scholarly journals Prognostic Value of GDF-15 in Predicting Prolonged Intensive Care Stay following Cardiac Surgery: A Pilot Study

2021 ◽  
Vol 2021 ◽  
pp. 1-10
Author(s):  
Henry Barton ◽  
Elisabeth Zechendorf ◽  
Dirk Ostareck ◽  
Antje Ostareck-Lederer ◽  
Christian Stoppe ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Intensive Care ◽  
Cardiopulmonary Bypass ◽  
Confidence Interval ◽  
Prediction Models ◽  
Unit Length ◽  
Cardiopulmonary Bypass Time ◽  
Icu Stay ◽  
Intensive Care Stay ◽  
Prolonged Icu Stay

Introduction. Predicting intensive care unit length of stay and outcome following cardiac surgery is currently based on clinical parameters. Novel biomarkers could be employed to improve the prediction models. Materials and Methods. We performed a qualitative cytokine screening array to identify highly expressed biomarkers in preoperative blood samples of cardiac surgery patients. After identification of one highly expressed biomarker, growth differentiation factor 15 (GDF-15), a quantitative ELISA was undertaken. Preoperative levels of GDF-15 were compared in regard to duration of intensive care stay, cardiopulmonary bypass time, and indicators of organ dysfunction. Results. Preoperatively, GDF-15 was highly expressed in addition to several less highly expressed other biomarkers. After qualitative analysis, we could show that preoperatively raised levels of GDF-15 were positively associated with prolonged ICU stay exceeding 48 h (median 713 versus 1041 pg/ml, p = 0.003 ). It was also associated with prolonged mechanical ventilation and rates of severe sepsis but not with dialysis rates or cardiopulmonary bypass time. In univariate regression, raised GDF-15 levels were predictive of a prolonged ICU stay (OR 1.01, 95% confidence interval 1–1.02, and p = 0.029 ). On ROC curves, GDF-15 was found to predict prolonged ICU stay ( AUC = 0.86 , 95% confidence interval 0.71–0.99, and p = 0.003 ). Conclusion. GDF-15 showed potential as predictor of prolonged intensive care stay following cardiac surgery, which might be valuable for risk stratification models.

Prognostic Value of GDF-15 in Predicting Prolonged Intensive Care Stay following Cardiac Surgery: A Retrospective Case-Control Study

2021 ◽  
Author(s):  
Henry Barton ◽  
Elisabeth Zechendorf ◽  
Dirk Ostareck ◽  
Antje Ostareck-Lederer ◽  
Christian Stoppe ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Intensive Care ◽  
Confidence Interval ◽  
Prediction Models ◽  
Unit Length ◽  
Icu Stay ◽  
Intensive Care Stay ◽  
Cardio Pulmonary Bypass ◽  
Prolonged Icu Stay ◽  
Pulmonary Bypass

Abstract Background: Predicting intensive care unit length of stay and outcome following cardiac surgery is currently based on clinical parameters. Novel biomarkers could be employed to improve the prediction models. Methods: We performed a qualitative cytokine screening array to identify highly expressed biomarkers in preoperative blood samples of cardiac surgery patients. After identification of one highly expressed biomarker, growth differentiation factor 15 (GDF-15), a quantitative ELISA was undertaken. Preoperative levels of GDF-15 were compared in regard to duration of intensive care stay, cardio-pulmonary bypass time and indicators of organ dysfunction.Results: Preoperatively, GDF-15 was highly expressed in addition to several less highly expressed other biomarkers. After qualitative analysis we could show that preoperatively raised levels of GDF-15 was positively associated with prolonged ICU stay exceeding 48 h (median 713 versus 1041 pg/ml, p = 0.003). It was also associated with prolonged mechanical ventilation and rates of severe sepsis but not with dialysis rates or cardio-pulmonary bypass time. In univariate regression, raised GDF-15 levels were predictive of a prolonged ICU stay (OR 1.01, 95% Confidence Interval 1 – 1.02, p= 0.029). On ROC curves, GDF-15 was found to predict prolonged ICU stay (AUC= 0.86, 95% Confidence Interval 0.71 – 0.99, p= 0.003).Conclusion: GDF-15 showed potential as predictor of prolonged intensive care stay following cardiac surgery, which might be valuable for risk stratification models.

scholarly journals Tissue oxygen saturation during anaesthesia, cardiopulmonary bypass and intensive care stay for cardiac surgery

Critical Care ◽  
2008 ◽  
Vol 12 (Suppl 2) ◽  
pp. P71
Author(s):  
J Sanders ◽  
D Martin ◽  
A Smith ◽  
B Keogh ◽  
M Mutch ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Intensive Care ◽  
Cardiopulmonary Bypass ◽  
Oxygen Saturation ◽  
Tissue Oxygen Saturation ◽  
Tissue Oxygen ◽  
Intensive Care Stay

Comparison of outcomes of the use of Del Nido and St. Thomas cardioplegia in adult and paediatric cardiac surgery: a systematic review and meta-analysis

Perfusion ◽  
2020 ◽  
Vol 35 (8) ◽  
pp. 724-735 ◽  
Author(s):  
Ashlynn Ler ◽  
Faizus Sazzad ◽  
Geok Seen Ong ◽  
Theo Kofidis
Keyword(s):  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Relative Risk ◽  
Confidence Interval ◽  
Mean Difference ◽  
Aortic Cross Clamp Time ◽  
Aortic Cross Clamp ◽  
Cardiopulmonary Bypass Time ◽  
Paediatric Cardiac Surgery ◽  
Adult Cardiac Surgery

Background: In recent years, the use of del Nido cardioplegia, initially intended for paediatric cardiac surgery, has been extended to adult cardiac surgery in many institutions. Our aim was thus to compare the outcomes of the use of del Nido cardioplegia with that of conventional cardioplegia and discuss its role in both adult and paediatric cardiac surgery. Method: A systematic literature search was conducted in August 2019 on Medline (via PubMed), Embase and Cochrane electronic databases according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Any retrospective studies and randomised controlled trials that reported findings comparing the outcomes of the use of del Nido cardioplegia with that of St. Thomas cardioplegia were included. Results: We observed shorter aortic cross-clamp time (mean difference: −15.18, confidence interval: −27.21 to −3.15, p = 0.01) and cardiopulmonary bypass time (mean difference: −13.52, confidence interval: −20.64 to −6.39, p = 0.0002) associated with the use of del Nido cardioplegia in adult cardiac surgery as compared to St. Thomas cardioplegia. Defibrillation rates were significantly lower in patients who had been given del Nido cardioplegia, in both adult (relative risk: 0.28, confidence interval: 0.12 to 0.64, p = 0.003) and paediatric patients (relative risk: 0.25, confidence interval: 0.08 to 0.79, p = 0.02). Conclusion: Del Nido cardioplegia may be a viable alternative to the use of St. Thomas cardioplegia in both adult and paediatric patients, providing similar postoperative outcomes while also affording the additional advantage of shorter aortic cross-clamp time and cardiopulmonary bypass time (in adult cardiac surgery) and decreased rates of defibrillation (in both adult and paediatric cardiac surgery).

scholarly journals Causes influencing the length of stay of cardiac surgery patients in the intensive care unit

2015 ◽  
Vol 1 (1) ◽  
pp. 40
Author(s):  
Nikoleta Dimitropoulou ◽  
Aggeliki Stamou ◽  
Christina Marvaki
Keyword(s):  
Intensive Care Unit ◽  
Cardiac Surgery ◽  
Intensive Care ◽  
Coronary Artery ◽  
Demographic Characteristics ◽  
Average Hospital ◽  
Prolonged Stay ◽  
Icu Stay ◽  
History Of ◽  
Prolonged Icu Stay

Introduction: The incidence of postoperative morbidity has increased, a fact which may lead to prolonged hospitalization of the patient in the Intensive Care Unit (ICU) and generally in the hospital.Aim: The aim of the present study was to explore the complications after cardiac surgery responsible for the prolonged stay of patients in the ICU.Material and method: The studied sample consisted of 80 patients who were hospitalized in the Intensive Care Unit General Hospital of Athens from January 2013 to June 2014. For data collection a special registration form with information coming from the medical records of patients was used. Data analysis was performed by the IBM SPSS 21.0 (Statistical Package for Social Sciences).Results: Regarding to demographic characteristics Regarding the demographic characteristics and medical history of the studied sample, the majority were male (58.7%, n=47), with a mean age of 73 years and an average hospital stay of 3.3 days. The major causes of prolonged ICU stay was respiratory failure (20%, n=16), arrhythmias (17.5%, n = 14), bleeding (15%, n=12), myocardial infarction (11.3%, n=9), and pulmonary edema (10%,n=8). Τhe bivariate analysis showed statistical relationship to the level of 0,20 (p<0,20) between the prolonged ICU stay and age, coronary artery disease as the cause of entry, coronary artery bypass, diabetes melitus and chronic obstructive pulmonary disease.Conclusion: Patients with a history of heart failure, diabetes or obstructive pulmonary disease seems to have a greater chance for a prolonged ICU stay after cardiac surgery. Early recognition of demographic and clinical factors that may lead to the prolonged ICU stay can provide very important information about how to improve perioperative care of the patient.

scholarly journals Post-intensive care syndrome after a critical COVID-19: cohort study from a Belgian follow-up clinic

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Anne-Françoise Rousseau ◽  
Pauline Minguet ◽  
Camille Colson ◽  
Isabelle Kellens ◽  
Sourour Chaabane ◽  
...  
Keyword(s):  
Cohort Study ◽  
Intensive Care ◽  
Inpatient Rehabilitation ◽  
Quadriceps Strength ◽  
Biological Parameters ◽  
Icu Stay ◽  
Icu Discharge ◽  
Prolonged Icu Stay ◽  
Post Intensive Care Syndrome

Abstract Purpose Many patients with coronavirus disease 2019 (COVID-19) required critical care. Mid-term outcomes of the survivors need to be assessed. The objective of this single-center cohort study was to describe their physical, cognitive, psychological, and biological outcomes at 3 months following intensive care unit (ICU)-discharge (M3). Patients and methods All COVID-19 adults who survived an ICU stay ≥ 7 days and attended the M3 consultation at our multidisciplinary follow-up clinic were involved. They benefited from a standardized assessment, addressing health-related quality of life (EQ-5D-3L), sleep disorders (PSQI), and the three principal components of post-intensive care syndrome (PICS): physical status (Barthel index, handgrip and quadriceps strength), mental health disorders (HADS and IES-R), and cognitive impairment (MoCA). Biological parameters referred to C-reactive protein and creatinine. Results Among the 92 patients admitted to our ICU for COVID-19, 42 survived a prolonged ICU stay and 32 (80%) attended the M3 follow-up visit. Their median age was 62 [49–68] years, 72% were male, and nearly half received inpatient rehabilitation following ICU discharge. At M3, 87.5% (28/32) had not regained their baseline level of daily activities. Only 6.2% (2/32) fully recovered, and had normal scores for the three MoCA, IES-R and Barthel scores. The main observed disorders were PSQI > 5 (75%, 24/32), MoCA < 26 (44%, 14/32), Barthel < 100 (31%, 10/32) and IES-R ≥ 33 (28%, 9/32). Combined disorders were observed in 13/32 (40.6%) of the patients. The EQ-5D-3L visual scale was rated at 71 [61–80]. A quarter of patients (8/32) demonstrated a persistent inflammation based on CRP blood level (9.3 [6.8–17.7] mg/L). Conclusion The burden of severe COVID-19 and prolonged ICU stay was considerable in the present cohort after 3 months, affecting both functional status and biological parameters. These data are an argument on the need for closed follow-up for critically ill COVID-19 survivors.

Esmolol before cardioplegia and as cardioplegia adjuvant reduces cardiac troponin release after cardiac surgery. A randomized trial

Perfusion ◽  
2016 ◽  
Vol 32 (4) ◽  
pp. 313-320 ◽  
Author(s):  
Elena Bignami ◽  
Marcello Guarnieri ◽  
Annalisa Franco ◽  
Chiara Gerli ◽  
Monica De Luca ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Cardiac Surgery ◽  
Intensive Care ◽  
Placebo Group ◽  
Cardiopulmonary Bypass ◽  
Hospital Stay ◽  
Troponin T ◽  
Mechanical Activity ◽  
Double Blind ◽  
Elective Cardiac Surgery

Background: Cardioplegic solutions are the standard in myocardial protection during cardiac surgery, since they interrupt the electro-mechanical activity of the heart and protect it from ischemia during aortic cross-clamping. Nevertheless, myocardial damage has a strong clinical impact. We tested the hypothesis that the short-acting beta-blocker esmolol, given immediately before cardiopulmonary bypass and as a cardioplegia additive, would provide an extra protection to myocardial tissue during cardiopulmonary bypass by virtually reducing myocardial activity and, therefore, oxygen consumption to zero. Materials and methods: This was a single-centre, double-blind, placebo-controlled, parallel-group phase IV trial. Adult patients undergoing elective valvular and non-valvular cardiac surgery with end diastolic diameter >60 mm and ejection fraction <50% were enrolled. Patients were randomly assigned to receive either esmolol, 1 mg/kg before aortic cross-clamping and 2 mg/kg with Custodiol® crystalloid cardioplegia or equivolume placebo. The primary end-point was peak postoperative troponin T concentration. Troponin was measured at Intensive Care Unit arrival and at 4, 24 and 48 hours. Secondary endpoints included ventricular fibrillation after cardioplegic arrest, need for inotropic support and intensive care unit and hospital stay. Results: We found a reduction in peak postoperative troponin T, from 1195 ng/l (690–2730) in the placebo group to 640 ng/l (544–1174) in the esmolol group (p=0.029) with no differences in Intensive Care Unit stay [3 days (1-6) in the placebo group and 3 days (2-5) in the esmolol group] and hospital stay [7 days (6–10) in the placebo group and 7 days (6–12) in the esmolol group]. Troponin peak occurred at 24 hours for 12 patients (26%) and at 4 hours for the others (74%). There were no differences in other secondary end-points. Conclusions: Adding esmolol to the cardioplegia in high-risk patients undergoing elective cardiac surgery reduces peak postoperative troponin levels. Further investigation is necessary to assess esmolol effects on major clinical outcomes.

P4714Individual patient data meta-analysis comparing general anesthesia and deep sedation on safety and length of intensive care unit stay in patients undergoing percutaneous mitral valve repair

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
A Jobs ◽  
S De Waha-Thiele ◽  
J Ledwoch ◽  
H Sievert ◽  
T Rassaf ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Confidence Interval ◽  
Deep Sedation ◽  
Meta Analysis ◽  
Valve Repair ◽  
Two Stage ◽  
Intensive Care Stay ◽  
Safety Endpoint ◽  
Procedural Success

Abstract Background Percutaneous edge-to-edge mitral valve repair (PMVR) has emerged as a treatment option for patients with severe mitral regurgitation not considered suitable candidates for surgery. The procedure can be performed in general anesthesia (GA) or deep sedation (DS) without mechanical ventilation. However, debate remains about the optimal approach. Purpose To compare the impact of the anesthetic method on efficacy, safety, and length of intensive care stay. Methods We identified studies comparing GA versus DS in patients undergoing PMVR by searching PubMed and CENTRAL. We included studies for which investigators agreed to provide individual patient data. Analyzed outcomes were a composite safety endpoint comprising all-cause death, stroke, pneumonia, and major to life-threating bleeding as well as length of intensive care unit stay. We performed an one-stage and two-stage meta-analysis on each outcome after multiple imputation of missing data. For two-stage meta-analysis, between-study heterogeneity was estimated according to Paule-Mandel and confidence intervals were derived using the method proposed by Hartung and Knapp. Results We included five observational studies (n=647 patients). Procedural success was achieved in 618 of 647 (95.5%) patients. The composite safety endpoint occurred in 92 of 647 (14.2%) patients with no difference between patients treated with GA or DS. In this regard, risk ratio was 0.78 (95% confidence interval, 0.53 to 1.14; P=0.20) following the one-stage approach and 0.73 (95% confidence interval, 0.30 to 1.80; P=0.39) following the two-stage approach. Length of intensive care stay was longer after GA as compared to DS (adjusted mixed linear regression model, 1.94 days, 95% confidence interval, 1.29 to 2.59 days, P<0.001; random effects model pooling study-specific estimates from adjusted linear models 1.40 days, 95% confidence interval, 0.54 to 2.22 days, P=0.0104). Conclusion Both, DS and GA offer good procedural success rates and a similar safety profile. However, length of intensive care stay is shorter after DS.

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