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Background Although peripherally inserted central catheters (PICCs) have been widely used, they have not been frequently used in anesthesia practice. The central venous pressure measured via PICCs are reportedly as accurate as that measured via central venous catheters (CVCs), but the findings concerning rapid infusion are unclear. This study examined whether or not pressure-resistant PICCs could be used for rapid fluid infusion.  Methods The in-line pressure was measured in similar-sized double-lumen catheters—4-Fr PICC (55, 45 and 35 cm) and 17-G CVC (20 and 13 cm)—at flow rates of saline decided using a roller pump system. We also examined the flow rate at an in-line pressure of 300 mmHg, which is the critical pressure at which hemolysis is considered to occur during blood transfusion. Results The pressure-resistant PICCs obtained a high flow rate similar to that of CVCs, but the in-line pressures increased in proportion to the flow rate and catheter length. Flow rates at an intra-circuit pressure of 300 mmHg were not significantly different between the 45-cm PICC and 20-cm CVC. Conclusion Pressure-resistant PICCs can be used for rapid fluid infusion.

Objective: The aim was to systematically compare the drug compatibility with various closed intravenous (i.v.) infusion containers, to provide a reference for selecting a relatively superior infusion container and improve the medication safety for patients in clinical practice. Methods: The compatibility of four commonly used clinical injections (ceftazidime, pantoprazole sodium, ambroxol hydrochloride, edaravone) with three representative closed i. v. infusion containers (non-PVC infusion bags, upright polypropylene infusion bags, inner sealed polypropylene infusion bags) prefilled with infusion fluids (0.9% sodium chloride or 5% dextrose) in the Chinese market were investigated in this study. The particle counts of both infusion fluids and diluted chemical injections by infusion fluids in various infusion containers were determined by the light obscuration method. At 0, 2 and 6 h after four injections following dilution with infusion fluids in each container, the pH of the solutions was detected, and the physical properties were examined by visual inspection. Meanwhile, the drug concentrations were assessed by high performance liquid chromatography (HPLC). Results: As for either infusion fluids or diluted injections by infusion fluids, the particle counts in non-PVC infusion bags were significantly greater than those in the other two bags under some circumstances. The particle counts in diluted injections by infusion fluids increased dramatically compared with those in infusion fluids in all infusion containers, especially for the small-size particles. But pH, physical properties and drug concentrations of diluted infusion solutions in all infusion containers remained nearly unchanged over the test period. Conclusion: Closed i. v. infusion containers included in this study are all well-compatible with four injections. Moreover, the closed infusion containers produced by Chinese manufacturers have met the international quality standard. Particularly, the intravenous admixture preparation process needs to be optimized to reduce the overall particulate contaminants.

Aim/Objective: The aims were two-fold: 1) to identify the type of allergic and hypersensitivity ADRs resulting from the administration of PEGylated granulocyte colony-stimulating factor (PEG-GCSF) and asparaginase (PEG-ASE) and 2) to assess the role of corticosteroids and anti-histamines in the management of these ADRs. Methods: A systematic literature review of case reports and case series on drug-induced ADRs was undertaken between January 1992 and November 23 for PEG-ASE, and from January 2000 to November 2023 for PEG-GCSF, reflecting the period since the drugs were first approved for clinical use. Data on the type, onset and management of hypersensitivity reaction was extracted. Results: 53 ADR cases were identified for PEG-ASE. Out of these, 9 cases related to a drug-induced allergic/hypersensitivity ADR mainly anaphylaxis or anaphylactoid-reactions. Most ADRS appeared after the 2nd or 3rd dose. However, 5 cases happened during or right after the first infusion. In all cases ADRs were managed by treatment with intravenous fluids, corticosteroids, and anti-histamines (diphenhydramine), with 3 cases requiring administration of epinephrine. For PEG-GSCF, 60 ADR cases were identified of which 5 were hypersensitivity/allergic reactions. Two cases presented as a skin rash appearing 1- or 7-days after PEG-GCSF administration and were managed with anti-histamines and corticosteroids. Three cases reported anaphylaxis or anaphylactoid reactions which appeared within 1 hour of the first dose and required fluid replacement, epinephrine, and corticosteroids. Interestingly, one case could be switched to non-PEG GCSF without ADRs. Conclusion: A similar number of ADR case reports were identified for both drugs over the period considered. Both PEGylated biologicals were associated with hypersensitivity/allergic reactions. Onset was varied, but early onset could suggest prior sensitisation to any component of the formulation, including PEG, a widely used pharmaceutical excipient also present in many personal care products. In the UK, premedication with anti-histamines and corticosteroids is recommended for PEG-ASE, but not PEG-GCSF. Further studies could determine if this recommendation should be expanded and whether patients should be assessed for possible hypersensitivity prior to initiating treatment with PEGylated biologicals.

The dysregulated immune response during sepsis involves endothelial injury, which may be augmented by infusion of clear fluids such as crystalloids. Plasma has been suggested as an alternative resuscitation fluid but it is unclear whether previously observed benefits were due to the type of fluid, or due to less volume required to restore tissue perfusion. We hypothesized that resuscitation with plasma reduces endothelial injury, inflammation, and organ injury compared to similar and higher volumes of crystalloids in a rat pneumosepsis model. Rats were intratracheally inoculated with Streptococcus Pneumoniae to induce pneumosepsis. Twenty-four hours after inoculation, animals were randomized to 4 groups: healthy controls (non-resuscitated, n = 6), 10 ml/kg/hr (standard-volume, n = 11) crystalloid resuscitation, 3.33 ml/kg/hr (low-volume, n = 11) crystalloid resuscitation or 3.33 ml/kg/hr plasma resuscitation (n = 11). Plasma markers of inflammation and endothelial injury were measured. Organs were harvested for histology and wet-to-dry weight ratio determination. Inoculated animals developed pneumosepsis, with lower mean arterial pressures (p < 0.001) and higher lactate levels (p < 0.001) compared to healthy controls. Animals resuscitated with plasma showed a trend towards lower syndecan-1 levels compared to the standard-volume crystalloid group (82 vs 99 ng/mL, p = 0.06) and had lower levels of VCAM-1 (424 vs 592 ng/mL, p < 0.01) compared to the standard volume crystalloid group, but not when compared to the low-volume crystalloid group. Other markers of endothelial injury or inflammation were not significantly different between groups. No significant differences were observed in histologic injury scores and wet-to-dry ratios. Plasma resuscitation modestly reduces endothelial injury compared to crystalloid resuscitation. This effect might be attributed to decreased resuscitation volumes rather than the type of fluid.

18 Participants were randomized to receive 30 ml/kg bodyweight Ringer’s Lactate at 37° or 15 °C over 30 min. In a second session, participants were crossed over. Over a 120 min period after starting the fluid bolus we measured mean arterial pressure (MAP), cardiac output, systemic vascular resistance, and catecholamine levels. After infusion with cold fluids, the absolute increase in MAP at 45 min was significantly higher at + 6.5 mmHg (95% CI 4.8–8.2) compared with warm fluids (+ 0.6 mmHg, 95% CI, − 1.6 to 2.8; p  < 0.001). This increase in MAP was longer-lasting after cold fluids (81.7 min, 95% CI 62.5–100.9) than after warm fluids (19.2, 95% CI 3.4–35; p  < 0.001). While cardiac output was similar, systemic vascular resistance increase was greater after cold fluids (159 dyn s/cm 5 , 95% CI 9.5–309) compared to warm fluids (− 66 dyn s/cm 5 , 95% CI − 191 to 57; p  = 0.012). Moreover, noradrenaline increased by up to 246% during cold fluids, and decreased with warm fluids ( p  < 0.001). Fluid bolus given at 15 °C, compared to 37 °C, leads to a greater and more prolonged increase in MAP accompanied by release of intrinsic noradrenaline and vasoconstriction. These results suggest that fluid temperature rather than volume is predominantly responsible for any increase in MAP. Trial Registration : EudraCT-nummer 2022-002137-34 and clinicaltrials.gov NCT05610254 (first registration 09/11/2022).

Patients on home parenteral nutrition (HPN) are at risk for catheter-related complications; mainly infections and occlusions. We have previously shown in HPN patients presenting with catheter sepsis that catheter locking with taurolidine dramatically reduced re-infections when compared with heparin. Our HPN population therefore switched from heparin to taurolidine in 2008. The aim of the present study was to compare long-term effects of this catheter lock strategy on the occurrence of catheter-related bloodstream infections and occlusions in HPN patients. Data of catheter-related complications were retrospectively collected from 212 patients who received HPN between January 2000 and November 2011, comprising 545 and 200 catheters during catheter lock therapy with heparin and taurolidine, respectively. We evaluated catheter-related bloodstream infection and occlusion incidence rates using Poisson-normal regression analysis. Incidence rate ratios were calculated by dividing incidence rates of heparin by those of taurolidine, adjusting for underlying disease, use of anticoagulants or immune suppressives, frequency of HPN/fluid administration, composition of infusion fluids, and duration of HPN/fluid use before catheter creation. Bloodstream infection incidence rates were 1.1/year for heparin and 0.2/year for taurolidine locked catheters. Occlusion incidence rates were 0.2/year for heparin and 0.1/year for taurolidine locked catheters. Adjusted incidence ratios of heparin compared to taurolidine were 5.9 (95% confidence interval, 3.9-8.7) for bloodstream infections and 1.9 (95% confidence interval, 1.1-3.1) for occlusions. Given that no other procedural changes than the catheter lock strategy were implemented during the observation period, these data strongly suggest that taurolidine decreases catheter-related bloodstream infections and occlusions in HPN patients compared with heparin.

Purpose To evaluate the impact of temperature-controlled pars plana vitrectomy (PPV) on structural and functional outcomes in a rabbit eye model in vivo. Methods Ten healthy New Zealand White rabbits underwent temperature-controlled PPV in the right eye (group A), using a device specifically designed to heat the infusion fluid/air and integrated into the vitrectomy machine, and conventional PPV in the left eye (group B). Both eyes received ophthalmic examination and electroretinography (ERG) before and 1 week postoperatively. After 1-week ERG, rabbits were enucleated and then sacrificed. Histological and immunohistochemical examinations were performed on enucleated eyes and expression of glial fibrillary acidic protein (GFAP) and vimentin investigated. Results Postoperatively, only group B showed significantly decreased amplitude and increased latency of a-wave at 3 cd·s/m 2 (p = 0.001 and 0.005, respectively). Significant increase of b-wave latency at 0.01 cd·s/m 2 was detected in both groups (p = 0.019 and 0.023, respectively). Postoperatively, amplitude of oscillatory potentials (OPs) increased significantly in group A (p = 0.023) and decreased in group B. In both groups, OPs latency significantly increased at 1-week test (P < 0.05). A greater number of eyes without structural retinal alterations was detected in group A compared to group B (6 vs 5, respectively). GFAP expression was higher in group B than group A, even if the difference was not statistically significant. Conclusion Temperature-controlled PPV resulted in more favorable functional and structural outcomes in rabbit eyes compared with conventional PPV, supporting the potential beneficial role of the intraoperative management of intraocular temperature in vitreoretinal surgery.

The aim of this study was to synthesize and evaluate nanostructured lipid carriers (NLCs) loaded with Remdesivir (RDV) to control its side effects in COVID-19 patients. Due to the low solubility and short half-life of RDV in the blood, an injectable formulation was prepared using sulphobutylether-beta-cyclodextrin. However, it can accumulate in the kidney and cause renal impairment. NLCs improve the parenteral delivery of hydrophobic drugs such as RDV by increasing drug solubility and bioavailability. For the synthesis of RDV-NLCs, the aqueous phase containing Tween 80 was injected into the lipid phase under rapid stirring and was sonicated. The experimental conditions were optimized using Box-Behnken design and Design Expert software. The optimum formulation contained a total lipid of 2.13%, a total surfactant of 1%, and a hot bath time of 71 min. The optimum formulation showed particle size, polydispersity index, zeta potential, and entrapment efficiency values of 151.0 ± 1.7 nm (from 149.1 to 152.1), 0.4 ± 0.1 (from 0.3 to 0.5), −43.8 ± 1.2 mV (from −42.4 to −44.7), and 81.34 ± 1.57% (from 79.52 to 82.33%), respectively. RDV-NLCs showed acceptable stability for 30 days at 25 ℃ and were compatible with commonly used intravenous infusion fluids for 48 h. FE-SEM images of RDV-NLC showed spherical particles with a mean diameter of 207 nm. The NLC-RDV formulation showed a sustained release of RDV with a low risk of dose-dumping, minimizing potential side effects. In addition, RDV in the form of RDV-NLC causes less cytotoxicity to healthy normal kidney cells, which is expected to reduce renal impairment in COVID-19 patients.

Hyaluronidases are enzymes that degrade hyaluronan an important constituent of the extracellular matrix. They have been used as a spreading agent, improving the absorption of drugs and facilitating the subcutaneous infusion of fluids. Here, we investigated the influence of bovine testes hyaluronidase (HYAL) during cutaneous wound healing in in vitro and in vivo assays. We demonstrated in the wound scratch assay that HYAL increased the migration and proliferation of fibroblasts in vitro at low concentration, e.g. 0.1 U HYAL enhanced the cell number by 20%. HYAL presented faster and higher reepithelialization in in vivo full-thickness excisional wounds generated on adult Wistar rats back skin already in the early phase at 2nd day post operatory compared to vehicle-control group. Wound closured area observed in the 16 U and 32 U HYAL treated rats reached 38% and 46% compared to 19% in the controls, respectively. Histological and biochemical analyses supported the clinical observations and showed that HYAL treated wounds exhibited increased granulation tissue, diminished edema formation and regulated the inflammatory response by modulating the release of pro and anti-inflammatory cytokines, growth factor and eicosanoids mediators. Moreover, HYAL increased gene expression of peroxisome proliferator-activated receptors (PPAR) γ and PPAR β/δ, the collagen content in the early stages of healing processes as well as angiogenesis. Altogether these data revealed that HYAL accelerates wound healing processes and might be beneficial for treating wound disorders.

AimsMain purpose of presenting this clinical case is that RSV BRONCHIOLITIS can present with lobar pneumonia,Fulminant viral septic shock with DIC,pulmonory haemorrhage and asystole. Viral VS Bacterial sepsis- clinically difficult to differentiate.Methods1 month old girl,unwell for 2 days with cough,decrease oral intake, seen by GP in the morning and diagnosed as BRONCHIOLITIS,same day evening presented to the hospital with apnoea in the car arrived at PAU within 3 mins of apnoea.O/E-no HR or breathing,bleeding from nose and mouth,pale looking,mottled, CRT 5 sec.CPR started and connected to monitor showed asystole.Immediate cardiac arrest call was activated.Intubated, cannula inserted, 2 doses of adrenaline given IV,Bolus of normal saline 10mls/kg thrice,partial septic screening done and covered with triple antibiotics amoxycillin,gentamycin and cefotaxime.After 10 mins of resuscitation baby responded. Given vitamin K and transfused with O negative blood and FFP.Blood gas showed mixed metabolic and respiratory acidosis and hence connected to ventilator started on morphine,maintenance fluids,ionotropes,morphine infusion and transferred to tertiary centre. In tertiary centre admitted for 11 days,extubated to CPAP on day 5, weaned to high flow on day 6, RA on day 9. Ionotropes for 1 day,acylovir, vitamin k for 9 and 6 days respectively.Neuroprotective measures followed.ResultsNPA for RSV positive, covid 19 PCR negative, blood c/s,CSF c/s and CSF PCR for bacteria and viruses negative, X ray chest consolidation upper lobes bilateral,CT Angiogram subsegmental consolidation and possible intraparenchymal haemorrhage. Initial Echo pulmonory hypertension and repeat Echo normal.MRI Brain -hypersensitivity in posterior putamina. Deranged coagulation profile.APTT more than 180, PT 16.2, INR 1.4ConclusionRSV positive bronchiolitis with all complications can mimic bacterial sepsis and its clinically difficult to differentiate between viral and bacterial septic shock.As this baby’s blood C/S was negative only positive thing was RSV in NPA, We have to consider this case as RSV BRONCHIOLITIS with fulminant septic shock with pneumonia, DIC, Pulmonory Haemorrhage leading to Asystole.Management of bacterial and viral Septic shock is pretty much the same except in certain cases we may have to use antivirals drugs when indicated.