Pulmonary Epithelial Proteins as Specific Biomarkers of Lung Injury After Cardiac Surgery
THE LUNGS and heart can be visualized as closely related neighbors, with any intervention or disease of one intricately affecting the other. Despite refinements in the perfusion, surgical, and anesthetic regimens, lung injury after cardiac surgery continues to pose a formidable diagnostic and management challenge.1 A multitude of factors, such as median sternotomy, cardiopulmonary bypass (CPB) and associated inflammatory response, blood transfusion, capillary injury, mechanical ventilation and, cardiopulmonary interactions contribute to lung injury after cardiac surgery.
Acute Kidney Injury (AKI) is an important complication after cardiac surgery and increases the morbidity and mortality of patients while increasing health care costs.1 AKI occurs in up to 30% of patients undergoing cardiac surgery, and dialysis is necessary in 1% to 2%.2 Preoperative risk factors for AKI in these patients include age, diabetes, anemia, renal insufficiency, contrast exposure, atrial fibrillation, and lower ejection fraction. Intraoperative factors include cardiopulmonary bypass (CPB) time, nonpulsatile flow, lowest hematocrit on pump, renal perfusion pressure, inflammatory response, and blood transfusion.
This article is protected by copyright. All rights reserved. PMID: 31264222 [PubMed - as supplied by publisher]
Conclusion: In surgical oncology patients, ABT is associated with greater rate of recurrence.
Abstract Context: Cardiac anesthesiologists play a key role during the conduct of cardiopulmonary bypass (CPB). There are variations in the practice of CPB among extracorporeal technologists in India. Aims: The aim of this survey is to gather information on variations during the conduct of CPB in India. Settings and Design: This was an online conducted survey by Indian College of Cardiac Anaesthesia, which is the research and academic wing of the Indian Association of Cardiovascular Thoracic Anaesthesiologists. Subjects and Methods: Senior consultants heading cardiac anesthesia departments in both teachi...
Acute kidney injury (AKI) is a common and serious complication of cardiac surgery. It is associated with increased morbidity and mortality. On a population level, the financial impact and overall incremental annual index hospitalization costs associated with AKI exceed $1 billion in the United States alone. The pathogenesis is multifaceted and complex. Although novel biomarkers may be useful in detecting AKI at an earlier stage, treatment of AKI remains elusive. Prevention of AKI is still key to the management of AKI, and strategies include maintenance of renal perfusion and avoidance of nephrotoxins and blood transfusion-related insults.
To the Editor Brady et al performed a novel retrospective investigation into outcomes after prolonged, otherwise intermediate-risk surgery. We take issue with the wording of their conclusion. From our perspective, they studied duration of surgery not anesthesia duration because it is for the prolonged surgery that prolonged anesthesia was administered. Obviously having a control group for similar surgery and similar duration without anesthesia would be practically impossible. One possible imaginary control group would be being anesthetized for a similarly prolonged number of hours without any surgery. From practical experi...
ConclusionEsmolol HA allowed better control of IO bleeding, blood transfusion and FT. Masimo continuous monitoring of rSO2 assured preserved cerebral perfusion. Masimo measured PVI could non-invasively monitor tissue perfusion.
Conclusion Application of HBOC led to an increase of systemic and pulmonary vascular resistance in this animal model of ARDS. The increase in RVP was reversed by iNO. Pulmonary vasoconstriction by hemoglobin glutamer-200 in combination with iNO did not improve arterial oxygenation in ARDS.
Conclusions: In patients who receive HITHOC the fluid load can reduce the microvascular impairment restoring the normal tissue perfusion. This process takes days but is most evident in the first 72 h. The use of colloid and blood transfusion is much more effective in restoring microcirculation and reducing tissue damaging. PMID: 29507790 [PubMed]
Abstract BACKGROUND: Cardiac surgery on Jehovah's Witnesses (JW) can be challenging, given the desire to avoid blood products. Establishment of a blood conservation program involving the pre-, intra- and post-operative stages for all patients may lead to a minimized need for blood transfusion in all patients. METHODS: Pre-operatively, all JW patients were treated with high dose erythropoietin 500 IU/kg twice a week. JW patients were compared to matching non-JW patients from the congenital cardiac database, two per JW to serve as control. Blood use, ventilation time, bypass time, pre-operative hematocrit, firs...