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1.
Sci Total Environ ; 928: 172464, 2024 Jun 10.
Article in English | MEDLINE | ID: mdl-38621535

ABSTRACT

Biofouling is a serious challenge for global salmon aquaculture and farmers have to regularly clean pen nets to avoid impacts on stock health and farms' structural integrity. The removed material is released into the surrounding environment. This includes cnidarian species such as hydroids, whose nematocyst-bearing fragments can impact gill health and fish welfare. There is also increasing evidence of the association of parasites and pathogens with biofouling organisms and cleaning fragments. It is unknown whether and how far local current regimes disperse biofouling material and whether this material reaches and interacts with adjacent pens or even neighbouring farms downstream, or wild fish populations in surrounding environments. We focussed on the cnidarian hydroid Ectopleura larynx, one of the most abundant biofouling species on Norwegian aquaculture installations. Using a 3D hydrodynamic model parameterised with physical and biological properties of hydroid particles (derived via field and laboratory studies), we simulated the dispersal of net cleaning waste from two Norwegian salmon farms. Our results demonstrate that net cleaning waste is extensively dispersed throughout neighbouring pens, and even to adjacent aquaculture facilities. Salmon were exposed to concentrations of biofouling particles up to 41-fold elevated compared to background concentrations, and for up to 30.5 h. Maximum dispersal distance of hydroid particles was 5.5 km from the point of release, achieved largely within 48 h. Least-cost distance calculations show that this distance exceeds the nearest-neighbour distance of 70 % of Norway's salmon farms (654 farms). Our study provides some evidence that actions taken to manage biofouling at salmon farms may affect neighbouring farms and surrounding natural environments. The results highlight the potential risks associated with net cleaning: the dispersal of harmful cnidarian particles, associated pathogens, and non-indigenous species, thus underlining the need for novel farming or net cleaning technologies that prevent the release of potentially harmful cleaning waste.


Subject(s)
Aquaculture , Biofouling , Salmon , Animals , Biofouling/prevention & control , Norway
2.
Aquat Toxicol ; 267: 106825, 2024 Feb.
Article in English | MEDLINE | ID: mdl-38176169

ABSTRACT

Oil and gas industries in the Northern Atlantic Ocean have gradually moved closer to the Arctic areas, a process expected to be further facilitated by sea ice withdrawal caused by global warming. Copepods of the genus Calanus hold a key position in these cold-water food webs, providing an important energetic link between primary production and higher trophic levels. Due to their ecological importance, there is a concern about how accidental oil spills and produced water discharges may impact cold-water copepods. In this review, we summarize the current knowledge of the toxicity of petroleum on North Atlantic and Arctic Calanus copepods. We also review how recent development of high-quality transcriptomes from RNA-sequencing of copepods have identified genes regulating key biological processes, like molting, diapause and reproduction in Calanus copepods, to suggest linkages between exposure, molecular mechanisms and effects on higher levels of biological organization. We found that the available ecotoxicity threshold data for these copepods provide valuable information about their sensitivity to acute petrogenic exposures; however, there is still insufficient knowledge regarding underlying mechanisms of toxicity and the potential for long-term implications of relevance for copepod ecology and phenology. Copepod transcriptomics has expanded our understanding of how key biological processes are regulated in cold-water copepods. These advances can improve our understanding of how pollutants affect biological processes, and thus provide the basis for new knowledge frameworks spanning the effect continuum from molecular initiating events to adverse effects of regulatory relevance. Such efforts, guided by concepts such as adverse outcome pathways (AOPs), enable standardized and transparent characterization and evaluation of knowledge and identifies research gaps and priorities. This review suggests enhancing mechanistic understanding of exposure-effect relationships to better understand and link biomarker responses to adverse effects to improve risk assessments assessing ecological effects of pollutant mixtures, like crude oil, in Arctic areas.


Subject(s)
Copepoda , Petroleum , Water Pollutants, Chemical , Animals , Water Pollutants, Chemical/toxicity , Food Chain , Water/pharmacology , Arctic Regions , Petroleum/toxicity , Petroleum/metabolism
3.
Mar Pollut Bull ; 184: 114207, 2022 Nov.
Article in English | MEDLINE | ID: mdl-36228407

ABSTRACT

We simulate the combined natural and pollutant-induced survival of early life stages of NEA cod and haddock, and the impact on the adult populations in response to the time of a major oil spill in a single year. Our simulations reveal how dynamic ocean processes, controlling both oil transport and fate and the frequency of interactions of oil with drifting fish eggs and larvae, mediate the magnitude of population losses due to an oil spill. The largest impacts on fish early life stages occurred for spills initiated in Feb-Mar, concomitant with the initial rise in marine productivity and the earliest phase of the spawning season. The reproductive health of the adult fish populations was maintained in all scenarios. The study demonstrates the application of a simulation system that provides managers with information for the planning of development activities and for the protection of fisheries resources from potential impacts.


Subject(s)
Environmental Pollutants , Gadiformes , Petroleum Pollution , Animals , Fisheries , Fishes
4.
Sci Rep ; 11(1): 5326, 2021 03 05.
Article in English | MEDLINE | ID: mdl-33674623

ABSTRACT

Although beneficial effects of an early goal directed therapy (EGDT) after cardiac arrest and successful return of spontaneous circulation (ROSC) have been described, clinical implementation in this period seems rather difficult. The aim of the present study was to investigate the feasibility and the impact of EGDT on myocardial damage and function after cardiac resuscitation. A translational pig model which has been carefully adapted to the clinical setting was employed. After 8 min of cardiac arrest and successful ROSC, pigs were randomized to receive either EGDT (EGDT group) or therapy by random computer-controlled hemodynamic thresholds (noEGDT group). Therapeutic algorithms included blood gas analysis, conductance catheter method, thermodilution cardiac output and transesophageal echocardiography. Twenty-one animals achieved successful ROSC of which 13 pigs survived the whole experimental period and could be included into final analysis. cTnT and LDH concentrations were lower in the EGDT group without reaching statistical significance. Comparison of lactate concentrations between 1 and 8 h after ROSC exhibited a decrease to nearly baseline levels within the EGDT group (1 h vs 8 h: 7.9 vs. 1.7 mmol/l, P < 0.01), while in the noEGDT group lactate concentrations did not significantly decrease. The EGDT group revealed a higher initial need for fluids (P < 0.05) and less epinephrine administration (P < 0.05) post ROSC. Conductance method determined significant higher values for preload recruitable stroke work, ejection fraction and maximum rate of pressure change in the ventricle for the EGDT group. EGDT after cardiac arrest is associated with a significant decrease of lactate levels to nearly baseline and is able to improve systolic myocardial function. Although the results of our study suggest that implementation of an EGDT algorithm for post cardiac arrest care seems feasible, the impact and implementation of EGDT algorithms after cardiac arrest need to be further investigated.


Subject(s)
Early Goal-Directed Therapy/methods , Heart Arrest/therapy , Animals , Swine
5.
Mar Environ Res ; 162: 105184, 2020 Dec.
Article in English | MEDLINE | ID: mdl-33065519

ABSTRACT

A simulation model framework (SYMBIOSES) that includes a 3-dimensional ocean physics and biology model and a model for transport and fate of oil was used to investigate the potential for bioaccumulation and lethal/sublethal effects of oil components in the copepod Calanus finmarchicus in the Lofoten-Vesterålen archipelago of Norway. The oil model is coupled with the biology model by way of a bioaccumulation model, from which mortality and reduction in reproduction are calculated via a total body burden (TBB). The simulation results indicate that copepod body burden levels are affected by the spill type (surface spill, subsea blowout) and the spill timing (spring, autumn). The effects of oil component bioaccumulation on the copepod population for all scenarios are small, though greatest in the subsea blowout scenarios. We attribute this to the limited spatial and temporal overlap between copepods and oil in the environment simulated by the model. The coupling of the processes of oil transport, bioaccumulation/excretion and the associated effects are discussed in the context of the model framework and with a view towards applications for Ecological Risk Assessment (ERA).


Subject(s)
Copepoda , Petroleum Pollution , Petroleum , Water Pollutants, Chemical , Animals , Norway , Petroleum/toxicity , Petroleum Pollution/adverse effects , Water Pollutants, Chemical/toxicity
6.
PLoS One ; 15(3): e0228502, 2020.
Article in English | MEDLINE | ID: mdl-32203559

ABSTRACT

Most Atlantic salmon mariculture operations use open sea cages for the grow out phase. The ultimate fate and effects of the effluents and the possibilities of disease transfer between fish farms are major concerns for farmers, governance and the general public alike. Numerical model systems applied to studying and managing effluents and disease transfer in mariculture must realistically resolve the hydrodynamics in the vicinity of the fish farms. In the present study, the effects of the aquaculture structures on the current patterns were introduced in the ocean model system SINMOD. The drag parameters for the ocean model were determined by comparing the simulation results from the ANSYS Fluent ® software suite and SINMOD in an idealized channel setting with uniform currents. The model was run for a number of realistic scenarios in high horizontal resolution (∼30 m) with sea cages influencing the flow field. Comparisons between extensive current measurements and the simulation results showed that the model system reproduced the current local current field well. By running simulation scenarios with and without the effects of the sea cages on the flow field, it was possible to assess the importance of such effects for numerical dispersal models and aquaculture environment interactions simulations and hence for assessment of environmental impacts.


Subject(s)
Aquaculture , Computer Simulation , Hydrodynamics , Animals , Oceans and Seas , Porosity , Salmon/growth & development , Water/chemistry
7.
Anaesth Crit Care Pain Med ; 39(1): 75-85, 2020 02.
Article in English | MEDLINE | ID: mdl-31170485

ABSTRACT

BACKGROUND: Continuous non-invasive cardiac output devices using digital photoplethysmography (PPG) are widely available for bedside use, but their interchangeability with reference methods has not yet been evaluated in a systematic review and patient data meta-analysis. METHODS: A systematic review and meta-analysis of studies comparing non-invasive cardiac output monitoring using PPG with the invasive bolus thermodilution method was performed. With ethical approval, all published studies from the PUBMED, Embase, Scopus, Web of Science, and Google Scholar databases from January 1, 2010 to January 1, 2018 were included. From these analysed studies, individual patient data were interpreted using the interchangeability methods for both absolute values and changes in cardiac output measurements. RESULTS: Ten studies comparing PPG and bolus thermodilution in the operating room and intensive care settings were included. The interchangeability rate (95% CI) was 37% (24-48) (n=1350 pairs of measurements). The interchangeability rate was poorer with the CNAP device (CNSystems, Graz, Austria) [18% (17-20)] than with the Clearsight (Edwards Lifesciences, Irvine, CA) device [33% (31-34), P<0.0001], for patients receiving norepinephrine [19% (17-20) vs. 33% (32-34), P<0.0001], and for patients with low mean arterial pressure (<65mmHg) [26% (23-29) vs. 30% (29-31), P<0.0001]. Among the 1009 comparisons of the changes in cardiac output between both methods, 561 (56%) were interpretable with a trend interchangeability rate at 24% (12-36). CONCLUSIONS: Cardiac output measurements using PPG were not interchangeable with bolus thermodilution in regard to both absolute values and changes in cardiac output measurements, and should be used with caution in clinical practice. TRIAL REGISTRATION: PROSPERO ID CRD42018089513.


Subject(s)
Cardiac Output , Photoplethysmography/methods , Thermodilution/methods , Humans , Monitoring, Intraoperative , Reproducibility of Results
8.
Thorac Cardiovasc Surg ; 67(6): 444-449, 2019 Sep.
Article in English | MEDLINE | ID: mdl-30218991

ABSTRACT

BACKGROUND: Patients receiving arterial grafts have superior late survival after coronary artery bypass graft (CABG) surgery. The aim of our study was to evaluate the mid- and long-term results of total arterial (TA) revascularization in the elderly. METHODS: Between January 2005 and December 2012, a retrospective study on age-, gender-, and EuroSCORE-matched patients aged 70 years and older was performed. Altogether, 356 patients who received isolated CABG were assigned to either TA group or control (CON) group. RESULTS: No significant differences were noted in regard to preoperative risk factors. The number of distal anastomoses was significantly higher in the CON group (3.6 ± 0.6 vs. 2.9 ± 0.8; p < 0.001). Postoperatively, no significant differences were noted in regard to morbidity or mortality. There were no significant differences in mortality rate at 1 year (5.6 vs. 5.2%; p = 0.98), or 5 years (9.0 vs. 12.1%; p = 0.39) between both groups. However, the TA group was associated with significantly higher rate of event-free survival (p = 0.017). CONCLUSION: This study suggests that TA revascularization is an effective procedure. Lower rates of late cardiac events encourage the use of this concept for the elderly.


Subject(s)
Coronary Artery Bypass/methods , Coronary Artery Disease/surgery , Mammary Arteries/surgery , Radial Artery/transplantation , Saphenous Vein/transplantation , Age Factors , Aged , Coronary Artery Bypass/adverse effects , Coronary Artery Bypass/mortality , Coronary Artery Disease/mortality , Female , Germany , Humans , Male , Postoperative Complications/mortality , Progression-Free Survival , Retrospective Studies , Risk Factors , Time Factors
10.
Article in German | MEDLINE | ID: mdl-29772592

ABSTRACT

The anaesthesiological management of patients scheduled for cardiac surgery has been refined distinctively over the last decade due to different reasons. The continuing growth of the elderly patient population and the increasing number of combined cardiac surgery procedures in octogenarians on the one hand are one aspect. The rapid development of minimally invasive cardiac surgery and the enhancements in mechanical, artificial heart assist devices on the other hand can be seen as additional decisive factors. All of these innovations in the field of cardiac surgery implicate further enhancements regarding the anaesthesiological management. This review article addresses the following subareas of cardiac anaesthesia: significance of pharmacological myocardial protection, anaesthetic management during cardiopulmonary bypass, importance of "Enhanced Recovery After Cardiac Surgery"-protocols as well as innovations in the field of minimally invasive cardiac surgery like transcatheter aortic valve implantation.


Subject(s)
Anesthesia, Cardiac Procedures/methods , Cardiac Surgical Procedures/methods , Aged , Aged, 80 and over , Cardiotonic Agents/therapeutic use , Hemodynamics , Humans , Monitoring, Intraoperative
11.
Mar Pollut Bull ; 126: 63-73, 2018 Jan.
Article in English | MEDLINE | ID: mdl-29421135

ABSTRACT

We simulate oil spills of 1500 and 4500m3/day lasting 14, 45, and 90days in the spawning grounds of the commercial fish species, Northeast Arctic cod. Modeling the life history of individual fish eggs and larvae, we predict deviations from the historical pattern of recruitment to the adult population due to toxic oil exposures. Reductions in survival for pelagic stages of cod were 0-10%, up to a maximum of 43%. These reductions resulted in a decrease in adult cod biomass of <3% for most scenarios, up to a maximum of 12%. In all simulations, the adult population remained at full reproductive potential with a sufficient number of juveniles surviving to replenish the population. The diverse age distribution helps protect the adult cod population from reductions in a single year's recruitment after a major oil spill. These results provide insights to assist in managing oil spill impacts on fisheries.


Subject(s)
Gadiformes , Petroleum Pollution , Animals , Computer Simulation , Environment , Fisheries , Larva , Ovum , Reproduction
12.
Eur J Anaesthesiol ; 35(3): 200-207, 2018 03.
Article in English | MEDLINE | ID: mdl-28937529

ABSTRACT

BACKGROUND: Propofol is widely used in routine clinical practice for the induction and maintenance of anaesthesia. Although propofol is regarded as a well tolerated anaesthetic, its effect on intact or damaged endothelial cells has not yet been elucidated. OBJECTIVE: The aim of this study was to investigate the effects of different concentrations of propofol on cell damage, metabolic activity, barrier function and wound healing capacity of human endothelial cells. DESIGN: An in vitro investigation. SETTING: Research Laboratory of the Department of Anaesthesiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Kiel, Germany. MATERIALS: In vitro cultures of primary human umbilical vein endothelial cells (HUVECs). INTERVENTIONS: Intact HUVEC or wounded HUVEC monolayers were incubated with or without different concentrations of propofol (10, 30 and 100 µmol l). MAIN OUTCOME MEASURES: Cell damage, metabolic activity, monolayer permeability, wound healing capacity, protein phosphorylation. RESULTS: Propofol did not alter the morphology, induce cell damage or influence metabolic activity of intact HUVEC cells. Permeability of a HUVEC monolayer was increased by propofol 100 µmol l (P < 0.05). Wound closure was inhibited by the addition of propofol 30 and 100 µmol l (P < 0.05 and P < 0.01). This effect was associated with increased phosphorylation of extracellular signal regulated kinases (Erk) 1/2 (30 and 100 µmol l; both P < 0.05) and decreased phosphorylation of Rho kinase (Rock) (100 µmol l; P < 0.05). CONCLUSION: Propofol does not damage intact endothelial cells, but increases permeability of an endothelial cell monolayer at high concentrations and inhibits wound closure in vitro. Further experimental and clinical in vivo research should be performed to clarify the influence of propofol on endothelial wound healing.


Subject(s)
Capillary Permeability/drug effects , Human Umbilical Vein Endothelial Cells/drug effects , Propofol/pharmacology , Wound Healing/drug effects , Capillary Permeability/physiology , Cells, Cultured , Dose-Response Relationship, Drug , Human Umbilical Vein Endothelial Cells/physiology , Humans , Hypnotics and Sedatives/pharmacology , Phosphorylation/drug effects , Phosphorylation/physiology , Wound Healing/physiology
13.
Thorac Cardiovasc Surg ; 66(5): 410-416, 2018 08.
Article in English | MEDLINE | ID: mdl-27380377

ABSTRACT

BACKGROUND: In 1997, a modified right atrial anastomosis (cavoatrial technique) for orthotopic heart transplantation (oHTx) was first developed in our institution. The purpose of this study is to report our long-term experience with this technique compared with biatrial and bicaval technique. METHODS: Retrospectively, 202 consecutive oHTx between 1997 and 2013 were analyzed. The applied transplantation techniques were biatrial (n = 108), bicaval (n = 22), and cavoatrial (n = 72). RESULTS: Demographic data were similar in all groups. The cardiopulmonary bypass and cross-clamp time were significantly shorter in the biatrial group. Follow-up echocardiographic examination showed excellent results in all groups with no relevant differences. After 1 year, occurrence of severe tricuspid regurgitation (biatrial 1.9% vs bicaval 0.0% vs cavoatrial 1.4%) was low in all groups. Rate of permanent pacemaker implantations was also low (12.0% vs 5.0% vs 11.1%). There were no significant differences in survival between the groups. CONCLUSION: The cavoatrial technique can be a safe and simple alternative for heart transplantation. Easy handling and similar reduced postoperative complications encourage the use of this technique.


Subject(s)
Heart Atria/transplantation , Heart Failure/surgery , Heart Transplantation/methods , Vena Cava, Inferior/surgery , Vena Cava, Superior/surgery , Adult , Aged , Anastomosis, Surgical , Cardiopulmonary Bypass , Female , Heart Atria/physiopathology , Heart Failure/diagnosis , Heart Failure/mortality , Heart Failure/physiopathology , Heart Transplantation/adverse effects , Heart Transplantation/mortality , Humans , Kaplan-Meier Estimate , Male , Middle Aged , Operative Time , Postoperative Complications/etiology , Recovery of Function , Retrospective Studies , Risk Factors , Time Factors , Treatment Outcome , Young Adult
14.
Eur J Cardiothorac Surg ; 53(4): 764-770, 2018 04 01.
Article in English | MEDLINE | ID: mdl-29186375

ABSTRACT

OBJECTIVES: Unilateral pulmonary oedema (UPE) is a rare but potentially life-threatening complication that has been described after minimally invasive mitral valve surgery (MICS). Over the last 8 years, we have witnessed, in our institution, several cases of severe UPE requiring immediate postoperative extracorporeal life support after MICS. Reviewing the available literature, data regarding this complication after MICS are rare. Consequently, we decided to retrospectively analyse patients scheduled for MICS in our institution. METHODS: After approval by our institutional review board, 256 MICS patients were analysed. As a primary end-point, we defined a newly developed UPE, radiographically evident within the first 24 h postoperatively. Secondary end-points were length of stay in the intensive care unit, length of stay in the hospital and in-hospital mortality. Chest radiographs were analysed by an independent consultant of radiology. RESULTS: Fifty-one (19.9%) patients showed increased right-sided pulmonary vascular congestion in the 1st postoperative chest radiography performed in the intensive care unit. Five (1.95%) patients immediately required extracorporeal life support after admission to the intensive care unit. Cardiopulmonary bypass time was significantly longer in the UPE group [UPE vs non-UPE 213 (49) vs 196 (43) min; P = 0.013]. More patients with UPE showed a preoperative increase of C-reactive protein >0.4265 mg/dl (P = 0.05). Logistic regression analysis identified a preoperative increase in C-reactive protein >0.4265 mg/dl as well as a prolonged cardiopulmonary bypass time (odds ratio 1.009, 95% confidence level 1.002-1.016; P = 0.014) independent risk factors, significantly associated with the development of UPE (odds ratio 2.583, 95% confidence interval 1.275-5.233; P = 0.008), a prolonged cardiopulmonary bypass time (odds ratio 1.009, 95% confidence interval 1.002-1.016; P = 0.014). The presence of pulmonary hypertension (odds ratio 0.273, 95% confidence interval 0.08-0.84; P = 0.02) seemed to be a protective factor regarding the genesis of UPE. CONCLUSIONS: In accordance with the rarely available literature regarding UPE after MICS, our analysis led us to hypothesize the possibility of an inflammatory disposition for UPE. The role of pulmonary hypertension remains unclear in our patient population. Clinical Trials Number: NCT02655094.


Subject(s)
Mitral Valve/surgery , Pulmonary Edema/etiology , Hospital Mortality , Humans , Length of Stay , Male , Middle Aged , Minimally Invasive Surgical Procedures/adverse effects , Minimally Invasive Surgical Procedures/methods , Pulmonary Edema/diagnostic imaging , Pulmonary Edema/mortality , Radiography, Thoracic , Retrospective Studies , Risk Factors
15.
Anesthesiology ; 127(6): 918-933, 2017 12.
Article in English | MEDLINE | ID: mdl-28872484

ABSTRACT

BACKGROUND: Ischemic myocardial damage accompanying coronary artery bypass graft surgery remains a clinical challenge. We investigated whether xenon anesthesia could limit myocardial damage in coronary artery bypass graft surgery patients, as has been reported for animal ischemia models. METHODS: In 17 university hospitals in France, Germany, Italy, and The Netherlands, low-risk elective, on-pump coronary artery bypass graft surgery patients were randomized to receive xenon, sevoflurane, or propofol-based total intravenous anesthesia for anesthesia maintenance. The primary outcome was the cardiac troponin I concentration in the blood 24 h postsurgery. The noninferiority margin for the mean difference in cardiac troponin I release between the xenon and sevoflurane groups was less than 0.15 ng/ml. Secondary outcomes were the safety and feasibility of xenon anesthesia. RESULTS: The first patient included at each center received xenon anesthesia for practical reasons. For all other patients, anesthesia maintenance was randomized (intention-to-treat: n = 492; per-protocol/without major protocol deviation: n = 446). Median 24-h postoperative cardiac troponin I concentrations (ng/ml [interquartile range]) were 1.14 [0.76 to 2.10] with xenon, 1.30 [0.78 to 2.67] with sevoflurane, and 1.48 [0.94 to 2.78] with total intravenous anesthesia [per-protocol]). The mean difference in cardiac troponin I release between xenon and sevoflurane was -0.09 ng/ml (95% CI, -0.30 to 0.11; per-protocol: P = 0.02). Postoperative cardiac troponin I release was significantly less with xenon than with total intravenous anesthesia (intention-to-treat: P = 0.05; per-protocol: P = 0.02). Perioperative variables and postoperative outcomes were comparable across all groups, with no safety concerns. CONCLUSIONS: In postoperative cardiac troponin I release, xenon was noninferior to sevoflurane in low-risk, on-pump coronary artery bypass graft surgery patients. Only with xenon was cardiac troponin I release less than with total intravenous anesthesia. Xenon anesthesia appeared safe and feasible.


Subject(s)
Anesthesia, Intravenous , Coronary Artery Bypass/trends , Internationality , Methyl Ethers/administration & dosage , Troponin I/blood , Xenon/administration & dosage , Aged , Anesthetics, Inhalation/administration & dosage , Biomarkers/blood , Coronary Artery Bypass/adverse effects , Female , Humans , Male , Middle Aged , Postoperative Complications/blood , Postoperative Complications/prevention & control , Prospective Studies , Sevoflurane , Single-Blind Method , Treatment Outcome
17.
Eur J Cardiothorac Surg ; 51(3): 465-471, 2017 03 01.
Article in English | MEDLINE | ID: mdl-28111360

ABSTRACT

Objectives: Innovations in surgical techniques and perioperative management have continuously improved survival rates for acute aortic dissection type A (AADA). The aim of our study was to evaluate long-term outcome and quality of life (QoL) after surgery for AADA in elderly patients compared with younger patients. Methods: We retrospectively evaluated 242 consecutive patients, who underwent surgery for AADA between January 2004 and April 2014. Patients were divided into two groups: those aged 70 years and older (elderly group; n = 78, mean age, 76 ± 4 years) and those younger than 70 years (younger group; n = 164, mean age, 56 ± 10 years). QoL was assessed with the Short Form Health Survey Questionnaire (SF-36) 1 year after surgery. Results: The questionnaire return rate was 91.0%. There were already significant differences noted between the two groups with regard to preoperative risk factors on admission. The clinical presentation with a cardiac tamponade was higher in the elderly group (62.8% vs 47.6%; P = 0.03). Intraoperatively, complex procedures were more common in the younger group (21.3% vs 5.2%; P = 0.001). Accordingly, cardiopulmonary bypass and cross-clamping times were significantly longer in the younger group. The operative mortality was similar in both groups (3.8% vs 1.2%; P = 0.33). In the elderly population, 30-day mortality was higher (21.8% vs 7.9%; P = 0.003). One-year (72% vs 85%), 3-year (68% vs 84%) and 5-year (63% vs 79%) survival rates were satisfactory for the elderly group, but significantly lower compared with the younger group ( P = 0.008). The physical component summary score also was similar between the groups (39.14 ± 11.12 vs 39.12 ± 12.02; P = 0.99). However, the mental component summary score might be slightly higher in the elderly group but not statistically significant (51.61 ± 10.73 vs 48.63 ± 11.25; P = 0.12). Conclusions: Satisfactory long-term outcome and the general perception of well-being encourage surgery in selected elderly patients with AADA.


Subject(s)
Aortic Aneurysm/surgery , Aortic Dissection/surgery , Quality of Life , Acute Disease , Adolescent , Adult , Age Factors , Aged , Aged, 80 and over , Aortic Dissection/rehabilitation , Aortic Aneurysm/rehabilitation , Emergencies , Female , Humans , Kaplan-Meier Estimate , Male , Middle Aged , Patient Satisfaction , Psychometrics , Retrospective Studies , Risk Factors , Treatment Outcome , Vascular Surgical Procedures/adverse effects , Vascular Surgical Procedures/methods , Vascular Surgical Procedures/rehabilitation , Young Adult
18.
J Cardiothorac Vasc Anesth ; 30(5): 1205-11, 2016 Oct.
Article in English | MEDLINE | ID: mdl-27499343

ABSTRACT

OBJECTIVES: The reliability of dynamic and volumetric variables of fluid responsiveness in the presence of pericardial effusion is still elusive. The aim of the present study was to investigate their predictive power in a porcine model with hemodynamic relevant pericardial effusion. DESIGN: A single-center animal investigation. PARTICIPANTS: Twelve German domestic pigs. INTERVENTIONS: Pigs were studied before and during pericardial effusion. Instrumentation included a pulmonary artery catheter and a transpulmonary thermodilution catheter in the femoral artery. Hemodynamic variables like cardiac output (COPAC) and stroke volume (SVPAC) derived from pulmonary artery catheter, global end-diastolic volume (GEDV), stroke volume variation (SVV), and pulse-pressure variation (PPV) were obtained. MEASUREMENTS AND MAIN RESULTS: At baseline, SVV, PPV, GEDV, COPAC, and SVPAC reliably predicted fluid responsiveness (area under the curve 0.81 [p = 0.02], 0.82 [p = 0.02], 0.74 [p = 0.07], 0.74 [p = 0.07], 0.82 [p = 0.02]). After establishment of pericardial effusion the predictive power of dynamic variables was impaired and only COPAC and SVPAC and GEDV allowed significant prediction of fluid responsiveness (area under the curve 0.77 [p = 0.04], 0.76 [p = 0.05], 0.83 [p = 0.01]) with clinically relevant changes in threshold values. CONCLUSIONS: In this porcine model, hemodynamic relevant pericardial effusion abolished the ability of dynamic variables to predict fluid responsiveness. COPAC, SVPAC, and GEDV enabled prediction, but their threshold values were significantly changed.


Subject(s)
Fluid Therapy , Hemodynamics/physiology , Pericardial Effusion/physiopathology , Animals , Disease Models, Animal , Female , Male , Pericardial Effusion/therapy , Reproducibility of Results , Swine
19.
Minerva Anestesiol ; 82(11): 1158-1169, 2016 11.
Article in English | MEDLINE | ID: mdl-27352070

ABSTRACT

BACKGROUND: Today, most of the pre-emptive hemodynamic optimization algorithms are based on variables associated with invasive techniques like arterial cannulation. The non-invasive Nexfin™ technology is able to estimate continuous Cardiac Index (CI) and pulse pressure variation (PPV). However, the efficiency of an early goal directed therapy (EGDT) algorithm based on non-invasive variables has to be proven. The aim of our study was to investigate the feasibility of a non-invasive driven EGDT protocol and its impact on patient's outcome. METHODS: Seventy-nine patients (ASA II-III) undergoing elective major abdominal surgery were randomized to either study group (SG, N.=39) or control group (CG, N.=40). The SG was treated according to an algorithm based on non-invasive CI and PPV, whereas the CG received standard of care. Postoperative complications up to 28 days and length of hospital stay (LOS) in both groups were recorded. RESULTS: There was no significant difference between the groups regarding demographics, hemodynamic variables, preoperative risk scores and duration of surgery. The total amount of complications was higher in the CG (SG 94 vs. CG 132 complications, P=0.22) without reaching statistical significance. LOS revealed no difference between both groups (SG, 9 [7-15] vs. CG, 9 [7-15.25] days, P=0.82). We have seen no impact of the non-invasive optimization protocol with respect to postoperative mortality. CONCLUSIONS: In this patient collective, we could demonstrate the feasibility of a non-invasive approach for hemodynamic optimization. However, EGDT based on non-invasive variables was not able to significantly improve outcome.


Subject(s)
Abdomen/surgery , Body Surface Area , Cardiac Output/physiology , Clinical Protocols , Length of Stay/statistics & numerical data , Postoperative Complications , Aged , Algorithms , Elective Surgical Procedures , Feasibility Studies , Female , Hemodynamics , Humans , Male , Treatment Outcome
20.
Mar Environ Res ; 119: 197-206, 2016 Aug.
Article in English | MEDLINE | ID: mdl-27326463

ABSTRACT

In the current study differences were evaluated between a complex 3D multistage population model (SINMOD) and a simpler consumer-resource population model for estimating the effects of crude oil on the marine copepod Calanus finmarchicus. The SINTEF OSCAR model was used to simulate hypothetical oil spills in the Lofoten area in 1995, 1997, and 2001. Both population models simulated a negligible effect of crude oil on the Calanus' biomass when assuming low species sensitivity. The simple model estimated a larger effect on the biomass (up to a 100% decline) compared to the complex model (maximum decline of 60-80%) at high species sensitivity to crude oil. These differences may be related to the inclusion of copepod advection in the complex model. Our study showed that if little data is available to parameterize a model, or if computational resources are scarce, the simple model could be used for risk screening. Nevertheless, the possibility of including a dilution factor for time-varying biomass should be examined to improve the estimations of the simple model. The complex model should be used for a more in depth risk analysis, as it includes physical processes such as the drift of organisms and differentiation between developmental stages.


Subject(s)
Copepoda/physiology , Environmental Monitoring , Models, Theoretical , Petroleum Pollution , Petroleum/toxicity , Water Pollutants, Chemical/toxicity , Animals , Population Dynamics , Zooplankton
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