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Pubblicazioni recenti - cardiopulmonary
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Metformin-associated lactic acidosis exacerbated by acute kidney injury in an overseas traveler.
CEN Case Rep2021 Nov;():. doi: 10.1007/s13730-021-00665-z.
Hayashi Ayano, Ishimura Takuya, Sugimoto Hisashi, Suzuki Hiroyuki, Hamasaki Akihiro, Tsukamoto Tatsuo,
Abstract
We report the case of metformin-associated lactic acidosis (MALA) exacerbated by acute kidney injury (AKI) in a 65-year-old Asian American woman who was an overseas traveler. She had vomiting and diarrhea before arriving in Osaka, Japan, from the Philippines. She suffered from worsening respiratory distress, consciousness loss and anuria the day after coming to Japan. When she arrived at our emergency room via ambulance, she appeared to be in a state shock. Arterial blood gas analysis revealed severe lactic acidosis (pH 6.681, PO 302 Torr under O supplementation, PCO 15 Torr, HCO1.7 mmol/L, and lactate 17.00 mmol/L). She also had renal failure (BUN 108 mg/dL and serum creatinine 8.68 mg/dL) with hyperkalemia (6.1 mEq/L). We collected medical information from family members, and found her prescription medicines including metformin, diuretics and angiotensin-converting enzyme inhibitor (ACEI). We diagnosed her with MALA due to an unintended overdose of metformin resulting from acute kidney injury that can be induced by ACEI and diuretics in the volume-depleted condition. We immediately started hemodialysis therapy. Although she had a temporary cardiopulmonary arrest at the beginning of the treatment, her physical status was gradually improved and the severe acidemia resolved. On hospital day 4, she had urine and no longer needed hemodialysis therapy. On day 14, she was discharged and returned to the United States without noticeable sequelae. This is a case report of an overseas traveler who was successfully rescued through the collection of accurate medical information and understanding of the pathological condition.
© 2021. The Author(s).
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Optimizing high-flow nasal cannula flow settings in adult hypoxemic patients based on peak inspiratory flow during tidal breathing.
Ann Intensive Care2021 Nov;11(1):164. doi: 10.1186/s13613-021-00949-8.
Li Jie, Scott J Brady, Fink James B, Reed Brooke, Roca Oriol, Dhand Rajiv,
Abstract
BACKGROUND:
Optimal flow settings during high-flow nasal cannula (HFNC) therapy are unknown. We investigated the optimal flow settings during HFNC therapy based on breathing pattern and tidal inspiratory flows in patients with acute hypoxemic respiratory failure (AHRF).
METHODS:
We conducted a prospective clinical study in adult hypoxemic patients treated by HFNC with a fraction of inspired oxygen (FO) ??0.4. Patient's peak tidal inspiratory flow (PTIF) was measured and HFNC flows were set to match individual PTIF and then increased by 10 L/min every 5-10 min up to 60 L/min. FO was titrated to maintain pulse oximetry (SpO) of 90-97%. SpO/FO, respiratory rate (RR), ROX index [(SpO/FO)/RR], and patient comfort were recorded after 5-10 min on each setting. We also conducted an in vitro study to explore the relationship between the HFNC flows and the tracheal FO, peak inspiratory and expiratory pressures.
RESULTS:
Forty-nine patients aged 58.0 (SD 14.1) years were enrolled. At enrollment, HFNC flow was set at 45 (38, 50) L/min, with an FO at 0.62 (0.16) to obtain an SpO/FO of 160 (40). Mean PTIF was 34 (9) L/min. An increase in HFNC flows up to two times of the individual patient's PTIF, incrementally improved oxygenation but the ROX index plateaued with HFNC flows of 1.34-1.67 times the individual PTIF. In the in vitro study, when the HFNC flow was set higher than PTIF, tracheal peak inspiratory and expiratory pressures increased as HFNC flow increased but the FO did not change.
CONCLUSION:
Mean PTIF values in most patients with AHRF were between 30 and 40 L/min. We observed improvement in oxygenation with HFNC flows set above patient PTIF. Thus, a pragmatic approach to set optimal flows in patients with AHRF would be to initiate HFNC flow at 40 L/min and titrate the flow based on improvement in ROX index and patient tolerance.
TRIAL REGISTRATION:
ClinicalTrials.gov (NCT03738345). Registered on November 13th, 2018. https://clinicaltrials.gov/ct2/show/NCT03738345?term=NCT03738345&draw=2&rank=1.
© 2021. The Author(s).
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Ultrafiltration and cardiopulmonary bypass associated acute kidney injury: A systematic review and meta-analysis.
Clin Cardiol2021 Nov;():. doi: 10.1002/clc.23750.
Kandil Omneya A, Motawea Karam R, Darling Edward, Riley Jeffrey B, Shah Jaffer, Elashhat Mohamed Abdalla Mohamed, Searles Bruce, Aiash Hani,
Abstract
BACKGROUND:
Cardiopulmonary bypass is known to raise the risk of acute kidney injury (AKI). Previous studies have identified numerous risk factors of cardiopulmonary bypass including the possible impact of perioperative ultrafiltration. However, the association between ultrafiltration (UF) and AKI remains conflicting. Thus, we conducted a meta-analysis to further examine the relationship between UF and AKI.
HYPOTHESIS:
Ultrafiltration during cardiac surgery increases the risk of developping Acute kidney Injury.
METHODS:
We searched PubMed, Web of Science, EBSCO, and SCOPUS through July 2021. The RevMan (version 5.4) software was used to calculate the pooled risk ratios (RRs) and mean differences along with their associated confidence intervals (95% CI).
RESULTS:
We identified 12 studies with a total of 8005 patients. There was no statistically significant difference in the incidence of AKI between the group who underwent UF and the control group who did not (RR?=?0.90, 95% CI?=?0.64-1). Subgroup analysis on patients with previous renal insufficiency also yielded nonsignificant difference (RR?=?0.84, 95% CI?=?0.53 -1.33, p?=?.47). Subgroup analysis based on volume of ultrafiltrate removed (> or
CONCLUSION:
UF in cardiac surgery is not associated with increased AKI incidence and may be safely used even in baseline chronic injury patients.
© 2021 The Authors. Clinical Cardiology published by Wiley Periodicals LLC.
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Fisetin ameliorates cognitive impairment by activating mitophagy and suppressing neuroinflammation in rats with sepsis-associated encephalopathy.
CNS Neurosci Ther2021 Nov;():. doi: 10.1111/cns.13765.
Ding Hongguang, Li Ya, Chen Shenglong, Wen Yin, Zhang Shiying, Luo Ensi, Li Xusheng, Zhong Wenhong, Zeng Hongke,
Abstract
BACKGROUND:
Fisetin, the effective ingredient of the traditional Chinese medicine named Cotinus coggygria, is recommended to be active therapeutic in many disorders. However, its role in sepsis-associated encephalopathy (SAE) remains unclarified.
METHODS:
Cecal ligation and puncture (CLP) operation was performed to establish a rat model of SAE. Rats were grouped according to the surgery operation and fisetin administration. Cognitive impairment was assessed by Morris water maze test. Disruption of blood-brain barrier (BBB) integrity was detected by Evan's blue staining. The mitophagy, reactive oxygen species (ROS) generation, NLRP3 inflammasome activation, and pro-inflammatory cytokines levels were measured through western blot and double immunofluorescence labeling. A transmission electron microscope was applied for the observation of mitochondrial autophagosomes.
RESULTS:
Rats in the CLP group presented increased expression of IL-1R1, pNF-?B, TNF-?, and iNOS in microglial cells, indicating severe inflammation in the central nervous system (CNS). Nevertheless, there was no increase in BBB permeability. Meanwhile, NLRP3 inflammasome was activated in cerebral microvascular endothelial cells (CMECs), presented with an elevation of caspase-1 expression and IL-1? secretion into CNS. In addition, we found fisetin significantly improved cognitive dysfunction in rats with SAE. Neuroprotective effects of fisetin might be associated with inhibition of neuroinflammation, represented with decreased expression of IL-1R1, pNF-?B, TNF-?, and iNOS in microglia. Furthermore, fisetin induced mitophagy, scavenged ROS, blocked NLRP3 inflammasome activation of CMECs, as evidenced by decreased expression of caspase-1 and reduced release of IL-1? into CNS.
CONCLUSION:
Collectively, fisetin-blocked NLRP3 inflammasome activation via promoting mitophagy in CMECs may suppress the secretion of IL-1? into CNS, reduce neuroinflammation, and contribute to the amelioration of cognitive impairment.
© 2021 The Authors. CNS Neuroscience & Therapeutics Published by John Wiley & Sons Ltd.
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Feasibility of completing Multidimensional Dyspnea Profile and Dyspnea-12 over the telephone in patients with oxygen-dependent disease.
BMJ Open Respir Res2021 Nov;8(1):. doi: e001027.
Bech Thea Wilhelmine, Eklund Moa, Spaak Elisabeth, Palm Andreas, Ekström Magnus,
Abstract
BACKGROUND:
Breathlessness is prevalent in severe disease and consists of different dimensions that can be measured using the Multidimensional Dyspnea Profile (MDP) and Dyspnea-12 (D-12). We aimed to evaluate the feasibility of MDP and D-12 over telephone interviews in oxygen-dependent patients, compared with other patient-reported outcomes (modified Medical Research Council (mMRC) and Chronic Obstructive Pulmonary Disease Assessment Test (CAT)) and with completion by hand.
METHODS:
Cross-sectional, telephone study of 50 patients with home oxygen therapy. Feasibility was assessed as completion time (self-reported by patients and measured), difficulty (self-reported) and help required to complete the instruments (staff). Completion time was compared with mMRC and CAT, and feasibility was compared with completion by hand in cardiopulmonary outpatients (n=182). Feasibility by age and gender was analysed using logistic regression.
RESULTS:
Of 136 patients approached, 50 (37%) participated (mean age: 72±10 years, 66%?women). Completion times (in minutes) were relatively short for MDP (self-reported 6 (IQR 5-10), measured 8 (IQR 6-10)) and D-12 (self-reported 5 (IQR 3-8), measured 3 (IQR 3-4)), and slightly longer than mMRC (median 1 (IQR 1-1)) and CAT (median 3 (IQR 2-5)). Even though the majority of patients required no help, more assistance was required by older patients. Compared with patients reporting by hand, completion over the telephone required somewhat longer time and more assistance.
CONCLUSION:
Many patients with severe oxygen-dependent disease were unable or unwilling to assess symptoms over the telephone. However, among those able to participate, MDP and D-12 are feasible to measure multiple dimensions of breathlessness over the telephone.
© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
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Indications and outcome after lung transplantation in children under 12 years of age: A 16-year single center experience.
J Heart Lung Transplant2021 Oct;():. doi: S1053-2498(21)02571-7.
Iablonskii Pavel, Carlens Julia, Mueller Carsten, Aburahma Khalil, Niehaus Adelheid, Boethig Dietmar, Franz Maximilian, Floethmann Katharina, Sommer Wiebke, Optenhoefel Joerg, Tudorache Igor, Greer Mark, Koeditz Harald, Jack Thomas, Hansmann Georg, Kuehn Christian, Horke Alexander, Hansen Gesine, Haverich Axel, Warnecke Gregor, Avsar Murat, Salman Jawad, Bobylev Dmitry, Ius Fabio, Schwerk Nicolaus,
Abstract
OBJECTIVE:
Paediatric lung transplantation poses unique management challenges. Experience regarding indications and outcome is scarce, especially in younger children. The primary aim of this study was to investigate outcome after first lung transplantation in children
METHODS:
Records of patients
RESULTS:
Of the 117 patients underwent first lung transplantation at our institution, of whom 42 (35.8%) patients were
CONCLUSIONS:
Lung transplantation in children under 12 years is challenging due to underlying medical conditions and operative complexity. Nevertheless, outcomes are comparable to those in older children.
Copyright © 2021 International Society for Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved.
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Occupational Hantavirus Infections in Agricultural and Forestry Workers: A Systematic Review and Metanalysis.
Viruses2021 Oct;13(11):. doi: 2150.
Riccò Matteo, Peruzzi Simona, Ranzieri Silvia, Magnavita Nicola,
Abstract
Hantaviruses are zoonotic pathogens that can cause serious human disorders, including hemorrhagic fever with renal syndrome and hantavirus cardiopulmonary syndrome. As the main risk factor for human infections is the interaction with rodents, occupational groups such as farmers and forestry workers are reportedly at high risk, but no summary evidence has been collected to date. Therefore, we searched two different databases (PubMed and EMBASE), focusing on studies reporting the prevalence of hantaviruses in farmers and forestry workers. Data were extracted using a standardized assessment form, and results of such analyses were systematically reported, summarized and compared. We identified a total of 42 articles, including a total of 28 estimates on farmers, and 22 on forestry workers, with a total workforce of 15,043 cases (821 positive cases, 5.5%). A pooled seroprevalence of 3.7% (95% confidence interval [95% CI] 2.2-6.2) was identified in farmers, compared to 3.8% (95% CI 2.6-5.7) in forestry workers. Compared to the reference population, an increased occurrence was reported for both occupational groups (odds ratio [OR] 1.875, 95% CI 1.438-2.445 and OR 2.892, 95% CI 2.079-4.023 for farmers and forestry workers, respectively). In summary, our analyses stress the actual occurrence of hantaviruses in selected occupational groups. Improved understanding of appropriate preventive measures, as well as further studies on hantavirus infection rates in reservoir host species (rodents, shrews, and bats) and virus transmission to humans, is needed to prevent future outbreaks.
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Individualized Assessment of Exercise Capacity in Response to Acute and Long-Term Enzyme Replacement Therapy in Pediatric Pompe Disease.
J Pers Med2021 Oct;11(11):. doi: 1105.
Bar-Yoseph Ronen, Tal Galit, Dumin Elena, Hanna Moneera, Mainzer Gur, Zucker-Toledano Merav, Shallufi George, Jahshan Mira, Mandel Hanna, Bentur Lea,
Abstract
BACKGROUND:
Enzyme replacement therapy (ERT) with alglucosidase alfa improves the prospect of patients with infantile-onset Pompe disease (IOPD). However, a progressive decline has been reported. Objective quantification of the response to ERT when assessing newer strategies is warranted.
METHODS:
This combined retrospective-prospective study assessed the acute and long-term effects of ERT on exercise in IOPD patients. Evaluation included cardiopulmonary exercise testing (CPET), 6-min walking test (6MWT), spirometry, motor function test (GMFM-88) and enzyme blood levels.
RESULTS:
Thirty-four CPETs (17 pre- and 17 two days-post ERT) over variable follow-up periods were performed in four patients. Two days following ERT, blood enzyme levels increased (median, 1.22 and 10.15 ?mol/L/h ( = 0.003)). However, FEV1, FVC and GMFM-88, the median 6MWD and the peak VO were unchanged. Long-term evaluations showed stabilization in young patients but progressive deterioration in adolescents. Clinical deterioration was associated with more pronounced deterioration in peak VO followed in the decreasing order by 6MWD, FVC and GMFM-88.
CONCLUSIONS:
The peak VO and 6MWD might serve as more sensitive markers to assess clinical deterioration. More studies are needed to clarify the sensitivity of the peak VO and 6MWT for quantification of individualized response. This may be important when assessing newer strategies and formulations in IOPD.
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Fox Serum Proteomics Analysis Suggests Host-Specific Responses to Infection in Canids.
Pathogens2021 Nov;10(11):. doi: 1513.
Gillis-Germitsch Nina, Kockmann Tobias, Kapel Christian M O, Thamsborg Stig M, Webster Pia, Tritten Lucienne, Schnyder Manuela,
Abstract
Dogs infected with the cardiopulmonary nematode may suffer from respiratory distress and/or bleeding disorders. Descriptions of clinical signs in foxes are rare, despite high prevalence. To evaluate the impact of infection on coagulation and immune response, serum proteins from eight experimentally infected foxes before and after inoculation (day 0, 35, 84, 154) were subjected to differential proteomic analyses based on quantitative data and compared to available data from dogs. The number of proteins with differential abundance compared to the uninfected baseline increased with chronicity of infection. Bone marrow proteoglycan, chitinase 3-like protein 1 and pulmonary surfactant-associated protein B were among the most prominently increased proteins. The abundance of several proteins involved in coagulation was decreased. Enriched pathways obtained from both increased and decreased proteins included, among others, "platelet degranulation" and "haemostasis", and indicated both activation and suppression of coagulation. Qualitative comparison to dog data suggests some parallel serum proteomic alterations. The comparison, however, also indicates that foxes have a more adequate immunopathological response to infection compared to dogs, facilitating persistent infections in foxes. Our findings imply that foxes may be more tolerant to infection, as compared to dogs, reflecting a longer evolutionary host-parasite adaptation in foxes, which constitute a key wildlife reservoir.
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Effects of Isolated Soy Protein Supplementation Combined with Aerobic Exercise Training on Improving Body Composition, Anthropometric Characteristics and Cardiopulmonary Endurance in Women: A Pilot Study.
Int J Environ Res Public Health2021 Nov;18(22):. doi: 11798.
Li Fang, Hsueh Ying-Ting, Hsu Yi-Ju, Lee Mon-Chien, Chang Chun-Hao, Ho Chin-Shan, Huang Chi-Chang,
Abstract
Today, women are concerned with health promotion but also with improvements in body weight and shape. The purpose of this study was to investigate the effects of aerobic exercise training (AET) combined with isolated soy protein (ISP) supplementation on the body composition, anthropometric characteristics, and cardiopulmonary endurance of women. The qualified subjects were randomly assigned to AET or AET + ISP groups. Women in the AET + ISP group were given an ISP-rich supplement (40 g/day) 5 days a week for 8 weeks; those in the AET group were given the same amount of water in an identical manner. All women received 60 min of AET twice a week for 8 weeks at an intensity of 40-65% heart rate reserve (HRR) and their body composition, anthropometric characteristics, and physical fitness were measured one week before and after the 8-week AET class. A total of 16 subjects (age: 36.13 ± 5.76 years) completed the study and were included in the dataset. The results of this study show that the AET + ISP group obtained greater reductions in body weight (effect size = 0.99), body mass index (BMI, effect size = 1.04), percentage body fat (PBF, effect size = 1.18), circumferences (waist and hip, all effect sizes > 0.8), and greater gains in the percentage lean body mass (PLBM, effect size = 0.89), compared with the AET group, without significant differences in 20 m multi-stage shuttle run test (20 m MST). We conclude that there is a trend for the consumption of ISP following AET to improve the body composition and anthropometric characteristics in women, compared with those who received the same AET without ISP supplementation.
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Impact of Lipoprotein(a) Levels on Perioperative Outcomes in Cardiac Surgery.
Cells2021 Oct;10(11):. doi: 2829.
Heinisch Paul Philipp, Mihalj Maks, Huber Markus, Schefold Joerg C, Hartmann Alexander, Walter Michael, Steinhagen-Thiessen Elisabeth, Schmidli Juerg, Stüber Frank, Räber Lorenz, Luedi Markus M,
Abstract
Altered lipid metabolism has been shown to be of major importance in a range of metabolic diseases, with particular importance in cardiovascular disease (CVD). As a key metabolic product, altered lipoprotein(a) (Lp(a)) levels may be associated with adverse clinical outcomes in high-risk cardiovascular patients undergoing cardiac surgery. We aimed to investigate the impact of the important metabolite Lp(a) on complications and clinical outcomes in high-risk patients. A prospective observational cohort study was performed. Data were derived from the Bern Perioperative Biobank (ClinicalTrials.gov NCT04767685), and included 192 adult patients undergoing elective cardiac surgery. Blood samples were collected at 24 h preoperatively, before induction of general anaesthesia, upon weaning from cardiopulmonary bypass (CPB), and the first morning after surgery. Clinical endpoints included stroke, myocardial infarction, and mortality within 30 days after surgery or within 1 year. Patients were grouped according to their preoperative Lp(a) levels: 30 mg/dL ( 71, 37%). The groups with increased vs. normal Lp(a) levels were comparable with regard to preoperative demographics and comorbidities. Median age was 67 years (interquartile range (IQR) 60.0, 73.0), with median body mass index (BMI) of 23.1 kg/m (23.7, 30.4), and the majority of patients being males (75.5%). Over the observational interval, Lp(a) levels decreased in all types of cardiac surgery after CPB (mean decline of approximately -5 mg/dL). While Lp(a) levels decreased in all patients following CPB, this observation was considerably pronounced in patients undergoing deep hypothermic circulatory arrest (DHCA) (decrease to preoperative Lp(a) levels by -35% (95% CI -68, -1.7), = 0.039). Increased Lp(a) levels were neither associated with increased rates of perioperative stroke or major adverse events in patients undergoing cardiac surgery, nor with overall mortality in the perioperative period, or at one year after surgery. Other than for cohorts in neurology and cardiology, elevated Lp(a) might not be a risk factor for perioperative events in cardiac surgery.
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Can the Six-Minute Walk Test Be Used to Individualize Physical Activity Intensity in Patients with Breast Cancer?
Cancers (Basel)2021 Nov;13(22):. doi: 5851.
Tubiana-Mathieu Nicole, Cornette Thibault, Mandigout Stephane, Leobon Sophie, Vincent François, Venat Laurence, Deluche Elise,
Abstract
BACKGROUND:
Adapted physical activity (APA) aids breast cancer patients. It is necessary to use an adapted target heart rate (HR) when prescribing exercise intensity.
METHODS:
In total, 138 patients previously included in two published randomized clinical trials underwent the CPET and 6MWT before and after adjuvant therapy. Of these patients, 85 had performed APA, and 53 had received only the usual therapy. HRs were recorded during the two tests.
RESULTS:
Before starting chemotherapy, good agreement (intraclass correlation (ICC) 0.69; confidence interval at 95% IC (0.591-0.769);
CONCLUSIONS:
The 6MWT-HR can be used to prescribe exercise intensity for breast cancer patients both before and after specific treatment with concomitant APA.
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Chronotropic Incompetence in Non-Hospitalized Patients with Post-COVID-19 Syndrome.
J Clin Med2021 Nov;10(22):. doi: 5434.
Jimeno-Almazán Amaya, Pallarés Jesús G, Buendía-Romero Ángel, Martínez-Cava Alejandro, Courel-Ibáñez Javier,
Abstract
Patients recovering from COVID-19 commonly report persistence of dyspnea, exertional fatigue, and difficulties in carrying out their daily activities. However, the nature of these symptoms is still unknown. The purpose of the study was to identify limiting causes of cardiopulmonary origin for the performance of physical exercise in post-COVID-19 condition that could explain the symptomatic persistence of dyspnea or fatigue-related symptoms. Thirty-two non-hospitalized patients with post-COVID-19 condition (i.e., still presenting a chronic symptomatic phase lasting >90 days since debut of symptoms that lasted for at least 2 months and cannot be explained by an alternative diagnosis) completed a clinical examination including echocardiography, submaximal and maximal cardiorespiratory fitness tests (Ekblom-Bak and Bruce's protocols), and a battery of validated questionnaires about fatigue and exercise intolerance. Four participants (12.5%) reported an abnormal cardiac response to exercise during the submaximal test, which aroused suspicion of the presence of chronotropic incompetence. All of them were confirmed with a positive diagnosis maximal exercise test after cardiology screening, even with a comprehensive clinical examination, resting ECG, and echocardiogram, without other findings. No statistical differences were found in any physiological variables or questionnaire values, between patients with positive and negative diagnoses. Chronotropic incompetence and other autonomic disorders may appear in patients with mild forms of COVID-19 presentation and may persist in the long term, being responsible for exercise intolerance after resolution of acute infection. Clinicians should be aware that chronotropic incompetence and other autonomic disorders may be a complication of COVID-19 and should consider appropriate diagnostic and therapeutic interventions in these patients, especially when early exercise-related fatigability is reported.
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Rapid Ventricular Pacing as a Safe Procedure for Clipping of Complex Ruptured and Unruptured Intracranial Aneurysms.
J Clin Med2021 Nov;10(22):. doi: 5406.
Grabert Josefin, Huber-Petersen Stefanie, Lampmann Tim, Eichhorn Lars, Vatter Hartmut, Coburn Mark, Velten Markus, Güresir Erdem,
Abstract
Surgical treatment of intracranial aneurysm requires advanced technologies to achieve optimal results. Recently, rapid ventricular pacing (RVP) has been described to be an elegant technique that facilitates clip reconstruction of complex unruptured intracranial aneurysm (uIA). However, there is also a growing need for intraoperative tools to ensure safe clip reconstruction of complex ruptured intracranial aneurysm (rIA). We conducted a retrospective analysis of 17 patients who underwent RVP during surgical reconstruction of complex aneurysms. Nine patients had uIA while eight patients underwent surgery for rIA suffering from consecutive subarachnoid hemorrhage (SAH). Hemodynamic data, critical events, laboratory results, and anesthesia-related complications were evaluated. No complications were reported concerning anesthesia induction and induction times were similar between patients exhibiting uIA or rIA ( = 0.08). RVP induced a significant decline of median arterial pressure (MAP) in both groups (
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Preoperative Predictors of Adverse Clinical Outcome in Emergent Repair of Acute Type A Aortic Dissection in 15 Year Follow Up.
J Clin Med2021 Nov;10(22):. doi: 5370.
Freundt Miriam, Kolat Philipp, Friedrich Christine, Salem Mohamed, Gruenewald Matthias, Elke Gunnar, Pühler Thomas, Cremer Jochen, Haneya Assad,
Abstract
BACKGROUND:
Acute type A aortic dissection (AAAD) has high mortality. Improvements in surgical technique have lowered mortality but postoperative functional status and decreased quality of life due to debilitating deficits remain of concern. Our study aims to identify preoperative conditions predictive of undesirable outcome to help guide perioperative management.
METHODS:
We performed retrospective analysis of 394 cases of AAAD who underwent repair in our institution between 2001 and 2018. A combined endpoint of parameters was defined as (1) 30-day versus hospital mortality, (2) new neurological deficit, (3) new acute renal insufficiency requiring postoperative renal replacement, and (4) prolonged mechanical ventilation with need for tracheostomy.
RESULTS:
Total survival/ follow-up time averaged 3.2 years with follow-up completeness of 94%. Endpoint was reached by 52.8%. Those had higher EuroSCORE II (7.5 versus 5.5), higher incidence of coronary artery disease (CAD) (9.2% versus 3.2%), neurological deficit (ND) upon presentation (26.4% versus 11.8%), cardiopulmonary resuscitation (CPR) (14.4% versus 1.6%) and intubation (RF) before surgery (16.9% versus 4.8%). 7-day mortality was 21.6% versus 0%. Hospital mortality 30.8% versus 0%.
CONCLUSIONS:
This 15-year follow up shows, that unfavorable postoperative clinical outcome is related to ND, CAD, CPR and RF on arrival.
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Compound Mutation in Cardiac Sarcomere Proteins Is Associated with Increased Risk for Major Arrhythmic Events in Pediatric Onset Hypertrophic Cardiomyopathy.
J Clin Med2021 Nov;10(22):. doi: 5256.
Pollmann Kathrin, Kaltenecker Emanuel, Schleihauf Julia, Ewert Peter, Görlach Agnes, Wolf Cordula M,
Abstract
Hypertrophic cardiomyopathy (HCM) is associated with adverse left ventricular (LV) remodeling causing dysfunction and malignant arrhythmias. Severely affected patients present with disease onset during childhood and sudden cardiac death risk (SCD) stratification is of the highest importance in this cohort. This study aimed to investigate genotype-phenotype association regarding clinical outcome and disease progression in pediatric onset HCM. Medical charts from forty-nine patients with pediatric HCM who had undergone genetic testing were reviewed for retrospective analysis. Demographic, clinical, transthoracic echocardiographic, electrocardiographic, long-term electrocardiogram, cardiopulmonary exercise test, cardiac magnetic resonance, and medication data were recorded. Childhood onset HCM was diagnosed in 29 males and 20 females. Median age at last follow-up was 18.7 years (range 2.6-51.7 years) with a median follow-up time since diagnosis of 8.5 years (range 0.2-38.0 years). Comparison of patients carrying mutations in distinct genes and comparison of genotype-negative with genotype-positive individuals, revealed no differences in functional classification, LV morphology, hypertrophy, systolic and diastolic function, fibrosis and cardiac medication. Patients with compound mutations had a significantly higher risk for major arrhythmic events than a single-mutation carrier. No association between affected genes and disease severity or progression was identified in this cohort.
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U SO CARE-The Impact of Cardiac Ultrasound during Cardiopulmonary Resuscitation: A Prospective Randomized Simulator-Based Trial.
J Clin Med2021 Nov;10(22):. doi: 5218.
Zöllner Karim, Sellmann Timur, Wetzchewald Dietmar, Schwager Heidrun, Cleff Corvin, Thal Serge C, Marsch Stephan,
Abstract
BACKGROUND:
Actual cardiopulmonary resuscitation (CPR) guidelines recommend point-of-care ultrasound (POCUS); however, data on POCUS during CPR are sparse and conflicting. This randomized trial investigated the effects of POCUS during CPR on team performance and diagnostic accuracy.
METHODS:
Intensive Care and Emergency Medicine residents performed CPR with or without available POCUS in simulated cardiac arrests. The primary endpoint was hands-on time. Data analysis was performed using video recordings.
RESULTS:
Hands-on time was 89% (87-91) in the POCUS and 92% (89-94) in the control group (difference 3, 95% CI for difference 2-4,
CONCLUSIONS:
POCUS during CPR resulted in lower hands-on times and delayed rhythm analysis. Correct POCUS diagnoses occurred in 52%, correct treatment decisions in 44%, and inappropriate treatment decisions in 2%. Training on POCUS during CPR should focus on diagnostic accuracy and maintenance of high-quality CPR.
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Diet in Scleroderma: Is There a Need for Intervention?
Diagnostics (Basel)2021 Nov;11(11):. doi: 2118.
Burlui Alexandra Maria, Cardoneanu Anca, Macovei Luana Andreea, Rezus Ciprian, Boiculese Lucian Vasile, Graur Mariana, Rezus Elena,
Abstract
Systemic sclerosis (SSc) patients exhibit a plethora of risk factors for nutritional decline, including the presence of chronic inflammation and the progressive nature of disease-related multisystem involvement. The prevalence and consequences of nutritional decline in scleroderma are frequently underestimated, its management currently remaining a subject of debate. The main objective of the present study was to perform a detailed assessment of scleroderma patients' diet as well as their eating habits and to describe the relationships with weight loss and malnutrition risk in the absence of professional nutritional counseling.
METHODS:
We used a translated and validated version of the EPIC-Norfolk FFQ (European Prospective Investigation into Cancer and Nutrition Norfolk Food Frequency Questionnaire) to evaluate the patients' diet and MUST (Malnutrition Universal Screening Tool) to investigate the risk of malnutrition. Disease activity was estimated using the EUSTAR-AI (European Scleroderma Trials and Research group Activity Index).
RESULTS:
We included 69 patients with SSc, of which 42 underwent a detailed dietary assessment. Dietary factors were connected to body composition and digestive symptoms. We found high sodium intake and frequent suboptimal energy consumption in our study group, including patients with cardiopulmonary involvement. Liver transaminases were inversely correlated with the consumption of nuts and seeds. Malnutrition and weight loss were significantly associated with pulmonary hypertension, heart failure, albumin levels, and the extent of skin fibrosis, but not advanced age. Although the patients with EUSTAR-AI ? 2.5 were more frequently included in the moderate and high malnutrition risk categories, these results did not reach statistical significance.
CONCLUSIONS:
Currently, there is an unmet need for longitudinal and interventional research focusing on the long-term significance, ramifications, and management of nutritional impairment in SSc patients with various clinical manifestations. Our results indicate that scleroderma patients could benefit from personalized nutritional counseling in an interdisciplinary setting.
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Characteristics of Children Likely to Have Spontaneous Resolution of Obstructive Sleep Apnea: Results from the Childhood Adenotonsillectomy Trial (CHAT).
Children (Basel)2021 Oct;8(11):. doi: 980.
Magnusdottir Solveig, Hilmisson Hugi, Raymann Roy J E M, Witmans Manisha,
Abstract
OBJECTIVE:
To evaluate if cardiopulmonary coupling (CPC) calculated sleep quality (SQI) may have a role in identifying children that may benefit from other intervention than early adenotonsillectomy (eAT) in management of obstructive sleep apnea (OSA).
METHODS:
A secondary analysis of electrocardiogram-signals (ECG) and oxygen saturation-data (SpO) collected during polysomnography-studies in the prospective multicenter Childhood Adenotonsillectomy Trial (CHAT) to calculate CPC-SQI and apnea hypopnea index (AHI) was executed. In the CHAT, children 5-9 years with OSA without prolonged oxyhemoglobin desaturations were randomly assigned to adenotonsillectomy (eAT) or watchful waiting with supportive care (WWSC). The primary outcomes were to document change in attention and executive function evaluated with the Developmental Neuropsychological Assessment (NEPSY). In our analysis, children in the WWSC-group with spontaneous resolution of OSA (AHI
RESULTS:
Of the 227 children randomized to WWSC, 203 children had available data at both baseline and 7-month follow-up. The group that showed resolution of OSA at month 7 ( = 43, 21%) were significantly more likely to have high baseline SQI 79.96 [CI 75.05, 84.86] vs. 72.44 [CI 69.50, 75.39], = 0.005, mild OSA AHI 4.01 [CI 2.34, 5.68] vs. 6.52 [CI 5.47, 7.57], = 0.005, higher NEPSY-attention-executive function score 106.22 [CI 101.67, 110.77] vs. 101.14 [CI 98.58, 103.72], = 0.038 and better quality of life according to parents 83.74 [CI 78.95, 88.54] vs. 77.51 [74.49, 80.53], = 0.015. The groups did not differ when clinically evaluated by Mallampati score, Friedman palate position or sleep related questionnaires.
CONCLUSIONS:
Children that showed resolution of OSA were more likely to have high-SQI and mild OSA, be healthy-weight and have better attention and executive function and quality of life at baseline. As this simple method to evaluate sleep quality and OSA is based on analyzing signals that are simple to collect, the method is practical for sleep-testing, over multiple nights and on multiple occasions. This method may assist physicians and parents to determine the most appropriate therapy for their child as some children may benefit from WWSC rather than interventions. If the parameters can be used to plan care a priori, this would provide a fundamental shift in how childhood OSA is diagnosed and managed.
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Determining Factors for Independent Walking in Patients Undergoing Cardiovascular Surgery: Differences between Coronary Artery Bypass Grafting, Heart Valve Surgery, and Aortic Surgery.
Healthcare (Basel)2021 Oct;9(11):. doi: 1475.
Sakamoto Yui, Morimoto Yosuke, Hanada Masatoshi, Yano Yudai, Sawai Terumitsu, Miura Takashi, Eishi Kiyoyuki, Kozu Ryo,
Abstract
Physical deconditioning often occurs during the acute phase after cardiovascular surgery, and unassisted walking is required to achieve independence, to manage cardiac diseases, and to prevent recurrences. This study aims to investigate the characteristics of independent walking after cardiovascular surgery. We conducted a retrospective cohort study in patients who underwent cardiovascular surgeries (total of 567 patients): 153 in the coronary artery bypass grafting (CABG) group, 312 in the heart valve surgery group, and 102 in the aortic surgery group. We evaluated the effect of each surgery group on the cardiac rehabilitation (CR) progression. The factors associated with independent walking were age, renal diseases, intensive care unit (ICU) length of stay, and post-operative respiratory complications in the CABG group. In the heart valve surgery group, the factors were New York Heart Association functional classification, renal and respiratory diseases, ICU length of stay, duration of mechanical ventilatory support, and post-operative cardiovascular and respiratory complications. In the aortic surgery group, these were ICU length of stay and acute kidney injury. The CR progression in patients who underwent aortic surgery was significantly longer than those who underwent CABG and heart valve surgery (
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