Journal of cardiothoracic and vascular anesthesia最新文献

{"title":"The Prevalence and Prognostic Implications of Elevated Pulmonary Vascular Resistance in Septic Patients.","authors":"Hongmin Zhang, Beijun Gao, Ye Liu, Xiaoting Wang, Qing Zhang","doi":"10.1053/j.jvca.2025.06.012","DOIUrl":"https://doi.org/10.1053/j.jvca.2025.06.012","url":null,"abstract":"<p><strong>Objective: </strong>Pulmonary vascular resistance (PVR) elevation is a critical factor contributing to acute right ventricular (RV) dysfunction. This study was designed to investigate the prevalence and prognostic significance of this condition in septic patients.</p><p><strong>Design: </strong>An observational study.</p><p><strong>Setting: </strong>A tertiary hospital intensive care unit.</p><p><strong>Participants: </strong>A total of 638 septic patients.</p><p><strong>Intervention: </strong>None.</p><p><strong>Measurements and main results: </strong>Hemodynamic, echocardiographic, and prognostic data were collected. PVR was estimated using tricuspid regurgitation and RV outflow tract velocity-time integral. A PVR value exceeding 2.0 Wood units (WU) was considered abnormal. RV systolic dysfunction (RVSD) was determined by tricuspid annular plane systolic excursion, fractional area change, or RV S' velocity. Patients were categorized into four groups: (1) normal RV function (n = 205); (2) isolated RVSD (n = 76); (3) isolated PVR elevation (n = 195), and (4) RVSD + PVR elevation (n = 162). Cox regression analysis revealed that the presence of combined RVSD and PVR elevation was independently associated with 30-day mortality (hazard ratio [HR]: 2.907, 95% confidence interval [CI]: 1.385-6.100, p = 0.005). Conversely, neither isolated RVSD nor isolated PVR elevation was significantly associated with 30-day mortality (HR: 0.617, 95% CI: 0.168-2.274, p = 0.468; HR: 1.074, 95% CI: 0.469-2.461, p = 0.865, respectively). Subgroup analysis revealed that, compared with PVR ≤2.0 WU, PVR >2.0 WU was associated with 30-day mortality in patients with RVSD (HR: 3.878, 95% CI: 1.139-13.203, p = 0.030), but not in those with normal RV systolic function (HR: 1.632, 95% CI: 0.793-3.358, p = 0.183).</p><p><strong>Conclusions: </strong>In septic patients, the combination of elevated PVR and RVSD was an independent predictor of 30-day mortality. However, neither PVR elevation nor RVSD alone was significantly associated with 30-day mortality. Further studies are warranted to elucidate the complex interplay between these factors in septic patients and explore potential therapeutic interventions.</p>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144540276","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Repetition Is Unwelcome-But Sometimes Still Instructive!","authors":"Matthias Heringlake, Lennart Henry Muras, Sascha Treskatsch","doi":"10.1053/j.jvca.2025.06.010","DOIUrl":"https://doi.org/10.1053/j.jvca.2025.06.010","url":null,"abstract":"","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144560237","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sympathetic Crashing Acute Pulmonary Edema During AngioJet Rheolytic Thrombectomy.","authors":"Heitor J S Medeiros, Leah J Lee, A Sassan Sabouri","doi":"10.1053/j.jvca.2025.06.014","DOIUrl":"https://doi.org/10.1053/j.jvca.2025.06.014","url":null,"abstract":"","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144560238","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Delirium After Cardiac Surgery: A Puzzle With Many Pieces.","authors":"Jack Kalin, Alexander Shapeton, Jamel Ortoleva","doi":"10.1053/j.jvca.2025.06.004","DOIUrl":"https://doi.org/10.1053/j.jvca.2025.06.004","url":null,"abstract":"","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144512015","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Advances in Cardiovascular Pharmacotherapy. IV. Sodium-Glucose Cotransporter Type 2 Inhibitors, Part 2: Mechanisms for Myocardial Protection, Adverse Effects, and Perioperative Implications.","authors":"Paul S Pagel, Dustin Hang, Julie K Freed, George J Crystal","doi":"10.1053/j.jvca.2025.06.015","DOIUrl":"https://doi.org/10.1053/j.jvca.2025.06.015","url":null,"abstract":"<p><p>This second part of a two-part review on the cardiovascular pharmacology of sodium-glucose cotransporter type 2 inhibitors (SGLT2i) describes the mechanisms that have been proposed to explain how these drugs improve outcomes in heart failure and myocardial infarction and discusses their adverse effects and perioperative implications for patients with or without diabetes undergoing major surgery. The mechanism(s) by which SGLT2i exert beneficial cardiovascular actions are incompletely understood at present, but they are most likely multifactorial in origin, as no single factor has been proven definitive when considered alone. SGLT2i increase the risk of genital mycotic infections and diabetic ketoacidosis (DKA) in patients with diabetes, but the drugs do not cause severe hypoglycemia requiring intervention, urinary tract infection, hypovolemia, or acute kidney injury, among other postulated adverse outcomes. Perioperative euglycemic DKA (euDKA) is rare, but vigilance for its occurrence is required when an anion gap metabolic acidosis develops despite normal or only modestly elevated glucose concentration. Current guidelines recommend withholding SGLT2i for at least 48 hours to minimize the risk of DKA before elective major surgery in patients with but not without diabetes. The guidelines further emphasize the need to maintain a high index of suspicion for DKA and euDKA when SGLT2i therapy cannot be stopped because of urgent or emergent surgery so that appropriate treatment can be promptly initiated to prevent morbidity and mortality.</p>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144553674","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating the Predictive Performance of Estimated Glomerular Filtration Rate Equations for Acute Kidney Injury Following Coronary Artery Bypass Grafting Surgery: A Multicenter Retrospective Cohort Study.","authors":"Qi Yin, Zikun Wang, Mingliang Li, Zihua Liu, Yangyang Sun, Yilin Pan, Wanyue Dong, Kai Xu, Lixiang Han, Xin Zhao, Yangyang Zhang, Xiaoxin Liu, Zhi Li, Tingting Xu","doi":"10.1053/j.jvca.2025.05.048","DOIUrl":"https://doi.org/10.1053/j.jvca.2025.05.048","url":null,"abstract":"<p><strong>Objectives: </strong>Coronary artery bypass grafting (CABG) is widely used worldwide to treat the growing incidence of coronary artery disease due to population growth and aging. However, postoperative complications, especially acute kidney injury, are a major concern affecting patient outcomes. We aimed to evaluate different estimated glomerular filtration rate calculation methods to predict postoperative acute kidney injury after CABG, highlighting their importance in assessing surgical risk and renal function preoperatively.</p><p><strong>Design: </strong>Retrospective data collection followed by calculation and comparison.</p><p><strong>Setting: </strong>A multicenter retrospective study.</p><p><strong>Participants: </strong>There were 4,904 patients who underwent CABG at four centers (Shanghai Chest Hospital, Qilu Hospital, Jiangsu Province Hospital, and Ningxia General Hospital) from January 2010 to December 2023.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>The research utilized a range of evaluative methodologies, including the receiver operating characteristic curve, polar plot, decision curve analysis, net reclassification index, and integrated discrimination improvement, to evaluate and compare the predictive performance and applicability of the Cockcroft-Gault equation, the Berlin Initiative Study equation, the Chronic Kidney Disease Epidemiology Collaboration equation, and the full age spectrum equation (FAS) across the entire cohort, with particular attention to elderly individuals aged 70 years and older. The FAS equation performed best with an area under the curve of 0.752. In the elderly subgroup, the FAS, Berlin Initiative Study, and Chronic Kidney Disease Epidemiology Collaboration equations demonstrated similar predictive abilities and clinical utility.</p><p><strong>Conclusions: </strong>The FAS equation demonstrated superior predictive performance for the incidence of AKI in both the entire cohort and the elderly cohorts.</p>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144560234","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Beyond the Score: Evaluating Large Language Models for Clinical Use in Anesthesia.","authors":"Hazem Lashin","doi":"10.1053/j.jvca.2025.06.007","DOIUrl":"https://doi.org/10.1053/j.jvca.2025.06.007","url":null,"abstract":"","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144496780","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of Combination of Subcutaneous Lidocaine With Two Different Doses of Nitroglycerin Versus Subcutaneous Lidocaine Alone for Ultrasound-guided Radial Artery Cannulation: A Randomized Controlled Trial.","authors":"Saras Singh, Rajnish Kumar, Nishant Sahay, Shagufta Naaz","doi":"10.1053/j.jvca.2025.05.046","DOIUrl":"https://doi.org/10.1053/j.jvca.2025.05.046","url":null,"abstract":"<p><strong>Objective(s): </strong>To estimate the first-attempt and overall-attempt success rates of radial artery cannulation and to compare the diameters and cross-sectional area (CSA) of the radial artery before and 5 minutes after subcutaneous administration of different doses of nitroglycerin with lidocaine.</p><p><strong>Design: </strong>A double-blinded, randomized controlled study.</p><p><strong>Setting: </strong>A single-center study conducted in a tertiary care hospital.</p><p><strong>Participants: </strong>All adult patients aged 18 to 70 years of either sex belonging to American Society of Anesthesiologists physical status classes I, II, or III.</p><p><strong>Interventions: </strong>Group C: 0.25 mL of 2% lidocaine + 0.25 mL of normal saline Group T1: 0.25 mL of 2% lidocaine + 0.25 mL of nitroglycerin 250 μg. Group T2: 0.25 mL of 2% lidocaine + 0.25 mL of nitroglycerin 500 μg.</p><p><strong>Measurements and main results: </strong>The nitroglycerin groups (500 μg and 250 μg) had higher first-attempt success rates (77.1% and 82.6%) compared with the lidocaine group at 51.1% (p = 0.002, chi-square: 12.61). This could be because the subcutaneous nitroglycerin injection increased the CSA of the radial artery greater than lidocaine (7.13 ± 4.41 mm² and 5.81 ± 4.69 mm²v 1.33 ± 3.93 mm²; analysis of variance F = 25.4, p < 0.001).</p><p><strong>Conclusions: </strong>Subcutaneous infiltration of nitroglycerin before cannulation improved the first-attempt success rate in adult patients and a comparable overall attempt success rate was obtained even with lower doses of nitroglycerin. There was an increase in the diameters of the radial artery, which would have improved the success rate.</p>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144528065","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Scoping Review of Validated Echocardiographic Methods for Grading Right Ventricular Dysfunction: Proposal for an Evidence-Based Multiparametric Framework.","authors":"Jacqueline K Olive, Miguel Yaport, Omar Al-Qudsi, Michael Cutrone, Lior Abramson, Leila Ledbetter, Aaliyah Alvin, Cory J Vatsaas, Carmelo A Milano, Yuriy S Bronshteyn","doi":"10.1053/j.jvca.2025.06.009","DOIUrl":"https://doi.org/10.1053/j.jvca.2025.06.009","url":null,"abstract":"<p><p>Assessing the severity of right ventricular (RV) dysfunction using echocardiography (echo) remains subjective, in part because current guidelines do not recommend how to synthesize various echo parameters to form a global assessment of RV dysfunction. To address this unmet need, this scoping review aimed (1) to identify all multiparametric RV dysfunction scoring systems that use routine echo parameters and (2) to synthesize these models with 2025 guidelines to create a multiparametric framework for RV dysfunction assessment. MEDLINE, EMBASE, and Web of Science databases were searched for studies in adult patients that propose and validate a multiparametric scoring system for grading RV dysfunction. All studies underwent independent review during abstract and full-text screening. Screening of 2,229 initial citations yielded 10 observational studies consisting of diverse cohorts, including, but not limited to, patients with heart failure, undergoing cardiac surgery, and admitted to the intensive care unit. Six validated echo parameters were identified: RV dilation, RV systolic dysfunction (represented by tricuspid annular plane systolic excursion, S', or fractional area change), tricuspid regurgitation, elevated right atrial pressure, RV-pulmonary artery uncoupling (ratio of tricuspid annular plane systolic excursion to pulmonary artery systolic pressure), and paradoxical interventricular septal motion. The studies demonstrated that multiparametric RV dysfunction scores had greater clinical prognostic value than did any individual RV echo parameter alone. Our proposed simple framework for assessing RV dysfunction enables clinicians to use routinely obtained echo data to identify high-risk or subtle RV phenotypes and to guide clinical decision-making in a variety of perioperative, intensive, and emergency care settings.</p>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144540274","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Extracorporeal Cardiopulmonary Resuscitation in Hypothermic Cardiac Arrest: Severe Hypoglycemia Does Not Preclude Survival With Good Neurologic Outcome.","authors":"Michał P Pluta, Tomasz Darocha, Hubert Hymczak, Anna Witt-Majchrzak, Ewelina Nowak, Konrad Mendrala, Barbara Barteczko-Grajek, Sylweriusz Kosiński, Mathieu Pasquier, Krzysztof Kępa, Dominik Drobiński, Rafał Podsiadło, Romuald Lango, Paweł Podsiadło","doi":"10.1053/j.jvca.2025.06.006","DOIUrl":"https://doi.org/10.1053/j.jvca.2025.06.006","url":null,"abstract":"<p><strong>Objective: </strong>Prolonged hypoglycemia can cause irreversible brain damage. Clinicians may thus be reluctant to initiate extracorporeal cardiopulmonary resuscitation in hypothermic cardiac arrest patients with severe hypoglycemia. The aim of this study was to evaluate the survival rate with good neurologic outcomes of patients with hypothermic cardiac arrest and severe hypoglycemia.</p><p><strong>Design: </strong>Retrospective study.</p><p><strong>Setting: </strong>Multicenter study based on data from the HELP Registry.</p><p><strong>Participants: </strong>Adult victims of accidental hypothermia with a core temperature ≤28°C and cardiac arrest who had undergone extracorporeal rewarming between January 2014 and June 2024 were included in the study.</p><p><strong>Interventions: </strong>Patients with initial blood glucose concentration <3 mmol/L (<54 mg/dL) (severe hypoglycemia) were compared with those with glucose level ≥3 mmol/L (≥54 mg/dL). Survival to hospital discharge with favorable neurologic outcome was considered the primary outcome.</p><p><strong>Measurements and main results: </strong>The study population consisted of 127 patients, of whom 21 (17%) presented with glucose concentration <3 mmol/L (<54 mg/dL) on admission to the hospital. By hospital discharge, 8 of 21 patients (38%) with severe hypoglycemia had survived in good neurologic condition. The lowest blood glucose level in a patient who survived without neurologic deficit was 0.9 mmol/L (16 mg/dL). There was no statistically significant difference in survival rates between patients with and without severe hypoglycemia (38% v 43%, p = 0.7).</p><p><strong>Conclusions: </strong>In patients with hypothermic cardiac arrest, severe hypoglycemia on admission to the hospital does not rule out survival with good neurologic outcomes after extracorporeal rewarming.</p>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144528066","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}