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Study Objective: To determine the association of practitioner dashboard feedback of intraoperative glycemic and temperature control on maintenance of normoglycemia and normothermia., Design: Retrospective review., Setting: Single tertiary care institution., Patients: Patients over the age of 18 undergoing cardiac surgery from February 17, 2021 through February 16, 2023. During the study interval, 15 anesthesiologists providing care during 2255 procedures were analyzed: 1114 prior to the individual faculty dashboard distribution and 1141 after commencement of dashboard distribution., Interventions: On February 17, 2022, anesthesia faculty members began receiving monthly individualized dashboards indicating their personal intraoperative glycemic and temperature compliance rates., Measurements: Baseline patient demographic characteristics, surgical and cardiopulmonary bypass times, perioperative temperature and glucose concentrations, and the incidence of sternal wound infections. Glycemic compliance was defined as final serum glucose between 80 and 180 mg/dL. Temperature compliance was defined as an average temperature during the final 30 min of the surgical procedure between 35 and 37.3 °C inclusive., Main Results: Dashboard distribution was associated with a significant decrease in the average glucose concentration (median location shift by -6 mg% (95% confidence interval (CI) -8, -4), p < 0.001) from 157 mg/dL to 152 mg/dL and final glucose concentration (median location shift by -17 mg/dL (95% CI -19, -14, p < 0.001) from 161 mg/dL to 145 mg/dL. The intervention was associated with an improvement in glycemic compliance from 71.4% to 87.1% (odds ratio (OR): 2.71(95% CI 2.19, 3.37, p < 0.001)). There were no significant differences in final temperature (36.3 °C [Q1, Q3: 36.0, 36.6] vs. 36.3 °C [Q1, Q3: 36.0, 36.7] (p = 0.232)) with the intervention nor were there any statistically significant differences in temperature compliance (93.9% vs. 92.9%, OR: 0.79 (95% CI 0.55-1.14, p = 0.25). There were no statistically significant changes in the incidence of superficial, deep, or any wound infections with the intervention., Conclusions: Individualized practitioner dashboard distribution may be an effective tool to increase intraoperative glycemic control., Competing Interests: Declaration of competing interest The authors have no financial or personal relationships with other people or organizations that could inappropriately influence or bias this work., (Copyright © 2024 Elsevier Inc. All rights reserved.)

The Society of Cardiovascular Anesthesiologists (SCA) is committed to improving the quality, safety, and value that cardiothoracic anesthesiologists bring to patient care. To fulfill this mission, the SCA supports the creation of peer-reviewed manuscripts that establish standards, produce guidelines, critically analyze the literature, interpret preexisting guidelines, and allow experts to engage in consensus opinion. The aim of this report, commissioned by the SCA President, is to summarize the distinctions among these publications and describe a novel SCA-supported framework that provides guidance to SCA members for the creation of these publications. The ultimate goal is that through a standardized and transparent process, the SCA will facilitate up-to-date education and implementation of best practices by cardiovascular and thoracic anesthesiologists to improve patient safety, quality of care, and outcomes., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2023 International Anesthesia Research Society.)

The lymphatic vasculature regulates lung homeostasis through drainage of fluid and trafficking of immune cells and plays a key role in the response to lung injury in several disease states. We have previously shown that lymphatic dysfunction occurs early in the pathogenesis of chronic obstructive pulmonary disease (COPD) caused by cigarette smoke (CS) and that this is associated with increased thrombin and fibrin clots in lung lymph. However, the direct effects of CS and thrombin on lymphatic endothelial cells (LECs) in COPD are not entirely clear. Studies of the blood vasculature have shown that COPD is associated with increased thrombin after CS exposure that causes endothelial dysfunction characterized by changes in the expression of coagulation factors and leukocyte adhesion proteins. Here, we determined whether similar changes occur in LECs. We used an in vitro cell culture system and treated human lung microvascular lymphatic endothelial cells with cigarette smoke extract (CSE) and/or thrombin. We found that CSE treatment led to decreased fibrinolytic activity in LECs, which was associated with increased expression of plasminogen activator inhibitor 1 (PAI-1). LECs treated with both CSE and thrombin together had a decreased expression of tissue factor pathway inhibitor (TFPI) and increased expression of adhesion molecules. RNA sequencing of lung LECs isolated from mice exposed to CS also showed upregulation of prothrombotic and inflammatory pathways at both acute and chronic exposure time points. Analysis of publicly available single-cell RNA sequencing of LECs as well as immunohistochemical staining of lung tissue from COPD patients supported these data and showed increased expression of inflammatory markers in LECs from COPD patients compared to those from controls. These studies suggest that in parallel with blood vessels, the lymphatic endothelium undergoes inflammatory changes associated with CS exposure and increased thrombin in COPD. Further research is needed to unravel the mechanisms by which these changes affect lymphatic function and drive tissue injury in COPD., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Trivedi, Lu, Summers, Kim, Rhee, Houghton, Byers, Lis and Reed.)

Competing Interests: Disclosures Dr Bangalore serves on the advisory board of Abbott Vascular, Boston Scientific, Biotronik, Amgen, Pfizer, Merck, Reata, Inari, and Truvic. The other authors report no conflicts.

Unprofessional behavior in the procedural arena is associated with worse patient outcomes. This is thought to be due to breakdowns in communication structures and team dynamics. Behavioral issues are often uncovered during the investigation of serious event reports. Understanding differences in behavior deviations enables leadership to best address each type with an appropriate response. This allows institutions to address reckless behavior and unprofessionalism, while concomitantly creating a culture that fosters trust to promote self-reporting and sharing of information. These are characteristics of high-reliability organizations that produce sustained excellence in patient outcomes., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Background: Electrocardiography (ECG) electrodes require special expiration tracking after the manufacturer's packaging is opened. Compliance with this requirement, however, can be inconsistent. The authors tested the efficacy of a device that provides for expiration tracking of bulk-packaged electrodes to improve compliance., Methods: The device tested is a bin with an automated countdown timer that could be used for storing and dispensing open ECG electrodes. Seven operating rooms were inspected three times each before and after implementation of the device. Compliance with expiration dating of open electrodes was recorded for each inspection., Results: Compliance was found in 3 of the 21 (14.3%) baseline inspections. Following implementation of the devices, compliance was found in 20 of 21 (95.2%) inspections. This increase in compliance was statistically significant (p < 0.01)., Conclusion: A storage and dispensing device with automated countdown timer significantly improved compliance with expiration dating regulations for bulk-packaged ECG electrodes. It also has the potential to reduce supply cost, packaging waste, and inconvenience compared with individually wrapped electrodes., (Copyright © 2023 The Joint Commission. Published by Elsevier Inc. All rights reserved.)