Interactive cardiovascular and thoracic surgery
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Interact Cardiovasc Thorac Surg · Mar 2015
ReviewSurgical management for the first 48 h following blunt chest trauma: state of the art (excluding vascular injuries).
This review aims to answer the most common questions in routine surgical practice during the first 48 h of blunt chest trauma (BCT) management. Two authors identified relevant manuscripts published since January 1994 to January 2014. Using preferred reporting items for systematic reviews and meta-analyses statement, they focused on the surgical management of BCT, excluded both child and vascular injuries and selected 80 studies. ⋯ Lung herniation, traumatic diaphragmatic rupture and pericardial rupture are life-threatening situations requiring prompt diagnosis and surgical advice. (Grades C and D). Tracheobronchial repair is mandatory in cases of tracheal tear >2 cm, oesophageal prolapse, mediastinitis or massive air leakage (Grade C). These evidence-based surgical indications for BCT management should support protocols for chest trauma management.
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Interact Cardiovasc Thorac Surg · Mar 2015
Comparative StudyThe importance of pleural integrity for effective and safe thoracic paravertebral block: a retrospective comparative study on postoperative pain control by paravertebral block.
Recently, paravertebral block (PVB) has been reported to be an effective analgesic modality for post-thoracotomy pain, but there is no consensus on how thoracic PVB can be more effective. Our hypothesis that intact pleura has a significant impact on the analgesic effectiveness of thoracic PVB was evaluated. ⋯ According to our analysis, creating a sub-pleural space without pleural disruption is essential for quality thoracic PVB.
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Interact Cardiovasc Thorac Surg · Mar 2015
Use of a novel vasoactive-ventilation-renal score to predict outcomes after paediatric cardiac surgery.
Prior studies have established peak postoperative lactate and the vasoactive-inotrope score (VIS) as modest predictors of outcome following paediatric cardiac surgery. We developed a novel vasoactive-ventilation-renal (VVR) score and aimed to determine if this index, which incorporates postoperative respiratory, cardiovascular and renal function, would more consistently predict outcome in this patient population. ⋯ The novel 48-h VVR was a robust predictor of outcome following paediatric cardiac surgery and outperformed the VIS and peak postoperative lactate.
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Interact Cardiovasc Thorac Surg · Mar 2015
Review Meta AnalysisDoes preoperative statin therapy prevent postoperative atrial fibrillation in patients undergoing cardiac surgery?
A best evidence topic was written according to a structured protocol. The question addressed was: does preoperative statin therapy prevent postoperative atrial fibrillation (AF) in patients undergoing cardiac surgery? There were 445 papers found using the reported search. From these, 12 represented the best evidence to answer the clinical question. ⋯ Although the majority of studies (10 of 12) support the use of statins preoperatively, 2 studies found no association between preoperative statin therapy and the reduction of postoperative AF. In conclusion, the available evidence suggests that preoperative statin therapy in patients undergoing elective cardiac surgery is associated with the following: (1) a lower incidence and risk of developing postoperative AF, (2) reduced stroke, (3) a shorter hospital stay and (4) reduced levels of inflammatory markers postoperatively. However, while the evidence supports the use of statins preoperatively, the optimal duration, dose and type of statin cannot be concluded from this review.