Unstable Hemodynamics Research Articles

Clinical Case of Posterior Reversible Encephalopathy Syndrome in a Female Patient Undergoing Surgery for Rectal Cancer

Introduction. Posterior reversible encephalopathy syndrome (PRES) refers to a relatively obscure syndrome with unclear pathogenesis, leading to patient disability, occurring in 58% of cases against a background of arterial hypertension. Clinical manifestations include cephalalgia, epileptic seizures, and visual disturbances, potentially culminating in complete blindness. The clinical case represents a rare life-threatening condition that may pose challenges for an attending physician regarding the appropriate therapeutic strategy.Aim. To demonstrate the occurrence of posterior reversible encephalopathy syndrome during an anterior resection of the rectum, as well as to discuss the correct therapeutic strategy.Materials and methods. A 63-year-old female patient with a history of chronic arterial hypertension was admitted for surgical intervention due to rectal cancer. The operation was performed under general anesthesia and marked by unstable hemodynamics, with blood pressure rising to 160/100 mmHg. After awakening, the patient exhibited loss of vision and coordination disturbances, accompanied by uncontrolled arterial hypertension, with blood pressure rising to 182/130 mmHg. Magnetic resonance imaging revealed areas of hyperintense signal bilaterally in the occipital lobes without signs of diffusion restriction. The neurological deficits were managed through a comprehensive therapeutic regimen, utilizing nootropics, antioxidants, and antihypoxic agents, in conjunction with appropriate antihypertensive treatment. Vision was restored within two weeks.Results and discussion. The management of posterior reversible encephalopathy syndrome following a hypertensive crisis during surgical intervention should encompass etiological treatment, alongside correction of neurological symptoms utilizing relevant pharmacological agents. An appropriate and timely treatment obtains high potential to resolve the syndrome.Conclusion. Posterior reversible encephalopathy syndrome may develop in patients with a history of arterial hypertension and manifest as a sudden onset of hemodynamic instability during and after surgical intervention, potentially leading to cortical blindness. In such cases, antihypertensive therapy, in conjunction with corrective medications, is advisable.

Experience of Venoarterial Extracorporeal Life Support-Assisted Brain Death Donation With Severe Hemodynamic Instability.

To explore the experience of extracorporeal life support (ECLS)-assisted maintenance of brain death donors with extremely unstable hemodynamics. We retrospectively analyzed the clinical data of 12 brain-dead donors who received ECLS in our hospital from May 2015 to May 2022 due to extremely unstable hemodynamics. The organ acquisition status was analyzed. The transplant outcome of the livers and kidneys procured from these donors on ECLS was also evaluated, who are currently considered as having extended criteria. After ECLS, the hemodynamics of these 12 patients quickly stabilized and all completed apnea testing and reached the criteria for brain death. The 12 donors on ECLS contributed 36 organs: 1 heart, 2 lungs, 11 livers, and 22 kidneys. All liver and kidney transplant recipients survived within 1 year after transplantation. The 12-month graft survival rate for these 22 ECLS transplanted kidneys was 95%. Four (18.2%) kidney transplant recipients developed DGF. The average creatinine at discharge was 2.01 ± 0.70 mg/dL (1.14-3.67 mg/dL), which showed a downward trend in the first year after operation. The 12-month graft survival rate for these 11 ECLS transplanted livers was 100%. There was no incidence of primary nonfunction. The transaminase and bilirubin in the liver transplantation recipient group showed a downward trend, with an average total bilirubin of 2.23 ± 0.17 mg/dL (1.93-2.46 mg/dL) and an average alanine aminotransferase level of 46.55 ± 17.45 (33-89 units/L) at the time of discharge. ECLS can maintain the organ function of potential brain death donors with extremely unstable circulation and does not affect the functional recovery of the graft.

Association of Conscious Sedation With Dexmedetomidine and Outcome in Stroke Patients Undergoing Thrombectomy in the DEVT and RESCUE-BT Trials.

Although dexmedetomidine (DEX) is widely administered during endovascular treatment (EVT) to enhance procedural adherence of patients with acute ischemic stroke (AIS) with large vessel occlusion, there is limited research on the association of DEX and outcomes among these patients. Hence, this study aimed to explore the safety and outcomes of DEX during conscious sedation (CS) in a real-world setting among patients undergoing EVT. This study was an individual patient-level pooled analysis of 2 multicenter randomized clinical trials RESCUE-BT and DEVT. This study included patients who underwent EVT because of occlusion of the internal carotid artery or middle cerebral artery. The DEX group included those receiving intraprocedural DEX for CS, whereas the patients without intraprocedural DEX sedation were categorized into the non-DEX group. The primary outcome was functional independence (modified Rankin Scale score of 0-2 at 90 days). Adjusted odds ratio (aOR) and 95% CI were obtained by logistic regression models. A total of 728 patients were included in this study, of whom 308 (42.3%) were female. The median (interquartile range) age was 69 (59-76) years; the median baseline NIH Stroke Scale score was 16 (12-19). Compared with the non-DEX group, the DEX group had a significantly lower rate of functional independence (40.3% vs 51.3%; aOR 0.66; 95% CI 0.46-0.93; p = 0.019). There was a significantly higher rate of unstable procedural hemodynamics in the DEX group (9.7% vs 2.3%; aOR 4.60, 95% CI 2.12-9.99, p < 0.001). In subgroup analysis, similar results were found in intraprocedural DEX-treated patients when compared with local anesthesia or intraprocedural midazolam-treated patients, respectively. There was a negative association between procedural DEX administration during CS and functional outcomes in patients with AIS receiving EVT in a real-world setting. A larger cohort is warranted to validate our findings. This study provides Class II evidence that the use of DEX during EVT of AIS is associated with a worse outcome compared with other agents.

Dynamic changes in bleeding sites: Evaluating contrast extravasation on computed tomography and angiography in pelvic fractures.

Contrast extravasation ("blush") on contrast-enhanced computed tomography (CECT) indicates active bleeding, but diagnostic angiography (AG) following CECT sometimes differs from the CECT findings in patients with pelvic fractures. This study aimed to evaluate the concordance rate between blush on CECT and AG based on pelvic anatomical location. This retrospective single-center study included patients (18 years or older) with pelvic fractures between 2015 and 2023 who had AG after CECT. Angiography was performed in patients with blush or hematoma on CECT, or unstable hemodynamics due to pelvic fracture. Pelvic bleeding regions were categorized separately into left and right as anterior internal iliac artery and posterior internal iliac artery based on pelvic arterial anatomy. The concordance rate between blush on CECT and AG was assessed using the k statistic. A total of 87 patients with pelvic fractures were included. Among these, 75 (86%) had blush on CECT, and 12 (14%) had no blush on CECT. The concordance rate was 83% (95% confidence interval, 0.03-0.57; k = 0.30) when assessed on an individual patient basis and 53% (95% confidence interval, 0.24-0.44; k = 0.34) when evaluated by anatomical regions on a unilateral half of the pelvis. The concordance rate for the anatomical hemipelvis evaluation was significantly lower compared with the individual evaluation ( p < 0.001). Thirty-three percent of patients with unilateral blush on CECT showed new contralateral blushes during AG. The location of active bleeding often differs between CECT and AG, indicating that bleeding may change intermittently and at various sites over time. This suggests the importance of evaluating both sides of the pelvic arteries during AG rather than solely relying on CECT findings. Prognostic and Epidemiological; Level IV.

Validity of lung ultrasound with bedside lung ultrasonography in emergency protocol in diagnosing pneumonia

Background: Pneumonia is an acute inflammation of the lung parenchyma caused by microorganisms. In 2020, pneumonia was included in the top 10 diseases requiring hospitalization in Indonesia with a mortality rate of 23% for patients treated in the intensive care unit. The diagnosis of pneumonia is based on anamnesis, physical examination, and supporting examinations. However, in practice, diagnostic procedures in patients with immobilization or patients with unstable hemodynamics are difficult to perform. Lung ultrasound (LUS) with bedside lung ultrasonography in emergency (BLUE) protocol is a simple and portable supporting examination that is known to be able to diagnose pneumonia more easily, accurately, and quickly. Therefore, a study related to the validity of LUS in diagnosing pneumonia needs to be conducted. Methods: This study is a diagnostic test. The study was conducted over a period of 6 months (August 2023 to February 2024) at Prof. Dr. I.G.N.G. Ngoerah hospital. In this study, the validity was assessed consisting of sensitivity, specificity, and accuracy of LUS in diagnosing pneumonia. Data were analyzed using STATA MP 17. Results: The total subjects in this study were 70 people. The sensitivity of LUS in diagnosing pneumonia was 86.8% (CI95%=74.7-94.5%) and the specificity was 70.6% (CI95%=44-89.7%), with an accuracy of 82.8%. The positive test predictive value was 90.2% (CI95%=78.6-96.7%) and the negative test predictive value was 63.2% (CI95%=38.4-83.7%). Thus, in subjects with LUS suggestive of pneumonia, pneumonia management can be done immediately. However, in subjects with LUS results not showing pneumonia, further supporting examinations are needed to confirm the diagnosis of pneumonia. Sensitivity, specificity, and accuracy varies based on age, body mass index, immunocompromised status, and degree of pneumonia Conclusions: LUS with BLUE protocol is a valid supporting examination in diagnosing pneumonia (rule in disease).

Perioperative Management of Pediatric Combined Heart and Liver Transplantation: A 17 year single center experience.

An increasing number of centers are undertaking combined heart and liver transplantation in adult and pediatric patients with congenital heart disease. The primary aim of this study was to describe the perioperative management of a single center cohort, identifying challenges and potential solutions. We conducted a retrospective review of all patients undergoing combined heart and liver transplantation at Stanford Children's Hospital from 2006 to 2022. Preoperative information included cardiac diagnosis, hemodynamics, and severity of liver disease. Intraoperative data included length of surgery, cardiopulmonary bypass time, and blood products transfused. Postoperative data included blood products transfused in the intensive care unit, time to extubation, length of intensive care unit stay, survival outcomes and 30-day adverse events. Eighteen patients underwent en bloc combined heart and liver transplantation at Stanford Children's Hospital from 2006 to 2022, and the majority 15 (83%) were transplanted for failing Fontan circulation with Fontan Associated Liver Disease. Median surgical procedure time was 13.4 [11.5, 14.5] h with a cardiopulmonary bypass time of 4.3 [3.9, 5.8] h. Median total blood products transfused in the operating room post cardiopulmonary bypass was 89.4 [63.9, 127.0] mLs/kg. Nine patients (50%) had vasoplegia during cardiopulmonary bypass. Activated prothrombin complex concentrates were used post cardiopulmonary bypass in 15 (83%) patients with a 30-day thromboembolism rate of 22%. Median time to extubation was 4.0 [2.8, 6.5] days, median intensive care unit length of stay 20.0 [7.8, 48.3] days and median hospital length of stay 54.0 [30.5, 68.3] days. Incidence of renal replacement therapy was 11%; however, none required renal replacement therapy by the time of hospital discharge. Neurological events within 30 days were 17% and the 30 day and 1 year survival was 89%. Perioperative challenges include major perioperative bleeding, unstable hemodynamics, and end organ injury including acute kidney injury and neurological events. Successful outcomes for en bloc combined heart and liver transplantation are possible with careful multidisciplinary planning, communication, patient selection, and integrated peri-operative management.

Aortic Thrombus Formation in the Mixing Zone of a Patient With Acute Myocarditis

A 66-year-old man presented with chills, exertional dyspnea, and palpitations; he later developed a fever. Because of his elevated cardiac enzymes and electrocardiography and coronary angiography findings, he was diagnosed with acute myocarditis. Given his unstable hemodynamics, an intra-aortic balloon pump was inserted; however, he experienced a hemodynamic collapse due to refractory ventricular fibrillation. He was then cannulated with venoarterial extracorporeal membrane oxygenation and microaxial flow pump and underwent steroid pulse therapy. His lactate levels were elevated, and computed tomography imaging revealed an aortic thrombus possibly formed in the mixing zone of the venoarterial extracorporeal membrane oxygenation and microaxial flow pump. Based on the antibody test results, he was diagnosed with heparin-induced thrombocytopenia; thus, heparin was replaced with argatroban. Surgical intervention restored the arterial flow. The patient was stabilized and discharged on day 47.

The Management of Splenic Injuries.

Splenic injury is one of the most common abdominal parenchymal organ injuries. Since the spleen is a parenchymal organ with abundant blood flow, its injury can easily result in hemorrhagic shock. Therefore, prompt and appropriate management for hemostasis is critical. Management of splenic injury is determined by the hemodynamic status and the grade of injury. Splenectomy is the primary choice in cases with unstable hemodynamics, but splenic repair or non-operative management, including conservative treatment or transcatheter arterial embolization (TAE), may be chosen to preserve the spleen if time permits. Non-operative management has advantages over operative management in terms of complications and medical economics. TAE also plays a significant role in non-operative management by contributing to the improvement of patient outcomes.

028. Traumatic Diaphragmatic Rupture with Unstable Hemodynamic: A Case Report of a Rare Surgical Trauma Emergency

Background: Traumatic diaphragmatic rupture (TDR) with unstable hemodynamics is a life-threatening condition often masked by other injuries, necessitating timely diagnosis and treatment. This case report illustrates the significance of rapid response and resuscitation in managing a 17-year-old female patient with TDR following a severe traffic accident. Case: A 17-year-old female patient was admitted after a motorcycle accident, arriving at the hospital 4 hours and 10 minutes post-incident. She displayed respiratory distress (SpO2: 80% on FM) and severe hemodynamic instability (BP: 70/40 mmHg, HR: 121 bpm). Grade IV traumatic diaphragmatic rupture (AAST) was confirmed alongside multiple injuries. Resuscitation began with intubation, 1 L of crystalloid fluid, and a 1-unit PRC transfusion. Initial management improved her BP to 80/60 mmHg; however, it later dropped to 60/40 mmHg. A FAST Ultrasonography (USG) revealed free echogenic fluid in the hepatorenal space, prompting emergency exploratory laparotomy. Intraoperatively, a diaphragmatic rupture was identified, with herniation of the liver, stomach, and colon. Surgical interventions included diaphragmatic repair and chest tube insertion. Postoperatively, the patient required vasopressors (dobutamine and epinephrine) to stabilize her hemodynamics (BP: 100/60 mmHg, HR: 83 bpm). Conclusion: Early diagnosis and aggressive resuscitation are vital in managing TDR with unstable hemodynamics, underscoring the necessity for rapid assessment and intervention.

Extracorporeal membrane oxygenation ameliorate hepatic injury in brain death rat donors with hemodynamic instability.

Donation after brain death (DBD) serves as the primary source for liver transplantation. However, livers obtained through DBD often incur damage due to unstable hemodynamics, potentially impacting transplantation outcomes. Extracorporeal Membrane Oxygenation (ECMO) emerges as an optimal technique for donor liver retrieval and has found application in clinical settings. Despite its clinical implementation, the precise mechanisms through which ECMO enhances liver functions remain elusive. This study aims to investigate the mechanisms underlying how ECMO ameliorates liver function in brain-dead donors. We randomly assigned 18 male Sprague-Dawley (SD) rats (350 ± 50 g) into three groups: Con (n = 6), DBD-assisted drug (n = 6), and DBD-assisted ECMO (n = 6). After 3 h of ECMO, the rats were sacrificed. We assessed and compared changes in heart rate, blood pressure, cumulative liver damage (evaluated through HE and TUNEL staining), serum levels of AST and ALT, alterations in serum oxidative stress factors (MDA, H2O2, SOD, and 8-OHdG), and serum concentrations of related inflammatory factors (interleukin [IL]-1β, IL-6, IL-8, and TNF-α) among rats in the Con, DBD-assisted drug, and DBD-assisted ECMO groups. Subsequently, we established a rat orthotopic liver transplantation (OLT) model and transplanted livers obtained through the aforementioned methods. The post-transplantation status of the livers was observed. After 3 h of brain death, liver injury worsened, accompanied by a significant increase in serum transaminases, inflammatory responses, oxidative stress, and TUNEL staining. Strikingly, ECMO not only stabilized hemodynamics after DBD but also mitigated liver damage, leading to an alleviated status post liver transplantation. ECMO stabilizes hemodynamics, attenuates inflammatory responses and oxidative stress, thereby enhancing the quality of liver grafts for transplantation.

Tamponing in severe liver injuries (two clinical cases)

Favorable outcomes of surgical treatment of two patients with blunt liver damage of IV degree according to E. Moore as part of polytrauma are presented. In conditions of unstable hemodynamics and extremely severe state of the patient, the authors used a method of liver damage tamponing with a single tampon material (cotton surgical sheet) as an initial hemostasis. The applied method of liver damage tamponing helps to achieve a stable initial hemostasis, it does not require a highly-qualified surgical team and can be used in second- and third-level trauma centers.

How to perform Point of Care Ultrasound at resuscitation and when it is useful.

Point of Care Ultrasound (POCUS) can be useful as a tool before, during and after the performance of cardiopulmonary resuscitation (CPR). Before or after resuscitation it can help with monitoring unstable hemodynamics, has the potential to identify reversible causes if patient deteriorates. During resuscitation POCUS can help detect potentially treatable causes of the cardiac arrest. Performance of POCUS while resuscitation requires experienced sonologists and a good team structure to embed the examination in advanced cardiovascular life support (ACLS) algorithms. This article gives an overview and tips about how to detect potential reversible causes of patient deterioration in all three phases of CPR. We describe some special situations in which resuscitation could take place. Further we give a comment about sonographic education of physicians and nonacademic medical staf.

Predictors of nursing home conveyances to emergency department

BackgroundWith increasing rates of patient conveyances from nursing homes to emergency departments worldwide, we aim to examine factors causing high rates of conveyances from nursing homes to the emergency department (ED) of an acute tertiary hospital.MethodsThis was a prospective study involving presentation of ED attendances from nursing home residents during out-of-hours over a 23-month period from April 2020 to February 2022. Data was collected from a standardized manual form used by the Emergency Department to document nursing home conveyances.ResultsA total of 338 pre-conveyance forms were reviewed. The most common reasons for conveyances to ED were neurological symptoms (16%), unstable hemodynamics (12%), fever (11%) and falls (10%). The peak conveyances occurred between 1600 and 1900 h on weekends. Respiratory rate, oxygenation requirements and high National Early Warning Score (NEWS) were significantly associated with increased conveyances to the emergency department. When the components of NEWS were analyzed individually, decision for ambulance conveyance to emergency department was significantly associated with respiratory rate (p < .001), oxygen saturation (p < .001), and the use of oxygen supplementation (p < .005).ConclusionsUnstable hemodynamics and falls were among the leading factors for nursing home conveyances to the emergency department, which highlights the need to implement better fall prevention strategies and standardized parameters monitoring in nursing homes. Future research should focus on outcomes of conveyances and the characteristics of nursing home with higher conveyance rates. This would aid to assess the appropriateness of conveyances and to identify strategies to decrease preventable conveyances.

The Role of the Gut Microbiota in Complications among Hemodialysis Patients.

The composition of the gut microbiota varies among end-stage renal disease (ESRD) patients on the basis of their mode of renal replacement therapy (RRT), with notably more pronounced dysbiosis occurring in those undergoing hemodialysis (HD). Interventions such as dialysis catheters, unstable hemodynamics, strict dietary restrictions, and pharmacotherapy significantly alter the intestinal microenvironment, thus disrupting the gut microbiota composition in HD patients. The gut microbiota may influence HD-related complications, including cardiovascular disease (CVD), infections, anemia, and malnutrition, through mechanisms such as bacterial translocation, immune regulation, and the production of gut microbial metabolites, thereby affecting both the quality of life and the prognosis of patients. This review focuses on alterations in the gut microbiota and its metabolites in HD patients. Additionally, understanding the impact of the gut microbiota on the complications of HD could provide insights into the development of novel treatment strategies to prevent or alleviate complications in HD patients.

ӨЛҮМ МЕНЕН БАЙЛАНЫШКАН КУРЧ ИШЕМИЯЛЫК ИНСУЛЬТ МЕНЕН ООРУГАН БЕЙТАПТАРДЫН КЛИНИКАЛЫК ЖАНА НЕЙРОВИЗУАЛДЫК ӨЗГӨЧӨЛҮКТӨРҮ

Effective and rapid diagnosis of stroke, as well as verification of factors determining its outcome, are of crucial importance, and largely predetermine the prognosis of the disease. We studied neuroimaging features in patients with acute ischemic stroke associated with fatal outcome. The study design was a cohort, retrospective, comparative, analytical study, which included the analysis of medical records of 100 patients over 18 years of age with the diagnosis of ischemic stroke. As a result, in patients who were included in the main study group (those who died from ischemic stroke or its complications), hospital mortality was associated with initial severity of the condition due to soporotic consciousness, short hospital stay, unstable hemodynamics, and respiratory failure, which was the reason for the need for ventilator use. The neuroimaging picture in the deceased patients was characterized by signs of increasing cerebral edema with dislocation phenomena.More aggressive control of vascular risk factors, including hypertension, diabetes and hyperlipidemia at the prehospital level is preventive not only of stroke itself, but also of its complicated forms, which ultimately affects the incidence of ischemic stroke and mortality from it.

Renin-Angiotensin System Genes Polymorphisms in Patients With COVID-19 and Its Relation to Severe Cases of SARS-CoV-2 Infection.

Different variants of single nucleotide polymorphisms (SNPs) of angiotensinogen (AGT), angiotensin-converting enzyme type 1 (ACE1), and angiotensin II receptors type 1 (AGTR1) and 2 (AGTR2) genes determine different susceptibility to cardiovascular disease (CVD) and hypertension, which can be considered as risk factors for fatal outcomes among coronavirus disease 2019 (COVID-19) patients. The objective of our study was to assess the relation between the frequency of SNPs of the renin-angiotensin system (RAS) components, and the severity of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. The cross-sectional study included 100 patients with a laboratory-confirmed diagnosis of COVID-19 admitted to the hospital. Criteria for severe COVID-19 included respiratory rate (RR) > 30/min, blood oxygen saturation (SpO2) ≤ 93%, signs of unstable hemodynamics with systolic blood pressure (SBP) < 90 and/or diastolic blood pressure (DBP) < 60 mm Hg. All patients were identified with alleles and genotypes of the polymorphic markers rs4762 of the AGT gene, rs1799752 of the ACE1 gene, rs5186 of the AGTR1 gene and rs1403543 of the AGTR2 gene using the polymerase chain reaction method in human DNA preparations on real-time CFX96C1000 Touch, Bio-Rad equipment (Syntol, Russia). Statistical analysis was performed in R v.4.2. Patients were divided into groups with severe (n = 44) and moderate COVID-19 (n = 56). For ACE1 rs1799752, a significant deviation from the population distribution was detected in both studied subgroups. A higher frequency of the C allele SNP rs5186 AGTR1 gene was detected in the group with severe disease. More frequent A/A genotype of SNP rs1403543 AGTR2 was detected among females with severe COVID-19. Haplotype analysis revealed more common DCG haplotype among patients with severe COVID-19. The odds ratio for severe COVID-19 in the presence of the DCG haplotype was 3.996 (95% confidential interval: 1.080 -14.791, P < 0.05). Our data suggest that the SNP genes of the RAS components, may allow to identify groups of patients predisposed to a more severe course of COVID-19.

Empagliflozin to prevent post-operative atrial fibrillation in patients undergoing coronary artery bypass graft surgery: Rationale and design of the EMPOAF trial.

Postoperative atrial fibrillation (POAF) is one of the most common types of acute AF and can complicate the treatment course of approximately one third of patients undergoing cardiac surgery. Sodium-glucose cotransporter-2 (SGLT2) inhibitors are among the newest antidiabetic drugs which can be therapeutic options for preventing POAF by different mechanisms. Empagliflozin to Prevent POAF (EMPOAF) is an interventional, investigator-initiated, double-blind, placebo-controlled, multicenter, randomized controlled trial which will be conducted in two referral teaching cardiology hospitals in Tehran. Four-hundred ninety-two adult patients who are scheduled for elective isolated coronary artery bypass graft (CABG) surgery will be randomly assigned to one of the groups of intervention (empagliflozin 10mg daily) or placebo starting at least 3 days before surgery until discharge. Key exclusion criteria are a history of diabetes mellitus, AF, ketoacidosis, or recurrent urinary tract infections along with severe renal or hepatic impairment, unstable hemodynamics, and patients receiving SGLT2 inhibitors for another indication. The primary outcome will be the incidence of POAF. Key secondary endpoints will be the composite rate of life-threatening arrhythmias, postoperative acute kidney injury, hospitalization length, in-hospital mortality, stroke, and systemic embolization. Key safety endpoints will be the rate of life-threatening and/or genitourinary tract infections, hypoglycemia, and ketoacidosis. EMPOAF will prospectively evaluate whether empagliflozin 10mg daily can reduce the rate of POAF in patients undergoing elective CABG. Enrolment into this study has started by November 2023 and is expected to be ended before the end of 2025.

Ultrasonic Cardiac Output Monitor (USCOM) Parameters in Pediatric COVID-19 Patients: A Case Series

Background: The increase in the spread of the novel coronavirus (SARS-CoV-2) has put many children at risk around the world. Some of these patients are in critical condition and present with shock symptoms and cardiac system problems. The ultrasonic cardiac output monitor (USCOM) is a non-invasive device that determines a person's cardiac output using continuous wave Doppler ultrasound. Objectives: The current study aims to present the clinical and laboratory manifestations of children with coronavirus disease (COVID-19) and to use a USCOM device for hemodynamic assessment to record and review their clinical information. Patients and Methods: We introduce 22 cases of children infected with coronavirus admitted to a public hospital in Iran. We examined the hemodynamics of these patients using USCOM and reported our experience with pediatric patients presenting with shock. This was a retrospective study, and data were collected using medical records. Results: In this study, 22 pediatric cases (10 girls and 12 boys) infected with coronavirus were reported. The youngest was 3 months old and the oldest was 14 years old. The most commonly observed symptoms were low back pain (N = 15), fever (N = 12), and seizures (N = 10). We found that the hemodynamics of the patients, including systemic vascular resistance (SVR), were abnormal and were associated with hypotension and unstable hemodynamics. The children responded well to the administration of an intravenous norepinephrine drip. Conclusion: This study presents detailed clinical and laboratory results of 22 children with COVID-19. Additionally, their hemodynamic status was measured and presented using the USCOM device. This information can provide physicians with a comprehensive understanding of the clinical history of patients referred with COVID-19, thereby improving their knowledge and care delivery.

Modeling a Caring Approach towards Children with Fallot’s Tetralogy Repair: A Focus on the Child’s Profile

Children with Tetralogy of Fallot (TOF) continue to be on the rise in Africa. More research is needed to improve caring approach towards children with surgically corrected TOF. The consequences of surgical correction of TOF remains an important area of research interest as children with TOF repair run the high risk of increase mortality resulting from acute cardiopulmonary problems. Yet little or no research published focused on investigating which clinical or para-clinical profile of children going in for surgical correction could be the cause of morbidity or mortality amongst children with TOF repair. The aim of the study was to determine the association between the profiles of children visiting the Surgical Heart Center for consultation with Tetralogy of Fallot (TOF) on the healing process after surgical repair. It was a descriptive quantitative study in which 303 nurses were issued questionnaires. Data was collected using convenient sampling technique and analyzed using multiple corresponding analysis in SPSS software version 21.0. The results showed that the clinical symptoms, clinical history, para-clinical characteristics, and postoperative complications identified three groups of children operated on for TOF: children with unstable hemodynamics; children who usually have symptoms such as systolic thrill, oppression in chest, tachycardia, and heart murmur; and finally children with symptoms of failure to thrive and heart murmur.

Atropine sulfate may be effective to recover the unstable hemodynamics in coronary artery spasms related to atrial fibrillation ablation procedures.

Coronary artery spasms related to atrial fibrillation ablation procedures could cause lethal ventricular fibrillation or cardiopulmonary arrest. It may be useful to try intravenous atropine sulfate while preparing urgent coronary artery angiography in hemodynamically unstable coronary artery spasms cases to prevent development of the lethal arrhythmias.