scholarly journals Diaphragm Ultrasound in Cardiac Surgery: State of the Art

Medicines ◽  
2022 ◽  
Vol 9 (1) ◽  
pp. 5
Author(s):  
Abdallah Fayssoil ◽  
Nicolas Mansencal ◽  
Lee S. Nguyen ◽  
David Orlikowski ◽  
Hélène Prigent ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Cardiac Surgery ◽  
State Of The Art ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Artery Bypass Graft ◽  
Weaning From Mechanical Ventilation ◽  
Diaphragm Dysfunction

In cardiac surgery, patients are at risk of phrenic nerve injury, which leads to diaphragm dysfunction and acute respiratory failure. Diaphragm dysfunction (DD) is relatively frequent in cardiac surgery and particularly affects patients after coronary artery bypass graft. The onset of DD affects patients’ prognosis in term of weaning from mechanical ventilation and hospital length of stay. The authors present a narrative review about diaphragm physiology, techniques used to assess diaphragm function, and the clinical application of diaphragm ultrasound in patients undergoing cardiac surgery.

Bleeding Outcomes Associated with Coronary Artery Bypass Graft Surgery and Recent Clopidogrel Exposure

2015 ◽  
Vol 16 (2) ◽  
pp. 70 ◽  
Author(s):  
Danielle M. Blais ◽  
Sarah M. Zukkoor ◽  
Charles Hayes ◽  
Kerry K. Pickworth ◽  
Kyle Porter ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Postoperative Complications ◽  
Length Of Stay ◽  
Coronary Artery Bypass Graft ◽  
Major Bleeding ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Artery Bypass Graft

<p><b>Background:</b> Guidelines recommend discontinuing clopidogrel for at least 5 days before elective coronary artery bypass graft surgery (CABG) to limit blood transfusions and for at least 24 hours before urgent CABG to reduce major bleeding complications. Studies have produced conflicting results regarding whether recent exposure to clopidogrel increases bleeding, the need for intraoperative and postoperative blood products, postoperative complications, and hospital length of stay. We evaluated the effect of clopidogrel exposure on major bleeding at our institution within 5 days of CABG.</p><p><b>Methods:</b> We conducted a retrospective review of patients who underwent CABG at a tertiary academic medical center. The primary outcome was major bleeding, defined as transfusion of 4 units of packed red blood cells (PRBCs) and/or a need for reexploration. Secondary outcomes included non-life-threatening bleeding, defined as transfusion of 2 units but <4 units of PRBCs; postoperative complications; hospital length of stay; readmission within 30 days of the procedure; and hospital mortality. Major bleeding events were analyzed with a logistic regression model that adjusted for covariates of bleeding risk factors.</p><p><b>Results:</b> Of the 715 patients we reviewed, 169 patients received clopidogrel within 5 days before CABG, and 546 patients did not. A significantly higher incidence of major bleeding was observed in the clopidogrel group compared with the group not exposed to clopidogrel (32% versus 17%, <i>P</i> = .002). After adjusting for covariates, patients exposed to clopidogrel had significantly higher odds of major bleeding (odds ratio, 2.1; 95% confidence interval, 1.3-3.4; <i>P</i> = .003). The groups were similar with respect to postoperative complications, except for infection. The clopidogrel-exposed group had a significantly higher rate of leg site infections (3% versus 0.2%, <i>P</i> = .003).</p><p><b>Conclusions:</b> Clopidogrel exposure within 5 days of CABG is associated with an increased risk of major bleeding.</p>

scholarly journals Preoperative C-reactive Protein Predicts Long-term Mortality and Hospital Length of Stay after Primary, Nonemergent Coronary Artery Bypass Grafting

2010 ◽  
Vol 112 (3) ◽  
pp. 607-613 ◽  
Author(s):  
Tjörvi E. Perry ◽  
Jochen D. Muehlschlegel ◽  
Kuang-Yu Liu ◽  
Amanda A. Fox ◽  
Charles D. Collard ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Length Of Stay ◽  
Coronary Artery Bypass Graft ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Artery Bypass Graft

Background Preoperative C-reactive protein (CRP) levels more than 10 mg/l have been shown to be associated with increased morbidity and mortality after cardiac surgery. We examine the value of preoperative CRP levels less than 10 mg/l for predicting long-term, all-cause mortality and hospital length of stay in surgical patients undergoing primary, nonemergent coronary artery bypass graft-only surgery. Methods We examined the association between preoperative CRP levels stratified into four categories (&lt; 1, 1-3, 3-10, and &gt; 10 mg/l), and 7-yr all-cause mortality and hospital length of stay in 914 prospectively enrolled primary, nonemergent coronary artery bypass graft-only surgical patients using a proportional hazards regression model. Results Eighty-seven patients (9.5%) died during a mean follow-up period of 4.8 +/- 1.5 yr. After proportional hazards adjustment, the 3-10 and &gt; 10 mg/l preoperative CRP groups were associated with long-term, all-cause mortality (hazards ratios [95% CI]: 2.50 [1.22-5.16], P = 0.01 and 2.66 [1.21-5.80], P = 0.02, respectively) and extended hospital length of stay (1.32 [1.07-1.63], P &lt; 0.001 and 1.27 [1.02-1.62], P = 0.001, respectively). Conclusion We demonstrate that preoperative CRP levels as low as 3 mg/l are associated with increased long-term mortality and extended hospital length of stay in relatively lower-acuity patients undergoing primary, nonemergent coronary artery bypass graft-only surgery. These important findings may allow for more objective risk stratification of patients who present for uncomplicated surgical coronary revascularization.

Cardiac Surgery Nurse Practitioner Home Visits Prevent Coronary Artery Bypass Graft Readmissions

2014 ◽  
Vol 97 (5) ◽  
pp. 1488-1495 ◽  
Author(s):  
Michael H. Hall ◽  
Rick A. Esposito ◽  
Renee Pekmezaris ◽  
Martin Lesser ◽  
Donna Moravick ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Coronary Artery ◽  
Coronary Artery Bypass Graft ◽  
Coronary Artery Bypass ◽  
Nurse Practitioner ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Home Visits ◽  
Artery Bypass Graft

Hemodynamic Effects of Synchronized High-frequency Jet Ventilation Compared with Low-frequency Intermittent Positive-pressure Ventilation after Myocardial Revascularization

2000 ◽  
Vol 92 (1) ◽  
pp. 24-24 ◽  
Author(s):  
Jacques-Andre Romand ◽  
Miriam M. Treggiari-Venzi ◽  
Thierry Bichel ◽  
Peter M. Suter ◽  
Michael R. Pinsky
Keyword(s):  
Mechanical Ventilation ◽  
High Frequency ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Left Ventricular ◽  
Artery Bypass Graft ◽  
Jet Ventilation ◽  
High Frequency Jet Ventilation ◽  
Venous Oxygen Saturation ◽  
Controlled Mechanical Ventilation

Background The purpose of this prospective study was to examine the effect on cardiac performance of selective increases in airway pressure at specific points of the cardiac cycle using synchronized high-frequency jet ventilation (sync-HFJV) delivered concomitantly with each single heart beat compared with controlled mechanical ventilation in 20 hemodynamically stable, deeply sedated patients immediately after coronary artery bypass graft. Methods Five 30-min sequential ventilation periods were used interspersing controlled mechanical ventilation with sync-HFJV twice to control for time and sequencing effects. Sync-HFJV was applied using a driving pressure, which generated a tidal volume resulting in gas exchanges close to those obtained on controlled mechanical ventilation and associated with the maximal mixed venous oxygen saturation. Hemodynamic variables including cardiac output, mixed venous oxygen saturation and vascular pressures were recorded at the end of each ventilation period. Results The authors found that in 20 patients, hemodynamic changes induced by controlled mechanical ventilation and by sync-HFJV were similar. Cardiac index did not change (mean +/- SD for controlled mechanical ventilation: 2.6 +/- 0.7 l x min(-1) x m(-2); for sync-HFJV: 2.7 +/- 0.7 l x min(-1) x m(-2); P value not significant). This observation persisted after stratification according to baseline left-ventricular contractility, as estimated by ejection fraction. Conclusions The authors conclude that after coronary artery bypass graft, if gas-exchange values are maintained within normal range, sync-HFJV does not result in more favorable hemodynamic support than controlled mechanical ventilation. These findings contrast with the beneficial effects of sync-HFJV, resulting in marked hypocapnia, on cardiac performance observed in patients with terminal left-ventricular failure.

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