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Cardiac surgical critical care

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https://www.readbyqxmd.com/read/28089599/impact-of-oral-chlorhexidine-on-bloodstream-infection-in-critically-ill-patients-systematic-review-and-meta-analysis-of-randomized-controlled-trials
#1
REVIEW
Luciano Silvestri, William I Weir, Dario Gregori, Nia Taylor, Durk F Zandstra, Joris J M van Saene, Hendrick K F van Saene
OBJECTIVES: Oropharyngeal overgrowth of microorganisms in the critically ill is a risk factor for lower respiratory tract infection and subsequent invasion of the bloodstream. Oral chlorhexidine has been used to prevent pneumonia, but its effect on bloodstream infection never has been assessed in meta-analyses. The authors explored the effect of oral chlorhexidine on the incidence of bloodstream infection, the causative microorganism, and on all-cause mortality in critically ill patients...
November 2, 2016: Journal of Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/28019045/autonomic-modulation-for-the-treatment-of-ventricular-arrhythmias-therapeutic-use-of-percutaneous-stellate-ganglion-blocks
#2
Marat Fudim, Richard Boortz-Marx, Chetan B Patel, Albert Y Sun, Jonathan P Piccini
Ventricular tachycardia (VT), ventricular fibrillation (VF) and electrical storm are commonly encountered emergency conditions in cardiac and surgical intensive care units. In most cases, recurrent ventricular arrhythmias or electrical storm are associated with a heightened sympathetic tone. These arrhythmias can be difficult to treat and may be refractory to beta-blockade, antiarrhythmic therapy, sedation, and mechanical hemodynamic support. While monomorphic ventricular tachycardia and PVC-triggered polymorphic ventricular tachycardia may sometimes be amenable to successful ablation, some patients may be too critically ill to make such an approach feasible...
December 26, 2016: Journal of Cardiovascular Electrophysiology
https://www.readbyqxmd.com/read/28004200/hyperinsulinemic-normoglycemia-decreases-glucose-variability-during-cardiac-surgery
#3
Alaa Abd-Elsayed, Edward J Mascha, Dongsheng Yang, Daniel I Sessler, Andra Duncan
PURPOSE: Increased glucose variability may be associated with worse outcomes in critically ill patients. Hyperinsulinemic normoglycemia provides intensive glucose control during surgery and may reduce glucose variability. Our objective was to compare glycemic variability between two methods of glucose control in cardiac surgical patients: hyperinsulinemic normoglycemia vs standard insulin infusion. We also assessed whether the effect differed between patients with and without diabetes mellitus...
December 21, 2016: Journal of Anesthesia
https://www.readbyqxmd.com/read/27978948/association-between-presence-of-a-cardiac-intensivist-and-mortality-in-an-adult-cardiac-care-unit
#4
Soo Jin Na, Chi Ryang Chung, Kyeongman Jeon, Chi-Min Park, Gee Young Suh, Joong Hyun Ahn, Keumhee C Carriere, Young Bin Song, Jin-Oh Choi, Joo-Yong Hahn, Jin-Ho Choi, Seung-Hyuk Choi, Young Keun On, Hyeon-Cheol Gwon, Eun-Seok Jeon, Duk-Kyung Kim, Jeong Hoon Yang
BACKGROUND: Dedicated intensive care unit (ICU) physician staffing is associated with a reduction in ICU mortality rates in general medical and surgical ICUs. However, limited data are available on the role of a cardiac intensivist in the cardiac intensive care unit (CICU). OBJECTIVES: This study investigated the association of cardiac intensivist-directed care with clinical outcomes in adult patients admitted to the CICU. METHODS: This study analyzed 2,431 patients admitted to the CICU at Samsung Medical Center in Seoul, South Korea, from January 2012 to December 2015...
December 20, 2016: Journal of the American College of Cardiology
https://www.readbyqxmd.com/read/27956843/lung-protective-mechanical-ventilation-strategies-in-cardiothoracic-critical-care-a-retrospective-study
#5
Vasileios Zochios, Matthew Hague, Kimberly Giraud, Nicola Jones
A body of evidence supports the use of low tidal volumes in ventilated patients without lung pathology to slow progress to acute respiratory distress syndrome (ARDS) due to ventilator associated lung injury. We undertook a retrospective chart review and tested the hypothesis that tidal volume is a predictor of mortality in cardiothoracic (medical and surgical) critical care patients receiving invasive mechanical ventilation. Independent predictors of mortality in our study included: type of surgery, albumin, H(+), bilirubin, and fluid balance...
2016: International Journal of General Medicine
https://www.readbyqxmd.com/read/27923680/the-100-most-cited-manuscripts-in-emergency-abdominal-surgery-a-bibliometric-analysis
#6
Thomas Ellul, Nicholas Bullock, Tarig Abdelrahman, Arfon G M T Powell, Jolene Witherspoon, Wyn G Lewis
BACKGROUND: The number of citations a scientific article receives provides a good indication of its impact within any given field. This bibliometric analysis aimed to identify the 100 most cited articles in Emergency Abdominal Surgery (EAS), to highlight key areas of interest and identify those that have most significantly shaped contemporary clinical practice in this newly evolving surgical specialty. This is of increasing relevance as concerns grow regarding the variable and suboptimal outcomes in Emergency General Surgery...
January 2017: International Journal of Surgery
https://www.readbyqxmd.com/read/27872993/cardiac-catheterization-in-pediatric-patients-supported-by-extracorporeal-membrane-oxygenation-a-15-year-experience
#7
Nicholas S Boscamp, Mariel E Turner, Matthew Crystal, Brett Anderson, Julie A Vincent, Alejandro J Torres
Cardiac catheterization is commonly performed in patients being supported by extracorporeal membrane oxygenation (ECMO). We aimed to evaluate the safety, benefit, and outcomes of catheterization in pediatric patients supported by ECMO. Retrospective review of cardiac catheterizations performed in patients ≤18 years of age while on ECMO at a large tertiary care center between January 2000 and May 2015. A total of 55 catheterizations were performed on 51 patients during 53 unique ECMO courses. Indications for ECMO include ventricular dysfunction (22), cardiac arrest (20), inability to wean from cardiopulmonary bypass (7), and persistent cyanosis (4)...
November 21, 2016: Pediatric Cardiology
https://www.readbyqxmd.com/read/27826706/clinical-associations-of-early-dysnatremias-in-critically-ill-neonates-and-infants-undergoing-cardiac-surgery
#8
Jon Kaufman, Daniel Phadke, Suhong Tong, Jennifer Eshelman, Sarah Newman, Christopher Ruzas, Eduardo M da Cruz, Suzanne Osorio
: Dysnatremias (DN) are common electrolyte disturbances in cardiac critical illness and are known risk factors for adverse outcomes in certain populations. Little information exists on DN in children with cardiac disease admitted to the cardiac intensive care unit (CICU) after undergoing cardiac surgery, either corrective or palliative. The aim was to determine the incidence and adverse outcomes associated with DN in neonates and infants undergoing cardiac surgery. Retrospective cohort and single center study performed at Children's Hospital Colorado from May 2013 to May 2014, in children under 1 year old admitted to the CICU after undergoing surgery for congenital or acquired cardiac disease...
November 8, 2016: Pediatric Cardiology
https://www.readbyqxmd.com/read/27816127/surgical-critical-care-for-the-trauma-patient-with-cardiac-disease
#9
REVIEW
Michael M Woll, Linda L Maerz
The elderly population is rapidly increasing in number. Therefore, geriatric trauma is becoming more prevalent. All practitioners caring for geriatric trauma patients should be familiar with the structural and functional changes naturally occurring in the aging heart, as well as common preexisting cardiac diseases in the geriatric population. Identification of the shock state related to cardiac dysfunction and targeted assessment of perfusion and resuscitation are important when managing elderly patients. Finally, management of cardiac dysfunction in the trauma patient includes an appreciation of the inherent effects of trauma on cardiac function...
December 2016: Anesthesiology Clinics
https://www.readbyqxmd.com/read/27799174/global-patient-outcomes-after-elective-surgery-prospective-cohort-study-in-27-low-middle-and-high-income-countries
#10
(no author information available yet)
BACKGROUND: As global initiatives increase patient access to surgical treatments, there remains a need to understand the adverse effects of surgery and define appropriate levels of perioperative care. METHODS: We designed a prospective international 7-day cohort study of outcomes following elective adult inpatient surgery in 27 countries. The primary outcome was in-hospital complications. Secondary outcomes were death following a complication (failure to rescue) and death in hospital...
November 2016: British Journal of Anaesthesia
https://www.readbyqxmd.com/read/27721980/fluid-responsiveness-prediction-using-vigileo-flotrac-measured-cardiac-output-changes-during-passive-leg-raise-test
#11
Anton Krige, Martin Bland, Thomas Fanshawe
BACKGROUND: Passive leg raising (PLR) is a so called self-volume challenge used to test for fluid responsiveness. Changes in cardiac output (CO) or stroke volume (SV) measured during PLR are used to predict the need for subsequent fluid loading. This requires a device that can measure CO changes rapidly. The Vigileo™ monitor, using third-generation software, allows continuous CO monitoring. The aim of this study was to compare changes in CO (measured with the Vigileo device) during a PLR manoeuvre to calculate the accuracy for predicting fluid responsiveness...
2016: Journal of Intensive Care
https://www.readbyqxmd.com/read/27716696/early-enteral-nutrition-therapy-in-congenital-cardiac-repair-postoperatively-a-randomized-controlled-pilot-study
#12
Manoj Kumar Sahu, Anuradha Singal, Ramesh Menon, Sarvesh Pal Singh, Alka Mohan, Mala Manral, Divya Singh, V Devagouru, Sachin Talwar, Shiv Kumar Choudhary
BACKGROUND AND OBJECTIVES: Adequate nutritional supplementation in infants with cardiac malformations after surgical repair is a challenge. Critically ill infants in the early postoperative period are in a catabolic stress. The mismatch between estimated energy requirement (EER) and the intake in the postoperative period is multifactorial, predisposing them to complications such as immune deficiency, more infection, and growth failure. This study aimed to assess the feasibility and efficacy of enriched breast milk feed on postoperative recovery and growth of infants after open heart surgery...
October 2016: Annals of Cardiac Anaesthesia
https://www.readbyqxmd.com/read/27668841/rapid-response-teams-is-it-time-to-reframe-the-questions-of-rapid-response-team-measurement
#13
Gail G Salvatierra, Ruth C Bindler, Kenn B Daratha
PURPOSE: The purpose of this article is to present an overview of rapid response team (RRT) history in the United States, provide a review of prior RRT effectiveness research, and propose the reframing of four new questions of RRT measurement that are designed to better understand RRTs in the context of contemporary nursing practice as well as patient outcomes. ORGANIZING CONSTRUCT: RRTs were adopted in the United States because of their intuitive appeal, and despite a lack of evidence for their effectiveness...
September 26, 2016: Journal of Nursing Scholarship
https://www.readbyqxmd.com/read/27576447/association-between-off-hour-presentation-and-endotracheal-intubation-related-adverse-events-in-trauma-patients-with-a-predicted-difficult-airway-a-historical-cohort-study-at-a-community-emergency-department-in-japan
#14
Yuko Ono, Takuya Sugiyama, Yasuyuki Chida, Tetsuya Sato, Hiroaki Kikuchi, Daiji Suzuki, Masakazu Ikeda, Koichi Tanigawa, Kazuaki Shinohara
BACKGROUND: A reduction in medical staff such as occurs in hospitals during nights and weekends (off hours) is associated with a worse outcome in patients with several unanticipated critical conditions. Although difficult airway management (DAM) requires the simultaneous assistance of several appropriately trained medical caregivers, data are scarce regarding the association between off-hour presentation and endotracheal intubation (ETI)-related adverse events, especially in the trauma population...
August 30, 2016: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
https://www.readbyqxmd.com/read/27554331/anaesthetic-management-of-breast-surgery-in-a-patient-with-eisenmenger-syndrome
#15
J C Galán Gutiérrez, F E Fernández Suárez, P Miranda García, L A Sopena Zubiria
Eisenmenger syndrome (ES) is a complex combination of cardiovascular abnormalities defined as pulmonary hypertension with investment or bidirectional flow through an intracardiac or aortopulmonary communication, usually secondary to a congenital heart disease not resolved promptly. It carries a significant risk of perioperative mortality, with an incidence close to 30% for non-cardiac surgery. We report the anaesthetic management in a ES patient undergoing breast surgery, which was successfully performed under general anaesthesia combined with thoracic analgesic blocks...
January 2017: Revista Española de Anestesiología y Reanimación
https://www.readbyqxmd.com/read/27541335/intravenous-heparin-during-ruptured-abdominal-aortic-aneurysmal-repair
#16
REVIEW
Simon Lammy, James P Blackmur, Jeremy M T Perkins
BACKGROUND: There have been enormous advances in the screening, diagnosis, intervention and overall prognosis of abdominal aortic aneurysms (AAAs) in the last decade, but despite these, ruptured AAAs (rAAAs) still cause around 3500 to 6000 deaths in England and Wales each year. Open repair remains standard treatment for rAAA in most centres but increasingly endovascular aneurysm repair (EVAR) is being adopted. This has a 30-day postoperative mortality of 40%. This has remained static despite surgical, anaesthetic and critical care advances...
August 19, 2016: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/27496825/immediate-icu-care-for-patients-following-aortic-arch-surgery
#17
Maung Hlaing
Patients undergoing aortic arch surgery are at high risk for stroke, delirium, low cardiac output, respiratory failure, renal failure, and coagulopathy. A significantly higher mortality is seen in patients experiencing any of these complications when compared with those without complications. As surgical, perfusion, and anesthetic techniques improve, the incidence of major complications have decreased. A recent paradigm shift in cardiac surgery has focused on rapid postoperative recovery, and a similar change has affected the care of patients after arch surgery...
December 2016: Seminars in Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/27476983/assessment-and-utility-of-frailty-measures-in-critical-illness-cardiology-and-cardiac-surgery
#18
REVIEW
Naheed Rajabali, Darryl Rolfson, Sean M Bagshaw
Frailty is a clearly emerging theme in acute care medicine, with obvious prognostic and health resource implications. "Frailty" is a term used to describe a multidimensional syndrome of loss of homeostatic reserves that gives rise to a vulnerability to adverse outcomes after relatively minor stressor events. This is conceptually simple, yet there has been little consensus on the operational definition. The gold standard method to diagnose frailty remains a comprehensive geriatric assessment; however, a variety of validated physical performance measures, judgement-based tools, and multidimensional scales are being applied in critical care, cardiology, and cardiac surgery settings, including open cardiac surgery and transcatheter aortic value replacement...
September 2016: Canadian Journal of Cardiology
https://www.readbyqxmd.com/read/27473720/transesophageal-lung-ultrasonography-a-novel-technique-for-investigating-hypoxemia
#19
Yiorgos Alexandros Cavayas, Martin Girard, Georges Desjardins, André Y Denault
BACKGROUND: Acute deterioration in respiratory status commonly occurs in patients who cannot be transported for imaging studies, particularly during surgical procedures and in critical care settings. Transthoracic lung ultrasonography has been developed to allow rapid diagnosis of respiratory conditions at the bedside. Nevertheless, the thorax is not always accessible, especially in the perioperative setting. Transesophageal lung ultrasonography (TELU) can be used to circumvent this problem...
November 2016: Canadian Journal of Anaesthesia, Journal Canadien D'anesthésie
https://www.readbyqxmd.com/read/27439784/retrospective-review-of-critical-incidents-in-the-post-anaesthesia-care-unit-at-a-major-tertiary-hospital
#20
Suze Dominique Bruins, Pauline Meng Choo Leong, Shin Yi Ng
INTRODUCTION: We reviewed patients with critical incidents that occurred in the post-anaesthesia care unit (PACU) at a major tertiary hospital, and the effect of these incidents on PACU length of stay and discharge disposition was assessed. METHODS: A retrospective review was conducted of patients in the PACU over a two-year period from 24 June 2011 to 23 August 2013. Data on critical incidents were recorded in the administrative database using a standardised data form...
July 21, 2016: Singapore Medical Journal
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