Use of noninvasive volume assessment methods to predict acute blood loss in spontaneously breathing volunteers

Objective@#The use of noninvasive volume assessment methods to predict acute blood loss in spontaneously breathing patients remains unclear. We aimed to investigate changes in the pleth variability index (PVI), vena cava collapsibility index (VCCI), end-tidal carbon dioxide (EtCO2), pulse pressure (PP), and mean arterial pressure (MAP) in spontaneously breathing volunteers after acute loss of 450 mL blood and passive leg raise (PLR). @*Methods@#This prospective observational study enrolled healthy volunteers in the blood donation center of an academic hospital. We measured the PVI, EtCO2, VCCI, MAP, and PP before blood donation; at the 0th and 10th minute of blood donation; and after PLR. The primary outcome was the changes in PVI, EtCO2, VCCI, MAP, and PP. @*Results@#We enrolled thirty volunteers. There were significant differences among the four obtained measurements of the PVI, EtCO2, and MAP (P<0.001, P<0.001, P<0.001, respectively). Compared to the predonation values, post-hoc analysis revealed an increase in the PVI at the 0th min postdonation (mean difference [MD], 5.4±5.9; 95% confidence interval [CI], -7.6 to -3.1; P<0.001); a decrease in the EtCO2 and MAP at the 0th and 10th minute postdonation, respectively (MD, 2.4±4.6; 95% CI, 0.019 to 4.84; P=0.008 and MD, 6.4±6.4; 95% CI, 3 to 9.7; P<0.001, respectively). Compared with EtCO2 at the 10th minute, the value increased after PLR (MD, 1.8±3.2; 95% CI, 0.074 to 4.44; P=0.006). @*Conclusion@#The PVI and EtCO2 could detect early hemodynamic changes after acute blood loss. However, it remains unclear whether they can determine volume status in spontaneously breathing patients.

Use of noninvasive volume assessment methods to predict acute blood loss in spontaneously breathing volunteers

Objective@#The use of noninvasive volume assessment methods to predict acute blood loss in spontaneously breathing patients remains unclear. We aimed to investigate changes in the pleth variability index (PVI), vena cava collapsibility index (VCCI), end-tidal carbon dioxide (EtCO2), pulse pressure (PP), and mean arterial pressure (MAP) in spontaneously breathing volunteers after acute loss of 450 mL blood and passive leg raise (PLR). @*Methods@#This prospective observational study enrolled healthy volunteers in the blood donation center of an academic hospital. We measured the PVI, EtCO2, VCCI, MAP, and PP before blood donation; at the 0th and 10th minute of blood donation; and after PLR. The primary outcome was the changes in PVI, EtCO2, VCCI, MAP, and PP. @*Results@#We enrolled thirty volunteers. There were significant differences among the four obtained measurements of the PVI, EtCO2, and MAP (P<0.001, P<0.001, P<0.001, respectively). Compared to the predonation values, post-hoc analysis revealed an increase in the PVI at the 0th min postdonation (mean difference [MD], 5.4±5.9; 95% confidence interval [CI], -7.6 to -3.1; P<0.001); a decrease in the EtCO2 and MAP at the 0th and 10th minute postdonation, respectively (MD, 2.4±4.6; 95% CI, 0.019 to 4.84; P=0.008 and MD, 6.4±6.4; 95% CI, 3 to 9.7; P<0.001, respectively). Compared with EtCO2 at the 10th minute, the value increased after PLR (MD, 1.8±3.2; 95% CI, 0.074 to 4.44; P=0.006). @*Conclusion@#The PVI and EtCO2 could detect early hemodynamic changes after acute blood loss. However, it remains unclear whether they can determine volume status in spontaneously breathing patients.

Reliability of chest pain risk scores in cancer patients with suspected acute coronary syndrome

Objective@#The history, electrocardiogram, age, risk factors, troponin (HEART), the thrombolysis in myocardial infarction (TIMI), and Global Registry of Acute Coronary Events (GRACE) scores are useful risk stratification tools in the emergency department (ED). However, the accuracy of these scores in the cancer population is not well known. This study aimed to compare the performance of cardiac risk stratification scores in cancer patients with suspected acute coronary syndrome (ACS) in the ED. @*Methods@#This prospective cohort study recruited patients with cancer who visited the ED because of suspected ACS. The development of any major adverse cardiac events (MACE) within 6 weeks was recorded, with the study outcome being a MACE within 6 weeks of ED admission. @*Results@#A total of 178 patients participated in this study, of whom 5.6% developed a MACE. Statistically significant differences were found between the mean HEART and TIMI scores in predicting MACE. The HEART score had the highest area under the curve (0.64; 95% confidence interval, 0.48–0.81), highest sensitivity (80%), and highest negative predictive value (97.5) in patients with cancer. @*Conclusion@#We found a similar rate of MACE in cancer patients with low-risk chest pain compared to that in the general population. However, the HEART, TIMI, and GRACE scores had a lower performance in cancer patients with MACE compared to that in the general population.

Myopericarditis caused by severe acute respiratory syndrome coronavirus 2

A 25-year-old man presented to the emergency department with acute-onset chest pain and shortness of breath. A physical examination revealed coarse crackles in the both lower lungs. Consolidation and ground-glass opacities suggesting viral infection were detected in the right lower lobe on chest computed tomography. Laboratory findings revealed elevated troponin, leukocytosis, and lymphopenia. Electrocardiography revealed ST segment elevation with PR depression in leads I, aVL, V5, and V6, and ST depression and PR elevation in aVR. Echocardiography revealed diffuse cardiac hypokinesia and a decreased left ventricular ejection fraction. Suspecting coronavirus disease 2019 (COVID-19)–related myopericarditis, the patient was hospitalized. After one week of empirical antibiotics, antivirals, and supportive therapy, his condition improved. Antibody testing for COVID-19 was positive on hospitalization day 8. The presentation of myopericarditis can be vague and mislead physicians during the COVID-19 pandemic. Myopericarditis should be included as a differential diagnosis for patients with suspected COVID-19.

Reliability of chest pain risk scores in cancer patients with suspected acute coronary syndrome

Objective@#The history, electrocardiogram, age, risk factors, troponin (HEART), the thrombolysis in myocardial infarction (TIMI), and Global Registry of Acute Coronary Events (GRACE) scores are useful risk stratification tools in the emergency department (ED). However, the accuracy of these scores in the cancer population is not well known. This study aimed to compare the performance of cardiac risk stratification scores in cancer patients with suspected acute coronary syndrome (ACS) in the ED. @*Methods@#This prospective cohort study recruited patients with cancer who visited the ED because of suspected ACS. The development of any major adverse cardiac events (MACE) within 6 weeks was recorded, with the study outcome being a MACE within 6 weeks of ED admission. @*Results@#A total of 178 patients participated in this study, of whom 5.6% developed a MACE. Statistically significant differences were found between the mean HEART and TIMI scores in predicting MACE. The HEART score had the highest area under the curve (0.64; 95% confidence interval, 0.48–0.81), highest sensitivity (80%), and highest negative predictive value (97.5) in patients with cancer. @*Conclusion@#We found a similar rate of MACE in cancer patients with low-risk chest pain compared to that in the general population. However, the HEART, TIMI, and GRACE scores had a lower performance in cancer patients with MACE compared to that in the general population.

Myopericarditis caused by severe acute respiratory syndrome coronavirus 2

A 25-year-old man presented to the emergency department with acute-onset chest pain and shortness of breath. A physical examination revealed coarse crackles in the both lower lungs. Consolidation and ground-glass opacities suggesting viral infection were detected in the right lower lobe on chest computed tomography. Laboratory findings revealed elevated troponin, leukocytosis, and lymphopenia. Electrocardiography revealed ST segment elevation with PR depression in leads I, aVL, V5, and V6, and ST depression and PR elevation in aVR. Echocardiography revealed diffuse cardiac hypokinesia and a decreased left ventricular ejection fraction. Suspecting coronavirus disease 2019 (COVID-19)–related myopericarditis, the patient was hospitalized. After one week of empirical antibiotics, antivirals, and supportive therapy, his condition improved. Antibody testing for COVID-19 was positive on hospitalization day 8. The presentation of myopericarditis can be vague and mislead physicians during the COVID-19 pandemic. Myopericarditis should be included as a differential diagnosis for patients with suspected COVID-19.