Publications by authors named "Belley-Cote E"
Background: Delirium is an acute state of confusion associated with adverse postoperative outcomes. Delirium is diagnosed clinically using screening tools; most cases go undetected. Identifying a delirium biomarker would allow for accurate diagnosis, application of therapies, and insight into causal pathways.
View Article and Find Full Text PDFObjectives: Atrial fibrillation is the most common complication of cardiac surgery and occurs frequently in patients without a history of the arrhythmia. We conducted a systematic review and meta-analysis of randomized controlled trials to assess whether prophylactic ablation during cardiac surgery in patients without a history of atrial fibrillation prevents atrial fibrillation.
Methods: We searched CENTRAL, MEDLINE and Embase from inception to August 2024.
Aims: The left atrial appendage (LAA) produces natriuretic peptides and its removal or occlusion might increase the risk of heart failure (HF). We aimed to investigate the incidence of HF after LAA occlusion or removal (LAAO) in the Left Atrial Appendage Occlusion Study (LAAOS III).
Methods And Results: Patients (n = 4811) with atrial fibrillation (AF) and a CHADS-VASc score ≥2, who were having cardiac surgery for another indication, were randomized to undergo surgical LAAO or not.
Antibiotic Treatment for 7 versus 14 Days in Patients with Bloodstream Infections.
N Engl J Med
November 2024
Background: Bloodstream infections are associated with substantial morbidity and mortality. Early, appropriate antibiotic therapy is important, but the duration of treatment is uncertain.
Methods: In a multicenter, noninferiority trial, we randomly assigned hospitalized patients (including patients in the intensive care unit [ICU]) who had bloodstream infection to receive antibiotic treatment for 7 days or 14 days.
Background: Cardiogenic shock remains highly associated with early mortality, with mortality often exceeding 50%. We sought to determine the association between prognostic factors and in-hospital and 30-day mortality in cardiogenic shock.
Methods: We performed a systematic review and meta-analysis of prognostic factors in cardiogenic shock, searching MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials for records up to June 5, 2023.
Article Synopsis
- * The LeAAPS trial is a large, international study involving 6,500 patients to evaluate the effectiveness of LAAE for preventing strokes during cardiac surgery, with strict inclusion criteria and randomization methods.
- * The trial will assess various outcomes including stroke incidents and safety events over a five-year follow-up to establish how effective and safe LAAE is in this patient population.
Article Synopsis
- Blood products, specifically RBC transfusions, are commonly used in critically ill patients, prompting a detailed review of current practices and evidence to guide healthcare providers.
- A panel of experts evaluated existing literature and developed specific questions regarding RBC transfusions, ultimately analyzing 23 key studies to form strong and conditional recommendations.
- Overall, a restrictive transfusion strategy was found to be safer for most critically ill patients, decreasing RBC use without raising the risk of death or complications; however, it may not be suitable for patients with acute coronary syndrome (ACS).
Article Synopsis
- After heart surgery, some patients develop a condition called atrial fibrillation (AF), which can lead to important health issues.
- Researchers are studying how to predict, prevent, and manage this condition in people who have had surgery.
- There are currently 121 studies happening, mostly focusing on preventing AF, but more work is needed to understand how to control it over time.
Article Synopsis
- - The Intensive Care Medicine Rapid Practice Guideline (ICM-RPG) provides evidence-based recommendations for using small-volume versus conventional blood collection tubes in adult ICU patients.
- - A systematic review of 23 panelists across 8 countries revealed high certainty that small-volume tubes minimize blood sampling volume and show moderate certainty in reducing transfusion risks, despite some imprecision in the data.
- - The panel strongly recommends small-volume tubes due to their benefits, including reduced waste and successful implementation in various countries, although there are initial costs related to validating these tubes for laboratory use.
Background: Cardiovascular failure is recognized as a common final pathway at the end of life but there is a paucity of data describing terminal arrhythmias.
Aim: We aimed to describe arrhythmias recorded peri-mortem in critically ill patients.
Study Design: We enrolled intensive care unit patients admitted to two tertiary Canadian medico-surgical centres.
Article Synopsis
- This clinical practice guideline from the European Society of Intensive Care Medicine focuses on the choice of resuscitation fluids for critically ill adult patients, with two more parts planned to address fluid volume and removal.
- An international panel of experts used the GRADE methodology to assess the evidence and guide their recommendations.
- The guideline offers conditional recommendations favoring crystalloids over albumin in various patient scenarios, while also addressing specific cases with varying levels of evidence certainty, such as traumatic brain injury and cirrhosis.
Article Synopsis
- The study aimed to analyze how sex and gender are considered in acute care trials and whether there have been changes in reporting practices since the 2016 guidelines on sex and gender equity in research.
- The systematic review included 88 trials published in major medical journals, finding that the representation of female participants was low at 34.2%, and only 28.4% reported race or ethnicity, predominantly featuring white and male participants.
- Results revealed limited use of sex and gender-based analysis (SGBA), with cardiovascular trials performing better than ICU trials, indicating a significant need for improvement in inclusivity and reporting practices in clinical research.*
Importance: Catheter ablation is associated with reduced heart failure (HF) hospitalization and death in select patients with atrial fibrillation (AF) and heart failure with reduced ejection fraction (HFrEF). However, the benefit in patients with HF with preserved ejection fraction (HFpEF) is uncertain.
Objective: To investigate whether catheter ablation for AF is associated with reduced HF-related outcomes according to HF phenotype.
Survival to hospital discharge among patients with out-of-hospital cardiac arrest (OHCA) is low and important regional differences in treatment practices and survival have been described. Since the 2017 publication of the Canadian Cardiovascular Society's position statement on OHCA care, multiple randomized controlled trials have helped to better define optimal post cardiac arrest care. This working group provides updated guidance on the timing of cardiac catheterization in patients with ST-elevation and without ST-segment elevation, on a revised temperature control strategy targeting normothermia instead of hypothermia, blood pressure, oxygenation, and ventilation parameters, and on the treatment of rhythmic and periodic electroencephalography patterns in patients with a resuscitated OHCA.
View Article and Find Full Text PDFBackground: Although intravenous tranexamic acid is used in cardiac surgery to reduce bleeding and transfusion, topical tranexamic acid results in lower plasma concentrations compared with intravenous tranexamic acid, which may lower the risk of seizures. We aimed to determine whether topical tranexamic acid reduces the risk of in-hospital seizure without increasing the risk of transfusion among cardiac surgery patients.
Methods: We conducted a multicenter, double dummy, blinded, randomized controlled trial of patients recruited by convenience sampling in academic hospitals undergoing cardiac surgery with cardiopulmonary bypass.
Background: Atrial fibrillation (AF) is one of the most common complications after cardiac surgery. New-onset post-operative AF may signal an elevated risk of AF and associated outcomes in long-term follow-up. We aimed to estimate the rate of AF recurrence as detected by an implantable loop recorder (ILR) in patients experiencing post-operative AF within 30 days after cardiac surgery.
View Article and Find Full Text PDFArticle Synopsis
- The GRADE approach is a widely recognized framework used to summarize evidence in systematic reviews and to create clinical practice guidelines.
- This overview outlines the application of GRADE in developing clinical practice guidelines, targeting clinicians and researchers involved in this process.
- Key aspects discussed include guideline endorsement, handling conflicts of interest, prioritizing outcomes, rating evidence certainty, and the overall development and implementation of trustworthy guidelines.
Background: An analytical benchmark for high-sensitivity cardiac troponin (hs-cTn) assays is to achieve a coefficient of variation (CV) of ≤ 10.0 % at the 99th percentile upper reference limit (URL) used for the diagnosis of myocardial infarction. Few prospective multicenter studies have evaluated assay imprecision and none have determined precision at the female URL which is lower than the male URL for all cardiac troponin assays.
View Article and Find Full Text PDFArticle Synopsis
- The GRADE approach evaluates the certainty of evidence in systematic reviews and meta-analyses, catering to clinicians and researchers involved in these processes.
- The text explains the methods of using GRADE, including evidence assessment, summarization with profiles or tables, and communication of results while highlighting related challenges and benefits.
- The overview serves as a guide for systematic review developers, methodologists, and users of evidence, illustrating how GRADE can be effectively applied in evidence synthesis.