Impact factor 0.175

Signa Vitae

A Journal In Intensive Care And Emergency Medicine

Month: November 2010 (Page 1 of 2)

NHE-1 Inhibitors and Erythropoietin for Maintaining Myocardial Function during Cardiopulmonary Resuscitation

Abstract

Efforts to successfully restore life in cardiac arrest victims are formidably challenging. They require not only that cardiac activity be initially reestablished but that injury to vital organs be prevented or minimized. In this article, we discuss the effects that cardiac arrest and resuscitation have on the myocardium, describing first the functional myocardial abnormalities that occur during cardiac resuscitation, which may limit the ability to reestablish cardiac activity. We then discuss strategies for minimizing myocardial injury and examine novel therapies aimed at minimizing ischemia and reperfusion injury. Finally, we discuss sodium-hydrogen exchanger isoform-1(NHE-1) inhibitors and erythropoietin for maintaining myocardial function during cardiopulmonary resuscitation.

Keywords: myocardial ischemic injury, reperfusion myocardial injury, cardiopulmonary resuscitation, NHE-1 inhibitors, erythropoietin

Read More

Risk factors and outcomes for congenital diaphragmatic hernia in neonatal intensive care unit patients

Abstract

Objectives. Congenital diaphragmatic hernia (CDH) is one of the most common and serious congenital disorders seen in the neonatal intensive care unit (NICU) and it is associated with a high mortality. In order to determine the risk factors and outcomes of CDH, we summarized data from a 10 year period.
Methods. A retrospective study was conducted on 38 CDH patients. Clinical characteristics and risk factors were compared and non-conditional logistic regression analysis was performed to determine independent predictors for mortality.
Results. Thirty patients, from a total of 38, underwent surgery for CDH. The total survival rate in patients with CDH was 63.2% (24/38) and the overall operative mortality was 20.0% (6/30). There was a significant difference between CDH patients who survived (n=24) and those who died (n=14) in the age on admission, 5-minute Apgar score, onset of respiratory distress, cardiac malformations and presence of persistent pulmonary hypertension of newborn (PPHN). Using logistic regression analysis, the following factors independently predicted mortality: the age on admission (OR: 8.15, 95%CI: 1.43 to 46.41) and cardiac malformations (OR: 18.54, 95%CI: 1.32 to 259.62). Moreover, when we compared CDH patients who survived after surgery (n=24) with those who died (n=6), there was a significant difference in the admission age, 1-minute Apgar score, presence of PPHN, lung hypoplasia, time of stabilization prior to surgery, and highest oxygenation index after surgery.
Conclusions. Mortality was very high in CDH patients and was associated with care procedures. Risk factors for mortality in neonatal CDH were the age on admission and associated malformations.

Key words: congenital diaphragmatic hernia, risk factor, neonatal intensive care unit

Read More

Assessing outcome of out-of-hospital cardiac arrest due to subarachnoid hemorrhage using brain CT during or immediately after resuscitation

Abstract

Objectives. The clinical course and outcome of out-of-hospital cardiopulmonary arrest (OHCPA) due to subarachnoid hemorrhage (SAH) is unclear. The objective of this study is to clarify them.
Study design. Single- center, observational study.
Setting. We usually perform a brain computed tomography (CT) in OHCPA patients who present without a clear etiology (42% of all OHCPA), such as trauma, to determine the cause of OHCPA and to guide treatment.
Patients. The study included OHCPA patients without a clear etiology, who were transferred to our center and who underwent a brain CT during resuscitation.
Methods of measurement. Patients’ records were reviewed; initial cardiac rhythm, existence of a witness and bystander cardiopulmonary resuscitation efforts (CPR) were compared with patients’ outcomes.
Results. Sixty-six patients were enrolled. 72.7% achieved return of spontaneous circulation (ROSC), 71.2% were admitted, 30.3% survived more than 7 days, and 9.1. survived-to-discharge. In 41 witnessed OHCPA, 87.8% obtained ROSC, 85.4% were admitted, and 14.6% survived-to-discharge. All survivors were witnessed. In 25 non-witnessed OHCPA, 48% obtained ROSC and were admitted, and no patients were discharged. Initial cardiac rhythm was ventricular fibrillation (VF), pulseless electrical activity (PEA) and asystole in 3.0%, 39.4%, and 47.0%. In 2 VF patients 50.0% survived-to- discharge, and there was no survivor with PEA or asystole.
Conclusion. This study shows a high rate of ROSC and admission in OHCPA patients with a SAH, and also reveals their very poor neurological outcome. We conclude that the detection of a SAH in OHCPA patients is important to determine the accurate frequency of SAH in this patient group and to guide appropriate treatment of all OHCPA patients.

Keywords: out-of-hospital cardiac arrest, brain CT, outcome, autopsy imaging, postmortem imaging

Read More

Epinephrine administration via a laryngeal mask airway: what is the optimal dose?

Abstract

Background. The aim of this animal study was to clarify the effects of laryngeal mask airway (LMA)-administrated epinephrine and to assess the optimal dose.
Methods. Thirty pigs were anesthetized and intubated with a cuffed tracheal tube (TT) and an LMA. Then they were assigned to one of five groups. The control group received distilled water 10 mL via the TT; the TT group received epinephrine 50 μg/kg via the TT; and the other three groups received two, four or six times the TT dose of epinephrine via the LMA. Heart rate (HR) and arterial pressure were monitored before and after drug administration for 15 minutes.
Results. After epinephrine administration, the LMA-6 and TT groups had elevated systolic, diastolic and mean arterial pressures at 1 min and there was no significant difference between the two groups. In the TT group, these parameters peaked at 2 min then declined rapidly. In the LMA-6 group, they increased more slowly, and then maintained a plateau. The control, LMA-2 and LMA-4 groups failed to display significant persistent (>2 min) hemodynamic changes.
Conclusions. We could not identify an optimal LMA-administrated epinephrine dose. The TT route is suitable when a high peak drug effect is required and the LMA route may be preferable if a persistent plateau effect is desired. Effective LMA administration of drugs may require larger doses than those given via TT.

Keywords: airway, drug delivery, epinephrine, laryngeal mask airway (LMA), tracheal tube

Read More

Transverse myelitis following general and thoracic epidural anaesthesia

Abstract

Acute bacterial transverse myelitis, secondary to an epidural catheter, developed in a 49-year-old man who underwent surgery for carcinoma of the left lung. Left pneumonectomy was performed under combined general and epidural (Th6-7) anesthesia. The operative procedure, anaesthesia and early postoperative course were uneventful. On the fifth postoperative day, the patient developed neurological deficits consistent with high-level paraplegia. Elevated inflammatory parameters along with the results of cerebrospinal fluid analysis and magnetic resonance imaging were suggestive of acute transverse bacterial myelitis of the dorsal part of the spinal cord secondary to epidural analgesia. Despite prompt antibiotic therapy, anti-oedema treatment and rehabilitation, the neurological deficit failed to resolve.

Keywords: epidural anaesthesia, paraplegia, transverse myelitis

Read More

Page 1 of 2

© 2015. Signa Vitae. Except where otherwise noted, content on this site is licensed under a Creative Commons Attribution 4.0 International license.