• Login
    View Item 
    •   UMB Digital Archive
    • School, Graduate
    • Theses and Dissertations All Schools
    • View Item
    •   UMB Digital Archive
    • School, Graduate
    • Theses and Dissertations All Schools
    • View Item
    JavaScript is disabled for your browser. Some features of this site may not work without it.

    Browse

    All of UMB Digital ArchiveCommunitiesPublication DateAuthorsTitlesSubjectsThis CollectionPublication DateAuthorsTitlesSubjects

    My Account

    LoginRegister

    Statistics

    Display statistics

    Post-operative epicardial pacing and hemodynamic support among Aortic Valve Patients

    • CSV
    • RefMan
    • EndNote
    • BibTex
    • RefWorks
    Thumbnail
    Name:
    Brady_umaryland_0373D_10490.pdf
    Size:
    1.275Mb
    Format:
    PDF
    Download
    Author
    Brady, Barbara Anne
    Advisor
    Storr, Carla L.
    Date
    2013
    Type
    dissertation
    
    Metadata
    Show full item record
    Abstract
    Background: Burdens of cardiac and extra-cardiac co-morbidity, coupled with complex surgical and anesthesia interventions, require intense intra- and post-operative monitoring and care to optimize outcomes. Despite a need for clinical guidance, a paucity of studies explores post-operative temporary epicardial pacing, vasopressor and inotropic medication use among aortic valve replacement (AVR) patients. Purpose: To better target post-operative interventions for AVR patients, associations between pre and intra-operative risk factors (e.g., chronic conditions, QRS duration and medication use), cardiovascular interventions (pacing and hemodynamic support), and post-operative outcomes (morbidity and resource utilization) were explored. Methods: Medical records of 195 patients having an AVR from 11/2007 to 10/2011 were reviewed from a single academic medical center. Cross-sectional analyses used multivariable analyses to identify factors associated with temporary epicardial pacing, acute kidney injury, and length of stay. Results: Patients were equally represented in gender, nearly all (88%) Caucasian, with a mean age of 67.7 years (SD=12.9). More than a third of patients (36%) were paced at time of bypass separation; 13% of the total continued to be paced after 7 a.m. of post-operative day-1. Females were more likely to be paced in the CSICU (OR = 3.08, 1.30-7.31), while pre-operative co-morbidities, ejection fraction, QRS duration, stain or ACE/ARB uses and CPB time did not have an independent effect. Post-operative pacing and level of hemodynamic support were not associated with day-2 renal function. Prolonged CSICU stays were associated with female gender, age>75 years, and if both epicardial and hemodynamic supports were used as compared to no cardiovascular support. Prolonged hospital stays were associated with prolonged CSICU stay > 4 days and age>75 years. Conclusions: Post-operative management of AVR patients has considerable variability. While it would be useful to pre-operatively identify patients requiring extended post-operative pacing and hemodynamic support, no co-morbidities were associated. Additional studies are needed to better risk stratify AVR patients so interventions can be targeted so the care team can better plan care and monitor progress.
    Description
    University of Maryland, Baltimore. Nursing. Ph.D. 2013
    Keyword
    epicardial pacing
    hemodynamic support
    Acute Kidney Injury
    Aortic Valve
    Length of Stay
    Postoperative Care
    Identifier to cite or link to this item
    http://hdl.handle.net/10713/3637
    Collections
    Theses and Dissertations School of Nursing
    Theses and Dissertations All Schools

    entitlement

     
    DSpace software (copyright © 2002 - 2023)  DuraSpace
    Quick Guide | Policies | Contact Us | UMB Health Sciences & Human Services Library
    Open Repository is a service operated by 
    Atmire NV
     

    Export search results

    The export option will allow you to export the current search results of the entered query to a file. Different formats are available for download. To export the items, click on the button corresponding with the preferred download format.

    By default, clicking on the export buttons will result in a download of the allowed maximum amount of items.

    To select a subset of the search results, click "Selective Export" button and make a selection of the items you want to export. The amount of items that can be exported at once is similarly restricted as the full export.

    After making a selection, click one of the export format buttons. The amount of items that will be exported is indicated in the bubble next to export format.