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Daily Critical Care Pearls #215: Who should receive volume resuscitation with 20% albumin after cardiac surgery? 👇👇👇 ✔ Recent pilot data suggest that using 20% albumin for such fluid boluses, compared to crystalloid, may reduce vasopressor duration and dose, potentially achieving hemodynamic targets with less fluid and thereby minimizing the negative effects of volume overload and prolonged vasopressor therapy ✔ Accordingly, the following study was performed to evaluate the effect of fluid bolus therapy with 20% albumin on the duration of vasopressor therapy compared with crystalloid (the HAS FLAIR-II RCT) ✔ The HAS FLAIR-II RCT showed that volume resuscitation with 20% albumin had no effect on vasopressor duration (primary outcome) or mortality. However, randomization to albumin bolus therapy was associated with a reduced positive fluid balance (a secondary outcome). ✔ For cost-effectiveness reasons, some clinicians restrict the use of albumin in these patients to only three severe conditions: patients requiring more than 3 L crystalloids in the early post-operative period, hypoabuminemic patients with a level below 38 g/L and patients considered fluid overloaded. #criticalcare #clinicalpharmacy #medicine #pearls

Interventional cardiology is a medical specialty that diagnoses and treats heart and blood vessel conditions without performing actual heart surgery. Interventional cardiologists use small tubes called catheters, inserted in the patient’s body through a puncture in arteries in the wrist or groin region. Working with these small tubes, which they put through the blood vessels, allows interventional cardiologists to avoid open-heart surgeries. Yet they achieve results that can be life-saving, like when treating a heart attack. Interventional cardiologists treat patients with vascular (blood vessel) and coronary (heart) diseases, and structural heart disease. These diseases include heart valve defects and septal defects — abnormalities in the walls separating heart chambers. #interventionalcardiology #minimallyinvasivecardiology #Nonsurgicalhearttreatments

A recent study shows minimally invasive surgery to remove brain clots within 24 hours of a stroke leads to better survival rates and recovery for patients. The study found that patients who underwent minimally invasive clot removal within 24 hours of experiencing a stroke had significantly better outcomes at 180 days compared to those receiving only standard medical care. This translates to a higher survival rate and improved functionality for stroke patients. Minimally Invasive Surgery Offers Advantages: Faster Clot Removal: The minimally invasive approach allows surgeons to access and remove clots more quickly, minimizing brain damage. Improved Recovery: Early intervention with surgery leads to better chances of a full recovery for stroke patients. Reduced Hospital Stays: Faster recovery can translate to shorter hospital stays and lower healthcare costs. #CSurgeries #Stroke #MinimallyInvasiveSurgery

A total of nine studies were included, and the results showed that both surgical modalities had good safety profiles in the early and long-term stages. For early endpoint events, the risk of all-cause mortality and major bleeding within 30 years was similar in the staged TAVR + PCI and the contemporaneous TAVR + PCI (P > 0.05). Additionally, the risk of myocardial infarction, stroke, acute kidney injury and pacemaker implantation within 30 days or perioperatively is similar (P > 0.05). For long-term endpoint events, the risk of all-cause mortality, myocardial infarction and stroke was similar in the two groups at ≥2 years (P > 0.05). In patients undergoing TAVR who required coronary revascularization, no significant differences were observed in the early and long-term outcomes between those receiving concurrent TAVR and PCI versus staged surgery.

A teenager with chest pain on exertion 16 y/o girl presented with chest pain during sport and decreased exercise tolerance. Cardiological work-up revealed myocardial bridging of the LAD over a length of 7 cm, with reversible ischemia on SPECT myocardial perfusion imaging. Given the morphology of intramyocardial course and severity of symptoms, surgical unroofing of the LAD was scheduled. Surgery was uneventful, with quick postoperative recovery. ·        Myocardial bridging is a common coronary anomaly, in which a coronary artery runs through heart muscle, needing multimodal imaging to find those needing treatment. ·        Beta-blockers and calcium-channel blockers are first treatments, with revascularization for those not responding to medication. ·        Revascularization options include PCI or surgical myotomy, chosen based on lesion specifics, atherosclerosis, expertise, and patient preference. https://lnkd.in/extx2xup

Here is a quick update on Regions Open Heart Surgery week! Two patients have undergone surgery and they are both doing great. 👏🏾👏🏾👏🏾👏🏾 The first case is a 64-year-old female. Diagnosed with Type A Aortic Dissection and Right Atrial hematoma. She had Repair of Type A aortic dissection with total arch replacement and excision of right atrial hematoma. The second case is a 58-year-old female, diagnosed with Coronary Artery Disease (3 vessels) and underwent a Coronary artery bypass graft x3. At Regions, we deal with complex cardiac surgeries. Cases that ordinarily can’t be done around and patients have to travel abroad! We have a comprehensive cardiac program that includes cardiologists, vascular cardiologists and cardiac surgeons. Book appointment to see our specialists today! For more information, please call 07047000010. …exceptional people providing exceptional healthcare. #Regionshealthcare #cardiacsurgery #openheart #cardiaccare #linkedin #hospitals #specialist #clinicaloperations

Post-hoc analysis of the 350 patient OPHIQUE trial determines risk factors of postoperative complications in high-risk noncardiac surgery patients optimized with hemodynamic treatment strategies. - The prevalence of complications was high for patients treated according to hemodynamic treatment strategy. - Factors associated with complications in this population were age, the preoperative hemoglobin and surgical complications - as seen in the Figure below. - These factors were associated with outcome in this population treated according to hemodynamic treatment strategy. - Neither blood pressure, cardiac output, intraoperative volume, nor norepinephrine dose were associated with complications. 🔗https://lnkd.in/e8y-GKQ6

EECP therapy candidates include 1. Patients who are not candidate for invasive procedures due to comorbid disease, poor physical health or advanced CAD. 2. Patients who had no response to medical treatment. 3. Patients who are waiting for surgery and use EECP to maintain the condition. 4. Patients who need EECP for cardiac rehabilitation after surgery. 5. Patients who are risk averse and prefer heart treatment without surgery. 6. Patients who can't afford surgery due to high cost. #eecp #cardiology #cardiovascularhealth #cardiologist #angina #heartdisease #medical #medicaldevice #CardiologyCare #dispositifmedical #cardiologue #cardiologie #ECP

Patients with CKD and ESRD are at higher risk of in-hospital mortality, cardiovascular, and non-cardiovascular complications after TAVR. The risk of complications is highest in patients with ESRD and does not result in more frequent conversion to open heart surgery. These results emphasize the importance of individualized patient selection for TAVR and procedural planning among patients with chronic renal insufficiency.

Look at the data on our hemostatic powder! Bleeding from GI tumors has been a therapeutic challenge because of the high rate of unsuccessful hemostasis using a conventional endoscopic approach and studies have shown that the rebleeding and mortality rates are higher after emergency surgery where immediate hemostasis was difficult to achieve. New data from this multicenter, controlled trial of 106 patients in 9 centers, shows that our hemostatic powder has a significantly lower 30-day rebleed rate compared to SET (Standard Endoscopic Treatment). (2.1% vs 21.3% for SET). Read here to get a more in-depth look at this study and see other clinically relevant data points: https://bit.ly/44Pt9mA Learn more about hemostatic powder here: https://bit.ly/3sXKegs #endoscopy #cookgastro #hemostasis #medicaldevices #healthcare