Comparison of Tools for Postoperative Pulmonary Complications After Cardiac Surgery

Yu-qiang, Wang; Luo, Zeruxin; Huang, Wei; Zhang, Xiu; Guo, Yingqiang; Yu, Pengming

doi:10.1053/j.jvca.2023.03.031

Cited by 7 publications

(4 citation statements)

References 43 publications

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“…Modified [ 20 , 21 , 22 , 23 ] Kroenke’s PPCs severity score offered an acceptable and applicable grading system for the severity of PPCs ( Supplementary Materials S1, Table S1 ). It was recently compared with the Melbourne Group Scale, and both were deemed to be useful tools for grading PPCs in CS patients [ 59 ]. To overcome Kroenke’s score inferiority in more severe cases, we found it appropriate to set the score value ≥3 as a cut-off in the analysis of the PPC incidence [ 55 ].…”

Section: Discussionmentioning

confidence: 99%

“…The incidence and severity of PPCs were scored and agreed upon by two independent, blinded assistants, using the original operational definitions of Kroenke [ 23 ] and subsequent modifications [ 20 , 21 , 22 , 59 ]. Score values were determined daily, and as an individual PPK severity score, the worst registered value (i.e., the highest grade) within 7 days after surgery was used for the analyses.…”

Section: Methodsmentioning

confidence: 99%

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The Influence of High-Dose Parenteral Vitamin C on the Incidence and Severity of Postoperative Pulmonary Complications in Cardiac Surgery with Extracorporeal Circulation: A Randomized Controlled Trial

Karadžić Kočica,

Ristić,

Soldatović

et al. 2024

Nutrients

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Cardiac surgery (CS) with extracorporeal circulation (ECC), induces intense oxidative stress (OS) and systemic inflammatory response (SIR), which may seriously affect postoperative lung function. We aimed to test if high parenteral (200 mg/kg/24 h) daily doses of Vitamin C (VitC), given within 48 h after the beginning of the operation, may reduce the incidence and severity of postoperative pulmonary complications (PPCs) in CS patients. This single-center, prospective, randomized, single-blinded, interventional trial included 150 patients, assigned to control Group A (n = 75) and interventional Group B (n = 75). Group B intraoperatively received one-fourth (i.e., 50 mg/kg) of the planned daily Vit C dose, divided into three equal parts and diluted in 10 mL of normal saline, while Group A received an equal volume of normal saline at the same time frames (i.e., the induction of anesthesia, aortic cross-clamp release, and sternal closure). After 6 h from the first intraoperative dose, the following regimen was applied: Group B: 50 mg/kg, 30 min i.v. infusion of VitC in 50 mL of normal saline, every 6 h, for the next 48 h, and Group A: 30 min i.v. infusion of an equal volume of normal saline every 6 h, for the next 48 h. Modified Kroenke’s score was used to determine the incidence and severity of PPCs. The overall incidence of PPCs was 36.7% and was significantly lower in Group B (13.3% vs. 60.0%, p < 0.001). The PPCs severity score was also significantly lower in Group B (1 vs. 3, p < 0.001). In addition, patients from Group B had significantly less damaged lungs, better postoperative renal function, shorter ICU stays, fewer ICU re-admissions, and lower hospital mortality. No VitC-related adverse effects were recorded. High parenteral daily VitC doses given within 48 h after the beginning of CS are safe and effective in reducing the incidence and severity of PPCs. A multicenter RCT is needed to confirm these results.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

The Influence of High-Dose Parenteral Vitamin C on the Incidence and Severity of Postoperative Pulmonary Complications in Cardiac Surgery with Extracorporeal Circulation: A Randomized Controlled Trial

Karadžić Kočica,

Ristić,

Soldatović

et al. 2024

Nutrients

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“…[28] Fourth, two score tools for practical use in the CS, one of them being Kroenke's score, were compared and it was concluded that both can identify PPC effectively. [43] Yet, the validity of Kroenke's score to identify severe PPC remains disputable. To overcome this, we set the score value ≥3 as a cut-off in the analysis of the PPC incidence.…”

Section: Discussionmentioning

confidence: 99%

“…[38] The incidence and severity of PPC were scored and agreed by two independent, blinded assistants, using the original operational definitions of Kroenke [39] and subsequent modifications. [40][41][42][43] Score values were determined daily, and as an individual PPK severity score, the worst registered value (i.e. the highest grade) within 7 days after surgery was used for the analyses.…”

Section: Interventionsmentioning

confidence: 99%

The Influence of High Dose Parenteral Vitamin C Supplementation on Incidence and Severity of Postoperative Pulmonary Complications after Cardiac Surgery with Extracorporeal Circulation: A Prospective, Randomized, Single-Blinded, Interventional Study

Kočica,

Ristić,

Soldatović

et al. 2024

Preprint

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: Cardiac surgery (CS) with extracorporeal circulation (ECC), induces oxidative stress and systemic inflammatory response, which may seriously affect postoperative lung function. We aimed to test if high parenteral (200mg/kg/24h) perioperative (48h) doses of Vitamin C (VitC) may reduce the incidence and severity of postoperative pulmonary complications (PPC) in selected CS patients. Single centered, prospective, randomized, single-blinded, interventional study included 150 patients, assigned to control group A (n=75) and interventional group B (n=75). Group B intraoperatively received 1/4 of the planned daily Vit C dose (200mg/kg/24h), diluted in 10 ml of normal saline, divided into three parts, while Group A received an equal volume of normal saline at the same time frames. After 6 h from the first intraoperative dose, the following regimen was applied: Group B: 200 mg/kg/24h - 30 min i.v. infusion of VitC in 50 ml of normal saline, every 6h, for the next 48h, and Group A: 30 min i.v. infusion of an equal volume of normal saline every 6 hours, for the next 48h. Modified Kroenke’s score was used to determine the incidence and severity of PPC. The overall incidence of PPC was 36.7% and was significantly lower in Group B (13.3% v.s. 60.0%, p&lt;0.001). The severity of PPC was also significantly lower in Group B [1(1) v.s. 3(2), p&lt;0.001]. Besides, patients from Group B had significantly less damaged lungs and better postoperative renal function, shorter ICU stay, fewer ICU re-admissions, and lower hospital mortality. High parenteral daily VitC doses (200mg/kg/24h) given to selected CS patients for 48h after CS are safe and effective in reducing the incidence and severity of PPC. Further multicenter RCT is needed to confirm these results.

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Clinimetrics: The Melbourne Group Scale

Boden,

Hackett

2024

Journal of Physiotherapy

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Comparison of Tools for Postoperative Pulmonary Complications After Cardiac Surgery

Cited by 7 publications

References 43 publications

The Influence of High-Dose Parenteral Vitamin C on the Incidence and Severity of Postoperative Pulmonary Complications in Cardiac Surgery with Extracorporeal Circulation: A Randomized Controlled Trial

The Influence of High-Dose Parenteral Vitamin C on the Incidence and Severity of Postoperative Pulmonary Complications in Cardiac Surgery with Extracorporeal Circulation: A Randomized Controlled Trial

The Influence of High Dose Parenteral Vitamin C Supplementation on Incidence and Severity of Postoperative Pulmonary Complications after Cardiac Surgery with Extracorporeal Circulation: A Prospective, Randomized, Single-Blinded, Interventional Study

Clinimetrics: The Melbourne Group Scale

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