The role of patient's profile and allogeneic blood transfusion in development of post-cardiac surgery infections: a retrospective study

Contains fulltext : 137068.pdf (publisher's version ) (Open Access)OBJECTIVES: We aimed to investigate the association of patient characteristics and allogeneic blood transfusion products in development of post-cardiac surgery nosocomial infections. METHODS: This retrospective study was conducted in 7888 patients undergoing cardiac surgery with median sternotomy and cardiopulmonary bypass. Multivariable logistic regression analysis was used for independent effect of variables on infections. RESULTS: A total of 970 (12.3%) patients developed one or several types of postoperative infections. Urinary (n = 351, 4.4%) and pulmonary tract infections (n = 478, 6.1%) occurred more frequently than sternal wound infections (superficial: n = 102, 1.3%, deep: n = 72, 0.9%) and donor site infections (n = 61, 0.8%). Interventions, including valve replacement (P = 0.002) and coronary artery bypass grafting combined with valve replacement (P = 0.012), were associated with increased risk of several types of postoperative infections. Patients' profiles changed substantially over the years; morbid obesity (P = 0.019), smoking (P = 0.001) and diabetes mellitus (P = 0.001) occur more frequently nowadays. Furthermore, surgical site infections showed to be related to morbid obesity (P < 0.001) and higher risk stratification (P = 0.031). Smoking (P < 0.001) and chronic obstructive pulmonary disease (P < 0.001) were related to pulmonary tract infections. In addition, diabetic patients developed more sepsis (P = 0.003) and advanced age was associated with development of urinary tract infections (P < 0.001). Even after correcting for other factors, blood transfusion was associated with all types of postoperative infection (P < 0.001). This effect remained present in both leucocyte-depleted and non-leucocyte-depleted transfusion. CONCLUSIONS: Our data showed that post-cardiac surgery infections occur more frequently in patients with predetermined risk factors. The amount of blood transfusions was integrally related to every type of postoperative infection

Impact of Intraoperative Events on Cerebral Tissue Oximetry in Patients Undergoing Cardiopulmonary Bypass

Item does not contain fulltextPrevious studies showed that decreased cerebral saturation during cardiac surgery is related to adverse postoperative outcome. Therefore, we investigated the influence of intraoperative events on cerebral tissue saturation in patients undergoing cardiac surgery with cardiopulmonary bypass (CPB). A total of 52 adult patients who underwent cardiac surgery using pulsatile CPB were included in this prospective explorative study. Cerebral tissue oxygen saturation (SctO2) was measured in both the left and right cerebral hemisphere. Intraoperative events, involving interventions performed by anesthesiologist, surgeon, and clinical perfusionist, were documented. Simultaneously, in-line hemodynamic parameters (partial oxygen pressure, partial carbon dioxide pressure, hematocrit, arterial blood pressure, and CPB flow rates) were recorded. Cerebral tissue saturation was affected by anesthetic induction (p < .001), placement of the sternal retractor (p < .001), and initiation (p < .001) as well as termination of CPB (p < .001). Placement (p < .001) and removal of the aortic cross-clamp (p = .026 for left hemisphere, p = .048 for right hemisphere) led to changes in cerebral tissue saturation. In addition, when placing the aortic crossclamp, hematocrit (p < .001) as well as arterial (p = .007) and venous (p < .001) partial oxygen pressures changed. Cerebral tissue oximetry effectively identifies changes related to surgical events or vulnerable periods during cardiac surgery. Future studies are needed to identify methods of mitigating periods of reduced cerebral saturation

An arterio-venous bridge for gradual weaning from adult veno-arterial extracorporeal life support

Purpose: Weaning from extracorporeal life support (ELS) is particularly challenging when cardiac recovery is slow, largely incomplete and hard to predict. Therefore, we describe an individualized gradual weaning strategy using an arterio-venous (AV) bridge incorporated into the circuit to facilitate weaning. Methods: Thirty adult patients weaned from veno-arterial ELS using an AV bridge were retrospectively analyzed. Serial echocardiography and hemodynamic monitoring were used to assess cardiac recovery and load responsiveness. Upon early signs of myocardial recovery, an AV bridge with an Hoffman clamp was added to the circuit and weaning was initiated. Support flow was reduced stepwise by 10-15% every 2 to 8 hours while the circuit flow was maintained at 3.5-4.5 L/min. Results: The AV bridge facilitated gradual weaning in all 30 patients (median age: 66 [53-71] years; 21 males) over a median period of 25 [8-32] hours, with a median support duration of 96 [31-181] hours. During weaning, the median left ventricular ejection fraction was 25% [15-32] and the median velocity time integral of the aortic valve was 16 cm [10-23]. Through the weaning period, the mean arterial blood pressure was maintained at 70 mmHg and the activated partial thromboplastin time was 60±10 seconds without additional systemic heparinization. Neither macroscopic thrombus formation in the ELS circuit during and after weaning nor clinically relevant thromboembolism was observed. Conclusion: Incorporation of an AV bridge for weaning from veno-arterial ELS is safe and feasible to gradually wean patients with functional cardiac recovery without compromising the circuit integrity. © SAGE Publications