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Second International Symposium on Intensive Care and Emergency Medicine for Latin America São Paulo, Brazil, 25–28 June 2003

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Second International Symposium on Intensive Care and Emergency Medicine for Latin America São Paulo, Brazil, 25–28 June 2003 Available online http://ccforum.com/supplements/7/S3 Critical Care Volume 7 Suppl 3, 2003 Second International Symposium on Intensive Care and Emergency Medicine for Latin America São Paulo, Brazil, 25–28 June 2003 Published online: 25 June 2003 These abstracts are online at http://ccforum.com/supplements/7/S3 © 2003 BioMed Central Ltd (Print ISSN 1364-8535; Online ISSN 1466-609X) CARDIOLOGY P1 Impact of peroperative administration of steroid over inflammatory response and pulmonary dysfunction following cardiac surgery HTF Mendonça Filho1,2, LAA Campos1, RV Gomes1, FES Fagundes1, EM Nunes1, R Gomes2, F Bozza2, PT Bozza2, HC Castro-Faria-Neto2 1Surgical Intensive Care Unit, Hospital Pró-Cardíaco, Rio de Janeiro, RJ, Brazil; 2Laboratory of Immunopharmacology, Department of Pharmacodymamics, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil Critical Care 2003, 7(Suppl 3):P1 (DOI 10.1186/cc2197) Introduction Cardiac surgery with cardiopulmonary bypass (CPB) NS (n = 37). MIF circulating levels were assayed at the anesthesia is a recognized trigger of systemic inflammatory response, usually induction, 3, 6, and 24 hours after CPB. A standard weaning proto- related to postoperative acute lung injury (ALI). As an attempt to col with fast track strategy was adopted, and indicators of organ dampen inflammatory response, steroids have been perioperatively dysfunction and therapeutic intervention were registered during the administered to patients. Macrophage migration inhibitory factor first 72 hours postoperative. (MIF), a regulator of the endotoxin receptor, is implicated in the pathogenesis of ALI. We have previously detected peak circulating Results Levels of MIF assayed 6 hours post CPB correlated levels of MIF, 6 hours post CPB. Experimental data have shown directly to the postoperative duration of mechanical ventilation that steroids may induce MIF secretion by mononuclear cells. This (P = 0.014, rho = 0.282) and inversely to PaO2/FiO2 ratio study aims to correlate levels of MIF assayed 6 hours post CPB to (P = 0.0021, rho = –0.265). No difference in MIF levels was noted the intensity of postoperative pulmonary dysfunction, analysing the between the groups. The duration of mechanical ventilation was impact of perioperative steroid administration. higher (P = 0.005) in the group MP (7.92 ± 6.0 hours), compared with the group NS (4.92 ± 3.6 hours). Methods We included patients submitted to cardiac surgery with CPB, electively started in the morning, performed by the same Conclusion Circulating levels of MIF assayed 6 hours post CPB are team under a standard technique except for the addition of methyl- correlated to postoperative pulmonary performance. Immunosup- prednisolone (15 mg/kg) to the CPB priming solution for patients pressive doses of methylprednisolone did not affect circulating levels from group MP (n = 37), but not for the remaining patients — group of MIF and may be related to prolonged mechanical ventilation. P2 Immediate and short-term safety of catheter-based autologous bone marrow-derived mononuclear cell transplantation into myocardium of patients with severe ischemic heart failure HF Dohmann1,2, E Perin1, A Sousa1, SA Silva1, C Gonzáles1, C Falcão1, R Verney1, L Belém1, H Dohmann1 1Hospital Pró-Cardíaco, Rio de Janeiro, RJ, Brazil; 2Texas Heart Institute, 6770 Bertner Avenue, Houston, TX 77030, USA Critical Care 2003, 7(Suppl 3):P2 (DOI 10.1186/cc2198) Background Bone marrow-derived mononuclear cell (BM-MNC) ventricular contractions (PVC) and QT dispersion using a 24-hour transplantation into the myocardium has been proposed as a new Holter test at baseline, immediately after the procedure and then therapy for ischemic heart failure (HF). Successful cellular therapy after 8 weeks. Perfusion tests to quantify the left ventricular (LV) for HF using myoblast transplantation has been reported previously ischemic mass and echocardiograms to evaluate the ejection frac- but malignant arrhythmias (MA) were an issue. We investigated the tion (EF) were performed at baseline and then repeated at safety of BM-MNC transplantation into the myocardium for MA. 8 weeks. Methods A prospective study to evaluate the safety of autologous Results Fourteen patients (12 males, 56.9 ± 10 years) with severe BM-MNC transplantation in patients with severe ischemic HF not HF (LV EF 30 ± 6%) were enrolled. All patients had triple-vessel amenable to myocardial revascularization was conducted. Bone disease and 64% had previous myocardial revascularization. A marrow was harvested from the iliac crest and BM-MNCs were total of 30 × 106 BM-MNC were injected at 15 sites. All patients selected by Ficoll gradient. Hibernating myocardium areas were were discharged from hospital 48 hours after the procedure. The targeted using electromechanical mapping in catheter-based estimated LV ischemic area on MIBI SPECT was measured by per- subendocardial injections (MyoStar, Cordis, Miami Lakes, FL, centual of myocardial defect reverse, 14.8 ± 15% of LV mass at USA). All patients were evaluated for MA, number of premature baseline that was reduced to 5 ± 11% (P = 0.009) at 8 weeks after S1 Critical Care June 2003 Vol 7 Suppl 3 Second International Symposium on Intensive Care and Emergency Medicine for Latin America procedure. EF increased 16% (P = 0.03) at 8 weeks. The number of Conclusion BM-MNC transplantation into myocardium of patients PVC was reduced at 24 hours (483 ± 4598 versus 236 ± 6243, with severe heart failure was safely performed and short term P = not significant) and at 8 weeks (483 ± 4598 versus 191 ± 1236, follow-up suggests electrical stability as observed by a decrease in P = not significant). No MA were documented at 24 hours or at the QT dispersion, maintenance in the number of PVC and an 8 weeks. QT dispersion decreased from 63 ± 24 ms at baseline to absence of MA. Possible mechanisms may be due to ischemic LV 54±16ms (P = 0.3) at 2 months of follow-up. mass reduction and improvement in myocardium contractility. P3 Clinical improvement after autologous bone marrow mononuclear cell transplantation HF Dohmann1,2, E Perin1, SA Silva1, A Sousa1, L Belém1, A Rabichovisky1, F Rangel1, R Esporcatte1, LA Campos1, H Dohmann1 1Hospital Pró-Cardíaco, Rio de Janeiro, RJ, Brazil; 2Texas Heart Institute, 6770 Bertner Avenue, Houston, TX 77030, USA Critical Care 2003, 7(Suppl 3):P3 (DOI 10.1186/cc2199) Background Our group and others have reported symptoms, Results All 14 patients (two females, 57 ± 10 years old) had multi- myocardial perfusion and mechanical improvements with bone vessel disease and previous myocardial infarction. The patients marrow mononuclear cell (BM-MNC) transplantation into areas of presented a significant 73% reduction in total reversibility defect hibernating myocardial in end stage ischemic heart disease (ESIHD) (P = 0.022, from 15.15 ± 14.99% to 4.53 ± 10.61%) in an 8 week patients. However, there is no information about the course of these follow-up. The NYHA class were 2.21 ± 0.89 at baseline and improvements during time. We evaluated, week by week, the improve- improved to 1.14 ± 0.36 at 8 weeks (P = 0.0003). The CCS ments in New York Heart Association (NYHA) functional class, CCS angina class were 2.64 ± 0.84 at baseline and improved to angina class and ejection fraction (EF) by echocardiography in ESIHD 1.28 ± 0.61 (P = 0.0001). The EF moved from 30 ± 5% at the patients to BM-MNC transendocardial delivery. baseline to 35 ± 7% at 8 weeks (P = 0.02). We obtained a signifi- cant improvement of NYHA at the fourth week (P = 0.0002) and Methods In 14 patients, bone marrow was harvested from iliac for CCS at the seventh week (P = 0.000006). Concomitantly we crest and BM-MNCs were selected by Ficoll gradient. Endocardial observed a significant improvement in EF by echo between the injections targeting hibernated myocardial areas were performed sixth and eighth weeks (P = 0.04). utilizing electromechanical mapping (MyoStar, Cordis, Miami Lakes, FL, USA). At baseline and during a follow-up of 10 weeks the patients were evaluated about their NYHA functional class, Conclusion These preliminary data suggest a time window for clin- CCS angina class, and EF by echo (Simpson). Ischemic area was ical, functional and myocardial perfusion improvements with evaluated by SPECT-MIBI (Siemens ICON workstation) before and BM-MNC transplantation during the second month of follow-up. 8 weeks after BM-MNC transplantation. The statistical analysis This data, if confirmed in more powerful studies, may be useful for used for comparisons between baseline and 8 weeks was analysis informing patients submitted to BM-MNC transplantation to hiber- of variance, and that for evaluation of peak of improvements during nating myocardial areas, as well as to identify the major mechanism time was a generalized linear model with time strata. involved in this approach. P4 Primary angioplasty in a public hospital: initial results MA Mattos, DG Toledo, CE Mattos, RA Abitbol, MHV Assad, BR Tura, OS Oliveira Instituto Nacional de Cardiologia Laranjeiras, Rio de Janeiro, RJ, Brazil Critical Care 2003, 7(Suppl 3):P4 (DOI 10.1186/cc2200) Background Many studies in the literature show that primary of symptom onset. Of these patients, the mean age was 61 years. angioplasty is the best method for myocardial reperfusion. Males comprised 56.1% (31). Traditional risk factors prevalence were 17.5% for diabetes melli- Objectives The aim of the study was to evaluate the angiographic tus, 73.7% for hypertension, 43.9% for current smoker, 52.6% and clinical results of primary angioplasty in patients with acute hypercholesterolemia and 56.1% for family history of CAD. Of the myocardial infarction (AMI). patients, 31.5% had a history of myocardial infarction. Anterior wall AMI occurred in 35 patients and inferior in 22. Of the Methods We prospectively studied 1055 patients with AMI, in a patients, 54.4% were submitted to direct angioplasty within coronary unit care, from March 1994 to March 2003.
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