Cardiac surgery patients present considerable variation in pre-operative hemodynamic variables (original) (raw)
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Environment-Behaviour Proceedings Journal
Early mobilization should begin 24 to 48 hours after ICU admission. Early mobilization is a progressive process determined by the patient's functional abilities and endurance. The study aims to identify the hemodynamic challenge changes in post-cardiac operation at the National Heart Institute (NIH) Malaysia. Results show a significant association of hemodynamic challenge changes in Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP), Mean Arterial Pressure (MAP), and Saturation of Peripheral Oxygenation (SPO2) with early mobilization post-cardiac. In conclusion, early mobilization is a safe practice for post-operative cardiac surgery. Further study is required for implementation in other various cases in Malaysia.
Iranian Heart Journal, 2020
Background: Advanced monitoring can lead to the early recovery of patients in complicated and high-risk surgical operations. The aim of this study was to evaluate the effects of advanced monitoring on the hemodynamics of patients undergoing cardiac surgery. Methods: In this study, patients undergoing cardiac surgery were divided into 2 groups of control and advanced monitoring. In each group, 25 patients were examined. The patients had moderate-to-severe left ventricular dysfunction (ejection fraction < 35%). The patients in the case group were placed on the FloTrac cardiac output monitor, which is used as a therapeutic guide in the operating room and the intensive care unit (ICU). Results: Upon ICU admission, the average stroke volume variation and the mean cardiac index in the advanced monitoring group in the first 6 hours were 10 and 2.7, respectively, and in the second 6 hours were 11 and 2.8, correspondingly. The mean serum level administered was 1000 cc in the first 6 hours and 500 cc in the second 6 hours. In the control group, the mean serum level administered was 2000 cc in the first 6 hours and 500 cc in the second 6 hours, which had a significant relationship between the 2 groups in the first 6 hours (P = 0.01). Additionally, 84% of the patients with advanced monitoring were extubated in the first 6 hours (P = 0.0). Conclusions: This study showed that cardiac surgery in patients with moderate-to-severe left ventricular dysfunction using advanced monitoring and goal-directed hemodynamic therapy based on the cardiac index, the stroke volume variation, and the stroke volume index reduced the duration of intubation after surgery.
Annals of Surgery, 1989
Among hypertensive and diabetic patients undergoing elective noncardiac surgery, preoperative status and intraoperative changes in mean arterial pressure (MAP) were evaluated as predictors of postoperative ischemic complications. Of 254 patients evaluated before operation and monitored during operation, 30 (12%) had postoperative cardiac death, ischemia, or infarction. Twenty-four per cent of patients with a previous myocardial infarction or cardiomegaly had an ischemic postoperative cardiac complication. Only 7% of those without either of these conditions sustained an ischemic complication. No other preoperative characteristics, including the presence of angina, predicted ischemic cardiac risk. Nineteen per cent of patients who had 20 mm Hg or more intraoperative decreases in MAP lasting 60 minutes or more had ischemic cardiac complications. Patients who had more than 20 mm Hg decreases in MAP lasting 5 to 59 minutes and more than 20 mm Hg increases lasting 15 minutes or more also had increased complications (p < 0.03). Changes in pulse were not independent predictors of complications and the use of the rate-pressure product did not improve prediction based on MAP alone. In conclusion patients with a previous infarction or radiographic cardiomegaly are at high risk for postoperative ischemic complications. Prolonged intraoperative increases or decreases of 20 mm or more in MAP also resulted in a significant increase in these potentially life-threatening surgical complications. I N THE LAST 20 years there have been numerous studies of the risk of perioperative ischemia among patients undergoing noncardiac surgery.'`5 Many of the studies relied on retrospective analysis of charts.2'4'5 Dr.
British Journal of Anaesthesia, 2005
Background. Prediction of the response of the left ventricular stroke volume to fluid administration remains an unsolved clinical problem. We compared the predictive performance of various haemodynamic parameters in the perioperative period in patients undergoing coronary artery bypass surgery. These parameters included static indicators of cardiac preload and functional parameters, derived from the arterial pressure waveform analysis. These included the systolic pressure variation (SPV) and its delta down component (dDown), pulse pressure variation (PPV), stroke volume variation (SVV), and a new parameter, termed the respiratory systolic variation test (RSVT), which is a measure of the slope of the lowest systolic pressure values during a standardized manoeuvre consisting of three successive incremental pressure-controlled breaths.
Surgery, 1997
Background. Previous investigations have suggested that preoperative invasive hemodynamic monitoring with "optimization" of cardiovascularfunction may favorably affect the outcome among patients undergoing peripheral vascular surgery. The purpose of this study was to evaluate the effect of fireoperative optimization of hemodynamic parameters on outcome in patients undergoing aortic reconstruction (AR) or limb salvage p rocedures (LSP) in a randomized, prospective clinical trial. Methods. All 72 patients who consented to participate in this study were admitted to the intensive care unit at least 12 hours before operation for placement of a pulmonary artery catheter (PAC). Patients who were randomized to the treatment group (n = 32) were "optimized" by adjusting their hemoglobin concentration, oxygen saturation (SaOz), cardiac out@.tt, or afterload until the mixed venous 0, saturation (SvOa) was at least 65 %. The control group (n = 40) underwent placement of a PAC and had oxygen transport parameters measured without any attempt to optimize SvOz Results. There were no significant dgf erences between the treatment and control groups with respect to age, gende7; type of o@ration, initial Acute Physiology and Chronic Health Evaluation (APACHE) II score, Sv02, pulmonary artery occlusion pressure, or cardiac index. All treatment patients achieved an
Therapeutics and Clinical Risk Management
Background: Major abdominal surgery (MAS) is associated with increased morbidity and mortality. The main objective of our study was to evaluate the predictive value of heart-rate variability (HRV) concerning development of postoperative complications in patients undergoing MAS. The secondary objectives were to identify the relationship of HRV and use of vasoactive drugs during anesthesia, intensive care unit length of stay (ICU-LOS), and hospital length of stay (H-LOS). Patients and methods: Sixty-five patients scheduled for elective MAS were enrolled in a prospective, single-center, observational study. HRV was measured by spectral analysis (SA) preoperatively during orthostatic load. Patients were divided according to cardiac autonomic reactivity (CAR; n=23) and non-cardiac autonomic reactivity (NCAR; n=30). Results: The final analysis included 53 patients. No significant difference was observed between the two groups regarding type of surgery, use of minimally invasive techniques or epidural catheter, duration of surgery and anesthesia, or the amount of fluid administered intraoperatively. The NCAR group had significantly greater intraoperative blood loss than the CAR group (541.7±541.9 mL vs 269.6±174.3 mL, p,0.05). In the NCAR group, vasoactive drugs were used during anesthesia more frequently (n=21 vs n=4; p,0.001), and more patients had at least one postoperative complication compared to the CAR group (n=19 vs n=4; p,0.01). Furthermore, the NCAR group had more serious complications (Clavien-Dindo $ Grade III n=6 vs n=0; p,0.05) and a greater number of complications than the CAR group (n=57 vs n=5; p,0.001). Significant differences were found for two specific subgroups of complications: hypotension requiring vasoactive drugs (NCAR: n=10 vs CAR: n=0; p,0.01) and ileus (NCAR: n=11 vs CAR: n=2; p,0.05). Moreover, significant differences were found in the ICU-LOS (NCAR: 5.7±3.5 days vs CAR: 2.6±0.7 days; p,0.0001) and H-LOS (NCAR: 12.2±5.6 days vs CAR: 7.2±1.7 days; p,0.0001). Conclusion: Preoperative HRV assessment during orthostatic load is objective and useful for identifying patients with low autonomic physiological reserves and high risk of poor postoperative course.
Critical Care, 2008
all 10 cities including the rural areas of the province of Kerman. All data were finally analyzed by SPSS software (version 11.5). Results On the basis of recorded statistical analysis, the mortality cases of human rabies in the province of Kerman during one decade was 10 persons (eight males and two females). One-half of them (50%) were bitten by dogs and the others (50%) by foxes. Among the reported deaths, 40% were from Kahnooj county (Jiroft region). The reported data indicated that 21,546 persons were bitten by animals during 10 years in the province of Kerman. The mean of age of the people who were bitten by dogs was 24.80 years (SD = ±14.6), while the mean age of the people who were bitten by foxes was 57.25 years (SD = ±1.50). There was a significant difference between the mean age of these two groups of the people (P < 0.05). The most frequent rate of injured people was reported in the age group 10-19 years old and the frequency rate of males (76.00%) was more than females (24.00%). Therefore, there was a statistically significant difference between males and females in this study (P < 0.01). About 60% of all persons that were bitten by animals were from rural areas and 40% of them were from urban areas (P < 0.05). Among the people who were bitten and injured by animals during one decade in the province of Kerman, 85.70% of them were not treated by the rabies prophylaxis treatment regimen. Among all of them who were bitten by animals, 50% were injured through hands and feet, 40%
Hemodynamics in off-pump surgery: normal versus compromised preoperative left ventricular function
European Journal of Cardio-Thoracic Surgery, 2005
Objective: Off-pump coronary surgery (OPCABG), avoiding cardiopulmonary bypass and cardioplegic arrest, seems to be a better choice in patients with poor baseline cardiac function. Since cardiocirculatory collapse could be induced by heart displacement in this group of patients at high risk, a greater pathophysiologic understanding of the hemodynamic derangements occurring in such patients is needed. Methods: Twentyeight elective OPCABG patients were evaluated for hemodynamic changes induced by heart displacement, using arterial thermodilution to measure cardiac output and global end-diastolic volume. Hemodynamic parameters were recorded: at baseline; during proper exposure and stabilization of each vessel; and at the end of surgery. Patients were divided into two groups, according to baseline ejection fraction (EF): group A (EFO30%; NZ16), group B (EF%30%; NZ12). Results: Heart displacement induced a significant drop in the cardiac and stroke index, with a lesser decrease of mean arterial pressure because of raised systemic vascular resistance. Preload, measured as global end diastolic volume, significantly decreased in group A, while it remained unchanged or increased in group B. Linear regression between the preload index and left ventricular stroke work was significant only in group A. Conclusions: Patients with poor baseline cardiac function can well tolerate OPCABG. However, the pathophysiologic modifications underlying the hemodynamic changes are different compared to those in patients with good preoperative cardiac performance.