Acute Cardiointestinal Syndrome Resulting From Postoperative Acute Biventricular Heart Failure

Jarry, Stéphanie; Calderone, Alexander; Dion, Dominique; Bouchard, Denis; Couture, Étienne J.; Denault, André

doi:10.1053/j.jvca.2022.02.011

Cited by 2 publications

(3 citation statements)

References 24 publications

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“…In the presence of more severe elevation of the right atrial pressure with or without significant tricuspid regurgitation, systolic reversal of the venous Doppler waveform will be observed (Figure 2C). Those signals can also correlate with other venous Doppler signs of venous congestion like those observed with pulmonary hypertension, 10 pericardectomy, 11 and right heart failure, 12 which are mainly determined by increased backward venous pressure. The association between portal venous pulsatility and delirium has been reported 5,6 but not using femoral venous Doppler, which may represent a simpler and faster technique to detect congestive delirium.…”

Section: Discussionmentioning

confidence: 98%

Pulsatile Femoral Vein Doppler and Congestive Delirium, What Is the Relationship?: A Case Report

et al. 2022

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Delirium is common in patients undergoing cardiac surgery, and venous congestion has been reported as an important risk factor. We report a 69-year-old patient who developed postoperative delirium in the intensive care unit following aortic valve replacement surgery. The postoperative course was complicated by delirium for which echographic signs of venous congestion on the portal and the renal but also the femoral veins and their resolution correlated with the course of delirium. The use of common femoral vein Doppler as a simple bedside technique to predict and identify congestive delirium has not been reported before.

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Section: Discussionmentioning

confidence: 98%

Pulsatile Femoral Vein Doppler and Congestive Delirium, What Is the Relationship?: A Case Report

et al. 2022

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“…[22][23][24][25] Other instruments such as the NIRO 300 and Oxiplex TS have also been used to provide similar information, but their clinical use in cardiac surgery has not been detailed extensively. 22,[26][27][28] We hereby present the first case series in the literature describing our preliminary experience in adults using hemoglobin chromophores with complementary information from other noninvasive monitoring devices. The goal of this case series is to introduce readers to this new modality and present easily identifiable patterns that may further characterize the mechanisms of cerebral desaturation.…”

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confidence: 99%

“…22–25 Other instruments such as the NIRO 300 and Oxiplex TS have also been used to provide similar information, but their clinical use in cardiac surgery has not been detailed extensively. 22,26–28…”

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confidence: 99%

Early Detection and Correction of Cerebral Desaturation With Noninvasive Oxy-Hemoglobin, Deoxy-Hemoglobin, and Total Hemoglobin in Cardiac Surgery: A Case Series

Calderone

Jarry

Couture

et al. 2022

Anesthesia &Amp; Analgesia

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Regional cerebral oxygen saturation (rSo 2 ) obtained from near-infrared spectroscopy (NIRS) provides valuable information during cardiac surgery. The rSo 2 is calculated from the proportion of oxygenated to total hemoglobin in the cerebral vasculature. Root O3 cerebral oximetry (Masimo) allows for individual identification of changes in total (ΔcHbi), oxygenated (Δo 2 Hbi), and deoxygenated (ΔHHbi) hemoglobin spectral absorptions. Variations in these parameters from baseline help identify the underlying mechanisms of cerebral desaturation. This case series represents the first preliminary description of Δo 2 Hbi, ΔHHbi, and ΔcHbi variations in 10 cardiac surgical settings. Hemoglobin spectral absorption changes can be classified according to 3 distinct variations of cerebral desaturation. Reduced cerebral oxygen content or increased cerebral metabolism without major blood flow changes is reflected by decreased Δo 2 Hbi, unchanged ΔcHbi, and increased ΔHHbi Reduced cerebral arterial blood flow is suggested by decreased Δo 2 Hbi and ΔcHbi, with variable ΔHHbi. Finally, acute cerebral congestion may be suspected with increased ΔHHbi and ΔcHbi with unchanged Δo 2 Hbi. Cerebral desaturation can also result from mixed mechanisms reflected by variable combination of those 3 patterns. Normal cerebral saturation can occur, where reduced cerebral oxygen content such as anemia is balanced by a reduction in cerebral oxygen consumption such as during hypothermia. A summative algorithm using rSo 2 , Δo 2 Hbi, ΔHHbi, and ΔcHbi is proposed. Further explorations involving more patients should be performed to establish the potential role and limitations of monitoring hemoglobin spectral absorption signals. (Anesth Analg 2022;135:1304-14) GLOSSARY ΔcHbi = index representing changes in the total (ΔHHbi + Δo 2 Hbi) hemoglobin component of the rSo 2 ; ΔHHbi = index representing changes in the deoxygenated hemoglobin component of the rSo 2 ; Δo 2 Hbi = index representing changes in the oxygenated hemoglobin component of the rSo 2 ; Cao 2 = arterial oxygen content; CBF = cerebral blood flow; CMRo 2 = cerebral metabolic rate of oxygen; COVID-19 = coronavirus disease 2019; CPB = cardiopulmonary bypass; dP/dT = change in the pressure over time ratio; HITS = high-intensity transient signal; IT = intratracheal; LE = lower extremity; LV = left ventricular; LVEF = left ventricular ejection fraction; NIRS = near-infrared spectroscopy; pEEG = processed electroencephalography; Pfa = femoral artery pressure; Ppa = pulmonary artery pressure; Pra = radial arterial pressure; Prv = right ventricular pressure; rSo 2 = regional oxygen saturation; RV = right ventricular; SVC = superior vena cava; TCD = transcranial Doppler; UE = upper extremity

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Acute Cardiointestinal Syndrome Resulting From Postoperative Acute Biventricular Heart Failure

Cited by 2 publications

References 24 publications

Pulsatile Femoral Vein Doppler and Congestive Delirium, What Is the Relationship?: A Case Report

Pulsatile Femoral Vein Doppler and Congestive Delirium, What Is the Relationship?: A Case Report

Early Detection and Correction of Cerebral Desaturation With Noninvasive Oxy-Hemoglobin, Deoxy-Hemoglobin, and Total Hemoglobin in Cardiac Surgery: A Case Series

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