RESUMEN
Extracorporeal membrane oxygenation (ECMO) is used in cases of severe respiratory failure refractory to medical management. Use of ECMO is increasing, along with new cannulation strategies including oxygenated right ventricular assist devices (oxy-RVADs). Multiple dual lumen cannulas are now available, which increase the potential for patient mobility and decrease the number of vascular access sites. However, dual lumen, single cannula flow can be limited by adequate inflow, requiring the need for an additional inflow cannula to meet patient demands. This cannula configuration may result in differential flows in the inflow and outflow limbs and altered flow dynamics, increasing the risk of intracannula thrombus. We describe a series of four patients treated with oxy-RVAD for COVID-19-associated respiratory failure complicated by dual lumen ProtekDuo intracannula thrombus.
Asunto(s)
COVID-19 , Oxigenación por Membrana Extracorpórea , Insuficiencia Respiratoria , Trombosis , Humanos , Cánula , Oxigenación por Membrana Extracorpórea/efectos adversos , COVID-19/complicaciones , Insuficiencia Respiratoria/etiología , Insuficiencia Respiratoria/terapia , Trombosis/etiologíaRESUMEN
Iatrogenic tracheal injuries are an uncommon but serious complication of endotracheal tube intubation. We present two cases that illustrate iatrogenic tracheal injuries presenting hours after the time of their injury. This report addresses the critical diagnostic evaluation and management of iatrogenic tracheal injuries resulting from endotracheal intubation.
Asunto(s)
Intubación Intratraqueal , Tráquea , Humanos , Enfermedad Iatrogénica , Intubación Intratraqueal/efectos adversos , Tráquea/diagnóstico por imagenRESUMEN
This highlights in our specialty for 2019 begin with the ongoing major developments in transcatheter valve interventions. Thereafter, the advances in left ventricular assist devices are reviewed. The recent focus on conduit selection and robotic options in coronary artery bypass surgery are then explored. Finally, this special articles closes with a discussion of pulmonary hypertension in noncardiac surgery, anesthetic technique in cardiac surgery, as well as postoperative pneumonia and its outcome consequences.
Asunto(s)
Anestesia , Anestesiología , Procedimientos Quirúrgicos Cardíacos , Implantación de Prótesis de Válvulas Cardíacas , Procedimientos Quirúrgicos Cardíacos/efectos adversos , Puente de Arteria Coronaria , Humanos , Resultado del TratamientoRESUMEN
The introduction of intracoronary stents represented a major advance in interventional cardiology. While bare metal stents set the benchmark for improved safety over angioplasty, intimal hyperplasia and subsequent restenosis were important limitations. First-generation drug-eluting stents demonstrated significant improvements in efficacy, but not necessarily safety, and further technologic developments have focused on optimizing both. Current advances and understanding in stent design continue to improve on these concepts. This review summarizes past and present technology with particular emphasis on the principles underlying the efficacy and safety of drug-eluting stents, and offers a glimpse into the next generations of stents aimed at treating symptomatic coronary artery disease.