An Evidence-Based Review on Guided Imagery Utilization in Adult Cardiac Surgery

2010 ◽  
Vol 3 (1) ◽  
pp. 22-30 ◽  
Author(s):  
Jesus Casida ◽  
Suzanne A. Lemanski
Keyword(s):  
Cardiac Surgery ◽  
Psychological Health ◽  
Guided Imagery ◽  
Well Being ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Research Quality ◽  
Therapeutic Modality ◽  
Level Of Evidence ◽  
Adult Cardiac Surgery

This article illustrates a comprehensive review, synthesis, and critical appraisal of the research evidence surrounding guided imagery utilization in cardiac surgery. By adding guided imagery in the “usual care” of adult cardiac surgery patients, pre- and postoperative anxiety and pain, as well as hospital length of stay may be reduced. However, in spite of fairly strong “level” of evidence, the limited number of studies and low research quality deter the full acceptance of guided imagery as a standard therapeutic modality in this population. Acute and critical care nurses can offer guided imagery to their patients based on the documented safety of its use and clinically significant findings that it may have a direct impact on patients’ recovery outcomes. Higher quality, methodologically rigorous, and larger-scale studies are warranted to establish the efficacy and standard utilization of guided imagery during perioperative and rehabilitative periods. Future studies should also address long-term outcomes, specifically on physical and psychological health, well-being, and overall quality of life after cardiac surgery.

scholarly journals Cerebral oximetry in adult cardiac surgery to reduce the incidence of neurological impairment and hospital length-of-stay: A prospective, randomized, controlled trial

2020 ◽  
pp. 175114372097728
Author(s):  
Sean R Bennett ◽  
Neil Smith ◽  
Miriam R Bennett
Keyword(s):  
Cardiac Surgery ◽  
Intensive Care ◽  
Length Of Stay ◽  
Neurological Impairment ◽  
Hospital Length ◽  
Cerebral Oximetry ◽  
Neurological Dysfunction ◽  
Hospital Length Of Stay ◽  
Major Organ ◽  
Adult Cardiac Surgery

Background Cerebral oximetry using near-infrared spectroscopy (NIRS) has been shown to reduce neurological dysfunction and hospital length-of-stay after adult cardiac surgery in some but not all studies. We audited maintaining cerebral saturations at or above baseline and showed improved neurological and length-of-stay outcomes. Our hypothesis for this study was that our NIRS protocol would improve neurological and length-of-stay outcomes. Methods This prospective, single centre, double-blinded controlled study randomized 182 consecutive patients, scheduled for cardiac surgery using cardiopulmonary bypass. Participants were randomized by concealed envelope prior to anaesthesia. NIRS study group were managed perioperatively using our NIRS protocol of 8 interventions, increase cardiac output, normocapnia, increase mean arterial pressure, increase inspired oxygen, depth of anaesthesia, blood transfusion, correction of bypass cannula, change of surgical plan to restore levels equal to or above baseline. The control group had standard management without NIRS. Primary outcomes were neurological impairment (early and late) and hospital length-of-stay. Secondary outcomes were ventilation times, intensive care length-of-stay, major organ dysfunction and mortality. Results 91 patients entered each group. There was a significant improvement in self-reported six-month general functionality in the NIRS group ( p = 0.016). Early neurological dysfunction and hospital length-of-stay was the same in both groups. Of the secondary outcomes only Intensive Care length-of-stay was statistically significant, being shorter in the NIRS group ( p = 0.026). Conclusion Maintaining cerebral saturations above baseline reduces time spent in Intensive Care and may improve long term functional recovery but not stroke, major organ dysfunction and mortality.

Introspection into Institutional Database Allows for Focused Quality Improvement Plan in Cardiac Surgery: Example for a New Global Healthcare System

2013 ◽  
Vol 79 (10) ◽  
pp. 1040-1044 ◽  
Author(s):  
Elizabeth Lancaster ◽  
Mackenzie Postel ◽  
Nancy Satou ◽  
Richard Shemin ◽  
Peyman Benharash
Keyword(s):  
Risk Factors ◽  
Cardiac Surgery ◽  
Hospital Length ◽  
Social Needs ◽  
Hospital Length Of Stay ◽  
Chronic Obstructive ◽  
Readmission Rates ◽  
Specific Patient ◽  
Increased Risk ◽  
Adult Cardiac Surgery

Reducing readmission rates is vital to improving quality of care and reducing healthcare costs. In accordance with the Patient Protection and Affordable Care Act, Medicare will cut payments to hospitals with high 30-day readmission rates. We retrospectively reviewed an institutional database to identify risk factors predisposing adult cardiac surgery patients to rehospitalization within 30 days of discharge. Of 2302 adult cardiac surgery patients within the study period from 2008 to 2011, a total of 218 patients (9.5%) were readmitted within 30 days. Factors found to be significant predictors of readmission were nonwhite race ( P = 0.003), government health insurance ( P = 0.02), ejection fraction less than 40 per cent ( P = 0.001), chronic lung disease ( P < 0.001), and hospital length of stay greater than 7 days ( P = 0.02). Patients undergoing aortic and mitral valve operations had an increased risk of readmission compared with other cardiac operations ( P < 0.001). The most common reasons for rehospitalization were pneumonia and other respiratory complications (n = 27 [12.4%]). Recognition of risk factors is crucial to reducing readmissions and improving patient care. Our data suggest that optimizing cardiopulmonary status in patients with comorbidities such as heart failure and chronic obstructive pulmonary disease, increasing directed pneumonia prophylaxis, patient education tailored to specific patient social needs, earlier patient follow-up, and better communication between inpatient and outpatient physicians may reduce readmission rates.

scholarly journals Trauma resource pit stop: increasing efficiency in the evaluation of lower severity trauma patients

2021 ◽  
Vol 6 (1) ◽  
pp. e000670
Author(s):  
Imad S Dandan ◽  
Gail T Tominaga ◽  
Frank Z Zhao ◽  
Kathryn B Schaffer ◽  
Fady S Nasrallah ◽  
...  
Keyword(s):  
Injury Severity ◽  
Diagnostic Testing ◽  
Trauma Team ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Trauma Patients ◽  
Level Of Evidence ◽  
Evaluation Time ◽  
Retrospective Comparison ◽  
Trauma Bay

BackgroundOvertriage of trauma patients is unavoidable and requires effective use of hospital resources. A ‘pit stop’ (PS) was added to our lowest tier trauma resource (TR) triage protocol where the patient stops in the trauma bay for immediate evaluation by the emergency department (ED) physician and trauma nursing. We hypothesized this would allow for faster diagnostic testing and disposition while decreasing cost.MethodsWe performed a before/after retrospective comparison after PS implementation. Patients not meeting trauma activation (TA) criteria but requiring trauma center evaluation were assigned as a TR for an expedited PS evaluation. A board-certified ED physician and trauma/ED nurse performed an immediate assessment in the trauma bay followed by performance of diagnostic studies. Trauma surgeons were readily available in case of upgrade to TA. We compared patient demographics, Injury Severity Score, time to physician evaluation, time to CT scan, hospital length of stay, and in-hospital mortality. Comparisons were made using 95% CI for variance and SD and unpaired t-tests for two-tailed p values, with statistical difference, p<0.05.ResultsThere were 994 TAs and 474 TRs in the first 9 months after implementation. TR’s preanalysis versus postanalysis of the TR group shows similar mean door to physician evaluation times (6.9 vs. 8.6 minutes, p=0.1084). Mean door to CT time significantly decreased (67.7 vs. 50 minutes, p<0.001). 346 (73%) TR patients were discharged from ED; 2 (0.4%) were upgraded on arrival. When admitted, TR patients were older (61.4 vs. 47.2 years, p<0.0001) and more often involved in a same-level fall (59.5% vs. 20.1%, p<0.0001). Undertriage was calculated using the Cribari matrix at 3.2%.DiscussionPS implementation allowed for faster door to CT time for trauma patients not meeting activation criteria without mobilizing trauma team resources. This approach is safe, feasible, and simultaneously decreases hospital cost while improving allocation of trauma team resources.Level of evidenceLevel II, economic/decision therapeutic/care management study.

scholarly journals Older trauma patients are at high risk of delirium, especially those with underlying dementia or baseline frailty

2021 ◽  
Vol 6 (1) ◽  
pp. e000639
Author(s):  
Danielle Ní Chróinín ◽  
Nevenka Francis ◽  
Pearl Wong ◽  
Yewon David Kim ◽  
Susan Nham ◽  
...  
Keyword(s):  
Older Patients ◽  
Multivariable Analysis ◽  
Primary Outcome Measure ◽  
Hospital Length ◽  
Assessment Tools ◽  
Hospital Length Of Stay ◽  
Trauma Patients ◽  
Level Of Evidence ◽  
Increased Risk ◽  
History Of

BackgroundGiven the increasing numbers of older patients presenting with trauma, and the potential influence of delirium on outcomes, we sought to investigate the proportion of such patients who were diagnosed with delirium during their stay—and patient factors associated therewith—and the potential associations between delirium and hospital length of stay (LOS). We hypothesized that delirium would be common, associated with certain patient characteristics, and associated with long hospital LOS (highest quartile).MethodsWe conducted a retrospective observational cohort study of all trauma patients aged ≥65 years presenting in September to October 2019, interrogating medical records and the institutional trauma database. The primary outcome measure was occurrence of delirium.ResultsAmong 99 eligible patients, delirium was common, documented in 23% (23 of 99). On multivariable analysis, adjusting for age, frailty and history of dementia, frailty (OR 4.09, 95% CI 1.08 to 15.53, p=0.04) and dementia (OR 5.23, 95% CI 1.38 to 19.90, p=0.02) were independently associated with likelihood of delirium. Standardized assessment tools were underused, with only 34% (34 of 99) screened within 4 hours of arrival. On univariate logistic regression analysis, having an episode of delirium was associated with long LOS (highest quartile), OR of 5.29 (95% CI 1.92 to 14.56, p<0.001). In the final multivariable model, adjusting for any (non-delirium) in-hospital complication, delirium was independently associated with long LOS (≥16 days; OR 4.81, p=0.005).DiscussionIn this study, delirium was common. History of dementia and baseline frailty were associated with increased risk. Delirium was independently associated with long LOS. However, many patients did not undergo standardized screening at admission. Early identification and targeted management of older patients at risk of delirium may reduce incidence and improve care of this vulnerable cohort. These data are hypothesis generating, but support the need for initiatives which improve delirium care, acknowledging the complex interplay between frailty and other geriatric syndromes in the older trauma patients.Level of evidenceIII.

Gross motor development is delayed following early cardiac surgery

2012 ◽  
Vol 22 (5) ◽  
pp. 574-582 ◽  
Author(s):  
Suzanne H. Long ◽  
Susan R. Harris ◽  
Beverley J. Eldridge ◽  
Mary P. Galea
Keyword(s):  
Cardiac Surgery ◽  
Motor Development ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Gross Motor ◽  
Gross Motor Development ◽  
Surgical Critical Care ◽  
Motor Outcome ◽  
First Year Of Life ◽  
Study Participants

AbstractObjectiveTo describe the gross motor development of infants who had undergone cardiac surgery in the neonatal or early infant period.MethodsGross motor performance was assessed when infants were 4, 8, 12, and 16 months of age with the Alberta Infant Motor Scale. This scale is a discriminative gross motor outcome measure that may be used to assess infants from birth to independent walking. Infants were videotaped during the assessment and were later evaluated by a senior paediatric physiotherapist who was blinded to each infant's medical history, including previous clinical assessments. Demographic, diagnostic, surgical, critical care, and medical variables were considered with respect to gross motor outcomes.ResultsA total of 50 infants who underwent elective or emergency cardiac surgery at less than or up to 8 weeks of age, between July 2006 and January 2008, were recruited to this study and were assessed at 4 months of age. Approximately, 92%, 84%, and 94% of study participants returned for assessment at 8, 12, and 16 months of age, respectively. Study participants had delayed gross motor development across all study time points; 62% of study participants did not have typical gross motor development during the first year of life. Hospital length of stay was associated with gross motor outcome across infancy.ConclusionActive gross motor surveillance of all infants undergoing early cardiac surgery is recommended. Further studies of larger congenital heart disease samples are required, as are longitudinal studies that determine the significance of these findings at school age and beyond.

scholarly journals Music intervention to relieve anxiety and pain in adults undergoing cardiac surgery: a systematic review and meta-analysis

Open Heart ◽  
2021 ◽  
Vol 8 (1) ◽  
pp. e001474
Author(s):  
Ellaha Kakar ◽  
Ryan J Billar ◽  
Joost van Rosmalen ◽  
Markus Klimek ◽  
Johanna J M Takkenberg ◽  
...  
Keyword(s):  
Systematic Review ◽  
Cardiac Surgery ◽  
Rating Scale ◽  
Meta Analysis ◽  
Numeric Rating Scale ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Music Intervention ◽  
Opioid Use ◽  
Beneficial Effects

ObjectivesPrevious studies have reported beneficial effects of perioperative music on patients’ anxiety and pain. We performed a systematic review and meta-analysis of randomised controlled trials investigating music interventions in cardiac surgery.MethodsFive electronic databases were systematically searched. Primary outcomes were patients’ postoperative anxiety and pain. Secondary outcomes were hospital length of stay, opioid use, vital parameters and time on mechanical ventilation. PRISMA guidelines were followed and PROSPERO database registration was completed (CRD42020149733). A meta-analysis was performed using random effects models and pooled standardised mean differences (SMD) with 95% confidence intervals were calculated.ResultsTwenty studies were included for qualitative analysis (1169 patients) and 16 (987 patients) for meta-analysis. The first postoperative music session was associated with significantly reduced postoperative anxiety (SMD = –0.50 (95% CI –0.67 to –0.32), p<0.01) and pain (SMD = –0.51 (95% CI –0.84 to –0.19), p<0.01). This is equal to a reduction of 4.00 points (95% CI 2.56 to 5.36) and 1.05 points (95% CI 0.67 to 1.41) on the State-Trait Anxiety Inventory and Visual Analogue Scale (VAS)/Numeric Rating Scale (NRS), respectively, for anxiety, and 1.26 points (95% CI 0.47 to 2.07) on the VAS/NRS for pain. Multiple days of music intervention reduced anxiety until 8 days postoperatively (SMD = –0.39 (95% CI –0.64 to –0.15), p<0.01).ConclusionsOffering recorded music is associated with a significant reduction in postoperative anxiety and pain in cardiac surgery. Unlike pharmacological interventions, music is without side effects so is promising in this population.

scholarly journals Intravenous iron therapy for patients with preoperative iron deficiency or anaemia undergoing cardiac surgery reduces blood transfusions: a systematic review and meta-analysis

2020 ◽  
Vol 31 (2) ◽  
pp. 141-151
Author(s):  
Saurabh Gupta ◽  
Puru Panchal ◽  
Kevin Gilotra ◽  
Ann Mary Wilfred ◽  
Winston Hou ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Relative Risk ◽  
Iron Deficiency ◽  
Observational Studies ◽  
Meta Analysis ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Pooled Data ◽  
Iv Iron ◽  
Preoperative Anaemia

Abstract OBJECTIVES The benefits of preoperative intravenous (IV) iron treatment in cardiac surgery patients with preoperative anaemia or iron deficiency have not been well-established. We performed a systematic review and meta-analysis to determine the effects of treating preoperative anaemia or iron deficiency with IV iron in adult cardiac surgery patients. METHODS We searched Cochrane Central Register of Controlled Trials, Medical Literature Analysis and Retrieval Systems Online and Excerpta Medica Database for randomized controlled trials (RCTs) and observational studies comparing IV iron to oral iron or no iron. We performed title and abstract, full-text screening, data extraction and risk of bias assessment independently and in duplicate. We pooled data using a random effects model and evaluated the overall quality of evidence. RESULTS We identified 4 RCTs and 7 observational studies. Pooled data from observational studies suggested a benefit of IV iron compared to no iron on mortality [relative risk 0.39, 95% confidence interval (CI) 0.23–0.65; P &lt; 0.001, very low quality], units transfused per patient (mean difference −1.22, 95% CI −1.85 to −0.60; P &lt; 0.001, very low quality), renal injury (relative risk 0.50, 95% CI 0.36–0.69; P &lt; 0.001, very low quality) and hospital length of stay (mean difference −4.24 days, 95% CI −6.86 to −1.63; P = 0.001, very low quality). Pooled data from RCTs demonstrated a reduction in the number of patients transfused with IV iron compared to oral or no iron (relative risk 0.81, 95% CI 0.70–0.94; P = 0.005, moderate quality). The pooled estimates of effect from RCTs for mortality, hospital length of stay, units transfused per patient and renal injury were consistent in direction with observational studies. CONCLUSIONS This meta-analysis suggests that IV iron improves postoperative morbidity in adult cardiac surgery patients with preoperative anaemia or iron deficiency. A large, rigorous, placebo-controlled, double-blinded, multicentre trial is needed to clarify the role of IV iron in this patient population. Clinical trial registration International prospective register of systematic reviews ID Number CRD42019122844

scholarly journals Matched pilot study examining cannabis-based dronabinol for acute pain following traumatic injury

2020 ◽  
Vol 5 (1) ◽  
pp. e000391 ◽  
Author(s):  
Elisabeth Schneider-Smith ◽  
Kristin Salottolo ◽  
Claire Swartwood ◽  
Casey Melvin ◽  
Robert M Madayag ◽  
...  
Keyword(s):  
Acute Pain ◽  
Primary Outcome ◽  
Traumatic Injury ◽  
Hospital Length ◽  
Opioid Consumption ◽  
Hospital Length Of Stay ◽  
Level Of Evidence ◽  
Off Label ◽  
Admission Data ◽  
Sparing Effect

BackgroundTo determine whether adjunctive dronabinol, a licensed form of delta-9-tetrahydrocannabinol, reduces opioid consumption when used off-label for managing acute pain following traumatic injury.MethodsThis matched cohort study included patients who were admitted with a traumatic injury between 1 March 2017 and 30 October 2017. The hospital pharmacy database was used to identify patients who received dronabinol (cases), and they were matched 1:1 to patients who did not receive dronabinol (controls) using age, cause of injury and hospital length of stay. The primary outcome, change in opioid consumption, was calculated using morphine milligram equivalents (MME). The change in MME was calculated for cases as total MME over 48 hours with adjunctive dronabinol minus 48 hours prior to dronabinol, and for controls as total MME 48–96 hours from admission minus 0–48 hours from admission. Data are presented as mean and SE or median and IQR. Statistical analysis was performed using paired t-tests and McNemar’s tests.ResultsThere were 66 patients included: 33 cases and 33 matched controls. Dronabinol was initiated 55 (28–107) hours from admission. Cases and controls were well matched. Cases had a significant reduction in opioid consumption with adjunctive dronabinol (−79 (20) MME, p<0.001), while opioid consumption was unchanged for controls (−9 (20) MME, p=0.63). This resulted in a ninefold greater reduction in opioid consumption for cases versus controls that was statistically different between pairs (p=0.02). Nineteen (58%) cases reported using marijuana; in this subset, opioid consumption was reduced with adjunctive dronabinol (−97 (24) MME, p<0.001) versus a non-significant increase in opioid consumption in matched controls (11 (29) MME, p=0.70); difference between groups, p=0.01.ConclusionsThe results of this study suggest adjunctive dronabinol reduces opioid consumption following traumatic injury. The opioid-sparing effect of dronabinol may be greater in patients who are marijuana users.Level of evidenceIII.

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