Ventilatory management of the patient with hyperimmunoglobulinemia E (Job) syndrome

Hyperimmunoglobulinemia E (Job syndrome) is a primary immunodeficiency that features abscesses of the skin, lung, and viscera; pneumonia; and elevated levels of serum immunoglobulin E. Pulmonary infections lead to lung abscesses, pneumatoceles, and bronchiectasis. We report the ventilatory management of a patient with Job syndrome.     

Heart rate variability measures poorly predict atrial fibrillation after off-pump coronary artery bypass grafting

Study Objective

To investigate associations of heart rate variability (HRV) measurements with postoperative atrial fibrillation (AF) in patients undergoing off-pump coronary surgery.

Design

Prospective, observational, exploratory study.

Setting

Large university-affiliated community medical center.

Patients

50 patients undergoing off-pump coronary artery bypass grafting (CABG).

Interventions

Preoperative recording of electrocardiograms (ECGs) with subsequent off-line HRV analysis. Monitored ECG telemetry for 5 days after operation.

Measurements

Frequency and time domain analyses, and additional non-linear HRV determinations. Multivariate regression analysis of predictors of postoperative AF.

Main Results

AF occurred in 23 (46%) patients. Only the low to high-frequency ratio was associated with AF (2.35 ± 1.8 v. 4.57 ± 5.0 for patients without AF, P < 0.05).

Conclusions

The off-pump approach does not protect against AF, and nonlinear HRV analyses provide little value in predicting AF after off-pump CABG.