OSA Symptoms Associated With and Predictive of Anxiety in Middle-Aged Men: Secondary Analysis of NHANES Data

Object

This population-based study examined obstructive sleep apnea (OSA) symptoms predictive of anxiety in middle-aged men.

Method

Secondary analyses were conducted on the National Health and Nutrition Examination Survey (NHANES) 2007–2008 data using weighted samples and complex sample analysis techniques (unweighted N = 1,217).

Findings

Nonrefreshing sleep (χ² = 69.333, p < 0.001), excessive daytime sleepiness (χ² = 47.766, p < 0.001), and sleep fragmentation (χ² = 30.692, p < 0.001) were significantly associated with anxiety. Nonrefreshing sleep (OR 3.582, p < 0.001) and awakenings due to apneic episodes (OR 2.047, p = 0.001) were predictive of anxiety.

Conclusion

Comorbid anxiety and OSA symptoms are common and have implications for activities of daily living, social responsibilities, and quality of life. Screening for anxiety among men with OSA symptoms is recommended.     

Effect of residual leaning force on intrathoracic pressure during mechanical ventilation in children

Aim

Determine the effect of residual leaning force on intrathoracic pressure (ITP) in healthy children receiving mechanical ventilation. We hypothesized that application of significant residual leaning force (2.5 kg or 20% of subject body weight) would be associated with a clinically important change in ITP.

Methods

IRB-approved pilot study of healthy, anesthetized, paralyzed mechanically ventilated children (6 months to 7 years). Peak endotracheal pressure (ETP), a surrogate of ITP, was continuously measured before and during serial incremental increases in sternal force from 10% to 25% of the subject's body weight. A delta ETP of ≥2.0 cmH₂O was considered clinically significant.

Results

13 healthy, anesthetized, paralyzed mechanically ventilated children (age: 26 ± 24 m, range: 6.5-87 m; weight: 13 ± 5 kg, range: 7.4-24.8 kg) were enrolled. Peak ETP increased from baseline for all force applications (10% body weight: mean difference of 0.8 cmH₂O, p < 0.01; 15% body weight: mean difference of 1.1 cmH₂O, p < 0.01; 20% body weight: mean difference of 1.5 cmH₂O, p < 0.01; 25% body weight: mean difference of 1.89 cmH₂O, p < 0.01). Residual leaning force of ≥2.5 kg was associated with a 2.0 cmH₂O change in peak ETP (odds ratio 7.5; CI⁹⁵ 1.5-37.7; p = 0.014) while sternal force ≥20% body weight was not (odds ratio 2.4; CI⁹⁵ 0.6-9.2; p = 0.2).

Conclusion

In healthy anesthetized children, changes in ETP were detectable at residual leaning forces as low as 10% of subject body weight. Residual leaning force of 2.5 kg was associated with increases in ETP ≥2.0 cmH₂O.     

Accuracy of body mass index to determine obesity in women with breast cancer: An observational study of Taiwanese sample

Background

Obesity is common in women with breast cancer. The risk of obesity-induced metabolic syndrome is higher in Asians than in Caucasians. Excessive body fat accumulation has been associated with a worse prognosis. However, the most popular clinical indicator of obesity is not fat itself, but body mass index (BMI).

Objectives

The purposes of this study were to determine the consistency of BMI and body fat percentage (BF%) in determining obesity and to identify the best BMI cutoffs for identifying obesity in Taiwanese women with breast cancer.

Methods

Body fat and fat-free mass were measured by bioelectrical impedance 1 day before breast surgery for 200 women with breast cancer. BMI was calculated as weight (in kilograms) divided by height (in meters) squared.

Results

BMI and BF% were highly correlated (r = 0.91; p < 0.001). However, BMI exhibited poor sensitivity for identifying obesity (47%). The sensitivity of BMI to detect obesity was better in women over age 60. The best BMI cutoff for obesity was 22.3 kg/m² with a sensitivity and specificity of 89% (95% CI = 83-94%) and 87% (95% CI = 77-93%) respectively, and the total accuracy rate improved from 65% to 89%.

Conclusions

Using BMI to identify obesity in Taiwanese women with breast cancer requires careful attention to the diagnostic criterion chosen. The World Health Organization criterion tends to underestimate the prevalence of obesity, especially for younger women with breast cancer (under age 40).     

Validation of the Chinese version of the Subjective Global Assessment scale of nutritional status in a sample of patients with gastrointestinal cancer

Background and aims

To verify the validity of the Subjective Global Assessment (SGA) on the nutritional assessment and prognosis prediction in Chinese patients with gastrointestinal cancer.

Methods

Five hundred and five patients with newly diagnosed gastrointestinal cancer who underwent surgeries were enrolled between August 2004 and August 2006. The sample consisted of 307 males (60.8%) and 198 females (39.2%). The nutritional status was assessed using SGA for each patient prior to operation. Simultaneously, anthropometric parameters and laboratory tests including serum albumin (ALB) and prealbumin (PA) levels were also obtained. The postoperative evaluation included length of stay, occurrence of complications, and in-hospital medical expenditures.

Results

Based on the results of preoperative SGA, the patients were classified into 3 groups: well nourished (group A), mildly to moderately malnourished (group B), and severely malnourished (group C). The number in each group was 275 (54.4%), 214 (42.4%), and 16 (3.2%), respectively. ANOVA tests revealed significant group differences existed for body mass index (BMI), triceps skinfold thickness (TSF), PA, ALB, length of stay, and in-hospital medical expenditures (p < 0.05). The more severely malnourished the patient, the BMI, TSF, PA, and ALB became lower, the length of stay became longer and the medical cost became higher. The occurrence of postoperative complications did not show significant difference among the different SGA groups (X² = 4.16, p = 0.125). And patients in different cancer stages (TNM staging) had no statistical differences in terms of their length of stay (F = 1.433, p = 0.232) and the occurrence of postoperative complications (X² = 4.836, p = 0.184).

Conclusions

The SGA is safe, inexpensive, and easy to use clinically for nurses. This study demonstrated that it can be a reliable method to assess the nutritional status of Chinese patients with gastrointestinal cancer. The SGA could also help predict certain health outcomes, such as length of stay, in-hospital medical expenditures.     

New body mass index for predicting prognosis in patients with antineutrophil cytoplasmic antibody‐associated vasculitis

ObjectivesBody mass index (BMI) is a known indicator of all‐cause mortality. However, conventional BMI does not reflect the three‐dimensional human body. To overcome this limitation, a new BMI has been proposed that provides a closer approximation of real human body shape. This study investigated the associations between the new BMI and poor outcomes in patients with antineutrophil cytoplasmic antibody‐associated vasculitis (AAV).MethodWe retrospectively reviewed the medical records of 242 patients with AAV in a single tertiary medical center. Based on the new BMI, the patients were categorized into four groups: underweight (<18.5 kg/m^2.5), healthy weight (18.5 to <25.0 kg/m^2.5), overweight (25.0 to <30.0 kg/m^2.5), and obese (≥30.0 kg/m^2.5). The association among the new BMI and death, relapse, end‐stage renal disease (ESRD) development, cerebrovascular accident, and cardiovascular disease was analyzed.ResultsThe underweight group, according to the new BMI, had higher hazard ratios (HRs) for all‐cause mortality (HR: 3.180, 95% confidence interval [CI]: 1.134–8.922, p = 0.028), relapse (HR: 2.141, 95% CI: 1.019–4.368, p = 0.036), and ESRD development (HR: 2.729, 95% CI: 1.190–6.259, p = 0.018) than the healthy weight group. However, according to the conventional BMI, there were no differences in the risks for all poor outcomes between the underweight and healthy weight groups. Multivariate logistic regression analysis demonstrated that being underweight, according to the new BMI, was an independent risk factor for all‐cause mortality (HR: 5.285; 95% CI: 1.468–19.018; p = 0.011).ConclusionBeing underweight, according to the new BMI, is associated with poor outcomes in patients with AAV.     

The effects of bisphenol A (BPA) exposure on fat mass and serum leptin concentrations have no impact on bone mineral densities in non-obese premenopausal women

Objectives

Bisphenol A (BPA) exposure may promote obesity, but its effect on bone mineral density (BMD) has not been reported in humans. We aimed to examine the relationships between BPA exposure, body composition, serum estradiol, leptin, osteocalcin levels and BMDs in healthy premenopausal women.

Design and methods

In this cross-sectional study, a total of 246 healthy premenopausal women aged 20 years and older with regular menstrual cycles were investigated. Body mass index (BMI), fat mass, fat-free mass and BMDs were measured by DXA. Serum estradiol, leptin, osteocalcin, urinary BPA and NTx levels were also tested.

Results

Urinary BPA levels were positively associated with fat mass (r = 0.193, p = 0.006) and leptin (r = 0.236, p = 0.001) but not with fat-free mass after adjusting for age and BMI. BPA was not associated with serum estradiol levels, BMDs, or bone resorption marker NTx and bone formation parameter osteocalcin, either. A multivariate stepwise regression analysis confirmed that serum leptin levels were positively influenced by fat mass (β = 0.746, p < 0.001) and BPA (β = 0.127, p = 0.01) but negatively correlated with fat-free mass (β = − 0.196, p < 0.001). However, the changes of BMDs at the lumbar spine (β = 0.298, p < 0.001) and femoral neck (β = 0.305, p < 0.001) were primarily explained by fat-free mass, and were irrelevant of the fat mass, leptin or BPA exposure.

Conclusions

Although BPA exposure is related with increased amount of fat mass and elevated serum leptin levels, it has neutral effect on BMDs in premenopausal women, possibly due to the exclusive role of fat-free mass, which is unrelated to BPA in determining BMDs.     

Combination of conventional blood cultures and the SeptiFast molecular test in patients with suspected sepsis for the identification of bloodstream pathogens

We evaluated performances of the molecular test SeptiFast (SF) for the detection of agents of bloodstream infection (BSI) in patients with suspected sepsis, the majority of them under antibiotic treatment and at high prevalence of HIV-1 infection (10.5%). Matched SF and blood culture (BC) samples (n = 1186) from 1024 patients were studied. Two hundred fifty-one episodes of BSI out of 1144 were identified with the combined methods (22%). SF identified more episodes of BSI than BC: 206 versus 176 (χ² = 7.008, P = 0.0081) and a significantly higher number of Gram-negative bacteria than BC (77 versus 53, χ² = 9.12; P = 0.0025), as well as of polymicrobial infections (χ² = 4.50, P = 0.0339). In conclusion, SF combined with BC improved the diagnosis of sepsis, especially in immunocompromised patients.     

Apport de l’exercice physique et du régime dans la prise en charge de la gonarthrose chez l’obèse

Objective

Our objective was to determine whether exercise and weight loss are more effective either separately or in combination, in improving pain and physical function in obese adults with moderate knee osteoarthritis (OA).

Patients and methods

Forty-five obese adults, with a body mass index greater than 35 kg/m² or 30 ≤ BMI < 35 associated to at least one cardiovascular risk factor, suffering from knee pain with evident radiographic signs of knee OA, were involved in our study. All patients were evaluated at baseline and at the end of the study. The assessment parameters were weight loss, the bioelectric impedance analysis, pain, six-minute walk distance, cardiovascular parameters, and muscular strength. The physical function was measured with the Womac and the Lequesne indexes. Patients were randomized into four groups, a control group (G1), exercise only group (G2), diet plus exercise group (G3) and diet only group (G4).

Results

There was no difference between the four groups at baseline. Significant improvement of function (Womac) was noticed in groups performing exercise only (G2) (26 %), diet plus exercise (G3) (37,89 %) and diet only (G4) (18,34 %). We also noticed an improvement in pain in G2 (p = 0.04), G3 (p < 0.001) and G4 (p = 0.02). The improvement of quadriceps strength was noted only in G2 (p = 0.01) et G3 (p = 0.001) without any change in control group and diet only group (G4). The improvement of cardiovascular parameters was observed only in G2 and G3. Weight loss, decreased BMI and waist circumference was more important in diet plus exercise group (G3).

Conclusion

The combination of weight loss and exercise provide better improvements in physical function and pain in obese adults with knee OA compared with either intervention alone. Exercise used alone or associated to dietary provides better improvements in physical capacity and muscle strength.     

Association of a 27-bp repeat polymorphism in intron 4 of endothelial constitutive nitric oxide synthase gene with hypertension in a Tunisian population

Objectives

Nitric oxide (NO) produced by endothelial nitric oxide synthase (eNOS) mediates endothelium-dependent vasodilatation and antithrombotic action. Controversial results regarding the association of eNOS gene (NOS3) polymorphisms with hypertension have been reported. In the present study, we examined a possible association between the 27-base pair (bp) repeat polymorphism in intron 4 of the NOS3 gene and hypertension in a sample of the Tunisian population.

Design and methods

A total of 295 Tunisian patients with hypertension and 395 healthy controls were included in the study. The NOS3 gene intron 4a4b variable number of tandem repeats polymorphism was analyzed by PCR.

Results

A significant differences in genotype distribution and allele frequency was observed between patients and controls. Patients with hypertension had a frequency of 6.4% for the 4a4a genotype, 32.7% for the 4a4b genotype and 60.9% for the 4b4b genotype. The controls had a frequency of only 2.3% for the 4a4a genotype, 28.4% for the 4a4b genotype and 69.4% for the 4b4b genotype (χ² = 11.81, p = 0.003). The hypertension patient group showed a significant higher frequency of the 4a allele compared to the controls (0.23 vs. 0.16; χ² = 8.61, p = 0.003). The odds ratio of hypertension for 4a vs 4b allele frequencies was statistically significant 1.66 [1.09-2.53] at 95% CI, p = 0.01 in males, whereas it was non-significant in females (1.23 [0.84-1.81], p = 0.26).

Conclusion

The present study showed a significant and independent association between the NOS34a4b gene polymorphism (presence of 4a allele) and hypertension in the Tunisian population.     

Ability of code leaders to recall CPR quality errors during the resuscitation of older children and adolescents

Aim

Performance of high quality CPR is associated with improved resuscitation outcomes. This study investigates code leader ability to recall CPR error during post-event interviews when CPR recording/audiovisual feedback-enabled defibrillators are deployed.

Patients and methods

Physician code leaders were interviewed within 24 h of 44 in-hospital pediatric cardiac arrests to assess their ability to recall if CPR error occurred during the event. Actual CPR quality was assessed using quantitative recording/feedback-enabled defibrillators. CPR error was defined as an overall average event chest compression (CC) rate <95/min, depth <38 mm, ventilation rate >10/min, or any interruptions in CPR >10 s. We hypothesized that code leaders would recall error when it actually occurred ≥75% of the time when assisted by audiovisual alerts from a CPR recording feedback-enabled defibrillators (analysis by χ²).

Results

810 min from 44 cardiac arrest events yielded 40 complete data sets (actual and interview); ventilation data was available in 24. Actual CPR error was present in 3/40 events for rate, 4/40 for depth, 32/40 for interruptions >10 s, and 17/24 for ventilation frequency. In post-event interviews, code leaders recalled these errors in 0/3 (0%) for rate, 0/4 (0%) for depth, and 19/32 (59%) for interruptions >10 s. Code leaders recalled these CPR quality errors less than 75% of the time for rate (p = 0.06), for depth (p < 0.01), and for CPR interruption (p = 0.04). Quantification of errors not recalled: missed rate error median = 94 CC/min (IQR 93–95), missed depth error median = 36 mm (IQR 35.5–36.5), missed CPR interruption >10 s median = 18 s (IQR 14.4–28.9). Code leaders did recall the presence of excessive ventilation in 16/17 (94%) of events (p = 0.07).

Conclusion

Despite assistance by CPR recording/feedback-enabled defibrillators, pediatric code leaders fail to recall important CPR quality errors for CC rate, depth, and interruptions during post-cardiac arrest interviews.     

Assessing the impact of immersive simulation on clinical performance during actual in-hospital cardiac arrest with CPR-sensing technology: A randomized feasibility study

Aim

Advanced simulation tools are increasingly being incorporated into cardiopulmonary resuscitation (CPR) training. These educational methods have been shown to improve trainee performance in simulated settings, but translation into clinical practice remains unknown for many aspects of CPR quality. This study attempts to measure the impact of simulation-based training for resuscitation team leaders on some measures of CPR quality during actual in-hospital resuscitation attempts.

Methods

In this prospective, randomized interventional cluster trial, internal medicine resident physicians (post-graduate year 2) were randomized using a random number generator to participate in a 4-h, immersive simulation course in cardiopulmonary resuscitation leadership using a high-fidelity simulator with video debriefing prior to serving as resuscitation team leaders at an academic medical center. Objective metrics of actual resuscitation performance were obtained from a CPR-sensing monitor/defibrillator.

Results

Thirty-two residents were randomized to receive simulation training or no additional training between April and July 2007 and data were collected following 98 actual resuscitations between July 2007 and June 2008. CPR quality from resuscitations led by 14 simulation-trained and 16 control group residents was similar in terms of mean compression depth (48 vs 49 mm; p = 0.53); compression rate (107 vs 104 min⁻¹; p = 0.30); ventilation rate (12 vs 12 min⁻¹; p = 0.45) and no-flow fraction (0.08 vs 0.07; p = 0.34).

Conclusions

Although we failed to detect any significant differences in objective measures of CPR quality, we have demonstrated that CPR-sensing technology has the potential for use in assessing the impact of a simulation curriculum on some aspects of actual resuscitation performance. A larger study, performed in a setting with lower baseline performance, would be required to assess the specific simulation curriculum.     

Effect of therapeutic hypothermia vs δ-opioid receptor agonist on post resuscitation myocardial function in a rat model of CPR

Aim

This study is to compare the effect of the δ-opioid receptor agonist, d-Ala²-d-Leu⁵ enkephalin (DADLE) with normothermic control and therapeutic hypothermia on post resuscitation myocardial function and 72-h survival in a rat model of cardiac arrest and resuscitation.

Methods

Ventricular fibrillation (VF) was induced in 15 male Sprague-Dawley rats. After 8 min of untreated VF, cardiopulmonary resuscitation was performed for 8 min before defibrillation. Animals were randomized to three groups of five: (a) normothermia; (b) hypothermia (32 °C); and (c) normothermia with DADLE intravenous infusion (1 mg/kg h⁻¹). Hypothermia and drug infusion were started after successful defibrillation. Myocardial functions, including cardiac output (CO), left ventricular ejection fraction (LVEF), and myocardial performance index (MPI) were measured echocardiographically together with duration of survival.

Results

The 72-h survival was significantly greater in the hypothermic group than in both DADLE and normothermic group (p = 0.02). However, the survival time of the DADLE treated animals was significantly longer than that of the normothermia group (51.8 ± 18.9 vs 18.8 ± 10.1 h, p < 0.01). DADLE group showed significantly better CO (PR 60 min, p = 0.049), better LVEF (PR 60 min, p = 0.044; PR 240 min, p < 0.001) and lower MPI (PR 60 min, p = 0.043; PR 240 min, p = 0.045) than normothermic group. Hypothermia group also showed significantly better CO (PR 60 min, p = 0.044; PR 240 min, p = 0.007), better LVEF (PR 60 min, p = 0.001; PR 240 min, p < 0.001) and lower MPI (PR 60 min, p = 0.003; PR 240 min, p = 0.012) than the normothermic group.

Conclusions

DADLE attenuated post resuscitation myocardial dysfunction and increased short term survival time. However, the 72-h survival in the DADLE group was less than that in the hypothermia group.     

Improved Auscultation Skills in Paramedic Students Using a Modified Stethoscope

Background

The Ventriloscope® (Lecat's SimplySim, Tallmadge, OH) is a modified stethoscope used as a simulation training device for auscultation.

Objective

To test the effectiveness of the Ventriloscope as a training device in teaching heart and lung auscultatory findings to paramedic students.

Methods

A prospective, single-hospital study conducted in a paramedic-teaching program. The standard teaching group learned heart and lung sounds via audiocassette recordings and lecture, whereas the intervention group utilized the modified stethoscope in conjunction with patient volunteers. Study subjects took a pre-test, post-test, and a follow-up test to measure recognition of heart and lung sounds.

Results

The intervention group included 22 paramedic students and the standard group included 18 paramedic students. Pre-test scores did not differ using two-sample t-tests (standard group: t [16] = −1.63, p = 0.12) and (intervention group: t [20] = −1.17, p = 0.26). Improvement in pre-test to post-test scores was noted within each group (standard: t [17] = 2.43, p = 0.03; intervention: t [21] = 4.81, p < 0.0001). Follow-up scores for the standard group were not different from pre-test scores of 16.06 (t [17] = 0.94, p = 0.36). However, follow-up scores for the intervention group significantly improved from their respective pre-test score of 16.05 (t [21] = 2.63, p = 0.02).

Conclusion

Simulation training using a modified stethoscope in conjunction with standardized patients allows for realistic learning of heart and lung sounds. This technique of simulation training achieved proficiency and better retention of heart and lung sounds in a safe teaching environment.     

Improving outcome after out-of-hospital cardiac arrest by strengthening weak links of the local Chain of Survival; quality of advanced life support and post-resuscitation care

Background

Survival after out-of-hospital cardiac arrest (OHCA) depends on a well functioning Chain of Survival. We wanted to assess if targeted attempts to strengthen the weak links of our local chain; quality of advanced life support (ALS) and post-resuscitation care, would improve outcome.

Materials and methods

Utstein data from all OHCAs in Oslo during three distinct 2-year time periods 1996-1998, 2001-2003 and 2004-2005 were collected. Before the second period the local ALS guidelines changed with increased focus on good quality chest compressions with minimal pauses, while standardized post-resuscitation care including goal directed therapy with therapeutic hypothermia and percutaneous coronary intervention was added in the third period. Additional a priori sub-group analyses of arrests with cardiac aetiology as well as bystander witnessed ventricular fibrillation/tachycardia (VF/VT) arrests with cardiac aetiology were performed.

Results

ALS was attempted in 454, 449, and 417 patients with OHCA in the first, second and last time period, respectively. From the first to the third period VF/VT arrests declined (40% vs. 33%, p = 0.039) and fewer arrests were witnessed (80% vs. 72%, p = 0.022) and response intervals increased (7 ± 4 to 9 ± 4 min, p < 0.001). Overall survival increased from 7% (first period) to 13% (last period), p = 0.002, and survival in the sub-group of bystander witnessed VF/VT arrests with cardiac aetiology increased from 15% (first period) to 35% (last period), p = 0.001.

Conclusions

Survival after OHCA was increased after improving weak links of our local Chain of Survival, quality of ALS and post-resuscitation care.     

A randomised control trial of prompt and feedback devices and their impact on quality of chest compressions—A simulation study

Aim

This study aims to compare the effect of three CPR prompt and feedback devices on quality of chest compressions amongst healthcare providers.

Methods

A single blinded, randomised controlled trial compared a pressure sensor/metronome device (CPREzy™), an accelerometer device (Phillips Q-CPR) and simple metronome on the quality of chest compressions on a manikin by trained rescuers. The primary outcome was compression depth. Secondary outcomes were compression rate, proportion of chest compressions with inadequate depth, incomplete release and user satisfaction.

Results

The pressure sensor device improved compression depth (37.24–43.64 mm, p = 0.02), the accelerometer device decreased chest compression depth (37.38–33.19 mm, p = 0.04) whilst the metronome had no effect (39.88 mm vs 40.64 mm, p = 0.802). Compression rate fell with all devices (pressure sensor device 114.68–98.84 min⁻¹, p = 0.001, accelerometer 112.04–102.92 min⁻¹, p = 0.072 and metronome 108.24 min⁻¹ vs 99.36 min⁻¹, p = 0.009). The pressure sensor feedback device reduced the proportion of compressions with inadequate depth (0.52 vs 0.24, p = 0.013) whilst the accelerometer device and metronome did not have a statistically significant effect. Incomplete release of compressions was common, but unaffected by the CPR feedback devices. Users preferred the accelerometer and metronome devices over the pressure sensor device. A post hoc study showed that de-activating the voice prompt on the accelerometer device prevented the deterioration in compression quality seen in the main study.

Conclusion

CPR feedback devices vary in their ability to improve performance. In this study the pressure sensor device improved compression depth, whilst the accelerometer device reduced it and metronome had no effect.     

A prospective controlled trial of the effect of a multi-faceted intervention on early recognition and intervention in deteriorating hospital patients

Aim

To determine whether the introduction of a multi-faceted intervention (newly designed ward observation chart, a track and trigger system and an associated education program, COMPASS^©) to detect clinical deterioration in patients would decrease the rate of predefined adverse outcomes.

Methods

A prospective, controlled before-and-after intervention of trial was conducted in all consecutive adult patients admitted to four medical and surgical wards during a 4 month period, 1157 and 985, respectively. A sub-group of patients underwent vital sign and medical review analysis pre-intervention (427) and post-intervention (320). The outcome measures included: number of unplanned admissions to the intensive care unit (ICU), Medical Emergency Team (MET) reviews and unexpected hospital deaths, vital sign documentation frequency and incidence of a medical review following clinical deterioration. This study is registered, ACTRN12609000808246.

Results

Reductions were seen in unplanned admissions to ICU (21/1157 [1.8%] vs. 5/985 [0.5%], p = 0.006) and unexpected hospital deaths (11/1157 [1.0%] vs. 2/985 [0.2%], p = 0.03) during the intervention period. Medical reviews for patients with significant clinical instability (58/133 [43.6%] vs. 55/79 [69.6%] p < 0.001) and number of patients receiving a MET review increased (25/1157 [2.2%] vs. 38/985 [3.9%] p = 0.03) during the intervention period. Mean daily frequency of documentation of all vital signs increased during the intervention period (3.4 [SE 0.22] vs. 4.5 [SE 0.17], p = 0.001).

Conclusion

The introduction of a multi-faceted intervention to detect clinical deterioration may benefit patients through increased monitoring of vital signs and the triggering of a medical review following an episode of clinical instability.     

Correlation between postprandial bile acids and body fat mass in healthy normal-weight subjects

Background

Bile acids (BAs) play important roles in glucose regulation and energy homeostasis via G protein-coupled receptors, such as enteroendocrine L cell TGR5. The aim of the present study was to investigate the relationship between postprandial BA levels and body composition after ingestion of a standard test meal.

Methods

Eleven healthy subjects of normal weight (body-mass index, 22.0 ± 1.6 kg/m² [mean ± SD]), ingested a 400-kcal test meal, and blood samples were obtained from them before ingestion and every 30 min for 120 min after ingestion. The BA fractions were measured with high-performance liquid chromatography. To evaluate body composition, body impedance analysis was performed 1 h before ingestion of the test meal.

Results

Concentrations of both total BA and total glycine-conjugated BA (GCBA) at 30, 60, 90, and 120 min after test-meal ingestion were significantly higher than those at baseline. The body-mass index was correlated with total GCBA at baseline. Moreover, body fat mass was correlated with total GCBA at 30 min (r = – 0.688, P = 0.019) and 60 min (r = – 0.642, P = 0.033) and with total BA at 30 min (r = – 0.688, P = 0.019) and 60 min (r = – 0.642, P = 0.033).

Conclusion

The postprandial BA response is inversely related with body fat mass in healthy subjects of normal weight.     

Markers of intestinal injury are associated with endotoxemia in successfully resuscitated patients

Aims

Gut dysfunction is suspected to play a major role in the pathophysiology of post-resuscitation disease through an increase in intestinal permeability and endotoxin release. However this dysfunction often remains occult and is poorly investigated. The aim of this pilot study was to explore intestinal failure biomarkers in post-cardiac arrest patients and to correlate them with endotoxemia.

Methods

Following resuscitation after cardiac arrest, 21 patients were prospectively studied. Urinary intestinal fatty acid-binding protein (IFABP), which marks intestinal permeability, plasma citrulline, which reflects the functional enterocyte mass, and whole blood endotoxin were measured at admission, days 1–3 and 6. We explored the kinetics of release and the relationship between IFABP, citrulline and endotoxin values.

Results

IFABP was extremely high at admission and normalized at D3 (6668 pg/mL vs 39 pg/mL, p = 0.01). Lowest median of citrulline (N = 20–40 μmol/L) was attained at D2 (11 μmol/L at D2 vs 24 μmol/L at admission, p = 0.01) and tended to normalize at D6 (21 μmol/L). During ICU stay, 86% of patients presented a detectable endotoxemia. Highest endotoxin level was positively correlated with highest IFABP level (R² = 0.31, p = 0.01) and was inversely correlated with lowest plasma citrulline levels (R² = 0.55, p < 0.001). Endotoxin levels increased between admission and D2 in patients with post-resuscitation shock, whereas it decreases in patients with no shock (median +0.33 EU vs −0.19 EU, p = 0.03). Highest endotoxin level was positively correlated with D3 SOFA score (R² = 0.45, p = 0.004).

Conclusion

Biomarkers of intestinal injury are altered after cardiac arrest and are associated with endotoxemia. This could worsen post-resuscitation shock and organ failure.     

Effects of adenosine monophosphate on induction of therapeutic hypothermia and neuronal damage after cardiopulmonary resuscitation in rats

Background

Animal studies and pathophysiological considerations suggest that therapeutic hypothermia after cardiopulmonary resuscitation is the more effective the earlier it is induced. Therefore this study is sought to examine whether pharmacological facilitated hypothermia by administration of 5′-adenosine monophosphate (AMP) is neuroprotective in a rat model of cardiac arrest (CA) and resuscitation.

Methods

Sixty-one rats were subjected to CA. After 6 min of ventricular fibrillation advanced cardiac life support was started. After successful return of spontaneous circulation (ROSC, n = 40), animals were randomized either to placebo group (n = 14) or AMP group (800 mg/kg body weight, n = 14). Animals were kept at an ambient temperature of 18 °C for 12 h after ROSC and core body temperature was measured using a telemetry temperature probe. Neuronal damage was analyzed by counting Nissl-positive (i.e. viable) neurons and TUNEL-positive (i.e. apoptotic) cells in coronal brain sections 7 days after ROSC. Functional status evaluated on days 1, 3 and 7 after ROSC by a tape removal test.

Results

Time until core body temperature dropped to <34.0 °C was 31 min [28; 45] in AMP-treated animals and 125 min [90; 180] in the control group (p = 0.003). Survival until 7 days after ROSC was comparable in both groups. Also number of Nissl-positive cells (AMP: 1 [1; 7] vs. placebo: 2 [1; 3] per 100 pixel; p = 0.66) and TUNEL-positive cells (AMP: 56 [44; 72] vs. placebo: 53 [41; 67] per 100 pixel; p = 0.70) did not differ. Neither did AMP affect functional neurological outcome up to 7 days after ROSC. Mean arterial pressure 20 min after ROSC was 49 [45; 55] mmHg in the AMP group in comparison to 91 [83; 95] mmHg in the control group (p < 0.001).

Conclusion

Although application of AMP reduced the time to reach a core body temperature of <34 °C neither survival was improved nor neuronal damage attenuated. Reason for this is probably induction of marked hypotension as an adverse reaction to AMP treatment.