The Thoracic and cardiovascular surgeon
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Thorac Cardiovasc Surg · Dec 1998
Randomized Controlled Trial Clinical TrialDiagnostic value of procalcitonin: the influence of cardiopulmonary bypass, aprotinin, SIRS, and sepsis.
The reasons for a systemic inflammatory response syndrome (SIRS) following ECC are not yet fully understood. Procalcitonin (PCT) blood levels may distinguish between bacterial infections and a non-bacterial systemic inflammation. We investigated the influence of ECC, ECC modified by application of aprotinin, systemic inflammation, and bacterial infection on the PCT values. ⋯ In this study it was demonstrated that ECC and the use of aprotinin did not have any influence on the secretion of PCT. A systemic bacterial infection caused a significant increase of PCT, whereas PCT values remained normal in case of a SIRS. So it seems to be possible to distinguish between a primary SIRS and a bacterial sepsis by means of PCT.
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Thorac Cardiovasc Surg · Dec 1998
Percutaneous dilatational tracheostomy: results and long-term outcome of critically ill patients following cardiac surgery.
Tracheostomy is widely regarded as the method of choice for long-term airway control in critically ill patients. The advantages of tracheostomy have to be balanced against the surgical risks of conventional surgical tracheostomy. However, the alternative technique of percutaneous dilatational tracheostomy (PDT) has been associated with fewer procedure-related complications. ⋯ PDT can be performed safely in patients following cardiac surgery as a bedside technique with a low incidence of procedural and postprocedural complications and an acceptable functional and cosmetic long-term outcome. Further studies are needed to define the optimal timing of PDT after translaryngeal intubation.
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Thorac Cardiovasc Surg · Oct 1998
Clinical Trial Controlled Clinical TrialEarly extubation after cardiac surgery: a prospective clinical trial including patients at risk.
Recent evidence suggests that early extubation after cardiac surgery can be performed without increased morbidity, resulting in economic advantages. However, most studies on this subject exclude patients with preoperative risk factors described as predictors for prolonged mechanical ventilation. The purpose of our prospective clinical trial was to decide whether early extubation is feasible independent of preoperative patient status, in particular independent of preoperative risk factors. ⋯ 1. All patients are basically suitable for early extubation, with the presence of preoperative risk factors used in this study being poor predictors of prolonged ventilation. 2. The necessity of prolonged ventilation is primarily determined by intra- or perioperative complications.
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Thorac Cardiovasc Surg · Oct 1998
Case ReportsHeparin removal after cardiopulmonary bypass in a patient with adverse reaction to protamine.
A 74-year-old man underwent elective coronary surgery under cardiopulmonary bypass. A few minutes after the protamine administration was started, he suddenly developed a severe hypotension necessitating cardiac massage and recannulation for pump assistance. ⋯ In 35 minutes ACT decreased from 480 sec to 180 sec and clots appeared in the operating field. This system provides an excellent alternative to protamine in patients with an adverse reaction to protamine.