Seminars in thoracic and cardiovascular surgery
-
Lung volume-reduction surgery is a proven palliative procedure for emphysema, and in patients with heterogeneous upper-lobe disease as well as low baseline exercise capacity, even mortality benefits can be realized. However, its application is limited by high postoperative morbidity and stringent selection criteria that effectively exclude many patients. This has been the impetus for the development of less-invasive approaches to lung volume reduction. ⋯ Refining patient selection and dose of treatment are subjects of ongoing research to improve the efficacy data. Safety profiles are more promising, with rare procedure-related mortality and fewer complications experienced than with surgical lung volume reduction. The field of bronchoscopic lung volume reduction continues to evolve, with the aim of making symptom palliation more available to a wider range of patients at lower risks.
-
Semin. Thorac. Cardiovasc. Surg. · Jan 2010
ReviewBlood conservation in cardiac surgery: let's get restrictive.
Despite increasing evidence suggesting harmful effects of blood transfusions, physician practices are slow to change. A systematic approach is required to successfully minimize the need for red cell transfusions in the perioperative cardiac surgical patient. ⋯ In addition it requires physician education regarding the potential deleterious effects of blood and the more recent evidence that restrictive transfusion strategies are safe and possibly beneficial to postoperative surgical outcomes. In this article, we review the data with respect to blood transfusions in cardiac surgery patients as well as management strategies to minimize the need for blood transfusions in the perioperative period.
-
Cardiac surgery presents a life-saving and life-enhancing opportunity to hundreds of thousands of patients each year in the United States. However, many patients face significant challenges during the postoperative period, including pain, anxiety, and tension. ⋯ Massage therapy is a therapy that has significant evidence to support its role in meeting these needs. This paper looks at the data surrounding the use of massage therapy in cardiac surgery patients, with a special focus on the experience at Mayo Clinic.
-
Semin. Thorac. Cardiovasc. Surg. · Jan 2010
ReviewVasoplegia during cardiac surgery: current concepts and management.
Vasoplegic syndrome (VS) is a recognized and relatively common complication of cardiopulmonary bypass (CPB), appearing with an incidence ranging between 5% and 25%. It is characterized by significant hypotension, high or normal cardiac outputs and low systemic vascular resistance (SVR), and increased requirements for fluids and vasopressors during or after CPB. Patients developing VS are at increased risk for death and other major complications following cardiac surgery. This review will focus on the pathophysiology and contemporary strategies of treating VS encountered after CPB.