Interactive cardiovascular and thoracic surgery
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Interact Cardiovasc Thorac Surg · Oct 2008
ReviewDoes the administration of mannitol prevent renal failure in open abdominal aortic aneurysm surgery?
A best evidence topic in cardiovascular surgery was written according to a structured protocol. The question addressed was whether mannitol might prevent renal failure in patients undergoing open repair of an abdominal aortic aneurysm. Altogether more than 25 papers were found using the reported search, of which eight represented the best evidence to answer the clinical question. ⋯ Of note also is that the earlier studies used urine output as their main indicator of renal failure in reaching their conclusions. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. We conclude that no clinical trials to date have demonstrated any clinical reduction in the incidence of renal failure in patients undergoing repair of an abdominal aortic aneurysm who have been given mannitol.
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Interact Cardiovasc Thorac Surg · Oct 2008
ReviewIs manipulation of mediastinal chest drains useful or harmful after cardiac surgery?
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was: in patients who have undergone cardiothoracic surgery does manipulation of drainage tubes affect drainage volumes or post-surgical outcome? Altogether 681 papers were found using the reported search, of which four represented the best evidence to answer the clinical question. Duncan and Erickson in 1982 found that chest tube stripping can lead to very low negative intrathoracic pressures. ⋯ In our paper the authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. We conclude that due to possible tissue damage and lack of demonstrable benefit, in most patients drainage tube manipulation should not be performed. No differences in either safety or efficacy have been demonstrated between the milking and stripping methods of manipulation.
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Interact Cardiovasc Thorac Surg · Oct 2008
Utilization and outcome of coronary revascularization and valve procedures in acute heart failure--an evaluation based on the classification from the European Society of Cardiology.
Early invasive treatments in patients with acute heart failure (AHF) are critical components to improve outcome. We aimed to establish if such treatments were applied according to existing guidelines and also to assess the subsequent mortality in the complete AHF population. All patients with AHF admitted to the intensive care unit/coronary care unit during the years 2003-2004 (n=302) were retrospectively reviewed and classified according to the European Society of Cardiology. ⋯ Invasively treated patients had lower in-hospital mortality in both cardiogenic shock (35% vs. 70%, P=0.006) and less severe AHF (6% vs.17%, P=0.042). The study revealed an appropriate use of invasive revascularization. The high mortality in patients with severe AHF indicates that more effective treatment options are needed in eligible patients.
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Interact Cardiovasc Thorac Surg · Oct 2008
Early tracheal extubation in adults undergoing single-lung transplantation for chronic obstructive pulmonary disease: pilot evaluation of perioperative outcome.
The objective of this pilot study was to evaluate the safety and success of early tracheal extubation (ETE) as compared to delayed tracheal extubation (DTE) in single-lung transplantation (SLT) for chronic obstructive pulmonary disease (COPD). This retrospective observational study was undertaken at a university hospital. Fifty-seven adult patients who underwent SLT for COPD (1998-2003) were enrolled. ⋯ The anesthetic technique associated with ETE in SLT for COPD was characterized by limited systemic anesthetics and perioperative thoracic epidural analgesia. Appropriate ETE in SLT for COPD is not only safe but also results in equivalent perioperative outcome when compared to the traditional technique of DTE. Future studies should be powered to examine whether ETE reduces native lung complications such as hyperinflation, pneumonia and pneumothorax.