Seminars in cardiothoracic and vascular anesthesia
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Semin Cardiothorac Vasc Anesth · Dec 2010
Randomized Controlled TrialEffects of nondependent lung ventilation with continuous positive-pressure ventilation and high-frequency positive-pressure ventilation on right-ventricular function during 1-lung ventilation.
Background. The application of volume-controlled high frequency positive pressure ventilation (HFPPV) to the nondependent lung (NL) may have comparable effects to continuous positive airway pressure (CPAP) on the right ventricular (RV) function, oxygenation, and surgical conditions during one lung ventilation (OLV) for thoracotomy. Methods. ⋯ The application of NL-HFPPV resulted in improved REF by 33%, SVI and DO2 (P < 0.01) and reduced RVEDVI, RVSWI, PVRI, oxygen uptake, and shunt fraction by 24.8% (P < 0.01) than in the NL-CPAP groups. Conclusion. We concluded that the use of NL-HFPPV is a feasible option and offers improved RV function and oxygenation during OLV for open thoracotomy.
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Semin Cardiothorac Vasc Anesth · Dec 2010
Diagnosis of acute respiratory distress syndrome in nosocomial pneumonia.
Acute respiratory distress syndrome (ARDS) complicates nosocomial pneumonias (NPn) in 12% to 33% of patients with associated increases in mortality of up to 80%. A timely diagnosis of ARDS with NPn is, however, problematic. The aim of this investigation was to improve the diagnosis and treatment of the early stages of ARDS with NPn. ⋯ Elevation of extravascular lung water index along with other ARDS diagnostic criteria (oxygenation index, central hemodynamic indices) was predictive of early stage of ARDS in patients with NPn. The standard diagnostic criteria for ARDS, including the Murray score, oxygenation index, and radiographic data only predicted the later stages of ARDS in NPn. Early diagnosis of ARDS with concomitant NPn in the current study was associated with improved treatment results with decreased duration of artificial ventilation and intensive care unit stay.
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Semin Cardiothorac Vasc Anesth · Dec 2010
Dynamics of extravascular pulmonary water and intracranial pressure in patients with ischemic stroke.
The objective of the present study was to examine the relationship among extravascular pulmonary water, intracranial and cerebral perfusion pressure, hemodynamic parameters (eg, cardiac index, system vascular resistance index), and brain stem function during acute ischemic stroke. The subjects were 17 comatose patients with ischemic stroke who were admitted to an intensive care unit. The results revealed an elevation in extravascular lung water in the absence of cardiac dysfunction. ⋯ There was a correlation between auditory-evoked potential parameters and extravascular lung water during the study period. The correlation between auditory-evoked potentials and extravascular lung water may imply that ischemic brainstem injury plays a significant role in the development of increased pulmonary capillary permeability and the elevation of extravascular lung water. Brain stem injury is a cause of noncardiogenic lung edema in comatose patients following acute ischemic stroke.
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Semin Cardiothorac Vasc Anesth · Dec 2010
Review Case ReportsThe management of antiplatelet therapy in patients with coronary stents undergoing noncardiac surgery.
Whereas the development of coronary stents has been a major breakthrough in the treatment of coronary artery disease, stent thrombosis, associated with myocardial infarction and death, has introduced a new challenge in the care of patients with coronary stents undergoing noncardiac surgery. This review presents the authors' recommendations regarding the optimal management of such patients. ⋯ On the other hand, managing a patient undergoing non-elective surgery is more difficult and necessitates a case-by-case assessment of bleeding risk versus thrombotic risk based on patient comorbidities, type of stents present, details of the coronary intervention, and type of surgical procedure. Patients with a risk of bleeding that outweighs the risk of stent thrombosis should discontinue at least clopidogrel, whereas all other patients should continue dual antiplatelet therapy throughout the perioperative period.
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Semin Cardiothorac Vasc Anesth · Dec 2010
ReviewA review of perioperative statin therapy for noncardiac surgery.
The leading cause of perioperative morbidity and mortality after major noncardiac surgery is cardiovascular complications. Clinical trials of lipid-lowering 3-hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) reductase inhibitors (statins) have shown improved cardiovascular outcomes; therefore, statins have become a mainstay in the prevention of cardiovascular disease. ⋯ This review will (1) examine the evidence for using perioperative statin therapy in the noncardiac surgical patient (2) explore the possible consequences of statin withdrawal, and (3) revisit the evidence for the safety of statin use. Further studies are still needed to establish the optimal dosage as well as timing and length of statin therapy perioperatively.