Journal of cardiothoracic and vascular anesthesia最新文献

{"title":"Postoperative Sore Throat Following Double-lumen Tube Insertion in Adults Undergoing Surgery: A Scoping Review.","authors":"Pooja Bihani, Devishree Das, Rishabh Jaju, Satyajeet Misra","doi":"10.1053/j.jvca.2025.08.031","DOIUrl":"https://doi.org/10.1053/j.jvca.2025.08.031","url":null,"abstract":"<p><p>Double-lumen tubes (DLTs) are associated with a high incidence of postoperative sore throat (POST). The aim of this scoping review was to map the current evidence for POST prevention following DLT use in adults and identify knowledge gaps. Literature search was conducted via standard electronic search engines. Randomized controlled trials (RCTs) involving adult patients undergoing surgeries with DLTs, where POST (incidence or severity) was reported as a primary outcome, were included. Twelve RCTs involving 1,632 patients were included in this review. Most studies were of good quality. The maximum incidence of POST (56.4%) and hoarseness of voice (44.3%) was present in the first postoperative hour in the control groups. Even at 24 hours, the incidence of POST was 31.2% in the control groups and 20% in the intervention groups. Several pharmacologic interventions, like benzydamine hydrochloride spray, intravenous dexamethasone, esketamine gargle, and superior laryngeal nerve blocks, were used to reduce POST following DLT use. Nonpharmacologic strategies, including the use of silicone DLTs, thermal softening techniques, and optimized intubation maneuvers, were also effective in reducing POST. With preemptive pharmacologic interventions, the incidence of POST ranged from 7.22% to 31% in the first hour, while for nonpharmacologic methods, the incidence was 30% to 45.9%. The review identified several areas where credible research is lacking, including the absence of studies focusing on patient-centric outcomes or the development of composite scoring systems. Similarly, there is minimal research on the use of artificial intelligence, simulation training, and three-dimensional printing to decrease POST following DLT use.</p>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145080266","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":"Changes in Respiratory Variation of Velocity-Time Integral and Peak Velocity of Left Ventricular Outflow Tract after Tidal Volume Challenge Predict Fluid Responsiveness in Elderly Patients with Low Tidal Volume Ventilation: A Prospective Observational Study.","authors":"Jing-Jie Wan, Jin Xie, Ke Peng, Jun Chen, Yu-Kun Zhang, Fu-Hai Ji","doi":"10.1053/j.jvca.2025.08.028","DOIUrl":"https://doi.org/10.1053/j.jvca.2025.08.028","url":null,"abstract":"<p><strong>Objective: </strong>We hypothesized that changes in respiratory variation of velocity-time integral (ΔVTI) and peak velocity (ΔVpeak) of left ventricular outflow tract after tidal volume challenge (TVC) better predict fluid responsiveness in elderly patients with low tidal volume ventilation.</p><p><strong>Design: </strong>A prospective observational study.</p><p><strong>Setting: </strong>A tertiary teaching hospital.</p><p><strong>Participants: </strong>Ninety-six critically ill elderly patients without arrhythmias under mechanical ventilation were enrolled in this study.</p><p><strong>Interventions: </strong>TVC was performed by increasing the tidal volume from 6 to 8 mL/kg of predicted body weight. Passive leg raising was performed to identify fluid responders (increase in stroke volume >10%).</p><p><strong>Measurement and main results: </strong>Pulse pressure variation (PPV), ΔVTI, and ΔVpeak were measured before and 1 minute after TVC. Receiver operating characteristic curves and gray zones were used to assess the ability of changes in PPV (ΔPPV_TVC), ΔVTI (ΔVTI_TVC), and ΔVpeak (ΔVpeak_TVC) after TVC to predict fluid responsiveness. The mean age was 75 years, and 75% were male. Forty-five (46.9%) patients were the responders. The area under the receiver operating characteristic curves for ΔPPV_TVC to predict fluid responsiveness was 0.89 (95% confidence interval 0.82-0.95, p < 0.001), including 43.8% of patients in the gray zone. ΔVTI_TVC and ΔVpeak_TVC predicted fluid responsiveness with AUCs of 0.96 (95% CI 0.90-0.99, p < 0.001) and 0.94 (95% CI 0.87-0.98, p < 0.001), including 11.5% and 19.8% of patients in the gray zones, respectively.</p><p><strong>Conclusion: </strong>In elderly patients with low tidal volume ventilation, ΔVTI_TVC and ΔVpeak_TVC predicted fluid responsiveness accurately and better than ΔPPV_TVC.</p>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145053521","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":"Combined Fascia Iliaca Compartment-Sciatic Nerve Blocks Reduce Early Cardiovascular Events in Chronic Limb-Threatening Ischemia: A Propensity Score-Matched Retrospective Study.","authors":"Manman Liu, Wanxia Xiong, Jie Liu, Biling Wu, Youwen Chen, Yuejiao Song, Xiaoru Lin, Ming Ding, Chao Liang","doi":"10.1053/j.jvca.2025.08.009","DOIUrl":"https://doi.org/10.1053/j.jvca.2025.08.009","url":null,"abstract":"<p><strong>Objective: </strong>To compare postoperative outcomes between combined fascia iliaca compartment-sciatic nerve blockade (FICB-SNB) and monitored anesthesia care (MAC) in patients with chronic limb-threatening ischemia (CLTI) undergoing lower-extremity revascularization (LER).</p><p><strong>Design: </strong>Retrospective matched cohort study (1:1 propensity score matching).</p><p><strong>Setting: </strong>Single-center analysis of CLTI patients undergoing LER.</p><p><strong>Participants: </strong>216 matched pairs (total n = 432) selected from 505 eligible patients.</p><p><strong>Interventions: </strong>FICB-SNB (n = 216) versus MAC (n= 216).</p><p><strong>Measurements & main results: </strong>Primary outcomes: Compared to MAC, FICB-SNB did not significantly reduce in-hospital major adverse cardiovascular events (MACE) (odds ratio [OR], 0.49; 95% confidence interval [CI], 0.18-1.32; p = 0.15) or 1-year MACE (p > 0.05).</p><p><strong>Secondary outcomes: </strong>FICB-SNB demonstrated superior postoperative analgesia, reducing rest pain by 67% (OR, 0.33; 95% CI, 0.23-0.48; p < 0.001). No differences were observed in myocardial injury after noncardiac surgery, complications, or amputation rates (p > 0.05 for all).</p><p><strong>Conclusions: </strong>FICB-SNB improves analgesia but does not significantly reduce short- or long-term MACE. The trend toward lower in-hospital MACE suggests transient intraoperative cardiovascular stabilization not sustained at 1 year. A prospective randomized trial with standardized protocols to control confounders and validate clinical trends is warranted.</p>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145033225","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":"Prospective Evaluation of Thrombotic Complications After Internal Jugular Vein Cannulation for External Bypass.","authors":"Armin Niklas Flinspach, Kai Zacharowski, Florian Jürgen Raimann, Florian Piekarski","doi":"10.1053/j.jvca.2025.08.027","DOIUrl":"https://doi.org/10.1053/j.jvca.2025.08.027","url":null,"abstract":"<p><strong>Objectives: </strong>To determine the incidence and subsequent complications of internal jugular vein (IJV) thrombosis after cannulation performed during cardiopulmonary bypass (CPB) to ensure adequate venous drainage during minimally invasive cardiac surgery.</p><p><strong>Design: </strong>Single-center observational trial SETTINGS: Intensive care postoperative monitoring of cardiac surgery patients and diagnosis of IJV thrombi at a university tertiary hospital during the 13-month study period from December 1, 2022, to January 11, 2024.</p><p><strong>Participants: </strong>44 patients undergoing catheterization of the IJV for total CPB.</p><p><strong>Intervention: </strong>Structured ultrasound of the IJV at 12 to 16 hours after removing the cannula, in the context of intensive care therapy.</p><p><strong>Measurements & main results: </strong>The incidence of ultrasound-detected IJV thrombi was 79.5%. Thrombi located at the insertion site were smaller compared to those located distally. No major complications were observed during cannula insertion or removal, and none of the patients had clinical symptoms related to IJV thrombi. There were no correlations between cannula size (p = 0.886), intravascular insertion length (p = 0.086), duration of CPB (p = 0.094), or body weight (p = 0.590).</p><p><strong>Conclusions: </strong>Although IJV thrombosis was frequent, all cases remained clinically silent. These findings suggest that although thrombus formation is common, the risk of symptomatic or obstructive thrombosis may be low. Structured ultrasound follow-up and a risk-adapted anticoagulation strategy, as suggested by recent ESVS guidelines, may optimize postoperative management and outcomes.</p>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145015498","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":"Effects of Volatile Sedation Versus Propofol on Time to Extubation in the Intensive Care Unit After Cardiac Surgery: A Systematic Review and Meta-analysis.","authors":"Maria Luisa Garo, Pasquale Rinaldi, Andrea Galderisi, Marta Di Folco, Alessandro Ruggiero, Alessia Mattei, Lorenzo Schiavoni, Giuseppe Nasso, Giuseppe Pascarella, Massimo Chello, Mario Lusini, Rita Cataldo, Massimiliano Carassiti, Felice Eugenio Agrò, Alessandro Strumia","doi":"10.1053/j.jvca.2025.08.025","DOIUrl":"https://doi.org/10.1053/j.jvca.2025.08.025","url":null,"abstract":"<p><strong>Background: </strong>Optimal sedation management is critical in the postoperative care of cardiac surgery patients admitted to the intensive care unit (ICU), where sedative choice may influence respiratory, hemodynamic, and recovery outcomes. Propofol is the most widely used sedative, but volatile anesthetics are gaining interest due to their pharmacologic advantages. This systematic review and meta-analysis was designed to compare volatile anesthetics with propofol for ICU sedation after cardiac surgery, focusing on time to extubation as the primary outcome, and ICU and hospital length of stay, hemodynamic support, and postoperative complications as secondary outcomes.</p><p><strong>Methods: </strong>PubMed, Web of Science, and Scopus were searched from July to October 2024 without language or date restrictions. Eligible studies were randomized controlled trials comparing volatile anesthetics with propofol for postoperative ICU sedation in adult cardiac surgery patients. Studies without extractable data were excluded. Risk of bias was assessed using the Cochrane risk-of-bias 2.0 tool. Meta-analyses were performed using random-effects models.</p><p><strong>Results: </strong>Five randomized controlled trials involving 384 patients were included. Sedation with volatile anesthetics significantly reduced time to extubation compared with propofol (weighted mean difference [WMD] = -55 minutes, 95% CI -93 to -17, p < 0.001), although heterogeneity was high (I² = 95.9%, τ² = 1,731.95, p < 0.001). No significant differences were observed for ICU (WMD = -4.26 hours, 95% CI: -17.07 to 8.55, I² = 89.9%, t² = 143.76, z = -0.65, p = 0.51) or hospital (WMD = -1.94 days, 95% CI: -4.17 to 0.30, I² = 65.1%, t² = 2.53) length of stay. Secondary outcomes (use of vasopressors and/or positive inotropes, postoperative atrial fibrillation, and nausea and/or vomiting) were inconsistently reported and showed no clear pattern.</p><p><strong>Discussion: </strong>Volatile anesthetics reduce extubation time compared with propofol in adult cardiac surgery patients sedated in the ICU. However, evidence on secondary outcomes remains inconclusive due to limited and heterogeneous data.</p>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145053673","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":"Pain Trajectories After Cardiac Surgery Performed Via Midline Sternotomy.","authors":"Negmeldeen Mamoun, Morgan A Rosser, Kamrouz Ghadimi, Omar Al-Qudsi, Michael Cutrone, John Whittle, Brandi Bottiger, Michael Manning","doi":"10.1053/j.jvca.2025.08.015","DOIUrl":"https://doi.org/10.1053/j.jvca.2025.08.015","url":null,"abstract":"<p><strong>Objectives: </strong>Acute pain after cardiac surgery performed via midline sternotomy is reported to be moderate to severe in intensity in up to three-quarters of patients in the early postoperative period. This work was designed to describe different pain trajectories in this patient population. Furthermore, the association between patient baseline and perioperative characteristics and the development of different pain trajectories was investigated.</p><p><strong>Design: </strong>An Institutional Review Board-approved retrospective study.</p><p><strong>Setting: </strong>A single, large quaternary academic hospital.</p><p><strong>Participants: </strong>Adult patients undergoing cardiac surgery via midline sternotomy over a 9-year period.</p><p><strong>Interventions: </strong>Pain trajectories were modeled using Numeric Rating Scale pain scores collected over the first 6 postoperative days. Latent class analysis was employed to identify separate pain trajectory groups using a random-effects linear model.</p><p><strong>Measurement and main results: </strong>The final study cohort consisted of 6,390 patients. Three pain trajectories were identified: well-controlled (n = 1,106, 17.3%), rapidly improving (n = 3,878, 60.7%), and slowly improving (n = 1,406, 22%). When comparing patients in the slowly improving pain trajectory group with the rapidly improving and well-controlled groups, they were significantly younger (both p < 0.001), had higher BMI (both p < 0.001), had a history of and/or current tobacco use (p < 0.001, p = 0.026, respectively), and received significantly more intraoperative and postoperative opioids (both p < 0.001).</p><p><strong>Conclusions: </strong>In this study, one out of five patients had a less favorable, slowly improving pain profile, where pain was uncontrolled in the early postoperative period. Preoperative identification of these patients may allow clinicians to employ additional early interventions, including regional anesthesia, to improve pain control after midline sternotomy.</p>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145053595","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":"Development and Validation of an Online Nomogram Calculator to Predict Postoperative Pneumonia in Elderly Patients with Esophageal Cancer after Transthoracic Esophagectomy.","authors":"Jingjing Liu, Yanfeng Wang, Yanping Wang, Weidong Mi, Qiang Fu","doi":"10.1053/j.jvca.2025.07.033","DOIUrl":"https://doi.org/10.1053/j.jvca.2025.07.033","url":null,"abstract":"<p><strong>Objectives: </strong>Postoperative pneumonia after esophagectomy is common, which may seriously burden elderly patients and aggravate their postoperative conditions. We sought to create an online nomogram calculator to predict postoperative pneumonia in elderly patients with esophageal cancer after transthoracic esophagectomy.</p><p><strong>Design: </strong>Multivariable prediction models.</p><p><strong>Setting: </strong>The Chinese People's Liberation Army (PLA) General Hospital.</p><p><strong>Participants: </strong>Elderly patients (N = 607) underwent transthoracic esophagectomy between January 2012 and December 2019.</p><p><strong>Interventions: </strong>Confirm the occurrence of postoperative pneumonia.</p><p><strong>Measurements and main results: </strong>Univariable and multivariable logistic regression analyses were used to identify independent risk factors for postoperative pneumonia. A nomogram calculator was constructed according to the independent risk factors in the training cohort and then tested in the validation cohort. Multivariable logistic analysis showed that preoperative leukocyte count (p = 0.018), partial pressure of carbon dioxide (pCO₂) (p = 0.024), tumor location (p = 0.038), and operative duration (p < 0.001) were independent risk factors for postoperative pneumonia. We then developed a nomogram calculator using these four factors. The C-statistics of this nomogram in the training, validation, and entire cohorts were 0.680, 0.655, and 0.669, respectively. Risk analysis and decision curve analysis revealed that the nomogram provided good diagnostic power and net benefit.</p><p><strong>Conclusion: </strong>We developed an online nomogram calculator that can predict the risk of postoperative pneumonia in elderly patients with esophageal cancer after transthoracic esophagectomy simply and conveniently.</p>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145040223","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":"Urinary Liver-Type Fatty Acid Binding Protein as a Postoperative Marker of Acute Kidney Injury in Patients Undergoing EndovascularAortic Aneurysm Repair.","authors":"Domenico Abelardo, Pasquale Raimondo, Cristina Santonocito, Alessio Barile, Mauro D'Amora, Andrea Esposito, Martina Maria Giambra, Maria Grazia Lumia, Giovanni Mastrangelo, Danilo Menna, Francesco Murgolo, Angelo Pascarella, Rosetta Salvatore, Rosaria Vignale, Sergio Zacà, Gianluca Paternoster","doi":"10.1053/j.jvca.2025.08.020","DOIUrl":"https://doi.org/10.1053/j.jvca.2025.08.020","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the role of urinary liver-type fatty acid binding protein (L-FABP) in early detection of acute kidney injury (AKI) after endovascular aortic aneurysm repair (EVAR) for abdominal aortic aneurysm (AAA).</p><p><strong>Design: </strong>Prospective, observational, multicenter study.</p><p><strong>Setting: </strong>Four university hospitals from January 2024 to June 2024.</p><p><strong>Participants: </strong>Fifty-nine hospitalized patients with AAA.</p><p><strong>Interventions: </strong>Patients undergoing EVAR were included. Demographic data, comorbidities, and renal function data were recorded at baseline and after intervention. L-FABP data were collected at baseline and at 6 hours and 24 hours after surgery.</p><p><strong>Measurements and main results: </strong>The cohort had a mean age of 70.2 ± 7.3 years and was predominantly male (84.7%). Positive L-FABP results were observed in 24.1% of patients at 6 hours post-EVAR and in 23.7% at 24 hours post-EVAR. A positive L-FABP status at both time points was significantly associated with elevated postoperative serum creatinine (SCr) and reduced estimated glomerular filtration rate (eGFR) (p ≤ 0.015), reduced urine output (p = 0.009 and p < 0.001), and shorter hospital length of stay (LOS) (p = 0.004 and p = 0.013). Multivariable logistic regression analysis fully confirmed these associations. Predictive models incorporating L-FABP achieved high accuracy for identifying patients with reduced diuresis (up to 86.1%). Additionally, L-FABP at 6 hours and 24 hours predicted LOS, whereas SCr and eGFR values did not.</p><p><strong>Conclusion: </strong>Urinary L-FABP is emerging as a sensitive biomarker for AKI in patients undergoing EVAR.</p>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145075003","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":"Left Bundle Branch Area Pacing: Expanding Efficiency, Emerging Mechanisms, and the Next Frontier in Cardiac Physiological Pacing.","authors":"Jordan Holloway, Michael Essandoh, Jonathan Tang","doi":"10.1053/j.jvca.2025.08.012","DOIUrl":"https://doi.org/10.1053/j.jvca.2025.08.012","url":null,"abstract":"","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145033237","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":"Practice Pattern Variability in the Use of Pulmonary Arterial Catheters in Cardiac Surgery.","authors":"Emily J MacKay, Bo Zhang, Joseph M Beaty, Katelyn A Devine, Vikas O'Reilly-Shah, Michael R Mathis, Wilson Y Szeto, Peter W Groeneveld, John G Augoustides","doi":"10.1053/j.jvca.2025.08.013","DOIUrl":"https://doi.org/10.1053/j.jvca.2025.08.013","url":null,"abstract":"<p><strong>Objectives: </strong>To quantify intraoperative pulmonary arterial catheter (PAC) use during cardiac surgery and identify hospital-, anesthesiologist-, and patient-level factors associated with PAC utilization.</p><p><strong>Design: </strong>A cross-sectional, observational study using generalized logistic mixed models to examine variations in PAC use.</p><p><strong>Setting: </strong>Fifty-three US academic hospitals participating in the Multicenter Perioperative Outcomes Group (MPOG) national registry PARTICIPANTS: 145,343 adult patients undergoing cardiac surgery between January 1, 2016, and December 31, 2022.</p><p><strong>Intervention(s): </strong>Receipt of intraoperative PAC, defined by ≥60 minutes of physiologically plausible pulmonary arterial pressures.</p><p><strong>Measurements & main results: </strong>The primary outcome was PAC utilization. Mixed-effects logistic regression quantified fixed-effect predictors, and variation attributable to anesthesiologists and then to anesthesiologists nested within a hospital was characterized using median odds ratio (MOR). Of the 145,343 cardiac surgeries performed across 53 hospitals, 104,626 (72%) included PAC monitoring. PAC use varied widely across hospitals (0-98%) and across anesthesiologists (0-100%). PAC was used most frequently in heart transplants (94%) and lung transplants (87%) and least frequently in pulmonic valve procedures (30%). A patient's likelihood of receiving a PAC was influenced most strongly by hospital (MOR, 15.00; 95% confidence interval [CI], 8.98-28.32), with substantially less variation attributable to an anesthesiologist within the same hospital (MOR, 1.70; 95% CI, 1.61-1.81).</p><p><strong>Conclusions: </strong>Intraoperative PAC monitoring is used in nearly three-quarters of cardiac surgeries at US academic centers, with hospital practice pattern the factor most closely associated with PAC utilization.</p>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145015463","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}