Vasoactive Inotrope Score as a tool for clinical care in children post cardiac surgery

Objectives: This study aims to analyze the nosocomial infection factors in post–cardiac surgery extracorporeal membrane oxygenation (ECMO) supportive treatment (pCS-ECMO). Methods: The clinical data of the pCS-ECMO patients who obtained nosocomial infections (NI) were collected and analyzed retrospectively. Among the 74 pCS-ECMO patients, 30 occurred with NI, accounting for 40.5%; a total of 38 pathogens were isolated, including 22 strains of Gram-negative bacteria (57.9%), 15 strains of Gram-positive bacteria (39.5%), and 1 fungus (2.6%). Results: Multidrug-resistant strains were highly concentrated, among which Acinetobacter baumannii and various coagulase-negative staphylococci were the main types; NI was related to mechanical ventilation time, intensive care unit (ICU) residence, ECMO duration, and total hospital stay, and the differences were statistically significant (P < .05). The binary logistic regression analysis indicated that ECMO duration was a potential independent risk factor (OR = 0.992, P = .045, 95.0% CI = 0.984-1.000). Conclusions: There existed significant correlations between the secondary infections of pCS-ECMO and mechanical ventilation time, ICU residence, ECMO duration, and total hospital stay; therefore, hospitals should prepare appropriate preventive measures to reduce the incidence of ECMO secondary infections.

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Acute Post-cardiac Surgery Renal Failure: Prevention Through Individualized Intense Hemodynamic Management

Case Medical Research ◽

10.31525/ct1-nct04005105 ◽

2019 ◽

Author(s):

Keyword(s):

Renal Failure ◽

Cardiac Surgery ◽

Hemodynamic Management ◽

Failure Prevention ◽

Post Cardiac Surgery

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Faculty Opinions recommendation of Can dexmedetomidine be a safe and efficacious sedative agent in post-cardiac surgery patients? a meta-analysis.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.717958816.793465922 ◽

2012 ◽

Author(s):

Michael Haney

Keyword(s):

Cardiac Surgery ◽

Meta Analysis ◽

Sedative Agent ◽

Post Cardiac Surgery

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4494 Predictors of Reintubation After Cardiac Surgery

Journal of Clinical and Translational Science ◽

10.1017/cts.2020.182 ◽

2020 ◽

Vol 4 (s1) ◽

pp. 50-50

Author(s):

Robert Edward Freundlich ◽

Gen Li ◽

Jonathan P Wanderer ◽

Frederic T Billings ◽

Henry Domenico ◽

...

Keyword(s):

Clinical Trial ◽

Cardiac Surgery ◽

High Risk ◽

Query Language ◽

Risk Estimation ◽

Clinical Care ◽

Model Development ◽

Calibration Plot ◽

Iterative Model ◽

Strong Candidate

OBJECTIVES/GOALS: We modeled risk of reintubation within 48 hours of cardiac surgery using variables available in the electronic health record (EHR). This model will guide recruitment for a prospective, pragmatic clinical trial entirely embedded within the EHR among those at high risk of reintubation. METHODS/STUDY POPULATION: All adult patients admitted to the cardiac intensive care unit following cardiac surgery involving thoracotomy or sternotomy were eligible for inclusion. Data were obtained from operational and analytical databases integrated into the Epic EHR, as well as institutional and departmental-derived data warehouses, using structured query language. Variables were screened for inclusion in the model based on clinical relevance, availability in the EHR as structured data, and likelihood of timely documentation during routine clinical care, in the hopes of obtaining a maximally-pragmatic model. RESULTS/ANTICIPATED RESULTS: A total of 2325 patients met inclusion criteria between November 2, 2017 and November 2, 2019. Of these patients, 68.4% were male. Median age was 63.0. The primary outcome of reintubation occurred in 112/2325 (4.8%) of patients within 48 hours and 177/2325 (7.6%) at any point in the subsequent hospital encounter. Univariate screening and iterative model development revealed numerous strong candidate predictors (ANOVA plot, figure 1), resulting in a model with acceptable calibration (calibration plot, figure 2), c = 0.666. DISCUSSION/SIGNIFICANCE OF IMPACT: Reintubation is common after cardiac surgery. Risk factors are available in the EHR. We are integrating this model into the EHR to support real-time risk estimation and to recruit and randomize high-risk patients into a clinical trial comparing post-extubation high flow nasal cannula with usual care. CONFLICT OF INTEREST DESCRIPTION: REF has received grant funding and consulting fees from Medtronic for research on inpatient monitoring.

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Long Term Renal Outcomes in Children with Acute Kidney Injury Post-Cardiac Surgery

Kidney International Reports ◽

10.1016/j.ekir.2021.04.018 ◽

2021 ◽

Author(s):

Sidharth Kumar Sethi ◽

Rajesh Sharma ◽

Aditi Gupta ◽

Abhishek Tibrewal ◽

Romel Akole ◽

...

Keyword(s):

Acute Kidney Injury ◽

Cardiac Surgery ◽

Kidney Injury ◽

Renal Outcomes ◽

Post Cardiac Surgery

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Incidence of acute kidney injury post cardiac surgery: a comparison of the AKIN and KDIGO criteria

Brazilian Journal of Anesthesiology (English Edition) ◽

10.1016/j.bjane.2021.02.016 ◽

2021 ◽

Author(s):

Tiago Furquim da Silva ◽

Kelly Regina da Cruz Silva ◽

Crissiane Melo Nepomuceno ◽

Cora Salles Maruri Corrêa ◽

João Pedro Mello Godoy ◽

...

Keyword(s):

Acute Kidney Injury ◽

Cardiac Surgery ◽

Kidney Injury ◽

Post Cardiac Surgery

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Post–Cardiac Surgery Atrial Fibrillation

Cardiac Electrophysiology Clinics ◽

10.1016/j.ccep.2020.11.011 ◽

2021 ◽

Vol 13 (1) ◽

pp. 133-140

Author(s):

Jason D. Matos ◽

Frank W. Sellke ◽

Peter Zimetbaum

Keyword(s):

Atrial Fibrillation ◽

Cardiac Surgery ◽

Post Cardiac Surgery

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Bilirubin adsorption for the treatment of severe hyperbilirubinemia after cardiac surgery: A retrospective cohort study

The International Journal of Artificial Organs ◽

10.1177/0391398821997841 ◽

2021 ◽

pp. 039139882199784

Author(s):

Xiaolan Chen ◽

Lu Li ◽

Ming Bai ◽

Shiren Sun ◽

Xiangmei Chen

Keyword(s):

Cardiac Surgery ◽

Total Bilirubin ◽

Serum Bilirubin ◽

Multivariate Analyses ◽

Reduction Rate ◽

Mortality Rates ◽

Increased Risk ◽

Bilirubin Adsorption ◽

Severe Hyperbilirubinemia ◽

Post Cardiac Surgery

Objective: Severe hyperbilirubinemia after cardiac surgery increases in-hospital and 1-year mortality. Our present study aimed to analyze the safety and efficacy of bilirubin adsorption (BA) in patients with post-cardiac-surgery severe hyperbilirubinemia. Methods: We retrospectively included patients who underwent BA due to severe hyperbilirubinemia after cardiac surgery in our center between January 2015 and December 2018. The change of serum bilirubin, alanine aminotransferase, aspartate aminotransferase, and 30-day and 1-year mortality were assessed as endpoints. Univariate and multivariate analyses were employed to identify the risk factors of patient 30-day mortality. Result: A total of 25 patients with 44 BA treatments were included. One BA treatment reduced total bilirubin (TB) concentration from 431.65 ± 136.34 to 324.83 ± 129.44 µmol/L ( p < 0.001), with a reduction rate of 24.8%. No clinically relevant thrombosis of the extracorporeal circuit occurred during the BA treatment. The 30-day and 1-year mortality rates were 68% ( n = 18) and 84% ( n = 21), respectively. Multivariate analysis identified that TB level before BA treatment (odds ratio [OR] 1.010, 95% confidence interval [CI] 1.000–1.019; p = 0.043) was an independent risk factor of 30-day mortality. Conclusions: BA treatment should be considered as an effective and safe method for the reduction of serum bilirubin in patients with post-cardiac-surgery severe hyperbilirubinemia. Patients with higher TB level before BA treatment had a relatively increased risk of 30-day mortality. Further studies are needed to evaluate the timing of BA for severe hyperbilirubinemia after cardiac surgery.

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