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Jenkins DP, Martinez G, Salaunkey K, Reddy SA, Pepke-Zaba J. Perioperative Management in Pulmonary Endarterectomy. Semin Respir Crit Care Med 2023; 44:851-865. [PMID: 37487525 DOI: 10.1055/s-0043-1770123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/26/2023]
Abstract
Pulmonary endarterectomy (PEA) is the treatment of choice for patients with chronic thromboembolic pulmonary hypertension (PH), provided lesions are proximal enough in the pulmonary vasculature to be surgically accessible and the patient is well enough to benefit from the operation in the longer term. It is a major cardiothoracic operation, requiring specialized techniques and instruments developed over several decades to access and dissect out the intra-arterial fibrotic material. While in-hospital operative mortality is low (<5%), particularly in high-volume centers, careful perioperative management in the operating theater and intensive care is mandatory to balance ventricular performance, fluid balance, ventilation, and coagulation to avoid or treat complications. Reperfusion pulmonary edema, airway hemorrhage, and right ventricular failure are the most problematic complications, often requiring the use of extracorporeal membrane oxygenation to bridge to recovery. Successful PEA has been shown to improve both morbidity and mortality in large registries, with survival >70% at 10 years. For patients not suitable for PEA or with residual PH after PEA, balloon pulmonary angioplasty and/or PH medical therapy may prove beneficial. Here, we describe the indications for PEA, specific surgical and perioperative strategies, postoperative monitoring and management, and approaches for managing residual PH in the long term.
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Affiliation(s)
- David P Jenkins
- Department of Cardiothoracic Surgery, Royal Papworth Hospital NHS Foundation Trust, Cambridge Biomedical Campus, Cambridge, United Kingdom
| | - Guillermo Martinez
- Department of Anaesthesiology, Royal Papworth Hospital NHS Foundation Trust, Cambridge Biomedical Campus, Cambridge, United Kingdom
| | - Kiran Salaunkey
- Department of Anaesthesiology, Royal Papworth Hospital NHS Foundation Trust, Cambridge Biomedical Campus, Cambridge, United Kingdom
| | - S Ashwin Reddy
- Pulmonary Vascular Disease Unit, Royal Papworth Hospital NHS Foundation Trust, Cambridge Biomedical Campus, Cambridge, United Kingdom
| | - Joanna Pepke-Zaba
- Pulmonary Vascular Disease Unit, Royal Papworth Hospital NHS Foundation Trust, Cambridge Biomedical Campus, Cambridge, United Kingdom
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2
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Briassoulis G, Briassoulis P, Ilia S. The best PEEP or the optimal PEEP or the piece PEEP of the mechanical power puzzle? Crit Care 2022; 26:298. [PMID: 36192804 PMCID: PMC9527713 DOI: 10.1186/s13054-022-04162-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Accepted: 08/25/2022] [Indexed: 11/10/2022] Open
Affiliation(s)
- George Briassoulis
- grid.8127.c0000 0004 0576 3437Postgraduate Program “Emergency and Intensive Care in Children Adolescents and Young Adults”, Pediatric Intensive Care Unit, School of Medicine, University of Crete, Section 6D (Delta), Office 03, Voutes, 71003 Heraklion, Crete Greece
| | - Panagiotis Briassoulis
- grid.5216.00000 0001 2155 08002nd Department of Anaesthesiology, School of Medicine, Attikon Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Stavroula Ilia
- grid.8127.c0000 0004 0576 3437Postgraduate Program “Emergency and Intensive Care in Children Adolescents and Young Adults”, Pediatric Intensive Care Unit, School of Medicine, University of Crete, Section 6D (Delta), Office 03, Voutes, 71003 Heraklion, Crete Greece
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3
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Fu Z, Tao X, Xie W, Yang P, Gao Q, Wang J, Zhai Z. Different response of the oxygen pathway in patients with chronic thromboembolic pulmonary hypertension treated with pulmonary endarterectomy versus balloon pulmonary angioplasty. Front Cardiovasc Med 2022; 9:990207. [PMID: 36237910 PMCID: PMC9551285 DOI: 10.3389/fcvm.2022.990207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Accepted: 08/31/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundOxygen pathway limitation exists in chronic thromboembolic pulmonary hypertension (CTEPH). Pulmonary endarterectomy (PEA) and balloon pulmonary angioplasty (BPA) are two effective interventions for CTEPH, but their effects and comparison of these two interventions on the oxygen pathway are not well demonstrated.MethodsCTEPH patients with available pulmonary function test, hemodynamics, and blood gas analysis before and after the interventions were included for comparison of oxygen pathway in terms of lung ventilation, lung gas exchange, oxygen delivery, and oxygen extraction between these two interventions.ResultsThe change in the percentage of the predicted forced expiratory volume in the 1 s (−3.4 ± 12.7 vs. 3.8 ± 8.7%, P = 0.006) and forced vital capacity (−5.5 ± 13.0 vs. 4.2 ± 9.9%, P = 0.001) among the PEA group (n = 24) and BPA group (n = 46) were significantly different. Patients in the PEA group had a significant increase in their arterial oxygen saturation (from 92.5 ± 3.6 to 94.6 ± 2.4%, P = 0.022), while those in the BPA group had no change, which could be explained by a significant improvement in ventilation/perfusion (−0.48 ± 0.53 vs. −0.17 ± 0.41, P = 0.016). Compared with patients post-BPA, patients post-PEA were characterized by higher oxygen delivery (756.3 ± 229.1 vs. 628.8 ± 188.5 ml/min, P = 0.016) and higher oxygen extraction (203.3 ± 64.8 vs. 151.2 ± 31.9 ml/min, P = 0.001).ConclusionPartial amelioration of the oxygen pathway limitations could be achieved in CTEPH patients treated with PEA and BPA. CTEPH patients post-PEA had better performance in lung gas exchange, oxygen delivery, and extraction, while those post-BPA had better lung ventilation. Cardiopulmonary rehabilitation may assist in improving the impairment of the oxygen pathway.
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Affiliation(s)
- Zhihui Fu
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
- National Center for Respiratory Medicine, Beijing, China
- Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China
- National Clinical Research Center for Respiratory Diseases, Beijing, China
- Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, and Peking Union Medical College, Beijing, China
- Department of Pulmonary and Critical Care Medicine, Quanzhou First Hospital Affiliated to Fujian Medical University, Quanzhou, China
| | - Xincao Tao
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
- National Center for Respiratory Medicine, Beijing, China
- Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China
- National Clinical Research Center for Respiratory Diseases, Beijing, China
| | - Wanmu Xie
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
- National Center for Respiratory Medicine, Beijing, China
- Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China
- National Clinical Research Center for Respiratory Diseases, Beijing, China
| | - Peiran Yang
- National Center for Respiratory Medicine, Beijing, China
- Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China
- National Clinical Research Center for Respiratory Diseases, Beijing, China
- State Key Laboratory of Medical Molecular Biology, Department of Physiology, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Qian Gao
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
- National Center for Respiratory Medicine, Beijing, China
- Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China
- National Clinical Research Center for Respiratory Diseases, Beijing, China
| | - Jinzhi Wang
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Zhenguo Zhai
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
- National Center for Respiratory Medicine, Beijing, China
- Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China
- National Clinical Research Center for Respiratory Diseases, Beijing, China
- Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, and Peking Union Medical College, Beijing, China
- *Correspondence: Zhenguo Zhai,
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DELAPORTE A, PUJOLLE E, Van der LINDEN P, VINCENT JL, JOOSTEN A, ALEXANDER B, FILS JF, THÈS J, GENTY T, ION I, MERCIER O, FADEL E, STEPHAN F. Effect of 4% albumin priming solution on postoperative pulmonary edema in patients undergoing pulmonary thrombo-endarterectomy: a propensity-matched analysis. Minerva Anestesiol 2022; 88:754-755. [DOI: 10.23736/s0375-9393.22.16564-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Abstract
PURPOSE OF REVIEW Transpulmonary thermodilution (TPTD) devices invasively measure not only cardiac output but also several other haemodynamic variables estimating cardiac preload, cardiac preload, systolic function, the lung oedema and systolic function, the lung oedema and the pulmonary permeability. In light of the recent literature, we describe how different indices are measured, emphasize their clinical interest and list potential limits and side-effects of the technique. RECENT FINDINGS Estimation of cardiac output measurement with TPTD is now well established, at least when compared with the pulmonary artery catheter. The advantage of calibrating the pulse contour analysis, as it is allowed by TPTD indices, is clearly established over uncalibrated devices. The greatest advantage of TPTD is to measure extravascular lung water and pulmonary permeability, which may be useful to diagnose acute respiratory distress syndrome and manage fluid therapy in various critical diseases. It also allows a rapid detection of left ventricular systolic failure. The information it provides must be considered complementary to that provided by echocardiography. SUMMARY TPTD provides several indices that may help in making decisions during the therapeutic management of haemodynamically unstable patients. It should be used for the most critically ill patients, whose management requires a reliable, precise and holistic view of the cardiopulmonary condition.
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Tsuchiya N, Griffin L, Yamashiro T, Gibo S, Okane T, Yasutani T, Murayama S. Imaging findings of pulmonary edema: Part 2. Infrequent or unusual pulmonary edema with definitive imaging findings. Acta Radiol 2020; 61:195-203. [PMID: 31237773 DOI: 10.1177/0284185119856880] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Pulmonary edema is a common condition with numerous causes, some of which are infrequently encountered. This review article describes various uncommon conditions/disease that are associated with pulmonary edema and which show characteristic imaging findings on chest computed tomography or other imaging modality. Thus, this review reflects the variety of factors involved in this frequently encountered condition. We demonstrate the wide range of situations that lead to the development of pulmonary edema by showing the imaging findings of unique cases. These rare varieties of pulmonary edema have distinctive imaging and clinical features that aid in providing an accurate diagnosis.
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Affiliation(s)
- Nanae Tsuchiya
- Department of Radiology, Graduate School of Medical Science, University of the Ryukyus, Okinawa, Japan
- Department of Radiology, University of Wisconsin-Madison, Madison, WI, USA
| | - Lindsay Griffin
- Department of Radiology, University of Wisconsin-Madison, Madison, WI, USA
| | - Tsuneo Yamashiro
- Department of Radiology, Graduate School of Medical Science, University of the Ryukyus, Okinawa, Japan
| | - Shinji Gibo
- Department of Radiology, Urasoe General Hospital, Okinawa, Japan
| | - Tsuyoshi Okane
- Department of Radiology, Urasoe General Hospital, Okinawa, Japan
| | | | - Sadayuki Murayama
- Department of Radiology, Graduate School of Medical Science, University of the Ryukyus, Okinawa, Japan
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Magoon R, Karanjkar A, Kaushal B, Sharan S. Extravascular Lung Water Estimation for Prediction of Reperfusion Injury After Pulmonary Endarterectomy: A Closer Look. J Cardiothorac Vasc Anesth 2019; 34:1392-1393. [PMID: 31812564 DOI: 10.1053/j.jvca.2019.11.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 11/01/2019] [Accepted: 11/08/2019] [Indexed: 11/11/2022]
Affiliation(s)
- Rohan Magoon
- Department of Cardiac Anesthesia, Cardiothoracic Centre, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Ameya Karanjkar
- Department of Cardiac Anesthesia, Cardiothoracic Centre, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Brajesh Kaushal
- Department of Cardiac Anesthesia, Cardiothoracic Centre, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Sandeep Sharan
- Department of Cardiac Anesthesia, Cardiothoracic Centre, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
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8
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Butchart AG, Zochios V, Villar SS, Jones NL, Curry S, Agrawal B, Jenkins DP, Klein AA. Measurement of extravascular lung water to diagnose severe reperfusion lung injury following pulmonary endarterectomy: a prospective cohort clinical validation study. Anaesthesia 2019; 74:1282-1289. [PMID: 31273760 PMCID: PMC6772184 DOI: 10.1111/anae.14744] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2019] [Indexed: 11/28/2022]
Abstract
The measurement of extravascular lung water is a relatively new technology which has not yet been well validated as a clinically useful tool. We studied its utility in patients undergoing pulmonary endarterectomy as they frequently suffer reperfusion lung injury and associated oedematous lungs. Such patients are therefore ideal for evaluating this new monitor. We performed a prospective observational cohort study during which extravascular lung water index measurements were taken before and immediately after surgery and postoperatively in intensive care. Data were analysed for 57 patients; 21 patients (37%) experienced severe reperfusion lung injury. The first extravascular lung water index measurement after cardiopulmonary bypass failed to predict severe reperfusion lung injury, area under the receiver operating characteristic curve 0.59 (95%CI 0.44–0.74). On intensive care, extravascular lung water index correlated most strongly at 36 h, area under the receiver operating characteristic curve 0.90 (95%CI 0.80–1.00). Peri‐operative extravascular lung water index is not a useful measure to predict severe reperfusion lung injury after pulmonary endarterectomy, however, it does allow monitoring and measurement during the postoperative period. This study implies that extravascular lung water index can be used to directly assess pulmonary fluid overload and that monitoring patients by measuring extravascular lung water index during their intensive care stay is useful and correlates with their clinical course. This may allow directed, pre‐empted therapy to attenuate the effects and improve patient outcomes and should prompt further studies.
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Affiliation(s)
- A G Butchart
- Department of Cardiothoracic Anaesthesia and Intensive Care Medicine, Royal Papworth Hospital, Cambridge, UK
| | - V Zochios
- Department of Intensive Care Medicine, University Hospitals Birmingham National Health Service Foundation Trust, Queen Elizabeth Hospital Birmingham, University of Birmingham, UK
| | - S S Villar
- MRC Biostatistics Unit, University of Cambridge School of Clinical Medicine, Cambridge Institute of Public Health, UK
| | - N L Jones
- Department of Cardiothoracic Anaesthesia and Intensive Care Medicine, Royal Papworth Hospital, Cambridge, UK
| | - S Curry
- Department of Cardiothoracic Anaesthesia and Intensive Care Medicine, Royal Papworth Hospital, Cambridge, UK
| | - B Agrawal
- Department of Radiology, Royal Papworth Hospital, Cambridge, UK
| | - D P Jenkins
- Department of Cardiothoracic Surgery, Royal Papworth Hospital, Cambridge, UK
| | - A A Klein
- Department of Cardiothoracic Anaesthesia and Intensive Care Medicine, Royal Papworth Hospital, Cambridge, UK
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9
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Sanada TJ, Tanabe N, Ishibashi-Ueda H, Ishida K, Naito A, Sakao S, Suda R, Kasai H, Nishimura R, Sugiura T, Shigeta A, Taniguchi Y, Masuda M, Tatsumi K. Involvement of pulmonary arteriopathy in the development and severity of reperfusion pulmonary edema after pulmonary endarterectomy. Pulm Circ 2019; 9:2045894019846439. [PMID: 30957648 PMCID: PMC6540513 DOI: 10.1177/2045894019846439] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Reperfusion pulmonary edema (RPE) is a common complication after pulmonary
endarterectomy (PEA) in patients with chronic thromboembolic pulmonary
hypertension (CTEPH). However, the precise mechanisms underlying the development
of RPE remain unclear. To evaluate the effects of pulmonary vasculopathy on RPE,
the severity of the pulmonary arteriopathies and venopathies of lung tissues
biopsied during PEA were pathologically quantified in 33 CTEPH patients. The
severity of RPE was classified from grade 0 (no RPE) to 4 (death due to RPE)
based on the arterial oxygen tension/inspiratory oxygen fraction (P/F ratio) and
necessity of respiratory management. Among the 33 patients (27 women; mean
age = 63.3 years), 17 (51.5%) patients developed RPE. The severity of pulmonary
arteriopathy (obstruction ratio) correlated with the grade of RPE (r = 0.576,
P = 0.0005). The obstruction ratio also correlated with the
P/F ratio (r = −0.543, P = 0.001) and the perioperative mean
pulmonary arterial pressure (r = 0.445, P = 0.009).
Multivariate logistic regression analysis revealed that the obstruction ratio
was a significant independent determinant for the development of RPE (odds
ratio = 15.7; 95% confidence interval = 2.29–108.00,
P = 0.005). In conclusion, pulmonary arteriopathy could be a
determinant of the development and severity of RPE after PEA.
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Affiliation(s)
- Takayuki Jujo Sanada
- 1 Department of Respirology (B2), Graduate School of Medicine, Chiba University, Chiba, Japan.,2 Department of Advanced Medicine in Pulmonary Hypertension, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Nobuhiro Tanabe
- 1 Department of Respirology (B2), Graduate School of Medicine, Chiba University, Chiba, Japan.,2 Department of Advanced Medicine in Pulmonary Hypertension, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Hatsue Ishibashi-Ueda
- 3 Department of Pathology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Keiichi Ishida
- 4 Department of Cardiovascular Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Akira Naito
- 1 Department of Respirology (B2), Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Seiichiro Sakao
- 1 Department of Respirology (B2), Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Rika Suda
- 1 Department of Respirology (B2), Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Hajime Kasai
- 1 Department of Respirology (B2), Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Rintaro Nishimura
- 1 Department of Respirology (B2), Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Toshihiko Sugiura
- 1 Department of Respirology (B2), Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Ayako Shigeta
- 1 Department of Respirology (B2), Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Yu Taniguchi
- 1 Department of Respirology (B2), Graduate School of Medicine, Chiba University, Chiba, Japan.,5 Division of Cardiovascular Medicine, Kobe University Graduate School of Medicine, Chuo-Ku, Kobe, Japan
| | - Masahisa Masuda
- 4 Department of Cardiovascular Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Koichiro Tatsumi
- 1 Department of Respirology (B2), Graduate School of Medicine, Chiba University, Chiba, Japan
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Kratzert WB, Boyd EK, Saggar R, Channick R. Critical Care of Patients After Pulmonary Thromboendarterectomy. J Cardiothorac Vasc Anesth 2019; 33:3110-3126. [PMID: 30948200 DOI: 10.1053/j.jvca.2019.03.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 02/19/2019] [Accepted: 03/01/2019] [Indexed: 12/16/2022]
Abstract
Pulmonary thromboendarterectomy (PTE) remains the only curative surgery for patients with chronic thromboembolic pulmonary hypertension (CTEPH). Postoperative intensive care unit care challenges providers with unique disease physiology, operative sequelae, and the potential for detrimental complications. Central concerns in patients with CTEPH immediately after PTE relate to neurologic, pulmonary, hemodynamic, and hematologic aspects. Institutional experience in critical care for the CTEPH population, a multidisciplinary team approach, patient risk assessment, and integration of current concepts in critical care determine outcomes after PTE surgery. In this review, the authors will focus on specific aspects unique to this population, with integration of current available evidence and future directions. The goal of this review is to provide the cardiac anesthesiologist and intensivist with a comprehensive understanding of postoperative physiology, potential complications, and contemporary intensive care unit management immediately after pulmonary endarterectomy.
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Affiliation(s)
- Wolf B Kratzert
- Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA.
| | - Eva K Boyd
- Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Rajan Saggar
- Department of Internal Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Richard Channick
- Department of Internal Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA
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11
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Ng O, Giménez-Milà M, Jenkins DP, Vuylsteke A. Perioperative Management of Pulmonary Endarterectomy-Perspective from the UK National Health Service. J Cardiothorac Vasc Anesth 2018; 33:3101-3109. [PMID: 30686656 DOI: 10.1053/j.jvca.2018.11.033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Indexed: 11/11/2022]
Affiliation(s)
- Oriana Ng
- Division of Anaesthesiology, Singapore General Hospital, Singapore
| | - Marc Giménez-Milà
- Department of Anesthesia and Intensive Care, Hospital Universitari Bellvitge, Barcelona, Spain; Biomedical Research Institute of Bellvitge, Barcelona, Spain
| | - David P Jenkins
- Department of Cardiothoracic Surgery, Royal Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom
| | - Alain Vuylsteke
- Department of Anaesthesia and Intensive Care, Royal Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom.
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12
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Tagami T, Ong MEH. Extravascular lung water measurements in acute respiratory distress syndrome: why, how, and when? Curr Opin Crit Care 2018; 24:209-215. [PMID: 29608455 PMCID: PMC6037282 DOI: 10.1097/mcc.0000000000000503] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE OF REVIEW Increase in pulmonary vascular permeability accompanied with accumulation of excess extravascular lung water (EVLW) is the hallmark of acute respiratory distress syndrome (ARDS). Currently, EVLW and pulmonary vascular permeability index (PVPI) can be quantitatively measured using the transpulmonary thermodilution (TPTD) technique. We will clarify why, how, and when EVLW and PVPI measurements should be performed. RECENT FINDINGS Although the Berlin criteria of ARDS are simple and widely used, several criticisms of them have been published. The last 2 decades have witnessed the introduction and evolution of the TPTD technique for measuring EVLW and PVPI. Several publications have recommended to evaluate EVLW and the PVPI during the treatment of critically ill patients. Accurate and objective diagnoses can be made for ARDS patients using EVLW and PVPI. EVLW more than 10 ml/kg is a reasonable criterion for pulmonary edema, and EVLW more than 15 ml/kg for a severe condition. In addition to EVLW more than 10 mL/kg, PVPI more than three suggests increased vascular permeability (i.e., ARDS), and PVPI less than 2 represent normal vascular permeability (i.e., cardiogenic pulmonary edema). SUMMARY EVLW and PVPI measurement will open the door to future ARDS clinical practice and research, and have potential to be included in the future ARDS definition.
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Affiliation(s)
- Takashi Tagami
- Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
- Department of Emergency and Critical Care Medicine, Nippon Medical School Tama Nagayama Hospital, Tokyo, Japan
| | - Marcus Eng Hock Ong
- Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
- Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore
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