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Objective: Hypercoagulation and high incidence of thrombosis during COVID-19 is well established. However, there is a lack of data, how it changes over time. The main purpose of our study was to access different parts of hemostasis in few months after acute disease. Material and methods. Patients discharged from our hospital were invited for follow up examination in 2,3-3,8 (group 1 - 55 pts) or 4,6-5,7 months (group 2 - 45 pts) after admission. Control group (37 healthy adults) had been collected before pandemic started. Standard coagulation tests, aggregometry, thrombodynamics and fibrinolysis results were compared between groups. Result(s): D-dimer was significantly higher, and was APPT was significantly lower in group 2 compared to group 1, while fibrinogen, prothrombin levels didn't differ. Platelet aggregation induced by ASA, ADP, TRAP, spontaneous aggregation didn't differ significantly between groups. Thrombodynamics revealed hypocoagulation in both group 1 and group 2 compared to control: V, mum/min 27,3 (Interquartile range (IQR) 26,3;29,4) and 28,3 (IQR 26,5;30,1) vs. 32,6 (IQR 30,4;35,9) respectively;all p < 0,001. Clot size and density in both group 1 and group 2 were significantly lower than in control group. Fibrinolysis appeared to be enhanced in x2 compared to control and group 1. Lysis progression, %/min was higher: 3,5 (2,5;4,8) vs. 2,4 (1,6;3,5) and 2,6 (2,2;3,4) respectively, all p < 0,05. Lysis onset time in both group 1 and group 2 was significantly shorter compared to control. Conclusion(s): We revealed normalization of parameters of clot formation process in 2-6 months after COVID-19, while fibrinolysis remained still enhanced. Further study is required to investigate the clinical significance of these changes.Copyright © Creative Cardiology 2021.
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Background Surgical strategies to achieve biventricular (BiV) repair in children with borderline left ventricle (LV) continue to evolve. We report our innovative strategy of LV recruitment utilizing systemic to pulmonary artery shunt upsizing along with fenestrated atrial septation (FAS). Case The case is a 22mo old with hypoplastic left heart variant with type A aortic arch interruption and bilateral SVC. The LV, aortic and mitral valve were hypoplastic not meeting criteria for BiV repair. He underwent stage 1 palliation (Norwood with 4mm BTT shunt). Frequent COVID infections and over-circulation led to BiV dysfunction and cardiogenic shock requiring ECMO support for 4 days. At 5 months of age cardiac catheterization (CC) revealed good hemodynamic parameters for a stage 2 Glenn. An MRI also revealed growth of the left ventricle. Decision-making A decision was made to engage in a staged LV recruitment process to achieve BiV repair. We elected to avoid a volume offloading procedure in the form of a Glenn. To optimize continued volume loading on the LV, Stage 2 palliation consisted of upsizing to a 5mm BTT shunt with 4mm FAS. MRI at 22 months showed an LV volume of 60ml/m2 associated with CC hemodynamics showing LA pressure of 13mmHg, and LV end-diastolic pressure of 12mmHg. He underwent BiV repair with takedown of DKS, with primary anastomosis of the aorta and the pulmonary artery to their respective circulations. The postoperative echocardiogram illustrated a gradient of 5mmHg and 3mmHg through the mitral and aortic valve respectively. The pt was placed on a beta blocker and discharged on day 5 following BiV conversion. This strategy provides increased pulmonary blood flow with increased bloodflow across the mitral valve and inflow into the LV. In so doing may enhance the rate of LV growth. Furthermore, this strategy avoids the bidirectional Glenn (BDG), a volume offloading operation. Conclusion Shunt upsizing with FAS is well tolerated. It has the potential advantage for fewer operations to achieve BiV circulation due to rapid LV growth in comparison to other staged LV recruitment strategies involving the BDG.Copyright © 2023 American College of Cardiology Foundation
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Aim: Troponin I is an important prognostic marker in critically ill patients with COVID-19, similar to cytokines and other inflammatory mediators. The aim of this study was to evaluate the predictive value of troponin I levels for mortality in geriatric patients transferred to the intensive care unit for COVID-19 pneumonia according to age group. Material(s) and Method(s): Seventy-four patients with COVID-19 pneumonia were grouped according to age (Group 1:65-74 years, Group 2: 75-84 years, and Group 3: >= 85 years) and retrospectively analyzed. Demographics, clinical findings, laboratory results upon admission to the intensive care unit, and outcomes were compared among the groups. Predictive value of troponin I levels upon admission to intensive care unit (Troponin Iicu), difference in troponin levels between general wards and intensive care unit (Troponin Idiff), C-reactive protein, ferritin, lactate dehydrogenase, neutrophil-to-lymphocyte ratio, procalcitonin, and D-dimer levels for mortality were also investigated. Result(s): The mortality rate was 74.3% for the patients overall, and increased, albeit insignificantly, with increasing age. Neither Troponin Iicu nor Troponin Idiff was predictive for mortality for any of the age groups or for the patients overall. Ferritin, lactate dehydrogenase, neutrophil-to-lymphocyte ratio, and C-reactive protein levels were predictive for mortality for patients overall (p= 0.016, p= 0.001, p= 0.013, and p < 0.001, respectively). Discussion(s): For geriatric patients, troponin I levels at the time of the first admission to the ICU are not sufficient to predict mortality alone and should be evaluated together with other parameters.Copyright © 2022, Derman Medical Publishing. All rights reserved.
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The proceedings contain 67 papers. The topics discussed include: cardiovascular system and COVID-19;long term sequale on COVID-19;fighting vascular disease: thoughts about 2022 Taiwan hypertension guidelines;quantification of hemodynamic parameters using 4D flow MRI;nanomedicine for the treatment of atherosclerosis;direct thrombus imaging;clinical outcome in patients with deep vein thrombosis;cardiovascular benefits of SGLT-2 inhibitor;central blood pressure and pressure wave reflection in cardiovascular abnormalities: do not put them in shade;association between excess pressure and cognitive function among elderly population;visceral adipose tissue, coronary artery calcification and heart failure: a moderated mediation analysis;and the cardio-ankle vascular index was associated with CHADS2 score in patients with atrial fibrillation: a coupling registry study.
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Introduction: The bispectral index monitors the unawareness component of balanced anaesthesia and gives us the depth of Anesthesia.It reflects the response of the brain to a variety of hypnotic and inhaled anaesthesia agents. The aim of this study was to see the effect of different MAC values of isoflurane on the bispectral index and hemodynamic variations at different MAC values. Material(s) and Method(s): This prospective study was conducted on 20 patients at tertiary care center for 6 months. After induction of Anesthesia, following parameters were recorded: noninvasive blood pressure measurement, heart rate, oxygen saturation, ETCo2 and BIS values. The BIS was continuously monitored and when the MAC values of isoflurane were 0.5, 0.7, 1, 1.2 and 1.5 corresponding BIS values and all the other haemodynamic parameters were noted. Result(s): In 11 patients out of 20 patients satisfactory BIS of 40-60 was achieved at MAC 0.5. In 16 out of 20 patients satisfactory BIS 40-60 was achieved at 0.7 MAC. In all the 20 patients satisfactory BIS was achieved at 1 MAC.In 2 out of 20 patients we couldn't proceed beyond 1.0 MAC because of the fall in MAP to <65mm of Hg. In 4 out of 20 patients we couldn't proceed beyond 1.2MAC because of the fall in MAP to <65mm of Hg. Conclusion(s): Isoflurane produced satisfactory BIS of 40-60 in 16 patients at 0.7 MAC and in all the 20 patients at 1 MAC.Use of BIS in our study helped in better titration of Isoflurane according to patient's individual needs thereby we avoided light plane of anaesthesia or deep hypnosis and the adverse effects associated with it. Copyright © 2022 Wolters Kluwer Medknow Publications. All rights reserved.
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Aim/Introduction: COVID-19 pandemic has introduced significant new challenges in everyday medical practice, as history of COVID-19 infection becomes increasingly prevalent and its potential long-term effects and interactions with other known or unknown health problems have not been fully clarified. Here, we aimed to characterize patients with a history of COVID-19 infection who underwent myocardial perfusion imaging at the department of nuclear medicine of a tertiary cardiovascular medicine center. Material(s) and Method(s): Records of all patients with a history of COVID-19 infection with/without need for hospitalization who underwent scintigraphy from April, 1, 2021 to March, 31, 2022 at our department were obtained. Patients undergoing scintigraphy for indications other than myocardial ischemia/viability detection (for example lung perfusion scans, bone scans) were excluded. Regarding myocardial perfusion studies, the presence of scar or ischemia was determined, together with basic hemodynamic parameters (blood pressure, systolic-SBP, diastolic-DBP, pulse-PP) and the respective changes from rest to maximal stress, according to stress test applied. Result(s): In total, 152 patients undergoing myocardial perfusion imaging reported previous COVID-19 infection. For 3 patients, data were incomplete, so the remaining 149 formed our study group (94 male, 55 female, age 67>10years, 5>4 months after COVID-19 infection). In 48 of them (32.2%), treadmill stress test according to Bruce protocol was applied. Another 60 received intravenous adenosine infusion (40.3%), the remaining 41 undergoing regadenoson test (27.5%). Patient age differed significantly according to stress test type (treadmill: 63>10 years, adenosine 70>8 years, regadenoson: 66>10 years, p=0.0001). Forty five patients (30.2%) had reversible perfusion defects compatible with ischemia, while 21 (14.1%) showed permanent perfusion defects (myocardial scar). Both ischemia and scar were more common among patients who needed hospitalization due to COVID-19 compared to those with milder symptoms (ischemia: 17/40 among patients with history of hospitalization, 28/109 among those with no hospitalization due to COVID-19, p=0.048;scar: 11/40 among patients with history of hospitalization, 10/109 among those with no hospitalization, p=0.004). Among those undergoing treadmill test, the ones with history of COVID-19 hospitalization showed higher SBP and PP increase during exercise (86>17 versus 60>24mmHg for SBP, 65>18 versus 45>24mmHg for PP, p=0.009 and p=0.048 respectively), while DBP differences were insignificant. Conclusion(s): Abnormal myocardial perfusion findings in the form of both fixed and reversible perfusion defects are more common among patients needing hospitalization for COVID-19 infection. Altered hemodynamic response to exercise is also present in this patient population.
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Background: Acute kidney injury (AKI) is frequent in critical ill patients and around 20% of patients admitted to intensive care unit (ICU) require continuous renal replacement therapy (CRRT). In our center, during the first pandemic wave, we observed severe metabolic acidosis associated with a worsening of respiratory function in our COVID-19 patients receiving continuous hemodialysis (CVVHD) and hemodiafiltration (CVVHDF). The aim of the study is to assess the association between arterial blood gas (ABG) data and haemodynamic parameters in COVID-19 patients receiving CVVHD or CVVHDF. Regional citrate anticoagulation was applied for all CRRT treatments. Our hypothesis was that hypoperfused patients could face a reduced metabolic and hepatic activity, making them unable to metabolize the citrate to bicarbonate, worsening their acidosis instead of correcting it. Method(s): This is a retrospective, observational study. It includes 10 COVID-19 patients hospitalized at the ICU of the Bufalini Hospital of Cesena (Italy) from the 11th of March to 26th of April 2020 and treated with CRRT. Overall, 28 CRRT treatments were analysed and patients were divided in two groups: 1) Hypotensive Group (MAP < 70 mmHg);2) Non Hypotensive Group (MAP> 70 mmHg). ABG and MAP data were recorded pre and post-treatment. Patients with severe or worsening metabolic acidosis (pH < 7.3) pre-CRRT were defined as "non-adjusters". Result(s): A number of 9 (50%) hypotensive patients were able to correct their acidotic status, while (70%) of normotensive patients were able to improve their pH. The number of patients and treatments is too low to calculate p-value. In 28 CRRTs performed, 16 (57%) corrected their pH. (57%), while 12 (43%) severe acidosis were refractory to the treatment. Eighteen patients (64%) presented hypotension, 10 (36%) presented with normal pressure levels (MAP>65mmHg). In hypotensive patients,mean pre-CRRT pH value was 7,31 (+/-0,07) with BE mean value-3,4 (+/-2,7);in non-hypotensive group the pre- CRRT mean pH value was 7,33 (+/-0,01) with BE mean value-2,67 (+/-4,7). Mean lactate levels in the hypotensive group were 1,26 (+/-0,6), in the non hypotensive group the mean value was 1,6 (+/-0,74). Conclusion(s): In COVID19 patients, the impairement of organ perfusion might reduce the ability of the liver to metabolise citrate, worsening metabolic acidosis. The use of CRRT with lactate-buffered fluids in some cases might not be helpful, leading to further increases in lactate levels.
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About 1 out of 10 patients infected with Sars-CoV2 have persistent symptoms beyond 4 weeks and some of them meet diagnostic criteria for postural tachycardia syndrome (Long-COVID POTS). The pathophysiology of Long-COVID POTS is unknown, but autonomic dysfunction may play a role. We hypothesize Long-COVID POTS patients have impaired cardiovascular autonomic reflexes and cardiac sympathovagal balance. We conducted a case-control study with patients recruited from the Vanderbilt Autonomic Dysfunction Center and an historical population of healthy controls. Hemodynamic parameters were measured before and during 75degree head up tilt. Supine ECG and finger blood pressure were continuously measured for spontaneous heart rate variability analysis. The Low Frequency (0.04-0.15Hz, LF ) and High Frequency (0.15-0.4 Hz, HF ) oscillatory modulations of sino-atrial node discharge were computed. We included 14 Long-COVID POTS patients and 15 controls matched by age (34+/-11 vs 28+/-7;p=0.09) and BMI (26.1+/-5.3 vs 23.0+/-2.6;p=0.06). As expected, the orthostatic HR increase was higher in Long-COVID POTS compared to controls (40+/-18 vs 21+/-1, p<0.05). Spectral analysis of heart rate variability in 9 patients and 15 controls (Figure) showed that Long-COVID POTS had reduced HF (363+/-420 vs 933+/-1000 ms ;p<0.05) and similar LF (798+/-596 //////////vs 962+/-1075 ms ;p=0.68), resulting in a greater LF/HF ratio (3.7+/-2.9 vs 1.4+/-1.3;p<0.05). Patients with Long-COVID POTS have reduced markers of cardiovagal modulation, but normal cardiac sympathetic activation. Our results suggest that parasympathetic dysfunction contributes to the pathophysiology of Long-COVID POTS.
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Aim and background: The prevalence of acute kidney injury (AKI) among COVID-19 patients admitted to ICU was 46%. There is a paucity of data on renal recovery in a cohort of patients with AKI. Since COVID-19 is considered a public health issue, the estimates from this study might help in prognostication and health resource management. Objective: To evaluate the predictors and dynamics of renal recovery in critically ill COVID-19 patients with AKI. To study the duration and magnitude of AKI, the proportion of patients dependent on dialysis at hospital discharge, and mortality among COVID-AKI patients. Materials and methods: A single-centre, observational study was conducted in a mixed adult ICU from March 1, 2020, to February 1, 2021. COVID-19 patients who presented with or developed AKI as per KDIGO criteria within 7 days of ICU admission were included. Baseline characteristics, hemodynamic parameters, and renal recovery kinetics were captured till the discharge of the patient. Patients were followed up till 90 days post-discharge. Logistic regression with best subset selection was performed with renal recovery as an outcome (recovery is defined as attaining AKI stage 0 by KDIGO definition or 33% reduction of serum creatine from baseline) and APACHE II, rapidity of onset and progression of AKI, the magnitude of AKI, inflammatory markers, comorbidities, and P/F ratios as predictor variables. There were no multicollinearities, influential observations. Penalized-likelihood criteria (AIC and BIC models) were applied and a model with the lowest AIC or BIC was considered as the best fit to predict nonrecovery from AKI. Results: 200 patients' data were analysed, of which 67 patients recovered from AKI. Of the 67 patients, 16, 9, and 10 patients had transient AKI (<48 hours), persistent AKI (2-7 days), and AKD (7-90 days), respectively. Dialysis was required for 136 patients. The average duration for recovery from AKI was 7.4 days. The best fit model with the lowest BIC that predicted nonrecovery from AKI were: the combination of APACHE II, day onset of AKI, and magnitude of AKI. Results of logistic regression showed admission APACHE II, day onset of AKI, and magnitude of AKI were statistically significant in predicting non-recovery from AKI [OR 1.1 (p < 0.001;95% CI 1.06-1.16), OR 1.6 (p = 0.001;1.24-2.24), and OR 2.9 (p < 0.001;2.03-4.36), respectively]. This model had sufficient discrimination with AUC 0.86 and was well calibrated [Hosmer-Lemeshow (HL) chi2, p = 0.06]. Overall mortality among COVID-AKI patients was 84%. Two patients were dependent on dialysis at hospital discharge. Upon follow-up of 31 survivors for 90 days, four deaths were recorded. Conclusion: In our study, a higher APACHE II score at admission, the longer time interval between admission to the onset of AKI and the higher magnitude of AKI during ICU stay predicted poor renal recovery. A significant proportion of our patients require dialysis support and this poses a challenge on hospital resources and financial burden to the family. We observed higher mortality among COVID-19 patients with AKI compared to those with AKI not associated with COVID-19.
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Objectives: Hospital resource usage is under constant review, and the extent and intensity of postoperative care requirements for vascular surgical procedures has been especially relevant in the setting of the COVID-19 (coronavirus disease 2019) pandemic and its impact on staffed intensive care unit (ICU) beds. We evaluated the feasibility of regional anesthesia and low-intensity postoperative care for patients undergoing transcarotid artery revascularization (TCAR) at our institution. Methods: All patients at high risk for carotid endarterectomy undergoing TCAR at a single institution from 2018 to 2020 were reviewed. Perioperative management was standardized by the use of an institutional protocol that included hemodynamic parameters and requisite medications, anticoagulation and/or antiplatelet regimens, neurovascular examination guidelines, and nursing instructions. The anesthetic modality was at the surgeon’s preference. Patients were transferred to the postanesthesia care unit (PACU) for 2 hours (with a 1:1 or 1:2 nursing ratio) followed by the step-down unit (1:4 nursing ratio) for 4 hours, followed by transfer to the floor (1:6 ratio) or, alternatively, were transferred to the ICU (1:1 ratio). Intravenous (IV) blood pressure medications could be administered in all environments, except for the floor. The recovery location and length of stay were recorded. Results: A total of 83 patients had undergone TCAR during the study period. The mean age was 72 ± 9 years, 59% were men, and 36% were symptomatic. Regional anesthesia was used for 84%, with none converted to general anesthesia intraoperatively. Postoperatively, only seven patients (8%) had required monitoring in the ICU overnight (decided perioperatively). This was mostly for patients with prior neurologic symptoms but for one patient was because of a postoperative neurologic event and for another patient because of pulseless electrical activity arrest. Of the 83 patients, 76 (92%) had been monitored in the PACU, with 8 transferred to the floor after 4 hours and 13 discharged directly from the PACU (owing to limited bed availability). Of the patients in the PACU, 55 were transferred to the step-down unit after 2 hours and discharged from there. Six patients had required IV antihypertensive agents, and eight had required IV vasoactive support postoperatively. The mean length of stay in the ICU was 3.7 days (range, 1-15 days). The mean length of hospital stay was 1.8 ± 2.3 days (3.7 ± 5.4 days for those requiring the ICU and 1.4 ± 1.2 days for those not requiring the ICU). The incidence of stroke, death, and myocardial infarction was 2.4%. There was one postoperative stroke considered to be a recrudescence of a prior stroke, and one respiratory arrest fatality in a frail patient with a neck hematoma, both of whom had been treated under general anesthesia. Conclusions: Using perioperative care protocols, TCAR can safely be performed while avoiding both general anesthesia and an ICU stay for most patients.
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Background: The use of intermittent infusion of Levosimendan (L) demonstrated to be able to reduce hospitalisations and to improve functional capacity and quality of life in patients with advanced heart failure (HF). Purpose: To describe our preliminary experience regarding L intermittent infusions in advanced HF older outpatients. Methods: A maximum of three consecutive L infusions were carried out 14 days apart. The duration of each session was 8 hours. The starting infusion rate was 0.05 μg/Kg/min, titrated every 30/60' up to a maximum of 0.2 μg/Kg/min based on blood pressure, heart rate and arrhythmias recorded during telemetry. We evaluated patients by clinical, laboratory and echocardiographic controls at baseline and two weeks after the end of treatment. Results: Since November 2020 we enrolled 17 patients with a mean age of 77 years;12% were women. HF etiology was ischemic in 64% of cases and the mean ejection fraction was 30%. A total of 41 infusions were performed, the mean dose of L administered was 5.4 mg/infusion. Three patients did not complete the expected treatment, one due to an intercurrent COVID-19 infection and two because of social issues. In 28 sessions the maximum infusion rate was reached, while in 12 a lower rate;in one case drug infusion was suspended (Figure 1). The main complication observed was marked non-symptomatic hypotension, followed by the onset of atrial fibrillation or frequently ventricular extrasystole. As shown in Figure 2, at the end of the infusion cycles, there was an improvement of clinical and hemodynamic parameters. Moreover, at the end of the infusion cycles, we observed a reduction in the mean dose of loop diuretic prescribed and an increase in the prescription of disease- modify treatment, according to HF guidelines (Figure 3). Conclusions: In our preliminary experience repeated infusions of L appear to be well tolerated in older patients with advanced HF. Although there was an improvement in congestion parameters and targeted therapy for HF, more data will be needed in the future to confirm its safety and efficacy, also in terms of guidelines-directed medical therapy. (Figure Presented).
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The health care burden and risks to health care workers imposed by novel coronavirus disease 2019 (COVID-19) mandated the need for a simple, noninvasive, objective, and parsimonious risk stratification system predicting the level of care, need for definitive airway, and titration of the ongoing patient care. Shock index (SI = heart rate/systolic blood pressure) has been evaluated in emergency triage, sepsis, and trauma settings including different age group of patients. The ever accumulating girth of evidences demonstrated a superior predictive value of SI over other hemodynamic parameters. Inclusion of respiratory and/or neurological parameters and adjustment of the cutoffs appropriate to patient age increase the predictability in the trauma and sepsis scenario. Being reproducible, dynamic, and simple, SI can be a valuable patient risk stratification tool in this ongoing era of COVID-19 pandemic.
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Background: Most of the time propofol and ketamine have been used as an induction agent in adult surgical patients but propofol may cause cardiorespiratory depression while ketamine increases heart rate and arterial blood pressure. On the other hand, the clinical effects of propofol and ketamine seem to be complementary. Ketofol is most commonly used for procedural sedation hence exploring its effectiveness for induction will be paramount for the clinical care of surgical patients. Objective: This study aims to compare the hemodynamic changes between ketofol and propofol within 30 min after induction of general anesthesia for elective surgical patients. Methodology: A Double-blind Randomized Controlled Trial was done on 62 patients aged between 18 and 65 years and the American Society of Anesthesiologist class I & II those have been allocated randomly into ketofol and propofol groups. A change in systolic blood pressure, mean arterial pressure, and heart rate within 30mins was followed for both groups. After the normal distribution of data was tested analytic statistics were calculated for variables in the study using Mixed ANOVA, Independent samples T-test, and Mann Whitney U test as appropriate, and for categorical data Chi-square test or fisher's exact test was used for analysis. P-value < 0.05 is considered statistically significant with a power of 90%. Results: Both the mean systolic blood pressure and mean arterial pressure were significantly decreased in the propofol group immediately after induction, at 5th minute, 10th minute, and 15th minute compared to the baseline value with a statistically significant value of (p < 0.05). There was a significant increase in mean heart rate in the ketofol group immediately after induction and on the 5th minute after induction compared to the baseline value (p = 0.001 and p = 0.022 respectively). Conclusion and recommendations: We conclude the administration of ketofol (0.75 mg/kg of ketamine and 1.5 mg/kg of propofol) for induction of general anesthesia has better hemodynamic stability than propofol during the first 30 min after induction. We recommend to researchers to do further randomize controlled trials, with invasive blood pressure measurement and multicenter study.
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Introduction: One of the key challenges in treating COVID-19 ARDS patients is hemodynamic monitoring. Therapies proven to be effective in ARDS, such as protective ventilation, fluid restriction or high PEEP tend to alter right ventricular (RV) function and indicate a closer in-bed management, which is particularly difficult in prone position (PP) patients. Transthoracic echocardiography(TTE) enables a direct window for hemodynamic monitoring of RV performance. Objective: To assess characteristics and potential hemodynamic benefits of proning on the RV in ICU patients with SARS-CoV-2 ARDS, using echocardiography. Methods: This is an observational, cross-sectional study of SARS-CoV-2 ARDS in 11 patients hospitalized in a 12 bed ICU in Farhat Hached University hospital in December 2020. All patients were deeply sedated and curarized during the study. After a stabilization period (MAP ≥ 65mmHg), TTE was performed first in the supine position before putting the patient on PP. Same measures were repeated during a second scan 4 to 8 hours after PP setting. Norepinephrine infusion levels were not changed between the two scans. The average duration of a scan was 20 ± 10 minutes depending mostly on echogenicity. Several frequencies and harmonics were tested and we selected the ones that provided the best image quality. PP ventilation (PPV) was performed continuously for 12 hours using the 'swimmer position' that enabled affordable TTE views. A quantitative study of the RV was performed using RV focused 4C view. A special view dedicated to the IVC was studied. Parameters measured were RV basal end diastolic diameter, S' peak wave in TDI, tricuspid annular plane systolic excursion (TAPSE), fractional area change (FAC) and maximal trans tricuspid velocity (MTTV). Post hoc analysis was performed by two readers (one intensivist and one cardiologist). All parameters are expressed as a mean of two measurements. Results: Twenty-four TTEs were performed in 11 patients respectively 40 ± 15mn before and 5.8 ± 1.1hrs after the PP setting. Patients were 71.0 ± 9.4yrs aged, 5(45%) obese, 7(63%) had diabetes mellitus, 4(36%) hypertension, 1(9%) coronary artery disease. All (100%) were on sinus rhythm. 7(63.6%) presented moderate ARDS and 3(27.3%) severe ARDS. None of the patients developed RV failure prior to the examination. The PPV achieved a non-statistically significant improvement in RV function as assessed by the increase of S', TAPSE, a decrease in RV basal diameter and an increase in FAC. A statistically significant decrease in MTTV (mean 3.20 ± 0.49 m/s before PP vs mean 2.47 ± 0.77m/s (p = 0.01)) was objectified. Conclusions: PPV improves hemodynamic parameters of the RV. TEE 4C view is sufficient in the assessment of RV function in PP. SPAP monitoring could be the key parameter to quickly and reliably assess RV response to PPV.
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Patient 60 years old, a teacher working from home, got infected from her husband. The husband was an asymptomatic. Symptoms were loss of taste and smell, fever, weakness, nausea, vomiting, diarrhea, blurred vision. Hemodynamic parameters-BP 90/60 mm Hg, HR-99 bpm. Her regular HR was 55-60 bpm. Due to the overloading of hospitals, there was a queue for hospitalization at home. She was receiving the treatment of a family doctor. On the 9th day, her condition became worst. CT-scan picture showed 20% of lung lesions. Hemodynamic parameters were-BP 80/50 mm Hg, HR-115 beats. Due to of progressive dehydration, the high temperature lasted for 12 days. In anamnesis she has a drug allergy, chronic hypertension with left anterior bundle branch block because of suffering with rheumatic heart disease from the childhood. Any kind of liquid per oral caused immediate nausea and vomiting. Saturation was 74. We had to start i/v therapy at home in order to stop severe dehydration and high fever. Mobile oxygen delivery devices were used to monitor saturation. With that treatment during the day, the saturation indicator was 92. But at night, when the saturation went down below 86, the device, by means of an audible alert, gave a signal to connect oxygen. BP dropped to 70/50 mm Hg, HR-120 bpm. The patient also received factor XA inhibitor, antibiotic therapy, antiviral therapy, vitamins C and D. After these measures, she felt better, but could not take liquid on her own, as it still caused nausea. On the 14th day, a place was vacated in one of the hospitals and she was hospitalized. In the hospital, she spent another 10 days, the hemodynamics returned to normal and the second CT-scan showed 5% of the lungs damage. She was discharged of her own free will. For 1.5 months after that, she still felt severe weakness and was unable to work.
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BACKGROUND: COVID-19 can cause a clinical spectrum from asymptomatic disease to life-threatening respiratory failure and acute respiratory distress syndrome (ARDS). There is an ongoing discussion whether the clinical presentation and ventilatory parameters are the same as typical ARDS or not. There is no clear understanding of how the hemodynamic parameters have been affected in COVID-19 ARDS patients. We aimed to compare hemodynamic and respiratory parameters of moderate and severe COVID-19 and non-COVID-19 ARDS patients. These patients were monitored with an advanced hemodynamic measurement system by the transpulmonary thermodilution method in prone and supine positions. PATIENTS AND METHODS: Data of 17 patients diagnosed with COVID-19 and 16 patients diagnosed with other types of diseases with moderate and severe ARDS, mechanically ventilated, placed in a prone position, had advanced hemodynamic measurements with PiCCO, and stayed in the intensive care unit for more than a week were analyzed retrospectively. Patient characteristics and arterial blood gases analysis recorded at admission and respiratory and advanced hemodynamic parameters during the first week were compared in prone and supine positions. RESULTS: No difference was observed in the respiratory parameters including respiratory system compliance between COVID-19 and non-COVD-19 patients in prone and supine positions. In comparison of advanced hemodynamic parameters in the first week of intensive care, the extravascular lung water and pulmonary vascular permeability indexes measured in supine position of COVID-19 ARDS patients were found to be significantly higher than non-COVID-19 patients. Duration of prone position was significantly longer in patients diagnosed with COVID-19 ARDS. CONCLUSIONS: The results of this study suggested that COVID-19 ARDS is a variant of typical ARDS with a different pathophysiology. HOW TO CITE THIS ARTICLE: Asar S, Acicbe Ö, Sabaz MS, Tontu F, Canan E, Cukurova Z, et al. Comparison of Respiratory and Hemodynamic Parameters of COVID-19 and Non-COVID-19 ARDS Patients. Indian J Crit Care Med 2021;25(6):704-708.