Journal of cardiothoracic and vascular anesthesia
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J. Cardiothorac. Vasc. Anesth. · Aug 2022
Observational StudyRenal-Resistive Index and Acute Kidney Injury in Aortic Surgery: An Observational Pilot Study.
Acute kidney injury (AKI) is a common perioperative complication in patients undergoing cardiovascular surgery, increasing mortality, morbidities, and costs. Recently, growing interest has risen in the use of the renal-resistive index (RRI) as a predictor of perioperative AKI. The aim of this study was to evaluate the role of RRI variation to identify postoperative AKI. ⋯ RRI variation could be a useful tool to investigate kidney function in patients undergoing aortic surgery. The %RRI in the perioperative time seems to detect AKI onset early and potentially could enhance renal-protective management within 24 hours after surgery.
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J. Cardiothorac. Vasc. Anesth. · Aug 2022
Association Between Exogenous Nitric Oxide Given During Cardiopulmonary Bypass and the Incidence of Postoperative Kidney Injury in Children.
To compare the incidence and severity of acute kidney injury (AKI) after cardiac surgery with cardiopulmonary bypass and the administration of exogenous nitric oxide in children. ⋯ This single-center, retrospective, cohort study found no change in the incidence and severity of postoperative AKI after the administration of nitric oxide into the cardiopulmonary bypass circuit in children.
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J. Cardiothorac. Vasc. Anesth. · Aug 2022
Observational StudyUtility of Lung Ultrasound in the Estimation of Extravascular Lung Water in a Pediatric Population-A Prospective Observational Study.
Lung ultrasound (LUS) is a promising bedside modality for the estimation of extravascular lung water index (EVLWI), but has not been validated against objective measures in children. This study aimed to investigate the correlation of LUS B-line scoring with EVLWI, thresholds indicating elevated EVLWI, and its outcome following pediatric cardiac surgery. ⋯ LUS B-line scoring has limited utility in semiquantitative estimation of EVLWI at lower thresholds of EVLWI in pediatric cardiac surgical patients. It may have better discrimination and acceptable sensitivity and specificity at higher thresholds of EVLWI. Contrasting with multiple reports of clinical utility, these results call for wider evaluation of LUS and its clinical modifiers like age, pathology, and pretest probability in estimation of EVLWI.
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J. Cardiothorac. Vasc. Anesth. · Aug 2022
Case ReportsThe Value of Thromboelastography (TEG) in COVID-19 Critical Illness as Illustrated by a Case Series.
To develop a practical thromboelastograph guided (TEG) anticoagulation protocol to guide the management of COVID-19 critically ill patients. ⋯ TEG provides patient-specific evidence for a hypercoagulable state in patients receiving all types of anticoagulant therapy. The proposed TEG algorithm guides anticoagulation management decisions to maintain or escalate anticoagulant dose and/or change choice of anticoagulant. A TEG algorithm may help negotiate the potential harm/benefit balance of full-dose anticoagulation in critically ill COVID-19 patients, by allowing for a more individualized approach that goes beyond the review of activated partial thromboplastin time (aPTT) levels.