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Ott S, Lee ZY, Müller-Wirtz LM, Cangut B, Roessler J, Patterson W, Thomas CM, Bekele BM, Windpassinger M, Lobdell K, Grant MC, Arora RC, Engelman DT, Fremes S, Velten M, O'Brien B, Ruetzler K, Heyland DK, Stoppe C. The effect of a selenium-based anti-inflammatory strategy on postoperative functional recovery in high-risk cardiac surgery patients - A nested sub-study of the sustain CSX trial. Life Sci 2024; 351:122841. [PMID: 38897349 DOI: 10.1016/j.lfs.2024.122841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Revised: 06/05/2024] [Accepted: 06/11/2024] [Indexed: 06/21/2024]
Abstract
AIM The cardiac surgery-related ischemia-reperfusion-related oxidative stress triggers the release of cytotoxic reactive oxygen and nitrogen species, contributing to organ failure and ultimately influencing patients' short- and long-term outcomes. Selenium is an essential co-factor for various antioxidant enzymes, thereby contributing to the patients' endogenous antioxidant and anti-inflammatory defense mechanisms. Given these selenium's pleiotropic functions, we investigated the effect of a high-dose selenium-based anti-inflammatory perioperative strategy on functional recovery after cardiac surgery. MATERIALS AND METHODS This prospective study constituted a nested sub-study of the SUSTAIN CSX trial, a double-blinded, randomized, placebo-controlled multicenter trial to investigate the impact of high-dose selenium supplementation on high-risk cardiac surgery patients' postoperative recovery. Functional recovery was assessed by 6-min walk distance, Short Form-36 (SF-36) and Barthel Index questionnaires. KEY FINDINGS 174 patients were included in this sub-study. The mean age (SD) was 67.3 (8.9) years, and 78.7 % of the patients were male. The mean (SD) predicted 30-day mortality by the European System for Cardiac Operative Risk Evaluation II score was 12.6 % (9.4 %). There was no difference at hospital discharge and after three months in the 6-min walk distance between the selenium and placebo groups (131 m [IQR: not performed - 269] vs. 160 m [IQR: not performed - 252], p = 0.80 and 400 m [IQR: 299-461] vs. 375 m [IQR: 65-441], p = 0.48). The SF-36 and Barthel Index assessments also revealed no clinically meaningful differences between the selenium and placebo groups. SIGNIFICANCE A perioperative anti-inflammatory strategy with high-dose selenium supplementation did not improve functional recovery in high-risk cardiac surgery patients.
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Affiliation(s)
- Sascha Ott
- Deutsches Herzzentrum der Charité, Department of Cardiac Anaesthesiology and Intensive Care Medicine, Berlin, Germany; Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany; DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany; Outcomes Research Consortium, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH 44195, USA.
| | - Zheng-Yii Lee
- Deutsches Herzzentrum der Charité, Department of Cardiac Anaesthesiology and Intensive Care Medicine, Berlin, Germany; Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany; Department of Anaesthesiology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Lukas M Müller-Wirtz
- Department of Anaesthesiology, Intensive Care and Pain Therapy, Saarland University Medical Center and Saarland University Faculty of Medicine, 66424 Homburg, Saarland, Germany; Outcomes Research Consortium, Department of Anesthesiology, Cleveland Clinic, OH, USA.
| | - Busra Cangut
- Department of Cardiovascular Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Julian Roessler
- Outcomes Research Consortium, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH 44195, USA; Institute of Anaesthesiology, University Hospital Zurich, 8091 Zurich, Switzerland
| | - William Patterson
- Outcomes Research Consortium, Department of Anesthesiology, Cleveland Clinic, OH, USA.
| | - Christian M Thomas
- Deutsches Herzzentrum der Charité, Department of Cardiac Anaesthesiology and Intensive Care Medicine, Berlin, Germany; Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Infectious Diseases and Respiratory Medicine, Berlin, Germany.
| | - Biniam M Bekele
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany; Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charité (DHZC), Augustenburger Platz 1, 13353 Berlin, Germany.
| | - Marita Windpassinger
- Department of Anesthesia, Critical Care and Pain Medicine, Division of General Anesthesia and Intensive Care Medicine, Medical University Vienna, Vienna, Austria.
| | - Kevin Lobdell
- Department of Thoracic and Cardiovascular Surgery, Sanger Heart and Vascular Institute, Carolinas Medical Center, Charlotte, NC 28203, USA.
| | - Michael C Grant
- Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins Medical Institutions, Baltimore, MD, USA; Armstrong Institute for Patient Safety and Quality, The Johns Hopkins Medical Institutions, Baltimore, MD, USA.
| | - Rakesh C Arora
- Division of Cardiac Surgery, Harrington Heart and Vascular Institute, University Hospitals, Cleveland, OH, USA
| | - Daniel T Engelman
- Heart and Vascular Program, Baystate Health and University of Massachusetts Chan Medical School-Baystate, 759 Chestnut Street, Springfield, MA 01199, USA
| | - Stephen Fremes
- Division of Cardiac Surgery, Schulich Heart Centre, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, M4N 3M5, Department of Surgery, University of Toronto, Toronto, Canada.
| | - Markus Velten
- Department of Anesthesiology and Pain Management, Division of Cardiovascular and Thoracic Anesthesiology, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA.
| | - Benjamin O'Brien
- Deutsches Herzzentrum der Charité, Department of Cardiac Anaesthesiology and Intensive Care Medicine, Berlin, Germany; Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany; DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany; St Bartholomew's Hospital and Barts Heart Centre, Department of Perioperative Medicine, London EC1A 7BE, UK.
| | - Kurt Ruetzler
- Outcomes Research Consortium, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH 44195, USA; Department of General Anesthesia, Anesthesiology Institute, Cleveland Clinic, Cleveland, USA.
| | - Daren K Heyland
- Clinical Evaluation Research Unit, Department of Critical Care Medicine, Queen's University, Kingston, ON, Canada.
| | - Christian Stoppe
- Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital, Würzburg, Würzburg, Germany; Department of Cardiac Anesthesiology and Intensive Care Medicine, Charité Berlin, Berlin, Germany.
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Paton M, Chan S, Serpa Neto A, Tipping CJ, Stratton A, Lane R, Romero L, Broadley T, Hodgson CL. Association of active mobilisation variables with adverse events and mortality in patients requiring mechanical ventilation in the intensive care unit: a systematic review and meta-analysis. THE LANCET. RESPIRATORY MEDICINE 2024; 12:386-398. [PMID: 38513675 DOI: 10.1016/s2213-2600(24)00011-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Revised: 01/07/2024] [Accepted: 01/17/2024] [Indexed: 03/23/2024]
Abstract
BACKGROUND Mobilisation during critical illness is now included in multiple clinical practice guidelines. However, a large, randomised trial and systematic review have recently identified an increased probability of adverse events and mortality in patients who received early active mobilisation in the intensive care unit (ICU). We aimed to determine the effects of mobilisation compared with usual care on adverse events and mortality in an acute ICU setting. In subgroup analyses, we specifically aimed to investigate possible sources of harm, including the timing and duration of mobilisation achieved, ventilation status, and admission diagnosis. METHODS In this systematic review with frequentist and Bayesian analyses, we searched MEDLINE, Embase, Cochrane Central Register of Controlled Trials, CINAHL, SPORTDiscus, SCOPUS, Web of Science, and PEDro electronic databases, as well as clinical trial registries (ICTRP and ClinicalTrials.gov), from inception to March 16, 2023, without language restrictions. Eligible studies were randomised controlled trials that examined active mobilisation compared with either no mobilisation or mobilisation commencing later, or at a lower frequency or intensity, in adults who were critically ill during or after a period of mechanical ventilation in an acute ICU setting. Two authors independently screened reports, extracted data, and assessed the risk of bias using the Cochrane risk-of-bias tool (version 1). The primary outcome was the number of adverse events that occurred during the implementation of mobilisation, with the effect of mobilisation on mortality being the secondary outcome. Risk ratios (RRs) with 95% CIs were calculated in R (version 4.0.3) using random-effects modelling, with Bayesian analysis completed to calculate the probability of treatment harm (ie, RR >1). Subgroup analyses were completed to investigate the association of various factors of mobilisation on adverse events and mortality: duration of mobilisation (longer [≥20 min per day] vs shorter [<20 min per day]), timing of commencement (early [≤72 h from ICU admission] vs late [>72 h from ICU admission]), ventilation status at commencement (all patients mechanically ventilated vs all patients extubated), and ICU admission diagnosis (surgical vs medical). This study was registered with PROSPERO, CRD42022369272. FINDINGS After title and abstract screening of 14 440 studies and review of 466 full texts, 67 trials with 7004 participants met inclusion criteria, with 59 trials contributing to the meta-analysis. Of the 67 included studies, 15 (22%) did not mention adverse events and 13 (19%) reported no adverse events occurring across the trial period. Overall, we found no effect of mobilisation compared with usual care on the occurrence of adverse events (RR 1·09 [95% CI 0·69-1·74], p=0·71; I2 91%; 32 731 events, 20 studies; very low certainty), with a 2·96% occurrence rate (693 events in 23 395 intervention sessions; 25 studies). Mobilisation did not have any effect on mortality (RR 0·98 [95% CI 0·87-1·12], p=0·81; I2 0%; n=6218, 58 studies; moderate certainty). Subgroup analysis was hindered by the large amount of data that could not be allocated and analysed, making the results hypothesis generating only. INTERPRETATION Implementation of mobilisation in the ICU was associated with a less than 3% chance of an adverse event occurring and was not found to increase adverse events or mortality overall, providing reassurance for clinicians about the safety of performing this intervention. Subgroup analyses did not clearly identify any specific variable of mobilisation implementation that increased harm. FUNDING None.
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Affiliation(s)
- Michelle Paton
- Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia; Department of Physiotherapy, Monash Health, Clayton, VIC, Australia
| | - Sarah Chan
- Department of Physiotherapy, Monash Health, Clayton, VIC, Australia
| | - Ary Serpa Neto
- Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia; Department of Critical Care, University of Melbourne, Melbourne, VIC, Australia; Department of Critical Care Medicine, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | - Claire J Tipping
- Department of Physiotherapy, Alfred Health, Melbourne, VIC, Australia
| | - Anne Stratton
- Department of Physiotherapy, Alfred Health, Melbourne, VIC, Australia
| | - Rebecca Lane
- School of Health Sciences, Swinburne University, Hawthorn, VIC, Australia
| | - Lorena Romero
- Ian Potter Library, Alfred Health, Melbourne, VIC, Australia
| | - Tessa Broadley
- Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Carol L Hodgson
- Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia; Department of Critical Care, University of Melbourne, Melbourne, VIC, Australia; Department of Physiotherapy, Alfred Health, Melbourne, VIC, Australia; Critical Care Division, The George Institute for Global Health, Sydney, NSW, Australia.
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Maze Y, Tokui T, Narukawa T, Murakami M, Yamaguchi D, Inoue R, Hirano K, Takamura T, Nakamura K, Seko T, Kasai A. Impact of the Barthel Index Score and Prognosis on Patients Undergoing Transcatheter Aortic Valve Replacement and Surgical Aortic Valve Replacement. Circ J 2024; 88:483-491. [PMID: 37899252 DOI: 10.1253/circj.cj-23-0458] [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] [Indexed: 10/31/2023]
Abstract
BACKGROUND Few studies have compared the Barthel Index (BI) score and postoperative outcomes of transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR). We aimed to examine the relationship between the BI score and postoperative outcomes in patients who underwent TAVR and SAVR.Methods and Results: The study included patients who underwent SAVR between January 2014 and December 2022 (n=293) and patients who underwent TAVR between January 2016 and December 2022 (n=312). We examined the risk factors for long-term mortality in the 2 groups. The mean (±SD) preoperative BI score was 88.7±18.0 in the TAVR group and 95.8±12.3 in the SAVR group. The home discharge rate was significantly lower in the SAVR than TAVR group. The BI score at discharge was significantly higher in the SAVR than in TAVR group (86.2 vs. 80.2; P<0.001). Significant risk factors for long-term mortality in the TAVR group were sex (P<0.001) and preoperative hemoglobin level (P=0.008), whereas those in the SAVR group were preoperative albumin level (P=0.04) and postoperative BI score (P=0.02). The cut-off point of the postoperative BI score determined by receiver operating characteristic curve analysis was 60.0. CONCLUSIONS The BI score at discharge was a significant risk factor for long-term mortality in the SAVR group, with a cut-off value of 60.0.
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Affiliation(s)
- Yasumi Maze
- Department of Thoracic and Cardiovascular Surgery, Ise Red Cross Hospital
| | - Toshiya Tokui
- Department of Thoracic and Cardiovascular Surgery, Ise Red Cross Hospital
| | - Takahiro Narukawa
- Department of Thoracic and Cardiovascular Surgery, Ise Red Cross Hospital
| | - Masahiko Murakami
- Department of Thoracic and Cardiovascular Surgery, Ise Red Cross Hospital
| | - Daisuke Yamaguchi
- Department of Thoracic and Cardiovascular Surgery, Ise Red Cross Hospital
| | - Ryosai Inoue
- Department of Thoracic and Cardiovascular Surgery, Ise Red Cross Hospital
| | - Koji Hirano
- Department of Thoracic and Cardiovascular Surgery, Ise Red Cross Hospital
| | | | | | - Tetsuya Seko
- Department of Cardiology, Ise Red Cross Hospital
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Broadley T, Higgins A, Hodgson C. Physical rehabilitation, mobilization and patient-centred outcomes: what is new? Curr Opin Crit Care 2023; 29:505-512. [PMID: 37641507 DOI: 10.1097/mcc.0000000000001081] [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: 08/31/2023]
Abstract
PURPOSE OF REVIEW Physical rehabilitation and mobilization interventions aim to reduce the incidence of intensive care unit (ICU)-acquired weakness and subsequently reduce morbidity in critically ill patients. This chapter will explore the evidence for physical rehabilitation and mobilization with an emphasis on patient-centred outcomes selected in randomized controlled trials. This is particularly pertinent at a time when clinicians are deciding how to implement physical rehabilitation and mobilization into the treatment of critically ill patients. RECENT FINDINGS Multiple trials of physical rehabilitation and mobilization were published in 2022 and 2023 with conflicting results. Analysing the complexities of physical rehabilitation research provides an insight into these results and will aid in the interpretation of trials of physical rehabilitation and mobilization. SUMMARY Patient-centred outcomes are often utilized in physical rehabilitation and mobilization research, but this does not automatically correspond to an increase in research quality. Improving consistency in trials of physical rehabilitation will aid in the interpretation and translation of physical rehabilitation research.
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Affiliation(s)
- Tessa Broadley
- Department of Epidemiology and Preventive Medicine, Australian and New Zealand Intensive Care Research Centre
- Alfred Health, Melbourne
| | - Alisa Higgins
- Department of Epidemiology and Preventive Medicine, Australian and New Zealand Intensive Care Research Centre
- The George Institute for Global Health, Sydney
| | - Carol Hodgson
- Department of Epidemiology and Preventive Medicine, Australian and New Zealand Intensive Care Research Centre
- Alfred Health, Melbourne
- The George Institute for Global Health, Sydney
- Department of Critical Care, The University of Melbourne, Melbourne, Australia
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Outcomes of Genetic Testing-Based Cardiac Rehabilitation Program in Patients with Acute Myocardial Infarction after Percutaneous Coronary Intervention. Cardiol Res Pract 2022; 2022:9742071. [PMID: 36032316 PMCID: PMC9402363 DOI: 10.1155/2022/9742071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Revised: 06/20/2022] [Accepted: 06/21/2022] [Indexed: 11/18/2022] Open
Abstract
Objective There can be extreme variability between individual responses to exercise training, and the identification of genetic variants associated with individual variabilities in exercise-related traits could guide individualized exercise programs. We aimed to screen the exercise-related gene sensitivity of patients with acute myocardial infarction after PCI by establishing the gene spectrum of aerobic exercise and cardiopulmonary function sensitivity, test the effect of individualized precision exercise therapy, and provide evidence for the establishment of a precision medicine program for clinical research. Methods Aerobic exercise- and cardiopulmonary function-related genes and single-nucleotide polymorphisms (SNPs) were obtained by data mining utilizing a major publicly available biomedical repository, the NCBI PubMed database. Biological samples from all participants underwent DNA testing. We performed SNP detection using Samtools. A total of 122 patients who underwent PCI were enrolled in the study. We screened the first 24 cases with a high mutation frequency for aerobic exercise- and cardiopulmonary function-related genes and the last 24 cases with a low mutation frequency and separated them into two groups for the exercise intervention experiment. Results In both the low mutation frequency group and the high mutation frequency group, after 8 weeks of exercise intervention, 6 MWT distance, 6 MWT%, VO2/kg at peak, and VO2/kg at AT were significantly improved, and the effect in the high mutation frequency group was significantly higher than that in the low mutation frequency group (6 MWT distance: 468 vs. 439, P=0.003; 6 MWT%: 85 vs. 77, P=0.002, VO2/kg at peak: 14.7 vs. 13.3, P=0.002; VO2/kg at AT: 11.9 vs. 13.3, P=0.003). Conclusions There is extreme variability between individual responses to exercise training. The identification of genetic variants associated with individual variabilities in exercise-related traits could guide individualized exercise programs. We found that the subjects with a high mutation frequency in aerobic exercise and cardiopulmonary function-related genes achieved more cardiorespiratory fitness benefits in the aerobic exercise rehabilitation program and provided evidence for the establishment of a precision medicine program for clinical research.
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