35 research outputs found
The impact of exercise capacity in the atherosclerotic patient: Keep on walking!
__Abstract__
Peripheral arterial disease (PAD) is a manifestation of systemic arteriosclerosis. It is a
common disease affecting millions of people. Depending on the age of the investigated
population prevalences between 4% to 29% has been reported. It is alarming that the
prevalence is expected to rise in the following decades due to the aging of the western
population and the increase of risk factors such as diabetes mellitus, obesity and lack of
exercise. Patients with PAD are of an increased risk of cardiovascular events and mortality.
In addition, they may also experience signifi cant limitations in their physical
functioning and impairment in their quality of life. It is important to diagnose patients
with PAD early in the course of the disease to provide them optimal treatment as soon as
possible in attempting to lower the complication rates, improve morbidity, mortality and
subsequent their quality of life. However, symptoms of PAD are diverse. The classical
symptoms are intermittent claudication consisted of calf pain provoked by walking and
declining at rest. Earlier investigations, on the other hand, have demonstrated a large
range of symptoms ranging from no pain at all till pain at rest . A major problem is
that between 20% till 50% of the patients are asymptomatic . Commonly, to
identify patients with PAD the resting ankle brachial index (ABI) is used. This is the ratio
between the ankle’s systolic blood pressure, measured at the dorsalis pedis or posterial
tibial arterie using a Doppler ultrasonic instrument, and the systolic blood pressure at the
arm. An ABI below 0.90 is associated with angiographic stenosis of more than 50% .
According to the guidelines a resting ABI of < 0.90 is defi ned as PAD. Several studies have
found that an ABI of < 0.90 is associated with an increased risk of cardiovascular diseases
and mortality. Moreover it can also be used for prognostic risk stratifi cation
Microcirculatory Monitoring in Children with Congenital Heart Disease Before and After Cardiac Surgery
In this prospective observational study, we investigated whether congenital heart disease (CHD) affects the microcirculation and whether the microcirculation is altered following cardiac surgery with cardiopulmonary bypass (CPB). Thirty-eight children with CHD undergoing cardiac surgery with CPB and 35 children undergoing elective, non-cardiac surgery were included. Repeated non-invasive sublingual microcirculatory measurements were performed with handheld vital microscopy. Before surgery, children with CHD showed similar perfused vessel densities and red blood cell velocities (RBCv) but less perfused vessels (p < 0.001), lower perfusion quality (p < 0.001), and higher small vessel densities (p = 0.039) than children without CHD. After cardiac surgery, perfused vessel densities and perfusion quality of small vessels declined (p = 0.025 and p = 0.032), while RBCv increased (p = 0.032). We demonstrated that CHD was associated with decreased microcirculatory perfusion and increased capillary recruitment. The microcirculation was further impaired after cardiac surgery. Decreased microcirculatory perfusion could be a warning sign for altered tissue oxygenation and requires further exploration. Graphical abstract: [Figure not available: see fulltext.].</p
Microcirculatory Monitoring in Children with Congenital Heart Disease Before and After Cardiac Surgery
In this prospective observational study, we investigated whether congenital heart disease (CHD) affects the microcirculation and whether the microcirculation is altered following cardiac surgery with cardiopulmonary bypass (CPB). Thirty-eight children with CHD undergoing cardiac surgery with CPB and 35 children undergoing elective, non-cardiac surgery were included. Repeated non-invasive sublingual microcirculatory measurements were performed with handheld vital microscopy. Before surgery, children with CHD showed similar perfused vessel densities and red blood cell velocities (RBCv) but less perfused vessels (p < 0.001), lower perfusion quality (p < 0.001), and higher small vessel densities (p = 0.039) than children without CHD. After cardiac surgery, perfused vessel densities and perfusion quality of small vessels declined (p = 0.025 and p = 0.032), while RBCv increased (p = 0.032). We demonstrated that CHD was associated with decreased microcirculatory perfusion and increased capillary recruitment. The microcirculation was further impaired after cardiac surgery. Decreased microcirculatory perfusion could be a warning sign for altered tissue oxygenation and requires further exploration
Peri-operative red blood cell transfusion in neonates and infants: NEonate and Children audiT of Anaesthesia pRactice IN Europe: A prospective European multicentre observational study
BACKGROUND: Little is known about current clinical practice concerning peri-operative red blood cell transfusion in neonates and small infants. Guidelines suggest transfusions based on haemoglobin thresholds ranging from 8.5 to 12 g dl-1, distinguishing between children from birth to day 7 (week 1), from day 8 to day 14 (week 2) or from day 15 (≥week 3) onwards. OBJECTIVE: To observe peri-operative red blood cell transfusion practice according to guidelines in relation to patient outcome. DESIGN: A multicentre observational study. SETTING: The NEonate-Children sTudy of Anaesthesia pRactice IN Europe (NECTARINE) trial recruited patients up to 60 weeks' postmenstrual age undergoing anaesthesia for surgical or diagnostic procedures from 165 centres in 31 European countries between March 2016 and January 2017. PATIENTS: The data included 5609 patients undergoing 6542 procedures. Inclusion criteria was a peri-operative red blood cell transfusion. MAIN OUTCOME MEASURES: The primary endpoint was the haemoglobin level triggering a transfusion for neonates in week 1, week 2 and week 3. Secondary endpoints were transfusion volumes, 'delta haemoglobin' (preprocedure - transfusion-triggering) and 30-day and 90-day morbidity and mortality. RESULTS: Peri-operative red blood cell transfusions were recorded during 447 procedures (6.9%). The median haemoglobin levels triggering a transfusion were 9.6 [IQR 8.7 to 10.9] g dl-1 for neonates in week 1, 9.6 [7.7 to 10.4] g dl-1 in week 2 and 8.0 [7.3 to 9.0] g dl-1 in week 3. The median transfusion volume was 17.1 [11.1 to 26.4] ml kg-1 with a median delta haemoglobin of 1.8 [0.0 to 3.6] g dl-1. Thirty-day morbidity was 47.8% with an overall mortality of 11.3%. CONCLUSIONS: Results indicate lower transfusion-triggering haemoglobin thresholds in clinical practice than suggested by current guidelines. The high morbidity and mortality of this NECTARINE sub-cohort calls for investigative action and evidence-based guidelines addressing peri-operative red blood cell transfusions strategies. TRIAL REGISTRATION: ClinicalTrials.gov, identifier: NCT02350348