Hemodynamic Stability Of Patient Research Articles

A systematic approach to weaning from extracorporeal membrane oxygenation in patients with refractory cardiac failure.

Veno-arterial extracorporeal membrane oxygenation (V-A ECMO) is commonly used to provide haemodynamic support for patients with severe cardiac failure. However, timing ECMO weaning remains challenging. We aimed to examine if an integrative weaning approach based on predefined haemodynamic, respiratory and echocardiographic criteria is associated with successful weaning. All patients weaned from ECMO between April 2017 and April 2019 at Aarhus University Hospital, Denmark, were consecutively enrolled. Predefined haemodynamic, respiratory and echocardiographic criteria were assessed before and during ECMO flow reduction. A weaning attempt was commenced in haemodynamic stable patients and patients remaining stable at minimal flow were weaned from ECMO. Comparisons were made between patients who met the criteria for weaning at first attempt and patients who did not meet these criteria. Patients completing a full weaning attempt with no further need for mechanical support within 24h were defined as successfully weaned. A total of 38 patients were included in the study, of whom 26 (68%) patients met the criteria for weaning. Among these patients, 25 (96%) could be successfully weaned. Successfully weaned patients were younger and had less need for inotropic support and ECMO duration was shorter. Fulfilling the weaning criteria was associated with successful weaning and both favourable 30-d survival and survival to discharge. An integrative weaning approach based on haemodynamic, respiratory and echocardiographic criteria may strengthen the clinical decision process in predicting successful weaning in patients receiving ECMO for refractory cardiac failure.

Effect of preoperative multimedia based video information on perioperative anxiety and hemodynamic stability in patients undergoing surgery under spinal anesthesia.

Background and Aims:Pre-anesthesia checkup (PAC) gives unique opportunity for providing necessary information, patient education and allaying anxiety. Our objective was to measure the effect of preoperative multimedia video information (self made short video of 12 minutes) on patient's anxiety and hemodynamic parameters during surgery under spinal anesthesia.Methods:This prospective randomized study was conducted in 80 patients of either sex with ASA physical status I and II posted for lower limb surgery under spinal anesthesia. Patents were randomized to control or test group. At the end of preoperative visit, patients in test group watched the film and patient in control group did not watch any video. Verbal briefing by the attending anesthesiologist on the day of surgery was given to all patients of both the groups. Anxiety using Amsterdam Preoperative Anxiety and Information Scale (APAIS) and hemodynamic parameters (SBP, DBP and HR) at various time intervals (A1: Baseline, A2: post intervention, A3: just before surgery, A4: after surgery) were measured.Results:Baseline anxiety (A1) scores were severe in both the groups and showed no statistical significance (P = 0.436). Patients in test group (video) showed better/lower anxiety levels than the control group (non video) at A2 (P = 0.020) and A3 (P = 0.005) respectively, similarly hemodynamic parameters were better controlled and showed lesser deviation from baseline values in test group as compared to control group and showed statistical significant difference (P < 0.001) just before surgery.Conclusion:Combination of multimedia based video information at the time of PAC and short verbal briefing on the day of surgery by the attending anesthesiologist provides effective management of perioperative anxiety. It can be cost effective way of enhancing patient care and providing adequate information to people with reading and comprehension difficulties.

Pediyatrik Kalp Cerrahisi Anestezisinde Remifentanil ve Fentanilin İntraoperatif Hemodinamik Etkilerinin Karşılaştırılması

Objective: The aim of this prospective observational study was to compare the hemodynamic effects of remifentanil and fentanyl, which are used as intraoperative analgesics in pediatric cardiac surgery. Methods: Patients were divided into two groups as those who received continuous intravenous remifentanil infusion (Group R) or intermittent intravenous fentanyl for intraoperative analgesia (Group F). These groups were compared in terms of hemodynamic characteristics and intraoperative complications. Results: The most common congenital cardiac pathology observed in the patients included in the study was ventricular septal defects (32%). Intraoperative complications occurred in 21 (40%) patients, and ventricular fibrillation was the most common complication (n=6; 11.5%). When the patients in both groups were compared in terms of intraoperative hemodynamic indicators, the mean arterial pressure values of the patients in Group R after sternotomy were significantly lower than those of the patients in Group F (p=0.034). No statistically significant difference was found between the two groups in terms of other hemodynamic indicators. When the two groups were compared in terms of intraoperative complications, the difference was not statistically significant although the number of patients with complications was higher in Group F (p=0.1). Conclusion: As a result of this study, it was found that remifentanil was as effective as fentanyl in maintaining intraoperative hemodynamic stability in patients undergoing pediatric cardiac surgery.

Abstract 12575: Feasibility of Management in General Ward Settings for Hemodynamic Stable Patients With Acute Myocardial Infarction

Background: Although admission to the coronary care unit (CCU) is strongly recommended for ST-segment elevation myocardial infarction (STEMI) patients receiving primary percutaneous coronary intervention (PPCI) by current guidelines, it remains unclear whether it is suitable for hemodynamically stable patients with acute myocardial infarction (AMI). The aim of this study was to evaluate the safety of management in the general ward (GW) in hemodynamically stable AMI patients after PPCI compared to the CCU. Methods: Using a large nationwide administrative database, a cohort of 19,426 patients who were diagnosed as AMI in 52 hospitals, which were capable of admission to CCU, between Jan 2015 and Dec 2019, was retrospectively analyzed. Patients with mechanical circulatory support and Killip classification 4, and without PPCI, on the day of admission were excluded. Consequently, 5,736 patients were divided into the CCU group (n=3,488) and the GW group (n=2,248) based on the type of hospitalization room on admission after PPCI. A propensity score-matched (PSM) analysis was performed between the 2 groups, and 1,690 pairs of patients were matched. Results: The CCU group showed a higher prevalence of Killip classification 3 and ambulance use compared to the GW group. In the PSM model, Kaplan-Meier curve analysis showed there was no significant difference in the incidence of 30 days in-hospital mortality (Log rank p=0.48). On the other hand, total cost of hospitalization was lower in the GW group. Multivariable analysis did not show the association of GW admission with 30 days in-hospital mortality (HR: 1.07, 95% CI: 0.63-1.82, p=0.795). Conclusions: Management in the GW was not associated with 30 days in-hospital mortality for hemodynamically stable AMI patients after PPCI compared to the CCU, whereas it reduced the total cost of hospitalization. It may be feasible for hemodynamically stable AMI patients to be admitted directly to the GW after PPCI.

Heart rate control in patients with sepsis and septic cardiomyopathy: the role of Ivabradine

Tachycardia is an independent risk factor for mortality of patients with sepsis and multiple organ dysfunction syndrome (MODS), and has attracted extensive attention in recent years. Ivabradine, a specific blocker of hyperpolarization-activated cyclic nucleotide-gated (HCN) channel in sinoatrial node, is capable of inducing heart rate reduction (HRR) via binding specific sites of the channel and promotes ventricular filling because of prolongation of the diastolic period. Ivabradine has no negative effect on inotropic contractility, conductivity, and systemic vascular resistance. While Ivabradine has recently shown its beneficial effects in diverse randomized controlled trials on heart failure, this medicine may be a potential option to treat tachycardia in patients with sepsis and septic cardiomyopathy (SCM). Preliminary findings demonstrate that Ivabradine can remarkably lower heart rate and improve hemodynamic stability in patients with sepsis. In addition, Ivabradine has been reported to ameliorate microcirculation perfusion and suppress the inflammatory response. This review discusses the effects of Ivabradine on heart rate control in patients with sepsis and SCM.

Volumetric Capnography in Pediatric Extracorporeal Membrane Oxygenation: A Case Series

The kinetics of carbon dioxide elimination (VCO 2 ) may be used as a surrogate for pulmonary blood flow. As such, we can apply a novel use of volumetric capnography to assess hemodynamic stability in patients requiring extracorporeal membrane oxygenation (ECMO). We report our experience of pediatric patients requiring ECMO support who were monitored using volumetric capnography. We describe the use of VCO 2 and its association with successful decannulation. This is a prospective observational study of pediatric patients requiring ECMO support at The Children's Hospital at Montefiore from 2017 to 2019. A Respironics NM3 monitor was applied to each patient. Demographics, hemodynamic data, blood gases, and VCO 2 (mL/min) data were collected. Data were collected immediately prior to and after decannulation. Over the course of the study period, seven patients were included. Predecannulation VCO 2 was higher among patients who were successfully decannulated than nonsurvivors (109 [35, 230] vs. 12.4 [7.6, 17.2] mL/min), though not statistically significant. Four patients (57%) survived without further mechanical support; two (29%) died, and one (14%) was decannulated to Berlin. Predecannulation VCO 2 appears to correlate with hemodynamic stability following decannulation. This case series adds to the growing literature describing the use of volumetric capnography in critical care medicine, particularly pediatric patients requiring ECMO. Prospective studies are needed to further elucidate the use of volumetric capnography and optimal timing for ECMO decannulation.

Management of acute type A aortic dissection during COVID-19 outbreak: Experience from Anzhen.

We seek to report our management protocol and early outcomes of acute type A aortic dissection (ATAAD) repair during the early phase of coronavirus disease 2019 (COVID-19). From January 23 to April 30, 2020, we performed ATAAD repair for 33 patients, including three with pregnancy-related TAADs. Confirmation of COVID-19 depended on the results of two nucleic acid tests and pulmonary computed tomography scan. Based on testing results and hemodynamic stability, patients were triaged to an isolated intensive care unit or negative pressure operating room for emergency surgery. Mean age 50.2 ± 13.3 years and 20 were male (60.1%) and 8 patients were febrile (>37.3°C; 24.2%) and 17 were lymphopenic (51.5%). No patient was excluded from COVID-19 infection preoperatively. Extensive aortic repair with total arch replacement (TAR) was performed in 24 (72.7%), and limited proximal repair in 9 patients (27.3%). Cardiopulmonary bypass and cross-clamp times averaged 177 ± 34 and 88 ± 20 min for TAR, and 150 ± 30 and 83 ± 18 min for hemiarch, respectively. The mean operation time was 410 ± 68.3 min. Operative mortality was 6.1% (2/33). Complications included reintubation in four (12.1%), acute kidney failure in two (6.1%), and cerebral infarction in one (3.0%). No paraplegia nor re-exploration for bleeding occurred. COVID-19 was excluded in 100% eventually. No nosocomial infection occurred. Nor did any patient/surgical staff develop fever or test positive during the study period. The results of this study show that our management protocol based on testing results and hemodynamic stability in patients with ATAAD during the COVID-19 pandemic was effective and achieved favorable early surgical outcomes.

Resuscitative endovascular balloon occlusion of the aorta (REBOA) : Current aspects of material, indications and limits: an overview

Hintergrund„Resuscitative endovascular balloon occlusion of the aorta“ (REBOA) stellt ein endovaskuläres Verfahren dar, bei dem ein Blockballon in die Aorta eingeführt wird, um eine distal des Ballons gelegene Blutung zu verringern und gleichzeitig die kardiale und zerebrale Oxygenierung zu verbessern.Ziel der ArbeitVorstellung der REBOA-Technik, der möglichen Indikationen, der benötigen Materialien und der möglichen Komplikationen des Verfahrens.Material und MethodenNichtsystematischer Übersichtsartikel über die aktuelle Literatur.ErgebnisseREBOA stellt gerade bei traumatisch bedingten Blutungen und rupturierten Aortenaneurysmen ein mögliches additives Verfahren zur hämodynamischen Stabilisierung dar. Die Komplikationsrate des Verfahrens liegt bei ungefähr 5 %, wobei Zugangskomplikationen im Vordergrund stehen, jedoch auch letale Komplikationen möglich sind.DiskussionEine aortale Ballonblockade wird bei der Versorgung rupturierter Aortenaneurysmen standardmäßig eingesetzt. Es gibt wachsende Evidenz, dass REBOA bei der Versorgung polytraumatisierter Patienten mit einem hämorrhagischen Schock aufgrund einer abdominellen oder viszeralen Blutung eine vergleichsweise minimal-invasive Alternative zur offen chirurgischen Aortenklemmung mittels Thorakotomie darstellt. Mit der Entwicklung neuer Ballonkatheter, die ohne Führungsdraht und mit geringeren Schleusendurchmessern auskommen, wird auch ein Einsatz bei anderen Krankheitsbildern wie postoperativen abdominellen Nachblutungen, gynäkologischen Blutungen oder als additives Verfahren bei der kardiopulmonalen Reanimation diskutiert.

A RETROSPECTIVE STUDY TO COMPARE INFUSION OF PROPOFOL AND KETAMINE-PROPOFOL MIXTURE (KETOFOL) AS ANESTHETIC MAINTENANCE AGENTS IN PATIENTS UNDERGOING VARIOUS SURGICAL PROCEDURES IN TERTIARY CARE CENTRES

Introduction: The existing evidence suggests that the use of low doses and titers of ketamine can be effective in reducing the cardiovascular effects of propofol; nevertheless, this administration method can increase the chance of waking up during anesthesia. Some studies have reported the effect of anesthesia induction using a single propofol dose and low ketamine doses on the hemodynamic stability of patients in short-term outpatient operations in emergency departments. The aim of this study is to compare the effect of ketofol and propofol , to evaluate the intra and post-operative hemodynamic effects of ketofol infusion in comparison with propofol infusion.&#x0D; Methods: This Retrospective study involved Prior Consent from the Hospital Authorities &amp; was found to be within ethical standards. Data of 100 surgeries were selected which were managed with propofol ( 50 surgeries ) &amp; ketofol ( 50 surgeries) separately admitted to the local surgical units in last 5 years. The two groups were compared in terms of heart rate, systolic, diastolic and mean blood pressure, severity of pain and nausea, vomiting frequency and the doses of analgesics and antiemetic drugs used.&#x0D; Results: 38 (76%) out of 50 of the patients were male in the propofol group and 31 ( 62%) out of 50 were male in the ketofol group and the difference was not Significant .The mean age of the patients was 39.68 ± 7.32 years in the ketofol and 34.14 ± 7.61 years in the propofol groups . There was no statistical difference between the two groups regarding age and sex distribution. There was no difference between the two groups regarding systolic, diastolic and mean arterial blood pressure before induction and after. The intensity of nausea was not significantly different between the two groups. Postoperative pain severity and drug dosage were not significantly different between the two study groups.&#x0D; Conclusion: The infusion of a mixture of ketamine and propofol improves hemodynamic stability in addition to better analgesia compared to the infusion of propofol alone. But it led to heightened risk of nausea and vomiting. Future studies are recommended to address these issues. In addition, further studies are warranted to investigate the use of sub-hypnotic doses of ketamine + ketofol combination for infusion in surgical procedures. When these parameters are considered, ketofol might be used as an alternative to propofol.&#x0D; Keyword: Ketofol, Propofol, Retrospective Study. Comparative study, Ketamine

Intravenous fluid therapy in the noncritically ill patient. Our experience at a tertiary care emergency department in Abu Dhabi

Background: Intravenous (IV) fluids are a commonly prescribed treatment in the emergency department (ED). Often the prescription of a treatment to be administered in the ED prolongs the patients' length of stay (LOS). We hypothesize that IV fluids are overprescribed in the ED, mainly in patients classified as Emergency Severity Index (ESI) triaged level 3 (T3) and level 4 (T4). Methods: We conducted a quality audit to assess the appropriateness of IV fluid use in adult (age > 16 years) hemodynamically (HD) stable ESI triaged T3 and T4 patients at a tertiary hospital ED during two 6-month periods. Appropriate use of IV fluids was defined from the published literature and our own clinical experience. The primary outcome looked at was the number of patients appropriately prescribed IV fluids before and after implementing a list of indications for IV fluid use in HD stable patients. Results: Analysis showed 62.8% of T3 triaged patients and 74.2% of T4 patients were inappropriately prescribed IV fluids before the implementation of our indication list. This compared similar to 63.6% of T3 triaged patients and 71.4 % of T4 triaged patients after implementation. Median LOS of patients who received IV fluids was 3.5 and 3 hours for T3 and T4 patients, respectively. Conclusion: The data obtained in this quality audit demonstrated no difference in the use of IV fluids before and after implementing a list of indications for fluid therapy in HD stable T3 and T4 patients in our ED. We believe that developing a structured education program for caregivers in addition to patient education may help improve utilization of IV fluid based on true clinical indication.

Neuromuscular blockade and airway management during endotracheal intubation in Brazilian intensive care units: a national survey.

ObjectiveTo describe the use of neuromuscular blockade as well as other practices among Brazilian physicians in adult intensive care units.MethodsAn online national survey was designed and administered to Brazilian intensivists. Questions were selected using the Delphi method and assessed physicians’ demographic data, intensive care unit characteristics, practices regarding airway management, use of neuromuscular blockade and sedation during endotracheal intubation in the intensive care unit. As a secondary outcome, we applied a multivariate analysis to evaluate factors associated with the use of neuromuscular blockade.ResultsFive hundred sixty-five intensivists from all Brazilian regions responded to the questionnaire. The majority of respondents were male (65%), with a mean age of 38 ( 8.4 years, and 58.5% had a board certification in critical care. Only 40.7% of the intensivists reported the use of neuromuscular blockade during all or in more than 75% of endotracheal intubations. In the multivariate analysis, the number of intubations performed monthly and physician specialization in anesthesiology were directly associated with frequent use of neuromuscular blockade. Etomidate and ketamine were more commonly used in the clinical situation of hypotension and shock, while propofol and midazolam were more commonly prescribed in the situation of clinical stability.ConclusionThe reported use of neuromuscular blockade was low among intensivists, and sedative drugs were chosen in accordance with patient hemodynamic stability. These results may help the design of future studies regarding airway management in Brazil.

Laryngeal Mask Ventilation during Tracheostomy Improves Intraoperative Hemodynamic Stability in Patients Undergoing Total Laryngectomy

Abstract Background and objectives: Laryngectomy with extensive extirpational neck dissection is still the treatment of choice for patients with advanced laryngeal cancer. During the initial part of laryngectomy – tracheostomy, there is a significant upper airway obstruction, caused by the cancer process itself and worsened by surgical pressure and manipulation during creation of tracheostomy. This study aims to make comparative assessment of the patient’s hemodynamic parameters, operated using three of the most popular approaches during tracheostomy: local anesthesia with preserved spontaneous ventilation; general anesthesia with ventilation by endotracheal intubation and general anesthesia with ventilation by laryngeal mask airway. Methods: A prospective cohort study was conducted in a tertiary referral center. Sixty patients with advanced laryngeal cancer appointed for total laryngectomy, were enrolled in the study. They were randomly assigned into three groups, according to the ventilation method used during the tracheostomy. Results: Patients who underwent tracheostomy under local anesthesia displayed statistically the highest levels of SAP, DAP, MAP and heart rate intraoperatively. The group of patients who underwent tracheostomy with endotracheal intubation, also displayed significantly higher levels of hemodynamic parameters during the procedure compared with the group with laryngeal mask airway ventilation, despite the fact that both groups were under general anesthesia. Conclusions: To our knowledge, this is the first study to demonstrate that laryngeal mask ventilation during tracheostomy improves intraoperative hemodynamic stability in patients undergoing total laryngectomy compared to endotracheal intubation.

A comparative study for efficacy and safety of low doses of clonidine for hemodynamic stability in patients undergoing laparoscopic cholecystectomy

Background: This randomized prospective double-blind study was designed to evaluate the efficacy and side effects of low doses clonidine for perioperative haemodynamic stability and postoperative recovery.Methods: Patient’s with ASA grade I–II undergoing laparoscopic cholecystectomy were randomized into three groups of 30 patients each. All patients received either normal saline 10 ml (Group I) or 0.8 µg/kg (Group II) or 1 µg/kg (Group III) over duration of 180 seconds, 10 min prior to laryngoscopy and intubation. Anaesthesia was induced with 1% propofol (2 mg/kg) and maintained with nitrous oxide 60% in oxygen and isoflurane. The parameters assessed at various time intervals were heart rate, systolic blood pressure, diastolic blood pressure, mean arterial pressure and sedation score.Results: Both doses of clonidine proved to be effective in perioperative haemodynamic stability. Clonidine 0.8 mcg/kg was as effectve and safer to Clonidine 1 mcg/kg for attenuatíon of the hemodynamíc responses to laparoscopy. There were no significant differences in the parameters of recovery between groups.Conclusions: Significant hemodynamic derangements can occur during laproscopic cholecystectomy at intubation, pneumoperitoneum and extubation. These were effectively attenuated by premedication with 0.8 mcg/kg and 1 mcg/kg of intravenous clonidine. Dose of 1 mcg/kg though found to be effective but produced adverse effects in form of hypotension and bradycardia.

Intraventricular thrombus and severe mitral regurgitation in the acute phase of takotsubo cardiomyopathy: two case reports

BackgroundTakotsubo cardiomyopathy is characterized by chest symptoms, electrocardiographic changes, and new regional wall motion abnormality in the apical segment of the left ventricle in the absence of obstructive coronary artery disease. Particularly, apical ballooning is broadly recognized as the classic form of takotsubo cardiomyopathy. Although the prognosis of most patients with takotsubo cardiomyopathy is generally favorable, complications associated with the morphological features of transient apical ballooning are not uncommon.Case presentationWe describe two cases of transient complications in postmenopausal patients with takotsubo cardiomyopathy. Intraventricular thrombus was observed in Asian patient 1, and severe mitral regurgitation was observed in Asian patient 2. These complications were confirmed by transthoracic echocardiography immediately after typical takotsubo cardiomyopathy with apical ballooning was diagnosed. Anticoagulant therapy with heparin and warfarin was continued for 1 week in patient 1. After the therapy, complete resolution of the apical thrombus and recovery of systolic function of the left ventricle was observed by follow-up transthoracic echocardiography. In patient 2, transthoracic echocardiography indicated significant mitral regurgitation, which was caused by left ventricular tethering of the anterior mitral leaflet rather than left ventricular outflow tract obstruction or systolic anterior motion. Because the hemodynamic stability in patient 2 had been preserved, she was managed with conservative treatment. After approximately 1 month, follow-up transthoracic echocardiography revealed that mitral regurgitation had almost disappeared with complete resolution of left ventricular wall motion abnormalities.ConclusionsThe presented cases indicated that important complications, such as intraventricular thrombus and severe mitral regurgitation, are associated with takotsubo cardiomyopathy in the acute phase. Because these complications are risk factors for developing a thromboembolic event or heart failure and/or pulmonary edema, timely and accurate identification of these complications is critical to achieving optimal clinical outcomes in patients with takotsubo cardiomyopathy.

Influence of different PEEP levels on electrical impedance tomography findings in patients under general anesthesia ventilated in the lateral decubitus position.

To determine the effect of various PEEP levels on electrical impedance tomography (EIT) measured differences in regional ventilation, hemodynamics, lung mechanics and parameters of alveolar gas exchange. Thirty three patients scheduled for elective urologic surgery in general anesthesia in lateral decubitus position were randomized into three groups—PEEP 0, 5 and 10 mbar. EIT recording, arterial blood gas analysis and hemodynamic parameters were captured at three timepoints—before induction (T0), 5 min after lateral positioning (T1) and 90 min after positioning (T2). Dynamic compliance (Cdyn) was measured at T1 and T2. Offline EIT data analysis was performed to calculate EIT derived parameters of ventilation distribution. Patients ventilated with PEEP of 10 mbar had a significantly lower A-a (alveolo arterial) gradient over measurements and symmetrical distribution of ventilation measured by EIT. There was no significant difference in Cdyn, center of ventilation indices and inhomogeneity index between groups. There was no difference of mean arterial pressure, cardiac index and heart rate between groups. Patients with 5 mbar of PEEP had higher stroke volume index compared to 0 and 10 mbar at baseline and over measurements. Nondependent/dependent TV ratio as well as global inhomogeneity index were correlated with A-a gradient. Dynamic compliance showed no correlation to A-a gradient. In our study, a PEEP level of 10 mbar improved alveolar gas exchange without compromising hemodynamic stability in patients mechanically ventilated in the lateral decubitus position. EIT measured parameters may be used to determine optimal ventilation parameters in these patients with inhomogeneous lung mechanics. Further studies are needed in patients with various lung pathologies.

Diagnostic Yield and Accuracy of Bedside Echocardiography in the Emergency Department in Hemodynamically Stable Patients.

The goal of this study was to determine the diagnostic yield of focused cardiac ultrasound (FOCUS) in hemodynamically stable patients in the emergency department and secondarily to confirm the accuracy of these studies when compared to formal echocardiography. All hemodynamically stable adult patients who had an emergency physician-performed FOCUS examination completed over a 1-year period were identified using our electronic ultrasound database. Hemodynamic stability was defined as presenting systolic blood pressure higher than 90 mm Hg and not requiring any form of positive pressure ventilation. There were 1198 FOCUS examinations performed: 976 in hemodynamically stable patients who were included in our analysis. Twenty-seven percent of patients had new findings, including 154 (16%) new diagnoses of reduced left ventricular function, 105 (11%) new pericardial effusions, and 44 (5%) new diagnoses of RV dilatation. Dyspnea as an indication for the FOCUS examination was the strongest predictor of a positive study. Of patients included, 28% underwent formal echocardiography within 2 days and were analyzed for concordance with regard to left ventricular function and the presence of pericardial effusion. Of 270 studies, 208 were accurate, and 62 were inaccurate, for raw agreement of 77% (κ = 0.53). When stratified by sonographer experience, there was no impact on accuracy. Focused cardiac ultrasound in the emergency department for hemodynamically stable patients revealed new findings in 27% of studies, with a modest correlation with formal echocardiography. In stable patients, FOCUS has the potential for rapid diagnosis of cardiac disease, particularly in patients with dyspnea.

Effect of dexmedetomidine on tracheal intubation under general anesthesia for abdominal surgery

Objective To study the effect of dexmetomidine on tracheal intubation under abdominal anesthesia. Methods From January 2015 to January 2018, 100 patients were selected to perform tracheal intubation under abdominal anesthesia in Shanxi Provincial Hospital of Taiyuan.A total of 100 patients under abdominal surgery were randomly divided into two groups, with 50 patients in each group.The observation group was given dexmetomidine intravenous injection during the operation, while the control group was not given dexmetomidine during the operation.The blood pressure and heart rate of the two groups were compared before and after anesthesia.The recovery time of spontaneous respiration, eye opening time, extubation time, incidence of adverse events, cough score and restlessness score were compared between the two groups, and the cognitive function of the two groups was compared. Results After anesthesia, the systolic blood pressure[(103.75±2.26) mmHg], diastolic blood pressure[(71.92±1.95)mmHg], heart rate[(70.91±1.89)rpm]in the observation group were significantly higher than those in the control group[(100.37±2.91)mmHg, (70.27±1.84)mmHg, (69.08 ±1.63)](t=6.487, 4.532, 5.185, all P<0.05). The recovery time of spontaneous respiration[(7.14±1.37)min], eye opening time[(9.85±2.31)min]and extubation time[(20.57±2.94)min]in the observation group were significantly shorter than those in the control group[(8.75±1.89)min, (12.41±2.97)min, (24.06±3.42)min](t=4.877, 4.811, 5.472, all P<0.05). The incidence rate of adverse events in the observation group (8%) was lower than 24% in the control group (χ2=4.762, P<0.05). The score of cough and the score of restlessness in the observation group were (4.09±1.63) and (4.27±1.96), respectively, which were significantly lower than those in the control group[(6.24±2.18) and (6.51 ±2.32)](t=5.186, 5.215, all P<0.05). At 6 h after operation, the scores of MMSE, vocabulary memory, simple calculation and picture memory in the observation group were (23.95±2.13), (7.35±1.08), (7.14±1.12) and (7.26±1.17), respectively, which were higher than those in the control group[(20.47±1.91), (6.17±0.94), (5.89±1.04), (6.02±0.89)](t=8.601, 5.828, 5.783, 5.965, all P<0.05). Conclusion The application of dexmetomidine in patients under general anesthesia under tracheal intubation can effectively reduce the fluctuation of hemodynamic indicators after anesthesia, help to maintain the hemodynamic stability of patients, and promote the recovery of consciousness after operation.It can prevent adverse events during recovery of anesthesia and reduce the effect of anesthesia on cognitive function of patients. Key words: Anesthesia, general; Surgical procedures, operative; Abdomen; Hemodynamics; Cognitive function; Dexmetidine

Contrast-enhanced ultrasound performance in predicting blunt splenic injuries requiring only observation and monitoring.

To assess contrast enhanced ultrasound (CEUS) performance in the prediction of non-operatively managed bluntspleen injuries requiring only observation and monitoring during follow-up and to evaluate if CEUS accuracy was higher thanconventional ultrasound (US) in this field. In 112 hemodynamic stable blunt spleen trauma patients,CEUS was performed for follow-up after computed tomography evaluation in the emergency department. CEUS and US performancewere assessed considering as true negative cases patients that had not underwent interventional or surgical treatmentduring follow-up and were assessed as negative for splenic complications respectively by CEUS or US examinations. CEUS showed sensitivity of 100%, specificity of 96.1%, positive predictive value of 69.2%, negative predictive value of100.0% and accuracy of 96.4%. CEUS showed a significantly higher accuracy than conventional US (p=0.013). CEUS is a very useful imaging modality during follow-up of blunt splenic trauma non-operatively managed, allowing an efficientprediction of splenic injuries requiring only observation and monitoring during follow-up.

Treatment of Traumatic - Hemorrhagic Shock

Shock represents a condition of inadequate tissue perfusion due to circulatory insufficiency. Hemorrhage is the most common cause of shock in injured patients. Traumatic hemorrhagic shock presents a life-threatening condition due to the development of multifunctional organ dysfunction syndrome, which can be diagnosed due to symptomatology and changes in vital parameters. This study aims to analyse the epidemiological characteristics of traumatic - hemorrhagic shock and to demonstrate the efficacy of therapy in hemodynamic stabilization in patients with shock during the first 12 hours of intensive treatment at University Clinical Center of Kosovo.

Advances in Vasodilatory Shock: A Concise Review.

Vasodilatory shock is a critical manifestation of cardiovascular failure. There is uncontrolled vasodilation and vascular hyporesponsiveness to endogenous vasoconstrictors, causing the failure of physiologic vasoregulatory mechanisms. Unfortunately, only few randomized studies exist to guide clinical management and hemodynamic stabilization in patients who do not respond to the standard approach of managing vasodilatory shock. The present review offers the latest updates in management of this important clinical entity and a guidance framework for future research.How to cite this articleLahiry S, Thakur S, Chakraborty DS. Advances in Vasodilatory Shock: A Concise Review. Indian J Crit Care Med 2019;23(10):475–480.