The uncalibrated pulse contour cardiac output during off-pump coronary bypass surgery: performance in patients with a low cardiac output status and a reduced left ventricular function

BACKGROUND: We compared the continuous cardiac index measured by the FloTrac/Vigileo™ system (FCI) to that measured by a pulmonary artery catheter (CCI) with emphasis on the accuracy of the FCI in patients with a decreased left ventricular ejection fraction (LVEF) and a low cardiac output status during off-pump coronary bypass surgery (OPCAB). We also assessed the influence of several factors affecting the pulse contour, such as the mean arterial pressure (MAP), the systemic vascular resistance index (SVRI) and the use of norepinephrine. METHODS: Fifty patients who were undergoing OPCAB (30 patients with a LVEF ≥ 40%, 20 patients with a LVEF < 40%) were enrolled. The FCI and CCI were measured and we performed a Bland-Altman analysis. Subgroup analyses were done according to the LVEF (< 40%), the CCI (≤ 2.4 L/min/m), the MAP (60-80 mmHg), the SVRI (1,600-2,600 dyne/s/cm(5)/m(2)) and the use of norepinephrine. RESULTS: The FCI was reliable at all the time points of measurement with an overall bias and limit of agreement of -0.07 and 0.67 L/min/m(2), respectively, resulting in a percentage error of 26.9%. The percentage errors in the patients with a decreased LVEF and in a low cardiac output status were 28.2% and 22.3%, respectively. However, the percentage error in the 91 data pairs outside the normal range of the SVRI was 40.2%. CONCLUSIONS: The cardiac output measured by the FloTrac/Vigileo™ system was reliable even in patients with a decreased LVEF and in a low cardiac output status during OPCAB. Acceptable agreement was also noted during the period of heart displacement and grafting of the obtuse marginalis branch.ope

Interfacility transport of critically ill children

Interfacility transport of critically ill children (transport) is a challenging component of pediatric critical care. The risk associated with the transport may be reduced by a specialized pediatric transport team, a screening tool for critically ill children, and a standardized handover between referring and referred physicians. Further research is necessary in Korea regarding the above measures for the safe and effective transport

Effect of preoperative statin therapy on myocardial protection and morbidity endpoints following off-pump coronary bypass surgery in patients with elevated C-reactive protein level

BACKGROUND: The aim of this study was to investigate the effects of preoperative statin therapy on myocardial protection and morbidity endpoints following off-pump coronary bypass graft surgery (OPCAB) in patients with elevated serum high-sensitivity C-reactive protein (hs-CRP) levels. METHODS: Of the 492 patients who underwent multivessel OPCAB from March 2007 to February 2009, the records of 144 patients whose baseline hs-CRP level > 2 mg/L were reviewed. According to the history of preoperative statin therapy for at least one week, patients were classified as either statin group or control group (72 subjects each). Preoperative and operative characteristics and postoperative data including troponin (Tn)-T level and major morbidity endpoints were obtained and compared. Major morbidity endpoints were defined as permanent stroke, renal dysfunction, hemostatic re-exploration, deep sternal wound infection, and the number of patients requiring prolonged ventilation. RESULTS: Preoperative and operative characteristics were similar between the two groups. There were no significant differences in the incidence of morbidity endpoints between the two groups, except for the number of patients requiring dialysis, which was significantly lower in the statin group (8 vs. 1, P = 0.033). Tn-T level at 24 h after surgery was also significantly lower in the statin group. CONCLUSIONS: In this study, we observed beneficial effects of preoperative statin therapy for at least one week in terms of less myocardial enzyme release and fewer patients requiring dialysis following OPCAB in patients whose preoperative hs-CRP was elevatedope

Angiopoietin-1 is an apoptosis survival factor for endothelial cells

AbstractWe examined the effect of angiopoietin-1 (Ang1) on apoptosis in human umbilical vein endothelial cells (HUVECs). Ang1 (5–1000 ng/ml) dose-dependently inhibited apoptosis under a serum-deprived state. A significant apoptotic inhibition occurred with as low as 50 ng/ml. Two hundred ng/ml of Ang1 inhibited to approximately 50% of the control apoptotic rates for 96 h. Furthermore, an augmented antiapoptotic effect of Ang1 by the addition of 20 ng/ml vascular endothelial growth factor was observed. This Ang1-induced strong antiapoptotic effect in endothelial cells is a novel and intriguing finding and could be an additional description of Ang1-induced direct biological function

A Study on the Lateral Load Capacity of a Novel Hybrid Monopile via a Centrifuge Model Test

publishedVersio

Removal of Blunt Esophageal Foreign Body Using Foley Catheter in Children

Purpose Foreign body ingestion is a common cause for children to visit the emergency department. Removal of esophageal foreign body was usually done by an endoscopy. After Bigler introduced the Foley catheter technique for esophageal foreign body in 1966, many studies were performed regarding such technique. However, only a few researchers in Korea have attempted to report this technique. This study reports a 10-year experience of the Foley catheter removal method for blunt esophageal foreign body at a single center in Korea. Methods Medical records of patients who were treated as esophageal foreign body with Foley catheters between March 2005 and February 2015 were retrospectively reviewed. Their clinical characteristics and outcomes were evaluated. Results A total of 73 patients were treated as esophageal foreign body impaction using the Foley catheter method. Foreign body removals were successful in 67 (91.8%) cases. Six failed cases were treated with esophagoscopy or endoscopy. The mean age was 3.7 years old. The most common foreign body was a coin (80.8%). Foreign bodies were lodged at the upper esophagus level most frequently (79.5%), followed by the middle esophagus (12.3%) and the lower esophagus (6.8%). During the removal procedure, 43.8% of patients were sedated, and 95.9% were treated with fluoroscopy. There were no positive correlations between the removal success and sedation (P=0.54) or using a fluoroscopy (P=0.23). In 69 cases (94.5%), there were no serious complications. However, in one patient, complications, such as vomiting, fever, and esophageal ulceration were observed. One patient complained fever and esophageal ulceration. In 3 (60%) of the total 5 patients with button battery ingestion, serious complications, such as fever or esophageal ulceration, occurred. Conclusion Removal of blunt esophageal foreign body using a Foley catheter in children is a useful and relatively safe method. However, patients with button battery ingestion need more attention when trying the Foley catheter removal technique