R E Dalton, R S Tripathi, E E Abel, D S Kothari, M S Firstenberg, S P Stawicki, T J Papadimos
{"title":"Polyneuropathy and myopathy in the elderly.","authors":"R E Dalton, R S Tripathi, E E Abel, D S Kothari, M S Firstenberg, S P Stawicki, T J Papadimos","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Critical illness polyneuropathy and myopathy is associated with intensive care unit therapies; it is an independent predictor of mortality and will be increasingly affecting the practice of critical care. Most patients with this illness are over 50 years of age, and as our population demographics shift in favor of an aging population, physicians must be aware that this malady will have a rising incidence in the perioperative period. Intensivists, anesthesiologists, surgeons, and geriatricians/internists must remain vigilant. Here we present a concise overview of critical illness polyneuropathy and myopathy, its diagnosis, associations, and possible interventions.</p>","PeriodicalId":89769,"journal":{"name":"HSR proceedings in intensive care & cardiovascular anesthesia","volume":"4 1","pages":"15-9"},"PeriodicalIF":0.0,"publicationDate":"2012-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/5a/c3/hsrp-04-015.PMC3484926.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31264007","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":"Perioperative management of antiplatelet therapy in patients with drug-eluting stents.","authors":"G Dimitrova, D B Tulman, S D Bergese","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Significant advancements in percutaneous treatment of coronary artery disease have been achieved with the introduction of bare metal stents. They have two major drawbacks: acute/subacute stent thrombosis, successfully managed with antiplatelet therapy immediately after stent implantation; and in-stent restenosis, prevention of which has been achieved with the development of drug-eluting stents. Drug-eluting stents have become preferred therapy for patients undergoing coronary artery intervention, though reports of late stent thrombosis have led to uncertainty about the duration of antiplatelet therapy after drug-eluting stents placement. Much controversy remains regarding perioperative management of patients with these devices, presenting for surgery or other invasive procedures. The purpose of this review is to provide an overview of the changing culture of coronary artery stenting, in addition to discussing perioperative management strategies and controversies surrounding coronary stents and antiplatelet therapy. A comprehensive literature search of MEDLINE was conducted using as keywords: antiplatelet therapy, non-coronary surgery, drug-eluting stents, and stent thrombosis. There is no definite standard of care for the perioperative management of drug-eluting stents in patients with drug-eluting stents. However, there is a growing understanding of the importance of continuation of drug-eluting stents in the perioperative period in order to prevent stent thrombosis along with a concern about the possibility of increased bleeding. Appropriate timing of surgery after coronary artery stenting, team approach to the perioperative management of such patients with involvement of cardiologist, anesthesiologist, and surgeon, and development of an individual plan for each patient, weighing that patient's risk of thrombosis vs the risk of bleeding, could improve patient safety and optimize outcome.</p>","PeriodicalId":89769,"journal":{"name":"HSR proceedings in intensive care & cardiovascular anesthesia","volume":"4 3","pages":"153-67"},"PeriodicalIF":0.0,"publicationDate":"2012-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/22/72/hsrp-04-153.PMC3485386.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31264044","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}
G Biondi-Zoccai, G Landoni, A Zangrillo, P Agostoni, G Sangiorgi, M G Modena
{"title":"Use of the LUCAS mechanical chest compression device for percutaneous coronary intervention during cardiac arrest: is it really a game changer?","authors":"G Biondi-Zoccai, G Landoni, A Zangrillo, P Agostoni, G Sangiorgi, M G Modena","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Cardiopulmonary support including closed chest compression is a mainstay in the management of cardiac arrest. However, traditional means (i.e. manual) chest compression may be logistically challenging, especially in patients requiring emergent invasive procedures such as percutaneous coronary intervention for cardiac arrest due to acute myocardial infarction. The LUCAS mechanical chest compression device provides external and automated closed chest compression, thus enabling even complex invasive procedures without interrupting cardiopulmonary support. Nonetheless, no randomized trial has proved to date its benefit in comparison to standard manual chest compression, and to date only observational studies and consensus opinion support its clinical use.</p>","PeriodicalId":89769,"journal":{"name":"HSR proceedings in intensive care & cardiovascular anesthesia","volume":"3 3","pages":"203-5"},"PeriodicalIF":0.0,"publicationDate":"2011-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/38/8d/hsrp-03-203.PMC3484633.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31355897","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}
J Cremer, J Schoettler, A Thiem, C Grothusen, G Hoffmann
{"title":"The MIDCAB approach in its various dimensions.","authors":"J Cremer, J Schoettler, A Thiem, C Grothusen, G Hoffmann","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>Minimally invasive direct coronary artery bypass grafting (MIDCAB) offers arterial revascularization of the left anterior descending coronary artery especially in lesions unsuitable for percutaneous coronary interventions. By avoidance of sternotomy and cardiopulmonary bypass its invasivity is less than that of conventional bypass surgery.</p><p><strong>Methods: </strong>A literature search of all published minimal invasive direct coronary artery bypass grafting studies was performed for the period from January 1995 through November 2011. Additionally, the authors reviewed their experience in more than one thousand patients treated by minimal invasive direct coronary artery bypass grafting within the last 14 years at their institution.</p><p><strong>Results: </strong>Early mortally ranged from 1.2 to 1.3%. Midterm mortality ranged up to 3.2%. At 6-month follow up 3.6% grafts were occluded and 7.2% had a significant stenosis which resulted in target vessel revascularization in 3.3% of cases. The conversion rate to sternotomy or cardiopulmonary bypass ranged between 1.2 and 6.2%.</p><p><strong>Conclusions: </strong>In the past MIDCAB was predominantly used in patients with isolated lesions of the left anterior descending coronary artery. In combination with percutaneous interventions it provides an attractive option for full revascularization in multi vessel disease especially in older patients with significant comorbidities. Overall minimal invasive direct coronary artery bypass grafting is associated with few perioperative complications and with high graft patency rates in the mid-term and long-term course.</p>","PeriodicalId":89769,"journal":{"name":"HSR proceedings in intensive care & cardiovascular anesthesia","volume":"3 4","pages":"249-53"},"PeriodicalIF":0.0,"publicationDate":"2011-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/5a/b7/hsrp-03-249.PMC3563440.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31355914","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":"I can't get (or give) no satisfaction....","authors":"M John","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":89769,"journal":{"name":"HSR proceedings in intensive care & cardiovascular anesthesia","volume":"3 3","pages":"207-8"},"PeriodicalIF":0.0,"publicationDate":"2011-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/87/6c/hsrp-03-207.PMC3484635.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31264565","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":"First expert forum of the roland hetzer international cardiothoracic and vascular surgery society. Lisbon, portugal, october 1, 2011.","authors":"F Beyersdorf","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":89769,"journal":{"name":"HSR proceedings in intensive care & cardiovascular anesthesia","volume":"3 4","pages":"225-6"},"PeriodicalIF":0.0,"publicationDate":"2011-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/02/91/hsrp-03-225.PMC3484638.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31264566","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":"Intracranial placement of a nasogastric tube in a non-trauma patient.","authors":"F Araimo, R Caramia, E Meschesi","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":89769,"journal":{"name":"HSR proceedings in intensive care & cardiovascular anesthesia","volume":"3 1","pages":"71"},"PeriodicalIF":0.0,"publicationDate":"2011-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/c7/04/hsrp-03-071.PMC3484606.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31265233","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":"Pexelizumab and survival in cardiac surgery.","authors":"L Testa, M Meco, S Cirri, F Bedogni","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>A recent international consensus conference on the reduction in mortality in cardiac anesthesia and intensive care included pexelizumab, a recombinant monoclonal antibody to the component 5 of the complement system, among the ancillary (i.e. non-surgical) drugs/techniques/strategies that might influence survival rates in patients undergoing cardiac surgery. The consensus conferences state that \"A subgroup analysis of a meta-analysis of randomized controlled trials suggested that pexelizumab might reduce mortality (longest follow up available, up to 6 months) in patients undergoing coronary artery bypass grafting. Pexelizumab was not included among the most important topics of the consensus conference as it was the only topic that did not receive a sufficient percentage of votes from the audience (32% at the first round and 35% at the second round). Pexelizumab is no longer on the market, however, the concept of reducing the generalized inflammatory process accompanying cardiopulmonary bypass deserves further investigation.</p>","PeriodicalId":89769,"journal":{"name":"HSR proceedings in intensive care & cardiovascular anesthesia","volume":"3 1","pages":"23-4"},"PeriodicalIF":0.0,"publicationDate":"2011-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/d5/95/hsrp-03-023.PMC3484601.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31355886","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":"Role of continuous positive airway pressure to the non-ventilated lung during one-lung ventilation with low tidal volumes.","authors":"N H Badner, C Goure, K E Bennett, G Nicolaou","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>In multiple study populations large tidal volumes (8 - 12 ml/kg) have deleterious effects on lung function in multiple study populations. The accepted approach to hypoxemia during one-lung ventilation is the application of continuous positive airway pressure to the non-ventilated lung first, followed by application of positive end-expiratory pressure to the ventilated lung. To our knowledge the effectiveness of positive end-expiratory pressure or continuous positive airway pressure on maintaining PaO(2) with one-lung ventilation was not studied with smaller tidal volume (6ml/kg) ventilation. Our objective was to compare continuous positive airway pressure of 5 cm H(2)O or positive end-expiratory pressure of 5 cm H(2)O during small tidal volume one-lung ventilation.</p><p><strong>Methods: </strong>Thirty patients undergoing elective, open thoracotomy with one-lung ventilation were randomized to continuous positive airway pressure or positive end-expiratory pressure and then crossed over to the other modality. </p><p><strong>Results: </strong>There was a statistically significant higher PaO(2) (141±81.6 vs 112±48.7, p = 0.047) with continuous positive airway pressure than positive end-expiratory pressure while on one-lung ventilation. Two patients desaturated requiring 100% O(2) with both positive end-expiratory pressure and continuous positive airway pressure. On two occasions the surgeon requested the continuous positive airway pressure be discontinued due to lung inflation.</p><p><strong>Conclusion: </strong>The use of continuous positive airway pressure of 5 cm H(2)O to the non-ventilated lung while using small tidal volumes for one-lung ventilation improved PaO(2) when compared with positive end-expiratory pressure of 5 cm H(2)O to the ventilated lung.</p>","PeriodicalId":89769,"journal":{"name":"HSR proceedings in intensive care & cardiovascular anesthesia","volume":"3 3","pages":"189-94"},"PeriodicalIF":0.0,"publicationDate":"2011-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/f8/d4/hsrp-03-189.PMC3484631.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31263430","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":"A journey into clinical evidence: from case reports to mixed treatment comparisons.","authors":"G Biondi-Zoccai, G Landoni, M G Modena","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":89769,"journal":{"name":"HSR proceedings in intensive care & cardiovascular anesthesia","volume":"3 2","pages":"93-6"},"PeriodicalIF":0.0,"publicationDate":"2011-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3484626/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31264560","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}