Journal of cardiothoracic and vascular anesthesia
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J. Cardiothorac. Vasc. Anesth. · Feb 2024
Observational StudyUnresponsive Low Mixed Venous Oxygen Saturation During Early Intensive Care Unit Stay is Associated With Increased Risk of Organ Dysfunction After Cardiac Surgery: A Single-Center Retrospective Study.
The aim of the study was to determine if unresponsive mixed venous oxygen saturation (SvO2) values during early postoperative hours are associated with postoperative organ dysfunction. ⋯ Patients with SvO2 <60% at ICU admission and 4 hours later had the greatest risk of postoperative MODS. Responsiveness to a goal-directed therapy protocol targeting maintaining or increasing SvO2 ≥60% at and after ICU admission may be beneficial.
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J. Cardiothorac. Vasc. Anesth. · Feb 2024
Observational StudyThe IMPACT Score: A New Score to Predict the Risk of Early Mortality in Cardiogenic Shock Patients Treated With Venoarterial Extracorporeal Membrane Oxygenation.
Venoarterial extracorporeal membrane oxygenation (VA-ECMO) requires considerable human and financial resources. Few studies have focused on early mortality (ie, occurring within 72 hours after VA-ECMO implantation). The objective of this study was to establish a prognosis score-the IMPACT score (prediction of early mortality associated with VA-ECMO using preimplantation characteristics)-by determining the risk factors associated with early mortality. ⋯ In the authors' experience, 26% of patients treated with VA-ECMO presented early mortality. The IMPACT score is a reliable predictor of early mortality and may assist with VA-ECMO initiation decision-making.
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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
Fundamental Electrophysiology Principles Related to Perioperative Management of Cardiovascular Implantable Electronic Devices.
An increasing number of patients undergoing elective or emergency surgery in the United States have a cardiovascular implantable electronic device. Practice advisories and consensus statements have been issued by the American Society of Anesthesiologists and the Heart Rhythm Society, advocating a multidisciplinary approach. ⋯ Many problems with devices have been observed, including confusing rhythms, failure of magnets to provide the desired change in device function, and actual device malfunction. With these clinical case examples taken from the authors' collective experience, this article provides an in-depth understanding of some key electrophysiology principles relevant to cardiovascular implantable electronic device function and appropriate perioperative management.