Extravascular Lung Water and Effect on Oxygenation Assessed by Lung Ultrasound in Adult Cardiac Surgery

Emperador, F.; Bennett, Sean; Gonzalez, Julia; Saati, Ahmed; Alsaywid, Basim; Fernández, José A.

doi:10.7759/cureus.9953

Cited by 5 publications

(5 citation statements)

References 16 publications

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“…Moreover, higher peak values of EVLW were correlated with increased ventilation time and ICU stay, possibly suggesting more difficult weaning in these patients [ 44 ]. Estimation of EVLW by the means of lung ultrasound has also been described in cardiac surgery and is discussed in Section 3.2 [ 45 ].…”

Section: Monitoring the Weaning And Assessing Causes Of Sbt Failurementioning

confidence: 99%

Difficult Respiratory Weaning after Cardiac Surgery: A Narrative Review

Nicolotti

Grossi

Nicolini

et al. 2023

JCM

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Respiratory weaning after cardiac surgery can be difficult or prolonged in up to 22.7% of patients. The inability to wean from a ventilator within the first 48 h after surgery is related to increased short- and long-term morbidity and mortality. Risk factors are mainly non-modifiable and include preoperative renal failure, New York Heart Association, and Canadian Cardiac Society classes as well as surgery and cardio-pulmonary bypass time. The positive effects of pressure ventilation on the cardiovascular system progressively fade during the progression of weaning, possibly leading to pulmonary oedema and failure of spontaneous breathing trials. To prevent this scenario, some parameters such as pulmonary artery occlusion pressure, echography-assessed diastolic function, brain-derived natriuretic peptide, and extravascular lung water can be monitored during weaning to early detect hemodynamic decompensation. Tracheostomy is considered for patients with difficult and prolonged weaning. In such cases, optimal patient selection, timing, and technique may be important to try to reduce morbidity and mortality in this high-risk population.

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Section: Monitoring the Weaning And Assessing Causes Of Sbt Failurementioning

confidence: 99%

Difficult Respiratory Weaning after Cardiac Surgery: A Narrative Review

Nicolotti

Grossi

Nicolini

et al. 2023

JCM

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“…26) CPB can result in decreased lung compliance and poor oxygenation, which may be related to extended breathing. 26,27) In our systematic review, the use of GDP protocols resulted in a reduction in mortality with an OR of 0.55 among patients undergoing heart surgery, but statistically not significant. This result is similar to the findings in some meta-analyses such as Giglio 22,23,25) and RCT studies.…”

Section: Discussionmentioning

confidence: 68%

Intraoperative Goal-Directed Perfusion in Cardiac Surgery with Cardiopulmonary Bypass: The Roles of Delivery Oxygen Index and Cardiac Index

Pratomo,

Sudadi,

Setianto

et al. 2024

ATCS

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CPB = cardiopulmonary bypass DO2 = oxygen delivery VO2 = oxygen consumption ICU = intensive care unit AKI = acute kidney injury GDP = goal-directed perfusion CI = cardiac index MAP = mean arterial pressure RCTs = randomized controlled trials PROSPERO = the international prospective register of systematic reviews PRISMA = preferred reporting items for the systematic reviews and meta-analyses PIC = population, intervention, control DO2I = oxygen delivery index LOS = length of stay Purpose: Goal-directed perfusion (GDP) refers to individualized goal-directed therapy using comprehensive monitoring and optimizing the delivery of oxygen during cardiopulmonary bypass (CPB). This study aims to determine whether the intraoperative GDP protocol method has better outcomes compared to conventional methods. Methods: We searched the PubMed, Central, and Scopus databases up to October 12, 2023. We primarily examined the GDP protocol in adult cardiac surgery, using CPB with oxygen delivery index (DO2I) and cardiac index (CI) as the main parameters. Results: In all, 1128 participants from seven studies were included in our analysis. The results showed significant differences in the duration of intensive care unit (ICU) stays (p = 0.01), with a mean difference of −0.33 (−0.59 to 0.07), and hospital length of stay (LOS) (p = 0.0002), with a mean difference of −0.84 (−1.29 to −0.39). There was also a notable reduction in postoperative complications (p <0.00001), odds ratio (OR) of 0.43 (0.32-0.60). However, there was no significant decrease in mortality rate (p = 0.54), OR of 0.77 (0.34-1.77). Conclusion: Postoperative acute kidney injury and ICU and hospital LOS are significantly reduced when GDP protocols with indicators of flow management, oxygen delivery index, and CI are used in intraoperative cardiac surgery using CPB.

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“…As a non-invasive bedside investigation, lung ultrasound may be used to judge EVLW, whereby the more B-lines in lung ultrasound, the more serious the EVLW. 29 …”

Section: Discussionmentioning

confidence: 99%

“…As a non-invasive bedside investigation, lung ultrasound may be used to judge EVLW, whereby the more B-lines in lung ultrasound, the more serious the EVLW. 29 Usually, new onset of AF during liver transplantation may be self-limiting, 19 often lasting between 1 hour and 1 week. 11 The main treatment includes maintaining hemodynamic stability and controlling ventricular rate.…”

Section: Discussionmentioning

confidence: 99%

New onset atrial fibrillation during orthotopic liver transplantation induced by iced saline injection for transpulmonary thermodilution: a case report

Wang

Guo

2022

J Int Med Res

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Transpulmonary thermodilution is often used to measure extravascular lung water during liver transplantation. Here, the case of new onset atrial fibrillation during orthotopic liver transplantation, which may have been induced by iced saline injection for transpulmonary thermodilution measurement, is described. A 52-year-old male patient underwent orthotopic liver transplantation due to alcoholic cirrhosis combined with portal hypertension. During dissection of the recipient liver, transpulmonary thermodilution was performed. At 3 minutes following iced saline injected, atrial fibrillation occurred, the ventricular rate increased to more than 120 beats per min, and blood pressure dropped to 75/50 mmHg. Massive haemorrhage, inferior vena cava clamping, electrolyte disorder, acid-base balance disorder, and hypothermia were all ruled out, and iced saline injection was suspended. Hemodynamic stability was maintained with phenylephrine and lanatocide C (cedilanid), and chemical cardioversion was performed using amiodarone. During the reperfusion phase, transient hemodynamic instability was managed by norepinephrine. The neohepatic phase was uneventful. Atrial fibrillation lasted for 5 days and reversed to sinus rhythm automatically. The patient was hemodynamically stable during this period, and recovery was smooth with no thromboembolic events. In conclusion, atrial fibrillation may be induced by iced saline injection for transpulmonary thermodilution measurement during orthotopic liver transplantation.

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Extravascular Lung Water and Effect on Oxygenation Assessed by Lung Ultrasound in Adult Cardiac Surgery

Cited by 5 publications

References 16 publications

Difficult Respiratory Weaning after Cardiac Surgery: A Narrative Review

Difficult Respiratory Weaning after Cardiac Surgery: A Narrative Review

Intraoperative Goal-Directed Perfusion in Cardiac Surgery with Cardiopulmonary Bypass: The Roles of Delivery Oxygen Index and Cardiac Index

New onset atrial fibrillation during orthotopic liver transplantation induced by iced saline injection for transpulmonary thermodilution: a case report

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