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Crane Stephenson posted an update 2 days, 9 hours ago
05 ±12.49 vs. 69.78 ±13.73 mm Hg at P < 0.0001), max diastolic blood pressure (57.03 ±9.31 vs. 50.41 ±13.82 mm Hg; P < 0.0003), and max as well as min mean arterial blood pressure (46.8 ±10.13 vs. 41.39 ±15.46 mm Hg; P < 0.001) (27.88 ±5.71 vs. 26.14 ±7.35 mm Hg; P < 0.02).
In newborns suffering from respiratory failure and treated with I-F, higher SpO2 values, lower heart rate, and higher arterial blood pressure coincide with success of the I-F therapy.
In newborns suffering from respiratory failure and treated with I-F, higher SpO2 values, lower heart rate, and higher arterial blood pressure coincide with success of the I-F therapy.
Current evidence suggests that intraoperative goal-directed haemodynamic therapy (GDT) should be considered for high-risk patients undergoing major gastrointestinal surgery. We aimed to evaluate if an algorithm using venoarterial carbon dioxide difference (CO2 gap) and pulse pressure variation (PPV) as therapeutic targets during GDT would decrease the major complications after gastrointestinal surgery.
This was a before-and-after study (n = 204) performed in a tertiary hospital on patients who underwent elective open major gastrointestinal surgeries. The inclusion criteria were surgeries expected to last more than two hours, family and physician’s agreement on total postoperative support, and survival expectancy of at least three months. The exclusion criteria were previous haemodynamic instability, presence of infection, cardiac arrhythmias, and emergency surgery. In the intervention group (IG), an algorithm was applied using fluids, dobutamine, and noradrenaline during the intraoperative period aiming at MAP > 65 mm Hg, SpO2 > 95%, CO2 gap < 6 mm Hg, and PPV < 13%. The control group (CG) comprised consecutive eligible patients who were operated by the same team before the institution of the algorithm.
The rates of moderate and severe postoperative complications were lower in the IG (11% vs. 23%; IC RR = 0.47, 95% CI 0.246-0.929; P = 0.025). The respective 90- and 180-day mortality rates in the IG and CG were 9.8% vs. 22.5% (P = 0.014) and 12.6% vs. 25.5% (P = 0.020).
An algorithm aiming to minimise the CO2 gap and normalise PPV was feasible and effective in decreasing rates of moderate and severe complications after surgery in high-risk patients.
An algorithm aiming to minimise the CO2 gap and normalise PPV was feasible and effective in decreasing rates of moderate and severe complications after surgery in high-risk patients.
Endotracheal intubation (ETI) can cause a cardiovascular response. The aim of the present study was to investigate the effect of intravenous lidocaine on the hemodynamic response to ETI during sufentanil-based induction of anaesthesia.
Ninety patients aged 18-65 years were recruited, induction of anaesthesia was initiated by sufentanil, midazolam, cisatracurium, and propofol, the patients were randomized to three groups Group L1 received 1 mg/kg-1 of lidocaine, Group L1.5 received 1.5 mg kg-1 of lidocaine, Group S received an equal volume of normal saline (NS). Lidocaine or NS was administered in a bolus 2 min before ETI. Systolic arterial pressure (SAP), diastolic arterial pressure (DAP), mean arterial pressure (MAP), and heart rate (HR) were recorded at four time points before anaesthetic induction, 1 min after lidocaine administration, immediately after ETI, 5 min after ETI. The incidences of hypotension, hypertension, bradycardia, and tachycardia were also recorded.
The SAP, DAP, MAP, and HR at baseline were not significantly different among the three groups (P = 0.620, P = 0.575, P = 0.433, P = 0.537, respectively). Immediately after ETI, the SAP in Group L1 was significantly lower than Group S (P = 0.024), while the DAP, MAP, and HR were comparable among the three groups at the same time points (P > 0.05). There were no significant differences in the incidences of hypotension, hypertension, bradycardia and tachycardia among the three groups (P > 0.200).
Intravenous lidocaine could attenuate the increase of blood pressure but not HR after ETI during sufentanil-based induction of anaesthesia without increased incidence of side-effects.
Intravenous lidocaine could attenuate the increase of blood pressure but not HR after ETI during sufentanil-based induction of anaesthesia without increased incidence of side-effects.
ANCA-associated vasculitides (AAV) is a group of rare disorders where inflammation and damage of the small blood vessels lead to dysfunction of the supplied organs. In severe flares of the disease patients may require intensive care unit (ICU) admission and treatment. The study aims to characterize Polish patients with AAV who were admitted to the ICU and compare them to the others.
An observational, retrospective study based on the POLVAS – registry of Polish adult patients with AAV was carried out. Selleckchem EED226 Patients admitted to the ICU (ICU group) were identified and compared with the patients who did not require ICU admission (non-ICU group). Characteristics and comparison between groups were made using standard statistic descriptive methods.
30 patients admitted to the ICU were identified among 573 cases included in the registry. All patients in the ICU group with available data were ANCA positive. The clinical manifestations related to the ICU admission were respiratory, renal and central nervous system involvement. The treatment regimen for remission induction was similar in both groups. Almost half of the patients in the ICU-group (48.3%) required dialysis, whereas in the non-ICU group it was 21.8% (P = 0.01). Infections were also more frequent in the ICU group (72.4% vs. 36.9% P < 0.001). The mortality rate among patients who needed ICU treatment was significantly higher when compared to the rest of the patients (53.6% vs. 7.8%; P < 0.001).
In the Polish AAV cohort one in twenty patients required ICU admission. This group was characterized by multiple organ involvement and high mortality.
In the Polish AAV cohort one in twenty patients required ICU admission. This group was characterized by multiple organ involvement and high mortality.