Left side clot in transit in double-lung transplantation diagnosticated by transesophageal echocardiography: what's next?

A 61-year-old man with no predisposition to thrombosis underwent sequential double lung transplantation without extracorporeal membrane oxygenation (ECMO) support due to terminal stage COPD. After implantation and reperfusion of both lungs, a complete transoesophageal echocardiography study was performed to check the pulmonary venous anastomosis. The study showed a large, heterogeneous, dense, hyperechoic free-floating mass in the left atrium compatible with a clot in transit from the pulmonary circulation. The surgical team were notified of this finding so that they could reopen the anastomosis and remove the clot to prevent a major complication. There were no clinical manifestations when the patient was awakened.

Update on the use of ultrasound in the diagnosis and monitoring of the critical patient.

Hemodynamic and respiratory complications are the main causes of morbidity and mortality in in critical care units (CCU). Imaging techniques are a key tool in differential diagnosis and treatment. In the last decade, ultrasound has shown great potential for bedside diagnosis of respiratory disease, as well as for the hemodynamic assessment of critically ill patients. Ultrasound has proven to be a useful guide for identifying the type of shock, estimating cardiac output, guiding fluid therapy and vasoactive drugs, providing security in the performance of percutaneous techniques (thoracentesis, pericardiocentesis, evacuation of abscesses/hematomas), detecting dynamically in real time pulmonary atelectasis and its response to alveolar recruitment maneuvers, and predicting weaning failure from mechanical ventilation. Due to its dynamic nature, simple learning curve and absence of ionizing radiation, it has been incorporated as an essential tool in daily clinical practice in CCUs. The objective of this review is to offer a global vision of the role of ultrasound and its applications in the critically ill patient.

[Identity of gender and intensive care: influence of masculinity and femininity in the perception of nursing care]. / Identidad de género y cuidados intensivos: influencia de la masculinidad y la feminidad en la percepción de los cuidados enfermeros.

INTRODUCTION: Nursing has essentially been the work of women. The increase in men incorporating into nursing makes us think about whether there are different ways of expressing and practicing a profession in relationship to gender. OBJECTIVE: To describe if there are different ways of perceiving and assessing ICU work from a gender perspective. METHODOLOGY: A qualitative phenomenological study. SAMPLE: 6 male nurses and 6 female nurses from the ICU of the Hospital Universitario de Bellvitge (HUB). DATA COLLECTION: In-depth semi-constructed interview. Content analysis. RESULTS: Male nurses describe ICU work in terms of autonomy in making decisions and professional competence. They claim responsibility for their identity as nurses and stress the low social recognition of the profession. They prioritize the responsibility of decision making over the final outcome and evaluate family satisfaction in terms of prestige and competence. They are more practical. Female nurses describe the work in terms of control and follow-up of the patient's evolution. They emphasize the final care outcome and evaluate satisfaction in terms of a relationship of confidence and warm patient care. They are more meticulous. CONCLUSIONS: There are differences in how they classify their ICU work, in the self-evaluation of professional identity, behavior in the development of the nursing care and in perception of family satisfaction. No differences are observed regarding problem solving with the technology.

Multicentric survey on the use of intraoperative echocardiography in cardiovascular surgery in Spain. / Encuesta multicéntrica sobre el empleo de la ecocardiografía intraoperatoria en cirugía cardiovascular en España. Artículo breve.

Transesophageal echocardiography (TEE) is an essential tool in the intraoperative and postoperative period of cardiac surgery with recently wide diffusion. We aimed to know the current situation of TEE in the field of cardiovascular anesthesiology in Spain through a national survey that explores the availability of equipment, indication and use of this technique as well as the training and accreditation of professionals involved. The findings show that in Spain intraoperative TEE is an integral part of cardiovascular procedures today and in most centers it is performed by anesthesiologists highly involved in this type of surgery. Despite the absence of structured training in the curriculum of our specialty, anesthesiologists acquire the skills through specific short-term rotations and a high percentage of them have obtained official accreditation.

[Major complications in the recovery unit following heart transplant: incidence and risk factors]. / Incidencia y predictores de complicaciones graves tras el trasplante cardiaco en la Unidad de Reanimación.

OBJECTIVE: To assess the incidence of major complications in the postoperative recovery unit and to analyze the associated recipient, donor, and surgical risk factors. MATERIAL AND METHODS: We studied a series of consecutive orthotopic heart transplants carried out in our hospital from 2001 through 2007. Patients who experienced major complications during their stay in the recovery ward were compared with those who did not. Exitus, primary graft failure, severe infection, and need for hemodialysis were considered major complications. RESULTS: One hundred fifty-two patients were enrolled. The mean stay in the recovery unit was 3 days (range, 225-5 days). Thirty-nine patients (26%) developed major complications in the recovery unit and 113 did not. The complications were primary graft failure (20%), infection (12%), and acute renal failure (53%). Patients with and without major complications were significantly different with respect to mean (SD) age (55 [6] vs 50 [12] years, respectively; P=.001), presence of diabetes mellitus (41% vs 14%, P=.0001), classification in New York Heart Association functional class IV/IV status (54% vs 34%, P=.05), emergency transplantation (46% vs 18%, P=.001), mean cardiopulmonary bypass time (145 [66] vs 119 [35], P=.03), pretransplant use of an intra-aortic balloon pump (15% vs 6%, P=.04). Multivariate analysis demonstrated an association between major complications and emergency transplantation (OR, 5.67; P=.001), recipient age over 55 years (OR, 2.99; P=.027), and diabetes mellitus (OR, 2.86; P=.048). CONCLUSIONS: The incidence of major complications in our postoperative recovery unit was 26%. The most common complications were primary graft failure, infection, and acute renal failure. Emergency transplantation, older age, and a diagnosis of diabetes mellitus in the recipient were predictors of complication.

Actualización sobre el uso de la ecografía en el diagnóstico y monitorización del paciente crítico / Update on the use of ultrasound in the diagnosis and monitoring of the critical patient

Las complicaciones cardiorrespiratorias son las principales causas de morbimortalidad en las unidades de cuidados críticos (UCC). Las técnicas de imagen son una pieza fundamental tanto en el diagnóstico diferencial como en el tratamiento. En la última década la ecografía ha demostrado gran potencial para el diagnóstico a pie de cama de patología respiratoria, así como para la valoración hemodinámica de los pacientes críticos. La ecografía ha demostrado ser una guía útil para la identificación del tipo de shock, la estimación del gasto cardiaco, guiar la fluidoterapia y los fármacos vasoactivos, aportar seguridad en la realización de las técnicas percutáneas (toracocentesis, pericardiocentesis, evacuación de abscesos/hematomas), objetivar de forma dinámica y en tiempo real la atelectasia pulmonar y su respuesta a las maniobras de reclutamiento alveolar, y predecir el fracaso en el destete de la ventilación mecánica. Por su carácter dinámico, sencilla curva de aprendizaje y ausencia de radiación ionizante, se ha incorporado como una herramienta imprescindible en la práctica clínica diaria en las UCC. El objetivo de la presente revisión es ofrecer una visión global del papel de la ecografía y sus aplicaciones en el paciente crítico.(AU)

Hemodynamic and respiratory complications are the main causes of morbidity and mortality in in critical care units (CCU). Imaging techniques are a key tool in differential diagnosis and treatment. In the last decade, ultrasound has shown great potential for bedside diagnosis of respiratory disease, as well as for the hemodynamic assessment of critically ill patients. Ultrasound has proven to be a useful guide for identifying the type of shock, estimating cardiac output, guiding fluid therapy and vasoactive drugs, providing security in the performance of percutaneous techniques (thoracentesis, pericardiocentesis, evacuation of abscesses/hematomas), detecting dynamically in real time pulmonary atelectasis and its response to alveolar recruitment maneuvers, and predicting weaning failure from mechanical ventilation. Due to its dynamic nature, simple learning curve and absence of ionizing radiation, it has been incorporated as an essential tool in daily clinical practice in CCUs. The objective of this review is to offer a global vision of the role of ultrasound and its applications in the critically ill patient.(AU)

Encuesta multicéntrica sobre el empleo de la ecocardiografía intraoperatoria en cirugía cardiovascular en España. Artículo breve / Multicentric survey on the use of intraoperative echocardiography in cardiovascular surgery in Spain

La ecocardiografía transesofágica (ETE) es una herramienta fundamental en el intraoperatorio y postoperatorio de cirugía cardiaca con una gran difusión en los últimos años. El objetivo de este trabajo es conocer la situación actual de la ETE en el ámbito de la anestesiología en cirugía cardiaca en España a través de una encuesta nacional que explora la disponibilidad de equipos, indicación y utilización de dicha técnica, así como la formación y acreditación de los profesionales responsables. Los hallazgos muestran que en España la ETE intraoperatoria es parte integral de los procedimientos cardiovasculares hoy en día y en la mayor parte de los centros es realizada por anestesiólogos altamente involucrados en este tipo de cirugías. A pesar de la ausencia de formación estructurada en el currículum formativo de nuestra especialidad, los anestesiólogos adquieren las competencias mediante rotaciones específicas de corta duración y un alto porcentaje de ellos ha obtenido la acreditación oficial

Transesophageal echocardiography (TEE) is an essential tool in the intraoperative and postoperative period of cardiac surgery with recently wide diffusion. We aimed to know the current situation of TEE in the field of cardiovascular anesthesiology in Spain through a national survey that explores the availability of equipment, indication and use of this technique as well as the training and accreditation of professionals involved. The findings show that in Spain intraoperative TEE is an integral part of cardiovascular procedures today and in most centers it is performed by anesthesiologists highly involved in this type of surgery. Despite the absence of structured training in the curriculum of our specialty, anesthesiologists acquire the skills through specific short-term rotations and a high percentage of them have obtained official accreditation

Identidad de género y cuidados intensivos: influencia de la masculinidad y la feminidad en la percepción de los cuidados enfermeros / Identity of gender and intensive cares: Influence of masculinity and femininity in the perception of nursing care

IntroducciónLa enfermería ha sido fundamentalmente un trabajo de mujeres. El incremento en la incorporación de hombres a la enfermería nos hace reflexionar en torno a la cuestión de si existen diferentes formas de expresar y practicar una profesión en relación con el género.ObjetivoDescribir si existen diferentes maneras de percibir y valorar el trabajo en la unidad de cuidados intensivos (UCI) desde una perspectiva de género.MetodologíaEstudio cualitativo fenomenológico. Muestra: 6 enfermeros y 6 enfermeras de la UCI del Hospital Universitario de Bellvitge. Recogida de datos: entrevista semiestructurada en profundidad. Análisis de contenido.ResultadosLos enfermeros describen el trabajo en la UCI en términos de autonomía en las decisiones y competencia profesional, reivindican su identidad como enfermeros y destacan el bajo reconocimiento social que se hace de la profesión, priorizan más la responsabilidad en la toma de decisiones que el resultado final y valoran la satisfacción familiar en términos de prestigio y competencia. Son más prácticos. Las enfermeras califican el trabajo en términos de control y seguimiento en la evolución del enfermo, destacan más el resultado final del cuidado y valoran la satisfacción en términos de relación de confianza y calidez asistencial. Son más detallistas.ConclusionesExisten diferencias en la manera de calificar el trabajo en la UCI, en la valoración de la identidad profesional, el comportamiento en el desarrollo de los cuidados de enfermería y en la percepción de la satisfacción familiar. No se observan diferencias en relación con el abordaje en la resolución de problemas con la tecnología (AU)

IntroductionNursing has essentially been the work of women. The increase in men incorporating into nursing makes us think about whether there are different ways of expressing and practicing a profession in relationship to gender.ObjectiveTo describe if there are different ways of perceiving and assessing ICU work from a gender perspective.MethodologyA qualitative phenomenological study. Sample: 6 male nurses and 6 female nurses from the ICU of the Hospital Universitario de Bellvitge (HUB). Data collection: In-depth semi-constructed interview. Content analysis.ResultsMale nurses describe ICU work in terms of autonomy in making decisions and professional competence. They claim responsibility for their identity as nurses and stress the low social recognition of the profession. They prioritize the responsibility of decision making over the final outcome and evaluate family satisfaction in terms of prestige and competence. They are more practical. Female nurses describe the work in terms of control and follow-up of the patient's evolution. They emphasize the final care outcome and evaluate satisfaction in terms of a relationship of confidence and warm patient care. They are more meticulous.ConclusionsThere are differences in how they classify their ICU work, in the self-evaluation of professional identity, behavior in the development of the nursing care and in perception of family satisfaction. No differences are observed regarding problem solving with the technology (AU)

Incidencia y predictores de complicaciones graves tras el trasplantecardiaco en la Unidad de Reanimación / Major complications in the recovery unit following heart transplant: incidence and risk factors

OBJETIVO: Determinar las complicaciones durante elpostoperatorio en Reanimación y analizar qué variablesdel receptor, donante y quirúrgicas se asocian a complicacionesmayores.MATERIAL Y MÉTODO: Analizamos una serie de trasplantescardiacos ortotópicos consecutivos realizados ennuestro centro entre 2001-2007. Se compararon pacientesque no presentaron complicaciones mayores (CM) durantela estancia en Reanimación (Grupo 1) con los que sí lasdesarrollaron (Grupo 2). Se consideró CM el exitus, falloprimario del injerto (FPI), infección grave y necesidad dehemodiálisis.RESULTADOS: Incluimos 152 pacientes cuyo tiempo depermanencia en Reanimación fue de 3 (2,25-5) días. Cientotrece pacientes no presentaron CM en Reanimación(Grupo 1), mientras que 39 pacientes (26%) sí desarrollaroncomplicaciones (Grupo 2): FPI (20%), infección (12%)y disfunción renal grave (5,3%). Observamos diferenciassignificativas entre los grupos respecto a edad (50 ± 12 vs55 ± 6; p = 0,001), diabetes (14 vs. 41%; p = 0,0001), clasefuncional New York Heart Association IV/IV (34 vs. 54%;p = 0,04), trasplante urgente (18 vs 46%; p = 0,001), tiempode circulación extracorpórea (119 ± 35 vs. 145 ± 66minutos; p = 0,03), balón de contrapulsación pretrasplante(6 vs 15%; p = 0,04). El análisis multivariado demostróasociación entre las CM y el trasplante urgente (OR: 5,67;p = 0,001), receptor mayor de 55 años (OR: 2,99;p = 0,027) y diabético (OR: 2,86; p = 0,048).CONCLUSIONES: Un 26% de los pacientes cardiacosdesarrollaron CM en Reanimación. Las más frecuentesfueron el FPI, la infección y la disfunción renal grave. Sonvariables predictivas independientes de su aparición eltrasplante urgente, edad y diabetes mellitus del receptor (AU)

OBJECTIVE: To assess the incidence of majorcomplications in the postoperative recovery unit andto analyze the associated recipient, donor, and surgicalrisk factors.MATERIAL AND METHODS: We studied a series ofconsecutive orthotopic heart transplants carried out inour hospital from 2001 through 2007. Patients whoexperienced major complications during their stay in therecovery ward were compared with those who did not.Exitus, primary graft failure, severe infection, and needfor hemodialysis were considered major complications.RESULTS: One hundred fifty-two patients were enrolled.The mean stay in the recovery unit was 3 days (range,2.25-5 days). Thirty-nine patients (26%) developed majorcomplications in the recovery unit and 113 did not. Thecomplications were primary graft failure (20%), infection(12%), and acute renal failure (5.3%). Patients with andwithout major complications were significantly differentwith respect to mean (SD) age (55 [6] vs 50 [12] years,respectively; P=.001), presence of diabetes mellitus (41%vs 14%, P=.0001), classification in New York HeartAssociation functional class IV/IV status (54% vs 34%,P=.05), emergency transplantation (46% vs 18%, P=.001),mean cardiopulmonary bypass time (145 [66] vs 119 [35],P=.03), pretransplant use of an intra-aortic balloon pump(15% vs 6%, P=.04). Multivariate analysis demonstratedan association between major complications andemergency transplantation (OR, 5.67; P=.001), recipientage over 55 years (OR, 2.99; P=.027), and diabetesmellitus (OR, 2.86; P=.048).CONCLUSIONS: The incidence of major complicationsin our postoperative recovery unit was 26%. The mostcommon complications were primary graft failure,infection, and acute renal failure. Emergencytransplantation, older age, and a diagnosis of diabetesmellitus in the recipient were predictors of complication (AU)