The International Society for Heart and Lung Transplantation (ISHLT): 2024 infection definitions for durable and acute mechanical circulatory support devices.

Infections remain a significant concern in patients receiving mechanical circulatory support (MCS), encompassing both durable and acute devices. This consensus manuscript provides updated definitions for infections associated with durable MCS devices and new definitions for infections in acute MCS, integrating a comprehensive review of existing literature and collaborative discussions among multidisciplinary specialists. By establishing consensus definitions, we seek to enhance clinical care, facilitate consistent reporting in research studies, and ultimately improve outcomes for patients receiving MCS.

Pre-emptive intraoperative administration of PCC4 in cardiac surgery patients at high risk of bleeding: A pilot study.

Background: Four-factor prothrombin complex (PCC4), a concentrate of factors II, VII, IX, and X and proteins C and S, has been used selectively for reversal of oral anticoagulation before surgery. There is data to support PCC4 as opposed to supplemental fresh frozen plasma (FFP) to manage postoperative bleeding following cardiac surgery. The preemptive, intraoperative use of PCC4 in cardiothoracic surgery has not been studied though it may prevent postoperative bleeding, the need for blood transfusion and the risk of transfusion-related acute lung injury, volume overload, and right ventricular (RV) heart failure.

The Pathophysiology and Management of Hemorrhagic Shock in the Polytrauma Patient.

The recognition and management of life-threatening hemorrhage in the polytrauma patient poses several challenges to prehospital rescue personnel and hospital providers. First, identification of acute blood loss and the magnitude of lost volume after torso injury may not be readily apparent in the field. Because of the expression of highly effective physiological mechanisms that compensate for a sudden decrease in circulatory volume, a polytrauma patient with a significant blood loss may appear normal during examination by first responders.

Sedation and paralytic use in open abdomen patients-results from the EAST SLEEP Survey.

Background: Patients with an open abdomen after trauma or emergency surgery may benefit from reduced sedation and chemical paralysis. We studied the effect of attending surgeon experience on sedation depth and paralytic use, as well as enteral nutrition and time between laparotomies.

Methods: We performed an institutional review board-approved survey (Sedation Level after Emergent ExLap without Primary Fascial Closure) of the senior and active Eastern Association for the Surgery of Trauma membership using Qualtrics (Qualtrics, Inc, Provo, UT).

Experiences of Kidney Transplant Recipients as Patient Navigators.

Background And Objective: The use of trained kidney transplant recipients as patient navigators resulted in increased completion of the steps in the transplant process by dialysis patients. We sought to understand the experiences of these patient navigators.

Setting And Participants: Six kidney transplant recipients were hired and employed by transplant centers in Ohio, Kentucky, and Indiana.

Optimizing transfusion strategies in damage control resuscitation: current insights.

From clinical and laboratory studies of specific coagulation defects induced by injury, damage control resuscitation (DCR) emerged as the most effective management strategy for hemorrhagic shock. DCR of the trauma patient who has sustained massive blood loss consists of 1) hemorrhage control; 2) permissive hypotension; and 3) the prevention and correction of trauma-induced coagulopathies, referred to collectively here as acute coagulopathy of trauma (ACOT). Trauma patients with ACOT have higher transfusion requirements, may eventually require massive transfusion, and are at higher risk of exsanguinating.

Extending surgeon response times in tier 2 traumas does not adversely affect patient outcomes.

Background: The presence of a trauma surgeon during patient resuscitations is required at most American College of Surgeons-verified trauma centers despite little evidence showing improved patient outcomes in the less-than-critically injured (Tier 2) trauma patients. This study was designed to identify the impact of extending required surgeon response times on outcomes in tier 2 trauma patients.

Methods: An American College of Surgeons-verified level 2 trauma center extended the maximum allowed surgeon response time for tier 2 activations from 60 min to 120 min on November 1, 2011.

Complication rates and center enrollment volume in the carotid revascularization endarterectomy versus stenting trial.

Background And Purpose: Evidence indicates that center volume of cases affects outcomes for both carotid endarterectomy and stenting. We evaluated the effect of enrollment volume by site on complication rates in the Carotid Revascularization Endarterectomy Versus Stenting Trial (CREST).

Methods: The primary composite end point was any stroke, myocardial infarction, or death within 30 days or ipsilateral stroke in follow-up.

Mitral valve repair in a transplanted heart via right thoracotomy.

With increasing longevity of many heart transplant recipients, the need for cardiac surgery upon the transplanted heart will become more common Herein is presented an illustrative case that reinforces the utility of a right-side thoracotomy to approach valve repair in the transplanted heart.

Allograft replacement of the aortic valve for active endocarditis.

Purpose: In the 50 months preceding March 1995, 35 adult patients underwent aortic valve replacement with a cryopreserved human aortic valve allograft. Nine of these patients had active endocarditis. The remaining 26 patients had aortic valve pathology without active infection.

Chlorhexidine gluconate 0.12% oral rinse reduces the incidence of total nosocomial respiratory infection and nonprophylactic systemic antibiotic use in patients undergoing heart surgery.

Unlabelled: STUDY OFJECTIVE: The purpose of this study was to test the effectiveness of oropharyngeal decontamination on nosocomial infections in a comparatively homogeneous population of patients undergoing heart surgery.

Design: This was a prospective, randomized, double-blind, placebo-controlled clinical trial. Experimental and control groups were selected for similar infection risk parameters.

Durability of emergency coronary artery bypass for complications of failed angioplasty.

Although emergency coronary artery bypass for complications of percutaneous transluminal coronary angioplasty (PTCA) has proved to be a relatively successful 'bail-out' procedure, little is known about the durability of revascularization under these potentially disastrous circumstances. The authors therefore retrospectively examined their results with this procedure. Emergency coronary artery bypass for complications of PTCA was performed in 112 patients between 1 January 1984 and 19 May 1992.

Prophylaxis of heart transplant rejection with either antithymocyte globulin-, Minnesota antilymphocyte globulin-, or an OKT3-based protocol.

We compared an equine antithymocyte globulin (ATGAM)-based protocol with a Minnesota antilymphocyte globulin (MALG)-based protocol and a murine monoclonal CD-3 (OKT-)-based protocol in 3 groups of heart transplant (HT) recipients. Thirty-four recipients received a four-day course of ATGAM. Thirty HT recipients received a 14-day course of OKT3.

New hospital emphasizes patient accessibility and continuity of care. Interview by Karen Gardner.

As a 14-year veteran of the board of Lutheran Hospital of Indiana Inc., Fort Wayne, Thomas Baumgartner participated fully in the evolution of Lutheran's new acute care facility, which opened last May after five years of planning and construction. The Lutheran system includes the new not-for-profit, 350-bed hospital; a subsidiary comprising four urgent care clinics; joint ventures with several medical entities that provide clinical services such as rehabilitation and nursing; and a four-year college (the Lutheran College of Health Professionals).

Nurturing mission. A case study of a hospital's cultural growth.

Recognizing the need to enhance his hospital's fulfillment of its mission as a religious organization, the chief executive officer of Lutheran Hospital of Indiana, Inc., Fort Wayne, initiated a process to change the institution's corporate culture to reflect the mission. After assessing hospital managers' perceptions of the hospital's mission, a planning committee drafted a mission statement.

Cardiac transplantation in patients with preexisting malignancies.

A history of preexisting malignancy has been considered a contraindication to cardiac transplantation. The reasons for this prejudice include concerns about potentially deficient intrinsic immunomodulation and fear of cancer recurrence (or development of second cancers) because of therapeutic immunosuppression. In the past four years at the Northern Indiana Heart Institute seven patients with preexisting malignancies underwent cardiac transplantation.