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Original Articles
Pediatrics
Perioperative hemodynamic protective assessment of adaptive support ventilation usage in pediatric surgical patients
Dmytro Dmytriiev, Mykola Melnychenko, Oleksandr Dobrovanov, Oleksandr Nazarchuk, Marian Vidiscak
Acute Crit Care. 2022;37(4):636-643.   Published online October 19, 2022
DOI: https://doi.org/10.4266/acc.2022.00297
  • 2,857 View
  • 116 Download
  • 1 Web of Science
  • 2 Crossref
AbstractAbstract PDF
Background
The aim of this study was to evaluate the hemodynamic protective effects of perioperative ventilation in pressure-controlled ventilation (PCV) and adaptive support ventilation (ASV) modes based on non-invasive hemodynamic monitoring indicators. Methods: The study included 32 patients who were scheduled for planned open abdominal surgery. Depending on the chosen ventilation strategy, patients were included in two groups of PCV mode ventilation (n=14) and ASV mode ventilation (n=18). The hemodynamic effects of the ventilation strategies were assessed by estimated continuous cardiac output (esCCO) and cardiac index (esCCI). Results: Preoperative cardiac output (CO) was 6.1±1.3 L/min in group 1 patients and 6.3±0.8 L/min in group 2 patients, and preoperative cardiac index (CI) was 3.9±0.4 L/min/m2 in group 1 patients and 3.8±0.8 L/min/m2 in group 2 patients. The ejection fraction (EF) in group 1 subjects was 55.4%±0.3%; this rate was 56.5%±0.5% in group 2 subjects. Group 1 patients experienced a 14.7% CO decrease to 5.2±0.7 L/min, a 17.9% CI decrease to 3.2±0.6 L/min/m2 , and a 12.8% mean arterial pressure decrease to 82.3±9.4 mm Hg 30 minutes after the start of surgery. One hour after the start of surgery, the CO mean values of group 2 patients were lower than baseline by 7.9% and differed from the dynamics of patients in group 1, in whom CO was lower than baseline by 13.1%. At the end of the operation, the CO values were lower than baseline by 11.5% and 6.3% in patients of groups 1 and 2, respectively. Our data showed that the changes in EF during and after surgery correlated with CO indicators determined by the esCCO. Conclusions: In our study, perioperative ventilation in ASV mode was more protective than PCV mode and was characterized by lower tidal volume (16.2%) and driving pressure (12.1%). Hemodynamically-controlled mechanical ventilation reduces the negative impact of cardiopulmonary interactions,

Citations

Citations to this article as recorded by  
  • Trends in the dynamics of morbidity and mortality from hypertension in the Republic of Kazakhstan from 2010 to 2019
    Yeldos Makhambetchin, Aigerim Yessembekova, Ardak Nurbakyttana, Aza Galayeva, Saparkul Arinova
    Polski Merkuriusz Lekarski.2024; 52(1): 95.     CrossRef
  • Clinical evaluation of ventilation mode on acute exacerbation of chronic obstructive pulmonary disease with respiratory failure
    Jun-Jun Wang, Zhong Zhou, Li-Ying Zhang
    World Journal of Clinical Cases.2023; 11(26): 6040.     CrossRef
Thoracic Surgery
Blood Conservation Strategy during Cardiac Valve Surgery in Jehovah’s Witnesses: a Comparative Study with Non-Jehovah’s Witnesses
Tae Sik Kim, Jong Hyun Lee, Chan-Young Na
Korean J Crit Care Med. 2016;31(2):101-110.   Published online May 31, 2016
DOI: https://doi.org/10.4266/kjccm.2016.31.2.101
  • 10,665 View
  • 197 Download
  • 2 Crossref
AbstractAbstract PDF
Background:
We compared the clinical outcomes of cardiac valve surgery in adult Jehovah’s Witness patients refusing blood transfusion to those in non-Jehovah’s Witness patients without any transfusion limitations.
Methods
From 2005 to 2014, 25 Jehovah’s Witnesses (JW group) underwent cardiac valve surgery using a blood conservation strategy. Twenty-five matched control patients (non-JW group) were selected according to sex, age, operation date, and surgeon. Both groups were managed according to general guidelines of anticoagulation for valve surgery.
Results
The operative mortality rate was 4.0% in the JW group and 0% in the non-JW group (p = 1.000). There was no difference in postoperative major complications between the groups (p = 1.000). The overall survival rate at 5 and 10 years was 85.6% ± 7.9% and 85.6% ± 7.9% in the JW group, respectively, and 100.0% ± 0.0% and 66.7% ± 27.2% in the non-JW group (p = 0.313). The valve-related morbidity-free survival rates (p = 0.625) and late morbidity-free survival rates (p = 0.885) were not significantly different between the groups.
Conclusions
Using a perioperative strategy for blood conservation, cardiac valve surgery without transfusion had comparable clinical outcomes in adult patients. This blood conservation strategy could be broadly applied to major surgeries with careful perioperative care.

Citations

Citations to this article as recorded by  
  • Optimising bloodless cardiovascular surgery for Jehovah’s Witnesses and beyond
    Matti Jubouri, Fatemeh Hedayat, Sakina Abrar, Sophie L. Mellor, Louise J. Brown, Amer Harky
    Coronary Artery Disease.2022; 33(1): 52.     CrossRef
  • Outcomes of perioperative management in Jehovah's Witness patients undergoing surgeries with a risk of bleeding: a retrospective, single-center, observational study
    Keum Young So, Sang Hun Kim
    Medical Biological Science and Engineering.2022; 5(1): 6.     CrossRef
Pulmonary/Cardiology
Perioperative Risk Factors associated with Immediate Postoperative Extracorporeal Membrane Oxygenation in Lung Transplants
Ha Yeon Kim, Sungwon Na, Hyo Chae Paik, Jonglin Ha, Jeongmin Kim
Korean J Crit Care Med. 2015;30(4):286-294.   Published online November 30, 2015
DOI: https://doi.org/10.4266/kjccm.2015.30.4.286
  • 5,472 View
  • 55 Download
  • 1 Crossref
AbstractAbstract PDF
Background
Extracorporeal membrane oxygenation (ECMO) is administered for a few days after lung transplantation (LTx) in recipients who are expected to have early graft dysfunction. Despite its life-saving potential, immediate postoperative ECMO has life-threatening complications such as postoperative bleeding. We investigated the risk factors related to the use of immediate postoperative ECMO.
Methods
We retrospectively reviewed the records of 60 LTx patients who were at our institution from October 2012 to May 2015. Perioperative variables associated with postoperative ECMO were compared between the two groups.
Results
There were 26 patients who received postoperative ECMO (ECMO group) and 34 patients who did not (control group). Multivariate regression analysis revealed preoperative ECMO (odds ratio [OR] 12.55, 95% confidence intervals [CI] 1.34 – 117.24, p = 0.027) and lower peripheral pulse oxymetry saturation (SpO2) at the end of surgery (OR 0.71, 95% CI 0.54 – 0.95, p = 0.019) were independent risk factors for postoperative ECMO in LTx patients. The incidences of complications, such as re-operation, tracheostomy, renal failure and postoperative atrial fibrillation, were higher in the ECMO group. There was no difference in the duration of postoperative intensive care unit stay or postoperative 30-day mortality between the two groups.
Conclusions
The preoperative ECMO and lower SpO2 at the end of surgery were associated with postoperative ECMO. Further, postoperative adverse events were higher in the ECMO group compared with the control group. This study suggests that determination of postoperative ECMO requires careful consideration because of the risks of postoperative ECMO in LTx patients.

Citations

Citations to this article as recorded by  
  • The Future of Research on Extracorporeal Membrane Oxygenation (ECMO)
    Ji Young Lee
    Korean Journal of Critical Care Medicine.2016; 31(2): 73.     CrossRef
Case Reports
Cardiology
Cardiogenic Shock in a Patient with Intermediate Coronary Artery Disease due to Preoperative Spasm
Donghun Shin, Min Jin Lee, Chul Hong Park, Joongkeun Kim, Dae Sung Lee, Jun Hyok Oh
Korean J Crit Care Med. 2014;29(3):222-225.   Published online August 31, 2014
DOI: https://doi.org/10.4266/kjccm.2014.29.3.222
  • 3,875 View
  • 50 Download
AbstractAbstract PDF
The best management strategy for angiographically intermediated coronary artery diseases remains controversial. Lesions, when coupled with spasm, can lead to catastrophic results and cardiogenic shock. We report a case of a 62-year-old man who had an intermediate coronary artery disease presenting with cardiogenic shock due to coronary spasm during a preoperative period.
Postoperative Acute Cerebral Infarction Occurring after General Anesthesia
Seong Ho Ok, Seong Min Yang, Woochan Kim, Il Woo Shin, Heon Keun Lee, Young Kyun Chung, Ju Tae Sohn
Korean J Crit Care Med. 2013;28(4):323-326.
DOI: https://doi.org/10.4266/kjccm.2013.28.4.323
  • 2,768 View
  • 17 Download
AbstractAbstract PDF
The common predisposing risk factors for perioperative stroke include: previous stroke, atrial fibrillation, old age (> 75 years), carotid stenosis, and diabetes mellitus. An endoscopic sinus surgery was performed in a 49-year-old male with chronic paranasal sinusitis and nasal polyps. The vital signs, physical and laboratory examinations, and electrocardiography on admission were within the normal limit. Anesthesia was maintained with nitrous oxide in oxygen and 6% desflurane. The operation and anesthesia were uneventful with the exception of transient intraoperative hypotension. The patient recovered fully from the anesthesia (modified Aldrete score: 10) in the recovery room. However, he developed right arm weakness and dysarthria in the general ward 7 hours after the operation. We report a rare case of multifocal acute cerebral infarctions found on the postoperative magnetic resonance imaging in a noncardiac surgical patient.
Original Article
Perioperative Care for Kidney Transplantation
Jong Hoon Lee, Myoung Soo Kim, Kyung Ock Jeon, Yu Seun Kim
Korean J Crit Care Med. 2001;16(1):11-16.
  • 4,530 View
  • 402 Download
AbstractAbstract PDF
The evaluation of a patient referred for kidney transplantation is divided into 3 phases. First, a through evaluation is carried out, both to identify risk factors for undergoing transplantation. Second, a surgical evaluation is carried out to look for signs of vascular disease and urological abnormalities, and finally an immunologic evaluation is initiated to assess the patient's blood and HLA types. In patients with chest pain, chronic heart failure, or abnormal EEG, non-invasive cardiac test, when necessary followed by coronary angiography, is indicated. Patients with significant narrowing of the major coronary vessels should undergo percutaneous angioplasty or bypass grafting before transplantation. In diabetic patients over the age of 45, coronary artery disease is a common occurrence even in the absence of symptoms or clinical signs. Non-invasive cardiac evaluation during exercise should be performed routinely. The decision to perform a renal transplantation in a patient who has previously been treated for a malignancy is not an easy one. A waiting period of 2 years seems justified for most neoplasm. A waiting time of more than 2 years is required in malignant melanoma, breast carcinoma, or colorectal carcinomas. The advantages of immediate function after kidney transplantation include a higher long-term success rate, the ability to use potentially nephrotoxic immunosuppressive agents at an earlier time, shortened hospitalization and cost of the procedure as well as the avoidance of post-operative dialysis. Deliberate hydration of the patients during surgery is carried out in order to reduce the risk of acute tubular necrosis. This can be done with either crystalloid or colloid solution. The amount of intravenous solution depends on the patient's hydration status at the start of the procedure and CVP reading during the operation. Close monitoring of urine output is maintained in the early post-operative period. Intravenous hydration is maintained to keep up with the post-operative diuresis. Hypertension is very common in the post-operative period and must be controlled to reduce the risk of post-operative bleeding. If the patient is oliguric in the immediate post-operative period, an attempt at deliberate hydration is employed, however, if the oliguria persists, such hydration must be abandoned in order to avoid pulmonary edema. Dialysis will be required if the kidney does not function adequately. The price a transplant recipient pays for effective immunosuppression is an increased risk of developing infectious complications. Empirical administration of antibiotics, anti-viral agents, or anti-fungal agents in clinically declining patients is justified.

ACC : Acute and Critical Care