A 3-hour fast-track extubation protocol for early extubation after cardiac surgery.

Objectives: Early extubation after cardiac surgery improves outcomes and reduces cost. We investigated the effect of a multidisciplinary 3-hour fast-track protocol on extubation, intensive care unit length of stay time, and reintubation rate after a wide range of cardiac surgical procedures.

Methods: We performed an observational study of 472 adult patients undergoing cardiac surgery at a large academic institution.

Severe Acute Blood Loss Anemia in Jehovah's Witnesses Undergoing Cardiac Surgery: Single Academic Center Experience.

Objective: To determine the effect of severe acute blood loss anemia (ABLA) on postoperative outcomes in Jehovah's Witness (JW) patients undergoing cardiac surgery.

Design: This was a retrospective cohort study of adult JW patients undergoing cardiac surgery requiring cardiopulmonary bypass (CPB) between January 1998 and December 2018 at Barnes-Jewish Hospital in St. Louis, Missouri.

Intraoperative Assessment of Hepatic Vein Tracings in Constrictive Pericarditis During Surgical Pericardiectomy.

CONSTRICTIVE PERICARDITIS is characterized by progressive inflammation and fibrosis of the pericardium. It manifests with symptoms of heart failure. The only effective treatment is surgical pericardiectomy.

Disseminated Ureaplasma infection as a cause of fatal hyperammonemia in humans.

Hyperammonemia syndrome is a fatal complication affecting immunosuppressed patients. Frequently refractory to treatment, it is characterized by progressive elevations in serum ammonia of unknown etiology, ultimately leading to cerebral edema and death. In mammals, ammonia produced during amino acid metabolism is primarily cleared through the hepatic production of urea, which is eliminated in the kidney.

Mild hypercapnia after uncomplicated heart surgery is not associated with hemodynamic compromise.

Objective: The aim of this study was to examine the effects of small changes in PaCO(2) on hemodynamic parameters after uncomplicated heart surgery with cardiopulmonary bypass.

Design: This was a prospective, randomized crossover study.

Setting: A large academic medical center.

Case report: inferior vena-cava right atrial anastomotic stenosis after bicaval orthotopic heart transplantation.

Purpose: This case report describes the occurrence of acute postoperative liver and renal failure after bicaval orthotopic heart transplantation (OHT) due to stenosis of the inferior vena cava (IVC)-right atrial (RA) anastomosis. We also discuss the role of measuring femoral venous pressure and transesophageal echocardiography (TEE) in establishing the diagnosis.

Clinical Features: A 42-yr-old female patient with idiopathic dilated cardiomyopathy underwent an OHT, using the bicaval anastomotic technique.

Flooding the surgical field with carbon dioxide during open heart surgery improves segmental wall motion.

Air embolization to the coronary arteries is a common cause of myocardial ischemia during open heart surgery. Carbon dioxide emboli may be absorbed faster than air emboli. In this randomized, double blind, placebo-controlled trial, we determined that flooding the surgical field with carbon dioxide is associated with improved myocardial function assessed by transesophageal echocardiography.

Use of the Patient State Index (PSI) to assist in the diagnosis of perioperative neurological injury and brain death.

We present a series of three postoperative cases that were admitted to a cardiothoracic intensive care unit (ICU) after major surgery. Due to the possible presence of residual postoperative neuromuscular blockade after surgery, a processed electroencephalograph (EEG) was applied prior to starting sedation. This was markedly abnormal in all three cases, and not in keeping with the residual anesthesia.

Progress in postoperative ICU management.

The clinical case presented in this article illustrates how many of the more recent advances in the management of critically ill patients apply to current clinical practice. Simple cost-effective general measures (eg, optimal sterile precautions during procedures; hand washing; early goal-directed resuscitation with appropriate fluids, inotropes, and antibiotics; and surgical source control of infected foci) still should form the basis of clinical practice, however. There has been renewed interest in blood transfusion therapy and its associated risks.

Inhaled prostacyclin is safe, effective, and affordable in patients with pulmonary hypertension, right heart dysfunction, and refractory hypoxemia after cardiothoracic surgery.

Background: The purpose of this study was to describe our institutional experience in using inhaled prostacyclin as a selective pulmonary vasodilator in patients with pulmonary hypertension, refractory hypoxemia, and right heart dysfunction after cardiothoracic surgery.

Methods: Between February 2001 and March 2003, cardiothoracic surgical patients with pulmonary hypertension (mean pulmonary artery pressure >30 mm Hg or systolic pulmonary artery pressure >40 mm Hg), hypoxemia (PaO(2)/fraction of inspired oxygen <150 mm Hg), or right heart dysfunction (central venous pressure >16 mm Hg and cardiac index <2.2 L.

The importance of prior stroke for the adjusted risk of neurologic injury after cardiac surgery for women and men.

Background: Women are at higher risk for stroke after cardiac surgery than men. Prior analysis of risk profiles for perioperative stroke that have mostly combined data from women and men may fail to identify gender-specific risks. The purpose of this study was to evaluate whether patient gender impacts adjusted risk for stroke after cardiac surgery.