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El-Akkawi AI, Media AS, Eykens Hjørnet N, Nielsen DV, Modrau IS. Timing of Chest Tube Removal Following Adult Cardiac Surgery: A Cluster Randomized Controlled Trial. SCAND CARDIOVASC J 2024; 58:2294681. [PMID: 38112193 DOI: 10.1080/14017431.2023.2294681] [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] [Received: 07/03/2023] [Accepted: 12/09/2023] [Indexed: 12/21/2023]
Abstract
OBJECTIVES Early chest tube removal following cardiac surgery may be associated with an increased risk of pleural or pericardial effusions following cardiac surgery. This study compares the effects of two fast-track chest tube removal protocols regarding the risk of pleural or pericardial effusions, requirement of opioids, respiratory function, and postoperative complications. DESIGN Prospective non-blinded cluster-randomized study with alternating chest tube removal protocol in adult patients undergoing elective cardiac surgery. Monthly changing allocation to scheduled chest tube removal on the day of surgery (Day 0) versus removal on the 1st postoperative day (Day 1) provided no air leakage and output < 200 mL within the last four hours. RESULTS A total of 527 patients were included in the study from September 1st 2020 until October 29th 2021 and randomly allocated to chest tube removal at day 0 (n = 255), and day 1 (n = 272). More than every fourth patient required drainage for pleural effusion with no significant difference between the groups. Earlier removal of chest tubes did not reduce requirement of analgesics, improve early respiratory function, or reduce postoperative complications. The study was halted for futility after halfway interim analysis showed insufficient promise of any treatment benefit. CONCLUSION Fast-track protocols with chest tube removal within the first 24 h after cardiac surgery may be associated a high rate of pleural effusions.
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Affiliation(s)
- Ali Imad El-Akkawi
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Ara Shwan Media
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Niels Eykens Hjørnet
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Dorthe Viemose Nielsen
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Ivy Susanne Modrau
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
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Setlers K, Jurcenko A, Arklina B, Zvaigzne L, Sabelnikovs O, Stradins P, Strike E. Identifying Early Risk Factors for Postoperative Pulmonary Complications in Cardiac Surgery Patients. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:1398. [PMID: 39336439 PMCID: PMC11433804 DOI: 10.3390/medicina60091398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2024] [Revised: 08/15/2024] [Accepted: 08/25/2024] [Indexed: 09/30/2024]
Abstract
Background and Objectives: Postoperative pulmonary complications (PPCs) are common in patients who undergo cardiac surgery and are widely acknowledged as significant contributors to increased morbidity, mortality rates, prolonged hospital stays, and healthcare costs. Clinical manifestations of PPCs can vary from mild to severe symptoms, with different radiological findings and varying incidence. Detecting early signs and identifying influencing factors of PPCs is essential to prevent patients from further complications. Our study aimed to determine the frequency, types, and risk factors significant for each PPC on the first postoperative day. The main goal of this study was to identify the incidence of pleural effusion (right-sided, left-sided, or bilateral), atelectasis, pulmonary edema, and pneumothorax as well as detect specific factors related to its development. Materials and Methods: This study was a retrospective single-center trial. It involved 314 adult patients scheduled for elective open-heart surgery under CPB. Results: Of the 314 patients reviewed, 42% developed PPCs within 12 h post-surgery. Up to 60.6% experienced one PPC, while 35.6% developed two PPCs. Pleural effusion was the most frequently observed complication in 89 patients. Left-sided effusion was the most common, presenting in 45 cases. Regression analysis showed a significant association between left-sided pleural effusion development and moderate hypoalbuminemia. Valve surgery was associated with reduced risk for left-sided effusion. Independent parameters for bilateral effusion include increased urine output and longer ICU stays. Higher BMI was inversely related to the risk of pulmonary edema. Conclusions: At least one PPC developed in almost half of the patients. Left-sided pleural effusion was the most common PPC, with hypoalbuminemia as a risk factor for effusion development. Atelectasis was the second most common. Bilateral effusion was the third most common PPC, significantly related to increased urine output. BMI was an independent risk factor for pulmonary edema development.
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Affiliation(s)
- Kaspars Setlers
- Department of Cardiovascular Anesthesia and Intensive Care, Pauls Stradins Clinical University Hospital, LV-1002 Riga, Latvia
- Department of Anesthesiology, Riga Stradins University, LV-1007 Riga, Latvia
| | | | - Baiba Arklina
- Department of Cardiovascular Anesthesia and Intensive Care, Pauls Stradins Clinical University Hospital, LV-1002 Riga, Latvia
- Department of Anesthesiology, Riga Stradins University, LV-1007 Riga, Latvia
| | - Ligita Zvaigzne
- Institute of Radiology, Pauls Stradins Clinical University Hospital, LV-1002 Riga, Latvia
| | - Olegs Sabelnikovs
- Department of Anesthesiology, Riga Stradins University, LV-1007 Riga, Latvia
- Department of Intensive Care, Pauls Stradins Clinical University Hospital, LV-1002 Riga, Latvia
| | - Peteris Stradins
- Department of Cardiac Surgery, Pauls Stradins Clinical University Hospital, LV-1002 Riga, Latvia
- Department of Surgery, Riga Stradins University, LV-1007 Riga, Latvia
| | - Eva Strike
- Department of Cardiovascular Anesthesia and Intensive Care, Pauls Stradins Clinical University Hospital, LV-1002 Riga, Latvia
- Department of Anesthesiology, Riga Stradins University, LV-1007 Riga, Latvia
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Shiravi F, Shahzamani M, Hosseini SA, Shafie D. A Comparison of the Clinical Outcomes of Minimum and Maximum Hematocrit Levels During Cardiopulmonary Bypass (CPB) in Low-risk Patients Undergoing Coronary Artery Bypass Graft Surgery (CABG): A Cross-sectional Study. Adv Biomed Res 2024; 13:3. [PMID: 38525389 PMCID: PMC10958727 DOI: 10.4103/abr.abr_145_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 07/23/2023] [Accepted: 07/30/2023] [Indexed: 03/26/2024] Open
Abstract
Background This study investigated the clinical outcomes at the minimum and maximum levels of hematocrit (HCT) during cardiopulmonary bypass (CPB) in low-risk patients undergoing coronary artery bypass graft (CABG) surgery. Materials and Methods In this cross-sectional study, 85 patients who underwent CABG with an ejection fraction of greater than 35% were selected. Based on the HCT range during CPB, patients were divided into two groups: minimum HCT: HCT = 16-18% and maximum HCT: HCT = 25-27%. Then the operation outcomes, amount of drainage, and transfusion were recorded and compared between these groups. Results In the middle tube 8 h after surgery and left tube 24 h after surgery, the amount of drainage in the minimum HCT group with mean of 71.00 ± 130.9 and 60.65 ± 71.23, respectively, was significantly lower than the maximum HCT group with mean of 101.5 ± 246.50 and 123.76 ± 93.17, respectively (P value < 0.05). The incidence of cognitive disorders in the maximum HCT group was significantly higher than in the minimum HCT group (11.1% vs. 0%, P value = 0.041). Also, the mean transfusion of packed red blood cell (PRBC) and fresh frozen plasm (FFP) during CPB in the maximum HCT group, with mean of 346.7 ± 86.22 and 396.1 ± 21.05, respectively, were significantly higher than the minimum HCT group with mean of 178.8 ± 80.91 and 136.8 ± 46.77, respectively (P value < 0.05). After CPB, there was no significant difference in transfusion products (P value > 0.05). Conclusion According to the results of this study, patients undergoing CABG surgery with maximum HCT level versus minimum HCT level during CPB, need more packed cells and fresh frozen plasma products transfusion, which will be associated with the complication of cognitive impairment.
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Affiliation(s)
- Fatemeh Shiravi
- Department of Blood Circulation Technology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mehran Shahzamani
- Department of Surgery, Chamran Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Sayyed Alireza Hosseini
- Department of Surgery, Chamran Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Davood Shafie
- Department of Cardiology, Heart Failure Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
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Ribé L, Shihadeh FD, Afifi RO, Estrera AL, Prakash SK. Outcomes of cardiothoracic surgery in women with Turner syndrome. Ann Cardiothorac Surg 2023; 12:569-576. [PMID: 38090343 PMCID: PMC10711414 DOI: 10.21037/acs-2023-adw-0083] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 08/01/2023] [Indexed: 06/30/2024]
Abstract
BACKGROUND To describe short- and mid-term surgical outcomes of patients with Turner syndrome (TS) after cardiovascular interventions. METHODS All individuals >12 years of age at the time of surgical repair for cardiovascular disease (valve or coarctation repairs, aortic disease, aortic dissection) from 2002 to 2022 were eligible. The primary endpoint was complications or death within 30 days of intervention. Secondary outcomes included late complications and reinterventions within six months. Combined data from the University of Texas Health Science Center at Houston and the Turner Syndrome Society of the United States were included in the analysis. RESULTS We identified 22 patients who met the inclusion criterion. The median age was 46 years (range, 21-75 years), with 86% having estrogen replacement therapy. The most common medical condition was hypertension (77%), followed by hypothyroidism (59%). The most frequent indication for surgery was aortic root or ascending aortic aneurysms (68%), followed by symptomatic aortic stenosis in patients with bicuspid aortic valve (64%), coarctation of aorta (45%), and acute aortic dissection (18%). Respiratory complications were the most common (68%). Pleural effusions were the most frequent found sign on imaging studies (68%). Thoracentesis, or chest tube placement, was required in 33% (5/15). Respiratory failure requiring specific support with high flow oxygen and/or thoracentesis occurred in 36% (8/22). CONCLUSIONS Patients with TS may be at an increased risk for postoperative complications after aortic surgery. Bicuspid aortic valve (59%) and coarctation of the aorta (45%) were the most common congenital malformations among our study group. Our study showed that respiratory complications were the most common, with pleural effusions being the most common post-surgery complication.
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Affiliation(s)
- Lucas Ribé
- Department of Cardiothoracic and Vascular Surgery, McGovern Medical School at UTHealth Houston, Houston, TX, USA
| | - Ferial D. Shihadeh
- Department of Pediatric Endocrinology, McGovern Medical School at UTHealth Houston, Houston, TX, USA
| | - Rana O. Afifi
- Department of Cardiothoracic and Vascular Surgery, McGovern Medical School at UTHealth Houston, Houston, TX, USA
| | - Anthony L. Estrera
- Department of Cardiothoracic and Vascular Surgery, McGovern Medical School at UTHealth Houston, Houston, TX, USA
| | - Siddharth K. Prakash
- Department of Internal Medicine, McGovern Medical School at UTHealth Houston, Houston, TX, USA
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Welch H, Harris J, Pufulete M, Dimagli A, Benedetto U, Maskell N. Does previous asbestos exposure increase the risk of a post coronary artery bypass graft (CABG) pleural effusion - a routine data study? BMC Pulm Med 2023; 23:307. [PMID: 37605147 PMCID: PMC10441712 DOI: 10.1186/s12890-023-02555-9] [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: 05/11/2023] [Accepted: 07/06/2023] [Indexed: 08/23/2023] Open
Abstract
BACKGROUND Development of pleural effusion (PE) following CABG is common. Post-CABG PE are divided into early- (within 30 days of surgery) and delayed-onset (30 days-1 year) which are likely due to distinct pathological processes. Some experts suggest asbestos exposure may confer an independent risk for late-onset post-CABG PE, however no large studies have explored this potential association. RESEARCH QUESTION To explore possible association between asbestos exposure and post-CABG PE using routine data. METHODS All patients who underwent CABG 01/04/2013-31/03/2018 were identified from the Hospital Episode Statistics (HES) Database. This England-wide population was evaluated for evidence of asbestos exposure, pleural plaques or asbestosis and a diagnosis of PE or PE-related procedure from 30 days to 1 year post-CABG. Patients with evidence of PE three months prior to CABG were excluded, as were patients with a new mesothelioma diagnosis. RESULTS 68,150 patients were identified, of whom 1,003 (1%) were asbestos exposed and 2,377 (3%) developed late-onset PE. After adjusting for demographic data, Index of Multiple Deprivation and Charlson Co-morbidity Index, asbestos exposed patients had increased odds of PE diagnosis or related procedure such as thoracentesis or drainage (OR 1.35, 95% CI 1.03-1.76, p = 0.04). In those with evidence of PE requiring procedure alone, the adjusted OR was 1.66 (95% CI 1.14-2.40, p = 0.01). Additional subgroup analysis of the 518 patients coded for pleural plaques and asbestosis alone revealed an adjusted OR of post-CABG PE requiring a procedure of 2.16 (95% CI 1.38-3.37, p = 0.002). INTERPRETATION This large-scale study demonstrates prior asbestos exposure is associated with modestly increased risk of post-CABG PE development. The risk association appears higher in patients with assigned clinical codes indicative of radiological evidence of asbestos exposure (pleural plaques or asbestosis). This association may fit with a possible inflammatory co-pathogenesis, with asbestos exposure 'priming' the pleura resulting in greater propensity for PE evolution following the physiological insult of CABG surgery. Further work, including prospective studies and clinicopathological correlation are suggested to explore this further.
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Affiliation(s)
- Hugh Welch
- University of Bristol, Bristol, UK.
- Academic Respiratory Unit, North Bristol NHS Trust 2nd Floor Office, Learning and Research Building Southmead Hospital Southmead Way, Bristol, BS10 5NB, UK.
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Yu H, Zuo Y, Xu Z, Zhao D, Yue J, Liu L, Guo Y, Huang J, Deng X, Liang P. Comparison effects of two muscle relaxant strategies on postoperative pulmonary complications in transapical transcatheter aortic valve implantation: a propensity score-matched analysis. J Cardiothorac Surg 2023; 18:50. [PMID: 36721168 PMCID: PMC9890810 DOI: 10.1186/s13019-023-02166-9] [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: 10/17/2022] [Accepted: 01/24/2023] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Prior studies have reported conflicting results on the effect of sugammadex on postoperative pulmonary complications (PPCs) and research on this topic in transapical-transcatheter aortic valve implantation (TA-TAVI) was sparse. The current study aimed to investigate whether there were differences in the incidence of PPCs between two muscle relaxant strategies (rocuronium/sugammadex vs. cisatracurium/neostigmine) in patients undergoing TA-TAVI. METHODS This retrospective observational study enrolled 245 adult patients underwent TA-TAVI between October 2018 and January 2021. The patients were grouped according to the type of muscle relaxant strategies (115 with rocuronium/sugammadex in the R/S group and 130 with cisatracurium/neostigmine in the C/N group, respectively). Pre- and intraoperative variables were managed by propensity score match (PSM) at a 1:2 ratio. PPCs (i.e., respiratory infection, pleural effusion, pneumothorax, atelectasis, respiratory failure, bronchospasm and aspiration pneumonitis) were evaluated from the radiological and laboratory findings. RESULTS After PSM, 91 patients in the R/S group were selected and matched to 112 patients in the C/N group. Patients in the R/S group showed lower PPCs rate (45.1% vs. 61.6%, p = 0.019) compared to the C/N group. In addition, the R/S group showed significant shorter extubation time (7.2 ± 6.2 vs. 10.3 ± 8.2 min, p = 0.003) and length of hospital stay (6.9 ± 3.3 vs. 8.0 ± 4.0 days, p = 0.034). CONCLUSION The rocuronium/sugammadex muscle relaxant strategy decreases the incidence of PPCs in patients undergoing TA-TAVI when compared to cisatracurium/neostigmine strategy. Trial registration ChiCTR, ChiCTR2100044269. Registered March 14, 2021-Prospectively registered, http://www.Chictr.org.cn .
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Affiliation(s)
- Hong Yu
- grid.13291.380000 0001 0807 1581Department of Anesthesiology, West China Hospital, Sichuan University, No.37 Guoxue Alley, Chengdu, 610041 China
| | - Yiding Zuo
- grid.13291.380000 0001 0807 1581Department of Anesthesiology, West China Hospital, Sichuan University, No.37 Guoxue Alley, Chengdu, 610041 China
| | - Zhao Xu
- grid.13291.380000 0001 0807 1581Department of Anesthesiology, West China Hospital, Sichuan University, No.37 Guoxue Alley, Chengdu, 610041 China
| | - Dailiang Zhao
- grid.13291.380000 0001 0807 1581Department of Anesthesiology, West China Hospital, Sichuan University, No.37 Guoxue Alley, Chengdu, 610041 China
| | - Jianming Yue
- grid.13291.380000 0001 0807 1581Department of Anesthesiology, West China Hospital, Sichuan University, No.37 Guoxue Alley, Chengdu, 610041 China
| | - Lulu Liu
- grid.13291.380000 0001 0807 1581Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, 610041 China
| | - Yingqiang Guo
- grid.13291.380000 0001 0807 1581Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, 610041 China
| | - Jiapeng Huang
- grid.266623.50000 0001 2113 1622Department of Anesthesiology and Perioperative Medicine, University of Louisville, Louisville, KY USA
| | - Xiaoqian Deng
- grid.13291.380000 0001 0807 1581Department of Anesthesiology, West China Hospital, Sichuan University, No.37 Guoxue Alley, Chengdu, 610041 China
| | - Peng Liang
- grid.13291.380000 0001 0807 1581Department of Anesthesiology, Day Surgery Center, West China Hospital, Sichuan University, No.37 Guoxue Alley, Chengdu, 610041 China
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7
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Schiefenhövel F, Poncette AS, Boyle EM, von Heymann C, Menk M, Vorderwülbecke G, Grubitzsch H, Treskatsch S, Balzer F. Pleural effusions are associated with adverse outcomes after cardiac surgery: a propensity-matched analysis. J Cardiothorac Surg 2022; 17:298. [PMID: 36476289 PMCID: PMC9727876 DOI: 10.1186/s13019-022-02050-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 11/27/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Pleural effusions commonly occur in patients recovering from cardiac surgery; however, the impact on outcomes is not well characterized. The purpose of this study is to characterize the clinical outcomes of cardiac surgery patients with pleural effusion. METHODS All patients undergoing cardiac surgery between 2006 and 2019 at a tertiary care university hospital were included in this observational, cross-sectional analysis using propensity matching. RESULTS Of 11,037 patients that underwent cardiac surgery during the study period, 6461 (58.5%) had no pleural effusion (Group 0), 3322 (30.1%) had pleural effusion only (Group 1), and 1254 (11.4%) required at least one secondary drainage procedure after the index operation (Group 2). After propensity matching, the mortality of patients who underwent secondary drainage procedures was 6.1% higher than in Group 1 (p < 0.001). Intensive care unit (ICU) stay was longer for those with pleural effusions (18 [IQR 9-32] days in Group 2, 10 [IQR 6-17] days for Group 1, and 7 [IQR 4-11] days for Group 0, p < 0.001). Patients with pleural effusions had a higher incidence of hemodialysis (246 [20.0%] in Group 2, 137 [11.1%] in Group 1, 98 [7.98%] in Group 0), and a longer ventilation time in the ICU (57 [IQR 21.0-224.0] hours in Group 2, 25.0 [IQR 14.0-58.0] hours in Group 1, 16.0 [IQR 10.0-29.0] hours in Group 0). CONCLUSION Pleural effusions, especially those that require a secondary drainage procedure during recovery, are associated with significantly worse outcomes including increased mortality, longer length of stay, and higher complication rates. These insights may be of great interest to scientists, clinicians, and industry leaders alike to foster research into innovative methods for preventing and treating pleural effusions with the aim of improving outcomes for patients recovering from cardiac surgery.
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Affiliation(s)
- Fridtjof Schiefenhövel
- grid.6363.00000 0001 2218 4662Charité – Universitätsmedizin Berlin, corporate Member of Freie Universität and Humboldt-Universität zu Berlin, Institute of Medical Informatics, Charitéplatz 1, 10117 Berlin, Germany ,grid.15474.330000 0004 0477 2438Klinikum rechts der Isar, Technical University of Munich, School of Medicine, Department of Anaesthesiology and Intensive Care, Munich, Germany ,grid.15474.330000 0004 0477 2438Klinikum rechts der Isar, Technical University of Munich, School of Medicine, Institute of Artificial Intelligence and Informatics in Medicine, Munich, Germany
| | - Akira-Sebastian Poncette
- grid.6363.00000 0001 2218 4662Charité – Universitätsmedizin Berlin, corporate Member of Freie Universität and Humboldt-Universität zu Berlin, Department of Anesthesiology and Intensive Care Medicine, Charitéplatz 1, 10117 Berlin, Germany ,grid.6363.00000 0001 2218 4662Charité – Universitätsmedizin Berlin, corporate Member of Freie Universität and Humboldt-Universität zu Berlin, Institute of Medical Informatics, Charitéplatz 1, 10117 Berlin, Germany
| | - Edward M. Boyle
- grid.416611.5Department of Cardiothoracic Surgery, St. Charles Medical Center, Bend, OR USA
| | - Christian von Heymann
- grid.415085.dDepartment of Anesthesia, Intensive Care Medicine, Emergency Medicine and Pain Therapy, Vivantes Klinikum im Friedrichshain, Berlin, Germany
| | - Mario Menk
- grid.6363.00000 0001 2218 4662Charité – Universitätsmedizin Berlin, corporate Member of Freie Universität and Humboldt-Universität zu Berlin, Department of Anesthesiology and Intensive Care Medicine, Charitéplatz 1, 10117 Berlin, Germany ,grid.6363.00000 0001 2218 4662Charité – Universitätsmedizin Berlin, corporate Member of Freie Universität and Humboldt-Universität zu Berlin, Institute of Medical Informatics, Charitéplatz 1, 10117 Berlin, Germany
| | - Gerald Vorderwülbecke
- grid.6363.00000 0001 2218 4662Charité – Universitätsmedizin Berlin, corporate Member of Freie Universität and Humboldt-Universität zu Berlin, Department of Anesthesiology and Intensive Care Medicine, Charitéplatz 1, 10117 Berlin, Germany
| | - Herko Grubitzsch
- grid.6363.00000 0001 2218 4662Charité – Universitätsmedizin Berlin, corporate Member of Freie Universität and Humboldt-Universität zu Berlin, Department of Cardiovascular Surgery, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Sascha Treskatsch
- grid.6363.00000 0001 2218 4662Charité – Universitätsmedizin Berlin, corporate Member of Freie Universität and Humboldt-Universität zu Berlin, Department of Anesthesiology and Intensive Care Medicine, Hindenburgdamm 30, 12203 Berlin, Germany
| | - Felix Balzer
- grid.6363.00000 0001 2218 4662Charité – Universitätsmedizin Berlin, corporate Member of Freie Universität and Humboldt-Universität zu Berlin, Institute of Medical Informatics, Charitéplatz 1, 10117 Berlin, Germany
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Booth DE, Gopalakrishna-Remani V, Cooper ML, Green FR, Rayman MP. Boosting and lassoing new prostate cancer SNP risk factors and their connection to selenium. Sci Rep 2021; 11:17877. [PMID: 34504230 PMCID: PMC8429712 DOI: 10.1038/s41598-021-97412-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 07/05/2021] [Indexed: 11/15/2022] Open
Abstract
We begin by arguing that the often used algorithm for the discovery and use of disease risk factors, stepwise logistic regression, is unstable. We then argue that there are other algorithms available that are much more stable and reliable (e.g. the lasso and gradient boosting). We then propose a protocol for the discovery and use of risk factors using lasso or boosting variable selection. We then illustrate the use of the protocol with a set of prostate cancer data and show that it recovers known risk factors. Finally, we use the protocol to identify new and important SNP based risk factors for prostate cancer and further seek evidence for or against the hypothesis of an anticancer function for Selenium in prostate cancer. We find that the anticancer effect may depend on the SNP-SNP interaction and, in particular, which alleles are present.
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Affiliation(s)
- David E Booth
- M&IS Department, Kent State University, 595 Martinique Circle, Kent, OH, 44242, USA.
| | | | - Matthew L Cooper
- Department of Internal Medicine, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Fiona R Green
- Division of Cardiovascular Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Margaret P Rayman
- Department of Nutritional Sciences, University of Surrey, Guildford, GU27XH, UK
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Omar AS, Shoman B, Sudarsanan S, Shouman Y. Chest radiography requirements for patients with asymptomatic COVID-19 undergoing coronary artery bypass surgery: Three case reports. World J Virol 2021; 10:130-136. [PMID: 34079694 PMCID: PMC8152452 DOI: 10.5501/wjv.v10.i3.130] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 02/03/2021] [Accepted: 03/31/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus-2, represents a major challenge to health care systems both globally and regionally, with many opting by cancelling elective surgeries. Cardiac operations in patients diagnosed with COVID-19 have been imperative due to their emergency nature, critical condition of patients awaiting cardiac surgery, and accumulated number of cardiac surgical interventions throughout the last months.
CASE SUMMARY Here we describe three COVID-19 positive cases who underwent coronary surgery, on an urgent basis. We did not experience worsening of the patients’ clinical condition due to COVID-19 and therefore a routine post-operative chest X-ray (CXR) was not required. None of the health care providers attending the patients endured cross infection. Further trials would be needed in order to confirm these results.
CONCLUSION While the pandemic has adversely hit the health systems worldwide, cardiac surgical patients who concomitantly contracted COVID-19 may undergo a smooth post-operative course as a routine post-operative CXR may not be required.
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Affiliation(s)
- Amr Salah Omar
- Department of Cardiothoracic Surgery, Heart Hospital, Hamad Medical Corporation, Doha 3050, DA, Qatar
- Department of Critical Care Medicine, Beni Suef University, Beni Suef 3050, DA, Qatar
- Department of Medicine, Weill Cornell Medical College, Doha 3050, DA, Qatar
| | - Bassam Shoman
- Department of Cardiothoracic Surgery, Heart Hospital, Hamad Medical Corporation, Doha 3050, DA, Qatar
| | - Suraj Sudarsanan
- Department of Cardiothoracic Surgery, Heart Hospital, Hamad Medical Corporation, Doha 3050, DA, Qatar
| | - Yasser Shouman
- Department of Cardiothoracic Surgery, Heart Hospital, Hamad Medical Corporation, Doha 3050, DA, Qatar
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10
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Omar AS, Shoman B, Sudarsanan S, Shouman Y. Chest radiography requirements for patients with asymptomatic COVID-19 undergoing coronary artery bypass surgery: Three case reports. World J Virol 2021. [PMID: 34079694 DOI: 10.5501/wjv.v10.i3.130.] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus-2, represents a major challenge to health care systems both globally and regionally, with many opting by cancelling elective surgeries. Cardiac operations in patients diagnosed with COVID-19 have been imperative due to their emergency nature, critical condition of patients awaiting cardiac surgery, and accumulated number of cardiac surgical interventions throughout the last months. CASE SUMMARY Here we describe three COVID-19 positive cases who underwent coronary surgery, on an urgent basis. We did not experience worsening of the patients' clinical condition due to COVID-19 and therefore a routine post-operative chest X-ray (CXR) was not required. None of the health care providers attending the patients endured cross infection. Further trials would be needed in order to confirm these results. CONCLUSION While the pandemic has adversely hit the health systems worldwide, cardiac surgical patients who concomitantly contracted COVID-19 may undergo a smooth post-operative course as a routine post-operative CXR may not be required.
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Affiliation(s)
- Amr Salah Omar
- Department of Cardiothoracic Surgery, Heart Hospital, Hamad Medical Corporation, Doha 3050, DA, Qatar
| | - Bassam Shoman
- Department of Cardiothoracic Surgery, Heart Hospital, Hamad Medical Corporation, Doha 3050, DA, Qatar
| | - Suraj Sudarsanan
- Department of Cardiothoracic Surgery, Heart Hospital, Hamad Medical Corporation, Doha 3050, DA, Qatar
| | - Yasser Shouman
- Department of Cardiothoracic Surgery, Heart Hospital, Hamad Medical Corporation, Doha 3050, DA, Qatar
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11
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Ahmad I, Khan B, Ul Islam M, Jan A, Farooq O, Hassan Khan W, Ghani U. Incidence and Causes of Reintubation Other Than Reopening of the Chest in Post-Cardiac Surgical Patients in a Tertiary Care Hospital. Cureus 2021; 13:e14939. [PMID: 34123636 PMCID: PMC8189528 DOI: 10.7759/cureus.14939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective To determine the incidence of endotracheal reintubation, excluding surgical reopening, in post-cardiac surgical patients in a tertiary care hospital. Material and methods A retrospective descriptive analysis of 408 patients who underwent different cardiac surgeries during this period. Post-operative extubation was performed when patients fulfilled the preset criteria for extubation, which include consciousness (awake and aware), stable vital signs, acceptable arterial blood gases, acceptable respiratory mechanics, a maximum inspiratory force greater than 20-25 cm H2O, chest tube drainage less than 100 ml per hour, normal temperature and electrolytes. The total number of patients who were reintubated within 72 hours of extubation was noted. The criteria for reintubation included altered conscious level with Glasgow Coma Score (GCS) of less than 8, respiratory failure, unstable hemodynamics, and arrhythmias such as ventricular tachycardia (VT) and fibrillation. All of the information was collected retrospectively on a specifically prepared form. Data was entered and evaluated in Statistical Package for the Social Sciences. The research was piloted in the Cardiac Intensive Care Unit (CICU) of Northwest General Hospital and Research Center, Hayatabad, Peshawar from December 2018 to March 2020. Results Out of 408 patients who had cardiac surgeries, only nine (2.2%) were reintubated after initial extubation. The average time for which patients remained on the ventilator was 8 ± 2 hours. The reasons for reintubation were recorded. Among those reintubated, eight patients (88.88%) had undergone coronary artery bypass grafting (CABG) whereas one patient (11.11%) had undergone mitral valve replacement (MVR). In three (33.33%) patients, stroke (hemiplegia in two and global brain ischemia in one) with low GCS was the primary cause of reintubation. Arrhythmias - which included VT, ventricular fibrillation (VF), and supraventricular tachyarrhythmias (SVT) - were responsible for three (33.33%) cases of reintubation. Respiratory failure - with a partial pressure of oxygen in arterial blood less than 60 mmHg, along with tachypnea - was responsible for reintubation in two (22.22%) patients. In one (11.11%) patient who had MVR, cardiac arrest was the underlying reason; the cause of arrest could not be retrieved from the retrospective data. Notably, as a common variable, five (62.5%) out of the eight reintubated CABG patients had a poor left ventricular function. Conclusion Causes of reintubation were primarily cardiac (arrhythmias) and neurological, followed by respiratory causes in our center. Patients with poor left ventricular function and diffuse coronary artery disease appear to have a higher incidence of reintubation which can lead to extended CICU and hospital stay, elevated mortality, and higher costs.
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Affiliation(s)
- Imtiaz Ahmad
- Anesthesiology, Rehman Medical Institute, Peshawar, PAK
| | - Bahauddin Khan
- Cardiothoracic Surgery, Rehman Medical Institute, Peshawar, PAK
| | | | - Azam Jan
- Cardiothoracic Surgery, Rehman Medical Institute, Peshawar, PAK
| | - Omer Farooq
- Cardiothoracic Surgery, Rehman Medical Institute, Peshawar, PAK
| | | | - Usman Ghani
- Surgery, Hayatabad Medical Complex, Peshawar, PAK
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12
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Brookes JDL, Williams M, Mathew M, Yan T, Bannon P. Pleural effusion post coronary artery bypass surgery: associations and complications. J Thorac Dis 2021; 13:1083-1089. [PMID: 33717581 PMCID: PMC7947477 DOI: 10.21037/jtd-20-2082] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Background One of the most frequent complications of coronary artery bypass grafting (CABG) is pleural effusion. Limited previous studies have found post-CABG pleural effusion to be associated with increased length-of-stay and greater morbidity post-CABG. Despite this the associations of this common complication are poorly described. This study sought to identify modifiable risk factors for effusion post-CABG. Methods A retrospective cohort study of prospectively collected data assessed patients who underwent CABG over two-years. Data was collected for risk factors and sequelae related to pleural effusion requiring drainage. Results A total of 409 patients were included. Average age was 64.9±10.2 years, 330 (80.7%) were male. 59 (14.4%) patients underwent drainage of pleural effusion post-CABG. Effusions were drained on average 9.9±8.4 days post-CABG. Earlier removal of drain tubes and removal near time of extubation were associated with development of pleural effusion. Post-CABG pleural effusion was associated with post-operative renal impairment (P<0.01) and pericardial effusion (P<0.01). Patients with pleural effusion were more likely to require readmission to ICU (P<0.01), reintubation (P=0.03) and readmission to hospital (P=0.03). Conclusions Pleural effusion is a common complication of cardiac surgery and is associated with significant morbidity and resource utilization. This study identifies several associated complications that should be considered in the presence of pleural effusion. Modifiable associated factors in the management of drains that may contribute to accumulation of pleural effusion include: early removal of chest drains, higher outputs and removal during or close to mechanical ventilation. Further research is required to assess how adjusting these modifiable factors can decrease rates of effusion post-operatively.
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Affiliation(s)
- John D L Brookes
- Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, New South Wales, Australia
| | - Michael Williams
- Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, New South Wales, Australia.,Sydney Medical School, The University of Sydney, New South Wales, Australia
| | - Manish Mathew
- Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, New South Wales, Australia
| | - Tristan Yan
- Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, New South Wales, Australia.,Sydney Medical School, The University of Sydney, New South Wales, Australia.,Professor of Cardiovascular and Thoracic Surgery, Macquarie University, New South Wales, Australia.,Clinical Professor of Surgery, Faculty of Medicine, The University of Sydney, New South Wales, Australia.,The Baird Institute, Newtown, New South Wales, Australia
| | - Paul Bannon
- Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, New South Wales, Australia.,Sydney Medical School, The University of Sydney, New South Wales, Australia.,The Baird Institute, Newtown, New South Wales, Australia.,Bosch Professor of Surgery, Faculty of Medicine, The University of Sydney, New South Wales, Australia
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13
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Abstract
Cardiothoracic surgery posits an arrangement of large, significant hemodynamic, and physiologic alterations upon the human body, which predisposes a patient to develop pathology. The care of these patients in the postoperative realm requires an astute physician with deep understanding of the cardiopulmonary system, who is able to address subtle developing problems promptly, before the patient suffers further sequelae. In this review, we describe the presentation and management of an assortment of important complications which occur in the pulmonary system. In addition, we aim to shed better light upon how the physiology of a patient responds to the condition of cardiothoracic surgery.
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14
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Rodriguez Lima DR, Yepes AF, Birchenall Jiménez CI, Mercado Díaz MA, Pinilla Rojas DI. Real-time ultrasound-guided thoracentesis in the intensive care unit: prevalence of mechanical complications. Ultrasound J 2020; 12:25. [PMID: 32337606 PMCID: PMC7184066 DOI: 10.1186/s13089-020-00172-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 04/16/2020] [Indexed: 12/29/2022] Open
Abstract
Background The use of thoracic ultrasound during thoracentesis reduces complications. The aim of this study was to determine the prevalence of complications for real-time ultrasound-guided thoracentesis performed by intensivists. As a secondary objective, the change in oxygenation before and after the procedure was evaluated. Patients and methods An observational prospective study was conducted. A total of 81 cases of real-time ultrasound-guided thoracentesis performed by intensivists in the intensive care unit (ICU) of Méderi Major University Hospital, Bogotá, Colombia, between August 2018 and August 2019 were analyzed. Thoracentesis performed by interventional radiologists and using techniques different from the focus of this study were excluded from the analysis. Results There was one pneumothorax, for a prevalence rate of mechanical complications in this population of 1.2%. The mean partial oxygen pressure to inspired oxygen fraction ratio (PaO2/FiO2) prior to the procedure was 198.1 (95% CI 184.75–211.45), with a PaO2/FiO2 after the procedure of 224.6 (95% CI 213.08–226.12) (p < 0.05). Conclusions Real-time ultrasound-guided thoracentesis performed by intensivists is a safe procedure and leads to a significant improvement in oxygenation rates. Future studies are required to determine the impact of these results on other outcomes, such as mortality, ICU stay, and days of mechanical ventilation.
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Affiliation(s)
- David Rene Rodriguez Lima
- Emergency Medicine and Critical and Intensive Care Medicine, Hospital Universitario Mayor Méderi-Universidad del Rosario, Bogotá, Colombia.
| | - Andrés Felipe Yepes
- Critical and Intensive Care Medicine, Hospital Universitario Mayor Méderi-Universidad del Rosario, Bogotá, Colombia
| | | | - Mario Andrés Mercado Díaz
- Critical and Intensive Care Medicine, Hospital Universitario Mayor Méderi-Universidad del Rosario, Bogotá, Colombia
| | - Darío Isaías Pinilla Rojas
- Critical and Intensive Care Medicine, Hospital Universitario Mayor Méderi-Universidad del Rosario, Bogotá, Colombia
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15
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Weiss MG, Møller JE, Dahl JS, Riber L, Sibilitz KL, Lykking EK, Borregaard B. Causes and characteristics associated with early and late readmission after open-heart valve surgery. J Card Surg 2020; 35:747-754. [PMID: 32048362 DOI: 10.1111/jocs.14460] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVES The objectives of the study were to describe the causes of readmission from discharge to 30 days and from day 31 to 180 after discharge and to investigate the characteristics associated with overall and cause-specific readmissions after open-heart valve surgery. METHODS A single-center, retrospective cohort of 980 patients undergoing open-heart valve surgery from 2013 to 2016. Time to the first readmission was analyzed using univariable and multivariable Cox proportional hazard models. Results are reported as hazard ratios (HR) with 95% confidence intervals (CI). RESULTS In total, 366 patients (37%) experienced unplanned cardiac readmission within 180 days after discharge. Within 30 days after discharge, the most frequent causes of readmission were pericardial/pleural effusions (n = 87), infections (n = 50), and atrial fibrillation/flutter (n = 45). Accordingly, infections (n = 32) were the most common cause from day 31 to 180. No powerful predictors of overall cardiac readmission were identified, but several characteristics were associated with cause-specific readmissions: age ≤65 years (HR: 1.85; CI: 1.18-2.88), male gender (HR: 1.85; CI: 1.11-3.09), high alcohol intake (HR: 1.99; CI: 1.22-3.24) and mitral valve procedures (HR: 1.86; CI: 1.11-3.10) were associated with readmissions due to effusions. Ischemic heart disease with a prior percutaneous coronary intervention (HR: 2.94; CI: 1.53-5.63), mitral valve procedures (HR: 2.10; CI: 1.23-3.59), and postoperative atrial fibrillation/flutter (HR: 1.71; CI: 1.03-2.85) were associated with atrial fibrillation/flutter readmissions. CONCLUSION Predicting overall readmissions after open-heart valve surgery is difficult as causes of readmissions vary and different causes are associated with different characteristics. Future studies should target reducing cause-specific readmissions.
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Affiliation(s)
- Marc G Weiss
- Department of Cardiothoracic and Vascular Surgery, Odense University Hospital, Odense, Denmark
| | - Jacob E Møller
- Department of Cardiology, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark.,Department of Cardiology, Centre for Cardiac, Vascular, Pulmonary and Infectious Diseases, Rigshospitalet, Copenhagen, Denmark
| | - Jordi S Dahl
- Department of Cardiology, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Lars Riber
- Department of Cardiothoracic and Vascular Surgery, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Kirstine L Sibilitz
- Department of Cardiology, Centre for Cardiac, Vascular, Pulmonary and Infectious Diseases, Rigshospitalet, Copenhagen, Denmark
| | - Emilie K Lykking
- Department of Cardiothoracic and Vascular Surgery, Odense University Hospital, Odense, Denmark
| | - Britt Borregaard
- Department of Cardiothoracic and Vascular Surgery, Odense University Hospital, Odense, Denmark.,Department of Cardiology, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
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16
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Van Linden A, Hecker F, Courvoisier DS, Arsalan M, Köhne J, Brei C, Holubec T, Walther T. Reduction of drainage-associated complications in cardiac surgery with a digital drainage system: a randomized controlled trial. J Thorac Dis 2019; 11:5177-5186. [PMID: 32030235 DOI: 10.21037/jtd.2019.12.20] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Background Thoracic chest drains are placed after cardiac surgery allowing for the clearance of blood, fluid, and air to prevent post-operative complications. Despite its importance, there is little data on the application of digital chest drainage systems in cardiac surgery. Therefore, the differences between an analog and a digital chest drainage system in cardiac surgery patients were investigated in a randomized controlled trial. Methods A total of 354 elective cardiac surgery patients were preoperatively randomized 1:1 between September 2016 and September 2017 to either an analog (Ocean) or a digital (Thopaz+) chest drainage system aiming to compare drainage-associated postoperative outcome parameters. Results A total of 340 patients were included in the analysis (analog: 188; digital: 152) with no significant differences in preoperative baseline parameters. Incidence of X-rays to detect air leaks was significantly lower in the digital group (analog: 20.2%; digital: 8.6%; P<0.01). Patients treated with the digital system showed a 3.3% reduction of re-thoracotomies, however, not statistically significant (analog: 5.3%; digital: 2.0%; P=0.19). Median total fluid amount did not significantly differ between study groups [median (P25; P75); analog: 705 (400; 1,333) mL; digital: 686 (404; 1,229) mL; P=0.83]; however, the use of the digital drainage system resulted in a quicker removal with a reduced median drainage duration of 16 hours (analog: 65 hours; digital: 49 hours; P≤0.01). Conclusions The study provides evidence that digital drainage systems can be safely applied in cardiac surgery patients. The use of the digital management system led to a decreased incidence of drainage-associated complications as well as to shortened chest tube duration. Findings require confirmation by additional studies.
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Affiliation(s)
- Arnaud Van Linden
- Department of Cardiothoracic and Vascular Surgery, Goethe University Hospital Frankfurt, Frankfurt, Germany
| | - Florian Hecker
- Department of Cardiothoracic and Vascular Surgery, Goethe University Hospital Frankfurt, Frankfurt, Germany
| | | | - Mani Arsalan
- Department of Cardiothoracic and Vascular Surgery, Goethe University Hospital Frankfurt, Frankfurt, Germany
| | - Josepha Köhne
- Department of Cardiac Surgery, Kerckhoff Clinic, Bad Nauheim, Germany
| | - Christina Brei
- Medela Medizintechnik GmbH & Co. Handels KG, Dietersheim, Germany
| | - Tomas Holubec
- Department of Cardiothoracic and Vascular Surgery, Goethe University Hospital Frankfurt, Frankfurt, Germany
| | - Thomas Walther
- Department of Cardiothoracic and Vascular Surgery, Goethe University Hospital Frankfurt, Frankfurt, Germany
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17
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Baribeau Y, Westbrook B, Baribeau Y, Maltais S, Boyle EM, Perrault LP. Active clearance of chest tubes is associated with reduced postoperative complications and costs after cardiac surgery: a propensity matched analysis. J Cardiothorac Surg 2019; 14:192. [PMID: 31703606 PMCID: PMC6842236 DOI: 10.1186/s13019-019-0999-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 09/20/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Chest tubes are routinely used to evacuate shed mediastinal blood in the critical care setting in the early hours after heart surgery. Inadequate evacuation of shed mediastinal blood due to chest tube clogging may result in retained blood around the heart and lungs after cardiac surgery. The objective of this study was to compare if active chest tube clearance reduces the incidence of retained blood complications and associated hospital resource utilization after cardiac surgery. METHODS Propensity matched analysis of 697 consecutive patients who underwent cardiac surgery at a single center. 302 patients served as a baseline control (Phase 0), 58 patients in a training and compliance verification period (Phase 1) and 337 were treated prospectively using active tube clearance (Phase 2). The need to drain retained blood, pleural effusions, postoperative atrial fibrillation, ICU resource utilization and hospital costs were assessed. RESULTS Propensity matched patients in Phase 2 had a reduced need for drainage procedures for pleural effusions (22% vs. 8.1%, p < 0.001) and reduced postoperative atrial fibrillation (37 to 25%, P = 0.011). This corresponded with fewer hours in the ICU (43.5 [24-79] vs 30 [24-49], p = < 0.001), reduced median postoperative length of stay (6 [4-8] vs 5 [4-6.25], p < 0.001) median costs reduced by $1831.45 (- 3580.52;82.38, p = 0.04) and the mean costs reduced by an average of $2696 (- 6027.59;880.93, 0.116). CONCLUSIONS This evidence supports the concept that efforts to actively maintain chest tube patency in early recovery is useful in improving outcomes and reducing resource utilization and costs after cardiac surgery. TRIAL REGISTRATION Clinicaltrial.gov, NCT02145858, Registered: May 23, 2014.
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Affiliation(s)
- Yvon Baribeau
- Department of Cardiac Surgery, New England Heart and Vascular Institute, Catholic Medical Center, 100 McGregor St, Manchester, NH, 03102, USA.
| | - Benjamin Westbrook
- Department of Cardiac Surgery, New England Heart and Vascular Institute, Catholic Medical Center, 100 McGregor St, Manchester, NH, 03102, USA
| | - Yanick Baribeau
- Department of Anesthesia and Critical Care, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Simon Maltais
- Department of Cardiothoracic Surgery, Centre Hospitalier Universitaire de Montréal, Montreal, Canada
| | - Edward M Boyle
- Department of Thoracic Surgery, St. Charles Medical Center, Bend, OR, USA
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18
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Kiss R, Farkas N, Jancso G, Kovacs K, Lenard L. Determination of frail state and association of frailty with inflammatory markers among cardiac surgery patients in a Central European patient population. Clin Hemorheol Microcirc 2019; 76:341-350. [PMID: 31683468 DOI: 10.3233/ch-190681] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
INTRODUCTION With the aging of the population, the screening of frail patients, especially before high-risk surgery, come to the fore. The background of the frail state is not totally clear, most likely inflammatory processes are involved in the development. METHODS Our survey of patients over age of 65 who were on cardiac surgery were performed with Edmonton Frail Scale (EFS). Patients' demographic, perioperative data, incidence of complications and correlations of inflammatory laboratory parameters were studied with the severity of the frail state. RESULTS On the basis of EFS, 313 patients were divided into non-frail (NF,163,52%), pre-frail (PF,89,28.5%) and frail (F,61,19.5%) groups. Number of complications in the three groups were different (NF:0.67/patient, PF:0.76/patient, F:1.08/patient). We showed significant difference between NF and F in both intensive care and hospital stay, but there was no statistical difference between the groups in hospital deaths (NF:5/163, PF:3/89, F:5/61). We also found a significant difference between NF and F patients in preoperative fibrinogen-, CRP- and white blood cell count levels. CONCLUSIONS We first present the incidence of frailty in patients with heart surgery in a Central-European population. According to our results, inflammatory processes are likely to play a role in the development of the frail state.
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Affiliation(s)
- Rudolf Kiss
- Heart Institute, Medical School, University of Pécs, Pécs, Hungary, and Szentágothai Research Centre, University of Pécs, Pécs, Hungary
| | - Nelli Farkas
- Institute of Bioanalysis, Medical School, University of Pécs, Pécs, Hungary
| | - Gabor Jancso
- Department of Surgical Research and Techniques, Medical School, University of Pécs, Pécs, Hungary
| | - Krisztina Kovacs
- Department of Biochemistry and Medical Chemistry, Medical School, University of Pécs, Pécs, Hungary
| | - Laszlo Lenard
- Heart Institute, Medical School, University of Pécs, Pécs, Hungary, and Szentágothai Research Centre, University of Pécs, Pécs, Hungary
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19
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Motono N, Iwai S, Funasaki A, Sekimura A, Usuda K, Uramoto H. What is the allowed volume threshold for chest tube removal after lobectomy: A randomized controlled trial. Ann Med Surg (Lond) 2019; 43:29-32. [PMID: 31194145 PMCID: PMC6551566 DOI: 10.1016/j.amsu.2019.05.011] [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: 01/26/2019] [Revised: 05/18/2019] [Accepted: 05/24/2019] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION The management of chest tubes and the volume threshold for chest tube removal after pulmonary resection remain controversial. Several studies have reported the volume threshold for chest tube removal following pulmonary resection to range from 200 to 450 mL/24 h. METHODS A prospective randomized single-blind clinical study was performed with data collected from patients who had undergone lobectomy and lymph node dissection at our hospital between June 2014 and April 2018. The patients were randomly assigned to the High group (removal of chest tube when drainage was <450 mL/24 h) or Low group (removal of chest tube when drainage was <200 mL/24 h) at postoperative day (POD) 2. The primary end point was drainage time. The secondary end point were complications and rate of thoracentesis. RESULTS Seventy patients met the inclusion criteria and were randomized, with 35 patients assigned to the High group and 35 patients to the Low group. The average duration of chest tube placement was 2.05 days in the High group and 2.31 days in the Low group. The duration of chest tube placement in the High group was significantly shorter than that in the Low group (p = 0.02). There were no major postoperative complications in either group. Thoracentesis was not necessary in either group. CONCLUSION Pleural effusion of 450 mL/day is tolerable as the volume threshold for the removal of a chest tube after pulmonary resection.
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Affiliation(s)
- Nozomu Motono
- Department of Thoracic Surgery, Kanazawa Medical University, 1-1 Daigaku, Uchinada, Ishikawa, 920-0293, Japan
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20
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Yu P, Lin D, Catalano M, Cassiere H, Manetta F, Kohn N, Hartman A. Impact of novel oral anticoagulants vs warfarin on effusions after coronary artery bypass grafting. J Card Surg 2019; 34:419-423. [DOI: 10.1111/jocs.14054] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 03/21/2019] [Accepted: 03/26/2019] [Indexed: 01/24/2023]
Affiliation(s)
- Pey‐Jen Yu
- Division of Cardiovascular and Thoracic SurgeryZucker School of Medicine at Hofstra/NorthwellManhasset New York
| | - Dishen Lin
- Division of Cardiovascular and Thoracic SurgeryZucker School of Medicine at Hofstra/NorthwellManhasset New York
| | - Michael Catalano
- Division of Cardiovascular and Thoracic SurgeryZucker School of Medicine at Hofstra/NorthwellManhasset New York
| | - Hugh Cassiere
- Division of Cardiovascular and Thoracic SurgeryZucker School of Medicine at Hofstra/NorthwellManhasset New York
| | - Frank Manetta
- Division of Cardiovascular and Thoracic SurgeryZucker School of Medicine at Hofstra/NorthwellManhasset New York
| | - Nina Kohn
- Department of BiostatisticsThe Feinstein Institute for Medical ResearchManhasset New York
| | - Alan Hartman
- Division of Cardiovascular and Thoracic SurgeryZucker School of Medicine at Hofstra/NorthwellManhasset New York
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21
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Ahmed OF, kakamad FH, Al-Neaimy SY, Salih RQ, Mohammed SH, Salih AM. Outcome of combined coronary artery bypass grafting and aortic valve replacement; a case series. INTERNATIONAL JOURNAL OF SURGERY OPEN 2019. [DOI: 10.1016/j.ijso.2019.11.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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22
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Coronary artery bypass graft surgery complications: A review for emergency clinicians. Am J Emerg Med 2018; 36:2289-2297. [PMID: 30217621 DOI: 10.1016/j.ajem.2018.09.014] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 09/05/2018] [Accepted: 09/07/2018] [Indexed: 01/28/2023] Open
Abstract
INTRODUCTION Coronary artery bypass graft (CABG) surgery remains a high-risk procedure, and many patients require emergency department (ED) management for complications after surgery. OBJECTIVE This narrative review provides an evidence-based summary of the current data for the emergency medicine evaluation and management of post-CABG surgery complications. DISCUSSION While there has been a recent decline in all cardiac revascularization procedures, there remains over 200,000 CABG surgeries performed in the United States annually, with up to 14% of these patients presenting to the ED within 30 days of discharge with post-operative complications. Risk factors for perioperative mortality and morbidity after CABG surgery can be divided into three categories: patient characteristics, clinician characteristics, and postoperative factors. Emergency physicians will be faced with several postoperative complications, including sternal wound infections, pneumonia, thromboembolic phenomena, graft failure, atrial fibrillation, pulmonary hypertension, pericardial effusion, strokes, renal injury, gastrointestinal insults, and hemodynamic instability. Critical patients should be evaluated in the resuscitation bay, and consultation with the primary surgical team is needed, which improves patient outcomes. This review provides several guiding principles for management of acute complications. Understanding these complications and an approach to the management of hemodynamic instability is essential to optimizing patient care. CONCLUSIONS Postoperative complications of CABG surgery can result in significant morbidity and mortality. Physicians must rapidly diagnose these conditions while evaluating for other diseases. Early surgical consultation is imperative, as is optimizing the patient's hemodynamics, including preload, heart rate, cardiac rhythm, contractility, and afterload.
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23
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Song IK, Kim EH, Lee JH, Kang P, Kim HS, Kim JT. Utility of Perioperative Lung Ultrasound in Pediatric Cardiac Surgery. Anesthesiology 2018; 128:718-727. [DOI: 10.1097/aln.0000000000002069] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Abstract
Background
Pediatric cardiac patients are at risk for perioperative respiratory insufficiency. The objective of this study was to assess the utility of perioperative lung ultrasound examination in pediatric cardiac surgery.
Methods
In this randomized, controlled trial, children (5 yr old or younger) undergoing cardiac surgery were allocated into a control (n = 61) or intervention (n = 61) group. The control group received only lung ultrasound examinations at the end of surgery and 6 to 12 h after surgery. The intervention group received lung ultrasound examinations and an ultrasound-guided recruitment maneuver depending on ultrasound findings after inducing anesthesia, at the end of surgery, and 6 to 12 h after surgery. Primary outcomes were incidences of intra- and postoperative desaturation, and postoperative pulmonary complications. Multiple comparisons were corrected (P ≤ 0.017) in the primary outcome analysis.
Results
Of the 120 children included in the analysis, postoperative desaturation (64% vs. 27%; P < 0.001; odds ratio [OR], 0.210; 95% CI, 0.097 to 0.456) occurred more in the control group. The incidences of intraoperative desaturation (36% vs. 19%; P = 0.033; OR, 0.406; 95% CI, 0.176 to 0.939) and postoperative pulmonary complications (12% vs. 3%; P = 0.093; OR, 0.271; 95% CI, 0.054 to 1.361) were similar between the groups. Lung ultrasound scores were better in the intervention group than in the control group. Duration of mechanical ventilation was longer in the control group than in the intervention group (38 ± 43 vs. 26 ± 25 h; 95% CI of mean difference, 0 to 25; P = 0.048).
Conclusions
Perioperative lung ultrasound examination followed by ultrasound-guided recruitment maneuver helped decrease postoperative desaturation events and shorten the duration of mechanical ventilation in pediatric cardiac patients.
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Affiliation(s)
- In-Kyung Song
- From the Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (I.-K.S.); and the Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea (E.-H.K., J.-H.L., P.K., H.-S.K., J.-T.K.)
| | - Eun-Hee Kim
- From the Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (I.-K.S.); and the Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea (E.-H.K., J.-H.L., P.K., H.-S.K., J.-T.K.)
| | - Ji-Hyun Lee
- From the Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (I.-K.S.); and the Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea (E.-H.K., J.-H.L., P.K., H.-S.K., J.-T.K.)
| | - Pyoyoon Kang
- From the Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (I.-K.S.); and the Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea (E.-H.K., J.-H.L., P.K., H.-S.K., J.-T.K.)
| | - Hee-Soo Kim
- From the Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (I.-K.S.); and the Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea (E.-H.K., J.-H.L., P.K., H.-S.K., J.-T.K.)
| | - Jin-Tae Kim
- From the Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (I.-K.S.); and the Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea (E.-H.K., J.-H.L., P.K., H.-S.K., J.-T.K.)
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Siddiqui KM, Samad K, Jonejo F, Khan MF, Ahsan K. Factors affecting reintubations after cardiac and thoracic surgeries in cardiac intensive care unit of a tertiary care hospital. Saudi J Anaesth 2018; 12:256-260. [PMID: 29628837 PMCID: PMC5875215 DOI: 10.4103/sja.sja_631_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background Reintubation and readmission after cardiothoracic surgeries are not uncommon, and its reasons are multifactorial. The study goal was to identify the factors that contribute reintubation after cardiac and thoracic surgery in tertiary care hospital and to compare the outcome with international benchmark. Methodology A prospective, observational study was planned in Cardiac Intensive Care Unit (CICU). The study included all those patients who required readmission in CICU due to endotracheal intubation following cardiac and thoracic surgeries. The study was conducted from January to December 2016. The primary focus was to identify the reasons for reintubation within 72 h of extubation after CICU discharge and its association with outcome. Results Out of 750 patients who shifted out from CICU following successful extubation, only 32 were readmitted and among them in 25 patients (3.33%) were reintubated and their reasons reintubation were noted. Patients underwent a coronary artery bypass grafting (CABG) with valve replacement had a higher incidence of reintubation 3/39 (7.69%) when compared with CABG 13/517 (2.51%) and 4/135 (2.96%) valve procedure alone. Single cause of endotracheal reintubation was observed in 7 patients (28%), in which 5 patients (20%) had respiratory and 2 patients had (8%) cardiac reason while 18 patients (72%) were observed with multisystem involvement, in which 7 patients (28%) had both respiratory and cardiovascular causes, and 2 (8%) had both respiratory and neurological causes. More than 70% cause of endotracheal reintubation was both respiratory and cardiovascular. The CICU stay after reintubations was 12.88 ± 16.88 days and the hospital stay prolonged to 23.84 ± 21.61 days. Conclusion Reasons of reintubation were mainly respiratory and cardiac. The rate of reintubations is high when multisystem involvement is there. CICU, hospital stay, and mortality are increases after reintubation.
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Affiliation(s)
| | - Khalid Samad
- Department of Anaesthesiology, Aga Khan University, Karachi, Pakistan
| | - Faisal Jonejo
- Department of Anaesthesiology, Aga Khan University, Karachi, Pakistan
| | | | - Khalid Ahsan
- Department of Anaesthesiology, Aga Khan University, Karachi, Pakistan
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Active Clearance of Chest Tubes Reduces Re-Exploration for Bleeding After Ventricular Assist Device Implantation. ASAIO J 2017; 62:704-709. [PMID: 27556153 PMCID: PMC5098460 DOI: 10.1097/mat.0000000000000437] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Chest tubes are utilized to evacuate shed blood after left ventricular assist device (LVAD) implantation, however, they can become clogged, leading to retained blood. We implemented a protocol for active tube clearance (ATC) of chest tubes to determine if this might reduce interventions for retained blood. A total of 252 patients underwent LVAD implantation. Seventy-seven patients had conventional chest tube drainage (group 1), whereas 175 patients had ATC (group 2). A univariate and multivariate analysis adjusting for the use of conventional sternotomy (CS) and minimally invasive left thoracotomy (MILT) was performed. Univariate analysis revealed a 65% reduction in re-exploration (43-15%, p < 0.001), and an 82% reduction in delayed sternal closure (DSC; 34-6%, p <0.001). In a sub-analysis of CS only, there continued to be statistically significant 53% reduction in re-exploration (45% vs. 21%, p = 0.0011), and a 77% reduction in DSC (35% vs. 8%, p < 0.001) in group 2. Using a logistic regression model adjusting for CS versus MILT, there was a significant reduction in re-exploration (odds ratio [OR] = 0.44 [confidence interval {CI} = 0.23-0.85], p = 0.014) and DSC (OR = 0.20 [CI = 0.08-0.46], p <0.001) in group 2. Actively maintaining chest tube patency after LVAD implantation significantly reduces re-exploration and DSC.
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Morabito J, Bell MT, Montenij LJ, Mayes LM, Pan Z, Dieleman JM, Meguid RA, Bartels K. Perioperative Considerations for Chylothorax. J Cardiothorac Vasc Anesth 2017; 31:2277-2281. [PMID: 28939323 DOI: 10.1053/j.jvca.2017.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Indexed: 11/11/2022]
Affiliation(s)
- Joseph Morabito
- Department of Anesthesiology, University of Colorado Denver, Aurora, CO
| | - Marshall T Bell
- Department of Surgery, Division of Cardiothoracic Surgery, University of Colorado Denver, Aurora, CO
| | - Leon J Montenij
- Department of Anesthesiology and Intensive Care, University Medical Center, Utrecht, The Netherlands
| | - Lena M Mayes
- Department of Anesthesiology, University of Colorado Denver, Aurora, CO
| | - Zenggang Pan
- Department of Pathology, University of Colorado Denver, Aurora, CO
| | - Jan M Dieleman
- Department of Anesthesiology and Intensive Care, University Medical Center, Utrecht, The Netherlands
| | - Robert A Meguid
- Department of Surgery, Division of Cardiothoracic Surgery, University of Colorado Denver, Aurora, CO
| | - Karsten Bartels
- Department of Anesthesiology, University of Colorado Denver, Aurora, CO.
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Fiorelli A, Caronia F, Prencipe A, Santini M, Stiles B. The role of video-assisted thoracoscopic surgery for management of symptomatic pleural effusion after coronary artery bypass surgery: a best evidence topic report. J Thorac Dis 2017; 9:2339-2343. [PMID: 28932537 DOI: 10.21037/jtd.2017.06.119] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
A best evidence topic in thoracic surgery was written addressing whether video-assisted thoracoscopic surgery (VATS) talc pleurodesis could be justified in patients with pleural effusion (PE) after coronary artery bypass graft (CABG) surgery and no-responded to repeated thoracentesis. Ten papers were identified to answer the question. Of these, two were case-series study including ≥4 patients, 7 retrospective analytical studies, and one observational study but no randomized controlled trial (RCTs) was included in the analysis. The score of the level of evidence was low; only one study presented a level of evidence of 2, 7 studies a level of 3b; and two studies a level of evidence of 4. The incidence of symptomatic post-CABG PE ranged from 2% to 9.7%. Management strategies included medical management, thoracentesis, and/or surgical drainage. Most of the authors treated early and late PE with thoracentesis or chest drainage, while VATS with pleurodesis was reserved only for selected patients with persistent effusion after repeating thoracentesis and/or chest drainage. All studies but one do not include follow-up, thus rendering it difficult to define the real role of thoracentesis or chest drainage as definitive treatments for effusion, given the incomplete data regarding how many patients' effusions recur. Conversely, with follow up reported, no case of recurrence was found after VATS procedure. In patients who underwent delayed VATS, it was common to identify the formation of tenacious peel that trapped the lung. In three cases conversion to thoracotomy was required to decorticate the inflammatory peel that covered the pleura and did not allow the lung re-expansion. However, only five papers showed that VATS for management of post-CABG PEs is safe and efficacious and its use could help to prevent trapped lung through the resection of adhesions and loculations sometimes associated with multiple previous thoracentesis or chest drainage. As the low grade of evidence from the present analysis, future randomized controlled studies are wanted to define the real effectiveness of VATS in this field.
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Affiliation(s)
- Alfonso Fiorelli
- Thoracic Surgery Unit, Università della Campania Luigi Vanvitelli, Naples, Italy
| | - Francesco Caronia
- Thoracic Surgery Unit, Istituto Oncologico del Mediterraneo, Catania, Italy
| | - Aldo Prencipe
- Cardio-thoracic Surgery Unit, Spedali Civili di Brescia, Brescia, Italy
| | - Mario Santini
- Thoracic Surgery Unit, Università della Campania Luigi Vanvitelli, Naples, Italy
| | - Brendon Stiles
- Department of Cardiothoracic Surgery, NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York, NY, USA
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Abo Elnasr M, Arafat AA, Abdel Wahab A, Taha AHM. Intercostal versus subxiphoid approach for pleural drainage post coronary artery bypass grafting. ACTA ACUST UNITED AC 2017. [DOI: 10.1016/j.jescts.2017.01.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Characteristics of Pleural Effusions in Acute Idiopathic Pericarditis and Post-Cardiac Injury Syndrome. Ann Am Thorac Soc 2016; 13:298-300. [PMID: 26848607 DOI: 10.1513/annalsats.201510-668le] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Balzer F, von Heymann C, Boyle EM, Wernecke KD, Grubitzsch H, Sander M. Impact of retained blood requiring reintervention on outcomes after cardiac surgery. J Thorac Cardiovasc Surg 2016; 152:595-601.e4. [PMID: 27210474 DOI: 10.1016/j.jtcvs.2016.03.086] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Revised: 03/06/2016] [Accepted: 03/18/2016] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Evacuation of shed blood from around the heart and lungs is a critical requirement for patients in early recovery after cardiac surgery. Incomplete evacuation of shed blood can result in retained blood, which may require subsequent reinterventions to facilitate recovery. The purpose of this study was to determine the incidence of retained blood requiring reintervention and examine the impact on outcomes. METHODS We performed a cross-sectional, observational study of all adult patients undergoing cardiac surgery between 2006 and 2013. Subjects who required an intervention to remove blood, blood clot, or bloodily fluid were attributed to the retained blood group. These patients were compared with those not presenting with any of the defined criteria for retained blood. Multivariate regression was performed to account for confounders. RESULTS Of 6909 adult patients who underwent cardiac surgery, 1316 (19%) presented with a retained blood-related condition. Retained blood was associated with increased in-hospital mortality (odds ratio [OR], 4.041; 95% confidence interval [CI], 2.589-6.351, P < .001) and a length of stay more than 13 days in the hospital (OR, 3.853; 95% CI, 2.882-5.206; P < .001) and 5 days in the intensive care unit (OR, 4.602; 95% CI, 3.449-6.183; P < .001). The OR for a time of ventilation greater than 23 hours was 3.596 (95% CI, 2.690-4.851; P < .001) and for incidence of renal replacement therapy was 4.449 (95% CI, 3.188-6.226; P < .001). CONCLUSIONS Postoperative retained blood is a common outcome and associated with higher in-hospital mortality, longer intensive care unit and hospital stay, and higher incidence of renal replacement therapy. Further research is needed to validate these results and explore interventions to reduce these complications.
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Affiliation(s)
- Felix Balzer
- Department of Anesthesiology and Intensive Care Medicine, Campus Charité Mitte and Campus Virchow-Klinikum, Charité - Universitätsmedizin, Berlin, Germany.
| | - Christian von Heymann
- Department of Anesthesiology and Intensive Care Medicine, Campus Charité Mitte and Campus Virchow-Klinikum, Charité - Universitätsmedizin, Berlin, Germany; Department of Anesthesiology, Intensive Care Medicine, Emergency and Pain Medicine, Vivantes Klinikum im Friedrichshain, Berlin, Germany
| | | | - Klaus D Wernecke
- Charité - Universitätsmedizin Berlin and SOSTANA GmbH, Berlin, Germany
| | - Herko Grubitzsch
- Department of Cardiovascular Surgery, Campus Charité Mitte, Charité - Universitätsmedizin, Berlin, Germany
| | - Michael Sander
- Department of Anesthesiology and Intensive Care Medicine, Campus Charité Mitte and Campus Virchow-Klinikum, Charité - Universitätsmedizin, Berlin, Germany; Department of Anesthesiology and Intensive Care Medicine, Universitätsklinikum Giessen und Marburg GmbH, Giessen, Germany
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Active clearance of chest drainage catheters reduces retained blood. J Thorac Cardiovasc Surg 2016; 151:832-838.e2. [DOI: 10.1016/j.jtcvs.2015.10.015] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Revised: 10/01/2015] [Accepted: 10/10/2015] [Indexed: 11/23/2022]
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Forouzannia SK, Sarvi A, Sarebanhassanabadi M, Nafisi-Moghadam R. Elimination of routine chest radiographs following off-pump coronary artery bypass surgery: A randomized controlled trial study. Adv Biomed Res 2015; 4:236. [PMID: 26682202 PMCID: PMC4673704 DOI: 10.4103/2277-9175.167966] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Accepted: 09/09/2014] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Post cardiac surgery routine chest radiographs (CXRs), ordered without any clinical and laboratory indications, is a standard obligatory practice in many cardiothoracic centers. Routine CXRs incur cost, manpower, and radiation. The objective of this study is to assess early outcome in off-pump coronary artery bypass (OPCAB) patients with postoperative routine versus clinically indicated CXR protocols. MATERIALS AND METHODS This study is a randomized clinical trial conducted on 231 OPCAB candidates in Afshar Cardiac Center, Yazd, Iran. Patients were categorized into two groups. All 118 patients in group A had routine postoperative CXRs. The 113 patients in group B were selectively exposed to CXR only on clinical indications. All patients were postoperatively followed up for 30 days. Data gathered from both groups were statistically analyzed. RESULTS Routine postoperative CXRs obtained in 118 OPCAB group A candidates showed abnormal findings in 20 patients that did not require new intervention. One month follow-up of these patients showed no complications. In 113 OPCAB candidates of group B, 7 on-demand CXRs were obtained on clinical evaluation that required added intervention. In a 1-month follow-up of this group, five patients presented with symptomatic complaints. On re-examination, none needed readmission, intervention, or paraclinical evaluation. No complications were observed due to CXR elimination. CONCLUSION The study suggests that postoperative CXR selected on clinical grounds in place of routine CXR does not change early postoperative outcome of OPCAB procedure.
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Affiliation(s)
| | - Ali Sarvi
- Department of Medicine, Islamic Azad University, Yazd Branch, Yazd, Iran
| | | | - Reza Nafisi-Moghadam
- Department of Radiology, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
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Brims FJH, Davies MG, Elia A, Griffiths MJD. The effects of pleural fluid drainage on respiratory function in mechanically ventilated patients after cardiac surgery. BMJ Open Respir Res 2015; 2:e000080. [PMID: 26339492 PMCID: PMC4554963 DOI: 10.1136/bmjresp-2015-000080] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Revised: 04/10/2015] [Accepted: 04/13/2015] [Indexed: 01/01/2023] Open
Abstract
Background Pleural effusions occur commonly after cardiac surgery and the effects of drainage on gas exchange in this population are not well established. We examined pulmonary function indices following drainage of pleural effusions in cardiac surgery patients. Methods We performed a retrospective study examining the effects of pleural fluid drainage on the lung function indices of patients recovering from cardiac surgery requiring mechanical ventilation for more than 7 days. We specifically analysed patients who had pleural fluid removed via an intercostal tube (ICT: drain group) compared with those of a control group (no effusion, no ICT). Results In the drain group, 52 ICTs were sited in 45 patients. The mean (SD) volume of fluid drained was 1180 (634) mL. Indices of oxygenation were significantly worse in the drain group compared with controls prior to drainage. The arterial oxygen tension (PaO2)/fractional inspired oxygen (FiO2) (P/F) ratio improved on day 1 after ICT placement (mean (SD), day 0: 31.01 (8.92) vs 37.18 (10.7); p<0.05) and both the P/F ratio and oxygenation index (OI: kPa/cm H2O=PaO2/mean airway pressure×FiO2) demonstrated sustained improvement to day 5 (P/F day 5: 39.85 (12.8); OI day 0: 2.88 (1.10) vs day 5: 4.06 (1.73); both p<0.01). The drain group patients were more likely to have an improved mode of ventilation on day 1 compared with controls (p=0.028). Conclusions Pleural effusion after cardiac surgery may impair oxygenation. Drainage of pleural fluid is associated with a rapid and sustained improvement in oxygenation.
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Affiliation(s)
- Fraser J H Brims
- Department of Respiratory Medicine , Sir Charles Gairdner Hospital , Perth, Western Australia , Australia ; Faculty of Medicine , Dentistry and Health Sciences, University of Western Australia , Western Australia , Australia ; Institute for Lung Health , Western Australia , Australia
| | - Michael G Davies
- Adult Intensive Care Unit , Royal Brompton Hospital , London , UK
| | - Andy Elia
- Adult Intensive Care Unit , Royal Brompton Hospital , London , UK
| | - Mark J D Griffiths
- Adult Intensive Care Unit , Royal Brompton Hospital , London , UK ; Unit of Critical Care , Royal Brompton Campus, National Heart & Lung Institute of Imperial College , London , UK
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Graven T, Wahba A, Hammer AM, Sagen O, Olsen Ø, Skjetne K, Kleinau JO, Dalen H. Focused ultrasound of the pleural cavities and the pericardium by nurses after cardiac surgery. SCAND CARDIOVASC J 2015; 49:56-63. [PMID: 25611808 PMCID: PMC4389761 DOI: 10.3109/14017431.2015.1009383] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Objectives. We aimed to study the feasibility and reliability of focused ultrasound (US) examinations to quantify pericardial (PE)- and pleural effusion (PLE) by a pocket-size imaging device (PSID) performed by nurses in patients early after cardiac surgery. Design. After a 3-month training period, with cardiologists as supervisors, two nurses examined 59 patients (20 women) with US using a PSID at a median of 5 days after cardiac surgery. The amount of PE and PLE was classified in four categories by US (both) and chest x-ray (PLE only). Echocardiography, including US of the pleural cavities, by experienced cardiologists was used as reference. Results. Focused US by the nurses was more sensitive than x-ray to detect PLE. The correlations of the quantification of PE and PLE by the nurses and reference was r (95% confidence interval) 0.76 (0.46–0.89) and 0.81 (0.73–0.89), both p < 0.001. PE and PLE were drained in one and six (eight cavities) patients, all classified as large amount by the nurses. Conclusions. Cardiac nurses were able to obtain reliable measurements and quantification of both PE and PLE bedside by focused US and outperform the commonly used chest x-ray regarding PLE after cardiac surgery.
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Affiliation(s)
- Torbjørn Graven
- Department of Medicine, Levanger Hospital, Nord-Trøndelag Health Trust , Levanger , Norway
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Szelkowski LA, Puri NK, Singh R, Massimiano PS. Current trends in preoperative, intraoperative, and postoperative care of the adult cardiac surgery patient. Curr Probl Surg 2015; 52:531-69. [DOI: 10.1067/j.cpsurg.2014.10.001] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Olivencia-Yurvati AH, Cherry BH, Gurji HA, White DW, Newton JT, Scott GF, Hoxha B, Gourlay T, Mallet RT. Novel Split Chest Tube Improves Post-Surgical Thoracic Drainage. JOURNAL OF CLINICAL & EXPERIMENTAL CARDIOLOGY 2014; 5. [PMID: 25478289 PMCID: PMC4251778 DOI: 10.4172/2155-9880.1000321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Objective Conventional, separate mediastinal and pleural tubes are often inefficient at draining thoracic effusions. Description We developed a Y-shaped chest tube with split ends that divide within the thoracic cavity, permitting separate intrathoracic placement and requiring a single exit port. In this study, thoracic drainage by the split drain vs. that of separate drains was tested. Methods After sternotomy, pericardiotomy, and left pleurotomy, pigs were fitted with separate chest drains (n=10) or a split tube prototype (n=9) with internal openings positioned in the mediastinum and in the costo-diaphragmatic recess. Separate series of experiments were conducted to test drainage of D5W or 0.58 M sucrose, an aqueous solution with viscosity approximating that of plasma. One litre of fluid was infused into the thorax, and suction was applied at −20 cm H2O for 30 min. Results When D5W was infused, the split drain left a residual volume of 53 ± 99 ml (mean value ± SD) vs. 148 ± 120 for the separate drain (P=0.007), representing a drainage efficiency (i.e. drained vol/[drained + residual vol]) of 95 ± 10% vs. 86 ± 12% for the separate drains (P = 0.011). In the second series, the split drain evacuated more 0.58 M sucrose in the first minute (967 ± 129 ml) than the separate drains (680 ± 192 ml, P<0.001). By 30 min, the split drain evacuated a similar volume of sucrose vs. the conventional drain (1089 ± 72 vs. 1056 ± 78 ml; P = 0.5). Residual volume tended to be lower (25 ± 10 vs. 62 ± 72 ml; P = 0.128) and drainage efficiency tended to be higher (98 ± 1 vs. 95 ± 6%; P = 0.111) with the split drain vs. conventional separate drains. Conclusion The split chest tube drained the thoracic cavity at least as effectively as conventional separate tubes. This new device could potentially alleviate postoperative complications.
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Affiliation(s)
- Albert H Olivencia-Yurvati
- Departments of Surgery, University of North Texas Health Science Center, Fort Worth, TX, USA ; Cardiovascular Research Institute, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Brandon H Cherry
- Departments of Integrative Physiology, University of North Texas Health Science Center, Fort Worth, TX, USA ; Cardiovascular Research Institute, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Hunaid A Gurji
- Departments of Integrative Physiology, University of North Texas Health Science Center, Fort Worth, TX, USA ; Cardiovascular Research Institute, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Daniel W White
- Departments of Integrative Physiology, University of North Texas Health Science Center, Fort Worth, TX, USA ; Cardiovascular Research Institute, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - J Tyler Newton
- Departments of Surgery, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Gary F Scott
- Departments of Integrative Physiology, University of North Texas Health Science Center, Fort Worth, TX, USA ; Cardiovascular Research Institute, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Besim Hoxha
- Departments of Surgery, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Terence Gourlay
- Bioengineering Unit, Wolfson Centre, University of Strathclyde, Glasgow, UK
| | - Robert T Mallet
- Departments of Surgery, University of North Texas Health Science Center, Fort Worth, TX, USA ; Departments of Integrative Physiology, University of North Texas Health Science Center, Fort Worth, TX, USA ; Cardiovascular Research Institute, University of North Texas Health Science Center, Fort Worth, TX, USA
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Christiansen LK, Frederiksen CA, Juhl-Olsen P, Jakobsen CJ, Sloth E. Point-of-care ultrasonography changes patient management following open heart surgery. SCAND CARDIOVASC J 2014; 47:335-43. [PMID: 24295290 DOI: 10.3109/14017431.2013.859294] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVES Although pericardial effusions (PE) and pleural effusions (PLE) may lead to life-threatening respiratory and circulatory deterioration following open heart surgery the postoperative frequency is not fully recognized. The diagnosis is typically based on ultrasonography, X-ray or computer tomography and often disclosed when circulatory collapse is evident. Point-of-care (POC) ultrasonography protocols constitute a noninvasive evaluation of the cardiopulmonary status. We hypothesized that POC ultrasonography could diagnose unknown PE and PLE. DESIGN Patients scheduled for open heart surgery were eligible for inclusion. Baseline evaluation including POC examination and dyspnea score was performed one day prior to surgery and repeated on the 4th and 30th postoperative day. RESULTS Eighty patients were included and complete follow-up was 80%. Thirteen patients (19%) had PE on the 4th day postsurgery and 19 patients (30%) had PE on the 30th day. Ultrasonography facilitated change in management in one patient with PE requiring drainage. Forty-nine patients (70%) had PLE on the 4th day following surgery and 19 patients (30%) had PLE on the 30th postoperative day. Ultrasonography facilitated a change in management in seven patients with PLE requiring drainage. CONCLUSION POC ultrasonography detected pathology, otherwise undisclosed, and was responsible for a change in management in a considerable number of cases.
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Nearman H, Klick JC, Eisenberg P, Pesa N. Perioperative Complications of Cardiac Surgery and Postoperative Care. Crit Care Clin 2014; 30:527-55. [DOI: 10.1016/j.ccc.2014.03.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Rosso E, Lopez P, Roedlisch MN, Narita M, Oussoultzoglou E, Bachellier P. Double Omental Flap Reduced Perianastomotic Collections and Relaparotomy Rates after Pancreaticoduodenectomy with Pancreaticogastrostomy. World J Surg 2012; 36:1672-8. [DOI: 10.1007/s00268-012-1546-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Ferreiro L, González-Barcala FJ, Valdés L. Derrame pleural tras la cirugía de revascularización mediante derivación aortocoronaria. Med Clin (Barc) 2012; 138:300-5. [DOI: 10.1016/j.medcli.2011.07.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2011] [Revised: 06/30/2011] [Accepted: 07/05/2011] [Indexed: 10/17/2022]
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Kim YH, Namkung J, Lim BG, Min SH, Shin HW, Lim CH. Pleural effusion after microtia reconstructive surgery -A case report-. Korean J Anesthesiol 2011; 61:166-8. [PMID: 21927690 PMCID: PMC3167139 DOI: 10.4097/kjae.2011.61.2.166] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2010] [Revised: 02/15/2011] [Accepted: 02/16/2011] [Indexed: 11/24/2022] Open
Abstract
Microtia reconstructive surgery is usually a multi-stage repair procedure that involves the use of cartilage and skin grafts. Complications can arise at both ear reconstruction sites and cartilage donor sites. In particular, pneumothorax, atelectasis, chest scars, and chest deformities are known to be associated with the harvesting of costal cartilage. However, delayed pleural effusion can also develop. Our patient complained of a cough and chest pain at 5 days postoperatively, and pleural effusion was detected by chest radiography. However, thoracentesis was not performed and the effusion resolved spontaneously and completely.
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Affiliation(s)
- Yun Hee Kim
- Department of Anesthesiology and Pain Medicine, College of Medicine, Korea University, Seoul, Korea
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Talwar S, Agarwala S, Mittal CM, Choudhary SK, Airan B. Pleural effusions in children undergoing cardiac surgery. Ann Pediatr Cardiol 2011; 3:58-64. [PMID: 20814477 PMCID: PMC2921519 DOI: 10.4103/0974-2069.64368] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Persistent pleural effusions are a source of significant morbidity and mortality following surgery in congenital heart disease. In this review, we discuss the etiology, pathophysiology, and management of this common complication.
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Affiliation(s)
- Sachin Talwar
- Cardiothoracic Center and Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, India
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