Massive hemoptysis represents a life-threatening disorder due to different etiologies. Developmen... more Massive hemoptysis represents a life-threatening disorder due to different etiologies. Development of recombinant factor concentrates allows for novel treatments in this emergent setting. We present a patient with chronic thromboembolic pulmonary hypertension who underwent pulmonary thromboendarterectomy. Postoperative course was complicated by massive hemoptysis resulting in severe hypoxemia requiring extracorporeal membrane oxygenation and multiple daily blood transfusions. After failure of conservative and interventional approaches, recombinant factor seven was administered via bronchial isolation. Following treatment, her hemoptysis dramatically resolved with eventual discharge and excellent function at follow-up. This case presents the novel use of intrapulmonary activated factor seven to control massive hemoptysis.
Seminars in Cardiothoracic and Vascular Anesthesia, Dec 1, 2006
Genetic variants in the coagulation system have been known since antiquity. Today, because of mod... more Genetic variants in the coagulation system have been known since antiquity. Today, because of modern improvements in diagnosis and medical management, the clinician is likely to encounter a spectrum of coagulation factor deficiencies and identified polymorphic variants in the surgical population. Because perioperative hemorrhagic and thrombotic complications are potentially serious, it is important to understand the role that these defects and variants may play in predicting risk and optimizing patient management. The implications of coagulation genetics on the perioperative management of the cardiac surgery patient are reviewed.
Journal of Cardiothoracic and Vascular Anesthesia, May 1, 2021
Objective:Conventional ultrafiltration (CUF) during cardiopulmonary bypass (CPB) serves to hemoco... more Objective:Conventional ultrafiltration (CUF) during cardiopulmonary bypass (CPB) serves to hemoconcentrate blood volume to avoid allogeneic blood transfusions. Previous studies have determined weight-indexed CUF volumes as a continuous variable are associated with postoperative AKI after cardiac surgery but optimal weight-indexed volumes that predict AKI have not been described.Design:Retrospective cohortSetting:Single-center university hospitalParticipants:1,641 consecutive patients that underwent elective cardiac surgery between June 2013-December 2015.Interventions:CUF volume was removed during CPB in all participants as part of our routine practice. We investigated the association of dichotomized weight indexed CUF volume removal with postoperative AKI development to provide pragmatic guidance for clinical practice at our institution.Measurements and Main results:Primary outcomes of postoperative AKI was defined by the KDIGO staging criteria and dichotomized, weight indexed CUF volumes (ml/kg) were defined by (i) extreme quartiles (<Q1 vs. >Q3) and by (ii) Youden’s criterion that best predicted AKI development. Multivariable logistic regression models were developed to test the association of these dichotomized indices with AKI status. Postoperative AKI occurred in 827 patients (50.4%). Higher CUF volumes were associated with AKI development by quartiles (CUF >Q3=32.6 vs. CUF <Q1=10.4 ml/kg; OR=1.68, 95% CI:1.19-2.3) and Youden’s criterion (CUF ≥32.9 vs. CUF <32.9 ml/kg; OR=1.60, 95% C:1.21-2.13). Despite similar intraoperative nadir hematocrits between groups (P=0.8), higher CUF volumes were associated with more allogeneic blood transfusions (p=0.002) and longer lengths-of-stay (p<0.001).Conclusions:Removal of weight-indexed CUF volumes >32 mL/kg increased the risk for postoperative AKI development. Importantly, CUF volume removal of any amount did not mitigate allogeneic blood transfusion during elective cardiac surgery. Prospective studies are needed to validate these findings.
Massive hemoptysis represents a life-threatening disorder due to different etiologies. Developmen... more Massive hemoptysis represents a life-threatening disorder due to different etiologies. Development of recombinant factor concentrates allows for novel treatments in this emergent setting. We present a patient with chronic thromboembolic pulmonary hypertension who underwent pulmonary thromboendarterectomy. Postoperative course was complicated by massive hemoptysis resulting in severe hypoxemia requiring extracorporeal membrane oxygenation and multiple daily blood transfusions. After failure of conservative and interventional approaches, recombinant factor seven was administered via bronchial isolation. Following treatment, her hemoptysis dramatically resolved with eventual discharge and excellent function at follow-up. This case presents the novel use of intrapulmonary activated factor seven to control massive hemoptysis.
Seminars in Cardiothoracic and Vascular Anesthesia, Dec 1, 2006
Genetic variants in the coagulation system have been known since antiquity. Today, because of mod... more Genetic variants in the coagulation system have been known since antiquity. Today, because of modern improvements in diagnosis and medical management, the clinician is likely to encounter a spectrum of coagulation factor deficiencies and identified polymorphic variants in the surgical population. Because perioperative hemorrhagic and thrombotic complications are potentially serious, it is important to understand the role that these defects and variants may play in predicting risk and optimizing patient management. The implications of coagulation genetics on the perioperative management of the cardiac surgery patient are reviewed.
Journal of Cardiothoracic and Vascular Anesthesia, May 1, 2021
Objective:Conventional ultrafiltration (CUF) during cardiopulmonary bypass (CPB) serves to hemoco... more Objective:Conventional ultrafiltration (CUF) during cardiopulmonary bypass (CPB) serves to hemoconcentrate blood volume to avoid allogeneic blood transfusions. Previous studies have determined weight-indexed CUF volumes as a continuous variable are associated with postoperative AKI after cardiac surgery but optimal weight-indexed volumes that predict AKI have not been described.Design:Retrospective cohortSetting:Single-center university hospitalParticipants:1,641 consecutive patients that underwent elective cardiac surgery between June 2013-December 2015.Interventions:CUF volume was removed during CPB in all participants as part of our routine practice. We investigated the association of dichotomized weight indexed CUF volume removal with postoperative AKI development to provide pragmatic guidance for clinical practice at our institution.Measurements and Main results:Primary outcomes of postoperative AKI was defined by the KDIGO staging criteria and dichotomized, weight indexed CUF volumes (ml/kg) were defined by (i) extreme quartiles (<Q1 vs. >Q3) and by (ii) Youden’s criterion that best predicted AKI development. Multivariable logistic regression models were developed to test the association of these dichotomized indices with AKI status. Postoperative AKI occurred in 827 patients (50.4%). Higher CUF volumes were associated with AKI development by quartiles (CUF >Q3=32.6 vs. CUF <Q1=10.4 ml/kg; OR=1.68, 95% CI:1.19-2.3) and Youden’s criterion (CUF ≥32.9 vs. CUF <32.9 ml/kg; OR=1.60, 95% C:1.21-2.13). Despite similar intraoperative nadir hematocrits between groups (P=0.8), higher CUF volumes were associated with more allogeneic blood transfusions (p=0.002) and longer lengths-of-stay (p<0.001).Conclusions:Removal of weight-indexed CUF volumes >32 mL/kg increased the risk for postoperative AKI development. Importantly, CUF volume removal of any amount did not mitigate allogeneic blood transfusion during elective cardiac surgery. Prospective studies are needed to validate these findings.
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