Treatment with Rasburicase in Hospitalized Patients with Cardiorenal Syndrome: Old Treatment, New Scenario.

Cardiorenal syndrome (CRS) involves joint dysfunction of the heart and kidney. Acute forms share biochemical alterations like hyperuricaemia (HU) with tumour lysis syndrome (TLS). The mainstay treatment of acute CRS with systemic overload is diuretics, but rasburicase is used in TLS to prevent and treat hyperuricaemia.

Infectious complications following major heart surgery from the day of the surgery to hospital discharge.

Background: At some point in their lives, many people will require major heart surgery (MHS). Patients are generally older adults with various risk factors for infection. However, the incidence of infection after MHS is poorly known, as reported infection data are frequently biased due to different factors like the surgical procedure, postoperative timing, and infectious syndromes or etiologic agents, among others.

Atrial myxoma surgery and P-wave remodeling.

Introduction: Data regarding atrial electrocardiographic parameters in patients with atrial myxomas are scarce.

Methods: We aimed to study atrial electrocardiographic features in patients with atrial myxomas, before and after surgery. We also analyze the incidence of atrial fibrillation during follow-up and its correlation with different P-wave indexes.

How should microbiology laboratories interpret cultures of the sonicate of closed needleless connectors?

Introduction: Our objective was to determine whether there is a cut-off in the needleless connectors' (NCs) cultures that when combined with skin cultures it was as efficient as conventional superficial cultures to rule-out catheter colonization (CC) and catheter-related bloodstream infection (CRBSI).

Methods: During 10 months, we collected samples and then we analyzed the validity values of skin+NCs cultures for CC and CRBSI considering the best cut-off showing at least >90% of specificity to have a high negative predictive value using a ROC curve.

Results: We collected a total of 167 catheters.

Colonization of the nasal airways by Staphylococcus aureus on admission to a major heart surgery operating room: A real-world experience.

Introduction: Nasal swab culture is used to identify Staphylococcus aureus colonization, as this is a major risk factor for surgical site infection (SSI) in patients who are going to undergo major heart surgery (MHS). We determined nasal carriage of S. aureus in patients undergoing MHS by comparing the yield of a conventional culture with that of a rapid molecular test (Xpert® SA Nasal Complete, Cepheid).

Do lower respiratory tract samples contribute to the assessment of carriage of Staphylococcus aureus in patients undergoing mechanical ventilation after major heart surgery?

Colonization by Staphylococcus aureus is regularly assessed in patients undergoing major heart surgery (MHS). Despite pre-surgical decontamination attempts, a significant proportion of MHS patients remain colonized by S. aureus at the time of surgery.

Infections in patients after Berlin Heart EXCOR assist device implantation.

Objectives: Berlin Heart EXCOR devices (BHED) are ventricular assist devices (VAD) used mainly as a bridge to heart transplantation (HT) in pediatric population. The aim of our study is to report the infections diagnosed in adult patients undergoing a BHED implantation.

Methods: Adult patients receiving a BHED between Jul 2009 and Oct 2017 at our institution were included.

Impact of selective digestive decontamination without systemic antibiotics in a major heart surgery intensive care unit.

Purpose: The incidence density of ventilator-associated pneumonia (VAP) is higher in patients undergoing major heart surgery than in other populations, despite the introduction of bundles of preventive measures, because many risk factors are not amenable to intervention. Selective digestive decontamination (SDD) has been shown to be efficacious for decreasing the frequency of VAP, although it has not been incorporated into the routine of most intensive care units. The objective of our study was to evaluate the efficacy of SDD without parenteral antibiotics for preventing VAP in a major heart surgery intensive care unit.

Assessment of central venous catheter colonization using surveillance culture of withdrawn connectors and insertion site skin.

Background: Culture of catheter hubs and skin surrounding the catheter entry site has a negative predictive value for catheter tip colonization. However, manipulation of the hub for culture requires the hubs to be swabbed, introducing potential dislodging of biofilm and subsequent migration of microorganisms. Hubs are usually closed with needleless connectors (NCs), which are replaced regularly.

Ethanol lock therapy (E-Lock) in the prevention of catheter-related bloodstream infections (CR-BSI) after major heart surgery (MHS): a randomized clinical trial.

Background: Lock-therapy with antimicrobials has been used for the treatment and prevention of catheter-related bloodstream infections (CR-BSI). Experiences with Ethanol-Locks (E-locks) have included therapeutic interventions with variable results. Patients undergoing Major Heart Surgery (MHS) are a high-risk population for CR-BSI.

Impact of four sequential measures on the prevention of ventilator-associated pneumonia in cardiac surgery patients.

Introduction: Ventilator-associated pneumonia (VAP) is the most frequent infection in patients admitted to intensive care units.

Methods: We compared rates of VAP, days on mechanical ventilation (MV), and cost of antimicrobial agents before and during implementation.

Results: We collected data from 401 patients before the intervention and from 1,534 patients during the intervention.

Pre-emptive broad-spectrum treatment for ventilator-associated pneumonia in high-risk patients.

Purpose: Patients requiring mechanical ventilation (MV) for >48 h after major heart surgery (MHS) are at a high risk of acquiring ventilator-associated pneumonia (VAP) and tracheobronchitis (VAT). Most non-pharmacological interventions to prevent VAP in such patients are usually already implemented. The objective of this study was to evaluate the efficacy in preventing lower respiratory infections of antibiotics active against multidrug-resistant pathogens in this very high-risk population.

Incidence and risk factors for ventilator-associated pneumonia after major heart surgery.

Purpose: Major heart surgery (MHS) patients are a particularly high-risk population for nosocomial infections. Our objective was to identify risk factors for ventilator-associated pneumonia (VAP) in patients undergoing MHS.

Methods: Prospective study including 1,844 patients operated from 2003 to 2006.

Continuous aspiration of subglottic secretions in the prevention of ventilator-associated pneumonia in the postoperative period of major heart surgery.

Objective: Aspiration of endotracheal secretions is a major step in the prevention of ventilator-associated pneumonia (VAP). We compared conventional and continuous aspiration of subglottic secretions (CASS) procedures in ventilated patients after major heart surgery (MHS).

Materials And Methods: Randomized comparison during a 2-year period.

Treatment and outcomes of severe cardiac disease with surgical indication in very old patients.

Objective: To describe and compare the crude and risk-adjusted survival of a series of octogenarians with symptomatic severe aortic stenosis (SAS) or severe coronary artery disease (SCAD).

Methods: We reviewed the treatment and outcomes of 130 consecutive patients > or = 80 years old hospitalized for SAS or SCAD.

Results: Mean age was 82.

Cultures of sternal wound and mediastinum taken at the end of heart surgery do not predict postsurgical mediastinitis.

The aim of the study was to assess of the role of intraoperative cultures taken at the end of major heart surgery (MHS) in the prediction of postoperative mediastinitis (PM) in patients undergoing MHS over a 6-month period in a tertiary university hospital. Just before wound closure, a sample of the sternal border was taken, swabbing back and forth the sternal border and the subcutaneous tissues. A second sample was taken after irrigation of the deep mediastinal structures with 10 mL of Ringer lactate.

Effects of thoracic epidural meperidine on arterial oxygenation during one-lung ventilation in thoracic surgery.

Objective: To compare the effects that the use of general intravenous anesthesia (propofol-fentanyl) (GA) or general anesthesia combined with thoracic epidural anesthesia with meperidine (TEA-M) may have on arterial oxygenation during one-lung ventilation (OLV).

Design: Prospective.

Setting: Tertiary care hospital.

Haemodynamic monitoring and liver function evaluation by pulsion cold system Z-201 (PCS) during orthotopic liver transplantation.

Pulsion cold system (PCS, COLD) is a haemodynamic monitoring system that allows measurement of cardiac output (CO), partial blood volumes, lung water, and liver function. The aim of the study was to evaluate this monitoring system during human orthotopic liver transplantation (OLT) for the following: (a) to determine agreement between CO measurements via pulmonary artery thermodilution (CO TDpa), and aortic transpulmonary thermodilution (CO TDa); (b) to compare the preload dates obtained with the COLD with central venous pressure (CVP) and pulmonary capillary wedge (PCWP); and (c) to assess the use of the plasma disappearance rate (PDR) of indocyanine green (ICG) as a measure of graft function. Fifteen consecutive patients undergoing OLT were studied.