AUCTORES
Globalize your Research
Research Article | DOI: https://doi.org/10.31579/2639-4162/112
1 Tehran University of Medical Sciences, Amir Alam Hospital complex, Department of anesthesiology, Tehran, Iran.
2 Tehran University of Medical Sciences, Imam Khomeini Hospital complex, Department of anesthesiology, Tehran, Iran.
3Tehran University of Medical Sciences, School of medicine, Tehran, Iran.
4 Department of Nursing, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
5 Iran university of medical sciences, School of medicine, Tehran, Iran.
6 Islamic azad university, school of food industrial engineering, Tehran, Iran.
7 Shahid Beheshti University of Medical Sciences, Tehran, Iran
*Corresponding Author: Kianoush Saberi, Imam Khomeini Hospital Complex, Tohid Squre, Tehran, Iran.
Citation: Kianoush Saberi, Misha Seyednia, Fatemeh Abdoli, Ali Abdoli, Hossein Saberi, et al, (2023), Investigating the Relationship Between Changes in Cerebral Oximetry and Area Under the Curve with Short-Term Complications after Cardiac Surgery, J. General Medicine and Clinical Practice. 6(6); DOI:10.31579/2639-4162/112
Copyright: © 2023, Kianoush Saberi. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Received: 04 August 2023 | Accepted: 25 August 2023 | Published: 29 August 2023
Keywords: cerebral oximetry, complications of cardiac surgery
Background: The availability of monitoring equipment is increasing today. These devices range from invasive to non-invasive. The selection of appropriate monitoring is based on their advantages, disadvantages and costs. In general, the role of non-invasive brain monitoring is expanding due to its performance accuracy as well as greater output stability. Annually, nearly half of one million patients who undergo heart surgery commonly experience neurological complications such as cognitive disorders, neuropsychological disorders, etc. In this study we aimed to investigate the relationship between short-term complications after heart surgery with cerebral oximetry changes and the space under the curve (duration of rSo2 drop) so that this monitoring may be used for heart surgery in the future.
Methods: This prospective cross-sectional study was performed on 101 patients in the cardiac surgery room of Imam Khomeini Hospital in Tehran during 2019-2020. After entering the operating room, patients underwent routine monitoring such as: NIBP, ECG, HR, Spo2, ETCo2 will be placed. Then, before induction of anesthesia, they are monitored by INVOS 5100c cerebral oximeter rSo2. Patients will be followed up for 7 days, the duration of intubation and hospitalization in the ICU and complications such as renal failure, CVA and death will be recorded for them. P-value less than 0.05 was significant.
Result: There is a significant relationship between the AUC left and IHD (P-value=0.034), CVA (P-value=0.05), multivalve surgery (P-value=0.05), CABG surgery (P-value=0.001), dissection surgery (P-value=0.009), ICU stay (left P-value=0.01, right P-value=0.005), intubation time (P-value=0.023), people who die within a week (P-value=0.036). There is a significant relationship between the amount of rSO2Left and the EF variable before the operation (P-value=0.014), stage 3 kidney failure and mortality rate after one week (P-value=0.001). the Cross lamp duration is the highest for patients whose rSO2Left was in the region of (10-20) and the lowest Cross lamp duration for patients who did not have drop in rSO2Left (P-value=0.002). There is a significant difference in pump time between people who did not have a drop in rSO2 and people who had a drop of more than 20 minutes (P-value=0.032). The cross lamp duration of patients in the first group of rSO2 has a significant relationship with the other three groups (P-value<0.001).
Conclusion: The mean level below the cerebral oximetry chart (AUC) in patients with IHD and CVA was significant. This means that the disease affects the amount of oxygenation during the operation.
In patients undergoing CABG surgery, the data recorded on the right forehead showed a lower area under the curve. Also, patients with dissection of the aorta have more significant data on the right side.
Also, the left data of patients had a significant relationship with the EF variable before surgery and this variable affects the patient's brain oxygen level.
Today, the availability of monitoring devices is expanding. These devices range from invasive to non-invasive. Choosing the right monitoring is based on their advantages, disadvantages and costs. In general, the role of non-invasive brain monitoring is expanding due to the accuracy in performance and more stable output. Every year, nearly half of one million patients who undergo heart surgery commonly experience neurological complications such as cognitive disorders, neuropsychological disorders, etc., in a quarter of them these changes remain stable and the main cause of these complications is brain tissue ischemia (2-5). Neurological complications are one of the most important complications after heart surgery, and POCD (postoperative cognitive dysfunction) is usually seen in 23-81% of these patients (28). Other complications of the central nervous system after cardiovascular surgery can be mentioned as cerebral embolism, decreased perfusion of all parts of the brain, inflammation, cerebral hyperthermia, cerebral edema, and dysfunction of the blood-brain barrier. In addition to the above, it seems that the processes that damage the CNS can also affect other vital organs of the body and lead to damage in them as well (2). Cerebral oximetry and jugular bulb oximetry are used to evaluate brain oxygenation, which jugular bulb oximetry measures jugular oxygen saturation (Sjvo2) through the vein directly and invasively. Cerebral oximetry can measure the oxygen saturation of the cerebral vessels (rSo2) even in those with a diameter of less than one mm. It can measure the oxygen saturation locally and non-invasively through infrared light that sensors are placed on the forehead and one of its most important advantages compared with jugular bulb oximetry is that cerebral oximetry can also measure rSo2 in nonpulsatile times, such as when the patient is on cardiopulmonary bypass or cardiopulmonary arrest (1). It has been shown in some studies that interventions based on cerebral oximetry monitoring have been effective in improving the outcome of patients (1).
Considering the above, in this study, we decided to investigate the relationship between short-term complications after heart surgery with changes in cerebral oximetry and the space under the curve (duration of rSo2 drop), so that perhaps this monitoring can be used for heart surgery in the future.
This is a prospective cross-sectional study on 101 eligible patients undergoing heart surgery in Imam Khomeini Hospital from March 2018 to March 2020. All patients aged 20-80 years after obtaining informed consent and meeting the entry criteria (age 20-80 years, non-emergency cardiac surgery) will be monitored by the INVOS cerebral oximetry device and their data will be entered into a questionnaire and the amount and type of complications will be evaluated during hospitalization.
Using the sample size formula plus 10
101 patients aged 20-80 underwent heart surgery at Imam Khomeini Hospital and entered this prospective cross-sectional study. After obtaining informed consent, they were examined by the INVOS cerebral oximetry device, and their data were entered into a questionnaire, and the amount and type of complications were evaluated during the hospitalization period.
The demographic information of 101 patients of this study is analyzed in Table No.1
| N (%) | ||
| Gender | Male | 64 (63.4%) |
| Female | 37 (36.6%) | |
| BMI | 18 - 25 | 44 (43.6%) |
| 25 - 30 | 57 (56.4%) | |
| Smoker | No | 83 (82.2%) |
| Yes | 18 (17.8%) | |
| Age | Mean ± SD | 52.92 ± 16.68 |
| Median (Range) | 55 (19,79) |
Table 1: demographic information of patients
In table number 2, we examine the clinical information of the patients.
| N (%) | ||
| IHD | No | 66 (65.3%) |
| Yes | 35 (34.7%) | |
| CHF | No | 76 (75.2%) |
| Yes | 25 (24.8%) | |
| CKD | No | 94 (93.1%) |
| Yes | 7 (6.9%) | |
| DM | No | 85 (84.2%) |
| Yes | 16 (15.8%) | |
| HTN | No | 57 (56.4%) |
| Yes | 44 (43.6%) | |
| CVA | No | 89 (88.1%) |
| Yes | 12 (11.9%) | |
| CABG | No | 88 (87.1%) |
| Yes | 13 (12.9%) | |
| Valve surgery | No | 60 (59.4%) |
| Yes | 41 (40.6%) | |
| CABG + Valve surgery | No | 85 (84.2%) |
| Yes | 16 (15.8%) | |
| Multivalve surgery | No | 88 (87.1%) |
| Yes | 13 (12.9%) | |
| Dissection | No | 83 (82.2%) |
| Yes | 18 (17.8%) | |
| EF | <30> | 18 (17.8%) |
| >30% | 83 (82.2%) |
Table 2: Clinical information of patients
Cerebral oximetry changes and the area under the drop time curve (rSo2) have been analyzed in Table No. 3.
| N (%) | P-value* | ||
| LEFT rSO2<30> | 0 | 39 (38.6%) | <0> |
| <10> | 29 (28.7%) | ||
| 10 – 20 | 18 (17.8%) | ||
| >20 | 15 (14.9%) | ||
| RIGHT rSO2<30> | 0 | 41 (40.6%) | |
| <10> | 30 (29.7%) | ||
| 10 – 20 | 15 (14.9%) | ||
| >20 | 15 (14.9%) | ||
| Mean ± SD | Median (Range) | ||
| LEFT AUC | 339.77 ± 331.15 | 230 (100,1930) | |
| RIGHT AUC | 383.47 ± 471.4 | 200 (100,2350) |
Table 3: Examining changes in cerebral oximetry and the area under the curve of the drop time
In table number 4, we examine the average and standard deviation of variables calculated during the operation.
| N (%) | |||
| Duration of ICU add(days) | Death in the operating room | 2 (2.0%) | |
| <3> | 35 (34.7%) | ||
| 3 – 5 | 51 (50.5%) | ||
| >5 | 13 (12.9%) | ||
| Extubation time(hrs) | Death in the operating room& Icu | 7 (6.9%) | |
| <8> | 24 (23.8%) | ||
| 8 – 24 | 56 (55.4%) | ||
| >24 | 14 (13.9%) | ||
| Mean ± SD | Median (Range) | ||
| Pomp time(min) | 148.62 ± 65.67 | 137 (20,350) | |
| Cross Clamp time(min) | 91.58 ± 36.29 | 90 (30,208) |
Table 4: Checking the mean and standard deviation of each Variable
In table number 5, we examine the complications that occurred in the first week after the operation.
| N (%) | ||
| AKI stage1 W1 | No | 87 (86.1%) |
| Yes | 14 (13.9%) | |
| AKI stage2 W1 | No | 86 (85.1%) |
| Yes | 15 (14.9%) | |
| AKI stage3 W1 | No | 93 (92.1%) |
| Yes | 8 (7.9%) | |
| Dialysis W1 | No | 99 (98.0%) |
| Yes | 2 (2.0%) | |
| Death W1 | No | 84 (83.2%) |
| Yes | 17 (16.8%) |
Table 5: Complications that occurred during the first week after the operation
In table number 6, we examine the relationship between changes in cerebral oximetry and area under the curve with demographic and clinical information of people.
| LEFT AUC | RIGHT AUC | |||||
| Mean ± SD | P-value* | Mean ± SD | P-value* | |||
| Gender | Male | 365.33 ± 360.62 | 0.358 | 387 ± 475.95 | 0.933 | |
| Female | 293.21 ± 269.21 | 377.43 ± 472.1 | ||||
| BMI | 18 - 25 | 375.19 ± 370.27 | 0.388 | 369.64 ± 453.97 | 0.81 | |
| 25 - 30 | 310.12 ± 295.68 | 395.93 ± 491.98 | ||||
| Smoker | No | 335.02 ± 303.95 | 0.802 | 380.71 ± 489.8 | 0.925 | |
| Yes | 358.5 ± 433.47 | 393.06 ± 414.55 | ||||
| IHD | No | 384.26 ± 378.31 | 0.034 | 451.47 ± 556.37 | 0.015 | |
| Yes | 249.08 ± 178.03 | 244.76 ± 140.23 | ||||
| CHF | No | 340.81 ± 350.53 | 0.962 | 417.74 ± 515.45 | 0.275 | |
| Yes | 336.7 ± 274.01 | 280.68 ± 290.6 | ||||
| CKD | No | 347.97 ± 336.94 | 0.085 | 391.07 ± 482.78 | 0.099 | |
| Yes | 186 ± 132.59 | 246.75 ± 113.88 | ||||
| DM | No | 346.09 ± 347.65 | 0.691 | 402.12 ± 508.41 | 0.429 | |
| Yes | 304.5 ± 225.43 | 284 ± 147.98 | ||||
| HTN | No | 306.09 ± 282.78 | 0.289 | 370.32 ± 463.79 | 0.759 | |
| Yes | 386.73 ± 388.51 | 404.79 ± 491 | ||||
| CVA | No | 353.38 ± 340.74 | 0.05 | 400.68 ± 490.94 | 0.009 | |
| Yes | 199.86 ± 163.2 | 213.86 ± 95.26 | ||||
| CABG | No | 351.37 ± 348.02 | 0.087 | 413.65 ± 498.08 | 0.001 | |
| Yes | 249.56 ± 119.23 | 184.3 ± 96.42 | ||||
| Valvular | No | 346.98 ± 377.02 | 0.834 | 342.51 ± 404.37 | 0.391 | |
| Yes | 331.17 ± 271.43 | 436.85 ± 548.64 | ||||
| cabg-valv | No | 350.12 ± 343.91 | 0.493 | 395.66 ± 492.12 | 0.542 | |
| Yes | 275.82 ± 240.17 | 292.78 ± 273.49 | ||||
| Multivalve | No | 309.13 ± 252.93 | 0.05 | 366.94 ± 461.47 | 0.461 | |
| Yes | 510.83 ± 596.73 | 481.18 ± 539.84 | ||||
| dissection | No | 319.57 ± 337.58 | 0.321 | 309.02 ± 317.76 | 0.009 | |
| Yes | 408.22 ± 307.42 | 641.88 ± 764.35 | ||||
| Age.c | 20 - 40 | 388.52 ± 408.77 | 0.474 | 439.76 ± 546.72 | 0.26 | |
| 40 - 60 | 282.21 ± 247.94 | 252.26 ± 163.34 | ||||
| 60 + | 317.17 ± 256.95 | 419.81 ± 537.95 | ||||
*Based on T-test
Table 6: Examining the relationship between the space under the curve and demographic information, diseases and type of operation
In Table No. 7, we examine the average AUC during the operation against the variables of operation time and complications one week after the operation.
| LEFT AUC | RIGHT AUC | |||||
| Mean ± SD | P-value* | Mean ± SD | P-value* | |||
| Duration of ICU add(days) | No | 1122 ± . | 0.01 | 1917 ± . | 0.005 | |
| <3> | 444 ± 462.5 | 426.79 ± 514.05 | ||||
| (3 - 5) | 273.95 ± 195.4 | 359.74 ± 443.38 | ||||
| >5 | 236.73 ± 111.89 | 223.83 ± 103.4 | ||||
| Extubation time(hrs) | No | 820.75 ± 656.86 | 0.023 | 1260 ± 1007.54 | 0.008 | |
| <8> | 346.84 ± 413.91 | 285.42 ± 309.62 | ||||
| (8 - 24) | 310.02 ± 261.66 | 364.7 ± 447.81 | ||||
| >24 | 274.36 ± 122.29 | 389.4 ± 445.22 | ||||
| EF | <30> | 359.93 ± 265.59 | 0.804 | 289 ± 297.91 | 0.431 | |
| >30% | 335.43 ± 345.27 | 402.97 ± 499.37 | ||||
| AKI stage1 W1 | No | 341.1 ± 340.69 | 0.933 | 399.91 ± 499.82 | 0.464 | |
| Yes | 332.33 ± 284.77 | 286.36 ± 235.79 | ||||
| AKI stage2 W1 | No | 353.09 ± 356.06 | 0.424 | 413.72 ± 501.2 | 0.176 | |
| Yes | 272.15 ± 141.89 | 204.73 ± 133.53 | ||||
| AKI stage3 W1 | No | 344.51 ± 345.37 | 0.686 | 382.47 ± 473.11 | 0.957 | |
| Yes | 291 ± 104.93 | 392 ± 488.2 | ||||
| Dialysis W1 | No | 339.51 ± 333.28 | 0.951 | 384.72 ± 474.44 | 0.843 | |
| Yes | 360 ± . | 290 ± . | ||||
| Death W1 | No | 303.63 ± 283.07 | 0.036 | 334.97 ± 391.61 | 0.048 | |
| Yes | 507.57 ± 476.05 | 618.54 ± 724.06 | ||||
*Based on T-Test
Table 7: Examining the average AUC against the variables of operation time and complications one week after the operation
In table number 8, we examine the amount of rSO2 of patients based on demographic characteristics, diseases and type of operation.
| LEFT rSO2<30> | RIGHT rSO2<30> | |||||||||||||||||
| 0 | <10> | 10 - 20 | >20 | P-value* | 0 | <10> | 10 - 20 | >20 | P-value* | |||||||||
| Gender | Male | 26 (66.7%) | 17 (58.6%) | 14 (77.8%) | 7 (46.7%) | 0.275 | 27 (65.9%) | 19 (63.3%) | 11 (73.3%) | 7 (46.7%) | 0.466 | |||||||
| Female | 13 (33.3%) | 12 (41.4%) | 4 (22.2%) | 8 (53.3%) | 14 (34.1%) | 11 (36.7%) | 4 (26.7%) | 8 (53.3%) | ||||||||||
| BMI | 18 - 25 | 17 (43.6%) | 13 (44.8%) | 5 (27.8%) | 9 (60.0%) | 0.322 | 19 (46.3%) | 13 (43.3%) | 6 (40.0%) | 6 (40.0%) | 0.963 | |||||||
| 25 - 30 | 22 (56.4%) | 16 (55.2%) | 13 (72.2%) | 6 (40.0%) | 22 (53.7%) | 17 (56.7%) | 9 (60.0%) | 9 (60.0%) | ||||||||||
| smoker | No | 34 (87.2%) | 24 (82.8%) | 12 (66.7%) | 13 (86.7%) | 0.28 | 36 (87.8%) | 26 (86.7%) | 8 (53.3%) | 13 (86.7%) | 0.018 | |||||||
| Yes | 5 (12.8%) | 5 (17.2%) | 6 (33.3%) | 2 (13.3%) | 5 (12.2%) | 4 (13.3%) | 7 (46.7%) | 2 (13.3%) | ||||||||||
| IHD | No | 28 (71.8%) | 18 (62.1%) | 13 (72.2%) | 7 (46.7%) | 0.316 | 29 (70.7%) | 19 (63.3%) | 7 (46.7%) | 11 (73.3%) | 0.346 | |||||||
| Yes | 11 (28.2%) | 11 (37.9%) | 5 (27.8%) | 8 (53.3%) | 12 (29.3%) | 11 (36.7%) | 8 (53.3%) | 4 (26.7%) | ||||||||||
| CHF | No | 33 (84.6%) | 21 (72.4%) | 14 (77.8%) | 8 (53.3%) | 0.117 | 34 (82.9%) | 20 (66.7%) | 12 (80.0%) | 10 (66.7%) | 0.353 | |||||||
| Yes | 6 (15.4%) | 8 (27.6%) | 4 (22.2%) | 7 (46.7%) | 7 (17.1%) | 10 (33.3%) | 3 (20.0%) | 5 (33.3%) | ||||||||||
| CKD | No | 38 (97.4%) | 27 (93.1%) | 17 (94.4%) | 12 (80.0%) | 0.159 | 39 (95.1%) | 28 (93.3%) | 15 (100.0%) | 12 (80.0%) | 0.147 | |||||||
| Yes | 1 (2.6%) | 2 (6.9%) | 1 (5.6%) | 3 (20.0%) | 2 (4.9%) | 2 (6.7%) | 0 (0.0%) | 3 (20.0%) | ||||||||||
| DM | No | 33 (84.6%) | 26 (89.7%) | 15 (83.3%) | 11 (73.3%) | 0.574 | 36 (87.8%) | 27 (90.0%) | 12 (80.0%) | 10 (66.7%) | 0.186 | |||||||
| Yes | 6 (15.4%) | 3 (10.3%) | 3 (16.7%) | 4 (26.7%) | 5 (12.2%) | 3 (10.0%) | 3 (20.0%) | 5 (33.3%) | ||||||||||
| HTN | No | 20 (51.3%) | 17 (58.6%) | 13 (72.2%) | 7 (46.7%) | 0.41 | 24 (58.5%) | 18 (60.0%) | 8 (53.3%) | 7 (46.7%) | 0.833 | |||||||
| Yes | 19 (48.7%) | 12 (41.4%) | 5 (27.8%) | 8 (53.3%) | 17 (41.5%) | 12 (40.0%) | 7 (46.7%) | 8 (53.3%) | ||||||||||
| CVA | No | 34 (87.2%) | 25 (86.2%) | 17 (94.4%) | 13 (86.7%) | 0.837 | 35 (85.4%) | 27 (90.0%) | 14 (93.3%) | 13 (86.7%) | 0.845 | |||||||
| Yes | 5 (12.8%) | 4 (13.8%) | 1 (5.6%) | 2 (13.3%) | 6 (14.6%) | 3 (10.0%) | 1 (6.7%) | 2 (13.3%) | ||||||||||
| CABG | No | 33 (84.6%) | 26 (89.7%) | 17 (94.4%) | 12 (80.0%) | 0.588 | 34 (82.9%) | 28 (93.3%) | 12 (80.0%) | 14 (93.3%) | 0.412 | |||||||
| Yes | 6 (15.4%) | 3 (10.3%) | 1 (5.6%) | 3 (20.0%) | 7 (17.1%) | 2 (6.7%) | 3 (20.0%) | 1 (6.7%) | ||||||||||
| valvular | No | 18 (46.2%) | 16 (55.2%) | 10 (55.6%) | 11 (73.3%) | 0.354 | 20 (48.8%) | 14 (46.7%) | 11 (73.3%) | 10 (66.7%) | 0.229 | |||||||
| Yes | 21 (53.8%) | 13 (44.8%) | 8 (44.4%) | 4 (26.7%) | 21 (51.2%) | 16 (53.3%) | 4 (26.7%) | 5 (33.3%) | ||||||||||
| cabg-valv | No | 34 (87.2%) | 23 (79.3%) | 16 (88.9%) | 12 (80.0%) | 0.735 | 36 (87.8%) | 24 (80.0%) | 12 (80.0%) | 13 (86.7%) | 0.786 | |||||||
| Yes | 5 (12.8%) | 6 (20.7%) | 2 (11.1%) | 3 (20.0%) | 5 (12.2%) | 6 (20.0%) | 3 (20.0%) | 2 (13.3%) | ||||||||||
| multivalv | No | 34 (87.2%) | 27 (93.1%) | 14 (77.8%) | 13 (86.7%) | 0.507 | 36 (87.8%) | 27 (90.0%) | 12 (80.0%) | 13 (86.7%) | 0.821 | |||||||
| Yes | 5 (12.8%) | 2 (6.9%) | 4 (22.2%) | 2 (13.3%) | 5 (12.2%) | 3 (10.0%) | 3 (20.0%) | 2 (13.3%) | ||||||||||
| dissection | No | 31 (79.5%) | 23 (79.3%) | 12 (66.7%) | 12 (80.0%) | 0.707 | 33 (80.5%) | 25 (83.3%) | 12 (80.0%) | 8 (53.3%) | 0.121 | |||||||
| Yes | 8 (20.5%) | 6 (20.7%) | 6 (33.3%) | 3 (20.0%) | 8 (19.5%) | 5 (16.7%) | 3 (20.0%) | 7 (46.7%) | ||||||||||
| Age.c | 20 - 40 | 10 (25.6%) | 4 (13.8%) | 6 (35.3%) | 4 (26.7%) | 0.564 | 10 (24.4%) | 5 (16.7%) | 2 (14.3%) | 7 (46.7%) | 0.339 | |||||||
| 40 - 60 | 11 (28.2%) | 14 (48.3%) | 5 (29.4%) | 5 (33.3%) | 13 (31.7%) | 12 (40.0%) | 5 (35.7%) | 5 (33.3%) | ||||||||||
| 60 + | 18 (46.2%) | 11 (37.9%) | 6 (35.3%) | 6 (40.0%) | 18 (43.9%) | 13 (43.3%) | 7 (50.0%) | 3 (20.0%) | ||||||||||
*P-value based on Chi-Square And fisher Exact test
In table number 9, we examine the rSO2 level of patients against the variables of operation time and complications one week after the operation.
Table 8: Examination of the rSO2 level of patients based on demographic characteristics, diseases and type of operation
| LEFT rSO2<30> | RIGHT rSO2<30> | ||||||||||||||||||
| 0 | <10> | 10 - 20 | >20 | P-value* | Pairwise comparison | 0 | <10> | 10 - 20 | >20 | P-value* | Pairwise comparison | ||||||||
| Duration of ICU add(days) | No | 1 (2.6%) | 0 (0.0%) | 0 (0.0%) | 1 (6.7%) | 0.081 | 1 (2.4%) | 0 (0.0%) | 0 (0.0%) | 1 (6.7%) | 0.124 | ||||||||
| <3> | 17 (43.6%) | 10 (34.5%) | 3 (16.7%) | 5 (33.3%) | 20 (48.8%) | 7 (23.3%) | 5 (33.3%) | 3 (20.0%) | |||||||||||
| 3 - 5 | 21 (53.8%) | 12 (41.4%) | 11 (61.1%) | 7 (46.7%) | 19 (46.3%) | 16 (53.3%) | 8 (53.3%) | 8 (53.3%) | |||||||||||
| >5 | 0 (0.0%) | 7 (24.1%) | 4 (22.2%) | 2 (13.3%) | 1 (2.4%) | 7 (23.3%) | 2 (13.3%) | 3 (20.0%) | |||||||||||
| Extubation time(hrs) | No | 2 (5.1%) | 2 (6.9%) | 1 (5.6%) | 2 (13.3%) | 0.136 | 1 (2.4%) | 3 (10.0%) | 2 (13.3%) | 1 (6.7%) | 0.005 | ||||||||
| <8> | 13 (33.3%) | 8 (27.6%) | 1 (5.6%) | 2 (13.3%) | 17 (41.5%) | 4 (13.3%) | 2 (13.3%) | 1 (6.7%) | |||||||||||
| 8 - 24 | 21 (53.8%) | 15 (51.7%) | 14 (77.8%) | 6 (40.0%) | 20 (48.8%) | 21 (70.0%) | 8 (53.3%) | 7 (46.7%) | |||||||||||
| >24 | 3 (7.7%) | 4 (13.8%) | 2 (11.1%) | 5 (33.3%) | 3 (7.3%) | 2 (6.7%) | 3 (20.0%) | 6 (40.0%) | |||||||||||
| EF W1 | <30> | 4 (10.3%) | 5 (17.2%) | 2 (11.1%) | 7 (46.7%) | 0.014 | 3 (7.3%) | 6 (20.0%) | 5 (33.3%) | 4 (26.7%) | 0.092 | ||||||||
| >30% | 35 (89.7%) | 24 (82.8%) | 16 (88.9%) | 8 (53.3%) | 38 (92.7%) | 24 (80.0%) | 10 (66.7%) | 11 (73.3%) | |||||||||||
| AKI stage1 W1 | No | 37 (94.9%) | 22 (75.9%) | 15 (83.3%) | 13 (86.7%) | 0.159 | 36 (87.8%) | 25 (83.3%) | 12 (80.0%) | 14 (93.3%) | 0.702 | ||||||||
| Yes | 2 (5.1%) | 7 (24.1%) | 3 (16.7%) | 2 (13.3%) | 5 (12.2%) | 5 (16.7%) | 3 (20.0%) | 1 (6.7%) | |||||||||||
| AKI stage2 W1 | No | 36 (92.3%) | 24 (82.8%) | 13 (72.2%) | 13 (86.7%) | 0.249 | 40 (97.6%) | 22 (73.3%) | 11 (73.3%) | 13 (86.7%) | 0.019 | ||||||||
| Yes | 3 (7.7%) | 5 (17.2%) | 5 (27.8%) | 2 (13.3%) | 1 (2.4%) | 8 (26.7%) | 4 (26.7%) | 2 (13.3%) | |||||||||||
| AKI stage3 W1 | No | 39 (100.0%) | 27 (93.1%) | 17 (94.4%) | 10 (66.7%) | 0.001 | 41 (100.0%) | 29 (96.7%) | 12 (80.0%) | 11 (73.3%) | 0.002 | ||||||||
| Yes | 0 (0.0%) | 2 (6.9%) | 1 (5.6%) | 5 (33.3%) | 0 (0.0%) | 1 (3.3%) | 3 (20.0%) | 4 (26.7%) | |||||||||||
| Dialysis W1 | No | 39 (100.0%) | 28 (96.6%) | 18 (100.0%) | 14 (93.3%) | 0.366 | 41 (100.0%) | 29 (96.7%) | 15 (100.0%) | 14 (93.3%) | 0.375 | ||||||||
| Yes | 0 (0.0%) | 1 (3.4%) | 0 (0.0%) | 1 (6.7%) | 0 (0.0%) | 1 (3.3%) | 0 (0.0%) | 1 (6.7%) | |||||||||||
| Death W1 | No | 37 (94.9%) | 26 (89.7%) | 15 (83.3%) | 6 (40.0%) | <0> | 40 (97.6%) | 26 (86.7%) | 9 (60.0%) | 9 (60.0%) | <0> | ||||||||
| Yes | 2 (5.1%) | 3 (10.3%) | 3 (16.7%) | 9 (60.0%) | 1 (2.4%) | 4 (13.3%) | 6 (40.0%) | 6 (40.0%) | |||||||||||
| Pomp time(min) | 137.64 ± 63.11 | 143.52 ± 50.24 | 156.22 ± 70.7 | 177.93 ± 86.52 | 0.214** | 127 ± 59.95 | 157.5 ± 49.95 | 159.33 ± 60.91 | 179.27 ± 94.79 | 0.032** | (1-4) | ||||||||
| Cross Clamp time(min) | 76.26 ± 26.55 | 95.03 ± 32.8 | 112.83 ± 38.87 | 99.27 ± 46.73 | 0.002** | (1-3) | 71.66 ± 25.88 | 101.33 ± 29.51 | 102.47 ± 40.4 | 115.67 ± 44.06 | <0> | (1-2,1-3,1-4) | |||||||
*P-value based On Chi-Square and Fisher Exact Test
** P-value Based on ANOVA (Bonferoni pairwise comparison)
Table 9: Examining the rSO2 level of patients against the variables of operation time and complications one week after the operation
In this study 64 (63.4%) were male and the rest were female. 44 (43.6%) of the patients are in the normal range of BMI (18-25) and the rest are in the abnormal range, and 18 (17.8%) of the patients are smokers. Of the total number of patients, 34 (34.7%) had IHD, 25 (24.8%) had CHF, 7 (6.9%) had CKD, 16 (15.8%) had DM, 44 (43.6%) had HTN, 12 (11.9%) had CVA, and 13 (12.9%) had CABG, 16 (15.8%) had CABG-Valve operation, 46 (45.5%) were treated with Valve operation, 13 (12.9%) with Multivalve operation and finally 23 (22.8%) had Dissection.
Based on the baseline rSo2 recorded by pressure self-adhesive on the left forehead, 39 (38.6%) of the patients had no drop oxygen below 30%, 29 (28.7%) of the patients had a drop oxygen below 30% for less than 10 minutes, 18 (17.8%) of the patients had a drop oxygen below 30
Clearly Auctoresonline and particularly Psychology and Mental Health Care Journal is dedicated to improving health care services for individuals and populations. The editorial boards' ability to efficiently recognize and share the global importance of health literacy with a variety of stakeholders. Auctoresonline publishing platform can be used to facilitate of optimal client-based services and should be added to health care professionals' repertoire of evidence-based health care resources.
Journal of Clinical Cardiology and Cardiovascular Intervention The submission and review process was adequate. However I think that the publication total value should have been enlightened in early fases. Thank you for all.
Journal of Women Health Care and Issues By the present mail, I want to say thank to you and tour colleagues for facilitating my published article. Specially thank you for the peer review process, support from the editorial office. I appreciate positively the quality of your journal.
Journal of Clinical Research and Reports I would be very delighted to submit my testimonial regarding the reviewer board and the editorial office. The reviewer board were accurate and helpful regarding any modifications for my manuscript. And the editorial office were very helpful and supportive in contacting and monitoring with any update and offering help. It was my pleasure to contribute with your promising Journal and I am looking forward for more collaboration.
We would like to thank the Journal of Thoracic Disease and Cardiothoracic Surgery because of the services they provided us for our articles. The peer-review process was done in a very excellent time manner, and the opinions of the reviewers helped us to improve our manuscript further. The editorial office had an outstanding correspondence with us and guided us in many ways. During a hard time of the pandemic that is affecting every one of us tremendously, the editorial office helped us make everything easier for publishing scientific work. Hope for a more scientific relationship with your Journal.
The peer-review process which consisted high quality queries on the paper. I did answer six reviewers’ questions and comments before the paper was accepted. The support from the editorial office is excellent.
Journal of Neuroscience and Neurological Surgery. I had the experience of publishing a research article recently. The whole process was simple from submission to publication. The reviewers made specific and valuable recommendations and corrections that improved the quality of my publication. I strongly recommend this Journal.
Dr. Katarzyna Byczkowska My testimonial covering: "The peer review process is quick and effective. The support from the editorial office is very professional and friendly. Quality of the Clinical Cardiology and Cardiovascular Interventions is scientific and publishes ground-breaking research on cardiology that is useful for other professionals in the field.
Thank you most sincerely, with regard to the support you have given in relation to the reviewing process and the processing of my article entitled "Large Cell Neuroendocrine Carcinoma of The Prostate Gland: A Review and Update" for publication in your esteemed Journal, Journal of Cancer Research and Cellular Therapeutics". The editorial team has been very supportive.
Testimony of Journal of Clinical Otorhinolaryngology: work with your Reviews has been a educational and constructive experience. The editorial office were very helpful and supportive. It was a pleasure to contribute to your Journal.
Dr. Bernard Terkimbi Utoo, I am happy to publish my scientific work in Journal of Women Health Care and Issues (JWHCI). The manuscript submission was seamless and peer review process was top notch. I was amazed that 4 reviewers worked on the manuscript which made it a highly technical, standard and excellent quality paper. I appreciate the format and consideration for the APC as well as the speed of publication. It is my pleasure to continue with this scientific relationship with the esteem JWHCI.
This is an acknowledgment for peer reviewers, editorial board of Journal of Clinical Research and Reports. They show a lot of consideration for us as publishers for our research article “Evaluation of the different factors associated with side effects of COVID-19 vaccination on medical students, Mutah university, Al-Karak, Jordan”, in a very professional and easy way. This journal is one of outstanding medical journal.
Dear Hao Jiang, to Journal of Nutrition and Food Processing We greatly appreciate the efficient, professional and rapid processing of our paper by your team. If there is anything else we should do, please do not hesitate to let us know. On behalf of my co-authors, we would like to express our great appreciation to editor and reviewers.
As an author who has recently published in the journal "Brain and Neurological Disorders". I am delighted to provide a testimonial on the peer review process, editorial office support, and the overall quality of the journal. The peer review process at Brain and Neurological Disorders is rigorous and meticulous, ensuring that only high-quality, evidence-based research is published. The reviewers are experts in their fields, and their comments and suggestions were constructive and helped improve the quality of my manuscript. The review process was timely and efficient, with clear communication from the editorial office at each stage. The support from the editorial office was exceptional throughout the entire process. The editorial staff was responsive, professional, and always willing to help. They provided valuable guidance on formatting, structure, and ethical considerations, making the submission process seamless. Moreover, they kept me informed about the status of my manuscript and provided timely updates, which made the process less stressful. The journal Brain and Neurological Disorders is of the highest quality, with a strong focus on publishing cutting-edge research in the field of neurology. The articles published in this journal are well-researched, rigorously peer-reviewed, and written by experts in the field. The journal maintains high standards, ensuring that readers are provided with the most up-to-date and reliable information on brain and neurological disorders. In conclusion, I had a wonderful experience publishing in Brain and Neurological Disorders. The peer review process was thorough, the editorial office provided exceptional support, and the journal's quality is second to none. I would highly recommend this journal to any researcher working in the field of neurology and brain disorders.
Dear Agrippa Hilda, Journal of Neuroscience and Neurological Surgery, Editorial Coordinator, I trust this message finds you well. I want to extend my appreciation for considering my article for publication in your esteemed journal. I am pleased to provide a testimonial regarding the peer review process and the support received from your editorial office. The peer review process for my paper was carried out in a highly professional and thorough manner. The feedback and comments provided by the authors were constructive and very useful in improving the quality of the manuscript. This rigorous assessment process undoubtedly contributes to the high standards maintained by your journal.
International Journal of Clinical Case Reports and Reviews. I strongly recommend to consider submitting your work to this high-quality journal. The support and availability of the Editorial staff is outstanding and the review process was both efficient and rigorous.
Thank you very much for publishing my Research Article titled “Comparing Treatment Outcome Of Allergic Rhinitis Patients After Using Fluticasone Nasal Spray And Nasal Douching" in the Journal of Clinical Otorhinolaryngology. As Medical Professionals we are immensely benefited from study of various informative Articles and Papers published in this high quality Journal. I look forward to enriching my knowledge by regular study of the Journal and contribute my future work in the field of ENT through the Journal for use by the medical fraternity. The support from the Editorial office was excellent and very prompt. I also welcome the comments received from the readers of my Research Article.
Dear Erica Kelsey, Editorial Coordinator of Cancer Research and Cellular Therapeutics Our team is very satisfied with the processing of our paper by your journal. That was fast, efficient, rigorous, but without unnecessary complications. We appreciated the very short time between the submission of the paper and its publication on line on your site.
I am very glad to say that the peer review process is very successful and fast and support from the Editorial Office. Therefore, I would like to continue our scientific relationship for a long time. And I especially thank you for your kindly attention towards my article. Have a good day!
"We recently published an article entitled “Influence of beta-Cyclodextrins upon the Degradation of Carbofuran Derivatives under Alkaline Conditions" in the Journal of “Pesticides and Biofertilizers” to show that the cyclodextrins protect the carbamates increasing their half-life time in the presence of basic conditions This will be very helpful to understand carbofuran behaviour in the analytical, agro-environmental and food areas. We greatly appreciated the interaction with the editor and the editorial team; we were particularly well accompanied during the course of the revision process, since all various steps towards publication were short and without delay".
I would like to express my gratitude towards you process of article review and submission. I found this to be very fair and expedient. Your follow up has been excellent. I have many publications in national and international journal and your process has been one of the best so far. Keep up the great work.
We are grateful for this opportunity to provide a glowing recommendation to the Journal of Psychiatry and Psychotherapy. We found that the editorial team were very supportive, helpful, kept us abreast of timelines and over all very professional in nature. The peer review process was rigorous, efficient and constructive that really enhanced our article submission. The experience with this journal remains one of our best ever and we look forward to providing future submissions in the near future.
I am very pleased to serve as EBM of the journal, I hope many years of my experience in stem cells can help the journal from one way or another. As we know, stem cells hold great potential for regenerative medicine, which are mostly used to promote the repair response of diseased, dysfunctional or injured tissue using stem cells or their derivatives. I think Stem Cell Research and Therapeutics International is a great platform to publish and share the understanding towards the biology and translational or clinical application of stem cells.
I would like to give my testimony in the support I have got by the peer review process and to support the editorial office where they were of asset to support young author like me to be encouraged to publish their work in your respected journal and globalize and share knowledge across the globe. I really give my great gratitude to your journal and the peer review including the editorial office.
I am delighted to publish our manuscript entitled "A Perspective on Cocaine Induced Stroke - Its Mechanisms and Management" in the Journal of Neuroscience and Neurological Surgery. The peer review process, support from the editorial office, and quality of the journal are excellent. The manuscripts published are of high quality and of excellent scientific value. I recommend this journal very much to colleagues.
Dr.Tania Muñoz, My experience as researcher and author of a review article in The Journal Clinical Cardiology and Interventions has been very enriching and stimulating. The editorial team is excellent, performs its work with absolute responsibility and delivery. They are proactive, dynamic and receptive to all proposals. Supporting at all times the vast universe of authors who choose them as an option for publication. The team of review specialists, members of the editorial board, are brilliant professionals, with remarkable performance in medical research and scientific methodology. Together they form a frontline team that consolidates the JCCI as a magnificent option for the publication and review of high-level medical articles and broad collective interest. I am honored to be able to share my review article and open to receive all your comments.
“The peer review process of JPMHC is quick and effective. Authors are benefited by good and professional reviewers with huge experience in the field of psychology and mental health. The support from the editorial office is very professional. People to contact to are friendly and happy to help and assist any query authors might have. Quality of the Journal is scientific and publishes ground-breaking research on mental health that is useful for other professionals in the field”.
Dear editorial department: On behalf of our team, I hereby certify the reliability and superiority of the International Journal of Clinical Case Reports and Reviews in the peer review process, editorial support, and journal quality. Firstly, the peer review process of the International Journal of Clinical Case Reports and Reviews is rigorous, fair, transparent, fast, and of high quality. The editorial department invites experts from relevant fields as anonymous reviewers to review all submitted manuscripts. These experts have rich academic backgrounds and experience, and can accurately evaluate the academic quality, originality, and suitability of manuscripts. The editorial department is committed to ensuring the rigor of the peer review process, while also making every effort to ensure a fast review cycle to meet the needs of authors and the academic community. Secondly, the editorial team of the International Journal of Clinical Case Reports and Reviews is composed of a group of senior scholars and professionals with rich experience and professional knowledge in related fields. The editorial department is committed to assisting authors in improving their manuscripts, ensuring their academic accuracy, clarity, and completeness. Editors actively collaborate with authors, providing useful suggestions and feedback to promote the improvement and development of the manuscript. We believe that the support of the editorial department is one of the key factors in ensuring the quality of the journal. Finally, the International Journal of Clinical Case Reports and Reviews is renowned for its high- quality articles and strict academic standards. The editorial department is committed to publishing innovative and academically valuable research results to promote the development and progress of related fields. The International Journal of Clinical Case Reports and Reviews is reasonably priced and ensures excellent service and quality ratio, allowing authors to obtain high-level academic publishing opportunities in an affordable manner. I hereby solemnly declare that the International Journal of Clinical Case Reports and Reviews has a high level of credibility and superiority in terms of peer review process, editorial support, reasonable fees, and journal quality. Sincerely, Rui Tao.
Clinical Cardiology and Cardiovascular Interventions I testity the covering of the peer review process, support from the editorial office, and quality of the journal.
Clinical Cardiology and Cardiovascular Interventions, we deeply appreciate the interest shown in our work and its publication. It has been a true pleasure to collaborate with you. The peer review process, as well as the support provided by the editorial office, have been exceptional, and the quality of the journal is very high, which was a determining factor in our decision to publish with you.
The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews journal clinically in the future time.
Clinical Cardiology and Cardiovascular Interventions, I would like to express my sincerest gratitude for the trust placed in our team for the publication in your journal. It has been a true pleasure to collaborate with you on this project. I am pleased to inform you that both the peer review process and the attention from the editorial coordination have been excellent. Your team has worked with dedication and professionalism to ensure that your publication meets the highest standards of quality. We are confident that this collaboration will result in mutual success, and we are eager to see the fruits of this shared effort.
Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, I hope this message finds you well. I want to express my utmost gratitude for your excellent work and for the dedication and speed in the publication process of my article titled "Navigating Innovation: Qualitative Insights on Using Technology for Health Education in Acute Coronary Syndrome Patients." I am very satisfied with the peer review process, the support from the editorial office, and the quality of the journal. I hope we can maintain our scientific relationship in the long term.
Dear Monica Gissare, - Editorial Coordinator of Nutrition and Food Processing. ¨My testimony with you is truly professional, with a positive response regarding the follow-up of the article and its review, you took into account my qualities and the importance of the topic¨.
Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, The review process for the article “The Handling of Anti-aggregants and Anticoagulants in the Oncologic Heart Patient Submitted to Surgery” was extremely rigorous and detailed. From the initial submission to the final acceptance, the editorial team at the “Journal of Clinical Cardiology and Cardiovascular Interventions” demonstrated a high level of professionalism and dedication. The reviewers provided constructive and detailed feedback, which was essential for improving the quality of our work. Communication was always clear and efficient, ensuring that all our questions were promptly addressed. The quality of the “Journal of Clinical Cardiology and Cardiovascular Interventions” is undeniable. It is a peer-reviewed, open-access publication dedicated exclusively to disseminating high-quality research in the field of clinical cardiology and cardiovascular interventions. The journal's impact factor is currently under evaluation, and it is indexed in reputable databases, which further reinforces its credibility and relevance in the scientific field. I highly recommend this journal to researchers looking for a reputable platform to publish their studies.
Dear Editorial Coordinator of the Journal of Nutrition and Food Processing! "I would like to thank the Journal of Nutrition and Food Processing for including and publishing my article. The peer review process was very quick, movement and precise. The Editorial Board has done an extremely conscientious job with much help, valuable comments and advices. I find the journal very valuable from a professional point of view, thank you very much for allowing me to be part of it and I would like to participate in the future!”
Dealing with The Journal of Neurology and Neurological Surgery was very smooth and comprehensive. The office staff took time to address my needs and the response from editors and the office was prompt and fair. I certainly hope to publish with this journal again.Their professionalism is apparent and more than satisfactory. Susan Weiner
My Testimonial Covering as fellowing: Lin-Show Chin. The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews.
My experience publishing in Psychology and Mental Health Care was exceptional. The peer review process was rigorous and constructive, with reviewers providing valuable insights that helped enhance the quality of our work. The editorial team was highly supportive and responsive, making the submission process smooth and efficient. The journal's commitment to high standards and academic rigor makes it a respected platform for quality research. I am grateful for the opportunity to publish in such a reputable journal.
My experience publishing in International Journal of Clinical Case Reports and Reviews was exceptional. I Come forth to Provide a Testimonial Covering the Peer Review Process and the editorial office for the Professional and Impartial Evaluation of the Manuscript.
