Journal of cardiothoracic and vascular anesthesia
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J. Cardiothorac. Vasc. Anesth. · Apr 2022
Review2021 Acute Respiratory Distress Syndrome Update, With Coronavirus Disease 2019 Focus.
Acute respiratory distress syndrome (ARDS) is a heterogeneous lung disease responsible for significant morbidity and mortality among critically ill patients, including those infected with severe acute respiratory syndrome coronavirus 2, the virus responsible for coronavirus disease 2019. Despite recent advances in pathophysiology, diagnostics, and therapeutics, ARDS is dangerously underdiagnosed, and supportive lung protective ventilation and prone positioning remain the mainstay interventions. Rescue therapies, including neuromuscular blockade and venovenous extracorporeal membrane oxygenation, remain a key component of clinical practice, although benefits are unclear. Even though coronavirus disease 2019 ARDS has some distinguishing features from traditional ARDS, including delayed onset, hyperinflammatory response, and pulmonary microthrombi, it clinically is similar to traditional ARDS and should be treated with established supportive therapies.
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J. Cardiothorac. Vasc. Anesth. · Apr 2022
Heated Humidified Breathing Circuit Rewarming in Hypothermic Patients Post-Cardiopulmonary Bypass-Pilot Study.
Hypothermia on intensive care unit (ICU) admission after cardiac surgery and cardiopulmonary bypass is common. It contributes to postoperative complications including shivering, coagulopathy, increased blood loss and transfusion requirements, morbid cardiac events, metabolic acidosis, increased wound infections, and prolonged hospital length of stay. The current standard of care for rewarming ICU patients is forced air warming blankets. However, high-quality evidence on additional benefit rendered by other warming methods, such as heated humidified breathing circuits (HHBC), is lacking. Therefore, the authors conducted a pilot study to examine whether the addition of HHBC to standard forced air warming blankets in hypothermic patients (≤35°C) admitted to the ICU after cardiac surgery using cardiopulmonary bypass reduced time to normothermia. ⋯ The present pilot study detected a similar time to normothermia, extubation, and normal pH when HHBC were added to standard forced air warming blankets in hypothermic patients (≤35°C) admitted to the ICU after cardiac surgery using cardiopulmonary bypass. A future larger prospective study designed to detect smaller, but clinically meaningful, reductions in the time to key clinical events for patients treated with HHBC is feasible and warranted.
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J. Cardiothorac. Vasc. Anesth. · Apr 2022
Observational StudyPrecannulation International Normalized Ratio is Independently Associated With Mortality in Veno-Arterial Extracorporeal Membrane Oxygenation.
To explore whether precannulation international normalized ratio (INR) is associated with in-hospital mortality in venoarterial extracorporeal membrane oxygenation (VA-ECMO) patients. ⋯ An INR >1.8 before VA-ECMO cannulation is associated independently with in-hospital mortality. Precannulation INR should be considered by clinicians so that ECMO resources can be better allocated and risks of organ failure and intracranial hemorrhage can be better understood.
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J. Cardiothorac. Vasc. Anesth. · Apr 2022
General Anesthesia Leads to Underestimation of Regurgitation Severity in Patients With Secondary Mitral Regurgitation Undergoing Transcatheter Mitral Valve Repair.
To evaluate the effect of general anesthesia (GA) on severity of mitral regurgitation (MR) in patients undergoing transcatheter mitral valve repair (TMVR). ⋯ GA underestimates regurgitation severity in patients with secondary, but not primary MR, undergoing TMVR. This effect must be considered when evaluating the immediate result of the procedure.