Custodiol HTK Versus Plegisol: in-Vitro Comparison With The Use of Immature (H9C2) and Mature (HCM) Cardiomyocytes Cultures

Background: Although cardioplegia is used since the ‘70s of the last century, debate on cardioprotection during cardio-surgical procedures is still actual. The selection of a particular method depends mainly on the preferences and experience of a specific center or even surgeon. Crystalloid cardioplegia is an aqueous ion solution similar to intracellular (Custodiol HTK) or extracellular (Plegisol) fluid. Numerous publications compare different types of cardioplegic solutions, but only a few used cultured cells in laboratory conditions. Methods: In this study, the authors compare two crystalloid solutions using an in-vitro model simulating cardioplegic arrest. The efficacy of myocardial protection during ischemia was investigated with susceptible indicators like the appearance of the deleterious effect of reactive oxygen species and oxidative stress markers. Incubated human cardiomyocytes and rat cardiomyoblasts H9C2 in cardioplegia for 4h were examined for expression of oxidative stress markers (MnSOD, iNOS, HSP27), cardioplegic solutions cytotoxicity, and peroxidation damage of the cell’s lipids and proteins. All tests were performed after 0.5h, 1h, 2h, and 4h in identical physical and biological conditions, which is difficult to achieve in clinical trials. Results: The tests performed on matured cells of human cardiomyocytes showed the superiority of Custodiol HTK. Differences between solutions on immature cells H9C2 were not relevant. Both Plegisol and Custodiol HTK produced a similar expression of MnSOD and iNOS. There was no significant advantage of Custodiol over Plegisol in the cytotoxicity test. However, Custodiol induced a higher level of lipid peroxidation. Conclusions: Considering proceeded examinations on cultured cardiomyocytes, Custodiol HTK appears to be safer than Plegisol.

Features of the infusion therapy at the prehospital stage with the ongoing bleeding

The article covers the principles of holding the infusion therapy at the prehospital stage with the ongoing uncontrolled bleeding. The scientific work shows the effectiveness of isoosmolar crystalloid solutions in conditions of low capillary pressure, which is typical for blood loss. The article shows that the concept of an acceptable hypotension is the most optimal approach to the infusion therapy if the ongoing bleeding is suspected in peacetime as well as in combat conditions. Recommendations are given for ensuring and maintaining venous access during short, long and delayed evacuation of victims with the suspected ongoing bleeding.

Physical compatibility of Normosol-R with critical care medications used in patients with COVID-19 during simulated Y-site administration

Disclaimer In an effort to expedite the publication of articles , AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. Purpose Guidelines from the National Institutes of Health support the use of balanced crystalloid solutions such as Normosol-R (Hospira, Lake Forest, IL) for patients with coronavirus disease 2019 (COVID-19). However, their clinical utility is hindered by a lack of Y-site compatibility data that is essential for use in patients with limited intravenous access. The objective of this study was to determine the physical compatibility of selected intensive care unit medications with Normosol-R. Methods The study involved laboratory simulation of Y-site compatibility. Medications tested included amiodarone, caspofungin, dexmedetomidine, dobutamine, dopamine, epinephrine, levofloxacin, norepinephrine, pantoprazole, phenylephrine, piperacillin/tazobactam, vancomycin, and vasopressin. Tests performed were visual assessment with Tyndall light, turbidity measurement, and pH assessment. Tests were performed immediately after mixing (with the exception of turbidity testing) and after 1 hour and 4 hours. Results Incompatibility was defined as observation of haze, gas, particulate, or color change or admixture turbidity above 0.3 or above 0.5 nephelometric turbidity unit (NTU), depending on whether the baseline turbidity was less than or greater than 0.5 NTU, respectively. Analysis of solubility and compatibility based on change from baseline to admixture pH in relation to reported acid dissociation constant (pKa) was performed. There was no evidence of visual incompatibility for any of the admixtures when mixed with Normosol-R. Turbidity exceeded the defined threshold with pantoprazole, phenylephrine, and highly concentrated norepinephrine. Pantoprazole was the only test medication with a significant pH change when compared to its pKa. Conclusion Normosol-R is compatible for Y-site administration with all tested medications except for pantoprazole, phenylephrine, and highly concentrated norepinephrine, allowing for potential increased use in patients with COVID-19.

Infusion and transfusion therapy: main aspects

The adequate choice of strategy for infusion therapy is an essential component of successful management of critically ill patients. Infusion therapy is one of the main methods of maintai-ning vital functions of patients in the perioperative period. In the practice of a doctor, there are reasonable doubts about the feasibility and safety of various solutions for infusion therapy. Both are fundamental principles of infusion therapy, and the changes that have taken place, of course, need to be understood from the standpoint of evidence-based medicine. Balanced crystalloid solutions were safe and clinically effective, their use is provided by the Bri-tish Consensus Guidelines on Intravenous Fluid Therapy for Adult Surgical Patients.

Polyuria after Renal Transplantation: A Case Report and Review of Literature

Polyuria is defined as a urine output (UOP) of more than 3 litres per day in adults or 2 l/m2/day in children. Polyuria is common following live donor kidney transplantation (LDKT). This case report and review describes a 32-year-old male with chronic kidney disease who underwent LDKT. The donor was his brother. He had polyuria in the postoperative period with the maximum urine flow rate of 3700 ml/hr and the first 24-hour urine output of 42 litres. He was managed with intravenous crystalloid solutions guided by the central venous pressure and the mean arterial pressure. Electrolytes were replaced with potassium chloride, calcium gluconate and magnesium sulfate. He made an uneventful recovery. The Polyuria improved without any pharmacological interventions. Therefore, guided fluid and electrolyte administration is the key to the successful management of post-transplant polyuria.

The influence of solution choice on fluid resuscitation in patients with septic shock

The aim. Compare the hemodynamic effects and safety of infusion of the balanced crystalloid solution, sorbitol-based solution, and standard solution (0.9 % sodium chloride). Materials and methods. A prospective randomized clinical trial was carried out, the study included 68 adult patients, who had the active surgical infection, and were in a state of septic shock. A corresponding solution with a volume of 500 ml was used for resuscitation. Hemodynamic and other clinical and laboratory parameters were monitored. Results. There was no significant difference in mean arterial pressure (MAP) between the 3 groups before the 45th minute (p>0.05), from the 50th minute to 2 hours they were found only between the NS and Sorb groups (p <0.05). No statistically significant difference in heart rate (HR) was obtained in any measurement (p> 0.05). Cardiac output (CO) and oxygen delivery (DO2) did not differ until 35 min (p> 0.05) and up to 40 min (p> 0.05); after 40 min and 45 min, a significant difference was also found between the Sorb and NS groups (p <0.05). After infusion of a sorbitol-containing solution and a balanced polyionic solution, the acid-base state of the blood significantly improved. The applied dose of the sorbitol-containing solution was safe for renal function and blood clotting in septic shock in this study. But the applied balanced polyionic solution may be associated with a decrease in the number of platelets. Daily changes by APACHE II scores in each group were not statistically significant. The difference in 7-day and 28-day mortality between groups was not statistically significant (p>0.05). Conclusions. In our study, the balanced polyionic solution with 1.9 % sodium lactate and 6 % sorbitol was the most effective and safe infusion solution for the treatment of septic shock, it can be used as a supplement to balanced crystalloid solutions. When using a balanced polyionic solution (Ringer's acetate) with 0.07 % L-malonic acid, the platelet count should be monitored more often