Erratum 2

Yanase F, Cutuli SL, Naorungroj T, et al. Temperature and haemodynamic effects of a 100 mL bolus of 20% albumin at room versus body temperature in cardiac surgery patients. Crit Care Resusc 2021; 23: 14-23. In this article, on page 19 and 20, Figure 1 and Figure 2 footers were incorrect. The figures were shown as mean and standard deviation, not mean and standard error.

A PROSPECTIVE RANDOMISED STUDY TO ASSESS WHETHER PROPHYLACTIC ATROPINE ADMINISTRATION ATTENUATES THE NEGATIVE HAEMODYNAMIC EFFECTS OF INDUCTION OF ANAESTHESIA WITH PROPOFOL AND FENTANYL

INTRODUCTION: To provide optimal surgical conditions safely and to avoid particular complications, balanced general anaesthesia by administering a combination of propofol and fentanyl as analgesics. This type of balanced anaesthesia often induces unwanted bradycardia and hypotension, raising concerns regarding haemodynamic stability and tissue oxygenation. It is possible that atropine could replace the common clinical practice of administering vasoactive medication such as phenylephrine or norepinephrine to maintain mean arterial pressure (MAP) levels. AIM OF THE STUDY: To study the effect of atropine in suppressing the negative haemodynamic effects of induction agents- propofol and fentanyl in patients receiving general anaesthesia. MATERIALS AND METHODS: This is a prospective randomised interventional study carried out in Department of Anaesthesiology in Kanyakumari Government Medical College from January 2018 to June 2019. Patients were allocated into two groups (25 patients each) by randomization. After preoxygenation Group A: Patient receives Atropine. Patient in Group S: Receives Saline. BMI, Height, weight, Heart rate, Noninvasive blood pressure, Mean arterial pressure were recorded for every minute for 15 minutes. RESULTS: The demographic parameters like age, height, weight and BMI were similar in both groups. Comparing the SBP of both group, at base and 1 minute the difference of SBP was small. After that, the SBP was increasing trend in Atropine subjects and SBP was decreasing trend in saline subjects (P<0.001). Comparing the DBP between the two groups, Base and 1 minutes, the DBP of both groups were not differed signicantly (P>0.05),after that the DBP of Atropine group DBP was increasing trend and the DBP of saline group was decreasing trend (P<0.001). The HR of the both groups were increasing and decreasing accordingly (P<0.001). Comparing the MAP of both groups at base through 15 minutes,MAP of both group at 1minute was not differed signicantly (P>0.05),after that the MAP of Atropine subjects were increasing and Saline subjects were decreasing trend P<0.001). Percentage of fall of parameters (SBP, DBP, HR, and MAP) was more signicant at 5 and 15 mins compared to 10 mins in both th group. This may be due to the intubation response after the 5 minute of induction. All values were signicant with P<0.001. CONCLUSION: Administration of atropine before Propofol and Fentanyl induction during general anaesthesia can signicantly attenuate the fall in Systolic Blood Pressure, Diastolic Blood Pressure, Heart Rate and Mean Arterial Pressure.

Haemodynamic effects of riociguat in CTEPH and PAH: a ten-year observational study

BackgroundLong-term treatment with riociguat has been shown to enhance exercise capacity in patients of pulmonary arterial hypertension (PAH) and inoperable or persistent/recurrent chronic thromboembolic pulmonary hypertension (CTEPH). This study sought to evaluate the long-term haemodynamic effects of riociguat in patients of PAH and inoperable CTEPH.MethodsDuring this single-center long-term observational study, riociguat was administered at a three-times-daily dose of up to 2.5 mg. The primary outcome was pulmonary vascular resistance (PVR). The secondary outcomes included mean pulmonary arterial pressure (PAP), cardiac index (CI), mortality, clinical worsening events, 6-min walking distance (6 MWD), and World Health Organization functional class (WHO FC).Results37 patients (CTEPH, n=19; PAH, n=18) were included. The median follow-up period was 96 months. The survival estimates for all the patients at 1/3/5/8 year were 0.97/0.86/0.72/0.61, without significant difference between patients with CTEPH and PAH. At the final data cut-off, PVR decreased (1232±462 dyn·s·cm–5versus 835±348 dyn·s·cm–5, p<0.001), CI increased (1.7±0.4 L·min−1·m−2versus 2.4±0.5 L·min−1·m−2, p<0.001), 6 MWD increased by 43.1±59.6 m, and WHO FC improved/stabilised/worsened in 40/35/25% of patients versus baseline. Improvement in PAP was not shown. Compared with patients in WHO FC I/II and III/IV at baseline, the 8-year clinical worsening-free survival estimates were 0.51 versus 0.19 (p=0.026).ConclusionsRiociguat improved PVR and CI for up to 8 years, but not PAP. WHO FC may have certain predictive value for the long-term prognosis.

Inhaled nitric oxide improves the hepatopulmonary syndrome: a physiologic analysis

The hepatopulmonary syndrome (HPS) is defined by liver dysfunction, intrapulmonary vasodilatation and abnormal oxygenation. Hypoxaemia is progressive and liver transplant is the only effective treatment. Severe hypoxaemia is a life-threatening HPS complication, particularly after transplant. We evaluated gas-exchange and haemodynamic effects of invasive therapies in a consecutive sample of 26 pre-transplant patients. Inhaled nitric oxide significantly improved partial pressure of oxygen (12.4 mm Hg; p=0.001) without deleterious effects on cardiac output. Trendelenburg positioning resulted in a small improvement, and methylene blue did not, though individual responses were variable. Future studies should prospectively evaluate these strategies in severe post-transplant hypoxaemia.

Effect of empagliflozin on albuminuria, eGFR and serum creatinine: updated results from the ABCD nationwide empagliflozin audit

Introduction: Evidence from phase III and the EMPA-REG OUTCOME trials have demonstrated improvements in renal endpoints with empagliflozin use. The EMPA-KIDNEY trial is currently underway and is assessing whether there are benefits of empagliflozin in improving renal outcomes in people both with and without diabetes, and the mechanism has been suggested to be similar to that of ACE inhibitors with the haemodynamic effects of sodium-glucose co-transporter-2 inhibition reducing intraglomerular pressure.Aim: To assess the impacts of empagliflozin use on albuminuria and estimated glomerular filtration rate (eGFR) in a real-world UK-based audit.Methods: Data were collated via the ABCD nationwide audit programme, with analyses performed using either t-tests/ ANOVA or Wilcoxon signed rank/Kruskal–Wallis tests. Pre-specified stratified subgroup analyses by baseline eGFR and baseline albuminuria levels were also performed.Results: Our results demonstrated significant reductions in albuminuria across the population as a whole. When stratified by baseline albuminuria levels, those with microalbuminuria (30–300 μg/mg) or macroalbuminuria (>300 μg/mg) had significant improvements in urine albumin levels at 6-month (3–9-month) follow-up, with median changes of −17.7 μg/mg (p<0.0001; 95% CI −17.4 to −23.7) and 379.4 μg/mg (p=0.03; 95% CI −269.9 to −725.4), respectively. Across the population as a whole, eGFR reduced initially (at 6 months, −1.26 mL/min/1.73 m3; p<0.0001; 95% CI −0.87 to −1.64) before recovering to baseline by 24 months. When stratified by baseline eGFR, those with reduced renal function (eGFR <90) recovered quickest, with improvements in eGFR noted from baseline by 24 months.Conclusion: In this real-world analysis, the results are comparable to those in randomised controlled trials and are likely more generalisable to UK clinical practice. Unfortunately, we do not have clinical endpoints such as end-stage renal failure, renal death or dialysis as part of our dataset. Future audits could consider including these data to establish clinical as well as biochemical outcomes.

Echocardiography – techniques and pitfalls whilst diagnosing persistent (patent) foramen ovale as a risk factor in divers with a history of decompression sickness

The case of a diver with a history of decompression sickness (DCS) after recreational scuba diving is presented. Cutis marmorata, a subtype of cutaneous DCS, has been consistently associated with the presence of a persistent (patent) foramen ovale (PFO) as a risk factor. Diagnostic uncertainty arose when transthoracic echocardiography with antecubital injection of agitated saline bubbles (ASBs) did not show any significant shunt, but the presence of a large Eustachian valve was counteracted by intra-femoral injection of ASBs, showing a large PFO with spontaneous shunting. The importance of proper echocardiography techniques prior to resorting to intra-femoral injection of ASBs to counteract the haemodynamic effects of the Eustachian valve is emphasised.