Critical Care Commons^™

Functional Determination Of Calcium-Binding Sites Required For The Activation Of Inositol 1,4,5-Trisphosphate Receptors, Vikas Arige, Lara E Terry, Larry E Wagner, Sundeep Malik, Mariah R Baker, Guizhen Fan, Suresh K Joseph, Irina I Serysheva, David I Yule

Faculty, Staff and Student Publications

Inositol 1,4,5-trisphosphate receptors (IP3Rs) initiate a diverse array of physiological responses by carefully orchestrating intracellular calcium (Ca2+) signals in response to various external cues. Notably, IP3R channel activity is determined by several obligatory factors, including IP3, Ca2+, and ATP. The critical basic amino acid residues in the N-terminal IP3-binding core (IBC) region that facilitate IP3 binding are well characterized. In contrast, the residues conferring regulation by Ca2+ have yet to be ascertained. Using comparative structural analysis of Ca2+-binding sites identified in two main families of intracellular Ca2+-release channels, ryanodine receptors (RyRs) and IP3Rs, we identified putative acidic residues coordinating Ca2+ …

Hemodynamic Variations In Cardiogenic Shock Phenotypes, Jason Katz

Journal of Shock and Hemodynamics

Patients with cardiogenic shock are not all the same. They present with a variety of hemodynamic profiles and other features that may allow us to create specific phenotypes. It is possible that phenotyping these patients at presentation may then help us to identify the optimal and earliest therapies that will improve outcomes and, at the same time, help us to overcome some of the heterogeneity currently undermining clinical trials.

Pulmonary Hypertension With “Normal” Pulmonary Vascular Resistance, Marwan F. Jumean, Sriram Nathan, Maria Patarroyo Aponte

Journal of Shock and Hemodynamics

Abstracts not available for Perspectives.

Role Of Veno-Arterial Extracorporeal Membrane Oxygenation In Left Ventricular Conditioning After Lung Transplantation, Emily A. Ingebretson

Journal of Shock and Hemodynamics

End-stage pulmonary hypertension alters intracardiac pressures, leading to distention and failure of the right ventricle, leftward shifting of the intraventricular septum, and, thus, underfilling of the left ventricle (LV). Following the resolution of severely elevated pulmonary vascular resistance with bilateral lung transplantation, the LV is exposed to relatively high filling pressures from a potentially hypertrophic right ventricle pushing blood through normalized pulmonary vascular resistance. Veno-arterial extracorporeal membrane oxygenation (V-A ECMO) may be a valuable tool to provide a more gradual exposure of the LV to the newly available preload in the immediate postoperative phase of transplantation, thereby reducing the likelihood …

Scai Shock Stage Classification: What Is Missing From The Latest Update?, Biykem Bozkurt

Journal of Shock and Hemodynamics

The revised Society for Cardiovascular Angiography and Interventions classifications reflect graduation of severity within each stage and pathway by which patients progress or recover. However, they are limited regarding the following: their predictive role to guide therapy; escalation of therapy or referral; variability in diagnostic criteria and interpretation; presence of other disease modifiers and confounders; variability of etiology and reversibility of cause; response to therapy and trajectory to be taken into risk stratification; magnitude and phenotypes of end-organ damage. Thus, we need a modified risk score to predict the necessity to escalate therapy and consider advanced therapies, such as mechanical …

Should All Shock Centers Offer Ecpr? Balancing Futility, Cost Effectiveness, And Hope, Michael Mooney

Journal of Shock and Hemodynamics

There are over 400,000 out-of-hospital cardiac arrests (OHCA) in the United States annually. Of those, 50% are refractory cardiac arrest, defined as the lack of return of spontaneous circulation (ROSC) after 30 minutes of appropriate cardiopulmonary resuscitation (CPR) in the absence of hypothermia. Extracorporeal cardiopulmonary resuscitation (ECPR) has been increasingly used given its potential to improve survival and offer improved neurological outcomes.

Systemic Inflammatory Response Syndrome And Mechanical Circulatory Support Devices, Mircea R. Mihu, Aly El-Banayosy

Journal of Shock and Hemodynamics

Systemic inflammatory response syndrome is an increased inflammatory state affecting the whole body. Mechanical circulatory support (MCS) is a temporary or permanent form of extracorporeal support that may have an associated complication of an exacerbated inflammatory response to the extracorporeal circuit. This brief review will focus on understanding the complex pathophysiology of inflammatory response to MCS, factors that influence the extent of the inflammatory response, the inflammatory response and outcomes as well as potential therapeutic strategies.

Role Of Hypothermia In Cardiogenic Shock, Filio Billia

Journal of Shock and Hemodynamics

While patient management in the intensive care unit has undoubtedly improved over the last 20 years, many questions remain. Neurological prognostication has become very important and aided in improving survival outcomes over time. The limited number of randomized control trials and limitations from currently completed studies leave the field with little certainty regarding targeted temperature management. In addition, implementing hypothermia can use multiple methods and protocols that impact the interpretation and comparison of results.

Management Of Severe Aortic Stenosis In Cardiogenic Shock: Early Percutaneous Mechanical Circulatory Support Or Emergent Transcatheter Aortic Valve Replacement?, Sandeep Nathan

Journal of Shock and Hemodynamics

Aortic stenosis (AS) affects an estimated 1.5 million patients in the United States, with 250,000 patients or more suffering severe, symptomatic aortic stenosis. A subset of these patients also have unrevascularized coronary artery disease and left ventricular dysfunction, representing an extreme risk population of AS patients. Cardiogenic shock (CS) complicates a small minority of AS presentations and/or patients referred for transcatheter aortic valve replacement (TAVR) but is responsible in these cases for a disproportionately high rate of morbidity and mortality. Indeed, CS results in a 4-fold increase in TAVR mortality, proportional to shock severity and largely independent of procedural complications. …

A Case Of Inferior Myocardial Infarction Complicated By Ventricular Septal Rupture Leading To Cardiogenic Shock: Tandem Heart To The Rescue!, Shehab Al-Ansari, Sachin Kumar, Angelo Nascimbene, Manish K. Patel, Igor D. Gregoric

Journal of Shock and Hemodynamics

Ventricular septal rupture (VSR) is a rare but life-threatening complication of acute myocardial infarction. We present a case of VSR-related refractory cardiogenic shock that was successfully managed with TandemHeart® followed by surgical repair.

Early Unloading In Venoarterial Extracorporeal Membrane Oxygenation Shock: When, How, Where, And Why?, Benedikt Schrage

Journal of Shock and Hemodynamics

As extracorporeal membrane oxygenation increases the left ventricular afterload, a successful treatment plan should include strategies to address this issue. One promising approach to do so is the addition of a second device for active left ventricular unloading. However, this relatively new approach is currently only based on retrospective data. This article summarizes the current perspectives on this approach, provides recommendations for its application, and highlights the need for randomized data on this topic.

Microcirculation Versus Macrocirculation In Cardiogenic Shock, Christian Jung

Journal of Shock and Hemodynamics

Macro- and microcirculation are important parameters in cardiogenic shock. Microcirculation is relevant for monitoring organ function and prognosis. Serum lactate might be the best daily life parameter to assess microcirculation, and the crude 8-hour value can be used for outcome prediction. Any treatment should consider the consequences of microcirculation and macrocirculation.

Hemodynamics Of Prolonged Percutaneous Mechanical Circulatory Support – When Vasodilatation Sets, Holger Thiele

Journal of Shock and Hemodynamics

Hemodynamics play an important role in cardiogenic shock assessment for prognosis estimation and for phenotyping cardiogenic shock. This is best done by pulmonary artery catheters. In general, at the beginning of cardiogenic shock, patients have vasoconstriction, which over time may lead to vasodilation. This is often triggered by percutaneous mechanical circulatory support. This review will elucidate the hemodynamics and the factors that possibly lead to vasodilation in patients with mechanical circulatory support.

Society For Improving Medical Professional Learning Collaborative: What’S It All About?, Joseph B. Zwischenberger, Katherine Breetz, Daniel Cooper

Journal of Shock and Hemodynamics

The Society for Improving Medical Professional Learning (SIMPL) Collaborative is a non-profit, educational, quality improvement consortium focused on developing tools, curricula, and policies to improve physician training. The goal is to provide educators and learners with convenient, reliable, and valid evaluation tools for frequent, real-time workplace assessment and feedback. The SIMPL Operating Room application provides this platform. It was developed to provide high-quality, time-sensitive, procedural feedback. Its objective is to facilitate intra-rotation corrections.

SIMPL is available to all residency programs and has matured to include over 175 residency programs, involving 19 different specialties, 4000 trainees, 5000 attendings, and 354,800 evaluations …

Houston Shock: A Practical Scoring System Incorporating Cardiogenic Shock Dynamic Changes, Marwan F. Jumean, Sriram Nathan, Igor D. Gregoric, Biswajit Kar

Journal of Shock and Hemodynamics

Cardiogenic shock has an unacceptably high mortality rate and additional tools are needed to improve outcomes. The Society of Cardiovascular Angiography and Interventions (SCAI) shock severity classification has provided a unified definition of shock severity that has proven to be reproducible and predictive of survival. However, cardiogenic shock assessment goes beyond standardizing its severity, and a uniform and practical approach to comprehensive assessment that may guide therapy in a dynamic state is currently lacking.

Since cardiogenic shock is a rapidly evolving pathophysiological catastrophe, we propose a new assessment tool – the Houston SHOCK Score – which incorporates dynamic changes. The …

Journal Of Shock And Hemodynamics, Vol 1., Iss. 1 (Print Version)

Journal of Shock and Hemodynamics

The print version of Volume I, Issue I of the Journal of Shock and Hemodynamics was published in September 2022. The PDF of the print version is downloadable here.

Decreasing Unnecessary Laboratory Testing In Medical Critical Care, Nirajan Adhikari, Kriti Suwal, Sushmita Khadka, Binita Dahal, Litty Thomas, Chandrakala Dadeboyina, Sri Senapathi, James Walsh

Advances in Clinical Medical Research and Healthcare Delivery

The overuse of laboratory testing is common in the intensive care unit (ICU) which leads to an increased cost of care and an increased potential for harm to the patient. There is no evidence that obtaining daily laboratory tests helps to reduce mortality or morbidity in critical care patients. We conduced a retrospective study where chart review was performed to assess the frequency of unnecessary laboratory testing followed by a quality improvement initiative. With our study we were successful at reducing the inappropriate laboratory testing and improving the appropriate laboratory testing through our study.

A Case Of Malpositioned Endotracheal Tube With Resultant Left Lung Collapse., Anushri Naga, Anushri Naga

Digital Journal of Clinical Medicine

BACKGROUND

ENDOTRACHEAL INTUBATION IS USUALLY DONE AS A PART OF EMERGENCY MANAGEMENT OF PATIENTS WITH A THREATENED AIRWAY AND GENERAL ANAESTHSIA, IN ORDER TO ENSURE PATENCY OF THE AIRWAY AS WELL AS PROPER VENTILATION. POSITIONING AN ET TUBE CORRECTLY IS OF PARAMOUNT IMPORTANCE IN ORDER TO PREVENT HYPOVENTILATION, INAPPROPRIATE VENTILATION AND ALSO COLLAPSE OF LUNG DUE TO MALPOSITIONING OF ET TUBE.

ETT POSITION IS USUALLY ASSESSED USING FRONTAL CHEST RADIOGRAPH. THE POSITION OF THE ETT IS DEPENDENT ON THE POSITION OF THE HEAD & NECK. THE MANDIBLE CAN BE USED FOR ASSESSMENT OF WHETHER THE NECK IS IN A NEUTRAL …

A Novel Qkd Approach To Enhance Iiot Privacy And Computational Knacks, Kranthi Kumar Singamaneni, Gaurav Dhiman, Sapna Juneja, Ghulam Muhammad, Salman A Alqahtani, John Zaki

Faculty, Staff and Student Publications

The industry-based internet of things (IIoT) describes how IIoT devices enhance and extend their capabilities for production amenities, security, and efficacy. IIoT establishes an enterprise-to-enterprise setup that means industries have several factories and manufacturing units that are dependent on other sectors for their services and products. In this context, individual industries need to share their information with other external sectors in a shared environment which may not be secure. The capability to examine and inspect such large-scale information and perform analytical protection over the large volumes of personal and organizational information demands authentication and confidentiality so that the total data …

The Emerging Spectrum Of Cardiopulmonary Pathology Of The Coronavirus Disease 2019 (Covid-19): Report Of 3 Autopsies From Houston, Texas, And Review Of Autopsy Findings From Other United States Cities, Manish Bodas, Bharathiraja Subramaniyan, Harry Karmouty-Quintana, Peter F Vitiello, Matthew S Walters

Faculty, Staff and Student Publications

The mammalian respiratory system or lung is a tree-like branching structure, and the main site of gas exchange with the external environment. Structurally, the lung is broadly classified into the proximal (or conducting) airways and the distal alveolar region, where the gas exchange occurs. In parallel with the respiratory tree, the pulmonary vasculature starts with large pulmonary arteries that subdivide rapidly ending in capillaries adjacent to alveolar structures to enable gas exchange. The NOTCH signalling pathway plays an important role in lung development, differentiation and regeneration post-injury. Signalling via the NOTCH pathway is mediated through activation of four NOTCH receptors …