An obesity paradox of Asian body mass index after cardiac surgery: arterial oxygenations in duration of mechanic ventilation.

BACKGROUND: Numerous studies have documented an obesity paradox that overweight of Caucasian patients has better prognosis after cardiac surgery. This study is to examine Asian patients' BMI to see whether an obesity paradox exists in DMV after cardiac surgery. METHODS: A retrospective study consisted of 428 patients after cardiac surgery from January 2006 to December 2010 in the medical center of Taiwan. The Asian BMI was divided into 3 groups: under-normal weight patients (BMI < 24; n = 165), overweight patients (BMI 24 to <27; n = 130), and obese patients (BMI ≥ 27; n = 133). Multivariable analysis and paired t were used to compare all variables. RESULTS: Overweight patients were significantly associated with the shortest DMV. Under-normal weight patients had significantly better oxygenations of AaDO2 and P/F ratio in the DMV; however, they correlated with the longest DMV, older age, more female, lower LVSV, higher BUN, more dialysis-dependent, and poorer outcomes, namely, 1-year mortality, HAP, reintubation, tracheotomy, and LOS. CONCLUSIONS: Asian overweight patients after cardiac surgery have better prognosis. Under-normal weight patients have higher risk factors, longer DMV, and poorer outcomes; even though they have better arterial oxygenations, they seem to need better arterial oxygenations for successful weaning ventilator.

Utilizing exhaled carbon monoxide measurement with self-declared smoking cessation: enhancing abstinence effectiveness in Taiwanese outpatients.

BACKGROUND: Presently, the Department of Health Taiwan has begun to fund a smoking cessation program, and the annual cessation rate was 8.9% in 2010. This study aims to see whether to enhance abstinence effectiveness by utilizing exhaled carbon monoxide (COExh) measurement with self-declared smoking cessation. METHODS: The longitudinal prospective study gathered 33 subjects on quitting smoking with the motivation to join the grant program in chest outpatient from August 2009 to July 2010. Overall, subjects were given nicotine replacement therapy (NRT) in the first stage, and explored abstinence rate results in evaluation stage. The cutoff point of COExh 6 ppm or less than (≤) and patients' self-declared abstinence reports confirmed a smoking cessation success status. Point abstinences were defined as the smokers refrained from smoking at least 7 days, while continuous abstinences were defined as nonsmoking at least 3, 6 and 12 months. RESULTS: The validities were 198 tracking results for two stages (P < 0.001 vs P < 0.001), and sensitivity (56.5% vs 60.0%), specificity (90.1% vs 82.6%), positive predictive value (63.4% vs 60.0%) and negative predictive value (87.2% vs 82.6%) were detected. Moreover, the validities were 33 results for point and continuous abstinences at 3 month (P < 0.001 vs P < 0.001), and higher successful rates. Point abstinence rates at 3, 6 and 12 months follow-up for overall subjects were 27.2%, 15.2% and 18.1%, respectively. Continuous abstinence rates at 3, 6 and 12 months were 24.2%, 12.1% and 12.1%, respectively. CONCLUSIONS: Utilizing COExh measurement with self-declared smoking cessation enhanced abstinence effectiveness in Taiwanese outpatients.