ABSTRACT
BACKGROUND: While inhaled nitric oxide (iNO) has revealed benefit in cardiac arrest in an animal model, no published data has yet demonstrated the impact of iNO in humans with cardiac arrest. METHODS: In this pilot study, we administered iNO, along with standard post-resuscitative care, in adults with in-hospital cardiac arrest (IHCA) following achievement of return of spontaneous circulation (ROSC) at an academic tertiary medical center. Patients receiving iNO were compared to age-matched controls with IHCA receiving standard care from an institutional registry. The primary outcome was survival to discharge; secondary outcome was favorable neurologic outcome, defined by a Glasgow Outcome Score of 4 or 5. Propensity-score (PS) matching analysis was performed between patients receiving iNO versus controls. RESULTS: Twenty adults with IHCA receiving iNO were compared to 199 controls with IHCA. Similar age, Charlson comorbidity index, and initial rhythm were noted in both groups. Patients receiving iNO had higher rates of survival to discharge compared to controls (35% vs 11%, p < 0.0001) but no difference in favorable neurologic outcome (15% vs 9%, p = 0.39) in the unmatched population. In the PS-matched analysis, patients receiving iNO had higher survival to discharge (35% vs 20%, p = 0.0344) than the control group but no difference in favorable neurologic outcome (15% vs 20%, p = 0.13) were noted between both groups. CONCLUSIONS: In this pilot study, iNO was associated with significantly higher rates of survival to discharge but not favorable neurologic outcome among patients with IHCA compared to controls. This benefit was also observed in the PS-matched analysis. A large scale randomized controlled trial comparing standard of care supplemented with iNO to standard of care alone is warranted in patients with cardiac arrest (Funded by Stony Brook University Renaissance School of Medicine, ClinicalTrials.gov number, NCT04134078).
Subject(s)
Heart Arrest/drug therapy , Nitric Oxide/therapeutic use , Administration, Inhalation , Aged , Feasibility Studies , Female , Hospitals , Humans , Male , Middle Aged , Nitric Oxide/administration & dosage , Pilot Projects , Prospective StudiesSubject(s)
Blood Transfusion/methods , Chemical and Drug Induced Liver Injury , Hemoperitoneum , Hypotension , Paracentesis , Point-of-Care Testing , Ultrasonography/methods , Aged , Brain Diseases/diagnosis , Brain Diseases/etiology , Chemical and Drug Induced Liver Injury/complications , Chemical and Drug Induced Liver Injury/diagnosis , Chemical and Drug Induced Liver Injury/physiopathology , Diagnosis, Differential , Heart Failure/diagnosis , Heart Failure/therapy , Hemoperitoneum/diagnosis , Hemoperitoneum/etiology , Hemoperitoneum/physiopathology , Hemoperitoneum/therapy , Humans , Hypotension/diagnosis , Hypotension/etiology , Liver/pathology , Male , Paracentesis/instrumentation , Paracentesis/methods , Respiration, Artificial/methods , Treatment OutcomeABSTRACT
BACKGROUND: Blood eosinophils are used to determine eligibility for agents targeting IL-5 in patients with uncontrolled asthma. However, little is known about the variability of blood eosinophil measures in these patients before treatment initiation. OBJECTIVE: To characterize variability and patterns of variability of blood eosinophil levels in a real-world clinic for severe asthmatics. METHODS: Retrospective review of blood eosinophils measured over a 5-year period in patients enrolled in an urban clinic. Repeated measures of blood eosinophil levels in individuals were evaluated, and cluster analysis was performed to characterize patients by eosinophil patterns. Clinical characteristics associated with eosinophil levels and patterns of variability were analysed. RESULTS: Patients treated in the Bellevue Hospital Asthma Clinic within a 3-month period were identified (n = 219). Blood eosinophil measures were obtained over the previous 5 years. Only 6% (n = 13) of patients had levels that were consistently above 300 cells/µL. Nearly 50% (n = 104) had eosinophil levels that traversed the threshold of 300 cells/µL. In contrast, 102 (46%) had levels that never reached the threshold of 300 cells/µL. Cluster analyses revealed three clusters with differing patterns of levels and variability. There was a suggestion of decreased clinical control and increased atopy in the cluster with the greatest variability in blood eosinophil measures. CONCLUSION: In an urban clinic for patients referred for uncontrolled asthma, blood measures of eosinophils were variable and showed differing patterns of variability. These data reinforce the need to perform repeated eosinophil blood measures for appropriate designation for therapeutic intervention.
Subject(s)
Asthma/blood , Asthma/pathology , Eosinophils/metabolism , Eosinophils/pathology , Severity of Illness Index , Adult , Aged , Female , Follow-Up Studies , Humans , Male , Middle Aged , Retrospective StudiesSubject(s)
Anticoagulants/administration & dosage , Chest Pain/diagnosis , Dyspnea/diagnosis , Echocardiography/methods , Point-of-Care Testing , Pulmonary Embolism , Thrombolytic Therapy/methods , Chest Pain/etiology , Diagnosis, Differential , Dyspnea/etiology , Endometrial Neoplasms/complications , Female , Humans , Lower Extremity/blood supply , Lower Extremity/diagnostic imaging , Middle Aged , Patient Care Management/methods , Pulmonary Artery/diagnostic imaging , Pulmonary Embolism/diagnosis , Pulmonary Embolism/etiology , Pulmonary Embolism/physiopathology , Pulmonary Embolism/therapy , Venous Thrombosis/complications , Venous Thrombosis/diagnosis , Venous Thrombosis/physiopathologyABSTRACT
Recent studies have postulated that the vasoactive peptide urotensin II (UII) plays a role in the control of vascular remodeling by inducing smooth muscle proliferation and fibroblast-mediated collagen deposition. The present study examined the expression of UII mRNA and immunoreactivity in rat carotid arteries before and after balloon angioplasty. In addition, the effect of UT receptor blockade was assessed in this model using a selective non-peptidic UT receptor antagonist, SB-611812. In carotid arteries of uninjured rats (naïve group), there was weak expression of UII in endothelial cells and little to no expression in vascular smooth muscle cells. At day 7, there was intimal proliferation associated with pronounced expression of UII in myointimal cells. By day 14, there was extensive intimal thickening exhibiting strong expression of UII. The contralateral arteries of all groups exhibited similar UII expression to that of naïve arteries. Animals treated with methylcellulose (vehicle) for 28 days showed a significant increase in intimal thickening compared to sham operated animals. Treatment with the SB-611812 resulted in a significant 60% reduction in intima-to-media area ratio when compared to vehicle treatment (P<0.005). These findings demonstrate upregulation of UII following balloon angioplasty, and a significant reduction in intimal lesion in response to UT receptor blockade. The present study suggests an important role for UII in the pathogenesis of restenosis following balloon angioplasty.
