Journal of cardiothoracic and vascular anesthesia
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J. Cardiothorac. Vasc. Anesth. · Feb 2024
Observational StudyComparison Between Changes in Systolic-Pressure Variation and Pulse-Pressure Variation After Passive Leg Raising to Predict Fluid Responsiveness in Postoperative Critically Ill Patients.
The authors aimed to evaluate the precision of changes in systolic-pressure variation after passive leg raising (PLR) as a predictor of fluid responsiveness in postoperative critically ill patients, and to compare the precision of changes in pulse-pressure variation after PLR (ΔPPVPLR) with changes in systolic-pressure variation after PLR (ΔSPVPLR). ⋯ ΔSPVPLR and ΔPPVPLR could accurately predict fluid responsiveness in postoperative critically ill patients. There was no difference in the ability to predict fluid responsiveness between ΔSPVPLR and ΔPPVPLR.
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J. Cardiothorac. Vasc. Anesth. · Feb 2024
ReviewRole of Intraoperative Neuromonitoring to Predict Postoperative Delirium in Cardiovascular Surgery.
Postoperative delirium (POD) can occur in up to 50% of older patients undergoing cardiovascular surgery, resulting in hospitalization and significant morbidity and mortality. This study aimed to determine whether intraoperative neurophysiologic monitoring (IONM) modalities can be used to predict delirium in patients undergoing cardiovascular surgery. ⋯ Significant IONM changes are associated with an increased risk of POD in patients undergoing cardiovascular surgery. These findings offer a basis for future research and analysis of EEG and somatosensory evoked potential monitoring to predict, detect, and prevent POD.
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J. Cardiothorac. Vasc. Anesth. · Feb 2024
Observational StudyThe Urethral Perfusion Index During Off-Pump Coronary Artery Bypass Surgery: An Observational Study.
The IKORUS system (Vygon, Écouen, France) allows continuous monitoring of the urethral perfusion index (uPI) using a photoplethysmographic sensor mounted near the base of the balloon of a dedicated urinary catheter. We aimed to test the hypothesis that the uPI decreases during off-pump coronary artery bypass (OPCAB) surgery and to investigate the relationship between the uPI and macrocirculatory variables. ⋯ The uPI decreases during OPCAB surgery, specifically during the cardiac positioning phase. There was no clinically important association between uPI and either cardiac output, mean arterial pressure, or heart rate. It, therefore, remains to be determined whether intraoperative uPI decreases are clinically important, reflect alterations in intra-abdominal tissue perfusion that are not reflected by systemic macrohemodynamics, and can help clinicians guide therapeutic interventions.
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J. Cardiothorac. Vasc. Anesth. · Feb 2024
Identifying High-Risk Patients for Severe Pulmonary Complications after Cardiosurgical Procedures as a Target Group for Further Assessment of Lung-Protective Strategies.
It remains unclear whether intraoperative lung-protective strategies can reduce the rate of respiratory complications after cardiac surgery, partly because low-risk patients have been studied in the past. The authors established a screening model to easily identify a high-risk group for severe pulmonary complications (ie, pneumonia or acute respiratory distress syndrome) that may be the ideal target population for the assessment of the potential benefits of such measures. ⋯ The authors suggest that future research on intraoperative lung-protective measures focuses on this high-risk population, primarily aiming to mitigate severe forms of postoperative pulmonary dysfunction associated with poor outcomes and increased resource consumption.