Early clinical outcomes of two regimens of prophylactic antibiotics in cardiac surgical patients with delayed sternal closure

BACKGROUND Delayed sternal closure(DSC)can be a lifesaving approach for certain patients who have undergone cardiac surgery.The value of the type of prophylactic antibiotics in DSC is still debatable.AIM To investigate clinical outcomes of different prophylactic antibiotic regimens in patients who had DSC after cardiac surgery.METHODS This was a retrospective observational single-center study.Fifty-three consecutive patients who underwent cardiac surgery and had an indication for DSC were included.Patients were subjected to two regimens of antibiotics:Narrow-spectrum and broad-spectrum regimens.RESULTS The main outcome measures were length of hospital and intensive care unit(ICU)stay,duration of mechanical ventilation,and mortality.Of the 53 patients,12(22.6%)received narrow-spectrum antibiotics,and 41(77.4%)received broad-spectrum antibiotics.The mean age was 59.0±12.1 years,without significant differences between the groups.The mean duration of antibiotic use was significantly longer in the broad-spectrum than the narrowspectrum group(11.9±8.7 vs 3.4±2.0 d,P<0.001).The median duration of open chest was 3.0(2.0-5.0)d for all patients,with no difference between groups(P=0.146).The median duration of mechanical ventilation was significantly longer in the broad-spectrum group[60.0(Δinterquartile range(IQR)170.0)h vs 50.0(ΔIQR 113.0)h,P=0.047].Similarly,the median length of stay for both ICU and hospital were significantly longer in the broadspectrum group[7.5(ΔIQR 10.0)d vs 5.0(ΔIQR 5.0)d,P=0.008]and[27.0(ΔIQR 30.0)d vs 19.0(ΔIQR 21.0)d,P=0.031].Five(9.8%)patients were readmitted to the ICU and 18(34.6%)patients died without a difference between groups.CONCLUSION Prophylactic broad-spectrum antibiotics did not improve clinical outcomes in patients with DSC post-cardiac surgery but was associated with longer ventilation duration,length of ICU and hospital stays vs narrow-spectrum antibiotics.

Impact of COVID-19 pandemic on liver,liver diseases,and liver transplantation programs in intensive care units

Emerging worldwide data have been suggesting that coronavirus disease 2019(COVID-19)pandemic consequences are not limited to the respiratory and cardiovascular systems but encompass adverse gastrointestinal manifestations including acute liver injury as well.Severe cases of liver injury associated with higher fatality rates were observed in critically ill patients with COVID-19.Intensive care units(ICU)have been the center of disposition of severe cases of COVID-19.This review discusses the pathogenesis of acute liver injury in ICU patients with COVID-19,and analyzes its prevalence,consequences,possible drug-induced liver injury,and the impact of the pandemic on liver diseases and transplantation programs.

Chest radiography requirements for patients with asymptomatic COVID-19 undergoing coronary artery bypass surgery:Three case reports

BACKGROUND The coronavirus disease 2019(COVID-19),caused by severe acute respiratory syndrome coronavirus-2,represents a major challenge to health care systems both globally and regionally,with many opting by cancelling elective surgeries.Cardiac operations in patients diagnosed with COVID-19 have been imperative due to their emergency nature,critical condition of patients awaiting cardiac surgery,and accumulated number of cardiac surgical interventions throughout the last months.CASE SUMMARY Here we describe three COVID-19 positive cases who underwent coronary surgery,on an urgent basis.We did not experience worsening of the patients’clinical condition due to COVID-19 and therefore a routine post-operative chest Xray(CXR)was not required.None of the health care providers attending the patients endured cross infection.Further trials would be needed in order to confirm these results.CONCLUSION While the pandemic has adversely hit the health systems worldwide,cardiac surgical patients who concomitantly contracted COVID-19 may undergo a smooth post-operative course as a routine post-operative CXR may not be required.

Unusual bronchoscopic value in percutaneous dilatational tracheostomy:A case report

BACKGROUND The usage of bronchoscopy during percutaneous dilatational tracheostomy remains under debate.The proponents of bronchoscopy advocating safety of the procedure,whereas the critics raising the concerns about the cost,possible delay in the procedure,and waiting for the device.CASE SUMMARY We are highlighting a case of percutaneous dilatational tracheostomy where bronchoscopy aided in diagnosing a rare situation of wire entrapment within the endotracheal tube,treated by withdrawing the wire from the endotracheal tube with good outcome.CONCLUSION The bronchoscopy guided approach permitted early diagnosis and helped to end the procedure without complication or possible major surgery in a case of accidental wire puncture of the endotracheal tube.

Low dose corticosteroids in COVID-19 with refractory shock:We are not sure?

Low dose corticosteroids to adult patients with coronavirus disease 2019(COVID-19)and refractory shock was given some evidence,the evidence was of low quality given particularly for shock-reversal.Evidence.However bacterial sepsis may not provide a similar evidence like in a viral related one.We think that suggesting steroids for COVID-19 may not be adequate in the current time and future data analysis should be directed to find possible evidence in a matched population.