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de Courson H, Chadefaux G, Loiseau A, Georges D, Biais M. Myocardial dysfunction assessed by speckle-tracking in good-grade subarachnoid hemorrhage patients (WFNS 1-2): a prospective observational study. Crit Care 2023; 27:455. [PMID: 37990276 PMCID: PMC10664298 DOI: 10.1186/s13054-023-04738-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Accepted: 11/14/2023] [Indexed: 11/23/2023] Open
Abstract
BACKGROUND Cardiac complications due to non-traumatic subarachnoid hemorrhage (SAH) are usually described using classical echocardiographic evaluation. Strain imaging appears to have better sensitivity than standard echocardiographic markers for the diagnosis of left ventricular dysfunction. The aim of this study was to determine the prevalence of cardiac dysfunction defined as a Global Longitudinal Strain (GLS) ≥ - 20% in patients with good-grade SAH (WFNS 1 or 2). METHODS Seventy-six patients with good-grade SAH were prospectively enrolled and analyzed at admission for neurocritical care. Transthoracic echocardiography was performed on days 1, 3, and 7 after hemorrhage. Routine measurements, including left ventricular ejection fraction (LVEF), were performed, and off-line analysis was performed by a blinded examiner, to determine 2-, 3-, and 4-cavity longitudinal strain and left ventricular GLS. GLS was considered altered if it was ≥ - 20%, we also interested the value of ≥ - 17%. LVEF was considered altered if it was < 50%. RESULTS On day 1, 60.6% of patients had GLS ≥ - 20% and 21.2% of patient had GLS ≥ - 17%. In comparison, alteration of LVEF was present in only 1.7% of patients. The concordance rate between LVEF < 50% and GLS ≥ - 20% and LVEF ≥ 50% and GLS < - 20% was 46%. CONCLUSION Strain imaging showed a higher prevalence (60.6%) of left ventricular dysfunction during the acute phase of good-grade SAH (WFNS 1 or 2) than previously described.
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Affiliation(s)
- Hugues de Courson
- Department of Anesthesiology and Critical Care, Bordeaux University Hospital, Place Amélie Raba-Léon, Hôpital Tripode, 33000, Bordeaux, France
- INSERM, BPH, U1219, University of Bordeaux, 33000, Bordeaux, France
| | - Grégoire Chadefaux
- Department of Anesthesiology and Critical Care, Bordeaux University Hospital, Place Amélie Raba-Léon, Hôpital Tripode, 33000, Bordeaux, France
| | - Alexandre Loiseau
- Department of Anesthesiology and Critical Care, Bordeaux University Hospital, Place Amélie Raba-Léon, Hôpital Tripode, 33000, Bordeaux, France
| | - Delphine Georges
- Department of Anesthesiology and Critical Care, Bordeaux University Hospital, Place Amélie Raba-Léon, Hôpital Tripode, 33000, Bordeaux, France
| | - Matthieu Biais
- Department of Anesthesiology and Critical Care, Bordeaux University Hospital, Place Amélie Raba-Léon, Hôpital Tripode, 33000, Bordeaux, France.
- INSERM, U1034, Biology of Cardiovascular Diseases, University of Bordeaux, 33600, Pessac, France.
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Vos ME, Cox EGM, Schagen MR, Hiemstra B, Wong A, Koeze J, van der Horst ICC, Wiersema R. Right ventricular strain measurements in critically ill patients: an observational SICS sub-study. Ann Intensive Care 2022; 12:92. [PMID: 36190597 PMCID: PMC9530097 DOI: 10.1186/s13613-022-01064-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 09/16/2022] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Right ventricular (RV) dysfunction is common in critically ill patients and is associated with poor outcomes. RV function is usually evaluated by Tricuspid Annular Plane Systolic Excursion (TAPSE) which can be obtained using critical care echocardiography (CCE). Myocardial deformation imaging, measuring strain, is suitable for advanced RV function assessment and has widely been studied in cardiology. However, it is relatively new for the Intensive Care Unit (ICU) and little is known about RV strain in critically ill patients. Therefore, the objectives of this study were to evaluate the feasibility of RV strain in critically ill patients using tissue-Doppler imaging (TDI) and explore the association between RV strain and conventional CCE measurements representing RV function. METHODS This is a single-center sub-study of two prospective observational cohorts (Simple Intensive Care Studies (SICS)-I and SICS-II). All acutely admitted adults with an expected ICU stay over 24 h were included. CCE was performed within 24 h of ICU admission. In patients in which CCE was performed, TAPSE, peak systolic velocity at the tricuspid annulus (RV s') and TDI images were obtained. RV free wall longitudinal strain (RVFWSL) and RV global four-chamber longitudinal strain (RV4CSL) were measured during offline analysis. RESULTS A total of 171 patients were included. Feasibility of RVFWSL and RV4CSL was, respectively, 62% and 56% in our population; however, when measurements were performed, intra- and inter-rater reliability based on the intraclass correlation coefficient were good to excellent. RV dysfunction based on TAPSE or RV s' was found in 56 patients (33%) and 24 patients (14%) had RV dysfunction based on RVFWSL or RV4CSL. In 14 patients (8%), RVFWSL, RV4CSL, or both were reduced, despite conventional RV function measurements being preserved. These patients had significantly higher severity of illness scores. Sensitivity analysis with fractional area change showed similar results. CONCLUSIONS TDI RV strain imaging in critically ill patients is challenging; however, good-to-excellent reproducibility was shown when measurements were adequately obtained. Future studies are needed to elucidate the diagnostic and prognostic value of RV strain in critically ill patients, especially to outweigh the difficulty and effort of imaging against the clinical value.
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Affiliation(s)
- Madelon E Vos
- University Medical Center Groningen, Department of Anaesthesiology, University of Groningen, Groningen, The Netherlands.
| | - Eline G M Cox
- University Medical Center Groningen, Department of Critical Care, University of Groningen, Groningen, The Netherlands
| | - Maaike R Schagen
- Erasmus Medical Center, Department of Internal Medicine, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Bart Hiemstra
- Department of Anaesthesiology, Location VU Medical Center, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Adrian Wong
- Department of Critical Care, King's College Hospital, London, UK
| | - Jacqueline Koeze
- University Medical Center Groningen, Department of Critical Care, University of Groningen, Groningen, The Netherlands
| | - Iwan C C van der Horst
- Department of Intensive Care Medicine, University of Maastricht, University Medical Center Maastricht, Maastricht, The Netherlands
| | - Renske Wiersema
- University Medical Center Groningen, Department of Critical Care, University of Groningen, Groningen, The Netherlands.,Department of Cardiology, Erasmus University Rotterdam, Erasmus Medical Center, Rotterdam, the Netherlands
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Left ventricular longitudinal strain variations assessed by speckle-tracking echocardiography after a passive leg raising maneuver in patients with acute circulatory failure to predict fluid responsiveness: A prospective, observational study. PLoS One 2021; 16:e0257737. [PMID: 34591884 PMCID: PMC8483378 DOI: 10.1371/journal.pone.0257737] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 09/08/2021] [Indexed: 01/22/2023] Open
Abstract
Background An association was reported between the left ventricular longitudinal strain (LV-LS) and preload. LV-LS reflects the left cardiac function curve as it is the ratio of shortening over diastolic dimension. The aim of this study was to determine the sensitivity and specificity of LV-LS variations after a passive leg raising (PLR) maneuver to predict fluid responsiveness in intensive care unit (ICU) patients with acute circulatory failure (ACF). Methods Patients with ACF were prospectively included. Preload-dependency was defined as a velocity time integral (VTI) variation greater than 10% between baseline (T0) and PLR (T1), distinguishing the preload-dependent (PLD+) group and the preload-independent (PLD-) group. A 7-cycles, 4-chamber echocardiography loop was registered at T0 and T1, and strain analysis was performed off-line by a blind clinician. A general linear model for repeated measures was used to compare the LV-LS variation (T0 to T1) between the two groups. Results From June 2018 to August 2019, 60 patients (PLD+ = 33, PLD- = 27) were consecutively enrolled. The VTI variations after PLR were +21% (±8) in the PLD+ group and -1% (±7) in the PLD- group (p<0.01). Mean baseline LV-LS was -11.3% (±4.2) in the PLD+ group and -13.0% (±4.2) in the PLD- group (p = 0.12). LV-LS increased in the whole population after PLR +16.0% (±4.0) (p = 0.04). The LV-LS variations after PLR were +19.0% (±31) (p = 0.05) in the PLD+ group and +11.0% (±38) (p = 0.25) in the PLD- group, with no significant difference between the two groups (p = 0.08). The area under the curve for the LV-LS variations between T0 and T1 was 0.63 [0.48–0.77]. Conclusion Our study confirms that LV-LS is load-dependent; however, the variations in LV-LS after PLR is not a discriminating criterion to predict fluid responsiveness of ICU patients with ACF in this cohort.
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Prognostic value and time course evolution left ventricular global longitudinal strain in septic shock: an exploratory prospective study. J Clin Monit Comput 2020; 35:1501-1510. [PMID: 33216237 DOI: 10.1007/s10877-020-00620-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 11/13/2020] [Indexed: 01/25/2023]
Abstract
Our main objective was to describe the course of GLS during the first days of septic shock and to assess the agreement between GLS values and longitudinal strain measured in apical four chambers. A prospective observational single centre study was conducted at the Nimes University Hospital's ICU. All patients admitted for a diagnosis of septic shock without pre-existing heart disease were eligible. Echocardiography (LVEF and GLS) was performed on the first day, and repeated once between day 3 and day 5 then once between day 6 and day 8. We enrolled 40 consecutive patients. Four patients were excluded. In overall population, GLS at T1 was impaired (- 11.0%, IQR(interquartile range) [- 15; - 10]). On T2 exams, a significant improvement of the GLS (- 11% vs - 16% p = 0.02) was observed whereas LVEF remained stable over time. A good agreement between GLS and longitudinal strain measured on a four chambers view was found. Based on the Bland and Altman method, the mean of differences for T1 exams was 0.1 (95% CI [- 0.6; 0.8]) with limits of agreement ranging from - 4 to 4. Myocardial strain is depressed at the early phase of septic shock and improves over time. A single measurement of LS4C view appears sufficient at bedside.
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Aksakal E, Simsek Z, Aksu U, Birdal O, Ateş ES, Kalkan K, Gulcu O, Demirelli S, Aksakal E, Tas H. Acute cardiac effects of high dose steroid treatment: A speckle tracking echocardiography study. JOURNAL OF CLINICAL ULTRASOUND : JCU 2019; 47:351-355. [PMID: 30785648 DOI: 10.1002/jcu.22716] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 01/25/2019] [Accepted: 02/08/2019] [Indexed: 06/09/2023]
Abstract
PURPOSE High-dose steroid therapy (HDST) has frequent side-effects that appear at its cessation and depend on its dose. However, there is a lack of studies about the acute effects of HDST on cardiac function in adult patients. METHODS We included in this study 30 patients who underwent HDST (intravenously at doses ranging from 250 to 1000 mg) and 30 healthy control subjects with similar demographic and clinical characteristics, between September and December 2016. Echocardiographic measurements were made before and during the first 3 hours after the end of treatment, and results were compared between patients and controls. RESULTS There was no difference in baseline biochemical and echocardiographic characteristics between the patient and control groups. While left ventricular global longitudinal strain (LVGLS) and strain rate E were higher after treatment, no significant change was observed in conventional echocardiographic variables. CONCLUSIONS LVGLS, but not conventional echocardiographic variables, showed an increase in cardiac systolic function at the acute phase of HDST.
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Affiliation(s)
- Emrah Aksakal
- Department of Cardiology, Erzurum Education and Research Hospital, Erzurum, Turkey
| | - Ziya Simsek
- Department of Cardiology, Kayseri Education and Research Hospital, Kayseri, Turkey
| | - Uğur Aksu
- Department of Cardiology, Erzurum Education and Research Hospital, Erzurum, Turkey
| | - Oguzhan Birdal
- Department of Cardiology, Atatürk University Faculty of Medicine, Erzurum, Turkey
| | - Esma Selva Ateş
- Department of Cardiology, Atatürk University Faculty of Medicine, Erzurum, Turkey
| | - Kamuran Kalkan
- Department of Cardiology, Erzurum Education and Research Hospital, Erzurum, Turkey
| | - Oktay Gulcu
- Department of Cardiology, Erzurum Education and Research Hospital, Erzurum, Turkey
| | - Selami Demirelli
- Department of Cardiology, Erzurum Education and Research Hospital, Erzurum, Turkey
| | - Enbiya Aksakal
- Department of Cardiology, Atatürk University Faculty of Medicine, Erzurum, Turkey
| | - Hakan Tas
- Department of Cardiology, Atatürk University Faculty of Medicine, Erzurum, Turkey
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Abstract
PURPOSE OF REVIEW Sepsis and septic shock are prevalent conditions that are likely to increase in prevalence in the future. Given the high mortality and morbidity associated with sepsis and sepsis-induced cardiac dysfunction, we must continue to make advances in knowledge of the complex physiologic interactions and how we may target specific mediators for potential therapeutic options in the future. RECENT FINDINGS Multiple biomarkers have been discovered, which when assayed in sepsis-induced cardiomyopathy predict morbidity and mortality. With increased sensitivity of echocardiography, we can diagnose subclinical cardiac dysfunction, which may have future implications for slowing or preventing progressive dysfunction. SUMMARY Sepsis-induced cardiomyopathy is the result of complicated interactions between the pathogen, the body's response to infection, and iatrogenic injury. Interplay between inflammatory, metabolic, and adrenergic systems results in direct and indirect myocardial injury leading to decreases in both systolic and diastolic cardiac function. As the interactions are further elucidated with additional research into other proteins and mediators, new treatment options can be researched. VIDEO ABSTRACT.
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Iannaccone A, Bruno G, Ravera A, Gay F, Salvini M, Bringhen S, Sabia L, Avenatti E, Veglio F, Milan A. Evaluation of Cardiovascular Toxicity Associated with Treatments Containing Proteasome Inhibitors in Multiple Myeloma Therapy. High Blood Press Cardiovasc Prev 2018; 25:209-218. [PMID: 29582365 DOI: 10.1007/s40292-018-0256-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Accepted: 03/19/2018] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Recently new treatment options have substantially increased survival for patients with relapsed and/or refractory multiple myeloma (RRMM). Among these, proteasome inhibitors (PI), such as bortezomib and carfilzomib, offer high response rate and prolonged survival. These agents are generally well tolerated but demonstrated a significant cardiovascular toxicity, mostly for regimen containing carfilzomib. AIM To assess the cardiovascular damage in patients treated with PI for RRMM. METHODS 28 consecutive subjects treated with PI for RRMM were evaluated and compared with a population of 22 control (Con) subjects, matched for age, sex and mean 24 h blood pressure (24hMBP). All individuals underwent trans-thoracic echocardiography, ambulatory blood pressure monitoring and pulse wave velocity (PVW) study. RESULTS PI patients did not have significant differences in blood pressure load and PWV compared to controls. Among echocardiographic parameters, the global longitudinal strain (GLS) was significantly decreased in PI subjects (p = 0.02). The GLS was significantly lower also considering only patients treated with carfilzomib. Moreover, among carfilzomib patients, we found increase values of left ventricle mass indexed by BSA (LVMi; p = 0.047). After correction for age, sex, BSA, 24hMBP and morphological and functional parameters of LV, treatment with PI and carfilzomib were significantly associated with GLS (p = 0.01; p = 0.036, respectively). CONCLUSIONS PI treatment is associated with subclinical LV dysfunction in patients with RRMM compared to controls, as demonstrated by lower GLS values. These results are confirmed also considering patients treated with carfilzomib. Moreover, in this subgroup of patients, the LVMi is also increased, suggesting higher cardiotoxicity with this treatment.
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Affiliation(s)
- Andrea Iannaccone
- Hypertension Unit, Division of Internal Medicine, Department of Medical Sciences, University Hospital "Città della Salute e della Scienza", University of Torino, Turin, Italy.
| | - G Bruno
- Hypertension Unit, Division of Internal Medicine, Department of Medical Sciences, University Hospital "Città della Salute e della Scienza", University of Torino, Turin, Italy
| | - A Ravera
- Hypertension Unit, Division of Internal Medicine, Department of Medical Sciences, University Hospital "Città della Salute e della Scienza", University of Torino, Turin, Italy
| | - F Gay
- Myeloma Unit, Division of Hematology, Department of Molecular Biotechnology and Health Sciences, University Hospital 'Città della Salute e della Scienza di Torino', University of Torino, Turin, Italy
| | - M Salvini
- Myeloma Unit, Division of Hematology, Department of Molecular Biotechnology and Health Sciences, University Hospital 'Città della Salute e della Scienza di Torino', University of Torino, Turin, Italy
| | - S Bringhen
- Myeloma Unit, Division of Hematology, Department of Molecular Biotechnology and Health Sciences, University Hospital 'Città della Salute e della Scienza di Torino', University of Torino, Turin, Italy
| | - L Sabia
- Hypertension Unit, Division of Internal Medicine, Department of Medical Sciences, University Hospital "Città della Salute e della Scienza", University of Torino, Turin, Italy
| | - E Avenatti
- Hypertension Unit, Division of Internal Medicine, Department of Medical Sciences, University Hospital "Città della Salute e della Scienza", University of Torino, Turin, Italy
| | - F Veglio
- Hypertension Unit, Division of Internal Medicine, Department of Medical Sciences, University Hospital "Città della Salute e della Scienza", University of Torino, Turin, Italy
| | - A Milan
- Hypertension Unit, Division of Internal Medicine, Department of Medical Sciences, University Hospital "Città della Salute e della Scienza", University of Torino, Turin, Italy
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Nafati C, Gardette M, Leone M, Reydellet L, Blasco V, Lannelongue A, Sayagh F, Wiramus S, Antonini F, Albanèse J, Zieleskiewicz L. Use of speckle-tracking strain in preload-dependent patients, need for cautious interpretation! Ann Intensive Care 2018; 8:29. [PMID: 29468335 PMCID: PMC5821613 DOI: 10.1186/s13613-018-0376-8] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Accepted: 02/16/2018] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND In critical patients, left ventricular ejection fraction and fractional shortening are used to reflect left ventricular systolic function. An emerging technique, two-dimensional-strain echocardiography, allows assessment of the left ventricle systolic longitudinal deformation (global longitudinal strain) and the speed at which this deformation occurs (systolic strain rate). This technique is of increasing use in critical patients in intensive care units and in the peri-operative period where preload constantly varies. Our objective, in this prospective single-center observational study, was to evaluate the effect of fluid resuscitation on two-dimensional-strain echocardiography measurements in preload-dependent critically ill patients. We included 49 patients with preload dependence attested by an increase of at least 10% in the left ventricular outflow track velocity-time integral measured by echocardiography during a passive leg raising maneuver. Echocardiography was performed before fluid resuscitation (echocardiography 1) and after preload independency achievement (echocardiography 2). RESULTS Two-dimensional-strain echocardiography was feasible in 40 (82%) among the 49 patients. With preload dependence correction, the absolute value of global longitudinal strain and systolic strain rate was significantly increased from, respectively, - 13.3 ± 3.5 to - 18.4% ± 4.5 (p < 0.01) and - 1.11 s-1 ± 0.29 to - 1.55 s-1 ± 0.55 (p < 0.001). The fluid resuscitation affects GLS and SSR in preload-dependent patients, with a shift, for GLS, from pathological to normal values. CONCLUSION In critically ill patients, the assessment of the systolic function by two-dimensional-strain echocardiography needs prior evaluation of preload dependency, in order to adequately interpret this variable. Future studies should assess the ability of global longitudinal strain to guide fluid management in the critically ill patients.
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Affiliation(s)
- C Nafati
- Department of Anesthesia and Intensive Care Medicine, University Hospital of Marseille, la Timone Hospital, Marseille, France. .,Service d'anesthésie et de réanimation, CHU de la Timone, 264 rue Saint Pierre, 13005, Marseille, France.
| | - M Gardette
- Department of Anesthesia and Intensive Care Medicine, University Hospital of Marseille, la Timone Hospital, Marseille, France
| | - M Leone
- Department of Anaesthesia and Intensive Care Medicine, University Hospital of Marseille, North Hospital, Marseille, France.,Centre d'Investigation Clinique, Aix-Marseille University, AP-HM, 14901, Marseille, France
| | - L Reydellet
- Department of Anesthesia and Intensive Care Medicine, University Hospital of Marseille, la Timone Hospital, Marseille, France
| | - V Blasco
- Department of Anesthesia and Intensive Care Medicine, University Hospital of Marseille, la Timone Hospital, Marseille, France
| | - A Lannelongue
- Department of Anesthesia and Intensive Care Medicine, University Hospital of Marseille, la Timone Hospital, Marseille, France
| | - F Sayagh
- Department of Anesthesia and Intensive Care Medicine, University Hospital of Marseille, la Timone Hospital, Marseille, France
| | - S Wiramus
- Department of Anesthesia and Intensive Care Medicine, University Hospital of Marseille, la Timone Hospital, Marseille, France
| | - F Antonini
- Department of Anaesthesia and Intensive Care Medicine, University Hospital of Marseille, North Hospital, Marseille, France
| | - J Albanèse
- Department of Anesthesia and Intensive Care Medicine, University Hospital of Marseille, la Timone Hospital, Marseille, France
| | - L Zieleskiewicz
- Department of Anaesthesia and Intensive Care Medicine, University Hospital of Marseille, North Hospital, Marseille, France
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Salehi M, Saberi K, Rahmanian M, Bakhshandeh AR, Sharifi S. Assessment of limited chest x-ray technique in postcardiac surgery management. Ann Card Anaesth 2017; 20:38-41. [PMID: 28074793 PMCID: PMC5290692 DOI: 10.4103/0971-9784.197829] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objectives: The objective of this study is to investigate the safety of elimination of chest radiography in the postcardiac surgery Intensive Care Unit (ICU). Methods and Design: We compared patients in two different groups of routine CXR (RCXR) and limited CXR (LCXR) and their diagnostic and therapeutic outcome in a University hospital-based single center from 2014 to 2016. 3 CXR in the RCXR group and 1 CXR in the limited group was performed, in addition to on-demand criteria. Measurement and Main Results: A total of 978 samples were acceptable for analysis which 55.21% of RCXR and 59.50% of LCXR were male patients. In total, 523 abnormalities in RCXR group and 154 occasions in LCXR group resulted in 26.73% diagnostic efficacy for RCXRs and 28.57% for LCXR. From 1956 CXR that was taken in RCXR group, 72 occasions required intervention (3.68%) and 84 cases out of 539 (15.58%) LCXR needed an action to therapy. This means a 14.40% in RCXRs’ abnormalities and 56.00% of LCXRs’ abnormalities were accompanied with some interventions. Conclusions: Abolishing routine CXR in the ICUs would not be harmful for the patients, and it can be managed based on their clinical status and other safer imaging techniques.
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Affiliation(s)
- Mehrdad Salehi
- Department of Cardiac Surgery, Imam Khomeini Medical and Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Kianoush Saberi
- Department of Anesthesiology, Imam Khomeini Medical and Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehrzad Rahmanian
- Department of Cardiac Surgery, Imam Khomeini Medical and Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Reza Bakhshandeh
- Department of Cardiac Surgery, Imam Khomeini Medical and Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Shahnaz Sharifi
- Nursery Faculty, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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