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The year in cardiothoracic and Vascular Anesthesia：Selected Highlights From 2009

麻醉与监护论坛 2010年第3期17卷 197-209页

作者： Harish Ramakrishna, MD, FASE Jens Fassl, MD Ashish Sinha, MD Prakash Patel, MD Hynek Riha, MD, DEAA, FCCP Michael Andritsos, MD Insung Chung,MD John G.T. Augoustides, MD, FASE, FAHA Mayo Clinic Scottsdale AZ Department of anesthesiology and critical care University of Basel Basel Switzerland Department of anesthesiology and critical care University of Pennsylvania School of Medicine Philadelphia PA Department of anesthesiology and Intensive care medicine Institute for Clinical and Experimental Medicine Prague Czech Republic Department of anesthesiology The Ohio State University Columbus OH

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纤维蛋白原与止血：获得性出血治疗的主要靶点

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麻醉与镇痛 2013年第3期9卷 33-44页

作者： Jerrold H. Levy Fania Szlam Kenichi A. Tanaka Roman M. Sniecienski Department of anesthesiology Emory University School of Medicine Cardiothoracic Anesthesiology and Critical Care Emory Healthcare Atlanta Georgia

纤维蛋白原在止血过程中起着关键作用。其在凝血酶的作用下裂解以及随后聚合成纤维蛋白条索从而形成网状结构的过程，对有效的血块形成是必要的。在急性失血时，为了维持足够的血容量和组织灌注常常需要输注晶体、胶体或者红细胞。尽管... 详细信息

纤维蛋白原在止血过程中起着关键作用。其在凝血酶的作用下裂解以及随后聚合成纤维蛋白条索从而形成网状结构的过程，对有效的血块形成是必要的。在急性失血时，为了维持足够的血容量和组织灌注常常需要输注晶体、胶体或者红细胞。尽管液体复苏是重要的，但常可导致剩余凝血因子的稀释以及稀释性凝血障碍的产生。此时纤维蛋白原是最先下降到极低水平的凝血因子。现今对于纤维蛋白原在急性出血中的作用认识仍不够深入，许多医学中心未将其作为治疗出血的常规监测指标。本研究回顾了近期一些明确临床上纤维蛋白原置换在治疗获得性出血中的重要性研究。若纤维蛋白原缺失，补充纤维蛋白原则成为改善和维持止血功能的关键措施；然而，何时开始补充纤维蛋白原仍没有定论。相较于传统的输注新鲜冰冻血浆和冷沉淀，冻干人纤维蛋白原浓缩液的应用在一些国家也越来越广泛。如今一些报道认为纤维蛋白原浓缩剂可成为传统止血措施之外的一种选择。目前尚需要一些关于补充纤维蛋白原在获得性出血中应用的前瞻性研究，从而准确评估其临床应用范围、最有效的补充方法以及应用的安全性。

关键词：人纤维蛋白原急性出血止血功能获得性治疗临床应用靶点新鲜冰冻血浆

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Effect of Oxygen Therapy by Venturi Mask versus Non Invasive Ventillation on the Outcome of Patients Who Devolope Hypoxia after Open Heart Surgery

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Open Journal of anesthesiology 2018年第9期8卷 241-254页

作者： Yousry El-Saied Rizk Tarek Samy Essawy Ahmed Hamdy Abd Elrahman Ali Mohamed Ahmed El-Gazzar Abdelkhalek Fouad Mahmoud cardiothoracic Surgery and Department of critical care medicine Faculty of Medicine Benha University Egypt Department of Chest Benha University Hospital Benha Egypt Anesthesia and Intensive care Department Benha Egypt cardiothoracic Surgery Benha University Benha Egypt Internal medicine Ministry of Health Cairo Egypt

Background: cardiothoracic surgery is a common cause of acute respiratory failure and is associated with increased morbidity and mortality. We aimed to compare the outcomes of open heart surgery patients treated using oxygen delivery devices with patients who receive NIV as a first-line therapy for hypoxemic respiratory failure. Materials and Methods: 40 patients who developed acute hypoxemic respiratory failure after open heart surgery and admitted to cardiothoracic ICU 20 patients received NIV and 20 patient received oxygen by venture mask. For all patients the following measurements were performed before and after CPAP AND Venture use: CBC, blood urea, serum creatinine body temperature, chest X-ray, Arterial blood gases (arterial pH, sodium bicarbonate, pcO2, SpO2 and PaO2-to-FiO2 ratio). Results: Mean PO2 and SO2 have increased after using of both venture and Cpap, increase in both PCO2 and HCO3 levels after using Venturi mask, CPAP mask was superior to venturi mask in avoiding the need of intubation, decreasing The ICU stay median length and also median length of hospitalization, all were lower in CPAP group than venture group. Also the mortality rate was lower in CPAP group than the venturi group. Conclusion: Using CPAP mask in severe AHRF following open heart surgery can avoid intubation, decreases the levels of tachypnea and arterial hypoxemia, decreases ICU stay, the length of hospitalization and also decreases the mortality rate compared with patients receiving high-concentration oxygen therapy with venture mask.

关键词： Open Heart Surgery Venture Mask CPAP Mask Non Invasive Ventilation O2 Therapy

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Association of latitude and altitude with adverse outcomes in patients with COVID-19: The VIRUS registry

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World Journal of critical care medicine 2022年第2期11卷 102-111页

作者： Aysun Tekin Shahraz Qamar Romil Singh Vikas Bansal Mayank Sharma Allison M LeMahieu Andrew C Hanson Phillip J Schulte Marija Bogojevic Neha Deo Simon Zec Diana J Valencia Morales Katherine A Belden Smith F Heavner Margit Kaufman Sreekanth Cheruku Valerie C Danesh Valerie M Banner-Goodspeed Catherine A St Hill Amy B Christie Syed A Khan Lynn Retford Karen Boman Vishakha KKumar John C O'Horo Juan Pablo Domecq Allan J Walkey Ognjen Gajic Rahul Kashyap Salim Surani TheSociety of critical care medicine(SCCM)Discovery Viral Infection and Respiratory Illness Universal Study(VIRUS):COVID-Registry Investigator Group Department of anesthesiology Mayo ClinicRochesterMN 55905United States Post-baccalaureate Research Education Program Mayo Clinic College of Medicine and ScienceRochesterMN 55905United States Division of Pulmonary and critical care medicine Department of Internal MedicineMayo ClinicRochesterMN 55905United States Division of Clinical Trials and Biostatistics Department of Quantitative Health SciencesMayo ClinicRochesterMN 55905United States Alix School of medicine Mayo ClinicRochesterMN 55905United States Division of Infectious Diseases Thomas Jefferson University HospitalPhiladelphiaPA 19107United States Prisma Health GreenvilleSC 29605United States Englewood Health EnglewoodNJ 07631United States divisions of cardiothoracic anesthesiology and critical care medicine Department of Anesthesiology and Pain ManagementUT Southwestern Medical CenterDallasTX 75390United States Center for Applied Health Research Baylor Scott and White HealthDallasTX 75246United States Department of anesthesiology Critical Care and Pain MedicineBeth Israel Deaconess Medical CenterBostonMA 02215United States Allina Health MinneapolisMN 55407United States Department of critical care Atrium Health NavicentMaconGA 31201United States Division of critical care medicine Mayo Clinic Health SystemMankatoMN 56001United States Society of critical care medicine Mount ProspectIL 60056United States Division of Infectious Diseases Mayo ClinicRochesterMN 55905United States Division of Nephrology and Hypertension Department of Internal MedicineMayo ClinicRochesterMN 55905United States Pulmonary Center Division of PulmonaryAllergyCritical Care and Sleep MedicineDepartment of MedicineEvans Center of Implementation and Improvement SciencesBoston University School of MedicineBostonMA 02118United States Department of Pulmonary and critical care medicine Texas A&M UniversityBryanTX 77807United States 不详

BACKGROUND The coronavirus disease 2019(COVID-19)course may be affected by environmental *** studies previously suggested a link between climatological factors and COVID-19 fatality ***,individual-level impact of these factors has not been thoroughly evaluated *** To study the association of climatological factors related to patient location with unfavorable outcomes in *** In this observational analysis of the Society of critical care medicine Discovery Viral Infection and Respiratory Illness Universal Study:COVID-19 Registry cohort,the latitudes and altitudes of hospitals were examined as a covariate for mortality within 28 d of admission and the length of hospital *** for baseline parameters and admission date,multivariable regression modeling was *** estimating equations were used to fit the *** Twenty-two thousand one hundred eight patients from over 20 countries were *** median age was 62(interquartile range:49-74)years,and 54%of the included patients were *** median age increased with increasing latitude as well as the frequency of ***,the percentage of comorbidities was lower in elevated *** within 28 d of hospital admission was found to be 25%.The median hospital-free days among all included patients was 20 *** the significant linear relationship between mortality and hospital-free days(adjusted odds ratio(aOR)=1.39(1.04,1.86),P=0.025 for mortality within 28 d of admission;aOR=-1.47(-2.60,-0.33),P=0.011 for hospital-free days),suggesting that adverse patient outcomes were more common in locations further away from the Equator;the results were no longer significant when adjusted for baseline differences(aOR=1.32(1.00,1.74),P=0.051 for 28-day mortality;aOR=-1.07(-2.13,-0.01),P=0.050 for hospital-free days).When we looked at the altitude’s effect,we discovered that it demonstrated a non-linear association with mortality wi

关键词： 28 d mortality Altitude COVID-19 Hospital-free days Latitude Outcomes

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Extracorporeal blood purification strategies in sepsis and septic shock:An insight into recent advancements

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World Journal of critical care medicine 2023年第2期12卷 71-88页

作者： Yatin Mehta Rajib Paul Abdul Samad Ansari Tanmay Banerjee Serdar Gunaydin Amir Ahmad Nassiri Federico Pappalardo Vedran Premužić Prachee Sathe Vinod Singh Emilio Rey Vela Institute of critical care and anesthesiology Medanta the MedicityGurugram 12201India Department of Internal medicine Apollo HospitalsJubilee HillsHyderabad 500033India Department of critical care Nanavati Max Super Specialty HospitalMumbai 400065India Department of Internal medicine&critical care Medica Institute of Critical Care MedicineMedica Superspecialty HospitalKolkata 700099India Department of Cardiovascular Surgery University of Health SciencesAnkara City Hospital CampusAnkara 06933Turkey Department of Nephrology Shahid Beheshti University of Medical SciencesTehran 19839-63113Iran cardiothoracic and Vascular Anesthesia and Intensive care AO SS Antonio e Biagio e Cesare ArrigoAlessandria 15121Italy Department of Nephrology Clinical Hospital ZagrebClinic for internal diseasesZagreb 10000Croatia Department of critical care medicine D.Y.Patil Medical CollegeSant Tukaram NagarPimpri ColonyPimpri-ChinchwadPune 411018India Department of critical care medicine Institute of critical care MedicineHospital Name-Sir Ganga Ram HospitalNew Delhi 110001India Cardiac Surgery Intensive care Unit Samaritan University HospitalBogotá11Colombia

BACKGROUND Despite various therapies to treat sepsis,it is one of the leading causes of mortality in the intensive care unit patients *** about the pathophysiology of sepsis has sparked interest in extracorporeal therapies(ECT)which are intended to balance the dysregulation of the immune system by removing excessive levels of inflammatory *** To review recent data on the use of ECT in sepsis and to assess their effects on various inflammatory and clinical *** In this review,an extensive English literature search was conducted from the last two decades to identify the use of ECT in sepsis.A total of 68 articles from peer-reviewed and indexed journals were selected excluding publications with only *** Results showed that ECT techniques such as high-volume hemofiltration,coupled plasma adsorption/filtration,resin or polymer adsorbers,and CytoSorb®are emerging as adjunct therapies to improve hemodynamic stability in ***®has the most published data in regard to the use in the field of septic shock with reports on improved survival rates and lowered sequential organ failure assessment scores,lactate levels,total leucocyte count,platelet count,interleukin-IL-6,IL-10,and TNF *** Clinical acceptance of ECT in sepsis and septic shock is currently still limited due to a lack of large random clinical *** addition to patient-tailored therapies,future research developments with therapies targeting the cellular level of the immune response are expected.

关键词： CytoSorb® Hemadsorbers Inflammatory mediators Extracorporeal therapies Sepsis

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血液凝固：止血与凝血酶调节

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麻醉与镇痛 2011年第2期7卷 25-39页

作者： Kenichi A. Tanaka, MD, MSc Nigel S. Key, MD Jerrold H. Levy, MD 蒋琦亮(译) 徐美英(校) Division of cardiothoracic Anesthesia and critical care Department of Anesthesiology Emory University School of Medicine Atlanta Georgia Division of Hematology Department of Internal Medicine University of North Carolina at Chapel Hill Chapel Hill North Carolina 不详

围手术期出血是一个棘手的问题，尤其是伴随着强效抗凝药物临床应用的日趋增多，这一问题变得更具挑战性。理解和掌握当今的凝血概念对于手术前确定患者固手术期的出血风险并在固手术期给予有效的止血治疗十分重要。具有丝氨酸蛋白酶活... 详细信息

围手术期出血是一个棘手的问题，尤其是伴随着强效抗凝药物临床应用的日趋增多，这一问题变得更具挑战性。理解和掌握当今的凝血概念对于手术前确定患者固手术期的出血风险并在固手术期给予有效的止血治疗十分重要。具有丝氨酸蛋白酶活性的凝血酶在激活其他丝氧酸蛋白酶原（无活性的酶前体）、辅助因子和细胞表面受体的过程中发挥着关键的作用。机体在遭受创伤后通过对凝血酶生成的严密调控可以获得局部快速止血而无全身不可控血栓形成的效果。手术期间，出血／血液稀释、输血和手术应激可以严重干扰凝血和炎性反应系统。手术后出血常常需要输注同种异体血治疗，这促进了凝血酶的产生与止血作用。但是手术后促凝血物质的活性和炎性反应也同时增加。因此，可能需要采用抗血栓治疗来预防围手术期血栓性并发症。新型止血药和抗血栓形成药物的开发应用使得围手术期止血管理和防治血栓形成方面取得了很大的进步。然而，当前治疗的局限性在于，传统的凝血检查并不能反映整个凝血过程，使得对药物治疗进行优化变得比较困难。理解凝血酶生成的体内调节机制和药物调控可能有助于在不增加促血栓生成风险的条件下控制出血。在这篇综述里，我们采用多种简化凝血模型对止血和凝血酶形成的调节机制进行探讨。

关键词：凝血酶生成止血治疗调节血液凝固抗血栓形成药物手术后出血蛋白酶活性围手术期

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Low dose corticosteroids in COVID-19 with refractory shock:We are not sure?

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World Journal of anesthesiology 2020年第1期9卷 1-2页

作者： Amr Salah Omar Department of cardiothoracic Surgery/Cardiac Anaesthesia and ICU Heart HospitalHamad Medical CorporationDoha 3050Qatar Department of critical care medicine Beni Suef UniversityBeni Suef 71515Egypt Department of medicine Weill Cornell Medical College in QatarDoha 3050Qatar

Low dose corticosteroids to adult patients with coronavirus disease 2019(COVID-19)and refractory shock was given some evidence,the evidence was of low quality given particularly for *** bacterial sepsis may not provide a similar evidence like in a viral related *** think that suggesting steroids for COVID-19 may not be adequate in the current time and future data analysis should be directed to find possible evidence in a matched population.

关键词： Corticosteroids Sepsis Shock COVID-19 Refractory Outcome

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Lung transplantation as therapeutic option in acute respiratory distress syndrome for coronavirus disease 2019-related pulmonary fibrosis

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Chinese Medical Journal 2020年第12期133卷 1390-1396页

作者： Jing-Yu Chen Kun Qiao Feng Liu Bo Wu Xin Xu Guo-Qing Jiao Rong-Guo Lu Hui-Xing Li Jin Zhao Jian Huang Yi Yang Xiao-Jie Lu Jia-Shu Li Shu-Yun Jiang Da-Peng Wang Chun-Xiao Hu Gui-Long Wang Dong-Xiao Huang Guo-Hui Jiao Dong Wei Shu-Gao Ye Jian-An Huang Li Zhou Xiao-Qin Zhang Jian-Xing He Wuxi Lung Transplant Center Wuxi People’s Hospital Affiliated to Nanjing Medical UniversityWuxiJiangsu 214023China Department of Thoracic Surgery Shenzhen Third People’s HospitalShenzhenGuangdong 518100China Department of Thoracic Surgery/Oncology State Key Laboratory and National Clinical Research Center for Respiratory DiseaseThe First Affiliated Hospital of Guangzhou Medical UniversityGuangzhouGuangdong 510120China Department of cardiothoracic Surgery Wuxi People’s Hospital Affiliated to Nanjing Medical UniversityWuxiJiangsu 214023China Department of critical care medicine Zhongda HospitalSchool of MedicineSoutheast UniversityNanjingJiangsu 210009China Wuxi Fifth Hospital WuxiJiangsu 214000China Department of Respiratory medicine and critical care medicine The First People’s Hospital of Lianyungang CityLianyungangJiangsu 222061China Department of critical care medicine Wuxi People’s Hospital Affiliated to Nanjing Medical UniversityWuxiJiangsu 214023China Department of anesthesiology Wuxi People’s Hospital Affiliated to Nanjing Medical UniversityWuxiJiangsu 214023China Department of Respiratory medicine The First Affiliated Hospital of Soochow UniversitySuzhouJiangsu 215006China

Background:critical patients with the coronavirus disease 2019(COVID-19),even those whose nucleic acid test results had turned negative and those receiving maximal medical support,have been noted to progress to irreversible fatal respiratory *** transplantation(LT)as the sole therapy for end-stage pulmonary fibrosis related to acute respiratory distress syndrome has been considered as the ultimate rescue therapy for these ***:From February 10 to March 10,2020,three male patients were urgently assessed and listed for *** conducting a full ethical review and after obtaining assent from the family of the patients,we performed three LT procedures for COVID-19 patients with illness durations of more than one month and extremely high sequential organ failure assessment ***:Two of the three recipients survived post-LT and started participating in a rehabilitation *** of the LT team collaboration and perioperative logistics were summarized and continually *** pathological results of the explanted lungs were concordant with the critical clinical manifestation,and provided insight towards better understanding of the *** health affair systems,virology detection tools,and modern communication technology all play key roles towards the survival of the patients and their ***:LT can be performed in end-stage patients with respiratory failure due to COVID-19-related pulmonary *** confirmed positive-turned-negative virology status without organ dysfunction that could contraindicate LT,LT provided the final option for these patients to avoid certain death,with proper protection of transplant surgeons and medical *** ensuring instant seamless care for both patients and medical teams,the goal of reducing the mortality rate and salvaging the lives of patients with COVID-19 can be attained.

关键词： Coronavirus disease 2019 Lung transplantation Acute respiratory distress syndrome Pulmonary fibrosis Sequential Organ Failure Assessment score

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Utilization of extracorporeal membrane oxygenation during the COVID-19 pandemic

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World Journal of critical care medicine 2021年第1期10卷 1-11页

作者： Asim Kichloo Akshay Kumar Rawan Amir Michael Aljadah Najiha Farooqi Michael Albosta Jagmeet Singh Shakeel Jamal Zain El-Amir Akif Kichloo Nazir Lone Department of Internal medicine Central Michigan UniversitySaginawMI 48603United States Department of cardiothoracic Surgery University of PittsburghPittsburghPA 15260United States Department of Internal medicine University of MarylandBaltimoreMD 20742United States Department of Internal medicine Medical College of WisconsinMilwaukeeWI 53226United States Department of Surgery Central Michigan UniversitySaginawMI 48603United States Department of Nephrology and Transplant Nephrology Guthrie Robert Packer HospitalSayrePA 18840United States Department of anesthesiology and critical care Saraswathi Institute of Medical SciencesUttar Pradesh 245304India Department of Pulmonology and critical care Northwell HealthRiverheadNY 11901United States

The ongoing outbreak of severe acute respiratory syndrome coronavirus-2[SARSCoV-2,or coronavirus disease 2019(COVID-19)]was declared a pandemic by the World Health Organization on March 11,***,more than 65 million people have been infected with this SARS-CoV-2 virus,and over 1.5 million people have died due to the viral *** a tremendous amount of medical progress has been made since its inception,there continues to be ongoing research regarding the pathophysiology,treatments,and *** a vast majority of those infected develop only mild to moderate symptoms,about 5%of people have severe forms of infection resulting in respiratory failure,myocarditis,septic shock,or multi-organ *** maximal cardiopulmonary support and invasive mechanical ventilation,mortality remains *** membrane oxygenation(ECMO)remains a valid treatment option when maximal conventional strategies *** of ECMO in the pandemic is challenging from both resource allocation and ethical *** article reviews the rationale behind its use,current status of utilization,and future considerations for ECMO in critically ill COVID-19 patients.

关键词： Extracorporeal membrane oxygenation COVID-19 critical care Acute respiratory distress syndrome Shock Research

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Emerging therapeutics in the management of COVID-19

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World Journal of Virology 2021年第1期10卷 1-29页

作者： Asim Kichloo Michael Albosta Akshay Kumar Michael Aljadah Mohamed Mohamed Zain El-Amir Farah Wani Shakeel Jamal Jagmeet Singh Akif Kichloo Department of Internal medicine Samaritan Medical CenterWatertownNY 13601United States Department of Internal medicine Central Michigan UniversitySaginawMI 48602United States Department of cardiothoracic Surgery University of PittsburghPittsburghPA 15260United States Deparment of Internal medicine Medical College of WisconsinMilwaukeeWI 53226United States Department of Family medicine Samaritan Medical CenterWatertownNY 13601United States Department of Transplant Nephrology Geisinger Commonwealth School of MedicineSayrePA 18510United States Department of anesthesiology and critical care Saraswathi Institue of Medical SciencesUttar Pradesh 245304India

Abstract The severe acute respiratory syndrome coronavirus 2(coronavirus disease 2019,COVID-19)pandemic has placed a tremendous burden on healthcare systems *** for treatment of the virus are extremely inconsistent due to the lack of time evaluating drug efficacy in clinical ***,there is a deficiency of published literature that comprehensively discusses all therapeutics being considered for the treatment of COVID-19.A review of the literature was performed for articles related to therapeutics and clinical trials in the context of the current COVID-19 *** used PubMed,Google Scholar,and *** to search for articles relative to the topic of *** used the following keywords:“COVID-19”,“therapeutics”,“clinical trials”,“treatment”,“FDA”,“ICU”,“mortality”,and“management”.In addition,searches through the references of retrieved articles was also *** this paper,we have elaborated on the therapeutic strategies that have been hypothesized or trialed todate,the mechanism of action of each therapeutic,the clinical trials finished or inprocess that support the use of each therapeutic,and the adverse effects associated with each ***,there is no treatment that has been proven to provide significant benefit in reducing morbidity and *** are many clinical trials for numerous different therapeutic agents currently *** looking back and measuring successful strategies from previous pandemics in addition to carrying out ongoing research,we provide ourselves with the greatest opportunity to find treatments that are beneficial.

关键词： COVID-19 Therapeutics Infectious disease SARS-CoV-2 Pharmacology Virology

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