Treatment of myxoedema coma factors associated with fatal outcome

1985 ◽  
Vol 108 (1) ◽  
pp. 65-71 ◽  
Author(s):  
Britta Hylander ◽  
Urban Rosenqvist
Keyword(s):  
Heart Rate ◽  
Retrospective Study ◽  
Body Temperature ◽  
Causes Of Death ◽  
Fatal Outcome ◽  
Compartment Model ◽  
High Serum ◽  
High Serum Level ◽  
Factors Associated ◽  
Two Compartment Model

Abstract. Treatment of myxoedema coma has been associated with a high mortality. The causes of death were analysed in this paper by retrospective study of the records of 11 myxoedema coma patients. The serum thyroxine (T4) and triiodothyronine (T3) levels were estimated retrospectively from the amounts of hormone given to the patients by a two-compartment model. Seven patients died and 4 survived. The patients who died were significantly older (78.9 ± 2.2 years, mean ± sem) than those who survived (66.8 ± 3.7 years). The initial heart rate was lower in the deceased group, but both groups had increased their heart rate on treatment. The surviving patients showed an increase in body temperature during the first 3 days of treatment, in contrast to the patients who eventually died. The deceased patients had received larger amounts of thyroid hormone and had calculated levels of T3 that were nearly twice as high as those of the surviving patients. Old age and a high serum level of T3 are determinants for the fatal outcome of myxoedema coma. Our analysis underscores the importance of using a cautious replacement regimen in myxoedema coma patients.

Effect of O2 affinity on arterial PO2 in animals with central vascular shunts

1982 ◽  
Vol 53 (6) ◽  
pp. 1360-1364 ◽  
Author(s):  
S. C. Wood
Keyword(s):  
Body Temperature ◽  
Compartment Model ◽  
Congenital Defects ◽  
Arterial Blood ◽  
Venous Shunt ◽  
Two Compartment Model ◽  
Ectothermic Vertebrate ◽  
The Right ◽  
Dissociation Curves

Central vascular or intracardiac shunts result in venous admixture and reduced saturation of systemic arterial blood. This is pronounced in most species of amphibians and reptiles and may occur as congenital defects in homeotherms. A two-compartment model is useful to analyze the effects of shunt on O2 transport. The PO2 of a mixture of pulmonary (ideal) and mixed venous (shunt) blood will be a function of the resulting O2 saturation, analogous to the principle of the “mixing method” in vitro. Furthermore, for a given saturation, the PO2 of systemic arterial blood (PaO2) should be inversely related to the O2 affinity of the mixed blood. The present study tested this two-compartment model of shunt in animals with normally occurring right-to-left shunts (amphibians and reptiles) and with dogs having artificial shunts. The O2 dissociation curves (ODC) of the blood were manipulated by varying body temperature and blood pH. For any level of saturation of systemic arterial blood, the PaO2 was found to increase with factors that shifted the ODC to the right. This experimental support of mathematical models of shunting and PaO2 suggests that animals with intracardiac or central vascular shunts are benefited by low-O2-affinity blood, a condition that is common in amphibians and reptiles. For an individual ectothermic vertebrate, an increase in O2 demand due to increased body temperature would, because of decreased O2 affinity, be accompanied and perhaps facilitated by an increase in PaO2 if saturation remained constant.

Estimating changes in mean body temperature for humans during exercise using core and skin temperatures is inaccurate even with a correction factor

2007 ◽  
Vol 103 (2) ◽  
pp. 443-451 ◽  
Author(s):  
Ollie Jay ◽  
Francis D. Reardon ◽  
Paul Webb ◽  
Michel B. DuCharme ◽  
Tim Ramsay ◽  
...  
Keyword(s):  
Body Temperature ◽  
Skin Temperature ◽  
Correction Factor ◽  
Estimation Error ◽  
Compartment Model ◽  
Traditional Model ◽  
Mean Skin Temperature ◽  
Mean Body Temperature ◽  
Two Compartment Model ◽  
Adjusted Model

Changes in mean body temperature (ΔT̄b) estimated by the traditional two-compartment model of “core” and “shell” temperatures and an adjusted two-compartment model incorporating a correction factor were compared with values derived by whole body calorimetry. Sixty participants (31 men, 29 women) cycled at 40% of peak O2 consumption for 60 or 90 min in the Snellen calorimeter at 24 or 30°C. The core compartment was represented by esophageal, rectal (Tre), and aural canal temperature, and the shell compartment was represented by a 12-point mean skin temperature (T̄sk). Using Tre and conventional core-to-shell weightings ( X) of 0.66, 0.79, and 0.90, mean ΔT̄b estimation error (with 95% confidence interval limits in parentheses) for the traditional model was −95.2% (−83.0, −107.3) to −76.6% (−72.8, −80.5) after 10 min and −47.2% (−40.9, −53.5) to −22.6% (−14.5, −30.7) after 90 min. Using Tre, X = 0.80, and a correction factor ( X0) of 0.40, mean ΔT̄b estimation error for the adjusted model was +9.5% (+16.9, +2.1) to −0.3% (+11.9, −12.5) after 10 min and +15.0% (+27.2, +2.8) to −13.7% (−4.2, −23.3) after 90 min. Quadratic analyses of calorimetry ΔT̄b data was subsequently used to derive best-fitting values of X for both models and X0 for the adjusted model for each measure of core temperature. The most accurate model at any time point or condition only accounted for 20% of the variation observed in ΔT̄b for the traditional model and 56% for the adjusted model. In conclusion, throughout exercise the estimation of ΔT̄b using any measure of core temperature together with mean skin temperature irrespective of weighting is inaccurate even with a correction factor customized for the specific conditions.

scholarly journals MDR/XDR Acinetobacter baumannii hospital infection associated with high mortality: A retrospective study in the PICU

2019 ◽  
Author(s):  
Jingyi Shi ◽  
Ting Sun ◽  
Yun Cui ◽  
Chunxia Wang ◽  
Fei Wang ◽  
...  
Keyword(s):  
Retrospective Study ◽  
High Risk ◽  
Acinetobacter Baumannii ◽  
High Mortality ◽  
Pediatric Patients ◽  
Bloodstream Infections ◽  
High Serum ◽  
Drug Resistant ◽  
High Serum Level ◽  
Risk Of Mortality

Abstract Background Multiple drug-resistant (MDR) and extensively drug-resistant (XDR) Acinetobacter baumannii presents challenges for clinical treatment and causes high mortality in children. We aimed to assess the risk factors for MDR/XDR Acinetobacter baumannii (MDR/XDR-AB) infection and for 28-day mortality in this patient population.Methods This retrospective study included 102 pediatric patients who developed MDR/XDR-AB infection in the pediatric intensive care unit (PICU) of Shanghai Children’s Hospital in China from January 2015 to December 2017. Clinical presentations and outcome of the patients were analyzed.Results Of the 102 patients (63 males and 39 females; mean age: 51.79 months), There were 63 (61.77%) male in the case group. The 28-day mortality rate was 29.41%. 18(17.64%) had bloodstream infections;4(3.92%) for which cerebrospinal fluid (CSF) cultures were positive; 14(13.73%) of them got positive cultures in aseptic fluid; 10 (9.8%) had central line-associated bloodstream infections; lower respiratory isolates (56/102) accounted for 54.9% of all patients. Multivariate logistic analysis indicated that high serum level of BUN (RR, 1.216, 95%CI, 1.27-2.616; P = 0.001) and high serum level of Cr (RR, 1.823, 95%CI, 0.902-0.980), were associated with high risk of mortality in MDR/XDR-AB infected patients.Conclusion MDR/XDR-Ab infection is a serious concern in pediatric patients with high mortality (29.41%). Mortality rate is higher in blood stream infection and central nervous system infection. Acute kidney injury is associated with high risk of mortality. Early use of tigarecycline might be involved in improving MDR/XDR-AB bacteremia.

scholarly journals Pharmacokinetics and Pharmacodynamics of Cefepime in Adults with Hematological Malignancies and Febrile Neutropenia after Chemotherapy

Antibiotics ◽  
2021 ◽  
Vol 10 (5) ◽  
pp. 504
Author(s):  
José C. Álvarez ◽  
Sonia I. Cuervo ◽  
Edelberto Silva ◽  
Jorge A. Díaz ◽  
Lorena L. Jiménez ◽  
...  
Keyword(s):  
Febrile Neutropenia ◽  
Serum Creatinine ◽  
Empirical Therapy ◽  
Compartment Model ◽  
High Serum ◽  
Open Label ◽  
Hematological Neoplasms ◽  
Two Compartment Model ◽  
Low Levels ◽  
Study Participants

Patients with chemotherapy-induced febrile neutropenia (CIFN) may have changes in the pharmacokinetics (PK) compared to patients without malignancies or neutropenia. Those changes in antibiotic PK could lead to negative outcomes for patients if the therapy is not adequately adjusted to this. In this, open-label, non-randomized, prospective, observational, and descriptive study, a PK model of cefepime was developed for patients with hematological neoplasms and post-chemotherapy febrile neutropenia. This study was conducted at a cancer referral center, and study participants were receiving 2 g IV doses of cefepime every 8 h as 30-min infusions. Cefepime PK was well described by a two compartment model with a clearance dependent on a serum creatinine level. Using Monte Carlo simulations, it was shown that continuous infusions of 6g q24h could have a good achievement of PK/PD targets for MIC levels below the resistance cut-off point of Enterobacteriaceae. According to the simulations, it is unnecessary to increase the daily dose of cefepime (above 6 g daily) to increase the probability of target attainment (PTA). Cumulative fraction of response (CFR) using interment dosing was suboptimal for empirical therapy regimens against K. pneumoniae and P. aeruginosa, and continuous infusions could be used in this setting to maximize exposure. Patients with high serum creatinine levels were more likely to achieve predefined PK/PD targets than patients with low levels.

Wearable Triboelectric Nanogenerators for Heart Rate Monitoring

2021 ◽  
Author(s):  
Sophia Shen ◽  
Xiao Xiao ◽  
Xiao Xiao ◽  
Jun Chen
Keyword(s):  
Heart Rate ◽  
Cardiovascular Diseases ◽  
Causes Of Death ◽  
Heart Rate Monitoring ◽  
Triboelectric Nanogenerators ◽  
Physiological Indicator

Cardiovascular diseases are currently the leading causes of death globally and are projected to remain the leading cause in 2040, making heart rate an important physiological indicator to regularly monitor....

scholarly journals Factors Associated with Initial Public School Reopening Plans During the US COVID-19 Pandemic: a Retrospective Study

2021 ◽  
Author(s):  
Brystana G. Kaufman ◽  
Nirosha Mahendraratnam ◽  
Thuy-vi Nguyen ◽  
Laura Benzing ◽  
Jessica Beliveau ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Public School ◽  
Factors Associated ◽  
The Us

scholarly journals Estimation of cardiovascular drift through ear temperature during prolonged steady-state cycling: a study protocol

2021 ◽  
Vol 7 (1) ◽  
pp. e000907
Author(s):  
Giovanni Polsinelli ◽  
Angelo Rodio ◽  
Bruno Federico
Keyword(s):  
Heart Rate ◽  
Steady State ◽  
Body Temperature ◽  
Study Protocol ◽  
External Auditory Canal ◽  
Exercise Intensity ◽  
Core Body Temperature ◽  
Cardiovascular Drift ◽  
Core Body ◽  
Steady State Cycling

IntroductionThe measurement of heart rate is commonly used to estimate exercise intensity. However, during endurance performance, the relationship between heart rate and oxygen consumption may be compromised by cardiovascular drift. This physiological phenomenon mainly consists of a time-dependent increase in heart rate and decrease in systolic volume and may lead to overestimate absolute exercise intensity in prediction models based on heart rate. Previous research has established that cardiovascular drift is correlated to the increase in core body temperature during prolonged exercise. Therefore, monitoring body temperature during exercise may allow to quantify the increase in heart rate attributable to cardiovascular drift and to improve the estimate of absolute exercise intensity. Monitoring core body temperature during exercise may be invasive or inappropriate, but the external auditory canal is an easily accessible alternative site for temperature measurement.Methods and analysisThis study aims to assess the degree of correlation between trends in heart rate and in ear temperature during 120 min of steady-state cycling with intensity of 59% of heart rate reserve in a thermally neutral indoor environment. Ear temperature will be monitored both at the external auditory canal level with a contact probe and at the tympanic level with a professional infrared thermometer.Ethics and disseminationThe study protocol was approved by an independent ethics committee. The results will be submitted for publication in academic journals and disseminated to stakeholders through summary documents and information meetings.

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