Shock Management For Cardio-Surgical ICU Patients — The Golden Hours

Hauffe, Till; Krüger, Bernard; Béttex, Dominique; Rudiger, Alain

doi:10.15420/cfr.2015.1.2.75

Cited by 15 publications

(7 citation statements)

References 122 publications

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“…Neurologists and psychiatrists are available for expert consultation 24 h/day. The principles of patient management in this particular ICU have recently been summarized [ 11 , 12 ].…”

Section: Methodsmentioning

confidence: 99%

Intra-operative events during cardiac surgery are risk factors for the development of delirium in the ICU

et al. 2016

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BackgroundRisk factors for delirium following cardiac surgery are incompletely understood. The aim of this study was to investigate whether intra-operative pathophysiological alterations and therapeutic interventions influence the risk of post-operative delirium.MethodsThis retrospective cohort study was performed in a 12-bed cardiosurgical intensive care unit (ICU) of a university hospital and included patients consecutively admitted after cardiac surgery during a 2-month period. The diagnosis of delirium was made clinically using validated scores. Comparisons between patients with and without delirium were performed with non-parametric tests. Logistic regression was applied to identify independent risk factors. Results are given as number (percent) or median (range).ResultsOf the 194 consecutive post-cardiac surgery patients, 50 (26 %) developed delirium during their ICU stay. Univariate analysis revealed that significant differences between patients with and without delirium occurred in the following intra-operative variables: duration of cardiopulmonary bypass (184 [72–299] vs 113 (37–717) minutes, p < 0.001), lowest mean arterial pressure (50 [30–70] vs 55 [30–75] mmHg, p = 0.004), lowest haemoglobin level (85 [56–133] vs 98 [53–150] g/L, p = 0.005), lowest body temperature (34.5 [24.4–37.2] vs 35.1 [23.9–37.2] °C, p = 0.035), highest noradrenaline support (0.11 [0.00–0.69] vs 0.07 [0.00–0.42] μg/kg/minute, p = 0.001), and frequency of red blood cell transfusions (18 [36 %] vs 26 [18 %], p = 0.018) and platelet transfusions (23 [46 %] vs 24 [17 %], p < 0.001). Only platelet transfusions remained an independent risk factor in the multivariate analysis (p < 0.001).ConclusionsIn patients undergoing cardiac surgery, various intra-operative events, such as transfusion of platelets, were risk factors for the development of a post-operative delirium in the ICU. Further research is needed to unravel the underlying mechanisms.

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“…Neurologists and psychiatrists are available for expert consultation 24 h/day. The principles of patient management in this particular ICU have recently been summarized [ 11 , 12 ].…”

Section: Methodsmentioning

confidence: 99%

Intra-operative events during cardiac surgery are risk factors for the development of delirium in the ICU

et al. 2016

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“…The ICU is led by certified specialists in intensive care medicine. The treatment goals of our cardio-surgical ICU patients have been summarized (Hauffe et al, 2015(Hauffe et al, , 2016. Neurologists and psychiatrists are available for expert consultation at all hours.…”

Section: Patients and Proceduresmentioning

confidence: 99%

QTc prolongation after haloperidol administration in critically ill patients post cardiovascular surgery: A cohort study and review of the literature

et al. 2020

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Objective From case reports, haloperidol administration has been associated with QTc prolongation, torsades de pointes, and sudden cardiac death. In a vulnerable population of critically ill patients after cardiac surgery, however, it is unclear whether haloperidol administration affects the QTc interval. Thus, the aim of this study is to explore the effect of haloperidol in low doses on this interval. Method This retrospective cohort study was performed on a cardio-surgical intensive care unit (ICU), screened 2,216 patients and eventually included 68 patients with delirium managed with oral and intravenous haloperidol. In this retrospective analysis, electrocardiograms were taken prior and within 24 h after haloperidol administration. The effect of haloperidol on QTc was determined with a Person correlation, and inter-group differences were measured with new long QT comparisons. Results In total, 68 patients were included, the median age was 71 (64–79) years and predominantly male (77%). Haloperidol administration followed ICU admission by three days and the cumulative dose was 4 (2–9) mg. As a result, haloperidol administration did not affect the QTc (r = 0.144, p = 0.23). In total, 31% (21/68 patients) had a long QT before and 27.9% (19/68 patients) after haloperidol administration. Only 12% (8/68 patients) developed a newly onset long QT. These patients were not different in the route of administration, cumulative haloperidol doses, comorbidities, laboratory findings, or medications. Significance of results These results indicated that low-dose intravenous haloperidol was safe and not clinically relevant for the development of a newly onset long QT syndrome or adverse outcomes and support recent findings inside and outside the ICU setting.

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“…e study was performed in the cardiosurgical ICU at the University Hospital Zurich, Switzerland. e treatment principles of patients hospitalized in this particular ICU have been summarized [16,17]. In our practice, patients generally arrive from the operation room under propofol sedation.…”

Section: Settingmentioning

confidence: 99%

Cardiovascular Safety of Clonidine and Dexmedetomidine in Critically Ill Patients after Cardiac Surgery

Grest

Kurmann

Müller

et al. 2020

Critical Care Research and Practice

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Purpose. The aim of this retrospective study was to assess the haemodynamic adverse effects of clonidine and dexmedetomidine in critically ill patients after cardiac surgery. Methods. 2769 patients were screened during the 30-month study period. Heart rate (HR), mean arterial pressure (MAP), and norepinephrine requirements were assessed 3-hourly during the first 12 hours of the continuous drug infusion. Results are given as median (interquartile range) or numbers (percentages). Results. Patients receiving clonidine (n = 193) were younger (66 (57–73) vs 70 (63–77) years, p=0.003) and had a lower SAPS II (35 (27–48) vs 41 (31–54), p=0.008) compared with patients receiving dexmedetomidine (n = 141). At the start of the drug infusion, HR (90 (75–100) vs 90 (80–105) bpm, p=0.028), MAP (70 (65–80) vs 70 (65–75) mmHg, p=0.093), and norepinephrine (0.05 (0.00–0.11) vs 0.12 (0.03–0.19) mcg/kg/min, p<0.001) were recorded in patients with clonidine and dexmedetomidine. Bradycardia (HR < 60 bpm) developed in 7.8% with clonidine and 5.7% with dexmedetomidine (p=0.51). Between baseline and 12 hours, norepinephrine remained stable in the clonidine group (0.00 (−0.04–0.02) mcg/kg/min) and decreased in the dexmedetomidine group (−0.03 (−0.10–0.02) mcg/kg/min, p=0.007). Conclusions. Dexmedetomidine and the low-cost drug clonidine can both be used safely in selected patients after cardiac surgery.

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Shock Management For Cardio-Surgical ICU Patients — The Golden Hours

Cited by 15 publications

References 122 publications

Intra-operative events during cardiac surgery are risk factors for the development of delirium in the ICU

Intra-operative events during cardiac surgery are risk factors for the development of delirium in the ICU

QTc prolongation after haloperidol administration in critically ill patients post cardiovascular surgery: A cohort study and review of the literature

Cardiovascular Safety of Clonidine and Dexmedetomidine in Critically Ill Patients after Cardiac Surgery

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