Yerim Kim

The effects of prolonged inspiratory time during one-lung ventilation: a randomised controlled trial

We evaluated the effects of a prolonged inspiratory time on gas exchange in subjects undergoing one‐lung ventilation for thoracic surgery. One hundred patients were randomly assigned to Group I:E = 1:2 or Group I:E = 1:1. Arterial blood gas analysis and respiratory mechanics measurements were performed 10 min after anaesthesia induction, 30 and 60 min after initiation of one‐lung ventilation, and 15 min after restoration of conventional two‐lung ventilation. The mean (SD) ratio of the partial pressure of arterial oxygen to fraction of inspired oxygen after 60 min of one‐lung ventilation was significantly lower in Group I:E = 1:2 compared with Group I:E = 1:1 (27.7 (13.2) kPa vs 35.2 (22.1) kPa, respectively, p = 0.043). Mean (SD) physiological dead space‐to‐tidal volume ratio after 60 min of one‐lung ventilation was significantly higher in Group I:E = 1:2 compared with Group I:E = 1:1 (0.46 (0.04) vs 0.43 (0.04), respectively, p = 0.008). Median (IQR [range]) peak inspiratory pressure was higher in Group I:E = 1:2 compared with Group I:E = 1:1 after 60 min of one‐lung ventilation (23 (22–25 [18–29]) cmH2O vs 20 (18–21 [16–27]) cmH2O, respectively, p < 0.001) and median (IQR [range]) mean airway pressure was lower in Group I:E = 1:2 compared with Group I:E = 1:1 (10 (8–11 [5–15]) cmH2O vs 11 (10–13 [5–16]) cmH2O, respectively, p < 0.001). We conclude that, compared with an I:E ratio of 1:2, an I:E ratio of 1:1 resulted in a modest improvement in oxygenation and decreased shunt fraction during one‐lung ventilation.

Left Ventricular Geometry Determines Prognosis and Reverse J-Shaped Relation Between Blood Pressure and Mortality in Ischemic Stroke Patients

OBJECTIVESnThis study sought to investigate the prognostic significance of left ventricular (LV) mass and geometry in ischemic stroke survivors, as well as the LV geometry-specific differences in the blood pressure-mortality relationship.nnnBACKGROUNDnLV mass and geometry are well-known prognostic factors in various populations; however, there arexa0noxa0data on their role in ischemic stroke patients.nnnMETHODSnWe prospectively recruited 2,328 consecutive patients admitted with acute ischemic stroke to our institute between 2002 and 2010. Of these, 2,069 patients were analyzed in whom echocardiographic data were available to assess LV mass and geometry.nnnRESULTSnAll-cause mortality was significantly greater in patients with concentric hypertrophy (adjusted hazard ratio [HR]: 1.417; 95% confidence interval [CI]: 1.045 to 1.920) and concentric remodeling (HR: 1.540; 95% CI: 1.115 to 2.127) but nonsignificantly in those with eccentric hypertrophy (HR: 1.388; 95% CI: 0.996 to 1.935) compared with normal geometry in multivariate analyses. Relative wall thickness was a significant predictor of all-cause mortality (HR: 1.149 per 0.1-U increase in relative wall thickness; 95% CI: 1.021 to 1.307), whereas LV mass index was not (HR: 1.003 per 1 g/m2 increase in LV mass index; 95% CI: 0.999 to 1.007). Similar results were observed with cardiovascular mortality. In multivariable fractional polynomials, patients with altered LV geometry showed reverse J-curve relationships between acute-phase systolic blood pressure and all-cause or cardiovascular mortality, with the highest risks in the lower extremes, whereas those with normal geometry did not.nnnCONCLUSIONSnEchocardiographic assessment of LV geometry provided independent and additive prognostic information inxa0ischemic stroke patients. A reverse J-shaped relation of mortality with blood pressure was found in patients with abnormal LVxa0geometry.

Prediction of post-stroke dementia using NINDS-CSN 5-minute neuropsychology protocol in acute stroke.

BACKGROUNDnThe National Institute of Neurological Disease and Stroke-Canadian Stroke Network (NINDS-CSN) 5-minute neuropsychology protocol consists of only verbal tasks, and is proposed as a brief screening method for vascular cognitive impairment. We evaluated its feasibility within two weeks after stroke and ability to predict the development of post-stroke dementia (PSD) at 3 months after stroke.nnnMETHODnWe prospectively enrolled subjects with ischemic stroke within seven days of symptom onset who were consecutively admitted to 12 university hospitals. Neuropsychological assessments using the NINDS-CSN 5-minute and 60-minute neuropsychology protocols were administered within two weeks and at 3 months after stroke onset, respectively. PSD was diagnosed with reference to the American Heart Association/American Stroke Association statement, requiring deficits in at least two cognitive domains.nnnRESULTSnOf 620 patients, 512 (82.6%) were feasible for the NINDS-CSN 5-minute protocol within two weeks after stroke. The incidence of PSD was 16.2% in 308 subjects who had completed follow-up at 3 months after stroke onset. The total score of the NINDS-CSN 5-minute protocol differed significantly between those with and without PSD (4.0 ± 2.7, 7.4 ± 2.7, respectively; p < 0.01). A cut-off value of 6/7 showed reasonable discriminative power (sensitivity 0.82, specificity 0.67, AUC 0.74). The NINDS-CSN 5-minute protocol score was a significant predictor for PSD (adjusted odds ratio 6.32, 95% CI 2.65-15.05).nnnDISCUSSIONnThe NINDS-CSN 5-minute protocol is feasible to evaluate cognitive functions in patients with acute ischemic stroke. It might be a useful screening method for early identification of high-risk groups for PSD.

Physical Activity Frequency and the Risk of Stroke: A Nationwide Cohort Study in Korea

Background The current guideline recommends moderate‐ to vigorous‐intensity physical activity (PA) at least 40 min/day for 3 to 4 days/week. Although recent evidence has demonstrated that low‐dose PA could reduce cardiovascular mortality, the relationship between low‐dose PA and the risk of stroke remains uncertain. Methods and Results Using data from a nation‐wide sample cohort in Korea, we examined 336 326 individuals who received a general health examination between 2009 and 2010. Level of PA was assessed using a questionnaire for weekly PA frequencies regarding 3 intensity categories: light, moderate, and vigorous. Moderate‐ to vigorous‐intensity PA (MVPA) was classified into 4 frequency categories: none, 1 to 2, 3 to 4, or ≥5 times/week. Cox proportional hazard models were constructed to estimate the risk of stroke. During the average follow‐up of 3.6 years, 2213 stroke cases occurred. MVPA was none in 50%, 1 to 2 times/week in 20%, 3 to 4 times/week in 13%, and ≥5 times/week in 18% of the cohort. Individuals with MVPA 1 to 2 times/week had a 16% reduced risk of stroke (adjusted hazard ratio, 0.84; 95% confidence interval, 0.73–0.96) compared with those with no MVPA. The population attributable fraction of no MVPA was 12%, which was the second most important risk factor for a stroke after hypertension. Conclusions Even 1 to 2 times a week of MVPA might be beneficial to prevent a first‐ever stroke in the general population, although a quantitative validation of the questionnaire is needed. From a public health perspective, we need to encourage inactive people to start exercising with more‐achievable goals.

Effects of glycemic variability and hyperglycemia in acute ischemic stroke on post-stroke cognitive impairments

AIMSnWe aimed to investigate the effect of glycemic variability in the acute stage of stroke on the development of post-stroke cognitive impairment (PSCI).nnnMETHODSnPatients who underwent blood glucose tests at least five times within 7u202fdays after acute ischemic stroke were included. Factors related to glycemic variability (standard deviation (SD), coefficient of variance (CV), and mean absolute glucose (MAG)) were calculated; neuropsychological assessments were administered 3u202fmonths after stroke. PSCI was defined as a score of less than -2 SDs for age-, sex-, and education-adjusted means in at least one cognitive domain.nnnRESULTSnA total of 354 patients were enrolled. PSCI was identified in 74 (20.9%) subjects. In the diabetic group (n =u202f87), MAG was a significant predictor for PSCI (adjusted OR, 1.94; 95% CI, 1.11-3.42); however, it was not significant in the non-diabetic group, although PSCI exhibited an increasing tendency within higher SD and MAG tertiles. Moreover, hyperglycemia demonstrated a detrimental effect on PSCI, regardless of diabetes status; this effect did not appear in poorly-controlled diabetic patients with HbA1cu202f≥u202f8.0%.nnnCONCLUSIONSnGlycemic variability and hyperglycemia during acute ischemic stroke were identified as novel predictors for PSCI. Although this result is not evidence of a causal relationship, our study suggests that monitoring glycemic index and controlling its variability during the acute phase of ischemic stroke may help to prevent poor cognitive outcomes.

Nocturnal Desaturation is Associated With Neurological Deterioration Following Ischemic Stroke: A Retrospective Observational Study

STUDY OBJECTIVESnThe mechanism of early neurological deterioration (END) in patients with stroke remains unclear. We assessed the relationship between nocturnal oxygen desaturation (NOD) in the stroke unit (SU) and END, especially occurring at nighttime, following acute stroke.nnnMETHODSnA retrospective analysis was performed on a total of 276 patients with ischemic stroke who were admitted to the SU between July 2013 and June 2015. The oxygen desaturation index was calculated from pulse oximetry data sampled every 1 minute during 9 hours on the first night (10:00 PM to 7:00 AM) after admission, and NOD was defined as oxygen desaturation index ≥ 5 events/h. END was defined as an increase of ≥ 2 points from the baseline National Institutes of Health Stroke Scale during 7 days after onset. We compared clinical characteristics and NOD between patients with and without END.nnnRESULTSnAmong the included patients (mean age 69.2; male 55.4%), 42 patients (15.2%) experienced END. The proportion of NOD was significantly greater in the END group (45.2% versus 12.8%, P < .001). After adjusting for confounders, NOD was independently associated with END (odds ratio 7.57; 95% confidence interval 3.14-18.27). Among END patients, 47.6% patients (n = 20) had END during nighttime. Moreover, NOD was more frequent in patients with END during nighttime compared to those with END during daytime (73.7% versus 26.1%, P = .002).nnnCONCLUSIONSnNOD in the SU was associated with END, especially during nighttime, after ischemic stroke. This suggests that treatment of sleep-disordered breathing could be a modifiable factor to possibly reduce the risk of neurological worsening among acute stroke patients.

MPS 16-01 Left Ventricular Geometry Determines Prognosis and U-shaped Relation between Blood Pressure and Mortality in Ischemic Stroke Patients

Objective: The left ventricular (LV) geometry is well-known prognosticators in various populations. However, there are no data on their role in ischemic stroke patients. We sought to investigate the prognostic significance of LV geometry in ischemic stroke survivors, and the LV geometry-specific differences in blood pressure-mortality relationship. Design and Method: We prospectively recruited 2,328 consecutive patients admitted with acute ischemic stroke to our institute between 2002 and 2010. Of these, 2,069 patients were analyzed, in whom echocardiographic data were available to assess LV geometry. Results: All-cause mortality was significantly greater in concentric hypertrophy (adjusted hazard ratio [HR], 1.451; 95% confidence interval [CI], 1.075 to 1.960) and concentric remodelling (HR, 1.581; 95% CI, 1.147 to 2.179), but marginally higher in eccentric hypertrophy (HR, 1.354; 95% CI, 0.974 to 1.883) than normal geometry in multivariate analyses. Relative wall thickness (RWT) and LV mass index (LVMi) were significantly or marginally associated with all-cause mortality (HR, 1.165, per 0.1U increase in RWT; 95% CI, 1.033 to 1.314 and HR, 1.004, per 1u200ag/m2 increase in LVMi; 95% CI, 1.000 to 1.007, respectively). Similar results were observed with vascular mortality. In multivariable fractional polynomials, patients with altered LV geometry showed U-curve relationships between acute-phase systolic blood pressure and all-cause or vascular mortality with highest risk in lower extremes, whereas those with normal geometry did not. Conclusions: Echocardiographic assessment for LV geometry provided independent prognostic information in ischemic stroke patients. The U-shaped relation of mortality with blood pressure was found in patients with abnormal LV geometry. Figure. No caption available.