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1.
BMC Cardiovasc Disord ; 20(1): 281, 2020 06 10.
Artículo en Inglés | MEDLINE | ID: mdl-32522145

RESUMEN

BACKGROUND: Thromboembolic ischemic stroke (IS) is one of the most feared complications of left ventricular assist device (LVAD) placement and represents a challenge to surgical management because of concomitant anticoagulant therapy. CASE PRESENTATION: A 39-year-old man presented with cardiogenic shock following an out-of-hospital cardiac arrest. After a period of stabilization, the patient was referred for LVAD placement. Upon recovery from anesthesia, he presented with acute neurological deficits suggestive of IS. A brain computed tomography confirmed the diagnosis, and an emergency decompressive hemicraniectomy (DHC) was performed. Anticoagulation was managed empirically. The patient's neurological status progressively improved and he was referred for heart transplantation at five months from DHC. One month later, cranioplasty was performed. CONCLUSIONS: This report suggests an anticoagulation management approach in combination with decompressive craniectomy after IS in a patient with LVAD placement was successful. An optimized anticoagulation management and collaborative team-based practice may contribute to successful outcomes in complex cases.


Asunto(s)
Craniectomía Descompresiva , Corazón Auxiliar , Accidente Cerebrovascular Isquémico/cirugía , Paro Cardíaco Extrahospitalario/terapia , Implantación de Prótesis/efectos adversos , Implantación de Prótesis/instrumentación , Choque Cardiogénico/terapia , Función Ventricular Izquierda , Adulto , Anticoagulantes/uso terapéutico , Humanos , Accidente Cerebrovascular Isquémico/diagnóstico por imagen , Accidente Cerebrovascular Isquémico/etiología , Masculino , Paro Cardíaco Extrahospitalario/diagnóstico , Paro Cardíaco Extrahospitalario/fisiopatología , Choque Cardiogénico/diagnóstico , Choque Cardiogénico/fisiopatología , Resultado del Tratamiento
4.
Eur Radiol Exp ; 3(1): 26, 2019 07 09.
Artículo en Inglés | MEDLINE | ID: mdl-31286281

RESUMEN

BACKGROUND: To evaluate patient radiation dose and procedural duration recorded during pulmonary arteriovenous malformation (PAVM) embolisation performed using high-frequency jet ventilation (HFJV) as compared with conventional intermittent positive pressure ventilation (IPPV) METHODS: Patients undergoing PAVM embolisation with HFJV assistance after April 2017 were retrospectively identified as group A, and those treated with IPPV before April 2017 as group B. Primary outcomes were patient radiation dose and procedural duration between groups A and B. Secondary outcomes were difference in diaphragmatic excursion between groups A and B, in group A with/without HFJ assistance, technical/clinical success, and complications. RESULTS: Twelve PAVMs were embolised in 5 patients from group A, and 15 PAVMs in 10 patients from group B. Mean patient radiation was significantly lower in group A than in group B (54,307 ± 33,823 mGy cm2 [mean ± standard deviation] versus 100,704 ± 43,930 mGy cm2; p = 0.022). Procedural duration was 33.4 ± 16.1 min in group A versus 57.4 ± 14.9 min in group B (p = 0.062). Diaphragmatic excursion was significantly lower in group A (1.3 ± 0.4 mm) than in group B (19.7 ± 5.2 mm; p < 0.001) and lower with near statistical significance in group A with HFJV than without HFJV (1.3 ± 0.4 mm versus 10.9 ± 3.1 mm; p = 0.062). Technical and clinical success was 100% in both groups, without relevant complications. CONCLUSION: HFJV-assisted PAVM embolisation is a safe, feasible technique resulting in reduced patient radiation doses and procedural time.


Asunto(s)
Malformaciones Arteriovenosas/terapia , Embolización Terapéutica , Ventilación con Chorro de Alta Frecuencia , Pulmón/irrigación sanguínea , Pulmón/fisiopatología , Adulto , Malformaciones Arteriovenosas/fisiopatología , Embolización Terapéutica/métodos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Respiración , Estudios Retrospectivos
5.
Intensive Care Med ; 45(10): 1401-1412, 2019 10.
Artículo en Inglés | MEDLINE | ID: mdl-31576435

RESUMEN

PURPOSE: To evaluate whether a perioperative open-lung ventilation strategy prevents postoperative pulmonary complications after elective on-pump cardiac surgery. METHODS: In a pragmatic, randomized, multicenter, controlled trial, we assigned patients planned for on-pump cardiac surgery to either a conventional ventilation strategy with no ventilation during cardiopulmonary bypass (CPB) and lower perioperative positive end-expiratory pressure (PEEP) levels (2 cm H2O) or an open-lung ventilation strategy that included maintaining ventilation during CPB along with perioperative recruitment maneuvers and higher PEEP levels (8 cm H2O). All study patients were ventilated with low-tidal volumes before and after CPB (6 to 8 ml/kg of predicted body weight). The primary end point was a composite of pulmonary complications occurring within the first 7 postoperative days. RESULTS: Among 493 randomized patients, 488 completed the study (mean age, 65.7 years; 360 (73.7%) men; 230 (47.1%) underwent isolated valve surgery). Postoperative pulmonary complications occurred in 133 of 243 patients (54.7%) assigned to open-lung ventilation and in 145 of 245 patients (59.2%) assigned to conventional ventilation (p = 0.32). Open-lung ventilation did not significantly reduce the use of high-flow nasal oxygenotherapy (8.6% vs 9.4%; p = 0.77), non-invasive ventilation (13.2% vs 15.5%; p = 0.46) or new invasive mechanical ventilation (0.8% vs 2.4%, p = 0.28). Mean alive ICU-free days at postoperative day 7 was 4.4 ± 1.3 days in the open-lung group vs 4.3 ± 1.3 days in the conventional group (mean difference, 0.1 ± 0.1 day, p = 0.51). Extra-pulmonary complications and adverse events did not significantly differ between groups. CONCLUSIONS: A perioperative open-lung ventilation including ventilation during CPB does not reduce the incidence of postoperative pulmonary complications as compared with usual care. This finding does not support the use of such a strategy in patients undergoing on-pump cardiac surgery. TRIAL REGISTRATION: Clinicaltrials.gov Identifier: NCT02866578. https://clinicaltrials.gov/ct2/show/NCT02866578.


Asunto(s)
Procedimientos Quirúrgicos Cardíacos/normas , Complicaciones Posoperatorias/etiología , Respiración Artificial/normas , Resultado del Tratamiento , Anciano , Procedimientos Quirúrgicos Cardíacos/métodos , Procedimientos Quirúrgicos Cardíacos/estadística & datos numéricos , Oxigenación por Membrana Extracorpórea/métodos , Femenino , Francia/epidemiología , Humanos , Pulmón/fisiopatología , Masculino , Persona de Mediana Edad , Respiración con Presión Positiva/métodos , Respiración con Presión Positiva/normas , Respiración con Presión Positiva/estadística & datos numéricos , Complicaciones Posoperatorias/epidemiología , Respiración Artificial/métodos , Respiración Artificial/estadística & datos numéricos , Volumen de Ventilación Pulmonar/fisiología
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