Pub Date : 2024-04-10DOI: 10.1097/ec9.0000000000000115
Bin Song, Zhentian Cui, Hongyan Ju, Yue Sun, Dandan Liu, Guang-Yu Li
This study aimed to summarize the clinical characteristics of patients with deep sternal wound infection-induced sepsis after median sternotomy and improve the treatment outcomes of infection-related sepsis. A retrospective cohort study was conducted on 21 patients with deep sternal wound infection-induced sepsis after median sternotomy who were admitted to the Department of Critical Care. The clinical manifestations, laboratory test results, infection control, and organ and nutritional support of the patients were summarized, and the follow-up data were obtained. The primary symptoms of deep sternal wound infection-induced sepsis included dyspnea, high fever, chills, and altered state of consciousness. Laboratory test results revealed increased inflammatory markers and decreased oxygenation index. Renal and liver function injury were observed in 8 and 4 patients, respectively; 18 and 12 patients demonstrated elevated D-dimer and N-terminal Pro B type natriuretic peptide levels, respectively. Of the 8 patients whose wound secretions tested positive for bacteria, Acinetobacter baumannii and Staphylococcus aureus infections were present in 6 and 2 patients, respectively. One of the 6 patients whose blood cultures tested positive for bacteria demonstrated Candida albicans infection. Fifteen patients received ventilator-assisted ventilation and 2 patients received renal replacement therapy. Of all the 21 patients, 17 were cured, 2 died, and 2 were discharged. Postmedian sternotomy sepsis attributed to a deep sternal wound infection usually results from a preexisting condition. The most prominent clinical manifestation is dyspnea, which is sometimes accompanied by the impairment of organ function. Infection prevention, proper nutrition support, and maintenance of healthy organ function are the cornerstones for successful treatment outcomes.
{"title":"Clinical analysis of patients with deep sternal wound infection-induced sepsis: a retrospective cohort study","authors":"Bin Song, Zhentian Cui, Hongyan Ju, Yue Sun, Dandan Liu, Guang-Yu Li","doi":"10.1097/ec9.0000000000000115","DOIUrl":"https://doi.org/10.1097/ec9.0000000000000115","url":null,"abstract":"\u0000 \u0000 \u0000 This study aimed to summarize the clinical characteristics of patients with deep sternal wound infection-induced sepsis after median sternotomy and improve the treatment outcomes of infection-related sepsis.\u0000 \u0000 \u0000 \u0000 A retrospective cohort study was conducted on 21 patients with deep sternal wound infection-induced sepsis after median sternotomy who were admitted to the Department of Critical Care. The clinical manifestations, laboratory test results, infection control, and organ and nutritional support of the patients were summarized, and the follow-up data were obtained.\u0000 \u0000 \u0000 \u0000 The primary symptoms of deep sternal wound infection-induced sepsis included dyspnea, high fever, chills, and altered state of consciousness. Laboratory test results revealed increased inflammatory markers and decreased oxygenation index. Renal and liver function injury were observed in 8 and 4 patients, respectively; 18 and 12 patients demonstrated elevated D-dimer and N-terminal Pro B type natriuretic peptide levels, respectively. Of the 8 patients whose wound secretions tested positive for bacteria, Acinetobacter baumannii and Staphylococcus aureus infections were present in 6 and 2 patients, respectively. One of the 6 patients whose blood cultures tested positive for bacteria demonstrated Candida albicans infection. Fifteen patients received ventilator-assisted ventilation and 2 patients received renal replacement therapy. Of all the 21 patients, 17 were cured, 2 died, and 2 were discharged.\u0000 \u0000 \u0000 \u0000 Postmedian sternotomy sepsis attributed to a deep sternal wound infection usually results from a preexisting condition. The most prominent clinical manifestation is dyspnea, which is sometimes accompanied by the impairment of organ function. Infection prevention, proper nutrition support, and maintenance of healthy organ function are the cornerstones for successful treatment outcomes.\u0000","PeriodicalId":72895,"journal":{"name":"Emergency and critical care medicine","volume":"2012 31","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140718701","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-18DOI: 10.1097/ec9.0000000000000109
Anmol Multani, Greg Stahl, Kerry Johnson, Scott Goade, R. Arnce
Sepsis has high prevalence and mortality rate, and it is imperative to identify populations at risk of poor sepsis outcomes. Septic patients with preexisting chronic comorbidities are shown to have worse sepsis outcomes. By identifying comorbidities with greater influence on sepsis progression, we can direct limited resources to septic patients with comorbidities and reduce health care costs. Chronic comorbidities can impact the risk of developing sepsis and having worse outcomes. Coronary artery disease (CAD) is a common comorbidity, especially in the elderly, and a leading cause of death globally. We wished to investigate the influence of CAD as a comorbidity on sepsis and hypothesized that preexisting CAD would increase mortality in hospitalized septic patients. We conducted retrospective observational study using patient data from Freeman Health System in Joplin, MO. We analyzed patient records from Freeman Health System database from January 1, 2019, to June 30, 2020. Septic patients were identified using the International Classification of Diseases, Tenth Revision sepsis codes. To identify septic patients with preexisting CAD, we used International Classification of Diseases, Tenth Revision codes for CAD. We compared mortality rates for septic patients with and without CAD. Two-sample proportion test was conducted to test the difference in mortality between septic patients with and without preexisting CAD. The difference in mortality for the total population was −0.016 (P = 0.553). In the male and female subgroups, the differences in mortality were 0.0122 (P = 0.739) and −0.0511 (P = 0.208), respectively. The differences in mortality in patients aged 40 to 64 years and 65 years and older were −0.0077 (P = 0.870) and 0.0007 (P = 0.983), respectively. The statistical tests failed to find significant differences when comparing septic patients with and without preexisting CAD. There was no significant difference in the age and sex subgroups. Our study showed that CAD alone was not associated with higher mortality due to sepsis in our population.
{"title":"Exploring the effects of coronary artery disease as a preexisting comorbidity on mortality in hospitalized septic patients: a retrospective observation study","authors":"Anmol Multani, Greg Stahl, Kerry Johnson, Scott Goade, R. Arnce","doi":"10.1097/ec9.0000000000000109","DOIUrl":"https://doi.org/10.1097/ec9.0000000000000109","url":null,"abstract":"\u0000 \u0000 \u0000 Sepsis has high prevalence and mortality rate, and it is imperative to identify populations at risk of poor sepsis outcomes. Septic patients with preexisting chronic comorbidities are shown to have worse sepsis outcomes. By identifying comorbidities with greater influence on sepsis progression, we can direct limited resources to septic patients with comorbidities and reduce health care costs. Chronic comorbidities can impact the risk of developing sepsis and having worse outcomes. Coronary artery disease (CAD) is a common comorbidity, especially in the elderly, and a leading cause of death globally. We wished to investigate the influence of CAD as a comorbidity on sepsis and hypothesized that preexisting CAD would increase mortality in hospitalized septic patients.\u0000 \u0000 \u0000 \u0000 We conducted retrospective observational study using patient data from Freeman Health System in Joplin, MO. We analyzed patient records from Freeman Health System database from January 1, 2019, to June 30, 2020. Septic patients were identified using the International Classification of Diseases, Tenth Revision sepsis codes. To identify septic patients with preexisting CAD, we used International Classification of Diseases, Tenth Revision codes for CAD. We compared mortality rates for septic patients with and without CAD.\u0000 \u0000 \u0000 \u0000 Two-sample proportion test was conducted to test the difference in mortality between septic patients with and without preexisting CAD. The difference in mortality for the total population was −0.016 (P = 0.553). In the male and female subgroups, the differences in mortality were 0.0122 (P = 0.739) and −0.0511 (P = 0.208), respectively. The differences in mortality in patients aged 40 to 64 years and 65 years and older were −0.0077 (P = 0.870) and 0.0007 (P = 0.983), respectively. The statistical tests failed to find significant differences when comparing septic patients with and without preexisting CAD. There was no significant difference in the age and sex subgroups.\u0000 \u0000 \u0000 \u0000 Our study showed that CAD alone was not associated with higher mortality due to sepsis in our population.\u0000","PeriodicalId":72895,"journal":{"name":"Emergency and critical care medicine","volume":"293 8","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140233288","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-29DOI: 10.1097/ec9.0000000000000111
Kaiming Wei, Yu Yao, Chuanzhen Liu, Yuan Cao
Mitral valve perforation refers to the occurrence of cracks or openings in the structure of the mitral valve, allowing blood to escape through these gaps. Typically, this is caused by infective endocarditis and the most common site is the anterior leaflet. However, it is crucial to explore other potential causes of valve damage, particularly when conventional risk factors are not apparent. We present a case of a middle-aged male patient who developed mitral valve perforation because of aortic valve regurgitation in the absence of infective endocarditis. Exploring such rare cases contributes to a deeper understanding of valvular diseases and enhances clinical decision making for effective management.
{"title":"An unusual anterior mitral leaflet perforation in a patient with no infective endocarditis: a case report","authors":"Kaiming Wei, Yu Yao, Chuanzhen Liu, Yuan Cao","doi":"10.1097/ec9.0000000000000111","DOIUrl":"https://doi.org/10.1097/ec9.0000000000000111","url":null,"abstract":"\u0000 \u0000 \u0000 Mitral valve perforation refers to the occurrence of cracks or openings in the structure of the mitral valve, allowing blood to escape through these gaps. Typically, this is caused by infective endocarditis and the most common site is the anterior leaflet. However, it is crucial to explore other potential causes of valve damage, particularly when conventional risk factors are not apparent.\u0000 \u0000 \u0000 \u0000 We present a case of a middle-aged male patient who developed mitral valve perforation because of aortic valve regurgitation in the absence of infective endocarditis.\u0000 \u0000 \u0000 \u0000 Exploring such rare cases contributes to a deeper understanding of valvular diseases and enhances clinical decision making for effective management.\u0000","PeriodicalId":72895,"journal":{"name":"Emergency and critical care medicine","volume":"42 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140411552","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-23DOI: 10.1097/ec9.0000000000000107
Mirko Barone, Regina Frontera, Rita Vaia Liouras, Massimo Ippoliti, Luca Serano, Carmine Giovanni Iovino, I. Dell’Atti, Luigi Vetrugno, F. Mucilli, S. M. Maggiore
Non-occlusive mesenteric ischemia in critically ill patients still has a poor prognosis. Despite several established risk factors, the interaction between clinical conditions and perfusion mismatch often leads to progressive organ failure. Workup is challenging because of the absence of typical abdominal signs and symptoms due to sedation, poor reactivity, need for ventilation, and confounding comorbidities. Moreover, imaging has poor specificity with findings often inconclusive. A bedside exploratory laparoscopy, as a complementary strategy, would allow for early and prompt diagnosis. Limits of a minimally invasive surgical rationale lie upon the effects of pneumoperitoneum induction, surgical stress, logistical resources, expertise, and costs.
{"title":"Non-occlusive mesenteric ischemia in critically ill patients: does bedside laparoscopy offer any real benefit?","authors":"Mirko Barone, Regina Frontera, Rita Vaia Liouras, Massimo Ippoliti, Luca Serano, Carmine Giovanni Iovino, I. Dell’Atti, Luigi Vetrugno, F. Mucilli, S. M. Maggiore","doi":"10.1097/ec9.0000000000000107","DOIUrl":"https://doi.org/10.1097/ec9.0000000000000107","url":null,"abstract":"\u0000 Non-occlusive mesenteric ischemia in critically ill patients still has a poor prognosis. Despite several established risk factors, the interaction between clinical conditions and perfusion mismatch often leads to progressive organ failure. Workup is challenging because of the absence of typical abdominal signs and symptoms due to sedation, poor reactivity, need for ventilation, and confounding comorbidities. Moreover, imaging has poor specificity with findings often inconclusive. A bedside exploratory laparoscopy, as a complementary strategy, would allow for early and prompt diagnosis. Limits of a minimally invasive surgical rationale lie upon the effects of pneumoperitoneum induction, surgical stress, logistical resources, expertise, and costs.","PeriodicalId":72895,"journal":{"name":"Emergency and critical care medicine","volume":"142 43","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139604497","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-01DOI: 10.1097/ec9.0000000000000113
{"title":"Management and outcome of pancreatic trauma: a 6-year experience at a level I trauma center: Erratum","authors":"","doi":"10.1097/ec9.0000000000000113","DOIUrl":"https://doi.org/10.1097/ec9.0000000000000113","url":null,"abstract":"","PeriodicalId":72895,"journal":{"name":"Emergency and critical care medicine","volume":"503 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139023347","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-01DOI: 10.1097/ec9.0000000000000112
{"title":"Congestive heart failure and sepsis a retrospective study of hospitalization outcomes from a rural hospital in Southwest Missouri: Erratum","authors":"","doi":"10.1097/ec9.0000000000000112","DOIUrl":"https://doi.org/10.1097/ec9.0000000000000112","url":null,"abstract":"","PeriodicalId":72895,"journal":{"name":"Emergency and critical care medicine","volume":"273 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138989758","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-01DOI: 10.1097/ec9.0000000000000116
{"title":"Inhibition of cathepsin B protects pancreatic acinar cells against apoptosis in early pancreatic trauma in rats: Erratum","authors":"","doi":"10.1097/ec9.0000000000000116","DOIUrl":"https://doi.org/10.1097/ec9.0000000000000116","url":null,"abstract":"","PeriodicalId":72895,"journal":{"name":"Emergency and critical care medicine","volume":"1154 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139019235","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-01DOI: 10.1097/ec9.0000000000000114
{"title":"Prognostic value of elevated cardiac and inflammatory biomarkers in patients with severe COVID-19: a single-center, retrospective study: Erratum","authors":"","doi":"10.1097/ec9.0000000000000114","DOIUrl":"https://doi.org/10.1097/ec9.0000000000000114","url":null,"abstract":"","PeriodicalId":72895,"journal":{"name":"Emergency and critical care medicine","volume":"25 11","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139018682","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Clarithromycin exerts an immunomodulatory role in several human diseases. However, whether this effect improves the prognosis in patients with sepsis remains controversial, and higher levels of clinical evidence are urgently needed. To the best of our knowledge, no meta-analysis to date has reported the clinical efficacy and safety of clarithromycin in sepsis. A comprehensive literature search of PubMed, EMBASE, and the Cochrane Library was conducted up to December 31, 2022. Only randomized controlled trials comparing the clinical efficacy and safety of clarithromycin with controls among patients with sepsis or septic shock were included. Data were pooled by applying a fixed-effects model and a relative risk (RR) estimate with 95% confidence intervals (CIs) using Review Manager (version 5.3; Cochrane Collaboration, Copenhagen, Denmark). Three randomized controlled trials involving a total of 910 patients were included. The pooled results confirmed that clarithromycin had no beneficial effect on progression to multiple organ dysfunction syndrome (RR: 1.51; 95% CI: 1.02–2.25; P = 0.04; I 2 = 0%), 28-day mortality (RR: 1.09; 95% CI: 0.87–1.36; P = 0.46; I 2 = 0%), and 90-day mortality (RR: 0.86; 95% CI: 0.71–1.03; P = 0.10; I 2 = 81%) in patients with sepsis or septic shock. Moreover, there was no difference in other serious adverse events between patients who received clarithromycin and those in the control group (RR: 1.02; 95% CI: 0.87–1.19; P = 0.83; I 2 = 18%). Our meta-analysis did not reveal an improvement to short-term outcomes in patients with sepsis treated with clarithromycin. However, administration of clarithromycin did not increase the risk of adverse events.
{"title":"Efficacy and safety of clarithromycin for patients with sepsis or septic shock: a systematic review and meta-analysis","authors":"Pengyue Zhao, Renqi Yao, Jiaqi Yang, Wei Wen, Yongming Yao, Xiaohui Du","doi":"10.1097/ec9.0000000000000106","DOIUrl":"https://doi.org/10.1097/ec9.0000000000000106","url":null,"abstract":"Clarithromycin exerts an immunomodulatory role in several human diseases. However, whether this effect improves the prognosis in patients with sepsis remains controversial, and higher levels of clinical evidence are urgently needed. To the best of our knowledge, no meta-analysis to date has reported the clinical efficacy and safety of clarithromycin in sepsis. A comprehensive literature search of PubMed, EMBASE, and the Cochrane Library was conducted up to December 31, 2022. Only randomized controlled trials comparing the clinical efficacy and safety of clarithromycin with controls among patients with sepsis or septic shock were included. Data were pooled by applying a fixed-effects model and a relative risk (RR) estimate with 95% confidence intervals (CIs) using Review Manager (version 5.3; Cochrane Collaboration, Copenhagen, Denmark). Three randomized controlled trials involving a total of 910 patients were included. The pooled results confirmed that clarithromycin had no beneficial effect on progression to multiple organ dysfunction syndrome (RR: 1.51; 95% CI: 1.02–2.25; P = 0.04; I 2 = 0%), 28-day mortality (RR: 1.09; 95% CI: 0.87–1.36; P = 0.46; I 2 = 0%), and 90-day mortality (RR: 0.86; 95% CI: 0.71–1.03; P = 0.10; I 2 = 81%) in patients with sepsis or septic shock. Moreover, there was no difference in other serious adverse events between patients who received clarithromycin and those in the control group (RR: 1.02; 95% CI: 0.87–1.19; P = 0.83; I 2 = 18%). Our meta-analysis did not reveal an improvement to short-term outcomes in patients with sepsis treated with clarithromycin. However, administration of clarithromycin did not increase the risk of adverse events.","PeriodicalId":72895,"journal":{"name":"Emergency and critical care medicine","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139235234","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-11-20DOI: 10.1097/ec9.0000000000000104
Weida Lu, Min Li, Fuqing Ji, H. Feng, Liangyi Qie, Guo Li, Q. Ji, Mingying Ling, Fan Jiang, X. Cui
Although pregnancy imposes extra risk in patients with pulmonary arterial hypertension (PAH), hemodynamic characteristics vary between PAH patients with and without cardiac shunts. However, previous studies did not take hemodynamic differences in PAH patients into consideration for pregnancy outcome analysis. We aimed to identify predictors for peripartum outcome of PAH patients without/with cardiac shunt. We retrospectively analyzed the medical records of PAH gravidae parturiated by cesarean delivery (C-section) from 4 hospitals. Maternal death and major adverse cardiac events (MACEs) occurring during pregnancy or within 6 weeks postpartum were defined as composite end points. Risk factors for end points were analyzed separately in patients with and without cardiac shunt. The effect of general anesthesia on MACEs and maternal death was analyzed by Mantel-Haenszel hierarchical analysis considering cardiac shunts. One hundred eighty-one PAH gravidae were included, of whom 85 had PAH without cardiac shunt and 96 with shunt. Patients who met combined end points were 19/85 in those without shunt compared with 23/96 in those with shunt. The mortality rates were 11.8% and 9.4%, respectively. Both World Health Organization functional class (WHO-FC) III/IV and general anesthesia were predictors for gravidae without shunt, whereas only WHO-FC III/IV was a predictor for gravidae with shunt. General anesthesia increased the MACE risk (odds ratio, 9.000; 95% confidence interval, 2.628–30.820) and maternal mortality (odds ratio, 11.000; 95% confidence interval, 2.595–46.622; P = 0.039) in patients without cardiac shunt but not in those with shunt during C-section. All PAH gravidae with WHO-FC III/IV are at high risk and should receive intensive care. General anesthesia should be avoided during C-section for PAH gravidae without a cardiac shunt.
{"title":"General anesthesia is an independent predictor for worse maternal outcome in pregnant pulmonary arterial hypertension patients without cardiac shunt but not for those with shunt","authors":"Weida Lu, Min Li, Fuqing Ji, H. Feng, Liangyi Qie, Guo Li, Q. Ji, Mingying Ling, Fan Jiang, X. Cui","doi":"10.1097/ec9.0000000000000104","DOIUrl":"https://doi.org/10.1097/ec9.0000000000000104","url":null,"abstract":"Although pregnancy imposes extra risk in patients with pulmonary arterial hypertension (PAH), hemodynamic characteristics vary between PAH patients with and without cardiac shunts. However, previous studies did not take hemodynamic differences in PAH patients into consideration for pregnancy outcome analysis. We aimed to identify predictors for peripartum outcome of PAH patients without/with cardiac shunt. We retrospectively analyzed the medical records of PAH gravidae parturiated by cesarean delivery (C-section) from 4 hospitals. Maternal death and major adverse cardiac events (MACEs) occurring during pregnancy or within 6 weeks postpartum were defined as composite end points. Risk factors for end points were analyzed separately in patients with and without cardiac shunt. The effect of general anesthesia on MACEs and maternal death was analyzed by Mantel-Haenszel hierarchical analysis considering cardiac shunts. One hundred eighty-one PAH gravidae were included, of whom 85 had PAH without cardiac shunt and 96 with shunt. Patients who met combined end points were 19/85 in those without shunt compared with 23/96 in those with shunt. The mortality rates were 11.8% and 9.4%, respectively. Both World Health Organization functional class (WHO-FC) III/IV and general anesthesia were predictors for gravidae without shunt, whereas only WHO-FC III/IV was a predictor for gravidae with shunt. General anesthesia increased the MACE risk (odds ratio, 9.000; 95% confidence interval, 2.628–30.820) and maternal mortality (odds ratio, 11.000; 95% confidence interval, 2.595–46.622; P = 0.039) in patients without cardiac shunt but not in those with shunt during C-section. All PAH gravidae with WHO-FC III/IV are at high risk and should receive intensive care. General anesthesia should be avoided during C-section for PAH gravidae without a cardiac shunt.","PeriodicalId":72895,"journal":{"name":"Emergency and critical care medicine","volume":"45 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139259679","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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