Editorial

3 pages, 2047 KiB

Open AccessEditorial

Intra-Aortic Balloon Pump and Ischemic Cardiogenic Shock May Still Be a Valuable Association

by Florian Rey, Raphaël Giraud and Karim Bendjelid

J. Clin. Med. 2021, 10(4), 778; https://doi.org/10.3390/jcm10040778 - 16 Feb 2021

Cited by 2 | Viewed by 3478

The IABP gives rise to greater myocardial perfusion by increasing the coronary pressure gradient from the aorta to the coronary circulation at a time when the aortic valve is closed [...] Full article

(This article belongs to the Special Issue Current Status of Cardiac Anesthesiology and Intensive Care)

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Research

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10 pages, 2032 KiB

Open AccessArticle

To Balloon or Not to Balloon? The Effects of an Intra-Aortic Balloon-Pump on Coronary Artery Flow during Extracorporeal Circulation Simulating Normal and Low Cardiac Output Syndromes

by Philippe Reymond, Karim Bendjelid, Raphaël Giraud, Gérald Richard, Nicolas Murith, Mustafa Cikirikcioglu and Christoph Huber

J. Clin. Med. 2021, 10(22), 5333; https://doi.org/10.3390/jcm10225333 - 16 Nov 2021

Cited by 2 | Viewed by 2403

Abstract

ECMO is the most frequently used mechanical support for patients suffering from low cardiac output syndrome. Combining IABP with ECMO is believed to increase coronary artery blood flow, decrease high afterload, and restore systemic pulsatile flow conditions. This study evaluates that combined effect [...] Read more.

ECMO is the most frequently used mechanical support for patients suffering from low cardiac output syndrome. Combining IABP with ECMO is believed to increase coronary artery blood flow, decrease high afterload, and restore systemic pulsatile flow conditions. This study evaluates that combined effect on coronary artery flow during various load conditions using an in vitro circuit. In doing so, different clinical scenarios were simulated, such as normal cardiac output and moderate-to-severe heart failure. In the heart failure scenarios, we used peripheral ECMO support to compensate for the lowered cardiac output value and reach a default normal value. The increase in coronary blood flow using the combined IABP-ECMO setup was more noticeable in low heart rate conditions. At baseline, intermediate and severe LV failure levels, adding IABP increased coronary mean flow by 16%, 7.5%, and 3.4% (HR 60 bpm) and by 6%, 4.5%, and 2.5% (HR 100 bpm) respectively. Based on our in vitro study results, combining ECMO and IABP in a heart failure setup further improves coronary blood flow. This effect was more pronounced at a lower heart rate and decreased with heart failure, which might positively impact recovery from cardiac failure. Full article

(This article belongs to the Special Issue Current Status of Cardiac Anesthesiology and Intensive Care)

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Graphical abstract

15 pages, 1345 KiB

Open AccessArticle

Application of an Exploratory Knowledge-Discovery Pipeline Based on Machine Learning to Multi-Scale OMICS Data to Characterise Myocardial Injury in a Cohort of Patients with Septic Shock: An Observational Study

by Bernardo Bollen Pinto, Vicent Ribas Ripoll, Paula Subías-Beltrán, Antoine Herpain, Cristina Barlassina, Eliandre Oliveira, Roberta Pastorelli, Daniele Braga, Matteo Barcella, Laia Subirats, Julia Bauzá-Martinez, Antonia Odena, Manuela Ferrario, Giuseppe Baselli, Federico Aletti, Karim Bendjelid and on behalf of the Shockomics Consortium

J. Clin. Med. 2021, 10(19), 4354; https://doi.org/10.3390/jcm10194354 - 24 Sep 2021

Cited by 2 | Viewed by 2141

Abstract

Currently, there is no therapy targeting septic cardiomyopathy (SC), a key contributor to organ dysfunction in sepsis. In this study, we used a machine learning (ML) pipeline to explore transcriptomic, proteomic, and metabolomic data from patients with septic shock, and prospectively collected measurements [...] Read more.

Currently, there is no therapy targeting septic cardiomyopathy (SC), a key contributor to organ dysfunction in sepsis. In this study, we used a machine learning (ML) pipeline to explore transcriptomic, proteomic, and metabolomic data from patients with septic shock, and prospectively collected measurements of high-sensitive cardiac troponin and echocardiography. The purposes of the study were to suggest an exploratory methodology to identify and characterise the multiOMICs profile of (i) myocardial injury in patients with septic shock, and of (ii) cardiac dysfunction in patients with myocardial injury. The study included 27 adult patients admitted for septic shock. Peripheral blood samples for OMICS analysis and measurements of high-sensitive cardiac troponin T (hscTnT) were collected at two time points during the ICU stay. A ML-based study was designed and implemented to untangle the relations among the OMICS domains and the aforesaid biomarkers. The resulting ML pipeline consisted of two main experimental phases: recursive feature selection (FS) assessing the stability of biomarkers, and classification to characterise the multiOMICS profile of the target biomarkers. The application of a ML pipeline to circulate OMICS data in patients with septic shock has the potential to predict the risk of myocardial injury and the risk of cardiac dysfunction. Full article

(This article belongs to the Special Issue Current Status of Cardiac Anesthesiology and Intensive Care)

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10 pages, 573 KiB

Open AccessArticle

Airway Care Interventions for Invasively Ventilated Critically Ill Adults—A Dutch National Survey

by Willemke Stilma, Sophia M. van der Hoeven, Wilma J. M. Scholte op Reimer, Marcus J. Schultz, Louise Rose and Frederique Paulus

J. Clin. Med. 2021, 10(15), 3381; https://doi.org/10.3390/jcm10153381 - 30 Jul 2021

Cited by 8 | Viewed by 2602

Abstract

Airway care interventions may prevent accumulation of airway secretions and promote their evacuation, but evidence is scarce. Interventions include heated humidification, nebulization of mucolytics and/or bronchodilators, manual hyperinflation and use of mechanical insufflation-exsufflation (MI-E). Our aim is to identify current airway care practices [...] Read more.

Airway care interventions may prevent accumulation of airway secretions and promote their evacuation, but evidence is scarce. Interventions include heated humidification, nebulization of mucolytics and/or bronchodilators, manual hyperinflation and use of mechanical insufflation-exsufflation (MI-E). Our aim is to identify current airway care practices for invasively ventilated patients in intensive care units (ICU) in the Netherlands. A self–administered web-based survey was sent to a single pre–appointed representative of all ICUs in the Netherlands. Response rate was 85% (72 ICUs). We found substantial heterogeneity in the intensity and combinations of airway care interventions used. Most (81%) ICUs reported using heated humidification as a routine prophylactic intervention. All (100%) responding ICUs used nebulized mucolytics and/or bronchodilators; however, only 43% ICUs reported nebulization as a routine prophylactic intervention. Most (81%) ICUs used manual hyperinflation, although only initiated with a clinical indication like difficult oxygenation. Few (22%) ICUs used MI-E for invasively ventilated patients. Use was always based on the indication of insufficient cough strength or as a continuation of home use. In the Netherlands, use of routine prophylactic airway care interventions is common despite evidence of no benefit. There is an urgent need for evidence of the benefit of these interventions to inform evidence-based guidelines. Full article

(This article belongs to the Special Issue Current Status of Cardiac Anesthesiology and Intensive Care)

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10 pages, 586 KiB

Open AccessArticle

Relationship between 30 Days Mortality and Incidence of Intraoperative Cardiac Arrest According to the Timing of ECMO

by Taehwa Kim, Seungeun Lee and Sungkwang Lee

J. Clin. Med. 2021, 10(9), 1977; https://doi.org/10.3390/jcm10091977 - 05 May 2021

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Abstract

Background: Recently, the use of extracorporeal membrane oxygenation (ECMO) in noncardiac surgery, such as thoracic surgery, has increased. However, there have been no studies on the mortality and incidence of intraoperative cardiac arrest with or without ECMO during thoracic surgery. Methods: Between January [...] Read more.

Background: Recently, the use of extracorporeal membrane oxygenation (ECMO) in noncardiac surgery, such as thoracic surgery, has increased. However, there have been no studies on the mortality and incidence of intraoperative cardiac arrest with or without ECMO during thoracic surgery. Methods: Between January 2011 and October 2018, 63 patients received ECMO support during thoracic surgery. All patients who applied ECMO from starting at any time before surgery to the day of surgery were included. Patients were divided into the emergency ECMO group and the non-emergency ECMO group according to the timing of ECMO. We compared the factors related to 30 day mortality using Cox regression analysis. Results: The emergency ECMO and non-emergency ECMO groups comprised 27 and 36 patients, respectively. On the operation day, cardiopulmonary resuscitation (CPR) was a very important result, and only occurred in the emergency ECMO group (n = 20, 74.1% vs. 0%, p < 0.001). The most common cause of ECMO indication was the CPR in the emergency ECMO group and respiratory failure in the non-emergency ECMO group. There were significant differences in 30 day mortality between the emergency ECMO group and the non-emergency ECMO group (n = 12, 44.4% vs. n = 3, 8.3%, p = 0.001). The Kaplan–Meier analysis curve for 30 day mortality showed that the emergency ECMO group had a significantly higher rate of 30 day mortality than the non-emergency ECMO group (X² = 14.7, p < 0.001). Conclusions: A lower incidence of intraoperative cardiac arrest occurred in the non-emergency ECMO group than in the emergency ECMO group. Moreover, 30 day mortality was associated with emergency ECMO. Full article

(This article belongs to the Special Issue Current Status of Cardiac Anesthesiology and Intensive Care)

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9 pages, 1456 KiB

Open AccessArticle

Kinetic GFR Outperforms CKD-EPI for Slow Graft Function Prediction in the Immediate Postoperative Period Following Kidney Transplantation

by Jonathan Dash, Thomas Verissimo, Anna Faivre, Lena Berchtold, Thierry Berney, Jérôme Pugin, Sophie de Seigneux and David Legouis

J. Clin. Med. 2020, 9(12), 4003; https://doi.org/10.3390/jcm9124003 - 10 Dec 2020

Cited by 4 | Viewed by 2129

Abstract

Background: Rapid identification of patients at high risk for slow graft function (SGF) is of major importance in the immediate period following renal graft transplantation, both for early therapeutic decisions and long-term prognosis. Due to the high variability of serum creatinine levels after [...] Read more.

Background: Rapid identification of patients at high risk for slow graft function (SGF) is of major importance in the immediate period following renal graft transplantation, both for early therapeutic decisions and long-term prognosis. Due to the high variability of serum creatinine levels after surgery, glomerular filtration rate (GFR) estimation is challenging. In this situation, kinetic estimated GFR (KeGFR) equations are interesting tools but have never been assessed for the identification of SGF patients. Methods: We conducted a single-center retrospective cohort study, including all consecutive kidney allograft recipients in the University Hospitals of Geneva from 2008 to 2016. GFR was estimated using both CKD-EPI and KeGFR formulae. Their accuracies for SGF prediction were compared. Patients were followed up for one year after transplantation. Results: A total of 326 kidney recipients were analyzed. SGF occurred in 76 (23%) patients. KeGFR estimation stabilized from the day following kidney transplantation, more rapidly than CKD-EPI. Discrimination ability for SGF prediction was better for KeGFR than CKD-EPI (AUC 0.82 and 0.66, p < 0.001, respectively). Conclusion: KeGFR computed from the first day after renal transplantation was able to predict SGF with good discrimination, outperforming CKD-EPI estimation. SGF patients had lower renal graft function overall at the one-year follow up. Full article

(This article belongs to the Special Issue Current Status of Cardiac Anesthesiology and Intensive Care)

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Review

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30 pages, 1657 KiB

Open AccessReview

The Right Ventricle in COVID-19

by Jean Bonnemain, Zied Ltaief and Lucas Liaudet

J. Clin. Med. 2021, 10(12), 2535; https://doi.org/10.3390/jcm10122535 - 08 Jun 2021

Cited by 18 | Viewed by 4141

Abstract

Infection with the novel severe acute respiratory coronavirus-2 (SARS-CoV2) results in COVID-19, a disease primarily affecting the respiratory system to provoke a spectrum of clinical manifestations, the most severe being acute respiratory distress syndrome (ARDS). A significant proportion of COVID-19 patients also develop [...] Read more.

Infection with the novel severe acute respiratory coronavirus-2 (SARS-CoV2) results in COVID-19, a disease primarily affecting the respiratory system to provoke a spectrum of clinical manifestations, the most severe being acute respiratory distress syndrome (ARDS). A significant proportion of COVID-19 patients also develop various cardiac complications, among which dysfunction of the right ventricle (RV) appears particularly common, especially in severe forms of the disease, and which is associated with a dismal prognosis. Echocardiographic studies indeed reveal right ventricular dysfunction in up to 40% of patients, a proportion even greater when the RV is explored with strain imaging echocardiography. The pathophysiological mechanisms of RV dysfunction in COVID-19 include processes increasing the pulmonary vascular hydraulic load and others reducing RV contractility, which precipitate the acute uncoupling of the RV with the pulmonary circulation. Understanding these mechanisms provides the fundamental basis for the adequate therapeutic management of RV dysfunction, which incorporates protective mechanical ventilation, the prevention and treatment of pulmonary vasoconstriction and thrombotic complications, as well as the appropriate management of RV preload and contractility. This comprehensive review provides a detailed update of the evidence of RV dysfunction in COVID-19, its pathophysiological mechanisms, and its therapy. Full article

(This article belongs to the Special Issue Current Status of Cardiac Anesthesiology and Intensive Care)

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22 pages, 1736 KiB

Open AccessReview

Challenges in Patient Blood Management for Cardiac Surgery: A Narrative Review

by Valentina Rancati, Emmanuelle Scala, Zied Ltaief, Mohamed Ziyad Gunga, Matthias Kirsch, Lorenzo Rosner and Carlo Marcucci

J. Clin. Med. 2021, 10(11), 2454; https://doi.org/10.3390/jcm10112454 - 01 Jun 2021

Cited by 8 | Viewed by 4037

Abstract

About 15 years ago, Patient Blood Management (PBM) emerged as a new paradigm in perioperative medicine and rapidly found support of all major medical societies and government bodies. Blood products are precious, scarce and expensive and their use is frequently associated with adverse [...] Read more.

About 15 years ago, Patient Blood Management (PBM) emerged as a new paradigm in perioperative medicine and rapidly found support of all major medical societies and government bodies. Blood products are precious, scarce and expensive and their use is frequently associated with adverse short- and long-term outcomes. Recommendations and guidelines on the topic are published in an increasing rate. The concept aims at using an evidence-based approach to rationalize transfusion practices by optimizing the patient’s red blood cell mass in the pre-, intra- and postoperative periods. However, elegant as a concept, the implementation of a PBM program on an institutional level or even in a single surgical discipline like cardiac surgery, can be easier said than done. Many barriers, such as dogmatic ideas, logistics and lack of support from the medical and administrative departments need to be overcome and each center must find solutions to their specific problems. In this paper we present a narrative overview of the challenges and updated recommendations for the implementation of a PBM program in cardiac surgery. Full article

(This article belongs to the Special Issue Current Status of Cardiac Anesthesiology and Intensive Care)

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