Journal of cardiothoracic and vascular anesthesia
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J. Cardiothorac. Vasc. Anesth. · Feb 1998
Comparative StudyGoal-directed transesophageal echocardiography performed by intensivists to assess left ventricular function: comparison with pulmonary artery catheterization.
Transesophageal echocardiography (TEE) is a valuable procedure for assessing left ventricular (LV) function, but it has not been widely applied in critical care because of the limited number of intensivists who are trained in echocardiography. This prospective study was designed to evaluate the feasibility of training intensivists to perform a goal-directed, limited-scope TEE to assess LV function in critically ill patients using a pediatric monoplane TEE probe. A secondary goal was to compare the usefulness of the TEE data with that of data obtained by a simultaneous pulmonary artery catheter (PAC). ⋯ Training intensivists in limited-scope, goal-directed TEE, using a pediatric monoplane probe to evaluate LV function, can be done rapidly and safely, and yield data pertinent to management of critically ill patients even in the early stages of skill acquisition.
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J. Cardiothorac. Vasc. Anesth. · Feb 1998
Relationships between cerebral blood flow velocities and arterial pressures during intra-aortic counterpulsation.
To determine the effects of intra-aortic counterpulsation (IABP) on cerebral blood flow velocity. ⋯ IABP modified the phasic profile of cerebral blood flow to reflect the arterial pressure waveform without affecting mean cerebral blood flow velocity. Peak systolic cerebral blood flow velocity was maintained in augmented beats despite the decreased systolic arterial pressure associated with afterload reduction. The acute decrease in cerebral blood flow velocity at pre-ejection was balanced by increased cerebral blood flow velocity during balloon inflation in diastole.
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J. Cardiothorac. Vasc. Anesth. · Dec 1997
The incidence of artery puncture with central venous cannulation using a modified technique for detection and prevention of arterial cannulation.
Cannulation of the central circulation is essential for management of patients who require major surgery, and for patients who are critically ill. Arterial puncture is the most frequent complication associated with central venous cannulation, and is potentially fatal. Detection of arterial puncture can be problematic, especially in patients with cyanotic congenital heart disease. ⋯ Pressure transduction of the steel needle is a useful technique for detecting arterial puncture and preventing arterial cannulation during attempts to achieve central venous cannulation.
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J. Cardiothorac. Vasc. Anesth. · Dec 1997
Comparative StudyPlatelet concentrate effects on thromboelastography.
This study evaluated platelet effects on thromboelastography to determine how morphologically abnormal platelets affected native whole blood analysis. ⋯ Viscoelastic changes in whole blood coagulation after the addition of platelet concentrates are not dependent on morphologically intact or functionally normal platelets. This in vitro study predicts that transfusion of poorly preserved platelet concentrates as well as fresh platelets would increase clot strength on thromboelastography if the recipient's blood were tested immediately after administration.
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J. Cardiothorac. Vasc. Anesth. · Dec 1997
Coagulation tests predict bleeding after cardiopulmonary bypass.
To determine the accuracy of coagulation profile laboratory tests, thromboelastography, and Sonoclot (SCT) values for predicting microvascular bleeding after cardiopulmonary bypass (CPB). ⋯ Contrary to previous studies, coagulation profile tests had the greatest sensitivity and specificity to differentiate patients with excessive bleeding (abnormal) from those without excessive bleeding (normal) after CPB. Therefore, these tests should be used to guide transfusion therapy in patients who have excessive bleeding after CPB.