Flow measurements: Can several “Wrongs” make a “Right”?

AIMS: Although measurement of maximum flow rate (Qmax) is a standard and straightforward test, it is often difficult to obtain reliable readings. We obtained multiple measurements using a simple home uroflow device which categorizes Qmax into ranges. We hypothesize that the average of a series of relatively coarse measurements of Qmax would be more repeatable and therefore more representative of an individual's voiding function than a single, albeit more precise measurement. METHODS: We studied 22 male volunteers with a wide range of Qmax. They were asked to record flow category (<10 ml/sec; 10-15 ml/sec; 15-20 ml/sec; >20 ml/sec) and voided volume twice daily for 12 days using the home flow device. In addition, a clinic-based flow recording using a spinning-disc uroflowmeter was obtained at both the start and the end of the 12-day period. RESULTS: Good agreement between mean home flow and mean clinic flow was seen with mean (SD) difference of 1.3 (5) ml/sec. The mean for consecutive halves of an individual's home flow data showed excellent agreement (-0.2 (1.3) ml/sec). The two clinic readings showed poorer agreement (2.3 (6.8) ml/sec) than the home readings, and poorer agreement even than between clinic and home flows. CONCLUSIONS: Although simple in design, the home flowmeter actually shows greater accuracy than might be expected when used repeatedly to study the flow rates of men. Simple flow devices such as this could be used in conjunction with voiding diaries to give a more representative picture of patients' day-to-day voiding function.     

A 10 min “no‐touch” time – is it enough in DCD? A DCD Animal Study

Donation after cardiac death (DCD) is under investigation because of the lack of human donor organs. Required times of cardiac arrest vary between 75s and 27min until the declaration of the patients' death worldwide. The aim of this study was to investigate brain death in pigs after different times of cardiac arrest with subsequent cardiopulmonary resuscitation (CPR) as a DCD paradigm. DCD was simulated in 20 pigs after direct electrical induction of ventricular fibrillation. The "no-touch" time varied from 2min up to 10min; then 30min of CPR were performed. Brain death was determined by established clinical and electrophysiological criteria. In all animals with cardiac arrest of at least 6min, a persistent loss of brainstem reflexes and no reappearance of bioelectric brain activity occurred. Reappearance of EEG activity was found until 4.5min of cardiac arrest and subsequent CPR. Brainstem reflexes were detectable until 5min of cardiac arrest and subsequent CPR. According to our experiments, the suggestion of 10min of cardiac arrest being equivalent to brain death exceeds the minimum time after which clinical and electrophysiological criteria of brain death are fulfilled. Therefore shorter "no-touch" times might be ethically acceptable to reduce warm ischemia time.     

Should We Give Prophylactic “Renal‐Dose” Dopamine After Coronary Artery Bypass Surgery?

OBJECTIVE: A prospective double-blind randomized study undertaken to assess the effect of postoperative prophylactic "renal-dose" dopamine on post-coronary artery bypass grafting surgery's clinical outcome. METHODS: Eighty-five consecutive patients undergoing CABG operation were randomized to receive either 3-5 microg/kg/min dopamine (group D, n = 41) or saline as placebo (group P, n = 45) for 48 postoperative hours. Clinical outcome parameters were collected for four postoperative days. RESULTS: Preoperative and operative parameters were similar in both groups. Four patients from group P and none from group D reached an end-point of the study (oliguria, renal dysfunction) and received dopamine. Two patients from group P and none from group D needed an additional inotropic support. Mean arterial pressure values were similar during the first 24 hours after operation, but left atrial pressure values tended to be higher in group P (10 +/- 4 vs 7 +/- 3 mmH2O, p = 0.18). The mean pH was higher in group D at 8 hours after operation (7.38 +/- 0.2 vs 7.36 +/- 0.3, p = NS), due to higher bicarbonate levels (23 +/- 2 mmol/l vs 21 +/- 2, p = 0.49). The incidence of lung congestion in chest X-rays and CT scans was significantly higher in group P (50% vs 29%, p = 0.073 at 48 hours postoperatively). Room air blood O2 saturation and maximal expiratory volume tended to be higher in group D (at 72 hours after operation- 92 +/- 4 vs 90%+/- 5, p = 0.29 and 646 +/- 276 vs 485 ml +/- 206, p = 0.16, respectively). There was no statistical difference in urine output but the amount of furosemide given to patients in group P was significantly higher (during the first 8 hours 2.5 +/- 0.5 vs. 0.3 mg +/- 1.6, p = 0.07). Plasma creatinine levels were significantly lower in group D (at 24 hours 0.93 +/- 0.02 vs 1.05 mg/dL +/- 0.02, p = 0.02). Mobilization after surgery was faster in group D. CONCLUSIONS: Prophylactic dopamine administration after coronary artery bypass grafting surgery improves patient hemodynamic and renal status, reduces the need for additional medical support (inotropes and furosemide) and thus, provides stable postoperative course.     

“Turn downs” in aortic emergencies: Reassurance or uncertainty?

“Turn‐down” rate has been reported to have a significant influence on outcomes, and being turned down for an operation is associated with significant short‐term mortality risk. A study examining the impact of the pandemic on the “turn‐down” rates of acute aortic syndromes in the United Kingdom reported an overall “turn‐down” rate of  7.3% in the early part of the pandemic. This review examines the significance of “turn‐downs” in this setting and scrutinizes the adequacy of reporting this complex variable.