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Protocols in cardiac surgery

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https://www.readbyqxmd.com/read/28437372/heart-rate-modification-of-cardiac-output-following-cardiac-surgery-the-importance-of-cardiac-time-intervals
#1
Guido Tavazzi, Andy Kontogeorgis, Fabio Guarracino, Niels Bergsland, Ana Martinez-Naharro, John Pepper, Susanna Price
OBJECTIVES: Inadequate cardiac output is associated with a poor outcome following cardiac surgery and is generally modified by the use of positive inotropic agents, volume resuscitation, and pacing. Echocardiography-guided pacemaker optimization is used in the outpatient setting, using different variables including total isovolumic time and the Tei index. We sought to determine the acute impact of heart rate on cardiac electromechanics, cardiac output, and stroke volume in the perioperative setting...
April 21, 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/28437263/a-randomised-trial-to-evaluate-preoperative-oral-carbohydrate-administration-on-insulin-resistance-in-off-pump-coronary-artery-bypass-patients
#2
Bora Lee, Sarah Soh, Jae-Kwang Shim, Ha Y Kim, Hyelin Lee, Young-Lan Kwak
BACKGROUND: In fasting cardiac surgery patients, preoperative carbohydrate (CHO) drink intake attenuated insulin resistance and improved cardiac metabolism, although its beneficial effects were not evident after cardiac surgery possibly due to cardiopulmonary bypass-related extreme systemic inflammation. OBJECTIVE: We aimed to evaluate whether preoperative CHO intake affected insulin resistance and free-fatty acid (FFA) concentrations in off-pump coronary revascularisation...
April 21, 2017: European Journal of Anaesthesiology
https://www.readbyqxmd.com/read/28430754/biomarkers-for-early-acute-kidney-injury-diagnosis-and-severity-prediction-a-pilot-multicenter-canadian-study-of-children-admitted-to-the-icu
#3
Jennifer Palermo, Allison B Dart, Alanna De Mello, Prasad Devarajan, Ronald Gottesman, Gonzalo Garcia Guerra, Greg Hansen, Ari R Joffe, Cherry Mammen, Nick Majesic, Catherine Morgan, Peter Skippen, Michael Pizzi, Ana Palijan, Michael Zappitelli
OBJECTIVE: Acute kidney injury occurs early in PICU admission and increases risks for poor outcomes. We evaluated the feasibility of a multicenter acute kidney injury biomarker urine collection protocol and measured diagnostic characteristics of urine neutrophil gelatinase-associated lipocalin, interleukin-18, and liver fatty acid binding protein to predict acute kidney injury and prolonged acute kidney injury. DESIGN: Prospective observational pilot cohort study...
April 20, 2017: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/28424936/preoperative-chemoradiotherapy-versus-perioperative-chemotherapy-for-patients-with-resectable-esophageal-or-gastroesophageal-junction-adenocarcinoma
#4
M C J Anderegg, P C van der Sluis, J P Ruurda, S S Gisbertz, M C C M Hulshof, M van Vulpen, N Haj Mohammed, H W M van Laarhoven, M J Wiezer, M Los, M I van Berge Henegouwen, R van Hillegersberg
BACKGROUND: This study compares neoadjuvant chemoradiotherapy (nCRT) with perioperative chemotherapy (pCT) for patients with resectable esophageal or gastroesophageal junction (GEJ) adenocarcinoma in terms of toxicity, postoperative complications, pathologic response, and survival. METHODS: This study retrospectively analyzed and compared 313 patients with resectable esophageal or GEJ adenocarcinoma treated with either nCRT (carboplatin/paclitaxel 41.4 Gy, n = 176) or pCT (epirubicin, cisplatin and capecitabine, n = 137)...
April 19, 2017: Annals of Surgical Oncology
https://www.readbyqxmd.com/read/28420664/the-uk-cardiac-and-vascular-surgery-interventional-anaemia-response-caviar-study-protocol-for-an-observational-cohort-study-to-determine-the-impact-and-effect-of-preoperative-anaemia-management-in-cardiac-and-vascular-surgical-patients
#5
Marisa Chau, Toby Richards, Caroline Evans, Anna Butcher, Timothy Collier, Andrew Klein
INTRODUCTION: Preoperative anaemia is linked to poor postsurgical outcome, longer hospital stays, greater risk of complications and mortality. Currently in the UK, some sites have developed anaemia clinics or pathways that use intravenous iron to correct iron deficiency anaemia prior to surgery as their standard of care. Although intravenous iron has been observed to be effective in a variety of patient settings, there is insufficient evidence in its use in cardiac and vascular patients...
April 18, 2017: BMJ Open
https://www.readbyqxmd.com/read/28416392/right-ventricular-function-after-cardiac-surgery-is-a-strong-independent-predictor-for-long-term-mortality
#6
Inge T Bootsma, Fellery de Lange, Matty Koopmans, Johannes Haenen, Piet W Boonstra, Tomas Symersky, E Christiaan Boerma
OBJECTIVE: To establish the all-cause mortality of right ventricular dysfunction after cardiac surgery in a heterogeneous group of cardiac surgery patients. DESIGN: Retrospective analysis of a heterogeneous group of 1,109 cardiac surgery patients in a 4-year period. SETTING: Single-center study in a tertiary teaching hospital. PARTICIPANTS: One thousand one hundred nine cardiac surgery patients. By protocol, patients were monitored with a pulmonary artery catheter, enabling continuous right ventricular ejection fraction (RVEF) measurements...
February 5, 2017: Journal of Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/28402472/direct-sternal-administration-of-vancomycin-and-gentamicin-during-closure-prevents-wound-infection%C3%A2
#7
Martin Andreas, Moritz Muckenhuber, Doris Hutschala, Alfred Kocher, Florian Thalhammer, Paul Vogt, Tatjana Fleck, Guenther Laufer
OBJECTIVES: Deep sternal wound infection is still a major complication in patients undergoing cardiac surgery. We previously identified mammary artery harvesting as a risk factor for decreased antibiotic tissue penetration. In addition, other risk factors including diabetes may inhibit sufficient tissue penetration of perioperative antibiotic prophylaxis. A novel closure protocol applying 2 topical antibiotics and further recommendations for sternal wiring was introduced at our department to decrease the incidence of sternal wound infections...
April 10, 2017: Interactive Cardiovascular and Thoracic Surgery
https://www.readbyqxmd.com/read/28394839/quality-and-safety-in-health-care-part-xxvi-the-adult-cardiac-surgery-database
#8
Jay A Harolds
The Adult Cardiac Surgery Database of the Society of Thoracic Surgeons has provided highly useful information in quality and safety in general thoracic surgery, including ratings of the surgeons and institutions participating in this type of surgery. The Adult Cardiac Surgery Database information is very helpful for writing guidelines and determining optimal protocols and for many research projects. This article discusses the history and current status of this database.
April 7, 2017: Clinical Nuclear Medicine
https://www.readbyqxmd.com/read/28382661/pre-operative-haemoglobin-levels-and-iron-status-in-a-large-multicentre-cohort-of-patients-undergoing-major-elective-surgery
#9
M Muñoz, M J Laso-Morales, S Gómez-Ramírez, M Cadellas, M J Núñez-Matas, J A García-Erce
Pre-operative anaemia in patients undergoing major surgical procedures has been linked to poor outcomes. Therefore, early detection and treatment of pre-operative anaemia is recommended. However, to effectively implement a pre-operative anaemia management protocol, an estimation of its prevalence and main causes is needed. We analysed data from 3342 patients (44.5% female) scheduled for either: elective orthopaedic surgery (n = 1286); cardiac surgery (n = 691); colorectal cancer resection (n = 735); radical prostatectomy (n = 362); gynaecological surgery (n = 203) or resection of liver metastases (n = 122)...
April 6, 2017: Anaesthesia
https://www.readbyqxmd.com/read/28360251/the-incidence-of-delirium-after-cardiac-surgery-in-the-elderly-protocol-for-a-systematic-review-and-meta-analysis
#10
Yulin Liao, Joseph H Flaherty, Jirong Yue, Yanyan Wang, Chuanyao Deng, Ling Chen
INTRODUCTION: Delirium is one of the most common complications after cardiac surgery in the elderly. Future studies aimed at preventing postoperative delirium will need an accurate estimate of incidence. However, there are no available systematic reviews on the incidence, and reports of incidence of postoperative delirium after a cardiac operation vary widely with significant heterogeneity. Therefore, we aim to perform a systematic review and meta-analysis to determine the most accurate incidence possible of postoperative delirium in individuals aged >65 years after cardiac surgery...
March 29, 2017: BMJ Open
https://www.readbyqxmd.com/read/28343236/effects-of-restricting-perioperative-use-of-intravenous-chloride-on-kidney-injury-in-patients-undergoing-cardiac-surgery-the-licra-pragmatic-controlled-clinical-trial
#11
David McIlroy, Deirdre Murphy, Jessica Kasza, Dhiraj Bhatia, Lisa Wutzlhofer, Silvana Marasco
PURPOSE: The administration of chloride-rich intravenous (IV) fluid and hyperchloraemia have been associated with perioperative renal injury. The aim of this study was to determine whether a comprehensive perioperative protocol for the administration of chloride-limited IV fluid would reduce perioperative renal injury in adults undergoing cardiac surgery. METHODS: From February 2014 through to December 2015, all adult patients undergoing cardiac surgery within a single academic medical center received IV fluid according to the study protocol...
March 25, 2017: Intensive Care Medicine
https://www.readbyqxmd.com/read/28333021/a-phase-1-2-trial-of-a-combination-of-paclitaxel-and-trastuzumab-with-daily-irradiation-or-paclitaxel-alone-with-daily-irradiation-after-transurethral-surgery-for-noncystectomy-candidates-with-muscle-invasive-bladder-cancer-trial-nrg-oncology-rtog-0524
#12
M Dror Michaelson, Chen Hu, Huong T Pham, Douglas M Dahl, Chin Lee-Wu, Gregory P Swanson, Jacqueline Vuky, R Jeffrey Lee, Luis Souhami, Brian Chang, Asha George, Howard Sandler, William Shipley
PURPOSE: Bladder preservation therapy is an effective treatment for muscle-invasive urothelial carcinoma (UC). In this study we treated noncystectomy candidates with daily radiation and weekly paclitaxel for 7 weeks. Patients whose tumors showed her2/neu overexpression were additionally treated with weekly trastuzumab. METHODS AND MATERIALS: Sixty-eight evaluable patients were treated with radiation therapy and either paclitaxel + trastuzumab (group 1) or paclitaxel alone (group 2)...
April 1, 2017: International Journal of Radiation Oncology, Biology, Physics
https://www.readbyqxmd.com/read/28329292/surgical-septal-myectomy-or-alcohol-septal-ablation-which-approach-offers-better-outcomes-for-patients-with-hypertrophic-obstructive-cardiomyopathy
#13
Shi Sum Poon, Mark Field, Dhiraj Gupta, Duke Cameron
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether surgical septal myectomy (SM) is more beneficial than alcohol septal ablation (ASA) in patients with hypertrophic obstructive cardiomyopathy. Altogether 218 articles were found using the reported search, of which 15 studies represented the best evidence to answer the clinical question. There were 14 observational studies and 1 meta-analysis study. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these articles are tabulated...
February 28, 2017: Interactive Cardiovascular and Thoracic Surgery
https://www.readbyqxmd.com/read/28329231/cardiac-protective-effects-of-remote-ischaemic-preconditioning-in-children-undergoing-tetralogy-of-fallot-repair-surgery-a-randomized-controlled-trial
#14
Qingping Wu, Tingting Wang, Shiqiang Chen, Quanjun Zhou, Haobo Li, Na Hu, Yinglu Feng, Nianguo Dong, Shanglong Yao, Zhengyuan Xia
Aims: Remote ischaemic preconditioning (RIPC) by inducing brief ischaemia in distant tissues protects the heart against myocardial ischaemia-reperfusion injury (IRI) in children undergoing open-heart surgery, although its effectiveness in adults with comorbidities is controversial. The effectiveness and mechanism of RIPC with respect to myocardial IRI in children with tetralogy of Fallot (ToF), a severe cyanotic congenital cardiac disease, undergoing open heart surgery are unclear. We hypothesized that RIPC can confer cardioprotection in children undergoing ToF repair surgery...
February 18, 2017: European Heart Journal
https://www.readbyqxmd.com/read/28325657/assessment-of-image-quality-of-repeated-limited-transthoracic-echocardiography-after-cardiac-surgery
#15
David J Canty, Johan Heiberg, Jen A Tan, Yang Yang, Alistair G Royse, Colin F Royse, Abdulelah Mobeirek, Fayez El Shaer, Turki Albacker, Rakan I Nazer, Muhammed Fouda, Bakir M Bakir, Ahmed A Alsaddique
OBJECTIVES: The use of limited transthoracic echocardiography (TTE) has been restricted in patients after cardiac surgery due to reported poor image quality. The authors hypothesized that the hemodynamic state could be evaluated in a high proportion of patients at repeated intervals after cardiac surgery. DESIGN: Prospective observational study. SETTING: Tertiary university hospital. PARTICIPANTS: The study comprised 51 patients aged 18 years or older presenting for cardiac surgery...
December 16, 2016: Journal of Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/28320201/analysis-of-never-events-following-adult-cardiac-surgical-procedures-in-the-united-states
#16
Michael P Robich, Brianna M Krafcik, Nishant K Shah, Alik Farber, Denis Rybin, Jeffrey J Siracuse
BACKGROUND: This study was conducted to determine the risk factors, nature, and outcomes of "never events" following open adult cardiac surgical procedures. Understanding of these events can reduce their occurrence, and thereby improve patient care, quality metrics, and cost reduction. METHODS: "Never events" for patients included in the Nationwide Inpatient Sample who underwent coronary artery bypass graft, heart valve repair/replacement, or thoracic aneurysm repair between 2003-2011 were documented...
March 16, 2017: Journal of Cardiovascular Surgery
https://www.readbyqxmd.com/read/28300357/pilot-randomized-controlled-trial-on-early-and-late-remote-ischemic-preconditioning-prior-to-complex-cardiac-surgery-in-young-infants
#17
Gonzalo Garcia Guerra, Ari R Joffe, Rob Seal, Ernest Phillipos, Maggie Wong, Elham Khodayari Moez, Irina A Dinu, Jonathan P Duff, David Ross, Ivan Rebeyka, Charlene M T Robertson
BACKGROUND: Remote ischemic preconditioning involves providing a brief ischemia-reperfusion event to a tissue to create subsequent protection from a more severe ischemia-reperfusion event to a different tissue/organ. The few pediatric remote ischemic preconditioning studies in the literature show conflicting results. AIM: We conducted a pilot randomized controlled trial to determine the feasibility of conducting a larger trial and to gather provisional data on the effect of early and late remote ischemic preconditioning on outcomes of infants after surgery for congenital heart disease...
April 2017: Paediatric Anaesthesia
https://www.readbyqxmd.com/read/28298879/adherence-to-all-steps-of-a-pain-management-protocol-in-intensive-care-patients-after-cardiac-surgery-is-hard-to-achieve
#18
L van Gulik, S J G M Ahlers, P Bruins, D Tibboel, C A J Knibbe, M van Dijk
Purpose. To investigate adherence to our pain protocol considering analgesics administration, number and timing of pain assessments, and adjustment of analgesics upon unacceptably high (NRS ≥ 4) and low (NRS ≤ 1) pain scores. Material and Methods. The pain protocol for patients in the intensive care unit (ICU) after cardiac surgery consisted of automated prescriptions for paracetamol and morphine, automated reminders for pain assessments, a flowchart to guide interventions upon high and low pain scores, and reassessments after unacceptable pain...
2017: Pain Research & Management: the Journal of the Canadian Pain Society
https://www.readbyqxmd.com/read/28298666/bivalirudin-as-an-alternative-anticoagulant-for-cardiopulmonary-bypass-during-adult-cardiac-surgery-a-change-in-practice
#19
Peter Gatt, Samuel Anthony Galea, Walter Busuttil, Charles Grima, Jeffrey Muscat, Yvette Farrugia
The referral of patients for open heart surgery, presenting with a history of heparin hypersensitivity instigated a multidisciplinary effort to find an alternative anticoagulant to heparin. The various options mentioned in the literature call for changes in the routine practice of open heart surgery on cardiopulmonary bypass. These changes involve mostly the perfusion setup and conduct on bypass and to a lesser extent the anesthetic and surgical practice. Nevertheless, the different professions involved in the cardiac surgical firm discussed the proposed changes in a multidisciplinary effort...
March 2017: Journal of Extra-corporeal Technology
https://www.readbyqxmd.com/read/28287533/isolation-of-endothelial-progenitor-cells-from-healthy-volunteers-and-their-migratory-potential-influenced-by-serum-samples-after-cardiac-surgery
#20
Christoph Emontzpohl, David Simons, Sandra Kraemer, Andreas Goetzenich, Gernot Marx, Jürgen Bernhagen, Christian Stoppe
Endothelial progenitor cells (EPCs) are recruited from the bone marrow under pathological conditions like hypoxia and are crucially involved in the neovascularization of ischemic tissues. The origin, classification and characterization of EPCs are complex; notwithstanding, two prominent sub-types of EPCs have been established: so-called "early" EPCs (subsequently referred to as early-EPCs) and late-outgrowth EPCs (late-EPCs). They can be classified by biological properties as well as by their appearance during in vitro culture...
February 14, 2017: Journal of Visualized Experiments: JoVE
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