Journal of cardiothoracic and vascular anesthesia
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J. Cardiothorac. Vasc. Anesth. · Aug 2022
Case ReportsThe Value of Thromboelastography (TEG) in COVID-19 Critical Illness as Illustrated by a Case Series.
To develop a practical thromboelastograph guided (TEG) anticoagulation protocol to guide the management of COVID-19 critically ill patients. ⋯ TEG provides patient-specific evidence for a hypercoagulable state in patients receiving all types of anticoagulant therapy. The proposed TEG algorithm guides anticoagulation management decisions to maintain or escalate anticoagulant dose and/or change choice of anticoagulant. A TEG algorithm may help negotiate the potential harm/benefit balance of full-dose anticoagulation in critically ill COVID-19 patients, by allowing for a more individualized approach that goes beyond the review of activated partial thromboplastin time (aPTT) levels.
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J. Cardiothorac. Vasc. Anesth. · Aug 2022
Association Between Exogenous Nitric Oxide Given During Cardiopulmonary Bypass and the Incidence of Postoperative Kidney Injury in Children.
To compare the incidence and severity of acute kidney injury (AKI) after cardiac surgery with cardiopulmonary bypass and the administration of exogenous nitric oxide in children. ⋯ This single-center, retrospective, cohort study found no change in the incidence and severity of postoperative AKI after the administration of nitric oxide into the cardiopulmonary bypass circuit in children.
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J. Cardiothorac. Vasc. Anesth. · Aug 2022
Is an Acute Perioperative Increase in Creatinine Production Rate a Potential Mechanism for an Early Creatinine-Based Signal of Renal Injury After Cardiac Surgery?
Previous studies report a creatinine-based signal of injury within hours after cardiac surgery, which is sooner than expected based on creatinine kinetic modelling. A plausible mechanism for such an early signal has not been established, but might be explained by an acute perioperative increase in creatinine production rate (Crprod-rate). The authors sought to test the hypothesis that perioperative Crprod-rate increases from baseline in patients undergoing cardiac surgery. ⋯ Perioperative Crprod-rate increased from baseline in patients undergoing cardiac surgery. This may represent a mechanism for an earlier creatinine-based signal of renal injury than previously thought possible.
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J. Cardiothorac. Vasc. Anesth. · Aug 2022
Left Atrial Strain Quantification by Intraoperative Transesophageal Echocardiography: Validation With Transthoracic Echocardiography.
Whereas left atrial (LA) strain has been well-validated using transthoracic echocardiography (TTE), its detection using transesophageal echocardiography (TEE) has not been studied. Conventional transesophageal views are known to be limited due to the posterior location of the LA. Here, the feasibility and accuracy of the deep transgastric long-axis LA focused view for peak atrial longitudinal strain (PALS) quantification was tested. ⋯ This exploratory study supported the feasibility of TEE for assessing LA longitudinal strain. There was an excellent correlation between atrial strain derived via TEE versus TTE, although values tended to be smaller on TEE, and bias between values was highly variable, suggesting that the values were not interchangeable.