Abstract W MP78: Intravascular Volume Delpetion in Hypertensive ED Stroke Patients

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Christopher Lewandowski ◽  
Joseph Miller ◽  
Lauren Rodriquez ◽  
Julian Suszanski ◽  
Jessica Levely
Keyword(s):  
Pilot Study ◽  
Volume Expansion ◽  
Clinical Information ◽  
High Serum ◽  
Volume Status ◽  
Stroke Patients ◽  
Volume Depletion ◽  
Clinical Indicators ◽  
Laboratory Markers ◽  
The Mean

Objective: The hypertensive response in acute stroke may mask patients who could be volume depleted. Our objective was to determine the incidence of stroke patients that are volume depleted despite hypertension. This is a pilot study using sonographic markers of volume status as compared to common clinical indicators of volume status. Methods: This was a prospective cohort study of suspected ischemic stroke patients with a NIHSS ≥ 4 and symptoms onset < 24 hours. Exclusion criteria were pregnancy, age < 18, or ICH. Trained investigators performed a sonographic assessment of volume status. An IVC collapsibility index (IVC-CI) > 50% was used to define volume depletion. Investigators collected demographic and clinical information, and laboratory markers of dehydration (elevated blood urea nitrogen to creatinine ratio, hemoconcentration or high serum osmolality). A standardized questionnaire was given to treating clinicians who were blinded to the IVC-CI. They indicated their assessment of the patient's volume status. The analysis excluded subjects ultimately diagnosed with a stroke mimic. Analysis incorporated descriptive and regression statistics using SAS 9.3. The local IRB approved the study. Results: 23 subjects were enrolled, 4 had stroke mimics and were excluded from analysis. Mimics consisted of psychogenic disorders and myelopathy. The mean age was 64 years, 89% were Black, 68% female, and 95% had preexisting HTN. The mean NIHSS was 9.2, the mean time from symptom onset 309 minutes and the mean presenting SBP 170 ± 31 mmHg. 68% of subjects had a cortical infarct on MRI and the remaining had lacunar infarcts. The mean IVC-CI was 70 ± 21% and 84% (95% CI 68 - 100%) of subjects had IVC-CI > 50%. Laboratory markers of dehydration were present in 5% of subjects. Treating physicians classified 29% as subjects as hypovolemic. There was no correlation between IVC-CI and SBP, NIHSS, infarct location or laboratory markers of dehydration (r = 0.04 - 0.29, p > 0.23). Conclusions: This pilot study suggests that despite being hypertensive, the majority of ED stroke patients have US indications of volume depletion and may be able to tolerate volume expansion. Future studies may identify which patients have improvement in cerebral perfusion with volume expansion.

Abstract WP46: Blood Pressure, Clinical Improvement And Recanalization Following Acute MCA Occlusion

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Nandakumar Nagaraja ◽  
Steven Warach ◽  
Amie W Hsia ◽  
Sungyoung Auh ◽  
Lawrence L Latour ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Clinical Improvement ◽  
Clinical Information ◽  
Collateral Flow ◽  
Stroke Patients ◽  
Mca Occlusion ◽  
The Mean ◽  
The Difference ◽  
Pre Treatment ◽  
B Test

Background: Blood pressure (BP) drop in the first 24 hours after stroke onset may occur in response to vessel recanalization. Clinical improvement could be due to recanalization or better collateral flow with persistent occlusion. We hypothesize that patients with combination of significant improvement on the NIHSS and a drop in BP at 24hr post tPA is associated with recanalization. Methods: We included intravenous t-PA patients from the Lesion Evolution of Stroke Ischemia On Neuroimaging (LESION) registry who had pre-treatment and 24 hour MRA scan, NIHSS scores at those times and an M1 MCA occlusion at baseline, but excluded those on pressors, pre tPA SBP<120 and tandem ICA occlusion. We classified recanalization status on the 24 hour MRA as none, partial or complete. We abstracted all BP measurements for the first 24 hours from the chart and calculated BP drop as the difference of the triage pre-tPA BP and the average of the last 3 hour readings preceding the 24 hour MRI. NIHSS improvement was defined as ≥4points improvement on NIHSS or NIHSS of 0 at 24hour. Patients with combination of drop in BP and NIHSS improvement were compared with others for recanalization status on 24hr MRA by Kendall Tau-b test. Results: Seventeen patients met the study criteria. There were 13 women, the mean age was 76 years and the median baseline NIHSS was 15. On the 24 hour MRA, 3, 8 and 6 patients had none, partial and complete recanalization, respectively. Patients with NIHSS improvement and a SBP drop ≥20 mmHg were more like to have recanalization at 24 hrs (57% Vs 0%, p=0.03). Similar patterns were seen for patients with NIHSS improvement and DBP drop ≥5mmHg (50% Vs 0%, p=0.04) or MAP drop ≥20mmHg (50% Vs 0%, p=0.04). Complete recanalization was only associated with the combination of NIHSS improvement with SBP drop ≥ 20mmHg (66% Vs 0%, p=0.04). A significant association was not found for recanalization with NIHSS improvement alone or drop in BP alone. Conclusion: There is an association of clinical improvement and BP drop in patients who recanalize. Bedside clinical information may be useful in the management of stroke patients.

Point-of-Care Echocardiography Unveils Misclassification of Acute Kidney Injury as Hepatorenal Syndrome

2019 ◽  
Vol 50 (3) ◽  
pp. 204-211 ◽  
Author(s):  
Juan Carlos Q. Velez ◽  
Bradley Petkovich ◽  
Nithin Karakala ◽  
J. Terrill Huggins
Keyword(s):  
Acute Kidney Injury ◽  
Kidney Function ◽  
Volume Expansion ◽  
Hepatorenal Syndrome ◽  
Point Of Care ◽  
Kidney Injury ◽  
Volume Status ◽  
Early Improvement ◽  
Abdominal Hypertension ◽  
The Mean

Introduction: Fulfillment of the diagnostic criteria for ­hepatorenal syndrome type 1 (HRS-1) requires prior failure of 2 days of intravenous volume expansion and/or diuretic withdrawal. However, no parameter of volume status is used to guide the need for volume expansion in patients with suspected HRS-1. We hypothesized that point-of-care echocardiography (POCE) may better characterize the volume status in patients with acute kidney injury (AKI) and cirrhosis to ascertain or disprove the diagnosis of HRS-1. Methods: A pilot observational study was conducted to determine the clinical utility of POCE-based examination of inferior vena cava diameter (IVCD) and collapsibility index (IVCCI) to assess intravascular volume status in patients with cirrhosis and AKI who had been deemed adequately volume-repleted and thereby assigned a clinical diagnosis of HRS-1. Early improvement in kidney function was defined as ≥20% decrease in serum creatinine (sCr) at 48–72 h. Results: A total of 53 patients were included. The mean sCr at the time of volume assessment was 3.2 ± 1.5 mg/dL, and the mean Model for End-Stage Liver Disease score was 29 ± 8. Fifteen (23%) patients had an IVCD <1.3 cm and IVCCI >40% and were reclassified as fluid-depleted, 11 (21%) had an IVCD >2 cm and IVCCI <40% and were reclassified as fluid-expanded, and 8 (15%) had and IVCD <1.3 cm and IVCCI <40% and were reclassified as having intra-abdominal hypertension (IAH). Twelve (23%) patients exhibited early improvement in kidney function following a POCE-guided therapeutic maneuver, that is, volume expansion, diuresis, or paracentesis for those deemed fluid-depleted, fluid-expanded or having IAH, respectively. Conclusion: POCE-based assessment of volume status in cirrhotic individuals with AKI reveals marked heterogeneity. Unguided volume expansion in these patients may lead to premature or delayed diagnosis of HRS-1.

Relationship Between Time from Ambulance Call to Arrival at Emergency Center and Level of Consciousness at Admission in Severe Stroke Patients

2012 ◽  
Vol 28 (1) ◽  
pp. 39-42 ◽  
Author(s):  
Kazuhiro Ohwaki ◽  
Takehiro Watanabe ◽  
Takayuki Shinohara ◽  
Tadayoshi Nakagomi ◽  
Eiji Yano
Keyword(s):  
Clinical Information ◽  
Stroke Patients ◽  
Publication Type ◽  
Emergency Center ◽  
Severe Stroke ◽  
Level Of Consciousness ◽  
The Mean ◽  
Prehospital Delays ◽  
The Impact ◽  
Mean Time

AbstractIntroductionTimely access to acute medical treatment can be critical for patients suffering from severe stroke. Little information is available about the impact of prehospital delays on the clinical conditions of stroke patients, but it is possible that prehospital delays lead to neurological deterioration. The aim of this study was to examine the impact of prehospital delays related to emergency medical services on the level of consciousness at admission in patients with severe stroke.MethodsThis retrospective study assessed 712 consecutive patients diagnosed with cerebrovascular diseases who were admitted to an intensive care unit in Tokyo, Japan, from April 1998 through March 2008. Data, including the time from the call to the ambulance service to the arrival of the ambulance at the patient location (on-scene), and the time from the arrival of the ambulance on-scene to its arrival at the emergency center were obtained. The following demographic and clinical information also were obtained from medical records: sex, age, and Glasgow Coma Scale (GCS) score at admission.ResultsThe mean time from ambulance call to arrival on-scene was 7 (SD=3) minutes, and the mean time from ambulance call to arrival at the center was 37 (SD=8) minutes. A logistic regression model for predicting GCS scores of 3 and 4 at admission was produced. After adjusting for sex, age, and time from arrival on-scene to arrival at the center, a longer call-to-on-scene time was significantly associated with poor GCS scores (OR = 1.056/min; 95% confidence interval, [CI] = 1.008-1.107). After adjusting for sex and age, a longer call-to-arrival at the center time also was significantly associated with poor GCS scores (OR = 1.020; 95% CI = 1.002-1.038).ConclusionsPrehospital delays were significantly associated with decreased levels of consciousness at admission in patients suffering from a stroke. As level of consciousness is the strongest predictor of outcome, reducing prehospital delays may be necessary to improve the outcomes in patients with severe stroke.OhwakiK, WatanabeT, ShinoharaT, NakagomiT, YanoE. Relationship between time from ambulance call to arrival at emergency center and level of consciousness at admission in severe stroke patients. Prehosp Disaster Med. 2012;28(1):1-4.

The Safety and Antimicrobial Properties of Stabilized Hypochlorous Acid in Acetic Acid Buffer for the Treatment of Acute Wounds—a Human Pilot Study and In Vitro Data

2021 ◽  
pp. 153473462110156
Author(s):  
Ewa A. Burian ◽  
Lubna Sabah ◽  
Klaus Kirketerp-Møller ◽  
Elin Ibstedt ◽  
Magnus M. Fazli ◽  
...  
Keyword(s):  
Pilot Study ◽  
Hypochlorous Acid ◽  
Treatment Time ◽  
Donor Site ◽  
Antimicrobial Properties ◽  
Prolonged Treatment ◽  
Wound Irrigation ◽  
The Mean ◽  
And Performance

Acute wounds may require cleansing to reduce the risk of infection. Stabilized hypochlorous acid in acetic buffer (HOCl + buffer) is a novel wound irrigation solution with antimicrobial properties. We performed a first-in-man, prospective, open-label pilot study to document preliminary safety and performance in the treatment of acute wounds. The study enrolled 12 subjects scheduled for a split-skin graft transplantation, where the donor site was used as a model of an acute wound. The treatment time was 75 s, given on 6 occasions. A total of 7 adverse events were regarded as related to the treatment; all registered as pain during the procedure for 2 subjects. One subject had a wound infection at the donor site. The mean colony-forming unit (CFU) decreased by 41% after the treatment, and the mean epithelialization was 96% on both days 14 (standard deviation [SD] 8%) and 21 (SD 10%). The study provides preliminary support for the safety, well-tolerance, and efficacy of HOCl + buffer for acute wounds. The pain was frequent although resolved quickly. Excellent wound healing and satisfying antimicrobial properties were observed. A subsequent in vitro biofilm study also indicated good antimicrobial activity against Pseudomonas aeruginosa with a 96% mean reduction of CFU, when used for a treatment duration of 15 min ( P < .0001), and a 50% decrease for Staphylococcus aureus ( P = .1010). Future larger studies are needed to evaluate the safety and performance of HOCl + buffer in acute wounds, including the promising antimicrobial effect by prolonged treatment on bacterial biofilms.

scholarly journals Mucosa plication reinforced colorectal anastomosis and trans-anal vacuum drainage: a pilot study with preliminary results

2021 ◽  
Author(s):  
Alexander Ferko ◽  
Juraj Váňa ◽  
Marek Adámik ◽  
Adam Švec ◽  
Michal Žáček ◽  
...  
Keyword(s):  
Pilot Study ◽  
Povidone Iodine ◽  
Anal Verge ◽  
Colorectal Anastomosis ◽  
Stapled Anastomosis ◽  
Neoadjuvant Radiotherapy ◽  
Lower Upper ◽  
Registration Number ◽  
The Mean ◽  
Diversion Rate

AbstractDehiscence of colorectal anastomosis is a serious complication that is associated with increased mortality, impaired functional and oncological outcomes. The hypothesis was that anastomosis reinforcement and vacuum trans-anal drainage could eliminate some risk factors, such as mechanically stapled anastomosis instability and local infection. Patients with rectal cancer within 10 cm of the anal verge and low anterior resection with double-stapled technique were included consecutively. A stapler anastomosis was supplemented by trans-anal reinforcement and vacuum drainage using a povidone-iodine-soaked sponge. Modified reinforcement using a circular mucosa plication was developed and used. Patients were followed up by postoperative endoscopy and outcomes were acute leak rate, morbidity, and diversion rate. The procedure was successfully completed in 52 from 54 patients during time period January 2019–October 2020. The mean age of patients was 61 years (lower–upper quartiles 54–69 years). There were 38/52 (73%) males and 14/52 (27%) females; the neoadjuvant radiotherapy was indicated in a group of patients in 24/52 (46%). The mean level of anastomosis was 3.8 cm (lower–upper quartiles 3.00–4.88 cm). The overall morbidity was 32.6% (17/52) and Clavien–Dindo complications ≥ 3 grade appeared in 3/52 (5.7%) patients. No loss of anastomosis was recorded and no patient died postoperatively. The symptomatic anastomotic leak was recorded in 2 (3.8%) patients and asymptomatic blind fistula was recorded in one patient 1/52 (1.9%). Diversion ileostomy was created in 1/52 patient (1.9%). Reinforcement of double-stapled anastomosis using a circular mucosa plication with combination of vacuum povidone-iodine-soaked sponge drainage led to a low acute leak and diversion rate. This pilot study requires further investigation.Registered at ClinicalTrials.gov.: Trial registration number is NCT04735107, date of registration February 2, 2021, registered retrospectively.

Sign in / Sign up

Export Citation Format

Share Document