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1.
Crit Care Nurse ; 44(3): 12-18, 2024 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-38821526

RESUMO

BACKGROUND: Emergency resternotomy in the intensive care unit for a patient who has undergone cardiac surgery can be daunting for surgeons and critical care staff. Clinicians involved are often unfamiliar with the surgical instruments and techniques needed. LOCAL PROBLEM: After an emergency intensive care unit resternotomy resulted in suboptimal performance and outcome, protocols for emergency resternotomy were established and improved. METHODS: Education and simulation training were used to improve staff comfort and familiarity with the needed techniques and supplies. The training intervention included simulations to provide hands-on experience, improve staff familiarity with resternotomy trays, and streamline emergency sternotomy protocols. Preintervention and postintervention surveys were used to assess participants' familiarity with the implemented plans and algorithms. RESULTS: All 44 participants (100%) completed the preintervention survey, and 41 of 44 participants (93%) returned the postintervention survey. After the intervention, 95% of respondents agreed that they were prepared to be members of the team for an emergency intensive care unit sternotomy, compared with 52% of respondents before the intervention. After the intervention, 95% of respondents strongly agreed or agreed that they could identify patients who might need emergency sternotomy, compared with 50% before the intervention. The results also showed improvement in staff members' understanding of team roles, activation and use of the emergency sternotomy protocol, and differences between guidelines for resuscitating patients who experience cardiac arrest after cardiac surgery and the post-cardiac arrest Advanced Cardiovascular Life Support protocol. CONCLUSION: Results of this quality improvement project suggest that simulation training improves staff comfort with and understanding of emergency resternotomy.


Assuntos
Treinamento por Simulação , Esternotomia , Humanos , Esternotomia/educação , Treinamento por Simulação/métodos , Masculino , Feminino , Pessoa de Meia-Idade , Adulto , Unidades de Terapia Intensiva , Competência Clínica/normas , Enfermagem de Cuidados Críticos/educação , Enfermagem de Cuidados Críticos/normas , Idoso , Cuidados Críticos , Idoso de 80 Anos ou mais
2.
Indian J Thorac Cardiovasc Surg ; 40(3): 357-360, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38681720

RESUMO

Bartter syndrome is a rare, renal tubulopathy caused by defective salt reabsorption in the thick ascending limb of the loop of Henle which results in salt wasting, hypokalemia, and metabolic disturbances. The electrolyte disturbances associated with this condition can be difficult to manage in the postoperative setting, especially in patients undergoing cardiac surgery. We report a case of a 62-year-old male with a history of diabetes, hypertension, coronary artery disease, and Bartter syndrome who underwent coronary artery bypass grafting and who developed severe lactic acidemia and severe electrolyte abnormalities postoperatively. Treatment consisted of aggressive resuscitation with crystalloid and intravenous (IV) electrolyte replacement.

3.
J Artif Organs ; 2024 Mar 07.
Artigo em Inglês | MEDLINE | ID: mdl-38451441

RESUMO

The shortcomings of expense, power requirements, infection, durability, size, and blood trauma of current durable LVADs have been recognized for many years. The LVADs of tomorrow aspire to be fully implantable, durable, mitigate infectious risk, mimic the pulsatile nature of the native cardiac cycle, as well as minimize bleeding and thrombosis. Power draw, battery cycle lifespan and trans-cutaneous energy transmission remain barriers to completely implantable systems. Potential solutions include decreases in pump electrical draw, improving battery lifecycle technology and better trans-cutaneous energy transmission, potentially from Free-range Resonant Electrical Energy Delivery. In this review, we briefly discuss the history of LVADs and summarize the LVAD devices in the development pipeline seeking to address these issues.

4.
ASAIO J ; 70(4): e61-e64, 2024 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-37913501

RESUMO

Mechanical circulatory support for cardiogenic shock complicated by acute severe aortic regurgitation poses a unique challenge for traditional veno arterial extracorporeal membrane oxygenation (ECMO) because of rapidly rising left ventricular pressures accentuated by the increased afterload from retrograde flow in femoral cannulation. This process necessitates rapid left ventricular unloading while also allowing for adequate native left ventricular function. Herein, we describe a case of cardiogenic and septic shock secondary to methicillin-resistant Staphylococcus aureus complicated by acute severe aortic regurgitation temporized by left atrial-veno arterial (LA-VA) ECMO via the Livanova TandemHeart system. Left ventricular unloading created a window of hemodynamic stability allowing for optimization of multiorgan failure and infectious source control before surgical aortic valve replacement.


Assuntos
Insuficiência da Valva Aórtica , Oxigenação por Membrana Extracorpórea , Staphylococcus aureus Resistente à Meticilina , Humanos , Oxigenação por Membrana Extracorpórea/efeitos adversos , Insuficiência da Valva Aórtica/complicações , Insuficiência da Valva Aórtica/cirurgia , Choque Cardiogênico/etiologia , Choque Cardiogênico/cirurgia , Átrios do Coração/cirurgia
5.
Indian J Thorac Cardiovasc Surg ; : 1-11, 2023 Feb 16.
Artigo em Inglês | MEDLINE | ID: mdl-36820202

RESUMO

Recent advances in veno-arterial (VA) and veno-venous (VV) extracorporeal membrane oxygenation (ECMO) technology and management have enabled us to support patients with cardiac and/or pulmonary failure, who may have previously been considered untreatable. VA ECMO and VV ECMO are by definition transient therapies and serve as a bridge to recovery, bridge to decision, bridge to transplant, or bridge to no recovery. Weaning ECMO should be considered for all patients once native cardiac and pulmonary function show signs of recovery. Currently, there are no universally accepted protocols for weaning VA and VV ECMO, and consequently, each individual center follows their own weaning protocols. The aim of this review article is to describe different approaches to safely wean from VA and VV ECMO.

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