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Cardiothoracic critical care

Marije Smit, Maureen J M Werner, Annemieke Oude Lansink-Hartgring, Willem Dieperink, Jan G Zijlstra, Matijs van Meurs
BACKGROUND: Intra-abdominal hypertension (IAH) is frequently present in critically ill patients and is an independent predictor for mortality. Better recognition of clinically important thresholds is necessary. Increased intra-abdominal pressure (IAP) is associated with renal dysfunction, and renal failure is one of the most consistently described organ dysfunctions associated with IAH. Obesity is also associated with kidney injury. The underlying mechanisms are not yet fully understood...
December 2016: Annals of Intensive Care
Anthony T Gerlach, Danielle M Blais, G Morgan Jones, Pamela K Burcham, Stanislaw P Stawicki, Charles H Cook, Claire V Murphy
BACKGROUND: Dexmedetomidine is commonly used for sedation in the Intensive Care Unit (ICU), and its use may be associated with hypotension. We sought to determine predictors of dexmedetomidine-associated hypotension. METHODS: Retrospective, single-center study of 283 ICU patients in four adults ICUs over a 12 month period. Univariate analyses were performed to determine factors associated with dexmedetomidine-related hypotension. Risk factors significant at the 0...
July 2016: International Journal of Critical Illness and Injury Science
J Shahin, P Ferrando-Vivas, G S Power, S Biswas, S T Webb, K M Rowan, D A Harrison
The models used to predict outcome after adult general critical care may not be applicable to cardiothoracic critical care. Therefore, we analysed data from the Case Mix Programme to identify variables associated with hospital mortality after admission to cardiothoracic critical care units and to develop a risk-prediction model. We derived predictive models for hospital mortality from variables measured in 17,002 patients within 24 h of admission to five cardiothoracic critical care units. The final model included 10 variables: creatinine; white blood count; mean arterial blood pressure; functional dependency; platelet count; arterial pH; age; Glasgow Coma Score; arterial lactate; and route of admission...
September 26, 2016: Anaesthesia
Helen M Mohan, Vimal J Gokani, Adam P Williams, Rhiannon L Harries
Consultant Outcomes Publication (COP) has the longest history in cardiothoracic surgery, where it was introduced in 2005. Subsequently COP has been broadened to include all surgical specialties in NHS England in 2013-14. The Association of Surgeons in Training (ASiT) fully supports efforts to improve patient care and trust in the profession and is keen to overcome potential unintended adverse effects of COP. Identification of these adverse effects is the first step in this process: Firstly, there is a risk that COP may lead to reluctance by consultants to provide trainees with the necessary appropriate primary operator experience to become skilled consultant surgeons for the future...
September 19, 2016: International Journal of Surgery
Simon Tilma Vistisen
Fluid responsiveness prediction is an unsettled matter for most critical care patients and new methods relying only on the continuous basic monitoring are desired. It was hypothesized that the post-ectopic beat, which is associated with increased preload, could be analyzed in relation to preceding sinus beats and that the change in cardiac performance (e.g. systolic blood pressure) at the post-ectopic beat could predict fluid responsiveness. Cardiothoracic critical care patients scheduled for a 500 ml volume expansion were observed...
July 26, 2016: Journal of Clinical Monitoring and Computing
Simon De Freitas, Caoilfhionn Connolly
INTRODUCTION: Unsuccessful thrombolysis in the setting of massive pulmonary embolism confers poor prognosis and the optimal management strategy is unknown. Options include re-thrombolysis and embolectomy. PRESENTATION OF CASE: A 32-year-old lady presented with massive pulmonary embolism accompanied by an intermittently-obstructive right atrial thrombus. Failure to improve with thrombolytic therapy prompted transfer to our cardiothoracic unit for emergency surgical embolectomy...
2016: International Journal of Surgery Case Reports
A J Spooner, L M Aitken, A Corley, J F Fraser, W Chaboyer
BACKGROUND: Despite a proliferation of evidence and the development of standardised tools to improve communication at handover, evidence to guide the handover of critical patient information between nursing team leaders in the intensive care unit is limited. OBJECTIVE: The study aim was to determine the content of information handed over during intensive care nursing team leader shift-to-shift handover. DESIGN: A prospective observational study...
September 2016: International Journal of Nursing Studies
Joseph A Dearani, Jeffrey P Jacobs, R Morton Bolman, JaBaris D Swain, Luca A Vricella, Samuel Weinstein, Emily A Farkas, John H Calhoon
Noncommunicable diseases account for 38 million deaths each year, and approximately 75% of these deaths occur in the developing world. The most common causes include cardiovascular diseases, cancer, respiratory diseases, and diabetes mellitus. Many adults with acquired cardiothoracic disease around the world have limited access to health care. In addition, congenital heart disease is present in approximately 1% of live births and is therefore the most common congenital abnormality. More than one million children in the world are born with congenital heart disease each year, and approximately 90% of these children receive suboptimal care or have no access to care...
September 2016: Annals of Thoracic Surgery
S Gelvez-Zapata, R D'Oliveiro, J Osgathorpe, J Lonsdale, M Petty, N Jones
No abstract text is available yet for this article.
December 2015: Intensive Care Medicine Experimental
S Gelvez-Zapata, R D'Oliveiro, K Eriksson, J Bracken, M Pontin, N Jones
No abstract text is available yet for this article.
December 2015: Intensive Care Medicine Experimental
Brian T Wessman, Carrie Sona, Marilyn Schallom
BACKGROUND: Poor communication among health-care providers is cited as the most common cause of sentinel events involving patients. Patient care in the critical care setting is incredibly complex. A consistent care plan is necessary between day/night shift teams and among bedside intensive care unit (ICU) nurses, consultants, and physicians. Our goal was to create a novel, easily accessible communication device to improve ICU patient care. METHODS: This communication improvement project was done at an academic tertiary surgical/trauma/mixed 36-bed ICU with an average of 214 admissions per month...
June 6, 2016: Journal of Intensive Care Medicine
Guido Tavazzi, Andy Kontogeorgis, Niels P Bergsland, Susanna Price
OBJECTIVE: Inotropic and vasopressor drugs are routinely used in critically ill patients to maintain adequate blood pressure and cardiac output in patients with cardiogenic shock although potentially at the expense of increasing myocardial oxygen demand. Pacing optimization has been demonstrated as effective in reducing catecholamine requirements in patients with chronic heart failure by improving cardiac efficiency; however, there are no reports relating to the effectiveness of pacemaker optimization on cardiac output in critically ill patients with cardiogenic shock in the intensive care...
August 2016: Critical Care Medicine
Nicholas D Andersen
No abstract text is available yet for this article.
July 2016: Journal of Thoracic and Cardiovascular Surgery
Yigal Helviz, Ilia Dzigivker, David Raveh-Brawer, Moshe Hersch, Shoshana Zevin, Sharon Einav
BACKGROUND: Enoxaparin is frequently used as prophylaxis for deep venous thrombosis in critically ill patients. OBJECTIVES: To evaluate three enoxaparin prophylactic regimens in critical care patients with and without administration of a vasopressor. METHODS: Patients admitted to intensive care units (general and post-cardiothoracic surgery) without renal failure received, once daily, a subcutaneous fixed dose of 40 mg enoxaparin, a subcutaneous dose of 0...
February 2016: Israel Medical Association Journal: IMAJ
M Słodki, M Respondek-Liberska, J D Pruetz, M T Donofrio
Infants born with congenital heart disease (CHD) may require emergent treatment in the newborn period. These infants are likely to benefit the most from a prenatal diagnosis, which allows for optimal perinatal planning. Several cardiac centers have created guidelines for the management of these high-risk patients with CHD. This paper will review and compare several prenatal CHD classification systems with a particular focus on the most critical forms of CHD in the fetus and newborn. A contemporary definition of critical CHD is one which requires urgent intervention in the first 24 h of life to prevent death...
August 2016: Journal of Perinatology: Official Journal of the California Perinatal Association
Hisham M F Sherif
Cardiothoracic surgical critical care has emerged as a unique area of practice within cardiothoracic surgery. Leaders of multidisciplinary, high-performing teams are uniquely educated, trained, and skilled surgeons. Certification in this specialty by the American Board of Thoracic Surgery is a recognition of their distinction. A foundational framework is proposed toward this goal.
July 2016: Journal of Thoracic and Cardiovascular Surgery
Andrew Wang, Paul Grayburn, Jill A Foster, Marti L McCulloch, Vinay Badhwar, James S Gammie, Salvatore P Costa, Robert Michael Benitez, Michael J Rinaldi, Vinod H Thourani, Randolph P Martin
BACKGROUND: The revised 2014 American College of Cardiology (ACC)/American Heart Association valvular heart disease guidelines provide evidenced-based recommendations for the management of mitral regurgitation (MR). However, knowledge gaps related to our evolving understanding of critical MR concepts may impede their implementation. METHODS: The ACC conducted a multifaceted needs assessment to characterize gaps, practice patterns, and perceptions related to the diagnosis and treatment of MR...
February 2016: American Heart Journal
Adam S Evans, Michael Mazzeffi, Natalia S Ivascu, Shane Dickerson, Jacob T Gutsche
In 2015, the demand for the presence of cardiothoracic anesthesiologists outside of the cardiac operating rooms continues to expand. Most notably, cardiothoracic anesthesiologists now find themselves called on to care for patients postoperatively in the cardiothoracic surgical intensive care unit. This article is the first in this annual series to review relevant contributions in postoperative cardiac critical care that may influence the cardiac anesthesiologist. We explore the use of extracorporeal membrane oxygenation, management of postoperative atrial fibrillation and coagulopathy, metabolic support of the critically ill cardiothoracic surgical patient, and new insights into delirium and acute kidney injury...
March 2016: Seminars in Cardiothoracic and Vascular Anesthesia
Shadi Baniasadi, Behrooz Farzanegan, Maryam Alehashem
BACKGROUND: Patients in the intensive care unit (ICU) are more prone to drug-drug interactions (DDIs). The software and charts that indicate all interactions may not be proper for clinical usage. This study aimed to identify the main drug classes associated with clinically significant DDIs in cardiothoracic ICU and categorize DDIs to make cardiothoracic intensivists aware of safe medication usage. METHODS: This prospective study was conducted over 6 months in a cardiothoracic ICU of a university-affiliated teaching hospital...
December 2015: Annals of Intensive Care
P J McCall, A Macfie, J Kinsella, B G Shelley
Lung resection is associated with significant perioperative morbidity, and a proportion of patients will require intensive care following surgery. We set out to characterise this population, assess their burden of disease and investigate the influence of anaesthetic and surgical techniques on their admission rate. Over a two-year period, 1169 patients underwent surgery, with 30 patients (2.6%) requiring unplanned intensive care. Patients requiring support had a higher mortality (0.2% vs 26.7%, p < 0.001)...
December 2015: Anaesthesia
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