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Signa Vitae

Journal of Intensive Care and Emergency Medicine

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Prenatal and postnatal risk factors for developing bronchopulmonary dysplasia

Abstract

Aim. To determine prenatal and postnatal risk factors for developing bronchopulmonary dysplasia in infants < 30 weeks of gestational age.
Methods. Over a 22-month period, 115 newborns were enrolled in the study. Details including gestational age, sex, birth weight, prenatal steroids, surfactant treatment, ventilatory support, days of postnatal oxygen requirement, late onset sepsis/pneumonia, air leaks, patency of ductus arteriosus, and fluid intake were collected. The presence of chorioamnionitis was diagnosed by histological examination. Commercial ELISA kits were used for the determination of the IL-6 and IL-8 levels.
Results. Twenty-five infants developed BPD and 90 were enrolled in the non BPD group. Lower gestational age and male sex increased the risk for BPD. There was no difference in the presence of chorioamnitis and the level of IL-6 and IL-8 measured in cord blood and gastric aspirate between the groups. Intubation in the delivery room (resuscitation), need for surfactant treatment, mechanical ventilation, late onset sepsis/pneumonia, increased oxygenation index increased the risk for BPD after adjustment for GA and gender.
Conclusion. In our cohort of infants with GA < 30 weeks exposure to prenatal inflammation did not increase the risk for BPD. However, low gestational age, male sex, need for resuscitation, mechanical ventilation and late onset sepsis were major risk factors for BPD development.

Key words: premature infant, bronchopulmonary dysplasia, respiratory distress syndrome, chorioamnionitis, interleukin 6, interleukin 8

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Haemodynamic changes after induction of anaesthesia with sevoflurane vs. propofol

Abstract

Inhalation induction with sevoflurane would appear to offer several objective advantages compared to  induction with propofol. In our study, the hemodynamic results of sevoflurane vs. propofol induction in patients undergoing thoracotomy were studied. In a prospective, randomized, blinded study 24  patients were randomly allocated to one of 2 groups: sevoflurane (S) and propofol (P) (n=12 each). For  hemodynamic monitoring the LIDCO plus system was used. Patients in  group S were induced into anaesthesia with sevofluran, remifentanil and vecuronium, whereas patients in group P with propofol, remifentanil and vecuronium. The anaesthesia was maintained with the same agents. Hemodynamic stability was guided using a special algorithm. The goal was oxygen delivery index (DO2I) > 500 mL min-1 m-2. According to the algorithm, patients received colloids or vasoactive drugs. Hemodynamic parameters were recorded before induction, 3 minutes after induction and 3 minutes after intubation and commencement of  one lung ventilation. The consumption of vasoactive drugs and colloids and the time from the beginning of  induction to intubation were documented. No statistically significant differences in measured hemodynamic parameters, remifentanil and colloid consumption between the S and P group were found. In group P, statistically more ephedrine was used (S: 4.2, P:20.8, p<0.05). Patients undergoing thoracotomy induced with sevoflurane are circulatory more stable than those induced with propofol.

Key words: thoracotomy, one lung ventilation, cardiac index,  Systemic Vascular Resistance Index (SVRI)

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Continuous infusion versus bolus injection of furosemide in critically ill patients. A systematic review and meta-analysis.

Abstract

Introduction. Fluid overload and a positive fluid balance are common in the intensive care unit (ICU). Furosemide is frequently administered to increase  urine output. A bolus injection is the traditional mode of administration, but many concerns have been raised about possible intravascular volume fluctuations, toxicity and enhanced tolerance. Furosemide related adverse effects can be enhanced in critically ill patients. Continuous infusion should allow better hemodynamic stability, less side effects  and an easier achievement of the desired diuretic effect. We performed a systematic review and meta-analysis to compare the effects and complications of continuous furosemide infusion  with those of bolus injections in critically ill patients in the ICU.
Methods. Studies were searched in PubMed (updated January 2009). Backward snowballing of included papers was performed. International experts were contacted for further studies.
The inclusion criteria were: random allocation to treatment, comparison of furosemide bolus vs continuous infusion, performed in surgical or intensive care patients. The exclusion criteria were: non-parallel design randomized trials, duplicate publications, non-human experimental studies, no outcome data.
Results. Four eligible randomized clinical trials were identified, including 129 patients (64 to continuous infusion and 65 to bolus treatment). Continuous perfusion was not associated with a significant reduction in risk of mortality as compared to bolus injection
Conclusions. Furosemide in continuous perfusion was not associated with a significant reduction in risk of hospital mortality as compared to bolus administration in critically ill patients in ICU, but existing data are insufficient to confidently assess the best way to administer  furosemide . Applying a protocol to drive furosemide therapy could be more relevant than the chosen mode of administration.

Key words: furosemide, kidney Failure, intensive care, drug therapy, meta-analysis, diuretics

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Biochemical changes in the patient’s plasma after red blood cell transfusion

Abstract

Introduction. The study aimed at in vivo assessment of the impact of administered red blood cells (RBCs) concentrates on the plasma levels of K+, lactate, pH, Na+, Ca++ and glucose, depending on the volume and age of administered products. Biochemical changes occurring during the storage of these products were studied in vitro simultaneously.
Materials and methods. Arterial blood samples were collected in vivo from patients before and after RBCs transfusion and plasma levels of biochemical parameters were determined. A group of 80 RBCs samples was analyzed simultaneously, with the samples being equally distributed throughout the recommended storage time of 1–35 days.
Results. The age of RBCs concentrate results in increased potassium and lactate levels and decreased pH, sodium and glucose levels in the RBCs samples. The concentrations were in the following ranges: potassium 4.0–40.5 mmol/L; lactate 4.1–28.0 mmol/L; pH 7.0–6.65; sodium 137–116 mmol/L; glucose 29.0–14.0 mmol/L. A prospectively selected group of 46 patients were administered a total of 354 RBCs units. The mean age of RBCs concentrates was 16.18 days. The number of administered RBCs units ranged from 2 to 38, a mean of 7.7 RBCs units/patient. The administration of 1 RBCs unit was associated with a mean in vivo increase of the potassium level by 0.07 mmol/L and lactate level by 0.13 mmol/L.
Conclusion. The administration of larger amounts of RBCs concentrates may lead to an increase in the patient’s plasma levels of potassium and lactate. This increase is proportional to the age and volume of RBCs.

Key words: red blood cells, transfusion, hyperkalemia, lactate

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Influence of tobacco use on postoperative opiate analgesia requirements in patients undergoing coronary artery bypass graft surgery

Abstract

Introduction. The objective of this study was to test the hypothesis that tobacco use status is independently associated with postoperative opioid requirements in patients undergoing coronary artery bypass grafting (CABG) when important demographic variables such as age and gender are taken into account.
Methods. A retrospective chart review of patients who underwent CABG surgery over a one year period at Mayo Clinic in Rochester, MN was performed.  Tobacco users (N=69) were compared to nonusers (N=345) with regards to opiate requirements and the occurrence of severe pain during the first 48 hours postoperatively.  For comparison, all postoperative opiates were converted to oral morphine equivalents (OME).  Adjusted analysis for age and gender was also performed.
Results. Tobacco users were younger than nonusers (P < 0.001), and a greater proportion of former users were male compared to never users (P = 0.003).  Tobacco users had greater mean opiate requirements 401 ± 284 than nonusers 314 ± 240 mg OME, (P = 0.009).  However, the association between tobacco use and greater postoperative opiate requirements lost significance after adjustment for age and gender.  Tobacco use was not associated with increased risk of the development of severe pain (P = 0.51).
Conclusions. Although current tobacco users undergoing CABG surgery utilize more opioid analgesics in the first 48 hours following extubation than nonusers of tobacco, when adjusted for age and gender, tobacco use was not independently associated with differences in postoperative opioid use.

Key words: tobacco use, postoperative opiates, acute pain, coronary artery bypass surgery

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