BackgroundA strategy of limited preoperative fasting, with carbohydrate (CHO) loading and intraoperative infusion of omega-3 polyunsaturated fatty acids (ω-3 PUFA), has seldom been tried in cardiovascular surgery. Brief fasting, followed by CHO intake 2 h before anesthesia, may improve recovery from CABG procedures and lower perioperative vasoactive drug requirements. Infusion of ω-3 PUFA may reduce occurrences of postoperative atrial fibrillation (POAF) and shorten hospital stays. The aim of this study was to assess morbidity (especially POAF) in ICU patients after coronary artery bypass grafting (CABG)/cardiopulmonary bypass (CPB) in combination, if preoperative fasts are curtailed in favor of CHO loading, and ω-3 PUFA are infused intraoperatively.MethodsFifty-seven patients undergoing CABG were randomly assigned to receive 12.5% maltodextrin (200 ml, 2 h before anesthesia), without infusing ω-3 PUFA (CHO, n = 14); water (200 ml, 2 h before anesthesia), without infusing ω-3 PUFA (controls, n = 14); 12.5% maltodextrin (200 ml, 2 h before anesthesia) plus intraoperative ω-3 PUFA (0.2 mcg/kg) (CHO + W3, n = 15); or water (200 ml, 2 h before anesthesia) plus intraoperative ω-3 PUFA (0.2 mcg/kg) (W3, n = 14). Perioperative clinical variables and mortality were analyzed, examining the incidence of POAF, as well as the need for inotropic vasoactive drugs during surgery and in ICU.ResultsTwo deaths occurred (3.5%), but there were no instances of bronchoaspiration and mediastinitis. Neither ICU stays nor total postoperative stays differed by group (P > 0.05). Patients given preoperative CHO loads (CHO and CHO + W3 groups) experienced fewer instances of hospital infection (RR = 0.29, 95%CI 0.09–0.94; P = 0.023) and were less reliant on vasoactive amines during surgery (RR = 0.60, 95% CI 0.38–0.94; P = 0.020). Similarly, the number of patients requiring vasoactive drugs while recovering in ICU differed significantly by group (P = 0.008), showing benefits in patients given CHO loads. The overall incidence of POAF was 29.8% (17/57), differing significantly by group (P = 0.009). Groups given ω-3 PUFA (W3 and CHO + W3 groups) experienced significantly fewer instances of POAF (RR = 4.83, 95% CI 1.56–15.02; P = 0.001).ConclusionPreoperative curtailment of fasting was safe in this cohort. When implemented in conjunction with CHO loading and infusion of ω-3 PUFA during surgery, expedited recovery from CABG with CPB was observed.Trial registrationNCT: 03017001
RESUMOO objetivo deste estudo foi avaliar associação entre a concentração sérica de peptídeo natriurético cerebral (BNP) e acometimento cardíaco provocado pela doença de Chagas crônica, e também com o tratamento antiparasitário da infecção com benzonidazol. Foram incluídos 84 pacientes adultos da demanda assistencial de um serviço de referência da Região Central do Brasil, localizado em Cuiabá (MT). Forma crônica indeterminada foi diagnosticada em 20 (23,8%) pacientes. Vinte e cinco indivíduos (29,8%) eram assintomáticos, porém tinham alterações eletrocardiográficas e/ou ecocardiográficas, sendo classificados como forma cardíaca assintomática. Os demais 39 (46,4%) pacientes já apresentavam sintomas de complicações cardiodigestivas e foram classificados como forma cardíaca sintomática. Mais da metade dos pacientes havia recebido tratamento etiológico prévio da doença e estavam em monitoramento da resposta terapêutica, que variou de 2 a 21 anos. Os níveis séricos de BNP mostraram-se elevados em 67 (79,8%) pacientes, sendo 17 (85,0%) com a forma indeterminada, 18 (72,0%) com a forma assintomática cardíaca e 32 (82,1%) com a forma sintomática cardiodigestiva. Porém, nem essas proporções (p=0,497) e nem a distribuição dos níveis séricos do BNP (p=0,881) se diferiram significativamente entre esses grupos de pacientes. Similarmente, elevados foram os níveis séricos de BNP entre os pacientes tratados e não tratados com benzonidazol, não se identificando associação estatística (p=0,368) entre os grupos. Os achados do estudo sugerem que o BNP está elevado em todas as formas clínicas da doença de Chagas crônica, mas não discrimina pacientes com e sem acometimento cardíaco e nem aqueles que receberam ou não tratamento antiparasitário específico. A ausência de associação observada neste estudo poderá orientar o delineamento de futuros estudos na busca de biomarcadores de acometimento cardíaco na doença de Chagas crônica.Palavras-chave: doença de chagas crônica, peptídeo natriurético cerebral, biomarcador.
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