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Emilio B Lobato - One of the best experts on this subject based on the ideXlab platform.
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treatment with phosphodiesterase inhibitors type iii and v milrinone and sildenafil is an effective combination during thromboxane induced acute pulmonary hypertension
BJA: British Journal of Anaesthesia, 2006Co-Authors: Thomas M Beaver, Jochen D Muehlschlegel, David S Kirby, Emilio B Lobato, Charles T Klodell, Avner SidiAbstract:Objectives. To evaluate the effects of phosphodiesterase type III and V (PDEIII and PDEV) inhibition on pulmonary and systemic haemodynamics in a porcine model of acute pulmonary hypertension. Methods. Twenty-four adult swine were anaesthetized with 1 MAC isoflurane and mechanically ventilated with an FIO2 of 100%. Micromanometer-tipped catheters were placed in the ascending aorta, pulmonary artery and right ventricle. Pulmonary flow was measured with a perivascular probe using transit time ultrasound. Pulmonary hypertension was induced with a continuous infusion of the thromboxane analogue, U46619. The animals were then randomized to four groups: Group 1 (n=6) received 50 mg of sildenafil (PDEV inhibitor) diluted in water via an Orogastric Tube; Group 2 (n=6) received 50 m gk g 1 of i.v. milrinone (PDEIII inhibitor); Group 3 (n=6) received sildenafil followed by milrinone; and Group 4 (n=6) received placebo via an Orogastric Tube. Results. Pulmonary hypertension was achieved in all animals. Calculated pulmonary vascular resistance decreased by an average of 36% after sildenafil (P<0.05), 41% after milrinone (P<0.05), and 61% with both drugs combined (P<0.05). Systemic vascular resistance decreased by 37% (P<0.05) with milrinone alone, and 36% (P<0.05) with milrinone and sildenafil combined but it was preserved in the sildenafil group. Cardiac output and right ventricular dP/dT were significantly improved after milrinone or both drugs combined, but not with sildenafil. Conclusion. Milrinone and sildenafil are effective pulmonary vasodilators, with independent action and additive effect. Both drugs combined achieved a better haemodynamic profile, with greater pulmonary vasodilatation and increased contractility but without additional systemic vasodilatation. The systemic haemodynamic profile (systemic vasodilation, cardiac output, right ventricular dP/dT) is improved with milrinone but not with sildenafil. Br J Anaesth 2006; 95: 317–22
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treatment with phosphodiesterase inhibitors type iii and v milrinone and sildenafil is an effective combination during thromboxane induced acute pulmonary hypertension
BJA: British Journal of Anaesthesia, 2006Co-Authors: Thomas M Beaver, Jochen D Muehlschlegel, David S Kirby, Emilio B Lobato, Charles T Klodell, Avner SidiAbstract:Objectives. To evaluate the effects of phosphodiesterase type III and V (PDEIII and PDEV) inhibition on pulmonary and systemic haemodynamics in a porcine model of acute pulmonary hypertension. Methods. Twenty-four adult swine were anaesthetized with 1 MAC isoflurane and mechanically ventilated with an FIO2 of 100%. Micromanometer-tipped catheters were placed in the ascending aorta, pulmonary artery and right ventricle. Pulmonary flow was measured with a perivascular probe using transit time ultrasound. Pulmonary hypertension was induced with a continuous infusion of the thromboxane analogue, U46619. The animals were then randomized to four groups: Group 1 (n=6) received 50 mg of sildenafil (PDEV inhibitor) diluted in water via an Orogastric Tube; Group 2 (n=6) received 50 m gk g 1 of i.v. milrinone (PDEIII inhibitor); Group 3 (n=6) received sildenafil followed by milrinone; and Group 4 (n=6) received placebo via an Orogastric Tube. Results. Pulmonary hypertension was achieved in all animals. Calculated pulmonary vascular resistance decreased by an average of 36% after sildenafil (P<0.05), 41% after milrinone (P<0.05), and 61% with both drugs combined (P<0.05). Systemic vascular resistance decreased by 37% (P<0.05) with milrinone alone, and 36% (P<0.05) with milrinone and sildenafil combined but it was preserved in the sildenafil group. Cardiac output and right ventricular dP/dT were significantly improved after milrinone or both drugs combined, but not with sildenafil. Conclusion. Milrinone and sildenafil are effective pulmonary vasodilators, with independent action and additive effect. Both drugs combined achieved a better haemodynamic profile, with greater pulmonary vasodilatation and increased contractility but without additional systemic vasodilatation. The systemic haemodynamic profile (systemic vasodilation, cardiac output, right ventricular dP/dT) is improved with milrinone but not with sildenafil. Br J Anaesth 2006; 95: 317–22
Vikhyat S Bebarta - One of the best experts on this subject based on the ideXlab platform.
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efficacy of oral administration of sodium thiosulfate in a large swine model of oral cyanide toxicity
Journal of Medical Toxicology, 2021Co-Authors: Tara B Hendryhofer, Vikhyat S Bebarta, Sari B Mahon, Matthew Brenner, Gerry R Boss, Joseph K MaddryAbstract:Cyanide is a deadly poison, particularly with oral exposure where larger doses can occur before symptoms develop. Prior studies and multiple governmentagencies highlight oral cyanide as an agent with the potential for use in a terrorist attack. Currently, there are no FDA approved antidotes specific to oralcyanide. An oral countermeasure that can neutralize and prevent absorption of cyanide from the GI tract after oral exposure is needed. Our objective was toevaluate the efficacy of oral sodium thiosulfate on survival and clinical outcomes in a large, swine model of severe cyanide toxicity. Swine (45-55kg) were instrumented, sedated, and stabilized. Potassium cyanide (8 mg/kg KCN) in saline was delivered as a one-time bolus via an Orogastric Tube. Three minutes after cyanide, animals randomized to the treatment group received sodium thiosulfate (510 mg/kg, 3.25 M solution) via Orogastric Tube. Our primary outcome was survival at 60 minutes after exposure. We compared survival between groups by log-rank, Mantel-Cox analysis and trended labs and vital signs. At baseline and time of treatment all animals had similar weights, vital signs, and laboratory values. Survival at 60 min was 100% in treated animals compared to 0% in the control group (p=0.0027). Animals in the control group became apneic and subsequently died by 35.0 min (20.2,48.5) after cyanide exposure. Mean arterial pressure was significantly higher in the treatment group compared to controls (p=0.008). Blood lactate (p=0.02) and oxygen saturation (p=0.02) were also significantly different between treatment and control groups at study end. Oral administration of sodium thiosulfate improved survival, blood pressure, respirations, and blood lactate concentrations in a large animal model of acute oral cyanide toxicity.
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efficacy of oral administration of sodium thiosulfate and glycine in a large swine model of oral cyanide toxicity
Annals of Emergency Medicine, 2019Co-Authors: Tara B Hendryhofer, Vikhyat S Bebarta, Sari B Mahon, Matthew Brenner, Gerry R Boss, Alyssa E WiteofAbstract:Study objective Cyanide is a deadly poison, particularly with oral exposure, in which larger doses can occur before any symptoms develop. Multiple governmental agencies highlight oral cyanide as an agent that can be used in a terrorist attack because it can be easily weaponized and is readily available. Currently, there are no Food and Drug Administration–approved antidotes specifically for oral cyanide. An oral countermeasure that can neutralize and prevent absorption of cyanide from the gastrointestinal tract after oral exposure is needed. The objective of this study is to determine if the combination of glycine and sodium thiosulfate administered orally is effective in reducing mortality in a large, swine model of oral cyanide toxicity. Methods Nine swine (45 to 55 kg) were instrumented, sedated, and stabilized. Potassium cyanide (at 8 mg/kg) in saline solution was delivered as a onetime bolus through an Orogastric Tube. Three minutes after cyanide administration, animals that were randomized to the treatment group received sodium thiosulfate (508.2 mg/kg, 3.25-M solution) and glycine (30 mg/kg, 3.5-M solution) through an Orogastric Tube. Survival at 60 minutes was the primary outcome. We compared survival between groups by log-rank Mantel-Cox analysis and trended laboratory results and vital signs. Results At baseline and treatment, all animals were similar. Survival at 60 minutes was 100% in treated animals compared with 0% in the control group (P=.003). By the study end, defined as death or 60 minutes after cyanide administration, there was a significant difference in the lactate concentration between the treatment and control groups (control 9.43 mmol/L [SD 4.08]; treatment 1.66 mmol/L [SD 0.82]; difference between means 7.69 mmol/L [SD 2.07]; 95% confidence interval difference –14.05 to –1.32). Mean arterial pressure was significantly different between the treatment and control groups at study end (control 26 mm Hg [SD 6.7]; treatment 81 mm Hg [SD 14]; difference between means 55.2 mm Hg [SD 7.1]; 95% confidence interval difference 37.8 to 72.6). pH and oxygen saturation were also significantly different between the treatment and control groups at study end. Conclusion The combination of oral sodium thiosulfate and glycine significantly improved survival and physiologic parameters in a large-animal model of oral cyanide toxicity.
Avner Sidi - One of the best experts on this subject based on the ideXlab platform.
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treatment with phosphodiesterase inhibitors type iii and v milrinone and sildenafil is an effective combination during thromboxane induced acute pulmonary hypertension
BJA: British Journal of Anaesthesia, 2006Co-Authors: Thomas M Beaver, Jochen D Muehlschlegel, David S Kirby, Emilio B Lobato, Charles T Klodell, Avner SidiAbstract:Objectives. To evaluate the effects of phosphodiesterase type III and V (PDEIII and PDEV) inhibition on pulmonary and systemic haemodynamics in a porcine model of acute pulmonary hypertension. Methods. Twenty-four adult swine were anaesthetized with 1 MAC isoflurane and mechanically ventilated with an FIO2 of 100%. Micromanometer-tipped catheters were placed in the ascending aorta, pulmonary artery and right ventricle. Pulmonary flow was measured with a perivascular probe using transit time ultrasound. Pulmonary hypertension was induced with a continuous infusion of the thromboxane analogue, U46619. The animals were then randomized to four groups: Group 1 (n=6) received 50 mg of sildenafil (PDEV inhibitor) diluted in water via an Orogastric Tube; Group 2 (n=6) received 50 m gk g 1 of i.v. milrinone (PDEIII inhibitor); Group 3 (n=6) received sildenafil followed by milrinone; and Group 4 (n=6) received placebo via an Orogastric Tube. Results. Pulmonary hypertension was achieved in all animals. Calculated pulmonary vascular resistance decreased by an average of 36% after sildenafil (P<0.05), 41% after milrinone (P<0.05), and 61% with both drugs combined (P<0.05). Systemic vascular resistance decreased by 37% (P<0.05) with milrinone alone, and 36% (P<0.05) with milrinone and sildenafil combined but it was preserved in the sildenafil group. Cardiac output and right ventricular dP/dT were significantly improved after milrinone or both drugs combined, but not with sildenafil. Conclusion. Milrinone and sildenafil are effective pulmonary vasodilators, with independent action and additive effect. Both drugs combined achieved a better haemodynamic profile, with greater pulmonary vasodilatation and increased contractility but without additional systemic vasodilatation. The systemic haemodynamic profile (systemic vasodilation, cardiac output, right ventricular dP/dT) is improved with milrinone but not with sildenafil. Br J Anaesth 2006; 95: 317–22
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treatment with phosphodiesterase inhibitors type iii and v milrinone and sildenafil is an effective combination during thromboxane induced acute pulmonary hypertension
BJA: British Journal of Anaesthesia, 2006Co-Authors: Thomas M Beaver, Jochen D Muehlschlegel, David S Kirby, Emilio B Lobato, Charles T Klodell, Avner SidiAbstract:Objectives. To evaluate the effects of phosphodiesterase type III and V (PDEIII and PDEV) inhibition on pulmonary and systemic haemodynamics in a porcine model of acute pulmonary hypertension. Methods. Twenty-four adult swine were anaesthetized with 1 MAC isoflurane and mechanically ventilated with an FIO2 of 100%. Micromanometer-tipped catheters were placed in the ascending aorta, pulmonary artery and right ventricle. Pulmonary flow was measured with a perivascular probe using transit time ultrasound. Pulmonary hypertension was induced with a continuous infusion of the thromboxane analogue, U46619. The animals were then randomized to four groups: Group 1 (n=6) received 50 mg of sildenafil (PDEV inhibitor) diluted in water via an Orogastric Tube; Group 2 (n=6) received 50 m gk g 1 of i.v. milrinone (PDEIII inhibitor); Group 3 (n=6) received sildenafil followed by milrinone; and Group 4 (n=6) received placebo via an Orogastric Tube. Results. Pulmonary hypertension was achieved in all animals. Calculated pulmonary vascular resistance decreased by an average of 36% after sildenafil (P<0.05), 41% after milrinone (P<0.05), and 61% with both drugs combined (P<0.05). Systemic vascular resistance decreased by 37% (P<0.05) with milrinone alone, and 36% (P<0.05) with milrinone and sildenafil combined but it was preserved in the sildenafil group. Cardiac output and right ventricular dP/dT were significantly improved after milrinone or both drugs combined, but not with sildenafil. Conclusion. Milrinone and sildenafil are effective pulmonary vasodilators, with independent action and additive effect. Both drugs combined achieved a better haemodynamic profile, with greater pulmonary vasodilatation and increased contractility but without additional systemic vasodilatation. The systemic haemodynamic profile (systemic vasodilation, cardiac output, right ventricular dP/dT) is improved with milrinone but not with sildenafil. Br J Anaesth 2006; 95: 317–22
T Piepho - One of the best experts on this subject based on the ideXlab platform.
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the Orogastric Tube guide as a novel strategy for gastric Tube insertion a prospective randomized controlled clinical trial
Minerva Anestesiologica, 2020Co-Authors: Marc Kriege, Christian Alflen, Irene Schmidtmann, Rudiger Noppens, Florian Heid, Frank Dette, T PiephoAbstract:BACKGROUND Gastric Tube insertion, either orally or nasally, is daily practice in anesthesia and intensive care. "Blind" insertion represents the common conventional method and is associated with low first-pass success and frequent complications. This trial aimed to evaluate the novel gastric Tube guide as a rigid conduit in regard to insertion success rate, time required and associated complications versus the conventional "blind" insertion method. We hypothesized that the insertion success rate is higher using the Orogastric Tube guide. METHODS This trial was approved by ethics committee prior to patient recruitment. In a randomized order, anesthetists performed oral insertion of a gastric Tube either with the Orogastric Tube guide (GTG) or by conventional "blind" technique (CONV) in elective surgical patients. Exclusion criteria were defined as age under 18 years, pregnancy, emergency surgery and patients without indication for tracheal intubation and gastric Tube insertion. RESULTS We examined 151 patients (GTG, N.=71; CONV, N.=80). The success rate was higher with the GTG compared to the conventional method (69/71 (97%) vs. 61/80 (76%); P<0.001). The median insertion time was 25 s (IQR 20-39) using the GTG and 31 s (IQR 24-58; P=0.027) with the conventional method. We found no differences with regard to complications between the groups (P=0.54). CONCLUSIONS Our findings suggest that the use of the GTG facilitates and fastens Orogastric Tube placement in anesthetized patients and thereby constitutes a benefit in clinical routine.
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Orogastric Tube insertion using the new gastric Tube guide first experiences from a manikin study
BMC Anesthesiology, 2017Co-Authors: Christian Alflen, Marc Kriege, Irene Schmidtmann, Rudiger Noppens, T PiephoAbstract:Orogastric Tube placement is a common procedure routinely used in clinical anesthesiology and intensive care medicine. Nevertheless high failure rates and severe complications have been reported. We conducted this study to evaluate if the usage of the new gastric Tube guide would speed up the placement of Orogastric Tubes and ease the procedure. Thirty one professionals were given a hands-on-training in Orogastric Tube placement in a simulation manikin without and with the gastric Tube guide. Afterwards they performed both methods in randomized order. We recorded the placement time, counted the required attempts and asked the participants to rate their experience with both methods. The median placement time using the gastric Tube guide was 14 s compared to 25 s without the device. In addition all participants were able to place the Orogastric Tube when using the gastric Tube guide compared to 26/31 (84%) without it. Furthermore 26/31 (84%) users preferred the gastric Tube guide over the standard method. Our results show that using the gastric Tube guide to place Orogastric Tubes in a manikin led to a significant shorter placement time and a higher overall success rate.
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Orogastric Tube insertion using the new gastric Tube guide: first experiences from a manikin study
'Springer Science and Business Media LLC', 2017Co-Authors: Christian Alflen, Marc Kriege, Irene Schmidtmann, Rudiger Noppens, T PiephoAbstract:Abstract Background Orogastric Tube placement is a common procedure routinely used in clinical anesthesiology and intensive care medicine. Nevertheless high failure rates and severe complications have been reported. We conducted this study to evaluate if the usage of the new gastric Tube guide would speed up the placement of Orogastric Tubes and ease the procedure. Methods Thirty one professionals were given a hands-on-training in Orogastric Tube placement in a simulation manikin without and with the gastric Tube guide. Afterwards they performed both methods in randomized order. We recorded the placement time, counted the required attempts and asked the participants to rate their experience with both methods. Results The median placement time using the gastric Tube guide was 14 s compared to 25 s without the device. In addition all participants were able to place the Orogastric Tube when using the gastric Tube guide compared to 26/31 (84%) without it. Furthermore 26/31 (84%) users preferred the gastric Tube guide over the standard method. Conclusion Our results show that using the gastric Tube guide to place Orogastric Tubes in a manikin led to a significant shorter placement time and a higher overall success rate
T Ciszek - One of the best experts on this subject based on the ideXlab platform.
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Orogastric Tube insertion length in very low birth weight infants
Journal of Perinatology, 1993Co-Authors: K J Gallaher, S Cashwell, V Hall, W Lowe, T CiszekAbstract:We determined the minimal insertion lengths for appropriate placement of Orogastric Tubes in very low birth weight infants (< 1500 gm). Feeding Tubes marked in centimeter increments were placed Orogastrically by using standard neonatal intensive care unit protocol. When radiographs were taken, the centimeter marking at the lip was recorded, and an investigator blinded to the recorded measurement scored the Orogastric Tube position on radiograph as high (too short), low (too far), or adequate. Data were collected until measurements were available for at least five separate infants for each 250 gm interval of birth weight < 1500 gm. A total of 188 radiographs in 31 consecutive, appropriately grown, very low birth weight infants were reviewed. Seventeen (9%) could not be interpreted because of radiographic technique or because the tip of the Orogastric Tube was not visible. Of the 171 radiographs suitable for review, the Orogastric Tube position was low in 8 (5%), high in 57 (33%), and in adequate position in 106 (62%). When data were stratified according to weight groups, minimum insertion lengths were identified, and provided clear and statistically significant separation for Orogastric Tubes positioned adequately versus those positioned high. The number of Orogastric Tubes positioned low was too small to provide meaningful information. This information was then used prospectively to assist in Orogastric Tube(s) position, with a subsequent increase in the percentage of Orogastric Tubes positioned adequately to 86%. This study confirms that there are minimum Orogastric Tube insertion lengths required for adequate intragastric positioning. Paying attention to this information can decrease the number of Orogastric Tubes that are positioned in the esophagus.