Journal of cardiothoracic and vascular anesthesia
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J. Cardiothorac. Vasc. Anesth. · Aug 2022
ReviewNear-Infrared Spectroscopy (NIRS) for Cerebral and Tissue Oximetry: Analysis of Evolving Applications.
THE USE OF NEAR-INFRARED SPECTROSCOPY (NIRS) has increased significantly worldwide in the past decade. This technology, first described more than 40 years ago, is based on the fact that near-infrared light is able to penetrate biologic tissue and can obtain real-time, noninvasive information on tissue oxygenation and metabolism. ⋯ Near-infrared spectroscopy has progressed beyond assessment of brain oxygenation to monitor local tissue and muscle oxygenation and perfusion. This review analyzes the published data and provides the clinician a comprehensive account of the perioperative utility of NIRS in cardiac, vascular and thoracic surgery, as well as its increasing role in tissue/muscle oxygenation monitoring.
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J. Cardiothorac. Vasc. Anesth. · Aug 2022
ReviewRight Heart Failure Management: Focus on Mechanical Support Options.
Millions of American adults suffer from right heart failure (RHF), a condition associated with high rates of hospitalization, organ failure, and death. There is a multitude of etiologies and mechanisms that lead to RHF, often in a feedforward spiral of decline. The management of advanced cases of RHF can be particularly difficult. ⋯ Currently available mechanical assist devices for RHF include venoarterial extracorporeal oxygenation and right ventricular assist devices, both surgical and percutaneous. Each advanced therapy has its own potential advantages and limitations, and often is appropriate in different clinical contexts. In this review, the authors describe the pathophysiology and medical therapies for RHF and then focus on the different types of advanced therapies that currently exist to help inform medical decision-making for this complicated patient cohort.
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J. Cardiothorac. Vasc. Anesth. · Aug 2022
ReviewTransfusion-Related Acute Lung Injury During Liver Transplantation: A Scoping Review.
Liver transplantation is associated with significant blood loss, often requiring massive blood product transfusion. Transfusion-related acute lung injury (TRALI) is a devastating cause of transfusion-related deaths. While reports have investigated the general incidence of TRALI, the incidence of TRALI specifically following transfusion during liver transplant remains unclear. ⋯ Based on reported mortality data, 26.67% of patients (12 of 45) diagnosed with TRALI died during the postoperative period. This scoping review underscores the importance of better understanding the incidence and presentation of TRALI after liver transplant surgery. The clinical implications of these results warrant the development of identification and management strategies for liver transplant patients at increased risk for developing TRALI.
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J. Cardiothorac. Vasc. Anesth. · Aug 2022
ReviewThrombosis and coagulopathy in COVID-19 patients rceiving ECMO: A narrative review of current literature.
Extracorporeal membrane oxygenation (ECMO) is an established part of the treatment algorithm for coronavirus disease 2019 (COVID-19)-related acute respiratory distress syndrome. An intense inflammatory response may cause an imbalance in the coagulation cascade making both thrombosis and bleeding common and notable features of the clinical management of these patients. Large observational and retrospective studies provide a better understanding of the pathophysiology and management of bleeding and thrombosis in COVID-19 patients requiring ECMO. ⋯ The incidence of heparin-induced thrombocytopenia is higher than the general patient cohort with acute respiratory distress syndrome or other indications for ECMO. The use of laboratory parameters to predict bleeding or thrombosis has a limited role. In this review, the authors discuss the complex pathophysiology of bleeding and thrombosis observed in patients with COVID-19 during ECMO support, and their effects on outcomes.
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J. Cardiothorac. Vasc. Anesth. · Aug 2022
Multicenter StudyPostoperative Pulmonary Complications After Cardiac Surgery: The VENICE International Cohort Study.
Postoperative pulmonary complications (PPC) remain a main issue after cardiac surgery. The objective was to report the incidence and identify risk factors of PPC after cardiac surgery. ⋯ Both individual risk factors and ventilatory settings were shown to explain the high level of PPCs. These findings require further investigations to assess a bundle strategy for optimal ventilation strategy to decrease PPC incidence.