scholarly journals Effects of Vitamin C on Organ Function in Cardiac Surgery Patients: A Systematic Review and Meta-Analysis

Nutrients ◽  
2019 ◽  
Vol 11 (9) ◽  
pp. 2103 ◽  
Author(s):  
Aileen Hill ◽  
Kai C. Clasen ◽  
Sebastian Wendt ◽  
Ádám G. Majoros ◽  
Christian Stoppe ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Cardiac Surgery ◽  
Length Of Stay ◽  
Vitamin C ◽  
Hospital Mortality ◽  
Organ Dysfunction ◽  
Meta Analysis ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Organ Function

Background: Cardiac surgery is associated with oxidative stress and systemic inflammation, which both contribute to postoperative organ dysfunction. Vitamin C is a pleiotropic, antioxidant, and potentially organ-protective micronutrient. Past clinical trials and meta-analyses have focused predominantly on occurrence of postoperative atrial fibrillation. Therefore, we investigated the influence of perioperative vitamin C administration on clinically relevant parameters closer related to the patient’s recovery, especially organ function, and overall outcomes after cardiac surgery. Methods: Randomized controlled trials (RCTs) comparing perioperative vitamin C administration versus placebo or standard of care in adult patients undergoing cardiac surgery were identified through systematic searches in Pubmed, EMBASE, and CENTRAL on 23 November 2018. Published and unpublished data were included. Assessed outcomes include organ function after cardiac surgery, adverse events, in-hospital mortality, intensive care unit, and hospital length-of-stay. Data was pooled only when appropriate. Results: A total of 19 RCTs with 2008 patients were included in this meta-analysis. Vitamin C significantly decreased the incidence of atrial fibrillation (p = 0.008), ventilation time (p < 0.00001), ICU length-of-stay (p = 0.004), and hospital length-of-stay (p < 0.0001). However, on average, vitamin C had no significant effects on in-hospital mortality (p = 0.76), or on the incidence of stroke (p = 0.82). High statistical heterogeneity was observed in most analyses. Conclusions: Vitamin C impacts clinically and economically important outcomes, such as ICU and hospital length-of-stay, duration of mechanical ventilation and lowers the incidence of atrial fibrillation. Due to missing reports on organ dysfunction, this meta-analysis cannot answer the question, if vitamin C can improve single- or multiorgan function after cardiac surgery.

Clinical and Economic Outcomes of Telemedicine Programs in the Intensive Care Unit: A Systematic Review and Meta-Analysis

2017 ◽  
Vol 33 (7) ◽  
pp. 383-393 ◽  
Author(s):  
Jing Chen ◽  
Dalong Sun ◽  
Weiming Yang ◽  
Mingli Liu ◽  
Shufan Zhang ◽  
...  
Keyword(s):  
Systematic Review ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Length Of Stay ◽  
Hospital Mortality ◽  
Meta Analysis ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Icu Length Of Stay ◽  
The Impact

Objective: To evaluate the impact of telemedicine programs in intensive care unit (Tele-ICU) on ICU or hospital mortality or ICU or hospital length of stay and to summarize available data on implementation cost of Tele-ICU. Methods: Controlled trails or observational studies assessing outcomes of interest were identified by searching 7 electronic databases from inception to July 2016 and related journals and conference literatures between 2000 and 2016. Two reviewers independently screened searched records, extracted data, and assessed the quality of included studies. Random-effect models were applied to meta-analyses and sensitivity analysis. Results: Nineteen of 1035 records fulfilled the inclusion criteria. The pooled effects demonstrated that Tele-ICU programs were associated with reductions in ICU mortality (15 studies; risk ratio [RR], 0.83; 95% confidence interval [CI], 0.72 to 0.96; P = .01), hospital mortality (13 studies; RR, 0.74; 95% CIs, 0.58 to 0.96; P = .02), and ICU length of stay (9 studies; mean difference [MD], −0.63; 95% CI, −0.28 to 0.17; P = .007). However, there is no significant association between the reduction in hospital length of stay and Tele-ICU programs. Summary data concerning costs suggested approximately US$50 000 to US$100 000 per Tele-ICU bed was required to implement Tele-ICU programs for the first year. Hospital costs of US$2600 reduction to US$5600 increase per patient were estimated using Tele-ICU programs. Conclusions: This systematic review and meta-analysis provided limited evidence that Tele-ICU approaches may reduce the ICU and hospital mortality, shorten the ICU length of stay, but have no significant effect in hospital length of stay. Implementation of Tele-ICU programs substantially costs and its long-term cost-effectiveness is still unclear.

scholarly journals Prophylaxis for postoperative atrial fibrillation: A quality initiative study exploring adherence to NICE guidance in a UK tertiary cardiothoracic intensive care unit

2019 ◽  
Vol 21 (4) ◽  
pp. 290-295
Author(s):  
Vasileios Zochios ◽  
Joht Singh Chandan ◽  
Thomas Taverner ◽  
Aswin Babu ◽  
Harjot Singh
Keyword(s):  
Atrial Fibrillation ◽  
Cardiac Surgery ◽  
Length Of Stay ◽  
Rate Control ◽  
Significant Proportion ◽  
Hospital Length ◽  
Postoperative Atrial Fibrillation ◽  
Hospital Length Of Stay ◽  
Nice Guidance ◽  
The Impact

Background Acute onset atrial fibrillation is a common dysrhythmia experienced by patients following cardiac surgery which can often cause morbidity and extended hospital length of stay. The primary aim of the study was to explore adherence to National Institute for Health and Care Excellence (NICE) guidance which suggests the need for prophylaxis for postoperative atrial fibrillation (POAF). Secondary aims were to explore factors contributing to the development POAF and the impact of POAF on patient-centred outcomes. Methods An analysis consisting of descriptive statistics and regression models was conducted using 138 patient’s records who underwent cardiac surgery between January and March 2017. Results We identified 83 (62%) patients on prophylactic rate control medications prior to surgery. During the study period, a total of 50 patients (36%) developed POAF, of which 28 were on prophylactic medication prior to surgery. Patients who developed POAF had significantly prolonged hospital length of stay compared to those who did not develop POAF. Conclusion Our study identified a significant proportion of patients not being offered prophylactic rate control prior to cardiac surgery. It is clear that poor patient outcomes are associated with the development of POAF and therefore there is an important need to ensure preventative measures are implemented in guidance relating to the management of these patients. Our results also suggest that tight management of clinical and physiological risk factors prior and during cardiac surgery may improve outcomes in this group of patients and could be considered in future enhanced recovery after cardiac surgery protocols.

scholarly journals The Impact of Volatile Anesthetic Choice on Postoperative Outcomes of Cardiac Surgery: A Meta-Analysis

2017 ◽  
Vol 2017 ◽  
pp. 1-12 ◽  
Author(s):  
Andres Zorrilla-Vaca ◽  
Rafael A. Núñez-Patiño ◽  
Valentina Torres ◽  
Yudy Salazar-Gomez
Keyword(s):  
Cardiac Surgery ◽  
Length Of Stay ◽  
Meta Analysis ◽  
Unit Length ◽  
Volatile Anesthetic ◽  
Hospital Length ◽  
Postoperative Outcomes ◽  
Hospital Length Of Stay ◽  
Randomized Controlled ◽  
The Impact

Objectives. To evaluate the impact of volatile anesthetic choice on clinically relevant outcomes of patients undergoing cardiac surgery. Methods. Major databases were systematically searched for randomized controlled trials (RCTs) comparing volatile anesthetics (isoflurane versus sevoflurane) in cardiac surgery. Study-level characteristics, intraoperative events, and postoperative outcomes were extracted from the articles. Results. Sixteen RCTs involving 961 patients were included in this meta-analysis. There were no significant differences between both anesthetics in terms of intensive care unit length of stay (SMD −0.07, 95% CI −0.38 to 0.24, P=0.66), hospital length of stay (SMD 0.06, 95% CI −0.33 to 0.45, P=0.76), time to extubation (SMD 0.29, 95% CI −0.08 to 0.65, P=0.12), S100β (at the end of surgery: SMD 0.08, 95% CI −0.33 to 0.49, P=0.71; 24 hours after surgery: SMD 0.21, 95% CI −0.23 to 0.65, P=0.34), or troponin (at the end of surgery: SMD −1.13, 95% CI −2.39 to 0.13, P=0.08; 24 hours after surgery: SMD 0.74, 95% CI −0.15 to 1.62, P=0.10). CK-MB was shown to be significantly increased when using isoflurane instead of sevoflurane (SMD 2.16, 95% CI 0.57 to 3.74, P=0.008). Conclusions. The volatile anesthetic choice has no significant impact on postoperative outcomes of patients undergoing cardiac surgery.

scholarly journals Early Tracheal Extubation for Postoperative Recovery in Cardiac Surgery: Systematic Review and Meta-Analysis

2020 ◽  
Author(s):  
Yi-Fan Zhao ◽  
Zhen-Dong Huang ◽  
Hui-Yun Gu ◽  
Chao Zhang ◽  
Guang-Ling Guo
Keyword(s):  
Myocardial Infarction ◽  
Cardiac Surgery ◽  
Length Of Stay ◽  
Meta Analysis ◽  
Tracheal Extubation ◽  
Postoperative Recovery ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Cochrane Library ◽  
Care Group

Abstract Background: How to promote the rapid recovery of patients undergoing cardiac surgery and quality of life has been the focus of doctors’ attention. To compare the safety and efficacy of early cardiac extubation with conventional extubation (late extubation) in patients undergoing cardiac surgery.Methods: Ovid MEDLINE, Ovid Embase, EBSCOhost, Cochrane Library and ISIWeb of Science (1946–November 25, 2019) were searched to obtain randomized controlled trials of early tracheal extubation in patients undergoing cardiac surgery.Results: Compared with the conventional care group, in terms of effectiveness, the intensive care unit (ICU) stay and hospital length of stay in the early tracheal extubation was significantly shorter. In terms of security, most outcomes, including mortality, bleeding, stroke, acute renal failure and arrhythmia, were not statistically significant, except for myocardial infarction. However, the risk of re-intubation in the early tracheal extubation was higher than that of conventional extubation.Conclusions: This meta-analysis confirmed that early tracheal extubation may effectively reduce ICU hospitalization time, hospital length of stay and the risk of myocardial infarction. Although early tracheal extubation does not increase the risk of safety events, the clinicians need to pay more attention to be aware of possible risk of re-intubation. Meanwhile, as a key time point for extubation within 4 hours, it may help a little to reduce the risk of re-intubation and myocardial infarction.

scholarly journals Impact of Vitamin C Supplementation on Post-Cardiac Surgery ICU and Hospital Length of Stay

2015 ◽  
Vol 5 (1) ◽  
Author(s):  
Anita Sadeghpour ◽  
Azin Alizadehasl ◽  
Majid Kyavar ◽  
Tahereh Sadeghi ◽  
Jalal Moludi ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Length Of Stay ◽  
Vitamin C ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Vitamin C Supplementation ◽  
Post Cardiac Surgery

scholarly journals In-Hospital Outcomes of Acute Kidney Injury After Pediatric Cardiac Surgery: A Meta-Analysis

2021 ◽  
Vol 9 ◽  
Author(s):  
Jef Van den Eynde ◽  
Hajar Rotbi ◽  
Marc Gewillig ◽  
Shelby Kutty ◽  
Karel Allegaert ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Cardiac Surgery ◽  
Length Of Stay ◽  
Cardiac Arrhythmias ◽  
Pediatric Population ◽  
Meta Analysis ◽  
Kidney Injury ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Hospital Outcomes

Background: Cardiac surgery-associated acute kidney injury (CS-AKI) is associated with increased morbidity and mortality in both adults and children. This study aimed to investigate the in-hospital outcomes of CS-AKI in the pediatric population.Methods: PubMed/MEDLINE, Embase, Scopus, and reference lists of relevant articles were searched for studies published by August 2020. Random-effects meta-analysis was performed, comparing in-hospital outcomes between patients who developed CS-AKI and those who did not.Results: Fifty-eight publications between 2008 and 2020 consisting of 18,334 participants (AKI: 5,780; no AKI: 12,554) were included. Higher rates of in-hospital mortality (odds ratio [OR] 7.22, 95% confidence interval [CI] 5.27–9.88), need for renal replacement therapy (RRT) (OR 18.8, 95% CI 11.7–30.5), and cardiac arrhythmias (OR 2.67, 95% 1.86–4.80) were observed in patients with CS-AKI. Furthermore, patients with AKI had longer ventilation times (mean difference [MD] 1.76 days, 95% CI 1.05–2.47), pediatric intensive care unit (PICU) length of stay (MD 3.31, 95% CI 2.52–4.10), and hospital length of stay (MD 5.00, 95% CI 3.34–6.67).Conclusions: CS-AKI in the pediatric population is associated with a higher risk of mortality, cardiac arrhythmias and need for RRT, as well as greater mechanical ventilation time, PICU and hospital length of stay. These results might help improve the clinical care protocols prior to cardiac surgery to minimize the disease burden of CS-AKI in children. Furthermore, etiology-specific approaches to AKI are warranted, as outcomes are likely impacted by the underlying cause.

scholarly journals Correction: Hill, A.; et al. Effects of Vitamin C on Organ Function in Cardiac Surgery Patients: A Systematic Review and Meta-Analysis. Nutrients 2019, 11, 2103

Nutrients ◽  
2020 ◽  
Vol 12 (12) ◽  
pp. 3910
Author(s):  
Aileen Hill ◽  
Kai Clasen ◽  
Sebastian Wendt ◽  
Ádám Majoros ◽  
Christian Stoppe ◽  
...  
Keyword(s):  
Systematic Review ◽  
Cardiac Surgery ◽  
Vitamin C ◽  
Meta Analysis ◽  
Organ Function

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