Journal of cardiothoracic and vascular anesthesia
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J. Cardiothorac. Vasc. Anesth. · Jul 2019
ReviewPediatric Transfusion Algorithms: Coming to a Cardiac Operating Room Near You.
Pediatric cardiac surgical patients are at particular risk for post-cardiopulmonary bypass hemorrhage. Moreover, both the incidence and volume of blood transfusions have been associated with increased morbidity in pediatric cardiac patients. Transfusion of red blood cells, platelets, and coagulation factors is necessary to combat the hemodilution associated with cardiopulmonary bypass and to treat postoperative bleeding. ⋯ Development of a transfusion algorithm for the pediatric cardiac population requires individualization at both the institutional level, considering local resources, equipment, and case mix, and the patient level, considering age, cardiac diagnosis, and planned procedure, at minimum. A growing body of literature suggests that application of appropriate intraoperative testing (platelet count, fibrinogen concentration, thromboelastometry) along with recognition of risk factors for bleeding, adequate bypass anticoagulation, and judicious use of factor concentrates allows for thoughtful transfusion and potentially improved outcomes in pediatric cardiac patients. This review examines the evolution of transfusion algorithms in pediatric cardiac surgery and examines the considerations involved in building an algorithm for this challenging, heterogenous population.
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J. Cardiothorac. Vasc. Anesth. · Jul 2019
Multicenter Study Observational StudyAn Update on Racial Disparities With 30-Day Outcomes After Coronary Artery Bypass Graft Under the Affordable Care Act.
The impact of race on outcomes after coronary artery bypass graft (CABG) has been reported before the enactment of the Patient Protection and Affordable Care Act. However, the impact of race on outcomes post-Affordable Care Act enactment remains unclear. The authors evaluated the association of race with outcomes after enactment of the Affordable Care Act in CABG patients. ⋯ Differential outcomes were observed for morbidity and mortality outcome measures. The persistence of racial disparities beyond the Affordable Care Act calls for multidisciplinary action.
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J. Cardiothorac. Vasc. Anesth. · Jul 2019
Observational StudyVentilatory Efficiency Identifies Patients Prone to Hypoxemia During One-Lung Ventilation.
One-lung ventilation (OLV) may be complicated by hypoxemia. Ventilatory efficiency, defined as the ratio of minute ventilation to carbon dioxide output (VE/VCO2), is increased with ventilation/perfusion mismatch and pulmonary artery hypertension, both of which may be associated with hypoxemia. Hence, the authors hypothesized increased VE/VCO2 will predict hypoxemia during OLV. ⋯ An increased VE/VCO2 slope may predict hypoxemia development in patients who undergo OLV.