Walterspacher S.,Cardiology and Intensive Care Medicine |
Walterspacher S.,Witten/Herdecke University |
Guckler J.,University Hospital Freiburg |
Pietsch F.,University Hospital Freiburg |
And 5 more authors.
Journal of Critical Care | Year: 2017
Purpose Respiratory muscle dysfunction is a key component of weaning failure. Balancing respiratory muscle loading and unloading by applying different ventilation modes along with spontaneous breathing episodes are established weaning strategies. However, the effects of body positioning on the respiratory muscles during weaning remains unclear. Materials and methods This study aimed at assessing respiratory drive by surface electromyography (EMG) of the diaphragm (EMGdia) and parasternal muscles (EMGpara) in tracheotomized patients during prolonged weaning in 3 randomized body positions—supine, 30° semirecumbent, and 80° sitting—during mechanical ventilation and spontaneous breathing. Results Nine patients were included for analysis. Cardiorespiratory parameters (heart rate, blood pressure, arterial oxygen saturation, dyspnea) did not change under each condition (all P > .05). EMGpara and EMGdia did not change under mechanical ventilation (both P > .05). EMGdia changed under spontaneous breathing from supine to sitting (0.45 ± 0.26 vs 0.32 ± 0.19; P = .012) and between semirecumbent to sitting (0.41 ± 0.23 vs 0.32 ± 0.19; P = .039), whereas EMGpara did not change. Conclusions This is the first study to show that body positioning influences respiratory drive to the diaphragm in tracheotomized patients with prolonged weaning from mechanical ventilation during unassisted breathing. Sitting position reduces respiratory drive compared with semirecumbent and supine positioning and might therefore be favored during spontaneous breathing trials. © 2016 Elsevier Inc.
Lassnig E.,Cardiology and Intensive Care Medicine |
Dinkhauser P.,Cardiology and Intensive Care Medicine |
Maurer E.,Cardiology and Intensive Care Medicine |
Eber B.,Cardiology and Intensive Care Medicine
Wiener Klinische Wochenschrift | Year: 2014
Heat stroke is a life-threatening condition due to an acute thermoregulatory failure during exposure to high environmental temperatures. We report a series of four cases (three exertional, one classic heat stroke) during the heat wave of July 2013 in Austria. All of them presented with a core temperature >41°C, central nervous dysfunction, acute respiratory and renal failure, disseminated intravascular coagulation, rhabdomyolysis, and severe electrocardiographic changes, two cases even mimicking ST-elevation myocardial infarction. The patients were cooled to normal temperature with the "Arctic sun" external cooling system within hours. Electrocardiographic changes resolved quickly. All patients primarily recovered from multiple organ dysfunction and could be discharged from intensive care unit. Unfortunately, the two elder patients died 1 week and 5 weeks later because of late complications. © 2014 Springer-Verlag.
Kozarov E.,Columbia University |
Huber K.,Cardiology and Intensive Care Medicine |
Wojta J.,Medical University of Vienna
Current Pharmaceutical Design | Year: 2015
Atherosclerosis is a systemic inflammatory disease leading to lipid-laden inflammatory lesions in the arterial walls that may destabilize and rupture. It is becoming clear that addressing the “classical” risk factors for atherosclerosis does not entirely reduce the risk of cardiovascular events. Novel biomarkers to be used in highthroughput assays are necessary for diagnosis, for determination of the residual risk and for monitoring the effects of the therapy. Since inflammation is a hallmark of atherosclerosis, tests for pro-inflammatory biomarkers have been introduced such as for hsCRP, fibrinogen and IL-6, with many more at different stages of development. There has been a dearth of novel approaches for the diagnosis and management of atherosclerosis, reflected in a continuous reliance on LDL cholesterol as a proven target of investigations. To bring another perspective, here we briefly overview the accumulated epidemiological and sero-epidemiological evidence suggesting systemic infections as a component of atherosclerotic inflammations. We have shown that different individuals’ plaques are colonized with different bacterial species (atherosclerosis microbiota). Most of the time the pathogens are likely in an intracellular state, shielded from the host immune responses. There are controlled clinical trials and metaanalyses that corroborate the infections, specifically periodontal disease as a contributing risk factor of atherosclerosis. Infection-related markers, including transcriptome signatures, may identify latent infection patients with sub-clinical disease. Thus, the emerging infection- associated markers of inflammation could complement the existing ones and their use as companion diagnostics for atherosclerosis should stimulate the growing field of personalized medicine within cardiovascular diseases. © 2015 Bentham Science Publishers.
Montalescot G.,Group 47 |
Van't Hof A.W.,Isala Clinics |
Lapostolle F.,Service DAide Medicale Urgente 93 |
Silvain J.,Group 47 |
And 23 more authors.
New England Journal of Medicine | Year: 2014
BACKGROUND The direct-acting platelet P2Y12 receptor antagonist ticagrelor can reduce the incidence of major adverse cardiovascular events when administered at hospital admission to patients with ST-segment elevation myocardial infarction (STEMI). Whether prehospital administration of ticagrelor can improve coronary reperfusion and the clinical outcome is unknown.METHODS We conducted an international, multicenter, randomized, double-blind study involving 1862 patients with ongoing STEMI of less than 6 hours' duration, comparing prehospital (in the ambulance) versus in-hospital (in the catheterization laboratory) treatment with ticagrelor. The coprimary end points were the proportion of patients who did not have a 70% or greater resolution of ST-segment elevation before percutaneous coronary intervention (PCI) and the proportion of patients who did not have Thrombolysis in Myocardial Infarction flow grade 3 in the infarct-related artery at initial angiography. Secondary end points included the rates of major adverse cardiovascular events and definite stent thrombosis at 30 days.RESULTS The median time from randomization to angiography was 48 minutes, and the median time difference between the two treatment strategies was 31 minutes. The two coprimary end points did not differ significantly between the prehospital and inhospital groups. The absence of ST-segment elevation resolution of 70% or greater after PCI (a secondary end point) was reported for 42.5% and 47.5% of the patients, respectively. The rates of major adverse cardiovascular events did not differ significantly between the two study groups. The rates of definite stent thrombosis were lower in the prehospital group than in the in-hospital group (0% vs. 0.8% in the first 24 hours; 0.2% vs. 1.2% at 30 days). Rates of major bleeding events were low and virtually identical in the two groups, regardless of the bleeding definition used.Conclusions: Prehospital administration of ticagrelor in patients with acute STEMI appeared to be safe but did not improve pre-PCI coronary reperfusion. Copyright © 2014 Massachusetts Medical Society. All rights reserved.