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Post cardiac surgery care

Reinhard Strametz, Martin N Bergold, Tobias Weberschock
BACKGROUND: Percutaneous dilatational tracheostomy (PDT) is one of the most common bedside surgical procedures performed in critically ill adults, on intensive care units (ICUs), who require long-term ventilation. PDT is associated with relevant life-threatening complications: Cuff rupture or accidental extubation may lead to hypoxia, aspiration or loss of airway. Puncture of the oesophagus, or creating a false passage during dilatation or replacement of the tracheostomy tube, can lead to pneumothorax or emphysema...
November 15, 2018: Cochrane Database of Systematic Reviews
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
Ilias P Doulamis, Despina N Perrea, George Mastrokostopoulos, Konstantina Drakopoulou, Konstantinos Voutetakis, Aspasia Tzani, Ioannis A Chloroyiannis
The restoration of left ventricular (LV) geometry in combination with coronary artery bypass grafting for the treatment of ischemic cardiac disease remains controversial. We hereby present the experience of our center with total arterial myocardial revascularization (TAMR) and spiral aneurysmorrhaphy for ischemic heart disease. A retrospective analysis of 101 patients with advanced cardiovascular disease who underwent TAMR and spiral aneurysmorrhaphy was performed. Spiral aneurysmorrhaphy is a modification of the linear aneurysmorrhaphy and was applied to patients who had a LV aneurysm with a diameter of less than 5 cm...
December 6, 2018: Heart and Vessels
Xu Wang, Yun Long, Huaiwu He, Guangliang Shan, Rui Zhang, Na Cui, Hao Wang, Xiang Zhou, Xi Rui, Wanglin Liu
BACKGROUND: Weaning post-cardiac surgery patients from mechanical ventilation (MV) poses a big challenge to these patients. Optimized left ventricular-arterial coupling (VAC) may be crucial for reducing the MV duration of these patients. However, there is no research exploring the relationship between VAC and the duration of MV. We performed this study to investigate the relationship between left ventricular-arterial coupling (VAC) and prolonged mechanical ventilation (MV) in severe post-cardiac surgery patients...
December 6, 2018: BMC Anesthesiology
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
Yi Ping, Huahua Gu
RATIONALE: Cerebral aneurysm is a common cause of intracranial hemorrhage, stroke, and death. It is treated with vascular surgeries, such as coil embolism and artery clipping. However, surgery itself is a risk factor that may cause rupture of aneurysm, and leads to irreversible brain damage, and even death. Rapid ventricular pacing (RVP) is a procedure that temporarily lowers blood pressure by increasing heart rate and reducing ventricular filling time. RVP has been widely used to reduce blood vessel tension in many cardiovascular surgeries...
November 2018: Medicine (Baltimore)
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
Marissa A Mayor, Sandeep J Khandhar, Joby Chandy, Hiran C Fernando
Enhanced recovery after surgery (ERAS) protocols aim to improve operative outcomes by focusing on perioperative care, including early mobilization, limitation of narcotics, and maintenance of fluid balance. We implemented a T-ERAA S (Thoracic-Early Recovery with Ambulation After Surgery) protocol which focused on early ambulation, with the rationale that a patient's mobility may be a reproducible and measurable metric for their overall status-pain control, respiratory function, cardiac function, and patient satisfaction...
November 2018: Journal of Thoracic Disease
Heather Smith, Ching Yeung, Stephen Gowing, Mouhannad Sadek, Donna Maziak, Sebastien Gilbert, Farid Shamji, Patrick Villeneuve, Sudhir Sundaresan, Andrew Seely
Atrial fibrillation (AF) is the most common sustained arrhythmia after non-cardiac thoracic surgery and is associated with a significant increase in perioperative morbidity, intensive care unit (ICU) admission, and mortality. Practical guidance is needed to assist clinicians in managing this critical issue and direct further research. Here we aim to provide a synoptic review and analysis of the literature to distil practical recommendations for prediction, prevention and management of post-operative atrial fibrillation (POAF) suitable for clinical application and further evaluation...
November 2018: Journal of Thoracic Disease
Liza Fitria, Putri Caesa, Juweni Joe, Eva M Marwali
OBJECTIVES: This study aims to investigate the impact of pre-operative malnutrition on nutritional outcome following congenital heart defects surgery. DESIGN: This is a prospective cohort study. SETTING: Pediatric Cardiac Intensive Care, Harapan Kita National Cardiovascular Center, Jakarta, Indonesia. PATIENT: Pediatric patients, aged younger than 36 months old with Aristotle score of 6-10, undergoing congenital heart defects surgery with cardiopulmonary bypass were included in this study...
November 29, 2018: Pediatric Cardiology
Charlene M T Robertson, Karin T Bork, Gerda Tawfik, Gwen Y Bond, Leonora Hendson, Irina A Dinu, Elham Khodayari Moez, Ivan M Rebeyka, Gonzalo Garcia Guerra, Ari R Joffe
OBJECTIVE: To reduce bilateral delayed-onset progressive sensory permanent hearing loss using a systems-wide quality improvement project with adherence to best practice for the administration of furosemide. DESIGN: Prospective cohort study with regular audiologic follow-up assessment of survivors both before and after a 2007-2008 quality improvement practice change. SETTING: The referral center in Western Canada for complex cardiac surgery, with comprehensive multidisciplinary follow-up by the Complex Pediatric Therapies Follow-up Program...
November 26, 2018: Pediatric Critical Care Medicine
Christ Ordookhanian, Sean W Kaloostian, Paul E Kaloostian
Anti-coagulation medications are widely used in clinical practice, especially in the United States as cardiac-related emergencies are on the rise. An overarching caveat in using anti-coagulation drugs as a long-term treatment regimen, such as warfarin, is that patients are closely monitored by their primary care provider. Routine monthly laboratory examinations are strictly required to assess the international normalized ratio (INR) which measures prothrombin time (PT), providing insight into how long it takes for blood to clot...
September 22, 2018: Curēus
Tess E Wright
BACKGROUND: Pediatric patients post-cardiac surgery have complex care needs requiring extensive discharge education and skill competency by caregivers to transition from the hospital environment to a medical home. The purpose of this quality improvement project was to implement a nesting protocol in the cardiovascular intensive care unit (CVICU) to improve discharge teaching and care coordination, with a goal to reduce readmission rates and increase caregiver satisfaction and understanding...
November 2018: Journal of Pediatric Nursing
Hao Yin, Oula Akawi, Stephanie A Fox, Fuyan Li, Caroline O'Neil, Brittany Balint, John-Michael Arpino, Alanna Watson, Jorge Wong, Linrui Guo, MacKenzie A Quantz, A Dave Nagpal, Bob Kiaii, Michael W A Chu, J Geoffrey Pickering
Leukocyte telomere shortening reflects stress burdens and has been associated with cardiac events. However, the patient-specific clinical value of telomere assessment remains unknown. Moreover, telomere shortening cannot be inferred from a single telomere length assessment. The authors investigated and developed a novel strategy for gauging leukocyte telomere shortening using autologous cardiac atrial referencing. Using multitissue assessments from 163 patients who underwent cardiovascular surgery, we determined that the cardiac atrium-leukocyte telomere length difference predicted post-operative complexity...
October 2018: JACC. Basic to Translational Science
John M Morton, Jaime Ponce, Elisabetta Malangone-Monaco, Ninh Nguyen
BACKGROUND: Bariatric surgery is an effective and enduring treatment for severe obesity. In addition to improvements in health status, bariatric surgery has been noted to potentially decrease post-operative health care costs particularly medication utilization. STUDY DESIGN: Longitudinal analysis of 2007-2012 claims data comparing a bariatric surgery cohort with a propensity matched non-surgical control group over a total five-year time period. Truven Health Analytics MarketScan Commercial Claims and Encounters Database with a total enrollment of 56 million covered lives from all insurers and representing all 50 states was employed...
November 16, 2018: Journal of the American College of Surgeons
T Jínek, L Adamčík, R Vrba, M Duda, M Škrovina
INTRODUCTION: Gastric resections due to carcinoma belong to the most demanding procedures in visceral surgery. This is due to the requirements for the extent of resection and lymphadenectomy, coupled with the need for functional reconstruction of the digestive tract. The procedure is associated with 18-46% morbidity, which delays administration of adjuvant therapy and worsens oncological results. Identification of risk factors for potential complications may play an important role in the indication and perioperative care...
2018: Rozhledy V Chirurgii: Měsíčník Československé Chirurgické Společnosti
Adrian Tarniceriu, Jarkko Harju, Zeinab Rezaei Yousefi, Antti Vehkaoja, Jakub Parak, Arvi Yli-Hankala, Ilkka Korhonen
Atrial fibrillation (AF) is the most common type of cardiac arrhythmia. Although not life-threatening itself, AF significantly increases the risk of stroke and myocardial infarction. Current tools available for screening and monitoring of AF are inadequate and an unobtrusive alternative, suitable for long-term use, is needed. This paper evaluates an atrial fibrillation detection algorithm based on wrist photoplethysmographic (PPG) signals. 29 patients recovering from surgery in the post-anesthesia care unit were monitored...
July 2018: Conference Proceedings: Annual International Conference of the IEEE Engineering in Medicine and Biology Society
Giovanni Introcaso, Matteo Nafi, Alice Bonomi, Camilla L'Acqua, Luca Salvi, Roberto Ceriani, Davide Carcione, Annalisa Cattaneo, Maria Teresa Sandri
Introduction: Acute kidney injury (AKI) remains among the most severe complication after cardiac surgery. The aim of this study was to evaluate the neutrophil gelatinase-associated lipocalin (NGAL) as possible biomarker for the prediction of AKI in an adult cardiac population. Materials and methods: Sixty-nine consecutive patients who underwent cardiac surgeries in our hospital were prospectively evaluated. In the intensive care unit (ICU) NGAL was measured as a new biomarker of AKI besides serum creatinine (sCrea)...
October 15, 2018: Biochemia Medica: časopis Hrvatskoga Društva Medicinskih Biokemičara
Travis Markham, Robert Wegner, Nadia Hernandez, Jae W Lee, Warren Choi, Holger K Eltzschig, John Zaki
STUDY OBJECTIVE: To investigate the impact of utilizing a multimodal analgesia protocol to allow the implementation of Enhanced Recovery after Cardiac Surgery (ERACS) in patients requiring cardio-pulmonary bypass. DESIGN: Retrospective analysis of patients treated with the proposed ERACS bundle in comparison to matched controls. SETTING: Single-center study. PATIENTS: A total of 50 patients undergoing elective cardiac surgery limited to on pump coronary artery bypass graft...
November 5, 2018: Journal of Clinical Anesthesia
Ryan J Fink, Andrew Young, N David Yanez, Marissa Hom, Jennifer Mai, Matthias Merkel
PURPOSE: A new postcardiac surgery fluid resuscitation strategy was implemented in our Cardiovascular Intensive Care Unit (CVICU) to implement evidence-based practice. We transitioned from a primarily albumin fluid-based strategy to a lactated Ringer's fluid-based strategy. We sought to determine whether a new postoperative fluid resuscitation strategy significantly altered the fluid composition for postcardiac surgery patients and what effect that would have on fluid resuscitation costs...
November 7, 2018: Pharmacotherapy
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