Search

© 2014 by the Journal of Biomedical Research. All rights reserved. Hemodynamic monitoring and optimization improve postoperative outcome during high-risk surgery. However, hemodynamic management practices among Chinese anesthesiologists are largely unknown. This study sought to evaluate the current intraoperative hemodynamic management practices for high-risk surgery patients in China. From September 2010 to November 2011, we surveyed anesthesiologists working in the operating rooms of 265 hospitals representing 28 Chinese provinces. All questionnaires were distributed to department chairs of anesthesiology or practicing anesthesiologists. Once completed, the 29-item questionnaires were collected and analyzed. Two hundred and 10 questionnaires from 265 hospitals in China were collected. We found that 91.4% of anesthesiologists monitored invasive arterial pressure, 82.9% monitored central venous pressure (CVP), 13.3% monitored cardiac output (CO), 10.5% monitored mixed venous saturation, and less than 2% monitored pulse pressure variation (PPV) or systolic pressure variation (SPV) during high-risk surgery. The majority (88%) of anesthesiologists relied on clinical experience as an indicator for volume expansion and more than 80% relied on blood pressure, CVP and urine output. Anesthesiologists in China do not own enough attention on hemodynamic parameters such as PPV, SPV and CO during fluid management in high-risk surgical patients. The lack of CO monitoring may be attributed largely to the limited access to technologies, the cost of the devices and the lack of education on how to use them. There is a need for improving access to these technologies as well as an opportunity to create guidelines and education for hemodynamic optimization in China.

Patients in the intensive care unit (ICU) and in the peri-operative phase are dependent on physicians and nurses for their fluid intake. Volume status optimization is required to maximize oxygen delivery to vital organs. Unnecessary fluid administration can, however, lead to general and pulmonary oedema, cardiac failure, infections, prolonged hospitalization and death. Besides signs like skin turgor, diuresis and skin colour, hemodynamic measurements like central venous pressure (CVP) and mean arterial pressure (MAP) are most often used for hemodynamic management. These parameters, however, often fail to accurately predict the response of a patient to fluid loading. Cardiac output (CO) is the amount of blood pumped through the circulation by the heart per minute. The general conception is that an increase in cardiac output will improve perfusion of vital organs. Increased flow might also imply improved oxygen delivery to the tissues. This is the basis of the fluid loading responsiveness strategy (FLR). This strategy aims to prevent fluid overloading by an accurate prediction of the response in cardiac output to fluid loading. Arthur Guyton__s work provided an important step forward to the determination of volume status directly. Together with the shape of cardiac output function curve, dimensions of the vascular system, blood viscosity and mean systemic filling pressure (MSFP) can be considered as a primary determinant of venous return and thus cardiac output. Ultimately, MSFP can be used to calculate stressed volume and, hence, quantify effective volume status in a specific patient. In this thesis, we review literature on fluid loading responsiveness research, we try to assess the impact of literature on hemodynamic management in Dutch ICU__s, we discuss a novel method to assess mean systemic filling pressure and last we discuss studies performed to assess the reliability of several challenges to predict FLR; +10 cmH2O PEEP, the fluid challenge, passive leg raising, the respiratory ventilator manoeuvre and the measurement of baseline MSFP. The manoeuvres are aimed at determining the working point of the circulation on the Frank- Starling curve. It is assumed that when the patient is on the ascending portion of the Frank- Starling curve an (auto)transfusion will increase cardiac output.

Background The development in the last decade of noninvasive, near infrared spectroscopy (NIRS) analysis of tissue hemoglobin saturation in vivo has provided a new and dramatic tool for the management of hemodynamics, allowing early detection and correction of imbalances in oxygen delivery to the brain and vital organs. Description The theory and validation of NIRS and its clinical use are reviewed. Studies are cited documenting tissue penetration and response to various physiologic and pharmacologic mechanisms resulting in changes in oxygen delivery and blood flow to the organs and brain as reflected in the regional hemoglobin oxygen saturation (rSO(2)). The accuracy of rSO(2) readings and the clinical use of NIRS in cardiac surgery and intensive care in adults, children and infants are discussed. Conclusions Clinical studies have demonstrated that NIRS can improve outcome and enhance patient management, avoiding postoperative morbidities and potentially preventing catastrophic outcomes.

Introduction: The mortality of acute renal failure (ARF) is 50-80% in critically ill patients and has not fallen significantly despite numerous advances in critical care strategies and renal replacement technologies over several decades. (1) A major problem with conducting research into acute renal failure (ARF) is the lack of a consensus definition (2). More than 30 different definitions of ARF have been used in the literature. This lack of a common reference point created confusion and made comparisons difficult. The Acute Dialysis Initiative (ADQI) group of experts developed and published a consensus definition of ARF. This definition goes under the acronym of RIFLE. This definition classified the patients with renal dysfunction according to the degree of impairment into patient at risk (R), with injury (I), with failure (F), with sustained loss (L) and with end stage (E) status in relation to their renal function. (2) Rifle criteria were based on changes in the patients’ glomerular filtration rate (GFR) and/or their urine output. (2) Discussion: The prophylactic and therapeutic use of dopamine, the more studied vasoactive drug, actually has not been supported. For all other vasoactive drugs, at this moment, data available are contradictory and few conclusions can be made. To protect renal function, despite wide use of vasoactive drugs, only the maintenance of adequate volume replacement and perfusion pressure may be certainly recommended. Conclusion: The use of vasoactive drugs is a pervasive practice in intensive care units, and hence, this area needs suitably powered, multi-center, randomized, placebo-controlled, double-blind studies to provide more rational indications for clinical practice.

BACKGROUND: Traumatic brain injury is still an important health problem worldwide. Traumatic brain injury not only causes direct mechanical damage to the brain but also induces biochemical changes that lead to secondary nerve cell loss. In this study, we investigated the neuroprotective effect of milrinone after traumatic brain injury (TBI) in a rat model. METHODS: Forty male Wistar albino rats, were used. Rats were divided into 4 groups: 1) sham, 2) TBI, 3) TBI + Ringers, and 4) TBI + Milrinone. In group 1 (sham), only craniotomy was performed. In group 2 (TBI), TBI was performed after craniotomy. In group 3 (TBI + Ringer), TBI was performed after craniotomy and intraperitoneal Ringers solution was given immediately afterward. Group 4 (TBI + Milrinone), TBI was performed after craniotomy, and milrinone was given 1.0 mg/kg milrinone intraperito-neally directly (0.5 mg/kg milrinone intraperitoneally again 24 hours, 48 hours, and 72 hours after trauma). Tests were performed for neurological and neurobehavioral functions. Immunohistochemistry and histopathology studies were performed. RESULTS: In group 4 compared with group 2 and group 3 groups, tests for neurological functions and neuro-behavioral functions were significantly better. In the mil-rinone treatment used in group 4, plasma and brain tissue tumor necrosis factor, 8-OH 2-deoxyguanosine , and inter-leukin 6 levels were significantly decreased, and increased plasma and tissue IL-10 levels were detected. Histopathological spinal cord injury and apoptotic index increased in groups 2 and 3, while significantly decreasing in group 4. CONCLUSIONS: This study shows for the first time that the anti-inflammatory, antioxidant and antiapoptotic prop-erties of milrinone may be neuroprotective after TBI.