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Keyvan Karkouti - One of the best experts on this subject based on the ideXlab platform.
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hyperglycemia during Cardiopulmonary Bypass is an independent risk factor for mortality in patients undergoing cardiac surgery
The Journal of Thoracic and Cardiovascular Surgery, 2005Co-Authors: Torsten Doenst, Duminda N Wijeysundera, Keyvan Karkouti, Christoph Peter Gerhard Zechner, Manjula Maganti, Vivek Rao, Michael A BorgerAbstract:Background Hyperglycemia is commonly present in the perioperative period in patients undergoing cardiac surgery, even during administration of insulin. A direct relationship between postoperative hyperglycemia and mortality has been established in diabetic patients undergoing cardiac surgery. However, this relationship might be confounded because patients with poor outcome receive more glucogenic drugs postoperatively. We assessed the influence of hyperglycemia (highest glucose level) during Cardiopulmonary Bypass on perioperative morbidity and mortality in diabetic and nondiabetic patients. Methods We performed a multivariate logistic regression analysis on all diabetic (n = 1579) and nondiabetic (n = 4701) patients undergoing cardiac surgery at the Toronto General Hospital between 1999 and 2001. Boluses of insulin were given during Cardiopulmonary Bypass when the glucose level exceeded 15 mmol/L, when the serum potassium level exceeded 6.0 mmol/L, or both. Results Overall mortality was 1.8% (n = 115). A high glucose level during Cardiopulmonary Bypass was an independent predictor of mortality in both diabetic (odds ratio, 1.20; confidence interval, 1.08-1.32) and nondiabetic (odds ratio, 1.12; confidence interval, 1.06-1.19; per millimole per liter increase in glucose) patients. A high glucose level during Cardiopulmonary Bypass was also an independent predictor of all major adverse events in both patient groups (odds ratio, 1.06; confidence interval, 1.03-1.09). A high glucose level was not closely related to Cardiopulmonary Bypass ( r = 0.3) or aortic crossclamp times ( r = 0.4). Conclusions A high peak serum glucose level during Cardiopulmonary Bypass is an independent risk factor for death and morbidity in diabetic patients and unexpectedly also in nondiabetic patients.
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hemodilution during Cardiopulmonary Bypass is an independent risk factor for acute renal failure in adult cardiac surgery
The Journal of Thoracic and Cardiovascular Surgery, 2005Co-Authors: Duminda N Wijeysundera, Keyvan Karkouti, Vivek Rao, W S Beattie, Christopher T Chan, Kathleen M Dattilo, George Djaiani, Joan IvanovAbstract:Background This observational study sought to determine whether the degree of hemodilution during Cardiopulmonary Bypass is independently related to perioperative acute renal failure necessitating dialysis support. Methods Data were prospectively collected on consecutive patients undergoing cardiac operations with Cardiopulmonary Bypass from 1999 to 2003 at a tertiary care hospital. The independent relationship was assessed between the degree of hemodilution during Cardiopulmonary Bypass, as measured by nadir hematocrit concentration, and acute renal failure necessitating dialysis support. Multivariate logistic regression was used to control for variables known to be associated with perioperative renal failure and anemia. Results Of the 9080 patients included in the analysis, 1.5% (n = 134) had acute renal failure necessitating dialysis support. There was an independent, nonlinear relationship between nadir hematocrit concentration during Cardiopulmonary Bypass and acute renal failure necessitating dialysis support. Moderate hemodilution (nadir hematocrit concentration, 21%-25%) was associated with the lowest risk of acute renal failure necessitating dialysis support; the risk increased as nadir hematocrit concentration deviated from this range in either direction ( P = .005). Compared with moderate hemodilution, the adjusted odds ratio for acute renal failure necessitating dialysis support with severe hemodilution (nadir hematocrit concentration 25%) it was 1.88 (95% confidence interval, 1.02-3.46). Conclusions Given that there is an independent association between the degree of hemodilution during Cardiopulmonary Bypass and perioperative acute renal failure necessitating dialysis support, patient outcomes may be improved if the nadir hematocrit concentration during Cardiopulmonary Bypass is kept within the identified optimal range. Randomized clinical trials, however, are needed to determine whether this is a cause-effect relationship or simply an association.
Duminda N Wijeysundera - One of the best experts on this subject based on the ideXlab platform.
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hyperglycemia during Cardiopulmonary Bypass is an independent risk factor for mortality in patients undergoing cardiac surgery
The Journal of Thoracic and Cardiovascular Surgery, 2005Co-Authors: Torsten Doenst, Duminda N Wijeysundera, Keyvan Karkouti, Christoph Peter Gerhard Zechner, Manjula Maganti, Vivek Rao, Michael A BorgerAbstract:Background Hyperglycemia is commonly present in the perioperative period in patients undergoing cardiac surgery, even during administration of insulin. A direct relationship between postoperative hyperglycemia and mortality has been established in diabetic patients undergoing cardiac surgery. However, this relationship might be confounded because patients with poor outcome receive more glucogenic drugs postoperatively. We assessed the influence of hyperglycemia (highest glucose level) during Cardiopulmonary Bypass on perioperative morbidity and mortality in diabetic and nondiabetic patients. Methods We performed a multivariate logistic regression analysis on all diabetic (n = 1579) and nondiabetic (n = 4701) patients undergoing cardiac surgery at the Toronto General Hospital between 1999 and 2001. Boluses of insulin were given during Cardiopulmonary Bypass when the glucose level exceeded 15 mmol/L, when the serum potassium level exceeded 6.0 mmol/L, or both. Results Overall mortality was 1.8% (n = 115). A high glucose level during Cardiopulmonary Bypass was an independent predictor of mortality in both diabetic (odds ratio, 1.20; confidence interval, 1.08-1.32) and nondiabetic (odds ratio, 1.12; confidence interval, 1.06-1.19; per millimole per liter increase in glucose) patients. A high glucose level during Cardiopulmonary Bypass was also an independent predictor of all major adverse events in both patient groups (odds ratio, 1.06; confidence interval, 1.03-1.09). A high glucose level was not closely related to Cardiopulmonary Bypass ( r = 0.3) or aortic crossclamp times ( r = 0.4). Conclusions A high peak serum glucose level during Cardiopulmonary Bypass is an independent risk factor for death and morbidity in diabetic patients and unexpectedly also in nondiabetic patients.
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hemodilution during Cardiopulmonary Bypass is an independent risk factor for acute renal failure in adult cardiac surgery
The Journal of Thoracic and Cardiovascular Surgery, 2005Co-Authors: Duminda N Wijeysundera, Keyvan Karkouti, Vivek Rao, W S Beattie, Christopher T Chan, Kathleen M Dattilo, George Djaiani, Joan IvanovAbstract:Background This observational study sought to determine whether the degree of hemodilution during Cardiopulmonary Bypass is independently related to perioperative acute renal failure necessitating dialysis support. Methods Data were prospectively collected on consecutive patients undergoing cardiac operations with Cardiopulmonary Bypass from 1999 to 2003 at a tertiary care hospital. The independent relationship was assessed between the degree of hemodilution during Cardiopulmonary Bypass, as measured by nadir hematocrit concentration, and acute renal failure necessitating dialysis support. Multivariate logistic regression was used to control for variables known to be associated with perioperative renal failure and anemia. Results Of the 9080 patients included in the analysis, 1.5% (n = 134) had acute renal failure necessitating dialysis support. There was an independent, nonlinear relationship between nadir hematocrit concentration during Cardiopulmonary Bypass and acute renal failure necessitating dialysis support. Moderate hemodilution (nadir hematocrit concentration, 21%-25%) was associated with the lowest risk of acute renal failure necessitating dialysis support; the risk increased as nadir hematocrit concentration deviated from this range in either direction ( P = .005). Compared with moderate hemodilution, the adjusted odds ratio for acute renal failure necessitating dialysis support with severe hemodilution (nadir hematocrit concentration 25%) it was 1.88 (95% confidence interval, 1.02-3.46). Conclusions Given that there is an independent association between the degree of hemodilution during Cardiopulmonary Bypass and perioperative acute renal failure necessitating dialysis support, patient outcomes may be improved if the nadir hematocrit concentration during Cardiopulmonary Bypass is kept within the identified optimal range. Randomized clinical trials, however, are needed to determine whether this is a cause-effect relationship or simply an association.
Torsten Doenst - One of the best experts on this subject based on the ideXlab platform.
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hyperglycemia during Cardiopulmonary Bypass is an independent risk factor for mortality in patients undergoing cardiac surgery
The Journal of Thoracic and Cardiovascular Surgery, 2005Co-Authors: Torsten Doenst, Duminda N Wijeysundera, Keyvan Karkouti, Christoph Peter Gerhard Zechner, Manjula Maganti, Vivek Rao, Michael A BorgerAbstract:Background Hyperglycemia is commonly present in the perioperative period in patients undergoing cardiac surgery, even during administration of insulin. A direct relationship between postoperative hyperglycemia and mortality has been established in diabetic patients undergoing cardiac surgery. However, this relationship might be confounded because patients with poor outcome receive more glucogenic drugs postoperatively. We assessed the influence of hyperglycemia (highest glucose level) during Cardiopulmonary Bypass on perioperative morbidity and mortality in diabetic and nondiabetic patients. Methods We performed a multivariate logistic regression analysis on all diabetic (n = 1579) and nondiabetic (n = 4701) patients undergoing cardiac surgery at the Toronto General Hospital between 1999 and 2001. Boluses of insulin were given during Cardiopulmonary Bypass when the glucose level exceeded 15 mmol/L, when the serum potassium level exceeded 6.0 mmol/L, or both. Results Overall mortality was 1.8% (n = 115). A high glucose level during Cardiopulmonary Bypass was an independent predictor of mortality in both diabetic (odds ratio, 1.20; confidence interval, 1.08-1.32) and nondiabetic (odds ratio, 1.12; confidence interval, 1.06-1.19; per millimole per liter increase in glucose) patients. A high glucose level during Cardiopulmonary Bypass was also an independent predictor of all major adverse events in both patient groups (odds ratio, 1.06; confidence interval, 1.03-1.09). A high glucose level was not closely related to Cardiopulmonary Bypass ( r = 0.3) or aortic crossclamp times ( r = 0.4). Conclusions A high peak serum glucose level during Cardiopulmonary Bypass is an independent risk factor for death and morbidity in diabetic patients and unexpectedly also in nondiabetic patients.
Marco Ranucci - One of the best experts on this subject based on the ideXlab platform.
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hematocrit on Cardiopulmonary Bypass and outcome after coronary surgery in nontransfused patients
The Annals of Thoracic Surgery, 2010Co-Authors: Marco Ranucci, Daniela Conti, Serenella Castelvecchio, Lorenzo Menicanti, Alessandro Frigiola, Andrea Ballotta, Gabriele PelisseroAbstract:Background Preoperative anemia and the lowest registered hematocrit value on Cardiopulmonary Bypass are recognized risk factors for morbidity and mortality after coronary operations. A low hematocrit often results in blood transfusions with all of the associated possible complications. The relative contribution of these three factors to long-term outcome is still not well established. This study aimed to identify the role of preoperative anemia and hemodilution during Cardiopulmonary Bypass as determinants of morbidity and mortality after coronary operations. Methods A consecutive series of 3,003 patients was analyzed. They had all undergone isolated coronary operations without receiving blood transfusions during their hospital stay. The preoperative hematocrit and the lowest hematocrit on Cardiopulmonary Bypass were analyzed in a multivariable model as predictors of major morbidity and operative mortality. Results After adjustment for the other explanatory variables, both the preoperative hematocrit and the lowest hematocrit on Cardiopulmonary Bypass were found to be independent risk factors for major morbidity, but not for operative mortality. However, low values of preoperative hematocrit were not associated with an increased morbidity, provided that the lowest hematocrit on Cardiopulmonary Bypass was maintained above 28%. Median values of the lowest hematocrit on Cardiopulmonary Bypass below 25% were associated with an increased major morbidity rate. Conclusions Excessive hemodilution during Cardiopulmonary Bypass is a risk factor for major morbidity even in the absence of blood transfusions. Techniques that aim to reduce the fall in hematocrit during Cardiopulmonary Bypass, including blood cardioplegia, may be useful, especially in patients with a low preoperative hematocrit.
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hyperlactatemia during Cardiopulmonary Bypass determinants and impact on postoperative outcome
Critical Care, 2006Co-Authors: Marco Ranucci, Daniela Conti, Barbara De Toffol, Giuseppe Isgro, Federica Romitti, Maira VicentiniAbstract:Introduction Hyperlactatemia during Cardiopulmonary Bypass is relatively frequent and is associated with an increased postoperative morbidity. The aim of this study was to determine which perfusion-related factors may be responsible for hyperlactatemia, with specific respect to hemodilution and oxygen delivery, and to verify the clinical impact of hyperlactatemia during Cardiopulmonary Bypass in terms of postoperative morbidity and mortality rate.
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oxygen delivery during Cardiopulmonary Bypass and acute renal failure after coronary operations
The Annals of Thoracic Surgery, 2005Co-Authors: Marco Ranucci, Giuseppe Isgro, Federica Romitti, Mauro Cotza, Simonetta Brozzi, Alessandra Boncilli, Antonio DittaAbstract:Background The degree of hemodilution during Cardiopulmonary Bypass has recently been identified as an independent risk factor for acute renal failure after cardiac operations. In this prospective observational study we have investigated the role of the lowest oxygen delivery, lowest hematocrit, and pump flow during Cardiopulmonary Bypass as possible risk factors for acute renal failure and renal dysfunction. Methods One thousand forty-eight consecutive patients undergoing coronary operations have been studied. For each patient we have recorded the lowest hematocrit on Cardiopulmonary Bypass, the correspondent lowest oxygen delivery, and the pump flow around the time of these determinations. The three variables have been explored in a multivariable model as possible risk factors for acute renal failure and postoperative serum creatinine levels increase. The role of transfusions in determining acute renal failure was subsequently included in the model. Results The best predictor for acute renal failure and peak postoperative serum creatinine levels was the lowest oxygen delivery, with a critical value at 272 mL·min −1 ·m −2 . The lowest hematocrit was an independent risk factor with a lowest predictive value at a cutoff of 26%. When corrected for the need for transfusions, only the lowest oxygen delivery remained an independent risk factor. Conclusions A high degree of hemodilution during Cardiopulmonary Bypass is a risk factor for postoperative renal dysfunction; however, its detrimental effects may be reduced by increasing the oxygen delivery with an adequately increased pump flow.
Warwick Butt - One of the best experts on this subject based on the ideXlab platform.
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nitric oxide administration during paediatric Cardiopulmonary Bypass a randomised controlled trial
Intensive Care Medicine, 2016Co-Authors: C J James, Johnny Millar, Stephen Horton, Christian P Brizard, Charlotte Molesworth, Warwick ButtAbstract:Purpose Cardiopulmonary Bypass induces an ischaemia–reperfusion injury and systemic inflammatory response, which contributes to low cardiac output syndrome following cardiac surgery. Exogenous nitric oxide during Cardiopulmonary Bypass has shown potential to ameliorate such injury. We undertook a large randomised controlled trial to investigate the clinical effects of administering nitric oxide to the Cardiopulmonary Bypass circuit in children.