Papers by Christos Dragoumanis
The intrathecally administered morphine offers powerful and lingering postoperative analgesia. To... more The intrathecally administered morphine offers powerful and lingering postoperative analgesia. Today it is applied widely for relief of postoperative pain associated with crowd of surgical interventions. The most common side effects of intrathecally administered morphine are pruritus with reported frequency between 60% and 100%, followed by postoperative nausea and vomiting (PONV) with a reported incidence between 30 and 50%. The intrathecal morphine induced pruritus because of its central mechanism is resistant to treatment with usual antipruritic drugs. Nonetheless, successful treatment of intrathecal morphine induced pruritus with opioid antagonists is accompanied with reversal of postoperative analgesia. Antagonists of subtype 3 receptors of 5-hydroxytryptamine (serotonin) - 5-ΗΤ3 antagonists are central acting antiemetic drugs. The 5-ΗΤ3 antagonists are indicated in patients whose postoperative analgesia is based on intrathecal morphine because this kind of analgesia is associa...
Journal of Radiology Case Reports, 2008
Thoracic Radiology: Apneic oxygenation for elimination of respiratory motion artefact in an intub... more Thoracic Radiology: Apneic oxygenation for elimination of respiratory motion artefact in an intubated patient undergoing helical computed tomography pulmonary angiography Dragoumanis et al.
SummArY. Non-invasive positive pressure ventilation (NIPPV) is considered as the first thera-peut... more SummArY. Non-invasive positive pressure ventilation (NIPPV) is considered as the first thera-peutic choice for the management of patients suffering from acute respiratory failure due to COPD exacerbations, acute pulmonary edema and in same cases, from acute hypoxemic respiratory distress. Recently, application of NIPPV has significantly increased in the ICU setting, aiming at reducing patients's length of ventilatory support. NIPPV can 1. facilitate the weaning process in cases of failure of the spontaneous breathing trial (SBT), 2. be used as a prophylactic alternative in patients with increased risk of extubation failure, 3. limit re-intubation in subjects with acute respiratory failure within 48 hours after extubation. COPD patients seem to have advantage over other subgroup categories, due to all the three aforementioned reasons, in terms of reducing length of mechanical ventilation. Pneumon 2009; 22(Suppl 2):71-72.
Journal of Medical Case Reports, 2007
Background: Amiodarone is a widely used antiarrythmic drug, which may produce secondary effects o... more Background: Amiodarone is a widely used antiarrythmic drug, which may produce secondary effects on the thyroid. In 14-18% of amiodarone-treated patients, there is overt thyroid dysfunction, usually in the form of amiodarone-induced thyrotoxicosis, which can be difficult to manage with standard medical treatment. Case presentation: Presented is the case of a 65-year-old man, under chronic treatment of atrial fibrillation with amiodarone, who was admitted to the Intensive Care Unit with acute cardiorespiratory failure and fever. He was recently hospitalized with respiratory distress, attributed to amiodarone-induced pulmonary fibrosis. Clinical and laboratory investigation revealed thyrotoxicosis due to amiodarone treatment. He was begun on thionamide, prednisone and betablockers. After a short term improvement of his clinical status the patient underwent percutaneous tracheotomy due to weaning failure from mechanical ventilation, which led to the development of recurrent thyrotoxicosis, unresponsive to medical treatment. Finally, the patient developed multiple organ failure and died, seven days later. Conclusion: We suggest that percutaneous tracheotomy could precipitate a thyrotoxic crisis, particularly in non-euthyroid patients suffering from concurrent severe illness and should be performed only in parallel with emergency thyroid surgery, when indicated.
Journal of Medical Case Reports, 2008
Introduction Respiratory failure may develop during the later stages of pregnancy and is usually ... more Introduction Respiratory failure may develop during the later stages of pregnancy and is usually associated with tocolysis or other co-existing conditions such as pneumonia, sepsis, pre-eclampsia or amniotic fluid embolism syndrome. Case presentation We present the case of a 34-year-old healthy woman with a twin pregnancy at 31 weeks and 6 days who experienced acute respiratory failure, a few hours after administration of tocolysis (ritodrine), due to preterm premature rupture of the membranes. Her chest discomfort was significantly ameliorated after the ritodrine infusion was stopped and a Cesarean section was performed 48 hours later under spinal anesthesia; however, 2 hours after surgery she developed severe hypoxemia, hypotension, fever and mild coagulopathy. The patient was intubated and transferred to the intensive care unit where she made a quick and uneventful recovery within 3 days. As there was no evidence for drug- or infection-related thromboembolic or myocardial causes ...
Journal of Critical Care, 2011
The aim of the study was to investigate heart rate (HR) and respiratory rate (RR) complexity in p... more The aim of the study was to investigate heart rate (HR) and respiratory rate (RR) complexity in patients with weaning failure or success, using both linear and nonlinear techniques. Materials and Methods: Forty-two surgical patients were enrolled in the study. There were 24 who passed and 18 who failed a weaning trial. Signals were analyzed for 10 minutes during 2 phases: (1) pressure support (PS) ventilation (15-20 cm H 2 O) and (2) weaning trials with PS (5 cm H 2 O). Low-and high-frequency (LF, HF) components of HR signals, HR multiscale entropy (MSE), RR sample entropy, cross-sample entropy between cardiorespiratory signals, Poincaré plots, and α1 exponent were computed in all patients and during the 2 phases of PS. Results: Weaning failure patients exhibited significantly decreased RR sample entropy, LF, HF, and α1 exponent, compared with weaning success subjects (P b .001). Their changes were opposite between the 2 phases, except for MSE that increased between and within groups (P b .001). A new model including rapid shallow breathing index (RSBI), α1 exponent, RR, and cross-sample entropies predicted better weaning outcome compared with RSBI, airway occlusion pressure at 0.1 second (P 0.1), and RSBI × P 0.1 (conventional model, R 2 = 0.887 vs 0.463; P b .001). Areas under the curve were 0.92 vs 0.86, respectively (P b .005). Conclusions: We suggest that nonlinear analysis of cardiorespiratory dynamics has increased prognostic impact upon weaning outcome in surgical patients.
Journal of Critical Care, 2010
Discontinuation of mechanical ventilation in critically ill patients is a challenging task and in... more Discontinuation of mechanical ventilation in critically ill patients is a challenging task and involves a careful weighting of the benefits of early extubation and the risks of premature spontaneous breathing trial. Recently, apart from studying different physiological variables by means of descriptive statistical tests, breathing pattern variability analysis has been performed for the assessment of weaning readiness. A limited number of clinical studies implementing different weaning protocols in heterogeneous groups of patients and using a variable set of signal processing techniques have appeared in the critical care literature, with varying results. The purpose of this review article is 3-fold: (1) to describe the different signal processing techniques being implemented for the assessment of weaning readiness, (2) to provide insight into the pathophysiological mechanisms that may govern breath-to-breath variability/complexity in health and disease, and (3) to present results from the critical care literature derived from the application of biosignal analysis tools for the identification of possible weaning indices.
Journal of Critical Care, 2008
In this study we tried to quantify the instantaneous and longitudinal correlations between differ... more In this study we tried to quantify the instantaneous and longitudinal correlations between different heart rate variability (HRV) indices and daily measured C-reactive protein (CRP) serum levels in a group of patients with severe sepsis. Metrics used were performed daily in 20 consecutive septic patients and included serum levels of CRP, power spectral analysis in both the time and frequency domain and the two values of standard deviations (SD1, SD2) obtained from the Poincaré plot. CRP blood levels exhibited significant negative correlations with LF, LF/HF and SDNN and positive correlations with HF and SD1/ SD2. SDNN, LF and HF power values were the most significant predictors of increasing CRP levels and proved to be significantly different between survivors (n= 16) and non-survivors (n=4).
Journal of Anesthesia, 2009
BMC Cardiovascular Disorders, 2010
Background: Liberation from the ventilator is a difficult task, whereas early echocardiographic i... more Background: Liberation from the ventilator is a difficult task, whereas early echocardiographic indices of weaning readiness are still lacking. The aim of this study was to test whether tricuspid annular plane systolic excursion (TAPSE) and right ventricular (RV) systolic (Sm) and diastolic (Em & Am) tissue Doppler imaging (TDI) velocities are related with duration of weaning in mechanically ventilated patients with acute respiratory failure due to acute pulmonary edema (APE). Methods: Detailed quantification of left and right ventricular systolic and diastolic function was performed at admission to the Intensive Care Unit by Doppler echocardiography, in a cohort of 32 mechanically ventilated patients with APE. TAPSE and RV TDI velocities were compared between patients with and without prolonged weaning (≥ or < 7 days from the first weaning trial respectively), whereas their association with duration of ventilation and left ventricular (LV) echo-derived indices was tested with multivariate linear and logistic regression analysis. Results: Patients with prolonged weaning (n = 12) had decreased TAPSE (14.59 ± 1.56 vs 19.13 ± 2.59 mm), Sm (8.68 ± 0.94 vs 11.62 ± 1.77 cm/sec) and Em/Am ratio (0.98 ± 0.80 vs 2.62 ± 0.67, p <0.001 for all comparisons) and increased Ε/ e' (11.31 ± 1.02 vs 8.98 ± 1.70, p <0.001) compared with subjects without prolonged weaning (n = 20). Logistic regression analysis revealed that TAPSE (R 2 = 0.53, beta slope = 0.76, p < 0.001), Sm (R 2 = 0.52, beta = 0.75, p < 0.001) and Em/Am (R 2 = 0.57, beta = 0.32, p < 0.001) can predict length of weaning ≥ 7 days. The above measures were also proven to correlate significantly with Ε/e' (r =-0.83 for TAPSE, r =-0.87 for Sm and r =-0.79 for Em/Am, p < 0.001 for all comparisons). Conclusions: We suggest that in mechanically ventilated patients with APE, low TAPSE and RV TDI velocities upon admission are associated with delayed liberation from mechanical ventilation, probably due to more severe LV heart failure.
Anesthesia & Analgesia, 2007
A step-by-step diagnosis of exclusion in a twin pregnancy with acute respiratory failure due to n... more A step-by-step diagnosis of exclusion in a twin pregnancy with acute respiratory failure due to non-fatal amniotic fluid embolism: a case report
Intensive Care Medicine
The original version of this article unfortunately contained a mistake. The members of the ESICM ... more The original version of this article unfortunately contained a mistake. The members of the ESICM Trials Group Collaborators were not shown in the article but only in the ESM. The full list of collaborators is shown below. The original article has been corrected.
Intensive Care Medicine
Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. ... more Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICUacquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9-27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6-16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score < 19, ICU stay > 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2-1.8), stage II (OR 1.6; 95% CI 1.4-1.9), and stage III or worse (OR 2.8; 95% CI 2.3-3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat.
Hippokratia
Sepsis emerges as the leading risk factor for acute kidney injury (AKI) development in critically... more Sepsis emerges as the leading risk factor for acute kidney injury (AKI) development in critically ill patients. Much effort has been invested so far on early diagnosis of AKI using promising biomarkers. This study aimed to determine whether urine alpha1-microglobulin (α1m), a lipocaline member previously used as an indicator of proximal tubular dysfunction, can early predict the development of sepsis-associated AKI (SAAKI) in critically ill patients. A prospective, observational study was conducted in a single center Intensive Care Unit (ICU). Patients with normal renal function admitted to the ICU followed for sepsis and AKI development. Urine α1m levels were analyzed in pooled samples from 24-hour urine collections on sepsis onset and at various time points thereafter. The diagnostic performance of urine α1m was assessed using thenonparametriccalculation of the area under the curve (AUC) of the receiver operating characteristic (ROC) curve. Among 286 critically ill patients admitt...
Vascular and Endovascular Surgery, 2007
The aim of the present study was to evaluate the changes in blood flow of anterior and middle cer... more The aim of the present study was to evaluate the changes in blood flow of anterior and middle cerebral arteries following carotid endarterectomy, using transcranial Doppler (TCD) flow studies. This study included 100 patients (72 men, mean age 65 years) who underwent carotid endarterectomy because of high-grade carotid stenosis or symptoms of ischemic stroke. Endarterectomy was performed by a distal shunt between the common carotid and internal carotid arteries. Blood flow in the anterior and middle cerebral arteries was assessed by TCD preoperatively and also in the postoperative period (1st and 4th day; 1st, 6th, and 12th month). Collateral circulation in the Willis circle was evaluated by common carotid compression. Patients with bilateral carotid stenosis &amp;amp;gt; or =70% exhibited a significantly increased flow velocity in the ipsilateral anterior cerebral artery (ACA), middle cerebral artery (MCA), and in the contralateral ACA. Patients with entirely occluded contralateral internal carotid artery showed the most pronounced changes in cerebral hemodynamics. Blood flow velocities returned to the preoperative values at 1 to 12 months following endarterectomy. Hyperperfusion syndrome was manifested in 14 patients, who exhibited significantly higher flow velocities in the ipsilateral MCA compared with asymptomatic patients. A transient bilateral increase of blood flow velocity in the anterior part of the Willis circle may often occur in the immediate postoperative period following carotid endarterectomy. Although its clinical significance is not entirely understood, this increase may be associated with cerebral hyperperfusion syndrome.
Journal of Cardiothoracic and Vascular Anesthesia, 2005
Journal of Cardiothoracic and Vascular Anesthesia, 2006
Uploads
Papers by Christos Dragoumanis