1,721,163 research outputs found
Potential nutritional and pharmacological treatment of glycocalyx alterations during sepsis
No full textDuring sepsis, a combination of pathophysiological insults disrupts the glycocalyx. the thickness of the glycocalyx is correlated with parameters of disease severity, making it a potential new and independent target for therapeutic strategies in sepsis. The aim of this review was to examine potential beneficial effects of nutritional and pharmacological measures on glycocalyx alterations during sepsis and their timing. (Cite this article as: Pergolizzi c, Franchi F, taccone Fs, Preiser Jc, scolletta s. Potential nutritional and pharmacological treatment of glycocalyx alterations during sepsis. Minerva anestesiol 2023;89:341-50. Doi: 10.23736/s0375-9393.22.16834-3
Energetic myocardial metabolism and oxidative stress: let's make them our friends in the fight against heart failure
No full textHeart failure (HF) is a syndrome causing a huge burden in morbidity and mortality worldwide. Current medical therapies for HF are aimed at suppressing the neurohormonal activation. However, novel therapies are needed for HF, independent of the neurohormonal axis, that can improve cardiac performance and prevent the progression of heart dysfunction. The modulation of cardiac metabolism may represent a new approach to the treatment of HF. The healthy heart converts chemical energy stored in fatty acids (FA) and glucose. Utilization of FA costs more oxygen per unit of ATP generated than glucose, and the heart gets 60-90% of its energy for oxidative phosphorylation from FA oxidation. The failing heart has been demonstrated to be metabolically abnormal, in both animal models and in patients, showing a shift toward an increased glucose uptake and utilization. The manipulation of myocardial substrate oxidation toward greater carbohydrate oxidation and less FA oxidation may improve ventricular performance and slow the progression of heart dysfunction. Impaired mitochondrial function and oxidative phosphorylation can reduce cardiac function by providing an insufficient supply of ATP to cardiomyocytes and by increasing myocardial oxidative stress. Although there are no effective stimulators of oxidative phosphorylation, several classes of drugs have been shown to open mitochondrial KATP channels and, indirectly, to improve cardiac protection against oxidative stress. This article focuses on the energetic myocardial metabolism and oxidative status in the normal and failing heart, and briefly, it overviews the therapeutic potential strategies to improve cardiac energy and oxidative status in HF patients. © 2009 Elsevier Masson SAS. All rights reserved
Pain in trauma patients at the emergency department: Expert operators should take care of it
No full text
Echocardiography to guide fluid therapy in critically ill patients: Check the heart and take a quick look at the lungs
No full textPractical approach to diastolic dysfunction in light of the new guidelines and clinical applications in the operating room and in the intensive care
Full text linkThere is growing evidence both in the perioperative period and in the field of intensive care (ICU) on the association between left ventricular diastolic dysfunction (LVDD) and worse outcomes in patients. The recent American Society of Echocardiography and European Association of Cardiovascular Imaging joint recommendations have tried to simplify the diagnosis and the grading of LVDD. However, both an often unknown pre-morbid LV diastolic function and the presence of several confounders—i.e., use of vasopressors, positive pressure ventilation, volume loading—make the proposed parameters difficult to interpret, especially in the ICU. Among the proposed parameters for diagnosis and grading of LVDD, the two tissue Doppler imaging-derived variables e′ and E/e′ seem most reliable. However, these are not devoid of limitations. In the present review, we aim at rationalizing the applicability of the recent recommendations to the perioperative and ICU areas, discussing the clinical meaning and echocardiographic findings of different grades of LVDD, describing the impact of LVDD on patients’ outcomes and providing some hints on the management of patients with LVDD. © 2018, The Author(s)
Cardiac output monitoring by pressure recording analytical method in cardiac surgery
No full textOBJECTIVE:
A less-invasive method has been developed that may provide an alternative to monitor cardiac output from arterial pressure: beat-to-beat values of cardiac output can be obtained by pressure recording analytical method (PRAM). The purpose of this study was to assess the reliability of cardiac output determination by PRAM in cardiac surgery.
METHODS:
Cardiac output was measured in 28 patients undergoing coronary artery bypass grafting at 15 min after anaesthesia induction, 30 min after extracorporeal circulation, 1 and 3 h after arrival in the intensive care unit using thermodilution (ThD) method through a pulmonary artery catheter and PRAM. ThD cardiac output was calculated as the mean of five separate measurements. PRAM provided beat-by-beat cardiac output data continuously throughout the study and the cardiac output values displayed on a dedicated personal computer at each time point were recorded. Correlations were calculated and differences were compared by Bland-Altman analysis.
RESULTS:
A total of 112 measurements were obtained. Cardiac output ranged from 2.3 to 7.4 l/min, and a good linear correlation (R2=0.78, P<0.0001) was found between ThD and PRAM. The highest degree of correlation (R2=0.86) was obtained at 3 h after arrival in the intensive care unit. The lower degree of correlation (R2=0.70) was obtained 30 min after extracorporeal circulation. At Bland-Altman analysis, the overall estimates of cardiac output measured by PRAM closely agreed with ThD (mean difference, 0.027; standard deviation, 0.43; limits of agreement, -0.83 and +0.89).
CONCLUSIONS:
Under the studied conditions, our results demonstrate good agreement between PRAM data and ThD measurements, and this new method has shown to be accurate for real-time monitoring of cardiac output in cardiac surgery. Further studies will be required to assess this method in higher-risk patients and in the setting of haemodynamic instability or arrhythmias. This is the first study designed to assess the accuracy of PRAM in cardiac surgery
Beat by beat monitoring of cardiac output with Pressure Recording Analytical Method (PRAM)
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