Peacher DF, Martina SD, Otteni CE, Wester TE, Potter JF, Moon RE. Immersion Pulmonary Edema and Comorbidities: Case Series and Updated Review. Med Sci Sports Exerc. 2014 Sep 12. [Epub ahead of print]
PURPOSE: Immersion pulmonary edema occurs in swimmers (especially triathletes) and scuba divers. Its pathophysiology and risk factors are incompletely understood. This study was designed to establish the prevalence of pre-existing comorbidities in individuals who experience immersion pulmonary edema.
METHODS: From 2008 to May 2010, individuals who had experienced immersion pulmonary edema were identified via recruitment for a physiological study. Past medical history and subject characteristics were compared with those available in the current body of literature.
RESULTS: At Duke University Medical Center, Durham, NC, 36 subjects were identified (mean age 48.4 ± 9.1 years), of whom 72.2% had one or more significant medical conditions at the time of IPE incident (e.g., hypertension, cardiac dysrhythmias or structural abnormality or dysfunction, asthma, diabetes mellitus, overweight or obesity, obstructive sleep apnea, hypothyroidism). Forty-five articles were included, containing 292 cases of IPE, of which 24.0% had identifiable cardiopulmonary risk factors. Within the recreational population, cases with identifiable risk factors comprised 44.9%. Mean age was 47.8 ± 11.3 in recreational divers/swimmers and 23.3 ± 6.4 years in military divers/swimmers.
CONCLUSION: Cardiopulmonary disease may be a common predisposing factor in immersion pulmonary edema in the recreational swimming/diving population, while pulmonary hypertension due to extreme exertion may be more important in military cases. Individuals with past history of immersion pulmonary edema in our case series had a greater proportion of comorbidities compared to published cases. The role of underlyingcardiopulmonary dysfunction may be underestimated, especially in older swimmers and divers. We conclude that an episode of immersion pulmonary edema should prompt evaluation of cardiac and pulmonary function.
Bottiger B, McCartney S, Akushevich I, Nicoara A, Yanamadala M, Swaminathan M. Use of mobile tablet devices and reduction in time to perioperative transesophageal echocardiography reporting: a historical cohort study. Can J Anaesth. 2014 Oct 28. [Epub ahead of print]
PURPOSE: Timely communication of intraoperative transesophageal echocardiography (TEE) findings to the postoperative care team is critical to optimizing patient care. We compared the use of a personal computer (PC) system with the use of a mobile tablet device (MTD) system for point-of-care TEE data entry and hypothesized that the MTD-based system would reduce the time to preliminary TEE reporting and decrease the incidence of delinquent reporting by 50%.
METHODS: In this historical cohort study, we reviewed 508 perioperative TEE reports entered by cardiothoracic anesthesia fellows. Reports were grouped based on whether data were entered on a PC (PC group) or a MTD (MTD group). Time to TEE reporting was defined as the time from the patient leaving the operating room to the time the TEE report was generated. Delinquent reports were defined as those generated >24 hr after the initial exam. Time to TEE reporting and incidence of delinquent reports were compared between the two groups.
RESULTS: Mean (SD) time to TEE reporting was significantly improved with MTD data entry vs PC data entry [233 (676) min vs 1,103 (3,830) min, respectively; mean difference 870 min; 95% confidence interval (CI) 293 to 1,448; P = 0.003], and median (IQR) time was also significantly improved [46 (163) min vs 126 (1,000) min, respectively; median difference 80 min; P = 0.0002]. The incidence of report delinquency with MTD data entry vs PC data entry was also significantly reduced [2.1% vs 6.8%, respectively; mean difference 2.2%; 95% CI 0.5 to 9.0; P = 0.02].
CONCLUSION: Implementation of a MTD system for data entry leads to improved TEE reporting time and reduces TEE reporting delinquency. Further studies are required to determine whether this strategy enhances quality of reporting, optimizes communication between care teams, and improves outcomes without increasing costs.
Fierro M, Sheikh T, Mukherji J. Intraoperative transesophageal echocardiography to evaluate acute cessation of venous inflow during cardiopulmonary bypass. Anesth Analg Case Reports. 2014;3(8):95-97.
Acute disruption of venous return during cardiopulmonary bypass (CPB) may be due to malposition of the venous cannula, kinks or obstruction of the venous tubing by a smaller cannula, airlock, or mechanical disruption of blood flow. We describe an acute obstruction of the venous cannula by blood clots that were visualized on the transesophageal echocardiogram during CPB. Appropriate measures were taken by the surgeon to evacuate the clot and restore CPB. The clots were not seen on the transesophageal echocardiogram before CPB raising suspicion that they originated in a lower extremity and migrated to the right atrium resulting in venous cannula obstruction.