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1.
Crit Care Clin ; 39(3): 559-576, 2023 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-37230556

RESUMO

The modern cardiothoracic intensive care unit (CTICU) developed as a result of advances in critical care, cardiology, and cardiac surgery. Patients undergoing cardiac surgery today are sicker, frailer, and have more complex cardiac and noncardiac morbidities. CTICU providers need to understand postoperative implications of different surgical procedures, complications that can occur in CTICU patients, resuscitation protocols for cardiac arrest, and diagnostic and therapeutic interventions such as transesophageal echocardiography and mechanical circulatory support. Optimum CTICU care requires a multidisciplinary team with collaboration between cardiac surgeons and critical care physicians with training and experience in the care of CTICU patients.


Assuntos
Procedimentos Cirúrgicos Cardíacos , Unidades de Terapia Intensiva , Humanos , Cuidados Críticos , Coração
2.
Anesthesiol Clin ; 40(2): 373-382, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-35659408

RESUMO

Burnout among critical care personnel has increased due to the additional psychological and physical demands of caring for critically ill patients with limited resources. Factors that increase the risk of burnout include compassion fatigue, lack of control over the work environment, difficult interpersonal relationships, and constant exposure to end-of-life issues. Organizational commitment to physician wellbeing depends on improving workplace efficiency, recognizing stressors in the critical care environment, and providing resources to help manage staffing shortages. Community building, training in communication, and team-building strategies are important steps in building collaboration and camaraderie in the workplace.


Assuntos
Esgotamento Profissional , COVID-19 , Fadiga de Compaixão , Esgotamento Profissional/prevenção & controle , Esgotamento Profissional/psicologia , Fadiga de Compaixão/psicologia , Humanos , Unidades de Terapia Intensiva , Satisfação no Emprego , Qualidade de Vida
3.
J Cardiothorac Vasc Anesth ; 36(7): 2114-2131, 2022 07.
Artigo em Inglês | MEDLINE | ID: mdl-34740543

RESUMO

Heart failure is an important cause of mortality and morbidity in the world. Changes in organ allocation for solid thoracic (lung and heart) transplantation has increased the number of patients on mechanical circulatory support. Temporary mechanical support devices include devices tht support the circulation directly or indirectly such as extracorporeal membrane oxygenation (ECMO) and temporary support for right-sided failure, left-sided failure or biventricular failure. Most often, these devices are placed percutaneously and require either guidance with echocardiography, continuous radiography (fluoroscopy) or both. Furthermore, these devices need imaging in the intensive care unit to confirm continued accurate placement. This review contains the imaging views and nuances of the temporary assist devices (including ECMO) at the time of placement and the complications that can be associated with each individual device.


Assuntos
Oxigenação por Membrana Extracorpórea , Insuficiência Cardíaca , Transplante de Coração , Coração Auxiliar , Oxigenação por Membrana Extracorpórea/métodos , Insuficiência Cardíaca/diagnóstico por imagem , Insuficiência Cardíaca/cirurgia , Humanos , Estudos Retrospectivos
4.
J Heart Lung Transplant ; 40(8): 856-859, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34059432

RESUMO

As the world responds to the global crisis of the COVID-19 pandemic an increasing number of patients are experiencing increased morbidity as a result of multi-organ involvement. Of these, a small proportion will progress to end-stage lung disease, become dialysis dependent, or both. Herein, we describe the first reported case of a successful combined lung and kidney transplantation in a patient with COVID-19. Lung transplantation, isolated or combined with other organs, is feasible and should be considered for select patients impacted by this deadly disease.


Assuntos
Injúria Renal Aguda/etiologia , Injúria Renal Aguda/cirurgia , COVID-19/complicações , COVID-19/cirurgia , Transplante de Rim , Transplante de Pulmão , Síndrome do Desconforto Respiratório/etiologia , Síndrome do Desconforto Respiratório/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade
8.
Anesthesiol Clin ; 36(4): 539-551, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30390777

RESUMO

Perioperative acute kidney injury is associated with morbidity and mortality. Several definitions have been proposed, incorporating small changes of serum creatinine and urinary output reduction as diagnostic criteria. In the surgical patient, comorbidities, type and timing of surgery, and nephrotoxins are important. Patient comorbidities remain a significant risk factor. Urgent or emergent surgery and cardiac or transplantation procedures are associated with a higher risk of acute kidney injury. Nephrotoxic drugs, contrast dye, and diuretics worsen preexisting kidney dysfunction or act as an adjunctive insult to perioperative injury. This review includes preoperative, intraoperative, and postoperative issues that can be mitigated.


Assuntos
Injúria Renal Aguda/prevenção & controle , Complicações Intraoperatórias/prevenção & controle , Assistência Perioperatória/métodos , Complicações Pós-Operatórias/prevenção & controle , Comportamento de Redução do Risco , Humanos
11.
Semin Cardiothorac Vasc Anesth ; 19(4): 331-41, 2015 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-26660057

RESUMO

The patient with thoracic aortic disease can present for open or endovascular repair. Thoracic endovascular aortic repair (TEVAR) has emerged as a minimally invasive option for a multitude of aortic pathology, including dissections, aneurysms, traumatic injuries, and ulcers. Postoperative management of these patients depends on the extent of procedure, whether it was open or endovascular, and, finally, on the preoperative comorbidities present. While procedural success has catapulted TEVAR to popularity, midterm results have been mixed. Additionally, periprocedural complications such as paraplegia and renal failure remain a significant morbidity in these patients.


Assuntos
Aorta Torácica/cirurgia , Doenças da Aorta/cirurgia , Procedimentos Endovasculares/métodos , Aorta Torácica/patologia , Doenças da Aorta/patologia , Cuidados Críticos/métodos , Humanos , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Cuidados Pós-Operatórios/métodos , Complicações Pós-Operatórias/epidemiologia
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