Articles: postoperative.
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Pediatr Crit Care Me · Mar 2014
Changes in Cerebral Oxygen Saturation Correlate with S100B in Infants Undergoing Cardiac Surgery With Cardiopulmonary Bypass.
The relationship of cerebral saturation measured by near-infrared spectroscopy with serum biomarker of brain injury S100B was investigated in infants undergoing cardiac surgery with cardiopulmonary bypass. ⋯ A wide cerebral arteriovenous difference measured by near-infrared spectroscopy during cardiopulmonary bypass is associated with increased serum S100B in the perioperative period and may be a modifiable risk factor for neurological injury.
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Comparative Study
Improved consistency in interpretation and management of cardiovascular variables by intensive care staff using a computerised decision-support system.
To investigate the potential of a computerised decision-support system (CDSS) to improve consistency of haemodynamic evaluation and treatment suggestions by intensive care unit clinical staff with different levels of expertise and experience. ⋯ Use of a CDSS significantly improved the consistency between categories of clinical ICU staff in assessing the cardiovascular status and making management decisions in postoperative cardiac surgery patients.
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Cardiovascular Case Report Posters IISESSION TYPE: Case Report PosterPRESENTED ON: Sunday, March 23, 2014 at 01:15 PM - 02:15 PMINTRODUCTION: We present a case of progressive hypoxemia with platypnea-orthodeoxia developing after lung resection surgery for lung cancer. ⋯ Symptoms of hypoxemia with platypnea-orthodeoxia are concerning for shunt physiology. The differential diagnosis includes sources of intracardiac (ASD, PFO) and intrapulmonary shunting. He had a prior intracardiac shunt on an earlier echo but not on the post-operative study. He had no evidence of other cardiac causes such as pericardial effusion, constrictive pericarditis or aortic aneurysm. He had an interstitial lung disease by CT scan but this was unchanged radiographically. There was no evidence of other pulmonary causes such as COPD, thromboembolic disease or an intrapulmonary shunt (arteriovenous malformation). He had no history of liver disease with shunt from cirrhosis or history of kyphoscoliosis. Platypnea-orthodeoxia was first described in 1949 and major causes are intracardiac shunts and intrapulmonary shunts. The intracardiac shunts are right-to-left and most often include atrial septal defect, patent foramen ovale or fenestrated atrial aneurysm. Other causes include pericardial effusion, lobectomy, pneumonectomy or upper abdominal surgery. This occurs from preferential blood flow towards the atrial septum that is accentuated by altered intracardiac anatomy, compliances of the right and left heart, pulmonary vascular resistance and transient right to left pressure gradients associated with respiratory and positional changes. This is generally not associated with pulmonary hypertension and atrial right-to-left shunting has been reported despite normal right-sided pressures. A right-to-left shunt is more likely to appear after a right-sided lung resection with most patients having symptoms develop a month to several months afterwards. Noncardiac causes can include intrapulmonary shunting, such as thromboembolic disease and AVMs, or cirrhosis and kyphoscolisoss. The key to diagnosis is clinical suspicion of symptoms of dyspnea and hypoxemia, induced or worsened by an upright posture. In conclusion, interatrial shunting through a PFO or ASD is a rare but clinically significant condition after thoracic surgery. There are several underlying etiologies and can occur in the immediate postoperative period or can be more delayed.Reference #1: Interatrial Shunting After Major Thoracic Surgery: A Rare but Clinically Significant Event. Ann Thorac Surg 2012;93:1647-51Reference #2: Dyspnoea and hypoxaemia after lung surgery: the role of interatrial right-to-left shunt. Eur Respir J 2006; 28: 174-181Reference #3: Platypnoea-orthodeoxia syndrome. Heart 2000;83:221-223DISCLOSURE: The following authors have nothing to disclose: Nitin Bhatt, Ulysses MagalangNo Product/Research Disclosure Information.
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Surgery Case Report Posters IISESSION TYPE: Case Report PosterPRESENTED ON: Sunday, March 23, 2014 at 01:15 PM - 02:15 PMINTRODUCTION: Pancreaticopleural fistulae (PPF) are rare communications between the pancreatic duct and the pleural cavity. More commonly the sequelae of alcoholism, PPF occasional results from peripancreatic surgery. ⋯ The following authors have nothing to disclose: Eric Toloza, Christian Sobky, Anna Cheng, Christy Chai, Ian Smithson, Lori Brown, Carla Moodie, Joseph Garrett, Colin Parsons, Pamela Hodul, Mokenge MalafaNo Product/Research Disclosure Information.
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Cancer Case Report Posters IISESSION TYPE: Case Report PosterPRESENTED ON: Sunday, March 23, 2014 at 01:15 PM - 02:15 PMINTRODUCTION: Primary paraganglioma of the lung is a rare tumor of which few cases are reported in literature. ⋯ The following authors have nothing to disclose: Giuseppe Fiorentino, Anna Annunziata, Rosa Cauteruccio, Raffaele Cobuccio, Mario CaputiNo Product/Research Disclosure Information.