American journal of critical care : an official publication, American Association of Critical-Care Nurses
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Delirium after surgery is a common condition that leads to poor outcomes. Few studies have examined the effect of postoperative delirium on outcomes after cardiac surgery. ⋯ Patients who have delirium after cardiac surgery have poorer outcomes than do similar patients without this complication. Development and implementation of an extensive care plan to address postoperative delirium is necessary for cardiac surgery patients who are at risk for or have delirium after the surgery.
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Observational Study
Pleth variability index and fluid responsiveness of hemodynamically stable patients after cardiothoracic surgery.
Fluid responsiveness is a measure of preload dependence and is defined as an increase in cardiac output due to volume expansion. Recent publications have suggested that variation in amplitude of the pulse oximetry waveform may be predictive of fluid responsiveness. The pleth variability index (PVI) was developed as a noninvasive bedside measurement of this variation in the pulse oximetry waveform. ⋯ Among postoperative cardiac surgery patients, PVI is not reliable for predicting fluid responsiveness as measured by pulmonary artery catheter thermodilution, regardless of ventilatory status.
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Weaning from mechanical ventilation to spontaneous breathing is associated with changes in the hemodynamic and autonomic nervous systems that are reflected by heart rate variability. Although cardiac dysrhythmias are an important manifestation of hemodynamic alterations, the impact of heart rate variability on the occurrence of dysrhythmias during weaning has not been specifically studied. ⋯ Heart rate variability power spectra during weaning were predictive of dysrhythmias.
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A major postoperative problem for infants undergoing cardiopulmonary bypass surgery is hypothermia. ⋯ The newly designed Heat Retention Head Wrap was associated with a gradual normalization of temperature during rewarming and did not interfere with routine perioperative care of infants undergoing bypass surgery. This pilot study indicates that the head wrap is both safe and feasible for use in infants undergoing cardiopulmonary bypass surgery.