scholarly journals ΔPCO2 and ΔPCO2/C(a−cv)O2 Are Not Predictive of Organ Dysfunction After Cardiopulmonary Bypass

2021 ◽  
Vol 8 ◽  
Author(s):  
Sheng Zhang ◽  
Dan Zheng ◽  
Xiao-Qiong Chu ◽  
Yong-Po Jiang ◽  
Chun-Guo Wang ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Cardiac Surgery ◽  
Intensive Care ◽  
Cardiopulmonary Bypass ◽  
Organ Dysfunction ◽  
Statistical Significance ◽  
Predictive Performance ◽  
Elective Cardiac Surgery ◽  
Icu Admission ◽  
The Difference

Background: Cardiac surgery is associated with a substantial risk of major adverse events. Although carbon dioxide (CO2)-derived variables such as venous-to-arterial CO2 difference (ΔPCO2), and PCO2 gap to arterial–venous O2 content difference ratio (ΔPCO2/C(a−cv)O2) have been successfully used to predict the prognosis of non-cardiac surgery, their prognostic value after cardiopulmonary bypass (CPB) remains controversial. This hospital-based study explored the relationship between ΔPCO2, ΔPCO2/C(a−cv)O2 and organ dysfunction after CPB.Methods: We prospectively enrolled 114 intensive care unit patients after elective cardiac surgery with CPB. Patients were divided into the organ dysfunction group (OI) and non-organ dysfunction group (n-OI) depending on whether organ dysfunction occurred or not at 48 h after CPB. ΔPCO2 was defined as the difference between central venous and arterial CO2 partial pressure.Results: The OI group has 37 (32.5%) patients, 27 of which (23.7%) had one organ dysfunction and 10 (8.8%) had two or more organ dysfunctions. No statistical significance was found (P = 0.84) for ΔPCO2 in the n-OI group at intensive care unit (ICU) admission (9.0, 7.0–11.0 mmHg), and at 4 (9.0, 7.0–11.0 mmHg), 8 (9.0, 7.0–11.0 mmHg), and 12 h post admission (9.0, 7.0–11.0 mmHg). In the OI group, ΔPCO2 also showed the same trend [ICU admission (9.0, 8.0–12.8 mmHg) and 4 (10.0, 7.0–11.0 mmHg), 8 (10.0, 8.5–12.5 mmHg), and 12 h post admission (9.0, 7.3–11.0 mmHg), P = 0.37]. No statistical difference was found for ΔPCO2/C(a−cv)O2 in the n-OI group (P = 0.46) and OI group (P = 0.39). No difference was detected in ΔPCO2, ΔPCO2/C(a−cv)O2 between groups during the first 12 h after admission (P > 0.05). Subgroup analysis of the patients with two or more failing organs compared to the n-OI group showed that the predictive performance of lactate and Base excess (BE) improved, but not of ΔPCO2 and ΔPCO2/C(a−cv)O2. Regression analysis showed that the BE at 8 h after admission (odds ratio = 1.37, 95%CI: 1.08–1.74, P = 0.009) was a risk factor for organ dysfunction 48 h after CBP.Conclusion : ΔPCO2 and ΔPCO2/C(a−cv)O2 cannot be used as reliable indicators to predict the occurrence of organ dysfunction at 48 h after CBP due to the pathophysiological process that occurs after CBP.

Esmolol before cardioplegia and as cardioplegia adjuvant reduces cardiac troponin release after cardiac surgery. A randomized trial

Perfusion ◽  
2016 ◽  
Vol 32 (4) ◽  
pp. 313-320 ◽  
Author(s):  
Elena Bignami ◽  
Marcello Guarnieri ◽  
Annalisa Franco ◽  
Chiara Gerli ◽  
Monica De Luca ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Cardiac Surgery ◽  
Intensive Care ◽  
Placebo Group ◽  
Cardiopulmonary Bypass ◽  
Hospital Stay ◽  
Troponin T ◽  
Mechanical Activity ◽  
Double Blind ◽  
Elective Cardiac Surgery

Background: Cardioplegic solutions are the standard in myocardial protection during cardiac surgery, since they interrupt the electro-mechanical activity of the heart and protect it from ischemia during aortic cross-clamping. Nevertheless, myocardial damage has a strong clinical impact. We tested the hypothesis that the short-acting beta-blocker esmolol, given immediately before cardiopulmonary bypass and as a cardioplegia additive, would provide an extra protection to myocardial tissue during cardiopulmonary bypass by virtually reducing myocardial activity and, therefore, oxygen consumption to zero. Materials and methods: This was a single-centre, double-blind, placebo-controlled, parallel-group phase IV trial. Adult patients undergoing elective valvular and non-valvular cardiac surgery with end diastolic diameter >60 mm and ejection fraction <50% were enrolled. Patients were randomly assigned to receive either esmolol, 1 mg/kg before aortic cross-clamping and 2 mg/kg with Custodiol® crystalloid cardioplegia or equivolume placebo. The primary end-point was peak postoperative troponin T concentration. Troponin was measured at Intensive Care Unit arrival and at 4, 24 and 48 hours. Secondary endpoints included ventricular fibrillation after cardioplegic arrest, need for inotropic support and intensive care unit and hospital stay. Results: We found a reduction in peak postoperative troponin T, from 1195 ng/l (690–2730) in the placebo group to 640 ng/l (544–1174) in the esmolol group (p=0.029) with no differences in Intensive Care Unit stay [3 days (1-6) in the placebo group and 3 days (2-5) in the esmolol group] and hospital stay [7 days (6–10) in the placebo group and 7 days (6–12) in the esmolol group]. Troponin peak occurred at 24 hours for 12 patients (26%) and at 4 hours for the others (74%). There were no differences in other secondary end-points. Conclusions: Adding esmolol to the cardioplegia in high-risk patients undergoing elective cardiac surgery reduces peak postoperative troponin levels. Further investigation is necessary to assess esmolol effects on major clinical outcomes.

Myocardial protection following del Nido cardioplegia in pediatric cardiac surgery

2018 ◽  
Vol 26 (4) ◽  
pp. 267-272 ◽  
Author(s):  
Debasish Panigrahi ◽  
Saibal Roychowdhury ◽  
Rahul Guhabiswas ◽  
Emmanuel Rupert ◽  
Mrinalendu Das ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Creatine Kinase ◽  
Cardiac Surgery ◽  
Intensive Care ◽  
Cardiopulmonary Bypass ◽  
Myocardial Protection ◽  
Troponin I ◽  
Blood Cardioplegia ◽  
Cardioplegia Solution ◽  
Creatine Kinase Mb

Background This study was designed to compare myocardial protection with del Nido cardioplegia and conventional blood cardioplegia in children undergoing cardiac surgery in Risk Adjustment for Congenital Heart Surgery categories 1 and 2. Methods Sixty patients were randomized into 2 groups receiving del Nido cardioplegia solution or conventional blood cardioplegia. Myocardial injury was assessed using biochemical markers (troponin I and creatine kinase-MB). Vasoactive-inotropic scores were calculated to compare inotropic requirements. Results Demographic characteristics, cardiopulmonary bypass time, and aortic crossclamp time were comparable in the 2 groups. Time-related changes in troponin I and creatine kinase-MB were similar in both groups. Statistically significant differences were seen in total cardioplegia volume requirement ( p < 0.0001), number of cardioplegia doses given ( p < 0.0001), packed red cell volume usage during cardiopulmonary bypass ( p < 0.02), and time taken to restore spontaneous regular rhythm ( p < 0.0001). Vasoactive-inotropic scores on transfer to the intensive care unit ( p < 0.040) and at 24 h ( p < 0.030) were significantly lower in the del Nido group. Duration of mechanical ventilation, intensive care unit stay, and hospital stay were comparable in the 2 groups. Conclusions Our results show that del Nido cardioplegia solution is as safe as conventional blood cardioplegia. Moreover, it provides the benefits of reduced dose requirement, lower consumption of allogenic blood on cardiopulmonary bypass, quicker resumption of spontaneous regular cardiac rhythm, and less inotropic support requirement on transfer to the intensive care unit and at 24 h, compared to conventional blood cardioplegia.

Comparison of Blood-conservation Strategies in Cardiac Surgery Patients at High Risk for Bleeding

2000 ◽  
Vol 92 (3) ◽  
pp. 674-682 ◽  
Author(s):  
Gregory A. Nuttall ◽  
William C. Oliver ◽  
Mark H. Ereth ◽  
Paula J. Santrach ◽  
Sandra C. Bryant ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Cardiac Surgery ◽  
Intensive Care ◽  
Cardiopulmonary Bypass ◽  
Tranexamic Acid ◽  
Combined Therapy ◽  
Autologous Blood ◽  
Blood Collection ◽  
Transfusion Requirements ◽  
Risk For Bleeding

Background Aprotinin and tranexamic acid are routinely used to reduce bleeding in cardiac surgery. There is a large difference in agent price and perhaps in efficacy. Methods In a prospective, randomized, partially blinded study, 168 cardiac surgery patients at high risk for bleeding received either a full-dose aprotinin infusion, tranexamic acid (10-mg/kg load, 1-mg x kg(-1) x h(-1) infusion), tranexamic acid with pre-cardiopulmonary bypass autologous whole-blood collection (12.5% blood volume) and reinfusion after cardiopulmonary bypass (combined therapy), or saline infusion (placebo group). Results There were complete data in 160 patients. The aprotinin (n = 40) and combined therapy (n = 32) groups (data are median [range]) had similar reductions in blood loss in the first 4 h in the intensive care unit (225 [40-761] and 163 [25-760] ml, respectively; P = 0.014), erythrocyte transfusion requirements in the first 24 h in the intensive care unit (0 [0-3] and 0 [0-3] U, respectively; P = 0.004), and durations of time from end of cardiopulmonary bypass to discharge from the operating room (92 [57-215] and 94 [37, 186] min, respectively; P = 0.01) compared with the placebo group (n = 43). Ten patients in the combined therapy group (30.3%) required transfusion of the autologous blood during cardiopulmonary bypass for anemia. Conclusions The combination therapy of tranexamic acid and intraoperative autologous blood collection provided similar reduction in blood loss and transfusion requirements as aprotinin. Cost analyses revealed that combined therapy and tranexamic acid therapy were the least costly therapies.

scholarly journals Evaluation of Blood Lactate Level as Predictor of Early Adverse Outcome after Cardiac Surgery under Cardiopulmonary Bypass

2019 ◽  
Vol 34 (1) ◽  
pp. 25-30 ◽  
Author(s):  
MAK Azad ◽  
KS Islam ◽  
MA Quasem
Keyword(s):  
Intensive Care Unit ◽  
Cardiac Surgery ◽  
Intensive Care ◽  
Cardiopulmonary Bypass ◽  
Blood Lactate ◽  
Lactate Level ◽  
Adverse Outcome ◽  
Independent Predictor ◽  
Blood Lactate Level ◽  
Adult Cardiac Surgery

Background: We examined the hypothesis that high blood lactate level in intensive care unit patient after adult cardiac surgery under cardiopulmonary bypass is associated with early adverse outcome. The objective of this study was to evaluate whether high blood lactate level after cardiac surgery is a predictor of the early outcome after adult cardiac surgery under cardiopulmonary bypass. Methods: This prospective observational study was carried out in the department of Cardiac Surgery at National Institute of Cardiovascular Disease (NICVD), Dhaka from July, 2013 to April 2014. A total number of 100 patients who underwent cardiac operation with cardiopulmonary bypass were enrolled in this study as per inclusion and exclusion criteria. Patients were divided into two groups according to their blood lactate level 6 hours after transferintensive care unit. Peroperative variables and postoperative variables were observed and recorded during the hospital course of patient. Categorical variables were analyzed by Chi- Square test and Fisher’s exact test and continuous variables were analyzed by ‘t’ test. Multiple Binary Logistic Regression Analysis of predictors for each of the outcome variables was done. Results: Blood lactate levels ≥3mmol/L 6 hours after transfer to intensive care unit were present in 57(57%) patients. Multiple logistic regression analysis showed higher blood lactate level was an independent predictor for early postoperative low output syndrome (OR 9.073, 95% CI 2.819 – 29.207, p = < .0001), pulmonary complication (OR 5.734, 95% CI 1.814 – 18.122, p = .003), neurological deficits (OR 9.725, 95% CI 1.111 - 85.147, p = .040), renal dysfunction (OR 7.393, 95% CI 1.855-29.469, p = .005), arrhythmia (OR 10.512, 95% CI 1.902 – 58.108, p = .007) and wound infection (OR 7.742, 95% CI 1.418 - 42.259, p = .018). Conclusions: High blood lactate level 6 hours after transfer to intensive care unit is an independent predictor for worse outcomes in adult patients after cardiac surgery under cardiopulmonary bypass. Bangladesh Heart Journal 2019; 34(1) : 25-30

scholarly journals Performance of Prognostic Scoring Systems in Trauma Patients in the Intensive Care Unit of a Trauma Center

2020 ◽  
Vol 17 (19) ◽  
pp. 7226
Author(s):  
Shao-Chun Wu ◽  
Sheng-En Chou ◽  
Hang-Tsung Liu ◽  
Ting-Min Hsieh ◽  
Wei-Ti Su ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Organ Dysfunction ◽  
Scoring Systems ◽  
Predictive Performance ◽  
Apache Ii ◽  
Trauma Patients ◽  
Saps Ii ◽  
Significant Difference ◽  
Prognostic Scoring Systems

Background: Prediction of mortality outcomes in trauma patients in the intensive care unit (ICU) is important for patient care and quality improvement. We aimed to measure the performance of 11 prognostic scoring systems for predicting mortality outcomes in trauma patients in the ICU. Methods: Prospectively registered data in the Trauma Registry System from 1 January 2016 to 31 December 2018 were used to extract scores from prognostic scoring systems for 1554 trauma patients in the ICU. The following systems were used: the Trauma and Injury Severity Score (TRISS); the Acute Physiology and Chronic Health Evaluation (APACHE II); the Simplified Acute Physiology Score (SAPS II); mortality prediction models (MPM II) at admission, 24, 48, and 72 h; the Multiple Organ Dysfunction Score (MODS); the Sequential Organ Failure Assessment (SOFA); the Logistic Organ Dysfunction Score (LODS); and the Three Days Recalibrated ICU Outcome Score (TRIOS). Predictive performance was determined according to the area under the receiver operator characteristic curve (AUC). Results: MPM II at 24 h had the highest AUC (0.9213), followed by MPM II at 48 h (AUC: 0.9105). MPM II at 24, 48, and 72 h (0.8956) had a significantly higher AUC than the TRISS (AUC: 0.8814), APACHE II (AUC: 0.8923), SAPS II (AUC: 0.9044), MPM II at admission (AUC: 0.9063), MODS (AUC: 0.8179), SOFA (AUC: 0.7073), LODS (AUC: 0.9013), and TRIOS (AUC: 0.8701). There was no significant difference in the predictive performance of MPM II at 24 and 48 h (p = 0.37) or at 72 h (p = 0.10). Conclusions: We compared 11 prognostic scoring systems and demonstrated that MPM II at 24 h had the best predictive performance for 1554 trauma patients in the ICU.

Abstract 19663: Failed Delayed Sternal Closure Following Neonatal Cardiac Surgery Predicted by High Mean Airway Pressure and Associated with Increased Post-operative Mortality

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Dashiell Massey ◽  
Kathryn A Williams ◽  
Ravi R Thiagarajan ◽  
Frank Pigula ◽  
Catherine K Allan
Keyword(s):  
Intensive Care Unit ◽  
Cardiac Surgery ◽  
Intensive Care ◽  
Cardiopulmonary Bypass ◽  
Categorical Variables ◽  
Sternal Closure ◽  
Increased Risk ◽  
Significant Difference ◽  
Delayed Sternal Closure ◽  
Neonatal Cardiac Surgery

Background: Myocardial edema, increased lung water, and anasarca are common following neonatal cardiac surgery with cardiopulmonary bypass and amplify the risk of hemodynamic instability and inadequate ventilation following sternal closure. Delayed sternal closure (DSC) in the intensive care unit one or more days following surgery is a common strategy to mitigate this risk, but has been associated with increased risk of infection. In addition, failed DSC has previously been identified as a risk factor for mortality. This study sought to identify predictor variables and determine impact of failed DSC. Methods: Records of all neonates undergoing DSC in the cardiac intensive care unit (CICU) following surgery with cardiopulmonary bypass between January 2008 and May 2013 were reviewed. Pre-operative, intra-operative and post-operative variables were compared for those patients who failed DSC versus those who did not. Continuous variables were compared utilizing Wilcoxon’s test and categorical variables using Fisher’s exact test. Results: Of 256 neonates undergoing DSC in the CICU, 22 failed first attempt at DSC. No significant difference between the two groups was appreciated in age, weight, or bypass (cross clamp, circulatory arrest, and total) times. Comparing DSC failures to successes, significantly more failures: followed Stage I palliation (63% vs. 31%); occurred later (post-operative day 4.7 vs. 2.8, p = 0.009); and were proceeded by higher mean airway pressures (9 vs. 8 cm H2O, p = 0.04), peak inspiratory pressure (27 vs. 24, p = 0.002), and inotrope score (12.1 vs. 9.6, p = 0.06). There was no association with systolic blood pressure or lactate prior to DSC. Failed DSC was associated with increased duration of mechanical ventilation (41.6 vs 7.4 days, p < 0.001), length of ICU stay (44.3 vs 12.0 days, p < 0.001), and mortality (38 vs 3%, p < 0.001). Conclusions: Mortality for patients who fail the first ICU attempt at delayed sternal closure is significantly higher than for those with successful sternal closure. Ventilatory pressures but not hemodynamic variables prior to DSC differed significantly between the two groups. First attempt at DSC was later in those who failed, suggesting that clinicians had a priori identified these patients as higher risk.

scholarly journals Effect of cardiopulmonary bypass on hemostasis in patients undergoing cardiac surgery

2018 ◽  
Vol 11 (2) ◽  
pp. 134
Author(s):  
Jubayer Ahmad ◽  
Redoy Ranjan ◽  
Heemel Saha ◽  
S. M. G. Saklayen ◽  
Masuda Begum ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Fibrinogen Level ◽  
Cardiopulmonary Bypass Time ◽  
Elective Cardiac Surgery ◽  
Bypass Group ◽  
Group A ◽  
The Mean ◽  
The Difference ◽  
Group B

<p class="Abstract">This study aimed to evaluate the hemostatic derangement in patients undergoing elective cardiac surgery using cardiopulmonary bypass. Total 55 patients of either sex, were divided into three groups: Group A (n=20): Patients selected for elective cardiac surgery without cardiopulmonary bypass; Group B (n=20): Patients who undergone cardiac surgery with cardiopulmonary bypass time &lt;90 min; and Group C (n=15): Patients who undergone cardiac surgery with cardiopulmonary bypass time either 90 min or more. The difference of mean hemoglobin, total count of WBC, and platelet count on immediate post-operative period and at 7 days after surgery were statistically significant among the groups. The mean hematocrit value, fibrinogen level and coagulation profile were statistically significant between the two groups in comparison to pre-operative value. The mean cross-clamp time and bypass time were statistically significant between the two sub-groups of cardiopulmonary bypass population. The mean blood loss was more (1513.3 ± 307.9 mL) where the cardiopulmonary bypass was used for &gt;90 min in comparison to other population. Prolong cardiopulmonary bypass time associated with more hemostatic abnormalities and complications can be minimized by shortening the bypass time.</p>

scholarly journals Prediction of the Length of Intensive Care After Cardiac Surgery Under Cardiopulmonary Bypass: Logistic Regression Analysis Based on Troponin I And EuroSCORE II

2021 ◽  
Vol 24 (4) ◽  
pp. E751-E757
Author(s):  
Tai Lai Ti Tai Wan Gu ◽  
Jianjiang Wu ◽  
Haiting Zhan ◽  
Yidan Huang ◽  
Jiang Wang
Keyword(s):  
Logistic Regression ◽  
Regression Analysis ◽  
Cardiac Surgery ◽  
Intensive Care ◽  
Cardiopulmonary Bypass ◽  
Predictive Model ◽  
Logistic Regression Analysis ◽  
Troponin I ◽  
Predictive Performance ◽  
Binary Logistic Regression Analysis

Aim: This study is to establish a model for patients undergoing cardiac surgery under cardiopulmonary bypass (CPB) to predict the length of intensive care. Methods: This is a single center retrospective study. A total of 265 patients admitted to the ICU after CPB from 2016 to 2017 were enrolled in the study. Preoperative indicators, intraoperative parameters, and postoperative data were collected. Each patient was scored for EuroSCORE II before surgery. According to the length of intensive care, all patients were divided into two groups: short stay (< 72 h) and long stay (≥ 72 h). A binary logistic regression analysis was performed to establish a regression model to evaluate the predictive performance of the indicators and the EuroSCORE II scoring system on the length of the intensive care. Results: Both troponin I and EuroSCORE II could predict the length of intensive care of patients undergoing cardiac surgery under CPB. After combing the two factors, the prediction efficiency was higher. Comparing the prediction results with the actual data, it showed that the method had high overall accuracy. Conclusions: The predictive model based on cTnI and EuroSCORE II can accurately predict the length of intensive care of patients undergoing cardiac surgery under CPB. This predictive model may help to improve ICU resource management.

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