Articles: outcome.
-
Interact Cardiovasc Thorac Surg · Dec 2004
Does the use of topical tranexamic acid in cardiac surgery reduce the incidence of post-operative mediastinal bleeding?
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether the use of topical tranexamic acid reduces the incidence of post-operative mediastinal bleeding. ⋯ We conclude that, only 1 RCT exists to answer this question, which demonstrated a clinically small benefit in favour of topical tranexamic acid in low risk patients. Further RCTs should be performed prior to any further use of topical tranexamic acid as a strategy to reduce post-operative bleeding.
-
Interact Cardiovasc Thorac Surg · Dec 2004
In aortic arch surgery is there any benefit in using antegrade cerebral perfusion or retrograde cerebral perfusion as an adjunct to hypothermic circulatory arrest?
A best evidence topic in cardiothoracic surgery was written according to a structured protocol. The question addressed was whether patients having aortic arch surgery benefit from antegrade or retrograde cerebral perfusion in addition to hypothermic circulatory arrest to reduce neurological injury or mortality. ⋯ The author, journal, date and country of publication, patient group studied, study type, relevant outcomes, results, and study weaknesses of these papers are tabulated. We conclude that antegrade cerebral perfusion is superior as an adjunct to hypothermic circulatory arrest when compared to retrograde cerebral perfusion or hypothermic circulatory arrest alone, although clinical evidence for this from prospective clinical trials is weak.
-
Anemia is common in acute critically ill patients. Although blood loss, either by trauma, surgery, phlebotomies or gastrointestinal bleeding, may play a role, the anemia in these patients bears many similarities to the anemia characteristic of chronic disease. Serum iron is low with a high concentration of ferritin and low-to-normal transferrin and serum transferrin receptor levels. ⋯ In individual situations, such as in cardiovascular and cancer patients, higher thresholds may be appropriate. The administration of rh-EPO is an alternative to reduce the need for red blood cell transfusions and to avoid transfusion-related complications. Although its efficacy has been shown, questions regarding cost-benefit, dose regimen and clinical outcomes need to be answered before its large-scale use can be recommended.
-
Heart, lung & circulation · Dec 2004
Hand-assisted Thoracoscopic Surgery causes less postoperative pain than limited thoracotomy after cessation of epidural analgesia.
Hand-assisted Thoracoscopic Surgery (HATS) is a novel minimally invasive technique for performing procedures conventionally performed by posterolateral thoracotomy. HATS overcomes a major drawback of thoracoscopic surgery in allowing full manual palpation of the lungs via a subcostal (mini-Kocher's) incision under videoscopic guidance, avoiding a thoracotomy, when the indication is pulmonary metastasectomy with curative intent or resection of undiagnosed lung nodules. It is postulated HATS may produce improved postoperative quality of life outcomes compared to thoracotomy. ⋯ HATS results in lower postoperative pain after cessation of epidural analgesia. This form of analgesia may therefore not be required, reducing the management complexity, complications and hospital stay associated with its use. SHORT ABSTRACT: Hand-assisted Thoracoscopic Surgery (HATS) is a novel technique allowing full manual lung palpation as an adjunct to Video-assisted Thoracoscopic Surgery (VATS). Fifty-two patients were prospectively randomised to receive limited thoracotomy or HATS. Pain scores were significantly lower after HATS compared to thoracotomy, indicating epidural analgesia may not be required.
-
To assess the consistency of caloric intake with American College of Chest Physicians (ACCP) recommendations for critically ill patients and to evaluate the relationship of caloric intake with clinical outcomes. ⋯ Study participants were underfed relative to ACCP targets. These targets, however, may overestimate needs because moderate caloric intake (ie, 33% to 65% of ACCP targets; approximately 9 to 18 kcal/kg per day) was associated with better outcomes than higher levels of caloric intake.