Journal of cardiothoracic and vascular anesthesia
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J. Cardiothorac. Vasc. Anesth. · Aug 2021
Observational StudyFluid Status After Cardiac Surgery Assessed by Bioelectrical Impedance Vector Analysis and the Effects of Extracorporeal Circulation.
Hydration status after cardiac surgery can be difficult to assess, often requiring invasive measurements. Bioelectrical impedance vector analysis (BIVA) is based on patterns of resistance (R) and reactance (Xc), corrected by height, and has been used in various clinical scenarios to determine body composition and monitor its changes over time. The purpose of the present study was to apply this method in cardiac surgery patients to assess the variation in hydration status and to compare its changes according to the use of extracorporeal circulation. ⋯ Fluid status assessment with BIVA in cardiac surgery showed an increase in total body water up to 24 hours after surgery. Off-pump surgery prevented overhydration, which partially could explain the reduction in some of the postoperative complications. BIVA could serve as a useful method for monitoring fluid status in the setting of goal-directed therapy to assist in maintaining euvolemia in cardiac surgical patients.
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J. Cardiothorac. Vasc. Anesth. · Aug 2021
Observational StudyPrognostic Value of Soluble Urokinase-Type Plasminogen Activator Receptor and High-Sensitivity C-Reactive Protein on Postoperative Mortality in Patients Undergoing Elective On-Pump Cardiac Surgery.
Elevated soluble urokinase-type plasminogen activator receptor (suPAR) and high-sensitivity C-reactive protein (hsCRP) have been associated with increased mortality in patients with cardiovascular disease. The aim of the present study was to explore the relationship between suPAR and hsCRP values and associated mortality after elective cardiac surgery. A secondary aim was to assess whether a combined risk model of European System for Cardiac Operative Risk Evaluation (EuroSCORE II), suPAR, and/or hsCRP would improve the prognostic accuracy compared with EuroSCORE II alone. ⋯ Elevated preoperative levels of suPAR and hsCRP were associated with all-cause mortality in elective cardiac surgery patients. However, inclusion of biomarkers did not improve the prognostic accuracy of EuroSCORE II.
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J. Cardiothorac. Vasc. Anesth. · Aug 2021
Using Machine Learning to Predict Postoperative Liver Dysfunction After Aortic Arch Surgery.
The study compared machine-learning models with traditional logistic regression to predicting liver outcomes after aortic arch surgery. ⋯ The machine-learning method of naïve Bayes predicts PLD after aortic arch surgery significantly better than traditional logistic regression.
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J. Cardiothorac. Vasc. Anesth. · Aug 2021
Simplified Algorithm for Evaluation of Perioperative Hypoxia and Hypotension (SALVATION): A Practical Echo-guided Approach Proposal.
Despite the valuable use of modern applications of perioperative ultrasound across multiple disciplines, there have been limitations to its implementation, restricting its impact on patient-based clinical outcomes. Point-of-care ultrasound evaluation of hypoxia and hypotension is an important tool to assess the underlying undifferentiated etiologies in a timely manner. ⋯ The authors here propose a simple, sequential and focused multiorgan approach, applicable for the evaluation of perioperative hypotension and hypoxia in emergency scenarios. The authors believe this approach will enhance the care provided in the postanesthesia care unit, operating room, and intensive care unit.
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J. Cardiothorac. Vasc. Anesth. · Aug 2021
Observational StudyU-Shaped Association Between Intraoperative Net Fluid Balance and Risk of Postoperative Recurrent Atrial Tachyarrhythmia Among Patients Undergoing the Cryo-Maze Procedure: An Observational Study.
The ability of perioperative fluid management to prevent postoperative recurrence of atrial tachyarrhythmia remains controversial. The aim of the present study was to assess if intraoperative net fluid balance was associated with atrial tachyarrhythmia recurrence after the Cryo-Maze procedure. ⋯ There is a significant U-shaped association between intraoperative net fluid balance and early atrial tachyarrhythmia recurrence among patients undergoing the Cryo-Maze procedure.