Journal of clinical anesthesia
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Case Reports
A complication of ECMO cannula placement resulting in hemodynamic and oxygenation alterations: A case report.
Veno-veno extracorporeal membrane oxygenation (VV ECMO) is used as a bridge to recovery in acute respiratory distress syndrome (ARDS) patients who have reversible lung failure. We present a complication of ECMO cannula placement/position resulting in hemodynamic and oxygenation alterations. These demonstrate principles related to the interaction of the VV ECMO circuit and patient cardio-pulmonary physiology. Consideration and comprehension of pulmonary shunt fraction, ECMO cannula recirculation ratio and ECMO blood flow to cardiac output (CO) ratio are central to continuous assessment and diagnosis of cardio-pulmonary changes encountered during management of VV ECMO.
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Sustained low efficiency dialysis (SLED) has been introduced as a mode of renal replacement therapy (RRT) for treating severe cardiac surgery-associated acute kidney injury (CSA-AKI) at some hospitals; SLED is performed using intermittent hemodialysis (IHD) devices but differs from conventional IHD in its duration and intensity. However, there are limited data comparing SLED against more conventional continuous RRT methods. We conducted a retrospective cohort study to compare outcomes of patients with severe CSA-AKI after an institutional transition from continuous RRT to SLED. ⋯ An institutional transition from continuous RRT to SLED, was associated with a significant lower cost with the use of SLED, while maintaining comparable postoperative outcomes in CSA-AKI patients.
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Case Reports
Critical tracheal stenosis from adenoid cystic carcinoma during pregnancy: Case report.
Malignancy during pregnancy complicates approximately 0.1% of patients. Primary tumors of the trachea comprise only 0.2% of respiratory system malignancies. Adenoid cystic carcinoma (ACC) is an adenocarcinoma that can originate from the seromucinous submucosal glands of the trachea and cause airway obstruction. Here we present the collaborative operative management of a Cesarean section delivery for a patient with critical airway obstruction secondary to ACC.