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1. Open-lung ventilation versus no ventilation during cardiopulmonary bypass in an innovative animal model of heart transplantation

Author

Varun Karnik, Sebastiano Maria Colombo, Leah Rickards, Silver Heinsar, Louise E. See Hoe, Karin Wildi, Margaret R. Passmore, Mahe Bouquet, Kei Sato, Carmen Ainola, Nicole Bartnikowski, Emily S. Wilson, Kieran Hyslop, Kris Skeggs, Nchafatso G. Obonyo, Charles McDonald, Samantha Livingstone, Gabriella Abbate, Andrew Haymet, Jae-Seung Jung, Noriko Sato, Lynnette James, Benjamin Lloyd, Nicole White, Chiara Palmieri, Mark Buckland, Jacky Y. Suen, David C. McGiffin, John F. Fraser, and Gianluigi Li Bassi

Subjects
Ventilation, Cardiopulmonary bypass, Heart transplant, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract

Abstract Open-lung ventilation during cardiopulmonary bypass (CPB) in patients undergoing heart transplantation (HTx) is a potential strategy to mitigate postoperative acute respiratory distress syndrome (ARDS). We utilized an ovine HTx model to investigate whether open-lung ventilation during CPB reduces postoperative lung damage and complications. Eighteen sheep from an ovine HTx model were included, with ventilatory interventions randomly assigned during CPB: the OPENVENT group received low tidal volume (VT) of 3 mL/kg and positive end-expiratory pressure (PEEP) of 8 cm H20, while no ventilation was provided in the NOVENT group as per standard of care. The recipient sheep were monitored for 6 h post-surgery. The primary outcome was histological lung damage, scored at the end of the study. Secondary outcomes included pulmonary shunt, driving pressure, hemodynamics and inflammatory lung infiltration. All animals completed the study. The OPENVENT group showed significantly lower histological lung damage versus the NOVENT group (0.22 vs 0.27, p = 0.042) and lower pulmonary shunt (19.2 vs 32.1%, p = 0.001). In addition, the OPENVENT group exhibited a reduced driving pressure (9.6 cm H2O vs. 12.8 cm H2O, p = 0.039), lower neutrophil (5.25% vs 7.97%, p ≤ 0.001) and macrophage infiltrations (11.1% vs 19.6%, p

Published
2024
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2. Arm and finger measurements in the third trimester: Implications for blood pressure measurement

Author

Leonie Roberts, Victoria Eley, Helen L. Barrett, Chu Zhang, Leah Rickards, Anita Pelecanos, Rebecca Christensen, and Annika Blackie

Subjects
Adult, Gestational hypertension, medicine.medical_specialty, Pregnancy Trimester, Third, Population, Blood Pressure, Pilot Projects, 030204 cardiovascular system & hematology, Thigh, Body Mass Index, Fingers, 03 medical and health sciences, 0302 clinical medicine, Pre-Eclampsia, Forearm, Pregnancy, Prenatal Diagnosis, Internal Medicine, medicine, Humans, Prospective Studies, 030212 general & internal medicine, education, education.field_of_study, Anthropometry, business.industry, Obstetrics and Gynecology, Blood Pressure Determination, medicine.disease, Circumference, Surgery, medicine.anatomical_structure, Blood pressure, Cuff, Arm, Female, business, Body mass index
Abstract

Objectives To obtain arm and finger measurements of women ≥32 weeks gestation to determine: the requirement for different arm cuff sizes; the suitability of available finger cuffs in this population; the best predictor of arm conicity; the frequency of cuff placement on the forearm or leg. Study design Prospective observational pilot study. Main outcome measures Right and left mid-arm circumference (MAC) and to compare these to the recommended cuff sizes; right and left finger circumference; right and left arm conicity; the responses of women to a three-point Likert scale regarding cuff placement. Results Measurements were obtained for 450 women at an Australian tertiary hospital with a median (IQR) gestation of 35.7 (34.0–37.0); 299 (66.4%) were Caucasian and 35 (7.8%) had gestational hypertension. The median (IQR) body mass index (BMI) was 29.6 kg/m2 (26.2–33.4), range 18.0–62.2. Median (IQR) right MAC was 29.9 cm (27.4–33), range 19.6–53.2. Based on right MAC, 58 (12.9%) required a large cuff and 6 (1.3%) a thigh cuff. Maximum right finger circumference was 7.0 cm. BMI, weight and right MAC were positively correlated with right arm conicity: r = 0.51, 0.42 and 0.45, p Conclusions A small percentage of women are likely to be unsuited to traditional arm cuffs. Available finger-cuffs would suit this population. BMI could potentially be used to select women with cone-shaped arms for future studies of alternative devices.

Published
2018
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