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Year in Review 2022: Noteworthy Literature in Cardiothoracic Critical Care. 2022年回顾:心胸危重症值得注意的文献。
IF 1.4 Q3 ANESTHESIOLOGY Pub Date : 2023-06-01 DOI: 10.1177/10892532231176854
Sarah Alber, Kenji Tanabe, Hans Tregear, Andrew Hennigan, Samuel Gilliland

The past year in critical care medicine was notable for ongoing sequelae of the COVID-19 pandemic, including nationwide shortages and critical care demand in many regions in excess of usual operating capacity. Despite these challenges, evidence-based medicine and investigations into the optimal management of the critically ill continued to be at the forefront. This article is a collection of studies published in 2022 which are specifically relevant to cardiothoracic critical care. These noteworthy publications add to the existing literature across a broad spectrum of topics, from optimal timing of mechanical circulatory support (MCS), delirium prevention, updates in nutrition guidelines, alternative defibrillation techniques, novel ventilator management, and observing the downstream psychological impact of extracorporeal membrane oxygenation (ECMO) therapy.

在过去的一年里,重症监护医学因COVID-19大流行的后遗症而备受关注,包括全国范围内的短缺和许多地区的重症监护需求超过了通常的运营能力。尽管面临这些挑战,循证医学和对危重病人最佳管理的调查仍然处于最前沿。本文收集了2022年发表的与心胸危重症特别相关的研究。这些值得注意的出版物增加了现有文献的广泛主题,从机械循环支持(MCS)的最佳时机,谵妄预防,营养指南的更新,替代除颤技术,新型呼吸机管理,以及观察体外膜氧合(ECMO)治疗的下游心理影响。
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引用次数: 2
Length of Hospital Stay as a Performance Metric-Is That a Fair Assessment? 住院时间作为绩效指标——这是一个公平的评估吗?
IF 1.4 Q3 ANESTHESIOLOGY Pub Date : 2023-03-01 DOI: 10.1177/10892532231159723
Siddharth Pahwa, Miklos D Kertai, Benjamin Abrams, Jiapeng Huang
In a healthcare sector that is constantly evolving, quality improvement has become one of the main areas of focus. Often tough to measure, the three pillars of quality improvement—structure, process, and outcome—provide the cornerstone on which advances in quality can be achieved. Length of stay (LOS) is one such often talked about outcome metric. It is desirable to have shorter lengths of stay since a longer LOS would generally indicate less efficient care and possibly higher complication rate and would in turn be less economical to the healthcare system. However, the relationship between the best possible care and LOS is seldom straightforward. This current issue of Seminars in Cardiothoracic and Vascular Anesthesia (SCVA) delves a bit into the strategies to predict and reduce hospital LOS. Two original research articles discuss predictive variables and therapeutic interventions to reduce hospital LOS, respectively. This is followed by two review articles to analyze the prevention and management of neurocognitive disorders after cardiac surgery and the management of perioperative diastolic dysfunction. A comprehensive review discusses biventricular repair from the perspective of the congenital cardiac anesthesiologist. The issue is rounded off by two interesting case reports that discuss challenging perioperative hemodynamic situations in thoracic surgery. In our firstOriginal Research article, Wang and colleagues analyzed the role of perioperative serum albumin and the albumin–bilirubin (ALBI) grade in predicting post-liver transplant LOS. In a single-institution study, they looked at 663 liver transplant recipients and concluded that a higher pre-operative serum albumin level was associated with a shorter hospital LOS. They also concluded that a lower ALBI grade, which is possibly a marker of greater hepatic synthetic activity, was associated with shorter hospital and intensive care unit (ICU) LOS in patients with a low Model for End Stage Liver Disease–sodium (MELD-Na) score. However, there was no difference in operative mortality across the ALBI grades. Higher MELD-Na scores are known to be associated with worse postoperative outcomes and would alert clinicians to the possibility of longer hospital and ICU LOS. The ability to risk stratify patients that are otherwise “low risk”with lowerMELD-Na scores based on ALBI grade makes this paper pertinent and may pave the way for future trials to investigate the role of ALBI in this subset of patients. Minimally invasive valve surgery has continued to evolve and can now be performed safely with shorter ICU and hospital LOS, while keeping the quality of the operation similar to that performed through a full sternotomy. Postoperative pain has been one of the barriers to a faster recovery and earlier discharge following minimally invasive valve surgery, and this may be because of extensive rib retraction and division of intercostal muscles associated with the surgical procedure. In the second Original
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引用次数: 0
A Retrospective Study of the Role of Perioperative Serum Albumin and the Albumin-Bilirubin Grade in Predicting Post-Liver Transplant Length of Stay. 围手术期血清白蛋白及白蛋白-胆红素分级预测肝移植术后住院时间的回顾性研究。
IF 1.4 Q3 ANESTHESIOLOGY Pub Date : 2023-03-01 DOI: 10.1177/10892532221141138
Ryan Wang, Daniel Katz, Hung-Mo Lin, Yuxia Ouyang, Jonathan Gal, Sumanth Suresh, Ismail Labgaa, Parissa Tabrizian, Samuel Demaria, Jeron Zerillo, Natalie K Smith

Introduction: Serum albumin's association with liver transplant outcomes has been investigated with mixed findings. This study aimed to evaluate perioperative albumin level, independently and as part of the albumin-bilirubin (ALBI) grade, as a predictor of post-liver transplant hospital and intensive care unit (ICU) length of stay (LOS).

Methods: Adult liver-only transplant recipients at our institution from September 2011 to May 2019 were included in this retrospective study. Repeat transplants were excluded. Demographic, laboratory, and hospital course data were extracted from an institutional data warehouse. Negative binomial regression was used to assess the association of LOS with ALBI grade, age, BMI, ASA score, Elixhauser comorbidity index, MELD-Na, warm ischemia time, units of platelets and cryoprecipitate transfused, and preoperative serum albumin.

Results: Six hundred and sixty-three liver transplant recipients met inclusion criteria. The median preoperative serum albumin was 3.1 [2.6-3.6] g/dL. The median postoperative ICU and hospital LOS were 3.8 [2.4-6.8] and 12 [8-20] days, respectively. Preoperative serum albumin predicted hospital but not ICU LOS (ratio .9 [95% confidence interval (CI) .84-.99], P = .03, hospital LOS vs ratio .92 [95% CI 0.84-1.02], P = .10, ICU LOS). For patients with MELD-Na ≤ 20, ALBI grade-3 predicted longer hospital and ICU LOS (ratio 1.40 [95% CI 1.18-1.66], P < .001, hospital LOS vs ratio 1.62 [95% CI 1.32-1.99], P < .001, ICU LOS). These associations were not significant for patients with MELD-Na > 20.

Conclusions: Serum albumin predicted post-liver transplant hospital LOS. ALBI grade-3 predicted increased hospital and ICU LOS in low MELD-Na recipients.

简介:血清白蛋白与肝移植结果的关系已被研究,结果好坏参半。本研究旨在评估围手术期白蛋白水平,作为白蛋白-胆红素(ALBI)分级的一部分,作为肝移植后住院和重症监护病房(ICU)住院时间(LOS)的预测因子。方法:回顾性研究纳入2011年9月至2019年5月在我院接受成人单肝移植的患者。排除重复移植。从机构数据仓库中提取人口统计、实验室和医院病程数据。采用负二项回归评估LOS与ALBI分级、年龄、BMI、ASA评分、Elixhauser合病指数、MELD-Na、热缺血时间、输血小板和冷沉淀单位、术前血清白蛋白的关系。结果:663例肝移植受者符合纳入标准。术前血清白蛋白中位数为3.1 [2.6-3.6]g/dL。术后ICU和医院LOS中位数分别为3.8[2.4-6.8]天和12[8-20]天。术前血清白蛋白预测医院,但不能预测ICU的LOS(比值为0.9)(95%可信区间(CI)为0.84)。[99], P = .03,医院LOS vs .92 [95% CI 0.84-1.02], P = .10, ICU LOS)。对于MELD-Na≤20的患者,ALBI 3级预测更长的住院和ICU LOS(比值1.40 [95% CI 1.18-1.66], P < .001,医院LOS vs比值1.62 [95% CI 1.32-1.99], P < .001, ICU LOS)。对于MELD-Na > 20的患者,这些关联不显著。结论:血清白蛋白预测肝移植术后医院LOS。ALBI 3级预测低MELD-Na受者的医院和ICU LOS增加。
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引用次数: 4
Thoracic Interfascial Plane Blocks and Outcomes After Minithoracotomy for Valve Surgery. 小开胸主动脉瓣手术后胸筋膜间平面阻滞及预后。
IF 1.4 Q3 ANESTHESIOLOGY Pub Date : 2023-03-01 DOI: 10.1177/10892532221136386
Sreekanth R Cheruku, Amanda A Fox, Hooman Heravi, Neelan Doolabh, Jennifer Davis, Jenny He, Christopher Deonarine, Lauren Bereuter, Joan Reisch, Farzin Ahmed, Lisa Skariah, Anthony Machi

Introduction. Thoracic interfascial plane blocks are increasingly used for pain management after minimally invasive thoracotomy for valve repair and replacement procedures. We hypothesized that the addition of these blocks to the intercostal nerve block injected by the surgeon would further reduce pain scores and opioid utilization. Methods. In this retrospective cohort study, 400 consecutive patients who underwent minimally invasive thoracotomy for mitral or aortic valve replacement and were extubated within 2 hours of surgery were enrolled. The maximum pain score and opioid utilization on the day of surgery and other outcome variables were compared between patients who received interfascial plane blocks and those who did not. Results.193 (48%) received at least one interfascial plane block while 207 (52%) received no interfascial plane block. Patients who received a thoracic interfascial plane block had a maximum VAS score on the day of surgery (mean 7.4 ± 2.5) after the block was administered which was significantly lower than patients in the control group who did not receive the block (mean 7.9 ± 2.2) (P = .02). Opioid consumption in the interfascial plane block group on the day of surgery was not significantly different from the control group. Conclusion. Compared to intercostal blocks alone, the addition of thoracic interfascial plane blocks was associated with a modest reduction in maximum VAS score on the day of surgery. However, no difference in opioid consumption was noted. Patients who received interfascial plane blocks also had decreased blood transfusion requirements and a shorter hospital length of stay.

介绍。胸间膜平面阻滞越来越多地用于微创开胸手术后的疼痛管理。我们假设在外科医生注射的肋间神经阻滞的基础上增加这些阻滞会进一步降低疼痛评分和阿片类药物的使用。方法。在这项回顾性队列研究中,400名连续接受微创开胸二尖瓣或主动脉瓣置换术并在手术后2小时内拔管的患者入组。比较接受筋膜间平面阻滞和未接受筋膜间平面阻滞的患者在手术当天的最大疼痛评分和阿片类药物使用以及其他结果变量。结果:193例(48%)接受了至少一次筋膜间面阻滞,207例(52%)未接受筋膜间面阻滞。接受胸筋膜间平面阻滞的患者在阻滞后手术当日VAS评分最高(平均7.4±2.5),显著低于未接受阻滞的对照组患者(平均7.9±2.2)(P = 0.02)。筋膜间平面阻滞组手术当日阿片类药物消耗与对照组无显著差异。结论。与单独的肋间阻滞相比,增加胸筋膜间平面阻滞与手术当天最大VAS评分的适度降低有关。然而,没有注意到阿片类药物消费的差异。接受筋膜间平面阻滞的患者输血需求减少,住院时间缩短。
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引用次数: 2
Perioperative Neurocognitive Disorders in Adults Requiring Cardiac Surgery: Screening, Prevention, and Management. 需要心脏手术的成人围手术期神经认知障碍:筛查、预防和管理。
IF 1.4 Q3 ANESTHESIOLOGY Pub Date : 2023-03-01 DOI: 10.1177/10892532221127812
Kimberly F Rengel, Christina S Boncyk, Daniella DiNizo, Christopher G Hughes

Neurocognitive changes are the most common complication after cardiac surgery, ranging from acute postoperative delirium to prolonged postoperative neurocognitive disorder. Changes in cognition are distressing to patients and families and associated with worse outcomes overall. This review outlines definitions and diagnostic criteria, risk factors for, and mechanisms of Perioperative Neurocognitive Disorders and offers strategies for preoperative screening and perioperative prevention and management of neurocognitive complications.

神经认知改变是心脏手术后最常见的并发症,从急性术后谵妄到术后延长的神经认知障碍。认知的改变对患者和家属来说是痛苦的,并且总体上与更糟糕的结果有关。本文概述了围手术期神经认知障碍的定义、诊断标准、危险因素和机制,并提出了围手术期神经认知并发症的术前筛查和预防及处理策略。
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引用次数: 4
Airway and Hemodynamic Considerations for the Anesthetic Management of an Intraluminal Tracheal Plasmacytoma. 腔内气管浆细胞瘤麻醉处理的气道和血流动力学考虑。
IF 1.4 Q3 ANESTHESIOLOGY Pub Date : 2023-03-01 DOI: 10.1177/10892532221140235
Joseph E Morabito, Colby G Simmons, Giorgio Zanotti, John D Mitchell, Karsten Bartels, Barbara J Wilkey

Central airway obstruction due to tracheal tumors presents unique challenges to the anesthesiologist. We present the case of a 44-year-old male taken to the OR for biopsy and resection of an undiagnosed tracheal mass. Intraoperative management was complicated by bleeding and significant hemodynamic instability, necessitating rapid surgical and anesthetic intervention. This ultimately led to abortion of surgical resection. Pathologic examination revealed a primary tracheal plasmacytoma, a rare type of tracheal tumor. Here, we describe anesthetic and hemodynamic considerations for a tracheal plasmacytoma. We discuss the approach to airway management in variable intrathoracic tracheal obstruction and the unpredictability of tracheal tumors.

由于气管肿瘤引起的中央气道阻塞对麻醉师提出了独特的挑战。我们提出的情况下,44岁的男性采取或活检和切除一个未确诊的气管肿块。术中处理因出血和明显的血流动力学不稳定而复杂化,需要快速手术和麻醉干预。这最终导致手术切除流产。病理检查发现原发性气管浆细胞瘤,一种罕见的气管肿瘤。在这里,我们描述麻醉和血流动力学考虑气管浆细胞瘤。我们讨论了可变胸内气管阻塞和气管肿瘤的不可预测性的气道管理方法。
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引用次数: 1
Perioperative Circulatory Support and Management for Lung Transplantation: A Case-Based Review. 肺移植围手术期循环支持和管理:一项基于病例的回顾。
IF 1.4 Q3 ANESTHESIOLOGY Pub Date : 2023-03-01 DOI: 10.1177/10892532221134574
Hong Liang, Ashley V Fritz, Archer K Martin

Lung transplantation (LTx) historically was performed with cardiopulmonary bypass (CPB) or Off-pump. Recent data suggest an increased interest in extracorporeal membrane oxygenation (ECMO) as perioperative circulatory support by many lung transplantation centers worldwide. However, there are no established guidelines for anesthetic management for LTx. We present a patient with a history of systemic sclerosis and interstitial lung disease complicated by acute onset of systemic pulmonary hypertension and right heart failure undergoing LTx. We aim to discuss perioperative circulatory support, including ECMO bridge to LTx, and how best to consider the varied intraoperative strategies of CPB vs ECMO vs off-pump during LTx, intraoperative maintenance, and coagulation management.

肺移植(LTx)历来是在体外循环(CPB)或无泵手术的情况下进行的。最近的数据表明,全球许多肺移植中心对体外膜氧合(ECMO)作为围手术期循环支持的兴趣越来越大。然而,对于LTx的麻醉管理尚无既定的指导方针。我们报告了一位有系统性硬化症和间质性肺疾病病史,并发急性全身性肺动脉高压和右心衰的患者,正在接受LTx手术。我们的目的是讨论围手术期的循环支持,包括ECMO到LTx的桥接,以及在LTx期间如何最好地考虑CPB、ECMO和停泵的各种术中策略,术中维护和凝血管理。
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引用次数: 1
Managing Diastolic Dysfunction Perioperatively. 围手术期舒张功能不全的处理。
IF 1.4 Q3 ANESTHESIOLOGY Pub Date : 2023-03-01 DOI: 10.1177/10892532221142441
Theodore J Cios, John C Klick, S Michael Roberts

Preoperative cardiac evaluation is a cornerstone of the practice of anesthesiology. This consists of a thorough history and physical attempting to elucidate signs and symptoms of heart failure, angina or anginal equivalents, and valvular heart disease. Current guidelines rarely recommend preoperative echocardiography in the setting of an adequate functional capacity. Many patients may have poor functional capacity and/or have medical history such that echocardiographic data is available for review. Much focus is often placed on evaluating major valvular abnormalities and systolic function as measured by ejection fraction, but a key impactful component is often overlooked-diastolic function. A diagnosis of diastolic heart failure is an independent predictor of mortality and is not uncommon in patients with normal systolic function. This narrative review addresses the clinical relevance and management of diastolic dysfunction in the perioperative setting.

术前心脏评估是麻醉学实践的基石。这包括详细的病史和体格检查,以阐明心衰、心绞痛或类似心绞痛和瓣膜性心脏病的体征和症状。目前的指南很少推荐术前超声心动图在足够的功能容量设置。许多患者可能功能能力差和/或有病史,因此超声心动图数据可用于审查。许多焦点通常放在评估主要的瓣膜异常和通过射血分数测量的收缩功能上,但一个关键的影响因素往往被忽视——舒张功能。舒张性心力衰竭的诊断是死亡率的独立预测因子,在收缩期功能正常的患者中并不罕见。本文综述了围手术期舒张功能障碍的临床意义和处理。
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引用次数: 1
A Review of Biventricular Repair for the Congenital Cardiac Anesthesiologist. 先天性心脏麻醉师双心室修复术综述。
IF 1.4 Q3 ANESTHESIOLOGY Pub Date : 2023-03-01 DOI: 10.1177/10892532221143880
Sean J Davies, James A DiNardo, Sitaram M Emani, Morgan L Brown

The management of children with a borderline ventricle has been debated for many years. The pursuit of a biventricular repair in these children aims to avoid the long-term sequelae of single ventricle palliation. There is a lack of anesthesia literature relating to the care of this complex heterogenous patient population. Anesthesiologists caring for these patients should have an understanding on the many different forms of physiology and the impact on provision of anesthesia and hemodynamic parameters, the goals of biventricular staging and completion as well as the pre-operative, intra-operative, and post-operative considerations relating to this high-risk group of patients.

儿童边缘性脑室的治疗已经争论多年。对这些儿童进行双心室修复的目的是避免单心室姑息的长期后遗症。缺乏麻醉文献有关护理这一复杂的异质患者群体。护理这些患者的麻醉师应该了解许多不同形式的生理学,对麻醉和血流动力学参数提供的影响,双心室分期和完成的目标,以及与这一高危患者群体相关的术前、术中和术后注意事项。
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引用次数: 1
Challenging Paradigms and Trusting Evidence: New Approaches to Perioperative Care. 挑战范式和信任证据:围手术期护理的新方法。
IF 1.4 Q3 ANESTHESIOLOGY Pub Date : 2022-12-01 DOI: 10.1177/10892532221138170
Meghan Prin, Nathan Clendenen, Hillary Lum, Miklos D Kertai, Benjamin A Abrams
the novel perspectives on the complexities of clinical perioperative care are impera-tive. This issue of Seminars in Cardiothoracic and Vascular Anesthesia (SCVA) emphasizes this ethos. Two original research studies evaluate methods to reduce the quantity of anesthetic and opioid medications needed for surgery, and a comprehensive two-part review evaluates the evidence for “ prehabilitation ” before cardiac surgery. This issue is rounded out by two systematic reviews on the use of TEE in liver transplantation, and two case reports describing the challenging management of intracardiac masses. This literature will guide readers towards a more patient-centered approach with less dependence on polypharmacy and, hopefully, optimize outcomes for cardiac surgery. This approach is all the more relevant as the population ages; surgical populations are aging faster than the general population and phrases like “ potentially inappropriate medications ” and “ deprescribing ” entered the perioperative lexicon. we the the are visible on the horizon and the of famed to The you know, the less you
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引用次数: 0
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Seminars in Cardiothoracic and Vascular Anesthesia
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