The December 2013 Podcast discusses perioperative considerations for right heart failure in the setting of LVAD implantation. Dr. Ambardekar is a cardiologist specializing in management of heart failure, and provides a unique perspective on this subject. The podcast discusses the pathophysiology of right heart failure, predictive test modalities for right hear failure at LVAD implantation, as well as postoperative considerations in this population. The discussion is an excellent complement to the article and is highly recommended.

 

 

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Perioperative fluid management is of significant importance during pulmonary resection surgery and esophagectomy. Excessive fluid administration has been consistently shown as a risk factor for lung injury after thoracic procedures. Probable causes of this serious complication include fluid overload, lung lymphatics and pulmonary endothelial damage. Along with new insights regarding the Starling equation and the absence of a third space, current evidence supports a restrictive fluid regimen for patients undergoing pulmonary resection surgery and esophagectomy. Multiple minimally invasive hemodyamic monitoring devices, including pulse pressure/stroke volume variation, esophageal Doppler, and extravascular lung water measurement, were evaluated for optimizing perioperative fluid therapy. Further research regarding the prevention, diagnosis, and treatment of acute lung injury after pulmonary resection and esophagectomy is required.

 

 

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