Intra-aortic balloon pump does not influence cerebral hemodynamics and neurological outcomes in high-risk cardiac patients undergoing cardiac surgery: an analysis of the IABCS trial

The intra-aortic balloon pump (IABP) is often used in high-risk patients undergoing cardiac surgery to improve coronary perfusion and decrease afterload. The effects of the IABP on cerebral hemodynamics are unknown. We therefore assessed the effect of the IABP on cerebral hemodynamics and on neurological complications in patients undergoing cardiac surgery who were randomized to receive or not receive preoperative IABP in the ‘Intra-aortic Balloon Counterpulsation in Patients Undergoing Cardiac Surgery’ (IABCS) trial. Methods: This is a prospectively planned analysis of the previously published IABCS trial. Patients undergoing elective coronary artery bypass surgery with ventricular ejection fraction ≤ 40% or EuroSCORE ≥ 6 received preoperative IABP (n = 90) or no IABP (n = 91). Cerebral blood flow velocity (CBFV) of the middle cerebral artery through transcranial Doppler and blood pressure through Finometer or intra-arterial line were recorded preoperatively (T1) and 24 h (T2) and 7 days after surgery (T3) in patients with preoperative IABP (n = 34) and without IABP (n = 33). Cerebral autoregulation was assessed by the autoregulation index that was estimated from the CBFV response to a step change in blood pressure derived by transfer function analysis. Delirium, stroke and cognitive decline 6 months after surgery were recorded. Results: There were no differences between the IABP and control patients in the autoregulation index (T1: 5.5 ± 1.9 vs. 5.7 ± 1.7; T2: 4.0 ± 1.9 vs. 4.1 ± 1.6; T3: 5.7 ± 2.0 vs. 5.7 ± 1.6, p = 0.97) or CBFV (T1: 57.3 ± 19.4 vs. 59.3 ± 11.8; T2: 74.0 ± 21.6 vs. 74.7 ± 17.5; T3: 71.1 ± 21.3 vs. 68.1 ± 15.1 cm/s; p = 0.952) at all time points. Groups were not different regarding postoperative rates of delirium (26.5% vs. 24.2%, p = 0.83), stroke (3.0% vs. 2.9%, p = 1.00) or cognitive decline through analysis of the Mini-Mental State Examination (16.7% vs. 40.7%; p = 0.07) and Montreal Cognitive Assessment (79.16% vs. 81.5%; p = 1.00). Conclusions: The preoperative use of the IABP in high-risk patients undergoing cardiac surgery did not affect cerebral hemodynamics and was not associated with a higher incidence of neurological complications. Trial registrationhttp://www.clinicaltrials.gov (NCT02143544)

Growth and production of nasturtium flowers in three hydroponic solutions Crescimento e produção de flores de nastúrcio cultivado em hidroponia com três soluções nutritivas

This experiment was carried out during April to August 2003 in a greenhouse at the Universidade Federal de Santa Maria, Rio Grande do Sul state, Brazil. The growth and production of nasturtium flowers (Tropaeolum majus) in hydroponics NFT system was typified. Treatments were displayed in a 3x11 factorial, with six replications, in entirely randomized experimental design, and were composed of three nutrition solutions and 11 assessment dates. Each plant was separated between aerial part and root for the evaluation of dry mass. The blossoming started 49 days after the transplant (DAT). The plants presented good development in hydroponics, as well as growing dry mass, stature, leaf area and IAF, during the cycle. The culture's growth rate presented larger accumulation of leaf mass from 49 DAT on, in linear relation. Biological productivity was adjusted to a 2nd degree equation. Nutrition solutions did not show statistical differences, however, Furlani (1997) solution was the most reasonably priced.<br>Com o objetivo de caracterizar o crescimento e produção de flores de nastúrcio (Tropaeolum majus) em hidroponia, no sistema NFT, conduziu-se um experimento em casa de vegetação da Universidade Federal de Santa Maria, de abril a agosto de 2003. O experimento foi um fatorial 3x11 com seis repetições, em delineamento experimental inteiramente casualizado, sendo os tratamentos constituídos de três soluções nutritivas e 11 datas de avaliação. Dividiu-se cada planta em parte aérea e raiz para avaliação da fitomassa seca. A floração iniciou aos 49 dias após o transplante (DAT). A planta apresentou bom desenvolvimento em hidroponia sendo a produção de fitomassa seca crescente durante o ciclo, bem como a estatura, a área foliar e o IAF. A taxa de crescimento da cultura apresentou maior acúmulo de fitomassa a partir dos 49 DAT com relação linear. A produtividade biológica ajustou-se a uma equação do 2º grau. As soluções nutritivas não apresentaram diferença estatística entre si, porém na análise de custo a solução Furlani (1997) foi a mais econômica