Hoong Sern Lim, Aaron Ranasinghe, Colin Chue, David Quinn, Majid Mukadam, Jorge Mascaro
OBJECTIVES: To evaluate the value of cardiac power output index (CPOi) in predicting severe primary graft dysfunction (PGD) after heart transplantation (defined as mechanical circulatory support [MCS] and/or mortality <30 days after transplant). DESIGN: Observational cohort study. SETTING: A heart transplant center in the United Kingdom. PARTICIPANTS: Consecutive patients who underwent heart transplantation from January 2014 to December 2019 (n = 160)...
July 10, 2020: Journal of Cardiothoracic and Vascular Anesthesia
Marta Priscila Bento Fernandes, Miguel Armengol de la Hoz, Valluvan Rangasamy, Balachundhar Subramaniam
OBJECTIVES: Machine learning models used to predict postoperative mortality rarely include intraoperative factors. Several intraoperative factors like hypotension (IOH), vasopressor-inotropes, and cardiopulmonary bypass (CPB) time are significantly associated with postoperative outcomes. The authors explored the ability of machine learning models incorporating intraoperative risk factors to predict mortality after cardiac surgery. DESIGN: Retrospective study. SETTING: Tertiary hospital...
July 12, 2020: Journal of Cardiothoracic and Vascular Anesthesia
Sarah B Walker, Thomas W Conlon, Bingqing Zhang, Janell L Mensinger, Julie C Fitzgerald, Adam S Himebauch, Christie Glau, Akira Nishisaki, Suchitra Ranjit, Vinay Nadkarni, Scott L Weiss
OBJECTIVES: Determine level of agreement among clinical signs of shock type, identify which signs clinicians prioritize to determine shock type and select vasoactive medications, and test the association of shock type-vasoactive mismatch with prolonged organ dysfunction or death (complicated course). DESIGN: Retrospective observational study. SETTING: Single large academic PICU. PATIENTS: Patients less than 18 years treated on a critical care sepsis pathway between 2012 and 2016...
July 28, 2020: Pediatric Critical Care Medicine
Sang-Wook Lee, Jun-Young Jo, Wook-Jong Kim, Dae-Kee Choi, In-Cheol Choi
Transit-time flow measurement (TTFM) is frequently used to evaluate intraoperative quality control during coronary artery bypass grafting (CABG) and has the ability to assess graft failure intraoperatively. However, perioperative factors affecting TTFM during CABG remain poorly understood. Patients who underwent CABG at a single institution between July 2016 and May 2018 were prospectively evaluated. TTFM and blood viscosity were measured haemodynamically, while mean flow (mL/min), pulsatility index, and diastolic filling were recorded...
July 31, 2020: Scientific Reports
Alexander Becker, Yehuda Hershkovitz, Kobi Peleg, Joseph Dubose, Givon Adi, Zahalka Aala, Boris Kessel
PURPOSE: This study was primarily aimed at establishing the incidence and impact of hypotension in patients with blunt traumatic brain injury based on National Trauma Registry Database. METHODS: A retrospective cohort study using the National Trauma Registry was conducted. Patients with TBI following blunt mechanisms of injury were examined, comparing those with and without hypotension (SBP < 90 mm Hg) on arrival. RESULTS: During the period from 1998 to 2017, the registry included 437...
July 31, 2020: Brain Injury
Kevin A Pettit, Nicholas A Schreiter, Entela B Lushaj, Joshua L Hermsen, Michael Wilhelm, Allison C Redpath Mahon, Kari L Nelson, Joshua J DeGrave, Nicholas Marka, Petros V Anagnostopoulos
Infants undergoing congenital heart surgery (CHS) with cardiopulmonary bypass (CPB) are at risk of acute kidney injury (AKI) and fluid overload. We hypothesized that placement of a passive peritoneal drain (PPD) can improve postoperative fluid output in such infants. We analyzed 115 consecutive patients, age birth to 60 days, admitted to the PICU after CHS with CPB between 2012 and 2018. Patients who needed postoperative ECMO were excluded. Linear and logistic regression models compared postoperative fluid balances, diuretics administration, AKI, vasoactive-inotropic scores (VIS), time intubated, and length of stay after adjusting for pre/operative predictors including STAT category, bypass time, age, weight, and open chest status...
July 30, 2020: Pediatric Cardiology
Helen Kest, Ashlesha Kaushik, William DeBruin, Mario Colletti, David Goldberg
We report three critically ill pediatric patients (aged 6-10 years), presenting with features of multisystem inflammatory syndrome in children (MIS-C) from April 4 to May 10, 2020, to a tertiary-care center in New Jersey, United States. All patients tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and were previously healthy. Clinical presentations were similar with fever, abdominal pain, gastrointestinal complaints, and/or rash. One patient had altered mental status with cerebrospinal fluid (CSF) findings consistent with aseptic meningitis...
2020: Case Reports in Pediatrics
Hasmukh Patel, Nirav Parikh, Ritesh Shah, Ramesh Patel, Rajesh Thosani, Pratik Shah, Lokesh Prajapat
Background and aims: Early goal-directed therapy (EGDT) provides preset goals to be achieved by intravenous fluid therapy and inotropic therapy with earliest detection of change in the hemodynamic profile. Improved outcome in cardiac surgery patients has been shown by perioperative volume optimization, while postoperative intensive care unit (ICU) stay can be decreased by improving oxygen delivery. Our aim of this study was to study the outcome of EGDT in patients undergoing elective cardiac surgery...
May 2020: Indian Journal of Critical Care Medicine
Shye-Jao Wu, Ya-Fen Fan
Right ventricular (RV) dysfunction may occur after cardiac surgery and it is not rare after corrective repair of tetralogy of Fallot (TOF). If traditional treatments with volume management, infusion of inotropic agents, and use of pulmonary vasodilators cannot stabilize the patient, extracorporeal membrane oxygenation (ECMO) or a ventricular assist device (VAD) will be considered as the last resort. Here, we report a young infant patient with RV failure after corrective repair of TOF and without closure of an atrial septal defect (ASD), who was rescued by veno-venous (VV) -ECMO...
2020: International Heart Journal
Taisuke Nakade, Hitoshi Adachi, Makoto Murata, Shigeto Naito
BACKGROUND: The increase in stroke volume during inotropic stimulation in patients with heart failure with reduced ejection fraction (HFrEF) is called the "pump function reserve." Few studies have reported on the relationship between pump function reserve and HF prognosis. In HFrEF patients who have pump function reserve, stroke volume increases during exercise. Simply put, the pulse pressure change (∆PP) during cardiopulmonary exercise testing (CPX) is closely related to the prognosis of patients with HFrEF...
July 29, 2020: Circulation Journal: Official Journal of the Japanese Circulation Society
Hamdy Singab
BACKGROUND: Right ventricular (RV) ejection fraction may remain normal or even high despite significant impairment of RV myocardial performance in cases of total repair for tetralogy of Fallot (TOF). The aim of this study is to evaluate the influence of pulmonary valve function preservation (PVFP) versus monocuspid transannular patch augmentation (MTAPA) surgical strategies for Fallot repair on postoperative RV performance. METHODS: This retrospective study enrolled all patients (N = 480) who had TOF repaired at our center over a period of 7 years (March 2012 to January 2019)...
June 15, 2020: Heart Surgery Forum
Luis F Álvarez Pérez, Jorge E Sandelis Pérez, Juan Nieves-Rivera, Hilton Franqui
Left ventricle non-compaction (LVNC) is a rare congenital cardiomyopathy characterized by thickened myocardium due to an arrest of the normal compaction of the embryonic sponge-like meshwork of myocardial fibers.  We present a 40-year-old man with no known systemic illnesses admitted with cardiogenic shock and multiorgan failure. Echocardiogram revealed severe enlargement of all four chambers with left ventricular ejection fraction (LVEF) <10%. Cardiac magnetic resonance imaging (CMR) showed hypertrabecular left ventricular myocardium with a ratio of non-compact to compact myocardium of 2...
June 23, 2020: Curēus
M R Mohd Ismail, K A Baharuddin, Z E Zainal Abidin, M A Abu Bakar, A S Sjahid
INTRODUCTION: Emergency department (ED) plays a main role in the initial management of patients who are critically ill. These patients require intra-hospital transfer for continuation of care. Adverse events can occur during this short duration and the distance of intra -hospital transfer. The aims of this study were to determine the incidence of adverse events during intrahospital transfer from ED and to determine the factors associated. METHODOLOGY: This was a cross-sectional observational study done from November 2017 until December 2017 at ED Hospital Sultan Abdul Halim (HSAH), a 650-bedded tertiary hospital in the state of Kedah...
July 2020: Medical Journal of Malaysia
Molly C Easterlin, Theodore De Beritto, Amy M Yeh, Fiona B Wertheimer, Rangasamy Ramanathan
Little is known about the effects of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on pregnant women, fetuses, and neonates, especially when the virus is contracted early in pregnancy. The literature is especially lacking on the effects of SARS-CoV-2 on extremely preterm (<28 weeks gestation) infants who have underdeveloped immune systems. We report the case of an extremely preterm, 25-week 5-days old infant, born to a mother with severe COVID-19 (coronavirus disease-2019) pneumonia. In this case, there is no evidence of vertical transmission of SARS-CoV-2 based on reverse transcription-polymerase chain reaction testing, despite extreme prematurity...
January 2020: Journal of Investigative Medicine High Impact Case Reports
Ana Suárez-Avellaneda, Jhon H Quintana, Cristian C Aragón, Linda M Gallego, Cindy-Natalia Gallego, Juan D Bolaños, Maria A Guerra, Maria Elena Ochoa, Marcela Granados, Ingrid Ruiz-Ordoñez, Gabriel J Tobón
Systemic lupus erythematosus (SLE) is an autoimmune disease with heterogeneous pathophysiologic mechanisms and diverse clinical manifestations. SLE is a frequent cause of intensive care unit (ICU) admissions. Multiple studies with controversial findings on the causes, evolution and outcomes of ICU-admitted patients with SLE have been published. The aim of this paper is to review the literature reporting the clinical characteristics and outcomes, such as mortality and associated factors, in such patients. Among the main causes of ICU admissions are SLE disease activity, respiratory failure, multi-organ failure and infections...
July 28, 2020: Lupus
Muhterem Duyu, Yasemin Mocan Çağlar, Zeynep Karakaya, Mine Usta Aslan, Seyhan Yılmaz, Aslı Nur Ören Leblebici, Anıl Doğan Bektaş, Meral Bahar, Meryem Nihal Yersel
Transcutaneous PCO2 (PTC CO2 ) and end-tidal PCO2 (PET CO2 ) measurement methods serve as alternatives to arterial PCO2 (PaCO2 ), providing continuous non-invasive monitoring. The objective of this study was to evaluate the PTC CO2 and PET CO2 methods with actual PaCO2 levels, and to assess the variability of measurements in relation to subject-related factors, such as skin and subcutaneous adipose tissue thickness and presence of pulmonary diseases. PTC CO2 , PET CO2 and PaCO2 were measured at the same time in intubated pediatric subjects...
July 27, 2020: Journal of Clinical Monitoring and Computing
Shubhi Kaushik, Sindy Villacres, Ruth Eisenberg, Shivanand S Medar
OBJECTIVES: To describe the incidence of and risk factors for acute kidney injury (AKI) in children with acute respiratory distress syndrome (ARDS) and study the effect of AKI on patient outcomes. DESIGN: A single-center retrospective study. SETTING: A tertiary care children's hospital. PATIENTS: All patients less than 18 years of age who received invasive mechanical ventilation (MV) and developed ARDS between July 2010 and July 2013 were included...
July 27, 2020: Journal of Intensive Care Medicine
Hamish M Aitken-Buck, Aram A Babakr, Ingrid C Fomison-Nurse, Isabelle van Hout, Philip J Davis, Richard W Bunton, Michael Ja Williams, Sean Coffey, Peter P Jones, Regis R Lamberts
BACKGROUND: The adipocytokine resistin is released from epicardial adipose tissue (EAT). Plasma resistin and EAT deposition are independently associated with atrial fibrillation (AF). The EAT secretome enhances arrhythmia susceptibility and inotropy of human myocardium. Therefore, we aimed to determine the effect of resistin on the function of human myocardium and how resistin contributes to the pro-arrhythmic effect of EAT. METHODS & RESULTS: EAT biopsies were obtained from 25 cardiac surgery patients...
July 27, 2020: American Journal of Physiology. Endocrinology and Metabolism
Neha Kumbhat, Shahab Noori
Several limitations and controversies surround the definition of hypotension; however, it remains one of the most common problems faced by neonates. Approximately 15% to 30% of neonates with hypotension fail to respond to volume and/or vasopressor or inotropes. They are considered to have refractory hypotension. Although it is thought to have multiple causes, absolute and relative adrenal insufficiency is considered as the main reason for refractory hypotension. This article focuses on the role of adrenal insufficiency in causing refractory hypotension in preterm and term infants, the different options of corticosteroids available, and their risk/benefit profiles...
September 2020: Clinics in Perinatology
Nilkant Phad, Koert de Waal
Primary function of cardiovascular system is to meet body's metabolic demands. The aim of inotrope therapy is to minimise adverse impact of cardiovascular compromise. Current use of inotropes is primarily guided by the pathophysiology of cardiovascular compromise and anticipated actions of inotropes. Lack of significant reduction in morbidity and mortality associated with cardiovascular compromise despite inotrope use, highlights major gaps in our understanding of circulatory targets, thresholds and choices of inotrope therapy...
September 2020: Clinics in Perinatology
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