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1,239 results on '"Cancio, Leopoldo C."'

153. Adjunct Use of Continuous Renal Replacement Therapy with Extracorporeal Membrane Oxygenation Achieves Negative Fluid Balance and Enhances Oxygenation Which Improves Survival in Critically Ill Patients without Kidney Failure.

Author

Thomas, Jason M., Dado, David N., Basel, Anthony P., Aden, James K., Thomas, Sarah B., Piper, Lydia, Britton, Garrett W., Cancio, Leopoldo C., Batchinsky, Andriy, Mason, Phillip E., Walter, Robert J., Sobieszczyk, Michal J., Biscotti, Mauer, Lee, T. Jake, Read, Matthew D., and Sams, Valerie G.

Subjects
EXTRACORPOREAL membrane oxygenation, RENAL replacement therapy, WATER-electrolyte balance (Physiology), KIDNEY failure, CRITICALLY ill
Abstract

Introduction: Fluid overload in extracorporeal membrane oxygenation (ECMO) patients has been associated with increased mortality. Patients receiving ECMO and continuous renal replacement therapy (CRRT) who achieve a negative fluid balance have improved survival. Limited data exist on the use of CRRT solely for fluid management in ECMO patients. Methods: We performed a single-center retrospective review of 19 adult ECMO patients without significant renal dysfunction who received CRRT for fluid management. These patients were compared to a cohort of propensity-matched controls. Results: After 72 h, the treatment group had a fluid balance of −3840 mL versus + 425 mL (p ≤ 0.05). This lower fluid balance correlated with survival to discharge (odds ratio 2.54, 95% confidence interval 1.10–5.87). Improvement in the ratio of arterial oxygen content to fraction of inspired oxygen was also significantly higher in the CRRT group (102.4 vs. 0.7, p ≤ 0.05). We did not observe any significant difference in renal outcomes. Conclusions: The use of CRRT for fluid management is effective and, when resulting in negative fluid balance, improves survival in adult ECMO patients without significant renal dysfunction. [ABSTRACT FROM AUTHOR]

Published
2022
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162. Evaluation of the use of sitagliptin for insulin resistance in burn patients

Author

Pruskowski, Kaitlin A, Shields, Beth A, Ainsworth, Craig R, and Cancio, Leopoldo C

Subjects
Original Article
Abstract

Background: Following severe burn injury, patients undergo profound metabolic changes, including insulin resistance and hyperglycemia. Hyperglycemia has been linked to impaired wound healing, increased risk of skin graft loss, increased muscle catabolism, increased infections, and mortality. Sitagliptin is a dipeptidyl peptidase-4 (DPP-4) inhibitor that improves glycemic control by slowing the inactivation of incretin hormones, increasing insulin synthesis and release from pancreatic beta cells and lowering glucagon secretion from pancreatic alpha cells. The objective of this study was to describe our institution’s experience with using sitagliptin to help mitigate insulin resistance after burn injury. Methods: This was a retrospective chart review that included 22 adult burn patients. Burn patients were prescribed sitagliptin regardless of their previous medical history of type 2 diabetes mellitus. Patients were included in this analysis if they were adults admitted for burn injury during a 13-month period and received at least 3 consecutive doses of sitagliptin. Patients were excluded if they did not have insulin use data 3 days pre- and 3 days post-sitagliptin initiation. The first day of sitagliptin initiation was considered day 0; data from day 0 were not included in either the pre- or post-sitagliptin analysis. Results: In the 3 days prior to sitagliptin initiation, patients received a median of 114.3 units per day (IQR 49.1, 228) in an attempt to maintain a blood glucose goal of less than 180 mg/dL. In the 3 days after sitagliptin was started, exogenous insulin requirements significantly decreased to a median to 36.3 units per day (IQR 11.7, 95) (P=0.009). Seven patients were on insulin infusions at the time of sitagliptin initiation. After sitagliptin was started, it took a median of 3 days (IQR 2, 3.25) to be liberated from the insulin infusion. In terms of safety, there were two episodes of hypoglycemia (BG

Published
2020

168. Between the devil and the deep blue sea: A review of 25 modern naval mass casualty incidents with implications for future Distributed Maritime Operations

Author

Tadlock, Matthew D., primary, Gurney, Jennifer, additional, Tripp, Michael S., additional, Cancio, Leopoldo C., additional, Sise, Michael J., additional, Bandle, Jesse, additional, Cubano, Miguel, additional, Lee, Joseph, additional, Vasquez, Matthew, additional, and Acosta, José A., additional

Published
2021
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171. Regional blood acidification inhibits coagulation during extracorporeal carbon dioxide removal (ECCO2R).

Author

Prat, Nicolas J., Meyer, Andrew D., Scaravilli, Vittorio, Cannon, Jeremy, Cancio, Leopoldo C., Cap, Andrew P., and Batchinsky, Andriy I.

Subjects
BLOOD coagulation, CARBON dioxide, BLOOD coagulation factors, PLATELET count, BLOOD gases, ACIDIFICATION, BLOOD platelet aggregation, VON Willebrand factor
Abstract

Background: Consumption of platelets and coagulation factors during extracorporeal carbon dioxide removal (ECCO2R) increases bleeding complications and associated mortality. Regional infusion of lactic acid enhances ECCO2R by shifting the chemical equilibrium from bicarbonate to carbon dioxide. Our goal was to test if regional blood acidification during ECCO2R inhibits platelet function and coagulation. Methods: An ECCO2R system containing a hemofilter circulated blood at 0.25 L/min in eight healthy ewes (Ovis aries) for 36 h. Three of the sheep received ECCO2R with no recirculation compared to five sheep that received ECCO2R plus 12 h of regional blood acidification via the hemofilter, placed upstream from the oxygenator, into which 4.4 M lactic acid was infused. Blood gases, platelet count and function, thromboelastography, coagulation‐factor activity, and von Willebrand factor activity (vWF:Ag) were measured at baseline, at start of lactic acid infusion, and after 36 h of extracorporeal circulation. Results: Twelve hours of regional acid infusion significantly inhibited platelet aggregation response to adenosine diphosphate; vWF; and platelet expression of P‐selectin compared to control. It also significantly reduced consumption of fibrinogen and of coagulation factors V, VII, IX, compared to control. Conclusions: Regional acidification reduces platelet activation and vitamin‐K‐dependent coagulation‐factor consumption during ECCO2R. This is the first report of a simple method that may enhance effective anticoagulation for ECCO2R. [ABSTRACT FROM AUTHOR]

Published
2022
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172. Dynamics of appearance and decay of gaseous microemboli during in vitro extracorporeal circulation.

Author

Harea, George T, Karaliou, Vitali, Roberts, Teryn R, Choi, Jae-Hyek, Beely, Brendan M, Cancio, Leopoldo C, and Batchinsky, Andriy I

Subjects
ARTIFICIAL blood circulation, CEREBRAL embolism & thrombosis, BIOMARKERS, IN vitro studies, CARDIAC surgery, GASES, COMPARATIVE studies, PRE-tests & post-tests, DESCRIPTIVE statistics, GLYCERIN, DATA analysis software
Abstract

Introduction: Extracorporeal life support (ECLS) patients are at risk for complications caused by gaseous microemboli (GME). GMEs can cause hypoxia, inflammation, coagulation, and end-organ damage. The objective of this in vitro study was to assess dynamics of GME formation during circulation of whole blood or a glycerol blood surrogate. We hypothesized that there is no difference in GME counts and sizes between whole blood and the glycerol blood surrogate and that the membrane lung reduces GME counts over time. Methods: A circulation platform was developed using the Cardiohelp ECLS system to run either donor blood or glycerol solution. We conducted 10 repetitions consisting of three phases of ultrasound GME detection using the EDAC™ Quantifier (Luna Innovations, Charlottesville, VA, USA) for each group. Phases were 3-minute recordings at the initiation of 2 L/min flow (Phase 1), post-injection of a GME suspension (Phase 2), and 10 minutes after injection (Phase 3). The number and size of GME pre- and post-ML were recorded separately and binned based on diameter ranges. Results: In Phase 1, GME count in blood was higher than in glycerol. In Phase 2, there was a large increase in GME counts; however, most GME were reduced post-membrane in both groups. In Phase 3, there was a significant decrease in GME counts compared to Phase 2. GME > 100 μm in glycerol decreased post membrane. Conclusions: We demonstrated GME formation and decay dynamics during in vitro circulation in an ECLS system with blood and glycerol. GME counts were higher in blood, likely due to varying rheological properties. There were decreases in GME levels post membrane in both groups after GME injection, with the membrane lung effectively trapping the GME, and additional reduction 10 minutes after GME injection. [ABSTRACT FROM AUTHOR]

Published
2022
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180. Distal organ inflammation and injury after resuscitative endovascular balloon occlusion of the aorta in a porcine model of severe hemorrhagic shock

Author

Li, Yansong, primary, Dubick, Michael A., additional, Yang, Zhangsheng, additional, Barr, Johnny L., additional, Gremmer, Brandon J., additional, Lucas, Michael L., additional, Necsoiu, Corina, additional, Jordan, Bryan S., additional, Batchinsky, Andriy I., additional, and Cancio, Leopoldo C., additional

Published
2020
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181. Assessment of spontaneous breathing during pressure controlled ventilation with superimposed spontaneous breathing using respiratory flow signal analysis

Author

Kreyer, Stefan, primary, Baker, William L., additional, Scaravilli, Vittorio, additional, Linden, Katharina, additional, Belenkiy, Slava M., additional, Necsoiu, Corina, additional, Muders, Thomas, additional, Putensen, Christian, additional, Chung, Kevin K., additional, Cancio, Leopoldo C., additional, and Batchinsky, Andriy I., additional

Published
2020
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195. T5 Preliminary Analysis of a Phase 3 Open-label, Controlled, Randomized Trial Evaluating the Efficacy and Safety of a Bioengineered Regenerative Skin Construct in Patients with Deep Partial-thickness Thermal Burns

Author

Holmes, James H, primary, Shupp, Jeffrey W, primary, Smith, David J, primary, Joe, Victor C, primary, Carson, Joshua S, primary, Litt, Jeffrey, primary, Kahn, Steven, primary, Short, Tracee, primary, Cancio, Leopoldo C, primary, Rizzo, Julie A, primary, Carter, Jeffrey E, primary, Foster, Kevin N, primary, and Gibson, Angela, primary

Published
2020
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