• Twitter
  • Facebook
  • Vimeo
  • FCUS Courses
  • Register for FCUS Course
  • Login
Intensive Care Network
  • About Us
    • What is ICN
    • Our Team
  • Events
  • Podcast Series
    • Podcast by Topic
      • Airway Podcasts
      • Cardiac Podcasts
      • Career Podcasts
      • Conference Podcasts
      • Education Podcasts
      • Evidence Podcasts
      • GI/Renal Podcasts
      • Haem Podcasts
      • Metabolic Podcasts
      • Miscellaneous Podcasts
      • Neuro Podcasts
      • Paeds Podcasts
      • Respiratory Podcasts
      • Resuscitation Podcasts
      • Sepsis Podcasts
      • Toxicology Podcasts
      • Trauma Podcasts
      • Ultrasound Podcasts
    • Podcast by Specialty
      • Anaesthetics
      • Emergency
      • ICU
      • Prehospital
    • SMACC
    • ICN
    • Jellybean
    • CICM ASM
  • Blog
  • Resources
    • Clinical Cases
    • Fav Posts/Other Sources
    • Game Changing Evidence
    • Radiology
      • ICU Radiology
    • Simulation Resources
    • Ultrasound
      • Lung Ultrasound
  • EXAMHELP
    • ANAESTHETICS PRIMARY
    • ANZCA FELLOWSHIP
    • CICM Fellowship
    • EMERGENCY PRIMARY
    • ICU Primary Exam
    • PAEDS FELLOWSHIP
  • Contact Us

VAD & transplanted patient with non-cardiac critical illness by Dr Peta Alexander

Home VAD & transplanted patient with non-cardiac critical illness by Dr Peta Alexander
VAD & transplanted patient with non-cardiac critical illness.

Use of Ventricular Assist Devices (VAD) and heart transplantation (HT) for end stage cardiac failure have increased significantly in recent decades. These support strategies hold inherently different risks in the face on non-cardiac critical illness, and require multidisciplinary team management.  

According to INTERMACS, more than 2500 VADs/year are implanted the USA. Most implanted devices are continuous flow left-VADs (75%) which deliver systemic cardiac output directly related to pump speed and inversely related to pressure gradient across the pump. Improved survivorship has resulted in increasing outpatient management, however 12-month mortality is 12%, and <30% of patients are major-event free for 1-year. Critical illness may be device related, including cerebrovascular accidents, gastrointestinal bleeding, infection or multi-organ system dysfunction. Alternatively, presenting complaints may be unrelated to the device, with 23-27% of VAD patients undergoing non-cardiac surgery during support. Regardless of etiology, patient management is inherently linked to optimizing device function. Maintaining Left-VAD flow depends on adequate preload, supported right ventricular contractility and afterload reduction whilst managing systemic vascular resistance. Attention to associated coagulopathy, anti-inflammatory therapy and early institution of anti-microbial agents should be considered.  

HT is established therapy for end-stage heart failure, with more than 5000 HT reported to ISHLT in 2015. Complexity has increased due to comorbidities and recipient age.  Etiologies of critical illness for HT patients include post-transplant complications such as acute rejection, graft failure and cardiac allograft vasculopathy. Acute rejection episodes affect >1/4 of patients within 1-year post-transplant. Systemic illnesses may also be associated with chronic immunosuppression, for example malignancy and unusual presentations of infectious disease; as well as medication toxicity where the post-transplant medication cocktail exacerbates underlying renal insufficiency and multi-organ dysfunction. Therapeutic interventions must also take into consideration potential drug-interactions. Recognizing and managing critical illness in the post-transplant population is exacerbated by vagal denervation blunting normal heart rate response, obscuring illness severity and limiting augmentation of cardiac output.  

the podcast

the slides

VAD & transplanted patient with non-cardiac critical illness by Dr Peta Alexander from CICM 2018 Annual Scientific Meeting

Subscribe to the ICN Podcast

Subscribe to the SMACC Podcast

Share this
Transplant or durable mechanical support by Professor David McGiffinWhole Body Ultrasound Centered on the Lung: A Holistic Approach by Daniel Lichtenstein
IPSN – Intensivist Parent Support Network WIN – Women in Intensive Care Network ICN UK ICN NZ ICN WA ICN VIC ICN NSW ICN QLD The ICN Story The Team Jellybean Podcasts ICN Blog SMACC Video SMACC Audio Video ECG Simulator by aclsmedicaltraining BASIC SCIENCE CLINIC Simulation Game Changing Evidence ICU Radiology Echo Guide ECHO Cases Clinical Cases EXAMHELP Jellybean Podcasts ICN Blog SMACC Video SMACC Audio Video CICM Fellowship ANZCA FELLOWSHIP PAEDS FELLOWSHIP EMERGENCY PRIMARY ANAESTHETICS PRIMARY End-o-bed-o-gram

  • About
    •  What is ICN
    •  The Team
    •  ICN NSW
    •  ICN QLD
    •  ICN VIC
    •  ICN WA
    •  ICN NZ
    •  ICN UK
  • Resources
    •  Lung US
    •  Exam Help
    •  Clinical Cases
    •  Echo Cases
    •  Echo Guide
    •  ICU Radiology
    •  Game Changing Evidence
    •  ICN Metafeed
    •  Simulation Resouces
  • Media
    •  SMACC Posters
    •  Audio
    •  Video
    •  Pecha Kuchas
  • Upskill
    •  Clinical Cases
    •  Echo Cases
    •  ICU Radiology
  • Exam Help
    •  End-o-Bed-o-Gram
    •  ICU Primary Exam
    •  CICM Fellowship
    •  ANZCA Fellowship
    •  Paeds Fellowship
    •  Emergency Primary
    •  Anaesthetics Primary

® 2023 The Intensive Care Network || All rights reserved || Disclaimer || Site Map || Contact ICN Support

Log in with your credentials

or     Create an account

Lost your password?

Forgot your details?

I remember my details

Create Account