Sugammadex has been approved for reversal of neuromuscular blockade by vecuronium and rocuronium in adults undergoing surgery. Although widely used in the operating room, sugammadex has not been ...investigated in the intensive care unit setting. This study aimed to evaluate the use of sugammadex in critically ill patients with a focus on known drug-related adverse reactions. In this single-center, retrospective, observational study, 91 critically ill patients who were administered sugammadex while in the ICU were evaluated. Electronic health records were reviewed, and baseline data, as well as indication and incidence of complications possibly related to sugammadex, were retrospectively collected. The most common procedures requiring neuromuscular blockade followed by reversal with sugammadex were bronchoscopy, percutaneous dilatative tracheostomy, and percutaneous endoscopic gastrostomy. Within 2 h following administration of sugammadex, skin rash and use of antihistamines were reported in 4 patients (4.4%) in total; bradycardia was observed in 9 patients (9.9%), and respiratory adverse events were described in 3 patients (3.3%). New-onset bleeding up to 24 h after sugammadex was reported in 7 patients (7.7%), 3of whom received transfusions of packed red blood cells. Sugammadex was well tolerated in critically ill patients and could be considered for reversal of neuromuscular blockade in this population. Larger prospective studies are required to determine the safety profile and evaluate the potential benefit and indications of sugammadex in the critical care setting.
Background Neonates and small infants with congenital cardiac disease undergoing cardiac surgery represent major challenges facing paediatric anaesthesia and perioperative medicine. Aims. We here ...aimed to investigate the success rates in performing ultrasound (US) guided central venous catheter insertion (CVC) in neonates and small infants undergoing cardiac surgery, and to evaluate the practicability and feasibility of thereby using a novel wireless US transducer (WUST). Methods Thirty neonates and small infants with a maximum body weight of 10 kg and need for CVC before cardiac surgery were included in this observational trial and were subdivided into two groups according to their weight: < 5 kg and greater than or equai to 5 kg. Cannulation success, failure rate, essential procedure related time periods, and complications were recorded and the clinical utility of the WUST was assessed by a 5-point Likert scale. Results In total, CVC-insertion was successful in 27 (90%) of the patients and the first attempt was successful in 24 (78%) of patients. Success rates of CVC were 80% < 5 kg and 100% greater than or equai to5 kg. Comparing the two groups we found a clear trend towards longer needle insertion time in patients weighing < 5 kg (33 28-69 vs. 24 15-37s, P = .07), whereas, the total time for catheter insertion and the duration of the whole procedure were similar in both groups (199 167-228 vs. 178 138-234 and 720538-818 vs. 660 562-833s. In total, we report 3 (10%) cases of local hematoma as procedure-related complications. Assessments of the WUST revealed very good survey results for all parameters of practicability and handling (all ratings between 4.5 and 5.0). Conclusion Although difficulties in CVC-placement seem to relate to vessel size and patient's weight, US guided CVC-insertion represents a valuable, fast, and safe intervention in neonates and small children undergoing cardiac surgery. Using the WUST is feasible for this clinical application and may aid in efforts aiming to optimize perioperative care. Trial registration Wireless US-guided CVC placement in infants; Clinicaltrials.gov: NCT04597021; Date of Registration: 21October, 2020; retrospectively registered. Keywords: Wireless ultrasound, Central venous catheter, Ultrasound guided catheter placement, Infants, Congenital heart disease
The product of the concentrations of urinary tissue inhibitor of metalloproteinases-2 and insulin-like growth factor binding protein-7 (urinary TIMP-2 × IGFBP-7) has been suggested as biomarker for ...early detection of acute kidney injury (AKI) in various clinical settings. However, the performance of urinary TIMP-2 × IGFBP-7 to predict AKI has never been assessed in patients undergoing orthotopic liver transplantation (OLT). Thus, the aim of this study was to assess the early predictive value of urinary TIMP-2 × IGFBP-7 for the development of AKI after OLT.
In this observational study, urinary TIMP-2 × IGFBP-7 was measured in samples from adult OLT patients. AKI was diagnosed and classified according to KDIGO criteria. Areas under the receiver operating curves (AUC) were calculated to assess predictive values of urinary TIMP-2 × IGFBP-7 for the development of AKI.
Forty patients (mean age 55 ± 8 years) were included. Twenty-eight patients (70%) developed AKI stage 1, 2, or 3 within 48 h after OLT. Urinary TIMP-2 × IGFBP-7 was not predictive for AKI at the end of OLT (AUC: 0.54, CI 0.32-0.75, P = 0.72), at day 1 (AUC: 0.60, CI 0.41-0.79, P = 0.31), or day 2 after OLT (AUC: 0.63, CI 0.46-0.8, P = 0.18).
Based on our results, routine clinical use of urinary TIMP-2 × IGFBP-7 cannot be recommended for risk assessment of AKI in patients undergoing OLT.
Acute kidney injury (AKI) is a serious complication in postoperative ICU patients. The incidence of AKI varies substantially based on the type of surgery and definition used. This study focuses on ...the incidence of AKI in postoperative ICU patients using full KDIGO criteria and related outcomes regarding to different types of surgery.
Retrospective cohort study.
Tertiary level university hospital, eight anaesthesiological/surgical ICUs, between 2016 and 2018.
6261 adult patients.
Primary outcome was 28-day all-cause mortality in different stages of AKI according to complete KDIGO criteria.
We found 3497 (55.9%) postoperative ICU patients with AKI. The severity distribution of AKI stage 1 to 3 was 19.7%, 28.4% and 7.8%, respectively, and 235 (4%) patients received RRT. The 28-day mortality was 3% (n = 205). Increasing AKI severity was associated with increased 28-day mortality when adjusted for other variables (AKI 2°: OR 2.81; 95% CI 1.55 to 5.24; p < 0.001 and AKI 3°: OR 11.37.; 95% CI 5.91 to 22.55; p < 0.001). Besides AKI stages 2 and 3, age (OR 1.02; 95% CI 1.01 to 1.04, p < 0.001), NYHA IV (OR 2.23; 95% CI 1.03 to 4.43, p = 0.042), need for surgical reintervention within 48 h (OR 2.92; 95% CI 1.76 to 4.72, p = 0.001), urgent surgery (OR 1.78; 95% CI 1.15 to 2.71, p = 0.01), emergency surgery (OR 2.63; 95% CI 1.58 to 4.31, p = 0.001), vascular surgery (OR 2.01; 95% CI 1.06 to 3.98, p = 0.033), and orthopedic and trauma surgery (OR 3.79; 95% CI 1.98 to 7.09, p < 0.001) versus cardiac surgery was significantly associated with increased risk for 28-days mortality in multivariate analysis.
AKI based on full KDIGO criteria is very common in postoperative ICU patients and it is associated with stepwise increase in 28-days mortality.
•Incidence & outcome of AKI classified by creatinine (SCr) and urine output (UO) criteria are unknown in surgical ICU patients•AKI occurred in nearly 56% of patients within the first week after ICU admission and is associated increased mortality.•The assessment of AKI based on SCr alone failed to identify AKI in many ICU patients.•The assessment of AKI based on both criteria, SCr and UO, increased the AKI incidence by 35%.•Adding the UO criteria unveiled a much higher number of patients with AKI in postoperative ICU patients.
Objectives
Only a small proportion of lung transplant recipients achieve a physical status comparable to healthy individuals in the long term. It is reasonable to hypothesize that the necessary ...cardiopulmonary adaptation required for strenuous physical exercise may be impaired. Exposure to high altitude provides an optimal platform to study the physiological cardiopulmonary adaptation in lung transplant recipients under aerobic conditions. To gain a deeper understanding, 14 healthy lung transplant recipients and healthcare professionals climbed the highest peak in North Africa (Mount Jebel Toubkal; 4167 m) in September 2019.
Methods
Monitoring included daily assessment of vital signs, repeated transthoracic echocardiography, pulmonary function tests, and capillary blood sampling throughout the expedition.
Results
Eleven out of fourteen lung transplant recipients reached the summit. All recipients showed a stable lung function and vital parameters and physiological adaptation of blood gases. Similar results were found in healthy controls. Lung transplant recipients showed worse results in the 6‐minute walk test at low and high altitude compared to controls (day 1: 662 m vs. 725 m, p < 0.001, day 5: 656 m vs. 700 m, p = 0.033) and a lack of contractile adaptation of right ventricular function with increasing altitude as measured by tricuspid plane systolic excursion on echocardiography (day 2: 22 mm vs. 24 mm, p = 0.202, day 5: 23 mm vs. 26 mm, p = 0.035).
Conclusions
Strenuous exercise in healthy lung transplant recipients is safe. However, the poorer cardiopulmonary performance in the 6‐minute walk test and the lack of right ventricular cardiac adaptation may indicate underlying autonomic dysregulation.
Elevated concentrations of D-dopachrome tautomerase (D-DT) were associated with adverse outcome in various clinical settings. However, no study assessed D-DT concentrations in patients requiring ...orthotopic liver transplantation (OLT). The aim of this observational study was to measure serum D-DT concentrations in patients undergoing OLT and associate D-DT with survival and acute kidney injury (AKI).
Forty-seven adults with end-stage liver disease undergoing OLT were included. Areas under the receiver operating curves (AUC) were calculated to assess predictive values of D-DT for outcome and AKI after OLT. Survival was analyzed by Kaplan–Meier curves.
Serum D-DT concentrations were greater in non-survivors than in survivors prior to OLT (86 50–117 vs. 53 31–71 ng/ml, P = 0.008), and on day 1 (357 238–724 vs. 189 135–309 ng/ml, P = 0.001) and day 2 (210 142–471 vs. 159 120–204 ng/ml, P = 0.004) following OLT. Serum D-DT concentrations predicted lethal outcome when measured preoperatively (AUC = 0.75, P = 0.017) and on postoperative day 1 (AUC = 0.75, P = 0.015). One-year survival of patients with preoperative D-DT concentrations >85 ng/ml was 50%, whereas that of patients with preoperative D-DT concentrations <85 ng/ml was 83% (Chi2 = 5.83, P = 0.016). In contrast, D-DT was not associated with AKI after OLT.
In patients undergoing OLT, serum D-DT might predict outcome after OLT.
Background The product of the concentrations of urinary tissue inhibitor of metalloproteinases-2 and insulin-like growth factor binding protein-7 (urinary TIMP-2 x IGFBP-7) has been suggested as ...biomarker for early detection of acute kidney injury (AKI) in various clinical settings. However, the performance of urinary TIMP-2 x IGFBP-7 to predict AKI has never been assessed in patients undergoing orthotopic liver transplantation (OLT). Thus, the aim of this study was to assess the early predictive value of urinary TIMP-2 x IGFBP-7 for the development of AKI after OLT. Methods In this observational study, urinary TIMP-2 x IGFBP-7 was measured in samples from adult OLT patients. AKI was diagnosed and classified according to KDIGO criteria. Areas under the receiver operating curves (AUC) were calculated to assess predictive values of urinary TIMP-2 x IGFBP-7 for the development of AKI. Results Forty patients (mean age 55 + or - 8 years) were included. Twenty-eight patients (70%) developed AKI stage 1, 2, or 3 within 48 h after OLT. Urinary TIMP-2 x IGFBP-7 was not predictive for AKI at the end of OLT (AUC: 0.54, CI 0.32-0.75, P = 0.72), at day 1 (AUC: 0.60, CI 0.41-0.79, P = 0.31), or day 2 after OLT (AUC: 0.63, CI 0.46-0.8, P = 0.18). Conclusion Based on our results, routine clinical use of urinary TIMP-2 x IGFBP-7 cannot be recommended for risk assessment of AKI in patients undergoing OLT. Keywords: Acute kidney injury, Liver transplantation, Urinary biomarker, TIMP-2, IGFBP-7
Most organisms consist of a functionally adaptive assemblage of hard and soft tissues. Despite the obvious advantages of reinforcing soft protoplasm with a hard scaffold, such composites can lead to ...tremendous mechanical stresses where the two meet. Although little is known about how nature relieves these stresses, it is generally agreed that fundamental insights about molecular adaptation at hard/soft interfaces could profoundly influence how we think about biomaterials. Based on two noncellular tissues, mussel byssus and polychaete jaws, recent studies suggest that one natural strategy to minimize interfacial stresses between adjoining stiff and soft tissue appears to be the creation of a “fuzzy” boundary, which avoids abrupt changes in mechanical properties. Instead there is a gradual mechanical change that accompanies the transcendence from stiff to soft and vice versa. In byssal threads, the biochemical medium for achieving such a gradual mechanical change involves the elegant use of collagen-based self-assembling block copolymers. There are three distinct diblock copolymer types in which one block is always collagenous, whereas the other can be either elastin-like (soft), amorphous polyglycine (intermediate), or silk-like (stiff). Gradients of these are made by an incrementally titrated expression of the three proteins in secretory cells the titration phenotype of which is linked to their location. Thus, reflecting exactly the composition of each thread, the distal cells secrete primarily the silk− and polyglycine−collagen diblocks, whereas the proximal cells secrete the elastin− and polyglycine−collagen diblocks. Those cells in between exhibit gradations of collagens with silk or elastin blocks. Spontaneous self-assembly appears to be by pH triggered metal binding by histidine (HIS)-rich sequences at both the amino and carboxy termini of the diblocks. In the polychaete jaws, HIS-rich sequences are expanded into a major block domain. Histidine predominates at over 20 mol % near the distal tip and diminishes to about 5 mol % near the proximal base. The abundance of histidine is directly correlated to transition metal content (Zn or Cu) as well as hardness determined by nanoindentation. EXAFS analyses of the jaws indicate that transition metals such as Zn are directly bound to histidine ligands and may serve as cross-linkers.
We report on 18 patients with myeloid neoplasms and associated tyrosine kinase (TK) fusion genes on treatment with the TK inhibitors (TKI) ruxolitinib (PCM1‐JAK2, n = 8; BCR‐JAK2, n = 1) and ...imatinib, nilotinib or dasatinib (ETV6‐ABL1, n = 9). On ruxolitinib (median 24 months, range 2‐36 months), a complete hematologic response (CHR) and complete cytogenetic response (CCR) was achieved by five of nine and two of nine patients, respectively. However, ruxolitinib was stopped in eight of nine patients because of primary resistance (n = 3), progression (n = 3) or planned allogeneic stem cell transplantation (allo SCT, n = 2). At a median of 36 months (range 4‐78 months) from diagnosis, five of nine patients are alive: four of six patients after allo SCT and one patient who remains on ruxolitinib. In ETV6‐ABL1 positive patients, a durable CHR was achieved by four of nine patients (imatinib with one of five, nilotinib with two of three, dasatinib with one of one). Because of inadequate efficacy (lack of hematological and/or cytogenetic/molecular response), six of nine patients (imatinib, n = 5; nilotinib, n = 1) were switched to nilotinib or dasatinib. At a median of 23 months (range 3‐60 months) from diagnosis, five of nine patients are in CCR or complete molecular response (nilotinib, n = 2; dasatinib, n = 2; allo SCT, n = 1) while two of nine patients have died. We conclude that (a) responses on ruxolitinib may only be transient in the majority of JAK2 fusion gene positive patients with allo SCT being an important early treatment option, and (b) nilotinib or dasatinib may be more effective than imatinib to induce durable complete remissions in ETV6‐ABL1 positive patients.
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•rCFD was used to time-extrapolate dynamics in 3D spouted beds simulated by CFD–DEM.•Bed distribution and residence time in a spray zone were accurately reproduced by ...rCFD.•Simulations of 1-h spray injection were performed to evaluate coating quality.•The addition of draft plates resulted in a broader surface coverage distribution.•A speedup of 2100 times was achieved compared with pure CFD–DEM.
Although numerical models such as the computational fluid dynamics–discrete element method (CFD–DEM) have enabled the accurate simulation of laboratory-scale apparatuses, the application of these methods to large-scale apparatuses with many particles and time scales ranging from minutes to hours remains a challenge. The recently developed recurrence CFD (rCFD) method seeks to overcome these issues in pseudo-periodic processes by extrapolating globally recurring patterns in a physically meaningful way and describing the transport and interaction of passive scalars using Lagrangian tracers. Spouted beds represent an interesting target because of the associated variety of flow regimes. They can be effectively described by CFD–DEM on the time scale of tens of seconds, whereas industrially relevant processes typically take hours. In this contribution, we established the validity of applying the Lagrangian rCFD method to spouted beds by demonstrating the accurate reproduction of the particle residence time distribution in a fictitious spray zone. The deposition of spray droplets onto tracer particles was simulated for 1h, and the particle surface coverage distribution was estimated using a statistical approach for both an unstabilized prismatic spouted bed and one stabilized by draft plates.
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