Pub Date : 2024-08-13DOI: 10.1016/j.hrtlng.2024.08.011
Sant Kumar MD , Hunter VanDolah BS , Ahmed Daniyaal Rasheed MD , Serenity Budd MS , Kelley Anderson PhD RN FNP , Alexander I. Papolos MD , Benjamin B.Kenigsberg M , Narayana Sarma V. Singam MD , Anirudh Rao MD , Hunter Groninger MD FAAHPM
Background
ICU patients and their families experience significant stress due to illness severity and prognostic uncertainty, making palliative care (PC) integral for symptom management, family support, and end-of-life care goals. The impact of PC in the Cardiac Intensive Care Unit (CICU) remains unstudied.
Objective
We explore the impact of early palliative care consultation (PCC) on patient outcomes in the CICU, including mortality, length of stay, and family meeting frequency.
Methods
This retrospective study at MedStar Washington Hospital Center included 209 adult patients admitted to the CICU between December 2021 and June 2022 receiving PCC. We compared outcomes between those receiving early (<72 h) and late (>72 h) PCC, including mortality, length of stay, and family meeting frequency. Statistical analysis included Wilcoxon rank sum tests, Chi-squared tests, Fisher's exact test, and Poisson regression models.
Results
The study included 209 patients admitted to the (M age = 68 years, SD = 14; 45 % female; 62 % Black, 30 % White) who received PCC, most (79 %) within 72 h. Early PCC was associated with shorter CICU stays (median, 3 vs. 5.5 days; p = 0.005). Early PCC patients had higher odds of family meetings (IRR=3.59; p < 0.001) and experienced a change in code status sooner (median 1 day vs. 3 days, p < 0.001). Late PCC patients were more likely to undergo tracheostomy (13.6% vs. 2.4 %; p = 0.007), cardioversion (9.1% vs. 1.8 %; p = 0.037), and have PEG tubes placed (13.6% vs. 2.4 %; p = 0.007).
Conclusions
Early PCC in the CICU is associated with shorter CICU stays, fewer procedures, and more frequent family meetings.
{"title":"Optimizing outcomes: Impact of palliative care consultation timing in the cardiovascular intensive care unit","authors":"Sant Kumar MD , Hunter VanDolah BS , Ahmed Daniyaal Rasheed MD , Serenity Budd MS , Kelley Anderson PhD RN FNP , Alexander I. Papolos MD , Benjamin B.Kenigsberg M , Narayana Sarma V. Singam MD , Anirudh Rao MD , Hunter Groninger MD FAAHPM","doi":"10.1016/j.hrtlng.2024.08.011","DOIUrl":"10.1016/j.hrtlng.2024.08.011","url":null,"abstract":"<div><h3>Background</h3><p>ICU patients and their families experience significant stress due to illness severity and prognostic uncertainty, making palliative care (PC) integral for symptom management, family support, and end-of-life care goals. The impact of PC in the Cardiac Intensive Care Unit (CICU) remains unstudied.</p></div><div><h3>Objective</h3><p>We explore the impact of early palliative care consultation (PCC) on patient outcomes in the CICU, including mortality, length of stay, and family meeting frequency.</p></div><div><h3>Methods</h3><p>This retrospective study at MedStar Washington Hospital Center included 209 adult patients admitted to the CICU between December 2021 and June 2022 receiving PCC. We compared outcomes between those receiving early (<72 h) and late (>72 h) PCC, including mortality, length of stay, and family meeting frequency. Statistical analysis included Wilcoxon rank sum tests, Chi-squared tests, Fisher's exact test, and Poisson regression models.</p></div><div><h3>Results</h3><p>The study included 209 patients admitted to the (M age = 68 years, SD = 14; 45 % female; 62 % Black, 30 % White) who received PCC, most (79 %) within 72 h. Early PCC was associated with shorter CICU stays (median, 3 vs. 5.5 days; <em>p</em> = 0.005). Early PCC patients had higher odds of family meetings (IRR=3.59; <em>p</em> < 0.001) and experienced a change in code status sooner (median 1 day vs. 3 days, <em>p</em> < 0.001). Late PCC patients were more likely to undergo tracheostomy (13.6% vs. 2.4 %; <em>p</em> = 0.007), cardioversion (9.1% vs. 1.8 %; <em>p</em> = 0.037), and have PEG tubes placed (13.6% vs. 2.4 %; <em>p</em> = 0.007).</p></div><div><h3>Conclusions</h3><p>Early PCC in the CICU is associated with shorter CICU stays, fewer procedures, and more frequent family meetings.</p></div>","PeriodicalId":55064,"journal":{"name":"Heart & Lung","volume":"68 ","pages":"Pages 265-271"},"PeriodicalIF":2.4,"publicationDate":"2024-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141978269","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-13DOI: 10.1016/j.hrtlng.2024.08.009
Li-Ming Chen , Jian-Bin Li , Rui Wu
Background
Early identification of risk factors for adverse COVID-19 progression in patients with autoimmune diseases is crucial for patient management, but data on the Chinese population are scarce.
Objectives
The purpose of this study was to identify predictors of severe COVID-19 in patients using blood cell ratios, such as the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), systemic immune-inflammation index (SII), and other inflammatory markers.
Methods
A retrospective study of 855 patients (746 females; median age 49 years) with autoimmune diseases and concurrent COVID-19 was conducted from December 2022 to February 2023 at the Rheumatology and Immunology Department of the First Affiliated Hospital of Nanchang University. Disease severity was assessed according to the 8th edition of the National Health Commission of the People's Republic of China's COVID-19 Diagnosis and Treatment Guidelines. The clinical classification criteria group mild and moderate cases as nonsevere cases and severe and critical cases as severe cases. A multivariate logistic regression model was established to evaluate the relationships between COVID-19 severity and demographic characteristics, comorbidities, medication use, and laboratory findings.
Results
The PLR, NLR, and SII were significantly greater in the severe COVID-19 group than in the nonsevere group (all P < 0.05). In addition to classical independent clinical risk factors, increases in the PLR (OR: 1.004, 95 % CI: 1.001∼1.007, p = 0.001), NLR (OR: 1.180, 95 % CI: 1.041∼1.337, p = 0.010), and SII (OR: 0.999, 95 % CI: 0.998∼1.000, p = 0.005) were identified as risk factors for severe COVID-19 in patients with autoimmune diseases. After adjusting for clinical risk factors, the PLR (AUC: 0.592 vs. 0.865; P < 0.05), NLR (AUC: 0.670 vs. 0.866; P < 0.05), and SII (AUC: 0.616 vs. 0.864; P < 0.05) demonstrated higher predictive values.
Conclusion
Early prediction of severe COVID-19 in patients with autoimmune diseases can be achieved using the NLR, PLR, and SII.
{"title":"Predictors of COVID-19 severity in autoimmune disease patients: A retrospective study during full epidemic decontrol in China","authors":"Li-Ming Chen , Jian-Bin Li , Rui Wu","doi":"10.1016/j.hrtlng.2024.08.009","DOIUrl":"10.1016/j.hrtlng.2024.08.009","url":null,"abstract":"<div><h3>Background</h3><p>Early identification of risk factors for adverse COVID-19 progression in patients with autoimmune diseases is crucial for patient management, but data on the Chinese population are scarce.</p></div><div><h3>Objectives</h3><p>The purpose of this study was to identify predictors of severe COVID-19 in patients using blood cell ratios, such as the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), systemic immune-inflammation index (SII), and other inflammatory markers.</p></div><div><h3>Methods</h3><p>A retrospective study of 855 patients (746 females; median age 49 years) with autoimmune diseases and concurrent COVID-19 was conducted from December 2022 to February 2023 at the Rheumatology and Immunology Department of the First Affiliated Hospital of Nanchang University. Disease severity was assessed according to the 8th edition of the National Health Commission of the People's Republic of China's COVID-19 Diagnosis and Treatment Guidelines. The clinical classification criteria group mild and moderate cases as nonsevere cases and severe and critical cases as severe cases. A multivariate logistic regression model was established to evaluate the relationships between COVID-19 severity and demographic characteristics, comorbidities, medication use, and laboratory findings.</p></div><div><h3>Results</h3><p>The PLR, NLR, and SII were significantly greater in the severe COVID-19 group than in the nonsevere group (all <em>P</em> < 0.05). In addition to classical independent clinical risk factors, increases in the PLR (OR: 1.004, 95 % CI: 1.001∼1.007, <em>p</em> = 0.001), NLR (OR: 1.180, 95 % CI: 1.041∼1.337, <em>p</em> = 0.010), and SII (OR: 0.999, 95 % CI: 0.998∼1.000, <em>p</em> = 0.005) were identified as risk factors for severe COVID-19 in patients with autoimmune diseases. After adjusting for clinical risk factors, the PLR (AUC: 0.592 vs. 0.865; <em>P</em> < 0.05), NLR (AUC: 0.670 vs. 0.866; <em>P</em> < 0.05), and SII (AUC: 0.616 vs. 0.864; <em>P</em> < 0.05) demonstrated higher predictive values.</p></div><div><h3>Conclusion</h3><p>Early prediction of severe COVID-19 in patients with autoimmune diseases can be achieved using the NLR, PLR, and SII.</p></div>","PeriodicalId":55064,"journal":{"name":"Heart & Lung","volume":"68 ","pages":"Pages 272-278"},"PeriodicalIF":2.4,"publicationDate":"2024-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S014795632400147X/pdfft?md5=ad10a960a76c9410ef1c3b0f6128dcb4&pid=1-s2.0-S014795632400147X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141978177","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-07DOI: 10.1016/j.hrtlng.2024.08.007
John Malin , Rasha Khan , Jose Manuel Martinez Manzano , Phuuwadith Wattanachayakul , Andrew Geller , Raul Leguizamon , Tara A John , Ian Mclaren , Alexander Prendergast , Simone A. Jarrett , Kevin Bryan Lo , Janani Rangaswami , Christian Witzke
Background
Pulmonary hypertension (pH) is a well-known complication among patients with chronic kidney disease (CKD). Arteriovenous fistulae (AVF) have been associated with pH mainly by increasing cardiac output. However, the burden of precapillary pH in individuals with CKD and an AVF is unclear.
Objectives
To better and more fully understand the mechanism and development of precapillary pH in patients with AVF, as well as the consequences of precapillary pH in these patients.
Methods
This was a large retrospective study of patients with CKD stage 4 or 5 who underwent right heart catheterization (RHC) from 2018 to 2023. The data were stratified according to the presence of AVF. To determine if AVF was independently associated with precapillary pH, we used a multivariable logistic regression analysis adjusting for demographics and potential comorbidities associated with precapillary pH, including diagnosis of chronic lung disease, obstructive sleep apnea, connective tissue disease, history of venous thromboembolism, chronic anemia, and heart failure.
Results
Of 651 patients with CKD4 or CKD5, 145 (22 %) had AVF and 506 (78 %) did not have AVF. Within the AVF group, the median age was 64 years (IQR 54–71), and they were predominantly males (61 %, n = 88) and African American (77 %, n = 111). A total of 31 % (n = 45) had evidence of precapillary pH, 30 % (n = 43) of combined pH, and 14 % (n = 20) of isolated postcapillary pH. Compared to the non-AVF group, precapillary pH was more likely in the AVF group (31% vs 17 %, p < 0.0001). On multivariable analysis, AVF was independently associated with precapillary pH (OR 2.47, CI 1.56–3.89; p < 0.0001). The median time from dialysis initiation to RHC date (and precapillary pH diagnosis) was 6 years (IQR 3–8).
Conclusion
Based on RHC findings, almost one-third of patients with CKD and AVF had precapillary pH. The presence of AVF was independently associated with precapillary pH.
{"title":"Association of arteriovenous fistulae with precapillary pulmonary hypertension – A single center retrospective analysis of invasive hemodynamic parameters","authors":"John Malin , Rasha Khan , Jose Manuel Martinez Manzano , Phuuwadith Wattanachayakul , Andrew Geller , Raul Leguizamon , Tara A John , Ian Mclaren , Alexander Prendergast , Simone A. Jarrett , Kevin Bryan Lo , Janani Rangaswami , Christian Witzke","doi":"10.1016/j.hrtlng.2024.08.007","DOIUrl":"10.1016/j.hrtlng.2024.08.007","url":null,"abstract":"<div><h3>Background</h3><p>Pulmonary hypertension (pH) is a well-known complication among patients with chronic kidney disease (CKD). Arteriovenous fistulae (AVF) have been associated with pH mainly by increasing cardiac output. However, the burden of precapillary pH in individuals with CKD and an AVF is unclear.</p></div><div><h3>Objectives</h3><p>To better and more fully understand the mechanism and development of precapillary pH in patients with AVF, as well as the consequences of precapillary pH in these patients.</p></div><div><h3>Methods</h3><p>This was a large retrospective study of patients with CKD stage 4 or 5 who underwent right heart catheterization (RHC) from 2018 to 2023. The data were stratified according to the presence of AVF. To determine if AVF was independently associated with precapillary pH, we used a multivariable logistic regression analysis adjusting for demographics and potential comorbidities associated with precapillary pH, including diagnosis of chronic lung disease, obstructive sleep apnea, connective tissue disease, history of venous thromboembolism, chronic anemia, and heart failure.</p></div><div><h3>Results</h3><p>Of 651 patients with CKD4 or CKD5, 145 (22 %) had AVF and 506 (78 %) did not have AVF. Within the AVF group, the median age was 64 years (IQR 54–71), and they were predominantly males (61 %, <em>n</em> = 88) and African American (77 %, <em>n</em> = 111). A total of 31 % (<em>n</em> = 45) had evidence of precapillary pH, 30 % (<em>n</em> = 43) of combined pH, and 14 % (<em>n</em> = 20) of isolated postcapillary pH. Compared to the non-AVF group, precapillary pH was more likely in the AVF group (31% vs 17 %, <em>p</em> < 0.0001). On multivariable analysis, AVF was independently associated with precapillary pH (OR 2.47, CI 1.56–3.89; <em>p</em> < 0.0001). The median time from dialysis initiation to RHC date (and precapillary pH diagnosis) was 6 years (IQR 3–8).</p></div><div><h3>Conclusion</h3><p>Based on RHC findings, almost one-third of patients with CKD and AVF had precapillary pH. The presence of AVF was independently associated with precapillary pH.</p></div>","PeriodicalId":55064,"journal":{"name":"Heart & Lung","volume":"68 ","pages":"Pages 260-264"},"PeriodicalIF":2.4,"publicationDate":"2024-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141908382","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
While moral distress frequency and intensity have been reported among clinicians around the world, resuscitations have not been well documented as its source.
Objectives
to examine the relationship between intensity and frequency of resuscitation- related moral distress and departmental culture among nurses and physicians working in inpatient medical departments.
Methods
This was a cross-sectional, prospective study of medical inpatient department staff from three hospitals. Questionnaires included a demographic and work characteristics questionnaire, the Resuscitation-Related Moral Distress Scale (a revised version of the Moral Distress Scale measuring frequency and intensity of moral distress), and a Departmental Culture Questionnaire.
Results
64 physicians and 201 nurses (response rate 64 %) participated, with a mean of 8.4 (SD = 5.1) resuscitations in the previous 6 months. Highest moral distress frequency scores were reported for items related to family demands or having no medical decision related to life- saving interventions for dying patients. Highest moral distress intensity scores were found when appropriate care for deteriorating patients was not given due poor staffing and when witnessing a resuscitation that could have been prevented had the staff identified the deterioration on time. Most participants strongly agreed (n = 228, 86.0 %) that their department medical director considers it important for staff to determine patients’ end-of-life preferences and that quality of life is of the highest value.
Conclusions
Clinicians working in medical inpatient department suffer from moderate frequency and high intensity levels of resuscitation-related moral distress. There was a statistically significant association between intention to leave employment with resuscitation-related moral distress frequency and intensity.
{"title":"The relationship between departmental culture and resuscitation-related moral distress among inpatient medical departments physicians and nurses","authors":"Dorit Weill-Lotan RH, PhD , Freda Dekeyser-Ganz PhD, RN , Julie Benbenishty RN PhD","doi":"10.1016/j.hrtlng.2024.07.001","DOIUrl":"10.1016/j.hrtlng.2024.07.001","url":null,"abstract":"<div><h3>Background</h3><p>While moral distress frequency and intensity have been reported among clinicians around the world, resuscitations have not been well documented as its source.</p></div><div><h3>Objectives</h3><p>to examine the relationship between intensity and frequency of resuscitation- related moral distress and departmental culture among nurses and physicians working in inpatient medical departments.</p></div><div><h3>Methods</h3><p>This was a cross-sectional, prospective study of medical inpatient department staff from three hospitals. Questionnaires included a demographic and work characteristics questionnaire, the Resuscitation-Related Moral Distress Scale (a revised version of the Moral Distress Scale measuring frequency and intensity of moral distress), and a Departmental Culture Questionnaire.</p></div><div><h3>Results</h3><p>64 physicians and 201 nurses (response rate 64 %) participated, with a mean of 8.4 (SD = 5.1) resuscitations in the previous 6 months. Highest moral distress frequency scores were reported for items related to family demands or having no medical decision related to life- saving interventions for dying patients. Highest moral distress intensity scores were found when appropriate care for deteriorating patients was not given due poor staffing and when witnessing a resuscitation that could have been prevented had the staff identified the deterioration on time. Most participants strongly agreed (<em>n</em> = 228, 86.0 %) that their department medical director considers it important for staff to determine patients’ end-of-life preferences and that quality of life is of the highest value.</p></div><div><h3>Conclusions</h3><p>Clinicians working in medical inpatient department suffer from moderate frequency and high intensity levels of resuscitation-related moral distress. There was a statistically significant association between intention to leave employment with resuscitation-related moral distress frequency and intensity.</p></div>","PeriodicalId":55064,"journal":{"name":"Heart & Lung","volume":"68 ","pages":"Pages 254-259"},"PeriodicalIF":2.4,"publicationDate":"2024-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141890993","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-31DOI: 10.1016/j.hrtlng.2024.07.010
Woon Hean Chong MD, Dipika Agrawal MD, Ze Ying Tan MD, Sridhar Venkateswaran MD, Adeline Yit Ying Tan MD, Ching Yee Tan MD, Norris Chun Ang Ling MD, Noel Stanley Wey Tut Tay MD
Background
Anti-fibrotics can reduce restrictive impairment in idiopathic pulmonary fibrosis (IPF). However, its effectiveness in non-IPF progressive fibrosing interstitial lung disease (non-IPF PF-ILD) remains uncertain.
Objective
We assess the efficacy and safety of anti-fibrotics pirfenidone and nintedanib versus placebo among non-IPF PF-ILD adult patients.
Methods
Meta-analysis was performed using PubMed, SCOPUS, and Cochrane databases to identify randomized controlled trials (RCTs). At respective centers, non-IPF PF-ILD was defined as clinical and radiological findings inconsistent with IPF and greater than 5 % forced vital capacity (FVC) decline, worsening radiological fibrosis or respiratory symptoms.
Results
Among seven RCTs involving 1,816 non-IPF PF-ILD patients, anti-fibrotics significantly reduced decline in FVC from baseline in milliliters (MD -66.80milliliters; P < 0.01) and percent predicted (MD -1.80 %; P < 0.01) compared to placebo. However, severity of FVC decline was less than 10 % (P = 0.33) in both groups. No significant difference in the decline of 6MWD from baseline in meters (P = 0.19) while on anti-fibrotics, although those on pirfenidone had less decline in 6MWD (MD -25.12 m; P < 0.01) versus placebo. The rates of all-cause mortality (P = 0.34), all-cause hospitalization (P = 0.44), and hospitalization for respiratory etiology (P = 0.06) were comparable in both groups. Adverse events of nausea/vomiting (54.2 % vs. 20.3 %; P < 0.01), diarrhea (65.2 % vs. 27.6 %; P = 0.02), anorexia/weight loss (23.0 % vs. 7.7 %; P < 0.01), neurological disorders (20.8 % vs. 12.6 %; P < 0.01), and events requiring therapy discontinuation were higher (18.4 % vs. 9.9 %; P < 0.01) in the anti-fibrotic group. Other adverse events of skin (P = 0.18) and respiratory disorders (P = 0.20) were equal.
Conclusion
The advent of anti-fibrotics offers alternative treatment to reduce lung function decline.
{"title":"A systematic review and meta-analysis of the clinical benefits and adverse reactions of anti-fibrotics in non-IPF progressive fibrosing ILD","authors":"Woon Hean Chong MD, Dipika Agrawal MD, Ze Ying Tan MD, Sridhar Venkateswaran MD, Adeline Yit Ying Tan MD, Ching Yee Tan MD, Norris Chun Ang Ling MD, Noel Stanley Wey Tut Tay MD","doi":"10.1016/j.hrtlng.2024.07.010","DOIUrl":"10.1016/j.hrtlng.2024.07.010","url":null,"abstract":"<div><h3>Background</h3><p>Anti-fibrotics can reduce restrictive impairment in idiopathic pulmonary fibrosis (IPF). However, its effectiveness in non-IPF progressive fibrosing interstitial lung disease (non-IPF PF-ILD) remains uncertain.</p></div><div><h3>Objective</h3><p>We assess the efficacy and safety of anti-fibrotics pirfenidone and nintedanib versus placebo among non-IPF PF-ILD adult patients.</p></div><div><h3>Methods</h3><p>Meta-analysis was performed using PubMed, SCOPUS, and Cochrane databases to identify randomized controlled trials (RCTs). At respective centers, non-IPF PF-ILD was defined as clinical and radiological findings inconsistent with IPF and greater than 5 % forced vital capacity (FVC) decline, worsening radiological fibrosis or respiratory symptoms.</p></div><div><h3>Results</h3><p>Among seven RCTs involving 1,816 non-IPF PF-ILD patients, anti-fibrotics significantly reduced decline in FVC from baseline in milliliters (MD -66.80milliliters; <em>P</em> < 0.01) and percent predicted (MD -1.80 %; <em>P</em> < 0.01) compared to placebo. However, severity of FVC decline was less than 10 % (<em>P</em> = 0.33) in both groups. No significant difference in the decline of 6MWD from baseline in meters (<em>P</em> = 0.19) while on anti-fibrotics, although those on pirfenidone had less decline in 6MWD (MD -25.12 m; <em>P</em> < 0.01) versus placebo. The rates of all-cause mortality (<em>P</em> = 0.34), all-cause hospitalization (<em>P</em> = 0.44), and hospitalization for respiratory etiology (<em>P</em> = 0.06) were comparable in both groups. Adverse events of nausea/vomiting (54.2 % vs. 20.3 %; <em>P</em> < 0.01), diarrhea (65.2 % vs. 27.6 %; <em>P</em> = 0.02), anorexia/weight loss (23.0 % vs. 7.7 %; <em>P</em> < 0.01), neurological disorders (20.8 % vs. 12.6 %; <em>P</em> < 0.01), and events requiring therapy discontinuation were higher (18.4 % vs. 9.9 %; <em>P</em> < 0.01) in the anti-fibrotic group. Other adverse events of skin (<em>P</em> = 0.18) and respiratory disorders (<em>P</em> = 0.20) were equal.</p></div><div><h3>Conclusion</h3><p>The advent of anti-fibrotics offers alternative treatment to reduce lung function decline.</p></div>","PeriodicalId":55064,"journal":{"name":"Heart & Lung","volume":"68 ","pages":"Pages 242-253"},"PeriodicalIF":2.4,"publicationDate":"2024-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141876757","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-31DOI: 10.1016/j.hrtlng.2024.07.011
Marco Clari RN, PhD , Federica Riva-Rovedda RN, MNS , Valerio Dimonte RN, MNS , Maria Matarese RN, MNS
Background
In people affected by chronic obstructive pulmonary disease (COPD), self-care is crucial for improving quality of life, decreasing symptom burden, and reducing health care-related costs. Unlike other chronic conditions, little is known about the factors that influence different self-care styles in COPD patients.
Objectives
To explore the factors that could influence the self-care styles of patients with COPD.
Methods
A mixed methods case study design was used. Quantitative and qualitative data were collected at the same stage in a purposive sample of patients with COPD through questionnaires, interviews, and focus groups. Data were analyzed separately and then integrated to compare the cases.
Results
Thirty-seven patients with COPD were recruited from an outpatient clinic, pulmonary rehabilitation unit and online in a patient support group. On average, participants scored below the level of adequacy in all self-care dimensions. Self-care maintenance was influenced by patient age, education level, and economic status. Most participants reported performing self-care behaviors, while some did not because they found it difficult or because they did not recognize their importance. When the quantitative and qualitative data of patients with higher and lower levels of self-care were integrated, four different styles of self-care were identified according to COPD severity, psychological distress and level of self-efficacy: proactive, inactive, reactive, and hypoactive.
Conclusions
Personal, clinical, psychological, and social factors not only influence the level of self-care performed by COPD patients but also contribute to the understanding of different self-care styles. This knowledge could support health care professionals in tailoring educational interventions.
{"title":"Self-care styles of patients with chronic obstructive pulmonary disease: A mixed methods case study","authors":"Marco Clari RN, PhD , Federica Riva-Rovedda RN, MNS , Valerio Dimonte RN, MNS , Maria Matarese RN, MNS","doi":"10.1016/j.hrtlng.2024.07.011","DOIUrl":"10.1016/j.hrtlng.2024.07.011","url":null,"abstract":"<div><h3>Background</h3><p>In people affected by chronic obstructive pulmonary disease (COPD), self-care is crucial for improving quality of life, decreasing symptom burden, and reducing health care-related costs. Unlike other chronic conditions, little is known about the factors that influence different self-care styles in COPD patients.</p></div><div><h3>Objectives</h3><p>To explore the factors that could influence the self-care styles of patients with COPD.</p></div><div><h3>Methods</h3><p>A mixed methods case study design was used. Quantitative and qualitative data were collected at the same stage in a purposive sample of patients with COPD through questionnaires, interviews, and focus groups. Data were analyzed separately and then integrated to compare the cases.</p></div><div><h3>Results</h3><p>Thirty-seven patients with COPD were recruited from an outpatient clinic, pulmonary rehabilitation unit and online in a patient support group. On average, participants scored below the level of adequacy in all self-care dimensions. Self-care maintenance was influenced by patient age, education level, and economic status. Most participants reported performing self-care behaviors, while some did not because they found it difficult or because they did not recognize their importance. When the quantitative and qualitative data of patients with higher and lower levels of self-care were integrated, four different styles of self-care were identified according to COPD severity, psychological distress and level of self-efficacy: proactive, inactive, reactive, and hypoactive.</p></div><div><h3>Conclusions</h3><p>Personal, clinical, psychological, and social factors not only influence the level of self-care performed by COPD patients but also contribute to the understanding of different self-care styles. This knowledge could support health care professionals in tailoring educational interventions.</p></div>","PeriodicalId":55064,"journal":{"name":"Heart & Lung","volume":"68 ","pages":"Pages 231-241"},"PeriodicalIF":2.4,"publicationDate":"2024-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0147956324001389/pdfft?md5=1c3d5e45a3eb5065c82a47e3a2f8a50f&pid=1-s2.0-S0147956324001389-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141876758","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-27DOI: 10.1016/j.hrtlng.2024.07.006
Saranpat Puthai MD , Wilawan Thirapatarapong MD
Background
Spinal cord ischemia (SCI) is a serious complication that can occur at the onset of aortic aneurysm (AA) or after AA surgery. SCI impairs ambulation in patients. However, there is a lack of evidence regarding ambulatory status and its associated factors.
Objectives
To identify the ambulatory status of patients with SCI due to AA and/or AA surgery and sociodemographic and clinical characteristics factors associated with ambulatory status.
Methods
A descriptive study using a retrospective medical record data was undertaken. Data were collected from the electronic health records of SCI patients resulting from AA or who underwent surgical intervention for AA from January 2009 through December 2021. We analyzed the data to determine the ambulatory status before discharge. The demographic and clinical characteristics of the patients were investigated using chi-square and Fisher's exact tests to identify factors associated with ambulatory status.
Results
Among the 4,142 patients diagnosed with AA, 30 developed SCI. Of these 30 AA patients with SCI, 63.3 % were male. The median age was 70 years, ranging from 39 to 89 years. Six had SCI at the time of AA diagnosis. Among the subset of 2,994 patients who underwent aortic surgery, 24 developed SCI postoperatively. At discharge, two-thirds of the SCI patients with AA were unable to ambulate, and almost half were bedridden. The factors associated with ambulatory status were length of stay, neurogenic bladder, and pressure ulcers.
Conclusions
Most patients with SCI due to AA and/or AA surgery are unable to walk before discharge. Length of stay, neurogenic bladder, and pressure ulcers were associated with poor ambulatory status. Older adults and those with medical comorbidities and complications are at particularly high risk for impaired ambulation.
背景：脊髓缺血（SCI）是主动脉瘤（AA）发病时或手术后可能出现的严重并发症。脊髓缺血会影响患者的行动能力。然而，目前还缺乏有关患者活动状态及其相关因素的证据：确定因 AA 和/或 AA 手术导致 SCI 的患者的活动状态，以及与活动状态相关的社会人口学和临床特征因素：采用回顾性病历数据进行描述性研究。我们从2009年1月至2021年12月期间因AA导致SCI或因AA接受手术治疗的患者的电子病历中收集了数据。我们对数据进行了分析，以确定出院前的非卧床状态。我们使用卡方检验（chi-square）和费雪精确检验（Fisher's exact）对患者的人口统计学特征和临床特征进行了调查，以确定与出院前状况相关的因素：在4142名确诊为AA的患者中，有30人患有SCI。在这 30 名 SCI AA 患者中，63.3% 为男性。年龄中位数为 70 岁，从 39 岁到 89 岁不等。其中 6 人在确诊 AA 时已患有 SCI。在接受主动脉手术的2994名患者中，有24人在术后出现了SCI。出院时，三分之二的AA SCI患者无法行走，近一半的患者卧床不起。住院时间、神经源性膀胱和压疮是影响患者能否行走的相关因素：结论：大多数因AA和/或AA手术导致SCI的患者在出院前无法行走。住院时间、神经源性膀胱和压疮与不良的活动状态有关。老年人、有内科合并症和并发症的患者步行能力受损的风险尤其高。
{"title":"Ambulatory status and related factors in patients with spinal cord ischemia due to aortic aneurysm","authors":"Saranpat Puthai MD , Wilawan Thirapatarapong MD","doi":"10.1016/j.hrtlng.2024.07.006","DOIUrl":"10.1016/j.hrtlng.2024.07.006","url":null,"abstract":"<div><h3>Background</h3><p>Spinal cord ischemia (SCI) is a serious complication that can occur at the onset of aortic aneurysm (AA) or after AA surgery. SCI impairs ambulation in patients. However, there is a lack of evidence regarding ambulatory status and its associated factors.</p></div><div><h3>Objectives</h3><p>To identify the ambulatory status of patients with SCI due to AA and/or AA surgery and sociodemographic and clinical characteristics factors associated with ambulatory status.</p></div><div><h3>Methods</h3><p>A descriptive study using a retrospective medical record data was undertaken. Data were collected from the electronic health records of SCI patients resulting from AA or who underwent surgical intervention for AA from January 2009 through December 2021. We analyzed the data to determine the ambulatory status before discharge. The demographic and clinical characteristics of the patients were investigated using chi-square and Fisher's exact tests to identify factors associated with ambulatory status.</p></div><div><h3>Results</h3><p>Among the 4,142 patients diagnosed with AA, 30 developed SCI. Of these 30 AA patients with SCI, 63.3 % were male. The median age was 70 years, ranging from 39 to 89 years. Six had SCI at the time of AA diagnosis. Among the subset of 2,994 patients who underwent aortic surgery, 24 developed SCI postoperatively. At discharge, two-thirds of the SCI patients with AA were unable to ambulate, and almost half were bedridden. The factors associated with ambulatory status were length of stay, neurogenic bladder, and pressure ulcers.</p></div><div><h3>Conclusions</h3><p>Most patients with SCI due to AA and/or AA surgery are unable to walk before discharge. Length of stay, neurogenic bladder, and pressure ulcers were associated with poor ambulatory status. Older adults and those with medical comorbidities and complications are at particularly high risk for impaired ambulation.</p></div>","PeriodicalId":55064,"journal":{"name":"Heart & Lung","volume":"68 ","pages":"Pages 227-230"},"PeriodicalIF":2.4,"publicationDate":"2024-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141789949","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
To the best of our knowledge, no prospective research studies have compared clinical practice to the American Heart Association (AHA) updated practice standards for in-hospital telemetry monitoring.
Objectives
Our aims were therefore (1) to investigate how patients were assigned to telemetry monitoring in accordance with the AHA's updated practice standards, (2) to determine the number and type of arrhythmic events, and (3) to describe subsequent changes in clinical management.
Methods
This prospective multicenter study included 1154 patients at three university hospitals in Norway. Data were collected 24/7 over a four-week period, with follow-up measurements from telemetry admission until hospital discharge.
Results
Of patients assigned to telemetry, 67 % (n = 767) met practice standards, corresponding to AHA Class I or II. Patients were predominantly men (65 %, n = 748), and the mean age was 65 years (SD ±16). The study included both patients with cardiac and non-cardiac diagnoses from various medical and surgical departments throughout the hospitals. Ninety-one percent of the patients in Class III were monitored based on indications that were reclassified from Class II to Class III (not indicated) in the updated practice standards (patients admitted with chest pain or post-percutaneous coronary intervention (PCI) without complications). Overall, arrhythmic events occurred in 37 % (n = 424) of patients, and they occurred in all classes. Eighteen percent (n = 59) of arrhythmic events occurred in Class III. Of all arrhythmias, 3 % (n = 14) were life threatening, and all of them occurring within Class I. Telemetry monitoring led to changes in clinical management in 22 % (n = 257) of patients due to clinical alarms, of which 71 % (n = 182) were related to medication management.
Conclusions
Most patients were appropriately monitored according to the AHA practice standards, meeting Class I and II. Arrhythmias occurred in all classes, but life-threatening arrhythmias only occurred in patients in Class I. However, a daily re-assessment of each patient's telemetry indication is warranted.
背景：据我们所知，还没有前瞻性研究将临床实践与美国心脏协会（AHA）更新的院内遥测监护实践标准进行比较：因此，我们的目标是：(1) 调查如何根据美国心脏协会更新的实践标准将患者分配到遥测监护；(2) 确定心律失常事件的数量和类型；(3) 描述临床管理的后续变化：这项前瞻性多中心研究包括挪威三所大学医院的 1154 名患者。在为期四周的时间里全天候收集数据，从遥测入院到出院进行随访测量：在被分配进行遥测的患者中，67%（n = 767）符合实践标准，相当于美国心脏协会的 I 级或 II 级。患者主要为男性（65%，n = 748），平均年龄为 65 岁（SD ±16）。研究对象包括各医院内科和外科的心脏病和非心脏病患者。91% 的 III 级患者是根据更新后的实践标准中从 II 级重新划分为 III 级（无指征）的指征进行监测的（因胸痛或经皮冠状动脉介入治疗 (PCI) 后无并发症入院的患者）。总体而言，37%（n = 424）的患者发生了心律失常事件，所有级别均有发生。18%（n = 59）的心律失常事件发生在 III 级。在所有心律失常中，3%（n = 14）有生命危险，且全部发生在 I 级。遥测监护导致 22% （n = 257）的患者因临床警报而改变临床管理，其中 71% （n = 182）与药物管理有关：结论：根据美国心脏协会的实践标准，大多数患者都得到了适当的监护，达到了 I 级和 II 级。所有级别的患者都发生了心律失常，但只有 I 级患者发生了危及生命的心律失常。
{"title":"Appropriateness and outcomes of hospitalized patients telemetry monitored for cardiac arrhythmias in accordance with the American Heart Association Practice Standards–A multicenter study","authors":"Marianne Sætrang Holm , Nina Fålun , Trond Røed Pettersen , Bjørn Bendz , Roy Miodini Nilsen , Jørund Langørgen , Alf Inge Larsen , Marianne Laastad Sørensen , Kristin E. Sandau , Tone Merete Norekvål","doi":"10.1016/j.hrtlng.2024.07.005","DOIUrl":"10.1016/j.hrtlng.2024.07.005","url":null,"abstract":"<div><h3>Background</h3><p>To the best of our knowledge, no prospective research studies have compared clinical practice to the American Heart Association (AHA) updated practice standards for in-hospital telemetry monitoring.</p></div><div><h3>Objectives</h3><p>Our aims were therefore (1) to investigate how patients were assigned to telemetry monitoring in accordance with the AHA's updated practice standards, (2) to determine the number and type of arrhythmic events, and (3) to describe subsequent changes in clinical management.</p></div><div><h3>Methods</h3><p>This prospective multicenter study included 1154 patients at three university hospitals in Norway. Data were collected 24/7 over a four-week period, with follow-up measurements from telemetry admission until hospital discharge.</p></div><div><h3>Results</h3><p>Of patients assigned to telemetry, 67 % (<em>n</em> = 767) met practice standards, corresponding to AHA Class I or II. Patients were predominantly men (65 %, <em>n</em> = 748), and the mean age was 65 years (SD ±16). The study included both patients with cardiac and non-cardiac diagnoses from various medical and surgical departments throughout the hospitals. Ninety-one percent of the patients in Class III were monitored based on indications that were reclassified from Class II to Class III (not indicated) in the updated practice standards (patients admitted with chest pain or post-percutaneous coronary intervention (PCI) without complications). Overall, arrhythmic events occurred in 37 % (<em>n</em> = 424) of patients, and they occurred in all classes. Eighteen percent (<em>n</em> = 59) of arrhythmic events occurred in Class III. Of all arrhythmias, 3 % (<em>n</em> = 14) were life threatening, and all of them occurring within Class I. Telemetry monitoring led to changes in clinical management in 22 % (<em>n</em> = 257) of patients due to clinical alarms, of which 71 % (<em>n</em> = 182) were related to medication management.</p></div><div><h3>Conclusions</h3><p>Most patients were appropriately monitored according to the AHA practice standards, meeting Class I and II. Arrhythmias occurred in all classes, but life-threatening arrhythmias only occurred in patients in Class I. However, a daily re-assessment of each patient's telemetry indication is warranted.</p></div>","PeriodicalId":55064,"journal":{"name":"Heart & Lung","volume":"68 ","pages":"Pages 217-226"},"PeriodicalIF":2.4,"publicationDate":"2024-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S014795632400133X/pdfft?md5=b5abf060d4e398207cb09a8157a7e5d3&pid=1-s2.0-S014795632400133X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141789950","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-23DOI: 10.1016/j.hrtlng.2024.07.008
Christina A. Day MSc , Rachel S. Berkowsky MSc , Amanda L. Zaleski PhD , Ming-Hui Chen PhD , Beth A. Taylor PhD, FACSM , Yin Wu PhD , Paul M. Parducci BSc , Yiming Zhang PhD , Bo Fernhall PhD, FACSM , Antonio B. Fernandez MD , Linda S. Pescatello PhD, FACSM
Background
Firefighters have a high prevalence of cardiovascular disease. The poor heart health of firefighters is implicated in their increased risk of sudden cardiac death (SCD). Exercise may be protective against SCD partially due to the immediate blood pressure (BP) reductions of 5–8 mmHg following exercise, termed postexercise hypotension (PEH)
Objectives
To examine PEH under ambulatory conditions after a maximal cardiopulmonary exercise test (CPET) among career firefighters
Methods
Firefighters (n = 19) completed a maximal CPET and non-exercise control (CONTROL) in random order on separate non-workdays and left the laboratory instrumented to an ambulatory BP (ABP) monitor. Ambulatory systolic BP (ASBP), diastolic BP (ADBP), and heart rate (AHR) were recorded at hourly intervals over 19hr. The ambulatory rate pressure product (ARPP) was calculated as ASBPxAHRx10–3 at each hourly interval. Repeated measures ANCOVA tested if the ABP, AHR, and ARPP responses differed after CPET vs CONTROL over 19hr
Results
Firefighters were middle-aged (39.5 ± 8.9 yr), overweight (29.2 ± 4.0 kg/m2) men with elevated BP (123.1 ± 9.6/79.8 ± 10.4 mmHg), while resting HR (67.7 ± 11.3 bpm) and RPP (8.4 ± 1.7mmHg*bpm*10–3) were in normal ranges. ASBP (16.6 ± 5.7 mmHg) and ADBP (3.1 ± 4.6 mmHg) increased after the CPET vs CONTROL over 19hr (ps<0.01), as did AHR (9.4 ± 7.9 bpm, p = 0.02) and ARPP (2.5 ± 1.1mmHg*bpm*10–3, p < 0.01).
Conclusions
Unexpectedly, the firefighters exhibited postexercise hypertension rather than PEH. The increases in ABP and AHR we observed indicated a sustained increase in cardiac demand. Further investigation is needed to confirm our findings and determine whether the adverse hemodynamic responses we observed contribute to the high prevalence of SCD that firefighters experience on the job.
{"title":"The influence of vigorous physical exertion on cardiac demand under conditions of daily living among firefighters with elevated blood pressure","authors":"Christina A. Day MSc , Rachel S. Berkowsky MSc , Amanda L. Zaleski PhD , Ming-Hui Chen PhD , Beth A. Taylor PhD, FACSM , Yin Wu PhD , Paul M. Parducci BSc , Yiming Zhang PhD , Bo Fernhall PhD, FACSM , Antonio B. Fernandez MD , Linda S. Pescatello PhD, FACSM","doi":"10.1016/j.hrtlng.2024.07.008","DOIUrl":"10.1016/j.hrtlng.2024.07.008","url":null,"abstract":"<div><h3>Background</h3><p>Firefighters have a high prevalence of cardiovascular disease. The poor heart health of firefighters is implicated in their increased risk of sudden cardiac death (SCD). Exercise may be protective against SCD partially due to the immediate blood pressure (BP) reductions of 5–8 mmHg following exercise, termed <em>postexercise hypotension</em> (PEH)</p></div><div><h3>Objectives</h3><p>To examine PEH under ambulatory conditions after a maximal cardiopulmonary exercise test (CPET) among career firefighters</p></div><div><h3>Methods</h3><p>Firefighters (<em>n</em> = 19) completed a maximal CPET and non-exercise control (CONTROL) in random order on separate non-workdays and left the laboratory instrumented to an ambulatory BP (ABP) monitor. Ambulatory systolic BP (ASBP), diastolic BP (ADBP), and heart rate (AHR) were recorded at hourly intervals over 19hr. The ambulatory rate pressure product (ARPP) was calculated as ASBPxAHRx10<sup>–3</sup> at each hourly interval. Repeated measures ANCOVA tested if the ABP, AHR, and ARPP responses differed after CPET vs CONTROL over 19hr</p></div><div><h3>Results</h3><p>Firefighters were middle-aged (39.5 ± 8.9 yr), overweight (29.2 ± 4.0 kg/m<sup>2</sup>) men with elevated BP (123.1 ± 9.6/79.8 ± 10.4 mmHg), while resting HR (67.7 ± 11.3 bpm) and RPP (8.4 ± 1.7mmHg*bpm*10<sup>–3</sup>) were in normal ranges. ASBP (16.6 ± 5.7 mmHg) and ADBP (3.1 ± 4.6 mmHg) increased after the CPET vs CONTROL over 19hr (ps<0.01), as did AHR (9.4 ± 7.9 bpm, <em>p</em> = 0.02) and ARPP (2.5 ± 1.1mmHg*bpm*10<sup>–3</sup>, <em>p</em> < 0.01).</p></div><div><h3>Conclusions</h3><p>Unexpectedly, the firefighters exhibited <em>postexercise hypertension</em> rather than PEH. The increases in ABP and AHR we observed indicated a sustained increase in cardiac demand. Further investigation is needed to confirm our findings and determine whether the adverse hemodynamic responses we observed contribute to the high prevalence of SCD that firefighters experience on the job.</p></div>","PeriodicalId":55064,"journal":{"name":"Heart & Lung","volume":"68 ","pages":"Pages 208-216"},"PeriodicalIF":2.4,"publicationDate":"2024-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141762773","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Clinical blood resources are scarce and autologous blood transfusion for extracorporeal membrane oxygenation (ECMO) withdrawal is less studied.
Objectives
To assess the use of staged autotransfusion during ECMO decannulation.
Methods
The study included ECMO withdrawal patients. Patients in the autologous transfusion group underwent staged transfusion during ECMO withdrawal, while those in the control group received 2.0 units of allogeneic packed red blood cells (RBCs) to increase hemoglobin (Hb). Parameters such as Hb, hematocrit (Hct), adverse events, decannulation success rate, volume of allogeneic RBC transfusions, and transfusion costs were compared.
Results
A total of 82 Chinese patients were enrolled, with a mean age of 46 years, 27 were female, and the top three primary diagnoses were cardiac arrest, acute myocarditis, and severe pneumonia. There were 41 individuals in the autologous blood transfusion group and 41 in the control group. No significant differences were observed in Hb, Hct, adverse events, and the success rate for decannulation between the two groups (all P > 0.05). Compared with the control group, the volume of allogeneic RBC transfusions [0 (0∼1.50) U vs. 3.5 (1.88∼40) U, P < 0.001] and the total cost [130 (130∼390) Chinese Yuan (CNY) vs. 910 (487.50, 1040) CNY, P = 0.002] were lower in the autologous transfusion group.
Conclusion
In comparison with allogeneic RBC transfusion, staged autotransfusion during ECMO decannulation not only effectively maintained Hb levels but also reduced the requirement for allogeneic RBC transfusions. In addition, this approach decreased the associated costs and did not increase the risk of clinical adverse events.
{"title":"Evaluation of staged autologous blood transfusion during extracorporeal membrane oxygenation decannulation: A retrospective study","authors":"Yun Gao , Xufeng Chen , Yong Mei, Tingting Yang, Xihua Huang, Hui Zhang, Yongxia Gao, Feng Sun, Huazhong Zhang, Xueli Ji, Juan Wu","doi":"10.1016/j.hrtlng.2024.07.009","DOIUrl":"10.1016/j.hrtlng.2024.07.009","url":null,"abstract":"<div><h3>Background</h3><p>Clinical blood resources are scarce and autologous blood transfusion for extracorporeal membrane oxygenation (ECMO) withdrawal is less studied.</p></div><div><h3>Objectives</h3><p>To assess the use of staged autotransfusion during ECMO decannulation.</p></div><div><h3>Methods</h3><p>The study included ECMO withdrawal patients. Patients in the autologous transfusion group underwent staged transfusion during ECMO withdrawal, while those in the control group received 2.0 units of allogeneic packed red blood cells (RBCs) to increase hemoglobin (Hb). Parameters such as Hb, hematocrit (Hct), adverse events, decannulation success rate, volume of allogeneic RBC transfusions, and transfusion costs were compared.</p></div><div><h3>Results</h3><p>A total of 82 Chinese patients were enrolled, with a mean age of 46 years, 27 were female, and the top three primary diagnoses were cardiac arrest, acute myocarditis, and severe pneumonia. There were 41 individuals in the autologous blood transfusion group and 41 in the control group. No significant differences were observed in Hb, Hct, adverse events, and the success rate for decannulation between the two groups (all <em>P</em> > 0.05). Compared with the control group, the volume of allogeneic RBC transfusions [0 (0∼1.50) U vs. 3.5 (1.88∼40) U, <em>P</em> < 0.001] and the total cost [130 (130∼390) Chinese Yuan (CNY) vs. 910 (487.50, 1040) CNY, <em>P</em> = 0.002] were lower in the autologous transfusion group.</p></div><div><h3>Conclusion</h3><p>In comparison with allogeneic RBC transfusion, staged autotransfusion during ECMO decannulation not only effectively maintained Hb levels but also reduced the requirement for allogeneic RBC transfusions. In addition, this approach decreased the associated costs and did not increase the risk of clinical adverse events.</p></div>","PeriodicalId":55064,"journal":{"name":"Heart & Lung","volume":"68 ","pages":"Pages 202-207"},"PeriodicalIF":2.4,"publicationDate":"2024-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0147956324001365/pdfft?md5=8f5a1e0161368b525b44fefdc95d25dc&pid=1-s2.0-S0147956324001365-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141753416","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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