Difference between pre-operative and cardiopulmonary bypass mean arterial pressure is independently associated with early cardiac surgery-associated acute kidney injury

<p>Abstract</p> <p>Background</p> <p>Cardiac surgery-associated acute kidney injury (CSA-AKI) contributes to increased morbidity and mortality. However, its pathophysiology remains incompletely understood. We hypothesized that intra-operative mean arterial pressure (MAP) relative to pre-operative MAP would be an important predisposing factor for CSA-AKI.</p> <p>Methods</p> <p>We performed a prospective observational study of 157 consecutive high-risk patients undergoing cardiac surgery with cardiopulmonary bypass (CPB). The primary exposure was delta MAP, defined as the pre-operative MAP minus average MAP during CPB. Secondary exposure was CPB flow. The primary outcome was early CSA-AKI, defined by a minimum RIFLE class - RISK. Univariate and multivariate logistic regression were performed to explore for association between delta MAP and CSA-AKI.</p> <p>Results</p> <p>Mean (± SD) age was 65.9 ± 14.7 years, 70.1% were male, 47.8% had isolated coronary bypass graft (CABG) surgery, 24.2% had isolated valve surgery and 16.6% had combined procedures. Mean (± SD) pre-operative, intra-operative and delta MAP were 86.6 ± 13.2, 57.4 ± 5.0 and 29.4 ± 13.5 mmHg, respectively. Sixty-five patients (41%) developed CSA-AKI within in the first 24 hours post surgery. By multivariate logistic regression, a delta MAP≥26 mmHg (odds ratio [OR], 2.8; 95%CI, 1.3-6.1, p = 0.009) and CPB flow rate ≥54 mL/kg/min (OR, 0.2, 0.1-0.5, p < 0.001) were independently associated with CSA-AKI. Additional variables associated with CSA-AKI included use of a side-biting aortic clamp (OR, 3.0; 1.3-7.1, p = 0.012), and body mass index ≥25 (OR, 4.2; 1.6-11.2, p = 0.004).</p> <p>Conclusion</p> <p>A large delta MAP and lower CPB flow during cardiac surgery are independently associated with early post-operative CSA-AKI in high-risk patients. Delta MAP represents a potentially modifiable intra-operative factor for development of CSA-AKI that necessitates further inquiry.</p

Pediatric infective endocarditis: Has Staphylococcus aureus overtaken viridans group streptococci as the predominant etiological agent?

BACKGROUND: Viridans group streptococci (VGS) have traditionally been the most common etiological agents of infective endocarditis (IE). Advances in cardiovascular surgery and the increasing use of long-term central venous catheters may have altered the epidemiology of pediatric IE

Newborn literacy program effective in increasing maternal engagement in literacy activities: an observational cohort study

Abstract Background Literacy is important for success in school and in adulthood. Book-gift programs at birth exist to help develop these foundations early on. The effectiveness of the Read to Me! Nova Scotia Family Literacy Program (a program where books and literacy materials are given to families in hospital when their baby is born) on the duration and frequency with which mothers engage in reading and other literacy based activities with their newborns was assessed. Methods An observational cohort study design was used. Mothers of babies who received the Read to Me! package in Nova Scotia born between January-August 2006 made up the intervention group (N = 1051). Mothers of babies born in Prince Edward Island between December 2006 and March 2008 made up the control group (N = 279) and did not receive any literacy package when their baby was born. A phone questionnaire was conducted consisting of questions regarding frequency and duration of maternal engagement in language and literacy-based activities with their infants. These activities included reading, singing, talking, listening to CDs and the radio and watching TV. Babies were aged 0–10 months at the time of the interview. Results Mothers who received the Read to Me! literacy package spent significantly more time reading to their babies, 17.9 ± 17.6 min/day compared to controls 12.6 ± 10.7 min/day, (p  Conclusions Read to Me! may be an inexpensive, easy to administer and effective intervention which results in increased shared reading of mothers and their newborns.</p