Background: The aim of this study was to assess the effect of timing and techniques of tracheostomy on mortality and morbidity in cardiovascular surgery patients. Methods: Between January 2000 and October 2007, a total of 19,559 cardiac and vascular operations were performed in our hospital, and 205 of these patients (1.04%) who underwent a tracheostomy procedure were included in this retrospective study. Results: Surgical tracheostomy (ST) was employed in 134 (65.4%) and percutaneous tracheostomy (PT) in 71 (34.6%) of the cases. There were 17 complications related to all tracheostomy procedures in 15 (7.3%) patients. Bleeding, requiring surgical intervention, occurred in five (3.7%) ST patients and in one (1.4%) PT patient. Cardiac arrest related to the procedure occurred in two (1.5%) ST patients. Pneumothorax occurred in three (2.2%) ST patients and in one (1.4%) PT patient, subcutaneous emphysema in three (2.2%) ST patients and in one (1.4%) PT patient, and tracheoesophageal fistula in one (0.7%) ST patient (p > 0.05). The postoperative infection rate was significantly lower, and cooperation of the patients, postoperative patient mobilization, and oral feeding rates were higher in the early tracheostomy group. The multifactorial mortality rates of early (
Combined prophylactic therapy with amiodarone and MgSO(4) at the early postoperative period without a maintenance phase is an effective, simple, well-tolerated, and possibly cost-effective regimen to prevent POAF in normomagnesemic, high-risk patients.
Bu çalışmada yeni geliştirilen bir enflamatuvar parametre olan nötrofil/lenfosit oranının koroner arter baypas greft (KABG) cerrahisi sonrası erken dönem mortalite prediktörü olarak etkisi araştırıldı. Ça lış mapla nı:Aralık 2011-Nisan 2012 tarihleri arasında kliniğimizde izole KABG cerrahisi yapılan ardışık 210 hasta prospektif olarak incelendi. Hastaların başlangıç özellikleri ve ameliyat öncesi nötrofil/lenfosit oranları belirlendi. Ameliyat sonrası takip süresi 86.1±38.9 gün idi. Primer sonlanım noktası, tüm-nedenlere bağlı mortalite olarak belirlendi. Bul gu lar: Dört hastada ameliyat sonrası ilk 30 günde olmak üzere, toplam sekiz hastada (%3.8) mortalite görüldü. Tek değişkenli analizlerde ameliyat öncesi nötrofil/lenfosit oranı, mortalite gelişen ve gelişmeyen gruplar arasında anlamlı derecede farklı olarak saptandı (p= 0.037). Alıcı işlem karakteristikleri (ROC) eğrisinde nötrofil/lenfosit oranı için eşik değeri 2.81 olarak belirlendi (AUC= 0.72, duyarlılık: %75, özgüllük: %67). İki grup arasında anlamlı farka sahip olan değişkenler ile yapılan lojistik regresyon analizinde ise, nötrofil/lenfosit oranı için eşik değerinin üzerinde olması mortalite için bağımsız bir prediktör olarak saptandı (OR 6.47, %95 CI 1.18-35.38, p= 0.031). So nuç: Kolay bir şekilde hesaplanabilen nötrofil/lenfosit oranı KABG cerrahisi sonrası erken dönem mortaliteyi öngörmede bağımsız bir faktör olarak kullanılabilir. Anah tar söz cük ler: Koroner arter baypas greftleme; lenfosit; mortalite; nötrofil. Background: In this study, we aimed to investigate the newly introduced inflammatory biomarker, neutrophil/ lymphocyte ratio, as a mortality predictor following coronary artery bypass graft (CABG) surgery. Methods: Between December 2011 and April 2012, 210 consecutive patients who underwent isolated CABG surgery in our clinic were prospectively analyzed. The baseline characteristics of the patients and preoperative neutrophil/ lymphocyte ratio were determined. The postoperative follow-up was 86.1±38.9 days. The primary endpoint was all-cause mortality. Results: Eight patients (3.8%) died of whom four deaths occurred during the first 30 days of follow-up. Univariate analyses revealed a significant difference in the preoperative neutrophil/lymphocyte ratio between the groups in which mortality was seen and the group in which no mortality was observed (p=0.037). The Receiver operating characteristic (ROC) curve showed a threshold value of 2.81 for neutrophil/lymphocyte ratio (AUC=0.72, sensitivity: 75%, specificity: 67%). Logistic regression analysis of the variables with significant differences between two groups revealed that the neutrophil/lymphocyte ratio over its threshold value was an independent predictor for mortality (OR 6.47, 95% CI 1.18-35.38, p=0.031). Conclusion: Neutrophil/lymphocyte ratio, which can be easily calculated, can be used as an independent factor in predicting early mortality following CABG surgery.
BackgroundAn elevated mean platelet volume is associated with increased platelet activation and thus may predict thrombotic events. The goal of this study was to investigate the association of the mean platelet volume and the major adverse events after coronary artery bypass surgery.MethodsBaseline clinical details and preoperative hematologic parameters were obtained prospectively in 205 consecutive patients undergoing coronary artery bypass surgery. Postoperative mortality and major adverse events were recorded in the early postoperative period (median of 72 days, interquartile range 58.5-109 days).ResultsCombined adverse events occurred in 37 patients (18.0%) during the early follow-up. The preoperative mean platelet volume and hematocrit levels were found to be associated with postoperative adverse events (p<0.001 for both variables). In multivariate logistic regression models, the preoperative mean platelet volume and hematocrit levels were strong independent predictors of combined adverse events after surgery (respectively OR 1.89, p=0.037; OR 0.87, p=0.011). After receiver-operating-characteristics curve analysis, using a cut-point of 8.75 fL, the preoperative mean platelet volume level predicted adverse events with a sensitivity of 54% and specificity of 70%. In a further model with cut-off points, higher preoperative mean platelet volume levels remained a powerful independent predictor of postoperative myocardial infarction (OR 3.60, p=0.013) and major adverse cardiac events (OR 2.53, p=0.045).ConclusionsAn elevated preoperative mean platelet volume is associated with an adverse outcome after coronary artery bypass grafting. In conclusion, we can say that mean platelet volume is an important, simple, readily available, and cost effective tool and can be useful in predicting the postoperative adverse events in patients undergoing coronary artery bypass grafting.
Bu çalışmada, farklı antikolagülan rejimlerinin protez kapak ile ilişkili komplikasyonlar ve feto-maternal mortalite ve morbidite üzerindeki etkileri araştırıldı ve en ideal antikolagülan tedavi rejimi belirlendi. Ça lış ma pla nı: Ocak 1990-Aralık 2015 tarihleri arasında mekanik kalp kapak replasmanı yapılan gebe kadınlarda antikoagülan tedavi rejimleri, retrospektif olarak incelendi. Mekanik kalp kapak replasmanı sonrası 57 hastada 72 gebelik gözden geçirildi ve dört farklı rejim belirlendi ve gebeliğin farklı trimesterlerinde değerlendirildi. Bul gu lar: Yetmiş iki gebeliğin, 40'ı sağlıklı yeni doğanla, 35'i (%48.6) sağlıklı yenidoğan, dördü (%5.6) prematüre doğum ve biri (%1.4) düşük doğum ağırlığı ile sonuçlandı. On sekiz (%25) terapötik ve 12 (%16.7) spontan düşüğün yanı sıra, iki (%2.8) ölü doğum izlendi. Gebelik süresince veya post-partum dönemde, yedi gebede kapak trombozu gelişti. Altı hastada (%10.5) kanama ve yine altı (%10.5) hastada periferik emboli meydana geldi. Maternal mortalite görülmedi. So nuç:Gebelik sırasında en ideal antikoagülasyon rejimine ilişkin tam bir fikir birliği olmamasına rağmen, birinci trimesterde varfarinin teratojenisite ve artmış düşük riskini önlemek için doz ayarlamalı fraksiyone olmayan heparin veya düşük molekül ağırlıklı heparin ile değiştirilmesi uygundur. Düşük molekül ağırlıklı heparinin uygulaması kolaydır ve güvenilir bir şekilde izlenebilir ve başarılı gebelik sonuçlarına da vesile olabilir. Ancak, gebeliğin tüm trimesterleri süresince, günde ≤5 mg varfarini geçmemek kaydıyla kullanılacak varfarin, embriyopati riskinin gebe tarafından kabul edildiği durumlarda, alternatif bir seçenek olabilir. Anah tarsöz cük ler: Antikoagülasyon; mekanik kalp kapağı; gebelik.
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