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https://www.readbyqxmd.com/read/28396605/bypassing-adverse-injection-reactions-to-nanoparticles-through-shape-modification-and-attachment-to-erythrocytes
#1
Peter Pope Wibroe, Aaron C Anselmo, Per H Nilsson, Apoorva Sarode, Vivek Gupta, Rudolf Urbanics, Janos Szebeni, Alan Christy Hunter, Samir Mitragotri, Tom Eirik Mollnes, Seyed Moein Moghimi
Intravenously injected nanopharmaceuticals, including PEGylated nanoparticles, induce adverse cardiopulmonary reactions in sensitive human subjects, and these reactions are highly reproducible in pigs. Although the underlying mechanisms are poorly understood, roles for both the complement system and reactive macrophages have been implicated. Here, we show the dominance and importance of robust pulmonary intravascular macrophage clearance of nanoparticles in mediating adverse cardiopulmonary distress in pigs irrespective of complement activation...
April 10, 2017: Nature Nanotechnology
https://www.readbyqxmd.com/read/28325788/decompression-illness-with-hypovolemic-shock-and-neurological-failure-symptoms-after-two-risky-dives-a-case-report
#2
Sebastian Klapa, Johannes Meyne, Wataru Kähler, Frauke Tillmans, Henning Werr, Andreas Binder, Andreas Koch
Hypovolemia is known to be a predisposing factor of decompression illness (DCI) while diving. The typical clinically impressive neurological symptoms of DCI may distract from other symptoms such as an incipient hypovolemic shock. We report the case of a 61-year-old male Caucasian, who presented with an increasing central and peripheral neural failure syndrome and massive hypovolemia after two risky dives. Computed tomography (CT) scans of the chest and Magnetic resonance imaging scans of the head revealed multiple cerebral and pulmonary thromboembolisms...
March 2017: Physiological Reports
https://www.readbyqxmd.com/read/28254373/dosing-antibiotic-prophylaxis-during-cardiopulmonary-bypass-a-higher-level-of-complexity-a-structured-review
#3
REVIEW
Fathima Paruk, Fekade B Sime, Jeffrey Lipman, Jason A Roberts
In highly invasive procedures such as open heart surgery, the risk of post-operative infection is particularly high due to exposure of the surgical field to multiple foreign devices. Adequate antibiotic prophylaxis is an essential intervention to minimise post-operative morbidity and mortality. However, there is a lack of clear understanding on the adequacy of traditional prophylactic dosing regimens, which are rarely supported by data. The aim of this structured review is to describe the relevant pharmacokinetic/pharmacodynamic (PK/PD) considerations for optimal antibiotic prophylaxis for major cardiac surgery including cardiopulmonary bypass (CPB)...
April 2017: International Journal of Antimicrobial Agents
https://www.readbyqxmd.com/read/28245519/pharmacokinetics-of-tranexamic-acid-in-neonates-and-infants-undergoing-cardiac-surgery
#4
Ralph Gertler, Michael Gruber, Stanislas Grassin-Delyle, Saïk Urien, Klaus Martin, Peter Tassani-Prell, Siegmund Braun, Simon Burg, Gunther Wiesner
AIM: Tranexamic acid (TXA) continues to be one of the antifibrinolytics of choice during paediatric cardiac surgery. However, in infants less than 1 year of age, the optimal dosing based on pharmacokinetic (PK) considerations is still under discussion. METHODS: Forty-three children less than 1 year of age were enrolled, of whom 37 required the use of cardiopulmonary bypass (CPB) and six were operated on without CPB. Administration of 50 mg kg(-1) TXA intravenously at the induction of anaesthesia was followed by 50 mg kg(-1) into the CPB prime in the CPB group...
February 28, 2017: British Journal of Clinical Pharmacology
https://www.readbyqxmd.com/read/28221198/red-cell-transfusion-associated-hemolysis-in-cardiac-surgery-an-observational-cohort-study
#5
Keyvan Karkouti, Jeannie L Callum, Jason P Acker, Paul Yip, Vivek Rao
BACKGROUND: Red cell viability is impaired during storage, resulting in excess hemolysis during storage and after transfusion. As a result, transfusions may oversaturate the hemoglobin clearance pathways, resulting in cell-free hemoglobin and iron toxicity in susceptible patients, such as those undergoing cardiac surgery with cardiopulmonary bypass. To explore this hypothesis, we assessed the relationship of red cell transfusions with cell-free hemoglobin and transferrin saturation levels in a consecutive cohort of cardiac surgical patients...
February 17, 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28077373/determination-of-renal-function-and-injury-using-near-infrared-fluorimetry-in-experimental-cardiorenal-syndrome
#6
Mizuko Ikeda, Rumie Wakasaki, Katie J Schenning, Thomas Swide, Jeong Heon Lee, M Bernie Miller, Hak Soo Choi, Sharon Anderson, Michael P Hutchens
Cardiorenal syndrome type 1 causes acute kidney injury but is poorly understood; animal models and diagnostic aids are lacking. Robust noninvasive measurements of glomerular filtration rate are required for injury models and clinical use. Several have been described but are untested in translational models and suffer from biologic interference. We developed a mouse model of cardiorenal syndrome and tested the novel near-infrared fluorophore ZW800-1 to assess renal and cardiac function. We performed murine cardiac arrest and cardiopulmonary resuscitation followed by transthoracic echocardiography, 2 and 24 h later...
April 1, 2017: American Journal of Physiology. Renal Physiology
https://www.readbyqxmd.com/read/27999040/population-pharmacokinetics-of-cefazolin-before-during-and-after-cardiopulmonary-bypass-to-optimize-dosing-regimens-for-children-undergoing-cardiac-surgery
#7
Pieter A J G De Cock, Hussain Mulla, Sarah Desmet, Filip De Somer, Brett C McWhinney, Jacobus P J Ungerer, Annelies Moerman, Sabrina Commeyne, Johan Vande Walle, Katrien Francois, Johan G C Van Hasselt, Peter De Paepe
Objectives: The objective of this study was to characterize cefazolin serum pharmacokinetics in children before, during and after cardiopulmonary bypass (CPB), in order to derive an evidence-based dosing regimen. Patients and methods: This study included children who received cefazolin before surgical incision, before cessation of CPB and after surgery. Blood samples of total and unbound cefazolin concentrations were collected before, during and after CPB. The cefazolin concentration-time profiles were analysed using population pharmacokinetic modelling and predictors for interindividual variability in pharmacokinetic parameters were investigated...
March 1, 2017: Journal of Antimicrobial Chemotherapy
https://www.readbyqxmd.com/read/27885446/post-cardiotomy-rescue-extracorporeal-cardiopulmonary-resuscitation-in-neonates-with-single-ventricle-after-intractable-cardiac-arrest-attrition-after-hospital-discharge-and-predictors-of-outcome
#8
Anastasios C Polimenakos, Vincent Rizzo, Chawki F El-Zein, Michel N Ilbawi
Extracorporeal cardiopulmonary resuscitation (ECPR) in children with cardiac arrest refractory to conventional cardiopulmonary resuscitation (CPR) has been reported with encouraging results. We reviewed outcomes of neonates with functional single ventricle (FSV) surviving post-cardiotomy ECPR after hospital discharge. Fifty-eight patients who required post-cardiotomy extracorporeal membrane oxygenation (ECMO) since the introduction of our ECPR protocol (January 2007-December 2011) were identified. Forty-one were neonates...
February 2017: Pediatric Cardiology
https://www.readbyqxmd.com/read/27862675/the-physiotherapist-and-the-esophageal-cancer-patient-from-prehabilitation-to-rehabilitation
#9
E M Guinan, J Dowds, C Donohoe, J V Reynolds, J Hussey
Esophageal cancer is a serious malignancy often treated with multimodal interventions and complex surgical resection. As treatment moves to centers of excellence with emphasis on enhanced recovery approaches, the role of the physiotherapist has expanded. The aim of this review is to discuss the rationale behind both the evolving prehabilitative role of the physiotherapist and more established postoperative interventions for patients with esophageal cancer. While a weak association between preoperative cardiopulmonary fitness and post-esophagectomy outcome is reported, cardiotoxicity during neoadjuvant chemotherapy and/or radiotherapy may heighten postoperative risk...
January 1, 2017: Diseases of the Esophagus: Official Journal of the International Society for Diseases of the Esophagus
https://www.readbyqxmd.com/read/27833481/cardiac-and-renal-protective-effects-of-dexmedetomidine-in-cardiac-surgeries-a-randomized-controlled-trial
#10
A S Ammar, K M Mahmoud, Z A Kasemy, M A Helwa
BACKGROUND: Cardiac and renal injuries are common insults after cardiac surgeries that contribute to perioperative morbidity and mortality. Dexmedetomidine has been shown to protect several organs against ischemia/reperfusion-(I/R) induced injury. We performed a randomized controlled trial to assess the effect of dexmedetomidine on cardiac and renal I/R injury in patients undergoing cardiac surgeries. MATERIALS AND METHODS: Fifty patients scheduled for elective cardiac surgeries were randomized to dexmedetomidine group that received a continuous infusion of dexmedetomidine initiated 5 min before cardiopulmonary bypass (1 μg/kg over 15 min, followed by 0...
October 2016: Saudi Journal of Anaesthesia
https://www.readbyqxmd.com/read/27812147/left-atrial-structure-and-function-in-heart-failure-with-preserved-ejection-fraction-a-relax-substudy
#11
Siddique A Abbasi, Ravi V Shah, Steven E McNulty, Adrian F Hernandez, Marc J Semigran, Gregory D Lewis, Michael Jerosch-Herold, Raymond J Kim, Margaret M Redfield, Raymond Y Kwong
Given the emerging recognition of left atrial structure and function as an important marker of disease in heart failure with preserved ejection fraction (HF-pEF), we investigated the association between left atrial volume and function with markers of disease severity and cardiac structure in HF-pEF. We studied 100 patients enrolled in the PhosphdiesteRasE-5 Inhibition to Improve CLinical Status and EXercise Capacity in Diastolic Heart Failure (RELAX) trial who underwent cardiac magnetic resonance (CMR), cardiopulmonary exercise testing, and blood collection before randomization...
2016: PloS One
https://www.readbyqxmd.com/read/27601212/associations-with-30-day-survival-following-extracorporeal-membrane-oxygenation-in-patients-with-acute-st-segment-elevation-myocardial-infarction-and-profound-cardiogenic-shock
#12
Wei-Chieh Lee, Chih-Yuan Fang, Huang-Chung Chen, Chien-Jen Chen, Cheng-Hsu Yang, Chi-Ling Hang, Hon-Kan Yip, Hsiu-Yu Fang, Chiung-Jen Wu
BACKGROUND: Limited data are available regarding the role of percutaneous cardiopulmonary support for the treatment of ST segment elevation myocardial infarction (STEMI) with profound cardiogenic shock (CS). The aim of this study is to identify the determinant factors for survival of patients with STEMI who underwent extracorporeal membrane oxygenation (ECMO) support. METHOD: From January 2005 to December 2013, 192 patients experienced STEMI with CS needed intra-aortic balloon pumping and support with vasoactive agents at our hospital...
November 2016: Heart & Lung: the Journal of Critical Care
https://www.readbyqxmd.com/read/27590461/pulmonary-and-systemic-vascular-resistances-after-cardiopulmonary-bypass-role-of-hemolysis
#13
Emanuele Rezoagli, Fumito Ichinose, Sabrina Strelow, Nathalie Roy, Kenneth Shelton, Rui Matsumine, Liu Chen, Edward A Bittner, Donald B Bloch, Warren M Zapol, Lorenzo Berra
OBJECTIVES: Prolonged cardiopulmonary bypass (CPB) is associated with hemolysis, resulting in increased plasma oxyhemoglobin and vascular nitric oxide depletion. The authors hypothesized that hemolysis associated with CPB would reduce nitric oxide bioavailability, resulting in high pulmonary and systemic vascular resistances that after CPB would normalize gradually over time, due to clearance of plasma oxyhemoglobin. The authors also investigated whether prolonged CPB (≥140 min) produced increased levels of hemolysis and greater pulmonary and systemic vasoconstriction...
June 8, 2016: Journal of Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/27577036/predictors-of-atrial-fibrillation-after-coronary-artery-bypass-grafting-a%C3%A2-bayesian-analysis
#14
Stéphanie Perrier, Nicolas Meyer, Tam Hoang Minh, Tarek Announe, Jonathan Bentz, Philippe Billaud, Arnaud Mommerot, Jean-Philippe Mazzucotelli, Michel Kindo
BACKGROUND: This study was conducted to identify preoperative predictors of postoperative atrial fibrillation (POAF) after isolated coronary artery bypass grafting (CABG) by using a Bayesian analysis that included information from prior studies. METHODS: We performed a prospective observational study from October 2008 to December 2013 of 1,481 patients who underwent isolated CABG with cardiopulmonary bypass and had no history of AF. Bayesian analysis was used to study the preoperative risks factors for POAF...
January 2017: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/27553752/pharmacokinetics-and-dosing-of-anti-infective-drugs-in-patients-on-extracorporeal-membrane-oxygenation-a-review-of-the-current-literature
#15
REVIEW
Jennifer Sherwin, Travis Heath, Kevin Watt
PURPOSE: Extracorporeal membrane oxygenation (ECMO) is a cardiopulmonary bypass device that is used to temporarily support the most critically ill of patients with respiratory and/or cardiac failure. Infection and its sequelae may be an indication for ECMO or infections may be acquired while on ECMO and are associated with a mortality >50%. Effective therapy requires optimal dosing. However, optimal dosing can be different in patients on ECMO because the ECMO circuit can alter drug pharmacokinetics...
September 2016: Clinical Therapeutics
https://www.readbyqxmd.com/read/27530641/extracorporeal-membrane-oxygenator-support-in-infants-with-systemic-pulmonary-shunts
#16
Phil Botha, Shriprasad R Deshpande, Michael Wolf, Micheal Heard, Bahaaldin Alsoufi, Brian Kogon, Kirk Kanter
BACKGROUND: Management of a patent systemic-pulmonary (SP) shunt and the resulting runoff during extracorporeal membrane oxygenation (ECMO) varies among institutions. We have used a strategy of increased flow without surgical reduction of the shunt diameter, and here report our results with this strategy. METHODS: In this database review of 169 successive veno-arterial ECMO runs performed between 2002 and 2013 in infants and neonates, ECMO flow, time to achieve lactate clearance, normal pH, and negative fluid balance were compared in patients with shunts and those without shunts...
September 2016: Journal of Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/27384524/alkaline-phosphatase-soluble-extracellular-adenine-nucleotides-and-adenosine-production-after-infant-cardiopulmonary-bypass
#17
Jesse A Davidson, Tracy Urban, Suhong Tong, Mark Twite, Alan Woodruff, Paul E Wischmeyer, Jelena Klawitter
RATIONALE: Decreased alkaline phosphatase activity after infant cardiac surgery is associated with increased post-operative cardiovascular support requirements. In adults undergoing coronary artery bypass grafting, alkaline phosphatase infusion may reduce inflammation. Mechanisms underlying these effects have not been explored but may include decreased conversion of extracellular adenine nucleotides to adenosine. OBJECTIVES: 1) Evaluate the association between alkaline phosphatase activity and serum conversion of adenosine monophosphate to adenosine after infant cardiac surgery; 2) assess if inhibition/supplementation of serum alkaline phosphatase modulates this conversion...
2016: PloS One
https://www.readbyqxmd.com/read/27236490/obesity-does-not-affect-propofol-pharmacokinetics-during-hypothermic-cardiopulmonary-bypass
#18
Iman A El-Baraky, Maggie M Abbassi, Tarek A Marei, Nirmeen A Sabry
OBJECTIVE: Because of the lack of data regarding the impact of obesity on propofol pharmacokinetics in patients undergoing cardiac surgery using hypothermic cardiopulmonary bypass (CPB), the authors sought to explore propofol pharmacokinetics and develop a predictive pharmacokinetic model that characterizes and predicts propofol pharmacokinetics in this population. DESIGN: A prospective, observational study. SETTING: A teaching hospital. PARTICIPANTS: The study comprised 17 obese and 17 control (nonobese) patients undergoing hypothermic CPB...
August 2016: Journal of Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/27231835/nicardipine-effects-on-renal-function-during-spine-surgery
#19
Cholhee Park, Ji Young Kim, Chanmi Kim, Chul Ho Chang
STUDY DESIGN: Single-center, prospective, randomized, and single-blinded clinical trial was conducted in patients (n=64) undergoing anterior or posterior spinal interbody fusion. OBJECTIVE: To investigate the renal protective effect of nicardipine during deliberate hypotension for spine surgery by measuring creatinine clearance (Ccr), serum cystatin C, urine output, and fractional excretion of sodium (FENa). SUMMARY OF BACKGROUND DATA: Deliberate hypotension during spine surgery may result in ischemic tissue damage of the kidney...
May 27, 2016: Clinical Spine Surgery
https://www.readbyqxmd.com/read/27222921/structural-and-functional-lung-impairment-in-adult-survivors-of-bronchopulmonary-dysplasia
#20
Steven Caskey, Aisling Gough, Stephen Rowan, Scott Gillespie, Jim Clarke, Marshall Riley, Jacqui Megarry, Paul Nicholls, Chris Patterson, Henry L Halliday, Michael D Shields, Lorcan McGarvey
RATIONALE: As more preterm infants recover from severe bronchopulmonary dysplasia (BPD), it is critical to understand the clinical consequences of this condition on the lung health of adult survivors. OBJECTIVES: To assess structural and functional lung parameters in young adult BPD survivors and preterm and term control subjects. METHODS: Young adult survivors of BPD (mean age, 24 yr) underwent spirometry, lung volume assessment, transfer factor, lung clearance index, and fractional exhaled nitric oxide measurements, together with high-resolution chest computed tomography and cardiopulmonary exercise testing...
August 2016: Annals of the American Thoracic Society
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