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Transesophageal echocardiography (TEE) probe-induced esophageal perforation is rare. A 67-year-old man underwent a Bentall procedure with mitral valve replacement under TEE monitoring. Two hours later, the patient had a blood-stained aspirate from the nasogastric tube. Contrast-enhanced computed tomography of the chest showed esophageal perforation, which was treated with the fluoroscopic deployment of covered metal stents. The patient had an uneventful recovery. [ABSTRACT FROM AUTHOR]

Sepsis, a life-threatening condition resulting from the body's response to an infection, remains a major global health concern. One of the critical complications associated with sepsis is coagulopathy, characterized by dysregulated blood clotting and a heightened risk of both thrombosis and bleeding. This abstract aims to provide a concise overview of the intricate interplay between sepsis and coagulopathy, shedding light on the underlying mechanisms and clinical implications. [ABSTRACT FROM AUTHOR]

Subclavian artery aneurysms are rare peripheral aneurysms. A giant subclavian artery aneurysm can lead to compression of the trachea or brachial plexus, erosion of the lung causing hemoptysis, hoarseness of voice, dysphagia, Horner's syndrome, and upper extremity deep vein thrombosis. Compression of the trachea and inability to ventilate the patient can be a real challenge for the anesthesiologist and must be anticipated. Computed tomographic angiography is a useful imaging modality for its diagnosis and to rule out additional aneurysms in the body. [ABSTRACT FROM AUTHOR]

Extracorporeal membrane oxygenation has been used in adult in cardiogenic shock due to myocardial infarction, myocardiopathy, myocarditis, or inability to come off cardiopulmonary bypass (CPB) after cardiac surgery.3 ECMO can provide partial or total support, but it is temporary. It is not a definitive treatment but a life support system that allows time for evaluation, diagnosis and treatment of the condition that causes heart failure. With high incidence of late stage coronary artery disease and infective myocarditis in India, the usage of ECMO for refractory cardiogenic shock is going to be a promising approach for effective management of refractory heat failure .ECMO has proven to be an effective therapeutic modality in managing cardiovascular collapse as a bridge to recovery or more definitive treatment options. [ABSTRACT FROM AUTHOR]

Extra corporeal membrane oxygenation (ECMO) has become an important modality in ICU for treating patients with severe hemodynamic and respiratory failure. It helps clinicians gain time for the primary disease to recover with definitive treatment, and aids in cardio pulmonary recovery of the patient. Most of the patients who require ECMO support are quite sick and fragile. Nosocomial infection is second most common complication after hemorrhage in ECMO patients. It affects about two-third of patients receiving ECMO. There is a lack of sufficient knowledge in this particular area. More focused efforts should be made in future to combat nosocomial infection in ECMO patients. [ABSTRACT FROM AUTHOR]

Protective lung ventilation is the mainstay ventilation strategy for patients on extracorporeal membrane oxygenation (ECMO), as prolonged mechanical ventilation increases morbidity and mortality; the technicalities of ventilation with ECMO have evolved in the last decade. ECMO on the other end of the spectrum is a complete or total extracorporeal support, which supplies complete physiological blood gas exchanges, normally performed by the native lungs and thus is capable of delivering oxygen (O2) and removing CO equal to the metabolic needs of the patient, it requires higher flows, is more complex, and uses bigger cannulas, higher dose of heparin and higher blood volume for priming. This review describes in detail carbon dioxide removal on ECMO. [ABSTRACT FROM AUTHOR]

Sepsis in patients on extracorporeal membrane oxygenation (ECMO) remains a serious complication. Its presence is a poor prognostic marker and increases overall mortality. Adult patients with prolonged duration on ECMO are at high risk of developing sepsis. Ventilator-associated pneumonia and bloodstream infections are the main sources of infection these patients. A strong early suspicion, drawing adequate volume for blood cultures, and early and timely administration of empirical antibiotics can help control the infection and decrease the morbidity and mortality. The diagnostic and the treatment are both challenging. Cardiac patients have increased risk of nosocomial infection while on ECMO, which may be in part due to longer cannulation times, as well as increased likelihood of undergoing major procedures or having an open chest. [ABSTRACT FROM AUTHOR]

Body fluid balance is an independent predictor of mortality. For each liter of fluid over and above 5 L, risk-adjusted excess mortality is seen. Mortality increased by 2.3% for each 1 L of fluid and hospital costs increased by $999. Accordingly, most recent guidelines have endorsed dynamic modeling. Passive leg raising-induced increase of aortic blood flow ≥ 10% predicts fluid responsiveness with a sensitivity of 97% and a specificity of 94%. Thus, passive leg raising is often used as gold standard for validation of other procedures (though it’s usefulness to assess respiratory variation in vena cava is not conclusive). STARLING, a device based on bioreactance, works on phase shift or time delay while bioimpedance works on the amplitude of the thoracic impedance. Unlike bioimpedance, bioreactance is not affected by the size of the patient, thoracic fluids, or position of sensors. STARLING is equipped with four sensor pads. Each pad contains two sensors, the outer sensor is a transmitting electrode and the inner sensor is a receiving electrode. The STARLINGmonitor induces a 75-KHz AC current. It thenmeasures the time delay/phase shift. STARLING system, a bioreactance-based dynamic assessment system for fluid responsiveness, predicts it accurately, precisely, and noninvasively. It reduces invasive risks and is independently validated against pulmonary artery catheter. It is not affected by vasopressors or shock and has wide range of application. [ABSTRACT FROM AUTHOR]

Rupture of a papillary muscle after acute myocardial infarction is a rare but potentially fatal complication. It can lead to acute, severe mitral regurgitation, pulmonary edema, cardiogenic shock, and death. Immediate surgical intervention in the form of mitral valve repair/replacement with concomitant coronary revascularization can reduce mortality. We herein report such a case who presented with cardiogenic shock and made a successful outcome after emergent surgery. [ABSTRACT FROM AUTHOR]

Dysglycemia has emerged as a very common challenge in critically ill patients, especially with regard to current coronavirus disease 2019 pandemic. Prediabetes, poorly controlled diabetes, pharmaceutical intervention in intensive care unit (ICU) with glucocorticoids, catecholamines and other medicines, and stress response all contribute to dysglycemia in critically ill patients. Early identification and management are the key to prevent further complications. Patient prognosis in terms of clinical outcome, length of ICU stay, and in-hospital morbidity/mortality are adversely affected by patient's dysglycemic status. Apart from hyperglycemia, the other three important pillars of dysglycemia are discussed in this article. Synopsis of early intervention have been captured from India-specific practice guidelines. Important landmark trials have also been captured in this article to provide a clarity on certain aspects of managing dysglycemia in ICUs. Hence, this review article is an attempt to bring forth the salient aspects in diagnosing and managing dysglycemia in critical care settings. [ABSTRACT FROM AUTHOR]

Central venous catheter insertion is a commonly performed procedure in the operating room and intensive care unit. It is associated with many complications, some of which may be life-threatening. We report here an accidental insertion of a hemodialysis catheter into the brachiocephalic trunk, which was successfully removed by an endovascular technique. [ABSTRACT FROM AUTHOR]

There are very few case reports of percutaneous device closure of anterior mitral leaflet perforation. We describe here a case of simultaneous percutaneous closure of aortic root perforation and anterior mitral perforation. These cases are challenging as they are presently done in high-risk patients with no guidelines described to date. [ABSTRACT FROM AUTHOR]

Retrosternal chest pain is the classical symptom of acute coronary syndrome (ACS). ACS sometimes presents with atypical symptoms and very rarely as headache as the only symptom. We present here a case where a patient who had undergone coronary artery bypass grafting presented with headache and on evaluation found to have complete occlusion of right coronary artery. [ABSTRACT FROM AUTHOR]

Ascariasis is a common helminthic infection, particularly in the tropical countries. We describe a case of eosinophilia who underwent coronary artery bypass graft (CABG) surgery. Postoperatively, he was found to have ascaris lumbricoides in the oral cavity. Timely detection and removal of the worm prevented the possible complications such as airway obstruction, bronchospasm, lung collapse, or intestinal obstruction. The case emphasizes the importance of considering parasitic infection as a differential diagnosis in patients presenting with eosinophilia for elective surgery. [ABSTRACT FROM AUTHOR]