Data_Sheet_1_Postoperative outcomes after total sevoflurane inhalation sedation using a disposable delivery system (Sedaconda-ACD) in cardiac surgery.docx

IntroductionThe COVID-19 pandemic prompted our team to develop new solutions for performing cardiac surgery without intravenous anesthetics due to a shortage of these drugs. We utilized an anesthetic conserving device (Sedaconda-ACD) to administer total inhaled anesthesia because specific vaporizers were unavailable for administering inhaled agents during cardiopulmonary bypass (CPB) in our center. We documented our experience and postoperative cardiovascular outcomes. The primary outcome was the peak level of troponin, with secondary outcomes encompassing other cardiovascular complications.Material and methodsA single-center retrospective study was conducted. We performed a multivariate analysis with a propensity score. This investigation took place at a large university referral center.ParticipantsAdult patients (age ≥ 18) who underwent elective cardiac surgery with CPB between June 2020 to March 2021.InterventionDuring the inclusion period, two anesthesia protocols for the maintenance of anesthesia coexisted—total inhaled anesthesia with Sedaconda-ACD and our classic protocol with intravenous drugs during and after CPB.Primary endpointTroponin peak level recorded after surgery (highest level recorded within 48 h following the surgery).ResultsOut of the 654 included patients, 454 were analyzed after matching (intravenous group = 297 and inhaled group = 157). No significant difference was found between the groups in postoperative troponin peak levels (723 ng/l vs. 993 ng/l–p = 0.2). Total inhaled anesthesia was associated with a decreased requirement for inotropic medications (OR = 0.53, 95% CI 0.29–0.99, p = 0.04).ConclusionIn our cohort, the Sedaconda-ACD device enabled us to achieve anesthesia without intravenous agents, and we did not observe any increase in postoperative complications. Total inhaled anesthesia with sevoflurane was not associated with a lower incidence of myocardial injury assessed by the postoperative troponin peak level. However, in our cohort, the use of inotropic drugs was lower.</p

Additional file 1 of Boot camp approach to surgical residency preparation: feedback from a French university hospital

Additional file 1

Additional file 1 of A universal predictive and mechanistic urinary peptide signature in acute kidney injury

Additional file 1: Supplementary Figure S1: S100A9 expression after epithelial injury. A. Urinary calprotectin (S100A8/A9) abundance 4 hours after cardiac bypass-surgery. B–F. Blood urea nitrogen (B), mRNA S100a9 (C), S100A9 immunostaining (D-E) and mRNA Kim1 (F) in sham mice and after bilateral renal ischemia/reperfusion (hours 6, 24 and 48). G–J. mRNA expression of S100a9 and Kim1 in MCT cells submitted to interleukin-1b (IL1β, 10 ng/mL) or tumor necrosis factor-1a (TNFa, 10 ng/mL) (G-H) or hypoxia (I-J). AKI, acute kidney injury; BUN, blood urea nitrogen; Norm, normoxia; Hyp, hypoxia. Supplementary Figure S2: Performances of the peptide-based signature to identify AKI that developed within the first 2 days following cardiac surgery. ROC curves with corresponding AUROC and 95% confidence intervals of the local clinical score (blue, pointed), the full 204 peptides-based score (red), the urinary NGAL level (yellow, pointed) and the nephrocheck ([IGFBP7].[TIMP2] product) in the validation cohort. Supplementary Figure S3: Reduction and combination of the peptide-based signature. A. ROC curves with corresponding AUROC and 95% confidence intervals of the local clinical score (blue, pointed), the full 204 peptides-based score (red), the reduced 17 peptides-based score (black, dashed) and the combination of local clinical and full peptide-based score in the validation cohort. B. List of peptides included in the reduced 17-peptides signature according to their parental protein. LMAN2, Lectin mannose binding 2 ; MGP, Matrix gla protein. Supplementary Figure S4: Performances of the 204 peptides-based signature and the reference urinary biomarker NGAL for AKI prediction in the external ICU validation cohort. A. ROC curves with corresponding AUROC and 95% confidence intervals of the 204 peptides-based score and the reference urinary biomarker NGAL to predict AKI after ICU admission. B. ROC curves with corresponding AUROC and 95% confidence intervals of the 204 peptides-based score and reference urinary biomarker NGAL to predict the development of AKI within seven days after admission. Supplementary Figure S5: Performances of the 204 peptides-based score for in-hospital mortality prediction. Odds-ratio (OR) of in-hospital mortality were calculated with unadjusted, Euroscore-II-adjusted or propensity score-adjusted logistic regression. Supplementary Table S1: Correlations between clinical characteristics and the 204-peptides-based score. BMI, body mass index; PAOD, peripheral artery obliterans disease; COPD, chronic obstructive pulmonary disease; LVEF, left ventricular ejection fraction; eGFR, estimated glomerular filtration rate; CBP, cardiac bypass; RBC, red blood cells. Supplementary Table S2: Performance of the peptide-based score to predict acute kidney injury in the external ICU validation cohort, according to the cause of admission to the intensive care unit. ICU, intensive care unit; AUROC, area under the receiver operating characteristics curve. Supplementary file S1: Methodology. Urinary peptidomics and statistical analyses