BACKGROUND Transfemoral aortic valve replacement (TAVR) is the standard treatment for elderly pat... more BACKGROUND Transfemoral aortic valve replacement (TAVR) is the standard treatment for elderly patients with aortic valve stenosis. Although safe and well-established, there is a risk of intraprocedural hemodynamic instability and silent cerebral embolism, which can lead to a decline in neurocognitive function and dementia. In clinical practice, comprehensive cognitive testing is difficult to perform. AI-assisted digital applications may help to optimize diagnosis and monitoring. Neurocognitive function was assessed by validated psychometric tests using "∆elta -App", which uses artificial intelligence and computational linguistic methods for extraction and analysis. Memory function was assessed using the 'Consortium to Establish a Registry for Alzheimer's Disease' (CERAD) word list and digit span task (DST) before TAVR and before hospital discharge. The study is registered in the German Register of Clinical Trials (). From October 2020 until March 2022, 141 patients were enrolled at University Hospital Heart Centre Brandenburg. Mean age was 81 ± 6 years, 42.6% were women. Time between the pre-and post-interventional test was on average 6 ± 3 days. Memory function before TAVR was found to be below average in relation to age and educational level. The pre-post TAVR comparison showed significant improvements in the wordlist repeat, P < 0.001 and wordlist recall test of CERAD, P < 0.001. There were no changes in the digital span test. CONCLUSIONS Despite impaired preoperative memory function before TAVR, no global negative effect on memory function after TVAR was detected. The improvements shown in the word list test should be interpreted as usual learning effects in this task. ognitive performance is usually conceptualized in terms of functional domains such as memory, attention, language, or executive functions. Cognitive impairments in the domains of attention and memory have been documented in patients with heart failure (HF). Heart failure is caused by increased afterload and myocardial remodeling and is a multifactorial consequence in patients with severe AS. Because of the considerable risk of open-heart surgery, transfemoral aortic valve replacement (TAVR) is the standard therapy in elderly patients at medium or high risk. In these patients, functional aspects, especially cognitive function, are of immense importance. Several factors could affect cognition in TAVR patients. One key factor contributing to cognitive decline is cereb-
Objectives: Acute kidney injury is an important complication in patients undergoing cardiac surge... more Objectives: Acute kidney injury is an important complication in patients undergoing cardiac surgery. Recently, several biomarkers to facilitate early detection of acute kidney injury have been proposed, among them Neutrophil-gelatinase-associated-lipocalin, Kidney-injury-molecule-1, and L-Fatty-acid-binding-protein. The expression of these markers is increased by ischemia-reperfusion injury and may thus be related to the duration of cardiopulmonary bypass (CPB). The present study was designed to determine the effects of CPB-duration on the postoperative course of acute kidney injury biomarkers in comparison with patients developing acute kidney injury according to the classical definition of a decrease in creatinine clearance in a cohort of cardiac surgery patients. Methods: Prospectively sampled data from 136 consecutive patients were analyzed retrospectively. Plasma and urine for determination of biomarkers and creatinine were collected at predefined time points before, immediately after, and up to three days after surgery. The median duration of CPB was 118 min. 29 patients developed acute kidney injury as defined by the acute kidney injury network creatinine criteria. The patients without acute kidney injury were grouped into a "CPB-short" (CPB<118min; n=51) and a "CPB-long" (CPB≥118min; n=56) group. Results: Preoperative plasma Neutrophil-gelatinase-associated-lipocalin and urinary L-Fatty-acidbinding-protein levels were higher in the acute kidney injury than in the CPB-short group. Early postoperative levels of plasmatic and urinary Neutrophil-gelatinase-associated-lipocalin and urinary L-Fatty-acid-binding-protein increased significantly after CPB in all groups and were either higher or not different in comparison between the CPB-long and the acute kidney injury group in the immediate postoperative period. Conclusion: Duration of CPB is a relevant factor for the expression of several biomarkers of renal tubular injury presumed to facilitate early detection of acute kidney injury after cardiac surgery. This questions the usefulness of the markers used in this study for early detection of renal dysfunction and prediction of a further decrease in glomerular filtration rate after cardiac surgery and suggest that CPB-time has to be taken into account when defining cutoff levels for acute kidney injury biomarkers in this setting.
Introduction The reliability of autocalibrated pressure waveform analysis by the FloTrac-Vigileo ... more Introduction The reliability of autocalibrated pressure waveform analysis by the FloTrac-Vigileo ® (FTV) system for the determination of cardiac output in comparison with intermittent pulmonary arterial thermodilution (IPATD) is controversial. The present prospective comparison study was designed to determine the effects of variations in arterial blood pressure on the reliability of the FTV system in patients undergoing coronary artery bypass grafting (CABG). Methods Comparative measurements of cardiac output by FTV (derived from a femoral arterial line; software version 1.14) and IPATD were performed in 16 patients undergoing elective CABG in the period before institution of cardiopulmonary bypass. Measurements were performed after induction of anesthesia, after sternotomy, and during five time points during graft preparation. During graft preparation, arterial blood pressure was increased stepwise in intervals of 10 to 15 minutes by infusion of noradrenaline and lowered thereafter to baseline levels. Results Mean arterial blood pressure was varied between 85 mmHg and 115 mmHg. IPATD cardiac output did not show significant changes during periods with increased arterial pressure either during sternotomy or after pharmacological manipulation. In contrast, FTV cardiac output paralleled changes in arterial blood pressure; i.e. increased significantly if blood pressure was raised and decreased upon return to baseline levels. Mean arterial blood pressure (MAP) and FTV cardiac output were closely correlated (r = 0.63 (95% confidence interval [CI]: 0.49-0.74), P < 0.0001) while no correlation between MAP and IPATD cardiac output was observed. Bland-Altman analyses for FTV versus IPATD cardiac output measurements revealed a bias of 0.4 l/min (8.5%) and limits of agreement from 2.1 to-1.3 l/min (42.2 to-25.3%). Conclusions Acute variations in arterial blood pressure alter the reliability of the FlowTrac/Vigileo ® device with the secondgeneration software. This finding may help to explain the variable results of studies comparing the FTV system with other cardiac output monitoring techniques, questions the usefulness of this device for hemodynamic monitoring of patients undergoing rapid changes in arterial blood pressure, and should be kept in mind when using vasopressors during FTV-guided hemodynamic optimization.
† Cognitive dysfunction after cardiac surgery might be associated with decreases in cerebral oxyg... more † Cognitive dysfunction after cardiac surgery might be associated with decreases in cerebral oxygen saturation. † Patients developing intraoperative cerebral desaturation showed worse early postoperative cognitive test results than patients without cerebral desaturation. † Hypnotic drug selection might be one of the factors attenuating the effects of cerebral desaturation on cognitive outcome after on-pump cardiac surgery. Background. Cognitive dysfunction is a frequent complication after cardiac surgery and has been found to be associated with decreases in cerebral oxygen saturation (Sc O 2) measured with near-infrared spectroscopy. Sevoflurane has neuroprotective properties in vitro and in animal models. This study was designed to determine cognitive and clinical outcomes after sevoflurane-compared with propofol-based anaesthesia for on-pump cardiac surgery and the impact of decreases in Sc O 2 under different anaesthesia regimens. Methods. One hundred and twenty-eight patients were randomly assigned to either i.v. anaesthesia with propofol-(PROP) or sevoflurane-based anaesthesia (SEVO). An intraoperative Sc O 2 , 50% was defined as desaturation. The Abbreviated Mental Test, Stroop Test, Trail-Making Test, Word Lists, and mood-assessment tests were performed before, 2, 4, and 6 days after cardiac surgery. Markers of general outcome were obtained. Results. The analysis groups had differences in baseline cognitive performance. Analysis of variance for repeated measures (incorporating covariance of baseline scores) showed that in three of four cognitive tests, patients with cerebral desaturation showed worse results than patients without desaturation. Patients assigned to sevoflurane-based anaesthesia showed better results in all cognitive tests than patients after propofol. Interactions between the anaesthetic regimen and desaturation were found in all four cognitive tests. There were no differences in markers of organ dysfunction or general clinical outcome. Conclusions. Patients with impaired cognitive performance before operation may be at particular risk for intraoperative cerebral insult. A sevoflurane-based anaesthesia was associated with better short-term postoperative cognitive performance than propofol.
<b>Copyright information:</b>Taken from "The metabolic and renal effects of adre... more <b>Copyright information:</b>Taken from "The metabolic and renal effects of adrenaline and milrinone in patients with myocardial dysfunction after coronary artery bypass grafting"http://ccforum.com/content/11/2/R51Critical Care 2007;11(2):R51-R51.Published online 30 Apr 2007PMCID:PMC2206480. The time course of plasma cystatin-C levels in patients with myocardial dysfunction after coronary artery bypass grafting surgery, treated with adrenaline (= 7) or milrinone (= 11), and in control patients (= 20) not needing inotropic support. Data are given as mean ± standard error of the mean. Significant difference (&lt; 0.05) in comparison with baseline values (paired test); significant difference (&lt; 0.05) in comparison with the control group (analysis of variance [ANOVA] with Fisher's predicted least-square difference [PLSD]); significant difference (&lt; 0.05) between the adrenaline and the milrinone group (ANOVA with Fisher's PLSD).
<b>Copyright information:</b>Taken from "The metabolic and renal effects of adre... more <b>Copyright information:</b>Taken from "The metabolic and renal effects of adrenaline and milrinone in patients with myocardial dysfunction after coronary artery bypass grafting"http://ccforum.com/content/11/2/R51Critical Care 2007;11(2):R51-R51.Published online 30 Apr 2007PMCID:PMC2206480. The time course of plasma glucose and insulin doses in patients with myocardial dysfunction after coronary artery bypass grafting surgery, treated with adrenaline (= 7) or milrinone (= 11), and in control patients (= 20) not needing inotropic support. Data are given as mean ± standard error of the mean. Significant difference (&lt; 0.05) in comparison with baseline values (paired test); significant difference (&lt; 0.05) in comparison with the control group (analysis of variance [ANOVA] with Fisher's predicted least-square difference [PLSD]); significant difference (&lt; 0.05) between the adrenaline and the milrinone group (ANOVA with Fisher's PLSD).
<b>Copyright information:</b>Taken from "The metabolic and renal effects of adre... more <b>Copyright information:</b>Taken from "The metabolic and renal effects of adrenaline and milrinone in patients with myocardial dysfunction after coronary artery bypass grafting"http://ccforum.com/content/11/2/R51Critical Care 2007;11(2):R51-R51.Published online 30 Apr 2007PMCID:PMC2206480. The time course of plasma lactate , pyruvate , and the lactate/pyruvate ratio in patients with myocardial dysfunction after coronary artery bypass grafting surgery, treated with adrenaline (= 7) or milrinone (= 11), and in control patients (= 20) not needing inotropic support. Data are given as mean ± standard error of the mean. Significant difference (&lt; 0.05) in comparison with baseline values (paired test); significant difference (&lt; 0.05) in comparison with the control group (analysis of variance [ANOVA] with Fisher's predicted least-square difference [PLSD]); significant difference (&lt; 0.05) between the adrenaline and the milrinone group (ANOVA with Fisher's PLSD).
Variations in arterial blood pressure are associated with parallel changes in FlowTrac/Vigileo ®-... more Variations in arterial blood pressure are associated with parallel changes in FlowTrac/Vigileo ®-derived cardiac output measurements: a prospective comparison study
Introduction Myocardial dysfunction necessitating inotropic support is a typical complication aft... more Introduction Myocardial dysfunction necessitating inotropic support is a typical complication after on-pump cardiac surgery. This prospective, randomized pilot study analyzes the metabolic and renal effects of the inotropes adrenaline and milrinone in patients needing inotropic support after coronary artery bypass grafting (CABG). Methods During an 18-month period, 251 patients were screened for low cardiac output upon intensive care unit (ICU) admission after elective, isolated CABG surgery. Patients presenting with a cardiac index (CI) of less than 2.2 liters/minute per square meter upon ICU admission – despite adequate mean arterial (titrated with noradrenaline or sodium nitroprusside) and filling pressures – were randomly assigned to 14-hour treatment with adrenaline (n = 7) or milrinone (n = 11) to achieve a CI of greater than 3.0 liters/minute per square meter. Twenty patients not needing inotropes served as controls. Hemodynamics, plasma lactate, pyruvate, glucose, acid-base ...
Mithilfe der zerebralen Oxymetrie kann die Sauerstoffversorgung des Gehirns nicht-invasiv uberwac... more Mithilfe der zerebralen Oxymetrie kann die Sauerstoffversorgung des Gehirns nicht-invasiv uberwacht werden. Eine Gruppe der Universitat Lubeck hat nun eine Ubersicht uber den klinischen Stellenwert bei der intraoperativen Uberwachung zusammengestellt.
Mithilfe der zerebralen Oxymetrie kann die Sauerstoffversorgung des Gehirns nicht-invasiv überwac... more Mithilfe der zerebralen Oxymetrie kann die Sauerstoffversorgung des Gehirns nicht-invasiv überwacht werden. Eine Gruppe der Universität Lübeck hat nun eine Übersicht über den klinischen Stellenwert bei der intraoperativen Überwachung zusammengestellt.
A perioperative infusion of sodium bicarbonate does not improve renal function in cardiac surgery... more A perioperative infusion of sodium bicarbonate does not improve renal function in cardiac surgery patients: a prospective observational cohort study
Objective: To determine the relationship between a decrease in cerebral oxygen saturation (rSO2) ... more Objective: To determine the relationship between a decrease in cerebral oxygen saturation (rSO2) – determined by near-infrared spectroscopy – below 80% of preoperative baseline and the incidence of stroke in patients undergoing deep hypothermic circulatory arrest (DHCA) for cardiac and/or thoracic aortic surgery. Setting: Cardiac anesthesia unit of a University Hospital Design: Retrospective analysis of the anesthesia charts and the institutional cardiac surgery database for the year 2006. Patients: 51 patients undergoing DHCA monitored bi-hemispherically with an INVOS 5100 cerebral oxymeter. Interventions: None Measurements and main results: Patients were grouped according to an rSO2 less or greater than 80% of baseline for the left or right hemisphere in a desaturation (n = 11) and a no-desaturation group (n = 40). No between group differences in demographic variables and preoperative baseline rSO2 were observed. Duration of cardiopulmonary bypass, aortic cross-clamp, DHCA and eff...
BACKGROUND Transfemoral aortic valve replacement (TAVR) is the standard treatment for elderly pat... more BACKGROUND Transfemoral aortic valve replacement (TAVR) is the standard treatment for elderly patients with aortic valve stenosis. Although safe and well-established, there is a risk of intraprocedural hemodynamic instability and silent cerebral embolism, which can lead to a decline in neurocognitive function and dementia. In clinical practice, comprehensive cognitive testing is difficult to perform. AI-assisted digital applications may help to optimize diagnosis and monitoring. Neurocognitive function was assessed by validated psychometric tests using "∆elta -App", which uses artificial intelligence and computational linguistic methods for extraction and analysis. Memory function was assessed using the 'Consortium to Establish a Registry for Alzheimer's Disease' (CERAD) word list and digit span task (DST) before TAVR and before hospital discharge. The study is registered in the German Register of Clinical Trials (). From October 2020 until March 2022, 141 patients were enrolled at University Hospital Heart Centre Brandenburg. Mean age was 81 ± 6 years, 42.6% were women. Time between the pre-and post-interventional test was on average 6 ± 3 days. Memory function before TAVR was found to be below average in relation to age and educational level. The pre-post TAVR comparison showed significant improvements in the wordlist repeat, P < 0.001 and wordlist recall test of CERAD, P < 0.001. There were no changes in the digital span test. CONCLUSIONS Despite impaired preoperative memory function before TAVR, no global negative effect on memory function after TVAR was detected. The improvements shown in the word list test should be interpreted as usual learning effects in this task. ognitive performance is usually conceptualized in terms of functional domains such as memory, attention, language, or executive functions. Cognitive impairments in the domains of attention and memory have been documented in patients with heart failure (HF). Heart failure is caused by increased afterload and myocardial remodeling and is a multifactorial consequence in patients with severe AS. Because of the considerable risk of open-heart surgery, transfemoral aortic valve replacement (TAVR) is the standard therapy in elderly patients at medium or high risk. In these patients, functional aspects, especially cognitive function, are of immense importance. Several factors could affect cognition in TAVR patients. One key factor contributing to cognitive decline is cereb-
Objectives: Acute kidney injury is an important complication in patients undergoing cardiac surge... more Objectives: Acute kidney injury is an important complication in patients undergoing cardiac surgery. Recently, several biomarkers to facilitate early detection of acute kidney injury have been proposed, among them Neutrophil-gelatinase-associated-lipocalin, Kidney-injury-molecule-1, and L-Fatty-acid-binding-protein. The expression of these markers is increased by ischemia-reperfusion injury and may thus be related to the duration of cardiopulmonary bypass (CPB). The present study was designed to determine the effects of CPB-duration on the postoperative course of acute kidney injury biomarkers in comparison with patients developing acute kidney injury according to the classical definition of a decrease in creatinine clearance in a cohort of cardiac surgery patients. Methods: Prospectively sampled data from 136 consecutive patients were analyzed retrospectively. Plasma and urine for determination of biomarkers and creatinine were collected at predefined time points before, immediately after, and up to three days after surgery. The median duration of CPB was 118 min. 29 patients developed acute kidney injury as defined by the acute kidney injury network creatinine criteria. The patients without acute kidney injury were grouped into a "CPB-short" (CPB<118min; n=51) and a "CPB-long" (CPB≥118min; n=56) group. Results: Preoperative plasma Neutrophil-gelatinase-associated-lipocalin and urinary L-Fatty-acidbinding-protein levels were higher in the acute kidney injury than in the CPB-short group. Early postoperative levels of plasmatic and urinary Neutrophil-gelatinase-associated-lipocalin and urinary L-Fatty-acid-binding-protein increased significantly after CPB in all groups and were either higher or not different in comparison between the CPB-long and the acute kidney injury group in the immediate postoperative period. Conclusion: Duration of CPB is a relevant factor for the expression of several biomarkers of renal tubular injury presumed to facilitate early detection of acute kidney injury after cardiac surgery. This questions the usefulness of the markers used in this study for early detection of renal dysfunction and prediction of a further decrease in glomerular filtration rate after cardiac surgery and suggest that CPB-time has to be taken into account when defining cutoff levels for acute kidney injury biomarkers in this setting.
Introduction The reliability of autocalibrated pressure waveform analysis by the FloTrac-Vigileo ... more Introduction The reliability of autocalibrated pressure waveform analysis by the FloTrac-Vigileo ® (FTV) system for the determination of cardiac output in comparison with intermittent pulmonary arterial thermodilution (IPATD) is controversial. The present prospective comparison study was designed to determine the effects of variations in arterial blood pressure on the reliability of the FTV system in patients undergoing coronary artery bypass grafting (CABG). Methods Comparative measurements of cardiac output by FTV (derived from a femoral arterial line; software version 1.14) and IPATD were performed in 16 patients undergoing elective CABG in the period before institution of cardiopulmonary bypass. Measurements were performed after induction of anesthesia, after sternotomy, and during five time points during graft preparation. During graft preparation, arterial blood pressure was increased stepwise in intervals of 10 to 15 minutes by infusion of noradrenaline and lowered thereafter to baseline levels. Results Mean arterial blood pressure was varied between 85 mmHg and 115 mmHg. IPATD cardiac output did not show significant changes during periods with increased arterial pressure either during sternotomy or after pharmacological manipulation. In contrast, FTV cardiac output paralleled changes in arterial blood pressure; i.e. increased significantly if blood pressure was raised and decreased upon return to baseline levels. Mean arterial blood pressure (MAP) and FTV cardiac output were closely correlated (r = 0.63 (95% confidence interval [CI]: 0.49-0.74), P < 0.0001) while no correlation between MAP and IPATD cardiac output was observed. Bland-Altman analyses for FTV versus IPATD cardiac output measurements revealed a bias of 0.4 l/min (8.5%) and limits of agreement from 2.1 to-1.3 l/min (42.2 to-25.3%). Conclusions Acute variations in arterial blood pressure alter the reliability of the FlowTrac/Vigileo ® device with the secondgeneration software. This finding may help to explain the variable results of studies comparing the FTV system with other cardiac output monitoring techniques, questions the usefulness of this device for hemodynamic monitoring of patients undergoing rapid changes in arterial blood pressure, and should be kept in mind when using vasopressors during FTV-guided hemodynamic optimization.
† Cognitive dysfunction after cardiac surgery might be associated with decreases in cerebral oxyg... more † Cognitive dysfunction after cardiac surgery might be associated with decreases in cerebral oxygen saturation. † Patients developing intraoperative cerebral desaturation showed worse early postoperative cognitive test results than patients without cerebral desaturation. † Hypnotic drug selection might be one of the factors attenuating the effects of cerebral desaturation on cognitive outcome after on-pump cardiac surgery. Background. Cognitive dysfunction is a frequent complication after cardiac surgery and has been found to be associated with decreases in cerebral oxygen saturation (Sc O 2) measured with near-infrared spectroscopy. Sevoflurane has neuroprotective properties in vitro and in animal models. This study was designed to determine cognitive and clinical outcomes after sevoflurane-compared with propofol-based anaesthesia for on-pump cardiac surgery and the impact of decreases in Sc O 2 under different anaesthesia regimens. Methods. One hundred and twenty-eight patients were randomly assigned to either i.v. anaesthesia with propofol-(PROP) or sevoflurane-based anaesthesia (SEVO). An intraoperative Sc O 2 , 50% was defined as desaturation. The Abbreviated Mental Test, Stroop Test, Trail-Making Test, Word Lists, and mood-assessment tests were performed before, 2, 4, and 6 days after cardiac surgery. Markers of general outcome were obtained. Results. The analysis groups had differences in baseline cognitive performance. Analysis of variance for repeated measures (incorporating covariance of baseline scores) showed that in three of four cognitive tests, patients with cerebral desaturation showed worse results than patients without desaturation. Patients assigned to sevoflurane-based anaesthesia showed better results in all cognitive tests than patients after propofol. Interactions between the anaesthetic regimen and desaturation were found in all four cognitive tests. There were no differences in markers of organ dysfunction or general clinical outcome. Conclusions. Patients with impaired cognitive performance before operation may be at particular risk for intraoperative cerebral insult. A sevoflurane-based anaesthesia was associated with better short-term postoperative cognitive performance than propofol.
<b>Copyright information:</b>Taken from "The metabolic and renal effects of adre... more <b>Copyright information:</b>Taken from "The metabolic and renal effects of adrenaline and milrinone in patients with myocardial dysfunction after coronary artery bypass grafting"http://ccforum.com/content/11/2/R51Critical Care 2007;11(2):R51-R51.Published online 30 Apr 2007PMCID:PMC2206480. The time course of plasma cystatin-C levels in patients with myocardial dysfunction after coronary artery bypass grafting surgery, treated with adrenaline (= 7) or milrinone (= 11), and in control patients (= 20) not needing inotropic support. Data are given as mean ± standard error of the mean. Significant difference (&lt; 0.05) in comparison with baseline values (paired test); significant difference (&lt; 0.05) in comparison with the control group (analysis of variance [ANOVA] with Fisher's predicted least-square difference [PLSD]); significant difference (&lt; 0.05) between the adrenaline and the milrinone group (ANOVA with Fisher's PLSD).
<b>Copyright information:</b>Taken from "The metabolic and renal effects of adre... more <b>Copyright information:</b>Taken from "The metabolic and renal effects of adrenaline and milrinone in patients with myocardial dysfunction after coronary artery bypass grafting"http://ccforum.com/content/11/2/R51Critical Care 2007;11(2):R51-R51.Published online 30 Apr 2007PMCID:PMC2206480. The time course of plasma glucose and insulin doses in patients with myocardial dysfunction after coronary artery bypass grafting surgery, treated with adrenaline (= 7) or milrinone (= 11), and in control patients (= 20) not needing inotropic support. Data are given as mean ± standard error of the mean. Significant difference (&lt; 0.05) in comparison with baseline values (paired test); significant difference (&lt; 0.05) in comparison with the control group (analysis of variance [ANOVA] with Fisher's predicted least-square difference [PLSD]); significant difference (&lt; 0.05) between the adrenaline and the milrinone group (ANOVA with Fisher's PLSD).
<b>Copyright information:</b>Taken from "The metabolic and renal effects of adre... more <b>Copyright information:</b>Taken from "The metabolic and renal effects of adrenaline and milrinone in patients with myocardial dysfunction after coronary artery bypass grafting"http://ccforum.com/content/11/2/R51Critical Care 2007;11(2):R51-R51.Published online 30 Apr 2007PMCID:PMC2206480. The time course of plasma lactate , pyruvate , and the lactate/pyruvate ratio in patients with myocardial dysfunction after coronary artery bypass grafting surgery, treated with adrenaline (= 7) or milrinone (= 11), and in control patients (= 20) not needing inotropic support. Data are given as mean ± standard error of the mean. Significant difference (&lt; 0.05) in comparison with baseline values (paired test); significant difference (&lt; 0.05) in comparison with the control group (analysis of variance [ANOVA] with Fisher's predicted least-square difference [PLSD]); significant difference (&lt; 0.05) between the adrenaline and the milrinone group (ANOVA with Fisher's PLSD).
Variations in arterial blood pressure are associated with parallel changes in FlowTrac/Vigileo ®-... more Variations in arterial blood pressure are associated with parallel changes in FlowTrac/Vigileo ®-derived cardiac output measurements: a prospective comparison study
Introduction Myocardial dysfunction necessitating inotropic support is a typical complication aft... more Introduction Myocardial dysfunction necessitating inotropic support is a typical complication after on-pump cardiac surgery. This prospective, randomized pilot study analyzes the metabolic and renal effects of the inotropes adrenaline and milrinone in patients needing inotropic support after coronary artery bypass grafting (CABG). Methods During an 18-month period, 251 patients were screened for low cardiac output upon intensive care unit (ICU) admission after elective, isolated CABG surgery. Patients presenting with a cardiac index (CI) of less than 2.2 liters/minute per square meter upon ICU admission – despite adequate mean arterial (titrated with noradrenaline or sodium nitroprusside) and filling pressures – were randomly assigned to 14-hour treatment with adrenaline (n = 7) or milrinone (n = 11) to achieve a CI of greater than 3.0 liters/minute per square meter. Twenty patients not needing inotropes served as controls. Hemodynamics, plasma lactate, pyruvate, glucose, acid-base ...
Mithilfe der zerebralen Oxymetrie kann die Sauerstoffversorgung des Gehirns nicht-invasiv uberwac... more Mithilfe der zerebralen Oxymetrie kann die Sauerstoffversorgung des Gehirns nicht-invasiv uberwacht werden. Eine Gruppe der Universitat Lubeck hat nun eine Ubersicht uber den klinischen Stellenwert bei der intraoperativen Uberwachung zusammengestellt.
Mithilfe der zerebralen Oxymetrie kann die Sauerstoffversorgung des Gehirns nicht-invasiv überwac... more Mithilfe der zerebralen Oxymetrie kann die Sauerstoffversorgung des Gehirns nicht-invasiv überwacht werden. Eine Gruppe der Universität Lübeck hat nun eine Übersicht über den klinischen Stellenwert bei der intraoperativen Überwachung zusammengestellt.
A perioperative infusion of sodium bicarbonate does not improve renal function in cardiac surgery... more A perioperative infusion of sodium bicarbonate does not improve renal function in cardiac surgery patients: a prospective observational cohort study
Objective: To determine the relationship between a decrease in cerebral oxygen saturation (rSO2) ... more Objective: To determine the relationship between a decrease in cerebral oxygen saturation (rSO2) – determined by near-infrared spectroscopy – below 80% of preoperative baseline and the incidence of stroke in patients undergoing deep hypothermic circulatory arrest (DHCA) for cardiac and/or thoracic aortic surgery. Setting: Cardiac anesthesia unit of a University Hospital Design: Retrospective analysis of the anesthesia charts and the institutional cardiac surgery database for the year 2006. Patients: 51 patients undergoing DHCA monitored bi-hemispherically with an INVOS 5100 cerebral oxymeter. Interventions: None Measurements and main results: Patients were grouped according to an rSO2 less or greater than 80% of baseline for the left or right hemisphere in a desaturation (n = 11) and a no-desaturation group (n = 40). No between group differences in demographic variables and preoperative baseline rSO2 were observed. Duration of cardiopulmonary bypass, aortic cross-clamp, DHCA and eff...
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