Changes In Hemodynamic Parameters Research Articles

Hemodynamic changes for half cover left subclavian artery ostium during thoracic endovascular aortic repair.

Some clinicians use endografts to cover half the left subclavian artery (LSA) ostium to cure some cases with insufficient proximal landing zone (PLZ) in thoracic endovascular aortic repair (TEVAR) treatment. We used computational fluid dynamics (CFD) to study the hemodynamic changes in the LSA because they may cause acute thrombosis or arteriosclerosis. The digital model of the aortic arch was established and named model A, which only included the supraarch branch of the LSA. By directly covering half of the LSA ostium, which was named as model B. All established models were imported into the Gambit grid division software for grid division and were subsequently imported into the Fluent software for hemodynamic numerical simulation and calculation to analyze the related changes in LSA hemodynamic parameters after stent implantation. Under the same aortic inlet flow, in model B, the local blood flow velocity of the LSA ostium increased and the whole blood flow velocity at the distal end decreased. The average wall shear stress (WSS) of the LSA was significantly decreased. Meanwhile there was an obvious turbulent flow in the LSA lumen, and the related blood flow state was disordered. CFD research confirmed that the implantation of an endograft covering half the LSA ostium can cause obvious hemodynamic changes, which is likely to cause a long-term arteriosclerosis or acute thrombosis of the LSA, finally increasing the risk of stroke. Once this operation is performed in some specific clinical cases for simplicity and economy, it seems that we should actively antiplatelet and follow up regularly.

Association of the key immunological and hemodynamic determinants with cervix ripening in pregnant women.

Aim: To investigate a correlation between cervical ripening, the immunological features and the hemodynamic characteristics of the cervix during the preparation for vaginal labor. Materials and Methods: We examined 75 pregnant women at different gestational age. General clinical and immunological studies were conducted in order to check serum concentration of cytokines IL-6, IL-1β, and TNF-α. Ultrasound and Doppler study were used to determine resistance index and systolic-diastolic ratio of blood flow in the common uterine artery as well as the descending and ascending parts and cervical stromal arteries. Results: Pregnant women with high cervical ripening score had high concentrations of the major proinflammatory cytokines (IL-1β, IL-6, and TNF-α). Analysis of the of the cervical blood flow indicators of the studied groups showed significant differences in the indices of vascular resistance in the vessels that feed the cervix. Our data showed a significant correlation between the cervix ripening and both the serum levels of the studied cytokines and the level of peripheral vascular resistance indices in the common uterine arteries of the cervix, and the blood flow indices in the cervical stromal vessels. Conclusions: Our study shows that the process of preparing the woman's body for labor is associated with immunological adjustment and increased hemodynamics of the cervix. We report that cervical ripening is associated with the immunological components and hemodynamic parameters of the cervix at late-stage pregnancy. Measuring cervix ripening and the accompanied changes in cytokine levels and hemodynamic parameters will form a more accurate assessment of birth preparedness and labor complications.

Effect on Onset and Duration of Sensory and Motor Block with Single Bolus Dose of Intravenous Dexmedetomidine as an Adjuvant on Spinal Anesthesia with 0.5% Hyperbaric Bupivacaine in Lower Limb Surgery

Background: The hyperbaric bupivacaine is being widely used for spinal anesthesia in lower limb surgeries. Dexmedetomidine can be used intravenously as well as an intrathecal injection along with spinal anesthesia for surgery below the umbilicus.
 Materials and Methods: This was a prospective, randomized double blinded study, where 100 patients posted for elective lower limb surgery under spinal anesthesia were divided into two groups. Group A received 0.5% hyperbaric bupivacaine as spinal anesthesia along with intravenous infusion of 0.5 μg /kg/hour of dexmedetomidine over a period of ten minutes. Group B received 0.5% hyperbaric bupivacaine as spinal anesthesia along with intravenous normal saline over a period of ten minutes.
 Results: The onset of sensory block was 3.19 ± 0.31 minutes in group A whereas 4.5 ± 0.22 minutes in group B. The onset of motor block was 4.28 ± 1.02 minutes in group A whereas 7.12 ± 0.87 in group B. The onset and duration of sensory and motor block were statistically significant. Regarding duration of sensory block, group A had 186.5 ± 14.04 minutes whereas group B had 148.2 ± 11.31 minutes with p value <0.001. The duration of motor block was 142 ± 11.42 minutes in group A whereas 122.4 ± 8.28 minutes in group B with p value <0.001. The duration of postoperative analgesia was prolonged in group A when compared with group B.
 Conclusion: Dexmedetomidine used as a single intravenous injection along with spinal anesthesia with 0.5% bupivacaine tends to shortens the onset of both sensory and motor blocks and increases the duration of sensory and motor blocks. It also prolongs the duration of analgesia with minimal or no changes in hemodynamic parameters.

Safety and efficacy of balloon pulmonary angioplasty for technically operable chronic thromboembolic pulmonary hypertension.

Balloon pulmonary angioplasty (BPA) has been proven effective for addressing technically inoperable chronic thromboembolic pulmonary hypertension (CTEPH). However, the effectiveness of BPA in technically operable CTEPH patients who, for various reasons, did not undergo the procedure remains an area requiring exploration. This study sought to assess the safety and efficacy of BPA in such cases. We collected and reviewed data from CTEPH patients who underwent BPA in a consecutive manner. Following multidisciplinary team (MDT) decisions, patients were classified into two groups: technically inoperable (group A) and operable (group B). Group B comprised patients deemed technically suitable for pulmonary endarterectomy (PEA) but who did not undergo the procedure for various reasons. All patients underwent a comprehensive diagnostic work-up, including right heart categorization at baseline and the last intervention. This study compared changes in hemodynamic parameters, functional capacity, and quality of life between the two groups. In total, 161 patients underwent 414 procedures at our center, with Group A comprising 112 patients who underwent 282 BPA sessions and group B comprising 49 patients who underwent 132 BPA sessions. Significantly, both groups exhibited improvements in hemodynamics, functional capacity, and quality of life. The occurrence rate of complications, including hemoptysis and lung injury, was similar [12 (63.2%) vs. 7 (36.8%), p = 0.68]. BPA demonstrated favorable outcomes in patients with proximal CTEPH who did not undergo pulmonary endarterectomy. However, the clinical impact of BPA in technically operable CTEPH was found to be less significant than in inoperable cases.

Standardized viscosity as a source of error in computational fluid dynamic simulations of cerebral aneurysms.

Computational fluid dynamics (CFD) simulations are a powerful tool for studying cerebral aneurysms, capable of evaluating hemodynamics in a way that is infeasible with imaging alone. However, the difficulty of incorporating patient-specific information and inherent obstacles of in vivo validation have limited the clinical usefulness of CFD of cerebral aneurysms. In this work we investigate the effect of using standardized blood viscosity values in CFD simulations of cerebral aneurysms when compared to simulations of the same aneurysms using patient-specific viscosity values derived from hematocrit measurements. The objective of this work is to determine the level of error, on average, that is, caused by using standardized values of viscosity in CFD simulations of cerebral aneurysms. By quantifying this error, we demonstrate the need for incorporating patient-specific viscosity in future CFD investigations of cerebral aneurysms. CFD simulations of forty-one cerebral aneurysms were conducted using patient-specific boundary conditions. For each aneurysm two simulations were conducted, one utilizing patient-specific blood viscosity derived from hematocrit measurements and another using a standardized value for blood viscosity. Hemodynamic parameters such as wall shear stress (WSS), wall shear stress gradient (WSSG), and the oscillatory shear index (OSI) were calculated for each of the simulations for each aneurysm. Paired t-tests for differences in the time-averaged maps of these hemodynamic parameters between standardized and patient-specific viscosity simulations were conducted for each aneurysm. Bland-Altman analysis was used to examine the cohort-wide changes in the hemodynamic parameters. Subjects were broken into two groups, those with higher than standard viscosity and those with lower than standard viscosity. An unpaired t-test was used to compare the percent change in WSS, WSSG, and OSI between patient-specific and standardized viscosity simulations for the two cohorts. The percent changes in hemodynamic parameters were correlated against the direction and magnitude of percent change in viscosity, aneurysm size, and aneurysm location. For all t-tests, a Bonferroni-corrected significance level of 0.0167 was used. 63.2%, 41.5%, and 48.7% of aneurysms showed statistically significant differences between patient-specific and standardized viscosity simulations for WSS, WSSG, and OSI respectively. No statistically significant difference was found in the percent changes in WSS, WSSG, and OSI between the group with higher than standard viscosity and those with lower than standard viscosity, indicating an increase in viscosity can cause either an increase or decrease in each of the hemodynamic parameters. On a study-wide level no significant bias was found in either direction for WSS, WSSG, or OSI between the simulation groups due to the bidirectional effect of changing viscosity. No correlation was found between percent change of viscosity and percent change of WSS, WSSG, or OSI, meaning an after-the-fact correction for patient-specific viscosity is not feasible. Standardizing viscosity values in CFD of cerebral aneurysms has a large and unpredictable impact on the calculated WSS, WSSG, and OSI when compared to CFD simulations of the same aneurysms using a patient-specific viscosity. We recommend implementing hematocrit-based patient-specific blood viscosity values for all CFD simulations of cerebral aneurysms.

Effect of acute normovolemic hemodilution in patients undergoing cardiac surgery with remimazolam anesthesia.

The reduced effects of allogeneic transfusion with acute normovolemic hemodilution (ANH) have been reported. Harvesting a large volume of blood may maximize the effect in patients with low body weight, and the prevention of hypotension is important. Remimazolam is an anesthetic with few circulatory responses. Our aim was to evaluate whether high-volume ANH reduces the need for transfusion in cardiac patients under remimazolam anesthesia. In this retrospective single-center study, we enrolled cardiopulmonary bypass (CPB) patients who received remimazolam anesthesia. Changes in hemodynamic parameters were assessed. The numbers of blood transfusions and chest tube outputs were also evaluated. In a total of 51 patients, ANH was performed in 27 patients with a mean body mass index of 23.2 (ANH volume: 740 ± 222mL). No significant differences were observed in mean blood pressure during blood collection. The intraoperative amount of red blood cell (RBC) transfusion was significantly lower in the ANH group than in the control group (431 ± 678 and 1260 ± 572mL, p < 0.001). The avoidance rates of RBC were 66.7 and 4.2%, respectively. The multivariate analysis result revealed that ANH correlated with RBC, with an odds ratio of 0.067 (95% confidence interval 0.005-0.84, p < 0.05). The postoperative bleeding at 24h was significantly lower in the ANH group (455 ± 228 and 797 ± 535mL, p < 0.01). In patients undergoing CPB, ANH reduced intraoperative transfusion amount and postoperative bleeding. Hemodynamic changes during blood collection were minimal under remimazolam anesthesia and high-volume ANH was feasible.

Assessing Passive Leg Raise Test in Pediatric Shock Using Electrical Cardiometry

AbstractPassive leg raise (PLR) is widely used to incite an autobolus to assess fluid responsiveness in adults; however, there is a paucity of studies exploring its utility in children. Our study aimed to analyze the efficacy of PLR in determining fluid responsiveness in children presenting with shock using electrical cardiometry. Patients in the age group of 0 to 20 years who presented in shock to our children's hospital emergency department were evaluated. Multiple hemodynamic metrics including, heart rate, systolic/diastolic blood pressure, cardiac output (CO), stroke index, stroke volume (SV), flow time corrected (FTC), and left ventricular ejection time (LVET) were recorded using the noninvasive ICON device and compared at baseline and post-PLR. A total of 68 patients had pre- and post-PLR data available for review between June and July 2022. Median age was 7 years (54% male); most common etiology was hypovolemic (67.6%) shock. Following PLR, there was no significant change in most hemodynamic parameters, including SV and CO; however, there was a significant difference in FTC (301 [pre-PLR] vs. 307 [post-PLR], p = 0.016) (ms) and LVET (232 [pre-PLR] vs. 234 [post-PLR], p = 0.014) (ms). A significantly higher proportion of children diagnosed with septic shock demonstrated fluid responsiveness (ΔSV ≥ 10% from baseline) compared with those with hypovolemic shock (p = 0.036). This study demonstrated no identifiable fluid responsiveness (ΔSV ≥ 10% from baseline) following PLR; however, a significantly higher proportion of children suffering from septic shock demonstrated fluid responsiveness compared with those with hypovolemic shock. Larger studies are needed to further assess the utility of PLR, as well as other modalities, in determining fluid responsiveness in children.

Body-weight support gait training in neurological intensive care: safety, feasibility, and delays before walking with or without suspension

BackgroundEarly Mobilization in Intensive Care Units (ICUs) enhances patients’ evolution, but has been rarely studied in neurological ICUs. The aim of this study was to assess gait training with body-weight support (BWS) in neuroICU, and to report on its safety, feasibility and on delays before walking with and without BWS.MethodsThis study was an observational one-year single-center study. Inclusion criteria were adults with a neurological injury requiring mechanical ventilation. Exclusion criteria were early death or ICU transfer. After weaning from ventilation, patients were screened for indications of BWS walking using predefined criteria.ResultsPatients’ conditions were mostly brain injuries: 32% subarachnoid hemorrhages, 42% focal strokes, and 12% traumatic brain injuries. Out of 272 admissions, 136 patients were excluded, 78 were eligible, and 33 performed BWS walking. Among non-eligible patients, 36 walked unsuspended upon ventilation weaning, 17 presented too severe impairments. Among the 45 eligible patients who did not receive BWS training, main reasons were workload and weekends (31%), medical barriers (29%), and early ICU discharge (22%). 78 BWS sessions were performed on the 33 beneficiaries (median sessions per patient 2, max 10). Pre-session, most patients had inadequate response to pain, orders, or simple orientation questions. Sitting without support was impossible for 74%. Most pre-post changes in hemodynamic, respiratory, and pain parameters were small, and recovered spontaneously after the session. Eight sessions were interrupted; reasons were pain, fatigue or major imbalance (4), syncope (1), occurrence of stool (2), and battery failure (1). None of these adverse events required medical intervention, patients recovered upon session interruption. Median session duration was 31 min, patients walked on median 17 m. First BWS session occurred on median 3 days after ventilation weaning, and 11 days before patients were able to walk unsuspended.ConclusionsVerticalization and walking using a suspension device in patients in neuroICU allows early gait training, despite challenging neurological impairments. It is safe and generally well tolerated.Trial registration: ClinicalTrials database (ID: NCT04300491).

Intrahospital Transport of Critically Ill Patients with Subarachnoid Hemorrhage-Frequency, Timing, Complications, and Clinical Consequences.

Patients with subarachnoid hemorrhage (SAH) often necessitate intra-hospital transport (IHT) during intensive care treatment. These transfers to facilities outside of the neurointensive care unit (NICU) pose challenges due to the inherent instability of the hemodynamic, respiratory, and neurological parameters that are typical in these patients. In this retrospective, single-center cohort study, a total of 108 IHTs were analyzed for demographics, transport rationale, clinical outcomes, and pre/post-IHT monitoring parameters. After establishing clinical thresholds, the frequency of complications was calculated, and predictors of thresholds violations were determined. The mean age was 55.7 (+/-15.3) years, with 68.0% showing severe SAH (World Federation of Neurosurgical Societies Scale 5). IHTs with an emergency indication made up 30.8% of all transports. Direct therapeutic consequences from IHT were observed in 38.5%. On average, the first IHT occurred 1.5 (+/-2.0) days post-admission and patients were transported 4.3 (+/-1.8) times during their stay in the NICU. Significant parameter changes from pre- to post-IHT included mean arterial pressure, systolic blood pressure, oxygen saturation, blood glucose levels, temperature, dosages of propofol and ketamine, tidal volume, inspired oxygen concentration, Horovitz index, glucose, pH, intracranial pressure, and cerebral perfusion pressure. Relevant hemodynamic thresholds were violated in 31.5% of cases, while respiratory complications occurred in 63.9%, and neurological complications in 20.4%. For hemodynamic complications, a low heart rate with a threshold of 61/min (OR 0.96, 95% CI 0.93-0.99, p = 0.0165) and low doses of midazolam with a threshold of 17.5 mg/h (OR 0.97, 95% CI 0.95-1.00, p = 0.0232) significantly predicted adverse events. However, the model did not identify significant predictors for respiratory and neurological outcomes. Conclusively, IHTs in SAH patients are associated with relevant changes in hemodynamic, respiratory, and neurological monitoring parameters, with direct therapeutic consequences in 4/10 IHTs. These findings underscore the importance of further studies on the clinical impact of IHTs.

Contribution of pressure and flow changes to resistance reduction after pulmonary arterial hypertension treatment: a meta-analysis of 3898 patients.

Pulmonary arterial hypertension (PAH)-targeted therapies exert significant haemodynamic changes; however, systematic synthesis is currently lacking. We searched PubMed, CENTRAL and Web of Science for studies evaluating mean pulmonary artery pressure (mPAP), cardiac index/cardiac output (CI/CO) and pulmonary vascular resistance (PVR) of PAH-targeted therapies either in monotherapy or combinations as assessed by right heart catheterisation in treatment-naïve PAH patients. We performed a random-effects meta-analysis with meta-regression. We included 68 studies (90 treatment groups) with 3898 patients (age 47.4±13.2 years, 74% women). In studies with small PVR reduction (<4 WU), CI/CO increase (R2=62%) and not mPAP reduction (R2=24%) was decisive for the PVR reduction (p<0.001 and p=0.36, respectively, in the multivariable meta-regression model); however, in studies with large PVR reduction (>4 WU), both CI/CO increase (R2=72%) and mPAP reduction (R2=35%) contributed significantly to the PVR reduction (p<0.001 and p=0.01, respectively). PVR reduction as a percentage of the pre-treatment value was more pronounced in the oral+prostanoid intravenous/subcutaneous combination therapy (mean difference -50.0%, 95% CI -60.8- -39.2%), compared to oral combination therapy (-41.7%, -47.6- -35.8%), prostanoid i.v./s.c. monotherapy (-31.8%, -37.6- -25.9%) and oral monotherapy (-21.6%, -25.4- -17.8%). Changes in haemodynamic parameters were significantly associated with changes in functional capacity of patients with PAH as expressed by the 6-min walking distance. Combination therapies, especially with the inclusion of parenteral prostanoids, lead to remarkable haemodynamic improvement in treatment-naïve PAH patients and may unmask the contribution of mPAP reduction to the overall PVR reduction in addition to the increase in CO.

Features of intrarenal hemodinamics as endotelial dysfunction indicator in patients with coronary heart disease in the post-COVID-19 period

BACKGROUND. Coronary heart disease (CHD) and obesity are common pathologies in patients who have had COVID-19. Endothelial dysfunction (ED) markers determination has been important in such patients due to the high risk of cardiovascular diseases progression and complications development.THE AIM Assessment of endothelial dysfunction severity in patients with CHD and obesity in the post-COVID-19 period to improve the management of these patients.PATIENTS AND METHODS. 49 patients were examined, who had COVID-19 a year ago. The first group (n=24) included patients with coronary artery disease in the post-COVID period. The second group (n=25) included patients with CHD and obesity who had COVID-19. We evaluated data from an ultrasound examination of the kidneys with duplex scanning of the renal arteries (resistance index (RI), pulsation index (PI)). We also studied the medical history, performed an objective examination, the results of a biochemical blood test, albuminuria levels.RESULTS. We demonstrated higher RI and PI of interlobar, segmental arteries in persons of the second group. An increase in RI and PI of segmental arteries accompanied by an increase in uric acid (p=0.001). The average level of microalbuminuria in the first group was 15,71± 4,51 μg/l, in the second group it was 24,38±5,38 μg/l (p=0.110). Increasing glucose levels accompanied by an elevation of C-reactive protein levels. Obesepatients had significantly higher levels of total cholesterol, triglycerides, low density lipoproteins than patients in the first group.CONCLUSION. We observed changes in lipid metabolism, a higher incidence of diabetes mellitus in females, and changes in intrarenal hemodynamic parameters associated with uric acid levels in patients with coronary heart disease and obesity in the post-COVID-19 period.

Patient-specific computational flow simulation reveals significant differences in paravisceral aortic hemodynamics between fenestrated and branched endovascular aneurysm repair

BackgroundEndovascular aneurysm repair with four-vessel fenestrated endovascular aneurysm repair (fEVAR) or branched endovascular aneurysm repair (bEVAR) currently represent the forefront of minimally invasive complex aortic aneurysm repair. This study sought to use patient-specific computational flow simulation (CFS) to assess differences in postoperative hemodynamic effects associated with fEVAR vs bEVAR. MethodsPatients from two institutions who underwent four-vessel fEVAR with the Cook Zenith Fenestrated platform and bEVAR with the Jotec E-xtra Design platform were retrospectively selected. Patients in both cohorts were treated for paravisceral and extent II, II, and V thoracoabdominal aortic aneurysms. Three-dimensional finite element volume meshes were created from preoperative and postoperative computed tomography scans. Boundary conditions were adjusted for body surface area, heart rate, and blood pressure. Pulsatile flow simulations were performed with equivalent boundary conditions between preoperative and postoperative states. Postoperative changes in hemodynamic parameters were compared between the fEVAR and bEVAR groups. ResultsPatient-specific CFS was performed on 20 patients (10 bEVAR, 10 fEVAR) with a total of 80 target vessels (40 renal, 20 celiac, 20 superior mesenteric artery stents). bEVAR was associated with a decrease in renal artery peak flow rate (−5.2% vs +2.0%; P < .0001) and peak pressure (−3.4 vs +0.1%; P < .0001) compared with fEVAR. Almost all renal arteries treated with bEVAR had a reduction in renal artery perfusion (n = 19 [95%]), compared with 35% (n = 7) treated with fEVAR. There were no significant differences in celiac or superior mesenteric artery perfusion metrics (P = .10-.27) between groups. Time-averaged wall shear stress in the paravisceral aorta and branches also varied significantly depending on endograft configuration, with bEVAR associated with large postoperative increases in renal artery (+47.5 vs +13.5%; P = .002) and aortic time-averaged wall shear stress (+200.1% vs −31.3%; P = .001) compared with fEVAR. Streamline analysis revealed areas of hemodynamic abnormalities associated with branched renal grafts which adopt a U-shaped geometry, which may explain the observed differences in postoperative changes in renal perfusion between bEVAR and fEVAR. ConclusionsbEVAR may be associated with subtle decreases in renal perfusion and a large increase in aortic wall shear stress compared with fEVAR. CFS is a novel tool for quantifying and visualizing the unique patient-specific hemodynamic effect of different complex EVAR strategies. Clinical RelevanceThis study used patient-specific CFS to compare postoperative hemodynamic effects of four-vessel fenestrated endovascular aneurysm repair (fEVAR) and branched endovascular aneurysm repair (bEVAR) in patients with complex aortic aneurysms. The findings indicate that bEVAR may result in subtle reductions in renal artery perfusion and a significant increase in aortic wall shear stress compared with fEVAR. These differences are clinically relevant, providing insights for clinicians choosing between these approaches. Understanding the patient-specific hemodynamic effects of complex EVAR strategies, as revealed by CFS, can aid in future personalized treatment decisions, and potentially reduce postoperative complications in aortic aneurysm repair.

Changes in cerebral hemodynamic parameters for patients with encephalopathies of different genesis

Mental function impairment is a common sign of encephalopathies, which various factors, including neurological disorders and cerebral hemodynamics, can cause.The purpose of the study was to establish changes in cerebral hemodynamic parameters in patients with encephalopathies of various origins.Material and methods. 520 patients with chronic traumatic encephalopathy (CTE, n=145), vascular encephalopathy in chronic brain ischemia (CVE, n=145), chronic alcoholic encephalopathy (CAE, n=102) and post-infectious encephalopathy (PIE, n=128) were examined. The patients were receiving inpatient treatment on the basis of the communal non-profit enterprise "Ternopil Regional Clinical Psychoneurological Hospital" during the period of 2021-2022. The cerebral blood flow was assessed using transcranial doppler scanning of intracranial and extracranial brachiocephalic vessels on a Philips HDI device.Research results. The most frequent disorders of cerebral hemodynamics in patients with CTE are the following: insufficient blood flow (44.83%), angiospasm (44.14%) and stenosis (40.69%); in patients with CVE – stenosis (67.59%), insufficient blood flow (66.21%) and venous stasis (64.83%); in patients with CAE – insufficient blood flow (32.35%), angiospasm (31.37%) and venous stasis (30.39%); in patients with PIE - angiospasm (45.31%), blood flow insufficiency (37.50%) and vertebro-basilar insufficiency (30.47%). Comparing the parameters of cerebral hemodynamics in patients with encephalopathies of various genesis, it was established that angiospasm in patients with CVE was recorded more often (by 23.11%) than in patients with CAE. A similar trend was noted in patients with CTE and PIE relative to the CAE group. The frequency of registration of blood flow insufficiency in patients with CVE probably exceeded the data of groups of CTE, CAE, and PIE (by 21.38, 33.86, and 28.71%, respectively). At the same time, the presence of changes within two distribution zones - carotid cerebral and vertebral-basilar in patients with CVE probably exceeded the data of the CAE and PIE groups. Regarding the comparison of the characteristics of stenoses, the frequency of detection of this phenomenon in patients with CTE probably exceeded the data of the CTE, CAE, and PIE groups (by 26.90, 53.86, and 64.46%, respectively). At the same time, the proportion of patients with significant stenosis in the CTE group probably exceeded the data of the CVE, CAE and PIE groups. The highest frequency of registration of venous stasis was established in patients with CTE (64.83%), which probably exceeded the data of the CTE, CAE and PIE groups. Vertebro-basilar insufficiency was not detected in patients with CAE, and in the PIE group its frequency of registration was 14.61% higher than the data of the CVE group and 18.06% higher than the data of the CTE group.Conclusions. The obtained results indicate the heterogeneity and polymorphism of the parameters of cerebral hemodynamics in patients with encephalopathies of various genesis, which requires further research to find possible relationships between them and cognitive dysfunction.

The Comparison of Early Hemodynamic Response to Single-Pulse Transcranial Magnetic Stimulation following Inhibitory or Excitatory Theta Burst Stimulation on Motor Cortex.

We present a new study design aiming to enhance the understanding of the mechanism by which continuous theta burst stimulation (cTBS) or intermittent theta burst stimulation (iTBS) paradigms elicit cortical modulation. Using near-infrared spectroscopy (NIRS), we compared the cortical hemodynamics of the previously inhibited (after cTBS) or excited (after iTBS) left primary motor cortex (M1) as elicited by single-pulse TMS (spTMS) in a cross-over design. Mean relative changes in hemodynamics within 6 s of the stimulus were compared using a two-sample t-test (p < 0.05) and linear mixed model between real and sham stimuli and between stimuli after cTBS and iTBS. Only spTMS after cTBS resulted in a significant increase (p = 0.04) in blood volume (BV) compared to baseline. There were no significant changes in other hemodynamic parameters (oxygenated/deoxygenated hemoglobin). spTMS after cTBS induced a larger increase in BV than spTMS after iTBS (p = 0.021) and sham stimulus after cTBS (p = 0.009). BV showed no significant difference between real and sham stimuli after iTBS (p = 0.37). The greater hemodynamic changes suggest increased vasomotor reactivity after cTBS compared to iTBS. In addition, cTBS could decrease lateral inhibition, allowing activation of surrounding areas after cTBS.

A comparative study of the efficacy of intravenous magnesium sulphate and intravenous dexmedetomidine in attenuating haemodynamic response to laryngoscopy and endotracheal intubation

Both laryngoscopy and tracheal intubation elicit a sympathetic and parasympathetic response, which varies depending on the depth of anaesthesia, duration of laryngoscopy, and patient characteristics. Although different methods have been used to suppress the response, an ideal agent has yet to be discovered. This study compares and contrasts the effectiveness of intravenous dexmedetomidine and intravenous magnesium sulphate in reducing hemodynamic response during laryngoscopy and endotracheal intubation.: This 18-month prospective, randomised, double-blind, placebo-controlled comparative research was conducted in the Department of Anaesthesiology and Critical Care, Bokaro General Hospital, Bokaro Steel City, Jharkhand. One hundred twenty consenting study participants were randomly divided into three groups of forty. Before induction, Group A received IV normal saline as a placebo. Group B received 1 mcg/kg IV dexmedetomidine before induction, while Group C received 30 mg/kg IV 50% magnesium sulphate before induction.: Gender distribution was consistent and equal among 120 patients. Gender, age, weight, ASA, and type of surgery did not differ significantly across groups. The three groups had no statistically significant difference in baseline hemodynamic parameters. When compared to the Control Group (A), there were statistically significant changes in hemodynamic parameters in the Dexmedetomidine (B) and Magnesium sulphate (C) groups. There was no hypotension, bradycardia, nausea, vomiting, dry mouth, or arrhythmias.: Dexmedetomidine and magnesium sulphate efficiently reduced the hemodynamic stress response to laryngoscopy and intubation, although dexmedetomidine attenuated the sympathetic response more effectively.

PECULIARITIES OF HEMODYNAMICS IN PATIENTS WITH CHRONIC HEART FAILURE CONSIDERING SEX DIMORPHISM

Introduction. Heart failure is an important factor in the development of pathological processes and pathophysiological manifestations; it can be modified at all stages of its development, regardless of sex and age, and be accompanied by arterial hypertension, heart ischemia, tachycardia, bradycardia, etc. The purpose of this study is to investigate the peculiarities of central hemodynamics in cases of chronic heart failure considering sex dimorphism. Materials and methods. The research comprised 149 individuals, aged between 18 and 75, with long-term heart failure, who received inpatient treatment at the Heart Failure Department of the National Centre of Cardiology "Acad. M.D. Strazhesko Institute of Cardiology” of the National Academy of Sciences of Ukraine for 2020 – 2022. Objective criteria such as heart rate, systolic and diastolic blood pressure, pulse pressure, systolic blood volume, and minute blood volume were used to assess the state of the cardiovascular system. All patients underwent an echocardiogram in M- and B-modes to assess the structural and functional state of the heart and to establish an accurate diagnosis. Results. Analyzing the obtained results, it should be noted that there is a certain sexual dimorphism in the indicators of central hemodynamics in patients with chronic heart failure: for instance, women with chronic heart failure demonstrates significantly higher values of blood pressure and pulse pressure than men with the same diagnosis. The values of minute blood volume in patients with chronic heart failure of both sexes were within the reference values. More pronounced changes in central hemodynamic parameters under chronic heart failure were observed in women compared to men. It should be noted that all investigations were conducted while individuals were receiving medical therapy for heart failure. It is note worthy that the results of the echocardiographic examination indicate profound changes in the heart structure in the patients with chronic heart failure. In particular, the set of the evaluated indicators point out left ventricle hypertrophy. The degree of hypertrophy provides unquestionable predictive value. Remodelling of the myocardium is a possible occurrence linked to arterial hypertension. Conclusion. Central hemodynamic indicators reveal sex dimorphism, with greater distinction observed in the patients with chronic heart failure, particularly among women. Despite this, the main indicators of hemodynamics in patients with chronic heart failure were within the reference values, which can be explained by the fact that the patients received drug therapy. However, the analysis of indicators obtained by echocardiographic study indicates profound changes in the heart structure in patients with chronic heart failure, which are more pronounced in male patients compared to their female counterparts.

Variations in NT-proBNP Levels in Pregnant Patients with and without SARS-CoV-2 Infection: Consequences for the Newborns.

NT-proBNP (N-terminal pro-brain natriuretic peptide) has a high negative predictive value for ruling out heart failure, a disorder linked with volume overload of the ventricles, and is used for diagnosis, prognosis, and risk stratification. Pregnancy causes in healthy women changes in physical and hemodynamic parameters and appears to be a risk factor for severe COVID-19 illness. The purpose of this study is to highlight the significance of monitoring NT-proBNP levels during pregnancy, particularly in patients who were infected with COVID-19 during pregnancy or were infected with the virus while giving birth. The findings of this comparative research indicate the importance of NT-proBNP in terms of foetal prognosis and birthweight. We collected blood samples to measure NT-proBNP concentrations from a cohort of 186 pregnant patients divided into two groups based on the presence of SARS-CoV-2 viral infection. Elevated NT-proBNP had an unfavourable implication on the newborn birth weight and Apgar score and expressed its influence on lower values. We consider that NT-proBNP testing in pregnant patients, especially those with COVID-19 infection, can be relevant and be used as a predictive marker to be taken into consideration when it comes to management, outcome, and treatment regarding pregnant patients and their newborns.

Changes of Hemodynamic Parameters over a Single Treatment Week in Patients Undergoing Chronic Intermittent Hemodialysis

Changes of Hemodynamic Parameters over a Single Treatment Week in Patients Undergoing Chronic Intermittent Hemodialysis

Evaluation of the pleth variability index, perfusion index, and other physiological parameters after COVID-19.

The aim of this study was to observe the changes in pleth variability index (PVI), perfusion index (PI) and other hemodynamic parameters in adult individuals who had had Coronavirus disease 2019 (COVID-19) and were currently living a normal life. A further aim was to draw attention to the fact that some hemodynamic changes after COVID-19 may cause long-term health problems. A total of 174 adult individuals who had had COVID-19 and were currently living a normal life and 56 healthy individuals with similar demographic characteristics who had not had COVID-19 were included in the study. The PI, PVI, oxygen saturation (SpO2), pulse rate (PR), total hemoglobin (Hgb), oxygen reserve index (ORI), and blood pressure values were measured by Masimo Radical 7. The data of individuals who had and did not have COVID-19 before were compared. The mean PVI (p = 0.008) and PI (p < 0.001) were significantly lower in people who had been exposed to COVID-19. Likewise, the mean of ORI, SpO2, and SpOC values was observed to be significantly lower in participants exposed to COVID-19 disease (p < 0.001, p < 0.001, and p = 0.006, respectively). The PVI had a positive correlation with body mass index (BMI) (r = 0.263, p < 0.001) and a negative correlation with SpO2 (r = -0.194, p = 0.003) and PR (r = 0.190, p = 0.004). The PVI, PI, and other physiological parameters could potentially be useful for monitoring COVID-19 patients and evaluating their response to therapy. We believe that people who have been exposed to COVID-19 may be more susceptible to other diseases; therefore, they should be subjected to regular clinical checks.

Novel Nebulized Milrinone Formulation for the Treatment of Acute Heart Failure Requiring Inotropic Therapy: A Phase 1 Study

Nonintravenous inotropic-delivery options are needed for patients with inotropic-dependent heart failure (HF) to reduce the costs, infections and thrombotic risks associated with chronic central venous catheters and home infusion services. We developed a novel, concentrated formulation of nebulized milrinone for inhalation and evaluated the feasibility, safety and pharmacokinetic profile in a prospective, single-arm, phase I clinical trial. We enrolled 10 patients with stage D HF requiring inotropic therapy during a hospital admission for acute HF. Milrinone 60 mg/4 mL was inhaled via nebulization 3 times daily for 48 hours. The coprimary outcomes were adverse events and pharmacokinetic profiles of inhaled milrinone. Acute changes in hemodynamic parameters were secondary outcomes. A concentrated nebulized milrinone formulation was well tolerated, without hypotensive events, arrhythmias or inhalation-related adverse events requiring discontinuation. Nebulized milrinone produced serum concentrations in the goal therapeutic range with a median plasma milrinone trough concentration of 39 (17-66) ng/mL and a median peak concentration of 207 (134-293) ng/mL. There were no serious adverse events. From baseline to 24 hours, mean pulmonary artery saturation increased (60% ± 7%-65 ± 5%; P = 0.001), and mean cardiac index increased (2.0 ± 0.5 mL/min/1.73m2-2.5 ± 0.1 mL/min/1.73m2; P = 0.001) with nebulized milrinone. In a proof-of-concept study, a concentrated, nebulized milrinone formulation for inhalation was safe and produced therapeutic serum milrinone concentrations. Nebulized milrinone was associated with improved hemodynamic parameters of cardiac output in a population with advanced HF. These promising results require further investigation in a longer-term trial in patients with inotrope-dependent advanced HF.