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Park SJ, Park SY, Kang SY, Kim JH, Heo JY, Yoo JY. The effect of ulinastatin on acute kidney injury in patients undergoing off-pump cardiac bypass surgery. J Cardiothorac Surg 2024; 19:96. [PMID: 38360763 PMCID: PMC10870510 DOI: 10.1186/s13019-024-02562-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 01/30/2024] [Indexed: 02/17/2024] Open
Abstract
BACKGROUND Ulinastatin, an anti-inflammatory and antioxidant trypsin inhibitor, has shown potential in mitigating acute kidney injury (AKI) and reducing serum creatinine levels after various surgeries. This retrospective study aimed to evaluate the effects of ulinastatin on AKI in patients undergoing off-pump coronary artery bypass (OPCAB) surgery. METHODS We hypothesized that the administration of ulinastatin could prevent AKI in OPCAB. Electrical medical records were reviewed to identify OPCAB patients between January 2015 and June 2020. The utilization of ulinastatin was randomly determined and applied during this period. Acute kidney injury was defined according to the KDIGO guideline, and its incidence was compared between the ulinastatin administration group and the control group. To investigate the effect of ulinastatin on renal function, multivariate logistic regression analysis was used to calculate propensity scores for each group. RESULTS A total 454 OPCAB were performed, and after following inclusion and exclusion process, 100 patients were identified in the ulinastatin group and 303 patients in the control group. Using 1:2 propensity score matching, we analyzed 100 and 200 patients in the ulinastatin and control groups. The incidence of AKI was similar between the groups (2.5% for the control group, 2.0% for the ulinastatin group, p > 0.999). However, the serum creatinine value on the first post-operative day were significantly lower in the ulinastatin group compared to the control group (0.774 ± 0.179 mg/dL vs 0.823 ± 0.216 mg/dL, P = 0.040), while no significant differences were observed for the other time points (P > 0.05). The length of ICU stay day was significantly shorter in the ulinastatin group (2.91 ± 2.81 day vs 5.22 ± 7.45 day, respectively, P < 0.001). CONCLUSIONS Ulinastatin did not have a significant effect on the incidence of AKI; it demonstrated the ability to reduce post-operative serum creatine levels at first post-operative day and shorten the length of ICU stay.
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Affiliation(s)
- Soo Jung Park
- Department of Anesthesiology and Pain Medicine, Ajou University School of Medicine, 164 Worldcup-Ro, Yeongtong-Gu, Suwon, Korea
| | - Sung Yong Park
- Department of Anesthesiology and Pain Medicine, Ajou University School of Medicine, 164 Worldcup-Ro, Yeongtong-Gu, Suwon, Korea
| | - Se Yoon Kang
- Department of Anesthesiology and Pain Medicine, Ajou University School of Medicine, 164 Worldcup-Ro, Yeongtong-Gu, Suwon, Korea
| | - Ji Ho Kim
- Department of Medical Sciences, Ajou University School of Medicine, Suwon, Korea
| | - Ji Yeong Heo
- Department of Anesthesiology and Pain Medicine, Ajou University School of Medicine, 164 Worldcup-Ro, Yeongtong-Gu, Suwon, Korea
| | - Ji Young Yoo
- Department of Anesthesiology and Pain Medicine, Ajou University School of Medicine, 164 Worldcup-Ro, Yeongtong-Gu, Suwon, Korea.
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Lin L, Niu M, Gao W, Wang C, Wu Q, Fang F, Wang Y, Wang W. Predictive role of glycocalyx components and MMP-9 in cardiopulmonary bypass patients for ICU stay. Heliyon 2024; 10:e23299. [PMID: 38163126 PMCID: PMC10756997 DOI: 10.1016/j.heliyon.2023.e23299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 11/29/2023] [Accepted: 11/30/2023] [Indexed: 01/03/2024] Open
Abstract
Background Shedding of glycocalyx is relevant to worse prognosis in surgical patients, and elevated levels of serum matrix metalloproteinase-9 (MMP-9) are associated with this phenomenon. This study aimed to investigate the dynamic alterations of serum glycocalyx components and MMP-9 during cardiopulmonary bypass (CPB), and evaluate their predictive capacities for prolonged intensive care unit (ICU) stay, as well as their correlation with coagulation dysfunction. Methods This retrospective study analyzed serum levels of syndecan-1, heparan sulfate (HS), and MMP-9 at different time points during CPB, and assessed their association with prolonged ICU stay and coagulation dysfunction. Results Syndecan-1, HS, and MMP-9 exhibited divergent changes during CPB. Serum levels of syndecan-1 (AUC = 78.0 %) and MMP-9 (AUC = 78.4 %) were validated as reliable predictors for prolonged ICU stay, surpassing the predictive value of creatinine (AUC = 70.0 %). Syndecan-1 (rho = 0.566, P < 0.01 at T1 and rho = 0.526, P < 0.01 at T2) and HS (rho = 0.403, P < 0.05 at T4) exhibited correlations with activated partial thromboplastin time (APTT) ratio beyond the normal range. Conclusions Our findings advocate the potential efficacy of serum glycocalyx components and MMP-9 as early predictive indicators for extended ICU stay following cardiac surgery with CPB. Additionally, we observed a correlation between glycocalyx disruption during CPB and coagulation dysfunction. Further studies with expansive cohorts are warranted to consolidate our findings and explore the predictive potential of other glycocalyx components.
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Affiliation(s)
- Lina Lin
- Department of Anesthesiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, 325000, China
| | - Mengying Niu
- Department of Anesthesiology, Peking University Third Hospital, Beijing, 100191, China
| | - Wei Gao
- Department of Anesthesiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, 325000, China
| | - Chundong Wang
- Department of Anesthesiology, Affiliated Dongyang Hospital of Wenzhou Medical University, Dongyang, Zhejiang, 322100, China
| | - Qiaolin Wu
- Department of Anesthesiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, 325000, China
| | - Fuquan Fang
- Department of Anesthesiology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, 310003, China
| | - Yongan Wang
- Department of Anesthesiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, 325000, China
| | - Weijian Wang
- Department of Anesthesiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, 325000, China
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Ma Y, Sui D, Yang S, Yang X, Oldam J, Semel JL, Wang Z, Fang N. Optimal postoperative delirium prediction after coronary artery bypass grafting surgery: a prospective cohort study. Front Cardiovasc Med 2023; 10:1251617. [PMID: 38144372 PMCID: PMC10739452 DOI: 10.3389/fcvm.2023.1251617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 11/27/2023] [Indexed: 12/26/2023] Open
Abstract
Background Postoperative delirium (POD) presents as a serious neuropsychiatric syndrome in patients undergoing off-pump coronary artery bypass grafting (OPCABG) surgery. This is correlated with higher mortality, cognitive decline, and increased costs. The Age-adjusted Charlson Comorbidity Index (ACCI) is recognized as an independent predictor for mortality and survival rate. The purpose of our study is to estimate the predictive value of the ACCI on the POD in patients undergoing OPCABG surgery. Methods This prospective cohort study enrolled patients undergoing OPCABG surgery between December 2020 and May 2021 in Qilu Hospital. Patients were divided into the low-ACCI group (score, 0-3) and the high-ACCI group (score ≥4) according to their ACCI scores. The Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) and CAM were used to diagnose POD within 7 days after surgery. The general, laboratory, and clinical data of the patients were recorded and collected. The characteristic ROC curve was applied to further assess the predictive value of the ACCI for POD in patients following OPCABG surgery. Results A total of 89 patients were enrolled, including 45 patients in the low-ACCI group and 44 patients in the high-ACCI group. The incidence of POD was higher in the high-ACCI group than in the low-ACCI group (45.5% vs. 15.6%, P = 0.003). Multivariate logistic regression analyses showed that the ACCI (OR, 2.433; 95% CI, 1.468-4.032; P = 0.001) was an independent risk factor for POD. The ACCI accurately predicted POD in patients following OPCABG surgery with an AUC of 0.738, and the Hosmer-Lemeshow goodness of fit test yielded X2 = 5.391 (P = 0.145). Conclusion The high-ACCI group showed a high incidence of POD. The ACCI was an independent factor associated with POD in patients following OPCABG surgery. In addition, the ACCI could accurately predict POD in patients following OPCABG surgery. Clinical Trial Registration ClinicalTrials.gov, identifier CHiCTR2100052811.
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Affiliation(s)
- Ying Ma
- Department of Geriatric Medicine, Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University, Qingdao, China
| | - Dongxin Sui
- Department of Respiration, The Second Hospital of Shandong University, Jinan, Shandong, China
| | - Shaozhong Yang
- Department of Anesthesiology, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Xiaomei Yang
- Department of Anesthesiology, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Joseph Oldam
- B.S. Neuroscience, Center for Research on Cardiac Intermediate Filaments, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Jessica L. Semel
- Centerfor Research on Cardiac Intermediate Filaments, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Zhihao Wang
- Department of Geriatric Medicine, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Ningning Fang
- Department of Anesthesiology, Qilu Hospital of Shandong University, Jinan, Shandong, China
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Ma Y, Li C, Peng W, Wan Q. The influence of delirium on mortality and length of ICU stay and analysis of risk factors for delirium after liver transplantation. Front Neurol 2023; 14:1229990. [PMID: 37869144 PMCID: PMC10585150 DOI: 10.3389/fneur.2023.1229990] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 09/13/2023] [Indexed: 10/24/2023] Open
Abstract
Objective To analyze the incidence, timing, risk factors and prognosis of delirium after liver transplantation (LT). Methods The clinical data of 321 patients undergoing LT in the Third Xiangya Hospital of Central South University from January 2018 to December 2022 were collected to investigate the incidence, onset, and risk factors for post-LT delirium and the impact of delirium on LT recipients' prognosis by statistical analysis. Results The incidence of post-LT delirium was 19.3% (62/321), and the median interval between LT and onset of delirium was 20.1 h. Univariate analysis showed that pre-LT variables (Model for End Stage Liver Disease (MELD) score, hospital stay, hepatic encephalopathy, infection, white blood cell (WBC) count, lymphocyte count, abnormal potassium, lactulose use), intraoperative variables (red blood cell transfusion, remimazolam use, dexmedetomidine use) and post-LT variables (hypernatraemia, acute rejection, reoperation, basiliximab use, tacrolimus concentration) were associated with post-LT delirium. Multivariate logistic regression analysis revealed that MELD score at LT ≥22 [OR = 3.400, 95% CI:1.468-7.876, p = 0.004], pre-LT hepatic encephalopathy [OR = 3.224, 95% CI:1.664-6.244, p = 0.001], infection within 2 months prior to LT [OR = 2.238, 95% CI:1.151-4.351, p = 0.018], acute rejection [OR = 2.974, 95% CI:1.322-6.690, p = 0.008], and reoperation [OR = 11.919, 95% CI:2.938-48.350, p = 0.001] were independent risk factors for post-LT delirium. Post-LT delirium was reduced in LT recipients exposing to intraoperative remimazolam [OR = 0.287, 95% CI: 0.113-0.733, p = 0.009] or ≥ 25 μg of intraoperative dexmedetomidine [OR = 0.441, 95% CI 0.225-0.867, p = 0.018]. As for clinical outcomes, patients with delirium had a higher percentage of staying at the (ICU) ≥7 d after LT than those without delirium [OR = 2.559, 95% CI 1.418-4.617, p = 0.002]. Conclusion The incidence of delirium was high and the onset of delirium was early after LT. Risk factors for post-LT delirium included high MELD score at LT, pre-LT hepatic encephalopathy and infections, acute rejection and reoperation. Intraoperative use of remimazolam or dexmedetomidine reduced post-LT delirium. Delirium had a negative impact on the length of ICU stay.
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Affiliation(s)
- Ying Ma
- Department of Transplant Surgery, The Third Xiangya Hospital of Central South University, Changsha, China
- Engineering and Technology Research Center for Transplantation Medicine of National Health Commission, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Cuiying Li
- Department of Transplant Surgery, The Third Xiangya Hospital of Central South University, Changsha, China
- Engineering and Technology Research Center for Transplantation Medicine of National Health Commission, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Weiting Peng
- Class 2, Grade 2019, 8-Year Clinical Medicine Program, Xiangya School of Medicine, Central South University, Changsha, China
| | - Qiquan Wan
- Department of Transplant Surgery, The Third Xiangya Hospital of Central South University, Changsha, China
- Engineering and Technology Research Center for Transplantation Medicine of National Health Commission, The Third Xiangya Hospital of Central South University, Changsha, China
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Colson P, Fellahi JL, Gaudard P, Provenchère S, Rozec B. Cost Analysis of Aprotinin Reintroduction in French Cardiac Surgery Centres: A Real-World Data-Based Analysis. Adv Ther 2023; 40:1803-1817. [PMID: 36867329 PMCID: PMC10070296 DOI: 10.1007/s12325-023-02464-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 02/14/2023] [Indexed: 03/04/2023]
Abstract
INTRODUCTION The European Medicines Agency restored aprotinin (APR) use for preventing blood loss in patients undergoing isolated coronary artery bypass graft (iCABG) in 2016 but requested the collection of patient and surgery data in a registry (NAPaR). The aim of this analysis was to evaluate the impact of APR reintroduction in France on the main hospital costs (operating room, transfusion and intensive unit stay) compared to the current use of tranexamic acid (TXA), which was the only antifibrinolytic available before APR reinstatement. METHODS A multicenter before-after post-hoc analysis to compare APR and TXA was carried out in four French university hospitals. APR use followed the ARCOTHOVA (French Association of Cardiothoracic and Vascular Anesthetists) protocol, which had framed three main indications in 2018. Data from 236 APR patients were retrieved from the NAPaR (N = 874); 223 TXA patients were retrospectively retrieved from each center database and matched to APR patients upon indication classes. Budget impact was evaluated using both direct costs associated with antifibrinolytics and transfusion products (within the first 48 h) and other costs such as surgery duration and ICU stay. RESULTS The 459 collected patients were distributed as: 17% on-label; 83% off-label. Mean cost per patient until ICU discharge tended to be lower in the APR group versus the TXA group, which resulted in an estimated gross saving of €3136 per patient. These savings concerned operating room and transfusion costs but were mainly driven by reduced ICU stays. When extrapolated to the whole French NAPaR population, the total savings of the therapeutic switch was estimated at around €3 million. CONCLUSION The budget impact projected that using APR according to ARCOTHOVA protocol resulted in decreased requirement for transfusion and complications related to surgery. Both were associated with substantial cost savings from the hospital's perspective compared with exclusive use of TXA.
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Affiliation(s)
- Pascal Colson
- Department of Anesthesiology and Critical Care Medicine, Arnaud de Villeneuve Hospital, CHU Montpellier, 371 avenue du doyen Gaston Giraud, 34295, Montpellier, France.
- Montpellier University, INSERM, CNRS, Institut de Génomique Fonctionnelle, Montpellier, France.
| | - Jean-Luc Fellahi
- Department of Anesthesiology and Critical Care Medicine, Louis Pradel Hospital, Hospices Civils de Lyon, 59 Boulevard Pinel, 69500, Lyon, France
- Laboratoire CarMeN, Inserm U1060, Université Claude Bernard Lyon 1, Lyon, France
| | - Philippe Gaudard
- Department of Anesthesiology and Critical Care Medicine, Arnaud de Villeneuve Hospital, CHU Montpellier, 371 avenue du doyen Gaston Giraud, 34295, Montpellier, France
- University of Montpellier, PhyMedExp, INSERM, CNRS, Montpellier, France
| | - Sophie Provenchère
- Department of Anesthesiology and Critical Care Medecine, AP-HP, Bichat-Claude-Bernard Hospital, Paris, France
- INSERM Clinical Investigation Center 007, Paris, France
| | - Bertrand Rozec
- Service d'Anesthésie-Réanimation, hôpital Laënnec, Centre Hospitalier Universitaire, 44093, Nantes, France
- Institut du Thorax, Institut National de la Santé et de la Recherche Médicale (INSERM), Centre National de la Recherche Scientifique (CNRS), Université de Nantes, 44093, Nantes, France
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Jamaati H, Karimi S, Ghorbani F, Panahi Y, Hosseini-Baharanchi FS, Hajimoradi M, Malek R, Noorali S, Mokhtari M, Khoundabi B, Sadr M, Mohamadnia A, Zahraei SM, Hashemian SM, Dastan F, Mortaz E, Tayeri K, Behtaj F, Vaezi H, Forouzanfar MM, Shafaghi S. Effectiveness of Different Vaccine Platforms in Reducing Mortality and Length of ICU Stay in Severe and Critical Cases of COVID-19 in the Omicron Variant Era: A National Cohort Study in Iran. J Med Virol 2023; 95:e28607. [PMID: 36815507 DOI: 10.1002/jmv.28607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 01/24/2023] [Accepted: 02/13/2023] [Indexed: 02/24/2023]
Abstract
OBJECTIVES Various SARS-CoV-2 vaccines with different platforms have been administered worldwide; however, their effectiveness in critical cases of COVID-19 has remained a concern. METHODS In this national cohort study, 24,016 ICU COVID-19 admissions were included from January to April 2022. The mortality and length of ICU-stay were compared between the vaccinated and unvaccinated patients. RESULTS 9,428(39.25%) patients were unvaccinated, and 14,588(60.75%) patients had received at least one dose of the vaccine. Compared to the unvaccinated, the first, second, and third doses of vaccine resulted in 8%, 20%, and 33% lower risk of ICU mortality in the adjusted model, with RR 0.92, 95%CI(0.84 to 1.001), RR 0.80, 95%CI(0.77 to 0.83), and RR 0.67, 95%CI(0.64 to 0.71), respectively. The mean survival time was significantly shorter in the unvaccinated versus the fully vaccinated patients(HR 0.84, 95%CI(0.80 to 0.88); p<0.001). All vaccine platforms successfully decreased the hazard of ICU death compared to the unvaccinated group. The duration of ICU-stay was significantly shorter in the fully vaccinated than in unvaccinated group(MD -0.62, 95%CI(-0.82 to -0.42);p<0.001). CONCLUSIONS Since COVID-19 vaccination in all doses and platforms has been able to reduce the risk of mortality and length of ICU-stay, universal vaccination is recommended based on vaccine availability. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Hamidreza Jamaati
- Chronic Respiratory Disease Research Center, National Research Institute of Tuberculosis and Lung Disease, Shahid Beheshti University of Medical Science, Tehran, Iran
| | - Saeed Karimi
- Ophthalmic research center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fariba Ghorbani
- Tracheal Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Yunes Panahi
- Pharmacotherapy Department Faculty of Pharmacy, Bagyattallah University of Medical Sciences
| | | | - Maryam Hajimoradi
- Lung Transplantation Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Rayka Malek
- Department of Biostatistics, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Sima Noorali
- Lung Transplantation Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Majid Mokhtari
- Department of Pulmonary and Critical Care Medicine, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Batoul Khoundabi
- Iran Helal Institute of Applied-Science and Technology, Research Center for Health Management in Mass Gathering, Red Crescent Society of the Islamic Republic of Iran, Tehran, Iran
| | - Makan Sadr
- Virology Research Center, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Abdolreza Mohamadnia
- Chronic Respiratory Disease Research Center, National Research Institute of Tuberculosis and Lung Disease, Shahid Beheshti University of Medical Science, Tehran, Iran
| | - Seyed Mohsen Zahraei
- Center for Communicable Disease Control, Ministry of Health and Medical Education, Tehran, Iran
| | - Seyed MohammadReza Hashemian
- Chronic Respiratory Disease Research Center, National Research Institute of Tuberculosis and Lung Disease, Shahid Beheshti University of Medical Science, Tehran, Iran
| | - Farzaneh Dastan
- Chronic Respiratory Disease Research Center, National Research Institute of Tuberculosis and Lung Disease, Shahid Beheshti University of Medical Science, Tehran, Iran.,Department of Clinical Pharmacy, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Esmaeil Mortaz
- Department of Immunology, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Clinical Tuberculosis and Epidemiology Research Center, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Katayoun Tayeri
- Center for Communicable Disease Control, Ministry of Health and Medical Education, Tehran, Iran
| | - Fatemeh Behtaj
- Deputy for treatment, Ministry of Health and Medical Education
| | - Hassan Vaezi
- Hospital Management and Clinical Excellence Center, Deputy for Treatment, Ministry of Health and Medical Education
| | - Mohammad Mehdi Forouzanfar
- Department of Emergency Medicine, School of Medicine, Shohada-e-Tajrish hospital, Shahid Beheshti University of Medical Science
| | - Shadi Shafaghi
- Lung Transplantation Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Said ASA, Hussein RRS, Khalil DM, Fahmy AM, Hassanein AHA, Abdelaty LN. Monotherapy versus polytherapy of enoxaparin and hydroxychloroquine for the treatment of COVID-19: A randomized controlled clinical trial. Pharm Pract (Granada) 2023; 21:2777. [PMID: 37090452 PMCID: PMC10117317 DOI: 10.18549/pharmpract.2023.1.2777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 11/03/2022] [Indexed: 04/08/2023] Open
Abstract
Objectives The current study aims to assess the efficacy and safety of Enoxaparin and hydroxychloroquine (HCQ) used as monothrapy or polytherapy versus standard care alone in Coronavirus 2019 (COVID-19) infected patients. Methods The current study included two hundred patients with laboratory confirmed COVID-19 infection. Patients admitted to hospital were randomly allocated into four groups: group I: received standard COVID-19 therapy, group II: received Enoxaparin 40mg/day subcutaneously (SC) plus standard therapy, group III: received 400 mg/day HCQ plus standard therapy & group IV: received a combination of 400 mg/day HCQ and Enoxaparin plus standard COVID-19 therapy. The disease progression was evaluated by duration to a negative polymerase chain reaction (PCR), length of hospital or Intensive Care Unit (ICU) stay, and mortality rate. The safety of treatments was evaluated by measuring adverse effects. Results The length of hospital stay, ICU admission and mortality were significantly decreased in Enoxaparin plus standard COVID-19 therapy group versus other groups. Conclusion These findings suggest that Enoxaparin was safe, effective, and well tolerated and has a role in decreasing the progression of the disease and its complications while HCQ did not discover any evidence of extra therapeutic benefits.
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Affiliation(s)
- Amira S A Said
- PhD. Department of Clinical Pharmacy, College of Pharmacy, Al Ain University, Al Ain, Abu Dhabi, UAE. Department of Clinical Pharmacy, Faculty of Pharmacy, Beni-Suef University, Egypt.
| | - Raghda R S Hussein
- PhD. Department of Clinical Pharmacy, Faculty of Pharmacy, Beni-Suef University, Egypt. Department of Clinical Pharmacy, Faculty of Pharmacy, October 6 University, Egypt.
| | - Doaa Mahmoud Khalil
- MD. Department of Public Health & Community Medicine, Faculty of Medicine, Beni-Suef University, Egypt.
| | - Alzhraa M Fahmy
- MD. Department of Tropical Medicine & Infectious Diseases, Faculty of Medicine, Beni-Suef University, Egypt.
| | - Ahmed H A Hassanein
- PhD. Phd of Biotechnology, Faculty of Postgraduate Studies for Advanced Science, Beni-Suef University, Egypt.
| | - Lamiaa N Abdelaty
- PhD. Department of Clinical Pharmacy, Faculty of Pharmacy, October 6 University, Egypt.
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Katipoglu B, Aydinli B, Demir A, Ozmen H. Preoperative red cell distribution width to lymphocyte ratio as biomarkers for prolonged intensive care unit stay among older patients undergoing cardiac surgery: a retrospective longitudinal study. Biomark Med 2022; 16:1067-1075. [PMID: 36314262 DOI: 10.2217/bmm-2022-0341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Introduction: Our aim was to use the red cell distribution width-lymphocyte ratio (RLR) as a novel biomarker to predict prolonged intensive care unit (ICU) length of stay (LOS) among older patients undergoing cardiovascular surgery. Methods: This longitudinal study included older patients admitted to a tertiary cardiovascular surgery hospital between January 2017 and January 2022. Results: A total of 574 patients were studied, including 83 patients (14.5%) who had prolonged ICU LOS and 471 (85.5%) control subjects. After adjustment for the European System for Cardiac Operative Risk Evaluation 2, the RLR score showed a 10% increased risk of prolonged ICU LOS (odds ratio: 1.10; CI: 1.05-1.16; p = 0.01). Conclusion: Preoperative RLR can be used to predict the risk of long-term intensive care stay in older cardiac surgery patients.
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Affiliation(s)
- Bilal Katipoglu
- University of Health Sciences, Gulhane Faculty of Medicine & Gulhane Training and Research Hospital, Division of Geriatrics, Ankara, 06010, Turkey
| | - Bahar Aydinli
- Department of Anesthesiology, Mersin City Education and Research Hospital, Mersin, 33230, Turkey
| | - Asli Demir
- Anesthesiology and Reanimation Department, Ankara City Hospital, Ankara, 06800, Turkey
| | - Harun Ozmen
- Department of Anesthesiology, Mersin City Education and Research Hospital, Mersin, 33230, Turkey
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Chen Y, Luo M, Cheng Y, Huang Y, He Q. A nomogram to predict prolonged stay of obesity patients with sepsis in ICU: Relevancy for predictive, personalized, preventive, and participatory healthcare strategies. Front Public Health 2022; 10:944790. [PMID: 36033731 PMCID: PMC9403617 DOI: 10.3389/fpubh.2022.944790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 07/18/2022] [Indexed: 01/21/2023] Open
Abstract
Objective In an era of increasingly expensive intensive care costs, it is essential to evaluate early whether the length of stay (LOS) in the intensive care unit (ICU) of obesity patients with sepsis will be prolonged. On the one hand, it can reduce costs; on the other hand, it can reduce nosocomial infection. Therefore, this study aimed to verify whether ICU prolonged LOS was significantly associated with poor prognosis poor in obesity patients with sepsis and develop a simple prediction model to personalize the risk of ICU prolonged LOS for obesity patients with sepsis. Method In total, 14,483 patients from the eICU Collaborative Research Database were randomized to the training set (3,606 patients) and validation set (1,600 patients). The potential predictors of ICU prolonged LOS among various factors were identified using logistic regression analysis. For internal and external validation, a nomogram was developed and performed. Results ICU prolonged LOS was defined as the third quartile of ICU LOS or more for all sepsis patients and demonstrated to be significantly associated with the mortality in ICU by logistic regression analysis. When entering the ICU, seven independent risk factors were identified: maximum white blood cell, minimum white blood cell, use of ventilation, Glasgow Coma Scale, minimum albumin, maximum respiratory rate, and minimum red blood cell distribution width. In the internal validation set, the area under the curve was 0.73, while in the external validation set, it was 0.78. The calibration curves showed that this model predicted probability due to actually observed probability. Furthermore, the decision curve analysis and clinical impact curve showed that the nomogram had a high clinical net benefit. Conclusion In obesity patients with sepsis, we created a novel nomogram to predict the risk of ICU prolonged LOS. This prediction model is accurate and reliable, and it can assist patients and clinicians in determining prognosis and making clinical decisions.
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10
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Yeong EK, Tung KY, Chang CH, Tsai SJ. The relationships between routine admission blood tests and burn size, and length of stay in intensive care unit. J Formos Med Assoc 2022; 121:2512-2519. [PMID: 35701304 DOI: 10.1016/j.jfma.2022.05.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 05/03/2022] [Accepted: 05/26/2022] [Indexed: 12/17/2022]
Abstract
BACKGROUND Although blood test is a routine in major burns, its relationship with burn size and intensive care unit length of stay (ICULOS) remains undetermined. We investigated the feasibility of using these tests as a reference for definite diagnosis of major burn size, burn size >20% of the total body surface area (TBSA), and their relationships with ICULOS. METHODS Data of routine laboratory blood tests within 24 h after burns (n = 73) were collected retrospectively. Correlation tests and regression analyses were performed. RESULTS Burns ≥20 TBSA had higher incidences of leucocytosis, hypoalbuminaemia, elevated haemoglobin (Hb), and elevated haematocrit (Hct). Burn size was correlated negatively with albumin but positively with Hb, Hct, and white blood cell (WBC) count. For each unit increase in blood urea nitrogen (BUN)/creatinine (Cr), there was an increase of 1.2 days of ICULOS in females, while in males, there was a 6.7 day increase for every unit increase in Hb and a 3.1 day increase for each unit increase in BUN. A female model including Hb and WBC was derived, discriminating burns ≥20 TBSA with sensitivity and specificity 0.94 and 1.0 respectively, and area under the receiver operating characteristic curve (AUROC) 0.96 (95% CI 0.91-1.00). The male model had sensitivity 0.96, specificity 1.0, and AUROC 0.96 (95% CI 0.89-1.00). CONCLUSION Admission Hb and WBC could be used as a reference for definite diagnosis of major burn size, especially in borderline cases. BUN/Cr in females, and Hb and BUN in males, were related to ICULOS.
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Affiliation(s)
- Eng-Kean Yeong
- Division of Plastic Surgery, Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan.
| | - Kwang-Yi Tung
- Division of Plastic Surgery, Department of Surgery, Mackay Memorial Hospital, Taipei, Taiwan
| | - Chin-Hao Chang
- Department of Medical Research, National Taiwan University Hospital, Taipei, Taiwan
| | - Shang-Jie Tsai
- Department of Medical Research, National Taiwan University Hospital, Taipei, Taiwan
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11
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Mariani F, Salvaterra E, Lettieri S, De Silvestri A, Corino A, Bosio M, Fraolini E, Piloni D, Rodi G, Corsico AG, Campo I. A mini-whole lung lavage to treat autoimmune pulmonary alveolar proteinosis (PAP). Respir Res 2022; 23:60. [PMID: 35300687 DOI: 10.1186/s12931-022-01982-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 03/09/2022] [Indexed: 11/12/2022] Open
Abstract
Background PAP is an ultra-rare respiratory syndrome characterized by the accumulation of surfactant within the alveoli. Whole lung lavage (WLL) is the current standard of care of PAP, however it is not a standardized procedure and the total amount of fluid used to wash each lung is still debated. Considering ICU hospitalization associated risks, a “mini-WLL” with anticipated manual clapping and reduced total infusion volume and has been proposed in our center. The aim of the study is to retrospectively analyze the efficacy of mini-WLL compared to standard WLL at the Pavia center. Methods 13 autoimmune PAP patients eligible for WLL were included: 7 patients were admitted to mini-WLL (9 L total infusion volume for each lung) and 6 patients underwent standard WLL (14 L of infusion volume). Functional data (VC%, FVC%, TLC%, DLCO%) and alveolar-arterial gradient values (A-aO2) were collected at the baseline and 1, 3, 6, 12, 18 months after the procedure. Results A statistically significant improvement of VC% (p = 0.013, 95%CI 3.49–30.19), FVC% (p = 0.016, 95%CI 3.37–32.09), TLC% (p = 0.001, 95%CI 7.38–30.34) was observed in the mini-WLL group in comparison with the standard WLL group, while no significant difference in DLCO% and A-aO2 mean values were reported. Conclusion Mini-WLL has demonstrated higher efficacy in ameliorating lung volumes, suggesting that a lower infusion volume is sufficient to remove the surfactant accumulation and possibly allows a reduced mechanical insult of the bronchi walls and the alveoli. However, no statistically significant differences were found in terms of DLCO% and Aa-O2.
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12
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Misar A, McLin VA, Calinescu AM, Wildhaber BE. Impact of length of donor ICU stay on outcome of patients after pediatric liver transplantation with whole and ex situ split liver grafts. Pediatr Transplant 2022; 26:e14186. [PMID: 34738698 DOI: 10.1111/petr.14186] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 09/22/2021] [Accepted: 10/19/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Patients who have a prolonged stay in the intensive care unit (ICU) are often excluded for organ donation because of supposed deleterious effects of a lengthy ICU stay. We aimed to determine the effects of a prolonged donor stay in the ICU on the outcome of liver transplantation (LT) in children. METHODS Retrospective review of 89 pediatric LT patients, age 0-18 years, period 2003-2018, including patients having undergone whole organ or in situ split LT. The patients were divided into two groups according to the donor length of stay in the ICU. A prolonged stay was defined as >5 days. Recipient, graft, and donor characteristics were compared; outcome parameters included recipient and graft survival rates and postoperative complications. RESULTS Group short (donor ICU stay <5 days) included 75 patients, group long (donor ICU stay >5 days) 14 patients. Baseline characteristics between recipients did not differ. Donors in group long had significantly more infectious complications and a higher gamma glutamyl transferase (gGT) the day of organ recovery. Incidence of biliary complications post-LT was significantly higher in group long (p = .029). Patient and graft survival rates did not differ significantly between groups. CONCLUSIONS Donors with a prolonged stay in the ICU should still be considered for liver donation if they fulfill most other selection criteria. Recipients from donors having stayed in ICU >5 days may be at increased risk of biliary complications.
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Affiliation(s)
- Aline Misar
- Pediatric Surgery Unit, Department of Pediatrics, Gynecology, and Obstetrics, Swiss Pediatric Liver Center, University Center of Pediatric Surgery of Western Switzerland, University of Geneva, Geneva, Switzerland
| | - Valerie A McLin
- Pediatric Gastroenterology, Hepatology and Nutrition Unit, Department of Pediatrics, Gynecology, and Obstetrics, Swiss Pediatric Liver Center, University of Geneva, Geneva, Switzerland
| | - Ana M Calinescu
- Pediatric Surgery Unit, Department of Pediatrics, Gynecology, and Obstetrics, Swiss Pediatric Liver Center, University Center of Pediatric Surgery of Western Switzerland, University of Geneva, Geneva, Switzerland
| | - Barbara E Wildhaber
- Pediatric Surgery Unit, Department of Pediatrics, Gynecology, and Obstetrics, Swiss Pediatric Liver Center, University Center of Pediatric Surgery of Western Switzerland, University of Geneva, Geneva, Switzerland
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13
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Fan R, Xie L, Peng X, Yu B, Zou H, Huang J, Yu X, Wang D, Yang Y. Preadmission Insulin-Treated Type 2 Diabetes Mellitus Patients Had Increased Mortality in Intensive Care Units. Diabetes Metab Syndr Obes 2022; 15:2135-2148. [PMID: 35911502 PMCID: PMC9325876 DOI: 10.2147/dmso.s369152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 07/09/2022] [Indexed: 11/23/2022] Open
Abstract
AIM To explore the clinical outcomes among preadmission insulin-treated type 2 diabetes mellitus (T2DM) in intensive care units (ICU). PATIENTS AND METHODS In this retrospective observational study, 578 T2DM patients admitted to ICU were recruited from March 2011 to February 2021, which were composed of 528 patients treated with insulin after ICU admission (including 300 preadmission non-insulin-treated and 228 preadmission insulin-treated patients) and 50 patients treated without insulin before and after ICU admission. Clinical outcomes were compared between the groups. Variables of age (± 10 years), gender, blood glucose >10 mmol/l on ICU admission, and original comorbidities were used for matching to get the 1:1 matched cohort. The Kaplan-Meier survival curves were graphed to describe the survival trend and Cox regression analysis was performed to get adjusted hazard ratio (HR). RESULTS Compared with the preadmission non-insulin-treated T2DM patients, preadmission insulin-treated T2DM patients had higher incidence of hypoglycemia [14.5% (33/228) vs 8.7% (26/300); p = 0.036]. In the 1:1 matched cohort, the preadmission insulin-treated T2DM patients had significantly increased mortality rate [30.0% (45/150) vs (16.0% (24/150)); adjusted HR, 1.68 (1.01-2.80)] than preadmission non-insulin-treated T2DM patients. Compared with T2DM patients treated without insulin before and after ICU admission, preadmission insulin-treated T2DM patients had higher mortality and longer length of ICU stay (all p < 0.05). CONCLUSION Preadmission insulin treatment was associated with increased mortality rate and longer length of ICU stay among T2DM patients in ICU. Preadmission insulin-treated T2DM patients might have worse clinical outcomes when they are critically ill.
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Affiliation(s)
- Rongping Fan
- Division of Endocrinology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430030, People’s Republic of China
- Branch of National Clinical Research Center for Metabolic Diseases, Wuhan, 430030, People’s Republic of China
| | - Lei Xie
- Division of Endocrinology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430030, People’s Republic of China
- Branch of National Clinical Research Center for Metabolic Diseases, Wuhan, 430030, People’s Republic of China
| | - Xuemin Peng
- Division of Endocrinology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430030, People’s Republic of China
- Branch of National Clinical Research Center for Metabolic Diseases, Wuhan, 430030, People’s Republic of China
| | - Bo Yu
- Division of Cardiology, Department of Internal Medicine and Hubei Key Laboratory of Genetics and Molecular Mechanisms of Cardiological Disorders, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430030, People’s Republic of China
| | - Huajie Zou
- Division of Endocrinology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430030, People’s Republic of China
- Branch of National Clinical Research Center for Metabolic Diseases, Wuhan, 430030, People’s Republic of China
- Division of Endocrinology, Department of Internal Medicine, The Affiliated Hospital of Qinghai University, Xining, Qinghai, 810001, People’s Republic of China
| | - Jiaojiao Huang
- Division of Endocrinology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430030, People’s Republic of China
- Branch of National Clinical Research Center for Metabolic Diseases, Wuhan, 430030, People’s Republic of China
| | - Xuefeng Yu
- Division of Endocrinology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430030, People’s Republic of China
- Branch of National Clinical Research Center for Metabolic Diseases, Wuhan, 430030, People’s Republic of China
| | - Daowen Wang
- Division of Cardiology, Department of Internal Medicine and Hubei Key Laboratory of Genetics and Molecular Mechanisms of Cardiological Disorders, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430030, People’s Republic of China
| | - Yan Yang
- Division of Endocrinology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430030, People’s Republic of China
- Branch of National Clinical Research Center for Metabolic Diseases, Wuhan, 430030, People’s Republic of China
- Correspondence: Yan Yang; Daowen Wang, Division of Endocrinology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430030, People’s Republic of China, Tel +86-27-83665513, Fax +86-27-83662883, Email ;
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Duan L, Hu GH, Wang E, Zhang CL, Huang LJ, Duan YY. Del Nido versus HTK cardioplegia for myocardial protection during adult complex valve surgery: a retrospective study. BMC Cardiovasc Disord 2021; 21:604. [PMID: 34922443 PMCID: PMC8683821 DOI: 10.1186/s12872-021-02411-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 11/26/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Histidine-tryptophan-ketoglutarate (HTK) and del Nido (DN) cardioplegia are intracellular-type and extracellular-type solution respectively, both can provide a long period of myocardial protection with single-dose infusion, but studies comparing the two are rare for adult cardiac surgery. This study aims to evaluate whether DN is suitable for cardioplegia in complex and high-risk valve surgery with long-term cardiac ischemia when compared with HTK. METHODS The perioperative records of adult patients infused with DN/HTK as a cardioplegic solution who underwent complex valve surgery with an expected myocardial ischaemic duration longer than 90 min between Oct 2018 and Oct 2019 were analysed retrospectively. RESULTS Of the 160 patients who received DN/HTK and underwent complex valve surgery, we propensity matched 73 pairs. Both groups achieved satisfactory cardiac arrest effects, and no significant difference was found in their cTnI and CK-MB levels within 12 to 72 h postoperatively. The DN group had a higher rate of return to spontaneous rhythm (0.88 v 0.52, P < 0.001), a lower frequency of postoperative severe arrythmias (12% v 26%, P = 0.036), a higher postoperative stroke volume (65 v 59 ml, P = 0.011) and a higher cardiac output (6.0 v 4.9 L/min, P = 0.007) as evaluated by echocardiography, fewer transfusions and shorter ICU stays (both P < 0.05). The two groups had similar inotrope usage and similar incidences of low cardiac output, morbidities and mortality. Subgroup analysis showed that when the aortic clamping time was greater than 120 min, the advantages of DN were weakened. CONCLUSIONS DN can be safely applied to complex valve surgery, and it has a similar myocardial protection effect as HTK. Further prospective studies are required to verify these retrospective findings. Trial registration retrospectively registered.
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Affiliation(s)
- Lian Duan
- Department of Cardiovascular Surgery, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China.
| | - Guo-Huang Hu
- Department of Surgery, Affiliated Changsha Hospital of Hunan Normal University, Changsha, China
| | - E Wang
- Department of Anesthesiology, Xiangya Hospital, Central South University, Changsha, China.
| | - Cheng-Liang Zhang
- Department of Cardiovascular Surgery, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Ling-Jin Huang
- Department of Cardiovascular Surgery, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Yan-Ying Duan
- Department of Occupational and Environmental Health, Public Health School, Central South University, Changsha, China
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15
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Andrei S, Isac S, Carstea M, Martac C, Mihalcea L, Buzatu C, Ionescu D, Georgescu DE, Droc G. Isolated liver trauma: A clinical perspective in a non-emergency center for liver surgery. Exp Ther Med 2021; 23:39. [PMID: 34849154 PMCID: PMC8613533 DOI: 10.3892/etm.2021.10961] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 09/21/2021] [Indexed: 12/16/2022] Open
Abstract
The management of liver trauma is, currently, still heterogeneous ranging from conservative to major invasive liver resections. When appropriate, these cases should be referred to a regional care center. The objective of this study was to analyze the expertise of a non-emergency center for liver surgery from Romania after initial stabilization in county hospitals. This study is a monocentric, retrospective, observational study, including 12 patients with hepatic trauma after a car accident, admitted between 2015 and 2019. We analyzed various clinical and biochemical data as independent variables, and the main outcome was considered the intensive care unit (ICU) length of stay. Our results revealed that intubation status at admission, norepinephrine infusion during surgery, hyperfibrinogenemia and duration of mechanical ventilation in patients with isolated liver trauma were correlated with prolonged ICU length of stay. Further prospective, more comprehensive studies are needed in order to evaluate the exact prognostic factors in terms of short- and long-term mortality.
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Affiliation(s)
- Stefan Andrei
- Department of Anesthesiology and Intensive Care I, 'Fundeni' Clinical Institute, 022328 Bucharest, Romania.,Department of Anesthesiology and Intensive Care, Faculty of Medicine, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Sebastian Isac
- Department of Anesthesiology and Intensive Care I, 'Fundeni' Clinical Institute, 022328 Bucharest, Romania.,Department of Physiology II and Neurosciences, Faculty of Medicine, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Maricica Carstea
- Department of Anesthesiology and Intensive Care I, 'Fundeni' Clinical Institute, 022328 Bucharest, Romania
| | - Cristina Martac
- Department of Anesthesiology and Intensive Care I, 'Fundeni' Clinical Institute, 022328 Bucharest, Romania
| | - Lucian Mihalcea
- Department of Anesthesiology and Intensive Care I, 'Fundeni' Clinical Institute, 022328 Bucharest, Romania
| | - Cristina Buzatu
- Department of Anesthesiology and Intensive Care I, 'Fundeni' Clinical Institute, 022328 Bucharest, Romania
| | - Dorin Ionescu
- Repartment of Medical Semiology, Discipline of Internal Medicine I and Nephrology, Faculty of Medicine, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania.,Department of Nephrology, Bucharest Emergency University Hospital, 050098 Bucharest, Romania
| | - Dragos Eugen Georgescu
- Department of Surgery, Faculty of Medicine, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Gabriela Droc
- Department of Anesthesiology and Intensive Care I, 'Fundeni' Clinical Institute, 022328 Bucharest, Romania.,Department of Anesthesiology and Intensive Care, Faculty of Medicine, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania
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16
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Tetaj N, Maritti M, Stazi G, Marini MC, Centanni D, Garotto G, Caravella I, Dantimi C, Fusetti M, Santagata C, Macchione M, De Angelis G, Giansante F, Busso D, Di Lorenzo R, Scarcia S, Carucci A, Cabas R, Gaviano I, Petrosillo N, Antinori A, Palmieri F, D’Offizi G, Ianniello S, Campioni P, Pugliese F, Vaia F, Nicastri E, Ippolito G, Marchioni L. Outcomes and Timing of Bedside Percutaneous Tracheostomy of COVID-19 Patients over a Year in the Intensive Care Unit. J Clin Med 2021; 10:jcm10153335. [PMID: 34362118 PMCID: PMC8347124 DOI: 10.3390/jcm10153335] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 07/23/2021] [Accepted: 07/26/2021] [Indexed: 12/29/2022] Open
Abstract
Background: The benefits and timing of percutaneous dilatational tracheostomy (PDT) in Intensive Care Unit (ICU) COVID-19 patients are still controversial. PDT is considered a high-risk procedure for the transmission of SARS-CoV-2 to healthcare workers (HCWs). The present study analyzed the optimal timing of PDT, the clinical outcomes of patients undergoing PDT, and the safety of HCWs performing PDT. Methods: Of the 133 COVID-19 patients who underwent PDT in our ICU from 1 April 2020 to 31 March 2021, 13 patients were excluded, and 120 patients were enrolled. A trained medical team was dedicated to the PDT procedure. Demographic, clinical history, and outcome data were collected. Patients who underwent PDT were stratified into two groups: an early group (PDT ≤ 12 days after orotracheal intubation (OTI) and a late group (>12 days after OTI). An HCW surveillance program was also performed. Results: The early group included 61 patients and the late group included 59 patients. The early group patients had a shorter ICU length of stay and fewer days of mechanical ventilation than the late group (p < 0.001). On day 7 after tracheostomy, early group patients required fewer intravenous anesthetic drugs and experienced an improvement of the ventilation parameters PaO2/FiO2 ratio, PEEP, and FiO2 (p < 0.001). No difference in the case fatality ratio between the two groups was observed. No SARS-CoV-2 infections were reported in the HCWs performing the PDTs. Conclusions: PDT was safe and effective for COVID-19 patients since it improved respiratory support parameters, reduced ICU length of stay and duration of mechanical ventilation, and optimized the weaning process. The procedure was safe for all HCWs involved in the dedicated medical team. The development of standardized early PDT protocols should be implemented, and PDT could be considered a first-line approach in ICU COVID-19 patients requiring prolonged mechanical ventilation.
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Affiliation(s)
- Nardi Tetaj
- UOC Resuscitation, Intensive and Sub-Intensive Care, National Institute for Infectious Diseases IRCCS, Lazzaro Spallanzani, 00149 Rome, Italy; (M.M.); (G.S.); (M.C.M.); (G.G.); (I.C.); (C.D.); (M.F.); (C.S.); (M.M.); (G.D.A.); (F.G.); (D.B.); (R.D.L.); (S.S.); (A.C.); (R.C.); (I.G.); (L.M.)
- Correspondence: ; Tel.: +39-065-517-0424
| | - Micaela Maritti
- UOC Resuscitation, Intensive and Sub-Intensive Care, National Institute for Infectious Diseases IRCCS, Lazzaro Spallanzani, 00149 Rome, Italy; (M.M.); (G.S.); (M.C.M.); (G.G.); (I.C.); (C.D.); (M.F.); (C.S.); (M.M.); (G.D.A.); (F.G.); (D.B.); (R.D.L.); (S.S.); (A.C.); (R.C.); (I.G.); (L.M.)
| | - Giulia Stazi
- UOC Resuscitation, Intensive and Sub-Intensive Care, National Institute for Infectious Diseases IRCCS, Lazzaro Spallanzani, 00149 Rome, Italy; (M.M.); (G.S.); (M.C.M.); (G.G.); (I.C.); (C.D.); (M.F.); (C.S.); (M.M.); (G.D.A.); (F.G.); (D.B.); (R.D.L.); (S.S.); (A.C.); (R.C.); (I.G.); (L.M.)
| | - Maria Cristina Marini
- UOC Resuscitation, Intensive and Sub-Intensive Care, National Institute for Infectious Diseases IRCCS, Lazzaro Spallanzani, 00149 Rome, Italy; (M.M.); (G.S.); (M.C.M.); (G.G.); (I.C.); (C.D.); (M.F.); (C.S.); (M.M.); (G.D.A.); (F.G.); (D.B.); (R.D.L.); (S.S.); (A.C.); (R.C.); (I.G.); (L.M.)
| | - Daniele Centanni
- Clinical and Research Department of Infectious Diseases, National Institute for Infectious Diseases IRCCS Lazzaro Spallanzani, 00149 Rome, Italy; (D.C.); (N.P.); (A.A.); (F.P.); (G.D.); (E.N.)
| | - Gabriele Garotto
- UOC Resuscitation, Intensive and Sub-Intensive Care, National Institute for Infectious Diseases IRCCS, Lazzaro Spallanzani, 00149 Rome, Italy; (M.M.); (G.S.); (M.C.M.); (G.G.); (I.C.); (C.D.); (M.F.); (C.S.); (M.M.); (G.D.A.); (F.G.); (D.B.); (R.D.L.); (S.S.); (A.C.); (R.C.); (I.G.); (L.M.)
| | - Ilaria Caravella
- UOC Resuscitation, Intensive and Sub-Intensive Care, National Institute for Infectious Diseases IRCCS, Lazzaro Spallanzani, 00149 Rome, Italy; (M.M.); (G.S.); (M.C.M.); (G.G.); (I.C.); (C.D.); (M.F.); (C.S.); (M.M.); (G.D.A.); (F.G.); (D.B.); (R.D.L.); (S.S.); (A.C.); (R.C.); (I.G.); (L.M.)
| | - Cristina Dantimi
- UOC Resuscitation, Intensive and Sub-Intensive Care, National Institute for Infectious Diseases IRCCS, Lazzaro Spallanzani, 00149 Rome, Italy; (M.M.); (G.S.); (M.C.M.); (G.G.); (I.C.); (C.D.); (M.F.); (C.S.); (M.M.); (G.D.A.); (F.G.); (D.B.); (R.D.L.); (S.S.); (A.C.); (R.C.); (I.G.); (L.M.)
| | - Matteo Fusetti
- UOC Resuscitation, Intensive and Sub-Intensive Care, National Institute for Infectious Diseases IRCCS, Lazzaro Spallanzani, 00149 Rome, Italy; (M.M.); (G.S.); (M.C.M.); (G.G.); (I.C.); (C.D.); (M.F.); (C.S.); (M.M.); (G.D.A.); (F.G.); (D.B.); (R.D.L.); (S.S.); (A.C.); (R.C.); (I.G.); (L.M.)
| | - Carmen Santagata
- UOC Resuscitation, Intensive and Sub-Intensive Care, National Institute for Infectious Diseases IRCCS, Lazzaro Spallanzani, 00149 Rome, Italy; (M.M.); (G.S.); (M.C.M.); (G.G.); (I.C.); (C.D.); (M.F.); (C.S.); (M.M.); (G.D.A.); (F.G.); (D.B.); (R.D.L.); (S.S.); (A.C.); (R.C.); (I.G.); (L.M.)
| | - Manuela Macchione
- UOC Resuscitation, Intensive and Sub-Intensive Care, National Institute for Infectious Diseases IRCCS, Lazzaro Spallanzani, 00149 Rome, Italy; (M.M.); (G.S.); (M.C.M.); (G.G.); (I.C.); (C.D.); (M.F.); (C.S.); (M.M.); (G.D.A.); (F.G.); (D.B.); (R.D.L.); (S.S.); (A.C.); (R.C.); (I.G.); (L.M.)
| | - Giada De Angelis
- UOC Resuscitation, Intensive and Sub-Intensive Care, National Institute for Infectious Diseases IRCCS, Lazzaro Spallanzani, 00149 Rome, Italy; (M.M.); (G.S.); (M.C.M.); (G.G.); (I.C.); (C.D.); (M.F.); (C.S.); (M.M.); (G.D.A.); (F.G.); (D.B.); (R.D.L.); (S.S.); (A.C.); (R.C.); (I.G.); (L.M.)
| | - Filippo Giansante
- UOC Resuscitation, Intensive and Sub-Intensive Care, National Institute for Infectious Diseases IRCCS, Lazzaro Spallanzani, 00149 Rome, Italy; (M.M.); (G.S.); (M.C.M.); (G.G.); (I.C.); (C.D.); (M.F.); (C.S.); (M.M.); (G.D.A.); (F.G.); (D.B.); (R.D.L.); (S.S.); (A.C.); (R.C.); (I.G.); (L.M.)
| | - Donatella Busso
- UOC Resuscitation, Intensive and Sub-Intensive Care, National Institute for Infectious Diseases IRCCS, Lazzaro Spallanzani, 00149 Rome, Italy; (M.M.); (G.S.); (M.C.M.); (G.G.); (I.C.); (C.D.); (M.F.); (C.S.); (M.M.); (G.D.A.); (F.G.); (D.B.); (R.D.L.); (S.S.); (A.C.); (R.C.); (I.G.); (L.M.)
| | - Rachele Di Lorenzo
- UOC Resuscitation, Intensive and Sub-Intensive Care, National Institute for Infectious Diseases IRCCS, Lazzaro Spallanzani, 00149 Rome, Italy; (M.M.); (G.S.); (M.C.M.); (G.G.); (I.C.); (C.D.); (M.F.); (C.S.); (M.M.); (G.D.A.); (F.G.); (D.B.); (R.D.L.); (S.S.); (A.C.); (R.C.); (I.G.); (L.M.)
| | - Silvana Scarcia
- UOC Resuscitation, Intensive and Sub-Intensive Care, National Institute for Infectious Diseases IRCCS, Lazzaro Spallanzani, 00149 Rome, Italy; (M.M.); (G.S.); (M.C.M.); (G.G.); (I.C.); (C.D.); (M.F.); (C.S.); (M.M.); (G.D.A.); (F.G.); (D.B.); (R.D.L.); (S.S.); (A.C.); (R.C.); (I.G.); (L.M.)
| | - Alessandro Carucci
- UOC Resuscitation, Intensive and Sub-Intensive Care, National Institute for Infectious Diseases IRCCS, Lazzaro Spallanzani, 00149 Rome, Italy; (M.M.); (G.S.); (M.C.M.); (G.G.); (I.C.); (C.D.); (M.F.); (C.S.); (M.M.); (G.D.A.); (F.G.); (D.B.); (R.D.L.); (S.S.); (A.C.); (R.C.); (I.G.); (L.M.)
| | - Ricardo Cabas
- UOC Resuscitation, Intensive and Sub-Intensive Care, National Institute for Infectious Diseases IRCCS, Lazzaro Spallanzani, 00149 Rome, Italy; (M.M.); (G.S.); (M.C.M.); (G.G.); (I.C.); (C.D.); (M.F.); (C.S.); (M.M.); (G.D.A.); (F.G.); (D.B.); (R.D.L.); (S.S.); (A.C.); (R.C.); (I.G.); (L.M.)
| | - Ilaria Gaviano
- UOC Resuscitation, Intensive and Sub-Intensive Care, National Institute for Infectious Diseases IRCCS, Lazzaro Spallanzani, 00149 Rome, Italy; (M.M.); (G.S.); (M.C.M.); (G.G.); (I.C.); (C.D.); (M.F.); (C.S.); (M.M.); (G.D.A.); (F.G.); (D.B.); (R.D.L.); (S.S.); (A.C.); (R.C.); (I.G.); (L.M.)
| | - Nicola Petrosillo
- Clinical and Research Department of Infectious Diseases, National Institute for Infectious Diseases IRCCS Lazzaro Spallanzani, 00149 Rome, Italy; (D.C.); (N.P.); (A.A.); (F.P.); (G.D.); (E.N.)
| | - Andrea Antinori
- Clinical and Research Department of Infectious Diseases, National Institute for Infectious Diseases IRCCS Lazzaro Spallanzani, 00149 Rome, Italy; (D.C.); (N.P.); (A.A.); (F.P.); (G.D.); (E.N.)
| | - Fabrizio Palmieri
- Clinical and Research Department of Infectious Diseases, National Institute for Infectious Diseases IRCCS Lazzaro Spallanzani, 00149 Rome, Italy; (D.C.); (N.P.); (A.A.); (F.P.); (G.D.); (E.N.)
| | - Gianpiero D’Offizi
- Clinical and Research Department of Infectious Diseases, National Institute for Infectious Diseases IRCCS Lazzaro Spallanzani, 00149 Rome, Italy; (D.C.); (N.P.); (A.A.); (F.P.); (G.D.); (E.N.)
| | - Stefania Ianniello
- Department of Radiology and Diagnostic Imaging, National Institute for Infectious Diseases IRCCS Lazzaro Spallanzani, 00149 Rome, Italy; (S.I.); (P.C.)
| | - Paolo Campioni
- Department of Radiology and Diagnostic Imaging, National Institute for Infectious Diseases IRCCS Lazzaro Spallanzani, 00149 Rome, Italy; (S.I.); (P.C.)
| | - Francesco Pugliese
- Department of Anesthesia and Critical Care Medicine, Sapienza University of Rome, 00161 Rome, Italy;
| | - Francesco Vaia
- Health Direction, National Institute for Infectious Diseases IRCCS Lazzaro Spallanzani, 00149 Rome, Italy;
| | - Emanuele Nicastri
- Clinical and Research Department of Infectious Diseases, National Institute for Infectious Diseases IRCCS Lazzaro Spallanzani, 00149 Rome, Italy; (D.C.); (N.P.); (A.A.); (F.P.); (G.D.); (E.N.)
| | - Giuseppe Ippolito
- Scientific Direction, National Institute for Infectious Diseases IRCCS Lazzaro Spallanzani, 00149 Rome, Italy;
| | - Luisa Marchioni
- UOC Resuscitation, Intensive and Sub-Intensive Care, National Institute for Infectious Diseases IRCCS, Lazzaro Spallanzani, 00149 Rome, Italy; (M.M.); (G.S.); (M.C.M.); (G.G.); (I.C.); (C.D.); (M.F.); (C.S.); (M.M.); (G.D.A.); (F.G.); (D.B.); (R.D.L.); (S.S.); (A.C.); (R.C.); (I.G.); (L.M.)
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Tribuddharat S, Sathitkarnmanee T, Ngamsangsirisup K, Nongnuang K. Efficacy of Intraoperative Hemodynamic Optimization Using FloTrac/EV1000 Platform for Early Goal-Directed Therapy to Improve Postoperative Outcomes in Patients Undergoing Coronary Artery Bypass Graft with Cardiopulmonary Bypass: A Randomized Controlled Trial. Med Devices (Auckl) 2021; 14:201-209. [PMID: 34234581 PMCID: PMC8253926 DOI: 10.2147/mder.s316033] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 06/10/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose Early goal-directed therapy (EGDT) using the FloTrac system reportedly improved postoperative outcomes among high-risk patients undergoing non-cardiac surgery. This study's objective was to evaluate the FloTrac/EV1000 platform's efficacy for improving postoperative outcomes in cardiac surgery. Patients and Methods Eighty-six adults undergoing coronary artery bypass graft (CABG) with cardiopulmonary bypass (CPB) in 2 tertiary referral centers were randomized to the EGDT or Control group. The Control group was managed with standard care to achieve the following goals: mean arterial pressure 65-90 mmHg; central venous pressure 8-12 mmHg; urine output ≥0.5 mL·kg-1·h-1; oxygen saturation >95%; and hematocrit 26-30%. The EGDT group was managed to reach similar goals using information from the FloTrac/EV1000 monitor. The targets were stroke volume variation <13%; stroke volume index 33-65 mL·beat-1·m-2; cardiac index 2.2-4.0 L·min-1·m-2; and systemic vascular resistance index 1600-2500 dynes·s·cm-5·m-2. Results The intensive care unit (ICU) stay of the EGDT group was significantly shorter (mean difference -29.5 h; 95% CI -17.2 to -41.8, P < 0.001). The mechanical ventilation time was also shorter in the EGDT group (mean difference -11.3 h; 95% CI -2.7 to -19.9, P = 0.011). The hospital LOS was shorter in the EGDT group (mean difference -1.1 d; 95% CI -0.1 to -2.1, P = 0.038). Conclusion EGDT using FloTrac/EV1000 can be applied in CABG with CPB to improve postoperative outcomes.
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Affiliation(s)
- Sirirat Tribuddharat
- Department of Anesthesiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002, Thailand
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Lo YL, Bih ZL, Yu YH, Li MC, Chen HM, Wu SY. Long-Term Medical Resource Consumption between Surgical Clipping and Endovascular Coiling for Aneurysmal Subarachnoid Hemorrhage: A Propensity Score-Matched, Nationwide, Population-Based Cohort Study. Int J Environ Res Public Health 2021; 18:ijerph18115989. [PMID: 34199671 PMCID: PMC8199713 DOI: 10.3390/ijerph18115989] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 05/28/2021] [Accepted: 06/02/2021] [Indexed: 12/21/2022]
Abstract
Purpose: To estimate long-term medical resource consumption in patients with subarachnoid aneurysmal hemorrhage (SAH) receiving surgical clipping or endovascular coiling. Patients and methods: From Taiwan’s National Health Insurance Research Database, we enrolled patients with aneurysmal SAH who received clipping or coiling. After propensity score matching and adjustment for confounders, a generalized linear mixed model was used to determine significant differences in the accumulative hospital stay (days), intensive care unit (ICU) stay, and total medical cost for aneurysmal SAH, as well as possible subsequent surgical complications and recurrence. Results: The matching process yielded a final cohort of 8102 patients (4051 and 4051 in endovascular coil embolization and surgical clipping, respectively) who were eligible for further analysis. The mean accumulative hospital stay significantly differed between coiling (31.2 days) and clipping (46.8 days; p < 0.0001). After the generalized linear model adjustment of gamma distribution with a log link, compared with the surgical clipping procedure, the adjusted odds ratios (aOR; 95% confidence interval [CI]) of the medical cost of accumulative hospital stay for the endovascular coil embolization procedure was 0.63 (0.60, 0.66; p < 0·0001). The mean accumulative ICU stay significantly differed between the coiling and clipping groups (9.4 vs. 14.9 days; p < 0.0001). The aORs (95% CI) of the medical cost of accumulative ICU stay in the endovascular coil embolization group was 0.61 (0.58, 0.64; p < 0.0001). The aOR (95% CI) of the total medical cost of index hospitalization in the endovascular coil embolization group was 0·85 (0.82, 0.87; p < 0.0001). Conclusions: Medical resource consumption in the coiling group was lower than that in the clipping group.
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Affiliation(s)
- Yang-Lan Lo
- Department of Neurosurgery, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan 256, Taiwan;
| | - Zen Lang Bih
- Department of Emergency Medicine, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan 256, Taiwan;
| | - Ying-Hui Yu
- Department of Colorectal Surgery, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan 256, Taiwan; (Y.-H.Y.); (M.-C.L.)
| | - Ming-Chang Li
- Department of Colorectal Surgery, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan 256, Taiwan; (Y.-H.Y.); (M.-C.L.)
| | - Ho-Min Chen
- Department of Food Nutrition and Health Biotechnology, College of Medical and Health Science, Asia University, Taichung 413, Taiwan;
- Big Data Center, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan 256, Taiwan
| | - Szu-Yuan Wu
- Department of Food Nutrition and Health Biotechnology, College of Medical and Health Science, Asia University, Taichung 413, Taiwan;
- Big Data Center, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan 256, Taiwan
- Division of Radiation Oncology, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan 256, Taiwan
- Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung 413, Taiwan
- Graduate Institute of Business Administration, Fu Jen Catholic University, Taipei 242062, Taiwan
- Centers for Regional Anesthesia and Pain Medicine, Wan Fang Hospital, Taipei Medical University, Taipei 110, Taiwan
- Correspondence: or
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19
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Zhong M, Xu W, Qiu Y, Li L, Qu H, Chen E. Association of Changes in Acute Gastrointestinal Injury Grade with Prognosis in Critically Ill Patients: A Prospective, Single-Center, Observational Study. J Multidiscip Healthc 2021; 14:279-286. [PMID: 33574672 PMCID: PMC7872930 DOI: 10.2147/jmdh.s291883] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 01/07/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose To investigate the association between the change of acute gastrointestinal injury (AGI) grade and the outcome in critically ill patients. Methods This was a prospectively observational study. All patients admitted in the ICU from October 2013 to June 2015, with the duration of ICU > 72 h and age >18 years, were enrolled in this study. The AGI grade and gastrointestinal symptoms were evaluated during ICU stay following the 2012 ESICM recommendation. The ICU mortality, duration of ICU stay, mechanical ventilation (MV) use, vasoactive drug use, and continuous renal replacement therapy of patients were recorded accordingly. Results A total of 320 patients were included, and 265 of them were diagnosed with AGI. The overall ICU mortality was 11.88%, while it was 13.58% in patients with AGI. In logistic regression analyses, the decreasing trend of AGI grade was identified as a protective factor for ICU death (odds ratio (OR), 0.484; 95% confidence interval (CI), 0.26–0.90), while the max AGI grade was a risk factor (OR, 3.464; 95% CI, 2.71–8.47) for ICU death. Conclusion The changes of AGI grades in critically ill patients were associated with their clinical outcomes. The ICU-acquired AGI patients associated with longer ICU stay days.
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Affiliation(s)
- Ming Zhong
- Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, People's Republic of China
| | - Wen Xu
- Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, People's Republic of China
| | - Yuzhen Qiu
- Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, People's Republic of China
| | - Lei Li
- Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, People's Republic of China
| | - Hongping Qu
- Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, People's Republic of China
| | - Erzhen Chen
- Department of Emergency, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, People's Republic of China
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Palacios-Baena ZR, Giannella M, Manissero D, Rodríguez-Baño J, Viale P, Lopes S, Wilson K, McCool R, Longshaw C. Risk factors for carbapenem-resistant Gram-negative bacterial infections: a systematic review. Clin Microbiol Infect 2021; 27:228-235. [PMID: 33130270 DOI: 10.1016/j.cmi.2020.10.016] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 10/16/2020] [Accepted: 10/17/2020] [Indexed: 01/04/2023]
Abstract
BACKGROUND Rapid and widespread increases in carbapenem resistance (CR) necessitate identification of risk factors to guide appropriate interventions. OBJECTIVES We aimed to identify risk factors for CR Gram-negative infection through a systematic literature review. DATA SOURCES We searched MEDLINE (via OvidSP and PubMed) and Embase (via OvidSP) databases and the Cochrane Central Register of Controlled Trials. STUDY ELIGIBILITY CRITERIA Prospective or retrospective cohort and case-control studies reporting quantitative data on risk factors associated with infections due to CR Gram-negative pathogens in hospitalized patients were eligible. PARTICIPANTS Studies included hospitalized patients with CR infection caused by Gram-negative bacterial pathogens (Enterobacterales and non-fermenters). METHODS Searches were conducted in January 2018/December 2019 to identify studies published since 2007. Risk factor data were extracted and grouped by factor. The primary metric was proportion of studies reporting a significant association with CR infection for each factor. RESULTS In total, 92 studies were identified. Risk factors most frequently reported as significantly associated with CR infection (>10 studies) were previous antibiotic use (91.1%; 72/79 studies); previous carbapenem use (82.6%; 57/69); previous colonization (72.7%; 8/11); mechanical ventilation (66.7%; 36/54); previous intensive care unit stay (64.4%; 38/59); dialysis (61.1%; 11/18); catheter (58.0%; 40/69); length of stay in hospital (54.5%; 30/55); comorbidities (52.7%; 39/74); APACHE II (51.7%; 15/29); and intubation (51.4%; 18/35). Risk factors were mostly consistent across different species and sites of infection. CONCLUSIONS Several variables, particularly previous antibiotic use, are strong risk factors for CR infection. Interventions to mitigate against CR infection should target these factors.
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Affiliation(s)
- Zaira R Palacios-Baena
- Infectious Diseases, Clinical Microbiology and Preventive Medicine Unit, Hospital Universitario Virgen Macarena, Institute of Biomedicine of Seville (IBIS), Seville, Spain.
| | - Maddalena Giannella
- Infectious Diseases Unit, Department of Medical and Surgical Sciences, Policlinico Sant'Orsola Malpighi, Bologna, Italy
| | - Davide Manissero
- Medical Affairs for Infection and Immune Diagnostics, QIAGEN, London, UK
| | | | - Pierluigi Viale
- Infectious Diseases Unit, Department of Medical and Surgical Sciences, Policlinico Sant'Orsola Malpighi, Bologna, Italy
| | - Sara Lopes
- Market Access, Shionogi Europe, London, UK
| | - Katy Wilson
- York Health Economics Consortium, University of York, York, UK
| | - Rachael McCool
- York Health Economics Consortium, University of York, York, UK
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Zhu Y, Wen L, You W, Wang Y, Wang H, Li G, Chen Z, Yang X. Influence of Ward Environments on External Ventricular Drain Infections: A Retrospective Risk Factor Analysis. Surg Infect (Larchmt) 2020; 22:211-216. [PMID: 32352893 DOI: 10.1089/sur.2019.355] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Ventriculostomy-related infection (VRI) is one of the most severe and common complications of external ventricular drains (EVD). Ward environment is closely related to hospital-acquired infection, but its role in EVD infection is unclear. For some other recognized risk factors, clinical evidence also remains complicated and undetermined. We aimed to evaluate ward environment including multi-bed accommodation and intensive care unit (ICU) stay as potential risk factors for VRI, as well as to confirm those already known factors. Methods: We reviewed EVDs retrospectively in our center between January 2012 and January 2017. Univariable and logistic regression analysis were performed to identify risk factors for EVD-related infection. Results: A total of 284 patients who underwent EVD procedure were included. Thirty-six (12.7%) developed EVD-related infection. Univariable analysis revealed that the infection group had longer intensive care unit (ICU) stay (6.81 vs. 3.65 days, p = 0.045) but multi-bed accommodation showed no statistical difference between the two groups (p = 0.404). Univariable analysis also showed VRI patients had lower pre-operational Glasgow Coma Scale (6.89 vs. 9.32, p = 0.001), longer drainage placement duration (11.4 vs. 8.30 days, p < 0.001), greater numbers of cerebrospinal fluid (CSF) sampling (3.89 vs. 1.73, p < 0.001), higher percentage of pre-operational artificial airway status (50.0% vs. 18.1%, p < 0.001), and higher percentage of intracranial hemorrhage diagnosis (88.9% vs. 73.8%, p = 0.048). Logistic regression analysis demonstrated longer post-operational ICU stay (>5 days, odds ratio [OR] = 3.21, p = 0.026) as independent risk factor for EVD-related infection. Other independent risk factors included CSF sampling counts (>3, OR = 5.14, p <0.001), EVD duration (>7 days, OR = 3.85, p = 0.028), and pre-operational artificial airway status (OR = 2.85, p = 0.038). Conclusions: Longer post-operational ICU stay, frequent CSF sampling, longer duration of EVD placement, and pre-operational intubation are independent risk factors for EVD infection. Multi-bed accommodation and bilateral EVD placement have no substantial influence on VRI risk.
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Affiliation(s)
- Yuanrun Zhu
- The First Affiliated Hospital, College of Medicine, Zhejiang University, Zhejiang Province, China
| | - Liang Wen
- The First Affiliated Hospital, College of Medicine, Zhejiang University, Zhejiang Province, China
| | - Wendong You
- The First Affiliated Hospital, College of Medicine, Zhejiang University, Zhejiang Province, China
| | - Yadong Wang
- The First Affiliated Hospital, College of Medicine, Zhejiang University, Zhejiang Province, China
| | - Hao Wang
- The First Affiliated Hospital, College of Medicine, Zhejiang University, Zhejiang Province, China
| | - Gu Li
- The First Affiliated Hospital, College of Medicine, Zhejiang University, Zhejiang Province, China
| | - Zuobing Chen
- The First Affiliated Hospital, College of Medicine, Zhejiang University, Zhejiang Province, China
| | - Xiaofeng Yang
- The First Affiliated Hospital, College of Medicine, Zhejiang University, Zhejiang Province, China
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Kojima T, Toda K, Oyanagi T, Yoshiba S, Kobayashi T, Sumitomo N. Early assessment of cardiac troponin I predicts the postoperative cardiac status and clinical course after congenital heart disease surgery. Heart Vessels 2020; 35:417-421. [PMID: 31522246 DOI: 10.1007/s00380-019-01497-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2018] [Accepted: 09/06/2019] [Indexed: 10/26/2022]
Abstract
Cardiac troponin I (cTnI) is a regulatory protein with a high sensitivity and specificity for cardiac injury. Preoperative and postoperative elevations of cTnI are usually considered predictors of the mortality and morbidity. However, little is known about the relationship between the cTnI and postoperative course after the congenital heart disease (CHD) operation. Sixty-five consecutive patients who underwent cardiac surgery for CHD at our institution between March 2016 and January 2017 were included. The cTnI was measured after the operation. Also, the association between the cTnI and duration of the catecholamine use, ICU stay, aortic cross clamp time, and other clinical parameters were assessed. The cTnI level on postoperative day 1 was positively correlated with the duration of the catecholamine use (p < 0.001) and ICU stay (p < 0.001). Also, a higher cTnI level was associated with a lower urine volume and higher lactate level 24 h after the ICU admission. In the multivariable regression analysis, the cTnI was a significant independent predictor of the catecholamine use (p = 0.002) and ICU stay (p = 0.003). The cTnI level on postoperative day 1 was a predictor of the duration of the catecholamine use and ICU stay.
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Affiliation(s)
- Takuro Kojima
- Division of Pediatric Cardiology, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka, 350-1298, Saitama, Japan
| | - Koichi Toda
- Division of Pediatric Cardiology, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka, 350-1298, Saitama, Japan
| | - Takayuki Oyanagi
- Division of Pediatric Cardiology, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka, 350-1298, Saitama, Japan
| | - Shigeki Yoshiba
- Division of Pediatric Cardiology, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka, 350-1298, Saitama, Japan
| | - Toshiki Kobayashi
- Division of Pediatric Cardiology, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka, 350-1298, Saitama, Japan
| | - Naokata Sumitomo
- Division of Pediatric Cardiology, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka, 350-1298, Saitama, Japan.
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Chiang HY, Huang HC, Chung CW, Yeh YC, Chen YC, Tien N, Lin HS, Ho MW, Kuo CC. Risk prediction for 30-day mortality among patients with Clostridium difficile infections: a retrospective cohort study. Antimicrob Resist Infect Control 2019; 8:175. [PMID: 31749963 PMCID: PMC6852910 DOI: 10.1186/s13756-019-0642-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 11/01/2019] [Indexed: 12/21/2022] Open
Abstract
Background Current guidelines have unsatisfied performance in predicting severe outcomes after Clostridium difficile infection (CDI). Our objectives were to develop a risk prediction model for 30-day mortality and to examine its performance among inpatients with CDI. Methods This retrospective cohort study was conducted at China Medical University Hospital, a 2111-bed tertiary medical center in central Taiwan. We included adult inpatients who had a first positive C. difficile culture or toxin assay and had diarrhea as the study population. The main exposure of interest was the biochemical profiles of white blood cell count, serum creatinine (SCr), estimated glomerular filtration rate, blood urea nitrogen (BUN), serum albumin, and glucose. The primary outcome was the 30-day all-cause mortality and the secondary outcome was the length of stay in the intensive care units (ICU) following CDI. A multivariable Cox model and a logistic regression model were developed using clinically relevant and statistically significant variables for 30-day mortality and for length of ICU stay, respectively. A risk scoring system was established by standardizing the coefficients. We compared the performance of our models and the guidelines. Results Of 401 patients, 23.4% died within 30 days. In the multivariable model, malignancy (hazard ratio [HR] = 1.95), ≥ 1.5-fold rise in SCr (HR = 2.27), BUN-to-SCr ratio > 20 (HR = 2.04), and increased glucose (≥ 193 vs < 142 mg/dL, HR = 2.18) were significant predictors of 30-day mortality. For patients who survived the first 30 days of CDI, BUN-to-SCr ratio > 20 (Odds ratio [OR] = 4.01) was the only significant predictor for prolonged (> 9 days) length of ICU stay following CDI. The Harrell's c statistic of our Cox model for 30-day mortality (0.727) was significantly superior to those of SHEA-IDSA 2010 (0.645), SHEA-IDSA 2018 (0.591), and ECSMID (0.650). Similarly, the conventional c statistic of our logistic regression model for prolonged ICU stay (0.737) was significantly superior to that of the guidelines (SHEA-IDSA 2010, c = 0.600; SHEA-IDSA 2018, c = 0.634; ESCMID, c = 0.645). Our risk prediction scoring system for 30-day mortality correctly reclassified 20.7, 32.1, and 47.9% of patients, respectively. Conclusions Our model that included novel biomarkers of BUN-to-SCr ratio and glucose have a higher predictive performance of 30-day mortality and prolonged ICU stay following CDI than do the guidelines.
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Affiliation(s)
- Hsiu-Yin Chiang
- Big Data Center, China Medical University Hospital, Taichung, 404 Taiwan
| | - Han-Chun Huang
- Big Data Center, China Medical University Hospital, Taichung, 404 Taiwan
| | - Chih-Wei Chung
- Big Data Center, China Medical University Hospital, Taichung, 404 Taiwan
| | - Yi-Chun Yeh
- Big Data Center, China Medical University Hospital, Taichung, 404 Taiwan
| | - Yi-Chin Chen
- Department of Medical Research, Department of Internal Medicine, China Medical University Hospital, Taichung, 404 Taiwan
| | - Ni Tien
- Department of Laboratory Medicine, China Medical University Hospital, Taichung, 404 Taiwan
| | - Hsiu-Shan Lin
- Department of Laboratory Medicine, China Medical University Hospital, Taichung, 404 Taiwan
| | - Mao-Wang Ho
- Division of Infectious Diseases, Department of Internal Medicine, China Medical University Hospital, Taichung, 404 Taiwan
| | - Chin-Chi Kuo
- Big Data Center, China Medical University Hospital, Taichung, 404 Taiwan
- Department of Medical Research, Department of Internal Medicine, China Medical University Hospital, Taichung, 404 Taiwan
- Kidney Institute and Division of Nephrology, Department of Internal Medicine, China Medical University Hospital, Taichung, 404 Taiwan
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Stoppe C, Ney J, Lomivorotov VV, Efremov SM, Benstoem C, Hill A, Nesterova E, Laaf E, Goetzenich A, McDonald B, Peine A, Marx G, Fehnle K, Heyland DK. Prediction of Prolonged ICU Stay in Cardiac Surgery Patients as a Useful Method to Identify Nutrition Risk in Cardiac Surgery Patients: A Post Hoc Analysis of a Prospective Observational Study. JPEN J Parenter Enteral Nutr 2018; 43:768-779. [PMID: 30506711 PMCID: PMC7379574 DOI: 10.1002/jpen.1486] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Accepted: 10/22/2018] [Indexed: 12/30/2022]
Abstract
BACKGROUND Cardiovascular surgery patients with a prolonged intensive care unit (ICU) stay may benefit most from early nutrition support. Using established scoring systems for nutrition assessment and operative risk stratification, we aimed to develop a model to predict a prolonged ICU stay ≥5 days in order to identify patients who will benefit from early nutrition interventions. METHODS This is a retrospective analysis of a prospective observational study of patients undergoing elective valvular, coronary artery bypass grafting, or combined cardiac surgery. The nutrition risk was assessed by well-established screening tools. Patients' preoperative EuroSCORE (European System for Cardiac Operative Risk Evaluation), primary disease, and intraoperative cardiopulmonary bypass (CPB) time were included as independent variables in a multivariate logistic regression analysis to predict a prolonged ICU stay (>4 days). RESULTS The number of cardiac surgery patients included was 1193. Multivariate analysis revealed that for prediction of ICU stay >4 days, both Nutritional Risk Screening 2002 (area under the curve (AUC): 0.716, P = .020) and Mini Nutritional Assessment (MNA) score (AUC: 0.715, P = .037) were significant, whereas for prediction of ICU stay >5 days, only the MNA score showed significant results (AUC: 0.762, P = .011). CONCLUSION Present data provide first evidence about the combined use of EuroSCORE, primary disease, CPB time, and nutrition risk screening tools for prediction of prolonged ICU stay in cardiac surgery patients. If prospectively evaluated in adequately designed studies, this model may help to identify patients with prolonged ICU stay to initiate early postoperative nutrition therapy and thus, facilitate an enhanced recovery.
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Affiliation(s)
- Christian Stoppe
- Department of Intensive Care Medicine and 3CARE, Medical Faculty RWTH Aachen, Aachen, Germany
| | - Julia Ney
- Department of Intensive Care Medicine and 3CARE, Medical Faculty RWTH Aachen, Aachen, Germany
| | - Vladimir V Lomivorotov
- Department of Anesthesiology and Intensive Care Medicine, Research Institute of Circulation Pathology, E. Meshalkin National Medical Research Centre, Novosibirsk, Russia
| | - Sergey M Efremov
- Department of Anesthesiology and Intensive Care Medicine, Research Institute of Circulation Pathology, E. Meshalkin National Medical Research Centre, Novosibirsk, Russia
| | - Carina Benstoem
- Department of Intensive Care Medicine and 3CARE, Medical Faculty RWTH Aachen, Aachen, Germany
| | - Aileen Hill
- Department of Intensive Care Medicine and 3CARE, Medical Faculty RWTH Aachen, Aachen, Germany
| | - Ekaterina Nesterova
- Department of Anesthesiology and Intensive Care Medicine, National Pirogov Medical Centre, Moscow, Russia
| | - Elena Laaf
- Department of Intensive Care Medicine and 3CARE, Medical Faculty RWTH Aachen, Aachen, Germany
| | - Andreas Goetzenich
- Department of Intensive Care Medicine and 3CARE, Medical Faculty RWTH Aachen, Aachen, Germany
| | - Bernard McDonald
- Division of Cardiac Anesthesia & Critical Care Medicine, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Arne Peine
- Department of Intensive Care Medicine and 3CARE, Medical Faculty RWTH Aachen, Aachen, Germany
| | - Gernot Marx
- Department of Intensive Care Medicine and 3CARE, Medical Faculty RWTH Aachen, Aachen, Germany
| | - Karl Fehnle
- Algora: Statistics and Clinical Research, Haar, Germany
| | - Daren K Heyland
- Clinical Evaluation Research Unit, Kingston General Hospital, Kingston, Ontario, Canada
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Bourjeily G, Danilack VA, Bublitz MH, Lipkind H, Muri J, Caldwell D, Tong I, Rosene-Montella K. Obstructive sleep apnea in pregnancy is associated with adverse maternal outcomes: a national cohort. Sleep Med 2017; 38:50-57. [PMID: 29031756 DOI: 10.1016/j.sleep.2017.06.035] [Citation(s) in RCA: 96] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Revised: 06/03/2017] [Accepted: 06/26/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Pregnancy and the obesity epidemic impacting women of reproductive age appear to predispose women to obstructive sleep apnea (OSA) in pregnancy. The aim of this study is to examine the association between OSA and adverse maternal outcomes in a national cohort. METHODS The National Perinatal Information Center in the US was used to identify women with a delivery discharge diagnosis of OSA from 2010 to 2014. We used the International Classification of Diseases, ninth Revision to classify OSA diagnosis and maternal outcomes. MEASUREMENTS The sample consisted of 1,577,632 gravidas with a rate of OSA of 0.12% (N = 1963). There was a significant association between OSA and preeclampsia (adjusted odds ratio (aOR) 2.22, 95% confidence interval (CI) 1.94-2.54), eclampsia (aOR 2.95, 1.08-8.02), and gestational diabetes (aOR 1.51, 1.34-1.72) after adjusting for a comprehensive list of covariates which includes maternal obesity. OSA status was also associated with a 2.5-3.5-fold increase in risk of severe complications such as cardiomyopathy, congestive heart failure, and hysterectomy. Length of hospital stay was significantly longer (5.1 + 5.6 vs 3.0 + 3.0 days, p < 0.001) and odds of an admission to an intensive care unit higher (aOR 2.74, 2.36-3.18) in women with OSA. CONCLUSIONS Compared to pregnant women without OSA, pregnant women with OSA have a significantly higher risk of pregnancy-specific complications such as gestational hypertensive conditions and gestational diabetes, and rare medical and surgical complications such as cardiomyopathy, pulmonary edema, congestive heart failure, and hysterectomy. OSA diagnosis was also associated with a longer hospital stay and significantly increased odds for admission to the intensive care unit.
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Affiliation(s)
- Ghada Bourjeily
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA; Department of Medicine, The Miriam Hospital, Providence, RI, USA.
| | - Valery A Danilack
- Department of Obstetrics and Gynecology, Warren Alpert Medical School of Brown University, Providence, RI, USA; Brown University School of Public Health, Department of Epidemiology, Providence, RI, USA; Division of Research, Women & Infants Hospital, Providence, RI, USA
| | - Margaret H Bublitz
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA; Department of Medicine, The Miriam Hospital, Providence, RI, USA; Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Heather Lipkind
- Department of Obstetrics and Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, CT, USA
| | - Janet Muri
- National Perinatal Information Center, Providence, RI, USA
| | - Donna Caldwell
- National Perinatal Information Center, Providence, RI, USA
| | - Iris Tong
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA; Department of Medicine, The Miriam Hospital, Providence, RI, USA
| | - Karen Rosene-Montella
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA
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Yuanbo Z, Jin W, Fei S, Liangong L, Xunfa L, Shihai X, Aijun S. ICU management based on PiCCO parameters reduces duration of mechanical ventilation and ICU length of stay in patients with severe thoracic trauma and acute respiratory distress syndrome. Ann Intensive Care 2016; 6:113. [PMID: 27873292 PMCID: PMC5118373 DOI: 10.1186/s13613-016-0217-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Accepted: 11/09/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study aimed to assess whether a management algorithm using data obtained with a PiCCO system can improve clinical outcomes in critically ill patients with acute respiratory distress syndrome (ARDS). RESULTS The PaO2/FiO2 ratio increased over time in both groups, with a sharper increase in the PiCCO group. There was no difference in 28-day mortality (3.2 vs. 3.6%, P = 0.841). Days on mechanical ventilation (3 vs. 5 days, P = 0.002) and ICU length of stay (6 vs. 11 days, P = 0.004) were significantly lower in the PiCCO group than in the CVP group. Treatment costs were lower in the PiCCO group than in the CVP group. Multivariate logistic regression model showed that the monitoring method (PiCCO vs. CVP) was independently associated with the length of ICU stay [odds ratio (OR) 3.16, 95% confidence interval (95% CI) 1.55-6.63, P = 0.001], as well as shock (OR 3.41, 95% CI 1.74-6.44, P = 0.002), shock and ARDS (OR 3.46, 95% CI 1.79-6.87, P = 0.002), and APACHE II score (OR 1.17, 95% CI 1.02-1.86, P = 0.014). CONCLUSIONS This study investigated the usefulness of the PiCCO system in improving outcomes for patient with severe thoracic trauma and ARDS and provided new evidence for fluid management in critical care settings.
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Affiliation(s)
- Zhong Yuanbo
- Emergency Center, Shenzhen People's Hospital, Shenzhen, 518020, China
| | - Wang Jin
- Emergency Center, Shenzhen People's Hospital, Shenzhen, 518020, China
| | - Shi Fei
- Emergency Center, Shenzhen People's Hospital, Shenzhen, 518020, China
| | - Long Liangong
- Emergency Center, Shenzhen People's Hospital, Shenzhen, 518020, China
| | - Liu Xunfa
- Emergency Center, Shenzhen People's Hospital, Shenzhen, 518020, China
| | - Xu Shihai
- Emergency Center, Shenzhen People's Hospital, Shenzhen, 518020, China
| | - Shan Aijun
- Emergency Center, Shenzhen People's Hospital, Shenzhen, 518020, China.
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Abstract
BACKGROUND Minimally invasive (MI) cardiac surgery was introduced to reduce problems associated with a full sternotomy. This meta-analysis aimed to investigate the effects of minimally invasive cardiac surgery on a range of clinical outcomes. METHODS To identify potential studies (randomised/prospective clinical trials) systematic searches were carried out. The search strategy included the concepts of "minimally invasive" OR "MIDCAB" AND "coronary artery bypass grafting" OR "cardiac surgery". This was followed by a meta-analysis investigating cross-clamp time, cardiopulmonary bypass (CPB) time, operation time, ventilation time, intensive care unit (ICU) stay, hospital stay, incidence of myocardial infarction and of stroke/neurologic complications. RESULTS Eight studies (9 intervention groups), totalling 596 participants were analysed. MI cardiac surgery was associated with a shorter ICU stay mean difference (MD) -0.7days (95% confidence interval (CI) -1.23 to -0.18, p=0.009) and longer cross-clamp MD 6.7min (95% CI 1.24 to 12.17, p=0.02), CPB MD 26.68min (95% CI 10.31 to 43.05, p=0.001), and operation times MD 55.03min (95% CI 22.76 to 87.31, p=0.0008). However no differences were found in the ventilation time MD -3.94h (95% CI -8.09 to 0.21, p=0.06), length of hospital stay MD -1.14days (95% CI -3.11 to 0.83, p=0.26) and in the incidence of myocardial infarction odds ratio (OR) 1.97 (95% CI 0.49 to 7.9, p=0.34) or stroke/neurologic complications OR 0.67 (95% CI 0.11 to 4.05, p=0.66). CONCLUSIONS Minimally invasive cardiac surgery is as safe as conventional surgery and could reduce costs due to a shorter period spent in ICU.
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Van de Steen O, Miri F, Gunjaca M, Klepac V, Gross B, Notario G, Wegzyn CM. The Burden of Severe Respiratory Syncytial Virus Disease Among Children Younger than 1 Year in Central and Eastern Europe. Infect Dis Ther 2016; 5:125-37. [PMID: 27174177 PMCID: PMC4929088 DOI: 10.1007/s40121-016-0109-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Indexed: 01/04/2023] Open
Abstract
INTRODUCTION Globally, respiratory syncytial virus (RSV) is the most common cause of serious lower respiratory tract infections (LRTIs) in young children, and is a major cause of hospital admission in children <1 year of age. The study evaluated the severity of RSV-associated LRTI disease among premature (<36 weeks gestational age (GA)) and term children <1 year of age and assessed the influence of GA on outcomes of RSV LRTI hospitalization in Central and Eastern Europe (CEE). METHODS Retrospective cohort survey of children <1 year of age hospitalized with an LRTI during the periods of October 2009 to April 2010 or October 2010 to April 2011 in 12 CEE countries. RESULTS Across two RSV seasons, 3474 evaluable children were hospitalized because of LRTI; 757 (21.8%) were premature and 2679 (77.1%) were term. RSV tests were positive in 1423 (42.4%) cases, of which 266 (18.7%) were premature and 1034 (72.7%) were term children. Among the RSV-positive patients, premature children had a significantly longer hospital stay (17 vs 8 days; P < 0.001), were more frequently hospitalized in the intensive care unit (ICU) (41.4% vs 12.6%) and remained in the ICU significantly longer (13 vs 6 days; P < 0.001) compared with term children. Premature children had a 3.3-fold (95% CI, 2.66-4.09) increased risk for ICU hospitalization compared with term children (P < 0.001). ICU hospitalization, prolonged hospital stay, supplemental oxygen administration and death occurred significantly more frequently among children with lower vs higher GA. CONCLUSION RSV infection is associated with substantial morbidity in CEE among premature and term children. The attributable morbidity, however, is significantly greater among premature children compared with term children, including longer hospital stays and more frequent and longer stays in the ICU. These findings are consistent with previously published data outside of CEE, demonstrating prematurity as a significant and independent predictor for severe RSV disease. FUNDING AbbVie Inc.
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Affiliation(s)
| | - Farzaneh Miri
- Abbott GmbH & Co. KG, Wiesbaden, Germany.,Alexion Pharma GmbH, Munich, Germany
| | | | | | - Baerbel Gross
- Medeor Consulting, Ghent, Belgium.,AbbVie, Baar, Switzerland
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Salah M, Hosny H, Salah M, Saad H. Impact of immediate versus delayed tracheal extubation on length of ICU stay of cardiac surgical patients, a randomized trial. Heart Lung Vessel 2015; 7:311-9. [PMID: 26811837 PMCID: PMC4712034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
INTRODUCTION Ultra-fast track anaesthesia aims at immediate extubation of cardiac surgical patients at the end of the operation. This study compares the effect of ultrafast track anesthesia versus continued postoperative mechanical ventilation on the intensive care unit length of stay. METHODS Fifty-two elective adult patients were randomly allocated into ultrafast track anaesthesia and conventional groups by computer-generated random numbers. Redo operations, pre-operative intubation, uncontrolled diabetes, shock/left ventricular ejection fraction < 45%, pulmonary artery systolic pressure >55mmHg, creatinine clearance -1, haemodynamic instability, or those with concerns of postoperative bleeding were excluded. Pre- and intra-operative management was similar and Logistic EuroSCORE II was calculated for all. Intra-operatively, haemodynamic parameters, urine output, oxygen saturation, arterial blood gas analysis, 5-lead electrocardiogram, operative bypass- and cross-clamp time, and opioid consumption were collected. Postoperatively, patients were compared during their intensive care unit stay. Data were analysed by χ²/Fischer exact, unpaired student's t-test, univariate two-group repeated measures with post hoc Dunnett's test, and Mann-Whitney U tests as appropriate. p < 0.05 was considered significant. RESULTS Patients were comparable regarding their peri-operative characteristics and EuroSCORE. The intensive care unit stay was shorter in the ultrafast track anaesthesia group [57.4 (18.6) vs. 95 (33.6) h. p < 0.001], without increasing postoperative renal, respiratory complications rate or reopening rate. CONCLUSIONS In this single center study, ultrafast track anaesthesia decreased intensive care unit stay without increasing the rate of post-operative complications.
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Affiliation(s)
- Moataz Salah
- Department of Anesthesia, Students Hospital, Cairo University, Cairo, Egypt
| | - Hisham Hosny
- Department of Anesthesia and Intensive Care Medicine, Kasr Al-Ainy faculty of medicine, Cairo University, Cairo, Egypt
| | - Maged Salah
- Department of Anesthesia and Intensive Care Medicine, Kasr Al-Ainy faculty of medicine, Cairo University, Cairo, Egypt
| | - Hoda Saad
- Department of Anesthesia and Intensive Care Medicine, Kasr Al-Ainy faculty of medicine, Cairo University, Cairo, Egypt
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Abstract
OBJECTIVE To re-evaluate the effects of perioperative beta-blockade on mortality and major outcomes after surgery. DESIGN A meta-analysis of parallel randomized, controlled trials published in English. SETTING A university-based electronic search. PARTICIPANTS Patients undergoing surgery. INTERVENTIONS Two interventions were evaluated: (1) Stopping or continuing a β-blocker in patients on long-term β-blocker therapy; and (2) Adding a β-blocker for the perioperative period. MEASUREMENTS AND MAIN RESULTS Stopping a β-blocker before the surgery did not change the risk of myocardial infarction (3 studies including 97 patients): risk ratio (RR), 1.08 (95% confidence interval 0.30, 3.95); I(2), 0%. Adding a β-blocker reduced the risk of death at 1 year: RR, 0.56 (0.31, 0.99); I(2), 0%; p = 0.046; number needed to treat 28 (19, 369) (4 studies with 781 patients). Adding a β-blocker reduced the 0-to-30 day risk of myocardial infarction: RR, 0.65 (0.47, 0.88); I(2), 12.9%; p = 0.006 (15 studies with 12,224 patients), but increased the risk of a stroke: RR, 2.18 (1.40, 3.38); I(2), 0%; p = 0.001 (8 studies with 11,737 patients); number needed to harm 177 (512, 88). CONCLUSIONS β-blockers reduced the 1-year risk of death, and this effect seemed greater than the risk of inducing a stroke.
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Affiliation(s)
- Joanne Guay
- University of Montreal, Montreal, Quebec, Canada.
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Alibrahim IJ, Kabbani MS, Abu-Sulaiman R, Al-Akhfash A, Mazrou KA. Outcome of tracheostomy after pediatric cardiac surgery. J Saudi Heart Assoc 2012; 24:163-8. [PMID: 23960690 DOI: 10.1016/j.jsha.2012.01.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2011] [Revised: 01/10/2012] [Accepted: 01/21/2012] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To investigate the incidence, timing indications and outcome of tracheotomy in children who underwent cardiac surgeries. METHODS All pediatric cardiac patients (under 14 years of age) who underwent cardiac surgeries and required tracheotomy from November 2000 to November 2010 were reviewed. The data were collected and reviewed retrospectively. RESULTS Sixteen children underwent tracheotomy after cardiac surgery. Fifteen of these cases had surgery for congenital heart disease, and one had surgery for an acquired rheumatic mitral valve disease. The mean ± SEMs of the durations of ventilation before and after tracheotomy were 60.4 ± 9.8 and 14.5 ± 4.79 days respectively (P value 0.0002). The means ± SEM of the lengths of ICU stay before and after tracheotomy were 63.31 ± 10.15 and 22 ± 5.4 days respectively (P value 0.0012). After the tracheotomy 12/16 patients (75%) were weaned from their ventilators and 10/16 were discharged from the PCICU. Six patients were discharged from the hospital and 3 were successfully decannulated. The overall survival rate was 9/16 (56%). CONCLUSION Tracheostomy shortens the duration of mechanical ventilation and facilitates discharge from the ICU. The mortality of tracheotomy patients is still significant but is mainly related to the primary cardiac disease.
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