Heart, lung and vessels
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Heart, lung and vessels · Jan 2015
A novel non-invasive ventilation mask to prevent and manage respiratory failure during fiberoptic bronchoscopy, gastroscopy and transesophageal echocardiography.
Fiberoptic bronchoscopy (for difficult intubation, bronchoalveolar lavage or biopsies), gastric endoscopies and transesophageal echocardiography (for transfemoral aortic valve replacement, MitraClip or left atrial appendage closure), are widespread diagnostic and therapeutic procedures. Non-invasive ventilation during upper endoscopies can be used to prevent or treat acute respiratory failure especially in high risk or sedated patients. We describe a novel full face mask specifically developed not only for "elective" non-invasive ventilation during upper endoscopies but also for emergent application without probe removal. The mask is formed by two halves fixed only at the upper extremity allowing opening and closure while the probe is in place. ⋯ In patients requiring a true ventilatory support (like patients with neuromuscular disease or those deeply sedated), Janus also allows effective manual or mechanical ventilation. Its use can improve safety, patient's comfort (as sedation can be titrated to the desired effect without fearing respiratory depression) and efficiency, avoiding time wasting and allowing procedure completion. Prospective trials are required to confirm its effectiveness.
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Heart, lung and vessels · Jan 2015
Beneficial impact of levosimendan in critically ill patients with or at risk for acute renal failure: a meta-analysis of randomized clinical trials.
The incidence of Acute Kidney Injury is nowadays high in critically ill patients. Its etiology is multifactorial and a primary role is played by low cardiac output syndrome. Everything targeted to normalize cardiac output should increase the renal perfusion and abolish the secondary vasoconstriction. Levosimendan is a calcium sensitizer drug with inotropic properties that improves cardiac output and seems to increase renal blood flow. The aim of this meta-analysis was to evaluate the role of levosimendan in critically ill patients with or at risk of Acute Kidney Injury. ⋯ This meta-analysis suggests that the use of levosimendan is associated with a significant reduction of Renal Replacement Therapy in critically ill patients.
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Heart, lung and vessels · Jan 2015
Ventilator strategies for VV ECMO management with concomitant tracheal injury and H1N1 influenza.
Tracheal injury is a rare but highly morbid complication of endotracheal intubation. Recent reviews have advocated conservative management of these injuries without operative intervention. Extracorporeal membrane oxygenation may be a useful tool in non-operative management of tracheal injury in the setting of severe respiratory failure and need for prolonged intubation. ⋯ Concomitant tracheal injury and acute lung injury pose a difficult ventilation dilemma. This patient was successfully managed by venovenous extracorporeal membrane oxygenation, high frequency oscillator ventilation, proning position and tube thoracostomy. The venovenous extracorporeal membrane oxygenation and ventilator management were essential for this patient's recovery.
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Heart, lung and vessels · Jan 2015
Ultrasound-guided carotid sheath block for carotid endarterectomy: a case series of the spread of injectate.
We aimed to show the spread of local anesthetic following an ultrasound-guided, double-injection technique of a carotid sheath block before carotid endarterectomy. ⋯ Ultrasound-guided carotid sheath block provided an extensive spread of local anesthetic. A complete ring formation of local anesthetic around the artery does not seem necessary for a successful anesthesia. The resulting nerve blockade thus appears sufficient for surgery, with minor risks compared to blind methods.
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Heart, lung and vessels · Jan 2015
Major themes for 2014 in cardiothoracic and vascular anaesthesia and intensive care.
There has been significant progress throughout 2014 in cardiothoracic and vascular anaesthesia and intensive care. There has been a revolution in the clinical approach to acute and chronic adult aortic diseases. Contemporary management of adult aortic disease is based on etiology, clinical presentation, extent, and integrated intervention with medical, endovascular and/or surgical measures. ⋯ Integrated guidelines address the management of myocardial revascularization including the percutaneous and surgical options. Despite 50 years since the first coronary artery bypass grafting procedure and impressive advances in interventional cardiology, surgical revascularization remains a gold standard for many patients with coronary artery disease. These advances in 2014 will likely further improve perioperative outcomes for our patients.