9 research outputs found
Nitroglycerin can facilitate weaning of difficult-to-wean chronic obstructive pulmonary disease patients: a prospective interventional non-randomized study
Combined Endovascular/Surgical Management of a Ruptured Para-Anastomotic Aneurysm of the Left Common Iliac Artery#
A 75-year old man presented with signs and symptoms of acute abdomen and a clinical picture of hypovolemic shock. An emergency CT scan revealed a ruptured para-anastomotic left common iliac artery aneurysm. The patient had undergone an elective abdominal aortic aneurysm repair operation and placement of an aortoiliac bifurcated graft 10 years before. Para-anastomotic aneurysms had developed in all 3 (aortic and the 2 iliac) anastomosis. As the patient was highrisk, a combined endovascular/surgical approach was undertaken. The patient was discharged 4 days later
Effects of acute and chronic cadmium administration on the vascular reactivity of rat aorta
The effect of acute and chronic cadmium (Cd) administration on the vascular function of the rat aorta was studied. The rats were randomly divided into four main groups (A: saline controls under chronic administration, B: Cd-treated rats under chronic administration, C: saline controls under acute administration, D: Cd-treated rats under acute administration). After their sacrifice, the aortic rings were divided into rings with endothelium (E+) and without (E-), and suspended in an isolated organ bath with Krebs - Henseleit buffer. Maximal tension (T max, in g) was measured in response to potassium chloride (KCl) and phenylephrine (PE) in all aortic rings. Relaxation response to acetylcholine (ACh) administration was expressed as percent of maximal tension induced by PE. Chronic administration: A statistically significant increase of the contraction was observed between groups B (i.m. Cd 0.5 mg/kg for 120 days) and A (i.m. 0.9% NaCl for 120 days) in response to KCl (20-60 mM) and the T max as well (in both the E+ and the E- subgroups). No statistically significant difference was observed in response to PE and ACh exposure. Acute administration: A statistically significant increase was observed between group D(E+) (i.m. Cd 2 mg/kg, 8 h before sacrifice) and group C(E+) (i.m. 0.9% NaCl, 8 h before sacrifice) in response to 10-30 mM of KCl, and a significant decrease between D(E-) and C(E-) in response to 10(-7)-10(-6) M of PE, though T (max) was increased between D(E-) and C(E-) with PE exposure. The contractile response levels of the E+ aortic rings to PE and ACh showed no statistically significant difference
Nitroglycerin can facilitate weaning of difficult-to-wean chronic obstructive pulmonary disease patients: a prospective interventional non-randomized study
Introduction: Both experimental and clinical data give convincing
evidence to acute cardiac dysfunction as the origin or a cofactor of
weaning failure in patients with chronic obstructive pulmonary disease.
Therefore, treatment targeting the cardiovascular system might help the
heart to tolerate more effectively the critical period of weaning. This
study aims to assess the hemodynamic, respiratory and clinical effects
of nitroglycerin infusion in difficult-to-wean patients with severe
chronic obstructive pulmonary disease.
Methods: Twelve difficult-to-wean (failed >= 3 consecutive trials)
chronic obstructive pulmonary disease patients, who presented systemic
arterial hypertension (systolic blood pressure >= 140mmHg) during
weaning failure and had systemic and pulmonary artery catheters in
place, participated in this prospective, interventional, non-randomized
clinical trial. Patients were studied in two consecutive days, i.e., the
first day without (Control day) and the second day with (Study day)
nitroglycerin continuous intravenous infusion starting at the beginning
of the spontaneous breathing trial, and titrated to maintain normal
systolic blood pressure. Hemodynamic, oxygenation and respiratory
measurements were performed on mechanical ventilation, and during a
2-hour T-piece spontaneous breathing trial. Primary endpoint was
hemodynamic and respiratory effects of nitroglycerin infusion. Secondary
endpoint was spontaneous breathing trial and extubation outcome.
Results: Compared to mechanical ventilation, mean systemic arterial
pressure, rate-pressure product, mean pulmonary arterial pressure, and
pulmonary artery occlusion pressure increased [from (mean +/- SD) 94
+/- 14, 13708 +/- 3166, 29.9 +/- 4.8, and 14.8 +/- 3.8 to 109 +/-
20mmHg, 19856 +/- 4877mmHg b/min, 41.6 +/- 5.8mmHg, and 23.4 +/- 7.4
mmHg, respectively], and mixed venous oxygen saturation decreased (from
75.7 +/- 3.5 to 69.3 +/- 7.5%) during failing trials on Control day,
whereas they did not change on Study day. Venous admixture increased
throughout the trial on both Control day and Study day, but this
increase was lower on Study day. Whereas weaning failed in all patients
on Control day, nitroglycerin administration on Study day enabled a
successful spontaneous breathing trial and extubation in 92% and 88%
of patients, respectively.
Conclusions: In this clinical setting, nitroglycerin infusion can
expedite the weaning by restoring weaning-induced cardiovascular
compromise