scholarly journals Effect of Del Nido cardioplegia on ventricular arrhythmias after cardiovascular surgery

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Chang Shu ◽  
Liang Hong ◽  
Xiao Shen ◽  
Wenhao Zhang ◽  
Yongsheng Niu ◽  
...  
Keyword(s):  
Cardiopulmonary Bypass ◽  
Ventricular Arrhythmias ◽  
Pediatric Patients ◽  
Cardiovascular Surgery ◽  
Multivariate Logistic Regression ◽  
Substantial Evidence ◽  
Postoperative Arrhythmia ◽  
Icu Stay ◽  
Medical University ◽  
Length Of Icu Stay

Abstract Background Del Nido cardioplegia (DNC) has been proven safe and effective in pediatric patients. However, the use of DNC in adult undergoing cardiovascular surgery lacks support with substantial evidence. This study aimed to evaluate the efficacy of DNC as a cardioplegia of prophylaxis to ventricular arrhythmias associated to cardiovascular surgery in adult patients. Methods This study recruited nine hundred fifty-four patients who underwent cardiopulmonary bypass surgeries in Nanjing Hospital affiliated to Nanjing Medical University between January 2019 and December 2019. Among 954 patients, 324 patients were treated with DNC (DNC group), and 630 patients were treated with St. Thomas cardioplegia (STH group). The incidence of postoperative arrhythmia as well as other cardiovascular events relavant to the surgery were investigated in both groups. Results In DNC group, the incidence of postoperative ventricular arrhythmias was lower (12.4% vs. 17.4%, P = 0.040), and the length of ICU stay was shorter (1.97 ± 1.49 vs. 2.26 ± 1.46, P = 0.004). Multivariate logistic regression demonstrated that the use of DNC helped to reduce the incidence of postoperative ventricular arrhythmias (adjusted odds ratio 0.475, 95% CI 0.266–0.825, P = 0.010). The propensity score-based analysis and subgroup analysis indicated that DNC has the same protecting effects towards myocardial in all kinds of cardiopulmonary bypass surgeries. Conclusions Del Nido cardioplegia may potentially reduce the incidence of postoperative ventricular arrhythmias, shorten the length of ICU stay and improve the overall outcome of the patients undergoing cardiovascular surgery.

scholarly journals A systematic review of the impact of intensive care admissions on post discharge cognition in children

2021 ◽  
Author(s):  
Ana Sánchez-Moreno Royer ◽  
Jamiu O. Busari
Keyword(s):  
Risk Factors ◽  
Intensive Care ◽  
Cognitive Development ◽  
High Risk ◽  
Pediatric Patients ◽  
Post Discharge ◽  
Icu Stay ◽  
Short And Long Term ◽  
Length Of Icu Stay

AbstractUnderstanding how hospitalization affects cognitive development is crucial to safeguard children’s cognition; however, there is little research evaluating the associations between NICU or PICU hospitalization and survivors’ cognition. The objective of this study is to identify and characterize the associations between a neonatal or pediatric ICU hospitalization and the short- and long-term cognition of survivors. The databases Cochrane Library, Medline, EBSCO, Embase, and Google Scholar and the journals JAMA Pediatrics, Journal of Pediatrics, Pediatrics, Archives of Disease in Childhood, Academic Pediatrics, Pediatric Critical Care Medicine and Child Development were searched until April 2021. Retrieved article references were analyzed. Included articles investigated cognition as an outcome of ICU hospitalization in non-preterm neonatal or pediatric patients. Case studies and studies analyzing diagnosis or treatment interventions were excluded. Four prospective cohort or case-control studies and two retrospective cohort studies were included, totaling 2172 neonatal and 42368 pediatric patients. Quality assessment using the BMJ Criteria and Cochrane Collaboration’s Risk-of-Bias tool displayed good results. Significant negative associations were found between neonatal cognition and length-of-ICU-stay at 9- (p<0.001) and 24 months (p<0.01), and between pediatric cognition and length-of-ICU-stay at discharge (p<0.001). Additional weeks on the neonatal ICU increased odds of impairment at 9- (OR 1.08, 95%CI 1.034–1.112) and 24 months (OR 1.11, 95%CI 1.065–1.165).Conclusion: There is a significant negative correlation between NICU and PICU hospitalization and the short- and long-term cognitive status. Future research must identify patient- and hospital-related risk factors and develop management strategies. What is Known:• Cognitive development relies on the presence of stimulating factors and absence of risk factors, and is hypothesized to be directly and indirectly affected by hospitalization in the short and long term.• No research examines the relation between survivor cognition post-discharge of a general pediatric hospitalization, and scarcely more of a neonatal or pediatric intensive care hospitalization. What is New:• NICU and PICU hospitalization is independent risk factors for survivor impaired cognition in the short and in the long term with a dose-response effect. High risk patients for cognitive impairment should be identified and appropriately followed-up.• Patients with an ICU hospitalization of over 2.5 days and two or more of the following factors should be considered high risk: increased mortality risk, invasive interventions, neurological or oncological diagnosis, postnatal complications or decreased maternal mental health status.

scholarly journals Safety of Albumin and Hydroxyethyl Starch as Priming Fluid for Cardiopulmonary Bypass in Cardiac Surgery: A Meta-analysis of Randomized Controlled Trials

2020 ◽  
Author(s):  
Mingtang Ye ◽  
Xiaodong Zang ◽  
Peicheng Ding ◽  
Ruonan Wang ◽  
Feng Chen ◽  
...  
Keyword(s):  
Cardiopulmonary Bypass ◽  
Hydroxyethyl Starch ◽  
Meta Analysis ◽  
Urine Volume ◽  
Length Of Hospital Stay ◽  
Fresh Frozen Plasma ◽  
Icu Stay ◽  
Fresh Frozen ◽  
Crystal Volume ◽  
Length Of Icu Stay

Abstract Introduction: Hydroxyethyl starch (HES) has been widely used for volume expansion, but its safety as priming fluid for cardiopulmonary bypass has been questioned recently. The aim of this meta-analysis is to compare the safety of albumin and hydroxyethyl starch as priming fluid for cardiopulmonary bypass.Methods: Pubmed, Embase database and Cochrane Library were searched for randomized controlled trials (RCTs) involving patients who received HES or albumin as priming fluid for cardiopulmonary bypass in cardiac surgery published up to October 2019. Two reviewers independently extracted the valid data, including the length of ICU stay, ventilator time, the length of hospital stay, crystal volume, fresh frozen plasma, platelet input, blood loss, blood platelet count. hemoglobin value, fibrin, APTT, PT, urea, creatinine and urine volume. Meta-analysis was performed with revman version 5.3. Results: Total 9 RCTs involving 452 patients were included in this meta-analysis. Compared with albumin, HES had similar effects on the length of ICU stay(MD = 0.70；95%CI：-0.14 to 1.55；P = 0.10；I2 = 89%);ventilation time(MD = 2.31 ;95%CI-3.93 to 8.55;P = 0.47,I2 = 60%); the length of hospital stay(MD = -0.31;95% CI:-2.00 to 1.37; P = 0.71 ;I2 = 0%); crystal volume(SMD = 0.26;95% CI:-0.09 to 0.61; P = 0.15;I2 = 0%); fresh frozen plasma(SMD = 0.25；95%CI：-0.08 to 0.59；P = 0.66；I2 =0%); platelet input(SMD =-0.17;95% Cl:-0.59 to 0.26;P =0.45;I2 = 0%);blood loss (SMD =0.31;95% Cl:-0.01 to 0.63;P = 0.06;I2 =29%);platelet count (SMD =-0.21;95% cl :-0.54 to 0.11; P = 0.20;I2 = 29% );hemoglobin value(SMD =0.1;95% CI: -0.15 to 0.36;P = 0.42; I2 = 0% ); fibrin (SMD =0.12;95% CI: -0.19 to 0.44 ; P = 0.45; I2 = 0% );APTT(MD =1.13;95% CI: -2.06 to 4.32 ; P = 0.49; I2 = 0%);PT(MD =0.10;95% CI: -0.21 to 0.40,P = 0.52; I2 = 0%);creatinine(SMD =0.09;95% CI: -0.32 to 0.50 ; P = 0.66; I2 = 51% );urine volume(SMD =0.11;95% CI: -0.26 to 0.48 ; P = 0.55; I2 = 43% ).but did not increase urea (SMD =-0.46;95% CI: -0.81 to -0.11; P = 0.01; I2 = 0%).Conclusions: HES was safe and effective compared to albumin as priming fluid for cardiopulmonary bypass because it did not affect renal function, coagulation function, liquid input, or the length of ICU stay and ventilation time of patients.

scholarly journals Assessment of Cardiopulmonary Bypass Duration Improves Novel Biomarker Detection for Predicting Postoperative Acute Kidney Injury after Cardiovascular Surgery

2021 ◽  
Vol 10 (13) ◽  
pp. 2741
Author(s):  
Tao Han Lee ◽  
Cheng-Chia Lee ◽  
Jia-Jin Chen ◽  
Pei-Chun Fan ◽  
Yi-Ran Tu ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Cardiopulmonary Bypass ◽  
Fatty Acid Binding Protein ◽  
Cardiovascular Surgery ◽  
Kidney Injury ◽  
Fatty Acid Binding ◽  
Discriminatory Ability ◽  
Postoperative Risk ◽  
Study Population ◽  
Postoperative Aki

Urinary liver-type fatty acid binding protein (L-FABP) is a novel biomarker with promising performance in detecting kidney injury. Previous studies reported that L-FABP showed moderate discrimination in patients that underwent cardiac surgery, and other studies revealed that longer duration of cardiopulmonary bypass (CPB) was associated with a higher risk of postoperative acute kidney injury (AKI). This study aims to examine assessing CPB duration first, then examining L-FABP can improve the discriminatory ability of L-FABP in postoperative AKI. A total of 144 patients who received cardiovascular surgery were enrolled. Urinary L-FABP levels were examined at 4 to 6 and 16 to 18 h postoperatively. In the whole study population, the AUROC of urinary L-FABP in predicting postoperative AKI within 7 days was 0.720 at 16 to 18 h postoperatively. By assessing patients according to CPB duration, the urinary L-FABP at 16 to 18 h showed more favorable discriminating ability with AUROC of 0.742. Urinary L-FABP exhibited good performance in discriminating the onset of AKI within 7 days after cardiovascular surgery. Assessing postoperative risk of AKI through CPB duration first and then using urinary L-FABP examination can provide more accurate and satisfactory performance in predicting postoperative AKI.

scholarly journals Implementation of daily goals in the ICU reduces length of ICU stay and errors of omission in patient care

Critical Care ◽  
2010 ◽  
Vol 14 (Suppl 1) ◽  
pp. P466
Author(s):  
JM Binnekade ◽  
A Brunsveld ◽  
S Arbous ◽  
MG Dijkgraaf ◽  
J Horn ◽  
...  
Keyword(s):  
Patient Care ◽  
Icu Stay ◽  
Length Of Icu Stay

384 Post-Operative ICU Admission for Elective Craniotomy for Intra-axial Brain Tumor Resection

Neurosurgery ◽  
2017 ◽  
Vol 64 (CN_suppl_1) ◽  
pp. 291-292
Author(s):  
Farhan A Mirza ◽  
Catherine Y Wang ◽  
Thomas Pittman
Keyword(s):  
Brain Tumor ◽  
Pediatric Patients ◽  
Prolonged Mechanical Ventilation ◽  
Pediatric Population ◽  
External Ventricular Drain ◽  
Tumor Resection ◽  
Retrospective Chart Review ◽  
Icu Admission ◽  
Icu Stay ◽  
Brain Tumor Resection

Abstract INTRODUCTION We reviewed our practice at the University of Kentucky in order to assess the safety of admitting adult and pediatric patients to floor beds after craniotomy, exclusively for intra-axial brain tumor resection. METHODS Retrospective chart review of patients, adults and pediatric, who underwent craniotomy by a single surgeon (TP) for intra axial brain tumor resection between January 2012 and December 2015. 413 patient charts were reviewed, 16 were omitted due to incomplete records. RESULTS >421 craniotomies for intra axial brain tumor resection were performed. 397 patients underwent surgery, 35 of whom were <18 years of age.188 females and 209 males. 351 patients (331 adults, 20 pediatric) were admitted to floor beds. In this group, length of operation was <4 hours in 346 patients (99.1%) and >4 hours in only 5 patients (0.9%). 3 patients (0.8%) required transfer to ICU within 24 hours of floor admission. 55 adult patients required ICU stay for various reasons: 9 patients had pre-operative or intra operative EVD placement; 15 patients required prolonged ventilation; 1 patient had to be taken back to the operating room for hemorrhage evacuation; 5 had intraventricular tumors and were planned ICU admissions; 26 patients were admitted pre-operatively to an ICU bed on a non neurosurgical service and were returning to their assigned beds. In the pediatric population, 15 patients required ICU stay: 8 were for EVD management and 7 for prolonged operation or frequent neurological evaluations. In this group, the length of operation was <4 hours in 40 patients(57.1%) and >4 hours in 30 patients (42.9%). CONCLUSION Admitting adult and pediatric patients to floor beds after craniotomy for intra-axial brain tumor resection is safe. There are some conditions that mandate ICU admission: these include prolonged mechanical ventilation and the presence of an external ventricular drain.

Multisite Near Infrared Spectroscopy During Cardiopulmonary Bypass in Pediatric Patients

2015 ◽  
Vol 39 (7) ◽  
pp. 584-590 ◽  
Author(s):  
Zaccaria Ricci ◽  
Roberta Haiberger ◽  
Lorenzo Tofani ◽  
Stefano Romagnoli ◽  
Isabella Favia ◽  
...  
Keyword(s):  
Infrared Spectroscopy ◽  
Cardiopulmonary Bypass ◽  
Near Infrared Spectroscopy ◽  
Near Infrared ◽  
Pediatric Patients

scholarly journals Attributable Cost and Length of Stay for Patients With Central Venous Catheter—Associated Bloodstream Infection in Mexico City Intensive Care Units A Prospective, Matched Analysis

2007 ◽  
Vol 28 (1) ◽  
pp. 31-35 ◽  
Author(s):  
Francisco Higuera ◽  
Manuel Sigfrido Rangel-Frausto ◽  
Victor Daniel Rosenthal ◽  
Jose Martinez Soto ◽  
Jorge Castañon ◽  
...  
Keyword(s):  
Intensive Care ◽  
Length Of Stay ◽  
Central Venous Catheter ◽  
Bloodstream Infection ◽  
Mexico City ◽  
Venous Catheter ◽  
Central Venous ◽  
Icu Stay ◽  
The Mean ◽  
Length Of Icu Stay

Background.No information is available about the financial impact of central venous catheter (CVC)-associated bloodstream infection (BSI) in Mexico.Objective.To calculate the costs associated with BSI in intensive care units (ICUs) in Mexico City.Design.An 18-month (June 2002 through November 2003), prospective, nested case-control study of patients with and patients without BSI.Setting.Adult ICUs in 3 hospitals in Mexico City.Patients and Methods.A total of 55 patients with BSI (case patients) and 55 patients without BSI (control patients) were compared with respect to hospital, type of ICU, year of hospital admission, length of ICU stay, sex, age, and mean severity of illness score. Information about the length of ICU stay was obtained prospectively during daily rounds. The daily cost of ICU stay was provided by the finance department of each hospital. The cost of antibiotics prescribed for BSI was provided by the hospitals' pharmacy departments.Results.For case patients, the mean extra length of stay was 6.1 days, the mean extra cost of antibiotics was $598, the mean extra hospital cost was $11,591, and the attributable extra mortality was 20%.Conclusions.In this study, the duration of ICU stay for patients with central venous catheter-associated BSI was significantly longer than that for control patients, resulting in increased healthcare costs and a higher attributable mortality. These conclusions support the need to implement preventive measures for hospitalized patients with central venous catheters in Mexico.

scholarly journals Clinical outcomes of gastroscopy in critically ill patients using high-dose proton pump inhibitor for suspected bleeding

2020 ◽  
Author(s):  
Won Gun Kwack
Keyword(s):  
Retrospective Study ◽  
Proton Pump Inhibitor ◽  
Proton Pump ◽  
Hemoglobin Level ◽  
High Dose ◽  
Gi Bleeding ◽  
Icu Mortality ◽  
Icu Patients ◽  
Icu Stay ◽  
Length Of Icu Stay

Abstract Background: Gastroscopy is a useful procedure for gastrointestinal (GI) bleeding. No definite clinical guidelines recommend on the choice of gastroscopy implementation in the intensive care unit (ICU) patient with suspected GI bleeding. The objective of this retrospective study was to compare the clinical effectiveness of gastroscopy in critically ill patients using high-dose proton pump inhibitor for suspected bleeding.Methods: ICU patients using a high-does proton pump inhibitor for suspected GI bleeding from January 2015 to February 2020 were retrospectively included. Massive GI bleeding, such as hematemesis and hematochezia, were excluded. After propensity score matching (PSM) between the gastroscopy and no gastroscopy groups, the change in hemoglobin level, requirement of RBC transfusion, length of ICU stay, and ICU mortality were compared. Results: Of the 116 subjects included, 34 patients had gastroscopy during ICU stay. Among the gastroscopy group, 13 (38.2%) patients showed normal findings, and the most frequent abnormal finding was gastric ulcer (n = 9, 26.5%), and 12 patients (35.3%) had a hemostatic procedure. After PSM, the gastroscopy group needed more red blood cell transfusion than the no-gastroscopy group (P = 0.01). There was no significant difference in the change in hemoglobin level (P = 0.10), length of ICU stay (P = 0.64), and ICU mortality (P = 0.55).Conclusion: This retrospective study showed that gastroscopy had no definite clinical benefit in ICU patients using high-dose proton pump inhibitor for suspected GI bleeding.

scholarly journals Cerebral Microhemorrhage: A Frequent Magnetic Resonance Imaging Finding in Pediatric Patients after Cardiopulmonary Bypass

2017 ◽  
Vol 7 ◽  
pp. 27 ◽  
Author(s):  
Paggie P C Kim ◽  
Benjamin W Nasman ◽  
Erica L Kinne ◽  
Udochukwu E Oyoyo ◽  
Daniel K Kido ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cardiopulmonary Bypass ◽  
Magnetic Resonance ◽  
Pediatric Patients ◽  
Univariate Analysis ◽  
Control Group ◽  
Time Interval ◽  
Female Age ◽  
Patients With Heart Failure ◽  
Cerebral Microhemorrhage

Objectives: This study was undertaken to estimate the incidence and burden of cerebral microhemorrhage (CM) in patients with heart disease who underwent cardiopulmonary bypass (CPB), as detected on susceptibility-weighted imaging (SWI), a magnetic resonance (MR) sequence that is highly sensitive to hemorrhagic products. Materials and Methods: With Institutional Review Board waiver of consent, MR imaging (MRI) of a cohort of 86 consecutive pediatric patients with heart failure who underwent heart transplantation evaluation were retrospectively reviewed for CM. A nested case–control study was performed. The CPB group consisted of 23 pediatric patients with heart failure from various cardiac conditions who underwent CPB. The control group was comprised of 13 pediatric patients with similar cardiac conditions, but without CPB history. Ten patients in the CPB group were female (age: 5 days to 16 years at the time of the CPB and 6 days to 17 years at the time of the MRI). The time interval between the CPB and MRI ranged from 11 days to 4 years and 5 months. Six patients in the control group were female, age range of 2 days to 6 years old. The number of CM on SWI was counted by three radiologists (PK, EK and DK). The differences in number of CM between groups were tested for significance using Mann–Whitney U-test, α = 0.05. Using the univariate analysis of variance model, the differences in number of CM between groups were also tested with adjustment for age at MRI. Results: There are statistically significant differences in CM on SWI between the CPB group and control group with more CM were observed in the CPB group without and with adjustment for age at MRI (P < 0.001). Conclusions: Exposure of CPB is associated with increased prevalence and burden of CM among pediatric patients with heart failure.

scholarly journals Ultrasound evaluation of complications after cardiovascular surgery in pediatric patients: A case series

2020 ◽  
Vol 1 (1) ◽  
pp. 108 ◽  
Author(s):  
Takahiro Hosokawa ◽  
Sio Suzuki ◽  
Yutaka Tanami ◽  
Yumiko Sato ◽  
Yoshihiro Ko ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Early Diagnosis ◽  
Radiation Exposure ◽  
Pediatric Patients ◽  
Cardiovascular Surgery ◽  
Case Series ◽  
Early Initiation ◽  
Site Infection ◽  
Ultrasound Evaluation ◽  
Selection Of

In contrast to computed tomography, ultrasound can be performed without radiation exposure, repeatedly performed by the patients’ bedside. Hence, in this case series, we describe the evaluation of complications including hematoma, superficialsurgical site infection, mediastinitis, and pseudoaneurysm associated mediastinitis using ultrasound in pediatric patients after cardiovascular surgery. To our knowledge, no previous reports have evaluated such complications using ultrasound. Ultrasound may be useful for the early diagnosis of these complications, and in the selection of subsequent examinations such as computed tomography, resulting in the early initiation of intervention.

Sign in / Sign up

Export Citation Format

Share Document