Systemic Hemodynamic Atherothrombotic Syndrome: Expanding the Concept

Background: Administration of IV tPA has traditionally necessitated admission to an ICU solely for monitoring, with relatively no need for extensive critical care services. Stroke Units that are capable of monitoring IV tPA patients have been proposed to reduce ICU use, but limited data exist that demonstrate safety. We report the largest series of non-ICU managed tPA cases in relation to safety and discharge outcomes. Methods: Consecutive cases admitted to our intermediate-level Stroke Unit spanning 2009-2011 were assembled. Unit capabilities include IV tPA management with nicardipine infusion for blood pressure control as needed, non-invasive or direct central/arterial line and cardiac monitoring, and BiPAP ventilation. Stroke Unit nurses underwent extensive orientation and participate in NET SMART Junior for continuing education. Overall sICH, and drip/ship sICH (parenchymal hemorrhage in combination with > 4 point increase on the NIHSS), systemic hemorrhage, and tPA related death rates were calculated, along with discharge mRS and total ICU cost savings per day. Results: A total of 302 Stroke Unit admissions for intravenous tPA occurred over the 3 year period, while another 31 (10%) were excluded due to critical care admission for systemic hemodynamic or pulmonary instability. Nicardipine infusions were used in 9 (10.5%) Stroke Unit tPA cases in 2009, 10 (9%) in 2010, and 14 (13%) in 2011. Overall sICH rate was 3.3% (n=10) and systemic hemorrhage rate was 2.9% (n=9) with 5 of these (56%) requiring transfusion. Estimated cost savings in total for this 3 year period was $362,400 for “avoided” ICU days. Conclusions: Intravenous tPA patients may be safely managed on non-ICU Stroke Units when nurses undergo extensive education to ensure clinical competence. Use of the ICU solely for management of tPA monitoring needs may constitute significant overuse of system resources at an expense that is not associated with additional safety benefit.

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Early hemodynamics and metabolic changes after total abdominal evisceration for experimental multivisceral transplantation

Acta Cirurgica Brasileira ◽

10.1590/s0102-86502009000200014 ◽

2009 ◽

Vol 24 (2) ◽

pp. 156-161 ◽

Cited By ~ 2

Author(s):

Ruy J. Cruz Junior ◽

Alejandra G. Garrido ◽

Maurício Rocha e Silva

Keyword(s):

Vena Cava ◽

En Bloc Resection ◽

Experimental Models ◽

Metabolic Changes ◽

Therapeutic Modality ◽

En Bloc ◽

Systemic Hemodynamic ◽

Circulating Blood Volume ◽

Multivisceral Transplantation ◽

The Impact

PURPOSE: Multivisceral transplantation (MVTx) has been accepted as standard therapeutic modality for patients with short-bowel syndrome associated with irreversible liver failure. Even nowadays, experimental models of MVTx grounds high incidence of intraoperative or early recipient mortality. Despite the known deleterious effects of hepatosplanchnic exenteration the impact of this procedure on systemic hemodynamics and metabolism remains to be determined. METHODS: Nine dogs (20.1±0.5 kg) were subjected to an en bloc resection of all abdominal organs including, stomach, duodenum, pancreas, liver, spleen, small bowel, and colon. A woven double velour vascular graft was interposed between the suprahepatic and infrahepatic vena cava. Systemic hemodynamic were evaluated through a Swan-Ganz catheter, ultrasonic flowprobes, and arterial lines. Systemic O2-derived variables, glucose, and lactate metabolism were analyzed throughout the experiment. RESULTS: Complete abdominal exenteration was associated with significant reduction in cardiac output, and mean arterial pressure (57% and 14%, respectively). Two hours after reperfusion a significant reduction in arterial pH and glucose were also observed. Oxygen consumption remained unaltered during the first two hours of the experiment, with a significant increase of lactate levels (1.4±0.3 vs. 7.6±0.4, p<0.05). Three animals died before the 3 hours of reperfusion were completed. Total abdominal exenteration for MVTx in dogs is associated with early major hemodynamics, and metabolic changes. CONCLUSION: The deleterious hemodynamic alterations observed are probably related with the association of severe acidosis, hyperlactemia, hypoglycemia, and reduction of total circulating blood volume. Close hemodynamic and metabolic monitoring should be provided during experimental MVTx in order to promote an increase in successful rates of this complex and challenging procedure.

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SYSTEMIC HEMODYNAMIC EFFECTS OF DELIBERATE HYPOTENSION WITH NICARDIPINE OR SODIUM NITROPRUSSIDE DURING TOTAL HIP ARTHROPLASTY

Anesthesiology ◽

10.1097/00000542-198809010-00037 ◽

1988 ◽

Vol 69 (3A) ◽

pp. A37-A37 ◽

Cited By ~ 6

Author(s):

M. Pinaud ◽

M. Babin ◽

J. M. Bernard ◽

D. Chedorge ◽

J. Letcnneur

Keyword(s):

Total Hip Arthroplasty ◽

Sodium Nitroprusside ◽

Hip Arthroplasty ◽

Hemodynamic Effects ◽

Systemic Hemodynamic ◽

Deliberate Hypotension ◽

Total Hip

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Renal, cardiac, and systemic hemodynamic effects of the dopamine receptor agonist SK&F 85174 in anesthetized dogs

Drug Development Research ◽

10.1002/ddr.430160108 ◽

1989 ◽

Vol 16 (1) ◽

pp. 71-77

Author(s):

Abdallah Dlewati ◽

Mustafa F. Lokhandwala ◽

Jacques E. Chelly ◽

Marie-Francoise Doursout

Keyword(s):

Dopamine Receptor ◽

Receptor Agonist ◽

Dopamine Receptor Agonist ◽

Hemodynamic Effects ◽

Systemic Hemodynamic ◽

Anesthetized Dogs

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REGIONAL AND SYSTEMIC HEMODYNAMIC DISTURBANCES IN CIRRHOSIS

Clinics in Liver Disease ◽

10.1016/s1089-3261(05)70184-7 ◽

2001 ◽

Vol 5 (3) ◽

pp. 617-627 ◽

Cited By ~ 24

Author(s):

K.V. Narayanan Menon ◽

Patrick S. Kamath

Keyword(s):

Systemic Hemodynamic

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Resolution of neonatal posthemorrhagic ventricular dilation coincident with patent ductus arteriosus ligation: case report

Journal of Neurosurgery Pediatrics ◽

10.3171/2020.3.peds19694 ◽

2020 ◽

Vol 26 (3) ◽

pp. 255-261 ◽

Cited By ~ 1

Author(s):

Erik B. Vanstrum ◽

Matthew T. Borzage ◽

Jason K. Chu ◽

Shuo Wang ◽

Nolan Rea ◽

...

Keyword(s):

Patent Ductus Arteriosus ◽

Intraventricular Hemorrhage ◽

Ductus Arteriosus ◽

Medical Intervention ◽

Cranial Ultrasound ◽

Ventricular Dilation ◽

Venous Flow ◽

Systemic Hemodynamic ◽

Patent Ductus

Preterm infants commonly present with a hemodynamically significant patent ductus arteriosus (hsPDA). The authors describe the case of a preterm infant with posthemorrhagic ventricular dilation, which resolved in a temporally coincident fashion to repair of hsPDA. The presence of a PDA with left-to-right shunting was confirmed at birth on echocardiogram and was unresponsive to repeated medical intervention. Initial cranial ultrasound revealed periventricular-intraventricular hemorrhage. Follow-up serial ultrasound showed resolving intraventricular hemorrhage and progressive bilateral hydrocephalus. At 5 weeks, the ductus was ligated with the goal of improving hemodynamic stability prior to CSF diversion. However, neurosurgical intervention was not required due to improvement of ventriculomegaly occurring immediately after PDA ligation. No further ventricular dilation was observed at the 6-month follow-up.Systemic venous flow disruption and abnormal patterns of cerebral blood circulation have been previously associated with hsPDA. Systemic hemodynamic change has been reported to follow hsPDA ligation, although association with ventricular normalization has not. This case suggests that the unstable hemodynamic environment due to left-to-right shunting may also impede CSF outflow and contribute to ventriculomegaly. The authors review the literature surrounding pressure transmission between a PDA and the cerebral vessels and present a mechanism by which PDA may contribute to posthemorrhagic ventricular dilation.

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