Does Perioperative Use of Renin-Angiotensin System Inhibitors Improve Patient Outcomes in Cardiac Surgery?
Qian Ding, Mark Berguson, Zugui Zhang, Hong Liu, Huang Nie, Jordan E. Goldhammer, Rohinton J. Morris, and Jianzhong Sun
- 2011 ACCF/AHA Guidelines for CABG: Uncertain about the safety of the preoperative administration of ACE inhibitors or ARBs in patients on chronic therapy and the safety of initiating ACE inhibitors or ARBs before hospital discharge
- 2014 ESC Guidelines: ACE inhibitors might be stopped 1 to 2 days before CABG to avoid the potential deleterious consequences of perioperative hypotension
- Guidelines state that ACE inhibitors or ARBs should be initiated postoperatively in CABG patients who were not receiving them preoperatively if they have an LVEF ≤40%, hypertension, diabetes, or CKD (Level of Evidence: A)
- There is still a lack of large clinical studies on the effects of perioperative use of RASi and long-term outcomes in cardiac surgery
David Nelson, MD, MBA; Kent Berg, MD, MBA; Rebecca Barnett, MD, MBChB; and Oren Guttman, MD, MBA
- When considering the operating room (OR) suite as a hospital business unit, one must not only acknowledge its revenue-earning contribution to financial solvency but also the potential for margin-eroding cost when utilized inefficiently. 1
- One particularly challenging contributor to perioperative inefficiency is when patients are prevented from moving out of the OR into downstream phases of care once surgery has been completed. These so-called “PACU delays” (also known as recovery room admission delays) are particularly concerning for OR leadership because they increase direct labor costs and result in opportunity cost when additional surgery is prevented from being performed
- At Thomas Jefferson University Hospital in Philadelphia, PA, PACU delays increased in frequency and magnitude in a relatively short period of time, prompting data-driven evaluation and innovation to determine underlying cause.
Improving Bedside Procedural Safety through Optimizing Timeout Documentation and a Pre-procedure Checklist
Jennifer Harris, MD; R. Benson Jones, MD; Kristin Lohr, MD; Grant Turner, MD; Drew Kotler, MD; Justine Blum, MD; Megan Margiotta, MD; Matthew Bokhari, MD; Erica Li, MD; Riti Kanesa-thasan, MD; Bracken Babula, MD; and Rebecca Jaffe, MD
GOAL: Improve the safety of patients undergoing bedside procedures while maintaining the full spectrum of graduated autonomy in procedure training for residents.
SMART Aim: Increase the rate of timeouts documented for bedside procedures from 29% to 50% by June 2018.
Effects of diabetes mellitus and chronic kidney disease on major outcomes in patients undergoing cardiac surgery
Mark W. Berguson, Jordan E. Goldhammer, Hong Liu, Rohinton Morris, and Jianzhong Sun
• Diabetes mellitus (DM) is the leading cause of chronic kidney disease (CKD). CKD typically manifests in late stages of DM.
• DM and CKD are prevalent in patients with cardiovascular disease.
• The impact of concurrent DM and CKD on major adverse cardiocerebral events (MACE) in patients undergoing cardiac surgery remains unclear.1,2
To determine the effect of DM and CKD on major outcomes in patients undergoing cardiac surgery.
Amir C. Dayan, MD and Richard H. Epstein, MD
- An intact pilot balloon is crucial to proper function of a cuffed endotracheal tube (ETT).
- Failure of the pilot balloon or disruption of the inflation tubing results in cuff deflation which may lead to inadequate ventilation and aspiration of oropharyngeal secretions.
- We describe a method that we employed using readily available components to repair a pilot balloon and inflation tubing, and report on the effectiveness of the repair method, as tested in vitro.
Effects of preoperative aspirin on major outcomes in graded high-risk patients undergoing cardiac surgery
Qian Ding, Eric Yuen, Mark Berguson, Hong Liu, Linong Yao, Jordan E. Goldhammer, and Jianzhong Sun
- Among patients with cardiovascular disease, nearly 70% take preventive aspirin.1
- The benefits of aspirin are greater as a patient’s risk of cardiovascular events increases; patients with a lower risk of cardiovascular events derive less of a benefit from aspirin.2
- The effect of aspirin in surgical patients has not yet been investigated, in particular if there is an optimal effect based on operative risk when undergoing cardiac surgery.
To determine the effects of preoperative aspirin on major outcomes after cardiac surgery in patients with low, medium, and high predicted operative mortality as determined by the EuroSCORE risk model.
Preoperative aspirin and major perioperative outcomes in patients with hypertension undergoing cardiac surgery
Qian Ding, Eric Yuen, Mark Berguson, Hong Liu, Linong Yao, Rohinton Morris, and Jianzhong Sun
- Hypertension is prevalent in patients undergoing cardiac surgery and associated with a higher incidence of cardiovascular complications.
- Aspirin has been shown to prevent cardiovascular events in patients with a high risk of cardiovascular disease.
- Very few studies have investigated aspirin and hypertension, particularly its effects on major outcomes in hypertensive patients undergoing cardiac surgery.1,2
To determine the effects of preoperative aspirin on postoperative outcomes for patients with hypertension undergoing cardiac surgery.
To examine the impact of chronic kidney disease and heart failure superimposed with hypertension on outcomes after cardiac surgery.
Printing is not supported at the primary Gallery Thumbnail page. Please first navigate to a specific Image before printing.