Efficacy of lower limb compression in the management of vasovagal syncope--randomized, crossover study.

INTRODUCTION: Vasovagal syncope (VS) is the most prevalent cause of transient loss of consciousness. The treatment consists of lifestyle modifications and pacemaker in some patients. The purpose of this study is to evaluate the effect of measures to compress the lower limbs in patients with recurrent episodes of VS submitted to the tilt-test (TT). METHODS AND RESULTS: Twenty patients, average age 30.5 years (15-75), 13 (65%) female, with a clinical diagnosis of VS and previous TT with a positive result and who had at least one episode of syncope during the last year, were included in this placebo-controlled randomized crossover study. The patients underwent two consecutive TT, at a 1-hour interval, with and without compression by pneumatic compression boots with 40 mmHg at the heels and 30 mmHg for the legs. The blood pressure (BP) and heart rate (HR) of these patients were monitored continuously. The outcome assessors were blinded. The results of the TT were positive in 13 (65%) of the patients in the control groups and in two (10%) of the patients with compression (P < 0.0001). Throughout the test, the systolic BP was not different among the groups. On the other hand, the HR measures showed a difference only in the tilted position at 2 minutes, of 73 ± 16 beats per minute (bpm) in the control group and of 69 ± 16 bpm (P = 0.047) in the compression group. CONCLUSION: Compression of the lower limbs is very effective to render the TT negative in patients with a diagnosis of VS.

Fluid overload and changes in serum creatinine after cardiac surgery: predictors of mortality and longer intensive care stay. A prospective cohort study.

INTRODUCTION: Fluid overload is a clinical problem frequently related to cardiac and renal dysfunction. The aim of this study was to evaluate fluid overload and changes in serum creatinine as predictors of cardiovascular mortality and morbidity after cardiac surgery. METHODS: Patients submitted to heart surgery were prospectively enrolled in this study from September 2010 through August 2011. Clinical and laboratory data were collected from each patient at preoperative and trans-operative moments and fluid overload and creatinine levels were recorded daily after cardiac surgery during their ICU stay. Fluid overload was calculated according to the following formula: (Sum of daily fluid received (L)--total amount of fluid eliminated (L)/preoperative weight (kg) × 100). Preoperative demographic and risk indicators, intra-operative parameters and postoperative information were obtained from medical records. Patients were monitored from surgery until death or discharge from the ICU. We also evaluated the survival status at discharge from the ICU and the length of ICU stay (days) of each patient. RESULTS: A total of 502 patients were enrolled in this study. Both fluid overload and changes in serum creatinine correlated with mortality (odds ratio (OR) 1.59; confidence interval (CI): 95% 1.18 to 2.14, P = 0.002 and OR 2.91; CI: 95% 1.92 to 4.40, P <0.001, respectively). Fluid overload played a more important role in the length of intensive care stay than changes in serum creatinine. Fluid overload (%): b coefficient = 0.17; beta coefficient = 0.55, P <0.001); change in creatinine (mg/dL): b coefficient = 0.01; beta coefficient = 0.11, P = 0.003). CONCLUSIONS: Although both fluid overload and changes in serum creatinine are prognostic markers after cardiac surgery, it seems that progressive fluid overload may be an earlier and more sensitive marker of renal dysfunction affecting heart function and, as such, it would allow earlier intervention and more effective control in post cardiac surgery patients.