RESUMO
OBJECTIVE: To characterize contemporary practice patterns in the use of transesophageal echocardiography during adult liver transplantation and to identify factors preventing more frequent use. DESIGN: Online questionnaire. SETTING: Liver transplantation centers in the United States performing 12 or more adult liver transplants in 2011. PARTICIPANTS: One representative from each qualifying center: The transplant anesthesiology director, a transplant anesthesiologist personally known to the authors, or the department of anesthesiology chair. INTERVENTIONS: Three e-mail attempts were made to solicit participation in the study between June and August 2012. MEASUREMENTS AND MAIN RESULTS: Of the 97 institutions identified, an anesthesiologist from each of 79 (81.4%) centers completed the questionnaire; 38.0% of centers reported routine use and 57.0% for special circumstances or rescue situations, yielding an overall use rate of 94.9%. This distribution was consistent regardless of operative volume, practice size, or academic affiliation. The sole factor predictive of routine transesophageal echocardiography use was an overlap between an institution's cardiac and transplant anesthesiology teams. In practices not routinely employing the technology, the most compelling reason was a sense that it was not necessary. Although 69.9% of transplant anesthesiologists reportedly were proficient in echocardiography, inadequate anesthesiologist training was also a strongly cited hindrance. CONCLUSIONS: Transesophageal echocardiography during adult liver transplantation in the United States has become widely prevalent, with notable growth in its use as a routine diagnostic and monitoring modality. Almost all institutions now use the technology at least occasionally, with the participation of cardiac anesthesiologists being predictive of a center's routine use.
Assuntos
Ecocardiografia Transesofagiana/estatística & dados numéricos , Transplante de Fígado/estatística & dados numéricos , Atitude do Pessoal de Saúde , Pesquisas sobre Atenção à Saúde , Humanos , Internet , Transplante de Fígado/métodos , Monitorização Intraoperatória , Assistência Perioperatória , Inquéritos e Questionários , Resultado do Tratamento , Estados UnidosAssuntos
Ecocardiografia Doppler em Cores , Ecocardiografia Transesofagiana , Coração Auxiliar , Choque Cardiogênico/diagnóstico por imagem , Choque Cardiogênico/terapia , Ultrassonografia de Intervenção/métodos , Adulto , Humanos , Masculino , Miocardite/complicações , Valor Preditivo dos Testes , Desenho de Prótese , Choque Cardiogênico/etiologiaAssuntos
Veias Braquiocefálicas/lesões , Embolia/diagnóstico por imagem , Migração de Corpo Estranho/diagnóstico por imagem , Ferimentos por Arma de Fogo/diagnóstico por imagem , Veias Braquiocefálicas/cirurgia , Ecocardiografia Transesofagiana/métodos , Embolia/etiologia , Embolia/cirurgia , Migração de Corpo Estranho/cirurgia , Ventrículos do Coração/diagnóstico por imagem , Humanos , Masculino , Ferimentos por Arma de Fogo/cirurgia , Adulto JovemRESUMO
INTRODUCTION: Each unit of packed red blood cells (PRBCs) is expected to raise circulating hemoglobin (HGB) by approximately 1 g/dL. There are few data on modifiers of this relationship other than gender and body mass index (BMI). METHODS: We recorded HGB before and after PRBC transfusion in a retrospective cohort of 103 patients and a prospective cohort of 93 patients with subarachnoid hemorrhage (SAH). RESULTS: In the retrospective cohort, 48 of 103 patients were transfused, and in the prospective cohort, 56 of 93 patients were transfused. In both groups, lower pre-transfusion HGB was associated with a larger increase in HGB (P < 0.001) after correction for the number of units of PRBCs given. In the prospective cohort, lower pre-transfusion HGB was associated with a greater rise in HGB (P < 0.001) after correction for number of units of PRBCs given, gender, and BMI in repeated measures analysis. Pre-transfusion HGB explained an additional 12% of variance in the data (P < 0.001). In both cohorts, the magnitude of the effect was similar. CONCLUSION: In patients with SAH, transfusion at lower HGB leads to a greater increase in HGB. Transfusion at lower HGB may be relatively more cost-effective, and this should be balanced against any potential benefit from higher HGB in SAH. One rather than 2 units of PRBCs are likely to be sufficient for most HGB targets after SAH, especially in patients with more severe anemia.