Early Outcomes of a High PaO2/FiO2 Ratio during Cardiopulmonary Bypass.

Background: In cardiac surgery, supraphysiological oxygen levels are frequently applied perioperatively. In this study, we examined the postoperative effect of perioperative hyperoxemia in cardiac surgery. Methods: All patients who underwent mitral valve replacement via the standard sternotomy method between 2010 and 2021 were analyzed by scanning the hospital data system. The patients were divided into 2 groups: the hyperoxemic group (partial pressure of oxygen/fraction of inspired oxygen [PaO2/FiO2] > 500 mmHg) (Group I) and the normoxemic group (300 mmHg < PaO2/FiO2 < 500 mmHg) (Group II) according to the mean of 3 PaO2/FiO2 values calculated by using 3 PaO2 and 3 FiO2 levels. Postoperative complications, the mechanical ventilation time, the need for noninvasive mechanical ventilator support, the length of intensive care unit (ICU) stay, the hospitalization period, and the mortality rate of the groups were compared. Results: A total of 78 patients were included in the study, and 53 of the patients (67.9%) were female. The mean age of the patients was 58.89±12.60 years. The total mechanical ventilation time was significantly higher in the hyperoxemic group than in Group II (P<0.001) (18.18±12.90 h and 11.45±7.85 h, respectively). The amount of postoperative bleeding was significantly higher in Group I (P=0.003) (539.47±201.74 mL and 417.50±186.93 mL, respectively). The total amount of blood products administered during surgery and ICU stay was higher in Group I (P=0.041) (3.55±1.59 units and 2.87±1.89 units, respectively). Conclusion: We observed that the group with hyperoxemia during cardiopulmonary bypass had a higher amount of postoperative bleeding and the need for transfusion, as well as a longer duration of mechanical ventilation and intensive care.

Blood types (ABO/Rhesus) and SARS-CoV-2 infection: a retrospective, cross-sectional study in 2828 healthcare workers.

Background: The authors aimed to investigate the relationship between ABO/Rhesus blood types and the risk of SARS-CoV-2 infection and hospitalization in healthcare workers (HCWs). Materials & methods: This study compared HCWs with (n = 510) and without (n = 2318) SARS-CoV-2 infection. Risk factors for SARS-CoV-2 infection and hospitalization in HCWs were shown as odds ratios with 95% CI. Results: Blood group O was found to be protective by 20% from the risk of developing SARS-CoV-2 infection in HCWs (29.2 vs 33.8%; odds ratio: 0.808; 95% CI: 0.655-0.996; p = 0.045). The prevalence of group O was lower in hospitalized patients than in outpatients (25 vs 29.5%; p = 0.614). Conclusion: These findings suggest that blood groups are associated with the development of SARS-CoV-2 infection.

Comparison of Demographic Profile, Laboratory, Epidemiology and Clinical Outcomes in Patients with Native Valve and Prosthetic Valve Endocarditis.

BACKGROUND: Infective endocarditis (IE) is a heterogenous infection that affects the endothelial surface of the intracardiac structures and other implanted intracardiac devices. We aimed to compare demographical characteristics, causative microorganisms, treatment, and prognosis of prosthetic and native valve endocarditis diagnosed in two separate hospitals. MATERIAL AND METHODS: Between 2010 and 2020, patients admitted with the diagnosis of IE were retrospectively included in our multicenter study. Patients' demographic and epidemiological data, clinical characteristics, infected intracardiac structure and sort of valve, culprit microorganisms, laboratory findings, treatment manifestations and in-hospital outcomes with a period of 6 months were obtained from an electronic medical record system. RESULTS: A total of 173 consecutive patients had diagnosed IE, 60.1% (104 patients) of them native valve endocarditis (NVE) and 39.8 % (69 patients) of them prosthetic valve endocarditis (PVE).  Baseline demographic properties were not different except hypertension and atrial fibrillation. Patients with prior hypertension were 25% (26 patients) in NVE; 39.1% (27 patients) in PVE and the difference was statistically significant. Septic shock was significantly higher in the PVE group than the NVE group (7.4% versus 1%; P = .036), and also recurrent endocarditis occurred more frequently in the PVE group than the NVE group (8.8% versus 1%; P = .016). CONCLUSION: In our study, although we detected higher mean age, HT, RDW and atrial fibrillation rates compared with NVE, we did not detect a significant difference in mortality and morbidity.

Is malignancy associated with pericardial effusion fluid volume or fluid character?

INTRODUCTION: Pericardial effusion develops due to different etiologies. The main goals of our study are to understand the etiology and determine whether the amount of pericardial effusion is significant in terms of malignancy. MATERIAL AND METHODS: 142 patients with pericardial effusion, who met the criteria between 1 January 2014 and 1 January 2019, were retrospectively analyzed. All of these patients underwent operation with the subxiphoidal approach. The fluid samples were sent to the microbiology and pathology laboratories for evaluation. Patients underwent follow-up after 1 month. RESULTS: Of the patients included in this study, 72 (61%) of 118 patients were operated on under general anesthesia with a laryngeal mask, and 46 (39%) underwent sedation and local anesthesia. The etiologies found in patients were as follows: effusions resulting from malignancy in 27 (22.9%), idiopathic in 24 (20.3%), cardiac causes (depending on the use of anticoagulants or postoperation) in 22 (18.6%), uremia in 20 (16.9%), infection in 18 (15.3%), and heart failure in 7 patients. The amount of fluid drained from the patients was 661.61 ± 458.34 mL. Out of 27 patients with malignancy, 21 (77.8%) had drainage over 500 mL of effusion fluid, and 6 (22.2%) had drainage under 500 mL. Patients who had positive results tended to have drainage over 500 mL compared with patients who had negative results in terms of malignancy (P = .033). CONCLUSION: The subxiphoidal approach to pericardial effusion is an easily applicable operation, whether therapeutic or diagnostic. The advantages of the subxiphoidal approach include drainage of all of the fluid and ease of sampling the pericardial fluid. We believe that the amount of fluid drained can lead us to consider malignancy as an etiology.

Anesthetic Management In Electrophysiology Laboratory: A Multidisciplinary Review.

Many clinical challenges have been encountered in electrophysiology laboratories (EP) while implanting intracardiac defibrillators for lethal arrhythmias, using pacemakers for bradyarrhythmias, placing pacemakers with multiple leads in patients with heart failure and cardiac ablation procedures. In this environment, anesthesiology plays a very critical role to ensure patients comfort, as well as maintains operator's convenience and facilitate management of undesired situations. EP laboratories are mostly used for diagnosis of certain heart diseases. Meanwhile, with the exponential increase in interventional procedures in our decade, electrophysiologists' need to cooperate with the anesthesiologists more frequently. The literature is still unclear about the effects of anesthetic agents on cardiac conduction pathways, but as we know with our previous data, the most agents we are using currently have more or less effect on the cardiac conduction systems. In this review, we aimed to describe the safe anesthesia methods in cardiac diagnostic procedures and have a closer look up the anesthetic outcomes of these procedures. This article comprehensively reviews the anesthesia practice encountered in electrophysiology laboratories.