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Pubblicazioni recenti - cardiopulmonary
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Pathophysiological effects of intravenous phosphodiesterase type 4 inhibitor in addition to surfactant lavage in meconium-injured newborn piglet lungs.
Pediatr Pulmonol2020 Jun;():. doi: 10.1002/ppul.24880.
Chen Wei-Yu, Lin Chih-Hsueh, Lee Yu-Sheng, Tsao Pei-Chen, Jeng Mei-Jy,
Abstract
BACKGROUND:
Nonsteroidal anti-inflammatory drugs such as selective phosphodiesterase type 4 (PDE4) inhibitors have potential anti-inflammatory and respiratory smooth muscle relaxation effects. This study aimed to investigate the pathophysiological effects of an intravenous PDE4 inhibitor (rolipram) and surfactant lavage (SL) in a newborn piglet model of meconium aspiration syndrome (MAS).
METHODS:
MAS was induced in 25 newborn piglets, which were randomly divided into control and four SL treatment groups administered with different doses of intravenous rolipram (0, 0.1, 0.5, and 1 mg/kg). Cardiopulmonary variables were monitored and recorded. The experimental time was 4 h. Serial blood was drawn for blood gas and biomarker analyses. Lung tissue was examined for histological analysis.
RESULTS:
All SL-treated groups revealed improved oxygenation during the 4-h experiments and had significantly lower peak inspiratory pressure levels than the control group at the end of experiments. All SL plus rolipram-treated groups exhibited significantly higher lung compliance than the control group. However, the animals receiving high-dose (0.5 and 1.0 mg/kg) rolipram demonstrated significantly elevated heart rates. Lung histology of the non-dependent sites revealed significantly lower lung injury scores in all SL-treated groups compared with that in the control group, but there were no differences among the rolipram-treated groups.
CONCLUSIONS:
In addition to SL, intravenous PDE4 inhibitors may further improve lung compliance in treating MAS; however, it is necessary to consider cardiovascular adverse effects, primarily tachycardia. Further investigations are required before the clinical application of intravenous PDE4 inhibitor as an anti-inflammatory agent to treat severe MAS. This article is protected by copyright. All rights reserved.
This article is protected by copyright. All rights reserved.
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TEG PlateletMapping assay results may be misleading in the presence of cold stored platelets.
Transfusion2020 Jun;():. doi: 10.1111/trf.15753.
Scorer Thomas G, FitzGibbon Lucy, Aungraheeta Riyaad, Sharma Umang, Peltier Grantham C, McIntosh Colby S, Reddoch-Cardenas Kristin M, Meyer Andrew, Cap Andrew P, Mumford Andrew D,
Abstract
BACKGROUND:
Viscoelastic tests (VETs) are used widely to monitor hemostasis in settings such as cardiac surgery. There has also been renewed interest in cold stored platelets (CSPs) to manage bleeding in this setting. CSPs are reported to have altered hemostatic properties compared to room temperature platelets (RTPs), including activation of GPIIb/IIIa. We investigated whether the functional differences between CSP and RTP affected the performance of the PlateletMapping VET on the TEG 5000 and 6s analyzer.
METHOD:
Platelet concentrates were divided equally into CSP (stored at 4°C?±?2°C) and RTP (stored at 22°C?±?2°C) fractions. Whole blood was treated to induce platelet dysfunction (WBIPD) by incubating with anti-platelet drugs (1.0 ?M ticagrelor and 10 ?M aspirin) or by simulating cardiopulmonary bypass. WBIPD samples were then mixed with 20% by volume of CSPs or RTPs to model platelet transfusion before analysis using the PlateletMapping VET.
RESULTS:
Addition of CSPs to WBIPD increased the PlateletMapping MA and MA parameters with the TEG 5000 analyzer (both p?
DISCUSSION:
The PlateletMapping MA and MA test results may be misleadingly high with CSPs, particularly with the TEG 5000 analyzer, most likely due to constitutive activation of GPIIb/IIIa on CSPs during storage. TEG PlateletMapping results should be interpreted with caution following CSP transfusion.
© 2020 Crown copyright.Transfusion © 2020 AABB.
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Management of primary skin cancer during a pandemic: Multidisciplinary recommendations.
Cancer2020 Jun;():. doi: 10.1002/cncr.32969.
Baumann Brian C, MacArthur Kelly M, Brewer Jerry D, Mendenhall William M, Barker Christopher A, Etzkorn Jeremy R, Jellinek Nathaniel J, Scott Jeffrey F, Gay Hiram A, Baumann John C, Manian Farrin A, Devlin Phillip M, Michalski Jeff M, Lee Nancy Y, Thorstad Wade L, Wilson Lynn D, Perez Carlos A, Miller Christopher J,
Abstract
During the coronavirus disease 2019 (COVID-19) pandemic, providers and patients must engage in shared decision making regarding the pros and cons of early versus delayed interventions for localized skin cancer. Patients at highest risk of COVID-19 complications are older; are immunosuppressed; and have diabetes, cancer, or cardiopulmonary disease, with multiple comorbidities associated with worse outcomes. Physicians must weigh the patient's risk of COVID-19 complications in the event of exposure against the risk of worse oncologic outcomes from delaying cancer therapy. Herein, the authors have summarized current data regarding the risk of COVID-19 complications and mortality based on age and comorbidities and have reviewed the literature assessing how treatment delays affect oncologic outcomes. They also have provided multidisciplinary recommendations regarding the timing of local therapy for early-stage skin cancers during this pandemic with input from experts at 11 different institutions. For patients with Merkel cell carcinoma, the authors recommend prioritizing treatment, but a short delay can be considered for patients with favorable T1 disease who are at higher risk of COVID-19 complications. For patients with melanoma, the authors recommend delaying the treatment of patients with T0 to T1 disease for 3 months if there is no macroscopic residual disease at the time of biopsy. Treatment of tumors ?T2 can be delayed for 3 months if the biopsy margins are negative. For patients with cutaneous squamous cell carcinoma, those with Brigham and Women's Hospital T1 to T2a disease can have their treatment delayed for 2 to 3 months unless there is rapid growth, symptomatic lesions, or the patient is immunocompromised. The treatment of tumors ?T2b should be prioritized, but a 1-month to 2-month delay is unlikely to worsen disease-specific mortality. For patients with squamous cell carcinoma in situ and basal cell carcinoma, treatment can be deferred for 3 months unless the individual is highly symptomatic.
© 2020 American Cancer Society.
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Inflammation, immunity, and vascular remodeling in pulmonary hypertension; Evidence for complement involvement?
Glob Cardiol Sci Pract2020 Apr;2020(1):e202001. doi: 10.21542/gcsp.2020.1.
Frid Maria G, Thurman Joshua M, Hansen Kirk C, Maron Bradley A, Stenmark Kurt R,
Abstract
Pulmonary (arterial) hypertension (PH/PAH) is a life-threatening cardiopulmonary disorder. Experimental evidence suggests involvement of inflammatory and autoimmune processes in pathogenesis of PH/PAH, however the triggering and disease-promoting mechanisms remain unknown. The complement system is a key arm of innate immunity implicated in various pro-inflammatory and autoimmune diseases, yet, surprisingly little is known about the role of complement in PH/PAH pathogenesis. The preponderance of the existing data associates complement with PH/PAH via analysis of plasma and does not study the lung directly. Therefore, we aimed to resolve this by analyzing both the mechanisms of local lung-specific complement activation and the correlation of dysregulated plasma complement to clinical outcome in PAH patients. In our recent studies, reviewed herein, we show, for the first time, that immunoglobulin-driven activation of the complement cascade, specifically its alternative pathway, in the pulmonary perivascular areas, is a key mechanism initiating pro-inflammatory processes in the early stage of experimental hypoxic PH (a form of "sterile inflammation"). In human patients with end-stage PAH, we have demonstrated that perivascular deposition of immunoglobulin G (IgG) and activation of the complement cascade are "longitudinally" persistent in the disease. We also showed, using unbiased network analysis, that plasma complement signaling, including again the Alternative pathway, is a prognostic factor of survival in patients with idiopathic PAH (IPAH). Based on these initial findings, we suggest that vascular-specific, immunoglobulin-driven dysregulated complement signaling triggers and maintains pulmonary vascular remodeling and PH. Future experiments in this area would facilitate discoveries on whether complement signaling can serve both as a biomarker and therapeutic target in PH/PAH.
Copyright ©2020 The Author(s).
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Plasma antioxidants and oxidative stress status in obese women: correlation with cardiopulmonary response.
PeerJ2020 ;8():e9230. doi: 10.7717/peerj.9230.
Adenan Dyg Mastura, Jaafar Zulkarnain, Jayapalan Jaime Jacqueline, Abdul Aziz Azlina,
Abstract
Introduction:
A high body fat coupled with low cardiopulmonary fitness and an increase in oxidative stress has been connoted as contributing factors in developing cardiovascular comorbidities. This study aimed to investigate the correlation between antioxidants and oxidative stress status with cardiopulmonary responses in women of different body mass index (BMI).
Subjects and Methods:
Eighty female adults were recruited and divided into three groups; normal weight ( = 23), overweight ( = 28) and obese ( = 29), according to their BMI. Blood samples were obtained prior to cardiopulmonary exercise testing. Plasma samples were separated by centrifugation and analysed for enzymatic antioxidant activity including catalase, glutathione peroxidase and superoxide dismutase. Non-enzymatic antioxidant activities were assessed using 2, 2'-azino-bis (3-ethylbenzothiazoline-6-sulphonic acid) (ABTS) radical scavenging and ferric reducing ability of plasma (FRAP) assays. To evaluate the oxidative stress status of subjects, levels of reactive oxygen species and malondialdehyde, the by-product of lipid peroxidation, were measured. Cardiopulmonary responses were analysed using cardiopulmonary exercise testing (CPET) which involved 15 various parameters such as peak oxygen consumption, metabolic equivalents and respiratory exchange ratio.
Results:
The obese group had significantly lower ABTS radical scavenging and FRAP activities than the normal weight group. A higher catalase activity was observed in the obese group than the normal weight group. Spearman's correlation showed an inverse relationship between catalase and peak oxygen consumption, while partial correlation analysis showed inverse correlations between superoxide dismutase and respiratory frequency, ABTS activity and oxygen pulse, and between ABTS activity and cardiac output.
Conclusion:
Our results demonstrate a lower cardiovascular fitness and antioxidant capacity in obese women; the higher catalase activity may be a compensatory mechanism. The negative correlations found between these two parameters may indicate the potential effect of antioxidants on the cardiopulmonary system and deserve further analysis in a larger population. Nevertheless, this study provides the basis for future studies to further explore the relationships between redox status and cardiopulmonary responses. This can potentially be used to predict future risk of developing diseases associated with oxidative stress, especially pulmonary and cardiovascular diseases.
©2020 Adenan et al.
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Major liver trauma post-mechanical cardiopulmonary resuscitation-the first reported case of survival with normal cardiovascular and neurological outcome.
Oxf Med Case Reports2020 Apr;2020(4):omz144. doi: 10.1093/omcr/omz144.
Sharma P, Hernandez-Caballero C,
Abstract
Cardiopulmonary resuscitation (CPR) is often conducted with mechanical devices, such as Lund University Cardiac Arrest System in the setting of cardiac arrest during coronary catheterization, to enable effective chest compressions for a prolonged period. Certain injuries from such devices are common such as skin lesions, sternal and rib fractures. Others are rarer, such as visceral injury to the heart, major vessels, lung, liver, spleen and stomach. Major liver injuries have been previously reported but were universally fatal. Here, we report the first case of a capsular liver tear post-mechanical CPR, requiring immediate laparotomy and primary repair, resulting in patient survival with a normal cardiovascular and neurological and outcome.
© The Author(s) 2020. Published by Oxford University Press.
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Single-incision laparoscopic total colectomy using an organ retractor: A case report.
Ann Med Surg (Lond)2020 Jul;55():101-105. doi: 10.1016/j.amsu.2020.04.032.
Ishimaru Kazuhide, Tominaga Tetsuro, Nonaka Takashi, Hisanaga Makoto, Fukuda Akiko, Yoshimoto Takafumi, Takei Daiki, Hidaka Shigekazu, Sawai Terumitsu, Nagayasu Takeshi,
Abstract
Introduction:
Single-incision laparoscopic surgery (SILS) has benefits, including less postoperative pain, a shorter incision, and improved cosmesis. However, SILS is technically difficult because of the limited movement. An organ retractor is an instrument that has the potential to overcome these limitations.
Presentation of case:
An 85-year-old woman with hematochezia was referred to our hospital. Emergency endoscopy showed diverticulosis of the entire colon and active bleeding from the ascending colon. Despite endoscopic clipping, the bleeding continued. SILS total colectomy using an organ retractor was performed due to uncontrollable diverticular bleeding. A 3-cm incision was placed in the umbilicus, and three conventional ports were inserted into the single umbilical incision. An organ retractor was used for hepatocolic ligament transection, transection of the ileocolic vessels, and transection of the mesentery of the sigmoid colon. For each transection, the tension was adjusted to provide a good operative view. The patient's postoperative course was uneventful.
Conclusion:
An organ retractor was effective for SILS total colectomy to maintain an adequate operative view, which enabled safe dissection.
© 2020 Published by Elsevier Ltd on behalf of IJS Publishing Group Ltd.
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Spirometry, cardiopulmonary exercise testing and the six-minute walk test results in sarcoidosis patients.
Sarcoidosis Vasc Diffuse Lung Dis2020 ;36(3):185-194. doi: 10.36141/svdld.v36i3.7663.
Arda Kiani, Alireza Eslaminejad, Mohsen Shafeipour, Fatemeh Razavi, Seyyed Reza Seyyedi, Babak Sharif-Kashani, Habib Emami, Mehrdad Bakhshayesh-Karam, Atefeh Abedini,
Abstract
Background:
The 6-minute walking test, cardiopulmonary exercise testing, and spirometry are useful tools for evaluation of respiratory impairment and functional capacity in patients with lung disease. Sarcoidosis is a multisystem granulomatous disease of unknown etiology.
Objectives:
Since the pulmonary involvement can affect the quality of life in sarcoidosis patients, this study is aimed to evaluate the tests mentioned above in order to examine the functional capacity of sarcoidosis patients in different stages as well as the cause of exercise intolerance.
Methods:
This cross-sectional study was carried out on 50 Iranian patients with sarcoidosis. Patients were classified into three groups based on the findings of the chest radiography as well as the pulmonary CT scan, reported by an expert radiologist. Pulmonary, cardiac, and activity function have been evaluated in the patients, using cardiopulmonary exercise testing, the 6-minutes walking test, and spirometry.
Results:
In cardiopulmonary exercise testing, percent-predicted peak VO (57.75±15.49, p=0.015) and percent-predicted O pulse (70.54±17.37, p=0.013) were significantly lower in the third group, in comparison with the others. Also, VE/CO (AT) (34.99±5.67, p=0.000) was significantly higher in the third group, in comparison with the other ones. Percent-predicted VO showed a strong positive correlation with age (r=0.377, p=0.009), TSH (r= 0.404, p=0.007), and percent-predicted FVC (r=0.443, p=0.002). In addition, O pulse had a positive correlation with BMI (r=0.324, p=0.026), percent-predicted FVC (r=0.557, p= 0.000), and percent-predicted FEV (r=0.316, p=0.032).
Conclusions:
According to this study, ventilatory limitation, pulmonary involvement, and deconditioning are the main causes of activity limitations in sarcoidosis patients.
Copyright: © 2020.
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Twenty Years of Repair of Ventricular Septal Defects in Ghana.
West Afr J Med;37(3):281-283.
Tamatey M N, Tettey M M, Edwin F, Aniteye E A, Entsua-Mensah K, Gyan B, Adzamli I K, Offei-Larbi G, Sereboe L A, Frimpong-Boateng K,
Abstract
BACKGROUND:
Ventricular Septal Defect (VSD) is the commonest congenital heart disease. Without appropriate treatment, it is associated with significant morbidity and mortality. Surgical repair under cardiopulmonary bypass has been the standard treatment. Results of such treatment is not readily available from the West African sub region. We analysed the outcome of surgical repair of VSDs carried out in this Centre over a 20-year period.
PATIENTS AND METHODS:
A retrospective study was done for all patients who had surgical repair of VSD from January 1993 to December 2012.
RESULTS:
There were a total of 207 patients, with 6 and 23 of them operated on in the first and last years of the study respectively. There were 121 (58.5%) males and 86 (41.5%) females. The mean age was 10.0 ± 10.5 (11 months - 55 years), with a median of 7 years. The modal class interval was 0 - 5 years (46.4%). Most of the VSDs were perimembranous 168 (81.1%), followed by outlet VSDs 19 (9.2%), muscular VSDs 11 (5.3%) and inlet VSDs 9 (4.4%). Fifty-four cases (26%) had associated congenital cardiac anomalies that needed concomitant surgical intervention, with the commonest being Pulmonary Stenosis (PS) 21 (10.1%), followed by Patent Ductus Ateriosus (PDA) 10 (4.8%). The complication rate was 6.4% (13 cases), comprising a morbidity of 4.4 % (9 cases) and early mortality of 2.0% (4 cases). The morbidity was due to bleeding requiring re-exploration 2 (1.0%), residual VSD requiring re-do 3 (1.4%), complete heart block requiring permanent pacemaker implantation 2 (1.0%), acute renal failure requiring dialysis 1 (0.5%), sternal wound infection requiring debridement 1 (0.5%). The mortality was due to pulmonary hypertension.
CONCLUSION:
With a morbidity of 4.4% and early mortality of 2.0%, the outcome of surgical repair of VSDs from this study is good. Children with VSDs must be offered repair as soon as possible to avoid the numerous complications that usually follow untreated VSDs.
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[Cardiac Tamponade by Chest Compression at Cardiopulmonary Resuscitation;Report of a Case].
Kyobu Geka2020 Jun;73(6):437-440.
Hirai Yasutaka, Oh Unsou,
Abstract
We report a case of right ventricular rupture caused by sternal bone fracture following chest compression at cardiopulmonary resuscitation (CPR). A 68-year-old man presented with syncope and was referred to our hospital in an ambulance. Ventricular fibrillation was confirmed by electrocardiography(ECG), and CPR was performed with chest compression. He was resuscitated and his ECG showed ST elevation. He immediately underwent percutaneous coronary intervention to the right coronary #1 which was subtotally occluded. Thereafter, massive cardiac tamponade was noted by echocardiography, and coronary injury or left ventricle( LV) rupture was suspected. Emergency exploratory surgery was performed through median sternotomy. Laceration of the right ventricle corresponding to the sternal bone fracture was found intraoperatively. We repaired the injury and he was discharged without complication. The possibility of iatrogenic cardiac tamponade should be considered when a resuscitated patient by chest compression develops hypotension.
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[Unilateral Pulmonary Edema during Aortic Valve Replacement through Median Sternotomy].
Kyobu Geka2020 Jun;73(6):417-422.
Toyama Masashi, Nakayama Masato, Fujita Yasuaki, Shimazu Shuzo, Sawasaki Takako,
Abstract
Unilateral pulmonary edema (UPE) has been reported as a re-expansion pulmonary edema that occurs following rapid re-expansion of a collapsed lung in a patient with pneumothorax or large volume of pleural fluid. Recently, UPE after minimally invasive cardiac surgery through right-sided thoracotomy has received considerable attention because of its increasing morbidity and mortality. However, development of UPE in patients undergoing cardiac surgery through median sternotomy has not generally been recognized. Herein, we present our experience of UPE of the right lung after aortic valve replacement through median sternotomy. UPE may reflect ventilation-induced lung injury in concomitant systemic inflammation by cardiopulmonary bypass. Heterogeneity of lung collapse and wide pleural opening, which induced lung overdistension during recruitement, were considered to be associated with the occurrence of UPE in this case. Preventive measures should be considered for patients with multiple risk factors, and a meticulous recruitment maneuver is required for lung re-expansion during cardiac surgery.
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[Analysis of Basic Life Support Training Provided to Pharmacy Students Using Feedback Device].
Yakugaku Zasshi2020 ;140(6):819-825. doi: 10.1248/yakushi.20-00005.
Maruyama Keiji, Takeuchi Yasuo, Ohkura Naoki, Kihara-Negishi Fumiko, Akiyama Nobu, Kaneko Ichiro,
Abstract
The quality of chest compression affects survival after sudden cardiac arrest, particularly when it occurs out of hospital. Pharmacy students should acquire basic life support skills as part of the model core curriculum of pharmacy education. Here, we trained first-year students at the Faculty of Pharmacy to deliver cardiopulmonary resuscitation and used a manikin with a real-time feedback device that quantified chest compression skills. Students were classified into shallow compressions (SC; <50 mm) and deep compressions (DC; ?50 mm) groups based on the depth of chest compressions measured prior to training. After training, the mean compression depth (mm) was significantly shallower for the SC, than the DC group and many students in the SC group did not reach a depth of 50 mm. Similarly, students were classified into slow compression rate (SR; ?120/min) and rapid compression rate (RR; >120/min) groups based on the results of training in the rate of chest compressions. Significant differences in mean compression rates were not found between the groups. However, correct compression rate (%), the percentage of maintaining 100-120 compression/min was significantly higher in the SR, than in the RR group. Chest compression rates correlated with compression depth, and chest compression tended to be too shallow in group that was too fast. The quality of chest compression might be improved by delivering chest compressions at a constant rate within the recommended range.
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Effect of robot-assisted surgery on anesthetic and perioperative management for minimally invasive radical prostatectomy under combined general and epidural anesthesia.
J Nippon Med Sch2020 May;():. doi: 10.1272/jnms.JNMS.2021_88-304.
Kishikawa Hiroaki, Suzuki Norihito, Suzuki Yasutomo, Hamasaki Tsutomu, Kondo Yukihiro, Sakamoto Atsuhiro,
Abstract
BACKGROUND:
Robot-assisted surgery and pure laparoscopic surgery are available for minimally invasive radical prostatectomy (MIRP). The differences in anesthetic management between the two MIRPs under combined general and epidural anesthesia (CGEA) remain unknown. This study therefore aimed to determine the effects of robot-assisted surgery on anesthetic and perioperative management for MIRP under CGEA.
METHODS:
A retrospective observational study was performed by obtaining data from the patients' electronic medical records. Demographic data, intraoperative parameters, postoperative complications, and hospital stays after the MIRPs were compared between patients who underwent robot-assisted laparoscopic radical prostatectomy (RALP) and those with pure laparoscopic radical prostatectomy (LRP).
RESULTS:
There were no differences in the patients' background data between the 102 who underwent RALP and 112 who underwent LRP. Anesthesia and surgical times were shorter in the RALP group than in the LRP group. Consumption of anesthetics, including intravenous opioids, and epidural ropivacaine, was less in the RALP group. Although the estimated blood loss and volume of colloid infusion were lower in the RALP group, the volume of crystalloid infusion was larger. Intraoperative allogeneic transfusion was not required in either group. There were no differences in incidents of postoperative cardiopulmonary complications or postoperative nausea and vomiting (PONV) in either MIRP group. Hospital stays after the procedure were shorter in the RALP group.
CONCLUSIONS:
Robot-assisted surgery required varied consumption of anesthetics and infusion management during MIRP under GCEA. It also shortened the postoperative hospital stay without increasing the rates of postoperative complications.
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Comparison of three autotransfusion devices for utilization in the pediatric population.
Perfusion2020 May;():267659120921090. doi: 10.1177/0267659120921090.
Melchior Richard W, Dreher Molly, Shade Brandon, Chappell Alexander, Fisher Douglas, Rosenthal Tami,
Abstract
INTRODUCTION:
A device that may help attenuate the amount of homologous blood product given to pediatric cardiac surgical patients is the autotransfusion device. Three separate autotransfusion devices were selected for evaluation. The Sorin Xtra, Fresenius Continuous Autotransfusion System Plus (CATS), and the Fresenius Continuous Autotransfusion System Smart (CATSmart) were evaluated based on the mechanical processes of each device, hematocrit value of the salvaged packed red cell product, time of processing, and the advantageous accessories with each device.
METHODS:
Each of the autotransfusion devices were used to collect salvageable blood from the surgical field as well as to process residual blood from the cardiopulmonary bypass circuit after decannulation. The cell salvage process was performed in accordance with the manufacturer's instructions for use and the recommended settings for processing and washing. The Sorin Xtra device had the 55?mL bowl set up for all cases, while the Fresenius continuous autotransfusion systems utilized the standard disposable for each device.
RESULTS:
Each cell salvage device was employed during 30 pediatric cardiac surgery procedures, and data for each device, was broken down into four groups based on patient weight (0-10, 10-20, 20-40, and >40?kg). For all patient sizes, the Sorin Xtra tended to produce the greatest volume of cell saver product (55-825?mL) as compared to the CATS and CATSmart devices (7-550?mL and 0-860?mL, respectively). The Continuous Autotransfusion System Smart tended to produce the highest hematocrit product, ranging from 44 to 81%.
DISCUSSION:
Through this evaluation, it was determined the continuous autotransfusion systems provided the highest hematocrit with the lowest recovered packed red cell volume, while the Sorin Xtra packed red cell product showed to have a lower hematocrit with a larger packed red cell volume. Each device proved effective within our pediatric population.
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Acute neuroradiological, behavioral, and physiological effects of nose-only exposure to vaporized cannabis in C57BL/6 mice.
Inhal Toxicol2020 Jun;():1-18. doi: 10.1080/08958378.2020.1767237.
Farra Yasmeen M, Eden Matthew J, Coleman James R, Kulkarni Praveen, Ferris Craig F, Oakes Jessica M, Bellini Chiara,
Abstract
The rapid increase of cannabis consumption reinforces the need to elucidate the health hazards of this practice. The presence of fine particulate matter in cannabis smoke and vapor poses a major concern, as it may contribute to cardiopulmonary disease. To facilitate the assessment of risks associated with cannabis inhalation, we developed and characterized a method for exposing mice to cannabis in a way that mimics the delivery of the drug to the airways of smokers. Cannabis (10.3% THC, 0.05% CBD) was vaporized to generate aerosols with a reproducible particle profile. Aerosols were acutely delivered to male, adult C57BL/6 mice via a nose-only exposure system. Serum THC levels were measured for increasing cannabis doses. Blood pressure and heart rate were recorded at baseline and following exposure. Behavioral response to cannabis inhalation in the open field was documented. Awake neurological activity upon cannabis exposure was monitored using BOLD fMRI. Cannabis aerosols contained particles with count median diameter of 243?±?39?nm and geometric standard deviation of 1.56?±?0.06. Blood serum THC levels increased linearly with aerosolized mass and peaked at 136?±?5?ng/mL. Cannabis inhalation decreased heart rate and blood pressure but promoted anxiety-like behavior. Observed differences in BOLD activation volumes linked cannabis to increased awareness to sensory stimuli and reduced behavioral arousal. Quantified physiological, behavioral, and neurological responses served as validation for our mouse model of cannabis inhalation. Animal models of aerosol exposure will be instrumental for uncovering the health outcomes of chronic cannabis use.
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Performance and Interpretation of Invasive Hemodynamic Exercise Testing.
Chest2020 May;():. doi: S0012-3692(20)31617-2.
Jain C Charles, Borlaug Barry A,
Abstract
Exertional dyspnea is a common complaint for patients seen in pulmonary, cardiac and general medicine clinics, and elucidating the cause is often challenging, particularly when physical examination, echocardiography, radiography and pulmonary function test results are inconclusive. Invasive cardiopulmonary exercise testing (CPET) has emerged as the gold standard test to define causes of dyspnea and exertional limitation in this population. In this review, we describe the methods for performing and interpreting invasive CPET, with particular attention to the hemodynamic and blood sampling data as they apply to patients being evaluated for heart failure and pulmonary hypertension.
Copyright © 2020. Published by Elsevier Inc.
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Challenging report of cardiopulmonary bypass in 16th week pregnant patient with endoventricular mass.
Heart Lung2020 May;():. doi: S0147-9563(20)30233-8.
Pilato Emanuele, Pinna Giovanni Battista, Grande Loredana, Cirillo Vera, Izzo Raffaele, Tufano Antonella, Guida Maurizio, Sarno Laura, Browning Rosie, Comentale Giuseppe,
Abstract
BACKGROUND:
Pregnancy usually represents a risk factor for aortic dissection or thrombotic events, but therapeutic options are very scarce because the foetus limits the common approaches especially in the early stages of pregnancy.
CASE PRESENTATION:
We present a challenging case of a young woman in her 16th week of gestation with an history of multiple abortions associated with autoimmune thrombophilia. A strictly designed perioperative management protocol was required to remove a huge right endoventricular mass, due to her decision to not terminate the pregnancy.
CONCLUSIONS:
Nowadays the mother, completely healthy, gived birth to her baby so it demonstrates how cardiac surgery, even in complicated circumstances, can be feasible during pregnancy through a multidisciplinary approach.
Copyright © 2020 Elsevier Inc. All rights reserved.
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Supportive Therapy: Extracorporeal Membrane Oxygenation.
Crit Care Clin2020 Jul;36(3):517-529. doi: S0749-0704(20)30018-X.
Bazan Vanessa M, Rodgers-Fischl Peter, Zwischenberger Joseph B,
Abstract
Acute high-risk pulmonary embolism (PE) is characterized by life-threatening hemodynamic instability that may lead to refractory cardiac arrest. Recently, extracorporeal membrane oxygenation (ECMO) has been used to provide primary cardiopulmonary support for select high-risk PE patients or before surgical embolectomy. This article reviews the growing body of literature regarding ECMO support of acute high-risk PE.
Copyright © 2020 Elsevier Inc. All rights reserved.
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The propofol-sparing effect of intravenous lidocaine in elderly patients undergoing colonoscopy: a randomized, double-blinded, controlled study.
BMC Anesthesiol2020 May;20(1):132. doi: 10.1186/s12871-020-01049-z.
Chen Mengmeng, Lu Yi, Liu Haoran, Fu Qingxia, Li Jun, Wu Junzheng, Shangguan Wangning,
Abstract
BACKGROUND:
Propofol provides a prominent sedation effect in colonoscopy. However, anesthesia and sedation induced with propofol in the elderly might result in cardiopulmonary complications, especially when it is combined with opoids in the regimen. This study aimed to test the hypothesis that the addition of intravenous lidocaine to propofol-based sedation could decrease the overall propofol requirement in elderly patients during colonoscopy while the procedural sedation satisfaction and the hemodynamic stability were not compromised.
METHODS:
Ninety-two patients undergoing colonoscopy were randomly enrolled into lidocaine+propofol (L?+?P) group or normal saline+propofol (NS?+?P) groups. Subjects received intravenous bolus of 1.5?mg/kg lidocaine followed by 4?mg?kg?h lidocaine continuous infusion in L?+?P group or equivalent volumes of normal saline for boluses and infusion in NS?+?P group. Anesthesia was induced with 2.5??g sufentanil followed by injection of 1.2?mg?kg propofol in all patients. A single supplemental bolus of 0.6?mg?kg propofol was administered whenever MOAA/S score?>?1 or had body movement during the colonoscopy. The recorded primary endpoints included: the total amount of propofol administered during entire procedure, the supplemental amount of propofol after induction, and the frequencies of boluses of supplemental propofol.
RESULTS:
A total of 79 patients were included in the final analysis. Compared with NS?+?P group, the total amounts of propofol (induction plus supplemental) were no significant differences in L?+?P group; however, the required supplemental propofol was less (69.9?±?39.2?mg vs. 51.5?±?38.6?mg) (P?=?0.039); the average frequencies of boluses of supplemental propofol given after induction were lower (2.1?±?1.1 vs. 1.4?±?0.9) (P?=?0.003); the calculated "unit propofol" infusion rate was lower (0.18?±?0.05 vs. 0.14?±?0.04?mg?kg?min) (P?=?0.002).
CONCLUSIONS:
The addition of intravenous lidocaine to propofol-based sedation resulted in a remarked reduction of supplemental propofol in the elderly during colonoscopy.
TRIAL REGISTRATION:
The present clinical trial was registered at http://www.chictr.org.cn on 11th March 2019 (registration No. ChiCTR1900021818).
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Wearable Patch Based Estimation of Oxygen Uptake and Assessment of Clinical Status during Cardiopulmonary Exercise Testing in Patients with Heart Failure.
J Card Fail2020 May;():. doi: S1071-9164(19)31644-6.
Shandhi Md Mobashir Hasan, Hersek Sinan, Fan Joanna, Sander Erica, Marco Teresa De, Heller J Alex, Etemadi Mozziyar, Klein Liviu, Inan Omer T,
Abstract
OBJECTIVE:
To estimate oxygen uptake (VO) from cardiopulmonary exercise testing (CPX) using simultaneously recorded seismocardiogram (SCG) and electrocardiogram (ECG) signals captured with a small wearable patch.
BACKGROUND:
CPX is an important risk stratification tool for patients with heart failure (HF) due to the prognostic value of the features derived from the gas exchange variables such as VO. However, CPX requires specialized equipment, as well as trained professionals to conduct the study.
METHODS:
We have conducted a total of 68 CPX tests on 59 subjects with HF with reduced ejection fraction (31% women, mean age 55±13 years, ejection fraction 0.27±0.11, 79% stage C). The subjects were fitted with a wearable sensing patch and underwent treadmill CPX. We divided the dataset into a training-testing (N=44) and a separate validation set (N=24). We developed globalized (population) regression models to estimate VO from the SCG and ECG signals measured continuously with the patch. We further classified the patients as stage D or C using the SCG and ECG features to assess the ability to detect clinical state from the wearable patch measurements alone. We developed the regression and classification model with cross-validation on the training-testing set and validated the models on the validation set.
RESULTS:
The regression model to estimate VO from the wearable features yielded a moderate correlation (R of 0.64) with a root-mean-square-error (RMSE) of 2.51±1.12 ml.kg.min on the training-testing set, whereas R and RMSE on the validation set were 0.76 and 2.28±0.93 ml.kg.min respectively. Furthermore, the classification of clinical state yielded accuracy, sensitivity, specificity, and an area under the receiver operating characteristic curve values of 0.84, 0.91, 0.64, and 0.74 respectively for the training-testing set, and 0.83, 0.86, 0.67, and 0.92 respectively for the validation set.
CONCLUSION:
Wearable SCG and ECG can assess CPX oxygen uptake and thereby classify clinical status for patients with HF. These methods may provide value in risk stratification of patients with HF by tracking cardiopulmonary parameters and clinical status outside of specialized settings, potentially allowing for more frequent assessments to be performed during longitudinal monitoring and treatment.
Copyright © 2020. Published by Elsevier Inc.
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