Journal of Clinical Medicine

Pulse contour devices estimate cardiac output (CO) by analysis of an invasive blood pressure (BP) waveform. However, arterial catheters are only employed in the highest risk patients. By contrast, automatic arm cuff devices are used for non-invasive BP monitoring in numerous hospital patients. Furthermore, these devices directly measure cuff pressure oscillations, which are directly related to pulsatile blood volume rather than BP. The hypothesis of this study was that automatic arm cuff devices...

BackgroundVasoplegic syndrome is frequently observed during cardiac surgery and resembles a complication of high mortality and morbidity. There is a clinical need for therapy and prevention of vasoplegic syndrome during complex cardiac surgical procedures. Therefore, we investigated different strategies in a porcine model of vasoplegia. MethodsWe evaluated new medical therapies and prophylaxis to avoid vasoplegic syndrome in a porcine model. After induction of anesthesia, cardiopulmonary bypass...

PURPOSEThis study was conducted to estimate the incidence of hypotension after spinal anaesthesia after inferior vena cava ultrasound (IVCUS) guided volaemic optimization compared with a control group in patients undergoing elective surgery. According to ESICM guidelines, hypotension was defined as two systolic arterial pressure (SAP) measurements < 80 mmHg and / or a mean arterial pressure (MAP) < 60 mmHg, or a drop in SAP of more than 50 mmHg or more than 25% from baseline, or a decrease in MA...

BackgroundSpinal anaesthesia is commonly used for many surgical procedures. One of its potential complications is arterial hypotension, which is nowadays prevented by an empirical fluid administration without any hemodynamic status assessment. However, this practice could increase the risk of volume overload in cardiovascular high-risk patients. Two non-invasive tests are performed to identify fluid-responsiveness: the Inferior Vena Cava Ultrasound (IVCUS) and the Passive Leg Raising Test (PLRT)...

BackgroundPoint-of-care platelet function tests are used by anaesthetists and surgeons to create risk management plans for patients who have recently taken antiplatelet medication. Thromboelastography (TEG), one method of determining platelet function, sometimes takes >60 minutes to produce results. Previous studies have shown a novel parameter, area under the curve at 15 minutes (AUC15), correlates with clinical outcomes but used privately-owned, custom-made software to calculate AUC15. This st...

IntroductionReliable hemodynamic parameters are crucial to prevent perioperative hypotension, one of the most significant modifiable risk factors for postoperative morbidity and mortality. The current standard of care for intraoperative hemodynamic monitoring is achieved through an arterial radial catheter, but its reliability has been increasingly questioned due to the incidence of a phenomenon called the radial-to-central arterial pressure gradient. Studies have shown that this gradient occurs...

BackgroundArterial blood pressure (ABP) waveforms are ever-changing. Variation in waveform morphology (VarM) may reflect the complex interactions of cardiovascular regulatory mechanisms. We investigated the association between VarM and the development of acute kidney injury (AKI) following cardiac surgery. MethodsIn tahis prospective observational single-cohort study, 101 patients undergoing elective cardiac surgery involving cardiopulmonary bypass (CPB) were enrolled. VarM was quantified from ...

BackgroundThe discordance between the macrocirculation and microcirculation in septic shock has been recognised but never explained. I present a novel mathematical hypothesis as to how heterogenous microcirculatory flow distribution directly induces a hyperdynamic circulation and how elevated central venous pressure induces microcirculatory dysfunction. MethodsI explore the tube law and modified Poiseuille resistance for compliant blood vessels. Using these equations a new equation is developed...

BackgroundValvular heart surgery is associated with considerable perioperative risks including hemodynamic instability, arrhythmias, renal dysfunction and prolonged ICU stay. Dexmedetomidine a selective 2-adrenoceptor agonist, provides sedation and sympatholysis and has been investigated as a cardioprotective adjunct. ObjectivesTo evaluate the effects of dexmedetomidine on intraoperative hemodynamic stability and postoperative outcomes in adult patients undergoing valvular replacement surgery. ...

BackgroundPulmonary hypertension (PH) patients are at higher risk of postoperative complications. We analyzed the association of PH with 30-day postoperative pulmonary complications (PPC). MethodsA single-center propensity score overlap weighting (OW) retrospective cohort study of 164 patients with mean pulmonary artery pressure (mPAP) of >20 mmHg within 24 months of procedure and a control cohort (N=1981), undergoing elective inpatient abdominal surgery or endoscopic procedures under general a...

PurposeTo improve the management level of general anesthesia during bronchoscopy in the children with diffuse alveolar hemorrhage (DAH). MethodsA retrospective study was conducted in the children with DAH who had performed bronchoscopy under general anesthesia with spontaneous respiration by face mask ventilation initially from June 2021 to June 2022 in our hospital. Results1. Thirty-four children who had underwent 38 bronchoscopy procedures were included. 2. General anesthesia induction was p...

Feasible estimations of perioperative changes in oxygen consumption could enable larger studies of its role in postoperative outcomes. Current methods, by pulmonary artery catheterisation or breathing gas analysis, are often regarded as either invasive or technically requiring. In this pilot study, we investigated the relationship between estimations of oxygen consumption, based on minimal-invasive cardiac output and arterial-central venous blood gas sampling, and indirect calorimetry in the per...

A central dogma in physiology is that oxygen release at tissues is not diffusion-limited because gas exchange at capillaries is rapid. This assertion has influenced clinical care, which focuses on optimising oxygen delivery through improving blood flow and oxygen content, rather than oxygen unloading from red blood cells (RBCs). Since storage of blood causes profound changes that slow oxygen release from RBCs, transfusions could compromise tissue respiration. We investigated this in transplant h...

BackgroundFluid management is a serious challenge for patients undergoing hemodialysis therapy (HD). Bioimpedance spectroscopy (BIS) is a promising technique to help with clinical hydration (HYD) assessment. The Fresenius Medical Care (FMC) Body Composition Monitor (BCM) is the standard but is large and expensive. Cella Medical has introduced a small wireless BIS device. This study compared the HYD status predicted by the two devices. MethodsFollowing the FMC BCM device manual guidelines, measu...

The complement system represents an ancient part of innate immunity and is comprised of multiple serum proteins. In several pathological conditions, including atypical hemolytic syndrome (aHUS), complement activation is contributing to disease progression. Therefore, pharmacological targeting of complement is a viable therapeutic strategy in this population. Recent data suggest complement activation in patients suffering from malignant hypertension and stenosing arteriosclerosis also called mal...

BackgroundVideo-laryngoscopy gives an opportunity to objectively document the peri-operative incidence of laryngopharyngeal reflux. Materials and MethodsTo quantify the local real-world incidence of laryngopharyngeal reflux, a single observer observed 100 adult patients undergoing elective video-laryngoscopy for their elective surgical procedures in the operating rooms at a single institution. ResultsLaryngopharynx in 4% of patients demonstrated visible active refluxing of gastroesophageal con...

BackgroundAcute kidney injury (AKI) is a significant complication in pediatric patients undergoing cardiac surgery. Iron metabolism-related indicators such as ferritin may predict AKI after adult cardiac surgery. However, it remains unclear whether ferritin can be used as a predictor of AKI after pediatric cardiac surgery. This study aims to investigate the association between preoperative serum ferritin levels and the risk of AKI in pediatric population. MethodsA prospective observational coho...

Calciphylaxis is a rare cutaneous vascular disease with clinical manifestations of intolerable pains, non-healing skin wounds, histologically characterized by calcification, fibrointimal hyperplasia, and thrombosis in microvessels. Currently, there are no approved guidelines for this disease. High prevalence of thrombophilias and hypercoagulable conditions in calciphylaxis patients have been recognized in recent years. Here, we report a case of uremic calciphylaxis patient whom was refractory to...

This article describes the modified arterial reservoir in detail. The modified arterial reservoir makes explicit the wave nature of both reservoir (Pres) and excess pressure (Pxs). The mathematical derivation and methods for estimating Pres in the absence of flow velocity data are described. There is also discussion of zero-flow pressure (Pzf), the pressure at which flow through the circulation ceases; its relationship to asymptotic pressure (P{infty}) estimated by the reservoir model; and the p...

IntroductionThe pathogenesis of Preeclampsia (PE) remains enigmatic. A new concept of Shrunken Pore Syndrome (SPS) has been proposed, where in there is shrinking of pore size of the glomerulus. The ratio eGFRcystatin C / eGFRcreatinine < 0.6 is considered as SPS. Few studies show that SPS exists in pregnant ladies in the first trimester. A novel biomarker which can predict preeclampsia in the first trimester is the need of the hour. Hence this study was done. MethodCystatin C and creatinine lev...