Journal of cardiothoracic and vascular anesthesia
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J. Cardiothorac. Vasc. Anesth. · Oct 2020
Observational StudyRescue Echocardiography/Ultrasonography in the Management of Combined Cardiac Surgical and Medical Patients in a Cardiac Intensive Care Unit.
Rescue point-of-care ultrasound (r-POCUS) in critical care medicine has revolutionized the management of critically ill patients with hemodynamic instability. However, clinical studies on its use among high-risk cardiac patients still are limited. The authors aimed to assess the utility of r-POCUS for managing high-risk cardiac patients in a mixed cardiac-surgical and cardiac-medical intensive care unit (ICU) in a quaternary care hospital by reviewing the indications and findings of r-POCUS and subsequent effect on patient management. ⋯ In this retrospective study, r-POCUS performed by attending intensivists resulted in diverse findings and was associated with rapid changes in clinical management of patients in a high-acuity, mixed cardiac-surgical and cardiac-medical ICU.
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J. Cardiothorac. Vasc. Anesth. · Oct 2020
ReviewCardiopulmonary Resuscitation in Intensive Care Unit Patients With Coronavirus Disease 2019.
Cardiopulmonary resuscitation (CPR) in patients with severe acute respiratory syndrome coronavirus-2-associated disease (coronavirus disease 2019) poses a unique challenge to health- care providers due to the risk of viral aerosolization and disease transmission. This has caused some centers to modify existing CPR procedures, limit the duration of CPR, or consider avoiding CPR altogether. In this review, the authors propose a procedure for CPR in the intensive care unit that minimizes the number of personnel in the immediate vicinity of the patient and conserves the use of scarce personal protective equipment. ⋯ Extracorporeal membrane oxygenation should be reserved for patients with few comorbidities and a single failing organ system. Reliable teleconferencing tools are essential to facilitate communication between providers inside and outside the patients' rooms. General principles regarding the ethics and peri-resuscitative management of coronavirus 2019 patients also are discussed.
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J. Cardiothorac. Vasc. Anesth. · Oct 2020
ReviewChallenges in Preparing and Managing the Critical Care Services for a Large Urban Area During COVID-19 Outbreak: Perspective From Delhi.
The coronavirus disease-2019 (COVID-19) pandemic has put healthcare services all over the world into a challenging situation. The contagious nature of the disease and the respiratory failure necessitating ventilatory care of these patients have put extra burden on intensive care unit (ICU) services. ⋯ The main challenges faced, among others, were estimating the number of ICU beds to be created; deciding on dedicated hospitals to treat COVID-19 patients; procuring ventilators, personal protective equipment, and other related material; mobilizing human resources and providing their training; and providing isolated in-house accommodations to the staff on duty. The authors acknowledge and agree that the methodology proposed in this article is but one way of approaching this difficult scenario and that there could be other, perhaps better, methods of dealing with such a problem.
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J. Cardiothorac. Vasc. Anesth. · Oct 2020
ReviewVasoplegia During Cardiopulmonary Bypass: Current Literature and Rescue Therapy Options.
Vasoplegia syndrome in the cardiac surgical intensive care unit and postoperative period has been an area of interest to clinicians because of its prevalence and effects on morbidity and mortality. However, there is a paucity of evidence regarding the treatment of vasoplegia syndrome during cardiopulmonary bypass (on-CPB VS). This review aims to detail the incidence, outcomes, and possible treatment options for patients who develop vasoplegia during bypass. ⋯ Pharmacologic agents that have been demonstrated as being effective in vasoplegia include vasopressin, terlipressin, methylene blue, hydroxocobalamin, angiotensin II (Giapreza), vitamin C, flurbiprofen (Ropion), and hydrocortisone. Although these agents have not been specifically evaluated for vasoplegia during CPB, they have shown signs of effectiveness for vasoplegia postoperatively to varying degrees. Understanding the evidence for, dosing, and side effects of these agents is crucial for cardiac anesthesiologists when treating vasoplegia during CPB bypass.
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J. Cardiothorac. Vasc. Anesth. · Oct 2020
ReviewArtificial Intelligence for Dynamic Echocardiographic Tricuspid Valve Analysis: A New Tool in Echocardiography.
There has been a resurgence of interest in the structure and function of the tricuspid valve (TV) with the established prognostic impact of functional tricuspid regurgitation. Current 3-dimensional transesophageal echocardiography prototype software is limited to exploration of the mitral and aortic valves exclusively. Thus, newer analytical software is required for dynamic geometric analysis of the TV morphology for remodeling. ⋯ The software offers high correlation to surgical inspection by its ability to analyze morphology and dynamics of the valve throughout the cardiac cycle. In addition, it allows higher reproducibility of data analysis and reduces interobserver variability with minimal need for manual intervention. Integration of interactivity through preprocedural placement of specific devices of different sizes and shapes in the mitral and aortic positions facilitates prognostic evaluation of surgical and interventional procedures.