Journal articles: 'Cardiothoracic Surgical Unit'

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Holzmann-Pazgal, Galit, Diane Hopkins-Broyles, Angela Recktenwald, Melinda Hohrein, Patricia Kieffer, Charles Huddleston, Sharma Anshuman, and Victoria Fraser. "Case-Control Study of Pediatric Cardiothoracic Surgical Site Infections." Infection Control & Hospital Epidemiology 29, no. 1 (January 2008): 76–79. http://dx.doi.org/10.1086/524323.

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A retrospective case-control study was performed to determine the risks and outcomes associated with pediatric cardiothoracic surgical site infection. Undergoing more than 1 cardiothoracic operative procedure, having preoperative infection, and undergoing surgery on a Monday were significant risk factors. Cardiothoracic surgical site infection increased hospital and pediatric intensive care unit length of stay. Deep surgical site infection significantly increased mortality.

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Mitchell, Jessica, Linda Bogar, and Nelson Burton. "Cardiothoracic Surgical Emergencies in the Intensive Care Unit." Critical Care Clinics 30, no. 3 (July 2014): 499–525. http://dx.doi.org/10.1016/j.ccc.2014.03.004.

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Ambrozic Powell, Frances. "Using Simulation Training in a Cardiothoracic Intensive Care Unit." AORN Journal 97, no. 6 (June 2013): 739–43. http://dx.doi.org/10.1016/j.aorn.2013.03.011.

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Beauchamp, K., S. Baker, C. McDaniel, W. Moser, DC Zalman, J. Balinghoff, AT Cheung, and M. Stecker. "Reliability of nurses' neurological assessments in the cardiothoracic surgical intensive care unit." American Journal of Critical Care 10, no. 5 (September 1, 2001): 298–305. http://dx.doi.org/10.4037/ajcc2001.10.5.298.

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BACKGROUND: Alterations in mental status are common among patients in the cardiothoracic surgical intensive care unit. Changes in mental status can be caused by metabolic factors, medications, or brain injury. In this setting, reliable, serial neurological evaluations are critical for assessing the effectiveness of treatment and the need for additional studies. OBJECTIVES: To estimate the reliability of the Rancho Los Amigos Cognitive Scale and the newly developed Neurologic Intensive Care Evaluation as measures of cognitive function in the cardiothoracic surgical intensive care unit. METHODS: Nurses used 1 of the 2 scales as part of routine neurological assessments of patients in the cardiothoracic surgical intensive care unit. For each test, scores of different observers were correlated and a reliability estimate formed. RESULTS: Interrater reliability was high for both evaluations (Rancho scale, 0.91; Neurologic Intensive Care Evaluation, 0.94). Correlations between the scores of different pairs of observers were also high (mean rho values, 0.84 for the Rancho scale and 0.77 for the Neurologic Intensive Care Evaluation). CONCLUSIONS: Both scales are reliable indicators of the neurological state of patients in the cardiothoracic surgical intensive care unit. These scales measure different, although limited, aspects of cognitive function. Each test was simple to administer and did not take more time than the standard nursing neurological examination. Most of the variability in scoring was related to the different degrees of stimulation used by examiners when assessing patients, not to differences in the interpretation of patients' responses.

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Brady, Lynette M., Maxine Thomson, Magaret A. Palmer, and John L. Harkness. "Successful control of endemic MRSA in a cardiothoracic surgical unit." Medical Journal of Australia 152, no. 5 (March 1990): 240–45. http://dx.doi.org/10.5694/j.1326-5377.1990.tb120917.x.

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Chaudhuri, Krish, Ros Woodfine, Paula Richardson, Svatka Micik, Craig Jurisevic, James Edwards, Rob Stuklis, and Mike Worthington. "Reporting of Clinical Risk Incidents in a Cardiothoracic Surgical Unit." Heart, Lung and Circulation 22, no. 6 (June 2013): 466–67. http://dx.doi.org/10.1016/j.hlc.2013.03.029.

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Pisano, Umberto, Robert Jeffrey, and George Gibson. "CABG & surgical infection. Observations from a Scottish cardiothoracic unit." International Journal of Surgery 11, no. 8 (October 2013): 613. http://dx.doi.org/10.1016/j.ijsu.2013.06.143.

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Meehan, DA, ME McRae, DA Rourke, C. Eisenring, and FA Imperial. "Analgesic administration, pain intensity, and patient satisfaction in cardiac surgical patients." American Journal of Critical Care 4, no. 6 (November 1, 1995): 435–42. http://dx.doi.org/10.4037/ajcc1995.4.6.435.

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BACKGROUND: Pain can adversely affect a patient's physiological and psychological recovery, yet little is known about the pain experience of cardiac surgical patients. OBJECTIVES: To examine nursing practice regarding analgesic administration and measure pain intensity and patient satisfaction with pain management practices. METHODS: To establish baseline nursing practice regarding analgesic administration, charts were reviewed retrospectively in 50 adult cardiac surgical patients, and the same information was collected concurrently for a prospective sample of 51 patients. The subjects completed visual analogue scales as a measure of pain intensity twice daily while in the cardiothoracic intensive care unit and Pain Relief Satisfaction Questionnaires on the day after transfer from the unit. RESULTS: Patients in the prospective group received significantly more analgesia. Pain intensity was moderate (4 or greater on the Visual Analogue Scale). Women had higher overall visual analogue scale scores than did men, 4.57 versus 3.70. Patients in whom an internal mammary artery had been used as a bypass graft had significantly higher scores compared with patients with vein grafts. The Pain Relief Satisfaction Questionnaire responses indicated that 96% of the patients experienced effective pain management in the cardiothoracic intensive care unit. CONCLUSIONS: Despite receiving analgesic doses twice those reported elsewhere for similar populations, the patients in this study reported moderate pain intensity. This finding was confounded by the fact that 96% expressed satisfaction with their pain management in the cardiothoracic intensive care unit. Frequent assessment and documentation of both pain and pain relief from interventions are necessary if the healthcare team is to implement an individualized analgesic regimen.

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Francis, Jeevan, Sneha Prothasis, Rutwik Hegde, Antony Attia, and Keith Buchan. "Management of temporary epicardial pacing wires in the cardiac surgical patient." British Journal of Hospital Medicine 82, no. 6 (June 2, 2021): 1–7. http://dx.doi.org/10.12968/hmed.2021.0079.

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Temporary epicardial pacing wires are used after cardiothoracic surgery to maintain a stable cardiac rhythm. They must be distinguished from the more commonly encountered transvenous temporary pacing wires, which are often used in coronary care units for the same purpose. Patients with temporary epicardial pacing wires may be transferred to hospital wards where these wires are not usually encountered, such as COVID wards, the general intensive care unit, the coronary care unit or general surgical wards if a laparotomy was required in the early period following cardiac surgery. Serious complications may arise in managing patients with temporary epicardial pacing wires, which are well known in the cardiothoracic unit but not so well known elsewhere in the hospital. This article discusses the dangers associated with the management of temporary epicardial pacing wires in adult patients, some of which are common to temporary transvenous pacing wires and others are unique to temporary epicardial pacing wires.

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Bouras, Christina, and Catherine Barrett. "Strategies to enhance patient-centred care in a cardiothoracic surgical unit." Practice Development in Health Care 6, no. 3 (2007): 150–64. http://dx.doi.org/10.1002/pdh.224.

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Weber, Stefan, Loreen A. Herwaldt, Louise-Anne McNutt, Paul Rhomberg, Pierre Vaudaux, Michael A. Pfaller, and Trish M. Perl. "An Outbreak ofStaphylococcus aureusin a Pediatric Cardiothoracic Surgery Unit." Infection Control & Hospital Epidemiology 23, no. 2 (March 2002): 77–81. http://dx.doi.org/10.1086/502010.

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Objective:To investigate an outbreak ofStaphylococcus aureussurgical-site infections.Design:Case–control study.Setting:Pediatric cardiothoracic surgery service of a tertiary-care university medical center.Method:Molecular typing was used to identify healthcare workers who carried the epidemic strain.Results:Three children acquired surgical-site infections caused by a single strain ofS. aureus. Fourteen (25%) of the staff members in the operating room and 17 (11%) on nursing units carried the epidemic strain (P= 01). A case–control study identified 4 healthcare workers who were associated statistically with the outbreak, 2 of whom (a cardiothoracic surgeon and a perfusionist) carried the epidemic strain in their nares. The surgeon also carried the epidemic strain on his hands. Each staff member who carried the epidemic strain was treated with mupirocin; those carrying the strain on their hands were required to wash their hands with chlorhexidine. The surgeon was not allowed to perform surgery until 2 of his hand cultures did not growS. aureus.Conclusions:Only three children were infected with the epidemic strain, but it was disseminated widely among staff who cared for children who underwent cardiothoracic surgery. No additional cases were identified after staff members who carried the epidemic strain were decolonized. Both classic epidemiologic methods and molecular typing techniques were necessary to identify the source and extent of this outbreak.

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Sochet, Anthony A., Alexander M. Cartron, Aoibhinn Nyhan, Michael C. Spaeder, Xiaoyan Song, Anna T. Brown, and Darren Klugman. "Surgical Site Infection After Pediatric Cardiothoracic Surgery." World Journal for Pediatric and Congenital Heart Surgery 8, no. 1 (December 29, 2016): 7–12. http://dx.doi.org/10.1177/2150135116674467.

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Background: Surgical site infection (SSI) occurs in 0.25% to 6% of children after cardiothoracic surgery (CTS). There are no published data regarding the financial impact of SSI after pediatric CTS. We sought to determine the attributable hospital cost and length of stay associated with SSI in children after CTS. Methods: We performed a retrospective, matched cohort study in a 26-bed cardiac intensive care unit (CICU) from January 2010 through December 2013. Cases with SSI were identified retrospectively and individually matched to controls 2:1 by age, gender, Risk Adjustment for Congenital Heart Surgery score, Society of Thoracic Surgeons–European Association for Cardiothoracic Surgery category, and primary cardiac diagnosis and procedure. Results: Of the 981 cases performed during the study period, 12 with SSI were identified. There were no differences in demographics, clinical characteristics, or intraoperative data. Median total hospital costs were higher in participants with SSI as compared to controls (US$219,573 vs US$82,623, P < .01). Children with SSI had longer median CICU length of stay (9 vs 3 days, P < .01), hospital length of stay (18 vs 8.5 days, P < .01), and duration of mechanical ventilation (2 vs 1 day, P < .01) and vasoactive administration (4.5 vs 1 day, P < .01). Conclusions: Children with SSI after CTS have an associated increase in hospital costs of US$136,950/case and hospital length of stay of 9.5 days/case. The economic burden posed by SSI stress the importance of infection control surveillance, exhaustive preventative measures, and identification of modifiable risk factors.

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Herfindal, Eric T., Linda R. Bernstein, and Donald T. Kishi. "Impact of Clinical Pharmacy Services on Prescribing on a Cardiothoracic/Vascular Surgical Unit." Drug Intelligence & Clinical Pharmacy 19, no. 6 (June 1985): 440–44. http://dx.doi.org/10.1177/106002808501900609.

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Morris, A., and C. Ward. "High incidence of vancomycin-associated leucopenia and neutropenia in a cardiothoracic surgical unit." Journal of Infection 22, no. 3 (May 1991): 217–23. http://dx.doi.org/10.1016/s0163-4453(05)80002-7.

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Mouline, Omar, Michael K. Wilson, Raj Puranik, and Tristan D. Yan. "Surgical Ventricular Restoration for Ischaemic Heart Failure: Experience of the Royal Prince Alfred Hospital Cardiothoracic Surgical Unit." Heart, Lung and Circulation 20, no. 4 (April 2011): 265. http://dx.doi.org/10.1016/j.hlc.2010.11.035.

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Karcher, Christian, Craig Jurisevic, Tim Southwood, David McCormack, Amy Rogers, Adrian Levine, and Joel Dunning. "The Australasian ANZSCTS/ANZICS guidelines on cardiothoracic advanced life support (CALS-ANZ)." Critical Care and Resuscitation 24, no. 3 (September 6, 2022): 218–23. http://dx.doi.org/10.51893/2022.3.sa3.

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Every year, more than 15 000 patients undergo cardiac surgery in Australia and NewZealand. 1 The overall incidence of cardiac arrest after cardiac surgery is between 0.7% and5.2%. 2, 3, 4, 5, 6 Most cardiac arrests occur within 24 hours of surgery, with up to 50% occurring in the first 3 hours following intensive care unit (ICU)admission. 2, 7 Compared with other in-hospital cardiac arrests, survival in this patient population is high (75% v 39%). 2, 8 The reasons for this include the high degree of cardiac monitoring; a high proportion of reversible causes, such as pericardial tamponade or haemorrhage, and the effects of internal cardiacmassage. 9, 10, 11 The application of standard advanced life support protocols in post-surgical cardiothoracic patients may lead to avoidable adverse events, and hence, specific resuscitation protocols have been developed and established in Europe and NorthAmerica. 12

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McMahon, Colin J., Karim Ayoubi, Rania Mehanna, Eithne Phelan, Eoin O’Cearbhaill, John Russell, and Lars Nölke. "Outcome of congenital tracheal stenosis in children over two decades in a national cardiothoracic surgical unit." Cardiology in the Young 30, no. 1 (November 20, 2019): 34–38. http://dx.doi.org/10.1017/s1047951119002725.

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AbstractObjective:To assess the outcomes of congenital tracheal stenosis among children.Materials and methods:A retrospective review of all children who underwent surgical repair of congenital tracheal stenosis reviewing charts, operative notes, echocardiograms, CT and MRI data from January 2002 to February 2019.Results:Twenty-six children underwent surgical treatment for tracheal stenosis. The median age was 3 months (range 0.3–35 months) and the median weight was 4.7 kg (range 2.5–13 kg) at the time of surgical intervention. Stridor was the most common presenting symptom in 17 patients (65% of patients). Twenty-one patients (81%) had concurrent cardiac anomalies, with pulmonary arterial sling being the most common, present in nine patients (34%). Extracorporeal life support was utilised in seven patients (27%) pre-operatively. Laryngeal release was required in 16 patients. In 7 patients an end-to-end anastomosis was performed, in 18 patients slide tracheoplasty, and 1 patient had a double slide tracheoplasty. The median cardiopulmonary bypass time was 106 minutes (range 25–255 minutes). The median cross-clamp time was 30 minutes (range 5–67 minutes). The median post-operative duration of ventilation was 5 days (range 0.5–16 days). The median ICU length of stay was 12.5 days (range 2–60 days). There were three hospital mortalities with 88% survival. One patient only required reintervention with balloon dilation. Twenty-two patients (85%) remained symptom-free on median follow-up at 7.6 years (range 0.2–17 years). Two patients since 2017 had 3D printed tracheas produced from CT imaging to assist surgical planning.Conclusion:Congenital tracheal stenosis can be managed effectively with excellent outcomes and 3D printed models assist in planning the optimal surgical intervention.

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Hamilton, D. I., and A. K. Bozkurt. "Surgical Correction of Congenital Heart Defects in Adults." Scottish Medical Journal 37, no. 3 (June 1992): 76–80. http://dx.doi.org/10.1177/003693309203700305.

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From April 1987 to April 1991, 30 patients over the age of 15 years underwent surgery for congenital heart defects in the adult department of the ***Professorial Unit of Cardiothoracic Surgery, Royal Infirmary of Edinburgh. Eighteen were females (60%) and 12 were males (40%). Ages ranged from 15 to 68 years (mean 38.1). Six patients 20% had undergone previous cardiac surgery. Operative and hospital mortality was zero. Major postoperative complications occurred in three patients. In the follow-up period between three months and four years, there has been one late death. The spectrum of patients with congenital heart defects over the age of 15 was reviewed. The relatively late presentation of these defects and the indications for operating in adult life are discussed.

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Sahu, Manoj Kumar, Seshagiribabu Yagani, Sarvesh Pal Singh, Ummed Singh, Dharmraj Singh, and Shivam Panday. "Postoperative Fluid Therapy in Adult Cardiac Surgical Patients and Acute Kidney Injury: A Prospective Observational Study." Journal of Cardiac Critical Care TSS 06, no. 02 (July 2022): 114–19. http://dx.doi.org/10.1055/s-0042-1755434.

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Abstract Background Normal saline (0.9% NS) is a common intravenous fluid used worldwide. Recent studies have shown that NS use is associated with increased incidence of acute kidney injury (AKI) and a need for renal replacement therapy (RRT). The practice is changing toward using balanced solutions to prevent AKI. Postcardiac surgery patients are more prone to develop AKI after cardiopulmonary bypass (CPB). We aim to study the type of fluid administrated, incidence of AKI, need for RRT, and overall outcome of these patients. Methods This prospective observational study was conducted in the cardiothoracic intensive care unit (cardiothoracic and vascular surgery intensive care unit) in a cohort of 197 adult patients who underwent on pump cardiac surgery in our hospital from July 2021 to October 2021 as a pilot study. Data was analyzed using SPSS 20.0 (IBM, Chicago, Illinois, United States). A p-value < 0.05 was considered significant. Results In our study, 58 (29.34%) patients developed AKI in the first three postoperative days and 16 (8.12%) patients required RRT. Incidence of AKI was found to be higher in patients who received NS only, as fluid of choice was 34.48% compared with other intravenous fluids. Patients with AKI had higher positive fluid balance (p < 0.001), longer CPB (p < 0.001), and aortic cross clamp (p = 0.006) times. Intensive care unit and hospital stay and mortality rates were higher in AKI patients than those without AKI (p < 0.001). Conclusion Our study demonstrated that NS was the commonly used crystalloid in our patients and was associated with increased incidence of AKI and RRT when compared with other balanced salts solutions.

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Simon, P., W. Zwoelfer, Ch Rosenits, A. N. Owen, F. Coraim, and W. Mohl. "Transaesophageal echocardiography in the management of patients in the surgical and cardiothoracic intensive care unit." Journal of Cardiothoracic Anesthesia 4, no. 6 (December 1990): 133. http://dx.doi.org/10.1016/0888-6296(90)90204-s.

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Laws, Elaine Gillian, and Susan Elizabeth Gwynne. "1305: A nursing challenge: The nursing organization of a mixed cardiological and cardiothoracic surgical unit." European Journal of Cardiovascular Nursing 5, no. 1_suppl (May 2006): 5. http://dx.doi.org/10.1177/14745151060050s105.

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Cox, Jill, and Sharon Roche. "Vasopressors and Development of Pressure Ulcers in Adult Critical Care Patients." American Journal of Critical Care 24, no. 6 (November 1, 2015): 501–10. http://dx.doi.org/10.4037/ajcc2015123.

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Background Vasopressors are lifesaving agents used to raise mean arterial pressure in critically ill patients in shock states. The pharmacodynamics of these agents suggest vasopressors may play a role in development of pressure ulcers; however, this aspect has been understudied. Objective To examine associations between type, dose, and duration of vasopressors (norepinephrine, epinephrine, vasopressin, phenylephrine, dopamine) and development of pressure ulcers in medical-surgical and cardiothoracic intensive care unit patients and to examine predictors of the development of pressure ulcers in these patients. Methods A retrospective correlational design was used in a sample of 306 medical-surgical and cardiothoracic intensive care unit patients who received vasopressor agents during 2012. Results Norepinephrine and vasopressin were significantly associated with development of pressure ulcers; vasopressin was the only significant predictor in multivariate analysis. In addition, mean arterial pressure less than 60 mm Hg in patients receiving vasopressors, cardiac arrest, and mechanical ventilation longer than 72 hours were predictive of development of pressure ulcers. Patients with a cardiac diagnosis at the time of admission to the intensive care unit were less likely than patients without such a diagnosis to experience pressure ulcers while in the unit. Conclusion The addition of vasopressin administered concomitantly with a first-line agent (often norepinephrine) may represent the point at which the risk for pressure ulcers escalates and may be an early warning to heighten strategies to prevent pressure ulcers. Conversely, because vasopressors cannot be terminated to avert development of pressure ulcers, these findings may add to the body of knowledge on factors that potentially contribute to the development of unavoidable pressure ulcers.

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Sahasrabudhe, Parag B., Mugdha D. Pradhan, Nikhil Panse, and Ranjit Jagtap. "Post-CABG Deep Sternal Wound Infection: A Retrospective Comparative Analysis of Early versus Late Referral to a Plastic Surgery Unit in a Tertiary Care Center." Indian Journal of Plastic Surgery 54, no. 02 (April 2021): 157–62. http://dx.doi.org/10.1055/s-0041-1731256.

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Abstract Background Deep sternal wound infections (DSWI) following median sternotomy are initially treated by the cardiothoracic surgeons and are referred to a plastic surgical unit late in the course of time. Methods This is a retrospective review done in a tertiary care teaching institute from January 2005 to June 2018 and the data of 72 patients who had DSWI out of 4,214 patients who underwent median sternotomy for coronary artery bypass grafting (CABG) was collected with respect to the duration between CABG and presentation of DSWI as well as time of referral to a plastic surgery unit. We defined early referral as < or equal to 15 days from presentation and late referral as > 15 days. Both groups were compared with respect to multiple parameters as well as early and late postoperative course, postoperative complications, and mortality. Results The early group had 33 patients, while the late group had 39 patients. The number of procedures done by the cardiothoracic team before referral to the plastic surgery unit is significant (p = 0.002). The average duration from the presentation of DSWI to definitive surgery was found to be 16.58 days in the early group and 89.36 days in the late group. The rest of the variables that were compared in both the groups did not have significant differences. Conclusion There is no statistical difference between early and late referral to plastic surgery in terms of mortality and morbidity. Yet, early referrals could lead to highly significant reduction in total duration of hospital stay, wound healing, and costs. Early referral of post-CABG DSWIs to Plastic surgeons by the cardiothoracic surgeons is highly recommended.

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Ajeigbe, Teslimat, Basmal Ria, Emma Wates, and Samuel Mattine. "Severe parapharyngeal abscess that developed significant complications: management during the COVID-19 pandemic." BMJ Case Reports 13, no. 12 (December 2020): e236449. http://dx.doi.org/10.1136/bcr-2020-236449.

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A 50-year-old Caucasian man presented to the emergency department during the early stages of the COVID-19 pandemic with a rapidly progressive facial swelling, fever, malaise and myalgia. The patient had recently travelled to a COVID-19-prevalent European country and was therefore treated as COVID-19 suspect. The day before, the patient sustained a burn to his left forearm after falling unconscious next to a radiator. A CT neck and thorax showed a parapharyngeal abscess, which was surgically drained, and the patient was discharged following an intensive care admission. He then developed mediastinitis 3 weeks post-discharge which required readmission and transfer to a cardiothoracic unit for surgical drainage. This report discusses the evolution of a deep neck space infection into a mediastinitis, a rare and life-threatening complication, despite early surgical drainage. This report also highlights the difficulties faced with managing patients during the COVID-19 pandemic.

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Schellenberg, Morgan, Lauren Hawley, Subarna Biswas, Damon H. Clark, and J. Perren Cobb. "Complications Following Brachial Arterial Catheterization in the Surgical Intensive Care Unit." American Surgeon 86, no. 10 (October 2020): 1260–63. http://dx.doi.org/10.1177/0003134820964211.

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Clinically, complication rates of brachial arterial catheterization appear to far exceed those of the radial or common femoral arteries. The study objective was to define the complication rate after brachial arterial line insertion. All patients undergoing arterial line placement to the brachial artery in the surgical intensive care units (SICUs) at our institution were retrospectively identified and included in the study (January 2016-December 2018). Demographics, complications (distal ischemia, thrombosis/dissection, brachial sheath hematoma, catheter-related sepsis, and inadvertent dislodgement), and outcomes were collected and analyzed. Over the study period, 53 patients underwent brachial arterial catheterization. Common admitting services were cardiothoracic surgery (n = 31, 58%), transplant surgery (n = 7, 13%), and neurosurgery (n = 4, 7%). The mean age was 55 ± 17 58 (24-84) years, and 58% (n = 31) were male. The hospital length of stay (LOS) was 37 ± 35 23 (1-132) days, and ICU LOS was 30 ± 27 20 (1-127) days. Mortality was 57% (n = 30). Complications of brachial arterial line placement occurred in 21 patients (40%). In summary, brachial arterial catheters were associated with high mortality and prolonged ICU length of stay. This likely reflects the critically ill nature of patients in whom conventional-site arterial line placement is not possible. Complications following brachial arterial catheterization were unacceptably high. On this basis, we recommend that the brachial artery be avoided whenever possible for arterial line placement in the SICU.

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Fukuhara, Shinya, Shinji Tomita, Takeshi Nakatani, Toshiya Fujisato, Yoshinori Ohtsu, Michiko Ishida, Chikao Yutani, and Soichiro Kitamura. "Current address: Shinji Tomita, MD, Cardiothoracic Surgical Unit, Level 4, Auckland City Hospital, Auckland, New Zealand." Circulation Journal 69, no. 7 (2005): 850–57. http://dx.doi.org/10.1253/circj.69.850.

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Chen, Qiong, Yanchun Peng, Yanjuan Lin, Sailan Li, Xizhen Huang, and Liang-Wan Chen. "Atypical Sleep and Postoperative Delirium in the Cardiothoracic Surgical Intensive Care Unit: A Pilot Prospective Study." Nature and Science of Sleep Volume 12 (December 2020): 1137–44. http://dx.doi.org/10.2147/nss.s275698.

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Takahashi, Mitsuko, Shinobu Itagaki, Jessica Laskaris, Farzan Filsoufi, and Ramachandra C. Reddy. "Percutaneous Tracheostomy Can be Safely Performed in Patients with Uncorrected Coagulopathy after Cardiothoracic Surgery." Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery 9, no. 1 (January 2014): 22–26. http://dx.doi.org/10.1097/imi.0000000000000041.

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Objective It is a common situation after cardiothoracic surgery that a tracheostomy is required for patients who are coagulopathic or on therapeutic anticoagulation. We present our results of percutaneous tracheostomy with uncorrected coagulopathy. Methods Between 2007 and 2012, a total of 149 patients in our Cardiothoracic Surgical Intensive Care Unit underwent percutaneous tracheostomy using the Ciaglia Blue Rhino system (Cook Medical, Bloomington, IN USA). The patients were divided into coagulopathic (platelets, ≤50,000; international normalized ratio of prothrombin time, ≥1.5; and/or partial thromboplastin time, ≥50) and noncoagulopathic groups. Coagulopathy, if present before percutaneous tracheostomy, was not routinely corrected. Results A total of 75 patients (49%) were coagulopathic. Twenty-one patients (14%) had two or more criteria. The coagulopathic patients had a lower platelet count [108 (106) vs 193 (111) (thousands), P < 0.001], with the lowest of 10; higher international normalized ratio of prothrombin time [1.7 (0.6) vs 1.2 (0.1), P < 0.001], with the highest of 5.3; longer partial thromboplastin time [40 (13) vs 33 (7) seconds, P < 0.001], with the longest of 85; and higher total bilirubin [4.6 (7.3) vs 1.9 (3.3) mg/dL, P = 0.005]. Patient demographics and comorbidities were comparable between the groups. No patients had overt bleeding. One coagulopathic patient (1.3%) had clinical oozing treated with packing, as opposed to zero in the noncoagulopathic patients ( P = 1.00). There were no patients with posttracheostomy mediastinitis or late tracheal stenosis. Conclusions Uncorrected coagulopathy and therapeutic anticoagulation did not increase bleeding risk for percutaneous tracheostomy in our cardiothoracic surgical patients.

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Elmetwaly, Rasha M., and Reham A. E. El Sayed. "Chest Tube Removal: Efficacy of Cold Application and Breathing Exercise on Pain and Anxiety Level." Evidence-Based Nursing Research 2, no. 4 (October 8, 2020): 12. http://dx.doi.org/10.47104/ebnrojs3.v2i4.159.

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Context: Post-cardiothoracic surgical chest tube removal (CTR) is considered a painful technique and one of the most painful patients' experiences in the intensive care unit. Painkillers are the most prevalent method to relieve the pain, but the patient may not respond well and achieved complete relaxation. Regardless of scientific advances, no efficient action is possessed to decrease pain and anxiety because of it. Aim: This study aimed to investigate the efficacy of cold application and breathing exercises on pain and anxiety levels following chest tube removal. Methods: A quasi-experimental design (one group pre/post-test) was utilized to achieve the aim. This study was conducted in the Intensive Care Unit at the Cardio-Thoracic Academy Affiliated to Ain Shams University Hospital, Cairo. A Purposive sample included 60 patients undergoing cardiothoracic surgical procedures and having at least two chest tubes in place. Data were collected using three tools; a structured interviewing questionnaire, pain intensity assessment visual numeric scale, short-form McGill pain assessment questionnaire, modified comfort scale, and breathing exercise checklist. Results: This study revealed that patients suffer from severe pain before CTR without cold application and breathing exercise (61.7%), or with the application of them (66.7%), the pain level improved during removal as 80% of patients display no pain when using the cold application and breathing exercise that increased to 95% after 10-15 minute of removal compared to 8.3% when cold application and breathing exercise not used. Otherwise, the anxiety level decreased during CTR as 58.3% had mild anxiety level with cold application and breathing exercises compared to 38.3% had a very severe anxiety level. Mild anxiety level increased to 91.7% after 10-15 minutes of CTR compared to 16.7 % when CTR without application. Conclusion: Cold application and breathing exercises are useful for reducing patients' pain and anxiety levels associated with chest tube removal after cardiothoracic surgery. Encouraging critical care nurses to use cold application and breathing exercises as a non-pharmacological pain relief technique during chest tube removal was highly recommended.

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Trongtrakul, Konlawij, Jayanton Patumanond, Piyarat Phairatwet, Chaiwut Sawawiboon, Anusang Chitsomkasem, Sathit Kurathong, Surasee Prommoon, Thananda Trakarnvanich, and Phichayut Phinyo. "External Validation of the Acute Kidney Injury Risk Prediction Score for Critically Ill Surgical Patients Who Underwent Major Non-Cardiothoracic Surgery." Healthcare 9, no. 2 (February 15, 2021): 209. http://dx.doi.org/10.3390/healthcare9020209.

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Background: Acute kidney injury (AKI) is a common complication encountered in an intensive care unit (ICU). In 2020, the AKI prediction score was developed specifically for critically ill surgical patients who underwent major non-cardiothoracic surgeries. This study aimed to externally validate the AKI prediction score in terms of performance and clinical utility. Methods: External validation was carried out in a prospective cohort of patients admitted to the ICU of the Faculty of Medicine Vajira Hospital between September 2014 and September 2015. The endpoint was AKI within seven days following ICU admission. Discriminative ability was based on the area under the receiver operating characteristic curves (AuROC). Calibration and clinical usefulness were evaluated. Results: A total of 201 patients were included in the analysis. AKI occurred in 37 (18.4%) patients. The discriminative ability dropped from good in the derivation cohort, to acceptable in the validation cohort (0.839 (95%CI 0.825–0.852) vs. 0.745 (95%CI 0.652–0.838)). No evidence of lack-of-fit was identified (p = 0.754). The score had potential clinical usefulness across the range of threshold probability from 10 to 50%. Conclusions: The AKI prediction score showed an acceptable discriminative performance and calibration with potential clinical usefulness for predicting AKI risk in surgical patients who underwent major non-cardiothoracic surgery.

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Mechanick, Jeffrey I., and Corey Scurlock. "Glycemic Control and Nutritional Strategies in the Cardiothoracic Surgical Intensive Care Unit—2010: State of the Art." Seminars in Thoracic and Cardiovascular Surgery 22, no. 3 (September 2010): 230–35. http://dx.doi.org/10.1053/j.semtcvs.2010.10.006.

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Nand, Parma, Indran Ramanathan, and Mark Webster. "Paradigm Shift in Aortic Surgery in Green Lane Cardiothoracic Surgical Unit at Auckland City Hospital 2002–2009." Heart, Lung and Circulation 20, no. 1 (January 2011): 44. http://dx.doi.org/10.1016/j.hlc.2010.10.023.

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Ditmyer, CE, M. Shively, DB Burns, and RT Reichman. "Comparison of continuous with intermittent bolus thermodilution cardiac output measurements." American Journal of Critical Care 4, no. 6 (November 1, 1995): 460–65. http://dx.doi.org/10.4037/ajcc1995.4.6.460.

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BACKGROUND: Few complete studies have been published to validate the agreement between continuous cardiac output and intermittent thermodilution cardiac output. OBJECTIVE: To analyze the agreement between cardiac output measurements by the continuous thermodilution method and the intermittent bolus thermodilution method, using a continuous cardiac output catheter in postoperative cardiothoracic surgery patients. METHODS: A convenience sample of 14 adult cardiothoracic surgical patients with thermodilution pulmonary artery catheters placed preoperatively was used. A total of 214 comparison measurements of cardiac output by both the continuous and intermittent thermodilution methods were taken on patient admission to the critical care unit, every 4 hours, and with any change greater than 10% from baseline readings. RESULTS: The intraclass correlation between continuous cardiac output and intermittent cardiac output was .89. The limits of agreement were -1.34 to 1.18 L/min, indicating that in 95% of readings the difference between continuous cardiac output and intermittent cardiac output were within this range. CONCLUSIONS: The continuous cardiac output monitoring method shows clinically acceptable agreement with the intermittent cardiac output method.

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Shakeel, Muhammad, Julie Bruce, Shah Jehan, Timothy K. McAdam, and Duff M. Bruce. "Use of Complementary and Alternative Medicine by Patients Admitted to a Surgical Unit in Scotland." Annals of The Royal College of Surgeons of England 90, no. 7 (October 2008): 571–76. http://dx.doi.org/10.1308/003588408x301046.

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INTRODUCTION Within the UK there are 50,000 practitioners of complementary medicine. Five million people have consulted such practitioners in one year. The aim of this study was to explore the use of complementary and alternative medicine (CAM) in patients attending general, vascular and cardiothoracic units at a regional Scottish centre. PATIENTS AND METHODS A questionnaire was administered to 450 patients attending the units over an 8-week period. The questionnaire consisted of demographic sections, a listing of 48 herbal preparations and alternative therapies, reasons for use and opinions on efficacy. RESULTS A total of 430 patients completed questionnaires (95%); age and sex were equally distributed over the sample. Of respondents, 68% (291 patients) had ever used CAM; 46% had used CAM in the preceding year. Half had used herbal preparations only, 13% non-herbal treatments and 35% both types of therapy. Only 10% were using CAM for the condition that led to their hospital admission. Two-thirds failed to inform their family physician about their use of CAM. CONCLUSIONS Despite concerns regarding the efficacy, safety and cost-effectiveness of complementary medicine, use amongst surgical patients is common.

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Gardner, Genevieve, Doug Elliott, Jaswin Gill, Melanie Griffin, and Matthew Crawford. "Patient Experiences Following Cardiothoracic Surgery: An Interview Study." European Journal of Cardiovascular Nursing 4, no. 3 (September 2005): 242–50. http://dx.doi.org/10.1016/j.ejcnurse.2005.04.006.

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Background: Numerous studies have investigated patient outcomes of cardiac surgery, including some examining health-related quality of life. While these studies have provided some insight into patients' physical function, social abilities and perceived quality of life, studies examining the experiences of individuals recovering from cardiac surgery have received only limited investigation. Aims: This paper presents a thematic analysis of interviews conducted with patients recovering from cardiothoracic surgery, about their memories and experiences of hospital and recovery post-hospital discharge. Methods: Using an exploratory qualitative approach, eight participants were interviewed 6 months following their surgery. Transcripts of interviews were examined using a content analysis approach, with open coding of text and categorising of similar concepts into themes. Findings: Participants reported varying degrees of pain and physical dysfunction during their recovery from surgery and some had still not returned to optimal function. Seven themes emerged from the data: impressions of ICU; comfort/discomfort; being sick/getting better; companionship/isolation; hope/hopelessness; acceptance/apprehension; and life changes. A number of the themes were constructed as a continuum, with participants often demonstrating a range of views or experiences. Many had little or no memory of their stay in the intensive care unit, although others had vivid recollections. Their impressions of hospital were mostly positive, although many experienced fear, apprehension, and mood disturbances at some time during their recovery. Most participants recalled being sick, reaching a turning point, and then getting better. Many participants reported a change in life view since their recovery from surgery. Conclusions: Attention to specific areas of patient orientation, education and support was identified to facilitate realistic expectations of recovery. In addition, some form of systematic follow-up that focuses on patient recovery in terms of both physical and psychological function is important.

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Russo, Philip L., and Denis W. Spelman. "A New Surgical-Site Infection Risk Index Using Risk Factors Identified by Multivariate Analysis for Patients Undergoing Coronary Artery Bypass Graft Surgery." Infection Control & Hospital Epidemiology 23, no. 7 (July 2002): 372–76. http://dx.doi.org/10.1086/502068.

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Objectives:To develop a new, simple, and practical risk index for patients undergoing coronary artery bypass graft (CABG) surgery, to develop a preoperative risk index that is predictive of surgical-site infection (SSI), and to compare the new risk indices with the National Nosocomial Infections Surveillance (NNIS) System risk index.Design:Potential risk factor and infection data were collected prospectively and analyzed by multivariate analysis. Two new risk indices were constructed and then compared with the NNIS System risk index for predictive power for SSI.Setting:Alfred Hospital is a 350-bed, university-affiliated, tertiary-care referral center. The cardiothoracic unit performs approximately 650 CABG procedures per year.Patients:All patients undergoing CABG surgery within the cardiothoracic unit at Alfred Hospital between December 1, 1996, and September 29, 2000, were included.Results:Potential risk factor data were complete for 2,345 patients. There were 199 SSIs. Obesity (odds ratio [OR], 1.78; 95% confidence interval [CI95], 1.24 to 2.55), peripheral or cerebrovascular disease (OR, 1.64; CI95, 1.16 to 2.33), insulin-dependent diabetes mellitus (OR, 2.29; CI95, 1.15 to 4.54), and a procedure lasting longer than 5 hours (OR, 1.75; CI95,1.18 to 2.58) were identified as independent risk factors for SSI. With the use of a different combination of these risk factors, two risk indices were constructed and compared using the Goodman-Kruskal nonparametric correlation coefficient (G). Risk index B had the highest G value (0.3405; CI95, 0.2245 to 0.4565), compared with the NNIS System risk index G value (0.3142; CI95, 0.1462 to 0.4822). The G value for risk index A constructed from preoperative variables only, was 0.3299 (CI95 0.2039 to 0.4559).Conclusion:Two new risk indices have been developed. Both indices are as predictive as the NNIS System risk index. One of the new risk indices can also be applied preoperatively.

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Peel, Trisha N., Eliza Watson, Kelly Cairns, Ho Yin (Ashley) Lam, Heidi Zhangrong Li, Ganan Ravindran, Jayan Seneviratne, et al. "Perioperative antimicrobial decision making: Focused ethnography study in orthopedic and cardiothoracic surgeries in an Australian hospital." Infection Control & Hospital Epidemiology 41, no. 6 (March 18, 2020): 645–52. http://dx.doi.org/10.1017/ice.2020.48.

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AbstractObjective:Antimicrobial use in the surgical setting is common and frequently inappropriate. Understanding the behavioral context of antimicrobial use is a critical step to developing stewardship programs.Design:In this study, we employed qualitative methodologies to describe the phenomenon of antimicrobial use in 2 surgical units: orthopedic surgery and cardiothoracic surgery.Setting:This study was conducted at a public, quaternary, university-affiliated hospital.Participants:Healthcare professionals from the 2 surgical unit teams participated in the study.Methods:We used focused ethnographic and face-to-face semi-structured interviews to observe antimicrobial decision-making behaviors across the patient’s journey from the preadmission clinic to the operating room to the postoperative ward.Results:We identified 4 key themes influencing decision making in the surgical setting. Compartmentalized communication (theme 1) was observed with demarcated roles and defined pathways for communication (theme 2). Antimicrobial decisions in the operating room were driven by the most senior members of the team. These decisions, however, were delegated to more junior members of staff in the ward and clinic environment (theme 3). Throughout the patient’s journey, communication with the patient about antimicrobial use was limited (theme 4).Conclusions:Approaches to decision making in surgery are highly structured. Although this structure appears to facilitate smooth flow of responsibility, more junior members of the staff may be disempowered. In addition, opportunities for shared decision making with patients were limited. Antimicrobial stewardship programs need to recognize the hierarchal structure as well as opportunities to engage the patient in shared decision making.

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Di Bidino, Rossella, Luz Irene Urbina, Marco Oradei, and Amerigo Cicchetti. "Evaluation of the use of Floseal®, a topical hemostatic agent, in cardiothoracic surgery." Global & Regional Health Technology Assessment 7, no. 1 (May 20, 2020): 14–25. http://dx.doi.org/10.33393/grhta.2020.695.

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Introduction: Achieving haemostasis is critical in surgical procedures. Surgical bleeding is associated with an increased risk of mortality and morbidity with consequences at both clinical and organizational level, and with significant economic implications. In addition to conventional methods for controlling intraoperative bleeding, many topical adjunctive hemostatic products are available; among them Floseal® (Baxter Healthcare Corporation), a gelatin-based hemostatic matrix. The aim of this study is to provide an updated systematic literature review of Floseal® in cardiac surgery and estimate its associated economic impact in an Italian hospital. Methods: A literature search was conducted in MEDLINE and the Cochrane Library over the period 2013-2016 to identify new publications related to Floseal® in cardiac surgery, in addition to those already included in the systematic review of Echave et al. Furthermore, we investigated the economic impact of the use of Floseal® adapting the model elaborated by Tackett et al. to the Italian NHS. Four new studies were selected. Results: High variability in surgical procedures, choice of hemostatic products compared to Floseal® and outcome definition is confirmed. Clinical, organizational, and economics endpoints were investigated. A cost-consequence analysis estimated relevant savings. A scenario analysis, despite showing a high variability in patient level savings (€ 441-2.831), confirmed economic advantages associated with Floseal®. Discussion: Results support prior research both in terms of heterogeneity of evidence on the effectiveness of Floseal® in cardiac surgery and cost implications. The use of Floseal® achieves substantial cost savings in a hypothetical Italian hospital with a cardiac surgery unit.

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Morell, Emily, Jess Thompson, Satish Rajagopal, Elizabeth D. Blume, and Rachna May. "Congenital Cardiothoracic Surgeons and Palliative Care: A National Survey Study." Journal of Palliative Care 36, no. 1 (October 9, 2019): 17–21. http://dx.doi.org/10.1177/0825859719874765.

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Background: The majority of children with advanced heart disease in the inpatient setting die in an intensive care unit under 1 year of age following multiple interventions. While pediatric cardiology and palliative care provider attitudes have been described, little is known about pediatric cardiothoracic surgeon attitudes toward palliative care in children with advanced heart disease. Objective: To describe perspectives of pediatric cardiothoracic surgeons regarding palliative care in pediatric heart disease. Design: Cross-sectional web-based national survey. Results: Of the 220 surgeons who were e-mailed the survey, 36 opened the survey and 5 did not meet inclusion criteria (n = 31). Median years of practice was 23.5 (range: 12-41 years), and 87.1% were male. Almost all (90%) reported that they had experience consulting palliative care. While 68% felt palliative care consultation was initiated at the appropriate time, 29% felt it occurred too late. When asked the appropriate timing for palliative care consultation in hypoplastic left heart syndrome, 45% selected “at time of prenatal diagnosis” and 30% selected “when surgical and transcatheter options have been exhausted.” Common barriers to palliative care involvement included the perception of “giving up” (40%) and concern for undermining parental hope (36%). Conclusions: While a majority of pediatric cardiothoracic surgeons are familiar with palliative care, there is variation in perception of appropriate timing of consultation. Significant barriers to consultation still exist, including concern that parents will think they are “giving” up, undermining parental hope, and influence of palliative care on the medical care team’s approach.

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Demma, Linda J., Anne M. Winkler, and Jerrold H. Levy. "A Diagnosis of Heparin-Induced Thrombocytopenia With Combined Clinical and Laboratory Methods in Cardiothoracic Surgical Intensive Care Unit Patients." Survey of Anesthesiology 56, no. 4 (August 2012): 167–68. http://dx.doi.org/10.1097/sa.0b013e31825c1e89.

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Bissell, M. G. "A Diagnosis of Heparin-Induced Thrombocytopenia with Combined Clinical and Laboratory Methods in Cardiothoracic Surgical Intensive Care Unit Patients." Yearbook of Pathology and Laboratory Medicine 2013 (January 2013): 381–83. http://dx.doi.org/10.1016/j.ypat.2012.07.042.

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Demma, Linda J., Anne M. Winkler, and Jerrold H. Levy. "A Diagnosis of Heparin-Induced Thrombocytopenia with Combined Clinical and Laboratory Methods in Cardiothoracic Surgical Intensive Care Unit Patients." Anesthesia & Analgesia 113, no. 4 (October 2011): 697–702. http://dx.doi.org/10.1213/ane.0b013e3182297031.

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Chung, CH, and KK Lai. "Beware of the Migrating Chest Pain and Widened Mediastinum: Case Series on Aortic Dissection." Hong Kong Journal of Emergency Medicine 9, no. 2 (April 2002): 95–101. http://dx.doi.org/10.1177/102490790200900206.

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Objective Aortic dissection is not a rare life-threatening emergency. Undiagnosed and untreated aortic dissection is associated with a high mortality. A review of cases in the hospital may provide a baseline picture to guide clinical decisions. Design Retrospective case review for a period of 3 years and 4 months. Setting District general hospital near the Hong Kong – Shenzhen ‘border’ with 24-hour Accident & Emergency service but without cardiothoracic surgical capability. Population All cases coded as ‘aortic dissection’ in the computerized ‘Clinical Management System’ of the hospital. Main outcome measures Date, sex, age, history of hypertension, presenting symptoms, pulse deficit, chest X-ray findings, pericardial effusion, A&E diagnosis, type of dissection and patient outcome. Results From August 1998 to November 2001, 26 cases of aortic dissection were identified. There were 19 males and 7 females. Age range was 26 to 90 years (mean 65.04 ± SD 15.04, median 66.50, mode 65). In the plain chest X-rays, widened superior mediastinum (>8 cm) was present in 19 patients (73.1%) and pleural effusion in three (11.5%). Pericardial effusion was found in six patients (23.1%). As regard to outcome, 11 were discharged home (42.3%), 14 were transferred to cardiothoracic surgical unit (where two subsequently died) and one died in the hospital. Conclusion The prevalence of aortic dissection may be more common than is generally appreciated by emergency physicians. Owing to its variable clinical presentations mimicking other diseases, the diagnosis of aortic dissection is easily missed. Higher clinical vigilance should be exercised for this potentially deadly condition.

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Marek, Jan, Victoria Jowett, Sachin Khambadkone, and Victor Tsang. "In Memoriam: Professor Marc R. de Leval (April 16, 1941–June 26, 2022) – an exceptional, inspirational, and most modest man." Cardiology in the Young 32, no. 9 (September 2022): 1363–64. http://dx.doi.org/10.1017/s104795112200230x.

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AbstractProfessor Marc de Leval (16 April 1941 –26 June 2022) was a pioneer in the field of congenital cardiothoracic surgery and former chair of the British Congenital Cardiac Association [https://www.bcca-uk.org/]. Professor de Leval was appointed as a Consultant Cardiothoracic Surgeon at Great Ormond Street Hospital in 1974. Throughout his distinguished career at Great Ormond Street Hospital, he worked with dedication to improve outcomes for cardiothoracic surgery. His contribution to academic cardiothoracic surgery was significant and far-reaching with over 300 peer-reviewed publications. Of particular note was his work in improving the palliation of children with cyanotic congenital heart disease by the use of the modified Blalock-Thomas-Taussig shunt and his pioneering work over many years to improve understanding of the Fontan circulation using in vitro modelling and computational fluid dynamics that led to the development of the total cavopulmonary connection. His other significant contributions include the importance of analysing surgical failures, being the co-editor of the most readable textbook in our field, and so much more. During his career, he trained many eminent surgeons from around the world, and a Marc de Leval Fellowship of The American Association for Thoracic Surgery [https://www.aats.org/about-the-foundation/the-reach-of-our-programs/foundation-honoring-our-mentors-program/marc-r-de-leval-md] now allows the opportunity for a trainee to study congenital cardiac surgery in the UK or Europe. Marc is fondly remembered by the staff at Great Ormond Street Hospital. The nurses recall his arrival at the break of day on the intensive care unit, having already been for a swim, and the diligence with which he observed his patients following surgery. Former trainees remember a man who, despite his standing, always remained courteous, approachable, and kind. Professor de Leval will be remembered not only as a skilled and dedicated surgeon but also as a distinguished scholar, one with a quest for knowledge in the pursuit of excellence.

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Harte, Jeffrey, Germander Soothill, John Glynn David Samuel, Laurence Sharifi, and Mary White. "Hospital-Acquired Blood Stream Infection in an Adult Intensive Care Unit." Critical Care Research and Practice 2021 (July 3, 2021): 1–6. http://dx.doi.org/10.1155/2021/3652130.

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Background. Hospital-acquired blood stream infections are a common and serious complication in critically ill patients. Methods. A retrospective case series was undertaken investigating the incidence and causes of bacteraemia in an adult intensive care unit with a high proportion of postoperative cardiothoracic surgical and oncology patients. Results. 405 eligible patients were admitted to the intensive care unit over the course of nine months. 12 of these patients developed a unit-acquired blood stream infection. The average Acute Physiology And Chronic Health Evaluation II (APACHE II) score of patients who developed bacteraemia was greater than that of those who did not (19.8 versus 16.8, respectively). The risk of developing bacteraemia was associated with intubation and higher rates of invasive procedures. The mortality rate amongst the group of patients that developed bacteraemia was 33%; this is in contrast to the mortality rate in our unit as 27.2%. There was a higher proportion of Gram-negative bacteria isolated on blood cultures (9 out of 13 isolates) than in intensive care units reported in other studies. Conclusion. Critical-care patients are at risk of secondary bloodstream infection. This study highlights the importance of measures to reduce the risk of infection in the intensive-care setting, particularly in patients who have undergone invasive procedures.

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Sellars, Louise, and Sam Rudham. "Assessment for early discharge of cardiothoracic surgical patients: Results of a pilot study conducted in one private intensive care unit." Australian Critical Care 30, no. 2 (March 2017): 129. http://dx.doi.org/10.1016/j.aucc.2017.02.055.

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Haines, Daniel, Johanna Hild, Jianghua He, Lucy Stun, Angie Ballew, Justin L. Green, Lewis Satterwhite, and Brigid C. Flynn. "A Retrospective, Pilot Study of De Novo Antidepressant Medication Initiation in Intensive Care Unit Patients and Post-ICU Depression." Critical Care Research and Practice 2017 (2017): 1–5. http://dx.doi.org/10.1155/2017/5804860.

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Post-ICU Syndromes (PICS) remain a devastating problem for intensive care unit (ICU) survivors. It is currently unknown if de novo initiation of an antidepressant medication during ICU stay decreases the prevalence of post-ICU depression. We performed a retrospective, pilot study evaluating patients who had not previously been on an antidepressant medication and who were started on an antidepressant while in the trauma surgical, cardiothoracic, or medical intensive care unit (ICU). The PHQ-2 depression scale was used to ascertain the presence of depression after ICU discharge and compared this to historical controls. Of 2,988 patients admitted to the ICU, 69 patients had de novo initiation of an antidepressant medication and 27 patients were alive and available for study inclusion. We found the prevalence of depression in these patients to be 26%, which is not statistically different than the prevalence of post-ICU depression in historical controls [95% CI (27.6%, 51.6%)]. De novo initiation of an antidepressant medication did not substantially decrease the prevalence of post-ICU depression in this retrospective, pilot study.

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Hinton, Jonathan, George Hunter, Madhava Dissanayake, and Rob Hatrick. "Acute respiratory distress secondary to a huge chronic left ventricular pseudo-aneurysm." Echo Research and Practice 6, no. 4 (September 2019): K19—K22. http://dx.doi.org/10.1530/erp-19-0018.

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Summary Pseudo-aneurysms are a rare, potentially life-threatening complication of a myocardial infarction. We present the case of a 45-year-old male who was brought to the emergency department in extremis and had a previous history of a late presentation inferior ST-elevation myocardial infarction treated percutaneously. Clinical examination revealed evidence of cardiogenic shock, pulmonary edema and a pulsatile epigastric mass. Chest X-ray demonstrated marked cardiomegaly and pulmonary edema. Urgent echocardiography confirmed the presence of a huge basal inferior wall pseudo-aneurysm with bi-directional flow. This was also associated with severe mitral regurgitation, due to posterior mitral annular involvement. The patient was transferred to the local cardiothoracic surgical unit where he underwent emergency repair of the pseudo-aneurysm and mitral valve replacement. Despite the surgery being complex he made a full recovery.

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Daly, A., P. Cullen, J. McGuinness, M. Redmond, and L. Nolke. "25 The surgical workload of adult congenital heart disease at the national cardiothoracic and transplant unit, Ireland: a 5 year review." Heart 101, Suppl 5 (September 2015): A14—A15. http://dx.doi.org/10.1136/heartjnl-2015-308621.25.

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Hamid, Safraz, Frederic Joyce, Aaliya Burza, Billy Yang, Alexander Le, Ahmad Saleh, and Robert S. Poston. "OR and ICU teams ‘running in parallel’ at the end of cardiothoracic surgery improves perceptions of handoff safety." BMJ Open Quality 10, no. 1 (February 2021): e001001. http://dx.doi.org/10.1136/bmjoq-2020-001001.

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The transfer of a cardiac surgery patient from the operating room (OR) to the intensive care unit (ICU) is both a challenging process and a critical period for outcomes. Information transferred between these two teams—known as the ‘handoff’—has been a focus of efforts to improve patient safety. At our institution, staff have poor perceptions of handoff safety, as measured by low positive response rates to questions found in the Agency for Health Care Research and Quality (AHRQ) Hospital Survey on Patient Safety Culture (HSOPS). In this quality improvement project, we developed a novel handoff protocol after cardiac surgery where we invited the ICU nurse and intensivist into the OR to receive a face-to-face handoff from the circulating nurse, observe the final 30 min of the case, and participate in the end-of-case debrief discussions. Our aim was to increase the positive response rates to handoff safety questions to meet or surpass the reported AHRQ national averages. We used plan, do, study, act cycles over the course of 123 surgical cases to test how our handoff protocol was leading to changes in perceptions of safety. After a 10-month period, we achieved our aim for four out of the five HSOPS questions assessing safety of handoff. Our results suggest that having an ICU team ‘run in parallel’ with the cardiac surgical team positively impacts safety culture.

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Journal articles on the topic 'Cardiothoracic Surgical Unit'

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