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[Intensive care treatment of cardiac surgery patients: focus on hemodynamics].
Anaesthesiologie
January 2025
Klinik für Herz‑, Thorax‑, Transplantations- und Gefäßchirurgie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland.
Hemodynamic treatment is a core task in the intensive medical care of cardiac surgery patients. The patient's underlying disease, the type of surgical procedure and the patient's individual characteristics play key roles in the selection of the treatment regimen. The basis of any targeted hemodynamic treatment is the differential diagnosis of the underlying pathological disorder.
View Article and Find Full Text PDFHemodynamic Management with Vasopressin for Cardiovascular Surgery.
Medicina (Kaunas)
December 2024
Department of Cardiovascular Surgery, University of Tsukuba Institute of Medicine, Tsukuba 305-8575, Japan.
: Vasopressin increases blood pressure through aquaporin-2-mediated water retention and is useful for managing hemodynamics after surgery. However, even after decades of study, clear clinical guidelines on doses and ideal use cases after cardiovascular surgery remain unclear. Here, the existing literature is synthesized on vasopressin use for cardiac surgeries and coupled with real-world clinical experience to outline a clearer clinical path for vasopressin use.
View Article and Find Full Text PDFMechanical Circulatory support for Septic Shock in Children and Adults: Different but Similar!
Can J Cardiol
December 2024
Senior Consultant Intensive Care, Royal Childrens Hospital, Melbourne, Australia; Professor Department of Critical Care, Faculty of Medicine, Melbourne University.
Whilst Extra-Corporeal Membrane Oxygenation (ECMO) for circulatory support in patients with severe septic shock, commenced in newborn infants and children in the late 1980's, ECMO has remained a controversial treatment for adults with refractory septic shock (RSS). This is fundamentally due to differences in the predominant hemodynamic response to sepsis. In newborn infants and very young children ventricular failure called Low Cardiac Output Syndrome (LCOS) is the major hemodynamic response whilst adolescents and adults have mainly vasoplegic shock.
View Article and Find Full Text PDFDoes methylene blue improve outcomes in patients with post-cardiac surgery vasoplegic syndrome?
Interdiscip Cardiovasc Thorac Surg
December 2024
Department Cardiothoracic Surgery, Gold Coast University Hospital, Southport, QLD, Australia.
Objectives: A best evidence topic was written according to a structured protocol described in ICVTS. The question addressed was 'In patients with vasoplegic syndrome following cardiac surgery with cardiopulmonary bypass, does adjunctive methylene blue improve outcomes including reduced mortality, morbidity and vasopressor requirements?'
Methods: Ovid Medline was searched using a reported search algorithm. Articles that represented the best evidence to answer the clinical question were selected, tabulated and discussed.
Endothelial Protection and Improved Micro- and Macrocirculation with Hemoadsorption in Critically Ill Patients.
J Clin Med
November 2024
Department of Anesthesiology and Intensive Therapy, Semmelweis University, 78 Üllői St., 1082 Budapest, Hungary.
A dysregulated immune response is associated with an excessive release of cytokines that can lead to systemic vasoplegia and vasoplegic shock with the development of multiorgan failure that is associated with an increased risk of dying. Under physiological circumstances, the endothelium and the glycocalyx are responsible for maintaining vascular tone, capillary permeability, and hemostasis, and controlling inflammation. In hyperinflammation, the endothelium and glycocalyx become damaged due to the excessive production of certain toxic proteins, along with an overwhelming release of cytokines.
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