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 of training intensivists to perform a goal-directed, limited-scope TEE to assess LV function in critically ill patients using a pediatric monoplane TEE probe. A secondary goal was to compare the usefulness of the TEE data with that of data obtained by a simultaneous pulmonary artery catheter (PAC). DESIGN:Prospective, blinded. SETTING:University teaching hospital. PARTICIPANTS:One hundred consecutive, intubated, intensive care unit patients. INTERVENTIONS:Five surgical intensivists with no previous background in echocardiography were trained under the supervision of two cardiologists to perform limited-scope TEE using a monoplane pediatric probe. One intensivist (A) reviewed the PAC data and recorded a diagnostic impression and therapeutic plan. A second intensivist (B), blinded to the PAC data, then performed TEE to determine cardiac volume, LV wall thickness, and LV global and regional wall motion. Intensivists A and B reviewed the data from both PAC and TEE, and intensivist A then formulated a new diagnosis and therapeutic plan. MEASUREMENTS AND MAIN RESULTS:Intensivists performed 48 TEE examinations under direct supervision of a cardiologist, and 52 without supervision, but reviewed poststudy. The average duration of TEE was 12 +/- 7 minutes. The intensivists' interpretations of TEE data were deemed correct in 93% of cases for LV wall thickness, 87% for intracardiac volume status, 81% for regional LV wall motion abnormalities, and 77% for global LV function. When the TEE and PAC technologies were compared, it was found that the TEE data disagreed with the PAC evaluation of intracardiac volume in 55% of cases and with the PAC assessment of myocardial function in 39% of cases. The post-PAC therapeutic recommendations were different from the post-TEE therapeutic recommendations in 58% of patients. CONCLUSIONS:Training intensivists in limited-scope, goal-directed TEE, using a pediatric monoplane probe to evaluate LV function, can be done rapidly and safely, and yield data pertinent to management of critically ill patients even in the early stages of skill acquisition.
journal_name
J Cardiothorac Vasc Anesthjournal_title
Journal of cardiothoracic and vascular anesthesiaauthors
Benjamin E,Griffin K,Leibowitz AB,Manasia A,Oropello JM,Geffroy V,DelGiudice R,Hufanda J,Rosen S,Goldman Mdoi
10.1016/s1053-0770(98)90048-9subject
Has Abstractpub_date
1998-02-01 00:00:00pages
10-5issue
1eissn
1053-0770issn
1532-8422pii
S1053-0770(98)90048-9journal_volume
12pub_type
杂志文章abstract:OBJECTIVES:The present study assessed the safety and efficacy of continuous venovenous hemodialysis (CVVHD) early after cardiac surgery. DESIGN:Retrospective database and medical record review. SETTING:University teaching hospital. PARTICIPANTS:Forty-five dialysis-dependent patients who underwent cardiac surgery wit...
journal_title:Journal of cardiothoracic and vascular anesthesia
pub_type: 杂志文章
doi:10.1053/j.jvca.2006.02.003
更新日期:2007-06-01 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::A pulmonary artery catheter (PAC) capable of continuous cardiac output (CCO) determination by thermodilution has recently been introduced. The purpose of this study was to compare CCO with two other methods of cardiac output (Ot) determination: electromagnetometry (EM) and standard bolus thermodilution cardiac output ...
journal_title:Journal of cardiothoracic and vascular anesthesia
pub_type: 杂志文章
doi:10.1016/1053-0770(94)90193-7
更新日期:1994-12-01 00:00:00
abstract:OBJECTIVE:To determine whether access to reimbursement increases anesthesiologists' use of intraoperative transesophageal echocardiography (TEE). DESIGN:Survey. SETTING:United States. PARTICIPANTS:Members of the Society of Cardiovascular Anesthesiologists, local Medicare carriers. INTERVENTIONS:None. MEASUREMENTS ...
journal_title:Journal of cardiothoracic and vascular anesthesia
pub_type: 杂志文章
doi:10.1053/jcan.2002.124137
更新日期:2002-06-01 00:00:00
abstract:OBJECTIVE:Postcardiopulmonary bypass hemorrhage remains a serious complication of cardiac surgery. Given concerns regarding adverse effects of blood product transfusion and limited efficacy of current antifibrinolytics, procoagulant medications, including recombinant factor VIIa (rFVIIa) and factor eight inhibitor bypa...
journal_title:Journal of cardiothoracic and vascular anesthesia
pub_type: 杂志文章
doi:10.1053/j.jvca.2014.04.015
更新日期:2014-10-01 00:00:00
abstract:OBJECTIVE:It was hypothesized that methylene blue could neutralize heparin in patients after cardiopulmonary bypass and become an alternative to protamine. DESIGN:This was a prospective unblinded study with patients serving as their own controls. SETTING PARTICIPANTS: A single, large university hospital. This study wa...
journal_title:Journal of cardiothoracic and vascular anesthesia
pub_type: 杂志文章
doi:10.1016/s1053-0770(05)80007-2
更新日期:1996-06-01 00:00:00
abstract:OBJECTIVE:Regional analgesia continues to evolve with the introduction of ultrasound-guided fascial plane blocks. Erector spinae plane block (ESPB) is a novel technique gaining recent acceptability as a perioperative modality of analgesia in various thoracic and abdominal surgeries. However, literature on the use of ES...
journal_title:Journal of cardiothoracic and vascular anesthesia
pub_type: 杂志文章
doi:10.1053/j.jvca.2019.08.009
更新日期:2020-04-01 00:00:00
abstract::The development of echocardiography was driven, in part, by a need to diagnose mitral regurgitation in patients undergoing finger fracture commissurotomy in the 1950s. Decades later, color Doppler became the cornerstone for noninvasive evaluation of mitral regurgitation. The authors present 2 cases of calcific mitral ...
journal_title:Journal of cardiothoracic and vascular anesthesia
pub_type: 杂志文章
doi:10.1053/j.jvca.2019.08.018
更新日期:2020-01-01 00:00:00
abstract::Middle aortic syndrome (MAS) is a rare vascular disease occurring in pediatric patients. MAS describes narrowing of the abdominal aorta, often referred to as abdominal coarctation. Extra-aortic vessels are commonly involved, including the renal and mesenteric arteries. Pediatric patients with MAS frequently present wi...
journal_title:Journal of cardiothoracic and vascular anesthesia
pub_type: 杂志文章,评审
doi:10.1053/j.jvca.2019.07.130
更新日期:2020-04-01 00:00:00
abstract::The recurrent or new trends of early extubation after cardiac surgery are here to stay in the 1990s. The preoperative status does not necessarily predict the postoperative course and prolonged mechanical ventilation following cardiac surgery should not be uncritically considered as routine. All patients should be asse...
journal_title:Journal of cardiothoracic and vascular anesthesia
pub_type: 杂志文章,评审
doi:10.1016/s1053-0770(05)80105-3
更新日期:1995-08-01 00:00:00
abstract::A case of MR progression after single-lung transplant as a significant contributor to postoperative respiratory failure is reported. Pre-existing MR may progress due to the decompressive effects of lung transplantation on RV dimension and consequent alteration of MV geometry. This case highlights the importance of int...
journal_title:Journal of cardiothoracic and vascular anesthesia
pub_type: 杂志文章
doi:10.1053/j.jvca.2014.06.017
更新日期:2014-12-01 00:00:00
abstract::Although a wide variety of positive inotropic agents have been administered to cardiac surgery patients, few of them have been carefully studied in controlled clinical trials, in surgical patient populations. The limited data available suggest that one of the more widely used agents, calcium, may lack efficacy and pos...
journal_title:Journal of cardiothoracic and vascular anesthesia
pub_type: 杂志文章,评审
doi:10.1016/1053-0770(93)90094-2
更新日期:1993-08-01 00:00:00
abstract:OBJECTIVES:To implement a statistical model for protamine titration. DESIGN:Prospective randomized trial. SETTING:University hospital. PARTICIPANTS:Sixty (n = 30+30) patients scheduled for elective coronary artery bypass surgery were randomly assigned to 2 groups. INTERVENTIONS:Protamine dose calculated according t...
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.2016.07.018
更新日期:2017-04-01 00:00:00
abstract::Since DeBakey's replacement of an aortic arch aneurysm using cardiopulmonary bypass and individual perfusion of the brachiocephalic and carotid arteries, selective cerebral perfusion has been used as an effective method of cerebral protection. Although interest in this technique waned with the evolution of hypothermic...
journal_title:Journal of cardiothoracic and vascular anesthesia
pub_type: 杂志文章,评审
doi:10.1016/s1053-0770(96)80181-9
更新日期:1996-01-01 00:00:00
abstract:OBJECTIVE:To investigate the prognostic impact of red blood cell (RBC) transfusion on the outcome after transfemoral transcatheter aortic valve replacement (TAVR). DESIGN:Nationwide, retrospective multicenter study. SETTING:Five University Hospitals. PARTICIPANTS:The nationwide FinnValve registry included data from ...
journal_title:Journal of cardiothoracic and vascular anesthesia
pub_type: 杂志文章,多中心研究
doi:10.1053/j.jvca.2019.06.038
更新日期:2019-11-01 00:00:00
abstract:OBJECTIVE:To determine the effect of nitroglycerin on coronary blood flow velocity during controlled hypotensive anesthesia in humans. DESIGN:Internally controlled prospective study. SETTING:Single university hospital. PARTICIPANTS:Twenty American Society of Anesthesiologists class I and II patients undergoing gener...
journal_title:Journal of cardiothoracic and vascular anesthesia
pub_type: 杂志文章
doi:10.1053/jcan.2000.9446
更新日期:2000-10-01 00:00:00
abstract:OBJECTIVE:To evaluate hemodynamic effects of sternal retractor removal and sternal closure after cardiopulmonary bypass and to correlate these changes with preoperative and intraoperative variables. DESIGN:Prospective. SETTING:University hospital. PARTICIPANTS:Fifty adults undergoing cardiac surgery. MEASUREMENTS A...
journal_title:Journal of cardiothoracic and vascular anesthesia
pub_type: 杂志文章
doi:10.1053/jcan.2001.26537
更新日期:2001-10-01 00:00:00
abstract::Tissue edema, in particular pulmonary edema, increasingly is recognized as a perioperative complication affecting outcome. Management strategies directed at avoiding excessive fluid administration, reducing inflammatory response, and decreasing capillary permeability commonly are advocated in perioperative care protoc...
journal_title:Journal of cardiothoracic and vascular anesthesia
pub_type: 杂志文章,评审
doi:10.1053/j.jvca.2017.02.018
更新日期:2017-08-01 00:00:00
abstract:OBJECTIVE:The goal of this study was to evaluate the efficacy of 100% oxygen and inhaled nitric oxide (iNO) in decreasing pulmonary vascular resistance (PVR) and transpulmonary gradient (TPG) in dilated cardiomyopathy patients being evaluated for orthotopic heart transplantation (OHT); who, despite maximal intravenous ...
journal_title:Journal of cardiothoracic and vascular anesthesia
pub_type: 临床试验,杂志文章
doi:10.1053/j.jvca.2006.01.028
更新日期:2007-02-01 00:00:00
abstract:OBJECTIVE:Mortality and morbidity of acute kidney injury (AKI) after cardiac surgery still remain high. The authors undertook the present study to evaluate the utility of early postoperative urinary albumin (uAlb) as a diagnostic marker for predicting occurrence of AKI and its severity in pediatric patients undergoing ...
journal_title:Journal of cardiothoracic and vascular anesthesia
pub_type: 杂志文章
doi:10.1053/j.jvca.2015.05.194
更新日期:2016-01-01 00:00:00
abstract::In this review, the authors discussed criteria for diagnosing ALI; incidence, etiology, preoperative risk factors, intraoperative management, risk-reduction strategies, treatment, and prognosis. The anesthesiologist needs to maintain an index of suspicion for ALI in the perioperative period of thoracic surgery, partic...
journal_title:Journal of cardiothoracic and vascular anesthesia
pub_type: 杂志文章,评审
doi:10.1053/j.jvca.2009.10.032
更新日期:2010-08-01 00:00:00
abstract:OBJECTIVES:To investigate an association between the preoperative plasma B-type natriuretic peptide (BNP) concentration and cerebral regional saturation (rSO2) measured using the INVOS oximeter (Medtronic, Minneapolis, MN). DESIGN:A retrospective data analysis. SETTING:Single university hospital. PARTICIPANTS:Patien...
journal_title:Journal of cardiothoracic and vascular anesthesia
pub_type: 杂志文章
doi:10.1053/j.jvca.2017.04.018
更新日期:2018-02-01 00:00:00
abstract::The care of patients undergoing cardiac surgery is becoming more complex, in part owing to the increasing burden of comorbid disease, frailty, and psychosocial issues. Many risk factors for postoperative morbidity and mortality are potentially modifiable if identified and treated in a timely fashion before surgery. Ca...
journal_title:Journal of cardiothoracic and vascular anesthesia
pub_type: 杂志文章,评审
doi:10.1053/j.jvca.2019.01.023
更新日期:2019-08-01 00:00:00
abstract::Cardiopulmonary bypass has been shown to activate various inflammatory cascades in the body, resulting in pathophysiological changes that may affect patient outcome after cardiac surgery. Many of these inflammatory cascades are enzyme mediated, involving serine proteases. This report reviews the mechanisms of bypass-m...
journal_title:Journal of cardiothoracic and vascular anesthesia
pub_type: 杂志文章,评审
doi:10.1016/s1053-0770(97)80006-7
更新日期:1997-04-01 00:00:00
abstract:OBJECTIVE:To investigate sedation and anesthesia trends and practice patterns for procedures in the cardiac electrophysiology laboratory (EPL). DESIGN:A survey distributed by e-mail. SETTING:US teaching hospitals with a training program in cardiac electrophysiology. PARTICIPANTS:Cardiologists involved in procedures ...
journal_title:Journal of cardiothoracic and vascular anesthesia
pub_type: 杂志文章
doi:10.1053/j.jvca.2010.11.006
更新日期:2011-08-01 00:00:00
abstract::Bleeding after cardiac surgery is a common and serious complication leading to transfusion of multiple blood products and resulting in increased morbidity and mortality. Despite the publication of numerous guidelines and consensus statements for patient blood management in cardiac surgery, research has revealed that a...
journal_title:Journal of cardiothoracic and vascular anesthesia
pub_type: 杂志文章,评审
doi:10.1053/j.jvca.2019.04.003
更新日期:2019-11-01 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::The anesthetic management and outcome data were examined in a retrospective case-controlled study that compared a conventional hypothermic cardioplegic technique with the recently described method of warm heart surgery, in patients undergoing urgent cardiac surgery. Hypothermic continuous oxygenated blood crystalloid ...
journal_title:Journal of cardiothoracic and vascular anesthesia
pub_type: 杂志文章
doi:10.1016/1053-0770(92)90185-a
更新日期:1992-04-01 00:00:00
abstract:OBJECTIVES:To determine whether smoking cessation can reduce the incidence of postoperative hypoxemia (POH) after on-pump coronary artery bypass grafting (CABG) surgery. DESIGN:Prospective, single-center, observational study. SETTING:Single-center university teaching hospital. PARTICIPANTS:The study comprised 300 pa...
journal_title:Journal of cardiothoracic and vascular anesthesia
pub_type: 杂志文章
doi:10.1053/j.jvca.2016.05.011
更新日期:2016-12-01 00:00:00
abstract::Quality improvement, research, and reporting of outcome results can be stratified by preoperative risk by using a logistic regression equation or scores to correct for multiple risk factors. The more than 30-fold mortality differences between lowest and highest risk patients make it critical to stratify outcome result...
journal_title:Journal of cardiothoracic and vascular anesthesia
pub_type: 杂志文章,评审
doi:10.1016/s1053-0770(98)90018-0
更新日期:1998-06-01 00:00:00