Journal of cardiothoracic and vascular anesthesia最新文献

{"title":"Crossing Boundaries: Utilizing Left-sided Impella for Right Ventricular Mechanical Support and Intraoperative Transesophageal Echocardiogram Considerations.","authors":"Yang Gu, Milica Bjelic, Kunal Panda, Julie Wyrobek, Heather Lander, Isaac Wu, Bartholomew Simon, Bryan Barrus","doi":"10.1053/j.jvca.2024.12.018","DOIUrl":"https://doi.org/10.1053/j.jvca.2024.12.018","url":null,"abstract":"<p><strong>Objective: </strong>Right ventricular failure is a leading cause of mortality among patients with various etiologies of cardiogenic shock. This case series outlines an innovative approach to directly unloading the right ventricle with the Impella LD or 5.5 without crossing the tricuspid valve in cases requiring tricuspid valve repair or replacement.</p><p><strong>Design: </strong>Retrospective single-center review.</p><p><strong>Setting: </strong>Single tertiary care university hospital.</p><p><strong>Participants: </strong>Patients who underwent Impella LD or 5.5 insertions for right ventricular support.</p><p><strong>Interventions: </strong>Impella LD or 5.5 inserted directly into the right ventricle via the pulmonary artery.</p><p><strong>Measurements and main results: </strong>Patients' baseline, intraoperative, and immediate postoperative clinical and echocardiographic data were obtained. Of the five consecutive patients with severe preoperative right ventricular failure who underwent surgical tricuspid valve procedures and Impella placement, three of the patients underwent concomitant left heart procedures. The Impella was preemptively inserted before separation from cardiopulmonary bypass in all patients. Four patients were extubated within the first 24 hours and ambulated with the Impella by postoperative day (POD) 3. By POD 10, four patients had sufficient right ventricular recovery to allow for Impella LD explant. One patient died due to septic shock with the right ventricular assist device still in place. One patient was transitioned to comfort measures 29 days after explant of the Impella device.</p><p><strong>Conclusions: </strong>Left-sided Impella can be used to support the right ventricle in patients who have undergone surgical tricuspid valve procedures. It provides direct right ventricular unloading, does not cross a newly replaced or repaired tricuspid valve, and allows early ambulation.</p>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142931902","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":"Intraoperative Stent Thrombosis of a Recently Placed Drug-eluting Stent During Coronary Artery Bypass Grafting.","authors":"Matthew Evers, Theodore Cios, Jonathan Tomasko, Christopher Collins","doi":"10.1053/j.jvca.2024.12.015","DOIUrl":"https://doi.org/10.1053/j.jvca.2024.12.015","url":null,"abstract":"","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142927244","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 Ventricular Outflow Tract Obstruction With Shock From Takotsubo Syndrome: Just as Bad as It Seems?","authors":"Jamel Ortoleva, Ezequiel Rodriguez, Dominic V Pisano","doi":"10.1053/j.jvca.2024.12.021","DOIUrl":"https://doi.org/10.1053/j.jvca.2024.12.021","url":null,"abstract":"","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142927246","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 Efficacy and Safety of Angiotensin II for Treatment of Vasoplegia in Critically Ill Patients: A Systematic Review.","authors":"Yuki Kotani, Martina Lezzi, Carlotta Pia Murru, Ashish K Khanna, Alexander Zarbock, Rinaldo Bellomo, Giovanni Landoni","doi":"10.1053/j.jvca.2024.12.022","DOIUrl":"https://doi.org/10.1053/j.jvca.2024.12.022","url":null,"abstract":"<p><strong>Objectives: </strong>To summarize evidence regarding intravenous angiotensin II administration in critical illness and provide an updated understanding of its effects on various organ dysfunction and renin-angiotensin system (RAS) biomarkers.</p><p><strong>Design: </strong>A systematic review.</p><p><strong>Setting: </strong>A search of PubMed, Embase, and the Cochrane Library from inception to May 3, 2024. Randomized controlled trials (RCTs), nonrandomized trials, quasi-randomized trials, observational studies, case reports, and case series were included. Comparative studies (RCTs and observational studies with comparator) were used for the main analysis.</p><p><strong>Participants: </strong>Critically ill adults and children.</p><p><strong>Interventions: </strong>Intravenous angiotensin II administration.</p><p><strong>Measurements and main results: </strong>Fifty-nine studies with a total of 2,918 participants (5 RCTs, 15 observational studies, and 39 case reports or case series) were analyzed. Septic shock and cardiac surgery were the most common clinical conditions (14 studies for each). In 14 comparative studies (5 RCTs and 9 observational studies), mortality was not different from that in controls, except in 1 observational study. Several studies reported decreased renal replacement therapy use, improved oxygenation and blood pressure response, and decreased rate of myocardial injury with angiotensin II therapy. There was no increase in thrombotic events or adverse events. Angiotensin II therapy reduced renin and angiotensin I levels without affecting other RAS biomarkers.</p><p><strong>Conclusions: </strong>Intravenous angiotensin II has been reported in almost 3000 critically ill patients with diverse types of shock. Despite unclear mortality impacts, angiotensin II seems to confer beneficial effects on several organ systems and RAS derangements, without increasing adverse events.</p>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142970869","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":"Comparison of Manual and Mechanical Ventilation During Intensive Care Unit Transport Following Cardiac Surgery: Impact on Oxygenation, Ventilation, and Hemodynamic Stability.","authors":"Yoshihisa Morita, Taro Kariya, Marc Torjman, Doug Pfeil, Kent Berg, Luigi Vetrugno, Jacob Raphael, Jordan Goldhammer","doi":"10.1053/j.jvca.2024.12.017","DOIUrl":"https://doi.org/10.1053/j.jvca.2024.12.017","url":null,"abstract":"<p><strong>Objectives: </strong>Following cardiac surgery, patients often require ventilatory support during transport to the intensive care unit (ICU). Manual ventilation using a bag valve mask (BVM) is commonly employed; however, mechanical ventilation may sometimes be preferred due to concerns regarding oxygenation, ventilation, and hemodynamic stability. The decision between manual and mechanical ventilation is typically based on clinical experience and surgical factors, as there is no established consensus or robust clinical evidence to guide this choice. The aim of this study was to compare oxygenation, ventilation, and hemodynamic parameters between manual ventilation with a BVM and mechanical ventilation using a transport ventilator.</p><p><strong>Design: </strong>A prospective, single-blinded clinical trial.</p><p><strong>Setting: </strong>A single-center tertiary academic hospital.</p><p><strong>Participants: </strong>A total of 48 patients who underwent cardiac surgery and were transported to the ICU between September 2023 and August 2024 were enrolled.</p><p><strong>Interventions: </strong>Patients meeting the inclusion criteria were randomly assigned to one of two groups: Patients in Arm 1received manual ventilation using a BVM during transport to the ICU; patients in Arm 2 received mechanical ventilation using a transport ventilator during transport to the ICU.</p><p><strong>Measurements and main results: </strong>Percentage changes in the PaO₂/FiO₂ ratio and PaCO₂ pre- and post-transport were not significantly different between the two groups (p = 0.133 and 0.902, respectively). However, hypotension, defined as a >10% decrease in mean arterial pressure, was significantly more frequent in the BVM group than in the mechanical ventilation group (p = 0.00986).</p><p><strong>Conclusions: </strong>In patients who have undergone cardiac surgery, hypotension occurred more frequently in the BVM group than in the mechanical ventilation group during transport to the ICU. However, oxygenation and ventilation parameters were comparable between the two groups.</p>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142931900","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":"Machine Learning for In-hospital Mortality Prediction in Critically Ill Patients With Acute Heart Failure: A Retrospective Analysis Based on the MIMIC-IV Database.","authors":"Jun Li, Yiwu Sun, Jie Ren, Yifan Wu, Zhaoyi He","doi":"10.1053/j.jvca.2024.12.016","DOIUrl":"https://doi.org/10.1053/j.jvca.2024.12.016","url":null,"abstract":"<p><strong>Background: </strong>The incidence, mortality, and readmission rates for acute heart failure (AHF) are high, and the in-hospital mortality for AHF patients in the intensive care unit (ICU) is higher. However, there is currently no method to accurately predict the mortality of AHF patients.</p><p><strong>Methods: </strong>The Medical Information Mart for Intensive Care Ⅳ (MIMIC-Ⅳ) database was used to perform a retrospective study. Patients meeting the inclusion criteria were identified from the MIMIC-Ⅳ database and randomly divided into a training set (n = 3,580, 70%) and a validation set (n = 1,534, 30%). The variates collected include demographic data, vital signs, comorbidities, laboratory test results, and treatment information within 24 hours of ICU admission. By using the least absolute shrinkage and selection operator (LASSO) regression model in the training set, variates that affect the in-hospital mortality of AHF patients were screened. Subsequently, in the training set, five common machine learning (ML) algorithms were applied to construct models using variates selected by LASSO to predict the in-hospital mortality of AHF patients. The predictive ability of the models was evaluated for sensitivity, specificity, accuracy, the area under the curve of receiver operating characteristics, and clinical net benefit in the validation set. To obtain a model with the best predictive ability, the predictive ability of common scoring systems was compared with the best ML model.</p><p><strong>Results: </strong>Among the 5,114 patients, in-hospital mortality was 12.5%. Comparing the area under the curve, the XGBoost model had the best predictive ability among all ML models, and the XGBoost model was chosen as the final model for its higher net benefit. Its predictive ability was superior to common scoring systems.</p><p><strong>Conclusions: </strong>The XGBoost model can effectively predict the in-hospital mortality of AHF patients admitted to the ICU, which may assist clinicians in precise management and early intervention for patients with AHF to reduce mortality.</p>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142949344","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 Impact of Blood Pressure Below Personalized Lower Cerebral Autoregulation Limit on Outcomes After Cardiac Surgery: A Retrospective Study.","authors":"Domagoj Mladinov, Ryan C Godwin, David Benz, Ibukun Mary Folorunso, Dan E Berkowitz, Ryan L Melvin","doi":"10.1053/j.jvca.2024.12.019","DOIUrl":"https://doi.org/10.1053/j.jvca.2024.12.019","url":null,"abstract":"<p><strong>Objective: </strong>The clinical importance of individualized blood pressure management in optimizing cerebral perfusion during cardiac surgery has been well established. However, consensus on blood pressure goals is lacking. The authors studied the associations between cerebral autoregulation metrics, hemodynamic parameters, and postoperative outcomes, and hypothesized that increased time of mean arterial pressure (MAP) below the lower limit of autoregulation (LLA) is associated with major morbidity and mortality (MMOM) incidence.</p><p><strong>Design: </strong>A retrospective, observational study.</p><p><strong>Setting: </strong>A university hospital.</p><p><strong>Participants: </strong>A total of 686 cardiovascular surgeries were included.</p><p><strong>Intervention: </strong>None.</p><p><strong>Measurement and main results: </strong>The area under the time-pressure curve (AUC) for MAP < LLA and time below LLA (AUC_ABP<LLA) were analyzed for associations with stroke, acute kidney injury, low cardiac output syndrome, mechanical ventilation lasting >48 hours, and postoperative mortality (ie, MMOM). There was no significant association between AUC_ABP<LLA and MMOM (p > 0.05). Relationships were observed between components of MMOM-operative mortality (p < 0.05) and low cardiac output syndrome (p < 0.05)-and AUC_ABP<LLA, when controlling for preoperative hemoglobin levels and logistic EuroSCORE.</p><p><strong>Conclusions: </strong>These findings indicate that LLA-related metrics have limited utility for predicting MMOM. Future research should explore their applicability in various contexts and patient cohorts.</p>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2024-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142964577","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":"What Is in a Name? When It Comes to Venoarterial Extracorporeal Membrane Oxygenation, Everything.","authors":"Jamel Ortoleva, Saul Ramirez, Dominic V Pisano, Alex Shapeton","doi":"10.1053/j.jvca.2024.12.010","DOIUrl":"https://doi.org/10.1053/j.jvca.2024.12.010","url":null,"abstract":"","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2024-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142914808","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":"Current Practice Management Guidelines in Neonates and Infants with Isolated Coarctation of the Aorta.","authors":"J C Waldman, R J Ing, M L Stone","doi":"10.1053/j.jvca.2024.12.012","DOIUrl":"https://doi.org/10.1053/j.jvca.2024.12.012","url":null,"abstract":"","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2024-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142927208","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 Advisory for Postoperative Pain Management of Thoracic Surgical Patients: Executive Summary: A Report by Society of Cardiovascular Anesthesiologists.","authors":"Benu Makkad, Timothy Lee Heinke, Raiyah Sheriffdeen, Marie-Louise Meng, Bessie Kachulis, Michael Conrad Grant, Wanda Maria Popescu, Jessica Louise Brodt, Diana Khatib, Christopher L Wu, Miklos D Kertai, Bruce Allen Bollen","doi":"10.1053/j.jvca.2024.12.003","DOIUrl":"https://doi.org/10.1053/j.jvca.2024.12.003","url":null,"abstract":"<p><p>Patients after thoracic surgery experience significant pain that can disrupt normal respiratory mechanics, increase the risk of respiratory complications, and impair recovery. Poorly controlled postoperative pain can develop into persistent postoperative pain. In addition, using opioids for pain control in the thoracic surgical population makes them more susceptible to opioid-related side effects due to their pre-existing comorbidities. The lack of consensus on how to effectively attain pain control in this surgical population has resulted in variability in the analgesic regimens utilized by providers across institutions and practices. The overall goal of this practice advisory is to identify opportunities for improvement in the postoperative pain management of thoracic surgical patients and provide guidance to perioperative providers through the provision of evidence-based recommendations.</p>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2024-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143046832","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}