Journal of cardiothoracic and vascular anesthesia
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J. Cardiothorac. Vasc. Anesth. · Sep 2019
ReviewExpiratory Central Airway Collapse in Adults: Corrective Treatment (Part 2).
Corrective treatment of expiratory central airway collapse (ECAC) consists of placement of airway stents or tracheobronchoplasty (TBP). The indication for corrective treatment is severe central airway collapse (>90 %), and severe symptoms that cause decline in quality of life. Patients are selected to undergo a trial of tracheal "Y" stent placement. ⋯ Patients who are considered poor surgical candidates because of the severity of comorbidities can be offered permanent stenting to palliate symptoms. The anesthetic management of airway stent placement and TBP is complex. This article reviews the medical management and corrective treatment of ECAC, anesthetic management of airway stent placement, and considerations during TBP.
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J. Cardiothorac. Vasc. Anesth. · Sep 2019
ReviewUltrasound Imaging for Diaphragm Dysfunction: A Narrative Literature Review.
Of the various muscles that make up the respiratory system, the diaphragm is the prima donna. In the past, only specialist research centers were able to estimate and challenge the effort of this muscle; this was achieved by measuring transdiaphragmatic pressure-an invasive technique involving a double-balloon probe inserted through the esophagus-or by measuring twitch pressure (ie, the pressure generated at the outside tip of the endotracheal tube). However, the prevalence of diaphragm dysfunction in critically ill patients requiring intubation can exceed 60% (at the time of hospital admission) and may rise to as high as 80% in patients requiring prolonged mechanical ventilation and experiencing difficult weaning. ⋯ Furthermore, US enables the course of diaphragmatic function to be followed on a day-to-day basis, from intensive care admission to discharge, and it can help us understand the different causes of underlying disease: trauma, infection (eg, sepsis-induced diaphragm dysfunction), cancer, weaning problems (eg, ventilation-induced diaphragm dysfunction), etc. Today, the assessment of diaphragm dysfunction with US provides an important first step toward improving the detection of diaphragm dysfunction and as a protective and supportive strategy for its management. The purposes of this review are as follows: (1) to explore which US method is best for evaluating diaphragm function in the intensive care unit and how and when it should be used, and (2) to discuss which diseases may involve the diaphragm, and what therapies should be used.
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J. Cardiothorac. Vasc. Anesth. · Sep 2019
Incidence of Massive Transfusion and Overall Transfusion Requirements During Lung Transplantation Over a 25-Year Period.
To establish the incidence of massive transfusion and overall transfusion requirements during lung transplantation, changes over time, and association with outcome in relation to patient complexity. ⋯ The incidence of massive transfusion did not change over time, whereas transfusion requirements in the whole cohort decreased. In patients transplanted from the intensive care unit, massive transfusion and transfusion requirements increased. Massive transfusion was associated with poor outcome.
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J. Cardiothorac. Vasc. Anesth. · Sep 2019
Observational StudySerial Observation of Blood Alcohol Concentration post Ethanol Pleurodesis (SOBER) Study: A Prospective Observational Study.
To measure the blood alcohol concentration levels in patients after chemical pleurodesis with ethanol sclerosant via video-assisted thoracoscopic surgery. ⋯ Significant systemic absorption of ethanol can occur after instillation of ethanol sclerosant, which potentially may affect the quality of recovery in patients. Postoperative management of these patients may need to be specifically tailored to take into account these observations.