Egyptian Journal of Critical Care Medicine最新文献

{"title":"The effect of the abdominal perfusion pressure on visceral circulation in critically ill patients with multiorgan dysfunction","authors":"H. ELatroush ,&nbsp;N. Abed ,&nbsp;A. Metwaly ,&nbsp;M. Afify ,&nbsp;M. Hussien","doi":"10.1016/j.ejccm.2015.12.001","DOIUrl":"https://doi.org/10.1016/j.ejccm.2015.12.001","url":null,"abstract":"<div><p>Ongoing studies investigating the intra abdominal pressure (IAP) shifted the belief of mesenteric circulation not to be only a culprit of decreased arterial hypoperfusion, but also other hydrostatic forces may impose its perfusion and may also act directly on the tissues. While the gut theory stated the engine of multiorgan dysfunction syndrome (MODS), abdominal perfusion pressure (APP) was examined in MODS patients to assess mesenteric circulation instead of merely abdominal arterial hypoperfusion.</p></div><div><h3>Aim</h3><p>We aimed to study the correlation between increased fluid gain and low APP and increased risk for visceral organ hypoperfusion.</p></div><div><h3>Patients and methods</h3><p>106 MODS patients were studied retrospectively, and included if a SOFA subscore of ⩾2 was recorded in at least 2 organ systems, routine laboratory investigations, lactate, fluid gain was defined as the cumulative positive fluid gained during resuscitation. Vital signs were recorded and IAP (measured through UB, closed loop small volume technique) and APP which is derived from the equation (mean arterial blood pressure MAP – intraabdominal pressure IAP) and Liver SOFA subscore were calculated as indirect markers of mesenteric hypoperfusion.</p></div><div><h3>Results</h3><p>The APP on admission was negatively correlated with lactate and fluid gain (<em>r</em> <!-->=<!--> <!-->−0.388 and −.225 <em>P</em> <!-->=<!--> <!-->0.0001 and .021 respectively).</p><p>The lower the APP, the worse the Liver SOFA subscore (85.3<!--> <!-->±<!--> <!-->14.2, 75.7<!--> <!-->±<!--> <!-->15.3, 73.1<!--> <!-->±<!--> <!-->24.6, 76.6<!--> <!-->±<!--> <!-->16.8 and 66<!--> <!-->±<!--> <!-->17.1 <em>p</em> 0.012), SOFA and lactate were the significant predictors for APP.</p></div><div><h3>Conclusion</h3><p>Low APP and positive fluid gain are associated with deteriorating visceral circulation manifested by high lactate levels and deteriorating liver function.</p></div>","PeriodicalId":31233,"journal":{"name":"Egyptian Journal of Critical Care Medicine","volume":"3 2","pages":"Pages 63-67"},"PeriodicalIF":0.3,"publicationDate":"2015-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.ejccm.2015.12.001","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"92110551","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictive value of thyroid hormone assessment in septic patients in comparison with C-reactive protein","authors":"Mohamed Hosny,&nbsp;Rania Rashad,&nbsp;Doaa Atef,&nbsp;Nashwa Abed","doi":"10.1016/j.ejccm.2015.11.001","DOIUrl":"10.1016/j.ejccm.2015.11.001","url":null,"abstract":"<div><h3>Introduction</h3><p>Thyroid dysfunction is associated with mortality in critically ill patients. We investigated the predictive value of the thyroid hormone compared to CRP in septic patients.</p></div><div><h3>Methods</h3><p>80 patients were included in a prospective, randomized study done in the critical care department.</p></div><div><h3>Results</h3><p>FT3, FT4, and TSH levels on the fifth day were below the normal range in 61.3%, 31.2%, and 23.8% patients respectively. There was a significant decrease in the FT3 level on admission compared to the fifth day (<em>p</em> <!-->&lt;<!--> <!-->0.001). By comparison of thyroid hormone levels in patients with sepsis, severe sepsis and septic shock; we found the mean level of FT3 was lower in patients with septic shock (1.3<!--> <!-->±<!--> <!-->0.4<!--> <!-->pg/ml) and severe sepsis (1.7<!--> <!-->±<!--> <!-->0.2<!--> <!-->pg/ml) as compared to patients with sepsis (2.4<!--> <!-->±<!--> <!-->1.2<!--> <!-->pg/ml). The mean FT3 level increased in survivors (2.9<!--> <!-->±<!--> <!-->1.03<!--> <!-->pg/ml) compared to non survivors (1.9<!--> <!-->±<!--> <!-->0.89<!--> <!-->pg/ml) (<em>p</em> <!-->&lt;<!--> <!-->0.001). Correlation of FT3 on the 5th day to CRP (<em>r</em> <!-->=<!--> <!-->−0.332, <em>p</em> <!-->=<!--> <!-->0.039), FT3 on 5th day to IL-6 (<em>r</em> <!-->=<!--> <!-->−0.339, <em>p</em> <!-->=<!--> <!-->0.035) in non survivors. Correlation of FT3 on the 5th day to APACHE II (<em>r</em> <!-->=<!--> <!-->−0.359, <em>p</em> <!-->=<!--> <!-->0.025) and SOFA score (<em>r</em> <!-->=<!--> <!-->−0.427, <em>p</em> <!-->=<!--> <!-->0.007). ROC curves indicated that FT3 on the 5th day had the greatest power for predicting ICU mortality (sensitivity 87.2% and specificity 73.2%). CRP (sensitivity 100% and specificity 92.7%) is a better tool than IL-6 (sensitivity 92.3% and specificity 80.5%) in predicting mortality in sepsis.</p></div><div><h3>Conclusion</h3><p>FT3 levels were negatively correlated to CRP and IL-6 levels as well as APACHE II, SOFA scores. FT3 may be used as a marker of disease severity and a predictor of mortality.</p></div>","PeriodicalId":31233,"journal":{"name":"Egyptian Journal of Critical Care Medicine","volume":"3 2","pages":"Pages 55-61"},"PeriodicalIF":0.3,"publicationDate":"2015-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.ejccm.2015.11.001","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116224143","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Atrial ejection force and brain natriuretic peptide as markers for mortality in sepsis","authors":"Mohammed Badr Salim ,&nbsp;Hesham Elaasr ,&nbsp;Mervat El Damarawy ,&nbsp;Ashraf Wadee ,&nbsp;Alaa Ashour ,&nbsp;Fatma Mohammad Nasr","doi":"10.1016/j.ejccm.2014.11.001","DOIUrl":"https://doi.org/10.1016/j.ejccm.2014.11.001","url":null,"abstract":"<div><h3>Background</h3><p>In early stages of septic shock, impaired myocardial function plays an important prognostic role. AEF and Plasma BNP level may be a valuable prognostic factor for patients with sepsis.</p></div><div><h3>Objective</h3><p>We aimed also to evaluate the value of atrial ejection force (AEF) B-type natriuretic peptide (BNP) in predicting the outcome of sepsis, severe sepsis and septic shock patients.</p></div><div><h3>Methods</h3><p>40 patients presenting with sepsis, severe sepsis or septic were included in the study. The patients had undergone transthoracic Echocardiographic examinations and BNP measurements on the 1st and 3rd day of admission. The patients were retrospectively divided into survivors and non survivors.</p></div><div><h3>Results</h3><p>There was a significant statistical difference in BNP level (<em>P</em> <!-->=<!--> <!-->0.0001) between the two groups. BNP showed a statistically significant rise in the non survival group from day 1 to day 3 (<em>p</em> <!-->=<!--> <!-->0.002) and a statistically significant decrease from day 1 to day 3 in the survived group (<em>p</em> <!-->=<!--> <!-->0.001). As regards the echo findings there was a statistically significant difference AEF 3rd day between survivors and non survivors (<em>P</em> <!-->=<!--> <!-->0.0001). The ROC curve showed that BNP 1st day, 3rd day are good tests for prediction of mortality in patients with sepsis.</p></div><div><h3>Conclusion</h3><p>Atrial ejection force on the first day of admission, unlike BNP level, might not be used as an independent predictor of mortality in patients with sepsis. BNP level correlates with the severity of sepsis. According to our study, AEF in the third day may be a good predictor for survival of patients presenting with sepsis.</p></div>","PeriodicalId":31233,"journal":{"name":"Egyptian Journal of Critical Care Medicine","volume":"3 1","pages":"Pages 29-35"},"PeriodicalIF":0.3,"publicationDate":"2015-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.ejccm.2014.11.001","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91712296","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Stroke volume variation compared with pulse pressure variation and cardiac index changes for prediction of fluid responsiveness in mechanically ventilated patients","authors":"Randa Aly Soliman ,&nbsp;Shereif Samir ,&nbsp;Ayman el Naggar ,&nbsp;Khalaf El Dehely","doi":"10.1016/j.ejccm.2015.02.002","DOIUrl":"https://doi.org/10.1016/j.ejccm.2015.02.002","url":null,"abstract":"<div><h3>Introduction</h3><p>Adequate volume resuscitation is very important for a favorable outcome of critically ill patients. Both over and under filling of intravascular volume could be deleterious. Static indices including central venous pressure, pulmonary capillary wedge pressure, left ventricular end-diastolic area, mean arterial pressure (MAP) and tachycardia are commonly used and are known to be of little value in discriminating responders from non-responders. On the other hand dynamic indices such as pulse pressure variation (PPV), inferior vena cava diameter, superior vena cava diameter, aortic blood flow, which are based on variation on the left ventricular stoke volume, have been shown to be more accurate predictors of fluid responsiveness in mechanically ventilated patients. In this study we are evaluating the ability of stroke volume variation (SVV) obtained by Vigileo–FloTrac device to predict fluid responsiveness in patients with acute circulatory failure under complete passive, volume controlled mechanical ventilation and correlating it to manually calculated PPV.</p></div><div><h3>Materials and methods</h3><p>Twenty five patients aged above 18<!--> <!-->years, with acute circulatory failure and at least one sign of tissue hypoperfusion requiring fluid resuscitation and mechanical ventilation were included. Excluded are patients with cardiogenic shock, acute pulmonary edema, LVEF &lt;50%, atrial fibrillation, frequent ectopics, significant aortic or mitral valve abnormalities or renal failure. Candidates were subjected to thorough clinical evaluation, lab investigation and ECG. Following sedation, muscle relaxation and maintenance of mean arterial pressure &gt;65<!--> <!-->mmHg by norepinephrine, 500<!--> <!-->ml of Hes-steril were administered over 10<!--> <!-->min. Static and dynamic hemodynamic parameters were taken in supine position before and after fluid challenge. Patients who had an increase of cardiac index measured by trans-thoracic echocardiography ⩾15% of baseline measurement were considered responders.</p></div><div><h3>Results</h3><p>Fourteen patients were fluid responders. Before fluid challenge SVV and PPV were significantly higher in responders than non-responders (<em>p</em> <!-->=<!--> <!-->0.0001 for each). SVV<!--> <!-->⩾<!--> <!-->8.15% predicted responders with a sensitivity of 100% and specificity 81.1% (AUC 0.906). PPV<!--> <!-->⩾<!--> <!-->10.2 also predicted responders with a sensitivity of 92.9% and specificity of 90.9% (AUC 0.974). The higher the SVV before fluid challenge the higher the percentage of increase of CI following fluid challenge (<em>r</em> <!-->=<!--> <!-->0.733, <em>p</em> <!-->=<!--> <!-->0.00). PPV showed the same correlation pattern with percentage increase of CI (<em>r</em> <!-->=<!--> <!-->0.798, <em>p</em> <!-->=<!--> <!-->0.00).</p></div><div><h3>Conclusions</h3><p>Baseline stroke volume variation ⩾8.15% predicted fluid responsiveness in mechanically ventilated patients with ac","PeriodicalId":31233,"journal":{"name":"Egyptian Journal of Critical Care Medicine","volume":"3 1","pages":"Pages 9-16"},"PeriodicalIF":0.3,"publicationDate":"2015-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.ejccm.2015.02.002","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91712300","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of body temperature and serum procalcitonin on the outcomes of critically ill neurological patients","authors":"Abeer Feasal,&nbsp;Abdou El Azab,&nbsp;Karim Mashhour,&nbsp;Amr El Hadidy","doi":"10.1016/j.ejccm.2015.05.001","DOIUrl":"https://doi.org/10.1016/j.ejccm.2015.05.001","url":null,"abstract":"<div><h3>Introduction</h3><p>Fever is common in patients with acute stroke, and mostly it is due to infectious complications. The neurologic effects of fever are significant, increased temperature in the post-injury period has been associated with increased cytokine activity and increased infarct size.</p></div><div><h3>Aim</h3><p>To test the hypothesis that fever and increased serum procalcitonin are associated with poor outcomes after neurological injury.</p></div><div><h3>Methodology</h3><p>Fifty patients (30 males (60%) and 20 females (40%) mean 43.8<!--> <!-->±<!--> <!-->11.7<!--> <!-->years) were divided into two groups: Group I: 25 traumatic patients (i.e., head injury) and Group II: 25 non-traumatic patients (i.e., stroke). Temperature was measured from admission until the patients were discharged or died, and PCT was measured on day 1 of admission and after 48<!--> <!-->h of admission.</p></div><div><h3>Results</h3><p>Fever has been associated with poor outcome, as fever is linked to worse GCS scores (12.6<!--> <!-->±<!--> <!-->1.2 vs. 7.7<!--> <!-->±<!--> <!-->2.6 in patients with fever, <em>P</em> 0.001), longer MV durations (3.6<!--> <!-->±<!--> <!-->1.0 vs. 22.4<!--> <!-->±<!--> <!-->9.1<!--> <!-->days, in patients with fever, <em>P</em> 0.001), longer ICU length of stay (8.1<!--> <!-->±<!--> <!-->4.7 vs. 23.0<!--> <!-->±<!--> <!-->8.0<!--> <!-->days in patients with fever, <em>P</em> 0.001) and increased mortality (<em>P</em> <!-->=<!--> <!-->0.001). There were significantly higher PCT levels in the mortality group versus the survived group at day 1 (4.15<!--> <!-->±<!--> <!-->0.82 vs. 2.47<!--> <!-->±<!--> <!-->0.059<!--> <!-->ng/ml, respectively, <em>P</em> 0.0001) and after 48<!--> <!-->h of admission (5.20<!--> <!-->±<!--> <!-->1.14 vs. 3.19<!--> <!-->±<!--> <!-->0.092<!--> <!-->ng/ml, respectively, <em>P</em> 0.0001).</p></div><div><h3>Conclusion</h3><p>Fever had a strong link to worse GCS, longer MV durations, increased length of ICU stay, higher mortality rates and worse overall outcomes in neurocritical patients. High PCT levels can predict mortality in those patients.</p></div>","PeriodicalId":31233,"journal":{"name":"Egyptian Journal of Critical Care Medicine","volume":"3 1","pages":"Pages 1-8"},"PeriodicalIF":0.3,"publicationDate":"2015-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.ejccm.2015.05.001","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91712297","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Aspirin resistance: Prevalence and clinical outcome in Egypt","authors":"Ahmed Salah,&nbsp;Mohammed El-Desuky,&nbsp;Amal Rizk,&nbsp;Amr El-Hadidy","doi":"10.1016/j.ejccm.2014.12.001","DOIUrl":"10.1016/j.ejccm.2014.12.001","url":null,"abstract":"<div><h3>Introduction</h3><p>The antiplatelet drug aspirin is considered as a cornerstone in medical treatment of patients with CV or cerebrovascular diseases. Despite its use, a significant number of patients had recurrent adverse ischemic events. Inter-individual variability of platelet aggregation in response to aspirin may be an explanation for some of these events. Multiple trials have linked aspirin resistance to these adverse events.</p></div><div><h3>Objectives</h3><p>The aim of this study was to estimate the prevalence of aspirin resistance among patients with coronary artery disease (CAD) in Egypt and evaluate its impact on clinical outcome.</p></div><div><h3>Methods</h3><p>A total of 50 patients with documented history of CAD were included; they were on aspirin 150<!--> <!-->mg/day for more than seven days and no other antiplatelet drugs. They were evaluated for aspirin resistance using light transmission aggregometry. Aspirin resistance was defined as a mean aggregation of &gt;20% with 0.5<!--> <!-->mg/ml arachidonic acid. They were followed up after six months for cardiac death, unstable angina (UA), myocardial infarction (MI), and stroke.</p></div><div><h3>Results</h3><p>Prevalence of aspirin resistance was 48% in our study group. Aspirin resistance was significantly higher in patients with family history of CAD (<em>p</em> <!-->=<!--> <!-->0.044), smoking (<em>p</em> <!-->=<!--> <!-->0.011), history of MI (<em>p</em> <!-->=<!--> <!-->0.024), history of percutaneous coronary intervention (PCI) (<em>p</em> <!-->=<!--> <!-->0.001), and concomitant NSAIDs intake (<em>p</em> <!-->=<!--> <!-->0.047). Moreover, aspirin resistance was more common among patients with multi-vessel CAD (<em>p</em> <!-->=<!--> <!-->0.024). Aspirin-resistant patients had a significantly higher rate of UA (<em>p</em> <!-->=<!--> <!-->0.001) and all major adverse cardiac events (MACE) (<em>p</em> <!-->&lt;<!--> <!-->0.001).</p></div>","PeriodicalId":31233,"journal":{"name":"Egyptian Journal of Critical Care Medicine","volume":"3 1","pages":"Pages 23-27"},"PeriodicalIF":0.3,"publicationDate":"2015-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.ejccm.2014.12.001","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121426318","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sudden cardiac death in ischemic heart disease. Pathophysiology and risk stratification","authors":"Nabil El-Sherif","doi":"10.1016/j.ejccm.2015.02.001","DOIUrl":"https://doi.org/10.1016/j.ejccm.2015.02.001","url":null,"abstract":"","PeriodicalId":31233,"journal":{"name":"Egyptian Journal of Critical Care Medicine","volume":"3 1","pages":"Pages 17-22"},"PeriodicalIF":0.3,"publicationDate":"2015-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.ejccm.2015.02.001","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91712298","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Demographics of Acute Coronary Syndrome (ACS) Egyptian patients admitted to Assiut University Hospital: Validation of TIMI and GRACE scores","authors":"Haitham M. Abdelmoneim,&nbsp;Hosam Hasan-Ali,&nbsp;Samir S. Abdulkader","doi":"10.1016/j.ejccm.2014.07.001","DOIUrl":"10.1016/j.ejccm.2014.07.001","url":null,"abstract":"<div><h3>Aims</h3><p>This prospective cross-sectional observational study aimed at reporting the demographics of ACS patients admitted to Assiut University Hospital, Egypt, and validating both TIMI (Thrombolysis in Myocardial Infarction) and GRACE (Global Registry of Acute Coronary Events) scores in the prediction of both in-hospital MACE and 30-day mortality and recurrent MI in both ST-elevation myocardial infarction (STEMI) and unstable angina/non-ST-elevation myocardial infarction (UA/NSTEMI) patients.</p></div><div><h3>Methods</h3><p>Data were collected from all admitted patients over one year from April 1, 2011.</p></div><div><h3>Results</h3><p>The study included 795 patients, 270 (34%) with STEMI and 525 (66%) with UA/NSTEMI with a comparable mean age (58<!--> <!-->±<!--> <!-->11 vs 57<!--> <!-->±<!--> <!-->12<!--> <!-->years, respectively). The STEMI patients had higher rates of male gender (75% vs 64%), smoking (51% vs 38%), and familial predisposition (16% vs 7%). The UA/NSTEMI patients had higher rates of a history of previous ischemia (70% vs 24%), hypertension (59% vs 33%), and diabetes (45% vs 34%). STEMI was associated with a higher in-hospital MACE (23.3% vs 13.7%) and a higher 30-day all-cause mortality rate (9% vs 2%) and recurrent non-fatal MI (35% vs 15%).</p></div><div><h3>Conclusion</h3><p>ACS occurs at a relatively young age in our locality, in patients sharing common known coronary risk factors. STEMI patients, in our locality, represent approximately one-third of ACS patients and are associated with worse in-hospital as well as 30-day outcomes. Both TIMI and GRACE risk scores are valid for use in ACS patients in the Assiut governorate (c-statistics 0.72–0.97), with a better discriminative ability for the GRACE score, especially in UA/STEMI patients.</p></div>","PeriodicalId":31233,"journal":{"name":"Egyptian Journal of Critical Care Medicine","volume":"2 1","pages":"Pages 3-11"},"PeriodicalIF":0.3,"publicationDate":"2014-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.ejccm.2014.07.001","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130970410","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessment of hypotension during dialysis as a manifestation of myocardial ischemia in patients with chronic renal failure","authors":"Randa Aly Soliman ,&nbsp;Mohamed Fawzy ,&nbsp;Hussein Kandil ,&nbsp;Alia Abd el Fattah","doi":"10.1016/j.ejccm.2014.05.001","DOIUrl":"10.1016/j.ejccm.2014.05.001","url":null,"abstract":"<div><h3>Introduction</h3><p>Intradialytic hypotension (IDH) remains to be a major complication of hemodialysis occurring in nearly 25% of dialysis sessions. It is a significant independent factor affecting mortality in hemodialysis patients. Autonomic nervous system dysfunction, blood sequestration in the setting of hypovolemia, cardiovascular diseases and increased plasma level of end products of nitric oxide metabolism are possible causes. In this controlled prospective study we examined patients with chronic renal failure and intradialytic hypotension to evaluate the relationship between this hypotension and myocardial ischemia after controlling other possible causes.</p></div><div><h3>Materials and methods</h3><p>Thirty patients with chronic renal failure who are on regular dialysis were enrolled. Before dialysis, patients were subjected to history taking and clinical examination. Echocardiography and several lab tests were done. Glomerular filtration rate (GFR) was calculated using Cockcroft’s and Gault formula. Autonomic dysfunction was also assessed. The dialysis session was standardized in all patients. Intradialytic blood pressure was monitored and hypotension was classified as mild (SBP<!--> <!-->&gt;<!--> <!-->100<!--> <!-->mmHg), moderate (SBP 80–100) or severe (SBP<!--> <!-->&lt;<!--> <!-->80). After dialysis, myocardial ischemia was assessed using stress myocardial perfusion imaging (MPI) (Pharmacologic stress testing using Dipyridamole) and is further classified as mild, moderate or severe ischemia. Patients with sepsis, hemoglobin level less than 9<!--> <!-->g/dL, diabetes mellitus, low cardiac output, coronary artery disease, significant valvular lesion or body weight below the dry weight of the patient were excluded from the study. Bronchial asthma, emphysema and severe COPD are contraindications to Dipyridamole and thus were also excluded from the study.</p></div><div><h3>Results</h3><p>Twenty patients had no or mild intradialytic hypotension whereas ten patients had moderate or severe hypotension. Among the first group, only two patients (10%) were found to have myocardial ischemia, while in the latter group, seven patients (70%) had myocardial ischemia that’s mostly moderate (<em>p</em> <!-->=<!--> <!-->0.002). Stress induced LV dysfunction was also significantly prevalent in patients with moderate or severe intradialytic hypotension as opposed to other group (<em>p</em> <!-->=<!--> <!-->0.002) LVED.</p></div><div><h3>Conclusions</h3><p>Patients with CKD and regular hemodialysis who experience moderate or severe intradialytic hypotension have significantly higher prevalence of myocardial ischemia and stress induced myocardial dysfunction, than those who experience no or mild intradialytic hypotension.</p></div>","PeriodicalId":31233,"journal":{"name":"Egyptian Journal of Critical Care Medicine","volume":"2 1","pages":"Pages 13-18"},"PeriodicalIF":0.3,"publicationDate":"2014-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.ejccm.2014.05.001","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127406807","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prognostic value of T peak-to-end interval for risk stratification after acute myocardial infarction","authors":"Tarek Mohamed Abdelrahman","doi":"10.1016/j.ejccm.2014.09.001","DOIUrl":"10.1016/j.ejccm.2014.09.001","url":null,"abstract":"<div><h3>Aim</h3><p>Fatal arrhythmia is the main cause of sudden death in patients with acute myocardial infarction either during hospital admission or in post-discharge period. Our aim is to identify groups at high risk of arrhythmic mortality by using a simple bed-side test in electrocardiogram.</p></div><div><h3>Background</h3><p>Trans-mural dispersion of repolarization (TDR) in patients with ST elevation myocardial infarction is the main trigger of arrhythmias. The potential value of measuring the interval between the peak and end of the T wave (Tpeak-Tend, Tp-Te) as an index of spatial dispersion of repolarization is a parameter thought to be capable of reflecting dispersion of repolarization and thus may be prognostic tool for detection of arrhythmic risk. Little is known about its use for identifying risk of arrhythmias in acute myocardial infarction and this must be approached with great caution and require careful validation.</p></div><div><h3>Methods</h3><p>A prospective analysis of data from 564 patients admitted to our CCU by acute myocardial infarction along a period of two years from January 2012 to December 2013 was done. After exclusion of valvular, congenital lesions, HOCM, IDCM, pericardial diseases, accessory pathway, any Bundle branch block, metabolic disorders and re-perfusion arrhythmia. Analysis of TpTe interval and its dispersion were done for all patients and a Holter-24<!--> <!-->h was performed after one month. Patients were then classified into two groups based on Lown grading score for arrhythmia: group (I) (441 patients) with no or minimal arrhythmias (Lown score &lt;3), and group (II) (123) with high grade arrhythmias (Lown score ⩾3). In-hospital predischarge echocardiography was done for all patients to evaluate left ventricular functions and presence of myocardial aneurysm. Signal average ECG was done to detect low amplitude signals (LAS). Pre-discharge coronary angiography was done for all patients.</p></div><div><h3>Results</h3><p>Statistical analysis of the results revealed that, group (II) patients carry a significantly higher number of obese, diabetic, and hypertensive patients. Most of patients in this group were smokers, having higher creatinine levels, and exposed previously to cerebral insults in significantly higher values than group (I). Also, group (II) patients need significantly higher doses of diuretic and ACEIs than group (I). The percentage of anterior wall infarction is significantly higher in group (II), with higher inferior wall affection in group (I). TpTe interval and dispersion between both groups revealed that, a higher TpTe interval was found in group (II) than group (I) and this was linked to occurrence of sudden death or malignant VT and deterioration in Lv functions than in group (I). Also, patients in group (II) exposed to re-infarction and cardiogenic shock in statistically significant values (<em>P</em> <!-->&lt;<!--> <!-->0.01) than group (I).</p></div><div><h3>Conclusion</h3><p>TpT","PeriodicalId":31233,"journal":{"name":"Egyptian Journal of Critical Care Medicine","volume":"2 1","pages":"Pages 19-27"},"PeriodicalIF":0.3,"publicationDate":"2014-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.ejccm.2014.09.001","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129979184","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}