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Outstanding Clinical Review

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744 papers 1000+ followers Topics related to cardiac anesthesia & critical care
Mohamad Alkhouli, Horst Sievert, David R Holmes
Transcatheter closure of patent foramen ovale (PFO) in patients with cryptogenic stroke is gaining momentum after the recent publication of four randomized clinical trials suggesting its benefit. This article provides a contemporary overview of the anatomy and pathophysiology of PFO, the available diagnostic tools for the assessment and risk stratification of PFO, and the current and future landscape of PFO closure devices and their optimal utilization. It also summarizes the current data on PFO closure for stroke prevention, and discusses the remaining open issues in the field of PFO closure...
April 8, 2019: European Heart Journal
Bradley J Hindman, Franklin Dexter
The 2018 American Heart Association stroke care guidelines consider endovascular thrombectomy to be the standard of care for patients who have acute ischemic stroke in the anterior circulation when arterial puncture can be made: (1) within 6 h of symptom onset; or (2) within 6-24 h of symptom onset when specific eligibility criteria are satisfied. The aim of this 2-part review is to provide practical perspective on the clinical literature regarding anesthesia care of endovascular thrombectomy patients. In the preceding companion article (part 1), the rationale for rapid workflow and maintenance of blood pressure before reperfusion were reviewed...
April 2019: Anesthesia and Analgesia
Bradley J Hindman
In the United States, stroke ranks fifth among all causes of death and is the leading cause of serious long-term disability. The 2018 American Heart Association stroke care guidelines consider endovascular thrombectomy to be the standard of care for patients who have acute ischemic stroke in the anterior circulation when arterial puncture can be made within 6 hours of symptom onset or within 6-24 hours of symptom onset when specific eligibility criteria are satisfied. The aim of this 2-part review is to provide practical perspective on the clinical literature regarding anesthesia care of patients treated with endovascular thrombectomy...
April 2019: Anesthesia and Analgesia
Chiara De Fazio, Markus B Skrifvars, Eldar Søreide, Jacques Creteur, Anders M Grejs, Jesper Kjærgaard, Timo Laitio, Jens Nee, Hans Kirkegaard, Fabio Silvio Taccone
BACKGROUND: The aim of this study was to explore the performance and outcomes for intravascular (IC) versus surface cooling devices (SFC) for targeted temperature management (TTM) after out-of-hospital cardiac arrest. METHODS: A retrospective analysis of data from the Time-differentiated Therapeutic Hypothermia (TTH48) trial (NCT01689077), which compared whether TTM at 33 °C for 48 h results in better neurologic outcomes compared with standard 24-h duration...
February 22, 2019: Critical Care: the Official Journal of the Critical Care Forum
Jerome Crowley, Brett Cronin, Michael Essandoh, David D'Alessandro, Ken Shelton, Adam A Dalia
No abstract text is available yet for this article.
January 23, 2019: Journal of Cardiothoracic and Vascular Anesthesia
Mark Steven Link
No abstract text is available yet for this article.
February 1, 2019: Circulation
Tina L Palmieri
PURPOSE OF REVIEW: Blood transfusion is ubiquitous in major burn injury. The present article describes recent research findings directly impacting blood transfusion strategies in major burn injury both in the operating room and the ICU. RECENT FINDINGS: Transfusion strategies have been the focus of recent burn investigations. First, a randomized prospective trial encompassing both the ICU and operating room reported that a restrictive red blood cell transfusion threshold (7 g/dl) had equivalent outcomes to a traditional threshold (10 g/dl) for burns more than 20% in terms of mortality, infection, length of stay, duration of mechanical ventilation, and wound healing despite receiving significantly fewer transfusions...
January 22, 2019: Current Opinion in Anaesthesiology
Jody C Olson
PURPOSE OF REVIEW: Hospitalizations due to complications of cirrhosis continue to rise. Patients with chronic liver disease who suffer acute decompensation [acute-on-chronic liver failure (ACLF)] often require intensive care support and are at high risk for short-term mortality. Given the high mortality rate associated with this condition is incumbent on intensive care providers who care for this patient population to have a working knowledge of ACLF with its associated complications, management strategies and prognosis...
April 2019: Current Opinion in Critical Care
Andrew J MacDonald, Mitra K Nadim, François Durand, Constantine J Karvellas
PURPOSE OF REVIEW: Acute kidney injury (AKI) in cirrhosis consists of varying phenotypes, with hepatorenal syndrome (HRS) representing a single entity. Prompt recognition and diagnosis of AKI cause identifies appropriate therapeutic measures. This review provides an overview of AKI definitions, highlights challenges in quantifying renal impairment in cirrhosis, lists novel diagnostic AKI biomarkers, and summarizes transplantation implications. RECENT FINDINGS: Biomarkers (neutrophil gelatinase-associated lipocalin, kidney injury molecule-1, interleukin-18, and liver-type fatty acid-binding protein) may assist in the identification of underlying acute tubular necrosis...
April 2019: Current Opinion in Critical Care
Edith R Reshef, Nicholas D Schiff, Emery N Brown
Anesthetics have profound effects on the brain and central nervous system. Vital signs, along with the electroencephalogram and electroencephalogram-based indices, are commonly used to assess the brain states of patients receiving general anesthesia and sedation. Important information about the patient's arousal state during general anesthesia can also be obtained through use of the neurologic examination. This article reviews the main components of the neurologic examination focusing primarily on the brainstem examination...
March 2019: Anesthesiology
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
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
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...
January 2019: European Respiratory Journal: Official Journal of the European Society for Clinical Respiratory Physiology
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...
January 2019: European Respiratory Journal: Official Journal of the European Society for Clinical Respiratory Physiology
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
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...
March 2019: Journal of the American Society of Echocardiography
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
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
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...
January 12, 2019: Lancet
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
2018-12-25 17:32:48
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