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https://www.readbyqxmd.com/read/28743148/-impact-of-cardiac-anaesthesia-on-patient-outcome
#1
Martina Nowak-Machen
The perioperative management of complex patients in a highly technical and subspecialized environment is the domain of the cardiac anesthesiologist. Evidence suggests that hemodynamic management using goal directed hemodynamic therapy (GDHT) improves patient outcome. Organ protection remains a main concern during cardiac surgery using extracorporeal circulation. Mortality can be decreased when remote ischemic preconditioning techniques (RIPC) are being used. Neurological outcomes can be improved with near-infrared-spectometry (NIRS), volatile anesthetics increase myocardial protection through preconditioning and perioperative echocardiography increases overall patient survival...
July 2017: Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie: AINS
https://www.readbyqxmd.com/read/28743102/incidence-of-delirium-after-cardiac-surgery-protocol-for-the-delirium-cs-canada-cross-sectional-cohort-study
#2
(no author information available yet)
BACKGROUND: Delirium is a recognized complication of cardiac surgery and is the focus of increasing attention owing to its negative effect on postoperative outcomes. However, little is known about the actual incidence of delirium following cardiac surgery, with published rates ranging widely, from 3%-78%. We describe the protocol for the DELIRIUM-CS Canada study, which will use validated and easily implementable bedside tools to determine the incidence of postoperative delirium in a contemporary cardiac surgery population...
July 13, 2017: CMAJ Open
https://www.readbyqxmd.com/read/28743074/coronary-perfusion-pressure-and-compression-quality-in-maternal-cardiopulmonary-resuscitation-in-supine-and-left-lateral-tilt-positions-a-prospective-crossover-study-using-mannequins-and-swine-models
#3
Satoshi Dohi, Kiyotake Ichizuka, Ryu Matsuoka, Kohei Seo, Masaaki Nagatsuka, Akihiko Sekizawa
OBJECTIVE: The risk of maternal and fetal mortality is high if cardiopulmonary arrest occurs during pregnancy. To assess the best position for maternal cardiopulmonary resuscitation (CPR), a prospective randomized crossover study was undertaken, involving basic life support mannequin-based simulation (BLS-MS) and a swine model of pulseless electrical activity (an unstable cardiac state) incorporating a fetal mannequin (PEA-FM). STUDY DESIGN: The BLS-MS (performed by certified rescuers) served to evaluate the quality of chest compressions in 30° left lateral tilt (LLT) and supine positions...
July 16, 2017: European Journal of Obstetrics, Gynecology, and Reproductive Biology
https://www.readbyqxmd.com/read/28742954/carbon-dioxide-elimination-by-cardiomyocytes-a-tale-of-high-carbonic-anhydrase-activity-and-membrane-permeability
#4
EDITORIAL
Erik R Swenson
Life as a multicellular organism requires a heart with a coordinated contractile activity that must never cease, and in this regard, it is very much like the brain with a high mass-specific 'resting' metabolic rate. To maintain this constant activity requires a high rate of oxygen consumption and resultant carbon dioxide generation and, pari passu, the rapid exchange of large amounts of these gases with capillary blood. While oxygen has been far more the focus of the two gases in cardiac physiology, the work of Arias-Hidalgo et al (1) in this issue of the journal offers new insights and better understanding of how CO2 uniquely traverses its path from production in the mitochondria to the capillary blood, and does so with much smaller driving gradients than necessary for oxygen...
July 25, 2017: Acta Physiologica
https://www.readbyqxmd.com/read/28742911/targeted-temperature-management-for-48-vs-24-hours-and-neurologic-outcome-after-out-of-hospital-cardiac-arrest-a-randomized-clinical-trial
#5
Hans Kirkegaard, Eldar Søreide, Inge de Haas, Ville Pettilä, Fabio Silvio Taccone, Urmet Arus, Christian Storm, Christian Hassager, Jørgen Feldbæk Nielsen, Christina Ankjær Sørensen, Susanne Ilkjær, Anni Nørgaard Jeppesen, Anders Morten Grejs, Christophe Henri Valdemar Duez, Jakob Hjort, Alf Inge Larsen, Valdo Toome, Marjaana Tiainen, Johanna Hästbacka, Timo Laitio, Markus B Skrifvars
Importance: International resuscitation guidelines recommend targeted temperature management (TTM) at 33°C to 36°C in unconscious patients with out-of-hospital cardiac arrest for at least 24 hours, but the optimal duration of TTM is uncertain. Objective: To determine whether TTM at 33°C for 48 hours results in better neurologic outcomes compared with currently recommended, standard, 24-hour TTM. Design, Setting, and Participants: This was an international, investigator-initiated, blinded-outcome-assessor, parallel, pragmatic, multicenter, randomized clinical superiority trial in 10 intensive care units (ICUs) at 10 university hospitals in 6 European countries...
July 25, 2017: JAMA: the Journal of the American Medical Association
https://www.readbyqxmd.com/read/28742888/targeted-temperature-management-after-cardiac-arrest-finding-the-right-dose-for-critical-care-interventions
#6
Clifton W Callaway
No abstract text is available yet for this article.
July 25, 2017: JAMA: the Journal of the American Medical Association
https://www.readbyqxmd.com/read/28742797/a-comparison-of-selective-aortic-arch-perfusion-and-resuscitative-endovascular-balloon-occlusion-of-the-aorta-for-the-management-of-hemorrhage-induced-traumatic-cardiac-arrest-a-translational-model-in-large-swine
#7
Ed B G Barnard, James E Manning, Jason E Smith, Jason M Rall, Jennifer M Cox, James D Ross
BACKGROUND: Survival rates remain low after hemorrhage-induced traumatic cardiac arrest (TCA). Noncompressible torso hemorrhage (NCTH) is a major cause of potentially survivable trauma death. Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) at the thoracic aorta (Zone 1) can limit subdiaphragmatic blood loss and allow for IV fluid resuscitation when intrinsic cardiac activity is still present. Selective Aortic Arch Perfusion (SAAP) combines thoracic aortic balloon hemorrhage control with intra-aortic oxygenated perfusion to achieve return of spontaneous circulation (ROSC) when cardiac arrest has occurred...
July 2017: PLoS Medicine
https://www.readbyqxmd.com/read/28742772/medication-errors-in-pediatric-anesthesia-a-report-from-the-wake-up-safe-quality-improvement-initiative
#8
Lauren M Y Lobaugh, Lizabeth D Martin, Laura E Schleelein, Donald C Tyler, Ronald S Litman
BACKGROUND: Wake Up Safe is a quality improvement initiative of the Society for Pediatric Anesthesia that contains a deidentified registry of serious adverse events occurring in pediatric anesthesia. The aim of this study was to describe and characterize reported medication errors to find common patterns amenable to preventative strategies. METHODS: In September 2016, we analyzed approximately 6 years' worth of medication error events reported to Wake Up Safe. Medication errors were classified by: (1) medication category; (2) error type by phase of administration: prescribing, preparation, or administration; (3) bolus or infusion error; (4) provider type and level of training; (5) harm as defined by the National Coordinating Council for Medication Error Reporting and Prevention; and (6) perceived preventability...
July 24, 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28742724/epidemiology-of-noninvasive-ventilation-in-pediatric-cardiac-icus
#9
Ryan A Romans, Steven M Schwartz, John M Costello, Nikhil K Chanani, Parthak Prodhan, Avihu Z Gazit, Andrew H Smith, David S Cooper, Jeffrey Alten, Kshitij P Mistry, Wenying Zhang, Janet E Donohue, Michael Gaies
OBJECTIVE: To describe the epidemiology of noninvasive ventilation therapy for patients admitted to pediatric cardiac ICUs and to assess practice variation across hospitals. DESIGN: Retrospective cohort study using prospectively collected clinical registry data. SETTING: Pediatric Cardiac Critical Care Consortium clinical registry. PATIENTS: Patients admitted to cardiac ICUs at PC4 hospitals. INTERVENTIONS: None...
July 22, 2017: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/28742649/thoracoscopic-implantation-of-an-array-electrode-in-the-pericardium-transverse-sinus-to-reduce-defibrillation-threshold
#10
Antonio Curnis, Claudio Muneretto, Gianluigi Bisleri, Manuel Cerini, Lorenza Inama, Francesca Salghetti, Raffaella De Vito, Laura Giroletti, Fabrizio Rosati, Daniele Giacopelli, Francesca Vassanelli, Luca Bontempi
Among the implantable cardioverter defibrillator recipients, there is still a subgroup of patients in whom the defibrillation threshold is too high and the maximal shock output of the implantable cardioverter defibrillator can fail to terminate a ventricular arrhythmia. We report a new thoracoscopic minimally invasive approach to place a standard array electrode in the transverse pericardial sinus of a patient implanted with a cardiac resynchronization and defibrillation therapy device with persistent high defibrillation threshold...
July 25, 2017: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery
https://www.readbyqxmd.com/read/28742647/the-dis-utility-of-a-change-in-troponin-i-for-diagnosis-of-non-st-segment-elevation-myocardial-infarction-in-an-observation-unit
#11
Iani Patsias, Benjamin Swanson, Michael Hudson, Sachin Parikh, Khaled Nour, Gordon Jacobsen, James McCord
BACKGROUND: Observation units (OUs) may be an efficient and effective setting to diagnose and risk stratify patients with coronary ischemia and myocardial infarction (MI). Given improved cardiac troponin I (cTnI) assays and expanded utilization of OUs, it is not uncommon for patients with mildly elevated cTnI to be evaluated in OUs. We investigated the serial cTnI results in OU patients to determine whether absolute or relative cTnI changes were useful for the diagnosis of MI. METHODS: This was a retrospective study of 260 patients placed in the OU from a single center in 2007, with an initial cTnI in the indeterminate range of 0...
September 2017: Critical Pathways in Cardiology
https://www.readbyqxmd.com/read/28742646/comparison-of-3-symptom-classification-methods-to-standardize-the-history-component-of-the-heart-score
#12
Michael R Marchick, Michael L Setteducato, Jesse J Revenis, Matthew A Robinson, Emily C Weeks, Thomas F Payton, David E Winchester, Brandon R Allen
OBJECTIVES: The History, Electrocardiography, Age, Risk factors, Troponin (HEART) score enables rapid risk stratification of emergency department patients presenting with chest pain. However, the subjectivity in scoring introduced by the history component has been criticized by some clinicians. We examined the association of 3 objective scoring models with the results of noninvasive cardiac testing. METHODS: Medical records for all patients evaluated in the chest pain center of an academic medical center during a 1-year period were reviewed retrospectively...
September 2017: Critical Pathways in Cardiology
https://www.readbyqxmd.com/read/28742643/sensitive-troponin-i-and-stress-testing-in-the-emergency-department-for-the-early-management-of-chest-pain-using-2-hour-protocol
#13
Shahriar Dadkhah, Zakaria Almuwaqqat, Samian Sulaiman, Husein Husein, Quang Nguyen, Saad Ali, Tuncay Taskesen
BACKGROUND: Despite improvements in identifying high-risk patients with non-ST segment ACS (acute coronary syndrome), low risk patients presenting with atypical chest pain and non-diagnostic Electrocardiogram (ECG) continued to undergo unnecessary admissions and testing. Since 1992, our chest pain protocol included using 4-hour serial biomarkers from ED admission in combination with stress testing to evaluate these patients. Our study aimed at determining whether a new accelerated diagnostic protocol using sensitive cardiac troponin I (cTnI) 2 hours after admission to the ED followed by stress testing is safe and effective in emergency settings, allowing for appropriate triage, earlier discharge and reducing costs...
September 2017: Critical Pathways in Cardiology
https://www.readbyqxmd.com/read/28742642/pathway-for-the-management-of-sleep-apnea-in-the-cardiac-patient
#14
Emad F Aziz, Allison Selby, Edgar Argulian, Joshua Aziz, Eyal Herzog
Sleep-disordered breathing is a highly prevalent medical condition, which if undiagnosed leads to increased morbidity and mortality, particularly related to increased incidence of cardiovascular events. It is therefore imperative that we identify patient population at high risk for sleep apnea and refer them to the appropriate therapy as early as possible. Up-to-date there is no management guideline specifically geared towards cardiac patients. Thus, we propose a (SAP) Sleep Apnea Pathway to correctly identify and triage these patients to the appropriate therapy...
September 2017: Critical Pathways in Cardiology
https://www.readbyqxmd.com/read/28742629/noonan-syndrome-an-underestimated-cause-of-severe-to-profound-sensorineural-hearing-impairment-which-clues-to-suspect-the-diagnosis
#15
Alban Ziegler, Natalie Loundon, Laurence Jonard, Hélène Cavé, Geneviève Baujat, Souad Gherbi, Vincent Couloigner, Sandrine Marlin
OBJECTIVE: To highlight Noonan syndrome as a clinically recognizable cause of severe to profound sensorineural hearing impairment. STUDY DESIGN: New clinical cases and review. SETTING: Patients evaluated for etiological diagnosis by a medical geneticist in a reference center for hearing impairment. PATIENTS: Five patients presenting with confirmed Noonan syndrome and profound sensorineural hearing impairment. INTERVENTIONS: Diagnostic and review of the literature...
July 24, 2017: Otology & Neurotology
https://www.readbyqxmd.com/read/28742596/advances-in-fetal-cardiac-imaging
#16
Elena Sinkovskaya
This review presents a detailed discussion on recent trends in fetal cardiac imaging. Ultrasound technique which are most useful for clinical practice today and will likely change the approach to cardiac evaluation in the future are presented.
September 2017: Clinical Obstetrics and Gynecology
https://www.readbyqxmd.com/read/28742590/failed-intrauterine-pregnancy-what-is-a-failed-pregnancy-what-is-not
#17
Timothy P Canavan
Pregnancy failure is defined as a lack of sonographic evidence of current or expected viability. Technologic advances in ultrasound imaging continue to redefine diagnostic criteria of pregnancy failure or success. When evaluating a pregnancy, the first step is an assessment of maternal risk factors for failure. Imaging clues such as an empty gestational sac measuring ≥25 mm or an embryo ≥7 mm without cardiac activity are reliable signs of pregnancy failure, whereas embryonic growth <1 mm/d is not. Combinations of sonographic findings can be used for a more accurate prediction of pregnancy success or failure...
September 2017: Clinical Obstetrics and Gynecology
https://www.readbyqxmd.com/read/28742517/type-1-rhizomelic-chondrodysplasia-punctata-with-a-homozygous-pex7-mutation
#18
Nursel Muratoğlu Şahin, Meliha Esra Bilici, Erdal Kurnaz, Melek Pala Akdoğan, Serdar Ceylaner, Zehra Aycan
INTRODUCTION: Rhizomelic chondrodysplasia punctata (RCDP) is a rare peroxisomal disease characterised by punctate calcifications of non-ossified cartilage epiphyseal centres. The main biochemical marker of all RCDP types is a decrease in the levels of plasmalogens. Additionally, the accumulation of phytanic acid can be used as a differential marker between types of RDCP. Due to the biochemical overlap between types 1 and 5 RCDP, a genetic analysis of these genes should be performed in patients to identify the type...
July 25, 2017: Journal of Pediatric Endocrinology & Metabolism: JPEM
https://www.readbyqxmd.com/read/28742197/mir-24-alleviates-cardiomyocyte-apoptosis-after-myocardial-infarction-via-targeting-bim
#19
L-J Pan, X Wang, Y Ling, H Gong
OBJECTIVE: Ischemia hypoxia induces cardiomyocyte (CM) apoptosis in the process of acute myocardial infarction (AMI). It was showed that pro-apoptosis factor BIM participates in regulating tumor cell apoptosis under ischemia or hypoxia condition, while its role in CM apoptosis after AMI is still unclear. It was revealed that miR-24 expression was significantly reduced in myocardial tissue after AMI. Bioinformatics analysis exhibits that miR-24 is targeted to the 3'-UTR of BIM. This study aims to investigate the role of miR-24 in mediating BIM expression and CM apoptosis...
July 2017: European Review for Medical and Pharmacological Sciences
https://www.readbyqxmd.com/read/28742031/patient-specific-left-ventricular-flow-simulations-from-transthoracic-echocardiography-robustness-evaluation-and-validation-against-ultrasound-doppler-and-magnetic-resonance-imaging
#20
David Larsson, Jeannette H Spuhler, Sven Petersson, Tim Nordenfur, Massimiliano Colarieti-Tosti, Johan Hoffman, Reidar Winter, Matilda Larsson
The combination of medical imaging with computational fluid dynamics (CFD) has enabled the study of 3D blood flow on a patient-specific level. However, with models based on gated high-resolution data, the study of transient flows, and any model implementation into routine cardiac care, is challenging. The present paper presents a novel pathway for patient-specific CFD modelling of the left ventricle (LV), using 4D transthoracic echocardiography (TTE) as input modality. To evaluate the clinical usability, two sub-studies were performed...
July 21, 2017: IEEE Transactions on Medical Imaging
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