Abstract:
OBJECTIVE:To assess the association between postoperative central venous oxygen saturation (ScvO(2)) and arterial lactate with outcome after cardiac surgery. DESIGN:Prospective observational study. SETTING:University-affiliated tertiary care hospital. PARTICIPANTS:Patients after coronary artery bypass and/or valve surgery. INTERVENTIONS:None. MEASUREMENTS AND MAIN RESULTS:Postoperative ScvO(2) and arterial lactate were obtained on arrival to the intensive care unit (ICU). ScvO(2) and lactate were drawn again at 8 and 24 hours, respectively, after ICU admission. Moderate global tissue hypoxia (GTH) was defined as ScvO(2) <70% and lactate ≥2 to <4 mmol/L, and severe GTH was defined as ScvO(2) <70% and lactate ≥4 mmol/L. Occult hypoperfusion was defined as moderate-to-severe GTH with mean arterial pressure ≥65 mmHg, central venous pressure ≥8 mmHg, and urine output ≥0.5 mL/kg/h. ScvO(2) on ICU admission negatively correlated with postoperative 24-hour lactate (p = 0.009), which was a strong predictor of time on mechanical ventilation, total complications, and ICU and hospital lengths of stay (p < 0.001 for all comparisons). On admission to the ICU, 19 patients (32%) exhibited occult hypoperfusion. Patients with severe GTH (n = 8) had longer ICU lengths of stay (p = 0.04) and a trend toward longer length of mechanical ventilation (p = 0.17) and number of complications per patient (p = 0.09) compared with those without GTH (n = 10). CONCLUSIONS:The incidence of GTH is high after cardiac surgery. Postoperative ScvO(2) and lactate may be valuable measurements to identify patients with occult hypoperfusion and subsequently guide hemodynamic optimization to positively affect postoperative outcomes in patients after cardiac surgery.
journal_name
J Cardiothorac Vasc Anesthjournal_title
Journal of cardiothoracic and vascular anesthesiaauthors
Hu BY,Laine GA,Wang S,Solis RTdoi
10.1053/j.jvca.2011.07.021subject
Has Abstractpub_date
2012-02-01 00:00:00pages
52-7issue
1eissn
1053-0770issn
1532-8422pii
S1053-0770(11)00541-6journal_volume
26pub_type
杂志文章abstract:OBJECTIVES:To determine whether individualized selection of double-lumen tubes or alternatives based on three-dimensional reconstruction of the tracheobronchial image from routine preoperative computed tomography (CT) scans leads to clinically appropriate choices. DESIGN:Prospective observational study; comparison to ...
journal_title:Journal of cardiothoracic and vascular anesthesia
pub_type: 杂志文章
doi:10.1016/s1053-0770(99)90003-4
更新日期:1999-10-01 00:00:00
abstract:OBJECTIVE:The actions of volatile anesthetics on left ventricular (LV) function in normal and failing hearts have been previously evaluated, but the effects of these agents on left atrial (LA) function in the presence of LV dysfunction are unknown. The hypothesis was tested that isoflurane alters LA mechanics evaluated...
journal_title:Journal of cardiothoracic and vascular anesthesia
pub_type: 杂志文章
doi:10.1053/j.jvca.2003.09.006
更新日期:2003-12-01 00:00:00
abstract:OBJECTIVES:Several substances may be released from ischemic tissues with the declamping shock that occurs during abdominal aortic aneurysm surgery. To clarify the relationship between tissue ischemia and venous endothelin-1 (ET-1) level in humans, plasma ET-1 and oxygen content in the iliac vein were measured before an...
journal_title:Journal of cardiothoracic and vascular anesthesia
pub_type: 杂志文章
doi:10.1016/s1053-0770(05)80132-6
更新日期:1995-10-01 00:00:00
abstract::In the UK, mortality rate during pregnancy/in the peripartal period is 14.1 per 100,000 maternities with heart disease being the leading cause of non-obstetric maternal mortality (10% to 15% of all maternal deaths). Owing to the advances in the treatment of congenital heart disease (CHD), an increasing percentage of w...
journal_title:Journal of cardiothoracic and vascular anesthesia
pub_type: 杂志文章,评审
doi:10.1053/j.jvca.2019.12.021
更新日期:2020-12-01 00:00:00
abstract::Survival of patients with congenital heart disease has significantly improved over the last 2 decades, confronting interventionalists, surgeons, anesthesiologists, cardiologists, and intensivists with often unfamiliar complex pathophysiology in the perioperative setting. Aside from cardiac catheterization, echocardiog...
journal_title:Journal of cardiothoracic and vascular anesthesia
pub_type: 杂志文章,评审
doi:10.1053/j.jvca.2019.11.036
更新日期:2020-05-01 00:00:00
abstract:OBJECTIVES:During cardiac surgery, circulating red blood cells (RBCs) are at risk of exposure to environmental factors during extracorporeal circulation and transfusion of stored RBCs. For this study, the authors observed morphological differences, deformability, density distribution, and erythrocyte indices of RBCs du...
journal_title:Journal of cardiothoracic and vascular anesthesia
pub_type: 杂志文章
doi:10.1053/j.jvca.2019.03.030
更新日期:2019-11-01 00:00:00
abstract:OBJECTIVES:To determine whether amrinone is bound to cardiopulmonary bypass circuits. When amrinone is administered to children during cardiopulmonary bypass, determine whether measured amrinone concentrations differ from those predicted based on a reported volume of distribution of 1.6 L/kg. DESIGN:In vitro study: Up...
journal_title:Journal of cardiothoracic and vascular anesthesia
pub_type: 杂志文章
doi:10.1016/s1053-0770(05)80321-0
更新日期:1995-06-01 00:00:00
abstract:OBJECTIVES:Intraoperative management directed to early extubation of children undergoing cardiac surgery has been suggested as a viable alternative to prolonged postoperative mechanical ventilation. The authors evaluated the safety and efficacy of this approach in a randomized prospective trial. DESIGN:A prospective r...
journal_title:Journal of cardiothoracic and vascular anesthesia
pub_type: 杂志文章,随机对照试验
doi:10.1053/j.jvca.2008.11.011
更新日期:2009-06-01 00:00:00
abstract:OBJECTIVE:To examine whether a thromboxane receptor antagonist, NT-126, or a thromboxane synthase inhibitor, OKY-046, prevents circulatory changes caused by protamine reversal of heparin and to evaluate the significance of thromboxane generation in the phenomena. DESIGN:Prospective, randomized, controlled, animal stud...
journal_title:Journal of cardiothoracic and vascular anesthesia
pub_type: 杂志文章
doi:10.1053/jcan.2000.18449
更新日期:2000-12-01 00:00:00
abstract:OBJECTIVE:The agreement between cardiac output measurements via pulmonary artery thermodilution (CO[PA]) and transpulmonary aortic thermodilution (CO[AT]) during one-lung ventilation was studied. DESIGN:Animal study with repeated simultaneous measurements comparing 2 cardiac output measurement techniques. SETTING:Exp...
journal_title:Journal of cardiothoracic and vascular anesthesia
pub_type: 杂志文章
doi:10.1053/j.jvca.2004.01.026
更新日期:2004-04-01 00:00:00
abstract::This study compared the use of high-frequency jet ventilation (HFJV) and tidal ventilation (TV) in a group of dogs with induced global myocardial ischemia before and after cardiopulmonary bypass. Transesophageal echocardiography was used to determine whether HFJV with its lower airway pressures could improve cardiac p...
journal_title:Journal of cardiothoracic and vascular anesthesia
pub_type: 杂志文章
doi:10.1016/1053-0770(91)90153-k
更新日期:1991-08-01 00:00:00
abstract:OBJECTIVE:To characterize the impact, on failure to rescue, of cerebrovascular accident as a first postoperative complication after thoracic endovascular aortic aneurysm repair (TEVAR). DESIGN:A retrospective cohort study using of National Surgical Quality Improvement Program Participants User File. SETTING:United St...
journal_title:Journal of cardiothoracic and vascular anesthesia
pub_type: 杂志文章
doi:10.1053/j.jvca.2020.11.061
更新日期:2020-12-02 00:00:00
abstract:OBJECTIVES:To determine the effect of the introduction of a specialty-specific progressive care unit (PCU) on the intensive care unit (ICU) to which relatively low-acuity patients had previously been admitted. DESIGN:Retrospective cohort study. SETTING:The thoracic (noncardiac) surgical ICU of a tertiary referral ins...
journal_title:Journal of cardiothoracic and vascular anesthesia
pub_type: 杂志文章
doi:10.1053/j.jvca.2007.12.015
更新日期:2008-06-01 00:00:00
abstract::Tricuspid regurgitation is a notable aspect of congestive heart failure and is linked with worse outcomes if untreated. Functional tricuspid regurgitation commonly is seen in patients with heart failure, particularly in patients presenting for surgical management, such as those for mechanical cardiac assist device imp...
journal_title:Journal of cardiothoracic and vascular anesthesia
pub_type: 杂志文章,评审
doi:10.1053/j.jvca.2020.06.022
更新日期:2020-06-12 00:00:00
abstract:OBJECTIVES:To determine the incidence of postoperative diaphragm dysfunction as diagnosed by ultrasonography. DESIGN:Explorative prospective observational study. SETTING:University intensive care unit. PARTICIPANTS:One hundred consecutive patients undergoing elective cardiac surgery. INTERVENTIONS:Diaphragm ultraso...
journal_title:Journal of cardiothoracic and vascular anesthesia
pub_type: 杂志文章
doi:10.1053/j.jvca.2020.06.038
更新日期:2020-12-01 00:00:00
abstract::Cardiopulmonary bypass (CPB) has been one of the most important additions to the field of heart surgery in the past century. However, significant morbidity associated with CPB has led to the increasing implementation of off-pump coronary artery bypass (OPCAB). The use of OPCAB has broadened surgical revascularization ...
journal_title:Journal of cardiothoracic and vascular anesthesia
pub_type: 杂志文章,评审
doi:10.1053/j.jvca.2019.05.005
更新日期:2020-01-01 00:00:00
abstract:OBJECTIVES:To understand whether different anesthesia and analgesia methods affected the incidence of chronic postsurgical pain (CPSP) in patients who underwent uniportal video-assisted lung surgery and to explore the influence factors of CPSP. DESIGN:Retrospective study. SETTING AND PARTICIPANTS:A total of 120 patie...
journal_title:Journal of cardiothoracic and vascular anesthesia
pub_type: 杂志文章
doi:10.1053/j.jvca.2019.10.046
更新日期:2020-04-01 00:00:00
abstract:OBJECTIVE:The authors compared thoracic epidural with ON-Q infiltrating catheters in patients having open thoracotomy to determine whether one method better relieves postoperative pain and would allow earlier discharge from the hospital and, hence, cost savings. DESIGN:Retrospective chart review. SETTING:University h...
journal_title:Journal of cardiothoracic and vascular anesthesia
pub_type: 杂志文章
doi:10.1053/j.jvca.2013.02.017
更新日期:2013-06-01 00:00:00
abstract::This study investigated whether the prophylactic administration of methylprednisolone sodium succinate (MPSS) could prevent an increase in plasma endotoxin levels during cardiac surgery with cardiopulmonary bypass. MPSS (1 g/patient) or saline was given intravenously with induction in the steroid (n = 6) and control (...
journal_title:Journal of cardiothoracic and vascular anesthesia
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1016/1053-0770(93)90113-y
更新日期:1993-02-01 00:00:00
abstract:OBJECTIVE:To assess the value of gastric intramucosal pH measurement in patients with low output after cardiac surgery. DESIGN:Prospective clinical study. SETTING:University hospital. PARTICIPANTS:Fifteen patients with low output after cardiac surgery were included. Those who survived the first postoperative day (n ...
journal_title:Journal of cardiothoracic and vascular anesthesia
pub_type: 杂志文章
doi:10.1016/s1053-0770(97)90211-1
更新日期:1997-04-01 00:00:00
abstract::Left ventricular assist devices (LVADs) have been used as an effective therapeutic option in patients with advanced heart failure, either as a bridge to transplantation or, in some patients, as a bridge to recovery. LVAD withdrawal with ventricular recovery represents the optimal outcome for patients previously implan...
journal_title:Journal of cardiothoracic and vascular anesthesia
pub_type: 杂志文章
doi:10.1053/j.jvca.2020.12.043
更新日期:2021-01-05 00:00:00
abstract::SEPSIS REMAINS one of the most common causes of childhood morbidity, mortality, and higher healthcare costs, with over 75,000 hospital admissions in the United States and an estimated 4 million cases worldwide per year. While standardized criteria to define sepsis are in flux, the general concept of sepsis is a severe...
journal_title:Journal of cardiothoracic and vascular anesthesia
pub_type: 杂志文章,评审
doi:10.1053/j.jvca.2019.10.029
更新日期:2020-05-01 00:00:00
abstract::Pulmonary thromboendarterectomy (PTE) remains the only curative surgery for patients with chronic thromboembolic pulmonary hypertension (CTEPH). Postoperative intensive care unit care challenges providers with unique disease physiology, operative sequelae, and the potential for detrimental complications. Central conce...
journal_title:Journal of cardiothoracic and vascular anesthesia
pub_type: 杂志文章,评审
doi:10.1053/j.jvca.2019.03.005
更新日期:2019-11-01 00:00:00
abstract::The incidence of primary cardiac tumors is very rare (0.02%) with the majority being benign. Angiosarcoma is the most common malignant cardiac tumor. However, regardless of the histological nature of cardiac tumors, they can cause life-threatening mechanical obstruction. We present a case of urgent surgical removal of...
journal_title:Journal of cardiothoracic and vascular anesthesia
pub_type: 杂志文章
doi:10.1053/j.jvca.2018.12.018
更新日期:2019-07-01 00:00:00
abstract:OBJECTIVE:To assess whether or not a positive fluid balance masks acute kidney injury (AKI) and is associated with adverse outcomes after cardiac surgery. DESIGN:Retrospective analysis. SETTING:Tertiary university-affiliated metropolitan hospital: single center. PARTICIPANTS:Three thousand two hundred seven consecut...
journal_title:Journal of cardiothoracic and vascular anesthesia
pub_type: 杂志文章
doi:10.1053/j.jvca.2015.02.004
更新日期:2015-10-01 00:00:00
abstract:OBJECTIVE:The goal of the study was to investigate the role time of day plays in perioperative outcomes. The authors examined intraoperative transfusion rates throughout the day in adult cardiac surgery patients. They hypothesized that the rate of transfusion changes with later case start times in scheduled cardiac sur...
journal_title:Journal of cardiothoracic and vascular anesthesia
pub_type: 杂志文章
doi:10.1053/j.jvca.2019.10.044
更新日期:2020-03-01 00:00:00
abstract:OBJECTIVE:Intraoperative monitoring of myogenic motor evoked potentials to transcranial electrical stimulation (tc MEPs) is a new method to assess the integrity of the motor pathways. The authors studied the effects of 50% nitrous oxide (N2O) and a low-dose propofol infusion on tc MEPs paired electrical stimulation dur...
journal_title:Journal of cardiothoracic and vascular anesthesia
pub_type: 杂志文章
doi:10.1016/s1053-0770(99)90169-6
更新日期:1999-02-01 00:00:00
abstract:OBJECTIVES:To characterize existing practice patterns for intraoperative evaluation and grading of diastolic dysfunction in patients undergoing cardiac surgery. DESIGN:A 14-question, multiple-choice survey of current practice for patients with diastolic dysfunction and the use of intraoperative transesophageal echocar...
journal_title:Journal of cardiothoracic and vascular anesthesia
pub_type: 杂志文章
doi:10.1053/j.jvca.2015.11.002
更新日期:2016-04-01 00:00:00
abstract:OBJECTIVE:Two types of material are used to manufacture double-lumen endobronchial tubes (DLTs): Polyvinylchloride (PVC) and silicon. PVC DLTs (Broncho-Cath) and silicon DLTs (Silbroncho) not only differ in material, but also subtly differ in structure. The goal of this study was to determine whether the incidences of ...
journal_title:Journal of cardiothoracic and vascular anesthesia
pub_type: 杂志文章,随机对照试验
doi:10.1053/j.jvca.2014.05.028
更新日期:2015-02-01 00:00:00
abstract:OBJECTIVES:Transesophageal echocardiography (TEE) is a valuable procedure for assessing left ventricular (LV) function, but it has not been widely applied in critical care because of the limited number of intensivists who are trained in echocardiography. This prospective study was designed to evaluate the feasibility o...
journal_title:Journal of cardiothoracic and vascular anesthesia
pub_type: 杂志文章
doi:10.1016/s1053-0770(98)90048-9
更新日期:1998-02-01 00:00:00