Progress of late-onset circulatory collapse in preterm infants / 国际儿科学杂志

Late-onset circulatory collapse(LCC)in preterm infants is characterized by sudden onset of hypotension and/or oliguria after the first week of life, which is resistant to volume expanders and inotropes but responds rapidly to timely glucocorticoids treatment.LCC should be managed promptly and properly, or it may cause respiratory, digestive complications and life-long neurological problems.Relative adrenal insufficiency is considered the most likely cause of LCC, but its pathophysiology remains unclear.This review summarizes the current reserch about LCC regarding its pathophysiology, clinical features, diagnosis, treatment, and prognosis.

Clinical Features of Late-Onset Circulatory Collapse in Preterm Infants

PURPOSE: This study aimed to investigate the incidence and clinical features of late-onset circulatory collapse (LCC) in preterm infants. METHODS: Medical records of 327 preterm infants (born before 32 gestational weeks) admitted to the neonatal intensive care unit of Seoul National University Bundang Hospital between January 2014 and December 2017 were reviewed. LCC was defined as sudden onset of refractory hypotension occurring after 7 days of life without obvious causes, which responded to glucocorticoid administration. Clinical characteristics and outcomes in infants with LCC were compared with those in infants with hypotension associated with identifiable causes, which developed after 7 days of life. RESULTS: Among 327 preterm infants who enrolled in this study, 65 infants developed hypotension with oliguria after 7 days of life. Among these 65 infants, 35 (53.8%) met the criteria for LCC and 30 (46.2%) were diagnosed with hypotension associated with other identifiable causes. No statistically significant differences were observed in the baseline pre- and perinatal characteristics between infants with LCC and those with hypotension associated with other causes. Infants with hypotension associated with other causes showed a higher mortality rate than those with LCC (33.3% vs. 5.7%, P=0.004). The mean gestational age and birth weight of infants with LCC were 27+5±2+1 weeks and 963±245 g, respectively. LCC occurred at a mean postnatal age of 18 days. The median body weight at the time of diagnosis of LCC was 1,200 g. No association was observed between LCC and gestational age. CONCLUSION: Among preterm infants born before 32 gestastional weeks who developed hypotension after 7 days of life, nearly 50% were diagnosed with LCC without apparent identifiable causes. Infants with LCC showed a lower mortality rate than those with hypotension associated with other causes.

Cardiac arrest due to intracranial hypotension following pseudohypoxic brain swelling induced by negative suction drainage in a cranioplasty patient: a case report / 대한마취과학회지

Pseudohypoxic brain swelling (PHBS) is known to be an uncommon event that may occur during and following an uneventful brain surgery, when negative suction drainage is used. The cerebrospinal fluid loss related to suction drainage can evoke intracranial hypotension that progress to PHBS. The main presentations of PHBS are sudden unexpected circulatory collapses, such as severe bradycardia, hypotension, cardiac arrest, consciousness deterioration and diffuse brain swelling as seen with brain computerized tomography (CT). We present a stuporous 22-year-old patient who underwent cranioplasty under general anesthesia. The entire course of the general anesthesia and operation progressed favorably. However, the time of scalp suture completion, sudden bradycardia and hypotension occurred, followed by cardiac arrest immediately after initiation of subgaleal and epidural suction drainage. After successful resuscitation, the comatose patient was transferred to the neurosurgical intensive care unit and PHBS was confirmed using brain CT.

Venous air embolism during hepatic resection in a patient with liver cirrhosis: A case report

Venous air embolism (VAE) is a potentially fatal complication in patients with chronic liver disease during liver surgery, although VAE is unlikely to occur during laparotomy in a supine position. We report a case presenting unexpected cardiovascular collapse due to venous air embolism in a patient with liver cirrhosis during hepatic resection.

Early Induction of Continuous Hemodiafiltration for the Prevention of Organ Failure after Cardiac Surgery / 日本心臓血管外科学会雑誌

Systemic inflammation after cardiac surgery using cardiopulmonary bypass (CPB), is closely associated with postoperative organ dysfunction. We evaluated the efficacy of continuous hemodiafiltration (CHDF) in controlling postoperative organ dysfunction, focusing on serum inflammatory substances and organ protection. We enrolled 14 patients with postoperative circulatory collapse. The mean age of patients was 71 years. Heart valve surgery was performed in 9 patients, coronary artery bypass grafting in 5 and graft replacement of the thoracic aorta in 2. The mean CPB time was 297±28 min. CHDF was initiated on the first or second postoperative day in 12 patients. A polysulfone membrane dialyzer and nafamostat mesilate were used for CHDF. 1) On blood examinations, serum IL-6 and IL-8 concentrations decreased 12 h after the initiation of CHDF (216±50→92±27 pg/dl, 71±23→30±7 pg/dl, respectively). Serum aldosterone decreased at 12 h (144±20→104±21 pg/ml). Four hours after the initiation of CHDF, systemic blood pressure significantly increased from 94±6 to 123±6 mmHg. The systemic vascular resistance index significantly increased from 1,431±137 dyn·sec·cm^-5·m² to 1,893±167. Urine volume significantly increased from 42±38 to 100±29 ml/h. Serum creatinine decreased from 2.1±0.3 mg/dl to 1.7±0.2 mg/dl on the second day. Respiratory function had significantly improved at 24 h. Early induction of CHDF reduced serum inflammatory substances, resulting in quick circulatory recovery without organ failure.

Clinical Analysis of Elevated Serum AST Level in Emergency Patients

PURPOSE: Serum aspartate aminotransferase (AST) is an enzyme widly used in the diagnosis of acute liver disease. It is also highly sensitive in cases of myocardial infarction and muscular injury. This study is designed to ascertain the utility of AST for diagnosis in emergency room. METHODS: From July 2001 to September 2002, 98 patients with AST greater than ten times (400 U/L) the normal range were identified by the biochemistry laboratory in the Emergency Medical Center of Chonnam National University Hospital. The patients 'clinical records were studied to determine the diagnosis, the clinical course, the physical finding on arrival, the past history, other serological and imaging studies, etc. RESULTS: The most common cause of elevated AST level was hepatic in origin (74 cases, 75.5%). Other causes were soft tissue injury (13 cases, 13.3%) and myocardial infarction (11 cases, 11.2%). In group with hepatic causes for raised AST, 21 (28.3%) patients had pancreaticobiliary desease, 20 (27.0%) patients were in conditions producing hepatic ischemia, 18 (24.3%) patients had hepatocellular desease, 6 (8.1%) patients had traumatic liver injury, and 4 (5.4%) patients had malignancy. The hepatic ischemia was caused by sepsis (6 cases, 30.0%), heart failure (6 cases, 30.0%), hypoxia (5 cases, 25.0%), and prolonged hypotension (3 cases, 15.0%). CONCLUSION: The main cause of a notably increased serum AST level is known to be hepatocellular disease, but this study for emergency patients revealed that other causes, such as hepatic ischemia, traumatic liver injury, and muscular disease, were also remarkable. When the level of serum AST is abnormally high, the clinician must consider not only hepatocellular disease but also prolonged hypotension, circulatory collapse, hypoxia, traumatic liver injury, etc.