Journal of cardiothoracic and vascular anesthesia
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J. Cardiothorac. Vasc. Anesth. · Dec 2014
Meta AnalysisDexmedetomidine Reduces the Risk of Delirium, Agitation and Confusion in Critically Ill Patients: A Meta-analysis of Randomized Controlled Trials.
Delirium frequently is observed in critically ill patients in the intensive care unit (ICU) and is associated strongly with a poor outcome. Dexmedetomidine seems to reduce time to extubation and ICU stay without detrimental effects on mortality. The objective of the authors' study was to evaluate the effect of this drug on delirium, agitation, and confusion in the ICU setting. ⋯ This meta-analysis of randomized controlled studies suggests that dexmedetomidine could help to reduce delirium in critically ill patients.
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J. Cardiothorac. Vasc. Anesth. · Dec 2014
Persistent Kidney Injury at Hospital Discharge After Cardiac Surgery with Cardiopulmonary Bypass in Patients with Normal Preoperative Serum Creatinine and Normal Estimated Glomerular Filtration Rate.
Acute kidney injury is a serious complication after cardiac surgery. Although it resolves in most cases, a significant portion of patients persistently have raised creatinine values at hospital discharge. These patients are at greater risk for developing chronic kidney disease and mortality. Therefore, the present study aimed to ascertain risk factors of persistent acute kidney injury after cardiac surgery in patients with normal preoperative renal function. ⋯ Age ≥ 70 years, higher peak postoperative creatinine within 48 hours, and lower hemoglobin on intensive care unit arrival are associated with persistent acute kidney injury. Strategies to improve hemoglobin on intensive care unit arrival potentially can reduce persistent acute kidney injury. The authors recommend that patients aged ≥ 70 years undergo further renal evaluation for better risk stratification.
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J. Cardiothorac. Vasc. Anesth. · Dec 2014
Comparative Study Observational StudyCephalic Versus Digital Plethysmographic Variability Index Measurement: A Comparative Pilot Study in Cardiac Surgery Patients.
Noninvasive measurement of digital plethysmographic variability index (PVI(digital)) has been proposed to predict fluid responsiveness, with conflicting results. The authors tested the hypothesis that cephalic sites of PVI measurement (namely PVI(ear) and PVI(forehead)) could be more discriminant than PVI(digital) to predict fluid responsiveness after cardiac surgery. ⋯ PVI(forehead) was more discriminant than PVI(digital) and could be a valuable alternative to arterial PPV in predicting fluid responsiveness.