Surgery ICU Research Articles

Precision Opioid Prescription in ICU Surgery: Insights from an Interpretable Deep Learning Framework

Precision Opioid Prescription in ICU Surgery: Insights from an Interpretable Deep Learning Framework

Timing of surgery for children and adolescents sustaining complete traumatic spinal cord injury.

Spinal cord injury (SCI) trials have historically underrepresented pediatric patients. There are limited pediatric data examining the influence of surgical timing on complications and mortality for children and adolescents who have sustained complete traumatic SCI. The following multicenter cohort study used Trauma Quality Improvement Program data from 2010 to 2020. The authors identified pediatric patients (aged < 18 years) who sustained complete traumatic SCI and underwent surgical intervention within 7 days of admission. Propensity score matching was performed between patients who underwent surgery within 24 hours versus ≥ 24 hours. The authors then assessed differences for the following outcomes: major in-hospital complications, immobility-related complications, length of stay (LOS), and mortality. There were 837 patients with complete traumatic SCI managed across 297 trauma centers identified for study inclusion (70% underwent early surgery). After matching, 494 patients were available for analysis. Patients undergoing delayed surgery experienced longer ICU LOS (mean difference 3.74 days, 95% CI 0.91-6.57 days) and more major in-hospital complications (OR 1.77, 95% CI 1.16-2.73) and immobility-related complications (OR 2.09, 95% CI 1.25-3.56). There were no differences in mortality between groups. Younger age, non-White race, penetrating injuries, lower Glasgow Coma Scale score at admission, severe concomitant abdominal injuries, and motor vehicle collision injury mechanisms were associated with increased time to surgery. The authors demonstrated an association between early surgery and shorter ICU LOS and reduced in-hospital complications. Future work is needed to quantify the impact of surgical timing on functional neurological outcomes and to explore upstream social determinants of health influencing timing of surgery.

Comparative effectiveness of Castor single-branch stent and hybrid surgery for the left subclavian artery in managing acute Type B aortic dissection with an inadequate proximal landing zone

Abstract Background Our study aims to compare the clinical outcomes and risk factors for adverse events between TEVAR with branch stent-graft and Hybrid surgery for the reconstruction of the left subclavian artery. Methods We retrospectively analyzed data from patients with insufficient proximal landing zones of acute Type B aortic dissection treated at our hospital from January 2017 to December 2022. According to the surgical method, patients were divided into TEVAR group (n=58) and Hybrid group (n=69). The primary endpoint was all-cause mortality. Results The diameter of the proximal landing zone in the TEVAR group was larger than that in the Hybrid group (31.5mm vs 30.3mm, P=0.037). Early Results: There was no significant difference in major adverse events and 30-day mortality between the TEVAR and Hybrid groups. The Hybrid group had significantly longer surgery time (110min vs 238min), hospital stay (8d vs 12d), and ICU stay (0d vs 1d) compared to the TEVAR group (P&amp;lt;0.001). Mid-Term Results: There was no statistical difference in mid-term mortality rates (3.4% vs 8.7%; P=0.398) between the TEVAR and Hybrid groups. The rate of mid-term adverse events was significantly higher in the Hybrid group compared to the TEVAR group (23.2% vs 6.9%; P=0.023). The rate of re-intervention was significantly higher in the Hybrid group compared to the TEVAR group (17.4% vs 3.4%; P=0.027). The 18-month freedom from mid-term adverse event rate was 93.1% (95% CI, 86.4% - 99.8%) for the TEVAR group and 76.8% (95% CI, 66.6% - 87.0%) for the Hybrid group. There was a significant difference in the rate of mid-term adverse events between the TEVAR and Hybrid groups, with the Hybrid group being higher (6.9% vs 23.2%, P=0.013). COX regression results showed: Diameter of the proximal landing zone (HR=0.6, 95%CI=0.4–0.9, P=0.009) was an independent risk factor for postoperative aortic-related adverse events. Conclusions TEVAR reconstruction of LSA and hybrid surgery are both safe and effective treatments for acute Type B aortic dissection with insufficient proximal landing zones. There is no difference in early adverse events and 30-day mortality rates between TEVAR reconstruction of LSA and hybrid surgery. Compared to hybrid surgery, TEVAR reconstruction of LSA has the advantages of shorter operation time, hospital stay, and ICU duration. There is no difference in aortic-related mortality and all-cause mortality between TEVAR reconstruction of LSA and hybrid surgery. However, TEVAR has significantly lower rates of mid-term adverse events and re-intervention compared to the hybrid group. The diameter of the proximal landing zone are risk factors for all-cause mortality.

Predictors of Weaning Failure from Mechanical Ventilation in Post Cardiac Surgery Patients

Abstract Background Cardiac surgery disrupts homeostasis, putting the patient in danger. Weaning from a ventilator requires clinical judgement and multiple signs. Patients recovering from anaesthesia can restart spontaneous ventilation. Cardiopulmonary bypass recovers during breathing. Weaning patients from mechanical ventilation after heart surgery involves vital capacity, tidal volume, respiratory rate, and minute ventilation. Others have related advanced age, comorbidities, protracted extracorporeal circulation, cardiac dysfunction, and low cardiac output to unsuccessful weaning of cardiac patients from mechanical ventilation and postoperative hemodynamics and neurological alterations to long-term ventilation. Aim To determine predictors of unsuccessful weaning from mechanical ventilation after cardiac surgery, and therefore avoid the potentially hazardous long stay in ICU. Subjects and Methods This study was conducted at Ain Shams University Hospital, post cardiac surgery ICU including 80 patients undergo cardiac surgery and receiving mechanical ventilation after operation. Results Most of our included patients were successfully extubated. Most of our included patients developed intraoperative complications; the commonest complications were pacemaker wire followed by VF. Most of our included patients have CABG followed by MVR. Most of our included patients have mild tracheal secretion followed by moderate secretion. Charlson Comorbidity Index, COPD and CVS were statistically significant higher in failed extubation than weaned group while MBP and PO2/FIO2were statistically significant lower in failed than weaned patients. Conclusion From findings of this study we can conclude that SOFA (≥ 6), Comorbidity index (&amp;gt;3), sever tracheal Secretion, RR/TV (≥57), MV (≥ 13.5) are independent predictors of failed weaning from mechanical ventilation.

To investigate the relation between LDH and CRP levels and mortality of COVID-19 (SARS-CoV-2) patients admitted in SURGERY ICU at Shariati Hospital from 19 February 2020 till 19 February 2021

Background: The aim of this study is to investigate the relationship between LDH and CRP levels and the mortality of COVID-19 (SARS-CoV-2) patients admitted to the SURGERY ICU at Shariati Hospital from 19 February 2020 to 19 February 2021. Methods: Our study is a cross-sectional descriptive study. A total of 81 patients were enrolled in this study. We examined lab reports, including CBC parameters (WBC, neutrophil count, neutrophil percentage), other inflammatory markers ESR and CRP, and also studied the medical records of cases to collect details about age, gender, length of stay in SURGERY ICU, BMI, fever, survival status, comorbidity, intubation, and NIV. These patients were referred to Shariati Hospital, Tehran, from 19 February 2020 to 19 February 2021, regarding the relationship between LDH and CRP levels and the mortality of COVID-19 (SARS-CoV-2) patients admitted to the SURGERY ICU. The data obtained was analyzed using SPSS software, and a significance value of &lt; 0.05 was considered. Results: In this study, the data of 81 patients were considered. The data were obtained from the medical records of Shariati Hospital, Tehran. We used 11 variables to compare data from different patients that were recorded in the registry and system of medical records in Shariati Hospital, Tehran. The study population included 81 patients, of which 41 were female and 40 were male, ranging in age from 25 to 89. In total, 80.2% had mild disease versus 18.5% who had severe disease. Sixty-five patients survived, and 16 were admitted to the SURGERY ICU with endotracheal intubation and later died. The length of stay in the SURGERY ICU ranged from 1 to 25 days. Out of 81 patients, 52 (62.4%) had comorbidity, and 29 (35.8%) did not have comorbidity. Twelve patients (14.8%) received NIV, and 69 patients (85.2%) did not receive NIV. Most of the patients did not have a fever. The minimum and maximum levels of CRP were 4 and 416, respectively, and for LDH were 9 and 2401, respectively. The prognostic factors for the severity of COVID-19 infection identified in this study (CRP and LDH) help predict the course of the disease at an early stage. Elevated concentrations of CRP and LDH at admission were found to be associated with a higher risk for COVID-19 severity as they were significant (p-value =0.049 and 0.048, respectively). Conclusions: This study’s laboratory investigation showed that the SURGERY ICU patients had significantly higher values of inflammatory markers CRP and LDH than the non-SURGERY ICU patients. LDH and CRP were superior and effective biomarkers in predicting the severity of COVID-19.

The Management and Outcomes of Septic Shock Among Surgical Patients at the Jimma University Medical Center, Jimma, Ethiopia: A Prospective Study.

Background and objective Sepsis and septic shock are major healthcare issues in surgical patients admitted to the surgery ward or ICU, affecting millions of people worldwide annually, with a mortality rate between one in three and one in six of those affected.The incidence and mortality of sepsis vary greatly by region, with the highest prevalence in Sub-Saharan Africa, Oceania, South Asia, East Asia, and Southeast Asia. Of all sepsis cases in 2017, 33.1 million people suffered from ill health due to underlying infectious diseases, and 15.8 million suffered from underlying injuries or non-communicable diseases. Methods This prospective observational study was conducted at the Jimma University Medical Centre (JUMC) in Jimma town in southwest Ethiopia, from April 2023 to October 2023. Allsurgical patients aged ≥15 years who presented with or developed septic shock at the Jimma University Medical Centre were included. Results The study involved a total of 61 patients. The median age of the patients was 45 years [interquartile range (IQR): 40-60years], and 77% (n=47) of the patients were male. The most frequent source of infection in this study was community-acquired infection (83.3%, n=49). The most common focus of sepsis was the intra-abdominal infection of the digestive system (82%, n=50). Lactate level testing and blood cultures before administering antibiotics were not done for all septic shock patients. Source control surgery was performed in 52.5% (n=32) of patients after developing septic shock, and 84.4% (n=27) of surgeries were performed within 24 hours. The 30-day mortality rate was 80.3%, with an ICU mortality rate of 78.94%. The median length of stay in the ICU was three days (IQR: 1-5 days), and the median length of hospital stay was six days (IQR: 2-15 days). Conclusions The mortality rate in our cohort washigher compared to that in studies from high-income and low-income countries. There was poor adherence and compliance with the Surviving Sepsis Campaign (SSC) (the one-hour bundle) guidelines. The length of stay in hospitals and ICUs was lower compared to studies from high-income countries due to the high early mortality rates.

A Systematic Review and Meta-Analysis of MicroRNA as Predictive Biomarkers of Acute Kidney Injury.

Acute kidney injury (AKI) affects 10-15% of hospitalised patients and arises after severe infections, major surgeries, or exposure to nephrotoxic drugs. AKI diagnosis based on creatinine level changes lacks specificity and may be delayed. MicroRNAs are short non-coding RNA secreted by all cells. This review of studies measuring miRNAs in AKI aimed to verify miRNAs as diagnostic markers. The study included data from patients diagnosed with AKI due to sepsis, ischaemia, nephrotoxins, radiocontrast, shock, trauma, and cardiopulmonary bypass. Out of 71 studies, the majority focused on AKI in sepsis patients, followed by cardiac surgery patients, ICU patients, and individuals receiving nephrotoxic agents or experiencing ischaemia. Studies that used untargeted assays found 856 differentially regulated miRNAs, although none of these were confirmed by more than one study. Moreover, 68 studies measured miRNAs by qRT-PCR, and 2 studies reported downregulation of miR-495-3p and miR-370-3p in AKI patients with sepsis after the AKI diagnosis. In three studies, upregulation of miR-21 was reported at the time of the AKI diagnosis with a significant pooled effect of 0.56. MiR-21 was also measured 19-24 h after cardiac surgery in three studies. However, the pooled effect was not significant. Despite the considerable research into miRNA in AKI, there is a knowledge gap in their applicability as diagnostic markers of AKI in humans.

Analysis of Risk Factors of Difficult Weaning from Mechanical Ventilation after Pediatric Cardiac Surgery: A Single Center Prospective Study

Abstract Background Weaning from mechanical ventilation (MV( and timing of extubation are crucial components in the postoperative management of cardiac surgery as altered respiratory mechanics and positive pressure ventilation may have significant influence on hemodynamics. Aim: To evaluate risk factors for failure of weaning from mechanical ventilation after pediatric cardiac surgery and to assess the frequency of phrenic nerve injury. Methodology This Cohort study included medical records of 101 children admitted consecutively to Pediatric post-cardiac surgery ICU in Academy of Cardiovascular surgery in Ain Shams university Hospitals between April, 2020 and April, 2021, who had undergone heart surgery. The patients were divided into two groups : - successefully weaned group. - Difficult to wean group. Diaphragmatic ultrasound was done for every difficult weaning patient to assess diaphragmatic paralysis. Result: Age (P &amp;lt; 0.001), Weight (P &amp;lt; 0.001), volum intake (P &amp;lt; 0.001), systolic blood pressure (P = 0.017), Diastolic blood pressure (P = 0.004), were significantly lower in patients who showed difficult weaning compared to patients with successful weaning. Furthermore operation time (P &amp;lt; 0.001), use of noradrenaline (P = 0.019), use of adrenaline ( P = 0.017), use of Milirinon ( P = 0.003), respiratory rate ( P = 0.003), inotropic support (P = 0.001), positive fluid balance (P &amp;lt; 0.001), heart failure, renal failure, Pulmonary complications, need of pace maker, sepsis ( P &amp;lt; 0.001), diaphragmatic paralysis ( P &amp;lt; 0.001), transposition of great arteries operations ( P = 0.009), were significantly higher in patients who showed difficult weaning compared to patients with successful weaning. While use of dobutamine, discharge with open chest, reoperation, transfusion &amp;gt; 50 ml / kg, urine output, reoperation bleeding and any operation other than atrial septal defect, transposition of great arteries all did not affect weaning difficulty. Conclusion younger age, operation time, as well as sepsis were the best predictors for difficulty of weaning.

Evaluation of Stenotrophomonas Maltophilia Bloodstream Infections in a Tertiary Pediatric Cardiovascular Surgery Intensive Care Unit in Turkey

Background: Stenotrophomonas maltophilia poses a significant challenge as a drug-resistant opportunistic bacterium, particularly in ICU settings. However, its impact on pediatric ICU patients, especially those undergoing cardiovascular surgery, are scarce. Therefore, we aimed to analyze the factors behind S. maltophilia bloodstream infections (BSI) in our tertiary pediatric cardiovascular surgery ICU by evaluating the 2-year data. Methods: In this retrospective study, we analyzed data of 11 (mean age 20.3±17.6 months) and 18 cases (mean age 22.4±18.5 months) diagnosed with S. maltophilia BSI out of 635 and 685 children who underwent cardiovascular surgery from March 2021 to February 2022, and March 2022 to February 2023, respectively. Factors including age, gender, cardiac pathologies, surgical risk scores, duration of extracorporeal membrane oxygenation (ECMO) and mechanical ventilation, length of ICU stay, and use of broad-spectrum antibiotics were compared. Results: The incidence of S. maltophilia BSI increased by 50.5% in 2022-2023 compared to the previous year. While no significant differences were noted in age, gender, or surgical frequency, notable distinctions emerged in ECMO and mechanical ventilation durations, ICU length of stay, and broad-spectrum antibiotic usage (p values&lt;0.05). Conclusion: Prolonged ECMO and mechanical ventilation, along with extended ICU stays and broad-spectrum antibiotic administration following highrisk cardiac surgeries, emerged as significant contributors to S. maltophilia BSI in our ICU. This underscores the necessity for a comprehensive approach encompassing infection control protocols, prudent antimicrobial utilization, and strategies to minimize invasive procedures. Such a multifaceted approach is paramount in mitigating the prevalence of S. maltophilia BSI, especially in high-risk ICU environments.

Safety and Feasibility of Neuromuscular Electrical Stimulation in Patients with Extracorporeal Membrane Oxygenation.

Background/Objectives: The aim of this study was to investigate the feasibility and safety of neuromuscular electrical stimulation (NMES) in patients on extracorporeal membrane oxygenation (ECMO) and thoroughly assess any potential adverse events. Methods: We conducted a prospective observational study assessing safety and feasibility, including 16 ICU patients on ECMO support who were admitted to the cardiac surgery ICU from January 2022 to December 2023. The majority of patients were females (63%) on veno-arterial (VA)-ECMO (81%), while the main cause was cardiogenic shock (81%) compared to respiratory failure. Patients underwent a 45 min NMES session while on ECMO support that included a warm-up phase of 5 min, a main phase of 35 min, and a recovery phase of 5 min. NMES was implemented on vastus lateralis, vastus medialis, gastrocnemius, and peroneus longus muscles of both lower extremities. Two stimulators delivered biphasic, symmetric impulses of 75 Hz, with a 400 μsec pulse duration, 5 sec on (1.6 sec ramp up and 0.8 sec ramp down) and 21 sec off. The intensity levels aimed to cause visible contractions and be well tolerated. Primary outcomes of this study were feasibility and safety, evaluated by whether NMES sessions were successfully achieved, and by any adverse events and complications. Secondary outcomes included indices of rhabdomyolysis from biochemical blood tests 24 h after the application of NMES. Results: All patients successfully completed their NMES session, with no adverse events or complications. The majority of patients achieved type 4 and 5 qualities of muscle contraction. Conclusions: NMES is a safe and feasible exercise methodology for patients supported with ECMO.

Effects of pay-for-performance based antimicrobial stewardship on antimicrobial consumption and expenditure: An interrupted time series analysis

ObjectivesTo evaluate the impact of pay-for-performance on antimicrobial consumption and antimicrobial expenditure in a large teaching hospital in Guangzhou, China. MethodsWe collected data from hospital information system from January 2018 through September 2022 in the inpatient wards. Antimicrobial consumption was evaluated using antibiotic use density (AUD) and antibiotic use rate (AUR). The economic impact of intervention was assessed by antimicrobial expenditure percentage. The data was analyzed using interrupted time series (ITS) analysis. ResultsFollowing the implementation of the intervention, immediate decreases in the level of AUD were observed in Department of Hematology Unit 3 (β = −66.93 DDDs/100PD, P = 0.002), Urology (β = −32.80 DDDs/100PD, P < 0.001), Gastrointestinal Surgery Unit 3 (β = −11.44 DDDs/100PD, P = 0.03), Cardiac Surgery (β = −14.30 DDDs/100PD, P = 0.01), ICU, Unit 2 (β = −81.91 DDDs/100PD, P = 0.02) and Cardiothoracic Surgery ICU (β = −41.52 DDDs/100PD, P = 0.05). Long-term downward trends in AUD were also identified in Organ Transplant Unit (β = −1.64 DDDs/100PD, P = 0.02). However, only Urology (β = −6.56 DDDs/100PD, P = 0.02) and Gastrointestinal Surgery Unit 3 (β = −8.50 %, P = 0.01) showed an immediate decrease in AUR, and long-term downward trends in AUR were observed in Pediatric ICU (β = −1.88 %, P = 0.05) and ICU Unit 1 (β = −0.55 %, P = 0.02). ConclusionThis study demonstrates that the adoption of pay-for-performance effectively reduces antibiotic consumption in specific departments of a hospital in Guangzhou in the short term. However, it is important to recognize that the long-term impact of such interventions is often limited. Additionally, it should be noted that the overall effectiveness of the intervention across the entire hospital was not significant.

Analysis of Nurses' Pain Assessment Records in Colorectal Surgery: A Retrospective Study

Objective: The study aims to evaluate the effectiveness of pain management, establish a pain profile, and reveal the current state of pain assessment after colorectal surgery. Materials and Methods: A retrospective and descriptive design was used. The research population included the records of patients hospitalized in the general surgery ICU of a hospital between November 2020 and November 2021 after colorectal surgery. The measures were a Descriptive Information Form and a Pain Evaluation Follow-up Form. Results: Patients’ mean age was 61.32±14.21 years. Males were 64.2%. Colon (65.9%) and rectal (34.1%) surgeries had been performed. Postoperative mean pain values were 2.84±1.79 at the 0th-2nd hours and 1.68±1.44 (0-4) at the 37th-48th hours. The values were significantly higher in patients without chronic diseases. Of the nurses, 94.7% used scales with proven validity and reliability, but there were no records about the pain’s location, character, duration, and factors that increased or decreased. Conclusions: Nurses’ records about pain management after colorectal surgery were missing. The records analyzed were not enough to determine the pain profile after colorectal surgery. The role of pain and analgesia records in effective pain management should be considered, and the management of the electronic record system should be supported.

(1285) - Verticalization Therapy: Safety and Efficacy in the Cardiac Surgery ICU

(1285) - Verticalization Therapy: Safety and Efficacy in the Cardiac Surgery ICU

The Relationship of The Nurse's Handover Process With Implementation of Patient Safety Targets in The Surgery Room and Icu

&lt;div&gt;&lt;table cellspacing="0" cellpadding="0" align="left"&gt;&lt;tbody&gt;&lt;tr&gt;&lt;td align="left" valign="top"&gt;&lt;p&gt;&lt;em&gt;Every year, millions of patients suffer injuries or die because of unsafe and Not Good-quality health care. Many medical practices and healthcare-related risks have emerged as major challenges to patient safety and contribute significantly to the burden of harm from unsafe care. The aim of this research is to determine the relationship between the nurse handover process and the implementation of patient safety targets in the surgical ward and ICU of the &lt;/em&gt;&lt;em&gt;Royal Prim&lt;/em&gt;&lt;em&gt;e&lt;/em&gt;&lt;em&gt; &lt;/em&gt;&lt;em&gt;Hospital &lt;/em&gt;&lt;em&gt;Medan&lt;/em&gt;&lt;em&gt; &lt;/em&gt;&lt;em&gt;2022. This research is a type of quantitative research with a pre-experimental design method type one group pretest-posttest (single group initial test-final test), with a population of all nurses working in the surgical ward (26 nurses) and ICU (26 nurses). 25 nurses) &lt;/em&gt;&lt;em&gt;Royal Prim&lt;/em&gt;&lt;em&gt;e&lt;/em&gt;&lt;em&gt; &lt;/em&gt;&lt;em&gt;Hospital &lt;/em&gt;&lt;em&gt;Medan&lt;/em&gt;&lt;em&gt;, totaling 51 people. Research sample collection techniques are primary data, secondary data and tertiary data. The instrument used is a questionnaire. Research data analysis is univariate analysis and bivariate analysis. The results of the research showed that there was a significant increase in the implementation of the nurse handover process before the treatment was 24.75 and it increased after the treatment to 39.22. Shows that there was a significant increase in the implementation of patient safety targets before treatment, amounting to 27.65 and an increase after treatment to 43.39. And showing a p value (0.005) &amp;lt; 0.05, it shows that there is a significant relationship between the handover process and the implementation of patient safety targets at the RSU. Royal Prima Medan in 2022&lt;/em&gt;&lt;em&gt;.&lt;/em&gt;&lt;/p&gt;&lt;p&gt;&lt;em&gt;&lt;br /&gt;&lt;/em&gt;&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;/tbody&gt;&lt;/table&gt;&lt;/div&gt;&lt;strong&gt;&lt;em&gt;Keyword : Handover, Hospital, Patient Safety&lt;/em&gt;&lt;/strong&gt;

Capillary refill time assessment after fluid challenge in patients on venoarterial extracorporeal membrane oxygenation: A retrospective study

BackgroundMonitoring fluid therapy is challenging in patients assisted with Veno-arterial ECMO. The aim of our study was to evaluate the usefulness of capillary refill time to assess the response to fluid challenge in patients assisted with VA-ECMO. MethodsRetrospective monocentric study in a cardiac surgery ICU. We assess fluid responsiveness after a fluid challenge in patients on VA-ECMO. We recorded capillary refill time before and after fluid challenge and the evolution of global hemodynamic parameters. ResultsA total of 27 patients were included. The main indications for VA-ECMO were post-cardiotomy cardiogenic shock (44%). Thirteen patients (42%) were responders and 14 non-responders (58%). In the responder group, the index CRT decreased significantly (1.7 [1.5; 2.1] vs. 1.2 [1; 1.3] s; p = 0.01), whereas it remained stable in the non-responder group (1.4 [1.1; 2.5] vs. 1.6 [0.9; 1.9] s; p = 0.22). Diagnosis performance of CRT variation to assess response after fluid challenge shows an AUC of 0.68 (p = 0.10) with a sensitivity of 79% [95% CI, 52–92] and a specificity of 69% [95% CI, 42–87], with a threshold at 23%. ConclusionIn patients treated with VA-ECMO index capillary refill time is a reliable tool to assesses fluid responsiveness. SpecialtyCritical care, Cardiac surgery, ECMO.

Bronchus compression is a predictor for reobstruction in coarctation with hypoplastic arch repair.

The surgical treatment of coarctation of aorta with hypoplastic aortic arch (CoA/HAA) was challenging to achieve long-lasting arch patency. We reviewed early and late outcomes in our centre and identified predictors for arch reobstruction. A retrospective analysis of medical records was performed to identify CoA/HAA patients who underwent primary arch reconstruction via median sternotomy between 2011 and 2020. Preoperative aortic arch geometry was analysed with cardiac computed tomographic angiography. Bedside flexible fibre-optic bronchoscopy was routinely performed after surgery in intensive care unit. There were 104 consecutive patients (median age 39.5 days) who underwent extended end-to-end anastomosis, extended end-to-side anastomosis and autograft patch augmentation. Early mortality was 3.8% and overall survival was 94.1% [95% confidence interval (CI) 89.6-98.8%] at 1, 3 and 5 years. Reobstruction-free survival was 85.1% (95% CI 78.4-92.3%) at 1 year, 80.6% (95% CI 73.1-88.9%) at 3 years and 77.4% (95% CI 69.2-86.6%) at 5 years. Preoperative aortic arch geometric parameters were not important factors for reobstruction. Nineteen patients (18.3%) were detected with left main bronchus compression (LMBC) on flexible fibre-optic bronchoscopy. Cardiopulmonary bypass time [P < 0.001, hazard ratio (95% CI): 1.02 (1.01-1.03)] and postoperative LMBC [P = 0.034, hazard ratio (95% CI): 2.99 (1.09-8.23)] were independent predictive factors on multivariable Cox regression analysis of reobstruction-free survival. Aortic arch can be satisfactorily repaired by extended end-to-end anastomosis, extended end-to-side anastomosis and autograft patch augmentation via median sternotomy in CoA/HAA. Cardiopulmonary bypass time and postoperative LMBC detected by flexible fibre-optic bronchoscopy are significant predictors for long-term arch reobstruction.

Percutaneous Dilatational Tracheostomy in a Cardiac Surgical Intensive Care Unit: A Single-Center Experience.

A significant proportion of cardiac surgery intensive care unit (CSICU) patients require long-term ventilation, necessitating tracheostomy placement. The goal of this study was to evaluate the long-term postoperative outcomes and complications associated with percutaneous dilatational tracheostomy (PDT) in CSICU patients. All patients undergoing PDT after cardiac, thoracic, or vascular operations in the CSICU between January 1, 2013 and January 1, 2021 were identified. They were evaluated for mortality, decannulation time, and complications including bleeding, infection, and need for surgical intervention. Multivariable regression models were used to identify predictors of early decannulation and the complication rate. Ninety-three patients were identified for this study (70 [75.3%] male and 23 [24.7%] female). Furthermore, 18.3% of patients had chronic obstructive pulmonary disease (COPD), 21.5% had history of stroke, 7.5% had end-stage renal disease, 33.3% had diabetes, and 59.1% were current smokers. The mean time from PDT to decannulation was 39 days. Roughly one-fifth (20.4%) of patients were on dual antiplatelet therapy and 81.7% had anticoagulation restarted 8 hours post-tracheostomy. Eight complications were noted, including 5 instances of bleeding requiring packing and 1 case of mediastinitis. There were no significant predictors of decannulation prior to discharge. Only COPD was identified as a negative predictor of decannulation at any point in time (hazard ratio, 0.28; 95% confidence interval, 0.08-0.95; p=0.04). Percutaneous tracheostomy is a safe and viable alternative to surgical tracheostomy in cardiac surgery ICU patients. Patients who undergo PDT have a relatively short duration of tracheostomy and do not have major post-procedural complications.

Influence of timing of Levosimendan administration on outcomes in cardiac surgery.

Though a subgroup analysis has shown improved survival for patients suffering severely reduced ventricular function undergoing coronary artery bypass grafting, RCTs were not able to demonstrate overall beneficial effects of perioperative Levosimendan in cardiac surgery. This might be due to Levosimendan's pharmacokinetics reaching a steady-state concentration only 4-8 h after administration. Thus, this study now analysed the influence of timing of Levosimendan administration on perioperative outcome in cardiac surgery patients preoperatively presenting with severely reduced ventricular function and therefore considered at high-risk for intra- or postoperative low cardiac output syndrome. We hypothesized that prolonged preoperative Levosimendan administration ("preconditioning") would reduce mortality. All adult patients undergoing cardiac surgery between 2006 and 2018 perioperatively receiving Levosimendan were included in this retrospective, observational cohort study (n = 498). Patients were stratified into 3 groups: Levosimendan started on the day prior to surgery ("preop"), Levosimendan started on the day of surgery ("intraop") or post ICU admission ("postop"). After propensity score matching (PSM) was performed, outcomes defined according to proposed standard definitions for perioperative outcome research were compared between groups. After PSM, there were no significant differences in patients' characteristics, comorbidities and type/priority of surgery between groups. Compared to intraop or postop Levosimendan treatment, preop treated patients had significantly lower in-hospital-mortality (preop vs. intraop. vs. postop = 16,7% vs. 33,3% vs. 42,3%), duration of mechanical ventilation and rate of continuous renal replacement therapy. Prolonged preoperative treatment with Levosimendan of cardiac surgery patients preoperatively presenting with severely reduced left ventricular function might be beneficial in terms of postoperative outcome. Our results are in line with recent experts' recommendations concerning the prolonged perioperative use of Levosimendan. We strongly recommend that future randomized trials include this "preconditioning" treatment as an experimental arm.

The attitudes about life-sustaining treatment among cardiac surgery ICU patients and their families.

To investigate the attitudes among cardiac surgery ICU patients and their families regarding life-sustaining treatment. A total of 172 pairs of patients in the cardiac surgery ICU of Nanjing First Hospital and their family members were enrolled in this study that examined their attitudes toward life-sustaining treatment using a willingness to care for life-sustaining treatment questionnaire. The consistency of the attitudes of patients and family members toward life-sustaining treatment was analyzed by the chi-square test with a paired design. The most popular life-sustaining treatment for cardiac ICU patients was noninvasive mechanical ventilation (79.1%); the most unpopular was intra-aortic balloon counterpulsation (48.3%). Most patients and their families had not considered electric defibrillation (65.7%), but most understood and were willing to permit cardiopulmonary resuscitation (76.2%). Few family members agreed that patients should receive a pacemaker (25.0%). The consistency of life support attitudes of patients and their families ranged from 12.8% to 60.5% for procedures both would agree to, 1.2% to 19.8% for procedures they were unwilling to permit, and 0.6% to 39.0% for procedures they had not considered. Kappa values ranged from 0.218 to 0.597 (P < 0.05), with general consistency. Cardiac surgery ICU patients families are generally consistent in their attitudes toward life-sustaining treatment, and family members' choices are not representative of patients' wishes.

Aspiration Pneumonitis.

Background: Aspiration pneumonitis also called as Mendelson's syndrome is a lung injury from acute inflammation that occurs after chemical burns in the airways and lung parenchyma, caused by the inhalation of gastric content. Depending on the quantity, nature of the aspirated material, and the host factors, the damage can lead to acute respiratory distress with a mortality rate up to 70%.&#x0D; Case report: A 73-year-old male, was admitted from the emergency department to cardiovascular surgery ICU, diagnosed with ruptured abdominal aortic aneurysm. The patient presented with severe hypotension, tachycardic with altered mental status and was immediately sent to the operating room. At the moment of shifting to the operating table, the patient had cardiocirculatory arrest, large amount of gastric content came out of the patient’s mouth. While the patient was assisted with chest compressions, suction was immediately done in the oropharyngeal cavity, the patient was intubated with direct laryngoscopy, the tube cuff had its adequate pressure assured to prevent further aspiration.Bronchial lavage was performed before patient ventilation. The cardiac rhythm was restored, and the surgical incision started. Within 30 minutes from the aspiration, during the surgery the patient appeared symptoms of Mendelson’s syndrome. The arterial blood gas test was presented with hypoxemia in 100% with retention. Empiric antibiotic and corticosteroid were administered. After the surgery the patient was transferred to the ICU and was ventilated according to the ARDS protocol. The patient had other complications during his stay in ICU and was extubated after nine days and was discharged home after 19 days.&#x0D; Discussion: Regardless of the measures taken to avoid aspiration pneumonia during emergency surgery, it is sometimes inevitable and it is important to know how to act and treat the patient according to the primary underlying condition.&#x0D; Conclusions: Treatment with early, empiric, broad-spectrum antibiotics should be administered then selection of pathogen specific antibiotics or decision to stop or continue the use of antibiotics is made based on quantitative bacteriology