Transcatheter aortic valve implantation (TAVI) can be complicated by acute kidney injury (AKI). AKI has been found to be independently associated with mortality, but the risk factors are unclear. The association between arterial stiffness and renal dysfunction is well known, but the association between TAVI and AKI requires investigation. We retrospectively investigated 74 patients undergoing TAVI under general anesthesia about risk factors of AKI after TAVI including peripheral pulse pressure as an index of arterial stiffness. AKI after TAVI occurred in 44.6% (33 patients), the length of stay in ICU and that in hospital after TAVI were both significantly longer in AKI patients than in non-AKI patients (P<0.001) and there was significant difference in 1 year mortality between them (P=0.015). In multivariable logistic regression analysis, the incidence of AKI was independently associated with transapical approach (OR: 13.1, 95%CI: 3.34-50.9, P<0.01) and peripheral pulse pressure (OR: 1.09, 95%CI: 1.04-1.13, P<0.001). Elevated pulse pressure can be a predictor of AKI after TAVI.
Objective: We aimed to identify the risk factors of phlebitis in patients admitted in the ICU receiving intravenous nicardipine hydrochloride. Methods: The incidence and risk factors of nicardipine hydrochloride infusion-related phlebitis were retrospectively investigated in 118 ICU patients (173 intravenous catheters) from May 2017 to December 2018. Multiple logistic regression analysis was performed to identify the risk factors for phlebitis; receiver operating characteristic analysis was used to determine the optimal cut-off level of each factor. Results: The incidence of nicardipine hydrochloride-related phlebitis was 19.7%. The statistically significant or marginally significant independent factors following the multiple logistic regression analysis were serum albumin level (OR 0.32, 95%CI 0.14–0.71, P = 0.006), time-weighted average of nicardipine hydrochloride infusion rate (OR 1.27, 95%CI 1.10–1.47, P = 0.001), and infusion duration (OR 1.02, 95%CI 1.00–1.04, P = 0.057). The optimal cut-off values defined from ROC analyses were serum albumin levels lower than 3.3 g/dL, nicardipine hydrochloride infusion rate faster than 4.1 mg/hr, and infusion duration longer than 22.7 hr. Conclusion: Nicardipine hydrochloride-related phlebitis is significantly associated with lower serum albumin levels (≤3.3 g/dL), faster nicardipine hydrochloride infusion rate (≥4.1 mg/hr), and longer infusion duration (≥22.7 hr).
Patients who undergo Fontan surgery have specific hemodynamics, wherein the systemic venous blood returns directly to the pulmonary arteries. Therefore, managing respiratory circulation in such cases is often difficult. We report a case of a pediatric patient who required tracheal intubation and was put on positive-pressure ventilation for plastic bronchitis following the Fontan procedure that disrupted the circulatory dynamics. A 7-year-old boy was admitted to the ICU for respiratory management due to worsening of oxygenation after the onset of plastic bronchitis. He underwent tracheal intubation and was placed on positive-pressure ventilation support; however, his circulatory dynamics was disrupted immediately after that. A veno venous membrane oxygenator was then used, and his oxygenation improved. A mucous plug was removed by bronchoscopy. Subsequently, ventilator management was performed, with the airway pressure reduced as much as possible, and infusion management was performed using central venous pressure as an index. Patients with Fontan circulation are at a risk of developing hemodynamic disruption with routine interventions. The number of patients with Fontan circulation is increasing as surgical outcomes improve. Therefore, it is important to understand the specific hemodynamics involved for treating such patients.