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ThoracicSurgery

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Critical Care

Whether hydroxyethyl starch (HES) is safe for perioperative use is not known. Evaluating HES in cardiac surgery, Jacob and colleagues suggested conclusion was of a more favorable safety profile for HES 130/0.4 [1]. The authors, however, wrongly stated that they followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines because the meta-analysis lacked a table of included study characteristics, an assessment of bias, identification of any pre-specified subgroup analyses, and tests of interaction to compare different HES solutions. In many included studies, the control group received HES, patients with heavy bleeding were excluded post hoc, and anti-fibrinolytic drugs were used to minimize bleeding. For instance, in two included trials the group assigned to gelatin actually received significantly more postoperative HES 130/0.4 than the group allocated to HES 130/0.4 [2,3]. In an included trial of HES 130/0.4, the results from one of the four study centers were excluded post hoc without explanation [4]. Other sources of bias were aggregation of intra- with postoperative blood loss and preferential use of calculated rather than measured blood loss. Furthermore, no tests of interaction were presented even to address the question of whether HES 130/0.4 differs from other HES solutions in its effect on bleeding risk after cardiac surgery.  
ccforum.com
about 5 years ago
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Prevention of blood clots in patients undergoing cardiac or thoracic surgery | Cochrane

Patients undergoing surgery have an increased probability of developing blood clots in their veins (venous thromboembolism). These clots may be in the deep veins (deep vein thrombosis) or travel to the lungs (pulmonary embolism). As in other types of surgery, effective prevention of blood clots (thromboprophylaxis) after cardiac or thoracic surgery may reduce the risk of postoperative vein clots. These potential benefits, however, have to be balanced against the associated risks of bleeding. This systematic review looked at the effectiveness and safety of anticoagulants (medicines that reduce the ability of the blood to clot), mechanical interventions (such as pneumatic pumps on the legs to promote blood flow), and caval filters (a type of vascular filter, implanted into the main abdominal vein to prevent movement of clots from the legs to the lungs) in patients undergoing cardiac or thoracic surgery.  
cochrane.org
about 5 years ago
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Cardiology - Wikipedia, the free encyclopedia

Cardiology (from Greek καρδίᾱ kardiā, "heart" and -λογία -logia, "study") is a branch of medicine dealing with disorders of the heart. The field includes medical diagnosis and treatment of congenital heart defects, coronary artery disease, heart failure, valvular heart disease and electrophysiology. Physicians who specialize in this field of medicine are called cardiologists, a specialty of internal medicine. Pediatric cardiologists are pediatricians who specialize in cardiology. Physicians who specialize in cardiac surgery are called cardiothoracic surgeons or cardiac surgeons, a specialty of general surgery.  
en.wikipedia.org
about 5 years ago
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The TITRe2 trial - INTENSIVE

Jake Barlow critically appraises the TITRe2 trial, assessing transfusion thresholds following non-emergency cardiac surgery  
intensiveblog.com
about 5 years ago
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UCLA Clinicians 3D Print Heart Models to Prepare for Transcatheter Valve Replacements (VIDEO) |

Patients receiving transcatheter cardiac valve replacements tend to be more fragile than those getting open heart surgery. It is particularly important to  
medgadget.com
about 5 years ago
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Fresh frozen plasma for patients undergoing surgery on the heart or blood vessels | Cochrane

Fresh frozen plasma is obtained from whole blood from blood donors. It contains a number of factors that help blood to clot. The risk of bleeding in open heart surgery or surgery on the main blood vessels in the body is high. Fresh frozen plasma is sometimes administered to these patients to reduce bleeding. It can be administered prophylactically (to prevent bleeding) or therapeutically (to treat bleeding). However, there are risks of side effects from fresh frozen plasma, such as severe allergic reactions or breathing problems.  
cochrane.org
almost 5 years ago
Www.bmj
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Cognitive decline after heart surgery is uncommon, review finds

Cognitive impairment after cardiovascular surgery is uncommon in older people, a systematic evidence review published in the Annals of Internal Medicine has concluded.1 However, the researchers said that the evidence was limited and that the individual study quality was low.  
feeds.bmj.com
almost 5 years ago
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New standards to try to resolve heart surgery row - BBC News

New proposals have been put forward in an effort to resolve a long-running row about the congenital heart surgery in England.  
bbc.co.uk
almost 5 years ago
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Surgery Research — Pediatric and General Thoracic

The research projects by the Division of Pediatric General and Thoracic Surgery at Children’s Hospital of Pittsburgh of UPMC include a variety of significant lab- and clinic-based initiatives.  
chp.edu
almost 5 years ago
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Preoperative statin therapy for patients undergoing cardiac surgery | Cochrane

Cardiac surgery can effectively treat patients with heart disease but is associated with a risk ratio for adverse events at the same time. Despite the increasing proportion of patients undergoing cardiac surgery with major co-morbidities, operative results have remained stable during past decades, which may be related to advancements in surgical techniques. Nonetheless, perioperative care of these patients remains to be optimised.  
cochrane.org
almost 5 years ago
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Critical Care

Microvascular reactivity is decreased in patients with septic shock; this is associated with worse clinical outcomes. The objectives of the present study were to investigate microvascular reactivity in cardiac surgery patients and to assess any association with clinical outcomes.  
ccforum.com
almost 5 years ago
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CCC Update 012 | LITFL: Life in the Fast Lane Medical Blog

The 12th update to the Critical Care Compendium, with ECMO, cardiac arrest after cardiac surgery, gas embolism, apnoeic oxygenation, & more!  
lifeinthefastlane.com
almost 5 years ago
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Critical Care

As evidence-based effective treatment protocols for delirium after cardiac surgery are lacking, efforts should be made to identify risk factors for preventive interventions. Moreover, knowledge of these risk factors could increase validity of etiological studies in which adjustments need to be made for confounding variables. This review aims to systematically identify risk factors for delirium after cardiac surgery and to grade the evidence supporting these associations.  
ccforum.com
almost 5 years ago
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Guiding Fluid Therapy in High-Risk Thoracic Surgery

In 2009 the institutional guidelines changed for perioperative fluid therapy in patients undergoing extrapleural pneumonectomy. This study assesses the consequences of those changes.  
medscape.com
almost 5 years ago
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SGEM#129: That Chest Tube…She’s a Beauty

Guest Skeptics: Dr. Rick Malthaner is the Director of Thoracic Surgery Research, Professor of Surgery, Epidemiology and Biostatistics at the Schulich School of Medicine and Dentistry, Western University, Canada.  
thesgem.com
almost 5 years ago
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New Self-Positioning Transcatheter Mitral Valve Developed by National University of Singapore |

Transcatheter heart valve replacements have become life savers for many frail patients who are unsuitable for open heart surgery. While many benefit from i  
medgadget.com
over 4 years ago
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No Benefit From Ischemic Preconditioning at Cardiac Surgery

It may fascinate, but two large randomized trials say it doesn't work. In them, remote ischemic preconditioning prior to on-pump cardiac surgery made no clinical difference compared with a sham procedure.  
medscape.com
over 4 years ago
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Beta blockers are associated with increased risk of cardiovascular events after surgery

A large Danish study, published in JAMA Internal Medicine, has found that treatment with beta blockers was associated with a statistically significant increase in the rate of major adverse cardiovascular events and death within 30 days of non-cardiac surgery.1  
feeds.bmj.com
over 4 years ago
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Critical Care

Cardiac surgery encompasses various stimuli that trigger pro-inflammatory mediators, reactive oxygen species and mobilization of leucocytes. The aim of this study was to evaluate the effect of xenon on the inflammatory response during cardiac surgery.  
ccforum.com
over 4 years ago
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Critical Care

In a recent article, Balzer et al. [1] reported an unexpected relationship between an initial central venous oxygen saturation (ScvO2) >80 % on ICU admission and increased morbidity and mortality in cardiac surgery patients. Interestingly, as compared with low (<60 %) or normal (60–80 %) ScvO2 levels, values above 80 % were associated with more acute kidney injury (AKI) and a higher hemodialysis need. This goes against common belief that a higher ScvO2 is a prerequisite for more optimal organ, and in particular kidney, protection.  
ccforum.com
over 4 years ago