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