Cardiology Intensive Care Unit Research Articles

Evaluation of hyperglycemia at admission as a marker of severity of coronary lesions in non-diabetic patients with myocardial infarction

High blood glucose (HBG) at admission is a major common metabolic disorder in patients with acute myocardial infarction (MI). However, only few data have examined its predictive performance over established risk score. The aim of our study was to determine the correlation between hyperglycemia at admission in non-diabetic patients and the severity of coronary artery lesions evaluated by the Synthax score. We conducted a cross-sectional study including all the patients admitted for MI in the cardiology intensive care unit of Casablanca from june 2018 to february 2019. The population was divided into 2 groups: hyperglycemia (glycemia at admission > 1.10 g/l) and non-hyperglycemia (< 1.10 g/l) regardless of previous diabetic status. The primary composite endpoint (all-cause death and non-fatal MI) was compared between the two groups. A total of 193 patients were included. A total of 63.4% presented with hyperglycemia on admission, 89% were over 65 years. There were significant differences in baseline clinical status established by calculating CHADSVASC score (2.60 ± 1.54 vs 1.5 ± 1.05; P = 0.01). Biological status differed significantly between the 2 groups especially troponine Ic, LDL cholesterol and triglyceride which were higher in HBG patients (32.20 ± 63.93 vs. 17.64 ± 31.16 P = 0.014; 0.94 ± 0.33 vs. 0.87 ± 0,27 P = 0.015; 1.45 ± 0.67 vs. 1.16 ± 0.42 P = 0.04 respectively). SYNTAX score was higher in the hyperglycemia group 11.21 ± 8.377 vs. 7.50 ± 8.782 P = 0.03. A multivariate analysis showed that hyperglycemia on admission was an independent predictor of severity of coronary artery lesions and was significantly associated with long-term clinical outcomes. In non-diabetic patients with MI, hyperglycemia on admission was predictive of coronary artery lesions’ severity and was associated with poor long-term clinical outcomes. Further study is needed to evaluate specific therapeutic strategies to prevent cardiovascular events occurring in these patients.

The PEST Model: A Quality Improvement Project to Reduce Self-extubation in the Intensive Care Unit.

Self-extubation is an adverse patient event that can lead to severe complications. Gaps in clinical practice from the lack of nursing awareness and decision making capacity have often resulted in cases of preventable self-extubation. Review of current evidence suggests that initiatives to support nursing clinical decision making can help prevent adverse patient events such as self-extubation. The aim of this study was to reduce the incidence of self-extubation by 50% in a cardiology intensive care unit over 1 year. A quality improvement project was undertaken with a PEST model of nursing care introduced from January 2017 to December 2017 in the cardiology intensive care unit to guide nursing staff to assess and render appropriate interventions along patient domains such as pain, endotracheal tube securement, sedation, and tie to prevent incidences of self-extubation. Incidences of self-extubation have reduced to 5 cases in 2017, reflecting a 50% improvement from 10 cases in 2016. Formalizing practice standards into an easy-to-remember mnemonics or framework can improve patient outcomes. Policy makers must be aware that initiatives to facilitate decision making can improve patient safety.

PB1882 DECONSTRUCTING RICHTER SYNDROME TUMOR NICHE: JAGGED‐1 LIGAND LEADS THE WAY

Background:Richter Syndrome (RS) is defined as the occurrence of a high‐grade lymphoma (usually diffuse large B‐cell lymphoma ‐ DLBCL) in patients with a previous/concomitant diagnosis of chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL).RS usually occurs in lymph‐nodes, but sometimes may infiltrate extranodal sites.Isolated cardiac involvement is very unique.Most DLBCL‐type RS does not share lesions with de novo subtypes.NOTCH1 mutation was reported in almost 30% of cases,but NOTCH1 signaling activation independent of its mutational status,as NOTCH ligands mapping in tumor niche, remain scarcely estimated, as opposed to CLL.This has directed our attention to the role of cell non‐autonomous NOTCH1 activation at the cross‐roads between other pathways coming from the niche (i.e. immune checkpoint axis). CLL cells also express the NOTCH ligand JAGGED1 (JAG1), that contributes to CLL pathogenesis by activating its own signaling.Experimental proofs in other settings were made, linking the NOTCH1‐JAG1 signaling to the immunological niche.Strikingly, DLBCL‐type RS exhibits PD‐1/PD‐L1 axis upregulation in up to 80% of cases.Taking advantage of these findings, we decided to perform immunohistochemistry (IHC), using validated antibodies,to dissect the precise anatomy of the NOTCH/ligand interface in RS,in vivo.Aims:1) To investigate context‐dependent, cell‐autonomous/cell non‐autonomous NOTCH1 network activation, using IHC stains. Specifically, we focused on NOTCH1 and its ligand JAG1, a well‐known pivotal player in embryonic heart and cardiac diseases. 2) To zoom into the PD‐1/PDL‐1 axis activation in immune niche, and crosslink the immune‐evasion pathway to tumor oncogenic promotion.Methods:A 69‐year old female was admitted to the Cardiology Intensive Care Unit (ICU), for tachy‐/bradycardia. A cardiac computed tomography identified a voluminous rounded mass at the interatrial septum.The pathologic diagnosis was consistent with non‐GC DLBCL.Bone marrow (BM) biopsy detected CLL/SLL.Molecular analysis did not reveal SF3B1,NOTCH1 and TP53 alterations but evidenced the same IgVH mutation in both mass and BM specimens,proving a clonally‐related RS.Results:IHC stains for the cleaved NOTCH1‐intracellular domain (ICD) protein was negative on both RS lymphoma cells and the surrounding stroma, as in BM specimen. On the contrary, JAG1 was markedly positive both on large neoplastic lymphocytes and in the stromal compartment (Figure 1A). Conversely, JAG1 staining was moderate‐to‐weak on CLL lymphocytes in the BM, as well as in the stromal scaffold (Figure 1B), indicating differential expressions. Unexpectedly, JAG1 upregulation occurred independently of NOTCH1 receptor co‐activation. According to this, JAG1 may stimulate other pro‐survival cascades in the neoplastic B cells, transducing microenvironmental cues, coming from TME, where JAG1 itself was found highly expressed. In addition, we performed IHC stain for PD‐1, proving strong positivity on tumor‐infiltrating lymphocytes (TILs) (Figure 1C); moreover, PD‐L1 marked both neoplastic cells and stromal meshwork in the cardiac TME (Figure 1D).Summary/Conclusion:Our report proved the importance of IHC in characterizing JAG1‐NOTCH1 ligand‐receptor interactions in the RS pathogenesis, in order to anatomically characterize cell‐extrinsic pathways in vivo. We traced JAG1 upregulation, independently of NOTCH1 signaling activation and described PD‐1/PD‐L1 axis functional switching in the context of a very unique extra‐nodal RS localization, thus identifying novel potential actionable therapeutic targets.image

Management of high risk pulmonary embolism in the intensive unit care of IBN Rochd University Hospital, Casablanca

High-risk acute pulmonary embolism (PE) is associated with a mortality approaching 25% and remains defined by shock or hypotension. The high early mortality in the presence of a state of shock makes it an urgent diagnosis by favoring examinations in the patient's bed. The aim of this study was to describe the clinical features of patients admitted for acute high-risk PE, the main findings and their prognosis. This is a retrospective study conducted on 112 patients hospitalized in cardiology intensive care unit at IBN ROCHD University Hospital of Casablanca, Morocco for PE between January 2016 and October 2018, including 25 with acute PE at high risk. The average age of the patients with cardiogenic shock was 64.9 years, with a standard deviation of 17.3; with a higher frequency in the elderly > 70 years ( P = 0.06). The sex ratio (M/F) was 0.37, the risk factors for venous thromboembolism were not different from the non-shock group. The clinical presentation was a respiratory distress chart with SpO2 < 95%, arterial hypotension < 90 mmHg systolic and tachycardia > 100bpm in 88% of cases ( P = 0.003). Electrically, rhythm disorders were not more frequent than in stable patients. The echocardiography made it possible to make the diagnosis and initiate the treatment by thrombolysis without waiting for the results of the thoracic angioscanner. A thrombus was found in 24% of cases, right ventricular (RV) dysfunction in 72% of patients ( P = 0.04) with dilatation of RV, paradoxical septum and Pulmonary hypertension in more than 80% of patients. Thrombolysis was used in 88% of patients ( P < 0.001), treatment with non fractionnal heparine, dobutamine was initiated in 52% of cases ( P < 0.01). Mortality was 36% compared to 7% in the non-shock group ( P = 0.026). Despite rapid management and treatment thrombolytics and vasoactive drugs, high-risk acute PE remains a poor prognosis with significant intra-hospital mortality.

First 48 hours systolic blood pressure measurement at the acute phase of acute myocardial infarction is associated with one-year cardiovascular mortality among elderly patients

Optimal blood pressure (BP) in the elderly patients after acute myocardial infarction (AMI) is still a matter of debate and systolic blood pressure (SBP) target at the acute phase remains to be determined. In a prospective observational study, we aimed to identify optimal SBP during the 48 first hours in AMI and its prognostic value for one-year cardiovascular (CV) mortality. From the RICO survey database, all consecutive patients > 75 years admitted for an AMI in cardiology intensive care unit of the university hospital of Dijon from 01/02/2012 to 31/01/2015 and discharged alive were included ( n = 814). Exclusion criteria were in-hospital death, cardiogenic shock and end-stage renal disease. The endpoints were one-year CV mortality and major adverse cardiac events (MACE). The mean SBP values over the first 48 hours following admission were recorded and analysed. The mSBP cut-off value was determined by ROC curve analysis for the prediction of one-year CV mortality (125 mmHg). Patients were divided into 2 groups according to mSBP [< 125 mmHg ( n = 391) vs ≥ 125 mmHg ( n = 423)]. The median age was 82 years. Patients with mSBP < 125 mmHg had a two-fold risk of one-year CV death compared to mSBP ≥ 125 mmHg patients [47 (12.0%) vs 28 (6.6%), P = 0.008]. By multivariate logistic regression analysis, mSBP < 125 mmHg [OR(95%CI): 1.91(1.07–3.41)] remained a strong predictor of one-year CV mortality, beyond diabetes [OR(95%CI): 2.83(1.47–5.43)], LVEF < 40% [OR(95%CI): 2.44 (1.36–4.36)], BMI < 21 kg/m 2 [OR(95%CI): 2.24(1.11–4.55)] and GRACE risk score [OR(95%CI): 1.04(1.02–1.05)]. In our large population-based study in elderly patients with AMI, low mSBP (< 125 mmHg) in the first 48 hours after admission was an independent and powerful predictor of one-year CV mortality. If confirmed by further cohort studies, early mSBP measurement could help to improve risk stratification. Our results may suggest an optimal blood pressure target in elderly patients.

Prognostic Factors for Acute Heart Failure (AHF) in the Cardiology Intensive Care Unit (ICU) of the University Hospital Point G (UH Pt G)

Background and Aim: The absence of data in our context motivates this study aiming to determine the frequency of AHF at the ICU, assess the in-hospital evolution of the disease and to find out poor prognosis.Material and Methods: It was an observational and descriptive study covering the time from January 1, 2014 to March 30, 2017 involving all inpatient records in ICU. From January 2014 to December 2017, collected data included those on socio-demographic, history of diseases and physical examination, and some labor dataincluding Pro BNP, serum creatinine, blood ionogram, cardiac enzymes and blood count. Also data electrocardiography, echocardiography and in-hospital evolution were collected. Statistical Analysis:Statistical analysis was performed using SPSS (IBM Inc) version 18. Results: AHF occured in 47.36% with a mean age of 58.74 ± 18.407 and extremes of 17 and 90 years, women representing 53.1% (sex ratio Male:Female = 0.88). Hypertension and diabetes were the predominant cardiovascular risk factors with respectively 67.4% and 18.4%. At admission 44%, 37.7% and 17.9% of patients were respectively hypertensive, normotensive and hypotensive. The clinical expression was mainly global heart failure with 42.6% followed by left heart failure and right heart failure with respectively 37% and 20.4%. The coronary syndromes (all forms) was the first cause of ICA with 34% of cases followed by pulmonary embolism and hypertension with respectively 25.3% and 24.1%. Mean hospital stay was 5.61 ± 3.527 days (1 to 25 days). Complications were recorded in 18.5% of patients with cardiogenic shock in half of all cases. In multi-variate analysis, only hypotension at admission was shown to be the independent factor of poor prognosis with p = 0.016 and OR = 4.453 (1.322 - 14.996). Conclusion: As a common manifestation heart failure can be rapidly fatal in presence of collapsus or hypotension at admission. These factors should be accurately managed to reduce mortality, which remains high in our context.

Complicated High Blood Pressure in Hospital Area in Lom&amp;amp;#233;

The target of the study was to identify patients living with Compound high blood pressure and describe the epidemiological, treatment and progressive aspects. We had realized retrospective and descriptive study completed throughout twelve months from 1st January to December 31, 2011. The study took into account 250 hypertensives known or not admitted in the cardiology and medical intensive care units at the Sylvanus Olympio Teaching Hospital in Lomé. In total, the frequency of complications of the High Blood Pressure was 33.3% with a male predominance. Patients’ average age was 52.4 years. The most frequent reasons of admission were coma (32%) and hypertensive eruption (28%). The excessive consumption of salt and alcohol were other dominant modifiable risks factors with respectively 36.8% and 22.8%. Neurologic complications were the most frequent of cerebrovascular accidents (CVA) (66%) among which strokes represented 69.7%. Cardiac complications came in second position (31.2%). Double treatment was optional in 62.2% cases with IEC+ Ica++ associated. In 56.6% cases patients with renal disease in terminal stage had been dialysed. The level of total lethality was 34%. The main cause of death was CVA (cerebrovascular accidents) (85.9%). High Blood Pressure is then a very plague with regard to its complications. Its effective caretaking is nothing but through primary prevention based on sensitization, education of the entire grass-roots and it requires the mobilization of all social components.

A fatal case of fulminant myocarditis caused by influenza A virus

Introduction. Myocarditis is defined as an inflammation of a heart muscle, which can be caused by a number of agents, among which viruses are the most common. Fulminant myocarditis is a rapidly progressive, life-threatening myocarditis, followed by the development of cardiogenic shock. Among viruses, there are a number of common ones, but according to our knowledge, there are only a few cases of fulminant myocarditis caused by influenza A virus described in the literature. Case report. We presented a 44-year-old man who was admitted to the Cardiology Intensive Care Unit because of the clinical as well as electrocardiographic signs pointing to the STsegment elevated myocardial infarction with peracute development of heart failure and cardiogenic shock and subsequently lethal outcome, despite applied circulatory support. The urgent coronarography showed no signs of coronary artery disease, while the autopsy revealed myocarditis and the realtime polymerase chain reaction of nasopharyngeal swab revealed influenza A(H3) virus. Conclusion. Fulminant myocarditis is a life-threatening cardiac disease which should be treated in Intensive Care Units with both medicament and mechanical circulatory support and antiviral therapy and which, despite the applied therapy, has a high mortality rate. Influenza A virus is a rare cause of fulminant myocarditis which should be taken into consideration.

Prognostic Factors Associated with Aortic Dissection at the Cardiac Intensive Care Unit of the Point “G” Hospital University Center, Bamako, Mali

Objective: The purpose of this study was to describe the prognostic factors associated with aortic dissection with the cardiology intensive care unit of the Point “G” Hospital University Center. Methodology: This was a descriptive transversal study from January 2010 to February 2017 that included all inpatients during this period. Results: Of 6912 patients admitted, 23 patients were admitted for an aortic dissection, a frequency of 0.33%. Of these, (6) six were under age 50 (26.1%) and the majority age group was 50 - 69 years old. Cardiovascular risk factors were high blood pressure, smoking, and diabetes with 73.9%, 60% and 13% of cases, respectively. At the clinic, chest pain and dyspnea were the main symptoms with respectively 65.2% and 52.2% and with 56.5% asphygmy was associated with pain. Para-clinically, renal failure and anemia were the major laboratory abnormalities found with respectively 43.75% and 31.25% of cases. Doppler echocardiography revealed lesions associated with aortic dissection. In the thoracic angioscan, the aortic dissection was type A (43.5%) and 56.5% type B. The co-morbidities, the associated lesions and the hemodynamic state of the patient indicate the degree of urgency. The treatment was medical. The evolution was full of complications with 52.2% of deaths including 7 (seven) type A patients. Intra-hospital death was 26.1%. Other complications were heart failure (47.8%), the renal failure (43.75%) and an aortic aneurysm (34.8%). Conclusion: Aortic dissection is a life-threatening medical and surgical emergency.

Coronary angiography characteristics of out-of-hospital sudden cardiac arrest occurring in sport-related acute myocardial infarction

Although out-of-hospital sudden cardiac arrest (OHSCA) frequently occurs in sport-related acute myocardial infarction (AMI), contemporary clinical and coronary angiography (CA) findings remains poorly described. In a large retrospective study at a French regional scale, we aimed to investigate clinical and CA characteristics of patients who experienced OHSCA in sport-related AMI. From the RICO database, a French regional AMI survey, we retrospectively analysed the consecutive patients admitted in cardiology intensive care unit of a single university hospital from January 2011 to January 2018 for sport-related AMI and who underwent CA ( n = 100). Data from patients with OHSCA (OHSCA +) were compared with patients without OHSCA (OHSCA -). Among the study population, 20% had OHSCA. Main characteristics are presented in Table 1 (Median (IQR) or %). AMI patients with OHSCA were 6 y older, and were characterized by a higher rate of culprit lesion involving LAD, and had much poorer hospital outcome. CAD extent and proximal distribution of lesions showed a trend toward a more severe profile. Larger studies are needed to confirm our findings.

First 48 hours systolic blood pressure measurement at the acute phase of acute myocardial infarction is associated with one-year cardiovascular mortality among elderly patients

Optimal blood pressure (BP) in the elderly patients after acute myocardial infarction (AMI) is still a matter of debate and systolic blood pressure (SBP) target at the acute phase remains to be determined. In a prospective observational study, we aimed to identify optimal SBP during the 48 first hours in AMI and its prognostic value for one-year cardiovascular (CV) mortality. From the RICO survey database, all consecutive patients > 75 years admitted for an AMI in cardiology intensive care unit of the university hospital of Dijon from 01/02/2012 to 31/01/2015 and discharged alive were included ( n = 814). Exclusion criteria were in-hospital death, cardiogenic shock and end-stage renal disease. The endpoints were one-year CV mortality and major adverse cardiac events (MACE). The mean SBP values over the first 48 hours following admission were recorded and analysed. mSBP cut-off value was determined by ROC curve analysis for the prediction of one-year CV mortality (125 mmHg). Patients were divided into 2 groups according to mSBP [< 125 mmHg ( n = 391) vs. ≥ 125 mmHg ( n = 423)]. The median age were 82 years. Patients with mSBP < 125 mmHg had a two-fold risk of one-year CV death compared to mSBP ≥ 125 mmHg patients [47 (12.0%) vs. 28 (6.6%), P = 0.008]. By multivariate logistic regression analysis, mSBP < 125 mmHg [OR(95% CI): 1.91(1.07–3.41)] remained a strong predictor of one-year CV mortality, beyond diabetes [OR(95% CI): 2.83(1.47–5.43)], LVEF < 40% [OR(95% CI): 2.44 (1.36–4.36)], BMI < 21 kg/m 2 [OR(95% CI): 2.24(1.11–4.55)] and GRACE risk score [OR(95% CI): 1.04(1.02–1.05)]. In our large population-based study in elderly patients with AMI, low mSBP (< 125 mmHg) in the first 48 hours after admission was an independent and powerful predictor of one-year CV mortality. If confirmed by further cohort studies, early mSBP measurement could help to improve risk stratification. Our results may suggest an optimal blood pressure target in elderly patients.

Doppler-Echocardiography for assessment of systemic vascular resistances in cardiogenic shock Patients

Objective Impaired vascular tone plays an important role in cardiogenic shock (CS) and constitutes a therapeutic target with vasopressor treatment. Echocardiography can provide a non-invasive estimation of systemic vascular resistance (SVR). The aim of the present study was to compare doppler echocardiography with the transpulmonary thermodilution (TPTD) method for the assessment of SVR in patients with CS. Methods This prospective monocentric comparison study was conducted in a single cardiology intensive care unit (Hopital Nord, Marseille, France). We assessed systemic vascular resistance index (SVRi) by both echocardiography and TPTD in 28 patients admitted for CS, on admission and after introduction of an inotrope or vasopressor treatment. Results A total of 35 paired echocardiographic and TPTD estimation of SVRi were compared. Echocardiography values ranged from 1309 to 3526 dyne-s-m2/cm5 and TPTD values ranged from 1320 to 3901 dyne-s-m2/cm5. A statistically significant correlation was found between echocardiography and TPTD (r = 0.86, 95% CI 0.74; 0.93, P Conclusion Doppler echocardiography constitutes an accurate non-invasive alternative to TPTD to provide an estimation of SVR in patients with CS.

Venoarterial extracorporeal mebrane oxygenation in the cardiology intensive care unit of the University Hospital Centre Rijeka

Venoarterial extracorporeal mebrane oxygenation in the cardiology intensive care unit of the University Hospital Centre Rijeka

Determinants of clinical presentation on outcomes in older patients with myocardial infarction.

Myocardial infarction without chest pain misleads the clinician, resulting in a diagnosis delay and an increase of mortality. The main objective of the present study was to determine the risk factors of atypical presentation in older patients with myocardial infarction. All consecutive patients aged ≥75 years presenting with myocardial infarction and hospitalized in the cardiology intensive care unit were included in the present prospective multicenter observational study. All patients benefited from both specialized cardiac management and geriatric assessment. A total of 215 consecutive patients were included. The mean age was 85 ± 6 years. A total of 142 patients (66%) had a typical presentation (i.e. chest pain) and 73 patients (34%) had an atypical clinical presentation (i.e. no chest pain). A total of 29 (13.5%) patients died within 30 days of the index hospitalization. Higher Cumulative Illness Rating Score-Geriatric severity index score (P = 0.019) and initial atrial fibrillation (P = 0.022) were predictive of 30-day all-cause mortality. Typical presentation (P = 0.010) was a protective factor of 30-day all-cause mortality. A Cumulative Illness Rating Score for Geriatrics total score increase (P = 0.0003) and residing in a nursing home (P = 0.024) emerged as independent risk factors for atypical presentation. In "real-life" elderly patients, comorbidities influence the prognosis of myocardial infarction, but also clinical presentation. Identification of patients at risk of atypical presentation; that is, patients with multiple comorbid conditions, might help refine the prognostic value in older patients with myocardial infarction. Geriatr Gerontol Int 2018; 18: 1591-1596.

The EYE-MI Pilot Study: A Prospective Acute Coronary Syndrome Cohort Evaluated With Retinal Optical Coherence Tomography Angiography.

To evaluate the association between retinal microvasculature (vascular density) on optical coherence tomography-angiography (OCT-A) and the cardiovascular profile of patients hospitalized for acute coronary syndrome (ACS). EYE-Myocardial Infarction (EYE-MI) study is a prospective cross-sectional study in the Cardiology Intensive Care Unit of Dijon University Hospital. Retinal OCT-A was performed for each patient within 2 days after admission. Superficial retinal capillary plexus (SCP) vascular density was measured. The population was divided into tertiles according to OCT-A data. Overall, 237 cases were retained for analysis. Patients in the tertile with the lowest retinal vascular density (RVD) were older, and more frequently had systemic hypertension and diabetes. Moreover, American Heart Association (AHA) risk and Global Registry of Acute Coronary Events (GRACE) scores were higher and left ventricular ejection fraction (LVEF) was lower in these patients. In multivariate analysis, the AHA risk score (odds ratio [OR], 1.06; 95% confidence interval [CI], 1.04-1.09; P < 0.001) and LVEF (OR, 0.95; 95% CI, 0.93-0.98; P = 0.001) were significantly associated with the lowest tertile of RVD. The association between RVD and a high-risk cardiovascular profile was confirmed by a moderate correlation with the GRACE scores (Spearman r = -0.33, P < 0.001). SCP density measured on OCT-A was associated with the cardiovascular risk profile and with impaired LVEF in patients with a high-risk cardiovascular status. In the future, quantitative retinal microvascular data could be considered a good surrogate of the cardiovascular risk profile and could improve cardiovascular risk assessments.

Trends in Organ Transplantation. DCD in West Pomeranian in Poland

Introduction Over the last fifty years, organ transplantation has become a routine medical procedure, bringing immense benefits to hundreds of thousands of patients. In the last 20 years the use of human organs for transplantation constantly increased. It is currently the most cost-effective way of treatment of end-stage renal disease and the only available treatment for end-stage failure of organs such as the liver, lung and heart. The lack of a sufficient number of transplanted organs is a fundamental limitation and problem facing transplantologists worldwide. Aim The aim of this study was to evaluate the knowledge and training needs of the medical staff of Intensive Care Units and Cardiology Intensive Care Units in terms of harvesting organs from donors after death due to irreversible cardiac arrest (DCD). Material and Methods The study involved 368 people from hospitals in West Pomeranian, Pomeranian and Lubusz voivodeships. The study was conducted from January 2013 to August 2015 among the medical staff in ICU and Cardiology Intensive Care Units. The questionnaire used for the survey consisted of 23 questions: 20 closed and 3 open questions. Results The study showed that 98.4% of respondents accept the transplant as a way of treatment. In analyzed attitudes, 79% of respondents declared acceptance for neurological criteria as appropriate to diagnose death in case of potential organ donor. Major percentage of respondents claimed lack of agreement on equal treatment of cardiovascular and neurological criteria in diagnosing death of potential donor. Despite the declaration of knowledge of the terms DCD and NHBD, the vast majority of respondents (93%) did not know the Maastricht classification, and 80% did not know the procedures related to the procurement of organs from DCD donors. Conclusions The main factors in the activities related to the collection and donation of organs are good will, knowledge and qualifications of ICU workers. The attitude of the medical personnel to the idea of transplantation is extremely important. There is a psychologically difficult moment, when it comes to realize that the efforts of keeping the patient alive became futile, and his death became a fact. Referring to the results of studies in other countries of the European Union, there is a general inquietude and immense difference in personal attitudes toward organ donation from patients after brain death versus DCD. Emphasis must be placed primarily on the transparency of procedures in order to avoid any possible confusion. It is necessary to conduct regular training to medical staff so it can feel properly qualified. It will substantially increase the comfort and affect the certainty in making decisions. Keywords organ transplantation, organ donation, medical staff training, psychological aspects of organ transplantation, ethics

HYPERTENSIVE EMERGENCY IN A DIALYSIS PATIENT

Objective: We present o clinical case of a patient in dialysis with a hypertensive emergency crisis, resistant in treatment. Design and method: A 67 year old woman was presented in the emergency department with shortness of breath, vomiting, headache and dizziness. Her clinical examination revealed moderate dyspnea with bilateral rales, disorientation, reduced muscle strength in the left arm and leg and positive Barre sign. Her Systolic Blood Pressure was 240 mmHg and her Diastolic Blood Pressure was 120mmHg. Her medical history included chronic renal failure, in dialysis during the last 6 years, due to diabetic and hypertensive renal disease. A cranial computed tomography was performed with no signs of stroke or hemorrhage. The patient was classified as having a hypertensive emergency and was admitted in the cardiological intensive care unit. She was treated with intravenous glyceryl trinitrate up to the maximum dose of 0,2 mg/min for more than 30 minutes and intravenous esmolol without adequate control of the blood pressure and any clinical improvement. A combined medical council of nephrologists and cardiologists was held, in which the admission of intravenous nitroprusside of reduced dosage and under strict monitoring was decided. Results: The patient showed a rapid clinical improvement and a fall in her blood pressure up to 170/100 mmHg. She was monitored for 24 hours and was released from the hospital with instruction for a different, more potent, regular medical treatment. Conclusions: Discussion: Hypertensive emergencies are a clinical entity that requires particular alertness when treating dialysis patients. Pathophysiology includes a variety of mechanisms, such as increased vascular resistance, activation of the renin-angiotensin-aldosterone axis and hyperparathyroidism. Addressing hypertensive crises remains a matter of great importance in these patients. Administration of sodium nitroprusside remains a highly effective option, which can be done with careful monitoring of patients with end-stage renal failure.

The relationship of delirium and risk factors for cardiology intensive care unit patients with the nursing workload.

To evaluate the relationship of delirium and risk factors for cardiology intensive care unit (ICU) patients with the nursing workload. Delirium is a common syndrome in patients with cardiac problems. The risk factors causing delirium and the presence and type of delirium affect the nurse workload and patient care quality adversely. This cross-sectional study was conducted with 133 patients staying at the cardiology ICU of a university hospital between 5 January-31 March 2017. The study data were collected using the Patient Information Form, Delirium Risk Factors' Form and Therapeutic Intervention Scoring System-28 (TISS-28) scale to identify the nurse workload. The statistical analysis of the data was performed using frequency, chi-square, Mann-Whitney U, correlation and regression analyses. It was found that patients who developed delirium were 65years or older, they had more nasogastric/total parenteral nutrition (NG/TPN), benzodiazepine and physical restraints in comparison with those with no delirium development, and that the prevalence of hypoxia and hypoalbuminemia were higher in these patients. The mean TISS-28 score was higher in patients with delirium, compared with those without delirium. There was a positive correlation between the mean Acute Physiology and Chronic Health Evaluation II (APACHE II) scores and the mean TISS-28 score of the patients. The mean TISS-28 score was found to significantly increase with being at the age of 65 and above and the administration of mechanical ventilation. The patients with delirium required a mean of 60-min additional care. Our study results suggest that the presence of delirium and the delirium risk factors, irrespective of delirium, increase the nurse workload. An effective management of delirium risk factors can improve the patient care quality by reducing delirium occurrence and nurse workload.

Ischemic Hepatitis – Intercorrelated Pathology

Ischemic hepatitis is an important, yet underdiagnosed pathological condition seen in either cardiology or hepatology clinics or intensive care units. The main causes are severe heart failure, circulatory and septic shock. Close monitoring of biological tests (AST, ALT, LDH) together with hemodynamic parameters (blood pressure, cardiac output and central venous pressure) allow for rapid and accurate diagnosis. Correction of hemodynamic parameters, hypoxemia, hepatic and/or renal dysfunction leads to a more favorable outcome of these patients.

Predictive factors of cardiogenic shock in children with supraventricular tachycardia

Supraventricular tachycardia (SVT) is the most common arrhythmia in children. Isolated SVT inducing cardiogenic shock is rare and factors leading to cardiac dysfunction are unknown. We aim to determine the predictive factors of cardiogenic shock in children with SVT. In total, 109 children under the age of 1 [median age 10 days (1 d; 30 d)], who were referred for SVT to our pediatric cardiologic intensive care unit were included. Cardiogenic shock was defined as a systemic ventricular ejection fraction under 50% and the need for inotropes use. Types of SVT, antenatal diagnosis of arrhythmia, demographic data, clinical and biological characteristics and the therapeutic management were reviewed. Seventeen percent of patients had cardiogenic shock [median age 12 days (3.5 d; 17.5 d)]. Heart failure was significantly more frequent in case of flutter (54.5% in flutter; 13.3% in other SVT; P < 0.01). When the heart rate was high, the risk of failure was greater [median heart rate flutter/other SVT: 280 bpm (235; 300)/230 bpm (210; 280); P = 0.04]. Abortive therapy by adenosine worked for 60% of other types of SVT with or without cardiogenic shock but was ineffective for patients with flutter in our sample. On the other hand, almost all cases of flutter were reduced by electrical cardioversion. Twenty-nine percent of patients had experienced fetal tachycardia without any additional risk of cardiogenic shock (on all cardiogenic shock 42.1% with antenatal arrhythmia and 57.9% without antenatal tachycardia). Associated congenital heart diseases were not a risk factor of cardiogenic shock. The occurrence of cardiogenic shock is not uncommon in children with SVT and concerns mainly patients with flutter. Faster heart rate and the ineffectiveness of adenosine are associated with potentially severe outcomes. These predictive factors of shock will help identify higher risk patients and improve the therapeutic management.