scholarly journals Efficacy of Intraoperative Hemodynamic Optimization Using FloTrac/EV1000 Platform for Early Goal-directed Therapy to Improve Postoperative Outcomes in Patients Undergoing Coronary Artery Bypass Graft with Cardiopulmonary Bypass: A Randomized Controlled Trial

2021 ◽  
Author(s):  
Sirirat Tribuddharat ◽  
Thepakorn Sathitkarnmanee ◽  
Kriangsak Ngamsangsirisup ◽  
Krisana Nongnuang
Keyword(s):  
Standard Care ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Mean Difference ◽  
Control Group ◽  
Artery Bypass Graft ◽  
Vasoactive Drugs ◽  
Goal Directed Therapy ◽  
Early Goal Directed Therapy ◽  
Hemodynamic Optimization

Abstract Background: Early goal-directed therapy (EGDT) using the FloTrac system reportedly decreased mortality, morbidity, and length of stay (LOS) in intensive care unit (ICU) and hospital among high-risk patients undergoing non-cardiac surgery. The objective of this study was to evaluate the efficacy of the FloTrac/EV1000 platform for improving postoperative outcomes in cardiac surgery. Methods: Eighty-six adults undergoing coronary artery bypass graft (CABG) with cardiopulmonary bypass (CPB) were randomized to the EV1000 or Control group. The Control group was managed with standard care to achieve the following goals: mean arterial pressure 65-90 mmHg; central venous pressure 8-12 mmHg; urine output ≥ 0.5 mL/kg/h; oxygen saturation > 95%; and hematocrit 26-30%. The EV1000 group was managed to reach similar goals using information from the FloTrac/EV1000 monitor. The targets were: stroke volume variation (SVV) < 13%; cardiac index (CI) 2.2-4.0 L/min/m2; stroke volume index (SVI) 33‑65 mL/beat/m2; and systemic vascular resistance index (SVRI) 1600‑2500 dynes/s/cm5/m2. Results: The LOS in ICU of the EV1000 group was significantly shorter (mean difference -29.5 h; 95%CI -17.2 to -41.8, p < 0.001). The mechanical ventilation time was also shorter in the EV1000 group (mean difference -11.3 h; 95%CI -2.7 to -19.9, p = 0.011). The hospital LOS was shorter in the EV1000 group (mean difference -1.1 d; 95%CI -0.1 to -2.1, p =0.038). The EV1000 group received a higher number of inotropic or vasoactive drugs than the Control group in pre-bypass period, but less in post-bypass, postoperative period before transfer to the ICU, and in the ICU. The EV1000 group had less atrial fibrillation with rapid ventricular response, acute respiratory distress syndrome, and acute renal injury.Conclusions: Compared with standard care, intraoperative hemodynamic optimization using the FloTrac/EV1000 platform for the EGDT protocol in patients undergoing CABG with CPB resulted in shorter ventilator time, shorter ICU and hospital LOS, and fewer postoperative complications. The EV1000 group required more fluid and inotropic or vasoactive drugs in the pre-bypass period to optimize SVV, CI, and SVRI and to maintain the target MAP resulting in better myocardium oxygen supply reflected in fewer drugs required during post-bypass, before transfer to, and in, the ICU.Trial registrationThe study was registered with ClinicalTrials.gov (NCT04292951) on 03/03/2020.

Acute and Chronic Changes in Platelet Volume and Count After Cardiopulmonary Bypass Induced Thrombocytopenia in Man

1987 ◽  
Vol 57 (01) ◽  
pp. 55-58 ◽  
Author(s):  
J F Martin ◽  
T D Daniel ◽  
E A Trowbridge
Keyword(s):  
Platelet Count ◽  
Mean Platelet Volume ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Control Group ◽  
Artery Bypass Graft ◽  
Platelet Volume ◽  
Young Males ◽  
The Mean

SummaryPatients undergoing surgery for coronary artery bypass graft or heart valve replacement had their platelet count and mean volume measured pre-operatively, immediately post-operatively and serially for up to 48 days after the surgical procedure. The mean pre-operative platelet count of 1.95 ± 0.11 × 1011/1 (n = 26) fell significantly to 1.35 ± 0.09 × 1011/1 immediately post-operatively (p <0.001) (n = 22), without a significant alteration in the mean platelet volume. The average platelet count rose to a maximum of 5.07 ± 0.66 × 1011/1 between days 14 and 17 after surgery while the average mean platelet volume fell from preparative and post-operative values of 7.25 ± 0.14 and 7.20 ± 0.14 fl respectively to a minimum of 6.16 ± 0.16 fl by day 20. Seven patients were followed for 32 days or longer after the operation. By this time they had achieved steady state thrombopoiesis and their average platelet count was 2.44 ± 0.33 × 1011/1, significantly higher than the pre-operative value (p <0.05), while their average mean platelet volume was 6.63 ± 0.21 fl, significantly lower than before surgery (p <0.001). The pre-operative values for the platelet volume and counts of these patients were significantly different from a control group of 32 young males, while the chronic post-operative values were not. These long term changes in platelet volume and count may reflect changes in the thrombopoietic control system secondary to the corrective surgery.

Capnography and Pulse Oximetry Improve Fast Track Extubation in Patients Undergoing Coronary Artery Bypass Graft Surgery: A Randomized Clinical Trial

2021 ◽  
Author(s):  
Seyed Tayeb Moradian ◽  
Fatemah Beitollahi ◽  
Mohammad Saeid Ghiasi ◽  
Amir vahedian-azimi
Keyword(s):  
Clinical Trial ◽  
Pulse Oximetry ◽  
Fast Track ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Intervention Group ◽  
Control Group ◽  
Artery Bypass Graft ◽  
Cabg Surgery ◽  
Non Invasive

Abstract Background Use of capnography as a non-invasive method during the weaning process for fast track extubation (FTE) is controversial. We conducted the present study to determine whether pulse oximetry and capnography could be utilized as alternatives to arterial blood gas (ABG) measurements in patients under mechanical ventilation (MV) following coronary artery bypass graft (CABG) surgery. Methods In this randomized clinical trial, 70 patients, who were candidates for CABG surgery, were randomly assigned into two equal groups (n = 35); the intervention group and the control group. In the intervention group, the ventilator management and weaning from MV was done using Etco2 from capnography and SpO2 from pulse oximetry. Meanwhile, in the control group, weaning was done based on ABG analysis. The length of intensive care unit (ICU) stay, time to extubation, number of manual ventilator setting changes, and alarms were compared between the groups. Results The end-tidal carbon dioxide (ETCO2) levels in the intervention group were completely similar to the partial pressure of carbon dioxide (PaCo2) in the control group (39.5 ± 3.1 vs. 39.4 ± 4.32, P > 0.05). The mean extubation times were significantly shorter in the intervention group compared to those in the control patients (212.2 ± 80.6 vs. 342.7 ± 110.7, P < 0.001). Moreover, the number of changes in the manual ventilator setting and the number of alarms were lower in the intervention group (P < 0.05). However, the differences in the length of stay in ICU between the two groups were not significant (P = 0.219). Conclusion According to our results, the use of non-invasive monitors, including capnography and pulse oximetry, is emphasized in order to utilize FTE after CABG surgery. Furthermore, it is a safe and valuable monitor that could be a good alternative for ABG in this population. Nevertheless, further studies with larger sample sizes and on different disease states and populations are required to assess the accuracy of our findings. Trial registration: IRCT, IRCT201701016778N6, Registered 3 March 2017, https://www.irct.ir/trial/7192

Increased Risk of Sternal Complications in Patients with Plasma Cell Dyscrasias (PCDs) Undergoing Coronary Artery Bypass Graft (CABG)

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 5319-5319
Author(s):  
Malini M Patel ◽  
Shams B Bufalino ◽  
Anai N Kothari ◽  
Paul C Kuo ◽  
Sucha Nand
Keyword(s):  
Renal Failure ◽  
Coronary Artery ◽  
Coronary Artery Bypass Graft ◽  
Coronary Artery Bypass ◽  
Odds Ratio ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Control Group ◽  
Artery Bypass Graft ◽  
Increased Risk

Abstract Introduction: Skeletal events, including fractures, form an important part of the clinical spectrum of PCDs. Skeletal surveys, even though less sensitive than MRI, remain the usual method of screening for lytic lesions and fractures in these patients but may miss subtle abnormalities. Patients undergoing a CABG normally require a midline sternal incision, which may increase the risk of a skeletal event. Patients with PCDs also have an increased risk of infection, thrombosis, and renal failure. To our knowledge, there is no published data about complications of cardiothoracic surgery in these patients. We hypothesized that patients with PCDs will have a higher risk of complications when compared to those without such history. Methods: Data on patients who underwent non-urgent coronary artery bypass graft (CABG) surgery from 2007 to 2011 was obtained by querying the Healthcare Cost and Utilization State Inpatient Databases for Florida and California. Information was available only for the inpatient stay plus a 30-day follow-up period. Diagnoses of multiple myeloma and monoclonal gammopathy of unknown significance (MGUS) were identified using ICD-9-CM codes. Mixed-effects logistic models were used to measure the association between PCDs and postoperative sternal complications controlling for demographics and comorbidity. Secondary outcomes of study in bivariate analysis included postoperative complications and 30-day readmission rates. Results: A total of 54,422 patients who underwent non-urgent CABG were identified. Of those patients, 500 were known to have a PCD. Ninety two percent of those patients (462 out of 500) had a diagnosis of MGUS. Median age was 66.6 years for the control group and 65.4 years in the PCDs group, and the male to female ratio was equal in both cohorts. In the PCD group, there was a statistically significant higher incidence of anemia, obesity, and renal failure prior to surgical intervention. Sternal infections occurred in 519 (1%) of the patients in the control group versus 18 (3.6%) of the patients in PCDs group (p<0.001). The 30-day all cause readmission rate was similar between the two groups but the 30-day sternal complication rate was significantly higher in the PCDs group (6.8% vs 3.7%; p<0.001). The odds ratio of sternal infection was 3.84 (CI 2.38-6.20) and the odds ratio of sternal dehiscence was 3.87 (CI 1.98-7.57) in the PCDs group when compared to the control group, both of which are statistically significant. Similarly, the odds ratio of sternal complications at 30-days was 1.92 (CI 1.35-2.73) in the PCDs group when compared to the control group. There were no statistically significant differences in the rates of postoperative myocardial infarctions, strokes, urinary tract infections, acute kidney injury, pneumonias, deep venous thrombosis, and gastrointestinal complications between the two cohorts. Conclusions: Our data shows that patients with PCDs have a lower hemoglobin level, renal insufficiency, and are obese at the time of coronary bypass surgery. It is important to note that the majority of the subjects in our study population had MGUS, a condition usually associated with little morbidity. Nonetheless, our cohort of patients with PCDs had a significantly increased risk of sternal wound infection and dehiscence. The treating physicians should be aware of these risks and patients should be informed. Prospective studies will be necessary to confirm and extend these findings. Disclosures No relevant conflicts of interest to declare.

Haemolysis during cardiopulmonary bypass: how to reduce the free haemoglobin by managing the suctioned blood separately

Perfusion ◽  
2001 ◽  
Vol 16 (6) ◽  
pp. 519-524 ◽  
Author(s):  
A Pierangeli ◽  
V Masieri ◽  
F Bruzzi ◽  
E De Toni ◽  
G Grillone ◽  
...  
Keyword(s):  
Cardiopulmonary Bypass ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Control Group ◽  
Study Group ◽  
Artery Bypass Graft ◽  
Operative Field ◽  
Free Plasma Haemoglobin ◽  
Free Plasma

During cardiopulmonary bypass (CPB) the collection of the patient’s blood from the operating area is of fundamental importance. This blood is collected in the cardiotomy reservoir using field suckers and can be managed in different ways. It can be filtered in the cardiotomy reservoir and redirected to the venous reservoir, then oxygenated and returned to the patient, or it can be managed separately: collected in the cardiotomy reservoir, treated at the end of the operation and only after this, returned to the patient. The aim of this study is to determine in vivo the effect of a separate management of the suction blood from the operative field, using the Avant D903 oxygenator (Dideco, Mirandola, Italy). Twenty-one patients undergoing coronary artery bypass graft surgery with CPB were selected and put into two groups at random. In the control group ( n 10) the suction blood in the cardiotomy reservoir was filtered and immediately redirected into the venous reservoir, oxygenated and returned to the patient. In the study group ( n 11) the suctioned blood was collected in the D903 Avant’s (Dideco) cardiotomy reservoir and returned to the patient only after having been washed at the end of the operation, using a Compact Advanced (Dideco), as required. Clinical data demonstrated that while in the study group it was possible to keep the free plasma haemoglobin (FPH) concentrations the same as at the beginning, in the control group there was a significant increase in FPH from 5.0 3.5 mg/dl (baseline) to 37 16.7 mg/dl (120 min after CPB).

Intravenous glycoprotein IIbIIIa inhibitor bridging for urgent coronary artery bypass graft after acute coronary syndrome

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M.R.C Ferreira ◽  
L.M Baracioli ◽  
T Dalcoquio ◽  
C.A.K Nakashima ◽  
C.D Soffiatti ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass Graft ◽  
Red Blood Cells ◽  
Coronary Artery Bypass ◽  
Blood Cells ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Control Group ◽  
Artery Bypass Graft ◽  
Coronary Syndrome

Abstract Background Previous studies have shown the safety of intravenous glycoprotein (GP) IIbIIIa inhibitors used as a bridging after ADP receptor blocker withdrawal in patients with stable coronary artery disease and previous percutaneous coronary interventions (PCI) undergoing cardiac or non-cardiac surgeries. However, there are few data analyzing GP IIbIIIa inhibitor bridging among patients with acute coronary syndromes (ACS) scheduled for coronary artery bypass graft (CABG) during the same hospitalization. Purpose To evaluate the safety of tirofiban bridging after clopidogrel withdraw in post-ACS patients schedule for CABG during the same hospitalization. Methods Fifty-six patients who underwent CABG after tirofiban bridging post-ACS (bridge group - BG) were compared to 56 sex and age-matched controls also submitted to same-hospitalization CABG post-ACS without bridging (control group - CG). All patients received aspirin plus clopidogrel for ACS; clopidogrel was withdrawn 5 to 7 days before CABG and aspirin was maintained during the whole perioperative period. The primary endpoint was chest tube output in the first 24h after CABG (CTO24h). We hypothesized that BG would be non-inferior to CG, with a non-inferiority margin of 25% in excess of CTO24h in the BG compared to the CG, based on prior literature data. Other exploratory analyses were: blood transfusions, number of red blood cells/patient and re-thoracotomy 24h after surgery. A multivariable linear regression model was developed considering CTO24h as dependent variable and adjusted for other eight co-variates, described in the figure. Results From the 112 patients included (75% men; mean age 60.2±9.3 years), in comparison with CG, BG had higher proportion of STEMI (80.0% vs. 28.6%, p&lt;0.01), fibrinolytic utilization (25% vs. 7.1%, p&lt;0.05), PCI in the acute phase (92.9% vs. 0%, p&lt;0.01) and LMCA stenosis (30.4% vs. 7.1% p&lt;0.01). Tirofiban was utilized by clinician discretion due to PCI in the same hospitalization previously to CABG (n=52), previous PCI up to 3 months before index event (n=3) or severe LMCA stenosis (n=1). BG patients received tirofiban for a mean of 4.3±2.1 days and it was withdrawn at a mean of 6.6±4.3 hours before CABG. After adjustments, BG was non-inferior to CG regarding CTO24h (figure) There were no significant differences between BG and CG regarding need for blood transfusion (26.8% vs. 26.8%, p&gt;0.99), mean number of red blood cells/patient (0.3±0.8 vs 0.5±1.2, p=0.35) or re-thoracotomy due to bleeding (5.4% vs 0%, p=0.24). Conclusion Among ACS patients submitted to urgent CABG after clopidogrel withdrawal, tirofiban bridging, compared to no bridging, was not associated with higher risk of bleeding in the first 24 hours after surgery. Our study suggests that tirofiban may be a safe therapy to patients with high risk of thrombotic complication (such as stent thrombosis or re-infarction) after clopidogrel withdraw. Figure 1 Funding Acknowledgement Type of funding source: None

The effects of ocean sounds on sleep after coronary artery bypass graft surgery

1992 ◽  
Vol 1 (1) ◽  
pp. 91-97 ◽  
Author(s):  
JW Williamson
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass Graft ◽  
White Noise ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Control Group ◽  
Artery Bypass Graft ◽  
Falling Asleep ◽  
Cabg Patients

OBJECTIVE: To investigate the influence of ocean sounds (white noise) on the night sleep pattern of postoperative coronary artery bypass graft (CABG) patients after transfer from an intensive care unit. DESIGN: A before and after trial with an experimental and a control group was used in this intervention study. SETTING: A large public hospital with primary, secondary, and tertiary care facilities. PATIENTS: A consecutive sample of 60 first-time CABG patients was systematically assigned to the experimental or the control group. INTERVENTION: For the experimental group, the sounds were played on the Marsona Sound Conditioner (Marpac Corporation, Wilmington, NC) for three consecutive nights posttransfer from the ICU. No control of environment, except for the elimination of white noise, was done for the control group. MAIN OUTCOME MEASURES: The Richards-Campbell Sleep Questionnaire, a visual analog scale, provided self-reported sleep scores on six variables. Analysis of covariance was used to test the difference between the posttest scores of the groups, with the pretest used as the covariate. RESULTS: There were significant differences in sleep depth, awakening, return to sleep, quality of sleep, and total sleep scores; the group receiving ocean sounds reported higher scores, indicating better sleep. There was no difference in the falling asleep scores. CONCLUSION: The use of ocean sounds is a viable intervention to foster optimal sleep patterns in postoperative CABG patients after transfer from the ICU.

scholarly journals Effect of Dexmedetomidine on The Neuroglobin Expression in Elderly Patients With Minimally Invasive Coronary Artery Bypass Graft Surgery

2021 ◽  
Vol 24 (5) ◽  
pp. E776-E780
Author(s):  
Yan Gao ◽  
Huidan Yu ◽  
Wenlong Wang ◽  
Yeming Wang ◽  
Jinliang Teng ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Minimally Invasive ◽  
Elderly Patients ◽  
Coronary Artery Bypass ◽  
Mmse Score ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Expression Level ◽  
Control Group ◽  
Artery Bypass Graft

Background: To study the effect of dexmedetomidine (Dex) on the expression of Neuroglobin (Ngb) and postoperative cognitive function in elderly patients undergoing minimally invasive coronary artery bypass surgery. Methods: Forty patients, who underwent elective minimally invasive off-pump coronary artery bypass grafting in our hospital from January 2018 to December 2019, were randomly divided into the Dex group (N = 20) and control group (N = 20). Venous blood samples were taken to determine the expression level of Ngb in both groups. Mini mental status examination (MMSE) was used to detect the cognitive function of patients. Results: The expression level of Ngb in the Dex group was significantly higher than that in the control group at 6h after one-lung ventilation and postoperative 24h (P < .01). The MMSE score of the Dex group was significantly higher than the control group at postoperative 7 days and postoperative 30 days (P < .01). Although with no statistical significance, the MMSE score of the Dex group was higher than the control group at postoperative 90 days (P > .05). The incidence of postoperative cognitive dysfunction (POCD) in the Dex group was significantly lower than that in the control group at postoperative 7 days and postoperative 30 days (P < .05). Conclusion: Dex used in elderly patients undergoing minimally invasive coronary artery bypass graft surgery can effectively increase the expression level of Ngb and reduce the incidence of POCD.

scholarly journals Precision implementation of early ambulation in elderly patients underwent off-pump coronary artery bypass graft surgery: a randomized controlled clinical trial

2020 ◽  
Author(s):  
Zhaomei Cui ◽  
Na Li ◽  
Yiou Fan ◽  
Xin Zhuang ◽  
Jing Liu ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Control Group ◽  
Controlled Clinical Trial ◽  
Artery Bypass Graft ◽  
Early Ambulation ◽  
Off Pump ◽  
Pump Coronary Artery Bypass ◽  
To Receive

Abstract Background Though early ambulation (EA) is associated with improved outcomes for post-operative patients, precision initiative on EA for elderly patients has rarely been reported. The aim of this study is to determine the safety and effectiveness of precision implementation of EA in elderly patients underwent off-pump coronary artery bypass graft (OPCABG) surgery. Methods We conducted a single-center, randomized and controlled clinical trial involving elderly patients(≥60 years) in who EA support was implemented after OPCABG surgery. Patients were randomly assigned to precision early ambulation (PEA) group or routine ambulation (Control) group. Innovatively referring age-predicted maximal heart rate (APMHR) and VO 2max was the highlight of PEA. The primary end-point was the postoperative length of stay in hospital (PLOS). The secondary end-point included 90-day mortality, laboratory test, length of stay in ICU, the incidence of multiple organ complications as well as post-traumatic stress disorder (PTSD). Results There were 178 patients were enrolled, with 89 patients assigned to receive PEA and 89 to receive control procedure. By intent-to-treat analysis, during PEA program, participants performed a much longer distance of ambulation on the third day ( P =0.000). Mild-to-moderate physical activity in PEA group ameliorates PLOS ( P =0.031), Time of first bowel ( P =0.000) and partial pressure O 2 ( P g =0.001). Additionally, patients in PEA group showed significantly lower incidence of PTSD than those in Control group ( P =0.000). Conclusion APMHR and VO 2max are valuable for target intensity and exercise formula. PEA after OPCAPG surgery is safe and reliable for elderly patients, which not only reduces the hospital stay but also improves patients’ postoperative functional status.

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