Seminars in thoracic and cardiovascular surgery
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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.
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Semin. Thorac. Cardiovasc. Surg. · Jan 2010
ReviewGlycemic control and nutritional strategies in the cardiothoracic surgical intensive care unit--2010: state of the art.
Patients in the cardiothoracic surgical intensive care unit are generally critically ill and undergoing a systemic inflammatory response to cardiopulmonary bypass, ischemia/reperfusion, and hypothermia. This presents several metabolic challenges: hyperglycemia in need of intensive insulin therapy, catabolism, and uncertain gastrointestinal tract function in need of nutritional strategies. ⋯ In this review, an approach for intensive metabolic support in the cardiothoracic surgical intensive care unit is presented incorporating the most recent clinical evidence. This approach advocates an IIT blood glucose target of 80-110 mg/dL if, it can be implemented safely, with early nutrition support (using parenteral nutrition as needed) to prevent a critical energy debt.
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Semin. Thorac. Cardiovasc. Surg. · Jan 2010
Safety in the operating room: team approach saves lives.
Improvements in technology, classic peer review, and even relentless determination of the individual practitioner have proven insufficient to eliminate adverse events in surgical patients. Preventing avoidable harm must focus on changing the operating room culture from one of separate--and well-meaning individuals--to a cohesive approach by surgeons, anesthesiologists, nurses, and associated or health staff. Neily and colleagues report the results of a comprehensive team training program implemented across 74 Veterans Health or facilities, which was associated with an 18% reduction in annual mortality (rate ratio = 0.82; P = 0.01).
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Semin. Thorac. Cardiovasc. Surg. · Jan 2010
The National Lung Cancer Screening Trial: the ripple effect begins?
Preliminary results of the National Lung Screening Trial were recently announced. The significant implications of this trial for thoracic surgical practice are reviewed.