Abstract Objectives The objective of this meta-analysis of randomized trials was to evaluate if the administration of furosemide with matched hydration using the RenalGuard System reduces ...contrast-induced acute kidney injury (CI-AKI) in patients undergoing interventional procedures. Background CI-AKI is a serious complication following angiographic procedures and a powerful predictor of unfavorable early and long-term outcomes. Methods Online databases were searched up to October 1, 2016, for randomized controlled trials. The primary outcome was the incidence of CI-AKI, and the secondary outcomes were need for renal replacement therapy, mortality, stroke, and adverse events. Results A total of four trials (n = 698) published between 2011 and 2016 were included in the analysis and included patients undergoing percutaneous coronary procedures and transcatheter aortic valve replacement. RenalGuard therapy was associated with a lower incidence of CI-AKI compared with control treatment (27 of 348 7.76% patients vs. 75 of 350 21.43% patients; odds ratio OR: 0.31; 95% confidence interval CI: 0.19 to 0.50; I2 = 4%; p < 0.00001) and with a lower need for renal replacement therapy (2 of 346 0.58% patients vs. 12 of 348 3.45% patients; OR: 0.19; 95% CI: 0.05 to 0.76; I2 = 0%; p = 0.02). No major adverse events occurred in patients undergoing RenalGuard therapy. Conclusions The main finding of this meta-analysis is that furosemide with matched hydration by the RenalGuard System may reduce the incidence of CI-AKI in high-risk patients undergoing percutaneous coronary intervention or transcatheter aortic valve replacement. However, further independent high-quality randomized trials should elucidate the effectiveness and safety of this prophylactic intervention in interventional cardiology.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Objective Percutaneous procedures for the treatment of mitral valve disease represent valuable therapeutic options for high-risk patients. The anesthetic management of these patients is complex, as ...they often suffer from cardiac failure and present multiple comorbidities. A recently developed device for transcatheter mitral valve annuloplasty (Cardioband – Valtech Cardio, Or Yehuda, Israel) is now available in clinical practice. The aim of this study was to present the authors’ experience with Cardioband device implantation and to describe their anesthetic strategy. Design Retrospective study. Setting Cardiac catheterization laboratory of a teaching hospital. Participants Thirteen patients undergoing Cardioband implantation. Interventions All the procedures were performed under general anesthesia with continuous transesophageal echocardiographic monitoring. Three-dimensional echocardiography, inotropic therapy, cardiac pacing, and mechanical circulatory support always were available and performed as needed. Measurements and Main Results Mean age was 73±7.1 years, and mean preoperative ejection fraction was 38±7.4%. No complications related to anesthetic management were recorded. The authors observed 1 episode of device malfunction and 1 case of accidental damage to the circumflex artery. Postoperative complications were observed in 3 patients, involving detachment of the anchors, anemia requiring transfusions, vascular injury, and new-onset atrial fibrillation. Six patients (46%) required ICU admission. All patients (100%) were discharged from the hospital. Conclusions Cardioband device implantation under general anesthesia is a feasible approach when performed by skilled physicians with all the expertise and the resources of high-volume centers used to dealing with severely ill patients.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
Objectives Delirium frequently is observed in critically ill patients in the intensive care unit (ICU) and is associated strongly with a poor outcome. Dexmedetomidine seems to reduce time to ...extubation and ICU stay without detrimental effects on mortality. The objective of the authors’ study was to evaluate the effect of this drug on delirium, agitation, and confusion in the ICU setting. Design Meta-analysis of all the randomized clinical trials ever performed on dexmedetomidine versus any comparator in the ICU setting. Setting Intensive care units. Participants Critically ill patients. Interventions None Measurements and Main Results Pertinent studies were independently searched in BioMedCentral, PubMed, Embase, and the Cochrane Central Register of clinical trials. Primary endpoint was the rate of delirium, including the adverse events, agitation and confusion. The 13 included manuscripts (14 trials) randomized 3,029 patients. Overall analysis showed that the use of dexmedetomidine was associated with significant reductions in the incidence of delirium, agitation and confusion (298/1,565 19% in the dexmedetomidine group v 337/1,464 23% in the control group, RR = 0.68 0.49 to 0.96, p = 0.03). Results were confirmed in subanalyses performed on patients undergoing noninvasive ventilation (1/53 2% in the dexmedetomidine group v 7/49 14% in the control group, RR=0.18 0.03 to 1.01, p = 0.05), receiving midazolam as a comparator (268/1,164 23% in the dexmedetomidine group v 277/1,025 27% in the control group, RR = 0.68 0.47 to 1.00, p = 0.05) and in general ICU setting patients (204/688 30% in the dexmedetomidine group v 204/560 36% in the control group, RR = 0.68 0.45 to 0.81, p< 0.01). Conclusions This meta-analysis of randomized controlled studies suggests that dexmedetomidine could help to reduce delirium in critically ill patients.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
Abstract Purpose Inotropes and vasopressors are cornerstone of therapy in septic shock, but search for the best agent is ongoing. We aimed to determine which vasoactive drug is associated with the ...best survival. Materials and Methods PubMed, BioMedCentral, Embase and the Cochrane Central Register were searched. Randomized trials performed in septic patient with at least one group allocated to an inotrope/vasopressor were included. Network meta-analysis with a frequentist approach was performed. Results The 33 included studies randomized 3470 patients to 16 different comparators. As compared with placebo, levosimendan (Odds Ratio OR = 0.17, 95% Confidence Interval CI = 0.05–0.60), dobutamine (OR =0.30, 95% CI = 0.09–0.99), epinephrine (OR =0.35, 95% CI = 0.13–0.96), vasopressin (OR =0.37, 95% CI = 0.16–0.89), and norepinephrine plus dobutamine (OR =0.42, 95% CI = 0.11–0.96) were significantly associated with survival. Norepinephrine improved survival compared with dopamine (OR =0.81, 95% CI = 0.66–1.00). Rank analysis showed that levosimendan had the highest probability of being the best treatment. Conclusions Among several regimens for pharmacological cardiovascular support in septic patients, regimens based on inodilators have the highest probability of improve survival.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK, ZRSKP
Objectives Postoperative pulmonary complications (PPC) are among the most common complications after noncardiac surgery. Men, smokers, and elderly patients with chronic obstructive pulmonary disease ...or heart failure are more likely to experience PPC. The majority of patients undergoing vascular surgery belong in these categories and are at higher risk of developing PPC. Moreover, the surgical site is one of the most important risk factors associated with PPC, and aortic surgery carries the highest risk. The aim of this systematic review was to obtain an additional understanding of the real incidence of PPC after open abdominal aortic surgery and the impact of PPC on survival. Design Systematic review and meta-analysis. Setting Hospitals Participants Patients who underwent open abdominal aortic surgery. Interventions None. Measurements and Main Results A literature search was performed on BioMedCentral, PubMed, Embase, and the Cochrane Register of clinical trials. All prospective or retrospective studies reporting data on PPC after open abdominal aortic surgery were included. Co-primary endpoints were the PPC rate and the correlation between PPC and perioperative mortality. The secondary endpoint was the difference in the PPC rate and mortality between elective and urgent surgery. Data on 269,637 patients from 213 studies were analyzed. The overall median incidence of PPC was 10.3% (interquartile range 5.55%-19.1%). Pneumonia, respiratory insufficiency, prolonged mechanical ventilation, need for unplanned mechanical ventilation, atelectasis, acute respiratory distress syndrome, pulmonary edema, and pleural effusions were the most common PPC reported in the literature. Occurrence of PPC was associated with postoperative mortality ( r = 0.65, p<0.01) and was significantly higher in urgent procedures (p<0.001). Conclusions Incidence of PPC after open abdominal aortic surgery is high and is associated with increased postoperative morbidity and mortality.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
6.
Colloids Versus Crystalloids: Is That the Real Problem? Guarnieri, Marcello, MD; Belletti, Alessandro, MD; Meroni, Roberta, MD ...
Journal of cardiothoracic and vascular anesthesia,
02/2017, Volume:
31, Issue:
1
Journal Article
Peer reviewed
Open access
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
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