Journal of cardiothoracic and vascular anesthesia
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J. Cardiothorac. Vasc. Anesth. · Oct 2018
Meta AnalysisVasopressin in Cardiac Surgery: A Meta-analysis of Randomized Controlled Trials.
To summarize the results of randomized controlled trials on the use of vasopressin as a vasopressor agent in cardiac surgery. ⋯ Our meta-analysis suggests that arginine vasopressin may reduce the rate of perioperative complications in patients undergoing elective or emergency cardiac surgery. No difference in postoperative mortality was observed. An adequately powered multicenter trial is required for reliable estimation of the effects of arginine vasopressin on perioperative complication rates and mortality in cardiac surgical patients.
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J. Cardiothorac. Vasc. Anesth. · Oct 2018
ReviewImpella RP in the Treatment of Right Ventricular Failure: What We Know and Where We Go.
Temporary mechanical circulatory support devices for the treatment of acute right ventricular failure represent crucial tools for clinical practice. Right ventricular failure presents specific treatment issues, and dedicated percutaneous devices are less in number compared to the left ventricle. Current data and insights on mechanical circulatory support for the right ventricle come mostly from the context of cardiac surgery, predominantly the setting of acute right ventricular failure after left ventricular assist device implantation. ⋯ Even though treatment indications are clear, technical and management issues still are relevant because of the limited scientific data available. Appropriate positioning and repositioning, interaction with right ventricular valvular apparatus, anticoagulation management, weaning, and patient mobilization are examples of the open challenges. In line with the positive initial experience with this device, future research efforts should be focused on the improvement of device limitations and on providing additional data that might drive optimal clinical management.
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J. Cardiothorac. Vasc. Anesth. · Oct 2018
Meta AnalysisSteroids and Survival in Critically Ill Adult Patients: A Meta-analysis of 135 Randomized Trials.
Corticosteroids have important effects on intermediate outcomes in critically ill patients, but their effect on survival is unknown. The objective of this meta-analysis was to analyze the effect on mortality of corticosteroids in critical and perioperative settings. ⋯ This meta-analysis documents the safety of corticosteroids in the overall critically ill population with the notable exception of brain injury patients, a setting where the authors confirmed their detrimental effect on survival. A possible beneficial effect of corticosteroids on survival was found among patients with respiratory diseases and in patients with bacterial meningitis.
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J. Cardiothorac. Vasc. Anesth. · Oct 2018
ReviewCerebral Neuromonitoring During Cardiac Surgery: A Critical Appraisal With an Emphasis on Near-Infrared Spectroscopy.
Neurological complications of cardiac surgery have a large effect on patient outcomes. In this review, the value of several modes of central nervous system monitoring for improving perioperative care is critiqued. The electroencephalogram (EEG) has been used as a means for detecting brain ischemia. ⋯ Because near-infrared spectroscopy-measured regional cerebral oxygen saturation does not distinguish arterial from venous blood, these measurements reflect the adequacy of oxygen delivery versus demand. Over short periods, filtered regional cerebral oxygen saturation data may provide a clinically feasible method of monitoring cerebral autoregulation that overcomes many limitations of transcranial Doppler. Ongoing studies have demonstrated that the latter methodology for determining perioperative blood pressure targets has large potential for reducing organ injury from cardiac surgery.
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J. Cardiothorac. Vasc. Anesth. · Oct 2018
Meta AnalysisClinical Outcomes of Adult Patients Who Receive Extracorporeal Membrane Oxygenation for Postcardiotomy Cardiogenic Shock: A Systematic Review and Meta-Analysis.
To investigate the clinical outcomes of adult patients receiving extracorporeal membrane oxygenation (ECMO) for postcardiotomy cardiogenic shock (PCS). ⋯ The short-term and midterm survival rates of PCS patients treated with ECMO were disappointingly low, and post-ECMO complication rates were relatively high.