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Saxena R, Agrawal T, Saxen R, Pathak M, Nayak S, Jadhav AS, Rathod KJ, Sinha A. Relationship between preoperative nutritional status assessed using anthropometric measures and postoperative complications in pediatric surgical patients. Pediatr Surg Int 2024; 40:156. [PMID: 38871828 DOI: 10.1007/s00383-024-05736-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/02/2024] [Indexed: 06/15/2024]
Abstract
AIM To determine the relationship between preoperative nutritional status assessed using anthropometric measures and postoperative complications in pediatric surgical patients. METHODOLOGY This prospective observational cohort study included 650 patients from 6 months to 18 years undergoing elective surgery at our institution. Elective surgery included procedures such as herniotomy, orchidopexy, urethroplasty, cystoscopy, PUV fulguration, pyeloplasty, ureteric reimplantation, stoma formation/closure, anorectoplasty, pull-through, choledochal cyst excision and repair, VP shunt insertion, lipomyelomeningocele repair, diastematomyelia excision and repair, and cyst excision. Nutritional status was standardized using Z scores for weight, length, and BMI. Patients were monitored for a month following surgery to detect any complications, and they were classified into five grades using the Clavien-Dindo classification. The duration of hospital stays and readmission within 30 days following discharge were secondary outcomes. RESULTS There were 627 patients of both sexes involved in the study: 350 patients aged 6 months to 5 years (Group A), while 277 were aged between 5 and 18 years (Group B). Wasting status was 47.71% in Group A and 41.52% in Group B. In Group A, 40% of patients were stunted, while 83.75% were in Group B. Group A had 57.14% underweight patients. The complication rate was 39.14% in Group A and 38.99% in Group B. The incidence of postoperative complications was not significantly different in malnourished patients. The patients with prolonged duration of surgery (> 2 h) developed more complications in both groups (Group A-67.2%, Group B-82.6%; p < 0.0001). In addition, the patients who experienced complications had lengthier hospital stays (p < 0.001 in both groups) and increased readmission rates (p = 0.016 in Group A and p = 0.008 in Group B). CONCLUSION In our study, half of the patients in Group A and nearly two-third in Group B were malnourished. The preoperative poor nutritional status based on anthropometric parameters is not associated with increased postoperative complications. Randomized control trials linking preoperative malnutrition based on anthropometric measures and clinical outcomes in pediatric surgery patients are necessary to provide more robust information on this subject.
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Affiliation(s)
- Rahul Saxena
- Paediatric Surgery, All India Institute of Medical Sciences, Jodhpur, 342001, Rajasthan, India.
| | - Tripti Agrawal
- Paediatric Surgery, All India Institute of Medical Sciences, Jodhpur, 342001, Rajasthan, India
| | - Rahul Saxen
- Paediatric Surgery, All India Institute of Medical Sciences, Jodhpur, 342001, Rajasthan, India
| | - Manish Pathak
- Paediatric Surgery, All India Institute of Medical Sciences, Jodhpur, 342001, Rajasthan, India
| | - Shubhalaxmi Nayak
- Paediatric Surgery, All India Institute of Medical Sciences, Jodhpur, 342001, Rajasthan, India
| | - Avinash Sukdev Jadhav
- Paediatric Surgery, All India Institute of Medical Sciences, Jodhpur, 342001, Rajasthan, India
| | - Kirtikumar J Rathod
- Paediatric Surgery, All India Institute of Medical Sciences, Jodhpur, 342001, Rajasthan, India
| | - Arvind Sinha
- Paediatric Surgery, All India Institute of Medical Sciences, Jodhpur, 342001, Rajasthan, India
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Le Gac G, Mansour A, Labory M, Flecher E, Chabanne C, Ecoffey C, Beloeil H, Nesseler N. Patient-reported outcomes: validation of the French Quality of Recovery-15 score in cardiac surgery. Br J Anaesth 2024:S0007-0912(24)00280-0. [PMID: 38834488 DOI: 10.1016/j.bja.2024.04.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 04/22/2024] [Accepted: 04/24/2024] [Indexed: 06/06/2024] Open
Affiliation(s)
- Grégoire Le Gac
- Department of Anesthesia and Critical Care, Pontchaillou, University Hospital of Rennes, Rennes, France; INSERM, Univ Rennes, CHU Rennes, Department of Anesthesia and Critical Care, CLCC Eugène Marquis, COSS (Chemistry Oncogenesis Stress Signaling) - UMR_S 1242, Rennes, France; University of Rennes, CHU Rennes, Inserm, CIC 1414 (Centre d'Investigation Clinique de Rennes), Rennes, France.
| | - Alexandre Mansour
- Department of Anesthesia and Critical Care, Pontchaillou, University Hospital of Rennes, Rennes, France; University of Rennes, CHU Rennes, Inserm, CIC 1414 (Centre d'Investigation Clinique de Rennes), Rennes, France; University of Rennes, CHU de Rennes, Inserm, IRSET, UMR_S 1085, Rennes, France
| | - Martin Labory
- Department of Anesthesia and Critical Care, Pontchaillou, University Hospital of Rennes, Rennes, France
| | - Erwan Flecher
- Department of Thoracic and Cardiovascular Surgery, Pontchaillou, University Hospital of Rennes, Rennes, France; University of Rennes, CHU de Rennes, Inserm, LTSI, U1099, Rennes, France
| | - Céline Chabanne
- Department of Thoracic and Cardiovascular Surgery, Pontchaillou, University Hospital of Rennes, Rennes, France
| | - Claude Ecoffey
- Department of Anesthesia and Critical Care, Pontchaillou, University Hospital of Rennes, Rennes, France
| | - Hélène Beloeil
- Department of Anesthesia and Critical Care, Pontchaillou, University Hospital of Rennes, Rennes, France; INSERM, Univ Rennes, CHU Rennes, Department of Anesthesia and Critical Care, CLCC Eugène Marquis, COSS (Chemistry Oncogenesis Stress Signaling) - UMR_S 1242, Rennes, France; University of Rennes, CHU Rennes, Inserm, CIC 1414 (Centre d'Investigation Clinique de Rennes), Rennes, France
| | - Nicolas Nesseler
- Department of Anesthesia and Critical Care, Pontchaillou, University Hospital of Rennes, Rennes, France; University of Rennes, CHU Rennes, Inserm, CIC 1414 (Centre d'Investigation Clinique de Rennes), Rennes, France; University of Rennes, CHU de Rennes, Inra, Inserm, Institut NUMECAN - UMR_A 1341, UMR_S 1241, Rennes, France
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Feng Z, Cao X, Zhao C, Niu J, Yan Y, Shi T, Hao J, Zheng X. Serum CIRP increases the risk of acute kidney injury after cardiac surgery. Front Med (Lausanne) 2024; 10:1258622. [PMID: 38235271 PMCID: PMC10791772 DOI: 10.3389/fmed.2023.1258622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 11/20/2023] [Indexed: 01/19/2024] Open
Abstract
Introduction Acute kidney injury (AKI) is a frequent perioperative complication. The underlying mechanisms of cardiac surgery-associated AKI are still not completely elucidated. Cold-induced RNA-binding protein (CIRP) has been subsequently found to be regulated by various stress conditions. During cardiac surgery and cardiopulmonary bypass (CPB), the host is subjected to hypothermia and inadequate organ perfusion, resulting in an upregulation of CIRP secretion. The aim of this study is to evaluate the role of elevated extracellular CIRP level as a contributing factor in the development of AKI. Methods A total of 292 patients who underwent cardiac surgery were retrospectively enrolled and their serum samples were collected preoperative and postoperative. Demographic data, intraoperative data, in-hospital outcomes, and the occurrence of AKI were also collected for the patients. The correlation between CIRP and intraoperative procedures, as well as its association with postoperative outcomes were analyzed. Results In multivariable analysis, higher ΔCIRP (p = 0.036) and body mass index (p = 0.015) were independent risk factors for postoperative AKI. Meanwhile, patients with postoperative AKI exhibited lower survival rate in 2-year follow-up (p = 0.008). Compared to off-pump coronary artery bypass grafting surgery, patients who underwent on-pump coronary artery bypass grafting, valve surgery, aortic dissection and other surgery showed higher ΔCIRP, measuring 1,093, 666, 914 and 258 pg/mL, respectively (p < 0.001). The levels of ΔCIRP were significantly higher in patients who underwent CPB compared to those who did not (793.0 ± 648.7 vs. 149.5 ± 289.1 pg/mL, p < 0.001). Correlation analysis revealed a positive correlation between ΔCIRP levels and the duration of CPB (r = 0.502, p < 0.001). Patients with higher CIRP levels are at greater risk of postoperative AKI (OR: 1.67, p = 0.032), especially the stage 2-3 AKI (OR: 2.11, p = 0.037). Conclusion CIRP secretion increases with prolonged CPB time after cardiac surgery, and CIRP secretion is positively correlated with the duration of CPB. Cardiac surgeries with CPB exhibited significantly higher levels of CIRP compared to non-CPB surgeries. Elevation of CIRP level is an independent risk factor for the incidence of AKI, especially the severe AKI, and were associated with adverse in-hospital outcomes.
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Affiliation(s)
| | | | | | | | | | | | | | - Xinglong Zheng
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, Xi'an, Shaanxi, China
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Hadaya J, Verma A, Marzban M, Sanaiha Y, Shemin RJ, Benharash P. Impact of Pulmonary Complications on Outcomes and Resource Use After Elective Cardiac Surgery. Ann Surg 2023; 278:e661-e666. [PMID: 36538628 DOI: 10.1097/sla.0000000000005750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To characterize the impact of pulmonary complications (PCs) on mortality, costs, and readmissions after elective cardiac operations in a national cohort and to test for hospital-level variation in PC. BACKGROUND PC after cardiac surgery are targets for quality improvement efforts. Contemporary studies evaluating the impact of PC on outcomes are lacking, as is data regarding hospital-level variation in the incidence of PC. METHODS Adults undergoing elective coronary artery bypass grafting and/or valve operations were identified in the 2016-2019 Nationwide Readmissions Database. PC was defined as a composite of reintubation, prolonged (>24 hours) ventilation, tracheostomy, or pneumonia. Generalized linear models were fit to evaluate associations between PC and outcomes. Institutional variation in PC was studied using observed-to-expected ratios. RESULTS Of 588,480 patients meeting study criteria, 6.7% developed PC. After risk adjustment, PC was associated with increased odds of mortality (14.6, 95% CI, 12.6-14.8), as well as a 7.9-day (95% CI, 7.6-8.2) increase in length of stay and $41,300 (95% CI, 39,600-42,900) in attributable costs. PC was associated with 1.3-fold greater hazard of readmission and greater incident mortality at readmission (6.7% vs 1.9%, P <0.001). Significant hospital-level variation in PC was present, with observed-to-expected ratios ranging from 0.1 to 7.7. CONCLUSIONS Pulmonary complications remain common after cardiac surgery and are associated with substantially increased mortality and expenditures. Significant hospital-level variation in PC exists in the United States, suggesting the need for systematic quality improvement efforts to reduce PC and their impact on outcomes.
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Affiliation(s)
- Joseph Hadaya
- Division of Cardiac Surgery, Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, Los Angeles, CA
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Cordeiro ALL, Soares LO, Gomes-Neto M, Petto J. Inspiratory Muscle Training in Patients in the Postoperative Phase of Cardiac Surgery: A Systematic Review and Meta-Analysis. Ann Rehabil Med 2023; 47:162-172. [PMID: 37403313 DOI: 10.5535/arm.23022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 05/23/2023] [Indexed: 07/06/2023] Open
Abstract
To review the evidence about inspiratory muscle training (IMT) in patients in postoperative of cardiac surgery. We conducted this systematic review used the databases Ovid, LILACS, CINAHL, PubMed, PEDro, and CENTRAL. Randomized clinical trials that addressed IMT after cardiac surgery were selected. The outcomes assessed were maximum inspiratory pressure (MIP), maximum expiratory pressure (MEP), tidal volume (TV), peak expiratory flow (PEF), functional capacity (6-minute walk test) and length of hospital stay. The mean difference between groups and the respective 95% confidence interval (CI) were calculated and used to quantify the effect of continuous outcomes. Seven studies were selected. The IMT was superior to the control over MIP 15.77 cmH2O (95% CI, 5.95-25.49), MEP 15.87 cmH2O (95% CI, 1.16-30.58), PEF 40.98 L/min (95% CI, 4.64-77.32), TV 184.75 mL (95% CI, 19.72-349.77), hospital stay -1.25 days (95% CI, -1.77 to -0.72), but without impact on functional capacity 29.93 m (95% CI, -27.59 to 87.45). Based on the results presented, IMT was beneficial as a form of treatment for patients after cardiac surgery.
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Affiliation(s)
- André Luiz Lisboa Cordeiro
- Department of Medicine and Human Health, Bahiana School of Medicine and Public Health, Salvador, Brazil
- Department of Physical Therapy, Centro Universitário Nobre, Feira de Santana, Brazil
| | - Lucas Oliveira Soares
- Department of Physical Therapy, Centro Universitário Nobre, Feira de Santana, Brazil
- Physiotherapy Department, Hospital Geral Clériston Andrade, Feira de Santana, Brazil
| | - Mansueto Gomes-Neto
- Department of Physical Therapy, Universidade Federal da Bahia, Salvador, Brazil
| | - Jefferson Petto
- Department of Medicine and Human Health, Bahiana School of Medicine and Public Health, Salvador, Brazil
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Trancart L, Rey N, Scherrer V, Wurtz V, Bauer F, Aludaat C, Demailly Z, Selim J, Compère V, Clavier T, Besnier E. Effect of mechanical ventilation during cardiopulmonary bypass on end-expiratory lung volume in the perioperative period of cardiac surgery: an observational study. J Cardiothorac Surg 2022; 17:331. [PMID: 36550556 PMCID: PMC9784092 DOI: 10.1186/s13019-022-02063-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 12/06/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Many studies explored the impact of ventilation during cardiopulmonary bypass (CPB) period with conflicting results. Functional residual capacity or End Expiratory Lung Volume (EELV) may be disturbed after cardiac surgery but the specific effects of CPB have not been studied. Our objective was to compare the effect of two ventilation strategies during CPB on EELV. METHODS Observational single center study in a tertiary teaching hospital. Adult patients undergoing on-pump cardiac surgery by sternotomy were included. Maintenance of ventilation during CPB was left to the discretion of the medical team, with division between "ventilated" and "non-ventilated" groups afterwards. Iterative intra and postoperative measurements of EELV were carried out by nitrogen washin-washout technique. Main endpoint was EELV at the end of surgery. Secondary endpoints were EELV one hour after ICU admission, PaO2/FiO2 ratio, driving pressure, duration of mechanical ventilation and post-operative pulmonary complications. RESULTS Forty consecutive patients were included, 20 in each group. EELV was not significantly different between the ventilated versus non-ventilated groups at the end of surgery (1796 ± 586 mL vs. 1844 ± 524 mL, p = 1) and one hour after ICU admission (2095 ± 562 vs. 2045 ± 476 mL, p = 1). No significant difference between the two groups was observed on PaO2/FiO2 ratio (end of surgery: 339 ± 149 vs. 304 ± 131, p = 0.8; one hour after ICU: 324 ± 115 vs. 329 ± 124, p = 1), driving pressure (end of surgery: 7 ± 1 vs. 8 ± 1 cmH2O, p = 0.3; one hour after ICU: 9 ± 3 vs. 9 ± 3 cmH2O), duration of mechanical ventilation (5.5 ± 4.8 vs 8.2 ± 10.0 h, p = 0.5), need postoperative respiratory support (2 vs. 1, p = 1), occurrence of pneumopathy (2 vs. 0, p = 0.5) and radiographic atelectasis (7 vs. 8, p = 1). CONCLUSION No significant difference was observed in EELV after cardiac surgery between not ventilated and ventilated patients during CPB.
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Affiliation(s)
- Léa Trancart
- grid.41724.340000 0001 2296 5231Department of Anaesthesiology and Critical Care, CHU Rouen, 76031 Rouen, France
| | - Nathalie Rey
- grid.41724.340000 0001 2296 5231Department of Anaesthesiology and Critical Care, CHU Rouen, 76031 Rouen, France
| | - Vincent Scherrer
- grid.41724.340000 0001 2296 5231Department of Anaesthesiology and Critical Care, CHU Rouen, 76031 Rouen, France
| | - Véronique Wurtz
- grid.41724.340000 0001 2296 5231Department of Anaesthesiology and Critical Care, CHU Rouen, 76031 Rouen, France
| | - Fabrice Bauer
- grid.41724.340000 0001 2296 5231Department of Cardiac Surgery, CHU Rouen, 76031 Rouen, France ,grid.10400.350000 0001 2108 3034Rouen Univ, Inserm U1096, EnVi, 76000 Rouen, France
| | - Chadi Aludaat
- grid.41724.340000 0001 2296 5231Department of Cardiac Surgery, CHU Rouen, 76031 Rouen, France
| | - Zoe Demailly
- grid.41724.340000 0001 2296 5231Department of Anaesthesiology and Critical Care, CHU Rouen, 76031 Rouen, France ,grid.10400.350000 0001 2108 3034Rouen Univ, Inserm U1096, EnVi, 76000 Rouen, France
| | - Jean Selim
- grid.41724.340000 0001 2296 5231Department of Anaesthesiology and Critical Care, CHU Rouen, 76031 Rouen, France ,grid.10400.350000 0001 2108 3034Rouen Univ, Inserm U1096, EnVi, 76000 Rouen, France
| | - Vincent Compère
- grid.41724.340000 0001 2296 5231Department of Anaesthesiology and Critical Care, CHU Rouen, 76031 Rouen, France ,grid.10400.350000 0001 2108 3034Rouen Univ, Inserm U1239, 76000 Rouen, France
| | - Thomas Clavier
- grid.41724.340000 0001 2296 5231Department of Anaesthesiology and Critical Care, CHU Rouen, 76031 Rouen, France ,grid.10400.350000 0001 2108 3034Rouen Univ, Inserm U1096, EnVi, 76000 Rouen, France
| | - Emmanuel Besnier
- grid.41724.340000 0001 2296 5231Department of Anaesthesiology and Critical Care, CHU Rouen, 76031 Rouen, France ,grid.10400.350000 0001 2108 3034Rouen Univ, Inserm U1096, EnVi, 76000 Rouen, France ,grid.417615.0Departement d’Anesthésie-Réanimation, CHU Charles Nicolle, 1 Rue de Germont, 76031 Rouen Cedex, France
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Muacevic A, Adler JR. Outcomes of Surgical and Mechanical Thrombectomy in Massive Saddle Pulmonary Embolism: A National Perspective. Cureus 2022; 14:e29885. [PMID: 36348926 PMCID: PMC9629997 DOI: 10.7759/cureus.29885] [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] [Accepted: 09/25/2022] [Indexed: 11/25/2022] Open
Abstract
Introduction Saddle pulmonary embolism (PE) is a type of central PE that involves the bifurcation of the pulmonary arteries. First-line treatment is usually systemic thrombolytics, but surgical and mechanical thrombectomy (ST and MT) are used for patients with contraindications to thrombolytics or right heart strain. This study compares surgical and mechanical thrombectomy trends and outcomes in patients with saddle PE. Methods The data was extracted from the National In-Patient Sample (NIS) from 2016-2018 using the International Classification of Diseases-10-Clinical Modification (ICD-10-CM) diagnosis codes. We used the Cochrane-Armitage trend test to analyze the trends of ST and MT and the chi-square test for statistical analyses. A two-tailed p-value of <0.05 was considered statistically significant. Results The overall trend of MT in saddle PE rose from 2016 to 2018, while ST remained stable. Around 95% of patients undergoing ST/MT were emergent admissions, with 82.5% occurring in teaching hospitals. Patients of age >65 years and more with comorbidity burdens were more likely to undergo MT over ST. In-hospital mortality after ST was 15.1%, and after MT was 11.1% (p:<0.001). The most common complications after ST were congestive heart failure (CHF) and atrial fibrillation (AF), and after MT were vascular events and CHF. Conclusion The use of mechanical thrombectomy has steadily increased during the study period. ST is more common in large/teaching hospitals, weekend admissions, and patients transferred from other facilities. MT is more common in elderly patients with a higher comorbidity burden. Patients who underwent MT had lower mortality, length of hospital stay, and post-procedural complications.
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Effectiveness of Mild to Moderate Hypothermic Cardiopulmonary Bypass on Early Clinical Outcomes. J Cardiovasc Dev Dis 2022; 9:jcdd9050151. [PMID: 35621862 PMCID: PMC9145413 DOI: 10.3390/jcdd9050151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 04/20/2022] [Accepted: 05/06/2022] [Indexed: 11/24/2022] Open
Abstract
Background: Intraoperative hypothermia is an integral part of cardiopulmonary bypass (CPB), and a precise degree of hypothermia may improve the early clinical outcomes of cardiac surgery. Presently, there is no agreement on an accurate, advantageous temperature range for routine use in CPB. To address this issue, we conducted a retrospective observational study to compare the effects of different hypothermic temperature ranges on primary (inotropic support, blood loss, and platelet count) and secondary (ventilation support and in-hospital stay) outcomes in patients undergoing elective cardiac surgery. Methods: Data were retrieved from the medical database of the Cardiovascular Surgery Department, King Edward Medical University, Lahore-Pakistan (a tertiary care hospital), dating from February 2015 to December 2017. Patients were divided into mild (34 °C to 36 °C), intermediate (31 °C to 33 °C), or moderate (28 °C to 30 °C) hypothermic groups. Results: Out of 275 patients, 245 (89.09%) fit the inclusion criteria. The cohort with mild hypothermic CPB temperatures presented better clinical outcomes in terms of requiring less inotropic support, less blood loss, fewer blood transfusions, improved platelet counts, shorter in-hospital stays, and required less ventilation support, when compared with other hypothermic groups. Conclusions: Mild hypothermic CPB (34 °C to 36 °C) may produce better clinical outcomes for cardiac surgery and improve the quality of health of cardiac patients.
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Chiong XH, Wong ZZ, Lim SM, Ng TY, Ng KT. The use of cerebral oximetry in cardiac surgery: A systematic review and meta-analysis of randomized controlled trials. Ann Card Anaesth 2022; 25:384-398. [PMID: 36254901 PMCID: PMC9732949 DOI: 10.4103/aca.aca_149_21] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
High prevalence of cerebral desaturation is associated with postoperative neurological complications in cardiac surgery. However, the evidence use of cerebral oximetry by correcting cerebral desaturation in the reduction of postoperative complications remains uncertain in the literature. This systematic review and meta-analysis aimed to examine the effect of cerebral oximetry on the incidence of postoperative cognitive dysfunction in cardiac surgery. Databases of MEDLINE, EMBASE, and CENTRAL were searched from their inception until April 2021. All randomized controlled trials comparing cerebral oximetry and blinded/no cerebral oximetry in adult patients undergoing cardiac surgery were included. Observational studies, case series, and case reports were excluded. A total of 14 trials (n = 2,033) were included in this review. Our pooled data demonstrated that patients with cerebral oximetry were associated with a lower incidence of postoperative cognitive dysfunction than the control group (studies = 4, n = 609, odds ratio [OR]: 0.15, 95% confidence interval [CI]: 0.04 to 0.54, P = 0.003, I2 = 88%; certainty of evidence = very low). In terms of postoperative delirium (OR: 0.75, 95%CI: 0.50-1.14, P = 0.18, I2 = 0%; certainty of evidence = low) and postoperative stroke (OR: 0.81 95%CI: 0.37-1.80, P = 0.61, I2 = 0%; certainty of evidence = high), no significant differences (P > 0.05) were reported between the cerebral oximetry and control groups. In this meta-analysis, the use of cerebral oximetry monitoring in cardiac surgery demonstrated a lower incidence of postoperative cognitive dysfunction. However, this finding must be interpreted with caution due to the low level of evidence, high degree of heterogeneity, lack of standardized cognitive assessments, and cerebral desaturation interventions.
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Affiliation(s)
- Xin Hui Chiong
- School of Medicine, University of Aberdeen, United Kingdom
| | - Zhen Zhe Wong
- School of Medicine, International Medical University, Kuala Lumpur, Malaysia
| | - Siu Min Lim
- Department of Anesthesiology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Tyng Yan Ng
- Department of Anesthesiology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Ka Ting Ng
- Department of Anesthesiology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia,Address for correspondence: Dr. Ka Ting Ng, Department of Anesthesiology, Faculty of Medicine, University of Malaya, Kuala Lumpur - 50603, Malaysia. E-mail:
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de Aquino TN, de Faria Rosseto S, Lúcio Vaz J, de Faria Cordeiro Alves C, Vidigal FDC, Galdino G. Evaluation of respiratory and peripheral muscle training in individuals undergoing myocardial revascularization. J Card Surg 2021; 36:3166-3173. [PMID: 34085324 DOI: 10.1111/jocs.15698] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 05/06/2021] [Accepted: 05/11/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To investigate the effect of peripheral muscle strength training (PMT) and respiratory muscle strength training (RMT) muscle strength training associated with conventional physical therapy on the respiratory muscle strength, functional capacity, and quality of life in the immediate postoperative period of patients undergoing coronary artery bypass graft (CABG). METHODS This was a randomized controlled trial. Eighty-three patients undergoing CABG were divided into two groups: Intervention group, patients that received PMT and RMT associated with conventional physical therapy, one session a day for 5 days; control group, patients that received conventional physical therapy, one session a day for 5 days. All patients had respiratory muscle strength, peripheral muscle strength, functional capacity, and quality of life evaluated by manovacuometry, dynamometry, 6-min walking test, and 36-item Short-Form Health Survey Questionnaire, respectively, before and 5 days after CABG. RESULTS Both groups showed a significantly reduced respiratory muscle strength after CABG; however, in the intervention group, the inspiratory muscle strength reduction was lower (confidence interval [CI] 95%: 2.29 [1.9; 27.54]). The quality of live domains for pain (CI 95%: 3.08 [5.21; 24.97]) and vitality perception (CI 95%: 2.51 [2.12; 19.53]) worsened in the control and improved in the intervention group (pain: CI 95%: 1.19 [-3.38; 13.09]; vitality CI 95%: 0.07 [-6.55; 7.04]). Both groups showed reduced functional capacity and expiratory muscle strength after CABG. CONCLUSION Conventional physical therapy combined with PMT and RMT may reduce inspiratory muscle strength loss and improve pain and vitality perception in the immediate postoperative period after CABG.
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Affiliation(s)
- Tarcísio Nema de Aquino
- Department of Motricity Sciences, Federal University of Alfenas, Alfenas, Minas Gerais, Brazil.,Department of Rehabilitation and Cardiology of Hospital Santa Lucia, Poços de Caldas, Minas Gerais, Brazil
| | - Simone de Faria Rosseto
- Department of Motricity Sciences, Federal University of Alfenas, Alfenas, Minas Gerais, Brazil.,Department of Rehabilitation and Cardiology of Hospital Santa Lucia, Poços de Caldas, Minas Gerais, Brazil
| | - Jaqueline Lúcio Vaz
- Department of Motricity Sciences, Federal University of Alfenas, Alfenas, Minas Gerais, Brazil.,Department of Rehabilitation and Cardiology of Hospital Santa Lucia, Poços de Caldas, Minas Gerais, Brazil
| | | | | | - Giovane Galdino
- Department of Motricity Sciences, Federal University of Alfenas, Alfenas, Minas Gerais, Brazil
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Liu Z, Zhang X, Zhai Q. Clinical investigation of nosocomial infections in adult patients after cardiac surgery. Medicine (Baltimore) 2021; 100:e24162. [PMID: 33530207 PMCID: PMC7850681 DOI: 10.1097/md.0000000000024162] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 12/10/2020] [Indexed: 01/05/2023] Open
Abstract
Nosocomial infections (NI) are common complications after cardiac surgery. To date, there have been few manuscripts investigating NI in the intensive care unit after cardiac surgery. Our study was designed to investigate the characteristics of the distribution of pathogenic bacteria, antibiotic resistance and risk factors for NI.A total of 1360 patients received standard postoperative care, including antibiotic prophylaxis. Microbiological examinations of sputum, blood, catheter tips and excrement were performed as clinically indicated to isolate pathogens. Thirty potential associated variables were collected and compared between the 2 different groups according to the development of NI using univariate and multivariate analyses.Eighty-nine patients (6.54%) acquired a microbiologically documented NI. There was a significant difference in mortality between the 2 groups with or without postoperative NI (23.60% vs 2.28%, P < .00). A total of 98 pathogens (73.13%) were isolated from sputum, 32 pathogens (23.88%) from blood and only 1 (0.75%) from urine. Three (2.24%) surgical site infections were detected, including 2 superficial surgical site infections and 1 mediastinitis. The most common pathogens were Gram-negative bacteria (78.36%), followed by Gram-positive bacteria (14.93%) and fungi (6.71%). The major pathogenic species had different levels of drug resistance, and most of them exhibited multidrug resistance. Six out of thirty variables were identified as independent risk factors for the development of NI, namely, duration of surgery, low cardiac output syndrome, continuous veno-venous hemofiltration, mechanical ventilation time, reintubation and tracheostomy.We analyzed the characteristics of the distribution of pathogens, antibiotic resistance and risk factors for NI in our center and provided some suggestions for clinical practice. In addition to antibiotic treatment, avoidance of risk factors and aggressive infection control measures may be crucial to stop or prevent outbreaks.
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Albanesi B, Nania T, Barello S, Villa G, Rosa D, Caruso R, Udugampolage NS, Casole L, Dellafiore F. Lived experience of patients in
ICU
after cardiac surgery: A phenomenological study. Nurs Crit Care 2020; 27:204-213. [DOI: 10.1111/nicc.12562] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 09/21/2020] [Accepted: 09/24/2020] [Indexed: 12/23/2022]
Affiliation(s)
- Beatrice Albanesi
- Department of Medicine and Psychology Sapienza University Rome Italy
| | - Tiziana Nania
- Health Professions Research and Development Unit IRCCS Policlinico San Donato Milan Italy
| | - Serena Barello
- Department of Psychology, EngageMinds Hub Research Center Università Cattolica del Sacro Cuore Milan Italy
| | | | - Debora Rosa
- IRCCS Istituto Auxologico Italiano Milan Italy
| | - Rosario Caruso
- Health Professions Research and Development Unit IRCCS Policlinico San Donato Milan Italy
| | | | - Lorenzo Casole
- Health Professions Research and Development Unit IRCCS Policlinico San Donato Milan Italy
| | - Federica Dellafiore
- Health Professions Research and Development Unit IRCCS Policlinico San Donato Milan Italy
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13
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Robich M, Ryzhov S, Kacer D, Palmeri M, Peterson SM, Quinn RD, Carter D, Sheppard F, Hayes T, Sawyer DB, Rappold J, Prudovsky I, Kramer RS. Prolonged Cardiopulmonary Bypass is Associated With Endothelial Glycocalyx Degradation. J Surg Res 2020; 251:287-295. [PMID: 32199337 DOI: 10.1016/j.jss.2020.02.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 01/23/2020] [Accepted: 02/16/2020] [Indexed: 01/06/2023]
Abstract
BACKGROUND The endothelial glycocalyx (EG) is involved in critical regulatory mechanisms that maintain endothelial vascular integrity. We hypothesized that prolonged cardiopulmonary bypass (CPB) may be associated with EG degradation. We performed an analysis of soluble syndecan-1 levels in relation to duration of CPB, as well as factors associated with cell stress and damage, such as mitochondrial DNA (mtDNA) and inflammation. METHODS Blood samples from subjects undergoing cardiac surgery with CPB (n = 54) were obtained before and during surgery, 4-8 h and 24 h after completion of CPB, and on postoperative day 4. Flow cytometry was used to determine subpopulations of white blood cells. Plasma levels of mtDNA were determined using quantitative polymerase chain reaction and plasma content of shed syndecan-1 was measured. To determine whether syndecan-1 was signaling white blood cells, the effect of recombinant syndecan-1 on mobilization of neutrophils from bone marrow was tested in mice. RESULTS CPB is associated with increased mtDNA during surgery, increased syndecan-1 blood levels at 4-8 h, and increased white blood cell count at 4-8 h and 24 h. Correlation analysis revealed significant positive associations between time on CPB and syndecan-1 (rs = 0.488, P < 0.001) and level of syndecan-1 and neutrophil count (rs = 0.351, P = 0.038) at 4-8 h. Intravenous administration of recombinant syndecan-1 in mice resulted in a 2.5-fold increase in the number of circulating neutrophils, concurrent with decreased bone marrow neutrophil number. CONCLUSIONS Longer duration of CPB is associated with increased plasma levels of soluble syndecan-1, a signal for EG degradation, which can induce neutrophil egress from the bone marrow. Development of therapy targeting EG shedding may be beneficial in patients with prolonged CPB.
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Affiliation(s)
- Michael Robich
- Maine Medical Center Cardiovascular Institute, Portland, Maine; Maine Medical Center Research Institute, Scarborough, Maine
| | - Sergey Ryzhov
- Maine Medical Center Research Institute, Scarborough, Maine
| | - Doreen Kacer
- Maine Medical Center Research Institute, Scarborough, Maine
| | - Monica Palmeri
- Maine Medical Center Cardiovascular Institute, Portland, Maine; Maine Medical Center Research Institute, Scarborough, Maine
| | | | - Reed D Quinn
- Maine Medical Center Cardiovascular Institute, Portland, Maine
| | - Damien Carter
- Maine Medical Center Research Institute, Scarborough, Maine; Maine Medical Center, Department of Surgery, Portland, Maine
| | - Forest Sheppard
- Maine Medical Center, Department of Surgery, Portland, Maine
| | - Timothy Hayes
- Maine Medical Center, Department of Pathology, Portland, Maine
| | - Douglas B Sawyer
- Maine Medical Center Cardiovascular Institute, Portland, Maine; Maine Medical Center Research Institute, Scarborough, Maine
| | - Joseph Rappold
- Maine Medical Center Cardiovascular Institute, Portland, Maine; Maine Medical Center Research Institute, Scarborough, Maine; Maine Medical Center, Department of Surgery, Portland, Maine
| | - Igor Prudovsky
- Maine Medical Center Research Institute, Scarborough, Maine
| | - Robert S Kramer
- Maine Medical Center Cardiovascular Institute, Portland, Maine; Maine Medical Center Research Institute, Scarborough, Maine.
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Effect of a Perioperative Intra-Aortic Balloon Pump in High-Risk Cardiac Surgery Patients: A Randomized Clinical Trial. Crit Care Med 2019; 46:e742-e750. [PMID: 29727370 DOI: 10.1097/ccm.0000000000003185] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVES The aim of this study was to evaluate the efficacy of perioperative intra-aortic balloon pump use in high-risk cardiac surgery patients. DESIGN A single-center randomized controlled trial and a meta-analysis of randomized controlled trials. SETTING Heart Institute of São Paulo University. PATIENTS High-risk patients undergoing elective coronary artery bypass surgery. INTERVENTION Patients were randomized to receive preskin incision intra-aortic balloon pump insertion after anesthesia induction versus no intra-aortic balloon pump use. MEASUREMENTS AND MAIN RESULTS The primary outcome was a composite endpoint of 30-day mortality and major morbidity (cardiogenic shock, stroke, acute renal failure, mediastinitis, prolonged mechanical ventilation, and a need for reoperation). A total of 181 patients (mean [SD] age 65.4 [9.4] yr; 32% female) were randomized. The primary outcome was observed in 43 patients (47.8%) in the intra-aortic balloon pump group and 42 patients (46.2%) in the control group (p = 0.46). The median duration of inotrope use (51 hr [interquartile range, 32-94 hr] vs 39 hr [interquartile range, 25-66 hr]; p = 0.007) and the ICU length of stay (5 d [interquartile range, 3-8 d] vs 4 d [interquartile range, 3-6 d]; p = 0.035) were longer in the intra-aortic balloon pump group than in the control group. A meta-analysis of 11 randomized controlled trials confirmed a lack of survival improvement in high-risk cardiac surgery patients with perioperative intra-aortic balloon pump use. CONCLUSIONS In high-risk patients undergoing cardiac surgery, the perioperative use of an intra-aortic balloon pump did not reduce the occurrence of a composite outcome of 30-day mortality and major complications compared with usual care alone.
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15
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Vesteinsdottir E, Helgason KO, Sverrisson KO, Gudlaugsson O, Karason S. Infections and outcomes after cardiac surgery-The impact of outbreaks traced to transesophageal echocardiography probes. Acta Anaesthesiol Scand 2019; 63:871-878. [PMID: 30888057 PMCID: PMC6619098 DOI: 10.1111/aas.13360] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 02/18/2019] [Indexed: 01/13/2023]
Abstract
Background Infections are a frequent complication of cardiac surgery. The intraoperative use of transesophageal echocardiography (TEE) may be an underrecognized risk factor for post‐operative infections. The aim of this study was to investigate infection rates and outcomes after cardiac surgery in a nationwide cohort, especially in relation to periods where surface damaged TEE probes were used. Methods This was a retrospective, observational study at Landspitali University Hospital. All consecutive cardiac surgery patients from 1 January 2013 to 31 December 2017 were included. Patients’ charts were reviewed for evidence of infection, post‐operative complications or death. Results During the study period, 973 patients underwent cardiac surgery at Landspitali and 198 (20.3%) developed a post‐operative infection. The most common infections were: Pneumonia (9.1%), superficial surgical site (5.7%), bloodstream (2.8%) and deep sternal wound (1.7%). Risk factors for developing an infection included: The duration of procedure, age, insulin‐dependent diabetes, EuroScore II, reoperation for bleeding and an operation in a period with a surface damaged TEE probe in use. Twenty‐two patients were infected with a multidrug resistant strain of Klebsiella oxytoca, 10 patients with Pseudomonas aeruginosa and two patients developed endocarditis with Enterococcus faecalis. All three pathogens were cultured from the TEE probe in use at respective time, after decontamination. The 30‐day mortality rate in the patient cohort was 3.2%. Conclusions The intraoperative use of surface damaged TEE probes caused two serious infection outbreaks in patients after cardiac surgery. TEE probes need careful visual inspection during decontamination and probe sheaths are recommended.
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Affiliation(s)
- Edda Vesteinsdottir
- Department of Anaesthesia and Intensive Care Landspitali - The National University Hospital of Iceland Reykjavik Iceland
| | - Kristjan Orri Helgason
- Department of Clinical Microbiology Landspitali - The National University Hospital of Iceland Reykjavik Iceland
| | - Kristinn Orn Sverrisson
- Department of Anaesthesia and Intensive Care Landspitali - The National University Hospital of Iceland Reykjavik Iceland
| | - Olafur Gudlaugsson
- Department of Infectious Diseases Landspitali - The National University Hospital of Iceland Reykjavik Iceland
| | - Sigurbergur Karason
- Department of Anaesthesia and Intensive Care Landspitali - The National University Hospital of Iceland Reykjavik Iceland
- Faculty of Medicine, School of Health Sciences University of Iceland Reykjavik Iceland
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16
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Prolonged use of noninvasive positive pressure ventilation after extubation among patients in the intensive care unit following cardiac surgery: The predictors and its impact on patient outcome. Sci Rep 2019; 9:9539. [PMID: 31266972 PMCID: PMC6606632 DOI: 10.1038/s41598-019-45881-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 06/11/2019] [Indexed: 01/15/2023] Open
Abstract
This retrospective, observational cohort study aimed to determine the independent risk factors and impact of prolonged non-invasive positive pressure ventilation (NIPPV) after extubation among patients in the intensive care unit following cardiac surgery. Patients who received prophylactic NIPPV after extubation were categorized into prolonged (NIPPV duration >3 days, n = 83) and non-prolonged groups (NIPPV duration ≤3 days, n = 105). The perioperative characteristics and hospital outcomes were recorded. The multivariate analyses identified the preoperative residual volume/total lung capacity (RV/TLC) ratio (adjusted odds ratio [AOR]: 1.10; 95% CI:1.01–1.19, p = 0.022) and postoperative acute kidney injury (AKI) with Kidney Disease Improving Global Outcomes (KDIGO) stage 2–3, 48 h after surgery (AOR: 3.87; 95% CI:1.21–12.37, p = 0.023) as independent predictors of prolonged NIPPV. Patients with both RV/TLC ratio > 46.5% and KDIGO stage 2–3 showed a highly increased risk of prolonged NIPPV (HR 27.17, p = 0.010), which was in turn associated with higher risk of postoperative complications and prolonged ICU and hospital stays. Preoperative RV/TLC ratio and postoperative AKI could identify patients at higher risk for prolonged NIPPV associated with poor outcomes. These findings may allow early recognition of patients who are at a higher risk for prolonged NIPPV, and help refine the perioperative management and critical care.
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17
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Ratajska M, Chochowska M, Kulik A, Bugajski P. Myofascial release in patients during the early postoperative period after revascularisation of coronary arteries. Disabil Rehabil 2019; 42:3327-3338. [PMID: 31050562 DOI: 10.1080/09638288.2019.1593518] [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] [Indexed: 10/26/2022]
Abstract
Purpose: The evaluation of the impact of soft tissue manual therapy with a myofascial release on pulmonary function, postoperative pain, fatigue, breathing difficulties and physical fitness, in patients during the early postoperative period after coronary artery bypass grafting and off-pump coronary artery bypass grafting surgery.Materials and methods: The study included 80 subjects (59 males) with an average age of 64.13 years old. They were randomised into two groups: group I (n = 40) received a conventional form of rehabilitation and group II (n = 40) additionally, from day 3 to day 6 post-surgery, was provided the Carol Manheim form of myofascial release. Subjects were evaluated three times: before the surgery, on day 4 and 6 post-surgery. Using the visual analogue scale, the following symptoms were measured: pain intensity, breathing difficulties and level of physical endurance. Fatigue after performing physical exercises was measured using the Borg scale. Spirometry was used to measure the one-second forced expiratory volume and forced vital capacity.Results: Positive changes were observed in both groups with regard to all analysed variables. However, group II compared to group I showed a significantly greater improvement (p < 0.05; the Mann-Whitney U test) in relation to: pain intensity on day 4 (mean 5.46 vs 6.58) and on day 6 (mean 3.05 vs 5.35) after the surgery; lower breathing difficulties on day 6 post-surgery (mean 4.08 vs 5.63); limiting physical fitness on day 6 post-surgery (mean 6.35 vs 5.13). Between the condition prior to the surgery and day 6 post-surgery in group II compared to group I, there was a significantly smaller (p < 0.05; Student's t-test) decrease in one-second forced expiratory volume (mean -0.65 vs -0.9 L/s) and the volume of forced vital capacity (mean -0.63 vs -1.33 L). Between day 4 and 6 post-surgery in group II compared to group I, there was a significantly higher (p < 0.05; Student's t-test) increase in the one-second forced expiratory volume (mean 0.21 vs 0.11 L/s) and forced vital capacity (mean 0.32 vs 0.12 L).Conclusions: Implementing myofascial release techniques in the conventional form of cardiosurgical rehabilitation might enhance the improvement in pulmonary function, lessen breathing difficulties, pain intensity and fatigue, it might augment the increase in physical endurance among patients during the early postoperative period after coronary artery bypass grafting and off-pump coronary artery bypass grafting surgery.Implications for rehabilitationThe implementation of myofascial release techniques in conventional cardiac rehabilitation may improve the pulmonary function in patients during the early postoperative period, after revascularisation of coronary arteries.The adoption of myofascial release techniques in conventional cardiac rehabilitation may decrease breathing difficulties, pain intensity, fatigue and increase the physical fitness in patients during the early postoperative period, after the revascularisation of the coronary arteries.The implementation of myofascial release techniques in conventional cardiac rehabilitation may enhance patients' improvement during the early postoperative period, after the revascularisation of the coronary arteries.
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Affiliation(s)
- Maria Ratajska
- Department of Cardiovascular Surgery, Strus Hospital Poznan, Poznan, Poland
| | - Małgorzata Chochowska
- Department of Rehabilitation, Poznan University School of Physical Education, Gorzow Wielkopolski, Poland
| | - Anita Kulik
- Department of Rehabilitation, Poznan University School of Physical Education, Gorzow Wielkopolski, Poland
| | - Paweł Bugajski
- Department of Cardiovascular Surgery, Strus Hospital Poznan, Poznan, Poland.,Poznan University of Medical Sciences, Poznan, Poland
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18
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Natanov R, Gueler F, Falk CS, Kühn C, Maus U, Boyle EC, Siemeni T, Knoefel AK, Cebotari S, Haverich A, Madrahimov N. Blood cytokine expression correlates with early multi-organ damage in a mouse model of moderate hypothermia with circulatory arrest using cardiopulmonary bypass. PLoS One 2018; 13:e0205437. [PMID: 30308065 PMCID: PMC6181365 DOI: 10.1371/journal.pone.0205437] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 09/25/2018] [Indexed: 12/12/2022] Open
Abstract
Cardiopulmonary bypass (CPB) with moderate hypothermic cardiac arrest (MHCA) is essential for prolonged complex procedures in cardiac surgery and is associated with postoperative complications. Although cytokine release provoked through MHCA under CPB plays a pivotal role in postoperative organ damage, the pathomechanisms are unclear. Here, we investigated the cytokine release pattern and histological organ damage after MHCA using a recently described mouse CPB model. Eight BALB/c mice underwent 60 minutes of circulatory arrest under CPB, were successively rewarmed and reperfused. Blood cytokine concentrations and liver and kidney function parameters were measured and histological changes to these organs were compared to control animals. Our results showed a marked increase in proinflammatory cytokines and histological changes in the kidney, lung, and liver after CPB. Furthermore, clinical chemistry showed signs of hemolysis and acute kidney injury. These results suggest early onset of solid organ injury which correlates with increased leukocyte infiltration. A better understanding of the interplay between pro-inflammatory cytokine activation and solid organ injury in this model of CBP with MHCA will inform strategies to reduce organ damage during cardiac surgeries in the clinic.
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Affiliation(s)
- Ruslan Natanov
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Lower Saxony, Germany
| | - Faikah Gueler
- Department of Nephrology, Hannover Medical School, Hannover, Lower Saxony, Germany
| | - Christine S. Falk
- Institute of Transplant Immunology, Integrated Research and Treatment Center Transplantation (IFB-Tx), Hannover Medical School, Hannover, Lower Saxony, Germany
| | - Christian Kühn
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Lower Saxony, Germany
| | - Ulrich Maus
- Department of Pneumology, Hannover Medical School, Hannover, Lower Saxony, Germany
| | - Erin C. Boyle
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Lower Saxony, Germany
| | - Thierry Siemeni
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Lower Saxony, Germany
| | - Ann-Katrin Knoefel
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Lower Saxony, Germany
| | - Serghei Cebotari
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Lower Saxony, Germany
| | - Axel Haverich
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Lower Saxony, Germany
| | - Nodir Madrahimov
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Lower Saxony, Germany
- * E-mail:
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Valkenet K, Trappenburg J, Hulzebos E, van Meeteren N, Backx F. Effects of a pre-operative home-based inspiratory muscle training programme on perceived health-related quality of life in patients undergoing coronary artery bypass graft surgery. Physiotherapy 2017; 103:276-282. [DOI: 10.1016/j.physio.2016.02.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Accepted: 02/21/2016] [Indexed: 01/22/2023]
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Abstract
Sequential regression approaches can be used to analyze processes in which covariates are revealed in stages. Such processes occur widely, with examples including medical intervention, sports contests and political campaigns. The naïve sequential approach involves fitting regression models using the covariates revealed by the end of the current stage, but this is only practical if the number of covariates is not too large. An alternative approach is to incorporate the score (linear predictor) from the model developed at the previous stage as a covariate at the current stage. This score takes into account the history of the process prior to the stage under consideration. However, the score is a function of fitted parameter estimates and, therefore, contains measurement error. In this article, we propose a novel technique to account for error in the score. The approach is demonstrated with application to the sprint event in track cycling and is shown to reduce bias in the estimated effect of the score and avoid unrealistically extreme predictions.
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Affiliation(s)
- Joanne L Moffatt
- School of Computing Science and Engineering, University of Salford, Salford, UK
| | - Phil Scarf
- Salford Business School, University of Salford, Salford, UK
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Abstract
Over the past two decades there has been a steady evolution in the practice of adult cardiac surgery with the introduction of “off-pump” surgery. However, respiratory complications remain a leading cause of postcardiac surgical morbidity and can prolong hospital stays and increase costs. The high incidence of pulmonary complications is in part due to the disruption of normal ventilatory function that is inherent to surgery in the thoracic region. Furthermore, patients undergoing such surgery often have underlying illnesses such as intrinsic lung disease (e.g., chronic obstructive pulmonary disease) and pulmonary dysfunction secondary to cardiac disease (e.g., congestive heart failure) that increase their susceptibility to postoperative respiratory problems. Given that many patients undergoing cardiac surgery are thus susceptiple to pulmonary complications, it is remarkable that more patients do not suffer from them during and after cardiac surgery. This is to a large degree because of advances in anesthetic, surgical and critical care that, for example, have reduced the physiological insults of surgery (e.g., better myocardial preservation techniques) and streamlined care in the immediate postoperative period (e.g., early extubation). Moreover, the development of minimally invasive surgery and nonbypass techniques are further evidence of the attempts at reducing the homeostatic disruptions of cardiac surgery. This review examines the available information on the incidences, consequences, and treatments of postcardiac surgery respiratory complications.
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Affiliation(s)
- Charles Weissman
- Department of Anesthesiology and Critical Care Medicine, Hadassah-Hebrew University School of Medicine, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
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22
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Gomes Neto M, Martinez BP, Reis HFC, Carvalho VO. Pre- and postoperative inspiratory muscle training in patients undergoing cardiac surgery: systematic review and meta-analysis. Clin Rehabil 2016; 31:454-464. [DOI: 10.1177/0269215516648754] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Mansueto Gomes Neto
- Departamento de Biofunção, Universidade Federal da Bahia, Salvador, Brazil
- Programa de Pós-graduação em Medicina e Saúde da Universidade Federal da Bahia, Salvador, Brazil
- The GREAT Group (GRupo de Estudos em ATividade física), Brazil
| | - Bruno P Martinez
- Departamento de Fisioterapia da Universidade do Estado da Bahia, Salvador, Brazil
| | - Helena FC Reis
- Departamento de Biofunção, Universidade Federal da Bahia, Salvador, Brazil
| | - Vitor O Carvalho
- The GREAT Group (GRupo de Estudos em ATividade física), Brazil
- Departamento de Fisioterapia da Universidade Federal de Sergipe, Aracaju, Brazil
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23
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Cheng M, Li JQ, Wu TC, Tian WC. Short-Term Effects and Safety Analysis of Retrograde Autologous Blood Priming for Cardiopulmonary Bypass in Patients with Cardiac Valve Replacement Surgery. Cell Biochem Biophys 2016; 73:441-446. [PMID: 27352335 DOI: 10.1007/s12013-015-0661-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
This randomized, double-blind study evaluated the short-term effects and safety of perioperative retrograde autologous priming (RAP) for cardiopulmonary bypass (CPB) in patients with cardiac replacement surgery to determine if this approach is a better substitute for crystal liquids priming in patients with valvular heart disease. We observed that RAP significantly decreased the actual priming volume, preserved the hematocrit and hemoglobin level during CPB to a certain degree, and decreased lactate accumulation in CPB period. Moreover, RAP lowered the volume of transfusion and dosage blood products. Thus, our results showed that RAP approach effectively improved tissue perfusion and lowered intraoperative Lac levels, by reducing the hemodilution, which safely and reliably improve the microcirculation perfusion.
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Affiliation(s)
- Ming Cheng
- Department of Cardiac Surgery, The Second Affiliated Hospital of Harbin Medical University, Nangang, Harbin, 150086, Heilongjiang, People's Republic of China.
| | - Jun-Quan Li
- Department of Cardiac Surgery, The Second Affiliated Hospital of Harbin Medical University, Nangang, Harbin, 150086, Heilongjiang, People's Republic of China.
| | - Tian-Chi Wu
- Department of Cardiac Surgery, The Second Affiliated Hospital of Harbin Medical University, Nangang, Harbin, 150086, Heilongjiang, People's Republic of China
| | - Wei-Chen Tian
- Department of Cardiac Surgery, The Second Affiliated Hospital of Harbin Medical University, Nangang, Harbin, 150086, Heilongjiang, People's Republic of China
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Almashrafi A, Alsabti H, Mukaddirov M, Balan B, Aylin P. Factors associated with prolonged length of stay following cardiac surgery in a major referral hospital in Oman: a retrospective observational study. BMJ Open 2016; 6:e010764. [PMID: 27279475 PMCID: PMC4908878 DOI: 10.1136/bmjopen-2015-010764] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES Two objectives were set for this study. The first was to identify factors influencing prolonged postoperative length of stay (LOS) following cardiac surgery. The second was to devise a predictive model for prolonged LOS in the cardiac intensive care unit (CICU) based on preoperative factors available at admission and to compare it against two existing cardiac stratification systems. DESIGN Observational retrospective study. SETTINGS A tertiary hospital in Oman. PARTICIPANTS All adult patients who underwent cardiac surgery at a major referral hospital in Oman between 2009 and 2013. RESULTS 30.5% of the patients had prolonged LOS (≥11 days) after surgery, while 17% experienced prolonged ICU LOS (≥5 days). Factors that were identified to prolong CICU LOS were non-elective surgery, current congestive heart failure (CHF), renal failure, combined coronary artery bypass graft (CABG) and valve surgery, and other non-isolated valve or CABG surgery. Patients were divided into three groups based on their scores. The probabilities of prolonged CICU LOS were 11%, 26% and 28% for group 1, 2 and 3, respectively. The predictive model had an area under the curve of 0.75. Factors associated with prolonged overall postoperative LOS included the body mass index, the type of surgery, cardiopulmonary bypass machine use, packed red blood cells use, non-elective surgery and number of complications. The latter was the most important determinant of postoperative LOS. CONCLUSIONS Patient management can be tailored for individual patient based on their treatments and personal attributes to optimise resource allocation. Moreover, a simple predictive score system to enable identification of patients at risk of prolonged CICU stay can be developed using data that are routinely collected by most hospitals.
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Affiliation(s)
- Ahmed Almashrafi
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
| | - Hilal Alsabti
- Cardiothoracic Surgery Division, Department of Surgery, Sultan Qaboos University Hospital, Muscat, Oman
| | - Mirdavron Mukaddirov
- Cardiothoracic Surgery Division, Department of Surgery, Sultan Qaboos University Hospital, Muscat, Oman
| | - Baskaran Balan
- Cardiothoracic Surgery Division, Department of Surgery, Sultan Qaboos University Hospital, Muscat, Oman
| | - Paul Aylin
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
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Kinnunen EM, Mosorin MA, Perrotti A, Ruggieri VG, Svenarud P, Dalén M, Onorati F, Faggian G, Santarpino G, Maselli D, Dominici C, Nardella S, Musumeci F, Gherli R, Mariscalco G, Masala N, Rubino AS, Mignosa C, De Feo M, Della Corte A, Bancone C, Chocron S, Gatti G, Juvonen T, Biancari F. Validation of a New Classification Method of Postoperative Complications in Patients Undergoing Coronary Artery Surgery. J Cardiothorac Vasc Anesth 2016; 30:330-7. [DOI: 10.1053/j.jvca.2015.09.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Indexed: 11/11/2022]
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Comparison of intraoperative volume and pressure-controlled ventilation modes in patients who undergo open heart surgery. J Clin Monit Comput 2016; 31:75-84. [PMID: 26992377 DOI: 10.1007/s10877-016-9824-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Accepted: 01/03/2016] [Indexed: 12/20/2022]
Abstract
Respiratory problems occur more frequently in patients who undergo open heart surgery. Intraoperative and postoperative ventilation strategies can prevent these complications and reduce mortality. We hypothesized that PCV would have better effects on gas exchange, lung mechanics and hemodynamics compared to VCV in CABG surgery. Our primary outcome was to compare the PaO2/FiO2 ratio. Patients were randomized into two groups, (VCV, PCV) consisting of 30 individuals each. Two patients were excluded from the study. I/E ratio was adjusted to 1:2 and, RR:10/min fresh air gas flow was set at 3L/min in all patients. In the VCV group TV was set at 8 mL/kg of the predicted body weight. In the PCV group, peak inspiratory pressure was adjusted to the same tidal volume with the VCV group. PaO2/FiO2 was found to be higher with PCV at the end of the surgery. Time to extubation and ICU length of stay was shorter with PCV. Ppeak was similar in both groups. Pplateau was lower and Pmean was higher at the and of the surgery with PCV compared to VCV. The hemodynamic effects of both ventilation modes were found to be similar. PVC may be preferable to VCV in patients who undergo open heart surgery. However, it would be convenient if our findings are supported by similar studies.
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Johnson EA, Zubair MM, Armsby LR, Burch GH, Good MK, Lasarev MR, Hohimer AR, Muralidaran A, Langley SM. Surgical Quality Predicts Length of Stay in Patients with Congenital Heart Disease. Pediatr Cardiol 2016; 37:593-600. [PMID: 26739006 DOI: 10.1007/s00246-015-1319-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Accepted: 12/07/2015] [Indexed: 10/22/2022]
Abstract
Historically, the primary marker of quality for congenital cardiac surgery has been postoperative mortality. The purpose of this study was to determine whether additional markers (10 surgical metrics) independently predict length of stay (LOS), thereby providing specific targets for quality improvement. Ten metrics (unplanned ECMO, unplanned cardiac catheterization, revision of primary repair, delayed closure, mediastinitis, reexploration for bleeding, complete heart block, vocal cord paralysis, diaphragm paralysis, and change in preoperative diagnosis) were defined in 2008 and subsequently collected from 1024 consecutive index congenital cardiac cases, yielding 990 cases. Four patient characteristics and 22 case characteristics were used for risk adjustment. Univariate and multivariable analyses were used to determine independent associations between each metric and postoperative LOS. Increased LOS was independently associated with revision of the primary repair (p = 0.014), postoperative complete heart block requiring a permanent pacemaker (p = 0.001), diaphragm paralysis requiring plication (p < 0.001), and unplanned postoperative cardiac catheterization (p < 0.001). Compared with patients without each metric, LOS was 1.6 (95 % CI 1.1-2.2, p = 0.014), 1.7 (95 % CI 1.2-2.3, p = 0.001), 1.8 (95 % CI 1.4-2.3, p < 0.001), and 2.0 (95 % CI 1.7-2.4, p < 0.001) times as long, respectively. These effects equated to an additional 4.5-7.8 days in hospital, depending on the metric. The other 6 metrics were not independently associated with increased LOS. The quality of surgery during repair of congenital heart disease affects outcomes. Reducing the incidence of these 4 specific surgical metrics may significantly decrease LOS in this population.
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Affiliation(s)
- Eric A Johnson
- Division of Pediatric Cardiology, Doernbecher Children's Hospital, Oregon Health & Science University (OHSU), 3181 S.W. Sam Jackson Park Rd., Portland, OR, 97239, USA.
| | - M Mujeeb Zubair
- Division of Pediatric Cardiothoracic Surgery, Doernbecher Children's Hospital, Oregon Health & Science University (OHSU), 3181 S.W. Sam Jackson Park Rd., Portland, OR, 97239, USA
| | - Laurie R Armsby
- Division of Pediatric Cardiology, Doernbecher Children's Hospital, Oregon Health & Science University (OHSU), 3181 S.W. Sam Jackson Park Rd., Portland, OR, 97239, USA
| | - Grant H Burch
- Division of Pediatric Cardiology, Doernbecher Children's Hospital, Oregon Health & Science University (OHSU), 3181 S.W. Sam Jackson Park Rd., Portland, OR, 97239, USA
| | - Milon K Good
- Division of Pediatric Cardiothoracic Surgery, Doernbecher Children's Hospital, Oregon Health & Science University (OHSU), 3181 S.W. Sam Jackson Park Rd., Portland, OR, 97239, USA
| | - Michael R Lasarev
- Oregon Institute of Occupational Health Sciences, Oregon Health & Science University (OHSU), 3181 S.W. Sam Jackson Park Rd., Portland, OR, 97239, USA
| | - A Roger Hohimer
- Division of Perinatology, Oregon Health & Science University (OHSU), 3181 S.W. Sam Jackson Park Rd., Portland, OR, 97239, USA
| | - Ashok Muralidaran
- Division of Pediatric Cardiothoracic Surgery, Doernbecher Children's Hospital, Oregon Health & Science University (OHSU), 3181 S.W. Sam Jackson Park Rd., Portland, OR, 97239, USA
| | - Stephen M Langley
- Division of Pediatric Cardiothoracic Surgery, Doernbecher Children's Hospital, Oregon Health & Science University (OHSU), 3181 S.W. Sam Jackson Park Rd., Portland, OR, 97239, USA
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The Effect of Treatment Delays Associated with Inpatient Inter-hospital Transfer from Peripheral to Tertiary Hospitals for the Surgical Treatment of Cardiology Patients. Heart Lung Circ 2016; 25:75-81. [DOI: 10.1016/j.hlc.2015.05.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2014] [Revised: 05/10/2015] [Accepted: 05/23/2015] [Indexed: 11/21/2022]
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Gilliland S, Brainard J. Postoperative Noninvasive Ventilation Following Cardiothoracic Surgery. Semin Cardiothorac Vasc Anesth 2015; 19:302-8. [DOI: 10.1177/1089253215572699] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Postoperative pulmonary complications following cardiac and thoracic surgery are common and associated with significant morbidity and mortality. Noninvasive ventilation has emerged as a successful and well-validated strategy to treat various acute medical conditions. More recently, noninvasive ventilation has been studied in selective surgical patient populations with the goal of preventing postoperative complications and treating acute respiratory failure. In this clinical review, we will briefly examine the incidence of pulmonary complications following cardiothoracic surgery and the physiology and mechanics of acute respiratory failure and noninvasive ventilation. We then present a systematic review of the indications, patient selection, and current literature investigating the specific use of noninvasive ventilation in this population.
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Oliveira LBD, Rodrigues ARB, Püschel VADA, Silva FAD, Conceição SLD, Béda LB, Fidelis B, Santana-Santos E, Secoli SR. Avaliação da carga de trabalho no pós-operatório de cirurgia cardíaca segundo o Nursing Activities Score. Rev Esc Enferm USP 2015; 49 Spec No:80-6. [DOI: 10.1590/s0080-623420150000700012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Accepted: 07/31/2015] [Indexed: 11/21/2022] Open
Abstract
RESUMO Objetivo Identificar os fatores associados à carga de trabalho de enfermagem no cuidado a pacientes no pós-operatório de cirurgia cardíaca. Método Estudo de coorte prospectivo, conduzido com 187 pacientes da Unidade de Terapia Intensiva Cirúrgica (UTI) do Instituto do Coração. Os dados foram coletados nas primeiras 24 e 72 horas do paciente na UTI. A variável dependente foi a carga de trabalho calculada por meio do Nursing Activities Score (NAS) e as independentes foram de natureza demográfico-clínicas e escores de morbimortalidade. Para análise dos dados utilizou-se os testes de Wilcoxon-Mann-Whitney e de correlação de Spearman, e a regressão linear com modelo de efeitos mistos. Resultados A maioria dos pacientes era do sexo masculino (59,4%), com média de idade de 61 anos (±12,7) e 43,9% desenvolveram algum tipo de complicação no pós-operatório. Nas 24 horas, a carga de trabalho foi de 82,4% (±3,4) e foi de 58,1% (±3,4) nas 72 horas. Os fatores associados ao aumento do NAS foram: tempo de internação do paciente na UTI (p=0,036) e a presença de complicações (p<0,001). Conclusão A gravidade do paciente nas 24 horas, em oposição a inúmeros estudos, não influenciou no aumento da carga de trabalho, a qual se mostrou associada ao tempo de internação e às complicações.
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Bartz RR, Ferreira RG, Schroder JN, Davies J, Liu WW, Camara A, Welsby IJ. Prolonged pulmonary support after cardiac surgery: incidence, risk factors and outcomes: a retrospective cohort study. J Crit Care 2015. [DOI: 10.1016/j.jcrc.2015.04.125] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Azarfarin R, Ashouri N, Totonchi Z, Bakhshandeh H, Yaghoubi A. Factors influencing prolonged ICU stay after open heart surgery. Res Cardiovasc Med 2014; 3:e20159. [PMID: 25785249 PMCID: PMC4347792 DOI: 10.5812/cardiovascmed.20159] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2014] [Revised: 07/01/2014] [Accepted: 09/11/2014] [Indexed: 11/17/2022] Open
Abstract
Background: There are different risk factors that affect the intensive care unit (ICU) stay after cardiac surgery. Objectives: The aim of this study was to evaluate possible risk factors influencing prolonged ICU stay in a large referral hospital. Patients and Methods: We conducted a case-control study to determinate causes of prolonged ICU stay in 280 adult patients undergoing cardiac surgery in a tertiary care center for cardiovascular patients, Tehran, Iran. These patients were divided into two groups according to ICU stay ≤ 96 and > 96 hours. We evaluated perioperative risk factors of ICU stay > 96 hours. Results: Among the 280 patients studied, 184 (65.7%) had stayed ≤ 96 hours and 96 (34.3%) had stayed > 96 hours in ICU. Frequency of prolonged ICU stay was 34.2% in patients undergoing coronary artery bypass graft (CABG), 30.8% in patients with valve surgery, and 44.8% in patients with CABG plus valve surgery. Patients with > 96 hours of ICU stay received more blood transfusion and intravenous inotropes. They also had longer anesthesia, cardiopulmonary bypass, and postoperative intubation time. There were higher incidence of postoperative tamponade, re-exploration, re-intubation, hemodialysis, and hypotension in this group (P < 0.05 for all comparisons). Conclusions: In this study, about one-third of patients had prolonged ICU stay. Factors influencing prolonged ICU stay were medical and some non-medical factors. In the present study, up to 30% of the patients had a prolonged ICU stay of > 96 hours. Additional data from well-designed investigations are needed for further assessment of the factors influencing prolonged ICU stay after cardiac surgery.
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Affiliation(s)
- Rasoul Azarfarin
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran
| | - Nasibeh Ashouri
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran
- Corresponding author: Nasibeh Ashouri, Rajaie Cardiovascular Medical and Research Center, Vali-Asr St., Niayesh Blvd, Tehran, IR Iran. Tel: +98-2166353011, Fax: +98-2122663293, E-mail:
| | - Ziae Totonchi
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran
| | - Hooman Bakhshandeh
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran
| | - Alireza Yaghoubi
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran
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Baghban M, Paknejad O, Yousefshahi F, Gohari Moghadam K, Bina P, Samimi Sadeh S. Hospital-acquired pneumonia in patients undergoing coronary artery bypass graft; comparison of the center for disease control clinical criteria with physicians' judgment. Anesth Pain Med 2014; 4:e20733. [PMID: 25289379 PMCID: PMC4183076 DOI: 10.5812/aapm.20733] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Revised: 07/12/2014] [Accepted: 07/15/2014] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Following coronary artery bypass graft (CABG), patients are at high risk (3.2%-8.3%) for developing hospital-acquired pneumonia (HAP) with mortality rate of 24% to 50%. Some of routine features in patients undergoing CABG are similar to clinical criteria of Center of Disease Control (CDC) for diagnosis of pneumonia. This may lead to over-diagnosis of pneumonia in these patients. OBJECTIVES This study aimed to assess the frequency of CDC criteria for diagnosis of pneumonia in patients undergoing CABG. PATIENTS AND METHODS This study was performed on CABG candidates admitted to post cardiac surgery Intensive Care Unit (ICU) in a six-month period. Patient's records, Chest-X-Ray, and Laboratory tests were assessed for PNU1-CDC criteria for HAP diagnosis. At the same time, a physician who was unaware of the study protocol assessed the clinical diagnosis. Then the results were compared with CDC criteria-based diagnosis. RESULTS Of total 300 patients, 9 (3%) met CDC criteria for diagnosis of pneumonia while none of the cases were diagnosed as HAP according to the physicians' clinical diagnosis. All nine patients were discharged with proper general condition and no need of antibiotic therapy. This study showed that loss of consciousness, tachypnea, dyspnea, PaO2 < 60 mm Hg, PaO2/FiO2 < 240, and local infiltration in 24 hours of operation were misleading features of CDC criteria, which were not considered in physicians' clinical judgment to establish the diagnosis. CONCLUSIONS Our findings suggest that in Post-CABG patients, physicians could judge the occurrence of HAP more accurately in comparison to making the diagnosis based on CDC criteria alone. Expert physician may intentionally do not take some of these criteria into account according the patients' course of disease. Therefore, it is suggested that the value of these criteria in special group of patients like those undergoing CABG should be re-evaluated.
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Affiliation(s)
- Mahboubeh Baghban
- Internal Medicine Department, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Omalbanin Paknejad
- Internal Medicine Department, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Fardin Yousefshahi
- Anesthesia and Critical Care Department, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
- Corresponding author: Fardin Yousefshahi, Anesthesia and Critical Care Department, Faculty of Medicine, Women Hospital, North Nejatollahi Street, Tehran University of Medical Sciences, P. O. Box: 1597856511, Tehran, Iran. Tel: +98-2188897761-4, Fax: +98-2188915959, E-mail: .
| | - Keivan Gohari Moghadam
- Internal Medicine Department, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Payvand Bina
- Department of Basic and Clinical Research, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Saghar Samimi Sadeh
- Anesthesia and Critical Care Department, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
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Fergerson BD, Manecke GR. Goal-directed therapy in cardiac surgery: are we there yet? J Cardiothorac Vasc Anesth 2014; 27:1075-8. [PMID: 24267575 DOI: 10.1053/j.jvca.2013.08.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2013] [Indexed: 11/11/2022]
Affiliation(s)
- Byron D Fergerson
- Department of Anesthesiology University of California San Diego San Diego, CA
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Wen T, Attenello FJ, He S, Cen Y, Kim-Tenser MA, Sanossian N, Amar AP, Mack WJ. Racial and Socioeconomic Disparities in Incidence of Hospital-Acquired Complications Following Cerebrovascular Procedures. Neurosurgery 2014; 75:43-50. [DOI: 10.1227/neu.0000000000000352] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Miyata H, Murakami A, Tomotaki A, Takaoka T, Konuma T, Matsumura G, Sano S, Takamoto S. Predictors of 90-day mortality after congenital heart surgery: the first report of risk models from a Japanese database. J Thorac Cardiovasc Surg 2014; 148:2201-6. [PMID: 25444193 DOI: 10.1016/j.jtcvs.2013.01.053] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2012] [Revised: 12/12/2012] [Accepted: 01/14/2013] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The purpose of this study was to develop risk models for congenital heart surgery short-term and midterm outcomes from a nationwide integrated database drawn from hospitals in Japan. METHODS The Japan Congenital Cardiovascular Surgery Database collects clinical information from institutions throughout Japan specializing in congenital heart surgery. Variables and definitions used in the Japan Congenital Cardiovascular Surgery Database are almost identical to those of the Society of Thoracic Surgeons-European Association for Cardiothoracic Surgery database for congenital heart surgery. We used logistic regression to develop risk models, which were then validated through spilt-sample validation. In addition to procedural complexity categories by Risk Adjustment in Congenital Heart Surgery (RACHS-1) score, we incorporated patient characteristics to predict surgical outcome. RESULTS Among 8923 congenital heart operations performed at 69 sites with cardiac surgical programs, 30-day mortalities by RACHS-1 category were as follows: I, 0.1% (n=1319); II, 0.5% (n=3211); III, 2.2% (n=3285); IV, 4.3% (n=818); and V and VI, 8.6% (n=290). From the test data set (n=7223), we developed 3 risk models (30-day mortality, 90-day mortality, and 90-day and in-hospital mortality) with 11 variables, including age category, RACHS-1 category, preoperative risk factors, number of surgical procedures, unplanned reoperations, status of surgery, surgery type, asplenia, and prematurity (<35 weeks). For the performance metrics of the risk models, C statistic values of 30-day, 90-day, and 90-day and in-hospital mortalities for the test data set were 0.85, 0.85, and 0.84, respectively. When only the RACHS-1 score was used for discrimination, the C statistic values of 30-day, 90-day, and 90-day and in-hospital mortalities for the validation data set were 0.73, 0.73, and 0.77, respectively. CONCLUSIONS The proposed risk scores and categories have high discrimination power for predicting mortality, demonstrating improvement relative to existing consensus-based methods. Risk models incorporating these measures may be useful for comparing mortality outcomes cross institutions or countries with mixed cases.
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Affiliation(s)
- Hiroaki Miyata
- Japan Cardiovascular Surgery Database Organization, Tokyo, Japan.
| | - Arata Murakami
- Japan Cardiovascular Surgery Database Organization, Tokyo, Japan
| | - Ai Tomotaki
- Japan Cardiovascular Surgery Database Organization, Tokyo, Japan
| | | | - Takeshi Konuma
- Japan Cardiovascular Surgery Database Organization, Tokyo, Japan
| | - Goki Matsumura
- Japan Cardiovascular Surgery Database Organization, Tokyo, Japan
| | - Syunji Sano
- Japan Cardiovascular Surgery Database Organization, Tokyo, Japan
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Agarwal HS, Wolfram KB, Saville BR, Donahue BS, Bichell DP. Postoperative complications and association with outcomes in pediatric cardiac surgery. J Thorac Cardiovasc Surg 2013; 148:609-16.e1. [PMID: 24280709 DOI: 10.1016/j.jtcvs.2013.10.031] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Revised: 08/20/2013] [Accepted: 10/11/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Our primary aim was to study postoperative complications in pediatric cardiac surgery patients and their association with cardiopulmonary bypass (CPB) use. The secondary aim was to evaluate the association of postoperative complications with established outcome measures. METHODS A single-institution retrospective observational study was undertaken of consecutive pediatric cardiac surgery patients during a 1-year period. Five cardiac and 15 extracardiac complications were studied. CPB use, CPB parameters, demographics, and Risk Adjusted Classification for Congenital Heart Surgery (RACHS-1) levels were evaluated as risk factors for complications. Outcomes, including mechanical ventilation duration, pediatric cardiac intensive care unit stay, hospital stay, and mortality were studied. RESULTS A total of 325 patients were studied: 271 with CPB and 54 without CPB. Of the 325 patients, 141 (43%) had ≥1 complication (95% confidence interval, 38%-49%). Of the 325 patients, 82 (25%) developed cardiac and 120 (37%) developed extracardiac complications. The evidence from logistic regression analysis was insufficient to suggest a relationship between CPB support and the incidence of cardiac or extracardiac complications after adjusting for age, gender, previous sternotomy, and RACHS-1 levels. For patients receiving CPB, longer CPB times, higher RACHS-1 levels, and a lower temperature with CPB were associated with a greater number of cardiac complications (P < .01). Longer CPB times and higher RACHS-1 levels were associated with a greater number of extracardiac complications (P = .006). Postoperative complications were significantly associated with an increased mechanical ventilation duration, pediatric cardiac intensive care unit stay, and hospital stay and mortality (P < .01). CONCLUSIONS Postoperative complications occurred in 43% of pediatric cardiac surgeries performed both with and without CPB. The complications were associated with longer mechanical ventilation and pediatric cardiac intensive care unit and hospital stays, and increased mortality.
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Affiliation(s)
- Hemant S Agarwal
- Department of Pediatrics, Vanderbilt University School of Medicine, Monroe Carell Jr, Children's Hospital at Vanderbilt, Nashville, Tenn.
| | - Karen B Wolfram
- Department of Pediatrics, Vanderbilt University School of Medicine, Monroe Carell Jr, Children's Hospital at Vanderbilt, Nashville, Tenn
| | - Benjamin R Saville
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tenn
| | - Brian S Donahue
- Department of Pediatrics, Vanderbilt University School of Medicine, Monroe Carell Jr, Children's Hospital at Vanderbilt, Nashville, Tenn; Division of Pediatric Cardiac Anesthesia, Department of Anesthesia, Vanderbilt University Medical Center, Nashville, Tenn
| | - David P Bichell
- Department of Cardiothoracic Surgery, Monroe Carell Jr Children's Hospital at Vanderbilt, Nashville, Tenn
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Li W, Zheng B, Xu H, Deng Y, Wang S, Wang X, Su D. Isoflurane Prevents Neurocognitive Dysfunction After Cardiopulmonary Bypass in Rats. J Cardiothorac Vasc Anesth 2013; 27:502-9. [DOI: 10.1053/j.jvca.2012.09.005] [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: 06/18/2012] [Indexed: 11/11/2022]
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Abstract
BACKGROUND Inspiratory muscle training (IMT) before cardiac surgery has proved to be a promising intervention to reduce postoperative pneumonia in a randomized controlled trial setting. Effects of IMT in routine care have not been reported. OBJECTIVE The purpose of this study was to investigate the effect of IMT before cardiac surgery on postoperative pneumonia in routine care at a Dutch university medical center using propensity scoring. DESIGN This was an observational cohort study. METHODS All candidates for cardiac surgery were preoperatively stratified by a physical therapist for low risk or high risk for postoperative pulmonary complications. Patients at high risk either engaged in an unsupervised IMT program (20 minutes a day) at home for at least 2 weeks before surgery (group 1) or received usual care (no IMT) (group 2). Results in terms of outcome measures were adjusted with propensity scores to reduce bias caused by nonrandom treatment assignment. RESULTS The results showed that of the 94 patients at high risk in group 1, 1 patient (1.1%) developed a postoperative pneumonia. In group 2, 8 out of the 252 patients at high risk (3.2%) developed this pulmonary complication (adjusted odds ratio=0.34, 95% confidence interval=0.04-3.38). No significant differences were found regarding median (25th-75th percentile) ventilation time (7 [5-9] hours versus 7 [5-10] hours), length of stay in the intensive care unit (23 [21-24] hours versus 23 [21-25] hours), or total postoperative length of stay (7 [6-11] days versus 7 [5-9] days). LIMITATIONS The most important limitations of this study were confounding, incomplete data collection, and a low incidence of the primary outcome. CONCLUSIONS Propensity scoring is believed to be a valuable tool of great potential interest to researchers in the field of observational studies. Whether IMT in routine care resulted in less postoperative pneumonia cannot be concluded.
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Przkora R, Martin TD, Hess PJ, Kulkarni RS. Intrathecal morphine in two patients undergoing deep hypothermic circulatory arrest during aortic surgery -A case report-. Korean J Anesthesiol 2012; 63:563-6. [PMID: 23277821 PMCID: PMC3531539 DOI: 10.4097/kjae.2012.63.6.563] [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: 11/08/2011] [Revised: 01/27/2012] [Accepted: 02/02/2012] [Indexed: 11/16/2022] Open
Abstract
We retrospectively report the first use of intrathecal morphine prior to incision in two male patients undergoing a complex aortic reconstruction, who required complete circulatory arrest under deep hypothermia for intraoperative and postoperative pain control. We administered intrathecal morphine to two male patients undergoing circulatory arrest and deep hypothermia. Patients were fully heparinized prior to cardiopulmonary bypass. Deep hypothermic circulatory arrest was performed by cooling the patients to 18℃. Following the surgery, the neurologic status was monitored. The management of postoperative pain is a quality standard in health care. During the first 24 hours after surgery, we observed excellent analgesia without the associated side effects, thus, reducing the time required for pain control by the nursing staff. A successful analgetic strategy not only enhances the patient satisfaction, but may improve the postoperative outcome. However, complications, such as increased risk of epidural hematoma formation, are of special concern in cardiac surgery.
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Affiliation(s)
- Rene Przkora
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, USA. ; Department of Anesthesiology, University of Florida College of Medicine, Gainesville, USA
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Emaminia A, Corcoran PC, Siegenthaler MP, Means M, Rasmussen S, Krause L, LaPar DJ, Horvath KA. The universal bed model for patient care improves outcome and lowers cost in cardiac surgery. J Thorac Cardiovasc Surg 2012; 143:475-81. [DOI: 10.1016/j.jtcvs.2011.10.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2011] [Revised: 08/02/2011] [Accepted: 10/03/2011] [Indexed: 11/17/2022]
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Giakoumidakis K, Baltopoulos GI, Charitos C, Patelarou E, Galanis P, Brokalaki H. Risk factors for prolonged stay in cardiac surgery intensive care units. Nurs Crit Care 2011; 16:243-51. [PMID: 21824229 DOI: 10.1111/j.1478-5153.2010.00443.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES To identify the factors that might affect the length of stay in the intensive care unit (ICU-LOS) among cardiac surgery patients. BACKGROUND ICU-LOS forms an important factor for assessing the effectiveness of the provided nursing care. A number of factors can be accused for increasing patient hospitalization. The nursing workload (NWL), among others, was found to play a significant role as it is closely associated with the quality of care. DESIGN An observational cohort study among 313 consecutive patients who were admitted to the cardiac surgery intensive care unit of a general, tertiary hospital of Athens, Greece from November 2008 to November 2009. METHODS Data collection was performed by using a short questionnaire (for basic demographic information) and two instruments, the Nursing Activities Score (NAS) and the logistic EuroSCORE, for assessing the NWL and the perioperative risk for each patient respectively. RESULTS ICU-LOS of more than 2 days increased with age and was more common among females (p < 0.001 and p = 0.02, respectively). Multivariate logistic regression analysis revealed a positive association between increased perioperative risk and the increased ICU-LOS [odd ratio (OR) 1.9, 95% confidence interval (CI) 1.0-3.5, p = 0.04], while patients with a first day NAS of more than 61.6% had an almost 5.2 times greater probability to stay in the cardiac surgery unit for more than 2 days (OR 5.2, 95% CI 3.0-8.8, p < 0.001). CONCLUSIONS Increased level of NWL and patient perioperative risk are closely associated with increased ICU-LOS. RELEVANCE TO CLINICAL PRACTICE The correlation between patient perioperative risk and ICU-LOS encourages the early identification of high-risk patients for prolonged hospitalization. Furthermore, the relationship between NWL and ICU-LOS allows the early identification of these patients with the use of an independent nursing tool.
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Lola I, Levidiotou S, Petrou A, Arnaoutoglou H, Apostolakis E, Papadopoulos GS. Are there independent predisposing factors for postoperative infections following open heart surgery? J Cardiothorac Surg 2011; 6:151. [PMID: 22082355 PMCID: PMC3223138 DOI: 10.1186/1749-8090-6-151] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2011] [Accepted: 11/14/2011] [Indexed: 01/22/2023] Open
Abstract
Background Nosocomial infections after cardiac surgery represent serious complications associated with substantial morbidity, mortality and economic burden. This study was undertaken to evaluate the frequency, characteristics, and risk factors of microbiologically documented nosocomial infections after cardiac surgery in a Cardio-Vascular Intensive Care Unit (CVICU). Methods All patients who underwent open heart surgery between May 2006 and March 2008 were enrolled in this prospective study. Pre-, intra- and postoperative variables were collected and examined as possible risk factors for development of nosocomial infections. The diagnosis of infection was always microbiologically confirmed. Results Infection occurred in 24 of 172 patients (13.95%). Out of 172 patients, 8 patients (4.65%) had superficial wound infection at the sternotomy site, 5 patients (2.9%) had central venous catheter infection, 4 patients (2.32%) had pneumonia, 9 patients (5.23%) had bacteremia, one patient (0.58%) had mediastinitis, one (0.58%) had harvest surgical site infection, one (0.58%) had urinary tract infection, and another one patient (0.58%) had other major infection. The mortality rate was 25% among the patients with infection and 3.48% among all patients who underwent cardiac surgery compared with 5.4% of patients who did not develop early postoperative infection after cardiac surgery. Culture results demonstrated equal frequencies of gram-positive cocci and gram-negative bacteria. A backward stepwise multivariable logistic regression model analysis identified diabetes mellitus (OR 5.92, CI 1.56 to 22.42, p = 0.009), duration of mechanical ventilation (OR 1.30, CI 1.005 to 1.69, p = 0.046), development of severe complications in the CICU (OR 18.66, CI 3.36 to 103.61, p = 0.001) and re-admission to the CVICU (OR 8.59, CI 2.02 to 36.45, p = 0.004) as independent risk factors associated with development of nosocomial infection after cardiac surgery. Conclusions We concluded that diabetes mellitus, the duration of mechanical ventilation, the presence of complications irrelevant to the infection during CVICU stay and CVICU re-admission are independent risk factors for the development of postoperative infection in cardiac surgery patients.
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Affiliation(s)
- Ioanna Lola
- Laboratory of Microbiology, University Hospital of Ioannina, Ioannina, Greece.
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Affiliation(s)
- Joseph D Tobias
- Department of Anesthesiology and Pediatrics, Nationwide Children's Hospital and the Ohio State University, Columbus, Ohio. E-mail:
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Schöttler J, Hagemann A, Grothusen C, Stohn S, Pleger D, von der Brelie M, Cremer J, Haake N. [Mid-term outcome of cardiac surgery patients with prolonged postoperative intensive care treatment]. Med Klin Intensivmed Notfmed 2011; 106:41-7. [PMID: 21975841 DOI: 10.1007/s00063-011-0025-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2010] [Revised: 11/27/2010] [Accepted: 11/30/2010] [Indexed: 11/30/2022]
Abstract
BACKGROUND The number of patients of advanced age and with severe comorbidities undergoing cardiac surgery is rising. Therefore, in addition to the cardiac surgery procedure itself, postoperative intensive care treatment plays an increasingly important role. The mid-term outcome of patients with postoperative long-term stays in intensive care and perioperative risk factors for an adverse outcome have not been sufficiently evaluated. MATERIAL AND METHODS All patients who underwent cardiac surgery in our institution between 2000 and 2004 and who required intensive care treatment on our cardiac surgery intensive care unit for at least 1 week were analyzed. Patients who received heart or lung transplantation or surgery for congenital heart failure were excluded. A total of 31 perioperative variables were evaluated for 230 patients. Follow-up was performed 1 year postoperatively. RESULTS In all, 4.3% of our patients required a prolonged stay in intensive care following cardiac surgery. Overall 1-year mortality among patients with a long-term stay in intensive care was 26.9%. The logistic regression identified postoperative renal failure requiring dialysis (OR 4.98) as the strongest predictor for mortality within the first year after surgery, followed by postoperative tracheotomy and preoperatively known atrial fibrillation. CONCLUSION Mid-term survival among patients who underwent cardiac surgery followed by a complicated postoperative course is encouragingly high. The risk factors identified for an adverse prognosis may be helpful in improving therapy strategies and general therapy decision-making.
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Affiliation(s)
- J Schöttler
- Klinik für Herz- und Gefäßchirurgie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Deutschland.
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Welsby IJ, Lockhart E, Phillips-Bute B, Campbell ML, Mathew JP, Newman MF, Peterson E, Milano CA. Storage age of transfused platelets and outcomes after cardiac surgery. Transfusion 2011; 50:2311-7. [PMID: 20573071 DOI: 10.1111/j.1537-2995.2010.02747.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND The relationship between duration of platelet (PLT) storage, currently limited to 5days, and surgical outcomes has not been established. We tested the hypothesis that PLT storage age was associated with adverse outcomes. STUDY DESIGN AND METHODS A retrospective cohort of aortocoronary bypass (CABG) surgery patients from January 1996 to January 2005 receiving one or more PLT transfusions was selected for study. The composite primary ("short-term") outcome was 30-day mortality or prolonged hospital stay. Secondary outcomes included complications and survival to annual follow-up. Multivariable logistic regression models and Cox proportional hazards regression analysis evaluated the association between PLT storage age and outcomes, expressed as an odds ratio (OR) or hazard ratio with 95% confidence intervals (CIs), respectively. RESULTS PLT transfusion was administered to 3272 of 10,275 CABG patients and 2578 received units of known storage age, which ranged between 2 and 5days (median, 4days; 25th percentile, 3days; 75th percentile, 5 days). The mortality rate for the 1637 patients receiving a single plateletpheresis transfusion was 3.8%, while 21.6% experienced a prolonged hospital stay or death. After adjusting for the number of PLT and red blood cell (RBC) units transfused, RBC storage age, and preoperative mortality risk, there was no association between PLT storage age and short-term outcome (OR, 1.01; 95% CI, 0.90-1.14), survival (hazard ratio [HR], 1.04; 95% CI, 0.96-1.13), or postoperative infections. CONCLUSIONS PLT storage age was not associated with adverse short-term outcomes, decreased long-term survival, or infections after cardiac surgery.
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Affiliation(s)
- Ian J Welsby
- Department of Anesthesiology, Duke University Medical Center, and the Duke Clinical Research Institute, Durham, North Carolina 27710, USA.
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Nosrati M, Boroumand M, Tahmasebi S, Sotoudeh M, Sheikhfathollahi M, Goodarzynejad H. Excess costs associated with common healthcare-associated infections in an Iranian cardiac surgical unit. J Hosp Infect 2010; 76:304-7. [DOI: 10.1016/j.jhin.2010.07.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2010] [Accepted: 07/08/2010] [Indexed: 11/24/2022]
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Giakoumidakis K, Baltopoulos GI, Charitos C, Patelarou E, Fotos NV, Brokalaki-Pananoudaki H. Risk factors for increased in-hospital mortality: a cohort study among cardiac surgery patients. Eur J Cardiovasc Nurs 2010; 11:23-33. [DOI: 10.1016/j.ejcnurse.2010.09.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
| | | | - Christos Charitos
- Cardiothoracic Surgeon, Director of the 2nd Cardiothoracic Department, “Evangelismos” General Hospital of Athens, Greece
| | | | - Nikolaos V Fotos
- Faculty of Nursing, National & Kapodistrian University of Athens, Greece
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Homi HM, Calvi CL, Lynch J, Grocott HP. Longitudinal Assessment of Neurocognitive Function in Rats After Cardiopulmonary Bypass: Evidence for Long-Term Deficits. J Cardiothorac Vasc Anesth 2010; 24:293-9. [DOI: 10.1053/j.jvca.2009.07.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2009] [Indexed: 11/11/2022]
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Mastropierro R, Bettinzoli M, Bordonali T, Patroni A, Barni C, Manzato A. Pneumonia in a Cardiothoracic Intensive Care Unit: Incidence and Risk Factors. J Cardiothorac Vasc Anesth 2009; 23:780-8. [DOI: 10.1053/j.jvca.2009.03.019] [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: 11/20/2008] [Indexed: 01/15/2023]
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