Scarica il documento in formato pdf (574 KB - ANCE
Scarica il documento in formato pdf (574 KB - ANCE Scarica il documento in formato pdf (574 KB - ANCE
weeks and months later after discharge. However, this is not only an issue of mortality. In fact, the treatment of these patients is often dramatic for the patients themselves (owing to the physical and psychological suffering they are exposed to) for their relatives, who are exposed to a very stressful time, and for staff, due to hard work, and frustration after frequent failures in spite of their maximum efforts. In addition, patients subject to a prolonged postoperative stay may occupy the intensive care beds for many days, and need a high usage of supplies (blood and hemoderivates, drugs, mechanical ventilation, etc.) and the performance of procedures in excess (tracheostomy, intra-aortic balloon pump, etc.) which, besides affecting the rhythm of the operating theatre are turned into a cost that sometimes is equal to the cost for all other much more numerous patients with non complicated courses. Considering the heavy burden that of the long stay in intensive care still can have in clinical, organisational and economical decisions, it is reasonable to carry out researches aimed to compare already validated models to the purpose of checking the ones which are more accurate in predicting the prolongation of stay in intensive care. After identifying the models, it is desirable that they are spread to professional Societies in order to sensitise field operators’ awareness on the issue of proper intervention indications and on the opportunity of identifying those patients for whom an intervention is not to be recommended and to whom alternate treatment, medical or angioplasty, should be suggested. REFERENCES 1. Pinna Pintor P, Bobbio M, Giammaria M. La valutazione del rischio operatorio [Operative risk evaluation]. In: Trattato di Cardiologia ANMCO [ANMCO cardiology treatise]. Excerpta Medica, San Donato Milanese (MI), Italy, 2000: 3445-60. 2. Shroyer ALW, Grover FL, Edwards FH. 1995 Coronary artery bypass risk model: The Society of Thoracic Surgeons Adult Cardiac National Database. Ann Thorac Surg 1998; 65: 879-84. 3. Parsonnet V, Dean D, Bernstein AD. A method of uniform stratification of risk for evaluating the results of surgery in acquired adult heart disease. Circulation 1989; 79 (suppl 1): 3-12. 4. Hannan EL,Kilburn H, Racz M, Shields E, Chassin MR. Improving the outcomes of coronary artery bypass surgery in New York State. JAMA 1994; 271: 761-766. 5. Ivanov J, Tu JV, Naylor D. Ready-made, recalibrated, or remodeled? Circulation 1999; 99: 2098-2104. 6. Parsonnet V, Bernstein AD, Gera M. Clinical usefulness of risk-stratified outcome analysis in cardiac surgery in New Jersey. Ann Thorac Surg 1996; 61: S8-S11. 7. National Adult Cardiac Surgical Database Report 1999-2000. Edited by Keogh BE and Kinsman R. The Society of Cardiothoracic Surgeons of Great Britain and Ireland, 2001: 17-22. From "STS National database". Internet site: http://www.scts.org/doc/5483 8. Cleveland Clinic Heart Center. Surgical Outcomes 2001. http://www.clevelandclinic.org/heartcenter/pub/about/default.asp 9. Edwards FH. The changing spectrum of risk factors in coronary bypass surgery. In: Proceedings Symposium "Costs and Risks of Heart Surgery", I Quaderni della Fondazione n. 5 [Foundation no. 5 Notebooks], Turin, Italy, 2000: 11-15. http://space.tin.it/salute/ppinnapi/symp2000/edwards.htm. 10. Warner CD, Weintraub WS, Craver JM, Jones EL, Gott JP, Guyton RA. Effect of cardiac surgery patient characteristics on patient outcomes from 1981 through 1995. Circulation 1997; 96: 1575-1579. 11. Ferguson TB Jr, Dziuban SW Jr, Edwards FH, Eiken MC, Shroyer AL, Pairolero PC, Anderson RP, Grover FL. The STS National database: current changes and challenges for the new millenium. Ann Thorac Surg 2000; 69: 680-691 12. From "CABG Surgery in New Jersey 1996-1997". http://www.state.nj.us/health/hcsa/cabgs98 /cabgs98t.htm 13. National Adult Cardiac Surgical Database Report 1999-2000. Edited by Keogh BE and Kinsman R. The Society of Cardiothoracic Surgeons of Great Britain and Ireland, 2001: 17-22. From "STS National database". Internet site: http://www.scts.org/doc/5483 14. Staat P, Cucherat M, George M, Lehot JJ, Jegaden O, Andre-Fouet X, Beaune J. Severe morbidity after coronary artery surgery: development and validation of a simple predictive clinical score. Eur Heart J 1999; 20: 960-966. 15. Staat P, Cucherat M, George M, Lehot JJ, Jegaden O, Andre-Fouet X, Beaune J. Severe morbidity after coronary artery surgery: development and validation of a simple predictive clinical score. Eur Heart J 1999; 20: 960-966. 16. Tu JV, Mazer CD, Levinton C, Armstrong PW, Naylor CD. A predictive index for length of stay in the intensive care unit following cardiac surgery. CMAJ 1994; 151: 177-185. P. Pinna Pintor et al. Risk prediction in heart surgery 15
16 Giornale Italiano di Cardiologia Pratica It J Practice Cardiol Ottobre 2003 17. Bashour CA, Yared JP, Ryan TA, Rady MY, Mascha E, Leventhal MJ, Starr NJ. Longterm survival and functional capacity in cardiac surgery patients after prolonged intensive care. Crit Care Med 2000; 28: 3847- 3853. 18. Pinna Pintor P, Colangelo S, Bobbio M. Evolution of case-mix in heart surgery: from mortality risk to complication risk. EJCTS 2002; 22:927-933. 19. Lazar HL, Fitzgerald C, Gross S, Heeren T, Aldea GS, Shemin RJ. Determinants of length of stay after coronary artery bypass graft surgery. Circulation 1995; 92 (suppl): II20-II24. 20. Weintraub WS, Jones EL, Craver J, Guyton R, Cohen C. Determinants of prolonged length of hospital stay after coronary bypass surgery. Circulation 1989; 80: 276- 284. 21. Kurki TSO, Kataja M. Preoperative prediction of postoperative morbidity in coronary artery bypass grafting. Ann Thorac Surg 1996; 61: 1740-1745. 22. Lahey SJ, Borlase BC, Lavin PT, Levitsky S. Preoperative risk factors that predict hospital length of stay in coronary artery bypass patients >60 years old. Circulation 1992; 86 (suppl): II181-II185. 23. Ferraris VA, Ferraris SP: Risk factors for postoperative morbidity. J Thorac Cardiovasc Surg 1996; 111: 731-741. 24. Stricker K, Rothen HU, Takala J. Resource use in the ICU: short- vs. long-term patients. Acta Anaesthesiol Scand. 2003 May;47(5):508-15. 25. Hughes M, MacKirdy FN, Norrie J, Grant IS. Outcome of long-stay intensive care patients. Intensive Care Med. 2001 Apr;27(4):779-82. 26. Ryan TA, Rady MY, Bashour CA, Leventhal M, Lytle B, Starr NJ. Predictors of outcome in cardiac surgical patients with prolonged intensive care stay. Chest 1997; 112: 1035- 1042. 27. Holmes L, Loughead K, Treasure T, Gallivan S. Which patients will not benefit from further intensive care after cardiac surgery? Lancet 1994; 344: 1200-1202. 28. Magovern JA, Sakert T, Magovern GJ, Benckart DH, Burkholder JA, Liebler GA, Magovern GJ Sr. A model that predicts morbidity and mortality after coronary artery bypass graft surgery. J Am Coll Cardiol 1996; 28: 1147-1153.
- Page 2 and 3: Giornale Italiano di Cardiologia Pr
- Page 4 and 5: Indice Editoriale Pag. 4 L. Pagliar
- Page 6 and 7: il caso di ricordare che siamo nell
- Page 8 and 9: Risk prediction in heart surgery: m
- Page 10 and 11: factors were compared based on the
- Page 12 and 13: Overestimation Mortality (%) Mortal
- Page 14 and 15: spital mortality of patients who re
- Page 18 and 19: Precocità degli interventi prevent
- Page 20 and 21: NON FUMARE! FAI CONTENTO IL TUO CUO
- Page 22 and 23: Aspetti clinici, diagnosi ECG, indi
- Page 24 and 25: della frequenza. Le restanti tachic
- Page 26 and 27: Aritmia Risposta alle manovre Modal
- Page 28 and 29: Terapia Le alternative terapeutiche
- Page 30 and 31: Le Figure 3,4 e 5 mostrano la local
- Page 32 and 33: Istituzione di “Stroke Unit” ne
- Page 34 and 35: evitabile. Questo tempo è molto pi
- Page 36 and 37: potrebbero annullare gli effetti po
- Page 38 and 39: fatti dimostrato che la sola differ
- Page 40 and 41: and Hispanic origin: (Updated 11/20
- Page 42 and 43: Cooperazione biventricolare negli a
- Page 44 and 45: stata successivamente indicizzata p
- Page 46 and 47: Variabile Controlli Atleti P ANULUS
- Page 48 and 49: Tenuto conto che il picco di veloci
- Page 50 and 51: ventricular myocardial function in
- Page 52 and 53: differenti regimi antipertensivi, c
- Page 54 and 55: Prevenzione della morte improvvisa
- Page 56 and 57: BIBLIOGRAFIA 1. Davies MJ. The card
- Page 58 and 59: sali di 0,7-0,8, si avvicina o supe
- Page 60 and 61: Classe III 1. Sincope di causa non
- Page 62 and 63: Nuovi paradigmi interpretativi dell
- Page 64 and 65: Queste tre fasi sono le fasi extrac
16<br />
Giornale Italiano di Cardiologia Pratica<br />
It J Practice Cardiol<br />
Ottobre 2003<br />
17. Bashour CA, Yared JP, Ryan TA, Rady MY,<br />
Mascha E, Leventhal MJ, Starr NJ. Longterm<br />
survival and functional capacity <strong>in</strong> cardiac<br />
surgery patients after prolonged <strong>in</strong>tensive<br />
care. Crit Care Med 2000; 28: 3847-<br />
3853.<br />
18. P<strong>in</strong>na P<strong>in</strong>tor P, Colangelo S, Bobbio M.<br />
Evolution of case-mix <strong>in</strong> heart surgery:<br />
from mortality risk to complication risk.<br />
EJCTS 2002; 22:927-933.<br />
19. Lazar HL, Fitzgerald C, Gross S, Heeren T,<br />
Aldea GS, Shem<strong>in</strong> RJ. Determ<strong>in</strong>ants of<br />
length of stay after coronary artery bypass<br />
graft surgery. Circulation 1995; 92 (suppl):<br />
II20-II24.<br />
20. We<strong>in</strong>traub WS, Jones EL, Craver J, Guyton<br />
R, Cohen C. Determ<strong>in</strong>ants of prolonged<br />
length of hospital stay after coronary<br />
bypass surgery. Circulation 1989; 80: 276-<br />
284.<br />
21. Kurki TSO, Kataja M. Preoperative prediction<br />
of postoperative morbidity <strong>in</strong> coronary<br />
artery bypass graft<strong>in</strong>g. Ann Thorac Surg<br />
1996; 61: 1740-1745.<br />
22. Lahey SJ, Borlase BC, Lav<strong>in</strong> PT, Levitsky S.<br />
Preoperative risk factors that predict hospital<br />
length of stay <strong>in</strong> coronary artery bypass<br />
patients >60 years old. Circulation 1992; 86<br />
(suppl): II181-II185.<br />
23. Ferraris VA, Ferraris SP: Risk factors for postoperative<br />
morbidity. J Thorac Cardiovasc<br />
Surg 1996; 111: 731-741.<br />
24. Stricker K, Rothen HU, Takala J. Resource<br />
use <strong>in</strong> the ICU: short- vs. long-term patients.<br />
Acta Anaesthesiol Scand. 2003<br />
May;47(5):508-15.<br />
25. Hughes M, MacKirdy FN, Norrie J, Grant<br />
IS. Outcome of long-stay <strong>in</strong>tensive care<br />
patients. Intensive Care Med. 2001<br />
Apr;27(4):779-82.<br />
26. Ryan TA, Rady MY, Bashour CA, Leventhal<br />
M, Lytle B, Starr NJ. Predictors of outcome<br />
<strong>in</strong> cardiac surgical patients with prolonged<br />
<strong>in</strong>tensive care stay. Chest 1997; 112: 1035-<br />
1042.<br />
27. Holmes L, Loughead K, Treasure T, Gallivan<br />
S. Which patients w<strong>il</strong>l not benefit from<br />
further <strong>in</strong>tensive care after cardiac surgery?<br />
Lancet 1994; 344: 1200-1202.<br />
28. Magovern JA, Sakert T, Magovern GJ,<br />
Benckart DH, Burkholder JA, Liebler GA,<br />
Magovern GJ Sr. A model that predicts<br />
morbidity and mortality after coronary artery<br />
bypass graft surgery. J Am Coll Cardiol<br />
1996; 28: 1147-1153.
Change language