scholarly journals Hypophosphataemia after cardiopulmonary bypass – incidence and clinical significance, a South African perspective

2020 ◽  
pp. 30-36
Author(s):  
LE Grobbelaar ◽  
G Joubert ◽  
BJS Diedericks
Keyword(s):  
Mechanical Ventilation ◽  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
South African ◽  
Cardioplegic Solution ◽  
Refeeding Syndrome ◽  
Icu Stay ◽  
Cardioactive Drug ◽  
African Perspective ◽  
One Year

Background: Hypophosphataemia is well-known in the intensive care units (ICU), for example, in refeeding syndrome. There is limited research available for hypophosphataemia in the ‘post-cardiac surgery’ population. Objectives: Defining the incidence of hypophosphataemia after cardiopulmonary bypass, in a South African population. Secondary objectives include the clinical implication of hypophosphataemia on duration of mechanical ventilation, ICU stay, and cardioactive drug support; and possible associations between demographic variables, intraoperative variables (including cardioplegic solution), and the postoperative phosphate levels. Methods: This was a single-centre, non-blinded, prospective cohort analytical study at an academic hospital, in patients presenting for open cardiac surgery. Over a one-year period, 101 patients were included. Preoperative variables included all the factors of the EuroSCORE II risk evaluation score. Intraoperative variables recorded were drug and blood product administration, cardioplegic solution and cardiopulmonary bypass-related variables. Postoperatively, serum phosphate levels were taken daily and postoperative care measures, such as duration of cardioactive drug support, mechanical ventilation, and ICU stay, were recorded. Results: The incidence of hypophosphataemia, immediately postoperative, was 12.6% (95% confidence interval [CI] 6.7–21.0%) and peaked on Day 3 at 29.0% (95% CI 20.1–39.4%). New onset hypophosphataemia at any stage during the ICU stay was 52.6% (95% CI 42.1–63.0%). No significant associations between hypophosphataemia and secondary objectives were found. Conclusion: Hypophosphataemia was common with an incidence higher than expected. This did not translate into a clinical effect, as the degree was usually mild (0.66–0.79 mmol/L).G

scholarly journals Severity of hyperoxia as a risk factor in patients undergoing on-pump cardiac surgery

2017 ◽  
Vol 24 (3) ◽  
pp. 153-158
Author(s):  
Gabrielius Jakutis ◽  
Ieva Norkienė ◽  
Donata Ringaitienė ◽  
Tomas Jovaiša
Keyword(s):  
Mechanical Ventilation ◽  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Hospital Stay ◽  
Prolonged Mechanical Ventilation ◽  
Length Of Hospital Stay ◽  
Infectious Complications ◽  
Research Database ◽  
Elective Cardiac Surgery ◽  
The Impact

Background. Hyperoxia has long been perceived as a desirable or at least an inevitable part of cardiopulmonary bypass. Recent evidence suggest that it might have multiple detrimental effects on patient homeostasis. The aim of the study was to identify the determinants of supra-physiological values of partial oxygen pressure during on-pump cardiac surgery and to assess the impact of hyperoxia on clinical outcomes. Materials and methods. Retrospective data analysis of the institutional research database was performed to evaluate the effects of hyperoxia in patients undergoing elective cardiac surgery with cardiopulmonary bypass, 246 patients were included in the final analysis. Patients were divided in three groups: mild hyperoxia (MHO, PaO2 100–199 mmHg), moderate hyperoxia (MdHO, PaO2 200–299 mmHg), and severe hyperoxia (SHO, PaO2 >300 mmHg). Postoperative complications and outcomes were defined according to standardised criteria of the Society of Thoracic Surgeons. Results. The extent of hyperoxia was more immense in patients with a lower body mass index (p = 0.001) and of female sex (p = 0.005). A significant link between severe hyperoxia and a higher incidence of infectious complications (p – 0.044), an increased length of hospital stay (p – 0.044) and extended duration of mechanical ventilation (p < 0.001) was confirmed. Conclusions. Severe hyperoxia is associated with an increased incidence of postoperative infectious complications, prolonged mechanical ventilation, and increased hospital stay.

scholarly journals Effect of Mechanical Ventilation During Cardiopulmonary Bypass On End-Expiratory Lung Volume in The Perioperative Period of Cardiac Surgery

2021 ◽  
Author(s):  
Lea Trancart ◽  
Nathalie Rey ◽  
Vincent Scherrer ◽  
Véronique Wurtz ◽  
Fabrice Bauer ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Lung Volume ◽  
Perioperative Period ◽  
Tertiary Teaching ◽  
Significant Difference ◽  
Residual Capacity ◽  
Tertiary Teaching Hospital ◽  
The Impact

Abstract Background Many studies explored the impact of ventilation during cardiopulmonary bypass period. However, its effect on Functional residual capacity or End Expiratory Lung Volume (EELV) has not been specifically studied. Our objective was to compare the effect of two ventilation strategies during cardiopulmonary bypass (CPB) on EELV. Methods observational monocenter study in a tertiary teaching hospital. Adult patients undergoing on-pump cardiac surgery by sternotomy were included and ventilated on the GE Carescape R860® ventilator. Maintenance of ventilation during CPB was left to the discretion of the medical team, with division between "ventilated" and "non-ventilated" groups afterwards. Iterative per and postoperative measurements of EELV were carried out by nitrogen washin-washout technique. Results 40 patients were included, 20 in each group. EELV was not significantly different between the ventilated versus non-ventilated groups at the end of surgery (1796±586ml vs. 1844±524ml; p=1). No significant difference between the two groups was observed on oxygenation, duration of mechanical ventilation, need postoperative respiratory support, occurrence of pneumopathy and radiographic atelectasis. Conclusion Maintaining mechanical ventilation during CPB does not seem to allow a better preservation of EELV in our population.

scholarly journals SAT-LB80 Elevated Pre-Op Thyrotropin Levels Are Associated With Increased 30-Day Mortality in Patients Undergoing Cardiac Surgery With Cardiopulmonary Bypass

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Shariq Rashid Masoodi ◽  
Rameesa Batul ◽  
Khurram Maqbool ◽  
Amir Zahoor ◽  
Mona Sood ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Thyroid Hormone ◽  
Thyroid Hormones ◽  
Thyroid Function ◽  
Thyroid Dysfunction ◽  
Hormone Levels ◽  
Icu Stay ◽  
Thyroid Hormone Levels ◽  
Serum Thyroid Hormones

Abstract BACKGROUND: The association between thyroid dysfunction and postoperative mortality is contentious. Thyroid function is frequently depressed during and after cardiopulmonary bypass surgical procedures, and this may adversely affect myocardial performance and postop outcome.OBJECTIVES: To study i) the changes and clinical significance of serum thyroid hormones during cardiopulmonary bypass (CPB), and ii) the association between biochemically assessed peri-op thyroid function and 30-day mortality after CBPSTUDY DESIGN: Prospective Cohort StudySUBJECTS: 279 patients undergoing various cardiac surgeries under cardiopulmonary bypass.METHODS: All consenting patients undergoing open heart surgery in last five years at a tertiary care centre in North-India were studied. The thyroid hormone levels (Total T3, T4 and TSH) were measured before admission, and postoperatively on Day 1 & 7, and 3 months following surgery. The patients’ gender, age, weight, body mass index, heart disease details, previous cardiac surgeries, and cardiac surgery-related data such as pump time, aortic clamping time, hypothermia duration, postoperative hemodynamic status and postoperative use of inotropic drugs were recorded and analysed. Patients were classified as having biochemically overt or subclinical hyperthyroidism or hypothyroidism, normal thyroid function, or non-classifiable state based on preoperative thyroid-stimulating hormone and total T4 values. Outcome data were collected from hospital records. Biochemical thyroid dysfunction was not systematically treated. Outcomes measured were length of ICU stay, postoperative complications and 30-day mortality.RESULTS: There was significant changes in thyroid function in patients undergoing cardiopulmonary bypass surgery (Fig 1). All patients showed a decrease in T3, T4 and TSH after surgery. Post-op complications were observed in 137 patients (49%) most common being atrial fibrillation (34%) followed by acute kidney injury (23%), infections (18%), dyselectrolytemia (7%), bleeding (1.4%) and ARDS (1.4%). Of 263 patients followed, eventually 26 patients expired with a mortality rate of 8.89% (95% CI, 0.4 - 19.4). Perioperatively, there was a significant correlation between 30-day with type of surgery (r, 0.26), aortic clamp time (r, 0.45), CBP time (r, 0.48), number of inotropes used (r, 0.57), hours of mechanical ventilation (r, 0.4), ICU stay (r, 0.13) and post-op complications (r, 0.24), as well as with the reduction in the thyroid hormone levels; 17 (7%), 3 (20%) and 6 (46%) patients of those with pre-op TSH level of &lt;6.5, &gt;6.5 and &gt;10.5 mIU/L expired (p &lt;0.001).CONCLUSION: Pre-op thyroid dysfunction is associated with increased mortality in patients undergoing cardiac surgery with CBP. Excess mortality with elevated serum TSH levels suggests the importance of timely detection and intervention in individuals with thyroid dysfunction undergoing cardiac surgery.Table of Contents oTable 1. Characteristics of patients who expired versus those who survived cardiac surgery with cardiopulmonary bypass (CPB) oFig 1. Changes in serum thyroid hormones during CPB surgery oTable 1. Characteristics of patients who expired versus those who survived cardiac surgery with cardiopulmonary bypass (CPB) oFigures in parenthesis indicate ±Standard Deviation, unless indicated otherwise oFig 1. Changes in serum thyroid hormones during CPB surgery

Factors Facilitating the Success of Fast Endotracheal Extubation after Cardiac Surgery

2021 ◽  
Vol 104 (3) ◽  
pp. 388-395
Keyword(s):  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Low Dose ◽  
Heart Surgery ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Factors Influencing ◽  
Post Cardiopulmonary Bypass ◽  
One Year ◽  
Endotracheal Extubation

Objective: To study factors influencing fast endotracheal extubation after cardiac surgery. Materials and Methods: A one-year retrospective cohort study conducted via hospital medical informatics, included patients aged over 15 years old that underwent elective valvular heart surgery by means of cardiopulmonary bypass under general anesthesia. Results: Fifty-seven patients were enrolled in the present study including nine (15.8%) as fast endotracheal extubation in the operating theatre, 18 (31.6%) within eight hours postoperatively, and 30 (52.6%) non-fast endotracheal extubation eight hours after surgery. The preoperative and intraoperative factors were a younger age (p=0.018), high % left ventricular ejection function (LVEF) (p=0.023), and low creatinine level (p=0.026), as well as post cardiopulmonary bypass dexmedetomidine (p=0.01), reversal of muscle relaxant (p=0.004), and low dose dobutamine (p=0.003), respectively. However, multiple logistic regression analyses showed only two favorable factors, which were preoperative % LVEF of 60 or more (adjusted OR 11.266, 95% CI 1.700 to 74.664, p=0.012), and the intraoperative low dose dobutamine of 3 μg/kg/minute or less (adjusted OR 6.896, 95% CI 1.463 to 32.510, p=0.015). In addition, there were no significant complications. Conclusion: The factors influencing fast endotracheal extubation were preoperative% LVEF of 60 or more and intraoperative low dose dobutamine of 3 μg/kg/minute or less. Keywords: Cardiac surgery, Fast endotracheal extubation, Valvular heart disease

scholarly journals Early Enteral Nutrition Tolerance in Patients With Cardiogenic Shock Requiring Mechanical Circulatory Support

2021 ◽  
Vol 8 ◽  
Author(s):  
Wen-jun Liu ◽  
Jun Zhong ◽  
Jing-chao Luo ◽  
Ji-li Zheng ◽  
Jie-fei Ma ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Cardiac Surgery ◽  
Enteral Nutrition ◽  
Cardiogenic Shock ◽  
Mechanical Circulatory Support ◽  
Circulatory Support ◽  
Early Enteral Nutrition ◽  
Vasoactive Drugs ◽  
Icu Stay ◽  
Significant Difference

Background: Enteral nutrition (EN) is recommended within the first 24–48 h for patients with hemodynamic stability, following admission to an intensive care unit (ICU). However, for patients with approximate stable hemodynamics requiring mechanical circulatory support and vasoactive drugs, the application of early EN remains controversial. We sought to evaluate the tolerance of early EN in patients with cardiogenic shock who required vasoactive drugs and mechanical circulatory support after cardiac surgery.Methods: This single-center, prospective observational study included patients with cardiogenic shock, requiring vasoactive drugs and mechanical circulatory support after cardiac surgery, undergoing EN. The primary endpoint was EN tolerance and secondary endpoints were mortality, length of mechanical ventilation, and length of ICU stay.Results: From February 2019 to December 2020, 59 patients were enrolled, of which 25 (42.37%) developed intolerance within 3 days of starting EN. Patients in the EN intolerant group had a longer median length of mechanical ventilation (380 vs. 128 h, p = 0.006), a longer median ICU stay (20 vs. 11.5 days, p = 0.03), and a higher proportion of bloodstream infections (44 vs. 14.71%, p = 0.018). The median EN calorie levels for all patients in the first 3 days of EN were 4.00, 4.13, and 4.28 kcal/kg/day, respectively. Median protein intake levels of EN in the first 3 days were 0.18, 0.17, and 0.17 g/kg/day, respectively. No significant difference was observed in the median dose of vasoactive drugs between the groups (0.035 vs. 0.05 μg/kg/min, p = 0.306).Conclusions: Patients with cardiogenic shock after cardiac surgery had a high proportion of early EN intolerance, and patients with EN intolerance had a worse prognosis, but no significant correlation was identified between EN tolerance and the dose of vasoactive drugs.

Perioperative use of renin-angiotensin system inhibitors and short-term outcomes in patients undergoing cardiac surgery

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
R.M Vieira De Melo ◽  
D.C Azevedo ◽  
L.N Danziato ◽  
M.T.C.F Fernandes ◽  
L.F.C Alcantara ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Acute Kidney Injury ◽  
Cardiac Surgery ◽  
Multivariate Regression ◽  
Enzyme Inhibitor ◽  
Kidney Injury ◽  
Adverse Outcomes ◽  
Icu Mortality ◽  
Short Term ◽  
Icu Stay

Abstract Background Controversy exists about whether preoperative angiotensin-converting enzyme inhibitor (ACEi) or an angiotensin receptor blocker (ARB) therapy is associated with adverse outcomes after cardiac surgery. Current guidelines stated that it is uncertain about the safety of the preoperative administration of this medications because of the potential deleterious consequences of perioperative hypotension Purpose To determine the effect of preoperative therapy with ACEi or ARB on short-term outcome after cardiac surgery. Methods Single-center prospective cohort between January 2018 and December 2019. Patients were eligible if they were submitted to elective on-pump cardiac surgery and aged ≥18 years. Patients were divided into two groups according to previous use of ACEi or ARB. All preoperative demographic, clinical, and intraoperative surgical variables were collected prospectively. Outcomes of interests were intensive care unit (ICU) mortality, incidence and duration (hours) of postoperative shock (defined as the need for intravenous vasopressors or inopressors), postoperative acute kidney injury (AKI), defined as a doubling of serum creatinine, duration of mechanical ventilation (hours) and length of stay in the ICU (days). A multivariate regression was performed for categorical outcomes and Kruskal-Wallis test for non-parametric continuous variables. Results 353 patients were evaluated in the period, 182 (51.6%) of male sex, with a mean age of 54.5 (±14.7) and STS mortality and EURO scores of 1.93 (±1.81) and 1.89 (±1.9), respectively. Coronary artery bypass grafting was the common procedure, 168 (47.6%). After multivariate regression, use of ACEi or ARB preoperatively was associated with postoperative shock: RR: 2.03, CI 1.25–3.30, p=0.004; incidence of AKI: RR: 2.84, CI 1.01–7.98, increased length of ICU stay: 4 (3–6) vs 3 (2–5), p=0.03; and increased duration of shock: 10 (0–39) vs 0 (0–24), p&lt;0.01. There was no association with the duration of mechanical ventilation: 10.5 (6–20) vs 11.0 (5–18), p=0.31 or ICU mortality: 14 (7.3%) vs 16 (10.0%), p=0,44. Conclusions The use of preoperative ACEi or ARBs was associated with increased incidence and duration of postoperative shock, incidence of acute kidney injury, and durations of mechanical ventilation and ICU stay. Funding Acknowledgement Type of funding source: None

Sign in / Sign up

Export Citation Format

Share Document