Surveillance of hospital-acquired infections in an intensive care department-the benefit of the full-time presence of an infection control nurse.

In the 42-bed intensive care department of a teaching hospital, the creation of a full-time infection control nurse post was followed by a 42% reduction in device-related hospital-acquired infection rates over a period of three years, and 33% reduction over a period of five years. Permanent surveillance accompanied by revision of procedures and bedside teaching were key factors in the improvement of quality of care. In the specific setting of an intensive care department, this study validates the previous conclusions reached in the SENIC study and emphasizes the essential role played by the infection control nurse in the care of critically ill patients.

Outcome of cardiac surgery patients with complicated intensive care unit stay.

Risk stratification has become an essential element in the practice of cardiac surgery. Several studies have identified preoperative risk factors for adverse outcome. However, outcome is mostly defined by 30-day mortality and morbidity.

Effects of normothermia versus hypothermia on extravascular lung water and serum cytokines during cardiopulmonary bypass: a randomized, controlled trial.

Objective: To evaluate the influence of perfusion temperature on the systemic effects of cardiopulmonary bypass (CPB), including extravascular lung water index (EVLWI), and serum cytokines.

Design: Prospective, randomized, controlled study.

Setting: Cardiothoracic intensive care unit of a university hospital.

Exaggerated chronotropic and energetic response to dobutamine after orthotopic cardiac transplantation.

Background: After heart transplantation, the transplanted denervated heart displays both an exaggerated chronotropic and an exaggerated inotropic response to circulating catecholamines. This study assessed whether denervated transplanted hearts also display an exaggerated energetic response when challenged with dobutamine.

Methods And Results: A total of 18 heart transplant recipients and 14 normal volunteers underwent measurements of myocardial oxygen consumption (MVO2), external work (EW), and pressure-volume area (PVA), at rest and during infusion of dobutamine.

Cardiac function after intermittent antegrade warm blood cardioplegia: contribution of the double-indicator dilution technique.

Objective: To evaluate cardiac performance following coronary artery surgery using two different techniques of cardioplegia.

Design: Randomized prospective study.

Setting: Adult cardiothoracic intensive care unit in a university hospital.

Effects of conventional physiotherapy, continuous positive airway pressure and non-invasive ventilatory support with bilevel positive airway pressure after coronary artery bypass grafting.

Background: Coronary artery bypass graft (CABG) surgery with the use of mammary arteries is associated with severe alteration of lung function parameters. The purpose of the present study was to compare the effect on lung function tests of conventional physiotherapy using incentive spirometry (IS) with non-invasive ventilation on continuous positive airway pressure (CPAP) and with non-invasive ventilation on bilevel positive airway pressure (BiPAP or NIV-2P), METHODS: Ninety-six patients were randomly assigned to 1 of 3 groups: NIV-2P (1 h/3 h), CPAP (1 h/3 h) and IS (20/2 h). Pulmonary function tests and arterial blood gases analyses were obtained before surgery.

The effect of chronic mechanical circulatory support on neuroendocrine activation in patients with end-stage heart failure.

Objective: To evaluate if the improvement of patients supported with a Novacor was associated with a normalization in neuroendocrine activity.

Methods: Six patients had a Novacor implanted for end-stage heart failure. Four patients were transplanted after a mean of 4.

Randomized trial of intermittent antegrade warm blood versus cold crystalloid cardioplegia.

Background: We performed a prospective randomized trial to compare intermittent antegrade warm blood cardioplegia with intermittent antegrade and retrograde cold crystalloid cardioplegia.

Methods: Two hundred consecutive patients scheduled for isolated coronary bypass surgical procedures were randomized into two groups: Group 1 (n = 92) received cold crystalloid cardioplegia with moderate systemic hypothermia, group 2 (n = 108) received intermittent antegrade warm blood cardioplegia with systemic normothermia. Preoperative, intraoperative, and postoperative data were prospectively collected.

Cardiac troponin I as an early marker of myocardial damage after coronary bypass surgery.

Study Objective: To evaluate the performance of cardiac specific markers, cardiac troponin I (cTnI) and CK-MB by mass assay (CK-MB mass), for the early diagnosis of myocardial ischemia and/or infarction after coronary bypass surgery.

Methods: Prospective clinical, electrocardiograpic and biologic follow-up of 117 patients undergoing isolated coronary surgery with the use of intermittent anterograde normothermic blood cardioplegia. Blood samples for biochemical analysis were drawn before surgery (T0) and at 2 (T1), 6 (T2), 10 (T3) and 20 h (T4) after aortic cross-clamp release.

Chronic dissection of the thoracic aorta in a patient with tuberculous pleuro-pericarditis.

We describe a case of chronic dissection of thoracic aorta presumed to be due to tuberculosis from pleuro-pericarditis foci and who was cured by antituberculous therapy and surgery. With the recent increase of tuberculosis cases, tuberculous aortitis might become less rare and the clinicians should suspect this diagnosis in subjects with aortic dissection and history of tuberculosis.

Combined heart-kidney transplantation: report on six cases.

Background: Combined heart-kidney transplantation has become a new therapeutic solution for patients with coexisting, irreversible heart and kidney failure. Though this combined approach has several theoretical advantages over sequential transplantation, it has yet to be established that it does not jeopardize patient and graft outcomes. We here report our experience with six cases of combined heart-kidney transplantation from single donors and review the literature in order to clarify this issue.

Is mechanical circulatory support helpful before cardiac retransplantation?

Ventricular assist devices are widely used as a bridge for cardiac transplantation patients. The purpose of the present study was to evaluate retrospectively, whether the use of ventricular assist devices could increase survival after early or late retransplantation. Over the past 10 years, 219 patients were transplanted in the authors' centre.

Analysis of the accuracy of continuous thermodilution cardiac output measurement. Comparison with intermittent thermodilution and Fick cardiac output measurement.

Objective: To evaluate the accuracy of cardiac output measurement obtained by a new continuous thermodilution cardiac output (CCO) pulmonary artery catheter compared to intermittent thermodilution (TCO) and the direct Fick method.

Design: Prospective open trial.

Setting: University hospital, intensive care unit.

Successful bridge to retransplantation with the wearable Novacor left ventricular assist system.

The wearable version of the Novacor left ventricular assist system has been implanted in a 44-year-old man as a bridge to retransplantation. Apart from a temporary right ventricular failure, the postoperative course was smooth and the patient underwent retransplantation after 95 days of support. Expected complications like infection or bleeding could be avoided or minimized.

Use of exercise electrocardiography, technetium-99m-MIBI perfusion tomography, and two-dimensional echocardiography for coronary disease surveillance in a low-prevalence population of heart transplant recipients.

Background: Coronary artery disease has been reported to be a significant cause of long-term morbidity and mortality after heart transplantation. However, the diagnosis of coronary disease by means of noninvasive procedures has shown disappointing accuracy, and many centers currently recommend an annual surveillance coronary angiogram.

Methods: We prospectively studied the accuracy and feasibility of a symptom-limited upright bicycle exercise, combined with computerized electrocardiogram analysis, echocardiography, and perfusion scintigraphy in 37 consecutive heart transplant recipients at 2.

[Implantable and portable left ventricular assistance: initial successful clinical application in Belgium].

On July 13, 1994, at the "Cliniques universities St. Luc", a wearable left ventricular assist device was successfully implanted, for the first time in Belgium, in a 44-year-old male. He had been readmitted with end-stage congestive heart failure 7 years after a first cardiac transplantation.

Hemodynamic effects and safety of sotalol in the prevention of supraventricular arrhythmias after coronary artery bypass surgery.

Sotalol is a beta-adrenergic blocking drug with the additional property of lengthening the cardiac action potential. These electrophysiologic properties render the drug attractive for use in the prevention of postoperative supraventricular arrhythmias (SVA), and previous studies have suggested that it was indeed effective. The hemodynamic response to sotalol and its safety early after coronary artery bypass graft (CABG) surgery were therefore studied.

Flow-mediated vasodilator response to tachycardia of epicardial coronary arteries is preserved in heart transplant recipients.

Background: Increasing blood flow through conduit arteries induces vasodilation through endothelium-dependent mechanisms. In humans, flow-mediated dilation of angiographically normal epicardial coronary arteries has been observed during tachycardia, this response being impaired in the presence of atherosclerosis.

Methods And Results: To evaluate whether the endothelium-dependent physiological vasodilatory response of epicardial coronary arteries to tachycardia is preserved in heart transplant recipients, 22 patients with angiographically smooth coronary arteries were studied with quantitative angiography.

Aortic valve replacement thirty-one months after orthotopic heart transplantation.

Aortic valve replacement with a St. Jude prosthesis was performed 31 months after orthotopic heart transplantation in a 28-year-old male patient with Steinert's disease and idiopathic cardiomyopathy. The donor heart was reported as being normal by the cardiologist of the referring hospital.

Spontaneous favorable outcome of tracheal laceration.

We present the case of a 57-year-old woman with a huge tracheal laceration after intubation. With simple supportive therapy, the laceration healed in ten days, and the patient made an uneventful recovery. At the three-month follow-up, no sequelae were observed.