Добавил:
Sekretar
kiopkiopkiop18@yandex.ru
t.me/Prokururor I Вовсе не секретарь, но почту проверяю
Опубликованный материал нарушает ваши авторские права? Сообщите нам.
Вуз:
Предмет:
Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_3978_Библиотеки_им_академика_М_И_Перельмана
.pdf
425
15.4 Cardiac Surgery Risk Calculators
In an era of increasing emphasis on the quality of medical care, benchmarking of
cardiac surgical outcomes is essential to allow proper risk-adjusted comparisons.
Cardiac surgery risk calculators represent the cornerstone in the prediction of surgi-
cal outcomes, allowing for the comparison of observed-to-expected rates and risk-
adjusted event rates. Furthermore, risk calculators are useful tools for proper patient
selection and informed patient consent. Multiple risk calculators in cardiac surgery
have been developed, but only two systems have been thoroughly validated:
15.4.1 The STS Cardiac Surgery Risk Calculator
The STS database has served as the source of patient data to develop the STS car-
diac surgery risk calculators. Although initially intended for CABG, iterations have
been created for aortic, mitral, or tricuspid valve surgery. Risk models are devel-
oped through multivariable logistic regression, and predicted risks are calculated
for specific outcome variables. Initial calculators focused on operative mortality,
but in 2003 specific risk calculators were developed for nine endpoints: operative
mortality, permanent stroke, renal failure, prolonged ventilation, deep sternal wound
infection, major morbidity or mortality, prolonged postoperative length of stay (>
14 days), and short postoperative length of stay (Shroyer et al. 2003). Definitions
for each endpoint and the variables used for the calculations have been previously
described by the STS (Shahian et al. 2009). The risk calculators for specific out-
comes can be accessed at http://riskcalc.sts.org/STSWebRiskCalc273/.
15.4.2 The European System for Cardiac Operative Risk
Evaluation (EuroSCORE)
The EuroSCORE was developed in 1999 from nearly 20,000 patients and 128
European centers as a simplified tool to calculate the operative mortality risk in
cardiac surgery. The initial version was developed as an additive system with scores
for each risk factor derived from coefficients obtained in a multivariable regression
model (Roques et al. 1999). The total score was calculated as the sum of the scores
of 17 participating variables, and it was correlated to a specific predicted mortal-
ity risk. In 2003 a second iteration was developed, the logistic EuroSCORE, as a
multivariable logistic regression formula; similar to the additive system, coefficients
were determined for each participating variable, and the categorical or continuous
values of each variable were entered in a logistic regression formula that calculated
the predicted mortality risk as described under 2.2 (Michel et al. 2003). The additive
system seemed to underestimate the outcomes in high-risk patients (EuroSCORE
>6) and the logistic EuroSCORE was developed to bridge this gap in the calcula-
tions. A third iteration was developed in 2011, the EuroSCORE II, as a logistic
regression formula similar to the logistic EuroSCORE, with several modifications
to the participating variables (http://www.euroscore.org/calc.html).
15 Risk and Outcome Assessments
https://t.me/med1917
426
Unlike the STS risk calculator, the EuroSCORE does not include calculations for
morbidity endpoints and does not provide separate risk models for each type of
cardiac surgical procedure; however, it adjusts for the number of surgical interven-
tions, e.g., CABG with mitral valve surgery counts as two procedures, CABG with
mitral and tricuspid valve surgery counts as three procedures. The EuroSCORE risk
calculator can be accessed at http://www.euroscore.org/
15.5 Limitations of Current Databases
Clinical databases have been successful in presenting early outcomes following car-
diac surgery; however, longitudinal follow-up including midterm or long-term out-
comes has been limited. At present, only early outcome data is available in clinical
databases, while administrative databases, although with lower data accuracy, have
the potential to retrieve long-term data through payer claims records. The difficulty
to assign patient identifiers that could serve as relational links among databases has
prevented the integration of early- and long-term outcome data. Likewise, the dif-
ficulty in merging clinical databases from different specialties has restricted the
assessment of cardiac care outcomes to either surgical or medical modalities of
treatment. An attempt to bridge this gap is in effect by standardizing the data defini-
tions between the American College of Cardiology and the Society of Thoracic
Surgeons databases.
15.6 Summary
The last two decades have witnessed the origin and expansion of a variety of multi-
institutional registries, essential tools in the assessment of outcomes and the imple-
mentation of quality improvement initiatives. The analysis of risk-adjusted results
has been useful in identifying institutions with outlier results and implementing
specific strategies to address gaps in the quality of care. The data analysis of early
outcomes in cardiac surgery has been satisfactory through clinical databases, but
there are still limitations in assessing the continuity of cardiac care, necessary in the
modeling of mid- and long-term outcomes. In the current landscape of scrutiny by
consumers and payer organizations, quality improvement remains at the forefront
agenda of organized medicine; thus, proper risk adjustment through reliable regional
and nationwide registries is essential for the accurate assessment of the quality of
cardiac care.
References
Anderson RP (1994) First publications from the Society of Thoracic Surgeons National Database.
Ann Thorac Surg 57:6–7
Bewick V, Cheek L, Ball J (2004) Statistics review 13: receiver operating characteristic curves.
Crit Care 8:508–512
Bewick V, Cheek L, Ball J (2005) Statistics review 14: logistic regression. Crit Care 9:112–118
M. Caceres
https://t.me/med1917
427
Caceres M, Braud RL, Garrett HE Jr (2010) A short history of the Society of Thoracic Surgeons
national cardiac database: perceptions of a practicing surgeon. Ann Thorac Surg 89:332–339
Ellis H (2008) Florence Nightingale: creator of modern nursing and public health pioneer.
J
Perioper Pract 18:404–406
Grover FL, Shroyer AL, Hammermeister K, Edwards FH, Ferguson TB Jr, Dziuban SW Jr,
Cleveland JC Jr, Clark RE, McDonald G (2001) A decade’s experience with quality improve-
ment in cardiac surgery using the Veterans Affairs and Society of Thoracic Surgeons national
databases. Ann Surg 234:464–472
Hannan EL, Cozzens K, King SB III, Walford G, Shah NR (2012) The New York State cardiac
registries: history, contributions, limitations, and lessons for future efforts to assess and pub-
licly report healthcare outcomes. J Am Coll Cardiol 59:2309–2316
Hosmer DW, Lemeshow S (2000) Applied logistic regression, 2nd edn. Wiley, New York
Michel P, Roques F, Nashef SA, EuroSCORE Project Group (2003) Logistic or additive
EuroSCORE for high-risk patients? Eur J Cardiothorac Surg 23:684–687
O’Connor GT, Plume SK, Olmstead EM, Coffin LH, Morton JR, Maloney CT, Nowicki ER,
Tryzelaar JF, Hernandez F, Adrian L et al (1991) A regional prospective study of in-hospital
mortality associated with coronary artery bypass grafting. The Northern New England
Cardiovascular Disease Study Group. JAMA 266:803–809
Peduzzi P, Concato J, Kemper E, Holford TR, Feinstein AR (1996) A simulation study of the
number of events per variable in logistic regression analysis. J Clin Epidemiol 49:1373–1379
Roques F, Nashef SA, Michel P, Gauducheau E, de Vincentiis C, Baudet E, Cortina J, David M,
Faichney A, Gabrielle F, Gams E, Harjula A, Jones MT, Pintor PP, Salamon R, Thulin L (1999)
Risk factors and outcome in European cardiac surgery: analysis of the EuroSCORE multina-
tional database of 19030 patients. Eur J Cardiothorac Surg 15:816–822
Shahian DM, O’Brien SM, Filardo G, Ferraris VA, Haan CK, Rich JB, Normand S-LT, DeLong
ER, Shewan CM, Dokholyan RS, Peterson ED, Edwards FH, Anderson RP (2009) The Society
of Thoracic Surgeons 2008 cardiac surgery risk models: Part 1. Coronary artery bypass grafting
surgery. Ann Thorac Surg 88:2–22
Shroyer LW, Coombs LP, Peterson ED, Eiken MC, Delong ER, Chen AY, Ferguson TB, Grover FL
(2003) The Society of Thoracic Surgeons: 30-day operative mortality and morbidity risk mod-
els. Ann Thorac Surg 75:1856–1864
Weiss ES, Chang DD, Joyce DL, Nwakanma LU, Yuh DD (2008) Optimal timing of coronary
artery bypass after acute myocardial infarction: a review of California discharge data. J Thorac
Cardiovasc Surg 135:503–511
Welke KF, Peterson ED, Vaughan-Sarrazin MS, O’Brien SM, Rosenthal GE, Shook GJ, Dokholyan
RS, Haan CK, Ferguson TB Jr (2007) Comparison of cardiac surgery volumes and mortality
rates between the Society of Thoracic Surgeons and Medicare databases from 1993 through
2001. Ann Thorac Surg 84:1538–1546
15 Risk and Outcome Assessments
https://t.me/med1917
429
A. Dabbagh et al. (eds.), Postoperative Critical Care for Cardiac Surgical Patients,
DOI 10.1007/978-3-642-40418-4, © Springer-Verlag Berlin Heidelberg 2014
A
Aaslid, R. , 147
Abciximab , 170, 171, 177
ABG. See Arterial blood gases (ABG) analysis
Acid–base balance
anion gap (AG) , 389, 402
arterial blood gases analysis (ABG) , 398–400
arterial pH, pCO
2
and bicarbonate
measurements , 387–388
base excess , 401–402
blood buffer systems , 386
body compensatory system and action
time , 386
Boston rules , 400–401
buffer base , 388–389
fl uid administration , 393–394
fl uid and electrolyte management
colloids , 398
crystalloids , 397–398
dilution acidosis , 396
hyperchloremic acidosis , 395
metabolizable anions and base excess ,
396–397
SID , 396
homeostasis , 392
hydro-electrolytic , 392
kidneys and lungs , 387
metabolic acidosis , 404–407
metabolic alkalosis , 407–409
osmolar and hydro-electrolytic balances , 392
pathophysiology of , 394–395
phosphate ions , 387
plasma proteins , 387
respiratory acidosis , 409–411
respiratory alkalosis , 411
standard base excess (SBE) , 389, 401–402
standard bicarbonate , 388
Stewart’s approach , 391, 403–404
strong ion difference (SID) , 390–391,
403–404
Acute kidney injury (AKI)
cardiopulmonary bypass , 302–303
hydroxyethyl starches , 347
noncardiac complications
acute renal failure , 222
diagnosis , 223
etiology for , 222
management , 223–224
risk factors for , 222, 223
Acute postoperative pain management
analgesic methods , 264–265
chronic pain
CABG , 262
chest pain , 262–264
etiologic mechanisms , 263
leg pain , 262, 264
potential risk factors , 263
etiologic risk factors , 261–262
fast-track anesthesia approach , 259–260
multimodal analgesic methods , 260
pain-related health-care costs , 258
pathophysiology , 260–261
patient satisfaction and expectations , 260
perioperative surgical stress response , 259
pharmacologic methods
alpha 2 agonists , 273
NSAIDs ( see Nonsteroidal anti-
infl ammatory drugs (NSAIDs))
opioids ( see Opioids)
progressive biopsychosocial
epiphenomena , 258
regional anesthetic techniques
intercostals nerve block , 278
intrapleural infi ltration , 278
neuraxial blocks ( see Neuraxial blocks)
surgical wound , 277
stress response , 259
Adaptation to the Intensive Care Environment
(ATICE) , 132
Agrò, F.E. , 73–76, 313–372, 385–412
Index
https://t.me/med1917
430
AKI. See Acute kidney injury (AKI)
Albumin (HA)
calcium , 318, 369
clinical use , 334–336
composition and concentration , 334
hypovolemia treatment , 334
pharmacokinetics , 334
potential risks and side effects , 336
Alfentanil , 270, 272
Allison, K.P. , 352
Alpha 2 agonists , 265, 273
American Society of Neurophysiological
Monitoring (ASNM) , 134
Analgesic agents , 50, 59–61,
139, 140
Antiarrhythmic therapy , 50, 56–58,
238, 241
Anticoagulants , 299
apixaban , 164, 165
dabigatran , 163–165
DTIs , 164, 168, 169
fondaparinux , 164, 168
LMWH , 164, 167
rivaroxaban , 164, 165
UFH , 164, 167
warfarin , 163, 166
Antifi brinolytics , 178–179
Antihypertensive agents , 49–55
Antimicrobial prophylaxis , 42–43
Antiplatelet therapy , 169–171
Apixaban , 164, 165
Aranki, S.F. , 182–192
Arrhythmias
CVC insertion , 97
diagnosis of , 202–203
magnesium supplementation , 371
management , 203
mean arterial pressure , 79
metabolic alkalosis , 408
oculocardiac refl ex , 31
Arterial blood gases (ABG) analysis ,
398–400
metabolic acidosis , 404–407
metabolic alkalosis , 407–409
respiratory acidosis , 409–411
respiratory alkalosis , 411
Arterial-jugular vein oxygen gradient
(AjvDO
2
) , 146–147
Arterial line cannulation, IBP monitoring.
See Invasive blood pressure (IBP)
monitoring
Aspiration pneumonia , 216–217
Aspirin , 86, 169, 171, 177
Astrup, P. , 388
Auditory-evoked potential (AEP) , 131, 141
Automated blood pressure monitoring
compartment syndrome , 79–80
oscillometric technique , 79
Axillary artery cannulation , 84, 299
B
Bainbrid, F. , 26
Bainbridge refl ex , 28
Baker, A. , 146, 147
Baroreceptors refl ex , 28–29
Benedetto, M. , 73–76, 313–372, 385–412
Benes, J. , 363
Berger, H. , 133
Bernard, C. , 314
Bezold-Jarisch refl ex , 29–30
Bispectral analysis index , 140
Bivalirudin , 164, 168, 169, 189, 194
Blasco, V. , 346
Bloodstream infections (BSIs)
central venous catheter insertion strategies ,
229–230
diagnosis , 228
nosocomial infections , 228
signs and symptoms , 228
treatment , 228–229
Brachial artery cannulation , 84
Bradyarrhythmias , 241–242
Brainstem auditory-evoked response
(BAEP) , 141
BSIs. See Bloodstream infections (BSIs)
Bunn, F. , 332
Byrne, J.G. , 182–192
C
Caceres, M. , 417–426
C a
2+
homeostasis , 5, 7, 15–16
California discharge database , 423
Calmodulin (CaM) , 14, 16–18
Camm, A.J. , 237
Cardiac electrical system cells , 2, 4, 8
Cardiac output monitoring
bioimpedance and bioreactance ,
110–111
EDM , 108–109
Fick principle , 105
indicator dilution techniques , 105–107
partial carbon dioxide (CO
2
) rebreathing ,
107–108
pulse contour analysis , 109–110
selection of , 112–113
USCOM , 111–112
Index
https://t.me/med1917
431
Cardiac physiology
cardiac refl exes
Bainbridge refl ex , 28
baroreceptors refl ex , 28–29
Bezold-Jarisch refl ex , 29–30
chemoreceptor refl ex , 31
Cushing refl ex , 30
oculocardiac refl ex , 31
Valsalva maneuver , 30
cardiac work
cardiac output , 26
ejection fraction , 26
stroke volume , 25–26
cellular physiology
action potential , 11–13
atrial and ventricular syncytium , 11
contractile mechanisms , 18–24
excitation-contraction coupling ,
14–18
coronary arteries, anatomy of , 8–10
Frank-Starling relationship ,
26–27
heart, anatomy of
atrioventricular valve , 3
atrium and ventricles , 2–3
cardiac connective tissue cells , 4
cardiac contractile tissue cells , 4–8
conductive tissue cells , 8, 9
endocardium , 4
fi brous and parietal pericardium , 3
tricuspid valve , 3
visceral pericardium , 4
normal cardiac cycle , 24–25
Cardiac refl exes
Bainbridge refl ex , 28
baroreceptors refl ex , 28–29
Bezold-Jarisch refl ex , 29–30
chemoreceptor refl ex , 31
Cushing refl ex , 30
oculocardiac refl ex , 31
Valsalva maneuver , 30
Cardiac surgery registries
administrative databases
California discharge database , 423
MEDPAR registry , 422
NIS , 423
clinical databases
New York State Cardiac Registry ,
423–424
Northern New England Cardiovascular
Disease Study Group , 424
STS , 424
Veterans Administration Cardiac
Database , 424
Cardiac surgery risk calculators
EuroSCORE , 425–426
STS database , 425
Cardiopulmonary bypass (CPB)
CABG , 200
circuit structure
anticoagulation , 299
arterial and venous cannulation , 299
arterial fi lter , 300
blood circuit , 297
cardioplegia , 299–300
cardiotomy , 298
centrifugal pump , 298
heat exchanger , 300
history , 296–297
MECC , 300–301
membrane oxygenator , 298–299
roller pump , 297
ultrafi ltration , 301
complications
AKI , 302–303
cognitive disorder , 305
hematologic effect , 302
hypoperfusion , 305
infl ammation , 301
lung , 303–304
OPCAB , 305–306
stroke , 304
hemodilution , 135
mean arterial pressure , 80
postoperative hyperthermia , 131
Cardiopulmonary resuscitation (CPR) ,
46, 205–207
Cardiovascular complications and
management
assist devices
ECMO , 208–209
IABP , 207–208
VAD , 208
cardiac monitoring , 198–199
complications
arrhythmias , 202–203
hemodynamic instability ,
200–202
PMI , 199–200
CPR , 205–207
POCT , 204–205
vasoplegic syndrome , 203–204
Cardiovascular monitoring
cardiac output monitoring ( see Cardiac
output monitoring)
CVP monitoring ( see Central venous
catheters (CVCs))
hemodynamic parameters , 113–114
Index
https://t.me/med1917
432
Cardiovascular monitoring (cont.)
IBP monitoring ( see Invasive blood
pressure (IBP) monitoring)
noninvasive blood pressure monitoring
automated blood pressure monitoring ,
79–80
Riva-Rocci/Korotkoff technique , 78–79
pulmonary artery pressure monitoring
( see Pulmonary artery catheter
(PAC))
TEE , 114
Carotid sinus refl ex , 28–29
Central nervous system (CNS)
dysfunction after cardiac surgery , 246
postoperative injuries
CPB-related equipment , 253
mechanisms and potential etiologies of ,
248–252
pharmacologic neuroprotection , 252
risk factors , 248
time-based classifi cation , 247–248
type I and type II injuries , 246, 247
postoperative monitoring
bispectral analysis index, sedation/
analgesia level , 140
of cardiac surgery patients , 130–131
cerebral oximetry , 141–144
dynamic CT scanning , 150
EEG ( see Electroencephalography (EEG))
evoked potentials , 140–141
fMRI , 150
ICP monitoring , 151
laser Doppler fl owmetry , 150–151
magnetic resonance angiography , 150
neurologic monitoring , 253
positron emission tomography , 150
sedation assessment scales , 132–133
SjvO
2
catheter insertion ( see Jugular
venous oxygen saturation (SjvO
2
))
thermal diffusion fl owmetry , 151
transcranial Doppler , 147–150
Central venous catheters (CVCs)
complications of
arrhythmia , 97
bleeding and air emboli , 97
infection , 97
mechanical , 94–95
misinterpretation of data , 97–98
thromboembolic , 96
CVP curve , 89–90
indications and contraindications for , 89
insertion of
external jugular vein , 94
femoral vein , 94
LIJV approach , 93
peripheral CVCs , 94
right internal jugular vein approach ,
90–93
subclavian approach , 93–94
ultrasound-guided CVC insertion ,
94–95
Central venous pressure (CVP) monitoring.
See Central venous catheters (CVCs)
Cerebral oximetry , 141–144, 249, 305
Chemoreceptor refl ex , 31
Chronic pain
CABG , 262
chest pain , 262–264
etiologic mechanisms , 263
leg pain , 262, 264
risk factors , 263
Chytra, I. , 362
Clopidogrel , 169, 171
Clotting disorders , 331, 339
CNS. See Central nervous system (CNS)
Coagulopathies , 81, 89, 175–176
Cole, D.J. , 146, 147
Colloids
and acid–base status , 398
balanced and unbalanced colloids , 333
vs. crystalloids , 348–350
vs. HES , 350–353
high molecular weight molecules , 332
isotonic and hypertonic colloids , 333
natural colloids ( see Albumin (HA))
pharmacokinetics , 333, 334
physiological properties , 333
plasma-adapted and non-plasma-adapted
colloids , 333
synthetic ( see Synthetic/artifi cial colloids)
Compartment syndrome , 81, 83
brachial artery cannulation , 84
noninvasive blood pressure monitoring ,
79–80
Constant, I. , 134
Constat , 137
Conte, A.H. , 213–231
Context-sensitive half-life (CSHL) , 270
Continuous wave Doppler (CWD) technology ,
111
Coronary arteries , 8–10, 44, 281
Cost–benefi t analysis , 74–76
Cost-effectiveness analysis (CEA) , 74
Cost minimization analysis (CMA) , 74
Cost–utility analysis (CUA) , 74
CPB. See Cardiopulmonary bypass (CPB)
CPR. See Cardiopulmonary resuscitation
(CPR)
Index
https://t.me/med1917
433
Crystalloids
and acid–base status , 397–398
classifi cation , 328
vs. colloids , 348–350
HCS , 332
latest-generation crystalloids , 330–331
low molecular weight salts , 327
pharmacokinetics , 328
potential risks and side effects
clotting disorders , 331
electrolyte modifi cations , 331
water distribution modifi cation , 331
properties of , 329, 330
Ringer lactate and Ringer acetate , 330
saline solution , 329–330
Cushing refl ex , 30
Cushin, H. , 30
CVCs. See Central venous catheters
(CVCs)
D
Dabbagh, A. , 1–39, 77–114, 129–151,
245–253, 257–283
Dabigatran , 163–165
Daily, P.O. , 91
Datsur, D.K. , 144
Delirium , 66–67, 247, 366
Denault, A. , 143
Desmopressin , 179
Dexmedetomidine , 62, 214, 252, 273
Dextrans , 337–338
Dietrich, G. , 336
Direct blood pressure monitoring. See Invasive
blood pressure (IBP) monitoring
Direct thrombin inhibitors (DTIs) , 164, 168,
169, 188
Disseminated intravascular coagulopathy
(DIC) , 175–176
Dobutamine , 48, 49, 364
Dopamine , 44–47
Drug-induced thrombocytopenia , 176–177.
See also Heparin-induced
thrombocytopenia (HIT)
Duke Clinical Research Institute , 424
E
Eason, M.J. , 279
ECMO. See Extracorporeal membrane
oxygenation (ECMO)
ECS. See Extracellular space (ECS)
EDM. See Esophageal Doppler monitoring
(EDM)
Electroencephalography (EEG) , 132
cardiac surgery patients , 134–135, 138–139
electrodes , 136–138
evoked potentials , 140–141
normal and abnormal EEG , 137–138
time epochs , 137
wakefulness, sleep, and anesthesia , 137
waves and electrical characteristics ,
135–136
Electrolyte management
magnesium , 371
potassium , 369–370
sodium , 364–368
End diastolic volume (EDV) , 25, 26
End systolic volume (ESV) , 25, 26
English, I.C. , 90
Epinephrine , 46, 47, 57, 199
Epsilon-aminocaproic acid (EACA) , 178–179
Eptifi batide , 170, 171, 177
Esophageal Doppler monitoring (EDM) ,
106, 108–109
European System for Cardiac Operative Risk
Evaluation (EuroSCORE) , 425–426
Excitation-contraction coupling (ECC) , 13–14
Ca
2+
homeostasis , 15–16
controllers of , 16–18
functioning organelles of , 14–15
External jugular vein , 94
Extracellular space (ECS)
chemical properties , 317, 319
chloride, anion , 319
fl uid and electrolyte balance , 315
hypertonic solutions , 327, 328
interstitial space (ISS) , 315
intravascular space , 315
osmotic pressure , 319–320
potassium, cation , 318
sodium, cation , 318
transcellular space (TCS) , 315
Extracorporeal membrane oxygenation
(ECMO) , 131, 208–209
F
Fellin, R. , 41–70
Femoral artery cannulation , 84, 299
Femoral vein , 94, 99, 299
Fentanyl , 59, 60, 270–271
Fick, A.E. , 105
Fick principle , 105
Fish oil , 170
Fluid management and electrolyte balance
balanced vs. unbalanced solutions , 353
clinical management , 325–327
Index
https://t.me/med1917
434
Fluid management and electrolyte
balance (cont.)
colloids ( see Colloids)
crystalloids ( see Crystalloids)
dextrans , 337–338
extracellular space (ECS) ( see
Extracellular space (ECS))
fl uid movement, capillary membranes ,
321–323
GDT ( see Goal-directed therapy (GDT))
gelatins. , 338–339
hydroxyethyl starches ( see Hydroxyethyl
starches (HES))
hypertonic colloid solutions , 347–348
ICS ( see Intracellular space (ICS))
ionic balance
bicarbonate , 319
body fl uids properties , 317
calcium , 318
chloride , 319
electric neutrality , 317
Gamble gram , 317
magnesium , 318
potassium , 318
sodium , 318
liberal vs. restricted approach , 354–356
osmolar balance , 319–321
postoperative ICU
electrolyte modifi cations , 325
water distribution modifi cation , 323
Fondaparinux , 164, 168, 184, 189, 194
Foroughi, M. , 213–231, 295–306
Forssman, W. , 88
Frank, O. , 26, 109
Frank-Starling relationship , 23, 26–27
Franz, A. , 345
Functional magnetic resonance imaging
(fMRI) , 150
Fuster, V. , 237
G
Gabapentin , 258, 265, 276
Gallandat Huet, R.C.G. , 345
Gamble gram , 317, 392
Ganz, W. , 98
Gelatins , 338–339
Gibbon, J. , 296
Gibbs, E.L. , 144
Girbes, R. , 325
Global end-diastolic volume (GEDV) ,
106, 361
Glycocalyx , 324–325, 372
Goal-directed therapy (GDT)
clinical impact , 363–364
DO2 physiologically , 356–358
fl uid infusions , 356
hemodynamic variables , 358–361
inotropic/vasoactive drugs , 356
monitoring systems , 362–363
Gugino, L.D. , 134, 137
H
HA. See Albumin (HA)
Haghjoo, M. , 233–242
Haloperidol , 66, 67, 177
Hasselbalch, K.A. , 388
Hastings , 388
H
2
blockers , 69
Hemopericardium , 96
Henderson–Hasselbalch equation , 318, 388,
392, 393
Heparin-induced thrombocytopenia (HIT) ,
182–183, 194
aortic stenosis , 190, 191
argatroban , 189
bivalirudin , 189
consequences of , 184–186
coronary artery disease , 190
danaparoid , 188
diagnosis , 186–187
heparin-induced antibodies , 182
incidence of , 184, 185
laboratory test interpretation , 177–178
lepirudin , 188
management , 187–188
pathophysiology , 183–184
4-T score , 177–178
Herbal supplements , 170
HES. See Hydroxyethyl starches (HES)
Hirt, L. , 29
HIT. See Heparin-induced thrombocytopenia
(HIT)
Hosmer–Lemeshow test , 420, 421
Hydromorphone , 59, 60
Hydroxyethyl starches (HES)
α-amylases , 340
black boxed , 352
classifi cation , 340–342
clinical role of , 352
clinical use , 343–344
CPB-induced infl ammatory process , 350
endothelial activation , 350
enzymatic degradation of , 351
gelatins , 352
hemodynamic effects , 351
isolated renal perfusion model , 352
Index
https://t.me/med1917
435
natural polysaccharides , 339
pharmacokinetics , 341–343
plasma-expanding effect , 350
potential risks and side effects
anaphylaxis , 347
coagulation and platelet function ,
344–345
kidney dysfunction , 345–347
storing and itching , 347
Hyperchloremia , 331, 353, 393, 395, 398, 411
Hyperglycemia , 366
epinephrine , 46
hypovolemic shock , 327
intensive care units , 67–68
Hypertonic colloid solutions , 347–348
Hypertonic crystalloid solutions (HCS) , 332
I
IABP. See Intra-aortic balloon pump (IABP)
ICS. See Intracellular space (ICS)
IJV. See Internal jugular vein (IJV)
Incremental cost-effectiveness ratio
(ICER) , 74
Indicator dilution techniques , 105–107,
109–110
Inotropic agents
cardiovascular effects of , 199
dobutamine , 48, 49
hypotensive patient , 48–49
milrinone , 48, 49
Insulin therapy , 68
Intercostals nerve block , 278
Internal jugular vein (IJV) , 90–93, 145, 299
International Classifi cation of Diseases (ICD)
codes , 418
Intra-aortic balloon pump (IABP) , 99, 109,
169, 181, 207–208
Intracellular space (ICS)
body water , 315
chemical properties , 317, 319
fl uid and electrolyte balance , 315
hypertonic solutions , 327, 328
osmotic pressure , 319–320
Intracranial pressure (ICP) monitoring , 151
Intra-thoracic blood volume (ITBV) , 106
Intravenous antiarrhythmic agents , 50, 56–58
Invasive blood pressure (IBP) monitoring
arterial line cannulation and , 80
axillary artery , 84
brachial artery , 84
contraindications , 81
dorsalis pedis , 85
femoral artery , 84
indications , 81
needle through catheter technique ,
82, 83
posterior tibialis , 85
radial artery , 82–83
Seldinger method , 82
superfi cial temporal artery , 85
technical considerations in , 86–87
ulnar artery , 85
arterial line transducer and coupling
system , 87–88
cardiac output and SVR , 80–81
in cardiac surgery patients , 80
complications
infectious complications , 86
ischemic complications , 85
thrombus formation , 85–86
features of , 80
MAP , 80
Isley, M.R. , 134
J
Jarisch, A. , 29
Jarvela, K. , 332
Jöbsis, F. , 142
Jones, S.B. , 350
Jörgensen, K.E. , 388
Jugular venous oxygen saturation (SjvO
2
)
AjvDO
2
, 146–147
complications of , 146
contraindications for , 144–145
data collection , 146
technique of , 145
K
Ketamine , 252, 265, 275
Ketorolac therapy , 59, 61
Kharasch, E.D. , 333
Korotkoff, N.S. , 78
Korotkoff sounds , 78–79
L
Laser Doppler fl owmetry , 150–151
Laxenaire, M. , 347
Leacche, M. , 182–192
Left anterior descending (LAD) artery , 8–10
Left circumfl ex coronary artery (LCX) , 8–10
Left internal jugular vein (LIJV) approach , 93
Left main coronary artery (LMCA) , 8–10
Legendre, C. , 346
Ley, S.J. , 349, 350
Index
https://t.me/med1917
Соседние файлы в папке Библиотека им академика М.И. Перельмана