British journal of anaesthesia
-
The ultrasound cardiac output monitor (USCOM) is a continuous wave Doppler system designed to measure cardiac output (CO) non-invasively and intermittently either from the pulmonary or from the aortic valve. USCOM scan quality is critical to obtaining reliable data and during anaesthesia it is said to deteriorate with increasing age. The aim of this study was to investigate the effect of age on supra-sternal USCOM scan repeatability during anaesthesia. ⋯ Increasing age has a significant effect on USCOM scan quality and data reliability.
-
Pain and renal dysfunction occur in sickle cell disease. Morphine used to treat pain also co-activates platelet-derived growth factor receptor-β (PDGFR-β), which can adversely affect renal disease. We examined the influence of morphine in mesangial cells in vitro and in mouse kidneys in vivo. ⋯ Morphine stimulates mitogenic signalling leading to mesangial cell proliferation and promotes renal dysfunction in sickle mice.
-
Blood flow patterns are important modifiers of platelet interactions with plasma coagulation factors. However, it is not feasible to evaluate rheological effects of haemodilution on coagulation using conventional coagulation testing. ⋯ Blood flow affects thrombus formation after haemodilution and subsequent haemostatic component interventions, with differential effects at low and high flow.
-
Randomized Controlled Trial
Open-label, phase II study of routine high-flow nasal oxygen therapy in cardiac surgical patients.
Respiratory complications after cardiac surgery increase morbidity, mortality, and length of stay. Studies suggest that routine delivery of positive airway pressure after extubation may be beneficial. We sought to determine whether the routine administration of nasal high-flow oxygen therapy (NHF) improves pulmonary function after cardiac surgery. ⋯ Routine use of NHF did not increase / ratio on Day 3 but did reduce the requirement for escalation of respiratory support.
-
Microcirculatory alterations play a central role in the pathophysiology of sepsis. We investigated probe-based confocal laser endomicroscopy (pCLE) to assess alterations in mucosal microcirculatory perfusion in vivo in a porcine model of septic shock and in patients fulfilling consensus criteria for severe sepsis. ⋯ pCLE reliably detected and quantified microcirculatory alterations in the gastrointestinal mucosa in a porcine model of sepsis and in patients with severe sepsis. Our data suggest that pCLE is a promising tool to assess the efficacy of therapeutic interventions on mucosal microcirculation in real-time, even in the clinical context.