Pub Date : 2017-02-01DOI: 10.1097/01.sa.0000521733.95008.78
Jeong-Hyun Choi, Eun-Ho Lee, Myung-Soo Jang, Dae-Hee Jeong, Mi Kyeong Kim
OBJECTIVES The aim of this study was to determine the association between PaCO2 and patient outcome in patients admitted to the intensive care unit (ICU) after coronary artery bypass grafting (CABG). DESIGN A retrospective cohort study. SETTING Single-institutional, university hospital. PARTICIPANTS All patients admitted to the ICU after CABG between January 2009 and December 2012. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Based on PaCO2 status during the first 24 hours after CABG, 1,011 patients were classified into 4 groups: normocapnia, hypocapnia, hypercapnia, and dual hyper/hypocapnia. The 30-day mortality rate was 0.7% (n = 4) for normocapnia, 1.5% (n = 4) for hypocapnia, 2.2% (n = 3) for hypercapnia, and 7.5% (n = 4) for the dual-exposure group. The extubation times were 13.3±21.7 hours, 15.8±21.37 hours, 21.79±39.70 hours, and 42.29±75.35 hours, respectively. After adjusting for confounding variables, the dual hypocapnia and hypercapnia exposure group was associated with increased 30-day mortality (odds ratio [OR] = 8.08; 95% confidence interval [CI], 1.82-35.86; p = 0.006) and delayed extubation (OR = 2.40; 95% CI, 1.24-4.64; p = 0.010). CONCLUSIONS Exposure to both hypocapnia and hypercapnia within 24 hours after CABG was associated independently with increased risk of 30-day mortality and delayed extubation. Exposure to either hypocapnia or hypercapnia alone was not associated with patient outcome.
{"title":"Association Between Arterial Carbon Dioxide Tension and Outcome in Patients Admitted to the Intensive Care Unit After Coronary Artery Bypass Surgery.","authors":"Jeong-Hyun Choi, Eun-Ho Lee, Myung-Soo Jang, Dae-Hee Jeong, Mi Kyeong Kim","doi":"10.1097/01.sa.0000521733.95008.78","DOIUrl":"https://doi.org/10.1097/01.sa.0000521733.95008.78","url":null,"abstract":"OBJECTIVES\u0000The aim of this study was to determine the association between PaCO2 and patient outcome in patients admitted to the intensive care unit (ICU) after coronary artery bypass grafting (CABG).\u0000\u0000\u0000DESIGN\u0000A retrospective cohort study.\u0000\u0000\u0000SETTING\u0000Single-institutional, university hospital.\u0000\u0000\u0000PARTICIPANTS\u0000All patients admitted to the ICU after CABG between January 2009 and December 2012.\u0000\u0000\u0000INTERVENTIONS\u0000None.\u0000\u0000\u0000MEASUREMENTS AND MAIN RESULTS\u0000Based on PaCO2 status during the first 24 hours after CABG, 1,011 patients were classified into 4 groups: normocapnia, hypocapnia, hypercapnia, and dual hyper/hypocapnia. The 30-day mortality rate was 0.7% (n = 4) for normocapnia, 1.5% (n = 4) for hypocapnia, 2.2% (n = 3) for hypercapnia, and 7.5% (n = 4) for the dual-exposure group. The extubation times were 13.3±21.7 hours, 15.8±21.37 hours, 21.79±39.70 hours, and 42.29±75.35 hours, respectively. After adjusting for confounding variables, the dual hypocapnia and hypercapnia exposure group was associated with increased 30-day mortality (odds ratio [OR] = 8.08; 95% confidence interval [CI], 1.82-35.86; p = 0.006) and delayed extubation (OR = 2.40; 95% CI, 1.24-4.64; p = 0.010).\u0000\u0000\u0000CONCLUSIONS\u0000Exposure to both hypocapnia and hypercapnia within 24 hours after CABG was associated independently with increased risk of 30-day mortality and delayed extubation. Exposure to either hypocapnia or hypercapnia alone was not associated with patient outcome.","PeriodicalId":22104,"journal":{"name":"Survey of Anesthesiology","volume":"37 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2017-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75507161","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-02-01DOI: 10.1097/01.sa.0000513238.17281.55
S. Grape, K. Kirkham, M. Baeriswyl, E. Albrecht
{"title":"The Analgesic Efficacy of Sciatic Nerve Block in Addition to Femoral Nerve Block in Patients Undergoing Total Knee Arthroplasty: A Systematic Review and Meta-analysis","authors":"S. Grape, K. Kirkham, M. Baeriswyl, E. Albrecht","doi":"10.1097/01.sa.0000513238.17281.55","DOIUrl":"https://doi.org/10.1097/01.sa.0000513238.17281.55","url":null,"abstract":"","PeriodicalId":22104,"journal":{"name":"Survey of Anesthesiology","volume":"36 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2017-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73046343","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-02-01DOI: 10.1097/SA.0000000000000291
E. Fominskiy, V. A. Nepomniashchikh, V. Lomivorotov, F. Monaco, Chiara Vitiello, A. Zangrillo, G. Landoni
B leeding is a common and prominent complication during and after surgery. Excessive blood loss is associated with prolonged length of intensive care and mechanical ventilation, increased morbidity and mortality, and higher overall health care costs. Blood product transfusions are used for the management of bleeding and coagulopathy, but the use of allogeneic red blood cells (RBCs) and fresh frozen plasma can lead to adverse outcomes after surgery. Treating coagulopathic bleeding using fibrinogen concentrate (FC) could reduce the use of allogeneic blood product transfusion as fibrinogen contributes to the achievement and maintenance of hemostasis. A meta-analysis of randomized controlled studies (RCTs) comparing fibrinogen supplementation with placebo or other hemostatic treatments (fresh frozen plasma, platelets, cryoprecipitate, and coagulation factor concentrates) in the perioperative setting was carried out to investigate the effects
{"title":"Efficacy and Safety of Fibrinogen Concentrate in Surgical Patients: A Meta-analysis of Randomized Controlled Trials","authors":"E. Fominskiy, V. A. Nepomniashchikh, V. Lomivorotov, F. Monaco, Chiara Vitiello, A. Zangrillo, G. Landoni","doi":"10.1097/SA.0000000000000291","DOIUrl":"https://doi.org/10.1097/SA.0000000000000291","url":null,"abstract":"B leeding is a common and prominent complication during and after surgery. Excessive blood loss is associated with prolonged length of intensive care and mechanical ventilation, increased morbidity and mortality, and higher overall health care costs. Blood product transfusions are used for the management of bleeding and coagulopathy, but the use of allogeneic red blood cells (RBCs) and fresh frozen plasma can lead to adverse outcomes after surgery. Treating coagulopathic bleeding using fibrinogen concentrate (FC) could reduce the use of allogeneic blood product transfusion as fibrinogen contributes to the achievement and maintenance of hemostasis. A meta-analysis of randomized controlled studies (RCTs) comparing fibrinogen supplementation with placebo or other hemostatic treatments (fresh frozen plasma, platelets, cryoprecipitate, and coagulation factor concentrates) in the perioperative setting was carried out to investigate the effects","PeriodicalId":22104,"journal":{"name":"Survey of Anesthesiology","volume":"91 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2017-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82210312","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-02-01DOI: 10.1097/SA.0000000000000289
S. Kulhari, N. Bharti, I. Bala, S. Arora, Gurpreet Singh
{"title":"Efficacy of Pectoral Nerve Block Versus Thoracic Paravertebral Block for Postoperative Analgesia After Radical Mastectomy: A Randomized Controlled Trial","authors":"S. Kulhari, N. Bharti, I. Bala, S. Arora, Gurpreet Singh","doi":"10.1097/SA.0000000000000289","DOIUrl":"https://doi.org/10.1097/SA.0000000000000289","url":null,"abstract":"","PeriodicalId":22104,"journal":{"name":"Survey of Anesthesiology","volume":"84 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2017-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89005353","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-02-01DOI: 10.1097/SA.0000000000000288
V. Pavoni, L. Gianesello, C. Martinelli, Andrew Horton, A. Nella, G. Gori, Martina Simonelli, G. Scisciolo
Tracheal intubation during routine and rapid-sequence intubation is facilitated by rocuronium, which is a nondepolarizing aminosteroid neuromuscular block (NMB) agent, higher doses of which (1.2 mg/kg) typically produces a complete neuromuscular blockade in less than 2 minutes that is long acting. Recovery from NMB and restoration of full control of pharyngeal and laryngeal muscles are important in airway maintenance and protection in surgical patients. Neuromuscular block can be accurately monitored using acceleromyography. Sugammadex, the first of a new class of selective muscle relaxant–binding drugs, is used to rapidly and effectively reverse NMB induced by aminosteroid neuromuscular-blocking drugs. Studies have looked at NMB reversal on various muscles, none of which correlate exactly with recovery of laryngeal muscles. An observational study was carried out to evaluate the efficacy of sugammadex in reversing rocuronium-induced NMB of laryngeal muscle function using neurophysiologic monitoring. Another aim of this study was to establish the time of recovery after 16 mg/kg of sugammadex using motor-evoked potentials (MEPs) compared with acceleromyography. All statistical tests were 2-sided with a significance level of 0.05, and the results were presented as the mean (continuous variables) ± SD or percentage (categorical variables). The test results showed that myogenicMEPs responses were absent, and neuromuscular monitoring showed a deep block in all patients (train-of-4 ratio of 0, posttetanic count of 1–2) at the time of sugammadex administration. It was also observed that the time to complete recovery of the basal myogenic MEPs amplitudes was 70 ± 18.2 at the laryngeal adductor muscles and 135 ± 14.1 seconds at the abductor digiti minimi. The value of the corresponding train-of-4 ratio was 0.7 ± 0.1. Incomplete neuromuscular recovery can cause respiratory impairment and hypoxemia in patients; hence, complete recovery of neuromuscular transmission at the laryngeal muscles is paramount for airway protection. This neurophysiologic study confirmed that administering 16 mg/kg sugammadex caused complete and effective recovery of laryngeal nerve function from rocuroniuminduced NMB. No adverse effects due to transcutaneous stimulation (such as cardiac arrhythmias and skin irritation) of the laryngeal nerve were observed, and no adverse effects due to sugammadex were noted.
{"title":"Recovery of Laryngeal Nerve Function With Sugammadex After Rocuronium-Induced Profound Neuromuscular Block","authors":"V. Pavoni, L. Gianesello, C. Martinelli, Andrew Horton, A. Nella, G. Gori, Martina Simonelli, G. Scisciolo","doi":"10.1097/SA.0000000000000288","DOIUrl":"https://doi.org/10.1097/SA.0000000000000288","url":null,"abstract":"Tracheal intubation during routine and rapid-sequence intubation is facilitated by rocuronium, which is a nondepolarizing aminosteroid neuromuscular block (NMB) agent, higher doses of which (1.2 mg/kg) typically produces a complete neuromuscular blockade in less than 2 minutes that is long acting. Recovery from NMB and restoration of full control of pharyngeal and laryngeal muscles are important in airway maintenance and protection in surgical patients. Neuromuscular block can be accurately monitored using acceleromyography. Sugammadex, the first of a new class of selective muscle relaxant–binding drugs, is used to rapidly and effectively reverse NMB induced by aminosteroid neuromuscular-blocking drugs. Studies have looked at NMB reversal on various muscles, none of which correlate exactly with recovery of laryngeal muscles. An observational study was carried out to evaluate the efficacy of sugammadex in reversing rocuronium-induced NMB of laryngeal muscle function using neurophysiologic monitoring. Another aim of this study was to establish the time of recovery after 16 mg/kg of sugammadex using motor-evoked potentials (MEPs) compared with acceleromyography. All statistical tests were 2-sided with a significance level of 0.05, and the results were presented as the mean (continuous variables) ± SD or percentage (categorical variables). The test results showed that myogenicMEPs responses were absent, and neuromuscular monitoring showed a deep block in all patients (train-of-4 ratio of 0, posttetanic count of 1–2) at the time of sugammadex administration. It was also observed that the time to complete recovery of the basal myogenic MEPs amplitudes was 70 ± 18.2 at the laryngeal adductor muscles and 135 ± 14.1 seconds at the abductor digiti minimi. The value of the corresponding train-of-4 ratio was 0.7 ± 0.1. Incomplete neuromuscular recovery can cause respiratory impairment and hypoxemia in patients; hence, complete recovery of neuromuscular transmission at the laryngeal muscles is paramount for airway protection. This neurophysiologic study confirmed that administering 16 mg/kg sugammadex caused complete and effective recovery of laryngeal nerve function from rocuroniuminduced NMB. No adverse effects due to transcutaneous stimulation (such as cardiac arrhythmias and skin irritation) of the laryngeal nerve were observed, and no adverse effects due to sugammadex were noted.","PeriodicalId":22104,"journal":{"name":"Survey of Anesthesiology","volume":"5 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2017-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75330414","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-02-01DOI: 10.1097/SA.0000000000000286
Eun-Hee Kim, H. Shim, W. Kim, Sue-young Lee, Sun-Kyung Park, Ji-Hyuk Yang, T. Jun, C. Kim
{"title":"Predictive Value of Intraoperative Thromboelastometry for the Risk of Perioperative Excessive Blood Loss in Infants and Children Undergoing Congenital Cardiac Surgery: A Retrospective Analysis","authors":"Eun-Hee Kim, H. Shim, W. Kim, Sue-young Lee, Sun-Kyung Park, Ji-Hyuk Yang, T. Jun, C. Kim","doi":"10.1097/SA.0000000000000286","DOIUrl":"https://doi.org/10.1097/SA.0000000000000286","url":null,"abstract":"","PeriodicalId":22104,"journal":{"name":"Survey of Anesthesiology","volume":"30 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2017-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83638251","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-01-01DOI: 10.1097/SA.0000000000000330
S. Rijkenberg, W. Stilma, R. Bosman, N. Meer, P. H. Voort
Postsurgical pain is common in critically ill patients, such as cardiac surgery patients, and can have a negative effect on recovery. The experience of severe pain during intensive care unit (ICU) stays has been linked to the development of posttraumatic stress disorder–related symptoms. In response, pain monitoring practices using validated scales are used in ICU patients. Because these patients are often in a nonverbal state, scales such as the Behavioral Pain Scale (BPS) and Critical-Care Pain Observation Tool (CPOT) are often implemented. This prospective observational cohort study aimed to compare the interrater reliability, internal consistency, and discriminant validation of the BPS and the CPOT in mechanically ventilated patients who were unable to self-report pain after cardiac surgery. The study was set in a 20-bed, closed-format ICU
{"title":"Pain Measurement in Mechanically Ventilated Patients After Cardiac Surgery: Comparison of the Behavioral Pain Scale (BPS) and the Critical-Care Pain Observation Tool (CPOT)","authors":"S. Rijkenberg, W. Stilma, R. Bosman, N. Meer, P. H. Voort","doi":"10.1097/SA.0000000000000330","DOIUrl":"https://doi.org/10.1097/SA.0000000000000330","url":null,"abstract":"Postsurgical pain is common in critically ill patients, such as cardiac surgery patients, and can have a negative effect on recovery. The experience of severe pain during intensive care unit (ICU) stays has been linked to the development of posttraumatic stress disorder–related symptoms. In response, pain monitoring practices using validated scales are used in ICU patients. Because these patients are often in a nonverbal state, scales such as the Behavioral Pain Scale (BPS) and Critical-Care Pain Observation Tool (CPOT) are often implemented. This prospective observational cohort study aimed to compare the interrater reliability, internal consistency, and discriminant validation of the BPS and the CPOT in mechanically ventilated patients who were unable to self-report pain after cardiac surgery. The study was set in a 20-bed, closed-format ICU","PeriodicalId":22104,"journal":{"name":"Survey of Anesthesiology","volume":"107 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86253523","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-01-01DOI: 10.1097/SA.0000000000000331
George W. Williams, B. Shankar, E. M. Klier, A. Chuang, S. E. Marjiya-Villarreal, Omonele O Nwokolo, Aanchal Sharma, A. Sereno
Physicians and medical residents working overnight shifts suffer from sleep deprivation, cognitive dysfunction, and decreased sensorimotor performance due to disturbances in circadian rhythms. This can lead to medical errors and work-related injuries and accidents. This observational study used Stanford Sleepiness Scale (SSS) and 2 novel touch-based tablet applications (ProPoint andAntiPoint tasks) to determine whether cognitive and sensorimotor performances slowed in residents following overnight call compared with routine daytime shift. The effects of stress, rest, and caffeine consumption on these measures were also evaluated. The study data were composed of 30 anesthesiology residents in the daytime shifts (Routine) and 30 residents in the overnight shift (Call) at The University of Texas Health Science Center at Houston. The participating residents were asked to perform the
{"title":"Sensorimotor and Executive Function Slowing in Anesthesiology Residents After Overnight Shifts","authors":"George W. Williams, B. Shankar, E. M. Klier, A. Chuang, S. E. Marjiya-Villarreal, Omonele O Nwokolo, Aanchal Sharma, A. Sereno","doi":"10.1097/SA.0000000000000331","DOIUrl":"https://doi.org/10.1097/SA.0000000000000331","url":null,"abstract":"Physicians and medical residents working overnight shifts suffer from sleep deprivation, cognitive dysfunction, and decreased sensorimotor performance due to disturbances in circadian rhythms. This can lead to medical errors and work-related injuries and accidents. This observational study used Stanford Sleepiness Scale (SSS) and 2 novel touch-based tablet applications (ProPoint andAntiPoint tasks) to determine whether cognitive and sensorimotor performances slowed in residents following overnight call compared with routine daytime shift. The effects of stress, rest, and caffeine consumption on these measures were also evaluated. The study data were composed of 30 anesthesiology residents in the daytime shifts (Routine) and 30 residents in the overnight shift (Call) at The University of Texas Health Science Center at Houston. The participating residents were asked to perform the","PeriodicalId":22104,"journal":{"name":"Survey of Anesthesiology","volume":"69 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86097540","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-01-01DOI: 10.1097/01.sa.0000527509.33364.fd
E. OʼBrien, Beverly Newhouse, B. Cronin, K. Robbins, A. Nguyen, S. Khoche, Ulrich H. Schmidt
Manual hand ventilation and portable machine ventilation are both widely used during in-hospital transport of intubated patients following surgery, but the comparative safety and reliability of each mode of ventilation are still unclear. This prospective randomized study aimed at examining the hemodynamic consequences of manual and portable ventilation during transport from the operating room (OR) to the intensive care unit (ICU) in intubated patients following cardiac surgery. The study also hypothesized that manual ventilation after cardiac surgery would result in greater changes in measured end-tidal carbon dioxide (ETCO2) and pulmonary artery (PA) pressure when compared to machine ventilation. The study data were composed of 36 cardiac surgery patients with planned intubation during transport to the ICU. Following surgery, the patients were randomized into 2 cohorts to receive either manual ventilation (with a self-inflating bag-valve resuscitator) or machine ventilation (attached to a portable transport ventilator) during in-hospital transport. Hand ventilation was done by the anesthesiologist who provided care during surgery, and machine ventilation was set by a respiratory therapist to match parameters in the OR at the end of the case. Hemodynamic variables, ETCO2, and PA pressures before and during transport and upon arrival in the ICU were recorded. A 2-sided, unpaired t test was used to determine differences between values, and a threshold P < 0.05 was considered statistically significant. The 3 study outcomes measured were the difference from baseline ETCO2, hemodynamic changes from baseline, and changes in PA pressure before and after transport. There was no difference in transport time between hand-ventilated (mean, 5 ± 1.41 minutes) and machine-ventilated (mean, 5.47 ± 1.74 minutes) patients (P = 0.369). The transport ETCO2 excursion was significantly different between hand-ventilated (5.44) and machineventilated patients (2.32, P = 0.0126), but the total ETCO2 excursion was not significant (P = 0.066). These differences were not associated with a difference inmean PA pressure. No differences were found in mean arterial pressure, heart rate, or SpO2 (ICU vs OR). In conclusion, manual ventilation was associated with greater changes from baseline ETCO2 than machine ventilation during transport after cardiac surgery, but these differences were not associated with changes in mean PA pressure, vital signs, oxygen saturation, or heart rhythm upon arrival at ICU. The results do not support routine use of a transport ventilator in patients transported after cardiac surgery.
{"title":"Hemodynamic Consequence of Hand Ventilation Versus Machine Ventilation During Transport After Cardiac Surgery","authors":"E. OʼBrien, Beverly Newhouse, B. Cronin, K. Robbins, A. Nguyen, S. Khoche, Ulrich H. Schmidt","doi":"10.1097/01.sa.0000527509.33364.fd","DOIUrl":"https://doi.org/10.1097/01.sa.0000527509.33364.fd","url":null,"abstract":"Manual hand ventilation and portable machine ventilation are both widely used during in-hospital transport of intubated patients following surgery, but the comparative safety and reliability of each mode of ventilation are still unclear. This prospective randomized study aimed at examining the hemodynamic consequences of manual and portable ventilation during transport from the operating room (OR) to the intensive care unit (ICU) in intubated patients following cardiac surgery. The study also hypothesized that manual ventilation after cardiac surgery would result in greater changes in measured end-tidal carbon dioxide (ETCO2) and pulmonary artery (PA) pressure when compared to machine ventilation. The study data were composed of 36 cardiac surgery patients with planned intubation during transport to the ICU. Following surgery, the patients were randomized into 2 cohorts to receive either manual ventilation (with a self-inflating bag-valve resuscitator) or machine ventilation (attached to a portable transport ventilator) during in-hospital transport. Hand ventilation was done by the anesthesiologist who provided care during surgery, and machine ventilation was set by a respiratory therapist to match parameters in the OR at the end of the case. Hemodynamic variables, ETCO2, and PA pressures before and during transport and upon arrival in the ICU were recorded. A 2-sided, unpaired t test was used to determine differences between values, and a threshold P < 0.05 was considered statistically significant. The 3 study outcomes measured were the difference from baseline ETCO2, hemodynamic changes from baseline, and changes in PA pressure before and after transport. There was no difference in transport time between hand-ventilated (mean, 5 ± 1.41 minutes) and machine-ventilated (mean, 5.47 ± 1.74 minutes) patients (P = 0.369). The transport ETCO2 excursion was significantly different between hand-ventilated (5.44) and machineventilated patients (2.32, P = 0.0126), but the total ETCO2 excursion was not significant (P = 0.066). These differences were not associated with a difference inmean PA pressure. No differences were found in mean arterial pressure, heart rate, or SpO2 (ICU vs OR). In conclusion, manual ventilation was associated with greater changes from baseline ETCO2 than machine ventilation during transport after cardiac surgery, but these differences were not associated with changes in mean PA pressure, vital signs, oxygen saturation, or heart rhythm upon arrival at ICU. The results do not support routine use of a transport ventilator in patients transported after cardiac surgery.","PeriodicalId":22104,"journal":{"name":"Survey of Anesthesiology","volume":"28 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80007527","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-01-01DOI: 10.1097/SA.0000000000000328
C. Labriola, D. Paparella, G. Labriola, Pierpaolo Dambruoso, M. Cassese, G. Speziale
A lthough percutaneous pulmonary vent and coronary sinus (CS) cardioplegia have been identified as a fundamental skill to provide a safe surgical environment for patients undergoing minimally invasive cardiac surgery for aortic valve replacement (MIAVR), data on the feasibility and results of these have not yet been reported. The aim of this retrospective analysis was to evaluate the reliability and efficacy of ProPlege and EndoVent catheters, commonly referred to as “necklines,” for intraoperative CS cardioplegia and pulmonary artery venting in the setting of MIAVR. The study evaluated the records of 51patients who underwent MIAVR either through upper hemisternotomy or right anterior thoracotomy. The ProPlege device was placed into the CS under transesophageal echocardiography and pressure guidance, and the EndoVent device was placed using pressure-curve monitoring by the anesthesiologist prior to the surgical procedure. Minimally invasive cardiac surgery for aortic valve replacement was performed through a J-shaped upper hemisternotomy in 38 patients and a right anterior thoracotomy in 13 patients. Line performance, time needed for placement, rate of successful placement, and major perioperative complications were recorded and reviewed. Necklines were placed successfully in all patients, and the mean time for the placement was 14 ± 9 minutes for ProPlege and 9 ± 4 minutes for EndoVent. A total of 110 doses of retrograde cardioplegiawere delivered through the ProPlege device at a mean flow rate of 173±35mL/min and amean pressure of 41±6mmHg. Venting of the heart by the pulmonary catheter grading was “excellent” in 33 patients, “sufficient” in 12 patients, and “not adequate” in 2 patients. Thesewere surgeon-reported scores based on satisfaction in the degree of freedom from blood in the field. Results showed no deaths or complications, including perioperative myocardial infarction, postoperative re-exploration for bleeding, stroke, kidney failure, or low-output syndrome. In conclusion, ProPlege devices and EndoVent catheters were found to be reliable and ensured effective CS cardioplegia and pulmonary artery venting in the setting of MIAVR. The necklines provided adequate myocardial protection, acceptable grade of venting of the heart, and unobstructed vision and access during MIAVR procedures. Further research is required to demonstrate the advantages of necklines over conventional techniques.
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