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Outstanding Clinical Review

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702 papers 1000+ followers Topics related to cardiac anesthesia & critical care
Ori Wand, Elad Guber, Alexander Guber, Gali Epstein Shochet, Lilach Israeli-Shani, David Shitrit
BACKGROUND: Tranexamic Acid (TA) is an antifibrinolytic drug currently used systemically to control bleeding. To date, there are no prospective studies of the effectiveness of inhaled TA for hemoptysis treatment. OBJECTIVE: To prospectively assess the effectiveness of TA inhalations (i.e. nebulized TA) for hemoptysis treatment. METHODS: We conducted a double-blind, randomized controlled trial of treatment with nebulize TA (500mg, three times daily) vs...
October 12, 2018: Chest
Edmund Kenneth Kerut, William F Campbell, Michael E Hall, Michael R McMullan
A patent foramen ovale (PFO) is implicated in several pathologic processes, including that of cryptogenic stroke (cCVA). Recent trials identify "high-risk" PFOs in patients with cCVA as likely to benefit from percutaneous closure. The younger the patient (<60 years old) the more likely a PFO may be attributable to the cCVA. The RoPE Score index helps determine the likelihood that an existing PFO is related to a cCVA. This may help guide the clinician and patient when contemplating percutaneous PFO closure...
October 10, 2018: Echocardiography
S Magder
Measurement of arterial pressure is one of the most basic elements of patient management. Arterial pressure is determined by the volume ejected by the heart into the arteries, the elastance of the walls of the arteries, and the rate at which the blood flows out of the arteries. This review will discuss the three forces that determine the pressure in a vessel: elastic, kinetic, and gravitational energy. Emphasis will be placed on the importance of the distribution of arterial resistances, the elastance of the walls of the large vessels, and critical closing pressures in small arteries and arterioles...
October 11, 2018: Critical Care: the Official Journal of the Critical Care Forum
Amy C Walker, Nicholas J Johnson
The post-cardiac arrest syndrome is a highly inflammatory state characterized by organ dysfunction, systemic ischemia and reperfusion injury, and persistent precipitating pathology. Early critical care should focus on identifying and treating arrest etiology and minimizing further injury to the brain and other organs by optimizing perfusion, oxygenation, ventilation, and temperature. Patients should be treated with targeted temperature management, although the exact temperature goal is not clear. No earlier than 72 hours after rewarming, prognostication using a multimodal approach should inform discussions with families regarding likely neurologic outcome...
August 2018: Cardiology Clinics
Ruchika Goel, Eshan U Patel, Melissa M Cushing, Steven M Frank, Paul M Ness, Clifford M Takemoto, Ljiljana V Vasovic, Sujit Sheth, Marianne E Nellis, Beth Shaz, Aaron A R Tobian
Importance: Increasing evidence supports the role of red blood cells (RBCs) in physiological hemostasis and pathologic thrombosis. Red blood cells are commonly transfused in the perioperative period; however, their association with postoperative thrombotic events remains unclear. Objective: To examine the association between perioperative RBC transfusions and postoperative venous thromboembolism (VTE) within 30 days of surgery. Design, Setting, and Participants: This analysis used prospectively collected registry data from the American College of Surgery National Surgical Quality Improvement Program (ACS-NSQIP) database, a validated registry of 525 teaching and nonteaching hospitals in North America...
September 1, 2018: JAMA Surgery
Thibault Michel, Hatem Ksouri, Antoine G Schneider
PURPOSE OF REVIEW: The utilization of continuous renal replacement therapy (CRRT) increases throughout the world. Technological improvements have made its administration easier and safer. However, CRRT remains associated with numerous pitfalls and issues. RECENT FINDINGS: Even if new-generation CRRT devices have built-in safety features, understanding basic concepts remains of primary importance. SUMMARY: CRRT circuits' maximum recommended lifespan (72 h) can often not be achieved...
September 20, 2018: Current Opinion in Critical Care
Robert C Skeate, Ted Eastlund
PURPOSE OF REVIEW: The purpose of this review is to provide an overview of concepts recently presented in the literature that impact our understanding of transfusion related acute lung injury (TRALI) and transfusion associated circulatory overload (TACO), and how to distinguish between the two disorders. RECENT FINDINGS: An exceptionally clear review article by Brux and Sachs clarified the two-hit model of TRALI pathogenesis. The TRALI definition developed at the 2004 consensus conference helped demonstrate that TRALI is likely underreported...
November 2007: Current Opinion in Hematology
Shaney L Barratt, Andrew Creamer, Conal Hayton, Nazia Chaudhuri
Idiopathic pulmonary fibrosis (IPF) is an interstitial lung disease characterised by chronic, progressive scarring of the lungs and the pathological hallmark of usual interstitial pneumonia. Current paradigms suggest alveolar epithelial cell damage is a key initiating factor. Globally, incidence of the disease is rising, with associated high morbidity, mortality, and economic healthcare burden. Diagnosis relies on a multidisciplinary team approach with exclusion of other causes of interstitial lung disease...
August 6, 2018: Journal of Clinical Medicine
Deepak L Bhatt
No abstract text is available yet for this article.
September 25, 2018: JAMA: the Journal of the American Medical Association
Carlos L Alviar, P Elliott Miller, Dorothea McAreavey, Jason N Katz, Burton Lee, Brad Moriyama, Jeffrey Soble, Sean van Diepen, Michael A Solomon, David A Morrow
Contemporary cardiac intensive care units (CICUs) provide care for an aging and increasingly complex patient population. The medical complexity of this population is partly driven by an increased proportion of patients with respiratory failure needing noninvasive or invasive positive pressure ventilation (PPV). PPV often plays an important role in the management of patients with cardiogenic pulmonary edema, cardiogenic shock, or cardiac arrest, and those undergoing mechanical circulatory support. Noninvasive PPV, when appropriately applied to selected patients, may reduce the need for invasive mechanical PPV and improve survival...
September 25, 2018: Journal of the American College of Cardiology
Prashanth Nandhabalan, Nicholas Ioannou, Christopher Meadows, Duncan Wyncoll
Despite timely intervention, there exists a small subgroup of patients with septic shock who develop progressive multi-organ failure. Seemingly refractory to conventional therapy, they exhibit a very high mortality. Such patients are often poorly represented in large clinical trials. Consequently, good evidence for effective treatment strategies is lacking. In this article, we describe a pragmatic, multi-faceted approach to managing patients with refractory septic shock based on our experience of toxin-mediated sepsis in a specialist referral centre...
September 19, 2018: Critical Care: the Official Journal of the Critical Care Forum
J Mauricio Del Rio, Loreta Grecu, Alina Nicoara
Right ventricular (RV) function is an independent prognostic factor for short- and long-term outcomes in cardiac surgical patients. Patients with mitral valve (MV) disease are at increased risk of RV dysfunction before and after MV operations. Yet RV function is not part of criteria for decision making or risk stratification in this setting. The role of MV disease in the development of pulmonary hypertension (PHTN) and the ultimate impact of PHTN on RV function have been well described. Nonetheless, there are other mechanisms by which MV disease and MV surgery affect RV performance...
September 19, 2018: Seminars in Cardiothoracic and Vascular Anesthesia
Kristian Thygesen, Joseph S Alpert, Allan S Jaffe, Bernard R Chaitman, Jeroen J Bax, David A Morrow, Harvey D White
No abstract text is available yet for this article.
August 25, 2018: European Heart Journal
Andrew A Klein, Nikolas J Skubas, Joerg Ender
Transcatheter aortic valve replacement (TAVR) is performed with increasing frequency in the United States since Food and Drug Administration approval in 2011. The procedure involves the replacement of a severely stenosed native or bioprosthetic aortic valve with a specially constructed valvular prosthesis that is mounted onto a stent, without the use of cardiopulmonary bypass and the complications of a major open surgical procedure. TAVR has been performed mostly in elderly patients with multiple comorbidities or who have undergone previous cardiac surgery...
October 2014: Anesthesia and Analgesia
Ata Hassani Afshar, Leili Pourafkari, Nader D Nader
Transcatheter aortic valve replacement (TAVR) is rapidly gaining popularity as a viable option in the management of patients with symptomatic aortic stenosis (AS) and high risk for open surgical intervention. TAVR soon expanding its indications from "high-risk" group of patients to those with "intermediate-risk". As an anesthesiologist; understanding the procedure and the challenges inherent to it is of utmost importance, in order to implement optimal care for this generally frail population undergoing a rather novel procedure...
2016: Journal of Cardiovascular and Thoracic Research
Alexander Zarbock, Jay L Koyner, Eric A J Hoste, John A Kellum
Acute kidney injury (AKI) in the perioperative period is a common complication and is associated with increased morbidity and mortality. A standard definition and staging system for AKI has been developed, incorporating a reduction of the urine output and/or an increase of serum creatinine. Novel biomarkers may detect kidney damage in the absence of a change in function and can also predict the development of AKI. Several specific considerations for AKI risk are important in surgical patients. The surgery, especially major and emergency procedures in critically ill patients, may cause AKI...
August 22, 2018: Anesthesia and Analgesia
Josep Brugada, Oscar Campuzano, Elena Arbelo, Georgia Sarquella-Brugada, Ramon Brugada
The Brugada syndrome is an inherited disorder associated with risk of ventricular fibrillation and sudden cardiac death in a structurally normal heart. Diagnosis is based on a characteristic electrocardiographic pattern (coved type ST-segment elevation ≥2 mm followed by a negative T-wave in ≥1 of the right precordial leads V1 to V2 ), observed either spontaneously or during a sodium-channel blocker test. The prevalence varies among regions and ethnicities, affecting mostly males. The risk stratification and management of patients, principally asymptomatic, still remains challenging...
August 28, 2018: Journal of the American College of Cardiology
Patrick Northup, Bethany Reutemann
Hemostasis is a complex balance of clot formation and dissolution that is largely modulated by protein synthesis and degradation in the liver. In the state of end-stage liver disease, there is a disruption of the hemostatic system due to hepatic protein synthetic dysfunction. Because historical clinical laboratory testing often only analyzes a portion of the hemostasis system, the clinician may be misled into believing that cirrhosis patients are imbalanced with a tendency toward bleeding. The modern understanding of hemostasis in cirrhosis involves a rebalance of hemostasis with a tenuous equilibrium between clotting and bleeding, but an equilibrium nonetheless...
August 2018: Liver Transplantation
Michael Leise, Andres Cardenas
Hyponatremia in cirrhosis is defined as a serum sodium level ≤ 130 meq/L and occurs in approximately 22% of patients with cirrhosis. The appearance of hyponatremia in patients with cirrhosis portends a poor prognosis before liver transplantation, independent of the MELD score. With the development of the MELDNa score, the management of hyponatremia has become more relevant than ever before. Over-correction of hyponatremia before liver transplantation or peri-operatively can lead to the devastating neurologic condition known as osmotic demyelination syndrome which is often irreversible and fatal...
August 21, 2018: Liver Transplantation
Akhil Narang, Karima Addetia, Lynn Weinert, Megan Yamat, Atman P Shah, John E Blair, Victor Mor-Avi, Roberto M Lang
BACKGROUND: The prevalence of isolated cleft mitral valve (MV; no concomitant congenital heart disease or degenerative MV disease) with significant mitral regurgitation (MR) diagnosed using two-dimensional echocardiography (2DE) has been reported to be very low. Three-dimensional echocardiography (3DE) has enabled a more comprehensive visualization of the MV and detailed understanding of the mechanisms of MR and can potentially reveal isolated cleft MV that is not recognized with 2DE...
August 7, 2018: Journal of the American Society of Echocardiography
2018-08-14 13:01:30
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