Prevention of post-spinal anaesthesia hypotension in caesarean delivery using delayed supine positioning - A randomised controlled trial.

Background and Aims: Maternal hypotension is a common and dangerous consequence after a subarachnoid block for a caesarean section. Combining pharmacological methods such as norepinephrine infusion, ondansetron and non-pharmacological methods in delayed supine positioning better impacts the maternal haemodynamic profile. The present study assessed the benefits and adverse effects of combining pharmacological and non-pharmacological methods in hypotension prophylaxis. Methods: This randomised controlled trial was conducted at Cairo University Hospital's obstetric theatre from January to October 2020. The study included 85 parturients who were randomised to two groups. Group Sitting was left seated for 2 min after injection, and Group Control was made to lie down in the supine position immediately after the subarachnoid block. Both groups received prophylactic intravenous norepinephrine infusion, in addition to an ondansetron bolus, before surgery. Patients' systolic blood pressure (SBP) from intrathecal injection until delivery of the foetus, was documented. Results: The Sitting group's SBP (122 (14) mmHg) till delivery was statistically higher than the Control group's readings (114 (10) mmHg) (P = 0.004). The Sitting group's intraoperative SBP values were often greater than the Control group values. In addition, the Sitting group had a reduced hypotension incidence and a lower rate of ephedrine use than the other group, but bradycardia incidence was comparable between both groups. Conclusion: In elective caesarean delivery, combining pharmacological and non-pharmacological methods achieve better results regarding maternal hypotension, vasopressor consumption, nausea and vomiting, and foetal outcomes.

The potential use of ABO blood group system for risk stratification of COVID-19.

ABO blood groups is a cheap and affordable test that can be immediately retrieved from COVID-19 patients at the diagnosis. There is increasing evidence that non-O blood groups have both higher susceptibility and higher severity of COVID-19 infections. The reason behind such relationship seems elusive. Regarding susceptibility, Non-O individuals have Anti-A antibodies which can prevent viral entry across ACE-2 receptors, moreover, Non-O individuals are at higher risk of autoimmunity, hypercoagulable state, and dysbiosis resulting in an augmented tendency for vascular inflammatory sequelae of COVID-19. We can conclude, on the diagnostic level, that ABO blood groups can be potentially used for risk stratification of affected COVID-19 patients, to anticipate the deterioration of patients at higher risk for complications. On a therapeutic level, plasma from normal O blood group individuals might potentially replace the use of convalescent serum for the treatment of COVID-19.

Clinical relevance of early sublingual microcirculation monitoring in septic shock patients.

INTRODUCTION: Although microcirculation dysfunction plays unique role in septic shock, translation of microcirculation to clinical practices is limited by current semi-quantities analysis and unclear clinical relevance of microcirculation monitoring. Our aim was to critically evaluate the characteristic nature and relevant clinical important of microcirculation. EVIDENCE ACQUISITION: Pubmed (2000 to August 2015) were searched to identify observation, case-control, intervention and randomized clinical studies evaluating the relationship between microcirculation alterations and mortality, morbidity and drug responses. The STROBE and CONSORT Statement for assessment of the quality of included studies. EVIDENCE SYNTHESIS: We examined results from 17 observations, 4 randomized controlled trials and one case report published studies. This data set comprised of 637 patients. Early septic shock is associated with hypoperfusion and heterogeneous microcirculation that is associated with hyperlactemia and metabolic acidosis. The evidence on clinical relevance of microcirculation is less striking, mainly due to the limited number of studies and problems related to the methodological protocol of the studies and currently semi-quantitative analysis technique. In particular the baseline and time course of microcirculation alteration appears to be controversial. CONCLUSION: There is lack of evidences of clinical importance of early microcirculation monitoring and mechanism of microcirculation dysfunction in septic shock patients. This could be due to the methodological protocol of the studies and currently semi-quantitative analysis technique.

Preliminary clinical evaluation of automated analysis of the sublingual microcirculation in the assessment of patients with septic shock: Comparison of automated versus semi-automated software.

INTRODUCTION: The outcome of patients in septic shock has been shown to be related to changes within the microcirculation. Modern imaging technologies are available to generate high resolution video recordings of the microcirculation in humans. However, evaluation of the microcirculation is not yet implemented in the routine clinical monitoring of critically ill patients. This is mainly due to large amount of time and user interaction required by the current video analysis software. The aim of this study was to validate a newly developed automated method (CCTools®) for microcirculatory analysis of sublingual capillary perfusion in septic patients in comparison to standard semi-automated software (AVA3®). METHODS: 204 videos from 47 patients were recorded using incident dark field (IDF) imaging. Total vessel density (TVD), proportion of perfused vessels (PPV), perfused vessel density (PVD), microvascular flow index (MFI) and heterogeneity index (HI) were measured using AVA3® and CCTools®. RESULTS: Significant differences between the numeric results obtained by the two different software packages were observed. The values for TVD, PVD and MFI were statistically related though. CONCLUSION: The automated software technique successes to show septic shock induced microcirculation alterations in near real time. However, we found wide degrees of agreement between AVA3® and CCTools® values due to several technical factors that should be considered in the future studies.