Electric toy car to reduce anxiety before a cardiac catherisation: randomised controlled trial.

BACKGROUND: Anxiety before an invasive intervention is associated in children with persistent psychological disorders. We studied the effect of the transfer to the catheterisation room by an electric toy car on the anxiety of children and their parents before a cardiac catheterisation. METHODS: Forty-eight children with a median age of 5.6 years [4.2-7.0] were randomised to either riding on an electric car to go to the catheterisation laboratory or being transported lying supine on a gurney. Anxiety assessments were performed by a physician blinded to group allocation on the day before the procedure (T0) and at anaesthesia induction (T1). The modified Yale Preoperative Anxiety Scale Short Form (mYPAS-SF) and visual analogue scale for anxiety (VAS-A) were used in the children and the VAS-A in the parents. RESULTS: The mYPAS-SF, VAS-A-child, and the VAS-A-parent scores were significantly higher at T1 than at T0 (p < 0.001, p < 0.001, and p = 0.005, respectively). The primary outcome (the median mYPAS-SF score at T1) was not significantly different in the two groups when males and females were combined. At T1, the VAS-A-child score, however, was significantly lower in the intervention than the control group (22 versus 55, p < 0.001). In the boys, the median mYPAS-SF score at T1 was significantly lower in the intervention group (25.0 versus 51.0, p = 0.024). No difference was observed in girls. The VAS-A parent score was lower at T1 in the intervention group (60 versus 87, p = 0.05). CONCLUSION: Riding to the catheterisation laboratory on an electric toy car decreased anxiety in boys and decreased parental anxiety.

Should we use diastolic function parameters to determine preload responsiveness in cardiac surgery? A pilot study.

BACKGROUND: Left ventricular (LV) diastolic function (DF) may play an important role in predicting fluid responsiveness. However, few studies assessed the role of diastolic function in predicting fluid responsiveness. The aim of this pilot study was to assess whether parameters of right and left diastolic function assessed with transesophageal echocardiography, including the mitral E/e' ratio, is associated with fluid responsiveness among patients undergoing elective bypass graft surgery. We also sought to compare other methods of fluid responsiveness assessment, including echocardiographic and hemodynamic parameters, pulse pressure variation, and stroke volume variation (SVV) (arterial pulse contour analysis, Flotrac/Vigileo system). RESULTS: We prospectively studied seventy patients undergoing coronary artery bypass grafting (CABG) monitored with a radial arterial catheter, transesophageal echocardiography (TEE), and a pulmonary artery catheter (for cardiac output measurements), before and after the administration of 500 mL of crystalloid over 10 min after the anesthetic induction. Thirteen patients were excluded (total of 57 patients). Fluid responsiveness was defined as an increase in cardiac index of ≥ 15%. There were 21 responders (36.8%) and 36 non-responders (63.2%). No difference in baseline pulsed wave Doppler echocardiographic measurements of any components of the mitral, tricuspid, and pulmonary and hepatic venous flows were found between responders and non-responders. There was no difference in MV tissue Doppler measurements between responders and non-responders, including E/e' ratio (8.7 ± 4.1 vs. 8.5 ± 2.8 in responders vs. non-responders, P = 0.85). SVV was the only independent variable to predict an increase in cardiac index by multivariate analysis (P = 0.0208, OR = 1.196, 95% CI (1.028-1.393)). CONCLUSIONS: In this pilot study, we found that no parameters of right and left ventricular diastolic function were associated with fluid responsiveness in patients undergoing CABG. SVV was the most useful parameter to predict fluid responsiveness. TRIAL REGISTRATION: ClinicalTrials.gov , NCT02714244 . Registered 21 March 2016-retrospectively registered.

[Iatrogenic tracheal stenosis in patients with COPD: a medico-surgical challenge]. / Stenoza traheala iatrogena la pacientul cu BPOC: o provocare medico-chirurgicala.

This study analyzes a series of iatrogenic tracheal stenosis occurring in patients with COPD exacerbation which required oro-tracheal intubation. The tracheal stenosis occurred on average after 24 days of intubation and were clinically severe. Treatment algorithm first included bronchoscopic interventional techniques with an immediate success rate of 37%, but the results were unstable in time, requiring tracheal stenting. The surgical approach, which generally is the first choice in the treatment of tracheal stenosis, had discouraging results in these patients, with a low rate of success (20%) and an increased incidence of restenosis. The only solution for those postoperative complications was, again, interventional bronchoscopy. In conclusion, while for various other etiologies of tracheal stenosis the surgical resection is the first choice of treatment, in COPD patients interventional bronchoscopy often remains the only way of solving.

[Wegener granulomatosis with severe alveolar hemorrhagic syndrome]. / Granulomatoza Wegener cu sindrom de hemoragie alveolara severa.

The article presents the case of a female admitted for the suspicion of pulmonary TB (clinical and radiological pattern compatible with this diagnosis), in which the lack of bacteriological confirmation together with a rapid and dramatic deterioration of clinical, radiological and functional status excluded tuberculosis and oriented the diagnosis towards a severe alveolar hemorrhage; further tests confirmed a Wegener granulomatosis with pulmonary, renal and ORL manifestations. The evolution was rapidly favorable using pulse-therapy with cyclophosphamide and methylprednisolone i.v. The particularities of this case were: the use of helmet device for correction of the extremely severe hypoxemia for 3 weeks (no other studies reported such a long continuous duration of use of this device) and the lag between the pulmonary and the renal impairment.