Critical Care Echocardiography-A Driven Approach to Undifferentiated Shock.

The clinical approach to undifferentiated shock in critically ill patients should be revised to use modern, point-of-care tools that are readily available. With the increasing availability of 2-dimensional ultrasonography and advanced Doppler capabilities, a quick, simplified, and integrated stepwise approach to shock using critical care echocardiography is proposed. Evidence supports the feasibility and usefulness of critical care echo-cardiography in enhancing diagnostic accuracy for shock, but there is a lack of systematic application of the technology in patients with undifferentiated shock.

A framework for transforming the professional identity and brand image of All Nurses as Leaders.

Background: The professional identity and brand image of nurses as leaders have not kept pace with the roles and scope of contemporary nursing practice.

Purpose: To provide a framework to transform the professional identity and brand image of nursing from a caring discipline to one of leaders.

Methods: A Consensus Development Workgroup (CDW) design was used between the International Society for Professional Identity in Nursing (ISPIN) and the Institute for Brand Image of Nursing (IBIN) to advance the concept of All Nurses as Leaders across all settings and the public domain.

Outcomes of thoracoabdominal aortic aneurysm repair in patients with a previous myocardial infarction.

Objective: Many patients undergoing thoracoabdominal aortic aneurysm (TAAA) repair have had a previous myocardial infarction (MI). To address the paucity of data regarding outcomes in such patients, we aimed to compare outcomes after open TAAA repair in patients with and without previous MI.

Methods: From 1986 to 2022, we performed 3737 consecutive open TAAA repairs.

The severity of chronic obstructive pulmonary disease is associated with adverse outcomes after open thoracoabdominal aortic aneurysm repair.

Objective: We assessed associations between outcomes after open thoracoabdominal aortic aneurysm (TAAA) repair and preoperative airflow limitation stratified by the Global Initiative for Chronic Obstructive Lung Disease (GOLD) spirometric classification of chronic obstructive pulmonary disease (COPD) severity.

Methods: Among 2368 open elective TAAA repairs in patients with spirometric data, 1735 patients had COPD and 633 did not. Those with COPD were stratified by preoperative respiratory dysfunction as GOLD 1 (forced expiratory volume in the first second of expiration [FEV] ≥80% of predicted; n = 228), GOLD 2 (50% ≤ FEV < 80% of predicted; n = 1215), GOLD 3 (30% ≤ FEV < 50% of predicted; n = 260), or GOLD 4 (FEV < 30% of predicted; n = 32).

A Two-Step Transcriptome Analysis of the Human Heart Reveals Broad and Disease-Responsive Expression of Ectopic Olfactory Receptors.

G-protein-coupled receptors (GPCRs) are critical regulators of cardiac physiology and a key therapeutic target for the treatment of heart disease. Ectopic olfactory receptors (ORs) are GPCRs expressed in extra-nasal tissues which have recently emerged as new mediators in the metabolic control of cardiac function. The goals of this study were to profile OR gene expression in the human heart, to identify ORs dysregulated by heart failure caused by ischemic cardiomyopathy, and to provide evidence suggestive of a role for those altered ORs in the pathogenesis of heart failure.

Retrograde Cerebral Perfusion May Decrease Stroke Risk During Elective Aortic Arch Surgery.

Objective: Controversy remains regarding the optimal neuroprotection strategy for elective hemiarch replacement (HEMI). This study sought to compare outcomes in patients who underwent HEMI utilizing the 2 most common contemporary methods of cerebral protection.

Methods: The ARCH international aortic database was queried, and 782 patients undergoing elective HEMI with circulatory arrest from 2007 to 2012 were identified.

Evaluation of Lead-In Direct Oral Anticoagulant Prescribing Practices in Newly Diagnosed Venous Thromboembolism.

Various lead-in dosing strategies have been used in clinical practice for venous thromboembolism (VTE), and guidelines do not currently address if the full lead-in dosing duration is necessary after receiving parenteral anticoagulation. This study aims to identify whether full lead-in dosing duration surrounding parenteral anticoagulation affects thrombotic and bleeding outcomes. A single-center, retrospective cohort study was conducted of hospitalized patients diagnosed with VTE and treated with apixaban or rivaroxaban.

Smartphone AF Burden During the Blanking Period Predicts Catheter Ablation Outcomes: Insights From DECAAF II.

Background: Atrial fibrillation (AF) recurrence during the blanking period is under investigated. With the rise of smartphone-based electrocardiogram (ECG) monitoring, there's potential for better prediction and understanding of AF recurrence trends.

Objectives: In this study the authors hypothesize that AF burden derived from a single-lead Smartphone ECG during the blanking period predicts recurrence of atrial arrhythmias after ablation.

Significant Publications on Infectious Diseases Pharmacotherapy in 2022.

To provide summarization of the most significant infectious diseases (ID) pharmacotherapy articles published in peer-reviewed literature in 2022. Members of the Houston Infectious Diseases Network (HIDN) nominated notable articles providing significant contributions to ID pharmacotherapy in 2022. Article nominations included those pertaining to general ID, as well as those including coronavirus disease 2019 (COVID-19), and human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) pharmacotherapy.

Improving antimicrobial use through better diagnosis: The relationship between diagnostic stewardship and antimicrobial stewardship.

Antimicrobial stewardship programs (ASPs) exist to optimize antibiotic use, reduce selection for antimicrobial-resistant microorganisms, and improve patient outcomes. Rapid and accurate diagnosis is essential to optimal antibiotic use. Because diagnostic testing plays a significant role in diagnosing patients, it has one of the strongest influences on clinician antibiotic prescribing behaviors.

Cardiac Conduction System Pacing: A Comprehensive Update.

The field of cardiac pacing has changed rapidly in the last several years. Since the initial description of His bundle pacing targeting the conduction system, recent advances in pacing the left bundle branch and its fascicles have evolved. The field and investigators' knowledge of conduction system pacing including relevant anatomy and physiology has advanced significantly.

Outcomes of aortic root replacement in patients with Marfan syndrome: the role of valve-sparing and valve-replacing approaches.

Background: Marfan syndrome (MFS) is a heritable thoracic aortic disease with pervasive cardiovascular effects, including commonly, a dilated aortic root. Traditionally, the root is replaced using a mechanical composite valve graft (CVG); however, this valve-replacing (VR) approach necessitates a lifelong regimen of anticoagulation with a potential for late bleeding complications. In time, valve-sparing (VS) approaches were developed.

The Role of Bronchoalveolar Lavage in the Diagnosis of COVID-19 Pneumonia: A Report of Three Cases.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) initially infects and replicates in epithelial cells of the nasopharynx where there are relatively high levels of angiotensin-converting enzyme 2 receptor, which correlates with the highest sensitivity time point of the nasopharyngeal swab (NPS) real-time polymerase chain reaction (RT-PCR) during the first week, with subsequent decline thereafter. As viral shedding progresses throughout the respiratory tract, the virus can be detectable for up to 30 days in bronchoalveolar fluids. This report presents three cases of acute respiratory distress in the setting of multifocal pneumonia, with multiple false-negative NPS SARS-CoV-2/RT-PCR but positive SARS-CoV-2/RT-PCR in bronchoalveolar lavage (BAL) samples.

Flow-Sizing Critical Care Resources.

Objectives: To describe the factors affecting critical care capacity and how critical care organizations (CCOs) within academic centers in the U.S. flow-size critical care resources under normal operations, strain, and surge conditions.

Long-term outcomes of valve-sparing aortic root versus composite aortic valve graft replacement for aortic root aneurysm: Meta-analysis of reconstructed time-to-event data.

Background: We aimed to evaluate the long-term outcomes of valve-sparing aortic root replacement (VSARR) versus composite aortic valve graft replacement (CAVGR) for aortic root aneurysms.

Methods: Meta-analysis of Kaplan-Meier-derived time-to-event data from studies with follow-up including propensity-score matching or propensity-score adjustment.

Results: Six studies met our eligibility criteria, comprising 3215 patients (1770 patients treated with VSARR and 1445 patients with CAVGR).