Dexmedetomidine in Cardiac Surgery Patients Who Fail Extubation and Present with a Delirium State

2011 ◽  
Vol 14 (2) ◽  
pp. 93 ◽  
Author(s):  
Nihan Yapici ◽  
Turkan Coruh ◽  
Tamer Kehlibar ◽  
Fikri Yapici ◽  
Arif Tarhan ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Prospective Observational Study ◽  
Spontaneous Breathing Trial ◽  
Confusion Assessment Method ◽  
Assessment Method ◽  
Arterial Blood Gas ◽  
Elective Cardiac Surgery ◽  
Arterial Blood ◽  
Gas Measurements ◽  
Group D

Background: We evaluated the use of dexmedetomidine to facilitate the weaning of delirious postoperative patients from mechanical ventilation.Methods: We included 72 consecutive patients who underwent elective cardiac surgery in this prospective observational study. Each patient had failed at least 1 trial of continuous positive airway pressure (CPAP) and had agitation. Patients were assessed with the Richmond Agitation-Sedation Scale (RASS) and the Confusion Assessment Method for the Intensive Care Unit (CAMICU) 12 to 18 hours after their admission to the ICU. Midazolam and fentanyl were then given to all patients according to the sedation protocol. At 36 hours in the ICU, patients who had agitation and an inability to wean were randomly divided into 2 groups: group M, 34 patients who continued to follow the routine sedative protocol; and group D, 38 patients who were given dexmedetomidine. Arterial blood gas measurements, hemodynamic parameters, and time to extubation were recorded. Statistical analysis was performed with GraphPad InStat (version 2.02 for DOS).Results: All patients tested positive in the CAM-ICU assessment, and all had a delirium diagnosis. The 38 patients in group D tolerated a spontaneous breathing trial with CPAP and were extubated after a mean (SD) of 49.619 6.96 hours. The 2 groups had significantly different extubation times (58.389 3.958 hours versus 49.619 6.96 hours). The 2 groups had significantly different RASS scores at 48 and 60 hours and significantly different heart rates and PO2 values at 12 and 24 hours. The 2 groups showed no significant differences with regard to hemodynamic parameters.Conclusions: Dexmedetomidine may help to eliminate the emergence of agitation and can be a good treatment choice for the delirium state after cardiac surgery.

scholarly journals Cholinesterase alterations in delirium after cardiosurgery: a German monocentric prospective study

BMJ Open ◽  
2020 ◽  
Vol 10 (1) ◽  
pp. e031212 ◽  
Author(s):  
Elisabeth Hannah Adam ◽  
Victoria Haas ◽  
Simone Lindau ◽  
Kai Zacharowski ◽  
Bertram Scheller
Keyword(s):  
Cardiac Surgery ◽  
Ache Activity ◽  
Prospective Observational Study ◽  
Normal Activity ◽  
Confusion Assessment Method ◽  
Assessment Method ◽  
Secondary Outcome ◽  
Elective Cardiac Surgery ◽  
European System ◽  
Cardiac Operative Risk Evaluation

ObjectivesPostoperative delirium (POD) is a common complication after elective cardiac surgery. Recent evidence indicates that a disruption in the normal activity of the cholinergic system may be associated with delirium.DesignProspective observational study.SettingSingle-centre at a European academic hospital.Primary and secondary outcome measuresIn our study the enzyme activities of acetylcholinesterase (AChE) and butyrylcholinesterase (BChE) were determined preoperatively as well as on the first and second postoperative day. The confusion assessment method for the intensive care unit was used to screen patients for the presence of POD.ResultsA total of 114 patients were included in the study. POD was associated with a decrease in BChE activity on postoperative day 1 (p=0.03). In addition, patients who developed POD, had significantly lower preoperative AChE activity than patients without POD (p<0.01). Multivariate analysis identified a preoperatively decreased AChE activity (OR 3.1; 95% CI 1.14 to 8.46), anticholinergic treatment (OR 5.09; 95% CI 1.51 to 17.23), elevated European System for Cardiac Operative Risk Evaluation (OR 3.68; 95% CI 1.04 to 12.99) and age (OR 3.02; 95% CI 1.06 to 8.62) to be independently associated with the development of POD.ConclusionsWe conclude that a reduction in the acetylcholine hydrolysing enzyme activity in patients undergoing cardiac surgery may correlate with the development of POD.

Diagnostic Value of Cholinesterase Activity for the Development of Postoperative Delirium after Cardiac Surgery

2020 ◽  
Author(s):  
Shekhar Saha ◽  
Kübra Karaca ◽  
Ahmad Fawad Jebran ◽  
Narges Waezi ◽  
Katharina Ort ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Intensive Care ◽  
Postoperative Delirium ◽  
Carotid Artery Disease ◽  
Circulatory Arrest ◽  
Diagnostic Value ◽  
Confusion Assessment Method ◽  
Assessment Method ◽  
Elective Cardiac Surgery ◽  
Increased Risk

Abstract Background Depression of cholinesterase (CHE) activity has been reported to lead to an amplified neuroinflammatory response, which clinically manifests as postoperative delirium (PD). This observational study investigates the association between CHE activity and the development of PD following elective cardiac surgery. Methods Patients with preexisting neurologic deficits or carotid artery disease as well as patients undergoing reoperations or procedures under circulatory arrest have been excluded from this study. The Mini-Mental State Examination, the Confusion Assessment Method for the Intensive Care Unit, and the Intensive Care Delirium Screening Checklist were performed at regular intervals. CHE activity was estimated pre- and postoperatively until postoperative day (POD) 5 and at discharge. Results A total of 107 patients were included. PD was diagnosed in 34 (31.8%) patients, who have been compared with those without PD. Time on ventilator, length of ICU, and hospital stay were longer in patients with PD (p = 0.001, p < 0.001, and p = 0.004, respectively). MMSE scores were lower in patients with PD (p < 0.001; p = 0.015). CHE activity on POD 1 to 4 as well as at discharge were lower in the delirium group (p = 0.041; p = 0.029; p = 0.015; p = 0.035; p = 0.028, respectively). A perioperative drop of CHE activity of more than 50% and a postoperative CHE activity below 4,800 U/L (on POD 0) were independently associated with an increased risk of development of PD (p = 0.038; p = 0.008, respectively). Conclusion In addition to the established functional tests, routine estimation of CHE activity may serve as an additional diagnostic tool allowing for the timely diagnosis and treatment of PD in cardiac surgery patients.

scholarly journals Postoperative delirium after cardiac surgery of elderly patients as an independent risk factor for prolonged length of stay in intensive care unit and in hospital

2021 ◽  
Author(s):  
Andrea Kirfel ◽  
Jan Menzenbach ◽  
Vera Guttenthaler ◽  
Johanna Feggeler ◽  
Andreas Mayr ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Cardiac Surgery ◽  
Intensive Care ◽  
Length Of Stay ◽  
Elderly Patients ◽  
Postoperative Delirium ◽  
Confusion Assessment Method ◽  
Assessment Method ◽  
Hospital Length Of Stay ◽  
Confusion Assessment

Abstract Background Postoperative delirium (POD) is a relevant and underdiagnosed complication after cardiac surgery that is associated with increased intensive care unit (ICU) and hospital length of stay (LOS). The aim of this subgroup study was to compare the frequency of tested POD versus the coded International Statistical Classification of Diseases and Related Health Problems (ICD) diagnosis of POD and to evaluate the influence of POD on LOS in ICU and hospital. Methods 254 elective cardiac surgery patients (mean age, 70.5 ± 6.4 years) at the University Hospital Bonn between September 2018 and October 2019 were evaluated. The endpoint tested POD was considered positive, if one of the tests Confusion Assessment Method for ICU (CAM-ICU) or Confusion Assessment Method (CAM), 4 'A's Test (4AT) or Delirium Observation Scale (DOS) was positive on one day. Results POD occurred in 127 patients (50.0%). LOS in ICU and hospital were significantly different based on presence (ICU 165.0 ± 362.7 h; Hospital 26.5 ± 26.1 days) or absence (ICU 64.5 ± 79.4 h; Hospital 14.6 ± 6.7 days) of POD (p < 0.001). The multiple linear regression showed POD as an independent predictor for a prolonged LOS in ICU (48%; 95%CI 31–67%) and in hospital (64%; 95%CI 27–110%) (p < 0.001). The frequency of POD in the study participants that was coded with the ICD F05.0 and F05.8 by hospital staff was considerably lower than tests revealed by the study personnel. Conclusion Approximately 50% of elderly patients who underwent cardiac surgery developed POD, which is associated with an increased ICU and hospital LOS. Furthermore, POD is highly underdiagnosed in clinical routine.

scholarly journals Accuracy of two pulse-oximetry measurements for INTELLiVENT-ASV in mechanically ventilated patients: a prospective observational study

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Shinshu Katayama ◽  
Jun Shima ◽  
Ken Tonai ◽  
Kansuke Koyama ◽  
Shin Nunomiya
Keyword(s):  
Oxygen Saturation ◽  
Pulse Oximetry ◽  
Prospective Observational Study ◽  
Arterial Oxygen Saturation ◽  
Arterial Oxygen ◽  
Arterial Blood Gas ◽  
Mechanically Ventilated ◽  
Mechanically Ventilated Patients ◽  
Arterial Blood ◽  
Ventilated Patients

AbstractRecently, maintaining a certain oxygen saturation measured by pulse oximetry (SpO2) range in mechanically ventilated patients was recommended; attaching the INTELLiVENT-ASV to ventilators might be beneficial. We evaluated the SpO2 measurement accuracy of a Nihon Kohden and a Masimo monitor compared to actual arterial oxygen saturation (SaO2). SpO2 was simultaneously measured by a Nihon Kohden and Masimo monitor in patients consecutively admitted to a general intensive care unit and mechanically ventilated. Bland–Altman plots were used to compare measured SpO2 with actual SaO2. One hundred mechanically ventilated patients and 1497 arterial blood gas results were reviewed. Mean SaO2 values, Nihon Kohden SpO2 measurements, and Masimo SpO2 measurements were 95.7%, 96.4%, and 96.9%, respectively. The Nihon Kohden SpO2 measurements were less biased than Masimo measurements; their precision was not significantly different. Nihon Kohden and Masimo SpO2 measurements were not significantly different in the “SaO2 < 94%” group (P = 0.083). In the “94% ≤ SaO2 < 98%” and “SaO2 ≥ 98%” groups, there were significant differences between the Nihon Kohden and Masimo SpO2 measurements (P < 0.0001; P = 0.006; respectively). Therefore, when using automatically controlling oxygenation with INTELLiVENT-ASV in mechanically ventilated patients, the Nihon Kohden SpO2 sensor is preferable.Trial registration UMIN000027671. Registered 7 June 2017.

Arterial blood gas measurements during deep open-water breath-hold dives

2021 ◽  
Author(s):  
Tom Scott ◽  
Hanna van Waart ◽  
Xavier CE Vrijdag ◽  
David Mullins ◽  
Peter Mesley ◽  
...  
Keyword(s):  
Open Water ◽  
Absolute Pressure ◽  
Breath Hold ◽  
Blood Gas ◽  
Mixed Gas ◽  
Constant Weight ◽  
Arterial Blood Gas ◽  
Arterial Blood ◽  
Compression And Expansion ◽  
Gas Measurements

Arterial blood gas (ABG) measurements at both maximum depth and at re-surfacing prior to breathing have not previously been measured during freedives conducted to extreme depth in cold open-water conditions. An elite freediver was instrumented with a left radial arterial cannula connected to two sampling syringes through a low-volume splitting device. He performed two open-water dives to 60 metres depth (197', 7 atmospheres absolute pressure) in the constant weight with fins competition format. ABG samples were drawn at 60 metres (by a mixed-gas scuba diver), and again on re-surfacing before breathing. An immersed surface static apnea, of identical length to the dives and with ABG sampling at identical times, was also performed. Both dives lasted approximately two minutes. PaO2 increased during descent from an indicative baseline of 15.8 kPa (after hyperventilation and glossopharyngeal insufflation) to 42.8 and 33.3 kPa (dives one and two), and decreased precipitously (to 8.2 and 8.6 kPa) during ascent. PaCO2 also increased from a low indicative baseline of 2.8 kPa to 6.3 and 5.1 kPa on dives one and two; an increase not explained by metabolic production of CO2 alone since PaCO2 actually decreased during ascent (to 5.2 and 4.5 kPa). Surface static apnea caused a steady decrease in PaO2 and increase in PaCO2 without the inflections provoked by depth changes. Lung compression and expansion provoke significant changes in both PaO2 and PaCO2 during rapid descent and ascent on a deep freedive. These changes generally support predictive hypotheses and previous findings in less extreme settings.

Arterial blood gases

2007 ◽  
pp. 319-326
Keyword(s):  
Decision Making ◽  
Pulse Oximetry ◽  
Respiratory Rate ◽  
Management Strategy ◽  
Blood Gases ◽  
Capillary Blood ◽  
Blood Gas ◽  
Arterial Blood Gas ◽  
Arterial Blood ◽  
Gas Measurements

Arterial blood gas (ABGs) analysis forms the cornerstone of emergency respiratory investigation. In many situations values obtained dictate management strategy and facilitate decision-making. It is an uncomfortable procedure for the patients and if repeated ABGs are required, consider whether less invasive measures, such as respiratory rate, pulse oximetry or capillary blood gas measurements could be used....

Diaphragmatic Dysfunction After Elective Cardiac Surgery: A Prospective Observational Study

2020 ◽  
Vol 34 (12) ◽  
pp. 3336-3344 ◽  
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

scholarly journals A Prospective Observational Study of the Change in Systemic Ionised Calcium following 4% Citrate Locking of Venous Haemodialysis Catheters in Intensive Care Patients

2018 ◽  
Vol 46 (4) ◽  
pp. 381-385
Author(s):  
S. Shewdin ◽  
Y. C. Bong ◽  
S. Okano ◽  
M. D. Chatfield ◽  
J. Walsham
Keyword(s):  
Intensive Care ◽  
Observational Study ◽  
Prospective Observational Study ◽  
Clinical Signs ◽  
Dialysis Catheter ◽  
Citrate Solution ◽  
Arterial Blood Gas ◽  
Intensive Care Patients ◽  
Arterial Blood ◽  
Ionised Calcium

Traditionally heparin has been the anticoagulant of choice for venous dialysis catheter locking. There is systemic leakage of heparin catheter locking solutions at the time of injection. Alternative agents, such as citrate, are increasingly being used. We are not aware of any data in the critical care literature on the effect of citrate locking of venous dialysis catheters on systemic ionised calcium (iCa2+). To assess the effect of 4% citrate locking of venous dialysis catheters on systemic iCa2+ in intensive care patients we performed a prospective observational study of 50 paired samples in 26 intensive care patients receiving 4% citrate dialysis catheter locking in an adult tertiary intensive care unit between May 2016 and December 2016. Arterial blood gas (ABG) analysis was performed prior to venous dialysis catheter locking and a baseline iCa2+ result obtained. The catheter was locked with 4% citrate solution. A further ABG was sampled between 30 and 120 seconds later and the iCa2+ results were compared. Patients were observed for clinical signs of hypocalcaemia. On average, there was little difference between the pre- and post-catheter locking iCa2+ (median pre-locking iCa2+ 1.19 mmol/l, mean change of +0.004 mmol/l, 95% confidence interval [CI] −0.004 to 0.013, P=0.34). There was no evidence this difference differed by length of catheter (P=0.26) or site of catheter (P=0.85) insertion, but there was some evidence that this differed by receipt of citrate dialysis circuit anticoagulation (P=0.013). Patients who received citrate dialysis circuit anticoagulation had an increase in catheter locking iCa2+ by 0.017 mmol/l (95% CI 0.005 to 0.028). Locking of venous dialysis catheters with 4% citrate solution has no clinically significant effect on systemic iCa2+ in intensive care patients with indwelling venous dialysis catheters.

Ventilation of a rat with a large-animal respirator

1986 ◽  
Vol 61 (3) ◽  
pp. 1192-1194 ◽  
Author(s):  
J. D. Wood ◽  
N. L. Herman ◽  
D. R. Kostreva
Keyword(s):  
Ventilation System ◽  
Blood Gases ◽  
Large Animal ◽  
Arterial Blood Gases ◽  
Sprague Dawley ◽  
Arterial Blood Gas ◽  
Normal Limits ◽  
Arterial Blood ◽  
Gas Measurements ◽  
Catheter Tubing

Rats were effectively ventilated with 100% O2 mixed with room air utilizing a modified tracheostomy tube and a Bird Mark 7 respirator to maintain arterial blood gases within normal limits. A 3-cm segment of rubber pilot tubing was attached to a 15-mm respiratory connector and a 3-cm piece of polyethylene catheter tubing was fitted snugly into the other end. The catheter was inserted and secured into the trachea of 250- to 500-g Sprague-Dawley rats with the adaptor hose of the respirator fitted onto the 15-mm connector following tracheostomy. Manometer and inspiratory flow rate controls of the respirator were set to their minimum operating position. Appropriate rate control adjustments were made when necessary as determined by arterial blood gas measurements. By use of the above ventilation system, adequate arterial blood gases of anesthesized rats can be maintained for greater than 3 h.

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