Rapid recovery management: the effects on the patient who has undergone heart surgery.

OBJECTIVE: To determine whether patients who have undergone heart surgery can be managed with use of rapid recovery guidelines without any subsequent increase in complication, mortality, or readmission rates. DESIGN: Retrospective study, two groups, comparative. SETTING: Private midwestern hospital with 690 licensed beds. SUBJECTS: Group I consisted of 312 adult patients who had undergone heart surgery in 1993 who were managed using traditional methods. Group II consisted of 303 patients who had undergone heart surgery in 1994 who were managed using rapid recovery guidelines. OUTCOME MEASURES: Complications (pneumonia and wound infections), mortality, and readmission rates. RESULTS: Of the surgeries performed in 1994, 44% of the patients were discharged by postoperative day 4. No increase was noted in complication, mortality, and readmission rates. CONCLUSIONS: When compared to patients who were managed by traditional methods, these findings indicated that it is possible to manage adult patients who have undergone heart surgery using rapid recovery guidelines and maintain high-quality patient outcomes and level of satisfaction. In addition, cost savings and decreased resource use are added benefits.

A rapid recovery program for cardiac surgery patients.

Despite a strong national commitment to excellence in healthcare, the available resources are limited. Cardiac surgery consumes more healthcare resources than any other single treatment. It is imperative that healthcare professionals evaluate the traditional methods used to deliver quality care. Rapid recovery programs have been implemented in response to this challenge. The purpose of this article is to discuss development, implementation, and outcome evaluation of a rapid recovery program for cardiac surgery patients in a single health center. A multidisciplinary team examined care before, during, and after surgery, as well as after discharge. The team also evaluated standards of care and CARE Pathways. Changes in protocols were made to prevent the predictable complications of cardiac surgery. A decrease in intubation time, respiratory infections, wound infections, laboratory procedures, length of stay, and costs has been demonstrated. In a follow-up patient and family survey, high satisfaction with nursing care, patient and family education, and length of hospitalization has been voiced. Anticipated goals have been exceeded and improvements in standards continue to be made.

Assessment of host resistance to Trichinella spiralis in mice following preinfection exposure to 2,3,7,8-TCDD.

2,3,7,8-Tetrachlorodibenzo-p-dioxin (TCDD) has been reported to decrease host resistance to a variety of infectious agents when exposure occurs prior to infection. Resistance to viral infection has been observed at doses as low as 0.1 microgram TCDD/kg body wt, well below the thymolytic dose in mice. In the present study, female B6C3F1 mice were exposed to a single intraperitoneal injection of 0, 0.1, 1.0, 10.0, or 30.0 micrograms TCDD/kg 7 days prior to infection to determine the effects of TCDD exposure on resistance to the nematode parasite Trichinella spiralis. Exposure to 10 or 30 micrograms TCDD/kg delayed adult parasite elimination from the small intestine. Significantly more larvae were released by female parasites and greater numbers of encysted larvae were recovered from the muscle of mice exposed to TCDD. Proliferative responses of splenocytes and mesenteric lymph node cells stimulated with T. spiralis antigen were significantly suppressed at exposure levels of TCDD > or = 1.0 microgram/kg 7 days after infection and in splenocytes only at 14 days after infection, demonstrating the greater sensitivity of proliferative responses to TCDD exposure than actual host resistance to Ts infection. Suppressed proliferation was observed at doses which produced TCDD concentrations > or = 0.2 pmol/g of lymphoid tissue on Day 7 of infection. In addition, it was determined that infected mice had higher TCDD levels than noninfected mice given the same dose. These results suggest an interaction between TCDD exposure and infection, i.e., that exposure to TCDD altered the host response to infection, while infection delayed elimination of TCDD from the host.

Assessment of the immunotoxic potential of the fungicide dinocap in mice.

The immunotoxic potential of dinocap was evaluated in female C57BL/6J mice following in vivo and in vitro exposure to this fungicide. In in vivo studies, groups of mice were dosed by gavage with technical grade dinocap at dosages ranging from 12.5 to 50 mg/kg per day for 7 or 12 days and selected immune functions examined. Mice dosed at 50 mg/kg per day dinocap died after 4 days of dosing. Twelve days of dosing with dinocap at 25 mg/kg per day resulted in decreased thymus weights and cellularity, and increased spleen weights. No changes were observed in body weight, absolute differential peripheral leukocyte counts, the lymphoproliferative responses to B- or T-cell mitogens, the mixed lymphocyte reaction, or natural killer (NK) cell activity of spleen cells from mice exposed to dinocap. Lymphoproliferative responses to concanavalin A (Con A) and phytohemagglutinin (PHA), however, were reduced in thymocytes from mice dosed at 25 mg/kg per day dinocap. The cytotoxic T lymphocyte (CTL) response to P815 mastocytoma cells was enhanced in mice exposed for 7 days to 25 mg/kg per day dinocap. Exposure of mice for 7 days to 25 mg/kg per day dinocap also caused a significant reduction in the IgM and IgG plaque-forming cell (PFC) response to sheep red blood cells (SRBC). A time-course study indicated that dinocap-induced suppression of the IgM PFC response was due to a delay in the peak PFC response to SRBC. In vitro studies using murine thymocytes cultured with dinocap (10 micrograms/ml for 72 h) resulted in suppression of the proliferative response to Con A and PHA. Exposure of thymocytes to dinocap in vitro for as little as 30 min resulted in suppression of the mitogen-stimulated response in the absence of any apparent direct cytotoxic effect. These results suggest that dinocap alters the immune system of the mouse, however, these effects are relatively modest in terms of adverse immune function and are only seen at relatively high exposure levels.

Assessment of immune function development in mice irradiated in utero with 2450-MHz microwaves.

Groups of time-bred pregnant mice were irradiated with 2450-MHz microwaves at an incident power density of 28 mW/cm2 for 100 min daily from day 6 to day 18 of pregnancy. The average specific absorption rate (SAR) was 16.5 W/kg. Two experiments were performed under these conditions. At 3 and 6 weeks of age the mice were assessed for development of the primary immune response to sheep erythrocytes, in vitro mitogen-stimulated lymphocyte proliferation, and natural killer (NK) cell activity. No consistent significant difference in the primary immune response, in the mitogen response, or in the NK cell activity was observed between irradiated and sham-irradiated mice.

Assessment of the immune responsiveness of mice irradiated with continuous wave or pulse-modulated 425-MHz radio frequency radiation.

Groups of female BALB/C mice were irradiated with 425-MHz radio frequency (RF) radiation either continuous wave (CW) or pulse modulated (PM, 1-ms pulse width, 250 pulses/s). Mice were irradiated in a rectangular strip-transmission line at average forward powers of 78, 17.7, or 5 W for CW and 17.7, 5, or 1.25 W for PM. The mean specific absorption rate, as measured using twin-well calorimetry was 7.7 W/kg for a forward power of 70 W. No differences in the mitogen-stimulated response of lymphocytes or in the primary antibody response to sheep erythrocytes or polyvinylpyrrolidone were observed between irradiated and sham-irradiated mice, nor between mice exposed to either CW or PM 425-MHz RF radiation.