Fat embolism syndrome (FES), causing right heart dysfunction, is a rare disease that is often difficult to diagnose with imaging modalities such as computed tomography (CT). FES is the clinical presentation that follows the entry of fat globules into the systemic circulation, which typically results in respiratory failure, scattered petechiae, cardiovascular collapse, and neurological sequelae. It is mostly observed in the cases of orthopedic trauma but may occur in any circumstance where fat can enter the circulatory system. In this case report, the authors describe an atypical presentation of FES in a 24-week parturient. The use of bedside point-of-care ultrasonography (POCUS) and the focus-assessed transthoracic echocardiography (FATE) protocol aided in the prompt diagnosis of right heart failure and helped to confirm the diagnosis of FES with more advanced imaging technology.
Purpose of reviewThis review aims to summarize the current literature on pulmonary prehabilitation programs, their effects on postoperative pulmonary complications, and the financial implications of implementing these programs. Additionally, this review has discussed the current trends in pulmonary prehabilitation programs, techniques for improving rates of perioperative smoking cessation, and the optimal timing of these interventions.
Recent findingsPrehabilitation is a series of personalized multimodal interventions tailored to individual needs, including lifestyle and behavioral measures. Pulmonary prehabilitation has shown to reduce postoperative pulmonary complications (PPCs).
Importance: Abnormal left ventricular (LV) diastolic function, with or without a diagnosis of heart failure, is a common finding that can be easily diagnosed by intra-operative transesophageal echocardiography (TEE). The association of diastolic function with duration of hospital stay after coronary artery bypass (CAB) is unknown. Objective: To determine if abnormal LV diastolic function (diastolic dysfunction) is associated with length of hospital stay after coronary artery bypass surgery (CAB). Design: Prospective observational studySetting: A single tertiary academic medical centerParticipants: Patients with normal systolic function undergoing isolated CAB from September 2017 through June 2018. Exposures: LV function during diastole, as assessed by intra-operative TEE prior to coronary revascularization. Main Outcomes and Measures: The primary outcome was duration of postoperative hospital stay. Secondary intermediate outcomes included common postoperative cardiac, respiratory, and renal complications. Results: The study included 176 participants (mean age 65.2 +/- 9.2 years, 73% male); 106 (60.2%) had LV diastolic dysfunction. Median time to hospital discharge was significantly longer for subjects with diastolic dysfunction (9.1/IQR 6.6-13.5 days) than those with normal LV diastolic function (6.5/IAR 5.3-9.7days) (P< 0.001). The probability of hospital discharge was 34% lower (HR 0.66/95% CI 0.47-0.93) for subjects with diastole dysfunction, independent of potential confounders, including a baseline diagnosis of heart failure. There was a dose-response relation between severity of diastolic dysfunction and probability of discharge. LV diastolic dysfunction was also associated with postoperative cardio-respiratory complications; however, these complications did not fully account for the relation between LV diastolic dysfunction and prolonged length of hospital stay.Conclusions and Relevance: In patients with normal systolic function undergoing CAB, diastolic dysfunction is associated with prolonged duration of postoperative hospital stay. This association cannot be explained by baseline comorbidities or common post-operative complications.
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