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Papers by Penny Wilton

Research paper thumbnail of Abstract 29: Cardiac Surgery Episode Expenditures Associated With Healthcare-Associated Pneumonia

Circulation: Cardiovascular Quality and Outcomes, 2018

Objective: Pneumonia is the most common healthcare-associated infection (HAI) in patients undergo... more Objective: Pneumonia is the most common healthcare-associated infection (HAI) in patients undergoing cardiac surgery. While current efforts have focused on risk factors and clinical implications of pneumonia, few have examined its overall financial impact. Our objective was to compare 90-day episode expenditures for Medicare patients undergoing coronary artery bypass graft surgery (CABG) with and without pneumonia. Methods and Results: Using 2014-2015 Medicare Part A and B administrative claims data, we identified 50,550 patients undergoing isolated CABG. From this sample, we applied an established claims-based algorithm to identify 3,224 (6.4%) patients with new onset of pneumonia during their index admission and after their surgical procedure. Using generalized linear models, we found that average 90-day episode expenditures were 30% higher in patients with pneumonia ($55,442 vs. $42,745, p<0.001), adjusting for patient factors (age, sex, race, dual eligible status, and Elixhau...

Research paper thumbnail of Survey of Neuraxial Analgesia in Adult Cardiac surgery in the United Kingdom

Research paper thumbnail of The use of extracorporeal membrane oxygenation (ECMO) in severe delayed graft dysfunction after lung transplant

European Respiratory Journal, 2011

Introduction: Delayed graft dysfunction is an uncommon but serious complication in the first few ... more Introduction: Delayed graft dysfunction is an uncommon but serious complication in the first few days following successful lung transplantation and is associated with significant mortality. ECMO has been used in initial graft dysfunction with some success, but there have been few studies on its use in delayed graft failure. Objectives: To review the experience of using veno-venous (V-V) ECMO in patients with delayed graft dysfunction at Harefield Hospital from January 2010 to January 2011. Methods: A retrospective review of five cases of severe delayed graft failure requiring V-V ECMO was carried out. Results: Indications for lung transplant were COPD (2 patients), hypersensitivity pneumonitis (2 patients), pulmonary fibrosis and alpha-1 antitrypsin deficiency. Four patients (80%) were eventually discharged from hospital and are currently well with stable lung function and good functional status. One patient (20%) died 112 days after ECMO explantation. Mean transplant to implantatio...

Research paper thumbnail of Abstract 231: Does the Implementation of Pneumonia Prevention Practices Reduce Risk of Pneumonia Following Cardiac Surgery?

Circulation-cardiovascular Quality and Outcomes, 2018

Purpose: Pneumonia is the most prevalent healthcare-associated infection following isolated coron... more Purpose: Pneumonia is the most prevalent healthcare-associated infection following isolated coronary artery bypass surgery (CABG) and is associated with increased length of stay and mortality. Bund...

Research paper thumbnail of Does the implementation of pneumonia prevention practices reduce risk of pneumonia following cardiac surgery

Research paper thumbnail of Cardiac surgery episode expenditures associated with healthcare-associated pneumonia

Research paper thumbnail of Abstract 18: Center Variation in 90-Day Episode Expenditures for Cardiac Surgery - The Role of Healthcare-Associated Pnuemonia

Objective: Pneumonia is the most common healthcare-associated infection following cardiac surgery... more Objective: Pneumonia is the most common healthcare-associated infection following cardiac surgery, and associated with poorer clinical outcomes and substantially higher hospital costs. Less underst...

Research paper thumbnail of Evaluating the Impact of Pneumonia Prevention Recommendations After Cardiac Surgery

The Annals of Thoracic Surgery

Research paper thumbnail of Single cell transcriptomics identifies immunologic priming related to extra corporeal life support survival

As both sentinels and effectors of disease response, peripheral blood mononuclear cells are an ac... more As both sentinels and effectors of disease response, peripheral blood mononuclear cells are an accessible and attractive target for clinical application of high throughput, fluidics based single cell RNASeq (scRNASeq). However, new analytic tools required by unique characteristics of scRNASeq data lack validation in acutely ill patients. We report scRNASeq analysis of ~1,000 cells from each of 38 patients requiring veno-arterial extracorporeal life support (VA-ECLS)--a diverse group of critically ill patients experiencing circulatory collapse as a common endpoint to wide ranging diseases. We established an analysis pipeline capturing major biological signals from theses samples, confirmed by flow cytometry. Further, we found that these patients appeared immunologically poised at the outset of treatment as either reactive or permissive, and this balance predicted their survival. Annotated code detailing the analysis is available at https://github.com/vanandelinstitute/va_ecls.

Research paper thumbnail of The Effect of Acute Pulmonary Hypertension on Tricuspid Annular Height, Strain, and Curvature in Sheep

Cardiovascular Engineering and Technology

Research paper thumbnail of Engineering Analysis of Tricuspid Annular Dynamics in the Beating Ovine Heart

Annals of Biomedical Engineering

Research paper thumbnail of The effect of acute mechanical left ventricular unloading on ovine tricuspid annular size and geometry

Interactive cardiovascular and thoracic surgery, Sep 21, 2016

Left ventricular assist device (LVAD) implantation may alter right ventricular shape and function... more Left ventricular assist device (LVAD) implantation may alter right ventricular shape and function and lead to tricuspid regurgitation. This in turn has been reported to be a determinant of right ventricular (RV) failure after LVAD implantation, but the effect of mechanical left ventricular (LV) unloading on the tricuspid annulus is unknown. The aim of the study was to provide insight into the effect of LVAD support on tricuspid annular geometry and dynamics that may help to optimize LV unloading with the least deleterious effect on the right-sided geometry. In seven open-chest anaesthetized sheep, nine sonomicrometry crystals were implanted on the right ventricle. Additional nine crystals were implanted around the tricuspid annulus, with one crystal at each commissure defining three separate annular regions: anterior, posterior and septal. Left ventricular unloading was achieved by connecting a cannula in the left atrium and the aorta to a continuous-flow pump. The pump was used for...

Research paper thumbnail of The effect of pulmonary hypertension on ovine tricuspid annular dynamics†

European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery, Jan 8, 2015

Pulmonary hypertension (PHT) is associated with tricuspid annular dilatation, but the effect of a... more Pulmonary hypertension (PHT) is associated with tricuspid annular dilatation, but the effect of acute increase of pulmonary pressure on three-dimensional (3D) tricuspid annular dynamics and shape is unknown. Better understanding of tricuspid annular dynamics may lead to improved and more durable surgical reparative techniques. In nine open-chest anaesthetized sheep nine sonomicrometry crystals were implanted on the right ventricle while on cardiopulmonary bypass. Additional nine crystals were implanted around the tricuspid annulus (TA) with one crystal at each commissure defining three separate annular regions: anterior, posterior and septal. Two additional equidistant crystals were implanted between each commissure, creating three segments for every region. Pressure transducers were placed in the left ventricular (LV), right ventricular (RV) and right atrium. PHT was induced by acute pulmonary artery constriction with a pneumatic occluder. Sonomicrometry and echocardiographic data ...

Research paper thumbnail of Critical care outreach: implementation in a cardiothoracic centre

Introduction Community-acquired pneumonia remains a common condition worldwide. It is associated ... more Introduction Community-acquired pneumonia remains a common condition worldwide. It is associated with significant morbidity and mortality. The aim of this study was to evaluate conditions that could predict a poor outcome. Design Retrospective analyse of 69 patients admitted to the ICU from 1996 to 2003. Demographic data included age, sex and medical history. Etiologic agents, multiorgan dysfunction, nosocomial infections, SAPS II and PORT scores were recorded for each patient. For statistical analysis we used a t test, chi-square test and Mann-Whitney U test on SPSS ®. A value of P less than 0.05 was considered significant. Results Forty-seven patients were male and 22 patients were female. Mean age was 52 years. Sixty-seven percent had serious pre-morbid conditions including pulmonary disease (34.8%), cardiac problems (36.2%), diabetes (13%) and chronic liver disease (5.8%); 40.6% were smokers, drug abusers or alcohol dependents. Sixtyeight patients required invasive mechanical ventilation. The average length of ventilation was 13.5 days, median 8 days. The mean SAPS II score was 40.14 and the mean PORT score was 141. The mortality rate was 27.5% (SAPS II estimated mortality, 35%). Complications reported were ARDS (40.6%), septic shock (34.8%), acute renal failure (2.9%), cardiac arrest (8.7%) and nosocomial infeccions (46.4%). Mortality rates were higher for previous hepatic (75%) and metabolic (33%) diseases. We found a close association between crude mortality and SAPS II score (P = 0.003) and development of complications (P = 0.0028). Respiratory dysfunction (P = 0.006) and septic shock (P = 0.022) were most significantly related to mortality. No significant differences were founded regarding age, comorbidities, PORT score, etiologic agents, nosocomial infections and length of invasive mechanical ventilation. Conclusions Previous hepatic chronic disease was strictly related to higher mortality as well as isolation of MRSA. ARDS and septic shock predicted a poor outcome. SAPS II score was the best severity indicator of mortality. P2 Closed endotracheal suction system without periodic change versus open endotracheal system

Research paper thumbnail of Impact of critical care outreach on cardiac arrest rates and readmission rates in an adult cardiothoracic centre

Introduction Community-acquired pneumonia remains a common condition worldwide. It is associated ... more Introduction Community-acquired pneumonia remains a common condition worldwide. It is associated with significant morbidity and mortality. The aim of this study was to evaluate conditions that could predict a poor outcome. Design Retrospective analyse of 69 patients admitted to the ICU from 1996 to 2003. Demographic data included age, sex and medical history. Etiologic agents, multiorgan dysfunction, nosocomial infections, SAPS II and PORT scores were recorded for each patient. For statistical analysis we used a t test, chi-square test and Mann-Whitney U test on SPSS ®. A value of P less than 0.05 was considered significant. Results Forty-seven patients were male and 22 patients were female. Mean age was 52 years. Sixty-seven percent had serious pre-morbid conditions including pulmonary disease (34.8%), cardiac problems (36.2%), diabetes (13%) and chronic liver disease (5.8%); 40.6% were smokers, drug abusers or alcohol dependents. Sixtyeight patients required invasive mechanical ventilation. The average length of ventilation was 13.5 days, median 8 days. The mean SAPS II score was 40.14 and the mean PORT score was 141. The mortality rate was 27.5% (SAPS II estimated mortality, 35%). Complications reported were ARDS (40.6%), septic shock (34.8%), acute renal failure (2.9%), cardiac arrest (8.7%) and nosocomial infeccions (46.4%). Mortality rates were higher for previous hepatic (75%) and metabolic (33%) diseases. We found a close association between crude mortality and SAPS II score (P = 0.003) and development of complications (P = 0.0028). Respiratory dysfunction (P = 0.006) and septic shock (P = 0.022) were most significantly related to mortality. No significant differences were founded regarding age, comorbidities, PORT score, etiologic agents, nosocomial infections and length of invasive mechanical ventilation. Conclusions Previous hepatic chronic disease was strictly related to higher mortality as well as isolation of MRSA. ARDS and septic shock predicted a poor outcome. SAPS II score was the best severity indicator of mortality. P2 Closed endotracheal suction system without periodic change versus open endotracheal system

Research paper thumbnail of Effect of Left Ventricular Assist Device on Ovine Tricuspid Annular 3D Geometry

The Journal of Heart and Lung Transplantation, 2014

Research paper thumbnail of Effect of Pre-operative Albumin Level on Patient Outcomes after Implantation of Continuous Flow Left Ventricular Assist Device

The Journal of Heart and Lung Transplantation, 2014

Research paper thumbnail of Provision of intermittent renal replacement service outside an ICU is safe and effective

Research paper thumbnail of Outreach-led tracheostomy service in a cardiothoracic centre: early and safe facilitated discharge from critical care

Critical Care, 2007

Hydrogen sulfide is produced endogenously by a variety of enzymes involved in cysteine metabolism... more Hydrogen sulfide is produced endogenously by a variety of enzymes involved in cysteine metabolism. Clinical data indicate that endogenous levels of hydrogen sulfide are diminished in various forms of cardiovascular diseases. The aim of the current study was to investigate the effects of hydrogen sulfide supplementation on cardiac function during reperfusion in a clinically relevant experimental model of cardiopulmonary bypass. Twelve anesthetized dogs underwent hypothermic cardiopulmonary bypass. After 60 minutes of hypothermic cardiac arrest, reperfusion was started after application of either saline vehicle (control, n = 6), or the sodium sulfide infusion (1 mg/kg/hour, n = 6). Biventricular hemodynamic variables were measured by combined pressure-volume-conductance catheters. Coronary and pulmonary blood flow, vasodilator responses to acetylcholine and sodiumnitroprusside and pulmonary function were also determined. Administration of sodium sulfide led to a significantly better recovery of left and right ventricular systolic function (P < 0.05) after 60 minutes of reperfusion. Coronary blood flow was also significantly higher in the sodium sulfide-treated group (P < 0.05). Sodium sulfide treatment improved coronary blood flow, and preserved the acetylcholine-induced increases in coronary and pulmonary blood (P < 0.05). Myocardial ATP levels were markedly improved in the sulfide-treated group. Thus, supplementation of sulfide improves the recovery of myocardial and endothelial function and energetic status after hypothermic cardiac arrest during cardiopulmonary bypass. These beneficial effects occurred without any detectable adverse hemodynamic or cardiovascular effects of sulfide at the dose used in the current study.

Research paper thumbnail of Reversal of Severe Heart Failure With a Continuous-Flow Left Ventricular Assist Device and Pharmacological Therapy: A Prospective Study

Circulation, 2011

Background— We have previously shown that a specific combination of drug therapy and left ventric... more Background— We have previously shown that a specific combination of drug therapy and left ventricular assist device unloading results in significant myocardial recovery, sufficient to allow pump removal, in two thirds of patients with dilated cardiomyopathy receiving a Heartmate I pulsatile device. However, this protocol has not been used with nonpulsatile devices. Methods and Results— We report the results of a prospective study of 20 patients who received a combination of angiotensin-converting enzymes, β-blockers, angiotensin II inhibitors, and aldosterone antagonists followed by the β 2 -agonist clenbuterol and were regularly tested (echocardiograms, exercise tests, catheterizations) with the pump at low speed. Before left ventricular assist device insertion, patient age was 35.2±12.6 years (16 male patients), patients were on 2.0±0.9 inotropes, 7 (35) had an intra-aortic balloon pump, 2 were hemofiltered, 2 were ventilated, 3 had a prior Levitronix device, and 1 had extracorpor...

Research paper thumbnail of Abstract 29: Cardiac Surgery Episode Expenditures Associated With Healthcare-Associated Pneumonia

Circulation: Cardiovascular Quality and Outcomes, 2018

Objective: Pneumonia is the most common healthcare-associated infection (HAI) in patients undergo... more Objective: Pneumonia is the most common healthcare-associated infection (HAI) in patients undergoing cardiac surgery. While current efforts have focused on risk factors and clinical implications of pneumonia, few have examined its overall financial impact. Our objective was to compare 90-day episode expenditures for Medicare patients undergoing coronary artery bypass graft surgery (CABG) with and without pneumonia. Methods and Results: Using 2014-2015 Medicare Part A and B administrative claims data, we identified 50,550 patients undergoing isolated CABG. From this sample, we applied an established claims-based algorithm to identify 3,224 (6.4%) patients with new onset of pneumonia during their index admission and after their surgical procedure. Using generalized linear models, we found that average 90-day episode expenditures were 30% higher in patients with pneumonia ($55,442 vs. $42,745, p<0.001), adjusting for patient factors (age, sex, race, dual eligible status, and Elixhau...

Research paper thumbnail of Survey of Neuraxial Analgesia in Adult Cardiac surgery in the United Kingdom

Research paper thumbnail of The use of extracorporeal membrane oxygenation (ECMO) in severe delayed graft dysfunction after lung transplant

European Respiratory Journal, 2011

Introduction: Delayed graft dysfunction is an uncommon but serious complication in the first few ... more Introduction: Delayed graft dysfunction is an uncommon but serious complication in the first few days following successful lung transplantation and is associated with significant mortality. ECMO has been used in initial graft dysfunction with some success, but there have been few studies on its use in delayed graft failure. Objectives: To review the experience of using veno-venous (V-V) ECMO in patients with delayed graft dysfunction at Harefield Hospital from January 2010 to January 2011. Methods: A retrospective review of five cases of severe delayed graft failure requiring V-V ECMO was carried out. Results: Indications for lung transplant were COPD (2 patients), hypersensitivity pneumonitis (2 patients), pulmonary fibrosis and alpha-1 antitrypsin deficiency. Four patients (80%) were eventually discharged from hospital and are currently well with stable lung function and good functional status. One patient (20%) died 112 days after ECMO explantation. Mean transplant to implantatio...

Research paper thumbnail of Abstract 231: Does the Implementation of Pneumonia Prevention Practices Reduce Risk of Pneumonia Following Cardiac Surgery?

Circulation-cardiovascular Quality and Outcomes, 2018

Purpose: Pneumonia is the most prevalent healthcare-associated infection following isolated coron... more Purpose: Pneumonia is the most prevalent healthcare-associated infection following isolated coronary artery bypass surgery (CABG) and is associated with increased length of stay and mortality. Bund...

Research paper thumbnail of Does the implementation of pneumonia prevention practices reduce risk of pneumonia following cardiac surgery

Research paper thumbnail of Cardiac surgery episode expenditures associated with healthcare-associated pneumonia

Research paper thumbnail of Abstract 18: Center Variation in 90-Day Episode Expenditures for Cardiac Surgery - The Role of Healthcare-Associated Pnuemonia

Objective: Pneumonia is the most common healthcare-associated infection following cardiac surgery... more Objective: Pneumonia is the most common healthcare-associated infection following cardiac surgery, and associated with poorer clinical outcomes and substantially higher hospital costs. Less underst...

Research paper thumbnail of Evaluating the Impact of Pneumonia Prevention Recommendations After Cardiac Surgery

The Annals of Thoracic Surgery

Research paper thumbnail of Single cell transcriptomics identifies immunologic priming related to extra corporeal life support survival

As both sentinels and effectors of disease response, peripheral blood mononuclear cells are an ac... more As both sentinels and effectors of disease response, peripheral blood mononuclear cells are an accessible and attractive target for clinical application of high throughput, fluidics based single cell RNASeq (scRNASeq). However, new analytic tools required by unique characteristics of scRNASeq data lack validation in acutely ill patients. We report scRNASeq analysis of ~1,000 cells from each of 38 patients requiring veno-arterial extracorporeal life support (VA-ECLS)--a diverse group of critically ill patients experiencing circulatory collapse as a common endpoint to wide ranging diseases. We established an analysis pipeline capturing major biological signals from theses samples, confirmed by flow cytometry. Further, we found that these patients appeared immunologically poised at the outset of treatment as either reactive or permissive, and this balance predicted their survival. Annotated code detailing the analysis is available at https://github.com/vanandelinstitute/va_ecls.

Research paper thumbnail of The Effect of Acute Pulmonary Hypertension on Tricuspid Annular Height, Strain, and Curvature in Sheep

Cardiovascular Engineering and Technology

Research paper thumbnail of Engineering Analysis of Tricuspid Annular Dynamics in the Beating Ovine Heart

Annals of Biomedical Engineering

Research paper thumbnail of The effect of acute mechanical left ventricular unloading on ovine tricuspid annular size and geometry

Interactive cardiovascular and thoracic surgery, Sep 21, 2016

Left ventricular assist device (LVAD) implantation may alter right ventricular shape and function... more Left ventricular assist device (LVAD) implantation may alter right ventricular shape and function and lead to tricuspid regurgitation. This in turn has been reported to be a determinant of right ventricular (RV) failure after LVAD implantation, but the effect of mechanical left ventricular (LV) unloading on the tricuspid annulus is unknown. The aim of the study was to provide insight into the effect of LVAD support on tricuspid annular geometry and dynamics that may help to optimize LV unloading with the least deleterious effect on the right-sided geometry. In seven open-chest anaesthetized sheep, nine sonomicrometry crystals were implanted on the right ventricle. Additional nine crystals were implanted around the tricuspid annulus, with one crystal at each commissure defining three separate annular regions: anterior, posterior and septal. Left ventricular unloading was achieved by connecting a cannula in the left atrium and the aorta to a continuous-flow pump. The pump was used for...

Research paper thumbnail of The effect of pulmonary hypertension on ovine tricuspid annular dynamics†

European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery, Jan 8, 2015

Pulmonary hypertension (PHT) is associated with tricuspid annular dilatation, but the effect of a... more Pulmonary hypertension (PHT) is associated with tricuspid annular dilatation, but the effect of acute increase of pulmonary pressure on three-dimensional (3D) tricuspid annular dynamics and shape is unknown. Better understanding of tricuspid annular dynamics may lead to improved and more durable surgical reparative techniques. In nine open-chest anaesthetized sheep nine sonomicrometry crystals were implanted on the right ventricle while on cardiopulmonary bypass. Additional nine crystals were implanted around the tricuspid annulus (TA) with one crystal at each commissure defining three separate annular regions: anterior, posterior and septal. Two additional equidistant crystals were implanted between each commissure, creating three segments for every region. Pressure transducers were placed in the left ventricular (LV), right ventricular (RV) and right atrium. PHT was induced by acute pulmonary artery constriction with a pneumatic occluder. Sonomicrometry and echocardiographic data ...

Research paper thumbnail of Critical care outreach: implementation in a cardiothoracic centre

Introduction Community-acquired pneumonia remains a common condition worldwide. It is associated ... more Introduction Community-acquired pneumonia remains a common condition worldwide. It is associated with significant morbidity and mortality. The aim of this study was to evaluate conditions that could predict a poor outcome. Design Retrospective analyse of 69 patients admitted to the ICU from 1996 to 2003. Demographic data included age, sex and medical history. Etiologic agents, multiorgan dysfunction, nosocomial infections, SAPS II and PORT scores were recorded for each patient. For statistical analysis we used a t test, chi-square test and Mann-Whitney U test on SPSS ®. A value of P less than 0.05 was considered significant. Results Forty-seven patients were male and 22 patients were female. Mean age was 52 years. Sixty-seven percent had serious pre-morbid conditions including pulmonary disease (34.8%), cardiac problems (36.2%), diabetes (13%) and chronic liver disease (5.8%); 40.6% were smokers, drug abusers or alcohol dependents. Sixtyeight patients required invasive mechanical ventilation. The average length of ventilation was 13.5 days, median 8 days. The mean SAPS II score was 40.14 and the mean PORT score was 141. The mortality rate was 27.5% (SAPS II estimated mortality, 35%). Complications reported were ARDS (40.6%), septic shock (34.8%), acute renal failure (2.9%), cardiac arrest (8.7%) and nosocomial infeccions (46.4%). Mortality rates were higher for previous hepatic (75%) and metabolic (33%) diseases. We found a close association between crude mortality and SAPS II score (P = 0.003) and development of complications (P = 0.0028). Respiratory dysfunction (P = 0.006) and septic shock (P = 0.022) were most significantly related to mortality. No significant differences were founded regarding age, comorbidities, PORT score, etiologic agents, nosocomial infections and length of invasive mechanical ventilation. Conclusions Previous hepatic chronic disease was strictly related to higher mortality as well as isolation of MRSA. ARDS and septic shock predicted a poor outcome. SAPS II score was the best severity indicator of mortality. P2 Closed endotracheal suction system without periodic change versus open endotracheal system

Research paper thumbnail of Impact of critical care outreach on cardiac arrest rates and readmission rates in an adult cardiothoracic centre

Introduction Community-acquired pneumonia remains a common condition worldwide. It is associated ... more Introduction Community-acquired pneumonia remains a common condition worldwide. It is associated with significant morbidity and mortality. The aim of this study was to evaluate conditions that could predict a poor outcome. Design Retrospective analyse of 69 patients admitted to the ICU from 1996 to 2003. Demographic data included age, sex and medical history. Etiologic agents, multiorgan dysfunction, nosocomial infections, SAPS II and PORT scores were recorded for each patient. For statistical analysis we used a t test, chi-square test and Mann-Whitney U test on SPSS ®. A value of P less than 0.05 was considered significant. Results Forty-seven patients were male and 22 patients were female. Mean age was 52 years. Sixty-seven percent had serious pre-morbid conditions including pulmonary disease (34.8%), cardiac problems (36.2%), diabetes (13%) and chronic liver disease (5.8%); 40.6% were smokers, drug abusers or alcohol dependents. Sixtyeight patients required invasive mechanical ventilation. The average length of ventilation was 13.5 days, median 8 days. The mean SAPS II score was 40.14 and the mean PORT score was 141. The mortality rate was 27.5% (SAPS II estimated mortality, 35%). Complications reported were ARDS (40.6%), septic shock (34.8%), acute renal failure (2.9%), cardiac arrest (8.7%) and nosocomial infeccions (46.4%). Mortality rates were higher for previous hepatic (75%) and metabolic (33%) diseases. We found a close association between crude mortality and SAPS II score (P = 0.003) and development of complications (P = 0.0028). Respiratory dysfunction (P = 0.006) and septic shock (P = 0.022) were most significantly related to mortality. No significant differences were founded regarding age, comorbidities, PORT score, etiologic agents, nosocomial infections and length of invasive mechanical ventilation. Conclusions Previous hepatic chronic disease was strictly related to higher mortality as well as isolation of MRSA. ARDS and septic shock predicted a poor outcome. SAPS II score was the best severity indicator of mortality. P2 Closed endotracheal suction system without periodic change versus open endotracheal system

Research paper thumbnail of Effect of Left Ventricular Assist Device on Ovine Tricuspid Annular 3D Geometry

The Journal of Heart and Lung Transplantation, 2014

Research paper thumbnail of Effect of Pre-operative Albumin Level on Patient Outcomes after Implantation of Continuous Flow Left Ventricular Assist Device

The Journal of Heart and Lung Transplantation, 2014

Research paper thumbnail of Provision of intermittent renal replacement service outside an ICU is safe and effective

Research paper thumbnail of Outreach-led tracheostomy service in a cardiothoracic centre: early and safe facilitated discharge from critical care

Critical Care, 2007

Hydrogen sulfide is produced endogenously by a variety of enzymes involved in cysteine metabolism... more Hydrogen sulfide is produced endogenously by a variety of enzymes involved in cysteine metabolism. Clinical data indicate that endogenous levels of hydrogen sulfide are diminished in various forms of cardiovascular diseases. The aim of the current study was to investigate the effects of hydrogen sulfide supplementation on cardiac function during reperfusion in a clinically relevant experimental model of cardiopulmonary bypass. Twelve anesthetized dogs underwent hypothermic cardiopulmonary bypass. After 60 minutes of hypothermic cardiac arrest, reperfusion was started after application of either saline vehicle (control, n = 6), or the sodium sulfide infusion (1 mg/kg/hour, n = 6). Biventricular hemodynamic variables were measured by combined pressure-volume-conductance catheters. Coronary and pulmonary blood flow, vasodilator responses to acetylcholine and sodiumnitroprusside and pulmonary function were also determined. Administration of sodium sulfide led to a significantly better recovery of left and right ventricular systolic function (P < 0.05) after 60 minutes of reperfusion. Coronary blood flow was also significantly higher in the sodium sulfide-treated group (P < 0.05). Sodium sulfide treatment improved coronary blood flow, and preserved the acetylcholine-induced increases in coronary and pulmonary blood (P < 0.05). Myocardial ATP levels were markedly improved in the sulfide-treated group. Thus, supplementation of sulfide improves the recovery of myocardial and endothelial function and energetic status after hypothermic cardiac arrest during cardiopulmonary bypass. These beneficial effects occurred without any detectable adverse hemodynamic or cardiovascular effects of sulfide at the dose used in the current study.

Research paper thumbnail of Reversal of Severe Heart Failure With a Continuous-Flow Left Ventricular Assist Device and Pharmacological Therapy: A Prospective Study

Circulation, 2011

Background— We have previously shown that a specific combination of drug therapy and left ventric... more Background— We have previously shown that a specific combination of drug therapy and left ventricular assist device unloading results in significant myocardial recovery, sufficient to allow pump removal, in two thirds of patients with dilated cardiomyopathy receiving a Heartmate I pulsatile device. However, this protocol has not been used with nonpulsatile devices. Methods and Results— We report the results of a prospective study of 20 patients who received a combination of angiotensin-converting enzymes, β-blockers, angiotensin II inhibitors, and aldosterone antagonists followed by the β 2 -agonist clenbuterol and were regularly tested (echocardiograms, exercise tests, catheterizations) with the pump at low speed. Before left ventricular assist device insertion, patient age was 35.2±12.6 years (16 male patients), patients were on 2.0±0.9 inotropes, 7 (35) had an intra-aortic balloon pump, 2 were hemofiltered, 2 were ventilated, 3 had a prior Levitronix device, and 1 had extracorpor...