Alejandro Kohn Tuli

Rhabdomyolysis following Cardiac Surgery: A Prospective, Descriptive, Single-Center Study

Purpose. Rhabdomyolysis (RML) following cardiac surgery and its relationship with acute kidney injury (AKI) require investigation. Patients and Methods. All patients undergoing cardiac surgery in our hospital were enrolled in this prospective study during a 1-year period. To investigate the occurrence of RML and its association with AKI, all patients in the study underwent serial assessment of serum creatine kinase (CK) and myoglobin levels. Serial renal function, prior statin treatment, and outcome variables were recorded. Results. In total, 201 patients were included in the study: 185 men and 16 women with a mean age of 52.0 ± 12.4 years. According to the presence of RML (CK of ≥2,500 U/L), the patients were divided into Group I (RML present in 17 patients) and Group II (RML absent in 184 patients). Seven patients in Group I had AKI (41%) where 34 patients in group II had AKI (18.4%), P = 0.025. We observed a significantly longer duration of ventilation, length of stay in the ICU, and hospitalization in Group I (P < 0.001 for all observations). Conclusions. An early elevation of serum CK above 2500 U/L postoperatively in high-risk cardiac surgery could be used to diagnose RML that may predict the concomitance of early AKI.

Kinetics of Highly Sensitive Troponin T after Cardiac Surgery

Perioperative myocardial infarction (PMI) confers a considerable risk in cardiac surgery settings; finding the ideal biomarker seems to be an ideal goal. Our aim was to assess the diagnostic accuracy of highly sensitive troponin T (hsTnT) in cardiac surgery settings and to define a diagnostic level for PMI diagnosis. This was a single-center prospective observational study analyzing data from all patients who underwent cardiac surgeries. The primary outcome was the diagnosis of PMI through a specific level. The secondary outcome measures were the lengths of mechanical ventilation (LOV), stay in the intensive care unit (LOSICU), and hospitalization. Based on the third universal definition of PMI, patients were divided into two groups: no PMI (Group I) and PMI (Group II). Data from 413 patients were analyzed. Nine patients fulfilled the diagnostic criteria of PMI, while 41 patients were identified with a 5-fold increase in their CK-MB (≥120 U/L). Using ROC analysis, a hsTnT level of 3,466 ng/L or above showed 90% sensitivity and 90% specificity for the diagnosis of PMI. Secondary outcome measures in patients with PMI were significantly prolonged. In conclusion, the hsTnT levels detected here paralleled those of CK-MB and a cut-off level of 3466 ng/L could be diagnostic of PMI.

Current Concepts Surrounding Project Management for Complex Performance Improvement Initiatives

Hospitals are complex organizations that utilize highly trained, autonomously performing clinical professionals. Hospitals are now borrowing management practices from other industries. Most facilities have turned toward internal process improvement and team-based training. In this article, we will review the current concepts surrounding project management that are deployed to engage clinical specialists and improve care. Project management requires leadership commitment and an improvement aim. The essential drivers for success include creating an implementation plan, building consensus, developing meaningful data measures, and making continuous improvements.

Influence of acute kidney injury on high sensitive troponin after cardiac surgery. a single center retrospective observational study

The risk assessment of cardiac troponin and other cardiac biomarkers in end-stage renal disease is not equivalent where clinical decision making in patients with renal diseases based on cardiac biomarkers needs justification in relation to patient management or outcomes [1]. Long-term outcome could be influenced by acute kidney injury (AKI) in cardiac surgery [2], but cardiac troponins need exploration in theses settings.

Kinetics of high sensitive troponin T (HSTNT) after cardiac surgery

Perioperative myocardial infarction (PMI) in the setting of cardiac surgery represent a considerable risk to patients with significant mortality and morbidity. The role of highly sensitive cardiac troponin T (hsTnT) has not been evaluated in the setting of cardiac surgery, instead Cardiac Troponin T (TnT) and Creatine Kinase MB (CK-MB) are commonly used for the diagnosis of PMI [1].

Highly sensitive troponin t (hstnt) profile for outcome prediction after cardiac surgery

Changes in cardiac mediators remain a subject of research interest. Instantly obtainable biomarkers that are performed routinely, are inexpensive and are characterized by linkages to outcome in cardiac surgery settings are optimum. Post-operative conventional cardiac troponins are linked to short- and middle-length outcomes [1] but highly sensitive troponin T (hsTnT) has not been extensively evaluated in the same settings.