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Pubblicazioni recenti - cardiorespiratory
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Succeeding with rapid response systems- a never-ending process: A systematic review of how health-care professionals perceive facilitators and barriers within the limbs of the RRS.
Resuscitation2019 Sep;():. doi: S0300-9572(19)30595-7.
Olsen Siri Lerstøl, Søreide Eldar, Hillman Ken, Hansen Britt Sætre,
Abstract
BACKGROUND:
Meta-analyses show that hospital Rapid response systems (RRS) are associated with reduced rates of cardiorespiratory arrest and mortality. However, many RRS fail to provide appropriate outcomes. Thus an improved understanding of how to succeed with a RRS is crucial. By understanding the barriers and facilitators within the limbs of a RRS, these can be addressed.
OBJECTIVE:
To explore the barriers and facilitators within the limbs of a RRS as described by health-care professionals working within the system.
METHODS:
The electronic databases searched were: EMBASE, MEDLINE, CINAHL, Epistemonikos, Cochrane, PsychInfo and Web of Science. Search terms were related to RRS and their facilitators and barriers. Studies were appraised guided by the CASP tool. Twenty-one qualitative studies were identified and subjected to content analysis.
RESULTS:
Clear leadership, interprofessional trust and collaboration seems to be crucial for succeeding with a RRS. Clear protocols, feedback, continuous evaluation and interprofessional training were highlighted as facilitators. Reprimanding down the hierarchy, underestimating the importance of call-criteria, alarm fatigue and a lack of integration with other hospital systems were identified as barriers.
CONCLUSION:
To succeed with a RRS, the keys seem to lie in the administrative and quality improvement limbs. Clear leadership and continuous quality improvement provide the foundation for the continuing collaboration to manage deteriorating patients. Succeeding with a RRS is a never-ending process.
Copyright © 2019 The Author(s). Published by Elsevier B.V. All rights reserved.
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One-Year Lifestyle Intervention, Muscle Lipids, and Cardiometabolic Risk.
Med Sci Sports Exerc2019 Oct;51(10):2156-2165. doi: 10.1249/MSS.0000000000002030.
Maltais Alexandre, Lemieux Isabelle, Alméras Natalie, Tremblay Angelo, Bergeron Jean, Poirier Paul, Després Jean-Pierre,
Abstract
PURPOSE:
Low-attenuation muscle (LAM) area at mid-thigh, a computed tomography (CT)-derived index of intramuscular lipids, is associated with insulin resistance, obesity, and type 2 diabetes. The present study aimed at testing the hypothesis that changes in LAM area in trunk muscles from a single abdominal scan could provide relevant information to evaluate the effects of a lifestyle intervention without the use of a mid-thigh CT scan.
METHODS:
Cardiometabolic risk variables, including waist circumference, lipoprotein-lipid profile, glucose tolerance, and cardiorespiratory fitness, were assessed in a sample of 102 dyslipidemic viscerally obese men at baseline and after a 1-yr lifestyle intervention. Abdominal (L4-L5) and mid-thigh CT scans were performed and abdominal muscles classified as psoas and core muscles. Scans were segmented to calculate muscle areas, LAM areas, and mean attenuation values.
RESULTS:
All muscle groups showed a decrease in LAM areas (P < 0.0001) in response to the lifestyle intervention. Changes in LAM areas were significantly associated with changes in triglycerides, high-density lipoprotein (HDL) cholesterol, cholesterol/HDL cholesterol ratio and log triglycerides/HDL cholesterol ratio (mid-thigh, 0.20 ? |r| ? 0.29; psoas, 0.28 ? |r| ? 0.38; core, 0.29 ? |r| ? 0.34, P < 0.05). Changes in core LAM area were significantly associated with changes in 2-h glucose levels, glucose area measured during the oral glucose tolerance test and homeostasis model assessment of insulin resistance (0.21 ? r ? 0.34, P < 0.05). Stepwise regression analyses showed that changes in LAM psoas area were associated with changes in HDL cholesterol and the cholesterol/HDL cholesterol ratio independently from changes in visceral adiposity.
CONCLUSIONS:
Changes in trunk LAM areas are useful indices of changes in mid-thigh LAM area observed with a 1-yr lifestyle intervention. Thus, an additional mid-thigh scan is not necessary to evaluate muscle lipid content by CT when an abdominal CT scan is available.
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Structured review of post-cardiotomy extracorporeal membrane oxygenation: part 1-Adult patients.
J Heart Lung Transplant2019 Aug;():. doi: S1053-2498(19)31632-8.
Lorusso Roberto, Raffa Giuseppe Maria, Alenizy Khalid, Sluijpers Niels, Makhoul Maged, Brodie Daniel, McMullan Mike, Wang I-Wen, Meani Paolo, MacLaren Graeme, Kowalewski Mariusz, Dalton Heidi, Barbaro Ryan, Hou Xiaotong, Cavarocchi Nicholas, Chen Yih-Sharng, Thiagarajan Ravi, Alexander Peta, Alsoufi Bahaaldin, Bermudez Christian A, Shah Ashish S, Haft Jonathan, D'Alessandro David A, Boeken Udo, Whitman Glenn J R,
Abstract
Cardiogenic shock, cardiac arrest, acute respiratory failure, or a combination of such events, are all potential complications after cardiac surgery which lead to high mortality. Use of extracorporeal temporary cardio-circulatory and respiratory support for progressive clinical deterioration can facilitate bridging the patient to recovery or to more durable support. Over the last decade, extracorporeal membrane oxygenation (ECMO) has emerged as the preferred temporary artificial support system in such circumstances. Many factors have contributed to widespread ECMO use, including the relative ease of implantation, effectiveness, versatility, low cost relative to alternative devices, and potential for full, not just partial circulatory support. While there have been numerous publications detailing the short and midterm outcomes of ECMO support, specific reports about post-cardiotomy ECMO (PC-ECMO), are limited, single-center experiences. Etiology of cardiorespiratory failure leading to ECMO implantation, associated ECMO complications, and overall patient outcomes may be unique to the PC-ECMO population. Despite the rise in PC-ECMO use over the past decade, short-term survival has not improved. This report, therefore, aims to present a comprehensive overview of the literature with respect to the prevalence of ECMO use, patient characteristics, ECMO management, and in-hospital and early post-discharge patient outcomes for those treated for post-cardiotomy heart, lung, or heart-lung failure.
Copyright © 2019 International Society for Heart and Lung Transplantation. All rights reserved.
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A combination of tracheoplasty and tracheal stenting is an acceptable method of treating severe congenital tracheobronchial stenosis under extracorporeal membrane oxygenation.
J Pediatr Surg2019 Aug;():. doi: S0022-3468(19)30583-4.
Yeh Yi-Ting, Liu Chinsu, Tsai Hsin-Lin, Wu Fei-Yi, Soong Wen-Jue, Lee Yu-Sheng, Tsao Pei-Chen,
Abstract
BACKGROUND:
Congenital tracheobronchial stenosis (CTBS) is a rare congenital condition characterized by complete cartilage rings covering varying lengths of the major airway. In this study, we reviewed the outcomes of patients with CTBS receiving surgical tracheoplasty in our institute.
METHODS:
We retrospectively analyzed the outcomes of consecutive patients with CTBS operated between 2006 and 2017 when extracorporeal membrane oxygenation (ECMO) was used perioperatively.
RESULTS:
In total, 11 patients (median follow-up period, 4.2?years; interquartile range, 1.6-5.4) were included. Seven were symptomatic in the neonatal period, 10 had cardiorespiratory anomalies, 7 required preoperative bronchoscopic balloon dilatation, and 1 required preoperative stent placement. Slide tracheoplasty (STP) was performed in 9 patients, and 2 underwent pericardial patch tracheoplasty. Seven patients required postoperative balloon dilatation, and 6 required postoperative stent placement. Early stenting provided immediate ventilatory improvement in all patients and facilitated successful extubation in a median of 4?days after stenting in 80% of the patients.
CONCLUSIONS:
Under ECMO, severe CTBS could be successfully treated through a combination of tracheoplasty and bronchoscopic management. STP provided excellent results for solitary trachea stenosis with a minimum diameter of ?3?mm. In selected patients, postoperative tracheobronchial stent placement was crucial in minimizing the ECMO duration and facilitating extubation.
LEVEL OF EVIDENCE:
IV.
Copyright © 2019. Published by Elsevier Inc.
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Associations of wildfire smoke PM exposure with cardiorespiratory events in Colorado 2011-2014.
Environ Int2019 Sep;133(Pt A):105151. doi: S0160-4120(19)31740-4.
Stowell Jennifer D, Geng Guannan, Saikawa Eri, Chang Howard H, Fu Joshua, Yang Cheng-En, Zhu Qingzhao, Liu Yang, Strickland Matthew J,
Abstract
BACKGROUND:
Substantial increases in wildfire activity have been recorded in recent decades. Wildfires influence the chemical composition and concentration of particulate matter ?2.5??m in aerodynamic diameter (PM). However, relatively few epidemiologic studies focus on the health impacts of wildfire smoke PM compared with the number of studies focusing on total PM exposure.
OBJECTIVES:
We estimated the associations between cardiorespiratory acute events and exposure to smoke PM in Colorado using a novel exposure model to separate smoke PM from background ambient PM levels.
METHODS:
We obtained emergency department visits and hospitalizations for acute cardiorespiratory outcomes from Colorado for May-August 2011-2014, geocoded to a 4?km geographic grid. Combining ground measurements, chemical transport models, and remote sensing data, we estimated smoke PM and non-smoke PM on a 1?km spatial grid and aggregated to match the resolution of the health data. Time-stratified, case-crossover models were fit using conditional logistic regression to estimate associations between fire smoke PM and non-smoke PM for overall and age-stratified outcomes using 2-day averaging windows for cardiovascular disease and 3-day windows for respiratory disease.
RESULTS:
Per 1??g/m increase in fire smoke PM, statistically significant associations were observed for asthma (OR?=?1.081 (1.058, 1.105)) and combined respiratory disease (OR?=?1.021 (1.012, 1.031)). No significant relationships were evident for cardiovascular diseases and smoke PM. Associations with non-smoke PM were null for all outcomes. Positive age-specific associations related to smoke PM were observed for asthma and combined respiratory disease in children, and for asthma, bronchitis, COPD, and combined respiratory disease in adults. No significant associations were found in older adults.
DISCUSSION:
This is the first multi-year, high-resolution epidemiologic study to incorporate statistical and chemical transport modeling methods to estimate PM exposure due to wildfires. Our results allow for a more precise assessment of the population health impact of wildfire-related PM exposure in a changing climate.
Copyright © 2019 The Authors. Published by Elsevier Ltd.. All rights reserved.
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[Anesthesia in gastrointestinal endoscopy: peroral endoscopic myotomy].
Anaesthesist2019 Sep;():. doi: 10.1007/s00101-019-00655-y.
Löser B, Werner Y B, Löser A, Rösch T, Petzoldt M,
Abstract
Idiopathic achalasia is a motility disorder of the esophagus characterized by a dysfunction of the lower esophageal sphincter, which typically manifests as dysphagia. Peroral endoscopic myotomy (POEM) is an interventional endoscopic procedure for achalasia, which was introduced in 2010. Although results from randomized studies comparing short-term and long-term safety and efficacy are yet to be published, POEM is regarded to be less invasive than the standard treatment of achalasia (laparoscopic Heller myotomy). POEM is the first endoscopic procedure routinely performed with the patient under general anesthesia. During the preoperative assessment particular attention must be paid to the specific fasting intervals and the risk of aspiration during induction of anesthesia. For the purpose of temporary surgical access, the integrity of the esophageal wall is deliberately interrupted to create a long submucosal tunnel. As a result, unwanted fistulas can arise between the esophageal lumen, the mediastinum, the pleura or the intraperitoneal cavity. Endoscopically insufflated CO may escape into these surrounding compartments with subsequent systemic CO accumulation, capnomediastinum, tension capnoperitoneum or pneumothorax. As a result substantial cardiorespiratory instability can arise. Thus, the attending anesthesiologist must be familiar with these typical complications and with specific emergency measures, such as compensatory hyperventilation, percutaneous needle decompression and thoracic drainage. The POEM procedure is a therapeutic innovation and interdisciplinary challenge. However, anesthesia standards of care have not yet been specified. The aim of this review is therefore to outline some clinical recommendations for the daily clinical practice based on existing evidence.
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The effects of musical auditory stimulation on heart rate autonomic responses to driving: A prospective randomized case-control pilot study.
Complement Ther Med2019 Oct;46():158-164. doi: S0965-2299(19)30321-8.
Alves Myrela Alene, Garner David M, do Amaral Joice A T, Oliveira Fernando R, Valenti Vitor E,
Abstract
Stress induced by driving has been revealed to increase the chances of cardiovascular complications and is involved or related to traffic accidents. In order to develop strategies to avoid health problems during driving we aimed to evaluate the acute effects of auditory stimulation with music on heart rate variability (HRV) during driving in congested urban traffic. This is a prospective cross-sectional randomized controlled pilot study conducted with five healthy women. Subjects were evaluated on two different random days, whose order of execution was established through a randomization process. In the music protocol the volunteers were exposed to music for the entire 20?min of traffic while in the control protocol the subjects performed the same procedures but were not exposed to any music. We noted that all Higuchi fractal dimension parameters except Kmax 10, Kmax 130 and Kmax 140 were reduced between pre-driving in the control protocol vs. driving in the control protocol. The same changes were noted between pre-driving in the music protocol vs. driving in the control protocol. In conclusion, musical auditory stimulation improved nonlinear HRV changes induced by driving.
Copyright © 2019 Elsevier Ltd. All rights reserved.
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LVAD speed increase during exercise, which patients would benefit the most? A simulation study.
Artif Organs2019 Sep;():. doi: 10.1111/aor.13569.
Gross C, Moscato F, Schlöglhofer T, Maw M, Meyns B, Marko C, Wiedemann D, Zimpfer D, Schima H, Fresiello L,
Abstract
Patients supported with an LVAD have impaired cardiovascular adaptations during exercise, resulting in reduced total cardiac output and exercise intolerance. The aim of this study is to report associations among these impaired cardiovascular parameters and exercise hemodynamics, and to identify in which conditions an LVAD speed increase can provide substantial benefits to exercise. A cardiorespiratory simulator was used to reproduce the average hemodynamics of LVAD patients at exercise. Then, a sensitivity study was conducted where cardiovascular parameters were changed individually ±20% of their baseline value at exercise (heartrate, left/right ventricular contractility, total peripheral resistance and valve pathologies). Simulations were performed at a baseline LVAD speed of 2700 rpm and repeated at 3500 rpm to evaluate the benefits of a higher LVAD support on hemodynamics. Total cardiac output (TCO) was mostly impaired by a poor left ventricular contractility or vasodilation at exercise (-0.6 L/min), followed by a poor chronotropic response (-0.3 L/min) and by a poor right ventricular contractility (-0.2 L/min). LVAD speed increase better unloads the left ventricle and improves total cardiac output in all the simulated conditions. The most substantial benefits from LVAD speed increase were observed in case of poor left ventricular contractility (TCO +1.6 l/min) and vascular dysfunction (TCO +1.4 l/min) followed by lower heartrate (TCO +1.3 l/min) and impaired right ventricular contractility (TCO +1.1 l/min). Despite the presence of the LVAD, exercise hemodynamic is strongly depending on the ability of the cardiovascular system to adapt to exercise. A poor left ventricular inotropic response and a poor vascular function can strongly impair cardiac output at exercise. In these conditions LVAD speed increase can be an effective strategy to augment total cardiac output and unload the left ventricle. These results evidence the need to design a physiological LVAD speed controller, tailored on specific patient's needs.
© 2019 International Center for Artificial Organs and Transplantation and Wiley Periodicals, Inc.
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Doctor, ask your perimenopausal patient about her physical fitness; association of self-reported physical fitness with cardiometabolic and mental health in perimenopausal women: the FLAMENCO project.
Menopause2019 Sep;():. doi: 10.1097/GME.0000000000001384.
Aparicio Virginia A, Marín-Jiménez Nuria, Coll-Risco Irene, de la Flor-Alemany Marta, Baena-García Laura, Acosta-Manzano Pedro, Aranda Pilar,
Abstract
OBJECTIVE:
The aim of this study was to explore the association of self-reported physical fitness (PF) and its components with cardiometabolic and mental health in perimenopausal women.
METHODS:
These cross-sectional analyses included 191 participants (53?±?4 y old) from the FLAMENCO project. Self-reported PF was assessed with the International Fitness Scale (IFIS). Body mass index (BMI), fat mass (FM), waist circumference (WC), systolic and diastolic blood pressure (DBP), high-density lipoprotein cholesterol (HDL-C), triglycerides, C-reactive protein (CRP), and glucose were measured. The Beck's Depression Inventory, State-Trait Anxiety Inventory, Pittsburgh Sleep Quality Index, Life Orientation Test Revised, and Positive and Negative Affect Schedule were used to assess mental health.
RESULTS:
After adjusting for potential confounders, greater overall PF was associated with lower BMI, FM, WC (P?
CONCLUSIONS:
Self-reported PF was associated with better cardiometabolic and mental health in perimenopausal women. The IFIS might be proposed as an inexpensive, quick, and easy tool in clinical settings.
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Clues to Medieval Cardiorespiratory Physiology in the Divine Comedy.
Chest2019 Sep;156(3):637-639. doi: S0012-3692(19)31114-6.
Perciaccante Antonio, Bianucci Raffaella, Charlier Philippe, Deo Saudamini, Appenzeller Otto, Lippi Donatella,
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Impact of deep water running in interval training (DWR-IT) on body composition, functional capacity, and quality of life in overweight adults: study protocol for a randomized controlled trial.
Trials2019 Sep;20(1):562. doi: 10.1186/s13063-019-3618-7.
Pianna Bruna, Moreno Bianca Christianini, de Souza Caroline Aquino, Bôscoa Thais Fernanda, Alcalde Guilherme Eleutério, Barrile Silvia Regina, Gimenes Camila, Martinelli Bruno, Zamunér Antonio Roberto, Pessoa-Santos Bruna Varanda, Arca Eduardo Aguilar,
Abstract
BACKGROUND:
Interval training in deep water running (DWR-IT) is a training method to improve cardiovascular fitness, functional health, and quality of life and to help control body weight. Its main advantages are the reduction of joint overload and a low risk of musculoskeletal injuries. The aim of the study is to investigate the influence of DWR-IT on functional capacity, body composition, and quality of life of overweight middle-aged adults.
METHODS:
This is a randomized controlled, two-arm, open, parallel clinical trial with overweight adults. Volunteers will be allocated to a water group (WG), which will be submitted to the intervention, or a control group, which will not be subjected to any kind of intervention. The evaluation will be composed of anamnesis, electrical bioimpedance, six-minute walk test (6MWT), questionnaire on the Impact of Weight on Quality of Life-lite (IWQOL-LITE), Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale, chair stand test, arm curl test, and food frequency questionnaire. The DWR-IT will last for 12?weeks, systematically increasing the intensity and training volume.
DISCUSSION:
The objective of this clinical trial is to evaluate the effect of DWR-IT on overweight adults. The study is guided through practice based on scientific evidence for the use of training and aquatic rehabilitation. It is expected that after 12?weeks of aquatic intervention there will be a decrease in body fat by about 10%, evaluated by electrical bioimpedance, an increase of about 25% of cardiorespiratory endurance, evaluated by 6MWT, and an improvement of about 25% of physical function domains, self-esteem, distress in public places, and work, analyzed by IWQOL-LITE in the WG.
TRIAL REGISTRATION:
The study protocol was published in the Brazilian Registry of Clinical Trials (ReBEC) on June 16, 2016. Registration number: RBR-6dmh7d.
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Are Individuals Who Engage in More Frequent Self-Regulation Less Susceptible to Mental Fatigue?
J Sport Exerc Psychol2019 Sep;():1-9. doi: 10.1123/jsep.2018-0222.
Martin Kristy, Thompson Kevin G, Keegan Richard, Rattray Ben,
Abstract
The aim of this study was to investigate whether individuals who engage in more frequent self-regulation are less susceptible to mental fatigue. Occupational cognitive demand and participation in sports or exercise were quantified as activities requiring self-regulation. Cardiorespiratory fitness was also assessed. On separate occasions, participants either completed 90 min of an incongruent Stroop task (mental exertion condition) or watched a 90-min documentary (control condition). Participants then completed a cycling time-to-exhaustion (physical endurance) test. There was no difference in the mean time to exhaustion between conditions, although individual responses varied. Occupational cognitive demand, participation in sports or exercise, and cardiorespiratory fitness predicted the change in endurance performance (p = .026, adjusted R2 = .279). Only cognitive demand added significantly to the prediction (p = .024). Participants who reported higher levels of occupational cognitive demand better maintained endurance performance following mental exertion.
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The PVN Enhances Cardiorespiratory Responses to Acute Hypoxia via Input to the nTS.
Am J Physiol Regul Integr Comp Physiol2019 Sep;():. doi: 10.1152/ajpregu.00135.2019.
Ruyle Brian C, Martinez Diana, Heesch Cheryl M, Kline David D, Hasser Eileen M,
Abstract
Chemoreflex neurocircuitry includes the PVN, but the role of PVN efferent projections to specific cardiorespiratory nuclei is unclear. We hypothesized the PVN contributes to cardiorespiratory responses to hypoxia via projections to the nTS. Rats received bilateral PVN microinjections of AAV expressing inhibitory DREADD (GiDREADD) or GFP control. Efficacy of GiDREADD inhibition by the DREADD agonist Compound 21 (C21) was verified in PVN slices; C21 reduced evoked action potential discharge by reducing excitability to injected current in GiDREADD-expressing PVN neurons. We evaluated hypoxic ventilatory responses (plethysmography) and PVN and nTS neuronal activation (cFos immunoreactivity, IR) to 2 hr hypoxia (10% O) in conscious GFP and GiDREADD rats after intraperitoneal C21 injection. Generalized PVN inhibition via systemic C21 blunted hypoxic ventilatory responses and reduced PVN and also nTS neuronal activation during hypoxia. To determine if the PVN-nTS pathway contributes to these effects, we evaluated cardiorespiratory responses to hypoxia during selective PVN terminal inhibition in the nTS. Anesthetized GFP and GiDREADD rats exposed to brief hypoxia (10% O, 45s) exhibited depressor and tachycardic responses, and increased sympathetic and phrenic nerve activity. C21 was then microinjected into the nTS, followed after 60 min by another hypoxic episode. In GiDREADD but not GFP rats, PVN terminal inhibition by nTS C21 strongly attenuated the phrenic amplitude response to hypoxia. Interestingly, C21 augmented tachycardic and sympathetic responses without altering the coupling of sSNA to PhrNA during hypoxia. Data demonstrate that the PVN, including projections to the nTS, is critical in shaping sympathetic and respiratory responses to hypoxia.
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Cardiorespiratory alterations in patients undergoing hyperbaric oxygen therapy.
Rev Esc Enferm USP2019 Sep;53():e03469. doi: S0080-62342019000100471.
Martinelli Bruno, Noronha Judi Meloni, Sette Maria Fernanda Misquiatti, Santos Ieda Papille Dos, Barrile Silvia Regina, Simão José Cláudio,
Abstract
OBJECTIVE:
To evaluate cardiorespiratory alterations due to a single session of hyperbaric oxygen therapy.
METHOD:
Randomized study with patients: a control group and hyperbaric oxygen therapy. Evaluations occurred in the beginning, during, and after exposure to pure oxygen above atmosphere for 2 hours. Systemic blood pressure, peripheral oxygen saturation, pulse rate, lung volume and lung capacity, and maximal inspiratory and expiratory pressures were evaluated. Peripheral oxygen saturation, pulse rate, and systemic blood pressure were evaluated during the pressurizing in the first hour. Data were evaluated by means of ANOVA, Mann-Whitney, and independent t-test (p<0.05).
RESULTS:
A total of 14 adult patients were evaluated. In the group under therapy (seven subjects), aged: 49.57±14.59 years, there was a decrease in the pulse rate of 16 beats per minute after 35 minutes of therapy (intragroup analysis), and the peripheral oxygen saturation was higher within the same period compared to the control group.
CONCLUSION:
The hyperbaric oxygen therapy promotes cardiorespiratory alterations with the increase of the peripheral oxygen saturation and decrease of the pulse rate, without altering blood pressure levels and the strength, volumes, and respiratory capacities.
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The effects of cataract surgery on autonomic heart rate control: a prospective cross-sectional and analytical study.
Clinics (Sao Paulo)2019 ;74():e809. doi: S1807-59322019000100264.
Aoki Ricardo H, Bezerra Italla Maria Pinheiro, Almeida-Júnior Alvaro Dantas de, Barbosa Renata Thaís de A, Valenti Vitor E, Oliveira Fernando R, Roque Adriano L, Ferraz E Souza Júnior Hugo Macedo, Garner David M, Raimundo Rodrigo D, Abreu Luiz Carlos de,
Abstract
OBJECTIVES:
We aimed to evaluate the effects of cataract surgery on cardiac autonomic modulation.
METHODS:
A cross-sectional and analytical study was conducted at the Hospital Maria Braido in the city of São Caetano do Sul, São Paulo, between 2015 and 2016. We investigated 19 patients of both sexes who were all over 50 years old; all patients had a diagnosis of senile or bilateral cataracts and were recommended to undergo implantation of the intraocular lens. Heart rate variability (HRV) was evaluated before, during and after cataract surgery.
RESULTS:
There were no significant changes in the time and geometric domains of HRV before, during or after surgery. The high-frequency (HF) band in normalized units (nu) on the spectral analysis significantly increased (p=0.02, Cohen's d=0.9, large effect size). However, the low-frequency (LF) band in nu significantly decreased during surgery (p=0.02, Cohen's d=0.9, large effect size).
CONCLUSION:
Throughout the intraocular lens implantation cataract surgery, there was an increase in parasympathetic modulation and a decrease in the sympathetic component of the heart rate (HR). We propose that this result is attributable to the supine position of the patients during surgery and the trigeminal reflex.
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Changes in neurovascular coupling during cycling exercise measured by multi-distance fNIRS: a comparison between endurance athletes and physically active controls.
Exp Brain Res2019 Sep;():. doi: 10.1007/s00221-019-05646-4.
Seidel Oliver, Carius Daniel, Roediger Julia, Rumpf Sebastian, Ragert Patrick,
Abstract
It is well known that endurance exercise modulates the cardiovascular, pulmonary, and musculoskeletal system. However, knowledge about its effects on brain function and structure is rather sparse. Hence, the present study aimed to investigate exercise-dependent adaptations in neurovascular coupling to different intensity levels in motor-related brain regions. Moreover, expertise effects between trained endurance athletes (EA) and active control participants (ACP) during a cycling test were investigated using multi-distance functional near-infrared spectroscopy (fNIRS). Initially, participants performed an incremental cycling test (ICT) to assess peak values of power output (PPO) and cardiorespiratory parameters such as oxygen consumption volume (VOmax) and heart rate (HRmax). In a second session, participants cycled individual intensity levels of 20, 40, and 60% of PPO while measuring cardiorespiratory responses and neurovascular coupling. Our results revealed exercise-induced decreases of deoxygenated hemoglobin (HHb), indicating an increased activation in motor-related brain areas such as primary motor cortex (M1) and premotor cortex (PMC). However, we could not find any differential effects in brain activation between EA and ACP. Future studies should extend this approach using whole-brain configurations and systemic physiological augmented fNIRS measurements, which seems to be of pivotal interest in studies aiming to assess neural activation in a sports-related context.
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Cross-country skiing and running's association with cardiovascular events and all-cause mortality: A review of the evidence.
Prog Cardiovasc Dis2019 Sep;():. doi: S0033-0620(19)30110-0.
Laukkanen Jari A, Kunutsor Setor K, Ozemek Cemal, Mäkikallio Timo, Lee Duck-Chul, Wisloff Ulrik, Lavie Carl J,
Abstract
A large body of evidence demonstrates positive, graded effects of PA on cardiovascular disease (CVD) morbidity and mortality with increasing intensity compared with lower PA intensity. Running is often designated as a high-intensity PA with substantial evidence supporting its health benefits. Cross-country skiing is among the most demanding aerobic endurance exercises and requires engaging the upper- and lower-body. Cross-country skiing is often regarded as high-intensity PA, which has been associated with significant health benefits. However, a robust body of evidence identifying the dose-response relation between cross-country skiing volume and health outcomes is sparse. Therefore, this review aims to summarize the available evidence linking cross-country skiing with CVD morbidity and all-cause mortality; postulated pathways that may elucidate the relation between these associations; outline areas of ongoing uncertainty; and the implications for primary and secondary CVD prevention. To put the findings into perspective, we also summarized the evidence linking running with CVD morbidity and all-cause mortality. Though a head-to-head comparison is not available, the evidence indicates that performing PA as cross-country skiing associates with lower mortality risk when compared with that observed in those undertaking their PA as running. Potential adverse effects of extreme high weekly doses of cross-country skiing over decades may be cardiac arrhythmias, such as atrial fibrillation. Evidence suggests that cross-country skiing may reduce the risk of CVD events and all-cause mortality via anti-inflammatory pathways, improvements in endothelial function and reduced levels of CVD risk factors, such as lipids, glucose, and blood pressure; and enhancement of cardiorespiratory fitness.
Copyright © 2019. Published by Elsevier Inc.
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Survival rate and Outcome of extracorporeal life support (ECLS) for treatment of acute cardiorespiratory failure in trauma patients.
Sci Rep2019 Sep;9(1):12902. doi: 10.1038/s41598-019-49346-z.
Lang Nikolaus W, Schwihla Ines, Weihs Valerie, Kasparek Maximilian, Joestl Julian, Hajdu Stefan, Sarahrudi Kambiz,
Abstract
Extracorporeal life support (ECLS) remains the last option for cardiorespiratory stabilization of severe traumatic injured patients. Currently limited data are available and therefore, the current study assessed the survival rate and outcome of ECLS in a Level I trauma center. Between 2002 and 2016, 18 patients (7 females, 11 males) with an median age of 29.5 IQR 23.5 (range 1-64) years were treated with ECLS due to acute traumatic cardiorespiratory failure. Trauma mechanism, survival rate, ISS, SOFA, GCS, GOS, CPC, time to ECLS, hospital- and ICU stay, surgical interventions, complications and infections were retrospectively assessed. Veno-arterial ECLS was applied in 15 cases (83.3%) and veno-venous ECLS in 3 cases (16.6%). Survivors were significant younger than non-survivors (p?=?0.0289) and had a lower ISS (23.5 (IQR 22.75) vs 38.5 (IQR 16.5), p?=?n.s.). The median time to ECLS cannulation was 2 (IQR 0,25) hours in survivors 2 (IQR 4) in non-survivors. Average GCS was 3 (IQR 9.25) at admission. Six patients (33.3%) survived and had a satisfying neurological outcome with a mean GOS of 5 (IQR 0.25) (p?=?n.s.). ECLS is a valuable treatment in severe injured patients with traumatic cardiorespiratory failure and improves survival with good neurological outcome. Younger patients and patients with a lower ISS are associated with a higher survival rate. Consideration of earlier cannulation in traumatic cardiorespiratory failure might be beneficial to improve survival.
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What are the important morbidities associated with paediatric cardiac surgery? A mixed methods study.
BMJ Open2019 Sep;9(9):e028533. doi: 10.1136/bmjopen-2018-028533.
Brown Katherine L, Pagel Christina, Ridout Deborah, Wray Jo, Anderson David, Barron David J, Cassidy Jane, Davis Peter, Hudson Emma, Jones Alison, Mclean Andrew, Morris Stephen, Rodrigues Warren, Sheehan Karen, Stoica Serban, Tibby Shane M, Witter Thomas, Tsang Victor T, ,
Abstract
OBJECTIVES:
Given the current excellent early mortality rates for paediatric cardiac surgery, stakeholders believe that this important safety outcome should be supplemented by a wider range of measures. Our objectives were to prospectively measure the incidence of morbidities following paediatric cardiac surgery and to evaluate their clinical and health-economic impact over 6?months.
DESIGN:
The design was a prospective, multicentre, multidisciplinary mixed methods study.
SETTING:
The setting was 5 of the 10 paediatric cardiac surgery centres in the UK with 21 months recruitment.
PARTICIPANTS:
Included were 3090 paediatric cardiac surgeries, of which 666 patients were recruited to an impact substudy.
RESULTS:
Families and clinicians prioritised:Acute neurological event, unplanned re-intervention, feeding problems, renal replacement therapy, major adverse events, extracorporeal life support, necrotising enterocolitis, postsurgical infection and prolonged pleural effusion or chylothorax.Among 3090 consecutive surgeries, there were 675 (21.8%) with at least one of these morbidities. Independent risk factors for morbidity included neonatal age, complex heart disease and prolonged cardiopulmonary bypass (p<0.001). Among patients with morbidity, 6-month survival was 88.2% (95% CI 85.4 to 90.6) compared with 99.3% (95% CI 98.9 to 99.6) with none of the morbidities (p<0.001). The impact substudy in 340 children with morbidity and 326 control children with no morbidity indicated that morbidity-related impairment in quality of life improved between 6 weeks and 6 months. When compared with children with no morbidities, those with morbidity experienced a median of 13 (95% CI 10.2 to 15.8, p<0.001) fewer days at home by 6 months, and an adjusted incremental cost of £21 292 (95% CI £17 694 to £32 423, p<0.001).
CONCLUSIONS:
Evaluation of postoperative morbidity is more complicated than measuring early mortality. However, tracking morbidity after paediatric cardiac surgery over 6 months offers stakeholders important data that are of value to parents and will be useful in driving future quality improvement.
© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY. Published by BMJ.
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Clinical and Functional Characteristics of COPD Patients Across GOLD Classifications: Results of a Multicenter Observational Study.
COPD2019 Sep;():1-12. doi: 10.1080/15412555.2019.1659760.
Radovanovic Dejan, Contoli Marco, Marco Fabiano Di, Sotgiu Giovanni, Pelaia Girolamo, Braido Fulvio, Corsico Angelo Guido, Micheletto Claudio, Rogliani Paola, Scichilone Nicola, Saderi Laura, Santus Pierachille, Solidoro Paolo,
Abstract
Chronic obstructive pulmonary disease (COPD) is a heterogeneous disease. The severity grading systems proposed by the Global initiative for Chronic Obstructive Lung Disease (GOLD) have changed over time. The aim of the study was to evaluate if the different GOLD classifications can capture the complexity of the disease by investigating the distribution of lung function and clinical parameters across the GOLD classification systems. This was an observational, retrospective, multicentre study. COPD patients were stratified according to the GOLD severity grading proposed in the 2007, and to the ABCD assessment tool present in the 2011, and 2017 versions of the initiative. Data from body plethysmography, DLCO, comorbidities, exacerbation history, pharmacological therapy and eosinophil counts were collected. A total of 1360 patients (73.4% males) were included in the analysis. Overall, 37% of the patients were severe-very severe according to GOLD 2007. Compared with GOLD 2011, applying the GOLD 2017 criteria, the proportion of the at risk categories (C and D) was reduced by ?23%. Impairment in inspiratory capacity, DLCO and the prevalence of emphysema paralleled the GOLD 2007 classification only. The proportion of patients with ? 200 eosinophils/µL was higher in GOLD 2007 stages 3-4 compared with stages 1-2 (?=?0.008). Eosinophil levels were similar across risk classes in GOLD 2011 and 2017. Overall, 41.8% and 52.4% of the patients in the low risk groups according to GOLD 2011 and 2017 were exposed to inhaled corticosteroids. The GOLD 2011 and 2017 classifications, despite exploring symptoms and exacerbations, might miss other relevant patients' clinical characteristics such as lung function and phenotypes, which have a significant impact on outcomes and disease severity.
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