Doses Of Vasoactive Drugs Research Articles

Active Donor Management Goals in Serial Donors After Brain Death.

Management of potential organ donors is crucial in the donation process, considering that hemodynamic instability is quite common. In the this single-center retrospective observational study, we analyzed 87 utilized brain death donors consecutively admitted to our intensive care unit from January 1, 2019, to December 31, 2022. We assessed the achievement of donor management goals during the observation period, and we also evaluated whether the achieve-ment of donor goals differed between younger and older donors (arbitrary age cutoff of 65 years). In our series, mean age of donors was 67 ± 18 y, and organ-per-donor ratio was 2.3. The number of donor goals significantly increased during the 6-hour observation period (P < .001) and all donor goals were achieved in most donors (84/87) at the end of the observation period with no changes in the use and dose of vasoactive drugs. With respect to age, the number of donor goals was significantly higher in older donors at first evaluation, but goals significantly increased in both age subgroups of donors at the end of the 6-hour observation period. Our data strongly suggested that a strict hemodynamic monitoring schedule allows the achievement of donor goals both in older and in younger brain death donors. We confirmed our previous findings that hemodynamic management in brain death donors is influenced by age. A strict hemodynamic monitoring schedule of brain death donors is useful to consistently achieve donor goals.

Intraoperative serum lactate levels as a prognostic predictor of outcome for emergency abdominal surgery: a retrospective study

BackgroundThe relationship between intraoperative lactate levels and prognosis after emergency gastrointestinal surgery remains unclear. The purpose of this study was to investigate the prognostic value of intraoperative lactate levels for predicting in-hospital mortality, and to examine intraoperative hemodynamic managements.MethodsWe conducted a retrospective observational study of emergency GI surgeries performed at our institution between 2011 and 2020. The study group comprised patients admitted to intensive care units postoperatively, and whose intraoperative and postoperative lactate levels were available. Intraoperative peak lactate levels (intra-LACs) were selected for analysis, and in-hospital mortality was set as the primary outcome. The prognostic value of intra-LAC was assessed using logistic regression and receiver operating characteristic (ROC) curve analysis.ResultsOf the 551 patients included in the study, 120 died postoperatively. Intra-LAC in the group who survived and the group that died was 1.80 [interquartile range [IQR], 1.19–3.01] mmol/L and 4.22 [IQR, 2.15–7.13] mmol/L (P < 0.001), respectively. Patients who died had larger volumes of red blood cell (RBC) transfusions and fluid administration, and were administered higher doses of vasoactive drugs. Logistic regression analysis showed that intra-LAC was an independent predictor of postoperative mortality (odds ratio [OR] 1.210, 95% CI 1.070 –1.360, P = 0.002). The volume of RBCs, fluids transfused, and the amount of vasoactive agents administered were not independent predictors. The area under the curve (AUC) of the ROC curve for intra-LAC for in-hospital mortality was 0.762 (95% confidence interval [CI], 0.711–0.812), with a cutoff value of 3.68 mmol/L by Youden index.ConclusionsIntraoperative lactate levels, but not hemodynamic management, were independently associated with increased in-hospital mortality after emergency GI surgery.

Blood-pressure targets in comatose survivors of cardiac arrest with ST-elevation myocardial infarction treated with primary percutaneous coronary intervention - a BOX sub-study

Abstract Funding Acknowledgements Type of funding sources: Foundation. Main funding source(s): Novo Nordisk Foundation. Background After successful resuscitation from out-of-hospital cardiac arrest (OHCA), patients who remain comatose often need hemodynamic support with vasoactive drugs in order to secure an adequate perfusion pressure to vital organs. However, evidence regarding specific blood-pressure targets is sparse, and patients with concomitant heart disease such as acute ST-elevation myocardial infarction (STEMI) might benefit from a lower afterload and lower doses of vasoactive drugs. Purpose To assess the impact of blood-pressure on biochemical infarct size in comatose survivors of OHCA with STEMI and, further, to investigate whether a high or low mean arterial blood-pressure target is superior in preventing death or severe brain injury. Methods The BOX study (n=789) is a randomized trial with a 2-by-2 factorial design which evaluated a double-blind intervention of a high (77 mmHg) versus a low (63 mmHg) mean arterial blood-pressure target in comatose survivors of OHCA of presumed cardiac cause. In this pre-specified sub-study we included patients who had an initial electrocardiogram with STEMI recorded after return of spontaneous circulation (ROSC). The primary outcome was creatine kinase (CK), creatine kinase MB (CKMB), and troponin T (TnT) levels measured at 48 hours as surrogate markers of infarct size. A secondary outcome was a composite of all-cause death within one year from admission or discharge from the hospital with a Cerebral Performance Category (CPC) of 3 to 4, indicating severe neurological disability or a comatose or vegetative state. Results A total of 350 patients were included. Mean time to ROSC was 21±13 minutes. The mean age was 63±12 years and approximately 4 out of 5 were male. The prevalence of relevant prior medical history was as follows; hypertension 42%, diabetes 12%, chronic ischemic heart disease 20%, percutaneous coronary intervention 11%, coronary artery bypass grafting 4%, and congestive heart failure 10%. Mean CK, CKMB and TnT measured at 48 hours did not differ between the two blood-pressure target groups (p=0.42, p=0.14 and p=0.65, respectively). Within one year, 138 patients (39%) had died or been discharged with a CPC of 3 to 4 with no difference found between high or low blood pressure targets (hazard ratio, 1.02; 95% CI, 0.73-1.43; p=0.9). Conclusion Targeting a high versus a low mean arterial blood-pressure in comatose survivors of OHCA with STEMI did not affect infarct size estimated by coronary biomarkers at 48 hours nor did it result in a significant difference in death or severe neurologic disability. Although not evaluating side effects, this study thus suggests that the use of pharmacologic circulatory support in post-resuscitation care can be limited.

Effect of remimazolam tosilate versus etomidate on hemodynamics in patients undergoing valve replacement surgery: study protocol for a randomized controlled trial

BackgroundPatients with a history of cardiac disease are prone to develop cardiovascular adverse events such as hypotension, hypertension, and tachycardia during anesthesia induction. Therefore, hemodynamic stability is one of the most important concerns for induction of anesthesia in patients undergoing cardiac surgery. Remimazolam tosilate is a new, ultra-short-acting benzodiazepine agent, with the advantages of rapid onset, rapid offset, and minimal cardiorespiratory depression. We aim to compare the effect of remimazolam tosilate and etomidate on hemodynamics during anesthesia induction in patients undergoing valve replacement surgery.Methods/designThe trial is a prospective, randomized, double-blinded, controlled, single-center trial to compare the effect of remimazolam tosilate and etomidate on hemodynamics in patients undergoing valve replacement surgery. One hundred seventeen patients undergoing selective valve replacement surgery between January 1, 2022, and December 31, 2023, will be enrolled and randomly allocated into one of three groups: low-dose remimazolam group (Group LR), high-dose remimazolam group (Group HR), or etomidate group (Group E). The primary outcome is hemodynamic fluctuations during anesthesia induction (the difference between mean arterial pressure [MAP] to baseline, ▴MAP; and the difference between maximum or minimum heart rate [HR] and baseline, ▴HR). Secondary outcomes include the incidence of adverse cardiovascular events (hypotension, severe bradycardia, hypertension, tachycardia, and arrhythmia), the cumulative doses of vasoactive drugs used per patient, incidence and degree of injection pain and myoclonus, blood glucose values, and vital signs at different time points.DiscussionThis research will determine the effectiveness and safety of remimazolam tosilate induction on hemodynamics in patients undergoing valve replacement surgery.Trial registrationwww.chictr.org.cn identifier ChiCTR2100052535. Registered on 17th Dec 2021, http://www.chictr.org.cn/).

The effect of topical airway anesthesia on hemodynamic profiles during the induction period in patients undergoing cardiac surgery: Study protocol for a randomized controlled trial.

BackgroundPatients scheduled for cardiac surgery are often accompanied by cardiac dysfunction and hemodynamic instability. However, the conventional induction strategy for anesthesia using high-dose intravenous anesthetics is often associated with persistent and recurrent hypotension after tracheal intubation. The purpose of this study is to investigate the effects of topical airway anesthesia on the hemodynamic profile of patients undergoing cardiac surgery during the induction period.MethodsThis is a superiority, single-blind, randomized controlled study with two parallel groups. Participants scheduled to undergo elective cardiac surgery will be allocated into two blocks according to the New York Heart Association (NYHA) classification and then randomly assigned to the following two groups at a 1:1 ratio: the conventional induction group and the combined topical airway anesthesia induction group. The combined topical airway anesthesia induction strategy includes aerosol inhalation airway anesthesia, subglottic airway anesthesia, and general anesthesia induction using low-dose intravenous anesthetics. The primary outcome is the area under the curve (AUC) of blood pressure below baseline mean arterial pressure (MAP) from 3 to 15 min after endotracheal intubation. Secondary outcomes include the AUC above baseline MAP and below baseline MAP at other time points, the highest and lowest arterial blood pressure values during the induction period, type and dose of vasoactive drugs, incidence of arrhythmias, cardiac function, and the incidence of postoperative hoarseness and sore throat.DiscussionThe study will explore whether aerosol inhalation airway anesthesia and subglottic airway anesthesia could reduce the incidence and duration of hypotension during the induction period in patients undergoing cardiac surgery.Clinical Trial RegistrationThis trial was registered on www.ClinicalTrials.gov (NCT05323786).

PNEUMOPERICARDIUM: UNEXPECTED FINDING IN A BLUNT THORACIC TRAUMA

TYPE: Late Breaking Abstract TOPIC: Critical Care INTRODUCTION: Pneumopericardium is a rare finding. We present a clinical case of a pneumopericardium due to blunt thoracic trauma and its management. CASE PRESENTATION: A 22-year male admitted to the Emergency Department after a high energy car crash with blunt thoracic and abdominal trauma presented with severe hypotension and tachycardia. Thoracic x-ray showed a left pneumothorax and a chest tube was inserted. FAST ultrasound was positive on the Morrison space, prompting immediate surgical intervention, during which a right chest tube was inserted due to suspicion of right pneumothorax. After surgery, the patient remained in circulatory shock, warranting high doses of vasoactive drugs. A CT scan was performed, depicting a 15 mm pneumopericardium (Figure 1). ECG had a low voltage tracing, a mild elevation of cardiac biomarkers was noted and echocardiography showed preserved biventricular systolic function, a 10 mm inferior vena cava and no signs of cardiac compression, thus making tension pneumopericardium an unlikely diagnosis. The right chest drain was hypothesized as potential cause of the pneumopericardium. An urgent consultation with cardiac surgery was requested and low pressure suction was initiated in the ICU. Pneumopericardium dimensions improved over time, with no evidence of pericardial air on day three. DISCUSSION: Although its etiology remained unclear, close monitoring for signs of cardiac suffering throughout ICU stay and a conservative approach led to clinical resolution. CONCLUSIONS: This case highlights the need for a multidisciplinary approach when managing specific thoracic pathology in the ICU setting. DISCLOSURE: No significant relationships. KEYWORD: pneumopericardium

Characterization of Systemic and Regional Hemodynamics and Vascular Dysfunction in Mice with Fecal Induced Peritonitis.

Sepsis is associated with circulatory dysfunction contributing to disturbed blood flow and organ injury. Decreased organ perfusion in sepsis is attributed, in part, to the loss of vasoregulatory mechanisms. Identifying which vascular beds are most susceptible to dysfunction is important for monitoring the recovery of organ function and guiding interventions. This study aimed to investigate the development of vascular dysfunction as sepsis progressed to septic shock. Anesthetized C57Bl/6 mice were instrumented with a fiberoptic pressure sensor in the carotid artery for blood pressure measurements. In subgroups of mice, regional blood flow measurements were taken by positioning a perivascular flow probe around either the left carotid, left renal, or superior mesenteric arteries. Hemodynamic parameters and their responsiveness to bolus doses of vasoactive drugs were recorded prior to and continuously after injection of fecal slurry (1.3 mg/g body weight) for 4 h. Fecal slurry-induced peritonitis reduced mean arterial pressure (62.7 ± 2.4 mmHg vs. 37.5 ± 3.2 mmHg in vehicle and septic mice, respectively), impaired cardiac function, and eventually reduced organ blood flow (71.9%, 66.8%, and 65.1% in the superior mesenteric, renal, and carotid arteries, respectively). The mesenteric vasculature exhibited dysregulation before the renal and carotid arteries, and this underlying dysfunction preceded the blood pressure decline and impaired organ blood flow.

Out-of-the-ICU Mobilization in Critically Ill Patients: The Safety of a New Model of Rehabilitation.

OBJECTIVES:Early mobilization of ICU patients has been reported to be safe and feasible. Recently, our ICU implemented out-of-the-ICU wheelchair excursions as a daily rehabilitation practice. The aim of this study is to investigate the safety of participation in the out-of-the-ICU program for early mobilization.DESIGN:Retrospective cohort study.SETTING:Single general ICU in a tertiary teaching hospital.PATIENTS:Adult patients who were admitted to the ICU and underwent the out-of-the-ICU program as an early mobilization intervention was investigated.INTERVENTIONS:The out-of-the-ICU activities include visiting indoor area, visiting our outdoor garden, and bathing.MEASUREMENTS AND MAIN RESULTS:Medical records of ICU patients who participated in the out-of-the-ICU program were reviewed. The primary outcome was the occurrence rate of physical safety events, defined as unintentional removal of medical devices, patient agitation, a fall, or an injury. The secondary outcome was the occurrence rate of adverse physiologic changes, defined as hypotension, hypertension, bradycardia, tachycardia, desaturation, bradypnea, tachypnea, an increase in Fio2, or an increase in doses of vasoactive drugs. In total, 99 adult patients participated in the program, comprising a total of 423 out-of-the-ICU sessions. Among them, one session resulted in a physical safety event, the dislodgement of a tracheostomy tube. In 23 sessions, one or two adverse physiologic changes occurred. None of these events required additional treatment nor resulted in serious sequelae.CONCLUSIONS:An out-of-the-ICU program can be provided safely to adult ICU patients, provided that it is supervised by a dedicated intensivist with an appropriately trained multiprofessional staff and equipment on-site. It appears to contribute to the promotion of humanizing intensive care.

Early Enteral Nutrition Tolerance in Patients With Cardiogenic Shock Requiring Mechanical Circulatory Support.

Background: Enteral nutrition (EN) is recommended within the first 24–48 h for patients with hemodynamic stability, following admission to an intensive care unit (ICU). However, for patients with approximate stable hemodynamics requiring mechanical circulatory support and vasoactive drugs, the application of early EN remains controversial. We sought to evaluate the tolerance of early EN in patients with cardiogenic shock who required vasoactive drugs and mechanical circulatory support after cardiac surgery.Methods: This single-center, prospective observational study included patients with cardiogenic shock, requiring vasoactive drugs and mechanical circulatory support after cardiac surgery, undergoing EN. The primary endpoint was EN tolerance and secondary endpoints were mortality, length of mechanical ventilation, and length of ICU stay.Results: From February 2019 to December 2020, 59 patients were enrolled, of which 25 (42.37%) developed intolerance within 3 days of starting EN. Patients in the EN intolerant group had a longer median length of mechanical ventilation (380 vs. 128 h, p = 0.006), a longer median ICU stay (20 vs. 11.5 days, p = 0.03), and a higher proportion of bloodstream infections (44 vs. 14.71%, p = 0.018). The median EN calorie levels for all patients in the first 3 days of EN were 4.00, 4.13, and 4.28 kcal/kg/day, respectively. Median protein intake levels of EN in the first 3 days were 0.18, 0.17, and 0.17 g/kg/day, respectively. No significant difference was observed in the median dose of vasoactive drugs between the groups (0.035 vs. 0.05 μg/kg/min, p = 0.306).Conclusions: Patients with cardiogenic shock after cardiac surgery had a high proportion of early EN intolerance, and patients with EN intolerance had a worse prognosis, but no significant correlation was identified between EN tolerance and the dose of vasoactive drugs.

Transjugular intrahepatic portosystemic shunt in patients treated with a balloon tamponade for variceal hemorrhage without response to high doses of vasoactive drugs: A real-world multicenter retrospective study.

To evaluate the efficacy of transjugular intrahepatic portosystemic shunt (TIPS) and non-TIPS therapy (endoscopy and/or nonselective beta-blockers [NSBB]) in patients with cirrhosis and active variceal hemorrhage who did not respond to high-dose vasoactive drugs and required balloon tamponade for hemostasis. Medical records of cirrhotic patients who did not respond to high-dose vasoactive drugs and required balloon tamponade for hemostasis at five university hospitals in China between January 2011 and December 2018 were reviewed. Treatment outcomes were compared between the TIPS and the non-TIPS groups. Treatment failure of variceal hemorrhage within 5 days was reported in six patients of the non-TIPS group (N=70) and none of the TIPS group (N=66) (P=.028). The TIPS group had a higher 1-year variceal rebleeding-free rate compared with the non-TIPS group (95.5% vs 60.0%, P < .001). One patient treated with TIPS and nine with non-TIPS therapy experienced rebleeding within 5 days and 6 weeks after the intervention (P=.009). The cumulative 1-year survival rate was higher in the TIPS group than in the non-TIPS group (93.9% vs 78.6%, P=.01). The TIPS group had a higher incidence of hepatic encephalopathy within one year compared with the non-TIPS group (18.2% vs 4.3%, P=.026). For patients with cirrhosis and active variceal bleeding who do not respond to high-dose vasoactive agents and require a balloon tamponade for hemostasis, TIPS may be an appropriate treatment choice.

Early Antibody-Mediated Rejection in Non-Pre-Sensitized Heart Transplant Recipient

Introduction Antibody-mediated rejection (AMR) is an important cause of allograft dysfunction. It usually occurs after the first month of heart transplant (HT), but an early presentation is possible. We present an unusual case of a female HT recipient who had early AMR with no evidence of pre-sensitization to the donor. Case Report A woman, 45 years old, idiopathic dilated cardiomyopathy, two kids, with previous negative panel reactive antibody (PRA) was submitted to HT with success. The prospective crossmatch was negative and she did not receive blood cells during the surgery. The donor was a woman, 47 years old, who had a hemorrhagic stroke. After the procedure, she needed low doses of vasoactive drugs, received immunosuppression therapy according to institutional protocol and maintained normal ventricular function. On the 5th day, she developed biventricular graft dysfunction (left ventricular ejection fraction of 40%) requiring inotropes. The PRA revealed a donor specific antibody (DSA) not previously detected and the result of endomyocardial biopsy (EMB) confirmed acute AMR (pAMR2). Patient was successfully treated with methylprednisolone, plasmapheresis, immunoglobulin and rituximab. Biventricular function recovered; no DSA was detected and new EMB showed no rejection findings. Summary AMR results from recipient antibodies against donor-HLA antigens, causing complement activation, inflammation and injury to the allograft endothelium. In general, it occurs in the first two months after HT due to a rise in DSA by the contact with donor-HLA antigens. Early AMR, that occurs in the first week, is related to pre-sensitization to donor HLA antigens and associated with graft dysfunction. In this case report, no previous antibody had been detected. Two possibilities could explain such findings: the presence of non-HLA antibodies or the presence of memory B cells with levels of DSA too low to be detected on PRA. This case highlights the importance of monitoring antibodies in HT recipients with early allograft dysfunction even with previous negative PRA.

Evaluation of the sensitivity of different doses of vasoactive drugs in diagnosing erectile dysfunction in impotent patients: a prospective case-control study.

IntroductionErectile dysfunction (ED) is one of the most common sexual disorders worldwide affecting about 30 million men in the United States, and an estimated 100 million men worldwide. Penile duplex doppler ultrasound (PDDU) is performed using an intracavernosal injection (ICI) of a vasoactive agent to demonstrate both arterial insufficiency and veno-occlusive dysfunction. This article aims to evaluate the sensitivity of different doses of different vasoactive agents used to diagnose ED in impotent patients.Material and methodsThis study recruited 90 subjects with ED and 100 healthy subjects as controls. All of the subjects were assessed using the International Index of Erectile Function score (IIEF-5) while degree of erection was assessed by the Erection Hardness Score (EHS). Two penile duplex tests were done for each candidate two weeks apart.ResultsNone of the sample population achieved a normal clinical response (EHS >2) to 10 ug PGE1. In contrast, 60 controls (60%) had a normal response (EHS >2) to 10 ug PGE1. This difference in response between the sample and control populations to 10 ug PGE1 was of high statistical significance 11 (p <0.001). In contrast, 54 (60%) out of the 90 cases had normal clinical response (EHS >2) to 0.25cc Trimix (everywhere). Interestingly, 96 controls (96%) demonstrated normal response (EHS >2) to 0.25cc Trimix. This difference in response between the sample and control populations to 0.25 cc Trimix was also of high statistical significance (p <0.001).ConclusionsOur study demonstrated a statistically significant association between the response to Trimix over PGE1 and peak systolic velocity (PSV) and end diastolic velocity (EDV). Thus, we conclude that 0.25 cc Trimix is more sensitive than 20 ug PGE1 in diagnosing ED for impotent patients and also provides a more potent response.

Early Mobilization of Patients Receiving Vasoactive Drugs in Critical Care Units: A Systematic Review

Purpose: Mobilization is feasible, safe, and beneficial to patients admitted to critical care units. Vasoactive therapy appears to be one of the most common barriers to early mobilization. Many recent publications have studied the safety and feasibility of mobilizing patients with these vasoactive drugs. The aim of this review was to synthesize the prevailing evidence pertaining to mobilizing patients receiving vasoactive drugs. Methods: The protocol was developed and registered on PROSPERO (CRD42019127448). A comprehensive literature search was conducted using PubMed, Physiotherapy Evidence Database (PEDRO), Cochrane Central, and Embase (through Cochrane) for original research, including case studies and consensus guidelines. PRISMA guidelines were used to conduct and report this review. The included articles were appraised using the Newcastle-Ottawa Scale independently and a consensus reached by 3 reviewers. Results and Conclusion: Evidence determining specific doses of vasoactive drugs that would allow safe mobilization of patients in critical care is lacking. The criteria that have been used to determine the eligibility to mobilize patients on vasoactive drugs have not been consistent.

Impact of the use of vasoactive drugs in cardiac death donors on the early postoperative renal function and related complications in renal transplant recipients.

To explore the impact of the use of vasoactive drugs in donation after cardiac death (DCD) donors on graft function, with an attempt to guide the clinical practices of organ preservation and DCD kidney transplantation. The clinical data of 187 DCD donors and 304 recipients who were operated on in our center from February 2018 to May 2019 were retrospectively analyzed. Based on whether vasoactive drugs were used for maintaining blood pressure in DCD donors, the renal donors and recipients were divided into a high-dose group (norepinephrine ≥1.3 µg/kg/min or in combination with dopamine), a low-dose group (norepinephrine <1.3 µg/kg/min or in conjunction with dopamine), and a no-medication group (without the use of vasoactive drugs). The clinical features, post-transplant renal function, and complications were compared among these three groups. The early renal function 1 and 7 days after surgery was significantly superior in the high-dose group and no-medication group (P<0.05) but showed no significant difference between the low-dose group and the no-medication group (P>0.05). Blood urea nitrogen (BUN) on the 1st postoperative days was significantly higher in the high-dose group than in the low-dose group and the no-medication group (P<0.05). Renal function indicators, including serum creatinine (CRE), BUN, and blood uric acid (UA) on the 30th postoperative day, showed no significant difference among these three groups (P>0.05). The incidence of delayed graft function (DGF) after renal transplantation was significantly higher in the high-dose group than in the low-dose group and the no-medication group (P<0.05), whereas there was no significant difference between the groups in the incidences of graft rejection and infections (P>0.05). The use of vasoactive drugs in DCD donors can affect the early recovery of renal function in renal transplant recipients, particularly for those donors who are administered a high dose of vasoactive drugs. Therefore, donor maintenance should be performed cautiously with vasoactive drugs.

High doses of vasoactive drugs in treatment of refractory septic shock in elderly patient

High doses of vasoactive drugs in treatment of refractory septic shock in elderly patient

Reliability of three-dimensional color flow Doppler and two-dimensional pulse wave Doppler transthoracic echocardiography for estimating cardiac output after cardiac surgery

BackgroundThree-dimensional color flow Doppler (3DCF) is a new convenient technique for cardiac output (CO) measurement. However, to date, no one has evaluated the accuracy of 3DCF echocardiography for CO measurement after cardiac surgery. Therefore, this single-center, prospective study was designed to evaluate the reliability of three-dimensional color flow and two-dimensional pulse wave Doppler (2D-PWD) transthoracic echocardiography for estimating cardiac output after cardiac surgery.MethodsPost-cardiac surgical patients with a good acoustic window and a low dose or no dose of vasoactive drugs (norepinephrine < 0.05 μg/kg/min) were enrolled for CO estimation. Three different methods (third generation FloTrac/Vigileo™ [FT/V] system as the reference method, 3DCF, and 2D-PWD) were used to estimate CO before and after interventions (baseline, after volume expansion, and after a dobutamine test).ResultsA total of 20 patients were enrolled in this study, and 59 pairs of CO measurements were collected (one pair was not included because of increasing drainage after the dobutamine test). Pearson’s coefficients were 0.260 between the CO-FT/V and CO-PWD measurements and 0.729 between the CO-FT/V and CO-3DCF measurements. Bland-Altman analysis showed the bias between the absolute values of CO-FT/V and CO-PWD measurements was − 0.6 L/min with limits of agreement between − 3.3 L/min and 2.2 L/min, with a percentage error (PE) of 61.3%. The bias between CO-FT/V and CO-3DCF was − 0.14 L/min with limits of agreement between − 1.42 L /min and 1.14 L/min, with a PE of 29.9%. Four-quadrant plot analysis showed the concordance rate between ΔCO-PWD and ΔCO-3FT/V was 93.3%.ConclusionsIn a comparison with the FT/V system, 3DCF transthoracic echocardiography could accurately estimate CO in post-cardiac surgical patients, and the two methods could be considered interchangeable. Although 2D-PWD echocardiography was not as accurate as the 3D technique, its ability to track directional changes was reliable.

Extracorporeal Life Support in Organ Transplant Donors.

BackgroundExtracorporeal life support (ECLS) can be applied in brain-dead donors for organ perfusion before donation, thereby expanding the donor pool. The aim of this study was to examine the benefits and early clinical outcomes of ECLS for organ preservation.MethodsBetween June 2012 and April 2017, 9 patients received ECLS with therapeutic intent or for organ preservation. The following data were collected: demographics, purpose and duration of ECLS, cause of death, dose of vasoactive drugs, and need for temporary dialysis before organ retrieval. The early clinical outcomes of recipients were studied, as well as survival and graft function at 1 month.ResultsECLS was initiated for extracorporeal cardiopulmonary resuscitation in 5 patients. The other patients needed ECLS due to hemodynamic deterioration during the assessment of brain death. We successfully retrieved 18 kidneys, 7 livers, and 1 heart from 9 donors. All organs were transplanted and none were discarded. Only 1 case of delayed kidney graft function was noted, and all 26 recipients were discharged without any significant complications.ConclusionThe benefits of protecting the vital organs of donors is significant, and ECLS for organ preservation can be widely used in the transplantation field.

The Extra Corporeal Membrane Oxygenation (ECMO) in the Deceased Donors after Brain Death with Severe Hemodynamic Instability Allow to Optimize the Viability of Organs Procured for Transplantation

Introduction Some of the brain death donor manifest severe circulatory dysfunction that can lead to cardiac arrest and subsequently to donor lose or low quality of organs procured. Extra-corporeal membrane oxygenation (ECMO) can be applied to these donors to obtain organs with better quality with less ischemic damage. Objective To observe the clinical effect of the maintenance for the organ function by ECMO in brain death donor with severe hemodynamic instability. Methods 89 brain death donors maintained by ECMO were follow-up. The criteria for using the ECMO to protect the organ function were: A.Cardiac arrest, cardiopulmonary resuscitation history (cardiac compression>20min); B.Mean arterial pressure (MAP): in Adults<60~70mmHg; in children<50~60mmHg; in infant<40~50mmHg; C.Cardiac index<2L/m2·min)(3h);D.Large doses of vasoactive drugs: dopamine>20μg/(kg·min); (norepinephrine) epinephrine >1.0μg/(kg • min) (3h); E.Oliguria: <0.5mL/(kg·h); F.Blood biochemical indexes: Moderate, severe impairment on acute hepatic and renal function; G.Others: ST-T significantly changes in electrocardiogram; difficulty to correct the metabolic acidosis (3h). The organs were evaluated during their retrieval and as well their evolution after transplantation was evaluated. Results a total of 89 cases with ECMO maintenance were collected, equal to100 % of the total donation cases (100%). 178 kidneys, 89 livers were procured from these donors meanwhile 13 kidneys and 38 livers were discarded. Out of the discarded organs, 8 and 25 kidneys and livers respectively, were discarded due to ischemic damage as it was shown in a macroscopic evaluation. 165 of the procured kidneys were transplanted. DGF of kidney transplantation was observed in 18.8 % of the cases. Acute rejection incidence was 12.1%. Kidney survival rate was: 99.3% in one year,97.8% in three year,and 97.8% in five year. There was no difference outcome in patient or graft survival between the group with ECMO and the group without ECMO. Conclusion Our experience indicates that ECMO allows for the maintenance of abdominal organ tissue perfusion without warm ischemia before organ procurement, providing sufficient time for safe organ donation procedures and reducing the risk of unpredictable cardiac arrest that could result in the donor death and graft loss.ECMO in the brain dead donors with severe circulatory dysfunction allows to avoid organ donors lose and obtain good quality kidneys and livers; meaning low rates of primary dysfunction, DGF and acute rejection with excellent graft survival after transplantation.

The effects of continuous blood purification in patients with septic shock during perioperative period

Objective To evaluate the effects of continuous blood purification in patients with septic shock during perioperative period. Methods Forty-seven patients with infectious shock during perioperative period were enrolled and randomly divided into experimental group(group D, n=23) and control group(group F, n=24). Patients in group D received continuous venous hemofiltration starting before surgery till 72 hours after surgery. Patients in group F were treated with blood purification for 72 hours postoperatively. The blood oxygenation index, pH, HCO, base excess(BE), BUN, serum creatinine(SCr), SBP, DBP and HR were recorded in the two groups before surgery (T0), by the end of operation (T1), and 24 h (T2), and 48 h (T3), and 72 h (T4) after operation. The duration of operation, the perioperative doses of dopamine and metaraminol, and the recovery rate of patients were recorded, as well. Results Doses of dopamine and alamin in group D were significantly lower than those in group F (P 0.05), there was significant difference in oxygenation index at T2-T4 (P 0.05). There were no significant difference in biochemical indexes between group F and group D at T0 (P>0.05). Conclusions Continuous blood purification for perioperative patients with septic shock improved patients′ outcome: stabilizing homeostasis, maintaining the hemodynamics, reducing the doses of vasoactive drugs, improving patients′ tolerance and recovery rate. Key words: Perioperative period; Septic shock; Continuous blood purification

Renal and femoral venous blood flows are regulated by different mechanisms dependent on α-adrenergic receptor subtypes and nitric oxide in anesthetized rats

Venous and arterial walls are responsive to sympathetic system and circulating substances, nevertheless, very few is known about the venous blood flow regulation simultaneously to arterial vascular beds. In this study, we compared the venous and arterial blood flow regulation in visceral and muscular beds upon injection of different doses of vasoactive drugs which act in arterial vascular beds. Anesthetized adult male Wistar rats underwent to right femoral artery and vein cannulation for hemodynamic recordings and infusion of drugs. Doppler flow probes were placed around the left renal artery and vein, and left femoral artery and vein to evaluate the changes in flood flow. Phenylephrine (PHE) injection (α1-adrenergic receptor agonist) elicited vasoconstriction in all arteries and veins. Intravenous prazosin (PZS) (1mg/kg, α1-adrenergic receptor blocker) caused renal artery vasodilation, but not in the other beds. Vasoconstrictor effect of PHE was abolished by PZS in all vascular beds, except in femoral vein. Phentolamine (PTL) injection (1mg/kg, α1/α2-adrenergic receptor blocker) produced renal artery vasodilation with no change in other beds. After PTL, the vasoconstriction evoked by PHE was abolished in all vascular beds. Sodium Nitroprusside (SNP), a nitric oxide donor, elicited vasodilation in all beds, and after PTL but not post PZS injection, SNP enhanced the vasodilatory effect in femoral vein. Our findings suggest that the vasoconstriction in renal and femoral veins is mediated by different subtypes of α-adrenoceptors. The nitric oxide-dependent vasodilation in femoral vein enhances when α2-adrenoceptors are not under stimulation, but not in the other vascular beds investigated.