Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 181
Filtrar
1.
Crit Care ; 23(1): 389, 2019 Dec 02.
Artigo em Inglês | MEDLINE | ID: mdl-31791373

RESUMO

BACKGROUND: Intradialytic hypotension, a complication of intermittent hemodialysis, decreases the efficacy of dialysis and increases long-term mortality. This study was aimed to determine whether different predialysis ultrasound cardiopulmonary profiles could predict intradialytic hypotension. METHODS: This prospective observational single-center study was performed in 248 critically ill patients with acute kidney injury undergoing intermittent hemodialysis. Immediately before hemodialysis, vena cava collapsibility was measured by vena cava ultrasound and pulmonary congestion by lung ultrasound. Factors predicting intradialytic hypotension were identified by multiple logistic regression analysis. RESULTS: Intradialytic hypotension was observed in 31.9% (n = 79) of the patients, interruption of dialysis because of intradialytic hypotension occurred in 6.8% (n = 31) of the sessions, and overall 28-day mortality was 20.1% (n = 50). Patients were classified in four ultrasound profiles: (A) 108 with B lines > 14 and vena cava collapsibility > 11.5 mm m-2, (B) 38 with B lines < 14 and vena cava collapsibility ≤ 11.5 mm m-2, (C) 36 with B lines > 14 and vena cava collapsibility Di ≤ 11.5 mm m-2, and (D) 66 with B lines < 14 and vena cava collapsibility > 11.5 mm m-2. There was an increased risk of intradialytic hypotension in patients receiving norepinephrine (odds ratios = 15, p = 0.001) and with profiles B (odds ratios = 12, p = 0.001) and C (odds ratios = 17, p = 0.001). CONCLUSION: In critically ill patients on intermittent hemodialysis, the absence of hypervolemia as assessed by lung and vena cava ultrasound predisposes to intradialytic hypotension and suggests alternative techniques of hemodialysis to provide better hemodynamic stability.


Assuntos
Diálise/efeitos adversos , Hipotensão/etiologia , Ultrassonografia/classificação , APACHE , Lesão Renal Aguda/terapia , Idoso , Diálise/métodos , Feminino , Humanos , Hipotensão/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Escores de Disfunção Orgânica , Estudos Prospectivos , Estatísticas não Paramétricas , Ultrassonografia/métodos
2.
PLoS One ; 14(3): e0214087, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30893383

RESUMO

Pediatric myocarditis symptoms can be mild or as extreme as sudden cardiac arrest. Early identification of the severity of illness and timely provision of critical care is helpful; however, the risk factors associated with mortality remain unclear and controversial. We undertook a retrospective review of the medical records of pediatric patients with myocarditis in a tertiary care referral hospital for over 12 years to identify the predictive factors of mortality. Demographics, presentation, laboratory test results, echocardiography findings, and treatment outcomes were obtained. Regression analyses revealed the clinical parameters for predicting mortality. During the 12-year period, 94 patients with myocarditis were included. Of these, 16 (17%) patients died, with 12 succumbing in the first 72 hours after admission. Fatal cases more commonly presented with arrhythmia, hypotension, acidosis, gastrointestinal symptoms, decreased left ventricular ejection fraction, and elevated isoenzyme of creatine kinase and troponin I levels than nonfatal cases. In multivariate analysis, troponin I > 45 ng/mL and left ventricular ejection fraction < 42% were significantly associated with mortality. Pediatric myocarditis had a high mortality rate, much of which was concentrated in the first 72 hours after hospitalization. Children with very high troponin levels or reduced ejection fraction in the first 24 hours were at higher risk of mortality, and targeting these individuals for more intensive therapies may be warranted.


Assuntos
Ecocardiografia , Mortalidade Hospitalar , Miocardite/diagnóstico por imagem , Miocardite/mortalidade , Adolescente , Arritmias Cardíacas/diagnóstico por imagem , Arritmias Cardíacas/etiologia , Arritmias Cardíacas/mortalidade , Criança , Pré-Escolar , Feminino , Gastroenteropatias/diagnóstico por imagem , Gastroenteropatias/etiologia , Gastroenteropatias/mortalidade , Hospitalização , Humanos , Hipotensão/diagnóstico por imagem , Hipotensão/etiologia , Hipotensão/mortalidade , Masculino , Miocardite/complicações , Estudos Retrospectivos , Centros de Atenção Terciária , Fatores de Tempo
3.
Psychophysiology ; 56(3): e13305, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30456801

RESUMO

In addition to symptoms including fatigue, dizziness, reduced drive, or mood disturbance, individuals with chronic low blood pressure (hypotension) frequently report cognitive complaints. While attentional deficits have been empirically confirmed, it is still unknown whether the impairments also encompass executive functions. This study investigated cerebral blood flow modulations in hypotension during a precued antisaccade/prosaccade task requiring the executive function of proactive inhibition in addition to preparatory attention. Using functional transcranial Doppler sonography, bilateral blood flow velocities in the middle cerebral arteries (MCA) were recorded in 39 hypotensive and 40 normotensive participants. In the task, a stimulus appeared left or right of a fixation point 5 s after a cuing stimulus; subjects had to move their gaze to the mirror image position of the stimulus (antisaccade) or toward it (prosaccade control condition). Video-based eye tracking was used for ocular recording. A right dominant MCA blood flow increase arose during task preparation, which was smaller in hypotensive than normotensive participants. In addition, hypotensive participants exhibited lower peak velocity of the saccadic response. The extent of the reductions in blood flow and task performance in hypotension did not differ between antisaccade and prosaccade conditions. The smaller MCA flow increase may reflect reduced activity in the dorsolateral prefrontal and inferior parietal cortices during proactive inhibition and preparatory attention in hypotension. Given that group differences in blood flow and performance arose independent of task complexity and executive function load, hypotension may be characterized by basic attentional impairments rather than particular executive function deficits.


Assuntos
Atenção/fisiologia , Encéfalo/fisiopatologia , Circulação Cerebrovascular/fisiologia , Disfunção Cognitiva/fisiopatologia , Função Executiva/fisiologia , Hipotensão/fisiopatologia , Artéria Cerebral Média/fisiopatologia , Inibição Proativa , Desempenho Psicomotor/fisiologia , Movimentos Sacádicos/fisiologia , Adulto , Encéfalo/irrigação sanguínea , Encéfalo/diagnóstico por imagem , Doença Crônica , Disfunção Cognitiva/diagnóstico por imagem , Disfunção Cognitiva/etiologia , Medições dos Movimentos Oculares , Feminino , Neuroimagem Funcional , Humanos , Hipotensão/complicações , Hipotensão/diagnóstico por imagem , Masculino , Artéria Cerebral Média/diagnóstico por imagem , Ultrassonografia Doppler Transcraniana , Adulto Jovem
4.
Transl Stroke Res ; 10(1): 52-56, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-29766451

RESUMO

Early hemolysis occurs in the hematoma within 24 h in rat model of intracerebral hemorrhage (ICH). The present study investigated the prevalence of early hemolysis in ICH patients using MRI and the relationship between early hemolysis and perihematomal edema. Thirty ICH patients were prospectively enrolled within 24 h of onset. All patients had cranial CT on admission. Cranial MRI with T2 FLAIR-weighted imaging and T2*-weighted imaging were undertaken at days 1 and 14. The evolution of a non-hypointense lesion on T2*-weighted images and the relationship between the volume of that non-hypointense lesion and perihematomal edema volume were investigated. MRI images of 15 patients were analyzed. The median hematoma volume was 16.3 ml on admission. All patients underwent a baseline MRI within 24 h of ICH onset and showed a non-hypointense lesion within the hematoma on T2*-weighted images. The volume of non-hypointense lesion on T2*-weighted image was 6.0 (8.9) ml at day 1 and 8.6 (17.3) ml at day 14. The absolute perihematomal edema volume was 16.0 (17.9) ml and 24.8 (27.5) ml at days 1 and 14, respectively. There was a linear correlation between non-hypointense T2* lesion and perihematomal edema volume at day 1 and day 14 (p < 0.01). Early hemolysis in the hematoma occurs in humans and contributes to the development of perihematomal edema.


Assuntos
Hemorragia Cerebral/diagnóstico por imagem , Hemorragia Cerebral/fisiopatologia , Hemólise/fisiologia , Imagem por Ressonância Magnética , Idoso , Feminino , Seguimentos , Humanos , Hipertensão/diagnóstico por imagem , Hipertensão/fisiopatologia , Hipotensão/diagnóstico por imagem , Hipotensão/fisiopatologia , Processamento de Imagem Assistida por Computador , Masculino , Pessoa de Meia-Idade
5.
Medicina (Kaunas) ; 54(3)2018 Jul 12.
Artigo em Inglês | MEDLINE | ID: mdl-30344280

RESUMO

Background and objective: Hypotension and bradycardia are the most common hemodynamic disorders and side effects of spinal anesthesia (SA) on the cardiovascular system. SA-induced sympathetic denervation causes peripheral vasodilatation and redistribution of central blood volume that may lead to decreased venous return to the heart. The aim of the study was to evaluate the changes of inferior vena cava collapsibility index (IVC-CI) during SA in spontaneously breathing patients during elective knee joint replacement surgery to prognose manifestation of intraoperative hypotension and bradycardia. Materials and methods: 60 patients (American Society of Anesthesiologists (ASA) physical status I or II, no clinically significant cardiovascular pathology) of both sexes undergoing elective knee joint replacement surgery under SA were included in the prospective study. Inspiratory and expiratory inferior vena cava (IVCin, IVCex) diameters were measured using an ultrasound device in supine position before and immediately after SA, then 15 min, 30 min, and 45 min after SA was performed. The heart rate, along with systolic, diastolic, and mean arterial blood pressures were collected. The parameters were measured at the baseline and at the next four time points. Results: There were no significant changes in IVCin, IVCex, and IVC-CI compared to baseline and other time point measurements in hypotensive versus nonhypotensive and bradycardic versus nonbradycardic patients (p > 0.05). Changes in IVC diameter do not prognose hypotension and/or bradycardia during SA: the area under the curve (AUC) of the receiver operating characteristic (ROC) curve for IVC-CI at all measuring points was <0.7, p > 0.05. Conclusions: Reduction in IVC diameters and increase in IVC-CI do not predict hypotension and bradycardia during SA in spontaneously breathing patients undergoing elective knee joint replacement surgery.


Assuntos
Raquianestesia/efeitos adversos , Bradicardia/diagnóstico por imagem , Hipotensão/diagnóstico por imagem , Complicações Intraoperatórias/diagnóstico por imagem , Ultrassonografia/estatística & dados numéricos , Idoso , Artroplastia do Joelho/efeitos adversos , Bradicardia/induzido quimicamente , Procedimentos Cirúrgicos Eletivos/efeitos adversos , Feminino , Humanos , Hipotensão/induzido quimicamente , Complicações Intraoperatórias/induzido quimicamente , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Prospectivos , Curva ROC , Ultrassonografia/métodos , Veia Cava Inferior/diagnóstico por imagem
6.
Pediatr Res ; 84(Suppl 1): 1-12, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-30072808

RESUMO

Cardiac ultrasound techniques are increasingly used in the neonatal intensive care unit to guide cardiorespiratory care of the sick newborn. This is the first in a series of eight review articles discussing the current status of "neonatologist-performed echocardiography" (NPE). The aim of this introductory review is to discuss four key elements of NPE. Indications for scanning are summarized to give the neonatologist with echocardiography skills a clear scope of practice. The fundamental physics of ultrasound are explained to allow for image optimization and avoid erroneous conclusions from artifacts. To ensure patient safety during echocardiography recommendations are given to prevent cardiorespiratory instability, hypothermia, infection, and skin lesions. A structured approach to echocardiography, with the same standard views acquired in the same sequence at each scan, is suggested in order to ensure that the neonatologist confirms normal structural anatomy or acquires the necessary images for a pediatric cardiologist to do so when reviewing the scan.


Assuntos
Ecocardiografia/métodos , Doenças do Recém-Nascido/diagnóstico por imagem , Neonatologia/métodos , Artefatos , Cateterismo Venoso Central , Permeabilidade do Canal Arterial/diagnóstico por imagem , Desenho de Equipamento , Hemodinâmica , Humanos , Hipotensão/diagnóstico por imagem , Processamento de Imagem Assistida por Computador , Recém-Nascido , Recém-Nascido Prematuro , Unidades de Terapia Intensiva Neonatal , Neonatologistas , Segurança do Paciente , Derrame Pericárdico/diagnóstico por imagem , Síndrome da Persistência do Padrão de Circulação Fetal/diagnóstico por imagem , Choque/diagnóstico por imagem
7.
Am J Emerg Med ; 36(10): 1923.e5-1923.e7, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-30029817

RESUMO

BACKGROUND: We present a case of intracardiac rhabdomyosarcoma associated with cardiopulmonary instability which was diagnosed by emergency providers using point-of-care echocardiography. CASE REPORT: A previously healthy 49-year-old man presented to the Emergency Department with progressive dyspnea and hypotension. Emergency providers identified a left atrial mass using point-of-care ultrasound. Expedited advanced imaging and surgical management showed a malignant cardiac rhabdomyosarcoma. Why should an emergency physician be aware of this? This case report highlights the utility of point-of-care ultrasound in the work-up of patients with undifferentiated dyspnea and hypotension, even in cases of rare diagnoses. Early diagnosis and management of both benign and malignant intracardiac tumors is essential to preoperative planning and patient prognosis. Ultrasound findings consistent with intracardiac masses should be recognized and used to guide further consultation, advanced imaging, and treatment.


Assuntos
Ecocardiografia , Átrios do Coração/patologia , Neoplasias Cardíacas/diagnóstico por imagem , Sistemas Automatizados de Assistência Junto ao Leito , Rabdomiossarcoma/diagnóstico por imagem , Procedimentos Cirúrgicos Cardíacos , Dispneia/diagnóstico por imagem , Dispneia/etiologia , Serviço Hospitalar de Emergência , Átrios do Coração/cirurgia , Neoplasias Cardíacas/patologia , Neoplasias Cardíacas/cirurgia , Humanos , Hipotensão/diagnóstico por imagem , Hipotensão/etiologia , Masculino , Pessoa de Meia-Idade , Rabdomiossarcoma/patologia , Rabdomiossarcoma/cirurgia , Resultado do Tratamento , Ultrassonografia
10.
Ann Emerg Med ; 72(4): 478-489, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-29866583

RESUMO

STUDY OBJECTIVE: Point-of-care ultrasonography protocols are commonly used in the initial management of patients with undifferentiated hypotension in the emergency department (ED). There is little published evidence for any mortality benefit. We compare the effect of a point-of-care ultrasonography protocol versus standard care without point-of-care ultrasonography for survival and clinical outcomes. METHODS: This international, multicenter, randomized controlled trial recruited from 6 centers in North America and South Africa and included selected hypotensive patients (systolic blood pressure <100 mm Hg or shock index >1) randomized to early point-of-care ultrasonography plus standard care versus standard care without point-of-care ultrasonography. Diagnoses were recorded at 0 and 60 minutes. The primary outcome measure was survival to 30 days or hospital discharge. Secondary outcome measures included initial treatment and investigations, admissions, and length of stay. RESULTS: Follow-up was completed for 270 of 273 patients. The most common diagnosis in more than half the patients was occult sepsis. We found no important differences between groups for the primary outcome of survival (point-of-care ultrasonography group 104 of 136 patients versus standard care 102 of 134 patients; difference 0.35%; 95% binomial confidence interval [CI] -10.2% to 11.0%), survival in North America (point-of-care ultrasonography group 76 of 89 patients versus standard care 72 of 88 patients; difference 3.6%; CI -8.1% to 15.3%), and survival in South Africa (point-of-care ultrasonography group 28 of 47 patients versus standard care 30 of 46 patients; difference 5.6%; CI -15.2% to 26.0%). There were no important differences in rates of computed tomography (CT) scanning, inotrope or intravenous fluid use, and ICU or total length of stay. CONCLUSION: To our knowledge, this is the first randomized controlled trial to compare point-of-care ultrasonography to standard care without point-of-care ultrasonography in undifferentiated hypotensive ED patients. We did not find any benefits for survival, length of stay, rates of CT scanning, inotrope use, or fluid administration. The addition of a point-of-care ultrasonography protocol to standard care may not translate into a survival benefit in this group.


Assuntos
Protocolos Clínicos , Hipotensão/diagnóstico , Sistemas Automatizados de Assistência Junto ao Leito/estatística & dados numéricos , Ultrassonografia/estatística & dados numéricos , Serviço Hospitalar de Emergência , Feminino , Humanos , Hipotensão/diagnóstico por imagem , Hipotensão/mortalidade , Masculino , Pessoa de Meia-Idade , América do Norte , Melhoria de Qualidade , África do Sul
12.
Chin J Traumatol ; 21(3): 156-162, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29784591

RESUMO

PURPOSE: "Polytrauma" patients are of a higher risk of complications and death than the summation of expected mortality and morbidity of their individual injuries. The ideal goal in trauma resuscitation care is to identify and treat all injuries. With clinical and technological advanced imaging available for diagnosis and treatment of traumatic patients, point of care-rapid ultrasound in shock and hypotension (RUSH) significantly affects modern trauma services and patient outcomes. This study aims to evaluate the accuracy of RUSH and patient outcomes by early detection of the causes of unstable polytrauma. METHODS: This cross-sectional, prospective study included 100 unstable polytrauma patients admitted in Suez Canal University Hospital. Clinical exam, RUSH and pan-computed tomography (pan-CT) were conducted. The result of CT was taken as the standard. Patients were managed according to the advanced trauma life support (ATLS) guidelines and treated of life threatening conditions if present. Patients were followed up for 28 days for a short outcome. RESULTS: The most diagnostic causes of unstability in polytrauma patients by RUSH are hypovolemic shock (64%), followed by obstructive shock (14%), distributive shock (12%) and cardiogenic shock (10%) respectively. RUSH had 94.2% sensitivity in the diagnosis of unstable polytrauma patients; the accuracy of RUSH in shock patients was 95.2%. CONCLUSION: RUSH is accurate in the diagnosis of unstable polytrauma patients; and 4% of patients were diagnosed during follow-up after admission by RUSH and pan-CT.


Assuntos
Hipotensão/diagnóstico por imagem , Traumatismo Múltiplo/diagnóstico por imagem , Choque/diagnóstico por imagem , Adolescente , Adulto , Idoso , Criança , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Traumatismo Múltiplo/complicações , Traumatismo Múltiplo/mortalidade , Sistemas Automatizados de Assistência Junto ao Leito , Estudos Prospectivos , Adulto Jovem
14.
Anesth Analg ; 126(3): 769-775, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-28806208

RESUMO

BACKGROUND: In light of the increasing number of radiologic interventions performed under general anesthesia, the effects of contrast media (CM) on circulation and organ perfusion are of paramount importance. The objectives of this study were to systematically quantify effects on blood pressure, heart rate, and kidney function following intravenous administration of nonionic CM with normal and low osmolality. METHODS: In this controlled, double-blinded phase IV clinical trial, 40 consecutive patients were randomly assigned to receive repeated measures of either low-osmolar iopromide or iso-osmolar iodixanol. Normal saline solution (NSS) served as control. Blood pressure and heart rate were measured continuously from 1 minute before until 3 minutes after administration of CM and NSS. Urine output was recorded hourly. RESULTS: Administration of iopromide resulted in systemic hypotension lasting up to 300 seconds (105 ± 61 seconds) with the lowest mean arterial pressure of 39 mm Hg (56.7 ± 12.2 mm Hg). Iopromide caused a systolic/diastolic decrease of 31/26 mm Hg (P < .001), significant increase in heart rate (P = .042), and significant diuresis with a 2-fold higher per-hour urine output (P = .010). Administration of iodixanol and NSS had no significant influence on blood pressure (P > .640). CONCLUSIONS: Administration of low-osmolar iopromide was followed by a significant transient decrease in blood pressure and a rise in heart rate. Anesthetists and radiologists should be aware of these effects in patients in whom short episodes of disturbed tissue microcirculation may pose a clinical risk.


Assuntos
Meios de Contraste/efeitos adversos , Hipotensão/induzido quimicamente , Hipotensão/fisiopatologia , Iohexol/análogos & derivados , Tomografia Computadorizada por Raios X , Ácidos Tri-Iodobenzoicos/efeitos adversos , Administração Intravenosa , Adulto , Idoso , Meios de Contraste/administração & dosagem , Método Duplo-Cego , Feminino , Seguimentos , Humanos , Hipotensão/diagnóstico por imagem , Iohexol/administração & dosagem , Iohexol/efeitos adversos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Tomografia Computadorizada por Raios X/métodos , Ácidos Tri-Iodobenzoicos/administração & dosagem
15.
Am J Emerg Med ; 35(12): 1984.e3-1984.e7, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-28851498

RESUMO

OBJECTIVE: To assess the impact of an ultrasound hypotension protocol in identifying life-threatening diagnoses that were missed in the initial evaluation of patients with hypotension and shock. METHODS: A subset of cases from a previously published prospective study of hypotensive patients who presented at the Emergency Department in a single, academic tertiary care hospital is described. An ultrasound-trained emergency physician performed an ultrasound on each patient using a standardized hypotension protocol. In each case, the differential diagnosis and management plan was solicited from the treating physician immediately before and after the ultrasound. This is a case series of patients with missed diagnoses in whom ultrasound led to a dramatic shift in diagnosis and management by detecting life threatening pathologies. RESULTS: Following a published prospective study of the effect on an ultrasound protocol in 118 hypotensive patients, we identified a series of cases that ultrasound protocol unexpectedly determined serious life threatening diagnoses such as Takotsubo cardiomyopathy, pulmonary embolism, pericardial effusion with tamponade physiology, abdominal aortic aneurysm and perforated viscus resulting in proper diagnoses and management. These hypotensive patients had completely unsuspected but critical diagnoses explaining their hypotension, who in every case had their management altered to target the newly identified life-threatening condition. CONCLUSIONS: A hypotension protocol is an optimal use of ultrasound that exemplifies "right time, right place", and impacts decision-making at the bedside. In cases with undifferentiated hypotension, ultrasound is often the most readily available option to ensure that the most immediate life-threatening conditions are quickly identified and addressed in the order of their risk potential.


Assuntos
Cuidados Críticos , Serviço Hospitalar de Emergência , Hipotensão/diagnóstico por imagem , Hipotensão/diagnóstico , Sistemas Automatizados de Assistência Junto ao Leito , Ultrassonografia , Adulto , Idoso , Idoso de 80 Anos ou mais , Diagnóstico Diferencial , Feminino , Humanos , Hipotensão/terapia , Masculino , Pessoa de Meia-Idade , Sistemas Automatizados de Assistência Junto ao Leito/estatística & dados numéricos , Estudos Prospectivos
16.
J Huazhong Univ Sci Technolog Med Sci ; 37(3): 326-331, 2017 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-28585146

RESUMO

This study was to investigate the changes of autonomic nerve function and hemodynamics in patients with vasovagal syncope (VVS) during head-up tilt-table testing (HUT). HUT was performed in 68 patients with unexplained syncope and 18 healthy subjects served as control group. According to whether bradycardia, hypotension or both took place during the onset of syncope, the patients were divided during the test into three subgroups: vasodepressor syncope (VD), cardioinhibitory syncope (CI) and mixed syncope (MX) subgroups. Heart rate, blood pressure, heart rate variability (HRV), and deceleration capacity (DC) were continuously analyzed during HUT. For all the subjects with positive responses, the normalized low frequency (LFn) and the LF/HF ratio markedly decreased whereas normalized high frequency (HFn) increased when syncope occurred. Syncopal period also caused more significant increase in the power of the DC in positive groups. These changes were more exaggerated compared to controls. All the patients were indicative of a sympathetic surge in the presence of withdrawal vagal activity before syncope and a sympathetic inhibition with a vagal predominance at the syncopal stage by the frequency-domain analysis of HRV. With the measurements of DC, a decreased vagal tone before syncope stage and a vagal activation at the syncopal stage were observed. The vagal tone was higher in subjects showing cardioinhibitory responses at the syncopal stage. DC may provide an alternative method to understand the autonomic profile of VVS patients.


Assuntos
Sistema Nervoso Autônomo/fisiopatologia , Desaceleração , Síncope Vasovagal/fisiopatologia , Teste da Mesa Inclinada/estatística & dados numéricos , Nervo Vago/fisiopatologia , Adulto , Sistema Nervoso Autônomo/diagnóstico por imagem , Pressão Sanguínea/fisiologia , Bradicardia/complicações , Bradicardia/diagnóstico por imagem , Bradicardia/fisiopatologia , Estudos de Casos e Controles , Ecocardiografia , Eletrocardiografia , Feminino , Coração/diagnóstico por imagem , Coração/fisiopatologia , Frequência Cardíaca/fisiologia , Hemodinâmica/fisiologia , Humanos , Hipotensão/complicações , Hipotensão/diagnóstico por imagem , Hipotensão/fisiopatologia , Masculino , Pessoa de Meia-Idade , Postura/fisiologia , Síncope Vasovagal/complicações , Síncope Vasovagal/diagnóstico por imagem , Nervo Vago/diagnóstico por imagem
18.
A A Case Rep ; 9(3): 87-89, 2017 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-28459719

RESUMO

In a healthy 12-year-old female with scoliosis, prone positioning resulted in pressor-refractory cardiovascular collapse. Resumption of supine position immediately improved hemodynamics. Intraoperative transesophageal echocardiography (TEE) revealed a collapsed left atrium and biventricular failure. Repeat prone positioning resulted in a recurrence of hypotension. However, hemodynamic stabilization was restored and maintained by repositioning chest pads caudally. The patient successfully underwent a 6-hour scoliosis repair without perioperative morbidity. With this case, we aim to: (1) reintroduce awareness of this mechanical obstructive cause of reversible hypotension; (2) highlight the use of intraoperative TEE during prone hemodynamic collapse; and (3) suggest an alternative prone positioning technique if chest compression results in hemodynamic instability.


Assuntos
Hipotensão/etiologia , Decúbito Ventral , Escoliose/cirurgia , Criança , Ecocardiografia Transesofagiana , Hemodinâmica/fisiologia , Humanos , Hipotensão/diagnóstico por imagem , Masculino , Decúbito Ventral/fisiologia , Escoliose/complicações
19.
Neurol India ; 65(3): 566-569, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28488623

RESUMO

Management of giant intracranial aneurysms presents unique challenges to the neurosurgical team. Various techniques such as adenosine-induced hypotension, rapid ventricular pacing, and inducing deep hypothermia are described in the literature to effect circulatory arrest for the successful obliteration of giant aneurysms. We describe a novel technique of induced hypotension for clipping a giant aneurysm by using an inflatable balloon across the main pulmonary artery with a successful outcome. This technique has not been described earlier in the literature.


Assuntos
Procedimentos Endovasculares/efeitos adversos , Hipotensão/etiologia , Aneurisma Intracraniano/cirurgia , Instrumentos Cirúrgicos/efeitos adversos , Feminino , Humanos , Hipotensão/diagnóstico por imagem , Aneurisma Intracraniano/diagnóstico por imagem , Imagem por Ressonância Magnética , Pessoa de Meia-Idade , Artéria Pulmonar/diagnóstico por imagem , Artéria Pulmonar/cirurgia , Tomógrafos Computadorizados
20.
Singapore Med J ; 58(5): 230-233, 2017 May.
Artigo em Inglês | MEDLINE | ID: mdl-28536728

RESUMO

Functional echocardiography (fECHO) refers to a bedside, limited assessment of the ductus arteriosus, myocardial performance and pulmonary or systemic haemodynamics that is brief in nature and addresses a specific clinical question or management dilemma. This point-of-care ultrasonography is increasingly used internationally and locally among neonatal units to assist with management of neonatal haemodynamic conditions. This article intends to explain the modality, its indications, interpretation and implications for management, and how it impacts long-term outcomes, particularly in chronic lung disease for premature infants born before 32 weeks of gestation. This review will focus on fECHO as a clinical tool to assess the haemodynamics of sick neonates and how it assists in the logical choice for cardiovascular support. Training should be approached as a combined effort between the paediatric cardiology service and neonatology service.


Assuntos
Doenças Cardiovasculares/diagnóstico por imagem , Ecocardiografia , Neonatologia/métodos , Cardiologistas , Ecocardiografia/métodos , Feminino , Hemodinâmica , Humanos , Hipertensão Pulmonar/diagnóstico por imagem , Hipotensão/diagnóstico por imagem , Recém-Nascido , Unidades de Terapia Intensiva Neonatal , Masculino , Neonatologistas , Sistemas Automatizados de Assistência Junto ao Leito
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA