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Clinical Practice Guidelines for Cardiopulmonary Bypass

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https://www.readbyqxmd.com/read/29701385/predictors-of-acute-kidney-injury-in-the-postoperative-period-of-cardiac-surgery-associated-with-cardiopulmonary-bypass
#1
Raquel Moreira, Tiago Jacinto, Paulo Neves, Luís Vouga, Cristina Baeta
INTRODUCTION: Acute kidney injury (AKI) in the postoperative period of cardiac surgery occurs in 1 to 30% of the patients, mainly caused by ischemia secondary to renal hypoperfusion. Cardiopulmonary bypass (CPB) has a deleterious effect on renal function, constituting an aggression to the patient's homeostasis. AIM: To evaluate the incidence of AKI in the postoperative period of cardiac surgery in patients without preoperative renal insufficiency who underwent cardiac surgery with CPB, and explore the association between incidence of AKI and predictors related to CPB...
July 2017: Revista Portuguesa de Cirurgia Cardio-torácica e Vascular
https://www.readbyqxmd.com/read/29701358/carotid-stenosis-in-cardiac-surgery-patients
#2
Pedro Pinto Sousa, Gabriela Teixeira, João Gonçalves, Carlos Veiga, Pedro Sá Pinto, Pedro Brandão, Alexandra Canedo, Luis Vouga, Rui Almeida
INTRODUCTION: Ischemic stroke is a potential perioperative complication after an open heart surgery (OHS). Whether a carotid stenosis or occlusion is associated with an increased risk of perioperative stroke in patients or just a risk factor has been a concern of intense debate in the literature. METHODS: We retrospectively analyzed patients submitted to OHS between January and December2016 with known asymptomatic carotid disease. The data from 85 consecutive patients undergoing coronary artery bypass grafting, valve replacement, or both was collected...
July 2017: Revista Portuguesa de Cirurgia Cardio-torácica e Vascular
https://www.readbyqxmd.com/read/29678987/protocol-for-a-phase-iii-non-inferiority-randomised-comparison-of-a-new-fibrinogen-concentrate-versus-cryoprecipitate-for-treating-acquired-hypofibrinogenaemia-in-bleeding-cardiac-surgical-patients-the-fibres-trial
#3
Keyvan Karkouti, Jeannie Callum, Vivek Rao, Nancy Heddle, Michael E Farkouh, Mark A Crowther, Damon C Scales
INTRODUCTION: Coagulopathic bleeding is a serious complication of cardiac surgery to which an important contributor is acquired hypofibrinogenaemia (plasma fibrinogen <1.5-2.0 g/L). The standard intervention for acquired hypofibrinogenaemia is cryoprecipitate, but purified fibrinogen concentrates are also available. There is little comparative data between the two therapies and randomised trials are needed. METHODS AND ANALYSIS: FIBrinogen REplenishment in Surgery (FIBRES) is a multicentre, randomised (1:1), active-control, single-blinded, phase III trial in adult cardiac surgical patients experiencing clinically significant bleeding related to acquired hypofibrinogenaemia...
April 20, 2018: BMJ Open
https://www.readbyqxmd.com/read/29559750/sts-sca-amsect-clinical-practice-guidelines-anticoagulation-during-cardiopulmonary-bypass
#4
Linda Shore-Lesserson, Robert A Baker, Victor Ferraris, Philip E Greilich, David Fitzgerald, Philip Roman, John Hammon
Despite more than a half century of "safe" cardiopulmonary bypass (CPB), the evidence base surrounding the conduct of anticoagulation for CPB has not been organized into a succinct guideline. For this and other reasons, there is enormous practice variability relating to the use and dosing of heparin, monitoring heparin anticoagulation, reversal of anticoagulation, and the use of alternative anticoagulants. To address this and other gaps, the Society of Thoracic Surgeons (STS), the Society of Cardiovascular Anesthesiologists (SCA), and the American Society of Extracorporeal Technology (AmSECT) developed an Evidence Based Workgroup...
March 2018: Journal of Extra-corporeal Technology
https://www.readbyqxmd.com/read/29384058/inflammation-atrial-fibrillation-and-cardiac-surgery-current-medical-and-invasive-approaches-for-the-treatment-of-atrial-fibrillation
#5
Sahin Iscan, Bortecin Eygi, Yuksel Besir, Ismail Yurekli, Habib Cakir, Levent Yilik, Orhan Gokalp, Ali Gurbuz
Atrial fibrillation (AF) is a cardiac dysrhythmia commonly seen in clinical practice especially after cardiac surgery. It is associated with increased morbidity and mortality for the patients. The pathogenesis of AF is not exactly understood yet, but there is growing data about the relationship between AF and inflammation. Cardiac surgery itself is a big source for inflammation. It causes major surgical trauma, ischemia/reperfusion injury, hypothermia, low arterial pressure, and the equipment of cardiopulmonary bypass makes a large foreign surface thus it activates inflammatory response...
2018: Current Pharmaceutical Design
https://www.readbyqxmd.com/read/29362176/the-society-of-thoracic-surgeons-the-society-of-cardiovascular-anesthesiologists-and-the-american-society-of-extracorporeal-technology-clinical-practice-guidelines-anticoagulation-during-cardiopulmonary-bypass
#6
Linda Shore-Lesserson, Robert A Baker, Victor A Ferraris, Philip E Greilich, David Fitzgerald, Philip Roman, John W Hammon
Despite more than a half century of "safe" cardiopulmonary bypass (CPB), the evidence base surrounding the conduct of anticoagulation therapy for CPB has not been organized into a succinct guideline. For this and other reasons, there is enormous practice variability relating to the use and dosing of heparin, monitoring heparin anticoagulation, reversal of anticoagulation, and the use of alternative anticoagulants. To address this and other gaps, The Society of Thoracic Surgeons, the Society of Cardiovascular Anesthesiologists, and the American Society of Extracorporeal Technology developed an Evidence Based Workgroup...
February 2018: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/29346209/the-society-of-thoracic-surgeons-the-society-of-cardiovascular-anesthesiologists-and-the-american-society-of-extracorporeal-technology-clinical-practice-guidelines-anticoagulation-during-cardiopulmonary-bypass
#7
Linda Shore-Lesserson, Robert A Baker, Victor A Ferraris, Philip E Greilich, David Fitzgerald, Philip Roman, John W Hammon
Despite more than a half century of "safe" cardiopulmonary bypass (CPB), the evidence base surrounding the conduct of anticoagulation therapy for CPB has not been organized into a succinct guideline. For this and other reasons, there is enormous practice variability relating to the use and dosing of heparin, monitoring heparin anticoagulation, reversal of anticoagulation, and the use of alternative anticoagulants. To address this and other gaps, The Society of Thoracic Surgeons, the Society of Cardiovascular Anesthesiologists, and the American Society of Extracorporeal Technology developed an Evidence Based Workgroup...
February 2018: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/29237016/evaluation-of-cefazolin-antimicrobial-prophylaxis-during-cardiac-surgery-with-cardiopulmonary-bypass
#8
Divna Calic, Robert E Ariano, Rakesh C Arora, Hilary P Grocott, Ted M Lakowski, Ryan Lillico, Sheryl A Zelenitsky
Objectives: Although clinical practice guidelines recommend standard cefazolin antimicrobial prophylaxis (AP) dosing for cardiac surgery, limited data exist as to whether adequate concentrations are achieved in this patient population. The goal of our study was to characterize intraoperative cefazolin concentrations particularly at wound closure with regards to maintaining target cefazolin closure concentrations ≥40 mg/L. Methods: Adults undergoing cardiac surgery with cardiopulmonary bypass (CPB) and receiving cefazolin AP according to protocol were studied...
December 8, 2017: Journal of Antimicrobial Chemotherapy
https://www.readbyqxmd.com/read/28885216/microcirculation-measurements-barriers-for-use-in-clinical-routine
#9
Dietrich Henzler, Matthias Scheffler, Arne Westheider, Thomas Köhler
BACKGROUND: In patients with shock, inflammation and sepsis alterations in microcirculation are common problems. Although the pathophysiologic consequences are well understood, measurements of microcirculation have not entered clinical routine so far. OBJECTIVE: To characterize the requirements for clinical microcirculation measurement techniques and the barriers for implementation into routine practice. METHODS: Clinical review of reliability, reproducibility, validity, availability and usefulness of clinically available measurement techniques to be used in patients with sepsis or cardiac surgery with cardiopulmonary bypass...
2017: Clinical Hemorheology and Microcirculation
https://www.readbyqxmd.com/read/26543248/the-society-of-thoracic-surgeons-the-society-of-cardiovascular-anesthesiologists-and-the-american-society-of-extracorporeal-technology-clinical-practice-guidelines-for-cardiopulmonary-bypass-temperature-management-during-cardiopulmonary-bypass
#10
Richard Engelman, Robert A Baker, Donald S Likosky, Alina Grigore, Timothy A Dickinson, Linda Shore-Lesserson, John W Hammon
To improve our understanding of the evidence-based literature supporting temperature management during adult cardiopulmonary bypass, The Society of Thoracic Surgeons, the Society of Cardiovascular Anesthesiology and the American Society of ExtraCorporeal Technology tasked the authors to conduct a review of the peer-reviewed literature, including 1) optimal site for temperature monitoring, 2) avoidance of hyperthermia, 3) peak cooling temperature gradient and cooling rate, and 4) peak warming temperature gradient and rewarming rate...
September 2015: Journal of Extra-corporeal Technology
https://www.readbyqxmd.com/read/26279227/the-society-of-thoracic-surgeons-the-society-of-cardiovascular-anesthesiologists-and-the-american-society-of-extracorporeal-technology-clinical-practice-guidelines-for-cardiopulmonary-bypass-temperature-management-during-cardiopulmonary-bypass
#11
REVIEW
Richard Engelman, Robert A Baker, Donald S Likosky, Alina Grigore, Timothy A Dickinson, Linda Shore-Lesserson, John W Hammon
UNLABELLED: In order to improve our understanding of the evidence-based literature supporting temperature management during adult cardiopulmonary bypass, The Society of Thoracic Surgeons, the Society of Cardiovascular Anesthesiology and the American Society of ExtraCorporeal Technology tasked the authors to conduct a review of the peer-reviewed literature, including: 1) optimal site for temperature monitoring, 2) avoidance of hyperthermia, 3) peak cooling temperature gradient and cooling rate, and 4) peak warming temperature gradient and rewarming rate...
August 2015: Journal of Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/26234862/the-society-of-thoracic-surgeons-the-society-of-cardiovascular-anesthesiologists-and-the-american-society-of-extracorporeal-technology-clinical-practice-guidelines-for-cardiopulmonary-bypass-temperature-management-during-cardiopulmonary-bypass
#12
Richard Engelman, Robert A Baker, Donald S Likosky, Alina Grigore, Timothy A Dickinson, Linda Shore-Lesserson, John W Hammon
In order to improve our understanding of the evidence-based literature supporting temperature management during adult cardiopulmonary bypass, The Society of Thoracic Surgeons, the Society of Cardiovascular Anesthesiology and the American Society of ExtraCorporeal Technology tasked the authors to conduct a review of the peer-reviewed literature, including: 1) optimal site for temperature monitoring, 2) avoidance of hyperthermia, 3) peak cooling temperature gradient and cooling rate, and 4) peak warming temperature gradient and rewarming rate...
August 2015: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/25790208/anesthetic-management-during-cardiopulmonary-bypass-a-systematic-review
#13
REVIEW
Aaron E Barry, Mark A Chaney, Martin J London
Cardiopulmonary bypass (CPB) required for cardiac surgery presents unique challenges to the cardiac anesthesiologist responsible for providing the 3 most basic facets of any anesthetic: amnesia, analgesia, and muscle relaxation. Unique pathophysiologic changes during CPB result in pharmacokinetic alterations that impact the serum and tissue concentrations of IV and volatile anesthetics. Similarly, CPB causes pharmacodynamic alterations that impact anesthetic efficacy. The clinical significance of these alterations represents a "moving target" as practice evolves and the technology of CPB circuitry advances...
April 2015: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/25383671/platelet-transfusion-a-clinical-practice-guideline-from-the-aabb
#14
Richard M Kaufman, Benjamin Djulbegovic, Terry Gernsheimer, Steven Kleinman, Alan T Tinmouth, Kelley E Capocelli, Mark D Cipolle, Claudia S Cohn, Mark K Fung, Brenda J Grossman, Paul D Mintz, Barbara A O'Malley, Deborah A Sesok-Pizzini, Aryeh Shander, Gary E Stack, Kathryn E Webert, Robert Weinstein, Babu G Welch, Glenn J Whitman, Edward C Wong, Aaron A R Tobian
BACKGROUND: The AABB (formerly, the American Association of Blood Banks) developed this guideline on appropriate use of platelet transfusion in adult patients. METHODS: These guidelines are based on a systematic review of randomized, clinical trials and observational studies (1900 to September 2014) that reported clinical outcomes on patients receiving prophylactic or therapeutic platelet transfusions. An expert panel reviewed the data and developed recommendations using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework...
February 3, 2015: Annals of Internal Medicine
https://www.readbyqxmd.com/read/24869619/does-regional-variation-impact-decision-making-in-the-management-and-palliation-of-pancreatic-head-adenocarcinoma-results-from-an-international-survey
#15
Valerie Hurdle, Jean-Francois Ouellet, Elijah Dixon, Thomas J Howard, Keith D Lillemoe, Charles M Vollmer, Francis R Sutherland, Chad G Ball
BACKGROUND: Management and palliation of pancreatic head adenocarcinoma is challenging. End-of-life decision-making is a variable process involving multiple factors. METHODS: We conducted a qualitative, physician-based, 40-question international survey characterizing the impact of medical, religious, social, training and system factors on care. RESULTS: A total of 258 international clinicians completed the survey. Respondents were typically fellowship-trained (78%), with a mean of 16 years' experience in a university-affiliated (93%) hepato-pancreato-biliary group (96%) practice...
June 2014: Canadian Journal of Surgery. Journal Canadien de Chirurgie
https://www.readbyqxmd.com/read/24440007/the-year-in-cardiothoracic-and-vascular-anesthesia-selected-highlights-from-2013
#16
REVIEW
Harish Ramakrishna, Benjamin A Kohl, Jacob T Gutsche, Jens Fassl, Prakash A Patel, Hynek Riha, Kamrouz Ghadimi, William J Vernick, Michael Andritsos, George Silvay, John G T Augoustides
This article reviewed selected research highlights of 2013 that pertain to the specialty of cardiothoracic and vascular anesthesia. The first major theme is the commemoration of the sixtieth anniversary of the first successful cardiac surgical procedure with cardiopulmonary bypass conducted by Dr Gibbon. This major milestone revolutionized the practice of cardiovascular surgery and invigorated a paradigm of mechanical platforms for contemporary perioperative cardiovascular practice. Dr Kolff was also a leading contributor in this area because of his important contributions to the refinement of cardiopulmonary bypass and mechanical ventricular assistance...
February 2014: Journal of Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/24303597/report-from-amsect-s-international-consortium-for-evidence-based-perfusion-american-society-of-extracorporeal-technology-standards-and-guidelines-for-perfusion-practice-2013
#17
Robert A Baker, Shahna L Bronson, Timothy A Dickinson, David C Fitzgerald, Donald S Likosky, Nicholas B Mellas, Kenneth G Shann
UNLABELLED: One of the roles of a professional society is to develop standards and guidelines of practice as an instrument to guide safe and effective patient care. The American Society of Extracorporeal Technology (AmSECT) first published its Essentials for Perfusion Practice, Clinical Function: Conduct of Extracorporeal Circulation in 1993. The International Consortium for Evidence-Based Perfusion (ICEBP), a committee within AmSECT, was tasked with updating this document in 2010. The aim of this report is to describe the method of development and content of AmSECT's new professional standards and guidelines...
September 2013: Journal of Extra-corporeal Technology
https://www.readbyqxmd.com/read/24176099/the-impact-of-continuous-haemofiltration-with-high-volume-fluid-exchange-during-cardiopulmonary-bypass-surgery-on-the-recovery-of-patients-with-impaired-renal-function-a-pilot-randomised-trial
#18
RANDOMIZED CONTROLLED TRIAL
B Matata, N Mediratta, M Morgan, S Shirley, N Scawn, I Kemp, R Stables, A Haycox, R Houten, S Richards, C McLeod, S Lane, A Sharma, K Wilson
BACKGROUND: There is widespread variability in clinical practice within cardiac surgery units worldwide on the use of haemofiltration. The clinical impact and safety of this modality is, however, unknown. OBJECTIVES: The primary pilot trial objectives were as follows: to assess the feasibility of randomising 60 patients with impaired kidney function undergoing on-pump coronary artery bypass graft (CABG) surgery within 6 months; to assess the suitability and reliability of our chosen outcome measures; to explore issues that may impact on recruitment into a definitive trial; and to undertake an exploratory economic evaluation...
October 2013: Health Technology Assessment: HTA
https://www.readbyqxmd.com/read/24151752/prevention-and-management-of-potential-adverse-events-during-transapical-aortic-valve-replacement
#19
REVIEW
Ludwig K von Segesser, Gino Gerosa, Michael A Borger, Enrico Ferrari
BACKGROUND AND AIM OF THE STUDY: Transapical transcatheter aortic valve replacement (TAVR) is a new minimally invasive technique with a known risk of unexpected intra-procedural complications. Nevertheless, the clinical results are good and the limited amount of procedural adverse events confirms the usefulness of a synergistic surgical/anesthesiological management in case of unexpected emergencies. METHODS: A review was made of the authors' four-year database and other available literature to identify major and minor intra-procedural complications occurring during transapical TAVR procedures...
May 2013: Journal of Heart Valve Disease
https://www.readbyqxmd.com/read/24025294/nice-thromboprophylaxis-guidelines-are-not-associated-with-increased-pericardial-effusion-after-surgery-of-the-proximal-thoracic-aorta
#20
I A Rahman, A Hussain, A Davies, A J Bryan
INTRODUCTION: In 2010 the National Institute for Health and Clinical Excellence (NICE) released guidelines on venous thromboembolism. Strategy focused on risk assessment, antiembolic stockings, sequential compression devices, subcutaneous high dose enoxaparin (40 mg), early mobilisation and hydration. The 40 mg enoxaparin dose over the previous 20 mg regimen was worrisome, and its effect on pericardial effusion rates and mortality in proximal aortic surgery was investigated. METHODS: Proximal aortic reconstructions performed between December 2008 and April 2011 were identified from prospectively collected data in a tertiary centre database...
September 2013: Annals of the Royal College of Surgeons of England
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