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https://www.readbyqxmd.com/read/29679768/comparison-of-proaqt-pulsioflex%C3%A2-and-oesophageal-doppler-for-intraoperative-haemodynamic-monitoring-during-intermediate-risk-abdominal-surgery
#1
Grégoire Weil, Cyrus Motamed, Alexandre Eghiaian, Xavier Monnet, Stéphanie Suria
OBJECTIVE: To compare cardiac index (CI) between Proaqt/PulsioFlex® and esophageal Doppler (OD) and the ability of the PulsioFlex® to track CI changes induced by fluid challenge and secondly to assess the impact of the time interval between two auto-calibrations of PulsioFlex® on the accuracy of the measured CI. METHODS: In a single hospital, 49 intermediate-risk oncologic abdominal surgery patients were included in an observational study. We measured the cardiac Index (CI) provided by OD and by the Proaqt/PulsioFlex® before and after internal calibration, which were performed randomly at specific intervals after the initial one (30, 60, 90 and 120min)...
April 18, 2018: Anaesthesia, Critical Care & Pain Medicine
https://www.readbyqxmd.com/read/29679411/the-use-of-a-logistic-regression-model-to-develop-a-risk-assessment-of-intraoperatively-acquired-pressure-ulcer
#2
Ling Gao, Lina Yang, Xiaoqin Li, Jin Chen, Juan Du, Xiaoxia Bai, Xianjun Yang
AIMS AND OBJECTIVES: To screen the factors of intraoperatively acquired pressure ulcer (IAPU) and establish a new risk assessment model of IAPU. DESIGN: This is a prospective study. METHODS: A total of 1963 patients who received neurosurgery, orthopaedics, pediatric surgery and cardiac surgery therapy in Sichuan Academy of Medical Science and Provincial People's Hospital in China from October 2015 to October 2016 were enrolled in the study and their clinical parameters were collected...
April 20, 2018: Journal of Clinical Nursing
https://www.readbyqxmd.com/read/29679123/-wide-awake-hand-surgery-based-on-application-examples
#3
P Kaiser, M Keller, J Dörler, G Schmidle
OBJECTIVE: Anesthesiologic method with low bleeding level, risk level, and complication rate for surgical procedures on the hand without a tourniquet on an unsedated patient with the possibility for functional testing during surgery. INDICATIONS: Surgical procedures of the hand can be carried out using the wide awake technique depending on the patient's suitability and preference considering individual risk factors. CONTRAINDICATIONS: Absolute contraindications are allergies to the local anesthetic or its components...
April 20, 2018: Operative Orthopädie und Traumatologie
https://www.readbyqxmd.com/read/29678987/protocol-for-a-phase-iii-non-inferiority-randomised-comparison-of-a-new-fibrinogen-concentrate-versus-cryoprecipitate-for-treating-acquired-hypofibrinogenaemia-in-bleeding-cardiac-surgical-patients-the-fibres-trial
#4
Keyvan Karkouti, Jeannie Callum, Vivek Rao, Nancy Heddle, Michael E Farkouh, Mark A Crowther, Damon C Scales
INTRODUCTION: Coagulopathic bleeding is a serious complication of cardiac surgery to which an important contributor is acquired hypofibrinogenaemia (plasma fibrinogen <1.5-2.0 g/L). The standard intervention for acquired hypofibrinogenaemia is cryoprecipitate, but purified fibrinogen concentrates are also available. There is little comparative data between the two therapies and randomised trials are needed. METHODS AND ANALYSIS: FIBrinogen REplenishment in Surgery (FIBRES) is a multicentre, randomised (1:1), active-control, single-blinded, phase III trial in adult cardiac surgical patients experiencing clinically significant bleeding related to acquired hypofibrinogenaemia...
April 20, 2018: BMJ Open
https://www.readbyqxmd.com/read/29678977/minimizing-icu-neurological-dysfunction-with-dexmedetomidine-induced-sleep-mindds-protocol-for-a-randomised-double-blind-parallel-arm-placebo-controlled-trial
#5
Kenneth T Shelton, Jason Qu, Federico Bilotta, Emery N Brown, Gaston Cudemus, David A D'Alessandro, Hao Deng, Alan DiBiasio, Jacob A Gitlin, Eunice Y Hahm, Lauren E Hobbs, Timothy T Houle, Reine Ibala, Marco Loggia, Kara J Pavone, Shahzad Shaefi, George Tolis, M Brandon Westover, Oluwaseun Akeju
INTRODUCTION: Delirium, which is prevalent in postcardiac surgical patients, is an acute brain dysfunction characterised by disturbances in attention, awareness and cognition not explained by a pre-existing neurocognitive disorder. The pathophysiology of delirium remains poorly understood. However, basic science and clinical studies suggest that sleep disturbance may be a modifiable risk factor for the development of delirium. Dexmedetomidine is a α-2A adrenergic receptor agonist medication that patterns the activity of various arousal nuclei similar to sleep...
April 20, 2018: BMJ Open
https://www.readbyqxmd.com/read/29678896/outcomes-for-patients-with-rheumatic-heart-disease-after-cardiac-surgery-followed-at-rural-district-hospitals-in-rwanda
#6
Emmanuel K Rusingiza, Ziad El-Khatib, Bethany Hedt-Gauthier, Gedeon Ngoga, Symaque Dusabeyezu, Neo Tapela, Cadet Mutumbira, Francis Mutabazi, Emmanuel Harelimana, Joseph Mucumbitsi, Gene F Kwan, Gene Bukhman
BACKGROUND: In sub-Saharan Africa, continued clinical follow-up, after cardiac surgery, is only available at urban referral centres. We implemented a decentralised, integrated care model to provide longitudinal care for patients with advanced rheumatic heart disease (RHD) at district hospitals in rural Rwanda before and after heart surgery. METHODS: We collected data from charts at non-communicable disease (NCD) clinics at three rural district hospitals in Rwanda to describe the outcomes of 54 patients with RHD who received cardiac valve surgery during 2007-2015...
April 20, 2018: Heart: Official Journal of the British Cardiac Society
https://www.readbyqxmd.com/read/29678618/concomitant-surgical-atrial-fibrillation-ablation-is-safe-and-efficacious-in-patients-undergoing-double-valve-replacement-a-cohort-study
#7
Guang Tong, Hao Yu, Xuan Zhou, Ben Zhang, Shenghui Bi, Lin Luo, Tao Yan, Xianyue Wang, Hua Lu, Tao Ma, Xiaowu Wang, Zhongchan Sun, Weida Zhang
BACKGROUND: Current European Society of Cardiology Guidelines recommend concomitant atrial fibrillation (AF) ablation for all symptomatic patients undergoing other cardiac surgeries, but the safety and potential benefits of concomitant atrial fibrillation (AF) ablation at the time of double valve replacement (DVR: aortic and mitral valve replacement) remains unexamined. MATERIALS AND METHODS: We conducted a retrospective review of 238 patients with AF who underwent DVR with or without concomitant surgical ablation (Ablation group, n=113; Non-ablation group, n=125) at a single institute from April 2006 to September 2011...
April 17, 2018: International Journal of Surgery
https://www.readbyqxmd.com/read/29678435/prediction-of-patient-length-of-stay-on-the-intensive-care-unit-following-cardiac-surgery-a-logistic-regression-analysis-based-on-the-cardiac-operative-mortality-risk-calculator-euroscore
#8
Katherine Meadows, Richard Gibbens, Caroline Gerrard, Alain Vuylsteke
OBJECTIVE: The aim of this study was to develop a statistical model based on patient parameters to predict the length of stay (LOS) in the intensive care unit (ICU) following cardiac surgery in a single center. DESIGN: Data were collected from patients admitted to the ICU following cardiac surgery over a 10-year period (2006-2016). Both the additive and logistic EuroSCORE were calculated, and logistic regression analysis was carried out to formulate a model relating the predicted LOS to the EuroSCORE...
March 7, 2018: Journal of Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/29678433/clinical-outcomes-of-adult-patients-who-receive-extracorporeal-membrane-oxygenation-for-postcardiotomy-cardiogenic-shock-a-systematic-review-and-meta-analysis
#9
Liangshan Wang, Hong Wang, Xiaotong Hou
OBJECTIVE: To investigate the clinical outcomes of adult patients receiving extracorporeal membrane oxygenation (ECMO) for postcardiotomy cardiogenic shock (PCS). DESIGN: Meta-analysis of 20 observational studies. SETTING: Hospitals that perform cardiac surgery. PARTICIPANTS: The study included 2,877 PCS patients undergoing ECMO from 20 observational studies. INTERVENTIONS: ECMO use. MEASUREMENTS AND MAIN RESULTS: Twenty observational studies were selected for final analysis...
March 12, 2018: Journal of Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/29678304/improving-postoperative-neonatal-nutritional-practices-in-an-intensive-care-unit-using-the-pdsa-cycle
#10
Jennifer Newcombe, Eileen Fry-Bowers
Quality Improvement models offer a framework for health care professionals to follow in implementing process improvement changes. Use of these models promotes a systematic approach to problem solving, keeps providers from eliminating important steps, facilitates team work, and provides a clear plan for ongoing communication. This paper describes use of the Plan-Do-Study-Act model to implement a unit-based quality improvement project that focused on improving postoperative nutritional practices for neonates with critical congenital heart disease following complex cardiac surgery...
April 17, 2018: Journal of Pediatric Health Care
https://www.readbyqxmd.com/read/29677083/east-multicenter-trial-on-targeted-temperature-management-for-hanging-induced-cardiac-arrest
#11
Cindy H Hsu, Bryce E Haac, Mack Drake, Andrew C Bernard, Alberto Aiolfi, Kenji Inaba, Holly E Hinson, Chinar Agarwal, Joseph Galante, Emily M Tibbits, Nicholas J Johnson, David Carlbom, Mina F Mirhoseini, Mayur B Patel, Karen R OʼBosky, Christian Chan, Pascal O Udekwu, Megan Farrell, Jeffrey L Wild, Katelyn A Young, Daniel C Cullinane, Deborah J Gojmerac, Alexandra Weissman, Clifton Callaway, Sarah M Perman, Mariana Guerrero, Imoigele P Aisiku, Raghu R Seethala, Ivan N Co, Debbie Y Madhok, Bryan Darger, Dennis Y Kim, Lara Spence, Thomas M Scalea, Deborah M Stein
BACKGROUND: We sought to determine the outcome of suicidal hanging and the impact of targeted temperature management (TTM) on hanging-induced cardiac arrest (CA) through an Eastern Association for the Surgery of Trauma (EAST) multicenter retrospective study. METHODS: We analyzed hanging patient data and TTM variables from January 1992 to December 2015. Cerebral performance category (CPC) score of 1 or 2 was considered good neurologic outcome, while CPC of 3 or 4 was considered poor outcome...
April 19, 2018: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/29677063/the-anesthesia-perioperative-call-for-help-experience-at-a-quaternary-pediatric-medical-center-analysis-of-67-564-anesthesia-encounters
#12
Bistra G Vlassakova, Sean M Sinnott, Nissa Askins, Matthew X Callahan, Izabela C Leahy, David Zurakowski, Paul R Hickey, Joseph P Cravero
BACKGROUND: During the past several decades, anesthesia has become increasingly safe. Truly major adverse events are rare, and anesthesia quality researchers have instituted programs to evaluate "near miss" or less critical adverse events to evaluate the safety of anesthesia delivery. In this study, we aimed to evaluate calls for emergency help in our institution as a surrogate for pending critical events. We hypothesized that calls would be more common in patients with high American Society of Anesthesiologists (ASA) physical status, history of prematurity, and children with recent respiratory illness compared to those without these characteristics...
April 17, 2018: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/29677060/cerebral-small-vessel-but-not-large-vessel-disease-is-associated-with-impaired-cerebral-autoregulation-during-cardiopulmonary-bypass-a-retrospective-cohort-study
#13
Yohei Nomura, Roland Faegle, Daijiro Hori, Abbas Al-Qamari, Alexander J Nemeth, Rebecca Gottesman, Gayane Yenokyan, Charles Brown, Charles W Hogue
BACKGROUND: Impaired cerebral blood flow (CBF) autoregulation during cardiopulmonary bypass (CPB) is associated with stroke and other adverse outcomes. Large and small arterial stenosis is prevalent in patients undergoing cardiac surgery. We hypothesize that large and/or small vessel cerebral arterial disease is associated with impaired cerebral autoregulation during CPB. METHODS: A retrospective cohort analysis of data from 346 patients undergoing cardiac surgery with CPB enrolled in an ongoing prospectively randomized clinical trial of autoregulation monitoring were evaluated...
April 17, 2018: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/29677059/pediatric-perioperative-cardiac-arrest-death-in-the-off-hours-a-report-from-wake-up-safe-the-pediatric-quality-improvement-initiative
#14
Robert E Christensen, Angela C Lee, Marie S Gowen, Mallikarjuna R Rettiganti, Jayant K Deshpande, Jeffrey P Morray
BACKGROUND: Pediatric perioperative cardiac arrest (CA) is a rare but catastrophic event. This case-control study aims to analyze the causes, incidence, and outcomes of all pediatric CA reported to Wake Up Safe. Factors associated with CA and mortality after arrest are examined and possible strategies for improving outcomes are considered. METHODS: CA in children was identified from the Wake Up Safe Pediatric Anesthesia Quality Improvement Initiative, a multicenter registry of adverse events in pediatric anesthesia...
April 17, 2018: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/29677037/small-left-ventricular-size-is-an-independent-risk-factor-for-ventricular-assist-device-thrombosis
#15
Venkat Keshav Chivukula, Jennifer A Beckman, Anthony R Prisco, Shin Lin, Todd F Dardas, Richard K Cheng, Stephen D Farris, Jason W Smith, Nahush A Mokadam, Claudius Mahr, Alberto Aliseda
The prevalence of ventricular assist device (VAD) therapy has continued to increase due to a stagnant donor supply and growing advanced heart failure (HF) population. We hypothesize that left ventricular (LV) size strongly influences biocompatibility and risk of thrombosis. Unsteady computational fluid dynamics (CFD) was used in conjunction with patient-derived computational modeling and virtual surgery with a standard, apically implanted inflow cannula. A dual-focus approach of evaluating thrombogenicity was employed: platelet-based metrics to characterize the platelet environment and flow-based metrics to investigate hemodynamics...
April 18, 2018: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
https://www.readbyqxmd.com/read/29677033/characterization-of-the-glucocorticoid-receptor-in-children-undergoing-cardiac-surgery
#16
Saul Flores, David S Cooper, Amy M Opoka, Ilias Iliopoulos, Sarah Pluckebaum, Matthew N Alder, Kelli A Krallman, Rashmi D Sahay, Lin Fei, Hector R Wong
OBJECTIVES: Postoperative administration of corticosteroids is common practice for managing catecholamine refractory low cardiac output syndrome. Since corticosteroid activity is dependent on the glucocorticoid receptor, we sought to characterize glucocorticoid receptor levels in children undergoing cardiac surgery and examined the association between glucocorticoid receptor levels and cardiovascular dysfunction. DESIGN: Prospective observational cohort study. SETTING: Large, tertiary pediatric cardiac center...
April 19, 2018: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/29677020/clinical-experience-in-minimally-invasive-cardiac-surgery-with-virtually-wall-less-venous-cannulas
#17
Enrico Ferrari, Ludwig K von Segesser, Denis Berdajs, Ludwig Müller, Maximilian Halbe, Francesco Maisano
OBJECTIVE: Inadequate peripheral venous drainage during minimally invasive cardiac surgery (MICS) is a challenge and cannot always be solved with increased vacuum or increased centrifugal pump speed. The present study was designed to assess the benefit of virtually wall-less transfemoral venous cannulas during MICS. METHODS: Transfemoral venous cannulation with virtually wall-less cannulas (3/8″ 24F 530-630-mm ST) was performed in 10 consecutive patients (59 ± 10 years, 8 males, 2 females) undergoing MICS for mitral (6), aortic (3), and other (4) procedures (combinations possible)...
April 19, 2018: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery
https://www.readbyqxmd.com/read/29676943/impact-of-preoperative-thrombocytopenia-on-the-outcome-after-coronary-artery-bypass-grafting
#18
Wail Nammas, Magnus Dalén, Stefano Rosato, Riccardo Gherli, Daniel Reichart, Giuseppe Gatti, Francesco Onorati, Giuseppe Faggian, Marisa De Feo, Ciro Bancone, Sidney Chocron, Sorosh Khodabandeh, Giuseppe Santarpino, Antonino S Rubino, Daniele Maselli, Saverio Nardella, Antonio Salsano, Tiziano Gherli, Francesco Nicolini, Marco Zanobini, Matteo Saccocci, Karl Bounader, Paola D'Errigo, Tuomas Kiviniemi, Eeva-Maija Kinnunen, Andrea Perrotti, Juhani Airaksinen, Giovanni Mariscalco, Vito G Ruggieri, Fausto Biancari
The impact of thrombocytopenia on postoperative bleeding and other major adverse events after cardiac surgery is unclear. This issue was investigated in a series of patients who underwent isolated coronary artery bypass grafting (CABG) from the prospective, multicenter E-CABG registry. Preoperative thrombocytopenia was defined as preoperative platelet count <150 × 109 /L and it was considered moderate-severe when preoperative platelet count was <100 × 109 /L. Multilevel mixed-effects regression analysis was performed to adjust the effect of thrombocytopenia on outcomes for baseline and operative covariates as well as for interinstitutional differences in patient-blood management...
April 20, 2018: Platelets
https://www.readbyqxmd.com/read/29676474/a-rare-case-of-ewing-s-sarcoma-primitive-neuroectodermal-tumor-metastasizing-to-left-atrium-through-left-inferior-pulmonary-vein
#19
Suraj K Kulkarni, Nagaraj Moorthy, Shankar Somanna, Manjunath Cholenahally Nanjappa
Cardiac metastasis of Ewing's sarcoma is exceedingly rare. A 40-year-old male was admitted with complaints of nonproductive cough, exertional dyspnea, and fatigue since 4 months with a history of abdominal wall swelling which was excised and proven to be Ewing's sarcoma/primitive neuroectodermal tumor (PNET). A transthoracic echocardiography demonstrated inhomogeneous mass located posterior to the left ventricle and a solitary mass protruding into the left atrium through the left inferior pulmonary vein. Due to accompanying pulmonary metastasis and possible poor outcome of the surgery, surgical resection was not considered...
April 20, 2018: Echocardiography
https://www.readbyqxmd.com/read/29675930/relationship-between-ultrasonographic-and-biochemical-markers-of-tubal-ectopic-pregnancy-and-success-of-subsequent-management
#20
Batool Nadim, Chuan Lu, Fernando Infante, Shannon Reid, George Condous
OBJECTIVES: To determine whether there is an association between morphologic types of tubal ectopic pregnancy (EP), 0-hour human chorionic gonadotropin (hCG) levels, and subsequent management success. METHODS: We conducted a prospective study (November 2006-December 2015). Women had a diagnosis of EP by transvaginal ultrasonography if they had an inhomogeneous mass adjacent to the ovary and moving separately from it ("blob" sign), a mass with a hyperechoic ring around the gestational sac ("bagel" sign), or a gestational sac with an embryonic pole with or without a yolk sac with or without cardiac activity...
April 20, 2018: Journal of Ultrasound in Medicine: Official Journal of the American Institute of Ultrasound in Medicine
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