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Outstanding Clinical Review

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734 papers 1000+ followers Topics related to cardiac anesthesia & critical care
https://www.readbyqxmd.com/read/30621987/imaging-for-predicting-and-assessing-prosthesis-patient-mismatch-after-aortic-valve-replacement
#1
REVIEW
Philippe Pibarot, Julien Magne, Jonathon Leipsic, Nancy Côté, Philippe Blanke, Vinod H Thourani, Rebecca Hahn
Prosthesis-patient mismatch (PPM) occurs when the effective orifice area (EOA) of the prosthetic valve is too small in relation to a patient's body size, thus resulting in high residual postoperative pressure gradients across the prosthesis. Severe PPM occurs in 2% to 20% of patients undergoing surgical aortic valve replacement (AVR) and is associated with 1.5- to 2.0-fold increase in the risk of mortality and heart failure rehospitalization. The purpose of this article is to present an overview of the role of multimodality imaging in the assessment, prediction, prevention, and management of PPM following AVR...
January 2019: JACC. Cardiovascular Imaging
https://www.readbyqxmd.com/read/30614818/update-on-extracorporeal-membrane-oxygenation-coding
#2
Jason Fawley, Lena M Napolitano
No abstract text is available yet for this article.
January 3, 2019: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
https://www.readbyqxmd.com/read/30545968/haemodynamic-definitions-and-updated-clinical-classification-of-pulmonary-hypertension
#3
Gérald Simonneau, David Montani, David S Celermajer, Christopher P Denton, Michael A Gatzoulis, Michael Krowka, Paul G Williams, Rogerio Souza
Since the 1st World Symposium on Pulmonary Hypertension (WSPH) in 1973, pulmonary hypertension (PH) has been arbitrarily defined as mean pulmonary arterial pressure (mPAP) ≥25 mmHg at rest, measured by right heart catheterisation. Recent data from normal subjects has shown that normal mPAP was 14.0±3.3 mmHg. Two standard deviations above this mean value would suggest mPAP >20 mmHg as above the upper limit of normal (above the 97.5th percentile). This definition is no longer arbitrary, but based on a scientific approach...
December 13, 2018: European Respiratory Journal: Official Journal of the European Society for Clinical Respiratory Physiology
https://www.readbyqxmd.com/read/30545980/pulmonary-hypertension-in-chronic-lung-disease-and-hypoxia
#4
Steven D Nathan, Joan A Barbera, Sean P Gaine, Sergio Harari, Fernando J Martinez, Horst Olschewski, Karen M Olsson, Andrew J Peacock, Joanna Pepke-Zaba, Steeve Provencher, Norbert Weissmann, Werner Seeger
Pulmonary hypertension (PH) frequently complicates the course of patients with various forms of chronic lung disease (CLD). CLD-associated PH (CLD-PH) is invariably associated with reduced functional ability, impaired quality of life, greater oxygen requirements and an increased risk of mortality. The aetiology of CLD-PH is complex and multifactorial, with differences in the pathogenic sequelae between the diverse forms of CLD. Haemodynamic evaluation of PH severity should be contextualised within the extent of the underlying lung disease, which is best gauged through a combination of physiological and imaging assessment...
December 13, 2018: European Respiratory Journal: Official Journal of the European Society for Clinical Respiratory Physiology
https://www.readbyqxmd.com/read/29680828/viral-pneumonia-etiologies-and-treatment
#5
Dima Dandachi, Maria C Rodriguez-Barradas
Viral pathogens are increasingly recognized as a cause of pneumonia, in immunocompetent patients and more commonly among immunocompromised. Viral pneumonia in adults could present as community-acquired pneumonia (CAP), ranging from mild disease to severe disease requiring hospital admission and mechanical ventilation. Moreover, the role of viruses in hospital-acquired pneumonia and ventilator-associated pneumonia as causative agents or as co-pathogens and the effect of virus detection on clinical outcome are being investigated...
August 2018: Journal of Investigative Medicine: the Official Publication of the American Federation for Clinical Research
https://www.readbyqxmd.com/read/30598365/accuracy-of-jet-direction-on-doppler-echocardiography-in-identifying-the-etiology-of-mitral-regurgitation-in-obstructive-hypertrophic-cardiomyopathy
#6
Dustin Hang, Hartzell V Schaff, Rick A Nishimura, Brian D Lahr, Martin D Abel, Joseph A Dearani, Steve R Ommen
BACKGROUND: Mitral valve regurgitation (MR) mediated by systolic anterior motion (SAM) in obstructive hypertrophic cardiomyopathy (HCM) is traditionally characterized by a posteriorly directed jet on Doppler echocardiography. Many believe that MR in the absence of a posteriorly directed jet signals the presence of intrinsic mitral valve (MV) disease. METHODS: A total of 709 adult patients with obstructive HCM who underwent septal myectomy were evaluated; 330 of these patients had >2 + MR preoperatively and constituted the study group...
December 28, 2018: Journal of the American Society of Echocardiography
https://www.readbyqxmd.com/read/30586768/2018-aha-acc-guideline-for-the-management-of-adults-with-congenital-heart-disease-executive-summary
#7
Karen K Stout, Curt J Daniels, Jamil A Aboulhosn, Biykem Bozkurt, Craig S Broberg, Jack M Colman, Stephen R Crumb, Joseph A Dearani, Stephanie Fuller, Michelle Gurvitz, Paul Khairy, Michael J Landzberg, Arwa Saidi, Anne Marie Valente, George F Van Hare
No abstract text is available yet for this article.
August 16, 2018: Circulation
https://www.readbyqxmd.com/read/30589392/successful-management-of-massive-air-embolism-during-cardiopulmonary-bypass-using-multimodal-neuroprotection-strategies
#8
Olga L Quintero, Juan C Giraldo, Néstor F Sandoval
Complications and critical events during cardiopulmonary bypass (CPB) are very challenging, difficult to manage, and in some instances have the potential to lead to fatal outcomes. Massive cerebral air embolism is undoubtedly a feared complication during CPB. If not diagnosed and managed early, its effects are devastating and even fatal. It is a catastrophic complication and its early diagnosis and intraoperative management are still controversial. This is why the decision-making process during a massive cerebral air embolism represents a challenge for the entire surgical, anesthetic, and perfusion team...
December 27, 2018: Seminars in Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/30558872/antibiotic-allergy
#9
REVIEW
Kimberly G Blumenthal, Jonny G Peter, Jason A Trubiano, Elizabeth J Phillips
Antibiotics are the commonest cause of life-threatening immune-mediated drug reactions that are considered off-target, including anaphylaxis, and organ-specific and severe cutaneous adverse reactions. However, many antibiotic reactions documented as allergies were unknown or not remembered by the patient, cutaneous reactions unrelated to drug hypersensitivity, drug-infection interactions, or drug intolerances. Although such reactions pose negligible risk to patients, they currently represent a global threat to public health...
December 14, 2018: Lancet
https://www.readbyqxmd.com/read/30579402/perioperative-thrombocytopenia-evidence-evaluation-and-emerging-therapies
#10
REVIEW
A Nagrebetsky, H Al-Samkari, N M Davis, D J Kuter, J P Wiener-Kronish
Thrombocytopenia is a common perioperative clinical problem. While global haemostasis is influenced by many patient- and procedure-related factors, the contribution of thrombocytopenia to bleeding risk is difficult to predict, as platelet count does not linearly correlate with likelihood of bleeding. Thus, the widely used definition of thrombocytopenia and grading of its severity have limited clinical utility. We present a summary and analysis of the current recommendations for invasive procedures in thrombocytopenic patients, although the platelet count at which any given procedure may safely proceed is unknown...
January 2019: British Journal of Anaesthesia
https://www.readbyqxmd.com/read/30575886/in-flight-medical-emergencies-a-review
#11
Christian Martin-Gill, Thomas J Doyle, Donald M Yealy
Importance: In-flight medical emergencies (IMEs) are common and occur in a complex environment with limited medical resources. Health care personnel are often asked to assist affected passengers and the flight team, and many have limited experience in this environment. Observations: In-flight medical emergencies are estimated to occur in approximately 1 per 604 flights, or 24 to 130 IMEs per 1 million passengers. These events happen in a unique environment, with airplane cabin pressurization equivalent to an altitude of 5000 to 8000 ft during flight, exposing patients to a low partial pressure of oxygen and low humidity...
December 25, 2018: JAMA: the Journal of the American Medical Association
https://www.readbyqxmd.com/read/30567670/back-to-the-future-importance-of-spectral-doppler
#12
Andrej Alfirevic
Spectral Doppler is a part of the comprehensive echocardiographic imaging of the blood flow characteristics. Both pulsed-wave (PWD) and continuous-wave Doppler (CWD) provide valuable information about the blood flow speed and direction pattern. Evaluation of blood flow characteristics is crucially important in patients who present with thoracic aortic false aneurysm (TAFA). In the case presented, spectral Doppler interrogation, using both PWD and CWD, helped with establishing accurate mechanism for TAFA and guided surgical management...
November 13, 2018: Journal of Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/30557944/a-new-paradigm-in-the-management-of-acute-type-a-aortic-dissection-total-aortic-repair
#13
George Matalanis, Shoane Ip
The currently accepted guidelines of open surgical repair for acute type A aortic dissection include the resection of the primary entry tear, replacement of the ascending aorta and "hemi-arch" with an open distal anastomosis, and aortic valve resuspension and some form of obliteration of the aortic root false lumen. The principal aim is protection against aortic rupture, aortic regurgitation, and coronary ischemia and restoration of antegrade preferential true lumen perfusion. Proponents argue that this operation is tailored to be in the armamentarium of most cardiac surgeons and deliver the lowest early operative risk while leaving the infrequent long-term sequelae to be dealt with electively by experienced aortic centers...
January 2019: Journal of Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/30562594/multimodal-approach-for-neurologic-prognostication-of-out-of-hospital-cardiac-arrest-patients-undergoing-targeted-temperature-management
#14
Ji Hoon Kim, Min Joung Kim, Je Sung You, Hye Sun Lee, Yoo Seok Park, In Cheol Park, Sung Phil Chung
AIM: Since the introduction of targeted temperature management (TTM), the accuracy and timing of prognostic tests for post-cardiac arrest patients have changed. Although previous studies have demonstrated the effectiveness of a multimodal approach in assessing the prognosis of TTM patients, few studies have investigated an optimised strategy that sequentially combines different prognostic modalities. This study identified an optimal sequential combination of prognostic modalities to predict poor neurologic outcomes in patients undergoing TTM...
December 15, 2018: Resuscitation
https://www.readbyqxmd.com/read/30548128/fibrinolytic-shutdown-is-associated-with-thrombotic-and-hemorrhagic-complications-and-poorer-outcomes-after-liver-transplantation
#15
Ramona Nicolau-Raducu, Thiago Beduschi, Rodrigo Vianna, Christian Diez, Mahmoud Sleem, Singh Bhavnha, Georgia Vasileiou, Yehuda Raveh
Detrimental consequences of hypofibrinolysis, also known as fibrinolytic shutdown (FS), have recently arisen, and its significance in liver transplantation remains unknown. To fill this gap, this retrospective study included 166 adults who received transplants between 2016 and 2018 for whom baseline thromboelastography was available. Based on percent (%) clot lysis 30 minutes after maximal amplitude, patients were stratified into 3 fibrinolysis phenotypes: FS, physiologic fibrinolysis, and hyperfibrinolysis...
December 7, 2018: Liver Transplantation
https://www.readbyqxmd.com/read/30522653/arrhythmic-mitral-valve-prolapse-jacc-review-topic-of-the-week
#16
REVIEW
Marc A Miller, Srinivas R Dukkipati, Mohit Turagam, Steve L Liao, David H Adams, Vivek Y Reddy
There is an increasing awareness of the association between mitral valve prolapse and sudden cardiac death. There are several clinical risk factors associated with an increased risk of mitral valve prolapse-related sudden cardiac death, most of which can be evaluated with noninvasive diagnostic modalities. For example, characteristic changes on the electrocardiogram (T-wave inversions in the inferior leads), complex ventricular ectopy, a spiked configuration of the lateral annular velocities by echocardiography, and evidence of myocardial fibrosis by cardiac magnetic resonance imaging have all been implicated as markers of risk...
December 11, 2018: Journal of the American College of Cardiology
https://www.readbyqxmd.com/read/30528423/acute-lobar-atelectasis
#17
REVIEW
John J Marini
Lobar atelectasis (or collapse) is an exceedingly common, rather predictable and potentially pathogenic companion to many forms of acute illness, post-operative care, and chronic debility. Readily diagnosed by routine chest imaging and bedside ultrasound, the consequences from lobar collapse may be minor or serious, depending on extent, mechanism, patient vulnerability, abruptness of onset, effectiveness of hypoxic vasoconstriction and compensatory reserves. Measures taken to reduce secretion burden, assure adequate secretion clearance, maintain upright positioning, reverse lung compression and sustain lung expansion accord with a logical physiologic rationale...
December 5, 2018: Chest
https://www.readbyqxmd.com/read/30531609/sodium-glucose-cotransporter-2-inhibitors-an-overview-and-perioperative-implications
#18
Amit Bardia, Mabel Wai, Manuel L Fontes
PURPOSE OF REVIEW: Sodium-glucose cotransporter 2 (SGLT-2) inhibitors are a relatively new class of drugs used in the management of diabetes mellitus. This review will highlight key pharmacologic characteristics of this class of drugs; discuss their potential role in management of patients with cardiac disease; and raise several perioperative concerns for anesthesiologists caring for patients on SGLT-2 inhibitors. RECENT FINDINGS: Recent trials have shown a strong mortality benefit in diabetic patients on SGLT 2 inhibitors especially in patients with a high cardiovascular burden...
February 2019: Current Opinion in Anaesthesiology
https://www.readbyqxmd.com/read/30506589/the-transverse-and-oblique-sinuses-of-the-pericardium-anatomic-and-echocardiographic-insights
#19
Swetha Penmasta, Jeffrey J Silbiger
A number of masses and pseudomasses may be encountered during the echocardiographic examination of the transverse and oblique sinuses with significant clinical implications. This review discusses the clinically relevant anatomy of the pericardial sinuses emphasizing diagnostic pitfalls that may be encountered during their echocardiographic examination.
December 1, 2018: Echocardiography
https://www.readbyqxmd.com/read/30516586/causes-of-acute-respiratory-failure-in-the-immunocompromised-host
#20
Bruno L Ferreyro, Laveena Munshi
PURPOSE OF REVIEW: A wide spectrum of heterogeneous conditions can render a patient immunocompromised. Recent years have seen an increase in the number of immunocompromised patients given the earlier detection of conditions that require immunosuppressive therapies, changes in immunosuppressive regimens leading to increased survival or novel therapeutic advancements in oncologic care. Acute respiratory failure (ARF) is the leading cause of critical illness and mortality in this population...
February 2019: Current Opinion in Critical Care
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