Anesthesiology
Thushara Madathil; Cassie Carvalho; Sunil Rajan
Volume 10, Issue 1 , January 2024
Abstract
Objective: Fluids are administered to optimize hemodynamics during off-pump coronary arterybypass grafting (CABG), which may lead to a positive fluid balance and increased lung water,lung congestion, hypoxemia, prolonged mechanical ventilation, and longer hospital stays. Lungultrasound can assess extravascular ...
Read More
Objective: Fluids are administered to optimize hemodynamics during off-pump coronary arterybypass grafting (CABG), which may lead to a positive fluid balance and increased lung water,lung congestion, hypoxemia, prolonged mechanical ventilation, and longer hospital stays. Lungultrasound can assess extravascular lung water and help titrate diuretics and fluids, thus preventinghypoxemia. The primary objective of this study was to study the correlation between B-line scoresmeasured by lung ultrasound and the PaO2/FiO2 ratio (the ratio of arterial partial pressure of oxygento fractional inspired oxygen) after off-pump CABG.Methods: Forty off-pump CABG patients were included in this prospective observational study in atertiary care center from 2022 to 2023. The correlation coefficient from an earlier study was used tocalculate the sample size. A four-sector lung ultrasound was utilized for B-line scoring. B-line scoresand PaO2/FiO2 ratios were recorded at three time points: before the surgery commenced and at 24and 48 hours post-operation. The fluid balance was calculated at 24 and 48 hours post-operation.Pearson correlation coefficient was used to evaluate the correlation between B-line scores and fluidbalance with oxygenation, and its significance was assessed through a linear regression test.Results: The PaO2/FiO2 ratio and B-line scores exhibited a statistically significant moderate negativecorrelation at 24 hours post-surgery (r=-0.44; SD=-0.66, 95% CI=-0.66, -0.15; P=0.004) and a B-linescore exceeding 8 was associated with the lowest PaO2/FiO2 ratio. However, fluid balance and PaO2/FiO2 ratios revealed no correlation at 24 or 48 hours post-surgery. Additionally, fluid balance andB-line scores demonstrated a moderate positive correlation after 48 hours but no correlation at 24hours post-surgery.Conclusion: B-line scores always negatively correlated with PaO2/FiO2ratios, and scores greaterthan eight corresponded to the lowest ratio.
Critical Care
Mahboob Pouraghaei; Behzad Mohammadi; Ali Taghizadeh; Paria Habibollahi; Payman Moharamzadeh
Volume 1, Issue 2 , July 2015, , Pages 44-47
Abstract
Objective: Congestive heart failure (CHF) has become one of the most important health care problems in western countries. This article focuses on the outpatient diagnosis and management of heart failure. We want to compare the outcome of patients who were treated with high dose diuretics in the emergency ...
Read More
Objective: Congestive heart failure (CHF) has become one of the most important health care problems in western countries. This article focuses on the outpatient diagnosis and management of heart failure. We want to compare the outcome of patients who were treated with high dose diuretics in the emergency department (ED) without admission with patients who were admitted to hospital for standard treatment.
Methods: This was a randomized prospective clinical trial study. The patients who came to the ED from March 20, 2008 up to August 20, 2008 were divided into two groups randomly. The length of ED stay in the experimental group was documented. Also, readmission and mortality in 6 months and satisfaction in both groups were taken into consideration. All data were analyzed using SPSS 15.0.
Results: In experimental group, the rate of recurrent admission, expiration, discharge, clinic visit, and clinic admission was 8%, 4%, 29%, 18%, and 0% respectively. On the other hand, in control group it was 16%, 40%, 18%, 22%, and 2% respectively. Additionally, there was a significant difference between these groups (P = 0.00).
Conclusion: This study is the first regional prospective trial to comprehensively examine the therapeutic management in patients with CHF. This study, comparing the high dose diuretic efficacy in the decreasing of hospital stay and readmission; and decreasing mortality rate with routine therapy, showed that there was a significant difference between these two strategies in the mortality rate, readmission, and length of hospital stay (P = 0.00).