The Anesthesia & ICU Insights

*Endobronchial valve (EBV) treatment for emphysema, summary of treatment selection and outcome* *The key selection criteria for success (do) and restraints for treatment (don’t) are shown* *The criteria for success (do) are:* 1. Severe emphysema. 2. Complete interlobar fissure (no collateral flow) 3. Severe hyperinflation (residual volume (RV) >175% pred, RV/total lung capacity (TLC) >55%); 4. Symptomatic. 5. Non-smoking 6. On optimal treatment and 7. Stable condition. *The criteria for restraints (don’t) are* 1. Presence of a suspect nodule 2. Pleural pathology 3. Severe bronchiectasis 4. Incomplete fissure 5. Fibrosis 6. Severe cardiac comorbidity (i.e. pulmonary arterial hypertension (PAH), congestive heart failure (CHF), and coronary artery disease (CAD)) 7. Infectious lung disease 8. Chronic bronchitis or asthma 9. Prior lobectomy or lung volume reduction surgery (LVRS) on the treatment side. 10. Hypercapnia/hypoxemia; and immunocompromised. Dr. Azzam’s summaries

Thoracic ultrasound (TUS) is a non-invasive imaging technique used to evaluate the structures within the thoracic cavity, including the lungs, pleura, and chest wall. It is highly effective in diagnosing pleural effusions, pneumothorax, and other pulmonary conditions. TUS offers real-time visualization, making it a valuable tool for guiding procedures like thoracentesis. Its advantages include being radiation-free, portable, and relatively easy to perform at the bedside, enhancing its utility in various clinical settings. Dr. Azzam’s summaries

Aspirin👉 may cause ketotic hypoglycemia through: ✔️ oxidative phosphorylation, ✔️ glycogen depletion ✔️ and gluconeogenesis inhibition. ✅ Aspirin and other nonsteroidal anti-inflammatories may cause insulin secretion through prostaglandin-mediated effects.

Anticoagulant Medications ✅ Anticoagulation, in general, reduced the risk of ischemic stroke without increasing the risk of bleeding in cirrhosis. ✔️ Specifically regarding warfarin, its use in cirrhosis is challenging. ✔️ patients with cirrhosis can have aberrant INR values at baseline, making it difficult to monitor warfarin therapy. ✅ direct oral anticoagulants (DOACs) are generally well tolerated in CLD broadly. ✅ many DOACs are hepatically cleared. ❌ the American College of Cardiology guidelines state that DOACs “are not recommended for use with severe hepatic dysfunction 🆘 The European Heart Rhythm Association guidelines provide precise recommendations for cirrhosis: DOACs can be used: 🅰 relatively safely in Child-Pugh class A cirrhosis 🅱 variably in class B ❌ and should not be used in class C or with severe hepatic dysfunction. ❌ In Child-Pugh class B, additional caution is required if creatinine clearance is below 30 mL/min. 🅾 Additionally, rivaroxaban, due to its greater hepatic clearance, is disfavored. 🆘