4 research outputs found
Does lactate clearance prognosticates outcomes in ECMO therapy: a retrospective observational study
Abstract Background ECMO support is a final treatment modality for patients in the refractory cardiogenic arrest and postcardiotomy cardiogenic shock with an utmost importance. Eventhough it is linked to high mortality, its usage gains popularity worldwide. We assessed the fluctuation of lactate levels and the clearance of lactate during the ECMO therapy and its prognostic role on mortality. Methods Data were gathered on all patients receiving ECMO therapy longer than 48 h between January 2015 and December 2017 retrospectively. Blood lactate had been recorded before ECMO implantation and at specific time points during ECMO support as a routine procedure. In this study, the Lactate clearance at specific time points (Lactate clearance-1) and the duration that lactate cleared more than 10% of the initial lactate level (Lactate clearance-2) was measured. Statistical analysis included Mann Whitney U-test and ROC-curves to predict 30-day mortality. Results Fourty-eight patients underwent ECMO therapy for refractory cardiogenic shock resulting in 70.8% mortality. The lactate levels before and after ECMO therapy as well as the dynamic changes were significantly correlated with mortality variable. With AUC calculation, LC-2 has a strong discrimination (AUC = 0.97) on 30-day survivors and nonsurvivors. LAE-LBE (AUC = 0.785), L48-LBE (AUC = 0.706) showed moderate predictive power on 30-day mortality. Conclusions Changes in lactate levels after ECMO implantation is an important tool to assess effective circulatory support and it is found superior to single lactate measurements as a prognostic sign of mortality in our study. Based on our results, an early insertion of ECMO before lactate gets high was suggested. Serial changes on lactate levels and calculation of its clearance may be superior to single lactate on both effective circulatory support and as prognostic prediction. LC-2 showed a strong discrimination on 30-day mortality
Early Against Classic Extubation Outcomes Following Cardiac Surgery and Correlation With Rapid Shallow Breath Index
AbstractBackground/Aims:Overnight
postoperative ventilation following cardiovascular surgery was a
routine procedure since 1960 and the usage of high-dose opioid
anesthetic techniques strengthens the need. However early extubation
of postcardiac patients has been claimed as safer and more
cost-effective approach. Rapid shallow breath index (RSBI) is used
widely to standardize weaning from Mechanical ventilatory support
(MVS) and to predict failure of attempt. The aim of this
retrospective study was to determine the impact of early extubation
on post-cardiovasular surgery patients and the possible correlations
of RSBI values.
Methods:This
retrospective analysis was performed including 230 consecutive
patients -who underwent cardiac surgery from September 2017 to
January 2018 in a tertiary state hospital.Results:There
was significant difference between early extubated group and
conventional group in the prevalence of comorbidities, duration of
surgery, LOS in hospital and in the ICU. There was no significant
difference between groups either in mechanical ventilation parameters
including RSBI, mortality or morbidity.Conclusions: Early
extubation offers a substantial advantage in terms of accelerated
recovery, shorter intensive care unit, and hospital stay, suggesting
that efforts to reduce extubation times are cost-effective. Early
Extubation following cardiac surgery can be managed in a successful
manner and comparing to conventional practices it saves valuable
hours of patients. RSBI, in the original cut-off point, was found
useless as a weaning parameter while the threshold value for weaning
failure was 31
Our interventional lung assist experience with tracheoesophageal fistula in intensive care unit: A case report
A tracheoesophageal fistula (TEF) is a congenital or acquired communication between the trachea and esophagus. Acquired TEF is a rare but serious clinical entity. Here, we report the treatment of a patient with interventional lung assist (ILA) in the course of TEF -related hipercarbia and respiratory acidosis as a result of failure of protective ventilation strategy and his outcome after treatment. iLA contains a specially designed low resistance lung membrane, which uses the pressure difference between the arterial and venous circulation. This system enables the use of high airway pressures for oxygenation in combination with very low tidal volumes to avoid ventilator-induced lung injury and this gives time to patient for lung recovery. [Med-Science 2018; 7(1.000): 238-242