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Signa Vitae

Journal of Intensive Care and Emergency Medicine

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Central blood pressure and pulse wave velocity in patients with resistant hypertension


Background. The measurement of brachial pressure (BP) has passed been on for ages, but the central pressure detection could only be possible with invasive techniques, until recently non-invasive and modern technology was introduced into the clinical setting. Studies described that the increase in central blood pressure (CBP) is an indicator of future cardiovascular or target organ damage. Compared with the general population, cardiorenal morbidity is much higher in patients with resistant hypertension (RH). We investigated for the first time the value of CBP and pulse wave velocity (PWV) in a group of RH patients.

Materials and Methods. Data from 80 patients with RH (resistance to 3 or more drugs, one is diuretic) without chronic kidney disease, at University hospital Merkur, Zagreb from the period of June 2017 to January 2018 were analysed. The pulse wave velocity (PWV), mean arterial pressure (MAP), vessels age (older than biological age), pulse pressure (PP), central blood pressure (CBP), brachial pressure (BP) were evaluated using the noninvasive Agedio B900 device (Germany).

Results. The median age was 58.75 (SD-15.3). 27 (35%) of patients were male (avg 53.9 y). BP and CBP were elevated in all RH patients (53 F/27M). The difference between the median value of BP (145.9/90.52mmHg, F=146.4/89.5, M=145/92) and CBP (132.16/91.78mmHg, F=132/90, M 131/94) was statistically significant for systolic BP (p<0.01). The mean value of the total measured PWV value was higher than reference for age in all RH and was 8.84 m/s. The mean value of PP and MAP was higher than reference (60.11 and 123,87 mmHg). The difference between sex was statistically significant higher for PWV in females than males (M/F= 8.1/9.2m/s, p<0.01). The difference between MAP median concentration (M/F=125.83/123) and PP (M/F=56/62mmHg) was not statistically significant (p>0.01).

Conclusion. Currently no gold standard technique is available to measure the CBP. Future studies should address that the cuff method could be a promising device in every day practice for this high risk population.

Key words: resistant hypertension, central blood pressure

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Postintubation hypotension in elective surgery patients: a retrospective study


Objective. Postintubation hypotension (PIH) is a common and recognized adverse event associated with poor outcomes in emergency medicine patients requiring endotracheal intubation. Our objectives were to determine the incidence of PIH following tracheal intubation in elective surgery patients.

Materials and Methods. A retrospective study by reviewing the anesthesia records of all patients presenting for elective surgery requiring tracheal intubation between February 1, 2017, and March 1, 2017 was performed. Patients were divided into 2 groups according to the severity of the operation: Group S1 (major surgery) and Group S2 (minor surgery). The primary outcome measure was the incidence of PIH. PIH was claimed when systolic blood pressure (SBP) decreased below 90 mm Hg or decreased more than 20% from the baseline in two consecutive measurements at least 15 minutes after intubation. Secondary outcome measures included the relationship between PIH and anesthetic induction agents used to facilitate ETI and ASA physical status.

Results. A total of 291 elective surgery patients were identified. The primary outcome of PIH was observed in 10.3% with no difference between study groups (major surgery-10.2% vs. minor surgery-10.3%). Most of the patients who developed PIH were ASA II score (76.6%) and propofol was the most commonly used intravenous anesthetic associated with hypotension (96.7%).

Conclusion. Although a transient decrease in systolic and diastolic blood pressure has been reported in most patients undergoing intubation for elective surgery, development of PIH occured only in 10.3% of patients. Most of the patients who developed PIH were administered propofol.

Keywords: post-intubation hypotension, elective surgery, endotracheal intubation, adverse events

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High sensitive troponin concentration stability in dialysate of anuric patients on hemodialysis


Background. High sensitive troponin I (hsTnI) and high sensitive troponin T (hsTnT) are markers of cardiac damage. Cardiomyocyte necrosis increases its blood levels. It is known that dialysis is cardiotoxic and that results in lack of contractility of certain myocardial segments. This mechanism is primarily due to hypo perfusion of the myocardium during dialysis. The dialysis itself increases cardiovascular (CV) risk in patients by many different mechanisms. It has been proven that the incidence of heart failure is much more frequent in patients on hemodialysis than in healthy population.

The aim of this pilot study was to investigate the presence of troponin T molecules and troponin I in dialysate and compare their concentrations.

Materials and Methods. The study included 5 anuric patients (4M) on hemodialysis. The dialysate samples were sampled for each patient three times during a dialysis cycle. The first sample was taken after thirty minutes, the second sample was taken in the middle of dialysis (120 minutes) and the third sample was taken thirty minutes before the end of dialysis. The value of hsTnI was measured using a high-sensitivity test on the Immuno-enzymatic analyzer Abbott Architest i1000SR. According to CLSI EP15-A2 protocol verification of hsTnT chemiluminescent micro-particle immunoassay on the analytical platform Roche cobas e411 was performed.

Results. Altogether 15 samples (three for each patient) were processed. hsTnT was detected in all 15 samples (13.42 ± 1.18 ng / L), while hsTnI was detected in only 8 samples (0.14 ± 0.16 ng / L). To test the difference in detectability between hsTnT and hsTnI, chi square test was used and the difference was statistically significant (Yates chi-square 6.708, p = 0.009).

Conclusion. The presence of troponin molecules in dialysate was determined for the first time in scientific literature. This study has confirmed that TnT is present in all dialysate samples and that its concentration is stable in dialysate. TnI concentrations were detectable in significantly lower concentrations.

Key words: hemodialysis, hs troponin T, hs troponin I, dialysate

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Methods for detecting and monitoring cerebral vasospasm in aneurysmal subarachnoid hemorrhage


Critical thinking about diagnostics and monitoring of cerebral vasospasm must take into account few basic facts. The first important thing is to distinguish two anatomically different structures: cerebral blood vessels and living tissue of the brain. Size and shape of cerebral arteries are the main point in radiological (digital subtraction angiography and other) morphological methods of investigation in brain heamodynamics. Changes in living brain tissue during brain ischemia can be detected by biochemical (cerebral microdialysis) or physical methods (magnetic resonance imaging, electrophysiology). Therefore, considering symptomatic cerebral vasospasm, at least two different methods of diagnostics should be applied: morphological one for detecting the size and shapeof cerebral arteries, and biological or physical one for detecting ischemic brain tissue.

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Treatment of haemorrhagic shock: a case report


The aim of this case report is to demonstrate that during extensive and long-lasting mutilating operations it is necessary to use an aggressive volume replacing approach to maintain adequate tissue oxygenation.

A satisfactory level of tissue oxygenation is necessary to uphold the function and structure of cells, tissue and organs. Monitoring the haemodynamic function during the operation is an important task for the anaesthesiologist.

We present a case of a 58-year-old woman with widespread malignant disease, who underwent surgical treatment in our hospital.

The operation was mutilating and long-lasting. During the perioperative period the patient received a large volume of fluids and blood products due to extensive intraoperative blood loss. High doses of vasoactive drugs were also introduced to achieve haemodynamic stability.

Due to adequate and aggressive volume replacement, haemodynamic stability was eventually achieved and the outcome was beneficial for our patient.

Key words: haemodynamic stability, blood loss, volume replacement

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