Journal of cardiothoracic and vascular anesthesia最新文献

{"title":"Self-Directed Virtual Reality-Based Training versus Traditional Physician-Led Teaching for Point-of-Care Cardiac Ultrasound: A Randomized Controlled Study.","authors":"Charlene Khoo, Sagar Sharma, Ryan Ashraf Jefree, Davidson Chee, Zheng Ning Koh, Eunice Xin Yi Lee, Ne-Hooi Will Loh, Balakrishnan Ashokka, Suresh Paranjothy","doi":"10.1053/j.jvca.2024.10.037","DOIUrl":"10.1053/j.jvca.2024.10.037","url":null,"abstract":"<p><strong>Objective: </strong>To assess the learning efficacy of self-directed virtual reality ultrasound simulators as an alternative to traditional physician-led teaching for cardiac point-of-care ultrasound (POCUS) training.</p><p><strong>Design: </strong>Single blinded (observer), noninferiority, parallel group, randomized controlled study.</p><p><strong>Setting: </strong>Tertiary university hospital in Singapore.</p><p><strong>Participants: </strong>Forty-three medical students with no prior formal ultrasound training.</p><p><strong>Interventions: </strong>Participants first completed an e-learning module on basic ultrasonography. Participants' baseline knowledge was subsequently assessed using a multiple-choice question (MCQ) test. Participants were then randomized to either physician-led (PL) teaching or independent learning with a virtual-reality (VR) simulator to learn the 4 cardiac POCUS views. A post-training MCQ test and a practical skills test scored by 2 blinded assessors were conducted. Students repeated the MCQ test and skills test 1 month later.</p><p><strong>Measurements and main results: </strong>The VR group had higher baseline MCQ scores compared to the PL group (mean, 13.4 v 10.7). Immediately post-training, the PL group had a greater improvement in mean MCQ scores (from baseline) and higher total practical scores compared to the VR group (p = 0.03 and p < 0.01, respectively). At 1 month post-training, the PL group similarly had a greater mean change from baseline MCQ scores, but this difference was not statistically significant (p = 0.12). For practical scores, the VR group scored higher than the PL group, although this difference was not statistically significant (p = 0.06).</p><p><strong>Conclusions: </strong>Our study demonstrates that at 1 month post-training, self-directed VR training was noninferior to PL training. Although differences observed were not significant, there were trends to suggest enhanced retention of knowledge and skills with VR learning.</p>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":"95-103"},"PeriodicalIF":2.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142692967","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":"Like Mother, Like Daughter: A Case of Peripartum Spontaneous Coronary Artery Dissection.","authors":"Sherman Yu, Richa Dhawan, Eleanor S Kenny, Jennifer M Banayan, Natalie J Bodmer, Louise Y Sun, Daryl Oakes","doi":"10.1053/j.jvca.2024.09.011","DOIUrl":"10.1053/j.jvca.2024.09.011","url":null,"abstract":"","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":"292-300"},"PeriodicalIF":2.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142375438","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":"The Latest Consensus on Angiotensin II: Still More Work to Be Done.","authors":"Liliya Pospishil, Daniel A Kinney, Andrew P Notarianni","doi":"10.1053/j.jvca.2024.10.034","DOIUrl":"10.1053/j.jvca.2024.10.034","url":null,"abstract":"","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":"4-7"},"PeriodicalIF":2.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142621099","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":"Does an Enhanced Recovery After Cardiac Surgery Protocol With On-Table Extubation Improve Patient Outcome and Satisfaction?","authors":"Adelina S Werner, Maik Foltan, Marcus Creutzenberg, Bernhard M Graf, Andrea Stadlbauer, Maria Tafelmeier, Michael Arzt, Bernhard Floerchinger, Christof Schmid, Diane Bitzinger","doi":"10.1053/j.jvca.2024.11.002","DOIUrl":"10.1053/j.jvca.2024.11.002","url":null,"abstract":"","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":"328-329"},"PeriodicalIF":2.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142695430","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":"Absence of Early Diastolic Wave in Mitral Doppler Waveform due to Electromechanical Dissociation after Mitral Valve Replacement.","authors":"Dodda Brahmam, Saravana Babu, Subin Sukesan, Mamatha Munaf, Shrinivas Gadhinglajkar","doi":"10.1053/j.jvca.2024.10.016","DOIUrl":"10.1053/j.jvca.2024.10.016","url":null,"abstract":"","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":"333-335"},"PeriodicalIF":2.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142568603","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":"Con: Is the Radial Artery the Ideal Location for Invasive Blood Pressure Monitoring in Cardiac Surgery?","authors":"Bayli Zimmerman, Nayer Toma, Rafal Kopanczyk, Ryan Dalton, Samiya Saklayen","doi":"10.1053/j.jvca.2024.10.007","DOIUrl":"10.1053/j.jvca.2024.10.007","url":null,"abstract":"","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":"313-316"},"PeriodicalIF":2.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142568623","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":"Levosimendan in Patients with Low Cardiac Output Syndrome After Cardiac Surgery: A Substudy of the Multicenter Randomized CHEETAH Trial.","authors":"Vladimir Boboshko, Vladimir Lomivorotov, Pavel Ruzankin, Sergey Khrushchev, Liudmila Lomivorotova, Fabrizio Monaco, Maria Grazia Calabrò, Marco Comis, Tiziana Bove, Antonio Pisano, Alessandro Belletti","doi":"10.1053/j.jvca.2024.10.003","DOIUrl":"10.1053/j.jvca.2024.10.003","url":null,"abstract":"<p><strong>Objective: </strong>To test the hypothesis that levosimendan administration in patients with low cardiac output syndrome after cardiac surgery is associated with improved long-term (5-year follow-up) outcomes.</p><p><strong>Design: </strong>Single-center subanalysis of the multicenter randomized CHEETAH trial.</p><p><strong>Setting: </strong>Cardiac surgery department of a tertiary hospital.</p><p><strong>Participants: </strong>A total of 134 adult patients requiring hemodynamic support for a cardiac index <2.5 L/min/m² after cardiac surgery with cardiopulmonary bypass (CPB).</p><p><strong>Interventions: </strong>Patients were randomized (1:1 ratio) to receive levosimendan (continuous infusion with a starting dose of 0.05 μg/kg/min) or placebo, in addition to standard inotropic care.</p><p><strong>Measurements and main results: </strong>The primary endpoint was long-term mortality (1-5 years) after randomization. Secondary outcomes were hemodynamic parameters, need for inotropic support, acute kidney injury (AKI), need for renal replacement therapy, duration of mechanical ventilation, intensive care unit (ICU) and hospital stay, and 30-day mortality. No significant between-group difference in long-term mortality (5 years) was observed (hazard ratio, 1.59; 95% confidence interval, 0.81 to 3.11; p = 0.17). There were no significant differences in secondary outcomes, except for the difference in the mean pulmonary artery pressure at 4 to 6 hours after randomization, which was lower in the levosimendan group compared to the placebo group (median, 24 [interquartile range (IQR), 21.8-28] mmHg vs 26 [IQR, 22.2-33] mmHg; p = 0.019).</p><p><strong>Conclusions: </strong>Among patients requiring hemodynamic support after cardiac surgery with CPB, perioperative levosimendan infusion did not affect long-term survival (1-5 years) compared with placebo. Levosimendan also had no effect on major clinical outcomes such as AKI, ICU stay, hospital stay, and 30-day mortality.</p>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":"151-161"},"PeriodicalIF":2.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142557900","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":"Remimazolam in Cardiac Anesthesia: Not So \"Ultra-short Acting\" After All.","authors":"Fabrizio Monaco, Alice Bottussi, Gaia Barucco, Jacopo D'Andria Ursoleo","doi":"10.1053/j.jvca.2024.10.008","DOIUrl":"10.1053/j.jvca.2024.10.008","url":null,"abstract":"","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":"327-328"},"PeriodicalIF":2.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142501016","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":"Coronary Artery Bypass Graft Surgery with Cardiopulmonary Bypass after Craniotomy for Acute Subdural Hematoma.","authors":"Moataz Maher Emara, Mohamed Ragab Ebeid, Mahmoud Nabil Badr Eldin, Mohamed Ali Elhelw, Ahmed Abdellatif Elsayed, Fetoh Alaa Eldin, Shady Elhadidi, Wael Abdelaziz, Mahmoud Abdelfattah","doi":"10.1053/j.jvca.2024.10.011","DOIUrl":"10.1053/j.jvca.2024.10.011","url":null,"abstract":"","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":"335-336"},"PeriodicalIF":2.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142568649","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":"Utility of Frailty Index in Predicting Adverse Outcomes in Patients With the Same American Society of Anesthesiologists Class in Video-assisted Thoracoscopic Surgery.","authors":"Thor S Stead, Tzong-Huei Herbert Chen, Andrew Maslow, Shyamal Asher","doi":"10.1053/j.jvca.2024.10.028","DOIUrl":"10.1053/j.jvca.2024.10.028","url":null,"abstract":"<p><strong>Objectives: </strong>To investigate the utility of the five-item Modified Frailty Index (MFI-5) as a preoperative risk-stratification tool in video-assisted thoracoscopic surgery (VATS) for patients with the same American Society of Anesthesiologists (ASA) class.</p><p><strong>Design: </strong>This was a retrospective cohort study utilizing data from The American College of Surgeons' National Surgical Quality Improvement Program (NSQIP) database from 2008 to 2021.</p><p><strong>Setting: </strong>The NSQIP includes 685 participating hospitals in all 50 states, the majority being large, academic medical centers.</p><p><strong>Participants: </strong>All patients undergoing VATS were identified via CPT codes in the deidentified NSQIP dataset. Patients with invalid values for any variables of interest or significant covariates were excluded.</p><p><strong>Interventions: </strong>No interventions were applied to any patients in this retrospective cohort study.</p><p><strong>Measurements and main results: </strong>69,145 patients undergoing VATS were included, with the largest number having single lobectomy (32%) or unilateral wedge resection (26%). A total of 1,277 (1.8%) had unplanned reintubation, and 1,155 (1.7%) had ventilator dependence (VentDep) >48 hours after surgery. Of these patients, 66% were ASA class 3. Overall, ASA classification had a stronger correlation with both VentDep rates (adjusted R² difference: +6.1%) and reintubation rates (adjusted R² difference: +1.5%) than the MFI-5 score. However, combining ASA class with MFI-5 score was a stronger predictor for both primary outcomes than the ASA class alone (adjusted R² difference: +1.5%, p < 0.001). The MFI-5 had the strongest correlation with both outcomes among ASA class 3 patients, demonstrating exponentially increasing odds of VentDep and reintubation (MFI 3 v MFI 0: odds ratio = 5.1 [3.7, 7], p = 0.002). MFI-5 also helped classify risk within ASA class 2 patients but not as reliably as for ASA class 3 (ASA class 2 reintubation: increased probability from MFI 0-1 and 1-2; VentDep: increased probability from MFI 0-1 only, p = 0.005).</p><p><strong>Conclusions: </strong>The MFI-5 is a comorbidity-based scale that can be calculated preoperatively and considers distinct, but complementary information to the ASA class. Among VATS patients with identical ASA classes 2 and 3, the MFI-5 further stratified risk for reintubation and ventilator dependence >48 hours postsurgery.</p>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":"187-195"},"PeriodicalIF":2.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142621103","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}