Background: Surgical aortic valve replacement (SAVR) is an established therapy for severe calcific aortic stenosis. Enhanced recovery after cardiac surgery (ERACS) protocols have been shown to improve outcomes for elective cardiac procedures. The COVID-19 pandemic prompted early extubation post-elective surgeries to preserve critical care resources.
Aim Of This Study: To investigate the effects of extubating patients within 6 h post-elective SAVR on hospital and ICU length of stay, mortality rates, ICU readmissions, and postoperative pneumonia.
Study Design And Methods: The retrospective analysis at the University Hospital Aachen, Germany, includes data from 2017 to 2022 and compares a total of 73 elective SAVR patients. Among these, 23 patients were extubated within 6 h (EXT group), while 50 patients remained intubated for over 6 h (INT group).
Results: The INT group experienced longer postoperative ventilation, needed more vasopressor support, had a higher incidence of postoperative pneumonia, and longer ICU length of stay. No significant differences were noted in overall hospital length of stay, mortality, or ICU readmission rates between the groups.
Conclusion: This study demonstrates that early extubation in high-risk, multimorbid surgical aortic valve replacement patients is safe, and is associated with a reduction of pneumonia rates, and with shorter ICU and hospital length of stays, reinforcing the benefits of ERACS protocols, especially critical during the COVID-19 pandemic to optimize intensive care use.
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http://dx.doi.org/10.1186/s13019-024-02989-0 | DOI Listing |
Ann Card Anaesth
January 2025
All India Institute of Medical Sciences, Raipur, Chhattisgarh, India.
Pulmonary alveolar proteinosis (PAP) is a rare pulmonary pathology characterized by the accumulation of surfactant within type II alveolar epithelial cells. Whole lung lavage is the standard treatment for pulmonary alveolar proteinosis involving a large volume of fluid is infused into one lung and subsequently retrieved while the other lung is remains ventilated. Fast-tracking a patient undergoing whole lung lavage requires vigilant monitoring of arterial blood gases, fluid status, and respiratory mechanics.
View Article and Find Full Text PDFJ Cardiothorac Vasc Anesth
January 2025
Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy. Electronic address:
Extracorporeal membrane oxygenation (ECMO) is an advanced treatment for severe respiratory failure. Implantation of ECMO before invasive ventilation or extubation during ECMO has been reported and is becoming increasingly popular. Avoidance of sedation and invasive ventilation during ECMO (commonly referred to as "awake ECMO") may have potential advantages, including a lower rate of delirium, shorter mechanical ventilation time, and the possibility of undergoing early rehabilitation and/or physiotherapy.
View Article and Find Full Text PDFAm J Respir Crit Care Med
January 2025
Radbound Univeristy Medical Center, Nijmegen, Netherlands;
Rationale: In critically ill patients receiving invasive mechanical ventilation, switching from controlled to assisted ventilation is a crucial milestone towards ventilator liberation. The optimal timing for switching to assisted ventilation has not been studied.
Objectives: Our objective was to determine whether a strategy of early as compared to delayed switching affects the duration of invasive mechanical ventilation, ICU length of stay, and mortality.
Oxf Med Case Reports
January 2025
Anesthesiology, Intensive Care and Emergency Department, University Hospital Mohammed VI of Marrakesh, Marrakesh, Morocco.
Crush trauma of extremities, resulting from a crushing force, can be life-threatening even without involving vital organs. Crush syndrome, or traumatic rhabdomyolysis, occurs when muscle cell breakdown releases contents into the bloodstream, leading to systemic complications like acute renal failure. A 35-year-old woman trapped under rubble during11 hours during a seismic event, presenting with compartment syndrome in her left arm and thigh and crush syndrome.
View Article and Find Full Text PDFA A Pract
January 2025
Department of Psychology, Neuropsychology Lab, CarlVon Ossietzky Universität, Oldenburg, Germany.
An elderly patient with renal cell carcinoma underwent a robotic nephrectomy. After an uneventful intraoperative period, soon after extubation she developed generalized seizures and was diagnosed with posterior reversible encephalopathy syndrome (PRES) on neuroimaging. Management included antiepileptic and antihypertensive therapies, necessitating intensive care and neurorehabilitation.
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