The Effect of Dexmedetomidine Infusion vs. Morphine on Duration of Mechanical Ventilation in CABG: A Clinical Trial

Background: No single and ideal method has been proposed so far to decrease the time of mechanical ventilation while maintaining patients' hemodynamic stability after coronary bypass surgery. This study aimed to compare the effect of Dexmedetomidine and Morphine infusion on the latter parameters in patients after coronary artery bypass graft surgery in the intensive care unit. Materials and Methods: In this clinical trial study, 60 patients undergoing coronary artery bypass graft surgery were divided into two groups (N=30): the first group receiving Morphine and the second group receiving Dexmedetomidine. At admission to the ICU in the first group, Morphine was injected at a dose of 0.25 mg/kg, and in the second group, Dexmedetomidine was injected at a dose of 1 μg/kg for 10 minutes. Hemodynamic parameters and blood gas levels at preoperative cardiac care were compared between the two groups at the time of endotracheal tube withdrawal. Results: The trend of hemodynamic changes and blood gas levels during the intensive care unit stay did not differ between the two groups. The mean duration of mechanical ventilation in the Morphine group was 10.63/2 2.31 hours and in the Dexmedetomidine group was 9.77/1 1.92 hours, and there was no significant difference between the two groups (p=0.12). Conclusion: both Morphine and Dexmedetomidine had similar effects on hemodynamic stability and blood gas levels; however, Dexmedetomidine was associated with fewer drug-related side effects; so, it seems wise to consider Dexmedetomidine superior to Morphine in the postoperative period of CABG patients

Assessment of Central Venous Catheterization Using Electrocardiographic versus Landmark Techniques in Pediatrics Undergoing Open Heart Surgery; Which Technique is Superior?

Introduction: Central venous catheterization has been usually performed during major surgeries in order of central venous pressure assessment and fluid therapy. Variety of techniques has been performed for central venous catheterization previously but the information in this regard about pediatrics is limited. In the current study, the comparison of electrocardiographic technique with landmark one for central venous catheterization performance has been done. Methods: This is a cross-sectional study conducted on 75 patients underwent central venous catheterization for elective cardiovascular thoracic surgery. In the first step, the location of catheterization was estimated based on body surface landmarks. Then catheterization was done using electrocardiography. Then by cardio-surgeon aid, during open cardiac surgery, the catheter tip location was found (gold standard). Finally, chest X-ray was taken and catheter place based on radiological markers was recorded.Results: In the current study, 75 children with age under 18 years and gender distribution of 42.7% females and 57.3% males were assessed. Mean of central venous catheter depth in gold standard method was 7.5±1.35 centimeters. Significant association between central venous catheter placement in gold standard technique and both landmark and electrocardiographic was seen (P-value<0.001; r=0.94 and P-value<0.001; r=0.77). Logistic regression showed a significant association between weight and placement of catheter tip in landmark technique (P-value=0.038) as following formula (Depth of central venous catheter= 5.33+0.07*weight).Conclusion: Our study showed that the use of ECG for CVC considering carina-to-tip as reference was superior to the landmark. In addition, catheter tip correct position was affected by weight but not height based on landmark technique

Is Admission Serum Sodium Concentration a Clinical Predictor for the Outcome of Therapy in Critically Ill Poisoned Patients?

BACKGROUND Disorders of serum sodium concentration are some of the most electrolyte abnormalities in the intensive care unit (ICU) patients. These disorders adversely affect the function of vital organs and are associated with increased hospital mortality. PURPOSE In the present study we aimed to evaluate the effects of serum sodium concentration abnormalities at the time of hospital admission on the clinical outcome of therapy in a cohort of critically ill poisoned patients. METHODS In this cross-sectional study, 184 critically ill poisoned patients aged >18 years and in the first 8 hours of their poisoning, hospitalized in the ICU of a tertiary care university hospital (Isfahan, Iran) between 2010-2012, were evaluated at the admission time and 24 hours later for serum sodium concentration abnormalities and its relationship with age, gender, consciousness status, ingested drugs and clinical outcome of therapy. The clinical outcome was considered as recovery and mortality. Logistic Regression analysis was performed for predictive variables including serum sodium concentration abnormalities in patients' clinical outcome. FINDINGS On admission, 152 patients (82.6%) were eunatremic, 21 patients (11.4%) were hyponatremic and 11 patients (6%) were hypernatremic. In the second day eunatremia, hyponatremia and hypernatremia was observed in 84.4%, 13% and 2.2% respectively. Age (OR=1.92; CI=1.18-3.12) and severity of toxicity (OR=1.32; CI=1.12-2.41) were predicting factors of mortality in ICU poisoning patients. CONCLUSIONS Serum sodium concentration abnormalities are prevalent in critically ill poisoned patient but do not seem to have a predictive value for the clinical outcome of therapy

Right Atrial Thrombus in a COVID-19 Child Treated Through Cardiac Surgery

We herein report a case of large intracardiac thrombus in a child with SARS-CoV-2 infection (COVID-19). The diagnosis of COVID-19 was confirmed through HRCT and RT-PCR. Transthoracic echocardiography revealed a large thrombus in the right atrium treated successfully via cardiac surgery. The underlying mechanisms of this thrombus in the COVID-19 infection may be attributed to the hypercoagulation and inflammatory condition incurred by the COVID-19 virus

Comparing the effects of adaptive support ventilation and synchronized intermittent mandatory ventilation on intubation duration and hospital stay after coronary artery bypass graft surgery

Background: Different modes of mechanical ventilation are used for respiratory support after coronary artery bypass graft (CABG). This study aimed to compare the effect(s) of using adaptive support ventilation (ASV) and synchronized intermittent mandatory ventilation (SIMV) on the length of mechanical ventilation (intubation duration) and hospital stay after coronary artery bypass graft surgery. Materials and Methods: In a randomized control trial, 64 patients were ventilated with ASV as the experiment group or with SIMV as the control group after CABG surgery in Chamran Hospital of Isfahan University of Medical Sciences. The time of tracheal intubation and the length of hospital stay were compared between the two groups. Data were analyzed and described using statistical analysis (independent t-test). Results: The mean time of intubation duration was significantly lower in ASV group compared with SIMV group. (4.83 h vs 6.71 h, P < 0.001). The lengths of hospital stay in the ASV and the SIMV groups were 140.6 h and 145.1 h, respectively. This difference was significant between the two groups (P = 0.006). Conclusions: According to the results of this study, using ASV mode for mechanical ventilation after CABG led to a decrease in intubation duration and also hospital stay in comparison with the SIMV group. It is recommended to use ASV mode on ventilators for respiratory support of patients undergoing coronary artery bypass graft surgery

Modified ultrafiltration during cardiopulmonary bypass and postoperative course of pediatric cardiac surgery

Context: The use of cardiopulmonary bypass (CPB) provokes the inflammatory responses associated with ischemic/reperfusion injury, hemodilution and other agents. Exposure of blood cells to the bypass circuit surface starts a systemic inflammatory reaction that may causes post-CPB organ dysfunction, particularly in lungs, heart and brain. Evidence Acquisition: We investigated in the MEDLINE, PUBMED, and EMBASE databases and Google scholar for every available article in peer reviewed journals between 1987 and 2013, for related subjects to CPB with conventional or modified ultrafiltration (MUF) in pediatrics cardiac surgery patients. Results: MUF following separation from extracorporeal circulation (ECC) provides well known advantages in children with improvements in the hemodynamic, pulmonary, coagulation and other organs functions. Decrease in blood transfusion, reduction of total body water, and blood loss after surgery, are additional benefits of MUF. Conclusions: Consequently, MUF has been associated with attenuation of morbidity after pediatric cardiac surgery. In this review, we tried to evaluate the current evidence about MUF on the organ performance and its effect on post-CPB morbidity in pediatric patients

Evaluation of effect of continuous positive airway pressure during cardiopulmonary bypass on cardiac de-airing after open heart surgery in randomized clinical trial

Background: Cardiac and pulmonary veins de-airing are of the most important steps during open heart surgery. This study evaluates the effect of continuous positive airway pressure (CPAP) on air trapping in pulmonary veins and on quality of de-airing procedure. Materials and Methods: This randomized prospective double blind clinical trial conducted on 40 patients. In the control group: During cardiopulmonary bypass (CPB), the ventilator was turned off and adjustable pressure limit (APL) valve was placed in SPONT position. In CPAP group: During CPB, after turning the ventilator off, the flow of oxygen flow was maintained at the rate of 0.5 L/min and the APL valve was placed in MAN position on 20 mbar. During cardiopulmonary bypass (CPB) weaning, the patients were observed for air bubbles in left atrium by using transesophageal echocardiography. Results: The mean de-airing time after the start of mechanical ventilation in CPAP group (n = 20) was significantly lower than the control group (n = 20) (P = 0.0001). The mean time of the left atrium air bubbles occupation as mild (P = 0.004), moderate (P = 0.0001) and severe (P = 0.015) grading was significantly lower in CPAP group. Conclusions: By CPAP at 20 mbar during CPB in open heart surgery, de-airing process can be down in better quality and in significantly shorter time

Risk factors and the outcome of therapy in patients with seizure after Carbamazepine poisoning: A two-year cross-sectional study

Objective: We aimed to investigate the frequency of seizure after acute carbamazepine poisoning and the important risk factors related to the outcomes of therapy. Methods: In this two-year cross-sectional study conducted in a University Hospital in Iran, 114 patients with acute carbamazepine poisoning were divided into two groups of with seizure (n = 8) and without seizure (n = 106) after intoxication. Demographic data, average amount of drug ingestion, time elapsed from ingestion to hospital admission, history of seizure before poisoning, mental status, visual disturbances and nystagmus, duration of hospitalization, the outcomes of therapy, arterial blood gas values and serum biochemical indices were compared between the two groups. Findings: Patients with seizure had an estimated (Mean ± SD) ingestion of 14,300 ± 570 mg carbamazepine, which was significantly higher (P < 0.0001) than the seizure-free group (4600 ± 420 mg). The estimated average time between drug ingestion and hospital admission in patients with seizure and the seizure-free group were 515 ± 275 and 370 ± 46 minutes, respectively (P < 0.0001). In this study, 104 out of the total number of patients had recovered without any complication. Need for respiratory support, including airway support or intubation were the most recorded complication. One patient died after status epilepticus and aspiration pneumonia. Conclusion: The ingested amount of carbamazepine and the time elapsed from the ingestion of drug to hospital admission may influence the occurrence of seizure after acute carbamazepine poisoning; however, the outcome of supportive care in these patients seems to be positive