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Embase <1980 to 2015 Week 44>
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<1>
Accession Number
2015455817
Authors
Wang Z.J. Zhou Y.J. Galper B.Z. Gao F. Yeh R.W. Mauri L.
Institution
(Wang, Zhou, Gao) Beijing Institute of Heart Lung and Blood Vessel
Disease, Beijing Anzhen Hospital, Capital Medical University, Anzhen
Avenue #2, Chaoyang district, Beijing 100029, China
(Wang, Galper, Mauri) Brigham and Women's Hospital, Boston, MA, United
States
(Wang, Galper, Yeh, Mauri) Harvard Medical School, Boston, MA, United
States
(Yeh) Massachusetts General Hospital, Boston, MA, United States
(Yeh, Mauri) Harvard Clinical Research Institute, Boston, MA, United
States
Title
Association of body mass index with mortality and cardiovascular events
for patients with coronary artery disease: A systematic review and
meta-analysis.
Source
Heart. 101 (20) (pp 1631-1638), 2015. Date of Publication: 01 Oct 2015.
Publisher
BMJ Publishing Group
Abstract
Objectives: The association between obesity and prognosis in patients with
coronary artery disease (CAD) remains uncertain. We undertook a
meta-analysis for the effects of body mass index (BMI) on mortality and
cardiovascular events in these patients. Methods: We identified studies
that provided risk estimates for mortality or cardiovascular events on the
basis of BMI in patients with CAD. Summary estimates of relative risks
were obtained for five BMI groups: underweight, normal-weight, overweight,
obese and grade II/III obese. Mortality was analysed separately as
short-term (<6 months) and long-term (>6 months). Results: Data from 89
studies with 1 300 794 patients were included. Mean follow-up of long-term
estimates was 3.2 years. Using normal-weight as the reference, underweight
was associated with higher risk of short-term mortality (2.24 (1.85 to
2.72)) and long-term mortality (1.70 (1.56 to 1.86)), overweight and
obesity were both associated with lower risk of short-term mortality (0.69
(0.64 to 0.75); 0.68 (0.61 to 0.75)) and long-term mortality (0.78 (0.74
to 0.82); 0.79 (0.73 to 0.85)), but the long-term benefit of obesity
disappeared after 5 years of follow-up (0.99 (0.91 to 1.08)). Grade II/III
obesity was associated with lower risk of mortality in the short term
(0.76 (0.62 to 0.91)) but higher risk after 5 years of follow-up (1.25
(1.14 to 1.38)). The similar J-shaped pattern was also seen for
cardiovascular mortality and across different treatment strategies.
Meta-regression found an attenuation of the inverse association between
BMI and risk of mortality over longer follow-up. Conclusions Our data
support a J-shaped relationship between mortality and BMI in patients with
CAD. The limitation of current literature warrants better design of future
studies.
<2>
Accession Number
2015436088
Authors
Marazia S. Urso L. Contini M. Pano M. Zaccaria S. Lenti V. Sarullo F.M. Di
Mauro M.
Institution
(Marazia, Lenti) Cardiology Department, S. G. Moscati Hospital, Taranto,
Italy
(Urso) Department of Cardiology, Prof Petrucciani Rehabilitation Clinic,
Lecce, Italy
(Contini) Cardiovascular Surgery, Villa Verde Clinic, Taranto, Italy
(Pano, Zaccaria) Cardiovascular Surgery, V. Fazzi Hospital, Lecce, Italy
(Sarullo) Cardiovascular Rehabilitation Unit, Buccheri la
FerlaFatebenefratelli Hospital, Palermo, Italy
(Di Mauro) Department of Cardiovascular Disease, University of l'Aquila,
L'Aquila, Italy
Title
The role of ivabradine in cardiac rehabilitation in patients with recent
coronary artery bypass graft.
Source
Journal of Cardiovascular Pharmacology and Therapeutics. 20 (6) (pp
547-553), 2015. Date of Publication: 01 Nov 2015.
Publisher
SAGE Publications Ltd
Abstract
Background: Little is known about ivabradine in cardiac rehabilitation in
patients with coronary artery bypass graft (CABG). Methods: In this
prospective, randomized study, suitable patients admitted for cardiac
rehabilitation after recent CABG were randomized to ivabradine 5 mg twice
a day + standard medical therapy including bisoprolol 1.25 mg once daily
(group I-BB, n = 38) or standard medical therapy including bisoprolol 2.5
to 3.75 mg once daily (group BB, n = 43). Patients were evaluated at
admission, discharge, and 3 months. The primary end point was improvement
in functional status, and other end points were improvement in diastolic
function and recovery of systolic function. End points were assessed by
distance covered in 6-minute walking test (6MWT), percentage with normal
diastolic function, and percentage increase in left ventricular ejection
fraction (LVEF). Results: Cardiac rehabilitation improved functional
capacity in both groups. In group BB, distances covered in the 6MWT at
admission, discharge, and 3 months were 215 +/- 53, 314 +/- 32, and 347
+/- 42 m, respectively. Corresponding distances in group I-BB were 180 +/-
91, 311 +/- 58, and 370 +/- 55 m. Normal diastolic function was restored
in I-BB patients, increasing from 24% at admission to 50% and 79% at
discharge and 3 months; in BB patients, it decreased from 23% to 19% and
16%. The LVEF improved in I-BB patients, from 57% +/- 3% at admission to
62% +/- 4% at discharge and 66% +/- 3% at 3 months, while remaining
unchanged in BB patients (57% +/- 3%, 59% +/- 4%, and 59% +/- 3%).
Conclusion: Adding ivabradine to low-dose bisoprolol during cardiac
rehabilitation in patients with CABG improved functional capacity,
enhanced recovery of systolic function, and reduced diastolic dysfunction.
<3>
Accession Number
2015435235
Authors
Kamalipour H. Shahbazi S. Derakhshan M.M. Moinvaziri M.T. Allahyari E.
Institution
(Kamalipour) Anesthesia Department, Ordibehesht Hospital, Shiraz, Iran,
Islamic Republic of
(Shahbazi, Derakhshan, Moinvaziri, Allahyari) Shiraz Anesthesiology and
Critical Care Research Center, Shiraz University of Medical Sciences,
Shiraz, Iran, Islamic Republic of
Title
Comparison of US-guided catheterization of the right internal jugular vein
using medial-oblique and short axis techniques.
Source
International Cardiovascular Research Journal. 9 (4) (pp 210-215), 2015.
Date of Publication: 2015.
Publisher
Iranian Cardiovascular Research Journal
Abstract
Background: Although some investigations have shown higher rates of
successful first attempt and fewer attempts by using ultrasound-guided
Internal Jugular Vein (IJV) catheterization, arterial puncture is still
common. Objectives: The present study aimed to investigate US-guided
catheterization of the right IJV via medial-oblique technique and also
compare this technique to short-axis technique in open-heart surgery
patients. Patients and Methods: In this randomized clinical trial, 80
patients referred to cardiac operating room of Namazi hospital, Shiraz,
Iran from March to July 2014 were selected using census method. Block
randomization with website was also done. Then, the patients were divided
into two groups of 40, Short Axis Group (SAG) and Medial-Oblique Group
(M-OG). For short-axis technique, patient's head was positioned at zero
degree angulation with his trunk. For medial-oblique technique, on the
other hand, patient's head was tilted to left to 45 degrees between the
head and trunk. Sex, age, Body Mass Index (BMI), access time, guidewire
time, cannulation time, total attempts for catheterization, first, second,
and third attempt success, arterial puncture, hematoma, bleeding, and
catheter malposition were recorded. The overlap between the carotid artery
and IJV in zero- and 45-degree angulation was estimated through ultrasound
print. After all, Kolmogorov-Smirnov test was used to assess normal
distribution of the data. Then, the data were analyzed through Student's
t-test, Mann-Whitney U test, and chi-square test. P < 0.05 was considered
as statistically significant. Results: The results showed no significant
differences between the two groups regarding the duration of different
catheterization steps (P = 0.376). In all the cases in both groups,
accessing the vein was successful with three attempts or less. There were
no clinical complications of catheterization in the two groups. The mean
of overlap was 23.60 +/- 33.47 in zero-degree angulation between the head
and trunk and 32.72 +/- 36.38 in 45-degree angulation and this difference
was statistically significant (P = 0.001). Conclusions: The results of the
present study showed that both US-guided techniques under investigation
had the same duration in different catheterization steps, total success
rate, and primary mechanical complications, and could be used in clinics.
<4>
Accession Number
2015443819
Authors
Priye S. Jagannath S. Singh D. Shivaprakash S. Reddy D.P.
Institution
(Priye, Jagannath, Singh, Shivaprakash, Reddy) Department of Cardiac
Anaesthesiology, Vydehi Institute of Medical Sciences, Bengaluru,
Karnataka 560 066, India
Title
Dexmedetomidine as an adjunct in postoperative analgesia following cardiac
surgery: A randomized, double-blind study.
Source
Saudi Journal of Anaesthesia. 9 (4) (pp 353-358), 2015. Date of
Publication: 01 Oct 2015.
Publisher
Medknow Publications (B9, Kanara Business Centre, off Link Road, Ghatkopar
(E), Mumbai 400 075, India)
Abstract
Objectives: The purpose of this study was to determine analgesic efficacy
of dexmedetomidine used as a continuous infusion without loading dose in
postcardiac surgery patients. Settings and Design: A prospective,
randomized, double-blind clinical study in a single tertiary care hospital
on patients posted for elective cardiac surgery under cardiopulmonary
bypass. Interventions: Sixty-four patients who underwent elective cardiac
surgery under general anesthesia were shifted to intensive care unit (ICU)
and randomly divided into two groups. Group A (n = 32) received a 12 h
infusion of normal saline and group B (n = 32) received a 12 h infusion of
dexmedetomidine 0.4 mug/kg/h. Postoperative pain was managed with bolus
intravenous fentanyl. Total fentanyl consumption, hemodynamic monitoring,
Visual Analogue Scale (VAS) pain ratings, Ramsay Sedation Scale were
charted every 6 <sup>th</sup> hourly for 24 h postoperatively and
followed-up till recovery from ICU. Student's t-test, Chi-square/Fisher's
exact test has been used to find the significance of study parameters
between the groups. Results: Dexmedetomidine treated patients had
significantly less VAS score at each level (P < 0.001). Total fentanyl
consumption in dexmedetomidine group was 128.13 +/- 35.78 mug versus
201.56 +/- 36.99 mug in saline group (P < 0.001). A statistically
significant but clinically unimportant sedation was noted at 6 and 12 h (P
< 0.001, and P = 0.046 respectively). Incidence of delirium was less in
dexmedetomidine group (P = 0.086+). Hemodynamic parameters were
statistically insignificant. Conclusions: Dexmedetomidine infusion even
without loading dose provides safe, effective adjunct analgesia, reduces
narcotic consumption, and showed a reduced trend of delirium incidence
without undesirable hemodynamic effects in the cardiac surgery patients.
<5>
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Accession Number
2015455923
Authors
Une D. Al-Atassi T. Kulik A. Voisine P. Le May M. Ruel M.
Institution
(Une, Al-Atassi, Ruel) Division of Cardiac Surgery, University of Ottawa
Heart Institute, 40 Ruskin St., Ottawa, ON, Canada
(Le May) Division of Cardiology, University of Ottawa Heart Institute,
Ottawa, ON, Canada
(Kulik) Lynn Heart and Vascular Institute, Boca Raton, FL, United States
(Voisine) Division of Cardiac Surgery, Hopital Laval, Quebec City, QC,
Canada
(Ruel) Department of Epidemiology and Community Medicine, University of
Ottawa, Ottawa, ON, Canada
Title
Impact of Clopidogrel plus aspirin versus aspirin alone on the progression
of native coronary artery disease after bypass surgery analysis from the
Clopidogrel after surgery for coronary artery DiseasE (CASCADE) randomized
trial.
Source
Circulation. 130 (11) (pp S12-S18), 2014. Date of Publication: 09 Sep
2014.
Publisher
Lippincott Williams and Wilkins
Abstract
Background-The effects of dual antiplatelet therapy with aspirin and
clopidogrel on the progression of native coronary artery disease after
coronary artery bypass grafting are unknown. Methods and Results-In the
Clopidogrel After Surgery for Coronary Artery DiseasE (CASCADE) trial, a
total of 113 patients were randomized to receive aspirin plus clopidogrel
or aspirin plus placebo for 1 year after coronary artery bypass grafting.
In this secondary analysis, the 92 patients who underwent preoperative and
1-year postoperative angiograms at 2 centers had each of their coronary
stenoses graded serially by using 6 thresholds (grade 0 [0%-24%], grade 1
[25%-37%], grade 2 [38%-62%], grade 3 [63%-82%], grade 4 [83%-98%], and
grade 5 [99%-100%]). We compared the incidence and degree of evolving
coronary artery disease between the 2 treatment groups. A total of 543
preoperative stenoses and occlusions were quantified and followed. At
1-year postoperatively, there were 103 evolving (94 worsened, 9 improved)
and 22 new lesions. The right coronary artery territory and sites proximal
to a graft were more commonly associated with worsening coronary artery
disease (P<0.02). There were no differences in clinical events between
treatment groups, and the proportion of patients with evolving or new
lesions was also similar (70% versus 74%, aspirin-clopidogrel versus
aspirin-placebo, respectively; P=0.8). However, in evolving or new
lesions, the mean grade change (1.1+/-1.0 versus 1.6+/-1.1, respectively;
P=0.01) and the proportion of new occlusions (7% versus 22%; P=0.02) were
lower in the aspirin-clopidogrel group. Conclusions-The addition of
clopidogrel to aspirin correlates with less worsening of native coronary
artery disease 1 year after coronary artery bypass grafting. These
findings may help guide post-coronary artery bypass grafting antiplatelet
therapy. Clinical Trial Registration-URL: http://www.clinicaltrials.gov.
Unique identifier: NCT00228423.
<6>
Accession Number
2015327438
Authors
Dizon J.M. Nazif T.M. Hess P.L. Biviano A. Garan H. Douglas P.S. Kapadia
S. Babaliaros V. Herrmann H.C. Szeto W.Y. Jilaihawi H. Fearon W.F. Tuzcu
E.M. Pichard A.D. Makkar R. Williams M. Hahn R.T. Xu K. Smith C.R. Leon
M.B. Kodali S.K.
Institution
(Dizon, Nazif, Biviano, Garan, Hahn, Smith, Leon, Kodali) Department of
Medicine, Columbia University, 222 Westchester Ave, White Plains, NY
10604, United States
(Dizon, Nazif, Biviano, Hahn, Xu, Smith, Leon, Kodali) Cardiovascular
Research Foundation, New York, NY, United States
(Hess, Douglas) Department of Medicine, Duke University, Durham, NC,
United States
(Kapadia, Tuzcu) Cleveland Clinic, Cleveland, OH, United States
(Babaliaros) Emory University School of Medicine, Atlanta, GA, United
States
(Herrmann, Szeto) Hospital of the University of Pennsylvania,
Philadelphia, PA, United States
(Jilaihawi, Makkar) Cedars-Sinai Medical Center, Los Angeles, CA, United
States
(Fearon) Stanford University, Stanford, CA, United States
(Pichard) Medstar Washington Hospital Center, Washington, DC, United
States
(Williams) NYU Langone Medical Center, New York, NY, United States
Title
Chronic pacing and adverse outcomes after transcatheter aortic valve
implantation.
Source
Heart. 101 (20) (pp 1665-1671), 2015. Date of Publication: 10 Aug 2015.
Publisher
BMJ Publishing Group
Abstract
Objective: Many patients undergoing transcatheter aortic valve
implantation (TAVI) have a pre-existing, permanent pacemaker (PPM) or
receive one as a consequence of the procedure. We hypothesised that
chronic pacing may have adverse effects on TAVI outcomes. Methods and
results: Four groups of patients undergoing TAVI in the Placement of
Aortic Transcatheter Valves (PARTNER) trial and registries were compared:
prior PPM (n=586), new PPM (n=173), no PPM (n=1612), and left bundle
branch block (LBBB)/no PPM (n=160). At 1 year, prior PPM, new PPM and
LBBB/no PPM had higher all-cause mortality than no PPM (27.4%, 26.3%,
27.7% and 20.0%, p<0.05), and prior PPM or new PPM had higher
rehospitalisation or mortality/rehospitalisation (p<0.04). By Cox
regression analysis, new PPM (HR 1.38, 1.00 to 1.89, p=0.05) and prior PPM
(HR 1.31, 1.08 to 1.60, p=0.006) were independently associated with 1-year
mortality. Surviving prior PPM, new PPM and LBBB/no PPM patients had lower
LVEF at 1 year relative to no PPM (50.5%, 55.4%, 48.9% and 57.6%, p<0.01).
Prior PPM had worsened recovery of LVEF after TAVI (DELTA=10.0 prior vs
19.7% no PPM for baseline LVEF <35%, p<0.0001; DELTA=4.1 prior vs 7.4% no
PPM for baseline LVEF 35-50%, p=0.006). Paced ECGs displayed a high
prevalence of RV pacing (>88%). Conclusions: In the PARTNER trial, prior
PPM, along with new PPM and chronic LBBB patients, had worsened clinical
and echocardiographic outcomes relative to no PPM patients, and the
presence of a PPM was independently associated with 1-year mortality.
Ventricular dyssynchrony due to chronic RV pacing may be mechanistically
responsible for these findings.
<7>
Accession Number
2015434817
Authors
Fawzy H. Elatafy E. Elkassas M. Elsarawy E. Morsy A. Fawzy A.
Institution
(Fawzy, Elatafy, Morsy, Fawzy) Department of Cardiothoracic Surgery,
Faculty of Medicine, University of Tanta, Tanta 31125, Egypt
(Elkassas) Department of Cardiothoracic Surgery, Faculty of Medicine,
University of Suez Canal, Ismaileya, Egypt
(Elsarawy) Department of Cardiac Surgery, National Heat Institute, Cairo,
Egypt
Title
Can posterior pericardiotomy reduce the incidence of postoperative atrial
fibrillation after coronary artery bypass grafting?.
Source
Interactive Cardiovascular and Thoracic Surgery. 21 (4) (pp 488-491),
2015. Date of Publication: October 2015.
Publisher
Oxford University Press
Abstract
OBJECTIVES Atrial fibrillation (AF) is a common complication that
increases the morbidity after open heart surgery. The pathophysiology is
uncertain, and its prevention remains suboptimal. The aim of this study
was to assess the efficiency of posterior pericardiotomy in decreasing the
incidence of pericardial effusion and postoperative AF. METHODS This
multicentre randomized prospective study included 200 patients who
underwent open heart surgery; coronary artery bypass grafting procedure
between June 2010 and May 2012. A posterior pericardiotomy incision was
done in Group I (n = 100). A longitudinal incision, 4-cm long and 2-cm
width, was made parallel and posterior to the left phrenic nerve,
extending from the left inferior pulmonary vein to the diaphragm. Group II
constituted the control group (n = 100). Postoperative pericardial
effusion was assessed by echocardiography and rhythm follow-up was
monitored daily. RESULTS The incidence of postoperative AF was
significantly lower in the posterior pericardiotomy group than in the
control group (13 vs 30%, P = 0.01). The number of patients with
remarkable postoperative pericardial effusion was significantly lower in
the posterior pericardiotomy group (15 vs 50 patients, P = 0.04).
Tamponade developed in 3 patients in Group II (P = 0.07). There was a
significantly higher incidence of chest drainage in the posterior
pericardiotomy group than in the control group (1041 +/- 549 vs 911 +/-
122 ml; P = 0.04). There was no significant difference between the two
groups regarding hospital stay (8 vs 9 days, P > 0.05). CONCLUSIONS
Posterior pericardiotomy is a simple, safe and effective method for
reducing the incidence of postoperative pericardial effusion and related
atrial fibrillation by improving pericardial drainage after coronary
artery bypass grafting.
<8>
Accession Number
2015441263
Authors
Imazio M. Gaita F. LeWinter M.
Institution
(Imazio) Cardiology Department, Maria Vittoria Hospital, University of
Torino, Via Luigi Cibrario 72, Torino 10141, Italy
(Gaita) University Division of Cardiology, Department of Medical Sciences,
Citta della Salute e Della Scienza, University of Torino, Torino, Italy
(LeWinter) Cardiology Unit, University of Vermont, College of Medicine,
University of Vermont, Medical Center, Burlington, United States
Title
Evaluation and treatment of pericarditis: A systematic review.
Source
JAMA - Journal of the American Medical Association. 314 (14) (pp
1498-1506), 2015. Date of Publication: 13 Oct 2015.
Publisher
American Medical Association
Abstract
IMPORTANCE: Pericarditis is the most common form of pericardial disease
and a relatively common causeof chest pain. OBJECTIVE: To summarize
published evidence on the causes, diagnosis, therapy, prevention, and
prognosis of pericarditis. EVIDENCE REVIEW: A literature search of
BioMedCentral, Google Scholar, MEDLINE, Scopus, and the Cochrane Database
of Systematic Reviews was performed for human studies without language
restriction from January 1, 1990, to August 31, 2015. After literature
review and selection of meta-analyses, randomized clinical trials, and
large observational studies, 30 studies (5 meta-analyses, 10 randomized
clinical trials, and 16 cohort studies) with 7569 adult patients were
selected for inclusion. FINDINGS: The etiology of pericarditis may be
infectious (eg, viral and bacterial) or noninfectious (eg, systemic
inflammatory diseases, cancer, and post-cardiac injury syndromes).
Tuberculosis is a major cause of pericarditis in developing countries but
accounts for less than 5% of cases in developed countries, where
idiopathic, presumed viral causes are responsible for 80% to 90% of cases.
The diagnosis is based on clinical criteria including chest pain, a
pericardial rub, electrocardiographic changes, and pericardial effusion.
Certain features at presentation (temperature >38degreeC [>100.4degreeF],
subacute course, large effusion or tamponade, and failure of nonsteroidal
anti-inflammatory drug [NSAID] treatment) indicate a poorer prognosis and
identify patients requiring hospital admission. The most common treatment
for idiopathic and viral pericarditis in North America and Europe is NSAID
therapy. Adjunctive colchicine can ameliorate the initial episode and is
associated with approximately 50% lower recurrence rates. Corticosteroids
are a second-line therapy for those who do not respond, are intolerant, or
have contraindications to NSAIDs and colchicine. Recurrences may occur in
30% of patients without preventive therapy. CONCLUSIONS AND RELEVANCE:
Pericarditis is the most common form of pericardial disease worldwide and
may recur in as many as one-third of patients who present with idiopathic
or viral pericarditis. Appropriate triage and treatment with NSAIDs may
reduce readmission rates for pericarditis. Treatment with colchicine can
reduce recurrence rates.
<9>
Accession Number
2015445631
Authors
Patel N. Minhas J.S. Chung E.M.L.
Institution
(Patel, Minhas, Chung) Department of Cardiovascular Sciences, University
of Leicester, Leicester LE2 7LX, United Kingdom
(Patel, Chung) Leicester Cardiovascular Biomedical Research Unit,
Glenfield Hospital, Leicester LE3 9QP, United Kingdom
(Minhas) University Hospitals of Leicester NHS Trust, Leicester LE1 5WW,
United Kingdom
(Chung) Department of Medical Physics, University Hospitals of Leicester
NHS Trust, Leicester LE1 5WW, United Kingdom
Title
Risk Factors Associated with Cognitive Decline after Cardiac Surgery: A
Systematic Review.
Source
Cardiovascular Psychiatry and Neurology. 2015 , 2015. Article Number:
370612. Date of Publication: 2015.
Publisher
Hindawi Publishing Corporation (410 Park Avenue, 15th Floor, 287 pmb, New
York NY 10022, United States)
Abstract
Modern day cardiac surgery evolved upon the advent of cardiopulmonary
bypass machines (CPB) in the 1950s. Following this development, cardiac
surgery in recent years has improved significantly. Despite such advances
and the introduction of new technologies, neurological sequelae after
cardiac surgery still exist. Ischaemic stroke, delirium, and cognitive
impairment cause significant morbidity and mortality and unfortunately
remain common complications. Postoperative cognitive decline (POCD) is
believed to be associated with the presence of new ischaemic lesions
originating from emboli entering the cerebral circulation during surgery.
Cardiopulmonary bypass was thought to be the reason of POCD, but
randomised controlled trials comparing with off-pump surgery show
contradictory results. Attention has now turned to the growing evidence
that perioperative risk factors, as well as patient-related risk factors,
play an important role in early and late POCD. Clearly, identifying the
mechanism of POCD is challenging. The purpose of this systematic review is
to discuss the literature that has investigated patient and perioperative
risk factors to better understand the magnitude of the risk factors
associated with POCD after cardiac surgery.
<10>
Accession Number
2015452013
Authors
Breuer T. Emontzpohl C. Coburn M. Benstoem C. Rossaint R. Marx G. Schalte
G. Bernhagen J. Bruells C.S. Goetzenich A. Stoppe C.
Institution
(Breuer, Coburn, Rossaint, Schalte, Stoppe) University Hospital of the
RWTH Aachen, Department of Anaesthesiology, Pauwelsstr. 30, Aachen 52074,
Germany
(Emontzpohl, Benstoem, Goetzenich, Stoppe) University Hospital of the RWTH
Aachen, Department of Thoracic and Cardiovascular Surgery, Aachen, Germany
(Breuer, Marx, Bruells) University Hospital of the RWTH Aachen, Department
of Intensive and Intermediate Care, Pauwelsstr. 30, Aachen 52074, Germany
(Emontzpohl, Bernhagen, Stoppe) University Hospital, RWTH Aachen
University, Institute of Biochemistry and Molecular Cell Biology,
Pauwelsstr. 30, Aachen 52074, Germany
Title
Xenon triggers pro-inflammatory effects and suppresses the
anti-inflammatory response compared to sevoflurane in patients undergoing
cardiac surgery.
Source
Critical Care. 19 (1) , 2015. Date of Publication: October 15, 2015.
Publisher
BioMed Central Ltd.
Abstract
Introduction: Cardiac surgery encompasses various stimuli that trigger
pro-inflammatory mediators, reactive oxygen species and mobilization of
leucocytes. The aim of this study was to evaluate the effect of xenon on
the inflammatory response during cardiac surgery. Methods: This randomized
trial enrolled 30 patients who underwent elective on-pump coronary-artery
bypass grafting in balanced anaesthesia of either xenon or sevoflurane.
For this secondary analysis, blood samples were drawn prior to the
operation, intra-operatively and on the first post-operative day to
measure the pro- and anti-inflammatory cytokines interleukin-6 (IL-6),
interleukin-8/C-X-C motif ligand 8 (IL-8/CXCL8), and interleukin-10
(IL-10). Chemokines such as C-X-C motif ligand 12/ stromal cell-derived
factor-1aalpha (CXCL12/SDF-1aalpha) and macrophage migration inhibitory
factor (MIF) were measured to characterize xenon's perioperative
inflammatory profile and its impact on migration of peripheral blood
mononuclear cells (PBMC). Results: Xenon enhanced the postoperative
increase of IL-6 compared to sevoflurane (Xenon: 90.7 versus sevoflurane:
33.7 pg/ml; p = 0.035) and attenuated the increase of IL-10 (Xenon: 127.9
versus sevoflurane: 548.3 pg/ml; p = 0.028). Both groups demonstrated a
comparable intraoperative increase of oxidative stress (intra-OP: p =
0.29; post-OP: p = 0.65). While both groups showed an intraoperative
increase of the cardioprotective mediators MIF and CXCL12/SDF-1aalpha,
only MIF levels decreased in the xenon group on the first postoperative
day (50.0 ng/ml compared to 23.3 ng/ml; p = 0.012), whereas it remained
elevated after sevoflurane anaesthesia (58.3 ng/ml to 53.6 ng/ml). Effects
of patients' serum on chemotactic migration of peripheral mononuclear
blood cells taken from healthy volunteers indicated a tendency towards
enhanced migration after sevoflurane anaesthesia (p = 0.07). Conclusions:
Compared to sevoflurane, balanced xenon anaesthesia triggers
pro-inflammatory effects and suppresses the anti-inflammatory response in
cardiac surgery patients even though the clinical significance remains
unknown. Trial registration: This clinical trial was approved by the
European Medicines Agency (EudraCT-number: 2010-023942-63) and at
ClinicalTrials.gov (NCT01285271 ; first received: January 24, 2011).
<11>
Accession Number
2015443214
Authors
Wong C.X. Sullivan T. Sun M.T. Mahajan R. Pathak R.K. Middeldorp M. Twomey
D. Ganesan A.N. Rangnekar G. Roberts-Thomson K.C. Lau D.H. Sanders P.
Institution
(Wong, Sullivan, Sun, Mahajan, Pathak, Middeldorp, Twomey, Ganesan,
Rangnekar, Roberts-Thomson, Lau, Sanders) Centre for Heart Rhythm
Disorders, Department of Cardiology, Royal Adelaide Hospital, Adelaide, SA
5000, Australia
Title
Obesity and the risk of incident, post-operative, and post-ablation atrial
fibrillation: A meta-analysis of 626,603 individuals in 51 studies.
Source
JACC: Clinical Electrophysiology. 1 (3) (pp 139-152), 2015. Date of
Publication: June 2015.
Publisher
Elsevier Inc.
Abstract
Objectives The purpose of this study was to quantify the magnitude of
association between incremental increases in body mass index (BMI) and the
development of incident, post-operative, and post-ablation atrial
fibrillation (AF). Background Obesity has been estimated to account for
one-fifth of all AF and approximately 60% of recent increases in
population AF incidence. From a public health perspective, obesity,
therefore, is a modifiable risk factor that could be profitably targeted.
Methods A systematic review and meta-analysis was conducted. Medline and
EMBASE databases were searched for observational studies reporting data on
the association between obesity and incident, post-operative, and
post-ablation AF. Studies were included if they reported or provided data
allowing calculation of risk estimates. Results Data from 51 studies
including 626,603 individuals contributed to this analysis. There were 29%
(odds ratio [OR]: 1.29, 95% confidence interval [CI]: 1.23 to 1.36) and
19% (OR: 1.19, 95% CI: 1.13 to 1.26) greater excess risks of incident AF
for every 5-U BMI increase in cohort and case-control studies,
respectively. Similarly, there were 10% (OR: 1.10, 95% CI: 1.04 to 1.17)
and 13% (OR: 1.13, 95% CI: 1.06 to 1.22) greater excess risks of
post-operative and post-ablation AF for every 5-U increase in BMI,
respectively. Conclusions Incremental increases in BMI are associated with
a significant excess risk of AF in different clinical settings. For every
5-U increase in BMI, there were 10% to 29% greater excess risks of
incident, post-operative, and post-ablation AF. By providing a
comprehensive and reliable quantification of the relationship between
incremental increases in obesity and AF across different clinical
settings, our findings highlight the potential for even moderate
reductions in population body mass indexes to have a significant effect in
mitigating the rising burden of AF.
<12>
Accession Number
2015442865
Authors
Konstam M.A.
Institution
(Konstam) Cardio Vascular Center, Tufts Medical Center, Tufts University
School of Medicine, Box 108, 800 Washington Street, Boston, MA 02111,
United States
Title
Viability, remodeling, and CABG another STICH in the shroud of
observation-based paradigm?.
Source
JACC: Cardiovascular Imaging. 8 (10) (pp 1130-1132), 2015. Date of
Publication: October 2015.
Publisher
Elsevier Inc.
<13>
Accession Number
2015444464
Authors
Abd-Elshafy S.K. Khalaf G.S. Abo-Kerisha M.Z. Ahmed N.T. El-Aziz M.A.A.
Mohamed M.A.
Institution
(Abd-Elshafy) Department of Anesthesia and Intensive Care, Faculty of
Medicine, Assiut University Hospital, Assiut 74111, Egypt
(Khalaf, El-Aziz, Mohamed) Critical Care Nursing Department, Department of
Nursing, United States
(Abo-Kerisha) Clinical Pathology Department, Faculty of Medicine, United
States
(Ahmed) Critical Care and Emergency Nursing Department, Faculty of
Nursing, Alexandria University, Alexandria, Egypt
Title
Not All Sounds Have Negative Effects on Children Undergoing Cardiac
Surgery.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 29 (5) (pp 1277-1284),
2015. Date of Publication: 01 Oct 2015.
Publisher
W.B. Saunders
Abstract
Objective This study was designed to evaluate the role of music therapy on
the level of stress in children undergoing repair of congenital heart
disease. Design Prospective, randomized, double-blind, controlled clinical
trial. Setting Children's university hospital. Participants Fifty children
aged 4 to 12 years undergoing repair of congenital heart disease.
Interventions Patients were randomized into 2 equal groups (control group
and music group); in the control group, patients listened to a blank CD,
and in the music group, patients listened to a recorded CD of music and
songs preferred by the child. Demographic data, clinical data, and
preoperative vital signs were recorded. Baseline stress markers (blood
glucose and cortisol levels) were sampled. Patients were assessed
intraoperatively until extubation for vital signs and stress markers and
after extubation for pain and sedation scales. An interview was conducted
within the first postoperative week with the patients and their parents
for assessment of post-traumatic stress disorder and negative
postoperative behavior changes. Measurements and Main Results There were
no significant differences in demographic characteristics, clinical data,
vital signs, preoperative and at-extubation blood glucose levels, and
preoperative blood cortisol levels between groups. Significant differences
were found between groups in blood glucose levels and cortisol levels at
all intraoperative times, but only in cortisol blood levels at extubation.
Significant differences were found in pain score, sedation score,
occurrence of child post-traumatic stress disorder, and occurrence of
negative postoperative behavior. Conclusion Listening to favorable music
by children undergoing repair for congenital heart disease resulted in
less stress and more relaxation.
<14>
Accession Number
2015438627
Authors
Bin Abdulhak A.A. Baddour L.M. Erwin P.J. Hoen B. Chu V.H. Mensah G.A.
Tleyjeh I.M.
Institution
(Bin Abdulhak) Department of Medicine, School of Medicine, University of
Missouri-Kansas City, Kansas City, MO, United States
(Baddour, Tleyjeh) Division of Infectious Diseases, Mayo Clinic,
Rochester, MN, United States
(Erwin) Mayo Medical Library, Mayo Clinic, Rochester, MN, United States
(Hoen) Department of Infectious Diseases, Dermatology, and Internal
Medicine, University Medical Center of Guadeloupe, Cedex, France
(Chu) Division of Infectious Diseases, Department of Medicine, Duke
University Medical Center, Durham, NC, United States
(Mensah) Center for Translation Research and Implementation Science
(CTRIS), National Heart, Lung, and Blood Institute, National Institutes of
Health, Bethesda, MD, United States
(Tleyjeh) Division of Epidemiology, Mayo Clinic, Rochester, MN, United
States
(Tleyjeh) Department of Medicine, Infectious Diseases Section, King Fahad
Medical City, Riyadh, Saudi Arabia
(Tleyjeh) College of Medicine, Al Faisal University, Riyadh, Saudi Arabia
Title
Global and Regional Burden of Infective Endocarditis, 1990-2010: A
Systematic Review of the Literature.
Source
Global Heart. 9 (1) (pp 131-143), 2014. Date of Publication: 2014.
Publisher
Elsevier
Abstract
Infective endocarditis (IE) is a life-threatening disease associated with
serious complications. The GBD 2010 (Global Burden of Disease, Injuries,
and Risk Factors) study IE expert group conducted a systematic review of
IE epidemiology literature to inform estimates of the burden on IE in 21
world regions in 1990 and 2010. The disease model of IE for the GBD 2010
study included IE death and 2 sequelae: stroke and valve surgery. Several
medical and science databases were searched for IE epidemiology studies in
GBD high-, low-, and middle-income regions published between 1980 and
2008. The epidemiologic parameters of interest were IE incidence,
proportions of IE patients who developed stroke or underwent valve
surgery, and case fatality. Literature searches yielded 1,975 unique
papers, of which 115 published in 10 languages were included in the
systematic review. Eligible studies were population-based (17%),
multicenter hospital-based (11%), and single-center hospital-based studies
(71%). Population-based studies were reported from only 6 world regions.
Data were missing or sparse in many low- and middle-income regions. The
crude incidence of IE ranged between 1.5 and 11.6 cases per 100,000 people
and was reported from 10 countries. The overall mean proportion of IE
patients that developed stroke was 0.158 +/- 0.091, and the mean
proportion of patients that underwent valve surgery was 0.324 +/- 0.188.
The mean case fatality risk was 0.211 +/- 0.104. A systematic review for
the GBD 2010 study provided IE epidemiology estimates for many world
regions, but highlighted the lack of information about IE in low- and
middle-income regions. More complete knowledge of the global burden of IE
will require improved IE surveillance in all world regions.
<15>
Accession Number
2015449628
Authors
De Waal B.A. Buise M.P. Van Zundert A.A.J.
Institution
(De Waal) Department of Anesthesiology, Maastricht University Medical
Centre, P. Debyelaan 25, HX Maastricht 6229, Netherlands
(Buise) Department of Anesthesiology, Catharina Hospital, Postbus 1350, ZA
Eindhoven 5602, Netherlands
(Van Zundert) Discipline of Anesthesiology, University of Queensland,
Faculty of Medicine and Biomedical Sciences, Royal Brisbane and Women's
Hospital, Herston Campus, Brisbane, QLD 4029, Australia
Title
Perioperative statin therapy in patients at high risk for cardiovascular
morbidity undergoing surgery: A review.
Source
British Journal of Anaesthesia. 114 (1) (pp 44-52), 2014. Date of
Publication: 03 Sep 2014.
Publisher
Oxford University Press
Abstract
Statins feature documented benefits for primary and secondary prevention
of cardiovascular disease and are thought to improve perioperative
outcomes in patients undergoing surgery. To assess the clinical outcomes
of perioperative statin treatment in statin-naive patients undergoing
surgery, a systematic review was performed. Studies were included if they
met the following criteria: randomized controlled trials, patients aged
A18 yr undergoing surgery, patients not already on long-term statin
treatment, reported outcomes including at least one of the following:
mortality, myocardial infarction, atrial fibrillation, stroke, and length
of hospital stay. The following randomized clinical trials were excluded:
retrospective studies, trials without surgical procedure, trials without
an outcome of interest, studies with patients on statin therapy before
operation, or papers not written in English. The literature search
revealed 16 randomized controlled studies involving 2275 patients. Pooled
results showed a significant reduction in (i) mortality [risk ratio (RR)
0.53, 95% confidence interval (CI) 0.30.0.94, P=0.03], (ii) myocardial
infarction (RR 0.54, 95% CI 0.38.0.76, P<0.001), (iii) perioperative
atrial fibrillation (RR 0.53, 95% CI 0.43.0.66, P<0.001), and (iv) length
of hospital stay (days, mean difference 20.58, 95% CI -0.79 to -0.37,
P<0.001) in patients treated with a statin. Subgroup analysis in patients
undergoing non-cardiac surgery showed a decrease in the perioperative
incidence of mortality and myocardial infarction. Consequently,
anaesthetists should consider prescribing a standarddose statin before
operation to statin-naive patients undergoing cardiac surgery. However,
there are insufficient data to support final recommendations on
perioperative statin therapy for patients undergoing non-cardiac surgery.
<16>
Accession Number
2015450157
Authors
Guimaraes Marcelino C.A. Rueda Diaz L.J. da Cruz D.M.
Institution
(Guimaraes Marcelino, Rueda Diaz, da Cruz) School of Nursing, Instituto
Dante Pazzanese de Cardiologia, Brazil
(Guimaraes Marcelino, Rueda Diaz, da Cruz) The Brazilian Centre for
Evidence-based Healthcare, Brazil
(Rueda Diaz) Industrial University of Santander, Colombia
Title
The effectiveness of interventions in managing treatment adherence in
adult heart transplant patients: A systematic review.
Source
JBI Database of Systematic Reviews and Implementation Reports. 13 (9) (pp
279-308), 2015. Date of Publication: 2015.
Publisher
Joanna Briggs Institute
Abstract
BACKGROUND: Over the past 20 years, solid organ transplantation has
evolved from experimental treatments to an effective alternative for the
treatment of various diseases, including heart failure. Treatment
non-adherence is a limiting factor for the success of heart transplants. A
systematic review of the evidence is needed to examine the effectiveness
of interventions for managing adherence to treatment in heart transplant
patients. OBJECTIVE: The primary objective of this systematic review was
to synthesize the best available evidence regarding interventions for
managing adherence to pharmacological and non-pharmacological treatments
in heart/heart-lung transplant patients. INCLUSION CRITERIA: Types of
participants:This review considered primary studies that included patients
18 years old or older, who had undergone heart or heart-lung
transplantation (regardless of gender, ethnicity, comorbidities or whether
they had received other treatments or not) who were receiving
pharmacological and non-pharmacological treatments. Types of
interventions: This review considered studies that evaluated the
effectiveness of interventions in managing adherence to pharmacological or
non-pharmacological treatments among adult heart/heart-lung transplant
patients. Primary studies comparing standard care with any type of
intervention to maintain treatment adherence were considered. Types of
studies: This review considered any experimental study design including
randomized controlled trials; other research designs, such as
non-randomized controlled trials and before and after studies, were also
considered for inclusion. Types of outcomes: The primary outcome
considered was patient adherence to pharmacological or non-pharmacological
treatments by means of objective or self-report assessment. SEARCH
STRATEGY: Published and unpublished studies in English, Portuguese and
Spanish were searched in electronic databases. Searches were completed in
January 2014. METHODOLOGICAL QUALITY: Two independent reviewers, using the
standardized critical appraisal instruments from the Joanna Briggs
Institute Meta-Analysis of Statistics Assessment and Review Instrument,
assessed methodological quality. DATA EXTRACTION: Data were extracted
using the standardized data extraction tool from Joanna Briggs Institute
Meta-Analysis of Statistics Assessment and Review Instrument. DATA
SYNTHESIS: Statistical pooling was not possible due to substantial
heterogeneity of the studies; therefore data were presented as a narrative
summary. RESULTS: Three quasi-experimental studies were included in this
review. One study found that a dose reduction of immunosuppressive
medications from a twice-daily to a once-daily regimen had a positive
impact on treatment adherence; one found no significant difference in
treatment adherence between patients who received educational intervention
conducted in a teaching laboratory and those who received standard care;
the third one also reported no significant difference in outcomes between
a multifaceted intervention consisting of internet-based interactive
workshops and standard care. CONCLUSIONS: The current best evidence to
guide decisions regarding interventions to manage treatment adherence in
heart transplant patients is limited. There is weak evidence that
psycho-educational interventions (other than the standard care) has a
positive impact on adherence and that decreasing the complexity of the
treatment regimen by reducing the daily dose of the immunosuppressant drug
improves adherence in heart transplant patients.
<17>
Accession Number
2015390573
Authors
Gosselt A.N.C. Slooter A.J.C. Boere P.R.Q. Zaal I.J.
Institution
(Gosselt, Slooter, Boere, Zaal) University Medical Center Utrecht,
Department of Intensive Care Medicine, Heidelberglaan 100, Utrecht 3584
CX, Netherlands
Title
Risk factors for delirium after on-pump cardiac surgery: A systematic
review.
Source
Critical Care. 19 (1) , 2015. Article Number: 346. Date of Publication:
September 23, 2015.
Publisher
BioMed Central Ltd.
Abstract
Introduction: As evidence-based effective treatment protocols for delirium
after cardiac surgery are lacking, efforts should be made to identify risk
factors for preventive interventions. Moreover, knowledge of these risk
factors could increase validity of etiological studies in which
adjustments need to be made for confounding variables. This review aims to
systematically identify risk factors for delirium after cardiac surgery
and to grade the evidence supporting these associations. Method: A prior
registered systematic review was performed using EMBASE, CINAHL, MEDLINE
and Cochrane from 1990 till January 2015
(http://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42014007371).
All studies evaluating patients for delirium after cardiac surgery with
cardiopulmonary bypass (CPB) using either randomization or multivariable
data analyses were included. Data was extracted and quality was scored in
duplicate. Heterogeneity impaired pooling of the data; instead a
semi-quantitative approach was used in which the strength of the evidence
was graded based on the number of investigations, the quality of studies,
and the consistency of the association reported across studies. Results:
In total 1462 unique references were screened and 34 were included in this
review, of which 16 (47 %) were graded as high quality. A strong level of
evidence for an association with the occurrence of postoperative delirium
was found for age, previous psychiatric conditions, cerebrovascular
disease, pre-existent cognitive impairment, type of surgery,
peri-operative blood product transfusion, administration of risperidone,
postoperative atrial fibrillation and mechanical ventilation time.
Postoperative oxygen saturation and renal insufficiency were supported by
a moderate level of evidence, and there is no evidence that gender,
education, CPB duration, pre-existent cardiac disease or heart failure are
risk factors. Conclusion: Of many potential risk factors for delirium
after cardiac surgery, for only 11 there is a strong or moderate level of
evidence. These risk factors should be taken in consideration when
designing future delirium prevention strategies trials or when controlling
for confounding in future etiological studies.
<18>
Accession Number
2015440438
Authors
Je H.G. Shuman D.J. Ad N.
Institution
(Je, Shuman, Ad) Inova Heart and Vascular Institute, Falls Church, VA,
United States
Title
A systematic review of minimally invasive surgical treatment for atrial
fibrillation: A comparison of the Cox-Maze procedure, beating-heart
epicardial ablation, and the hybrid procedure on safety and efficacy.
Source
European Journal of Cardio-thoracic Surgery. 48 (4) (pp 531-541), 2015.
Article Number: ezu536. Date of Publication: October 2015.
Publisher
European Association for Cardio-Thoracic Surgery
Abstract
There is a growing trend to perform off-bypass surgical ablation for
atrial fibrillation (AF) because it is perceived to be safer and more
effective than the Cox-Maze procedure with cardiopulmonary bypass (CPB)
support. In this systematic review, we compared three minimally invasive
stand-alone surgical ablation procedures for AF: the endocardial Cox-Maze
procedure, epicardial surgical ablation and a hybrid epicardial surgical
and catheter-based endocardial ablation procedure (hybrid procedure).
Relevant studies were identified in MEDLINE and the Cochrane Database of
Systematic Reviews according to the Preferred Reporting Items for
Systematic Reviews and Meta-Analyses (PRISMA) guidelines. From 565 initial
studies, 37 were included in this review. The total number of patients
across all studies was 1877 (range 10-139). Two studies reported on
endocardial Cox-Maze procedures (n = 145), 26 reported on epicardial
surgical ablation (n = 1382) and 9 reported on hybrid surgical ablation (n
= 350). For minimally invasive Cox-Maze, epicardial and hybrid groups,
operative mortality rates were 0, 0.5 and 0.9%, perioperative permanent
pacemaker insertion rates were 3.5, 2.7 and 1.5%, incidence of conversion
to median sternotomy was 0, 2.4 and 2.5%, and reoperation for bleeding was
1.0, 1.5 and 2.2%, with mean length of stay (days) of 5.4, 6.0 and 4.6,
respectively. At 12 months, rates of sinus rhythm restoration were 93, 80
and 70%, and sinus restoration without anti-arrhythmic medications was 87,
72 and 71%, for Cox-Maze, epicardial and hybrid procedures, respectively.
Of the three procedures, the minimally invasive Cox-Maze procedure with
CPB support was most effective for the treatment of stand-alone AF and had
important safety advantages in conversion to sternotomy and major
bleeding. The minimally invasive Cox-Maze procedure with CPB support also
demonstrated the potential for a higher success rate 12 months following
the procedure.
<19>
[Use Link to view the full text]
Accession Number
26035251
Authors
Moerman A.T. Vanbiervliet V.M. Van Wesemael A. Bouchez S.M. Wouters P.F.
De Hert S.G.
Institution
(Moerman, Vanbiervliet, Van Wesemael, Bouchez, Wouters, De Hert) From the
Department of Anesthesiology, Ghent University Hospital, Ghent, Belgium
Title
Assessment of Cerebral Autoregulation Patterns with Near-infrared
Spectroscopy during Pharmacological-induced Pressure Changes.
Source
Anesthesiology. 123 (2) (pp 327-335), 2015. Date of Publication: 01 Aug
2015.
Abstract
BACKGROUND: Previous work has demonstrated paradoxical increases in
cerebral oxygen saturation (ScO2) as blood pressure decreases and
paradoxical decreases in ScO2 as blood pressure increases. It has been
suggested that these paradoxical responses indicate a functional cerebral
autoregulation mechanism. Accordingly, the authors hypothesized that if
this suggestion is correct, paradoxical responses will occur exclusively
in patients with intact cerebral autoregulation.
METHODS: Thirty-four patients undergoing elective cardiac surgery were
included. Cerebral autoregulation was assessed with the near-infrared
spectroscopy-derived cerebral oximetry index (COx), computed by
calculating the Spearman correlation coefficient between mean arterial
pressure and ScO2. COx less than 0.30 was previously defined as functional
autoregulation. During cardiopulmonary bypass, 20% change in blood
pressure was accomplished with the use of nitroprusside for decreasing
pressure and phenylephrine for increasing pressure. Effects on COx were
assessed. Data were analyzed using two-way ANOVA, Kruskal-Wallis test, and
Wilcoxon and Mann-Whitney U test.
RESULTS: Sixty-five percent of patients had a baseline COx less than 0.30,
indicating functional baseline autoregulation. In 50% of these patients (n
= 10), COx became highly negative after vasoactive drug administration
(from -0.04 [-0.25 to 0.16] to -0.63 [-0.83 to -0.26] after administration
of phenylephrine, and from -0.05 [-0.19 to 0.17] to -0.55 [-0.94 to -0.35]
after administration of nitroprusside). A negative COx implies a decrease
in ScO2 with increase in pressure and, conversely, an increase in ScO2
with decrease in pressure.
CONCLUSIONS: In this study, paradoxical changes in ScO2 after
pharmacological-induced pressure changes occurred exclusively in patients
with intact cerebral autoregulation, corroborating the hypothesis that
these paradoxical responses might be attributable to a functional cerebral
autoregulation.
<20>
Accession Number
25071414
Authors
Fleischer S. Berg A. Behrens J. Kuss O. Becker R. Horbach A. Neubert T.R.
Institution
(Fleischer) Institute of Health and Nursing Science, Medical Faculty,
Martin-Luther-University Halle-Wittenberg, Halle, Germany
(Berg) Institute of Health and Nursing Science, Medical Faculty,
Martin-Luther-University Halle-Wittenberg, Halle, Germany
(Behrens) Institute of Health and Nursing Science, Medical Faculty,
Martin-Luther-University Halle-Wittenberg, Halle, Germany
(Kuss) Institute of Medical Epidemiology, Biostatistics, and Informatics,
Medical Faculty, Martin-Luther-University Halle-Wittenberg, Halle, Germany
(Becker) Stadtisches Klinikum Munchen GmbH Akademie, Munich, Germany
(Horbach) Sana Herzchirurgische Klinik Stuttgart, Stuttgart, Germany ;
Department 4: Health and Social Work, University of Applied Sciences,
Frankfurt/Main, Germany ; Hessian Institute of Nursing Research (HessIP),
Franfurt/Main, Germany
(Neubert) Department of Nursing Research, University Hospital Giessen and
Marburg, Location Marburg, Germany ; Institute for Theoretical
Surgery/Department of Visceral, Thoracic and Vascular Surgery, University
Hospital Giessen and Marburg, Location Marburg, Germany
Title
Does an additional structured information program during the intensive
care unit stay reduce anxiety in ICU patients?: a multicenter randomized
controlled trial.
Source
BMC anesthesiology. 14 (pp 48), 2014. Date of Publication: 2014.
Abstract
BACKGROUND: Communication and information in order to reduce anxiety in
the intensive care unit (ICU) has been described as area needing
improvement. Therefore, the aim of this trial was to evaluate whether a
structured information program that intensifies information given in
standard care process reduces anxiety in ICU patients.
METHODS: Multicenter, two-armed, non-blinded, parallel-group randomized
controlled trial in hospitals in the cities of Marburg, Halle, and
Stuttgart (Germany). The trial was performed in cardiac surgery, general
surgery, and internal medicine ICUs. Two-hundred and eleven elective and
non-elective ICU patients were enrolled in the study (intervention group,
n=104; control group, n=107). The experimental intervention comprised a
single episode of structured oral information that was given in addition
to standard care and covered two main parts: (1) A more standardized part
about predefined ICU specific aspects - mainly procedural, sensory and
coping information, and (2) an individualized part about fears and
questions of the patient. The control group received a non-specific
episodic conversation of similar length additional to standard care. Both
conversations took place at the beginning of the ICU stay and lasted 10-15
minutes. Study nurses administered both interventions. The primary outcome
ICU-related anxiety (CINT-Score, 0-100 pts., higher scores indicate higher
anxiety) was assessed after admission to a regular ward.
RESULTS: The primary outcome could be measured in 82 intervention group
participants and 90 control group participants resulting in mean values of
20.4 (SD 14.4) compared to 20.8 (SD 14.7) and a mean difference of -0.2
(CI 95% -4.5 to 4.1).
CONCLUSIONS: A structured information intervention additional to standard
care during ICU stay had no demonstrated additional benefit compared to an
unspecific communication of similar duration. Reduction of anxiety in ICU
patients will probably require more continuous approaches to information
giving and communication.
TRIAL REGISTRATION: ClinicalTrials.gov NCT00764933.
<21>
Accession Number
23958073
Authors
Kus A. Hosten T. Gurkan Y. Gul Akgul A. Solak M. Toker K.
Institution
(Kus) Department of Anesthesiology and Reanimation, Medical Faculty of
Kocaeli University, Umuttepe, Kocaeli, Turkey. Electronic address:
(Hosten) Department of Anesthesiology and Reanimation, Medical Faculty of
Kocaeli University, Umuttepe, Kocaeli, Turkey
(Gurkan) Department of Anesthesiology and Reanimation, Medical Faculty of
Kocaeli University, Umuttepe, Kocaeli, Turkey
(Gul Akgul) Department of Thoracic Surgery, Medical Faculty of Kocaeli
University, Umuttepe, Kocaeli, Turkey
(Solak) Department of Anesthesiology and Reanimation, Medical Faculty of
Kocaeli University, Umuttepe, Kocaeli, Turkey
(Toker) Department of Anesthesiology and Reanimation, Medical Faculty of
Kocaeli University, Umuttepe, Kocaeli, Turkey
Title
A comparison of the EZ-Blocker with a Cohen Flex-Tip blocker for one-lung
ventilation.
Source
Journal of cardiothoracic and vascular anesthesia. 28 (4) (pp 896-899),
2014. Date of Publication: 01 Aug 2014.
Abstract
OBJECTIVES: The EZ-Blocker (IQ Medical Ventures BV, Rotterdam,
Netherlands) is a newly designed device for one-lung ventilation. The aim
of this study was to compare the effectiveness of the Cohen Flex-Tip
bronchial blocker (Cook, Bloomington, IN) and the EZ-Blocker for one-lung
ventilation during thoracic surgery.
DESIGN: Randomized and prospective.
SETTING: A university hospital.
PARTICIPANTS: This study included 40 patients undergoing thoracic surgical
procedures.
INTERVENTIONS: Patients were assigned to 2 study groups: Patients who
received the Cohen Flex-Tip blocker were assigned to the Cohen group, and
patients who received the EZ-Blocker were assigned to the EZ group. In
both groups, fiberoptic guidance was used during placement of the
bronchial blockers. Comparisons between the groups included the time to
correct placement, the incidence of malpositioning, and the satisfaction
level of the surgeon (good, fair, poor).
MEASUREMENTS AND MAIN RESULTS: One-lung ventilation was achieved
successfully for all patients. The time to correct placement (mean+/-SD)
was significantly shorter in the EZ group (146+/-56 seconds) compared with
the Cohen group (241+/-51 seconds; p=0.01). The incidence of
malpositioning was significantly lower in the EZ group compared with the
Cohen group (p=0.018). Surgeon satisfaction was similar in both groups.
CONCLUSIONS: In this study, both bronchial blockers provided similar
surgical exposure during thoracic procedures. The EZ-Blocker had a shorter
time to correct positioning and less frequent intraoperative
malpositioning.
<22>
Accession Number
24447503
Authors
Al Shehri A.M. El-Tahan M.R. Al Metwally R. Qutub H. El Ghoneimy Y.F.
Regal M.A. Zien H.
Institution
(Al Shehri) Department of Cardiology, King Fahd Hospital of the University
of Dammam, Al Khubar, Saudi Arabia
(El-Tahan) Department of Anaesthesia and Surgical ICU, King Fahd Hospital
of the University of Dammam, Al Khubar, Saudi Arabia. Electronic address:
mohamedrefaateltahan@yahoo.com
(Al Metwally) Department of Anaesthesia and Surgical ICU, King Fahd
Hospital of the University of Dammam, Al Khubar, Saudi Arabia
(Qutub) Department of Pulmonology and Intensive Care Unit, King Fahd
Hospital of the University of Dammam, Al Khubar, Saudi Arabia
(El Ghoneimy) Cardiothoracic Surgery, King Fahd Hospital of the University
of Dammam, Al Khubar, Saudi Arabia
(Regal) Cardiothoracic Surgery, King Fahd Hospital of the University of
Dammam, Al Khubar, Saudi Arabia
(Zien) Department of Anaesthesia and Surgical ICU, King Fahd Hospital of
the University of Dammam, Al Khubar, Saudi Arabia
Title
Right ventricular function during one-lung ventilation: effects of
pressure-controlled and volume-controlled ventilation.
Source
Journal of cardiothoracic and vascular anesthesia. 28 (4) (pp 880-884),
2014. Date of Publication: 01 Aug 2014.
Abstract
OBJECTIVES: To test the effects of pressure-controlled (PCV) and
volume-controlled (VCV) ventilation during one-lung ventilation (OLV) for
thoracic surgery on right ventricular (RV) function.
DESIGN: A prospective, randomized, double-blind, controlled, crossover
study.
SETTING: A single university hospital.
PARTICIPANTS: Fourteen pairs of consecutive patients scheduled for
elective thoracotomy.
INTERVENTIONS: Patients were assigned randomly to ventilate the dependent
lung with PCV or VCV mode, each in a randomized crossover order using
tidal volume of 6 mL/kg, I: E ratio 1: 2.5, positive end-expiratory
pressure (PEEP) of 5 cm H2O and respiratory rate adjusted to maintain
normocapnia.
MEASUREMENTS AND MAIN RESULTS: Intraoperative changes in RV function
(systolic and early diastolic tricuspid annular velocity (TAV),
end-systolic volume (ESV), end-diastolic volume (EDV) and fractional area
changes (FAC)), airway pressures, compliance and oxygenation index were
recorded. The use of PCV during OLV resulted in faster systolic
(10.1+/-2.39 vs. 5.8+/-1.67 cm/s, respectively), diastolic TAV (9.2+/-1.99
vs. 4.6+/-1.42 cm/s, respectively) (p<0.001) and compliance and lower ESV,
EDV and airway pressures (p<0.05) than during the use of VCV. Oxygenation
indices were similar during the use of VCV and PCV.
CONCLUSIONS: The use of PCV offers more improved RV function than the use
of VCV during OLV for open thoracotomy. These results apply specifically
to younger patients with good ventricular and pulmonary functions.
<23>
Accession Number
24094562
Authors
Wang S. Zhang J. Cheng H. Yin J. Liu X.
Institution
(Wang) Department of Anesthesiology, Wuhu Second People's Hospital, Wuhu
City, Anhui, China. Electronic address: wuhuwsl@163.com
(Zhang) Department of Anesthesiology, Wuhu Second People's Hospital, Wuhu
City, Anhui, China
(Cheng) Department of Anesthesiology, Wuhu Second People's Hospital, Wuhu
City, Anhui, China
(Yin) Department of Anesthesiology, Wuhu Second People's Hospital, Wuhu
City, Anhui, China
(Liu) Department of Anesthesiology, Wuhu Second People's Hospital, Wuhu
City, Anhui, China
Title
A clinical evaluation of the ProSeal laryngeal mask airway with a Coopdech
bronchial blocker for one-lung ventilation in adults.
Source
Journal of cardiothoracic and vascular anesthesia. 28 (4) (pp 900-903),
2014. Date of Publication: 01 Aug 2014.
Abstract
OBJECTIVE: To compare the effects of one-lung ventilation (OLV) offered by
ProSeal laryngeal mask airway (PLMA) or endotracheal tube (ETT) with
Coopdech bronchial blocker (BB) in adult patients undergoing thoracoscopic
procedures, and also to evaluate the feasibility and security of
application of PLMA with Coopdech BB for OLV.
DESIGN: Prospective, randomized study.
SETTING: A local hospital.
PARTICIPANTS: One-hundred adult patients undergoing thoracoscopic
procedures.
INTERVENTIONS: PLMA with Coopdech BB (group PLMA-BB, n=50) or ETT with
Coopdech BB (group ETT-BB, n=50) was used for OLV.
MEASUREMENTS AND MAIN RESULTS: There were no differences between the
groups in terms of time of OLV, time of correct placement of the BB, or
cases of BB dislodgement. Forty-seven patients succeeded in OLV in the
PLMA-BB group (94%), all patients succeeded in OLV in the ETT-BB group
(100%), and there was no significant difference in success rate between
groups (p>0.05). Arterial oxygen tension, end-expiration tidal volume, and
peak airway pressure showed no statistical difference in TLV or 30 minutes
after the initiation of OLV between 2 groups (p>0.05).
CONCLUSION: The combined use of PLMA and Coopdech BB in adult patients can
achieve adequate OLV for brief thoracoscopic procedures.
<24>
Accession Number
24480179
Authors
Kang W.-S. Kim S.-H. Chung J.W.
Institution
(Kang) Department of Anaesthesiology and Pain Medicine, Konkuk University
Hospital, Konkuk University Medical Center; Research Institute of Medical
Science, Konkuk University School of Medicine, Seoul, Korea
(Kim) Department of Anaesthesiology and Pain Medicine, Konkuk University
Hospital, Konkuk University Medical Center; Research Institute of Medical
Science, Konkuk University School of Medicine, Seoul, Korea. Electronic
address: yshkim75@daum.net
(Chung) Department of Thoracic and Cardiovascular Surgery, Cleveland
Clinic, Cleveland, Ohio
Title
Comparison of pulmonary gas exchange according to intraoperative
ventilation modes for mitral valve repair surgery via thoracotomy with
one-lung ventilation: a randomized controlled trial.
Source
Journal of cardiothoracic and vascular anesthesia. 28 (4) (pp 908-913),
2014. Date of Publication: 01 Aug 2014.
Abstract
OBJECTIVE: Impaired pulmonary gas exchange after cardiac surgeries with
cardiopulmonary bypass (CPB) often occurs, and the selection of mechanical
ventilation mode, pressure-controlled ventilation (PCV) or
volume-controlled ventilation (VCV), may be important for preventing
hypoxia and improving oxygenation. The authors hypothesized that patients
with PCV would show better oxygenation, compared with VCV, during one-lung
ventilation (OLV) for mitral valve repair surgery (MVP) via thoracotomy.
DESIGN: Randomized controlled trial.
SETTING: University teaching hospital.
PARTICIPANTS: Sixty patients in each group.
INTERVENTIONS: MVP was performed using thoracotomy with OLV by PCV or VCV.
MEASUREMENTS AND MAIN RESULTS: Arterial partial pressure of oxygen (PaO2)
and fraction of inspired oxygen (FIO2) were measured before anesthesia
induction (T0), at skin incision (T1), after administration of heparin
(T2), at 30 minutes after CPB weaning (T3), just before departure from the
operating room to the intensive care unit (ICU) (T4), and 1 hour after ICU
admission (T5), and PaO2/FIO2 ratio was calculated. Peak inspiratory
pressure (PIP) and mean inspiratory pressure (Pmean) were recorded at T1,
T2, T3, and T4. No significant difference was noted in the PaO2/FIO2 ratio
between the groups at any measured point. PIP in the PCV group at all
measured points was lower than that in the VCV group (T1, p<0.001; T2,
p<0.001; T3, p<0.001; T4, p=0.025, respectively). Pmean was not different
between the two groups at any measured point.
CONCLUSIONS: PCV during OLV in patients undergoing MVP via a thoracotomy
with OLV showed lower PIP compared with VCV, but this did not improve
pulmonary gas exchange.
<25>
Accession Number
24686029
Authors
Zhang W. Fang C. Li J. Geng Q.-T. Wang S. Kang F. Pan J.-H. Chai X.-Q. Wei
X.
Institution
(Zhang) Department of Anesthesiology, Anhui Medical University Affiliated
Auhui Provincial Hospital, People's Republic of China
(Fang) Department of Anesthesiology, Anhui Medical University Affiliated
Auhui Provincial Hospital, People's Republic of China. Electronic address:
doctor_fc@163.com
(Li) Department of Anesthesiology, Anhui Medical University Affiliated
Auhui Provincial Hospital, People's Republic of China
(Geng) Department of Anesthesiology, Anhui Medical University Affiliated
Auhui Provincial Hospital, People's Republic of China
(Wang) Department of Anesthesiology, Anhui Medical University Affiliated
Auhui Provincial Hospital, People's Republic of China
(Kang) Department of Anesthesiology, Anhui Medical University Affiliated
Auhui Provincial Hospital, People's Republic of China
(Pan) Department of Anesthesiology, Anhui Medical University Affiliated
Auhui Provincial Hospital, People's Republic of China
(Chai) Department of Anesthesiology, Anhui Medical University Affiliated
Auhui Provincial Hospital, People's Republic of China
(Wei) Department of Anesthesiology, Anhui Medical University Affiliated
Auhui Provincial Hospital, People's Republic of China
Title
Single-dose, bilateral paravertebral block plus intravenous sufentanil
analgesia in patients with esophageal cancer undergoing combined
thoracoscopic-laparoscopic esophagectomy: a safe and effective
alternative.
Source
Journal of cardiothoracic and vascular anesthesia. 28 (4) (pp 966-972),
2014. Date of Publication: 01 Aug 2014.
Abstract
OBJECTIVE: Paravertebral block (PVB) has been shown to be an ideal aid for
analgesia after thoracic or abdominal surgery. The authors studied the
safety and efficacy of the single-dose and bilateral ultrasound-guided
(USG)-PVB before combined thoracoscopic-laparoscopic esophagectomy (TLE)
along with intravenous sufentanil analgesia as a method of pain relief in
comparison with intravenous sufentanil as a sole analgesic agent.
DESIGN: Prospective, randomized study.
SETTING: Single university hospital.
PARTICIPANTS: Fifty-two patients undergoing TLE.
INTERVENTIONS: A USG-PVB was performed before surgery using a solution of
30 mL of 0.5% ropivacaine by 3 injections of 10 mL each at the right T5
and bilateral T8 (PVB group, n=26) or the saline injection of 10 mL at
every site (control group, n=26).
MEASUREMENTS AND MAIN RESULTS: Successful PVBs were achieved in all
patients of the PVB group. Intraoperative mean remifentanil usage and
end-tidal sevoflurane concentration were lower in the PVB group (p<0.001).
Hemodynamic parameters were stable in both groups. Postoperative pain
scores both at rest and on coughing were lower during the first 8 hours in
the PVB group than those in the control group (p<0.05). Cumulative
sufentanil consumption delivered by patient-controlled analgesia (PCA) was
significantly lower in the PVB group at all time points (p<0.05).
Postoperative pulmonary function was better at the third postoperative day
in the PVB group (p<0.05), with quicker hospital discharge and lower
hospital costs (p<0.05).
CONCLUSIONS: The single-dose and bilateral PVB given before TLE combined
with sufentanil may provide better postoperative analgesia and early
discharge in patients undergoing TLE.
<26>
Accession Number
24231197
Authors
Yoo J.Y. Kim D.H. Choi H. Kim K. Chae Y.J. Park S.Y.
Institution
(Yoo) Department of Anesthesiology and Pain Medicine, Ajou University,
School of Medicine, Suwon, Korea
(Kim) Department of Anesthesiology and Pain Medicine, Ajou University,
School of Medicine, Suwon, Korea
(Choi) Department of Thoracic and Cardiovascular Surgery, Ajou University,
School of Medicine, Suwon, Korea
(Kim) Department of Anesthesiology and Pain Medicine, Ajou University,
School of Medicine, Suwon, Korea
(Chae) Department of Anesthesiology and Pain Medicine, Ajou University,
School of Medicine, Suwon, Korea
(Park) Department of Anesthesiology and Pain Medicine, Ajou University,
School of Medicine, Suwon, Korea. Electronic address: anepark@hanmail.net
Title
Disconnection technique with a bronchial blocker for improving lung
deflation: a comparison with a double-lumen tube and bronchial blocker
without disconnection.
Source
Journal of cardiothoracic and vascular anesthesia. 28 (4) (pp 904-907),
2014. Date of Publication: 01 Aug 2014.
Abstract
OBJECTIVE: One-lung ventilation (OLV) is accomplished with a double-lumen
tube (DLT) or a bronchial blocker (BB). The authors compared the
effectiveness of lung collapse using DLT, BB, and BB with the
disconnection technique.
DESIGN: Prospective, randomized, blind trial.
SETTING: A university hospital.
PARTICIPANTS: Fifty-two patients undergoing elective pneumothorax surgery.
INTERVENTIONS: Patients were assigned randomly to 1 of 3 groups: The DLT
group (group 1), the BB group (group 2), and the BB with the disconnection
technique group (group 3). The authors modified the disconnection
technique in group 3 as follows: (1) turned off the ventilator and opened
the adjustable pressure-limiting valve, allowing both lungs to collapse
and (2) after loss of the CO2 trace on the capnograph, inflated the
blocker cuff and turned on the ventilator, allowing only dependent-lung
ventilation.
MEASUREMENTS AND MAIN RESULTS: Five and ten minutes after OLV, the degree
of lung collapse was assessed by the surgeon, who was blinded to the
isolation technique. The quality of lung collapse at 5 and 10 minutes was
significantly better in groups 1 and 3 than in group 2. No significant
differences were observed for the degree of lung collapse at any time
point between groups 1 and 3. The average time for loss of the CO2 trace
on the capnograph was 32.3+/-7.0 seconds in group 3.
CONCLUSIONS: A BB with spontaneous collapse took longer to deflate and did
not provide equivalent surgical exposure to the DLT. The disconnection
technique could be helpful to accelerate lung collapse with a BB.
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