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Matej Podbregar - One of the best experts on this subject based on the ideXlab platform.
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Monitoring mixed venous oxygen saturation in patients with Obstructive Shock after massive pulmonary embolism
Wiener Klinische Wochenschrift, 2004Co-Authors: Bojan Krivec, Gorazd Voga, Matej PodbregarAbstract:Patients with massive pulmonary embolism and Obstructive Shock usually require hemodynamic stabilization and thrombolysis. Little is known about the optimal and proper use of volume infusion and vasoactive drugs, or about the titration of thrombolytic agents in patients with relative contraindication for such treatment. The aim of the study was to find the most rapidly changing hemodynamic variable to monitor and optimize the treatment of patients with Obstructive Shock following massive pulmonary embolism. Ten consecutive patients hospitalized in the medical intensive care unit in the community General Hospital with Obstructive Shock following massive pulmonary embolism were included in the prospective observational study. Heart rate, systolic arterial pressure, central venous pressure, mean pulmonary-artery pressure, cardiac index, total pulmonary vascular-resistance index, mixed venous oxygen saturation, and urine output were measured on admission and at 1, 2, 3, 4, 8, 12, and 16 hours. Patients were treated with urokinase through the distal port of a pulmonary-artery catheter. At 1 hour, mixed venous oxygen saturation, systolic arterial pressure and cardiac index were higher than their admission values (31±10 vs. 49±12%, p
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Monitoring mixed venous oxygen saturation in patients with Obstructive Shock after massive pulmonary embolism.
Wiener klinische Wochenschrift, 2004Co-Authors: Bojan Krivec, Gorazd Voga, Matej PodbregarAbstract:Patients with massive pulmonary embolism and Obstructive Shock usually require hemodynamic stabilization and thrombolysis. Little is known about the optimal and proper use of volume infusion and vasoactive drugs, or about the titration of thrombolytic agents in patients with relative contraindication for such treatment. The aim of the study was to find the most rapidly changing hemodynamic variable to monitor and optimize the treatment of patients with Obstructive Shock following massive pulmonary embolism. Ten consecutive patients hospitalized in the medical intensive care unit in the community General Hospital with Obstructive Shock following massive pulmonary embolism were included in the prospective observational study. Heart rate, systolic arterial pressure, central venous pressure, mean pulmonary-artery pressure, cardiac index, total pulmonary vascular-resistance index, mixed venous oxygen saturation, and urine output were measured on admission and at 1, 2, 3, 4, 8, 12, and 16 hours. Patients were treated with urokinase through the distal port of a pulmonary-artery catheter. At 1 hour, mixed venous oxygen saturation, systolic arterial pressure and cardiac index were higher than their admission values (31+/-10 vs. 49+/-12%, p<0.0001; 86+/-12 vs. 105+/-17 mmHg, p<0.01; 1.5+/-0.4 vs. 1.9+/-0.7 L/min/m2, p<0.05; respectively), whereas heart rate, central venous pressure, mean pulmonary-artery pressure and urine output remained unchanged. Total pulmonary vascular-resistance index was lower than at admission (29+/-10 vs. 21+/-12 mmHg/L/min/m2, p<0.05). The relative change of mixed venous oxygen saturation at hour 1 was higher than the relative changes of all other studied variables (p<0.05). Serum lactate on admission and at 12 hours correlated to mixed venous oxygen saturation (r=-0.855, p<0.001). In Obstructive Shock after massive pulmonary embolism, mixed venous oxygen saturation changes more rapidly than other standard hemodynamic variables.
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Monitoring mixed venous oxygen saturation in patients with Obstructive Shock after massive pulmonary embolism
Wiener Klinische Wochenschrift, 2004Co-Authors: Bojan Krivec, Gorazd Voga, Matej PodbregarAbstract:Background Patients with massive pulmonary embolism and Obstructive Shock usually require hemodynamic stabilization and thrombolysis. Little is known about the optimal and proper use of volume infusion and vasoactive drugs, or about the titration of thrombolytic agents in patients with relative contraindication for such treatment. The aim of the study was to find the most rapidly changing hemodynamic variable to monitor and optimize the treatment of patients with Obstructive Shock following massive pulmonary embolism. Patients and methods Ten consecutive patients hospitalized in the medical intensive care unit in the community General Hospital with Obstructive Shock following massive pulmonary embolism were included in the prospective observational study. Heart rate, systolic arterial pressure, central venous pressure, mean pulmonary-artery pressure, cardiac index, total pulmonary vascular-resistance index, mixed venous oxygen saturation, and urine output were measured on admission and at 1, 2, 3, 4, 8, 12, and 16 hours. Patients were treated with urokinase through the distal port of a pulmonary-artery catheter. Results At 1 hour, mixed venous oxygen saturation, systolic arterial pressure and cardiac index were higher than their admission values (31±10 vs. 49±12%, p
Eichi Narimatsu - One of the best experts on this subject based on the ideXlab platform.
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how to manage tension gastrothorax a case report of tension gastrothorax with multiple trauma due to traumatic diaphragmatic rupture
International Journal of Emergency Medicine, 2017Co-Authors: Naofumi Bunya, Keigo Sawamoto, Shuji Uemura, Takashi Toyohara, Yukino Mori, Ryoko Kyan, Kei Miyata, Hideto Irifune, Keisuke Harada, Eichi NarimatsuAbstract:Tension gastrothorax is a kind of Obstructive Shock with prolapse and distention of the stomach into the thoracic cavity. Progressive gastric distension leads to mediastinal shift, reduced venous return, decreased cardiac output, and ultimately cardiac arrest. Therefore, it is crucial to decompress the stomach distension for the initial resuscitation of tension gastrothorax. A 75-year-old female was transported to our resuscitation bay due to motor vehicle crash. At the time of arrival to our hospital, the patient developed cardiac arrest. While undergoing cardiopulmonary resuscitation, an unstable pelvic ring was recognized, so we performed a resuscitative thoracotomy to control hemorrhage and to perform direct cardiac massage. Once we performed the thoracotomy, the stomach and omentum prolapsed out of the thoracotomy site and through the diaphragm rupture site and spontaneous circulation was recovered. Neither the descending aorta nor the heart was collapsed. Although we had continued the treatment for severe pelvic fracture (including blood transufusions), the patient died. Given that (1) the stomach prolapsed out of the body at the time of the thoracotomy; (2) at the same timing, spontaneous circulation returned; and (3) the descending aorta and heart did not collapse, we hypothesized that the main cause of the initial cardiac arrest was tension gastrothorax. Recognition of tension gastrothorax pathophysiology, which is a form of Obstructive Shock, makes it possible to manage this injury correctly.
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How to manage tension gastrothorax: a case report of tension gastrothorax with multiple trauma due to traumatic diaphragmatic rupture
International Journal of Emergency Medicine, 2017Co-Authors: Naofumi Bunya, Keigo Sawamoto, Shuji Uemura, Takashi Toyohara, Yukino Mori, Ryoko Kyan, Kei Miyata, Hideto Irifune, Keisuke Harada, Eichi NarimatsuAbstract:Background Tension gastrothorax is a kind of Obstructive Shock with prolapse and distention of the stomach into the thoracic cavity. Progressive gastric distension leads to mediastinal shift, reduced venous return, decreased cardiac output, and ultimately cardiac arrest. Therefore, it is crucial to decompress the stomach distension for the initial resuscitation of tension gastrothorax. Case presentation A 75-year-old female was transported to our resuscitation bay due to motor vehicle crash. At the time of arrival to our hospital, the patient developed cardiac arrest. While undergoing cardiopulmonary resuscitation, an unstable pelvic ring was recognized, so we performed a resuscitative thoracotomy to control hemorrhage and to perform direct cardiac massage. Once we performed the thoracotomy, the stomach and omentum prolapsed out of the thoracotomy site and through the diaphragm rupture site and spontaneous circulation was recovered. Neither the descending aorta nor the heart was collapsed. Although we had continued the treatment for severe pelvic fracture (including blood transufusions), the patient died. Given that (1) the stomach prolapsed out of the body at the time of the thoracotomy; (2) at the same timing, spontaneous circulation returned; and (3) the descending aorta and heart did not collapse, we hypothesized that the main cause of the initial cardiac arrest was tension gastrothorax. Conclusions Recognition of tension gastrothorax pathophysiology, which is a form of Obstructive Shock, makes it possible to manage this injury correctly.
R Alcázar - One of the best experts on this subject based on the ideXlab platform.
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Obstructive Shock due to labor-related diaphragmatic hernia.
Critical care medicine, 1998Co-Authors: Julián Ortega-carnicer, Alfonso Ambrós, R AlcázarAbstract:Objective To report diaphragmatic hernia as a cause of obstrucive Shock in the peripartum period. Design Case report. Setting An adult, 12-bed medical/surgical intensive care unit of a general hospital. Patients One patient who developed an Obstructive Shock following vaginal labor and was transferred under mechanical ventilation from a local hospital. Interventions Central venous pressure, blood pressure, blood gas analysis, electrocardiogram, and chest radiograph during and after Obstructive Shock. Measurements and Main Results During Shock, systolic blood pressure was 60 mm Hg, central venous pressure was +12 mm Hg, and the electrocardiogram showed a supraventricular tachycardia and an acute cor pulmonale pattern. Chest radiograph showed signs of left diaphragmatic hernia and right mediastinal shift. Chest ultrasound examination demonstrated loops of bowel in the left pleural space. After surgical resolution of the left diaphragmatic hernia, the patient's blood pressure increased to 120/80 mm Hg, the central venous pressure decreased to +1 mm Hg, and the PaO2 increased to 154 torr (20.5 kPa) while receiving mechanical ventilation with an FiO2 of 50%. The electrocardiogram showed disappearance of the acute cor pulmonale pattern. The chest radiograph showed a central venous catheter located in a persistent left superior vena cava without abnormalities of the diaphragm, the mediastinum, or the lung. Conclusion Diaphragmatic hernia must be included in the differential diagnosis of Obstructive Shock in pregnant patients. (Crit Care Med 1998; 26:616-618)
Hideo Yasunaga - One of the best experts on this subject based on the ideXlab platform.
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Early enteral nutrition for cardiogenic or Obstructive Shock requiring venoarterial extracorporeal membrane oxygenation: a nationwide inpatient database study
Intensive Care Medicine, 2018Co-Authors: Hiroyuki Ohbe, Hayato Yamana, Hiroki Matsui, Kiyohide Fushimi, Hideo YasunagaAbstract:Purpose Despite extensive research on enteral nutrition (EN) for patients in Shock, it remains unclear whether this should be postponed in patients with cardiogenic or Obstructive Shock requiring venoarterial extracorporeal membrane oxygenation (VA-ECMO). In this study, we aimed to compare outcomes of early and delayed EN for patients with cardiogenic or Obstructive Shock requiring VA-ECMO. Methods In this retrospective database study drawing on the Japanese Diagnosis Procedure Combination inpatient database from July 2010 to March 2016, we identified patients with cardiogenic or Obstructive Shock who had received VA-ECMO for more than 2 days. We allocated the patients to two groups: those who received EN within 2 days (early) or 3 days or more (delayed) after starting VA-ECMO. We then used a marginal structural model to analyze associations between early EN and various outcomes, including in-hospital mortality and 28-day mortality. Results We identified 1769 eligible patients during the 69-month study period, 220 of whom (12%) received early EN. After using a marginal structural model to adjust for baseline and time-dependent confounders, we found that the early EN group showed significantly lower in-hospital mortality [hazard ratio 0.78, 95% confidence interval (95% CI) 0.62–0.98, P = 0.032] and lower 28-day mortality (hazard ratio 0.74, 95% CI 0.56–0.97, P = 0.031) than the delayed EN group. Conclusions According to this retrospective database study, early EN is not associated with harm but rather with lower mortality in patients with cardiogenic or Obstructive Shock requiring at least 2 days of VA-ECMO.
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Early enteral nutrition for cardiogenic or Obstructive Shock requiring venoarterial extracorporeal membrane oxygenation: a nationwide inpatient database study
Intensive care medicine, 2018Co-Authors: Hiroyuki Ohbe, Hayato Yamana, Hiroki Matsui, Kiyohide Fushimi, Hideo YasunagaAbstract:Purpose Despite extensive research on enteral nutrition (EN) for patients in Shock, it remains unclear whether this should be postponed in patients with cardiogenic or Obstructive Shock requiring venoarterial extracorporeal membrane oxygenation (VA-ECMO). In this study, we aimed to compare outcomes of early and delayed EN for patients with cardiogenic or Obstructive Shock requiring VA-ECMO.
Ming-jui Hung - One of the best experts on this subject based on the ideXlab platform.
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Tension pneumothorax-induced Takotsubo syndrome: A case report.
Medicine, 2019Co-Authors: Wei-siang Chen, Ming-jui HungAbstract:Rationale Takotsubo syndrome (TTS) is a form of acute and usually reversible heart failure syndrome. Transient left ventricular dysfunction and electrocardiographic changes could mimic acute coronary syndrome but there are actually no Obstructive coronary lesions. Patient concerns A 76-year-old woman with chronic lung disease developed spontaneous tension pneumothorax with the presentation of severe dyspnea, respiratory failure, left ventricular dysfunction, and anterior wall ST-segment elevation on 12-lead electrocardiogram. Acute coronary syndrome was excluded by normal coronary angiograms. Diagnosis The patient was diagnosed as tension pneumothorax complicated by TTS. Interventions The woman underwent tubal thoracostomy for tension pneumothorax-induced Obstructive Shock. However, the patient further underwent ligation bullectomy for persistent air leakage 2 weeks later. Outcomes The left ventricular dysfunction recovered 1 week after resolution of tension pneumothorax. Anterior wall ST-segment elevation resolved 25 days after admission. Lessons Concurrent electrocardiograms and echocardiographic serial evaluations should be performed to provide more comprehensive information when dealing with tension pneumothorax patients.
