Atif Irfan Khan, Gopal Kumar Patidar, R Lakshmy, Neeti Makhija, Sachin Talwar, Anjali Hazarika
OBJECTIVES: In this study, we aimed to determine the consequences of different amounts of leukocyte transfusion on the outcome of patients undergoing cardiac surgery. DESIGN: This was a prospective, single-blinded cohort study conducted for 1 year from July 2018 to June 2019. SETTING: The study setting was the Department of Transfusion Medicine, along with Cardiac Anaesthesia, Cardiac Surgery and Cardiac biochemistry departments in a tertiary care cardiac centre...
September 15, 2020: Transfusion Medicine
Sarfaraz Rahiman, Remi Kowalski, Sit Yee Kwok, Sunit Matha, Bryn Jones, Joseph J Smolich, Jonathan P Mynard, Warwick Butt, Johnny Millar
OBJECTIVES: Milrinone is an inodilator widely used in the postoperative management of children undergoing cardiac surgery. The literature supporting its inotropic effect is sparse. We sought to study the effect of milrinone on the vasculature and its effects on the ventricular function using wave intensity analysis. We also intended to evaluate the feasibility of using wave intensity analysis by the bedside. DESIGN: prospective single-center observational study...
September 15, 2020: Critical Care Medicine
Li Gao, Yuwei Wang, Wenhui Zhang, Xiaojia Zhu, Qianwen Gao, Yujie Xiao, Kesu Chen, Fuming Liu, Long Chen
This study was to investigate the inotropic effect of atractylodin and its underlying mechanism. The cardiac Pressure-Volume loop (P-V loop), Langendroffperfused isolated rat heart, patch-clamp, Ca2+ transient and western blot techniques were used. The results demonstrated that atractylodin (3 mg/kg, ip) remarkably increased the left ventricularstroke work, cardiac output, stroke volume, heart rate, ejection fraction, end-systolic pressure, peakrates ofrise and fall of left ventricular pressures (+dP/dtmax , -dP/dtmax ),the slopes of end-systolic pressure-volume relationship (also named as end-systolic elastance, Ees) and reducing end-systolic volume and end-diastolic volume in the in vivo rat study...
September 15, 2020: Clinical and Experimental Pharmacology & Physiology
Emily A Vail, Meng-Shiou Shieh, Penelope S Pekow, Hayley B Gershengorn, Allan J Walkey, Peter K Lindenauer, Hannah Wunsch
RATIONALE: Patients undergoing cardiac surgery often require vasopressor or inotropic ('vasoactive') medications, but patterns of postoperative use are not well described. OBJECTIVES: This study aimed to describe vasoactive medication administration throughout hospitalization for cardiac surgery, to identify patient and hospital-level factors associated with postoperative use, and to quantify variation in treatment patterns among hospitals. METHODS: Retrospective study using the Premier Healthcare Database...
September 14, 2020: Annals of the American Thoracic Society
Amit Saha, Paul Kurlansky, Yuming Ning, Joseph Sanchez, Justin Fried, Lucas J Witer, Yuji Kaku, Hiroo Takayama, Yoshifumi Naka, Koji Takeda
Post-cardiotomy shock (PCS) is associated with substantial morbidity and mortality. We reviewed our 12-year experience of venoarterial extracorporeal membrane oxygenation (VA-ECMO) therapy for PCS. Between July 2007 and June 2018, 156 consecutive patients underwent VA-ECMO for PCS. We retrospectively investigated patient characteristics, indications, and management to determine factors affecting outcomes. Secondary analysis was performed by dividing the cohort into Era 1 (2007-2012, n = 52) and Era 2 (2013-2018, n = 104) for comparison...
September 14, 2020: Journal of Artificial Organs: the Official Journal of the Japanese Society for Artificial Organs
Ashlesha Kaushik, Sandeep Gupta, Mangla Sood, Seema Sharma, Shikha Verma
BACKGROUND: Recently, severe manifestations associated with coronavirus disease 2019 (COVID-19) called multisystem inflammatory syndrome in children (MIS-C) have been recognized. Analysis of studies for this novel syndrome is needed for a better understanding of effective management among affected children. METHODS: An extensive search strategy was conducted by combining the terms multisystem inflammatory syndrome in children and coronavirus infection or using the term multisystem inflammatory syndrome in children in bibliographic electronic databases (PubMed, EMBASE, and CINAHL) and in preprint servers (BioRxiv...
September 8, 2020: Pediatric Infectious Disease Journal
Sara Zaher, Raghad Al-Subaihi, Aeshah Al-Alshaya, Manar Al-Saggaf, Mariam O Al Amoudi, Hala Babtain, Arwa Neyaz
BACKGROUND: Enteral-nutrition (EN) is an essential therapeutic intervention. Many studies internationally have reviewed the feeding practices in intensive-care units (ICU) and recorded the incidence of underfeeding in these settings, yet none were performed in the Middle-East including Saudi-Arabia. The purpose of the study is to assess the adequacy of EN delivery and to investigate the enteral-feeding practices in ICU at a specialised tertiary-care hospital in Saudi-Arabia. METHODOLOGY: In this observational study we prospectively monitored energy and protein delivery for 6 consecutive days in critically-ill patients...
September 14, 2020: JPEN. Journal of Parenteral and Enteral Nutrition
Hongbai Wang, Qipeng Luo, Yinan Li, Liang Zhang, Xie Wu, Fuxia Yan
Background: Levosimendan, a calcium sensitizer, enhances the myocardial function by generating more energy-efficient myocardial contractility than that achieved through adrenergic stimulation with catecholamines. We conducted this meta-analysis to primarily investigate the effects of levosimendan on all-cause mortality in pediatric patients undergoing cardiac surgery under cardiopulmonary bypass. Methods: The databases of Pubmed, Embase, and Cochrane Library were searched till 21st March 2020. The eligible criteria were participants with age<18 year and undergoing cardiac surgery for congenital heart disease (CHD), and studies of comparison between levosimendan and placebo or other inotropes...
2020: Frontiers in Pediatrics
Alessandro Parodi, Laura Costanza De Angelis, Martina Re, Sarah Raffa, Mariya Malova, Andrea Rossi, Mariasavina Severino, Domenico Tortora, Giovanni Morana, Maria Grazia Calevo, Maria Pia Brisigotti, Francesca Buffelli, Ezio Fulcheri, Luca Antonio Ramenghi
Placental pathology as a predisposing factor to intraventricular hemorrhage remains a matter of debate, and its contribution to cerebellar hemorrhage development is still largely unexplored. Our study aimed to assess placental and perinatal risk factors for intraventricular and cerebellar hemorrhages in preterm infants. This retrospective cohort study included very low-birth weight infants born at the Gaslini Children's Hospital between January 2012 and October 2016 who underwent brain magnetic resonance with susceptibility-weighted imaging at term-equivalent age and whose placenta was analyzed according to the Amsterdam Placental Workshop Group Consensus Statement...
2020: Frontiers in Neurology
Huw Garland, Alain Vuylsteke
Biased agonism, which is the concept that different ligands activate different downstream signalling partners in different ratios to cause different functional effects, is yet to gain appropriate appreciation in the field of inotropic pharmacology. Biased agonism has already proven to be a clinically translatable technology in analgesic pharmacology, but this development is yet to be translated into inotropes. A better appreciation of bias in clinically used inotropes and a focus on bias when developing novel inotropes has the potential to lead to more targeted, personalized, and cleaner inotropes...
August 7, 2020: Journal of Cardiothoracic and Vascular Anesthesia
M T Yap, P Yubbu, S W Yong, W V Hing, Y S Ong, N K Devaraj, A G Ani Suraya, G T Koh, H Leman
BACKGROUND: The long waiting time for Tetralogy of Fallot (TOF) operation may potentially increase the risk of hypoxic insult. Therefore, the objective of this study is to determine the frequency of acute neurological complications following primary TOF repair and to identify the peri-operative risk factors and predictors for the neurological sequelae. METHODS: A retrospective review of the medical and surgical notes of 68 patients who underwent TOF repair in Hospital Serdang, from January 2013 to December 2017 was done...
September 2020: Medical Journal of Malaysia
Kevin C Pan, Sai Shankar, Johnny Millar, Roberto Chiletti, Warwick Butt, Yves d'Udekem, Siva P Namachivayam
OBJECTIVES: Levosimendan use is associated with more successful decannulation from veno-arterial extracorporeal membrane oxygenation (VA ECMO) in adults. We sought to determine the role of levosimendan in children who required VA ECMO after cardiac surgery. METHODS: This observational study compares the outcomes of children who required VA ECMO after cardiac surgery and received levosimendan for weaning with those who did not receive the drug. A doubly robust estimation methodology (inverse probability of treatment weighting with regression adjustment) was used to balance study covariates (age, weight, sex, lactate pre-ECMO, vasoactive-inotropic score pre-ECMO, ECMO indication, ECMO modality, Risk Adjustment for Congenital Heart Surgery-1 category), and the final model was further adjusted for duration of ECMO...
September 10, 2020: European Journal of Cardio-thoracic Surgery
Yojiro Koda, Hiroto Kitahara, Hidefumi Nishida, Valluvan Jeevanandam, Takeyoshi Ota
BACKGROUND: Recently, del Nido cardioplegia solution (DN) has been utilized in adult cardiac surgery. However, adequate interval of maintenance dose(s) is still unclear. The purpose of this study was to assess the safety and efficacy of our DN protocol by comparing with conventional cold whole blood cardioplegia (CWB). METHODS: A total of 1003 consecutive patients (DN group, N = 350 vs. CWB group, N = 653) underwent cardiovascular surgery between July 2013 and September 2018 were included in this study...
September 10, 2020: Perfusion
Yinan Li, Qipeng Luo, Xie Wu, Yuan Jia, Fuxia Yan
Background: The benefit-risk profile of perioperative corticosteroids in pediatric patients undergoing cardiac surgery remains controversial. Objective: To investigate the influence of perioperative corticosteroids on the postoperative mortality and clinical outcomes in pediatric patients undergoing cardiac surgery with cardiopulmonary bypass. Methods: We conducted a systematic search using MEDLINE, EMBASE, and Cochrane Database through August 31, 2019. We included randomized controlled trials comparing perioperative corticosteroids with other clinical interventions, placebo, or no treatment in children between 0 and 18 years of age undergoing cardiac surgery...
2020: Frontiers in Pediatrics
Paulami Chatterjee, Mahmoud Gheblawi, Kaiming Wang, Jeannie Vu, Palsa Kondaiah, Gavin Y Oudit
The apelinergic system is widely expressed and acts through autocrine and paracrine signaling to exert protective effects, including vasodilatory, metabolic, and inotropic effects on the cardiovascular (CV) system. The apelin pathway's dominant physiological role has delineated therapeutic implications for coronary artery disease, heart failure (HF), aortic aneurysm, pulmonary arterial hypertension (PAH), and transplant vasculopathy. Apelin peptides interact with the renin-angiotensin system (RAS) by promoting angiotensin converting enzyme 2 (ACE2) transcription leading to increased ACE2 protein and activity while also antagonizing the effects of angiotensin II (Ang II)...
September 18, 2020: Clinical Science (1979-)
Da Hyun Kim, Eun Ju Ha, Seong Jong Park, Won Kyoung Jhang
Red blood cell distribution width (RDW) is a component of routine complete blood count, which reflects variability in the size of circulating erythrocytes. Recently, there have been many reports about RDW as a strong prognostic marker in various disease conditions in the adult population. However, only a few studies have been performed in children. This study aimed to investigate the association between RDW and pediatric intensive care unit (PICU) mortality in critically ill children. This study includes 960 patients admitted to the PICU from November 2012 to May 2018...
September 4, 2020: Medicine (Baltimore)
Trisha Radia, Nia Williams, Pankaj Agrawal, Katharine Harman, Jonathan Weale, James Cook, Atul Gupta
Multisystem Inflammatory Syndrome in Children (MIS-C) is a new phenomenon reported worldwide with temporal association with Covid-19. The objective of this paper is to evaluate reported cases in children and adolescents. From 1726 papers, 35 documented papers related to MIS-C cases identified 783 individual cases of MIS-C between March-June 2020; with 55% being male (n = 435) and a median age of 8.6 years (IQR, 7-10 years; range 3 months-20 years). Patients with MIS-C were noted to have a high frequency of gastrointestinal symptoms (71%) including abdominal pain (34%) and diarrhea (27%)...
August 11, 2020: Paediatric Respiratory Reviews
Kathirvel Subramaniam, Michael L Boisen, Liora Yehushua, Stephen A Esper, Dennis P Philips, Kimberly Howard-Quijano
OBJECTIVE: In this paper, the authors report their experience of perioperative transthoracic echocardiography (TTE) practice and its impact on perioperative patient management. DESIGN: Retrospective case series. SETTING: Single institution, tertiary university hospital. PARTICIPANTS: A total of 101 adult ASA II-V male and female patients >18 years old who were scheduled for or having surgery were included in this retrospective case series...
June 19, 2020: Journal of Cardiothoracic and Vascular Anesthesia
Katherine E Bline, Melissa Moore-Clingenpeel, Josey Hensley, Lisa Steele, Kristin Greathouse, Larissa Anglim, Lisa Hanson-Huber, Jyotsna Nateri, Jennifer A Muszynski, Octavio Ramilo, Mark W Hall
BACKGROUND: Severe critical illness-induced immune suppression, termed immunoparalysis, is associated with longer duration of organ dysfunction in septic children. mRNA studies have suggested differential benefit of hydrocortisone in septic children based on their immune phenotype, but this has not been shown using a functional readout of the immune response. This study represents a secondary analysis of a prospectively conducted immunophenotyping study of pediatric severe sepsis to test the hypothesis that hydrocortisone will be differentially associated with clinical outcomes in children with or without immunoparalysis...
September 4, 2020: Critical Care: the Official Journal of the Critical Care Forum
Ariane S J M Annicq, Elise Randle, Padmanabhan Ramnarayan
OBJECTIVES: To describe the clinical characteristics and outcomes of referrals for extracorporeal membrane oxygenation to a regional pediatric intensive care transport service, and identify clinical features at initial referral that predict the eventual need for extracorporeal membrane oxygenation. DESIGN: Retrospective analysis of prospectively collected data. SETTING: Specialist pediatric intensive care transport service based at a large U...
July 27, 2020: Pediatric Critical Care Medicine
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