scholarly journals Intraoperative Thrombolysis for Pulmonary Embolism during Thymoma Resection

2021 ◽  
pp. 1-3
Author(s):  
Georgios Stefanakis ◽  
Georgios Stefanakis ◽  
Vasileia Nyktari ◽  
Georgios Papastratigakis ◽  
Panagiotis Vardakis ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Pulmonary Embolism ◽  
Cardiac Output ◽  
Current Practice ◽  
Mediastinal Mass ◽  
Clinical Evidence ◽  
Risky Decision ◽  
Low Cardiac Output ◽  
Life Saving ◽  
Patient’S History

We report a case of pulmonary embolism during resection of a mediastinal mass requiring intraoperative thrombolysis. The diagnosis, although difficult to establish due to simultaneous bleeding and technical difficulties with transthoracic echocardiography, was based on the patient’s history and clinical evidence of low cardiac output and was confirmed by clinical improvement post thrombolysis. When awakened in the intensive care unit, the patient was found to be blind and also required a tracheostomy. We present this case, as it requires complex clinical reasoning throughout different stages of its management and it demonstrates that, when facing an imminent disaster, a risky decision not necessarily conforming to current practice but based on individualisation of treatment can be life-saving.

Hemodynamics in Sepsis

2006 ◽  
Vol 17 (4) ◽  
pp. 435-445
Author(s):  
Tom Ahrens
Keyword(s):  
Intensive Care Unit ◽  
Cardiac Output ◽  
Tissue Oxygenation ◽  
Capillary Flow ◽  
Timely Manner ◽  
Central Venous ◽  
Low Cardiac Output ◽  
High Cardiac Output ◽  
Hemodynamic State ◽  
Mixed Venous

Hemodynamics in sepsis change as sepsis develops. Initial hemodynamics of sepsis often are much different from later stages of sepsis, shifting from low cardiac output states to high cardiac output states. Tissue oxygenation also changes with initial mixed venous oxyhemoglobin (Svo2) or central venous oxyhemoglobin (Scvo2) levels below normal, with later stages reflecting high values. These changes occur as sepsis progresses, producing a marked disturbance in capillary flow and tissue oxygenation. Treatments for these changes in sepsis are different, making the identification of the hemodynamic state essential to optimally treat the patient. Fortunately, hemodynamic monitoring techniques are markedly improved from older techniques such as the pulmonary artery catheter. With noninvasive techniques such as esophageal and external Doppler for measuring hemodynamics, clinicians beyond the intensive care unit can make hemodynamic assessments that were not possible until just recently. This improved assessment should make it much easier to properly identify sepsis and initiate appropriate treatments in a timely manner.

scholarly journals Identification of Low Cardiac Output Syndrome at the Bedside: A Pediatric Cardiac Intensive Care Unit Survey

2019 ◽  
Vol 39 (2) ◽  
pp. e1-e7 ◽  
Author(s):  
Matthew J. Nordness ◽  
Ashly C. Westrick ◽  
Heidi Chen ◽  
Mark A. Clay
Keyword(s):  
Intensive Care Unit ◽  
Cardiac Output ◽  
Cardiac Surgery ◽  
Intensive Care ◽  
Years Of Experience ◽  
Cardiac Intensive Care Unit ◽  
Low Cardiac Output Syndrome ◽  
Low Cardiac Output ◽  
Cardiac Intensive Care ◽  
Intensive Care Unit Nurses

BACKGROUND Low cardiac output syndrome is a transient constellation of signs and symptoms that indicate the heart’s inability to supply sufficient oxygen to tissues and end-organs to meet metabolic demand. Because the term lacks a standard clinical definition, the bedside diagnosis of this syndrome can be difficult. OBJECTIVE To evaluate concordance among pediatric cardiac intensive care unit nurses in their identification of low cardiac output syndrome in pediatric patients after cardiac surgery. METHODS An anonymous survey was distributed to 69 pediatric cardiac intensive care unit nurses. The survey described 10 randomly selected patients aged 6 months or younger who had undergone corrective or palliative cardiac surgery at a freestanding children’s hospital in a tertiary academic center. For each patient, data were presented corresponding to 5 time points (0, 6, 12, 18, and 24 hours postoperatively). The respondent was asked to indicate whether the patient had low cardiac output syndrome (yes or no) at each time point on the basis of the data presented. RESULTS The response rate was 46% (32 of 69 nurses). The overall Fleiss k value was 0.30, indicating fair agreement among raters. When the results were analyzed by years of experience, agreement remained only slight to fair. CONCLUSIONS Regardless of years of experience, nurses have difficulty agreeing on the presence of low cardiac output syndrome. Further research is needed to determine whether the development of objective guidelines could improve recognition and facilitate communication between the pediatric cardiac intensive care unit nurse and the medical team.

Risk factors for poor outcome after ECMO treatment of low cardiac output after cardiac surgery

2007 ◽  
Vol 55 (S 1) ◽  
Author(s):  
S Deiters ◽  
H Welp ◽  
J Graf ◽  
A Löher ◽  
S Schneider ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiac Output ◽  
Cardiac Surgery ◽  
Low Cardiac Output ◽  
Poor Outcome ◽  
Ecmo Treatment

Heart Failure due to Tension Hydrothorax after Left Pneumonectomy

2013 ◽  
Vol 16 (6) ◽  
pp. 319 ◽  
Author(s):  
Kim Maguire ◽  
Calvin Leung ◽  
Visali Kodali ◽  
Brice Taylor ◽  
Jacques-Pierre Fontaine ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cardiac Output ◽  
Rare Complication ◽  
Right Heart Failure ◽  
Symptomatic Improvement ◽  
Extrapleural Pneumonectomy ◽  
Pleural Mesothelioma ◽  
Low Cardiac Output ◽  
Mediastinal Shift ◽  
Left Pleural Effusion

Tension hydrothorax is a rare complication of pneumonectomy for pleural mesothelioma and an exceptionally rare cause of heart failure. We describe a patient who had undergone extrapleural pneumonectomy, chemotherapy, and radiation for pleural mesothelioma and who developed heart failure symptoms within months of the completion of treatment. Investigation showed a massive left pleural effusion resulting in tension hydrothorax, mediastinal shift, and evidence of right heart failure with constrictive physiology and low cardiac output. Therapeutic thoracentesis resulted in increase in cardiac output and symptomatic improvement.

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