Effects of severity of long-standing congestive heart failure on pulmonary function

To investigate the effects of severity of long-standing congestive heart failure (CHF) on pulmonary function, we studied 53 (47 men) consecutive patients, all heart transplant candidates. Their mean (+/- SD) age and ejection fraction were 47 +/- 12 years and 23 +/- 7%, respectively. All patients underwent spirometry, lung volume, diffusion capacity (DLCO), maximum inspiratory (PImax) and expiratory pressure (PEmax) measurement. Maximum cardiopulmonary exercise test on a treadmill was also performed to determine maximum oxygen consumption ((V) over dot O(2)max). On the basis of (V) over dot O(2)max, the patients were then divided into those with a (V) over dot O(2)max 214 ml min(-1) kg(-1) (group 1, n = 30) and those with a (V) over dot O(2)max less than or equal to 14 mi min(-1) kg(-1) (group 2, n = 23). In comparison with group 1, group 2 patients had lower FEV1/FVC (70 +/- 8% vs 75 +/- 7%, P = 0.008), lower FEF25-75 (46 +/- 21 vs 70 +/- 26%pred, P < 0.001), lower TLC (76 +/- 15 vs 85 +/- 13%pred, P = 0.02) and lower PImax (68 +/- 20 vs 87 +/- 22 cmH(2)O, P = 0.003), but comparable DLCO (84 +/- 15 vs 88 +/- 20%pred, P = N.S.), and PEmax (99 +/- 25 vs 96 +/- 22 cmH(2)O, P = N.S.). In conclusion, our data suggest that respiratory abnormalities, such as restrictive defects, airway obstruction, and inspiratory muscle weakness, are more pronounced in patients with severe CHF than in those with mild-to-moderate disease. Further studies are required to investigate the extent to which these abnormalities contribute to dyspnoea during daily activities in patients with heart failure

Phrenic nerve dysfunction after cardiac operations - Electrophysiologic evaluation of risk factors

Background and study objective: Phrenic nerve injury may occur after cardiac surgery; however, its cause has not been extensively investigated with electrophysiology, The purpose of this study was to determine by electrophysiologic means the importance of various possible risk factors in the development of phrenic nerve dysfunction after cardiac surgical operations. Design: A prospective study was conducted, Setting: A tertiary teaching hospital pro tided the background for the stud. Patients: Sixty-three cardiac surgery patients on whom surgical operations were performed by the same surgical team constituted the study group. Mean (+/-SD) age and ejection fraction were 63+/-5 years and 50+/-10%, respectively. Interventions: Measurement of phrenic nerve conduction latency time after transcutaneous stimulation preoperatively and at 23 h and 7 and 30 days postoperatively. Results: Thirteen patients had abnormal phrenic nerve function postsurgery, 12 on the left side and one bilaterally, Logistic regression anal)sis revealed that among the potential risk factors investigated, use of ice slush for myocardial preservation was the only independent risk factor related to phrenic nerve dysfunction (p=0.01), carrying an 8-fold higher incidence for this complication, In contrast, age, ejection fraction of the left ventricle, operative/bypass/aortic cross-clamp time, left internal mammary artery use, and diabetes mellitus were not found to be associated with phrenic neuropathy. The postoperative outcome of patients who received ice slush compared with that of those who had cold saline solution did not differ in terms of early morbidity and mortality, Conclusion: Among the risk factors investigated, only the use of ice slush was significantly associated with postoperative phrenic nerve dysfunction. Therefore, ice should be avoided in cardiac surgery, since it does not seem to provide additional myocardial protection

Contribution of lung function to exercise capacity in patients with chronic heart failure

Background: The importance of exercise capacity as an indicator of prognosis in patients with heart disease is well recognized. However, factors contributing to exercise limitation in such patients have not been fully characterized and in particular, the role of lung function in determining exercise capacity has not been extensively investigated. Objective: To examine the extent to which pulmonary function and respiratory muscle strength indices predict exercise performance in patients with moderate to severe heart failure. Methods: Fifty stable heart failure patients underwent a maximal symptom-limited cardiopulmonary exercise test on a treadmill to determine maximum oxygen consumption (VO2max), pulmonary function tests and maximum inspiratory (PImax) and expiratory (PEmax) pressure measurement. Results: In univariate analysis, VO2max correlated with forced vital capacity (r = 0.35, p = 0.01), forced expiratory volume in 1 s (r = 0.45, p = 0.001), FEV1/FVC ratio (r = 0.37, p = 0.009), maximal midexpiratory flow rate (FEF25-75, r = 0.47, p < 0.001), and PImax (r = 0.46, p = 0.001), but not with total lung capacity, diffusion capacity or PEmax. In stepwise linear regression analysis, FEF25-75 and PImax were shown to be independently related to VO2max, with a combined r and r(2) value of 0.56 and 0.32, respectively. Conclusions: Lung function indices overall accounted for only approximately 30% of the variance in maximum exercise capacity observed in heart failure patients. The mechanism(s) by which these variables could set exercise limitation in heart failure awaits further investigation

Clostridium subterminale septicemia in an immunocompetent patient

Clostridium subterminale is a Clostridium species that has been rarely isolated in the blood of immunocompromised patients. We report a case of C. subterminale septicemia in an immunocompetent patient who presented with acute mediastinitis following spontaneous esophageal rupture. © 2016 The Authors

Characteristics, risk factors and outcomes of Clostridium difficile infections in Greek Intensive Care Units

Background: Clostridium difficile is one of the major causes of diarrhoea among critically ill patients and its prevalence increases exponentially in relation to the use of antibiotics and medical devices. We sought to investigate the incidence of C. difficile infection in Greek units, and identify potential risk factors related to C. difficile infection. Methods: A prospective multicenter cohort analysis of critically ill patients (3 ICUs from 1/1/2014 to 31/12/2014). Results: Among 970(100%) patients, 95(9.79%) with diarrhoea, were included. Their demographic, comorbidity and clinical characteristics were recorded on admission to the unit. The known predisposing factors for the infection were recorded and the diagnostic tests to confirm C. difficile were conducted, based on the current guidelines. The incidence of C. difficile infection was 1.3% (n = 13). All-cause mortality in patients with diarrhoea, C. difficile infection and attributable mortality in patients with C. difficile infection was 28%, 38.5% and 30.8% respectively. Sequential Organ Failure Assessment (SOFA) scores on admission were significantly lower and prior C. difficile infection was more common in patients with current C. difficile infection. Regarding other potential risk factors, no difference was found between groups. No factor was independently associated with C. difficile infection. Conclusions: C. difficile infection is low in Greek intensive care units, but remains a serious problem among the critically-ill. Mortality was similar to reports from other countries. No factor was independently associated with C. difficile infection. © 2019 Elsevier Lt

Older age, disease severity and co-morbidities independently predict mortality in critically ill patients with copd exacerbation

INTRODUCTION Mechanically ventilated critically ill patients with acute COPD exacerbation (AECOPD) have significantly higher rates of morbidity and mortality compared to patients hospitalized for AECOPD but not requiring ventilatory support. The aim of this study was to describe the characteristics and outcomes of ventilated critically ill AECOPD patients and to identify prognostic variables associated with 28-day ICU mortality. METHODS One hundred and twenty-seven patients admitted to the University respiratory ICU in ‘Sotiria’ Hospital due to AECOPD were retrospectively studied. Data were extracted from the medical records of the ICU database. Demographic features, comorbidities, disease severity, exacerbation rate, and treatment, were recorded along with SOFA and APACHE-II scores and laboratory variables. RESULTS Thirty-five percent of the patients died in the ICU (mean age 73±8 vs 67±8 years in survivors, p<0.001). Non-survivors had significantly more comorbidities compared to survivors (p<0.001), significantly higher APACHE II score (30±7 vs 22±7, p<0.001), and significantly higher rates of multi-organ failure (MOF) (62% vs 10.2%, p<0.001). Independent factors associated with ICU mortality were older age (OR=1.13 per year increase; 95% CI: 1.04–1.22, p=0.004), APACHE II score on admission (OR=1.11 per unit increase; 95% CI: 1.04–1.22, p=0.004), Charlson Comorbidity Index (CCI) (OR=1.79 per unit increase; 95% CI: 1.25–2.55, p=0.001), admission lactate levels (OR=2.60 per mEq/L increase; 95% CI: 1.17-5.80, p=0.019), and COPD severity (OR=4.57; 95% CI: 1.14–18.22, p=0.032). CONCLUSIONS Severe physiological derangement upon ICU admission, COPD disease severity and high co-morbidity burden are predictive factors of 28-day mortality in critically ill AECOPD patients. © 2021 Galani M. et al