Radovan Radonić

Assesment of hemodynamics by basic ultrasound

Basic ultrasound can provide important information about the main parts of the circulatory system, the heart, and the main vessels. At the bedside, only by brief visual impression of the heart function and infe-rior vena cava diameter, and without any measurements, the attending physician can get important information which can influence the clinical opinion-making process and the management of the hemo-dynamically unstable patient. No less im-portant is to obtain information about the lungs, particularly to estimate if extravas-cular lung water is present in excess or not. Ultrasound can help in the detection of the potentially reversible causes of hemody-namic instability or arrest and can guide the treatment. Examples are pneumotho-rax, cardiac tamponade, thromboembo-lism, the detection of blood in the pleural, pericardial or abdominal space after trau-ma and the detection and treatment of the source of the infection.

Testing of potential biomarkers of cerebral ischemia and vasospasm in patients with cerebral aneurysm surgery

Biomarkers for the prediction of vasospasm and delayed cerebral ischemia in patients with a ruptured cerebral aneurysm could be helpful. In this prospective clinical study, endothelin-1, lactate, pCO 2 , and pO 2 were measured in arterial and internal jugular vein blood before, during and after surgical treatment of a cerebral aneurysm, and were tested as potential predictors of neurologic outcome in patients. Forty-one patients were enrolled in the study, 23 of them were operated on after aneurismal rupture with development of subarachnoid hemorrhage (SAH) and 18 patients were operated on for a nonruptured aneurysm. All of the involved patients survived. There was no difference in neurologic outcome between those operated on with a ruptured or nonruptured aneurysm. Endothelin-1 and lactate concentrations as well as pO 2 and pCO 2 from arterial and venous blood samples and their venoarterial difference did not differ between groups with and without an aneurismal rupture. Venoarterial difference of endothelin-1 concentrations on the day after surgery significantly differed between the groups with favorable and nonfavorable neurologic outcome. Other variables did not show a statistically significant difference. Significant correlation was found between endothelin-1 and lactate concentrations, suggesting involvement of the same pathophysiological process. Another interesting finding was lower arterial and venous pCO 2 in patients with lower initial Glasgow Coma Scale (GCS) score and higher Hunt Hess score in the phase after extubation. We can conclude that the measured biochemical parameters did not show sufficient predictive power to be useful for prediction of cerebral vasospasm and neurologic outcome in everyday clinical practice. However, some correlations that do exist between them suggest involvement of the same pathophysiological process.