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Right ventricular (RV) dysfunction in cardiac surgery can lead to RV failure, which is associated with increased morbidity and mortality. Abnormal RV function can be identified using RV pressure monitoring. The primary objective of the study is to determine the proportion of patients with abnormal RV early to end-diastole diastolic pressure gradient (RVDPG) and abnormal RV end-diastolic pressure (RVEDP) before initiation and after cardiopulmonary bypass (CPB) separation. The secondary objective is to evaluate if RVDPG before CPB initiation is associated with difficult and complex separation from CPB, RV dysfunction, and failure at the end of cardiac surgery. Prospective study. Tertiary care cardiac institute. Cardiac surgical patients. Cardiac surgery. Automated electronic quantification of RVDPG and RVEDP were obtained. Hemodynamic measurements were correlated with cardiac and extracardiac parameters from transesophageal echocardiography and postoperative complications. Abnormal RVDPG was present in 80% of the patients (n = 105) at baseline, with a mean RVEDP of 14.2 ± 3.9 mmHg. Patients experienced an RVDPG > 4 mmHg for a median duration of 50.2% of the intraoperative period before CPB initiation and 60.6% after CPB separation. A total of 46 (43.8%) patients had difficult/complex separation from CPB, 18 (38.3%) patients had RV dysfunction, and 8 (17%) had RV failure. Abnormal RVDPG before CPB was not associated with postoperative outcome. Elevated RVDPG and RVEDP are common in cardiac surgery. RVDPG and RVEDP before CPB initiation are not associated with RV dysfunction and failure but can be used to diagnose them. [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]

• Nurses need situation awareness to detect early signs of deterioration. • Eye-tracking is a promising alternative to measure nurses' situation awareness. • Before the cardiac arrest, designated nurses focused on the patient and monitor. • Teammates checked the patient and monitor less frequently and more briefly. • Designated nurses had higher situation awareness than teammates. Eye tracking has emerged as a new technology for assessing nurses' visual attention in simulation, but its relationship with situation awareness, a precursor to clinical decision-making, remains to be defined. This study compared role-based situation awareness and visual attention using eye-tracking in simulation. Newly hired nurses participated in a cardiac arrest simulation as part of an orientation program. Eye-tracking data were collected to assess visual attention during the prearrest period. Participants completed a situation awareness questionnaire after the simulation. Data were compared according to participants' roles in the simulation. Results suggest a role-based difference in nurses' visual attention and situation awareness: designated nurses (n = 12) looked at the patient more often, for longer periods and were more aware of signs of patient deterioration than teammates (n = 14). : This study was the first to combine eye-tracking and situation awareness data to compare two nursing roles during a precardiac arrest simulation. The findings also suggest gaps and learning needs in nurses' understanding of signs of patient deterioration and other nontechnical skills. [ABSTRACT FROM AUTHOR]