Postoperative Cardiac Patients Research Articles

Effects of early mobilization in elderly patients undergoing cardiac surgery.

Although early mobilization is associated with improved outcomes in postoperative cardiac patients, implementation of early mobilization in elderly patients is still a challenge. In this study, we aimed to design and assess an early mobilization program for cardiac rehabilitation. We conducted a clinical trial in elderly patients aged over 65years after coronary artery bypass graft surgery. Patients were randomly assigned to an early mobilization group (Group A) or a routine therapy group (Group B). Short-Form International Physical Activity Questionnaire (SF-IPAQ), to assessment balance Time Up and Go (TUG), to assessment functional capacity the 2-min walking test (2MWT) and the short physical performance battery (SPPB) were used as a reference to formulate and monitor the early mobilization regimen. A total of 100 patients were enrolled (n = 50 per group). The mean walking distance in Group A was significantly higher at 135.6 ± 9.29 than the mean walking distance in Group B which was lower at 123.4 ± 8.48. Also, the patients in Group B had a mean SF-IPAQ of 389.44 with an SD of 85.7, P < 0.001, whereas the mean SF-IPAQ amount in Group A was 556.16 with an SD of 91.47. In early mobilization group, a strong positive connection was indicated by the correlation coefficient of r = 0.957 between the amount of SF-IPAQ and 2 MWT and there was a significant negative association r = - 0.768 between 2MWT and TUG. Our study's findings suggest that early mobilization and functional exercises enhanced balance, functionality, and life quality for older cardiac patients.

Assessment of QTc-interval Prolonging Medication Utilization and Associated Potential Drug-Drug Interactions in Hospitalized Cardiac Patients: A Cross-Sectional Study in Cardiology

Background: Several medications are linked to QTc-interval prolongation and torsades de pointes (TdP), a risk that is more common among hospitalized patients due to polypharmacy and associated QTc-interval-prolonging drug-drug interactions (QTc-pDDIs). Objective: This study aimed to identify the prevalence of QTc-interval-prolonging drug (QTc-Drug) utilization and QTc-pDDIs among postoperative cardiac patients admitted to the National Institute of Cardiovascular Diseases (NICVD). Method: We conducted a cross-sectional study at the NICVD, reviewing patients' medication charts for the use of QTc-Drugs and QTc-pDDIs. The CredibleMeds list was used to identify drugs associated with QTc-interval prolongation, while Micromedex Drug-Int.® and Lexicomp Interact® were utilized to screen for QTc-pDDIs. Results: A total of 384 patients, with an average age of 48.9 ± 13.9 years, were included in the study. On average, patients used 10.3 ± 1.7 medications. Of the 3,956 medications prescribed, 22.9% were QTc-Drugs. The most frequently used QTc-Drug classes were diuretics (69.3%), anti-emetics (61.5%), and proton pump inhibitors (51.0%). Overall, 99.7% of patients received at least one QTc-Drug. The most frequent QTc-pDDI was ciprofloxacin-domperidone (7.6%), classified as major by Micromedex and a category B interaction by Lexicomp. Conclusion: The prevalence of QTc-Drugs was very high among postoperative cardiac patients, with nearly all patients (99.7%) receiving at least one QTc-Drug. The most common QTc-pDDI was ciprofloxacin-domperidone (7.6%), identified as a major interaction by Micromedex and a category B interaction by Lexicomp. Category X (contraindicated) QTc-pDDIs should be avoided in hospitalized patients.

The Efficacy of Ultrasound Guided Bilateral Transversus Thoracic Plane Block for Postoperative Pain Control in Cardiac Surgery

Abstract Background Cardiothoracic surgeries are associated with significant pain. Optimal analgesia is a vital part of strategies intended to improve patients' experience and outcomes. Traditionally, analgesia in these types of surgeries has depended on large doses of I.V. opioids. Aim of the Work The aim of the study was to evaluate the effect of postoperative bilateral US guided TTPB block on postoperative pain control in patients undergoing cardiac surgery through mid-line sternotomy compared to systemic analgesia. Patients and Methods This study is a randomized clinical trial study at Ain-shams University Hospitals, Cairo, Egypt. In our study, patients were randomly allocated into two groups with 40 patients in each group. Group 1 (study group) received TTP block., whereas Group 2(control group) received systemic analgesics. The two groups were compared regarding their demographic data (age, sex, body weight and height), A numerical rating scale (NRS) for sternal pain, morphin consumption during 24 hours after extubation and time of first rescue analgesia, heart rate and blood pressure in icu, time of extubation, ICU length of stay, total length stay of the hospital. Results Our study showed that when compared to general anesthesia with systemic opioids, TTPB block is associated with significantly better postoperative pain control. Conclusion Tranversus thoracic plaine block is technically simple, safe and very effective technique and can be used as a part of multimodal analgesia in postoperative cardiac surgical patients for better patient comfort and satisfaction and also helps in superior pulmonary rehabilitation, thus assisting in better outcome and less unwanted side effects of systemic analgesics.

The effect of antipsychotic medications on QTc and delirium in paediatric cardiac patients with ICU delirium.

Children with prolonged hospital admissions for CHD often develop delirium. Antipsychotic medications (APMs) have been used to treat delirium but are known to prolong the QTc duration. There is concern for prolongation of the QTc interval in cardiac patients who may be more vulnerable to electrocardiogram (ECG) changes and may have postoperative QTc prolongation already. The goal of this study was to determine the effect of APM on QTc duration in postoperative paediatric cardiac patients and determine the effect of quetiapine and risperidone in treating delirium and QTc prolongation. Retrospective study, July 1, 2017-May 31, 2022. Tertiary children's hospital. Included were patients admitted to the paediatric cardiac ICU at Children's Healthcare of Atlanta. None. ECGs, delirium scores, and drug information were collected. Delirium was defined as Cornell Assessment of Pediatric Delirium (CAPD) score >9. Mixed effect models were performed to evaluate the effect of surgery on QTc change and the effect of antipsychotics on QTc and CAPD changes. There were 139 children, 55% male and 67% surgical admissions. Median age was 5.9 months. Mean QTc increased after cardiac surgery by 18 ms (p = 0.014, 95% CI 3.65-32.4). There was no significant change in QTc after antipsychotic administration (p = 0.064). The mean CAPD score decreased (12.5-7.2; p < 0.001). Quetiapine had the most improvement in delirium, and risperidone had the least improvement (77.8%, n = 14; 37.8%, n = 34, respectively; p = 0.002). The QTc interval did not have a statistically significant change after the administration of antipsychotics, while there was improvement in the CAPD score. APMs may be administered safely without significant prolongation of the QTc and are an effective treatment for delirium.

Study of Factors Influencing Early Kinesiophobia in Older Patients after Coronary Artery Bypass Grafting in China

Background: Kinesiophobia is highly prevalent among postoperative cardiac patients. Early identification of kinesiophobia in patients who have undergone coronary artery bypass grafting (CABG) can improve their ability to participate in physical activities. However, there is limited research on the factors influencing kinesiophobia in older patients during the early stages after CABG. To investigate the factors influencing early kinesiophobia in older patients after coronary artery bypass grafting and to examine the correlation between these factors and social support and rehabilitation exercise self-efficacy. Methods: Using convenience sampling, 117 older patients who underwent coronary artery bypass grafting in the cardiac surgery ward of a tertiary grade A hospital in Bengbu City from October 2022 to September 2023 were analyzed. The survey was conducted on-site using a general information questionnaire, the Chinese version of the Tampa Scale for Kinesiophobia Heart (TSK-SV Heart), the Cardiac Exercise Self-Efficacy Instrument (CESEI), the Social Support Rating Scale (SSRS), and the pain assessment scale. Single-factor analysis, multifactor regression analysis, and Spearman's correlation analysis were employed. Results: Among the 117 older patients in the early postoperative phase following coronary artery bypass grafting, the incidence of kinesiophobia was 73.5%. Single-factor analysis revealed that education level, medical expense coverage, place of residence, and pain scores were significantly associated with kinesiophobia (p &lt; 0.05). Multifactor regression analysis identified age and monthly income as factors influencing cardiac exercise self-efficacy (p &lt; 0.05). Age, education level, medical expense coverage, and monthly income affected patient social support (p &lt; 0.05). Spearman's correlation analysis revealed significant negative correlations among cardiac exercise self-efficacy, social support, and kinesiophobia level (p &lt; 0.001). Conclusion: The incidence of early kinesiophobia is relatively high among older patients after coronary artery bypass grafting. Educational level, medical expense coverage, place of residence, and postoperative pain were influential factors. Both cardiac exercise self-efficacy and social support have a significant impact on kinesiophobia in patients. Therefore, clinical healthcare professionals should prioritize older patients undergoing postcoronary artery bypass grafting with lower educational levels and monthly incomes. Effective and evidence-based clinical interventions can be tailored based on these influencing factors and their correlations to promote active participation in rehabilitation exercises and improve patient outcomes in the early postoperative phase.

Postoperative cognitive dysfunction in heart transplantation recipients.

This study aimed to investigate the occurrence and risk factors of postoperative neurocognitive disorder (NCD) in patients who underwent heart transplantation. Seventy-six heart transplant patients were analyzed for clinical data including gender, age, height, weight, education level, left ventricular ejection fraction (LVEF), stroke volume (SV), transplantation duration, and pretransplant medical history. Cognitive function was assessed using the mini-mental status examination (MMSE) and Montreal cognitive assessment (MoCA) scales. Patients were categorized into cognitively normal and impaired groups based on the presence or absence of cognitive dysfunction, and their cognitive function scores were compared. Multivariate logistic regression was used to identify independent risk factors for cognitive impairment in postoperative cardiac transplant patients. Cognitive dysfunction was observed in 48 out of 76 heart transplant patients, representing an incidence of 63.2%. Cognitive impairment in heart transplant recipients predominantly affected multiple cognitive domains. Logistic regression analysis identified age (OR=1.057, 95% CI 1.002-1.115), gender (OR=.200, 95% CI.044-.919), education level (OR=.728, 95% CI.600-.883), LVEF (OR=.891, 95% CI.820-.969), and history of diabetes (OR=7.674, 95% CI 1.317-44.733) as independent risk factors for postoperative NCD in heart transplant recipients (P<.05). The study found a high incidence of postoperative NCD in heart transplant patients, with gender, age, education level, LVEF, and diabetes history being significant risk factors. Early identification and intervention targeting these risk factors may help prevent NCD in postheart transplant patients and improve long-term outcomes.

Cardiac resternotomy after cardiac surgery in kids: CRACK the chest.

Emergent resuscitation of postoperative paediatric cardiac surgical patients requires specialised skills and multidisciplinary teamwork. Bedside resternotomy is a rare but life-saving procedure and few studies focus on ways to prepare providers and improve performance. We created a multidisciplinary educational intervention that addressed teamwork and technical skills. We aimed to evaluate the efficiency of the intervention to decrease time to perform critical tasks and improve caregiver comfort. A simulation-based, in situ resternotomy educational intervention was implemented. Pre-intervention data were collected. Educational aids were used weekly during day and night nursing huddles over a three-month period. All ICU charge nurses had separate educational sessions with study personnel and were required to demonstrate competency in all the critical tasks. Post-intervention simulations were performed after intervention and at 6 months and post-intervention surveys were performed. A total of 186 providers participated in the intervention. There was a decrease in time to obtain defibrillator, setup resternotomy equipment and internal defibrillator paddles and deliver sedation and fluid (all p < 0.05). Time to escort family from the room and obtain blood was significantly decreased after intervention (p < 0.05). There was no difference in time to first dose of epinephrine, defibrillator pads on the patient, or time to call the cardiovascular surgeon or blood bank. Providers reported increased comfort in identifying equipment needed for resternotomy (p < 0.01) and setting up the internal defibrillator paddles (p < 0.01). Implementation of a novel educational intervention increased provider comfort and decreased time to perform critical tasks in an emergent resternotomy scenario.

Investigating Potential Correlations between Calcium Metabolism Biomarkers and Periprocedural Clinical Events in Major Cardiovascular Surgeries: An Exploratory Study.

Background: There is emerging but conflicting evidence regarding the association between calcium biomarkers, more specifically ionized calcium and the prognosis of intensive care unit (ICU) postoperative cardiac patients. Methods: Our study investigated the relationship between ionized calcium, vitamin D, and periprocedural clinical events such as cardiac, neurologic and renal complications, major bleeding, vasoactive-inotropic score (VIS), and length of ICU and hospitalization. Results: Our study included 83 consecutive subjects undergoing elective major cardiac surgery requiring cardiopulmonary bypass. The mean age of the participants was 64.9 ± 8.5 years. The majority of procedures comprised isolated CABG (N = 26, 31.3%), aortic valve procedures (N = 26, 31.3%), and mitral valve procedures (N = 12, 14.5%). A difference in calcium levels across all time points (p < 0.001) was observed, with preoperative calcium being directly associated with intraoperative VIS (r = 0.26, p = 0.016). On day 1, calcium levels were inversely associated with the duration of mechanical ventilation (r = -0.30, p = 0.007) and the length of hospital stay (r = -0.22, p = 0.049). At discharge, calcium was inversely associated with length of hospital stay (r = -0.22, p = 0.044). All calcium levels tended to be lower in those who died during the 1-year follow-up (p = 0.054). Preoperative vitamin D levels were significantly higher in those who experienced AKI during hospitalization (median 17.5, IQR 14.5-17.7, versus median 15.3, IQR 15.6-20.5, p = 0.048) Conclusion: Fluctuations in calcium levels and vitamin D may be associated with the clinical course of patients undergoing cardiac surgery. In our study, hypocalcemic patients exhibited a greater severity of illness, as evidenced by elevated VIS scores, and experienced prolonged mechanical ventilation time and hospital stays. Additional larger-scale studies are required to gain a deeper understanding of their impact on cardiac performance and the process of weaning from cardiopulmonary bypass, as well as to distinguish between causal and associative relationships.

Impact of right ventriculotomy on cardiac function after pulmonary valve sparing repair of tetralogy of Fallot and double outlet right ventricle with pulmonary stenosis.

Pulmonary valve-sparing repair of tetralogy of Fallot and double outlet right ventricle with pulmonary stenosis has the advantage of reduced incidence of late pulmonary valve regurgitation and better-preserved cardiac function. However, a right ventriculotomy is sometimes necessary in order to adequately relieve subvalvular pulmonary stenosis. We aimed to compare postoperative cardiac function and patients' symptoms between pulmonary valve-sparing repair with and without right ventriculotomy. We retrospectively collected data from electronic medical records of Ramathibodi Hospital from 1st January 2013 to 31st October 2023. Patients diagnosed with tetralogy of Fallot and double outlet right ventricle with pulmonary stenosis who underwent pulmonary valve-sparing repair were included. Patients who underwent other types of repairs and whose medical record data were significantly missing were excluded. Demographic data, operative, and postoperative details were collected and reviewed. There were 49 patients included in our study with 10 patients undergoing pulmonary valve-sparing repair with and the other 39 without right ventriculotomy. Before-discharge echocardiographic parameters were generally similar between both groups (tricuspid annular plane systolic excursion = 0.9 versus 0.89 cm, P = 0.737; pressure gradient across pulmonary valve across pulmonary valve = 24 versus 19 mmHg, P = 0.275; left ventricular end-systolic volume index = 17.84 versus 19.19 ml/m2, P = 0.437; left ventricular end-diastolic volume index = 63.79 versus 61.13 ml/m2, P = 0.436). Patients' symptoms were also not statistically different. There was no early and late death up to the end date of our study. Right ventriculotomy in pulmonary valve-sparing repair did not result in worse postoperative cardiac function and symptoms. This suggested that the previously thought-to-be hazardous incision could be strongly considered if mandated.

Noninvasive Cardiac Output Monitoring by Electrical Cardiometry with Transthoracic Echocardiography in Postoperative Paediatric Cardiac Surgical Patients: Comment.

Noninvasive Cardiac Output Monitoring by Electrical Cardiometry with Transthoracic Echocardiography in Postoperative Paediatric Cardiac Surgical Patients: Comment.

Pecto-intercostal Fascial Plane Block: A Novel Technique for Analgesia in Patients with Sternal Dehiscence.

Sternal wound complications following sternotomy need a multidisciplinary approach in high-risk postoperative cardiac surgical patients. Poorly controlled pain during surgical management of such wounds increases cardiovascular stress and respiratory complications. Multimodal analgesia including intravenous opioids, non-opioid analgesics, and regional anesthesia techniques, like central neuraxial blocks and fascial plane blocks, have been described. Pecto-intercostal fascial plane block (PIFB), a novel technique, has been effectively used in patients undergoing cardiac surgery. Under ultrasound (US) guidance PIFB is performed with the aim of depositing local anesthetic between two superficial muscles, namely the pectoralis major muscle and the external intercostal muscle. The authors report a series of five cases where US-guided bilateral PIFB was used in patients undergoing sternal wound debridement. Patients had excellent analgesia intraoperatively as well as postoperatively for 24 hours with minimal requirement of supplemental analgesia. None of the patients experienced complications due to PIFB administration. The authors concluded that bilateral PIFB can be effectively used as an adjunct to multimodal analgesia with general anesthesia and as a sole anesthesia technique in selected cases of sternal wound debridement.

Enhancing Congenital Cardiac Postprocedural Care: A QR Code-Enabled Medical Bracelet Pilot Study.

The study aimed to evaluate the feasibility of using QR code-enabled medical bracelets for congenital heart disease (CHD) patients after hospital discharge to ensure quick communication of vital information to other medical personnel in emergency situations. A prospective study was conducted where QR code-enabled medical bracelets were given to families of postoperative pediatric cardiac patients. The QR code linked to a secure medical information sheet detailing the patient's cardiac history. Post-study surveys were completed by providers and families to assess their experiences with the bracelet. Of the 20 participants enrolled, 65% used the QR bracelet when seeking medical care. 55% found the bracelet useful, and 70% rated their experience as either "positive" or "very positive". Additionally, 80% recommended the bracelet for other patients undergoing cardiac procedures. The use of QR code bracelets for postoperative CHD patients has shown high levels of satisfaction from families and providers, potentially reducing medical errors and treatment delays.

Ischemic Stroke in the Cardiac Surgery Intensive Care Unit: A Quality Improvement Study

ObjectiveTo investigate the frequency of stroke and code stroke activation, and the factors influencing code stroke management in postoperative cardiac surgical patients. DesignA retrospective quality improvement study conducted between January 1st, 2016, and December 31st, 2021. SettingCardiac Surgery Recovery Unit (CSRU) at London Health Sciences Centre (LHSC) in London, Ontario, Canada. ParticipantsPost-cardiac surgery patients aged 18 years or older who developed ischemic stroke during their admission to the CSRU. InterventionsNo specific interventions were administered as part of this study. “Code Stroke" activation mobilizes a specialized team. The objectives include assessment by a physician within 10 minutes, obtaining neuroimaging and interpretation within 45 minutes, and commencement of treatment within 60 minutes. Measurements and Main ResultsThe incidence rate of stroke in the CSRU was 1.3%, and 34% of these cases had code stroke activated. The last known well time was 11 +/- 8 hours. The most common reasons for not activating code stroke were not meeting both timing and clinical criteria. The average time to Computed Tomography (CT) scan was 36 +/- 22 minutes. Among patients who had code stroke activated, 24% had large vessel occlusion (LVO), and 67% of those with LVO had an established stroke on their initial CT. ConclusionCode stroke was activated in only one-third of patients who experienced a stroke following cardiac surgery. Additionally, out of those who had code stroke activated, only one-fourth were diagnosed with LVO. Among those with LVO, two-thirds were found to have a well-established stroke on non-contrast CT scans and were deemed ineligible for intervention.

Robust Artificial Intelligence Tool for Atrial Fibrillation Diagnosis: Novel Development Approach Incorporating Both Atrial Electrograms and Surface ECG and Evaluation by Head-to-Head Comparison With Hospital-Based Physician ECG Readers.

Atrial fibrillation (AF) increases risk of embolic stroke, and in postoperative patients, increases cost of care. Consequently, ECG screening for AF in high-risk patients is important but labor-intensive. Artificial intelligence (AI) may reduce AF detection workload, but AI development presents challenges. We used a novel approach to AI development for AF detection using both surface ECG recordings and atrial epicardial electrograms obtained in postoperative cardiac patients. Atrial electrograms were used only to facilitate establishing true AF for AI development; this permitted the establishment of an AI-based tool for subsequent AF detection using ECG records alone. A total of 5 million 30-second epochs from 329 patients were annotated as AF or non-AF by expert ECG readers for AI training and validation, while 5 million 30-second epochs from 330 different patients were used for AI testing. AI performance was assessed at the epoch level as well as AF burden at the patient level. AI achieved an area under the receiver operating characteristic curve of 0.932 on validation and 0.953 on testing. At the epoch level, testing results showed means of AF detection sensitivity, specificity, negative predictive value, positive predictive value, and F1 (harmonic mean of positive predictive value and sensitivity) as 0.970, 0.814, 0.976, 0.776, and 0.862, respectively, while the intraclass correlation coefficient for AF burden detection was 0.952. At the patient level, AF burden sensitivity and positive predictivity were 96.2% and 94.5%, respectively. Use of both atrial electrograms and surface ECG permitted development of a robust AI-based approach to postoperative AF recognition and AF burden assessment. This novel tool may enhance detection and management of AF, particularly in patients following operative cardiac surgery.

Early Cardiac Arrest Hemodynamics, End-Tidal C o2 , and Outcome in Pediatric Extracorporeal Cardiopulmonary Resuscitation: Secondary Analysis of the ICU-RESUScitation Project Dataset (2016-2021).

Cannulation for extracorporeal membrane oxygenation during active extracorporeal cardiopulmonary resuscitation (ECPR) is a method to rescue patients refractory to standard resuscitation. We hypothesized that early arrest hemodynamics and end-tidal C o2 (ET co2 ) are associated with survival to hospital discharge with favorable neurologic outcome in pediatric ECPR patients. Preplanned, secondary analysis of pediatric Utstein, hemodynamic, and ventilatory data in ECPR patients collected during the 2016-2021 Improving Outcomes from Pediatric Cardiac Arrest study; the ICU-RESUScitation Project (ICU-RESUS; NCT02837497). Eighteen ICUs participated in ICU-RESUS. There were 97 ECPR patients with hemodynamic waveforms during cardiopulmonary resuscitation. None. Overall, 71 of 97 patients (73%) were younger than 1 year old, 82 of 97 (85%) had congenital heart disease, and 62 of 97 (64%) were postoperative cardiac surgical patients. Forty of 97 patients (41%) survived with favorable neurologic outcome. We failed to find differences in diastolic or systolic blood pressure, proportion achieving age-based target diastolic or systolic blood pressure, or chest compression rate during the initial 10 minutes of CPR between patients who survived with favorable neurologic outcome and those who did not. Thirty-five patients had ET co2 data; of 17 survivors with favorable neurologic outcome, four of 17 (24%) had an average ET co2 less than 10 mm Hg and two (12%) had a maximum ET co2 less than 10 mm Hg during the initial 10 minutes of resuscitation. We did not identify an association between early hemodynamics achieved by high-quality CPR and survival to hospital discharge with favorable neurologic outcome after pediatric ECPR. Candidates for ECPR with ET co2 less than 10 mm Hg may survive with favorable neurologic outcome.

Opioid Utilization after Cardiac Surgery in the Pediatric Medicaid-Insured Population

To determine the variation of outpatient opioid prescribing across the US in postoperative pediatric cardiac patients. Retrospective, cross-sectional study using a concatenated database of Medicaid claims between from 2016 through 2018 of children 0-17years, discharged after cardiac surgery and receiving an opioid prescription within 30days. Filled prescriptions were identified and converted to morphine milligram equivalents (MME). Use, duration, and dose were analyzed by sex, race, ethnicity, residence urbanicity, and region. Among 17 186 Medicaid-enrolled children after cardiac surgery, 2129 received opioids within 30days of discharge. Females received lower doses than males (coefficient -0.17, P=.022). Hispanic individuals were less likely to receive opioids (coefficient 0.53, P<.05, 95% CI: 0.38-0.71) and for shorter periods (coefficient 0.83, P<.001). Midwest (MW) (OR 0.61, 95% P-values < 0.05, 95% CI: 0.46-0.80) and Northeast (NE) (OR 0.43, 95% P-values < 0.05, 95% CI: 0.30-0.61) regions were less likely to receive opioids but used higher doses compared with the Southeast (SE) (MW coefficient 0.41, Southwest (SW) coefficient 0.18, NE coefficient 0.32, West (W) coefficient 0.19, P<.05). There were significant variations in opioid prescribing after cardiac surgery by race, ethnicity, sex, and region. National guidelines for outpatient use of opioids in children after cardiac surgery may help limit practice variation and reduce potential harms in outpatient opioid usage.

Predictors of Psychological Distress among Post-Operative Cardiac Patients: A Narrative Review.

Following surgery, over 50% of cardiac surgery patients report anxiety, stress and/or depression, with at least 10% meeting clinical diagnoses, which can persist for more than a year. Psychological distress predicts post-surgery health outcomes for cardiac patients. Therefore, post-operative distress represents a critical recovery challenge affecting both physical and psychological health. Despite some research identifying key personal, social, and health service correlates of patient distress, a review or synthesis of this evidence remains unavailable. Understanding these factors can facilitate the identification of high-risk patients, develop tailored support resources and interventions to support optimum recovery. This narrative review synthesises evidence from 39 studies that investigate personal, social, and health service predictors of post-surgery psychological distress among cardiac patients. The following factors predicted lower post-operative distress: participation in pre-operative education, cardiac rehabilitation, having a partner, happier marriages, increased physical activity, and greater social interaction. Conversely, increased pain and functional impairment predicted greater distress. The role of age, and sex in predicting distress is inconclusive. Understanding several factors is limited by the inability to carry out experimental manipulations for ethical reasons (e.g., pain). Future research would profit from addressing key methodological limitations and exploring the role of self-efficacy, pre-operative distress, and pre-operative physical activity. It is recommended that cardiac patients be educated pre-surgery and attend cardiac rehabilitation to decrease distress.

Validation of NEWS2, SIRS, and qSOFA in Postoperative Cardiac Patients: A Retrospective Cohort Study

IntroductionThe ‘quick Sepsis Related Organ Failure Assessment’ (qSOFA), ‘Systemic Inflammatory Response Syndrome’ (SIRS), and ‘National Early Warning Score’ 2 (NEWS2) scores are yet to be comparatively validated in ward-based cardiac surgical patients despite widespread routine use in clinical practice. We sought to assess the predictive validity of NEWS, SIRS, and qSOFA in identifying postoperative, ward-level cardiac surgical patients at risk of poor short-term mortality. MethodsAll adult patients who underwent cardiac surgery at a single tertiary center between November 2014 and October 2017 were identified. Data for bedside observations, hematological results, and microbiology requests were obtained from electronic health records. Survival data were acquired from a national registry. The primary outcome was the discriminatory ability, measured by the area under the receiver operating characteristic (AUROC), of each score for in-hospital mortality. ResultsOne thousand five hundred forty three (male n = 1101, 71%) patients were included. Overall in-hospital mortality was 2.4%. There was no significant difference in discriminatory ability of NEWS (AUROC 0.5060), SIRS (AUROC 0.4874), and qSOFA (AUROC 0.5139) for in-hospital mortality (P = 0.881). Sensitivity for this outcome was ubiquitously low (13.51-40.54%). ConclusionsCurrent illness-severity scores show a low discriminatory ability for in-hospital mortality in ward-based cardiac surgical patients. Caution should be used in the application of these prognostic screening tools for early detection of poor outcomes in this population.

The Efficacy of Ultrasound Guided Bilateral Pectoralis Nerve Block for Postoperative Pain Control in Cardiac Surgery, Randomized Control Trial

Abstract Background Cardiothoracic surgeries are associated with significant pain. Optimal analgesia is a vital part of enhanced recovery after surgery strategies intended to improve patients' perioperative experience and outcomes. Traditionally, analgesia in these types of surgeries has depended on large doses of I.V. opioids. This is particularly pertinent given the current focus on removing needless perioperative opioid administration, and thereby decreasing the potential for opioid side effects. Aim of the Work The aim of the study was to evaluate the effect of postoperative bilateral US guided Pecs block on postoperative pain control in patients undergoing cardiac surgery through mid-line sternotomy compared to systemic analgesia. Patients and Methods Approval was obtained from the research ethics committee of Faculty of Medicine; Ain Shams University and a written informed consent was taken from each patient to participate in the study, patients were randomly allocated into two groups with 15 patients in each group. Group 1 (control group) received systemic analgesics, whereas Group 2 (study group) received pecs block. Results Our study showed that when compared to general anesthesia with systemic opioids, PECs block is associated with significantly better postoperative pain control. Conclusion Pecs block is technically simple, safe and very effective technique and can be used as a part of multimodal analgesia in postoperative cardiac surgical patients for better patient comfort and satisfaction and also helps in superior pulmonary rehabilitation, thus assisting in better outcome and less unwanted side effects of systemic analgesics.

DEXMEDETOMIDINE/ FENTANYL INFUSION IN OPEN CARDIAC SURGERIES

Background: patients of open heart surgeries are now a days extudated early for fasttraking &amp; improve patient outcome. Aims and Objectives: To compare the efficacy of dexmedetomidine/ fentanyl for sedoanalgesia&amp; time ro extubation in post-operative adult cardiac surgical patients. Methods: A prospective randomized double-blind study involving 60 adult patients undergoing open heart surgery were divided into two groups, each involving 30 patients. One group received fentanyl at 1 µg/kg/h (Group A) and the other received dexmedetomidine at 0.5 µg/kg/h (Group B) for post-operative sedation with intermittent rescue dose of fentanyl 0.5 µg/kg bolus in either group as rescue analgesia as per requirement. The efficacy of sedation was assessed using the Ramsay sedation score. The time taken for extubation from the stoppage of infusion was noted.Patients were enrolled in two Randomised groups of 30 patients each. With occasional rescue doses of fentanyl 0.5 g/kg bolus in either group as needed, one group (Group A) received fentanyl at 1 g/kg/h and the other (Group B) received dexmedetomidine at 0.5 g/kg/h for postoperative sedation. The Ramsay sedation score was used to evaluate the effectiveness of the sedation. It was noticed how long it took to extubate once the infusion was stopped. Results: Haemodynamic parameters between the two groups were comparable. Sedation scores between fentanyl and dexmedetomidine groups were comparable. Average time (in minutes) required for extubation was 100.04 (±43.6 SD) in the dexmedetomidine group compared with 159.4 (±93.3 SD) in the fentanyl group. The difference in mean time for extubation was statistically significant. Conclusions: As compare to fentanyl , Dexmedetomidine facilitates adequate sedation for mechanical ventilation and also provide early extubation.