Oxygenation Targets in Cardiac Surgery Patients - a Before-and-after Study

Introduction: The contribution of fluid temperature to the effect of crystalloid fluid bolus therapy (FBT) in post-cardiac surgery patients is unknown. We evaluated the hemodynamic effects of FBT with fluid warmed to 40°C (warm FBT) versus room-temperature fluid. Methods: In this single centre prospective before-and-after study, we evaluated the effects of 500 ml of warm versus room-temperature compound sodium lactate administered over <30 minutes, in 50 cardiac surgery patients admitted to ICU. We recorded hemodynamics continuous before and for 30 minutes after the first FBT. We defined CI responsiveness (CI-R) as an CI increase >15% of baseline immediately after FBT and effect dissipation if the CI returned to <5% of baseline and MAP responsiveness as >10% increase and dissipation as return to <3 mmHg of baseline. Results: Hypotension (56%) and low CI (40%) typically triggered FBT. Temperature decreased >0.3°C in 13 (52%) patients after room-temperature FBT versus 0 (0%) after warm FBT (p < 0.01). CI and MAP responsiveness was similar (16 [64%] versus 11 [44%], p = 0.15 and 15 [60%] versus 17 [68%], p = 0.77, respectively). Among CI responders, CI increased more with room-temperature FBT (+0.6 [IQR, 0.5–1.1] versus +0.5 [IQR, 0.4–0.6] L/min/m2, p = 0.01). However, dissipation was more common after room-temperature versus warm FBT (9/16 [56%] versus 1/11 [9%], p = 0.02). Conclusion: In postoperative cardiac surgery patients, warm FBT preserved core temperature and induced smaller but more sustained CI increases among responders. Fluid temperature appears to impact both core temperature and the duration of CI response.

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Comparison of Levosimendan and Milrinone for ECLS Weaning in Patients After Cardiac Surgery—A Retrospective Before-and-After Study

Journal of Cardiothoracic and Vascular Anesthesia ◽

10.1053/j.jvca.2018.04.019 ◽

2018 ◽

Vol 32 (5) ◽

pp. 2112-2119 ◽

Cited By ~ 15

Author(s):

Annina Jacky ◽

Alain Rudiger ◽

Bernard Krüger ◽

Markus J. Wilhelm ◽

Sebastian Paal ◽

...

Keyword(s):

Cardiac Surgery ◽

Before And After ◽

Before And After Study

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The Association Between Pulsatile Cardiopulmonary Bypass and Acute Kidney Injury After Cardiac Surgery: A Before-and-After Study

Journal of Cardiothoracic and Vascular Anesthesia ◽

10.1053/j.jvca.2019.05.021 ◽

2020 ◽

Vol 34 (1) ◽

pp. 108-113 ◽

Cited By ~ 2

Author(s):

Tim G. Coulson ◽

Eve McPhilimey ◽

Florian Falter ◽

Yasir Abu-Omar ◽

Andrew A. Klein

Keyword(s):

Acute Kidney Injury ◽

Cardiac Surgery ◽

Cardiopulmonary Bypass ◽

Kidney Injury ◽

Before And After ◽

Before And After Study

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Ultrasound-Guided Continuous Thoracic Erector Spinae Plane Block Within an Enhanced Recovery Program Is Associated with Decreased Opioid Consumption and Improved Patient Postoperative Rehabilitation After Open Cardiac Surgery—A Patient-Matched, Controlled Before-and-After Study

Journal of Cardiothoracic and Vascular Anesthesia ◽

10.1053/j.jvca.2018.11.021 ◽

2019 ◽

Vol 33 (6) ◽

pp. 1659-1667 ◽

Cited By ~ 25

Author(s):

Philippe Macaire ◽

Nga Ho ◽

Tan Nguyen ◽

Binh Nguyen ◽

Viet Vu ◽

...

Keyword(s):

Cardiac Surgery ◽

Enhanced Recovery ◽

Erector Spinae ◽

Ultrasound Guided ◽

Postoperative Rehabilitation ◽

Enhanced Recovery Program ◽

Erector Spinae Plane Block ◽

Before And After ◽

Recovery Program ◽

Before And After Study

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Rapid 500 mL albumin bolus versus rapid 200 mL bolus followed by slower continuous infusion in post-cardiac surgery patients: a pilot before-and-after study

Critical Care and Resuscitation ◽

10.51893/2021.3.oa9 ◽

2021 ◽

Vol 23 (3) ◽

pp. 320-328

Author(s):

Fumitaka Yanase ◽

◽

Thummaporn Naorungroj ◽

Salvatore L Cutuli ◽

Glenn M Eastwood ◽

...

Keyword(s):

Cardiac Surgery ◽

Venous Pressure ◽

Single Centre ◽

Central Venous ◽

Fluid Bolus ◽

Mechanically Ventilated ◽

Before And After ◽

Before And After Study ◽

Trial Setting ◽

Post Cardiac Surgery

OBJECTIVE: To evaluate the haemodynamic effects of rapid fluid bolus therapy (FBT) (500 mL of 4% albumin over several minutes) versus combined FBT (rapid 200 mL FBT followed by a 300 mL infusion over 30 minutes). DESIGN: Single centre, prospective, before-and-after trial. SETTING: A tertiary intensive care unit in Australia. PARTICIPANTS: Fifty mechanically ventilated post-cardiac surgery patients. INTERVENTIONS: Rapid 4% albumin FBT versus combined FBT. MAIN OUTCOME MEASURES: We recorded haemodynamic parameters from before FBT to 30 minutes after FBT. A mean arterial pressure (MAP) response was defined by a MAP increase > 10%, and a cardiac index (CI) response was defined by a CI increase > 15%. RESULTS: Immediately after rapid FBT versus combined FBT, there was a CI response in 13 patients (52%) compared with five patients (20%) respectively (P = 0.038), and a MAP response in 11 patients (44%) in each group. However, from FBT administration to 30 minutes, there was a time and group interaction such that MAP was higher in the rapid FBT group (P = 0.003), as was the case for central venous pressure (P = 0.002) and mean pulmonary artery pressure (P < 0.001). Body temperature fell immediately and was lower with rapid FBT but became warmer than with combined FBT later (P < 0.001). At 30 minutes, a MAP response was seen in ten patients (40%) compared with nine patients (36%) (P < 0.99) and a CI response was present in eight patients (32%) compared with 11 patients (44%) (P = 0.56) in the rapid versus combined FBT groups respectively. CONCLUSION: Rapid FBT was superior to combined FBT in terms of mean MAP levels and immediate CI response. However, the number of MAP responders or CI responders was similar at 30 minutes.

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Only problem gamblers spend less money when loot boxes are removed from a game: A before and after study of Heroes of the Storm

10.31234/osf.io/a3kp2 ◽

2019 ◽

Cited By ~ 1

Author(s):

David Zendle

Keyword(s):

Video Games ◽

Problem Gambling ◽

Video Game ◽

Real World ◽

Complex Pattern ◽

Problem Gamblers ◽

Before And After ◽

Gambling Severity ◽

Reliable Correlation ◽

Before And After Study

Loot boxes are items in video games that may be paid for with real-world money, but which contain randomised contents. There is a reliable correlation between loot box spending and problem gambling severity: The more money gamers spend on loot boxes, the more severe their problem gambling tends to be. However, it is unclear whether this link represents a case in which loot box spending causes problem gambling; a case in which the gambling-like nature of loot boxes cause problem gamblers to spend more money; or whether it simply represents a case in which there is a general dysregulation in in-game spending amongst problem gamblers, nonspecific to loot boxes.The multiplayer video game Heroes of the Storm recently removed loot boxes. In order to better understand links between loot boxes and problem gambling, we conducted an analysis of players of Heroes of the Storm (n=112) both before and after the removal of loot boxes.There were a complex pattern of results. In general, when loot boxes were removed from Heroes of the Storm, problem gamblers appeared to spend significantly less money in-game in contrast to other groups. These results suggest that the presence of loot boxes in a game may lead to problem gamblers spending more money in-game. It therefore seems possible that links between loot box spending and problem gambling are not due to a general dysregulation in in-game spending amongst problem gamblers, but rather are to do with specific features of loot boxes themselves.

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