Objective The aim of this study was to prospectively reassess the natural evolution and complications of temporary epicardial wires (TEW) after cardiac surgery. Design Observational prospective ...study. Setting Monocentric. Participants All adult patients having cardiac surgery with TEW insertion, except for those undergoing cardiac transplantation or having permanent pacemakers. Interventions Thresholds were measured daily until wire removal or permanent device insertion. Descriptive statistics and analysis of variance (ANOVA) were performed with p<0.05 as the significance threshold. Main results Two hundred thirty-six patients were enrolled. All had ventricular and only 142 (60%) both ventricular and atrial unipolar FEP15, Ethicon TEW. In most TEW (74%), capture thresholds increased significantly by the first (atrial wires) and by the second (ventricular wires) postoperative day and continued to increase until the fifth day, followed by a plateau. For the others, 2 opposite profiles were noticed: 10% of the total TEW lost their capture function before the fourth postoperative day, whereas 16% remained functional beyond the seventh postoperative day. Both atrial and ventricular sensitivity degraded significantly by the second day. The median energy output used for pacing was 17.5 mA (atrial) and 20 mA (ventricular), regardless of the capture thresholds. Major complications related to TEW were noted in 0.8% of cases. Conclusion Despite widespread use, the natural history of TEW is still a major concern. Pacing with high-energy output is a possible factor leading to capture dysfunction that must be avoided. Education of all operators is needed.
Imaging Findings in Pulmonary Vasculitis Castañer, Eva, MD; Alguersuari, Anna, MD; Andreu, Marta, MD ...
Seminars in ultrasound, CT, and MRI,
12/2012, Letnik:
33, Številka:
6
Journal Article
Recenzirano
Vasculitis is a destructive inflammatory process affecting blood vessels. Pulmonary vasculitis may develop secondary to other conditions or constitute a primary idiopathic disorder. Thoracic ...involvement is most common in primary idiopathic large-vessel vasculitides (Takayasu arteritis, giant cell arteritis, Behçet disease) and primary antineutrophil cytoplasmic autoantibody-associated small-vessel vasculitides (Wegener granulomatosis, microscopic polyangiitis, Churg–Strauss syndrome). Primary pulmonary vasculitides are rare, and their signs and symptoms are nonspecific, overlapping with those of infections, connective tissue diseases, and malignancies. The radiologic findings in primary pulmonary vasculitis vary widely and can include vessel wall thickening, nodular or cavitary lesions, ground-glass opacities, and consolidations, among others. Diffuse alveolar hemorrhage usually results from primary small-vessel vasculitis in the lungs. To diagnose vasculitis, medical teams must recognize characteristic combinations of clinical, radiologic, laboratory, and histopathologic features.
Allergy to benznidazole: cross-reactivity with other nitroimidazoles Noguerado-Mellado, Blanca; Rojas-Pérez-Ezquerra, Patricia; Calderón-Moreno, María ...
The journal of allergy and clinical immunology in practice (Cambridge, MA),
05/2017, Letnik:
5, Številka:
3
Journal Article
Simultaneous stimulation of 2 left ventricular (LV) sites could enhance the effectiveness of cardiac resynchronization therapy (CRT). The aim of this study was to evaluate the acute hemodynamic ...response to dual-site LV CRT. Two LV pacing leads were successfully implanted in 12 CRT candidates (New York Heart Association classes III to IV, QRS ≥120 ms). Target positions were the lateral or posterolateral vein (site A) and anterior or anterolateral vein (site B). A conductance catheter was placed in the left ventricle for pressure–volume measurements. Tested CRT configurations were alternated by atrial overdrive pacing at a fixed rate and included site A and B single-site CRT and dual-site LV CRT (2 LV sites plus right ventricular apex) at 4 atrioventricular intervals. Overall, single-site LV CRT significantly enhanced stroke volume, stroke work, maximum pressure derivative, and conductance-derived indexes of LV synchrony when delivered in site A, whereas no significant changes were noticed with pacing in site B. Specifically, site-A pacing resulted in a higher stroke volume increase (LV pacing site associated with the best hemodynamic response best-LV) in 8 patients, and site-B pacing, in 4 patients. At intermediate atrioventricular intervals, dual-site LV CRT resulted in improved stroke volume, stroke work, maximum pressure derivative, and LV synchrony with respect to single-site CRT when delivered at the best-LV (all p <0.05). However, single-site CRT at best-LV produced results similar to dual-site LV CRT when the atrioventricular interval was optimized in each patient. In conclusion, adding a second LV lead does not result in further improvement in acute hemodynamic response with respect to standard CRT when the single LV pacing site and atrioventricular interval are optimal.
Background The Joint Commission on the Accreditation of Healthcare Organizations reports that communication breakdowns are responsible for 85% of sentinel events in hospitals. Patients in surgical ...ICUs are the most vulnerable to communication errors. Fellows and residents are an integral part of the surgical ICU team, but little is known about resident–fellow communication and its impact on surgical ICU patient outcomes. The objective of this study is to describe resident–fellow patient care communication patterns in the surgical ICU and correlate established communication patterns with short-term outcomes. Study Design A prospective observational trial was conducted for 136 consecutive surgical ICU days. We evaluated resident–fellow communication of four cardiorespiratory events: hypotension, new arrhythmias, tachypnea, and desaturation. We prospectively defined three short-term outcomes: improved, not improved, and worse. An intervention was attempted to improve communication. Results Three hundred twelve events were collected (166 observational and 146 interventional). PGY3 residents covered approximately 60% of days in both phases. PGY3 residents were responsible for 73% of communication errors in the observational phase and 59% of communication errors in the interventional phase. Communication errors were more likely in the late shift (p < 0.0001). The late shift was responsible for 77% of all communication errors. Communication errors resulted in worse short-term outcomes for cardiorespiratory events (p < 0.0002). Effective communication was a significant predictor of improved short-term outcomes (p < 0.0003). The intervention decreased communication errors in the late shift by 10% (p < 0.052). Conclusions Communication errors occurred more frequently during the late shift. These communication errors were associated with worsened short-term outcomes. Improved communication in the surgical ICU is a fruitful target to improve clinical outcomes.
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