Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 17 de 17
Filtrar
Más filtros

Bases de datos
País/Región como asunto
Tipo del documento
Intervalo de año de publicación
1.
Am J Transplant ; 23(8): 1227-1240, 2023 08.
Artículo en Inglés | MEDLINE | ID: mdl-37156300

RESUMEN

Intracardiac thrombosis and/or pulmonary thromboembolism (ICT/PE) is a rare but devastating complication during liver transplantation. Its pathophysiology remains poorly understood, and successful treatment remains a challenge. This systematic review summarizes the available published clinical data regarding ICT/PE during liver transplantation. Databases were searched for all publications reporting on ICT/PE during liver transplantation. Data collected included its incidence, patient characteristics, the timing of diagnosis, treatment strategies, and patient outcomes. This review included 59 full-text citations. The point prevalence of ICT/PE was 1.42%. Thrombi were most often diagnosed during the neohepatic phase, particularly at allograft reperfusion. Intravenous heparin was effective in preventing early-stage thrombus from progressing further and restoring hemodynamics in 76.32% of patients it was utilized for; however, the addition of tissue plasminogen activator or sole use of tissue plasminogen activator offered diminishing returns. Despite all resuscitation efforts, the in-hospital mortality rate of an intraoperative ICT/PE was 40.42%, with nearly half of these patients dying intraoperatively. The results of our systematic review are an initial step for providing clinicians with data that can help identify higher-risk patients. The clinical implications of our results warrant the development of identification and management strategies for the timely and effective treatment of these tragic occurrences during liver transplantation.


Asunto(s)
Cardiopatías , Trasplante de Hígado , Embolia Pulmonar , Trombosis , Humanos , Activador de Tejido Plasminógeno , Trasplante de Hígado/efectos adversos , Trasplante de Hígado/métodos , Trombosis/etiología , Trombosis/diagnóstico , Embolia Pulmonar/diagnóstico , Embolia Pulmonar/tratamiento farmacológico , Embolia Pulmonar/etiología
2.
J Cardiovasc Electrophysiol ; 30(11): 2453-2459, 2019 11.
Artículo en Inglés | MEDLINE | ID: mdl-31502324

RESUMEN

BACKGROUND: An internal risk stratification algorithm was developed to decrease the risk of major adverse cardiac events (MACEs) during lead extractions (LEs). OBJECTIVE: To report upon the impact of a risk stratification algorithm (RISE [RIsk Stratification prior to lead Extraction] protocol) on outcomes of LEs in a high-volume center. METHODS: A retrospective review of a prospectively maintained LEs database was performed to identify features associated with MACEs. On the basis of the retrospective data, the RISE protocol differentiated LEs procedures into "High" and "Low" risk for occurrence of MACEs. High-risk LEs included dual-coil defibrillator lead (≥3 years), pacemaker and single-coil lead (≥5 years), and any StarFix coronary sinus lead. During the prospective evaluation of the RISE protocol, "High-risk" LEs were performed in an operating room (OR) or hybrid laboratory with the cardiac anesthesiologist, OR nursing team, perfusionist in the room, and a cardiac surgeon on the premises. "Low-risk" LEs were performed in the electrophysiology (EP) laboratory with anesthesia provided by EP nursing team. The preintervention (pre-RISE) and postintervention (post-RISE) group spanned 19 and 40 months and consisted of 449 (632 leads) and 751 patients (1055 leads), respectively. The primary outcome of MACEs in the two groups was compared. RESULTS: Protocol compliance was 100%. The primary outcome of MACEs occurred in 15 patients (3.34%) before and 12 (1.6%) after implementation of the RISE protocol (P = .04). CONCLUSION: RISE identified a low-risk group where minimal resources are needed and allowed for rapid intervention in the high-risk group that reduced the consequences of MACEs.


Asunto(s)
Protocolos Clínicos , Desfibriladores Implantables , Remoción de Dispositivos/efectos adversos , Marcapaso Artificial , Complicaciones Posoperatorias/prevención & control , Anciano , Anciano de 80 o más Años , Bases de Datos Factuales , Remoción de Dispositivos/mortalidad , Femenino , Hospitales de Alto Volumen , Humanos , Masculino , Persona de Mediana Edad , Ohio , Complicaciones Posoperatorias/mortalidad , Estudios Prospectivos , Diseño de Prótesis , Mejoramiento de la Calidad , Indicadores de Calidad de la Atención de Salud , Estudios Retrospectivos , Medición de Riesgo , Factores de Riesgo , Factores de Tiempo , Resultado del Tratamiento
3.
Pacing Clin Electrophysiol ; 42(12): 1552-1557, 2019 12.
Artículo en Inglés | MEDLINE | ID: mdl-31702059

RESUMEN

BACKGROUND: The perioperative anesthesia care during subcutaneous implantable cardioverter-defibrillator (S-ICD) implantation is still evolving. OBJECTIVE: To assess the feasibility and safety of S-ICD implantation with monitored anesthesia care (MAC) versus general anesthesia (GA) in a tertiary care center. METHODS: This is a single-center retrospective study of patients undergoing S-ICD implantation between October 2012 and May 2019. Patients were categorized into MAC and GA group based on the mode of anesthesia. Procedural success without escalation to GA was the primary endpoint of the study, whereas intraprocedural hemodynamics, need of pharmacological support for hypotension and bradycardia, length of the procedure, stay in the post-anesthesia care unit, and postoperative pain were assessed as secondary endpoints. RESULTS: The study comprises 287 patients with MAC in 111 and GA in 176 patients. Compared to MAC, patients in GA group were younger and had a higher body mass index. All patients had successful S-ICD implantation. Only one patient (0.9%) in the MAC group was converted to GA. Despite a similar baseline heart rate (HR) and mean arterial blood pressure (MAP) in both groups, patients with GA had significantly lower HR and MAP during the procedure and more frequently required pharmacological hemodynamic support. Length of the procedure, stay in the postanesthesia care unit, and postoperative pain was similar in both groups. CONCLUSION: This retrospective experience suggests that implantation of S-ICD is feasible and safe with MAC. Use of GA is associated with more frequent administration of hemodynamic drugs during S-ICD implantation.


Asunto(s)
Anestesia/métodos , Desfibriladores Implantables , Implantación de Prótesis/métodos , Anestesia General , Anestesia Local , Bradicardia/tratamiento farmacológico , Estudios de Factibilidad , Femenino , Hemodinámica , Humanos , Hipotensión/tratamiento farmacológico , Tiempo de Internación/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Tempo Operativo , Dimensión del Dolor , Dolor Postoperatorio/prevención & control , Estudios Retrospectivos
4.
J Cardiothorac Vasc Anesth ; 33(4): 1105-1121, 2019 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-30197170

RESUMEN

Left ventricular assist device (LVAD) therapy has greatly improved outcomes in patients with end-stage heart failure. However, development of right ventricular failure (RVF) in LVAD recipients is associated with increased long- and short-term morbidity and mortality. The incidence of RVF after LVAD placement is difficult to assess due to the lack of a common definition. Risk-score models attempting to identify patients at risk for RVF prior to the placement of LVADs had equivocal outcomes. With the exception of cardiac magnetic resonance, right ventricle (RV) imaging lacks accuracy. Echocardiographic evaluation is expanded to 3D technology and deformation imaging in an attempt to get further insight into the functional reserve of the RV in states of abnormal RV function. Beyond commonly use agents, pharmacological treatment for RVF and post-bypass vasoplegia in LVAD patients include the off-label use of methylene blue and/or hydroxycobalamin. Communication among the perioperative team may be beneficial for early initiation of temporary right-sided mechanical support in order to avoid RVF-related complications. As long-term RVADs are unavailable, currently approved treatment of prolonged RVF is limited to heart transplantation or the placement of a total artificial heart as bridge-to-transplant. Strategies to improve outcome in this patient population should include better risk stratification for RVF prior to LVAD placement as well as frank discussions about LVAD candidacy in patients ineligible for transplantation. The development of durable right-sided mechanical support would improve the scope of care of LVAD patients developing persistent RVF.


Asunto(s)
Insuficiencia Cardíaca/cirugía , Ventrículos Cardíacos/cirugía , Corazón Auxiliar/tendencias , Disfunción Ventricular Derecha/cirugía , Insuficiencia Cardíaca/diagnóstico por imagen , Insuficiencia Cardíaca/etiología , Ventrículos Cardíacos/diagnóstico por imagen , Corazón Auxiliar/efectos adversos , Humanos , Disfunción Ventricular Derecha/diagnóstico por imagen , Disfunción Ventricular Derecha/etiología
5.
J Cardiothorac Vasc Anesth ; 30(5): 1228-33, 2016 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-27640893

RESUMEN

BACKGROUND: To date, general anesthesia has been suggested as the preferred approach for implantation of a subcutaneous implantable cardioverter-defibrillator (S-ICD). The purpose of this study was to assess the use of monitored anesthesia care (MAC) for S-ICD implantation. The goals were to assess adequate sedation and analgesia (efficacy endpoints) and major perioperative airway or hemodynamic compromise (safety endpoints). The authors hypothesized that MAC may provide adequate sedation and analgesia and no major perioperative airway or hemodynamic compromise during S-ICD implantation and multiple defibrillation threshold (DFT) testing. METHODS: Prospectively collected data of patients who underwent S-ICD implantation with MAC from 2015 to 2016 were analyzed retrospectively. The efficacy endpoints were the provision of an optimal depth of sedation and analgesia to facilitate S-ICD implantation without intra-procedure patient discomfort or awareness, and the absence of "severe" pain at the lead tunneling and the generator insertion sites post-procedure. The safety endpoints included: (1) periprocedural hypotension, as defined by a mean arterial pressure (MAP)<60 mmHg refractory to conventional pharmacotherapy, (2) heart rate (HR)<45 bpm requiring pharmacologic support, and (3) sedation-induced airway compromise requiring endotracheal intubation. MEASUREMENTS: MAP and HR were recorded during S-ICD implantation and DFT testing. The maximum and minimum infusion rates of propofol, supplemental sedatives, and analgesics, and doses of vasopressor and/or inotropic agents administered intra-procedurally were recorded. Post-procedure pain scores also were noted. RESULTS: Ten patients underwent S-ICD implantation with MAC (mean age, 56 years; 50% men; mean left ventricular ejection fraction was 39%). Implantation of the S-ICD system using MAC was successful in all patients without any major adverse events. The mean baseline MAP was 92.8 mmHg, and the mean end-procedure MAP was 88 mmHg (p = 0.26). When compared to baseline and end-procedure, the mean lowest intra-procedure MAP was significantly lower (67.4 mmHg; p = 0.0001). The mean baseline HR was 65.7 bpm, and the mean end-procedure HR was 70.1 bpm (p = 0.28). When compared to baseline and end-procedure, the mean lowest intra-procedure HR was significantly lower (55.8 bpm; p<0.001). MAC was not associated with airway compromise in any patient, and post-procedure pain was rated as no greater than "mild". CONCLUSIONS: Among a heterogeneous patient population undergoing S-ICD implantation and DFT testing, the use of MAC is efficacious, feasible, and safe.


Asunto(s)
Anestésicos Intravenosos/administración & dosificación , Presión Arterial/efectos de los fármacos , Desfibriladores Implantables , Frecuencia Cardíaca/efectos de los fármacos , Monitoreo Intraoperatorio/métodos , Propofol/administración & dosificación , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Estudios Retrospectivos
7.
Semin Cardiothorac Vasc Anesth ; 26(1): 83-85, 2022 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-34965170

RESUMEN

Cefazolin is an antibiotic that is commonly administered perioperatively to reduce the risk of surgical site infections. Cephalosporins have a well-established safety profile, but have been associated with thrombocytopenia and neutropenia due to their myelosuppressive effects. While this effect may be benign in healthy patients undergoing minor surgery, it can be detrimental in patients with underlying hematologic disorders presenting for open-heart surgery. Herein, we discuss the first case in the literature of cefazolin-induced thrombocytopenia and severe coagulopathy in a patient with polycythemia vera (PCV) during a coronary artery bypass-grafting surgery.


Asunto(s)
Policitemia Vera , Trombocitopenia , Cefazolina/efectos adversos , Puente de Arteria Coronaria/efectos adversos , Humanos , Policitemia Vera/inducido químicamente , Policitemia Vera/complicaciones , Policitemia Vera/tratamiento farmacológico , Infección de la Herida Quirúrgica/inducido químicamente , Infección de la Herida Quirúrgica/complicaciones , Trombocitopenia/inducido químicamente
8.
Heart Surg Forum ; 14(3): E157-9, 2011 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-21676680

RESUMEN

Amniotic fluid embolism is usually a life-threatening complication of an otherwise healthy pregnancy. Medical management of the coagulopathy and cardiovascular collapse is challenging and is often unsuccessful. We present a case and advocate the use of temporary circulatory support and pulmonary embolectomy in what would otherwise have been a fatal scenario.


Asunto(s)
Embolectomía/métodos , Embolia de Líquido Amniótico/terapia , Circulación Extracorporea/métodos , Embolia Pulmonar/complicaciones , Embolia Pulmonar/terapia , Adulto , Terapia Combinada , Femenino , Humanos , Embarazo , Resultado del Tratamiento
9.
Transplantation ; 105(4): 711-722, 2021 04 01.
Artículo en Inglés | MEDLINE | ID: mdl-33760790

RESUMEN

BACKGROUND: Pulmonary artery obstruction is an uncommon but significant complication after lung transplantation. Although numerous reports have documented its occurrence, the hemodynamic parameters associated with its presentation and diagnostic considerations remain ill-defined. This systematic review summarizes evidence in the literature surrounding pulmonary artery obstruction after lung transplantation surgery. METHODS: Databases were searched for all articles and abstracts reporting on pulmonary artery obstruction. Data collected included the number of patients studied, patient characteristics, incidences of pulmonary artery obstruction, and timing and imaging modality used for diagnosis. RESULTS: Thirty-four full-text citations were included in this review. The point prevalence of pulmonary artery obstruction was 3.66%. The peak pulmonary artery velocity associated with obstruction was found to be 2.60 ± 0.58 m/s. The diameter of the obstructed pulmonary artery predictive of poor outcomes was noted to be 0.78 ± 0.40 cm. The majority of diagnoses were made in the late postoperative period using pulmonary angiogram and transesophageal echocardiography. Overall, 76% of patients (47 of 62) required emergent procedural reintervention, and 23% of patients (14 of 62) diagnosed with pulmonary artery obstruction died during their hospital stay. CONCLUSIONS: This systematic review underscores the importance of identifying pulmonary artery obstruction immediately after lung transplant surgery. The clinical implications of these results warrant the development of identification and management strategies for early detection of irregularities in pulmonary artery anastomosis in lung transplant patients.


Asunto(s)
Trasplante de Pulmón/efectos adversos , Arteria Pulmonar/cirugía , Estenosis de Arteria Pulmonar/cirugía , Adolescente , Adulto , Femenino , Hemodinámica , Mortalidad Hospitalaria , Humanos , Masculino , Persona de Mediana Edad , Prevalencia , Arteria Pulmonar/diagnóstico por imagen , Arteria Pulmonar/fisiopatología , Circulación Pulmonar , Reoperación , Medición de Riesgo , Factores de Riesgo , Estenosis de Arteria Pulmonar/diagnóstico por imagen , Estenosis de Arteria Pulmonar/mortalidad , Estenosis de Arteria Pulmonar/fisiopatología , Factores de Tiempo , Resultado del Tratamiento , Adulto Joven
10.
Int J Crit Illn Inj Sci ; 10(3): 148-151, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33409131

RESUMEN

Mitral regurgitation (MR), one of the most common valvulopathies, occurs in at least 10% of the individuals older than 75 years. The long-standing volume overload occurring in severe MR inevitably leads to left ventricular (LV) enlargement and dysfunction; untreated, severe MR can progress to heart failure and death. Hypotension following separation from cardiopulmonary bypass after mitral valve intervention should alert an anesthesiologist to consider a myriad of differential diagnoses. This includes, but is not limited to, afterload mismatch, which can contribute to severe LV dysfunction, even in patients with seemingly normal preoperative ejection fraction. We present a case of acute on chronic biventricular failure after mitral valve repair due to afterload mismatch and discuss its management intraoperatively. Admittedly, identifying the causes of hypotension to guide treatment after mitral valve surgery in patients with severe MR is challenging. High index of suspicion and transesophageal echocardiogram guidance are important for prompt diagnosis, increasing the likelihood of successful outcomes with appropriate clinical management.

11.
J Interv Card Electrophysiol ; 57(2): 311-318, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-31813098

RESUMEN

PURPOSE: To assess the feasibility and safety of same-day discharge after S-ICD implantation by implementing a specific analgesia protocol and phone follow-up. METHODS: Consecutive patients presenting for outpatient S-ICD implantation were enrolled between 1/1/2018 and 4/30/2019. An analgesia protocol included pre-operative acetaminophen and oxycodone, intraoperative local bupivacaine, and limited use of oxycodone-acetaminophen at discharge. The primary outcome was successful same-day discharge. Numerical Pain Rating Scale (NPRS) on postoperative day (POD) 1, 3, 14, and 30 and any unplanned health care visits during the 1-month follow-up period were assessed. RESULTS: Out of 53 potentially eligible S-ICD patients, 49 patients (92.5%) were enrolled and successfully discharged on the same day. Mean age of these 49 patients was 47 ± 14 years. There were no acute procedural complications. Severe pain (NPRS ≥ 8) on POD 0, 1, and 3 was present in 14.3%, 14.3%, and 8.2% of patients, respectively. The total in-hospital stay was 534 ± 80 min. Four unplanned visits (8%) due to cardiac or device-related issues occurred during 1-month follow-up, including 2 patients with heart failure exacerbation, one patient with an incisional infection, and one patient with inappropriate shocks. CONCLUSIONS: With the appropriate institutional protocol including specific analgesics and phone follow-up, same-day discharge after outpatient S-ICD implantation is feasible and appears safe for most patients.. Device-related pain can be severe in the first 3 days post-implantation and can be successfully treated with limited supply of narcotic medications.


Asunto(s)
Analgesia/métodos , Desfibriladores Implantables , Seguridad del Paciente , Implantación de Prótesis/métodos , Anciano , Continuidad de la Atención al Paciente , Estudios de Factibilidad , Femenino , Humanos , Tiempo de Internación/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Manejo del Dolor , Dimensión del Dolor
12.
J Heart Lung Transplant ; 38(5): 530-544, 2019 05.
Artículo en Inglés | MEDLINE | ID: mdl-30718043

RESUMEN

BACKGROUND: Pulmonary cuff dysfunction, either due to pulmonary vein obstruction, pulmonary vein stenosis, or pulmonary vein thrombosis, is an uncommon, yet serious complication after lung transplantation. Although there have been numerous reports of its occurrence, there is little consensus regarding the hemodynamic parameters associated with its presentation and diagnostic considerations. This systematic review summarizes the evidence surrounding pulmonary cuff dysfunction after lung transplantation surgery and empirically analyzes its implications. METHODS: Databases were examined for all articles and abstracts reporting on pulmonary cuff dysfunction. Data collected included: number of patients studied; patients' characteristics; incidences of pulmonary vein stenosis and pulmonary vein thrombosis; and timing and imaging modality utilized for diagnosis. RESULTS: Thirty-four full-text citations were included in this review. The point prevalence of pulmonary vein stenosis and thrombosis were 1.4% and 2.5%, respectively. The peak pulmonary cuff velocity associated with dysfunction was found to be 1.59 ± 0.66 m/sec. The diameter of the dysfunctional pulmonary vein was noted to be 0.48 ± 0.20 cm. The majority of diagnoses were made in the early post-operative period using transesophageal echocardiography. Overall, 41.3% of patients (26 of 63) required emergent procedural reintervention, and 32% of patients (20 of 63) diagnosed with pulmonary cuff dysfunction died during their hospital stay. CONCLUSIONS: This systematic review underscores the importance of identifying pulmonary cuff dysfunction after lung transplant surgery, and the usefulness of transesophageal echocardiography for detection of this complication. The clinical implications of these results warrant the further development of identification and management strategies for lung transplant patients.


Asunto(s)
Funcionamiento Retardado del Injerto/diagnóstico , Trasplante de Pulmón/efectos adversos , Circulación Pulmonar/fisiología , Estenosis de Vena Pulmonar/complicaciones , Funcionamiento Retardado del Injerto/etiología , Funcionamiento Retardado del Injerto/fisiopatología , Ecocardiografía Transesofágica , Humanos , Estenosis de Vena Pulmonar/diagnóstico , Estenosis de Vena Pulmonar/fisiopatología
13.
J Clin Anesth ; 31: 53-9, 2016 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-27185678

RESUMEN

BACKGROUND: The recently approved subcutaneous implantable cardioverter/defibrillator (S-ICD) uses a single extrathoracic subcutaneous lead to treat life-threatening ventricular arrhythmias, such as ventricular tachycardia and ventricular fibrillation. This is different from conventional transvenous ICDs, which are typically implanted under sedation. Currently, there are no reports regarding the anesthetic management of patients undergoing S-ICD implantation. STUDY OBJECTIVES: This study describes the anesthetic management and outcomes in patients undergoing S-ICD implantation and defibrillation threshold (DFT) testing. METHODS: The study population consists of 73 patients who underwent S-ICD implantation. General anesthesia (n = 69, 95%) or conscious/deep sedation (n = 4, 5%) was used for device implantation. MEASUREMENTS: Systolic blood pressure (SBP) and heart rate were recorded periprocedurally for S-ICD implantation and DFTs. Major adverse events were SBP <90 mm Hg refractory to vasopressor agents, significant bradycardia (heart rate <45 beats per minute) requiring pharmacologic intervention and, "severe" pain at the lead tunneling site and the S-ICD generator insertion site based on patient perception. INTERVENTIONS: Of the 73 patients, 39 had SBP <90 mm Hg (53%), and intermittent boluses of vasopressors and inotropes were administered with recovery of SBP. In 2 patients, SBP did not respond, and the patients required vasopressor infusion in the intensive care unit. MAIN RESULTS: Although the S-ICD procedure involved extensive tunneling and a mean of 2.5 ± 1.7 DFTs per patient, refractory hypotension was a major adverse event in only 2 patients. The mean baseline SBP was 132.5 ± 22.0 mm Hg, and the mean minimum SBP during the procedure was 97.3 ± 9.2 mm Hg (P < .01). There was also a mean 13-beats per minute decrease in heart rate (P < .01), but no pharmacologic intervention was required. Eight patients developed "severe" pain at the lead tunneling and generator insertion sites and were adequately managed with intravenous morphine. CONCLUSIONS: Among a heterogeneous population, anesthesiologists can safely manage patients undergoing S-ICD implantation and repeated DFTs without wide swings in SBP and with minimal intermittent pharmacologic support.


Asunto(s)
Anestesia General/métodos , Arritmias Cardíacas/terapia , Sedación Consciente/métodos , Desfibriladores Implantables , Implantación de Prótesis/métodos , Adulto , Anciano , Arritmias Cardíacas/fisiopatología , Presión Sanguínea/fisiología , Bradicardia/etiología , Cardioversión Eléctrica/efectos adversos , Cardioversión Eléctrica/métodos , Femenino , Frecuencia Cardíaca/fisiología , Humanos , Hipotensión/etiología , Masculino , Persona de Mediana Edad , Dolor/etiología , Implantación de Prótesis/efectos adversos , Estudios Retrospectivos
14.
J Thorac Dis ; 7(12): 2139-50, 2015 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-26793334

RESUMEN

While many factors depend on successful implantation and outcome of left ventricular assist devices (LVAD), echocardiography remains an integral part and is vital to the success of this process. Transesophageal echocardiography (TEE) allows interrogation of all the cardiac structures and great vessels. The pre-implantation TEE exam establishes a baseline and may identify potential problems that need palliation. Among these, most significant are aortic insufficiency (AI), intracardiac thrombi, poor right ventricular (RV) function, and intracardiac shunts. The post-implantation exam allows for adequate de-airing of the heart and successful LVAD initiation. The position and flow profiles of the inflow and outflow cannulas of the LVAD may be assessed. Finally, it assists in the astute management and vigilant identification and correction of a number of complications in the immediate post-implantation period. TEE will continue to remain vital to the successful outcomes LVAD patients.

15.
Front Pharmacol ; 5: 127, 2014.
Artículo en Inglés | MEDLINE | ID: mdl-24917818

RESUMEN

Cardiac surgery associated acute kidney injury (CSA-AKI) is associated with poor outcomes including increased mortality, length of hospital stay (LOS) and cost. The incidence of acute kidney injury (AKI) is reported to be between 3 and 30% depending on the definition of AKI. We designed a multicenter randomized controlled trial to test our hypothesis that a perioperative infusion of sodium bicarbonate (SB) during cardiac surgery will attenuate the post-operative rise in creatinine indicating renal injury when compared to a perioperative infusion with normal saline. An interim analysis was performed after data was available on the first 120 participants. A similar number of patients in the two treatment groups developed AKI, defined as an increase in serum creatinine the first 48 h after surgery of 0.3 mg/dl or more. Specifically 14 patients (24%) who received sodium chloride (SC) and 17 patients (27%) who received SB were observed to develop AKI post-surgery, resulting in a relative risk of AKI of 1.1 (95% CI: 0.6-2.1, chi-square p-value = 0.68) for patients receiving SB compared to those who received SC. The data safety monitoring board for the trial recommended closing the study early as there was only a 12% probability that the null hypothesis would be rejected. We therefore concluded that a perioperative infusion of SB failed to attenuate the risk of CSA-AKI.

16.
SELECCIÓN DE REFERENCIAS
DETALLE DE LA BÚSQUEDA