Search

Objective: Postoperative pulmonary complications (PPC) remain a main issue after cardiac surgery. The objective was to report the incidence and identify risk factors of PPC after cardiac surgery., Design: An international multicenter prospective study (42 international centers in 9 countries)., Participants: A total of 707 adult patients who underwent cardiac surgery under cardiopulmonary bypass., Interventions: None MEASUREMENTS AND MAIN RESULTS: During a study period of 2 weeks, the investigators included all patients in their respective centers and screened for PPCs. PPC was defined as the occurrence of at least 1 pulmonary complication among the following: atelectasis, pleural effusion, respiratory failure, respiratory infection, pneumothorax, bronchospasm, or aspiration pneumonitis. Among 676 analyzed patients, 373 patients presented with a PPC (55%). The presence of PPC was significantly associated with a longer intensive care length of stay and hospital length of stay. One hundred ninety (64%) patients were not intraoperatively ventilated during cardiopulmonary bypass. Ventilation settings were similar regarding tidal volume, respiratory rate, inspired oxygen. In the regression model, age, the Euroscore II, chronic obstructive pulmonary disease, preoxygenation modality, intraoperative positive end-expiratory pressure, the absence of pre- cardiopulmonary bypass ventilation, the absence of lung recruitment, and the neuromuscular blockade were associated with PPC occurrence., Conclusion: Both individual risk factors and ventilatory settings were shown to explain the high level of PPCs. These findings require further investigations to assess a bundle strategy for optimal ventilation strategy to decrease PPC incidence., Competing Interests: Conflict of Interest None., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Objective: To assess the effect of systemic vascular resistance (SVR) on the reliability of the ClearSight system (Edwards Lifesciences, Irvine, CA) for measuring blood pressure (BP) and cardiac output (CO)., Design: Observational study., Setting: University hospital., Participants: Twenty-five patients undergoing cardiac surgery., Interventions: None., Measurements and Main Results: BP, measured using ClearSight and an arterial line, and CO, measured using ClearSight and a pulmonary artery catheter, were recorded before (T1) and two minutes after phenylephrine or ephedrine administration. Bland-Altman analysis was used to compare BP and CO measurements at T1. A polar plot was used to assess trending abilities. Patients were divided into the following three groups according to the SVR index (SVRI) at T1: low (<1,200 dyne s/cm 5 /m 2 ), normal (1,200-25,00 dyne s/cm 5 /m 2 ), and high (>2,500 dyne s/cm 5 /m 2 ). The bias in BP and CO was -4.8 ± 8.9 mmHg and 0.10 ± 0.81 L/min, respectively, which was correlated significantly with SVRI (p < 0.05). The percentage error in CO was 40.6%, which was lower in the normal SVRI group (33.3%) than the low and high groups (46.3% and 47.7%, respectively). The angular concordance rate was 96.3% and 95.4% for BP and 87.0% and 92.5% for CO after phenylephrine and ephedrine administration, respectively. There was a low tracking ability for CO changes after phenylephrine administration in the low-SVRI group (angular concordance rate 33.3%)., Conclusion: The ClearSight system showed an acceptable accuracy in measuring BP and tracking BP changes in various SVR states; however, the accuracy of CO measurement and its trending ability in various SVR states was poor., Competing Interests: Conflict of Interest Koichi Suehiro has received speaker fees from Edwards Lifesciences., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Objectives: To assess whether a tissue Doppler imaging (TDI)-based parameter consisting of the sum of early diastolic velocities of the mitral annulus (Me') and tricuspid annulus (Te') can serve as a predictor of adverse outcomes after cardiac surgery., Design: Prospective, observational study., Setting: University hospital., Participants: The study comprised 100 patients undergoing cardiac surgery., Interventions: None., Measurements and Main Results: After anesthetic induction, transesophageal echocardiography was performed to obtain the values of the early transmitral flow velocity (E), Me', and Te'. The primary endpoint was the incidence of postoperative major organ morbidity and mortality (MOMM) events, including death, redo surgery, prolonged ventilation, stroke, sternal infection, and dialysis. Receiver operating characteristic and multivariate logistic analyses were used to examine the prognostic performance of TDI-based parameters for predicting MOMM incidence. The secondary endpoint was the incidence of death or rehospitalization for cardiovascular disease within 1 year post-discharge. TDI-based parameters were measured in 87 of the 100 patients enrolled. Me' plus Te' had better prognostic ability (area under the curve 0.771; threshold 13 cm/s; sensitivity 86.7%; specificity 64.9%) than that of Me' or E to Me' (E/Me')% and was an independent predictor of MOMM (odds ratio 0.45; 95% confidence interval 0.28-0.74, p = 0.001), whereas Me' was not. Lower Me' plus Te' (≤13 cm/s) was associated with a significantly higher incidence and earlier onset of cardiovascular events within 1 year post-discharge (p = 0.012)., Conclusions: Compared with Me' and E/Me', which traditionally are used for assessing diastolic function, Me' plus Te' showed better prognostic ability for both short- and long-term outcomes of cardiac surgery., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Objectives: The aims of this study were to compare cardiac output (CO) measured by the new fourth-generation FloTrac™/Vigileo™ system (Version 4.00) (COFVS) with that measured by a pulmonary artery catheter (COREF), and to investigate the ability of COFVS to track CO changes induced by increased peripheral resistance., Design: Prospective study., Setting: University Hospital., Participants: Twenty-three patients undergoing cardiac surgery., Interventions: Phenylephrine (100 µg) was administered., Measurements and Main Results: Hemodynamic variables, including CO(REF) and CO(FVS), were measured before and after phenylephrine administration. Bland-Altman analysis was used to assess the discrepancy between CO(REF) and CO(FVS). Four-quadrant plot and polar-plot analyses were utilized to evaluate the trending ability of CO(FVS) against CO(REF) after phenylephrine boluses. One hundred thirty-six hemodynamic interventions were performed. The bias shown by the Bland-Altman analysis was-0.66 L/min, and the percentage error was 55.4%. The bias was significantly correlated with the systemic vascular resistance index (SVRI) before phenylephrine administration (p<0.001, r(2) = 0.420). The concordance rate determined by four-quadrant plot analysis and the angular concordance rate calculated using polar-plot analysis were 87.0% and 83.0%, respectively. Additionally, this trending ability was not affected by SVRI state., Conclusions: The trending ability of the new fourth-generation FloTrac™/Vigileo™ system after increased vasomotor tone was greatly improved compared with previous versions; however, the discrepancy of the new system in CO measurement was not clinically acceptable, as in previous versions. For clinical application in critically ill patients, this vasomotor tone-dependent disagreement must be decreased., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Objective: To investigate the correlation between intraoperative body temperature and postoperative adverse effects in patients who underwent esophagectomy procedures., Design: Retrospective cohort study., Setting: University Hospital., Participants: One hundred twenty-one patients undergoing esophagectomy were enrolled., Interventions: None., Measurements and Main Results: Various perioperative and intraoperative variables were recorded. Hypothermia was defined as a urinary bladder temperature<35°C. Multiple logistic regression analysis was conducted to identify independent significant predictors of postoperative complications. In addition, the authors also determined a cutoff point for intraoperative minimum urinary bladder temperature by analyzing receiver operating characteristic (ROC) curves for occurrence of adverse events at 1 month after surgery. No patients died within 1 month after the surgery. There were 53 patients with early postoperative complications, and 51 had experienced intraoperative hypothermia. Factors that were correlated significantly with complications included age (p=0.02); hypothermia (p<0.01); and doses of ephedrine (p<0.01), phenylephrine (p<0.01), and fentanyl (p<0.01). Multiple logistic regression analysis identified intraoperative hypothermia as a significant independent predictor for the development of early perioperative complications (odds ratio 2.57; 95% confidence interval 1.09-6.08). The area under the ROC curve for body temperature was 0.71, and the cutoff point was 35°C (sensitivity=0.65, specificity=0.72)., Conclusions: Intraoperative hypothermia was identified as an independent risk factor for early postoperative adverse events following esophagectomy., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Objective: To determine if increases in discrepancy between ScvO2 and SvO2 (ScvO2 - SvO2 = ΔSO2) during surgery in cardiac surgery patients can predict postoperative complications., Design: Prospective, observational study., Setting: University hospital., Participants: One hundred two patients undergoing cardiac surgery were enrolled., Interventions: None., Measurements and Main Results: Central venous oxygen saturation (ScvO2) and mixed venous oxygen saturation (SvO2) values during surgery automatically were collected. The average value of ΔSO2 for every minute was calculated. The area under the receiver operating characteristic curve for prolonged postoperative ICU stay (≥3 days) was 0.745 for ΔSO2, which was significantly different from those of ScvO2 and SvO2 (p<0.05) (ScvO2; 0.584, SvO2; 0.598). The optimal threshold value of ΔSO2 to predict prolonged ICU stay (≥3 days) was 12% (sensitivity: 72.0%, specificity: 76.9%). Postoperative ICU duration, ventilation time, and hospital stay were significantly longer in Group D patients (intraoperative maximum ΔSO2 ≥12%) than those in Group N patients (intraoperative maximum ΔSO2<12%). As for postoperative complications, the number of patients with postoperative use of intra-aortic balloon pumping, delirium, respiratory failure requiring tracheotomy, and severe complications was significantly higher in Group D patients. Multivariate logistic regression models were used to evaluate the independent effects of perioperative variables on the risk of developing prolonged ventilation (>24 hours) and prolonged ICU stay (≥3 days). A discrepancy in intraoperative ΔSO2 was an independent risk factor for prolonged postoperative ventilation and ICU stay., Conclusion: The discrepancy between ScvO2 and SvO2 during cardiac surgery is an independent risk factor of postoperative complications such as prolonged ICU stay and ventilation time., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Objectives: Ejection fraction (EF) is considered an unreliable index in patients with mitral regurgitation (MR). Left ventricular dysfunction (LVD) frequently occurs after mitral valve repair (MVR), with the incidence being 15% to 34%. This study aimed at investigating whether preoperative early diastolic mitral annular velocity (E') is associated with LVD after MVR., Design: Retrospective study., Setting: University hospital., Participants: Sixty-three patients undergoing MVR for severe MR., Interventions: None., Measurements and Main Results: LVD was defined by a postoperative EF of<50%. Receiver operating characteristic (ROC) analysis and separate multivariate logistic regression models were used to examine the independent effects of echocardiographic variables on LVD risk. LVD occurred in 20 patients (31.7%). E' was correlated significantly with perioperative EF change (p = 0.019, r = 0.293). The area under the ROC curve was 0.777 (95% confidence interval [CI]: 0.644-0.911) for E', and the optimal threshold value of E' for predicting LVD was 6.5 cm/s (sensitivity, 80%; specificity, 67.4%). The frequency of LVD was 33.3% for a preoperative EF< 65%; 44.4% for preoperative EF< 65% and left ventricular end-systolic diameter>32 mm; and 88.9% for preoperative EF< 65%, left ventricular end-systolic diameter>32 mm, and E'< 6.5 cm/s (p = 0.006). Multivariate logistic regression models analysis revealed that E' was an independent risk factor for LVD (odds ratio: 1.98, 95% CI: 1.22-3.22)., Conclusions: Preoperative E' value was an independent risk factor of LVD after mitral valve repair in patients with severe MR., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Objectives: To evaluate the percent change of cerebral oxygen saturation (SctO(2)) during single-lung ventilation (SLV) and its correlation with preoperative respiratory functions., Design: A prospective, observational study., Setting: Clinical hospital., Participants: Forty patients scheduled for pulmonary lobectomy requiring one-lung ventilation for at least 1 hour under combined epidural/general anesthesia., Interventions: None., Measurements and Main Results: SctO(2) was measured using an INVOS 5100 (Somanetics Corp, Troy, MI) before anesthesia (baseline value) and until SLV was completed. In addition, arterial blood gases (ABGs) were measured every 30 minutes. The minimum SctO(2) value during SLV was recorded and percent change from baseline calculated. The correlations with preoperative respiratory function (percent volume capacity [%VC], and percent forced expiratory volume in 1 second [FEV(1)]) and preoperative ABG levels (PaO(2) and PaCO(2)) were examined using the Pearson correlation coefficient. The level of statistical significance was set at p < 0.05. In 28 patients (70%), the minimum SctO(2) during SLV was lower than the baseline value (baseline SctO(2), 69.0% ± 9.12%; range, 53%-80%; median = 71%; minimum SctO(2), 66.6% ± 10.5%; range, 46%-89%; median, 67.5%). The percent change from baseline SctO(2) was -4.68% ± 13.5% (-21% to 32%; median, 3.5%) and was significantly negatively correlated with preoperative respiratory function (FEV(1): r = -0.482, p < 0.05; VC: r = -0.518, p < 0.05) and preoperative arterial blood PaO(2) (r = -0.351, p < 0.05)., Conclusions: Greater decreases were found in SctO(2) during SLV in patients with better preoperative respiratory function. These findings suggest that intraoperative monitoring during SLV should include not only measurement of SpO(2) and PaO(2) but also SctO(2)., (Copyright © 2011 Elsevier Inc. All rights reserved.)

Objectives: To investigate the ability of stroke volume variation (SVV) calculated by the Vigileo-FloTrac system (Edwards Lifescience, Irvine, CA) to predict fluid responsiveness in patients undergoing one-lung ventilation (OLV)., Design: Prospective, observational study., Setting: Clinical hospital., Participants: Thirty patients scheduled for a pulmonary lobectomy requiring OLV for at least 1 hour under combined epidural/general anesthesia., Interventions: After starting OLV, hydroxyethyl starch, 500 mL, was administered for 30 minutes., Measurements and Main Results: Hemodynamic variables including heart rate, mean arterial pressure, cardiac index, stroke volume index (SVI), and SVV were measured before and after volume loading. SVV before volume loading was significantly correlated with the absolute changes in SVV (ΔSVV) and percentage changes in stroke volume index (ΔSVI) after volume loading (ΔSVV: p < 0.05, r = -0.893; ΔSVI: p < 0.05, r = 0.866). Of the 30 patients, 15 (50%) were responders to intravascular volume expansion (an increase in SVI ≥ 25%), and 15 (50%) were nonresponders (an increase in SVI <25%). The area under the ROC curve was 0.900 for SVV (95% confidence interval, 0.809-0.991), whereas the optimal threshold value of SVV to discriminate between responders and nonresponders was 10.5% (sensitivity: 82.4%, specificity: 92.3%)., Conclusions: The authors found that SVV measured by the Vigileo-FloTrac system was able to predict fluid responsiveness in patients undergoing surgery with OLV with acceptable levels of sensitivity and specificity., (Copyright © 2010 Elsevier Inc. All rights reserved.)