INTERNATIONAL ANESTHESIOLOGY CLINICS最新文献

{"title":"Mechanical circulatory support in the intensive care unit.","authors":"Philip Sommer, Mark Nunnally","doi":"10.1097/AIA.0000000000000381","DOIUrl":"https://doi.org/10.1097/AIA.0000000000000381","url":null,"abstract":"Goals for mechanical circulatory support (MCS) have grown from facilitating surgical procedures 1 and supporting respiratory dysfunction 2,3 to minimizing iatrogenic harm, facilitating reha-bilitation, and sustaining patients in cardiogenic shock. MCS in the intensive care unit (ICU) should be thought of as a complete clinical service more than a technology because of the numerous clinical care issues that need to be assessed/addressed. intra-aortic balloon counterpulsation in the ICU setting, mainly on use of extracorporeal membrane oxygenation (ECMO) in the ICU.","PeriodicalId":46852,"journal":{"name":"INTERNATIONAL ANESTHESIOLOGY CLINICS","volume":"60 4","pages":"46-54"},"PeriodicalIF":0.6,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10470411","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":"Total artificial heart system.","authors":"Michael Essandoh, Nicolas Kumar","doi":"10.1097/AIA.0000000000000377","DOIUrl":"https://doi.org/10.1097/AIA.0000000000000377","url":null,"abstract":"Heart failure is a ubiquitous condition affecting over 60 million people globally and causes substantial morbidity and mortality. Conventionally, terminal heart failure is treated with guidelinedirected medical therapy and cardiac resynchronization therapy, which unfortunately becomes refractory over time, and necessitates escalation to advanced therapies or heart transplantation. Heart transplantation is the ultimate therapy for medically refractory advanced heart failure. Still, the limited supply of donor hearts (~4000 yearly) has spurred the development of mechanical circulatory support (MCS) strategies for heart failure treatment as bridge-to-decision making, bridge-to-myocardial recovery, bridge-to-orthotopic heart transplantation (BTT), and destination therapy (DT).","PeriodicalId":46852,"journal":{"name":"INTERNATIONAL ANESTHESIOLOGY CLINICS","volume":"60 4","pages":"39-45"},"PeriodicalIF":0.6,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10096557","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":"Mechanical circulatory support devices in noncardiac surgery.","authors":"Kristin C Trela","doi":"10.1097/AIA.0000000000000374","DOIUrl":"https://doi.org/10.1097/AIA.0000000000000374","url":null,"abstract":"Mechanical circulatory support (MCS) devices are percutaneously or surgically implantable devices that support either the circulatory system, the pulmonary system, or both. Device tech-nology has improved over time, resulting in more patients using MCS, particularly left ventricular assist devices (LVAD). 1 In addition, the COVID-19 pandemic has brought MCS to the forefront due to the utilization of extracorporeal membrane oxygenation (ECMO) to support patients in profound respiratory failure. 2 The increase in MCS patients has led to more patients requiring anesthesia for noncardiac surgery (NCS), which can be secondary to the pathology that required MCS in the fi rst place, a complication of MCS, or an entirely separate pathology. 3 Thus, it is prudent for anesthesiologists to under-stand the basic principles of how these devices work to provide safe anesthetics. This article focuses on the general principles surrounding the preoperative evaluation of the MCS patient presenting for NCS, focusing on the most likely encountered devices in this scenario: the intra-aortic balloon pump (IABP), ECMO, and the LVAD.","PeriodicalId":46852,"journal":{"name":"INTERNATIONAL ANESTHESIOLOGY CLINICS","volume":"60 4","pages":"55-63"},"PeriodicalIF":0.6,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10094178","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":"Mechanical circulatory support devices: historical overview and modern approach.","authors":"Danisa K Daubenspeck","doi":"10.1097/AIA.0000000000000376","DOIUrl":"https://doi.org/10.1097/AIA.0000000000000376","url":null,"abstract":"Heart failure (HF) continues to be a pervasive problem both nationally and globally, and with an aging population its prevalence is only increasing. It is estimated that ~6 million Americans over 20 years old were diagnosed with HF between 2015 and 2018, and projections estimate that the number will be > 8 million by 2030. There have been multiple classification systems developed to help risk stratify, prognosticate, and determine treatment forHF patients. These include theNewYork Heart Association (NYHA) functional classification, the American College of Cardiology (ACC) and American Heart Association (AHA) stages, and The Interagency Registry for Mechanically Assisted Circulation (INTERMACS) profiles. The ultimate goal of these systems is to provide early identification and create a pathway for intervention whether in the form of medical therapy, mechanical circulatory support (MCS), or a combination of both. The termMCS encompasses a wide variety of options ranging from percutaneous temporary devices used as a bridge-to-transplantation (BTT) or myocardial recovery to permanent implantable devices meant as destination therapy (DT). The MCS devices commonly used today include the intraaortic balloon pump (IABP), Impella (Abiomed, Danvers, MA), TandemHeart (LivaNova, London, UK), total artificial heart (TAH), venoarterial and veno-venous extracorporeal membrane oxygenation (VA-ECMO and VV-ECMO), durable left ventricular assist devices (LVAD), and percutaneous right ventricular assist devices (RVAD). Various models and configurations of these listed devices can be used to support the left or right ventricle individually (LV, RV), and some can be used to provide biventricular support. The who, what, andwhen ofMCS requires a multidisciplinary team approach, considering numerous variables in order to provide the optimal therapy for each individual patient. This article presents an overview of the history and indications for MCS, as well as how to select patients for MCS and a brief explanation of available devices.","PeriodicalId":46852,"journal":{"name":"INTERNATIONAL ANESTHESIOLOGY CLINICS","volume":"60 4","pages":"1-7"},"PeriodicalIF":0.6,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10094181","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":"Pulsatile versus nonpulsatile blood flow during cardiopulmonary bypass.","authors":"Mark A Chaney","doi":"10.1097/AIA.0000000000000378","DOIUrl":"https://doi.org/10.1097/AIA.0000000000000378","url":null,"abstract":"Evolution chose pulsatile blood fl ow; man developed pulseless perfusion. ” 1 Controversy surrounding the importance of pulsatile fl ow (PF) dates back to Hippocrates and Aristotle. 2 Development of cardiopulmonary bypass (CPB) in the 1950s accelerated the PF versus nonpulsatile fl ow (NPF) debate, which remains ongoing to this day. 3,4 Numerous animal studies reveal substantial potential bene fi ts of PF when compared with NPF in the acute setting of CPB (hours), but similar such comparisons in humans are not convincing. Increased use of continuous- fl ow left ventricular assist devices (CF-LVAD) has opened the door for quite unique pathophysiological manifestations of chronic NPF (months/ years).","PeriodicalId":46852,"journal":{"name":"INTERNATIONAL ANESTHESIOLOGY CLINICS","volume":"60 4","pages":"8-15"},"PeriodicalIF":0.6,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10087419","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":"Intra-aortic balloon pump counterpulsation: technical function, management, and clinical indications.","authors":"Laura S González, Michelle Grady","doi":"10.1097/AIA.0000000000000379","DOIUrl":"https://doi.org/10.1097/AIA.0000000000000379","url":null,"abstract":"The intra-aortic balloon pump (IABP) was one of the fi rst mechanical circulatory support (MCS) devices invented and 55 years later remains one of the most commonly used. 1 IABPs are used to assist patients with acute coronary syndromes (ACS), cardiogenic shock, or decompensated heart failure (HF), as well as support high-risk patients undergoing cardiac catheterization and surgery. This paper discusses the technology and physiology of IABP counterpulsation, technical aspects of its use, and indications for counterpulsation in a variety of medical and surgical settings. 1 including lung resections, liver resections, cesarean deliveries, hip replacements, and maxillofacial reconstruction.","PeriodicalId":46852,"journal":{"name":"INTERNATIONAL ANESTHESIOLOGY CLINICS","volume":"60 4","pages":"16-23"},"PeriodicalIF":0.6,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10094182","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":"Mechanical circulatory support: complications, outcomes, and future directions.","authors":"Daniel S Cormican, Claire Madden, Marc F Rodrigue","doi":"10.1097/AIA.0000000000000373","DOIUrl":"https://doi.org/10.1097/AIA.0000000000000373","url":null,"abstract":"Mechanical circulatory support (MCS) has expanded con-siderably over the past decade; conditions that were once considered invariably terminal (or at least without therapeutic option) are now routinely offered MCS, often with favorable results. However, complications associated with MCS can be fatal, intended results from therapy are not always achieved, and improvements in currently existing devices are needed. We provide a contemporary review of the complications, outcomes, and future directions of MCS.","PeriodicalId":46852,"journal":{"name":"INTERNATIONAL ANESTHESIOLOGY CLINICS","volume":"60 4","pages":"72-80"},"PeriodicalIF":0.6,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10097815","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":"Ethical issues surrounding mechanical circulatory support.","authors":"Victoria Yin, Baddr A Shakhsheer, Peter Angelos, Sean C Wightman","doi":"10.1097/AIA.0000000000000372","DOIUrl":"https://doi.org/10.1097/AIA.0000000000000372","url":null,"abstract":"Recent innovations in mechanical circulatory support (MCS) have significantly increased survival for patients with cardiac and respiratory failure. The introduction ofMCS into patient care has profoundly changed the management of heart failure and other previously fatal medical conditions. Among other devices, MCS therapies include ventricular assist devices (VAD), total artificial hearts, and extracorporeal membrane oxygenation (ECMO). Due to the quality of life implications associated with these devices, many ethical issues arise that providers must face when treating patients with MCS. Here we outline the ethical considerations physicians should understand while offering and managing MCS. The initial conversationwhen approaching patients regardingMCS should include an ethical process of informed consent, planned surrogate involvement for possible future decision-making, and clarification of bridge versus destination therapy. We discuss why routine palliative care involvement is recommended in the management of MCS patients. We examine how MCS impacts patients, families, caregivers, and clinicians, including physicians, respiratory therapists, and nurses. We also discuss ethical dilemmas that arise with the use of emergency MCS. In addition, deactivation of MCS is an ethically challenging process. Lastly, we discuss specific considerations for the use of MCS in pediatric patients. As MCS is a resource-intensive and invasive therapy with significant risks, physicians should be educated and aware of the ethical issues surrounding it.","PeriodicalId":46852,"journal":{"name":"INTERNATIONAL ANESTHESIOLOGY CLINICS","volume":"60 4","pages":"64-71"},"PeriodicalIF":0.6,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10097816","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":"Percutaneous mechanical circulatory support for the anesthesiologist: indications, management, and basic physiological principles.","authors":"Elizabeth K H Cotter, Shea Stoops, Chinwe Dryer","doi":"10.1097/AIA.0000000000000380","DOIUrl":"https://doi.org/10.1097/AIA.0000000000000380","url":null,"abstract":"in advanced stages of heart failure or cardiogenic shock (CS) Since the 1960s, the primary form of mechanical support has been the intra-aortic balloon pump (IABP). As technology has advanced, smaller, more minimally invasive devices for ventricular support have been developed. In fact, the use of temporary mechanical circulatory support (MCS) has grown more than 30-fold since 2007. 1 Some MCS devices require surgical insertion, but the area of largest growth is in devices that can be placed percutaneously for rapid stabilization of hemodynamics. Increased utilization of MCS will require anesthesiologists to be familiar with the commonly used devices and basic principles of management. General anesthesiologists may be asked to support patients during elective high-risk electrophysiology procedures or emergent noncardiac Anesthesiologists with certi fi cation in echocardiography may be asked to assist in image guidance for insertion of these devices, and anesthesia intensivists may help care for these patients during their potentially lengthy stays in the intensive care unit (ICU). This paper seeks to provide a basic understanding of the indications, management, and basic physiological principles of percutaneous MCS (pMCS) devices as well as speci fi c considerations for the anesthesiologist.","PeriodicalId":46852,"journal":{"name":"INTERNATIONAL ANESTHESIOLOGY CLINICS","volume":"60 4","pages":"31-38"},"PeriodicalIF":0.6,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10094183","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":"Logistics of perioperative diagnostic point-of-care ultrasound: nomenclature, scope of practice, training, credentialing/privileging, and billing.","authors":"Yuriy S Bronshteyn, Jeanna Blitz, Nazish Hashmi, Sundar Krishnan","doi":"10.1097/AIA.0000000000000369","DOIUrl":"https://doi.org/10.1097/AIA.0000000000000369","url":null,"abstract":"In modern health care, the performance of many bedside procedures and the evaluation of critically ill patients is facilitated by point-of-care ultrasound (PoCUS). PoCUS has unique and evolving value to each specialty. Thus, the chronology of adoption of PoCUS has varied significantly across specialties. For instance, anesthesiologists were early to adopt PoCUS for regional anesthesia, vascular access, and transesophageal echocardiography, but slow to integrate other PoCUS applications that were more rapidly adopted by acute care specialties such as critical care and emergency medicine. These latter 2 specialties have shown that PoCUS of the heart, lungs, abdomen, and/or lower extremity veins can be used to rapidly narrow the differential diagnosis of hypotension, respiratory failure, and other kinds of acute organ dysfunction. Since acute organ dysfunction management is also part of the routine work of anesthesiologists, it is not surprising that anesthesiologists are now trying to integrate more diagnostic PoCUS into their work. Furthermore, separate from acute organ dysfunction, diagnostic PoCUS has relevance to anesthesiologists in nonacute settings, such as the preoperative evaluation clinic where the ultrasound data can help with risk stratification and the evaluation of chronic symptoms. To use diagnostic PoCUS successfully, anesthesiologists will need to overcome, at minimum, the challenges that have historically hampered diagnostic PoCUS use in critical care and emergency medicine: variability in training and uncertainties in credentialing/privileging and billing. To address these challenges, anesthesiology departments will need to standardize training and work with hospital administrators to define locally appropriate credentialing/privileging and billing protocols. The following review offers a roadmap on how these things could be accomplished by drawing on both the experiences of other specialties and on guidance recently published by anesthesiology-specific professional medical organizations. Specifically, the review covers the following diagnostic PoCUS topics: (i) nomenclature; (ii) anesthesiology-relevant scope of practice; (iii) minimum level of training needed to achieve competence; (iv) credentialing/privileging; and (v) billing.","PeriodicalId":46852,"journal":{"name":"INTERNATIONAL ANESTHESIOLOGY CLINICS","volume":"60 3","pages":"1-7"},"PeriodicalIF":0.6,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10073870","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}