Anesthesia Considerations in Infective Endocarditis

Hermanns, Henning; Eberl, Susanne; Terwindt, Lotte E.; Mastenbroek, Thierry C B; Bauer, Wolfgang O; Vaart, Thomas W. van der; Preckel, Benedikt

doi:10.1097/aln.0000000000004130

Cited by 11 publications

(18 citation statements)

References 234 publications

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“…Coagulopathy in patients with IE is likely to be multifactorial [ 4 ], especially in the perioperative period [ 10 ]. Hence, ROTEM analysis cannot assess the whole picture of coagulopathy in IE, such as platelet dysfunction.…”

Section: Discussionmentioning

confidence: 99%

“…Based on the presented changes of the coagulation system, management of coagulation disturbances and bleeding complications represent particular challenges in patients with IE [ 10 ]. Intraoperative point-of-care coagulation testing (POCT), such as rotational thromboelastometry (ROTEM) may assist in decision-making concerning perioperative coagulation management [ 11 ].…”

Section: Introductionmentioning

confidence: 99%

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Patients with infective endocarditis undergoing cardiac surgery have distinct ROTEM profiles and more bleeding complications compared to patients without infective endocarditis

Breel¹,

Wensing²,

Eberl³

et al. 2023

PLoS ONE

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Background The coagulation system is crucial in the pathogenesis of infective endocarditis and undergoes significant changes during course of the disease. However, little is known about the implications of those changes in the perioperative period. Aim of the present study was to delineate the specific coagulation patterns and their clinical consequence in patients undergoing cardiac surgery due to infective endocarditis. Methods In this single-centre, exploratory, prospective observational study, we investigated the incidence and degree of coagulopathy in patients with (n = 31) and without infective endocarditis (n = 39) undergoing cardiac valve surgery. The primary outcome was the differences between these two groups in rotational thromboelastometry (ROTEM) results before, during and after surgery. The secondary outcomes were the differences between the groups in heparin sensitivity, bleeding complications, and transfusion requirements. Results Most ROTEM parameters in EXTEM, INTEM and FIBTEM assays were significantly altered in patients with infective endocarditis. Clotting time in the EXTEM assay was significantly prolonged in the endocarditis group at all time-points, while all clot firmness parameters (A5, A10 and MCF) were significantly increased. The heparin sensitivity index was significantly lower in the endocarditis group (median index 0.99 vs 1.17s. IU-1.kg-1, p = .008), indicating increased heparin resistance. Patients with infective endocarditis had more bleeding complications as assessed by the universal definition of perioperative bleeding score (OR 3.0, p = .018), and more patients with endocarditis underwent early re-exploration (p = .018). Conclusions The findings of this exploratory investigation show significantly altered coagulation profiles in patients with infective endocarditis, with concomitant hyper- and hypocoagulability. Furthermore, the incidence of bleeding complications and transfusion requirements were increased in patients with endocarditis. These results show the potential of ROTEM to detect coagulation abnormalities in patients with infective endocarditis. Existing point-of-care coagulation testing guided algorithms for optimizing perioperative coagulation management possibly need to be adjusted for these high-risk patients undergoing cardiac surgery.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Patients with infective endocarditis undergoing cardiac surgery have distinct ROTEM profiles and more bleeding complications compared to patients without infective endocarditis

Breel¹,

Wensing²,

Eberl³

et al. 2023

PLoS ONE

Self Cite

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“…American experts recommend early surgery, while European experts highlight the need to weigh the benefits of antibiotic completion before surgery against the risk of an uncontrolled source of infection. This lack of agreement in the guidelines highlights the paucity of evidence in the literature and has led anesthesiologists to advocate for multidisciplinary decisions, including surgical, anesthetic and ICU teams in a recent comprehensive review [5 ▪▪ ].…”

Section: Managementmentioning

confidence: 99%

“…Despite these data, few well conducted studies or reviews are dedicated to critically ill IE patients. In addition, nearly half of IE patients undergo a surgical intervention [5 ▪▪ ], hence the perioperative management of these patients is of particular interest. This review will discuss the contemporary literature and will provide an overview of the current state of knowledge regarding the perioperative and intensive care of critically ill IE patients…”

Section: Introductionmentioning

confidence: 99%

Endocarditis in the intensive care unit: an update

Lakbar

Delamarre

Einav

et al. 2022

Current Opinion in Critical Care

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Purpose of reviewThe incidence of infective endocarditis (IE) is increasing worldwide, resulting in a higher number of patients with IE being admitted to intensive care units (ICU). Nearly half of patients with IE develop a complication during their clinical course. However, few well conducted studies or reviews are devoted to critically ill IE patients. This review discusses the contemporary perioperative and intensive care literature.Recent findings IE epidemiology is changing towards elderly and frail patients. ICU patients are at risk of risk of developing IE because they are often in a pro-inflammatory state and many also have several indwelling catheters, which favors infection. Increased performance and recent advances in cardiac imaging allow for easier diagnosis of EI, but the applicability of these techniques to ICU patients is still relatively limited. New developments in antibiotic treatment and adjunctive therapies are explored further in this review.

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“…Especially in the perioperative period, serious IE-related complications occur frequently and may have a significant impact on outcome [2]. However, the literature focusing on the perioperative care of patients undergoing surgery for IE is limited [3,4].…”

Section: Introductionmentioning

confidence: 99%

Perioperative Complications in Infective Endocarditis

Hermanns,

Alberts,

Preckel

et al. 2023

JCM

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Infective endocarditis is a challenging condition to manage, requiring collaboration among various medical professionals. Interdisciplinary teamwork within endocarditis teams is essential. About half of the patients diagnosed with the disease will ultimately have to undergo cardiac surgery. As a result, it is vital for all healthcare providers involved in the perioperative period to have a comprehensive understanding of the unique features of infective endocarditis, including clinical presentation, echocardiographic signs, coagulopathy, bleeding control, and treatment of possible organ dysfunction. This narrative review provides a summary of the current knowledge on the incidence of complications and their management in the perioperative period in patients with infective endocarditis.

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Anesthesia Considerations in Infective Endocarditis

Cited by 11 publications

References 234 publications

Patients with infective endocarditis undergoing cardiac surgery have distinct ROTEM profiles and more bleeding complications compared to patients without infective endocarditis

Patients with infective endocarditis undergoing cardiac surgery have distinct ROTEM profiles and more bleeding complications compared to patients without infective endocarditis

Endocarditis in the intensive care unit: an update

Perioperative Complications in Infective Endocarditis

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