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Journal and News Scan
March 7, 2016
Submitted by: Mark Ferguson
This literature review evaluated 21 studies that included nearly 4000 patients having undergone transcatheter aortic valve implantation (TAVI), specifically focusing on prosthesis-patient mismatch (PPM). Overall prevalence of PPM was 35%, with 8% of patients having severe PPM. PPM occurred less often after TAVI than after surgical AVR. PPM was not associated with increased long-term mortality.
March 7, 2016
Submitted by: Mark Ferguson
Outcomes of tricuspid valve replacement at a single institution over a 4 decade period were reviewed. A bioprosthesis was used in 82%, and the surgical mortality was nearly 28%. Freedom from structural deterioration was better in the mechanical valve group. Mechanical valves were, however, associated with earlier and more severe morbidity, including a significantly higher incidence of thromboembolic complications.
March 4, 2016
Submitted by: Rakesh Arora
Surgical intervention in older people is increasing in prevalance but is associated with higher rates of adverse postoperative outcomes as compared to younger people. Current models of preoperative risk assessment and optimisation may be indequate for this complex surgical population. In this article, the Authors discuss the challenges and potential solutions in the establishment of quality surgical care for older people.
March 4, 2016
Submitted by: Rakesh Arora
Lactic acidosis is a very common biological issue for the postoperative patient with shock. This very nice review addresses thehemodynamic consequences of shock-associated lactic acidosis and highlights the various therapeutic options that can be considered by the bedside clinician.
March 4, 2016
Submitted by: Rakesh Arora
The optimal timing of tracheotomy in critically ill patients remains a topic of debate. The Authors performed a systematic review to clarify the potential benefits of early versus late tracheotomy. Three categories of timing of tracheotomy (within 4 versus after 10 days, within 4 versus after 5 days, within 10 versus after 10 days) were analyzed. Twelve studies with a total of 2,689 patients were included in this analysis. The Authors have identified that early tracheotomy is associated with more ventilator-free days, shorter ICU stays, less sedation, and reduced long-term mortality, compared to late tracheotomy
February 28, 2016
Submitted by: Lisa Brown
The goal of this study was to determine if there is an association between PPI use and incident chronic kidney disease (CKD) in the general population. Two cohorts were studied, the Atherosclerosis Risk in Communities (ARIC), a population based cohort (10,482 subjects followed for a median of 13.9 years) and the Geisinger Health System in Pennsylvania (248,751 subjects followed for a median of 6.2 years). In the ARIC cohort, after adjustment for confounders, the risk of incident CKD was 1.5 times greater in those taking PPIs at baseline compared to those who did not. The 10-year risk of CKD in PPI users at baseline was 11.8% whereas the expected risk (without PPI use) was 8.5%. In the Geisinger Health System cohort, the adjusted risk of incident CKD was 1.17 times greater in PPI users than in those who did not use PPIs. In addition, twice daily dosing of PPIs was associated with a greater risk of CKD than once daily dosing. This observational cohort study identified an association between PPI use and incident CKD, but does not provide evidence to prove causality.
February 28, 2016
Submitted by: Ruben Osnabrugge
In this trial 2100 undergoing coronary surgery were randomized to aspirin 100mg or placebo. The primary outcome was defined as a composite of death and thrombotic complications (myocardial infarction, stroke, pulmonary embolism, renal failure or bowel infarction) at 30 days.
There was no difference between the two treatment groups for the primary endpoint (aspirin group 19.3% versus placebo group 20.4% , p=0.55). Other endpoints included cardiac tamponade (aspirin group 1.1% versus placebo 0.4%, p=0.08) and major hemorrhage leading to reoperation (aspirin group 1.8% versus placebo 2.1%, p=0.75).
The authors conclude that preoperative aspirin did not lead to a higher risk of death, thrombotic complications or reoperation due to bleeding.
February 24, 2016
Submitted by: Marcelo Jimenez
Routine use of PET scans to follow up asymptomatic patients do not affect survival, according to this retrospective analysis of a cohort of 97,152 lung cancer and 4,446 esophageal cancer patients. They compared high and low level of use of PET centers, and found no differences in two-year survival.
February 23, 2016
Submitted by: Mark Ferguson
This consensus effort provides a new definition for septic shock, which affects a subset of patients with sepsis. The definition requires the presence of circulatory disturbances (BP unresponsive to fluids and requiring pressors), cellular and metabolic abnormalities (serum lactate level >2 mmol/L). The presence of these criteria is associated with an increased risk of mortality compared to sepsis alone.
February 20, 2016
Submitted by: Aristotle Protopapas
A succinct editorial from a British academic transplant surgeon. It discusses the need for stratifying the utilization of donor lungs based on recent and previous retrospective papers from North American and European databases. Professor Dark also briefly debates the needs for research on assessing and optimizing the organs.