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<1>
Accession Number
2010321335
Authors
Bainbridge D. Martin J. Ahmad Sabry M.H.I. Craig A. Iglesias I.
Institution
(Bainbridge, Iglesias) Departments of Anesthesia and Perioperative
Medicine, University of Western Ontario, London, ON, Canada
(Martin) Pharmacology and Physiology, University of Western Ontario,
London, ON, Canada
(Ahmad Sabry) Alexandria Faculty of Medicine, Alexandria University,
Alexandria, Egypt
(Craig) Greenlane Surgical Short Stay Unit, Auckland, New Zealand
(Bainbridge) Department of Anesthesia and Perioperative Medicine, London
Health Sciences Centre-University Hospital, 339 Windermere Road, London,
ON N6A 5A5, Canada
Title
Orogastric tubes do not improve transesophageal echocardiographic imaging
during cardiac surgery: A randomized trial.
Source
Canadian Journal of Anesthesia. 57 (3) (pp 216-221), 2010. Date of
Publication: March 2010.
Publisher
Springer New York (233 Springer Street, New York NY 10013-1578, United
States)
Abstract
Introduction: Image quality is often an overlooked consideration that
affects the quality and findings of a perioperative transesophageal
echocardiography (TEE) study. We undertook a study to evaluate the
potential benefit of orogastric (OG) tube insertion following tracheal
intubation as a method to improve TEE image quality. Methods: In this
prospective randomized double-blind controlled trial, 32 adult cardiac
surgery patients were randomized to receive either an orogastric (OG) tube
with suctioning or no OG tube following tracheal intubation and before TEE
probe insertion. Two independent observers graded the quality of related
TEE images on a scale from 1 to 4, and the total image scores (total
scores out of a possible 20) were compared between groups across five
different views. All analyses were by intention to treat. Results: For the
total scores, there was no difference between the OG and control groups
(mean 12.3 [2.1] vs 12.8 [1.8], respectively; P = 0.7). There was a
numerically small but statistically significant difference in total scores
between reviewers (score 2.4 [0.7] vs 2.2 [0.9]; mean difference -0.2; 95%
confidence interval -0.4 to -0.02; P < 0.001). For the most part, the
raters agreed on the scores for each view. Overall, 96% of the total
scores were identical or differed by only one point. Conclusion: While
this study was underpowered to detect small changes in image quality, the
use of an OG tube for routine cases did not improve the overall quality of
the related images acquired during TEE examination. Canadian
Anesthesiologists' Society 2010.

<2>
Accession Number
2010372192
Authors
Bilehjani E. Fakhari S.
Institution
(Bilehjani) Department of Cardiovascular Anesthesia, Tabriz University of
Medical Sciences, Madani Heart Hospital, Tabriz, Iran, Islamic Republic of
(Fakhari) Madani Heart Hospital, Daneshqah Street, Tabriz, Iran, Islamic
Republic of
Title
Hemodynamic response to laryngoscopy in ischemic heart disease: Macintosh
blade versus glidescope videolaryngoscope.
Source
Rawal Medical Journal. 34 (2) (pp 151-154), 2009. Date of Publication:
July - Dec. 2009.
Publisher
Pakistan Medical Association (Garden Road, Karachi - 3, Pakistan)
Abstract
Objective To determine the hemodynamic response to laryngoscopy/tracheal
intubation using GlideScope videolaryngoscope in patients with
ischemic heart diseases. Methods In a randomized clinical trial, 80 adult
patient, candidate for coronary artery bypass graft surgery were allocated
in two groups for laryngoscopy (MC=Macintosh blade or GS=GlideScope). The
hemodynamic response, laryngoscopy time, success rate and complication
rate were compared. Results Two patients were excluded because of long
postoperative intubation period. Demographic data and airway
characteristics were comparable. There was no failed intubation.
Laryngoscopy time in MC group was shorter than GS group (14.50+/-8.30
versus 48.80+/-47.82 respectively, p=0.001). Stylet was used commonly and
more attempts to intubation were done in GS group. Hemodynamic response to
orotracheal intubation in 1, 5 and 15 min following intubation was not
different between two groups. Conclusions GlideScope technique
did not have any benefit and increased laryngoscopy time, need to use
stylet and required more attempts. (Rawal Med J 2009;34: 151-154).

<3>
Accession Number
2010362717
Title
Herbal medicine.
Source
Focus on Alternative and Complementary Therapies. 15 (2) (pp 152-157),
2010. Date of Publication: June 2010.
Publisher
Wiley-Blackwell (350 Main Street, Malden MA 02148, United States)

<4>
Accession Number
2010377050
Authors
Deng B. Tan Q.-Y. Zhao Y.-P. Wang R.-W. Jiang Y.-G.
Institution
(Deng, Tan, Zhao, Wang, Jiang) Thoracic Surgery Department, Institute of
Surgery Research, Daping Hospital, Third Military Medical University,
Chongqing 400042, China
Title
Suction or non-suction to the underwater seal drains following pulmonary
operation: Meta-analysis of randomised controlled trials.
Source
European Journal of Cardio-thoracic Surgery. 38 (2) (pp 210-215), 2010.
Date of Publication: August 2010.
Publisher
Elsevier (P.O. Box 211, Amsterdam 1000 AE, Netherlands)
Abstract
Objectives: The decision to proceed to simple underwater seal drainage or
to apply active suction to the underwater seal following pulmonary
operation is a controversial one. For the sake of selecting the
alternative to reduce postoperative air leakage, we performed a
meta-analysis of randomised controlled trials (RCTs) to determine the
benefit of suction or non-suction following lung surgery on patient
outcomes. Methods: RCTs published in English from 1999 to 2009 were
included. A fixed-effect model was developed for postoperative
pneumothorax cases. A random-effects model was developed for quantitative
data synthesis, including prolonged air-leak cases, duration of air
leakage, time for the removal of chest tubes and hospital stay. Results:
Odds ratio (95% confidence interval (CI)), expressed as suction versus
non-suction, was 0.11 (0.03-0.49) for postoperative pneumothorax cases;
relative risk was 1.48 (0.82-2.70) for prolonged air-leakage cases;
weighted mean difference was 1.16 (-0.63 to 2.94) for the duration of air
leakage, 0.96 (-0.12 to 2.05) for the time for removal of chest tubes and
2.19 (0.61-4.98) for the hospital stay. Conclusion: There is no necessity
to use suction in most cases, since it cannot decrease the incidence of
prolonged air leak. However, suction can reduce the occurrence of
postoperative pneumothorax resulting from early air leak. As a result, the
early use of postoperative suction might be crucial to specific patients
to whom early elimination of residual space is very important. 2010
European Association for Cardio-Thoracic Surgery.

<5>
Accession Number
2010379773
Authors
Serruys P.W. Silber S. Garg S. Van Geuns R.J. Richardt G. Buszman P.E.
Kelbaek H. Van Boven A.J. Hofma S.H. Linke A. Klauss V. Wijns W. Macaya C.
Garot P. DiMario C. Manoharan G. Kornowski R. Ischinger T. Bartorelli A.
Ronden J. Bressers M. Gobbens P. Negoita M. Van Leeuwen F. Windecker S.
Institution
(Serruys, Garg, Van Geuns) Department of Cardiology, Erasmus Medical
Center, Molewaterplein 40, Ba-583, 3015 GD Rotterdam, Netherlands
(Ronden, Bressers, Gobbens) Cardialysis, Rotterdam, Netherlands
(Van Boven, Hofma) Medisch Centrum Leeuwarden, Leeuwarden, Netherlands
(Silber) Kardiologische Praxis und Praxisklinik, Munich, Germany
(Klauss) University Hospital Munich (Innenstadt), Munich, Germany
(Ischinger) Hospital Bogenhausen, Munich, Germany
(Richardt) Herz-Kreislauf-Zentrum, Segeberger Kliniken, Bad Segeberg,
Germany
(Linke) Herzzentrum Leipzig, Leipzig, Germany
(Buszman) Medical University of Silesia, Katowice, Poland
(Kelbaek) Rigshospitalet, Copenhagen, Denmark
(Wijns) Onze Lieve Vrouw Ziekenhuis, Aalst, Belgium
(Macaya) Hospital Universitario, Madrid, Spain
(Garot) Institut Cardiovasculaire Paris-Sud, Quincy, France
(DiMario) Royal Brompton Hospital, London, United Kingdom
(Manoharan) Royal Victoria Hospital, Belfast, United Kingdom
(Kornowski) Rabin Medical Center, Tel Aviv University, Tel Aviv, Israel
(Bartorelli) Centro Cardiologico Monzino, Milan, Italy
(Negoita, Van Leeuwen) Medtronic, Santa Rosa, CA, United States
(Windecker) Bern University Hospital, Bern, Switzerland
Title
Comparison of zotarolimus-eluting and everolimus-eluting coronary stents.
Source
New England Journal of Medicine. 363 (2) (pp 136-146), 2010. Date of
Publication: 08 Jul 2010.
Publisher
Massachussetts Medical Society (860 Winter Street, Waltham MA 02451-1413,
United States)
Abstract
BACKGROUND: New-generation coronary stents that release zotarolimus or
everolimus have been shown to reduce the risk of restenosis. However, it
is unclear whether there are differences in efficacy and safety between
the two types of stents on the basis of prospectively adjudicated end
points endorsed by the Food and Drug Administration. METHODS: In this
multicenter, noninferiority trial with minimal exclusion criteria, we
randomly assigned 2292 patients to undergo treatment with coronary stents
releasing either zotarolimus or everolimus. Twenty percent of patients
were randomly selected for repeat angiography at 13 months. The primary
end point was target-lesion failure, defined as a composite of death from
cardiac causes, any myocardial infarction (not clearly attributable to a
nontarget vessel), or clinically indicated target-lesion revascularization
within 12 months. The secondary angiographic end point was the extent of
in-stent stenosis at 13 months. RESULTS: At least one off-label criterion
for stent placement was present in 66% of patients. The
zotarolimus-eluting stent was noninferior to the everolimus-eluting stent
with respect to the primary end point, which occurred in 8.2% and 8.3% of
patients, respectively (P<0.001 for noninferiority). There were no
significant between-group differences in the rate of death from cardiac
causes, any myocardial infarction, or revascularization. The rate of stent
thrombosis was 2.3% in the zotarolimus-stent group and 1.5% in the
everolimus-stent group (P = 0.17). The zotarolimus-eluting stent was also
noninferior regarding the degree (+/-SD) of in-stent stenosis
(21.65+/-14.42% for zotarolimus vs. 19.76+/-14.64% for everolimus, P =
0.04 for noninferiority). In-stent late lumen loss was 0.27+/-0.43 mm in
the zotarolimus-stent group versus 0.19+/-0.40 mm in the everolimusstent
group (P = 0.08). There were no significant between-group differences in
the rate of adverse events. CONCLUSIONS: At 13 months, the new-generation
zotarolimus-eluting stent was found to be noninferior to the
everolimus-eluting stent in a population of patients who had minimal
exclusion criteria. Copyright 2010 Massachusetts Medical Society. All
rights reserved.

<6>
Accession Number
2010324480
Authors
Serrano C.V. Souza J.A. Lopes N.H. Fernandes J.L. Nicolau J.C. Blotta
M.H.S.L. Ramires J.A.F. Hueb W.A.
Institution
(Serrano, Souza, Lopes, Fernandes, Nicolau, Ramires, Hueb) Heart Institute
(InCor), Medical School, University of Sao Paulo, Brazil
(Fernandes, Blotta) Department of Clinical Pathology, Faculty of Medical
Sciences, State University of Campinas, Brazil
Title
Reduced expression of systemic proinflammatory and myocardial biomarkers
after off-pump versus on-pump coronary artery bypass surgery: A
prospective randomized study.
Source
Journal of Critical Care. 25 (2) (pp 305-312), 2010. Date of
Publication: June 2010.
Publisher
W.B. Saunders (Independence Square West, Philadelphia PA 19106-3399,
United States)
Abstract
Background: The effects of off-pump (OffPCABG) and on-pump (OnPCABG)
coronary artery bypass grafting (CABG) on myocardium and inflammation are
unclear. Objective: Compare the inflammatory response and myocardial
injury from patients (pts) submitted to OffPCABG with those that undergo
OnPCABG. Methods: Patients with normal left ventricular function were
assigned to OffPCABG (n = 40) and OnPCABG (n = 41). Blood samples were
collected before and 24 hours after surgery for determination of creatine
kinase (CK)-MB (CK-MB), troponin I (cTnI), interleukin (IL)-6, IL-8,
P-selectin, intercellular adhesion molecule (ICAM)-1 and C-reactive
protein (CRP). Mortalities were registered at 12 months. Results:
Preoperative CK-MB and cTnI levels were 3.1 +/- 0.6 IU and 1.2 +/- 0.5
ng/mL for OffPCABG and 3.0 +/- 0.5 IU and 1.0 +/- 0.2 ng/mL for OnPCABG
pts. Postoperative CK-MB and cTnI levels were 13.9 +/- 6.5 IU and 19.0 +/-
9.0 ng/mL for OffPCABG vs 29.5 +/- 11.0 IU and 31.5 +/- 10.1 ng/mL for
OnPCABG (P < .01). OffPCABG and OnPCABG pts had similar preoperative IL-6
(10 +/- 7 and 9 +/- 13 pg/mL), IL-8 (19 +/- 7 and 17 +/- 7 pg/mL), soluble
P-selectin (70 +/- 21 and 76 +/- 23 pg/mL), soluble ICAM-1 (117 +/- 50 and
127 +/- 52 ng/mL), and CRP (0.09 +/- 0.05 and 0.11 +/- 0.07 mg/L). At 24
hours, for OffPCABG and OnPCABG: IL-6 was 37 +/- 38 and 42 +/- 41
^,+/- g/mL; IL-8, 33 +/- 31 and 60 +/- 15 ^,+/- pg/mL;
soluble P-selectin, 99 +/- 26 and 172 +/- 30 ^,+/- pg/mL;
soluble ICAM-1, 227 +/- 47 and 236 +/- 87 ^,+/- ng/mL; and CRP,
10 +/- 11 and 14 +/- 13 ^,+/- mg/L ( P < .01 vs preoperation;
^+/-P < .01 vs OffPCABG). Increased 24-hour postoperative CRP
levels was the only marker to have significant positive correlations with
events and occurred just for the OnPCABG pts. In-hospital and 1-year
mortalities for the OnPCABG and OffPCABG pts were 2.0% and 2.2% (P = .1)
and 2.7% and 4.7% (P = .06), respectively. Conclusions: Thus, the absence
of CPB during CABG preserves better the myocardium and attenuates
inflammation-however, without improving survival. 2009.

<7>
Accession Number
2010324863
Authors
Sabzmakan L. Hazavehei S. Morowatisharifabad M. Hasanzadeh A. Rabiee K.
Sadeqi M.
Institution
(Sabzmakan) Qazvin University of Medical Sciences, Iran, Islamic Republic
of
(Hazavehei, Hasanzadeh, Sadeqi) Hamadan University of Medical Sciences,
Iran, Islamic Republic of
(Morowatisharifabad) Yazd University of Medical Sciences, Iran, Islamic
Republic of
(Rabiee) Isfahan Cardiovascular Research Center, Iran, Islamic Republic of
Title
The effects of a PRECEDE-based educational program on depression, general
health, and quality of life of coronary artery bypass grafting patients.
Source
Asian Journal of Psychiatry. 3 (2) (pp 79-83), 2010. Date of
Publication: June 2010.
Publisher
Elsevier (P.O. Box 211, Amsterdam 1000 AE, Netherlands)
Abstract
Background: Depression is commonly reported as a consequence of coronary
artery bypass grafting surgery. It is the most important barrier to proper
treatment of cardiac patients, causing failure in accepting the condition,
decreasing the motivation in following the therapeutic recommendations,
and negatively affecting the patients' function and quality of life.
Objective(s): The objective of this study was to investigate the effects
of a PRECEDE-based educational program on depression, general health, and
quality of life in coronary artery bypass grafting surgery patients.
Methods: The experimental study included 54 post-bypass surgery patients
in Isfahan Cardiovascular Research Center. The patients were randomly
assigned to intervention and comparison groups (27 patients in each). The
data were collected using four questionnaires (Cardiac Depression Scale,
General Health Questionnaire-12, SF-36, and a PRCEDE-based questionnaire
to measure predisposing, reinforcing, enabling factors, and self-help
behaviors). All subjects were pre-tested. The intervention, consisting of
nine educational sessions per week (60-90 min each) was implemented. The
patients were followed for 2 months post-intervention and post-tested at
the end of the second month. Results: Following the educational
intervention, the mean scores of predisposing factors, enabling factors,
reinforcing factors and self-helping behaviors were significantly
increased in the intervention group, compared to the comparison group (p <
0.001). The mean score for depression in the comparison group (104.5 +/-
30.4) and intervention group (112.8 +/- 21.9) decreased significantly
following educational intervention, but the change was more pronounced in
the intervention group compared with the control group (66.2 +/- 22 vs.
89.2 +/- 27.8). The difference between the two groups on the basis of
general health was statistically significant (p < 0.0001). Improvements in
quality of life on the basis of physical function (p < 0.04), role
limitations resulting from emotional status (p < 0.01), and mental health
(p < 0.04) were statistically significant. Conclusion: The findings of the
study confirmed the effectiveness of an educational program based on the
PRECEDE Model on decreasing depression level, improving general health,
and increasing quality of life in coronary artery bypass grafting surgery
patients. 2010 Elsevier B.V. All rights reserved.

<8>
Accession Number
2010372817
Authors
Koizumi T. Fitzgerald P.J. Honda Y. Ellis S.G. Kent K. Martin S.L. Brown
C.L. Masud A.R.Z. Patterson J.B. Greenberg J. Friedman M. Uchida T. Stone
G.W.
Institution
(Koizumi, Fitzgerald, Honda) Stanford University, Stanford, CA, United
States
(Ellis) Cleveland Clinic Foundation, Cleveland, OH, United States
(Kent) Washington Cardiology Center, Washington, DC, United States
(Martin) Nebraska Heart Institute, Lincoln, NE, United States
(Brown) Piedmont Hospital, Atlanta, GA, United States
(Masud) Buffalo General Hospital, Buffalo, NY, United States
(Patterson) Forsyth Medical Center, Winston-Salem, NC, United States
(Greenberg) Florida Heart Institute, Orlando, FL, United States
(Friedman, Uchida) Boston Scientific Corporation, Natick, MA, United
States
(Stone) Columbia University Medical Center, Cardiovascular Research
Foundation, New York, NY, United States
Title
Vascular responses to the multiple overlapped paclitaxel-eluting stents
for the treatment of bare-metal in-stent restenotic lesions: Angiographic
and intravascular ultrasound analysis from the TAXUS-V ISR Trial.
Source
Cardiovascular Revascularization Medicine. 11 (3) (pp 140-148), 2010.
Date of Publication: July 2010.
Publisher
Elsevier Inc. (360 Park Avenue South, New York NY 10010, United States)
Abstract
Background: Although effective coverage of coronary diffuse in-stent
restenosis (ISR) lesions has warranted the use of multiple drug-eluting
stents, the vessel response to paclitaxel-eluting stent (PES) overlap is
not fully understood. Methods and materials: In the TAXUS-V ISR, i.e.,
comparing PES versus brachytherapy for the treatment of bare-metal ISR,
angiographic analyses at 9-month follow-up were available in 184 ISR
lesions treated with PES. Results: In-stent late loss in entire stented
segment of multiple PES (n=50) was 0.45+/-0.48 mm, whereas that of single
PES (n=134) was 0.3+/-0.47 mm, P=06. No aneurysm was observed at
overlapping PES segments at 9 months. Stent thrombosis up to 9 months was
observed in one in each group (single PES, 0.7% vs. multiple PES, 1.8%;
P=47). In a subset of 30 patients, volumetric intravascular ultrasound
analysis demonstrated that in-stent net volume obstruction was 12.3+/-12.4
in single PES (n=20) and 14.9+/-9.8 in multiple PES (n=10), P=60. The
changes of vessel and lumen at the overlapping PES segment were similar to
those of the adjacent 5-mm segments ({increment}minimum lumen area,
mm²: -1.2+/-1.0, -1.1+/-1.1, -0.8+/-0.9, P=48;
{increment}vessel volume, mm³/mm: -0.2+/-1.4, 0.1+/-1.7,
0.3+/-1.3, P=37; proximal, overlap, distal segment, respectively). There
was no late incomplete stent apposition at overlapping PES segments.
Conclusions: No in vivo evidence of adverse local vessel response at the
site of overlapping PES for the treatment of bare-metal ISR has been
demonstrated. 2010 Elsevier Inc.

<9>
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Accession Number
2010378581
Authors
Aslan A. Osmanagaoglu S. Cavolli R. Emiroglu O. Kaya K. Kahraman D. Uymaz
O.K. Tasoz R. Ozyurda U.
Institution
(Aslan, Kahraman, Uymaz) Division of Cardiovascular Surgery, Canada
(Osmanagaoglu) Division of Anesthesiology and Reanimation, Kavaklidere
Umut Hospital, Turkey
(Cavolli, Kaya) Division of Cardiovascular Surgery, Ozel Ankara Ulus
Hospital, Turkey
(Emiroglu, Tasoz, Ozyurda) Department of Cardiovascular Surgery, Ankara
University, School of Medicine, Ankara, Turkey
Title
Sodium nitroprusside infusion prevents hypothyroidism in patients
undergoing coronary artery bypass grafting: A prospective randomized
clinical trial.
Source
Journal of Cardiovascular Medicine. 11 (8) (pp 575-582), 2010. Date of
Publication: August 2010.
Publisher
Lippincott Williams and Wilkins (345 Hudson St., 16th Fl., New York NY
10014-4502, United States)
Abstract
OBJECTIVE: The level of thyroid hormones is an important factor in
determining the outcome of coronary artery bypass patients. Sodium
nitroprusside (SNP) is a natural donor of nitric oxide which has been
shown to interfere with thyroid hormone synthesis. Whether clinical use of
sodium nitroprusside has any effect on thyroid function has not yet been
investigated. The aim of this study was to investigate the effects of SNP
administration on circulating levels of thyroid hormones. METHODS: One
hundred and six consecutive patients who underwent coronary artery bypass
grafting operation were prospectively randomized to receive continuous
infusions of either SNP or saline limited to the rewarming time of
cardiopulmonary bypass (CPB). Free triiodothyronine (T3), total T3, free
thyroxine (T4), total T4 and thyroid-stimulating hormone (TSH) levels were
analyzed. RESULTS: Free T3, TSH and albumin changes of SNP and control
groups were statistically different from each other. In the SNP group,
free T3 values stayed in the euthyroid range between CPB and post-CPB
periods, the period when SNP was infused, whereas it continued to decline
to hypothyroidic levels in the control group. In addition, in the SNP
group, an elevation in TSH levels was observed during the CPB period.
Postoperatively, an earlier restoration of free T3 and TSH levels was
observed in the SNP group when compared to the control group. CONCLUSION:
In this study, administration of SNP during cardiopulmonary bypass is
shown to regulate free T3 and TSH levels positively. 2010 Italian
Federation of Cardiology.

<10>
Accession Number
70195127
Authors
Van De Vyver K. Labeau S. Brusselaers N. Vogelaers D. Blot S.
Institution
(Van De Vyver, Labeau, Brusselaers, Vogelaers, Blot) GhentBelgium
Source
Clinical Microbiology and Infection. Conference: 20th ECCMID Vienna
Austria. Conference Start: 20100410 Conference End: 20100413. Conference
Publication: (var.pagings). 16 (pp S112), 2010. Date of Publication:
April 2010.
Publisher
Blackwell Publishing Ltd
Abstract
Objective: Ventilator-associated pneumonia (VAP) is the most frequent
nosocomial infection in the intensive care unit. Reducing inoculums of
oral pathogenic microorganisms by adequate oral care could prevent VAP.
Methods: A systematic review of the literature concerning oral
decontamination with chlorhexidine or povidone-iodine on intubated
patients, and subsequent meta-analysis evaluating the effects of oral
decontamination on the incidence of VAP was performed. Relevant articles
were searched for in electronic databases as PubMed, CINAHL, Web of
Science and CENTRAL and supplemented by manual searches of reference
lists. Only randomized controlled trials evaluating the effect of oral
care with use of chlorhexidine or povidone-iodine vs. oral care without
use of an antiseptic on the incidence of VAP in adult intubated patients
were included. Data were extracted as dichotomous variables. Data analysis
was performed using RevMan 5.0. Statistical analysis was conducted
according the Mantel-Haenszel model to obtain the relative risk (RR) and
95% confidence interval (CI). Heterogeneity was assessed using the Chi-2
test. Results: Eleven studies were included in the analysis (n
patients=1971) of which 9 that investigated the effect of oral care with
use of chlorhexidine (n patients=1862) and 2 that assessed the effect of
oral care with use of povidone-iodine (n patients=109). The use of an
antisepticum resulted in a significant reduction of the incidence of VAP
with a RR of 0.63 (95%CI 0.50-0.81; p=0.0002). These results are valid for
chlorhexidine (RR 0.68; 95% CI 0.53-0.88; p=0.004) and povidone-iodine (RR
0.38; 95% CI 0.19-0.75; p=0.005). Among studies important differences
exists concerning concentrations of the antiseptic used, frequency of oral
care, and study methodology and diagnostic criteria for VAP. Clinical
heterogeneity was confirmed statistically and was moderate
(X²=43%; p=0.08) for the trials using chlorhexidine and high
(X²=66%; p=0.09) for those assessing povidone-iodine. Subgroup
analyses revealed most beneficial effects with concentrations of 0.12% and
2% chlorhexidine and 10% povidone-iodine, and in a population of cardiac
surgery patients. Conclusions: This analysis shows that oral
decontamination with an antiseptic reduces the incidence of VAP
significantly. Both chlorhexidine and povidone-iodine show this effect.
However, further research is needed to make recommendations about the
concentration and frequency of application.

<11>
Accession Number
70195130
Authors
Dohmen P. Guleri A. Petrosillo N. Utili R. Gonzalez San V. Seaton R.A.
Gonzalez-Ramallo V.J. Hetzer R. Heep M. Thurston H.J. Chaves R.L.
Source
Clinical Microbiology and Infection. Conference: 20th ECCMID Vienna
Austria. Conference Start: 20100410 Conference End: 20100413. Conference
Publication: (var.pagings). 16 (pp S113), 2010. Date of Publication:
April 2010.
Publisher
Blackwell Publishing Ltd
Abstract
Objective: Randomized controlled trials are scarce in endocarditis and
might not be representative for the general patient population. The aim of
this registry was to describe the clinical experience with Daptomycin
(DAP) for the treatment of infective endocarditis (IE) in Europe. DAP is
approved in Europe for the treatment of right-sided endocarditis due to S.
aureus at a dose of 6 mg/kg once daily. Methods: In this multi-centre,
retrospective, non-interventional registry, the outcome data were
collected in patients (pts) who were diagnosed with native or prosthetic
valve IE and treated with at least one dose of DAP. Clinical outcomes were
assessed at the end of DAP treatment by the investigators using standard
definitions (cured, improved, failure, non-evaluable). Success was defined
as the sum of cured or improved outcome rates. Results: Of the total 2581
pts in the EU-CORE registry from Jan 2006 to Aug 2009, 276 pts (68% male
and 53%>=65 years of age) had IE. A total of 117 (42%) pts received DAP in
an ICU, congestive heart failure was present in 31 (11%) pts and cardiac
arrhythmias in 59 (21%) pts. Right sided endocarditis was observed in 66
(24%) pts, left sided endocarditis in 191 (69%) pts, and right plus left
sided endocarditis in 19 (7%) pts, respectively. The most common primary
pathogen was S. aureus (n=73, 26%), of which 25 were reported as MRSA. 180
(66%) pts received concomitant antibiotic therapy, most commonly
aminoglycosides (71, 26%) or carbapenems (46, 17%). The majority of pts
received DAP doses of 6 mg/kg (62%) or higher (21%). The clinical outcome
per IE type were: Right sided endocarditis, success 92%, failure 5%,
non-evaluable (NE) 3%; Left sided endocarditis, success 76%, failure 9%,
NE 14%; Right plus left sided endocarditis, success 89%, NE 11%.The
proportion of pts with low Creatinine clearance (< 30 L/min) improved from
17% (46/276) initially to 13% (35/276) at the end of DAP treatment.
Serious AEs were reported in 34 (12%) pts and 20 (7%) pts discontinued the
study drug due to AEs. Conclusions: Daptomycin appears effective and well
tolerated against a variety of clinical presentations of infective
endocarditis. Success rates and adverse event profile, including renal
safety were comparable to those observed in the pivotal trials. Further
clinical studies on infective endocarditis e.g. on the impact of DAP at
higher doses might be warranted.

<12>
Accession Number
70199170
Authors
Haase-Fielitz A. Bellomo R. Devarajan P. Dragun D. Haase M.
Institution
(Haase-Fielitz, Bellomo, Haase) Department of Nephrology and Intensive
Care Medicine, Charite University Medicine Berlin, Campus
Virchow-Klinikum, Berlin, Germany
(Haase-Fielitz, Haase) Department of Intensive Care, Austin Health,
Melbourne, Australia
(Devarajan) Cincinnati Children's Hospital Medical Center, Cincinnati, OH,
United States
(Dragun) Center for Cardiovascular Research, Charite University Medicine,
Berlin, Germany
Source
Hemodialysis International. Conference: Annual Dialysis Conference - 29th
Annual Conference on Peritoneal Dialysis, 15th International Symposium on
Hemodialysis, and 20th Annual Symposium on Pediatric Dialysis Houston, TX
United States. Conference Start: 20090308 Conference End: 20090310.
Conference Publication: (var.pagings). 13 (1) (pp 122-123), 2009. Date
of Publication: January 2009.
Publisher
Blackwell Publishing Inc.
Abstract
Purpose: To test whether perioperative sodium bicarbonate infusion can
attenuate postoperative acute kidney injury (AKI) in cardiac surgical
patients. Methods: In a double-blind, randomized-controlled trial, we
enrolled 100 cardiac surgical patients at increased risk of postoperative
AKI. Patients were randomized to either 24 hours of intravenous infusion
of sodium bicarbonate (4 mmol/kg) or sodium chloride (4 mmol/kg). The
primary outcome measure was the proportion of patients developing acute
renal dysfunction defined as a postoperative increase in plasma creatinine
concentration >25% of baseline within the first 5 postoperative days.
Secondary outcomes included changes in plasma creatinine, plasma urea,
urinary neutrophil gelatinase-associated lipocalin, and urinary neutrophil
gelatinase-associated lipocalin/urinary creatinine ratio. ResuIts:Patients
were well balanced for baseline characteristics. Sodium bicarbonate
infusion increased plasma bicarbonate concentration (P<0.001), base excess
(P<0.001), plasma pH (P<0.001), and urine pH (P< 0.001). Fewer patients in
the sodium bicarbonate group (16/50) developed a postoperative increase in
serum creatinine compared with control (26/50) (OR 0.43 [95% CI
0.19-0.98]) (P = 0.043). The increase in plasma creatinine, plasma urea,
urinary neutrophil gelatinase-associated lipocalin, and urinary neutrophil
gelatinase-associated lipocalin/urinary creatinine ratio was less in
patients receiving sodium bicarbonate (P= 0.014, 0.047, 0.009, and 0.004).
There were no significant side effects. Conclusions: Sodium bicarbonate
loading and continuous infusion were associated with a lower incidence of
acute renal dysfunction in cardiac surgical patients undergoing
cardiopulmonary bypass. The findings of this pilot study justify further
investigation (ClinicalTrials.gov, NCT00334191).