Journal of cardiothoracic and vascular anesthesia
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J. Cardiothorac. Vasc. Anesth. · Aug 1995
ReviewPro: early extubation after cardiac surgery decreases intensive care unit stay and cost.
The recurrent or new trends of early extubation after cardiac surgery are here to stay in the 1990s. The preoperative status does not necessarily predict the postoperative course and prolonged mechanical ventilation following cardiac surgery should not be uncritically considered as routine. All patients should be assessed for tracheal extubation at the earliest opportunity when the criteria are met in the ICU. ⋯ The substantial difference in cost savings per cardiac case between "criteria discharge" and "actual discharge" points out the importance of the organization of the process of care being delivered. To achieve maximum cost benefit from early extubation in cardiac patients, the organization of the perioperative management of these patients must be optimized. This process of care includes intraoperative anesthetic modification; organization of ICU and staff expertise; postoperative early extubation and management; acute pain service; ICU discharge policy; utilization of step-down unit and surgical ward; and communication among cardiac patient management teams (cardiovascular surgeon, cardiac anesthesiologist, ICU staff, nurses, respiratory therapists, physiotherapists, and social workers), which are all vital to the success of such a program.
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J. Cardiothorac. Vasc. Anesth. · Aug 1995
Comparative StudyDetermination of normal versus abnormal activated partial thromboplastin time and prothrombin time after cardiopulmonary bypass.
The study's objective was to determine the prothrombin time (PT) and activated partial thromboplastin time (aPTT) values that differentiated normal from excessively bleeding patients immediately after cardiopulmonary bypass (CPB). ⋯ The aPTT and PT values that produce the maximal sensitivity and specificity in the ROC analysis may be helpful to differentiate patients who are bleeding excessively from those patients who are not after CPB and to guide transfusion of blood products. New whole blood coagulation devices with rapid turn-around times had similar predictive value for bleeding tendency compared with standardized laboratory tests.
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J. Cardiothorac. Vasc. Anesth. · Aug 1995
Comparative StudyEvaluation of the Paratrend 7 intravascular blood gas monitor during cardiac surgery: comparison with the C4000 in-line blood gas monitor during cardiopulmonary bypass.
To evaluate the performance of the Paratrend 7 intravascular blood gas monitor (Biomedical Sensors, High Wycombe, UK, Ltd) during cardiac surgery and compare it with that of an in-line blood gas monitor placed in the arterial limb of an extracorporeal circuit during cardiopulmonary bypass. ⋯ The intravascular sensor used in this study functioned well during cardiopulmonary bypass and the postbypass phase. The performance of the intravascular sensor was better than the in-line blood gas monitor during cardiopulmonary bypass.
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J. Cardiothorac. Vasc. Anesth. · Aug 1995
Comparative StudyContinuous thermodilution cardiac output: agreement with Fick and bolus thermodilution methods.
Cardiac outputs were determined with continuous thermodilution, bolus thermodilution, and the Fick method during pharmacologically varied hemodynamics. ⋯ Automatic cardiac output computed with continuous thermodilution appears accurate and reliable. Also, good agreement was confirmed between cardiac output derived by continuous and bolus thermodilution methods and bolus thermodilution and Fick methods.