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Management of Challenging Cardiopulmonary Bypass Separation
F. Monaco, AL. Di Prima, JH. Kim, MJ. Plamondon, A. Yavorovskiy, V. Likhvantsev, V. Lomivorotov, LA. Hajjar, G. Landoni, H. Riha, AMGA. Farag, G. Gazivoda, FS. Silva, C. Lei, N. Bradic, MR. El-Tahan, NAR. Bukamal, L. Sun, CY. Wang
Jazyk angličtina Země Spojené státy americké
Typ dokumentu časopisecké články, přehledy
- MeSH
- dysfunkce pravé srdeční komory * MeSH
- echokardiografie transezofageální MeSH
- hrudní chirurgie * MeSH
- kardiochirurgické výkony * MeSH
- kardiopulmonální bypass škodlivé účinky MeSH
- lidé MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
SEPARATION from cardiopulmonary bypass (CPB) after cardiac surgery is a progressive transition from full mechanical circulatory and respiratory support to spontaneous mechanical activity of the lungs and heart. During the separation phase, measurements of cardiac performance with transesophageal echocardiography (TEE) provide the rationale behind the diagnostic and therapeutic decision-making process. In many cases, it is possible to predict a complex separation from CPB, such as when there is known preoperative left or right ventricular dysfunction, bleeding, hypovolemia, vasoplegia, pulmonary hypertension, or owing to technical complications related to the surgery. Prompt diagnosis and therapeutic decisions regarding mechanical or pharmacologic support have to be made within a few minutes. In fact, a complex separation from CPB if not adequately treated leads to a poor outcome in the vast majority of cases. Unfortunately, no specific criteria defining complex separation from CPB and no management guidelines for these patients currently exist. Taking into account the above considerations, the aim of the present review is to describe the most common scenarios associated with a complex CPB separation and to suggest strategies, pharmacologic agents, and para-corporeal mechanical devices that can be adopted to manage patients with complex separation from CPB. The routine management strategies of complex CPB separation of 17 large cardiac centers from 14 countries in 5 continents will also be described.
5 Negovsky Reanimatology Research Institute Moscow Russia
Department of Anaesthesiology Faculty of Medicine University of Malaya Kuala Lumpur Malaysia
Department of Anesthesia and Intensive Care Cardiovascular Institute Dedinje Belgrade Serbia
Department of Anesthesia and Intensive Care IRCCS San Raffaele Scientific Institute Milan Italy
Department of Anesthesiology and Intensive Care 1st Moscow State Medical University Moscow Russia
Department of Anesthesiology and Intensive Care Novosibirsk State University Novosibirsk Russia
Department of Anesthesiology and Pain Medicine University of Ottawa Ottawa Canada
Department of Anesthesiology Hospital de Santa Maria Lisbon Portugal
Department of Cardiac Anesthesia King Abdullah Medical City Holy Capital Makkah Saudi Arabia
Faculty of Medicine Vita Salute San Raffaele University Milan Italy
Intensive Care Department Moscow Regional Research and Clinical Institute Moscow Russia
Citace poskytuje Crossref.org
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- $a SEPARATION from cardiopulmonary bypass (CPB) after cardiac surgery is a progressive transition from full mechanical circulatory and respiratory support to spontaneous mechanical activity of the lungs and heart. During the separation phase, measurements of cardiac performance with transesophageal echocardiography (TEE) provide the rationale behind the diagnostic and therapeutic decision-making process. In many cases, it is possible to predict a complex separation from CPB, such as when there is known preoperative left or right ventricular dysfunction, bleeding, hypovolemia, vasoplegia, pulmonary hypertension, or owing to technical complications related to the surgery. Prompt diagnosis and therapeutic decisions regarding mechanical or pharmacologic support have to be made within a few minutes. In fact, a complex separation from CPB if not adequately treated leads to a poor outcome in the vast majority of cases. Unfortunately, no specific criteria defining complex separation from CPB and no management guidelines for these patients currently exist. Taking into account the above considerations, the aim of the present review is to describe the most common scenarios associated with a complex CPB separation and to suggest strategies, pharmacologic agents, and para-corporeal mechanical devices that can be adopted to manage patients with complex separation from CPB. The routine management strategies of complex CPB separation of 17 large cardiac centers from 14 countries in 5 continents will also be described.
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- $a Hajjar, Ludhmila Abrahão $u Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy; Department of Cardiopneumology, Instituto do Coracao, University of São Paulo, Hospital SirioLibanes, São Paulo, Brazil
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