Cardiac Function in Brain Death, Usage of Advanced Hemodynamic Monitoring

Background: This study used advanced hemodynamic monitoring along with simultaneous echocardiography to assess donated heart function of brain death patients using advanced hemodynamic monitoring and its efficacy in organ donation. Methods: Forty-eight brain death patients who were candidates of heart donation on the basis of primary standard investigations were selected with purposive and convenient sampling methods. They were investigated with advanced hemodynamic monitoring after echocardiography and primary assessments and the gleaned data were recorded. Results: Echocardiography showed that LVS (left ventricle size) and LVF (left ventricle function) were normal in %100 and %87.5 of patients, respectively. LVEF (left ventricle ejection fraction) was <%50 in %12.5 and >%50 in %87.5 of patients. SVR was smaller than 1200 at the beginning of the study that reached %54.4 at the end of the study. CI (cardiac index) was < 2.4 in %16.7 of the patients at the onset of the study that reached %25 at the end. Reduction of CI and SVR in patients with EF <%50 was significantly higher than that in patients with EF>%50. Conclusion: Given the extensive pathological changes in the cardiovascular system exerted by brain death, advanced hemodynamic monitoring, if performed continually, can greatly aid in managing inotropic drugs in these patients, decision-making for managing intravascular volume, creating hemodynamic stability, and finally, preventing deterioration of function of the donated heart and loss of a donated organ.

Timely Recognition and Early Multi-Step Antinflammatory Therapy May Prevent ICU Admission of Patients With MIS-C: Proposal for a Severity Score

In this observational study, we report the clinical, therapeutics and outcome features of 23 patients with multisystem inflammatory syndrome (MIS-C) who have been treated in Gaslini Children Hospital (Genoa, Italy) with a multistep antinflammatory treatment protocol, based on disease severity at admission. Patients were initially assigned to four severity classes on admission and treated accordingly. The therapeutic options ranged from IV immunoglobulin alone to a combination of IVIG plus pulses of methylprednisolone plus anakinra for patients with marked cardiac function impairment or signs of macrophage activation syndrome, with rapid treatment escalation in case of inadequate therapeutic response. With the application of this therapeutic strategy, no patient required admission to Intensive Care Unit (ICU) or invasive mechanical ventilation, and no inotropic drugs administration was required. Early aggressive treatment of MIS-C, with therapeutic interventions modulated based on the severity of clinical manifestations may help to prevent the progression of the inflammatory process and to avoid the need of admission to the ICU. A timely intervention with anti-IL-1 blockers can play a pivotal role in very severe patients that are at risk to have an incomplete response to immunoglobulins and steroids.

Risk Factors for Venous Thromboembolism in Severe COVID-19: A Study-Level Meta-Analysis of 21 Studies

Venous thromboembolism (VTE) in patients with COVID-19 in intensive care units (ICU) is frequent, but risk factors (RF) remain unidentified. In this meta-analysis (CRD42020188764) we searched for observational studies from ICUs reporting the association between VTE and RF in Medline/Embase up to 15 April 2021. Reviewers independently extracted data in duplicate and assessed the certainty of the evidence using the GRADE approach. Analyses were conducted using the random-effects model and produced a non-adjusted odds ratio (OR). We analysed 83 RF from 21 studies (5296 patients). We found moderate-certainty evidence for an association between VTE and the D-dimer peak (OR 5.83, 95%CI 3.18–10.70), and length of hospitalization (OR 7.09, 95%CI 3.41–14.73) and intubation (OR 2.61, 95%CI 1.94–3.51). We identified low-certainty evidence for an association between VTE and CRP (OR 1.83, 95% CI 1.32–2.53), D-dimer (OR 4.58, 95% CI 2.52–8.50), troponin T (OR 8.64, 95% CI 3.25–22.97), and the requirement for inotropic drugs (OR 1.67, 95% CI 1.15–2.43). Traditional VTE RF (i.e., history of cancer, previous VTE events, obesity) were not found to be associated to VTE in COVID-19. Anticoagulation was not associated with a decreased VTE risk. VTE RF in severe COVID-19 correspond to individual illness severity, and inflammatory and coagulation parameters.

The Effects of Total Parenteral Nutrition on Plasma Aluminium Level in Premature

There are studies showing that parenteral nutrition fluids used for adaptation of preterm infants contain aluminum. It is known that aluminum accumulates in the body, disrupts mental development, affects bone mineral structure. In our study, we aimed to investigate parenteral nutrition and aluminum transmission in preterm infants. A total of 45 babies born during pregnancy week ≤32 and / or under 1500 gr were included in the study. A statistically significant increase was observed when we compared the levels of aluminum in the cord blood and in the 14th day of the patients. When the factors affecting serum aluminum levels were examined, no significant difference was found between birth weight, birth week and gender. No statistically significant difference was found between the duration of taking antibiotics, inotropic drugs serum aluminum levels. Statistically significance was found between number of days of furosemid administeration and serum Al levels. Longer parenteral nutrition was associated with greater increase in serum aluminium levels. A significant positive correlation was found between serum aluminium levels on 14th day and the calcium and magnesium levels in the TPN solutions which were administered in the first 7 days. In conclusion, the increase in serum aluminum levels in preterm infants fed parenteral nutrition was found to be statistically significant. In infants with longer parenteral nutrition, the increase in serum aluminum levels was greater. It is planned to continue our research in terms of long term effects of aluminum.

Albumin Nanoparticle Formulation for Heart-Targeted Drug Delivery: In Vivo Assessment of Congestive Heart Failure

Congestive heart failure is a fatal cardiovascular disease resulting in tissue necrosis and loss of cardiac contractile function. Inotropic drugs such as milrinone are commonly used to improve the myocardial contractility and heart function. However, milrinone is associated with severe side effects and lower circulation time. In this article, a novel protein nanoparticle formulation for heart-targeted delivery of milrinone has been designed and tested. The formulation was prepared using albumin protein conjugated with the targeting ligand, angiotensin II peptide to form nanoparticles following the ethanol desolvation method. The formulation was characterized for size, charge, and morphology and tested in a rat model of congestive heart failure to study pharmacokinetics, biodistribution, and efficacy. The overall cardiac output parameters were evaluated comparing the formulation with the control non-targeted drug, milrinone lactate. This formulation exhibited improved pharmacokinetics with a mean retention time of 123.7 min, half-life of 101.3 min, and clearance rate of 0.24 L/(kg*h). The targeted formulation also significantly improved ejection fraction and fractional shortening parameters thus improving cardiac function. This study demonstrates a new approach in delivering inotropic drugs such as milrinone for superior treatment of congestive heart failure.

Successful treatment of severe calcium channel blocker poisoning: a clinical case

The article describes the successful experience of treating a female patient with severe poisoning by a mixture of drugs with a predominant cardiotoxic effect. The number of drugs taken was many times higher than the potentially lethal dose. Hemodynamics has been supported by vasopressors and inotropic drugs for a long time, antidotes, sorbents, detoxification agents were used. Due to inadequate spontaneous ventilation, the patient was on artificial lung ventilation for 24 days. After 26 days in the intensive care unit, she was transferred to the therapeutic department in a stable state and without neurological deficit. We believe that this material will be useful for intensive care physicians when providing emergency care to patients in such situations.

Leading predictors of early and late hospital mortality among patients with acute decompensated heart failure and ways to improve prognosis

Objective: to analyze the leading causes of early (first two days) and late (after the second day) hospital mortality among of patients with acute decompensated heart failure.Materials and methods: a retrospective single-center cohort (n=718) of patients with acute decompensated heart failure.Results: predictors of prognosis for early hospital mortality were pulmonary edema, hepatomegaly, the need for inotropic and vasopressive drugs, the level of systolic blood pressure and creatinine. Predictors of prognosis for late hospital mortality were pulmonary edema, the need for inotropic drugs, community-acquired pneumonia, and laboratory markers of acute renal injury.Conclusion: Tactical approaches are proposed to reduce hospital mortality of patients with acute decompensated heart failure.

PRE-EXPERIMENTAL STUDY TO ASSESS THE EFFECTIVENESS OF A STRUCTURED TEACHING PROGRAM ON KNOWLEDGE REGARDING THE ADMINISTRATION OF SELECTED INOTROPIC DRUGS AMONG THE STAFF NURSES IN SELECTED HOSPITAL KASHMIR

Nowadays we are observing there are enough number of cardiovascular patients and also day by day their ratio is getting increased at huge number because Cardiovascular diseases are the number one cause of death globally, taking an estimated 17.9 million lives each year. Cardiovascular diseases are a group of disorders of the heart and blood vessels and include coronary heart disease and other conditions. Four out of five deaths are due to heart attacks and strokes and one third of these deaths occur prematurely in people under 70 years of age. Individual at risk may demonstrate raised blood pressure, glucose, and lipids as well as overweight and obesity. These can all be easily measured in primary care facilities. Identifying those at high risk of cardiovascular diseases and ensuring they receive appropriate treatment and can prevent premature deaths. For those conditions inotropic drugs play a vital role in rehablitating the cardiovascular disease patients. Inotropic state is most commonly used in reference to various drugs that affect the strength of contraction of heart muscle. Inotropic drugs are the medicines that change the force of hearts contractions. There are two kinds of inotropes namely positive which strengthen the force of heart beat and negative inotropes which weaken the force of heartbeat. So inotropic drugs are the commonly drugs used to treat cardiovascular conditions. Therefore in view of this pre-experimental one group pre-test post-test research design study was conducted to as assess the effectiveness of a structured teaching program on knowledge regarding the administration of inotropic drugs among the staff nurses in selected hospital of Kashmir for which 60 subjects were selected by simple random sampling technique. After data collection structured knowledge questionnaire was used to assess the knowledge among subjects. The data was analyzed by descriptive and inferential statistics by using chi-square and t-test. The findings revealed that in posttest majority of the study subjects 6(10%) had excellent knowledge, 53(88.3%) had good knowledge, 1(1.7%) had average and none had below average knowledge with posttest mean score 26.15 standard deviation 3.019 with mean percentage 63.78 and mean difference 12.97. Study concludes that null hypothesis was rejected because there was gain in knowledge among staff nurses after imparting structured teaching programme. The study also concluded that null hypothesis was accepted because there was statistically no significant association between selected variable (professional qualification, working experience, place of posting, and in-service education programme attended) at p> 0.001 of staff nurses with their pre-test knowledge scores at 0.05 level of significance.

A complex rare presentation of rice tablet poisoning: A case report

Aluminum phosphide, known as "rice tablet" (RT), is a common cause of suicide in adult women in Iran, with a high rate of lethal outcome. We report a patient with RT toxicity, with a complex syndrome of hepatic failure, renal failure, Brugada electrocardiography (ECG) patterns, and pleuropericardial effusion. The patient received conventional management with fluid therapy, gastric washing, activated charcoal followed by intra-aortic balloon pump insertion, inotropic drugs support, and mechanical ventilation. The unique features of our case are related to a combination of multiorgan failure with Brugada atypical ECG patterns and pleuropericardial effusion. Among the aforementioned complications, pleuropericardial effusion, ascites, and Brugada syndrome are exceedingly rare events. The patient was treated with high-dose inotropic drugs and intra-aortic balloon pump insertion. Despite tremendous management of metabolic acidosis, all efforts failed, and the patient died with sudden cardiac arrest.