Anesthesiology
Thushara Madathil; Cassie Carvalho; Sunil Rajan
Volume 10, Issue 1 , January 2024
Abstract
Objective: Fluids are administered to optimize hemodynamics during off-pump coronary arterybypass grafting (CABG), which may lead to a positive fluid balance and increased lung water,lung congestion, hypoxemia, prolonged mechanical ventilation, and longer hospital stays. Lungultrasound can assess extravascular ...
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Objective: Fluids are administered to optimize hemodynamics during off-pump coronary arterybypass grafting (CABG), which may lead to a positive fluid balance and increased lung water,lung congestion, hypoxemia, prolonged mechanical ventilation, and longer hospital stays. Lungultrasound can assess extravascular lung water and help titrate diuretics and fluids, thus preventinghypoxemia. The primary objective of this study was to study the correlation between B-line scoresmeasured by lung ultrasound and the PaO2/FiO2 ratio (the ratio of arterial partial pressure of oxygento fractional inspired oxygen) after off-pump CABG.Methods: Forty off-pump CABG patients were included in this prospective observational study in atertiary care center from 2022 to 2023. The correlation coefficient from an earlier study was used tocalculate the sample size. A four-sector lung ultrasound was utilized for B-line scoring. B-line scoresand PaO2/FiO2 ratios were recorded at three time points: before the surgery commenced and at 24and 48 hours post-operation. The fluid balance was calculated at 24 and 48 hours post-operation.Pearson correlation coefficient was used to evaluate the correlation between B-line scores and fluidbalance with oxygenation, and its significance was assessed through a linear regression test.Results: The PaO2/FiO2 ratio and B-line scores exhibited a statistically significant moderate negativecorrelation at 24 hours post-surgery (r=-0.44; SD=-0.66, 95% CI=-0.66, -0.15; P=0.004) and a B-linescore exceeding 8 was associated with the lowest PaO2/FiO2 ratio. However, fluid balance and PaO2/FiO2 ratios revealed no correlation at 24 or 48 hours post-surgery. Additionally, fluid balance andB-line scores demonstrated a moderate positive correlation after 48 hours but no correlation at 24hours post-surgery.Conclusion: B-line scores always negatively correlated with PaO2/FiO2ratios, and scores greaterthan eight corresponded to the lowest ratio.
Trauma
Alper Alp; Burcu Arslan; Dilek Gibyeli Genek; Bülent Huddam
Volume 9, Issue 1 , January 2023, , Pages 72-75
Abstract
Objective: Rhabdomyolysis is an important etiology for developing acute kidney injury(AKI). Among the many varying reasons for rhabdomyolysis, electrical injury seems to bea lesser-known factor. The clinical presentation of rhabdomyolysis is usually in the formof severe and widespread pain, tenderness, ...
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Objective: Rhabdomyolysis is an important etiology for developing acute kidney injury(AKI). Among the many varying reasons for rhabdomyolysis, electrical injury seems to bea lesser-known factor. The clinical presentation of rhabdomyolysis is usually in the formof severe and widespread pain, tenderness, weakness in the muscles and dark urine. Itis characterized by the disruption of cell integrity in myocytes as a result of widespreaddamage to skeletal muscles and the passage of intracellular components into thecirculation.Case Presentation: Here we presented a case report of a young man who hadrhabdomyolysis induced by electrical injury which is relatively less common among theother etiological factors with preserved renal functions. He had electrical injury relatedwounds on extremities. Urgent intravenous fluid therapy was initiated as soon as hisadmission to the emergency department (ED), without delay.Conclusion: AKI is very common due to the nephrotoxic effect of myoglobinuria and theprerenal status. It is rare that AKI does not develop in patients with a severe increase increatinine kinase. It is a very important point to start effective fluid therapy in a short time.