Search

Cardiac surgery associated-acute kidney injury is a common and serious postoperative complication of cardiac surgery, which is associated with increased postoperative morbidity and mortality. This study aimed to explore the association between cardiopulmonary bypass (CPB) blood flow rate (BFR), and major adverse kidney events (MAKEs) at day 30. Retrospective single-center before–after observational study. Patients were divided in 2 groups according to CPB flow rates: a first group with an institutional protocol targeting a CPB-BFR of >2.2 L/min/m² (low CPB-BFR group), and a second group with a modified institutional protocol targeting a CPB-BFR of >2.4 L/min/m² (high CPB-BFR group). The primary outcome was MAKE at 30 days, defined as the composite of death, renal replacement therapy or persistent renal dysfunction. The data were collected from clinical routines in university hospital. Adult patients who underwent elective and urgent cardiac surgery without severe chronic renal failure, for whom CPB duration was ≥90 minutes. We included 533 patients (low CPB-BFR group, n = 270; high CPB-BFR group, n = 263). A significant decrease in MAKE at 30 days was observed in the high CPB-BFR group (3% v 8%; odds ratio [OR], 0.779; 95% confidence interval [CI], 0.661-0.919; p < 0.001) mainly mediated by a lower 30-day mortality in the high CPB-BFR group (1% v 5%; OR, 0.697; 95% CI, 0.595-0.817; p = 0.001), as was renal replacement therapy (1% v 4%; OR, 0.739; 95% CI, 0.604-0.904; p = 0.016). In patients undergoing cardiac surgery, increased CPB-BFR was associated with a decrease in MAKE at 30 days including mortality and renal replacement therapy. [Display omitted] [ABSTRACT FROM AUTHOR]

• VA ECMO is a treatment option for refractory cardiogenic shock and cardiac arrest. • Lower limb ischemia (LLI) could represent a complication of femoral VA ECMO. • Surgical femoral VA ECMO is associated with a low rate of LLI. • LLI does not result into an increased risk of in-hospital mortality. • Female sex is an independent risk factor of LLI. To analyze the incidence, clinical impact on survival, and risk factors of lower limb ischemia (LLI) of surgical peripheral femoral venoarterial extracorporeal membrane oxygenation (VA ECMO) in the current era. A retrospective analysis of the authors' institutional database of VA ECMO was performed. Patients were divided into 2 groups according to the occurrence of LLI. The primary endpoint was survival to hospital discharge. Risk factors of LLI were searched with multivariate analyses. University hospital. Adult patients receiving peripheral VA ECMO for refractory cardiogenic shock and cardiac arrest. None. From January 2018 to December 2021, 188 patients (mean age: 52.0 ± 14.1 years; 63.8% male, 36.2% female) received peripheral VA ECMO. Male sex was more prevalent in the group without LLI (65.9% v 33.3%; p = 0.031). Twelve (6.4%) patients developed LLI during VA ECMO support (n = 6) or after VA ECMO removal (n = 6). Survival to hospital discharge was not statistically different between patients with and without LLI (50.0% v 48.3%; p = 0.571). Female sex patients were at increased risk for LLI (odds ratio 4.38, 95% CI 1.21-15.81; p = 0.024). Peripheral femoral VA ECMO through a surgical approach is associated with a low LLI rate, which does not increase the risk of in-hospital mortality. The female sex is an independent risk factor for LLI. [Display omitted] [ABSTRACT FROM AUTHOR]

The aortic-to-radial arterial pressure gradient is described during and after cardiopulmonary bypass (CPB), and can lead to underestimating arterial blood pressure. The authors hypothesized that central arterial pressure monitoring would be associated with lower norepinephrine requirements than radial arterial pressure monitoring during cardiac surgery. An observational prospective cohort with propensity score analysis. At a tertiary academic hospital's operating room and intensive care unit (ICU). A total of 286 consecutive adult patients undergoing cardiac surgery with CPB (central group: 109; radial group: 177) were enrolled and analyzed. To explore the hemodynamic effect of the measurement site, the authors divided the cohort into 2 groups according to a femoral/axillary (central group) or radial (radial group) site of arterial pressure monitoring. The primary outcome was the intraoperative amount of norepinephrine administered. Secondary outcomes included norepinephrine-free hours and ICU-free hours at postoperative day 2 (POD2). A logistic model with propensity score analysis was built to predict central arterial pressure monitoring use. The authors compared demographic, hemodynamic, and outcomes data before and after adjustment. Central group patients had a higher European System for Cardiac Operative Risk Evaluation. (EuroSCORE) compared to the radial group—7.9 ± 14.0 versus 3.8 ± 7.0, p < 0.001. After adjustment, both groups had similar patient EuroSCORE and arterial blood pressure levels. Intraoperative norepinephrine dose regimens were 0.10 ± 0.10 µg/kg/min in the central group and 0.11 ± 0.11 µg/kg/min in the radial group (p = 0.519). Norepinephrine-free hours at POD2 were 38 ± 17 hours versus 33 ± 19 hours in central and radial groups, respectively (p = 0.034). The ICU-free hours at POD2 were greater in the central group: 18 ± 13 hours versus 13 ± 13 hours, p = 0.008. Adverse events were less frequent in the central group than in the radial group—67% versus 50%, p = 0.007. No differences in the norepinephrine dose regimen were found according to the arterial measurement site during cardiac surgery. However, norepinephrine use and length of stay in the ICU were shorter, and adverse events were decreased when central arterial pressure monitoring was used. [ABSTRACT FROM AUTHOR]

The ProCCard study tested whether combining several cardioprotective interventions would reduce the myocardial and other biological and clinical damage in patients undergoing cardiac surgery. Prospective, randomized, controlled trial. Multicenter tertiary care hospitals. 210 patients scheduled to undergo aortic valve surgery. A control group (standard of care) was compared to a treated group combining five perioperative cardioprotective techniques: anesthesia with sevoflurane, remote ischemic preconditioning, close intraoperative blood glucose control, moderate respiratory acidosis (pH 7.30) just before aortic unclamping (concept of the "pH paradox"), and gentle reperfusion just after aortic unclamping. The primary outcome was the postoperative 72-h area under the curve (AUC) for high-sensitivity cardiac troponin I (hsTnI). Secondary endpoints were biological markers and clinical events occurring during the 30 postoperative days and the prespecified subgroup analyses. The linear relationship between the 72-h AUC for hsTnI and aortic clamping time, significant in both groups (p < 0.0001), was not modified by the treatment (p = 0.57). The rate of adverse events at 30 days was identical. A non-significant reduction of the 72-h AUC for hsTnI (−24%, p = 0.15) was observed when sevoflurane was administered during cardiopulmonary bypass (46% of patients in the treated group). The incidence of postoperative renal failure was not reduced (p = 0.104). This multimodal cardioprotection has not demonstrated any biological or clinical benefit during cardiac surgery. The cardio- and reno-protective effects of sevoflurane and remote ischemic preconditioning therefore remain to be demonstrated in this context. [ABSTRACT FROM AUTHOR]

Postoperative atrial fibrillation (POAF) is a major complication after cardiac surgery, and an early postoperative introduction of beta-blockers is recommended to reduce its incidence. Landiolol, a new intravenous short-acting beta-1 blocker, could present a useful and safe macrohemodynamic profile after cardiac surgery. Detailed metabolic and hemodynamic effects of landiolol on cardiac performance, however, remain poorly documented. The authors aimed to investigate the dose-dependent hemodynamic and metabolic effects of landiolol in that specific setting. A prospective, randomized, double-blind study versus placebo. A tertiary university hospital. Adult patients scheduled for elective cardiac surgery with cardiopulmonary bypass. Incremental doses of intravenous landiolol (0.5, 1, 2, 5, and 10 μg/kg/min) were given within the 2 hours after arrival in the intensive care unit. Macrocirculatory parameters and cardiac performances were derived from transpulmonary thermodilution and transthoracic echocardiography. Metabolic data were obtained from arterial blood tests. From January to November 2019, 58 patients were analyzed and divided into a landiolol group (n = 30) and a control group (n = 28). Heart rate significantly decreased in the landiolol group (p < 0. 01), whereas mean arterial pressure and stroke volume remained unchanged. No significant modification was found in both left and right systolic and diastolic performances. Metabolic variables were similar in both groups. New-onset POAF occurred in 9 (32%) versus 5 (17%) patients in the control and landiolol groups, respectively (p = 0. 28). Infusion of landiolol in the range of 0.5-to-10 μg/kg/min during the early postoperative period presents a good macrohemodynamic safety profile in cardiac surgical patients and could be useful to prevent POAF. [ABSTRACT FROM AUTHOR]

Postoperative atrial fibrillation (POAF) is a major complication after cardiac surgery, and an early postoperative introduction of beta-blockers is recommended to reduce its incidence. Landiolol, a new intravenous short-acting beta-1 blocker, could present a useful and safe macrohemodynamic profile after cardiac surgery. Detailed metabolic and hemodynamic effects of landiolol on cardiac performance, however, remain poorly documented. The authors aimed to investigate the dose-dependent hemodynamic and metabolic effects of landiolol in that specific setting. A prospective, randomized, double-blind study versus placebo. A tertiary university hospital. Adult patients scheduled for elective cardiac surgery with cardiopulmonary bypass. Incremental doses of intravenous landiolol (0.5, 1, 2, 5, and 10 μg/kg/min) were given within the 2 hours after arrival in the intensive care unit. Macrocirculatory parameters and cardiac performances were derived from transpulmonary thermodilution and transthoracic echocardiography. Metabolic data were obtained from arterial blood tests. From January to November 2019, 58 patients were analyzed and divided into a landiolol group (n = 30) and a control group (n = 28). Heart rate significantly decreased in the landiolol group (p < 0. 01), whereas mean arterial pressure and stroke volume remained unchanged. No significant modification was found in both left and right systolic and diastolic performances. Metabolic variables were similar in both groups. New-onset POAF occurred in 9 (32%) versus 5 (17%) patients in the control and landiolol groups, respectively (p = 0. 28). Infusion of landiolol in the range of 0.5-to-10 μg/kg/min during the early postoperative period presents a good macrohemodynamic safety profile in cardiac surgical patients and could be useful to prevent POAF. [ABSTRACT FROM AUTHOR]

• Out-of-hospital cardiac arrest still represents a public health issue • Extracorporeal cardiopulmonary resuscitation (ECPR) could represent a rescue therapy • Optimal patient selection is of utmost importance to avoid futile implantations • Sustained shockable rhythm yielded a survival advantage in ECPR candidates To analyze the impact of the modification of the authors' institutional protocol on outcomes after extracorporeal cardiopulmonary resuscitation (ECPR) for out-of-hospital cardiac arrest (OHCA). An observational analysis. The protocol complied with national recommendations. A further eligibility criterion was added since January 2015: the presence of sustained shockable rhythm at extracorporeal life support (ECLS) implantation. To assess the impact of this change, patients were divided into two groups: (1) from January 2010 to December 2014 (group A) and (2) from January 2015 to December 2019 (group B). The primary endpoint was survival to hospital discharge with good neurologic outcome. Predictors of survival were searched with multivariate analyses. University hospital. Adult patients supported with ECPR for refractory OHCA. None. From January 2010 to December 2019, 85 patients had ECLS for OHCA (group A, n = 68, 80%; group B, n = 17, 20%). The mean age was 42.4 years, 78.8% were male. The rate of implantation of ECLS was significantly lower in group B (p = 0.01). Mortality during ECLS support was significantly lower (58.8 v 86.8%; p = 0.008), and the weaning rate was significantly higher (41.2 v 13.2%; p = 0.008) in group B. Survival to discharge with good neurologic outcome was significantly improved (23.5 v 4.4%; p = 0.027) in group B. A sustained shockable rhythm was the only independent predictor of survival to hospital discharge with good neurologic outcome. The modification of the authors' institutional protocol throughout the further criterion of sustained shockable rhythm yielded a favorable impact on outcomes after ECPR for OHCA. [Display omitted] [ABSTRACT FROM AUTHOR]

Hemodynamic conditions with reduced systemic vascular resistance commonly are observed in patients undergoing cardiac surgery and may range from moderate reductions in vascular tone, as a side effect of general anesthetics, to a profound vasodilatory syndrome, often referred to as vasoplegic shock. Therapy with vasopressors is an important pillar in the treatment of these conditions. There is limited guidance on the appropriate choice of vasopressors to restore and optimize systemic vascular tone in patients undergoing cardiac surgery. A panel of experts in the field convened to develop statements and evidence-based recommendations on clinically relevant questions on the use of vasopressors in cardiac surgical patients, using a critical appraisal of the literature following the GRADE system and a modified Delphi process. The authors unanimously and strongly recommend the use of norepinephrine and/or vasopressin for restoration and maintenance of systemic perfusion pressure in cardiac surgical patients; despite that, the authors cannot recommend either of these drugs with respect to the risk of ischemic complications. The authors unanimously and strongly recommend against using dopamine for treating post-cardiac surgery vasoplegic shock and against using methylene blue for purposes other than a rescue therapy. The authors unanimously and weakly recommend that clinicians consider early addition of a second vasopressor (norepinephrine or vasopressin) if adequate vascular tone cannot be restored by a monotherapy with either norepinephrine or vasopressin and to consider using vasopressin as a first-line vasopressor or to add vasopressin to norepinephrine in cardiac surgical patients with pulmonary hypertension or right-sided heart dysfunction. [ABSTRACT FROM AUTHOR]

Withdrawn in the early 2000s, aprotinin marketing authorization was reinstated by European Medicines Agency with a restrictive indication (isolated coronary artery bypass graft surgery, iCABG) and a safety registry (NAPaR) (1). This regsitry intended to record the pattern of use of aprotinin and to determine patient safety. It was terminated without safety signals associated with the product (2). Two aprotinin regimens were allowed: full-dose (FD) and half-dose (HD). Our objective was to compare efficacy and safety of each regimen in patients undergoing cardiac surgery with cardiopulmonary bypass. Between February 2016 and August 2022, 6730 adult patients were treated with aprotinin across 9 European countries (Germany, Austria, Belgium, France, Ireland, Norway, United Kingdom and Sweden) and were included in the registry Among the 1549 patients treated on-label (iCABG), 643 (42%) received the FD regimen and 906 (58%) the HD. Less thromboembolic events (0,5% vs 2,8%; P<0,001) and fibrinogen transfusion, but more platelets and cryoprecipitate were reported in the FD group (Table). Among the 5181 patients treated off-label (ascending aorta surgery, single or complex valves replacement, transplant), 2318 (45%) received the FD and 2863 (55%) the HD. Less mortality (5,4% vs 9,4%; P<0,001), thromboembolic events (1,4% vs 2,9%; P<0,001), renal events (14,8% vs 18,1%; P=0,002), reoperation for bleeding (5,2% vs 10,3%; P<0,001) and fibrinogen transfusion were reported in the FD group, in association with a rise in transfusion needs (platelets and cryoprecipitate). Regardless of the surgery, the FD of aprotinin, in comparison with the HD regimen, was associated with less postoperative TEE. Concerning aprotinin use in off-label high bleeding risk surgery, FD regimen was also associated with a decrease in postoperative mortality, reoperation for bleeding and renal dysfunction. To confirm these results, a multivariate analysis will be carried out on propensity-matched sets of HD and FD treated subjects. A large multicenter randomized trial is expected to consolidate the potential benefits of routine use of FD aprotinin in cardiac surgery patients. [ABSTRACT FROM AUTHOR]

Objective Little is known about changes in near-infrared spectroscopy-derived tissue hemoglobin index (HbI). The authors tested the hypothesis that absolute values and changes in brain hemoglobin index (HbI b ) and skeletal muscle hemoglobin index (HbI m ) could differ from the reference arterial hemoglobin (Hb) during fluid challenge. Design A prospective, monocenter observational study. Setting A 16-bed cardiac surgical intensive care unit in a teaching university hospital. Participants Fifty consecutive adult patients. Interventions Investigation before and after a fluid challenge. Measurements and Main Results Simultaneous comparative Hb, HbI b and HbI m data points were collected from a blood-gas analyzer and the EQUANOX device (Nonin Medical Inc., Plymouth, MN). Correlations were determined by linear regression. No significant relationship was found between absolute values of Hb and HbI b before ( R 2 = 0.04, p = 0.627) and after ( R 2 = 0.00006, p = 0.956) fluid challenge. No significant relationship was found between absolute values of Hb and HbI m before ( R 2 = 0.030, p = 0.226) and after ( R 2 = 0.05, p = 0.117) the fluid challenge. No significant relationship was found between changes in Hb and HbI b ( R 2 = 0.26, p = 0.263) and between changes in Hb and HbI m ( R 2 = 0.001, p = 0.801) after the fluid challenge. Bland-Altman analysis showed a poor concordance between changes in Hb and HbI b , and changes in Hb and HbI m, with large limits of agreement. Conclusions HbI b and HbI m cannot be used to provide continuous noninvasive estimation of Hb, and trends in HbI b and HbI m cannot be considered as noninvasive surrogates for the trend in Hb after cardiac surgery. [ABSTRACT FROM AUTHOR]

Objective To evaluate the impact of a simple written algorithm of early postoperative beta-blocker administration on daily practices. Design A prospective, single center observational study. Setting A 16-bed cardiac surgical intensive care unit in a university teaching hospital. Patients One hundred twenty-five consecutive adult patients chronically treated with beta-blockers and scheduled for conventional cardiac surgery. Interventions Two successive 4-month phases: Phase 1 = uncontrolled early postoperative beta-blocker administration (n = 73) and phase 2 = beta-blocker administration by an institutional written algorithm using incremental doses of bisoprolol and/or esmolol (n = 52). Measurements and Main Results The main endpoint was the number of patients receiving beta-blockers on the morning of postoperative day 1. Secondary endpoints were the number of patients receiving beta-blockers on the morning of postoperative day 1 and reaching the targeted therapeutic goal and the incidence of postoperative atrial fibrillation in the intensive care unit. A 79% increase in the number of patients receiving beta-blockers on the morning of postoperative day 1 (42% v 75%, p<0.001) was observed during the second phase of the study. The number of patients receiving beta-blockers on the morning of postoperative day 1 and reaching the targeted therapeutic goal was increased significantly by 127% (33% v 75%, p<0.001). The incidence of atrial fibrillation was similar between both phases of the study: 37% versus 31%, p = 0.567. Conclusions A simple written algorithm markedly improved early postoperative continuation of beta-blockers in chronically treated patients undergoing conventional cardiac surgery. [ABSTRACT FROM AUTHOR]

Objectives: Arterial pulse pressure variation (PPV) and digital plethysmographic variability index (PVI) have been proposed to predict fluid responsiveness during anesthesia and in critically ill patients. The present study aimed to compare the clinical utility of PPV and PVI in predicting fluid responsiveness after elective cardiac surgery. Design: A prospective observational study. Setting: A university hospital. Participants: Eighty-seven adult patients. Interventions: Admission to the intensive care unit after cardiac surgery. Investigation before and after fluid challenge. Measurements and Main Results: The discrimination of both PPV and PVI in predicting fluid responsiveness was compared by using areas under the receiver operating characteristics curves (ROCAUC). Sensibility analyses were conducted after exclusion of patients with a low perfusion index, patients receiving norepinephrine, and patients with right ventricular dysfunction. Fifty-seven (71%) patients were responders and twenty-three (29%) were nonresponders. ROCAUC were 0.73 [95% CI: 0.63-0.83] versus 0.60 [95% CI: 0.48-0.71] for PPV and PVI in the whole cohort of patients, respectively (p = 0.020). The inconclusive class of responses included 47 (59%) and 62 (77%) patients, respectively (p = 0.010); whereas the discrimination of PVI remained low whatever the subgroup of patients, the discrimination of PPV markedly increased in patients without perfusion index≤1.3 (ROCAUC = 0.83 [95% CI: 0.68-0.93]) and in patients without right ventricular dysfunction (ROCAUC = 0.85 [95% CI: 0.67-0.95]). Conclusions: PVI is not discriminant and probably inaccurate to predict fluid responsiveness after elective cardiac surgery. PPV could be of potential interest after exclusion of patients with a low perfusion index and right ventricular dysfunction. [Copyright &y& Elsevier]

Objective: Little is known about changes in near-infrared spectroscopy (NIRS)-derived cerebral (rSO2b) and somatic (rSO2s) oxygen saturation during a fluid challenge. The authors tested the hypothesis that they could differ from central venous oxygen saturation (ScvO2) and from one site to another. Design: A prospective observational study. Setting: A teaching university hospital. Participants: Fifty consecutive adult patients. Interventions: Admission to the intensive care unit after cardiac surgery and investigation before and after a fluid challenge. Measurements and Main Results: Simultaneous comparative ScvO2, rSO2b, and rSO2s data points were collected from a blood-gas analyzer and the EQUANOX monitor (Nonin Medical, Inc, Plymouth, MN). Correlations were determined by linear regression. Multiple stepwise linear regression models were used to assess independent variables associated with changes in ScvO2, rSO2b, and rSO2s. A statistically significant relationship was found between absolute values of ScvO2 and rSO2b (r = 0.42, p < 0.001) but not between absolute values of ScvO2 and rSO2s (r = 0.18, p = 0.066). No relationship was found between percent changes in ScvO2 and rSO2b (r = 0.05, p = 0.715) and between percent changes in ScvO2 and rSO2s (r = 0.02, p = 0.886) after the fluid challenge. Cardiac index contributed to the prediction of changes in ScvO2 (regression coefficient = −4.09, p = 0.006), whereas the mean arterial pressure contributed to the prediction of changes in rSO2b (regression coefficient = −0.05, p = 0.027). Conclusions: rSO2b and rSO2s cannot be used to provide noninvasive estimation of ScvO2, and trends in rSO2b and rSO2s cannot be considered as noninvasive surrogates for the trend in ScvO2 after cardiac surgery. Different independent variables contribute to the prediction of ScvO2, rSO2b, and rSO2s. [Copyright &y& Elsevier]

Objectives: The influence of the cardiac surgical procedure on B-type natriuretic peptide (BNP) for the identification of high-risk patients has not been evaluated. This study aimed to compare the prognostic utility of pre- and postoperative BNP in predicting adverse long-term outcome after coronary artery bypass graft (CABG) surgery and aortic valve replacement (AVR). Design: A retrospective study. Setting: A university teaching hospital. Participants: One hundred eighty-nine patients. Measurements and Main Results: Preoperative, early postoperative (24 hours), and late postoperative (day 5) BNP levels were measured. Major adverse cardiac events (MACEs) within 12 months after surgery were chosen as study endpoints. The predictive abilities of BNP measurements were compared using receiver operating characteristic (ROC) curves. Patients were stratified by CABG surgery (n = 100) and AVR (n = 89). Thirty-four (18%) patients experienced 44 MACEs over the study period. Preoperative BNP values were significantly different between groups. Postoperative BNP gradually increased by 431% on day 5 after CABG surgery and by 100% after AVR (both p < 0.001 v preoperative values). Pre- and early postoperative BNP values were accurate in predicting MACEs after AVR (areas under the ROC curves: 0.78 [95% confidence interval, 0.66-0.90] and 0.76 [95% confidence interval, 0.62-0.89], respectively) and inaccurate after CABG surgery (0.54 [95% confidence interval, 0.38-0.70] and 0.54 [95% confidence interval, 0.36-0.73], respectively). The late postoperative BNP value was of limited value. Conclusions: BNP measurements should take into account the type of cardiac surgery. Whatever the time of measurement, BNP accurately predicts long-term adverse outcome in valve surgery patients. A late postoperative BNP measurement is useless after cardiac surgery. [Copyright &y& Elsevier]

Objectives: The authors hypothesized that bioimpedance cardiography measured by the Endotracheal Cardiac Output Monitor (ECOM; ConMed, Utica, NY) is a convenient and reliable method for both cardiac index (CI) assessment and prediction in fluid responsiveness. Design: A prospective observational study. Setting: A teaching university hospital. Participants: Twenty-five adult patients. Interventions: Admission to the intensive care unit after conventional cardiac surgery and investigation before and after a fluid challenge. Measurements and Main Results: Simultaneous comparative CI data points were collected from transpulmonary thermodilution (TD) and ECOM. Correlations were determined by linear regression. Bland-Altman analysis was used to compare the bias, precision, and limits of agreement. The percentage error was calculated. Pulse-pressure variations (PPVs) and stroke-volume variations (SVVs) before fluid challenge were collected to assess their discrimination in predicting fluid responsiveness. A weak but statistically significant relationship was found between CITD and CIECOM (r = 0.31, p = 0.03). Bias, precision, and limits of agreement between CITD and CIECOM were 0.08 L/min/m2 (95% confidence interval, −0.11 to 0.27), 0.68 L/min/m2, and −1.26 to 1.42 L/min/m2, respectively. The percentage error was 51%. A nonsignificant positive relationship was found between percent changes in CITD and CIECOM after fluid challenge (r = 0.37, p = 0.06). Areas under the ROC curves for both PPV and SVV to predict fluid responsiveness were 0.86 (95% confidence interval, 0.67-1.06) and 0.89 (95% confidence interval, 0.74-1.04, respectively; p = 0.623). Conclusions: Continuous measurements of CI under dynamic conditions are consistent and easy to obtain with ECOM although not interchangeable with transpulmonary thermodilution. SVV given by ECOM is a dynamic parameter that predicts fluid responsiveness with good accuracy and discrimination. [Copyright &y& Elsevier]

Objectives: Although B-type natriuretic peptide (BNP) strongly predicts cardiac morbidity and mortality, the European System for Cardiac Operative Risk Evaluation (EuroSCORE) has a modest predictive value to identify a composite operative risk after cardiac surgery. The authors tested the hypothesis that a single preoperative BNP measurement would be superior to standard EuroSCORE in predicting composite adverse outcomes after cardiac surgery. Design: A prospective observational study. Setting: A teaching university hospital. Participants: Two hundred eight adult patients. Interventions: Conventional cardiac surgery with cardiopulmonary bypass. Measurements and Main Results: The preoperative additive EuroSCORE and BNP measurement were performed in all patients. Postoperative nonfatal major adverse cardiac events (malignant ventricular arrhythmia, myocardial infarction, and cardiac dysfunction), all-cause mortality, and prolonged lengths of stay were chosen as study endpoints. Predictive abilities of both EuroSCORE and BNP were assessed using logistic regression and compared with receiver operating characteristic (ROC) curves. Thirty-six (17%, 95% confidence interval [CI], 12%-22%) patients experienced 49 events over the study period. The areas under the ROC curves assessing the utility of EuroSCORE and BNP in predicting adverse outcome and prolonged in-hospital stay were 0.59 (95% CI, 0.48-0.69) versus 0.76 (95% CI, 0.68-0.85; p < 0.001) and 0.65 (95% CI, 0.57-0.74) versus 0.71 (95% CI, 0.63-0.80; p = 0.147), respectively. Using logistic regression, BNP considered as a dichotomized variable was the only independent predictor of adverse cardiac outcome (adjusted odds ratio = 10.7; 95% CI, 4.1-27.8; p < 0.001). Conclusions: Preoperative BNP measurement is a strong, independent, and more accurate predictor of adverse outcome than EuroSCORE in patients undergoing cardiac surgery. BNP could be considered as a simple and objective tool for the detection of high-risk patients after cardiac surgery. [Copyright &y& Elsevier]