Assessing Diaphragmatic Dysfunction After Elective Cardiac Surgery: Expanding the Role of Critical Care Ultrasound

AbstractIntroductionThe use of ultrasound for assessing diaphragmatic dysfunction after paediatric cardiac surgery may be under-utilised. This study aimed to evaluate the role of bedside ultrasound performed by an intensivist to diagnose diaphragmatic dysfunction and the need for plication after paediatric cardiac surgery.MethodsWe carried out a retrospective cohort study on prospectively collected data of postoperative children admitted to the paediatric cardiac ICU during 2013. Diaphragmatic dysfunction was suspected based on difficulties in weaning from positive pressure ventilation or chest X-ray findings. Ultrasound studies were performed by the paediatric cardiac ICU intensivist and confirmed by a qualified radiologist.ResultsOut of 344 postoperative patients, 32 needed diaphragm ultrasound for suspected dysfunction. Ultrasound studies confirmed diaphragmatic dysfunction in 17/32 (53%) patients with an average age and weight of 10.8±3.8 months and 6±1 kg, respectively. The incidence rate of diaphragmatic dysfunction was 4.9% in relation to the whole population. Diaphragmatic plication was needed in 9/17 cases (53%), with a rate of 2.6% in postoperative cardiac children. The mean plication time was 15.1±1.3 days after surgery. All patients who underwent plication were under 4 months of age. After plication, they were discharged with mean paediatric cardiac ICU and hospital stay of 19±3.5 and 42±8 days, respectively.ConclusionsCritical-care ultrasound assessment of diaphragmatic movement is a useful and practical bedside tool that can be performed by a trained paediatric cardiac ICU intensivist. It may help in the early detection and management of diaphragmatic dysfunction after paediatric cardiac surgery through a decision-making algorithm that may have potential positive effects on morbidity and outcome.

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COVID-19 related mortality in post-operative cardiac surgical patients

Journal of Cardiothoracic Surgery ◽

10.1186/s13019-021-01487-x ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Azhar Hussain ◽

Amina Khalil ◽

Priyanka Kolvekar ◽

Prity Gupta ◽

Shyamsunder Kolvekar

Keyword(s):

Cardiac Surgery ◽

Long Term Outcomes ◽

Case Presentation ◽

Elective Cardiac Surgery ◽

The United Kingdom ◽

Global Pandemic ◽

Cardiac Operations ◽

Related Mortality

Abstract Background COVID-19 has caused a global pandemic of unprecedented proportions. Elective cardiac surgery has been universally postponed with only urgent and emergency cardiac operations being performed. The National Health Service in the United Kingdom introduced national measures to conserve intensive care beds and significantly limit elective activity shortly after lockdown. Case presentation We report two cases of early post-operative mortality secondary to COVID-19 infection immediately prior to the implementation of these widespread measures. Conclusion The role of cardiac surgery in the presence of COVID-19 is still very unpredictable and further studies on both short term and long term outcomes are warranted.

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Diaphragmatic Dysfunction After Elective Cardiac Surgery: A Prospective Observational Study

Journal of Cardiothoracic and Vascular Anesthesia ◽

10.1053/j.jvca.2020.06.038 ◽

2020 ◽

Vol 34 (12) ◽

pp. 3336-3344 ◽

Cited By ~ 1

Author(s):

Andrea Bruni ◽

Eugenio Garofalo ◽

Laura Pasin ◽

Giuseppe Filiberto Serraino ◽

Gianmaria Cammarota ◽

...

Keyword(s):

Cardiac Surgery ◽

Observational Study ◽

Prospective Observational Study ◽

Diaphragmatic Dysfunction ◽

Elective Cardiac Surgery

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Critical Care Unit presurgical tour, is it helpful for patients undergoing elective cardiac surgery?

Enfermería Intensiva (English ed ) ◽

10.1016/j.enfie.2017.11.003 ◽

2018 ◽

Vol 29 (3) ◽

pp. 144-145

Author(s):

M.T. González-Gil

Keyword(s):

Critical Care ◽

Cardiac Surgery ◽

Critical Care Unit ◽

Elective Cardiac Surgery

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Road to recovery: a study protocol quantifying neurological outcome in cardiac surgery patients and the role of cerebral oximetry

BMJ Open ◽

10.1136/bmjopen-2019-032935 ◽

2019 ◽

Vol 9 (12) ◽

pp. e032935

Author(s):

Joanna S Semrau ◽

Stephen H Scott ◽

Andrew G Hamilton ◽

Dimitri Petsikas ◽

Darrin M Payne ◽

...

Keyword(s):

Cardiac Surgery ◽

Neurological Outcome ◽

Postoperative Delirium ◽

Cerebral Oximetry ◽

Elective Cardiac Surgery ◽

Peer Review Journal ◽

Registration Number ◽

Oral Presentations

IntroductionPatients undergoing cardiac surgery may experience both short-term and long-term postoperative neurological problems. However, the underlying cause of this impairment is unclear. Regional cerebral oxygen saturation (rSO2) levels may play a role in the development of acute dysfunction, known as postoperative delirium, in addition to longer term outcomes after cardiac surgery. Yet the degree of impairment has been difficult to define, partly due to subjective methods of assessments. This study aims to fill this knowledge gap by determining the relationship between rSO2, postoperative delirium and long-term neurological outcome after cardiac surgery using quantitative robotic technology.Methods and analysis95 patients scheduled for elective cardiac surgery will be recruited for this single-centre prospective observational study. Patients will be assessed before as well as 3 and 12 months after their surgery using the Kinarm End-Point Lab and standardised tasks. Intraoperatively, rSO2 and other haemodynamic data will be collected for the duration of the procedure. Following their operation, patients will also be screened daily for delirium during their hospital stay.Ethics and disseminationThis study has been approved by the Health Sciences Research Ethics Board at Queen’s University (DMED-1672–14). The results of this study will be published in a peer-review journal and presented at international and/or national conferences as poster or oral presentations. Participants wishing to know the results of this study will be contacted directly on data publication.Trial registration numberNCT04081649

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Noteworthy Literature Published in 2016 for Cardiothoracic Critical Care

Seminars in Cardiothoracic and Vascular Anesthesia ◽

10.1177/1089253216687859 ◽

2017 ◽

Vol 21 (1) ◽

pp. 23-29 ◽

Cited By ~ 1

Author(s):

Adam S. Evans ◽

Michael Mazzeffi ◽

Natalia Ivascu ◽

Edward Noguera ◽

Jacob Gutsche

Keyword(s):

Atrial Fibrillation ◽

Critical Care ◽

Cardiac Surgery ◽

Respiratory Failure ◽

Extracorporeal Membrane Oxygenation ◽

Operating Rooms ◽

Postoperative Atrial Fibrillation ◽

Annual Series ◽

Cardiac Critical Care

In 2016, demand for the presence of cardiothoracic anesthesiologists outside of the cardiac operating rooms continues to expand. This article is the second in this annual series to review relevant contributions in postoperative cardiac critical care that may impact the cardiac anesthesiologist. We explore the use of extracorporeal membrane oxygenation (ECMO), management of postoperative atrial fibrillation, coagulopathy, respiratory failure, and role of quality in cardiac surgery.

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