The Effects of On-Pump and Off-Pump Coronary Artery Bypass Surgery on Respiratory Function in the Early Postoperative Period

Background Respiratory complications are common after cardiac surgery and the use of extracorporeal circulation is one of the main causes of lung injury. We hypothesized a better postoperative respiratory function in OFF-pump coronary-artery bypass grafting (OPCABG) as compared with “ON-pump” (ONCABG). Methods This is a retrospective, single centre study at a Cardiothoracic intensive care unit (ICU) in a Tertiary University Hospital. Consecutive data on 339 patients undergoing elective CABG (n=215 ONCABG, n=124 OPCABG) were collected for one-year from the ICU electronic medical records. We compared respiratory variables (PaO2, PaO2/FiO2ratio, SaO2and PaCO2) at seven predefined time-points (ICU admission, 1st-3rd-6th-12th-18th-24th postoperative hour). We also evaluated time-to-extubation, rates of re-intubation and use of non-invasive ventilation (NIV). We used mixed-effects linear regression models (with time as random-effect for clustering of repeated measures) adjusted for a pre-determined set of covariates. Results The values of PaO2and PaO2/FiO2 were significantly higher in the OPCABG group only at ICU admission (mean differences: 9.7 mmHg, 95%CI 3.1-16.2; and 27, 95%CI 6.1-47.7, respectively). The OPCABG group showed higher PaCO2, overall (p=0.02) and at ICU admission (mean difference 1.8 mmHg, 95%CI 0.6-3), although mean values were always within normal range in both groups. No differences were seen in SaO2values, time-to-extubation, rate of re-intubation rate and use of postoperative NIV. Extubation rate was higher in OPCABG only at the 12th postoperative hour (92% vs ONCABG 82%, p=0.02). Conclusions OPCABG showed only marginal improvements of unlikelyclinical meaning.in oxygenation as compared to ONCABG in elective low-risk patients.</p

Hospital Resources May Be an Important Aspect of Mortality Rate among Critically Ill Patients with COVID-19: The Paradigm of Greece

For critically ill patients with coronavirus disease 2019 (COVID-19) who require intensive care unit (ICU) admission, extremely high mortality rates (even 97%) have been reported. We hypothesized that overburdened hospital resources by the extent of the pandemic rather than the disease per se might play an important role on unfavorable prognosis. We sought to determine the outcome of such patients admitted to the general ICUs of a hospital with sufficient resources. We performed a prospective observational study of adult patients with COVID-19 consecutively admitted to COVID&mdash;designated ICUs at Evangelismos Hospital, Athens, Greece. Among 50 patients, ICU and hospital mortality was 32% (16/50). Median PaO2/FiO2 was 121 mmHg (interquartile range (IQR), 86&ndash;171 mmHg) and most patients had moderate or severe acute respiratory distress syndrome (ARDS). Hospital resources may be an important aspect of mortality rates, since severely ill COVID-19 patients with moderate and severe ARDS may have understandable mortality, provided that they are admitted to general ICUs without limitations on hospital resources