Mean Arterial Pressure Research Articles (Page 1)

Acute traumatic spinal cord injury (tSCI) is among the more complex challenges in modern medicine and has far-reaching implications for the affected patients' quality of life. A practical summary for treating physicians of the currently recommended clinical measures for the acute care of patients with tSCI is needed as an evidence-based guide to treatment. This narrative review is based on pertinent publications (1984-2024) retrieved by a search in the PubMed, Cochrane, and EMBASE databases, with particular attention to the updated clinical practice guideline on acute spinal cord trauma issued by AO Spine in 2024. The abstracts were examined for relevance, and the full text of selected articles was studied. The evidence base for the management of tSCI includes only a small number of randomized controlled trials. As a result, the evidence underlying many of the recommendations is on a moderate or low level. Early surgical decompression (within 24 hours) is associated with a significantly better neurological outcome: it more than doubles the likelihood of an improvement of ≥ 2 points on the Abbreviated Injury Scale (AIS) (RR: 2.76, 95% confidence interval [1,60; 4,98]; moderate evidence level). Maintaining an adequate mean arterial blood pressure is considered to be essential, despite the absence of robust evidence for any specific protocol (very low evidence level). The use of corticosteroids remains controversial because of conflicting evidence. The treatment of tSCI requires a multidisciplinary, evidence-based approach including early surgery and patient-oriented hemodynamic management.

We aimed to investigate the effects of Xuebijing (XBJ) combined with levosimendan on the immune function and coagulation function in patients with sepsis complicated by myocardial injury. This double-blind, randomized controlled trial involved 88 sepsis patients with myocardial injury, split into control (n = 44, levosimendan plus conventional therapy) and combination (n = 44, control group's treatment plus XBJ injection) groups. Primary outcomes: coagulation parameters [prothrombin time (PT), activated partial thromboplastin time (APTT), platelet count (PLT), fibrinogen (Fib), and D-dimer (D-D)], immune function indicators (peripheral blood T lymphocyte subsets: CD4+, CD8+, and the CD4+/CD8+ ratio). Secondary outcomes: inflammatory markers [procalcitonin (PCT), C-reactive protein (CRP), and tumor necrosis factor (TNF-α)], vascular endothelial function markers [endothelin-1 (ET-1), nitric oxide (NO), vascular endothelial growth factor (VEGF), von Willebrand factor (vWF), and soluble thrombomodulin (sTM)], myocardial function biomarkers [cardiac troponin I (cTnI), creatine kinase isoenzyme (CK-MB), and B-type brain natriuretic peptide (BNP)], and hemodynamic parameter [heart rate (HR), mean arterial pressure (MAP), and central venous pressure (CVP)]. Post-treatment, serum levels of PCT, CRP, TNF-α, ET-1, vWF, sTM, PT, APTT, D-D, CD8+, cTnI, CK-MB, BNP, and HR were lower in both groups, with further reductions in the combination group. Levels of NO, VEGF, PLT, Fib, CD4+, CD4+/CD8+ ratio, MAP and CVP were higher in the combination group than in the control group (all P < 0.05). The combination of XBJ and levosimendan improves coagulation function, regulates immune function, enhances vascular endothelial function and hemodynamics, reduces inflammation, and alleviates myocardial injury.

Awake craniotomy and deep brain stimulation (DBS) procedures require the patient to be awake and adequate anesthesia conditions are typically achieved using ascalp block. These procedures inherently involve some degree of pain from local anesthetic injections during scalp block administration. We aimed to reduce the injection pain in scalp blocks using avibration stimulus. Atotal of 56patients aged between 18and 75years undergoing awake craniotomy and DBS procedures were enrolled in the study. All patients received aloading dose of dexmedetomidine before scalp block administration. Local anesthetic injections were applied sequentially to the identically named nerves on the right and left sides of the head. Avibration device was used during injections on one side, while injections on the other side were performed without vibration. The numeric rating scale (NRS) score and hemodynamic measurements during each injection, including heart rate and mean arterial pressure were compared between vibration and nonvibration sides. The NRS scores were lower on the side where vibration was used during scalp block injections (P < 0.001). Additionally, there was adecrease in heart rate and mean arterial pressure on the side where vibration was used compared to the baseline value (P < 0.005). The study showed that using topical vibration during ascalp block can decrease the pain of alocal anesthetic injection and maintain hemodynamic stability. ClinicalTrials.gov (NCT06038825).

Post-induction hypotension (PIH) is defined as mean arterial pressure less than 30% from baseline. It significantly affects patients' quality of life and can cause morbidity; however, its prognosis remains unclear, and its treatments need improvement. This study aimed to investigate the impact of diabetes mellitus (DM) and cardiac autonomic neuropathy (CAN) co-occurrence on PIH incidence in old patients and evaluate the effects of vasopressor/inotropic drugs on intraoperative complications during post-induction. This prospective observational study included 92 old patients with DM who planned for elective noncardiac/neuro surgery under general anesthesia. The patients were evaluated with Composite Autonomic Symptom Score 31 (COMPASS31) for CAN preoperatively. During the operation, vital signs were recorded for PIH evaluation. CAN incidence was 8.70%. PIH incidence in old patients with DM with CAN was 87.5% (vs. DM without CAN 67.9%) (p = 0.427). The percentages of patients with DM and CAN and those without CAN were 50% and 38.1% (p = 0.707), respectively, in needing a vasopressor drug, and were 87.5% and 75% (p = 0.675), respectively, with intraoperative complications. PIH incidence tended to be higher in old patients with DM and CAN than in those without CAN; however, the difference was not statistically significant. Furthermore, no significant differences were observed between these two groups of patients in using a vasopressor/inotropic drug or having intraoperative complications. However, the blood pressure trend showed more lability during induction and intubation in those with CAN. These findings could help develop new strategies to treat DM, CAN, and PIH.

Cavernous nerve injury (CNI) is a prominent etiological factor in the development of erectile dysfunction (ED). Nevertheless, the underlying pathophysiological mechanisms of CNI-induced ED (CNI-ED) are not fully elucidated. Galectin-3 (Gal-3), an indicator of inflammation and fibrosis, has been implicated in the pathogenesis of arteriogenic ED. In this study, we investigate the role of Gal-3 in CNI-ED and explore the potential mechanisms by which adipose-derived mesenchymal stem cell exosomes (ADSC-Exo) ameliorate CNI-ED. We established a bilateral CNI (BCNI) rat model and evaluated erectile function using intracavernous pressure (ICP), mean arterial pressure (MAP), and infrared ray thermography (IRT). The expression level of Gal-3 was measured in the major pelvic ganglia (MPG), penile corpus cavernosum, and cultured cells, with its expression modulated by lentiviral vectors. A combination of experimental approaches, including western blot, immunofluorescence, and flow cytometry analysis, were employed to investigate the role of Gal-3 in the progression of CNI-ED. Additionally, the potential molecular mechanisms by which ADSC-Exo ameliorates CNI-ED were explored. Our findings indicated that the expression of Gal-3 is significantly upregulated in the MPG and penile corpus cavernosum of BCNI rats. This upregulation was accompanied by oxidative stress and activation of the TLR4/MyD88/NF-κB signaling pathway. Following lentiviral knockdown of Gal-3, erectile function in BCNI rats was improved. Moreover, ADSC-Exo transplantation inhibited Gal-3 expression and the related inflammatory profibrotic cascades. Collectively, this study demonstrates that upregulation of Gal-3 promotes the pathogenesis of CNI-ED by triggering oxidative stress and inflammatory profibrotic cascades and highlights the therapeutic potential of ADSC-Exo in restoring erectile function via Gal-3 inhibition.

The growing volume of healthcare data presents opportunities for machine learning to improve treatment, uncover new patterns in data and predict patient outcomes. Selecting appropriate features for a machine learning model is an important step in the process as the choice of relevant variables directly influences the model's performance and interpretability. Effective feature selection can enhance both the accuracy and generalisability of the model, especially given the complexity and heterogeneity of healthcare data. The XGBoost algorithm is trained on the eICU Collaborative Research Database to predict in-hospital mortality, with focus on investigating the impact of different feature sets. The analysis cohort comprised 73210 patients. Different models are trained and tested using 20000 distinct feature sets, each containing ten features, to assess how different features influence model performance. The models are trained using a train/test split of 80/20. Shapley additive explanations (SHAP) values are used to evaluate the importance of individual features. On average, the feature sets achieve an area under the receiver operating characteristic curve (AUROC) of 0.811, with the highest AUROC of 0.832 obtained from the feature set comprising [admission diagnosis, age, albumin, creatinine, heart rate, mean blood pressure, motor (from Glasgow Coma Scale), respiratory rate, temperature, unit admit source]. Despite variations in feature composition, models exhibit comparable performance in terms of both AUROC and the area under the precision-recall curve (AUPRC). Overall, age emerges as particularly influential, appearing most frequently in the feature sets associated with the highest AUROC scores. However, this trend is not observed for AUPRC.The results show that different models can achieve similar discrimination for different feature sets and that feature importance and ranking vary accordingly. This suggests that there may be multiple routes to good performance and that evaluating several feature combinations could be more informative than focusing on a single best set. Average feature importances may not reliably indicate a variable's overall utility or real-world importance and should be interpreted within the context of specific combinations. Prospective evaluation of promising sets and attention to robustness across combinations may help guide validation and eventual clinical use.

Intraoperative hypotension is a recognized risk factor for delayed graft function (DGF) after kidney transplantation and may compromise both short- and long-term allograft outcomes. However, the controversy persists regarding the optimal vasopressors and inotropes for maintaining stable blood pressures intraoperatively and achieving good allograft outcome after kidney transplantation. Terlipressin has demonstrated the potential in stabilizing hemodynamics and enhancing renal blood flow in patients with hepatorenal syndrome and sepsis. Additionally, terlipressin may effectively correct efractory hypotension in those receiving renin-angiotensin system inhibitors (RASi). However, it is unclear whether terlipressin is suitable for optimizing perioperative blood pressures and is favorable for postoperative graft function in patients with kidney transplantation. We reported 4 cases of patients with end-stage renal disease undergoing allograft kidney transplantation who developed intraoperative hypotension unresponsive to dopamine or fluid resuscitation. Intravenous terlipressin rapidly stabilized hemodynamics and maintained adequate mean artery pressure throughout surgery, with a reduced consumption of other vasopressors. All patients demonstrated satisfactory early graft function within the first postoperative week, with improved glomerular filtration rate, and normal serum potassium concentration and urine output. Furthermore, renal function was stable at one-year follow-up. Terlipressin may represent an effective and renal-protective alternative for intraoperative blood pressure maintenance during kidney transplantation. Further controlled studies are warranted to validate the potentials of terlipressin for maintaining perioperative blood pressure and optimizing postoperative allograft function in patients undergoing kidney transplantation.

Background: Vitamin D deficiency has been increasingly implicated in the pathogenesis of hypertension through its regulatory effects on the renin–angiotensin system and vascular endothelial function. Objectives: This study aimed to evaluate the impact of high-dose vitamin D supplementation on blood pressure control in hypertensive individuals with concurrent vitamin D deficiency. Methods: A randomized, double-blind, placebo-controlled clinical trial was conducted at Holy Family Medical College and Hospital, Dhaka, from January 2022 to January 2023. A total of 48 adult hypertensive patients with vitamin D deficiency (serum 25(OH)D &lt;30 ng/ml) were enrolled and randomly assigned to either the Vitamin D Group (VDG, n=24) or Placebo Group (PG, n=24). The VDG received 50,000 IU of oral cholecalciferol weekly for 8 weeks, while the PG received a matching placebo. Baseline and post-intervention measurements included systolic (SBP), diastolic (DBP), and mean arterial pressure (MAP), along with serum 25(OH)D, parathormone, calcium, and electrolytes. Results: After 8 weeks, VDG showed significant reductions in SBP (−7.2 mmHg), DBP (−3.6 mmHg), and MAP (−4.8 mmHg) compared to negligible changes in the PG. Serum 25(OH)D levels increased substantially in VDG (+33.5 ng/ml vs. +2.0 ng/ml in PG), with normalization observed in 95.8% of VDG participants. Parathormone levels decreased significantly in VDG (−21.4 pg/ml), accompanied by a modest rise in serum calcium. No adverse effects were reported, and compliance was high in both groups. Conclusion: High-dose weekly vitamin D supplementation effectively improved vitamin D status and contributed to significant reductions in blood pressure among deficient hypertensive patients. These findings support the use of vitamin D as a safe and beneficial adjunct therapy for hypertension management in vitamin D-deficient populations. J Shaheed Suhrawardy Med Coll 2024; 16(1): 52-57

Hemodynamic instability during cardiac surgery, particularly procedures requiring cardiopulmonary bypass, increases the risk of mortality and adverse events. Conventional anesthetics such as propofol and etomidate have limitations in maintaining stability, prompting investigation of remimazolam, an ultra-short-acting benzodiazepine with a potentially favorable cardiovascular profile. This systematic review and meta-analysis evaluated the effects of remimazolam versus conventional anesthetics on hemodynamic stability, vasopressor use, extubation time, and recovery in cardiac surgery. Seven randomized controlled trials involving 557 patients were included following literature searches in PubMed, Scopus, and Cochrane Central Register of Controlled Trials. Data extraction and risk-of-bias assessment were conducted using the Cochrane RoB 2 tool, and certainty of evidence was graded with the Grading of Recommendations Assessment, Development, and Evaluation approach. Pooled analysis showed no significant differences in operative time (mean difference: 1.91 minutes, P = 0.53) or mean arterial pressure (mean difference: -0.90 mm Hg, P = 0.80). The risk of intraoperative hypotension was higher but not statistically significant with remimazolam (risk ratios: 1.25, P = 0.57); however, sensitivity analysis excluding one study demonstrated a significant 64% increase in hypotension risk (risk ratios: 1.64, P = 0.005), suggesting possible hemodynamic vulnerability. Remimazolam significantly shortened extubation time by 27.98 minutes (P = 0.04), while hospital stay, vasopressor use, and postoperative nausea and vomiting showed no significant differences. Overall, remimazolam did not significantly improve intraoperative hemodynamic stability compared with conventional anesthetics, but its main potential advantage may lie in enhancing recovery through faster extubation. The clinical importance of this finding remains uncertain, and remimazolam should not currently be regarded as superior for stability in cardiac anesthesia. Large, standardized randomized controlled trials are required to further define its safety and efficacy in cardiac surgery.

Depression is a recognized non-traditional risk factor for adverse cardiovascular disease (CVD) outcomes. The risk for CVD increases in women after menopause. The chronic mild unpredictable stress (CMS) paradigm is a validated rodent model of depression. In male rats, CMS results in higher blood pressure and sympathoexcitation that is mitigated by direct inhibition of the vasopressin V1b receptor (V1bR) within the paraventricular nucleus. In the present study we tested the hypothesis that ovariectomized (OVX) but not gonadally intact female rats display cardiovascular responses similar to male CMS rats and that these responses will be mitigated by systemic V1b R inhibition. Intact and OVX female rats and male rats were subjected to a 4-week CMS protocol or standard housing (control). Hemodynamics were assessed by telemetry. Left ventricular (LV) function and aortic pulse wave velocity (aPWV) were assessed 1 h after either vehicle or nelivaptan, 10 mg/kg i.p. mean arterial pressure and heart rate were similar in gonadally intact control and CMS female rats but were significantly elevated from baseline values in CMS OVX and male rats. aPWV was elevated in CMS male and OVX rats and improved after treatment with nelivaptan independent of blood pressure. Neither systolic nor diastolic LV function was impaired; however, V1bR inhibition increased LF ejection fraction in gonadally intact female rats. These findings support the concept that OVX females display cardiovascular responses similar to male rats when subjected to CMS. Systemic V1b R antagonism ameliorates aortic compliance in both male and OVX rats.

To analyze the influencing factors of postoperative hypotension (POH) following video-assisted thoracoscopic lung resection (VATS) and evaluate a predictive model combining non-invasive hemodynamic parameters with the inferior vena cava collapsibility index (IVCCI). A prospective study enrolled 100 VATS patients (September 2024-March 2025). Patients were stratified into POH (n = 36) and Non-POH (n = 64) groups based on mean arterial pressure (MAP ≤ 65 mmHg or ≥ 30% reduction from baseline) within 24hours postoperatively. Hemodynamic parameters (cardiac output [CO], systemic vascular resistance [SVR], stroke volume [SV], stroke volume variation [SVV], left ventricular stroke work [LVSW]) were monitored using the Non-invasive Continuous Arterial Blood Pressure And Cardiac Output Monitoring System. IVCCI was ultrasonographically measured post-extubation. Linear regression analyzed correlations between post-anesthetic emergence period hemodynamic parameters and POH, while multivariable logistic regression analysis was employed to identify predictive factors, leading to the development and validation of a clinical prediction model. The incidence of early POH was 36%. Multivariate analysis demonstrated that a model combining post-anesthesia emergence period left ventricular stroke work (PA_LVSW, OR = 0.880, P < 0.01), IVCCI (OR = 1.095, P = 0.01), baseline MAP, and ASA achieved an AUC of 0.940 (95% CI: 0.895-0.985), with 83.3% sensitivity and 89.1% specificity, outperforming individual predictors (IVCCI: AUC = 0.65; PA_LVSW༚AUC = 0.84). Early POH after VATS is closely associated with cardiac function suppression and volume status imbalance. The multiparameter model integrating PA_LVSW, IVCCI, ASA physical status, and baseline MAP effectively predicts POH. Chinese Clinical Trial Register, ChiCTR2500100275. Registered 7 April 2025 Retrospectively registered, https//www.chictr.org.cn/showprojEN.html? proj=259,898.

Background: Acellular therapies from Mesenchymal Stromal Cells (MSCs), including the full secretome (conditioned medium, CM) and purified small extracellular vesicles (sEVs), are promising restorative treatments for erectile dysfunction (ED). It remains unknown if the therapeutic benefit is driven by the complete secretome or if purified sEVs are the primary, sufficient component. This study aimed to systematically review and meta-analyze the preclinical evidence. Methods: We conducted a systematic review and parallel meta-analysis adhering to PRISMA guidelines. PubMed, Scopus, and Web of Science were searched from January 1st, 2014, to July 31st, 2025. Studies were eligible if they were preclinical ED models evaluating MSC-CM or purified sEVs against a control. Two parallel meta-analyses were performed using a random-effects model. Primary outcomes were erectile function (Intracavernous Pressure / Mean Arterial Pressure ratio; ICP/MAP) and histopathology (Smooth Muscle / Collagen ratio; SM/Col). Results: Our search yielded 1,942 records, with 87 full-text articles assessed. After applying strict PICO criteria, 7 primary studies were eligible for the meta-analysis (3 secretome, 4 sEVs). The overall risk of bias was moderate to high (0% allocation concealment). No studies directly compared secretome versus sEVs. The first meta-analysis (Secretome vs. Control, 3 studies, 4 data points, n=70) demonstrated a large, significant improvement in ICP/MAP (Standardized Mean Difference [SMD]: 2.40; 95% CI [1.65, 3.15]; p-value &lt; 0.001), with extreme heterogeneity (I-squared=85%). The second meta-analysis (sEVs vs. Control, 4 studies, n=68) also showed a large, significant improvement (SMD: 2.75; 95% CI [1.90, 3.60]; p-value &lt; 0.001), also with extreme heterogeneity (I-squared=88%). Conclusion: Both the full MSC secretome and purified sEVs demonstrate large, significant therapeutic effects. However, this quantitative conclusion is severely limited by the exceptionally small number of studies and the profound biomolecular heterogeneity (in cell source and purification) that invalidates direct comparison. The primary finding remains the total lack of comparative data.

Trihalomethanes (THMs), the leading species of disinfection byproducts in chlorinated tap water, have demonstrated cardiovascular toxicity. However, the association between THM exposure and blood pressure (BP) among pregnant women remains unclear. This study included 1456 women from a Chinese prospective birth cohort. We determined blood THM concentrations [chloroform (TCM), bromodichloromethane (BDCM), dibromochloromethane (DBCM), and bromoform (TBM)] across pregnancy trimesters (n = 3642) and repeatedly measured BP throughout pregnancy (n = 5816) and during postpartum (n = 1062). Blood concentrations of TCM and chlorinated THMs (Cl-THMs; the sum of TCM, BDCM, and DBCM) in the second, but not first, trimester were positively associated with gestational diastolic BP and mean arterial pressure (MAP). Additionally, women with higher second-trimester blood concentrations of brominated THMs (the sum of BDCM, DBCM, and TBM) and total THMs (TTHM; the sum of 4 THM) had an increased risk of experiencing a sharply rising MAP throughout pregnancy. Second-trimester blood concentrations of TCM, Cl-THMs, and TTHMs were positively associated with the risk of hypertension during pregnancy, particularly among women carrying male fetuses. However, blood concentrations of THMs were unrelated to postpartum BP. In summary, THM exposure in the second trimester may be associated with elevated BP and a greater risk of hypertension during pregnancy.

BackgroundAtrial fibrillation (AF) is a major cardiovascular issue in critically ill patients, linked to elevated mortality rates. The Stress Hyperglycemia Ratio (SHR), a novel metric of glucose control, has shown promise in predicting adverse outcomes in cardiovascular diseases. However, its impact on the relationship between organ dysfunction and mortality in AF remains unclear. This study aims to explore SHR’s role in modifying this association to improve risk prediction in critically ill AF patients.MethodsA retrospective cohort study was performed on MIMIC-IV 3.1 patients with critical illness and AF. The primary endpoints were in-hospital, 30-day, and 1-year mortality. Patients were stratified by SHR quartiles and categorized into four groups based on combined SHR and SOFA scores. Kaplan-Meier survival analysis and multivariate Cox regression assessed the association with mortality, and restriction cubic splines (RCS) were used to examine non-linear relationships. Mediation analysis using the Bootstrap method quantified the role of serum bicarbonate. A nomogram was developed with multivariable logistic regression, incorporating SHR, SOFA, and significant covariates from backward selection. The SHapley Additive exPlanations(SHAP) analysis provided insights into predictor contributions.ResultsOf the 15,358 patients included in the cohort, the median age was 66 years (IQR: 55–76), with 56.8% being male. The SHR-SOFA combination significantly stratified patients into four distinct risk groups (Q1-Q4), with the high SHR and high SOFA group (Q4) showing the poorest prognosis at all time points (log-rank P < 0.001). Multivariate Cox regression confirmed that Q4 had the highest mortality risk across all time points (in-hospital HR: 5.32, 95% CI: 4.31–6.57; 30-day HR: 4.27, 95% CI: 3.62–5.04; 1-year HR: 3.18, 95% CI: 2.82–3.59). RCS analysis indicated a nonlinear correlation between SHR and mortality, with a threshold effect at SHR = 1.0 in low SOFA patients. In contrast, high SOFA patients showed a J-shaped curve, with an ideal SHR of 1.2. The predictive nomogram, validated through backward stepwise regression, included SHR, SOFA score, age, mean arterial pressure (MBP), white blood cell count (WBC), bicarbonate, hemoglobin, sodium, and total calcium as key predictors. SHAP analysis highlighted SHR and SOFA as the most influential predictors, with age also playing a crucial role. Mediation analysis indicated that serum bicarbonate mediated 22.7% of SHR’s effect on in-hospital mortality, diminishing over time.ConclusionsThis study reveals a notable relationship among SHR and SOFA scores in forecasting mortality among critically sick patients with atrial fibrillation. The developed nomogram integrating SHR, SOFA, and other covariates offers a novel tool for risk stratification. SHAP analysis confirms SHR and SOFA as key predictors, highlighting their clinical utility in mortality assessment.Graphical abstractSupplementary InformationThe online version contains supplementary material available at 10.1186/s12933-025-02969-1.

Indocyanine green (ICG) clearance, determined by venous sampling, has shown promising results in the diagnosis of clinically significant portal hypertension (CSPH) in compensated advanced chronic liver disease (cACLD) and prognostication in decompensated ACLD (decompensated cirrhosis). Data on ICG clearance measurement by pulse dye densitometry (PDD) via finger clip are comparatively scarce. To evaluate the diagnostic (CSPH) and prognostic utility of ICG clearance throughout ACLD stages. ACLD (liver stiffness ≥ 10 kPa) patients undergoing same-day hepatic venous pressure gradient (HVPG) measurement and ICG clearance assessment via PDD in 2017-2022 were recruited from the prospective Vienna Cirrhosis Study (VICIS, NCT03267615). Two hundred and sixty-one ACLD patients (cACLD: n = 115, decompensated cirrhosis: n = 146) were included. Among cACLD patients (CSPH: 62.4%), ICG retention 15 min (ICG-R15) correlated moderately with HVPG (Spearman's rho:0.458; p < 0.001) and yielded a suboptimal diagnostic accuracy for CSPH (AUROC: 0.687 [95% CI: 0.585-0.789]). ICG-R15 showed a strong correlation with the model for end-stage liver disease score (rho: 0.701; p < 0.001) and correlated with biomarkers of endothelial dysfunction (von Willebrand factor), systemic inflammation (C-reactive protein, procalcitonin, interleukin 6) and extracellular matrix remodelling (enhanced liver fibrosis test). In decompensated cirrhosis, ICG-R15 additionally correlated with mean arterial pressure, serum sodium and renin levels. ICG-R15 predicted decompensation (subdistribution hazard ratio [SHR]: 1.042 [95% CI: 1.008-1.077] per %; p = 0.014) in cACLD and independently predicted ACLF/liver-related mortality in decompensated cirrhosis (adjusted SHR: 1.062 [95% CI: 1.025-1.100] per %; p < 0.001). ICG-R15 by PDD correlates with portal hypertension and systemic inflammation/circulatory dysfunction as key disease-driving mechanisms in ACLD. While showing insufficient discrimination for CSPH, ICG-R15 independently predicted ACLF/liver-related mortality in decompensated cirrhosis.

Sacrocolpopexy (ASC) is the gold standard for apical and multicompartment prolapse. With no approved mesh available in Australia, fascia lata (FL) is being offered as an alternative graft. The aim was to examine the outcomes of FL ASC. Prospective cohort study of women with ≥ stage 2 prolapse undergoing FL ASC with at least 6months follow-up. Primary outcome was defined as Patient Global Impression of Improvement (PGI-I). Secondary outcomes were Australian Pelvic Floor Questionnaire (APFQ), Pelvic Organ Prolapse Quantification (POP-Q) System and safety (Clavien Dindo Classification (CDC)). SPSS v29 was used for statistical analysis. Descriptive statistics, chi-square and paired t-test were used. From Feb 2022 to Jun 2025, 131 were planned for the procedure, seven were excluded from the overal analysis, leaving 124. Of those remaining, 101 (81.5%) had at least 6months follow-up with a median follow-up of 12months (range 6-39months). Mean age and BMI were 67years and 27kg/m2, respectively. Mean PGI-I was 1.7; 86 (85.1%) reported PGI-I as "very much better" or "much better". Postoperatively, significant improvement was seen in APFQ scores (p < 0.001 bladder and prolapse; p = 0.003 bowel; p = 0.02 sexual function), and mean POP-Q points Ba, C and Bp (p < 0.001). The majority, 79.2%, had no postoperative complications. CDC grade 3 was reported in 5.0%. Repeat surgery for thigh issues and recurrent prolapse were performed in two (2%) and three (3%) patients, respectively. Our study suggests that FL may be a promising graft for ASC, with high patient satisfaction scores and low major complication rate.

Introduction: Post-cardiac arrest care seeks to optimize cerebral perfusion for neurological recovery. Mean arterial pressure (MAP) is a key target in hemodynamic management, but guidelines recommend only a minimal threshold of 60–65 mmHg based on low-certainty evidence. Observational studies report better outcomes with higher MAP, but cannot prove causality. In contrast, randomized controlled trials (RCTs) that adjust MAP show inconsistent results. This discrepancy may reflect confounding in observational data, where higher MAP often indicates lower illness severity, and harm from excessive MAP in some RCT patients. Both study types dichotomized MAP, assuming a linear relationship. However, because both hypotension and hypertension may worsen outcomes, a nonlinear association is plausible. Identifying an optimal MAP range instead of using cutoffs may improve outcomes. Aims: We aimed to identify an optimal MAP range associated with the highest probability of neurological recovery, assuming a nonlinear relationship between MAP and outcome. Methods: We analyzed data from 1,146 out-of-hospital cardiac arrest survivors in the Korean Hypothermia Network prospective registry. MAPs were calculated for Day 1 (0–24h), Day 2 (30–48h), Day 3 (54–72h), and after return of spontaneous circulation. Restricted cubic spline (RCS) logistic regression modeled nonlinear associations between MAP and good neurological outcome (modified Rankin Scale 0–2 at 6 months). Optimal MAP ranges were derived from spline curves. Logistic regression evaluated associations between maintaining MAP within this range and outcomes, including 6-month survival. Results: RCS analysis showed a nonlinear association between MAP and neurological outcome across all time intervals. The MAP values associated with the highest predicted probability of good outcome were 99.5 mmHg on Day 1, 96.4 mmHg on Day 2, and 85.1 mmHg on Day 3. Based on these, the optimal MAP range was defined as 85–100 mmHg. Maintaining MAP within this range was significantly associated with good neurological outcome on Day 3 (adjusted OR 1.42, p = 0.036) and improved survival on Day 2 (adjusted OR 1.54, p = 0.006) and Day 3 (adjusted OR 1.39, p = 0.030). Conclusion: MAP and neurological outcome after cardiac arrest appear nonlinearly related. Maintaining MAP between 85 and 100 mmHg was associated with improved neurological recovery and survival, particularly on Days 2 and 3. This range warrants further investigation in interventional trials.

Background: Propofol is a first-line sedative for critically ill adults receiving invasive mechanical ventilation (IMV). However, it can contribute to hemodynamic instability, especially in the setting of intubation. The magnitude, timing, risk factors, and variability of sedation-associated mean arterial pressure (MAP) changes remain poorly characterized in ICU settings. Objectives: To quantify MAP changes following propofol sedation, identify risk factors for hemodynamic instability, and characterize associated interventions. Methods: We included adults (≥18 years old) across 11 ICUs in the Mayo Clinic Enterprise who required IMV and received ≥6 consecutive hours of propofol infusion between 05/05/2018 and 07/31/2024. The primary outcome was MAP change within 2-hours following sedation. Secondary outcomes included vasopressor use and hypotension (MAP ≤60 mmHg). Mixed-effects modeling was utilized to account for individual patient differences. The main model used a “neutral” adjustment, estimating a 5 mmHg MAP increase per 0.05 mcg/kg/min of norepinephrine equivalents, reduced to 3 mmHg per 0.05 mcg/kg/min after reaching a dose of 0.20 mcg/kg/min. Those on any vasopressors prior to propofol sedation initiation were analyzed separately. Results: Across 16,418 patients, 25.2% were on vasopressors before sedation initiation. Among the remaining 12,281 patients, 40.3% required vasopressors and 7.7% experienced hypotension within 2 hours of sedation ( Image 1 ). Post-intubation sedation was associated with a MAP reduction within the first 30 minutes (-6.58 mmHg; 95% CI: -6.85 to -6.32; P&lt;0.001; Images 2 and 3 ). There was substantial inter-patient variability in both baseline MAP (9.5% variation attributable to between-patient differences) and MAP decline after sedation (40.9% between-patient differences). Higher SOFA scores (-0.31 mmHg per point), older age (-0.04 mmHg per year), and male sex (-0.47 mmHg) were associated with lower MAP. Patients with higher illness severity experienced progressively greater MAP changes over time (-0.20 mmHg per hour per increasing SOFA point; P&lt;0.001). Conclusions: Propofol sedation is associated with clinically significant hemodynamic effects requiring intervention in the early post-intubation period. The marked inter-patient variability in hemodynamic responses highlights the importance of personalized management approaches. Risk stratification may help identify patients who could benefit from preemptive hemodynamic optimization.

Background: The Impella device provides percutaneous left ventricular support but may induce aortic regurgitation (AR) due to its transvalvular placement. In this study, we defined Impella-induced AR as consisting of two components: backward flow through the Impella cannula (Impella retrograde flow) and backward flow from the aorta into the left ventricle (LV retrograde flow). However, both the relationship between these regurgitant flows and afterload, and their actual volume, remain unknown. Hypothesis: We hypothesized that elevated afterload increases Impella-induced AR by augmenting both Impella and LV retrograde flow, thereby diminishing the effectiveness of Impella support. Methods: A mock circulation system was used to simulate Impella CP support under 135 unique hemodynamic conditions, created by testing every combination of three levels of circuit resistance (simulating peripheral resistance), nine Impella P-levels (P1–P9), and five levels of left ventricular function. Left ventricular function was simulated by adjusting the ejection-phase volume delivered by an external pump. The 100% ejection-phase volume was defined as 174 mL, and five levels were set at 20%, 30%, 40%, 50%, and 60%. For each condition, mean arterial pressure (MAP), Impella retrograde flow, LV retrograde flow, and their total (Impella-induced AR) were measured. Correlations between MAP and each individual regurgitant flow were analyzed. Results: Impella-induced AR was significantly correlated with MAP (r = 0.82, p &lt; 0.0001), with LV retrograde flow being most closely correlated (r = 0.90). Impella retrograde flow also increased with MAP (r = 0.64). At a clinically typical MAP of 65 mmHg, the average total regurgitant flow was 1.09 L/min, of which 0.97 L/min was LV retrograde flow and 0.12 L/min was Impella retrograde flow, demonstrating that significant Impella-induced AR occurs even at commonly targeted MAP levels. Conclusions: Elevated MAP increases Impella-induced AR, particularly LV retrograde flow, resulting in reduced effective circulatory support. Strict afterload management may be essential to maximize the hemodynamic benefits of Impella support.

Background: Resuscitative endovascular balloon occlusion of the aorta (REBOA) therapy augments circulation to the heart and brain during cardiopulmonary resuscitation (CPR). However, once return of spontaneous circulation (ROSC) is achieved, immediate REBOA deflation can cause significant loss of blood pressure and other hemodynamics 1 . Little is known about the potential harmful effects of REBOA deflation, under normal physiological conditions and low circulatory states. Research Question: Does REBOA catheter deflation cause a significant decrease in mean arterial pressure (MAP) under normal physiological conditions and after ROSC following cardiac arrest? How long does it take to recover in the absence of additional treatment? Methods: For the normal physiological conditions study, 6 pigs were anesthetized and instrumented. The REBOA was inflated to occlude the aorta at the level of the diaphragm for 7 minutes, then deflated completely. For the post-ROSC study, 8 pigs underwent head up (HUP) CPR with active compression decompression CPR, an impedance threshold device, and a head/thorax elevation device. A REBOA was placed after ~44 minutes of CPR. One minute after ROSC, the REBOA was deflated completely. In both studies, hemodynamic parameters were monitored continuously. Statistical comparisons were made using a paired samples t-test. Results: Hemodynamic findings before, during, and after the REBOA inflation are shown in Table 1. With REBOA inflation, MAP increased from 95.4±14.6 to 118.0±18.1 mmHg (p=0.01), and following deflation, MAP decreased from 119.1±19.0 to 84.3±24.4 mmHg (p=0.01). Parallel changes were observed other hemodynamics as well. Following REBOA deflation MAP and other hemodynamic parameters required 15 min to return to pre-REBOA values. REBOA during HUP CPR increased key hemodynamic parameters, whereas REBOA deflation post ROSC resulted in a profound and dangerous decrease in MAP from 79.4±33.7 to 50.4±23.4, p=0.017 (Table 2). Conclusion: REBOA deflation can lead to significant hypotension under normal conditions and life-threatening hypotension after ROSC. Strategies to maintain MAP during REBOA deflation will be needed to reduce these potentially harmful effects. 1. Segond, N., et al. (2024). Abstract Or108: Optimizing Post-resuscitation Care after Resuscitative Endovascular Balloon Occlusion of the Aorta and Automated Head-up Position Cardiopulmonary Resuscitation. Circulation, 150(Suppl_1), https://doi.org/10.1161/circ.150.suppl_1.or108