View clinical trials related to Post-cardiac Surgery.
Filter by:The use of antibiotic therapy is common in intensive care units and primarily involves beta-lactams. Its optimal implementation is made difficult by the pharmacokinetic changes inherent in critically ill patients. Despite the current recommendations from the French Society of Anesthesiology and Intensive Care (SFAR) and the French Society of Pharmacology and Therapeutics (SFPT), there are no recommendations on prescription modalities for patients under veno-arterial extracorporeal membrane oxygenation (VA-ECMO). The use of antibiotic therapy is common in VA-ECMO patients and their pharmacokinetic variability factors are then exacerbated. We aim to conduct a prospective, multicenter, interventional study designed to identify predictive factors for failure to achieve therapeutic target circulating concentrations of beta-lactams in patients under VA-ECMO treated with one of the studied beta-lactams
Cardiac output (CO) monitoring is of primary importance in high-risk surgery and critically ill patients. Intermittent thermodilution (ThD) by means of a pulmonary artery catheter (PAC) was invasiveness, the occurrence of complications, and inability to estimate CO on a beat-by-beat basis may explain the reduction in routine use. Echocardiography is now widely used. However, a poor acoustic window, inaccurate diameter calculations, and difficulty maintaining the angle of insonation and blood flow within the recommended values may lead to inaccuracy in CO estimation.Pulse contour methods (PCMs) are commonly used as they seem to fulfill most of the characteristics of an "ideal" hemodynamic monitoring system. Mostcare can continuously and real-time monitor important circulatory indicators such as cardiac output, peripheral vascular resistance index (SVRI), cardiovascular impedance (Ztot), cardiac cycle efficiency (CCE), and maximum pressure gradient (dp/dt MAX). It may help identify the causes of difficulty in weaning patients from ventilators after cardiac surgery.
Studies have shown that patients undergoing general anesthesia surgery are prone to pulmonary complications after surgery; about 30-72% of cardiac surgery patients have postoperative chest X-rays that reveal lung collapse, leading to gas exchange disorders and hypoxemia. Postoperative lung expansion therapy can increase ventilation-perfusion balance, increase lung volume, promote respiratory mucosal sputum production and reduce postoperative pain, and has been proven to improve postoperative pulmonary-related complications. Inducement spirometry is currently one of the mainstream methods of performing lung expansion treatment. It uses visual feedback to allow the patient to perform slow, deep breathing with sufficient airflow or volume to achieve the lung expansion effect; it is also used after cardiac surgery in our hospital. The main way for patients to perform lung expansion therapy; compared with only performing respiratory exercises after surgery, induced spirometry can reduce the incidence of lung collapse and respiratory distress in postoperative patients, and can also shorten the ICU stay and total hospitalization stay. Most cardiac surgery patients in our hospital are given health education on lung expansion therapy by nursing staff before and after surgery. This unit does not have specialized courses on lung expansion therapy, which may lead to differences in explanations between different nursing staff; some patients' lack of knowledge and understanding of lung expansion treatment resulted in the treatment effect not being as good as expected, which motivated the author to formulate a project for improvement. We hope to analyze, review and improve the current situation to improve the effectiveness of lung expansion treatment for patients. Based on the current situation analysis and relevant literature, a project to improve nursing guidance for lung expansion therapy was implemented.
Post-operative atrial fibrillation is a common problem post cardiac surgery with rates exceeding 30%. Atrial fibrillation has multiple adverse effects on cardiac hemodynamics and can lead to hypotension, diminished end organ perfusion and lengthen the stay in ICU. Amiodarone is the medication of choice used for pharmacological cardioversion and can be used with vasoactive medications. Intravenous amiodarone is associated with hypotension and end organ perfusion requiring escalation in vasoactive support. Vernakalant is novel anti-arrhythmic agent approved in Canada for cardioversion of atrial fibrillation that primarily works on atrial channels and has no effect on contractility or vasodilation. Clinical trials have proved good efficacy of Vernakalant in conversion of paroxysmal atrial fibrillation however there is no comparison of Amiodarone to Vernakalant in post-operative cardiac surgery. We plan to perform a clinical trial comparing Vernakalant to amiodarone in post-cardiac surgery patients with a primary outcome of cardioversion at 90 minutes. Secondary outcomes will follow duration of vasoactive medications, days in ICU and economics.