care unit and underwent echocardiography within 7 days from the diagnosis of septic shock. Patients who were previously diagnosed with structural heart disease or coronary artery disease were excluded. Left ventricular ejection fraction (LVEF) was divided into four categories: normal, ≥ 50%; mild, ≥ 40%; moderate, ≥ 30%; and severe dysfunction, < 30%. Wall motion impairment was categorized into the following patterns: normal, diffuse, ballooning, and focal.RESULTS: There were 141 patients with normal LVEF. Among patients with impaired LV wall motion, the diffuse pattern was the most common (34 patients), followed by the ballooning pattern (26 patients). Finally, 102 patients died, and in-hospital mortality was significantly higher in patients with severe LV systolic dysfunction (hazard ratio [HR], 1.97; 95% confidence interval [CI], 1.04–3.75; P = 0.039) and in patients with diffuse pattern of LV wall motion impairment (HR, 2.28; 95% CI, 1.19–4.36; P = 0.013) than in those with a normal LV systolic function.CONCLUSION: Severe LV systolic dysfunction and diffuse pattern of LV wall motion impairment significantly affected in-hospital mortality in patients with septic shock. Conventional echocardiographic evaluation provides adequate information on the development of myocardial damage and accurately predicts the prognosis of patients with septic shock.]]>
Adult ; Coronary Artery Disease ; Diagnosis ; Echocardiography ; Heart Diseases ; Hemodynamics ; Hospital Mortality ; Humans ; Intensive Care Units ; Mortality ; Prognosis ; Retrospective Studies ; Sepsis ; Shock, Septic ; Stroke Volume

BACKGROUND: Minimally invasive direct coronary artery bypass grafting (MIDCAB) has the advantage of allowing arterial grafting on the left anterior descending artery without a sternotomy incision. We present our single-center clinical experience of 66 consecutive patients. METHODS: All patients underwent MIDCAB through a left anterior small thoracotomy between August 2007 and July 2015. Preoperative, intraoperative, postoperative and follow-up data—including major adverse cardiovascular and cerebrovascular events (MACCE), graft patency, and the need for re-intervention—were collected. RESULTS: The mean age of the patients was 69.4±11.1 years and 73% were male. There was no conversion to an on-pump procedure or a sternotomy incision. The 30-day mortality rate was 1.5%. There were no cases of stroke, although 2 patients had to be re-explored for bleeding, and 81.8% were extubated in the operating room or on the day of surgery. The median stay in the intensive care unit and in the hospital were 1.5 and 9.6 days, respectively. The median follow-up period was 11 months, with a 5-year overall survival rate of 85.3%±0.09% and a 5-year MACCE-free survival rate of 72.8%±0.1%. Of the 66 patients, 32 patients with 36 grafts underwent a postoperative graft patency study with computed tomography angiography or coronary angiography, and 88.9% of the grafts were patent at 9.7±10.8 months postoperatively. CONCLUSION: MIDCAB is a safe procedure with low postoperative morbidity and mortality and favorable mid-term MACCE-free survival.
Angiography ; Arteries ; Coronary Angiography ; Coronary Artery Bypass ; Coronary Artery Disease ; Coronary Vessels ; Follow-Up Studies ; Hemorrhage ; Humans ; Intensive Care Units ; Male ; Minimally Invasive Surgical Procedures ; Mortality ; Operating Rooms ; Sternotomy ; Stroke ; Survival Rate ; Thoracotomy ; Transplants

BACKGROUND: The aim of this study was to compare the clinical outcomes of the sedative, analgesic, and hemodynamic effects of dexmedetomidine and midazolam for sedation after coronary artery bypass grafting (CABG). METHODS: The adult patients undergoing elective CABG surgery under general anesthesia were randomly assigned to the dexmedetomidine (DEX) and midazolam (MDZ) groups. From the time of the sternal closure, dexmedetomidine (0.5–0.7 μg/kg/h) was continuously administered (DEX group), and midazolam (0.03–0.1 mg/kg) was administered by bolus (MDZ group). To maintain the target sedation level (Richmond Agitation-Sedation Scale [RASS] range, −2 to −1) until extubation in the intensive care unit (ICU), continuous doses of dexmedetomidine were regulated and midazolam was administered intermittently. Sedation (RASS) and pain scores (visual analogue scale) and hemodynamic changes were recorded every two hours, until the end of the mechanical ventilation assistance after entering the ICU. RESULTS: The mean of the fraction within the target sedation level in each patient's total sedation time was 41.0% in the DEX group and 20.7% in the MDZ group (P = 0.026). In the DEX group, the RASS (P < 0.001) and cardiac index were lower (P = 0.047) than those in the MDZ group, but the other hemodynamic parameters and pain scores were not different. CONCLUSIONS: This study showed that post-operative infusion of dexmedetomidine maintained a stable sedation without side effects in patients who underwent CABG surgery.
Adult ; Anesthesia, General ; Conscious Sedation ; Coronary Artery Bypass ; Dexmedetomidine ; Hemodynamics ; Humans ; Intensive Care Units ; Midazolam ; Postoperative Care ; Respiration, Artificial ; Thoracic Surgery

OBJECTIVE: This study aimed to identify the effects of serum potassium and lactate on neurologic outcomes in out-of-hospital post-cardiac arrest adult patients. METHODS: This study was a single center, retrospective observational study. We recruited out-of-hospital post-cardiac arrest adult patients admitted to an intensive care unit from 2011 to 2017. Primary outcome was good neurologic outcome at discharge. To evaluate the prognostic impact of serum potassium and lactate, univariate and multivariate logistic regression analyses were performed. RESULTS: A total of 57 patients were included in this study. The number of patients with good neurologic outcome was 19 (33.3%). In the univariate analysis, good neurologic outcome patients showed a higher smoking rate, shorter pre-hospital transportation time, higher rate of percutaneous coronary intervention, and lower severity score (all p < 0.05). The good neurologic outcome patients also presented higher pH, lower partial pressure of carbon dioxide, and lower potassium regarding laboratory findings on the first hospital day (all p < 0.05). In the multivariate analysis, the independent factors favoring good neurologic outcome were pre-hospital transportation time (adjusted odds ratio [aOR], 0.82; 95% confidence interval [CI], 0.69–0.97; P=0.019) and lower partial pressure of carbon dioxide on the first hospital day (aOR, 0.95; 95% CI, 0.91–0.99; P=0.034). CONCLUSION: Serum potassium and lactate were not significantly associated with good neurologic outcome in out-of-hospital post-cardiac arrest adult patients. The prognostic factors for good neurologic outcome were pre-hospital transportation time and initial partial pressure of carbon dioxide.
Adult* ; Carbon Dioxide ; Cardiopulmonary Resuscitation ; Heart Arrest ; Humans ; Hydrogen-Ion Concentration ; Intensive Care Units ; Lactic Acid* ; Logistic Models ; Multivariate Analysis ; Observational Study ; Odds Ratio ; Partial Pressure ; Percutaneous Coronary Intervention ; Potassium* ; Prognosis ; Retrospective Studies ; Smoke ; Smoking ; Transportation

Kawasaki disease (KD) is an acute febrile mucocutaneous lymph node syndrome that commonly presents with stable hemodynamic status during the acute phase. An 8-year-old boy initially presented with severe hypotension and acute kidney injury. He was placed in the intensive care unit and was diagnosed with KD. Observed clinical features were defined as KD shock syndrome. His coronary artery was dilated during the subacute phase. Furthermore, he was given anti-hypertensive medications, owing to hypertension as an unusual complication of KD. We knew the importance of monitoring for blood pressure considering vasculitis as an aspect of the main pathogenesis of KD.
Acute Kidney Injury* ; Blood Pressure ; Child ; Coronary Vessels ; Hemodynamics ; Humans ; Hypertension* ; Hypotension ; Intensive Care Units ; Male ; Mucocutaneous Lymph Node Syndrome* ; Shock* ; Vasculitis

A 77-year-old woman was scheduled for a coronary artery bypass graft. Her preoperative transthoracic echocardiographic (TTE) examination revealed an enlarged left atrium with reduced systolic dysfunction (ejection fraction: 38%), moderate global hypokinesia of the left ventricle, and moderate mitral and tricuspid regurgitation. No thrombus was visualized on the preoperative TTE. However, the intraoperative transesophageal echocardiography performed before the cardiopulmonary bypass revealed a thrombus of approximately 1.3 × 1.8 cm in the left atrial appendage (LAA). The LAA thrombus was removed, an internal suture was placed on the LAA before the coronary artery bypass grafting, and the main operation was performed successfully. The patient was transferred to the intensive care unit to receive postoperative care. She was extubated 4 h after the surgery and was transferred to the general ward on postoperative day 3 without any neurological sequelae.
Aged ; Atrial Appendage* ; Cardiopulmonary Bypass ; Coronary Artery Bypass* ; Coronary Vessels* ; Echocardiography ; Echocardiography, Transesophageal* ; Female ; Heart Atria ; Heart Ventricles ; Humans ; Hypokinesia ; Intensive Care Units ; Patients' Rooms ; Postoperative Care ; Sutures ; Thrombosis* ; Transplants ; Tricuspid Valve Insufficiency

BACKGROUND AND OBJECTIVES: Genetic influence on T-wave peak to End (Tpe) time in patients with a first anterior acute myocardial infarction (AMI) is uncertain. A polymorphism in the angiotensin-II type 1 receptor (AT1R) gene was discovered recently. The polymorphism consists of an A or C variant, given three different possible genotypes: AA, AC, CC. The purpose of this study was to determine the effects of polymorphism of the AT1R gene polymorphism on Tpe after a first anterior AMI. SUBJECTS AND METHODS: The subjects were 142 patients (110 men, 32 women, 58±13 years) with a first anterior AMI; ten patients were excluded from this study. Based on the polymorphism of the AT1R gene, they were classified into two groups: Group 1 (AA genotype) of 91 patients and group 2 (AC and CC genotype) of 41 patients. A 12-lead resting ECG was recorded at admission to the coronary care unit in patients with anterior AMI and were manually measured with a ruler. QTc, QTd, QTcd, Tpe, Tpe/QT parameters were measured. RESULTS: There was no significant difference in the baseline characteristics of patients (p>0.05). We found significant reduction in QTc, QTd, QTcd, Tpe, Tpe/QT indices Group 1 (AA genotype) (mean 66±28 ms) than group 2 (AC and CC genotype) (mean 95±34 ms) (p<0.05). CONCLUSION: In patients with a first anterior AMI, AT1R gene polymorphisms may influence on repolarization parameters. Although further studies are required.
Coronary Care Units ; Electrocardiography ; Female ; Genotype ; Humans ; Male ; Myocardial Infarction*

PURPOSE: Enteral feeding remains controversial in patients receiving extracorporeal membrane oxygenation (ECMO), particularly in those treated with a high-dose vasopressor. This study examined the safety and feasibility of enteral nutritional support for patients undergoing ECMO in a cardiac care unit (CCU). METHODS: Adult patients admitted to the CCU undergoing ECMO from January 2014 to May 2015 were included. Patients with <48 hours of support, undergoing ECMO at another hospital, and inaccurate medical records were excluded. RESULTS: Among the 14 patients undergoing ECMO in the CCU, 2 patients were diagnosed with malnutrition and the others were in the normal state in the initial assessment. On the other hand, they had the malnutrition risk factors (anorexia, weight loss, fluid retention, and hypermetabolic state). Thirteen patients received enteral nutrition and 1 patient had possible oral intake. The average initiation day of enteral nutrition was 2.0±1.6 days on ECMO. The mean duration of enteral nutrition was 5.2±4.9 days and the target goal was achieved within 3 days. There were no serious adverse effects for enteral nutrition but 3 patients had gastrointestinal problems (diarrhea and anorexia), and gastrointestinal bleeding occurred in 1 patient. In 1 case, enteral nutrition had to be stopped due to the prone position. Overall, 5 patients were cured, 3 patients recovered through heart transplantation, and 6 patients died. CONCLUSION: Most CCU patients receiving ECMO were well nourished but had the malnutrition risk factors in progress. These results suggest that enteral feeding might be safe and feasible in patients treated with ECMO but there were minor side effects.
Adult ; Coronary Care Units* ; Enteral Nutrition* ; Extracorporeal Membrane Oxygenation ; Hand ; Heart Transplantation ; Hemorrhage ; Humans ; Malnutrition ; Medical Records ; Membranes* ; Nutritional Support ; Oxygen* ; Prone Position ; Risk Factors ; Weight Loss

PURPOSE: We aimed to investigate the clinical use of plasma neutrophil gelatinase-associated lipocalin (NGAL) in the emergency department (ED), especially for predicting the prognosis of heart failure. METHODS: In a retrospective study, patient selection was based on those who visited the ED between January 2015 and September 2015 and were diagnosed with heart failure and underwent laboratory tests, including B-type natriuretic peptide (BNP) and NGAL. They were divided in two groups, according to the presence or absence of the following events: one or more intubations, admission of intensive care unit (ICU), coronary angiography, renal replacement therapy, extracorporeal membrane oxygenation, intra-aortic balloon pumping, cardiopulmonary resuscitation (CPR), or death. RESULTS: We studied 63 patients with heart failure. The absence group consisted of 29 subjects, and the presence group consisted of 34 subjects. Patients who were younger, had a history of diabetes mellitus, had high level of serum creatinine, low estimated glomerular filtration (eGFR), high creatine kinase (CK) or high NGAL were associated with higher incidence of events and were statistically significant (p<0.001, 0.02, 0.005, 0.035, 0.03, 0.003). In the case of BNP, the presence group showed a higher value compared with the absence group, but was not statistically significant. In a multivariated logistic regression, age (OR=0.868, 95% confidence interval 0.788-0.956, p=0.004) and NGAL (OR=1.004, 95%CI 1.001-1.007, p=0.021) were considered as meaningful factors for predicting the event. CONCLUSION: NGAL elevation in this study showed to be a meaningful factor, indicating a prognosis to those patients who visited the ED and were diagnosed as heart failure.
Cardiopulmonary Resuscitation ; Coronary Angiography ; Creatine Kinase ; Creatinine ; Diabetes Mellitus ; Emergencies* ; Emergency Service, Hospital* ; Extracorporeal Membrane Oxygenation ; Filtration ; Heart Failure* ; Heart* ; Humans ; Incidence ; Intensive Care Units ; Intra-Aortic Balloon Pumping ; Intubation ; Lipocalins* ; Logistic Models ; Natriuretic Peptide, Brain ; Neutrophils ; Patient Selection ; Plasma ; Prognosis* ; Renal Replacement Therapy ; Retrospective Studies

A 76-year-old man with no notable medical history was scheduled for a robot-assisted radical prostatectomy. After the operation, he was given sugammadex. Two minutes later, ventricular premature contraction bigeminy began, followed by cardiac arrest. Cardiac arrest occurred three times and cardiopulmonary resuscitation was done. The patient recovered after the third cardiopulmonary resuscitation and was transferred to the intensive care unit. Coronary angiography was done on postoperative day 1. The patient was diagnosed with variant angina and discharged uneventfully on postoperative day 8.
Aged ; Cardiopulmonary Resuscitation ; Coronary Angiography ; Heart Arrest* ; Humans ; Intensive Care Units ; Prostatectomy