Seminars in Cardiothoracic and Vascular Anesthesia最新文献

{"title":"The Effect of Transport Manual and Mechanical Ventilation on Hemodynamics Change: Randomized Clinical Trial.","authors":"Yoshihisa Morita, Tomoki Sakata, Yuki Nakamura, Yuta Kikuchi, Jia Wang, Daisuke Kaneyuki, Taro Kariya, Jacob Raphael","doi":"10.1177/10892532251383583","DOIUrl":"https://doi.org/10.1177/10892532251383583","url":null,"abstract":"<p><p><b>Background:</b> Ventilation methods during ICU transport after cardiac surgery are critical. This study aimed to assess the effects of manual and mechanical ventilation on post-transport hypotension in patients undergoing cardiac surgery. <b>Methods:</b> This prospective clinical trial was conducted at a tertiary academic hospital. Adult patients who underwent open heart surgery were randomized to either (1) manual ventilation or (2) mechanical ventilation during transport. The primary outcomes were the hemodynamic parameters change. The secondary outcomes were the PaO2/FiO2 ratio and PaCO2 change. <b>Results:</b> A total of 78 patients were randomized into two groups: manual ventilation (n = 39) and mechanical ventilation (n = 39). Significant hypotension (>20% drop in mean arterial pressure post-transport) was noted in nine patients in the manual ventilation arm, but not in any patient in the mechanical ventilation arm. In manually ventilated patients, receiver operating characteristic curve analysis of systemic vascular resistance for significant hypotension showed that the area under the curve was 0.962 (95% CI, 0.891-1). No mechanically ventilated patients had significant hypotension. No significant difference was observed in % change in PaO2 and PaCO2 between the manual and mechanical ventilation arms. <b>Conclusion:</b> This study demonstrated that significant post-transport hypotension was more common in the manually ventilated arm than in the mechanically ventilated arm. No significant differences in oxygenation or ventilation were observed between the groups. The low systemic vascular resistance showed excellent predictive value for significant post-transport hypotension. Further research is warranted to identify patient-specific risk factors to enhance transportation safety.</p>","PeriodicalId":46500,"journal":{"name":"Seminars in Cardiothoracic and Vascular Anesthesia","volume":" ","pages":"10892532251383583"},"PeriodicalIF":1.0,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145139063","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of Preoperative Cannabis Use on Postoperative Pain and Outcomes Following Cardiothoracic Surgery.","authors":"Sareena Shah, Paul Fletcher, Kareem Hamadah, Drake Gilmore, Bryant Staples, Andrea Chadwick, Jianghua He, Jaromme Kim, Brigid Flynn","doi":"10.1177/10892532251374952","DOIUrl":"https://doi.org/10.1177/10892532251374952","url":null,"abstract":"<p><p>Cannabis use has grown both recreationally and medicinally in the United States over the past decades, alongside increased legalization and social acceptance. However, there remains little research investigating the effects of preoperative cannabis use on postoperative pain in patients undergoing surgery. We conducted a single-center prospective study in adults undergoing cardiac surgery via sternotomy. Patients seen for preoperative consultation in clinic were asked a standardized survey about cannabis use. Clinical data was collected via chart review. Primary outcomes were morphine equivalents in the first 48 hours postoperatively and Visual Analog Scale (VAS) scores. Secondary outcomes were time to extubation, postoperative nausea/vomiting, ICU length of stay (LOS), reoperation, and in-hospital mortality. The non-cannabis user group had 50 patients, and the cannabis user group had 23 patients. Average morphine equivalents in the first 48 hours were similar between cannabis users and non-users (60.98 vs 59.90; <i>P</i> = 0.93), as were VAS scores at 24 hours (5.52 vs 4.84; <i>P</i> = 0.414) and 48 hours (4.74 vs 3.90; <i>P</i> = 0.23). Average time to extubation (minutes) was nearly identical between cannabis users and non-users (718.41 vs 718.67; <i>P</i> = 0.99). There was also no significant difference in average LOS (days) between cannabis users and non-users (2.91 vs 3.48; <i>P</i> = 0.26). There were no differences in postoperative nausea/vomiting, reoperation, or in-hospital mortality. In patients undergoing cardiac surgery via sternotomy, there was no effect of cannabis use on any outcomes, including morphine equivalents, Visual Analog Scale scores, time to extubation, ICU length of stay, postoperative nausea or vomiting, reoperation, or in-hospital mortality.</p>","PeriodicalId":46500,"journal":{"name":"Seminars in Cardiothoracic and Vascular Anesthesia","volume":" ","pages":"10892532251374952"},"PeriodicalIF":1.0,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144993693","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Corrigendum to \"A Year of Advances in Cardiac Surgery, Transplantation, and Anesthetic Management\".","authors":"","doi":"10.1177/10892532251358936","DOIUrl":"https://doi.org/10.1177/10892532251358936","url":null,"abstract":"","PeriodicalId":46500,"journal":{"name":"Seminars in Cardiothoracic and Vascular Anesthesia","volume":" ","pages":"10892532251358936"},"PeriodicalIF":1.0,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145001684","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of Perioperative Non-Invasive Right Ventricular Myocardial Work in Left Ventricular Assist Device Implantation.","authors":"Katharina Seuthe, Benjamin Schuldes, Parwis Rahmanian, Henrik Ten Freyhaus, Bernd W Böttiger, Wolfgang A Wetsch, Michael Vandenheuvel, Eckhard Mauermann, Jakob Labus","doi":"10.1177/10892532251343169","DOIUrl":"10.1177/10892532251343169","url":null,"abstract":"<p><p><b>Background:</b> The novel method of non-invasive right ventricular (RV) myocardial work (MW) analysis provides a load-independent assessment of RV function by combining myocardial strain with loading conditions. However, its use has not been well described in the perioperative setting to date. We aimed to evaluate the feasibility of assessing RV MW, and to describe the perioperative course of this new technique. <b>Methods:</b> In this retrospective study, patients scheduled for LVAD surgery were evaluated for feasibility of RV MW analysis. Preoperative (T1) and postoperative (T2) transthoracic echocardiography (TTE) included the assessment of conventional echocardiographic measurements, myocardial strain, global work index (GWI), global constructive work (GCW), global wasted work (GWW), and global work efficiency (GWE) for the evaluation of RV function. <b>Results:</b> Ten patients had complete TTE data available for RV MW analysis, which indicated significant reduction of effective and ineffective RV MW (GWI, 212 mmHg% (IQR 128; 266) v 96 mmHg% (IQR 63; 150), <i>P</i> = 0.02; GCW, 331 mmHg% (IQR 263; 476) v 198 mmHg% (IQR 136; 274), <i>P</i> < 0.01; GWW, 171 mmHg% (IQR 102; 243) v 98 mmHg% (IQR 48; 153), <i>P</i> = 0.04), while GWE remained stable (69% (IQR 37; 78) v 64% (IQR 61; 78), <i>P</i> = 0.26) after LVAD implantation. Conventional parameters were not able to detect these changes. Moreover, there were different trends of RV MW indices in patients with and without postimplant RV failure. <b>Conclusion:</b> This study demonstrates that non-invasive RV MW assessment is feasible in the perioperative setting of LVAD implantation and provides valuable insights into RV function that are not captured by conventional echocardiographic methods. Further research is warranted to validate these findings.</p>","PeriodicalId":46500,"journal":{"name":"Seminars in Cardiothoracic and Vascular Anesthesia","volume":" ","pages":"182-191"},"PeriodicalIF":1.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144095387","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Association of New Onset Postoperative Atrial Fibrillation and Abnormal P-Terminal Force in Lead V1 After On-Pump Cardiac Surgery.","authors":"Mirjana Gander, Joanna Kochanska-Bieri, Firmin Kamber, Denis Berdajs, David Santer, Daniel Bolliger, Eckhard Mauermann","doi":"10.1177/10892532251321062","DOIUrl":"10.1177/10892532251321062","url":null,"abstract":"<p><p><b>Introduction:</b> Postoperative atrial fibrillation (POAF) after cardiac surgery is associated with higher morbidity and mortality. This paper presents several studies that conclude the presence of an aberrant p-terminal force vector in lead V1 (PTFV1) has been identified as a significant predictor of atrial fibrillation in the non-surgical population. It is uncertain whether or not there is an association of PTFV1 and new-onset POAF in patients after cardiac surgery. <b>Methods:</b> In this secondary analysis, adult patients undergoing on-pump cardiac surgery for aortocoronary bypasses, valve surgery, combined bypass, and valve surgery were analyzed from 12/2018 to 08/2020. Patients who had a previous occurrence of atrial fibrillation or atrial flutter, patients with pacemakers and/or Implantable Cardioverter-Defibrillators (ICDs), and those who did not have an electrocardiogram (ECG) performed within the 3 months before surgery were excluded. In addition, ECGs that were considered to be of low quality were also removed. Preoperative 12-lead ECGs were examined and the PTFV1 was measured. Secondarily, we examined the P-wave length in lead II, the area under the P-wave in lead II, PR interval, and QRS duration in lead V1 and II. The occurrence of POAF was extracted from the hospital record. <b>Results:</b> Out of a total of 252 patients, 62 patients (24.6%) developed new onset POAF during their hospital stay. POAF occurred primarily in older patients, with poor renal function, and exhibited larger left atria. Analysis of ORs (odds ratios) revealed that age, creatinine clearance, valve surgery, and left atrial volume index (LAVI) were associated with POAF. In the context of the multivariable analysis, it was demonstrated that only age presented a significant correlation with postoperative atrial fibrillation (POAF). There was no observed relationship between any of the parameters based on ECG and the occurrence of POAF. <b>Conclusion:</b> No association was found between PTFV1 or other ECG-based measurements and new onset POAF in cardiac surgery patients. Age was the only independent predictor of POAF.</p>","PeriodicalId":46500,"journal":{"name":"Seminars in Cardiothoracic and Vascular Anesthesia","volume":" ","pages":"168-181"},"PeriodicalIF":1.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12340142/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143417073","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Response on Rapid Review to Inform Policy Guidance on Welsh Respiratory ECMO Provision.","authors":"Manish Pandey","doi":"10.1177/10892532251325653","DOIUrl":"10.1177/10892532251325653","url":null,"abstract":"<p><p>Internationally, extracorporeal membrane oxygenation (ECMO) is now a core and standard organ support tool to provide tertiary critical care and cardiac services within a network of hospitals and a key tool for running an effective and efficient cardio-respiratory pathways. The letter aims to put the spotlight on some of the missing clinical evidence on respiratory ECMO and including them will help to arrive at a better-informed national ECMO policy decision.</p>","PeriodicalId":46500,"journal":{"name":"Seminars in Cardiothoracic and Vascular Anesthesia","volume":" ","pages":"203-208"},"PeriodicalIF":1.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143617296","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prognostic Value of Perioperative Near-Infrared Spectroscopy Monitoring for Postoperative Acute Kidney Injury in Pediatric Cardiac Surgery: A Systematic Review.","authors":"Cornelia K Niezen, Marco Modestini, Dario Massari, Arend F Bos, Thomas W L Scheeren, Michel M R F Struys, Jaap Jan Vos","doi":"10.1177/10892532251316682","DOIUrl":"10.1177/10892532251316682","url":null,"abstract":"<p><p>IntroductionPostoperative acute kidney injury (AKI) is a common postoperative complication in cardiac surgery, with varying reported incidences and prognostic factors. Renal hypoperfusion is believed to be a key factor contributing to postoperative AKI. Near-infrared spectroscopy (NIRS) monitoring, which assesses regional tissue saturation (RSO₂), has been suggested as a tool to predict postoperative AKI. The aim of this systematic review was to examine the prognostic value of perioperative NIRS monitoring in predicting postoperative AKI in pediatric patients.Methods and ResultsAfter a systematic search in PubMed, EMBASE, and Cochrane library, twenty studies (1517 patients) were included. The inter-rater agreement on study quality was strong, yet a high risk of bias was identified.ConclusionThe heterogeneity of the results-in part attributable to several potential confounding factors regarding study population, monitoring technique and the definition of AKI-together with the lack of a clear and consistent association between RSO₂ values and AKI, currently preclude recommending NIRS monitoring as a reliable and valid clinical tool to \"predict\" AKI in the individual patient.</p>","PeriodicalId":46500,"journal":{"name":"Seminars in Cardiothoracic and Vascular Anesthesia","volume":" ","pages":"209-218"},"PeriodicalIF":1.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12340143/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143392306","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Flash Pulmonary Edema and Respiratory Failure in a Preeclamptic Patient Requiring Intrapartum Extracorporeal Membrane Oxygenation.","authors":"Jeffrey Park, Kathleen A Smith, Anthony G Charles, Alan M Smeltz","doi":"10.1177/10892532251348054","DOIUrl":"10.1177/10892532251348054","url":null,"abstract":"<p><p>Flash pulmonary edema can affect up to 10% of women with preeclampsia. Although there is growing literature describing the use of extracorporeal membrane oxygenation (ECMO) in pregnant patients, there is very little research describing its use in the setting of preeclampsia. In this case report, an encouraging story of a woman with this complication who was successfully managed is described. In addition, the impact of normal physiologic changes of pregnancy on ECMO management is discussed.</p>","PeriodicalId":46500,"journal":{"name":"Seminars in Cardiothoracic and Vascular Anesthesia","volume":" ","pages":"225-229"},"PeriodicalIF":1.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144151831","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"ECMO for Adult Respiratory Failure: A Rapid Review of Clinical and Service Delivery Evidence to Guide Policy in Wales.","authors":"Michal Pruski, Michael Beddard, Susan O'Connell, Andrew Champion, Rhys Morris, Richard Pugh, Iolo Doull","doi":"10.1177/10892532241309787","DOIUrl":"10.1177/10892532241309787","url":null,"abstract":"<p><p>BackgroundWhile several studies have summarised the clinical effectiveness evidence for extracorporeal membrane oxygenation (ECMO), there are no evidence syntheses of the impact of centres' ECMO patient volume on patient outcomes or the impact of bedside ECMO care being delivered by either a perfusionist or a nurse. There is also limited information on the cost-effectiveness of ECMO.PurposeThis review was carried out to evaluate the clinical effectiveness and cost of different service delivery models of pulmonary ECMO to inform NHS Wales commissioning policy.Research DesignThe study utilised rapid review methodology, consisting of a systematic literature search and the inclusion of the highest quality of evidence available.Data CollectionOut of 1997 records identified via literature searches, 12 studies fell within the scope. The 2 meta-analyses comparing ECMO with lung-protective ventilation favoured ECMO.ResultsFive studies looking at the clinical impact of centre patient volume had large heterogeneity. Three studies estimated that with sufficient patient volume, nurse-delivered ECMO was cost-saving, with thresholds varying between 92 and 155 patient days per year. Three studies looked at the cost impact of ECMO delivery, with ECMO being cost incurring, but potentially cost-effective, with costs per patient being lower at higher volume centres.ConclusionsThe available evidence supports the use of ECMO in adult respiratory failure patients, despite it being cost-incurring. ECMO can be nurse-delivered without a significant negative impact on patient care. Yet decision-makers need to consider their local circumstances when making commissioning decisions.</p>","PeriodicalId":46500,"journal":{"name":"Seminars in Cardiothoracic and Vascular Anesthesia","volume":" ","pages":"192-202"},"PeriodicalIF":1.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12340146/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142878291","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Innovations in Risk Assessment, Monitoring, and Management in Cardiothoracic and Vascular Anesthesia.","authors":"Kevin A Maar, Andrea Szekely, Benjamin Abrams, Miklos D Kertai","doi":"10.1177/10892532251366444","DOIUrl":"10.1177/10892532251366444","url":null,"abstract":"","PeriodicalId":46500,"journal":{"name":"Seminars in Cardiothoracic and Vascular Anesthesia","volume":"29 3","pages":"165-167"},"PeriodicalIF":1.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144875878","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}