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[PMID]:29187110
[Au] Autor:Costello JM; Preze E; Nguyen N; McBride ME; Collins JW; Eltayeb OM; Mongé MC; Deal BJ; Stephenson MM; Backer CL
[Ad] Endereço:1 Division of Cardiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.
[Ti] Título:Experience with an Acuity Adaptable Care Model for Pediatric Cardiac Surgery.
[So] Source:World J Pediatr Congenit Heart Surg;8(6):665-671, 2017 11.
[Is] ISSN:2150-136X
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: We describe the implementation of and outcomes associated with an acuity adaptable care model for pediatric patients undergoing cardiac surgery. METHODS: Consecutive patients undergoing an index cardiac operation between July 2007 and June 2015 were included. From July 2007 through June 2010, a conventional model existed in which patients moved among units and care teams based on age, severity of illness, and operative status (conventional group). A transitional period existed between July 2010 and June 8, 2012 (transitional group). From June 9, 2012, through June 2015, an acuity adaptable model was used in which patients remained in the cardiac care unit and received care from the same clinical team throughout their hospitalization (acuity adaptable group). RESULTS: Included were 2,363 patients: 925 in the conventional group, 520 in the transitional group, and 918 in the acuity adaptable group. In relation to the conventional group, the adjusted odds of operative mortality in the acuity adaptable group was 0.55 (95% confidence interval: 0.26-1.18; P = .12). The failure to rescue rate (ie, number of deaths in patients with any complication divided by the number of total patients with any complication) decreased (conventional group, 8.7%; acuity adaptable group, 4.2%; P = .04). In relation to the conventional group, postoperative hospital length of stay tended to be shorter in the acuity adaptable group ( P = .07). CONCLUSIONS: The implementation of an acuity adaptable care model was feasible in our pediatric cardiac program. The favorable associations identified between the new model and outcomes are promising but warrant confirmation in a larger, multicenter study.
[Mh] Termos MeSH primário: Procedimentos Cirúrgicos Cardíacos/métodos
Unidades de Cuidados Coronarianos/organização & administração
Cuidados Críticos/organização & administração
Unidades de Terapia Intensiva Pediátrica/organização & administração
Modelos Organizacionais
Assistência Perioperatória/métodos
[Mh] Termos MeSH secundário: Adolescente
Criança
Pré-Escolar
Feminino
Seres Humanos
Lactente
Recém-Nascido
Masculino
Estudos Retrospectivos
Estados Unidos
[Pt] Tipo de publicação:JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T
[Em] Mês de entrada:1712
[Cu] Atualização por classe:180202
[Lr] Data última revisão:
180202
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171201
[St] Status:MEDLINE
[do] DOI:10.1177/2150135117733722


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[PMID]:28844513
[Au] Autor:Rosenbaum AN; Naksuk N; Gharacholou SM; Brenes-Salazar JA
[Ad] Endereço:Department of Cardiovascular Disease, Mayo Clinic, Rochester, Minnesota. Electronic address: rosenbaum.andrew@mayo.edu.
[Ti] Título:Outcomes of Nonagenarians Admitted to the Cardiac Intensive Care Unit by the Elders Risk Assessment Score for Long-Term Mortality Risk Stratification.
[So] Source:Am J Cardiol;120(8):1421-1426, 2017 Oct 15.
[Is] ISSN:1879-1913
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:There are limited data on outcomes of older adults admitted to cardiac intensive care units (CICU), and there are no data on outcomes after admission to the CICU in nonagenarians. Our purpose was to identify whether the Elders Risk Assessment (ERA) index could risk stratify older adults after CICU admission. We retrospectively identified 453 nonagenarians admitted to the CICU between 2004 and 2013. End points included mortality, length of stay, incidence of delirium, and discharge disposition. Average age of the cohort was 92 ± 2 years, and the average ERA score was 13 ± 6. A total of 258 patients were female (57%). Most common admission indication was acute decompensated heart failure (57%) followed by acute myocardial infarction (49%). Loss of independence was observed after CICU admission, with 66% of patients living independently before admission, decreasing to 47% at discharge. Overall length of stay was 6 ± 5 days and CICU stay was 2 ± 2 days. Fifteen percent of patients died before hospital discharge. Median survival was 452 (interquartile range 40 to 1,371) days. ERA score effectively predicted survival (log-rank test, p = 0.002). ERA score of 16 or greater and ERA score of 9 to 15 were both associated with increased risk of mortality compared with the reference (score 4 to 8): hazard ratio 2.00, 95% confidence interval 1.37 to 2.90, p = 0.003, and hazard ratio 1.48, 95% confidence interval 1.06 to 2.08, p = 0.02, respectively. In conclusion, nonagenarians admitted to CICU experience reasonable outcomes. The ERA score effectively risk stratifies nonagenarians admitted to the CICU and may help with identification of vulnerable patients at risk of adverse outcomes.
[Mh] Termos MeSH primário: Unidades de Cuidados Coronarianos/estatística & dados numéricos
Insuficiência Cardíaca/mortalidade
Infarto do Miocárdio/etiologia
Medição de Risco/métodos
[Mh] Termos MeSH secundário: Idoso de 80 Anos ou mais
Feminino
Seguimentos
Insuficiência Cardíaca/complicações
Mortalidade Hospitalar/tendências
Seres Humanos
Masculino
Minnesota/epidemiologia
Infarto do Miocárdio/mortalidade
Estudos Retrospectivos
Taxa de Sobrevida/tendências
Fatores de Tempo
[Pt] Tipo de publicação:JOURNAL ARTICLE; OBSERVATIONAL STUDY
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171003
[Lr] Data última revisão:
171003
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170829
[St] Status:MEDLINE


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[PMID]:28807523
[Au] Autor:Gandhi S; Mosleh W; Sharma UC; Demers C; Farkouh ME; Schwalm JD
[Ad] Endereço:McMaster University, Hamilton Health Sciences, Population Health Research Institute, Hamilton, Ontario, Canada. Electronic address: sumeet.gandhi@medportal.ca.
[Ti] Título:Multidisciplinary Heart Failure Clinics Are Associated With Lower Heart Failure Hospitalization and Mortality: Systematic Review and Meta-analysis.
[So] Source:Can J Cardiol;33(10):1237-1244, 2017 Oct.
[Is] ISSN:1916-7075
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Heart failure (HF) clinics (HFCs) are an integral aspect of the strategy for community HF care. METHODS: A systematic search was conducted to retrieve studies. We searched for candidate articles in the PubMed, EMBASE, and Cochrane databases from 1990 to January 2017. RESULTS: We included 16 randomized controlled trials in the meta-analysis with 3999 patients. The HFC group had a lower incidence of the primary composite end point of HF hospitalization and all-cause mortality (odds ratio [OR], 0.58; P = 0.0003). The benefit was maintained when stratified according to non-nurse led HFCs (OR, 0.52; P = 0.003), clinics that followed-up patients ≥ 3 months (OR, 0.51; P = 0.0009), patients with mean ejection fraction ≤ 30% (OR, 0.39; P = 0.02), and ejection fraction > 30% (OR, 0.72; P = 0.02), and patients with recent hospitalization for HF (OR, 0.51; P = 0.0001). There was no benefit in patients who were seen in HFCs with limited follow-up ≤ 3 months (OR, 0.91; P = 0.69), patients with stable HF without recent hospitalization (OR, 0.95; P = 0.70), and studies published after 2008 (OR, 0.89; P = 0.31). Patients in the HFC group had lower HF hospitalization rates (OR, 0.68; P = 0.003), however, no significant difference in all-cause hospitalization (OR, 1.04; P = 0.33). There was lower all-cause mortality in the HFC group (OR, 0.71; P = 0.006). CONCLUSIONS: The results of our analysis show a benefit of HFC to reduce HF hospitalization, and all-cause mortality. This was a cumulative benefit of all randomized clinical trials that assessed the benefit of HFC, with additional analysis showing a greater benefit among patients with recent emergency room visit or hospitalization, and patients seen frequently in follow-up ≥ 3 months.
[Mh] Termos MeSH primário: Unidades de Cuidados Coronarianos/organização & administração
Insuficiência Cardíaca/mortalidade
Insuficiência Cardíaca/terapia
Hospitalização/tendências
[Mh] Termos MeSH secundário: Causas de Morte/tendências
Saúde Global
Seres Humanos
Razão de Chances
Taxa de Sobrevida/tendências
[Pt] Tipo de publicação:JOURNAL ARTICLE; META-ANALYSIS; REVIEW
[Em] Mês de entrada:1709
[Cu] Atualização por classe:171026
[Lr] Data última revisão:
171026
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170816
[St] Status:MEDLINE


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[PMID]:28489130
[Au] Autor:Todo MC; Bergamasco CM; Azevedo PS; Minicucci MF; Inoue RMT; Okoshi MP; Paiva SR; Zornoff LM; Polegato BF
[Ad] Endereço:Medical Student, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista (Unesp), Botucatu, SP, Brazil.
[Ti] Título:Impact of coronary intensive care unit in treatment of myocardial infarction.
[So] Source:Rev Assoc Med Bras (1992);63(3):242-247, 2017 Mar.
[Is] ISSN:1806-9282
[Cp] País de publicação:Brazil
[La] Idioma:eng
[Ab] Resumo:Introduction: : The mortality rate attributed to ST-segment elevation myocardial infarction (STEMI) has decreased in the world. However, this disease is still responsible for high costs for health systems. Several factors could decrease mortality in these patients, including implementation of cardiac intensive care units (CICU). The aim of this study was to evaluate the effect of CICU implementation on prescribed recommended treatments and mortality 30 days after STEMI. Method:: We performed a retrospective study with patients admitted to CICU between 2005 and 2006 (after group) and between 2000 and 2002, before CICU implementation (before group). Results:: The after group had 101 patients, while the before group had 143 patients. There were no differences in general characteristics between groups. We observed an increase in angiotensin-converting enzyme inhibitors, clopidogrel and statin prescriptions after CICU implementation. We did not find differences regarding number of patients submitted to reperfusion therapy; however, there was an increase in primary percutaneous angioplasty compared with thrombolytic therapy in the after group. There was no difference in 30-day mortality (before: 10.5%; after: 8.9%; p=0.850), but prescription of recommended treatments was high in both groups. Prescription of angiotensin-converting enzyme inhibitors and beta-blocker decreased mortality risk by 4.4 and 4.9 times, respectively. Conclusion:: CICU implementation did not reduce mortality after 30 days in patients with STEMI; however, it increased the prescription of standard treatment for these patients.
[Mh] Termos MeSH primário: Unidades de Cuidados Coronarianos/estatística & dados numéricos
Infarto do Miocárdio com Supradesnível do Segmento ST/mortalidade
Infarto do Miocárdio com Supradesnível do Segmento ST/terapia
[Mh] Termos MeSH secundário: Antagonistas Adrenérgicos beta/uso terapêutico
Idoso
Inibidores da Enzima Conversora de Angiotensina/uso terapêutico
Prescrições de Medicamentos/estatística & dados numéricos
Feminino
Mortalidade Hospitalar
Seres Humanos
Modelos Logísticos
Masculino
Meia-Idade
Análise Multivariada
Estudos Retrospectivos
Fatores de Risco
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Adrenergic beta-Antagonists); 0 (Angiotensin-Converting Enzyme Inhibitors)
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170829
[Lr] Data última revisão:
170829
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170511
[St] Status:MEDLINE


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[PMID]:28427574
[Au] Autor:Holland EM; Moss TJ
[Ad] Endereço:Department of Medicine, University of Virginia Health System, Charlottesville, Virginia; Center for Advanced Medical Analytics, University of Virginia Health System, Charlottesville, Virginia. Electronic address: eh7sb@virginia.edu.
[Ti] Título:Acute Noncardiovascular Illness in the Cardiac Intensive Care Unit.
[So] Source:J Am Coll Cardiol;69(16):1999-2007, 2017 Apr 25.
[Is] ISSN:1558-3597
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Fifty years after the inception of the cardiac intensive care unit (CICU), noncardiovascular illnesses have become more prevalent and may contribute to morbidity and mortality. OBJECTIVES: The authors performed multivariate statistical analyses to determine the association of acute noncardiovascular illnesses with outcomes, including length of stay (LOS), mortality, and hospital readmission. METHODS: We studied 1,042 admissions between October 12, 2013 and November 28, 2014 to the CICU at the University of Virginia Health System, a tertiary-care academic medical center. Through systematic inspection of individual charts, we identified primary and secondary diagnoses, vital sign measurements, length of stay (LOS), hospital readmissions, and mortality. RESULTS: The most common primary diagnosis was acute coronary syndrome (25%), which consisted of both non-ST-segment elevation acute coronary syndrome (14%) and ST-segment elevation myocardial infarction (11%). Sepsis was the most frequent noncardiovascular primary diagnosis (5%), but it only occurred in 16% of all admissions. Acute kidney injury and acute respiratory failure each occurred in 30% of admissions. One-half of all admissions (n = 524; 50%) were marked by acute respiratory failure, acute kidney injury, or sepsis. Median LOS in the CICU and the hospital were 2 days (interquartile range [IQR]: 1 to 5 days) and 6 days (IQR: 3 to 11 days). Mortality was 7% in the CICU and 12% in the hospital. Of the 920 patients who survived to hospital discharge, 171 (19%) were readmitted within 30 days. Sepsis, acute kidney injury, and acute respiratory failure were associated with mortality. Acute kidney injury, acute respiratory failure, and new-onset subclinical atrial fibrillation, which occurred in 8% of admissions, were all associated with CICU LOS. CONCLUSIONS: Many patients in the modern CICU have acute noncardiovascular illnesses that are associated with mortality and increased LOS.
[Mh] Termos MeSH primário: Doenças Cardiovasculares/complicações
Unidades de Cuidados Coronarianos/estatística & dados numéricos
[Mh] Termos MeSH secundário: Idoso
Doenças Cardiovasculares/mortalidade
Comorbidade
Feminino
Seres Humanos
Tempo de Internação
Masculino
Meia-Idade
Readmissão do Paciente/estatística & dados numéricos
Virginia/epidemiologia
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1707
[Cu] Atualização por classe:170717
[Lr] Data última revisão:
170717
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170422
[St] Status:MEDLINE


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[PMID]:28287807
[Au] Autor:Raee MR; Nargesi AA; Heidari B; Mansournia MA; Larry M; Rabizadeh S; Zarifkar M; Esteghamati A; Nakhjavani M
[Ad] Endereço:Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
[Ti] Título:All-Cause and Cardiovascular Mortality following Treatment with Metformin or Glyburide in Patients with Type 2 Diabetes Mellitus.
[So] Source:Arch Iran Med;20(3):141-146, 2017 Mar.
[Is] ISSN:1735-3947
[Cp] País de publicação:Iran
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Both metformin and sulfonylurea (SU) drugs are among the most widely-used anti-hyperglycemic medications in patients with type 2 diabetes mellitus (T2DM). Previous studies have shown that treatment with SUs might be associated with decreased survival compared with metformin. This study aimed to evaluate all-cause and cardiovascular mortality rates between glyburide and metformin in patients diagnosed with T2DM. METHODS: This was a cohort study on 717 patients with T2DM (271 undergoing monotherapy with glyburide and 446 with metformin). Data were gathered from 2001 to 2014. All-cause and cardiovascular mortality were end-points. RESULTS: During the follow-up, 24 deaths were identified, of which 13 were cardiovascular in nature. The group with glyburide monotherapy had greater all-cause mortality (17 (6.3%) in glyburide vs. 7 (1.6%) in metformin, P = 0.001) and cardiovascular mortality (11 (4.1%) in glyburide vs. 2 (0.4%) in metformin; P = 0.001). Metformin was more protective than glyburide for both all-cause (HR: 0.27 [0.10 - 0.73] P-value = 0.01) and cardiovascular mortality (HR: 0.12 [0.20 - 0.66], P-value = 0.01) after multiple adjustments for cardiovascular risk factors. Among adverse cardiovascular events, non-fatal MI was higher in glyburide compared to metformin monotherapy group (3.2% vs. 0.8%; P-value = 0.03), but not coronary artery bypass grafting (P-value = 0.85), stenting (P-value = 0.69), need for angiography (P-value = 0.24), CCU admission (P-value = 0.34) or cerebrovascular accident (P-value = 0.10). CONCLUSION: Treatment with glyburide is associated with increased all-cause and cardiovascular mortality in patients with T2DM.
[Mh] Termos MeSH primário: Doenças Cardiovasculares/mortalidade
Diabetes Mellitus Tipo 2/tratamento farmacológico
Glibureto/uso terapêutico
Hipoglicemiantes/uso terapêutico
Metformina/uso terapêutico
[Mh] Termos MeSH secundário: Idoso
Doenças Cardiovasculares/epidemiologia
Causas de Morte
Estudos de Coortes
Angiografia Coronária/utilização
Ponte de Artéria Coronária/utilização
Doença da Artéria Coronariana/diagnóstico por imagem
Doença da Artéria Coronariana/epidemiologia
Doença da Artéria Coronariana/mortalidade
Doença da Artéria Coronariana/cirurgia
Unidades de Cuidados Coronarianos/utilização
Feminino
Seres Humanos
Irã (Geográfico)/epidemiologia
Masculino
Meia-Idade
Infarto do Miocárdio/diagnóstico por imagem
Infarto do Miocárdio/epidemiologia
Infarto do Miocárdio/mortalidade
Fatores de Proteção
Estudos Retrospectivos
Fatores de Risco
Acidente Vascular Cerebral/epidemiologia
Acidente Vascular Cerebral/mortalidade
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Hypoglycemic Agents); 9100L32L2N (Metformin); SX6K58TVWC (Glyburide)
[Em] Mês de entrada:1703
[Cu] Atualização por classe:170322
[Lr] Data última revisão:
170322
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170314
[St] Status:MEDLINE
[do] DOI:0172003/AIM.005


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[PMID]:28284460
[Au] Autor:Chen CC; Chiu IM; Cheng FJ; Wu KH; Li CJ
[Ad] Endereço:Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan.
[Ti] Título:The impact of prolonged waiting time for coronary care unit admission on patients with non ST-elevation acute coronary syndrome.
[So] Source:Am J Emerg Med;35(8):1078-1081, 2017 Aug.
[Is] ISSN:1532-8171
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: The boarding of patients in the emergency department consumes nursing and physician resources, and may delay the evaluation of new patients. It may also contribute to poor cardiovascular outcomes in patients with acute coronary syndrome (ACS). This study analyzed the relationship between the delay in coronary care unit (CCU) admission and the clinical outcomes of patients with ACS with non-ST-segment elevation (NSTE-ACS). METHODS: Patients were divided into 2 groups according to the CCU waiting time (<12h and >12h). Outcome variables including in-hospital mortality, gastrointestinal bleeding and stroke during hospitalization, and duration of hospital stay were compared between the 2 study groups. We used the GRACE risk scores to classify disease severity of the study patients for stratifying analysis. RESULT: A difference was found in the outcome of gastrointestinal bleeding. Among those with GRACE risk scores of <3 (low mortality risk) and 3 (high mortality risk), 5% and 3.1% of patients developed gastrointestinal bleeding, respectively, with CCU waiting time of >12h compared to CCU waiting time of <12h. However, there was no significant statistical difference (P=0.065 and 0.547). In addition, there were no significant differences in the in-hospital mortality rate, incidence of stoke, and duration of hospital stay between the 2 groups. CONCLUSION: There was no significant difference in the clinical outcomes of NSTE-ACS patients without profound shock between those with CCU waiting times of <12 and >12h. If necessary, CCU admission should be prioritized for patients whose hemodynamic instability or respiratory failure.
[Mh] Termos MeSH primário: Síndrome Coronariana Aguda/terapia
Unidades de Cuidados Coronarianos
Hemorragia Gastrointestinal/terapia
Tempo de Internação/estatística & dados numéricos
Admissão do Paciente/estatística & dados numéricos
Acidente Vascular Cerebral/terapia
Tempo para o Tratamento/estatística & dados numéricos
[Mh] Termos MeSH secundário: Síndrome Coronariana Aguda/complicações
Síndrome Coronariana Aguda/mortalidade
Síndrome Coronariana Aguda/fisiopatologia
Idoso
Benchmarking
Eletrocardiografia
Feminino
Hemorragia Gastrointestinal/mortalidade
Hemorragia Gastrointestinal/fisiopatologia
Mortalidade Hospitalar
Hospitalização
Seres Humanos
Masculino
Avaliação de Processos e Resultados (Cuidados de Saúde)
Estudos Retrospectivos
Medição de Risco
Acidente Vascular Cerebral/mortalidade
Acidente Vascular Cerebral/fisiopatologia
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171020
[Lr] Data última revisão:
171020
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170313
[St] Status:MEDLINE


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[PMID]:28262914
[Au] Autor:Hummel J; Rücker G; Stiller B
[Ad] Endereço:Department of Congenital Heart Defects and Pediatric Cardiology, Heart Center, University of Freiburg, Mathildenstr. 1, Freiburg, Germany, 79106.
[Ti] Título:Prophylactic levosimendan for the prevention of low cardiac output syndrome and mortality in paediatric patients undergoing surgery for congenital heart disease.
[So] Source:Cochrane Database Syst Rev;3:CD011312, 2017 Mar 06.
[Is] ISSN:1469-493X
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Low cardiac output syndrome remains a serious complication, and accounts for substantial morbidity and mortality in the postoperative course of paediatric patients undergoing surgery for congenital heart disease. Standard prophylactic and therapeutic strategies for low cardiac output syndrome are based mainly on catecholamines, which are effective drugs, but have considerable side effects. Levosimendan, a calcium sensitiser, enhances the myocardial function by generating more energy-efficient myocardial contractility than achieved via adrenergic stimulation with catecholamines. Thus potentially, levosimendan is a beneficial alternative to standard medication for the prevention of low cardiac output syndrome in paediatric patients after open heart surgery. OBJECTIVES: To review the efficacy and safety of the postoperative prophylactic use of levosimendan for the prevention of low cardiac output syndrome and mortality in paediatric patients undergoing surgery for congenital heart disease. SEARCH METHODS: We identified trials via systematic searches of CENTRAL, MEDLINE, Embase, and Web of Science, as well as clinical trial registries, in June 2016. Reference lists from primary studies and review articles were checked for additional references. SELECTION CRITERIA: We only included randomised controlled trials (RCT) in our analysis that compared prophylactic levosimendan with standard medication or placebo, in infants and children up to 18 years of age, who were undergoing surgery for congenital heart disease. DATA COLLECTION AND ANALYSIS: Two review authors independently extracted data and assessed risk of bias according to a pre-defined protocol. We obtained additional information from all but one of the study authors of the included studies. We used the five GRADE considerations (study limitations, consistency of effect, imprecision, indirectness, and publication bias) to assess the quality of evidence from the studies that contributed data to the meta-analyses for the prespecified outcomes. We created a 'Summary of findings' table to summarise the results and the quality of evidence for each outcome. MAIN RESULTS: We included five randomised controlled trials with a total of 212 participants in the analyses. All included participants were under five years of age. Using GRADE, we assessed there was low-quality evidence for all analysed outcomes. We assessed high risk of performance and detection bias for two studies due to their unblinded setting. Levosimendan showed no clear effect on risk of mortality (risk ratio (RR) 0.47, 95% confidence interval (CI) 0.12 to 1.82; participants = 123; studies = 3) and no clear effect on low cardiac output syndrome (RR 0.64, 95% CI 0.39 to 1.04; participants = 83; studies = 2) compared to standard treatments. Data on time-to-death were not available from any of the included studies.There was no conclusive evidence on the effect of levosimendan on the secondary outcomes. The levosimendan groups had shorter length of intensive care unit stays (mean difference (MD) 0.33 days, 95% CI -1.16 to 1.82; participants = 188; studies = 4; I² = 35%), length of hospital stays (0.26 days, 95% CI -3.50 to 4.03; participants = 75; studies = 2), and duration of mechanical ventilation (MD -0.04 days, 95% CI -0.08 to 0.00; participants = 208; studies = 5; I² = 0%). The risk of mechanical circulatory support or cardiac transplantation favoured the levosimendan groups (RR 1.49, 95% CI 0.19 to 11.37; participants = 60; studies = 2). Published data about adverse effects of levosimendan were limited. A meta-analysis of hypotension, one of the most feared side effects of levosimendan, was not feasible because of the heterogeneous expression of blood pressure values. AUTHORS' CONCLUSIONS: The current level of evidence is insufficient to judge whether prophylactic levosimendan prevents low cardiac output syndrome and mortality in paediatric patients undergoing surgery for congenital heart disease. So far, no significant differences have been detected between levosimendan and standard inotrope treatments in this setting.The authors evaluated the quality of evidence as low, using the GRADE approach. Reasons for downgrading were serious risk of bias (performance and detection bias due to unblinded setting of two RCTs), serious risk of inconsistency, and serious to very serious risk of imprecision (small number of included patients, low event rates).
[Mh] Termos MeSH primário: Baixo Débito Cardíaco/prevenção & controle
Cardiotônicos/uso terapêutico
Cardiopatias Congênitas/cirurgia
Hidrazonas/uso terapêutico
Complicações Pós-Operatórias/prevenção & controle
Piridazinas/uso terapêutico
[Mh] Termos MeSH secundário: Circulação Assistida/estatística & dados numéricos
Baixo Débito Cardíaco/etiologia
Baixo Débito Cardíaco/mortalidade
Unidades de Cuidados Coronarianos/estatística & dados numéricos
Cardiopatias Congênitas/mortalidade
Seres Humanos
Tempo de Internação/estatística & dados numéricos
Complicações Pós-Operatórias/mortalidade
Ensaios Clínicos Controlados Aleatórios como Assunto
Respiração Artificial/estatística & dados numéricos
[Pt] Tipo de publicação:JOURNAL ARTICLE; META-ANALYSIS; REVIEW
[Nm] Nome de substância:
0 (Cardiotonic Agents); 0 (Hydrazones); 0 (Pyridazines); 349552KRHK (simendan)
[Em] Mês de entrada:1707
[Cu] Atualização por classe:170913
[Lr] Data última revisão:
170913
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170307
[St] Status:MEDLINE
[do] DOI:10.1002/14651858.CD011312.pub2


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[PMID]:28034683
[Au] Autor:Carol Ruiz A; Masip Utset J; Ariza Solé A; researchers of the Codi Infart registry of Catalonia
[Ad] Endereço:Servicio de Cardiología, Unidad de Hospitalización, Hospital Moisés Broggi, Consorci Sanitari Integral (CSI), Sant Joan Despí, Barcelona, Spain. Electronic address: 35955acr@comb.cat.
[Ti] Título:Predictors of Late Reperfusion in STEMI Patients Undergoing Primary Angioplasty. Impact of the Place of First Medical Contact.
[So] Source:Rev Esp Cardiol (Engl Ed);70(3):162-169, 2017 Mar.
[Is] ISSN:1885-5857
[Cp] País de publicação:Spain
[La] Idioma:eng; spa
[Ab] Resumo:INTRODUCTION AND OBJECTIVES: The benefit of primary angioplasty may be reduced if there are delays to reperfusion. Identification of the variables associated with these delays could improve health care. METHODS: Analysis of the Codi Infart registry of Catalonia and of the time to angioplasty depending on the place of first medical contact. RESULTS: In 3832 patients analyzed, first medical contact took place in primary care centers in 18% and in hospitals without a catheterization laboratory in 37%. Delays were longer in these 2 groups than in patients attended by the outpatient emergency medical system or by hospitals with a catheterization laboratory (P < .0001, results in median): first medical contact to reperfusion indication time was 42minutes in both (overall 35minutes); first medical contact to artery opening time was 131 and 143minutes, respectively (overall 121minutes); total ischemia time was 230 and 260minutes (overall 215minutes). First medical contact to artery opening time > 120minutes was strongly associated with first medical contact in a center without a catheterization laboratory (OR, 4.96; 95% confidence interval, 4.14-5.93), and other factors such as age, previous coronary surgery, first medical contact during evening hours, nondiagnostic electrocardiogram, and Killip class ≥ III. Mortality at 30 days and 1 year was 5.6% and 8.7% and was independently associated with age, longer delay to angioplasty, Killip class ≥ II, and first medical contact in a center with a catheterization laboratory. CONCLUSIONS: In more than 50% of patients requiring primary angioplasty, the first medical contact occurs in centers without a catheterization laboratory, which is an important predictor of delay from diagnosis to artery opening.
[Mh] Termos MeSH primário: Reperfusão Miocárdica/estatística & dados numéricos
Infarto do Miocárdio com Supradesnível do Segmento ST/mortalidade
Infarto do Miocárdio com Supradesnível do Segmento ST/cirurgia
[Mh] Termos MeSH secundário: Angiografia Coronária/mortalidade
Angiografia Coronária/estatística & dados numéricos
Unidades de Cuidados Coronarianos/estatística & dados numéricos
Serviços Médicos de Emergência/estatística & dados numéricos
Feminino
Seres Humanos
Masculino
Meia-Idade
Reperfusão Miocárdica/mortalidade
Revascularização Miocárdica/mortalidade
Revascularização Miocárdica/estatística & dados numéricos
Transferência de Pacientes/estatística & dados numéricos
Sistema de Registros
Espanha/epidemiologia
Tempo para o Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1707
[Cu] Atualização por classe:170724
[Lr] Data última revisão:
170724
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161231
[St] Status:MEDLINE


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[PMID]:28024550
[Au] Autor:Brunette V; Thibodeau-Jarry N
[Ad] Endereço:Critical Care Department, Hôpital du Sacré-CÅ“ur de Montréal, University de Montréal, Montreal, Québec, Canada; Surgical Department, Montreal Heart Institute, Université de Montréal, Montreal, Québec, Canada. Electronic address: vbrunettemd@gmail.com.
[Ti] Título:Simulation as a Tool to Ensure Competency and Quality of Care in the Cardiac Critical Care Unit.
[So] Source:Can J Cardiol;33(1):119-127, 2017 Jan.
[Is] ISSN:1916-7075
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:Cardiac critical care units are high-risk clinical environments. Medical emergencies are frequent and require the intervention of a cohesive, efficient, and well trained interprofessional team. In modern clinical practice there is increased emphasis on safety but also increased lack of acceptance of medical errors and as a consequence, increased litigation. In the past decade, simulation-based learning has arisen as an effective and safe means to learn and practice acute care setting skills. It has been used and studied in different contexts including procedural skills training, crisis resource management and team training, patient and family member communication skills, and health care system quality improvement. Simulation-based education is a relatively recent teaching strategy and evidence of its efficacy continues to grow. Nevertheless, many influential medical societies are now promoting a simulation-based approach for cardiovascular training and continuing medical education. In this article we review the simulation literature in the intensive care unit and evaluate its integration in coronary care units and postoperative cardiovascular intensive care units. We also provide resources for educators and clinicians who wish to implement simulation workshops in these settings.
[Mh] Termos MeSH primário: Competência Clínica
Simulação por Computador
Unidades de Cuidados Coronarianos
Cuidados Críticos/normas
Educação Médica Continuada/métodos
Garantia da Qualidade dos Cuidados de Saúde
[Mh] Termos MeSH secundário: Seres Humanos
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170809
[Lr] Data última revisão:
170809
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161228
[St] Status:MEDLINE



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