Seminars in thoracic and cardiovascular surgery
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Semin. Thorac. Cardiovasc. Surg. · Jan 2006
ReviewSupportive care in acute respiratory distress syndrome.
Although the central focus of acute respiratory distress syndrome (ARDS) is the pathology within the lung, ARDS is very much a systemic disease. As such, the whole body needs care and support while the disease process within the lung runs its course. The issues of pain management, sedation, fluid balance, nutrition, metabolic and hormonal processes, infection control, and patient positioning are important for any patient in a critical care setting. For patients with ARDS, the required ventilatory support and ARDS-associated systemic inflammation mandate the above supportive measures.
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Semin. Thorac. Cardiovasc. Surg. · Jan 2006
ReviewEvaluation of patients for pulmonary endarterectomy.
Chronic thromboembolic obstruction of the pulmonary vascular bed has been increasingly recognized as a treatable form of pulmonary hypertension, with surgery referred to as a pulmonary endarterectomy. Careful evaluation of patients with pulmonary hypertension and proper selection of those with surgically accessible, chronic thromboembolic disease are critical determinants for a successful outcome from this operation. This article describes the clinical presentation, appropriate evaluation, and an approach to surgical selection for patients with chronic thromboembolic pulmonary hypertension.
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Semin. Thorac. Cardiovasc. Surg. · Jan 2006
ReviewDiagnostic studies in patients with acute respiratory distress syndrome.
Acute respiratory distress syndrome (ARDS) is a clinical-radiological diagnosis. Clinical diagnosis comprises severe hypoxemia assessed by arterial oxygen tension/fraction of inspired oxygen ratio of less than 200 and bilateral infiltrate on a chest radiograph in the absence of left atrial hypertension. The sensitivity and specificity of the clinical diagnosis vary based on the underlying etiology for ARDS. ⋯ Diffuse alveolar damage, a pathognomic of ARDS, is seen on histopathology on transbronchial lung biopsy or open lung biopsy. Most common complications of these procedures include transient hypoxemia, respiratory acidosis, and pneumothorax with occasional persistent air leak. The potential risk of diagnostic studies should be balanced against the possible foreseeable benefits of the diagnostic studies.
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Semin. Thorac. Cardiovasc. Surg. · Jan 2006
ReviewCurrent perspective on aortic valve repair and valve-sparing aortic root replacement.
Aortic valve repair and valve-sparing aortic root replacement are attractive concepts because they offer the possibility of valve competence without structural deterioration due to nonviability and they preclude the need for anticoagulation. Enthusiasm for aortic valve repair has waxed and waned over the past 45 years due in part to the inherent technical difficulties and poor mid-term results. ⋯ A current perspective on aortic valve repair and valve-sparing aortic root replacement is presented in the following review. Historical background, indications for repair, technical considerations, and outcomes data are discussed.
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Semin. Thorac. Cardiovasc. Surg. · Jan 2006
ReviewPostoperative acute respiratory distress syndrome development in the thoracic surgery patient.
Acute respiratory distress syndrome (ARDS) in the thoracic surgery patient is a dreaded complication that occurs in 4% to 5% of pneumonectomies. This peculiar syndrome is indistinct from other forms of ARDS yet is associated with an exceedingly higher mortality rate. Current management parallels ARDS treatment of other etiologies.