Journal of cardiothoracic and vascular anesthesia
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J. Cardiothorac. Vasc. Anesth. · Jan 2015
Observational StudyThe Safety of Transesophageal Echocardiography in Patients Undergoing Orthotopic Liver Transplantation.
To evaluate the safety of transesophageal echocardiography for the evaluation and intraoperative monitoring of patients during orthotopic liver transplantation. ⋯ Intraoperative transesophageal echocardiography is a relatively safe method of monitoring cardiac performance in liver transplant patients.
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J. Cardiothorac. Vasc. Anesth. · Jan 2015
Variation in Tracheal Reintubations Among Patients Undergoing Cardiac Surgery Across Washington State Hospitals.
The objectives of this study were to examine the variation in reintubations across Washington state hospitals that perform cardiac surgery, and explore hospital and patient characteristics associated with variation in reintubation. ⋯ After accounting for patient and procedure characteristics, significant heterogeneity in the relative odds of requiring reintubation was present across 16 nonfederal hospitals performing cardiac surgery in Washington state. The findings suggested that greater hospital volume and ICU teaching status were associated with fewer reintubations.
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J. Cardiothorac. Vasc. Anesth. · Jan 2015
Acute Kidney Injury and Long-term Risk of Cardiovascular Events After Cardiac Surgery: A Population-Based Cohort Study.
To examine the impact of postoperative acute kidney injury (AKI) on the long-term risk of myocardial infarction, heart failure, stroke, and all-cause mortality after elective cardiac surgery. The authors investigated whether time of onset of AKI altered the association between AKI and the adverse events. ⋯ Early- and late-onset AKI within 30 days of elective cardiac surgery was associated with a similarly increased 5-year risk of myocardial infarction, heart failure, stroke, and increased all-cause mortality.
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J. Cardiothorac. Vasc. Anesth. · Jan 2015
Comparative StudyEfficacy of Fibrinogen Concentrate Compared With Cryoprecipitate for Reversal of the Antiplatelet Effect of Clopidogrel in an In Vitro Model, as Assessed by Multiple Electrode Platelet Aggregometry, Thromboelastometry, and Modified Thromboelastography.
The management of dual-antiplatelet therapy when patients present for surgical revascularization is a clinical challenge. Whether increasing fibrinogen levels can restore hemostasis in this context is not established but may represent increased platelet glycoprotein fibrinogen binding, altered adenosine diphosphate (ADP)-dependent platelet activation, or an increase in formation of soluble fibrin as a component of whole blood clot. ⋯ Fibrinogen supplementation may play a role in the hemostatic resuscitation of patients on dual-antiplatelet therapy, but there is no evidence in this in vitro study that there is a specific platelet effect involved that would allow for platelet substitution.
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J. Cardiothorac. Vasc. Anesth. · Jan 2015
Central Venous-Arterial pCO2 and pH Difference Identifies Microcirculatory Hypoperfusion in Cardiac Surgical Patients With Normal Central Venous Oxygen Saturation: A Retrospective Analysis.
Parameters such as central venous oxygen saturation (ScvO2) are used increasingly to monitor adequate hemodynamic treatment. However, it still remains challenging to identify patients with assumed adequate circulatory status quantified by ScvO2 who suffer from macro- and microcirculatory hypoperfusion. The authors hypothesized that central venous-arterial pCO2 difference (dCO2) could serve as an additional parameter to evaluate the adequacy of perfusion in cardiac surgery patients. ⋯ The authors described dCO2 as a routinely available tool to detect global and microcirculatory hypoperfusion in postoperative cardiac surgical patients. The authors showed that in patients with an ScvO2≥70%, a high dCO2 (≥8 mmHg) was associated with increased postoperative lactate levels and decreased splanchnic function. These findings were associated with a longer need for mechanical ventilation and longer ICU stay.