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Ahmed SS, Yousuf MS, Samad K, Ullah H, Siddiqui KM. Factors influencing the use of postoperative bilevel positive airway pressure (BiPAP) in patients undergoing adult cardiac surgery: A retrospective cohort study. Health Sci Rep 2022; 5:e873. [PMID: 36210872 PMCID: PMC9528758 DOI: 10.1002/hsr2.873] [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: 04/13/2022] [Revised: 09/15/2022] [Accepted: 09/19/2022] [Indexed: 11/06/2022] Open
Abstract
BAckground and Aims Respiratory complications are one of the biggest challenges following cardiac surgery, which can lead to hypoxia and acute respiratory failure (ARF). The aim of this study to identify the factors led to BiPAP application for postoperative respiratory complications and its effectiveness as the main outcome measures after cardiac surgery. Methods It was a retrospective cohort study with consecutive sampling technique. A total of 335 postcardiac surgery patients medical record was reviewed who were underwent for surgery from November 1, 2018 to November 30, 2019. 265 patients were finalized for the recruitment, five patients were excluded before the final analysis. Data of 260 patients were analyzed for compiling of results. Results The mean age was 59 years. 196 (75.4%) patients were males and females were 64 (24.6%). Mean weight was 72 kg and mean body mass index (BMI) 26.67 kg/m2. BiPAP application was in 38 (14.6%) patients and significantly high in with high BMI, (p < 0.05). There are significant associations of BiPAP application patients with COPD (p < 0.05). Patients with positive fluid balance, cardiac dysfunction, and required inotropic support were significantly associated with BiPAP need (p < 0.05), respectively. Conclusion BiPAP is effective to treat ARF and other respiratory complications after adult cardiac surgeries. High BMI, atelectasis, and pneumonia are also the independent factors causing ARF. BiPAP can be a successful tool for preventing the adverse effects of postoperative pulmonary complications after cardiac surgery.
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Affiliation(s)
- Syed S. Ahmed
- Department of AnaesthesiologyAga Khan UniversityKarachiPakistan
| | | | - Khalid Samad
- Department of AnaesthesiologyAga Khan UniversityKarachiPakistan
| | - Hameed Ullah
- Department of AnaesthesiologyAga Khan UniversityKarachiPakistan
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2
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Landoni G, Likhvantsev V, Kuzovlev A, Cabrini L. Perioperative Noninvasive Ventilation After Adult or Pediatric Surgery: A Comprehensive Review. J Cardiothorac Vasc Anesth 2021; 36:785-793. [PMID: 33893015 DOI: 10.1053/j.jvca.2021.03.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 03/12/2021] [Accepted: 03/14/2021] [Indexed: 11/11/2022]
Abstract
Postoperative pulmonary complications and acute respiratory failure are among the leading causes of adverse postoperative outcomes. Noninvasive ventilation may safely and effectively prevent acute respiratory failure in high-risk patients after cardiothoracic surgery and after abdominal surgery. Moreover, noninvasive ventilation can be used to treat postoperative hypoxemia, particularly after abdominal surgery. Noninvasive ventilation also can be helpful to prevent or manage intraoperative acute respiratory failure during non-general anesthesia, primarily in patients with poor respiratory function. Finally, noninvasive ventilation is superior to standard preoxygenation in delaying desaturation during intubation in morbidly obese and in critically ill hypoxemic patients. The few available studies in children suggest that noninvasive ventilation could be safe and valuable in treating hypoxemic or hypercapnic acute respiratory failure after cardiac surgery; on the other hand, it could be dangerous after tracheoesophageal correction.
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Affiliation(s)
- Giovanni Landoni
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy; Faculty of Medicine, Vita Salute San Raffaele University, Milan, Italy.
| | - Valery Likhvantsev
- Department of Anesthesiology and Intensive Care, First Moscow State Medical University, Moscow, Russia; V. Negovsky Reanimatology Research Institute, Moscow, Russia
| | - Artem Kuzovlev
- V. Negovsky Reanimatology Research Institute, Moscow, Russia
| | - Luca Cabrini
- Università degli Studi dell'Insubria, Varese, Italy; Ospedale di Circolo e Fondazione Macchi, Varese, ASST-Settelaghi, Varese, Italy
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3
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Shkurka E, Spencer H. Inhaled hypertonic saline after pediatric lung transplant-Caution required? Pediatr Transplant 2020; 24:e13843. [PMID: 33026689 DOI: 10.1111/petr.13843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 07/20/2020] [Accepted: 08/24/2020] [Indexed: 12/01/2022]
Abstract
Management of pulmonary infection following lung transplant is multifaceted and includes respiratory physiotherapy. Inhaled hypertonic saline (HTS) has been introduced as an adjunct to physiotherapy in pediatric transplant patients. There are no published studies investigating the use of HTS in this population. This study aimed to evaluate the effect of inhaled HTS, in the acute post-operative period, in pediatric lung transplant patients. A retrospective case-note review was completed at a single UK pediatric transplant center. An intervention group who received HTS was compared to a historical control group. Participants were frequency matched for age, gender, and diagnosis (14 per group); median age in years was 13.7(IQR 12.7-15.3) in the controls and 14.8(IQR 12.4-16.1) in the intervention group. Primary outcome was the requirement of invasive and non-invasive ventilation. Secondary outcomes included oxygen use and length of stay. Median days of invasive ventilation were shorter in the control group (1, 95% CI 1-1) compared to the intervention group (2, 95% CI 1-2.5) (P < .05). Days of non-invasive ventilation and oxygen were higher in the HTS group, but this was not statistically significant. The controls displayed shorter median length of stay (23 days, 95% CI 20-24) compared to the intervention group (31 days, 95% CI 24.5-39) (P < .05). The results of this small study provide uncertainty regarding the safety of inhaled hypertonic saline after lung transplant. There was a trend of poorer acute outcomes in patients who received HTS. However, the findings should be interpreted with caution and further investigation using larger samples is required.
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Affiliation(s)
- Emma Shkurka
- Department of Physiotherapy, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Helen Spencer
- Department of Cardiothoracic Transplantation, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
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4
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Wu Q, Xiang G, Song J, Xie L, Wu X, Hao S, Wu X, Liu Z, Li S. Effects of non-invasive ventilation in subjects undergoing cardiac surgery on length of hospital stay and cardiac-pulmonary complications: a systematic review and meta-analysis. J Thorac Dis 2020; 12:1507-1519. [PMID: 32395288 PMCID: PMC7212120 DOI: 10.21037/jtd.2020.02.30] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Cardiac surgery often leads to pulmonary complications. Non-invasive ventilation (NIV) is a mechanical ventilation modality that may help to prevent the pulmonary complications, and the role of the prophylactic use of NIV in patients after cardiac surgery remains controversial. Methods We searched PubMed, Embase, Web of Science and Cochrane Central for randomized controlled trials comparing the use of NIV (continues positive airway pressure or bi-level positive airway pressure) with standard treatment in post-cardiac surgery subjects without language restriction. Two investigators screened the eligible studies up to July, 2019. Meta-analysis using random effect model or fixed effect model was conducted for pulmonary complications, mortality, rate of reintubation and cardiac complications, and mean difference (MD) or standard mean difference for length of hospital stay and length of ICU stay. Results We included nine randomized controlled trails with 830 subjects. The use of NIV failed to reduce the risk of pulmonary complications, including atelectasis [risk rate (RR) 0.60; 95% confidence interval (CI): 0.28 to 1.28, P=0.19] and pneumonia (RR 0.27; 95% CI: 0.05 to 1.64, P=0.16). However, it has shortened the length of ICU stay (MD -1.00 h, 95% CI: -1.38 to -0.63, P<0.00001) and the length of hospital stay (MD -1.00 d, 95% CI: -1.12 to -0.87, P<0.00001). NIV also failed to reduce the rate of reintubation (RR 0.68; 95% CI: 0.21 to 2.26, P=0.53) or the risk of cardiac complications (RR 0.81; 95% CI: 0.59 to 1.13, P=0.22). Conclusions The prophylactic use of NIV immediately in post-cardiac subjects who underwent cardiac surgery might be able to shorten the length of hospital stay and the length of ICU stay, but it has no significant effect on pulmonary complications, rate of reintubation or cardiac complications.
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Affiliation(s)
- Qinhan Wu
- Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Guiling Xiang
- Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Jieqiong Song
- Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Liang Xie
- Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Xu Wu
- Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Shengyu Hao
- Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Xiaodan Wu
- Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Zilong Liu
- Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Shanqun Li
- Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai 200032, China
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Ponomarev D, Kamenskaya O, Klinkova A, Loginova I, Vedernikov P, Kornilov I, Shmyrev V, Lomivorotov V, Chernavskiy A, Karaskov A. Chronic Lung Disease and Mortality after Cardiac Surgery: A Prospective Cohort Study. J Cardiothorac Vasc Anesth 2018; 32:2241-2245. [DOI: 10.1053/j.jvca.2017.12.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Indexed: 11/11/2022]
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Nigro Neto C, Costa EDD, Bezerra FJL, Ruy MSG, Saurith JLI, Viesi JHZ. Inhalational anesthesia maintenance with the Janus facial mask for transcatheter aortic-valve replacement: a case series. BRAZILIAN JOURNAL OF ANESTHESIOLOGY (ENGLISH EDITION) 2018. [PMID: 29941196 PMCID: PMC9391787 DOI: 10.1016/j.bjane.2018.01.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Background and objectives Aortic stenosis is the most common type of heart valve disease. Percutaneous aortic valve replacement has become the alternative for patients considered at high risk for surgery. Controlled mechanical ventilation with tracheal intubation has been the choice for this type of procedure, however the use of noninvasive ventilation in cardiac patients has shown to be beneficial. Janus is a novel full-face mask that allows application of noninvasive ventilation support during anesthesia. Our main objective was to evaluate the feasibility of transcatheter aortic valve replacement with prolonged transesophageal echocardiographic monitoring under deep inhalational sedation delivered through a new mask for noninvasive ventilation. Methods A case series observational study that included five patients with critical aortic stenosis that underwent inhalational anesthesia with sevoflurane for transcatheter aortic valve replacement in a hybrid room of a teaching hospital. Standard monitors and bispectral index were used, followed by inhalational induction and placement of the Janus mask. Anesthesia was maintained with sevoflurane. Patients were transferred to intensive care unit after the procedure. Complications related to the mask use, transesofageal echocardiography accessibility and respiratory implications to the patients were recorded. Results All procedures were uneventful and no major complications were observed intraoperatively. One patient presented CO2 retention (50 mmHg) and sevoflurane leak around the central opening of the mask, both without clinical significance. Conclusions The use of inhalational anesthesia with the facial mask Janus is a safe and efficient alternative to general anesthesia with tracheal intubation for transcatheter aortic valve replacement and can easily accommodate the use of transesophageal echocardiography intraoperatively.
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Nigro Neto C, Costa EDD, Bezerra FJL, Ruy MSG, Saurith JLI, Viesi JHZ. [Inhalational anesthesia maintenance with the Janus facial mask for transcatheter aortic-valve replacement: a case series]. Rev Bras Anestesiol 2018; 68:437-441. [PMID: 29941196 DOI: 10.1016/j.bjan.2018.01.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2017] [Revised: 01/06/2018] [Accepted: 01/20/2018] [Indexed: 10/28/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Aortic stenosis is the most common type of heart valve disease. Percutaneous aortic valve replacement has become the alternative for patients considered at high risk for surgery. Controlled mechanical ventilation with tracheal intubation has been the choice for this type of procedure, however the use of noninvasive ventilation in cardiac patients has shown to be beneficial. Janus is a novel full-face mask that allows application of noninvasive ventilation support during anesthesia. Our main objective was to evaluate the feasibility of transcatheter aortic valve replacement with prolonged transesophageal echocardiographic monitoring under deep inhalational sedation delivered through a new mask for noninvasive ventilation. METHODS A case series observational study that included five patients with critical aortic stenosis that underwent inhalational anesthesia with sevoflurane for transcatheter aortic valve replacement in a hybrid room of a teaching hospital. Standard monitors and bispectral index were used, followed by inhalational induction and placement of the Janus mask. Anesthesia was maintained with sevoflurane. Patients were transferred to intensive care unit after the procedure. Complications related to the mask use, transesofageal echocardiography accessibility and respiratory implications to the patients were recorded. RESULTS All procedures were uneventful and no major complications were observed intraoperatively. One patient presented CO2 retention (50mmHg) and sevoflurane leak around the central opening of the mask, both without clinical significance. CONCLUSIONS The use of inhalational anesthesia with the facial mask Janus is a safe and efficient alternative to general anesthesia with tracheal intubation for transcatheter aortic valve replacement and can easily accommodate the use of transesophageal echocardiography intraoperatively.
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8
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Li X, Su X, Chen B, Yao H, Yu Y, Leng X, Lu Q, Wang C, Lei J, Ruetzler K, Fernando HC, Gilbert S, Yeung C, Filosso PL, Shen J, Zhu C. Multidisciplinary team approach on a case of bilateral tension pneumothorax. J Thorac Dis 2018; 10:2528-2536. [PMID: 29850161 DOI: 10.21037/jtd.2018.04.81] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Xiaodong Li
- Department of Cardiothoracic Surgery, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Linhai 318000, China
| | - Xiaofen Su
- Department of Respiratory Medicine, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510230, China
| | - Baofu Chen
- Department of Cardiothoracic Surgery, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Linhai 318000, China.,School of Medicine, Shandong University, Jinan 250100, China
| | - Haijun Yao
- Intensive Care Unit, the Sixth People's Hospital of Shanghai Jiao Tong University, Shanghai 200233, China
| | - Yuetian Yu
- Intensive Care Unit, Renji Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200233, China
| | - Xuefeng Leng
- Department of Thoracic Surgery, the Affiliated Hospital of Chengdu University, Chengdu 610081, China
| | - Qiang Lu
- Department of Thoracic Surgery, Tangdu Hospital, the Fourth Military Medical University, Xi'an 710032, China
| | - Chunguang Wang
- Department of Anesthesiology, Baoding First Central Hospital, Baoding 071028, China
| | - Juanjuan Lei
- Department of Rehabilitation, Tangdu Hospital, the Fourth Military Medical University, Xi'an 710032, China
| | - Kurt Ruetzler
- Departments of Outcomes Research and General Anesthesiology, Cleveland Clinic, Main Campus, Cleveland, OH, USA
| | - Hiran C Fernando
- Inova Schar Cancer Institute, Inova Fairfax Medical Campus, Section of Thoracic Surgery, Department of Surgery 3300 Gallows Road, Falls Church, VA, USA
| | - Sebastien Gilbert
- Division of Thoracic Surgery, Department of Surgery, Faculty of Medicine, University of Ottawa, Ottawa, Canada.,Division of Thoracic Surgery, Department of Surgery, The Ottawa Hospital, Ottawa, Canada
| | - Ching Yeung
- Division of Thoracic Surgery, Department of Surgery, Faculty of Medicine, University of Ottawa, Ottawa, Canada.,Division of Thoracic Surgery, Department of Surgery, The Ottawa Hospital, Ottawa, Canada
| | | | - Jianfei Shen
- Department of Cardiothoracic Surgery, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Linhai 318000, China
| | - Chengchu Zhu
- Department of Cardiothoracic Surgery, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Linhai 318000, China
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Rezaei-Nodehi M, Shorofi SA, Bagheri-Nesami M, Ghafari R, Yazdani-Charati J, Darbeheshti M. The effect of pleasant olfactory mental imagery on the incidence and extent of atelectasis in patients after open heart surgery. Complement Ther Med 2017; 36:33-37. [PMID: 29458927 DOI: 10.1016/j.ctim.2017.11.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Revised: 05/10/2017] [Accepted: 11/21/2017] [Indexed: 10/18/2022] Open
Abstract
BACKGROUND AND PURPOSE Atelectasis is the most common pulmonary complication after open heart surgery. This study was intended to examine the effects of pleasant olfactory mental imagery on postoperative atelectasis in patients undergoing open heart surgery. MATERIALS AND METHODS This is a randomized controlled clinical trial. The sample consisted of 80 patients who were randomly assigned to either practice olfactory mental imagery (test group) or receive routine care (control group). A card with the image of roses was given to patients and they were asked to look at the image, visualize the scent of roses in the mind, and then sniff as much as possible, hold their breath for 2s and eventually exhale slowly through the nose. This procedure was consecutively repeated five times. After a fifteen-minute break, patients proceeded to practice olfactory mental imagery with other fruit images (banana, apple, and lemon). The test group executed the olfactory mental imagery for two hours in the morning and two hours in the afternoon on postoperative days 1 and 2. The control group received the routine ICU care. A questionnaire collected information on sociodemographic characteristics and clinical parameters. Chest radiographs were used to diagnose atelectasis, which were evaluated by the hospital radiologist. RESULTS No statistically significant differences were observed between the two groups regarding sociodemographic, medical and surgical information. The incidence of atelectasis in the test group (40%, n=16) was significantly lower than in the control group (67.5%, n=27) on postoperative day 2 (p=0.02). CONCLUSION Our findings suggest that olfactory mental imagery can improve respiratory function and reduce the risk of atelectasis in patients with cardiac surgery.
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Affiliation(s)
- Masoud Rezaei-Nodehi
- Student Research Committee, School of Nursing and Midwifery, Addiction Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Seyed Afshin Shorofi
- Traditional and Complementary Medicine Research Center, Addiction Institute, Mazandaran University of Medical Sciences, Sari, Iran; Adjunct Research Fellow, Flinders University, Adelaide, Australia
| | - Masoumeh Bagheri-Nesami
- Traditional and Complementary Medicine Research Center, Addiction Institute, Mazandaran University of Medical Sciences, Sari, Iran.
| | - Rahman Ghafari
- Department of Cardiac Surgery, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
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Rezaei-Nodehi M, Bagheri-Nesami M, Shorofi SA, Yazdani-Charati J, Ghafari R. Effects of pleasant olfactory mental imagery on the arterial oxygenation in patients with open heart surgery: A randomized controlled trial. Complement Ther Clin Pract 2017; 29:194-200. [PMID: 29122260 DOI: 10.1016/j.ctcp.2017.10.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Revised: 10/06/2017] [Accepted: 10/10/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND AND PURPOSE Arterial hypoxemia is one of the most common respiratory complications following cardiac surgery. This study was intended to examine the effects of pleasant olfactory mental imagery on postoperative hypoxemia in patients undergoing open heart surgery. MATERIALS AND METHODS This is a randomized controlled clinical trial. The sample consisted of 80 patients who were randomly assigned to either practice olfactory mental imagery (experimental group) or receive routine care (control group). A card with the image of roses was given to patients and they were asked to look at the image, visualize the scent of roses in the mind, and then sniff as much as possible, hold their breath for 2 s and eventually exhale slowly through the nose. This procedure was consecutively repeated five times. After a fifteen-minute break, patients proceeded to practice olfactory mental imagery with other fruit images. The experimental group executed the olfactory mental imagery for two hours in the morning and two hours in the afternoon on postoperative days 1 and 2. RESULTS No statistically significant differences were observed between the experimental and control groups regarding sociodemographic characteristics, medical and surgical information. This study also demonstrated that the mean Spao2 was significantly higher in the experimental group (97.400 ± 1.70) than the control group (96.465 ± 1.70) (p = 0.015). CONCLUSION The results of this study suggest that olfactory mental imagery can improve arterial oxygenation in patients with cardiac surgery.
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Affiliation(s)
- Masoud Rezaei-Nodehi
- Student Research Committee, School of Nursing and Midwifery, Mazandaran University of Medical Sciences, Sari, Iran
| | - Masoumeh Bagheri-Nesami
- Traditional and Complementary Medicine Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Seyed Afshin Shorofi
- Traditional and Complementary Medicine Research Center, Mazandaran University of Medical Sciences, Sari, Iran; Flinders University, Adelaide, Australia.
| | | | - Rahman Ghafari
- Department of Cardiac Surgery, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
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11
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de Araújo-Filho AA, de Cerqueira-Neto ML, de Assis Pereira Cacau L, Oliveira GU, Cerqueira TCF, de Santana-Filho VJ. Effect of prophylactic non-invasive mechanical ventilation on functional capacity after heart valve replacement: a clinical trial. Clinics (Sao Paulo) 2017; 72:618-623. [PMID: 29160424 PMCID: PMC5666445 DOI: 10.6061/clinics/2017(10)05] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 05/07/2017] [Accepted: 08/02/2017] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE During cardiac surgery, several factors contribute to the development of postoperative pulmonary complications. Non-invasive ventilation is a promising therapeutic tool for improving the functionality of this type of patient. The aim of this study is to evaluate the functional capacity and length of stay of patients in a nosocomial intensive care unit who underwent prophylactic non-invasive ventilation after heart valve replacement. METHOD The study was a controlled clinical trial, comprising 50 individuals of both sexes who were allocated by randomization into two groups with 25 patients in each group: the control group and experimental group. After surgery, the patients were transferred to the intensive care unit and then participated in standard physical therapy, which was provided to the experimental group after 3 applications of non-invasive ventilation within the first 26 hours after extubation. For non-invasive ventilation, the positive pressure was 10 cm H2O, with a duration of 1 hour. The evaluation was performed on the 7th postoperative day/discharge and included a 6-minute walk test. The intensive care unit and hospitalization times were monitored in both groups. Brazilian Registry of Clinical Trials (REBeC): RBR number 8bxdd3. RESULTS Analysis of the 6-minute walk test showed that the control group walked an average distance of 264.34±76 meters and the experimental group walked an average distance of 334.07±71 meters (p=0.002). The intensive care unit and hospitalization times did not differ between the groups. CONCLUSION Non-invasive ventilation as a therapeutic resource was effective toward improving functionality; however, non-invasive ventilation did not influence the intensive care unit or hospitalization times of the studied cardiac patients.
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Affiliation(s)
- Amaro Afrânio de Araújo-Filho
- Nucleo de Pos Graduacao em Ciencias da Saude, Universidade Federal de Sergipe, Aracaju, SE, BR
- Departamento de Fisioterapia, Universidade Tiradentes - UNIT, Aracaju, SE, BR
| | - Manoel Luiz de Cerqueira-Neto
- Departamento de Fisioterapia, Universidade Federal de Sergipe - UFS, Aracaju, SE, BR
- Departamento de Fisioterapia, Universidade Federal de Sergipe - UFS, Lagarto, SE, BR
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Esquinas AM, Benhamou MO, Glossop AJ, Mina B. Noninvasive Mechanical Ventilation in Acute Ventilatory Failure: Rationale and Current Applications. Sleep Med Clin 2017; 12:597-606. [PMID: 29108614 DOI: 10.1016/j.jsmc.2017.07.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Noninvasive ventilation plays a pivotal role in acute ventilator failure and has been shown, in certain disease processes such as acute exacerbation of chronic obstructive pulmonary disease, to prevent and shorten the duration of invasive mechanical ventilation, reducing the risks and complications associated with it. The application of noninvasive ventilation is relatively simple and well tolerated by patients and in the right setting can change the course of their illness.
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Affiliation(s)
- Antonio M Esquinas
- Intensive Care and Non-invasive Ventilatory Unit, Hospital Morales Meseguer, Avenida Marques Velez, Murcia 30008, Spain.
| | - Maly Oron Benhamou
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Northwell Health, Lenox Hill Hospital, New York, NY 10065, USA
| | - Alastair J Glossop
- Department of Critical Care, Sheffield Teaching Hospitals NHS Foundation Trust, Royal Hallamshire Hospital, Glossop Road, Sheffield S10 2HE, UK
| | - Bushra Mina
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Northwell Health, Lenox Hill Hospital, New York, NY 10065, USA
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13
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Ponomarev D, Kamenskaya O, Klinkova A, Loginova I, Lomivorotov V, Kornilov I, Shmyrev V, Chernavskiy A, Landoni G, Karaskov A. Prevalence and Implications of Abnormal Respiratory Patterns in Cardiac Surgery: A Prospective Cohort Study. J Cardiothorac Vasc Anesth 2016; 31:2010-2016. [PMID: 28242146 DOI: 10.1053/j.jvca.2016.12.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To investigate the prevalence and impact of abnormal respiratory patterns in cardiac surgery patients. DESIGN Prospective cohort study. SETTING Tertiary hospital. PARTICIPANTS Patients scheduled for elective coronary artery bypass graft surgery. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Pulmonary function tests were performed in 454 patients before surgery. Abnormal respiratory patterns were defined as follows: obstructive (forced expiratory volume in 1 s [FEV1]/forced vital capacity [FVC]<0.70), restrictive (FEV1/FVC≥0.70 and FVC<80% of predicted), and mixed (FEV1/FVC<0.70 and both FEV1 and FVC<80% of predicted). Of the 31 patients with a history of chronic obstructive pulmonary disease, no abnormal respiratory pattern was confirmed in 5. Of the 423 patients without a history of lung disease, the authors newly identified 57 obstructive, 46 restrictive, and 4 mixed patterns. Therefore, lung disease was reclassified in 24.7% of cases. Independent predictors of obstructive pattern were age, male sex, history of smoking, and chronic obstructive pulmonary disease. Obstructive lung disease was associated with 16 hours or longer ventilation. A reduced FEV1 was associated with a likelihood of atrial fibrillation (1-L decrement, odds ratio: 1.38, 95% confidence interval: 1.01-to-1.90, p = 0.04) and hospitalization time (regression coefficient: 1.23, 95% confidence interval: 0.54-to-1.91, p<0.001). CONCLUSIONS Abnormal respiratory patterns are common and often underdiagnosed in the cardiac surgery setting. Pulmonary function tests help reveal patients at risk of complications and may provide an opportunity for intervention.
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Affiliation(s)
- Dmitry Ponomarev
- Department of Anesthesia and Intensive Care, Academician EN Meshalkin Novosibirsk State Budget Research Institute of Circulation Pathology, Novosibirsk, Russia.
| | - Oksana Kamenskaya
- Department of Physiology, Academician EN Meshalkin Novosibirsk State Budget Research Institute of Circulation Pathology, Novosibirsk, Russia
| | - Asya Klinkova
- Department of Physiology, Academician EN Meshalkin Novosibirsk State Budget Research Institute of Circulation Pathology, Novosibirsk, Russia
| | - Irina Loginova
- Department of Physiology, Academician EN Meshalkin Novosibirsk State Budget Research Institute of Circulation Pathology, Novosibirsk, Russia
| | - Vladimir Lomivorotov
- Department of Anesthesia and Intensive Care, Academician EN Meshalkin Novosibirsk State Budget Research Institute of Circulation Pathology, Novosibirsk, Russia
| | - Igor Kornilov
- Department of Anesthesia and Intensive Care, Academician EN Meshalkin Novosibirsk State Budget Research Institute of Circulation Pathology, Novosibirsk, Russia
| | - Vladimir Shmyrev
- Department of Anesthesia and Intensive Care, Academician EN Meshalkin Novosibirsk State Budget Research Institute of Circulation Pathology, Novosibirsk, Russia
| | - Aleksander Chernavskiy
- Department of Cardiac Surgery, Academician EN Meshalkin Novosibirsk State Budget Research Institute of Circulation Pathology, Novosibirsk, Russia
| | - Giovanni Landoni
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Aleksander Karaskov
- Department of Cardiac Surgery, Academician EN Meshalkin Novosibirsk State Budget Research Institute of Circulation Pathology, Novosibirsk, Russia
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14
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Tekindur S, Yetim M, Kilickaya O. Timing of Extubation After Cardiac Surgery. J Cardiothorac Vasc Anesth 2016; 32:e35. [PMID: 27554221 DOI: 10.1053/j.jvca.2016.04.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Indexed: 11/11/2022]
Affiliation(s)
- Sukru Tekindur
- Gulhane Military Medical Academy Department of Anesthesiology and Reanimation, Ankara, Turkey
| | | | - Oguz Kilickaya
- Gulhane Military Medical Academy Department of Anesthesiology and Reanimation, Ankara, Turkey
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15
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Olper L, Bignami E, Di Prima AL, Albini S, Nascimbene S, Cabrini L, Landoni G, Alfieri O. Continuous Positive Airway Pressure Versus Oxygen Therapy in the Cardiac Surgical Ward: A Randomized Trial. J Cardiothorac Vasc Anesth 2016; 31:115-121. [PMID: 27771274 DOI: 10.1053/j.jvca.2016.08.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Indexed: 11/11/2022]
Abstract
BACKGROUND Noninvasive ventilation (NIV) is a common technique to manage patients with acute respiratory failure in the intensive care unit. However, use of NIV in general wards is less well described. The authors' aim was to demonstrate efficacy of NIV, applied in a cardiac surgery ward, in improving oxygenation in patients who developed hypoxemic acute respiratory failure after being discharged from the intensive care unit. DESIGN Randomized, open-label trial. SETTING University hospital. PARTICIPANTS Sixty-four patients with hypoxemia (PaO2/FIO2 ratio between 100 and 250) admitted to the main ward after cardiac surgery. INTERVENTIONS Patients were randomized to receive standard treatment (oxygen, early mobilization, a program of breathing exercises and diuretics) or continuous positive airway pressure in addition to standard treatment. Continuous positive airway pressure was administered 3 times a day for 2 consecutive days. Every cycle lasted 1 to 3 hours. All patients completed their 1-year follow-up. Data were analyzed according to the intention-to-treat principle. MEASUREMENTS AND MAIN RESULTS The primary endpoint was the number of patients with PaO2/FIO2<200 48 hours after randomization. Continuous positive airway pressure use was associated with a statistically significant reduction in the number of patients with PaO2/FIO2<200 (4/33 [12%] v 14/31 [45%], p = 0.003). One patient in the control group died at the 30-day follow-up. CONCLUSIONS Among patients with acute respiratory failure following cardiac surgery, administration of continuous positive airway pressure in the main ward was associated with improved respiratory outcome. This was the first study that was performed in the main ward of post-surgical patients with acute respiratory failure.
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Affiliation(s)
- Luigi Olper
- Cardiothoracic and Vascular Department, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Elena Bignami
- Cardiothoracic and Vascular Department, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Ambra L Di Prima
- Cardiothoracic and Vascular Department, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Santina Albini
- Cardiothoracic and Vascular Department, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Simona Nascimbene
- Cardiothoracic and Vascular Department, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Luca Cabrini
- Cardiothoracic and Vascular Department, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giovanni Landoni
- Cardiothoracic and Vascular Department, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy.
| | - Ottavio Alfieri
- Cardiothoracic and Vascular Department, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
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16
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Amin R, Al-Saleh S, Narang I. Domiciliary noninvasive positive airway pressure therapy in children. Pediatr Pulmonol 2016; 51:335-48. [PMID: 26663667 DOI: 10.1002/ppul.23353] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Revised: 11/09/2015] [Accepted: 11/21/2015] [Indexed: 12/28/2022]
Abstract
There has been a dramatic increase in the past few decades in the number of children receiving noninvasive positive airway pressure (PAP) therapy at home. Although PAP therapy was first prescribed for children with obstructive sleep apnea, the indications have rapidly widened to include treatment for central hypoventilation syndromes, neuromuscular and chest wall disorders as well as primary respiratory diseases. Given the rapidly expanding use of PAP therapy in children, pediatric pulmonologists need to be familiar with the indications, technical and safety considerations as well as potential complications and challenges that may arise when caring for children using PAP therapy. This review article covers the definition of PAP therapy, modes, interfaces, devices, indications, contraindications, suggested settings, complications as well as the factors influencing the adherence.
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Affiliation(s)
- Reshma Amin
- Division of Respiratory Medicine, The Hospital for Sick Children, Toronto, Canada.,Department of Paediatrics, University of Toronto, Toronto, Canada.,Department of Child Health and Evaluative Sciences, The Hospital for Sick Children, Toronto, Canada
| | - Suhail Al-Saleh
- Division of Respiratory Medicine, The Hospital for Sick Children, Toronto, Canada.,Department of Paediatrics, University of Toronto, Toronto, Canada.,Department of Physiology and Experimental Medicine, The Hospital for Sick Children, Toronto, Canada
| | - Indra Narang
- Division of Respiratory Medicine, The Hospital for Sick Children, Toronto, Canada.,Department of Paediatrics, University of Toronto, Toronto, Canada.,Department of Physiology and Experimental Medicine, The Hospital for Sick Children, Toronto, Canada
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17
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Sbrana F, Ripoli A, Formichi B. Anesthetic management in atrial fibrillation ablation procedure: Adding non-invasive ventilation to deep sedation. Indian Pacing Electrophysiol J 2016; 15:96-102. [PMID: 26937093 PMCID: PMC4750121 DOI: 10.1016/j.ipej.2015.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Anesthetic management of patients undergoing pulmonary vein isolation for atrial fibrillation has specific requirements. The feasibility of non-invasive ventilation (NIV) added to deep sedation procedure was evaluated. Seventy-two patients who underwent ablation procedure were retrospectively revised, performed with (57%) or without (43%) application of NIV (Respironic® latex-free total face mask connected to Garbin ventilator-Linde Inc.) during deep sedation (Midazolam 0.01–0.02 mg/kg, fentanyl 2.5–5 μg/kg and propofol: bolus dose 1–1.5 mg/kg, maintenance 2–4 mg/kg/h). In the two groups (NIV vs deep sedation), differences were detected in intraprocedural (pH 7.37 ± 0.05 vs 7.32 ± 0.05, p = 0.001; PaO2 117.10 ± 27.25 vs 148.17 ± 45.29, p = 0.004; PaCO2 43.37 ± 6.91 vs 49.33 ± 7.34, p = 0.002) and in percentage variation with respect to basal values (pH −0.52 ± 0.83 vs −1.44 ± 0.87, p = 0.002; PaCO2 7.21 ± 15.55 vs 34.91 ± 25.76, p = 0.001) of arterial blood gas parameters. Two episodes of respiratory complications, treated with application of NIV, were reported in deep sedation procedure. Endotracheal intubation was not necessary in any case. Adverse events related to electrophysiological procedures and recurrence of atrial fibrillation were recorded, respectively, in 36% and 29% of cases. NIV proved to be feasible in this context and maintained better respiratory homeostasis and better arterial blood gas balance when added to deep sedation.
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Affiliation(s)
| | | | - Bruno Formichi
- Fondazione Toscana Gabriele Monasterio, Pisa, Italy; National Research Council, Institute of Clinical Physiology, Pisa, Italy
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18
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Badenes R, Lozano A, Belda FJ. Postoperative pulmonary dysfunction and mechanical ventilation in cardiac surgery. Crit Care Res Pract 2015; 2015:420513. [PMID: 25705516 PMCID: PMC4332756 DOI: 10.1155/2015/420513] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Revised: 01/15/2015] [Accepted: 01/17/2015] [Indexed: 12/19/2022] Open
Abstract
Postoperative pulmonary dysfunction (PPD) is a frequent and significant complication after cardiac surgery. It contributes to morbidity and mortality and increases hospitalization stay and its associated costs. Its pathogenesis is not clear but it seems to be related to the development of a systemic inflammatory response with a subsequent pulmonary inflammation. Many factors have been described to contribute to this inflammatory response, including surgical procedure with sternotomy incision, effects of general anesthesia, topical cooling, and extracorporeal circulation (ECC) and mechanical ventilation (VM). Protective ventilation strategies can reduce the incidence of atelectasis (which still remains one of the principal causes of PDD) and pulmonary infections in surgical patients. In this way, the open lung approach (OLA), a protective ventilation strategy, has demonstrated attenuating the inflammatory response and improving gas exchange parameters and postoperative pulmonary functions with a better residual functional capacity (FRC) when compared with a conventional ventilatory strategy. Additionally, maintaining low frequency ventilation during ECC was shown to decrease the incidence of PDD after cardiac surgery, preserving lung function.
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Affiliation(s)
- Rafael Badenes
- Department of Anesthesiology and Surgical Intensive Care, Hospital Clinic Universitari de Valencia, University of Valencia, 46010 Valencia, Spain
| | - Angels Lozano
- Department of Anesthesiology and Surgical Intensive Care, Hospital Clinic Universitari de Valencia, University of Valencia, 46010 Valencia, Spain
| | - F. Javier Belda
- Department of Anesthesiology and Surgical Intensive Care, Hospital Clinic Universitari de Valencia, University of Valencia, 46010 Valencia, Spain
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19
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Preventive and therapeutic noninvasive ventilation in cardiovascular surgery. Curr Opin Anaesthesiol 2015; 28:67-72. [DOI: 10.1097/aco.0000000000000148] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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20
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Cabrini L, Nobile L, Plumari V, Landoni G, Borghi G, Mucchetti M, Zangrillo A. Intraoperative prophylactic and therapeutic non-invasive ventilation: a systematic review. Br J Anaesth 2014; 112:638-47. [DOI: 10.1093/bja/aet465] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
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21
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Sbrana F, Ripoli A, Formichi B. Safety and utility of noninvasive ventilation during deep sedation for catheter ablation of atrial fibrillation. J Cardiothorac Vasc Anesth 2013; 28:e6-e8. [PMID: 24295722 DOI: 10.1053/j.jvca.2013.09.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2013] [Indexed: 11/11/2022]
Affiliation(s)
| | | | - Bruno Formichi
- Fondazione Toscana Gabriele Monasterio and National Research Council, Institute of Clinical Physiology, Pisa, Italy
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22
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Guarracino F, Cabrini L, Ferro B, Landoni G, Lembo R, Mucchetti M, Bocchino S, Zangrillo A, Ambrosino N. Noninvasive Ventilation Practice in Cardiac Surgery Patients: Insights From a European Survey. J Cardiothorac Vasc Anesth 2013; 27:e63-5. [DOI: 10.1053/j.jvca.2013.04.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2012] [Indexed: 11/11/2022]
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