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Interpretation of Viscoelastic Hemostatic Assays in Cardiac Surgery Patients: Importance of Clinical Context.
Anesth Analg
January 2025
From the Department of Anesthesiology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands.
Background: Rotational thromboelastometry (ROTEM) is widely used for point-of-care coagulation testing to reduce blood transfusions. Accurate interpretation of ROTEM data is crucial and requires substantial training. This study investigates the inter- and intrarater reliability of ROTEM interpretation among experts and compares their interpretations with a ROTEM-guided algorithm.
View Article and Find Full Text PDFEnd-of-life issues in the ITU - 10 important points to remember.
Eur Heart J Acute Cardiovasc Care
January 2025
Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium.
End-of-life (EOL) issues have become increasingly common in intensive therapy units (ITUs), largely due to advances in critical care that enable patients to be kept alive for extended periods. Death in the ITU now generally follows an EOL decision, which can pose ethical, emotional, and practical challenges. Our approach to such issues should be based on adherence to the four bioethical principles -autonomy, beneficence, nonmaleficence, and distributive justice- as well as the concept of proportionate care, and requires careful and effective communication with the whole ITU team, including the patient and their family.
View Article and Find Full Text PDFA Controversial Clinical Case of a Child With Hypoplastic Left Heart Syndrome.
Pediatrics
January 2025
Cincinnati Children's Hospital Medical Center and Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio.
We present the case of a child born with hypoplastic left heart syndrome. After developing multiple complications following the first surgical stage (Norwood procedure), her parents decide not to proceed with the second stage (Glenn operation). Cardiac surgeons, pediatric intensivists, a psychologist, and a bioethicist analyze whether further surgical intervention is ethically obligatory.
View Article and Find Full Text PDFCardiac Arrest in the Setting of Left Lung Herniation Following Combined Heart-Lung Transplant: Case Report.
ASAIO J
November 2024
From the Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota.
A 40 year old woman who underwent combined heart-lung transplant for familial severe pulmonary hypertension experienced episodes of nonsustained ventricular tachycardia followed by sudden ventricular fibrillation arrest 8 days after transplant. Postarrest investigations revealed left lower lobe herniation into the right lower hemithorax, prompting emergent reoperation, and hernia reduction. Arrhythmias resolved following reduction of the herniated lung and facilitated rapid weaning from vasopressor and ventilatory support.
View Article and Find Full Text PDFThe role of acetazolamide in critical care and emergency medicine.
J Geriatr Cardiol
November 2024
Geriatric Medicine Residency Program, University of Rome "Tor Vergata", Rome, Italy.
Acetazolamide is the commonly prescribed oral and intravenous carbonic anhydrase inhibitor; over the years, its use in clinical practice has decreased in favor of more recent drugs. However, it is a rather handy drug, which can be useful in several clinical settings when managing critically ill patients. The objective of this review is the evaluation of the most recent evidence on the use of acetazolamide in emergency medicine and critical care medicine.
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