scholarly journals A Case of Two-Stage Surgery Preceded by Reduction of Hematoma under Epidural Anesthesia for Intrathoracic Giant Chronic Expanding Hematoma with Symptoms of Heart Failure

2021 ◽  
Vol 41 (1) ◽  
pp. 36-41
Author(s):  
Michiko GOTANDA ◽  
Yoshikazu MATSUOKA ◽  
Kazumasa HIROI ◽  
Yuto MATSUOKA ◽  
Motomu KOBAYASHI ◽  
...  
Keyword(s):  
Heart Failure ◽  
Epidural Anesthesia ◽  
Two Stage ◽  
Chronic Expanding Hematoma

scholarly journals Management of acutely decompensated chronic thromboembolic pulmonary hypertension in late pregnancy: a case report

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Luca Valko ◽  
Gyorgyi Csosza ◽  
Akos Merei ◽  
Diana Muhl ◽  
Reka Faludi ◽  
...  
Keyword(s):  
Heart Failure ◽  
Pulmonary Hypertension ◽  
Epidural Anesthesia ◽  
Chronic Thromboembolic Pulmonary Hypertension ◽  
Late Pregnancy ◽  
Right Heart Failure ◽  
Close Monitoring ◽  
Right Heart ◽  
Acute Decompensation ◽  
Thromboembolic Pulmonary Hypertension

Abstract Background Pregnancy in patients with pulmonary hypertension is associated with increased risk of maternal and fetal death. Physiological changes during pregnancy, labor and the postpartum period may all lead to acute decompensation of chronic right heart failure with rapid progression to circulatory collapse. As such, guidelines discourage planned pregnancies in women suffering from pulmonary hypertension. There are, however, rare cases of pulmonary hypertension which have previously been undiagnosed and only become apparent during late stage pregnancy. These individuals require close monitoring and multidisciplinary management. Case presentation We describe the case of a 34-year-old female who presented with acute decompensation of previously undiagnosed pulmonary hypertension during the 30th week of her second pregnancy. Echocardiography and CT scan confirmed severe pulmonary hypertension and right heart failure with no new thromboembolic component. Following stabilization of cardiorespiratory parameters with high FiO2 noninvasive ventilation, intravenous epoprostenol and levosimendan treatment, Cesarean section was performed under epidural anesthesia. Close monitoring was continued in the postoperative period and cardiovascular parameters were managed with ongoing inotropic and escalating vasodilator therapy. The findings were consistent with chronic thromboembolic pulmonary hypertension. Persistent hypoxia was found to be a result of right bronchial obstruction caused by blood clots, which resolved with bronchoscopic intervention. Ongoing postpartum management resulted in improved cardiovascular parameters and oxygenation. Epoprostenol treatment was successfully converted to subcutaneous treprostinil therapy and the patient was discharged home to care for her healthy baby girl. Optimal timing of pulmonary endarterectomy will be chosen based upon functional status and patient preference. Conclusions The case described is the first published report of previously undiagnosed pulmonary hypertension presenting with acute right heart failure in late pregnancy successfully managed by pharmacological therapy, noninvasive ventilation and a Cesarean performed under epidural anesthesia. The case illustrates that despite the challenges, acutely discovered right heart failure can be successfully managed with a comprehensive multidisciplinary treatment plan.

Readmission Risk Trajectories for Heart Failure Patients Using a Dynamic Prediction Approach (Preprint)

2019 ◽  
Author(s):  
Wei Jiang ◽  
Sauleh Siddiqui ◽  
Diego Martinez ◽  
Stephanie Cabral ◽  
Matthew Toerper ◽  
...  
Keyword(s):  
Heart Failure ◽  
High Risk ◽  
Hospital Stay ◽  
Vital Signs ◽  
Low Risk ◽  
Clinical Predictors ◽  
Moderate Risk ◽  
Two Stage ◽  
Heart Failure Patients ◽  
Readmission Risk

BACKGROUND Patients hospitalized with heart failure suffer the highest rates of 30-day readmission among any clinically-defined patient populations in the United States. Investigation into the predictability of 30-day readmissions can lead to clinical decision-support tools and targeted interventions that can help care providers to improve individual patient care and reduce readmission risk. OBJECTIVE We developed a dynamic readmission risk prediction model that yields daily predictions for hospitalized heart failure patients toward identifying risk trajectories over time. We identified clinical predictors associated with different patterns in readmission risk trajectories. METHODS A two-stage predictive modeling approach combining logistic and beta regression was applied to electronic health record (EHR) data accumulated daily to predict 30-day readmission for a cohort of 534 heart failure patient encounters over 2,750 patient-days. Unsupervised clustering was performed on predictions to uncover time-dependent trends in readmission risk over the patient’s hospital stay. RESULTS Readmission occurred in 107 (20.0%) encounters. The out-of-sample AUC for the two-stage predictive model was 0.73 (±0.08). Dynamic clinical predictors capturing lab results and vital signs had the highest predictive value compared to demographic, administrative, medication and procedural data included. Unsupervised clustering identified four risk trajectory groups: decreasing risk (24.5% encounters), high risk (21.2%), moderate risk (33.1%), and low risk (21.2%). The decreasing risk group demonstrated change in average probability of readmission from admission (0.69) to discharge (0.30), while the high risk (0.75), moderate risk (0.61), and low risk (0.39) maintained consistency over the hospital course. Clinical predictors that discriminated groups included lab measures (hemoglobin, potassium, sodium), vital signs (diastolic blood pressure), and the number of prior hospitalizations. CONCLUSIONS Dynamically predicting readmission and quantifying trends over patients’ hospital stay illuminated differing risk trajectory groups. Identifying risk trajectory patterns and distinguishing predictors may shed new light on indicators of readmission and the isolated effects of the index hospitalization.

scholarly journals INFLUENCE OF THE ANESTHESIA METHOD ON THE OUTCOMES OF CARDIAC SURGERY OF DIFFERENT COMPLEXITY IN CHILDREN

2017 ◽  
Vol 11 (4) ◽  
pp. 226-232
Author(s):  
Lyaylya Z. Biktasheva ◽  
I. N Menshugin ◽  
V. A Mazurok ◽  
A. E Bautin
Keyword(s):  
Heart Failure ◽  
Mechanical Ventilation ◽  
Postoperative Complications ◽  
Epidural Anesthesia ◽  
Perioperative Period ◽  
Significant Positive Effect ◽  
Early Activation ◽  
The Mean ◽  
Positive Effect ◽  
A Current

The Aristotle score: a complexity-adjusted method to evaluate surgical results. For an assessment of dynamics of quality of the provided cardio-surgical help, comparison of a perioperative case rate and a mortality depending on the degree of surgical risk at cardiac interventions the Aristotle score is used. Thoracic epidural anesthesia (TEA) in comparison with high-opioids intravenous anesthesia (IVA) contributes to hemodynamics stability and early activation of patients. Objective: To analyze a current of the perioperative period at cardiac interventions in children with various categories of complexity of surgical intervention on «Aristotle score» depending on a type of anesthesia. Materials and methods. The 139 children with congenital heart diseases (CHD) underwent surgical correction. Patients were treated in Federal State Budgetary Institution of the Russian Ministry of Health (Penza), and «Almazov National medical research Centre» from 2008 to 2017 yrs. Patients (139 people, the mean age M (SD) of 7.6 (5.6) months of life) were divided into groups according to the categories of operational complexity presented in the Aristotle score. The group 1 consisted of 85 (61.2%) patients underwent interventions of second category of complexity, the group 2 consisted of 49 (39.8%) patients underwent interventions of 3 and 4 categories of complexity. Results. In cardiosurgical operations of the 2nd category of the Aristotle scale complexity a significant positive effect of TEA on the perioperative period was revealed in the form of a decrease in the severity of intraoperative heart failure and the level of glycaemia, the total number of postoperative complications and the time of patients’ staying on mechanical ventilation, as well as the duration of ICU stay and the decrease thrombocytopenia severity and frequency. In operations of grade 3 and 4, in which the duration of extracorporeal circulation was greater, the use of TEA did not have a significant positive effect on the incidence of postoperative complications, but after epidural anesthesia the mean duration of the patients’ stay on the mechanical ventilation and in the ICU was also significantly less. Apparently, the result is a consequence of a lesser severity of heart failure and early activation of patients by excluding the use of opioids, which have a depressing effect on the central nervous system, cardiac, respiratory and other systems. It can also be assumed that the administration of local anesthetics within 24 hours after the operation maintained sympatholytic and antiarrhythmic effects, and also prevented the complications development as a result of effective analgesia. Sufficiently convincing evidence of high antinociceptive activity of TEA is the possibility of safe extubation of patients in both the 2-d and 3-d categories of surgical complexity demonstrated in our study already in the operating room. Conclusion. Use of high TEA as a component of the combined anesthesia at surgical correction of CHD in young children has positive impact on a current of the perioperative period in the form of decrease in severity of heart and respiratory failure, duration of respiratory support, early activation and reduction of ICU stay.

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