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Platogiannis N, Karelas D, Platogiannis D, Papanikolaou J. Aspiring use of a thrombectomy catheter for coronary air embolism aspiration. J Invasive Cardiol 2024; 36. [PMID: 38412441 DOI: 10.25270/jic/23.00259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
A 52-year-old man with a history of percutaneous coronary intervention (PCI) in the left anterior descending (LAD) coronary artery was admitted for a facilitated PCI following an anterior ST-elevation myocardial infarction treated with thrombolysis at a nearby clinic.
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Affiliation(s)
| | - Dimitrios Karelas
- The Cardiology Department, Trikala Hospital, Trikala, Thessaly, Greece.
| | | | - John Papanikolaou
- The Cardiology Department, Trikala Hospital, Trikala, Thessaly, Greece
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Tsolaki V, Zakynthinos GE, Karavidas N, Vazgiourakis V, Papanikolaou J, Parisi K, Zygoulis P, Makris D, Zakynthinos E. Comprehensive temporal analysis of right ventricular function and pulmonary haemodynamics in mechanically ventilated COVID-19 ARDS patients. Ann Intensive Care 2024; 14:25. [PMID: 38345712 PMCID: PMC10861421 DOI: 10.1186/s13613-024-01241-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 01/02/2024] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND Cardiac injury is frequently reported in COVID-19 patients, the right ventricle (RV) is mostly affected. We systematically evaluated the cardiac function and longitudinal changes in severe COVID-19 acute respiratory distress syndrome (ARDS) admitted to the intensive care unit (ICU) and assessed the impact on survival. METHODS We prospectively performed comprehensive echocardiographic analysis on mechanically ventilated COVID-19 ARDS patients, using 2D/3D echocardiography. We defined left ventricular (LV) systolic dysfunction as ejection fraction (EF) < 40%, or longitudinal strain (LS) > - 18% and right ventricular (RV) dysfunction if two indices among fractional area change (FAC) < 35%, tricuspid annulus systolic plane excursion (TAPSE) < 1.6 cm, RV EF < 44%, RV-LS > - 20% were present. RV afterload was assessed from pulmonary artery systolic pressure (PASP), PASP/Velocity Time Integral in the right ventricular outflow tract (VTIRVOT) and pulmonary acceleration time (PAcT). TAPSE/PASP assessed the right ventriculoarterial coupling (VACR). RESULTS Among 176 patients included, RV dysfunction was common (69%) (RV-EF 41.1 ± 1.3%; RV-FAC 36.6 ± 0.9%, TAPSE 20.4 ± 0.4mm, RV-LS:- 14.4 ± 0.4%), usually accompanied by RV dilatation (RVEDA/LVEDA 0.82 ± 0.02). RV afterload was increased in most of the patients (PASP 33 ± 1.1 mmHg, PAcT 65.3 ± 1.5 ms, PASP/VTIRVOT, 2.29 ± 0.1 mmHg/cm). VACR was 0.8 ± 0.06 mm/mmHg. LV-EF < 40% was present in 21/176 (11.9%); mean LV-EF 57.8 ± 1.1%. LV-LS (- 13.3 ± 0.3%) revealed a silent LV impairment in 87.5%. A mild pericardial effusion was present in 70(38%) patients, more frequently in non-survivors (p < 0.05). Survivors presented significant improvements in respiratory physiology during the 10th ICU-day (PaO2/FiO2, 231.2 ± 11.9 vs 120.2 ± 6.7 mmHg; PaCO2, 43.1 ± 1.2 vs 53.9 ± 1.5 mmHg; respiratory system compliance-CRS, 42.6 ± 2.2 vs 27.8 ± 0.9 ml/cmH2O, all p < 0.0001). Moreover, survivors presented significant decreases in RV afterload (PASP: 36.1 ± 2.4 to 20.1 ± 3 mmHg, p < 0.0001, PASP/VTIRVOT: 2.5 ± 1.4 to 1.1 ± 0.7, p < 0.0001 PAcT: 61 ± 2.5 to 84.7 ± 2.4 ms, p < 0.0001), associated with RV systolic function improvement (RVEF: 36.5 ± 2.9% to 46.6 ± 2.1%, p = 0.001 and RV-LS: - 13.6 ± 0.7% to - 16.7 ± 0.8%, p = 0.001). In addition, RV dilation subsided in survivors (RVEDA/LVEDA: 0.8 ± 0.05 to 0.6 ± 0.03, p = 0.001). Day-10 CRS correlated with RV afterload (PASP/VTIRVOT, r: 0.535, p < 0.0001) and systolic function (RV-LS, 0.345, p = 0.001). LV-LS during the 10th ICU-day, while ΔRV-LS and ΔPASP/RVOTVTI were associated with survival. CONCLUSIONS COVID-19 improvements in RV function, RV afterload and RV-PA coupling at day 10 were associated with respiratory function and survival.
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Affiliation(s)
- Vasiliki Tsolaki
- Critical Care Department, Faculty of Medicine, University Hospital of Larissa, University of Thessaly, Mezourlo, 41110, Larissa, Greece
| | | | - Nikitas Karavidas
- Critical Care Department, Faculty of Medicine, University Hospital of Larissa, University of Thessaly, Mezourlo, 41110, Larissa, Greece
| | - Vasileios Vazgiourakis
- Critical Care Department, Faculty of Medicine, University Hospital of Larissa, University of Thessaly, Mezourlo, 41110, Larissa, Greece
| | - John Papanikolaou
- Department of Cardiology, General Hospital of Trikala, Karditsis 56, 42131, Trikala, Thessaly, Greece
| | - Kyriaki Parisi
- Critical Care Department, Faculty of Medicine, University Hospital of Larissa, University of Thessaly, Mezourlo, 41110, Larissa, Greece
| | - Paris Zygoulis
- Critical Care Department, Faculty of Medicine, University Hospital of Larissa, University of Thessaly, Mezourlo, 41110, Larissa, Greece
| | - Demosthenes Makris
- Critical Care Department, Faculty of Medicine, University Hospital of Larissa, University of Thessaly, Mezourlo, 41110, Larissa, Greece
| | - Epaminondas Zakynthinos
- Critical Care Department, Faculty of Medicine, University Hospital of Larissa, University of Thessaly, Mezourlo, 41110, Larissa, Greece.
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Felfeli T, Corrin M, Papanikolaou J, Mandelcorn ED. MACULAR HOLE HYDRODISSECTION TECHNIQUE WITH HUMAN AMNIOTIC MEMBRANE FOR REPAIR OF LARGE MACULAR HOLES. Retin Cases Brief Rep 2023; 17:767-770. [PMID: 35970750 PMCID: PMC10597415 DOI: 10.1097/icb.0000000000001293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
PURPOSE To describe a combined surgical technique using the macular hole hydrodissection (MHH) with human amniotic membrane for repair of large macular holes. METHODS A step-by-step procedure and a surgical video using the combined MHH and human amniotic membrane technique are presented. DESCRIPTION AND TECHNIQUE As the first step, the MHH separates the adhesions of the macular hole to the underlying retinal pigment epithelium with a soft-tipped cannula through proportional reflux followed by gentle passive aspiration. The human amniotic membrane graft is marked to identify the nonsticky epithelial side and ensure that the stromal layer (sticky and nonshinny) is facing downward toward the retinal pigment epithelium. The graft is then tucked into the space created with MHH between the macular hole edges and the retinal pigment epithelium with closed forceps to decrease the likelihood of the graft from dislocating postoperatively. CONCLUSION The MHH in combination with the human amniotic membrane is a practical and effective technique for addressing challenging large macular holes.
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Affiliation(s)
- Tina Felfeli
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Michael Corrin
- Department of Biomedical Communications, University of Toronto, Toronto, Ontario, Canada
| | | | - Efrem D. Mandelcorn
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
- Department of Ophthalmology, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
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Tsolaki V, Zakynthinos GE, Papanikolaou J, Karavidas N, Vazgiourakis V, Papadonta ME, Zygoulis P, Pantazopoulos I, Makris D, Zakynthinos E. Positive End-Expiratory Pressure Deescalation in COVID-19-induced Acute Respiratory Distress Syndrome Unloads the Right Ventricle, Improving Hemodynamics and Oxygenation. Am J Respir Crit Care Med 2023; 208:205-208. [PMID: 37236626 PMCID: PMC10395492 DOI: 10.1164/rccm.202301-0154le] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 05/24/2023] [Indexed: 05/28/2023] Open
Affiliation(s)
- Vasiliki Tsolaki
- Critical Care Department, University Hospital of Larissa, Larissa, Greece
- Faculty of Medicine, University of Thessaly, Larissa, Greece
| | | | - John Papanikolaou
- Department of Cardiology, General Hospital of Trikala, Thessaly, Greece; and
| | - Nikitas Karavidas
- Critical Care Department, University Hospital of Larissa, Larissa, Greece
| | - Vasileios Vazgiourakis
- Critical Care Department, University Hospital of Larissa, Larissa, Greece
- Faculty of Medicine, University of Thessaly, Larissa, Greece
| | | | - Paris Zygoulis
- Critical Care Department, University Hospital of Larissa, Larissa, Greece
| | - Ioannis Pantazopoulos
- Faculty of Medicine, University of Thessaly, Larissa, Greece
- Department of Emergency Medicine, General University Hospital of Larissa, Thessaly, Greece
| | - Demosthenes Makris
- Critical Care Department, University Hospital of Larissa, Larissa, Greece
- Faculty of Medicine, University of Thessaly, Larissa, Greece
| | - Epaminondas Zakynthinos
- Critical Care Department, University Hospital of Larissa, Larissa, Greece
- Faculty of Medicine, University of Thessaly, Larissa, Greece
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Karelas D, Platogiannis N, Papanikolaou J. Cath lab activation with smartwatch's electrocardiogram tracings. J Invasive Cardiol 2023; 35:E392-E393. [PMID: 37769615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 09/30/2023]
Abstract
A 67-year-old man with a history of smoking, hyperlipidemia, and hypertension complained of central chest pain radiating to his left arm for 2 hours and contacted the attending cardiologist. Based on medical history and symptom description, the physician urged him to undergo a complete cardiac evaluation to rule in or out an acute coronary syndrome. Interestingly, the patient insisted on sending digitally for tele-consultation a lead-I tracing recorded by his Samsung Galaxy Watch 4 (Samsung Electronics) worn on his left wrist.
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Tsolaki V, Zakynthinos GE, Papanikolaou J, Vazgiourakis V, Parisi K, Fotakopoulos G, Makris D, Zakynthinos E. Levosimendan in the Treatment of Patients with Severe Septic Cardiomyopathy. Life (Basel) 2023; 13:1346. [PMID: 37374128 DOI: 10.3390/life13061346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 05/27/2023] [Accepted: 06/06/2023] [Indexed: 06/29/2023] Open
Abstract
(1) Background: The optimal treatment of septic cardiomyopathy (SCM) remains questionable. The aim of the study was to compare the treatment of SCM based on levosimendan versus the best available therapy. (2) Methods: We conducted an observational study including patients with severe septic cardiomyopathy and circulatory failure. (3) Results: Fourteen patients (61%) received levosimendan, and nine received other treatments. The patients in the levosimendan group were more severely ill [APACHE II: 23.5 (14, 37) vs. 14 (13, 28), respectively, p = 0.012], and there was a trend for more decompensated LV function depicted by the LVEF [15% (10, 20) vs. 25% (5, 30), respectively, p = 0.061]. However, they presented a significantly higher increase in LVEF after seven days [15% (10, 20) to 50% (30, 68) (p < 0.0001) vs. 25% (5, 30) to 25% (15, 50) (p = 0.309), and a significantly higher decrease in lactate levels during the first 24 h [4.5 (2.5, 14.4) to 2.85 (1.2, 15), p = 0.036 vs. 2.9 (2, 18.9) to 2.8 (1, 15), p = 0.536]. Seven-day survival (64.3% vs. 33.3%, p = 0.424) and ICU survival (50% vs. 22.2%, p = 0.172) were higher in the first group, although differences did not reach statistical significance. The degree of left ventricular impairment and the magnitude of EF improvement by the seventh-day post-SCM onset were associated with mortality in regression analysis. (4) Conclusions: Our study presents main hemodynamic data supporting the possible efficacy of levosimendan treatment in patients with severe SCM.
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Affiliation(s)
- Vasiliki Tsolaki
- Intensive Care Unit, University Hospital of Larissa, University of Thessaly Faculty of Medicine, 44110 Larissa, Greece
| | - George E Zakynthinos
- Third Cardiology Clinic, University of Athens, Sotiria Hospital, 11527 Athens, Greece
| | | | - Vasileios Vazgiourakis
- Intensive Care Unit, University Hospital of Larissa, University of Thessaly Faculty of Medicine, 44110 Larissa, Greece
| | - Kyriaki Parisi
- Intensive Care Unit, University Hospital of Larissa, University of Thessaly Faculty of Medicine, 44110 Larissa, Greece
| | - George Fotakopoulos
- Neurosurgical Department, University Hospital of Larissa, 44110 Larissa, Greece
| | - Demosthenes Makris
- Intensive Care Unit, University Hospital of Larissa, University of Thessaly Faculty of Medicine, 44110 Larissa, Greece
| | - Epaminondas Zakynthinos
- Intensive Care Unit, University Hospital of Larissa, University of Thessaly Faculty of Medicine, 44110 Larissa, Greece
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Papanikolaou J, Karelas D, Syrmos G, Platogiannis N. Intrapericardial Blood Re-transfused to Venous Circulation Through a Closed Circuit: A Life- Saving Management of Hemopericardium. J Invasive Cardiol 2023; 35:E321-E322. [PMID: 37410749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Subscribe] [Scholar Register] [Indexed: 07/08/2023]
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Karelas D, Platogiannis N, Papanikolaou J. Stent-in-stent underexpansion shockingly tackled with shockwave intravascular lithotripsy in the acute setting. Coron Artery Dis 2023; 34:221-222. [PMID: 36762641 DOI: 10.1097/mca.0000000000001222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
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Karelas D, Kostantinis S, Papanikolaou J, Platogiannis N. Radial Artery Spasm, Excision of Avulsed Fragment and Uncompromised Flow: An Oxymoron in Invasive Cardiology. J Invasive Cardiol 2023; 35:E217-E218. [PMID: 37029995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
Abstract
Transradial access may lead to anatomical and functional changes on the vessel wall due to puncture or material-associated trauma, inflammation and loss of endothelium's nitric oxide vasodilatory response. Despite the superficial and palpable radial artery course, caution and dexterity are important assets when puncturing, wiring, inserting the sheath, or maneuvering the catheters. Radial artery anatomic variations, tortuosity, and radial artery spasm are related with femoral access switch. The outer diameter of sheaths and catheters needs to match radial artery internal diameter; otherwise, friction or vascular stretch will occur, activating the surface endothelium and the coagulation cascade. Friction between the arterial wall and the equipment worsens endothelial function and precipitates patient discomfort, radial artery spasm, and ultimately, radial artery occlusion.
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Karelas D, Papanikolaou J, Platogiannis N. A Lifesaver Trinity for Unilateral Pulmonary Edema in a Cardiac Intensive Care Unit. J Invasive Cardiol 2022; 34:E639. [PMID: 35920733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
A 72-year-old man with chronic obstructive pulmonary disease complained of worsening dyspnea. Physical examination and several diagnostic tests led to a diagnosis of unilateral pulmonary edema, which manifests as a classic radiographic image, but is usually misdiagnosed. Low-cardiac-output state, unilateral pulmonary infiltrates, and respiratory failure sets the diagnosis. The trinity of high positive end-expiratory pressure, intra-aortic balloon pump, and continuous venovenous hemodiafiltration may be life-saving.
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Karelas D, Papanikolaou J, Kalantzis D, Platogiannis N. ACAOS (Anomalous Coronary Artery From the Opposite Sinus) as Part of a Chaos: 75 Years of Harmonious Occult Coexistence. J Invasive Cardiol 2022; 34:E488. [PMID: 35652715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
It is uncommon for the left anterior descending coronary artery to arise from the contralateral Valsalva sinus, and more of a rarity to see coexistent left main coronary artery anomaly. Our patient reported normal daily physical activity and denied further evaluation (stress test, scintigraphy) or cardiothoracic consultation. She continues to be symptom free at 1-month follow-up.
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Papanikolaou J, Karelas D, Kutsogiannis DJ, Platogiannis N, Karakitsos D. An underestimated tool for both cooling and circulatory support in cardiac arrest survivors developing severe hyperthermia. Resusc Plus 2022; 10:100224. [PMID: 35403070 PMCID: PMC8983430 DOI: 10.1016/j.resplu.2022.100224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 03/09/2022] [Accepted: 03/12/2022] [Indexed: 10/28/2022] Open
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Kutsogiannis DJ, Alharthy A, Balhamar A, Faqihi F, Papanikolaou J, Alqahtani SA, Memish ZA, Brindley PG, Brochard L, Karakitsos D. Mortality and Pulmonary Embolism in Acute Respiratory Distress Syndrome From COVID-19 vs. Non-COVID-19. Front Med (Lausanne) 2022; 9:800241. [PMID: 35308552 PMCID: PMC8931188 DOI: 10.3389/fmed.2022.800241] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 01/31/2022] [Indexed: 01/08/2023] Open
Abstract
Purpose There may be a difference in respiratory mechanics, inflammatory markers, and pulmonary emboli in COVID-19 associated ARDS vs. ARDS from other etiologies. Our purpose was to determine differences in respiratory mechanics, inflammatory markers, and incidence of pulmonary embolism in patients with and without COVID-19 associated ARDS admitted in the same period and treated with a similar ventilation strategy. Methods A cohort study of COVID-19 associated ARDS and non COVID-19 patients in a Saudi Arabian center between June 1 and 15, 2020. We measured respiratory mechanics (ventilatory ratio (VR), recruitability index (RI), markers of inflammation, and computed tomography pulmonary angiograms. Results Forty-two patients with COVID-19 and 43 non-COVID patients with ARDS comprised the cohort. The incidence of “recruitable” patients using the recruitment/inflation ratio was slightly lower in COVID-19 patients (62 vs. 86%; p = 0.01). Fifteen COVID-19 ARDS patients (35.7%) developed a pulmonary embolism as compared to 4 (9.3%) in other ARDS patients (p = 0.003). In COVID-19 patients, a D-Dimer ≥ 5.0 mcg/ml had a 73% (95% CI 45–92%) sensitivity and 89% (95% CI 71–98%) specificity for predicting pulmonary embolism. Crude 60-day mortality was higher in COVID-19 patients (35 vs. 15%; p = 0.039) but three multivariate analysis showed that independent predictors of 60-day mortality included the ventilatory ratio (OR 3.67, 95% CI 1.61–8.35), PaO2/FIO2 ratio (OR 0.93; 95% CI 0.87–0.99), IL-6 (OR 1.02, 95% CI 1.00–1.03), and D-dimer (OR 7.26, 95% CI 1.11–47.30) but not COVID-19 infection. Conclusion COVID-19 patients were slightly less recruitable and had a higher incidence of pulmonary embolism than those with ARDS from other etiologies. A high D-dimer was predictive of pulmonary embolism in COVID-19 patients. COVID-19 infection was not an independent predictor of 60-day mortality in the presence of ARDS.
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Affiliation(s)
- Demetrios J. Kutsogiannis
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, The University of Alberta, Edmonton, AB, Canada
- *Correspondence: Demetrios J. Kutsogiannis
| | | | - Abdullah Balhamar
- Critical Care Department, King Saud Medical City, Riyadh, Saudi Arabia
| | - Fahad Faqihi
- Critical Care Department, King Saud Medical City, Riyadh, Saudi Arabia
| | - John Papanikolaou
- Critical Care Department, King Saud Medical City, Riyadh, Saudi Arabia
| | - Saleh A. Alqahtani
- Department of Medicine, The Johns Hopkins University Hospital, Baltimore, MD, United States
| | - Ziad A. Memish
- Research and Innovation Center, King Saud Medical City, Riyadh, Saudi Arabia
| | - Peter G. Brindley
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, The University of Alberta, Edmonton, AB, Canada
| | - Laurent Brochard
- Department of Critical Care, Keenan Research Center and Li Ka Shing Institute, St. Michael's Hospital, Toronto, ON, Canada
- Interdepartmental Division of Critical Care Medicine, Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Dimitrios Karakitsos
- Critical Care Department, King Saud Medical City, Riyadh, Saudi Arabia
- Department of Internal Medicine, University of South Carolina, School of Medicine, Columbia, SC, United States
- Critical Care Department, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
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Karelas D, Papanikolaou J, Kossyvakis C, Platogiannis D. Old stuff still trending: use of propafenone as a safety net until catheter ablation in a patient with documented pre-excited atrial fibrillation and Wolff-Parkinson-White syndrome - a classic case report. Eur Heart J Case Rep 2021; 5:ytab485. [PMID: 34909576 PMCID: PMC8665683 DOI: 10.1093/ehjcr/ytab485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 08/12/2021] [Accepted: 11/15/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Atrial fibrillation in Wolff-Parkinson-White syndrome may result in life-threateningly rapid antegrade conduction over a bypass tract, manifested by an irregular broad-complex (pre-excited) tachycardia that can degenerate to ventricular fibrillation. The shortest pre-excited RR interval below 250 ms during atrial fibrillation (AF) predicts increased risk of sudden cardiac death. CASE SUMMARY We report a case of a 43-year-old man with unremarkable cardiac history who presented due to sudden-onset feeling of palpitations and pre-syncope after strenuous lifting. Electrocardiography depicted fast pre-excited AF. The shortest pre-excited RR interval was estimated at 160 ms, indicating an accessory pathway (AP) with short antegrade refractory period at risk for mediating sudden cardiac death. Direct current cardioversion restored sinus rhythm unravelling delta waves. The patient was put on propafenone 450 mg/day having an uneventful clinical course. On Day 10 post-admission, electrophysiological study induced rapid AF but the shortest pre-excited RR interval was substantially increased to 264 ms. A left anterolateral AP was ablated. The patient remained symptom free until his latest follow-up in the 3rd-month post-ablation without manifest pre-excitation on the surface electrocardiogram. DISCUSSION Treatment options of pre-excited AF include anti-arrhythmic agents but mainly electrical cardioversion. Cardioversion can safely restore sinus rhythm, while use of anti-arrhythmics often requires intensive care unit monitoring due to the risk of QT prolongation. Catheter ablation is the mainstay of therapy for symptomatic patients. Our rare report highlights the direct impact of propafenone on prolonging the refractoriness of the AP, effectively and safely, and reappraises propafenone's worthiness as a protective measure following pre-excited AF episode until ablation.
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Affiliation(s)
- Dimitrios Karelas
- Cardiology Department, General Hospital of Trikala, Karditsis 56, 42100 Trikala, Greece
| | - John Papanikolaou
- Cardiology Department, General Hospital of Trikala, Karditsis 56, 42100 Trikala, Greece
| | - Charalampos Kossyvakis
- Cardiology Department, Athens General Hospital ‘G. Gennimatas’, 154 Mesogion Avenue, 11527 Athens, Greece
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Papanikolaou J, Platogiannis N, Gialamas I, Platogiannis D. Pneumothorax post-pacemaker implantation: the novelty of Heimlich valve. Europace 2021; 23:927. [PMID: 33346341 DOI: 10.1093/europace/euaa362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- John Papanikolaou
- Department of Cardiology, General Hospital of Trikala, Karditsis 56, 42131 Trikala, Thessaly, Greece
| | - Nikolaos Platogiannis
- Department of Cardiology, General Hospital of Trikala, Karditsis 56, 42131 Trikala, Thessaly, Greece
| | - Ioannis Gialamas
- Department of Cardiology, General Hospital of Trikala, Karditsis 56, 42131 Trikala, Thessaly, Greece
| | - Dimitrios Platogiannis
- Department of Cardiology, General Hospital of Trikala, Karditsis 56, 42131 Trikala, Thessaly, Greece
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Papanikolaou J, Alharthy A, Platogiannis N, Balhamar A, Alqahtani SA, Memish ZA, Karakitsos D. Spontaneous coronary artery dissection in a patient with COVID-19. Coron Artery Dis 2021; 32:354-355. [PMID: 33394695 PMCID: PMC8103843 DOI: 10.1097/mca.0000000000000991] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Accepted: 10/22/2020] [Indexed: 11/26/2022]
Abstract
Supplemental Digital Content is available in the text.
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Affiliation(s)
- John Papanikolaou
- Critical Care Department, King Saud Medical City, Riyadh, Saudi Arabia
| | | | | | - Abdullah Balhamar
- Critical Care Department, King Saud Medical City, Riyadh, Saudi Arabia
| | - Saleh A. Alqahtani
- Department of Medicine, The Johns Hopkins University Hospital, Baltimore, Maryland, USA
| | - Ziad A. Memish
- Research & Innovation Centre, King Saud Medical City, Riyadh, Saudi Arabia
| | - Dimitrios Karakitsos
- Critical Care Department, King Saud Medical City, Riyadh, Saudi Arabia
- Critical Care Department, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
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Koukoubani T, Makris D, Daniil Z, Paraforou T, Tsolaki V, Zakynthinos E, Papanikolaou J. The role of antimicrobial resistance on long-term mortality and quality of life in critically ill patients: a prospective longitudinal 2-year study. Health Qual Life Outcomes 2021; 19:72. [PMID: 33658021 PMCID: PMC7927260 DOI: 10.1186/s12955-021-01712-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Accepted: 02/18/2021] [Indexed: 11/21/2022] Open
Abstract
Background In the recent era, antimicrobial resistance has been identified as one of the most important threats to human health worldwide. The rapid emergence of antibiotic-resistant pathogens (ABRP) in the modern intensive care unit (ICU) also represents a “nightmare scenario” with unknown clinical consequences. In the Greek ICU, in particular, gram negative ABRPs are now considered endemic. However, the possible longitudinal impact of ABRPs on long-term outcomes of ICU patients has not yet been determined. Methods In this two-year (January 2014-December 2015) single-centre observational longitudinal study, 351 non-neurocritical ICU patients ≥ 18 year-old were enrolled. Patients’ demographic, clinical and outcome data were prospectively collected. Quality-adjusted life years (QALY) were calculated at 6, 12, 18 and 24 months after ICU admission. Results Fifty-eight patients developed infections due to ABRP (ABRP group), 57 due to non-ABRP (non-ABRP group), and 236 demonstrated no infection (no-infection group) while in ICU. Multiple regression analysis revealed that multiple organ dysfunction syndrome score (OR: 0.676, 95%CI 0.584–0.782; P < 0.001) and continuous renal replacement therapy (OR: 4.453, 95%CI 1.805–10.982; P = 0.001) were the only independent determinants for ABRP infections in ICU. Intra-ICU, 90-day and 2-year mortality was 27.9%, 52.4% and 61.5%, respectively. Compared to the non-ABRP and no-infection group, the ABRP group demonstrated increased intra-ICU, 90-day and 2-year mortality (P ≤ 0.022), worse 2-year survival rates in ICU patients overall and ICU survivor subset (Log-rank test, P ≤ 0.046), and poorer progress over time in 2-year QALY kinetics in ICU population overall, ICU survivor and 2-year survivor subgroups (P ≤ 0.013). ABRP group was further divided into multi-drug and extensively-drug resistant subgroups [MDR (n = 34) / XDR (n = 24), respectively]. Compared to MDR subgroup, the XDR subgroup demonstrated increased ICU, 90-day and 2-year mortality (P ≤ 0.031), but similar 90-day and 2-year QALYs (P ≥ 0.549). ABRP infections overall (HR = 1.778, 95% CI 1.166–2.711; P = 0.008), as well as XDR [HR = 1.889, 95% CI 1.075–3.320; P = 0.027) but not MDR pathogens, were independently associated with 2-year mortality, after adjusting for several covariates of critical illness. Conclusions The present study may suggest a significant association between ABRP (especially XDR) infections in ICU and increased mortality and inability rates for a prolonged period post-discharge that requires further attention in larger-scale studies.
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Affiliation(s)
| | - Demosthenes Makris
- Department of Critical Care, School of Medicine, University of Thessaly, University Hospital of Larissa, Biopolis, 41110, Larissa, Greece
| | - Zoe Daniil
- Department of Critical Care, School of Medicine, University of Thessaly, University Hospital of Larissa, Biopolis, 41110, Larissa, Greece
| | - Theoniki Paraforou
- Department of Critical Care, General Hospital of Trikala, Thessaly, Greece
| | - Vasiliki Tsolaki
- Department of Critical Care, School of Medicine, University of Thessaly, University Hospital of Larissa, Biopolis, 41110, Larissa, Greece
| | - Epaminondas Zakynthinos
- Department of Critical Care, School of Medicine, University of Thessaly, University Hospital of Larissa, Biopolis, 41110, Larissa, Greece
| | - John Papanikolaou
- Department of Critical Care, School of Medicine, University of Thessaly, University Hospital of Larissa, Biopolis, 41110, Larissa, Greece.
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Alharthy A, Faqihi F, Papanikolaou J, Balhamar A, Blaivas M, Memish ZA, Karakitsos D. Thrombolysis in severe COVID-19 pneumonia with massive pulmonary embolism. Am J Emerg Med 2020; 41:261.e1-261.e3. [PMID: 32763101 PMCID: PMC7392155 DOI: 10.1016/j.ajem.2020.07.068] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 07/18/2020] [Accepted: 07/22/2020] [Indexed: 01/16/2023] Open
Abstract
Objective No guidelines exist for the management of massive pulmonary embolism (PE) in COVID-19. We present a COVID-19 patient with refractory acute respiratory syndrome (ARDS), and life-threatening PE who underwent successful thrombolysis. Case Presentation A previously healthy 47 year old male was admitted to our hospital due to severe COVID-19 pneumonia [confirmed by Real-Time-Polymerase-Chain-Reaction (RT-PCR)]. He had rapidly evolving ARDS [partial arterial pressure of oxygen to fractional inspired concentration of oxygen ratio: 175], and sepsis. Laboratory results showed lymphocytopenia, and increased D-dimer levels (7.7 μg/ml; normal: 0–0.5 μg/ml). The patient was treated in the intensive care unit. On day-1, ARDS-net/prone positioning ventilation, and empiric anti-COVID treatment integrating prophylactic anticoagulation was administered. On hospital day-2, the patient developed shock with worsening oxygenation. Point-of-care-ultrasound depicted a large thrombus migrating from the right atrium to the pulmonary circulation. Intravenous alteplase (100 mg over 2 h) was administered as rescue therapy. The patient made an uneventful recovery, and was discharged to home isolation (day-20) on oral rivaroxaban. Conclusion Thrombolysis may have a critical therapeutic role for massive PE in COVID-19; however the risk of potential bleeding should not be underestimated. Point-of-care ultrasound has a pivotal role in the management of refractory ARDS in COVID-19.
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Affiliation(s)
| | - Fahad Faqihi
- Critical Care Department, King Saud Medical City, Riyadh, Saudi Arabia
| | - John Papanikolaou
- Critical Care Department, King Saud Medical City, Riyadh, Saudi Arabia
| | - Abdullah Balhamar
- Critical Care Department, King Saud Medical City, Riyadh, Saudi Arabia
| | - Mike Blaivas
- University of South Carolina, School of Medicine, Columbia, SC, USA.
| | - Ziad A Memish
- Research and Innovation Centre, King Saud Medical City, Riyadh, Saudi Arabia
| | - Dimitrios Karakitsos
- Critical Care Department, King Saud Medical City, Riyadh, Saudi Arabia; University of South Carolina, School of Medicine, Columbia, SC, USA.
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Papanikolaou J, Ntalapascha M, Makris D, Koukoubani T, Tsolaki V, Zakynthinos G, Gourgoulianis K, Zakynthinos E. Diastolic dysfunction in men with severe obstructive sleep apnea syndrome but without cardiovascular or oxidative stress-related comorbidities. Ther Adv Respir Dis 2020; 13:1753466619880076. [PMID: 31566076 PMCID: PMC6769220 DOI: 10.1177/1753466619880076] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Background: We aimed to evaluate whether the severity of obstructive sleep apnea syndrome (OSAS) per se affects the prevalence of left ventricular (LV) diastolic dysfunction in patients without comorbidities. Methods: A total of 42 patients with first-diagnosed severe OSAS [apnea–hypopnea index (AHI) > 30] and 25 controls (AHI < 5), having been referred for snoring to the Sleep Laboratory Department of our tertiary Hospital, were enrolled in the study. Inclusion criteria were absence of any cardiovascular or oxidative stress-related comorbidities, and age between 20 and 70 years. Clinical, laboratory, echocardiographic, and polysomnographic data were recorded prospectively. Diastolic dysfunction diagnosis and grading was based on 2016 ASE/EACVI recommendations. Results: Severe OSAS was associated with significantly increased prevalence and degree of diastolic dysfunction (26/42; 61.9%) compared with controls (7/25; 28%) (p = 0.007). AHI ⩾ 55 (dichotomous value of severe OSAS subset) was also characterized by greater prevalence and degree of diastolic dysfunction compared with 30 < AHI < 55 patients (p = 0.015). In the severe OSAS subset, age >45 years-old, height <1.745 m, body-mass index (BMI) >27.76 kg m−2, OSAS severity (AHI > 57.35), oxidative stress (overnight reduction of reduced to oxidized glutathione ratio < 18.44%), and BMI/height ratio > 16.155 kg m−3 (an index describing ‘dense’, short-heavy patients) presented significant diagnostic utility in identifying diastolic dysfunction in ROC-curve analysis (0.697 ⩾ AUC ⩾ 0.855, 0.001 ⩽ p ⩽ 0.018). In binary logistic regression model, advanced age (OR 1.23, 95% CI 1.025–1.477; p = 0.026) and AHI (OR 1.123, 95% CI 1.007–1.253; p = 0.036) showed independent association with diastolic dysfunction in severe OSAS. Conclusions: The present prospective study may suggest that severe OSAS is significantly associated with LV diastolic dysfunction; OSAS clinical severity exerts a positive influence on (and possibly constitutes an independent risk factor of) LV diastolic dysfunction. The reviews of this paper are available via the supplementary material section.
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Affiliation(s)
- John Papanikolaou
- Department of Critical Care, University Hospital of Larissa, Biopolis, Larissa, 41110, Greece
| | | | - Demosthenes Makris
- Department of Critical Care, University Hospital of Larissa, Larissa, Thessaly, Greece
| | | | - Vasiliki Tsolaki
- Department of Critical Care, University Hospital of Larissa, Larissa, Thessaly, Greece
| | - George Zakynthinos
- Department of Critical Care, University Hospital of Larissa, Larissa, Thessaly, Greece
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Tsolaki V, Zarogiannis S, Zygoulis P, Kalomenidis I, Jagirdar R, Makris D, Daniil Z, Magkouta S, Triantafyllou I, Papanikolaou J, Gourgoulianis KI, Zakynthinos E. Malignant mesothelioma cells secrete natriuretic peptides: Data and diagnostic clinical implications. Respirology 2020; 25:1060-1065. [PMID: 32124515 DOI: 10.1111/resp.13788] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 02/04/2020] [Accepted: 02/04/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND OBJECTIVE Mesothelial cells and cardiomyocytes have shared embryonic mesodermal origin. Cardiomyocytes release BNP under stretch. We searched whether malignant mesothelioma cells also secrete BNP and if so, this has a meaningful impact. METHODS Part I: Prospectively, patients with pleural lesions on CT having malignant mesothelioma effusions (MME, n = 13) were compared to patients with malignant effusions with pleural lesions (MEa, n = 14). Age-matched patients with ME without pleural lesions (MEb, n = 16) and non-malignant effusions (NME, n = 25) were analysed. Part II: Retrospectively, samples from patients with mesothelioma (n = 14), lung cancer (n = 8) or heart failure (n = 9) were used. BNP was measured in pleural fluid and blood/plasma. Part III: BNP was assessed in the culture supernatants of benign (MeT-5A) and malignant mesothelioma cell lines (M14K-epithelioid, MSTO-biphasic and ZL34-sarcomatoid) (n = 10 per cell line in three different biological replicates). RESULTS In vitro, BNP concentration was significantly higher in the supernatant of all malignant cell lines than benign ones (P < 0.01), denoting BNP's production from the former. The pleural fluid to blood BNP ratio in MME was extremely high in Part I and Part II subjects (28.3 ± 12.1 and 25.9 ± 8.6, respectively) versus 1.1 ± 0.3 and 0.4 ± 0.1 in Part I ME and NME, respectively (P < 0.0001), and 0.8 ± 0.1 and 0.4 ± 0.1 in Part II ME and NME, respectively (P < 0.0001). BNP ratio ≥2.11 in Part I had 92% sensitivity and 94.5% specificity for MME (P < 0.0001). CONCLUSION BNP is secreted from malignant mesothelial cells. In clinical practice, the pleural fluid to blood BNP ratio can help in the diagnosis of malignant mesothelioma.
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Affiliation(s)
- Vasiliki Tsolaki
- Intensive Care Unit, University Hospital of Larissa, Faculty of Medicine, University of Thessaly, Larissa, Greece
| | - Sotirios Zarogiannis
- Department of Physiology, Faculty of Medicine, University of Thessaly, Larissa, Greece
| | - Paris Zygoulis
- Intensive Care Unit, University Hospital of Larissa, Faculty of Medicine, University of Thessaly, Larissa, Greece
| | - Ioannis Kalomenidis
- 1st Department of Critical Care and Pulmonary Medicine, 'Evangelismos Hospital', National and Kapodistrian University of Athens, Athens, Greece
| | - Rajesh Jagirdar
- Department of Physiology, Faculty of Medicine, University of Thessaly, Larissa, Greece
| | - Demosthenes Makris
- Intensive Care Unit, University Hospital of Larissa, Faculty of Medicine, University of Thessaly, Larissa, Greece
| | - Zoe Daniil
- Respiratory Medicine Department, University Hospital of Larissa, Faculty of Medicine, University of Thessaly, Larissa, Greece
| | - Sofia Magkouta
- 1st Department of Critical Care and Pulmonary Medicine, 'Evangelismos Hospital', National and Kapodistrian University of Athens, Athens, Greece
| | - Ioannis Triantafyllou
- Department of Computer Science and Biomedical Informatics, School of Sciences, University of Thessaly, Lamia, Greece
| | - John Papanikolaou
- Intensive Care Unit, University Hospital of Larissa, Faculty of Medicine, University of Thessaly, Larissa, Greece
| | - Konstantinos I Gourgoulianis
- Respiratory Medicine Department, University Hospital of Larissa, Faculty of Medicine, University of Thessaly, Larissa, Greece
| | - Epaminondas Zakynthinos
- Intensive Care Unit, University Hospital of Larissa, Faculty of Medicine, University of Thessaly, Larissa, Greece
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Papanikolaou J, Koukoubani T, Zakynthinos E. Superior Vena Cava Cancerous Thrombus Due to Squamous Cell Tongue Cancer: Virchow's Triad at Its Worst Version. Thromb Haemost 2019; 119:512-514. [PMID: 30743273 DOI: 10.1055/s-0039-1677712] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Superior vena cava (SVC) cancerous thrombosis is extremely sparse, especially in the setting of extrathoracic tumours. Herein, we present the case of a patient with a squamous cell carcinoma of the tongue, who presented with SVC syndrome possibly secondary to symptomatic metastatic pericardial effusion. In this unique patient, the disastrous concurrence of all the elements of Virchow's triad within the confined anatomical space of SVC may have precipitated extensive vessel thrombosis with catastrophic consequences. To our knowledge, there has been no previous report about presence of SVC cancerous thrombosis in squamous cell tongue cancer. In this respect, our report may provide an unusual mechanism of tongue cancer expansion, which clinicians should be familiar with. In addition, it may highlight the clinical importance of SVC thrombosis on patients' clinical outcome, as well as the role of transoesophageal echocardiography in early detection of occult thrombi in the sub-set of patients with SVC syndrome.
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Affiliation(s)
- John Papanikolaou
- Department of Cardiology, General Hospital of Trikala, Thessaly, Greece.,Department of Critical Care, University Hospital of Larissa, Thessaly, Greece
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Papanikolaou J, Spathoulas K, Makris D, Zakynthinos E. Thrombolysis for Massive Pulmonary Embolism in a Patient with Hemorrhagic Shock. Am J Respir Crit Care Med 2017; 194:e15-e16. [PMID: 27529567 DOI: 10.1164/rccm.201605-1035im] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- John Papanikolaou
- Department of Critical Care, University Hospital of Larissa, Faculty of Medicine, University of Thessaly, Larissa, Greece
| | - Konstantinos Spathoulas
- Department of Critical Care, University Hospital of Larissa, Faculty of Medicine, University of Thessaly, Larissa, Greece
| | - Demosthenes Makris
- Department of Critical Care, University Hospital of Larissa, Faculty of Medicine, University of Thessaly, Larissa, Greece
| | - Epaminondas Zakynthinos
- Department of Critical Care, University Hospital of Larissa, Faculty of Medicine, University of Thessaly, Larissa, Greece
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Palli E, Makris D, Papanikolaou J, Garoufalis G, Tsilioni I, Zygoulis P, Zakynthinos E. The impact of N-acetylcysteine and ascorbic acid in contrast-induced nephropathy in critical care patients: an open-label randomized controlled study. Crit Care 2017; 21:269. [PMID: 29089038 PMCID: PMC5664844 DOI: 10.1186/s13054-017-1862-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Accepted: 10/12/2017] [Indexed: 02/04/2023]
Abstract
Background The aim was to investigate whether the use of N-acetylcysteine and ascorbic acid reduce contrast-induced nephropathy incidence in critical care patients. Methods This was a one-center, two-arm, prospective, randomized, open-label, controlled trial in the Intensive Care Unit of the University Hospital of Larissa, Greece. Patients with stable renal function, who underwent non urgent contrast-enhanced computed tomography for diagnostic purposes, were included in the study. Patients in the treatment group (NacA, n = 60) received intravenously N-acetylcysteine (1200 mg) and ascorbic acid (2 g) dissolved separately in 100 ml of normal saline 2 hours before, and at 10 hours and 18 hours following the infusion of contrast agent, while control group patients (CG, n = 64) received only normal saline. All patients received additional hydration. Contrast-induced nephropathy was defined as relative increase by 25% of the baseline values of serum creatinine. Results Contrast-induced nephropathy in NacA and CG were 18.33% and 15.6%, respectively (p = 0.81). The percentage change median (interquartile range (IR)) of serum cystatin-C (mg/L) from baseline in patients who underwent contrast-induced tomography, were 37.23% (28.53) and 93.20% (46.90) in NacA and in CG, respectively (p = 0.03). The 8-isoprostane serum levels in NacA were significantly lower compared to CG at 2 hours (p = 0.012) and 24 hours (p = 0.006) following radiocontrast infusion. Multivariate analysis revealed that contrast-induced nephropathy was independently associated with a higher baseline ratio of serum urea/creatinine (odds ratio, 1.02; 95 CI%, 1.00–1.05) and with the use of nephrotoxic medications (odds ratio, 0.24; 95 CI%, 0.06–0.94). Conclusion Intravenous administration of N-acetylcysteine and ascorbic acid failed to reduce contrast-induced nephropathy in critically ill patients who underwent contrast-enhanced computed tomography, despite a significant reduction of 8-isoprostane levels in treated patients. Trial registration ClinicalTrials.gov, NCT01017796. Registered on 20 November 2009. Electronic supplementary material The online version of this article (doi:10.1186/s13054-017-1862-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Eleni Palli
- Department of Critical Care, University Hospital of Larissa, Thessaly, Greece
| | - Demosthenes Makris
- Department of Critical Care, University Hospital of Larissa, Thessaly, Greece.
| | - John Papanikolaou
- Department of Critical Care, University Hospital of Larissa, Thessaly, Greece
| | | | - Irini Tsilioni
- Department of Critical Care, University Hospital of Larissa, Thessaly, Greece
| | - Paris Zygoulis
- Department of Critical Care, University Hospital of Larissa, Thessaly, Greece
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Papanikolaou J, Platogiannis N, Nikoloulis N, Tsiampalis A, Karavidas N, Platogiannis D. Twin Hearts in Identical Twins. J Invasive Cardiol 2017; 29:E86-E87. [PMID: 28667813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Cardiac manifestations and angiographic characteristics of coronary artery disease in identical twins have been previously dealt with in a handful of case reports and series; yet, the results were highly controversial. Our rare case demonstrates striking similarities in both the timing and type of clinical manifestation, as well as in the underlying anatomy and the distribution of coronary artery disease. When premature coronary artery disease is found in one of a monozygotic twin pair, evaluating the other twin is a reasonable approach.
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Papanikolaou J, Platogiannis N, Platogiannis D. Intrapericardial Cisplatin Instillation in Recurrent Postinfarction Cardiac Tamponade. J Cardiothorac Vasc Anesth 2017; 32:458-460. [PMID: 28939322 DOI: 10.1053/j.jvca.2017.04.041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2017] [Indexed: 11/11/2022]
Affiliation(s)
- John Papanikolaou
- Department of Cardiology, General Hospital of Trikala, Trikala, Thessaly, Greece; Department of Critical Care, School of Medicine, University of Thessaly, University Hospital of Larissa, Larissa, Thessaly, Greece.
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Papanikolaou J, Platogiannis N, Gkekas D, Barmpatzas N, Spathoulas K, Platogiannis D. Discontinuation of prolonged dual antiplatelet therapy for a dental extraction; A nearly-fatal decision. Interv Cardiol 2017. [DOI: 10.4172/interventional-cardiology.1000569] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Papanikolaou J, Makris D, Tsolaki V, Spathoulas K, Zakynthinos E. Post-partum hemorrhage complicated by reverse-Takotsubo cardiogenic shock; a novel therapeutic approach. Am J Emerg Med 2016; 35:935.e1-935.e3. [PMID: 28012808 DOI: 10.1016/j.ajem.2016.12.034] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Revised: 12/12/2016] [Accepted: 12/13/2016] [Indexed: 10/20/2022] Open
Abstract
Takotsubo Cardiomyopathy (TTC) is a type of transient, yet severe left ventricular systolic dysfunction, rarely complicating extreme emotional stress ("primary" TTC) or critical medical/surgical illness ("secondary" TTC forms). Although usually reversible, TTC may result in cardiogenic shock with dismal prognosis. "Secondary" TTC forms are particularly in danger for this complication, bearing significantly worse short and long-term prognosis. Herein, we report a rare case of a life-threatening "secondary" TTC in a patient with post-cesarean section severe hemorrhage, and we point out that early co-administration of esmolol and levosimendan might be an effective and safe therapeutic approach in "reversing" TTC-induced cardiogenic shock, especially when invasive therapeutic strategies are practically unfeasible.
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Affiliation(s)
- John Papanikolaou
- Department of Critical Care, University Hospital of Larissa, School of Medicine, University of Thessaly, Larissa, Thessaly, Greece.
| | - Demosthenes Makris
- Department of Critical Care, University Hospital of Larissa, School of Medicine, University of Thessaly, Larissa, Thessaly, Greece.
| | - Vasiliki Tsolaki
- Department of Critical Care, University Hospital of Larissa, School of Medicine, University of Thessaly, Larissa, Thessaly, Greece.
| | - Konstantinos Spathoulas
- Department of Critical Care, University Hospital of Larissa, School of Medicine, University of Thessaly, Larissa, Thessaly, Greece.
| | - Epaminondas Zakynthinos
- Department of Critical Care, University Hospital of Larissa, School of Medicine, University of Thessaly, Larissa, Thessaly, Greece.
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Papanikolaou J, Tsolaki V, Makris D, Mantzarlis K, Zakynthinos E. Right Atrial Transverse Band Prevents a "Passing-by" Thrombus From Migrating Into Pulmonary Circulation. J Cardiothorac Vasc Anesth 2016; 30:e47-8. [PMID: 27474332 DOI: 10.1053/j.jvca.2016.03.154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Indexed: 11/11/2022]
Affiliation(s)
- John Papanikolaou
- Department of Critical Care, School of Medicine University of Thessaly, University Hospital of Larissa Thessaly, Greece
| | - Vasiliki Tsolaki
- Department of Critical Care, School of Medicine University of Thessaly, University Hospital of Larissa Thessaly, Greece
| | - Demosthenes Makris
- Department of Critical Care, School of Medicine University of Thessaly, University Hospital of Larissa Thessaly, Greece
| | - Konstantinos Mantzarlis
- Department of Critical Care, School of Medicine University of Thessaly, University Hospital of Larissa Thessaly, Greece
| | - Epaminondas Zakynthinos
- Department of Critical Care, School of Medicine University of Thessaly, University Hospital of Larissa Thessaly, Greece
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Papanikolaou J, Makris D, Zakynthinos E. The role of nuclear cardiac imaging in redefining neurogenic stunned myocardium in subarachnoid hemorrhage: a deeper look into the heart. Crit Care 2014; 18:490. [PMID: 25184437 PMCID: PMC4423632 DOI: 10.1186/s13054-014-0490-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Subarachnoid hemorrhage may be complicated by neurogenic stunned myocardium, a catecholamine-induced transient cardiomyopathy that displays a wide clinical spectrum of cardiac abnormalities, including electrocardiographic changes, arrhythmias, myocardial necrosis, and left ventricular systolic and diastolic dysfunction. However, less is known about the cardiac metabolic consequences of acute subarachnoid hemorrhage. Prunet and coworkers' recent study provides scintigraphic evidence suggesting that glucose metabolism and sympathetic cardiac innervation are severely and globally depressed during the acute phase of the disease. Metabolic and innervation abnormalities are largely overlapped and are probably not causally related to myocardial ischemia, suggesting that impaired glucose metabolism is probably neurogenic in nature. The scintigraphic defects seem to reverse slowly, within months of the onset of cerebral bleeding. Interestingly, scintigraphic evidence of metabolic myocardial alterations may exist even in the absence of clinical features of cardiac disease, possibly representing a subclinical type of neurogenic stunned myocardium.
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Affiliation(s)
- John Papanikolaou
- Department of Critical Care, School of Medicine, University of Thessaly, University Hospital of Larissa, Biopolis, Larissa, Thessaly, 41110, Greece.
| | - Demosthenes Makris
- Department of Critical Care, School of Medicine, University of Thessaly, University Hospital of Larissa, Biopolis, Larissa, Thessaly, 41110, Greece.
| | - Epaminondas Zakynthinos
- Department of Critical Care, School of Medicine, University of Thessaly, University Hospital of Larissa, Biopolis, Larissa, Thessaly, 41110, Greece.
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Papanikolaou J, Makris D, Mpaka M, Palli E, Zygoulis P, Zakynthinos E. New insights into the mechanisms involved in B-type natriuretic peptide elevation and its prognostic value in septic patients. Crit Care 2014; 18:R94. [PMID: 24887309 PMCID: PMC4075117 DOI: 10.1186/cc13864] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2013] [Accepted: 04/28/2014] [Indexed: 01/09/2023]
Abstract
Introduction Elevated plasma B-type natriuretic peptide (BNP) levels in patients with critical sepsis (severe sepsis and septic shock) may indicate septic cardiomyopathy. However, multiple heterogeneous conditions may also be involved in increased BNP level. In addition, the prognostic value of BNP in sepsis remains debatable. In this study, we sought to discover potential independent determinants of BNP elevation in critical sepsis. The prognostic value of BNP was also evaluated. Methods In this observational study, we enrolled mechanically ventilated, critically septic patients requiring hemodynamic monitoring through a pulmonary artery catheter. All clinical, laboratory and survival data were prospectively collected. Plasma BNP concentrations were measured daily for five consecutive days. Septic cardiomyopathy was assessed on day 1 on the basis of left and right ventricular ejection fractions (EF) derived from echocardiography and thermodilution, respectively. Mortality was recorded at day 28. Results A total of 42 patients with severe sepsis (N = 12) and septic shock (N = 30) were ultimately enrolled. Daily BNP levels were significantly elevated in septic shock patients compared with those with severe sepsis (P ≤0.002). Critical illness severity (assessed by Acute Physiology and Chronic Health Evaluation II and maximum Sequential Organ Failure Assessment scores), and peak noradrenaline dose on day 1 were independent determinants of BNP elevation (P <0.05). Biventricular EFs were inversely correlated with longitudinal BNP measurements (P <0.05), but not independently. Pulmonary capillary wedge pressures (PCWP) and volume expansion showed no correlation with BNP. In septic shock, increased central venous pressure (CVP) and CVP/PCWP ratio were independently associated with early BNP values (P <0.05). Twenty-eight-day mortality was 47.6% (20 of 42 patients). Daily BNP values poorly predicted outcome; BNP on day 1 > 800 pg/ml (the best cutoff point) fairly predicted mortality, with a sensitivity%, specificity% and area under the curve values of 65, 64 and 0.70, respectively (95% confidence interval = 0.54 to 0.86; P = 0.03). Plasma BNP levels declined faster in survivors than in nonsurvivors in both critical sepsis and septic shock (P ≤0.002). In septic shock, a BNP/CVP ratio >126 pg/mmHg/ml on day 2 and inability to reduce BNP <500 pg/ml implied increased mortality (P ≤0.036). Conclusions The severity of critical illness, rather than septic cardiomyopathy, is probably the major determinant of BNP elevation in patients with critical sepsis. Daily BNP values are of limited prognostic value in predicting 28-day mortality; however, fast BNP decline over time and a decrease in BNP <500 pg/ml may imply a favorable outcome.
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Karvouniaris M, Papanikolaou J, Makris D, Zakynthinos E. Sepsis-associated takotsubo cardiomyopathy can be reversed with levosimendan. Am J Emerg Med 2012; 30:832.e5-7. [DOI: 10.1016/j.ajem.2011.02.030] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2011] [Accepted: 02/21/2011] [Indexed: 11/30/2022] Open
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Sakorafas GH, Sabanis D, Lappas C, Mastoraki A, Papanikolaou J, Siristatidis C, Smyrniotis V. Interval routine appendectomy following conservative treatment of acute appendicitis: Is it really needed. World J Gastrointest Surg 2012; 4:83-6. [PMID: 22590661 PMCID: PMC3351492 DOI: 10.4240/wjgs.v4.i4.83] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2011] [Revised: 03/24/2012] [Accepted: 03/30/2012] [Indexed: 02/06/2023] Open
Abstract
Conservative management of acute appendicitis (AA) is gradually being adopted as a valuable therapeutic choice in the treatment of selected patients with AA. This approach is based on the results of many recent studies indicating that it is a valuable and effective alternative to routine emergency appendectomy. Existing data do not support routine interval appendectomy following successful conservative management of AA; indeed, the risk of recurrence is low. Moreover, recurrences usually exhibit a milder clinical course compared to the first episode of AA. The role of routine interval appendectomy is also questioned recently, even in patients with AA complicated by plastron or localized abscess formation. Surgical judgment is required to avoid misdiagnosis when selecting a conservative approach in patients with a presumed “appendiceal” mass.
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Affiliation(s)
- George H Sakorafas
- George H Sakorafas, Dimitrios Sabanis, Christos Lappas, Aikaterini Mastoraki, Vasileios Smyrniotis, 4th Department of Surgery, Athens University, Medical School, Attikon University Hospital, GR-115 26 Athens, Greece
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Karakitsos D, Papanikolaou J, Karabinis A, Alalawi R, Wachtel M, Jumper C, Alexopoulos D, Davlouros P. Acute effect of sildenafil on central hemodynamics in mechanically ventilated patients with WHO group III pulmonary hypertension and right ventricular failure necessitating administration of dobutamine. Int J Cardiol 2012; 167:848-54. [PMID: 22386699 DOI: 10.1016/j.ijcard.2012.02.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2011] [Revised: 12/11/2011] [Accepted: 02/04/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND/OBJECTIVES Sildenafil decreases pulmonary vascular resistance index (PVRI), in patients with pulmonary hypertension (PH). We investigated sildenafil's effects on central hemodynamics of mechanically ventilated patients with WHO group-III PH and RV failure necessitating dobutamine administration. METHODS Prospective non-controlled study involving 12 (9 males, 59 ± 4 years old), patients with the above characteristics. All patients in phase-1 (days 1-2) received dobutamine (5 μg/kg/min IV). During phase-2 (days 3-6), sildenafil was started via nasogastric tube (80 mg/day) and dobutamine discontinuation was attempted. Patients were designated responders or non-responders based on whether dobutamine could be stopped or not. Phase-3 lasted from day 7 to day of weaning from mechanical ventilation; or if weaning failed, until day 20 following admission (end-of-study). Invasive and echocardiographic parameters were repeatedly recorded throughout the study. RESULTS Significantly changed parameters (P<0.025) from baseline to phase-1, -2 and -3 (%change of mean ratios), in responders (n=7) included among others PVRI (-40%, -51%, -42%), RV stroke work index (RVSWI: 43%, 79%, 41%) and cardiac index (49%, 54%, 48%), which also differed significantly from non-responders (N=5). In phases-1 and -3 non-responders had not significant changes, in phase-2 PVRI (27%) and RVSWI (-22%) changed significantly. In contrast to non-responders, all responders were weaned from mechanical ventilation until the end-of-study (P<0.025). CONCLUSIONS Sildenafil may improve central hemodynamics and RV function indices in ventilated patients with WHO group-III PH and RV failure requiring dobutamine infusion, when they respond favorably to the latter. Accordingly, an adequate RV systolic reserve may be mandatory for sildenafil to exert its actions.
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Papanikolaou J, Makris D, Saranteas T, Karakitsos D, Zintzaras E, Karabinis A, Kostopanagiotou G, Zakynthinos E. New insights into weaning from mechanical ventilation: left ventricular diastolic dysfunction is a key player. Intensive Care Med 2011; 37:1976-85. [PMID: 21976188 DOI: 10.1007/s00134-011-2368-0] [Citation(s) in RCA: 84] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2011] [Accepted: 08/06/2011] [Indexed: 12/16/2022]
Abstract
PURPOSE To investigate the diagnostic performance of Doppler echocardiography (DE) in predicting the outcome of weaning from mechanical ventilation in patients without overt cardiac disease. METHODS Fifty critical care noncardiac patients who fulfilled predetermined criteria for weaning underwent DE before and at the end of spontaneous breathing trial (pre-SBT/end-SBT, respectively). "Conventional" mitral inflow analysis and "advanced" DE parameters [tissue Doppler imaging (TDI)-derived mitral/tricuspid annular velocities and color M-mode Doppler velocity of propagation (V p)] were used to assess left ventricular (LV) diastolic function/filling pressures. Weaning was considered successful if patients had been extubated after successful SBT and sustained spontaneous breathing for more than 48 h. RESULTS Twenty-eight patients (56%) failed weaning: 23 patients failed SBT and 5 required reintubation within 48 h. Weaning failure was associated with the degree of LV diastolic dysfunction at pre-SBT (P = 0.01). Patients who failed weaning presented evidence of increased LV filling pressures at pre-SBT, by demonstrating increased E/E m and E/V p ratios compared with patients with successful outcome (P ≤ 0.004); pre-SBT values of lateral E/E m greater than 7.8 and E/V p greater than 1.51 predicted weaning failure with an area under the curve, sensitivity (%), and specificity (%) of 0.86, 79, and 100, and 0.74, 75, and 73, respectively. Lateral E/E m was the only factor independently associated with weaning failure before SBT; OR (95% CI) 5.62 (1.17-26.96), P = 0.03. CONCLUSIONS Our findings suggest that LV diastolic dysfunction is significantly associated with weaning outcome in critically ill patients with preserved LV systolic function. An E/E m ratio greater than 7.8 may identify patients at high risk of weaning failure.
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Affiliation(s)
- John Papanikolaou
- Department of Critical Care, School of Medicine, University of Thessaly, University Hospital of Larissa, Thessaly, Greece. .,Biopolis, 41110, Larissa, Greece.
| | - Demosthenes Makris
- Department of Critical Care, School of Medicine, University of Thessaly, University Hospital of Larissa, Thessaly, Greece
| | - Theodosios Saranteas
- 2nd Department of Anaesthesiology, School of Medicine, University of Athens, University Hospital of Athens 'Attikon', Athens, Greece
| | | | - Elias Zintzaras
- Department of Biomathematics, School of Medicine, University of Thessaly, Larissa, Greece.,Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Tufts University School of Medicine, Boston, MA, USA
| | - Andreas Karabinis
- Department of Critical Care, General State Hospital of Athens, Athens, Greece
| | - Georgia Kostopanagiotou
- 2nd Department of Anaesthesiology, School of Medicine, University of Athens, University Hospital of Athens 'Attikon', Athens, Greece
| | - Epaminondas Zakynthinos
- Department of Critical Care, School of Medicine, University of Thessaly, University Hospital of Larissa, Thessaly, Greece. .,Biopolis, 41110, Larissa, Greece.
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Zakynthinos E, Daniil Z, Papanikolaou J, Makris D. Pulmonary hypertension in COPD: pathophysiology and therapeutic targets. Curr Drug Targets 2011; 12:501-13. [PMID: 21194405 DOI: 10.2174/138945011794751483] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2010] [Accepted: 06/25/2010] [Indexed: 11/22/2022]
Abstract
The incidence of mild to moderate pulmonary hypertension (PH) is highly prevalent, reaching to 50% in advanced chronic obstructive pulmonary disease (COPD). However, a subpopulation (1-4% in most studies) with grim prognosis despite moderate airflow limitation, present with "out-of-proportion" severe PH, is arbitrarily defined by a mean PH ≥ 40 mmHg, at rest. The sequence of changes that lead to PH in COPD begins at early disease stages by the impairment of endothelial function, which is associated with impaired release of endothelium-derived vasodilating (nitric oxide, prostacyclin) and vasoconstrictive agents (endothelin-1) and imbalance among them. PH in COPD is caused by vasoconstriction and remodelling of pulmonary arteries, which is characterized by the intimal proliferation of poorly differentiated smooth muscle cells and the deposition of elastic and collagen fibres. Hypoxia, inflammation and toxic effects of cigarette smoke, independently or additively interacting, are confirmed factors leading to PH. To date, long-term supplemental oxygen remains the primary treatment in COPD patients with PH. The administration of new vasodilators (prostanoids, endothelin-1 receptor antagonists and phosphodiesterase-5 inhibitors) dedicated to idiopathic pulmonary arterial hypertension in the disproportionate subgroup of patients with "out-of-proportion" PH may be considered in the setting of clinical trials. The use of these drugs in COPD patients with PH < 40 mmHg may worsen gas exchange, and to date, has no proven benefit. Future treatments must target more directly pathogenetic mechanisms. Therefore, novel agents have been proposed and are under active investigation, including 5-HT receptor antagonists, Rho-kinase inhibitors, statins and stem cell therapy.
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Affiliation(s)
- E Zakynthinos
- Critical Care Department, School of Medicine, University Hospital of Thessaly, Greece.
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Papanikolaou J, Karabinis A, Koukoubani T, Karakitsos D, Zakynthinos E. Pacemaker lead thrombosis and disseminated intravascular coagulation following warfarin therapy: case report and review of the literature. Hellenic J Cardiol 2011; 52:186-190. [PMID: 21478133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023] Open
Abstract
A 54-year-old male with a permanent pacemaker was admitted to the intensive care unit due to a stroke. This occurred six days following the initiation of warfarin therapy for paroxysmal atrial fibrillation. The patient presented with profuse bleeding through the sites of venipuncture and laboratory evidence of disseminated intravascular coagulation. Echocardiography revealed multiple thrombi adjacent to the pacemaker leads. Underlying thrombophilia and/or any other systemic disorders were excluded. Thereafter, he exhibited multiple organ failure and despite all therapeutic efforts he expired. In the absence of any thrombophilia, the rare patient with a preexisting intracardiac device, in whom warfarin is prescribed, might experience thrombotic events. The latter could be linked with the preexisting device and/or could be triggered by the initiation of warfarin treatment, but this is merely a hypothesis.
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Affiliation(s)
- John Papanikolaou
- Intensive Care Unit, University Hospital of Thessaly, Larissa, Thessaly, Greece.
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Papanikolaou J, Tsirantonaki M, Koukoulitsios G, Papageorgiou D, Mandila C, Karakitsos D, Karabinis A. Reversible posterior leukoencephalopathy syndrome and takotsubo cardiomyopathy: the role of echocardiographic monitoring in the ICU. Hellenic J Cardiol 2009; 50:436-438. [PMID: 19767289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023] Open
Abstract
We report a case of a female patient with acute renal failure due to polyarteritis nodosa. Her clinical course was initially complicated by an unusual form of hypertensive encephalopathy called reversible posterior leukoencephalopathy syndrome (RPLS). Soon afterwards she developed cardiogenic shock; she was intubated and admitted to our ICU. Echocardiography and pertinent laboratory data were suggestive of takotsubo cardiomyopathy (TTC), a rare form of stress-induced, reversible cardiac dysfunction. We hypothesized that TTC was pathophysiologically linked to RPLS, presumably through an overstimulation of the sympathetic nervous system. Both RPLS and TTC turned out to be totally reversible conditions, and intensive echocardiographic monitoring was of great importance in order to optimize the hemodynamic support in our patient.
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Affiliation(s)
- John Papanikolaou
- Intensive Care Unit, General Hospital of Athens G. Gennimatas, Athens, Greece.
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Papanikolaou J, Karakitsos D, Yang C, Saranteas T, Karabinis A. Transesophageal echocardiography in detecting tricuspid valve pathology in an intensive care unit patient. J Cardiothorac Vasc Anesth 2009; 24:211-3. [PMID: 19285428 DOI: 10.1053/j.jvca.2009.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2008] [Indexed: 11/11/2022]
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Saranteas T, Mandila C, Poularas J, Papanikolaou J, Patriankos A, Karakitsos D, Karabinis A. Transesophageal echocardiography and vascular ultrasound in the diagnosis of catheter-related persistent left superior vena cava thrombosis. Eur J Echocardiogr 2009; 10:452-5. [PMID: 19252187 DOI: 10.1093/ejechocard/jen334] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
We refer to a very rare case of catheter-related thrombosis in a trauma patient with persistent left and absent right superior vena cava. The role of ultrasound examination in the early diagnosis and treatment of thrombosis in the setting of intensive care unit (ICU) is thoroughly discussed. A 30-year-old man was admitted to the ICU due to multiple trauma. Six days after right internal jugular vein (IJV) catheter insertion, and during a vascular ultrasound examination, an IJV catheter-related thrombosis was diagnosed. Hence, the catheter was removed, and a follow-up ultrasound examination revealed thrombus remnant in the IJV extended into brachiocephalic vein. Subsequently, to exclude a possible extension of the thrombus in the superior vena cava, a transesophageal echocardiography (TEE) examination was performed. The latter revealed a distended coronary sinus and the presence of persistent left superior vena cava (PLSVC). Additionally, TEE examination disclosed thrombus remnant within the PLSVC that was also confirmed with CT venography. Anticoagulant therapy was started thus preventing major complications such as coronary sinus obstruction. This case underlines the role of cardiovascular ultrasound examination as an important tool in performing variety of monitoring in the setting of the ICU.
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Affiliation(s)
- Theodosios Saranteas
- 2nd Department of Anaesthesia and cardiovascular critical care, University of Athens, Attikon Hospital, Greece.
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Mandila C, Papanikolaou J, Saranteas T, Dounis G, Kostopanagiotou G, Karabinis A. Bicuspid aortic valve associated with persistent left and absent right superior vena cava. J Cardiothorac Vasc Anesth 2008; 23:579-80. [PMID: 19081270 DOI: 10.1053/j.jvca.2008.09.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2008] [Indexed: 11/11/2022]
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Papanikolaou J, Poularas J, Kalogeromitros A, Karakitsos D, Matsakas E, Karabinis A. P.045 REVERSIBLE LEFT VENTRICULAR DYSFUNCTION AND BRAIN NATRIURETIC PEPTIDE (BNP) PLASMA LEVELS IN PATIENTS WITH TRAUMATIC BRAIN INJURY. Artery Res 2007. [DOI: 10.1016/j.artres.2007.07.102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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