Serial application of the Cardiac Surgery Score (CASUS) to cardiac surgical patients

Abstract Objectives This study was aimed to assess the benefits of early tracheostomy (ET) compared with late tracheostomy (LT) on postoperative outcomes in pediatric cardiac surgical patients. Design Present one is a prospective, observational study. Setting The study was conducted at a cardiac surgical intensive care unit (ICU) of a tertiary care hospital. Participants All pediatric patients below 10 years of age, who underwent tracheostomy after cardiac surgery from January2019 to december2019, were subdivided into two groups according to the timing of tracheostomy: “early” if done before 7 days or “late” if done after 7 days postcardiac surgery. Interventions ET versus LT was measured in the study. Results Out of all 1,084 pediatric patients who underwent cardiac surgery over the study period, 41 (3.7%) received tracheostomy. Sixteen (39%) patients underwent ET and 25 (61%) underwent LT. ET had advantages by having reduced risk associations with the following variables: preoperative hospital stay (p = 0.0016), sepsis (p = 0.03), high risk surgery (p = 0.04), postoperative sepsis (p = 0.001), C-reactive protein (p = 0.04), ventilator-associated pneumonia (VAP; p = 0.006), antibiotic escalation (p = 0.006), and antifungal therapy (p = 0.01) requirement. Furthermore, ET was associated with lesser duration of mechanical ventilation (p = 0.0027), length of ICU stay (LOICUS; p = 0.01), length of hospital stay (LOHS; p = 0.001), lesser days of feed interruption (p = 0.0017), and tracheostomy tube change (p = 0.02). ET group of children, who had higher total ventilation-free days (p = 0.02), were decannulated earlier (p = 0.03) and discharged earlier (p = 0.0089). Conclusion ET had significant benefits in reduction of postoperative morbidities with overall shorter mechanical ventilation, LOICUS, and LOHS, better nutrition supplementation, lesser infection, etc. These benefits may promote faster patient convalescence and rehabilitation with reduced hospital costs.

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Preoperative cigarette smoking and short-term morbidity and mortality after cardiac surgery: a meta-analysis

Heart Asia ◽

10.1136/heartasia-2018-011069 ◽

2018 ◽

Vol 10 (2) ◽

pp. e011069 ◽

Cited By ~ 1

Author(s):

Nicholas Gregory Ross Bayfield ◽

Adrian Pannekoek ◽

David Hao Tian

Keyword(s):

Cardiac Surgery ◽

Smoking Status ◽

Meta Analysis ◽

Surgical Site Infections ◽

Neurological Complications ◽

Pulmonary Complications ◽

Morbidity And Mortality ◽

Surgical Patients ◽

Short Term ◽

Increased Risk

Currently, the choice of whether or not to electively operate on current smokers is varied among cardiothoracic surgeons. This meta-analysis aims to determine whether preoperative current versus ex-smoking status is related to short-term postoperative morbidity and mortality in cardiac surgical patients. Systematic literature searches of the PubMed, MEDLINE and Cochrane databases were carried out to identify all studies in cardiac surgery that investigated the relationship between smoking status and postoperative outcomes. Extracted data were analysed by random effects models. Primary outcomes included 30-day or in-hospital all-cause mortality and pulmonary morbidity. Overall, 13 relevant studies were identified, with 34 230 patients in current or ex-smoking subgroups. There was no difference in mortality (p=0.93). Current smokers had significantly higher risk of overall pulmonary complications (OR 1.44; 95% CI 1.27 to 1.64; p<0.001) and postoperative pneumonia (OR 1.62; 95% CI 1.27 to 2.06; p<0.001) as well as lower risk of postoperative renal complications (OR 0.82; 95% CI 0.70 to 0.96; p=0.01) compared with ex-smokers. There was a trend towards an increased risk of postoperative MI (OR 1.29; 95% CI 0.95 to 1.75; p=0.10). No difference in postoperative neurological complications (p=0.15), postoperative sternal surgical site infections (p=0.20) or postoperative length of intensive care unit stay (p=0.86) was seen. Cardiac surgical patients who are current smokers at the time of operation do not have an increased 30-day mortality risk compared with ex-smokers, although they are at significantly increased risk of postoperative pulmonary complications.

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Transfusion Requirements in Anemic Patients undergoing Cardiac Surgery

Research & Innovation in Anesthesia ◽

10.5005/jp-journals-10049-0028 ◽

2017 ◽

Vol 2 (1) ◽

pp. 26-27

Author(s):

Vaishali S Badge ◽

Henry Skinner

Keyword(s):

Cardiac Surgery ◽

Morbidity And Mortality ◽

Surgical Patients ◽

Transfusion Rate ◽

Allergic Reactions ◽

Blood Products ◽

Transfusion Requirements

ABSTRACT Cardiac surgery is one of the largest consumer of blood and blood products in medicine. The transfusion rate in cardiac surgery accounts to almost 40-90%. Although lifesaving, it still increases the risk of allergic reactions, risk of transmission of infection, increased morbidity and mortality. The aim of this study was to find out causes of anaemia and requirement of blood or blood products in cardiac surgical patients. How to cite this article Badge VS, Skinner H. Transfusion Requirements in Anemic Patients undergoing Cardiac Surgery. Res Inno in Anesth 2017;2(1):26-27.

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Abstract 4092: Initial Experience with Subxiphoid Percutaneous Epicardial Ventricular Tachycardia Ablation in Patients with Prior Cardiac Surgery

Circulation ◽

10.1161/circ.118.suppl_18.s_827 ◽

2008 ◽

Vol 118 (suppl_18) ◽

Author(s):

Srijoy Mahapatra ◽

George M McDaniel ◽

Pamela K Mason ◽

Gorav Ailawadi

Keyword(s):

Cardiac Surgery ◽

Success Rate ◽

Nyha Class ◽

Surgical Patients ◽

Surgical Patient ◽

Success Rates ◽

Ventricular Tachycardia Ablation ◽

Prior Surgery ◽

Vt Ablation ◽

Surgical Group

Introduction: Epicardial ablation via subxiphoid percutaenous access improves VT ablation success rate and is growing in popularity. However, it is unclear if this technique is feasible in patients with prior cardiac surgery because of pericardial adhesions. We describe results in our initial 12 patients with previous cardiac surgery. Methods: A total of 27 patients (11 women) underwent an epicardial VT ablation after failed antiarrhythmic drug therapy and at least one endocardial ablation. Twelve patients had undergone previous cardiac surgery (7 CABG, 3 valve only, 2 combined). The pericardium was accessed using a Tuohy needle. Then a guidewire and an irrigated tip catheter were used to free up adhesions. VT was mapped and ablated. We compared the results in patients with and without prior surgery. Results: There was no difference in the age (62±11 vs 58±13 years, p=ns), percent women (41 vs 40%, p=ns), EF (30±9 vs 27±11, p=ns), NYHA class (2.4±1.0 vs 2.1±0.9, p=ns) or use of beta-blockers (100 vs 93%, p=ns) or ACE inhibtors (100 vs 93%, p=ns) among patients with and without prior cardiac surgery. However, patients with prior surgery were more likely to have CAD (100 vs 66% p=0.02) and be on ASA (100 vs 73%, p=0.04.) The mean procedure (298±90 vs 178±45 min, p=0.01) and fluoroscopy time (106±24 vs 45±11 min, p=0.01) was longer in patients with prior surgery versus without surgery. The entire epicardium was mapped in 15/15 (100%) of the nonsurgical patients but only in 7/11 (64%) of the surgical patients due to adhesions (p=0.02.) The acute success rate, defined as elimination of all clinical VTs, was lower in the surgical group (75 vs 100%, p=0.02). Elimination of all VTs was achieved less often in post-surgical patient than non-surgical patients (58 vs 80%, p=0.04.) There were two occurrences of RV perforation in each group both treated with conservative therapy. There were no other complications. After 7±2 months, 66% of surgical patients and 80% of non-surgical patients were VT free (p=0.04) as monitored by ICD or 1, 3, and 6 month monitor. One patient in non-surgical group died of heart failure. Conclusion: Prior cardiac surgery does not preclude epicardial VT ablation but is associated with longer procedure times and lower success rates.

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Clinical descriptors of pneumothorax following chest tube removal in paediatric cardiac surgery

Cardiology in the Young ◽

10.1017/s1047951120003467 ◽

2020 ◽

pp. 1-4

Author(s):

Christine LaGrasta ◽

Mary McLellan ◽

Jean Connor

Keyword(s):

Cardiac Surgery ◽

Chest Radiograph ◽

Chest Tube ◽

Clinical Characteristics ◽

Clinical Status ◽

Surgical Patients ◽

Paediatric Cardiac Surgery ◽

Tube Removal ◽

Chest Tube Removal ◽

Clinically Significant

Abstract Background: There is limited data describing the characteristics of paediatric post-operative cardiac surgery patients who develop pneumothoraces after chest tube removal. Patient management after chest tube removal is not standardised across paediatric cardiac surgery programmes. The purposes of this study were to describe the frequency of pneumothorax after chest tube removal in paediatric post-operative cardiac surgical patients and to describe the patient and clinical characteristics of those patients who developed a clinically significant pneumothorax requiring intervention. Methods: A single-institution retrospective descriptive study (1 January, 2010–31 December, 2018) was utilised to review 11,651 paediatric post-operative cardiac surgical patients from newborn to 18 years old. Results: Twenty-five patients were diagnosed with a pneumothorax by chest radiograph following chest tube removal (0.2%). Of these 25 patients, 15 (1.6%) had a clinically significant pneumothorax and 8 (53%) did not demonstrate a change in baseline clinical status or require an increase in supplemental oxygen, 14 (93%) required an intervention, 9 (60%) were <1 year of age, 4 (27%) had single-ventricle physiology, and 5 (33%) had other non-cardiac anomalies/genetic syndromes. Conclusions: In our cohort of patients, we confirmed the incidence of pneumothorax after chest tube removal is low in paediatric post-operative cardiac surgery patients. This population does not always exhibit changes in clinical status despite having clinically significant pneumothoraces. We suggest the development of criteria, based on clinical characteristics, for patients who are at increased risk of developing a pneumothorax and would require a routine chest radiograph following chest tube removal.

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Surgical patients

10.1093/med/9780199696277.003.0011 ◽

2013 ◽

Author(s):

Martin Beed ◽

Richard Sherman ◽

Ravi Mahajan

Keyword(s):

Cardiac Surgery ◽

Postoperative Pain ◽

Bronchopleural Fistula ◽

Wound Dehiscence ◽

Surgical Patients ◽

Postoperative Sepsis ◽

Postoperative Haemorrhage ◽

Period 2 ◽

Cytokine Levels ◽

Tissue Trauma

Postoperative sepsisWound dehiscenceMajor postoperative haemorrhageHaemorrhage after cardiac surgeryTUR syndromeBronchopleural fistulaPostoperative painPatients commonly develop SIRS in the immediate postoperative period 2° to ↑cytokine levels caused by the surgical tissue trauma. This is normally a self-limiting response that subsides within 48 hours. Persistent SIRS, or the development of end-organ dysfunction, should prompt examination and investigations to elucidate the cause....

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Clinical agreement and interchangeability of TEG5000 and TEG6s during cardiac surgery

Anaesthesia and Intensive Care ◽

10.1177/0310057x19897657 ◽

2020 ◽

Vol 48 (1) ◽

pp. 43-52

Author(s):

Qi Wong ◽

Kelly P Byrne ◽

Scott C Robinson

Keyword(s):

Cardiac Surgery ◽

Reaction Time ◽

Alpha Angle ◽

Maximum Amplitude ◽

Surgical Patients ◽

Treatment Recommendation ◽

New Device ◽

Management Algorithm ◽

Arterial Blood ◽

Significant Difference

TEG6s® is a new device introduced by the Haemonetics Corporation and designed to provide the same information as TEG® 5000 (Haemonetics Corporation, Braintree, MA, USA) but with much greater ease of use. We tested whether using citrated TEG6s gave reaction time, maximum amplitude and percentage of clot that had lysed at 30 minutes values similar to a non-citrated TEG5000, to allow clinical interchangeability using our current thrombelastography management algorithm for cardiac surgery. We also examined the agreement between the alpha-angle and functional fibrinogen maximum amplitude in our cardiac surgical patients. In total, 243 paired arterial blood samples in 99 patients were tested, using TEG5000 (non-citrated) and TEG6s (citrated) after induction of anaesthesia (prior to heparin administration), following protamine administration at the end of the cardiac bypass and whenever a TEG5000 was requested after this by the attending anaesthetist. Bland–Altman plots and Lin’s concordance coefficient were used to compare agreement whereas modified Bland–Altman plots and McNemar’s test were used to illustrate the differences in management recommendations between the two thrombelastography devices. All 243 samples were compared for reaction time and alpha-angle; 239 samples were compared for maximum amplitude; 136 samples were compared for the percentage of clot that had lysed at 30 minutes; 16 samples were compared for functional fibrinogen maximum amplitude. Lin’s concordance coefficient for these parameters was: reaction time 0.63, alpha-angle 0.39, maximum amplitude 0.5, percentage of clot that had lysed at 30 minutes 0.09 and functional fibrinogen maximum amplitude 0.31. Differences between the two devices became more marked at more abnormal values. Significant differences in median values, suggesting a fixed bias, were found for maximum amplitude and functional fibrinogen maximum amplitude. Differences in treatment recommendation could only be calculated for reaction time and maximum amplitude. Maximum amplitude was found to have a significant difference in treatment recommendation between the two devices using our current thrombelastography management algorithm for cardiac surgery with TEG6s recommending treatment in 11.5% more patients than TEG5000. Using the TEG6s with our current TEG5000–based thrombelastography management algorithm for cardiac surgery would result in a change in treatment recommendation in at least 10% of our cardiac surgical patients. Agreement between the two thrombelastography devices appears to decrease with increasing patient coagulopathy. New algorithms will need to be developed and tested to validate TEG6s for cardiac surgical patients in our institution.

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Association between Oxygen Delivery and Consumption in Patients Undergoing Cardiac Surgery. is There Supply Dependence?

Anaesthesia and Intensive Care ◽

10.1177/0310057x9602400603 ◽

1996 ◽

Vol 24 (6) ◽

pp. 651-657 ◽

Cited By ~ 12

Author(s):

P. S. Myles ◽

R. Mcrae ◽

I. Ryder ◽

J. O. Hunt ◽

M. R. Buckland

Keyword(s):

Cardiac Surgery ◽

Oxygen Delivery ◽

Oxygen Supply ◽

Gas Analysis ◽

Surgical Patients ◽

Poor Agreement ◽

Oxygen Extraction Ratio ◽

Expired Gas Analysis ◽

Expired Gas ◽

The Relationship

We studied the relationship between oxygen delivery (DO2) and consumption (VO2) in twenty patients undergoing cardiac surgery, in order to determine if VO2was dependent on DO2(pathological oxygen supply dependence). We measured VO2from expired gas analysis (VO2G) and compared this to that calculated using the reverse Fick method (VO2F). Both VO2Gand VO2Fincreased after cardiopulmonary bypass (P<0.001), without change in DO2(i.e. oxygen extraction ratio increased). There was a significant relationship between changes in DO2and VO2F, both before bypass (r=0.74, P < 0.001) and after bypass (r=0.69, P < 0.001), while changes in DO2and VO2Ghad no such relationship (pre-bypass: r=0.38, P=0.094; post-bypass: r=0.10, P=0.68). There was poor agreement between VO2Fand VO2Gperioperatively. We could not demonstrate supply dependence in elective cardiac surgical patients.

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Postoperative Delirium is Associated with Postoperative Cognitive Dysfunction at One Week after Cardiac Surgery with Cardiopulmonary Bypass

Psychological Reports ◽

10.2466/pr0.105.3.921-932 ◽

2009 ◽

Vol 105 (3) ◽

pp. 921-932 ◽

Cited By ~ 17

Author(s):

Judith A. Hudetz ◽

Alison J. Byrne ◽

Kathleen M. Patterson ◽

Paul S. Pagel ◽

David C. Warltier

Keyword(s):

Cardiac Surgery ◽

Intensive Care ◽

Cognitive Impairment ◽

Cardiopulmonary Bypass ◽

Cognitive Dysfunction ◽

Postoperative Delirium ◽

Postoperative Cognitive Dysfunction ◽

Surgical Patients ◽

Nonverbal Memory ◽

Surgery Group

Postoperative delirium with cognitive impairment frequently occurs after cardiac surgery. It was hypothesized that delirium is associated with residual postoperative cognitive dysfunction in patients after surgery using cardiopulmonary bypass. Male cardiac surgical patients ( M age = 66 yr., SD = 8; M education = 13 yr., SD = 2) and nonsurgical controls ( M age = 62, SD = 7; M education = 12, SD = 2) 55 years of age or older were balanced on age and education. Delirium was assessed by the Intensive Care Delirium Screening Checklist preoperatively and for up to 5 days postoperatively. Recent verbal and nonverbal memory and executive functions were assessed (as scores on particular tests) before and 1 wk. after surgery. In 56 patients studied ( n = 28 Surgery; n=28 Nonsurgery), nine patients from the Surgery group developed delirium. In the Surgery group, the proportion of patients having postoperative cognitive dysfunction was significantly greater in those who experienced delirium (89%) compared with those who did not (37%). The odds of developing this dysfunction in patients with delirium were 14 times greater than those who did not. Postoperative delirium is associated with scores for residual postoperative cognitive dysfunction 1 wk. after cardiac surgery.

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