ABSTRACT
El iloprost inhalado es uno de los fármacos más recientes del grupo de prostanoides en el tratamiento de la hipertensión arterial pulmonar. No se ha definido su importancia en la hipertensión pulmonar en el perioperatorio de cirugía cardiovascular. En esta revisión se analizan los grupos con hipertensión pulmonar susceptibles de cirugía cardiaca, la importancia de la hipertensión pulmonar en cirugía cardiaca y, además, la evidencia clínica actual del uso del fármaco en este contexto.
Inhaled iloprost is one of the most recent drugs from prostanoids group's in the treatment of pulmonary arterial hypertension. His place in pulmonary hypertension seen in the perioperative cardiovascular surgery has not been defined. In this review we analyze pulmonary hypertension group's susceptibles of cardiac surgery and its importance, besides the current clinical evidence from drug use in this context.
Subject(s)
Humans , Hypertension, Pulmonary/drug therapy , Iloprost/administration & dosage , Postoperative Complications/drug therapy , Vasodilator Agents/administration & dosage , Administration, Inhalation , Cardiac Surgical ProceduresABSTRACT
Inhaled iloprost is one of the most recent drugs from prostanoids group's in the treatment of pulmonary arterial hypertension. His place in pulmonary hypertension seen in the perioperative cardiovascular surgery has not been defined. In this review we analyze pulmonary hypertension group's susceptibles of cardiac surgery and its importance, besides the current clinical evidence from drug use in this context.
Subject(s)
Hypertension, Pulmonary/drug therapy , Iloprost/administration & dosage , Postoperative Complications/drug therapy , Vasodilator Agents/administration & dosage , Administration, Inhalation , Cardiac Surgical Procedures , HumansABSTRACT
Objetivo: La concordancia entre los parámetros de la gasometría arterial y venosa central no se ha definido aún, por lo cual estudiamos la concordancia entre ambas en sujetos postoperados de cirugía de revascularización miocárdica en condición estable. Métodos: Se estudiaron sujetos de manera consecutiva con un diseño transversal. Se les determinó la posición del catéter venoso central y al mismo tiempo se obtuvo la muestra arterial y venosa central previa a su egreso de la terapia intensiva. Los datos se expresaron según el método estadístico de Bland-Altman y al coeficiente de correlación intraclase. El resultado estadístico aceptó una p < 0.05. Resultados: Se estudiaron 206 muestras de 103 sujetos postoperados, el pH y el lactato tuvieron una diferencia media (límites de acuerdo) de 0.029 ± 0.048 (−0.018, 0.077) y −0.12 ± 0.22 (−0.57, 0.33) respectivamente; la magnitud del coeficiente de correlación intraclase respectiva fue de 0.904 y 0.943; las relativas a la presión de oxígeno 27.86 ± 6.08 (15.9, 39.8) y la saturación de oxígeno 33.02 ± 6.13 (21, 45), magnitud 0.258 y 0.418. Conclusión: Los parámetros con mejor concordancia arterial y venosa central fueron el pH y el lactato.
Objective: The concordance between the parameters of arterial and central venous blood gases has not been defined yet. We studied the concordance between both parameters in post-surgical myocardial revascularization patients in stable condition. Methods: Consecutive subjects were studied in a cross-sectional design. The position of the central venous catheter was performed and simultaneously we obtained arterial and central venous blood samples prior to discharge from the intensive care unit. Data are expressed according to Bland-Altman statistical method and the intraclass correlation coefficient. Statistical result was accepted at P < .05. Results: Two hundred and six samples were studied of 103 post-surgical patients, pH and lactate had a mean difference (limits of agreement) 0.029 ± 0.048 (−0018, 0.077) and −0.12 ± 0.22 (−0.57, 0.33) respectively. The magnitude of the intraclass correlation coefficient was 0.904 and 0.943 respectively. The values related to oxygen pressure were 27.86 ± 6.08 (15.9, 39.8) and oxygen saturation 33.02 ± 6.13 (21, 45), with magnitude of 0.258 and 0.418 respectively. Conclusion: The best matching parameters between arterial and central venous blood samples were pH and lactate.
Subject(s)
Female , Humans , Male , Middle Aged , Blood Gas Analysis , Myocardial Revascularization , Arteries , Cross-Sectional Studies , Intensive Care Units , Postoperative Care , VeinsABSTRACT
OBJECTIVE: The concordance between the parameters of arterial and central venous blood gases has not been defined yet. We studied the concordance between both parameters in post-surgical myocardial revascularization patients in stable condition. METHODS: Consecutive subjects were studied in a cross-sectional design. The position of the central venous catheter was performed and simultaneously we obtained arterial and central venous blood samples prior to discharge from the intensive care unit. Data are expressed according to Bland-Altman statistical method and the intraclass correlation coefficient. Statistical result was accepted at P<.05. RESULTS: Two hundred and six samples were studied of 103 post-surgical patients, pH and lactate had a mean difference (limits of agreement) 0.029±0.048 (-0018, 0.077) and -0.12±0.22 (-0.57, 0.33) respectively. The magnitude of the intraclass correlation coefficient was 0.904 and 0.943 respectively. The values related to oxygen pressure were 27.86±6.08 (15.9, 39.8) and oxygen saturation 33.02±6.13 (21, 45), with magnitude of 0.258 and 0.418 respectively. CONCLUSION: The best matching parameters between arterial and central venous blood samples were pH and lactate.
Subject(s)
Blood Gas Analysis , Myocardial Revascularization , Arteries , Cross-Sectional Studies , Female , Humans , Intensive Care Units , Male , Middle Aged , Postoperative Care , VeinsABSTRACT
The patient is a 21-year-old female, diagnosed with cryptogenic cirrhosis at the age of 9. She presented with left post-pneumonic empyema that did not remit with conventional medical management and evolved with fistulization to the skin in the 7th intercostal space in the left subscapular region. We performed an open thoracic window procedure, and on the 6th day the patient was sent home with a portable vacuum-assisted closure device, with changes of the material every 4 days until the cavity was completed obliterated (92 days). Imaging tests showed full expansion of the lung, and chest wall reconstruction was performed with titanium rods. The high mortality of empyema in patients with liver disease requires both implementing and searching for new adjuvant therapies, like the use of vacuum-assisted closure systems and reconstruction with titanium rods. Controlled studies with a wide range of cases are needed for proper evaluation.
