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de Aquino TN, Prado JP, Crisafulli E, Clini EM, Galdino G. Efficacy of Respiratory Muscle Training in the Immediate Postoperative Period of Cardiac Surgery: A Systematic Review and Meta-Analysis. Braz J Cardiovasc Surg 2024; 39:e20220165. [PMID: 38315040 PMCID: PMC10836657 DOI: 10.21470/1678-9741-2022-0165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Accepted: 07/19/2023] [Indexed: 02/07/2024] Open
Abstract
INTRODUCTION This study aimed to evaluate the efficacy of respiratory muscle training during the immediate postoperative period of cardiac surgery on respiratory muscle strength, pulmonary function, functional capacity, and length of hospital stay. METHODS This is a systematic review and meta-analysis. A comprehensive search on PubMed®, Excerpta Medica Database (or Embase), Cumulative Index of Nursing and Allied Health Literature (or CINAHL), Latin American and Caribbean Health Sciences Literature (or LILACS), Scientific Electronic Library Online (or SciELO), Physiotherapy Evidence Database (or PEDro), and Cochrane Central Register of Controlled Trials databases was performed. A combination of free-text words and indexed terms referring to cardiac surgery, coronary artery bypass grafting, respiratory muscle training, and clinical trials was used. A total of 792 studies were identified; after careful selection, six studies were evaluated. RESULTS The studies found significant improvement after inspiratory muscle training (IMT) (n = 165, 95% confidence interval [CI] 9.68, 21.99) and expiratory muscle training (EMT) (n = 135, 95% CI 8.59, 27.07) of maximal inspiratory pressure and maximal expiratory pressure, respectively. Also, IMT increased significantly (95% CI 19.59, 349.82, n = 85) the tidal volume. However, no differences were found in the peak expiratory flow, functional capacity, and length of hospital stay after EMT and IMT. CONCLUSION IMT and EMT demonstrated efficacy in improving respiratory muscle strength during the immediate postoperative period of cardiac surgery. There was no evidence indicating the efficacy of IMT for pulmonary function and length of hospital stay and the efficacy of EMT for functional capacity.
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Affiliation(s)
- Tarcísio Nema de Aquino
- Instituto de Ciências da Motricidade, Universidade Federal
de Alfenas, Alfenas, Minas Gerais, Brazil
- Department of Rehabilitation and Cardiology, Hospital Santa
Lúcia, Poços de Caldas, Minas Gerais, Brazil
| | - João Paulo Prado
- Instituto de Ciências da Motricidade, Universidade Federal
de Alfenas, Alfenas, Minas Gerais, Brazil
| | - Ernesto Crisafulli
- Department of Medicine and Surgery, Respiratory Disease and Lung
Function Unit, University of Parma, Parma, Italy
| | - Enrico Maria Clini
- Department of Medical and Surgical Sciences, University of Modena
and Reggio Emilia and University Hospital of Modena Policlinico, Modena, Italy
| | - Giovane Galdino
- Instituto de Ciências da Motricidade, Universidade Federal
de Alfenas, Alfenas, Minas Gerais, Brazil
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Zhang N, Fan K, Ji H, Ma X, Wu J, Huang Y, Wang X, Gui R, Chen B, Zhang H, Zhang Z, Zhang X, Gong Z, Wang Y. Identification of risk factors for infection after mitral valve surgery through machine learning approaches. Front Cardiovasc Med 2023; 10:1050698. [PMID: 37383697 PMCID: PMC10294678 DOI: 10.3389/fcvm.2023.1050698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 05/31/2023] [Indexed: 06/30/2023] Open
Abstract
Background Selecting features related to postoperative infection following cardiac surgery was highly valuable for effective intervention. We used machine learning methods to identify critical perioperative infection-related variables after mitral valve surgery and construct a prediction model. Methods Participants comprised 1223 patients who underwent cardiac valvular surgery at eight large centers in China. The ninety-one demographic and perioperative parameters were collected. Random forest (RF) and least absolute shrinkage and selection operator (LASSO) techniques were used to identify postoperative infection-related variables; the Venn diagram determined overlapping variables. The following ML methods: random forest (RF), extreme gradient boosting (XGBoost), Support Vector Machine (SVM), Gradient Boosting Decision Tree (GBDT), AdaBoost, Naive Bayesian (NB), Logistic Regression (LogicR), Neural Networks (nnet) and artificial neural network (ANN) were developed to construct the models. We constructed receiver operating characteristic (ROC) curves and the area under the ROC curve (AUC) was calculated to evaluate model performance. Results We identified 47 and 35 variables with RF and LASSO, respectively. Twenty-one overlapping variables were finally selected for model construction: age, weight, hospital stay, total red blood cell (RBC) and total fresh frozen plasma (FFP) transfusions, New York Heart Association (NYHA) class, preoperative creatinine, left ventricular ejection fraction (LVEF), RBC count, platelet (PLT) count, prothrombin time, intraoperative autologous blood, total output, total input, aortic cross-clamp (ACC) time, postoperative white blood cell (WBC) count, aspartate aminotransferase (AST), alanine aminotransferase (ALT), PLT count, hemoglobin (Hb), and LVEF. The prediction models for infection after mitral valve surgery were established based on these variables, and they all showed excellent discrimination performance in the test set (AUC > 0.79). Conclusions Key features selected by machine learning methods can accurately predict infection after mitral valve surgery, guiding physicians in taking appropriate preventive measures and diminishing the infection risk.
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Affiliation(s)
- Ningjie Zhang
- Department of Blood Transfusion, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Kexin Fan
- Department of Laboratory Medicine, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Hongwen Ji
- Department of Anesthesiology, Fuwai Hospital National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Xianjun Ma
- Department of Blood Transfusion, Qilu Hospital of Shandong University, Jinan, China
| | - Jingyi Wu
- Department of Transfusion, Xiamen Cardiovascular Hospital Xiamen University, Xiamen, China
| | - Yuanshuai Huang
- Department of Transfusion, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Xinhua Wang
- Department of Transfusion, Beijing Aerospace General Hospital, Beijing, China
| | - Rong Gui
- Department of Transfusion, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Bingyu Chen
- Department of Transfusion, Zhejiang Provincial People's Hospital, Hangzhou, China
| | - Hui Zhang
- Department of Basic Medical Sciences, Changsha Medical University, Changsha, China
| | - Zugui Zhang
- Institute for Research on Equity and Community Health, Christiana Care Health System, Newark, DE, United States
| | - Xiufeng Zhang
- Department of Respiratory Medicine, Second Affiliated Hospital of Hainan Medical University, Haikou, China
| | - Zheng Gong
- Sino-Cellbiomed Institutes of Medical Cell & Pharmaceutical Proteins Qingdao University, Qingdao, Shandong, China
- Department of Basic Medicine, Xiangnan University, Chenzhou, China
| | - Yongjun Wang
- Department of Blood Transfusion, The Second Xiangya Hospital, Central South University, Changsha, China
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Muacevic A, Adler JR, AlShaikh BA, Alosaimi MA, Alghamdi AY, Yusnoraini N, Almashhor A. Risk Factors for Post-cardiac Surgery Infections. Cureus 2022; 14:e31198. [PMID: 36505103 PMCID: PMC9728502 DOI: 10.7759/cureus.31198] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/07/2022] [Indexed: 11/09/2022] Open
Abstract
Background Cardiac surgery infection is a life-threatening complication associated with high morbidity and mortality. One of the main types of these infections, surgical site infections (SSIs), also called postoperative wound infections basically delayed the post-surgical recovery in many patients. These infections rarely happen within 30 days after surgery due to different risk factors. Objectives The purpose of this study is to determine the risk factors that are involved in causing post-cardiac surgical infections. Methods This study was a retrospective study. The data of postoperative cardiac patients was obtained from the Cardiology and Cardiac Surgery Center in King Fahad Armed Force Hospital, Jeddah. Data on the patients were collected from 2016 to 2021. Eligible patients were those of age 18 and greater. These patients were evaluated on basis of the pre and postoperative risk factors and were analyzed for 30 days after discharge and those that developed SSIs were identified. Results Out of the total number of 2366 patients, 151 patients (6.4%) were identified with post-surgery infections out of which 107 (4.5%) had developed superficial wound infections (SSWIs) and 44 (1.9%) had developed deep wound infections (DSWIs). Infection mainly occurs in the male population (n=88, 58.3%). Major risk factors that were the main cause of post-cardiac surgery infections were diabetes (61.5%), hypertension (56.9%), smoking (38.4%), renal failure (27.1%), and re-do operation (25.1%). Conclusion Our study has demonstrated major risk factors that are involved in the occurrence of post-cardiac surgery infections like smoking, diabetes mellitus, sex, more than one operation during a single stay, etc. In the future, the contribution of various other factors involved in the occurrence of surgical site infections and best practices and methods should be studied and implemented to prevent the occurrence of post-cardiac surgery infections. Various simple techniques can still be utilized to prevent these sorts of infections, which will decrease the mortality rate.
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Westerway SC, Basseal JM. Endocavity Ultrasound Transducers: Why High-Level Disinfection Is Necessary. ULTRASCHALL IN DER MEDIZIN (STUTTGART, GERMANY : 1980) 2022; 43:204-208. [PMID: 32731272 DOI: 10.1055/a-1168-6602] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
As a medical imaging modality, ultrasound is used by a wide cross-section of practitioners including radiologists, obstetricians, gynecologists, gastroenterologists, urologists and cardiologists. The increasing popularity of ultrasound as a diagnostic tool is due not only to the ease of use and portability of systems, but also to the perceived safety aspect of the examination. This latter point needs to be examined. As with any reusable medical device, the ultrasound transducer, also known as a probe, could potentially be a vector for the transmission of pathogenic viruses and fungi between patients if not correctly disinfected after each use. This transmission risk is magnified for an endocavity transducer that has come in contact with the vagina, anal canal or oral cavity, as it could be contaminated with organisms transmitted by blood or mucosal, genital or rectal secretions. Based on the Spaulding system, transducers that come in contact with mucous membranes are classified as semi-critical devices that require high-level disinfection (HLD) after each patient procedure. This HLD process should eliminate all microorganisms except high numbers of bacterial endospores. Only a small number of countries worldwide have implemented transducer reprocessing guidelines that adhere to the Spaulding classification and recommend HLD for endocavity transducers. Overall, there is a lack of conformity among global health agencies regarding the use of HLD for endocavity transducers. This is primarily due to the perception that the infection transmission risk is negligible and that if an endocavity transducer has been covered with a single-use sheath for the procedure, then low-level disinfection provides sufficient protection against pathogen transmission. The objective of this study was to review the published risk of infection transmission from endocavity transducers. By highlighting the outbreaks and case reports that implicate pathogen transmission from transducers, we posit that HLD should be a global standard of practice for the reprocessing of endocavity transducers. It requires substantial time for national health administrations to develop and legislate new recommendations, and for practice changes to be accepted and implemented by healthcare providers. We recommend that Joint Commission International (JCI) and other equivalent organizations enforce the use of HLD of endocavity ultrasound transducers during their accreditation reviews.
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Affiliation(s)
| | - Jocelyne M Basseal
- Discipline of Infectious Diseases & Immunology, The University of Sydney Faculty of Medicine and Health, Sydney, Australia
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Chernevskaya E, Zuev E, Odintsova V, Meglei A, Beloborodova N. Gut Microbiota as Early Predictor of Infectious Complications before Cardiac Surgery: A Prospective Pilot Study. J Pers Med 2021; 11:jpm11111113. [PMID: 34834465 PMCID: PMC8622065 DOI: 10.3390/jpm11111113] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 10/26/2021] [Accepted: 10/27/2021] [Indexed: 02/06/2023] Open
Abstract
Cardiac surgery remains a field of medicine with a high percentage of postoperative complications, including infectious ones. Modern data indicate a close relationship of infectious disorders with pathological changes in the composition of the gut microbiome; however, the extent of such changes in cardiac surgery patients is not fully clarified. In this prospective, observational, single center, pilot study, 72 patients were included, 12 among them with the infectious complications. We analyzed the features of the fecal microbiota before and in the early postoperative period, as one of the markers for predicting the occurrence of bacterial infection. We also discovered the significant change in microbial composition in the group of patients with infectious complications compared to the non-infectious group before and after cardiac surgery, despite the intra-individual variation in composition of gut microbiome. Our study demonstrated that the group of patients that had a bacterial infection in the early postoperative period already had an altered microbial composition even before the surgery. Further studies will evaluate the clinical significance of the identified proportions of individual taxa of the intestinal microbiota and consider the microbiota as a novel target for reducing the risk of infectious complications.
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Affiliation(s)
- Ekaterina Chernevskaya
- Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, 25-2 Petrovka Str., 107031 Moscow, Russia; (E.Z.); (A.M.); (N.B.)
- Correspondence: ; Tel.: +7-906-792-7041
| | - Evgenii Zuev
- Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, 25-2 Petrovka Str., 107031 Moscow, Russia; (E.Z.); (A.M.); (N.B.)
- N. Pirogov National Medical Surgical Center, 70 Nizhnyaya Pervomayskaya Str., 105203 Moscow, Russia
| | - Vera Odintsova
- Atlas Biomed Group—Knomics LLC, 31 Malaya Nikitskaya Str., 121069 Moscow, Russia;
| | - Anastasiia Meglei
- Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, 25-2 Petrovka Str., 107031 Moscow, Russia; (E.Z.); (A.M.); (N.B.)
| | - Natalia Beloborodova
- Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, 25-2 Petrovka Str., 107031 Moscow, Russia; (E.Z.); (A.M.); (N.B.)
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Yang G, Huang X, Jiang S, Xu Z. Endogenous Endophthalmitis Caused by Klebsiella pneumoniae: A Ten-Year Retrospective Study in Western China. Ophthalmic Res 2020; 63:507-516. [PMID: 31940653 DOI: 10.1159/000505928] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 01/12/2020] [Indexed: 02/05/2023]
Abstract
OBJECTIVES The aim of this study was to analyse the clinical features, microbiology results, management and outcomes of patients with endogenous endophthalmitis caused by Klebsiella pneumoniae in western China. METHODS A retrospective review of medical records of 10 eyes in 10 subjects diagnosed with endogenous K. pneumoniae endophthalmitis from January 2008 to December 2018 was undertaken. RESULTS The top 3 predisposing medical conditions included diabetes mellitus (50%), malignancy (20%) and cardiac stent implantation (10%). Extraocular infective foci were mainly found in the liver (40%), lungs (20%) and kidneys (10%). The positive culture rate was 85.71% (6/7) in vitreous samples, 83.33% (5/6) in blood samples and 100% (4/4) in body fluid samples. Only 20% of the patients, who had good initial visual acuity (VA) better than hand movement (HM), achieved a final VA better than 1.0 (log MAR). The mortality rate was 10%. CONCLUSIONS Though the prognosis of endogenous K. pneumoniae endophthalmitis is often poor, patients with an initial VA better than HM may have a good prognosis under comprehensive treatments, including vitrectomy, systemic sensitive antibiotic injection and drainage of the primary infection loci.
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Affiliation(s)
- Guoyuan Yang
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, China
| | - Xi Huang
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, China
| | - Shanming Jiang
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, China
| | - Zhuping Xu
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, China,
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Vesteinsdottir E, Helgason KO, Sverrisson KO, Gudlaugsson O, Karason S. Infections and outcomes after cardiac surgery-The impact of outbreaks traced to transesophageal echocardiography probes. Acta Anaesthesiol Scand 2019; 63:871-878. [PMID: 30888057 PMCID: PMC6619098 DOI: 10.1111/aas.13360] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 02/18/2019] [Indexed: 01/13/2023]
Abstract
Background Infections are a frequent complication of cardiac surgery. The intraoperative use of transesophageal echocardiography (TEE) may be an underrecognized risk factor for post‐operative infections. The aim of this study was to investigate infection rates and outcomes after cardiac surgery in a nationwide cohort, especially in relation to periods where surface damaged TEE probes were used. Methods This was a retrospective, observational study at Landspitali University Hospital. All consecutive cardiac surgery patients from 1 January 2013 to 31 December 2017 were included. Patients’ charts were reviewed for evidence of infection, post‐operative complications or death. Results During the study period, 973 patients underwent cardiac surgery at Landspitali and 198 (20.3%) developed a post‐operative infection. The most common infections were: Pneumonia (9.1%), superficial surgical site (5.7%), bloodstream (2.8%) and deep sternal wound (1.7%). Risk factors for developing an infection included: The duration of procedure, age, insulin‐dependent diabetes, EuroScore II, reoperation for bleeding and an operation in a period with a surface damaged TEE probe in use. Twenty‐two patients were infected with a multidrug resistant strain of Klebsiella oxytoca, 10 patients with Pseudomonas aeruginosa and two patients developed endocarditis with Enterococcus faecalis. All three pathogens were cultured from the TEE probe in use at respective time, after decontamination. The 30‐day mortality rate in the patient cohort was 3.2%. Conclusions The intraoperative use of surface damaged TEE probes caused two serious infection outbreaks in patients after cardiac surgery. TEE probes need careful visual inspection during decontamination and probe sheaths are recommended.
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Affiliation(s)
- Edda Vesteinsdottir
- Department of Anaesthesia and Intensive Care Landspitali - The National University Hospital of Iceland Reykjavik Iceland
| | - Kristjan Orri Helgason
- Department of Clinical Microbiology Landspitali - The National University Hospital of Iceland Reykjavik Iceland
| | - Kristinn Orn Sverrisson
- Department of Anaesthesia and Intensive Care Landspitali - The National University Hospital of Iceland Reykjavik Iceland
| | - Olafur Gudlaugsson
- Department of Infectious Diseases Landspitali - The National University Hospital of Iceland Reykjavik Iceland
| | - Sigurbergur Karason
- Department of Anaesthesia and Intensive Care Landspitali - The National University Hospital of Iceland Reykjavik Iceland
- Faculty of Medicine, School of Health Sciences University of Iceland Reykjavik Iceland
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