Ebook Drug and device selection in heart failure: Part 2
➤ Gửi thông báo lỗi ⚠️ Báo cáo tài liệu vi phạmNội dung chi tiết: Ebook Drug and device selection in heart failure: Part 2
Ebook Drug and device selection in heart failure: Part 2
CHAPTERPercutaneous Mechanical SupportRaphael E Bonita, Kariann Abbate■ introductionThere are approximately 5.8 million people in the United States li Ebook Drug and device selection in heart failure: Part 2iving with heart failure (HF).1 These numbers are expected to increase over the next decade due to the aging population. Despite the Increasing prevalence of HF, the number of donor hearts available for transplant has remained stagnant. In 2010, there were 2,333 heart transplants performed in the Un Ebook Drug and device selection in heart failure: Part 2ited States.2 A severe donor shortage has limited the availability' of donor hearts resulting in prolonged waits for organs for patients with advancedEbook Drug and device selection in heart failure: Part 2
HF. Furthermore, more than 200,000 patients with heart failure are not eligible for transplant due to age or comorbidities.3 The advent of mechanicalCHAPTERPercutaneous Mechanical SupportRaphael E Bonita, Kariann Abbate■ introductionThere are approximately 5.8 million people in the United States li Ebook Drug and device selection in heart failure: Part 2ible for transplantation.I INDICATIONS FOR MECHANICAL ASSIST DEVICESMechanical assist devices are indicated for patients who are failing optimal medical therapy. When patients are exhibiting evidence of end-organ dysfunction despite optimal medical therapy, mechanical assist devices should be consid Ebook Drug and device selection in heart failure: Part 2ered. Mechanical assist devices are used for both acute and chronic HF. The National Institute of Health has developed profiles using data from InteraEbook Drug and device selection in heart failure: Part 2
gency Registry for Mechanically Assisted Circulatory Support (INTERMACS) to assist in clarification of target populations for mechanical assist deviceCHAPTERPercutaneous Mechanical SupportRaphael E Bonita, Kariann Abbate■ introductionThere are approximately 5.8 million people in the United States li Ebook Drug and device selection in heart failure: Part 2, and (3) destination therapy.Bridge to RecoveryMechanical assist devices are commonly used to support patients suffering from postcardlotomy shock that are unable to be weaned from cardiopulmonary’ bypasshttps://khothuvien.cori!Chapter 8: Percutaneous Mechanical Support111INTERMACS profile descript Ebook Drug and device selection in heart failure: Part 2ionTable 1Clinical presentationsTime frame for interventionProfile 1: Critical cardiogenic shockPatients with life-threatening hypotension despite rapEbook Drug and device selection in heart failure: Part 2
idly escalating inotropic support, critical organ hypoperfusion, often confirmed by worsening acidosis and/or lactate levels. "Crash and burn"DefinitiCHAPTERPercutaneous Mechanical SupportRaphael E Bonita, Kariann Abbate■ introductionThere are approximately 5.8 million people in the United States li Ebook Drug and device selection in heart failure: Part 2ted by worsening renal function, nutritional depletion, inability to restore volume balance, "sliding on inotropes*. Also describes declining status in patients unable to tolerate inotropic therapyDefinitive intervention needed within a few daysProfile 3: Stable but inotrope dependentPatients with s Ebook Drug and device selection in heart failure: Part 2table blood pressure, organ function, nutrition, and symptoms on continuous intravenous inotropic support (or a temporary circulatory support device oEbook Drug and device selection in heart failure: Part 2
r both), but demonstrated repeated failing to wean from support due to recurrent symptomatic hypotension or renal dysfunction "dependent stability*DefCHAPTERPercutaneous Mechanical SupportRaphael E Bonita, Kariann Abbate■ introductionThere are approximately 5.8 million people in the United States li Ebook Drug and device selection in heart failure: Part 2 experiences daily symptoms of congestion at rest or during ADL. Doses of diuretics generally fluctuate at very high levels. More intensive management and surveillance strategies should be considered, which may in some cases reveal poor compliance that would compromise outcomes with any therapy. Som Ebook Drug and device selection in heart failure: Part 2e patients may shuttle between 4 and 5Definitive intervention elective over a period of weeks to monthsProfile 5: Exertion intoleranceComfortable at rEbook Drug and device selection in heart failure: Part 2
est and with ADL but unable to engage in any other activity, living predominantly within the house. Patients are comfortable at rest without congestivCHAPTERPercutaneous Mechanical SupportRaphael E Bonita, Kariann Abbate■ introductionThere are approximately 5.8 million people in the United States li Ebook Drug and device selection in heart failure: Part 2on are marginal, patient may be more at risk than INTERMACS 4 and require definitive interventionVariable urgency depends upon maintenance of nutrition, organ fund ion and activityProfile 6: Exertion limitedPatient without evidence of fluid overload is comfortable at rest and with activities of dail Ebook Drug and device selection in heart failure: Part 2y living and minor activities outside the home but fatigues after the first few minutes of any meaningful activity. Attribution to cardiac limitationEbook Drug and device selection in heart failure: Part 2
requires careful measurement of peak oxygen consumption, in some cases with hemodynamic monitoring to confirm severity of cardiac impairment. "WalkingCHAPTERPercutaneous Mechanical SupportRaphael E Bonita, Kariann Abbate■ introductionThere are approximately 5.8 million people in the United States li Ebook Drug and device selection in heart failure: Part 2recise specification in future, this level includes patients who are without current or recent episodes of unstable fluid balance, living comfortably with meaningful activity limited to mild physical exertionTransplantation or circulator support may not currently be indicatedContd...112Drug and Devi Ebook Drug and device selection in heart failure: Part 2ce Selection in Heart FailureContd...Modifiers for profilesPossible profiles to modifyTemporary circulatory support can modify only patients in hospitEbook Drug and device selection in heart failure: Part 2
al (other devices would be INTERMACS devices) includes IABP, ECMO, TandemHeart®, levitronix, BVS 5000 or AB5000, Impella®1,2,3 in hospitalArrhythmia (CHAPTERPercutaneous Mechanical SupportRaphael E Bonita, Kariann Abbate■ introductionThere are approximately 5.8 million people in the United States li Ebook Drug and device selection in heart failure: Part 2requent ICD shock or requirement for external defibrillator, usually more than twice weeklyAny profileFrequent Flyer (FF)—Can modify only outpatients, designate a patient requiring frequent emergency visits or hospitalizations for diuretics, ultrafiltration, or temporary intravenous vasoactive thera Ebook Drug and device selection in heart failure: Part 2py3 if at home, 4, 5,6. A frequent flyer would rarely be profile 7INTERMACS, interagency registry for mechanically assisted circulatory support; ADL,Ebook Drug and device selection in heart failure: Part 2
activities of daily living; NYHA, New York Heart Association; IABP, Intra-aortic balloon pump; ECMO, extracorporeal \membrane oxygenating system; ICD,CHAPTERPercutaneous Mechanical SupportRaphael E Bonita, Kariann Abbate■ introductionThere are approximately 5.8 million people in the United States liCHAPTERPercutaneous Mechanical SupportRaphael E Bonita, Kariann Abbate■ introductionThere are approximately 5.8 million people in the United States liGọi ngay
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