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Postoperative care of cardiac surgery patient

Graham R McClure, Emilie P Belley-Cote, John Harlock, Andre Lamy, Michael Stacey, P J Devereaux, Richard P Whitlock
PURPOSE: Postoperative infection, particularly in cardiac surgery, results in significant morbidity, mortality, and healthcare cost. Identification of novel predictors of postoperative infection can target high-risk populations for prophylactic intervention. METHODS: Steroids in cardiac surgery (SIRS) was a multi-centre randomized-controlled trial assessing intraoperative administration of methylprednisone during cardiac surgery, which enrolled 7,507 patients across 80 centres in 18 countries...
December 10, 2018: Canadian Journal of Anaesthesia, Journal Canadien D'anesthésie
Sona Dave, Anand Nirgude, Pinakin Gujjar, Ritika Sharma
Background and Aims: Atrial fibrillation (AF) is a common postoperative complication after cardiac surgery due to multifactorial causes. The aim of this study was to evaluate the incidence and risk factors of postoperative atrial fibrillation (POAF) after cardiac surgery under cardiopulmonary bypass (CPB). Methods: A total of 150 adult patients undergoing coronary artery bypass graft (CABG) surgery and valvular surgeries were included. They were evaluated with respect to preoperative risk factors [age, use of β-blockers, left ventricular ejection fraction (LVEF), previous myocardial infarction (MI) and diabetes], intraoperative factors (CABG or valvular surgery, duration of CPB and aortic cross clamp time) and postoperative factors (duration of inotropic support and ventilatory support)...
November 2018: Indian Journal of Anaesthesia
E D Zvereva, B B Komakha, D A Zverev, M A Chernyavsky, M L Gordeev
OBJECTIVE: The purpose of the study was to assess surgical outcomes in patients suffering from an infrarenal abdominal aortic aneurysm and treated at the Department of Cardiovascular Surgery #2 of the National Medical Research Centre named after V.A. Almazov. PATIENTS AND METHODS: We carried out a non-randomized retrospective study including a total of 209 patients presenting with an infrarenal abdominal aortic aneurysm. Of these, 160 (76%) patients were subjected to open surgical interventions (Group One) and 49 (24%) patients underwent endovascular isolation of the abdominal aortic aneurysm (Group Two)...
2018: Angiologii︠a︡ i Sosudistai︠a︡ Khirurgii︠a︡, Angiology and Vascular Surgery
Damian Gimpel, Satya Shanbhag, Tushar Srivastava, Melanie MacLeod, Paul Conaglen, Nand Kejriwal, Nicholas Odom, Zaw Lin, David J McCormack, Adam El-Gamel
BACKGROUND: Enhanced recovery programs within cardiothoracic surgery are a well described benefit to patient postoperative outcomes. We describe our Australasian unit's experience of a day zero discharge enhanced recovery unit from the intensive care department. METHODS: A retrospective study was conducted on a prospectively maintained database at Waikato Cardiothoracic Unit from September 2014 till October 2017 with 1,739 patients undergoing cardiac surgery. Twenty-two (22) patients were excluded as deaths either intraoperative or in the intensive care unit (ICU) and therefore never discharged...
November 17, 2018: Heart, Lung & Circulation
Ke Peng, Fu-Hai Ji, Hua-Yue Liu, Juan Zhang, Qing-Cai Chen, Ya-Hui Jiang
PURPOSE: Major postoperative complications translate into increased health care resource utilization, prolonged hospital stays, and increased mortality. We aimed to assess the effects of perioperative dexmedetomidine use on postoperative mortality and the prevalence of major complications after cardiac and noncardiac surgery. METHODS: We searched the PubMed, EMBASE, and Cochrane databases to analyze all published evidence from randomized controlled trials (RCTs) and cohort studies comparing perioperative dexmedetomidine use versus no dexmedetomidine use in adult patients undergoing cardiac and noncardiac surgery...
December 7, 2018: Clinical Therapeutics
Kátia Alves Ramos, Cristiane Bitencourt Dias
INTRODUCTION: Among patients undergoing cardiac surgery, the occurrence of acute renal injury appears to be associated with worse prognosis and increased mortality. The objective of this study was to evaluate risk factors and the impact this complication on mortality and survival after cardiac surgery among patients without chronic kidney disease. METHODS: In this retrospective study, we reviewed the medical records of 142 patients who underwent elective coronary artery bypass grafting, valve replacement (single or multiple), or both (simultaneously) at a tertiary care hospital...
September 2018: Brazilian Journal of Cardiovascular Surgery
Krish C Dewan, Karan S Dewan, Jay J Idrees, Suparna M Navale, Brad F Rosinski, Lars G Svensson, A Marc Gillinov, Douglas R Johnston, Faisal Bakaeen, Edward G Soltesz
Importance: Persistent opioid use is currently a major health care crisis. There is a lack of knowledge regarding its prevalence and effect among patients undergoing cardiac surgery. Objective: To characterize the national population of cardiac surgery patients with opioid use disorder (OUD) and compare outcomes with the cardiac surgery population without OUD. Design, Setting, and Participants: In this retrospective population-based cohort study, more than 5...
December 5, 2018: JAMA Surgery
Laith Mukdad, William Toppen, Son Nguyen, Kwang Kim, Abie H Mendelsohn, Ali Zarrinpar, Peyman Benharash
INTRODUCTION: Postoperative dysphagia leads to aspiration pneumonia, prolonged hospital stay, and is associated with increased mortality. We have demonstrated the validity of a bedside targeted swallow evaluation following cardiac surgery. Since dysphagia following liver transplantation is not well examined, we evaluated the efficacy of this swallow screen method in postoperative liver transplant patients. METHODS: This was a prospective trial involving adult patients who underwent liver transplant surgery at our institution over a 5-month period...
December 4, 2018: Progress in Transplantation
Vladimir Milovanovic, Dejan Bisenic, Branko Mimic, Bilal Ali, Massimiliano Cantinotti, Ivan Soldatovic, Irena Vulicevic, Bruno Murzi, Slobodan Ilic
OBJECTIVE(S): Modified ultrafiltration has gained wide acceptance as a powerful tool against cardiopulmonary bypass morbidity in pediatric cardiac surgery. The aim of our study was to assess the importance of modified ultrafiltration within conditions of contemporary cardiopulmonary bypass characteristics. METHODS: Ninety⁻eight patients (overall cohort) weighing less than 12 kg undergoing surgical repair with cardiopulmonary bypass were prospectively enrolled in a randomized protocol to receive modified and conventional ultrafiltration (MUF group) or just conventional ultrafiltration (non-MUF group)...
December 1, 2018: Journal of Clinical Medicine
Christian Stoppe, Julia Ney, Vladimir V Lomivorotov, Sergey M Efremov, Carina Benstoem, Aileen Hill, Ekaterina Nesterova, Elena Laaf, Andreas Goetzenich, Bernard McDonald, Arne Peine, Gernot Marx, Karl Fehnle, Daren K Heyland
BACKGROUND: Cardiovascular surgery patients with a prolonged intensive care unit (ICU) stay may benefit most from early nutrition support. Using established scoring systems for nutrition assessment and operative risk stratification, we aimed to develop a model to predict a prolonged ICU stay ≥5 days in order to identify patients who will benefit from early nutrition interventions. METHODS: This is a retrospective analysis of a prospective observational study of patients undergoing elective valvular, coronary artery bypass grafting, or combined cardiac surgery...
December 2, 2018: JPEN. Journal of Parenteral and Enteral Nutrition
James C Witten, Syed T Hussain, Nabin K Shrestha, Steven M Gordon, Penny L Houghtaling, Faisal G Bakaeen, Brian Griffin, Eugene H Blackstone, Gösta B Pettersson
OBJECTIVE: Right-sided infective endocarditis is increasing because of increasing prevalence of predisposing conditions, and the role and outcomes of surgery are unclear. We therefore investigated the surgical outcomes for right-sided infective endocarditis. METHODS: From January 2002 to January 2015, 134 adults underwent surgery for right-sided infective endocarditis. Patients were grouped according to predisposing condition. Hospital outcomes, time-related death, and reoperation for infective endocarditis were analyzed...
September 25, 2018: Journal of Thoracic and Cardiovascular Surgery
Soojin Lee, Sehoon Park, Min Woo Kang, Hai-Won Yoo, Kyungdo Han, Yaerim Kim, Jung Pyo Lee, Kwon Wook Joo, Chun Soo Lim, Yon Su Kim, Hyeongsu Kim, Dong Ki Kim
PURPOSE: Dialysis-requiring acute kidney injury (AKI-D) after cardiac surgery is a major cause of in-hospital mortality. However, the long-term outcome has not been previously examined. MATERIALS AND METHODS: We performed a nationwide, population-based cohort study using the claims data in the Korean National Health Insurance System. Patients who underwent cardiac surgery between 2006 and 2015 were considered. RESULTS: Among 52,983 patients who underwent cardiac surgery, 1261 underwent dialysis postoperatively...
November 24, 2018: Journal of Critical Care
Esteban Aguayo, Robert Lyons, Yen-Yi Juo, Katherine L Bailey, Young-Ji Seo, Vishal Dobaria, Yas Sanaiha, Peyman Benharash
BACKGROUND: Depression affects between 10% and 40% of cardiac surgery patients and is associated with significantly worse outcomes. The incidence and impact of new-onset depression beyond acute follow-up remain ill-defined. The present study aimed to evaluate the incidence, risk factors, and prognostic implication of depression on 90-d readmission rates after coronary artery bypass grafting (CABG) surgery. METHODS: A retrospective cohort study was performed identifying adult patients without prior depression who underwent CABG surgery using the 2010-2014 National Readmissions Database...
January 2019: Journal of Surgical Research
Rebecca M Jedwab, Alison M Hutchinson, Bernice Redley
OBJECTIVE: The objective of this review was to identify evidence to inform clinical practice guidelines for magnesium sulphate (MgSO4 ) replacement therapy for postoperative cardiac surgery patients. DATA SOURCES: Three databases were systematically searched: CINAHL Complete, MEDLINE Complete, and EmBase. REVIEW METHOD USED: A systematic literature review method was used to locate, appraise, and synthesise available evidence for each step of the medication management cycle (indication, prescription, preparation, administration, and monitoring) for MgSO4 replacement therapy...
November 27, 2018: Australian Critical Care: Official Journal of the Confederation of Australian Critical Care Nurses
Meghan B Lane-Fall, Jose L Pascual, Hannah G Peifer, Laura J Di Taranti, Meredith L Collard, Juliane Jablonski, Jacob T Gutsche, Scott D Halpern, Frances K Barg, Lee A Fleisher
OBJECTIVE: To assess the effectiveness of standardizing operating room (OR) to intensive care unit (ICU) handoffs in a mixed surgical population. SUMMARY OF BACKGROUND DATA: Standardizing OR to ICU handoffs improves information transfer after cardiac surgery, but there is limited evidence in other surgical contexts. METHODS: This prospective interventional cohort study (NCT02267174) was conducted in 2 surgical ICUs in 2 affiliated hospitals...
November 29, 2018: Annals of Surgery
Sarah Tabbutt, Jennifer Schuette, Wenying Zhang, Jeffrey Alten, Janet Donohue, J William Gaynor, Nancy Ghanayem, Jeffrey Jacobs, Sara K Pasquali, Ravi Thiagarajan, Justin B Dimick, Mousumi Banerjee, David Cooper, Michael Gaies
OBJECTIVE: To develop a postoperative mortality case-mix adjustment model to facilitate assessment of cardiac ICU quality of care, and to describe variation in adjusted cardiac ICU mortality across hospitals within the Pediatric Cardiac Critical Care Consortium. DESIGN: Observational analysis. SETTING: Multicenter Pediatric Cardiac Critical Care Consortium clinical registry. PARTICIPANTS: All surgical cardiac ICU admissions between August 2014 and May 2016...
November 26, 2018: Pediatric Critical Care Medicine
Xuebing Chen, Qi Miao, Yangeng Yu, Fu Zhang, Leping Sun, Yunle Meng, Huijun Wang, Dongri Li
We report a case of blunt cardiac injury and pericardial tamponade following video-assisted thoracoscopic surgery (VATS) in a lung cancer patient with hypertension and cardiac hypertrophy. Anatomical findings included massive hemorrhage in the pericardium, cardiac hypertrophy, and a superficial contusion with a ruptured blood vessel on the epicardium at the lateral wall of the left ventricle. The patient died of pericardial tamponade due to blunt trauma from the tip of the thoracoscopic instrument. This case suggests that detailed assessment of the cardiovascular system, especially cardiac hypertrophy, careful preparation before surgery and careful monitoring of postoperative conditions are important...
November 24, 2018: Annals of Thoracic Surgery
Elizabeth Mahanna-Gabrielli, Todd A Miano, John G Augoustides, Cecilia Kim, Joseph E Bavaria, W Andrew Kofke
INTRODUCTION: Patients undergoing cardiac surgery are at high risk for postoperative delirium, which is associated with longer hospital and intensive care lengths of stays, increased morbidity and mortality. Because sleep disturbances are common in delirium, melatonin has been an area of interest in the treatment of delirium. The rs10830963 single nucleotide polymorphism of the melatonin receptor 1B gene can cause pathological dysfunction of this receptor and is associated with delayed morning offset of melatonin...
2018: PloS One
Katarzyna Kotfis, Aleksandra Szylińska, Mariusz Listewnik, Kacper Lechowicz, Monika Kosiorowska, Sylwester Drożdżal, Mirosław Brykczyński, Iwona Rotter, Maciej Żukowski
Introduction: Intubation time in patients undergoing cardiac surgery may be associated with increased mortality and morbidity. Premature extubation can have serious adverse physiological consequences. The aim of this study was to determine the influence of intubation time on morbidity and mortality in patients undergoing cardiac surgery. Methods: We performed a retrospective analysis of data on 1,904 patients undergoing isolated coronary artery bypass grafting (CABG) and stratified them by duration of intubation time after surgery - 0-6, 6-9, 9-12, 12-24 and over 24 hours...
2018: Therapeutics and Clinical Risk Management
Takahiko Tamura, Tomoaki Yatabe, Tsutomu Namikawa, Kazuhiro Hanazaki, Masataka Yokoyama
Although tight glucose control might reduce inflammation after cardiac surgery, it remains unclear whether inflammation can be controlled by maintaining glucose levels within 110-180 mg/dL. We hypothesized that a glucose target range of 110-180 mg/dL decreases inflammation after cardiovascular surgery. This retrospective study included 72 cardiovascular surgery patients divided into two groups according to the glucose control approach. Patients allocated to the closed-loop group received closed-loop glucose control (target glucose levels at 110-180 mg/dL) from admission to the intensive care unit until 9 a...
November 19, 2018: Journal of Artificial Organs: the Official Journal of the Japanese Society for Artificial Organs
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