01), tidal volume was greater (p = 0.02, ?2p = 0.16) and respiratory frequency was lower (p = 0.004, ?2p = 0.24) in Veterans with Gulf War Illness than controls. The findings for respiratory frequency remained significant in the matched subgroup (p = 0.004, ?2p = 0.35).
CONCLUSION:
In our sample, veterans with Gulf War Illness adopt a unique exercise ventilatory pattern characterized by reduced respiratory frequency, despite similar ventilation relative to controls. Although the mechanism(s) by which this pattern is achieved remains unresolved, our findings suggest that the components of ventilation should be considered when evaluating clinical conditions with unexplained exertional symptoms.
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Neurological outcomes after an out-of-hospital cardiac arrest among people living in high-rise buildings in South Korea.
Eur J Emerg Med2019 Nov;():. doi: 10.1097/MEJ.0000000000000643.
Sohn Youdong, Cho Youngsuk, Cho Gyuchong, ,
Abstract
OBJECTIVE:
Living in high-rise buildings may cause delays in reaching a hospital after an out-of-hospital cardiac arrest. This study aimed to compare neurological outcomes in people who had had an out-of-hospital cardiac arrest, according to their floor of residence.
METHODS:
We conducted a retrospective study of 1541 patients aged ?20 years who had out-of-hospital cardiac arrest between 1 October 2015 and 30 June 2018, using data from a central registry. We compared the outcomes of patients living on the first (ground) or second floor and those living on the third floor or above, using multiple logistic regression.
RESULTS:
Those living on higher floors were more likely to have been at home (88.1% vs. 58.0%); to have had bystander cardiopulmonary resuscitation (57.9% vs. 45.2%); and experienced a significantly longer emergency medical service response time [median interquartile range (IQR): 7 min (6-10 min) vs. 7 min (5-9 min), P = 0.001] and on-scene time [median (IQR): 16 min (11-23 min) vs. 12 min (8-19 min), P < 0.001]. The strongest predictors of a good neurological outcome were younger age [odds ratio (OR): 0.96, 95% confidence interval (CI): 0.94-0.97], being on a lower floor at the time of the cardiac arrest (OR: 1.82, 95% CI: 1.09-3.12) and having a shockable rhythm (OR: 21.97, 95% CI: 12.81-39.47).
CONCLUSION:
People living on higher floors have poorer outcomes after an out-of-hospital cardiac arrest. Further studies are required to assess factors causing a delay in the emergency medical service response time, and placement of automated external defibrillators in high-rise buildings.
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Comparing thoracoabdominal injuries of manual versus load-distributing band cardiopulmonary resuscitation.
Eur J Emerg Med2019 Nov;():. doi: 10.1097/MEJ.0000000000000642.
Sonnemans Lianne J P, Bayat Alireza R, Bruinen Aniek R C, van Wely Marleen H, Brouwer Marc A, Bosboom Dennis, van der Hoeven Johannes G, Prokop Mathias, Klein Willemijn M,
Abstract
OBJECTIVE:
To identify and compare manual and load-distributing band (LDB) cardiopulmonary resuscitation (CPR)-related injuries.
METHODS:
Retrospective observational cohort study. Adult, nontraumatic deaths with a postmortem computed tomography scan (PMCT) performed were classified into two groups: deceased after LDB CPR or after manual CPR. PMCT scans were reviewed for thoracoabdominal injuries such as fractures, pneumothorax and hemorrhage. The injuries between groups were compared.
RESULTS:
LDB CPR (n = 43) showed increased incidences of posterior rib fractures (53 vs 18%, P = 0.006), pneumothorax (23 vs 4%, P = 0.04) and more pericardial fluid (median 12 vs 6 mm, P = 0.002) compared with manual CPR (n = 29). Multivariable regression analysis revealed that LDB CPR was significantly associated with posterior rib fractures [odds ratio (OR) 5.37, 95% confidence interval (CI): 1.44-20.09, P = 0.01). Pneumothorax (OR 6.80, 95% CI: 0.73-62.99, P = 0.09) and the amount of pericardial fluid (OR 3.40, 95% CI: 0.20-56.32) were not significantly associated with LDB CPR. No significant difference was found for anterolateral rib fractures, sternal fractures, vertebral fractures, pleural fluid, hemothorax, hemopericardium, pneumoperitoneum, perihepatic, perisplenic and perirenal hemorrhage.
CONCLUSION:
Rib fractures, sternal fractures, hemothorax and hemopericardium are common CPR-related injuries. LDB CPR is significantly associated with more posterior rib fractures and a trend toward more pneumothoraces is observed when compared with manual CPR. This knowledge is important for caretakers in the case of ongoing CPR, as a pneumothorax may attribute to not achieving persistent return of spontaneous circulation, and to improve postresuscitation care of survivors.
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Pedometer Feedback Interventions Increase Daily Physical Activity in Phase III Cardiac Rehabilitation Participants.
J Cardiopulm Rehabil Prev2019 Nov;():. doi: 10.1097/HCR.0000000000000472.
Ozemek Cemal, Strath Scott J, Riggin Katrina, Harber Matthew P, Imboden Mary T, Kaminsky Leonard A,
Abstract
PURPOSE:
To determine the effects of individually tailored interventions designed to increase physical activity (PA) in cardiac patients.
METHODS:
A total of 99 (77 men and 22 women, 61.5 ± 10.7 yr) patients entering a phase III cardiac rehabilitation program completed a 12-wk PA intervention. Patients were randomized to usual care (UC, time-based recommendation), pedometer feedback (PF), newsletter-based motivational messaging (MM), or PF + MM. Both PF groups were given a goal of increasing steps/d by 10% of individual baseline value each week. If the goal for the week was not reached, the same goal was used for the next week. Physical activity was assessed for 7 d before beginning and after completing the program. The change in steps/d, moderate to vigorous intensity PA minutes, and sedentary time were compared among intervention groups.
RESULTS:
Average change in steps/d was found to be significantly greater (P < .01) in the PF (2957 ± 3185) and the PF + MM (3150 ± 3007) compared with UC (264 ± 2065) and MM (718 ± 2415) groups. No group experienced changes in moderate to vigorous intensity PA time and only the PF intervention group decreased sedentary time (baseline 470.2 ± 77.1 to postintervention 447.8 ± 74.9 min/d, P = .01).
CONCLUSION:
The findings from this study demonstrate that using PF was superior to the usual time-based PA recommendations and to newsletter-based MM in patients starting a phase III CR program. Cardiac rehabilitation programs are encouraged to implement PA feedback with individualized PA goals in order to support the increase in PA.
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Type 2 Diabetes Mellitus, Glycated Hemoglobin Levels, and Cardiopulmonary Exercise Capacity in Patients With Ischemic Heart Disease.
J Cardiopulm Rehabil Prev2019 Nov;():. doi: 10.1097/HCR.0000000000000451.
Uribe-Heredia Giovanna, Arroyo-Espliguero Ramón, Viana-Llamas María Carmen, Piccone-Saponara Luis Guillermo, Álvaro-Fernández Henar, García-Magallón Belén, Torán-Martínez Claudio, Silva-Obregón Alberto, Izquierdo-Alonso José Luis,
Abstract
PURPOSE:
Diabetes mellitus (DM) is associated with long-term cardiovascular complications, including ischemic heart disease (IHD). Nonetheless, DM may directly impair myocardial and lung structure and function. The aim of this study was to assess the impact of type 2 DM (T2DM) and glycemic control on cardiopulmonary exercise capacity in patients with IHD.
METHODS:
The study involved a cross-sectional analysis of 91 consecutive patients (57 ± 10 yr, 90% men) who underwent a cardiopulmonary exercise test at the beginning of an exercise-based standard phase-II cardiac rehabilitation program, 2 to 3 mo after an acute coronary syndrome. Association of T2DM with cardiopulmonary exercise test parameters was assessed using multiple linear regression analysis controlling for prespecified potential confounders.
RESULTS:
There were 26 (29%) diabetic subjects among IHD patients included in the study. After adjustment, T2DM was an independent predictor of a reduced peak oxygen uptake (VO2peak) (P = .005), a reduced pulse O2 trajectory (P = .001), a steeper minute ventilation to carbon dioxide output (VE/VCO2) slope (P = .046), and an increased dead space-to-tidal volume ratio (VD/VT) at peak exercise (P = .049). Glycated hemoglobin (HbA1c) levels were significantly associated with a reduced forced expiratory volume in the first second of expiration (FEV1) (P = .013), VE (P = .001), and VT (P = .007). VO2peak (P trend < .001), VO2 at anaerobic threshold (P trend < .001), and pulse O2 trajectory (P trend < .001) decreased among HbA1c tertiles.
CONCLUSIONS:
Patients with IHD and a previous diagnosis of T2DM had a reduced aerobic capacity and a ventilation-perfusion mismatch compared with nondiabetic patients. Poor glycemic control in men further deteriorates aerobic capacity probably due to ventilatory inefficiency.
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Diagnostic Validity of Cardiopulmonary Exercise Testing for Screening Pulmonary Hypertension in Patients With Chronic Obstructive Pulmonary Disease.
J Cardiopulm Rehabil Prev2019 Nov;():. doi: 10.1097/HCR.0000000000000456.
Kader Mohamed Nabhan, Moiz Jamal Ali, Bhati Pooja, Ali Mir Shad, Talwar Deepak,
Abstract
PURPOSE:
To determine diagnostic validity of cardiopulmonary exercise testing (CPX) parameters for detecting pulmonary hypertension (PH) in patients with chronic obstructive pulmonary disease (COPD) and to investigate association between CPX parameters and indices of PH.
METHODS:
This cross-sectional study enrolled 48 moderate to very severe COPD patients in whom PH was confirmed by echocardiography. Symptom-limited CPX was performed using an incremental exercise protocol. Relevant CPX parameters were derived and were tested for their diagnostic ability for diagnosing PH. Logistic regression was applied to examine the effect of various clinical covariates on the diagnostic ability of exercise test variables for detecting PH.
RESULTS:
Of the 48 patients, 29 were diagnosed with PH and 19 were negative for PH based on echocardiographic testing. CPX measures including peak oxygen uptake (% predicted VO2peak, VO2peak [mL/min], VO2/kg), oxygen pulse (VO2/HR % predicted, VO2/HR mL/beat), and peak minute ventilation (VEpeak [L/m]) were inversely correlated with mean pulmonary arterial pressure (mPAP). Peak VO2/HR and VO2peak were found to be significant predictors of PH in univariate analysis. VO2peak (%), VO2/HR (mL/beat), and desaturation (%) were identified as independent predictors of PH adjusted for age, forced expiratory volume in 1 sec (%), and forced vital capacity (L).
CONCLUSION:
The present study validates the use of CPX parameters such as VO2peak and VO2/HR as a diagnostic tool for correctly identifying PH in COPD patients. Therefore, CPX may be used as an adjunct to echocardiographic measurement of PH where there is unavailability of equipment and expertise.
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Circulatory support during lung transplantation.
Curr Opin Anaesthesiol2019 Nov;():. doi: 10.1097/ACO.0000000000000806.
Kiziltug Hannah, Falter Florian,
Abstract
PURPOSE OF REVIEW:
Lung transplantation can be performed off-pump, with sequential one-lung ventilation, or using mechanical circulatory support (MCS). MCS can either be in the form of cardiopulmonary bypass (CPB) or veno-arterial or veno-venous extracorporeal membrane oxygenation (VA ECMO or VV ECMO).This article reviews the indications, benefits and limitations of these different techniques and evaluates their effect on outcomes.
RECENT FINDINGS:
Recently, there has been a shift toward intraoperative ECMO support and away from CPB. The first results of this strategy are promising. The use of intraoperative ECMO with the possibility of prolongation of MCS into the postoperative period has been shown to lead to improved survival when compared with lung transplants not receiving ECMO. Recipients of organs from extended criteria donors show encouraging survival rates when the lungs are reperfused using MCS. A recent metaanalysis comparing ECMO versus CPB showed favourable outcomes supporting the use of ECMO despite not finding a difference in mortality between the two methods.
SUMMARY:
The trend toward ECMO and away from cardiopulmonary bypass is backed up with good survival rates. However, to date, there has not been a randomized controlled trial to further guide the choice of MCS strategy for lung transplantation.
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Assessment of cardiopulmonary resuscitation equipment in resuscitation trolleys in district hospitals in Botswana: A cross-sectional study.
Afr J Prim Health Care Fam Med2019 Oct;11(1):e1-e7. doi: 10.4102/phcfm.v11i1.2029.
Tsima Billy M, Rajeswaran Lakshmi, Cox Megan,
Abstract
INTRODUCTION:
Successful cardiopulmonary resuscitation (CPR) relies, in part, on the availability and the correct functioning of resuscitation equipment. These data are often lacking in resource-constrained African settings.
AIM:
To assess the availability and the functional status of CPR equipment in resuscitation trolleys at district hospitals in Botswana.
SETTING:
The study was conducted across four district hospitals in Botswana.
METHODS:
A cross-sectional study was conducted using a checklist adopted following the Emergency Medical Services of South Africa (EMSSA) guidelines, modified and contextualised to Botswana.
RESULTS:
All the four district hospitals had inadequate number of CPR equipment available in the resuscitation trolleys. The overall availability of drugs and equipment ranged from 19% to 31.1%. Availability of equipment needed for maintaining circulation and fluids ranged from 27% to 49%, while availability of items for airway and breathing ranged from 9.2% to 24.1%. The overall availability of essential drugs for resuscitation was only 20.4%, and in some wards expired drugs were kept in the trolley. Out of 40 wards that participated in the study, only 10 kept CPR algorithms in the resuscitation trolley. The resuscitation trolley was checked on a daily basis only in the critical care units.
CONCLUSION:
The resuscitation trolleys were not maintained as per standards. Failure to improve the existing situation could negatively impact the outcome of CPR. Evidence-based standard checklists for resuscitation trolleys need to be enforced to improve the quality of CPR provision in district hospitals in Botswana.
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