Objectives:The application of Enhanced Recovery After Surgery (ERAS) in cardiac surgery has been increasing in recent years. The goal of this controlled before-and-after study is to compare the postoperative follow-up periods of patients who had low left ventricular ejection fraction and were operated on for coronary artery bypass grafting using the ERAS protocol and the standard protocol (CABG). Methods: Controlled before-and-after study. A single hospital-based study. Perioperative data from 50 consecutive patients who used the standard protocol (preERAS) were matched with data from 50 consecutive patients in the prospective group (postERAS) which consisted of 50 consecutive patients. Patients with low left ventricular ejection fraction were detected in both groups. Results: Patient demographics, operation and cross-clamp durations, cross-clamp and CPB, amount of perioperative bleeding, time of extubation, length of stay in the intensive care unit and hospital, and complications were all recorded and compared between groups. The time of extubation was statistically significantly earlier in the posters group (7.2±2.2 h vs. 10.9±6.0 h, p=0.001). Perioperative blood loss was statistically significantly lower in the postERAS group than in the preERAS group (359±56.9 vs. 392±75.8 cc respectively, p=0.028). The patients under posters protocol stayed statistically importantly lower in the intensive care unit (2.1±0.5 days vs. 2.4±0.8 days, respectively p=0.002).
Conclusion:The ERAS pathway was found to be feasible in patients and was associated with shorter extubation time, less perioperative bleeding, and a shorter stay in the intensive care unit and hospital.
Objectives:We investigated the effects of endotracheal tubes with subglottic drainage (SGAETT) on the incidence of ventilator-associated pneumonia (VAP) in patients with chronic obstructive pulmonary disease (COPD) undergoing coronary artery bypass grafting (CABG). Methods: The patients were assigned to one of two groups. Group 1 patients used a SGAETT (n=94); Group 2 controls received standard endotracheal tubes (n=100). The demographic data, number of coronary bypasses performed, and cross clamp (CC) and cardiopulmonary bypass (CPB) durations were recorded. Endotracheal aspiration samples were obtained from patients with suspected VAP in the intensive care unit (ICU). Intubation time, length of ICU and hospital stays, erythrocyte transfusion volume, enteral nutrition needs, transportation needs, and reintubation and sedation needs were recorded. Results: The VAP rate was 6.8% in Group 1 and 19% in Group 2 (p<0.05). Group 1 patients had lower body weight, smoking, and transportation needs; Group 1 patients also had shorter ICU and hospital stays but demonstrated a greater average body surface area, higher mean pulmonary arterial pressure, more-frequent peptic ulcers, higher mean pulmonary arterial pressure, and Group 1 patients were more likely to have ejection fractions (EFs) less than 40% (p<0.05). A logistic regression analyses found SGAETT independently reduced VAP independently (OR: 0.037) (p<0.05). Conclusion: SGAETT reduces the incidence of VAP in patients with COPD undergoing cardiac surgery.
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