Journal of cardiothoracic and vascular anesthesia最新文献

英文中文

Early Prone Positioning As a Rescue Therapy for Moderate-to-severe Primary Graft Dysfunction After Bilateral Lung Transplant 早期俯卧位作为双侧肺移植术后中重度原发性移植物功能障碍的挽救疗法

IF 2.3 4区医学 Q2 ANESTHESIOLOGY

Journal of cardiothoracic and vascular anesthesia

Pub Date : 2025-02-01 DOI: 10.1053/j.jvca.2024.11.018

Nicolò Sella MD , Tommaso Pettenuzzo MD , Sabrina Congedi MD , Maria Bisi MD , Giulio Gianino MD , Agnese De Carolis MD , Carlo Alberto Bertoncello MD , Mario Roccaforte MD , Francesco Zarantonello MD , Paolo Persona MD, PhD , Enrico Petranzan MD , Gabriella Roca MD , Eugenio Biamonte MD , Michele Carron MD , Andrea Dell'Amore MD , Federico Rea MD , Annalisa Boscolo MD, PhD , Paolo Navalesi MD, FERS

Objectives

Primary graft dysfunction (PGD) affects survival after lung transplant (LT). The current hypothesis was that prone positioning (PP), proposed as a rescue maneuver to treat refractory hypoxemia due to PGD, may improve LT outcomes, especially when applied early.

Design

Bilateral LT recipients developing moderate-to-severe PGD within 24 hours from intensive care unit admission were enrolled. From January 2020 to November 2021, patients developing PGD after LT were turned prone between 24 and 48 hours after diagnosis, only in case of radiological or oxygenation worsening (“late PP” group). After November 2021, patients were routinely turned prone within 24 hours from PGD diagnosis (“early PP”). A propensity score–weighted analysis, adjusted for clinically relevant covariates, was applied.

Setting

Intensive care unit.

Participants

Bilateral LT recipients.

Interventions

Early PP, late PP, or supine position.

Measurements and Main Results

130 LT patients were screened and 67 were enrolled. A total of 25 (37%) recipients were treated in the supine position, 24 (36%) in early PP, and 18 (27%) in late PP. After propensity score weighting, both supine treatment (estimated effect for 1 ventilator-free day = 8.23, standard error: 2.97, p = 0.007) and early PP treatment (estimated effect = 9.42, standard error: 2.59, p < 0.001) were associated with greater 28-day ventilator-free days than late PP treatment (reference). Compared with late PP, early PP was also associated with better oxygenation, driving pressure, and static respiratory system compliance. Compared with supine recipients, the early PP group showed better oxygenation at 72 hours after PGD diagnosis.

Conclusions

Early PP in LT recipients with moderate-to-severe PGD seems to be associated with better 28-day ventilator-free days, oxygenation, and driving pressure than late PP.

目的：原发性移植物功能障碍（PGD）影响肺移植（LT）后的生存。目前的假设是，俯卧位（PP）作为治疗PGD引起的难治性低氧血症的抢救手法，可以改善LT的预后，特别是在早期应用时。设计：双侧肝移植受者在重症监护室入院后24小时内出现中度至重度PGD。从2020年1月至2021年11月，LT后发生PGD的患者在诊断后24至48小时内转为俯卧，仅在放射学或氧合恶化的情况下（“晚期PP”组）。2021年11月之后，患者通常在PGD诊断后24小时内俯卧（“早期PP”）。应用倾向性评分加权分析，调整临床相关协变量。环境：重症监护室。参与者：双侧肝移植受者。干预：早期PP、晚期PP或仰卧位。测量和主要结果：筛选了130例LT患者，67例入组。共有25名（37%）患者采用仰卧位，24名（36%）患者采用早期PP位，18名（27%）患者采用晚期PP位。倾向评分加权后，仰卧位治疗（1天无呼吸机估计效果= 8.23，标准误差：2.97,p = 0.007）和早期PP治疗（估计效果= 9.42，标准误差：2.59,p < 0.001）与晚期PP治疗相比，28天无呼吸机天数更长（参考）。与晚期PP相比，早期PP还与更好的氧合、驱动压和静态呼吸系统顺应性相关。与仰卧位受体相比，早期PP组在PGD诊断后72小时表现出更好的氧合。结论：与晚期PP相比，中度至重度PGD的LT受体早期PP似乎与更好的28天无呼吸机天数、氧合和驱动压相关。

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引用次数: 0

Use of Transcutaneous CO2 Monitoring in Adult Anesthesia 在成人麻醉中使用经皮二氧化碳监测仪。

IF 2.3 4区医学 Q2 ANESTHESIOLOGY

Journal of cardiothoracic and vascular anesthesia

Pub Date : 2025-02-01 DOI: 10.1053/j.jvca.2024.08.040

Elizabeth Shackel BA, MBChB, Rachel Takacs MBChB, FRCA, Fang Lam MB, BCh, Pramod Nalwaya MBBS, MD, FFARCSI

引用次数: 0

The Potential Role of Albumin in Reducing Cardiac Surgery–Associated Acute Kidney Injury: A Randomized Controlled Trial

IF 2.3 4区医学 Q2 ANESTHESIOLOGY

Journal of cardiothoracic and vascular anesthesia

Pub Date : 2025-02-01 DOI: 10.1053/j.jvca.2024.10.012

Jordi Miralles Bagán MD, PhD , Laura Parrilla Quiles MD , Pilar Paniagua Iglesias MD, PhD , Antoni J. Betbesé Roig MD, PhD , Sergi Sabaté Tenas MD, PhD , Sergio Pérez García MD , Mercedes García Álvarez MD, PhD

Objectives

Cardiac surgery–associated acute kidney injury (CSA-AKI) is a common complication with high morbidity and mortality. This study was designed to determine whether adding human albumin to the cardiopulmonary bypass (CPB) priming solution reduces the incidence of CSA-AKI.

Design

A double-blind, randomized controlled trial (RCT) involving 248 patients scheduled for cardiac surgery with CPB.

Setting

A single-center tertiary university hospital.

Participants

Adults with a baseline estimated glomerular filtration rate (eGFR) of ≥60 mL/min/1.73 m² and left ventricular ejection fraction ≥40%.

Interventions

Patients were randomized to receive either a crystalloid priming solution (Plasma-Lyte) plus 4% albumin (intervention group, n = 126) or a crystalloid solution alone (control group, n = 122) for CPB.

Measurements and Main Results

Data analyses were performed using the Chi-square test and Student's t-test, or their nonparametric equivalent. The primary outcome was the incidence of CSA-AKI, as defined by the Kidney Disease Improving Global Outcomes criteria, within 5 days postoperatively. Both cohorts were comparable in baseline and perioperative characteristics, including preoperative albumin levels. The incidence of CSA-AKI was 29.3% (n = 37) in the intervention group compared with 31.2% (n = 38) in the control group (odds ratio: 0.91, 95% confidence interval: 0.53-1.58). The observed difference in CSA-AKI incidence between the groups was not statistically significant. A post-hoc subgroup analysis of patients with a baseline eGFR of 60 to 70 mL/min/1.73 m² indicated a trend toward a reduced incidence of CSA-AKI in the intervention group compared with the control group (35.7% v 57.6%; odds ratio: 0.41, 95% confidence interval: 0.16-1.03). This trend was not observed in patients with an eGFR greater than 70 mL/min/1.73 m². No significant differences were observed between groups for the need for inotropes or vasoconstrictors, incidence of cardiogenic or distributive shock, bleeding, need for transfusion, or use of nephrotoxic drugs.

Conclusions

Adding albumin to the CPB priming solution did not decrease the incidence of CSA-AKI in patients with normal preoperative renal function. These findings suggest that albumin might benefit patients with impaired renal function, warranting further investigation.

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引用次数: 0

Articles to Appear in Future Issues

IF 2.3 4区医学 Q2 ANESTHESIOLOGY

Journal of cardiothoracic and vascular anesthesia

Pub Date : 2025-02-01 DOI: 10.1053/S1053-0770(25)00023-0

引用次数: 0

Aortic Regurgitation of Antegrade Cardioplegia: Solution-Dependence of Transesophageal Echocardiography Appearance 顺行性心脏骤停的主动脉瓣反流：经食管超声心动图表现的溶液依赖性。

IF 2.3 4区医学 Q2 ANESTHESIOLOGY

Journal of cardiothoracic and vascular anesthesia

Pub Date : 2025-02-01 DOI: 10.1053/j.jvca.2024.11.030

Yasuhiro Suda MD , Miho Takemitsu MD , Hotaka Ueda MD , Hiroshi Makino MD, PhD

引用次数: 0

Predicting Extent of Opioid Use Following Cardiac Surgery: A Pilot Study 预测心脏手术后阿片类药物使用的程度：一项初步研究。

IF 2.3 4区医学 Q2 ANESTHESIOLOGY

Journal of cardiothoracic and vascular anesthesia

Pub Date : 2025-02-01 DOI: 10.1053/j.jvca.2024.11.037

Miklos D. Kertai MD, MMHC, PhD , Rachel Rayl BA , Daniel B. Larach MD , Ashish S. Shah MD , Stephen Bruehl PhD

Objectives

This study was designed to test whether a negative affect phenotype reflecting depression, anxiety, anger, and pain catastrophizing predicts inpatient and outpatient opioid use outcomes following cardiac surgery.

Design

In a single-center prospective observational pilot study, the authors obtained validated measures of negative affect and opioid-related phenotype preoperatively and collected opioid use and opioid misuse-related outcomes at 30-day postoperative follow-up.

Setting

Quaternary medical center.

Participants

The final dataset included 30 adult patients undergoing elective cardiac surgery procedures between August 19, 2022, and August 29, 2023.

Interventions

None.

Measurements and Main Results

Opioid outcomes included: (1) total inpatient postoperative opioid use (in milligram morphine equivalents), (2) self-reported number of days that prescribed outpatient opioids were used during the 30-day follow-up period (Timeline Followback method), and (3) number of opioid misuse-related behaviors (Current Opioid Misuse Measure–9) at 30-day follow-up. Generalized linear model analyses using a Poisson distribution indicated that greater preoperative depression, anxiety, anger, pain catastrophizing, and opioid misuse risk (indexed by the Screener and Opioid Assessment for Patients with Pain- Revised) were all significantly (p < 0.002) associated with greater inpatient and outpatient postoperative opioid use, as well as more opioid misuse-related behaviors at 30-day follow-up (p < 0.001).

Conclusions

Patients with higher preoperative levels of negative affect (depression, anxiety, anger, and pain catastrophizing) use more inpatient and outpatient opioid analgesics following cardiac surgery, a pattern similar to noncardiac surgery populations. Results support further study of patient-specific approaches to opioid prescribing to reduce the risk for opioid use disorder post–cardiac surgery.

目的：本研究旨在检验反映抑郁、焦虑、愤怒和疼痛灾难化的负面影响表型是否能预测心脏手术后住院和门诊阿片类药物使用的结果。设计：在一项单中心前瞻性观察性先导研究中，作者在术前获得了负面影响和阿片类药物相关表型的有效测量，并在术后30天随访中收集了阿片类药物使用和滥用的相关结果。单位：第四医学中心。参与者：最终数据集包括30名在2022年8月19日至2023年8月29日期间接受选择性心脏手术的成年患者。干预措施:没有。测量方法和主要结果：阿片类药物结局包括：(1)住院患者术后阿片类药物使用总量（以毫克吗啡当量为单位），(2)30天随访期间门诊处方阿片类药物使用自我报告天数（时间轴回访法），(3)30天随访期间阿片类药物滥用相关行为数量（当前阿片类药物滥用测量-9）。使用泊松分布的广义线性模型分析表明，术前更大的抑郁、焦虑、愤怒、疼痛灾难和阿片类药物滥用风险（由疼痛患者的筛查和阿片类药物评估-修订）均与住院和门诊术后阿片类药物使用以及30天随访时更多的阿片类药物滥用相关行为显著（p < 0.002）相关（p < 0.001）。结论：术前负面情绪（抑郁、焦虑、愤怒和疼痛灾难化）水平较高的患者在心脏手术后更多地使用住院和门诊阿片类镇痛药，这一模式与非心脏手术人群相似。结果支持进一步研究患者特异性阿片类药物处方方法，以降低心脏手术后阿片类药物使用障碍的风险。

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引用次数: 0

Updating “Optimal” Perioperative Care for Stable Angina 更新“最佳”围手术期护理的稳定性心绞痛。

IF 2.3 4区医学 Q2 ANESTHESIOLOGY

Journal of cardiothoracic and vascular anesthesia

Pub Date : 2025-02-01 DOI: 10.1053/j.jvca.2024.11.006

Natalie J. Bodmer MD, Matthew W. Vanneman MD

引用次数: 0

Further Retractions of Dr. Joachim Boldt in the Journal of Cardiothoracic and Vascular Anesthesia Joachim Boldt博士在心胸血管麻醉杂志上的进一步撤稿。

IF 2.3 4区医学 Q2 ANESTHESIOLOGY

Journal of cardiothoracic and vascular anesthesia

Pub Date : 2025-02-01 DOI: 10.1053/j.jvca.2024.11.016

Lisa Q. Rong MD, MS , Edan Leshem BA , Joel A. Kaplan MD

引用次数: 0

Enhancing Surgical Recovery With Lung Prehabilitation Perioperatively 围手术期肺康复提高手术恢复。

IF 2.3 4区医学 Q2 ANESTHESIOLOGY

Journal of cardiothoracic and vascular anesthesia

Pub Date : 2025-02-01 DOI: 10.1053/j.jvca.2024.11.034

Gerald P. Rosen MD , Miguel Perez-Viloria MD , Ricardo Kaempfen MD , Daniel Bleykhman MD

引用次数: 0

Performance of Hemochron ACT-LR and ACT+ Test Cuvettes in Monitoring Low to Moderate Heparin Concentrations: An In Vitro Study 血色素ACT- lr和ACT+试验皿监测中低肝素浓度的性能：一项体外研究。

IF 2.3 4区医学 Q2 ANESTHESIOLOGY

Journal of cardiothoracic and vascular anesthesia

Pub Date : 2025-02-01 DOI: 10.1053/j.jvca.2024.12.001

Janne Moilanen MD , Marika Pada MD , Pasi Ohtonen MSc , Timo Kaakinen MD, PhD , Matti Pokela MD, PhD , Eeva-Riitta Savolainen MD, PhD , Tiina Erkinaro MD, PhD

Objectives

According to the manufacturer, the Hemochron ACT-LR cuvette is designated for heparin concentrations of 0 to 2.5 IU/mL, while the optimal concentration range for the ACT+ cartridge is 1 to 6 IU/mL. We hypothesized that at low to moderate heparin concentrations, the ACT-LR is more reliable than the ACT+.

Design

An in vitro study.

Setting

A tertiary care university hospital.

Participants

Twenty healthy adult volunteers.

Interventions

Donor blood samples were spiked with unfractionated heparin to concentrations of 0, 0.5, 1.0, 1.5, 2.0, and 2.5 IU/mL. From each concentration, 3 measurements were made with each test cassette using 3 different Hemochron Signature Elite devices, for a total of 720 ACT tests. The Bland-Altman method and intraclass correlation coefficients were used to analyze the data.

Measurements and Main Results

All 360 ACT+ tests yielded a result. Of 360, 38 (11%) ACT-LR tests ran above the upper measurement range; of these, 36 were from the 120 measurements at heparin concentrations ≥2.0 IU/mL. The bias between all ACT-LR and ACT+ measurements was 52 (95% CI, 48-56) celite seconds, and the limits of agreement were wide. Based on the intraclass correlation coefficients, the reliability of ACT+ was better than or equal to that of ACT-LR.

Conclusions

The performance of ACT+ is equal to that of ACT-LR up to a concentration of 0.5 IU/mL, above which ACT+ is superior to ACT-LR, questioning the rationale for a specific low-range test. However, there is a significant bias between ACT-LR and ACT+ measurements that needs to be considered if switching from one test to the other.

目的：据生产商介绍，haemchron ACT- lr比色管的肝素浓度范围为0 - 2.5 IU/mL，而ACT+试剂盒的最佳浓度范围为1 - 6 IU/mL。我们假设在低至中等肝素浓度下，ACT- lr比ACT+更可靠。设计：体外研究。环境：三级保健大学医院。参与者：20名健康成人志愿者。干预措施：供体血液样品加入未分离肝素，浓度分别为0、0.5、1.0、1.5、2.0和2.5 IU/mL。从每个浓度开始，每个测试盒使用3种不同的haemchron Signature Elite设备进行3次测量，总共进行720次ACT测试。采用Bland-Altman方法和类内相关系数对数据进行分析。测量和主要结果：所有360 ACT+测试都产生了结果。360例中，38例（11%）ACT-LR测试高于最高测量范围；其中，36例来自肝素浓度≥2.0 IU/mL的120例检测。所有ACT- lr和ACT+测量之间的偏差为52 (95% CI, 48-56) celite秒，一致性的限制范围很广。从类内相关系数来看，ACT+的信度优于或等于ACT- lr。结论：在0.5 IU/mL浓度下，ACT+与ACT- lr的性能相当，高于0.5 IU/mL时，ACT+优于ACT- lr，对进行特异性低量程检测的合理性提出质疑。然而，如果从一种测试切换到另一种测试，ACT- lr和ACT+测量之间需要考虑明显的偏差。

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