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Keywords = vasoactive management

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17 pages, 1108 KiB  
Article
The ADVanced Organ Support (ADVOS) Hemodialysis System in Postoperative Cardiogenic Shock and Multiple Organ Failure: First Results in Cardiac Surgery Patients
by Veronika Walter, Ekaterina Hinrichs, Tarek Alloush, Aritz Perez Ruiz de Garibay, Gregor Warnecke, Wiebke Sommer, Hanna Gravert, Christina Grothusen, Janine Becker, Alexander Thiem and Bernd Panholzer
Life 2025, 15(7), 1042; https://doi.org/10.3390/life15071042 - 30 Jun 2025
Viewed by 474
Abstract
Background: The management of multiple organ failure in the vulnerable cohort of cardiac surgery patients with cardiogenic shock remains a significant challenge, often impairing patient survival. A multimodal approach at targeting organ dysfunction seems to be a promising strategy, encompassing both hemodynamic support [...] Read more.
Background: The management of multiple organ failure in the vulnerable cohort of cardiac surgery patients with cardiogenic shock remains a significant challenge, often impairing patient survival. A multimodal approach at targeting organ dysfunction seems to be a promising strategy, encompassing both hemodynamic support as well as differentiated organ replacement therapy. Materials and Methods: In our retrospective study we examined the impact of the ADVOS (advanced organ support) system on overall outcomes and survival in an all-comers group of 22 cardiac surgery patients with postoperative cardiogenic shock and multiple organ failure. Aims: The objective of the study was to assess the feasibility and potential benefits of ADVOS treatment in this patient population. Results: The standard care management in combination with ADVOS therapy corrected acid–base balance (pH 7.33 vs. 7.44, p = 0.001; base excess −3.2 vs. 2.4 mmol/L, p < 0.001). This contributed to restoring hemodynamic balance after two consecutive ADVOS treatments (vasoactive inotropic score (VIS) 59 vs. 21, p = 0.007, noradrenaline 0.470 vs. 0.180 µg/kg/min, p = 0.009). Conclusions: Our findings indicate that ADVOS treatment is both feasible and safe, with a substantial proportion of patients demonstrating improvements in organ function and overall outcomes. Full article
(This article belongs to the Special Issue Advances in Intensive Care Medicine)
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14 pages, 1629 KiB  
Article
Characteristics, Outcomes and Mortality Risk Factors of Pediatric In-Hospital Cardiac Arrest in Western China: A Retrospective Study Using Utstein Style
by Jiaoyang Cao, Jing Song, Baoju Shan, Changxin Zhu and Liping Tan
Children 2025, 12(5), 579; https://doi.org/10.3390/children12050579 - 29 Apr 2025
Viewed by 455
Abstract
Background: Pediatric in-hospital cardiac arrest (IHCA) remains a critical health challenge with high mortality rates. Limited data from Western China prompted this study to investigate the characteristics of IHCA using the Utstein style. Methods: A retrospective analysis of 456 pediatric patients [...] Read more.
Background: Pediatric in-hospital cardiac arrest (IHCA) remains a critical health challenge with high mortality rates. Limited data from Western China prompted this study to investigate the characteristics of IHCA using the Utstein style. Methods: A retrospective analysis of 456 pediatric patients with IHCA (2018–2022) at the Children’s Hospital of Chongqing Medical University assessed demographics, arrest characteristics, outcomes and mortality risk factors. The primary outcome was survival to discharge; the secondary outcomes included return of spontaneous circulation (ROSC) > 20 min, 24 h survival, and favorable neurological outcomes. Logistic regression was used to identify the mortality risk factors. Results: ROSC > 20 min was achieved in 78.07% of cases, with 37.94% surviving to discharge (86.13% of survivors had favorable neurological outcomes). Etiological stratification identified general medical conditions (52.63%) as the predominant diagnoses, with surgical cardiac patients demonstrating superior resuscitation outcomes (ROSC > 20 min: 86.84%, discharge survival: 64.04%). Initial arrest rhythms predominantly featured non-shockable patterns, specifically bradycardia with poor perfusion (79.39%), whereas shockable rhythms (ventricular fibrillation/pulseless ventricular tachycardia) constituted only 4.17% of cases. Multivariable regression analysis identified five independent risk factors: vasoactive infusion before arrest (OR = 7.69), CPR > 35 min (OR = 13.92), emergency intubation (OR = 5.17), administration of >2 epinephrine doses (OR = 3.12), and rearrest (OR = 8.48). Notably, prolonged CPR (>35 min) correlated with higher mortality (8.96% survival vs. 48.54% for 1–15 min), yet all six survivors with CPR > 35 min had favorable neurological outcomes. Conclusions: These findings underscore the persistent challenges in pediatric IHCA management while challenging the conventional CPR duration thresholds for futility. The identified mortality risk factors inform resuscitation decision making and future studies. Full article
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14 pages, 1712 KiB  
Article
Management of Hemodynamic and Respiratory Instability and Anesthetic Approaches in Patients Undergoing Pulmonary Thrombectomy for Pulmonary Embolism
by Susana González-Suárez, John Camacho Oviedo, José Maria Suriñach Caralt, Maria Grao Roca, Isuru M. Dammala Liyanage, Mercedes Pérez Lafuente, Elisabeth Mena Muñoz, Carla González Junyent, María Martínez-Martínez, Daniel Barnés Navarro and Juan Carlos Ruíz-Rodríguez
J. Clin. Med. 2025, 14(8), 2704; https://doi.org/10.3390/jcm14082704 - 15 Apr 2025
Viewed by 820
Abstract
Background/Objectives: The incidence, timing, and predictors of hemodynamic and respiratory deterioration in patients with high-risk or intermediate-high-risk pulmonary embolism (PE) undergoing pulmonary mechanical thrombectomy (PMT) remain poorly understood. This hemodynamic and respiratory instability can lead to modifications in the anesthetic management. This study [...] Read more.
Background/Objectives: The incidence, timing, and predictors of hemodynamic and respiratory deterioration in patients with high-risk or intermediate-high-risk pulmonary embolism (PE) undergoing pulmonary mechanical thrombectomy (PMT) remain poorly understood. This hemodynamic and respiratory instability can lead to modifications in the anesthetic management. This study investigates these key factors and quantifies the 30-day mortality following thrombectomy. Methods: A retrospective study was conducted on 98 patients aged ≥18 years who underwent PMT. Patients were categorized based on the occurrence of cardiac arrest (CA). Results: Of the 98 patients, 34 had high-risk PE, 62 intermediate/high-risk, and 2 low risk. There were 27 cases of CA, 17 pre- and 10 intra-PMT. An SBP < 90 mmHg increases the risk of CA by 33 (p < 0.001); men have an 8-fold higher risk than women (p = 0.004); SpO2 <90% by 6 (p = 0.012); and pre-existing respiratory conditions increase the risk by 4 (p = 0.047)). N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels were 8206 ± 11660.86 and 2388.50 ± 5683.71 pg/mL (p = 0.035) in patients with and without CA, respectively. During PMT, 14% of patients required increased vasoactive drug use, and 38.77% were intubated, including 12 who required ECMO support. Sedation was administered in 64.3% of patients, while general anesthesia was used in 38.8%, with a preemptive indication in 23.5%. The survival rate of patients without CA before and/or during PMT was 96%. Conclusions: While PMT was successfully performed in all patients, hemodynamic and respiratory instability remained a significant concern. More than 10% of patients experienced severe hemodynamic instability, primarily during thrombus extraction, requiring conversion from sedation to general anesthesia. Male sex, pre-existing respiratory disease, SpO2 < 90%, and SBP < 90 mmHg were associated with an increased risk of CA. Additionally, elevated NT-proBNP levels were linked to a higher incidence of CA. Full article
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19 pages, 792 KiB  
Article
Unraveling Acute Cardiorenal Syndrome: Predictors and Consequences in Acute Heart Failure
by Georgios Aletras, Maria Bachlitzanaki, Maria Stratinaki, Emmanuel Lamprogiannakis, Stylianos Panagoutsos, Konstantia Kantartzi, Theodora Georgopoulou, Ioannis Petrakis, Emmanuel Foukarakis, Yannis Pantazis, Michael Hamilos and Kostas Stylianou
J. Clin. Med. 2025, 14(7), 2270; https://doi.org/10.3390/jcm14072270 - 26 Mar 2025
Cited by 2 | Viewed by 950
Abstract
Introduction: Acute cardiorenal syndrome (ACRS) is a common complication of acute heart failure (AHF), leading to worse outcomes and therapeutic challenges. This study aimed to identify clinical parameters associated with ACRS and evaluate its impact on prognosis in hospitalized AHF patients. Methods: This [...] Read more.
Introduction: Acute cardiorenal syndrome (ACRS) is a common complication of acute heart failure (AHF), leading to worse outcomes and therapeutic challenges. This study aimed to identify clinical parameters associated with ACRS and evaluate its impact on prognosis in hospitalized AHF patients. Methods: This prospective observational study included patients hospitalized for AHF at the Venizelio Cardiology Department from February to November 2023. Demographic characteristics, comorbidities, medications, laboratory and echocardiographic parameters, hospital stay, and in-hospital mortality were recorded. Patients with incomplete data or end-stage chronic kidney disease (CKD) were excluded. Survivors were followed for six months to assess renal function changes, readmissions, initiation of renal replacement therapy (RRT), and mortality. ACRS was defined as a serum creatinine increase of ≥0.3 mg/dL or ≥1.5 times baseline. Results: Among 218 hospitalized AHF patients, 112 (51.3%) developed ACRS. These patients were older, had higher CKD prevalence, worse New York Heart Association (NYHA) functional class, lower hemoglobin, and higher N-terminal Pro-B-type Natriuretic peptide (NT-proBNP) levels. Multivariate analysis identified CKD stage (OR 2.30, 95% CI 1.64–3.23, p < 0.001) and creatinine change on admission (OR 3.53, 95% CI 2.02–6.18, p < 0.001) as independent predictors of ACRS. ACRS was associated with higher in-hospital mortality, longer hospital stays, increased vasoactive medication use, worsening renal function, and higher six-month all-cause readmission and mortality rates. Conclusions: ACRS is a frequent and severe complication in AHF. CKD stage and creatinine on admission are key predictors. Early recognition for risk stratification and individualized management are crucial to improving outcomes in this high-risk population. Full article
(This article belongs to the Section Cardiology)
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15 pages, 1546 KiB  
Article
Efficacy of Single-Dose Del Nido Cardioplegia Beyond 90 Minutes in Adult Cardiac Surgery
by Murat Yücel, Emrah Uğuz, Kemal Eşref Erdoğan and Erol Şener
J. Clin. Med. 2025, 14(7), 2248; https://doi.org/10.3390/jcm14072248 - 26 Mar 2025
Viewed by 641
Abstract
Background: Del Nido (DN) cardioplegia is widely used in cardiac surgery for its efficacy in providing myocardial protection for up to 90 min with a single dose. However, its safety and efficacy during prolonged ischemia remain unclear. Methods: This retrospective study analyzed 471 [...] Read more.
Background: Del Nido (DN) cardioplegia is widely used in cardiac surgery for its efficacy in providing myocardial protection for up to 90 min with a single dose. However, its safety and efficacy during prolonged ischemia remain unclear. Methods: This retrospective study analyzed 471 patients who underwent cardiac surgery with CPB between January 2019 and September 2024. Patients were divided into two groups: ACC durations of 60–90 min (Group A, n = 240) and >90 min (Group B, n = 231). The perioperative characteristics, clinical outcomes, and biochemical markers were compared to evaluate the impact of prolonged ischemia. Results: Patients in Group B exhibited significantly higher postoperative troponin I and lactate levels at 4 h post-CPB, suggesting increased myocardial and metabolic stress. Lactate levels normalized within 24 h, indicating transient myocardial dysfunction. Defibrillation requirements and vasoactive inotropic score (VIS) were also significantly elevated in Group B, reflecting compromised myocardial electrical stability and hemodynamic challenges. However, the long-term outcomes such as mortality, LCOS, and MODS showed no significant differences between the groups. Conclusions: While DN cardioplegia provides sufficient myocardial protection for ACC durations within 90 min, its efficacy diminishes during prolonged ischemia, as evidenced by increased myocardial injury and hemodynamic instability. Tailored strategies, including standardized redosing protocols and enhanced perioperative management, are essential for optimizing outcomes in complex surgeries with extended ischemia times. Further prospective studies are needed to refine these protocols and assess alternative solutions for myocardial protection. Full article
(This article belongs to the Special Issue Cardiovascular Medicine and Cardiac Surgery)
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12 pages, 559 KiB  
Article
Candidemia in ICU Patients: What Are the Real Game-Changers for Survival?
by Bianca Leal de Almeida, Caroline Agnelli, Thaís Guimarães, Teresa Sukiennik, Paulo Roberto Passos Lima, Mauro José Costa Salles, Giovanni Luís Breda, Flavio Queiroz-Telles, Ana Verena Almeida Mendes, Luís Fernando Aranha Camargo, Hugo Manuel Paz Morales, Viviane Maria de Carvalho Hessel Dias, Afonso Rafael da Silva Junior, João Nóbrega de Almeida Junior, Camila de Melo Picone, Evangelina da Motta Pacheco Alves de Araújo, Edson Abdala, Flávia Rossi, Arnaldo Lopes Colombo and Marcello Mihailenko Chaves Magri
J. Fungi 2025, 11(2), 152; https://doi.org/10.3390/jof11020152 - 17 Feb 2025
Cited by 2 | Viewed by 1223
Abstract
Candidemia infection remains a critical challenge in intensive care units (ICUs), with high morbidity and mortality rates despite advances in therapeutic practices. This multicenter prospective surveillance study assessed the epidemiology, clinical management, and mortality predictors of candidemia in critically ill patients across two [...] Read more.
Candidemia infection remains a critical challenge in intensive care units (ICUs), with high morbidity and mortality rates despite advances in therapeutic practices. This multicenter prospective surveillance study assessed the epidemiology, clinical management, and mortality predictors of candidemia in critically ill patients across two periods (2010–2012 and 2017–2018) in 11 tertiary hospitals in Brazil. Among 314 ICU patients with candidemia, the overall mortality rate was 60.2%, with no significant reduction over time (58.8% vs. 62.6%, p = 0.721). Candida albicans was the predominant pathogen (43.6%), followed by C. tropicalis (20%) and C. glabrata (13.7%). The use of echinocandins increased significantly in the second period (21.1% to 41.7%, p < 0.001); however, 70% of patients still did not receive these agents as first-line therapy. Catheter removal due to candidemia was performed in only 52.1% of cases but was associated with improved 30-day survival (p < 0.001). Multivariate analysis identified cancer, inadequate treatment, and vasoactive drug use as independent predictors of mortality. Our findings underscore persistent gaps in adherence to guidelines, particularly regarding timely echinocandin initiation and catheter removal. Strengthening therapeutic strategies focused on these key interventions is essential to improving outcomes for ICU patients with candidemia. Full article
(This article belongs to the Special Issue Candida and Candidiasis: From Basics to Clinics)
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10 pages, 266 KiB  
Review
Coronary Endothelial Dysfunction and Vasomotor Dysregulation in Myocardial Bridging
by Takumi Toya
J. Cardiovasc. Dev. Dis. 2025, 12(2), 54; https://doi.org/10.3390/jcdd12020054 - 2 Feb 2025
Cited by 2 | Viewed by 1038
Abstract
Myocardial bridging (MB), a congenital variant where a coronary artery segment is tunneled within the myocardium, is increasingly recognized as a contributor to coronary endothelial and vasomotor dysfunction. Beyond the hallmark systolic compression observed on angiography, MB disrupts endothelial integrity, impairs the release [...] Read more.
Myocardial bridging (MB), a congenital variant where a coronary artery segment is tunneled within the myocardium, is increasingly recognized as a contributor to coronary endothelial and vasomotor dysfunction. Beyond the hallmark systolic compression observed on angiography, MB disrupts endothelial integrity, impairs the release of vasoactive substances, and induces vasomotor abnormalities. These effects exacerbate ischemic symptoms and predispose to atherosclerosis in the proximal segment, particularly in conditions such as ischemia/myocardial infarction with nonobstructive coronary arteries. Recent studies underscore MB’s association with coronary vasospasm, microvascular endothelial dysfunction, and adverse cardiovascular outcomes, including sudden cardiac death. These findings highlight the interplay between MB’s structural anomalies and functional impairments, with factors such as the bridge’s length, depth, and orientation influencing its hemodynamic significance. Advances in imaging and coronary physiology assessment, including acetylcholine testing and stress diastolic fractional flow reserve/iFR/RFR, have enhanced diagnostic precision. This review explores the multifaceted impact of MB on coronary physiology, emphasizing its role in endothelial dysfunction and vasomotor regulation. Recognizing MB’s contribution to cardiovascular disease is essential for accurate diagnosis and tailored management strategies aimed at mitigating ischemic risk and improving patient outcomes. Full article
14 pages, 1685 KiB  
Article
CytoSorb® Hemadsorption in Cardiogenic Shock: A Real-World Analysis of Hemodynamics, Organ Function, and Clinical Outcomes During Mechanical Circulatory Support
by Julian Kreutz, Lukas Harbaum, Cem Benin Barutcu, Amar Sharif Rehman, Nikolaos Patsalis, Klevis Mihali, Georgios Chatzis, Maryana Choukeir, Styliani Syntila, Bernhard Schieffer and Birgit Markus
Biomedicines 2025, 13(2), 324; https://doi.org/10.3390/biomedicines13020324 - 30 Jan 2025
Cited by 1 | Viewed by 1382
Abstract
Background: Cardiogenic shock (CS), characterized by inadequate tissue perfusion due to cardiac dysfunction, has a high mortality rate despite advances in treatment. Systemic inflammation and organ failure exacerbate the severity of CS. Extracorporeal hemadsorption techniques such as CytoSorb® have been introduced to [...] Read more.
Background: Cardiogenic shock (CS), characterized by inadequate tissue perfusion due to cardiac dysfunction, has a high mortality rate despite advances in treatment. Systemic inflammation and organ failure exacerbate the severity of CS. Extracorporeal hemadsorption techniques such as CytoSorb® have been introduced to control inflammation. However, evidence of their efficacy, particularly in patients on various mechanical circulatory support (MCS) systems, remains limited. Methods: This retrospective study analyzed data from 129 CS patients treated with CytoSorb® at the University Hospital of Marburg between August 2019 and December 2023. Those patients receiving MCS were grouped according to MCS type: (1) Impella, (2) VA-ECMO, and (3) ECMELLA. The hemodynamic parameters of circulatory support (e.g., MCS flow rates and vasoactive inotropic score, VIS) and laboratory and ventilation parameters were assessed 24 h before start of CytoSorb® therapy (T1) and 24 h after completion of CytoSorb® therapy (T2). Results: Of 129 CS patients (mean age: 64.7 ± 13.1 years), 103 (79.8%) received MCS. Comparing T1 and T2, there was a significant reduction in VIS in the entire cohort (T1: 38.0, T2: 16.3; p = 0.002), with a concomitant significant reduction in the level of MCS support in all subgroups, indicating successful weaning. Analysis of laboratory parameters showed significant reductions in lactate (T1: 2.1, T2: 1.3 mmol/L; p = 0.014), myoglobin (T1: 1549.0, T2: 618.0 µg/L; p < 0.01), lactate dehydrogenase (T1: 872.0, T2: 632.0 U/L; p = 0.048), and procalcitonin (T1: 2.9, T2: 1.6 µg/L; p < 0.001). However, a significant decrease in platelets (T1: 140.0, T2: 54.0 tsd/µL; p < 0.001) and albumin (T1: 25.0, T2: 22.0 g/dL; p < 0.001) was also documented. The median SOFA score of the entire cohort was 15.0 (IQR 12.0–16.0), predicting a mortality rate of >80%, which could be reduced to 60.5% in the present study. Conclusions: During CytoSorb® therapy in CS, a significant reduction in VIS was demonstrated, resulting in improved organ perfusion. Therefore, the results of this study underline that CytoSorb® therapy can be considered a useful “component” in the complex management of CS, especially when combined with MCS. To refine and optimize treatment strategies in CS, prospective studies are needed to better define the role of hemadsorption. Full article
(This article belongs to the Section Molecular and Translational Medicine)
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10 pages, 647 KiB  
Review
Vasopressor Therapy
by Jean-Louis Vincent and Filippo Annoni
J. Clin. Med. 2024, 13(23), 7372; https://doi.org/10.3390/jcm13237372 - 3 Dec 2024
Cited by 4 | Viewed by 7604
Abstract
Vasopressor therapy represents a key part of intensive care patient management, used to increase and maintain vascular tone and thus adequate tissue perfusion in patients with shock. Norepinephrine is the preferred first-line agent because of its reliable vasoconstrictor effects, with minimal impact on [...] Read more.
Vasopressor therapy represents a key part of intensive care patient management, used to increase and maintain vascular tone and thus adequate tissue perfusion in patients with shock. Norepinephrine is the preferred first-line agent because of its reliable vasoconstrictor effects, with minimal impact on heart rate, and its mild inotropic effects, helping to maintain cardiac output. Whichever vasopressor is used, its effects on blood flow must be considered and excessive vasoconstriction avoided. Other vasoactive agents include vasopressin, which may be considered in vasodilatory states, and angiotensin II, which may be beneficial in patients with high renin levels, although more data are required to confirm this. Dobutamine should be considered, along with continued fluid administration, to help maintain adequate tissue perfusion in patients with reduced oxygen delivery. In this narrative review, we consider the different vasopressor agents, focusing on the importance of tailoring therapy to the individual patient and their hemodynamic response. Full article
(This article belongs to the Section Emergency Medicine)
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12 pages, 810 KiB  
Review
PiCCO or Cardiac Ultrasound? Which Is Better for Hemodynamic Monitoring in ICU?
by Maria Andrei, Nicoleta Alice Dragoescu, Andreea Stanculescu, Luminita Chiutu, Octavian Dragoescu and Octavian Istratoaie
Medicina 2024, 60(11), 1884; https://doi.org/10.3390/medicina60111884 - 17 Nov 2024
Cited by 3 | Viewed by 3409
Abstract
Advanced hemodynamic monitoring is fundamental in the management of the critically ill. Blood pressure and cardiac function are key markers of cardiovascular system function;, thus, having accurate measurements of these parameters in critically ill patients is essential. Currently, there are various methods available [...] Read more.
Advanced hemodynamic monitoring is fundamental in the management of the critically ill. Blood pressure and cardiac function are key markers of cardiovascular system function;, thus, having accurate measurements of these parameters in critically ill patients is essential. Currently, there are various methods available to choose from, as well as a greater understanding of the methods and criteria to be able to compare devices and select the best option for our patients’ needs. Cardiac ultrasound and transpulmonary thermodilution help tailor the therapy for a patient’s individual needs by putting the results of a thorough hemodynamic assessment into context. Both these hemodynamic monitoring techniques have their advantages, drawbacks and limitations. Cardiac ultrasound is a safe, non-invasive, less expensive, efficient bedside tool for diagnosing, monitoring and guiding critically ill patients’ therapy management. It is recommended in the consensus guidelines as the first-choice method, especially when it comes to identifying different types of shock or the various factors involved. Pulse index contour continuous cardiac output (PiCCO) is a minimally invasive hemodynamic monitoring technique, integrating various static and hemodynamic parameters through a combination of trans-cardiopulmonary thermodilution and pulse contour analysis. The PiCCO method provides guidance to fluid and vasoactive therapy in critically ill patients and is also used for intraoperative and postoperative fluid management and monitoring in cardiac surgery. While invasive methods such as PiCCO are recommended for hemodynamic monitoring and can provide accurate information, they are not always necessary and are contraindicated in some cases. Full article
(This article belongs to the Special Issue Management of Septic Shock in ICU)
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13 pages, 1524 KiB  
Article
Peri-Interventional Hemodynamic Management Strategies for Percutaneous Chemosaturation of the Liver in Metastatic Cancer
by Patrick Rehn, Benjamin Tan, Jan Turra, Patrick Adler, Philipp Mayer, Dania Fischer, Mascha O. Fiedler-Kalenka, Felix C. F. Schmitt, De-Hua Chang, Christoph Lichtenstern, Mark O. Wielpütz, Hans-Ulrich Kauczor, Markus A. Weigand and Maximilian Dietrich
Cancers 2024, 16(21), 3698; https://doi.org/10.3390/cancers16213698 - 1 Nov 2024
Cited by 1 | Viewed by 1484
Abstract
Background: Hepatic chemosaturation for inoperable liver tumors is a palliative treatment option with a beneficial effect on survival. However, the procedure regularly leads to circulatory failure during the filtration phase, and hemodynamic management is challenging. Our study aimed to compare two different strategies [...] Read more.
Background: Hepatic chemosaturation for inoperable liver tumors is a palliative treatment option with a beneficial effect on survival. However, the procedure regularly leads to circulatory failure during the filtration phase, and hemodynamic management is challenging. Our study aimed to compare two different strategies for hemodynamic management during chemosaturation to develop hypotheses for improving patient care and reducing peri-interventional morbidity. Methods: We conducted a single-center retrospective cohort study including 66 procedures of chemosaturation between May 2016 and March 2024. Procedures were divided into two groups: group 1 was managed with norepinephrine as the only vasopressor and liberal use of hydroxyethyl starch (HES). Group 2 was managed with norepinephrine and vasopressin and the preferred use of balanced crystalloids. We compared these two groups with respect to hemodynamic parameters, laboratory values, and post-interventional complications. Results: The heart rate was highest and the mean arterial pressure (MAP) was lowest during the filtration phase in both groups (p = 0.868, p = 0.270). The vasoactive inotropic score (VIS) was significantly higher in group 2 during the filtration phase (31.5 vs. 89, p < 0.001). Group 1 received significantly more HES overall (1000 mL vs. 0 mL, p < 0.001). Lactate levels at admission to the ICU were higher in group 1 (22.9 vs. 14.45 mg/dL, p = 0.041). Platelet counts were lower in group 2 from directly after chemosaturation through day 2 (p = 0.022, p = 0.001, p = 0.032). The INR differed significantly directly after chemosaturation (1.13 vs. 1.26, p = 0.015). Overall, group 1 received significantly more blood products peri-interventionally. There were two bleedings and one ischemic stroke in the overall cohort. There was no peri-interventional mortality. Conclusions: Advanced hemodynamic management ensures low peri-interventional mortality and morbidity. High-dose vasopressors, including vasopressin and the preferred use of balanced crystalloids, are sufficient to stabilize circulatory function during chemosaturation. Full article
(This article belongs to the Section Clinical Research of Cancer)
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7 pages, 556 KiB  
Case Report
The Jack-in-the-Box: Pericardial Decompression Syndrome Managed by a Multidisciplinary Approach with Early Initiation of Veno-Arterial Extracorporeal Membrane Oxygenation: A Case Report
by Carmen Orban, Tudor Borjog, Claudia Talpau, Mihaela Agapie, Angelica Bratu, Mugurel Jafal and Mihai Popescu
Medicina 2024, 60(11), 1747; https://doi.org/10.3390/medicina60111747 - 24 Oct 2024
Viewed by 1185
Abstract
Post decompression syndrome (PDS) is a rare and life-threatening complication of pericardiocentesis, especially after rapid drainage of large amounts of pericardial fluid. We present the case of a 21-year-old man who presented with cardiac tamponade of unknown etiology. After preoperative optimization, surgical drainage [...] Read more.
Post decompression syndrome (PDS) is a rare and life-threatening complication of pericardiocentesis, especially after rapid drainage of large amounts of pericardial fluid. We present the case of a 21-year-old man who presented with cardiac tamponade of unknown etiology. After preoperative optimization, surgical drainage of the pericardial effusion was performed and approximately 2500 mL of fluid was released over 30 min. The patient rapidly developed hemodynamic collapse with severe biventricular dysfunction, with a left ventricle ejection fraction of 15%. Vasopressor and inotropic support were initiated with Noradrenaline and Dobutamine, further escalated to Adrenaline and Levosimendan with no improvement in clinical and hemodynamic parameters. Considering the high doses of vasoactive drugs, rescue veno-arterial extracorporeal membrane oxygenation (V-A ECMO) was started within the first 24 h. After 10 days on V-A ECMO, the cardiac function slowly recovered, and the extracorporeal mechanical support was successfully weaned. The diagnosis of paraneoplastic PDS secondary to angiosarcoma was made and the patient was successfully discharged to the ward on the 24th day. In conclusion, far from being the last option in the management of PDS, V-A ECMO deserves early consideration for securing adequate myocardial and systemic perfusion, while the cardiac function recovers, but a risk-to-benefit assessment should be made by an experienced multidisciplinary team. Full article
(This article belongs to the Section Cardiology)
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20 pages, 4075 KiB  
Review
Treatment-Related Reversible Cerebral Vasoconstriction Syndrome
by Giulia Avola and Alessandro Pezzini
J. Clin. Med. 2024, 13(19), 5930; https://doi.org/10.3390/jcm13195930 - 4 Oct 2024
Cited by 1 | Viewed by 4906
Abstract
Reversible cerebral vasoconstriction syndrome (RCVS) is a rare but significant cause of intracranial arteriopathy and stroke in young adults. The syndrome encompasses a spectrum of disorders radiologically characterized by reversible narrowing and dilation of intracranial arteries, often triggered by vasoactive drugs or the [...] Read more.
Reversible cerebral vasoconstriction syndrome (RCVS) is a rare but significant cause of intracranial arteriopathy and stroke in young adults. The syndrome encompasses a spectrum of disorders radiologically characterized by reversible narrowing and dilation of intracranial arteries, often triggered by vasoactive drugs or the postpartum period. The hallmark clinical feature of RCVS is thunderclap headache with or without other neurological signs. Though endothelial dysfunction and sympathetic hyperactivation are hypothesized to be key mechanisms, the exact pathogenesis of RCVS is still unclear. RCVS’s diagnosis could be challenging, since vasospasm proceeds centripetally, initially involving distal small pial and cortical arteries, and angiographic studies, especially brain magnetic resonance angiography (MRA) and computed tomography angiography (CTA), may miss it in the early phase of the disease, while early signs such as vascular hyperintensities may be visible on T2/FLAIR sequences before vasospasm onset. Catheter angiography is the gold standard and it could be used to assess vasospasm reversibility post-intra-arterial vasodilator administration. Treatment is mainly symptomatic, and nimodipine is the most commonly administered therapy, given orally or intra-arterially in severe cases. Since many aspects of RCVS remain partially known, further research is needed to better understand the complex pathophysiology of this unique clinical condition and to optimize specific management strategies. Full article
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11 pages, 775 KiB  
Article
Withdrawal/Withholding of Life-Sustaining Therapies: Limitation of Therapeutic Effort in the Intensive Care Unit
by Ángel Becerra-Bolaños, Daniela F. Ramos-Ahumada, Lorena Herrera-Rodríguez, Lucía Valencia-Sola, Nazario Ojeda-Betancor and Aurelio Rodríguez-Pérez
Medicina 2024, 60(9), 1461; https://doi.org/10.3390/medicina60091461 - 6 Sep 2024
Viewed by 1631
Abstract
Background/Objectives: The change in critically ill patients makes limitation of therapeutic effort (LTE) a widespread practice when therapeutic goals cannot be achieved. We aimed to describe the application of LTE in a post-surgical Intensive Care Unit (ICU), analyze the measures used, the [...] Read more.
Background/Objectives: The change in critically ill patients makes limitation of therapeutic effort (LTE) a widespread practice when therapeutic goals cannot be achieved. We aimed to describe the application of LTE in a post-surgical Intensive Care Unit (ICU), analyze the measures used, the characteristics of the patients, and their evolution. Methods: Retrospective observational study, including all patients to whom LTE was applied in a postsurgical ICU between January 2021 and December 2022. The LTE defined were brain death, withdrawal of measures, and withholding. Withholding limitations included orders for no cardiopulmonary resuscitation, no orotracheal intubation, no reintubation, no tracheostomy, no renal replacement therapies, and no vasoactive support. Patient and ICU admission data were related to the applied LTE. Results: Of the 2056 admitted, LTE protocols were applied to 106 patients. The prevalence of LTE in the ICU was 5.1%. Data were analyzed in 80 patients. A total of 91.2% of patients had been admitted in an emergency situation, and 56.2% had been admitted after surgery. The most widespread limitation was treatment withholding (83.8%) compared to withdrawal (13.8%). No differences were found regarding who made the decision and the type of limitation employed. However, patients with the limitation of no intubation had a longer stay (p = 0.025). Additionally, the order of not starting or increasing vasopressor support resulted in a longer hospital stay (p = 0.007) and a significantly longer stay until death (p = 0.044). Conclusions: LTE is a frequent measure in critically ill patient management and is less common in the postoperative setting. The most widespread measure was withholding, with the do-not-resuscitate order being the most common. The decision was made mainly by the medical team and the family, respecting the wishes of the patients. A joint patient-centered approach should be made in these decisions to avoid futile treatment and ensure end-of-life comfort. Full article
(This article belongs to the Section Intensive Care/ Anesthesiology)
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16 pages, 2350 KiB  
Review
TRPA1, TRPV1, and Caffeine: Pain and Analgesia
by Elizabeth A. Puthumana, Luna Muhamad, Lexi A. Young and Xiang-Ping Chu
Int. J. Mol. Sci. 2024, 25(14), 7903; https://doi.org/10.3390/ijms25147903 - 19 Jul 2024
Cited by 6 | Viewed by 5254
Abstract
Caffeine (1,3,7-trimethylxanthine) is a naturally occurring methylxanthine that acts as a potent central nervous system stimulant found in more than 60 different plants and fruits. Although caffeinated beverages are widely and casually consumed, the application of caffeine beyond dietary levels as pharmacologic therapy [...] Read more.
Caffeine (1,3,7-trimethylxanthine) is a naturally occurring methylxanthine that acts as a potent central nervous system stimulant found in more than 60 different plants and fruits. Although caffeinated beverages are widely and casually consumed, the application of caffeine beyond dietary levels as pharmacologic therapy has been recognized since the beginning of its recorded use. The analgesic and vasoactive properties of caffeine are well known, but the extent of their molecular basis remains an area of active research. There is existing evidence in the literature as to caffeine’s effect on TRP channels, the role of caffeine in pain management and analgesia, as well as the role of TRP in pain and analgesia; however, there has yet to be a review focused on the interaction between caffeine and TRP channels. Although the influence of caffeine on TRP has been demonstrated in the lab and in animal models, there is a scarcity of data collected on a large scale as to the clinical utility of caffeine as a regulator of TRP. This review aims to prompt further molecular research to elucidate the specific ligand–host interaction between caffeine and TRP by validating caffeine as a regulator of transient receptor potential (TRP) channels—focusing on the transient receptor potential vanilloid 1 (TRPV1) receptor and transient receptor potential ankyrin 1 (TRPA1) receptor subtypes—and its application in areas of pain. Full article
(This article belongs to the Special Issue TRP Channels in Physiology and Pathophysiology 2.0)
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