Use Of Inotropic Drugs Research Articles

WHAT DRUGS YOU CAN PREFER IN CARDIOGENIC SHOCK?

Abstract: Relevance. The use of nitroglycerin (NG) in cardiogenic shock (СS) helps to normalize blood pressure, reduce the risk of death and improve prognosis. Aim. To study the effect of vasopressors, inotropic drugs and nitroglycerin on hemodynamics and reducing the risk of death in patients with cardiogenic shock. Material and methods. A comparative assessment of the effectiveness of treatment of СS in myocardial infarction with nitroglycerin and traditional approaches to therapy was carried out. In the control group of patients with СS (17 people), dopamine or norepinephrine was administered in the traditional way. In the main group of patients with СS (22 people), large doses of nitroglycerin were administered. After the stabilization of the state of health, the drip injection of NG continued in the usual doses. Results. In 20 of 22 patients of the main group, immediately after the jet injection of nitroglycerin, blood pressure began to be determined or significantly increased, 14 of them survived (63.6%). In 9 cases, blood pressure did not decrease anymore, vasopressors were not administered, nitroglycerin was administered by drop for another 2-3 days, the treatment ended with discharge in a satisfactory state. In another 2 cases, it was necessary to administer vasopressors in parallel with the drip administration of nitroglycerin, after its jet administration. In the control group, the only patient survived (5.9%). Conclusions. Analysis of literature data indicates that in conditions of maximum depletion of reserves and a decrease in myocardial contractility in patients with cardiogenic shock, the use of vasopressors and inotropic drugs accelerates the decompensation of insufficient blood supply and increases the risk of death. The main way to combat СS is still urgent myocardial revascularization, however, the restoration of the functional activity of hibernated cardiomyocytes will be more successful and safer with their gradual activation. This problem can be successfully solved using the methods of mechanical support of blood circulation or with the help of nitroglycerin. It will be possible to verify the validity of this assumption only on the basis of the results of randomized clinical trials.

Translational model of vein graft failure following coronary artery bypass graft in atherosclerotic microswine.

Vein graft failure is a major complication following coronary artery bypass graft surgery. There is no translational model to understand the molecular mechanisms underlying vein-graft failure. We established a clinically relevant bypass graft model to investigate the underlying pathophysiological mechanisms of vein-graft failure and identify molecular targets for novel therapies. Six female Yucatan microswine fed with high cholesterol diet underwent off-pump bypass, using superficial epigastric vein graft, which was anastomosed to an internal mammary artery and distal left anterior descending artery. Vein-graft patency was examined 10-months after bypass surgery by echocardiography, coronary angiography, and optical coherence tomography followed by euthanasia. Coronary tissues were collected for histomorphometry studies. Atherosclerotic microswine were highly susceptible to sudden ventricular fibrillation with any cardiac intervention. Two out of six animals died during surgery due to ventricular fibrillation. Selection of the anesthetics and titration of their doses with careful use of inotropic drugs were the key to successful swine cardiac anesthesia. The hypotensive effects of amiodarone and the incidence of arrhythmia were avoided by the administration of magnesium sulfate. The vein-graft control tissue displayed intact endothelium with well-organized medial layer. The grafted vessels revealed complete occlusion and were covered with fibrous tissues. Expression of CD31 in the graft was irregular as the layers were not clearly defined due to fibrosis. This model represents the clinical vein-graft failure and offers a novel platform to investigate the underlying molecular mechanisms of vein-graft disease and investigate novel therapeutic approaches to prevent its progression.

Sports participation and myocarditis: Influence of sport types on disease severity.

ObjectiveTo study, in the context of acute myocarditis (AM) in sportsmen, the association between the category of sport practiced and the severity of AM.DesignRetrospective study.SettingSingle tertiary center.Patients82 sportspeople (≥2.5 h of sport per week) who presented an AM.Assessment of Risk FactorsThe type of sport activity before AM were collected.Main Outcome MeasuresComplicated AM was defined by a left ventricular ejection fraction <50% or the use of inotropic drugs or ventricular assist device.ResultsMean age was 29 ± 9 year-old, 77 (94%) were men. Sixteen (20%) had a complicated AM. Practicing sport over 6 h a week or a Mitchell’s Class IIIA sport were associated with complicated AM (44 vs. 17%, p = 0.019 and 38 vs. 11%, p = 0.008, respectively). Practicing a Mitchell’s Class IC sport was associated with uncomplicated AM (6 vs. 38%, p = 0.008).ConclusionIn sportspeople's AM, the pattern of sport activity (static or dynamic component, practice intensity) is associated with the disease’s severity.

Diagnostic value of monocyte chemoattractant Protein-1, soluble mannose receptor, Presepsin, and Procalcitonin in critically ill children admitted with suspected sepsis

IntroductionThe differentiation between systemic inflammatory response syndrome and sepsis is very important as it determines essential treatment decisions, such as selection, initiation, and duration of antibiotic therapy.ObjectivesWe aimed to investigate the diagnostic value of Procalcitonin, Monocyte Chemoattractant Protein-1, soluble Mannose Receptor, Presepsin as early biomarkers of pediatric sepsis in comparison to systemic inflammatory response syndrome in severely ill children.Patients and methodsThis study included 58 children diagnosed as sepsis (group 1), 24 children with systemic inflammatory response syndrome without infection (group 2), and 50 healthy children as controls (group 3). All the plasma levels of the studied biomarkers were measured and ROC curves were created for all the tested parameters to discriminate between sepsis and SIRS.ResultsThe area under the curve for Monocyte Chemoattractant Protein-1 was 0.926 (0.846-0.927) with sensitivity 100% and specificity 62.5%. The soluble Mannose Receptor had the highest sensitivity (100%), with AUC equals 1(.0.956-1.0) and specificity of 100%. The cut-off values for Procalcitonin, Presepsin, soluble Mannose Receptor, and Monocyte Chemoattractant Protein-1 and were: 0.62 ng/ml, 100 pg/ml, 13 ng/ml and 90 pg/ml, respectively. In septic cases, both soluble Mannose Receptor and Procalcitonin have positive correlations with the severity of sepsis, low Glasgow Coma Scale, ventilatory support, use of inotropic drugs and mortality rate (r = 0.950, 0.812, 0.795, 0.732 and 0.861respectively) for soluble Mannose Receptor and (0.536, 0.473, 0.422, 0.305 and 0.474 respectively) for Procalcitonin.ConclusionSoluble Mannose Receptor, Presepsin, and Monocyte Chemoattractant Protein-1 can be used to differentiate between sepsis and SIRS in critically ill children.

Миокардиальный станнинг в медицине неотложных и критических состояний, ассоциированных с системной гипоксией

Актуальность. Миокардиальный станнинг — феномен, заключающийся в продолжительном снижении сократительной способности миокарда после краткого периода ишемии/реперфузии, при котором не происходит омертвения ткани сердечной мышцы. Если изначально феномен станнинга ассоциировали исключительно с проявлениями ишемической болезни сердца, то в настоящее время имеется все больше свидетельств о том, что миокардиальный станнинг может осложнять совсем другую патологию. Цель: изучение результатов работ оте-чественных и зарубежных ученых, посвященных наблюдению феномена станнинга в медицине неотложных состояний, и систематизация накопленного клинического материала. Материалы и методы. Детальное изучение результатов современных клинических исследований, посвященных диагностике снижения сократительной способности миокарда у пациентов, находящихся в критических состояниях, которые развились не вследствие манифестации острого коронарного синдрома, обсуждению механизмов патогенеза миокардиальной дисфункции при этих состояниях и принципам оказания таким больным экстренной и специализированной медицинской помощи. Результаты. Для феномена миокардиального станнинга характерны следующие отличительные признаки: 1. Коронарный кровоток после перенесенного эпизода ишемии практически полностью восстанавливается. После ишемии очень часто регистрируется кратковременный период гиперперфузии. 2. Несмотря на восстановление коронарного кровотока, имеет место продолжительное снижение сократимости миокарда. 3. Необратимого повреждения кардиомиоцитов в период ишемии не происходит. 4. Снижение сократительной способности сердца, наблюдающееся после ишемии и последующей реперфузии, является полностью обратимым. Основными механизмами развития миокардиального станнинга являются: усиленная генерация активных форм кислорода в период реперфузии; перегрузка кардиомиоцитов кальцием; снижение сопряженности между процессами электрического возбуждения миокарда и его сократимостью. Продукция простациклина, активность ангиотензина I, II и ангиотензинпревращающего фермента, продукция брадикинина моделируют тяжесть мио-кардиальной дисфункции при станнинге. Причиной станнинга может быть индуцированная катехоламинами кардиотоксичность. Миокардиальный станнинг можно наблюдать у пациентов с геморрагическим, септическим шоком, субарахноидальными кровоизлияниями, на фоне проведения гемодиализа, после криза при феохромоцитоме, после реанимационной акции. Выводы. Миокардиальный станнинг требует своевременной диагностики, поскольку проведение гемодинамической коррекции не с помощью инотропной поддержки, а по другим направлениям, а именно за счет увеличения скорости объемной нагрузки (агрессивная инфузионная терапия) или применения вазопрессоров, может резко ухудшить состояние пациента вследствие увеличения нагрузки на ослабленное сердце.

Good clinical practice for the use of vasopressor and inotropic drugs in critically ill patients: state-of-the-art and expert consensus.

Vasopressors and inotropic agents are widely used in critical care. However, strong evidence supporting their use in critically ill patients is lacking in many clinical scenarios. Thus, the Italian Society of Anesthesia and Intensive Care (SIAARTI) promoted a project aimed to provide indications for good clinical practice on the use of vasopressors and inotropes, and on the management of critically ill patients with shock. A panel of 16 experts in the field of intensive care medicine and hemodynamics has been established. Systematic review of the available literature was performed based on PICO questions. Basing on available evidence, the panel prepared a summary of evidence and then wrote the clinical questions. A modified semi-quantitative RAND/UCLA appropriateness method has been used to determine the appropriateness of specific clinical scenarios. The panel identified 29 clinical questions for the use of vasopressors and inotropes in patients with septic shock and cardiogenic shock. High level of agreement exists among the panel members about appropriateness of inotropes/vasopressors' use in patients with septic shock and cardiogenic shock.

Les enjeux de la prise en charge de la maladie à virus Ébola sur le terrain épidémique

La République démocratique du Congo (RDC) connaît depuis août 2018, dans les provinces du Nord-Kivu et l’Ituri, la plus dévastatrice et la plus prolongée des épidémies de maladie à virus Ebola (MVE) de son histoire avec plus de 3 320 cas et 2209 décès en date du 7 décembre 2019. La stratégie de prise en charge de la MVE s’inscrit dans un scénario de crise humanitaire complexe grevé par un conflit armé et qui doit tenir compte de considérations ethniques et culturelles, des mesures de précautions drastiques imposées aux soignants ainsi que de limitations diagnostiques et thérapeutiques particulières. Le management médical repose en premier sur la prise en charge intensive et précoce des patients dans les centres de traitement Ebola (CTE). Elle est renforcée par le déploiement de l’évaluation de thérapeutiques spécifiques de l’infection par virus Ebola. Son objectif principal reste la performance du niveau de soins de support et renvoie à un remplissage liquidien massif avec un suivi drastique et évalué visant la compensation des pertes hydro-électrolytiques qui constitue l’invariant de la MVE. Ces mesures permettent souvent d’éviter l’évolution péjorative et le recours à une escalade du niveau de soins, comme l’épuration extra-rénale, la ventilation invasive ou le recours à des drogues inotropes, de réalisation non aisée dans le contexte du terrain épidémique. Nous rapportons le cas d’un patient hospitalisé présentant une forme sévère de la MVE et hospitalisé dans le CTE de Béni (Nord-Kivu),RDC au cours de cette épidémie, afin d’illustrer le projet de soin du patient atteint de fièvre hémorragique virale sévère à l’horizon 2020.

The effect of phosphorolcoline-coated cardiopulmonary by-pass circuits on morbidity and mortality in patients with congenital open cardiac surgery

Objective: Our aim in this study is to investigate the relationship between mortality and morbidity of phosphorylcholine coated oxygenator circuit used in heart-lung machine in congenital open heart surgery operations.&#x0D; Materials and Methods: The study was conducted in Dr. Sami Ulus Child Diseases Training and Research Hospital Cardiovascular Surgery Clinic between 2008-2009. 30 congenital heart patients were included. The patients were divided into 2 groups of 15 people. In one of the groups, a phosphorylcholine coated oxygenator circuit was used in the heart lung machine (Group P). In the other group, a standard oxygenator circuit was used (Group C).Congenital heart surgery was performed for 19 Ventricular Septal Defects (VSD), 5 Secundum Atrial Septal Defects (ASD), 3 Primum ASD, 2 Mitral insufficiency and 1 Discret subaortic membrane.&#x0D; Extubation times, intensive care and discharge times, 24-hour drainage follow-up, inotropic drug use, blood and fresh frozen plasma (FFP) transfusion amount, aspartate aminotransferase, alanine aminotransferase, creatine phosphokinase-MB, urea, blood urea nitrogen, creatinine, white cell number of platelets, lactate dehydrogenase, albumin, total protein, C-reactive protein, prothrombin time, partial thromboplastin time, fibrinogen, D-dimer, C5a and elastase levels were compared perioperatively.&#x0D; Results: In the study, it was determined that the discharge time was shorter in Group P. It was found that the increase in d-dimer values with fibrinogen was less in Group P. These were found to be statistically significant (p 0.05). There was no mortality in either group.&#x0D; Conclusion: In this study, phosphorylcholine-coated oxygenator did not significantly reduce the inflammatory response during cardiopulmonary by-pass (CPB). There was no difference between the two groups in terms of morbitidity and mortality.However, the fact that fibrinogen values, which are the acute phase reactants, are lower than the control group and the increase in d-dimer values remain limited may be important in terms of hemocompatibility of the phosphorylcholine coated circuit.

LEVOSEMINDAN VERSUS INTRA-AORTIC BALLOON PUMP IN LOW EJECTION FRACTION CABG PATIENTS

Background: Preoperative left ventricular dysfunction is an independent risk factor for perioperative mortality and morbidity and is also associated with postoperative low cardiac output syndrome. IABP improved outcomes in high-risk cardiac patients. However, installation of the balloon has many disadvantages. Recently, a new drug named Levosimendan is commonly used as an inotropic support. it does not increase oxygen demand of myocardium.Aim of the work: The purpose of our study was to compare the efficiency of levosimendan versus intra-aortic balloon pump in patients with poor left ventricular function undergoing coronary artery bypass grafting (CABG) with ejection fraction less than 35%.Patients and Methods: sixty patients were randomized into 2 groups, according to the treatment they received - either levosimendan (Group A) or intra-aortic balloon counter pulsation (Group B). and compared with respect to The use of inotropic drugs, weaning from CPB, Hemodynamics, transfusion requirements, ICU stay, hospital stay and in-hospital mortality.Results: There were no differences in preoperative characteristics including patients’ age, sex, BMI, and comorbidities. The Levosemindan group had reduced transfusion requirements and shorter ICU stay as compared to IABP group.Conclusion: levosimendan infusion after induction of anesthesia is a good choice with an acceptable option in comparison to IABP. The use of levosimendan in high-risk cardiac patients is comparable to IABP in improving hemodynamics during and after conventional on-pump CABG and results in a shorter ICU stay.

COMPARATIVE ASSESSMENT OF THE TIME OF PATIENTS’ STAY IN THE INTENSIVE CARE UNIT AFTER MITRAL VALVE REPLACEMENT WITH PRESERVATION OF THE POSTERIOR LEAFLET AND COMPLETE REMOVAL OF SUBVALVULAR STRUCTURES

The aim is to evaluate the effectiveness of time spent in the intensive care unit and the use of inotropic drugs after mitral valve replacement surgery with preservation of the posterior leaflet with comparison of complete removal of subvalvular structures. Material and methods. The study included 60 patients, including 28 patients after surgery with preservation of the posterior mitral valve leaflet and 32 patients after surgery with complete removal of subvalvular structures. The average age of the patients was 45.9±12.0 years. Inclusion criteria were the time spent in the intensive care unit after surgery, the use of inotropic drugs, and the duration of use of the ventilator. Results. In comparison, the control group in the intensive care unit received more inotropic drugs. In the main group of renal doses - 21 (75%) patients received dopamine - 2.38±0.21 micrograms per kilogram minute, adrenaline - 0.021±0.003 micrograms per kilogram minute. Cardiotonics were not received at therapeutic doses. Above therapeutic doses - 2 (7.14%) patients received (dopamine) - 8±0.01 micrograms per kilogram minute. In the second group of renal doses - 23 (71.87%) patients received dopamine 2.24±0.54 micrograms per kilogram minute, adrenaline - 0.021±0.001 micrograms per kilogram minute. Therapeutic doses of 5 (15.6%) patients dopamine - 5.2±0.4 micrograms per kilogram minute, adrenaline - 0.04±0.001 micrograms per kilogram minute. Above therapeutic doses of 2 (6.25%) patients, dopamine is 8.2±0.02 micrograms per kilogram minute, adrenaline is 0.07±0.003 micrograms per kilogram minute.

Sport and myocarditis: Is the way of practice as an impact on severity?

Acute myocarditis (AM) in athletes is a frequent source of concern. Investigate whether the way of practice has an impact on the severity of AM and on the occurrence of long-term adverse events if sport is resumed. 82 athletes (≥2 hours of sport per week) who presented an AM were retrospectively included from January 2009 to December 2019. AM was defined by onset of symptoms < 1 month and a positive endomyocardial biopsy (Dallas criteria) or a positive CMR (2 or 3 Lake Louise Criteria) associated with an elevation of troponin. The habits of practicing sport before and after AM were collected. Endpoints were severe AM, defined by a left ventricular ejection fraction < 50% or the use of inotropic drugs or ventricular assist device, and the occurrence of late (> 6 months after acute phase) heart failure, rehospitalization or recurrence. Mean age was 29 ± 9 years old, 77 (94%) were men, median time of practice was 5.4 ± 3.7 hours per week. Sixteen (29.5%) presented a severe AM. Practicing sport > 6 hours a week (43.8% vs. 16.7% P = 0.019) or a Mitchell's Class IIIA sport (37.5% vs. 10.6%; P = 0.008) was associated with severe AM. Practicing a Michell's Class IC sport (6.3% vs. 37.9%; P = 0.008) was associated with non-severe AM. Median follow-up was 33.8 [16.6–60], 65 (79.3%) patients resumed sport ( Fig. 1 ). In univariate Cox regression analysis, sport resumes (HR 0.97; 95% CI 0.20–4.57, P = 0.97), competition (HR 0.76; 95%CI 0.15–3.82; P = 0.74) and amount of hours of practice par week (HR 1.15; 95%CI 0.98–1.32; P = 0.06) were not associated with the occurrence of late heart failure, rehospitalization or recurrence ( Table 1 ). In athlete's AM, the way of sport participation (static or dynamic component, practice over 6 hours a week) is associated with the presentation's severity. The return to sport after the acute phase does not seem to be associated with the occurrence of adverse events.

Single-Dose Del Nido Cardioplegia vs. Blood Cardioplegia in Aortic Valve Replacement Surgery.

IntroductionIn this study, we aimed to compare Del Nido cardioplegia (DNC) with blood cardioplegia (BC) in aortic valve replacement.MethodsA two-year single-institute retrospective cohort study was accomplished. Subjects who underwent aortic valve replacement surgery were divided into two groups (DNC and BC) and outcomes were compared.ResultsPreoperative demographics and clinical data of the patients in both groups were similar. The time until cardiac arrest following administration of the first dose of cardioplegia was statistically significantly shorter in the BC group (47.0 sec. 25-103) than in the DNC group (63.0 sec. 48-140) (P=0.012). Cross-clamping time was longer in the BC group (48.7±12.3 min. vs. 41.5±11.8 min.) (P=0.041). Cardiopulmonary bypass time was statistically significantly shorter in the DNC group (BC 60.8±18.5 min., DNC 53.7±15.2 min.) (P=0.046). The rate of postoperative use of intravenous positive inotropic support drugs (dopamine, dobutamine, norepinephrine, etc.) for more than two hours was significantly higher in the BC group (20 [23.5%] in the BC group and nine [17.3%] in the DNC group) (P=0.035). Creatine kinase myocardial band and troponin I levels were slightly lower in patients receiving DNC, but no statistically significant difference was detected.ConclusionDel Nido cardioplegia is safe and can be used efficiently as an alternative to blood cardioplegia in isolated aortic valve replacement surgery.

The Effect of Preoperative Carbohydrate Loading on Clinical and Biochemical Outcomes after Cardiac Surgery: A Systematic Review and Meta-Analysis of Randomized Trials.

Background and aim: Preoperative fasting leads to metabolic stress and causes insulin resistance in patients undergoing cardiac surgery. The aim of this study was to assess the effect of preoperative oral carbohydrate loading (OCH) on outcome in patients undergoing planned cardiac surgery by systematically reviewing the literature and synthesizing evidence from randomized controlled trials (RCTs). Methods: Systematic search of PubMed/MEDLINE/Embase/Cinahl/Web of Science/ClinicalTrials databases was performed to identify relevant RCTs from databased inception until 05/03/2020. We included studies that compared outcome measures between OCH with control (placebo or standard starvation). We conducted a random-effect meta-analysis of clinical and biochemical parameters. Results: Nine studies (N = 9) were included with a total of 507 patients. OCH significantly decreased aortic clamping duration (n = 151, standardized mean difference (SMD) = −0.28, 95% confidence interval (CI) = −0.521 to −0.038, p = 0.023 and differences in means (DM) = −6.388, 95%CI = −11.246 to −1.529, p = 0.010). Patients from treatment groups had shorter intensive care unit (ICU) stay (n = 202, SMD = −0.542, 95%CI = −0.789 to −0.295, p < 0.001 and DM = −25.925, 95%CI = −44.568 to −7.283, p = 0.006) and required fewer units of insulin postoperatively (n = 85, SMD = −0.349, 95%CI = −0.653 to −0.044, p = 0.025 and DM = −4.523, 95%CI = −8.417 to −0.630, p = 0.023). The necessity to use inotropic drugs was significantly lower in the OCH group (risk ratio (RR) = 0.795, 95%CI = 0.689 to 0.919, p = 0.002). All other primary outcomes did not reveal a significant effect. Conclusions: Preoperative OCH in patients undergoing cardiac surgery demonstrated a 20% reduction in the use of inotropic drugs, a 50% reduction of the length of ICU stay, a 28% decrease in aortic clamping duration and a 35% decrease of postoperative insulin requirement.

Septic cardiopathy: disputable issues and prospects

The objective: to present current information about definitions, etiopathogenesis, clinical, laboratory and hemodynamic manifestations of septic cardiopathy, based on published data and the results of our own research.Results: septic cardiopathy is the most important pathogenetic component of sepsis, and cardiac dysfunction makes a significant contribution to its outcomes. It is found out that after staying in the intensive care unit for 3-4 days, the level of the inactive part of the precursor of the B-type natriuretic peptide (NT-proBNP) &gt; 3,450 pg/ml indicates of the risk of death: area under ROC curve (AUC) 0.708 (p = 0.0041), sensitivity 63.6%, and specificity 66.7%. At the same time, NT-proBNP &gt; 5,250 pg/ml is associated with the use of inotropic drugs: AUC 0.769 (p = 0.0007), sensitivity 76.9%, specificity 79.0%. The article describes the detection of septic cardiopathy using transpulmonary thermodilution and calculation of such indices as afterload-related cardiac performance and cardiac function index. Data on the age-related parameters of central hemodynamics and risk of pathological decrease in certain blood circulation indices characteristic of older patients are presented. The article discusses the feasibility of treating septic cardiopathy as a variant of acute heart failure, which can be manifested not only by a decreased systolic function (low left ventricular ejection fraction) but also by increased end-diastolic pressure in the ventricles (diastolic dysfunction) with a normal left ventricular ejection fraction.

Çocuk Yoğun Bakım Ünitesinde Başvuru Trombosit Değerinin Hasta Sağkalımına Etkisi

Introduction Thrombocytopenia is a common haematological finding in critically ill patients. Studies have shown that decreased platelet counts are associated with prolonged hospitalisation, increased costs, and mortality in adult populations. However, not enough studies have investigated the incidence of thrombocytopenia and the relationship between thrombocytopenia and the prognoses of paediatric patients who require treatment in the intensive care unit. We evaluated the effects of initial platelet counts on the outcomes of.pediatric intensive care unit patients. Material and Methods We performed a retrospective analysis of the records of all patients admitted to the pediatric intensive care unit between October 2016 and December 2017. The relationship between the initial thrombocyte counts and the need of invasive mechanical ventilation and non-invasive mechanical ventilation,inotropic drug use, continuous renal replacement need, duration of hospitalization and mortality rate were investigated. Results Totally 387 patients were included in the study. Age distributions ranged from 1 month to 17 years, and the mean patient age was 3.95±4.80 years. The most frequent diagnoses of patients were respiratory disorders (144 patients; 37.2%). There was a statistically significant relationship between thrombocyte levels of the first complete blood count performed during admission and invasive mechanical ventilation, non- invasive mechanical ventilation , inotropic drug use, mortality, acute kidney injury, and continuous renal replacement therapy. Analyses of receiver-operator characteristic (ROC) curves for the thrombocyte counts showed that with a cutoff value of 102,000, mortality had 92.7% sensitivity and 53.1% specificity. The odds ratios (ORs) and relationship between prognostic factors and thrombocytopenia were calculated using logistic regression models. ORs were 4.616 for continuous renal replasman therapy, 6.682 for inotropic drug use, and 3.649 for mortality. Conclusion A low platelet count at the time of admission to the pediatric intensive care unit should be considered an independent risk factor that increases mortality and morbidity and prolongs hospitalisation. Extensive care should be provided to this group of patients.

SAT-LB80 Elevated Pre-Op Thyrotropin Levels Are Associated With Increased 30-Day Mortality in Patients Undergoing Cardiac Surgery With Cardiopulmonary Bypass

BACKGROUND: The association between thyroid dysfunction and postoperative mortality is contentious. Thyroid function is frequently depressed during and after cardiopulmonary bypass surgical procedures, and this may adversely affect myocardial performance and postop outcome.OBJECTIVES: To study i) the changes and clinical significance of serum thyroid hormones during cardiopulmonary bypass (CPB), and ii) the association between biochemically assessed peri-op thyroid function and 30-day mortality after CBPSTUDY DESIGN: Prospective Cohort StudySUBJECTS: 279 patients undergoing various cardiac surgeries under cardiopulmonary bypass.METHODS: All consenting patients undergoing open heart surgery in last five years at a tertiary care centre in North-India were studied. The thyroid hormone levels (Total T3, T4 and TSH) were measured before admission, and postoperatively on Day 1 & 7, and 3 months following surgery. The patients’ gender, age, weight, body mass index, heart disease details, previous cardiac surgeries, and cardiac surgery-related data such as pump time, aortic clamping time, hypothermia duration, postoperative hemodynamic status and postoperative use of inotropic drugs were recorded and analysed. Patients were classified as having biochemically overt or subclinical hyperthyroidism or hypothyroidism, normal thyroid function, or non-classifiable state based on preoperative thyroid-stimulating hormone and total T4 values. Outcome data were collected from hospital records. Biochemical thyroid dysfunction was not systematically treated. Outcomes measured were length of ICU stay, postoperative complications and 30-day mortality.RESULTS: There was significant changes in thyroid function in patients undergoing cardiopulmonary bypass surgery (Fig 1). All patients showed a decrease in T3, T4 and TSH after surgery. Post-op complications were observed in 137 patients (49%) most common being atrial fibrillation (34%) followed by acute kidney injury (23%), infections (18%), dyselectrolytemia (7%), bleeding (1.4%) and ARDS (1.4%). Of 263 patients followed, eventually 26 patients expired with a mortality rate of 8.89% (95% CI, 0.4 - 19.4). Perioperatively, there was a significant correlation between 30-day with type of surgery (r, 0.26), aortic clamp time (r, 0.45), CBP time (r, 0.48), number of inotropes used (r, 0.57), hours of mechanical ventilation (r, 0.4), ICU stay (r, 0.13) and post-op complications (r, 0.24), as well as with the reduction in the thyroid hormone levels; 17 (7%), 3 (20%) and 6 (46%) patients of those with pre-op TSH level of <6.5, >6.5 and >10.5 mIU/L expired (p <0.001).CONCLUSION: Pre-op thyroid dysfunction is associated with increased mortality in patients undergoing cardiac surgery with CBP. Excess mortality with elevated serum TSH levels suggests the importance of timely detection and intervention in individuals with thyroid dysfunction undergoing cardiac surgery.Table of Contents oTable 1. Characteristics of patients who expired versus those who survived cardiac surgery with cardiopulmonary bypass (CPB) oFig 1. Changes in serum thyroid hormones during CPB surgery oTable 1. Characteristics of patients who expired versus those who survived cardiac surgery with cardiopulmonary bypass (CPB) oFigures in parenthesis indicate ±Standard Deviation, unless indicated otherwise oFig 1. Changes in serum thyroid hormones during CPB surgery

Predictive value of perfusion index for mortality in mechanically ventilated patients

Aim This study aimed to examine the prognostic significance of the perfusion index (PI) in mechanically ventilated patients. Methods Study included sixty patients who had the risk factors for the development of acute respiratory distress syndrome and received mechanical ventilator (MV) support in intensive care unit (ICU) unit between January 2017/January 2018. The demographic characteristics, vital signs, blood gas parameters, lactate levels, prognostic scores, and use of inotropic drugs were recorded. Arterial blood gas and PI measurements at the frontal region were performed at the time of and 12th and 24th hours of admission to the ICU. The patients were followed up for 60 days, and the outcome was recorded. Results Twelve patients (20%) died during the first 7 days, and 27 patients (45%) died within 60 days of the admission. Multivariate analyses to determine potential predictors of 7 and 30-day mortality showed that only 24th-hour lactate level was independent predictor of 60-day mortality, and the PI at 24th was the sole independent predictor of 7-day mortality. Conclusion The PI did not predict 60-day mortality in MV patients who had risk factors for the development of Acute Respiratory Distress Syndrome (ARDS). However, the PI at 24th may be a significant predictor of 7-day mortality.

N-terminal pro-B-type natriuretic peptide is a biomarker of myocardial stress in abdominal sepsis and septic shock

Aim. To evaluate the dynamics and prognostic significance of serum N-terminal pro-B-type natriuretic peptide (NT-proBNP) level in patients with severe abdominal sepsis.Methods. We analysed survey data of 54 patients (28 men and 26 women) aged 64.5 years [56.25–78.00] with abdominal sepsis or septic shock. Disease severity scored according to the Acute Physiology and Chronic Health Evaluation II criteria was 16.3 ± 0.8 and according to the Sequential Organ Failure Assessment (SOFA) was 3 [3–6]. Statistical analysis of these data was performed using correlation analysis, logistic regression and receiver operating characteristic analysis.Results. Serum NT-proBNP level during the 1st week following admission to the intensive care unit (ICU) exceeded normal values, i.e. 2,570 [116.25–6,559.5] to 4,600 [1,680–18,200] pg/ml. At all disease stages, serum NT-proBNP level correlated with sepsis severity scores (SOFA), procalcitonin (PCT) levels, lactatemia, mean arterial pressure, heart rate and inotropic and vasoactive–inotropic scales (rho = 0.329–0.433; p &lt; 0.02). On ICU days 3–4, serum NT-proBNP level of &gt;5100 pg/ml was associated with increased risk of mortality [65.6%–88.2%; area under the curve (AUC) = 0.806; р &lt; 0.0001]. Similarly, during this interval, elevated serum NT-proBNP level was associated with the use of inotropic drugs (OR = 1.0001, 95% CI = 1.000–1.0002, p &lt; 0.0059). Notably, we found that 76.9%–79.0% of the patients with serum NT-proBNP level of &gt;5250 pg/ml were receiving inotropic drugs including adrenaline, dopamine and dobutamine. We were unable to identify a specific association between serum NT-proBNP level and norepinephrine administration. On ICU days 7 and 8, among patients with serum NT-proBNP level of &gt;3450 pg/ml, we observed a very close relationship between serum NT-proBNP level and PCT (sensitivity = 63.6%, specificity = 66.7%, AUC = 0.708; р = 0.0041).Conclusion. Serum NT-proBNP level is considerably elevated in patients with abdominal sepsis or septic shock. NT-proBNP level was associated with both traditional indicators of sepsis severity and indicators characterising the state of systemic circulation. Notably, serum NT-proBNP level correlates with cardiac failure and inotropic drug requirement. Although the mechanisms underlying the observed increases in serum NT-proBNP level remain unclear, the present findings indicate that this mediator is clearly a significant biomarker and predictor of adverse outcomes related to abdominal sepsis and septic shock. Received 22 January 2020. Revised 27 January 2020. Accepted 11 February 2020. Funding: The study did not have sponsorship. Conflict of interest: Authors declare no conflict of interest. Author contributionsConception and study design: I.N. Tyurin, D.N. Protsenko, I.A. KozlovData collection and analysis: I.N. Tyurin, S.A. Rautbart, S.N. ShuryginStatistical analysis: I.N. Tyurin, S.A. RautbartDrafting the article: I.N. Tyurin, D.N. Protsenko, I.A. Kozlov, S.N. ShuryginCritical revision of the article: I.N. Tyurin, I.A. KozlovFinal approval of the version to be published: I.N. Tyurin, S.A. Rautbart, D.N. Protsenko, S.N. Shurygin, I.A. Kozlov

Accuracy of Pediatric Risk of Mortality (PRISM) III Score in Predicting Mortality Outcomes in a Pediatric Intensive Care Unit in Karachi.

BackgroundWith the advancements in medicine and increasing access to modern technology, pediatric intensive care units (PICU) are becoming a vital part of any health care setting. PICUs play a key role in saving the life of young patients. Various scales have been designed by researchers to aid in predicting the mortality of a patient admitted in PICU. Pediatric Risk of Mortality (PRISM) and Pediatric Index of Mortality (PIM) are among the most commonly used scales. Calculating the risk of mortality enables the physicians to classify the patients and helps in identifying which patients require more urgent care and resources. MethodsA hospital-based prospective study was carried out at PICU in a tertiary care hospital in Karachi from December 2017 to June 2019. All patients between the age of one month and 12 years were included in our study after informed consent from parents/guardians. A standard questionnaire was used and the PRISM III score was calculated at 24 hours of admission. All necessary investigations were carried out, and all statistical analyses were carried out using SPSS v.23 (IBM, Armonk, NY).ResultsA total of 407 patients were included in our study with the majority being males (54.5%). The mean age was 27±33 months. The mean duration of stay of patients in PICU was 80.15±36.58 hours. The mortality rate in our study was 37.35 % (n=152). The need for mechanical ventilation, use of inotropic drugs, higher temperatures, and low Glasgow Coma Scale scores were associated with poor survival. It was noted that as the PRISM III score increased, the mortality rate also increased. In our study, we found that PRISM III had good predictive power in our population. The area under the curve was 0.903±0.016 (p<0.001, 95% confidence interval: 0.872-0.934).ConclusionsPRISM III score showed excellent accuracy and predictive ability in our population. There was no significant difference in observed and expected mortality rates in our study. In a resource-limited setting, the prediction models highlight the cases where more medical attention is required and also enable the physicians to assess the prognosis of the patient so adequate measures can be taken beforehand.

Massive blood loss in pediatric practice

Background. Massive blood loss is one of the main causes of deaths and complications both in patients requiring extensive surgical interventions and those with severe trauma.Aim. To analyse available publications devoted to the definition, pathogenesis, diagnosis and intensive care of acute massive blood loss in children.Materials and methods. The conducted analysis involved 102 publications by Russian and foreign authors from the PubMed database devoted to the problem of massive blood loss in children.General findings. The paper presents modern definitions of massive blood loss in children. Special attention is paid to the pathogenesis, diagnosis and treatment of massive blood loss in severe trauma cases. The principles of correcting the deficiency of circulating blood volume, the use of inotropic and vasopressor drugs, as well as the elimination of severe anemia and hemostasis disorders, are considered. Publications devoted to the search for an optimal ratio of globular and plasma volumes during the transfusion of blood components are reviewed. It is shown that the reviewed publications report conflicting opinions regarding the use of antifibrinolytic medications. At the same time, the high efficiency of tranexamic acid and its positive effect on the functional outcome in patients with severe trauma is demonstrated. In order to optimize approaches to the management of massive blood loss in children, additional multicenter studies are required. These studies should consider the effect of the underlying disease that caused massive blood loss, as well as the treatment and diagnostic capacity of hospitals.