Descending aortic calcification increases renal dysfunction and in-hospital mortality in cardiac surgery patients with intraaortic balloon pump counterpulsation placed perioperatively: a case control study

The relationship between aortic calcification on chest radiograph and neurocognitive impairment after coronary artery bypass grafting

Background

In this study, we aimed to investigate the possible relationship between aortic calcification as detected by preoperative chest radiography and postoperative neurocognitive impairment in patients undergoing coronary artery bypass grafting.

Methods

A total of 124 patients (101 males, 23 females; mean age: 59.9±8.8 years; range, 34 to 84 years) who underwent coronary artery bypass grafting in our clinic between January 2019 and July 2019 were included. Of these patients, 35 whose preoperative chest radiography revealed aortic calcification in the aortic knuckle were included as the patient group. The control group consisted of 89 patients without aortic calcification. The patients with aortic calcification underwent additional imaging with thoracic computed tomography angiography and ascending aorta and aortic arch calcium scores were calculated. Neurocognitive dysfunction was assessed using the Standardized Mini-Mental State Examination. Postoperative delirium was evaluated by confusion assessment method in the intensive care unit. Both groups were compared for demographic, operative and postoperative data.

Results

Of all patients included in the study, the overall cerebrovascular event incidence was 3.2%. Although not statistically significant, the number of patients with neurocognitive decline was higher in the patient group than the control group (48.6% vs. 34.8%, respectively; p=0.157). Both Standardized Mini-Mental State Examination score decline and percentage decline were significantly higher in the patients with high aortic arch calcium scores (>2,250 AU). Carotid artery stenosis was 3.2 times higher in the patient group. In the patients with carotid artery stenosis, the aortic arch calcium scores were also higher (p=0.042).

Conclusion

Aortic calcification detectable on chest radiography with high calcium scores may be associated with neurocognitive impairment and carotid artery stenosis in patients undergoing coronary artery bypass grafting.

Continuous glucose monitoring on the ICU using a subcutaneous sensor

INTRODUCTION

Hypoglycemia is a frequent and feared complication of insulin therapy on the intensive care unit (ICU). Sedated patients in particular are at risk for hypoglycemia due to the absence of clinical symptoms. Furthermore, recent studies point to a correlation between the variability of blood glucose and mortality. Therefore, continuous glucose monitoring has the potential to influence outcome due to a better control of blood glucose in critically ill patients.

MATERIALS AND METHODS

We evaluated the efficacy, accuracy and safety of a new commercially available subcutaneous continuous glucose monitoring system (sCGM; Sentrino®, Medtronic) in a pilot study in critically ill adult patients. sCGM data were recorded for up to 72 h and values were compared with blood glucose values measured by cassette-based blood gas analyzer (BGA).

RESULTS

A total of 14 patients (eight male, six female), with a mean age of 62.1 ± 9.8 years, referred to the ICU after major abdominal surgery were studied. The average simplified acute physiology score (SAPS II) was 35 ± 9. Three patients had known type II diabetes. The average runtime of sensors was 44.1 ± 22.1 h. In comparison to BGA, measurement of blood glucose by sCGM revealed an accuracy of 1.5 mg/dl, and a precision of +34.2 mg/dl to -31.2 mg/dl. Linn's concordance correlation coefficient yielded 0.74 with a 95% confidence interval of 0.68-0.78. No hypoglycemic events, defined as a blood glucose level below 70 mg/dl, occurred during treatment.

CONCLUSIONS

sCGM monitoring via a subcutaneous sensor demonstrated high accuracy and considerable variability compared to blood gas samples, even in critically ill patients.

Year in review 2012: Critical Care--Cardiology

In this review I discuss key research papers in cardiology and intensive care published in Critical Care during 2012 with related studies published in other journals quoted whenever appropriate. These studies are grouped into the following categories: cardiovascular therapies, mechanical therapies, pathophysiologic mechanisms, hemodynamic monitoring, ultrasound in respiratory failure, microcirculation, and miscellaneous.

Transesophageal echocardiography in noncardiac thoracic surgery

In high-risk surgeries with medically complicated patients, transesophageal echocardiography (TEE) adds an additional level of monitoring with which few can disagree. This article presents multiple applications of TEE that can assist both the anesthesiologist and the surgeon through major noncardiac thoracic surgery. It highlights how TEE can be used as an adjuvant to lung resection surgery; TEE as a monitor during lung transplantation; TEE to assess patients for extracorporeal membrane oxygenation; TEE for thoracic aortic surgery; and TEE in the assessment of patients with acute pulmonary hypertension undergoing noncardiac thoracic surgery.