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Cardiac diseases in pregnancy
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
Saravanan Kuppuswamy, Sudarshan Balla
Continuous EKG and pulse oximetry monitoring is recommended to monitor for hypotension, hypoxemia, myocardial ischemia, and arrhythmias. The role of pulmonary artery catheter is controversial and should be decided on a case-by-case basis. Women in functional class IV and selected cases in functional class III, pulmonary hypertension, may benefit from a pulmonary artery catheter insertion before the process of labor and delivery is started (8). In some conditions, such as mitral stenosis, controlling the heart rate with a beta blocker infusion may be indicated to avoid tachycardia and decrease in cardiac output (113).
Circulation
Published in Kelvin Yan, Surgical and Anaesthetic Instruments for OSCEs, 2021
Given the course of the insertion of a pulmonary artery catheter, damage to anything along the way may pose risks to insertion. These include prosthetic and vegetated tricuspid and pulmonary valves as well as tumour/thrombus within the right heart or the vessels involved. Active endocarditis would contraindicate the procedure.
Surgical Strategies of Myectomy for Hypertrophic Obstructive Cardiomyopathy
Published in Srilakshmi M. Adhyapak, V. Rao Parachuri, Hypertrophic Cardiomyopathy, 2020
V. Rao Parachuri, Sreekar Balasundaram, Ameya Kaskar
We advocate the routine use of a pulmonary artery catheter for all these patients. Excessive inotropes should be avoided. Filling pressures should be maintained higher than normal. Noradrenaline may be utilized to prevent excessive fluid administration and subsequent hemodilution. Supra-ventricular arrhythmias are poorly tolerated and should be appropriately managed. Routine atrioventricular pacing may be required to augment higher ventricular filling.
Acute kidney injury in COVID 19 – an update on pathophysiology and management modalities
Published in Archives of Physiology and Biochemistry, 2023
Manoj Khokhar, Purvi Purohit, Dipayan Roy, Sojit Tomo, Ashita Gadwal, Anupama Modi, Mithu Banerjee, Praveen Sharma
The careful monitoring of intravascular volume status is a crucial tenet of conservative fluid management in cardiovascular and renal injury (Matthay et al.2020, p. 19). In the backdrop of sepsis-induced coagulopathy, mechanical ventilation with high PEEP can increase the risk of development of pulmonary hypertension, right heart failure, and hypoperfusion (Tang et al.2020). The currently available standard monitors have a low capability of identifying end-organ damage, thus contributing to increased risk of morbidity and mortality (Table 3). Pulmonary artery catheter (PAC) has shown promise in this regard because it can measure right atrial and right ventricular pressures as well as continuous mixed venous oxygen saturation (SvO2). Additionally, systemic vascular resistance (SVR), and cardiac output can also be measured (D'Alto et al.2018). This helps in minimising the expenditure of hospital resources and maximises monitoring sensitivity. The vigilant monitoring of hemodynamic status and fluid imbalance in COVID-19 associated AKI would help to tide over the period of renal impairment with better outcomes. Further, Ponce et al. (2020) described the workflow for the delivery and monitoring of peritoneal dialysis for patients without the risk of respiratory impairment.
Hemolysis during short-term mechanical circulatory support: from pathophysiology to diagnosis and treatment
Published in Expert Review of Medical Devices, 2022
Tim Balthazar, Johan Bennett, Tom Adriaenssens
Insufficient preload should be detected early to prevent ‘suction alarms’ and hemolysis by adequate hemodynamic monitoring. Accruing data suggest that use of pulmonary artery catheters is associated with improved outcomes in severe cardiogenic shock (which are often pVAD supported) patients [51,52]. Hemodynamic monitoring allows following of trends in cardiac filling pressures and relates these to changes in cardiac output as well as mixed venous oxygen saturation, which might lead to earlier intervention. The ability to trend filling pressures during changes in pVAD flow as well as fluid challenges is probably the most important use of the pulmonary artery catheter. The ‘normal’ for filling pressures is variable, and depends on pVAD flow as well as patient physiology. For a more detailed discussion on hemodynamic optimization during pVAD support, we refer to recent review articles [6,53].
Effects of remote ischemic preconditioning on platelet activation and reactivity in patients undergoing cardiac surgery using cardiopulmonary bypass: a randomized controlled trial
Published in Platelets, 2022
Youn Joung Cho, Karam Nam, Sol Ji Yoo, Seohee Lee, Jinyoung Bae, Ji-Young Park, Hang-Rae Kim, Tae Kyong Kim, Yunseok Jeon
Without premedication, patients were monitored with 5-lead electrocardiography, noninvasive sphygmomanometry, pulse oximetry, bispectral index, and cerebral oximetry. After local anesthesia with 1% lidocaine, peripheral arterial catheterization was established at the radial artery for continuous invasive arterial blood pressure monitoring. General anesthesia was induced with intravenous injection of midazolam (0.1 mg/kg) and sufentanil (1 µg/kg). Endotracheal intubation was facilitated with administration of rocuronium (0.6 mg/kg); patient’s lungs were ventilated in volume-controlled mode using an anesthesia machine. A central venous catheter was placed at the internal jugular vein under ultrasonographic guidance; a pulmonary artery catheter was introduced through the jugular catheter to monitor pulmonary artery pressure, cardiac index, and mixed venous oxygen saturation. Anesthesia was maintained using target-controlled infusion of propofol (effect site concentration: Ce of 1–4 µg/mL) and remifentanil (Ce of 4–8 ng/mL). Concentrations of propofol and remifentanil were adjusted to maintain the bispectral index below 40 and to maintain adequate hemodynamics in response to surgical stimuli.