Journal of cardiothoracic and vascular anesthesia
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J. Cardiothorac. Vasc. Anesth. · Oct 2018
ReviewImpella RP in the Treatment of Right Ventricular Failure: What We Know and Where We Go.
Temporary mechanical circulatory support devices for the treatment of acute right ventricular failure represent crucial tools for clinical practice. Right ventricular failure presents specific treatment issues, and dedicated percutaneous devices are less in number compared to the left ventricle. Current data and insights on mechanical circulatory support for the right ventricle come mostly from the context of cardiac surgery, predominantly the setting of acute right ventricular failure after left ventricular assist device implantation. ⋯ Even though treatment indications are clear, technical and management issues still are relevant because of the limited scientific data available. Appropriate positioning and repositioning, interaction with right ventricular valvular apparatus, anticoagulation management, weaning, and patient mobilization are examples of the open challenges. In line with the positive initial experience with this device, future research efforts should be focused on the improvement of device limitations and on providing additional data that might drive optimal clinical management.
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J. Cardiothorac. Vasc. Anesth. · Oct 2018
Meta AnalysisSteroids and Survival in Critically Ill Adult Patients: A Meta-analysis of 135 Randomized Trials.
Corticosteroids have important effects on intermediate outcomes in critically ill patients, but their effect on survival is unknown. The objective of this meta-analysis was to analyze the effect on mortality of corticosteroids in critical and perioperative settings. ⋯ This meta-analysis documents the safety of corticosteroids in the overall critically ill population with the notable exception of brain injury patients, a setting where the authors confirmed their detrimental effect on survival. A possible beneficial effect of corticosteroids on survival was found among patients with respiratory diseases and in patients with bacterial meningitis.
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J. Cardiothorac. Vasc. Anesth. · Oct 2018
Randomized Controlled TrialThe Effect of Inhaled Milrinone Versus Inhaled Levosimendan in Pulmonary Hypertension Patients Undergoing Mitral Valve Surgery - A Pilot Randomized Double-Blind Study.
To compare the effects of inhaled milrinone and levosimendan on pulmonary and systemic hemodynamics in patients with pulmonary hypertension. ⋯ Because inhaled levosimendan causes a decrease in PASP and MPAP without causing a decrease in SVR and MAP, the authors conclude that inhaled levosimendan is a selective pulmonary vasodilator. It is as effective as milrinone in reducing pulmonary artery pressures. In addition, it has advantage over inhaled milrinone because it is has a longer duration of action.
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J. Cardiothorac. Vasc. Anesth. · Oct 2018
ReviewCerebral Neuromonitoring During Cardiac Surgery: A Critical Appraisal With an Emphasis on Near-Infrared Spectroscopy.
Neurological complications of cardiac surgery have a large effect on patient outcomes. In this review, the value of several modes of central nervous system monitoring for improving perioperative care is critiqued. The electroencephalogram (EEG) has been used as a means for detecting brain ischemia. ⋯ Because near-infrared spectroscopy-measured regional cerebral oxygen saturation does not distinguish arterial from venous blood, these measurements reflect the adequacy of oxygen delivery versus demand. Over short periods, filtered regional cerebral oxygen saturation data may provide a clinically feasible method of monitoring cerebral autoregulation that overcomes many limitations of transcranial Doppler. Ongoing studies have demonstrated that the latter methodology for determining perioperative blood pressure targets has large potential for reducing organ injury from cardiac surgery.
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J. Cardiothorac. Vasc. Anesth. · Oct 2018
Randomized Controlled Trial Multicenter StudySix-Month Outcomes After High-Risk Coronary Artery Bypass Graft Surgery and Preoperative Intra-aortic Balloon Counterpulsation Use: An Inception Cohort Study.
To inform the design of a pivotal randomized controlled trial of prophylactic intra-aortic balloon counterpulsation (IABC) in patients undergoing coronary artery bypass graft (CABG) at high risk of postoperative low cardiac output syndrome (LCOS). ⋯ The study identified a group of patients at risk of LCOS in whom CABG surgery was associated with a substantial burden of perioperative morbidity. Preoperative IABC use was variable, supporting the need for further research.