Effect of Fentanyl Boluses on Cerebral Oxygenation and Hemodynamics in Preterm Infants: A Prospective Observational Study

Neonatology ◽  
2020 ◽  
Vol 117 (4) ◽  
pp. 480-487
Author(s):  
Souvik Mitra ◽  
M. Ege Babadagli ◽  
Tara Hatfield ◽  
Averie dePalma ◽  
Helen McCord ◽  
...  
Keyword(s):  
Cardiac Output ◽  
Observational Study ◽  
Preterm Infants ◽  
Prospective Observational Study ◽  
Cerebral Oxygenation ◽  
Left Ventricular ◽  
Oxygen Extraction ◽  
Preterm Neonates ◽  
Tissue Oxygen ◽  
Significant Difference

<b><i>Background:</i></b> Fentanyl is a commonly used off-label medication for pain control and sedation in preterm infants. Yet, the effect of fentanyl on cerebral hemodynamics in preterm neonates remains unexplored. <b><i>Objective:</i></b> To evaluate the effect of a bolus dose of fentanyl on the regional cerebral oxygen saturation (RcSO<sub>2</sub>), cerebral fractional tissue oxygen extraction (cFTOE) and left ventricular output (LVO) as compared with pre-administration baseline in preterm infants. <b><i>Methods:</i></b> This was a prospective observational study conducted in a level III Canadian NICU from September 2017 to February 2019. Preterm infants born &#x3c;37 weeks of gestation and scheduled to receive a fentanyl bolus (1–2 μg/kg/dose) were eligible. Infants with major congenital anomalies, medically unstable and those who had received fentanyl in the previous 48 h were excluded. <b><i>Outcomes:</i></b> The primary outcome was the difference between RcSO<sub>2</sub> measured 5 min prior to and RcSO<sub>2</sub> measured at defined time points after administration of fentanyl. <b><i>Results:</i></b> Twenty-eight infants were enrolled during the study period (median gestational age 28 weeks; interquartile range [IQR] 25–29 weeks; median birth weight 1,035 g [IQR 830–1,292 g]; median age 4 days [IQR 3–7 days]). Mean (±standard deviation) baseline RcSO<sub>2</sub> was 73.6% (±11.8), cFTOE was 21.9 (±11.2) and LVO was 380 (±147) mL/kg/min prior to fentanyl infusion. One-way ANOVA showed no statistically significant difference between baseline and any of the post-fentanyl cerebral oxygenation, tissue oxygen extraction or cardiac output measures (<i>p</i> &#x3e; 0.05). <b><i>Conclusion:</i></b> Administration of fentanyl bolus for procedural pain and sedation was not shown to significantly affect cerebral oxygenation, cerebral tissue oxygen extraction or cardiac output in stable preterm infants.

scholarly journals Brain and renal oxygenation measured by NIRS related to patent ductus arteriosus in preterm infants: a prospective observational study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jurate Navikiene ◽  
Ernestas Virsilas ◽  
Ramune Vankeviciene ◽  
Arunas Liubsys ◽  
Augustina Jankauskiene
Keyword(s):  
Observational Study ◽  
Patent Ductus Arteriosus ◽  
Preterm Infants ◽  
Prospective Observational Study ◽  
Cerebral Oxygenation ◽  
Ductus Arteriosus ◽  
Oxygen Extraction ◽  
Tissue Oxygen ◽  
Link Type ◽  
Patent Ductus

Abstract Background Patent ductus arteriosus (PDA) is common among preterm neonates. Haemodynamically significant ductus arteriosus (hsPDA) can cause ductal steal and contribute to poor outcomes. Our aim was to evaluate ductus arteriosus patency and significance using two-site near-infrared spectroscopy (NIRS) measurements in preterm infants older than 72 h as a supplemental tool to echocardiography. Methods In this prospective observational study, 123 preterm infants (gestational age (GA) < 32 weeks, birth weight < 1500 g) were enrolled. Sixty-four newborns had closed ductus arteriosus (noPDA), and 41 and 18 patients were assigned to the PDA and hsPDA groups, respectively, per predefined echocardiographic criteria. Cerebral and renal oxygenation were assessed during NIRS monitoring. Results A higher renal mean (±SD) regional tissue oxygen saturation (rSpO2) (76.7 (±7.64)) was detected in the noPDA group than in the PDA (71.7 (±9.02)) and hsPDA (67.4 (±13.48)) groups (p < 0.001). Renal fractional tissue oxygen extraction (FTOE) (0.18 (±0.079)) was lower in the noPDA group than in the PDA (0.23 (±0.092)) and hsPDA (0.24 (±0.117))0.117 groups (p = 0.002). Cerebral oxygenation was significantly lower in the hsPDA group (77.0 (±5.16)) than in the noPDA (79.3 (±2.45)) and PDA (79.7 (±2.27)) groups (p = 0.004). There was no significant difference in cerebral fractional tissue oxygen extraction (FTOE) between any of the groups. Conclusions Our results suggest that renal oxygenation is affected by ductus patency in preterm infants older than 72 h. Significant differences in cerebral oxygenation were observed between the hsPDA group and the PDA and noPDA groups. Trial registration ClinicalTrials.gov Identifier: NCT04295395. Registration date: 4 March 2020. This study was retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT04295395.

Agreement of Cardiac Output Measurements between Bioreactance and Transthoracic Echocardiography in Preterm Infants during the Transitional Phase: A Single-Centre, Prospective Study

Neonatology ◽  
2020 ◽  
Vol 117 (3) ◽  
pp. 271-278 ◽  
Author(s):  
Lizelle Van Wyk ◽  
Johan Smith ◽  
John Lawrenson ◽  
Willem Pieter de Boode
Keyword(s):  
Cardiac Output ◽  
Preterm Infants ◽  
Transthoracic Echocardiography ◽  
Ductus Arteriosus ◽  
Left Ventricular ◽  
Percentage Error ◽  
Preterm Neonates ◽  
Non Invasive ◽  
Left Ventricular Output ◽  
Transitional Phase

<b><i>Introduction:</i></b> Bioreactance cardiac output (CO) monitors are able to non-invasively and continuously monitor CO. However, as a novel tool to measure CO, it must be proven to be accurate and precise. <b><i>Objective:</i></b> To determine the agreement between CO measured with a bioreactance monitor and transthoracic echocardiography-derived left ventricular output parameters in preterm infants. <b><i>Methods:</i></b> This is a prospective observational study in 63 preterm neonates with non-invasive respiratory support, not requiring inotrope support. The infants underwent continuous bioreactance monitoring of CO and stroke volume (SV) and simultaneous transthoracic echocardiography every 6 h until 72 h of life. <b><i>Results:</i></b> The agreement between bioreactance and transthoracic echocardiography, for both SV and CO, was poor. The percentage error was 67.5% for SV and 71.6% for CO. The mean error was 60.4% for SV and 69.8% for CO. Bias was affected by numerous variables. After correcting for time, CO and SV bias were significantly affected by the presence of an open patent ductus arteriosus and the level of CO. <b><i>Conclusion:</i></b> Bioreactance cannot be considered interchangeable with transthoracic echocardiography to measure CO in preterm infants during the transition phase. Agreement between bioreactance and other CO metrics should be assessed before concluding its accuracy or inaccuracy in neonates.

scholarly journals 136 Effect of fentanyl boluses on cerebral oxygenation and hemodynamics in preterm infants: A prospective observational study

2019 ◽  
Vol 24 (Supplement_2) ◽  
pp. e53-e54
Author(s):  
Souvik Mitra ◽  
Ege Babadagli ◽  
Helen McCord ◽  
Averie DePalma ◽  
Walid El-Naggar ◽  
...  
Keyword(s):  
Observational Study ◽  
Preterm Infants ◽  
Prospective Observational Study ◽  
Cerebral Oxygenation

Effects of Single Loading Dose of Intravenous Caffeine on Cerebral Oxygenation in Preterm Infants

2020 ◽  
Author(s):  
Ozkan Ilhan ◽  
Meltem Bor
Keyword(s):  
Preterm Infants ◽  
Near Infrared ◽  
Cerebral Oxygenation ◽  
Clinical Importance ◽  
Oxygen Extraction ◽  
Loading Dose ◽  
Tissue Oxygen ◽  
Cerebral Tissue ◽  
Baseline Values ◽  
A Prospective Study

Abstract Objective The aim of this study was to evaluate the effects of caffeine on cerebral oxygenation in preterm infants. Study Design This was a prospective study of infants with a gestational age (GA) of < 34 weeks who were treated intravenously with a loading dose of 20 mg/kg caffeine citrate within the first 48 hours of life. Regional cerebral oxygen saturation (rSO2C) and cerebral fractional tissue oxygen extraction (cFTOE) were measured using near-infrared spectroscopy before administering caffeine (baseline), immediately after administering caffeine, and 1, 2, 3, 4, 6, and 12 hours after dose completion; postdose values were compared with the baseline values. Results A total of 48 infants with a mean GA of 29.0 ± 1.9 weeks, birth weight of 1,286 ± 301 g, and postnatal age of 32.4 ± 11.3 hours were included in the study. rSO2C significantly decreased from 81.3 to 76.7% soon after administering caffeine, to 77.1% at 1 hour, and to 77.8% at 2 hours with recovery at 3 hours postdose. rSO2C was 80.2% at 12 hours postdose. cFTOE increased correspondingly. Although rSO2C values were lower and cFTOE values were higher compared with the baseline values at 3, 4, 6, and 12 hours after caffeine administration, this was not statistically significant. Conclusion A loading dose of caffeine temporarily reduces cerebral oxygenation and increases cerebral tissue oxygen extraction in preterm infants. Most probably these changes reflect a physiological phenomenon without any clinical importance to the cerebral hemodynamics, as the reduction in cerebral oxygenation and increase in cerebral tissue oxygen extraction remain well within acceptable range.

scholarly journals Cranial Ultrasound in Moderate and Late Preterm Neonates: A Prospective Observational Study

2021 ◽  
Vol 41 (1) ◽  
pp. 42-47
Author(s):  
Om Krishna Pathak ◽  
Yengkhom Rameshwor Singh ◽  
Rahul Mugurkar ◽  
Pradeep Suryawanshi
Keyword(s):  
Observational Study ◽  
Preterm Infants ◽  
Prospective Observational Study ◽  
Late Preterm ◽  
Preterm Neonates ◽  
Cranial Ultrasound ◽  
Case Record ◽  
Mechanically Ventilated ◽  
Late Preterm Infants ◽  
Ultrasound Findings

Introduction: Preterm infants’ brain is vulnerable to ischemic and hemorrhagic injuries due to structural and molecular immaturities as well as associated co-morbidities, which is usually detected by bedside cranial ultrasound. Cranial ultrasound findings are common in preterm infants’ of < 32 weeks, so cranial ultrasound is routinely recommended in them but there is no such recommendation regarding moderate and late preterm infants. The objective of this study is to find the cranial ultrasound abnormalities in moderate and late preterm infants. Methods: This prospective observational study was conducted in a tertiary level neonatal care unit. Hundred moderate and late preterm neonates delivered or admitted within seventh day of life were included in the study. Cranial ultrasound scan was performed between third and seventh day of life and before discharge and ultrasound findings were noted. Data were collected in predesigned case record form and analysed using Fischer Exact test. Results: Out of 100 neonates, 47 (47%) were males and 53 (53%) females. There were 43 (43%) moderately preterm and 57 (57%) late preterm infants. Mean day of life for performing first and second cranial ultrasound was 4.17 (3 - 7) days and 13.24 (3 - 40) days respectively. Cranial abnormalities were noted in 26% neonates. Intra-ventricular haemorrhage grade 1 or 2 was the commonest abnormality noted. Choroid plexus cyst (4%), cerebral edema (3%), periventricular hyperechogenicity (3%) and hydrocephalus (1%) were the other abnormalities noted. Neonates having APGAR < 6 at one minute, mechanically ventilated and having co-morbidities had significantly higher incidence of abnormal findings. Conclusions: It is reasonable to perform screening cranial ultrasound in high risk moderate and late preterm infants having low APGAR score, mechanically ventilated and having co-morbidities.

scholarly journals Tissue oxygen saturation changes and postoperative complications in cardiac surgery: a prospective observational study

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Sabino Scolletta ◽  
Federico Franchi ◽  
Elisa Damiani ◽  
Armando Cennamo ◽  
Roberta Domizi ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Observational Study ◽  
Oxygen Saturation ◽  
Prospective Observational Study ◽  
Near Infrared ◽  
Oxygen Extraction ◽  
Tissue Oxygen Saturation ◽  
Tissue Oxygen ◽  
University Hospitals ◽  
Microvascular Reactivity

Abstract Background Cardiac surgery with extracorporeal circulation (ECC) can induce microvascular dysfunction and tissue hypoperfusion. We hypothesized that the alterations in near-infrared spectroscopy (NIRS)-derived parameters would be associated with post-operative complications in cardiac surgery patients. Methods Prospective observational study performed at two University Hospitals. Ninety patients undergoing cardiac surgery with ECC were enrolled. The NIRS sensor was applied on the thenar eminence. A vascular occlusion test (VOT, 3-min ischemia) was performed at baseline (t0), at Intensive Care Unit (ICU) admission (t1), 3 (t2) and 6 (t3) hours later. Baseline tissue oxygen saturation (StO2), oxygen extraction rate and microvascular reactivity indices were calculated. Results In the first hours after cardiac surgery, StO2 tended to increase (86% [80–89] at T3 versus 82% [79–86] at T0, p = ns), while both tissue oxygen extraction and microvascular reactivity tended to decrease, as indicated by increasing occlusion slope (− 8.1%/min [− 11.2 to − 7] at T3 versus − 11.2%/min [− 13.9 to − 7.9] at T0, p = ns) and decreasing recovery slope (1.9%/sec [1.1–2.9] at T3 versus 3.1%/sec [2.3–3.9] at T0, p = ns). No substantial differences were found in NIRS-derived variables and their changes over time between patients with complications and those without complications. Conclusions Peripheral tissue oxygen extraction and microvascular reactivity were reduced during the first hours after cardiac surgery. NIRS-derived parameters were not able to predict complications in this population of cardiac surgery patients.

scholarly journals Early effects of ventilatory rescue therapies on systemic and cerebral oxygenation in mechanically ventilated COVID-19 patients with acute respiratory distress syndrome: a prospective observational study

Critical Care ◽  
2021 ◽  
Vol 25 (1) ◽  
Author(s):  
Chiara Robba ◽  
◽  
Lorenzo Ball ◽  
Denise Battaglini ◽  
Danilo Cardim ◽  
...  
Keyword(s):  
Carbon Dioxide ◽  
Acute Respiratory Distress Syndrome ◽  
Observational Study ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Prospective Observational Study ◽  
Distress Syndrome ◽  
Cerebral Oxygenation ◽  
Arterial Blood ◽  
Early Effects

Abstract Background In COVID-19 patients with acute respiratory distress syndrome (ARDS), the effectiveness of ventilatory rescue strategies remains uncertain, with controversial efficacy on systemic oxygenation and no data available regarding cerebral oxygenation and hemodynamics. Methods This is a prospective observational study conducted at San Martino Policlinico Hospital, Genoa, Italy. We included adult COVID-19 patients who underwent at least one of the following rescue therapies: recruitment maneuvers (RMs), prone positioning (PP), inhaled nitric oxide (iNO), and extracorporeal carbon dioxide (CO2) removal (ECCO2R). Arterial blood gas values (oxygen saturation [SpO2], partial pressure of oxygen [PaO2] and of carbon dioxide [PaCO2]) and cerebral oxygenation (rSO2) were analyzed before (T0) and after (T1) the use of any of the aforementioned rescue therapies. The primary aim was to assess the early effects of different ventilatory rescue therapies on systemic and cerebral oxygenation. The secondary aim was to evaluate the correlation between systemic and cerebral oxygenation in COVID-19 patients. Results Forty-five rescue therapies were performed in 22 patients. The median [interquartile range] age of the population was 62 [57–69] years, and 18/22 [82%] were male. After RMs, no significant changes were observed in systemic PaO2 and PaCO2 values, but cerebral oxygenation decreased significantly (52 [51–54]% vs. 49 [47–50]%, p < 0.001). After PP, a significant increase was observed in PaO2 (from 62 [56–71] to 82 [76–87] mmHg, p = 0.005) and rSO2 (from 53 [52–54]% to 60 [59–64]%, p = 0.005). The use of iNO increased PaO2 (from 65 [67–73] to 72 [67–73] mmHg, p = 0.015) and rSO2 (from 53 [51–56]% to 57 [55–59]%, p = 0.007). The use of ECCO2R decreased PaO2 (from 75 [75–79] to 64 [60–70] mmHg, p = 0.009), with reduction of rSO2 values (59 [56–65]% vs. 56 [53–62]%, p = 0.002). In the whole population, a significant relationship was found between SpO2 and rSO2 (R = 0.62, p < 0.001) and between PaO2 and rSO2 (R0 0.54, p < 0.001). Conclusions Rescue therapies exert specific pathophysiological mechanisms, resulting in different effects on systemic and cerebral oxygenation in critically ill COVID-19 patients with ARDS. Cerebral and systemic oxygenation are correlated. The choice of rescue strategy to be adopted should take into account both lung and brain needs. Registration The study protocol was approved by the ethics review board (Comitato Etico Regione Liguria, protocol n. CER Liguria: 23/2020).

Dose-dependent effect of ANG II-receptor antagonist on myocyte remodeling in rat cardiac hypertrophy

1997 ◽  
Vol 273 (4) ◽  
pp. H1824-H1831 ◽  
Author(s):  
Masakazu Obayashi ◽  
Masafumi Yano ◽  
Michihiro Kohno ◽  
Shigeki Kobayashi ◽  
Taketo Tanigawa ◽  
...  
Keyword(s):  
Cardiac Output ◽  
Receptor Antagonist ◽  
Pressure Overload ◽  
Wall Stress ◽  
Treated Group ◽  
Left Ventricular ◽  
Abdominal Aortic ◽  
Significant Difference ◽  
And Function ◽  
Vehicle Treated Group

The goal of this study was to examine the effect of an angiotensin II type 1 (AT1)-receptor antagonist (TCV-116) on left ventricular (LV) geometry and function during the development of pressure-overload LV hypertrophy. A low (LD; 0.3 mg ⋅ kg−1 ⋅ day−1) or a high (HD; 3.0 mg ⋅ kg−1 ⋅ day−1) dose of TCV-116 was administered to abdominal aortic-banded rats over 4 wk, and hemodynamics and morphology were then evaluated. In both LD and HD groups, peak LV pressures were decreased to a similar extent compared with the vehicle-treated group but stayed at higher levels than in the sham-operated group. In the LD group, both end-diastolic wall thickness (3.08 ± 0.14 mm) and myocyte width (13.3 ± 0.1 μm) decreased compared with those in the vehicle-treated group (3.67 ± 0.19 mm and 15.3 ± 0.1 μm, respectively; both P < 0.05). In the HD group, myocyte length was further decreased (HD: 82.6 ± 2.6, LD: 94.1 ± 2.9 μm; P < 0.05) in association with a reduction in LV midwall radius (HD: 3.36 ± 0.12, LD: 3.60 ± 0.14 mm; P < 0.05) and peak midwall fiber stress (HD: 69 ± 8, LD: 83 ± 10 × 103dyn/cm2; P < 0.05). There was no significant difference in cardiac output among all groups. The AT1-receptor antagonist TCV-116 induced an inhibition of the development of pressure-overload hypertrophy. Morphologically, not only the width but also the length of myocytes was attenuated with TCV-116, leading to a reduction of midwall radius and hence wall stress, which in turn may contribute to a preservation of cardiac output.

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