Formal ultrasound curriculum for surgical critical care fellows leads to improvement in comfort and skills in the intensive care unit.

Background: Despite its importance, there are no official guidelines for point of care ultrasound training during surgical critical care fellowship. The primary objective of this study was to evaluate the comfort and competency of fellows after implementation of a point of care ultrasound program.

Methods: Surgical critical care fellows (n = 7) participated in an ultrasound rotation (2021-2022), including dedicated lectures and training with interventional and echocardiography technicians.

Rare Case of Tongue Ischemia Following Cardiopulmonary Bypass.

Tongue ischemia is a devastatingly rare disease complication that is typically attributed to cranial arteritis, vasculitis, or prolonged oral intubation that manifests in a patient as a phenotypically black or discolored tongue. There have been less than 10 cases reported in the literature, however, documenting tongue ischemia secondary to shock states requiring high-dose vasopressor support. In these cases, the ischemia or necrosis has typically been limited to the tip of the tongue or has been associated with unilateral disease as bilateral tongue involvement is unlikely given the collateral blood supply of the tongue.

The Future of Cardiothoracic Surgical Critical Care Medicine as a Medical Science: A Call to Action.

Cardiothoracic surgical critical care medicine (CT-CCM) is a medical discipline centered on the perioperative care of diverse groups of patients. With an aging demographic and an increase in burden of chronic diseases the utilization of cardiothoracic surgical critical care units is likely to escalate in the coming decades. Given these projections, it is important to assess the state of cardiothoracic surgical intensive care, to develop goals and objectives for the future, and to identify knowledge gaps in need of scientific inquiry.

Developing Cardiothoracic Surgical Critical Care Intensivists: A Case for Distinct Training.

Cardiothoracic surgical critical care medicine is practiced by a diverse group of physicians including surgeons, anesthesiologists, pulmonologists, and cardiologists. With a wide array of specialties involved, the training of cardiothoracic surgical intensivists lacks standardization, creating significant variation in practice. Additionally, it results in siloed physicians who are less likely to collaborate and advocate for the cardiothoracic surgical critical care subspeciality.

A Brief History of Cardiothoracic Surgical Critical Care Medicine in the United States.

Cardiothoracic surgical intensive care has developed in response to advances in cardiothoracic surgery. The invention of the cardiopulmonary bypass machine facilitated a motionless and bloodless surgical field and made operations of increasing complexity feasible. By the mid-1950s, the first successful procedures utilizing cardiopulmonary bypass took place.

Introduction to the Special Issue-Cardiothoracic Surgical Critical Care: A Future of Distinction.

Critical care after cardiothoracic surgery is an inseparable component of any successful surgical program addressing intrathoracic pathologies, including heart failure treatment with mechanical circulatory support, and respiratory failure requiring extracorporeal membrane oxygenation (ECMO) therapy [...

Pulmonary artery pulsatility index as a predictor of right ventricular failure in left ventricular assist device recipients: A systematic review.

Background: It is critical to identify patients at increased risk of right ventricular failure (RVF) before left ventricular assist device (LVAD) implantation. Pulmonary artery pulsatility index (PAPi) is a hemodynamic parameter that is a specific measure of right ventricular function and may better identify LVAD recipients at risk for RVF. This systematic review analyzes the predictive value of preoperative PAPi to RVF in the setting of LVAD implantation.

The Temporal Lobe as a Symptomatogenic Zone in Medial Parietal Lobe Epilepsy.

Some surgical failures after temporal lobe epilepsy surgery may be due to the presence of an extratemporal epileptogenic zone. Of particular interest is the medial parietal lobe due to its robust connectivity with mesial temporal structures. Seizures in that area may be clinically silent before propagating to the symptomatogenic temporal lobe.

Simulation-Based Assessments and Graduating Neurology Residents' Milestones: Status Epilepticus Milestones.

Background: The American Board of Psychiatry and Neurology and the Accreditation Council for Graduate Medical Education (ACGME) developed Milestones that provide a framework for residents' assessment. However, Milestones do not provide a description for how programs should perform assessments.

Objectives: We evaluated graduating residents' status epilepticus (SE) identification and management skills and how they correlate with ACGME Milestones reported for epilepsy and management/treatment by their program's clinical competency committee (CCC).

Evaluating the Impact of Pulmonary Artery Obstruction After Lung Transplant Surgery: A Systematic Review and Meta-analysis.

Background: Pulmonary artery obstruction is an uncommon but significant complication after lung transplantation. Although numerous reports have documented its occurrence, the hemodynamic parameters associated with its presentation and diagnostic considerations remain ill-defined. This systematic review summarizes evidence in the literature surrounding pulmonary artery obstruction after lung transplantation surgery.

New or Worsened Mitral Regurgitation After Surgical Aortic Valve Replacement: A Systematic Review.

Background: New or worsened mitral regurgitation (MR) is an uncommon yet serious complication after surgical aortic valve replacement (SAVR). While there have been numerous reports of its occurrence, there is little consensus regarding its presentation and management. This systematic review summarizes the evidence in the current literature surrounding new or worsened MR after SAVR and analyzes its potential implications.

Implantation of subcutaneous defibrillator is feasible and safe with monitored anesthesia care.

Background: The perioperative anesthesia care during subcutaneous implantable cardioverter-defibrillator (S-ICD) implantation is still evolving.

Objective: To assess the feasibility and safety of S-ICD implantation with monitored anesthesia care (MAC) versus general anesthesia (GA) in a tertiary care center.

Methods: This is a single-center retrospective study of patients undergoing S-ICD implantation between October 2012 and May 2019.

Pulmonary cuff dysfunction after lung transplant surgery: A systematic review of the evidence and analysis of its clinical implications.

Background: Pulmonary cuff dysfunction, either due to pulmonary vein obstruction, pulmonary vein stenosis, or pulmonary vein thrombosis, is an uncommon, yet serious complication after lung transplantation. Although there have been numerous reports of its occurrence, there is little consensus regarding the hemodynamic parameters associated with its presentation and diagnostic considerations. This systematic review summarizes the evidence surrounding pulmonary cuff dysfunction after lung transplantation surgery and empirically analyzes its implications.

Dermal tattooing following intravenous methylene blue for refractory hypotension after coronary artery bypass grafting.

The authors present an image of a middle-aged male after coronary artery bypass grafting who received intravenous methylene blue for refractory hypotension that resulted in dermal tattooing/staining of the venous vasculature of his left shoulder and left upper chest. Bhatt AM, Tripathi RS, Moran KR, Papadimos TJ. Dermal tattooing following intravenous methylene blue for refractory hypotension after coronary artery bypass grafting.