Hemodynamic Status Research Articles

Contribution of Computed Tomography in the Management of a Penetrating Knife Wound to the Skull: A Case Report and Review of the Literature

Introduction: Cranial wounds encephalic penetrating by stab are rare and repesent 0.4% of Head trauma. They are often observed in an attempt at autolysis in mentally ill people, or in physical aggression. We report here a case of an adolescent victim of attack by the penetration of a knife into his brain. Patient and method: This is a patient aged 17 years old, with no known medical history, admitted to the Emergency Reception Department of the Gabriel TOURE University Hospital for open head trauma following a physical attack with the penetration of a knife inside his headrane. The entire blade of the weapon was lodged in his brain parenchyma. The entry point was the right parietal bone. The patient had a Glasgow score of 15/15, with good hemodynamic status. The cranial scanner encephalic which was carried out a few minutes after his admission high lighted the presence of the knife blade at the level of parietal and temporal lobe of her hemisphere right. Result: The patient was operated successfully with extraction of a knife whose blade measured 6 to 7cm. A good postoperative evolution followed. Conscious and without motor deficit, he received a follow-up CT scan on day 7. Then he was released from the hospital with out patient follow-up. Conclusion: Cranial wounds-encephalic by penetration of a bladed weapon are very rare. The CT scan in emergency is the key examination to clarify the location, the number of foreign bodies, as well as brain lesions. They require rapid surgical treatment after CT evaluation. Their prognosis remains reserved regarding the severity of the head trauma, endocranial vascular lesions and infections.

Charting the course of blood flow: vessel-on-a-chip technologies in thrombosis studies

Cardiovascular diseases, primarily driven by thrombosis, remain the leading cause of global mortality. Although traditional cell culture and animal models have provided foundational insights, they often fail to capture the complex pathophysiology of thrombosis, which hinders the development of targeted therapies for cardiovascular diseases. The advent of microfluidics and vascular tissue engineering has propelled the advancement of vessel-on-a-chip technologies, which enable the simulation of the key aspects of Virchow’s Triad: hypercoagulability, alteration in blood flow, and endothelial wall injury. With the ability to replicate patient-specific vascular architectures and hemodynamic conditions, vessel-on-a-chip models offer unprecedented insights into the mechanisms underlying thrombosis formation and progression. This review explores the evolution of microfluidic technologies in thrombosis research, highlighting breakthroughs in endothelialized devices and their roles in emulating conditions such as vessel stenosis, flow reversal, and endothelial damage. The limitations and challenges of the current vessel-on-a-chip systems are addressed, and future perspectives on the potential for personalized medicine and targeted therapies are presented. Vessel-on-a-chip technology holds immense potential for revolutionizing thrombosis research, enabling the development of targeted, patient-specific diagnostic tools and therapeutic strategies. Realizing this potential will require interdisciplinary collaboration and continued innovation in the fields of microfluidics and vascular tissue engineering.

INVESTIGATING THE RELATIONSHIP BETWEEN BLEEDING, CLOTTING, AND COAGULOPATHY DURING AUTOMATED PARTIAL REBOA STRATEGIES IN A HIGHLY LETHAL PORCINE HEMORRHAGE MODEL.

Background: Death due to hemorrhagic shock, particularly, noncompressible truncal hemorrhage, remains one of the leading causes of potentially preventable deaths. Automated partial and intermittent resuscitative endovascular balloon occlusion of the aorta (i.e., pREBOA and iREBOA, respectively) are lifesaving endovascular strategies aimed to achieve quick hemostatic control while mitigating distal ischemia. In iREBOA, the balloon is titrated from full occlusion to no occlusion intermittently, whereas in pREBOA, a partial occlusion is maintained. Therefore, these two interventions impose different hemodynamic conditions, which may impact coagulation and the endothelial glycocalyx layer. In this study, we aimed to characterize the clotting kinetics and coagulopathy associated with iREBOA and pREBOA, using thromboelastography (TEG). We hypothesized that iREBOA would be associated with a more hypercoagulopathic response compared with pREBOA due to more oscillatory flow. Methods: Yorkshire swine (n = 8/group) were subjected to an uncontrolled hemorrhage by liver transection, followed by 90 min of automated pREBOA, iREBOA, or no balloon support (control). Hemodynamic parameters were continuously recorded, and blood samples were serially collected during the experiment (i.e., eight key time points: baseline (BL), T0, T10, T30, T60, T90, T120, T210 min). Citrated kaolin heparinase assays were run on a TEG 5000 (Haemonetics, Niles, IL). General linear mixed models were employed to compare differences in TEG parameters between groups and over time using STATA (v17; College Station, TX), while adjusting for sex and weight. Results: As expected, iREBOA was associated with more oscillations in proximal pressure (and greater magnitudes of peak pressure) because of the intermittent periods of full aortic occlusion and complete balloon deflation, compared to pREBOA. Despite these differences in acute hemodynamics, there were no significant differences in any of the TEG parameters between the iREBOA and pREBOA groups. However, animals in both groups experienced a significant reduction in clotting times (R time: P < 0.001; K time: P < 0.001) and clot strength (MA: P = 0.01; G: P = 0.02) over the duration of the experiment. Conclusions: Despite observing acute differences in peak proximal pressures between the iREBOA and pREBOA groups, we did not observe any significant differences in TEG parameters between iREBOA and pREBOA. The changes in TEG profiles were significant over time, indicating that a severe hemorrhage followed by both pREBOA and iREBOA can result in faster clotting reaction times (i.e., R times). Nevertheless, when considering the significant reduction in transfusion requirements and more stable hemodynamic response in the pREBOA group, there may be some evidence favoring pREBOA usage over iREBOA.

Robust arterial compliance estimation with Katz's fractal dimension of photoplethysmography.

Arterial compliance (AC) plays a crucial role in vascular aging and cardiovascular disease. The ability to continuously estimate aortic AC or its surrogate, pulse pressure (PP), through wearable devices is highly desirable, given its strong association with daily activities. While the single-site photoplethysmography (PPG)-derived arterial stiffness indices show reasonable correlations with AC, they are susceptible to noise interference, limiting their practical use. To overcome this challenge, our study introduces a noise-resistant indicator of AC: Katz's fractal dimension (KFD) of PPG signals. We showed that KFD integrated the signal complexity arising from compliance changes across a cardiac cycle and vascular structural complexity, thereby decreasing its dependence on individual characteristic points. To assess its capability in measuring AC, we conducted a comprehensive evaluation using both in silico studies with 4374 virtual human data and real-world measurements. In the virtual human studies, KFD demonstrated a strong correlation with AC (r = 0.75), which only experienced a slight decrease to 0.66at a signal-to-noise ratio of 15dB, surpassing the best PPG-morphology-derived AC measure (r = 0.41) under the same noise condition. In addition, we observed that KFD's sensitivity to AC varied based on the individual's hemodynamic status, which may further enhance the accuracy of AC estimations. These in silico findings were supported by real-world measurements encompassing diverse health conditions. In conclusion, our study suggests that PPG-derived KFD has the potential to continuously and reliably monitor arterial compliance, enabling unobtrusive and wearable assessment of cardiovascular health.

Usefulness of bicarbonate-based Impella purge solution in a patient with heparin-induced thrombocytopenia: the first case report of long-term management in Japan.

Percutaneous mechanical circulatory support utilizing micro-axial flow pumps, such as the Impella group of devices, has become a life-saving technique in the treatment of refractory cardiogenic shock, with ever-increasing success rates. A 30-year-old man presented with acute decompensated heart failure and a severely reduced left ventricular ejection fraction (17%). Despite initial treatment with inotropic drugs and intra-aortic balloon pump support, his hemodynamic status remained unstable. Transition to Impella CP mechanical circulatory support was made on day 6 owing to persistently low systolic blood pressure. A significant decline in platelet count prompted suspicion of heparin-induced thrombocytopenia (HIT), later confirmed by positive platelet-activated anti-platelet factor 4/heparin antibody and a 4Ts score of 6 points. Argatroban was initially used as the purge solution, but owing to complications, a switch to Impella 5.0 and a bicarbonate-based purge solution (BBPS) was performed. Despite additional veno-arterial extracorporeal membrane oxygenation support on day 24, the patient, aiming for ventricular assist device treatment and heart transplantation, died from infection and multiple organ failure. Remarkably, the Impella CP continued functioning normally until the patient's demise, indicating stable Impella pump performance using BBPS. This case highlights the usefulness of BBPS as an alternative to conventional Impella heparin purge solution when HIT occurs.

Prognostic Assessment of HLM Score in Heart Failure Due to Ischemic Heart Disease: A Pilot Study.

Background: Ischemic heart disease (IHD) represents the main cause of heart failure (HF). A prognostic stratification of HF patients with ischemic etiology, particularly those with acute coronary syndrome (ACS), may be challenging due the variability in clinical and hemodynamic status. The aim of this study is to assess the prognostic power of the HLM score in a population of patients with ischemic HF and in a subgroup who developed HF following ACS. Methods: This is an observational, prospective, single-center study, enrolling consecutive patients with a diagnosis of ischemic HF. Patients were stratified according to the four different HLM stages of severity, and the occurrence of CV death, HFH, and worsening HF events were evaluated at 6-month follow-up. A sub-analysis was performed on patients who developed HF following ACS at admission. Results: The study included 146 patients. HLM stage predicts the occurrence of CV death (p = 0.01) and CV death/HFH (p = 0.003). Cox regression analysis confirmed HLM stage as an independent predictor of CV death (OR: 3.07; 95% IC: 1.54-6.12; p = 0.001) and CV death/HFH (OR: 2.45; 95% IC: 1.43-4.21; p = 0.001) in the total population of patients with HF due to IHD. HLM stage potentially predicts the occurrence of CV death (p < 0.001) and CV death/HFH (p < 0.001) in patients with HF following ACS at admission. Conclusions: Pathophysiological-based prognostic assessment through HLM score is a potentially promising tool for the prediction of the occurrence of CV death and CV death/HFH in ischemic HF patients and in subgroups of patients with HF following ACS at admission.

Exploring the relationship between hemodynamics and the immune microenvironment in carotid atherosclerosis: Insights from CFD and CyTOF technologies

Carotid atherosclerosis is a major cause of stroke. Hemodynamic forces, such as shear stress and oscillatory shear, play an important role in the initiation and progression of atherosclerosis. The alteration of the immune microenvironment is the fundamental pathological mechanism by which diverse external environmental factors impact the formation and progression of plaques. However, Current research on the relationship between hemodynamics and immunity in atherosclerosis still lack of comprehensive understanding. In this study, we combined computational fluid dynamics (CFD) and Mass cytometry (CyTOF) technologies to explore the changes in the immune microenvironment within plaques under different hemodynamic conditions. Our results indicated that neutrophils were enriched in adverse flow environments. M2-like CD163+CD86+ macrophages were predominantly enriched in high WSS and low OSI environments, while CD163-CD14+ macrophages were enriched in low WSS and high OSI environments. Functional analysis further revealed T cell pro-inflammatory activation and dysregulation in modulation, along with an imbalance in M1-like/M2-like macrophages, suggesting their potential involvement in the progression of atherosclerotic lesions mediated by adverse flow patterns. Our study elucidated the potential mechanisms by which hemodynamics regulated the immune microenvironment within plaques, providing intervention targets for future precision therapies.

Cardiac Damage in Early Aortic Stenosis: Is the Valve to Blame?

BackgroundDespite the close association between aortic stenosis (AS) and cardiac damage (CD), it is unclear if CD is limited to patients with moderate and severe AS and which factors affect its progression. Although altered valvular hemodynamic status may drive the development of CD in AS, commonly occurring comorbidities may contribute. ObjectivesThe aim of this study was to determine the prevalence of and factors associated with CD in mild AS. MethodsThis retrospective study included 9,611 patients with mild AS (peak aortic valve velocity [Vmax] 2-3 m/s and description of abnormal aortic valve) from 2010 through 2021. CD was staged using the Genereux classification. ResultsAll but 20% (n = 1,901; stage 0) of patients with mild AS demonstrated CD: 1,613 (17%) stage 1, 4,843 (50%) stage 2, 891 (9%) stage 3, and 363 (4%) stage 4. Patients with higher stages had more comorbidities (hypertension, heart failure, ischemic heart disease, stroke, peripheral arterial disease, chronic kidney disease, chronic pulmonary disease, and diabetes mellitus) but had valvular hemodynamic status similar to those without CD. CD stage did not worsen with higher Vmax range (stage >1 in 64% with Vmax <2.5 m/s vs 61% with Vmax ≥2.5 m/s) but increased with the number of comorbidities, with stage >1 occurring in 50%, 53%, 60%, 66%, 72%, and 73% in the presence of 0, 1, 2, 3, 4, and 5 or more comorbidities, respectively. ConclusionsCD was highly prevalent in patients with mild AS. Among patients with mild AS, there was no relationship between the degree of CD and AS severity; instead, CD was highly associated with comorbidities.

Asymmetric Dimethylarginine and NT-proBNP Levels Provide SynergisticInformation in PulmonaryArterial Hypertension.

Plasma asymmetric dimethylarginine (ADMA) is elevated in pulmonary arterial hypertension (PAH) and is associated with unfavorable outcomes. The aim of this study was to assess changes in ADMA plasma levels for monitoring disease progression and outcomes during PAH-specific therapy. ADMA was measured at baseline and after at least 6months of follow-up using enzyme-linked immunosorbent assay and high-performance liquid chromatography. Changes in ADMA were analyzed in relation to changes in established PAH markers, including hemodynamic status, N-terminal pro-brain natriuretic peptide (NT-proBNP) and risk assessment scores. Impact on survival was assessed using Kaplan-Meier curves and Cox proportional hazards models. Between 2008 and 2019, ADMA samples were collected prospectively from 215 patients with PAH. Change in ADMA plasma level was a predictor of disease progression and survival. ΔADMA (median-0.03μmol/L; 95%CI:-0.145 to 0.0135) was correlated with change in mean pulmonary arterial pressure (P< 0.005; rS=0.287) but was not significantly correlated with ΔNT-proBNP (P=0.056; rS=0.135). Patients with decreased ADMA plasma levels at follow-up had better 3-year and 5-year survival rates (88% and 80%, respectively, vs 72% and 53% in those without decreases in ADMA) (P< 0.005; pulmonary hypertension-related mortality or lung transplantation). Patients with decreases in both ADMA and NT-proBNP had better survival rates compared with patients in whom only 1 parameter improved (P< 0.005). ΔADMA was a significant predictor of survival in Cox regression analysis and also when corrected for ΔNT-proBNP (HRs: 1.27 and 1.35, respectively; P< 0.005). ADMA and NT-proBNP provide synergistic prognostic information for patients with PAH. ADMA could be used as an objective and distinct biomarker for monitoring treatment response in PAH.

Hemodynamic coupling between a primary atherosclerotic plaque and subsequent secondary lesions

Atherosclerosis is one of the most common diseases of the arterial tree, especially in the coronary arteries. Stenoses exceeding 50% area reduction are shown to alternate the downstream coronary flow, and hemodynamics will lead to further atherogenesis. Clinical evidence also confirms that vascular stenoses are not stagnant since they are usually associated with downstream lesions. In this study, it is hypothesized that the formation of secondary plaques, or aneurysms downstream of a primary stenosis, compensates for the abnormal ranges of hemodynamic forces caused by the primary stenosis. An experimental setup captured the hemodynamics of non-Newtonian blood flow in three-dimensional (3D) printed phantoms of coronary arteries with various sequences of lesions. Then, based on the collected data, in silico models of these lesions were simulated using computational fluid dynamics. For the proposed cases, time-averaged wall shear stress, velocity profile, oscillatory shear index, and relative residence time were extracted at the plaque side and the plaque front walls and compared to the reference model with only the primary plaque. The secondary plaque postulated the abnormal hemodynamic conditions to its downstream, which implies endothelial activation and onset of further pathologic events. However, the secondary aneurysm restored flow conditions to normal after its distal shoulder, preventing more damage to the endothelium. Examined angiograms of patients with developed atherosclerotic lesions unveiled that a sequence of plaques is formed over time, and most interestingly, the series stopped after the formation of an aneurysm.

Measuring global cerebrovascular pulsatility transmission using 4D flow MRI

Pulse wave encephalopathy (PWE) is hypothesised to initiate many forms of dementia, motivating its identification and risk assessment. As candidate pulsatility based biomarkers for PWE, pulsatility index and pulsatility damping have been studied and, currently, do not adequately stratify risk due to variability in pulsatility and spatial bias. Here, we propose a locus-independent pulsatility transmission coefficient computed by spatially tracking pulsatility along vessels to characterise the brain pulse dynamics at a whole-organ level. Our preliminary analyses in a cohort of 20 subjects indicate that this measurement agrees with clinical observations relating blood pulsatility with age, heart rate, and sex, making it a suitable candidate to study the risk of PWE. We identified transmission differences between vascular regions perfused by the basilar and internal carotid arteries attributed to the identified dependence on cerebral blood flow, and some participants presented differences between the internal carotid perfused regions that were not related to flow or pulsatility burden, suggesting underlying mechanical differences. Large populational studies would benefit from retrospective pulsatility transmission analyses, providing a new comprehensive arterial description of the hemodynamic state in the brain. We provide a publicly available implementation of our tools to derive this coefficient, built into pre-existing open-source software.

Soluble guanylate cyclase stimulator as an emerging therapeutic option in the management of arrhythmias in heart failure rat model

Abstract Funding Acknowledgements Type of funding sources: Foundation. Main funding source(s): This research was supported by VEGA grant no. 2/0002/20 and 2/0006/23, the Slovak Research and Development Agency under contract no. 21-0410, European Regional Development Fund: ITMS2014+: 313011AVG3. This research was also partially supported by the Ministry of Health of the Czech Republic within the project for the development of the research organization [grant number 00023001 (IKEM)—institutional support] and also supported by the project National Institute for Research of Metabolic and Cardiovascular Diseases (Program EXCELES, Project No. LX22NPO5104)—Funded by the European Union—Next Generation EU Heart failure (HF) is a complex clinical syndrome characterized by a decrease in the efficiency of the heart pump, leading to a decline in hemodynamic status and cardiac remodelling, that can contribute to the formation of a substrate for arrhythmias. Antiarrhythmic drug therapy is still suboptimal and current therapies are not efficacious enough. The purpose of the current study was therefore to examine the efficiency of nitric oxide (NO)/soluble guanylyl cyclase (sGC)/cyclic guanosine monophosphate (cGMP) stimulator. We used as an experimental model male hypertensive Ren-2 transgenic rats (TGR, n = 16), normotensive Hannover Sprague–Dawley rats (HSD, n = 17), and a rat model of HF surgically induced by aortocaval fistula (ACF) in rats of both strains (n = 27). After ACF induction were rats treated by sGC stimulator BAY41-8543 (3 mg/kg/day for 30 weeks) alone or combined with angiotensin-converting enzyme inhibitor (ACEi) Trandolapril (0.25 mg/kg/day for 30 weeks). Age of the animals at the end of the experiment was 40 weeks. Left ventricle tissue and plasma samples were used for further analyses. Treatment by sGC stimulator significantly decreased rats' mortality, and systolic blood pressure, and significantly increased levels of antioxidant enzyme superoxide dismutase 1, matrix metalloproteinase 2, total and phosphorylated connexin 43 as well as protein kinase C epsilon, implicated in remodelling of extracellular matrix and intercellular communication, in the left ventricle of TGR rats. Application of sGC stimulator slightly normalized elevated collagen deposition and hydroxyproline content in the left ventricular tissue of TGR rats. Unfortunately, we did not observe any effect of the sGC stimulator in the TGR ACF group. These results support the hypothesis that sGC stimulators might represent a class of drugs suitable for combating heart failure with partially anti-arrhythmic potential, but further studies are needed.

Scalp Nerve Block for Enhanced Pain Control and Analgesic Optimization in Elective Craniotomy: A Randomized Controlled Trial with Analgesia Nociception Index Monitoring

In patients who are candidates for craniotomy, scalp nerve blocks have been shown to be effective in relieving pain intensity as well as postoperative hemodynamic stability after surgery, but the results have been inconsistent. We aimed to assess the effect of scalp block on pain control, intraoperative drug use under Analgesia Nociception Index (ANI) monitoring, and postoperative pain in patients who were candidates for elective craniotomy. In this randomized, single-blinded clinical trial study, candidates for craniotomy were randomly (using the block randomization method) divided into 2 groups before entering the operating room. The first group received a scalp block with bupivacaine (intervention), and the second group did not receive a scalp block (control) besides the routine anesthetic procedure in these patients. ANI, hemodynamic parameters, and the amounts of received remifentanil were conducted and compared. Patients under scalp block received less dosage of fentanyl than the nonscalp block group (mean=57.14±15.59 mcg vs. 250.00±65.04 mcg, respectively). Similarly, the dose of remifentanil required in the scalp block group was less (mean=3.04±1.95mg and 5.54±2.57mg, respectively). No difference was observed in hemodynamic parameters such as blood pressure and heart rate (before, during, and after surgery). However, the group receiving scalp block had higher ANI means than the control group. Scalp nerve block has an effective role in pain control (increasing ANI), consequently reducing the need for analgesic drugs such as fentanyl and remifentanil following craniotomy without changing the hemodynamic condition.

Erector spinae plane block for pain management in blunt chest trauma in military prehospital medicine, an interventional study

ABSTRACT Background Erector spinae plane block (ESPB) was presented in previous studies as a simple and safe technique with an excellent analgesic profile and improvement in respiratory function in multiple rib fractures. The purpose of this study was to investigate the efficiency of performing ESPB in the primary care unit for pain alleviation for individuals with blunt chest traumas. Methods This prospective interventional work was performed on 54 patients ranging in age from 20 to 50 years old, both sexes, American society of anesthesiology class I and II diagnosed with multiple rib fracture following blunt chest trauma. ESPB were performed using 20 mL of 0.25% levo-bupivacaine. Results The median (IQR) numeric rate scale was 9 (8–9) before block application and was significantly reduced to 1 (0–1) till it was 0 (0–1) in the 12th hour. After 24th hour, the median pain score was 2 (1–2), (p < 0.00). The mean arterial blood pressure and heart rate have significantly decreased following the block. Regarding complications of morphine, two patients only experienced mild vomiting. There were no other complications (local anesthetic toxicity, hematoma formation and pneumothorax). Conclusion Prehospital administration of ESPB for blunt chest trauma improved the pain scores, decreased the opioid administration without negative consequences on the hemodynamic state or occurrence of complications among participants.

The intelligent Impella: Future perspectives of artificial intelligence in the setting of Impella support.

Artificial intelligence (AI) has emerged as a potential useful tool to support clinical treatment of heart failure, including the setting of mechanical circulatory support (MCS). Modern Impella pumps are equipped with advanced technology (SmartAssist), enabling real-time acquisition and display of data related to both pump performance and the patient's haemodynamic status. These data emerge as an 'ideal' source for data-driven AI applications to predict the clinical course of an ongoing therapeutic protocol. Yet, no evidence of effective application of AI tools in the setting of Impella support is available. On this background, we aimed at identifying possible future applications of AI-based tools in the setting of temporary MCS with an Impella device. We explored the state of research and development at the intersection of AI and Impella support and derived future potential applications of AI in routine Impella clinical management. We identified different areas where the future implementation of AI tools may contribute to addressing important clinical challenges in the setting of Impella support, including (i) early identification of the best suited pathway of care according to patients' conditions at presentation and intention to treat, (ii) prediction of therapy outcomes according to different possible therapeutic actions, (iii) optimization of device implantation procedures and evaluation of proper pump position over the whole course of support and (iv) prevention and/or rationale management of haemocompatibility-related adverse events. For each of those areas, we discuss the potential advantages, challenges and implications of harnessing AI-driven insights in the setting of MCS with an Impella device. Temporary MCS with an Impella device has great potential to benefit from the integration of AI-based tools. Such tools may indeed translate into groundbreaking innovation supporting clinical decision-making and therapy regulation, in particular in complex scenarios such as the multidevice MCS strategy.

#1563 Family feedback survey on quality of dialysis withdrawal and end-of-life care on hemodialysis patients in an ICU – a single-center study from India

Abstract Background and Aims End-of-life care in hemodialysis is emerging, with limited implementation in developing countries. There is a sparsity of data on dialysis withdrawal and the quality of end-of-life care in these regions. Developing countries differ in their cultural, social, and spiritual practice compared to the Western world and family plays a major role in decision-making. No survey has been done on family's perception of dialysis withdrawal and end-of-life care in our settings. So, we studied feedback from families regarding the quality of dialysis withdrawal and end-of-life care provided to maintenance hemodialysis (MHD) patients admitted to our intensive care unit (ICU). Method This study was conducted at Kasturba Medical College, Manipal, MAHE, Manipal, India between January 2020 to October 2022 involving the data from end-stage kidney disease (ESKD) patients on MHD admitted in the ICU, who had withdrawn from dialysis before death and received end-of-life care as per the hospital policy (Blue Maple) from Renal supportive and Palliative care team. The baseline data was collected for all patients and indications for withdrawal of dialysis and ICU treatment and end-of-life care provided were collected. The next of kin were interviewed by telephone by a single interviewer using a modified Quality of Death and Dying questionnaire. The data was analyzed using SPSS 20 Results Among 98 ESKD patients on maintenance hemodialysis who died in our ICU, 23 were referred to Palliative care, counselled, had withdrawal of dialysis at least 48 hours before death and received end-of-life care. Table 1 outlines baseline characteristics. The mean age was 57 ± 12.09 years, with a male predominance (82.6%). Common comorbidities included hypertension (100%), type 2 diabetes (69.5%), and ischemic heart disease (65.2%). The primary cause for ICU admission was infectious disease (47.8%). The majority of reasons for dialysis withdrawal and end-of-life care were worsening hemodynamic status (82.6%) and illness deterioration (69.5%). After consent and establishment of futility, dialysis withdrawal was done for all patients (100%), No CPR for 100%, withdrawal of inotropes in 50%, and withdrawal of ventilator was done in 80% of the patients. A successful telephonic interview/survey was conducted with 21 out of the 23 subjects, with the majority of next of kin being the spouse (47.6%) followed by children (33.3%) and siblings (14.3%). The questionnaire and response are given in Table 2. All expressed a need for palliative care involvement. 82% accepted the decision of dialysis withdrawal and end-of-life care put forth by the doctor's team without difficulty;74% of families were present with the patient in their final hours and were grateful for the same 20% had their spiritual leader to visit during the end-of-life event. None of the family members (100%) interviewed had a guilty feeling and all had a positive rating on the involvement of the palliative care team and the need to ease patients' distress and suffering during their final hours (100%). Unfortunately, none of the patients had prior discussions of advance care planning (ACP) with their doctors regarding end-of-life care before the specific event Conclusion Our study highlights that families agree with the withdrawal of artificial life support measures, such as MHD, CPR, withdrawal of inotropes, and/withdrawal of ventilator in ICU settings when these interventions are considered futile for end-of-life care in ESKD patients. It also emphasizes the need for ACP, and early integration of palliative care for discussions about dialysis withdrawal, and withholding futile interventions at end-of-life care in ESKD patients, especially in resource-constrained settings like ours, for high-quality end-of-life care. This will also lead to better end-of-life care outcomes and improved patient and family satisfaction with care.

#2534 Classification of patients with acute kidney damage on the base of blood pressure value as a risk factor using a neural network

Abstract Background and Aims In acute kidney damage, the monitoring of hemodynamic status is best achieved by determining the blood pressure value. It is considered that the values of diastolic blood pressure in young and healthy people are constant from the aorta to the periphery, and the values of systolic and pulse pressure increase from the periphery to the aorta. The frequency of hypertension correlates with the presence of a cardiovascular precipitating risk factor in acute kidney injury, hypertension is also a modifying risk factor in the second and third stages of acute kidney injury, while the presence of hypotension on admission can be a clinical indicator of its cause. In patients with acute kidney damage and in patients with sepsis, the mechanism of autoregulation of mean arterial pressure, which is affected by stroke volume and heart rate, is not effective. The aim of the paper is to examine the classification of hospitalized patients with acute kidney injury based on blood pressure as a risk factor. Method The study included 86 patients over 18 years of age of both sexes (39 men 45.3% and 47 women 54.7%) with an average age of 66.85 ± 15.30 years who were diagnosed with acute kidney injury on admission to hospital treatment. Patients were divided into groups according to the stages of renal insufficiency. The study was designed as a cross-sectional comparative study. The assessment of the existence of acute kidney damage, as well as the determination of the stage of the disease, was based on the diagnostic criteria proposed by the K/DIGO expert group for acute kidney damage. The study did not include patients who had disease progression after acute kidney failure and were treated with dialysis for more than three months. Basic clinical, biochemical and hemodynamic parameters were determined in all subjects at the beginning of treatment, except for the analysis of nitrogen status, which was determined both before and at the end of treatment. During the formation of the neural network (pattern recognition Mat Lab), the parameters of systolic arterial pressure, diastolic arterial pressure normalized by min-max normalization to values from 0 to 1 were included. The data were randomly distributed into three categories: 80% for training, 10% for test, 10% for validation, which means that the parameters of 68 patients were used for training, 9 patients for validation and another 9 patients for the test. The number of input parameters is 33 to 39, while the number of output parameters is 2 in relation to treatment. Formed neural networks with different included blood pressure parameters, structures of 25 neurons in the hidden layer, with 55 and 15 epochs and with accuracy of 97.7% and 90.7% of patient classification. Results Our results show that 40.3% of patients in the third stage of acute kidney injury have hypertension. The lowest average values of systolic (108.44 ± 22.81 mmHg) and diastolic (65.56 ± 15.29 mmHg) blood pressure were experienced by patients in the first stage of acute kidney damage, and the lowest values of mean arterial pressure existed in the second stage of acute kidney damage (68.20 ± 44.96 mmHg) .Statistically significant risk factors for the development of the third stage of acute kidney damage in the multivariate analysis were patients older than 65 years, and mean arterial pressure values less than 65 mmHg. The confusion matrices showed that the classifiers adapted to the minimum and maximum values of systolic, diastolic and mean arterial blood pressure are well adapted and achieve satisfactory accuracy with 97.7% and 90.7%. Conclusion By comparing blood pressure parameters in hospitalized patients in relation to the stage of acute kidney damage, no statistically significant deviations were found. Univariate logistic regression analysis showed that age over 65 was a significant independent risk factor for stage three acute kidney injury, while the multivariate model showed that risk factors for the development of stage three acute kidney injury were patients same age and middle arterial blood pressure less than 65 mmHg. Satisfactory accuracy of formed neural networks when classifying patients during validation training and test was also demonstrated.

Outcomes of Lung Transplantation in Patients With Right Ventricular Dysfunction: A Single-Center Retrospective Analysis Comparing ECMO Configurations in a Bridge-to-Transplant Setting

This study aimed to assess the lung transplantation (LT) outcomes of patients with right ventricular dysfunction (RVD), focusing on the impact of various extracorporeal membrane oxygenation (ECMO) configurations. We included adult patients who underwent LT with ECMO as a bridge-to-transplant from 2011 to 2021 at a single center. Among patients with RVD (n = 67), veno-venous (V-V) ECMO was initially applied in 79% (53/67) and maintained until LT in 52% (35/67). Due to the worsening of RVD, the configuration was changed from V-V ECMO to veno-arterial (V-A) ECMO or a right ventricular assist device with an oxygenator (Oxy-RVAD) in 34% (18/67). They showed that lactic acid levels (2–6.1 mmol/L) and vasoactive inotropic score (6.6–22.6) increased. V-A ECMO or Oxy-RVAD was initiated and maintained until LT in 21% (14/67) of cases. There was no significant difference in the survival rates among the three configuration groups (V-V ECMO vs. configuration changed vs. V-A ECMO/Oxy-RVAD). Our findings suggest that the choice of ECMO configuration for LT candidates with RVD should be determined by the patient’s current hemodynamic status. Vital sign stability supports the use of V-V ECMO, while increasing lactic acid levels and vasopressor needs may require a switch to V-A ECMO or Oxy-RVAD.

Supervening Abscess Resulting in Streptococcus pyogenes Toxic Shock Syndrome Complicated by a Recent MRSA Infection in an Active Duty Military Member.

An 18-year-old male active duty US Army service member presented to the emergency department with a lower leg abscess in the region of a previously debrided methicillin-resistant Staphylococcus aureus abscess. After initial presentation, the patient became hypotensive, exhibited signs of renal failure, and developed a diffuse erythematous rash. Streptococcus pyogenes was grown from intraoperative cultures, and he was diagnosed with Streptococcal toxic shock syndrome (STSS). The patient subsequently underwent multiple surgical debridements, intravenous immunoglobulin treatment, and intravenous antibiotic administration. Streptococcal toxic shock syndrome may have a rapid onset and cause a sharp decline in hemodynamic status requiring admission to the intensive care unit. Any source of virulent Streptococcal pyogenes infection can cause STSS, including lower extremity abscesses. Therefore, it is imperative for physicians to recognize systemic involvement of seemingly isolated extremity infections. We encourage a high index of suspicion in treating bacterial abscesses for possible complications, and close monitoring of patient status. This suspicion should be even higher during outbreaks of bacteria that can cause STSS, much like the patient presented here.

INDICATORS OF CENTRAL HEMODYNAMICS IN ACQUIRED MYOPIA

Introduction. The presented study focuses on investigating the impact of acquired myopia on human central hemodynamics. Myopia, or nearsightedness, ranks as one of the most common ophthalmological disorders globally and in Ukraine, manifesting either congenitally or acquired over a lifetime. Ophthalmology specialists note a rapid increase in myopia cases across all age groups, with its prevalence posing a significant threat to vision and overall health. Viewing myopia as an adaptive response to a substantial visual strain one can presume that this adaptation might not be localized but generalized. The objective of the study is to examine the characteristics of central hemodynamics in individuals with acquired myopia. Materials and methods. The research was conducted on volunteers, 81 individuals aged 18 – 35, who were divided into a control group of 40 persons and a study group of 41 individuals diagnosed as having myopia. The diagnosis was established by specialists in Dnipro. The study was carried out at the General Practice Family Medicine Clinic No. 7 in Dnipro during 2022-2023. Central hemodynamic status was characterized by the following indicators: heart rate, systolic and diastolic blood pressure, pulse pressure, systolic blood volume, and minute blood volume. The Kerdo’s vegetative index was also calculated. Results. The study revealed that acquired myopia was accompanied by an increase in the absolute values of heart rate, systolic blood pressure, diastolic blood pressure, pulse pressure, and minute blood volume compared to the control group of volunteers. It is noteworthy that the systolic blood volume in the context of acquired myopia was lower than in the control group. The Kerdo’s index was higher in the group with acquired myopia compared to the control group. The obtained results indicate a certain dependency between central hemodynamics indicators, the Kerdo’s index value, and acquired myopia, which is an adaptive reaction of the visual system to significant loads in the modern information-cybernetic society. Changes in central hemodynamics indicators in individuals with myopia may reflect certain adaptive reactions of the cardiovascular system to this eye refraction disorder.