Inadequate Delivery Research Articles

Comparing the Push–Pull Technique to Pressure Bag for Administration of Blood Products: A Prospective Nonblinded Observation Simulation-based Study (CoPP toP Study)

Abstract Introduction: Shock is defined as inadequate delivery of oxygen to meet the tissue’s demands. There are four main types of shock: cardiogenic, obstructive, distributive, and hypovolemic. Hypovolemic shock causes include hemorrhage, dehydration, and burns. Blood loss results in inadequate oxygen delivery to the cells resulting in tissue death if not reversed. Rapid infusers allow for the rapid administration of blood and crystalloid products to patients in shock; however, many community emergency departments do not have these devices. The aim of our study is to determine the fastest way to administer blood when the viscosity of the fluid is taken into consideration in a simulated setting. Methods: Volunteers were assigned to one of two arms: either the push–pull technique or pressure bag technique. The push–pull technique involved using a 50 cc syringe connected to a 3-way stop-cock to withdraw and infuse the fluid. The pressure bag technique involved pumping a pressure bag up to the maximum to infuse the fluids. The speed of infusing 250 mL of intravenous fluids was recorded. The time for the subjects to collect the materials throughout the emergency department was also recorded. Results: A total of three trials were conducted. On average, the push–pull technique took 228 s and the pressure bag technique took 340 s. The push–pull technique took an average of 112 s less than the pressure bag technique. Subjects took 62 s to find the materials for the pressure bag technique. It took 133 s to find the material for the push–pull technique. Conclusion: This prospective nonblinded observation simulation-based study demonstrated that the push–pull technique was significantly faster than the pressure bag technique.

Implications of Municipal Revenue Collection on Service Delivery in South Africa: Challenges and Recommendations

In South Africa, citizens have protested against inadequate services provided by municipalities across different provinces. It is argued that most protests were caused by poor service delivery, a lack of community engagement, corruption, mismanagement of public resources, lack of institutional capacity and unqualified personnel. Thus, this study evaluates the difficulties associated with revenue collection and its implications on service delivery. To assess this aim, the study adopted a qualitative research approach. This study reviewed secondary data from different databases. The study keywords were used to search for relevant studies. The study was analyzed using a thematic content approach. Moreover, the study adopted two theoretical frameworks namely; ability to pay and the benefits theory. The key findings of this study include substantial difficulties in revenue collection, which in turn affect the provision of services. Poor service delivery is continuously caused by a lack of sufficient financial resources and ineffective revenue collection mechanisms. This study indicates a significant link between low revenue collection and inadequate service delivery. The recommendations of this study to municipalities include employing qualified officials, creating rebates and discounts for paying consumers, regularly examining critical credit regulations, guaranteeing high-quality service, and boosting revenue collection in light of these findings.

Inflammation-Targeted Biomimetic Nano-Decoys via Inhibiting the Infiltration of Immune Cells and Effectively Delivering Glucocorticoids for Enhanced Multiple Sclerosis Treatment.

Excessive infiltration of neutrophil and inflammatory cytokines accumulation as well as the inadequate delivery of drugs to the targeted site are key pathological cascades in multiple sclerosis (MS). Herein, inflammation-targeting biomimetic nano-decoys (TFMN) is developed that inhibit the infiltration of immune cells and effectively deliver glucocorticoids to lesions for enhanced MS treatment. Nano-decoys encapsulated with the glucocorticoid methylprednisolone (MPS) are prepared by coating neutrophil membrane (NM) on nanoparticles formed by the self-assembly of tannic acid and poloxamer188/pluronic68. Benefiting from the natural inflammation-targeting ability of activated neutrophil membranes, TFMN can target the lesion site and prevent neutrophils infiltration by adsorbing and neutralizing elevated neutrophil-related cytokines, subsequently modulating the inflammatory microenvironment in experimental autoimmune encephalomyelitis mice. TFMN exhibits a strong antioxidant capacity and scavenged excessive reactive oxygen species to enhance neuronal protection. Furthermore, at the inflammation site, perforin, discharged by cytotoxic T-lymphocytes, triggered the controlled release of MPS within the TFMN through perforin-formed pores in the NM. Simultaneously, this mechanism protected neurons from perforin-induced toxicity. The MPS liberated at the targeted site achieves optimal drug accumulation, thereby enhancing therapeutic efficacy. In conclusion, the innovative system shows potential for integrating various therapeutic agents, offering a novel strategy for CNS disorders.

The Emerging Role of GLP-1 Agonists in Burn Care: What Do We Know?

Glucagon-like peptide-1 (GLP-1) agonists mimic the action of GLP-1, a hormone that regulates blood glucose levels via stimulation of insulin release and inhibition of glucagon secretion. After burn, the current literature suggests that the use of GLP-1 agonists results in less insulin dependence with similar glucose control and hypoglycemic events to patients receiving a basal-bolus insulin regimen. GLP-1 agonists may also promote wound healing through various mechanisms including angiogenesis and improved keratinocyte migration. Despite the potential benefits, GLP-1 agonists reduce gastrointestinal motility which impacts their widespread adoption in burn care. This dysmotility can result in inadequate nutrition delivery, unintentional weight loss, and is a potential aspiration risk. The net impact of these medications on burn patients is unclear. Given their potential to demonstrate the safety, efficacy, and optimal dosing of various GLP-1 agonists in acute burn management.

A Model For Teaching Arabic Grammar In Light Of The Common European Framework Of Reference For Languages

With its intricate arrangement, classification, abundance, and bifurcation, Arabic grammar presents challenges for learners rooted in historical contextual factors and pedagogical approaches. This study addresses the need for a comprehensive examination and categorization of Arabic grammatical rules based on specific criteria aligned with the Common European Framework of Reference for Languages (CEFR). It aims to identify prevalent and obscure rules, offering a compilation organized according to CEFR standards. The objective is to streamline Arabic language acquisition by reducing the overwhelming quantity of rules presented in textbooks for non-native speakers. The primary obstacle learners face is the complex nature of Arabic grammar, compounded by inadequate organization and delivery of existing materials. This leads to a skewed focus on less practical rules, hindering everyday speech and writing proficiency. Statistical analyses reveal the need for restructuring instructional sequences to prioritize commonly used rules. The proposal advocates aligning grammatical structures with CEFR guidelines and incorporating essential structures for non-Arabic speakers, promoting a modern and coherent language. By addressing these issues, this study motivates learners and bridges the gap between non-native and native proficiency levels in Arabic. The research relied on older references for the theoretical framework due to the need for more specialized references on teaching Arabic grammar to non-native speakers.

Conceptualizing Extended Reality Metaverse-based Pedagogy Model: A Hospitality and Tourism Education Perspective

The prevalence of online learning has significantly increased, particularly in light of the COVID-19 pandemic. Nevertheless, the shift to online education has presented numerous obstacles and concerns. The correlation between a lack of enthusiasm towards online learning and subpar academic achievements suggests the necessity to tackle the issues that impact students' involvement. Educators need to address obstacles encountered by students in online learning, including diminished concentration and inadequate learning delivery. Metaverse technologies have attracted growing interest among academia and practitioners for their possibilities in online education. Although metaverse technologies show promise for online education, there is a lack of research on their suitability for hospitality education. Comprehending how metaverse technologies can be seamlessly incorporated into online hospitality educational environments is crucial for the progression of such technology. Therefore, this study aims to conceptualize an extended reality metaverse-based pedagogy model for online hospitality education. The conceptual paper is a great resource for stakeholders who are interested in investigating the possibilities of metaverse technologies for hospitality education. This work also establishes a basis for future research that investigates the application of metaverse technologies in online educational environments.

Ultrasound-Responsive HBD Peptide Hydrogel with Antibiofilm Capability for Fast Diabetic Wound Healing.

Despite advancements in therapeutic agents for diabetic chronic wounds, challenges such as suboptimal bioavailability, intricate disease milieus, and inadequate delivery efficacy have impeded treatment outcomes. Here, ultrasound-responsive hydrogel incorporated with heparin-binding domain (HBD) peptide nanoparticles is developed to promote diabetic wound healing. HBD peptide, derived from von Willebrand Factor with angiogenic activity, are first engineered to self-assemble into nanoparticles with enhanced biostability and bioavailability. Ultrasound responsive cargo release and hydrogel collapses are first verified through breakage of crosslinking. In addition, desired antioxidant and antibacterial activity of such hydrogel is observed. Moreover, the degradation of hydrogel under ultrasound stimulation into smaller fragments facilitated the deeper wound penetration of ≈400 µm depth. Complete wound closure is observed from diabetic mice with chronic wounds after being treated with the proposed hydrogel. In detail, in vivo studies revealed that hydrogels loaded with HBD peptide nanoparticles increased the levels of angiogenesis-related growth factors (VEGF-A, CD31, and α-SMA) to effectively accelerate wound repair. Overall, this study demonstrates that ultrasound-responsive HBD peptide hydrogel provides a synergistic therapeutic strategy for external biofilm elimination and internal effective delivery for diabetic wounds with biofilm infection.

Ischemic Microenvironment-Targeted Bioinspired Lipoprotein Sequentially Penetrates Cerebral Ischemic Lesions to Rescue Ischemic Stroke.

Reperfusion injury represents a significant impediment to recovery after recanalization in an ischemic stroke and can be alleviated by neuroprotectants. However, inadequate drug delivery to ischemic lesions impairs the therapeutic effects of neuroprotectants. To address this issue, an ischemic microenvironment-targeted bioinspired lipoprotein system encapsulating lipoic acid (LA@PHDL) is herein designed to sequentially penetrate ischemic lesions and be readily taken up by neurons and microglia. In transient middle cerebral artery occlusion (tMCAO) mouse models, LA@PHDL accumulates rapidly and preferentially in the ischemic brain, with a 2.29-fold higher than the nontargeted nanoplatform in the early stage. Furthermore, LA@PHDL effectively restores neurological function, reduces infarct volume to 17.70%, prevents brain cell necrosis and apoptosis, and attenuates inflammation in tMCAO mouse models. This design presents new opportunities for delivering neuroprotectants to cerebral ischemic lesions to improve the outcome of an ischemic stroke.

Effect of E-Recruitment on Employee Performance: A Case of Kajiado County Government

Purpose: The widespread use of information systems in a variety of activities and departments for organizational competitive advantage and success has been aided by businesses' widespread acceptance of technology. Despite this, the Kajiado county government has been facing inadequate service delivery, which is exacerbated by personnel performance that falls short of deadlines or timeframes in reaching targets. The purpose of this study was to determine the effect of e-recruitment on employee performance in Kenya's Kajiado County Government. The technological acceptability model supported the study. Methodology: This study utilized a descriptive research design. A total of 1689 employees, including supervisors and unionized workers, were part of the study's target demographic. A sample size of 313 was chosen by stratified random sampling. Questionnaires were used to compile data. Quantitative data was analyzed using thematic analysis, while qualitative data was analyzed using statistical analysis. The data was analyzed with descriptive and inferential statistics. Results: Regression of coefficients showed that e-recruitment had a positive and significant effect on employee performance in Kajiado county (β=0.287, p=0.000). Conclusion: The study concluded that e-recruitment had a positive and significant effect on employee performance in Kajiado County. The government of Kenya should encourage all the counties to embrace the e-recruitment process. This is because e-recruitment minimizes paperwork recruitment and also minimizes costs. Counties should also use digital databases for their employees to minimize forgery and also for easier tracking of the applicants.

Red Blood Cell Membrane Spontaneously Coated Nanoprodrug Based on Phosphatidylserine for Antiatherosclerosis Applications.

Atherosclerosis (AS) is characterized by the accumulation of lipids within the walls of coronary arteries, leading to arterial narrowing and hardening. It serves as the primary etiology and pathological basis for cardiovascular diseases affecting the heart and brain. However, conventional pharmacotherapy is constrained by inadequate drug delivery and pronounced toxic side effects. Moreover, the inefficacy of nanomedicine delivery systems in controlling disease progression may be attributed to nonspecific clearance by the mononuclear phagocyte system. Thus, a biomimetic platform spontaneously enveloped by red blood cell membrane is exploited for anti-atherosclerosis applications, offering favorable biocompatibility. The CLIKKPF polypeptide is introduced to develop red blood cell membrane spontaneously encapsulated nanotherapeutics only through simple coincubation. Given the functional modifications, RBC@P-LVTNPs is beneficial to facilitate the target drug delivery to the atherosclerotic lesion, responding precisely to the pathological ROS accumulation, thereby accelerating the on-demand drug release. Both in vivo and in vitro results also confirm the significant therapeutic efficacy and favorable biocompatibility of the biomimetic nanomedicine delivery system, thus providing a promising candidate for nanotherapeutics against AS.

Equipping Civil Technology Teachers with Hands-On Skills and Educational Resources for Effective Teaching of Practical Lessons

Continuous professional development for teachers will always be prioritized, especially in cases where there are obvious and conspicuous gaps in their subject-matter expertise and when they handle practical skills exercises with inadequate planning and delivery. Hence, this study explores the effects of equipping Civil Technology teachers with hands-on skills and provision of educational resources for effective teaching of practical lessons. This study purposefully sampled nine (09) Civil Technology teachers from Ekurhuleni East, Gauteng province of South Africa. This study was hinged on Stronge’s qualities of effective teachers as its framework. This study adapted a mixed method design where closed-ended questionnaires and semi-structured interviews were considered relevant data collection instrument and sources. A sequential explanatory design was used to analyze the collected data. The findings reveal that even though teachers get continuous hands-on skills training from the Gauteng Department of Education (GDE) annually, the trainings are often too generic and do not adequately boost teachers with confidence to teach specific skills (i.e., construction and plumbing) to learners. As a result, Civil Technology teachers could not actualize their continuous professional development training as an element of learning to become innovative skills teachers. The survey found that while certain Ekurhuleni East schools have instructional tools, some of the teachers were not trained to use them, which made it difficult to effectively teach practical lessons in Civil Technology. Therefore, this study recommended that the Gauteng Department of Education should focus on discipline specific instructional strategies that will promote innovation in skills-based activities in Civil Technology.

Volume-based enteral feeding for ward patients with acute neurological conditions: a pilot prospective cohort study.

Patients requiring enteral nutrition (EN) after neurological insults experience feeding interruptions, contributing to inadequate nutrition delivery. This prospective cohort study investigated if volume-based enteral feeding (VBF) improved the delivery of prescribed EN volume in ward patients with acute neurological conditions. Over two sequential periods, the usual care group received standard continuous rate-based feeding, and the intervention group received VBF with bi-daily EN rate adjustments to achieve target daily volume. The primary outcome was percentage of prescribed daily EN formula volume delivered. Differences in energy and protein provision, weight, malnutrition and safety were explored. An evaluation survey captured nurse acceptability of the protocol. The intervention group (n = 32) achieved greater median interquartile range (IQR) EN adequacy of prescribed volume at 92% (88-97) compared to 67% (54-78) for usual care (n = 35) (p < 0.001). VBF compared to rate-based feeding resulted in patients receiving more kilojoules (131 [121-138] kJ/kg vs. 84 [64-99] kJ/kg; p < 0.001) and protein (1.3 [1.2-1.5] g/kg vs. 0.9 [0.6-1.1] g/kg; p < 0.001). There were no differences in gastrointestinal intolerance between groups. Compliance to the VBF protocol was 90%, and 78% of staff reported high confidence using the protocol. The intervention group had less median weight loss at discharge (-1.4 [0.1 to -4.3] kg) than usual care (-3.6 [-1.3 to 8.4] kg; p < 0.011), but no differences in malnutrition status were observed. A VBF protocol delivered greater EN volume, energy and protein following neurological injury. The VBF protocol was feasible with high acceptability from nursing staff.

PUBLIC ADMINISTRATION REFORM: AN IMPETUS FOR GOOD GOVERNANCE AND POLITICAL SECURITY IN NIGERIA

Over the last decade, the Nigerian government has undertaken a wide ranging policy, institutional, and legal initiatives to enhance the country’s public service delivery. Despite these efforts, the nation has grappled with a myriad of issues that still undermine good governance and political security. These challenges include weak institutional capacity, corruption, poor leadership, inadequate public service delivery, political instability, limited resources, poor infrastructure, and a shortage of skilled human resources. This paper examines the strategies and mechanisms employed by public administrators in Nigeria to enhance good governance and political security, analyses the impact of effective public administration on political stability and security and identifies the challenges affecting the implementation of good governance principles through public administration in Nigeria. The study has adopted the New Public Management Theory proposed by Hood in 1991 and relied on secondary data. Findings from the study show that Nigerian public administration has undergone a series of reforms to enhance good governance and political security through various strategies and mechanisms such as capacity building, international cooperation, and ethical conduct. The study also reveals that corruption and lack of accountability, bureaucratic bottlenecks and insufficient capacity among others have been identified as challenges of the implementation of good governance principles in Nigeria. The paper recommends that the encouragement and promotion of transparency and accountability be given top priority; citizen participation should also be encouraged in the planning and decision-making process; empowering local governments through the allocation of adequate resources to foster political security. The paper also recommends the establishment of a proper recruitment base to promote professionalism and meritocracy in the public service.

Improving young patient- practitioner communication about sexual health during medical visits.

Young people face barriers that lead to gaps in sexual and reproductive health care communications. Issues such as discomfort discussing sexual health lead to inadequate delivery of services resulting in unintended pregnancies and STIs. Closing this communication gap between patients and health care practitioners would improve communication and health outcomes. The objective of this study was to gain feedback from focus groups about: (a)barriers and facilitators to communication surrounding sexual health and (b)the feasibility and acceptability of a question prompt list (QPL) and informational video emphasizing asking questions about sexual health during medical visits as tools young people could use to be more involved during visits. Three focus groups were conducted: two with young adults (n=14) and one with practitioners (n=5) of sexual/reproductive health care services. Practitioners were recruited from healthcare clinics. Young adults were aged 18-22 years old. Participants identified barriers to communication such as embarrassment over sexual health topics and practitioner assumptions about patients' base of knowledge. A facilitator to communication was patient-friendly language. Focus group participants offered suggestions on how to improve the QPL as well as themes that should be covered in an educational video. Participants viewed the QPL and educational video as useful for encouraging conversations between patient and practitioner. Many barriers obstruct communication between young adults and practitioners on topics relating to sexual health. Both the QPL and an educational videocould be used to enhance patient-practitioner communication.

Optimal nutritional therapy in critically ill patients: a narrative review

Inadequate nutrition delivery remains a pervasive issue in critically ill patients, with significant challenges in accurately measuring nutritional requirements and personalising nutrition. Current medical nutrition therapy is constrained by difficulty in objectively measuring nutritional requirements and patient responses. Both enteral and parenteral nutrition are effective, but achieving and assessing nutritional targets pose substantial challenges. The adoption of computerised nutrition monitoring is on the rise, with future strategies potentially incorporating advanced muscle monitoring tools such as ultrasound and bioelectrical impedance analysis (BIA). Early enteral nutrition has been shown to reduce complications and shorten ICU stays; however, it should be delayed in specific conditions such as gastrointestinal bleeding. When EN is not feasible, PN serves as a safe alternative. Indirect calorimetry offers a method to measure energy expenditure and guide nutritional interventions, though larger trials are necessary to validate its benefits in personalised nutrition strategies. Significant muscle mass loss is prevalent in ICU patients, necessitating optimal amino acid delivery. Protein intake should be tailored to lean mass rather than total body weight, and bedside techniques like BIA and muscle ultrasound can aid in personalising protein delivery. While high protein intake may help mitigate muscle loss, its effect on clinical outcomes remains debated. Further trials are essential to enhance personalised ICU nutrition and improve patient outcomes throughout their ICU and post-ICU care journey.

Precision in Action: The Role of Clustered Regularly Interspaced Short Palindromic Repeats/Cas in Gene Therapies.

Clustered Regularly Interspaced Short Palindromic Repeat (CRISPR)-associated enzyme-CAS holds great promise for treating many uncured human diseases and illnesses by precisely correcting harmful point mutations and disrupting disease-causing genes. The recent Food and Drug Association (FDA) approval of the first CRISPR-based gene therapy for sickle cell anemia marks the beginning of a new era in gene editing. However, delivering CRISPR specifically into diseased cells in vivo is a significant challenge and an area of intense research. The identification of new CRISPR/Cas variants, particularly ultra-compact CAS systems with robust gene editing activities, paves the way for the low-capacity delivery vectors to be used in gene therapies. CRISPR/Cas technology has evolved beyond editing DNA to cover a wide spectrum of functionalities, including RNA targeting, disease diagnosis, transcriptional/epigenetic regulation, chromatin imaging, high-throughput screening, and new disease modeling. CRISPR/Cas can be used to engineer B-cells to produce potent antibodies for more effective vaccines and enhance CAR T-cells for the more precise and efficient targeting of tumor cells. However, CRISPR/Cas technology has challenges, including off-target effects, toxicity, immune responses, and inadequate tissue-specific delivery. Overcoming these challenges necessitates the development of a more effective and specific CRISPR/Cas delivery system. This entails strategically utilizing specific gRNAs in conjunction with robust CRISPR/Cas variants to mitigate off-target effects. This review seeks to delve into the intricacies of the CRISPR/Cas mechanism, explore progress in gene therapies, evaluate gene delivery systems, highlight limitations, outline necessary precautions, and scrutinize the ethical considerations associated with its application.

Anticancer Activity of HER2-targeting CPP-PTEN-THP Chimeric Proteins.

Protein phosphatase and tensin homolog (PTEN) is a tumor suppressor protein with potential to be a new biotechnological drug for PTEN-deficient cancer treatment. This study aimed to develop PTEN-based chimeric proteins (CPP-PTEN-THP) for human epidermal growth factor receptor 2 (HER2)-positive breast cancer treatment, addressing current limitations like inadequate delivery, poor tumor penetration, and low selectivity, while assessing their potential HER2-specific anticancer effects. pCEFL-EGFP vector was used for both TAT-PTEN-LTV and KLA-PTEN-LTV construction. Non-contact co-cultures were employed using HEK-293T cells for protein expression, and HCC-1954 and MCF-7 cell lines for cytotoxicity testing. Protein detection was analyzed by western blotting and a docking prediction analysis was performed to infer the interactions. Endogenous and recombinant PTEN protein expression was confirmed in cell lysates. A 54-kDa signal matching the theoretical size of PTEN was detected, showing a greater level in TAT-PTEN-LTV (215.1±26.45%) and KLA-PTEN-LTV (129.2±1.44%) compared to endogenous PTEN. After the noncontact co-culture method, cytotoxic studies showed HCC-1954 preferential cell inhibition growth, with 25.95±0.9% and 12.25±1.29% inhibition by KLA-PTEN-LTV and TAT-PTEN-LTV respectively, compared to MCF-7 cells. An LTV-HER2 interaction model was proposed, inferring that LTV interactions are mainly due to the Pro, Trp, and Tyr residues that target HER2. The developed PTEN-based chimeric proteins have HER2-specific anticancer activity against HCC-1954 cells.

Unveiling the future of cardiac care: advances in mechanical circulatory support

Congestive heart failure (CHF) is a multifaceted clinical syndrome characterized by the inability of the heart to pump blood effectively, leading to inadequate oxygen and nutrient delivery to the body tissues. Despite advancements in treatment strategies, including guideline-directed medical treatment (GDMT), end-stage CHF remains a significant cause of morbidity and mortality worldwide. Heart transplantation is considered to be the gold standard treatment of end stage CHF but constrained by the lack of organ donors, lengthening waitlists, and the negative side effects of lifelong immunosuppressive medications. Mechanical circulatory support (MCS) has emerged as a pivotal intervention for patients with end-stage CHF, serving as a bridge to recovery, transplantation, or destination therapy. The aim of this narrative review is to highlight the historical development of MCS, to assess the recent status of MCS device technology and discuss current challenges associated with complications of MCS that need to be solved in the future by device development. The history of MCS dates back to pioneering efforts in the 1960s, with significant progress in device development and utilization over decades. MCS devices, including left ventricular assist devices (LVADs), extracorporeal membrane oxygenation (ECMO), and artificial hearts, play a crucial role in providing circulatory support to patients with end-stage CHF. Recent advancements in MCS technology aim to decrease the device size, enhance blood compatibility, reduce thrombo-embolic complications, and prolong device durability and battery life and improve physiological performance of MCS. Continued research and innovation are essential to address these challenges and improve outcomes in patients with end-stage CHF. Artificial intelligence (AI) has emerged as a valuable tool in cardiovascular medicine to facilitate risk prediction, patient selection, and treatment optimization for MCS and heart transplantation. Despite these advancements, challenges persist in MCS device selection, resource allocation, and integration of AI into clinical practice. Continued research and innovation are essential to address these challenges and improve outcomes in patients with advanced heart failure.

Periods of low renal perfusion pressure are associated with acute kidney injury following paediatric cardiac surgery.

Acute kidney injury is associated with worse outcomes after cardiac surgery. The haemodynamic goals to ameliorate kidney injury are not clear. Low post-operative renal perfusion pressure has been associated with acute kidney injury in adults. Inadequate oxygen delivery may also cause kidney injury. This study evaluates pressure and oximetric haemodynamics after paediatric cardiac surgery and their association with acute kidney injury. Retrospective case-control study at a children's hospital. Patients were < 6 months of age who underwent a Society of Thoracic Surgery-European Association for Cardio-Thoracic Surgery Congenital Heart Surgery categories ≥ 3. Low renal perfusion pressure was time and depth below several tested thresholds. The primary outcome was serum creatine-defined acute kidney injury in the first 7 days. Sixty-six patients (median age 8 days) were included. Acute kidney injury occurred in 36%. The time and depth of renal perfusion pressure < 42 mmHg in the first 24 hours was greater in acute kidney injury patients (94 versus 35 mmHg*minutes of low renal perfusion pressure/hour, p = 0.008). In the multivariable model, renal perfusion pressure < 42 mmHg was associated with acute kidney injury (aOR: 2.07, 95%CI: 1.25-3.82, p = 0.009). Mean arterial pressure, central venous pressure, and measures of inadequate oxygen delivery were not associated with acute kidney injury. Periods of low renal perfusion pressure (<42 mmHg) in the first 24 post-operative hours are associated with acute kidney injury. Renal perfusion pressure is a potential modifiable target that may mitigate the impact of acute kidney injury after paediatric cardiac surgery.

Oxygen delivery and consumption in comatose out-of-hospital cardiac arrest patients are affected by blood pressure targets

Abstract Funding Acknowledgements Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Grosserer L. F. Foghts Fond Background Hemodynamic instability is common after resuscitated out-of-hospital cardiac arrest (OHCA). Preventing inadequate oxygen delivery (DO2) to the cells and thus not meeting oxygen demand is crucial to prevent further organ dysfunction. Additionally, oxygen uptake in the cells may be impaired. Oxygen consumption (VO2; the amount of oxygen consumed by the body per minute) could thus also be affected in OHCA. Purpose This study aimed to describe the effect of different mean arterial blood pressure (MAP) and partial arterial oxygen pressure (PaO2) targets on DO2 and VO2. Methods This post-hoc study is based on the BOX trial, a 2x2 factorial design that randomized OHCA patients to a MAP of either 63 mmHg (MAP63) or 77 mmHg (MAP77) and a partial pressure of arterial oxygen of 9 to 10 kPa or a liberal oxygen target of a PaO2 of 13 to 14 kPa at two cardiac centers in Denmark. Pulmonary artery catheters were placed to evaluate cardiac output and collect mixed venous blood samples at prespecified time points. Oxygen blood contents were calculated for arterial (CaO2) and mixed venous blood (CvO2) as Hgb (mg/dl) x 10 x 1.39 x Saturation O2 (proportion) + 0.0225 x PaO2. DO2 = CO x CaO2, and VO2 = CO x (CaO2-CvO2). Results This study included 715 patients (90% of the total cohort with a pulmonary catheter) for analysis. A restrictive or liberal oxygen supplement did not affect DO2 or VO2 during the initial 48 hours. The MAP77 group exhibited on average 11% higher DO2 (95%CI: 6%-15%) and on average a 6% higher VO2 in the first 48 hours (95%CI: 3%-10%) compared to the MAP63 group (see Figure 1). Conclusion Targeting a PaO2 of either 9 to 10 kPa or 13 to 15 kPa resulted in no significant changes in the provision of oxygen to the cells, nor did it increase the consumption of oxygen. In contrast, targeting a MAP of 77 mmHg resulted in an increase in both the provision of oxygen and consumption of oxygen compared to a MAP target of 63 mmHg.Figure 1