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https://www.readbyqxmd.com/read/28640019/mini-fluid-challenge-of-100-ml-of-crystalloid-predicts-fluid-responsiveness-in-the-operating-room
#1
Matthieu Biais, Hugues de Courson, Romain Lanchon, Bruno Pereira, Guillaume Bardonneau, Marion Griton, Musa Sesay, Karine Nouette-Gaulain
BACKGROUND: Mini-fluid challenge of 100 ml colloids is thought to predict the effects of larger amounts of fluid (500 ml) in intensive care units. This study sought to determine whether a low quantity of crystalloid (50 and 100 ml) could predict the effects of 250 ml crystalloid in mechanically ventilated patients in the operating room. METHODS: A total of 44 mechanically ventilated patients undergoing neurosurgery were included. Volume expansion (250 ml saline 0...
June 21, 2017: Anesthesiology
https://www.readbyqxmd.com/read/28637179/is-delayed-surgical-revascularization-in-acute-myocardial-infarction-useful-or-dangerous-new-insights-into-an-old-problem
#2
Philippe Grieshaber, Peter Roth, Lukas Oster, Tobias M Schneider, Gerold Görlach, Bernd Nieman, Andreas Böning
OBJECTIVES: Haemodynamically stable patients admitted for coronary artery bypass grafting in acute myocardial infarction often undergo delayed surgery in order to avoid the risks of emergency surgery. However, initially stable patients undergoing delayed surgery may develop low cardiac output syndrome (LCOS) during the waiting period, which might be a major drawback of this strategy. We aim to define risk factors and clinical consequences of LCOS during the waiting period. METHODS: A total of 530 consecutive patients with acute myocardial infarction (33% non-ST-segment elevation myocardial infarction and 67% ST-segment-elevation myocardial infarction) underwent isolated coronary artery bypass grafting between 2008 and 2013...
June 20, 2017: Interactive Cardiovascular and Thoracic Surgery
https://www.readbyqxmd.com/read/28633352/aortopulmonary-window-results-of-repair-beyond-infancy%C3%A2
#3
Sachin Talwar, Bharat Siddharth, Saurabh Kumar Gupta, Shiv Kumar Choudhary, Shyam Sunder Kothari, Rajnish Juneja, Anita Saxena, Balram Airan
OBJECTIVES: To study the anatomic and haemodynamic data and results of surgery in patients undergoing surgical repair of aortopulmonary window beyond infancy. METHODS: Between July 2005 and December 2015, 23 patients, older than 1 year undergoing surgery for aortopulmonary window were analysed retrospectively. Postoperative clinical and echocardiography follow-up were performed. RESULTS: Median age and weight at repair was 4 years (range 14 months-12 years) and 12 kg (range 3...
June 13, 2017: Interactive Cardiovascular and Thoracic Surgery
https://www.readbyqxmd.com/read/28625450/vasoplegic-syndrome-an-update-on-perioperative-considerations
#4
REVIEW
Henry Liu, Ling Yu, Longqiu Yang, Michael S Green
Vasoplegic syndrome (VS) is increasingly recognized as an important clinical entity in perioperative medicine. VS is characterized by significant arterial hypotension, normal or high cardiac output, low systemic vascular resistance, and increased requirements for intravenous volume and vasopressors. Tremendous variations exist regarding incidence reported in the literature and management at different institutions; and the incidence of VS is likely significantly higher than many anesthesiologists believe. Thus the aims of this article are to review the pertinent aspects related to VS and alert clinical anesthesiologists to this under-recognized yet very challenging clinical condition...
August 2017: Journal of Clinical Anesthesia
https://www.readbyqxmd.com/read/28625386/hemodynamic-determinants-of-mortality-after-fontan-operation
#5
Hideo Ohuchi, Aya Miyazaki, Jun Negishi, Yosuke Hayama, Michikazu Nakai, Kunihiro Nishimura, Hajime Ichikawa, Isao Shiraishi, Osamu Yamada
BACKGROUND: Elevated central venous pressure (CVP), low cardiac output, and mild hypoxia are common early and late after Fontan operations. However, the association of these characteristics with late mortality is unclear. We aimed to elucidate the hemodynamic determinants of mortality after Fontan operation. METHOD: We evaluated early (group early; 0.5-5years postoperatively, n=387) and late (group late; ≥15years postoperatively, n=161) Fontan hemodynamics that included CVP (mm Hg), cardiac index (CI; L/min per m(2)), systemic ventricular end-diastolic volume index (mL/m(2)), ejection fraction (EF; %), and arterial blood oxygen saturation (%)...
July 2017: American Heart Journal
https://www.readbyqxmd.com/read/28616803/amitriptyline-may-have-possibility-to-induce-brugada-syndrome-rather-than-long-qt-syndrome
#6
Nur Jaharat Lubna, Takeshi Wada, Yuji Nakamura, Koki Chiba, Xin Cao, Hiroko Izumi-Nakaseko, Kentaro Ando, Atsuhiko T Naito, Yoshioki Satoh, Atsushi Sugiyama
Amitriptyline has been reported to induce long QT syndrome in addition to Brugada syndrome. We qualitatively and quantitatively analyzed the potential of amitriptyline to induce these lethal syndromes by using the halothane-anesthetized dogs (n = 6). Amitriptyline was intravenously administered in doses of 0.1, 1 and 10 mg/kg over 10 min every 20 min, which would provide approximately 1, 10 and 100 times higher plasma concentrations than a therapeutic one, respectively. The low dose hardly altered any of the cardiovascular variables...
June 14, 2017: Cardiovascular Toxicology
https://www.readbyqxmd.com/read/28606278/-efficacy-of-mitral-valve-repair-versus-replacement-in-severe-ischemic-mitral-regurgitation
#7
Z B Qiu, X Chen, M Xu, Y S Jiang, L M Wang, F H Huang, P S Liu, R Wang, F Xiang, J J Shao, W Qin
Objective: To compare the mortality, survival rate and the therapeutic efficacy between mitral valve repair and replacement as treatment for severe ischemic mitral regurgitation (IMR), and explore the middle- and long-term outcomes. Methods: Between January 2000 and January 2016, 378 patients with severe IMR underwent coronary artery bypass grafting (CABG) combined with mitral valve repair (n=162) or mitral valve replacement (n=216) in the Department of Cardiovascular Surgery of Nanjing First Hospital. Clinical data, in-hospital morbidity and mortality of patients were retrospectively reviewed...
June 13, 2017: Zhonghua Yi Xue za Zhi [Chinese medical journal]
https://www.readbyqxmd.com/read/28600090/hemodynamics-of-cardiogenic-shock
#8
REVIEW
Ariel Furer, Jeffrey Wessler, Daniel Burkhoff
Cardiogenic shock (CS) represents an advanced state of morbidity along the pathophysiologic pathway of end-organ hypoperfusion caused by reduced cardiac output and blood pressure. Acute coronary syndromes remain the most common cause of CS. The spectrum of hypoperfusion states caused by low cardiac output ranges from pre-CS to refractory CS and can be characterized by an array of hemodynamic parameters. This review provides the foundation for a hemodynamic understanding of CS including the use of hemodynamic monitoring for diagnosis and treatment, the cardiac and vascular determinants of CS, and a hemodynamic approach to risk stratification and management of CS...
July 2017: Interventional cardiology clinics
https://www.readbyqxmd.com/read/28593456/impact-of-hemodynamic-goal-directed-resuscitation-on-mortality-in-adult-critically-ill-patients-a-systematic-review-and-meta-analysis
#9
Maria Cronhjort, Olof Wall, Erik Nyberg, Ruifeng Zeng, Christer Svensen, Johan Mårtensson, Eva Joelsson-Alm
The effect of hemodynamic optimization in critically ill patients has been challenged in recent years. The aim of the meta-analysis was to evaluate if a protocolized intervention based on the result of hemodynamic monitoring reduces mortality in critically ill patients. We performed a systematic review and meta-analysis according to the Cochrane Handbook for Systematic Reviews of Interventions. The study was registered in the PROSPERO database (CRD42015019539). Randomized controlled trials published in English, reporting studies on adult patients treated in an intensive care unit, emergency department or equivalent level of care were included...
June 8, 2017: Journal of Clinical Monitoring and Computing
https://www.readbyqxmd.com/read/28589408/critically-underdeveloped-left-heart-morphology-associated-with-prematurity-and-low-birth-weight-conditional-staged-rehabilitation-towards-biventricular-repair-and-time-related-growth-of-left-heart-structures
#10
Fareed Ahmad, Robert Mangano, Shirah Shore, Anastasios Polimenakos
This is a case report of premature low birth weight infant with hypoplasia of left heart structures and a large malaligned VSD who underwent successful staged approach of biventricular repair. We obtained qualitative and quantitative echocardiographic, MRI, and conventional catheterization data to support stepwise strategy towards LV rehabilitation to sustain adequate cardiac output. A thorough and intense follow-up has shown significant growth of left heart structures and favorable clinical status following staged biventricular repair...
June 7, 2017: Pediatric Cardiology
https://www.readbyqxmd.com/read/28582490/impact-of-minimally-invasive-extracorporeal-circuits-on-octogenarians-undergoing-coronary-artery-bypass-grafting-have-we-been-looking-in-the-wrong-direction-%C3%A2
#11
Aschraf El-Essawi, Ingo Breitenbach, Benjamin Haupt, Rene Brouwer, Hassina Baraki, Wolfgang Harringer
OBJECTIVES: Minimally invasive extracorporeal circuits (MiECCs) aim at the preservation of physiologic reserves, the impact of which is expected to be most evident in patients in whom these are depleted. In this context, octogenarians present a subpopulation of specific interest. METHODS: Based on the type of the utilized ECC, we performed a retrospective comparison between all octogenarians ( n  = 324) who received a primary coronary artery bypass in our institution from 2003 until 2010...
June 3, 2017: European Journal of Cardio-thoracic Surgery
https://www.readbyqxmd.com/read/28582001/management-of-multivessel-disease-and-cardiogenic-shock
#12
REVIEW
Amerjeet S Banning, Anthony H Gershlick
Cardiogenic shock represents a state of low cardiac output and systemic hypoperfusion resulting in insufficient end-organ perfusion and consequent multiorgan failure. The main cause of this complication in the context of acute ST-elevation myocardial infarction is left ventricular dysfunction secondary to poor myocardial perfusion. In over 50% of cardiogenic shock cases, there is evidence of significant coronary stenosis within noninfarct-related arteries. Persistent ischemia in the noninfarct territory may contribute to ongoing hypotension...
October 2016: Interventional cardiology clinics
https://www.readbyqxmd.com/read/28580075/role-of-vasopressin-in-current-anesthetic-practice
#13
REVIEW
Keun Suk Park, Kyung Yeon Yoo
Arginine vasopressin (AVP), also known as antidiuretic hormone, is a peptide endogenously secreted by the posterior pituitary in response to hyperosmolar plasma or systemic hypoperfusion states. When administered intravenously, it causes an intense peripheral vasoconstriction through stimulation of V1 receptors on the vascular smooth muscle. Patients in refractory shock associated with severe sepsis, cardiogenic or vasodilatory shock, or cardiopulmonary bypass have inappropriately low plasma levels of AVP ('relative vasopressin deficiency') and supersensitivity to exogenously-administered AVP...
June 2017: Korean Journal of Anesthesiology
https://www.readbyqxmd.com/read/28577680/results-of-a-phase-i-ii-multi-center-investigation-of-udenafil-in-adolescents-after-fontan-palliation
#14
David J Goldberg, Victor Zak, Bryan H Goldstein, Shan Chen, Michelle S Hamstra, Elizabeth A Radojewski, Eileen Maunsell, Seema Mital, Shaji C Menon, Kurt R Schumacher, R Mark Payne, Mario Stylianou, Jonathan R Kaltman, Tina M deVries, James L Yeager, Stephen M Paridon
BACKGROUND: The Fontan operation results in a circulation that is dependent on low pulmonary vascular resistance to maintain an adequate cardiac output. Medical therapies that lower pulmonary vascular resistance may augment cardiac output and improve long-term outcomes. OBJECTIVES: This phase I/II clinical trial conducted by the Pediatric Heart Network was designed to evaluate short-term safety, pharmacokinetics (PK), and preliminary efficacy of udenafil in adolescents following Fontan...
June 2017: American Heart Journal
https://www.readbyqxmd.com/read/28575215/comparison-of-the-effects-of-selective-and-non-selective-his-bundle-pacing-on-cardiac-electrical-and-mechanical-synchrony
#15
Jinlong Zhang, Jianghong Guo, Xiaofeng Hou, Yao Wang, Zhiyong Qian, Kebei Li, Peibing Ge, Jiangang Zou
Aims: This study aimed to assess the acute effect of selective His bundle pacing (S-HBP), non-selective His bundle pacing (NS-HBP), and right ventricular septum pacing (RVSP) on electrical synchrony and left ventricular (LV) mechanical synchrony using electrocardiogram and phase analysis of gated single photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI). Methods and results: Totally 39 patients eligible for pacemaker were enrolled. Thirty-seven patients underwent successful His bundle pacing (HBP) including S-HBP in 23 and NS-HBP in 14 patients, respectively...
May 31, 2017: Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology
https://www.readbyqxmd.com/read/28574348/direct-multitype-cardiac-indices-estimation-via-joint-representation-and-regression-learning
#16
Wufeng Xue, Ali Islam, Mousumi Bhaduri, Shuo Li
Cardiac indices estimation is of great importance during identification and diagnosis of cardiac disease in clinical routine. However, estimation of multitype cardiac indices with consistently reliable and high accuracy is still a great challenge due to the high variability of cardiac structures and complexity of temporal dynamics in cardiac MR sequences. While efforts have been devoted into cardiac volumes estimation through feature engineering followed by a independent regression model, these methods suffer from the vulnerable feature representation and incompatible regression model...
May 26, 2017: IEEE Transactions on Medical Imaging
https://www.readbyqxmd.com/read/28574346/generative-adversarial-networks-for-noise-reduction-in-low-dose-ct
#17
Jelmer M Wolterink, Tim Leiner, Max A Viergever, Ivana Isgum
Noise is inherent to low-dose CT acquisition. We propose to train a convolutional neural network (CNN) jointly with an adversarial CNN to estimate routine-dose CT images from low-dose CT images and hence reduce noise. A generator CNN was trained to transform low-dose CT images into routine-dose CT images using voxel-wise loss minimization. An adversarial discriminator CNN was simultaneously trained to distinguish the output of the generator from routinedose CT images. The performance of this discriminator was used as an adversarial loss for the generator...
May 26, 2017: IEEE Transactions on Medical Imaging
https://www.readbyqxmd.com/read/28574213/comparison-of-cardiac-output-estimates-by-bioreactance-and-inert-gas-rebreathing-methods-during-cardiopulmonary-exercise-testing
#18
Nduka C Okwose, Shakir Chowdhury, David Houghton, Michael I Trenell, Christopher Eggett, Matthew Bates, Guy A MacGowan, Djordje G Jakovljevic
PURPOSE: This study assessed the agreement between cardiac output estimated by inert gas rebreathing and bioreactance methods at rest and during exercise. METHODS: Haemodynamic measurements were assessed in 20 healthy individuals (11 females, nine males; aged 32 ± 10 years) using inert gas rebreathing and bioreactance methods. Gas exchange and haemodynamic data were measured simultaneously under rest and different stages (i.e. 30, 60, 90, 120, 150 and 180 W) of progressive graded cardiopulmonary exercise stress testing using a bicycle ergometer...
June 2, 2017: Clinical Physiology and Functional Imaging
https://www.readbyqxmd.com/read/28572979/complex-effects-of-high-flow-nasal-cannula-therapy-on-hemodynamics-in-the-pediatric-patient-after-cardiac-surgery
#19
EDITORIAL
Yu Inata, Muneyuki Takeuchi
BACKGROUND: The high-flow nasal cannula (HFNC) system has been widely used for children in various clinical settings. However, the physiological and clinical impact of HFNC therapy on the pediatric patient with respiratory distress after cardiac surgery has not been thoroughly investigated. MAIN BODY OF THE ABSTRACT: It seems logical to use HFNC as a primary therapy for post-extubation respiratory failure after congenital heart surgery, in which low cardiac output syndrome and upper airway obstruction are commonly encountered; the HFNC therapy alleviates the work of breathing and large negative swings of intrathoracic pressure, which in turn helps to decrease the systemic ventricular afterload...
2017: Journal of Intensive Care
https://www.readbyqxmd.com/read/28571240/monitoring-microcirculatory-blood-flow-during-cardiopulmonary-bypass-in-paediatric-cardiac-surgery-patients-as-a-predictor-for-anaerobic-metabolism
#20
Ramesh Patel, Atul Solanki, Hasmukh Patel, Jignesh Patel, Himani Pandya, Jainam Sharma
INTRODUCTION: Improving tissue oxygenation is one of most important tasks in management of low cardiac output. Central venous oxygen saturation (ScvO2) and lactate are established criteria for monitoring the adequacy of tissue oxygenation. The venous-to-arterial carbon dioxide difference [P(v-a)CO2] is inversely associated with cardiac output. AIM: To study the use of P(v-a)CO2/C(a-v)O2 ratio as a marker of low cardiac output during Cardiopulmonary Bypass (CPB) in paediatric cardiac surgical patients...
April 2017: Journal of Clinical and Diagnostic Research: JCDR
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