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Comparison of emergency surgical cricothyroidotomy and percutaneous cricothyroidotomy by experienced airway providers in an obese,in vivo porcine hemorrhage airway model

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军事医学研究:英文版 2023年第4期10卷 421-430页

作者： Tomas Karlsson Andreas Brännström Mikael Gellerfors Jenny Gustavsson Mattias Günther department of Clinical Science and Education Section of Anesthesiology and Intensive CareKarolinska Institutet11883 StockholmSweden department of Neuroscience Karolinska Institutet17177 StockholmSweden department of Physiology and Pharmacology Section of Anesthesiology and Intensive CareKarolinska Institutet11883 StockholmSweden department of Perioperative medicine and intensive care Karolinska University Hospital17177 StockholmSweden Swedish Air Ambulance(SLA) 79291 MoraSweden Rapid Response Cars 18233 StockholmSweden.

Background: Emergency front-of-neck airway(eFONA) is a life-saving procedure in “cannot intubate, cannot oxygenate”(CICO). The fastest and most reliable method of eFONA has not been determined. We compared two of the most advocated approaches: surgical cricothyroidotomy and percutaneous cricothyroidotomy, in an obese, in vivo porcine hemorrhage model, designed to introduce real-time physiological feedback, relevant and high provider stress. The primary aim was to determine the fastest method to secure airway. Secondary aims were arterial saturation and partial pressure of oxygen, proxy survival and influence of experience.Methods: Twelve pigs [(60.3±4.1) kg] were anesthetized and exposed to 25%–35% total blood volume hemorrhage before extubation and randomization to Seldinger technique “percutaneous cricothyroidotomy”(n=6) or scalpelbougie-tube technique “surgical cricothyroidotomy”(n=6). Specialists in anesthesia and intensive care in a tertiary referral hospital performed the eFONA, simulating an actual CICO-situation.Results: In surgical cricothyroidotomy vs. percutaneous cricothyroidotomy, the median(interquartile range, IQR) times to secure airway were 109(IQR 71–130) s and 298(IQR 128–360) s(P=0.0152), arterial blood saturation(SaO2) were 74.7(IQR 46.6–84.2)% and 7.9(IQR 4.1–15.6)%(P=0.0167), PaO_(2) were 7.0(IQR 4.7–7.7) kPa and 2.0(IQR 1.1–2.9) kPa(P=0.0667), and times of cardiac arrest(proxy survival) were 137–233 s, 190(IQR 143–229) s, from CICO. All six animals survived surgical cricothyroidotomy, and two of six(33%) animals survived percutaneous cricothyroidotomy. Years in anesthesia, 13.5(IQR 7.5–21.3), did not influence time to secure airway.Conclusions: eFONA by surgical cricothyroidotomy was faster and had increased oxygenation and survival, when performed under stress by board certified anesthesiologists, and may be an indication of preferred method in situations with hemorrhage and CICO, in obese patients.

关键词： Emergency front-of-neck airway “Cannot intubate cannot oxygenate”(CICO) Surgical cricothyroidotomy,Percutaneous cricothyroidotomy Porcine model

Argon: a novel therapeutic option to treat neuronal ischemia and reperfusion injuries?

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Neural Regeneration Research 2015年第7期10卷 1043-1044页

作者： Felix Ulbrich Ulrich Goebel Department of Anesthesiology and Intensive Care Medicine University Medical CenterFreiburg Germany

Neuronal injury and neuroprotection：Ischemia and reperfusion injuries in neuronal cells such as acute ischemic stroke-represent the third leading cause of death in the world.Current therapeutic concepts mainly aim to re-establish cerebral blood flow within a time window of less than 3 hours with the goal of limiting secondary brain injury.

关键词： a novel therapeutic option to treat neuronal ischemia and reperfusion injuries MCAO NDS OGD

Accuracy of training blood volume quantifi cation using a visual estimation tool

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World Journal of Emergency medicine 2021年第3期12卷 174-178页

作者： Janett Kreutziger Philip Puchner Stefan Schmid Wolfgang Mayer Harald Prossliner Wolfgang Lederer department of General and Surgical intensive care medicine Medical University of InnsbruckInnsbruck 6020Austria department of anesthesiology and Critical care medicine Wels-Grieskirchen HospitalWels 4600Austria department of Transfusion medicine Medical University of InnsbruckInnsbruck 6020Austria department of Anaesthesia and intensive care medicine Medical University of InnsbruckInnsbruck 6020Austria

BACKGROUND:We investigated whether the use of a specially designed visual estimation tool may improve accuracy in quantifying blood volumes related to surface spreading.METHODS:A prospective,paired-control,single-blinded experimental study was performed at a medical university.Anesthesiologists and emergency medical personnel estimated various blood volumes on surfaces with varying absorptivity(carpet,towel,polyvinyl chloride,wooden fl ooring)in an experimental setting.We assessed the sensitivity of training blood volume quantifi cation using a self-designed visual estimation tool by comparing the accuracy of visual blood volume estimations before and after practical training with the tool.RESULTS:A total of 352 estimations by 44 participants were evaluated.Accurate estimations improved significantly from pre-training to post-training(P<0.05).The sensitivity of blood volume quantifi cation was 33.0%after training with the visual estimation tool.Estimations did not depend on age,profession,gender or years of the estimator’s professional experience.CONCLUSIONS:Training with a visual estimation tool by professional rescuers can improve the estimation accuracy of blood volumes spread on surfaces with varying absorptivity.

关键词： Academic training Emergency medicine Hemorrhage control Major bleeding

Protocadherin gamma C3:a new player in regulating vascular barrier function

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Neural Regeneration Research 2023年第1期18卷 68-73页

作者： Victoria Kaupp Kinga G.Blecharz-Lang Christina Dilling Patrick Meybohm Malgorzata Burek department of anesthesiology Intensive CareEmergency and Pain MedicineUniversity of WürzburgUniversity Hospital WürzburgWürzburgGermany department of Experimental Neurosurgery Charité-UniversitätsmedizinBerlinGermany

Defects in the endothelial cell barrier accompany diverse malfunctions of the central nervous system such as neurodegenerative diseases,stroke,traumatic brain injury,and systemic diseases such as sepsis,viral and bacterial infections,and cancer.Compromised endothelial sealing leads to leaking blood vessels,followed by vasogenic edema.Brain edema as the most common complication caused by stroke and traumatic brain injury is the leading cause of death.Brain microvascular endothelial cells,together with astrocytes,pericytes,microglia,and neurons form a selective barrier,the so-called blood-brain barrier,which regulates the movement of molecules inside and outside of the brain.Mechanisms that regulate blood-brain barrier permeability in health and disease are complex and not fully understood.Several newly discovered molecules that are involved in the regulation of cellular processes in brain microvascular endothelial cells have been described in the literature in recent years.One of these molecules that are highly expressed in brain microvascular endothelial cells is protocadherin gamma C3.In this review,we discuss recent evidence that protocadherin gamma C3 is a newly identified key player involved in the regulation of vascular barrier function.

关键词： blood-brain barrier brain microvascular endothelial cells permeability protein interaction protocadherin gamma C3 protocadherins tight junctions

MicroRNA-based targeting of the Rho/ROCK pathway in therapeutic strategies after spinal cord injury

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Neural Regeneration Research 2023年第2期18卷 311-312页

作者： Tetsu Kimura Yuta Horikoshi department of Anesthesia and intensive care medicine Akita University Graduate School of MedicineAkitaJapan

Spinal cord injury(SCI)is one of the leading causes of disability and is a devastating condition that requires long-term care,reduces social productivity,and gives an immense emotional burden on patients and their fa milies.SCI frequently occurs due to traffic accidents,falls,slips,violence,sports,and medical accidents in today's society.The initial mechanical damage triggers a secondary injury cascade that induces more intractable damage(Silva et al.,2014).Secondary injury mechanisms have been postulated,including neuronal apoptosis,inflammation,oxidative stress,and excitotoxicity.

关键词： damage injury emotional

Analysis and validation of diagnostic biomarkers and immune cell infiltration characteristics in pediatric sepsis by integrating bioinformatics and machine learning

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World Journal of Pediatrics 2023年第11期19卷 1094-1103页

作者： Wen‑Yuan Zhang Zhong‑Hua Chen Xiao‑Xia An Hui Li Hua‑Lin Zhang Shui‑Jing Wu Yu‑Qian Guo Kai Zhang Cong‑Li Zeng Xiang‑Ming Fang department of anesthesiology and intensive care School of MedicineThe First Affiliated HospitalZhejiang UniversityQingChun Road 79Hangzhou 310003China department of anesthesiology Shaoxing People’s Hospital(Shaoxing HospitalZhejiang University School of Medicine)Shaoxing 312000China department of anesthesiology Vagelos College of Physicians and SurgeonsColumbia UniversityNew YorkNYUSA

Background Pediatric sepsis is a complicated condition characterized by life-threatening organ failure resulting from a dysregulated host response to infection in children.It is associated with high rates of morbidity and mortality,and rapid detection and administration of antimicrobials have been emphasized.The objective of this study was to evaluate the diagnostic biomarkers of pediatric sepsis and the function of immune cell infiltration in the development of this illness.Methods Three gene expression datasets were available from the Gene Expression Omnibus collection.First,the differentially expressed genes(DEGs)were found with the use of the R program,and then gene set enrichment analysis was carried out.Subsequently,the DEGs were combined with the major module genes chosen using the weighted gene co-expression network.The hub genes were identified by the use of three machine-learning algorithms:random forest,support vector machine-recursive feature elimination,and least absolute shrinkage and selection operator.The receiver operating characteristic curve and nomogram model were used to verify the discrimination and efficacy of the hub genes.In addition,the inflammatory and immune status of pediatric sepsis was assessed using cell-type identification by estimating relative subsets of RNA transcripts(CIBERSORT).The relationship between the diagnostic markers and infiltrating immune cells was further studied.Results Overall,after overlapping key module genes and DEGs,we detected 402 overlapping genes.As pediatric sepsis diagnostic indicators,CYSTM1(AUC=0.988),MMP8(AUC=0.973),and CD177(AUC=0.986)were investigated and demonstrated statistically significant differences(P<0.05)and diagnostic efficacy in the validation set.As indicated by the immune cell infiltration analysis,multiple immune cells may be involved in the development of pediatric sepsis.Additionally,all diagnostic characteristics may correlate with immune cells to varying degrees.Conclusions The candidate hub genes(CD177,CYSTM1,and MMP8)were identifi

关键词： Paediatric sepsis Bioinformatics Machine-Learning Biomarkers Immune cell infiltration

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羟乙基淀粉溶液的容量复苏：近期文献综述

中华麻醉学杂志 2014年第8期34卷 912-918页

作者： Tim G.Kampmeier Christian Ertmer Hugo Van Aken Sebastian Rehberg department of anesthesiology intensive care and Pain medicine University Hospital of Muenster

对围术期或危重症病人实施个体化液体管理,需要谨慎权衡利弊,这是一项极具挑战性的日常临床工作.全世界近几十年来,羟乙基淀粉溶液一直用于围术期或危重症病人的容量复苏,然而2013年10月欧洲药品管理局提议,对于脓毒症、烧伤、肾功能不... 详细信息

对围术期或危重症病人实施个体化液体管理,需要谨慎权衡利弊,这是一项极具挑战性的日常临床工作.全世界近几十年来,羟乙基淀粉溶液一直用于围术期或危重症病人的容量复苏,然而2013年10月欧洲药品管理局提议,对于脓毒症、烧伤、肾功能不全及严重凝血功能障碍等危重症病人,一般情况下不宜使用羟乙基淀粉溶液.但这项提议基于的三个主要的随机对照试验,均因其设计方案和数据分析而倍受质疑.本文简要概述了羟乙基淀粉溶液的药代动力学和药效动力学;各代羟乙基淀粉溶液之间的不同点;围术期病人与危重症病人之间病理生理学的差异.此外,本文还对近来有关羟乙基淀粉溶液用于危重症病人和心脏手术围术期病人容量复苏的随机对照试验,进行了评论.

关键词：羟乙基淀粉液体治疗

A comprehensive neuromonitoring approach in a large animal model of cardiac arrest

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Animal Models and Experimental medicine 2022年第1期5卷 56-60页

作者： Filippo Annoni Lorenzo Peluso Lucas Akira Hirai Giovanni Babini Amina Khaldi Antoine Herpain Lorenzo Pitisci Lorenzo Ferlini Bruno Garcia Fabio Silvio Taccone Jacques Creteur Fuhong Su intensive care Experimental Laboratory Intensive Care UnitErasme HospitalBrusselBelgium intensive care Unit São Domingos HospitalSão LuísBrazil department of Pathophysiology and Transplants University of MilanMilanItaly department of anesthesiology Intensive Care and Emergency Fondazione IRCCS Ca’Granda Ospedale Maggiore PoliclinicoMilanItaly

Background:Anoxic brain injuries represent the main determinant of poor outcome after cardiac arrest(CA).Large animal models have been described to investigate new treatments during CA and post-resuscitation phase,but a detailed model that includes extensive neuromonitoring is lacking.Method:Before an electrically-induced 10-minute CA and resuscitation,46 adult pigs underwent neurosurgery for placement of a multifunctional probe(intracranial pressure or ICP,tissue oxygen tension or PbtO_(2) and cerebral temperature)and a bolt-based technique for the placement and securing of a regional blood flow probe and two sEEG electrodes;two modified cerebral microdialysis(CMD)probes were also inserted in the frontal lobes and accidental misplacement was prevented using a perforated head support.Result:42 animals underwent the CA procedure and 41 achieved the return of spontaneous circulation(ROSC).In 4 cases(8.6%)an adverse event took place during preparation,but only in two cases(4.3%)this was related to the neurosurgery.In 6 animals(13.3%)the minor complications that occurred resolved after probe repositioning.Conclusion:Herein we provide a detailed comprehensive neuromonitoring approach in a large animal model of CA that might help future research.

关键词： anoxic injury heart arrest ischemiareperfusion post-arrest resuscitation

Association between serosal intestinal microcirculation and blood pressure during major abdominal surgery

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Journal of intensive medicine 2021年第1期1卷 59-64页

作者： Arthur LM Tavy Anton FJ de Bruin E Christiaan Boerma Can Ince Matthias P Hilty Peter G Noordzij Djamila Boerma Mat van Iterson department of anesthesiology Intensive Care and Pain MedicineSt.Antonius HospitalNieuwegein 3435 CMthe Netherlands department of intensive care Medical Center LeeuwardenLeeuwarden 8934 ADthe Netherlands department of intensive care medicine Erasmus MCUniversity Medical Center RotterdamRotterdam 3015 GDthe Netherlands Institute of intensive care medicine University Hospital of ZurichZürich 8006Switzerland department of Surgery St.Antonius HospitalNieuwegein 3435 CMthe Netherlands

Background:In clinical practice,blood pressure is used as a resuscitation goal on a daily basis,with the aim of maintaining adequate perfusion and oxygen delivery to target organs.Compromised perfusion is often indicated as a key factor in the pathophysiology of anastomotic leakage.This study was aimed at assessing the extent to which the microcirculation of the bowel coheres with blood pressure during abdominal surgery.Methods:We performed a prospective and observational cohort study.In patients undergoing abdominal surgery,the serosal microcirculation of either the small intestine or the colon was visualized using handheld vital mi-croscopy(HVM).From the acquired HVM image sequences,red blood cell velocity(RBCv)and total vessel density(TVD)were calculated using MicroTools and AVA software,respectively.The association between microcircula-tory parameters and blood pressure was assessed using Pearson’s correlation analysis.We considered a two-sided P-value of<0.050 to be significant.Results:In 28 patients undergoing abdominal surgery,a total of 76 HVM images were analyzed.The RBCv was 335±96μm/s and the TVD was 13.7±3.4 mm/mm ^(2).Mean arterial pressure(MAP)was 71±12 mm Hg during microcirculatory imaging.MAP was not correlated with RBCv(Pearson’s r=−0.049,P=0.800)or TVD(Pearson’s r=0.310,P=0.110).Conclusion:In 28 patients undergoing abdominal surgery,we found no association between serosal intestinal microcirculatory parameters and blood pressure.

关键词： Intestinal microcirculation Handheld vital microscopy Abdominal surgery Hemodynamic management