Cardiac Intensive Care Unit
Cardiac Intensive Care Unit
News Article | May 19, 2017
TORONTO, May 19, 2017-- A Canadian cardiologist has published a report in the journal Eurointervention describing how he used a Canadian-invented device for the first time in the world to successfully insert a MitraClip® through a patient's jugular vein rather than the femoral vein. When Dr. Neil Fam examined his 86-year-old patient with severe mitral regurgitation--a condition in which the blood flows backward into the heart after it contracts--his options for treating her were limited. Because of her age and overall health, Ortensia Aceti of Sault Ste. Marie, Ont., was not a good candidate for surgery to repair her mitral valve, the flap between the two left chambers of her heart. She had been in and out of hospital with heart failure and medication was no longer controlling her symptoms. Instead, he decided on a catheter-based treatment to guide a MitraClip device to the heart and clamp the leaky valve. The catheter would usually be inserted through the femoral vein in the leg, but her vein was blocked. "We were locked out, blocked from accessing her heart," said Dr. Fam, an interventional cardiologist and director of the Cardiac Intensive Care Unit of St. Michael's Hospital in Toronto. Dr. Fam recalled a conversation he had about a year previously with Baylis Medical Company, Inc., a Canadian supplier of high-tech cardiology equipment, about one of their devices that was designed to achieve access to the heart from alternative approaches. For the first time in the world, Dr. Fam successfully used the company's SupraCross RF Solution to guide a MitraClip device through the jugular vein - a more direct route to the heart -- and successfully repair Mrs. Aceti's leaking mitral valve. Dr. Fam said this was possible, despite the awkward angle of the jugular vein in relation to the heart, because the tip of the sheath is steerable and the wire is equipped to deliver radiofrequency energy to puncture the septum of the heart. This allows the physician to position the system appropriately from this challenging angle and puncture the septum of the heart in a precise and controlled manner without using excessive force. The septum is the dividing wall between the left and right sides of the heart and it's the last barrier to getting to the mitral valve, which sits between the left ventricle and the left atrium. Dr. Fam said Mrs. Aceti had no complications and her condition improved, allowing her to be discharged to her home. At a followup appointment, she was doing well with no further heart failure. Sue Carlucci, one of Mrs. Aceti's three daughters, said that Dr. Fam explained the novel procedure to the family carefully in advance. "If Dr. Fam hadn't suggested this procedure, we probably would have lost our mom," she said. "He's our angel," she said, referring to St. Michael's nickname, the Urban Angel. Dr. Fam said that while this procedure would be appropriate for only selected patients, they are high-risk patients for which there may be no other treatment options. "Given the success of this procedure, the door is open for future studies of the jugular approach for treating the mitral valve," he said. Dr. Fam published a report of this procedure in Eurointervention on May 9. St. Michael's Hospital provides compassionate care to all who enter its doors. The hospital also provides outstanding medical education to future health care professionals in more than 29 academic disciplines. Critical care and trauma, heart disease, neurosurgery, diabetes, cancer care, care of the homeless and global health are among the hospital's recognized areas of expertise. Through the Keenan Research Centre and the Li Ka Shing International Healthcare Education Center, which make up the Li Ka Shing Knowledge Institute, research and education at St. Michael's Hospital are recognized and make an impact around the world. Founded in 1892, the hospital is fully affiliated with the University of Toronto.
Riley C.M.,Cardiac Intensive Care Unit
Pediatric Critical Care Medicine | Year: 2017
OBJECTIVE:: To understand sustainability and assure long-term gains in multidisciplinary performance improvement using an operating room to cardiac ICU handoff process focused on creation of a shared mental model. DESIGN:: Performance improvement cohort project with pre- and postintervention assessments spanning a 4-year period. SETTING:: Twenty-six bed pediatric cardiac ICU in a tertiary care children’s hospital. PATIENTS:: Cardiac surgery patients admitted to cardiac ICU from the operating room following cardiac surgery. INTERVENTIONS:: An interdisciplinary workgroup overhauled our handoff process in 2010. The new algorithm emphasized role delineation, standardized communication, and creation of a shared mental model. Our “I-5” mnemonic allowed validation and verification of a shared mental model between multidisciplinary teams. Staff orientation and practice guidelines were revised to incorporate the new process, visual aids were distributed and posted at each patient’s bedside, and lapses/audit data were discussed in multidisciplinary forum. MEASUREMENTS AND MAIN RESULTS:: Audits assessing equipment and information transfer during handoff were performed 8 weeks following implementation (n = 29), repeated at 1 year (n = 37), 3 years (n = 15), and 4 years (n = 50). Staff surveys prior to implementation, at 8 weeks, and 4 years postintervention assessed satisfaction. Comprehensiveness of information transfer improved in the 4 years following implementation, and staff satisfaction was maintained. At 4 years, discussion of all elements of information transfer was 94%, increased from 85% 8 weeks following implementation and discussion of four or more information elements was 100% increased from 93%. Of the 73% of staff who completed the survey at 4 years, 91% agreed that they received all necessary information, and 87% agreed that the handoff resulted in a shared mental model. CONCLUSIONS:: Our methods were effective in creating and sustaining high levels of staff communication and adherence to the new process, thus achieving sustainable gains. Performance improvement initiatives require proactive interdisciplinary maintenance to be successful long term. ©2017The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies
Araujo-Martnez A.,Cardiac Intensive Care Unit |
Garcia-Benitez L.,Cardiac Intensive Care Unit |
Hernandez-Beltran E.,Cardiac Intensive Care Unit |
Perez-Juarez F.,Cardiac Intensive Care Unit |
And 3 more authors.
Acta Pediatrica de Mexico | Year: 2016
BACKGROUND: Low free triiodothyronine level in patients undergoing heart surgery with cardiopulmonary bypass (CPB) is well described in literature, but the prevalence in pediatric Mexican population is yet unknown. OBJECTIVE: To know the prevalence of postoperative low free triiodothyronine level and the associated complications after cardiopulmonary bypass exposure in pediatric population in Mexico. MATERIAL AND METHODS: A sample of free triiodothyronine (FT3) blood was obtained in the early postoperative period of patients undergoing CPB heart surgery. Postoperative low FT3 level (PLFT3) was defned as any blood value under 2.9 pg/mL. Logistical regression models were used for analysis of independent variables, adjusted for complexity score (RACHS-1) and Aristotle Comprehensive Complexity Score. RESULTS. PLFT3 was present in 35.7% of the patients (n=109). Correlation with PLFT3 the following variables were observed: prolonged CPB time (p=0.001) prolonged aortic cross clamp (p=0.002) level of complexity of the surgery as measured by Aristotle ≥3 (p=0.001) and RACHS-1 ≥3 (p=0.021). Associated complications were: postoperative arrhythmias (p=0.008) extended intubation period (p=0.008) and higher infection rate (p=0.002).
Smolka G.,Upper Silesian Medical Center |
Peszek-Przybyla E.,Upper Silesian Medical Center |
Rychlik W.,Cardiac Intensive Care Unit |
Ochala A.,University of Silesia
Postepy w Kardiologii Interwencyjnej | Year: 2012
We describe a case of a 66-year-old man, with ischaemic cardiomyopathy, unstable angina and severe peripheral artery disease in whom after a successful percutaneous coronary intervention (PCI) of the circumflex branch with drug-eluting stent implantation, increasing vasoconstriction of the distal segment on guidewire occurred, resulting in vessel and systemic flow impairment, followed by cardiogenic shock. After about 1 h of resuscitation, due to haemodynamic instability, intra-aortic ballon pump (IABP) insertion via the transbrachial route was mandatory. Several minutes after IABP insertion, haemodynamic stabilization was obtained. Two h after admission to the Cardiac Intensive Care Unit (CICU) the patient regained consciousness. The IABP was removed 16 h later with vascular access suture Angio-Seal applied. The transbrachial route may be considered as IABP access in patients with no other access route, but due to the small vessel diameter along with technical difficulties there is always a risk of artery thrombosis or limb ischaemia.
Ganz F.D.,Hebrew University of Jerusalem |
Levy H.,Rambam Health Care Center |
Khalaila R.,Zefat Academic College |
Arad D.,Israel Ministry of Health |
And 5 more authors.
Journal of Nursing Scholarship | Year: 2015
Purpose: International studies report that nurse bullying is a common occurrence. The intensive care unit (ICU) is known for its high stress levels, one factor thought to increase bullying. No studies were found that investigated bullying in this population. The purpose of this study was to describe the prevalence of ICU nurse bullying and what measures were taken to prevent bullying. Design: This was a descriptive study of a convenience sample of 156 ICU nurses from five medical centers in Israel. Data collection was conducted over a 10-month period in 2012 and 2013. Methods: After ethical approval, three questionnaires (background characteristics, Negative Acts Questionnaire-Revised, and Prevention of Bullying Questionnaire) were administered according to unit preference. Descriptive statistics were calculated for all responses and a Pearson product moment correlation was calculated to determine the relationship between bullying and its prevention. Findings: Most of the nurses in the study were married, female staff nurses with a baccalaureate in nursing. No participant responded that they had been bullied daily, but 29% reported that they were a victim of bullying. The mean bullying score was 1.6 ± 1.4 out of 5. The mean prevention score was 2.4 ± 0.3 out of 4. Significant differences were found between hospitals on bullying, F (4,155) = 2.7, p = .039, and between hospitals, F (4,155) = 2.9, p = .026, and units, F (5,143) = 3.4, p = .006, on prevention. The Prevention Scale significantly correlated with the bullying scale (r = .58, p < .001). No other variables were found to be associated with either bullying or prevention scores. Conclusions: An alarming percentage of nurses were victims of bullying. Levels of bullying were low to moderate. Level of prevention was weak or moderate. The higher the level of bullying, the lower the level of prevention. The work environment as opposed to individual characteristics seems to have an impact on bullying and its prevention. Clinical Relevance: More measures must be taken to prevent bullying. Nurses must be educated to accept only a zero tolerance to bullying and to report bullying when confronted by bullying. © 2015 Sigma Theta Tau International.
PubMed | Hebrew University of Jerusalem, Israel Ministry of Health, Cardiac Intensive Care Unit, Hadassah Medical Center and 5 more.
Type: Journal Article | Journal: Journal of nursing scholarship : an official publication of Sigma Theta Tau International Honor Society of Nursing | Year: 2015
International studies report that nurse bullying is a common occurrence. The intensive care unit (ICU) is known for its high stress levels, one factor thought to increase bullying. No studies were found that investigated bullying in this population. The purpose of this study was to describe the prevalence of ICU nurse bullying and what measures were taken to prevent bullying.This was a descriptive study of a convenience sample of 156 ICU nurses from five medical centers in Israel. Data collection was conducted over a 10-month period in 2012 and 2013.After ethical approval, three questionnaires (background characteristics, Negative Acts Questionnaire-Revised, and Prevention of Bullying Questionnaire) were administered according to unit preference. Descriptive statistics were calculated for all responses and a Pearson product moment correlation was calculated to determine the relationship between bullying and its prevention.Most of the nurses in the study were married, female staff nurses with a baccalaureate in nursing. No participant responded that they had been bullied daily, but 29% reported that they were a victim of bullying. The mean bullying score was 1.6 1.4 out of 5. The mean prevention score was 2.4 0.3 out of 4. Significant differences were found between hospitals on bullying, F (4,155) = 2.7, p = .039, and between hospitals, F (4,155) = 2.9, p = .026, and units, F (5,143) = 3.4, p = .006, on prevention. The Prevention Scale significantly correlated with the bullying scale (r = .58, p < .001). No other variables were found to be associated with either bullying or prevention scores.An alarming percentage of nurses were victims of bullying. Levels of bullying were low to moderate. Level of prevention was weak or moderate. The higher the level of bullying, the lower the level of prevention. The work environment as opposed to individual characteristics seems to have an impact on bullying and its prevention.More measures must be taken to prevent bullying. Nurses must be educated to accept only a zero tolerance to bullying and to report bullying when confronted by bullying.
Sielski J.,Jan Kochanowski University |
Sielski J.,Cardiac Intensive Care Unit |
Janion-Sadowska A.,Cardiac Intensive Care Unit |
Sadowski M.,Cardiac Intensive Care Unit |
And 5 more authors.
Polskie Archiwum Medycyny Wewnetrznej | Year: 2012
INTRODUCTION: Advanced age is a significant risk factor for acute coronary syndrome (ACS). Because women live longer than men, they constitute the majority of elderly patients with ACS. OBJECTIVES: The aim of the study was to assess differences in clinical presentation, treatment, and prognosis in elderly women with non-ST-segment elevation myocardial infarction (NSTEMI). PATIENTS AND METHODS: A total of 1219 consecutive patients with NSTEMI (women, 43%) hospitalized during 1 year in a district of 1,300,000 inhabitants were analyzed. Data concerning in-hospital course were obtained from the Polish Registry of Acute Coronary Syndromes (PL-ACS), data on rehospitalization from the local branch of the National Health Fund, and data on mortality from the local register office. RESULTS: There were 387 patients aged under 65 years (women, 27%) and 832 aged over 65 years (women, 50.1%). In both groups, women had more risk factors than men. Coronary angiography and percutaneous transluminal coronary angioplasty were performed less frequently in the age group over 65 years, both in men and women, compared with the younger age group (23.8% vs. 41.9%, P <0.001 and 11.8% vs. 25.6%, P <0.01, respectively). Treatment outcomes were comparable between men and women in both age groups. CONCLUSIONS: In elderly patients with NSTEMI, the percentage of women is higher than that of men compared with the younger age group. Despite the fact that invasive approach was less frequently used in women, long-term prognosis was similar in both sexes. Copyright by Medycyna Praktyczna, 2012.
Watson J.,University of Cincinnati |
Watson J.,United Medical Systems |
Kinstler A.,Cardiac intensive care unit |
Vidonish W.P.,Cincinnati Childrens Hospital Medical Center |
And 5 more authors.
American Journal of Critical Care | Year: 2015
Background: Excessive exposure to noise places nurses at risk for safety events, near-misses, decreased job performance, and fatigue. Noise is particularly a concern in pediatric intensive care units, where highly skilled providers and vulnerable patients require a quiet environment to promote healing. Objective: To measure noise levels and noise duration on specialty pediatric intensive care units to explore sources of noise and its effects on the health of registered nurses. Methods: In a cross-sectional pilot study, levels and sources of noise in 3 different specialty pediatric intensive care units were assessed. Fifteen nurses were observed for 4-hour sessions during a 24-hour period. Sound pressure levels (noise) and heart rate were measured continuously, and stress ratings were recorded. Descriptive statistics were calculated for noise (level, source, location, and activity), heart rate, and stress. The Pearson correlation coefficient was calculated to analyze the relationship between heart rate and noise. Results: Mean noise level was 71.9 (SD, 9.2) dBA. Mean heart rate was 85.2/min (SD, 15.8/min) and was significantly associated with noise, unit, within-unit location, nurse sources, and noise activities. The most frequent sources of noise were patients' rooms, care activities, and staff communications. Conclusions: Noise levels in pediatric intensive care units exceed recommended thresholds and require immediate attention through effective interventions. Although noise was not associated with stress, a significant correlation with increased heart rate indicates that noise may be associated with adverse health outcomes. © 2015 American Association of Critical-Care Nurses.
Pollak U.,Cardiac Intensive Care Unit |
Yacobobich J.,Hematology Unit |
Yacobobich J.,Tel Aviv University |
Tamary H.,Hematology Unit |
And 3 more authors.
Journal of Extra-Corporeal Technology | Year: 2011
Heparin-induced thrombocytopenia (HIT) is an immunemediated coagulation side effect of heparin therapy characterized by thrombocytopenia and by a paradoxical prothrombotic state following heparin exposure when thrombotic or thromboembolic events accurse, the condition is classified as Heparin-induced thrombocytopenia with thrombosis (HITT). We report a case of HITT with evidence of small-vessel arterial thrombosis in a 5-day-old newborn receiving extracorporeal membrane oxygenation (ECMO) for congenital diaphragmatic hernia, and our attempt of bivalirudin alternative treatment. We also review previous reports regarding HIT and ECMO with the alternative management in this unique population.
Hughes M.L.,Great Ormond Street Hospital for Children |
Tsang V.T.,Cardiac Surgery |
Kostolny M.,Cardiac Surgery |
Giardini A.,Great Ormond Street Hospital for Children |
And 3 more authors.
Cardiology in the Young | Year: 2011
This study describes single-unit experience and explores risk stratification, with protocolised inter-stage cardiac magnetic resonance imaging for infants with hypoplastic left heart syndrome. Survival was retrospectively analysed among the cohort of locally followed survivors of Norwood Stage I procedure, who underwent magnetic resonance imaging under general anaesthesia from 2003 to 2008. This included 32 patients: 17 with Sano conduit and 15 with arterio-pulmonary shunt. The median (inter-quartile range) age and weight at scan were 3.1 (2.6-4.6) months and 5.0 (4.5-5.3) kilograms, respectively. Using morphologic definitions, the median coarctation index was 0.71 (0.57-0.83). The degree of proximal right and left pulmonary artery narrowing was 25% (14-44%) and 25% (11-50%), respectively. The median right ventricular ejection fraction was 54% (48-59%). The ejection fraction was not related to the coarctation index or to pulmonary artery narrowing. Patients were followed up for a median of 19.2 (10.8-46.0) months, during which 13 (41%) had an intervention in addition to routine Norwood Stage II surgery and seven died. Risk of death was related to reduced right ventricular ejection fraction, with a hazard ratio of 0.91 (95% confidence interval 0.85-0.98, p = 0.02), and the cumulative number of focal stenoses of neo-aortic arch and pulmonary arteries (hazard ratio 2.71, 95% confidence interval 1.14-6.44, p = 0.02). Conclusions: In addition to comprehensive three-dimensional morphologic imaging, inter-stage cardiac magnetic resonance imaging provides a ventricular functional index that may predict outcome in patients with hypoplastic left heart syndrome. Measures to preserve right ventricular systolic function and relieve stenoses are paramount within the complex management strategies for these patients. © Copyright Cambridge University Press 2011.