Cardiogenic shock following administration of propofol and fentanyl in a healthy woman: a case report

<p>Abstract</p> <p>Introduction</p> <p>Cardiogenic shock is very uncommon in healthy people. The differential diagnosis for patients with acute heart failure in previously healthy hearts includes acute myocardial infarction and myocarditis. However, many drugs can also depress myocardial function. Propofol and fentanyl are frequently used during different medical procedures. The cardiovascular depressive effect of both drugs has been well established, but the development of cardiogenic shock is very rare when these agents are used.</p> <p>Case presentation</p> <p>After a minor surgical intervention, a 32-year-old Caucasian woman with no significant medical history went into sudden hemodynamic deterioration due to acute heart failure. An urgent echocardiogram showed severe biventricular dysfunction and an estimated left ventricular ejection fraction of 20%. Extracorporeal life support and mechanical ventilation were required. Five days later her ventricular function had fully recovered, which allowed the progressive withdrawal of medical treatment. Prior to her hospital discharge, cardiac MRI showed neither edema nor pathological deposits on the delayed contrast enhancement sequences. At her six-month follow-up examination, the patient was asymptomatic and did not require treatment.</p> <p>Conclusion</p> <p>Although there are many causes of cardiogenic shock, the presence of abrupt hemodynamic deterioration and the absence of a clear cause could be related to the use of propofol and fentanyl.</p

Linking marine phytoplankton emissions, meteorological processes, and downwind particle properties with FLEXPART

Marine biogenic particle contributions to atmospheric aerosol concentrations are not well understood though they are important for determining cloud optical and cloud-nucleating properties. Here we examine the relationship between marine aerosol measurements (with satellites and model fields of ocean biology) and meteorological variables during the North Atlantic Aerosols and Marine Ecosystems Study (NAAMES). NAAMES consisted of four field campaigns between November 2015 and April 2018 that aligned with the four major phases of the annual phytoplankton bloom cycle. The FLEXible PARTicle (FLEX-PART) Lagrangian particle dispersion model is used to spatiotemporally connect these variables to ship-based aerosol and dimethyl sulfide (DMS) observations. We find that correlations between some aerosol measurements with satellite-measured and modeled variables increase with increasing trajectory length, indicating that biological and meteorological processes over the air mass history are influential for measured particle properties and that using only spatially coincident data would miss correlative connections that are lagged in time. In particular, the marine non-refractory organic aerosol mass correlates with modeled marine net primary production when weighted by 5 d air mass trajectory residence time (r = 0.62). This result indicates that non-refractory organic aerosol mass is influenced by biogenic volatile organic compound (VOC) emissions that are typically produced through bacterial degradation of dissolved organic matter, zooplankton grazing on marine phytoplankton, and as a by-product of photosynthesis by phytoplankton stocks during advection into the region. This is further supported by the correlation of non-refractory organic mass with 2 d residence-time-weighted chlorophyll a (r = 0.39), a proxy for phytoplankton abundance, and 5 d residence-time-weighted downward shortwave forcing (r = 0.58), a requirement for photosynthesis. In contrast, DMS (formed through biological processes in the seawater) and primary marine aerosol (PMA) concentrations showed better correlations with explanatory biological and meteorological variables weighted with shorter air mass residence times, which reflects their localized origin as primary emissions. Aerosol submicron number and mass negatively correlate with sea surface wind speed. The negative correlation is attributed to enhanced PMA concentrations under higher wind speed conditions. We hypothesized that the elevated total particle surface area associated with high PMA concentrations leads to enhanced rates of condensation of VOC oxidation products onto PMA. Given the high deposition velocity of PMA relative to submicron aerosol, PMA can limit the accumulation of secondary aerosol mass. This study provides observational evidence for connections between marine aerosols and underlying ocean biology through complex secondary formation processes, emphasizing the need to consider air mass history in future analyses

North Atlantic Ocean SST-gradient-driven variations in aerosol and cloud evolution along Lagrangian cold-air outbreak trajectories

Atmospheric marine particle concentrations impact cloud properties, which strongly impact the amount of solar radiation reflected back into space or absorbed by the ocean surface. While satellites can provide a snapshot of current conditions at the overpass time, models are necessary to simulate temporal variations in both particle and cloud properties. However, poor model accuracy limits the reliability with which these tools can be used to predict future climate. Here, we leverage the comprehensive ocean ecosystem and atmospheric aerosol– cloud dataset obtained during the third deployment of the North Atlantic Aerosols and Marine Ecosystems Study (NAAMES3). Airborne and ship-based measurements were collected in and around a cold-air outbreak during a 3 d (where d stands for day) intensive operations period from 17–19 September 2017. Cold-air outbreaks are of keen interest for model validation because they are challenging to accurately simulate, which is due, in part, to the numerous feedbacks and sub-grid-scale processes that influence aerosol and cloud evolution. The NAAMES observations are particularly valuable because the flight plans were tailored to lie along Lagrangian trajectories, making it possible to spatiotemporally connect upwind and downwind measurements with the state-of-the-art FLEXible PARTicle (FLEXPART) Lagrangian particle dispersion model and then calculate a rate of change in particle properties. Initial aerosol conditions spanning an east–west, closed-cell-to-clear-air transition region of the cold-air outbreak indicate similar particle concentrations and properties. However, despite the similarities in the aerosol fields, the cloud properties downwind of each region evolved quite differently. One trajectory carried particles through a cold-air outbreak, resulting in a decrease in accumulation mode particle concentra�tion (−42 %) and cloud droplet concentrations, while the other remained outside of the cold-air outbreak and experienced an increase in accumulation mode particle concentrations (+62 %). The variable meteorological conditions between these two adjacent trajectories result from differences in the local sea surface temperature in the Labrador Current and surrounding waters, altering the stability of the marine atmospheric boundary layer. Further comparisons of historical satellite observations indicate that the observed pattern occurs annually in the region, making it an ideal location for future airborne Lagrangian studies tracking the evolution of aerosols and clouds over time under cold-air outbreak condition