Cardiovascular Critical Care I

ii.

Antibiotic treatment

and susceptibilities, proximity to driveline site or VAD pocket, and any other potential

exposure or bacteremia secondary to the procedure. Prophylactic antibiotic coverage

for VAD-related or non–VAD-related surgical procedures should account for site of

procedure, previous infections, proximity to driveline site or VAD pocket, and any other

potential exposure or bacteremia secondary to the procedure. In some circumstances,

this requires broader prophylactic antibiotic coverage (Interact Cardiovasc Thorac Surg

2012;14:209-14).

VAD related or VAD specific, prolonged antimicrobial therapy (more than 4 weeks) is

commonly used.

suppression therapy may be considered for some infections.

Patient Case (Continued)

J.M. is no longer in AF but remains in cardiogenic shock. The cardiac intensive care unit team has consulted

the cardiothoracic surgeons for evaluation of his mitral valve disease and has considered advanced HF

therapies. In the patient’s decompensated state, he would likely need additional optimization if he were to

undergo surgery. Which temporary means of mechanical circulatory support (MCS) might be most favorable

to help stabilize this patient’s cardiogenic shock in the setting of moderate to severe mitral regurgitation?

Transplantation remains the gold-standard treatment for end-stage HF.

donor-recipient tissue compatibility.

Other limitations may include recipient characteristics of:

Mental health

Social support

Adherence to medication and appointments

Cancer

Infection

Tobacco or ethanol use

Illicit drug use

Additional considerations associated with thoracic transplantation in the ICU, such as immunosuppression,

rejection, and other complications, are beyond the scope of this review.