AIM： To determine the feasibility of performing computed tomography （CT）-guided transpulmonary radiofrequency ablation （RFA） for hepatocellular carcinoma （HCC） located in the hepatic dome. METHODS： A total of ...AIM： To determine the feasibility of performing computed tomography （CT）-guided transpulmonary radiofrequency ablation （RFA） for hepatocellular carcinoma （HCC） located in the hepatic dome. METHODS： A total of seven patients with HCC comprising seven nodules located in the hepatic dome were treated from April 2004 to December 2004. CTguided transpulmonary RFA was performed using a cool-tip type electrode （Radionics Company） based on a standardized energy protocol. All tumors located in the hepatic dome were not detectable by the usual ultrasound （US） methods. The lesion diameters ranged from 15 to 27 mm. RESULTS： RFA was technically feasible in all the patients. The puncture procedure was performed twice or less and the total average performance time was 40.6 min. Local tumor control was achieved in all the patients. The necrosis diameter ranged from 25 to 35 mm. The mean follow-up period was 9.6 （7-14 mo） mo. There was no local recurrenceat the follow-up points. Pneumothorax requiring pleural drainage was the main complication, which was observed in two of the seven patients （28.6%）. However, it improved with chest drainage tube, and the tube could be removed within 2-3 d. No other major complications were observed.CONCLUSION： CT-guided puncture is useful for the treatment of tumors located in the hepatic dome which are hardly detectable by US, even though pneumothorax sometimes may occur as a complication. In the cases with adhesion in the pleura for which artificial pleural effusion methods are not appropriate, CT-guided RFA is thus considered to be an alternative treatment for HCC located in the hepatic dome.展开更多
Background Intra-abdominal hypertension （IAH） is common in acute respiratory distress syndrome （ARDS） patients and when resulting in decrease of chest wall compliance will weaken the effect of positive end expirat...Background Intra-abdominal hypertension （IAH） is common in acute respiratory distress syndrome （ARDS） patients and when resulting in decrease of chest wall compliance will weaken the effect of positive end expiratory pressure （PEEP）. We investigated the effect of PEEP titrated by transpulmonary pressure （Ptp） on oxygenation and respiratory mechanics in ARDS patients with IAH compared with PEEP titrated by ARDSnet protocol. Methods ARDS patients admitted to the intensive care unit （ICU） of the Zhongda Hospital were enrolled. Patients were ventilated with volume control mode with tidal volume of 6 ml/kg under two different PEEP levels titrated by Ptp method and ARDSnet protocol. Respiratory mechanics, gas exchange and haemodynamics were measured after 30 minutes of ventilation in each round. IAH was defined as intra-abdominal pressure of 12 mmHg or more, Results Seven ARDS patients with IAH and 8 ARDS patients without IAH were enrolled. PEEP titrated by Ptp were significant higher than PEEP titrated by ARDSnet protocol in both ARDS patients with IAH （（17.3±2.6）cmH20 vs. （6.3±1.6） cmH2O and without IAH （（9.5±2.1） cmH2O vs. （7.8±1.9） cmH2O）. Arterial pressure of O2/fraction of inspired oxygen （PaO2/ FiO2） was much higher under PEEP titrated by Ptp when compared with PEEP titrated by ARDSnet protocol in ARDS patients with IAH （（27.2±4.0） cmHg vs. （20.9± 5.0） cmHg. But no significant difference of PaO2/FiO2 between the two methods was found in ARDS patients without IAH. In ARDS patients with IAH, static compliance of lung and respiratory system were higher under PEEP titrated by Ptp than by ARDSnet protocol. In ARDS patients with IAH, central venous pressure （CVP） was higher during PEEP titrated by Ptp than by ARDSnet protocol. Conclusion Positive end expiratory pressure titrated by transpulmonary pressure was higher than PEEP titrated by ARDSnet protocol and improved oxygenation and respiratory mechanics in ARDS patients with IAH.展开更多
Objective： The subclavian vein （SCV） is usually used to inject the indicator of cold saline for a transpul- monary thermodilution （TPTD） measurement. The SCV catheter being misplaced into the internal jugular （...Objective： The subclavian vein （SCV） is usually used to inject the indicator of cold saline for a transpul- monary thermodilution （TPTD） measurement. The SCV catheter being misplaced into the internal jugular （IJV） vein is a common occurrence. The present study explores the influence of a misplaced SCV catheter on TPTD variables. Methods： Thirteen severe acute pancreatitis （SAP） patients with malposition of the SCV catheter were enrolled in this study. TPTD variables including cardiac index （CI）, global end-diastolic volume index （GEDVI）, intrathoracic blood volume index （ITBVI）, and extravascular lung water index （EVLWl） were obtained after injection of cold saline via the misplaced SCV catheter. Then, the misplaced SCV catheter was removed and IJV access was constructed for a further set of TPTD variables. Comparisons were made between the TPTD results measured through the IJV and mis- placed SCV accesses. Results： A total of 104 measurements were made from TPTD curves after injection of cold saline via the IJV and misplaced SCV accesses. Bland-Altman analysis demonstrated an overestimation of ＋111.40 ml/m2 （limits of agreement： 6.13 and 216.70 ml/m2） for GEDVI and ITBVI after a misplaced SCV injection. There were no significant influences on CI and EVLWI. The biases of ＋0.17 L/（min.m2） for CI and ＋0.17 ml/kg for EVLWI were re- vealed by Bland-Altman analysis. Conclusions： The malposition of an SCV catheter does influence the accuracy of TPTD variables, especially GEDVI and ITBVI. The position of the SCV catheter should be confirmed by chest X-ray in order to make good use of the TPTD measurements.展开更多
Objective： Comparison of global end-diastolic volume index （GEDVI） obtained by femoral and jugular transpulmonary thermodilution （TPTD） indicator injections using the EV1000NolumnView device （Edwards Lifesci- e...Objective： Comparison of global end-diastolic volume index （GEDVI） obtained by femoral and jugular transpulmonary thermodilution （TPTD） indicator injections using the EV1000NolumnView device （Edwards Lifesci- ences, Irvine, USA）. Methods： In an 87-year-old woman with hypovolemic shock and equipped with both jugular and femoral vein access and monitored with the EV1000NolumeView device, we recorded 10 datasets, each comprising duplicate TPTD via femoral access and duplicate TPTD （20 ml cold saline） via jugular access. Results： Mean femoral GEDVI （（674.6±52.3） ml/m2） was significantly higher than jugular GEDVI （（552.3±69.7） ml/m2）, with P=-0.003. Bland-Airman analysis demonstrated a bias of （＋122±61） ml/m2, limits of agreement of -16 and ＋260 ml/m2, and a percentage error of 22%. Use of the correction-formula recently suggested for the PiCCO device significantly reduced bias and percentage error. Similarly, mean values of parameters derived from GEDVI such as pulmonary vascular permeability index （PVPI; 1.244±0.101 vs. 1.522±0.139; P〈0.001） and global ejection fraction （GEF; （24.7±1.6）% vs. （28.1±1.8）%; P〈0.001） were significantly different in the case of femoral compared to jugular indicator injection. Fur- thermore, the mean cardiac index derived from femoral indicator injection （（4.50±0.36） L/（min.m2）） was significantly higher （P=0.02） than that derived from jugular indicator injection （（4.12±0.44） L/（min.m2））, resulting in a bias of （＋0.38±0.37） L/（min.m2） and a percentage error of 19.4%. Conclusions： Femoral access for indicator injection results in markedly altered values provided by the EV1000NolumeView , particularly for GEDVI, PVPI, and GEF.展开更多
Acute respiratory distress syndrome(ARDS) represents a serious problem in critically ill patients and is associated with in-hospital mortality rates of 33%-52%. Recruitment maneuvers(RMs) are a simple, low-cost, feasi...Acute respiratory distress syndrome(ARDS) represents a serious problem in critically ill patients and is associated with in-hospital mortality rates of 33%-52%. Recruitment maneuvers(RMs) are a simple, low-cost, feasible intervention that can be performed at the bedside in patients with ARDS. RMs are characterized by the application of airway pressure to increase transpulmonary pressure transiently. Once non-aerated lung units are reopened, improvements are observed in respiratory system mechanics, alveolar reaeration on computed tomography, and improvements in gas exchange(functional recruitment). However, the reopening process could lead to vascular compression, which can be associated with overinflation, and gas exchange may not improve as expected(anatomical recruitment). The purpose of this review was to discuss the effects of different RM strategies- sustained inflation, intermittent sighs, and stepwise increases of positive end-expiratory pressure(PEEP) and/or airway inspiratory pressure- on the following parameters: hemodynamics, oxygenation, barotrauma episodes, and lung recruitability through physiological variables and imaging techniques. RMs and PEEP titration are interdependent events for the success of ventilatory management. PEEP should be adjusted on the basis of respiratory system mechanics and oxygenation. Recent systematic reviews and meta-analyses suggest that RMs are associated with lower mortality in patients with ARDS. However, the optimal RM method(i.e., that providing the best balance of benefit and harm) and the effects of RMs on clinical outcome are still under discussion, and further evidence is needed.展开更多
Objectives: Pulmonary valve insufficiency and right ventricular dysfunction may contribute to early and late morbidity and mortality after repair of Tetralogy of Fallot. Right ventricular dysfunction may be attributed...Objectives: Pulmonary valve insufficiency and right ventricular dysfunction may contribute to early and late morbidity and mortality after repair of Tetralogy of Fallot. Right ventricular dysfunction may be attributed to ventriculotomy incision, especially, when it is combined with a transannular patch as employed in the transventricular repair. Transatrial/transpulmonary approach without ventriculotomy and an attempt to preserve the pulmonary valve has been advocated as a method potentially diminishing such adverse events. The prevalence of associated morbidity and mortality and analysis of the results of various surgical approaches for repair of Tetralogy of Fallot formed the basis of this study. Methods: Nine hundred and ninety five patients during 20 yearS period (from 1992 and 2012) with primary diagnosis of Tetralogy of Fallot that underwent total repair operations in two medical centers were analyzed. The mean age of the patients was 2.9 ± 6.9 SE, with female/male ratio of 0.25. The mean long follow-up was 94 months ± 112 SD. Results: Repair via ventriculotomy with transannular patch was the most common technique (n = 627, 63%), followed by infundibulotomy without transannular patch (20%) and transatrial/transpulmonary approach without ventriculotomy (15%). The operative and long term mortality were 3.2% and 4.4%;2% and 3.1%;2% and 2.7% respectively. The overall operative and long term mortality for repairs was 2.9% and 3.4%, with high 3.94% and 6.6% respectively for repairs with right ventricular pulmonary valve conduit. There was statistically significant correlation between the type of repair and mortality risk. Use of transannular patch with ventriculotomy was associated with significant increase in overall mortality risk and operative mortality compared with ventriculotomy without transannular patch. [Odds ratio, 2.10;95% confidence interval: 1.29-3.64]. Operations that have been performed before 2000 have resulted in increased operative risk compared with those performed after 2000. [Odds ratio 1.45;95% confidence interval: 1.03-2.01]. Conclusions: Overall mortality for Tetralogy of Fallot repair was low. The repair by ventriculotomy with transannular patch was the most common technique and was associated with higher mortality. Repairs through infundibulotomy without transannular patch and repair without ventriculotomy were less common, but were associated with lower mortality. Current advances in management, anatomical substrate of the lesion, choice of a repair and surgical expertise may all determine the mortality risk.展开更多
With the advancement of medical technique and application of the new immunosuppressant agents, cardiac transplantation has become an effective treatment for end-stage heart disease caused by different reasons. The ort...With the advancement of medical technique and application of the new immunosuppressant agents, cardiac transplantation has become an effective treatment for end-stage heart disease caused by different reasons. The orthotopic procedure has been performed in many countries nowadays. Whether it is successful or not mainly depends on harvesting the denoted heart, operative technique and perioperative management.展开更多
Cardiogenic shock(CS)is a life-threatening condition characterized by acute end-organ hypoperfusion due to inadequate cardiac output that can result in multiorgan failure,which may lead to death.The diminished cardiac...Cardiogenic shock(CS)is a life-threatening condition characterized by acute end-organ hypoperfusion due to inadequate cardiac output that can result in multiorgan failure,which may lead to death.The diminished cardiac output in CS leads to systemic hypoperfusion and maladaptive cycles of ischemia,inflammation,vasoconstriction,and volume overload.Obviously,the optimal management of CS needs to be readjusted in view of the predominant dysfunction,which may be guided by hemodynamic monitoring.Hemodynamic monitoring enables(1)characterization of the type of cardiac dysfunction and the degree of its severity,(2)very early detection of associated vasoplegia,(3)detection and monitoring of organ dysfunction and tissue oxygenation,and(4)guidance of the introduction and optimization of inotropes and vasopressors as well as the timing of mechanical support.It is now well documented that early recognition,classification,and precise phenotyping via early hemodynamic monitoring(e.g.,echocardiography,invasive arterial pressure,and the evaluation of organ dysfunction and parameters derived from central venous catheterization)improve patient outcomes.In more severe disease,advanced hemodynamic monitoring with pulmonary artery catheterization and the use of transpulmonary thermodilution devices is useful to facilitate the right timing of the indication,weaning from mechanical cardiac support,and guidance on inotropic treatments,thus helping to reduce mortality.In this review,we detail the different parameters relevant to each monitoring approach and the way they can be used to support optimal management of these patients.展开更多
Resuscitation of septic shock is a complex issue because the cardiovascular disturbances that characterize septic shock vary from one patient to another and can also change over time in the same patient. Therefore, di...Resuscitation of septic shock is a complex issue because the cardiovascular disturbances that characterize septic shock vary from one patient to another and can also change over time in the same patient. Therefore, different therapies (fluids, vasopressors, and inotropes) should be individually and carefully adapted to provide personalized and adequate treatment. Implementation of this scenario requires the collection and collation of all feasible information, including multiple hemodynamic variables. In this review article, we propose a logical stepwise approach to integrate relevant hemodynamic variables and provide the most appropriate treatment for septic shock.展开更多
During the spring of 2009, a pandemic novel influenza A （H1NI） virus emerged and spread globally. As of January 3, 2009, more than 208 countries and overseas territories or communities have reported laboratoryconfir...During the spring of 2009, a pandemic novel influenza A （H1NI） virus emerged and spread globally. As of January 3, 2009, more than 208 countries and overseas territories or communities have reported laboratoryconfirmed cases of pandemic influenza H1N1 2009, including at least 12 799 death cases.1 Critical cases developed severe acute respiratory distress syndrome （ARDS） rapidly, which was refractory to conventional mechanical ventilation and rescue therapies.展开更多
基金Supported by the grant of Center of E-xcellence,Biomedical Research Using Accelerator Technology
文摘AIM： To determine the feasibility of performing computed tomography （CT）-guided transpulmonary radiofrequency ablation （RFA） for hepatocellular carcinoma （HCC） located in the hepatic dome. METHODS： A total of seven patients with HCC comprising seven nodules located in the hepatic dome were treated from April 2004 to December 2004. CTguided transpulmonary RFA was performed using a cool-tip type electrode （Radionics Company） based on a standardized energy protocol. All tumors located in the hepatic dome were not detectable by the usual ultrasound （US） methods. The lesion diameters ranged from 15 to 27 mm. RESULTS： RFA was technically feasible in all the patients. The puncture procedure was performed twice or less and the total average performance time was 40.6 min. Local tumor control was achieved in all the patients. The necrosis diameter ranged from 25 to 35 mm. The mean follow-up period was 9.6 （7-14 mo） mo. There was no local recurrenceat the follow-up points. Pneumothorax requiring pleural drainage was the main complication, which was observed in two of the seven patients （28.6%）. However, it improved with chest drainage tube, and the tube could be removed within 2-3 d. No other major complications were observed.CONCLUSION： CT-guided puncture is useful for the treatment of tumors located in the hepatic dome which are hardly detectable by US, even though pneumothorax sometimes may occur as a complication. In the cases with adhesion in the pleura for which artificial pleural effusion methods are not appropriate, CT-guided RFA is thus considered to be an alternative treatment for HCC located in the hepatic dome.
基金This study was supported by the grants from Foundation of National Key Clinical Department of Critical Care Medicine （2010）, the Ministry of Health of China （Special Fund for Health scientific Research in the Public Interest Program No. 201202011） and the National Natural Science Foundation of China （No. 81070049 and No. 81170057）.
文摘Background Intra-abdominal hypertension （IAH） is common in acute respiratory distress syndrome （ARDS） patients and when resulting in decrease of chest wall compliance will weaken the effect of positive end expiratory pressure （PEEP）. We investigated the effect of PEEP titrated by transpulmonary pressure （Ptp） on oxygenation and respiratory mechanics in ARDS patients with IAH compared with PEEP titrated by ARDSnet protocol. Methods ARDS patients admitted to the intensive care unit （ICU） of the Zhongda Hospital were enrolled. Patients were ventilated with volume control mode with tidal volume of 6 ml/kg under two different PEEP levels titrated by Ptp method and ARDSnet protocol. Respiratory mechanics, gas exchange and haemodynamics were measured after 30 minutes of ventilation in each round. IAH was defined as intra-abdominal pressure of 12 mmHg or more, Results Seven ARDS patients with IAH and 8 ARDS patients without IAH were enrolled. PEEP titrated by Ptp were significant higher than PEEP titrated by ARDSnet protocol in both ARDS patients with IAH （（17.3±2.6）cmH20 vs. （6.3±1.6） cmH2O and without IAH （（9.5±2.1） cmH2O vs. （7.8±1.9） cmH2O）. Arterial pressure of O2/fraction of inspired oxygen （PaO2/ FiO2） was much higher under PEEP titrated by Ptp when compared with PEEP titrated by ARDSnet protocol in ARDS patients with IAH （（27.2±4.0） cmHg vs. （20.9± 5.0） cmHg. But no significant difference of PaO2/FiO2 between the two methods was found in ARDS patients without IAH. In ARDS patients with IAH, static compliance of lung and respiratory system were higher under PEEP titrated by Ptp than by ARDSnet protocol. In ARDS patients with IAH, central venous pressure （CVP） was higher during PEEP titrated by Ptp than by ARDSnet protocol. Conclusion Positive end expiratory pressure titrated by transpulmonary pressure was higher than PEEP titrated by ARDSnet protocol and improved oxygenation and respiratory mechanics in ARDS patients with IAH.
基金Project supported by the National Natural Science Foundation of China(Nos.81501644,81471623,81130007,81270446,and 30801188)the Key Science and Technology Innovation Team Project of the Science and Technology Department of Zhejiang Province(No.2011R50018-16),China
文摘Objective： The subclavian vein （SCV） is usually used to inject the indicator of cold saline for a transpul- monary thermodilution （TPTD） measurement. The SCV catheter being misplaced into the internal jugular （IJV） vein is a common occurrence. The present study explores the influence of a misplaced SCV catheter on TPTD variables. Methods： Thirteen severe acute pancreatitis （SAP） patients with malposition of the SCV catheter were enrolled in this study. TPTD variables including cardiac index （CI）, global end-diastolic volume index （GEDVI）, intrathoracic blood volume index （ITBVI）, and extravascular lung water index （EVLWl） were obtained after injection of cold saline via the misplaced SCV catheter. Then, the misplaced SCV catheter was removed and IJV access was constructed for a further set of TPTD variables. Comparisons were made between the TPTD results measured through the IJV and mis- placed SCV accesses. Results： A total of 104 measurements were made from TPTD curves after injection of cold saline via the IJV and misplaced SCV accesses. Bland-Altman analysis demonstrated an overestimation of ＋111.40 ml/m2 （limits of agreement： 6.13 and 216.70 ml/m2） for GEDVI and ITBVI after a misplaced SCV injection. There were no significant influences on CI and EVLWI. The biases of ＋0.17 L/（min.m2） for CI and ＋0.17 ml/kg for EVLWI were re- vealed by Bland-Altman analysis. Conclusions： The malposition of an SCV catheter does influence the accuracy of TPTD variables, especially GEDVI and ITBVI. The position of the SCV catheter should be confirmed by chest X-ray in order to make good use of the TPTD measurements.
文摘Objective： Comparison of global end-diastolic volume index （GEDVI） obtained by femoral and jugular transpulmonary thermodilution （TPTD） indicator injections using the EV1000NolumnView device （Edwards Lifesci- ences, Irvine, USA）. Methods： In an 87-year-old woman with hypovolemic shock and equipped with both jugular and femoral vein access and monitored with the EV1000NolumeView device, we recorded 10 datasets, each comprising duplicate TPTD via femoral access and duplicate TPTD （20 ml cold saline） via jugular access. Results： Mean femoral GEDVI （（674.6±52.3） ml/m2） was significantly higher than jugular GEDVI （（552.3±69.7） ml/m2）, with P=-0.003. Bland-Airman analysis demonstrated a bias of （＋122±61） ml/m2, limits of agreement of -16 and ＋260 ml/m2, and a percentage error of 22%. Use of the correction-formula recently suggested for the PiCCO device significantly reduced bias and percentage error. Similarly, mean values of parameters derived from GEDVI such as pulmonary vascular permeability index （PVPI; 1.244±0.101 vs. 1.522±0.139; P〈0.001） and global ejection fraction （GEF; （24.7±1.6）% vs. （28.1±1.8）%; P〈0.001） were significantly different in the case of femoral compared to jugular indicator injection. Fur- thermore, the mean cardiac index derived from femoral indicator injection （（4.50±0.36） L/（min.m2）） was significantly higher （P=0.02） than that derived from jugular indicator injection （（4.12±0.44） L/（min.m2））, resulting in a bias of （＋0.38±0.37） L/（min.m2） and a percentage error of 19.4%. Conclusions： Femoral access for indicator injection results in markedly altered values provided by the EV1000NolumeView , particularly for GEDVI, PVPI, and GEF.
基金Supported by Brazilian Council for Scientific and Technological Development(CNPq),Carlos Chagas Filho Rio de Janeiro State Research Foundation(FAPERJ),Department of Science and Technology(DECIT)/Brazilian Ministry of HealthCoordination for the Improvement of Higher Level Personnel(CAPES)
文摘Acute respiratory distress syndrome(ARDS) represents a serious problem in critically ill patients and is associated with in-hospital mortality rates of 33%-52%. Recruitment maneuvers(RMs) are a simple, low-cost, feasible intervention that can be performed at the bedside in patients with ARDS. RMs are characterized by the application of airway pressure to increase transpulmonary pressure transiently. Once non-aerated lung units are reopened, improvements are observed in respiratory system mechanics, alveolar reaeration on computed tomography, and improvements in gas exchange(functional recruitment). However, the reopening process could lead to vascular compression, which can be associated with overinflation, and gas exchange may not improve as expected(anatomical recruitment). The purpose of this review was to discuss the effects of different RM strategies- sustained inflation, intermittent sighs, and stepwise increases of positive end-expiratory pressure(PEEP) and/or airway inspiratory pressure- on the following parameters: hemodynamics, oxygenation, barotrauma episodes, and lung recruitability through physiological variables and imaging techniques. RMs and PEEP titration are interdependent events for the success of ventilatory management. PEEP should be adjusted on the basis of respiratory system mechanics and oxygenation. Recent systematic reviews and meta-analyses suggest that RMs are associated with lower mortality in patients with ARDS. However, the optimal RM method(i.e., that providing the best balance of benefit and harm) and the effects of RMs on clinical outcome are still under discussion, and further evidence is needed.
文摘Objectives: Pulmonary valve insufficiency and right ventricular dysfunction may contribute to early and late morbidity and mortality after repair of Tetralogy of Fallot. Right ventricular dysfunction may be attributed to ventriculotomy incision, especially, when it is combined with a transannular patch as employed in the transventricular repair. Transatrial/transpulmonary approach without ventriculotomy and an attempt to preserve the pulmonary valve has been advocated as a method potentially diminishing such adverse events. The prevalence of associated morbidity and mortality and analysis of the results of various surgical approaches for repair of Tetralogy of Fallot formed the basis of this study. Methods: Nine hundred and ninety five patients during 20 yearS period (from 1992 and 2012) with primary diagnosis of Tetralogy of Fallot that underwent total repair operations in two medical centers were analyzed. The mean age of the patients was 2.9 ± 6.9 SE, with female/male ratio of 0.25. The mean long follow-up was 94 months ± 112 SD. Results: Repair via ventriculotomy with transannular patch was the most common technique (n = 627, 63%), followed by infundibulotomy without transannular patch (20%) and transatrial/transpulmonary approach without ventriculotomy (15%). The operative and long term mortality were 3.2% and 4.4%;2% and 3.1%;2% and 2.7% respectively. The overall operative and long term mortality for repairs was 2.9% and 3.4%, with high 3.94% and 6.6% respectively for repairs with right ventricular pulmonary valve conduit. There was statistically significant correlation between the type of repair and mortality risk. Use of transannular patch with ventriculotomy was associated with significant increase in overall mortality risk and operative mortality compared with ventriculotomy without transannular patch. [Odds ratio, 2.10;95% confidence interval: 1.29-3.64]. Operations that have been performed before 2000 have resulted in increased operative risk compared with those performed after 2000. [Odds ratio 1.45;95% confidence interval: 1.03-2.01]. Conclusions: Overall mortality for Tetralogy of Fallot repair was low. The repair by ventriculotomy with transannular patch was the most common technique and was associated with higher mortality. Repairs through infundibulotomy without transannular patch and repair without ventriculotomy were less common, but were associated with lower mortality. Current advances in management, anatomical substrate of the lesion, choice of a repair and surgical expertise may all determine the mortality risk.
文摘With the advancement of medical technique and application of the new immunosuppressant agents, cardiac transplantation has become an effective treatment for end-stage heart disease caused by different reasons. The orthotopic procedure has been performed in many countries nowadays. Whether it is successful or not mainly depends on harvesting the denoted heart, operative technique and perioperative management.
文摘Cardiogenic shock(CS)is a life-threatening condition characterized by acute end-organ hypoperfusion due to inadequate cardiac output that can result in multiorgan failure,which may lead to death.The diminished cardiac output in CS leads to systemic hypoperfusion and maladaptive cycles of ischemia,inflammation,vasoconstriction,and volume overload.Obviously,the optimal management of CS needs to be readjusted in view of the predominant dysfunction,which may be guided by hemodynamic monitoring.Hemodynamic monitoring enables(1)characterization of the type of cardiac dysfunction and the degree of its severity,(2)very early detection of associated vasoplegia,(3)detection and monitoring of organ dysfunction and tissue oxygenation,and(4)guidance of the introduction and optimization of inotropes and vasopressors as well as the timing of mechanical support.It is now well documented that early recognition,classification,and precise phenotyping via early hemodynamic monitoring(e.g.,echocardiography,invasive arterial pressure,and the evaluation of organ dysfunction and parameters derived from central venous catheterization)improve patient outcomes.In more severe disease,advanced hemodynamic monitoring with pulmonary artery catheterization and the use of transpulmonary thermodilution devices is useful to facilitate the right timing of the indication,weaning from mechanical cardiac support,and guidance on inotropic treatments,thus helping to reduce mortality.In this review,we detail the different parameters relevant to each monitoring approach and the way they can be used to support optimal management of these patients.
文摘Resuscitation of septic shock is a complex issue because the cardiovascular disturbances that characterize septic shock vary from one patient to another and can also change over time in the same patient. Therefore, different therapies (fluids, vasopressors, and inotropes) should be individually and carefully adapted to provide personalized and adequate treatment. Implementation of this scenario requires the collection and collation of all feasible information, including multiple hemodynamic variables. In this review article, we propose a logical stepwise approach to integrate relevant hemodynamic variables and provide the most appropriate treatment for septic shock.
文摘During the spring of 2009, a pandemic novel influenza A （H1NI） virus emerged and spread globally. As of January 3, 2009, more than 208 countries and overseas territories or communities have reported laboratoryconfirmed cases of pandemic influenza H1N1 2009, including at least 12 799 death cases.1 Critical cases developed severe acute respiratory distress syndrome （ARDS） rapidly, which was refractory to conventional mechanical ventilation and rescue therapies.
