Application of the improved simple bedside method for emergency temporary pacemaker implantation suitable for primary hospitals

The purpose of the research was to evaluate the safety and effectiveness of the X-ray-free improved simple bedside method for emergency temporary pacemaker implantation as well as the practicability of the method in primary hospitals. Patients [including those suffering from sick sinus syndrome and third-degree and advanced atrioventricular blockage (AVB)] who needed emergency temporary pacemaker implantation from July 2017 to August 2020 in Hunan Provincial People’s Hospital were selected. They were stochastically divided into a research group (95 cases) treated with the improved simple bedside method and a control group (95 cases) with X-ray guidance. The ordinary bipolar electrodes were used in both groups. On this condition, the operation duration, the first-attempt success rate of electrodes, pacing threshold, success rate of the operation, the rate of electrode displacement, and complications in the two groups were separately calculated. The comparison results of the research group with the control group are shown as follows: operation time [(18 ± 5.91) min vs. (43 ± 2.99) min, P < 0.05], the first-attempt success rate of the electrode (97% vs. 98%, P > 0.05), pacing threshold [(0.97 ± 0.35) vs. (0.97 ± 0.32) V, P > 0.05], success rate of the operation (98.9% vs. 100%, P > 0.05), the rate of electrode displacement (8.4% vs. 7.3%, P > 0.05) and complications (3.2% vs. 2.1%, P > 0.05). The emergency temporary pacemaker implantation based on the improved simple bedside method is as safe and effective as the surgical method under X-ray guidance, and the operation is simpler and easier to learn and requires a shorter operating time, therefore, it is more suitable for use in emergency and primary hospitals.

Renal Resistive Index as a Predictor of Acute Kidney Injury and Mortality in COVID-19 Critically Ill Patients

<b><i>Background:</i></b> Acute kidney injury (AKI) in patients with COVID-19 can be caused by multiple mechanisms. Renal resistive index (RRI) is a noninvasive instrument to evaluate kidney hemodynamics, and it is obtained by analysis of intrarenal arterial waves using Doppler ultrasound. This study aimed to determine the role of RRI in predicting AKI and adverse outcomes in critically ill patients with COVID-19. <b><i>Methods:</i></b> This cross-sectional study included 65 patients with confirmed SARS-CoV-2 pneumonia admitted to the critical care unit from April 1, 2020, to June 20, 2020. Informed consent was obtained from all individual participants included in the study. Cardiac, pulmonary, and kidney ultrasonographic evaluations were performed in a protocolized way. <b><i>Results:</i></b> In this cohort, 65 patients were included, mean age was 53.4 years, 79% were male, and 35% were diabetic. Thirty-four percent of patients developed AKI, 12% required RRT, and 35% died. Of the patients who developed AKI, 68% had RRI ≥ 0.7. Also, 75% of the patients who required RRT had RRI ≥ 0.7. In the adjusted Cox model, the RRI ≥ 0.7 was associated with higher mortality (HR 2.86, 95% CI: 1.19–6.82, <i>p</i> = 0.01). <b><i>Conclusions:</i></b> Critical care ultrasonography is a noninvasive, reproducible, and accurate bedside method that has proven its usefulness. An elevated RRI may have a role in predicting AKI, RRT initiation, and mortality in patients with severe SARS-CoV-2 pneumonia.

Reliability of Cardiac Percussion Technique to Determine Left Ventricular Geometry in Comparison with Transthoracic Echocardiography

Background: Cardiac percussion (CP) is a bedside technique to evaluate cardiac borders and chamber size. Although advanced cardiac imaging has revolutionized the methods to detect cardiomegaly, art of CP remains the most convenient option, especially in emergent situations. Although transthoracic echocardiography (TTE) is considered the gold standard to determine left ventricular (LV) size, CP can estimate LV size with equal accuracy as TTE in appropriate clinical setting. The aim of this study was to investigate the correlation of LV size assessed by CP technique versus standard TTE, as well as cardiothoracic ratio (CTR) on chest roentgenography (CXR). Methods: This descriptive study was conducted on Telemetry units. Patients were positioned in supine position at Gatch angle of 30-45 degrees. Cardiac dullness was measured in cm by percussing from mid clavicular line towards gladiolus of sternal body. Subsequently, findings were correlated with TTE dimensions of left ventricular end-diastolic diameter (LVEDD). Results: In 200 patients, mean age was 63+15.8 years, with 51% females. The LV diameter (LVD) measured by CP technique was observed to be similar to LVEDD measured by TTE (Mean- 4.65+0.67 cm versus 4.69+0.76 cm, COV 7.6%). The BlandAltman comparison of CP technique and TTE measurements indicated significant differences in variances between the two measures (r=0.270, p=<0.001). The LVD measured by CXR did not show correlation with LVEDD (5.79+1.21 cm, COV 14.3%) with significant differences in the variances between the two measures (r=-0.475, p<0.001). The LV volumes measured by CP technique were observed to have correlation with LV volumes measured by TTE (COV 14.9%). Conclusion: CP technique is a convenient bedside method that can be utilized to assess LVD and volume. It is shown to have a precise correlation with LVEDD measured by TTE. The study emphasizes role of bedside estimation of LV size by using the art of physical examination.

Development and validation of a point-of-care breath test for octane detection

Background There is a demand for a non-invasive bedside method to diagnose Acute Respiratory Distress Syndrome (ARDS). Octane was discovered and validated as the most important breath biomarker for diagnosis...

A preoperative modified Allen test result may be associated with long term mortality after hemodialysis access construction

Background: The modified Allen test (MAT) is a simple bedside method determining collateral hand circulation prior to hemodialysis (HD) access surgery. Hand ischemia as reflected by low systolic finger pressures ( Pdig) is associated with high mortality rates in severe kidney disease (CKD) patients. Aim of the present study was to assess a possible relation between absolute finger pressure drop (∂ Pdig) during a preoperative MAT and mortality after a first HD access construction. Methods: Pdig (systolic pressure, mmHg) was measured using digital plethysmography following compression of radial and ulnar arteries in CKD patients just before access surgery between January 2009 and December 2018 in one center. The greatest ∂ Pdig of both index fingers was used for analysis. Cardiovascular and overall mortality were assessed during the following 4 years using the ERA-EDTA classification system (codes 11, 14–16, 18, 22–26, 29). Cox regression analysis determined possible associations between ∂ Pdig and mortality. Results: Complete data sets were available in 108 patients (male n = 71; age 70 years ±12; mean follow up (FU) 1.6 years ±0.1; FU index 99% ±1). Median ∂ Pdig was 31 mmHg (range 0–167 mmHg). Patients having cardiovascular disease (CV+) demonstrated higher ∂ Pdig values (CV+ 44 ± 5 mmHg vs CV− 29 ± 3 mmHg, p = 0.012). A total of 26 patients (24%) died during FU (CV+ death, n = 16; 62%). For each 10 mmHg ∂ Pdig increase, overall mortality increased by 10%, and CV+ mortality by 15% (overall mortality: HR 1.10 [1.01–1.22], p = 0.048; CV+ mortality: 1.15 [1.03–1.29], p = 0.017). Following correction for age, ∂ Pdig remained associated with CV+ mortality (HR 1.13 [1.00–1.26], p = 0.043). Conclusions: A large drop in systolic finger pressure during a preoperative MAT is related to mortality after primary HD access surgery. The role of this potential novel risk parameter requires confirmation in a larger population.

The choice among thromboelastometry tests to assess effects of low molecular weight heparins administered in prevention doses

Цель исследования: изучить возможность использования тестов тромбоэластометрии (ТЭМ) для оценки эффекта профилактической дозы низкомолекулярных гепаринов (НМГ). Материалы и методы. В исследование включено 30 пациентов (14 мужчин и 16 женщин), которым выполнялась резекция печени в связи с метастатическим поражением колоректальным раком. Для профилактики тромботических осложнений в послеоперационном периоде использовали НМГ надропарин. У пациентов в первую неделю послеоперационного периода определяли активность антитромбина III (AT-III) и проводили ротационную ТЭМ, при которой исследовали 3 пробы крови: проба № 1 — утром натощак перед введением пациенту НМГ; проба № 2 — как и первая проба, но с добавлением в пробу НМГ in vitro до достижения целевой концентрации 0,5 МЕ / мл крови; проба № 3 — через 4 ч после подкожного введения НМГ. У 10 пациентов проведены тесты ТЭМ — INTEM и NATEM (нативный тест), в которых оценивали показатели CT, CFT, угол α, MCF; у 20 пациентов проведен только тест NATEM. Результаты. Средние показатели теста INTEM перед введением НМГ не выходили за рамки референтных значений, в тесте NATEM только показатель MCF превышал нормальные значения. После внесения в исследуемую пробу 0,5 МЕ / мл НМГ in vitro средние значения CT и CFT теста ТЭМ значимо удлинялись. Интервал CT теста INTEM был удлинен выше нормы в 2 наблюдениях, CFT теста INTEM превышал норму в 1 наблюдении. В тесте NATEM удлинение интервалов CT и CFT выше нормальных выявлено в 100% случаев. Показатели ТЭМ через 4 ч после введения НМГ были аналогичны результатам in vitro. Выявлены статистически значимые различия показателей нативного теста от активности AT-III, наибольшей чувствительностью и специфичностью из них обладали интервал CT и ΔCT. Заключение. Метод ротационной ТЭМ является перспективным прикроватным методом оценки антикоагулянтного эффекта профилактических доз НМГ. Использование этого метода в послеоперационном периоде позволит индивидуально дозировать антикоагулянты и повысить эффективность профилактики венозных тромбоэмболических осложнений. Objectives: to investigate the applicability of various types of thromboelastometry (TEM) to assess effects of low molecular weight heparins (LMWHs) administered in prevention doses. Patients/ Methods. The study included 30 patients (14 men and 16 women) who underwent liver resection due to metastatic lesions of colorectal cancer. LMWH (nadroparin) was used to prevent thrombotic complications in the postoperative period. In the first week of postoperative period antithrombin III (AT-III) activity was determined and rotational TEM was performed, in which 3 blood samples were examined: sample № 1 — in the morning, fasted, before LMWH administration; sample № 2 — like the first sample, but with in vitro LMWH addition to the sample to achieve the target concentration of 0.5 IU per 1 ml of blood; sample № 3–4 hours after subcutaneous LMWH administration. TEM tests — INTEM and NATEM (native test) were performed in 10 patients with CT, CFT, angle α, and MCF assessment; in 20 patients only NATEM test was performed. Results. The average values of INTEM test before LMWH administration were within the reference values, in NATEM test only MCF exceeded normal values. The average CT and CFT values in TEM test significantly increased after in vitro LMWH addition to the test sample. Elongation of CT interval in INTEM test was found in 2 cases, CFT in INTEM test exceeded the norm in 1 case. Elongation above normal of CT and CFT intervals in NATEM test was noticed in 100% of cases. TEM parameters in 4 hours after LMWH administration were similar to in vitro results. The statistically significant differences between native test parameters and AT-III activity were revealed; CT and ΔCT intervals had the greatest sensitivity and specificity. Conclusions. Rotational TEM is a perspective bedside method for anticoagulant effect assessment of LMWH prevention doses. Using this method in postoperative period will allow to dose anticoagulants individually and increase prophylaxis effectiveness of venous thromboembolic complications.

Multiplate® Platelet Aggregation Findings Are Dependent on Platelet Count but Can Be Corrected by Use of a Ratio

Impedance aggregometry (Multiplate®) detects the effects of platelet aggregation inhibitors and can predict thrombotic complications after coronary and cerebrovascular stent interventions. The bedside method uses whole blood samples not corrected for platelet count. It is claimed but not proved that the findings are unrelated to platelet count in the physiological range. We therefore investigated in the experimental study: (1) whether impedance aggregometry findings and platelet count are correlated and (2) whether the aggregation/platelet count ratio expresses platelet function independent of platelet count. Following ethics committee approval, platelet-rich plasma from healthy probands was diluted with platelet-poor plasma to obtain different platelet counts. Thereafter, platelet count was measured and samples were subjected to impedance aggregometry using thrombin receptor activating peptide (TRAP) for platelet activation. In all probands, impedance aggregometry findings and platelet count were highly correlated (r = 0.88 to 0.94; p < 0.05). The combination of all experiments revealed the proportionality between impedance aggregometry findings and platelet count (n = 31, r = 0.78, p = 0.0001). In contrast, the ratio of impedance aggregometry findings and platelet count was not significantly correlated with platelet count (r = 0.017; p = 0.3) and thus constitutes a specific measure for platelet function. In conclusion, impedance aggregometry findings subsequent to the activation with TRAP are dependent on both platelet function and platelet count. Normalization of impedance aggregometry findings for platelet count can be achieved by a ratio resulting in more specific results.

Quantitative Sensory Testing and Pain Management

Quantitative sensory testing (QST) is a psychophysical assessment of somatosensory system that complements neurological sensory examination. The information derived from QST presents the function of unmyelinated C-fibers, small myelinated Aδ-fibers, and large myelinated Aβ-fibers including their central pathways to the brain. QST may be performed by simple bedside method and by standardized method developed from the German Research Network on Neuropathic Pain (Deutscher Forschungsverbund Neuropathischer Schmerz, DFNS). The standardized QST makes it possible to subgroup patients with peripheral neuropathic pain of different etiologies according to sensory profiles with emerging evidence showing predictive value of QST for treatment efficacy. Keywords: Quantitative sensory testing, Neuropathic pain, Sensory profile

Optimisation of Heart Failure Management in Nursing Homes Using Point-of-Care Ultrasonography: Harmonious Trial Rationale and Design

IntroductionHeart failure is common in the nursing home population and presents many diagnostic and therapeutic challenges. Point-of-care ultrasonography is a bedside method that can be used to assess volume status more reliably than clinical examination. This trial was conceived to test whether point-of-care ultrasonography-guided management improves heart failure outcomes among nursing home residents.MethodsNursing home residents with heart failure will be enrolled in a multi-centre, prospective, randomised controlled trial. Residents will first be screened for heart failure. Patients with heart failure will be randomised in 1:1 fashion into two groups. Nursing home physicians will adjust diuretic therapy according to volume status for six months. Point-of-care ultrasonography will be used in the test group and clinical examination in the control group. The primary endpoint will be heart failure deterioration, defined as a composite of any of the following four events: the need for an intravenous diuretic application, the need for an emergency service intervention, the need for unplanned hospitalisation for non-injury causes, or death from whatever cause.Expected resultsThe expected prevalence of heart failure among nursing home residents is above 10%. Point-of-care ultrasonography-guided heart failure management will reduce the number of deteriorations of heart failure in the nursing home population.ConclusionThis study will explore the usefulness of point-of-care ultrasonography for heart failure management in the nursing home population.