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IPA

Category: Perfusion

Cerebral Perfusion

Cerebral Overperfusion Despite Reduced Cortical Metabolism Is Associated with Postoperative Delirium in Cardiac Surgery Patients: A Prospective Observational Study

This study investigates the relationship between cerebral overperfusion and postoperative delirium (POD) in cardiac surgery patients. Despite reduced cortical metabolism, patients with POD exhibited increased cerebral blood flow, measured via transcranial Doppler. Low bispectral index (BIS) values indicated reduced metabolism, but no differences in autoregulation impairments were noted. The findings suggest a mismatch between cerebral blood flow and metabolism contributes to POD, independent of cerebral autoregulation.

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December 21, 2024
Hypertrophic Cardiomyopathy

Anesthetic Precision in Severe Hypertrophic Cardiomyopathy: Navigating Perioperative Challenges

This case report details the anesthetic management of a 77-year-old female with hypertrophic obstructive cardiomyopathy (HOCM), undergoing surgery for ileal adenocarcinoma. It highlights challenges such as preventing left ventricular outflow tract obstruction and maintaining hemodynamic stability. A tailored approach, including vigilant monitoring, goal-directed fluid therapy, and careful use of vasopressors, ensured successful outcomes. The report underscores the importance of meticulous perioperative planning in HOCM cases.

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December 10, 2024
Goal Direct Perfusion

Efficacy of Goal-Directed Versus Preemptive Tranexamic Acid Administration in Cardiovascular Surgery: The GDT Trial

The GDT trial compares goal-directed tranexamic acid (TXA) administration guided by rotational thromboelastometry (ROTEM) to preemptive TXA administration in cardiovascular surgery. This multi-center, double-blind, randomized trial aims to determine non-inferiority in reducing postoperative bleeding. Secondary outcomes include transfusion rates, thromboembolic complications, seizures, and hospital costs. The study hypothesizes that selective TXA administration will lower adverse events compared to preemptive dosing.

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December 4, 2024
Sodium CPB

Relation Between Serum Sodium Trajectory and Survival in Septic Patients with Cardiopulmonary Bypass Surgery

This study examined the impact of serum sodium trajectory on 30-day mortality in septic patients after cardiopulmonary bypass (CPB) surgery using the MIMIC-IV database. Among 1,038 patients, serum sodium trajectories were classified into three groups, with higher levels linked to increased mortality. Elevated fluctuations, even within normal sodium ranges, were associated with adverse outcomes. These findings highlight the need for close monitoring and sodium management in critically ill patients undergoing CPB.

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December 3, 2024
Bad Impella

Efficacy and Safety of Impella in Cardiogenic Shock Following Acute Myocardial Infarction: A Meta-Analysis of Randomized Controlled Trials

This meta-analysis reviewed four randomized controlled trials (442 patients) to evaluate the use of Impella in managing cardiogenic shock (CS) following acute myocardial infarction (AMI). Impella reduced 6-month all-cause mortality (OR: 0.64, 95% CI: 0.43-0.95, P = .03) but showed no significant impact on 30-day mortality. However, Impella was linked to increased risks of major bleeding (OR: 3.61), limb ischemia (OR: 4.91), and sepsis (OR: 2.75). Future research is needed to balance survival benefits against these complications.

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December 3, 2024
ELSO Awake

“Awake” Cannulation of Patients for Venovenous Extracorporeal Membrane Oxygenation: An Analysis of the Extracorporeal Life Support Organization Registry

This study analyzed the outcomes of “awake” cannulation, where patients remain breathing spontaneously during venovenous ECMO cannulation, using data from over 28,000 patients. Only 2.8% underwent awake cannulation, which was associated with similar survival rates to mechanical ventilation cannulation after propensity score matching. Awake cannulation, increasingly utilized over time, shows potential for reducing ventilator-related lung injury but requires further research to identify optimal patient cohorts.

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November 24, 2024
Cerebral 2024

Cerebral Overperfusion Despite Reduced Cortical Metabolism Is Linked to Postoperative Delirium in Cardiac Surgery Patients

This study explores the association between cerebral overperfusion and postoperative delirium (POD) in cardiac surgery patients. Continuous monitoring of cerebral blood flow, oxygen levels, and brain activity revealed increased middle cerebral artery velocity (MCAV) in patients with POD, despite stable oxygen saturation and autoregulation. The findings suggest that impaired cortical metabolism may render the brain vulnerable to overperfusion during surgery, increasing POD risk.

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November 17, 2024
Hemoperfusion

Efficacy of Adjunct Hemoperfusion Compared to Standard Medical Therapy on 28-Day Mortality in Leptospirosis Patients with Renal Failure and Shock: A Single-Center Randomized Controlled Trial

This study evaluates the impact of hemoperfusion (HP) on 28-day mortality in leptospirosis patients with renal failure and septic shock. A total of 37 patients were randomized to receive either standard medical therapy (SMT) or SMT with HP. The HP group showed a 36.84% risk reduction in 28-day mortality and significant improvements in inflammatory markers, renal function, and pulmonary function. Hemoperfusion was shown to be a safe and effective adjunct therapy, promoting faster recovery and increased survival rates.

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September 29, 2024
Brain ECMO

Brain Death Donors on Extracorporeal Membrane Oxygenation Support

This study examines 15 brain death donors on extracorporeal membrane oxygenation (ECMO) support, admitted to a specialized intensive care unit between 2018 and 2023. The study evaluates the effect of a strict hemodynamic monitoring schedule during a 6-hour observation period on the utilization rate of organs. Results show an increase in utilization rates from 78% to 88% with no significant differences in donor characteristics or hemodynamic data between periods. Most donors required multiple vasoactive drugs to maintain adequate perfusion.

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September 1, 2024
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