دورية أكاديمية
أعرض في EDS

Clinical relevance of transcranial Doppler in a cardiac surgery setting: embolic load predicts difficult separation from cardiopulmonary bypass.

التفاصيل البيبلوغرافية
العنوان: Clinical relevance of transcranial Doppler in a cardiac surgery setting: embolic load predicts difficult separation from cardiopulmonary bypass.
المؤلفون: Jarry S; Department of Anesthesiology, Montreal Heart Institute, Université de Montréal, 5000 Belanger Street, Montreal, QC, H1T 1C8, Canada., Couture EJ; Department of Anesthesiology and Department of Medicine, Division of Intensive Care Medicine, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Quebec, QC, Canada., Beaubien-Souligny W; Department of Nephrology, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada., Fernandes A; Perfusion Service, Montreal Heart Institute, Université de Montréal, Montreal, QC, Canada., Fortier A; Montreal Health Innovations Coordinating Center, Montreal Heart Institute, Montreal, QC, Canada., Ben-Ali W; Department of Surgery and Department of Cardiology, Montreal Heart Institute, Montreal, QC, Canada., Desjardins G; Department of Anesthesiology, Montreal Heart Institute, Université de Montréal, 5000 Belanger Street, Montreal, QC, H1T 1C8, Canada., Huard K; Université de Montréal, Montreal, QC, Canada., Mailhot T; Research Center, Montreal Heart Institute, and Faculty of Nursing, Université de Montréal, Montreal, QC, Canada., Denault AY; Department of Anesthesiology, Montreal Heart Institute, Université de Montréal, 5000 Belanger Street, Montreal, QC, H1T 1C8, Canada. andre.denault@umontreal.ca.
المصدر: Journal of cardiothoracic surgery [J Cardiothorac Surg] 2024 Feb 13; Vol. 19 (1), pp. 90. Date of Electronic Publication: 2024 Feb 13.
نوع المنشور: Journal Article
اللغة: English
بيانات الدورية: Publisher: BioMed Central Country of Publication: England NLM ID: 101265113 Publication Model: Electronic Cited Medium: Internet ISSN: 1749-8090 (Electronic) Linking ISSN: 17498090 NLM ISO Abbreviation: J Cardiothorac Surg Subsets: MEDLINE
أسماء مطبوعة: Original Publication: [London] : BioMed Central, 2006-
مواضيع طبية MeSH: Cardiac Surgical Procedures*/adverse effects , Embolism*, Humans ; Cohort Studies ; Retrospective Studies ; Cardiopulmonary Bypass/adverse effects ; Clinical Relevance
مستخلص: Background: During cardiac surgery, transcranial Doppler (TCD) represents a non-invasive modality that allows measurement of red blood cell flow velocities in the cerebral arteries. TCD can also be used to detect and monitor embolic material in the cerebral circulation. Detection of microemboli is reported as a high intensity transient signal (HITS). The importance of cerebral microemboli during cardiac surgery has been linked to the increased incidence of postoperative renal failure, right ventricular dysfunction, and hemodynamic instability. The objective of this study is to determine whether the embolic load is associated with hemodynamic instability during cardiopulmonary bypass (CPB) separation and postoperative complications.
Methods: A retrospective single-centre cohort study of 354 patients undergoing cardiac surgery between December 2015 and March 2020 was conducted. Patients were divided in tertiles, where 117 patients had a low quantity of embolic material (LEM), 119 patients have a medium quantity of microemboli (MEM) and 118 patients who have a high quantity of embolic material (HEM). The primary endpoint was a difficult CPB separation. Multivariate logistic regression was used to determine the potential association between a difficult CPB separation and the number of embolic materials.
Results: Patients who had a difficult CPB separation had more HITS compared to patients who had a successful CPB separation (p < 0.001). In the multivariate analysis, patients with MEM decreased their odds of having a difficult CPB weaning compared to patients in the HEM group (OR = 0.253, CI 0.111-0.593; p = 0.001). In the postoperative period patients in the HEM group have a higher Time of Persistent Organ Dysfunction (TPOD), a longer stay in the ICU, a longer duration under vasopressor drugs and a higher mortality rate compared to those in the MEM and LEM groups.
Conclusion: The result of this study suggests that a high quantity of cerebral embolic material increases the odds of having a difficult CPB separation. Also, it seems to be associated to more complex surgery, a longer CPB time, a higher TPOD and a longer stay in the ICU. Six out of eight patients who died in this cohort were in the HEM group.
(© 2024. The Author(s).)
References: J Vasc Surg. 2018 Dec;68(6):1656-1666. (PMID: 29804744)
J Neurol Sci. 2020 Sep 15;416:117006. (PMID: 32623144)
J Cardiothorac Vasc Anesth. 2022 Dec;36(12):4505-4522. (PMID: 36100499)
Ann Thorac Surg. 2001 Feb;71(2):673-7. (PMID: 11235726)
Anesth Analg. 2021 Aug 1;133(2):379-392. (PMID: 33764341)
Stroke. 2010 Oct;41(10):2229-35. (PMID: 20724717)
N Engl J Med. 2000 Feb 17;342(7):476-82. (PMID: 10675429)
Can J Anaesth. 2017 Aug;64(8):885-887. (PMID: 28510783)
J Cardiothorac Vasc Anesth. 2021 Mar;35(3):763-779. (PMID: 32709385)
J Extra Corpor Technol. 2017 Dec;49(4):262-272. (PMID: 29302117)
Ann Thorac Surg. 2000 Apr;69(4):1229-35. (PMID: 10800824)
Anesth Analg. 2008 May;106(5):1376-84. (PMID: 18420847)
Stroke. 1993 Aug;24(8):1246-50. (PMID: 8342202)
J Cardiothorac Vasc Anesth. 2015 Aug;29(4):836-44. (PMID: 25976606)
Chest. 2005 Oct;128(4):2918-32. (PMID: 16236969)
Can J Anaesth. 2021 Jan;68(1):130-136. (PMID: 33063295)
A A Pract. 2019 Jan 1;12(1):30-32. (PMID: 30020109)
Ann Thorac Surg. 2000 Apr;69(4):1162-6. (PMID: 10800812)
Ann Thorac Surg. 1999 Jul;68(1):89-93. (PMID: 10421121)
Int J Cardiol. 2006 Oct 10;112(3):e85-6. (PMID: 16887218)
Am J Surg. 2009 Jan;197(1):55-63. (PMID: 18723157)
Circulation. 2005 Dec 20;112(25):3833-8. (PMID: 16365207)
J Am Heart Assoc. 2019 May 7;8(9):e010920. (PMID: 31017035)
N Engl J Med. 1988 May 5;318(18):1148-52. (PMID: 3362165)
JAMA Neurol. 2020 Jul 1;77(7):878-886. (PMID: 32282016)
J Cardiothorac Surg. 2010 Feb 04;5:5. (PMID: 20132556)
Chest. 2001 Jan;119(1):25-30. (PMID: 11157580)
J Thorac Cardiovasc Surg. 2000 Nov;120(5):856-62. (PMID: 11044310)
J Heart Valve Dis. 2011 Mar;20(2):171-4. (PMID: 21560817)
J Thorac Cardiovasc Surg. 2009 Jul;138(1):157-62. (PMID: 19577073)
Circulation. 2020 Oct 6;142(14):e193-e209. (PMID: 32842767)
Perfusion. 2005 May;20(3):151-6. (PMID: 16038387)
J Thorac Cardiovasc Surg. 2008 Mar;135(3):512-20. (PMID: 18329462)
J Thorac Cardiovasc Surg. 2004 Jun;127(6):1759-65. (PMID: 15173734)
Anesth Analg. 2009 Oct;109(4):1013-22. (PMID: 19762724)
J Am Coll Cardiol. 1992 Jul;20(1):70-7. (PMID: 1607541)
Cardiol Res. 2016 Dec;7(6):185-195. (PMID: 28197291)
J Cardiothorac Vasc Anesth. 2022 Sep;36(9):3517-3525. (PMID: 35618594)
Front Cardiovasc Med. 2021 Jun 14;8:667328. (PMID: 34195233)
J Cardiothorac Vasc Anesth. 2020 Aug;34(8):2116-2125. (PMID: 32037274)
Neurocrit Care. 2020 Apr;32(2):502-511. (PMID: 31264072)
J Am Heart Assoc. 2018 Oct 2;7(19):e009961. (PMID: 30371304)
Int J Artif Organs. 2011 Nov;34(11):1039-51. (PMID: 22183517)
J Extra Corpor Technol. 2009 Dec;41(4):P31-7. (PMID: 20092085)
J Extra Corpor Technol. 2013 Jun;45(2):128-32. (PMID: 23930383)
World J Pediatr Congenit Heart Surg. 2020 Jul;11(4):401-408. (PMID: 32645775)
J Cardiothorac Vasc Anesth. 2019 Oct;33(10):2781-2796. (PMID: 30573306)
Neurosurg Focus. 2019 Dec 1;47(6):E2. (PMID: 31786564)
J Thorac Cardiovasc Surg. 2020 May;159(5):e315-e317. (PMID: 31301900)
JAMA. 2002 Mar 20;287(11):1405-12. (PMID: 11903027)
Ann Thorac Surg. 2003 Feb;75(2):472-8. (PMID: 12607656)
Eur J Cardiothorac Surg. 2006 Feb;29(2):175-80. (PMID: 16376562)
Front Neurol. 2018 Oct 17;9:847. (PMID: 30386287)
J Cardiothorac Vasc Anesth. 2017 Oct;31(5):1656-1662. (PMID: 28416392)
J Card Surg. 2011 Mar;26(2):189-96. (PMID: 21395683)
J Cardiothorac Vasc Anesth. 2004 Oct;18(5):548-51. (PMID: 15578463)
Semin Cardiothorac Vasc Anesth. 2016 Sep;20(3):225-31. (PMID: 26783262)
Perfusion. 2004;19 Suppl 1:S49-55. (PMID: 15161064)
J Cardiothorac Vasc Anesth. 2019 Aug;33 Suppl 1:S11-S37. (PMID: 31279350)
فهرسة مساهمة: Keywords: Cardiac surgery; Cardiopulmonary bypass; Cerebral microemboli; High intensity transient signal; Transcranial Doppler
تواريخ الأحداث: Date Created: 20240212 Date Completed: 20240214 Latest Revision: 20240215
رمز التحديث: 20240215
مُعرف محوري في PubMed: PMC10863099
DOI: 10.1186/s13019-024-02591-4
PMID: 38347542
قاعدة البيانات: MEDLINE
الوصف
تدمد:1749-8090
DOI:10.1186/s13019-024-02591-4