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Postoperative respiratory complications in patients undergoing cardiac surgery occur in 20‒30% cases, and the most of them can be associated with ineffective cough and bronchial mucus evacuation.The objective. Comparative assessment of effectiveness and safety of methods for stimulating the evacuation of bronchial secretions using oscillatory PEP-therapy (Acapella Duet), oscillatory chest compression insufflator-aspirator “Comfort Cough Plus”, and the traditional method of manual chest percussion in the early period after cardiac surgery.Subjects and Methods. The prospective study included 120 cardiac surgery patients. They were divided into 3 groups (40 in each), depending on the type of the applied respiratory procedure. Distribution into groups was carried out by random selection. All procedures were performed 10‒12 hours after tracheal extubation. Before the procedure and 20 minutes after it, the efficiency of sputum discharge was assessed, gas exchange indices on room air breathing and maximum inspiratory lung capacity (MILC) were measured.Results. Ineffective bronchial mucus evacuating in the early period after tracheal extubation was observed in 86.7% of the patients. A single procedure of both PEP-therapy (Group 1) and mechanical cough stimulation (Group 2) led to improved sputum passage, as evidenced by an increase in the number of patients with productive cough by 4.25 times (p < 0.0009) and 5.3 times (p < 0.0007), respectively. In patients of Groups 1 and 2, an increase in MILC was observed (by 42.2% and 60.0%, respectively, p = 0.000001), the difference between the groups was statistically significant. In Control Group 3, with manual physiotherapy, the average increase in MILC was only 11.6%. Mechanical respiratory therapy procedures led to significant improvement in gas exchange variables, as evidenced by an increase in SpO2 in Groups 1 and 2 (p = 0.000009 and 0.000001, respectively) and a decrease in the proportion of patients with impaired oxygenating lung function (SpO2 below 92%) by 11 and 12 times, respectively (p < 0.01). The most significant changes were revealed in case of mechanical stimulation with aspirator-insufflator due to combination of two methods (oscillatory chest compression and lung inflation). In Control Group, no significant changes of gas exchange variables were observed.Conclusion: Mechanical vibratory methods for stimulating the bronchial secretion evacuation have significant advantages over classical manual chest massage in patients after cardiac surgery. Their positive effect on sputum passage, ventilatory parameters and gas exchange was noted, and the most pronounced effect was observed after oscillatory chest compression with insufflator-aspirator. The procedures were well tolerated and there were no complications associated with them.

Background To assess the usefulness of pre-operative contrast-enhanced transthoracic echocardiography (CE-TTE) and post-operative chest-x-ray (CXR) for evaluating central venous catheter (CVC) tip placements, with trans-esophageal echocardiography (TEE) as gold standard. Methods A prospective single-center, observational study was performed in 111 patients requiring CVC positioning into the internal jugular vein for elective cardiac surgery. At the end of CVC insertion by landmark technique, a contrast-enhanced TTE was performed by both the apical four-chambers and epigastric bicaval acoustic view to assess catheter tip position; then, a TEE was performed and considered as a reference technique. A postoperative CXR was obtained for all patients. Results As per TEE, 74 (67%) catheter tips were correctly placed and 37 (33%) misplaced. Considering intravascular and intracardiac misplacements together, they were detected in 8 patients by CE-TTE via apical four-chamber view, 36 patients by CE-TTE via epigastric bicaval acoustic view, and 12 patients by CXR. For the detection of catheter tip misplacement, CE-TTE via epigastric bicaval acoustic view was the most accurate method providing 97% sensitivity, 90% specificity, and 92% diagnostic accuracy if compared with either CE-TTE via apical four-chamber view or CXR. Concordance with TEE was 79% (p Conclusions The concordance between CE-TTE via epigastric bicaval acoustic view and TEE suggests the use of the former as a standard technique to ensure the correct positioning of catheter tip after central venous cannulation to optimize the use of hospital resources and minimize radiation exposure.

Fizioterapija Veselības aprūpe Physiotherapy Health Care Nosaukums – “Trauksmes, depresijas un dzīves kvalitātes salīdzinājums pacientiem pēc kardioķirurģiskajām operācijām”. Aktualitāte – Palielināta trauksme, depresija un samazināta dzīves kvalitāte ir raksturīga problēma gados vecākiem cilvēkiem. Noskaidrot hospitālās trauksmes, depresijas un dzīves kvalitātes savstarpējo saistību kardioķirurģiskajiem pacientiem ir būtiski aprūpes un rehabilitācijas procesa kvalitatīvai nodrošināšanai. Pētījuma mērkis – izpētīt un analizēt hospitālo trauksmi, depresiju un dzīves kvalitāti kardioķirurģiskajiem pacientiem. Metodes – kvantitatīvajā neeksperimentālajā pētījumā piedalījās sievietes un vīrieši (n=60) seniori, vecumā virs 65 gadiem no Paula Stradiņa Klīniskās Universitātes slimnīcas kardioķirurģiskās nodaļas. Dalībnieki tika uzrunāti un mērķtiecīgi aptaujāti par esošo veselības stāvokli klātienē, saņemot katra dalībnieka piekrišanu piedalīties pētījumā. Katram pacientam pirms operācijas tika novērtēta dzīves kvalitāte, pielietojot dzīves kvalitātes anketu SF-36 latviešu vai krievu valodā. Noskaidrojot katra dalībnieka operācijas dienu, piektajā pēcoperācijas dienā tika novērtēta pacientu hospitālā trauksme un depresija, pielietojot klīniskajos apstākļos izraisītas trauksmes un depresijas skalu (HADS). Iegūtie dati tika apkopoti un apstrādāti ar matemātiskās statistikas apstrādes metodēm, lai pierādītu statistisko būtiskuma līmeni tika izmatota p < 0,005. Rezultāti – Pētījumā iesaistītajiem pacientiem bija raksturīgi samazināta dzīves kvalitāte pirms operācijas. Senioriem pēc kardioķirurģiskās operācijas, vairāk, kā pusei jeb 58,33% respondentiem pēc operācijas netika novērota hospitālā trauksme. Savukārt, vairāk, kā pusei dalībnieku jeb 56,67% bija novērota kāda no depresijas pakāpēm (viegla, vidēja, smaga). Pētījumā tika atklāta statistiski nozīmīgi saistība p < 0,005 trīs dzīves kvalitātes domēniem (emocionālā veselība, ķermeņa sāpes, sociālā funkcionēšana) ar hospitālo trauksmi un depresiju. Secinājumi– Pētījuma rezultāti pierāda, ka kardioķirurģiskajiem pacientiem pirmsoperācijas periodā ir samazināta dzīves kvalitāte un pēc operācijas periodā ir paaugstināta depresija. Dzīves kvalitāte pirms operācijas periodā ir saistīta ar pēcoperācijas trauksmi un depresiju. Veiktais pētījums un tā rezultāti būs praktiski izmantojami, veselības aprūpes speciālistu profesionālajai pilnveidei klīniskās universitātes slimnīcās. Atslēgas vārdi – Trauksme un depresija, kardioloģiskie pacienti, kardioķirurģiskie pacienti, kardioķirurģija, dzīves kvalitāte Title – “Comparison of anxiety, depression and quality of life in patients after cardiac surgery”. Background – Increased anxiety, depression and reduced quality of life are common problems in the elderly. To find out the relationship between hospital anxiety, depression and quality of life in cardiac surgery patients is essential for the quality of the care and rehabilitation process. Objective – Explore and analyze hospital anxiety, depression and quality of life in cardiac surgical patients. Methods – The quantitative non-experimental study involved senior women and men (n=60) over the age of 65 from the Cardiac Surgery Department of Pauls Stradins Clinical University Hospital. Participants were addressed and purposefully interviewed about their current health status in person, receiving the consent of each participant to participate in the study. Quality of life was assessed for each patient before surgery using the quality of life questionnaire SF-36 in Latvian or Russian. Determining the day of each participant's operation, hospital anxiety and depression were assessed on the fifth postoperative day using the Clinical Anxiety and Depression Scale (HADS), determinating the day of surgery for each participant. The obtained data were collected and processed by mathematical statistics processing methods. Results – Patients in the study were typically affected by preoperative quality of life. For seniors after cardiac surgery, more than half or 58.33% of respondents did not experience hospital anxiety after surgery. On the other hand, more than half of the participants or 56.67% had some degree of depression (mild, moderate, severe). The study found a statistically significant association of p

The circulatory system is oscillatory in its nature. Oscillatory components linked to physiological processes and underlying regulatory mechanisms are identifiable in circulatory signals. Autonomic regulation is essential for the system's ability to deal with external exposure, and the integrity of oscillations may be considered a hallmark of a healthy system. Loss of complexity is seen as a consequence of several diseases and aging. Heart rate variability is known to decrease after cardiac surgery and remain reduced for up to 6 months. Oscillatory components of circulatory signals are linked to the system's overall complexity. We therefore hypothesize that the frequency distributions of circulatory signals show loss of oscillatory components after cardiac surgery and that the observed changes persist. We investigated the development of the circulatory frequency distributions of eight patients undergoing cardiac surgery by extracting three time series from conventional blood pressure and electrocardiography recordings: systolic blood pressure, heart rate, and amplitude of the electrocardiogram's R‐wave. Four 30‐min selections, representing key events of the perioperative course, were analyzed with the continuous wavelet transform, and average wavelet power spectra illustrated the circulatory frequency distributions. We identified oscillatory components in all patients and variables. Contrary to our hypothesis, they were randomly distributed through frequencies, patients, and situations, thus, not representing any reduction in the overall complexity. One patient showed loss of a 25‐s oscillation after surgery. We present a case where noise is misclassified as an oscillation, raising questions about the robustness of such analyses., Loss of complexity of biological systems is seen as a consequence of several diseases and aging, and heart rate variability is known to decrease after cardiac surgery. We explore the frequency distributions of ECG and blood pressure recordings of eight patients undergoing cardiac surgery, with the search for loss of oscillatory components and a reduction in overall complexity. Only one patient show loss of a distinct oscillation, and we do not identify any systematic reduction of complexity after cardiac surgery.

Актуальность. Хирургическая реваскуляризация миокарда является эффективным способом лечения больных с ишемической болезнью сердца. Обязательным этапом проведения экстракорпорального кровообращения является индуцированная остановка сердца и связанный с этим период общей ишемии. Поэтому при выполнении операций аортокоронарного шунтирования в условиях искусственного кровообращения развивается острая сердечная недостаточность, выраженная в той или иной степени. Несмотря на постоянное совершенствование методов искусственного кровообращения, анестезии и кардиопротекции, частота интраоперационного инфаркта миокарда составляет от 2 до 7,2 % случаев, острой сердечной недостаточности — от 2,7 до 51,2 %, острых нарушений сердечного ритма — от 20 до 63,6 %. Цель исследования: улучшить результаты лечения кардиохирургических больных с сердечной недостаточностью, перенесших оперативное вмешательство — шунтирование коронарных артерий с применением экстракорпорального кровообращения, путем усовершенствования протокола периоперационного ведения пациентов. Материалы и методы. На базе Государственного научного учреждения «Научно-практический центр профилактической и клинической медицины» Государственного управления делами было прооперировано 100 кардиохирургических больных ишемической болезнью сердца, которым было выполнено аортокоронарное шунтирование с использованием искусственного кровообращения. От всех больных было получено информированное согласие на участие в исследовании. Пациенты были разделены на две группы. Пациентам группы 1 (40 больных) в послеоперационном периоде коррекцию гемодинамических расстройств выполняли по стандартным действующим протоколам. В группе 2 (60 больных) был применен дифференцированный подход к коррекции гемодинамических расстройств. В подгруппе 1 (20 больных) в послеоперационном периоде коррекцию гемодинамических расстройств выполняли с помощью добутамина и достигли стабилизации. В подгруппе 2 (11 больных, у которых была диагностирована в предоперационном периоде гипофосфатемия) для коррекции гемодинамических расстройств кроме добутамина использовали препарат фруктозо-1,6-дифосфат по схеме: 5 г препарата вводили непосредственно перед началом перфузии и 5 г — на 30-й минуте искусственного крово­обращения. Препарат, эндогенный высокоэнергетический промежуточный метаболит гликолитического пути, непосредственно усиливает образование высокоэнергетического фосфата (аденозинтрифосфата). В подгруппе 3 (6 больных) в послеоперационном периоде кроме добутамина для коррекции гемодинамических расстройств применили препарат тиворель (1 мл 42 мг аргинина гидро­хлорида и 20 мг левокарнитина). В подгруппе 4 (23 больных) в послеоперационном периоде не было гемодинамических расстройств, коррекцию не выполняли. Результаты. Был разработан периоперационный анестезиологический менеджмент у кардиохирургических больных с сердечной недостаточностью, перенесших аортокоронарное шунтирование с использованием искусственного кровообращения. Для мониторинга функции сердечно-сосудистой системы использовали электрокардиографию, эхокардиографию, фазаграфию, определяли вариабельность сердечного ритма по Р.М. Баевскому. Фазаграфия — это инновационный метод обработки электрокардиограмм, разработанный НАН Украины. Суть метода — исследование симмет­рии/асимметрии зубца Т электрокардиограммы как маркера ишемических изменений миокарда. Определение симметричности волны Т в фазовом пространстве является эффективным диагностическим критерием наличия ишемии (показатель βТ) на электрокардиограмме. Результаты исследований свидетельствуют о возможности использования метода фазаграфии, в частности анализа симметрии зубца Т как маркера ишемических изменений в миокарде, у кардиохирургических больных, перенесших аортокоронарное шунтирование с использованием искусственного кровообращения. Установлено, что в группе 2 для стабилизации гемодинамики, кислородного статуса, микроциркуляции были использованы меньшие дозы симпатомиметиков, были меньше продолжительность их применения, частота гемодинамически значимой фибрилляции предсердий, доза введенного амиодарона, продолжительность искусственной вентиляции легких по сравнению с группой 1. Выводы. Полученные данные свидетельствуют, что разработанный алгоритм периоперационного ведения кардиохирургических больных с сердечной недостаточностью дает возможность значительно ускорить реабилитацию кардиохирургических больных, повысить комфорт пациента и сократить срок пребывания в больнице до 6–7 суток., Актуальність. Хірургічна реваскуляризація міокарда є ефективним способом лікування хворих з ішемічною хворобою серця. Обов’язковим етапом проведення екстракорпорального кровообігу є індукована зупинка серця й пов’язаний із цим період загальної ішемії. Тому при виконанні операцій аортокоронарного шунтування в умовах штучного кровообігу розвивається гостра серцева недостатність, виражена тією чи іншою мірою. Незважаючи на постійне вдосконалення методів штучного кровообігу, анестезії та кардіопротекції, частота інтраопераційного інфаркту міокарда становить від 2 до 7,2 % випадків, гострої серцевої недостатності — від 2,7 до 51,2 %, гострих порушень серцевого ритму — від 20 до 63,6 %. Мета дослідження: покращити результати лікування кардіохірургічних хворих із серцевою недостатністю, які перенесли оперативне втручання — шунтування коронарних артерій із застосуванням екстракорпорального кровообігу, шляхом удосконалення протоколу періопераційного ведення пацієнтів. Матеріали та методи. На базі Державної наукової установи «Науково-практичний центр профілактичної та клінічної медицини» Державного управління справами було прооперовано 100 кардіохірургічних хворих на ішемічну хворобу серця, яким було виконано аортокоронарне шунтування з використанням штучного кровообігу. Від усіх хворих було отримано інформовану згоду на участь у дослідженні. Пацієнти були розподілені на дві групи. Пацієнтам групи 1 (40 хворих) у післяопераційному періоді корекцію гемодинамічних розладів виконували за стандартним чинним протоколом. У групі 2 (60 хворих) був застосований диференційований підхід до корекції гемодинамічних розладів. У підгрупі 1 (20 хворих) у післяопераційному періоді корекцію гемодинамічних розладів виконували за допомогою добутаміну й досягли стабілізації. У підгрупі 2 (11 хворих, у яких була діагностована в передопераційному періоді гіпофосфатемія) для корекції гемодинамічних розладів крім добутаміну використовували препарат фруктозо-1,6-дифосфат за схемою: 5 г препарату вводили безпосередньо перед початком перфузії і 5 г — на 30-й хвилині штучного кровообігу. Препарат, ендогенний високоенергетичний проміжний метаболіт гліколітичного шляху, безпосередньо посилює утворення високоенергетичного фосфату (аденозинтрифосфату). У підгрупі 3 (6 хворих) у післяопераційному періоді крім добутаміну для корекції гемодинамічних розладів застосували препарат тиворель (1 мл розчину містить 42 мг аргініну гідрохлориду та 20 мг левокарнітину). Підгрупа 4 (23 хворих) у післяопераційному періоді не мала гемодинамічних розладів, корекцію не виконували. Результати. Було розроблено періопераційний анестезіологічний менеджмент у кардіохірургічних хворих із серцевою недостатністю, які перенесли аортокоронарне шунтування з використанням штучного кровообігу. Для моніторингу функції серцево-судинної системи використовували електрокардіографію, ехокардіографію, фазаграфію, визначали варіабельність серцевого ритму за Р.М. Баєвським. Фазаграфія — це інноваційний метод обробки електрокардіограм, розроблений НАН України. Суть методу — дослідження симетрії/асиметрії зубця Т електрокардіограми як маркера ішемічних змін міокарда. Визначення симетричності хвилі Т у фазовому просторі є ­ефективним ­діагностичним критерієм наявності ішемії (показник βТ) на ­електрокардіограмі. ­Результати ­досліджень свідчать про можливість використання методу фазаграфії, зокрема аналізу симетрії зубця Т як маркера ішемічних змін у міокарді, у кардіохірургічних хворих, які перенесли аортокоронарне шунтування з використанням штучного кровообігу. Встановлено, що в групі 2 для стабілізації гемодинаміки, кисневого статусу, мікроциркуляції були використані менші дози симпатоміметиків, були меншими тривалість їх застосування, частота гемодинамічно значимої фібриляції передсердь, доза введеного аміодарону, тривалість штучної вентиляції легень порівняно з групою 1. Висновки. Отримані дані свідчать, що розроблений алгоритм періопераційного ведення кардіохірургічних хворих із серцевою недостатністю дає можливість значно прискорити реабілітацію кардіохірургічних хворих, підвищити комфорт пацієнта й скоротити термін перебування в лікарні до 6–7 діб., Background. Surgical myocardial revascularization is an effective way to treat patients with coronary heart disease. A mandatory step in the process of extracorporeal circulation is an induced cardiac arrest and the associated period of general ische­mia. Therefore, when performing coronary artery bypass grafting in the conditions of artificial circulation, acute heart failure of varying degrees of severity develops. Despite continuous improvement of the methods for artificial circulation, anesthesia and cardioprotection, the incidence of intraoperative myocardial infarction is from 2 to 7.2 %, acute heart failure — from 2.7 to 51.2 %, acute cardiac arrhythmias — from 20 to 63.6 %. The aim of the study: to improve treatment outcomes in cardiac surgery patients with heart failure who underwent coronary artery bypass grafting using extracorporeal circulation, by improving the protocol of periope­rative management. Materials and methods. One hundred cardiac surgery patients with coronary artery disease underwent coronary artery bypass grafting at the State Scientific Institution “Scientific and Practical Center of Preventive and Clinical Medicine” of the Agency of State Affairs. Informed consent to participate in this study was obtained from all patients. They were divided into two groups. In patients of group 1 (n = 40), correction of hemodynamic disorders in the postoperative period was performed according to the standard current protocol. In group 2 (n = 60), a differentia­ted approach to the correction of hemodynamic disorders was used. In subgroup 1 (n = 20), correction of hemodynamic disorders in the postoperative period was performed with dobutamine, and stabilization was achieved. In subgroup 2 (11 patients who were diagnosed with preoperative hypophosphatemia), to correct hemodynamic disorders, fructose-1,6-diphosphate was used in addition to dobutamine according to the scheme: 5 g of the drug was admini­stered immediately before perfusion and 5 g — on 30th minute of artificial circulation. The drug, an endogenous high-energy intermediate metabolite of the glycolytic pathway, directly increases the formation of high-energy phosphate (adenosine triphosphate) [9]. In subgroup 3 (n = 6), in addition to dobutamine, tivorel was used in the postoperative period to correct hemodynamic disorders (1 ml solution contains 42 mg of arginine hydrochloride and 20 mg of levocarnitine). Subgroup 4 (n = 23) had no hemodynamic disorders in the postoperative period, correction was not performed. Results. To monitor the functions of the cardiovascular system, electrocardiography, echocardiography, phasagraphy were used, and heart rate variability was evaluated. Phasagraphy is an innovative method for processing electrocardiogram developed by the National Aca­demy of Sciences of Ukraine. The essence of the method is to study T wave symmetry/asymmetry on the electrocardiogram as a marker of ischemic changes in the myocardium. The results of the stu­dies indicate the possibility of using the method of phasagraphy, in particular the analysis of T wave symmetry as a marker of ischemic changes in the myocardium in cardiac surgery patients who underwent coronary artery bypass grafting with artificial circulation. In the vast majority of patients with ischemic heart disease, T wave symmetry is statistically significantly higher than in individuals without clinical signs of ischemic changes in the myocardium. It was found that in group 2 to stabilize hemodynamics, oxygen status and microcirculation, lower doses of sympathomimetics were used; duration of their use, frequency of hemodynamically significant atrial fibrillation, dose of injected amiodarone, duration of pulmonary ventilation were lower as well. Conclusions. The obtained data indicate that the developed algorithm for preoperative management of cardiac surgery patients with heart failure makes it possible to significantly accelerate their rehabilitation, increase patients’ comfort and to reduce hospital stay to 6–7 days.

Cilj: Identificirati, opisati i usporediti s drugim istraživanjima čimbenike rizika za razvoj infekcija povezanih sa SVK. Dokazati povezanost broja dana kateterizacije s rizikom za razvoj infekcija povezanih sa SVK. Metode: Provedeno je retrospektivno istraživanje u koje je bilo uključeno 200 bolesnika odjela Kardiokirurgije KBC Split kojima je na dan operacije, u operacijskoj sali plasiran SVK u venu jugularis. Uvidom u dokumentaciju uzeti su podatci o dobi bolesnika i broju dana kateterizacije. Svaki odstranjeni SVK poslan je na mikrobiološku analizu u mikrobiološki laboratorij KBC Split, zajedno sa uzetom hemokulturom. SVK kod kojeg nije došlo do porasta mikroorganizama na SVK ni hemokulturi smatra se sterilnim, SVK kod kojeg je došlo do porasta mikroorganizama, a da je hemokultura sterilna smatra se koloniziranim, SVK kod kojeg je došlo do porasta mikroorganizama na SVK i hemokulturi smatra se inficiranim. Rezultati: Od ukupnog broja bolesnika (200) kojima je plasiran SVK u njih 162 (81 %) nije dokazana infekcija povezna sa SVK, u 29 (14,5 %) bolesnika dokazana je kolonizacija SVK, a u 9 (4,5 %) dokazana je infekcija povezana sa SVK. Dokazano je da postoji statistički značajna razlika životne dobi između ispitivanih skupina ( χ2= 6.2; P =0,045). Medijan životne dobi bolesnika bez infekcije za 10 god. je veći nego onih s infekcijom (z = 1,92; P=0,055) na razini značajnosti od 96 %. Nije dokazana statistički značajna razlika između ispitanika bez infekcije i onih s kolonizacijom (z = 1,75; P=0,079). Nije dokazana statistički značajna razlika između ispitanika s infekcije i onih s kolonizacijom (z = 0,481; P=0,499). Postoji statistički značajna razlika medijana broja dana kateterizacije između ispitivanih skupina (χ2= 46,7; P

Patients perceive the intensive care unit (ICU) as being a stressful and anxiety-provoking environment. The physiological effects of stress and anxiety are found to be harmful and I therefore should be avoided in cardiac surgery patients. The aim of the study on which this I article is based was to describe cardiac surgery patients' experiences of music as a therapeutic I intervention in the ICU of a public hospital. The objectives of this article were to introduce I and then expose the cardiac patients to music as part of their routine postoperative care and to explore and describe their experiences of the music intervention. The findings of the research I are to be the basis for making recommendations for the inclusion of music as part of the routine postoperative care received by cardiac surgery patients in the ICU. A qualitative research I methodology, using a contextual, explorative and descriptive research design, was adopted. I The population of the study was cardiac surgery patients admitted to the ICU of a public hospital. An unstructured interview was conducted with each participant and content analysis and coding procedures were used to analyse the data. Four main themes were identified I in the results, namely practical and operational aspects of the music sessions; participants' I experiences; discomfort due to therapeutic apparatus and the ICU environment; and the role of I music and recommendations for music as a therapeutic intervention. Participants' experiences were mainly positive. Results focused on experiences of the music and also on the participants' I experiences of the operational aspects of the therapy, as well as factors within and around the participants. Pasiënte se persepsie van die intensiewesorgeenheid (ISE) is dat dit 'n stresvolle en angswekkende omgewing is. Die fisiologiese effekte van stres en angs is skadelik en daarom moet dit vermy word in die geval van pasiënte wat hartchirurgie ondergaan. Die doel van die studie waarop hierdie artikel gebaseer is, was om hartchirurgiepasiënte se ervaring van musiek as 'n terapeutiese intervensie in die ISE van 'n openbare hospitaal te beskryf. Die doelwitte van hierdie studie was om hartchirurgiepasiënte bekend te stel aan musiek as deel van hul roetine- postoperatiewe sorg en hulle dan daaraan bloot te stel om sodoende hulle ervarings van die musiekintervensie te ondersoek en beskryf. Die bevindinge van die navorsing sal gebruik word om aanbevelings te maak vir die insluiting van musiek as deel van die roetine- postoperatiewe sorg wat hartchirurgiepasiënte in die ISE ontvang. 'n Kwalitatiewe navorsingsmetodologie, met behulp van 'n kontekstuele, verkennende en beskrywende ontwerp, is gebruik. Die populasie van die studie was hartchirurgiepasiënte in die ISE van 'n openbare hospitaal. 'n Ongestruktureerde onderhoud is met elke deelnemer gevoer en inhoud-analise en koderingprosedures is gebruik om die data te ontleed. Vier hooftemas is in die resultate geïdentifiseer, naamlik praktiese en operasionele aspekte van die musieksessies; die deelnemers se ervarings; ongemak as gevolg van terapeutiese apparaat en die ISE-omgewing; asook die rol van musiek en aanbevelings vir musiek as 'n terapeutiese intervensie. Deelnemers se ervarings was hoofsaaklik positief. Die resultate het gefokus op die deelnemers se ervaring van die musiek asook hul ervaring van die operasionele aspekte van die terapie, sowel as faktore binne en rondom die deelnemers.

AIM: To determine the incidence of possible transfusion-related acute lung injury (TRALI) and related risk factors in cardiac surgery patients. ----- METHODS: A single-center prospective cohort study was conducted from January 2009 to March 2010 at the Zagreb University Hospital Center, Croatia. Patient-, transfusion-, and surgery-related data were collected. The study included 262 patients who were observed for respiratory worsening including measurements of arterial oxygen saturation (SaO2), fraction of inspired oxygen (FiO2), and partial pressure of arterial oxygen (PaO2). Possible TRALI was defined according to the Toronto Consensus Conference definition broadened for 24-hour post-transfusion. This cohort was divided in two groups. TRALI group included 32 participants with diagnosis of TRALI and the control group included 220 patients with or without respiratory worsening, but with no signs of ALI. ----- RESULTS: Possible TRALI was observed in 32 (12.2%) patients. Compared with the control group, possible TRALI patients had higher American Association of Anesthesiology scores, higher rate of respiratory comorbidity (43.8% vs 15.5%), and required more red blood cells (median 4, range [2.5-6] vs 2 [1-3]), plasma (5 [0-6] vs 0 [0-2]), and platelet units (0 [0-8] vs 0 [0-0]) (P

Mean systemic filling pressure (Pmsf)is defined as the pressure in the blood vessels during cardiac arrest. Pmsf is an important determinant for venous return to the heart and thus for cardiac output. This thesis describes a method to measure Pmsf at the bedside in intensive care patients and describes the clinical significance of Pmsf in the intensive care

Objective Negative-pressure ventilation (NPV) by external cuirass (RTX; Deminax Medical Instruments Limited, London, UK) in intubated patients after cardiac surgery improves hemodynamics measured by pulmonary artery catheter (PAC)-based methods with increased cardiac output (CO) and stroke volume (SV) without changing the heart rate (HR). The less-invasive pressure recording analytical method (PRAM) (MostCare; Vytech Health srl, Padova, Italy) allows radial artery monitoring of CO, SV, SV variation, and cardiac cycle efficiency (CCE). The authors investigated the hypothesis that NPV improves PRAM-based hemodynamics and arterial blood gas analysis in extubated cardiac surgery patients. Design A clinical investigation. Setting A teaching hospital. Participants Twenty recently extubated cardiac surgery patients. Interventions Five consecutive experimental ventilation modalities lasted 5 minutes: (1) baseline (no cuirass ventilation), (2) mode 1 (cuirass ventilation with a continuous negative pressure of −20 cmH 2 O), (3) rest 1 (no cuirass ventilation), (4) mode 2 (cuirass ventilation in the control mode of 12 breaths/min at −20 cmH 2 O, and (5) rest 2. Measurements and Main Results PRAM parameters were analyzed throughout the final minute of each experimental modality, concluding with arterial blood gas sampling. NPV was well tolerated. HR was unchanged. Mode 2 SV was higher than baseline and rest 2. Mode 2 CO was higher than rest 2. Rest 2 systolic blood pressure was lower than rest 1 and mode 2. Increased CCE with NPV was not significant ( p = 0.0696). Oxygenation and PCO 2 were unchanged although mode 2 pH increased. Conclusions Extubated sedated cardiac surgery patients comfortably tolerated NPV with unchanged HR. SV and pH increased.

OBJECTIVE Postoperative cognitive decline (POCD) is a frequent complication after cardiac surgery. Although intraoperative events are risk factors for POCD, the role played by preoperative hypoperfusion in cognitive decline has not yet been investigated. It is also unknown whether the impact of preoperative hypoperfusion in the left or right middle cerebral arteries (MCAs) can differentially account for POCD. The main aims of this study were to investigate whether preoperative cerebral hypoperfusion was associated with early POCD and whether lateralized hypoperfusion would differentially affect POCD in patients after cardiac surgery. METHODS Bilateral MCA continuous transcranial Doppler (TCD) sonography was preoperatively performed at rest in 31 right-handed patients who underwent cardiac surgery to detect cerebral blood flow (CBF) velocity. All patients completed a neuropsychological evaluation to assess attention, short-term memory, working memory, and psychomotor function before surgery and at discharge. POCD was defined using the standard deviation method. Logistic regression was used to investigate the association between hypoperfusion and POCD, controlling for common preoperative risk factors. RESULTS Fourteen patients (45%) exhibited POCD. Cerebral hypoperfusion in the left MCA selectively predicted the incidence of POCD (odds ratio = 0.90, p < .02), whereas CBF velocity in the right MCA was unrelated to POCD (odds ratio = 1.07, p = .39). CONCLUSIONS Patients who underwent cardiac surgery with reduced CBF velocity in the left MCA preoperatively are at greater risk for POCD. Left cerebral hypoperfusion may also represent an independent predictor of POCD in these patients. TCD evaluation may have substantial clinical benefits for the detection of patients at high risk of POCD after cardiac surgery.

One of the major factors limiting but also causing the application of modern technology in medicine is the response time to patients, should they need specialized medical care. In this work we propose a solution that is aiming to help and improve the patients' life after a cardiac surgery. This is a group of patients that have to be monitored for a short period after the operation. The aim of this project is to give the opportunity to these patients to be monitored at home after their operation so as to keep their rehabilitation period as smooth as possible and avoid unnecessary visits to the hospital or prevent adverse events. This is going to be achieved by creating an integrated web- based system which can regularly monitor several biosignals like ECG, blood pressure, arterial SpO2 and parameters like body weight and provide the tools to identify any unusual events. © 2011 ICST Institute for Computer Science, Social Informatics and Telecommunications Engineering. 55 LNICST 61 68 Cited By :2

Objective was evaluation of hospital-level reporting system for transfusion-related adverse events including non-serious and serious transfusion reactions in cardiac surgery patients. Magdalena Hospital has had a reporting system of transfusion reactions since 1998. Each transfusion reaction was assessed for severity as well as for the type and probability with which they could be ascribed to the transfusion. We retrospectively analysed a hospital database of patients over a period of 12 years (January 1998 - November 2009). Among them we set apart those who experienced adverse effect on transfusion. A total of 6484 patients underwent cardiac surgery of which 4366 (67.3%) received a blood transfusion, including 32224 RBC units, 20744 PLT units and 10632 FFP units. A total of 56 adverse transfusion reaction reports were received. Of these, 53 were judged transfusion related and resulting in 1.2% incidence of transfusion reaction in cardiac surgery patients. In the category not judged transfusion related reports, 1 report involved possible infectious complications and 2 reports were classified as “other reactions”. Reactions associated with transfusion were as follows: 20 allergic, 18 febrile non-haemolytic, 5 delayed haemolytic, 5 TRALI (1 definitely case), 3 non-specific reactions, 1 acute haemolytic reaction, and 1 TACO. It is likely that some mild reactions are underreported. This 12-year review reached no different frequency of transfusion reactions in cardiac surgery patients compared to other.

IntroductionProviding adequate feeding in cardiac surgery patients is gaining importance [1]. The aims were to assess the preoperative nutritional status, to compare postoperative energy needs with effectively delivered amounts, and to evaluate the impact of a dietitian on optimizing postoperative energy balances.MethodsA prospective interventional study in adult patients after elective CABG and/or heart valve surgery. The patients' nutritional risk was determined by the NRS 2002 and the Malnutrition Universal Screening Tool (MUST) [2]. A dedicated dietitian managed and assisted the nutritional approach. For each patient, global energy intake (intentional and non-intentional) and balance (difference between energy target and global caloric intake) were calculated daily during and after ICU stay until hospital discharge. The Harris-Benedict equation was used to calculate daily energy requirements. When energy delivery did not reach 60% of calculated needs, a protocol- driven nutritional intervention was initiated.ResultsTwo hundred patients were enrolled during a 10-month period, representing 2,690 study-days. Mean age was 67 ± 11 years. In total, 42.5% of the patients had a NRS 2002 score >3 and were considered to be nutritionally at risk. MUST identified a high, medium, or low risk in respectively 1%, 4% and 95% of subjects. Mean energy requirement was 2,046 ± 347 kcal and mean daily intake 1,452 ± 335 kcal. Sixty-two percent of the caloric need was met during the entire hospital stay. Nutritional intervention was necessary in 52% of cases: oral feeding supplementation for 546 study-days, enteral feeding: 401 days, parenteral feeding: 367 days. This reduced the mean cumulative caloric deficit to 9,085 kcal.ConclusionClose monitoring of caloric intake shouldered by interventions based on a predefined algorithm under supervision of a dedicated nutrition team restricts the caloric deficit in cardiac surgery patients.References1.Cresci G. et al. Nutrition intervention in the critically ill cardiothoracic patient. Nutr Clin Pract. 2012;27:323–334. doi: 10.1177/0884533612444135. [PubMed] [Cross Ref]2.Lomivorotov VV. et al. Prognostic value of nutritional screening tools for patients scheduled for cardiac surgery. Interact Cardiovasc ThoracSurg. 2013;16:162–168. [PMC free article] [PubMed]

Acute kidney injury (AKI) is a common complication associated with increased morbidity and mortality in cardiac surgery patients. In this context, the recent paper by Kim et al., showing that a peri-operative liberal ‘saline- and starch-based’ fluid management significantly enhanced the incidence of severe post-operative AKI in off-pump cardiac surgery patients, is to be acclaimed [1]. With regard to the potential culprit(s) triggering this AKI, the authors pointed at ‘usual suspects’ such as excess chloride and intrinsic starch-induced renal tubular lesions. However, it is noteworthy that patients in the at-risk group were less likely (p = 0.001!) to be receiving statins before surgery [1]. Statins may prevent kidney injury through inhibition of post-operative inflammatory processes. Compared with statin-naive subjects, cardiac surgery patients taking statins indeed had reduced levels of circulating C-reactive protein, tumour necrosis factor alpha, myeloperoxidase, and pro-inflammatory interleukin (IL)-1, IL-6, and IL-8 and higher concentrations of the anti-inflammatory IL-10 [2]. The largest meta-analysis to date, including nearly 60,000 cardiac surgery patients, revealed a 13 % reduction of post-operative AKI in patients pre-operatively treated with statins [3]. Whether statins embrace the kidney as friend or foe is debatable but probably depends upon the type of study cohort (e.g. septic vs. non-septic), the intervention (e.g. surgery), and pre-existing chronic kidney disease. For example, agent-dependent ‘high potency’ statin doses increase the risk of AKI in a general patient population [4] whereas the use of corresponding high doses in cardiac surgery patients appears to exhibit a reno-protective effect [5].