Impact of COVID-19 on cardiovascular testing in the United States versus the rest of the world

Objectives: This study sought to quantify and compare the decline in volumes of cardiovascular procedures between the United States and non-US institutions during the early phase of the coronavirus disease-2019 (COVID-19) pandemic. Background: The COVID-19 pandemic has disrupted the care of many non-COVID-19 illnesses. Reductions in diagnostic cardiovascular testing around the world have led to concerns over the implications of reduced testing for cardiovascular disease (CVD) morbidity and mortality. Methods: Data were submitted to the INCAPS-COVID (International Atomic Energy Agency Non-Invasive Cardiology Protocols Study of COVID-19), a multinational registry comprising 909 institutions in 108 countries (including 155 facilities in 40 U.S. states), assessing the impact of the COVID-19 pandemic on volumes of diagnostic cardiovascular procedures. Data were obtained for April 2020 and compared with volumes of baseline procedures from March 2019. We compared laboratory characteristics, practices, and procedure volumes between U.S. and non-U.S. facilities and between U.S. geographic regions and identified factors associated with volume reduction in the United States. Results: Reductions in the volumes of procedures in the United States were similar to those in non-U.S. facilities (68% vs. 63%, respectively; p = 0.237), although U.S. facilities reported greater reductions in invasive coronary angiography (69% vs. 53%, respectively; p < 0.001). Significantly more U.S. facilities reported increased use of telehealth and patient screening measures than non-U.S. facilities, such as temperature checks, symptom screenings, and COVID-19 testing. Reductions in volumes of procedures differed between U.S. regions, with larger declines observed in the Northeast (76%) and Midwest (74%) than in the South (62%) and West (44%). Prevalence of COVID-19, staff redeployments, outpatient centers, and urban centers were associated with greater reductions in volume in U.S. facilities in a multivariable analysis. Conclusions: We observed marked reductions in U.S. cardiovascular testing in the early phase of the pandemic and significant variability between U.S. regions. The association between reductions of volumes and COVID-19 prevalence in the United States highlighted the need for proactive efforts to maintain access to cardiovascular testing in areas most affected by outbreaks of COVID-19 infection

Atelectasia pulmonar em cães durante anestesia geral

A pressão intrapleural normalmente é menor que a pressão intrapulmonar. Consequentemente , os pulmões tendem ao colapso e se retraem, afastando-se da parede torácica. No início do século XX, Pasteur descreveu a atelectasia pulmonar, que ocorre com frequência durante a indução anestésica, persiste no período pós-operatório e pode contribuir de maneira significativa para a morbidade e o aumento nos gastos com medicamentos. em medicina veterinária, no entanto, a atelectasia não é frequentemente diagnosticada, apesar de que isso não implica afirmar que tal afecção não ocorra, visto que existem relatos do desenvolvimento desse quadro em cães e em outras espécies. No contexto da anestesia geral, essa complicação pulmonar pode ser encontrada em animais que respiram 80 a 100% de oxigênio. A partir dessas informações, torna-se necessário que o profissional da anestesiologia veterinária obtenha conhecimentos complementares sobre o tema. Com este trabalho, objetivou-se descrever alguns dos mecanismos da atelectasia e seus pontos relevantes, de modo a familiarizar os profissionais quanto aos pormenores dessa importante, e nem sempre bem compreendida, alteração fisiológica respiratória.Pleural pressure is usually lower than pulmonary pressure. Therefore, the lungs tend to collapse and increase its distance from thoracic walls. At the beginning of 20th century, Pasteur described the pulmonary atelectasis, which develops during induction of anesthesia and persists to the postoperative period. It can contribute significantly to morbidity and to increase the medical expenses. In veterinary medicine, pulmonary atelectasis is not frequently diagnosed, which doesn't rule out the occurrence of this disease, since there are reports of atelectsasis in dogs. This pulmonary complication can be found in animals that breathe 80% to 100% oxygen in anesthetic procedures. Based on this information, the veterinary anesthesiologist is required to search for complementary knowledge regarding to pulmonary atelectasis. This study, therefore, aimed to describe some of the mechanisms involved in the development of atelectasis. It aimed also to familiarize the anesthesiologist to this not always well- understood physiological breathing change.Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP

Características produtivas e imunológicas de frangos de corte submetidos a dietas suplementadas com cromo, criados sob diferentes condições de ambiente

Objetivou-se avaliar o desempenho, a resposta imune e as características de carcaça de frangos de corte alimentados com dietas suplementadas com cromo complexado a levedura (Saccharomyces cerevisae), criados em diferentes condições de temperatura. O experimento foi conduzido em câmaras climáticas com sistema de aquecimento e refrigeração, utilizando-se as seguintes condições de temperatura, de acordo com as idades: 1 a 3 dias (35, 35 e 35 ºC ± 2), 4 a 7 dias (35, 30, 25 ºC ± 2), 8 a 14 dias (34, 27 e 20 ºC ± 2), 15 a 21 dias (33, 26 e 18 ºC ± 2) e de 22 a 47 dias (32, 26 e 18 ºC ± 2), respectivamente, para temperatura quente, termoneutra e fria. As dietas foram suplementadas com 0, 400, 800, 1.200 μg Cr/kg. A suplementação de 400 μg Cr/kg melhora a viabilidade e, em aves mantidas em temperatura quente, a conversão alimentar, enquanto a temperatura de criação mostrou ter grande influência sobre as características produtivas em todas as fases de criação. As aves criadas em temperatura quente apresentam melhor resposta imune, maior rendimento de carcaça e pernas e resultados inferiores de desempenho e rendimento de peito.The objective of this experiment was to evaluate performance, immune response and traits concerning carcass and poultry cuts of broiler chickens fed diets supplemented with chromium-yeast (Saccharomyces cerevisae), reared under different environmental temperature conditions. Birds were reared in climate chambers with heating and cooling system, using the following environmental temperatures according to ages: from 1 to 3 days of age (35, 35 and 35 ºC ± 2), from 4 to 7 days of age (35, 30 and 25 ºC ± 2), from 8 to 14 days old (34, 27 and 20 ºC ± 2), from 15 to 21 days of age (33, 26 and 18 ºC ± 2) and from 22 to 47 days of age (32, 26 and 18 ºC ± 2), respectively, for high, thermoneutral and low temperatures. Diets were supplemented with 0; 400; 800; and 1,200 μg Cr/kg. Supplementation with 400 μg Cr/kg enhances the viability and, in birds reared in high temperature, feed conversion as well, while temperature showed to have great influence upon productive traits in every rearing phase. Chickens reared at high temperature presented better immune response, higher carcass dressing percentage and leg quarter yield, but inferior results for breast yield and performance.Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq

Two levels of the inspired oxygen fraction in propofol-anesthetized dogs with high intracranial pressure: cardiopulmonary function

In the initial stage of traumatic brain injury, the use of 1.0 inspired oxygen fraction (FiO2) is indicated. However, high FiO2 has been correlated with atelectasis. Thus, the effects of FiO2 = 1.0 and FiO2 = 0.6 on the cardiopulmonary function in propofol-anesthetized dogs with high intracranial pressure (ICP) were evaluated. Eight dogs were anesthetized on two occasions, receiving, during controlled ventilation, an FiO2 = 1 (G100) or an FiO2 = 0.6 (G60). Propofol was used for induction (10mg.kg-1) followed by a continuous rate infusion (0.6mg.kg-1.minute-1). An increase in the ICP was induced by temporary obliteration of the right jugular vein (OJv) 50 minutes after induction of anesthesia. The measurement was taken twenty minutes after OJv (T0) and then at 15-minute intervals (T15 to T60). Alveolar oxygen partial pressure in G60 was lower than in G100 during the whole procedure. Alveolar-arterial oxygen gradient in G100 was greater than in G60 at T0 and at T60. No differences were observed for arterial oxygen partial pressure/inspired oxygen fraction ratio, arterial-to-alveolar oxygen pressure ratio, respiratory index, venous admixture, oxygen delivery, oxygen consumption, oxygen extraction, heart rate, mean pulmonary arterial pressure, pulmonary arterial occlusion pressure, cardiac index, stroke index and systemic vascular resistance index. In G100, mean arterial pressure at T0 was higher than at T45. In dogs with high ICP, the cardiopulmonary function was not influenced by the different FiO2 used.No estágio inicial do trauma encefálico, o emprego de fração inspirada de oxigênio (FiO2) de 1,0 é indicado. Todavia, altas FiO2 têm sido correlacionadas com atelectasia. Assim, avaliaram-se os efeitos das FiO2 = 1.0 e FiO2 = 0.6 sobre a função cardiopulmonar em cães com pressão intracraniana (PIC) elevada e anestesiados com propofol. Oito animais foram anestesiados em duas ocasiões e receberam, durante a ventilação controlada, FiO2 = 1(G100) ou FiO2 = 0,6 (G60). Propofol foi usado para indução (10mg.kg-1) e seguido por infusão contínua (0,6mg.kg-1minuto-1). O aumento da PIC foi induzido pela obliteração temporária da veia jugular (OJv). As mensurações foram realizadas 20 minutos após OJv (T0) e em intervalos de 15 minutos (de T15 a T60). A pressão parcial de oxigênio alveolar no G60 foi menor do que no G100 durante todo o procedimento. O gradiente alveolar-arterial no G100 foi maior do que no G60, em T0 e T60. Não foram observadas diferenças para: relação pressão parcial de oxigênio/fração inspirada de oxigênio, relação arterioalveolar, índice respiratório, mistura arteriovenosa, oferta de oxigênio, consumo de oxigênio, taxa de extração de oxigênio, frequência cardíaca, pressão da artéria pulmonar média, pressão de oclusão da artéria pulmonar, índice cardíaco, índice sistólico e índice de resistência vascular sistêmica. No G100, a pressão arterial média em T0 foi maior do que em T45. Em cães com alta PIC, a função cardiopulmonar não foi influenciada pelas diferentes FiO2 empregadas.Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES

Diferentes frações inspiradas de oxigênio em coelhos hipovolêmicos anestesiados com propofol e submetidos à ventilação mecânica

Avaliaram-se os efeitos do fornecimento de diferentes frações inspiradas de oxigênio (FiO²) em coelhos hipovolêmicos, anestesiados com infusão contínua de propofol e mantidos em ventilação controlada sobre os parâmetros respiratórios, hemogasométricos e hemodinâmicos. Foram utilizados 50 coelhos (Nova Zelândia), pesando 3,5±0,3kg, distribuídos em 5 grupos: G100 (FiO²=1), G80 (FiO²=0,8), G60 (FiO²=0,6), G40 (FiO²=0,4) e G21 (FiO²=0,21), os quais receberam xilazina (1mg kg-1) e cetamina (15mg kg-1) pela via intramuscular. Transcorridos 20 minutos, foi administrado propofol (8mg kg-1 bolus e 0,5mg kg-1 min-1) e rocurônio (0,6mg kg-1 bolus e 0,6mg kg-1 h-1). Iniciou-se então, a ventilação mecânica no modo pressão controlada. Após 30 minutos, os animais foram submetidos à hipovolemia aguda, retirando-se sangue arterial (12mL kg-1). Os parâmetros foram mensurados 30 minutos após a indução anestésica (M0) e a cada dez minutos depois da exsanguinação (M1- M7). As variáveis foram submetidas à análise de variância seguida pelo teste de Tukey (P<0,05). Os valores de PaO², SaO², P A O², AaDO² diminuíram quanto mais baixas foram as FiO². Após a indução da hipovolemia, as variáveis DC, PAM, PaO², SaO², Vt, AaDO² diminuíram significativamente. Nenhuma alteração foi notada nos parâmetros FC e PaCO². As FiO² de 0,8 e 1,0 mostraram-se as mais indicadas por manter melhor estabilidade ventilatória e adequada troca gasosa.The effects of several inspired oxygen fractions (FiO²) on the blood gases, respiratory and hemodynamic parameters in mechanical ventilation hypovolemic rabbits anesthetized with continuous infusion of propofol were evaluated. A total of 50 rabbits (New Zealand), weighing 3.5±0.3kg, were divided into five groups: G100 (FiO²=1), G80 (FiO²=0.8), G60 (FiO²=0.6), G40 (FiO²=0.4) and G21 (FiO²=0.21), which received xylazine (1mg kg-1) and ketamine (15mg kg-1) intramuscularly. Exactly after 20 minutes, it was administered propofol (8mg kg-1 bolus and 0.5mg kg-1 min-1) and rocuronium (0.6mg kg-1 bolus and 0.6mg kg-1 h-1. Then, the mechanical ventilation by controlled pressure mode began. After 30 minutes, the animals underwent acute hypovolemia, withdrawing arterial blood (12mL kg-1). The parameters were measured 30 minutes after anesthetic induction (M0) and every ten minutes after exsanguination (M1-M7). The variables were subjected to analysis of variance followed by Tukey test (P<0.05). The values of PaO², SaO², PAO², AaDO² decreased as lower were the FiO². After the induction of hypovolemia, the variables CO, MAP, PaO², SaO², Vt, AaDO² decreased significantly. No change was noted in the parameters HR and PaCO². The FiO² of 0.8 and 1.0 proved to be the most suitable for maintaining stability, better ventilation and adequate gas exchange.Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP

The effects of 2 levels of the inspired oxygen fraction on blood gas variables in propofol-anesthetized dogs with high intracranial pressure

The influence of 2 different levels of the inspired oxygen fraction (FiO2) on blood gas variables was evaluated in dogs with high intracranial pressure (ICP) during propofol anesthesia (induction followed by a continuous rate infusion [CRI] of 0.6 mg/kg/min) and intermittent positive pressure ventilation (IPPV). Eight adult mongrel dogs were anesthetized on 2 occasions, 21 d apart, and received oxygen at an FiO2 of 1.0 (G100) or 0.6 (G60) in a randomized crossover fashion. A fiberoptic catheter was implanted on the surface of the right cerebral cortex for assessment of the ICP. An increase in the ICP was induced by temporary ligation of the jugular vein 50 min after induction of anesthesia and immediately after baseline measurement of the ICP. Blood gas measurements were taken 20 min later and then at 15-min intervals for 1 h. Numerical data were submitted to Morrison’s multivariate statistical methods. The ICP, the cerebral perfusion pressure and the mean arterial pressure did not differ significantly between FiO2 levels or measurement times after jugular ligation. The only blood gas values that differed significantly (P < 0.05) were the arterial oxygen partial pressure, which was greater with G100 than with G60 throughout the procedure, and the venous haemoglobin saturation, that was greater with G100 than with G60 at M0. There were no significant differences between FiO2 levels or measurement times in the following blood gas variables: arterial carbon dioxide partial pressure, arterial hemoglobin saturation, base deficit, bicarbonate concentration, pH, venous oxygen partial pressure, venous carbon dioxide partial pressure and the arterial-to-end-tidal carbon dioxide difference

Hemodinâmica de diferentes frações inspiradas de oxigênio em cães submetidos à infusão contínua de propofol sob ventilação espontânea

Avaliaram-se os efeitos do fornecimento de diferentes frações inspiradas de oxigênio (FiO2) sobre os parâmetros hemodinâmicos em cães submetidos à infusão contínua de propofol e mantidos em ventilação espontânea. Foram utilizados oito cães, os quais foram empregados em cinco grupos com diferentes FiO2, G100 (FiO2 = 1), G80 (FiO2 = 0,8), G60 (FiO2 = 0,6), G40 (FiO2 = 0,4) e G20 (FiO2 = 0,21), respeitando-se um intervalo de dez dias entre cada procedimento anestésico. Os animais foram induzidos e mantidos sob anestesia com propofol na dose de 0,7mg kg-1 min-1 e, após a intubação orotraqueal, iniciou-se o fornecimento de oxigênio conforme a FiO2 determinada para cada grupo. As primeiras mensurações, da freqüência cardíaca (FC), das pressões arteriais sistólica, diastólica e média (PAS, PAD e PAM), da resistência vascular periférica e pulmonar (RPT e RPV), do débito cardíaco (DC); da pressão venosa central (PVC), da pressão média da artéria pulmonar (PMAP), da pressão média capilar pulmonar (PMCP), da pressão parcial de oxigênio (PaO2) e do dióxido de carbono (PaCO2) no sangue arterial, foram efetuadas 30 minutos após o início da infusão do anestésico (M0), seguidas de intervalos de 15 minutos (M15, M30, M45 e M60). Os dados numéricos obtidos foram submetidos à Análise de Variância, seguida pelo teste Tukey (P<0,05). Os parâmetros hemodinâmicos não apresentaram diferenças significativas ao longo do tempo e entre os grupos. Os resultados obtidos permitiram concluir que as variáveis hemodinâmicas não são afetadas pelo emprego de diferentes FiO2.The effects of several inspired oxygen fractions (FiO2) in hemodynamics parameters in spontaneously breathing dogs submitted to continuous infusion of propofol were evaluated. Eight adult mongrel dogs were studied and the animals underwent five anesthesias. In each procedure the patient was submitted to a different FiO2, thereby resulting in five groups, namely: G100 (FiO2 = 1), G80 (FiO2 = 0.8), G60 (FiO2 =0.6), G40 (FiO2 = 0.4), and G20 (FiO2 = 0.21). The dose of propofol was sufficient to abolish protector reflex and ensure endotracheal intubation, followed by immediate continuous infusion of that drug (0.7mg kg-1 min-1). The initial measurement (M0) of heart rate (HR); systolic (SAP), diastolic (DAP) and mean pressure (MAP), systemic (SVR) and pulmoary vascular resistance (PVR), cardiac output (CO); central venous pressures (CVP); mean pulmonary pressure (MPAP); pulmonary capillary wedge pressure (PCWP), arterial partial pressure of oxygen (PaO2) and carbon dioxide (PaCO2) were recorded thirty minutes after the beginning of propofol infusion. Additional recordings were performed at each 15-minute interval during 60 minutes (M15, M30, M45, and M60). Numeric data were submitted to Analysis of Variance followed by Tukey Test (P<0.05). Significant values of hemodynamic parameters were not recorded neither during the experiment period nor among the groups. In conclusion, different FiO2 does not impair hemodynamic parameters.Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq