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Alerhand S, Adrian RJ, Long B, Avila J. Pericardial tamponade: A comprehensive emergency medicine and echocardiography review. Am J Emerg Med 2022; 58:159-174. [DOI: 10.1016/j.ajem.2022.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 05/03/2022] [Indexed: 10/18/2022] Open
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Ellenbroek DFJ, van Kessel L, Compagner W, Brouwer T, Bouwman RA, van Straten BAHM, Otterspoor LC, De Bie AJR. Diagnostic performance of echocardiography to predict cardiac tamponade after cardiac surgery. Eur J Cardiothorac Surg 2021; 62:6430389. [PMID: 34791128 PMCID: PMC9257667 DOI: 10.1093/ejcts/ezab468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 08/14/2021] [Accepted: 09/23/2021] [Indexed: 11/29/2022] Open
Affiliation(s)
- Dennis F J Ellenbroek
- Department of Intensive Care, Radboud University Medical Center, Nijmegen, Netherlands
| | - Luc van Kessel
- Department of Intensive Care, Catharina Hospital, Michelangelolaan 2, Eindhoven, Netherlands
| | - Wilma Compagner
- Department of Intensive Care, Catharina Hospital, Michelangelolaan 2, Eindhoven, Netherlands
| | - Tim Brouwer
- Department of Intensive Care, Catharina Hospital, Michelangelolaan 2, Eindhoven, Netherlands
| | - R Arthur Bouwman
- Department of Anesthesiology, Catharina Hospital, Eindhoven, Netherlands
| | | | - Luuk C Otterspoor
- Department of Cardiology, Catharina Hospital, Eindhoven, Netherlands
| | - Ashley J R De Bie
- Department of Intensive Care, Radboud University Medical Center, Nijmegen, Netherlands.,Department of Intensive Care, Catharina Hospital, Michelangelolaan 2, Eindhoven, Netherlands
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Khaja M, Santana Y, Rodriguez Guerra MA, Rehmani A, Perez Lara JL. Isolated Left Atrial Cardiac Tamponade Caused by Pleural Effusion. Cureus 2020; 12:e11578. [PMID: 33224685 PMCID: PMC7678883 DOI: 10.7759/cureus.11578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
A localized left atrial tamponade caused by left side pleural effusion is a rare finding that leads to hemodynamic instability. Here, we describe left atrial systolic and diastolic collapse resulting from left pleural effusion. An increase in intrapleural pressure by a pleural effusion can compress the pericardial space and lead to impaired cardiac filling and tamponade physiology. Here, we present a case of a 79-year old African American female who presented with shortness of breath and dry cough for a duration of one week. Chest radiograph and CT scan of the chest showed left pleural effusion. The echocardiogram revealed left atrial systolic and diastolic collapse due to pleural effusion, which triggered cardiac tamponade physiology. With the guidance of a bedside thoracic ultrasound, she underwent a diagnostic and therapeutic thoracentesis which resolved her symptoms. Repeat echocardiogram revealed resolution of the cardiac tamponade with no further indication of left atrial diastolic collapse. In conclusion, pleural effusions can cause tamponade physiology and can be resolved by thoracentesis. Early recognition by a bedside point-of-care ultrasound may help provide prompt relief of tamponade.
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Affiliation(s)
- Misbahuddin Khaja
- Internal Medicine/Pulmonary Critical Care, BronxCare Health System Affiliated with Icahn School of Medicine at Mount Sinai, Bronx, USA
| | - Yaneidy Santana
- Pulmonary Medicine, BronxCare Health System Affiliated with Icahn School of Medicine at Mount Sinai, Bronx, USA
| | - Miguel A Rodriguez Guerra
- Internal Medicine, BronxCare Health System Affiliated with Icahn School of Medicine at Mount Sinai, Bronx, USA
| | - Arsalan Rehmani
- Cardiology, Bronx Lebanon Hospital Center Affiliated with Icahn School of Medicine at Mount Sinai, Bronx, USA
| | - Jose L Perez Lara
- Pulmonary Medicine, BronxCare Health System Affiliated with Icahn School of Medicine at Mount Sinai, Bronx, USA
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Abstract
Resuscitation in the event of traumatic cardiac arrest was for a long time considered to be a less than promising technique to employ; however, current data indicate that the prospects of success need not be any poorer than for resuscitation due to cardiac distress. The targeted and rapid remedying of reversible causes can re-establish the circulatory function and the European Resuscitation Council (ERC) algorithm for traumatic cardiac arrest is a helpful guide in this respect. This case report illustrates the resolute implementation of this algorithm in the prehospital environment in the case of an attempted suicide by a thoracic knife wound.
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Treskatsch S, Balzer F, Knebel F, Habicher M, Braun JP, Kastrup M, Grubitzsch H, Wernecke KD, Spies C, Sander M. Feasibility and influence of hTEE monitoring on postoperative management in cardiac surgery patients. Int J Cardiovasc Imaging 2015; 31:1327-35. [PMID: 26047772 DOI: 10.1007/s10554-015-0689-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Accepted: 06/01/2015] [Indexed: 01/20/2023]
Abstract
Monoplane hemodynamic TEE (hTEE) monitoring (ImaCor(®) ClariTEE(®)) might be a useful alternative to continuously evaluate cardiovascular function and we aimed to investigate the feasibility and influence of hTEE monitoring on postoperative management in cardiac surgery patients. After IRB approval we reviewed the electronic data of cardiac surgery patients admitted to our intensive care between 01/01/2012 and 30/06/2013 in a case-controlled matched-pairs design. Patients were eligible for the study when they presented a sustained hemodynamic instability postoperatively with the clinical need of an extended hemodynamic monitoring: (a) hTEE (hTEE group, n = 18), or (b) transpulmonary thermodilution (control group, n = 18). hTEE was performed by ICU residents after receiving an approximately 6-h hTEE training session. For hTEE guided hemodynamic optimization an institutional algorithm was used. The hTEE probe was blindly inserted at the first attempt in all patients and image quality was at least judged to be adequate. The frequency of hemodynamic examinations was higher (ten complete hTEE examinations every 2.6 h) in contrast to the control group (one examination every 8 h). hTEE findings, including five unexpected right heart failure and one pericardial tamponade, led to a change of current therapy in 89% of patients. The cumulative dose of epinephrine was significantly reduced (p = 0.034) and levosimendan administration was significantly increased (p = 0.047) in the hTEE group. hTEE was non-inferior to the control group in guiding norepinephrine treatment (p = 0.038). hTEE monitoring performed by ICU residents was feasible and beneficially influenced the postoperative management of cardiac surgery patients.
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Affiliation(s)
- S Treskatsch
- Department of Anesthesiology and Intensive Care Medicine, Campus Charité Mitte and Campus Virchow Klinikum, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.
| | - F Balzer
- Department of Anesthesiology and Intensive Care Medicine, Campus Charité Mitte and Campus Virchow Klinikum, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - F Knebel
- Department of Cardiology, Campus Charité Mitte, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - M Habicher
- Department of Anesthesiology and Intensive Care Medicine, Campus Charité Mitte and Campus Virchow Klinikum, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - J P Braun
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, Klinikum Hildesheim GmbH, Hildesheim, Germany
| | - M Kastrup
- Department of Anesthesiology and Intensive Care Medicine, Campus Charité Mitte and Campus Virchow Klinikum, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - H Grubitzsch
- Department of Cardiovascular Surgery, Campus Charité Mitte, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | | | - C Spies
- Department of Anesthesiology and Intensive Care Medicine, Campus Charité Mitte and Campus Virchow Klinikum, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - M Sander
- Department of Anesthesiology and Intensive Care Medicine, Campus Charité Mitte and Campus Virchow Klinikum, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
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Arntfield RT, Millington SJ. Point of care cardiac ultrasound applications in the emergency department and intensive care unit--a review. Curr Cardiol Rev 2013; 8:98-108. [PMID: 22894759 PMCID: PMC3406278 DOI: 10.2174/157340312801784952] [Citation(s) in RCA: 94] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2011] [Revised: 04/02/2011] [Accepted: 05/12/2011] [Indexed: 12/20/2022] Open
Abstract
The use of point of care echocardiography by non-cardiologist in acute care settings such as the emergency department (ED) or the intensive care unit (ICU) is very common. Unlike diagnostic echocardiography, the scope of such point of care exams is often restricted to address the clinical questions raised by the patient's differential diagnosis or chief complaint in order to inform immediate management decisions. In this article, an overview of the most common applications of this focused echocardiography in the ED and ICU is provided. This includes but is not limited to the evaluation of patients experiencing hypotension, cardiac arrest, cardiac trauma, chest pain and patients after cardiac surgery.
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Affiliation(s)
- Robert T Arntfield
- Division of Critical Care and Division of Emergency Medicine, Western University, 800 Commissioners Rd East, London, Ontario, Canada, N6A 5W9.
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Dixon B, Santamaria JD, Reid D, Collins M, Rechnitzer T, Newcomb AE, Nixon I, Yii M, Rosalion A, Campbell DJ. The association of blood transfusion with mortality after cardiac surgery: cause or confounding? (CME). Transfusion 2012; 53:19-27. [DOI: 10.1111/j.1537-2995.2012.03697.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Carmona P, Mateo E, Casanovas I, Peña JJ, Llagunes J, Aguar F, De Andrés J, Errando C. Management of cardiac tamponade after cardiac surgery. J Cardiothorac Vasc Anesth 2011; 26:302-11. [PMID: 21868250 DOI: 10.1053/j.jvca.2011.06.007] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2010] [Indexed: 01/27/2023]
Affiliation(s)
- Paula Carmona
- Anaesthesia, Critical Care and Pain Medicine Department, Consorcio Hospital General of Valencia, Valencia, Spain.
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Anesthesia and the patient with pericardial disease. Can J Anaesth 2011; 58:952-66. [PMID: 21789738 DOI: 10.1007/s12630-011-9557-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2011] [Accepted: 06/29/2011] [Indexed: 01/30/2023] Open
Abstract
PURPOSE Pericardial diseases present unique perioperative considerations for the anesthesiologist. The purpose of this review is to provide a summary of the pertinent issues related to the etiology, diagnosis, pathophysiology, and perioperative management of patients presenting for operative treatment of pericardial disease. SOURCE A selective search of the anesthesia, cardiology, and cardiothoracic surgical literature was carried out with particular emphasis on acute pericarditis, effusion, tamponade, and constrictive pericarditis. PRINCIPAL FINDINGS The anesthesiologist needs to be well versed in the etiology (i.e., differential diagnosis), pathophysiology, and diagnostic modalities in order to best prepare the patient for surgery. Diagnosis and guidance of management requires a working knowledge of the specific associated hemodynamic consequences, particularly of the impaired diastolic function that can occur. Echocardiography is essential in the diagnosis and management of these patients. CONCLUSIONS Patients with acute and chronic pericardial diseases often require the need for surgical intervention. Several unique features of acute tamponade and constrictive pericarditis require careful perioperative consideration. With proper preparation and pre-anesthetic optimization, patients with a variety of pericardial diseases can be safely managed before, during, and after their surgical intervention.
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A case of coagula tamponade 4 years after Bentall procedure. J Echocardiogr 2011; 9:79-80. [PMID: 27276886 DOI: 10.1007/s12574-010-0070-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2010] [Revised: 09/07/2010] [Accepted: 09/08/2010] [Indexed: 11/27/2022]
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ten Tusscher BL, Groeneveld JAB, Kamp O, Jansen EK, Beishuizen A, Girbes ARJ. Predicting outcome of rethoracotomy for suspected pericardial tamponade following cardio-thoracic surgery in the intensive care unit. J Cardiothorac Surg 2011; 6:79. [PMID: 21624108 PMCID: PMC3118337 DOI: 10.1186/1749-8090-6-79] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2010] [Accepted: 05/30/2011] [Indexed: 11/10/2022] Open
Abstract
Objectives Pericardial tamponade after cardiac surgery is difficult to diagnose, thereby rendering timing of rethoracotomy hard. We aimed at identifying factors predicting the outcome of surgery for suspected tamponade after cardio-thoracic surgery, in the intensive care unit (ICU). Methods Twenty-one consecutive patients undergoing rethoracotomy for suspected pericardial tamponade in the ICU, admitted after primary cardio-thoracic surgery, were identified for this retrospective study. We compared patients with or without a decrease in severe haemodynamic compromise after rethoracotomy, according to the cardiovascular component of the sequential organ failure assessment (SOFA) score. Results A favourable haemodynamic response to rethoracotomy was observed in 11 (52%) of patients and characterized by an increase in cardiac output, and less fluid and norepinephrine requirements. Prior to surgery, the absence of treatment by heparin, a minimum cardiac index < 1.0 L/min/m2 and a positive fluid balance (> 4,683 mL) were predictive of a beneficial haemodynamic response. During surgery, the evacuation of clots and > 500 mL of pericardial fluid was associated with a beneficial haemodynamic response. Echocardiographic parameters were of limited help in predicting the postoperative course, even though 9 of 13 pericardial clots found at surgery were detected preoperatively. Conclusion Clots and fluids in the pericardial space causing regional tamponade and responding to surgical evacuation after primary cardio-thoracic surgery, are difficult to diagnose preoperatively, by clinical, haemodynamic and even echocardiographic evaluation in the ICU. Only absence of heparin treatment, a large positive fluid balance and low cardiac index predicted a favourable haemodynamic response to rethoracotomy. These data might help in deciding and timing of reinterventions after primary cardio-thoracic surgery.
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Affiliation(s)
- Birkitt L ten Tusscher
- Department of Intensive Care, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
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Smyth K, Hebballi R, Peterson MK. Use of transoesophageal echocardiography during the peri-operative period for trauma patients. J ROY ARMY MED CORPS 2011; 156:373-9. [PMID: 21302659 DOI: 10.1136/jramc-156-04s-18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
The medical facility at Camp Bastion continues to evolve as a consequence of the increased throughput of battlefield trauma patients. There is a requirement for rapid and accurate diagnosis of haemodynamic instability and continued haemodynamic monitoring throughout the peri-operative period. Transoesophageal echocardiography (TOE) has been used for this purpose in the arena of cardiac anaesthesia since the mid 1980s. It is being introduced to other peri-operative settings where severe haemodynamic instability is expected. The old proverb: 'There are none so blind as those who cannot see' (Jeremiah 5:21) is applicable to this topic, in that TOE is proven to be a rapid, portable, safe and effective tool in the assessment of the haemodynamically unstable patient. This paper explores the application of TOE for the assessment of the major causes of haemodynamic instability in the trauma population.
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Affiliation(s)
- K Smyth
- Royal Air Force, University Hospitals of Leicester NHS Trust, Glenfield Hospital, Groby Road, Leicester
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Abstract
The anesthetic management of patients with pericardial tamponade is challenging, as they present with not only the cardiovascular compromise that defines pericardial tamponade, but often have comorbid conditions that increase the complexity of their management. This review describes the pathophysiology, etiology, clinical presentation, and anesthetic management of patients with pericardial tamponade, with an emphasis on the intraoperative period and the management of pericardial window procedures, the most common clinical scenario where anesthesiologists will encounter pericardial tamponade.
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Affiliation(s)
- Christopher J O'Connor
- Department of Anesthesiology, Rush University Medical Center, 1653 West Congress Parkway, Chicago, IL 60612, USA.
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15
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Pepi M, Muratori M. Echocardiography in the diagnosis and management of pericardial disease. J Cardiovasc Med (Hagerstown) 2006; 7:533-44. [PMID: 16801815 DOI: 10.2459/01.jcm.0000234772.73454.57] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
This review covers the role of echocardiography in the diagnosis and management of the main pericardial disorders. The sensitivity of echocardiography in detecting pericardial fluid is very high and this technique allows the detection of effusion as well as the definition of the size of effusion (small, moderate and severe). The evaluation of the pericardial sac should be carefully performed through all the echocardiographic windows, differentiating diffuse from loculated (regional) effusions. Several echocardiographic and Doppler signs allow an accurate diagnosis of cardiac tamponade. The role of echocardiography is extremely important in atypical clinical presentation such as in patients in the postoperative period after cardiac surgery. Moreover, drainage of the effusion is mandatory in the presence of cardiac tamponade and in this regard echo-guided pericardiocentesis is the gold-standard method. Finally this review covers the echocardiographic diagnosis of pericardial cysts and masses and constrictive pericarditis.
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Affiliation(s)
- Mauro Pepi
- Centro Cardiologico Fondazione 'I. Monzino', I.R.C.C.S., Milan, Italy.
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Abstract
OBJECTIVE To describe the physiologic alterations, evaluation, and hemodynamic management of patients in the first 24 hrs after cardiac surgery. DESIGN A brief review of preoperative and intraoperative events, postoperative physiology, and a discussion of the evaluation and hemodynamic management of cardiac surgery patients postoperatively based on a review of the literature, known physiology, and clinical experience. RESULTS After cardiac surgery, patients undergo alterations in cardiac performance related to co-morbid conditions, preoperative myocardial insults and interventions, the surgical procedure, and intraoperative management. Predictable responses evolve rapidly in the first 24 hrs after surgery. Monitoring, diagnostic regimens, and therapeutic regimens exist to address the patterns of response and occasional complications. CONCLUSION By understanding preoperative and intraoperative events and their evolution in the intensive care unit, clinicians can effectively manage patients who experience cardiac surgery.
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Affiliation(s)
- Arthur C St André
- Surgical Critical Care, Washington Hospital Center, Washington, DC, USA
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Abstract
The pericardium envelopes the cardiac chambers and under physiological conditions exerts subtle functions, including mechanical effects that enhance normal ventricular interactions that contribute to balancing left and right cardiac outputs. Because the pericardium is non-compliant, conditions that cause intrapericardial crowding elevate intrapericardial pressure, which may be the mediator of adverse cardiac compressive effects. Elevated intrapericardial pressure may result from primary disease of the pericardium itself (tamponade or constriction) or from abrupt chamber dilatation (eg, right ventricular infarction). Regardless of the mechanism leading to increased intrapericardial pressure, the resultant pericardial constraint exerts adverse effects on cardiac filling and output. Constriction and restrictive cardiomyopathy share common pathophysiological and clinical features; their differentiation can be quite challenging. This review will consider the physiology of the normal pericardium and its dynamic interactions with the heart and review in detail the pathophysiology and clinical manifestations of cardiac tamponade, constrictive pericarditis, and restrictive cardiomyopathy.
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Affiliation(s)
- James A Goldstein
- Division of Cardiology, William Beaumont Hospital,3601 West Thirteen Mile Road, Royal Oak, MI 48073, USA,
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Affiliation(s)
- David H Spodick
- Division of Cardiovascular Medicine, Department of Medicine, Saint Vincent Hospital-Worcester Medical Center, Worcester, Mass, USA
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Lindenberger M, Kjellberg M, Karlsson E, Wranne B. Pericardiocentesis guided by 2-D echocardiography: the method of choice for treatment of pericardial effusion. J Intern Med 2003; 253:411-7. [PMID: 12653869 DOI: 10.1046/j.1365-2796.2003.01103.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND Percutaneous pericardiocentesis guided by 2-D echocardiography has been used at Linköping Heart Centre since 1983. AIM To evaluate our experience of this method including a follow-up and also to determine the aetiology of pericardial effusion. METHODS A retrospective study including 120 of 252 consecutive patients punctured. RESULTS The two most common aetiologies were cardiac surgery (77% valve surgery), followed by malignant disease. The postsurgical effusions became clinically important a median of 12 days after surgery (range 0-56 days). The median survival in the group with malignant disease was 89 days (30-day survival 87%, 1-year survival 10%). Indwelling catheter was used in 93% of the patients. There was no mortality but one patient needed a second pericardiocentesis after an accidental puncture of the right ventricle. Nine patients had rhythm aberrations. Recurring effusion that needed puncture was seen in 8%. CONCLUSION Pericardiocentesis guided by 2-D echocardiography is a safe and efficient method to treat pericardial effusion and also valuable as palliative treatment for patients with malignant aetiology of the effusion.
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Affiliation(s)
- M Lindenberger
- Department of Medicine and Care, Faculty of Health Sciences, Linköping University, Sweden
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Faehnrich JA, Noone RB, White WD, Leone BJ, Hilton AK, Sreeram GM, Mark JB. Effects of positive-pressure ventilation, pericardial effusion, and cardiac tamponade on respiratory variation in transmitral flow velocities. J Cardiothorac Vasc Anesth 2003; 17:45-50. [PMID: 12635060 DOI: 10.1053/jcan.2003.9] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To determine the effects of positive-pressure ventilation and experimentally induced pericardial effusion and tamponade on transmitral flow velocities in dogs. DESIGN Descriptive. SETTING University laboratory. PARTICIPANTS Eleven tracheally intubated and mechanically ventilated dogs. INTERVENTIONS Experimental pericardial effusion and cardiac tamponade were created by pericardial injection of warm saline. MEASUREMENTS AND MAIN RESULTS Hemodynamic parameters and pericardial pressures were monitored in the 11 dogs. Pulsed-wave Doppler tracings of mitral valve flow were obtained at the leaflet tips along with hemodynamic measurements at 4 stages: control, effusion (no decrease in mean arterial pressure), tamponade (>or=40% decrease in mean arterial pressure), and tamponade relief (after evacuation of pericardial fluid). Maximal variation (36%) in transmitral flow velocity over the respiratory cycle during positive-pressure ventilation was seen in the control stage. In the effusion and tamponade stages, variation in transmitral flow velocity decreased progressively to 29% (p = 0.1804, not significant) and 16% (p < 0.0001), respectively. CONCLUSION Intrathoracic pressure and lung volume changes caused by positive-pressure ventilation influence transmitral flow velocity patterns. Respiratory variation in transvalvular flow is pronounced during standard positive-pressure mechanical ventilation, decreases in the presence of pericardial effusion, and becomes almost nonexistent when cardiac tamponade is present. These findings show that the echocardiographic criteria used to diagnose cardiac tamponade based on mitral valve inflow patterns are different during positive-pressure ventilation from spontaneously breathing subjects.
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Affiliation(s)
- Jana A Faehnrich
- Department of Anesthesiology, Duke University Medical Center, and Anesthesiology Service, Veterans Affairs Medical Center, Durham, NC 27705, USA
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Anthi A, Tzelepis GE, Alivizatos P, Michalis A, Palatianos GM, Geroulanos S. Unexpected cardiac arrest after cardiac surgery: incidence, predisposing causes, and outcome of open chest cardiopulmonary resuscitation. Chest 1998; 113:15-9. [PMID: 9440561 DOI: 10.1378/chest.113.1.15] [Citation(s) in RCA: 79] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
STUDY OBJECTIVES To assess the incidence of acute mechanical causes precipitating sudden cardiac arrest in cardiac surgery patients during the immediate postoperative period. In addition, we report the success rate of cardiopulmonary resuscitation (CPR) in which open-chest CPR was employed at an early stage of the resuscitation effort. METHODS Data on all cardiac surgical patients who suffered a sudden cardiac arrest during the first 24 h after surgery were collected prospectively. CPR consisted of conventional closed-chest CPR initially and was followed within 3 to 5 min, if needed, by open-chest CPR. RESULTS Of 3,982 patients undergoing cardiac surgery over a 30-month period, 29 patients (0.7%) had a sudden cardiac arrest. Of these, 13 patients (45%) were successfully resuscitated with closed-chest CPR, 14 (48%) with open-chest CPR, and 2 (7%) died despite closed- and open-chest CPR. Four CPR survivors died subsequently in the ICU, yielding an overall hospital discharge rate of 79%. Perioperative myocardial infarction was the underlying cause of sudden cardiac arrest in 14 patients (48%), and mechanical impediments to cardiac function (tamponade or graft malfunction) in another 8 (28%) patients; in the remaining 7 patients (24%), no underlying cause was found. The length of ICU stay was 6+/-1 (mean+/-SE) days. None of the patients developed wound infection and all were neurologically intact at hospital discharge. CONCLUSION Mechanical factors account for a substantial portion (28%) of causes of sudden cardiac arrest occurring in hemodynamically stable patients during the immediate postoperative period. This high incidence, in conjunction with the high survival rate achieved by open CPR, supports an early approach to open-chest CPR in this group of patients.
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Affiliation(s)
- A Anthi
- Surgical Intensive Care Unit, Onassis Cardiac Surgical Center, Athens, Greece
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Abstract
This article presents an overview of the benefits and efficacy of transesophageal echocardiography (TEE) in the critically ill patient. The echocardiographic evaluation of ventricular function both regional and global, is discussed with special emphasis on ischemic heart disease; assessment of preload, interrogation of valvular heart disease (prosthetic and native) and its complications; endocarditis and its complications; intracardiac and extracardiac masses, including pulmonary embolism; aortic diseases (e.g., aneurysan, dissection, and traumatic tears); evaluation of patent foramen ovale and its association with central and peripheral embolic events; advancements in computer technology; and finally, the effect of TEE on critical care.
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Affiliation(s)
- D T Porembka
- Department of Anesthesia, University of Cincinnati College of Medicińe, Ohio, USA
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