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Protocols in cardiac surgery

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https://www.readbyqxmd.com/read/28108578/the-activated-clotting-time-in-cardiac-surgery-should-celite-or-kaolin-be-used
#1
Adrianus J De Vries, Annemieke Oude Lansink-Hartgring, Freek-Jan Fernhout, Rolf C G Huet, Edwin R van den Heuvel
OBJECTIVES: Both kaolin- and Celite-activated clotting times (ACT) are used to guide anticoagulation during cardiopulmonary bypass. It is unknown whether these methods lead to similar management procedures for anticoagulation in patients and are thus interchangeable in terms of bias, precision and variability. METHODS: We randomized 97 patients undergoing coronary artery bypass grafting or aortic valve replacement to either kaolin- or Celite-guided anticoagulation...
January 20, 2017: Interactive Cardiovascular and Thoracic Surgery
https://www.readbyqxmd.com/read/28094478/fluid-management-in-cardiac-surgery-patients-pitfalls-challenges-and-solutions
#2
Elena Bignami, Marcello Guarnieri, Marco Gemma
Fluid administration is a powerful tool for hemodynamic stabilization as it increases preload and improves cardiac function in fluid-responsive patients. However, there are various types of fluid to choose from. The use of colloids and crystalloids in non-cardiac Intensive Care Units (ICU) has been reported, showing controversial results. Many trials on sepsis in a non-cardiac ICU setting show that colloids, in particular hydroxyethyl starches and gelatins, might have a detrimental effect on kidney function, and on major outcomes such as mortality...
January 17, 2017: Minerva Anestesiologica
https://www.readbyqxmd.com/read/28093920/inspiratory-muscle-training-is-effective-to-reduce-postoperative-pulmonary-complications-and-length-of-hospital-stay-a-systematic-review-and-meta-analysis
#3
Filipa Kendall, José Oliveira, Bárbara Peleteiro, Paulo Pinho, Pedro Teixeira Bastos
PURPOSE: This study systematically review and meta-analyse the effectiveness of inspiratory muscle training (IMT) to reduce postoperative pulmonary complications (PPC) and length of hospital stay (LOS), both in the preoperative and/or postoperative periods of cardiac, pulmonary, and abdominal surgical patients. Sensitive analysis was performed to examine which patients benefit more from IMT according to methodological features (quality of studies and sample size), patient's characteristics (pulmonary risk stratification, age, and body mass index), type of surgery, period of training, and training protocols (training doses and level of supervision)...
January 17, 2017: Disability and Rehabilitation
https://www.readbyqxmd.com/read/28077517/two-phase-hospital-associated-outbreak-of-mycobacterium-abscessus-investigation-and-mitigation
#4
Arthur W Baker, Sarah S Lewis, Barbara D Alexander, Luke F Chen, Richard J Wallace, Barbara A Brown-Elliott, Pamela J Isaacs, Lisa C Pickett, Chetan B Patel, Peter K Smith, John M Reynolds, Jill Engel, Cameron R Wolfe, Carmelo A Milano, Jacob N Schroder, Robert D Davis, Matthew G Hartwig, Jason E Stout, Nancy Strittholt, Eileen K Maziarz, Jennifer Horan Saullo, Kevin C Hazen, Richard J Walczak, Ravikiran Vasireddy, Sruthi Vasireddy, Celeste M McKnight, Deverick J Anderson, Daniel J Sexton
BACKGROUND: Nontuberculous mycobacteria (NTM) commonly colonize municipal water and cause healthcare-associated outbreaks. We investigated a biphasic outbreak of Mycobacterium abscessus at a tertiary care hospital. METHODS: Case patients had recent hospital exposure and laboratory-confirmed colonization or infection with M. abscessus from January 2013 through December 2015. We conducted a multidisciplinary epidemiologic, field, and laboratory investigation. RESULTS: The incidence rate of M...
January 11, 2017: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
https://www.readbyqxmd.com/read/28075500/very-short-short-term-benefit-of-inpatient-outpatient-cardiac-rehabilitation-programs-after-coronary-artery-bypass-grafting-surgery
#5
Dejan Spiroski, Mojsije Andjić, Olivera Ilić Stojanović, Milica Lazović, Ana Djordjević Dikić, Miodrag Ostojić, Branko Beleslin, Snežana Kostić, Marija Zdravković, Dragan Lović
BACKGROUND: Exercise-based rehabilitation is an important part of treatment patients following coronary artery bypass graft (CABG) surgery. HYPOTHESIS: To evaluate effect of very short/short-term exercise training on cardiopulmonary exercise testing (CPET) parameters. METHODS: We studied 54 consecutive patients with myocardial infarction (MI) treated with CABG surgery referred for rehabilitation. The study population consisted of 50 men and 4 women (age 57...
January 11, 2017: Clinical Cardiology
https://www.readbyqxmd.com/read/28074802/goal-directed-therapy-improves-the-outcome-of-high-risk-cardiac-patients-undergoing-off-pump-coronary-artery-bypass
#6
Poonam Malhotra Kapoor, Rohan Magoon, Rajinder Singh Rawat, Yatin Mehta, Sameer Taneja, R Ravi, Milind P Hote
BACKGROUND: There has been a constant emphasis on developing management strategies to improve the outcome of high-risk cardiac patients undergoing surgical revascularization. The performance of coronary artery bypass surgery on an off-pump coronary artery bypass (OPCAB) avoids the risks associated with extra-corporeal circulation. The preliminary results of goal-directed therapy (GDT) for hemodynamic management of high-risk cardiac surgical patients are encouraging. The present study was conducted to study the outcome benefits with the combined use of GDT with OPCAB as compared to the conventional hemodynamic management...
January 2017: Annals of Cardiac Anaesthesia
https://www.readbyqxmd.com/read/28073791/rapid-deployment-aortic-replacement-radar-registry-in-spain-a-protocol
#7
Victor Bautista-Hernandez, Natalia Cal-Purriños, Jose M Arribas-Leal, Manuel Carnero-Alcazar, Jose F Gutierrez-Diez, Jose J Cuenca-Castillo
INTRODUCTION: Rapid deployment valves (RDV) represent a newly introduced approach to aortic valve replacement which facilitates surgical implantation and minimally invasive techniques, shortens surgical times and shows excellent haemodynamic performance. However, evidence on their safety, efficacy and potential complications is mostly fitted with small-volume and retrospective studies. Moreover, no current guidelines exist. To improve our knowledge on this technology, The Rapid Deployment Aortic Replacement (RADAR) Registry will be established across Spain with the aim of assessing RDV outcomes in the real-world setting...
January 10, 2017: BMJ Open
https://www.readbyqxmd.com/read/28069624/external-validation-of-the-revised-cardiac-risk-index-and-update-of-its-renal-variable-to-predict-30-day-risk-of-major-cardiac-complications-after-non-cardiac-surgery-rationale-and-plan-for-analyses-of-the-vision-study
#8
Pavel S Roshanov, Michael Walsh, P J Devereaux, S Danielle MacNeil, Ngan N Lam, Ainslie M Hildebrand, Rey R Acedillo, Marko Mrkobrada, Clara K Chow, Vincent W Lee, Lehana Thabane, Amit X Garg
INTRODUCTION: The Revised Cardiac Risk Index (RCRI) is a popular classification system to estimate patients' risk of postoperative cardiac complications based on preoperative risk factors. Renal impairment, defined as serum creatinine >2.0 mg/dL (177 µmol/L), is a component of the RCRI. The estimated glomerular filtration rate has become accepted as a more accurate indicator of renal function. We will externally validate the RCRI in a modern cohort of patients undergoing non-cardiac surgery and update its renal component...
January 9, 2017: BMJ Open
https://www.readbyqxmd.com/read/28054902/novel-goal-directed-hemodynamic-optimization-therapy-based-on-major-vasopressor-during-corrective-cardiac-surgery-in-patients-with-severe-pulmonary-arterial-hypertension-a-pilot-study
#9
Shuwen Li, Qing Ma, Yanwei Yang, Jiakai Lu, Zhiquan Zhang, Mu Jin, Weiping Cheng
INTRODUCTION: Pulmonary arterial hypertension (PAH) is a common and fatal complication of congenital heart disease (CHD). PAH-CHD increases the risk for postoperative complications. Recent evidence suggests that perioperative goal-directed hemodynamic optimization therapy (GDHOT) significantly improves outcomes in surgery patients. Standard GDHOT is based on major solution volume, vasodilators and inotropic therapy, while novel GDHOT is based on major vasopressor and inotropic therapy...
22, 2016: Heart Surgery Forum
https://www.readbyqxmd.com/read/28039238/effect-of-beta-blockers-on-perioperative-outcomes-in-vascular-and-endovascular-surgery-a-systematic-review-and-meta-analysis
#10
S Hajibandeh, S Hajibandeh, S A Antoniou, F Torella, G A Antoniou
BACKGROUND: To investigate the role of perioperative beta-blocker use in vascular and endovascular surgery. METHODS: We performed a systematic review in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement standards. The review protocol was registered with International Prospective Register of Systematic Reviews (registration number:CRD42016038111). We searched electronic databases to identify all randomized controlled trials and observational studies investigating outcomes of patients undergoing vascular and endovascular surgery with or without perioperative beta blockade...
January 2017: British Journal of Anaesthesia
https://www.readbyqxmd.com/read/27999663/implementation-of-goal-directed-fluid-therapy-during-hip-revision-arthroplasty-a-matched-cohort-study
#11
Marit Habicher, Felix Balzer, Viktor Mezger, Jennifer Niclas, Michael Müller, Carsten Perka, Michael Krämer, Michael Sander
BACKGROUND: Several randomized controlled trials (RCTs) have demonstrated that intraoperative goal-directed fluid therapy (GDFT) can decrease postsurgical complications in patients undergoing major abdominal surgery. However, very few studies have demonstrated the value of goal-directed therapy (GDT) in patients undergoing orthopaedic surgery and confirmed it is as useful in real-life conditions. Therefore, we initiated a GDFT implementation programme in patients undergoing hip revision arthroplasty in order to assess its effects on postoperative complications (e...
2016: Perioperative Medicine
https://www.readbyqxmd.com/read/27979834/ciclosporin-to-protect-renal-function-in-cardiac-surgery-ciprics-a-study-protocol-for-a-double-blind-randomised-placebo-controlled-proof-of-concept-study
#12
Per Ederoth, Edgars Grins, Alain Dardashti, Björn Brondén, Carsten Metzsch, André Erdling, Shahab Nozohoor, Arash Mokhtari, Magnus J Hansson, Eskil Elmér, Lars Algotsson, Stefan Jovinge, Henrik Bjursten
INTRODUCTION: Acute kidney injury (AKI) after cardiac surgery is common and results in increased morbidity and mortality. One possible mechanism for AKI is ischaemia-reperfusion injury caused by the extracorporeal circulation (ECC), resulting in an opening of the mitochondrial permeability transition pore (mPTP) in the kidneys, which can lead to cell injury or cell death. Ciclosporin may block the opening of mPTP if administered before the ischaemia-reperfusion injury. We hypothesised that ciclosporin given before the start of ECC in cardiac surgery can decrease the degree of AKI...
December 15, 2016: BMJ Open
https://www.readbyqxmd.com/read/27956673/prospective-observational-study-of-the-effect-of-dual-antiplatelet-therapy-with-tranexamic-acid-treatment-on-platelet-function-and-bleeding-after-cardiac-surgery
#13
J Amour, M Garnier, J Szymezak, Y Le Manach, D Helley, S Bertil, A Ouattara, B Riou, P Gaussem
BACKGROUND: The bleeding impact of dual antiplatelet therapy (DAPT), aspirin and clopidogrel, maintained until coronary artery bypass graft surgery (CABG), is still a matter of debate. The lack of preoperative antiplatelet activity measurement and heterogeneity of antifibrinolytic protocols in prior studies make the conclusions questionable. The aim of this prospective study was to determine, after preoperative antiplatelet activity measurement, if the maintenance of DAPT until CABG increases bleeding in patients treated with tranexamic acid (TA)...
December 2016: British Journal of Anaesthesia
https://www.readbyqxmd.com/read/27956247/computerised-insulin-dosing-calculators-for-the-management-of-continuous-insulin-infusions-after-cardiac-surgery-a-systematic-review-and-meta-analysis
#14
REVIEW
Megan H Higgs, Ritin S Fernandez
OBJECTIVES: To investigate the effectiveness of computerised insulin dosing calculators for the management of continuous insulin infusions in adult patients who underwent cardiac surgery. METHOD: A systematic review was conducted. The CINAHL, MEDLINE and Cochrane databases were searched for primary studies that compared a computerised insulin dosing calculator to a paper protocol. The main outcome measures were mean Blood Glucose Level (BGL), time to achieve BGL target range, time spent within BGL target range, the incidence of hyperglycaemia and the incidence of hypoglycaemia...
December 9, 2016: Intensive & Critical Care Nursing: the Official Journal of the British Association of Critical Care Nurses
https://www.readbyqxmd.com/read/27941511/a-comparison-between-dexmedetomidine-and-propofol-on-extubation-times-in-postoperative-adult-cardiac-surgery-patients-a-systematic-review-protocol
#15
John Nguyen, Noel Nacpil
The objective of this systematic review is to synthesize the best available evidence regarding the effects of dexmedetomidine compared to propofol on time to extubation, intensive care unit (ICU) length of stay (LOS), hospital LOS and mortality in postoperative adult cardiac surgery patients.The specific review question is as follows:What is the effectiveness of dexmedetomidine compared to propofol on times to extubation, ICU LOS, hospital LOS and mortality in postoperative adults undergoing cardiac surgery?...
November 2016: JBI Database of Systematic Reviews and Implementation Reports
https://www.readbyqxmd.com/read/27938898/the-impact-of-a-multidisciplinary-blood-conservation-protocol-on-patient-outcomes-and-cost-after-cardiac-surgery
#16
Niv Ad, Sari D Holmes, Jay Patel, Deborah J Shuman, Paul S Massimiano, Elmer Choi, David Fitzgerald, Linda Halpin, Lisa M Fornaresio
OBJECTIVE: Although associations between transfusion and inferior outcomes have been documented, there is a lack of blood transfusion standardization in cardiac surgery. At the Inova Heart and Vascular Institute, a multidisciplinary, criterion-driven algorithm for transfusion management was implemented. We examined the effect of our blood conservation protocol on transfusion rates and outcomes after cardiac surgery and on stability of transfusion over time. METHODS: Patients undergoing first-time cardiac surgery from 2006 (full year before protocol) were compared with those in 2009 (after protocol) and propensity score matched to improve balance...
November 16, 2016: Journal of Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/27925466/a-prospective-evaluation-of-contrast-and-radiation-dose-and-image-quality-in-cardiac-ct-in-children-with-complex-congenital-heart-disease-using-low-concentration-iodinated-contrast-agent-and-low-tube-voltage-and-current
#17
Qiao-Ru Hou, Wei Gao, Yu Min Zhong, Ai Min Sun, Qian Wang, Hai Sheng Qiu, Fang Wang, Jian Ying Li, Liwei Hu
OBJECTIVE: To assess image quality, contrast dose and radiation dose in cardiac CT in children with congenital heart disease using low-concentration iodinated contrast agent and low tube voltage and current in comparison with standard-dose protocol. METHODS: 110 patients with congenital heart disease were randomized to one of the two scan protocols: Group A (n=45) with 120mA tube current and contrast agent of 270mgI/ml in concentration (Visipaque, GE Healthcare), and Group B (n=65) with the conventional 160mA and 370mgI/mL concentration contrast (Iopamiro, Bracco)...
December 7, 2016: British Journal of Radiology
https://www.readbyqxmd.com/read/27919861/multiparametric-mri-in-differentiating-pulmonary-artery-sarcoma-and-pulmonary-thromboembolism-a-preliminary-experience
#18
Min Liu, Chunhai Luo, Ying Wang, Xiaojuan Guo, Zhanhong Ma, Yuanhua Yang, Tianjing Zhang
PURPOSE: We aimed to define multiparametric magnetic resonance imaging (MRI) findings to differentiate between pulmonary artery sarcoma (PAS) and pulmonary thromboembolism (PTE). METHODS: Eleven patients with suspected PTE were prospectively included to undergo pulmonary MRI before surgery or biopsy. MRI protocol included an unenhanced sequence, diffusion-weighted imaging (DWI, b=800 s/mm2) and a dynamic contrast-enhanced sequence. Morphologic characteristics including distribution, filling defect, and intensity were observed on T1-, T2-, and fat-suppressed T2-weighted imaging, DWI, and contrast-enhanced MRI...
January 2017: Diagnostic and Interventional Radiology: Official Journal of the Turkish Society of Radiology
https://www.readbyqxmd.com/read/27917566/perioperative-hypothermia-in-neonatal-intensive-care-unit-patients-effectiveness-of-a-thermoregulation-intervention-and-associated-risk-factors
#19
Branden M Engorn, Stephanie L Kahntroff, Karen M Frank, Sarabdeep Singh, Helen A Harvey, Charles T Barkulis, Annika M Barnett, Olamide O Olambiwonnu, Eugenie S Heitmiller, Robert S Greenberg
BACKGROUND: Hypothermia in neonatal intensive care unit patients is associated with morbidity. Perioperative normothermia is the standard of care. AIMS: We hypothesized that a quality improvement intervention (transport protocol, transport education, ongoing monitoring) would decrease the incidence of perioperative hypothermia. Secondarily, we hypothesized that patients undergoing surgery at a postmenstrual age of <37 weeks or at a weight of <1.5 kg would be at higher risk for perioperative hypothermia...
February 2017: Paediatric Anaesthesia
https://www.readbyqxmd.com/read/27910046/exosomes-based-gene-therapy-for-microrna-delivery
#20
Prabhu Mathiyalagan, Susmita Sahoo
Despite recent advances in scientific knowledge and clinical practice, cardiovascular disease management and treatment remain a major burden. While several treatment strategies using drugs and surgeries are being developed for cardiovascular manifestations, gene-based therapies hold significant promise. Recent findings from our laboratory unveiled a novel mechanism that exosomes, secreted nanovesicles from stem cells, mediate cardiac repair via transferring their unique repertoire of microRNAs (miRNA) to recipient cells in the heart...
2017: Methods in Molecular Biology
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