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1.
BMJ Open ; 11(6): e046102, 2021 06 14.
Artigo em Inglês | MEDLINE | ID: mdl-34127491

RESUMO

OBJECTIVES: We have previously established a method to measure transfer of nutrients between mother, placenta and fetus in vivo. The method includes measurements of maternal and fetal blood flow by Doppler ultrasound prior to spinal anaesthesia. Spinal anaesthesia affects maternal blood pressure and cardiac output. We aimed to determine the effect of spinal anaesthesia in mothers undergoing an elective caesarean section on blood pressure, heart rate and cardiac output, and whether cardiac output levels were comparable before induction of spinal anaesthesia and before delivery. DESIGN: Prospective cohort study. SETTING: Tertiary hospital in Norway. PARTICIPANTS: 76 healthy women with uneventful pregnancies undergoing an elective caesarean section. INTERVENTIONS: We induced spinal anaesthesia with a standard prevention of hypotension including intravenous fluid coloading and phenylephrine infusion. PRIMARY AND SECONDARY OUTCOME MEASURES: Primary outcome measure was maternal cardiac output, and secondary outcome measures were invasive systolic blood pressure and heart rate. We measured heart rate and blood pressure by continuous invasive monitoring with a cannula in the radial artery. Cardiac output was estimated based on continuous arterial waveform. We compared maternal parameters 30 s before induction of spinal anaesthesia to 30 s before delivery. RESULTS: Median age at delivery was 34.5 (range 21-43) years and 17 of 76 women were nulliparous. The most prevalent indications were previous caesarean section and maternal request. Among 76 included women, 71 had sufficient data for analysis of endpoints. Median cardiac output was 6.51 (IQR (5.56-7.54) L/min before spinal anaesthesia and 6.40 (5.83-7.56) L/min before delivery (p=0.40)). Median invasive systolic blood pressure increased from 128.5 (120.1-142.7) mm Hg to 134.1 (124.0-146.6) mm Hg (p=0.014), and mean heart rate decreased from 86.0 (SD 13.9) to 75.2 (14.2) (p<0.001). CONCLUSIONS: Maternal cardiac output at the time of caesarean delivery is comparable to levels before induction of spinal anaesthesia. TRIAL REGISTRATION NUMBER: NCT00977769.


Assuntos
Anestesia Obstétrica , Raquianestesia , Hipotensão , Adulto , Pressão Sanguínea , Débito Cardíaco , Cesárea , Feminino , Humanos , Hipotensão/etiologia , Noruega , Gravidez , Estudos Prospectivos , Vasoconstritores/uso terapêutico , Adulto Jovem
4.
J Coll Physicians Surg Pak ; 30(6): 619-622, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34102769

RESUMO

OBJECTIVE: To determine the predictive effect of pleth variability index(PVI)before anesthesia on hypotension after epidural anesthesia in cesarean section parturient women. STUDY DESIGN: Observational study. PLACE AND DURATION OF STUDY: Gansu Province People's Hospital, China, from March 2019 to May 2020. METHODOLOGY: One hundred and seven singleton parturient women, who underwent elective cesarean section, were selected. They were divided into no hypotension group (Group A) and hypotension group (Group B). Hypotension was defined as systolic blood pressure lower than 90 mmHg or >30% decrease in the mean arterial pressure. Receiver operating characteristic (ROC) curve was used to evaluate the predictive value of PVI before anesthesia and heart rate (HR) for hypotension after epidural anesthesia. RESULTS: After epidural anesthesia, 41 (38.32%) parturient women had hypotension. Basic values of HR and PVI before anesthesia in Group B were significantly higher than Group A (both p <0.001). The area under the ROC curve (AUC) of PVI basic value predicting hypotension was 0.824 (95% CI: 0.746-0.903, p <0.001), was greater than the AUC of HR basic value predicting hypotension, and the sensitivity and specificity of predicting hypotension were 92.7% and 66.7%, respectively. CONCLUSION: The PVI and HR values before anesthesia have certain value in predicting hypotension after epidural anesthesia in cesarean section. PVI value before epidural anesthesia has more clinical significance than the HR. Key Words: Pleth variability index (PVI, Heart rate (HR), Epidural anesthesia, Cesarean, Hypotension.


Assuntos
Anestesia Epidural , Raquianestesia , Hipotensão , Anestesia Epidural/efeitos adversos , Raquianestesia/efeitos adversos , Pressão Sanguínea , Cesárea/efeitos adversos , China , Feminino , Humanos , Hipotensão/epidemiologia , Hipotensão/etiologia , Gravidez
5.
J Clin Anesth ; 72: 110310, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-33932723

RESUMO

STUDY OBJECTIVE: To clarify whether intraoperative hypotension contributes to the development of postoperative cognitive dysfunction. DESIGN: A systematic review of prospective studies reporting on intraoperative hypotension and postoperative cognitive dysfunction in elective, non-cognitive impaired, adult surgical patients. PubMed, EMBASE and the Cochrane Library were searched up to the 1st of January 2021. SETTING: Studies had to use a clear definition of hypotension, although differing definitions were accepted. Neurocognitive tests to determine postoperative cognitive dysfunction had to be done pre- and postoperatively, with a minimum follow-up of seven days postoperatively. MEASUREMENTS: Risk of bias was assessed using the Cochrane Risk of Bias Tool 2.0 for randomized controlled trials and the Newcastle-Ottawa Scale for cohort studies. MAIN RESULTS: Out of 941 studies screened, five randomized controlled trials and four cohort studies were included for qualitative analysis. Extensive methodological differences between studies were present hindering proper quantitive analysis. No studies reported statistically significant differences in incidence of postoperative cognitive dysfunction in hypo- compared to normotensive patients. Five studies reported exact incidences of postoperative cognitive dysfunction. CONCLUSIONS: This systematic review showed no conclusive association between intraoperative hypotension and the development of postoperative cognitive dysfunction. Given the vast methodological differences of the included studies, the role of intraoperative hypotension in the development of postoperative cognitive dysfunction remains uncertain. Future research into the association between intraoperative hypotension and postoperative cognitive dysfunction should be conducted in a standardized manner.


Assuntos
Disfunção Cognitiva , Hipotensão , Complicações Cognitivas Pós-Operatórias , Adulto , Disfunção Cognitiva/epidemiologia , Disfunção Cognitiva/etiologia , Humanos , Hipotensão/epidemiologia , Hipotensão/etiologia , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Estudos Prospectivos
6.
Scand J Trauma Resusc Emerg Med ; 29(1): 61, 2021 Apr 30.
Artigo em Inglês | MEDLINE | ID: mdl-33931076

RESUMO

BACKGROUND: Hypotension is associated with worse outcome in patients with traumatic brain injury (TBI) and maintaining a systolic blood pressure (SBP) ≥110 mmHg is recommended. The aim of this study was to assess the incidence of TBI in patients suffering multiple trauma in mountain areas; to describe associated factors, treatment and outcome compared to non-hypotensive patients with TBI and patients without TBI; and to evaluate pre-hospital variables to predict admission hypotension. METHODS: Data from the prospective International Alpine Trauma Registry including mountain multiple trauma patients (ISS ≥ 16) collected between 2010 and 2019 were analysed. Patients were divided into three groups: 1) TBI with hypotension, 2) TBI without hypotension and 3) no TBI. TBI was defined as Abbreviated Injury Scale (AIS) of the head/neck ≥3 and hypotension as SBP < 110 mmHg on hospital arrival. RESULTS: A total of 287 patients were included. Fifty (17%) had TBI and hypotension, 92 (32%) suffered TBI without hypotension and 145 (51%) patients did not have TBI. Patients in group 1 were more severely injured (mean ISS 43.1 ± 17.4 vs 33.3 ± 15.3 vs 26.2 ± 18.1 for group 1 vs 2 vs 3, respectively, p < 0.001). Mean SBP on hospital arrival was 83.1 ± 12.9 vs 132.5 ± 19.4 vs 119.4 ± 25.8 mmHg (p < 0.001) despite patients in group 1 received more fluids. Patients in group 1 had higher INR, lower haemoglobin and lower base excess (p < 0.001). More than one third of patients in group 1 and 2 were hypothermic (body temperature < 35 °C) on hospital arrival while the rate of admission hypothermia was low in patients without TBI (41% vs 35% vs 21%, for group 1 vs 2 vs 3, p = 0.029). The rate of hypothermia on hospital arrival was different between the groups (p = 0.029). Patients in group 1 had the highest mortality (24% vs 10% vs 1%, p < 0.001). CONCLUSION: Multiple trauma in the mountains goes along with severe TBI in almost 50%. One third of patients with TBI is hypotensive on hospital arrival and this is associated with a worse outcome. No single variable or set of variables easily obtainable at scene was able to predict admission hypotension in TBI patients.


Assuntos
Lesões Encefálicas Traumáticas/complicações , Hipotensão/mortalidade , Traumatismo Múltiplo , Sistema de Registros , Centros de Traumatologia/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Lesões Encefálicas Traumáticas/diagnóstico , Feminino , Humanos , Hipotensão/etiologia , Hipotensão/fisiopatologia , Escala de Gravidade do Ferimento , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Taxa de Sobrevida/tendências , Adulto Jovem
7.
J Cardiothorac Vasc Anesth ; 35(8): 2273-2282, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34006466

RESUMO

Despite the valuable use of modern applications of perioperative ultrasound across multiple disciplines, there have been limitations to its implementation, restricting its impact on patient-based clinical outcomes. Point-of-care ultrasound evaluation of hypoxia and hypotension is an important tool to assess the underlying undifferentiated etiologies in a timely manner. However, there is a lack of consensus on the formal role of ultrasound during evaluation of perioperative hypoxia or hypotension. The previous ultrasound algorithms have adopted a complex technique that possibly ignore the pathophysiologic mechanisms underlying the conditions presenting in a similar fashion. The authors here propose a simple, sequential and focused multiorgan approach, applicable for the evaluation of perioperative hypotension and hypoxia in emergency scenarios. The authors believe this approach will enhance the care provided in the postanesthesia care unit, operating room, and intensive care unit.


Assuntos
Hipotensão , Algoritmos , Humanos , Hipotensão/diagnóstico , Hipotensão/etiologia , Hipóxia/diagnóstico por imagem , Hipóxia/etiologia , Unidades de Terapia Intensiva , Ultrassonografia
8.
Kidney Int ; 99(6): 1269-1272, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-34023027

RESUMO

Intradialytic hypotension (IDH) is a major complication of hemodialysis, leading to myocardial stunning, cerebral hypoperfusion, gut ischemia, loss of residual kidney function, high symptom burden, and death. This study by Keane et al. provides new data on the incidence of IDH over well-defined time intervals during the hemodialysis treatment session, clinical parameters associated with the timing of IDH onset, and whether timing of IDH impacts survival in a nationally representative hemodialysis cohort.


Assuntos
Hipotensão , Falência Renal Crônica , Humanos , Hipotensão/etiologia , Incidência , Isquemia , Falência Renal Crônica/terapia , Diálise Renal/efeitos adversos
9.
Ann Palliat Med ; 10(5): 5316-5321, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33977756

RESUMO

BACKGROUND: Intradialytic hypotension (IDH) remains the most frequent severe side effect of hemodialysis (HD) and increases patient morbidity and mortality. Excessive ultrafiltration (UF) is considered the leading cause of IDH. This study developed a suitable prescription of UF to reduce the incidences of IDH episodes. METHODS: A retrospective study was performed to analyze 33,224 HD/hemodiafiltration (HDF) treatments in 312 patients. The prescription of UF were determined following the International Society of Peritoneal Dialysis (ISPD) guideline. The Pearson's method was used to study the correlation between relative variables. The receiver operating characteristic (ROC) curve was used to predict the value of the UF/weight ratio (UF/Wt) for IDH in all patients to establish a diagnostic cut-off point. Univariate and multivariate logistic regression analyses were applied to study the risk factors of IDH. RESULTS: Twelve thousand five hundred and fifty-eight sessions of IDH (38.7%) were identified, among which 1,224 (3.6%) were recorded with intervention against IDH. Both the systolic blood pressure (SBP) and mean arterial pressure (MAP) of the hemodialytic patients were positively correlated with the UF quantity and the UF/Wt, but negatively correlated with blood flow. The ROC curve showed that UF/Wt =0.04 was the cut-off point for IDH. Age [per 10-year increment, odds ratio (OR) =1.005, 95% confidence interval (CI): 1.004 to 1.007, P=0.000], diabetes mellitus (OR =1.209, 95% CI: 1.122 to 1.303, P=0.000), and UF/Wt >0.04 (OR =1.605, 95% CI: 1.532 to 1.682, P=0.000) were all independently associated with higher incidences of IDH. CONCLUSIONS: IDH commonly occurs during HD in Chinese patients. Unchangeable factors such as diabetes and age, and modifiable factors including UF were associated with IDH. A UF/Wt threshold more than 0.04 may be a potential alert for avoiding IDH, especially in the elderly and diabetic patients.


Assuntos
Hipotensão , Ultrafiltração , Idoso , China , Humanos , Hipotensão/etiologia , Prescrições , Diálise Renal/efeitos adversos , Estudos Retrospectivos
11.
Chin Med J (Engl) ; 134(9): 1043-1051, 2021 Apr 20.
Artigo em Inglês | MEDLINE | ID: mdl-33883404

RESUMO

BACKGROUND: Hypotension is a common complication caused by spinal anesthesia (SA), which may have adverse impacts on the condition of the parturient and fetus. Liquid infusion was found to be relatively effective for reducing the incidence of hypotension. However, the question of whether colloid preload can optimize hemodynamic variables in the cesarean section remains controversial. This study aims to determine the effects of colloid preload on the incidence of hypotension induced by SA in elective cesarean section. METHODS: Related keywords were searched on PubMed, EMBASE, and Cochrane Library from inception dates to May 2020. Studies included were evaluated for eligibility and quality. The primary outcome was the intra-operative incidence of hypotension and severe hypotension. The secondary outcomes included the lowest intra-operative systolic blood pressure, the maximal intra-operative heart rate, the intra-operative needs of ephedrine and phenylephrine, the incidence of maternal nausea and/or vomiting, and neonatal outcomes (umbilical artery pH and Apgar scores). Apart from the above, RevMan 5.3 was used for the data analysis. RESULTS: Altogether nine randomized controlled trials were included in the meta-analysis. There were no significant differences in the incidence of intra-operative hypotension, severe hypotension, or neonatal outcomes between the colloid preload group and control group, except for the umbilical artery pH. CONCLUSION: This meta-analysis suggests that colloid preload does not significantly reduce the incidence of hypotension associated with SA in elective cesarean section.


Assuntos
Raquianestesia , Hipotensão , Raquianestesia/efeitos adversos , Cesárea/efeitos adversos , Coloides , Feminino , Humanos , Hipotensão/tratamento farmacológico , Hipotensão/epidemiologia , Hipotensão/etiologia , Incidência , Recém-Nascido , Gravidez , Vasoconstritores/uso terapêutico
12.
Eur J Anaesthesiol ; 38(6): 609-615, 2021 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-33927105

RESUMO

BACKGROUND: Intra-operative hypotension is associated with adverse postoperative outcomes. A machine-learning-derived algorithm developed to predict hypotension based on arterial blood pressure (ABP) waveforms significantly reduced intra-operative hypotension. The algorithm calculates the likelihood of hypotension occurring within minutes, expressed as the Hypotension Prediction Index (HPI) which ranges from 0 to 100. Currently, HPI is only available for patients monitored with invasive ABP, which is restricted to high-risk procedures and patients. In this study, the performance of HPI, employing noninvasive continuous ABP measurements, is assessed. OBJECTIVES: The first aim was to compare the performance of the HPI algorithm, using noninvasive versus invasive ABP measurements, at a mathematically optimal HPI alarm threshold (Youden index). The second aim was to assess the performance of the algorithm using a HPI alarm threshold of 85 that is currently used in clinical trials. Hypotension was defined as a mean arterial pressure (MAP) below 65 mmHg for at least 1 min. The predictive performance of the algorithm at different HPI alarm thresholds (75 and 95) was studied. DESIGN: Observational cohort study. SETTING: Tertiary academic medical centre. PATIENTS: Five hundred and seven adult patients undergoing general surgery. RESULTS: The performance of the algorithm with invasive and noninvasive ABP input was similar. A HPI alarm threshold of 85 showed a median [IQR] time from alarm to hypotension of 2.7 [1.0 to 7.0] min with a sensitivity of 92.7 (95% confidence interval [CI], 91.2 to 94.3), specificity of 87.6 (95% CI, 86.2 to 89.0), positive predictive value of 79.9 (95% CI, 77.7 to 82.1) and negative predictive value of 95.8 (95% CI, 94.9 to 96.7). A HPI alarm threshold of 75 provided a lower positive predictive value but a prolonged time from prediction to actual hypotension. CONCLUSION: This study demonstrated that the algorithm can be employed using continuous noninvasive ABP waveforms. This opens up the potential to predict and prevent hypotension in a larger patient population. TRIAL REGISTRATION: Clinical trials registration number NCT03533205.


Assuntos
Pressão Arterial , Hipotensão , Adulto , Algoritmos , Determinação da Pressão Arterial , Estudos de Coortes , Humanos , Hipotensão/diagnóstico , Hipotensão/etiologia , Aprendizado de Máquina
13.
BMJ Case Rep ; 14(4)2021 Apr 26.
Artigo em Inglês | MEDLINE | ID: mdl-33906888

RESUMO

Scombroid fish poisoning (SFP), the most common fish-related illness worldwide, is a histamine response caused by the heat stable toxin histamine. A healthy 48-year-old woman and co-author of this paper developed palpitations, tachycardia and hypotension 10 min after a tuna steak dinner. She subsequently developed numbness of her face, flushing, conjunctival erythema, abdominal pain, nausea, vomiting, diarrhoea, headache and chest pain. Her ECG revealed tachycardia with ST depression. Her hypotension did not respond to fluid resuscitation, and she required phenylephrine. Based on exposure history, clinical syndrome, exclusion of other diseases and consultation with poison control, a diagnosis of scombroid poisoning was established. The state health department was notified. The patient was weaned off vasopressors, dosed famotidine and discharged 43 hours after fish ingestion with no symptoms and normal ECG. SFP is an often misdiagnosed and underreported illness with the potential to cause life-threatening hypotension.


Assuntos
Doenças Transmitidas por Alimentos , Hipotensão , Animais , Feminino , Doenças Transmitidas por Alimentos/diagnóstico , Histamina , Humanos , Hipotensão/etiologia , Toxinas Marinhas , Pessoa de Meia-Idade , Atum
14.
Medicine (Baltimore) ; 100(14): e25299, 2021 Apr 09.
Artigo em Inglês | MEDLINE | ID: mdl-33832099

RESUMO

ABSTRACT: Intradialytic hypotension (IDH) may lead to a poor life quality and was associated with cardiovascular mortality in patients under hemodialysis. This study investigated the autonomic nerve and cardiovascular function in the IDH episodes.In this case-control study, 70 end stage renal disease patients (198 visits) were recruited. Pulse wave analysis and heart rate variability were evaluated before hemodialysis. Two definitions of IDH were confirmed by medical records. IDH-f indicated a drop of systolic blood pressure or mean arterial pressure, accompanied with symptoms; IDH-n indicated a low nadir systolic pressure during the hemodialysis. All parameters were evaluated for the possible predisposing factors under each definition.A total of 24 IDH-f and 37 IDH-n were noted in 177 visits. For both definitions, central pulse pressure seemed to be a consistent predisposing factor. Furthermore, lower sympathetic activity (odds ratio [OR] 0.55; 95% confidence interval [CI] 0.35-0.87), lower pulse pressure (OR 0.95; 95% CI 0.92-0.98), and higher augmentation index (OR 17.36; 95% CI 1.48-204.10) were the possible predisposing factors for IDH-f. On the contrary, lower mean arterial pressure (OR 0.87; 95% CI 0.78-0.98) was identified as the possible factor for IDH-n.It was suggested that the lower central pulse pressure and sympathetic activity might be involved in the development of IDH.


Assuntos
Hemodinâmica/fisiologia , Hipotensão/etiologia , Hipotensão/fisiopatologia , Falência Renal Crônica/terapia , Diálise Renal/efeitos adversos , Adulto , Idoso , Idoso de 80 Anos ou mais , Pressão Sanguínea/fisiologia , Estudos de Casos e Controles , Frequência Cardíaca , Humanos , Pessoa de Meia-Idade , Análise de Onda de Pulso
15.
Transfusion ; 61(4): 1336-1340, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33666248

RESUMO

BACKGROUND: Transfusion-related acute lung injury (TRALI) is a transfusion complication often mediated by recipient exposure to plasma from donors with human leukocyte antigen (HLA) and human neutrophil antigen (HNA) antibodies. Recipient anti-donor HLA or HNA antibodies have rarely been implicated. STUDY DESIGN AND METHODS: Herein, we describe a case of fatal TRALI mediated by recipient anti-HLA and anti-HNA antibodies. Cognate antibody-antigen match was confirmed with serologic and molecular assays. RESULTS: A 69-year-old G5P5 female with no prior transfusion history and metastatic cholangiocarcinoma with thromboembolic complications presented with heart failure and dyspnea. She was transfused 15 ml of a unit of Fya -negative red blood cells and subsequently developed acute onset dyspnea, hypoxemia, hypotension, and fever. Clinical investigations revealed bilateral infiltrates on chest X-ray and cognate recipient HLA and HNA antibodies to donor antigens. The patient died of acute respiratory failure within 24 h of transfusion. In total, the patient had Fya , HLA Class I, HNA, and human platelet antigen (HPA) alloantibodies. The 63-year-old female donor had detectable HLA class II antibodies (recipient class II genotype unavailable). CONCLUSION: The pathophysiology of TRALI has traditionally been ascribed to underlying conditions that put the recipient at risk in combination with donor biological response modifiers. This case illustrates alternative pathogenic mediators including alloantibodies to donor HLA and HNA. Additional studies to determine the contribution and frequency of recipient alloantibodies in TRALI may inform future mitigation strategies to further reduce the incidence of TRALI, particularly in female transfusion recipients.


Assuntos
Colangiocarcinoma/secundário , Antígenos HLA/imunologia , Neutrófilos/imunologia , Lesão Pulmonar Aguda Relacionada à Transfusão/diagnóstico , Idoso , Doadores de Sangue , Colangiocarcinoma/complicações , Dispneia/etiologia , Evolução Fatal , Feminino , Febre/etiologia , Humanos , Hipotensão/etiologia , Hipóxia/etiologia , Isoanticorpos/sangue , Pessoa de Meia-Idade , Plasma/imunologia , Síndrome do Desconforto Respiratório/diagnóstico , Síndrome do Desconforto Respiratório/etiologia , Tromboembolia/etiologia , Reação Transfusional/complicações , Lesão Pulmonar Aguda Relacionada à Transfusão/complicações , Lesão Pulmonar Aguda Relacionada à Transfusão/imunologia , Lesão Pulmonar Aguda Relacionada à Transfusão/fisiopatologia , Transplantados
16.
ESC Heart Fail ; 8(3): 2009-2015, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33760362

RESUMO

AIMS: Takotsubo syndrome (TTS) is a form of acute myocardial inflammation, often triggered by catecholamine release surges, which accounts for approximately 10% of 'myocardial infarctions' in female patients above the age of 50. Its associated substantial risk of in-hospital mortality is mainly driven by the development of hypotension and shock. While hypotension is induced largely by factors other than low cardiac output, its precise cause is unknown, and clinical parameters associated with hypotension have not been identified previously. We therefore sought to identify the incidence and clinical/laboratory correlates of early hypotension in TTS. METHODS AND RESULTS: We analysed the in-hospital data of patients recruited to the South Australian TTS Registry. Associations between the development of hypotension, patient demographics, severity of the acute TTS attack, and key biochemical markers were sought. One hundred thirteen out of 319 patients (35%) were hypotensive (median systolic blood pressure 80 mmHg) during their index hospitalization. Development of hypotension preceded all in-hospital deaths (n = 8). On univariate analyses, patients who developed hypotension had lower left ventricular ejection fraction (P = 0.009), and higher plasma N-terminal pro brain natriuretic peptide and troponin-T concentrations (P = 0.046 and 0.008, respectively), all markers of severity of the TTS attack; hypotension also occurred less commonly in male than in female patients (P = 0.014). On multivariate linear regression analysis, female sex and lower left ventricular ejection fraction were independent correlates of the development of hypotension (P = 0.009 and 0.010, respectively). CONCLUSIONS: Early development of hypotension is very common in TTS, and its presence is associated with a substantial risk of in-hospital mortality. Hypotension is a marker of severe TTS attacks and occurs more commonly in female TTS patients.


Assuntos
Hipotensão , Cardiomiopatia de Takotsubo , Austrália , Feminino , Humanos , Hipotensão/epidemiologia , Hipotensão/etiologia , Incidência , Laboratórios , Masculino , Volume Sistólico , Cardiomiopatia de Takotsubo/diagnóstico , Cardiomiopatia de Takotsubo/epidemiologia , Função Ventricular Esquerda
17.
Vasc Endovascular Surg ; 55(5): 475-481, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-33779409

RESUMO

BACKGROUND: To address the predictors of hemodynamic instability (HI) related to carotid artery stenting (CAS) and evaluate the association between HI and periprocedural adverse outcomes. METHODS: This study comprised all consecutive patients who underwent CAS for atherosclerotic carotid artery stenosis from March 2014 to May 2018. A standardized dose of atropine (0.4 mg) was given prior to stent deployment. Changes in heart rate, blood pressure, and neurological status were monitored and recorded. Potential predictors of HI were tested in multivariate analysis using binary logistic regression model. RESULTS: A total of 728 patients were enrolled. Two hundred twenty seven patients (31.2%) developed periprocedural HI. The presence of hypertension (OR, 2.037; 95% CI, 1.292-3.211; P = 0.0022), symptomatic carotid lesions (OR, 1.704; 95% CI, 1.057-2.747; P = 0.0287), right sided lesions (OR, 3.090; 95% CI, 1.934-4.935; P ≤ 0.0001), hyperechoic/calcified plaques (OR, 2.195; 95% CI, 1.458-3.304; p P = 0.0002), and longer lesions (OR, 1.043; 95% CI, 1.012-1.076; P = 0.0072) were significant predictable factors for the occurrence of HI. On the other hand, smoking was significantly associated with a 48.1% decrease in risk of development of HI (OR, 0.519; 95% CI, 0.358-0.754; P = 0.0006). There were no statistically significant differences in periprocedural morbidity or mortality between patients with and without HI. CONCLUSION: HI occurs in a considerable percentage of patients undergoing CAS. Hypertension, right sided, symptomatic carotid lesions, calcified plaques, and longer lesions were shown to be independent risk factors for the development of periprocedural HI. Conversely, smoking demonstrated a protective effect. HI did not appear to predispose to periprocedural adverse events.


Assuntos
Bradicardia/etiologia , Estenose das Carótidas/terapia , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/instrumentação , Hemodinâmica , Hipotensão/etiologia , Stents , Idoso , Idoso de 80 Anos ou mais , Pressão Sanguínea , Bradicardia/diagnóstico , Bradicardia/fisiopatologia , Estenose das Carótidas/diagnóstico por imagem , Estenose das Carótidas/fisiopatologia , Egito , Feminino , Frequência Cardíaca , Humanos , Hipotensão/diagnóstico , Hipotensão/fisiopatologia , Itália , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
18.
JAMA ; 325(12): 1164-1172, 2021 03 23.
Artigo em Inglês | MEDLINE | ID: mdl-33755076

RESUMO

Importance: Tracheal intubation is one of the most commonly performed and high-risk interventions in critically ill patients. Limited information is available on adverse peri-intubation events. Objective: To evaluate the incidence and nature of adverse peri-intubation events and to assess current practice of intubation in critically ill patients. Design, Setting, and Participants: The International Observational Study to Understand the Impact and Best Practices of Airway Management in Critically Ill Patients (INTUBE) study was an international, multicenter, prospective cohort study involving consecutive critically ill patients undergoing tracheal intubation in the intensive care units (ICUs), emergency departments, and wards, from October 1, 2018, to July 31, 2019 (August 28, 2019, was the final follow-up) in a convenience sample of 197 sites from 29 countries across 5 continents. Exposures: Tracheal intubation. Main Outcomes and Measures: The primary outcome was the incidence of major adverse peri-intubation events defined as at least 1 of the following events occurring within 30 minutes from the start of the intubation procedure: cardiovascular instability (either: systolic pressure <65 mm Hg at least once, <90 mm Hg for >30 minutes, new or increase need of vasopressors or fluid bolus >15 mL/kg), severe hypoxemia (peripheral oxygen saturation <80%) or cardiac arrest. The secondary outcomes included intensive care unit mortality. Results: Of 3659 patients screened, 2964 (median age, 63 years; interquartile range [IQR], 49-74 years; 62.6% men) from 197 sites across 5 continents were included. The main reason for intubation was respiratory failure in 52.3% of patients, followed by neurological impairment in 30.5%, and cardiovascular instability in 9.4%. Primary outcome data were available for all patients. Among the study patients, 45.2% experienced at least 1 major adverse peri-intubation event. The predominant event was cardiovascular instability, observed in 42.6% of all patients undergoing emergency intubation, followed by severe hypoxemia (9.3%) and cardiac arrest (3.1%). Overall ICU mortality was 32.8%. Conclusions and Relevance: In this observational study of intubation practices in critically ill patients from a convenience sample of 197 sites across 29 countries, major adverse peri-intubation events-in particular cardiovascular instability-were observed frequently.


Assuntos
Estado Terminal/terapia , Hipotensão/etiologia , Intubação Intratraqueal/efeitos adversos , Insuficiência Respiratória/terapia , Idoso , Estado Terminal/mortalidade , Feminino , Parada Cardíaca/etiologia , Humanos , Hipóxia/etiologia , Unidades de Terapia Intensiva , Intubação Intratraqueal/métodos , Modelos Logísticos , Masculino , Erros Médicos/estatística & dados numéricos , Pessoa de Meia-Idade , Estudos Prospectivos , Respiração Artificial , Vasoconstritores/uso terapêutico
20.
Zhong Nan Da Xue Xue Bao Yi Xue Ban ; 46(1): 84-90, 2021 Jan 28.
Artigo em Inglês, Chinês | MEDLINE | ID: mdl-33678641

RESUMO

With the advancement of disease treatments, the number of patients undergoing surgery worldwide is increasing. However, many patients still experience severe perioperative complications. Perioperative hypotension is one of the common side effects during surgery. Physiologically, perioperative hypotension can lead to insufficient perfusion of important organs and result in acute and chronic irreversible organ injury, which cause serious consequences for the patient's postoperative hospitalization and even the long-term outcome. Therefore, in order to optimize perioperative circulation management and improve the quality of life for patients after surgery, it is of great importance to investigate the relationship between perioperative hypotension and postoperative myocardial injury, ischemic stroke, postoperative delirium, acute kidney injury, and postoperative mortality. Individualized circulation management and reasonable application of vasoactive drugs may be the key point to early prevention and correct treatment of perioperative hypotension, which is of great significance for reducing perioperative related morbidity and mortality and improving the prognosis for the surgical patients.


Assuntos
Injúria Renal Aguda , Hipotensão , Injúria Renal Aguda/epidemiologia , Injúria Renal Aguda/etiologia , Humanos , Hipotensão/etiologia , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Qualidade de Vida
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