Comparison of manual and mechanical ventilation during transport of patients to the Intensive Care Unit after cardiac surgery

2006 ◽  
Vol 23 (Supplement 38) ◽  
pp. 39-40
Author(s):  
A. Canbulat ◽  
S. Goren ◽  
E. B. Mogol ◽  
F. N. Kaya
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Cardiac Surgery ◽  
Intensive Care

Risk Factors and Outcomes Associated With Readmission to the Intensive Care Unit After Cardiac Surgery

2016 ◽  
Vol 27 (1) ◽  
pp. 29-39 ◽  
Author(s):  
Young Ae Kang
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Cardiac Surgery ◽  
Intensive Care ◽  
Hospital Stay ◽  
Operation Time ◽  
Unplanned Readmission ◽  
High Blood Glucose ◽  
Icu Discharge

Unplanned readmission to the intensive care unit (ICU) is associated with poor prognosis, longer hospital stay, increased costs, and higher mortality rate. In this retrospective study, involving 1368 patients, the risk factors for and outcomes of ICU readmission after cardiac surgery were analyzed. The readmission rate was 5.9%, and the most common reason for readmission was cardiac issues. Preoperative risk factors were comorbid conditions, mechanical ventilation, and admission route. Perioperative risk factors were nonelective surgery, duration of cardiopulmonary bypass, and longer operation time. Postoperative risk factors were prolonged mechanical ventilation time, new-onset arrhythmia, unplanned reoperation, massive blood transfusion, prolonged inotropic infusions, and complications. Other factors were high blood glucose level, hemoglobin level, and score on the Acute Physiology and Chronic Health Evaluation II. In-hospital stay was longer and late mortality was higher in the readmitted group. These data could help clinical practitioners create improved ICU discharge protocols or treatment algorithms to reduce length of stay or to reduce readmissions.

scholarly journals Sedative use of Dexmedetomidine vs. Propofol after Cardiac Surgery: A critical review and meta-analysis.

2019 ◽  
Author(s):  
Hesham Abowali ◽  
Matteo Paganini ◽  
Garrett A Enten ◽  
Ayman Elbadawi ◽  
Enrico Camporesi
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Cardiac Surgery ◽  
Intensive Care ◽  
Length Of Stay ◽  
Hospital Length ◽  
Time Dependent ◽  
Hospital Length Of Stay ◽  
Ventilation Time ◽  
Mechanical Ventilation Time

Abstract Abstract Background : The use of dexmedetomidine for sedation post-cardiac surgery is controversial compared to the use of propofol. Methods : A computerized search on Medline, EMBASE, Web of Science, and Agency for Healthcare Research and Quality databases was performed for up to July 2019. Trials evaluating the efficacy of dexmedetomidine versus propofol in the postoperative sedation of cardiac surgery patients were selected. Primary study outcomes were classified as time-dependent (mechanical ventilation time; time to extubation; length of stay in the intensive care unit and the hospital) and non-time dependent (delirium, bradycardia, and hypotension). Results : Our final analysis included 11 RCTs published between 2003 and 2019 and involved a total of 1184 patients. Time to extubation was significantly reduced in the dexmedetomidine group (Standardized Mean Difference (SMD) = -0.61, 95% Confidence Interval (CI): -1.06 to -0.16, p=0.008), however no difference in mechanical ventilation time was observed (SMD= -0.72, 95% CI: -1.60 to 0.15, N.S.). Moreover, the dexmedetomidine group showed a significant reduction in Intensive Care Unit length of stay (SMD= -0.70, 95% CI: -0.98 to -0.42, p=0.0005) this did not translate into a reduced hospital length of stay (SMD= -1.13, 95% CI: -2.43 to 0.16, N.S). For non-time dependent factors: incidence of delirium was unaffected between groups (OR: 0.68, 95% CI: 0.43 to 1.06, N.S.), while the propofol group of patients had higher rates of bradycardia (OR: 3.39, 95% CI: 1.20 to 9.55, p=0.020) and hypotension (OR: 1.68, 95% CI: 1.09 to 2.58, p=0.017). Conclusion : Despite the ICU time advantages afforded by dexmedetomidine over propofol, the former does not contribute to an overall reduction in hospital length of stay or an overall improvement in postoperative outcomes for heart valve surgery and CABG patients. Time-dependent outcomes confounded by several factors including variability in staff, site-protocols, and complication rates between individual surgical cases. Keywords: dexmedetomidine; propofol; cardiac surgery; postoperative sedation.

Influence of Erythrocyte Concentrate Storage Time on Postsurgical Morbidity in Cardiac Surgery Patients

2003 ◽  
Vol 98 (4) ◽  
pp. 815-822 ◽  
Author(s):  
Santiago R. Leal-Noval ◽  
Irene Jara-López ◽  
José L. García-Garmendia ◽  
Ana Marín-Niebla ◽  
Angel Herruzo-Avilés ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Cardiac Surgery ◽  
Intensive Care ◽  
Confidence Interval ◽  
Prolonged Storage ◽  
Prolonged Stay ◽  
Ventilation Time ◽  
Duration Of Storage ◽  
Mechanical Ventilation Time

Background The transfusion of erythrocytes that have been stored for long periods of time can produce visceral ischemia and favor the acquisition of postsurgical infections. To estimate the role of the duration of storage of erythrocytes on morbidity in cardiac surgery, we performed an observational study. Methods All patients (n = 897) undergoing cardiac surgery during three consecutive years were included. Morbidity (main outcome measure) was evaluated by means of four surrogate measures: duration of stay in the intensive care unit longer than 4 days, mechanical ventilation time longer than 1 day, perioperative myocardial infarction rate, and severe postoperative infection rate. The mean duration of storage of all erythrocytes transfused and the duration of storage of the oldest unit transfused were used as storage variables. Results After considering multiple confounding variables related to patient severity, illness, and surgical difficulty, the duration of storage of erythrocytes was found to be associated neither with a more prolonged stay in the intensive care unit or mechanical ventilation time nor with increased rates of perioperative infarction, mediastinitis, or sepsis. However, each day of storage of the oldest unit was associated with an increment of the risk of pneumonia of 6% (95% confidence interval, 1-11; P = 0.018). The cutoff point of maximum sensitivity and specificity (54.8 and 66.9%) associated with a greater risk for pneumonia corresponded to 28 days of storage for the oldest unit (odds ratio, 2.74; 95% confidence interval, 1.18-6.36; P = 0.019). Conclusions Prolonged storage of erythrocytes does not increase morbidity in cardiac surgery. However, storage for longer than 28 days could be a risk factor for the acquisition of nosocomial pneumonia.

scholarly journals Sedative use of Dexmedetomidine vs. Propofol after Cardiac Surgery: A critical review and meta-analysis.

2019 ◽  
Author(s):  
Hesham Abowali ◽  
Matteo Paganini ◽  
Ayman Elbadawi ◽  
Enrico Camporesi
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Cardiac Surgery ◽  
Intensive Care ◽  
Length Of Stay ◽  
Time Dependent ◽  
Confounding Factors ◽  
Ventilation Time ◽  
Significant Difference ◽  
Mechanical Ventilation Time

Abstract BACKGROUND: The efficacy and safety of dexmedetomidine in sedation for postoperative cardiac surgeries is controversial when compared to propofol. METHODS: A computerized search of Medline, Cochrane and Google Scholar databases was performed through August 2018. Studies evaluating the efficacy of dexmedetomidine versus propofol in the sedation of postoperative cardiac surgery patients were searched. The main study outcomes were divided into time dependent (mechanical ventilation time; time to extubation; length of stay in the intensive care unit and in the hospital) and non-time dependent (delirium, bradycardia, and hypotension). RESULTS: The final analysis included 15 trials with a total of 2488 patients. Time to extubation was significantly reduced in the dexmedetomidine group (Standardized Mean Difference (SMD) = -0.54, 95% Confidence Interval (CI): -0.89 to -0.18, p=0.003), as well as mechanical ventilation time (SMD= -0.71, 95% CI: -1.19 to -0.23, p=0.004). Moreover, the dexmedetomidine group showed a significant reduction in Intensive Care Unit length of stay (SMD= -0.38, 95% CI: -0.60 to -0.16, p=0.001) and hospital length of stay (SMD= -0.39, 95% CI: -0.60 to -0.19, p<0.001). However, these time dependent outcomes could have been affected by several confounding factors, thus limiting the value of these results. Incidence of delirium was reduced in the dexmedetomidine group (OR: 0.47, 95% CI: 0.29 to 0.76, p=0.002), while this group of patients had higher rates of bradycardia (OR: 2.52, 95% CI: 1.15 to 5.55, p=0.021). There was no significant difference in rates of hypotension between the two groups. CONCLUSION: Despite the apparent time advantages afforded by dexmedetomidine over propofol, the former does not show particular overall improvements in postoperative care of cardiac surgery patients. Since time dependent outcomes seems to be affected by several confounding factors, more efforts are needed to analyze factors that could affect sedation in post-cardiac surgery patients and choose unbiased outcomes. KEYWORDS: Dexmedetomidine; propofol; cardiac surgery; postoperative sedation.

scholarly journals Sedative Use of Dexmedetomidine vs. Propofol after Cardiac Surgery A Critical Review and Meta-Analysis.

2020 ◽  
Author(s):  
Hesham A. Abowali ◽  
Matteo Paganini ◽  
Garrett Enten ◽  
Ayman Elbadawi ◽  
Enrico Camporesi
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Cardiac Surgery ◽  
Intensive Care ◽  
Length Of Stay ◽  
Hospital Length ◽  
Time Dependent ◽  
Hospital Length Of Stay ◽  
Ventilation Time ◽  
Mechanical Ventilation Time

Abstract Background The efficacy and safety of dexmedetomidine in sedation for postoperative cardiac surgeries are controversial when compared to propofol. Methods A computerized search on Medline, EMBASE, Web of Science, and Agency for Healthcare Research and Quality databases was performed through July 2019. Trials evaluating the efficacy of dexmedetomidine versus propofol in the sedation of postoperative cardiac surgery patients were selected. The primary study outcomes were divided into time-dependent (mechanical ventilation time; time to extubation; length of stay in the intensive care unit and the hospital) and non-time dependent (delirium, bradycardia, and hypotension). Results Our final analysis included 11 RCTs published between 2003 and 2019 and involved a total of 1184 patients. Time to extubation was significantly reduced in the dexmedetomidine group (Standardized Mean Difference (SMD) = -0.61, 95% Confidence Interval (CI): -1.06 to -0.16, p=0.008), however no difference in mechanical ventilation time was observed (SMD= -0.72, 95% CI: -1.60 to 0.15, N.S.). Moreover, the dexmedetomidine group showed a significant reduction in Intensive Care Unit length of stay (SMD= -0.70, 95% CI: -0.98 to -0.42, p=0.0005) this did not translate into a reduced hospital length of stay (SMD= -1.13, 95% CI: -2.43 to 0.16, N.S). For non-time dependent factors: incidence of delirium was unaffected between groups (OR: 0.68, 95% CI: 0.43 to 1.06, N.S.), while the propofol group of patients had higher rates of bradycardia (OR: 3.39, 95% CI: 1.20 to 9.55, p=0.020) and hypotension (OR: 1.68, 95% CI: 1.09 to 2.58, p=0.017). Conclusion Despite the ICU time advantages afforded by dexmedetomidine over propofol, the former does not contribute to an overall reduction in hospital length of stay or an overall improvement in postoperative outcomes of heart valve surgery and CABG patients. Additionally, time-dependent outcomes are affected by several confounding factors, and more efforts are needed to analyze factors that could affect sedation in post-cardiac surgery patients and choose unbiased outcomes.

scholarly journals Epidemiological features of healthcare associated infections in pediatric cardiac surgery

2021 ◽  
Vol 13 (3) ◽  
pp. 102-106
Author(s):  
A. S. Nabieva ◽  
B. I. Aslanov ◽  
V. N. Timchenko ◽  
N. A. Ponomarev
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Cardiac Surgery ◽  
Intensive Care ◽  
Congenital Heart ◽  
Healthcare Associated Infections ◽  
Epidemiological Features ◽  
Surgical Methods ◽  
Healthcare Associated

4—5 congenital heart defect cases per 1000 newborns are diagnosed worldwide. Some malformations require surgical methods of correction. Various risk factors contribute to the development of healthcare associated infections (HAIs). The HAIs are one of the leading causes of the prolongation of hospitalization length both in intensive care unit and in the inpatient departments, and they also play a significant role in increasing the number of lethal outcomes. A number of risk factors play an important role in the development of HAIs: the duration of post-operative mechanical ventilation, neonatal age, low birth weight, co-morbidities, including malformations of other body systems.

scholarly journals Early mobilization is associated with decreased mechanical ventilation and ICU length of stay following cardiac surgery

2021 ◽  
Vol 7 (4) ◽  
pp. 184
Author(s):  
Vasiliki Raidou ◽  
Stavros Dimopoulos ◽  
Foteini Chatzivasiloglou ◽  
Christos Kourek ◽  
Vasiliki Tsagari ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Cardiac Surgery ◽  
Intensive Care ◽  
Length Of Stay ◽  
Medical Records ◽  
Early Mobilization ◽  
Icu Stay ◽  
Icu Length Of Stay ◽  
Icu Discharge

Background: Early mobilization of the Intensive Care Unit (ICU) patients improves muscle strength and functional capacity. It has been demonstrated that prevents Intensive Care Unit Acquired Weakness (ICUAW) and accelerates ICU discharge. However, data on mobilization early after cardiac surgery are inadequate. This study aimed to record early mobilization and investigates the association with ICU findings in cardiac surgery patients.Material and Methods: In this observational study, 165 patients after cardiac surgery were enrolled. Of these, 159 were assessed for early mobilization and mobilization status during ICU stay. Mobilization practices were recorded from 1st post ICU admission and every 48 h until 7th day. The duration of mechanical ventilation (MV) support, ICU length of stay and clinical outcome were recorded from medical records registration. Results: Early mobilization consisted of active and passive limb mobilization, sitting in bed and transferring from bed to chair. The proportion of patients mobilized, was 18% (n = 29/159) on day 1, 53% (n = 46/87) on day 3, 54% (n = 22/41) on day 5 and 62% (n = 15/24) on day 7. ICU length of stay was reduced for mobilized patients (n = 29) on day 1 compared to non-mobilized ones (24 ± 10 vs 47 ± 73 h respectively, P = 0.001). The duration of MV was shorter in mobilized patients on day 3 (n =46) compared to bedridden, (18 ± 9 vs 23 ± 30 h respectively, P = 0.01).Conclusions: Early mobilization after cardiac surgery was found to be low with a significant trend to increase over ICU stay. It is also associated with a reduced duration of MV and ICU length of stay.

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