RESUMEN
Extracorporeal membrane oxygenation (ECMO) is used in cases of severe respiratory failure refractory to medical management. Use of ECMO is increasing, along with new cannulation strategies including oxygenated right ventricular assist devices (oxy-RVADs). Multiple dual lumen cannulas are now available, which increase the potential for patient mobility and decrease the number of vascular access sites. However, dual lumen, single cannula flow can be limited by adequate inflow, requiring the need for an additional inflow cannula to meet patient demands. This cannula configuration may result in differential flows in the inflow and outflow limbs and altered flow dynamics, increasing the risk of intracannula thrombus. We describe a series of four patients treated with oxy-RVAD for COVID-19-associated respiratory failure complicated by dual lumen ProtekDuo intracannula thrombus.
Asunto(s)
COVID-19 , Oxigenación por Membrana Extracorpórea , Insuficiencia Respiratoria , Trombosis , Humanos , Cánula , Oxigenación por Membrana Extracorpórea/efectos adversos , COVID-19/complicaciones , Insuficiencia Respiratoria/etiología , Insuficiencia Respiratoria/terapia , Trombosis/etiologíaRESUMEN
Iatrogenic tracheal injuries are an uncommon but serious complication of endotracheal tube intubation. We present two cases that illustrate iatrogenic tracheal injuries presenting hours after the time of their injury. This report addresses the critical diagnostic evaluation and management of iatrogenic tracheal injuries resulting from endotracheal intubation.
Asunto(s)
Intubación Intratraqueal , Tráquea , Humanos , Enfermedad Iatrogénica , Intubación Intratraqueal/efectos adversos , Tráquea/diagnóstico por imagenRESUMEN
This highlights in our specialty for 2019 begin with the ongoing major developments in transcatheter valve interventions. Thereafter, the advances in left ventricular assist devices are reviewed. The recent focus on conduit selection and robotic options in coronary artery bypass surgery are then explored. Finally, this special articles closes with a discussion of pulmonary hypertension in noncardiac surgery, anesthetic technique in cardiac surgery, as well as postoperative pneumonia and its outcome consequences.
Asunto(s)
Anestesia , Anestesiología , Procedimientos Quirúrgicos Cardíacos , Implantación de Prótesis de Válvulas Cardíacas , Procedimientos Quirúrgicos Cardíacos/efectos adversos , Puente de Arteria Coronaria , Humanos , Resultado del TratamientoAsunto(s)
Cateterismo Cardíaco/métodos , Insuficiencia de la Válvula Mitral/diagnóstico por imagen , Insuficiencia de la Válvula Mitral/cirugía , Instrumentos Quirúrgicos , Anciano de 80 o más Años , Procedimientos Quirúrgicos Cardíacos/métodos , Implantación de Prótesis de Válvulas Cardíacas/métodos , Humanos , Masculino , Intervención Coronaria Percutánea/métodosRESUMEN
Humanized mice are a state-of-the-art tool used to study several diseases, helping to close the gap between mice and human immunology. This review focuses on the potential obstacles in the analysis of immune system performance between humans and humanized mice in the context of severe acute inflammation as seen in sepsis or other critical care illnesses. The extent to which the reconstituted human immune system in mice adequately compares to the performance of the human immune system in human hosts is still an evolving question. Although certain viral and protozoan infections can be replicated in humanized mice, whether a highly complex and dynamic systemic inflammation like sepsis can be accurately represented by current humanized mouse models in a clinically translatable manner is unclear. Humanized mice are xenotransplant animals in the most general terms. Several organs (e.g., bone marrow mesenchymal cells, endothelium) cannot interact with the grafted human leukocytes effectively due to species specificity. Also the interaction between mice gut flora and the human immune system may be paradoxical. Often, grafting is performed utilizing an identical batch of stem cells in highly inbred animals which fails to account for human heterogeneity. Limiting factors include the substantial cost and restricting supply of animals. Finally, humanized mice offer an opportunity to gain knowledge of human-like conditions, requiring careful data interpretation just as in nonhumanized animals.
Asunto(s)
Carcinoma de Células Renales/terapia , Cateterismo de Swan-Ganz/métodos , Neoplasias Renales/terapia , Células Neoplásicas Circulantes/patología , Vena Cava Inferior , Trombosis de la Vena/terapia , Carcinoma de Células Renales/diagnóstico por imagen , Manejo de la Enfermedad , Humanos , Neoplasias Renales/diagnóstico por imagen , Vena Cava Inferior/diagnóstico por imagen , Trombosis de la Vena/diagnóstico por imagenAsunto(s)
Carcinoma de Células Renales/cirugía , Diafragma/cirugía , Manejo de la Enfermedad , Neoplasias Renales/cirugía , Células Neoplásicas Circulantes/patología , Grupo de Atención al Paciente , Carcinoma de Células Renales/diagnóstico por imagen , Diafragma/diagnóstico por imagen , Femenino , Humanos , Neoplasias Renales/diagnóstico por imagen , Persona de Mediana EdadRESUMEN
Scimitar syndrome is a rare association of congenital cardiopulmonary anomalies characterized by partial anomalous pulmonary venous return, in which an abnormal right pulmonary vein drains into the inferior vena cava. This case exemplifies the role of transesophageal echocardiography in perioperative management and surgical decision-making.
Asunto(s)
Ecocardiografía Transesofágica/métodos , Venas Pulmonares/anomalías , Venas Pulmonares/diagnóstico por imagen , Síndrome de Cimitarra/diagnóstico por imagen , Malformaciones Vasculares/diagnóstico por imagen , Adulto , Femenino , Humanos , Síndrome de Cimitarra/complicaciones , Malformaciones Vasculares/complicacionesRESUMEN
The introduction of intracoronary stents represented a major advance in interventional cardiology. While bare metal stents set the benchmark for improved safety over angioplasty, intimal hyperplasia and subsequent restenosis were important limitations. First-generation drug-eluting stents demonstrated significant improvements in efficacy, but not necessarily safety, and further technologic developments have focused on optimizing both. Current advances and understanding in stent design continue to improve on these concepts. This review summarizes past and present technology with particular emphasis on the principles underlying the efficacy and safety of drug-eluting stents, and offers a glimpse into the next generations of stents aimed at treating symptomatic coronary artery disease.