Cardiovascular Critical Care I
ii.
Antibiotic treatment
| (a) | Antibiotic coverage should account for site of suspected infection, previous pathogens |
|---|
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).
| (b) | Treatment duration depends largely on the type of infection. However, if the infection is |
|---|
VAD related or VAD specific, prolonged antimicrobial therapy (more than 4 weeks) is
commonly used.
| (c) | Because LVAD exchange is not without considerable risk, long-term oral antibiotic |
|---|
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
| d. | Severe pulmonary hypertension |
|---|
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.