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<1>
Accession Number
24343688
Authors
Borges D.L. Nina V.J.S. Costa M.A.G. Baldez T.E.P. dos Santos N.P. Lima
I.M. Figueredo E.D. Lula J.L.S.
Institution
(Borges, Nina, Costa, Baldez, dos Santos, Lima, Figueredo) Hospital
Universitario, Universidade Federal do Maranhao (HUUFMA), Sao Luis, MA,
Brazil
(Lula) Hospital Sao Domingos, Sao Luis, MA, Brazil
Title
Effects of different PEEP levels on respiratory mechanics and oxygenation
after coronary artery bypass grafting.
Source
Brazilian Journal of Cardiovascular Surgery. 28 (3) (pp 380-385), 2013.
Date of Publication: July-September&#x00C2; 2013.
Abstract
Objective: To compare the effects of different levels of positive
end-expiratory pressure on respiratory mechanics and oxygenation indexes
in the immediate postoperative period of coronary artery bypass grafting.
Methods: Randomized clinical trial in which 136 patients underwent
coronary artery bypass grafting between January 2011 and March 2012 were
divided into three groups and admitted to mechanical ventilation with
different positive endexpiratory pressure levels: Group A, 5
cmH²O (n=44), Group B, 8 cmH²O (n=47) and Group C,
10 cmH²O (n=45). Data about respiratory mechanics were obtained
from mechanical ventilator monitor and oxygenation indexes from arterial
blood gas samples, collected twenty minutes after intensive care unit
admission. Patients with chronic obstructive pulmonary disease and
patients submitted to off-pump, emergency or combined operations were not
included. For statistical analysis, we used Kruskal-Wallis, G and
Chi-square tests, considering results significant when P<0.05. Results:
Groups were homogeneous in terms of demographic, clinical and surgical
variables. Patients ventilated with positive end-expiratory pressure of 10
cmH²O (Group C) had best compliance (P=0.04) and airway
resistance values, this, however, without statistical significance. They
also had best oxygenation indexes, with statistical difference in all
analyzed variables, and lower frequency of hypoxemia (P=0.03). Conclusion:
Higher levels of positive end-expiratory pressure in immediate
postoperative period of coronary artery bypass grafting improved pulmonary
compliance values and increased oxygenation indexes, resulting in lower
frequency of hypoxemia.

<2>
Accession Number
24343683
Authors
Kawauchi T.S. de Almeida P.O. Lucy K.R. Bocchi E.A. Feltrim M.I.Z. Nozawa
E.
Institution
(Kawauchi, de Almeida, Lucy, Bocchi, Feltrim, Nozawa) Universidade de Sao
Paulo, Hospital das Clinicas, Instituto do Coracao, Sao Paulo, SP, Brazil
Title
Randomized and comparative study between two intra-hospital exercise
programs for heart transplant patients.
Source
Brazilian Journal of Cardiovascular Surgery. 28 (3) (pp 338-346), 2013.
Date of Publication: July-September&#x00C2; 2013.
Abstract
Objective: To compare the effects of two physical therapy exercise
in-hospital programs in pulmonary function and functional capacity of
patients in the postoperative period of heart transplantation. Methods:
Twenty-two heart transplanted patients were randomized to the control
group (CG, n=11) and training group (TG, n=11). The control group
conducted the exercise program adopted as routine in the institution and
the training group has had a protocol consisting of 10 stages, with
incremental exercises: breathing exercises, resistance training,
stretching and walking. The programs began on the first day after
extubation and stretched until hospital discharge. Assessed pulmonary
function, distance walked in six minutes walk test (6MWT) and peripheral
muscle strength by one repetition maximum test (1RM). Results: Similar
behavior was observed between the two groups treated, with statistically
significant increases between the first and second test of the following
variables: FVC (59% in CG and 35.2% in TG); MIP (8.6% in CG and 53.5% in
TG), MEP (28.8% in CG and 40.7% in TG) and 6MWT (44.5% in CG and 31.4% in
TG). There was an increase of peripheral strength by 1RM test, over time,
to the muscle groups of the elbow flexors, shoulder flexors, hip abductors
and knee flexors. Conclusion: Heart transplant patients benefit from
exercise programs in hospital, regardless of the program type applied. A
new training proposal did not result in superiority compared to routine
programme applied. Exercise protocols provided improves in ventilatory
variables and functional capacity of this population. Descriptors: Heart
transplantation. Rehabilitation. Physical therapy modalities.

<3>
Accession Number
21744061
Authors
Molino-Lova R. Pasquini G. Vannetti F. Paperini A. Forconi T. Polcaro P.
Zipoli R. Cecchi F. Macchi C.
Institution
(Molino-Lova, Pasquini, Vannetti, Paperini, Forconi, Polcaro, Zipoli,
Cecchi, Macchi) Cardiac Rehabilitation Unit, Don Gnocchi Foundation, Via
Imprunetana 124, 50023 Pozzolatico, Florence, Italy
Title
Effects of a structured physical activity intervention on measures of
physical performance in frail elderly patients after cardiac
rehabilitation: A pilot study with 1-year follow-up.
Source
Internal and Emergency Medicine. 8 (7) (pp 581-589), 2013. Date of
Publication: October 2013.
Abstract
The objective of this prospective randomized controlled study was to
compare the long-term effects of a structured physical activity
intervention with those of aerobic exercises alone, in a cohort of elderly
patients who had undergone elective cardiac surgery, and who were
classified as frail at the end of rehabilitation based on their Short
Physical Performance Battery (SPPB) score. At the end of rehabilitation,
140 frail elderly patients were randomly allocated either to the
intervention group (IG) or to the control group (CG). CG participants
received the usual aerobic exercise prescription, while IG participants
were also taught additional exercises for strength, flexibility, balance
and coordination. The improvement in SPPB score after 1 year was the
outcome of the study. IG showed a significant improvement in SPPB score
(9.0 + 1.1 vs. 7.7 + 1.4, p < 0.001), while no significant change was
found in CG (7.7 + 1.6 vs. 7.6 + 1.5, p = 0.252). IG also showed a
significantly higher proportion of participants who improved their SPPB
score of at least 1 point (70 vs. 37%, p < 0.001). In conclusions, our
structured physical activity intervention significantly improves the SPPB
score in frail elderly patients who have undergone elective cardiac
surgery. An intervention that improves the SPPB score might delay the
occurrence of mobility disability. 2011 SIMI.

<4>
Accession Number
2014414940
Authors
Husted S. James S.K. Bach R.G. Becker R.C. Budaj A. Heras M. Himmelmann A.
Horrow J. Katus H.A. Lassila R. Morais J. Nicolau J.C. Steg P.G. Storey
R.F. Wojdyla D. Wallentin L.
Institution
(Husted) Medical Department, Hospital Unit West, GI, Landevej 61, Herning
7400, Denmark
(James, Wallentin) Department of Medical Sciences and Uppsala Clinical
Research Center, Uppsala University, Uppsala, Sweden
(Bach) Cardiovascular Division, Washington University School of Medicine,
St Louis, MO, United States
(Becker, Wojdyla) Duke Clinical Research Institute, Duke University
Medical Center, Durham, NC, United States
(Budaj) Postgraduate Medical School, Grochowski Hospital, Warsaw, Poland
(Heras) Cardiology Department, Hospital Clinic, University of Barcelona,
Barcelona, Spain
(Himmelmann) AstraZeneca Research and Development, Molndal, Sweden
(Horrow) AstraZeneca Research and Development, Wilmington, DE, United
States
(Katus) Medizinishe Klinik, Universitatsklinikum Heidelberg, Heidelberg,
Germany
(Lassila) Division of Hematology and Laboratory Services Coagulation
Disorders, Helsinki University Central Hospital, Helsinki, Finland
(Morais) Santo Andre Hospital, Leiria, Portugal
(Nicolau) Heart Institute (InCor), University of Sao Paulo Medical School,
Sao Paulo, Brazil
(Steg) INSERM-Unite 698, Paris, France
(Steg) Assistance Publique-Hopitaux de Paris, Hopital Bichat, Paris,
France
(Steg) Universite Paris-Diderot, Sorbonne-Paris Cite, Paris, France
(Storey) Department of Cardiovascular Science, University of Sheffield,
Sheffield, United Kingdom
Title
The efficacy of ticagrelor is maintained in women with acute coronary
syndromes participating in the prospective, randomized, PLATelet
inhibition and patient Outcomes (PLATO) trial.
Source
European Heart Journal. 35 (23) (pp 1541-1550), 2014. Date of Publication:
14 Jun 2014.
Publisher
Oxford University Press
Abstract
Aims The aim of this study was to assess the relationship between sex and
clinical outcomes and treatment-related complications in patients with
ST-elevation or non-ST-elevation acute coronary syndromes (ACS) randomized
to treatment with ticagrelor or clopidogrel in the PLATelet inhibition and
patient Outcomes (PLATO) trial. Methods The associations between sex
subgroup and the primary composite outcomes, secondary outcomes, and major
bleeding endpoints as well as interaction of sex subgroup with treatment
effects were analysed using Cox proportional-hazards models. Results Sex
was not significantly associated with the probability of the primary
composite endpoint [adjusted hazard ratio (HR): 1.02 (0.91-1.16)], or
other adverse cardiovascular endpoints. Ticagrelor was similarly more
effective than clopidogrel in reducing rates of the primary endpoint in
women 11.2 vs. 13.2% [adjusted HR: 0.88 (0.74-1.06)] and men 9.4 vs. 11.1%
[adjusted HR: 0.86 (0.76-0.97)] (interaction P-value 0.78), all-cause
death in women 5.8 vs. 6.8% [adjusted HR: 0.90 (0.69-1.16)] and men 4.0
vs. 5.7% [adjusted HR: 0.80 (0.67-0.96)] (interaction P-value 0.49), and
definite stent thrombosis in women 1.2 vs. 1.4% [adjusted HR: 0.71
(0.36-1.38)] and men 1.4 vs. 2.1% [adjusted HR: 0.63 (0.45-0.89)]
(interaction P-value 0.78). The treatments did not differ for
PLATO-defined overall major bleeding complications in women [adjusted HR:
1.01 (0.83-1.23)] or men [adjusted HR: 1.10 (0.98-1.24)]. Sex had no
significant association with these outcomes (interactions P = 0.43-0.88).
Conclusion Female sex is not an independent risk factor for adverse
clinical outcomes in moderate-to-high risk ACS patients. Ticagrelor has a
similar efficacy and safety profile in men and women. 2014 The Author
2014. Published by Oxford University Press on behalf of the European
Society of Cardiology.

<5>
Accession Number
2014409592
Authors
Rhee J.-W. Wiviott S.D. Scirica B.M. Gibson C.M. Murphy S.A. Bonaca M.P.
Morrow D.A. Mega J.L.
Institution
(Rhee) Department of Medicine, Stanford University Medical Center,
Stanford, CA, United States
(Wiviott, Scirica, Gibson, Murphy, Bonaca, Morrow, Mega) Department of
Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston,
MA, United States
(Gibson) Department of Medicine, Beth Israel Deaconess Medical Center,
Harvard Medical School, Boston, MA, United States
Title
Clinical features, use of evidence-based therapies, and cardiovascular
outcomes among patients with chronic kidney disease following
non-ST-elevation acute coronary syndrome.
Source
Clinical Cardiology. 37 (6) (pp 350-356), 2014. Date of Publication: June
2014.
Publisher
John Wiley and Sons Inc.
Abstract
Background Chronic kidney disease (CKD) is associated with an increased
risk of cardiovascular events following acute coronary syndrome (ACS). The
underlying pathobiology and optimal treatments for this population
continue to be evaluated. Hypothesis Patients with CKD will receive fewer
evidence-based therapies and experience high rates of adverse
cardiovascular events in both the short- and long term. Methods The
MERLIN-TIMI 36 (Metabolic Efficiency With Ranolazine for Less Ischemia in
Non-ST-Elevation Acute Coronary Syndromes-Thrombolysis in Myocardial
Infarction 36) trial randomized non-ST-elevation ACS patients to
ranolazine or placebo, with no exclusion for renal dysfunction (except
dialysis). We conducted a prespecified analysis among 6543 patients based
on the degree of CKD. Results Patients with worse renal function were
older with more comorbidities (P < 0.0001 for each). They were less likely
to receive evidence-based cardiovascular medicines (P < 0.04 for each).
Rates of an early invasive management strategy varied based on renal
function; however, among patients with the highest TIMI risk scores, the
rates of an early invasive management strategy were similar regardless of
glomerular filtration rate (GFR) (P_interaction = 0.005). Lower
GFR was associated with increased rates of cardiovascular disease or
myocardial infarction in the short and long term, even after adjustment
(GFR <30 vs >90 mL/min/1.73 m²; hazard ratio [HR]: 3.24 [95%
confidence interval {CI}: 1.26-8.38] through 7 days and HR: 2.12 [95% CI:
1.33-3.39] through 1 year). The effect of ranolazine vs placebo on
clinical outcomes was similar among those with and without CKD
(P_interaction = not significant). Conclusions Following ACS,
patients with renal dysfunction had more cardiovascular risk factors but
were less likely to receive evidence-based medical therapies. A strong
graded, independent relationship between the degree of CKD and poor
clinical outcomes was observed over time. Continued efforts to optimize
ACS treatment strategies in patients with CKD are warranted. 2014 Wiley
Periodicals, Inc.

<6>
Accession Number
2014412057
Authors
Nishimura R.A. Otto C.M. Bonow R.O. Carabello B.A. Erwin III J.P. Guyton
R.A. O'Gara P.T. Ruiz C.E. Skubas N.J. Sorajja P. Sundt III T.M. Thomas
J.D. Anderson J.L. Halperin J.L. Albert N.M. Bozkurt B. Brindis R.G.
Creager M.A. Curtis L.H. Demets D. Hochman J.S. Kovacs R.J. Ohman E.M.
Pressler S.J. Sellke F.W. Shen W.-K. Stevenson W.G. Yancy C.W.
Title
2014 AHA/ACC guideline for the management of patients with valvular heart
disease: A report of the American College of Cardiology/American Heart
Association Task Force on Practice Guidelines.
Source
Journal of Thoracic and Cardiovascular Surgery. 148 (1) (pp e1-e132),
2014. Date of Publication: July 2014.
Publisher
Mosby Inc.

<7>
Accession Number
2014415441
Authors
Nombela-Franco L. Ribeiro H.B. Urena M. Allende R. Amat-Santos I.
Delarochelliere R. Dumont E. Doyle D. Delarochelliere H. Laflamme J.
Laflamme L. Garcia E. MacAya C. Jimenez-Quevedo P. Cote M. Bergeron S.
Beaudoin J. Pibarot P. Rodes-Cabau J.
Institution
(Nombela-Franco, Ribeiro, Urena, Allende, Amat-Santos, Delarochelliere,
Dumont, Doyle, Delarochelliere, Laflamme, Laflamme, Cote, Bergeron,
Beaudoin, Pibarot, Rodes-Cabau) Quebec Heart and Lung Institute, 2725
Chemin Ste-Foy, Quebec City, G1V 4G5 QC, Canada
(Nombela-Franco, Garcia, MacAya, Jimenez-Quevedo) Cardiovascular
Institute, Hospital Clinico San Carlos, Universidad Complutense, Madrid,
Spain
Title
Significant mitral regurgitation left untreated at the time of aortic
valve replacement: A comprehensive review of a frequent entity in the
transcatheter aortic valve replacement era.
Source
Journal of the American College of Cardiology. 63 (24) (pp 2643-2658),
2014. Date of Publication: 24 Jun 2014.
Publisher
Elsevier USA
Abstract
Significant mitral regurgitation (MR) is frequent in patients with severe
aortic stenosis (AS). In these cases, concomitant mitral valve repair or
replacement is usually performed at the time of surgical aortic valve
replacement (SAVR). Transcatheter aortic valve replacement (TAVR) has
recently been considered as an alternative for patients at high or
prohibitive surgical risk. However, concomitant significant MR in this
setting is typically left untreated. Moderate to severe MR after aortic
valve replacement is therefore a relevant entity in the TAVR era. The
purpose of this review is to present the current knowledge on the clinical
impact and post-procedural evolution of concomitant significant MR in
patients with severe AS who have undergone aortic valve replacement (SAVR
and TAVR). This information could contribute to improving both the
clinical decision-making process in and management of this challenging
group of patients. 2014 by the American College of Cardiology Foundation.

<8>
Accession Number
2014418705
Authors
De Oliveira R.A. Fernandes G.A. Lima A.C.G. Tajra Filho A.D. De Barros
Araujo Jr. R. Nicolau R.A.
Institution
(De Oliveira, Nicolau) Lasertherapy and Photobiology Center, Research and
Development Institute (IP and D), Universidade Do Vale Do Paraiba
(UNIVAP), Sao Paulo, Brazil
(De Oliveira, Fernandes) Novafapi College, Teresina, Piaui, Brazil
(Lima) University of Piaui State (UESPI), Teresina, Piaui, Brazil
(Tajra Filho, De Barros Araujo Jr.) Cardiac Surgery Department, Santa
Maria Hospital, Teresina, Piaui, Brazil
Title
The effects of LED emissions on sternotomy incision repair after
myocardial revascularization: A randomized double-blind study with
follow-up.
Source
Lasers in Medical Science. 29 (3) (pp 1195-1202), 2014. Date of
Publication: May 2014.
Publisher
Springer-Verlag London Ltd
Abstract
This study aimed to analyze the effects of light-emitting diode (LED)
therapy on sternotomy pain and healing in patients who underwent coronary
artery bypass grafting (CABG). The patients were followed for 6 months
after the surgery to determine their dehiscence. This study was conducted
with 90 volunteers who electively submitted to CABG. The volunteers were
randomly allocated into three different groups of equal size: LED ( of
640+20 nm and spatial average energy fluency of 1.2 J/cm²
during hospitalization), placebo, or control. The outcomes assessed were
pain when coughing by a visual analog scale (VAS) and the McGill
questionnaire and sternotomy healing by clinical assessment and
photographical register end interpretation. The LED group had better pain
reduction, as indicated by both the VAS and the McGill questionnaire
(number of words chosen and pain index) (p<0.05), on days 6 and 8 after
hospital discharge compared to the placebo and control groups. One month
after surgery, almost no individual mentioned pain when coughing. Three
researchers blindly analyzed the incision photographs to determine
hyperemia and wound closure, and they found that the LED group had both
less hyperemia and less incision bleeding or dehiscence. The LED therapy
(640 nm) had an analgesic effect on the sternotomies of patients who
underwent CABG, increasing their incision healing and preventing
dehiscence. 2013 Springer-Verlag.

<9>
Accession Number
2014409081
Authors
Karrowni W. Makki N. Dhaliwal A.S. Vyas A. Blevins A. Dughman S. Girotra
S. Cram P. Horwitz P.A.
Institution
(Karrowni) UnityPoint Clinic - St Luke's Hospital, Cedar Rapids, IA,
United States
(Makki, Dhaliwal, Vyas, Blevins, Dughman, Girotra, Cram, Horwitz)
University of Iowa Carver College of Medicine, 200 Hawkins Drive, Iowa
City, IA 52242, United States
Title
Single versus double stenting for unprotected left main coronary artery
bifurcation lesions: A systematic review and meta-analysis.
Source
Journal of Invasive Cardiology. 26 (6) (pp 229-233), 2014. Date of
Publication: June 2014.
Publisher
HMP Communications
Abstract
Objectives: We conducted a meta-analysis to assess outcomes for a
single-stent (SS) strategy versus a double-stent (DS) strategy in
treatment of distal unprotected left main coronary artery (ULMCA) lesions
in the drug-eluting stent (DES) era. BACKGROUND: Routine use of DES
implantation has contributed to improved outcomes in patients undergoing
percutaneous coronary intervention (PCI) for disease involving the ULMCA.
However, PCI for ULMCA bifurcation lesions continues to be technically
demanding and is an independent predictor of poor outcomes. While a number
of stenting techniques have been described, the optimal strategy remains
unknown. METHODS: SS treatment was defined as stenting of the main branch
alone and DS treatment as stenting of both the main and side branches. Our
co-primary endpoints were major adverse cardiovascular events (MACE), and
its individual components. RESULTS: We identified 7 observational studies
involving 2328 patients. Mean duration of follow-up was 32 months. We
adopted the random effect model when computing the combined odds ratio
(OR). There was decreased risk of MACE with SS strategy (20.4%) versus DS
strategy (32.8%) (OR, 0.51; 95% confidence interval [CI], 0.35-0.73).
There was also decreased target vessel/target lesion revascularization
(TLR/TVR) with SS strategy (10.1%) versus DS strategy (24.3%) (OR, 0.35;
95% CI, 0.25-0.49). CONCLUSION: Compared to the DS strategy of
percutaneous ULMCA bifurcation intervention, an SS approach may be
associated with better outcomes.

<10>
Accession Number
2014405815
Authors
Liu S. Bian C. Zhang Y. Jian Y. Liu W.
Institution
(Liu, Jian, Liu) Department of Cardiology, Affiliated Hospital of Hangzhou
Normal University, #126 Wenzhou Road, Hangzhou, Zhejiang Province 310015,
China
(Bian, Zhang) Department of Cardiology, Second Affiliated Hospital,
Zhejiang University, Hangzhou, Zhejiang Province, China
Title
Landiolol hydrochloride for prevention of atrial fibrillation after
cardiac surgery: A meta-analysis.
Source
PACE - Pacing and Clinical Electrophysiology. 37 (6) (pp 691-696), 2014.
Date of Publication: June 2014.
Publisher
Blackwell Publishing Inc.
Abstract
Background Atrial fibrillation (AF) is the most common arrhythmic
complication after cardiac surgery. Several studies have compared the
efficacy of landiolol and placebo or other agents in preventing new-onset
AF in patients after cardiac surgery. In this study, we conducted a
meta-analysis to determine whether landiolol is effective in preventing
new-onset AF after cardiac surgery. Methods and Results Five randomized
controlled trials and two retrospective analyses were included in this
study. The clinical outcomes of interest were the occurrence of AF after
cardiac surgery and major complications. Meta-analysis was performed using
RevMan 5.0.18 software, and pooled estimates of the effect were reported
as risk ratios (RR) with 95% confidence intervals (CI). The results of
this meta-analysis indicate that landiolol is significantly associated
with a decreased risk of occurrence of AF after cardiac surgery (RR =
0.33; 95% CI: 0.23-0.48; P < 0.00001) and is not associated with an
increased risk of major complications (RR = 0.79; 95% CI: 0.43-1.45; P =
0.45) compared with the control group. Conclusion Landiolol administration
in the perioperative period can reduce the occurrence of AF after cardiac
surgery without increasing the risk of major complications. It can be used
to prevent new-onset AF safely after cardiac surgery. 2014 Wiley
Periodicals, Inc.

<11>
Accession Number
2014409717
Authors
Lo Sapio P. Chechi T. Gensini G.F. Troisi N. Pratesi C. Chiti E. Dorigo W.
Chisci E. Pigozzi C. Michelagnoli S. Romano S.M.
Institution
(Lo Sapio, Troisi, Chisci, Pigozzi, Michelagnoli) Department of Surgery -
Vascular and Endovascular Surgery Unit, San Giovanni di Dio Hospital, via
Torregalli, 3, 50124 Florence, Italy
(Chechi) Cardiology Unit Santa Maria Annunziata Hospital ASF 10, Florence,
Italy
(Gensini, Pratesi, Chiti, Dorigo, Romano) Heart and Vessel Department,
University of Florence, Italy
Title
Impact of two different cardiac work-up strategies in patients undergoing
abdominal aortic aneurysm repair.
Source
International Journal of Cardiology. 175 (1) (pp e1-e3), 2014. Date of
Publication: 15 Jul 2014.
Publisher
Elsevier Ireland Ltd

<12>
Accession Number
2014405772
Authors
Barber R.L. Fletcher S.N.
Institution
(Barber) Leicester Royal Infirmary, Leicester, United Kingdom
(Fletcher) St George's University of London, London, United Kingdom
Title
A review of echocardiography in anaesthetic and peri-operative practice.
Part 1: Impact and utility.
Source
Anaesthesia. 69 (7) (pp 764-776), 2014. Date of Publication: July 2014.
Publisher
Blackwell Publishing Ltd
Abstract
Echocardiography is migrating rapidly across speciality boundaries and
clinical demand is expanding. Echocardiography shows promise for evolving
applications in the peri-operative assessment and therapeutic management
of patients undergoing non-cardiac surgery, whether it be elective or
emergency. Although evidence is limited with regard to significant impact
on outcomes from anaesthesia and surgery, there is little doubt about the
validity and power of two-dimensional real-time viewing of cardiac anatomy
and function. Echocardiography can be used to assist in decision-making
along the entire peri-operative pathway, and is increasingly delivered by
the previously referring physicians. The discussion around more widespread
incorporation of cardiac ultrasound into anaesthetic practice must take
into account competency, training and governance. Failure to do so
adequately may mean that the use of echocardiography is poorly applied and
costly. 2014 The Association of Anaesthetists of Great Britain and
Ireland.

<13>
Accession Number
2014405768
Authors
Ueki M. Kawasaki T. Habe K. Hamada K. Kawasaki C. Sata T.
Institution
(Ueki, Kawasaki, Habe, Hamada, Kawasaki, Sata) University of Occupational
and Environmental Health, Kitakyushu, Japan
Title
The effects of dexmedetomidine on inflammatory mediators after
cardiopulmonary bypass.
Source
Anaesthesia. 69 (7) (pp 693-700), 2014. Date of Publication: July 2014.
Publisher
Blackwell Publishing Ltd
Abstract
Cardiac surgery with cardiopulmonary bypass is associated with the
development of a systemic inflammatory response that can often lead to
dysfunction of major organs. We hypothesised that the highly selective
alpha₂-adrenergic agonist, dexmedetomidine, attenuates the
systemic inflammatory response. Forty-two patients were randomly assigned
to receive dexmedetomidine or saline after aortic cross-clamping). The
mean (SD) levels of the nuclear protein plasma high-mobility group box 1
increased significantly from 5.1 (2.2) ng.ml^-1 during (16.6
(7.3) ng.ml^-1) and after (14.3 (8.2) ng.ml^-1)
cardiopulmonary bypass in the saline group. In the dexmedetomidine group,
the levels increased significantly only during cardiopulmonary bypass (4.0
(1.9) ng.ml^-1 baseline vs 10.8 (2.7) ng.ml^-1) but
not after (7.4 (3.8) ng.ml^-1). Dexmedetomidine infusion also
suppressed the rise in mean (SD) interleukin-6 levels after
cardiopulmonary bypass (a rise of 124.5 (72.0) pg.ml^-1 vs 65.3
(30.9) pg.ml^-1). These suppressive effects of dexmedetomidine
might be due to the inhibition of nuclear factor kappa B activation and
suggest that intra-operative dexmedetomidine may beneficially inhibit
inflammatory responses associated with ischaemia-reperfusion injury during
cardiopulmonary bypass. 2014 The Association of Anaesthetists of Great
Britain and Ireland.

<14>
Accession Number
2014410030
Authors
Li S. Feng Z. Wu L. Huang Q. Pan S. Tang X. Ma B.
Institution
(Li, Feng, Wu, Huang) Department of Thoracic and Cardiovascular Surgery,
First Affiliated Hospital of Guangxi Medical University, 22 Shuangyong
Road, Guangxi Zhuang Autonomous Region, Nanning 530021, China
(Pan) Department of Pathophysiology, Guangxi Medical University, Nanning,
China
(Tang) Department of Epidemiology and Biostatistics, Guangxi Medical
University, Nanning, China
(Ma) Department of Histology and Embryology, Guangxi Medical University,
Nanning, China
Title
Analysis of 11 trials comparing muscle-sparing with posterolateral
thoracotomy.
Source
Thoracic and Cardiovascular Surgeon. 62 (4) (pp 344-352), 2014. Date of
Publication: June 2014.
Publisher
Georg Thieme Verlag
Abstract
Background Muscle-sparing thoracotomy (MST) has recently been developed in
an attempt to minimize tissue injuries during thoracic operation and
postoperative sequelae. However, its potential advantages over traditional
posterolateral thoracotomy (PLT) remain to be determined. Here, we
performed a meta-analysis on all available studies that compare the pros
and cons between the two approaches. Methods A total of 11 relevant
studies were found to satisfy our inclusive criteria from three electronic
databases. End points included postoperative pain, pulmonary function,
postoperative mortality, and perioperative complications. Results Data
from seven randomized controlled trials and four observational studies
were included (n = 408 and 564, respectively). Compared with PLT group,
MST group had a significantly reduced postoperative visual analog scale
score on day 1 (weighted mean difference [WMD], -0.79; 95% confidence
interval [CI], -1.10 to -0.48), week 1 (WMD, -0.60; 95% CI, -0.98 to
-0.22), and month 1 (WMD, -0.73; 95% CI, -1.30 to -0.16). However, no
difference between the two approaches was found on postoperative forced
vital capacity and forced expiratory volume in 1 second (week 1:
standardized mean difference [SMD], 0.44; 95% CI, -0.18 to 1.07 versus
SMD, 0.53; 95% CI, -0.13 to 1.18; month 1: SMD 0.26; 95% CI, -0.26 to 0.78
versus SMD, 0.38; 95% CI, -0.25 to 1.00), mortality (odds ratio [OR],
1.23; 95% CI, 0.49 to 3.09), and complications (OR, 0.86; 95% CI, 0.60 to
1.23). Conclusions MST may improve postoperative pain, but shows less
effect on other perioperative parameters. 2014 Georg Thieme Verlag KG
Stuttgart New York.

<15>
Accession Number
2014416953
Authors
Sagiroglu G. Meydan B. Copuroglu E. Baysal A. Yoruk Y. Altemur
Karamustafaoglu Y. Huseyin S.
Institution
(Sagiroglu, Copuroglu) Department of Anesthesiology, Faculty of Medicine
Houses, Trakya University, D- Bloc, No: 8, Edirne, Turkey
(Meydan) Department of Anesthesiology, Sureyyapasa Chest Disease and
Thoracic Surgery Hospital, Istanbul, Turkey
(Baysal) Department of Anesthesiology, Kartal Kosuyolu Yuksek Ihtisas
Training and Research Hospital, Istanbul, Turkey
(Yoruk, Altemur Karamustafaoglu) Department of Thoracic Surgery, Faculty
of Medicine, Trakya University, Edirne, Turkey
(Huseyin) Department of Cardiovascular Surgery, Faculty of Medicine,
Trakya University, Edirne, Turkey
Title
A comparison of thoracic or lumbar patient-controlled epidural analgesia
methods after thoracic surgery.
Source
World Journal of Surgical Oncology. 12 (1) , 2014. Article Number: 96.
Date of Publication: 04 May 2014.
Publisher
BioMed Central Ltd.
Abstract
Background: We aimed to compare patient-controlled thoracic or lumbar
epidural analgesia methods after thoracotomy operations.Methods: One
hundred and twenty patients were prospectively randomized to receive
either thoracic epidural analgesia (TEA group) or lumbar epidural
analgesia (LEA group). In both groups, epidural catheters were
administered. Hemodynamic measurements, visual analog scale scores at rest
(VAS-R) and after coughing (VAS-C), analgesic consumption, and side
effects were compared at 0, 2, 4, 8, 16, and 24 hours
postoperatively.Results: The VAS-R and VAS-C values were lower in the TEA
group in comparison to the LEA group at 2, 4, 8, and 16 hours after
surgery (for VAS-R, P = 0.001, P = 0.01, P = 0.008, and P = 0.029,
respectively; and for VAS-C, P = 0.035, P = 0.023, P = 0.002, and P =
0.037, respectively). Total 24-hour analgesic consumption was different
between groups (175 +/- 20 mL versus 185 +/- 31 mL; P = 0.034). The
comparison of postoperative complications revealed that the incidence of
hypotension (21/57, 36.8% versus 8/63, 12.7%; P = 0.002), bradycardia
(9/57, 15.8% versus 2/63, 3.2%; P = 0.017), atelectasis (1/57, 1.8% versus
7/63, 11.1%; P = 0.04), and the need for intensive care unit (ICU)
treatment (0/57, 0% versus 5/63, 7.9%; P = 0.03) were lower in the TEA
group in comparison to the LEA group.Conclusions: TEA has beneficial
hemostatic effects in comparison to LEA after thoracotomies along with
more satisfactory pain relief profile. 2014 Sagiroglu et al.; licensee
BioMed Central Ltd.

<16>
Accession Number
2014411169
Authors
Caruba T. Katsahian S. Schramm C. Nelson A.C. Durieux P. Begue D.
Juilliere Y. Dubourg O. Danchin N. Sabatier B.
Institution
(Caruba, Sabatier) Pharmacie, Hopital Europeen Georges Pompidou, APHP,
Paris, France
(Katsahian, Schramm, Nelson) URC Hopital Henri Mondor, APHP, Creteil,
France
(Katsahian, Durieux, Sabatier) Equipe 22, Centre de Recherche des
Cordeliers, UMRS 762 INSERM, Paris, France
(Durieux) Departement de Sante Publique et Informatique, Hopital Europeen
Georges Pompidou, APHP, Paris, France
(Begue) Faculte de Pharmacie, Universite Rene Descartes, Paris, France
(Juilliere) Cardiologie, Institut Lorrain du Coeur et des Vaisseaux Louis
Mathieu, Nancy, France
(Dubourg) Cardiologie, Hopital Ambroise Pare, APHP, Boulogne Billancourt,
France
(Dubourg) Universite de Versailles-Saint Quentin, Montigny-Le-Bretonneux,
France
(Danchin) Cardiologie, Hopital Europeen Georges Pompidou, APHP, Paris,
France
(Danchin) Faculte de Medecine, Universite Rene Descartes, Paris, France
Title
Treatment for stable coronary artery disease: A network meta-analysis of
cost-effectiveness studies.
Source
PLoS ONE. 9 (6) , 2014. Article Number: e98371. Date of Publication: 04
Jun 2014.
Publisher
Public Library of Science
Abstract
Introduction and Objectives: Numerous studies have assessed
cost-effectiveness of different treatment modalities for stable angina.
Direct comparisons, however, are uncommon. We therefore set out to compare
the efficacy and mean cost per patient after 1 and 3 years of follow-up,
of the following treatments as assessed in randomized controlled trials
(RCT): medical therapy (MT), percutaneous coronary intervention (PCI)
without stent (PTCA), with bare-metal stent (BMS), with drug-eluting stent
(DES), and elective coronary artery bypass graft (CABG). Methods: RCT
comparing at least two of the five treatments and reporting clinical and
cost data were identified by a systematic search. Clinical end-points were
mortality and myocardial infarction (MI). The costs described in the
different trials were standardized and expressed in US $ 2008, based on
purchasing power parity. A network meta-analysis was used to compare
costs. Results: Fifteen RCT were selected. Mortality and MI rates were
similar in the five treatment groups both for 1-year and 3- year
follow-up. Weighted cost per patient however differed markedly for the
five treatment modalities, at both one year and three years (P<0.0001). MT
was the least expensive treatment modality: US $3069 and 13 864 after one
and three years of follow-up, while CABG was the most costly: US $27 003
and 28 670 after one and three years. PCI, whether with plain balloon, BMS
or DES came in between, but was closer to the costs of CABG. Conclusions:
Appreciable savings in health expenditures can be achieved by using MT in
the management of patients with stable angina. 2014 Caruba et al.

<17>
Accession Number
2014398874
Authors
Bonini R.C.A. Staico R. Issa M. Arnoni A.S. Chaccur P. Abdulmassih Neto C.
Dinkhuysen J.J. Paulista P.P. de Souza L.C.B. Moreira L.F.P.
Institution
(Bonini, Moreira) Instituto do Coracao (Incor), Universidade de Sao Paulo,
Sao Paulo, SP, Brazil
(Staico, Issa, Arnoni, Chaccur, Abdulmassih Neto, Dinkhuysen, Paulista, de
Souza) Instituto Dante Pazzanese de Cardiologia, Sao Paulo, SP, Brazil
Title
Effects of skeletonized versus pedicled radial artery on postoperative
graft patency and flow.
Source
Arquivos Brasileiros de Cardiologia. 102 (5) (pp 441-447), 2014. Date of
Publication: 2014.
Publisher
Arquivos Brasileiros de Cardiologia
Abstract
Background: Radial artery (RA) was the second arterial graft introduced in
clinical practice for myocardial revascularization. The skeletonization
technique of the left internal thoracic artery (LITA) may actually change
the graft's flow capacity with potential advantages. This leads to the
assumption that the behavior of the RA, as a coronary graft, is similar to
that of the LITA, when skeletonized. Objective: This study evaluated
'free' aortic-coronary radial artery (RA) grafts, whether skeletonized or
with adjacent tissues. Methods: A prospective randomized study comparing
40 patients distributed into two groups was conducted. In group I, we used
skeletonized radial arteries (20 patients), and in group II, we used
radial arteries with adjacent tissues (20 patients). After the surgical
procedure, patients underwent flow velocity measurements. Results: The
main surgical variables were: RA internal diameter, RA length, and free
blood flow in the radial artery. The mean RA graft diameters as calculated
using quantitative angiography in the immediate postoperative period were
similar, as well as the flow velocity measurement variables. On the other
hand, coronary cineangiography showed the presence of occlusion in one RA
graft and stenosis in five RA grafts in GII, while GI presented stenosis
in only one RA graft (p = 0.045). Conclusion: These results show that the
morphological and pathological features, as well as the hemodynamic
performance of the free radial artery grafts, whether prepared in a
skeletonized manner or with adjacent tissues, are similar. However, a
larger number of non-obstructive lesions may be observed when RA is
prepared with adjacent tissues.

<18>
Accession Number
71507138
Authors
Landoni G. Greco M. Francesca I. Taddeo D. Saleh O. Belletti A. Putzu A.
Lembo R. Zangrillo A.
Institution
(Landoni, Greco, Francesca, Taddeo, Saleh, Belletti, Putzu, Lembo,
Zangrillo) Vita-Salute San Raffaele University, Milan, Italy
Title
Epidural analgesia reduces perioperative myocardial infarction and
all-cause mortality after cardiac surgery: But at least 25 epidural
hematomas have already happened.
Source
Critical Care. Conference: 34th International Symposium on Intensive Care
and Emergency Medicine Brussels Belgium. Conference Start: 20140318
Conference End: 20140321. Conference Publication: (var.pagings). 18 (pp
S153), 2014. Date of Publication: 17 Mar 2014.
Publisher
BioMed Central Ltd.
Abstract
Introduction Epidural analgesia on top of general anesthesia in cardiac
surgery might improve relevant clinical outcomes but the incidence of
epidural hematoma is under-reported. Methods An international web-based,
online, viral, anonymous survey, a systematic review of the literature,
and a meta-analysis of randomized and matched studies were performed.
Results Nine epidural hematomas were identified in 198 published
manuscripts. The risk of epidural hematoma (9:13,429) calculated on all
published evidence might be therefore estimated to be 1:1,492 (95%
confidence interval (CI) = 1:2,857 to 1:833). Through an anonymous,
web-based, viral, international survey, we identified at least 16 further
nonpublished epidural hematomas together with at least 72,400 epidural
analgesia catheters positioned in cardiac surgery in the last 20 years.
The risk of epidural hematoma (25:85,829) is therefore 1:3,436 (95% CI =
1:2,325 to 1:5,076) including both published and unpublished data. Out of
the 66 randomized and case-matched studies, 57 trials reported the
incidence of all-cause mortality at the longest available follow-up with a
significant reduction in the epidural group (59/3,137 (1.9%) in the
epidural group vs. 108/3,246 (3.3%) in the control arm, RR 0.64 (95% CI
0.48 to 0.85), P = 0.002, NNT = 69). Conclusion Epidural analgesia on top
of general anesthesia in cardiac surgery might reduce the incidence of
all-cause mortality (NNT 69). The incidence of epidural hematoma in this
setting is 1:3,436 (95% CI = 1:2,325 to 1:5,076) including both published
and unpublished data. In fact, we identified at least 25 epidural
hematomas that occurred so far from the following countries: Belgium (n =
1), Brazil (n = 1), France (n = 1), Germany (n = 2), India (n = 2), Italy
(n = 1), Japan (n = 2), Korea (n = 1), Malaysia (n = 1), Norway (n = 2),
Russia (n = 3), Sweden (n = 1), the UK (n = 3), and the USA (n = 4). Even
if from the public health point of view the benefits seem to encourage the
use of epidural analgesia in cardiac surgery with a possible reduction in
perioperative mortality, this topic merits further investigation and the
decision to insert the epidural catheter should be discussed with the
patient considering both local experience and legal dispute in case of
medical complications.

<19>
Accession Number
71507080
Authors
Vandenberghe W. Gevaert S. Peperstraete H. Herck I. Decruyenaere J. Hoste
E.
Institution
(Vandenberghe, Gevaert, Peperstraete, Herck, Decruyenaere, Hoste)
University Hospital Ghent, Belgium
Title
Acute kidney injury in cardiorenal syndrome type 1: A meta-analysis.
Source
Critical Care. Conference: 34th International Symposium on Intensive Care
and Emergency Medicine Brussels Belgium. Conference Start: 20140318
Conference End: 20140321. Conference Publication: (var.pagings). 18 (pp
S132), 2014. Date of Publication: 17 Mar 2014.
Publisher
BioMed Central Ltd.
Abstract
Introduction Cardiorenal syndrome type 1 (CRS-1) reflects an abrupt
worsening in cardiac function leading to acute kidney injury (AKI). Acute
cardiac conditions contributing to CRS-1 include acute heart failure
(AHF), acute coronary syndrome (ACS) and cardiac surgery (CS). The
objective of this study was to evaluate the epidemiology of AKI in CRS-1.
Methods This is a systematic review and meta-analysis. AKI defined by the
RIFLE definition and its modifications AKIN and KDIGO is grouped as
AKIRIFLE. Similarly, AKI defined by variations of worsening renal failure
is grouped as AKIWRF. Incidence of AKI is reported by the different
definitions of AKI. In addition, we report on mortality and length of
intensive care and hospital stay (LOSICU and LOShosp) for AKIRIFLE. Data
are reported as percentage, risk ratio (RR), and mean difference (MD).
Results Our literature search yielded 316 potential papers, of which 57
were included (20 papers on AHF, 15 ACS and 22 CS). A risk of bias
analysis showed a low risk for selection bias in 55% of the studies and
prospective data collection in 45%. AKIRIFLE was used in 33 studies (RIFLE
in 22, AKIN in 14, KDIGO in four), AKIWRF, with six variants, in 24
studies and use of RRT (AKIRRT) in 20 studies. The incidence of AKI in
CRS-1 patients defined by AKIRIFLE and AKIWRF was similar (22.5%,
respectively 22.4%, P = 0.401), and greater than AKIRRT (2.6%, both P
<0.001). AKIRIFLE occurred more frequently in AHF patients compared with
ACS and CS patients (55.0% vs. 14.9% vs. 19.3%; P = 0.009 respectively P =
0.001, P = NS for ACS vs. CS). This was similar when defined by AKIWRF.
AKIRRT was evenly distributed among CRS- 1 subtypes (AHF 4.3%, ACS, 1.7%,
and CS 3.1%, P = 0.611). Despite predominant low severity of AKIRIFLE
(stage 1: 16.9%, stage 2: 3.7%, and stage 3: 3.6%), AKIRIFLE was
associated with increased mortality (RR = 5.4), LOSICU (MD 1.7 days), and
LOShosp (MD 4.4 days), and increasing AKIRIFLE severity was associated
with increase in these three outcomes in all CRS-1 patients as well as in
the three subgroups. The impact of AKIRIFLE on mortality was greatest in
CS patients (AHF RR = 2.8, ACS RR = 3.5, and CS RR = 9.1). Not
surprisingly, AKIWRF had similar impact on outcomes, but AKIRRT had
greater impact compared with AKIRIFLE (mortality RR = 9.16, LOSICU MD =
10.6 days, and LOShosp, MD = 20.2 days). Conclusion Almost one-quarter of
patients with an acute cardiac condition had AKI, and RRT was used in
approximately 3%. AKI was associated with significant worse outcomes. AHF
patients experienced the highest incidence of AKI, but the impact on
mortality was greatest in CS patients.

<20>
Accession Number
71506987
Authors
Leme A. Hajjar L. Amato M. Fukushima J. Hashizume C. Nozawa E. Osawa E.
Nakamura R. Almeida J. Ianotti R. Auler Jr J. Galas F.
Institution
(Leme, Hajjar, Amato, Fukushima, Hashizume, Nozawa, Osawa, Nakamura,
Ianotti, Auler Jr, Galas) Heart Institute, Sao Paulo, Brazil
(Almeida) Instituto do Cancer do Estado de Sao Paulo, Brazil
Title
Intensive alveolar recruitment after cardiac surgery: A randomized
controlled clinical trial.
Source
Critical Care. Conference: 34th International Symposium on Intensive Care
and Emergency Medicine Brussels Belgium. Conference Start: 20140318
Conference End: 20140321. Conference Publication: (var.pagings). 18 (pp
S96-S97), 2014. Date of Publication: 17 Mar 2014.
Publisher
BioMed Central Ltd.
Abstract
Introduction Protective mechanical ventilation has been associated with
lower incidence of pulmonary and extrapulmonary complications in major
surgery. The aim of the present study is evaluate whether adding an
intensive alveolar recruitment protocol improves clinical outcomes and
reduces healthcare utilization in patients undergoing cardiac surgery.
Methods In this single-center, parallel-group trial, we randomly assigned
adult patients presenting signals of deficient gas exchange (PaO2/FIO2
<250 at a PEEP of 5 cmH2O) in the immediate postoperative period to either
intensive alveolar recruitment or a standard protocol, both using
low-tidal volume ventilation (6 ml/kg/ibw). Our hypothesis was that an
aggressive alveolar recruitment protocol will be translated to better lung
compliance, better gas exchange, fewer pulmonary complications and reduced
length of hospital stay when compared with the control group. Results A
total of 320 patients were enrolled in the study, 163 patients in the
standard protocol group and 157 in the intensive alveolar recruitment
group. Patients of the interventional group presented a higher incidence
of pneumonia than patients for the control group (5 (3.3%) vs. 19 (22%), P
= 0.004). The length of the hospital stay was shorter among patients
receiving intensive alveolar recruitment than among those receiving
standard care (10.9 (9.9 to 11.9) vs. 12.4 days (11.3 to 13.6); P =
0.045). There was no difference between groups according to extrapulmonary
complications and mortality. Conclusion In this trial, an intensive
alveolar recruitment protocol associated with a protective mechanical
ventilation strategy reduced pulmonary complication and length of hospital
stay in patients undergoing cardiac surgery (NCT01502332).

<21>
Accession Number
71506887
Authors
Sundin M. Almeida J. Osawa E. Galas F. Gaiane M. Zefferino S. Camara L.
Galas L.G. Hajjar L.
Institution
(Sundin, Osawa, Galas, Gaiane, Zefferino, Camara, Galas, Hajjar) Heart
Institute, Sao Paulo, Brazil
(Almeida) Instituto do Cancer do Estado de Sao Paulo, Brazil
Title
Early lactate-guided therapy in cardiac surgery patients: A randomized
controlled trial.
Source
Critical Care. Conference: 34th International Symposium on Intensive Care
and Emergency Medicine Brussels Belgium. Conference Start: 20140318
Conference End: 20140321. Conference Publication: (var.pagings). 18 (pp
S60), 2014. Date of Publication: 17 Mar 2014.
Publisher
BioMed Central Ltd.
Abstract
Introduction It is unknown whether lactate monitoring aimed to decrease
levels during the first hours in patients undergoing cardiac surgery
improves outcome. The aim of this study was to evaluate the effect of
lactate monitoring and resuscitation directed at decreasing lactate levels
in patients admitted to the ICU in the first 8 hours with lactate level
>3.0 mEq/l. Methods Patients were randomly allocated to two groups. In the
lactate group, treatment was guided by lactate levels with the objective
to decrease lactate by 20% or more per 2 hours for the initial 8 hours of
ICU stay. In the control group, the treatment team had no knowledge of
lactate levels (except for the admission value) during this period. The
primary outcome measure was the incidence of complications in 28 days.
Results The lactate group received more fluids and dobutamine. However,
there were no significant differences in lactate levels between the
groups. The rate of complications was similar between groups (11% vs. 7%,
P = 0.087). Length of ICU stay was higher in the lactate group (3.5 vs.
2.4 days, P = 0.047) when compared with the control group. Conclusion In
patients with hyperlactatemia on ICU admission, lactate-guided therapy did
not reduce complications and was related to a longer ICU length of stay.
This study suggests that goal-directed therapy aiming to decrease initial
lactate levels does not result in clinical benefit.

<22>
Accession Number
71506829
Authors
Bergamin F. Almeida J. Park C. Osawa E. Silva J. Galas F. Nagaoka D.
Fukushima J. Vieira S. Candido L. Oshiro C.O. Vincent J.L. Hajjar L.
Institution
(Bergamin, Almeida, Park, Osawa, Silva, Galas, Nagaoka, Fukushima, Vieira,
Candido, Oshiro, Hajjar) Instituto do Cancer do Estado de Sao Paulo,
Brazil
(Vincent) Erasme Hospital, Universite libre de Bruxelles, Brussels,
Belgium
Title
Transfusion requirements in septic shock patients: A randomized controlled
trial.
Source
Critical Care. Conference: 34th International Symposium on Intensive Care
and Emergency Medicine Brussels Belgium. Conference Start: 20140318
Conference End: 20140321. Conference Publication: (var.pagings). 18 (pp
S39), 2014. Date of Publication: 17 Mar 2014.
Publisher
BioMed Central Ltd.
Abstract
Introduction Perioperative red blood cell transfusion is commonly used to
address anemia, an independent risk factor for morbidity and mortality in
critically ill patients [1]; however, evidence regarding optimal blood
transfusion practice in septic shock is lacking. The aim of this study was
to define which is the best transfusion strategy in septic shock patients
regarding 28-day mortality and clinical outcomes: restrictive or liberal.
Methods The Transfusion Requirements After Cardiac Surgery (TRACS) study
is a prospective, randomized, controlled clinical noninferiority trial
conducted between February 2009 and February 2010 in an ICU at a
university hospital cardiac surgery referral center in Brazil. Consecutive
adult patients (n = 502) who underwent cardiac surgery with
cardiopulmonary bypass were eligible; analysis was by intention to treat.
This is a randomized controlled parallel-group trial, which included 300
patients admitted to a cancer ICU with diagnosis of septic shock. Patients
were randomly assigned to a liberal strategy of blood transfusion (to
maintain hemoglobin >9 g/dl) or to a restrictive strategy (hemoglobin >7
g/dl). Mortality in 28 days was the main outcome. Secondary outcomes were
clinical complications days free of organ dysfunction, ICU and hospital
length of stay, adverse effects of transfusion and 60-day mortality.
Results A total of 136 patients were included in the first part of the
trial. Mean age was 62 + 14 years, SAPS 3 at admission was 65 + 15 and all
patients had the diagnosis of solid neoplasm. Sixty-three patients (46.3%)
were included in the liberal strategy and 73 patients (53.7%) in the
restrictive strategy. Occurrence of 28-day mortality was similar between
groups (54% in liberal group vs. 56.2% in restrictive group; P = 0.395).
Conclusion Among cancer patients with septic shock, the use of a
restrictive perioperative transfusion strategy compared with a more
liberal strategy resulted in similar rates of 28-day-mortality.

<23>
Accession Number
71506767
Authors
Pugh R. John D.L. Thorpe C. Subbe C.
Institution
(Pugh, John) Glan Clwyd Hospital, Bodelwyddan, United Kingdom
(Thorpe, Subbe) Ysbyty Gwynedd, Bangor, United Kingdom
Title
Frailty measures in the critically ill: Are we approaching a critical age?
A systematic review.
Source
Critical Care. Conference: 34th International Symposium on Intensive Care
and Emergency Medicine Brussels Belgium. Conference Start: 20140318
Conference End: 20140321. Conference Publication: (var.pagings). 18 (pp
S18), 2014. Date of Publication: 17 Mar 2014.
Publisher
BioMed Central Ltd.
Abstract
Introduction As the general population ages, the proportion of critically
ill patients in whom frailty may adversely affect outcome is likely to
rise. The aim of this systematic review was to evaluate performance of
frailty measures in predicting ICU, hospital and long-term outcomes
following intensive care admission. Methods We performed a literature
search for original studies in: EMBASE, MEDLINE, Web of Knowledge,
Cochrane database of systematic reviews, and Database of Abstracts of
Reviews of Effects, using the terms 'frailty', 'frail elderly', 'critical
care', 'critically ill', 'critical illness' and 'intensive care'. Our
study inclusion criteria were that the study: included patients cared for
in intensive care, captured data relating to premorbid frailty, and
reported ICU, hospital and/or longterm outcome data. Results Initial
searches identified 606 reports, of which, following review of abstracts
and removal of duplicates, 66 full-text papers were evaluated. Of these,
11 met inclusion criteria. A further 19 papers that met inclusion criteria
were identified from relevant review articles and reference lists. There
was huge variation in populations studied, methodology, frailty measures
utilised and reported outcome measures. Of the 30 included studies, 11
studies evaluated patients undergoing major (including cardiothoracic)
surgery, two studies specifically assessed patients with pneumonia, one
study investigated patients in a burns ICU and one study restricted its
investigation to former nursing home residents. The most commonly used
measures of frailty were: measures of Activities of Daily Living (n = 9),
which predicted need for long-term institutional care, 30-day, 90-day,
6-month and 12-month mortality; Clinical Frailty Score [1] (n = 5), which
predicted ICU mortality, hospital mortality, 12-month mortality, quality
of life and functional dependence; and Knaus score [2] (n = 4), which
predicted ICU mortality, hospital and 12-month mortality. Conclusion
Measures of frailty appear to predict mortality and functional dependence
following critical admission across a wide range of clinical conditions.
However, comparative data regarding the relative accuracy and reliability
of frailty measures in the intensive care population are currently
deficient.