PMC:6640909 / 77260-81396 JSONTXT

{"project":"TEST0","denotations":[{"id":"31100109-199-206-7609","span":{"begin":366,"end":369},"obj":"[\"21685487\"]"},{"id":"31100109-103-110-7610","span":{"begin":638,"end":641},"obj":"[\"13435355\"]"},{"id":"31100109-167-174-7611","span":{"begin":811,"end":814},"obj":"[\"28846440\"]"},{"id":"31100109-123-130-7612","span":{"begin":940,"end":943},"obj":"[\"17717209\"]"},{"id":"31100109-128-135-7613","span":{"begin":945,"end":948},"obj":"[\"10936819\"]"},{"id":"31100109-142-149-7614","span":{"begin":1765,"end":1768},"obj":"[\"25712077\"]"},{"id":"31100109-87-94-7615","span":{"begin":1858,"end":1861},"obj":"[\"18042852\"]"},{"id":"31100109-92-99-7616","span":{"begin":1863,"end":1866},"obj":"[\"27014787\"]"},{"id":"31100109-81-88-7617","span":{"begin":2572,"end":2575},"obj":"[\"9485226\"]"},{"id":"31100109-105-112-7618","span":{"begin":2683,"end":2686},"obj":"[\"21530317\"]"},{"id":"31100109-94-101-7619","span":{"begin":2783,"end":2786},"obj":"[\"26186889\"]"},{"id":"31100109-99-106-7620","span":{"begin":2788,"end":2791},"obj":"[\"23109468\"]"},{"id":"31100109-165-172-7621","span":{"begin":2959,"end":2962},"obj":"[\"21530317\"]"},{"id":"31100109-166-173-7622","span":{"begin":3131,"end":3134},"obj":"[\"23550592\"]"},{"id":"31100109-113-120-7623","span":{"begin":3694,"end":3697},"obj":"[\"24075802\"]"},{"id":"31100109-118-125-7624","span":{"begin":3699,"end":3702},"obj":"[\"22092122\"]"},{"id":"31100109-193-200-7625","span":{"begin":3774,"end":3777},"obj":"[\"27363652\"]"}],"text":"9.2 Anaesthetic drugs\nFor induction, the use of propofol is not recommended due to its depressing effect on myocardial contractility and systemic vascular resistance. Therefore, etomidate (0.2–0.3 mg/kg) or a combination of midazolam and sufentanil are the preferred induction agents because myocardial contractility and systemic vascular resistance are unaffected [227]. Analgesia could be provided by short-acting opioids such as fentanyl or sufentanil. Anaesthesia is maintained using continuous infusion of propofol and an opioid.\nMechanical ventilation should avoid hypoxia and hypercarbia, which could result in an increase of PVR [228]. Protective ventilation settings with tidal volumes of 6–8 ml/kg and appropriate positive end expiratory pressure reduce the risk of ventilator-associated lung injury [229].\nTransoesophageal echocardiography (TOE) has become an essential diagnostic and monitoring tool during LT-MCS implantation [230, 231]. Preprocedural TOE may identify intracavitary thrombus: thrombus size, localization and mobility may affect the surgical strategy. Furthermore, patent foramen ovale, other atrial and ventricular septal defects can be identified. If evaluation is inconclusive, contrast can be added.\nAortic regurgitation (AR) decreases the efficiency of LT-MCS. Therefore, it is recommended to not only assess AR before surgery but also when the patient is on cardiopulmonary bypass (CPB). CPB mimics the haemodynamic situation of VAD support with similar pressure and flow in the ascending aorta. In this setting, a final decision on aortic valve surgery can be made for borderline cases. Furthermore, TOE provides valuable information about right ventricular function and the tricuspid valve and can affect (concomitant) surgery [232].\nIntraprocedural imaging of the inflow and outflow cannulas of the device is mandatory [233, 234]. Furthermore, TOE can help determine pharmacological support and pump speed settings while the patient is weaned from CPB, with special attention to the intraventricular septum in the 4-chamber view. Bulging of the intraventricular septum to the left and excessive unloading of the left ventricle (LV) indicate either excessive LVAD speed or RV failure.\nPatients at risk of RV failure may benefit from primary pharmacological support to increase myocardial contractility and to decrease PVR using a combination of epinephrine, milrinone and inhaled pulmonary vasodilators [e.g. inhaled nitric oxide (iNO) or/and iloprost]. Observational studies have demonstrated a beneficial effect of iNO therapy [235, 236]. However, iNO did not significantly reduce the incidence of RV failure in a multicentre randomized study [237]. Expert panels concluded that it is reasonable to consider using iNO during LVAD implantation [238, 239].\nEarly criteria for postprocedural diagnosis of RV failure are cardiac output \u003c2.0 l/min/m2, mixed venous oxygen saturation \u003c55% and mean arterial pressure \u003c50 mmHg [237]. High inotropic requirements and RV dilatation with concomitant collapse of the LV are signs of RV failure and should prompt the addition of temporary MCS for the RV [186].\nIf CPB is used, the suggested heparin dose is 400 IU/kg with a target activated clotting time of \u003e400 s. If the patient is on extracorporeal membrane oxygenation (ECMO) or the ECMO remains implanted for a period after LVAD implantation (e.g. for support of the RV), a dose of 100 IU/kg heparin and a target activated clotting time of 160–180 s is recommended. Similarly, off-pump LVAD implantation is usually performed under heparin 100 IU/kg. Thromboelastometry- and thromboelastography-guided therapy results in a significantly lower re-exploration rate [240, 241] and a decrease in the incidence of postoperative acute kidney injury [242].\nAfter LT-MCS implantation, preload should be optimized to ensure adequate VAD flows. However, overloading of the RV must be avoided. Any volume therapy should also take into account the likely quantity of blood products required to restore the coagulation status. To titrate volume status, assessment with TOE and the central venous pressure are essential."}

{"project":"MyTest","denotations":[{"id":"31100109-21685487-28905669","span":{"begin":366,"end":369},"obj":"21685487"},{"id":"31100109-13435355-28905670","span":{"begin":638,"end":641},"obj":"13435355"},{"id":"31100109-28846440-28905671","span":{"begin":811,"end":814},"obj":"28846440"},{"id":"31100109-17717209-28905672","span":{"begin":940,"end":943},"obj":"17717209"},{"id":"31100109-10936819-28905673","span":{"begin":945,"end":948},"obj":"10936819"},{"id":"31100109-25712077-28905674","span":{"begin":1765,"end":1768},"obj":"25712077"},{"id":"31100109-18042852-28905675","span":{"begin":1858,"end":1861},"obj":"18042852"},{"id":"31100109-27014787-28905676","span":{"begin":1863,"end":1866},"obj":"27014787"},{"id":"31100109-9485226-28905677","span":{"begin":2572,"end":2575},"obj":"9485226"},{"id":"31100109-21530317-28905678","span":{"begin":2683,"end":2686},"obj":"21530317"},{"id":"31100109-26186889-28905679","span":{"begin":2783,"end":2786},"obj":"26186889"},{"id":"31100109-23109468-28905680","span":{"begin":2788,"end":2791},"obj":"23109468"},{"id":"31100109-21530317-28905681","span":{"begin":2959,"end":2962},"obj":"21530317"},{"id":"31100109-23550592-28905682","span":{"begin":3131,"end":3134},"obj":"23550592"},{"id":"31100109-24075802-28905683","span":{"begin":3694,"end":3697},"obj":"24075802"},{"id":"31100109-22092122-28905684","span":{"begin":3699,"end":3702},"obj":"22092122"},{"id":"31100109-27363652-28905685","span":{"begin":3774,"end":3777},"obj":"27363652"}],"namespaces":[{"prefix":"_base","uri":"https://www.uniprot.org/uniprot/testbase"},{"prefix":"UniProtKB","uri":"https://www.uniprot.org/uniprot/"},{"prefix":"uniprot","uri":"https://www.uniprot.org/uniprotkb/"}],"text":"9.2 Anaesthetic drugs\nFor induction, the use of propofol is not recommended due to its depressing effect on myocardial contractility and systemic vascular resistance. Therefore, etomidate (0.2–0.3 mg/kg) or a combination of midazolam and sufentanil are the preferred induction agents because myocardial contractility and systemic vascular resistance are unaffected [227]. Analgesia could be provided by short-acting opioids such as fentanyl or sufentanil. Anaesthesia is maintained using continuous infusion of propofol and an opioid.\nMechanical ventilation should avoid hypoxia and hypercarbia, which could result in an increase of PVR [228]. Protective ventilation settings with tidal volumes of 6–8 ml/kg and appropriate positive end expiratory pressure reduce the risk of ventilator-associated lung injury [229].\nTransoesophageal echocardiography (TOE) has become an essential diagnostic and monitoring tool during LT-MCS implantation [230, 231]. Preprocedural TOE may identify intracavitary thrombus: thrombus size, localization and mobility may affect the surgical strategy. Furthermore, patent foramen ovale, other atrial and ventricular septal defects can be identified. If evaluation is inconclusive, contrast can be added.\nAortic regurgitation (AR) decreases the efficiency of LT-MCS. Therefore, it is recommended to not only assess AR before surgery but also when the patient is on cardiopulmonary bypass (CPB). CPB mimics the haemodynamic situation of VAD support with similar pressure and flow in the ascending aorta. In this setting, a final decision on aortic valve surgery can be made for borderline cases. Furthermore, TOE provides valuable information about right ventricular function and the tricuspid valve and can affect (concomitant) surgery [232].\nIntraprocedural imaging of the inflow and outflow cannulas of the device is mandatory [233, 234]. Furthermore, TOE can help determine pharmacological support and pump speed settings while the patient is weaned from CPB, with special attention to the intraventricular septum in the 4-chamber view. Bulging of the intraventricular septum to the left and excessive unloading of the left ventricle (LV) indicate either excessive LVAD speed or RV failure.\nPatients at risk of RV failure may benefit from primary pharmacological support to increase myocardial contractility and to decrease PVR using a combination of epinephrine, milrinone and inhaled pulmonary vasodilators [e.g. inhaled nitric oxide (iNO) or/and iloprost]. Observational studies have demonstrated a beneficial effect of iNO therapy [235, 236]. However, iNO did not significantly reduce the incidence of RV failure in a multicentre randomized study [237]. Expert panels concluded that it is reasonable to consider using iNO during LVAD implantation [238, 239].\nEarly criteria for postprocedural diagnosis of RV failure are cardiac output \u003c2.0 l/min/m2, mixed venous oxygen saturation \u003c55% and mean arterial pressure \u003c50 mmHg [237]. High inotropic requirements and RV dilatation with concomitant collapse of the LV are signs of RV failure and should prompt the addition of temporary MCS for the RV [186].\nIf CPB is used, the suggested heparin dose is 400 IU/kg with a target activated clotting time of \u003e400 s. If the patient is on extracorporeal membrane oxygenation (ECMO) or the ECMO remains implanted for a period after LVAD implantation (e.g. for support of the RV), a dose of 100 IU/kg heparin and a target activated clotting time of 160–180 s is recommended. Similarly, off-pump LVAD implantation is usually performed under heparin 100 IU/kg. Thromboelastometry- and thromboelastography-guided therapy results in a significantly lower re-exploration rate [240, 241] and a decrease in the incidence of postoperative acute kidney injury [242].\nAfter LT-MCS implantation, preload should be optimized to ensure adequate VAD flows. However, overloading of the RV must be avoided. Any volume therapy should also take into account the likely quantity of blood products required to restore the coagulation status. To titrate volume status, assessment with TOE and the central venous pressure are essential."}

{"project":"0_colil","denotations":[{"id":"31100109-21685487-7609","span":{"begin":366,"end":369},"obj":"21685487"},{"id":"31100109-13435355-7610","span":{"begin":638,"end":641},"obj":"13435355"},{"id":"31100109-28846440-7611","span":{"begin":811,"end":814},"obj":"28846440"},{"id":"31100109-17717209-7612","span":{"begin":940,"end":943},"obj":"17717209"},{"id":"31100109-10936819-7613","span":{"begin":945,"end":948},"obj":"10936819"},{"id":"31100109-25712077-7614","span":{"begin":1765,"end":1768},"obj":"25712077"},{"id":"31100109-18042852-7615","span":{"begin":1858,"end":1861},"obj":"18042852"},{"id":"31100109-27014787-7616","span":{"begin":1863,"end":1866},"obj":"27014787"},{"id":"31100109-9485226-7617","span":{"begin":2572,"end":2575},"obj":"9485226"},{"id":"31100109-21530317-7618","span":{"begin":2683,"end":2686},"obj":"21530317"},{"id":"31100109-26186889-7619","span":{"begin":2783,"end":2786},"obj":"26186889"},{"id":"31100109-23109468-7620","span":{"begin":2788,"end":2791},"obj":"23109468"},{"id":"31100109-21530317-7621","span":{"begin":2959,"end":2962},"obj":"21530317"},{"id":"31100109-23550592-7622","span":{"begin":3131,"end":3134},"obj":"23550592"},{"id":"31100109-24075802-7623","span":{"begin":3694,"end":3697},"obj":"24075802"},{"id":"31100109-22092122-7624","span":{"begin":3699,"end":3702},"obj":"22092122"},{"id":"31100109-27363652-7625","span":{"begin":3774,"end":3777},"obj":"27363652"}],"text":"9.2 Anaesthetic drugs\nFor induction, the use of propofol is not recommended due to its depressing effect on myocardial contractility and systemic vascular resistance. Therefore, etomidate (0.2–0.3 mg/kg) or a combination of midazolam and sufentanil are the preferred induction agents because myocardial contractility and systemic vascular resistance are unaffected [227]. Analgesia could be provided by short-acting opioids such as fentanyl or sufentanil. Anaesthesia is maintained using continuous infusion of propofol and an opioid.\nMechanical ventilation should avoid hypoxia and hypercarbia, which could result in an increase of PVR [228]. Protective ventilation settings with tidal volumes of 6–8 ml/kg and appropriate positive end expiratory pressure reduce the risk of ventilator-associated lung injury [229].\nTransoesophageal echocardiography (TOE) has become an essential diagnostic and monitoring tool during LT-MCS implantation [230, 231]. Preprocedural TOE may identify intracavitary thrombus: thrombus size, localization and mobility may affect the surgical strategy. Furthermore, patent foramen ovale, other atrial and ventricular septal defects can be identified. If evaluation is inconclusive, contrast can be added.\nAortic regurgitation (AR) decreases the efficiency of LT-MCS. Therefore, it is recommended to not only assess AR before surgery but also when the patient is on cardiopulmonary bypass (CPB). CPB mimics the haemodynamic situation of VAD support with similar pressure and flow in the ascending aorta. In this setting, a final decision on aortic valve surgery can be made for borderline cases. Furthermore, TOE provides valuable information about right ventricular function and the tricuspid valve and can affect (concomitant) surgery [232].\nIntraprocedural imaging of the inflow and outflow cannulas of the device is mandatory [233, 234]. Furthermore, TOE can help determine pharmacological support and pump speed settings while the patient is weaned from CPB, with special attention to the intraventricular septum in the 4-chamber view. Bulging of the intraventricular septum to the left and excessive unloading of the left ventricle (LV) indicate either excessive LVAD speed or RV failure.\nPatients at risk of RV failure may benefit from primary pharmacological support to increase myocardial contractility and to decrease PVR using a combination of epinephrine, milrinone and inhaled pulmonary vasodilators [e.g. inhaled nitric oxide (iNO) or/and iloprost]. Observational studies have demonstrated a beneficial effect of iNO therapy [235, 236]. However, iNO did not significantly reduce the incidence of RV failure in a multicentre randomized study [237]. Expert panels concluded that it is reasonable to consider using iNO during LVAD implantation [238, 239].\nEarly criteria for postprocedural diagnosis of RV failure are cardiac output \u003c2.0 l/min/m2, mixed venous oxygen saturation \u003c55% and mean arterial pressure \u003c50 mmHg [237]. High inotropic requirements and RV dilatation with concomitant collapse of the LV are signs of RV failure and should prompt the addition of temporary MCS for the RV [186].\nIf CPB is used, the suggested heparin dose is 400 IU/kg with a target activated clotting time of \u003e400 s. If the patient is on extracorporeal membrane oxygenation (ECMO) or the ECMO remains implanted for a period after LVAD implantation (e.g. for support of the RV), a dose of 100 IU/kg heparin and a target activated clotting time of 160–180 s is recommended. Similarly, off-pump LVAD implantation is usually performed under heparin 100 IU/kg. Thromboelastometry- and thromboelastography-guided therapy results in a significantly lower re-exploration rate [240, 241] and a decrease in the incidence of postoperative acute kidney injury [242].\nAfter LT-MCS implantation, preload should be optimized to ensure adequate VAD flows. However, overloading of the RV must be avoided. Any volume therapy should also take into account the likely quantity of blood products required to restore the coagulation status. To titrate volume status, assessment with TOE and the central venous pressure are essential."}

{"project":"2_test","denotations":[{"id":"31100109-21685487-28905669","span":{"begin":366,"end":369},"obj":"21685487"},{"id":"31100109-13435355-28905670","span":{"begin":638,"end":641},"obj":"13435355"},{"id":"31100109-28846440-28905671","span":{"begin":811,"end":814},"obj":"28846440"},{"id":"31100109-17717209-28905672","span":{"begin":940,"end":943},"obj":"17717209"},{"id":"31100109-10936819-28905673","span":{"begin":945,"end":948},"obj":"10936819"},{"id":"31100109-25712077-28905674","span":{"begin":1765,"end":1768},"obj":"25712077"},{"id":"31100109-18042852-28905675","span":{"begin":1858,"end":1861},"obj":"18042852"},{"id":"31100109-27014787-28905676","span":{"begin":1863,"end":1866},"obj":"27014787"},{"id":"31100109-9485226-28905677","span":{"begin":2572,"end":2575},"obj":"9485226"},{"id":"31100109-21530317-28905678","span":{"begin":2683,"end":2686},"obj":"21530317"},{"id":"31100109-26186889-28905679","span":{"begin":2783,"end":2786},"obj":"26186889"},{"id":"31100109-23109468-28905680","span":{"begin":2788,"end":2791},"obj":"23109468"},{"id":"31100109-21530317-28905681","span":{"begin":2959,"end":2962},"obj":"21530317"},{"id":"31100109-23550592-28905682","span":{"begin":3131,"end":3134},"obj":"23550592"},{"id":"31100109-24075802-28905683","span":{"begin":3694,"end":3697},"obj":"24075802"},{"id":"31100109-22092122-28905684","span":{"begin":3699,"end":3702},"obj":"22092122"},{"id":"31100109-27363652-28905685","span":{"begin":3774,"end":3777},"obj":"27363652"}],"text":"9.2 Anaesthetic drugs\nFor induction, the use of propofol is not recommended due to its depressing effect on myocardial contractility and systemic vascular resistance. Therefore, etomidate (0.2–0.3 mg/kg) or a combination of midazolam and sufentanil are the preferred induction agents because myocardial contractility and systemic vascular resistance are unaffected [227]. Analgesia could be provided by short-acting opioids such as fentanyl or sufentanil. Anaesthesia is maintained using continuous infusion of propofol and an opioid.\nMechanical ventilation should avoid hypoxia and hypercarbia, which could result in an increase of PVR [228]. Protective ventilation settings with tidal volumes of 6–8 ml/kg and appropriate positive end expiratory pressure reduce the risk of ventilator-associated lung injury [229].\nTransoesophageal echocardiography (TOE) has become an essential diagnostic and monitoring tool during LT-MCS implantation [230, 231]. Preprocedural TOE may identify intracavitary thrombus: thrombus size, localization and mobility may affect the surgical strategy. Furthermore, patent foramen ovale, other atrial and ventricular septal defects can be identified. If evaluation is inconclusive, contrast can be added.\nAortic regurgitation (AR) decreases the efficiency of LT-MCS. Therefore, it is recommended to not only assess AR before surgery but also when the patient is on cardiopulmonary bypass (CPB). CPB mimics the haemodynamic situation of VAD support with similar pressure and flow in the ascending aorta. In this setting, a final decision on aortic valve surgery can be made for borderline cases. Furthermore, TOE provides valuable information about right ventricular function and the tricuspid valve and can affect (concomitant) surgery [232].\nIntraprocedural imaging of the inflow and outflow cannulas of the device is mandatory [233, 234]. Furthermore, TOE can help determine pharmacological support and pump speed settings while the patient is weaned from CPB, with special attention to the intraventricular septum in the 4-chamber view. Bulging of the intraventricular septum to the left and excessive unloading of the left ventricle (LV) indicate either excessive LVAD speed or RV failure.\nPatients at risk of RV failure may benefit from primary pharmacological support to increase myocardial contractility and to decrease PVR using a combination of epinephrine, milrinone and inhaled pulmonary vasodilators [e.g. inhaled nitric oxide (iNO) or/and iloprost]. Observational studies have demonstrated a beneficial effect of iNO therapy [235, 236]. However, iNO did not significantly reduce the incidence of RV failure in a multicentre randomized study [237]. Expert panels concluded that it is reasonable to consider using iNO during LVAD implantation [238, 239].\nEarly criteria for postprocedural diagnosis of RV failure are cardiac output \u003c2.0 l/min/m2, mixed venous oxygen saturation \u003c55% and mean arterial pressure \u003c50 mmHg [237]. High inotropic requirements and RV dilatation with concomitant collapse of the LV are signs of RV failure and should prompt the addition of temporary MCS for the RV [186].\nIf CPB is used, the suggested heparin dose is 400 IU/kg with a target activated clotting time of \u003e400 s. If the patient is on extracorporeal membrane oxygenation (ECMO) or the ECMO remains implanted for a period after LVAD implantation (e.g. for support of the RV), a dose of 100 IU/kg heparin and a target activated clotting time of 160–180 s is recommended. Similarly, off-pump LVAD implantation is usually performed under heparin 100 IU/kg. Thromboelastometry- and thromboelastography-guided therapy results in a significantly lower re-exploration rate [240, 241] and a decrease in the incidence of postoperative acute kidney injury [242].\nAfter LT-MCS implantation, preload should be optimized to ensure adequate VAD flows. However, overloading of the RV must be avoided. Any volume therapy should also take into account the likely quantity of blood products required to restore the coagulation status. To titrate volume status, assessment with TOE and the central venous pressure are essential."}