Lucas Nepomuceno Barros1,2,3, Ricardo Barreira Uchoa4, Juan Alberto Cosquillo Mejia5,4, Rogean Rodrigues Nunes6, Denise Araujo Silva Nepomuceno Barros6, Filadelfo Rodrigues Filho5,4,7. 1. State University of Ceará, Fortaleza, Brazil. lucasnepomucenobarros@gmail.com. 2. Dr Carlos Alberto Studart Gomes - Messejana Hospital, Fortaleza, Brazil. lucasnepomucenobarros@gmail.com. 3. Fortaleza General Hospital, Fortaleza, Brazil. lucasnepomucenobarros@gmail.com. 4. Dr Carlos Alberto Studart Gomes - Messejana Hospital, Fortaleza, Brazil. 5. State University of Ceará, Fortaleza, Brazil. 6. Fortaleza General Hospital, Fortaleza, Brazil. 7. Professor in Professional Master's in Transplants, State University of Ceará, Fortaleza, Brazil.
Abstract
BACKGROUND: Right Ventricular Dysfunction (RVD) is the most frequent intraoperative hemodynamic complication in Heart Transplantation (HTx). RVD occurs in 0.04-1.0% of cardiac surgeries with cardiotomy and in 20-50% of HTx, with mortality up to 75%. No consensus has been established for how anesthesiologists should manage RVD, with management methods many times remaining unvalidated. METHODS: We conducted a systematic review, following PRISMA guidelines, to create an anesthetic protocol to manage RVD in HTx, using databases that include PubMed and Embase, until September 2018 based on inclusion and exclusion criteria. The articles screening for the systematic review were done two independent reviewers, in case of discrepancy, we consulted a third independent reviewer. Based on the systematic review, the anesthetic protocol was developed. The instrument selected to perform the validation of the protocol was AGREE II, for this purpose expert anesthetists were recruited to do this process. The minimum arbitration score for domains validation cutoff of AGREE II is arbitered to 70%. This study was registered at PROSPERO (115600). RESULTS: In the systematic review, 152 articles were included. We present the protocol in a flowchart with six steps based on goal-directed therapy, invasive monitoring, and transesophageal echocardiogram. Six experts judged the protocol and validated it. CONCLUSION: The protocol has been validated by experts and new studies are needed to assess its applicability and potential benefits on major endpoints.
BACKGROUND: Right Ventricular Dysfunction (RVD) is the most frequent intraoperative hemodynamic complication in Heart Transplantation (HTx). RVD occurs in 0.04-1.0% of cardiac surgeries with cardiotomy and in 20-50% of HTx, with mortality up to 75%. No consensus has been established for how anesthesiologists should manage RVD, with management methods many times remaining unvalidated. METHODS: We conducted a systematic review, following PRISMA guidelines, to create an anesthetic protocol to manage RVD in HTx, using databases that include PubMed and Embase, until September 2018 based on inclusion and exclusion criteria. The articles screening for the systematic review were done two independent reviewers, in case of discrepancy, we consulted a third independent reviewer. Based on the systematic review, the anesthetic protocol was developed. The instrument selected to perform the validation of the protocol was AGREE II, for this purpose expert anesthetists were recruited to do this process. The minimum arbitration score for domains validation cutoff of AGREE II is arbitered to 70%. This study was registered at PROSPERO (115600). RESULTS: In the systematic review, 152 articles were included. We present the protocol in a flowchart with six steps based on goal-directed therapy, invasive monitoring, and transesophageal echocardiogram. Six experts judged the protocol and validated it. CONCLUSION: The protocol has been validated by experts and new studies are needed to assess its applicability and potential benefits on major endpoints.
Entities:
Keywords:
Anesthesia; Heart transplantation; Protocol; Right ventricular dysfunction
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