scholarly journals Early extubation improves outcome following extracardiac total cavopulmonary connection

2019 ◽  
Vol 29 (1) ◽  
pp. 85-92 ◽  
Author(s):  
Masamichi Ono ◽  
Stanimir Georgiev ◽  
Melchior Burri ◽  
Benedikt Mayr ◽  
Julie Cleuziou ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Mean Arterial Pressure ◽  
Arterial Pressure ◽  
Intensive Care Unit Stay ◽  
Total Cavopulmonary Connection ◽  
Early Extubation ◽  
Group A ◽  
Group B ◽  
Cavopulmonary Connection

Abstract OBJECTIVES The aim of this study was to investigate the impact of an early extubation strategy on the outcome following extracardiac total cavopulmonary connection. METHODS From 1999 through 2017, 458 patients underwent extracardiac total cavopulmonary connection; 257 (56%) patients were managed with an early extubation strategy adopted in 2009 (group A). Their outcome was compared with those of 201 (44%) patients treated before 2009 (group B). In group A, the outcome of unstable patients, defined as >75th percentile for volume administered and inotrope scores, was compared with those of stable patients. RESULTS Ventilation time (median: 4 h vs 16 h, P < 0.001), fluid volume administered during the first 24 h (mean: 110 ml/kg vs 164 ml/kg, P = 0.003), chest tube duration (median: 3 days vs 4 days, P = 0.028) and length of intensive care unit stay (median: 6 days vs 7 days, P = 0.001) were less in group A than in group B. The reintubation rate (7% vs 6%, P = 0.547) and early mortality (0.8% vs 1.5%, P = 0.465) were similar between groups. The 80 unstable group A patients received more inotropic support (P < 0.001) and fluid volume (P < 0.001) than stable patients, but the ventilation time (6 h vs 5 h, P = 0.220), the reintubation rate (10% vs 6%, P = 0.283) and the length of intensive care unit stay (7 days vs 6 days, P = 0.590) were similar. In unstable patients, mean arterial pressure before extubation was significantly lower than stable patients (P = 0.001). However, mean arterial pressure in unstable patients increased significantly (P < 0.001) soon after extubation, and became similar to the value in stable patients. CONCLUSIONS Early extubation following extracardiac total cavopulmonary connection improves postoperative haemodynamics and recovery regardless of the initial haemodynamic status.

Early postoperative extubation of unstable patients following total cavopulmonary connection: impact on circulation and outcome

2016 ◽  
Vol 27 (5) ◽  
pp. 860-869 ◽  
Author(s):  
Stanimir Georgiev ◽  
Gunter Balling ◽  
Bettina Ruf ◽  
Kilian Ackermann ◽  
Jelena P. von Ohain ◽  
...  
Keyword(s):  
Mean Arterial Pressure ◽  
Fontan Operation ◽  
Management Tool ◽  
Total Cavopulmonary Connection ◽  
Early Extubation ◽  
Respective Group ◽  
Group 2 ◽  
Cavopulmonary Connection ◽  
Group 1 ◽  
Sustained Increase

AbstractObjectivesWe aimed to investigate whether early postoperative extubation following the Fontan operation is universally feasible and can be used as a management tool in unstable patients.MethodsAll patients undergoing the Fontan operation in our centre between 2004 and 2013 (n=253) were analysed. Until 2008, patients were extubated according to standard criteria and comprised group 1. Group 2 included all patients presenting after 2009, when early extubation was always aimed regardless of the haemodynamic status. Patients who exceeded the 75th percentiles for volume requirements and inotrope scores for the respective group were defined as unstable. Comparisons of outcomes between groups and subgroups and analysis of the changes in haemodynamic and treatment parameters with extubation in unstable patients after 2009 were performed.ResultsCompared with group 1, patients from group 2 were ventilated for shorter duration (p<0.001), had similar re-intubation rates (p=0.50), and needed less volume (p=0.01). In group 2, the unstable patients were not ventilated for longer durations (p=0.19), but had higher re-intubation rates (p=0.03) than the stable patients. Compared with the unstable patients from group 1, the unstable patients from group 2 were ventilated for shorter duration (p<0.001), had similar re-intubation rates (p=0.66), and needed less volume (p=0.006). There was a significant acute and sustained increase in mean arterial pressure with extubation and a parallel reduction in volume requirements and inotrope scores in the unstable patients from group 2.ConclusionsTimely extubation is universally applicable following the Fontan operation. Early postoperative extubation can be valuable for improving Fontan haemodynamics.

scholarly journals Observation of the clinical efficacy of dexmedetomidine in flexible bronchoscopy under general anesthesia: clinical case experience exchange

2019 ◽  
Vol 47 (12) ◽  
pp. 6215-6222 ◽  
Author(s):  
Hongtu Li ◽  
Na Zhang ◽  
Ke Zhang ◽  
Yanhua Wei
Keyword(s):  
Heart Rate ◽  
Mean Arterial Pressure ◽  
Adverse Events ◽  
Arterial Pressure ◽  
General Anesthesia ◽  
Recovery Time ◽  
Flexible Bronchoscopy ◽  
Stress Indices ◽  
Group A ◽  
Group B

Object To investigate the clinical efficacy and safety of dexmedetomidine in flexible bronchoscopy under general anesthesia. Methods A total of 114 patients were randomly divided into intervention group A and control group B. Group A received dexmedetomidine, fentanyl, and propofol as anesthesia, while Group B received fentanyl and propofol only. Changes in heart rate, mean arterial pressure, pulse oxygen saturation, stress indices (blood cortisol, adrenaline, and norepinephrine levels), incidence of adverse events, anesthesia dose, duration of procedure, and recovery time were compared between the groups at specific time points T0, T1, and T2 during bronchoscopy. Results There was no statistical difference between the groups at T0. At T1 and T2, pulse oxygen saturation, mean arterial pressure, heart rate, and stress indices in group A were significantly more favorable than those in group B. The incidence of adverse events (5.26%) in group A was significantly lower than that in group B (17.54%), and patients in group A required less propofol and had a faster recovery time than patients in group B. Conclusion Dexmedetomidine use in flexible bronchoscopy under general anesthesia is safe and effective and decreases the stress response in synergy with propofol to provide hemodynamic stability.

scholarly journals Subphenotypes in Patients with Septic Shock Receiving Vitamin C, Hydrocortisone, and Thiamine: A Retrospective Cohort Analysis

Nutrients ◽  
2019 ◽  
Vol 11 (12) ◽  
pp. 2976 ◽  
Author(s):  
Won-Young Kim ◽  
Jae-Woo Jung ◽  
Jae Chol Choi ◽  
Jong Wook Shin ◽  
Jae Yeol Kim
Keyword(s):  
Intensive Care Unit ◽  
Septic Shock ◽  
Intensive Care ◽  
Vitamin C ◽  
Blood Cell ◽  
White Blood Cell ◽  
Blood Cell Count ◽  
Group A ◽  
Group B ◽  
Group D

This study aimed to identify septic phenotypes in patients receiving vitamin C, hydrocortisone, and thiamine using temperature and white blood cell count. Data were obtained from septic shock patients who were also treated using a vitamin C protocol in a medical intensive care unit. Patients were divided into groups according to the temperature measurements as well as white blood cell counts within 24 h before starting the vitamin C protocol. In the study, 127 patients included who met the inclusion criteria. In the cohort, four groups were identified: “Temperature ≥37.1 °C, white blood cell count ≥15.0 1000/mm3” (group A; n = 27), “≥37.1 °C, <15.0 1000/mm3” (group B; n = 30), “<37.1 °C, ≥15.0 1000/mm3” (group C; n = 35) and “<37.1 °C, <15.0 1000/mm3” (group D; n = 35). The intensive care unit mortality rates were 15% for group A, 33% for group B, 34% for group C, and 49% for group D (p = 0.051). The temporal improvement in organ dysfunction and vasopressor dose seemed more apparent in group A patients. Our results suggest that different subphenotypes exist among sepsis patients treated using a vitamin C protocol, and clinical outcomes might be better for patients with the hyperinflammatory subphenotype.

scholarly journals 669 COVID-19-related acute pericarditis. A retrospective observational study

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Vito Maurizio Parato ◽  
Maria Chiara Galieni ◽  
Stefano Marcelli ◽  
Salvatore La Carruba
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Pericardial Effusion ◽  
Observational Study ◽  
Cardiovascular Complications ◽  
Retrospective Observational Study ◽  
Published Data ◽  
Acute Pericarditis ◽  
Group A ◽  
Group B

Abstract Aims Acute pericarditis is considered one of the cardiovascular complications of COVID-19. The published data suggest that the diagnosis of acute pericarditis in patients with COVID-19 infection may be more frequent than usually diagnosed and as a consequence, undertreated. The proposed investigation is a retrospective observational study in which 170 patients, admitted to an Intensive Care Unit because of a COVID-19 diagnosis, were analysed. All patients underwent cardiological evaluation including a bedside echocardiogram. The aim of the study was to evaluate the prevalence and clinical implications of acute pericarditis diagnosed through the presence of pericardial effusion. Methods and results The proposed investigation is a retrospective observational study enrolling patients admitted to Intensive Care Unit of Madonna del Soccorso Hospital (San Benedetto del Tronto, Italy) because of a SARS-CoV-2 induced severe acute respiratory syndrome. No. 170 patients, admitted from 1 April 2020 to 30 April 2021, were enrolled. All patients presented a variable picture of bilateral interstitial pneumonia characterized by ground glass opacifications at HR-Chest CT. Some patients underwent oro-tracheal intubation and invasive ventilation. All patients underwent cardiological consultation including a transthoracic bedside echocardiogram, using ultrasound E9-GE machine (Boston, MA, USA). Demographic, laboratory and clinical data were collected for all enrolled patients (Table 1). The diagnosis of acute pericarditis was defined by: (i) different degree of pericardial effusion; (ii) C-reactive proteine elevation. All patients were divided in two groups: (1) pericarditis group (a); (2) pericarditis-free group (b). Of 170 enrolled patient, 51 were females (30%) and 119 were males (70%). Median age for all patients was 67.6 ± 13.3 [females: 70.5 (±16.2); males: 66.4 (±11.7)]. Of 170, n. 60 patients had a diagnosis of acute pericarditis (32.2%). Group A (patient with acute pericarditis) consisted of 60 patients, age 69.2 (±12.6), 39 (65%) male [age 69.3 (±10.6)], 21 (35%) female [age 69.1 (±16.0)]. Of 60, only 6 had a pericardial effusion &gt;10 mm (10%); the remaining group A-patients (90%) had a mild pericardial effusion (&lt;10 mm). No patient had tamponade picture. Group B (pericarditis-free patients) included 110 patients, age 66.7 (±13.7), 80 (72.7%) males [age 65.0 (±12.1)], 30 (27.3%) females [age 71.4 (±16.6)]. Group A-patients (with pericarditis) had more days of intubation and a prolonged global hospital stay compared with group B (pericarditis-free). Other demographic, clinical and laboratory parameters were similar between the two groups. Conclusions Pericarditis is a frequent cardiovascular complication of COVID-19 (32.2% in our study). It may have clinical and prognostic implications.

scholarly journals Open Cardiac Compression in the Postoperative Cardiac Intensive Care Unit

1989 ◽  
Vol 17 (2) ◽  
pp. 129-135 ◽  
Author(s):  
J. Raman ◽  
R. F. Saldanha ◽  
J. M. Branch ◽  
D. S. Esmore ◽  
P. M. Spratt ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Heart Surgery ◽  
Open Heart Surgery ◽  
Functional Class ◽  
External Compression ◽  
Cardiac Compression ◽  
Group A ◽  
Cardiac Intensive Care ◽  
Group B

Thirty-nine patients required heroic resuscitative measures for sudden hypotension and cardiac arrest in the first 72 hours following cardiac surgery between January 1, 1984 and May 31, 1988. Emergency sternotomy with open cardiac compression was performed in twenty-four of these patients when external cardiac compression failed. These were categorised as Group A. Group B comprised the fifteen patients in whom resuscitation was entirely by means of external compression and adjuvant measures. Survival with NYHA Functional Class I and II status was noted in 75% of patients in Group A, compared with 20% in Group B (P <0.002). Emergency sternotomy with open cardiac compression is an effective way of resuscitating patients in the intensive care unit in the first few days following open heart surgery.

scholarly journals Effects of hypertonic saline preloading in sub arachnoid blockade for transurethral resection of prostate - A comparative study

2014 ◽  
Vol 22 (2) ◽  
pp. 66-71
Author(s):  
Amirul Islam ◽  
Md Rafayet Ullah Siddique ◽  
Md Mustafa Kamal ◽  
Debabrata Banik ◽  
AKM Akhtaruzzaman ◽  
...  
Keyword(s):  
Sodium Chloride ◽  
Mean Arterial Pressure ◽  
Arterial Pressure ◽  
Chloride Solution ◽  
Sodium Chloride Solution ◽  
Hypertonic Solution ◽  
Nacl Solution ◽  
Group A ◽  
In Trans ◽  
Group B

Background: Hypertonic solution is used to combat hypotension in sub-arachnoid block during trans urethral resection of prostate. Aims and objectives: To compare the effect of 3% sodium chloride solution with that of 0.9% sodium chloride solution, to combat sub-arachnoid block induced hypotension in trans urethral resection of prostate. Methods: A total number of sixty patients ASA grade I & II were selected randomly in two groups , thirty in each group. Group A received 15ml/kg of 0.9% NaCl solution and group B 4ml/kg of 3% NaCl solution as a preload. Sub arachnoid block performed at the L3/4 interspace in the sitting position. Heart rate, mean arterial pressure, amount of ephedrine, amount of used additional I/V normal saline, serum electrolytes and level of sensory block were observed. Results: Mean arterial pressure was differed significantly at late hours ie, 50min, 60min (P<0.001). Incidence of hypotension was 43% in group A, 16% in group B and was significant (p<0.05). Less additional I/V fluid was required in group B and difference was significant (P<0.05). Low doses of ephedrine was needed in group B and was highly significant (P<0.001). Conclusion: Preloading of hypertonic solution is superior to isotonic solution in trans urethral resection of prostate under sub arachnoid block. DOI: http://dx.doi.org/10.3329/jbsa.v22i2.18145 Journal of BSA, 2009; 22(2): 66-71

scholarly journals Transfusion Strategies in Patients with Mitral Valve Replacement

2021 ◽  
pp. 42-48
Author(s):  
B. M. Gumeniuk ◽  
I. P. Golota
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Mitral Valve ◽  
Blood Components ◽  
Transfusion Strategy ◽  
Donor Blood ◽  
Group A ◽  
Group B ◽  
Stage 1 ◽  
Packed Rbcs

The aim. To carry out research of liberal, restrictive and blood-saving transfusion strategies in patients with mitral valve replacement (MVR) in the conditions of artificial blood circulation during operation, in intensive care unit, and in the postoperative period. Material and methods. Retrograde examinations were performed in 70 patients who underwent surgery for ac-quired mitral valve disease. Our research consisted of three stages: stage 1 involved the study of the volume of transfu-sions of donor blood components during MVR, stage 2 involved the study of the volume of transfusion of donor blood components in the emergency room, stage 3 involved the study of the volume of transfusions of donor blood components in the intensive care unit. All the patients were divided into 3 groups. Group A included 14 patients in whom (arbitrary) liberal transfusion strategy (LTS) with transfusion of donor blood components was applied during the operation. Group B included 19 patients in whom (economical) restrictive transfusion strategy (RTS) during surgery with transfusion of donor blood components was applied. Group C included 37 patients in whom the patient’s autologous blood-saving tech-nology (BST) was applied during the operation. Results and discussion. At stage 1 of the study, the volume of packed RBCs per 1 transfusion in group A exceeded the volume of packed RBCs per 1 transfusion in group B by 68.0%. The volume of transfusions of native fresh-frozen plasma (FFP) in group A exceeded that in group B by 73.5%. The volume of platelet transfusions (PT) in group A at stage 1 was 75.0%. At stage 2 of the study, the total volume of PT in patients of group A was still 3.0 times higher and FFP was 2.7 times higher than that in group B. At this stage of the study, there was also a 2.6-fold decrease in the volume of PT per 1 transfusion in group B compared with group A. In total, during 3 stages of the study, the volume of PT use in group A was 5.7 times higher, and in group B it was 3.9 times higher than that in group C. The volume of FFP use in group A was 4.4 times higher, and in group B it was 3.8 times higher than that in group C. Conclusions. The use of LTS in group A and RTS in group B resulted in 5.2-fold and 3.8-fold increase in the total volume of transfused donor blood components, repsectively, compared to group C.

scholarly journals Taste and Smell Impairment in Critically Ill Patients With COVID-19: An Intensive Care Unit Study

2020 ◽  
pp. 014556132097746
Author(s):  
Pınar Sayın ◽  
Mustafa Altınay ◽  
Ayse Surhan Cınar ◽  
Hacı Mustafa Ozdemir
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Type Number ◽  
Analog Scale ◽  
Vas Score ◽  
Icu Stay ◽  
Sex Type ◽  
Group A ◽  
Group B ◽  
Taste And Smell

Objective: To determine taste and smell impairment rates in patients with coronavirus disease 2019 (COVID-19) who were hospitalized in the intensive care unit (ICU). Methods: Between March 2020 and May 2020, patients with COVID-19 hospitalized in the ICU were enrolled in this study. Upon discharge, patients were telephoned and asked to complete a survey related to taste and smell impairment. Characteristics were compared between patients with and without taste and/or smell impairment. Results: Fifty-two patients were enrolled (mean age, 61.32 ± 12.53 years; mean ICU stay, 10.19 ± 10.24 days). Age, sex, type/number of comorbid diseases, most ICU support modalities, and ICU stay duration did not significantly differ between groups. Patients in group B required more high-flow nasal oxygen therapy than patients in group A ( P = .010). In total, 22 (42.3%) of 52 patients experienced taste and/or smell impairment. Three patients experienced isolated smell impairment and one patient experienced isolated taste impairment. Among the 21 patients who experienced smell impairment, 18 (85.78%) experienced hyposmia (mean visual analog scale [VAS] score: 6.33 ± 0.97), while 3 (14.28%) experienced anosmia. Among the 19 patients who experienced taste impairment, 16 (84.22%) experienced hypogeusia (mean VAS score: 6.43 ± 1.03) and 3 (15.78%) experienced ageuisa. Among 22 patients who experienced taste and/or smell impairment, 15 (68.18%) patients (n = 15/22) experienced smell and/or taste impairment before the ICU stay, while 7 (31.82%) patients (n = 7/22) experienced impairment during the ICU stay. Overall, 28.84% (n = 15/52) of the patients experienced taste and/or smell impairment before the ICU stay. Conclusions: Patients who were hospitalized in the ICU experienced lower rates of taste and/or smell impairment. Some patients experienced taste and/or smell impairment during the ICU stay.

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