Superior cava vein saturation and cardiac lactate as cardiac output predictor after cardio-pulmonary bypass on children

Abstract
Objective: to evaluate cardiac heart lactate, superior cava vein saturation and microcirculation dysfunction as cardiac output predictors after surgery on patients with Tetralogy of Fallot (TF) through measuring serum level of sTNFR-1 and IL-6.
Design: cohort study
Setting: Cipto Mangunkusumo Hospital
Patient and participants: Subjects were children aged 1 to 6 years that underwent corrective surgery. Subjects who met the inclusion criteria were divided into 2 groups after ischemiareperfusion injury (post surgery). The first group was subjects with high cardiac lactate and the second group was subjects with low cardiac lactate.
Measurements and results: Subjects were observed for 24 hours; during surgery, 6 and 24 hours after aortic clamp removed. During July 2012 - December 2013, there were 52 patients who became subjects. There were proportion differences between cardiac lactate and cardiac output change after cardiac surgery. Increase of cardiac lactate has a correlation with increasing levels of sTNFR-1 and IL-6 and decreasing index of Tc, ScvO2 and cardiac output. There were correlations among low index of ScvO2, high index of cardiac lactate and decrease of cardiac output. High sTNFR-1 and IL-6 were correlated to low cardiac output. Cardiac lactate, ScvO2 and MAP can be used as predictors of cardiac output change in patients with cardio-pulmonary bypass. sTNFR-1 and IL-6 levels were correlated with cardiac output changes after cardiac surgery.
Conclusion: Cardiac lactate and ScvO2 are valuable in measuring cardiac output changes on patient with cardio-pulmonary bypass.

Superior cava vein saturation and cardiac lactate as cardiac output predictor after cardio-pulmonary bypass on children


Association of fluid overload with mortality in pediatric intensive care unit

Abstract
Objective: To determine association of fluid overload with mortality in critically ill patients in Pediatric Intensive Care Unit.
Design: This was a case-control study.
Settings: Pediatric Intensive Care Unit of Sanglah Hospital Denpasar, Bali in January 2013 to December 2014.
Patients and participants: Samples were patients who had completed treatment in Pediatric Intensive Care Unit of Sanglah Hospital Denpasar. Data was taken from medical records by simple random sampling technique both in the case and control groups. The cases were nonsurvivors and controls were survivors.
Intervention: Observation made on fluid overload, defined as the fluid accumulation more than 10%.
Results: Total of 120 children were examined in this study, which consisted of 60 samples for both case and control groups. The mean percentage of fluid accumulation was significantly higher in the case group (12.9±7.9%) compared to control (-1.4±8.2%), with mean difference 9.4% (95% CI:5.4-13.3; p<0.001). Fluid overload was associated with mortality (OR 11.5; 95% CI:3.7-35.6; p<0.001). Conclusions: Fluid overload is associated to and a risk factor for mortality in critically ill patients in pediatric intensive care unit. Fluid accumulation is higher in the non-survivors than survivors. Association of fluid overload with mortality in pediatric intensive care unit


Trying to get out of the box

Abstract
Dr. Paul E. Marik suggests thinking outside the box when we use enteral nutrition support in the intensive care unit where the administration of formula in bolus theoretically presents greater benefit in preserving lean mass against continuous feeding. But what happens when we use parenteral nutrition support? It is to this that we propose a new administration scheme based on amino acids bolus and safety limits by a central line.

Trying to get out of the box


Precision medicine and the federal sepsis initiative!

In his State of the Union address before both chambers of the US Congress on 20 January 2015, President Barack Obama announced the launch of a new initiative called Precision Medicine, “I want the country that eliminated polio and mapped the human genome to lead a new era of medicine – one that delivers the right treatment at the right time.”
At a White House Press briefing on 30 January 2015 President Obama further commented that “Doctors have always recognized that every patient is unique, and doctors have always tried to tailor their treatments as best they can to individuals.”