Cardiothoracic Anesthesia

Pressure-regulated volume control mode versus synchronized intermittent mandatory ventilation mode in management of acute respiratory failure complicating advanced liver disease Rafik Yousset Atalla, Dalia Fahmy Emam, Wail Ahmed Abdelaal The Egyptian Journal of Cardiothoracic Anesthesia 2018 12(3):35-41 Background A common cause of death in the ICUs is advanced liver disease and its complications. Respiratory complications are common in patients with advanced liver disease. Management of patients with advanced hepatic disease having acute respiratory failure mandates the use of lung-protective ventilation strategies to achieve adequate oxygenation. Objectives The aim of this study was to compare and evaluate the superiority of either pressure-regulated volume control (PRVC) mode versus synchronized intermittent mandatory ventilation (SIMV) mode in management of acute respiratory failure complicating advanced hepatic disease. Patients and methods A total of 80 patients were included in this study, who were randomized into two equal groups of 40 patients each, namely. group S and group PV. Group S was ventilated using SIMV mode, whereas group PV was ventilated using PRVC mode. Results There was a statistically significant difference between group PV and group S during the mechanical ventilation period regarding the PO2/FiO2 ratio, static compliance, and dynamic compliance values, with higher values in group PV than group S providing better oxygenation. There was a statistically significant difference in the duration of mechanical ventilation and the ICU stay between the two groups, with significantly lower values in the PV group than the S group. Conclusion We concluded that PRVC mode of mechanical ventilation is superior to SIMV in acute respiratory failure complicating advanced liver disease, as it resulted in improved oxygenation at lower inflation pressures.

Intraoperative thromboelastographic assessment of platelet function in a patient with low platelet count and high-mean platelet volume requiring cardiac surgery Francesco Del Sindaco, Daniel Rajeev, Sandra Faloye, Lisa Vipond The Egyptian Journal of Cardiothoracic Anesthesia 2018 12(3):42-44 An 80-year-old patient with low platelet count was admitted in our institution for aortic valve replacement and a coronary artery bypass graft. Because of thrombocytopenia, a mean platelet volume has been assessed, showing a value above the range. Two pools of platelets were booked but not transfused, neither in the theater nor during the postoperative period. A thromboelastographic assessment at the end of the cardiopulmonary bypass showed a normal overall platelet function, and no clinical issues (diffuse bleeding after protamine and/or oozing from the drain above the range, in the postoperative period) were noticed. The authors point out the importance of thromboelastographic or thromboelastometric assessments in patients with isolated thrombocytopenia and high-mean platelet volume to contribute to reduce the risk of inappropriate transfusions.

Tamponade-like picture caused by pericardial cyst Mostafa Eladawy, Anup Varghese The Egyptian Journal of Cardiothoracic Anesthesia 2018 12(3):45-48 Pericardial cysts are rare entities, they have an incidence rate of 1:100,000 which constitutes about 7.6% of all mediastinal masses (6). The differential diagnosis includes other solid tumors and cysts of the mediastinum, diaphragmatic hernia or tumors, aneurysms of the heart or great vessels (1). Although TTE can differentiate many of the causes of mediastinal masses, loculated pericardial effusion with a similar clinical picture can be difficult to differentiate on transthoracic echocardiography (8). Radiological examination with CT or MRI has been described to differentiate in difficult cases. In emergency situations, TEE examination could be a useful option as it can help differentiating a malignant from a benign pericardial cyst, check the extent of involvement of underlying myocardium or adjacent structures and assess the anatomical abnormalities or effects on different heart chambers. In our case we describe a case of a huge pericardial cyst which had affected the patient haemodynamics in a tamponade like picture, the intra-operative TEE assessment helped appreciating the compression effect on the right heart chambers and the intravascular resuscitation needed to counteract the external pressure of the pericardial cyst. The echocardiography also helped the decision making of performing the procedure on CPB.

Alexandros Sfakianakis
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