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The Anesthesiologist as Extracorporeal Membrane Oxygenation Intensivist: Heralding a New Era? 麻醉师作为体外膜氧强化治疗师:预示一个新时代?
Pub Date : 2024-07-12 DOI: 10.25259/jccc_29_2024
Marlice van Dyk
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引用次数: 0
Evaluation of Right Ventricular Function in Patients Undergoing Mitral Valve Replacement with Pulmonary Artery Systolic Pressure of more than 50 mmHg: A Prospective Analysis 评估肺动脉收缩压超过 50 mmHg 的二尖瓣置换术患者的右心室功能:前瞻性分析
Pub Date : 2024-07-12 DOI: 10.25259/jccc_27_2024
Biraj Majumder, Sarveshpal Singh, Sandeep Seth, Manoj Sahu, Satyavir Yadav, Ummed Singh, Surabhi Gupta, Shivam Pandey
The severity of pulmonary artery hypertension affects the outcomes of patients undergoing mitral valve replacement (MVR). Speckle-tracking derived strain is a new modality for the assessment of the right ventricular (RV) function as well as the longitudinal contractile pattern.Our main objective of this study was to evaluate the right ventricular (RV) function in patients undergoing MVR with pulmonary artery systolic pressure (PASP) of more than 50 mmHg at 1 and 4 weeks postoperatively.This prospective cohort study included 40 patients with rheumatic heart disease (RHD) (mitral stenosis [MS] and mitral regurgitation [MR]) scheduled to undergo MVR between January 2022 and December 2023 in AIIMS, New Delhi. Serial 2D echocardiography, tissue Doppler imaging, as well as RV speckle-tracking echocardiography were performed, and serum brain natriuretic peptide (BNP) levels were measured during the pre-operative period, 1st week and 4th weeks postoperatively to evaluate RV function.Tricuspid annular plane systolic excursion (TAPSE) and left ventricular ejection fractions (LVEFs) were significantly lower at 1 week after surgery, compared to pre-operative levels, and reached the pre-operative values at 4 weeks after surgery. The RV fractional area change (RVFAC) at 4 weeks postoperatively significantly increased compared to 1st week and baseline values. The tricuspid valve (TV) tissue velocity in systole (S'), TV velocity in diastole (E'), RV global strain (RVGLS), and RV free wall strain (RVFWLS) at post-operative 4 weeks were lower than pre-operative values, and this difference was statistically significant.Four weeks after MVR, in adult patients with RHD (MS and MR) having PASP >50 mmHg, it was observed that deformational indices or speckle-tracking echocardiography such as RVGLS and RVFWLS predict better RV dysfunction than linear indices like TAPSE. The BNP, PASP (delta TR), right atrial volume, left atrial volume, LV internal diameter in systole, and LV internal diameter in diastole decreased significantly in these patients. RVFAC increased significantly to compensate for the loss of longitudinal function.
肺动脉高压的严重程度会影响二尖瓣置换术(MVR)患者的预后。本研究的主要目的是评估肺动脉收缩压(PASP)超过 50 mmHg 的二尖瓣置换术患者在术后 1 周和 4 周的右心室功能。这项前瞻性队列研究纳入了 40 名风湿性心脏病(RHD)(二尖瓣狭窄 [MS] 和二尖瓣反流 [MR])患者,他们计划于 2022 年 1 月至 2023 年 12 月期间在新德里 AIIMS 接受 MVR。在术前、术后第1周和第4周进行了序列二维超声心动图、组织多普勒成像和RV斑点追踪超声心动图检查,并测量了血清脑钠肽(BNP)水平,以评估RV功能。三尖瓣环平面收缩期偏移(TAPSE)和左心室射血分数(LVEF)在术后1周显著低于术前水平,并在术后4周达到术前水平。与第一周和基线值相比,术后4周的左心室射血分数面积变化(RVFAC)明显增加。术后 4 周的三尖瓣(TV)组织收缩期速度(S')、TV 舒张期速度(E')、RV 整体应变(RVGLS)和 RV 游离壁应变(RVFWLS)均低于术前值,且差异具有统计学意义。在 PASP >50 mmHg 的 RHD(MS 和 MR)成人患者中,观察到 MVR 术后四周,RVGLS 和 RVFWLS 等变形指数或斑点追踪超声心动图比 TAPSE 等线性指数更能预测 RV 功能障碍。这些患者的 BNP、PASP(δ TR)、右心房容积、左心房容积、收缩期左心室内径和舒张期左心室内径均显著下降。RVFAC 明显增加,弥补了纵向功能的损失。
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引用次数: 0
Prognostic Cardiac Biomarkers and Tetralogy of Fallot Score: Do they Predict Outcomes in Intracardiac Tetralogy of Fallot Repair? 预后性心脏生物标志物和法洛氏四联症评分:它们能预测心内法洛四联症修复术的预后吗?
Pub Date : 2024-07-12 DOI: 10.25259/jccc_59_2023
Poonam Malhotra Kapoor, Rashmi Singh, Mohanish Badge, M. Prakash, Minati Choudhury, O. M. Mujahid, U. Chowdhury
One of the most common cyanotic congenital heart diseases seen in India is the tetralogy of Fallot (TOF). The presence of chronic hypoxia leads to increased susceptibility to ischemia and infections. The postoperative morbidity and mortality can be predicted earlier, by incorporating various biochemical markers in pre-operative workup, which can minimize post-operative mechanical ventilation and intensive care unit (ICU) stay. We aimed to study 11 different cardiac biomarkers and calculate the All India Institute of Medical Sciences (AIIMS) score as a prognostic marker in TOF patients.After obtaining Institute Ethics Committee approval from the Hospital Ethics Committee with Indian Council of Medical Research (ICMR) Trial No: 5/4/1-1/08-NCD-II and written informed consent, a prospective and observational study was conducted on 150 patients with TOF undergoing elective intra cardiac repair (ICR) divided into two groups. Anesthetic and surgical management was standardized for all patients as per institutional protocol. The data were analyzed in STATA software. The sample size was calculated on the basis of the area under the curve for various biomarkers shown in the previous literature reviews.There was a positive correlation between the Endothelin levels 48 h after bypass and post-operative outcome measures such as the duration of inotropes, duration of ventilation, and duration of ICU stay. Pre-cardiopulmonary bypass serum tumor necrosis factor-alpha (TNF-α) showed a significant correlation with mortality in group I patients (P = 0.009) and group II patients (P < 0.05). Intragroup comparison in survivors showed significant changes with time in lactate trends. The mean initial post-operative lactate was significantly lower for survivors than for non-survivors. In addition, the serial mean lactate decreased progressively in all surviving patients compared with non-survivors diagnostic receiver operating characteristic curve for the pressure of oxygen.The four biomarkers, namely, Endothelin, TNF-α, BNP, and base excess, were found to be highly sensitive and specific. Using these biomarkers, a score of 2.73 (the AIIMS TOF score) is considered morbid in patients post-ICR in the ICU. The chances of mortality are high, with a sensitivity of 96.9% and specificity of 89.2%.
法洛氏四联症(TOF)是印度最常见的紫绀型先天性心脏病之一。长期缺氧会导致缺血和感染的易感性增加。通过将各种生化指标纳入术前检查,可以提前预测术后发病率和死亡率,从而最大限度地减少术后机械通气和重症监护室(ICU)的住院时间。我们的目标是研究 11 种不同的心脏生物标志物,并计算出全印度医学科学研究所(AIIMS)的评分,作为 TOF 患者的预后标志物。在获得印度医学研究理事会(ICMR)试验编号:5/4/1-1/08-NCD-II 的医院伦理委员会批准和书面知情同意后,我们对 150 名接受择期心脏内修复术(ICR)的 TOF 患者进行了前瞻性观察研究,分为两组。所有患者的麻醉和手术管理均按照机构协议进行了标准化。数据使用 STATA 软件进行分析。样本量是根据以往文献综述中显示的各种生物标志物的曲线下面积计算得出的。分流术后 48 小时内皮素水平与术后结果指标(如肌注时间、通气时间和重症监护室住院时间)之间存在正相关。心肺搭桥术前血清肿瘤坏死因子-α(TNF-α)与第一组患者(P = 0.009)和第二组患者(P < 0.05)的死亡率有显著相关性。幸存者的组内比较显示,乳酸趋势随时间发生了显著变化。幸存者术后初始平均乳酸明显低于非幸存者。此外,与非存活者相比,所有存活患者的序列平均乳酸逐渐降低。利用这些生物标志物,在重症监护室接受心肺复苏术后的患者,如果评分达到 2.73(AIIMS TOF 评分),就被认为是病态。死亡率很高,灵敏度为 96.9%,特异性为 89.2%。
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引用次数: 0
A Bibliometric Study on Junctional Ectopic Tachycardia: Time and Trends have much to Tell! 有关交界性异位性心动过速的文献计量学研究:时间与趋势大有文章可做!
Pub Date : 2024-07-12 DOI: 10.25259/jccc_28_2024
Jes Jose, R. Magoon, Nitin Choudhary, Varun Suresh, Mukesh Kumar
Junctional ectopic tachycardia (JET), an arrhythmia of substantial clinical relevance, is no less than an eternal nemesis in cardiac critical care. Hence, we hereby present a bibliometric study evaluating the research trends in the subject.A Scopus search-based bibliometric analysis of the keyword “Junctional Tachycardia” OR “Junctional Ectopic Tachycardia” restricted to original articles and reviews was undertaken after excluding the veterinary-related papers. The metadata thus obtained was analyzed using Scimago Graphica 1.0.42 and VOSviewer version 1.6.20 to generate a graphical representation of the trends and the timelines based on the author keywords.A total of 926 papers of interest were identified and selected for the analysis, which revealed the geographical distribution of productivity being primarily concentrated in the Western developed nations, topic receptiveness largely appreciated in cardiovascular-related journals, and increased yearly output of the JET-associated papers. Further perusal identified 79 most frequently observed author keywords when limited to a minimum of 5 co-occurrences, which were grouped into seven color-coded clusters by VOSviewer, and mapped into keyword as well as author network, overlay, and density projections.Bibliometric analysis of JET papers from 1967 to 2024 shows a growing interest in the topic, awaiting newer insights into the molecular mechanisms and the preventative treatment strategies.
交界性异位心动过速(JET)是一种与临床密切相关的心律失常,也是心脏重症监护领域永恒的克星。因此,我们在此提交一项文献计量学研究,以评估该主题的研究趋势。在剔除兽医相关论文后,我们对关键词 "交界性心动过速 "或 "交界性异位性心动过速 "进行了基于 Scopus 搜索的文献计量学分析,分析对象仅限于原创文章和综述。分析结果显示,生产率的地理分布主要集中在西方发达国家,心血管相关期刊对主题的接受度较高,JET相关论文的年产量有所增加。对 1967 年至 2024 年的 JET 论文进行的文献计量分析表明,人们对这一主题的兴趣与日俱增,并期待着对分子机制和预防性治疗策略有更深入的了解。
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引用次数: 0
Extracorporeal Membrane Oxygenation Nursing Care 体外膜氧护理
Pub Date : 2024-07-12 DOI: 10.25259/jccc_18_2024
Varsha Sharma, Mukesh Joshi
Extracorporeal membrane oxygenation (ECMO) is increasingly being used with adult patients in respiratory failure or cardiac failure. ECMO is a complex treatment that requires diligent nursing care with the knowledge and ability to identify complications of ECMO can potentially reduce morbidity and mortality in these high-risk patients. Nurses are integral to the multidisciplinary team caring for patients in the intensive care unit and are fundamental to successful outcomes. The increased complexity of caring for the patient supported by ECMO adds to the challenge for the nursing team. The bedside intensive care nurse is supported by ECMO specialist nurses in the delivery of care and monitoring of the ECMO patient. This cardiopulmonary support system uses an artificial membrane lung to move blood forward and replace carbon dioxide with oxygen in venous blood.
体外膜肺氧合(ECMO)越来越多地用于呼吸衰竭或心力衰竭的成年患者。ECMO 是一种复杂的治疗方法,需要勤奋的护理人员具备识别 ECMO 并发症的知识和能力,这样才有可能降低这些高危患者的发病率和死亡率。护士是在重症监护病房护理患者的多学科团队中不可或缺的一员,也是取得成功结果的基础。护理由 ECMO 支持的患者的复杂性增加了护理团队面临的挑战。床旁重症监护护士在 ECMO 专科护士的支持下,为 ECMO 患者提供护理和监测。这种心肺支持系统使用人工膜肺向前输送血液,并用静脉血中的氧气置换二氧化碳。
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引用次数: 0
Euglycemic Diabetic Ketoacidosis with SGLT2 Inhibitor Therapy in a Patient Undergoing Off-Pump Coronary Artery Bypass: A Case Report 一名接受体外循环冠状动脉搭桥术的患者在接受 SGLT2 抑制剂治疗后出现糖尿病酮症酸中毒:病例报告
Pub Date : 2024-06-07 DOI: 10.25259/jccc_73_2023
Rohini Mayur Balaji, Srikanth Bhumana, Saravanan Sundarraj, Aravind Kalyanasundaram
Sodium-glucose cotransporter inhibitors are a class of oral hypoglycemic agents that are being increasingly used in the subset of patients with cardiovascular disease. Euglycemic diabetic ketoacidosis (EDKA) is a potentially uncommon side effect associated with their use, which requires prompt recognition and management. The authors present a case of a 66-year-old diabetic male patient, treated with dapagliflozin, undergoing coronary artery bypass grafting, who developed EDKA in the postoperative period. The classical signs and symptoms were absent as the patient was sedated and was on ventilator support. Persistent high anion gap acidosis in the absence of hemodynamic instability prompted further testing, which revealed ketosis and ketonuria. Treatment with a dextrose-insulin solution and cessation of further doses of dapagliflozin leads to an uneventful recovery and discharge. A high index of suspicion is warranted, especially in the setting of cardiac surgery, for the diagnosis and management of this potentially catastrophic complication.
钠-葡萄糖共转运体抑制剂是一类口服降糖药,越来越多地用于心血管疾病患者。优格症糖尿病酮症酸中毒(EDKA)是与使用此类药物相关的一种潜在的罕见副作用,需要及时识别和处理。作者介绍了一例接受冠状动脉旁路移植术的 66 岁男性糖尿病患者的病例,患者使用达帕格列净治疗后,在术后出现了 EDKA。由于患者服用镇静剂并使用呼吸机支持,因此没有典型的症状和体征。在没有出现血流动力学不稳定的情况下,持续的高阴离子间隙酸中毒促使患者接受进一步检查,结果显示患者出现酮症和酮尿。使用葡萄糖-胰岛素溶液治疗并停止继续服用达帕格列净后,患者顺利康复出院。对于这种潜在的灾难性并发症的诊断和处理,需要高度怀疑,尤其是在心脏手术的情况下。
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引用次数: 0
Anna: The Dog Who Set the Ball Rolling for the Blue Baby Operation 安娜:为 "蓝色宝宝 "行动奠定基础的狗狗
Pub Date : 2024-04-24 DOI: 10.25259/jccc_3_2024
Doniparthi Pradeep, Jaydeep Malakar
The practice of cardiac surgery has been greatly influenced by numerous notable figures throughout history. However, animal experiments have also played a crucial role in understanding the anatomy and physiology necessary for successful surgical interventions in humans. This is the author’s meek effort to hark back to the contributions of a dog who paved the route for the blue baby operation.
心脏外科的实践受到历史上众多著名人物的极大影响。然而,动物实验在理解人类成功进行外科干预所需的解剖学和生理学方面也发挥了至关重要的作用。这本书是作者的绵薄之力,旨在回顾一只为蓝婴手术铺平道路的狗所做出的贡献。
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引用次数: 0
The Global Extracorporeal Life Support Organization Chapter: South West Asia and Africa Extracorporeal Life Support Organization in 2024 全球体外生命支持组织分会:2024 年的西南亚和非洲体外生命支持组织
Pub Date : 2024-04-15 DOI: 10.25259/jccc_12_2024
Christine Stead
In early 2024, we can take a moment to acknowledge the journey we have been on in critical care, especially in the region that comprises Extracorporeal Life Support Organizations (ELSO’s) South West Asia and Africa Continent (SWAAC) Chapter. ELSO has been able to develop a global standard in foundational educational knowledge for adults. This is only possible with the participation of experts in every region. The process for developing this standard has now been published. ELSO is using this same process to develop the foundational knowledge for neonatal and pediatric education. We are grateful to many in the SWAACELSO region for your assistance in the development of a global standard in education and training. The SWAACELSO region has achieved so much in the recent past. Participation in all facets of extracorporeal life support (ECLS) and ELSO globally continues to advance how we work together and what is available for patients in communities everywhere. This region will continue to help lead in creating resiliency and innovation in the coming years. Personally, I am grateful for the dedication and commitment to improving life support that this region continues to advance.
2024 年初,我们可以花一点时间回顾一下我们在重症监护领域所走过的历程,尤其是在体外生命支持组织(ELSO)西南亚和非洲大陆(SWAAC)分会所在的地区。ELSO 已经制定了成人基础教育知识的全球标准。这只有在各地区专家的参与下才能实现。该标准的制定过程现已公布。ELSO 正在使用同样的程序来开发新生儿和儿科教育的基础知识。我们非常感谢西南大西洋及加勒比海地区的许多人在制定全球教育和培训标准过程中提供的帮助。西南大西洋及邻近地区最近取得了许多成就。在全球范围内参与体外生命支持 (ECLS) 和 ELSO 的方方面面,将继续推动我们的合作,并为各地社区的患者提供更多服务。在未来几年里,本地区将继续在创造复原力和创新方面发挥带头作用。就我个人而言,我非常感谢本地区对改善生命支持的奉献和承诺。
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引用次数: 0
Prolonged Stay in ICU after Cardiac Surgery: Challenges –A Review 心脏手术后在重症监护室长期住院:挑战 - 综述
Pub Date : 2024-04-15 DOI: 10.25259/jccc_70_2023
Prajeesh M. Nambiar, Anmol Bhan, Y. Mehta
Prolonged stay in the intensive care unit (ICU) following cardiac surgery has become a topic of increasing concern in the medical community. While advancements in surgical techniques and perioperative care have improved the outcomes of cardiac surgeries, some patients still experience extended ICU stays due to various complications and comorbidities. This review article aims to explore the reasons behind prolonged ICU stays after cardiac surgery, their impact on patient outcomes, and the strategies and innovations that healthcare providers can employ to mitigate these challenges.
心脏手术后在重症监护室(ICU)长期住院已成为医学界日益关注的话题。虽然手术技术和围手术期护理的进步改善了心脏手术的疗效,但仍有一些患者因各种并发症和合并症而延长了重症监护室的住院时间。这篇综述文章旨在探讨心脏手术后重症监护室留院时间延长的原因、其对患者预后的影响以及医疗服务提供者可采用的策略和创新方法,以减轻这些挑战。
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引用次数: 0
Ethics in Extracorporeal Membrane Oxygenation and South West Asia and Africa Extracorporeal Life Support Organization: A Robust Growth with Ethics 体外膜氧合的伦理与西南亚和非洲体外生命支持组织:有道德的稳健发展
Pub Date : 2024-04-15 DOI: 10.25259/jccc_17_2024
Poonam Malhotra Kapoor
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引用次数: 0
期刊
Journal of Cardiac Critical Care TSS
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