ABSTRACT
Experimental and clinical studies have shown the beneficial effects of triiodothyronine (T3) following myocardial revascularization on cardiopulmonary bypass (CPB). In this study, open-label T3 was administered to 68 high-risk patients undergoing open heart surgery. The New Jersey Risk Assessment was used to calculate the preoperative estimated surgical mortality. A loading dose of T3 was administered: (a) at release of the aortic cross-clamp, (b) whenever the patient became CPB dependent, (c) if the patient exhibited low cardiac output after discontinuing CPB and (d) as pretreatment before initiating CPB. All therapeutic modalities were followed by a continuous T3 infusion. Following T3 therapy, CPB was discontinued in all patients. Based upon discriminant analysis, a total of 26 deaths were expected from the entire group, but only 7 patients died, therefore, the observed mortality was reduced by 72% (p < 0.007). The use of T3 had a major impact on reducing surgical mortality, and may be advocated as a new therapeutic modality in patients with high estimated mortality undergoing open heart surgery.
Subject(s)
Cardiac Surgical Procedures/mortality , Cardiopulmonary Bypass/adverse effects , Triiodothyronine/therapeutic use , Adult , Aged , Aged, 80 and over , Double-Blind Method , Female , Hemodynamics/drug effects , Humans , Male , Middle Aged , Myocardial Revascularization/mortality , Prospective Studies , Risk Factors , Survival RateABSTRACT
The process of selecting a computer vendor can be time-consuming and somewhat tedious. Due to the large number of vendors and varying types of promotional material, it is difficult to decide whose systems should be scrutinized in greater detail. The Request for Proposal RFP process provides a means of standardizing each vendor's response and limiting the number of full proposals which must be evaluated. Further, the vendors' responses are tailored to the needs of the department.
