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.

Intensive care outcome of left main stem disease surgery: A single center three years’ experience

BACKGROUND Left main coronary artery(LMCA)supplies more than 80%of the left ventricle,and significant disease of this artery carries a high mortality unless intervened surgically.However,the influence of coronary artery bypass grafting(CABG)surgery on patients with LMCA disease on morbidity intensive care unit(ICU)outcomes needs to be explored.However,the impact of CABG surgery on the morbidity of the ICU population with LMCA disease is worth exploring.AIM To determine whether LMCA disease is a definitive risk factor of prolonged ICU stay as a primary outcome and early morbidity within the ICU stay as secondary outcome.METHODS Retrospective descriptive study with purposive sampling analyzing 399 patients who underwent isolated urgent or elective CABG.Patients were divided into 2 groups;those with LMCA disease as group 1(75 patients)and those without LMCA disease as group 2(324 patients).We correlated ICU outcome parameters including ICU length of stay,post-operative atrial fibrillation,acute kidney injury,re-exploration,perioperative myocardial infarction,post-operative bleeding in both groups.RESULTS Patients with LMCA disease had a significantly higher prevalence of diabetes(43.3%vs 29%,P=0.001).However,we did not find a statistically significant difference with regards to ICU stay,or other morbidity and mortality outcome measures.CONCLUSION Post-operative performance of Patients with LMCA disease who underwent CABG were comparable to those without LMCA involvement.Diabetes was more prevalent in patients with LMCA disease.These findings may help in guiding decision making for future practice and stratifying the patients’care.