Treatment Of Cardiac Patients Research Articles

Application of Decision Tree Method in ECG Signal Classification For Heart Disorder Detection

Cardiovascular Disease (CVD) is a group of diseases that affect the heart and blood vessels, and it is the leading cause of death globally. In Indonesia, Coronary Heart Disease (CHD) is one of the most prevalent CVDs. However, due to the high cost of drugs, lengthy treatment duration, and various supporting examinations required, treating CHD can be very expensive. An obstacle to treating heart disease in Indonesia is the insufficient number of cardiologists and experts experienced in interventional cardiology. Along with technological developments, the computer science community is encouraged to contribute to the medical field. For instance, using an electrocardiogram (ECG) can help prevent and minimize problems arising from heart disease. An Electrocardiogram (ECG) is a medical test that measures and records the heart’s electrical activity using a machine that detects electrical impulses. The use of Artificial Intelligence (AI) in ECG is rapidly increasing and has shown to have great potential in improving the diagnosis and treatment of cardiac patients. AI has become a valuable tool in helping doctors diagnose, predict risk, and manage heart disease with greater accuracy, speed, and precision. One of the machine learning methods used in this research is the decision tree method, which is often employed to make decisions. The decision tree method exhibited promising results, with an accuracy rate of 99% in identifying heart defects at an early stage. This method has significant potential to assist doctors in diagnosing heart defects at an early stage with high accuracy.

The effect of long holidays on emergency department visits and cardiac emergencies

Aims: Patients who visit the emergency department (ED) on holidays have delays in diagnosis and treatment due to a lack of personnel and equipment, and these holiday periods may result in increased morbidity and mortality. In this study, we aimed to investigate the impact of a nine-day holiday on ED admissions and admissions due to cardiac complaints in our country, Turkey. Methods: This was a retrospective study. Patients were analyzed in 4 periods: Pre-Eid-El-Fitr, Eid-El-Fitr, pre-Eid al-Adha, and Eid al-Adha. Waiting times in the ED, the left without being seen (LWBS), consultations, admission diagnoses of cardiac patients, referral status of cardiac patients, and hospitalization were examined. Results: The most frequent visits to the ED were on Eid al-Adha (n=6581, 40.1 %). The waiting time before the ED examination increased with the crowd, and the longest waiting time was observed during Eid al-Adha (38.09 ±51.74 min, p<0.001). LWBS rate was the highest during the Eid al-Adha (15.4%). It was observed that cardiac emergencies had shorter waiting times. Among the cardiac emergency patients, all NSTEMI patients could not be referred from the ED during the Eid al-Adha period due to the fullness of the angiography centers, and the patients were transferred to the intensive care unit when the beds became available. Conclusion: Due to the crowded EDs during extended holiday periods, the triage system gains importance for the early detection and treatment of cardiac patients. A regular patient flow chart should be established on a provincial basis to avoid delays in the treatment process of patients needing angiography.

Problematic aspects of iron deficiency compensation in heart failure

The initial contradictions in the problem of anemia treatment in cardiac patients are highlighted. The issues of diagnosis and treatment of iron deficiency, presented in the updated National clinical guidelines for chronic heart failure, are analyzed in detail. Based on them, involving own research, the author aims to develop a treatment and diagnostic program for anemia.

Tulburarea depresivă în contextul bolii cardiovasculare

Comorbidity of psychiatric disorders and heart disease is extremely common. The psychopharmacological treatment for psychiatric disorders in patients with cardiovascular disease has been an important topic of active investigation. In the last 20 years, psychiatric disorders – especially depression – have been found to be associated with an increased cardiovascular morbidity and mortality in patients with existing heart disease, spurring even greater interest in the effects of psychopharmacological treatment in cardiac patients. Evidence suggests that the recognition and the treatment of depression increase the prognosis of cardiovascular disease. In the case of clinically significant symptoms of depression or other psychosocial factors, the European guidelines recommend the consideration of interventions such as psychotherapy, medication or collaborative care.

Analysis of Savitzky-Golay Filter for Electrocardiogram De-Noising Using Daubechies Wavelets

Electrocardiogram (ECG) examination is of great importance in medical diagnosis of the cardiac disease, but wrong interpretation due to noise interference in the signal could be dangerous as this may lead to wrong diagnoses of patient’s heart condition. De-noising helps to reduce the noise level for a better interpretation of the signals. In this study, an analysis of Savitzky-Golay (S-G) filter for ECG de-noising using Daubechies wavelets has been carried out using MATLAB version 2015a. Noisy ECG signals downloaded from physionet.org under MIT-BIH arrhythmia database was de-noised using S-G filter of polynomial order 9 to data frames of length 21 displayed in both time and frequency domains while a quantitative evaluation was carried out to check the performance of the filter under signal-to-noise ratio (SNR), mean square error (MSE) and signal-to-interference ratio (SIR). Results show that de-noising using S-G filter for SNR, MSE, and SIR gives an average value of 32.78dB, 0.0001 and 1852.358dB respectively. This implies that the S-G filter helps eliminates the background noise as well as maintaining a good fit for our data, and also do not allow co-channel interference from other radio transmitters, which makes it an excellent filter for ECG signal de-noising. Hospitals management and cardiac health centers most understand the importance of these parameters in the selection of de-noising filters for good quality ECG in diagnosis and treatment of cardiac patients.

Two case reports: clinical experience with fixed combinations of indapamide/perindopril and amlodipine/perindopril in patients with arterial hypertension during the COVID-19 pandemic

The article, using the example of two clinical cases, discusses the severity of the course of COVID-19 depending on the presence of cardiovascular diseases and the effectiveness of their treatment. Randomized clinical trials and meta-analyses of the coronavirus infection indicate a greater likelihood of developing severe forms of COVID-19 in patients with high and very high cardiovascular risk, in older age groups, with comorbid pathology, especially with arterial hypertension (AH), coronary heart disease (CHD), chronic heart failure (CHF), diabetes mellitus (DM). Considering effectiveness, safety and influence on the prognosis, an adequately selected therapy for concomitant diseases can reduce the number of adverse outcomes of the coronavirus infection. A key role in the development and progression of cardiovascular pathology is played by the renin-angiotensin-aldosterone system (RAAS), so RAAS blockers remain the first-line medicine in the treatment of cardiac patients. The experts of the European Society of Cardiology, the American College of Cardiology and the Russian Society of Cardiology confirm the importance of continuing therapy with this class of medicine in patients having already received RAAS blockers according to such indications as AH, CHD and CHF during COVID-19 and emphasize the danger of their cancellation in high-risk patients. Most patients need to take several groups of medicine which affect complementary pathogenetic mechanisms. It is shown that the reason for the lack of achieving blood pressure control in clinical practice is monotherapy or non-optimally combined therapy of free acceptable but not rational combinations of antihypertensive medicine. Optimization of the therapeutic regimen using fixed combinations of indapamide/perindopril and amlodipine/perindopril has made it possible to achieve an effective reduction in blood pressure according to routine measurement and ambulatory blood pressure monitoring, to reduce blood pressure variability, to increase patients’ adherence to the treatment. The use of such medicine is becoming the most relevant during the COVID-19 pandemic.

Pharmacoeconomic and pharmacogenetic aspects of the implementation of a personalized approach in the treatment of cardiac patients

To investigate the possibilities of pharmacoeconomic and pharmacogenetic factors monitoring to assess the effectiveness of treatment of a cardiological profile patients as a part of the implementation of a personalized approach. 200 patients with arterial hypertension and CHD were examined. Pharmacotherapy was analyzed. ABC/VEN and DDD analysis, pharmacoeconomic analysis were applied. Genetic analysis of the polymorphism of the genes CYP2D6*4 and CYP2D6*10 encoding the subfamily of the cytochrome isoenzyme Р-450 was carried out. An original monitoring method was used to assess the effect of pharmacoeconomic and pharmacogenetic factors on the performance of cardiac care. When conducting a pharmacoeconomic analysis of cases of cardiac care, it was found that the costs of drug therapy are significant and take over 10% of the total costs. However, its effectiveness is insufficient in 58% of cases in inpatient and 37% in outpatient care. The analysis showed that there is an inverse mean correlation between gene polymorphism and clinical performance of cardiac care (r = -0.62) and a direct strong correlation between polypharmacy in pharmacotherapy, not accounting for interdrug interaction and clinical performance (r = 0.89).

Polypharmacy in the Treatment of Arterial Hypertension and Heart Failure

Due to the development of the pharmaceutical industry, today there are a large number of drugs with similar properties and efficacy, but little-studied pharmacodynamics and pharmacokinetics. There fore many medicines are prescribed more often and in larger quantities than necessary. That is why patients and doctors often face the problem of polypharmacy in various fields of medicine including cardiology. The paper presents the results of the analysis of 249 case histories of inpatients with cardiac profile. All patients with underlying cardiac pathology (arterial hypertension, ischemic heart disease) had concomitant diseases. Patients with arterial hypertension had other concomitant diseases, most often gout, diseases of the digestive system, anemia. Chronic heart failure was found in the majority of patients with arterial hypertension, ischemic heart disease, chronic rheumatic heart disease. We have determined which pharmacological groups of drugs are prescribed to patients with arterial hypertension or chronic heart failure and concomitant diseases: more than 60 % of patients are prescribed drugs that are unsuitable for their condition. We analyzed and compared treatment standards in Ukraine and the world and carried out that doctors in Ukraine use modern and effective methods of treatment. The risks of prescribing a large number of drugs to patients are analyzed and the risks of dangerous drug interactions that can threaten the life or health of the patient are identified. In particular, in the treatment of cardiac patients, doctors used combinations of calcium antagonists and beta-blockers, NSAIDs and antithrombotic drugs, corticosteroids and antibacterial drugs of the fluoroquinolone group, ACE inhibitors and potassium-preserving diuretics, antiarrhythmic drugs and highly active diuretics, etc. We compared medicinal prescriptions for the treatment of cardiovascular diseases with an interval of 10 years and revealed that in 2008 the therapy often did not comply with the international and Ukrainian treatment protocols, however, in 2018, unwanted drug interactions were found 4 times less often. That reflects the trend of doctors’ awareness of pharmacology and evidence-based medicine.

Co-occurrence of depressive disorders and cardiovascular diseases – selected aspects

Depressive disorders are a common problem in patients with cardiovascular diseases. They are associated with increased mortality, disability, increased healthcare expenditure and reduced quality of life. Depression occurs in 1 in 5 patients with coronary artery disease, peripheral arterial disease or heart failure. It significantly complicates the optimal management of a patient with cardiovascular disease, primarily by reducing compliance with healthy lifestyle principles and therefore reducing the effectiveness of recommended therapeutic methods. The mechanisms responsible for unfavorable prognosis in patients with cardiovascular disease and depression are associated with lifestyle factors, autonomic dysfunction, neuroendocrine disorders, inflammation, immune system dysfunction, insulin resistance and increased platelet reactivity. These mechanisms significantly interact in the regulation of both cardiovascular and central nervous system functions. Therefore, it is important to perform prompt and complete diagnosis of depression in a particular patient with cardiovascular disease, and to implement optimal therapeutic management from the psychiatric and cardiological point of view. In recent years, interest in the effect of antidepressants on cardiac parameters in patients with depression has increased. The assessment of the safety and efficacy of antidepressant therapy in the treatment of cardiac patients with depression is also important due to the fact that depression in these patients is often accompanied by other significant comorbidities such as diabetes, hypertension and tobacco addiction. The aim of this study was to review the most important aspects necessary in the cooperation of a psychiatrist and cardiologist that may enable the most effective treatment of patients with depressive disorders coexisting with selected cardiovascular diseases.

Major Cardiac-Psychiatric Drug-Drug Interactions: a Systematic Review of the Consistency of Drug Databases.

Major depressive disorder (MDD) and anxiety disorders (AD) are both highly prevalent among individuals with arrhythmia, ischemic heart disease, heart failure, hypertension, and dyslipidemia. There should be increased support for MDD and AD diagnosis and treatment in individuals with cardiac diseases, because treatment rates have been low. However, cardiac-psychiatric drug interaction can make pharmacologic treatment challenging. The objective of the present systematic review was to investigate cardiac-psychiatric drug interactions in three different widely used pharmacological databases (Micromedex, Up to Date, and ClinicalKey). Among 4914 cardiac-psychiatric drug combinations, 293 significant interactions were found (6.0%). When a problematic interaction is detected, it may be easier to find an alternative cardiac medication (32.6% presented some interaction) than a psychiatric one (76.9%). Antiarrhythmics are the major class of concern. The most common problems produced by these interactions are related to cardiotoxicity (QT prolongation, torsades de pointes, cardiac arrest), increased exposure of cytochrome P450 2D6 (CYP2D6) substrates, or reduced renal clearance of organic cation transporter 2 (OCT2) substrates and include hypertensive crisis, increased risk of bleeding, myopathy, and/or rhabdomyolysis. Unfortunately, there is considerable inconsistency among the databases searched, such that a clinician's discretion and clinical experience remain invaluable tools for the management of patients with comorbidities present in psychiatric and cardiac disorders. The possibility of an interaction should be considered. With a multidisciplinary approach, particularly involving a pharmacist, the prescriber should be alerted to the possibility of an interaction. MDD and AD pharmacologic treatment in cardiac patients could be implemented safely both by cardiologists and psychiatrists. PROSPERO Systematic Review Registration Number: CRD42018100424.

An IT Approach to Implementing Depression Treatment in Cardiac Patients (iHeart DepCare)

An IT Approach to Implementing Depression Treatment in Cardiac Patients (iHeart DepCare)

Characteristics of Beta-blocker Treatment in Cardiac Patients with Concomitant Chronic Obstructive Pulmonary Disease

Abstract Background: Recent scientific data demonstrated a potential beneficial effect of beta-blocker (BB) therapy in cardiac patients with chronic obstructive pulmonary disease (COPD). Our aim was to characterize the use of beta-blockers in these patients, in “real-life” conditions. Material and methods: We collected retrospectively the data of 60 consecutive cardiac patients (51 men, 9 women, mean age 67 years) with the concomitant diagnosis of COPD: main cardiac conditions, presence and reason of BB therapy, type of drug and dosage, main ECG and echocardiographic parameters, medication and data regarding COPD. Besides descriptive statistics, we compared the data of patients with and without BB therapy (chi-square test, level of significance alpha <0.05) in order to identify factors associated with BB usage. Results: In our study population, 41.6% of the patients had received BB treatment, the most frequently used drug being bisoprolol 2.5 mg and 5 mg q.d. (28%-28%), followed by carvedilol (32%). The prevalence of BB therapy was 51.2% in heart failure patients (48% in NYHA class III and IV, and 66.6% in dilated cardiomyopathy), 38.4% in hypertension, 81.8% in ischemic artery disease, and 64.7% in subjects with atrial fibrillation. The usage of BB therapy was significantly associated with the presence of heart failure (p = 0.047), dilated cardiomyopathy (p = 0.034), ischemic heart disease (p = 0.005), previous myocardial infarction (p = 0.003) and, inversely, with the acute exacerbation of COPD (p = 0.006). Conclusions: Despite the fact that every cardiac patient with COPD had a potential indication for BB treatment, this was used insufficiently, especially in case of heart failure patients. In daily practice, there is a need for continuous review and improvement of BB usage in these patients.

Thyroid Hormone and Cardioprotection.

The heart is a major target of thyroid hormones, with maintenance of euthyroid hormone balance critical for proper function. In particular, chronic low thyroid function can eventually lead to dilated heart failure with impaired coronary blood flow. New evidence also suggests that heart diseases trigger a reduction in cardiac tissue thyroid hormone levels, a condition that may not be detectible using serum hormone assays. Many animal and clinical studies have demonstrated a high prevalence of low thyroid function in heart diseases with worse outcomes from this condition. Animal and human studies have also demonstrated many benefits from thyroid hormone treatment of heart diseases, particularly heart failure. Nonetheless, this potential treatment has not yet translated to patients due to a number of important concerns. The most serious concern involves the potential of accidental overdose leading to increased arrhythmias and sudden death. Several important clinical studies, which actually used excessive doses of thyroid hormone analogs, have played a major role in convincing the medical community that thyroid hormones are simply too dangerous to be considered for treatment in cardiac patients. Nonetheless, this issue has not gone away due primarily to overwhelmingly positive evidence for treatment benefits and a new understanding of the cellular and molecular mechanisms underlying those benefits. This review will first discuss the clinical evidence for the use of thyroid hormones as a cardioprotective agent and then provide an overview of the cellular and molecular mechanisms underlying beneficial changes from thyroid hormone treatment of heart diseases. © 2016 American Physiological Society. Compr Physiol 6:1199-1219, 2016.

Iindividually typological and concomitant variability of morphological characteristics of the coronary arteries

Cardiovascular diseases are the leading cause of death and disability in the population in most developed countries. The organization of the vascular bed is an objective indicator of the state of the trophic tissue of any organ. The aim is to identify the individually-typological and concomitant variability of morphological characteristics of the coronary arteries in adults of the second period of mature and elderly. Materials and Methods: 161 coronary angiograms were investigated without evidence of pathological changes in coronary arteries of people of both sexes aged 36 to 74 years using the programs «Syngo Fast View», «ImageJ», «Adobe Photoshop CS7», «Microsoft Excel», «SPSS». Results: We identified the indivi-dually-typological and concomitant characteristics of the coronary arteries in people of different ages and sex in norm. Conclusions: Right and left coronary arteries have 3 types for the length of the main trunk (short, medium, long) and types of interposition of the branches of first order: 1 - compact (less than 47.420, less than 45.430), uniform (47.42 - 83.78; 45.43 -82.77), 3 - sparse (more than 83.78, 82.77 or more, respectively) depending on the angle between them (in diastole). Received data about anatomy of coronary arteries allows a more objective approach to the definition of tactics of treatment of cardiac patients.

HEART RATE-LOWERING THERAPY IN THE TREATMENT OF CHRONIC HEART FAILURE

Aspects of heart rate-lowering therapy in patients with chronic heart failure using If-channel blocker ivabradine are discussed. The evidence-based data on ivabradine use reveal its advantages, disadvantages and place in the treatment of cardiac patients.

АспектЫ РеАбиЛит АЦии и АДАпт АптиВнОЙ тРениРОВки сОтРУДникОВ и ВетеРАнОВ ОРГАнОВ ВнУтРенних ДеЛ с ФибРиЛЛЯЦиеЙ пРеДсеРДиЙ

Aim. Researching into the adaptative-and-recovery mechanism of a heart and a cardiovascular system during composite treatment in cardiac patients and athletes, completed of their sport activities, whom need support of cardiac function adaptation mechanisms during health-improving exercises. Material and methods. Methods of

Identification of the degree of knowledge of doctors about the use of vasoconstrictor in cardiac patients

Introduction: There is a clear lack of knowledge among professionals about the use of local anesthesia during dental treatment in cardiac patients, coming to delay emergency care or to indicate the use of vasopressors erroneously since its use brings benefi ts to the patient and the professional. Objective: To evaluate professionals’ perception of the use of local anesthetics with vasoconstrictors to perform dental procedures in patients with heart disease. Methods: This study was conducted by the application of a questionnaire that contained 12 questions which 100 professionals answered from January to September 2014. Results: 61% of professionals recommend that the use of local anesthesia associated with a vasoconstrictor to dental treatment for a cardiac patient. Half of them did not know to answer, “What is the concentration of vasoconstrictor recommended for use in a cardiac patient?” 81 professionals choose the lidocaine as the best anesthesia. Conclusion: The professionals demonstrate to know about the use of vasoconstrictors associated with local anesthetics in dental procedures; however, the total amount and concentration of the vasoconstrictors are unknown.

Changes in cognitive versus somatic symptoms of depression and event-free survival following acute myocardial infarction in the Enhancing Recovery In Coronary Heart Disease (ENRICHD) study

BackgroundRandomized controlled trials focusing on the effects of antidepressant treatment in cardiac patients have found modest effects on depressive symptoms but not on cardiac outcomes. A secondary analysis was conducted on data from the Enhancing Recovery in Coronary Heart Disease trial to assess whether changes in somatic or cognitive depressive symptoms following acute MI predicted event-free survival and whether the results differed per treatment arm (cognitive behavior therapy or care as usual). MethodsPatients who met depression criteria and completed the 6th month depression assessment (n=1254) were included in this study. Measurements included demographic and clinical data and the Beck Depression Inventory at baseline and 6 months. The primary endpoint was a composite of recurrent MI and mortality over 2.4 years (standard deviation=0.9 years). ResultsPositive changes (per 1 point increase) in somatic depressive symptoms (HR: 0.95; 95% CI: 0.92–0.98; p=0.001) but not in cognitive depressive symptoms (HR: 0.98; 95% CI: 0.96–1.01; p=0.19) were related to a reduced risk of recurrent MI and mortality after adjustment for baseline depression scores. There was a trend for an interaction effect between changes in somatic depressive symptoms and the intervention (p=0.08). After controlling for demographic and clinical variables, the association between changes in somatic depressive symptoms and event-free survival remained significant in the intervention arm (HR: 0.93; 95% CI: 0.88–0.98; p=0.01) only. LimitationsSecondary analyses. ConclusionsChanges in somatic depressive symptoms, and not cognitive symptoms, were related to improved outcomes in the intervention arm, independent of demographic and clinical variables.

New models of care for psychology in Canada's health services.

Psychological services health care have expanded beyond traditional areas of mental health to the full spectrum of health disorders, as research has increasingly shown the importance of psychological processes health outcomes. Behavioural and psychological factors can contribute to the onset, course, or severity of many chronic diseases, and psychology has much to offer with clinically and cost-effective interventions. Good principles of care, involving appropriate assessment, evidence-based interventions, and close collaboration with other health care providers, are vital for effective chronic disease management, but can be difficult to realise given issues of timely access, patient volumes, and availability of psychological services publicly funded health care. This article provides an overview of psychological interventions diverse areas of health psychology, with examples of innovative Canadian clinical service delivery models, particularly focussing on integrated screening and treatment for cardiac patients, computerized delivery of insomnia treatment, screening and brief intervention prior to joint replacement surgery, and on-site psychological consultation for family physicians. The case examples, developed and implemented Winnipeg, Manitoba, demonstrate components for consideration when redesigning psychological service models, such as more systematic approaches to identifying patient needs, stepped levels of care that increase intensity of service relative to need, integration into systems already handling large patient volumes, innovative use of technology, and location of psychological resources in situ for timely, brief access. Although still early stages of development and evaluation, these models show promise for improved access and enhanced ability to deliver psychological service to relevant patient volumes. Keywords: psychology services, public health care, stepped interventions, online treatment The understanding of disease and the role of psychological processes has evolved recent decades with the explosion of research fields such as psychoneuroimmunology. The biopsychosocial model of illness has flourished as a more biomedically based model has failed to fully explain differences disease course and outcomes (Baum & Posluszny, 1999). In addition, health care services have been burdened by care related to chronic disease. That is, the discovery of antibiotics the early 20th century and improvements diet and living conditions have revolutionized treatment and prevention of infectious diseases and have led to a shin emphasis to chronic illness, rehabilitation, and quality of life (Ray, 2004; U.S. Department of Health and Human Services, 2000). There has been growing recognition of the major influence of behavioural and psychological factors the onset, course, and severity of many of the most common chronic diseases (Gonder-Frederick, Cox, & Ritterband, 2002; Graff et al., 2006; Kiecolt-Glaser, Mcguire, Robles, & Glaser, 2002; Yusef et al., 2004). As well, behavioural factors have been identified as the primary causes of half of all cancers resulting deaths developed countries (Adami, Day, Trichopoulos, & Willett, 2001; Colditz, DeJong, Hunter, Trichopoulos, & Willett, 1996). There is strong evidence that psychological interventions can improve symptoms and quality of life and decrease distress and health care utilization across a range of health conditions including heart disease, diabetes, arthritis, and chronic pain (Hunsley, 2002). Going one step further, prevention efforts based on lifestyle interventions for individuals with elevated disease risk have shown promise (Diabetes Prevention Program Research Group, 2002, 2009). Psychological services health care have expanded beyond traditional areas of mental health to the full spectrum of health disorders, as research has increasingly shown the importance of psychological processes health outcomes. …

Updates on Critical Care Management of Cardiovascular Patients

Cardiology and cardiovascular surgery patients have historically been one of the sickest populations that physicians encounter. With the inherent compromise of the cardiac and/or respiratory system and the added complexity of a major surgical procedure, this patient group requires a demanding level of care. As innovations in the treatment of cardiac patients have prolonged life, we have encountered patients who require redo-redo-redo procedures. There has been a tremendous increase in the use of a wide variety of mechanical assist devices, transplantation procedures, robotic surgery, and hybrid approaches in which cardiac surgeons and cardiologists work in the same room on the same patient. Against this background, there have been quite a few changes taking place in the field of critical care. This report discusses the transformations being made in blood pressure management, blood product transfusion, prevention of healthcareassociated infections, physical therapy in cardiothoracic intensive care units (ICUs), ventilatory management, and the role of intensivists in cardiothoracic ICUs.