Cardiovascular surgery (London, England)
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Randomized Controlled Trial Clinical Trial
A prospective randomized study of abdominal aortic surgery without postoperative nasogastric decompression.
Nasogastric decompression following abdominal aortic aneurysmectomy or bypass, for 3-4 days, is a routine part of postoperative care in many centers. A prospective randomized study of 80 patients undergoing abdominal aortic surgery was performed in order to determine the necessity of prolonged nasogastric decompression. Patients were divided evenly between removal of the nasogastric tube upon tracheal extubation and retention of the tube until the passage of flatus. ⋯ There were no significant differences in any of the measured variables between the two groups. The length of hospital stay was similar in both groups and three patients in each group required a nasogastric tube or reinsertion of one. In conclusion, the routine postoperative use of nasogastric tubes for abdominal aortic procedures is unnecessary.
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Acute renal insufficiency is a common complication after surgery for congenital cardiovascular defects in neonates and is associated with a high incidence of morbidity and mortality. The authors reviewed their experience with continuous venovenous haemofiltration in neonates and infants with acute renal insufficiency resulting from low cardiac output following cardiovascular surgery. Twelve critically ill patients with pharmacologically intractable fluid overload were treated with continuous venovenous haemofiltration over a period of 42 months. ⋯ No complications relating to continuous venovenous haemofiltration were evident during the treatment. The survival rate was 59% (seven of 12). Continuous venovenous haemofiltration is a valid and simple method for controlling fluid overload in neonates and infants with low cardiac output.
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Between January 1975 and December 1989, 1860 patients were admitted to the American University of Beirut Medical Centre with abdominal injuries. Their mean age was 23 years. Of these patients 107 had vascular injuries (an incidence of 6%). ⋯ Two subgroups with a higher mortality were identified: patients with inferior vena caval injury associated with a liver injury had a mortality rate of 78.5%, and those with vascular injury associated with pelvic fracture had a mortality rate of 57% (P < 0.05). Abdominal vascular injuries have a high mortality rate, especially if the inferior vena cava is involved or associated pelvic fractures are present. Prompt resuscitation and control of bleeding are the key to an improved salvage rate.
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Between January 1991 and June 1993, coronary artery bypass grafting was performed without either cardiopulmonary bypass or cardiac arrest in 23 patients. Most patients had several surgical risk factors, including age > or = 70 years, poor left ventricular function, left main coronary artery stenosis, chronic renal failure, and aortic aneurysm. Distal anastomoses were made under temporary interruption of coronary flow. ⋯ There was one hospital death. Postoperative angiography was performed in 22 patients and showed a patency rate of 89%. In summary, coronary artery bypass grafting without cardiopulmonary bypass may improve the postoperative outcome of high-risk patients.
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Adult respiratory distress syndrome, characterized by high permeability pulmonary oedema caused by endothelial cell damage, resulting in refractory hypoxemia, has a very high mortality. Cardiopulmonary bypass is said to be responsible for the development of adult respiratory distress syndrome after cardiac surgery. The present study was performed in order to identify predicting and aetiological factors of adult respiratory distress syndrome and multiple organ failure after cardiac surgery. ⋯ Preoperative predictors were identified. Cardiopulmonary bypass alone was not found to be an important factor. Postoperative low cardiac output leading to splanchnic hypoperfusion may be the most important single factor in developing adult respiratory distress syndrome after cardiac surgery.