The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Jul 2013
Randomized Controlled Trial Comparative StudyA randomized comparison of different ventilator strategies during thoracotomy for pulmonary resection.
Protective lung ventilation is reported to benefit patients with acute respiratory distress syndrome. It is not known whether protective lung ventilation is also beneficial to patients undergoing single-lung ventilation for elective pulmonary resection. ⋯ The use of Hi-TV during single-lung ventilation for pulmonary resection resulted in no increase in morbidity and was associated with less hypercarbia, less dead space ventilation, better dynamic compliance, and less postoperative atelectasis.
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J. Thorac. Cardiovasc. Surg. · Jul 2013
Randomized Controlled TrialPenehyclidine hydrochloride preserves the intestinal barrier function in patients undergoing cardiopulmonary bypass.
The study objective was to investigate the protective effect of penehyclidine hydrochloride on intestinal barrier function integrity and its therapeutic potential on endotoxemia and systemic inflammatory response in patients undergoing cardiopulmonary bypass. ⋯ Penehyclidine hydrochloride preserves intestinal barrier function integrity, attenuates endotoxemia, and inhibits systemic inflammatory response in patients undergoing cardiopulmonary bypass, possibly by improving intestinal microcirculation and depressing stress response.
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J. Thorac. Cardiovasc. Surg. · Jul 2013
Complications of cerebrospinal fluid drainage after thoracic aortic surgery: a review of 504 patients over 5 years.
Cerebrospinal fluid drainage, a well-established means of preventing paraplegia after thoracic aortic aneurysm surgery, can result in serious, sometimes lethal complications. In a large group of patients who underwent surgical thoracic aortic aneurysm repair with cerebrospinal fluid drainage, we examined the incidences of and potential risk factors for these outcomes. ⋯ Cerebrospinal fluid drainage, as performed by our method, seems to be associated with a modest rate of intracranial bleeding in patients who undergo surgical thoracic aortic aneurysm repair. In contrast, postdural puncture headache is not uncommon, particularly in patients with connective tissue disease. Clinicians caring for these patients should consider the likelihood of postdural puncture headache, and any such patient with postoperative headache should be assessed for epidural blood patch placement.
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J. Thorac. Cardiovasc. Surg. · Jul 2013
Postoperative electroencephalographic seizures are associated with deficits in executive function and social behaviors at 4 years of age following cardiac surgery in infancy.
The occurrence of an electroencephalographic (EEG) seizure after surgery for complex congenital heart defects has been associated with worse neurodevelopmental (ND) outcomes. We previously identified postoperative seizures documented by 48-hour EEG monitoring in 11% of 178 neonates and infants. Evaluation at 1 year of age did not identify an adverse effect of an EEG seizure on ND outcomes. The current study was undertaken to determine if testing in the preschool period would identify deficits that become apparent as children develop. ⋯ The occurrence of a postoperative seizure is a biomarker of brain injury. This study confirms that postoperative EEG seizures are associated with worse ND outcomes, characterized by impairments of executive function and a higher prevalence of deficits in social interactions and repetitive/restricted behaviors in preschool survivors of cardiac surgery in infancy. However, EEG seizures were not associated with worse cognitive, language, or motor skills.
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J. Thorac. Cardiovasc. Surg. · Jul 2013
Effect of intensive care unit environment on in-hospital delirium after cardiac surgery.
The etiology of postcardiac surgery delirium is complex. Our primary objective was to determine the effect of the postoperative environment on the prevalence of delirium by examining the in-hospital delirium rates in 2 postoperative intensive care units with differing physical infrastructure. We further sought to identify other risk factors associated with in-hospital delirium. ⋯ The intensive care unit environment did not have a significant effect on the overall prevalence of delirium. However, that does not preclude the possibility that the intensive care unit environment might interact with other factors, such as age, in a complex manner. Attempts to reduce delirium by adjusting the intensive care unit environment alone will likely not be sufficient, and instead will require a more comprehensive multimodal approach.