Is Obesity a Risk Factor for Mortality in Coronary Artery Bypass Surgery?

Jin, Ruyun; Grunkemeier, Gary L.; Furnary, Anthony P.; Handy, John R.

doi:10.1161/circulationaha.104.489880

Cited by 88 publications

(46 citation statements)

References 35 publications

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“…5 Routine and serial quantitative PCT testing protocols may also be useful to guide antibiotic initiation and duration, particularly in cases of greater diagnostic uncertainty, for example traumatic brain injury. 5,6 REFERENCES. OBJECTIVES.…”

Section: Methodsmentioning

confidence: 99%

“…Other reasons given were simple dosing (6 [1][2][3][4][5][6][7][8][9][10][11])% and habit (13 [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20])%. More than one reason was allowed.…”

Section: Survey Of Glasgow Anaesthetists Use Of and Attitude Towards mentioning

confidence: 99%

“…With NHF, flow rate was set at 50 L/min. Arterial blood gases, respiratory rate, and discomfort were assessed at 1, 3,6, 12, 24, 36, and 48 h. Discomfort was assessed by asking patients to rate their discomfort with the used device by using a numerical scale from 0 (no discomfort) to 10 (maximum imaginable discomfort). Discomfort symptoms were also assessed for the dryness of the delivered oxygen (dryness of the mouth, throat, nose, difficulty to swallow and throat pain).…”

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confidence: 99%

“…Mean maternal age was 30.53 (6.2) years and mean gestational age was 30.36 (8) weeks. APACHE II score was 10.8 (6). 97 (47.5%) patients were admitted to CCD due to an obstetric cause.…”

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confidence: 99%

“…6,7 Clarification of any differences would improve pre-operative risk assessment, providing more information for the clinician and patient. It would also aid resource planning in the critical care unit.…”

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confidence: 99%

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ESICM 2010 MONDAY SESSIONS 11 October 2010

2010

Intensive Care Med

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INTRODUCTION. Fluid therapy is one of the cornerstones of hemodynamic management in critically ill patients. Although the aim of fluid therapy is to improve regional tissue perfusion, its adequacy is judged by the effect on cardiac stroke volume (SV). It is as yet unknown whether an increase in SV through a fluid challenge (FC) can also improve common parameters of regional perfusion. And if so, whether it is possible to predict the effect of a FC on regional perfusion parameters by performing a passive leg raising. METHODS. Critically ill patients, receiving invasive hemodynamic monitoring and requiring fluid therapy, were eligible for enrollment. They underwent a 30°passive leg raising (PLR) followed by a fluid challenge of 250 ml colloids. During the PLR and FC, stroke volume and cardiac output (CO) were measured as well as sublingual microcirculatory perfusion (sidestream dark field imaging), peripheral flow index (photoplethysmography of the finger) and tissue blood flow of the skin (laser Doppler flowmetry). RESULTS. 35 patients were included in our study, of which 15 (43%) were fluid responsive (FR; more than 10% increase in SV). Baseline SV and CO were significantly lower in responders than in non responders, as well as the sublingual perfusion. In the responsive patients sublingual vessel density and skin tissue blood flow increased following FC (Fig. 1), whereas PFI on the finger remained low. During the PLR no changes in any parameter were observed. Fluid responsiveness was best predicted by SV response to PLR (AUC 0.88 ± 0.08, p \ 0.01) and baseline SV (AUC 0.79 ± 0.08, p \ 0.01), followed by baseline sublingual vessel density (AUC 0.76 ± 0.09, p \ 0.05). It was not possible to predict the response effect of FC on regional perfusion by performing a PLR. CONCLUSIONS. In septic patients, parameters of regional perfusion are not related to systemic hemodynamic parameters and do not respond uniformly to fluid administration. In fact, it is questionable whether regional perfusion does benefit from fluid therapy at all following initial resuscitation. As such, the PLR has no value in optimizing regional perfusion. INTRODUCTION.We recently demonstrated that, compared to norepinephrine, dopamine was associated with a non significant increase in 28 day mortality ]) (1). However, arrhythmia resulted in discontinuation of the study drug in some patients, which was converted to open label norepinephrine in all cases. We conducted a per-protocol analysis limited to patients in whom the study drug was not discontinued. OBJECTIVES. To evaluate in a per protocol analysis the impact on outcome of dopamine and norepinephrine for the treatment of shock. METHODS. In a prospective, randomized study (NCT00314704), 858 patients received dopamine and 821 norepinephrine, according to a protocol described in detail elsewhere (1). Briefly, patients were randomized within 4 h max of the onset of shock to receive either dopamine (max dose 20 mcg/kg min) or norepinephrine (max dose 0.19 mcg/kg min). When the desired mean arter...

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Section: Methodsmentioning

confidence: 99%

“…Other reasons given were simple dosing (6 [1][2][3][4][5][6][7][8][9][10][11])% and habit (13 [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20])%. More than one reason was allowed.…”

Section: Survey Of Glasgow Anaesthetists Use Of and Attitude Towards mentioning

confidence: 99%

mentioning

confidence: 99%

“…Mean maternal age was 30.53 (6.2) years and mean gestational age was 30.36 (8) weeks. APACHE II score was 10.8 (6). 97 (47.5%) patients were admitted to CCD due to an obstetric cause.…”

mentioning

confidence: 99%

mentioning

confidence: 99%

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ESICM 2010 MONDAY SESSIONS 11 October 2010

2010

Intensive Care Med

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Safety of Hepatic Resections in Obese Veterans

Saunders

Rosman²,

Neihaus³

et al. 2012

Arch Surg

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To determine the effects of body mass index (BMI; calculated as weight in kilograms divided by height in meters squared) on outcomes after liver resection performed at Veterans Affairs medical centers. Design, Setting, and Patients: We queried the Veterans Affairs Surgical Quality Improvement Program database for liver resections (2005-2008) and grouped the patients into 5 BMI categories: normal weight (BMI 18.5-24.9), overweight (BMI 25.0-29.9), obese class 1 (BMI 30.0-34.9), obese class 2 (BMI 35.0-39.9), and obese class 3 (BMI Ն40.0). Differences in risk factors and perioperative complications across groups were analyzed in univariate and multivariate analyses. Results: Of 403 patients who underwent hepatectomy, 106 (26%) were normal weight, 161 (40%) were overweight, 94 (23%) were obese class 1, 31 (8%) were obese class 2, and 11 (3%) were obese class 3. Among these groups, higher BMI was associated with increased rates of hypertension (52%, 61%, 77%, 77%, and 73%, respectively; P=.002) and diabetes (18%, 27%, 36%, 39%, and 45%, respectively; P =.04) and lower incidence of smokers (53%, 35%, 30%, 16%, and 9%, respectively; PϽ.001). The BMI groups were similar in demographic characteristics and metrics correlating with preexisting liver disease. There were no differences across BMI groups in overall and specific morbidity or in length of stay. Compared with the other groups, obese class 3 patients received more blood transfusions (mean [SD], 4.3 [2.7] in obese class 3 patients vs 1.1 [0.2] in normal-weight patients; P=.02) and had a higher 30-day mortality (27% in obese class 3 patients vs 6% in normal-weight patients; P =.05). Multivariate analyses confirmed obese class 3 as an independent predictor of postoperative mortality. Conclusions: Obesity did not increase postoperative complications after liver resection in veterans. After adjusting for other clinical factors, extreme obesity (BMI Ն40.0) was an independent risk factor for increased mortality.

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Costs, Pathology, and Health Risks of Obesity and the Metabolic Syndrome

2007

The Metabolic Syndrome and Obesity

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Is Obesity a Risk Factor for Mortality in Coronary Artery Bypass Surgery?

Cited by 88 publications

References 35 publications

ESICM 2010 MONDAY SESSIONS 11 October 2010

ESICM 2010 MONDAY SESSIONS 11 October 2010

Safety of Hepatic Resections in Obese Veterans

Costs, Pathology, and Health Risks of Obesity and the Metabolic Syndrome

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