Noninvasive whole-body electrical bioimpedance cardiac output and invasive thermodilution cardiac output in high-risk surgical patients

Peri-operative increase of oxygen delivery has been shown to reduce mortality in high-risk surgical patients. This study compares the effectiveness of dopexamine and dobutamine when used to increase cardiac output as part of a regimen to increase oxygen delivery. Sixteen surgical patients were randomly allocated to receive either dopexamine or dobutamine, which was increased to a stable dose defined as either oxygen delivery index >600 ml/min/m2, or tachycardia >20% above baseline, other dysrhythmias or angina. At this “stable” dose there were significant increases in cardiac index (2.4±0.2 vs3.7± 0.3 l/min/m2) and oxygen delivery (380±73 vs 579±40 ml/min/m2) in the dopexamine group (P< 0.05); but not the dobutamine group. Five out of eight patients receiving dopexamine and three out of eight receiving dobutamine reached target oxygen delivery Three dobutamine patients, but no dopexamine patients, had angina or dysrhythmias. In preoperative high-risk surgical patients, dopexamine can allow greater increases in oxygen delivery than dobutamine, due to cardiac effects that limit the dobutamine infusion rate.

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Quality management in the prophylaxis of venous thrombembolism - Results of a survey including 464 medical and surgical patients

VASA ◽

10.1024/0301-1526/a000082 ◽

2011 ◽

Vol 40 (2) ◽

pp. 123-130

Author(s):

Klein-Weigel ◽

Richter ◽

Arendt ◽

Gerdsen ◽

Härtwig ◽

...

Keyword(s):

Renal Function ◽

High Risk ◽

Quality Management ◽

High Risk Group ◽

Surgical Patients ◽

Medical Patients ◽

Risk Status ◽

Vte Prophylaxis ◽

Safety Concerns

Background: We surveyed the quality of risk stratification politics and monitored the rate of entries to our company-wide protocol for venous thrombembolism (VTE) prophylaxis in order to identify safety concerns. Patients and methods: Audit in 464 medical and surgical patients to evaluate quality of VTE prophylaxis. Results: Patients were classified as low 146 (31 %), medium 101 (22 %), and high risk cases 217 (47 %). Of these 262 (56.5 %) were treated according to their risk status and in accordance with our protocol, while 9 more patients were treated according to their risk status but off-protocol. Overtreatment was identified in 73 (15.7 %), undertreatment in 120 (25,9 %) of all patients. The rate of incorrect prophylaxis was significantly different between the risk categories, with more patients of the high-risk group receiving inadequate medical prophylaxis (data not shown; p = 0.038). Renal function was analyzed in 392 (84.5 %) patients. In those patients with known renal function 26 (6.6 %) received improper medical prophylaxis. If cases were added in whom prophylaxis was started without previous creatinine control, renal function was not correctly taken into account in 49 (10.6 %) of all patients. Moreover, deterioration of renal function was not excluded within one week in 78 patients (16.8 %) and blood count was not re-checked in 45 (9.7 %) of all patients after one week. There were more overtreatments in surgical (n = 53/278) and more undertreatments in medical patients (n = 54/186) (p = 0.04). Surgeons neglected renal function and blood controls significantly more often than medical doctors (p-values for both < 0.05). Conclusions: We found a low adherence with our protocol and substantial over- and undertreatment in VTE prophylaxis. Besides, we identified disregarding of renal function and safety laboratory examinations as additional safety concerns. To identify safety problems associated with medical VTE prophylaxis and hot spots quality management-audits proved to be valuable instruments.

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Closure of median sternotomy by the Sternal Talon®-system in high-risk cardiac surgical patients

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-0029-1246714 ◽

2010 ◽

Vol 58 (S 01) ◽

Author(s):

M Müller ◽

C Heilmann ◽

S Sorg ◽

S Kueri ◽

M Thoma ◽

...

Keyword(s):

High Risk ◽

Median Sternotomy ◽

Surgical Patients

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Faculty of 1000 evaluation for Our study 20 years on: a randomized clinical trial of the effect of deliberate perioperative increase of oxygen delivery on mortality in high-risk surgical patients.

F1000 - Post-publication peer review of the biomedical literature ◽

10.3410/f.718128643.793485799 ◽

2013 ◽

Author(s):

Andreas Hoeft

Keyword(s):

Clinical Trial ◽

High Risk ◽

Randomized Clinical Trial ◽

Oxygen Delivery ◽

Surgical Patients

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MUKnine OPTIMUM protocol: a screening study to identify high-risk patients with multiple myeloma suitable for novel treatment approaches combined with a phase II study evaluating optimised combination of biological therapy in newly diagnosed high-risk multiple myeloma and plasma cell leukaemia

BMJ Open ◽

10.1136/bmjopen-2020-046225 ◽

2021 ◽

Vol 11 (3) ◽

pp. e046225

Author(s):

Sarah Brown ◽

Debbie Sherratt ◽

Samantha Hinsley ◽

Louise Flanagan ◽

Sadie Roberts ◽

...

Keyword(s):

Multiple Myeloma ◽

High Risk ◽

Plasma Cell ◽

Phase Ii ◽

Whole Body ◽

Cell Leukaemia ◽

High Dose ◽

Newly Diagnosed ◽

Genetic Changes ◽

Novel Treatment

IntroductionMultiple myeloma (MM) is a plasma cell tumour with over 5800 new cases each year in the UK. The introduction of biological therapies has improved outcomes for the majority of patients with MM, but in approximately 20% of patients the tumour is characterised by genetic changes which confer a significantly poorer prognosis, generally termed high-risk (HR) MM. It is important to diagnose these genetic changes early and identify more effective first-line treatment options for these patients.Methods and analysisThe Myeloma UK nine OPTIMUM trial (MUKnine) evaluates novel treatment strategies for patients with HRMM. Patients with suspected or newly diagnosed MM, fit for intensive therapy, are offered participation in a tumour genetic screening protocol (MUKnine a), with primary endpoint proportion of patients with molecular screening performed within 8 weeks. Patients identified as molecularly HR are invited into the phase II, single-arm, multicentre trial (MUKnine b) investigating an intensive treatment schedule comprising bortezomib, lenalidomide, daratumumab, low-dose cyclophosphamide and dexamethasone, with single high-dose melphalan and autologous stem cell transplantation (ASCT) followed by combination consolidation and maintenance therapy. MUKnine b primary endpoints are minimal residual disease (MRD) at day 100 post-ASCT and progression-free survival. Secondary endpoints include response, safety and quality of life. The trial uses a Bayesian decision rule to determine if this treatment strategy is sufficiently active for further study. Patients identified as not having HR disease receive standard treatment and are followed up in a cohort study. Exploratory studies include longitudinal whole-body diffusion-weighted MRI for imaging MRD testing.Ethics and disseminationEthics approval London South East Research Ethics Committee (Ref: 17/LO/0022, 17/LO/0023). Results of studies will be submitted for publication in a peer-reviewed journal.Trial registration numberISRCTN16847817, May 2017; Pre-results.

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123Iodine-metaiodobenzylguanidine scintigraphy versus whole-body magnetic resonance imaging with diffusion-weighted imaging in children with high-risk neuroblastoma — pilot study

Pediatric Radiology ◽

10.1007/s00247-020-04960-2 ◽

2021 ◽

Author(s):

Sebastian Gassenmaier ◽

Roland Bares ◽

Marcel Barreuther ◽

Tim Flaadt ◽

Peter Lang ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Pilot Study ◽

High Risk ◽

Magnetic Resonance ◽

Diffusion Weighted Imaging ◽

Whole Body ◽

Resonance Imaging ◽

Diffusion Weighted ◽

Body Magnetic Resonance Imaging ◽

Metaiodobenzylguanidine Scintigraphy

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Validation of the Berlin Questionnaire and American Society of Anesthesiologists Checklist as Screening Tools for Obstructive Sleep Apnea in Surgical Patients

Anesthesiology ◽

10.1097/aln.0b013e31816d91b5 ◽

2008 ◽

Vol 108 (5) ◽

pp. 822-830 ◽

Cited By ~ 302

Author(s):

Frances Chung ◽

Balaji Yegneswaran ◽

Pu Liao ◽

Sharon A. Chung ◽

Santhira Vairavanathan ◽

...

Keyword(s):

Obstructive Sleep Apnea ◽

High Risk ◽

Screening Tools ◽

Surgical Patients ◽

Apnea Hypopnea Index ◽

Berlin Questionnaire ◽

Obstructive Sleep ◽

American Society ◽

American Society Of Anesthesiologists ◽

Stop Questionnaire

Background Because of the high prevalence of obstructive sleep apnea (OSA) and its adverse impact on perioperative outcome, a practical screening tool for surgical patients is required. This study was conducted to validate the Berlin questionnaire and the American Society of Anesthesiologists (ASA) checklist in surgical patients and to compare them with the STOP questionnaire. Methods After hospital ethics approval, preoperative patients aged 18 yr or older and without previously diagnosed OSA were recruited. The scores from the Berlin questionnaire, ASA checklist, and STOP questionnaire were evaluated versus the apnea-hypopnea index from in-laboratory polysomnography. The perioperative data were collected through chart review. Results Of 2,467 screened patients, 33, 27, and 28% were respectively classified as being at high risk of OSA by the Berlin questionnaire, ASA checklist, and STOP questionnaire. The performance of the screening tools was evaluated in 177 patients who underwent polysomnography. The sensitivities of the Berlin questionnaire, ASA checklist, and STOP questionnaire were 68.9-87.2, 72.1-87.2, and 65.6-79.5% at different apnea-hypopnea index cutoffs. There was no significant difference between the three screening tools in the predictive parameters. The patients with an apnea-hypopnea index greater than 5 and the patients identified as being at high risk of OSA by the STOP questionnaire or ASA checklist had a significantly increased incidence of postoperative complications. Conclusions Similar to the STOP questionnaire, the Berlin questionnaire and ASA checklist demonstrated a moderately high level of sensitivity for OSA screening. The STOP questionnaire and the ASA checklist were able to identify the patients who were likely to develop postoperative complications.

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Safety aspects of the PiCCO thermodilution-cardiac output catheter during magnetic resonance imaging at 3 Tesla

Journal of Clinical Monitoring and Computing ◽

10.1007/s10877-020-00630-8 ◽

2021 ◽

Author(s):

Marieke Voet ◽

Christiaan G. Overduin ◽

Ernst L. Stille ◽

Jurgen J. Fütterer ◽

Joris Lemson

Keyword(s):

Magnetic Resonance Imaging ◽

Cardiac Output ◽

Magnetic Resonance ◽

Critically Ill ◽

Cardiac Output Monitoring ◽

Measured Temperature ◽

Resonance Imaging ◽

Worst Case ◽

Thermodilution Cardiac Output ◽

3T Mri

AbstractThermodilution cardiac output monitoring, using a thermistor-tipped intravascular catheter, is used in critically ill patients to guide hemodynamic therapy. Often, these patients also need magnetic resonance imaging (MRI) for diagnostic or prognostic reasons. As thermodilution catheters contain metal, they are considered MRI-unsafe and advised to be removed prior to investigation. However, removal and replacement of the catheter carries risks of bleeding, perforation and infection. This research is an in vitro safety assessment of the PiCCO™ thermodilution catheter during 3 T Magnetic Resonance Imaging (3T-MRI). In a 3T-MRI environment, three different PiCCO™ catheter sizes were investigated in an agarose-gel, tissue mimicking phantom. Two temperature probes measured radiofrequency-induced heating; one at the catheter tip and one at a reference point. Magnetically induced catheter dislocation was assessed by visual observation as well as by analysis of the tomographic images. For all tested catheters, the highest measured temperature increase was 0.2 °C at the center of the bore and 0.3 °C under “worst-case” setting for the tested MRI pulse sequences. No magnetically induced catheter displacements were observed. Under the tested circumstances, no heating or dislocation of the PiCCO™ catheter was observed in a tissue mimicking phantom during 3T-MRI. Leaving the catheter in the critically ill patient during MRI investigation might pose a lower risk of complications than catheter removal and replacement.

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