The Incidence of Perioperative Hypotension in Patients Undergoing Major Abdominal Surgery with the Use of Arterial Waveform Analysis and the Hypotension Prediction Index Hemodynamic Monitoring-A Retrospective Analysis.

Intraoperative hypotension (IH) is common in patients receiving general anesthesia and can lead to serious complications such as kidney failure, myocardial injury and increased mortality. The Hypotension Prediction Index (HPI) algorithm is a machine learning system that analyzes the arterial pressure waveform and alerts the clinician of an impending hypotension event. The purpose of the study was to compare the frequency of perioperative hypotension in patients undergoing major abdominal surgery with different types of hemodynamic monitoring. The study included 61 patients who were monitored with the arterial pressure-based cardiac output (APCO) technology (FloTrac group) and 62 patients with the Hypotension Prediction Index algorithm (HPI group). Our primary outcome was the time-weighted average (TWA) of hypotension below < 65 mmHg. The median TWA of hypotension in the FloTrac group was 0.31 mmHg versus 0.09 mmHg in the HPI group (p = 0.000009). In the FloTrac group, the average time of hypotension was 27.9 min vs. 8.1 min in the HPI group (p = 0.000023). By applying the HPI algorithm in addition to an arterial waveform analysis alone, we were able to significantly decrease the frequency and duration of perioperative hypotension events in patients who underwent major abdominal surgery.

Cerebral Perfusion Pressure-Guided Therapy in Patients with Subarachnoid Haemorrhage-A Retrospective Analysis.

BACKGROUND: Prevention and treatment of haemodynamic instability and increased intracranial pressure (ICP) in patients with subarachnoid haemorrhage (SAH) is vital. This study aimed to evaluate the effects of protocolised cerebral perfusion pressure (CPP)-guided treatment on morbidity and functional outcome in patients admitted to the intensive care unit (ICU) with SAH. METHODS: We performed a retrospective study comparing 37 patients who received standard haemodynamic treatment (control group) with 17 individuals (CPP-guided group) who were on the CPP-guided treatment aimed at maintaining CPP > 70 mmHg using both optimisations of ICP and mean arterial pressure (MAP). RESULTS: MAP, cumulative crystalloid doses and fluid balance were similar in both groups. However, the incidence of delayed cerebral ischaemia was significantly lower in the CPP-guided group (14% vs. 64%, p < 0.01), and functional outcome as assessed by the Glasgow Outcome Scale at 30 days after SAH was improved (29.0% vs. 5.5%, p = 0.03). CONCLUSIONS: This preliminary analysis showed that implementing a CPP-guided treatment approach aimed at maintaining a CPP > 70 mmHg may reduce the occurrence of delayed cerebral ischaemia and improve functional outcomes in patients with SAH. This observation merits further prospective investigation of the use of CPP-guided treatment in patients with SAH.

Intraoperative Hypotension Prediction-A Proactive Perioperative Hemodynamic Management-A Literature Review.

Intraoperative hypotension (IH) is a frequent phenomenon affecting a substantial number of patients undergoing general anesthesia. The occurrence of IH is related to significant perioperative complications, including kidney failure, myocardial injury, and even increased mortality. Despite advanced hemodynamic monitoring and protocols utilizing goal directed therapy, our management is still reactive; we intervene when the episode of hypotension has already occurred. This literature review evaluated the Hypotension Prediction Index (HPI), which is designed to predict and reduce the incidence of IH. The HPI algorithm is based on a machine learning algorithm that analyzes the arterial pressure waveform as an input and the occurrence of hypotension with MAP <65 mmHg for at least 1 min as an output. There are several studies, both retrospective and prospective, showing a significant reduction in IH episodes with the use of the HPI algorithm. However, the level of evidence on the use of HPI remains very low, and further studies are needed to show the benefits of this algorithm on perioperative outcomes.

[Application of microscopic MR for evaluation of cartilage repair]. / Zastosowanie mikrorezonansu magnetycznego w ocenie doswiadczalnej regeneracji chrzastki stawowej.

Magnetic resonance imaging is gold standard for noninvasive evaluation of articular cartilage damage and has been also used for monitoring cartilage repair. The aim of this study was to find correlation between histological microscopy and microscopic MR in evaluation of the repair of osteochondral defects in articular cartilage. Study was based animal model (rabbit). The cartilage repair process was evaluated histology and micro MR. Most of the defects were filled with fibrocartilage and fibrous tissue formed. Both methods were equally efficient to show repair tissue thickness, subchondral bone reconstruction and disintegration. Result of observation by both histological and MR microscopy and showed good correlation. Micro MR is promising evaluation tool for cartilage repair monitoring. Results of micro MR correlate well with standard microscopy.

[Value of collagen scaffolds in surgical reconstruction of articular cartilage]. / Ocena wartosci matryc kolagenowych w operacyjnej rekonstrukcji chrzastki stawowej.

Articular cartilage has a very limited capacity for regeneration and the untreated injuries of this tissue may lead to osteoarthritis. The aim of this study was to evaluate the application of collagen scaffolds in surgical reconstruction of articular cartilage. A group of 28 rabbits was used in the study. A defect penetrating into the subchondral bone was made. The animals were divided into 2 groups: group 1- defects filled with collagen scaffold, group II the defects remained empty. The results were evaluated at 4 a 12 weeks. Macroscopic and microscopic evaluation was performed. On gross examination of the group I complete filling of the defect with regenerated tissue was observed. This tissue had smooth surface and was completely integrated with the surrounding cartilage. In the group II the surface of the newly formed tissue showed large irregularities. The defect was partially filled and incompletely integrated with the residual cartilage. Microscopic results indicate presence of hyaline-like cartilage resembling normal articular cartilage in group I. Regenerate was more stable and remained stable with longer follow-up. Group II revealed mostly fibrous tissue in regenerate. Thickness was inadequate with visible surface irregularities and loss in tissue integrity. This study proved better results of reconstruction of articular cartilage by means of biodegradable scaffold.