The RECOVERY study documented lower 28-day mortality with the use of dexamethasone in hospitalize... more The RECOVERY study documented lower 28-day mortality with the use of dexamethasone in hospitalized patients on invasive mechanical ventilation or oxygen with COVID-19 Pneumonia. We aimed to examine the practice patterns of steroids use, and their impact on mortality and length of stay in ICU. We retrospectively examined records of all patients with confirmed Covid 19 pneumonia admitted to the ICU of Dubai hospital from January 1st, 2020 – June 30th, 2020. We assigned patients to four groups (No steroids, low dose, medium dose, and high dose steroids). The primary clinical variable of interest was doses of steroids. Secondary outcomes were 28-day mortality and length of stay in ICU”. We found variability in doses of steroid treatment. The most frequently used dose was the high dose. Patients who survived were on significantly higher doses of steroids and had significantly longer stays in ICU. The prescription of steroids in Covid-19 ARDS is variable. The dose of steroids impacts mort...
Introduction: COVID-19 has caused high rates of mortality. During pandemic peak, a significant nu... more Introduction: COVID-19 has caused high rates of mortality. During pandemic peak, a significant number of patients were admitted to undesignated ICU areas before transferring to designated ICU, owing to unavailability of ICU beds. We aimed to record the effect of care of critically sick patients with COVID-19 on prevalence of secondary bacterial infection. Methods: We retrospectively studied all critically ill patients with COVID-19 pneumonia meeting ICU admission criteria who were admitted to Dubai hospital between January 1, 2020, and June 30, 2020. All the patients who transferred to wards other than designated ICU constitute category as cases. All patients who directly admitted to the designated ICU ward from emergency department constitute controls. The demographics, clinical parameters, and treatment profile of these patients were recorded and compared. Prevalence of secondary bacterial infection was calculated. Results: Patients with COVID-19 had high prevalence of secondary b...
Objective To evaluate if children with ASD, or mothers of ASD children have elevated CRP during p... more Objective To evaluate if children with ASD, or mothers of ASD children have elevated CRP during pregnancy. Background Autism spectrum disorder (ASD) is a neuro developmental disorder with incidence of 1 in 68 children occur in all racial, ethnic, and socioeconomic groups. Economic burden between $11.5 billion - $60.9 billion and family average medical expenditures of $4110–$6200 per year. Conflicting evidence exist about role of maternal CRP during pregnancy with ASD child. Methods Searches on database; Pubmed, Medline, Embase and google scholar using key words; C reactive protein (CRP), Maternal CRP, ASD, autism, autistic disorder, Inflammation. All English-language studies published between 1960 and 2019 pertaining to CRP and ASD. All Studies which provided data on CRP levels during pregnancy (mCRP) of Mothers of offsprings with ASD and (mCRP) of mothers of normal subjects were selected. Data were extracted in the form of odd ratios of having high mCRP in mothers of children with ...
Coronary artery disease (CAD) is the most common killer disease, responsible for about onethird o... more Coronary artery disease (CAD) is the most common killer disease, responsible for about onethird of all deaths at ages above 35. The majority of all survivors of out-of-hospital cardiac arrests present to the emergency department (ED) with an initial shockable rhythm (ventricular fibrillation or pulse-less ventricular tachycardia), which is a predictor of survival. Odds for survival are less for non-shockable rhythm and favorable neurologic outcomes decrease as the length of cardiopulmonary resuscitation (CPR) increases. The median time-to-return of spontaneous circulation among those with favorable neurological outcomes is less than 10 minutes. On the other hand, a large review of more than 64,000 patients with in-hospital cardiac arrests showed that patients with longer median resuscitation times had a greater chance of the return of spontaneous circulation and survival to discharge. We described a case of prolonged resuscitation lasting almost three hours of CPR followed by successful percutaneous intervention with a favorable neurologic outcome.
The Egyptian Journal of Critical Care Medicine, 2018
Pheochromocytoma is a rare neuroendocrine tumors which overproduce catecholamines and arise from ... more Pheochromocytoma is a rare neuroendocrine tumors which overproduce catecholamines and arise from the adrenal gland or extra-adrenal chromaffin cells of the sympathetic and parasympathetic ganglia. We report a case of pheochromocytoma-induced inverted Takotsubo-like cardiomyopathy leading to cardiogenic shock successfully managed with veno-arterial (VA) extracorporeal membrane oxygenation (ECMO) as a bridge to pharmacological control and subsequent curative laparoscopic adrenalectomy.
Introduction: Positive end expiratory pressure (PEEP) exerts variable effects on preload, pulmona... more Introduction: Positive end expiratory pressure (PEEP) exerts variable effects on preload, pulmonary vascular flow, and afterload. Lung recruitment with gradual increase in PEEP improves oxygenation, but it may have variable cardiovascular effects. Method: A patient with respiratory failure from tetanus was recruited after informed consent. The sedated and paralyzed patient was subjected to sequential increase in PEEP with measurement of hemodynamics, ventilator parameters, and echocardiographic parameters (Doppler flow across tricuspid, pulmonic, and mitral valves at end inspiration and end expiration, in addition to blood volume flowing across RVOT and mitral valve). Results: We observed an initial rise in pulmonic and mitral blood flows, followed by a decline back to baseline around PEEP of 20, with an eventual decline associated with a drop in mean MAP <60 torr above PEEP of 29. Similar effects were also observed on blood volume flowing across RVOT and mitral valve. PEEP of 5 ...
The effects of the full moon on human behaviour have long fascinated researchers. There are consi... more The effects of the full moon on human behaviour have long fascinated researchers. There are considerable disagreements about the lunar effect on the human body and on human behaviour Some studies support this correlation, 1,2 while other studies negate it. 3-5 The intensive care unit (ICU) mortality rate has been studied in relation to the numbers of admissions during weekdays, weekends, the daytime, night shifts, off-hours, and specific months. we are not aware of any correlations between the full moon and ICU mortality rates.
Journal of the American Academy of Child & Adolescent Psychiatry, 2017
¼ À0.33, P ¼ 0.01) in individuals who were under the age of 13 years. In older individuals, chang... more ¼ À0.33, P ¼ 0.01) in individuals who were under the age of 13 years. In older individuals, change in time spent looking at backgroundobjects correlated with change in ABI-Restricted Repetitive Behavior (RRB) (r s [46] ¼ 0.33, P ¼ 0.01). In the VET, there were significant differences between TD subjects and subjects with ASD in the total number of images explored, adjusted for total viewing time. The group with ASD explored fewer images (P < 0.001). There were significant differences between groups in the average fixation time on high autism interest (HAI) objects (P ¼ 0.036). Correlations between perseveration on HAI and ABI-RRB interests were observed across all time points
Introduction: Coronavirus has caused more than a million deaths as of October 2020. Hospitals con... more Introduction: Coronavirus has caused more than a million deaths as of October 2020. Hospitals consider tracheostomy after the patient is virus negative, usually after 3 weeks. Prevalence and timing of tracheostomy and its impact on survival among COVID patients are unknown. Methods: A retrospective, single-center study of all patients with COVID-19 ARDS who underwent tracheostomy was conducted. Patients with age <18 and patients treated with ECMO were excluded. Duration of ventilation before tracheostomy was recorded. Clinical variables, outcome variables, and confounding variables were recorded and compared between patients with tracheostomy and without tracheostomy. The aim was to determine prevalence and timing of tracheostomy and its impact on clinical outcomes. Results: We found that tracheostomies were performed only in 21 out of 196 patients (10.8%). Tracheostomies were performed after 3 weeks on average (22.1 ± 7.5 days). Survival was significantly higher in patients who ...
Background: Most COVID-19 studies conclude old age and coexisting illnesses as mortality determin... more Background: Most COVID-19 studies conclude old age and coexisting illnesses as mortality determinants owing to different populations or methodologies, or omitting factors affecting outcomes. Methods: We analyzed COVID-19 patients’ data (N = 391) of Dubai Hospital between January 1, 2020 and June 30, 2020. Results: Only 19 patients (4.8%) were UAE nationals, while 372 (95.2%) were expatriates. Median age was 48 (interquartile range, 40–56) years; 22% were <40 years, and only 16.6% were female. Cough was the most common symptom (78.7%), fever was 77.4%, and gastrointestinal symptoms were least common (13.8%). Approximately 95% had elevated C-reactive protein (CRP) and D-dimers (79%), lymphocytopenia 47.3%, and thrombocytopenia 13.8%. Mortality was 30% for the total sample and 50% in ICU patients. ICU patients were older than non-ICU (age; 49.6 ± 10.9 vs. 46.7 ± 12.7 years, p = 0.04). Eighty-five percent of ICU patients required invasive mechanical ventilation, 78% vasopressors, 88%...
Introduction: COVID-19 has caused approximately one million deaths worldwide as of November 24, 2... more Introduction: COVID-19 has caused approximately one million deaths worldwide as of November 24, 2020. Markers of disease activity like ferritin, C-reactive protein (CRP), and D-dimers are frequently monitored to detect the best opportunity for intensive treatment. Methods: All patients of >18 years of age were included. The primary variables of interest, ferritin, CRP, and D-dimers, for each patient throughout hospitalization were recorded. Primary clinical outcomes of length of stay in ICU and survival were recorded. Demographics: age, gender, BMI, and nationality. Ferritin, CRP, and D-dimers were recorded daily if available for the whole ICU stay, and all other variables were recorded on admission day to ICU. Results: The sample includes 235 records. More than 95% of patients have all markers on the day of admission to ICU were ferritin (median 1,278; IQR 1,424), D-dimer 1.21 (3.4), and CRP 129.5 (121). Daily average levels of markers were different from their admission day lev...
Enteric salmonella infections are common in the United States though nonenteric salmonella infect... more Enteric salmonella infections are common in the United States though nonenteric salmonella infections in immunocompetent adults are exceedingly rare in the United States, and meningitis is one of the least common extra-intestinal sites. In addition, it is very unusual for a patient with bacterial meningitis to present with meningitis signs and symptoms of >72 h duration like aseptic meningitis. A 25-year-old Indian male, without any past medical history brought by friends to the ER had fever and irritability for a week. He became increasingly somnolent and confused three days back. Physical exam reveals signs of meningitis and laboratory showed cerebrospinal fluid (CSF) studies suggestive of bacterial meningitis. Culture of CSF grew Salmonella typhi and later on blood culture also grew S. typhi. The patient became worse with cerebral edema and hydrocephalous suspected by change in neurological status and confirmed by ultrasound of eye ball examining optic nerve sheath diameter and CT scan of brain. The patient required neurosurgical intervention and hence external ventricular drain was placed. The patient was also placed on mechanical ventilation. Subsequently he developed ventilator associated pneumonia (VAP) with carbapenem-resistant Pseudomonas aeruginosa. The patient underwent tracheostomy and successfully completed treatment of VAP and was transferred to his home country after four months. Thus we describe a rare case of salmonella meningitis in an immunocompetent adult.
The objective of this study was to detect if cardiopulmonary bypass time duration has any impact ... more The objective of this study was to detect if cardiopulmonary bypass time duration has any impact on the duration of postoperative mechanical ventilation (MV). The study design was a systematic review and regression analysis of pooled data from previously published studies. All available data are from prospective, retrospective, cross-sectional, and observational studies. Participants included only patient/human studies. There were no interventions. PubMed and Cochrane libraries were searched by utilizing different combinations of keywords: cardiopulmonary bypass and mechanical ventilation. Inclusion criteria were: (1) English articles, (2) studies with an adult population that underwent cardiac surgeries using cardiopulmonary bypass (CPB), (3) studies where the duration of CPB is provided as well as the duration of mechanical ventilation. A regression analysis was performed on the metadata. For the hours of MV, eight studies with 13 data sets (as some studies provide data in subgroups) were included for a total number of 989 subjects. The duration of CPB ranged from 55 to 173.5 minutes for these operations. Postoperative MV hours ranged from nine to 408 hours. Stepwise multiple regression analysis found that cardiopulmonary bypass time (CPBT), age, diabetes, male gender, and ejection fraction correlated with prolonged mechanical ventilation; CPBT was the most strongly correlated variable. Cardiopulmonary bypass time appears to affect clinical outcomes adversely and is associated with prolonged MV. Avoiding CPB or limiting it to a minimum may decrease the days of MV required.
Several factors determine the perioperative outcome besides the nature of the congenital heart de... more Several factors determine the perioperative outcome besides the nature of the congenital heart defect. Prolonged mechanical ventilation (PMV) is a major factor that determines mortality, length of stay (LOS), residual disability, and other functional outcomes. We aim to determine the clinical variables predicting PMV and LOS in hospital, and specifically the impact from the duration of cardiopulmonary bypass (CPB) and aortic cross-clamp (ACC).
Background: Low tidal volume ventilation (LTVV) strategy improves outcomes; however, despite reco... more Background: Low tidal volume ventilation (LTVV) strategy improves outcomes; however, despite recommended by guidelines, adherence to this practice is not high. Methods: Tidal volume for mechanically ventilated patients were recorded for each 12hour shift, day and night shifts for consecutive 101 patients. Adherence was determined by comparing these tidal volumes to standard low tidal volumes of 6 ml/kg of ideal body weight. Adherence rates were calculated and adherence rates of daytime shifts were compared to those of night time shifts. Adherence rates for weekday shifts were compared with those of weekend shifts. Clinical variables were recorded to analyze predictors of adherence pattern. Results: The sample size was 101 patients with 870 patient-ventilator days with 1734 patient ventilator shifts. Shift adherence was only 47.5%. There was no significant difference between day and night shifts or weekday and weekend shifts. Stepwise multiple regression analysis shows that age, gender, body mass index (BMI), and partial pressure of carbon dioxide (PCO2) have significant correlation with adherence to LTVV practice. Conclusion: The study found that adherence to lung protective low tidal volume mechanical ventilation practice is low.
The RECOVERY study documented lower 28-day mortality with the use of dexamethasone in hospitalize... more The RECOVERY study documented lower 28-day mortality with the use of dexamethasone in hospitalized patients on invasive mechanical ventilation or oxygen with COVID-19 Pneumonia. We aimed to examine the practice patterns of steroids use, and their impact on mortality and length of stay in ICU. We retrospectively examined records of all patients with confirmed Covid 19 pneumonia admitted to the ICU of Dubai hospital from January 1st, 2020 – June 30th, 2020. We assigned patients to four groups (No steroids, low dose, medium dose, and high dose steroids). The primary clinical variable of interest was doses of steroids. Secondary outcomes were 28-day mortality and length of stay in ICU”. We found variability in doses of steroid treatment. The most frequently used dose was the high dose. Patients who survived were on significantly higher doses of steroids and had significantly longer stays in ICU. The prescription of steroids in Covid-19 ARDS is variable. The dose of steroids impacts mort...
Introduction: COVID-19 has caused high rates of mortality. During pandemic peak, a significant nu... more Introduction: COVID-19 has caused high rates of mortality. During pandemic peak, a significant number of patients were admitted to undesignated ICU areas before transferring to designated ICU, owing to unavailability of ICU beds. We aimed to record the effect of care of critically sick patients with COVID-19 on prevalence of secondary bacterial infection. Methods: We retrospectively studied all critically ill patients with COVID-19 pneumonia meeting ICU admission criteria who were admitted to Dubai hospital between January 1, 2020, and June 30, 2020. All the patients who transferred to wards other than designated ICU constitute category as cases. All patients who directly admitted to the designated ICU ward from emergency department constitute controls. The demographics, clinical parameters, and treatment profile of these patients were recorded and compared. Prevalence of secondary bacterial infection was calculated. Results: Patients with COVID-19 had high prevalence of secondary b...
Objective To evaluate if children with ASD, or mothers of ASD children have elevated CRP during p... more Objective To evaluate if children with ASD, or mothers of ASD children have elevated CRP during pregnancy. Background Autism spectrum disorder (ASD) is a neuro developmental disorder with incidence of 1 in 68 children occur in all racial, ethnic, and socioeconomic groups. Economic burden between $11.5 billion - $60.9 billion and family average medical expenditures of $4110–$6200 per year. Conflicting evidence exist about role of maternal CRP during pregnancy with ASD child. Methods Searches on database; Pubmed, Medline, Embase and google scholar using key words; C reactive protein (CRP), Maternal CRP, ASD, autism, autistic disorder, Inflammation. All English-language studies published between 1960 and 2019 pertaining to CRP and ASD. All Studies which provided data on CRP levels during pregnancy (mCRP) of Mothers of offsprings with ASD and (mCRP) of mothers of normal subjects were selected. Data were extracted in the form of odd ratios of having high mCRP in mothers of children with ...
Coronary artery disease (CAD) is the most common killer disease, responsible for about onethird o... more Coronary artery disease (CAD) is the most common killer disease, responsible for about onethird of all deaths at ages above 35. The majority of all survivors of out-of-hospital cardiac arrests present to the emergency department (ED) with an initial shockable rhythm (ventricular fibrillation or pulse-less ventricular tachycardia), which is a predictor of survival. Odds for survival are less for non-shockable rhythm and favorable neurologic outcomes decrease as the length of cardiopulmonary resuscitation (CPR) increases. The median time-to-return of spontaneous circulation among those with favorable neurological outcomes is less than 10 minutes. On the other hand, a large review of more than 64,000 patients with in-hospital cardiac arrests showed that patients with longer median resuscitation times had a greater chance of the return of spontaneous circulation and survival to discharge. We described a case of prolonged resuscitation lasting almost three hours of CPR followed by successful percutaneous intervention with a favorable neurologic outcome.
The Egyptian Journal of Critical Care Medicine, 2018
Pheochromocytoma is a rare neuroendocrine tumors which overproduce catecholamines and arise from ... more Pheochromocytoma is a rare neuroendocrine tumors which overproduce catecholamines and arise from the adrenal gland or extra-adrenal chromaffin cells of the sympathetic and parasympathetic ganglia. We report a case of pheochromocytoma-induced inverted Takotsubo-like cardiomyopathy leading to cardiogenic shock successfully managed with veno-arterial (VA) extracorporeal membrane oxygenation (ECMO) as a bridge to pharmacological control and subsequent curative laparoscopic adrenalectomy.
Introduction: Positive end expiratory pressure (PEEP) exerts variable effects on preload, pulmona... more Introduction: Positive end expiratory pressure (PEEP) exerts variable effects on preload, pulmonary vascular flow, and afterload. Lung recruitment with gradual increase in PEEP improves oxygenation, but it may have variable cardiovascular effects. Method: A patient with respiratory failure from tetanus was recruited after informed consent. The sedated and paralyzed patient was subjected to sequential increase in PEEP with measurement of hemodynamics, ventilator parameters, and echocardiographic parameters (Doppler flow across tricuspid, pulmonic, and mitral valves at end inspiration and end expiration, in addition to blood volume flowing across RVOT and mitral valve). Results: We observed an initial rise in pulmonic and mitral blood flows, followed by a decline back to baseline around PEEP of 20, with an eventual decline associated with a drop in mean MAP <60 torr above PEEP of 29. Similar effects were also observed on blood volume flowing across RVOT and mitral valve. PEEP of 5 ...
The effects of the full moon on human behaviour have long fascinated researchers. There are consi... more The effects of the full moon on human behaviour have long fascinated researchers. There are considerable disagreements about the lunar effect on the human body and on human behaviour Some studies support this correlation, 1,2 while other studies negate it. 3-5 The intensive care unit (ICU) mortality rate has been studied in relation to the numbers of admissions during weekdays, weekends, the daytime, night shifts, off-hours, and specific months. we are not aware of any correlations between the full moon and ICU mortality rates.
Journal of the American Academy of Child & Adolescent Psychiatry, 2017
¼ À0.33, P ¼ 0.01) in individuals who were under the age of 13 years. In older individuals, chang... more ¼ À0.33, P ¼ 0.01) in individuals who were under the age of 13 years. In older individuals, change in time spent looking at backgroundobjects correlated with change in ABI-Restricted Repetitive Behavior (RRB) (r s [46] ¼ 0.33, P ¼ 0.01). In the VET, there were significant differences between TD subjects and subjects with ASD in the total number of images explored, adjusted for total viewing time. The group with ASD explored fewer images (P < 0.001). There were significant differences between groups in the average fixation time on high autism interest (HAI) objects (P ¼ 0.036). Correlations between perseveration on HAI and ABI-RRB interests were observed across all time points
Introduction: Coronavirus has caused more than a million deaths as of October 2020. Hospitals con... more Introduction: Coronavirus has caused more than a million deaths as of October 2020. Hospitals consider tracheostomy after the patient is virus negative, usually after 3 weeks. Prevalence and timing of tracheostomy and its impact on survival among COVID patients are unknown. Methods: A retrospective, single-center study of all patients with COVID-19 ARDS who underwent tracheostomy was conducted. Patients with age <18 and patients treated with ECMO were excluded. Duration of ventilation before tracheostomy was recorded. Clinical variables, outcome variables, and confounding variables were recorded and compared between patients with tracheostomy and without tracheostomy. The aim was to determine prevalence and timing of tracheostomy and its impact on clinical outcomes. Results: We found that tracheostomies were performed only in 21 out of 196 patients (10.8%). Tracheostomies were performed after 3 weeks on average (22.1 ± 7.5 days). Survival was significantly higher in patients who ...
Background: Most COVID-19 studies conclude old age and coexisting illnesses as mortality determin... more Background: Most COVID-19 studies conclude old age and coexisting illnesses as mortality determinants owing to different populations or methodologies, or omitting factors affecting outcomes. Methods: We analyzed COVID-19 patients’ data (N = 391) of Dubai Hospital between January 1, 2020 and June 30, 2020. Results: Only 19 patients (4.8%) were UAE nationals, while 372 (95.2%) were expatriates. Median age was 48 (interquartile range, 40–56) years; 22% were <40 years, and only 16.6% were female. Cough was the most common symptom (78.7%), fever was 77.4%, and gastrointestinal symptoms were least common (13.8%). Approximately 95% had elevated C-reactive protein (CRP) and D-dimers (79%), lymphocytopenia 47.3%, and thrombocytopenia 13.8%. Mortality was 30% for the total sample and 50% in ICU patients. ICU patients were older than non-ICU (age; 49.6 ± 10.9 vs. 46.7 ± 12.7 years, p = 0.04). Eighty-five percent of ICU patients required invasive mechanical ventilation, 78% vasopressors, 88%...
Introduction: COVID-19 has caused approximately one million deaths worldwide as of November 24, 2... more Introduction: COVID-19 has caused approximately one million deaths worldwide as of November 24, 2020. Markers of disease activity like ferritin, C-reactive protein (CRP), and D-dimers are frequently monitored to detect the best opportunity for intensive treatment. Methods: All patients of >18 years of age were included. The primary variables of interest, ferritin, CRP, and D-dimers, for each patient throughout hospitalization were recorded. Primary clinical outcomes of length of stay in ICU and survival were recorded. Demographics: age, gender, BMI, and nationality. Ferritin, CRP, and D-dimers were recorded daily if available for the whole ICU stay, and all other variables were recorded on admission day to ICU. Results: The sample includes 235 records. More than 95% of patients have all markers on the day of admission to ICU were ferritin (median 1,278; IQR 1,424), D-dimer 1.21 (3.4), and CRP 129.5 (121). Daily average levels of markers were different from their admission day lev...
Enteric salmonella infections are common in the United States though nonenteric salmonella infect... more Enteric salmonella infections are common in the United States though nonenteric salmonella infections in immunocompetent adults are exceedingly rare in the United States, and meningitis is one of the least common extra-intestinal sites. In addition, it is very unusual for a patient with bacterial meningitis to present with meningitis signs and symptoms of >72 h duration like aseptic meningitis. A 25-year-old Indian male, without any past medical history brought by friends to the ER had fever and irritability for a week. He became increasingly somnolent and confused three days back. Physical exam reveals signs of meningitis and laboratory showed cerebrospinal fluid (CSF) studies suggestive of bacterial meningitis. Culture of CSF grew Salmonella typhi and later on blood culture also grew S. typhi. The patient became worse with cerebral edema and hydrocephalous suspected by change in neurological status and confirmed by ultrasound of eye ball examining optic nerve sheath diameter and CT scan of brain. The patient required neurosurgical intervention and hence external ventricular drain was placed. The patient was also placed on mechanical ventilation. Subsequently he developed ventilator associated pneumonia (VAP) with carbapenem-resistant Pseudomonas aeruginosa. The patient underwent tracheostomy and successfully completed treatment of VAP and was transferred to his home country after four months. Thus we describe a rare case of salmonella meningitis in an immunocompetent adult.
The objective of this study was to detect if cardiopulmonary bypass time duration has any impact ... more The objective of this study was to detect if cardiopulmonary bypass time duration has any impact on the duration of postoperative mechanical ventilation (MV). The study design was a systematic review and regression analysis of pooled data from previously published studies. All available data are from prospective, retrospective, cross-sectional, and observational studies. Participants included only patient/human studies. There were no interventions. PubMed and Cochrane libraries were searched by utilizing different combinations of keywords: cardiopulmonary bypass and mechanical ventilation. Inclusion criteria were: (1) English articles, (2) studies with an adult population that underwent cardiac surgeries using cardiopulmonary bypass (CPB), (3) studies where the duration of CPB is provided as well as the duration of mechanical ventilation. A regression analysis was performed on the metadata. For the hours of MV, eight studies with 13 data sets (as some studies provide data in subgroups) were included for a total number of 989 subjects. The duration of CPB ranged from 55 to 173.5 minutes for these operations. Postoperative MV hours ranged from nine to 408 hours. Stepwise multiple regression analysis found that cardiopulmonary bypass time (CPBT), age, diabetes, male gender, and ejection fraction correlated with prolonged mechanical ventilation; CPBT was the most strongly correlated variable. Cardiopulmonary bypass time appears to affect clinical outcomes adversely and is associated with prolonged MV. Avoiding CPB or limiting it to a minimum may decrease the days of MV required.
Several factors determine the perioperative outcome besides the nature of the congenital heart de... more Several factors determine the perioperative outcome besides the nature of the congenital heart defect. Prolonged mechanical ventilation (PMV) is a major factor that determines mortality, length of stay (LOS), residual disability, and other functional outcomes. We aim to determine the clinical variables predicting PMV and LOS in hospital, and specifically the impact from the duration of cardiopulmonary bypass (CPB) and aortic cross-clamp (ACC).
Background: Low tidal volume ventilation (LTVV) strategy improves outcomes; however, despite reco... more Background: Low tidal volume ventilation (LTVV) strategy improves outcomes; however, despite recommended by guidelines, adherence to this practice is not high. Methods: Tidal volume for mechanically ventilated patients were recorded for each 12hour shift, day and night shifts for consecutive 101 patients. Adherence was determined by comparing these tidal volumes to standard low tidal volumes of 6 ml/kg of ideal body weight. Adherence rates were calculated and adherence rates of daytime shifts were compared to those of night time shifts. Adherence rates for weekday shifts were compared with those of weekend shifts. Clinical variables were recorded to analyze predictors of adherence pattern. Results: The sample size was 101 patients with 870 patient-ventilator days with 1734 patient ventilator shifts. Shift adherence was only 47.5%. There was no significant difference between day and night shifts or weekday and weekend shifts. Stepwise multiple regression analysis shows that age, gender, body mass index (BMI), and partial pressure of carbon dioxide (PCO2) have significant correlation with adherence to LTVV practice. Conclusion: The study found that adherence to lung protective low tidal volume mechanical ventilation practice is low.
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