Nimrod Adi

Tel Aviv Sourasky Medical Center

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Dekel Stavi

Tel Aviv Sourasky Medical Center

Amir Gal‐Oz

Tel Aviv Sourasky Medical Center

Yael Lichter

Tel Aviv Sourasky Medical Center

Yonatan Lahav

Kaplan Medical Center

Doron Halperin

Tel Aviv University

Patrick Sorkine

Mayanei Hayeshua Medical Center

Oded Cohen

Ben-Gurion University of the Negev

Ronan MacLoughlin

Aerogen (Ireland)

Galia Karp

Hospital de Clínicas

Yoel Angel

Tel Aviv Sourasky Medical Center

Cooperative Institutions

Tel Aviv University

107

Tel Aviv Sourasky Medical Center

Inserm

Universidade de São Paulo

Istituti di Ricovero e Cura a Carattere Scientifico

Intensive Care Society

University of Toronto

Assistance Publique – Hôpitaux de Paris

Harvard University

Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo

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Central catheter tip migration in critically ill patients

PLoS ONE (2022)

Roei Merin Amir Gal‐Oz Nimrod Adi Jacob Vine Reut Schvartz

Chest X-ray (CXR) is routinely required for assessing Central Venous Catheter (CVC) tip position after insertion, but there is limited data as to the movement of the tip location during hospitalization. We aimed to assess the migration of Central Venous Catheter (CVC) position, as a significant movement of catheter tip location may challenge some of the daily practice after insertion.Retrospective, single-center study, conducted in the Intensive Care and Cardiovascular Intensive Care Units in Tel Aviv Sourasky Medical Center 'Ichilov', Israel, between January and June 2019.We identified 101 patients with a CVC in the Right Internal Jugular (RIJ) with at least two CXRs during hospitalization.For each patient, we measured the CVC tip position below the carina level in the first and all consecutive CXRs. The average initial tip position was 1.52 (±1.9) cm (mean±SD) below the carina. The maximal migration distance from the initial insertion position was 1.9 (±1) cm (mean±SD). During follow-up of 2 to 5 days, 92% of all subject's CVCs remained within the range of the Superior Vena Cava to the top of the right atrium, regardless of the initial positioning.CVC tip position can migrate significantly during a patient's early hospitalization period regardless of primary location, although for most patients it will remain within a wide range of the top of the right atrium and the middle of the Superior Vena Cava (SVC), if accepted as well-positioned.

Central venous catheter

10.1371/journal.pone.0277618

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Citations (1)

553: INTRAVASCULAR LYMPHOMA PRESENTING WITH CRITICAL NEUROLOGIC DETERIORATION

Critical Care Medicine (2019)

Jacob Vine Yael Lichter Amir Gal‐Oz Chava Perry Yotam Pasternak

Vine, Jacob; Lichter, Yael; Oz, Amir Gal; Perry, Chava; Pasternak, Yotam; Adi, Nimrod Author Information

10.1097/01.ccm.0000625956.84027.33

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Changes in mean systemic filling pressure as an estimate of hemodynamic response to anesthesia induction using propofol

BMC Anesthesiology (2022)

Maayan Zucker Gregory Kagan Nimrod Adi Ilai Ronel Idit Matot

Abstract Background Even a small change in the pressure gradient between the venous system and the right atrium can have significant hemodynamic effects. Mean systemic filling pressure (MSFP) is the driving force of the venous system. As a result, MSFP has a significant effect on cardiac output. We aimed to test the hypothesis that the hemodynamic instability during induction of general anesthesia by intravenous propofol administration is caused by changes in MSFP. Methods We prospectively collected data from 15 patients undergoing major surgery requiring invasive hemodynamic monitoring. Hemodynamic parameters, including MSFP, were measured before and after propofol administration and following intubation, using venous return curves at a no-flow state induced by a pneumatic tourniquet. Results A significant decrease in MSFP was observed in all study patients after propofol administration (median (IQR) pressure 17 (9) mmHg compared with 25 (7) before propofol administration, p = 0.001). The pressure gradient for venous return (MSFP – central venous pressure; CVP) also decreased following propofol administration from 19 (8) to 12 (6) mmHg, p = 0.001. Central venous pressure did not change. Conclusions These results support the hypothesis that induction of anesthesia with propofol causes a marked reduction in MSFP. A possible mechanism of propofol-induced hypotension is reduction in preload due to a decrease in the venous vasomotor tone.

Haemodynamic response

Mean arterial pressure

Pain medicine

10.1186/s12871-022-01773-8

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Linear Correlation Between Mean Arterial Pressure and Urine Output in Critically Ill Patients

Critical Care Explorations (2024)

Yael Lichter Amir Gal‐Oz Nimrod Adi Asaph Nini Yoel Angel

Mean arterial pressure (MAP) plays a significant role in regulating tissue perfusion and urine output (UO). The optimal MAP target in critically ill patients remains a subject of debate. We aimed to explore the relationship between MAP and UO.

Mean arterial pressure

Urine output

Linear correlation

10.1097/cce.0000000000001141

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The quinary pattern of blast injury

American Journal of Disaster Medicine (2007)

Yoram Kluger Nimrod Adi Philippe Biderman Ami Mayo Patric Sorkin

Objective: Bombing is the primary weapon of global terrorism, and it results in a complicated, multidimensional injury pattern. It induces bodily injuries through the well-documented primary, secondary, tertiary, and quaternary mechanisms of blast. Their effects dictate special medical concern and timely implementation of diagnostic and management strategies. Our objective is to report on clinical observations of patients admitted to the Tel Aviv Medical Center following a terrorist bombing. Results: The explosion injured 27 patients, and three died. Four survivors who had been in close proximity to the explosion, as indicated by their eardrum perforation and additional blast injuries, were exposed to the blast wave. They exhibited a unique and immediate hyperinflammatory state, two upon admission to the intensive care unit and two during surgery. This hyper-inflammatory state manifested as hyperpyrexia, sweating, low central venous pressure, and positive fluid balance. This state did not correlate with the complexity of injuries sustained by any of the 67 patients admitted to the intensive care unit after previous bombings. Conclusion: The patients’ hyperinflammatory be-havior, unrelated to their injury complexity and severity of trauma, indicates a new injury pattern in explosions, termed the “quinary blast injury pattern.” Unconventional materials used in the manufacture of the explosive can partly explain the observed early hyperinflammatory state. Medical personnel caring for blast victims should be aware of this new type of bombing injury.

Blast injury

Trauma Center

10.5055/ajdm.2007.0005

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Citations (46)

37th International Symposium on Intensive Care and Emergency Medicine (part 2 of 3)

Critical Care (2017)

Daniel Rob R. Špunda Jaroslav Lindner Jana Šmalcová Ondřej Šmíd

Sevoflurane sample data in a standard single patient ICU room, VieCuri Medical Centre. Physical data of the ICU room: 52 m3, air refreshing rate minimum 6/hr

10.1186/s13054-017-1630-4

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Citations (60)

Feasibility of a single-stage tracheostomy decannulation protocol with endoscopy in adult patients

The Laryngoscope (2015)

Oded Cohen Sharon Tzelnick Yonatan Lahav Dekel Stavi Hagit Shoffel‐Havakuk

Objectives/Hypothesis Gradual decrease in tube size and tube capping are considered the standard of care for tracheostomy decannulation. Both of these actions result in increased airway resistance. Immediate decannulation may offer a more tolerable approach. Objective To assess the feasibility of immediate tracheostomy decannulation compared with the traditional decannulation methods. Methods This study is a single institute, case-control retrospective study of patients between the years 2009 to 2014. The study group included all patients who underwent immediate decannulation, whereas the control group comprised patients who underwent traditional staged decannulation. An immediate decannulation protocol included admission to the intensive care unit, a comprehensive evaluation, decannulation, 24 hours of monitoring, and observation until discharge. Results Twenty-nine patients were included in the study group and 20 in the control group. No significant statistical difference was found between the two groups in the patients' medical history and tracheostomy data, except for the Acute Physiology and Chronic Health Evaluation II score and duration of the deflated cuff, which were significantly higher in the control group. A significant difference was found in the complication rate between the groups. In the staged decannulation group, four patients failed decannulation and required reinsertion of the tracheostomy cannula, whereas there were no such failures in the immediate decannulation group. Hospitalization duration after decannulation of the study group patients was significantly shorter than that of the control group. Conclusion Immediate decannulation may offer a safe alternative for weaning from tracheostomy. It may also reduce the duration of the weaning process and hospitalization. Level of Evidence 3b Laryngoscope, 126:2057–2062, 2016

Medical record

Cuff

Tracheotomy

10.1002/lary.25800

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Citations (31)

THR-18, a 18-mer peptide derived from PAI-1, is neuroprotective and improves thrombolysis by tPA in rat stroke models

Neurological Research (2011)

Michael Krakovsky V Polianski Nimrod Adi Abd Al‐Roof Higazi Ronen R. Leker

The thrombolytic treatment of stroke is limited by a narrow therapeutic time window and is associated with significant adverse side effects. To improve this situation, the modulation of tissue-type plasminogen activator (tPA) activity by a synthetic plasminogen activator inhibitor-1-derived 18-mer peptide (THR-18) was examined in two models of stroke in rats.In the first model (thromboembolic), stroke was induced by intra-carotid injection of micro-clots to rats, and tPA (6 mg/kg) was intravenously infused for 30 minutes with or without THR-18 (1 mg/kg) at 4 hours post-induction. In the second model [transient middle cerebral artery occlusion (tMCAO)], stroke was induced for 2 hours by a transient mechanical occlusion. tPA and/or THR-18 (0.02, 0.1, and 1 mg/kg) were intravenously infused for 60 minutes at the time of reperfusion.In the thromboembolic model, cerebral blood flow, measured before and up to 5.5 hours post-induction, revealed that tPA administration caused reperfusion of flow at 30 minutes post-infusion. Later on, an additional increase in reperfusion was seen in the tPA+THR-18 group, and not with tPA alone. In both models, the frequency of intracranial hemorrhage in the tPA-treated group was found to be significantly higher than the control, and this tPA effect was attenuated by THR-18. In the thromboembolic study, infarct size and brain edema were similar in the control and tPA-treated rats. However, the combination of tPA and THR-18 caused a statistically significant reduction in both parameters (infarct size 17.8 versus 25.0%, brain edema 5 versus 8%, tPA+THR-18 versus control, respectively). In the tMCAO mechanical model, infarct size and brain edema were both increased by tPA treatment as compared to the control group, and this increase was markedly diminished by THR-18 co-administration. Neurobehavioral assessment of the tMCAO animals performed at 72 hours post-stroke induction revealed significant improvements (P<0.05-0.01) in neuroscores in all groups of animals treated with peptide-tPA, as compared to the tPA monotherapy group. A significant (P<0.05) improvement in the neurological outcome was also seen in the THR-18 monoterapy group, as compared to the control animals, thus demonstrating a clear neuroprotective effect by the peptide on its own.The results support the use of THR-18 together with tPA in the thrombolytic therapy of stroke, in order to achieve better patency, less tPA-induced damage, and possibly a widening of tPA therapeutic time window.

Stroke

Thromboembolic stroke

T-plasminogen activator

10.1179/1743132811y.0000000018

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Citations (9)

One-Stage Decannulation Procedure for Patients Undergoing Oral and Oropharyngeal Oncological Surgeries and Prophylactic Tracheotomy~!2009-11-01~!2010-02-23~!2010-06-18~!

The Open Otorhinolaryngology Journal (2010)

Oshri Wasserzug Nimrod Adi Oren Cavel Noam Weizman Ahmad Safadi

Objective: Decannulation of patients with tracheotomy usually requires decrease in tracheostomy tube size, capping for 24-48 hours and observation after tube removal.Delay in decannulation may increase cardiopulmonary load, prolong hospitalization and cause patient distress.We propose a one-stage procedure in an intensive care unit (ICU) setting for patients undergoing head and neck surgeries and temporary tracheotomy.Study Design and Setting: Patients undergoing resection of head and neck tumors involving the oral cavity or oropharynx in a tertiary cancer center were prospectively studied.Following clinical and laboratory assessments, the tracheostomy tube was removed under cardiopulmonary monitoring in the ICU.Results: All 24 study patients underwent successful decannulation and were discharged 24 hours later.Follow-up time was 5 months.None of them required reintubation or recannulation. Conclusion:A one-stage decannulation is feasible and safe for patients undergoing resection of head and neck tumors involving the oral cavity or oropharynx.This procedure may lessen hospitalization time and reduce patient's distress.

Tracheotomy

10.2174/1874428101004010073

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Delayed Administration of Thrombolysis for Cardiac Arrest due to Pulmonary Embolism: Case Report and Review of the Literature

Pinchas Halpern Patrick Sorkine Nimrod Adi Sharon Klier Ora Fried

The use of thrombolytic therapy during CPR in massive pulmonary embolism (PE) has been recognized. Ongoing areas of debate include optimal techniques, aiding in the diagnosis of fatal PE, and the use of thrombolysis or embolectomy in cardiac arrest due to PE. We report a case of Pulseless Electrical Activity (PEA) due to massive PE, successfully treated with a single bolus of streptokinase, and discuss the relevant literature.

Embolectomy

Pulseless electrical activity

Bolus (digestion)

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