BackgroundCardiotoxicity from anthracyclin chemotherapy is a leading cause of death in patients with cancer. Therefore, left ventricular (LV) function is routinely assessed during protocol to detect cardiotoxicity; however, animal studies suggest that right ventricular (RV) function may be also impaired. So, our objective was to investigate the incidence of RV dysfunction in children with osteosarcoma receiving anthracyclines and to highlight the role of 2D STE in early detection of RV dysfunction.ResultsRV function was affected by anthacyclines through direct cardiotoxic effect on RV myocardium without simultaneous derangement of LV function. Furthermore, there is a direct proportion between the incidence of RV dysfunction and the cumulative dose of anthracyclines. At the first echo follow-up at 10th week, 7 patients had impaired RV GLS in comparison to baseline study. At 20th week, the number of patients with impaired RV strain increased to 10. At 29th week, it reaches 12 patients. This effect was early detected by RV 2DSTE before adversely affecting TAPSE and FAC. The incidence of RV dysfunction from anthracyclines was around 12%, and the recovery rate was around 8% in 3 months after completion of chemotherapy.ConclusionRV 2DSTE is the best modality to detect early affection of RV function in comparison with other modalities. RV function decreases early even before derangement of LV function. Accordingly, it should be assessed separately in all patients who received anthracyclines even without evident LV affection.
Background: Sepsis-induced myocardial dysfunction (SIMD) occurs in 50% of septic patients and is characterized by reduced ejection fraction (EF), cardiac index, impaired contractility, and diastolic dysfunction (DD). In sepsis-induced cardiomyopathy (SICM), EF shows initial significant deterioration on the 1st day, then final improvement at the end of the study. This study evaluated the value of different parameters measured with trans-thoracic echocardiography (TTE) in the diagnosis and prognosis of SIMD in the surgical intensive care unit (SICU). Methodology: This prospective cohort study was conducted on 100 patients, aged from 18 to 50 years admitted to SICU being affected by sepsis or septic shock. TTE parameters [EF, tricuspid annular systolic excursion (TAPSE), inferior vena cava (IVC) diameter, E/A ratio and grading of DD and hemodynamic parameters [mean arterial blood pressure (MAP), heart rate (HR), central venous pressure (CVP)] on admission, three day post-admission and after one week. Results: The mortality rate was 45%. DD was found in 90%. The mortality group had higher DD, higher HR, and lower MAP than the surviving group, with an insignificant difference in LVEF, TAPSE, IVC, and CVP on the 3rd and 7th days. Sepsis-induced cardiomyopathy (SICM) was found in 31% of surviving patients. DD (grade III had the highest mortality followed by grade I then grade II), HR >110 bpm, and MAP < 65mmHg are independent factors that negatively affect the duration of survival significantly. Conclusion: TTE in patients with sepsis or septic shock is vital for diagnosis and prognosis. DD, tachycardia (HR >110 bpm), and hypotension (MAP < 65mmHg) are independent predictors of mortality in those patients. Patients with SICM (little reversible impairment of LV systolic function) had a good prognosis. Keywords: Sepsis Induced Myocardial Dysfunction, Diastolic dysfunction, Sepsis, Septic Shock Preregistration: The study was registered in the Ethical Committee of Faculty of Medicine, Tanta University, Tanta, Egypt (approval number: 31728/08/17) Abbreviations: SIMD–Sepsis-induced myocardial dysfunction; SICM–sepsis-induced cardiomyopathy; TTE– transthoracic echocardiogram. EF–Ejection fraction; DD–diastolic dysfunction; MD–Myocardial dysfunction; TAPSE–tricuspid annular systolic excursion; SICU–surgical intensive care unit Citation: El-Oraby MA, Shaban AES, El-Dada AA, El-Badawy AEH. Echocardiographic evaluation of sepsis induced myocardial dysfunction in patients with sepsis or septic shock: a prospective cohort study. Anaesth pain intensive care 2021;25(2):150-162. DOI: 10.35975/apic.v25i2.1463 Received: 6 November 2020, Reviewed: 30 December 2020, Accepted: 3 February 2021
Flash glucose monitoring (FGM) is increasingly used for blood glucose assessment due to ease of use and is now subsidized in Australia for blood glucose measurement for patients with Type 1 Diabetes Mellitus. Dysglycaemia is common following kidney transplantation and is associated with worse outcomes and there are data to support the use of FGM post‐transplant to better detect and manage changes in blood glucose levels. There is, however, no data on patient or staff perceptions of FGM, or resource implications in this setting. We prospectively evaluated patients and nursing staff experiences of FGM compared to traditional capillary glucose measurement in the immediate post‐transplant setting, along with resource utilization, cost of testing, staff time taken to test and accuracy. Twenty‐one kidney transplant recipients had a FGM sensor applied in the post‐operative period and results compared to capillary blood glucose monitoring (CBGM) measured at least four times a day. Six‐hundred‐fifty‐six glucose measurements were obtained, median per patient of 30 readings (IQR 10). Pearson's correlation between FGM and CBGM readings is 0.95 (p < .001). FGM readings were lower than CBGM by an average of 1.2 mmol/L (SD 0.7). Using a 5‐point preference questionnaire (with ratings varying from strongly disagree‐strongly agree), both patients and nurses were highly satisfied with the usability and convenience of FGM, with all preferring FGM over CBGM. Average time to perform FGM was 3.6 s versus 64 s for CBGM. In average, cost of FGM was $58 less than traditional testing per patient. FGM is an accurate, convenient and cost‐effective tool that may support optimal management of glycaemic control in the post‐transplant period.
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