The management of patients after cardiothoracic surgery can be very complex. Variabilities exist in hemodynamic status after cardiac surgery and the use of cardiopulmonary bypass - all of which can have a significant impact on myocardial Frank-Starling curves. Typically, invasive monitoring with pulmonary artery catheters is used to assess the complex physiology that these patients experience in the perioperative setting. However, the use of invasive monitoring is not without risk, and the broader benefits are poorly defined. Furthermore, there is growing evidence to support the use of hemodynamic early goal-directed therapy to optimize outcomes in critically ill patients. The purpose of this editorial statement is the review of some of the current literature with regards to the utility of goal-directed therapy as applied to the postoperative cardiac surgical patient.
Download full-text PDF |
Source |
---|---|
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6625333 | PMC |
http://dx.doi.org/10.4103/IJCIIS.IJCIIS_38_19 | DOI Listing |
Anaesth Crit Care Pain Med
January 2025
City Cardiological Center, Almaty, Kazakhstan.
Acute Heart Failure (AHF) is a leading cause of death and represents the most frequent cause of unplanned hospital admission in patients older than 65 years. Since the past decade, several randomized clinical trials have highlighted the importance and pivotal role of certain therapeutics, including decongestion by the combination of loop diuretics, the need for rapid goal-directed medical therapies implementation before discharge, risk stratification, and early follow-up after discharge therapies. Cardiogenic shock, defined as sustained hypotension with tissue hypoperfusion due to low cardiac output and congestion, is the most severe form of AHF and mainly occurs after acute myocardial infarction, which can progress to multiple organ failure.
View Article and Find Full Text PDFJ Clin Monit Comput
January 2025
Department of Anaesthesiology and Intensive Care, Bicetre hospital, Assistance Publique Hôpitaux de Paris (AP-HP), Le Kremlin Bicetre, France.
Intravenous fluid is administered during high-risk surgery to optimize stroke volume (SV). To assess ongoing need for fluids, the hemodynamic response to a fluid bolus is evaluated using a fluid challenge technique. The Acumen Assisted Fluid Management (AFM) system is a decision support tool designed to ease the application of fluid challenges and thus improve fluid administration during high-risk surgery.
View Article and Find Full Text PDFJ ECT
November 2024
Department of Psychiatry and Health Behavior, Medical College of Georgia at Augusta University, Augusta, GA.
Electroconvulsive therapy (ECT) is underused, logistically challenging for those who are justice-involved, and laced with ethical problems for those on death row. Herein we describe a case of a man without history of long-standing psychiatric illness who, after more than 15 years on death row, was hospitalized for altered mental status. After medical stabilization, the altered mental status persisted.
View Article and Find Full Text PDFPhys Ther
January 2025
School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, OH, United States.
Objective: This study aimed to describe the monitoring of treatment fidelity in a pragmatic pediatric rehabilitation trial using the National Institutes of Health Behavior Change Consortium framework, and to identify child and therapist factors that influence treatment fidelity.
Methods: Therapists (n = 28) were trained in the key ingredients (1-on-1, functional, goal-directed, motor learning intervention) and study protocol for a comparative effectiveness trial titled: A Comparison: High Intensity periodic vs. Every week therapy in children with cerebral palsy (ACHIEVE) for children ages 2 to 8 years with cerebral palsy.
BMJ Open
January 2025
College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.
Objective: Upper limb movement difficulties in children with acquired brain injury (ABI) result in longer recovery times compared with lower limb. Intensive neurorehabilitation promotes a good long-term functional outcome. Virtual reality (VR) and video game technologies are invaluable adjuncts to traditional neurological rehabilitation as they help to motivate, engage and gain children's compliance in goal-directed therapy.
View Article and Find Full Text PDFEnter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!