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1.
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue ; 33(1): 49-52, 2021 Jan.
Artículo en Chino | MEDLINE | ID: mdl-33565400

RESUMEN

OBJECTIVE: To explore the effect of different tidal volumes (VT) on the hemodynamics of right heart in acute respiratory distress syndrome (ARDS) rats induced by oleic acid (OA). METHODS: Sixty adult male Sprague-Dawley (SD) rats were divided into control group (n = 20), ARDS model group (n = 20), low VT (LVT) group (n = 10) and high VT (HVT) group (n = 10) by random number table. ARDS model was reproduced by injecting OA 0.15 mL/kg through a jugular vein. The control group was given the same amount of normal saline. The success of modeling was judged by the oxygenation index (PaO2/FiO2) 2 hours after modeling, at the same time, the lung tissues were collected, the wet/dry weight (W/D) ratio was determined, and the lung histopathological changes were measured by lung injury score. The rats in the LVT group and HVT group were given mechanical ventilation with VT of 6 mL/kg or 20 mL/kg for 4 hours, respectively at 2 hours after modeling. The rats in the control group and the ARDS model group maintained spontaneous breathing. After mechanical ventilation for 4 hours, the heart rate (HR), right ventricular systolic pressure (RVSP), the maximum rate of rising of right ventricular pressure (dp/dt max), and the blood pressure (BP) were measured. Meanwhile, arterial blood samples were collected for blood gas analysis, including pH value, arterial partial pressure of oxygen (PaO2), arterial partial pressure of carbon dioxide (PaCO2) and PaO2/FiO2. RESULTS: The rats in the ARDS model group showed symptoms of respiratory distress 1 hour after modeling, and the lung tissue samples showed obvious patchy bleeding 2 hours after modeling, while the control group showed no such changes. The PaO2/FiO2 in the ARDS model group was significantly lower than that in the control group [mmHg (1 mmHg = 0.133 kPa): 294.3±5.9 vs. 459.0±4.4, P < 0.01], and the lung W/D ratio and lung injury score were significantly higher (lung W/D ratio: 8.24±0.25 vs. 4.48±0.13, lung injury score: 0.60±0.03 vs. 0.12±0.02, both P < 0.01). It indicated that ARDS model was successfully reproduced. The arterial blood gas analysis and hemodynamic parameters of the ARDS model group were significantly worse than those of the control group. After 4-hour mechanical ventilation, the blood gas parameters of the LVT group were better than those of the ARDS model group and the HVT group [pH value: 7.36±0.02 vs. 7.24±0.02, 7.13±0.01; PaO2 (mmHg): 92.4±2.1 vs. 61.8±2.3, 76.6±2.2; PaCO2 (mmHg): 49.6±1.7 vs. 61.8±1.8, 33.6±1.3; PaO2/FiO2 (mmHg): 440.0±10.2 vs. 274.3±21.4, 364.7±10.5; all P < 0.05]. HR, BP and dp/dt max in the LVT group were significantly higher than those in the ARDS model group and the HVT group [HR (bpm): 346.9±5.4 vs. 302.3±10.1, 265.5±12.2; BP (mmHg): 125.4±2.2 vs. 110.0±2.5, 89.2±2.8; dp/dt max (mmHg/s): 1 393.3±30.3 vs. 1 236.4±20.5, 896.1±19.5; all P < 0.05], and RVSP was significantly lower than that in the ARDS model group and the HVT group (mmHg: 31.3±0.4 vs. 34.0±1.0, 38.8±0.9, both P < 0.05). CONCLUSIONS: Mechanical ventilation with low VT can improve the hemodynamic parameters of the right ventricle and protect the function of the right heart in ARDS rats.


Asunto(s)
Animales , Ventrículos Cardíacos , Hemodinámica , Masculino , Ratas , Ratas Sprague-Dawley , Respiración Artificial/efectos adversos , Volumen de Ventilación Pulmonar
2.
PLoS One ; 16(2): e0246636, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33556081

RESUMEN

BACKGROUND: Data on microcirculatory pattern of COVID-19 critically ill patients are scarce. The objective was to compare sublingual microcirculation parameters of critically ill patients according to the severity of the disease. METHODS: The study is a single-center prospective study with critically ill COVID-19 patients admitted in ICU. Sublingual microcirculation was assessed by IDF microscopy within 48 hours of ICU admission. Microcirculatory flow index (MFI), proportion of perfused vessel (PPV), total vessel density (TVD), De Backer score (DBS), perfused vessel density (PVD) and heterogeneity index (HI) were assessed. Patients were divided in 2 groups (severe and critical) according to the World health organization definition. FINDINGS: From 19th of March to 7th of April 2020, 43 patients were included. Fourteen patients (33%) were in the severe group and twenty-nine patients (67%) in the critical group. Patients in the critical group were all mechanically ventilated. The critical group had significantly higher values of MFI, DBS and PVD in comparison to severe group (respectively, PaCO2: 49 [44-45] vs 36 [33-37] mmHg; p<0,0001, MFI: 2.8 ± 0.2 vs 2.5 ± 0.3; p = 0.001, DBS: 12.7 ± 2.6 vs 10.8 ± 2.0 vessels mm-2; p = 0.033, PVD: 12.5 ± 3.0 vs 10.1 ± 2.4 mm.mm-2; p = 0.020). PPV, HI and TVD were similar between groups Correlation was found between microcirculatory parameters and PaCO2 levels. CONCLUSION: Critical COVID-19 patients under mechanical ventilation seem to have higher red blood cell velocity than severe non-ventilated patients.


Asunto(s)
/fisiopatología , Enfermedad Crítica , Microcirculación/fisiología , Microvasos/fisiopatología , Anciano , Dióxido de Carbono/metabolismo , Femenino , Hemodinámica , Humanos , Unidades de Cuidados Intensivos , Masculino , Persona de Mediana Edad , Oxígeno/metabolismo , Presión Parcial , Estudios Prospectivos , /fisiología
3.
Arq Bras Cardiol ; 116(1): 77-86, 2021 01.
Artículo en Inglés, Portugués | MEDLINE | ID: mdl-33566969

RESUMEN

BACKGROUND: The physical examination enables prognostic evaluation of patients with decompensated heart failure (HF), but lacks reliability and relies on the professional's clinical experience. Considering hemodynamic responses to "fight or flight" situations, such as the moment of admission to the emergency room, we proposed the calculation of the acute hemodynamic index (AHI) from values of heart rate and pulse pressure. OBJECTIVE: To evaluate the in-hospital prognostic ability of AHI in decompensated HF. METHODS: A prospective, multicenter, registry-based observational study including data from the BREATHE registry, with information from public and private hospitals in Brazil. The prognostic ability of the AHI was tested by receiver-operating characteristic (ROC) analyses, C-statistics, Akaike's information criteria, and multivariate regression analyses. p-values < 0.05 were considered statistically significant. RESULTS: We analyzed data from 463 patients with heart failure with low ejection fraction. In-hospital mortality was 9%. The median AHI value was used as cut-off (4 mmHg⋅bpm). A low AHI (≤ 4 mmHg⋅bpm) was found in 80% of deceased patients. The risk of in-hospital mortality in patients with low AHI was 2.5 times that in patients with AHI > 4 mmHg⋅bpm. AHI independently predicted in-hospital mortality in acute decompensated HF (sensitivity: 0.786; specificity: 0.429; AUC: 0.607 [0.540-0.674]; p = 0.010) even after adjusting for comorbidities and medication use [OR: 0.061 (0.007-0.114); p = 0.025). CONCLUSIONS: The AHI independently predicts in-hospital mortality in acute decompensated HF. This simple bed-side index could be useful in an emergency setting. (Arq Bras Cardiol. 2021; 116(1):77-86).


Asunto(s)
Insuficiencia Cardíaca , Brasil , Insuficiencia Cardíaca/diagnóstico , Hemodinámica , Mortalidad Hospitalaria , Humanos , Pronóstico , Estudios Prospectivos , Reproducibilidad de los Resultados
5.
Medicine (Baltimore) ; 100(6): e24666, 2021 Feb 12.
Artículo en Inglés | MEDLINE | ID: mdl-33578597

RESUMEN

BACKGROUND: Cardiopulmonary resuscitation (CPR) performance depends on individual ability and training. Well-trained or professional rescuers can maintain high-quality CPR for longer than laypeople. This study aimed to examine the effects of reducing resting intervals on CPR performance, physiological parameters, and hemodynamic parameters during prolonged CPR in well-trained providers. METHODS: The study enrolled 90 volunteers from the paramedic students of our institution. They were randomly divided into 3 groups: 2 minutes, 1 minute 45 seconds, and 1 minute 30 seconds rest groups. Each participant performed 5 cycles of chest compression only CPR (2 min/cycle) with different resting intervals according to grouping. CPR quality, physiological variations, and hemodynamic variations were measured for each cycle and compared across the groups. RESULTS: Of the 90 volunteers, 79 well-trained providers were finally included. The variation of the average chest compression depth across the 5 cycles showed significant differences between the 3 groups: from cycle 1 to 2: 1.2 (3.1) mm, -0.8 (2.0) mm, and -2.0 (3.0) mm in the 2 minutes, 1 minute 45 seconds, and 1 minute 30 seconds groups, respectively (P < .001); from cycle 1 to 3: 0.0 (3.0) mm, -0.7 (3.2) mm, and -2.6 (3.9) mm, respectively (P = .030). However, all 3 groups maintained the recommended rate and chest compression depth for all 5 cycles. Physiological and hemodynamic parameters showed no significant differences between the groups. CONCLUSIONS: Well-trained providers were able to maintain high-quality CPR despite reducing rest intervals. Adjusting the rest interval may help maintain overall CPR quality in special situations or where layperson rescuers are involved.


Asunto(s)
Reanimación Cardiopulmonar/educación , Hemodinámica/fisiología , Calidad de la Atención de Salud/estadística & datos numéricos , Descanso/fisiología , Técnicos Medios en Salud/educación , Técnicos Medios en Salud/estadística & datos numéricos , Reanimación Cardiopulmonar/estadística & datos numéricos , Oscilación de la Pared Torácica/estadística & datos numéricos , Oscilación de la Pared Torácica/tendencias , Auxiliares de Urgencia/educación , Auxiliares de Urgencia/estadística & datos numéricos , Fatiga , Femenino , Humanos , Masculino , Fenómenos Fisiológicos/fisiología , Estudios Prospectivos , Entrenamiento Simulado/métodos , Estudiantes , Factores de Tiempo , Adulto Joven
7.
Ther Adv Cardiovasc Dis ; 15: 1753944720977741, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33435837

RESUMEN

For decades, plasma arginine vasopressin (AVP) levels have been known to be elevated in patients with congestive heart failure (HF). Excessive AVP signaling at either or both the V1a and V2 receptors could contribute to the pathophysiology of HF by several mechanisms. V1a activation could cause vasoconstriction and/or direct myocardial hypertrophy as intracellular signaling pathways are closely related to those for angiotensin II. V2 activation could cause fluid retention and hyponatremia. A hemodynamic study with the pure V2 antagonist tolvaptan (TV) showed minimal hemodynamic effects. Compared with furosemide in another study, the renal and neurohormonal effects of TV were favorable. Several clinical trials with TV as adjunctive therapy in acute HF have shown beneficial effects on fluid balance and dyspnea, with no worsening of renal function or neurohormonal stimulation. Two smaller studies, one in acute and one in chronic HF, have shown comparable clinical and more favorable renal and neurohormonal effects of TV compared with loop diuretics. However, long-term treatment with TV did not alter outcomes in acute HF. No data are available other than single-dose studies of an intravenous pure V1a antagonist, which showed a vasodilating effect if plasma AVP levels were elevated. One hemodynamic study and one short-duration clinical trial with the balanced intravenous V1a/V2 antagonist conivaptan (CV) showed hemodynamic and clinical effects largely similar to those with TV in similar studies. A new orally effective balanced V1/V2 antagonist (pecavaptan) is currently undergoing phase II study as both adjunctive and alternative therapy during and after hospitalization for acute HF. The purpose of this review is to summarize what we have learned from the clinical experience with TV and CV, and to suggest implications of these findings for future work with newer agents.


Asunto(s)
Antagonistas de los Receptores de Hormonas Antidiuréticas/uso terapéutico , Benzazepinas/uso terapéutico , Insuficiencia Cardíaca/tratamiento farmacológico , Hemodinámica/efectos de los fármacos , Receptores de Vasopresinas/efectos de los fármacos , Tolvaptán/uso terapéutico , Animales , Antagonistas de los Receptores de Hormonas Antidiuréticas/efectos adversos , Benzazepinas/efectos adversos , Ensayos Clínicos como Asunto , Insuficiencia Cardíaca/metabolismo , Insuficiencia Cardíaca/fisiopatología , Humanos , Receptores de Vasopresinas/metabolismo , Transducción de Señal , Tolvaptán/efectos adversos , Resultado del Tratamiento
10.
Int Heart J ; 62(1): 112-118, 2021 Jan 30.
Artículo en Inglés | MEDLINE | ID: mdl-33455987

RESUMEN

Edge-to-edge repair using the MitraClip system is indicated in patients with severe mitral regurgitation (MR) who are at high risk for open-heart surgery due to comorbidity or reduced cardiac function. However, less is known about pre-procedural risk factors for mortality and morbidity following MitraClip implantation. Consecutive 25 patients with severe MR who underwent MitraClip therapy (mean age, 77 years old, 14 males) were included. Right heart catheterization and echocardiographic data before and after the procedure were collected and their prognostic impacts were investigated. Acute procedural success was 96%. At one week following MitraClip repair, left ventricular ejection fraction (LVEF) remained unchanged and left ventricular end-diastolic volume tended to be smaller. Cardiac index and mean pulmonary artery pressure (mPAP) were markedly improved following the procedure (P < 0.001 for both). In the multivariate analyses using baseline characteristics, both lower LVEF (hazard ratio 0.57, 95% confidence interval 0.30-0.89) and higher mPAP (hazard ratio 1.23, 95% confidence interval 1.06-1.56) were independently associated with post-procedural 1-year death or heart failure readmission (P < 0.05 for both). The lower LVEF and higher mPAP group had lower 1-year survival free from HF readmission compared with those without (16.7% versus 100%; P < 0.001). In conclusion, a combination of baseline mPAP and LVEF might be a useful tool in predicting post-MitraClip procedural clinical outcomes.


Asunto(s)
Cateterismo Cardíaco/métodos , Procedimientos Quirúrgicos Cardíacos/métodos , Implantación de Prótesis de Válvulas Cardíacas/instrumentación , Insuficiencia de la Válvula Mitral/cirugía , Anciano , Anciano de 80 o más Años , Procedimientos Quirúrgicos Cardíacos/mortalidad , Ecocardiografía/métodos , Diseño de Equipo/tendencias , Femenino , Insuficiencia Cardíaca/epidemiología , Prótesis Valvulares Cardíacas/efectos adversos , Implantación de Prótesis de Válvulas Cardíacas/mortalidad , Hemodinámica , Humanos , Masculino , Insuficiencia de la Válvula Mitral/fisiopatología , Readmisión del Paciente/estadística & datos numéricos , Pronóstico , Presión Esfenoidal Pulmonar/fisiología , Estudios Retrospectivos , Medición de Riesgo , Índice de Severidad de la Enfermedad , Volumen Sistólico , Resultado del Tratamiento , Función Ventricular Izquierda/fisiología
11.
Int Heart J ; 62(1): 175-177, 2021 Jan 30.
Artículo en Inglés | MEDLINE | ID: mdl-33455991

RESUMEN

Off-pump coronary artery bypass grafting (OPCABG) may be performed on patients with high surgical risk who are poor candidates for traditional mechanical circulatory support. Hemodynamic support with micro-axial mechanical circulatory devices has been performed with limited but promising results.We report a case of a 66-year-old male with multiple comorbidities and low cardiac output undergoing OPCABG. Impella CP device was deployed for "in-pump" support during surgical coronary revascularization resulting in intraoperative stability and uncomplicated post-operative recovery.Previous reports have described the use of the Impella Recover LP 5.0 device for use during OPCABG. We describe the successful and safe perioperative use of the Impella CP device. Despite lower flow rates, adequate support was achieved and the transfemoral cannulation and smaller outer diameter than the Impella 5.0 device may decrease the risk of complications and expedite recovery. Further research will be necessary to determine the optimal perioperative hemodynamic support strategy to offer hemodynamically unstable, high, and prohibitive risk patients.


Asunto(s)
Gasto Cardíaco Bajo/cirugía , Puente de Arteria Coronaria Off-Pump/instrumentación , Corazón Auxiliar/efectos adversos , Anciano , Cateterismo Cardíaco/métodos , Gasto Cardíaco Bajo/diagnóstico , Puente de Arteria Coronaria Off-Pump/métodos , Hemodinámica/fisiología , Humanos , Masculino , Atención Perioperativa/estadística & datos numéricos , Complicaciones Posoperatorias/prevención & control , Factores de Riesgo , Seguridad , Resultado del Tratamiento
12.
Medicine (Baltimore) ; 100(1): e23998, 2021 Jan 08.
Artículo en Inglés | MEDLINE | ID: mdl-33429762

RESUMEN

BACKGROUND: This study aimed to investigate the effects of dexmedetomidine (Dex) on hemodynamics and organ protection in congenital heart disease (CHD) children who underwent open-heart surgery under cryogenic cardiopulmonary bypass. METHODS: Ninety children were randomly allocated to group C (0.9% saline 0.2 µg/kg/hour), group D1 (Dex 0.2 µg/kg/hour), and group D2 (Dex 0.4 µg/kg/hour) (n = 30 per group). All participants received fentanyl, propofol and 1% sevoflurane for anesthesia induction. Hemodynamic data were measured from T0 (before the induction) to T7 (30 minutes after extubation). The difference of arterial internal jugular vein bulbar oxygen difference and cerebral oxygen extraction ratio were calculated according to Fick formula. Enzyme-linked immunosorbent assay was performed to detect the serum myocardial, brain and kidney injury markers. The incidence of acute kidney injury (AKI) was calculated by serum creatinine level. Tracheal extubation time, postoperative pain score and emergence agitation score were also recorded. RESULTS: Compared with group C, group D1, and D2 exhibited reduction in hemodynamic parameters, myocardial and brain injury indicators, and tracheal extubation time. There were no significant differences in blood urea nitrogen and neutrophil gelatinase-associated lipocalin or incidence of AKI among the 3 groups. Besides, the incidence of tachycardia, nausea, vomiting and moderate agitation, and the FLACC scale in group D1 and D2 were lower than those in group C. Moreover, Dex 0.4 g/kg/hour could further reduce the dosage of fentanyl and dopamine compared with Dex 0.2 g/kg/hour. CONCLUSIONS: Dex anesthesia can effectively maintain hemodynamic stability and diminish organ injuries in CHD children.


Asunto(s)
Dexmedetomidina/normas , Defectos de los Tabiques Cardíacos/tratamiento farmacológico , Administración Intravenosa , Agonistas de Receptores Adrenérgicos alfa 2/normas , Agonistas de Receptores Adrenérgicos alfa 2/uso terapéutico , Niño , Preescolar , China , Dexmedetomidina/uso terapéutico , Femenino , Defectos de los Tabiques Cardíacos/fisiopatología , Hemodinámica/efectos de los fármacos , Hemodinámica/fisiología , Humanos , Hipnóticos y Sedantes/normas , Hipnóticos y Sedantes/uso terapéutico , Masculino , Midazolam/uso terapéutico , Atención Perioperativa , Resultado del Tratamiento
14.
J Korean Med Sci ; 36(4): e28, 2021 Jan 25.
Artículo en Inglés | MEDLINE | ID: mdl-33496087

RESUMEN

Hospitalized coronavirus disease 2019 (COVID-19)-infected patients suffer from both physical impairments and mental stress. Respiratory insufficiency and cardiovascular disturbances require most of the intensive care interventions, but they are also accompanied by depressive conditions, sadness and fear of dying. Sedatives are mostly respiratory and cardiovascular depressants and do not provide resistance to the pro-inflammatory burst induced by the virus. Ketamine is a unique and safe drug that enables well-controlled sedation and anesthesia, attenuates depression and mitigates suicidal thoughts, without depressing respiratory or cardiovascular mechanics. This brief communication highlights the benefits potentially provided by ketamine to patients hospitalized for COVID-19 infection.


Asunto(s)
/tratamiento farmacológico , Depresión/tratamiento farmacológico , Ketamina/uso terapéutico , Estrés Psicológico/tratamiento farmacológico , Anestesia , Ansiedad/tratamiento farmacológico , Cuidados Críticos , Depresión/complicaciones , Hemodinámica , Hospitalización , Humanos , Hipnóticos y Sedantes , Sistema Inmunológico , Insuficiencia Respiratoria , Estrés Psicológico/complicaciones , Ideación Suicida , Resultado del Tratamiento
17.
Heart Fail Clin ; 17(1): 135-147, 2021 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-33220882

RESUMEN

In heart failure (HF), the impaired heart loses its ability to competently eject blood during systole or fill with blood during diastole, manifesting in multifaceted abnormal intracardiac or intravascular flow dynamics. Conventional imaging techniques are limited in their ability to evaluate multidirectional multidimensional flow alterations in HF. Four-dimensional (4-D) flow magnetic resonance imaging (MRI) has emerged as a promising technique to comprehensively visualize and quantify changes in 3-dimensional blood flow dynamics in complex cardiovascular diseases. This article reviews emerging applications of 4-D flow MRI hemodynamic markers in HF and etiologies at risk of progressing to HF.


Asunto(s)
Vasos Sanguíneos/diagnóstico por imagen , Insuficiencia Cardíaca/diagnóstico , Hemodinámica/fisiología , Imagen por Resonancia Cinemagnética/métodos , Miocardio/patología , Vasos Sanguíneos/fisiopatología , Insuficiencia Cardíaca/fisiopatología , Humanos , Espectroscopía de Resonancia Magnética
18.
Cardiovasc Pathol ; 50: 107295, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33002584

RESUMEN

Congenital ventricular diverticulum is a rare anomaly with an unclear pathology. Here, we report a male fetus at 24 weeks of gestation, diagnosed with right ventricular diverticulum associated with tetralogy of Fallot and absent pulmonary valve. The diverticulum was located at the anterosuperior wall of the right ventricle and faced into the massive pulmonary regurgitation flow jet. Intrauterine fetal death from heart failure resulted at 26 weeks of gestation. An autopsy revealed significant subendocardial fibrosis in the diverticular wall without inflammatory cell infiltration. Clinical and pathologic features suggested that the regurgitative blood flow contributed to the formation of the right ventricular diverticulum.


Asunto(s)
Divertículo/congénito , Corazón Fetal/anomalías , Ventrículos Cardíacos/anomalías , Hemodinámica , Circulación Pulmonar , Válvula Pulmonar/anomalías , Tetralogía de Fallot/complicaciones , Autopsia , Divertículo/diagnóstico por imagen , Divertículo/fisiopatología , Ecocardiografía Doppler en Color , Resultado Fatal , Muerte Fetal/etiología , Corazón Fetal/diagnóstico por imagen , Corazón Fetal/fisiopatología , Edad Gestacional , Insuficiencia Cardíaca/etiología , Insuficiencia Cardíaca/fisiopatología , Ventrículos Cardíacos/diagnóstico por imagen , Ventrículos Cardíacos/fisiopatología , Humanos , Masculino , Válvula Pulmonar/diagnóstico por imagen , Válvula Pulmonar/fisiopatología , Tetralogía de Fallot/diagnóstico por imagen , Tetralogía de Fallot/fisiopatología , Ultrasonografía Prenatal
19.
Medicine (Baltimore) ; 99(51): e23764, 2020 Dec 18.
Artículo en Inglés | MEDLINE | ID: mdl-33371141

RESUMEN

ABSTRACT: Passive leg raising (PLR) is a convenient and reliable test to predict fluid responsiveness. The ability of thoracic electrical bioimpedance cardiography (TEB) to monitor changes of cardiac output (CO) during PLR is unknown.In the present study, we measured CO in 61 patients with shock or dyspnea by TEB and transthoracic echocardiography (TTE) during PLR procedure. Positive PLR responsiveness was defined as the velocity-time integral (VTI) ≥10% after PLR. TTE measured VTI in the left ventricular output tract. The predictive value of TEB parameters in PLR responders was tested. Furthermore, the agreement of absolute CO values between TEB and TTE measurements was assessed.Among the 61 patients, there were 28 PLR-responders and 33 non-responders. Twenty-seven patients were diagnosed with shock and 34 patients with dyspnea, with 55.6% (15/27) and 54.6% (18/34) non-responders, respectively. A change in TEB measured CO (ΔCO) ≥9.8% predicted PLR responders with 75.0% sensitivity and 78.8% specificity, the area under the receiver operating characteristic curve (AUROC) was 0.79. The Δd2Z/dt2 (a secondary derivative of the impedance wave) showed the best predictive value with AUROC of 0.90, the optimal cut point was -7.1% with 85.7% sensitivity and 87.9% specificity. Bias between TEB and TTE measured CO was 0.12 L/min, and the percentage error was 65.8%.TEB parameters had promising performance in predicting PLR responders, and the Δd2Z/dt2 had the best predictive value. The CO values measured by TEB were not interchangeable with TTE in critically ill settings.


Asunto(s)
Gasto Cardíaco/fisiología , Cardiografía de Impedancia/instrumentación , Hemodinámica/fisiología , Adulto , Anciano , Área Bajo la Curva , Cardiografía de Impedancia/métodos , China , Enfermedad Crítica , Ecocardiografía/métodos , Femenino , Humanos , Unidades de Cuidados Intensivos/organización & administración , Unidades de Cuidados Intensivos/tendencias , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Curva ROC , Estadísticas no Paramétricas
20.
Isr Med Assoc J ; 22(12): 752-756, 2020 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-33381946

RESUMEN

BACKGROUND: Chronic thromboembolic pulmonary hypertension (CTEPH) is a rare, distinct pulmonary vascular disease caused by chronic obstruction of major pulmonary arteries, which can be cured by pulmonary endarterectomy. However, many CTEPH patients are not surgical candidates. Balloon pulmonary angioplasty (BPA) is an emerging technique used to treat inoperable CTEPH. OBJECTIVES: To describe the first Israeli experience with BPA for inoperable CTEPH. METHODS: In 2017 we established a BPA program at our institution. We reviewed the outcomes to date of BPA in our center. RESULTS: Forty-seven BPA procedures were performed in five patients with inoperable CTEPH (4-17 procedures/patient). Mean pulmonary artery pressure improved in all patients (median decrease 17 mmHg, range 10-26 mmHg). Pulmonary vascular resistance also improved (median decrease 11 Woods Units/m2, range 8-16 Woods Units/m2). Cardiac output increased in 4 of 5 patients and decreased in one. Functional capacity improved from New York Heart Association (NYHA) III to II in four patients; one patient was NYHA II at baseline without change after BPA. Six-minute walking distance improved by a median of 97 meters. (range 21-197 meters). Hemodynamic and functional improvements were sustained at follow-up 5-11 months after the last BPA procedure. BPA enabled 2 of 3 patients treated with parenteral prostanoids to be switched to oral therapy. There were no major complications. CONCLUSIONS: We successfully established BPA as a treatment for inoperable CTEPH in our center. BPA resulted in hemodynamic and clinical improvements that were sustained over time.


Asunto(s)
Angioplastia de Balón , Hipertensión Pulmonar/terapia , Embolia Pulmonar/terapia , Adulto , Angioplastia de Balón/métodos , Femenino , Hemodinámica , Humanos , Hipertensión Pulmonar/etiología , Masculino , Persona de Mediana Edad , Arteria Pulmonar , Embolia Pulmonar/complicaciones , Estudios Retrospectivos
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