Increased heart rate on first day in Intensive Care Unit is associated with increased mortality

Objective: To investigate the association of maximum HR during the first day of intensive care unit [ICU] and mortality

Methods: Data of 850 patients over 45 years of age, who were hospitalized in ICU, was retrospectively analyzed. They were divided into two groups; Group-I, patients with maximum HR<100/min Group-II, patients with maximum HR >/= 100/min on first day. The groups were compared regarding age, sex, use of beta-blockers, use of inotropic and vasopressor drugs, hemodynamic parameters, anemia, mechanical ventilation, length of hospitalization [ICU and total], mortality [ICU and total], and CHARLSON and APACHE-II scores

Results: The mean age of patients was 63 +/- 12 years and 86% were after non-cardiac surgery. Maximum HR was 83 +/- 11 in Group-I and 115 +/- 14/min in Group-II [p=0.002]. Group-II patients had more frequent vasopressor and inotropic drugs usage, [p<0.001], anemia, mechanical ventilation [p<0.005], higher CHARLSON and APACHE-II scores, stayed longer in ICU and hospital, and had higher ICU and hospital mortality compared to group-I [p<0.05]. APACHE-II scores and maximum HR<100/min were independent variables predicting ICU mortality in multivariate logistic regression analysis whereas usage of beta-blockers was not

Conclusions: Our study showed that maximum HR less than100/minute during the first day of ICU is associated with decreased mortality in Intensive Care Unit

Heat shock protein 60 antibody. a new marker for subsequent atrial fibrillation development

To examined the pre-and post-operative anti-HSP60 antibodies of serum from patients in preoperative sinus rhythm. We prospectively studied 45 consecutive patients admitted for elective CABG from 2004 to 2005. We randomly selected 10 patients developing AF [study sample [Group A]] and 10 postoperative patients without AF [control [Group B]. The study took place at the Department of Cardiovascular Surgery, Hacettepe University, Ankara, Turkey. Anti-HSP60 IgG value was 27.76 +/- 12.69 absorbance units [AU] in Group A preoperatively and decreased to 13.73 +/- 5.51 AU postoperatively. Controversially, preoperative value of anti-HSP60 IgG was 9.94 +/- 2.92 AU and decreased to 6.72 +/- 1.89 AU, postoperatively in Group B. Statistical analysis showed significant difference regarding preoperative anti-HSP60 IgG levels in Group A compared to Group B, which might be interpreted as an association between postoperative AF and preoperative levels of anti-HSP60 IgG. We provide the first evidence demonstrating the association of pre-and post-operative circulating anti-HSP60 antibodies with postoperative AF. These results suggest that serum HSP60 antibody levels may be a marker for subsequent development of AF

effect of halothane, isoflurane, sevoflurane and propofol infusion on renal function after coronary artery bypass surgery

Renal insufficiency after cardiac surgery is associated with increased mortality, morbidity, and length of stay in the intensive care unit. We investigated the effect of isoflurane, halothane, sevoflurane and propofol anesthesia on perioperative renal function following elective coronary artery surgery. The medical records of 224 patients, in the Hacettepe University Medical Faculty Hospital who had undergone cardiac surgery in one year, were retrospectively reviewed. 65 [29%] patients received isoflurane, 68 [30%] patients received halothane, 64 [29%] patients received sevoflurane, and 27 [12%] patients received propofol infusion as part of maintenance anesthesia for coronary artery bypass surgery. Patient characteristics [age, sex, preoperative ejection fraction], operative data [duration of CPB, duration of operation, number of distal anastomoses, usage of diuretic, intraoperative crystalloid and blood transfusion], intraoperative urinary output, preoperative and postoperative [6th hours and 24th hours] BUN and plasma creatinine levels, were not statistically significant between and within groups. Intraoperative inotropic agent [dopamine] was used in 8 [12.3%] patients in the isoflurane group, in 10 [14.7%] patients in the halothane group, in 11 [17.2%] patients in sevoflurane group and in 9 [33.3%] patients in the propofol group. Postoperatively fluid and blood transfusion, postoperative drainage, urinary output, diuretic usage were smiliar between the four groups [p>0,05]. Inotropic agent was used in 8 [12.3%] patients in the isoflurane group, in 9 [13.2%] patients in the halothane group, in 16 [25%] patients in the sevoflurane group and in 7 [25.9%] patients in the propofol group. It is concluded that, halothane, isoflurane, sevoflurane and propofol infusion anesthesia as part of anesthesia maintenance for elective coronary artery bypass surgery does not affect early postoperative renal functions