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Physiology

Hemodynamic consequences of severe lactic acidosis in shock states: from bench to bedside
March 4, 2016
Lactic acidosis is a very common biological issue for the postoperative patient with shock. This very nice review addresses thehemodynamic consequences of shock-associated lactic acidosis and highlights the various therapeutic options that can be considered by the bedside clinician.
Remote Ischemic Preconditioning and Outcomes of Cardiac Surgery
October 5, 2015
Pts undergoing CABG on-pump were randomized to remote preconditioning (upper arm ischemia) or sham intervention prior to surgical incision.  The primary end point was a combination of cardiovascular death, stroke, MI, and revascularization.  At 1 year there was no difference between the groups in the incidence of the end point, and other important cl
Hypotension After Cardiac Operations Based on Autoregulation Monitoring Leads to Brain Cellular Injury
July 6, 2015
This is a provocative study questioning the current practice of using blood pressure targets perioperatively to ensure adequate perfusion.  Plasma levels of a brain-specific injury biomarker (GFAP) were measured in 121 patients undergoing cardiac surgery.
Clinical Presentation of Patients With Tension Pneumothorax: A Systematic Review
May 19, 2015
The question in this review was whether patients who experience tension pneumothorax differ in presentation depending on whether they are breathing spontaneously or are on positive pressure ventilation.  Assisted ventilation was more often associated with hypoxia, hypotension, and cardiac arrest.  These adverse clinical signs frequently arose within
Comparison of continuous-flow and pulsatile-flow left ventricular assist devices: is there an advantage to pulsatility?
December 13, 2014
This publication by the University of Louisville group provides an excellent comparative analysis of the outcomes after continuous-flow (CF) vs. pulsatile flow (PF) LVADs.  Although the outcomes after CF LVAD implantation are clearly superior than those of PF LVADs, there are certainly unique morbidities after CF LVAD implantation.
The centenary (2015) of the transfer factor for carbon monoxide (TLCO): Marie Krogh's legacy
December 2, 2014
This is an interesting historical vignette describing the discovery of transfer factor (TLCO, DLCO) and its subsequent importance in pulmonary physiology and cardiorthoracic risk assessment.
Effect of Exercise and Pump Speed Modulation on Invasive Hemodynamics in Patients with Centrifugal Continuous Flow Left Ventricular Assist Devices
November 10, 2014
The effects of exercise, increasing pump speed, or both on invasive hemodynamics in centrifugal flow LVAD patients were analyzed in this small study.  Findings included:
Surgical myectomy improves pulmonary hypertension in obstructive hypertrophic cardiomyopathy
August 11, 2014
The authors of this study investigated the effect of myectomy on pulmonary hypertension in patients with hypertrophic cardiomyopathy (HCM).

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