Proportion of right ventricular failure and echocardiographic predictors in continuous-flow left ventricular assist device: a systematic review and meta-analysis.

Background: Right ventricular failure (RVF) in patients with a continuous-flow left ventricle assist device (CF-LVAD) is associated with higher incidence of mortality. This systematic review aims to assess the overall proportion of RVF and the pre-operative echocardiographic parameters which are best correlating to RVF. Methods: A systematic research was conducted between 2008 and 2019 on MEDLINE, EMBASE, PUBMED, UPTODATE, OVID, COCHRANE LIBRARY, and Google Scholar electronic databases by performing a PRISMA flowchart. All observational studies regarding echocardiographic predictors of RVF in patients undergoing CF-LVAD implantation were included. Results: A total number of 19 observational human studies published between 2008 and 2019 were included. We identified 524 RVF patients out of a pooled final population of 1741 patients. The RVF overall proportion was 28.25% with 95% confidence interval (CI) 0.24-0.34. The highest variability of perioperative echocardiographic parameters between the RVF and no right ventricular failure (NO-RVF) groups has been found with tricuspid annular plane systolic excursion (TAPSE), fractional area change (FAC), and right ventricular global longitudinal strain (RVGLS). Their standardized mean deviation (SMD) was - 0.33 (95% CI - 0.54 to - 0.11; p value 0.003), - 0.34 (95% CI - 0.53 to - 0.15; p value 0.0001), and 0.52 (95% CI 0.79 to 0.25; p value 0.0001), respectively. Conclusions: The echocardiographic predictors of RVF after CF-LVAD placement are still uncertain. However, there seems to be a trend of statistical correlation between TAPSE, FAC, and RVGLS with RVF event after CF-LVAD placement. Supplementary Information: The online version contains supplementary material available at 10.1007/s12055-022-01447-7.

Airways ultrasound in predicting difficult face mask ventilation.

BACKGROUND: Unanticipated difficult airway is a potentially life-threatening event during elective surgery or management of critical conditions. Nevertheless, predicting difficult mask ventilation currently remains a challenge due to the poor sensitivity of available clinical tests. Our primary goal was to verify whether preoperative upper airway ultrasound measurements were useful to predict difficult face mask ventilation. Our secondary goal was to evaluate clinical characteristics and differences between patients who are difficult to ventilate and patients who are not. METHODS: We performed a prospective observational study, enrolling 250 adult patients selected for colorectal, gastric, bariatric and pancreatic elective surgery between September 2017 and October 2018. We performed a preoperative US assessment of the airways, following a standardized protocol. We measured the hyomental distance (DIM), the thickness of the base of the tongue (SBL), the thickness of the soft tissues anterior to the hyoid bone (STTi), thyro-hyoid distance (DTI), the thickness of soft tissue anterior to the epiglottis (STTe), to the arytenoid (STTa) and to the commissure of the vocal cords (STTcv). RESULTS: SBL had a predictive role of difficult mask ventilation in curarized and noncurarized patients for values higher than 50 mm. Hyomental distance with hyperextension of the head and subluxation of the mandible (DIMs) had a predictive role in the curarized patient (protective parameter). CONCLUSIONS: Airways ultrasound evaluation could be an important tool to predict difficult mask ventilation. Further studies are necessary to validate the parameters found and correlate them to the preoperative clinical evaluation.

Heart failure: role and point of view of cardiac intensivist.

Heart failure is an acute or chronic syndrome where the heart is unable to provide adequate amount of oxygen to body tissues. The treatment of heart failure aims to give an immediate answer in terms of regression of volume overload and restoration of hemodynamic stability and then to ensure management of clinical exacerbation, reduction in hospital stay, and increasing of survival. The pharmacological treatment of heart failure includes drugs with different strength of evidence. When the patient is no more responsive to medical therapy a non-pharmacological approach may be required. The first step is cardiac resynchronization therapy and implantable cardiac defibrillator. Then hospitalization and inotropic support may be needed. When cardiac disease reaches the end stage, the severe decrease in multi organ perfusion requires a quick therapeutic response. This is a time dependent scenario, when mechanical circulatory support (MCS) plays a crucial role. MCS may be used as temporary hemodynamic support on situations where myocardial recovery is likely, such as after revascularization and in cases of fulminant acute myocarditis. Conversion to ventricular assist devices or transplantation should be considered if longer duration of MCS is required. Advances in the treatment of cardiogenic shock patients in terms of pharmacological therapies, short term and long term MCS could provide opportunities to improve survival, but they also increase the complexity of clinical care. For this reason a multidisciplinary shock team approach is paramount for early symptom detection, to guide initial haemodynamic therapy and for the right choice of MCS device at the right time.