tailieunhanh - Báo cáo y học: "Predicting outcome of rethoracotomy for suspected pericardial tamponade following cardio-thoracic surgery in the intensive care unit"

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học Wertheim cung cấp cho các bạn kiến thức về ngành y đề tài: Predicting outcome of rethoracotomy for suspected pericardial tamponade following cardio-thoracic surgery in the intensive care unit. | ten Tusscher et al. Journal of Cardiothoracic Surgery 2011 6 79 http content 6 1 79 JCTS JOURNAL OF CARDIOTHORACIC SURGERY RESEARCH ARTICLE Open Access Predicting outcome of rethoracotomy for suspected pericardial tamponade following cardio-thoracic surgery in the intensive care unit Birkitt L ten Tusscher1 Johan AB Groeneveld1 Otto Kamp2 Evert K Jansen3 Albertus Beishuizen1 and Armand RJ Girbes1 Abstract Objectives Pericardial tamponade after cardiac surgery is difficult to diagnose thereby rendering timing of rethoracotomy hard. We aimed at identifying factors predicting the outcome of surgery for suspected tamponade after cardio-thoracic surgery in the intensive care unit ICU . Methods Twenty-one consecutive patients undergoing rethoracotomy for suspected pericardial tamponade in the ICU admitted after primary cardio-thoracic surgery were identified for this retrospective study. We compared patients with or without a decrease in severe haemodynamic compromise after rethoracotomy according to the cardiovascular component of the sequential organ failure assessment SOFA score. Results A favourable haemodynamic response to rethoracotomy was observed in 11 52 of patients and characterized by an increase in cardiac output and less fluid and norepinephrine requirements. Prior to surgery the absence of treatment by heparin a minimum cardiac index L min m2 and a positive fluid balance 4 683 mL were predictive of a beneficial haemodynamic response. During surgery the evacuation of clots and 500 mL of pericardial fluid was associated with a beneficial haemodynamic response. Echocardiographic parameters were of limited help in predicting the postoperative course even though 9 of 13 pericardial clots found at surgery were detected preoperatively. Conclusion Clots and fluids in the pericardial space causing regional tamponade and responding to surgical evacuation after primary cardio-thoracic surgery are difficult to diagnose preoperatively .

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