P31 Compatibility of sildenafil citrate with noradrenaline and vasopressin during simulated y-site administration

2018 ◽  
Vol 103 (2) ◽  
pp. e1.36-e1
Author(s):  
O’Brien Fiona ◽  
M Howlett Moninne ◽  
V Breatnach Cormac ◽  
Kelly Helena ◽  
Alsalman Fatemah
Keyword(s):  
Pulmonary Hypertension ◽  
Treatment Options ◽  
Multiple Drug ◽  
List Type ◽  
Chemical Compatibility ◽  
Ph Change ◽  
Term Infants ◽  
Starting Point ◽  
Inhaled Prostacyclin ◽  
Physical And Chemical

AimOff-label use of IV sildenafil (Revatio) is one of the limited treatment options available in the treatment of Pulmonary Hypertension in the paediatric and neonatal population. The lack of compatibility data on the co-administration of IV sildenafil with other drugs in critical care means a dedicated line is required for sildenafil. However, in critically unwell patients multiple drug infusions are commonly administered and the dedication of an IV line for sildenafil could be problematic and can further increase the risks of adverse events.1,2 Our Lady’s Children’s Hospital Crumlin in Dublin Ireland, identified the following five drugs as critical and commonly encountered in PICU; Adrenaline, Noradrenaline, Vasopressin, Milrinone and Heparin. The aim of this study is to determine the physical and chemical compatibility of Noradrenaline and Vasopressin in combination with Sildenafil.MethodTo simulate Y-site conditions the drugs were mixed in a 1:1 ratio as previously demonstrated by Allen et al.3 Clear glass tubes as specified by the EP, were used to allow for the investigation of compatibility at specific time-points across a 24 hour period at room temperature. Drugs were prepared in accordance with clinical practice; Noradrenaline 60 micrograms/ml, vasopressin 0.4 units/ml and sildenafil 800 micrograms/ml. Different diluents: NaCl 0.9% w/v, Glucose 5% w/v and Glucose 10% w/v were examined. Chemical compatibility was assessed using HPLC and physical by pH determination and visual inspection of contents. Drugs were deemed compatible if concentrations of both remained between 90% and 110% of the original concentration3 and if no signs of physical incompatibility was noted (i.e. pH change, haze or cloudiness).ResultsNo physical incompatibility was noted between the compounds with stable pH and no visual changes. Concentrations of vasopressin, noradrenaline and sildenafil were all within concentration limits indicating chemical compatibility.ConclusionThe limited and incomplete data presented in the literature for the compatibility of drugs administered via Y-site in combination with sildenafil, makes studies such as this one invaluable to clinicians. The overall aim of this work is to provide a complete compatibility chart of all five drugs identified as critical in combination with Sildenafil at RT and at 37°C. This preliminary data provides a starting point in the investigation of the compatibility of Sildenafil in combination with commonly used ICU drug infusions.ReferencesFender RA, Hasselman TE, Wang Y, Harthan AA. Evaluation of the tolerability of intermittent intravenous sildenafil in paediatric patients with pulmonary hypertension. JPPT2016;21(5):419–25.Kelly LK, Porta NFM, Goodman DM, Carroll CL, Steinhorn RH. Inhaled prostacyclin for term infants with persistent pulmonary hypertension refractory to inhaled nitric oxide. JPeds2002;141(6):830–2.Allen LV, Jr., Levinson RS, Phisutsinthop D. Compatibility of various admixtures with secondary additives at Y-injection sites of intravenous administration sets. Am J Hosp Pharm1977;34(9):939–43.

Inhaled prostacyclin for term infants with persistent pulmonary hypertension refractory to inhaled nitric oxide

2002 ◽  
Vol 141 (6) ◽  
pp. 830-832 ◽  
Author(s):  
Lisa K. Kelly ◽  
Nicolas F.M. Porta ◽  
Denise M. Goodman ◽  
Christopher L. Carroll ◽  
Robin H. Steinhorn
Keyword(s):  
Nitric Oxide ◽  
Pulmonary Hypertension ◽  
Inhaled Nitric Oxide ◽  
Persistent Pulmonary Hypertension ◽  
Term Infants ◽  
Inhaled Prostacyclin

scholarly journals Neonatal and Postneonatal Pulmonary Hypertension

Children ◽  
2021 ◽  
Vol 8 (2) ◽  
pp. 131
Author(s):  
Satyan Lakshminrusimha
Keyword(s):  
Pulmonary Hypertension ◽  
Preterm Infants ◽  
Ductus Arteriosus ◽  
Right Ventricular Dysfunction ◽  
Fold Increase ◽  
Pulmonary Vein Stenosis ◽  
Term Infants ◽  
Pulmonary Vasodilators ◽  
Non Invasive Ventilation ◽  
Early Closure

During transition at birth with ventilation of the lungs, pulmonary vascular resistance (PVR) decreases from high fetal values, leading to an 8 to 10-fold increase in pulmonary blood flow (Qp). In some infants, this transition does not occur, resulting in pulmonary hypertension (PH). In infants, PH can present as: (a) primary PH in term neonates (idiopathic), (b) PH secondary to lung disease or hypoplasia in term infants, (c) acute PH in preterm infants with respiratory distress syndrome (RDS), (d) chronic PH with bronchopulmonary dysplasia (BPD) in preterm infants and (e) post-neonatal PH. A hemodynamically significant patent ductus arteriosus (PDA) can exacerbate PH in preterm infants due to increased Qp. Pulmonary vein stenosis (PVS) can complicate BPD with PH. Diagnosis of PH is based on clinical features, echocardiography and, in some intractable cases, cardiac catheterization. Therapy of PH includes oxygen, invasive or non-invasive ventilation, correction of acidosis, surfactant and selective and non-selective pulmonary vasodilators such as inhaled nitric oxide and sildenafil, respectively. Early closure of a hemodynamically significant PDA has the potential to limit pulmonary vascular remodeling associated with BPD and PH. The role of thiamine in pathogenesis of PH is also discussed with the recent increase in thiamine-responsive acute pulmonary hypertension in early infancy. Recognition and prompt therapy of PH can prevent right ventricular dysfunction, uncoupling and failure.

scholarly journals Metabolic-endocrine disruption due to preterm birth impacts growth, body composition, and neonatal outcome

2021 ◽  
Author(s):  
Lea Sophie Möllers ◽  
Efrah I. Yousuf ◽  
Constanze Hamatschek ◽  
Katherine M. Morrison ◽  
Michael Hermanussen ◽  
...  
Keyword(s):  
Body Composition ◽  
Preterm Birth ◽  
Postnatal Development ◽  
Endocrine Disruption ◽  
Fat Mass ◽  
Neonatal Morbidity ◽  
Neonatal Outcomes ◽  
Endocrine Function ◽  
List Type ◽  
Term Infants

Abstract Despite optimized nutrition, preterm-born infants grow slowly and tend to over-accrete body fat. We hypothesize that the premature dissociation of the maternal–placental–fetal unit disrupts the maintenance of physiological endocrine function in the fetus, which has severe consequences for postnatal development. This review highlights the endocrine interactions of the maternal–placental–fetal unit and the early perinatal period in both preterm and term infants. We report on hormonal levels (including tissue, thyroid, adrenal, pancreatic, pituitary, and placental hormones) and nutritional supply and their impact on infant body composition. The data suggest that the premature dissociation of the maternal–placental–fetal unit leads to a clinical picture similar to panhypopituitarism. Further, we describe how the premature withdrawal of the maternal–placental unit, neonatal morbidities, and perinatal stress can cause differences in the levels of growth-promoting hormones, particularly insulin-like growth factors (IGF). In combination with the endocrine disruption that occurs following dissociation of the maternal–placental–fetal unit, the premature adaptation to the extrauterine environment leads to early and fast accretion of fat mass in an immature body. In addition, we report on interventional studies that have aimed to compensate for hormonal deficiencies in infants born preterm through IGF therapy, resulting in improved neonatal morbidity and growth. Impact Preterm birth prematurely dissociates the maternal–placental–fetal unit and disrupts the metabolic-endocrine maintenance of the immature fetus with serious consequences for growth, body composition, and neonatal outcomes. The preterm metabolic-endocrine disruption induces symptoms resembling anterior pituitary failure (panhypopituitarism) with low levels of IGF-1, excessive postnatal fat mass accretion, poor longitudinal growth, and failure to thrive. Appropriate gestational age-adapted nutrition alone seems insufficient for the achievement of optimal growth of preterm infants. Preliminary results from interventional studies show promising effects of early IGF-1 supplementation on postnatal development and neonatal outcomes.

scholarly journals Pulmonary Hypertension in Acute and Chronic High Altitude Maladaptation Disorders

2021 ◽  
Vol 18 (4) ◽  
pp. 1692
Author(s):  
Akylbek Sydykov ◽  
Argen Mamazhakypov ◽  
Abdirashit Maripov ◽  
Djuro Kosanovic ◽  
Norbert Weissmann ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
High Altitude ◽  
Clinical Experience ◽  
Current Knowledge ◽  
Hypoxic Pulmonary Vasoconstriction ◽  
Treatment Options ◽  
Right Heart Failure ◽  
Channel Blockers ◽  
The Right ◽  
Extensive Clinical Experience

Alveolar hypoxia is the most prominent feature of high altitude environment with well-known consequences for the cardio-pulmonary system, including development of pulmonary hypertension. Pulmonary hypertension due to an exaggerated hypoxic pulmonary vasoconstriction contributes to high altitude pulmonary edema (HAPE), a life-threatening disorder, occurring at high altitudes in non-acclimatized healthy individuals. Despite a strong physiologic rationale for using vasodilators for prevention and treatment of HAPE, no systematic studies of their efficacy have been conducted to date. Calcium-channel blockers are currently recommended for drug prophylaxis in high-risk individuals with a clear history of recurrent HAPE based on the extensive clinical experience with nifedipine in HAPE prevention in susceptible individuals. Chronic exposure to hypoxia induces pulmonary vascular remodeling and development of pulmonary hypertension, which places an increased pressure load on the right ventricle leading to right heart failure. Further, pulmonary hypertension along with excessive erythrocytosis may complicate chronic mountain sickness, another high altitude maladaptation disorder. Importantly, other causes than hypoxia may potentially underlie and/or contribute to pulmonary hypertension at high altitude, such as chronic heart and lung diseases, thrombotic or embolic diseases. Extensive clinical experience with drugs in patients with pulmonary arterial hypertension suggests their potential for treatment of high altitude pulmonary hypertension. Small studies have demonstrated their efficacy in reducing pulmonary artery pressure in high altitude residents. However, no drugs have been approved to date for the therapy of chronic high altitude pulmonary hypertension. This work provides a literature review on the role of pulmonary hypertension in the pathogenesis of acute and chronic high altitude maladaptation disorders and summarizes current knowledge regarding potential treatment options.

Rising from the ashes: Satyam's story

2014 ◽  
Vol 4 (1) ◽  
pp. 1-8
Author(s):  
Tanvi Gautam
Keyword(s):  
Change Management ◽  
Subject Area ◽  
Executive Education ◽  
List Type ◽  
Corporate Communications ◽  
It Industry ◽  
Market Reactions ◽  
Content Type ◽  
Employee Trust ◽  
Starting Point

Subject area Leadership, human resource management, crisis management, change management and communication. Study level/applicability Executive education; postgraduate; undergraduate. Case overview This case study describes the collapse of Satyam, a leading IT industry service provider from India. Satyam went into a crisis mode after revelation of financial fraud by its Chairman. This resulted in a crisis not just for the company, its clients and employees – but it also had the potential to shake up the entire Indian IT industry the world over, by shattering investor and client confidence in the Indian IT sector. The case provides the students with an inside view of the unfolding of events at Satyam and the people challenges that emerge in a crisis scenario. The case outlines reactions from the industry, government, clients and employees as they tried to make sense of a very chaotic situation, and its multi-level ramifications both within India and outside. The case ends with Thallapalli Hari, the Global Head of Marketing and Communication and ex-head of HR, trying to visualise and prioritise a course of action to propose to other members of the leadership team. Expected learning outcomes The key aim of this case is to provide a backdrop to the crisis, and also help students put themselves in the role of an HR crisis manager as well as portray the decision making and communication challenges that emerge in chaotic situations. The importance of an immediate and yet strategic response is emphasised and the case is a great starting point to have a discussion on the competencies and skills required in HR to lead under unusual circumstances. This case allows participants to get an in-depth understanding of the collapse of Satyam. The case also illustrates principles of leadership, change management and communication, in particular: Leadership: The Satyam story is an HR and leadership crisis nightmare come true. What should an HR leader do when you wake up to find your company with a ruined reputation, minimal financial capital, 53,000 employees on the payroll and more than 500 clients with pending deliverables worldwide. Where do you begin? The case illustrates a situation where immediate action is required to stop the tailspin into which the company was heading. Change management: The situation demanded that change be managed from a chaotic system to a stable system. The big issue though remains as to how one can get a system into a state of stability when everything is changing at the same time. Most change management plans have some stable variables, however in the case of Satyam there were multiple changes taking place simultaneously. A combination of change in leadership, client relationships, employee trust and confidence, market reactions together make for a perfect storm. Dealing with even one of these changes is a challenge for a company. In the case of Satyam, its entire existence was at stake. Communication: The demands for communicating effectively in a crisis situation are different than communicating under stable systems. The choice of medium, the speed of response, the content all need careful monitoring. Whereas most companies have teams that separately deal with internal and external communication, Satyam provides a unique situation where managing both effectively at the same time was critical to the future of the firm. The stakes for effective communication are much higher under the circumstances. This case can be used in organizational behaviour, human resources and corporate communications modules being taught to under-graduates, post-graduates and for executive education. Supplementary materials Teaching notes are available for educators only. Please contact your library to gain login details or email [email protected] to request teaching notes.

Adenosine Infusion Improves Oxygenation in Term Infants With Respiratory Failure

PEDIATRICS ◽  
1996 ◽  
Vol 97 (3) ◽  
pp. 295-300
Author(s):  
G. Ganesh Konduri ◽  
Daisy C. Garcia ◽  
Nadya J. Kazzi ◽  
Seetha Shankaran
Keyword(s):  
Pulmonary Hypertension ◽  
Placebo Group ◽  
Extracorporeal Membrane Oxygenation ◽  
Normal Saline ◽  
Medical Center ◽  
Blood Gases ◽  
Adenosine Infusion ◽  
Term Infants ◽  
Membrane Oxygenation ◽  
Arterial Blood

Objective. Adenosine infusion causes selective pulmonary vasodilation in fetal and neonatal lambs with pulmonary hypertension. We investigated the effects of a continuous infusion of adenosine on oxygenation in term infants with persistent pulmonary hypertension of newborn (PPHN). Design. A randomized, placebo-controlled, masked trial comparing the efficacy of intravenous infusion of adenosine to normal saline infusion over a 24-hour period. Setting. Inborn and outborn level III neonatal intensive care units at a university medical center. Participants. Eighteen term infants with PPHN and arterial postductal Po2 of 60 to 100 Torr on inspired O2 concentration of 100% and optimal hyperventilation (PaCo2 <30 Torr) were enrolled into the study. Study infants were randomly assigned to receive a placebo infusion of normal saline, or adenosine infusion in doses of 25 to 50 µg/kg/min over a 24-hour period. Results. Nine infants each received adenosine or placebo. The two groups did not differ in birth weight, gestational age, or blood gases and ventilator requirements at the time of entry into the study. Four of nine infants in the adenosine group and none of the placebo group had a significant improvement in oxygenation, defined as an increase in postductal PaO2 of ≥20 Torr from preinfusion baseline. The mean PaO2 in the adenosine group increased from 69 ± 19 at baseline to 94 ± 15 during 50 µg/kg/min infusion rate of adenosine and did not change significantly in the placebo group. Arterial blood pressure and heart rate did not change during the study in either group. The need for extracorporeal membrane oxygenation, incidence of bronchopulmonary dysplasia, and mortality were not different in the two groups. Conclusion. Data from this pilot study indicate that adenosine infusion at a dose of 50 µg/kg/min improves PaO2 in infants with PPHN without causing hypotension or tachycardia. Larger trials are needed to determine its effects on mortality and/or need for extracorporeal membrane oxygenation in infants with PPHN.

PREVALANCE OF HEAD AND NECK CANCER IN UPPER ASSAM: AN INSTITUTIONAL STUDY.

2021 ◽  
pp. 50-51
Author(s):  
Ayesha Agarwal ◽  
Trishan Paul ◽  
Rudra Kanta Gogoi ◽  
Rheetwik Baruah ◽  
Chiranjeev Baruah
Keyword(s):  
Oral Cavity ◽  
Head And Neck ◽  
Treatment Options ◽  
Population Based ◽  
Population Based Study ◽  
Medical College ◽  
Starting Point ◽  
High Prevalence ◽  
North Eastern ◽  
Total Body

In India, head and neck cancers (HNCA) account for 14.3% cancers at all sites. In North-eastern India, there is a high prevalence of HNCA which can be associated with pervasive habit of using tobacco, lime and betel. The alarmingly high prevalence of cancers of head and neck in this part of India has prompted us to take up this study. Ahospital-based study on prevalence of cancer in various head and neck regions like oropharynx, oral cavity, pharynx, larynx, salivary glands and nasal cavity was conducted in Department of Radiation Oncology, Assam Medical College and Hospital from June 2020 to May 2021.The prevalence is found to be signicantly high at 57.59%, affecting males more than females in the age group of 50-59 years. HNCA of hypopharynx and oral cavity constituted a major burden of total body cancer. This study hopes to quantify and analyse the HNCAspectrum and should help as a starting point for a much needed population based study in this region. Acomprehensive effort is required to identify the cause of such high prevalence of HNCAin this region of India, generate awareness and treatment options suited to meet this challenge.

scholarly journals Sleep disordered breathing at the extremes of age: the elderly

Breathe ◽  
2016 ◽  
Vol 12 (1) ◽  
pp. 50-60 ◽  
Author(s):  
Alison McMillan ◽  
Mary J. Morrell
Keyword(s):  
Risk Factors ◽  
Older People ◽  
Sleep Disordered Breathing ◽  
Treatment Options ◽  
Current Evidence ◽  
List Type ◽  
Pressure Therapy ◽  
Age Related ◽  
The Impact ◽  
Disordered Breathing

Key pointsSleep disordered breathing (SDB) is common and its prevalence increases with age. Despite this high prevalence, SDB is frequently unrecognised and undiagnosed in older people.There is accumulating evidence that SDB in older people is associated with worsening cardio- cerebrovascular, cognitive and functional outcomes.There is now good evidence to support the use of continuous positive airway pressure therapy in older patients with symptomatic SDB.Educational aimsTo highlight the prevalence and presentation of sleep disordered breathing (SDB) in older people.To inform readers about the risk factors for SDB in older people.To explore the impact of SDB in older people.To introduce current evidence based treatment options for SDB in older people.Sleep disordered breathing (SBD) increases in prevalence as we age, most likely due to physiological and physical changes that occur with ageing. Additionally, SDB is associated with comorbidity and its subsequent polypharmacy, which may increase with increasing age. Finally, the increased prevalence of SDB is intrinsically linked to the obesity epidemic. SDB is associated with serious outcomes in younger people and, likewise, older people. Thus, identification, diagnosis and treatment of SDB is important irrelevant of age. This article reviews the age-related changes contributing to SDB, the epidemiology and the risk factors for SDB in older people, the association of SDB with adverse outcomes, and diagnostic and treatment options for this population.

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