Patients undergoing coronary artery bypass grafting (CABG) routinely stop low-dose aspirin therapy 7 to 10 days before the operation to restore normal platelet hemostatic function, but a new study suggests that it may be more beneficial to continue taking aspirin until the surgery. Israeli researchers studied 32 patients with coronary artery disease about to have CABG. Fourteen patients received aspirin until the day of the operation, and 18 patients stopped receiving aspirin at least one week beforehand. The results show that the patients who stopped aspirin one day before the operation had significantly improved oxygen levels with only a slight increase in bleeding. This group had a significantly shorter ventilation period following the surgery, an average of 3.8 hours compared to 6.9 hours, as well as a significantly shorter stay in the ICU. They also had significantly lower thromboxane A2 levels, 117 pg/mL compared with 1,306 pg/mL (which can usually cause lung injury after this surgery), and were significantly better in their oxygenation capability. While these patients' operations were 24 minutes longer than the other patients, and the patients experienced slightly increased bleeding, none of the patients in the study required more transfusions, nor were there any deaths in either group. The study appears in the May issue of CHEST, the peer-reviewed journal of the American College of Chest Physicians.
Perceptions of Death and Dying in the ICU: Doctors, Nurses, Residents, and Family
Following the deaths of 68 patients in the ICU, researchers from Nashville, TN, administered the 31-item Quality of Dying and Death (QODD) instrument to each of the patient's attending physician, nurse, resident, and, one month following the death, to one of the patient's family members to capture their views on the quality of the dying process. Significant differences were found between the opinions of members of these groups in the areas of patient autonomy, maintaining dignity, being touched by loved ones, and the overall quality of end of life. Overall, resident physicians and nurses provided the lowest scores on the questions, indicating greatest dissatisfaction, with mean scores of 67.8 and 66.9, respectively, whereas family and attending physicians provided higher scores, mean scores of 77.7 and 81.5, respectively. For example, when asked if a patient's dying was unnecessarily prolonged, 18% of family members, 30% of nurses, and 20% of resident physicians answered yes, on average for each patient. None of the attending physicians in the study felt any patient's death was unnecessarily prolonged. The study appears in the May issue of CHEST, the peer-reviewed journal of the American College of Chest Physicians.
Pet Owners With Pet-Allergic Asthma: Drugs Do Not Substitute for Pet Removal
Pet owners with pet-allergic asthma who removed their pets from their homes experienced improved airway responsiveness, required lower doses of inhaled corticosteroids (ICSs), and went in for fewer physician follow-up visits than pet owners who kept their pets. Researchers from Japan studied 20 patients with newly diagnosed pet-allergic asthma who had domestic pets, including hamsters, cats, dogs, and ferrets. While the clinician recommended that all patients give away their pets to reduce exposure, 10 patients gave away their pets, while 10 patients kept them. All patients underwent spirometry, blood tests, and skin-prick tests and were instructed to record their peak expiratory flow (PEF) values with a flowmeter twice daily at home. Results show that removal of pets from homes, combined with the proper drugs, significantly reduced airway responsiveness to methacholine in patients with pet-allergic asthma more than drugs alone. The study appears in the May issue of CHEST, the peer-reviewed journal of the American College of Chest Physicians.