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Postoperative care of cardiac surgery patient

Sachin Talwar, Amolkumar Bhoje, Rajesh Khadagawat, Pradeep Chaturvedi, Vishnubhatla Sreenivas, Neeti Makhija, Manoj Sahu, Shiv Kumar Choudhary, Balram Airan
BACKGROUND: Decreases in serum total thyroxin and total triiodothyronine occurs after cardiopulmonary bypass, and is reflected as poor immediate outcome. We studied effects of oral thyroxin supplementation in infants who underwent open-heart surgery. METHODS: In this prospective study, 100 patients were randomized into 2 groups: 50 in the thyroxin group (TH) and 50 in the placebo group (PL). Patients in the TH group received oral thyroxin (5 μg/kg) 12 hours before surgery and once daily for the remainder of their intensive care unit (ICU) stay...
September 2018: Journal of Thoracic and Cardiovascular Surgery
Zühre Uz, Can Ince, Philippe Guerci, Yasin Ince, Renata P Araujo, Bulent Ergin, Matthias P Hilty, Thomas M van Gulik, Bas A de Mol
Background: Management of tissue perfusion following cardiac surgery is a challenging task where common clinical parameters do not reflect microcirculatory dysfunction. Heterogeneity in blood flow perfusion and abnormalities in capillary density characterize microcirculatory dysfunction. The restoration of a normal microcirculation may become a novel target for therapy in the future in addition to macrocirculatory parameters. The aim of this study is to determine how the sublingual microcirculatory parameters vary at the bedside in post-cardiac surgery patients which underwent diuretic therapy to correct fluid overload...
2018: Perioperative Medicine
Hatem A El Shora, Ahmed A El Beleehy, Amr A Abdelwahab, Gaser A Ali, Tarek E Omran, Essam A Hassan, Amr A Arafat
BACKGROUND:  Adequate pain control after cardiac surgery is essential. Paravertebral block is a simple technique and avoids the potential complications of epidural catheters. The objective of this study is to compare the effect of ultrasound-guided bilateral thoracic paravertebral block with thoracic epidural block on pain control after cardiac surgery. MATERIALS AND METHODS:  Between March 2016 and 2017, 145 patients who had cardiac surgery through median sternotomy were randomized by stratified blocked randomization into two groups...
August 16, 2018: Thoracic and Cardiovascular Surgeon
Lei Zou, Xiaochun Song, Liang Hong, Xiao Shen, Jiakui Sun, Cui Zhang, Xinwei Mu
During the perioperative period of cardiac disease, as many risk factors exist, such as primary cardiac diseases, the use of vasopressors, ischemia-reperfusion injury during cardiopulmonary bypass (CPB), and surgical stress, the gut suffered from ischemia, anoxia and oxidative stress, which would lead to the enterocyte injury. The aim of this study was to explore whether serum intestinal fatty acid-binding protein (IFABP), which is excreted specifically from damaged intestinal enterocytes, as a predictor of prognosis in postoperative cardiac surgery patients...
August 2018: Medicine (Baltimore)
Kang Min Kim, Jae Gun Kwak, Beatrice Chia-Hui Shin, Eung Re Kim, Ji-Hyun Lee, Eun Hee Kim, Jin Tae Kim, Woong-Han Kim
Background: Early extubation after cardiovascular surgery has some clinical advantages, including reduced hospitalization costs. Herein, we review the results of ultra-fast-track (UFT) extubation, which refers to extubation performed on the operating table just after the operation, or within 1-2 hours after surgery, in patients with congenital cardiac disease. Methods: We performed UFT extubation in patients (n=72) with a relatively simple congenital cardiac defect or who underwent a simple operation starting in September 2016...
August 2018: Korean Journal of Thoracic and Cardiovascular Surgery
Vishwas Malik, Usha Kiran, Sandeep Chauhan, Neeti Makhija
Background and Aims: In patients undergoing open heart surgery, chest tubes are removed postoperatively when patients are well awake and stable. Pain during chest tube removal can be moderate to severe and can be the worst experience of hospitalization. Various modalities of pain relief during chest tube removal have been tried with variable results. We sought to examine the effect of transcutaneous electrical nerve stimulation (TENS) as an intervention for pain relief during chest tube removal after cardiac surgery...
April 2018: Journal of Anaesthesiology, Clinical Pharmacology
Katherine Cashen, John M Costello, Lisa M Grimaldi, Keshava Murty Narayana Gowda, Elizabeth A S Moser, Kurt D Piggott, Michael Wilhelm, Christopher W Mastropietro
OBJECTIVES: We sought to validate the Vasoactive-Ventilation-Renal score, a novel disease severity index, as a predictor of outcome in a multicenter cohort of neonates who underwent cardiac surgery. DESIGN: Retrospective chart review. SETTING: Seven tertiary-care referral centers. PATIENTS: Neonates defined as age less than or equal to 30 days at the time of cardiac surgery. INTERVENTIONS: Ventilation index, Vasoactive-Inotrope Score, serum lactate, and Vasoactive-Ventilation-Renal score were recorded for three postoperative time points: ICU admission, 6 hours, and 12 hours...
August 7, 2018: Pediatric Critical Care Medicine
Fabio Ramponi, Michael Seco, James B Edelman, Andrew G Sherrah, Paul G Bannon, R John L Brereton, Michael K Wilson, Michael P Vallely
Coronary surgery performed on an arrested heart, using one internal mammary artery and a saphenous vein carries two main potential drawbacks: the known failure rate of vein grafts and the relatively high rate of neurologic injury. To address these concerns, we describe a technique that achieves complete revascularization without manipulating the ascending aorta (anaortic, off-pump) and utilizing total arterial grafts. All patients undergo thorough preoperative investigation, including bilateral carotid, vertebral and subclavian artery Duplex ultrasounds...
July 2018: Annals of Cardiothoracic Surgery
Kannayiram Alagiakrishnan, Darren Mah, Gabor Gyenes
Cardiac rehabilitation program is an evidence-based intervention and established model of exercise delivery following myocardial infarction and heart failure. Although it forms an important part of recovery and helps to prevent future events and complications, there has been little focus on its potential cognitive benefits. Areas covered: Coronary artery disease and heart failure are common heart problems associated with significant morbidity and mortality, and cognitive decline is commonly seen in affected individuals...
August 9, 2018: Expert Review of Cardiovascular Therapy
Nicola Moran, Gobnait Byrne
AIMS: to explore cardiothoracic nurses' knowledge and self-reported competence of wound care following cardiac surgery and to ascertain if there were any differences in knowledge between nurses working in public and private hospitals. BACKGROUND: cardiothoracic nurses are the main providers of wound care for patients post cardiac surgery, however, there is a lack of research about their knowledge of wound care. DESIGN: a descriptive, quantitative design was used in the form of a cross-sectional, self-reported questionnaire...
August 9, 2018: British Journal of Nursing: BJN
Pedro N M P Coelho, Luís M R P C Miranda, Pedro M P Barros, José I G Fragata
OBJECTIVES: Cardiac surgery has little effect on life expectancy in elderly patients. Thus, improving the quality of life should be the main factor affecting therapeutic decisions. Most studies on quality of life in elderly patients undergoing cardiac surgery report improvement but have limitations. Consequently, we assessed improvements in the quality of life of elderly patients undergoing elective cardiac surgery, identified influencing variables and established patterns of mental and physical health variations in the first year postoperatively...
July 31, 2018: Interactive Cardiovascular and Thoracic Surgery
O Moreno, A Ochagavía, A Artigas, C Espinal, R Tomás, M D Bosque, C Fortià, F Baigorri
BACKGROUND: Transthoracic echocardiography can significantly change the management of many critical patients, and is being incorporated into many Intensive Care Units (ICU). Very few studies have examined the feasibility and impact of intensivists performing basic transthoracic echocardiography upon the management of critical patients after cardiac surgery. The present study therefore evaluates the quality of acquisition and accuracy of intensivist interpretation of basic transthoracic echocardiograms in the postoperative period of heart surgery...
July 30, 2018: Medicina Intensiva
Taylor Chuich, Christopher Lewis Cropsey, Yaping Shi, Daniel Johnson, Matthew S Shotwell, Christopher Patrick Henson
BACKGROUND: Sedative agents used during cardiac surgery can influence the patient's time to extubation, intensive care unit (ICU) and hospital length of stay, and incidence of delirium. OBJECTIVE: This study evaluates the effects of the intraoperative and postoperative use of dexmedetomidine versus propofol infusions. METHODS: This 19-month retrospective observational study at an academic medical center included 278 patients 18 years of age or older who underwent coronary artery bypass grafting (CABG), valve replacement surgery, or combined CABG plus valve surgery, who received either a dexmedetomidine or propofol infusion in addition to general anesthesia intraoperatively...
August 1, 2018: Annals of Pharmacotherapy
Marc-André Buchwald, Ursula Laasner, Christian Balmer, Vincenzo Cannizzaro, Beatrice Latal, Vera Bernet
INTRODUCTION: Children with trisomy 21 are prone to postoperative chylothorax, caused by malformation of the lymphatic system, after cardiac surgery. The clinical course of patients diagnosed with postoperative chylothorax and trisomy 21 was compared to that of patients without dysmorphic syndromes. Additionally, differences between the groups in composition, amount, and duration of chyle were analyzed to better understand chylothorax in patients with trisomy 21. MATERIALS AND METHODS: Retrospective cohort study using inpatient clinical databases during a 10-year period...
July 6, 2018: Journal of Pediatric Surgery
Hui Luo, Gang Qin, Lu Wang, Zhi Ye, Yundan Pan, Lingjin Huang, Wanjun Luo, Qulian Guo, Yonggang Peng, E Wang
OBJECTIVES: There is still controversy about whether an infant should have cardiac surgery concomitant with ongoing persistent pneumonia. This study analyzes the outcome of surgical treatment for infants with left-to-right shunt congenital heart disease accompanied with persistent pneumonia and discusses the perioperative management strategies for these cases. DESIGN: This is a retrospective cohort study. SETTING: This study was conducted in an academic hospital and is a single-center study...
May 27, 2018: Journal of Cardiothoracic and Vascular Anesthesia
Peta M A Alexander, Matthew DiOrio, Kristofer Andren, Kimberlee Gauvreau, Kshitij P Mistry, Derek Mathieu, Jonathan Wright, Catherine K Allan, Meena Nathan, John E Mayer, Ravi R Thiagarajan, Lisa Bergersen
OBJECTIVES: There is increasing demand for the limited resource of Cardiac ICU care. In this setting, there is an expectation to optimize hospital resource use without restricting care delivery. We developed methodology to predict extended cardiac ICU length of stay following surgery for congenital heart disease. DESIGN: Retrospective analysis by multivariable logistic regression of important predictive factors for outcome of postoperative ICU length of stay greater than 7 days...
July 26, 2018: Pediatric Critical Care Medicine
Nitin Agarwal, Andrew Faramand, Nima Alan, Zachary J Tempel, D Kojo Hamilton, David O Okonkwo, Adam S Kanter
OBJECTIVE Elderly patients, often presenting with multiple medical comorbidities, are touted to be at an increased risk of peri- and postoperative complications following spine surgery. Various minimally invasive surgical techniques have been developed and employed to treat an array of spinal conditions while minimizing complications. Lateral lumbar interbody fusion (LLIF) is one such approach. The authors describe clinical outcomes in patients over the age of 70 years following stand-alone LLIF. METHODS A retrospective query of a prospectively maintained database was performed for patients over the age of 70 years who underwent stand-alone LLIF...
July 27, 2018: Journal of Neurosurgery. Spine
Pattamawan Kosuma, Sitichok Wachirasrisirikul, Arom Jedsadayanmata
Background: Postoperative atrial fibrillation (POAF) is the most common complication among patients undergoing cardiac surgery. However, data on the economic burden and resource utilization associated with POAF in Asian population are limited. The present study aimed at estimating medical costs attributable to POAF after cardiac surgery in Thai population. Methods: We analysed data from claims database of patients who underwent valve replacement, coronary artery bypass grafting (CABG), or a combination of both procedures at a tertiary-care, academic hospital in Thailand...
2018: Cardiology Research and Practice
Alessandro Affronti, Francesco Casali, Paolo Eusebi, Cristina Todisco, Francesca Volpi, Virginia Beato, Emilia Virginia Manini, Giulia Scopetani, Temistocle Ragni
OBJECTIVES: To evaluate whether early tracheostomy is associated with better outcomes in mechanical ventilation-dependent patients after cardiac surgery compared with a late tracheostomy. DESIGN: Retrospective, observational study. SETTING: Cardiac surgical intensive care unit (ICU) of a tertiary care center. PARTICIPANTS: All patients who underwent tracheostomy after cardiac surgery between 2004 and 2015 were subdivided into the following 2 groups according to the timing of tracheostomy: "early" if the tracheostomy was performed before the 14th postoperative day and "late" from the 14th postoperative day onward...
May 28, 2018: Journal of Cardiothoracic and Vascular Anesthesia
Philippe Amabili, Aaron Wozolek, Ines Noirot, Laurence Roediger, Marc Senard, Anne-Françoise Donneau, Marie Bernard Hubert, Jean-François Brichant, Gregory A Hans
OBJECTIVES: To investigate whether the Edmonton Frail Scale (EFS), a multidimensional frailty assessment tool, improves the prediction of 30-day or in-hospital mortality over the use of the European System for Cardiac Outcome Risk Evaluation (EuroSCORE) II alone. DESIGN: Single-center prospective observational study. SETTING: University hospital. PARTICIPANTS: Patients aged 75 years or older undergoing cardiac surgery between February 2014 and May 2017...
May 27, 2018: Journal of Cardiothoracic and Vascular Anesthesia
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