A 61-year-old male patient, suffering from non-small cell lung carcinoma and multiple comorbidities, was posted for left upper lobectomy. The initial plan for lung isolation by double-lumen tube failed due to a difficult airway. After successful placement of the EZ blocker through a single-lumen tube (SLT), nasogastric tube (Ryle’s tube) insertion was attempted. It was difficult, requiring multiple attempts with laryngoscope and Magill’s forceps. All this movement had caused 3 cm displacement of the SLT. Repositioning of this tube then caused an unanticipated complication where the EZ blocker was found to be folded inside the trachea. The SLT and EZ blocker was taken out together over an airway exchange catheter, and new SLT and subsequently new EZ blocker was reinserted. The rest of the perioperative period was uneventful. Learning point: Any movement of the primary tube should be done bronchoscopy-guided or after due consideration of EZ blocker fixation at the multiport adapter.

Cardiac tumors, particularly papillary fibroelastomas (PFEs), often pose diagnostic challenges due to overlapping imaging characteristics with thrombi. While transthoracic and transesophageal echocardiography have high sensitivity for detecting fibroelastomas, their specificity remains limited. Tricuspid valve involvement is rare, with most cases occurring on the aortic valve. A 30-year-old male presented with exertional breathlessness for 2 months. Echocardiography revealed a mobile echogenic mass on the tricuspid valve, suggestive of PFE. Cardiac magnetic resonance imaging confirmed a non-mitotic lobulated mass, prompting surgical excision. However, histopathological examination identified the lesion as a thrombus rather than a fibroelastoma. This case underscores the importance of histopathological confirmation in differentiating between tumor and thrombus. Despite advancements in imaging, surgical excision remains a crucial approach when embolic risk is high. This report highlights the need for a multimodal diagnostic strategy to optimize patient management and reduce misdiagnosis-related complications.

Objectives: The objective of this study was to assess the safety of early active mobilization (EAM) in critically ill adults receiving vasopressor or inotropic support. Material and Methods: We conducted a prospective cohort study in a 10-bed intensive care unit in Colombia between September 2023 and November 2024. Eligible patients were adults ≥18 years with vasopressor or inotropic support for ≥2 h, stable dosing for ≥30 min, and the ability to follow simple commands (Glasgow Coma Scale score ≥13 or Richmond Agitation-Sedation Scale −2 to +1). Exclusion criteria were inability to perform active or assisted movement, severe hypoperfusion (lactate >6 mmol/L), prone positioning, multiple-organ failure, uncontrolled bleeding, post-cardiac arrest status, or recent cerebral/cardiac ischemic events. Interventions followed the frequency, intensity, time, and type of exercise principle and included EAM activities based on individual clinical assessment. We evaluated patients using standardized scales and monitored cardiorespiratory responses. The primary outcome was safety, defined as the absence of adverse events during or immediately after EAM. Results: We included 24 patients (mean age 66.5 ± 13.5 years, 62.5% male). Primary diagnoses were septic shock (29%) and cardiogenic shock (29%). Norepinephrine was required in 75% of patients (median dose 0.13 μg/kg/min). During EAM, 50% received supplemental oxygen and 25% required mechanical ventilation. Mobilization activities included sitting at the edge of the bed (46%), standing (29%), sitting in a chair (17%), and remaining semi-Fowler (8%). No adverse events occurred during any session. Only minimal, clinically non-significant increases in diastolic blood pressure (P < 0.05) and mean arterial pressure (P < 0.05) were observed. Conclusions: EAM in patients appears safe in critically ill adults receiving vasopressor or inotropic support when guided by structured assessment protocols. These findings challenge current restrictive mobility practices and suggest potential benefits for patient recovery. Larger studies are needed to confirm safety and establish evidence-based mobilization guidelines for hemodynamically supported patients.

Objectives: Cardiovascular diseases (CVD) are the leading cause of death and disability in the United States, with Asian Indians exhibiting a unique and heightened risk profile, marked by earlier onset and increased mortality. Indians often display significant dyslipidemia despite “healthy” body mass index (BMI) ranges, highlighting limitations of traditional risk factors. The objective of this retrospective, observational study was to assess the impact of race, sex, and age on lipid profile and BMI in Indians versus Whites, to guide more tailored CVD prevention and management strategies. Material and Methods: One hundred and ninety deidentified medical records were obtained from a cardiology clinic in New Jersey. The study stratified dyslipidemia and BMI differences by race, age, and sex to identify variations in cardiovascular risk profiles. Statistical analysis was performed using Statistical Package for the Social Sciences. Results: Indians showed significantly higher triglyceride levels despite lower BMI compared to Whites, with trends of elevated total cholesterol, low density lipoprotein, and non-high density lipoprotein cholesterol. Younger Indians (<50 years) had higher BMI and greater CVD risk than older Indians (>50 years). Females, irrespective of age, exhibited higher lipid profiles and increased CVD risk compared to males. Conclusion: Indians exhibit a pronounced risk for dyslipidemia, supporting the need for lower BMI cutoffs and ethnically tailored, early screening protocols, with a focus on younger adults and women, to reduce CVD risk.

Objectives: Acute post-operative pain can be a cause of significant morbidity in pediatric cardiac surgical patients. The purpose of this study was to evaluate the efficacy and safety of ultrasound-guided bilateral pecto-intercostal fascial plane block (PIFB) in pediatric cardiac surgical patients. Material and Methods: It was a randomized, prospective, single-blinded, comparative study in a tertiary care cardiac center. The study comprised 90 patients with acyanotic and cyanotic congenital heart disease undergoing cardiac surgery through midline sternotomy on cardiopulmonary bypass (CPB), randomized into two groups – Group P (PIFB) and Group C (control). Following surgical skin closure, Group P was administered bilateral PIFB using 3 mg/kg of 0.2% ropivacaine. Fentanyl was provided before extubation, while tramadol was employed post-extubation as rescue analgesia. Paracetamol was administered to both groups as part of a multimodal analgesia protocol. Results: Resting modified objective pain score (MOPS) at 1, 2, 4, 6, 8, 10, 12, 24, and 36 h was measured post-extubation. After exclusions, 83 patients were evaluated. MOPS at all-time intervals for 36 h was comparatively less in the PIFB group (P < 0.01). Time to extubate (P < 0.001), post-operative fentanyl pre-extubation (P < 0.001), time to first rescue analgesia (P < 0.001), tramadol post-extubation (P < 0.001), paracetamol requirement (P < 0.001), intensive care unit length of stay (P = 0.008), and the hospital length of stay (P = 0.007) were significantly less in Group P. No adverse events attributable to PIFB were observed. Conclusion: Ultrasound-guided bilateral PIFB represents a safe and effective modality for the management of acute post-operative pain in pediatric patients undergoing cardiac surgery with CPB.

Single ventricle physiology represents a group of heart malformations in which one of the two ventricles of the heart is non-functional. Children suffering from these conditions need to undergo surgical palliation in a staged manner. One part of this staged palliation is bidirectional Glenn procedure. In this article, we enumerate detailed, yet simplified technical steps of the surgery, especially for the budding cardiac surgeons.

Objectives: Sepsis is a leading cause of acute respiratory distress syndrome (ARDS) worldwide. Effective fluid management strategies are essential for treating these patients. This research assesses the practical implementation and outcomes of restrictive versus liberal fluid management approaches in ARDS caused by sepsis. The aim of the study is to assess the clinical outcomes linked to various fluid management strategies in real-world scenarios, providing insights to optimize clinical practices and develop personalized treatment protocols for very sick patients with ARDS. Material and Methods: This retrospective observational study included 120 patients with ARDS due to sepsis. They were treated at a tertiary care center in India between June 2022 and January 2024. Patients were categorized into restrictive fluid groups (RGs) and liberal fluid groups (LGs). 28-day mortality was considered the primary outcome, while the secondary outcomes included the period of ventilatory support, intensive care unit (ICU) length of stay, incidence of renal failure, need for renal replacement therapy (RRT), and new organ dysfunction. Results: Patients in the RG had a significant decline in 28-day mortality (25% vs. 40%, P = 0.043) and shorter period of ventilatory support (8 days vs. 12 days, P = 0.001) compared to the LG. ICU length of stay was also reduced (12 days vs. 16 days, P = 0.028). The incidence of renal failure or need for RRT was insignificant between groups. However, the incidence of new organ dysfunction was significant between groups. Conclusion: Restrictive fluid management in ARDS resulting from sepsis has been linked to better survival rates, shorter periods of mechanical ventilation, and reduced ICU stays. These results advocate for adopting restrictive fluid strategies.

In the elderly population, the most predominant etiology for hospitalization is heart failure (HF). The possibility of developing intraoperative and postoperative complications increases in patients with de novo HF or those who decompensate suddenly. Among the many classification systems described for HF, the 2013 American College of Cardiology Foundation/American Heart Association classification is the most commonly used. In this classification system, in accordance with the ejection fraction (EF), the HF is categorized into two types: First, those with reduced (≤40%) EF or systolic heart failure and second, those with preserved (≥50%) EF or diastolic heart failure. Plasma natriuretic peptide measurement and echocardiography constitute the diagnostic modalities of choice. Management of HF centers around a combination of diuretics, beta-blockers, angiotensin-converting enzyme inhibitors, arginine receptor neprilysin inhibitors, and sodium-glucose cotransporter-2 inhibitors. The emergence of newer, innovative therapies that are effective and well-tolerated, can potentially improve the outcomes of these patients. Perioperative risk assessment involves the awareness of the etiology of HF, the magnitude of symptoms of HF, concomitant cardiac or non-cardiac risk factors for morbidity/mortality, and the urgency and type of surgery. The review discusses the pharmacological, non-pharmacological, and perioperative management of HF.