Care Of Cardiac Surgery Patients Research Articles

Does the patient's physical activity affect the course of cardiac surgery - a comprehensive approach to cardiac surgery patients

Cardiovascular diseases represent a leading cause of morbidity worldwide. Over the past years, the field of cardiac surgery has significantly evolved. Globally, more than 2 million cardiac surgeries are performed annually. Among the main procedures are coronary artery bypass grafting (CABG), valve replacements, and heart transplants. The increasing number of patients requiring such treatment and, consequently, the rising number of procedures performed imply an improvement in their quality. With advancements in surgical techniques, the scope of patients eligible for procedures has also expanded. Patients undergoing cardiac surgeries are increasingly older and often suffer from significant comorbidities, such as hypertension and diabetes. Effective cardiac surgery significantly enhances the quality of life. When caring for a patient undergoing cardiac surgery, many aspects of the patient need to be considered to approach them holistically, while simultaneously creating an individualized treatment pathway. Not only the cardiac aspect but also various other factors need to be taken into account, including the patient's diet, medications, comorbidities, mental state, and physical activity. In this work, we emphasize the role of both postoperative and preoperative care for cardiac surgery patients, which, when properly executed, can be the key to the patient's recovery.

Discussion to: Optimizing care of cardiac surgery patients using a digital platform and a multidisciplinary team approach

Discussion to: Optimizing care of cardiac surgery patients using a digital platform and a multidisciplinary team approach

Survey on the Updated German S3 Guideline for Intensive Care in Cardiac Surgery Patients.

The German guideline on intensive care treatment of cardiac surgical patients provides evidence-based recommendations on management and monitoring. It remains unclear if, respectively, to which degree the guidelines are implemented into the daily practice. Therefore, this study aims to characterize the implementation of guideline recommendations in German cardiac surgical intensive care units (ICUs). An internet-based online survey (42 questions, 9 topics) was sent to 158 German head physicians of cardiac surgical ICUs. To compare the effect over time, most questions were based on a previously performed survey (2013) after introduction of the last guideline update in 2008. A total of n = 65 (41.1%) questionnaires were included. Monitoring changed to increased provision of available transesophageal echocardiography specialists in 86% (2013: 72.6%), SvO2 measurement in 93.8% (2013: 55.1%), and electroencephalography in 58.5% (2013: 2.6%). The use of hydroxyethyl starch declined (9.4% vs. 2013: 38.7%), gelatin 4% presented the most administered colloid with 23.4% (2013: 17.4%). Low cardiac output syndrome was primarily treated with levosimendan (30.8%) and epinephrine (23.1%), while norepinephrine (44.6%) and dobutamine (16.9%) represented the most favored drug combination. The main way of distribution was web-based (50.9%), with increasing impact on therapy regimens (36.9% vs. 2013: 24%). Changes were found in all questioned sectors compared with the preceding survey, with persisting variability between ICUs. Recommendations of the updated guideline have increasingly entered clinical practice, with participants valuing the updated publication as clinically relevant.

Prevalence of Postoperative Atrial Fibrillation and Impact to Nursing Practice-A Cross Sectional Study.

Atrial fibrillation is the most common clinically significant cardiac arrhythmia, and it might lead to heart failure, which prolongs the duration of hospitalization and consequently increases the cost of treatment. Thus, diagnosing and treating atrial fibrillation should be the first line of defense against further complications. This study aimed to determine the incidence rate of postoperative atrial fibrillation and correlation with cardiac surgery on heart valves. A specific aim was to determine the relationship between the prevalence of atrial fibrillation and socio-demographic features. The study has a prospective cross-sectional design. The questionnaire was anonymous, requesting socio-demographic information as inclusion criteria, and the data were analyzed using descriptive statistics methods. The sample was 201 patients. χ2 test and t-test were performed where we found that the frequency of atrial fibrillation was higher in the groups that have had valve surgery compared to other cardiac surgeries (χ2 = 7.695, ss = 2, p = 0.021). Atrial fibrillation increased with the age of the patients, but the prevalence of atrial fibrillation was not correlated with body weight. The results of this this study show that atrial fibrillation was higher in the participants who had valve surgery compared to other cardiac surgeries. There was also an increase in atrial fibrillation in the older participants. The results of this study can help to improve nursing practice and the quality of care for cardiac surgery patients with regard to daily activities, or planning nursing care due to the patient's condition.

Role of advanced imaging techniques in cardiac surgery: Aortic dissection.

Collaboration among cardiac surgeons and radiologists is essential to fully leverage advanced imaging technologies and improve the care of cardiac surgery patients. In this review, a cardiac surgeon and cardiovascular radiologist discuss imaging pearls and considerations in aortic dissection cases. The surgeon and the radiologist discuss imaging considerations in two aortic dissection cases. It is essential to obtain and review all phases of a CTA when diagnosing acute aortic pathology. Optimizing scan parameters and careful multiplanar image review is necessary for adept interpretation. Current CT technology allows ECG gating to eliminate motion artifact and allow for dynamic assessment of the aortic pathology. Concurrent evaluation of thoracic aorta and coronary arteries is feasible. A systematic review of the scan using landmarks is critical for appropriate diagnosis and reporting. As TEVAR is increasingly used for arch repair, collaboration with radiologists is essential for preoperative planning in redo cases. Collaboration among cardiac surgeons and radiologists is mutually beneficial for surgeons, radiologists, and their patients.

Implementation of clinical nutrition protocols in cardiac centers: A nationwide survey among surgeons

Objectives: One major factor contributing to ‘‘post-ICU disability’’ is the loss of functional lean body mass, highlighting the importance of nutrition support as an integral component of the perioperative care of cardiac surgery patients with greater comorbidities and frailty.

Transfusion practice in patients undergoing cardiac surgery in New Zealand-impact of the TRICS III study (the TRICS TRIPS study).

Cardiac surgery is the largest perioperative user of donated blood products. There is significant uncertainty as to the optimal threshold for RBC transfusion in patients undergoing cardiac surgery with little evidence to guide practice. We wished to determine whether the results of a large randomised controlled trial had changed practice. A prospective observational study of red blood cell (RBC) transfusions of patients undergoing cardiac surgery utilising cardiopulmonary bypass was undertaken as well as a cross-sectional self-administered online practice survey of clinicians ordering red blood cell transfusions in all publicly funded cardiac centres in New Zealand. Significantly more transfusions were administered to a pre-transfusion haemoglobin <75g/L and thus considered in agreement with the restrictive arm of the TRICS III study after completion of TRICS III study enrolment and before results were known (T1)=44% when compared to after results were known (T2=56.7%, p=0.01). Most respondents in the clinician survey had participated in the TRICS III study. After the publication of the findings of a large multi-national clinical trial, clinicians involved in the care of cardiac surgery patients were more restrictive in their administration of red blood cell transfusions than before the trial findings were published.

Pre-surgery optimization of patients’ expectations to improve outcome in heart surgery: Study protocol of the randomized controlled multi-center PSY-HEART-II trial

The PSY-HEART-I trial indicated that a brief expectation-focused intervention prior to heart surgery improves disability and quality of life 6 months after coronary artery bypass graft surgery (CABG). However, to investigate the clinical utility of such an intervention, a large multi-center trial is needed to generalize the results and their implications for the health care system. The PSY-HEART-II study aims to examine whether a preoperative psychological intervention targeting patients' expectations (EXPECT) can improve outcomes 6 months after CABG (with or without heart valve replacement). EXPECT will be compared to Standard of Care (SOC) and an intervention providing emotional support without targeting expectations (SUPPORT). In a 3-arm multi-center randomized, controlled, prospective trial (RCT), N = 567 patients scheduled for CABG surgery will be randomized to either SOC alone or SOC and EXPECT or SOC and SUPPORT. Patients will be randomized with a fixed unbalanced ratio of 3:3:1 (EXPECT: SUPPORT: SOC) to compare EXPECT to SOC and EXPECT to SUPPORT. Both psychological interventions consist of 2 in-person sessions (à 50 minute), 2 phone consultations (à 20 minute) during the week prior to surgery, and 1 booster phone consultation post-surgery 6 weeks later. Assessment will occur at baseline approx. 3-10 days before surgery, preoperatively the day before surgery, 4-6 days later, and 6 months after surgery. The study's primary end point will be patients’ illness-related disability 6 months after surgery. Secondary outcomes will be patients’ expectations, subjective illness beliefs, quality of life, length of hospital stay and blood sample parameters (eg, inflammatory parameters such as IL-6, IL-8, CRP). This large multi-center trial has the potential to corroborate and generalize the promising results of the PSY-HEART-I trial for routine care of cardiac surgery patients, and to stimulate revisions of treatment guidelines in heart surgery.

Need for Improved Care of Cardiac Surgery Patients With Opioid Use Disorder

Numerous studies have evaluated the relationships between opioid prescription and use with the care and outcomes of patients undergoing cardiac surgical procedures. In this issue of The Annals of Thoracic Surgery, Dewan and colleagues1 use the Nationwide Readmissions Database (NRD) to evaluate whether patients with diagnosed opioid use disorder (OUD) have greater risk of readmission after cardiac surgery than those without diagnosed OUD. Note that while 1% of their cohort was coded as having OUD, this proportion is much smaller than those with any opioid use presenting for cardiac surgery, which we found to be 10% at our institution.

The effects of a team-based planned care program on the quality of sleep in cardiac surgery patients hospitalized in the intensive care unit: A two-group controlled clinical trial.

BACKGROUND:Sleep disturbances as a major health problem are common in patients hospitalized in critical care units. This study examined the effects of a team-based care plan on the quality of sleep in patients hospitalized in a cardiac surgery intensive care unit (CSICU) of a multidisciplinary hospital.MATERIALS AND METHODS:In this clinical trial, 100 patients with cardiac surgery were selKMected through convenience sampling and then nonrandomly allocated to the intervention and or the control group. A plan of care with the recommendation of all intensive care unit care teams was designed and then applied. In this study, the Richards-Campbell Sleep Questionnaire was used to evaluate sleep quality. Patients in the intervention group received the care plan for two consecutive nights. The study's national approval code is IRCT2017091915512N2. Collected data were analyzed using SPSS software (v. 21), and by paired, independent t, Chi-square, and Fisher's exact tests.RESULTS:Quality of sleep in patients admitted to the CSICU is significantly improved by noise reduction both in the first and second nights. Moreover, the team-based care plan requires good coordination between all team members taking care of cardiac surgery patients admitted to the CSICU (P < 0.001).CONCLUSIONS:The team-based care plan significantly improves the quality of sleep. It may be due to the close coordination between all team members to avoid sleep disturbances.

Telemedicine in the era of coronavirus 19: Implications for postoperative care in cardiac surgery.

BackgroundThe Coronavirus 19 (COVID‐19) pandemic forced an unprecedented shift of postoperative care for cardiac surgery patients to telemedicine. How patients and surgeons perceive telemedicine is unknown. We examined patient and provider satisfaction with postoperative telehealth visits following cardiac surgery.MethodsBetween April 2020 and September 2020, patients who underwent open cardiac surgery and had a postoperative appointment via telemedicine were administered a patient satisfaction survey over the phone. Time of survey administration ranged from 1 to 4 weeks following their appointment. Surgeons also completed a satisfaction survey following each telemedicine appointment they conducted.ResultsFifty patients were surveyed. Of these, 36 (72%) had a postoperative appointment over the telephone, and 14 (28%) had a postoperative appointment via video‐chat. Overall, patients expressed satisfaction with the care that they received via our two telemedicine modalities (mean Likert scale agreement 4.8, SD 0.5). Despite this, 46% of patients said they would prefer their next postoperative appointment to be via telemedicine even if there was not a stay‐at‐home order in place. All surgeons surveyed reported (agree/strongly agree) that they would prefer to see their postoperative patients using telemedicine.ConclusionsThese findings highlight acceptability of continuing telemedicine use in the postoperative care of cardiac surgery patients.

Critical Care in Cardiac Surgery Patients with COVID-19: International and Own Experience

The widespread occurrence of coronavirus disease 2019 (COVID-19) in the world has led to a sharp de-crease in the number of cardiac surgery interventions and had a negative impact on treatment outcomes. We present an overview of the available literature on the effects of COVID-19 on cardiac surgery at this time. The lack of randomized studies and guidelines on the tactics of perioperative management of patients with cardiovascular pathology encourages to rely on isolated clinical cases presented in the literature. The presence of cardiovascular disease in COVID-19 patients has been identified as a risk factor associated with high morbidity and mortality from the first days of the pandemic. In addition to older age, chronic comorbidities increase the risk of severe COVID-19 infection as well as its lethal outcome. Among the predictors of 30-day mortality in COVID-19 patients in the postoperative period the following were under-lined: male sex (p˂0.001), high risk class according to the American Society of Anesthesiologists (ASA) (p˂0.001), age over 70 years (p˂0.001), emergency surgery (p = 0.026), oncological surgery (p = 0.046). To date, there are no studies on the perioperative management of cardiac surgery patients with acquired heart disease with persistent post-COVID-19 lung disease. We present the results of our own experience of perioperative management of a cardiac surgery patient with COVID-associated outpatient bilateral polysegmental pneumonia. Patients with cardiac surgery after COVID-19 required intensive preoperative preparation. Appointment of the proposed scheme of antibacterial therapy in combination with corticosteroids has reduced the intensity of inflammatory changes in lung tissue. Surgical improvement of intracardiac hemodynamics under cardiopulmonary bypass led to complete reduction of lung parenchyma injury and restoration of the respiratory system.&#x0D; Results. In patients with acquired heart disease, respiratory failure can be caused not only by post-COVID-19 lung injury, but also by impaired intracardiac hemodynamics with increased pulmonary artery pressure due to the initial heart disorders. Restoration of adequate gas exchange function in the group of post-COVID-19 patients is ineffective without timely cardiac surgery.

Cuidados de enfermagem na cirurgia cardí­aca: perspectivas da literatura atual

Objetivo: analisar as publicações cientí­ficas acerca dos cuidados de enfermagem ao paciente de cirurgia cardí­aca. Método: Trata-se de uma revisão integrativa da literatura, da modalidade exploratória, descritiva, com abordagem qualitativa. Foi realizada no perí­odo de agosto a outubro de 2020, nas seguintes bases de dados, indexadas a Biblioteca Virtual de Saúde: SciELO, LILACS e MEDLINE. Foram selecionadas 07 publicações, e estas foram analisadas, e organizadas em dois quadros, contendo: tí­tulo, autores, ano de publicação, e os cuidados de enfermagem na cirurgia cardí­aca. Resultados: O enfermeiro, junto com sua equipe, acompanha o paciente em todas as etapas da cirurgia cardí­aca, e realiza cuidados na alimentação, orientação e acolhimento da famí­lia, esclarecimentos para o procedimento, exame fí­sico e sistematização da assistência de enfermagem. Conclusão: os cuidados de enfermagem são essenciais na cirurgia cardí­aca, e que ainda é necessário novas pesquisas que fortaleçam e evidenciem esse cuidado.

Postoperative care of cardiac surgery patients: A protocolized approach towards enhanced recovery versus the conventional approach

ABSTRACT Background Patients post-cardiac surgery face multiple challenges, but poorly controlled pain and atelectasis remain major issues that can prolong their recovery journey. The aim of this study was to compare two protocols of postoperative care in cardiac surgery: An enhanced recovery program consisting of high flow nasal oxygen therapy together with pectointercostal block, versus conventional postoperative care. Patients and Methods Fifty adult participants above the age of 18, of either sex scheduled for cardiac surgery who required the utilization of cardiopulmonary bypass and median sternotomy approach, were included in the study. The participants were divided into ERAS Care group, where they received ultrasound-guided pectointercostal fascial plane block with subcutaneous local anaesthesia infiltration around the mediastinal drains and were extubated onto high flow nasal oxygen therapy (HFNO), and a Conventional (CONV) care group, where participants received fentanyl IV bolus dose followed by fentanyl IV infusion that was continued till the end of day zero and were extubated onto 6 L/min simple facemask. Results Participants in the ERAS group had shorter ICU stay, lower numeric pain rating scale scores, less need for rescue analgesia, better oxygenation and lung aeration scores, better patient satisfaction, and less late pulmonary complications on discharge radiological screening. However, gastrointestinal complications and hospital stay were compared in both groups. Conclusion ERAS care protocol in cardiac surgery patients led to shorter ICU ventilation periods, shorter ICU stay, better patient satisfaction and pain control, better oxygenation and lung aeration and less atelectasis on discharge radiology.

Clinical audit of early extubation in a tertiary referral cardiac surgery unit

Introduction Early extubation is a recognised standard of care for cardiac surgery patients[1]. Multiple studies have shown that there is no increase in morbidity and mortality for patients extubated early following cardiac surgery[2, 3], and that early extubation decreases Intensive Care Unit (ICU) stay[2, 4]. The JAMA 2019 guidelines define early extubation as within 6 hours post-operatively. The aim of this study was to assess local compliance with international guidelines. Methods We performed a retrospective analysis of all cardiac surgery undertaken in our institution over a 1-year period (n=343). 79% were male (n=273) and average age at time of operation was 64 years. We excluded patients who were not admitted to ICU post operatively (9%, n=31) or for whom incomplete data was available (5%, n=20). A total of 292 patient electronic records were therefore analysed. The extubation time was recorded, as well as total length of ICU stay, and total post-operative stay. Results Of the 292 patients analysed, the median time for extubation was 5.5 hours. 58% of patients were intubated for 6 hours or less. We found a significantly shorter length of ICU stay for patients intubated for 6 hours or less (2.17 days vs 2.82 days, P=.0275). However, there was no significant difference in total post-operative stay between the two groups (9.3 vs 10.7 days, P=.4004). Discussion We are extubating over 50% of patients within 6 hours post operatively. In line with previous research there is statistically significant less overall time spent in ICU when patients are extubated within 6 hours post-operatively, however this does not affect total inpatient stay. Overall, regardless of time of extubation, the median ICU stay was short at 2.5 days.

Zero balance ultrafiltration using dialysate during nationwide bicarbonate shortage: a retrospective analysis

BackgroundZero balance ultrafiltration (Z-BUF) utilizing injectable 8.4% sodium bicarbonate is utilized to treat hyperkalemia and metabolic acidosis associated with cardiopulmonary bypass (CPB). The nationwide shortage of injectable 8.4% sodium bicarbonate in 2017 created a predicament for the care of cardiac surgery patients. Given the uncertainty of availability of sodium bicarbonate solutions, our center pro-actively sought a solution to the sodium bicarbonate shortage by performing Z-BUF with dialysate (Z-BUF-D) replacement fluid for patients undergoing cardiopulmonary bypass.MethodsSingle-center, retrospective observational evaluation of the first 46 patients at an academic medical center who underwent Z-BUF using dialysate over a period of 150 days with comparison of these findings to a historical group of 39 patients who underwent Z-BUF with sodium chloride (Z-BUF-S) over the preceding 150 days. The primary outcome was the change in whole blood potassium levels pre- and post-Z-BUF-D. Secondary outcomes included changes in pre- and post-Z-BUF-D serum bicarbonate levels and the amount of serum bicarbonate used in each Z-BUF cohort (Z-BUF-D and Z-BUF-S).ResultsZ-BUF-D and Z-BUF-S both significantly reduced potassium levels during CPB. However, Z-BUF-D resulted in a significantly decreased need for supplemental 8.4% sodium bicarbonate administration during CPB (52 mEq ± 48 vs. 159 mEq ± 85, P < 0.01). There were no complications directly attributed to the Z-BUF procedure.ConclusionZ-BUF with dialysate appears to be analternative to Z-BUF with sodium chloride with marked lower utilization of intravenous sodium bicarbonate.

Effectiveness of negative pressure wound healing systems applying in sternotomy after cardiac surgery: a systematic review

Introduction: Despite the progress of prevention and peri-operative care of cardiac surgery patients, complications of the surgical wound still occur to 1-3% of patients and they are connected with high rates of hospital mortality.Aim: The present systematic review aims to investigate the effectiveness of the application of negative pressure wound therapy in median sternotomy wounds after cardiac surgery that occur deep infections.Material and Method: All the relevant Greek and International bibliography was searched to Pubmed, Cinahl, Sciverse Scopus and Proquest database. The Key words that were used were negative pressure wound treatment AND sternotomy AND cardiac surgery regarding the pursuit of the title, the abstract or the key words for publications from 2012 and after.Results: From 123 articles, 7 articles were finally chosen for studying of the full text. According to the results of the review, negative pressure wound treatment’s use to median sternotomy wounds provide the healing, the treatment and the prevention of infections and contributes to the reduction of the time and cost of hospitalization.Conclusions: The need to carry out more randomized clinical trials is highlighted so that the results can be generalized.

Improved Outcomes With Integrated Intensivist Consultation for Cardiac Surgery Patients.

This study examined the impact of integrated intensivist consultation in the immediate postoperative period on outcomes for cardiac surgery patients. A retrospective cohort study was conducted in 1711 adult cardiac surgery patients from a single quaternary care center in Minnesota. Outcomes were compared across 2 consecutive 2-year time periods reflecting an elective intensivist model (n = 801) and an integrated intensivist model (n = 910). Patients under the 2 models were comparable with respect to demographics, comorbidities, procedure types, and Society for Thoracic Surgery predicted risk of mortality score; however, patients in the earlier cohort were slightly older and more likely to have chronic kidney disease ( P = .003). Integrated intensivist involvement was associated with reduced postoperative ventilator time, length of stay (LOS), stroke, encephalopathy, and reoperations for bleeding (all P < .01) but was not associated with mortality. Intensivist integration into the postoperative care of cardiac surgery patients may reduce ventilator time, LOS, and complications but may not improve survival.

Perspectives of Post-Acute Transition of Care for Cardiac Surgery Patients.

Post-acute care (PAC) facilities improve patient recovery, as measured by activities of daily living, rehabilitation, hospital readmission, and survival rates. Seamless transitions between discharge and PAC settings continue to be challenges that hamper patient outcomes, specifically problems with effective communication and coordination between hospitals and PAC facilities at patient discharge, patient adherence and access to cardiac rehabilitation (CR) services, caregiver burden, and the financial impact of care. The objective of this review is to examine existing models of cardiac transitional care, identify major challenges and social factors that affect PAC, and analyze the impact of current transitional care efforts and strategies implemented to improve health outcomes in this patient population. We intend to discuss successful methods to address the following aspects: hospital-PAC linkages, improved discharge planning, caregiver burden, and CR access and utilization through patient-centered programs. Regular home visits by healthcare providers result in decreased hospital readmission rates for patients utilizing home healthcare while improved hospital-PAC linkages reduced hospital readmissions by 25%. We conclude that widespread adoption of improvements in transitional care will play a key role in patient recovery and decrease hospital readmission, morbidity, and mortality.

Qualitative research on the humanistic care of cardiac surgery patients in the operating room

Objective To investigate the status of humanistic care on patients with cardiac surgery of operating room nurse and explore the implementation of perioperative humanistic care on patients with cardiac surgery. Methods Purposive sampling method was used to deeply semi-structured interview 10 operating room nurses in a class-three grade A hospital of Guangxi from July 2016 to August 2016. The interview data was analyzed by using Colaizzi analysis method. Results There were three themes. The knowledge level of humanistic care was related to seniority, professional title and practical experience. The poor performances in the implementation of humanistic care were as following: the preoperative interview was not in place, nurses were lack of effective communication skills, and nurses did not pay attention to the protection of the privacy of patients and postoperative visits. The implementation of humanistic care improved the satisfaction of patients. Conclusions Operation room managers should arrange humanistic care topics and fully implement the humanistic nursing care of patients undergoing cardiac surgery in operation room so as to improve the patients' satisfaction. Key words: Thoracic surgery; Operating room nurse; Humanistic care; Qualitative research