Endotoxemia Correlates with Kidney Function and Length of Stay in Critically Ill Patients.

INTRODUCTION: Endotoxin is a key driver of sepsis, which frequently causes acute kidney injury (AKI). However, endotoxins may also be found in non-bacteremic critically ill patients, likely from intestinal translocation. Preclinical models show that endotoxins can directly injure the kidneys, and in COVID-19 patients, endotoxemia correlated with AKI. We sought to determine correlations between endotoxemia and kidney and hospital outcomes in a broad group of critically ill patients. METHODS: In this single-center, serial prospective study, 124 predominantly Caucasian adult patients were recruited within 48 h of admission to Stony Brook University Hospital Intensive Care Unit (ICU). Demographics, vital signs, laboratory data, and outcomes were collected. Circulating endotoxin was measured on days 1, 4, and 8 using the endotoxin activity assay (EAA). The association of EAA with outcomes was examined with EAA: (1) categorized as <0.6, ≥0.6, and nonresponders (NRs); and (2) used as a continuous variable. RESULTS: Patients with EAA ≥0.6 had a higher prevalence of proteinuria, and lower arterial oxygen saturation (SaO2) to fraction of inspired oxygen (FiO2) (SaO2/FiO2) ratio versus patients with EAA <0.6. EAA levels positively correlated with serum creatinine (sCr) levels on day 1. Patients whose EAA level stayed ≥0.6 had a slower decline in sCr compared to those whose EAA started at ≥0.6 and subsequently declined. Patients with AKI stage 1 and EAA ≥0.6 on day 1 showed slower decline in sCr compared to patients with stage 1 AKI and EAA <0.6. EAA ≥0.6 and NR patients had longer hospital stay and delayed ICU discharge versus EAA <0.6. CONCLUSIONS: High EAA levels correlated with worse kidney function and outcomes. Patients whose EAA levels fell, and those with AKI stage I and day 1 EAA <0.6 recovered more quickly compared to those with EAA ≥0.6, suggesting that removal of circulating endotoxins may be beneficial in critically ill patients.

Clinical features and outcome of dogs and cats with gastrointestinal pneumatosis: 30 cases (2010-2021).

OBJECTIVES: To describe the presentation, etiology, and outcome of dogs and cats diagnosed with gastrointestinal pneumatosis (GP). DESIGN: Retrospective study. SETTING: Three referral institutions. ANIMALS: Twenty-six dogs and 4 cats. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The most common sites of GP were the stomach (n = 19), followed by the colon (n = 8) and small intestine (n = 2). One case had pneumatosis of both the stomach and the colon. GP was most commonly associated with gastrointestinal disease in dogs (18/26 [69%]) and cats (3/4 [75%]), with common diagnoses including gastric dilatation and volvulus (n = 5), acute hemorrhagic diarrhea syndrome (n = 4), and gastrointestinal ulceration (n = 4). Of the 4 cases of gastrointestinal ulceration, 3 were dogs with a history of glucocorticosteroid or nonsteroidal anti-inflammatory drug administration and vomiting and diarrhea. Six of 30 cases (20%), all of which were dogs, were determined to have a surgical indication for exploratory celiotomy, although not solely on the basis of diagnosis of GP. Five cases underwent exploratory celiotomy, of which 1 (20%) survived to hospital discharge. Of the medically managed cases, 13 of 24 (54%) survived to hospital discharge. Overall, 14 of 30 cases (47%) survived to hospital discharge. CONCLUSIONS: GP is an uncommon diagnostic imaging finding that is associated with a variety of disease processes. Its development is often related to primary gastrointestinal diseases. In the absence of other surgical disease, exploratory celiotomy based solely on the diagnosis of GP is unlikely to be indicated.

Anesthetic management and anesthesia-related complications in dogs with a dilated cardiomyopathy phenotype: a retrospective study of 30 dogs (2010-2024).

OBJECTIVE: To describe perioperative anesthetic management in canines with a dilated cardiomyopathy (DCM) phenotype and to compare the frequency of general anesthesia-related complications with a control group of dogs without heart disease. ANIMALS: 30 dogs with DCM phenotype (cases) and 30 dogs without heart disease (controls). METHODS: Dogs presented to a teaching hospital between 2010 and 2024 that were diagnosed with a DCM phenotype via echocardiography were included in this study. Controls were dogs that presented during the same time period and were matched with cases based on their age, breed, and type of procedure; however, no standardization of treatment between the groups was performed. Medical records were reviewed to evaluate the occurrence of anesthetic complications. RESULTS: Of dogs with a DCM phenotype, 2 had overt DCM, 22 had occult DCM, and 6 had equivocal DCM. Dogs with DCM exhibited a lower likelihood of being premedicated with dexmedetomidine or induced with propofol. Conversely, DCM dogs were more likely to be induced with etomidate or midazolam compared to their counterparts without DCM. Dogs with DCM demonstrated an increased likelihood of experiencing cardiac arrhythmias during anesthesia, received comparatively lower volumes of IV fluids, and were more likely to be administered dobutamine during anesthesia. No significant differences were identified in terms of postanesthesia complications or survival rates to discharge. CLINICAL RELEVANCE: Dogs with a DCM phenotype, primarily characterized by asymptomatic presentation, demonstrated comparable perioperative outcomes under general anesthesia when compared to matched controls, though the lack of standardization in anesthetic management limits definitive conclusions.

Assessment protocol and reference values of vestibulo-ocular reflex (VOR) gain in the horizontal plane recorded with video-Head Impulse Test (vHIT) in a pediatric population. / Protocolo de evaluación y valores de referencia de la ganancia del reflejo vestíbulo-ocular (RVO) en el plano horizontal registrado mediante el video-Head Impulse Test (v-HIT) en población pediátrica.

PURPOSE: To develop an assessment protocol and establish reference values of vestibulo-ocular reflex gain of the horizontal semicircular canal obtained with vHIT in a pediatric population without vestibular changes. METHODS: Quantitative, non-experimental, analytical study with a non-probabilistic convenience sample. A total of 39 subjects aged 5 to 17 years were selected based on the inclusion and exclusion criteria. RESULTS: The mean gain obtained of the horizontal right semicircular canal was 0.93 and of the left one, 1.08, with statistically significant differences between the ears. There were no statistically significant differences between the 5-to-10-year and 11-to-17-year subgroups. CONCLUSION: The vestibulo-ocular reflex gain in children neared the values found in the international scientific literature and the adult population. The protocol developed can guide beginning professionals in the otoneurological evaluation of children.

OBJETIVO: Elaborar un protocolo de evaluación y establecer valores de referencia de las ganancias del reflejo vestíbulo-ocular del canal semicircular horizontal obtenidas con el v-HIT en población pediátrica sin alteraciones vestibulares. MÉTODO: Estudio cuantitativo, analítico, no experimental con muestreo no probabilístico por conveniencia. Se seleccionaron 39 sujetos entre 5 a 17 años, los cuales cumplieron los criterios de inclusión y exclusión. RESULTADOS: El promedio de la ganancia obtenida para el conducto semicircular horizontal derecho fue de 0,93 y para el conducto semicircular izquierdo fue de 1,08. Existen diferencias estadísticamente significativas entre oídos. No existen diferencias estadísticamente significativas entre los subgrupos de 5 a 10 años y 11 a 17 años. CONCLUSIÓN: La ganancia del reflejo vestíbulo-ocular en población pediátrica se acerca a los valores encontrados en la literatura científica internacional y de la población adulta. El protocolo confeccionado puede orientar a profesionales que están comenzando en la evaluación otoneurológica de esta población.

Protocolo de evaluación y valores de referencia de la ganancia del reflejo vestíbulo-ocular (RVO) en el plano horizontal registrado mediante el video-Head Impulse Test (v-HIT) en población pediátrica / Assessment protocol and reference values of vestibulo-ocular reflex (VOR) gain in the horizontal plane recorded with video-Head Impulse Test (vHIT) in a pediatric population

RESUMEN Objetivo Elaborar un protocolo de evaluación y establecer valores de referencia de las ganancias del reflejo vestíbulo-ocular del canal semicircular horizontal obtenidas con el v-HIT en población pediátrica sin alteraciones vestibulares. Método Estudio cuantitativo, analítico, no experimental con muestreo no probabilístico por conveniencia. Se seleccionaron 39 sujetos entre 5 a 17 años, los cuales cumplieron los criterios de inclusión y exclusión. Resultados El promedio de la ganancia obtenida para el conducto semicircular horizontal derecho fue de 0,93 y para el conducto semicircular izquierdo fue de 1,08. Existen diferencias estadísticamente significativas entre oídos. No existen diferencias estadísticamente significativas entre los subgrupos de 5 a 10 años y 11 a 17 años. Conclusión La ganancia del reflejo vestíbulo-ocular en población pediátrica se acerca a los valores encontrados en la literatura científica internacional y de la población adulta. El protocolo confeccionado puede orientar a profesionales que están comenzando en la evaluación otoneurológica de esta población.

ABSTRACT Purpose To develop an assessment protocol and establish reference values of vestibulo-ocular reflex gain of the horizontal semicircular canal obtained with vHIT in a pediatric population without vestibular changes. Methods Quantitative, non-experimental, analytical study with a non-probabilistic convenience sample. A total of 39 subjects aged 5 to 17 years were selected based on the inclusion and exclusion criteria. Results The mean gain obtained of the horizontal right semicircular canal was 0.93 and of the left one, 1.08, with statistically significant differences between the ears. There were no statistically significant differences between the 5-to-10-year and 11-to-17-year subgroups. Conclusion The vestibulo-ocular reflex gain in children neared the values found in the international scientific literature and the adult population. The protocol developed can guide beginning professionals in the otoneurological evaluation of children.