Impact of malnutrition on postoperative delirium development after on pump coronary artery bypass grafting

Background & aims: Even though malnutrition is frequently observed in cardiac population outcome data after cardiac surgery in malnourished patients is very rare. No thorough research was done concerning the impact of malnutrition on neuropsychological outcomes after cardiac surgery. The aim of our study was to analyze the incidence of postoperative delirium development in malnourished patients undergoing on pump bypass grafting. Methods: We performed a cohort study of adults admitted to Vilnius University Hospital Santariskiu Clinics for elective coronary artery bypass grafting. The nutritional status of the patients was assessed by Nutritional Risk Screening 2002 (NRS-2002) questionnaire the day before surgery. Patients were considered as having no risk of malnutrition when NRS-2002 score was less than 3 and at risk of malnutrition when NRS-2002 score was ≥3. During ICU stay patients were screened for postoperative delirium development using the CAM-ICU method. and divided into two groups: delirium and non delirium. The statistical analysis was preformed to evaluate the differences between the two independent groups. The logistic regression model was used to evaluate the potential preoperative and intraoperative risk factors of postoperative delirium. Results: Ninety-nine patients were enrolled in the study. Preoperative risk of malnutrition was detected in 24 % (n = 24) of the patients. The incidence of early postoperative delirium in overall study population was 8.0 % (n = 8). The incidence of the patients at risk of malnutrition was significantly higher in the delirium group (5 (62.5 %) vs 19 (20.9 %), p <0.0191). In multivariate logistic regression analysis risk of malnutrition defined by NRS 2002 was an independent preoperative and intraoperative risk factor of postoperative delirium after coronary artery bypass grafting (OR: 6.316, 95 % CI: 1.384-28.819 p = 0.0173). Conclusions: Preoperative malnutrition is common in patients undergoing elective coronary artery bypass grafting. Nutrition deprivation is associated with early postoperative delirium after on pump coronary artery bypass grafting

Pain management for patients experiencing chronic pain

Topic of the work: Pain Management for patients experiencing chronic pain. Chronic pain becomes a big medicine, economic and social problem that influences not just every person’s quality of life, disturbs normal social and personal life, family relations, but also public economic potential. Morbidity and incapacity to work in Lithuania meet global tendencies. Aim of the work: To evaluate the chronic pain of patients, their physical and emotional experiences and their knowledge about pain control. Goals of the work: 1. To find out the nature of pain and its intensity for patients who suffer from chronic pain. 2. To find out what methods patients use to decrease pain. 3. To evaluate how chronic pain influences everyday activities of a patient. 4. To evaluate how chronic pain influences emotional state of a patient. 5. To evaluate the knowledge of patients about the management of pain. Object of the research: Patients, who suffer from chronic pain and who are cured in VSI VUL “Santariskiu klinikos” anesthesiology, intensive therapy and pain treatment center. Methodology of the research: Questionnaire poll of patients is presented. 100 respondents were questioned. Results of the work: According to the data of the results, 85% suffered of the chronic pain. The biggest part of the respondents (38%) felt acute type pains. When pain intensity was analyzed, 47% of respondents felt acute pain. Dependence relation between the intensity of pain and age was not determined (p>0.05). The biggest part of people (54%) who suffer from chronic pains is able-bodied population. Treatment of chronic pain is a concurrent part of constant usage of medications. When medication usage was evaluated, it was determined that 41% of respondents used medications constantly, a part of respondents (43%) used medication just when they felt pain and 14% of the respondents did not use medications at all. The biggest part (73%) of the respondents indicated that their pain slightly decreased, 22% stated that usage of medication decreased pain moderately and 5% said that medication usage sufficiently decreased their pain. The bigger part of respondents (56%) did not know any not pharmacologic means to decrease chronic pain, 36% mentioned exercising and 8% of the respondents mentioned pool. There is a statistically significant link among knowledge of not pharmacological means for pain decreasing, their usage and a living location (p0.1). More than a half (57%) of respondents who participated in the poll stated that they do not have enough knowledge about pain management. 88% of the respondents expressed the usefulness of learning program of chronic pain management, 12% stated that this program is not necessary for them. Statistically there is no important relation among the necessity of pain management program, age and living place (p>0.05). The hypothesis was true that physical and emotional experiences of patients who suffer from chronic pains influence their inner feelings and that there was not enough knowledge about pain control

Ar Trendelenburgo padėtis yra vienintelis būdas pagerinti vidinių jungo venų vizualizaciją?

Background. A larger cross-sectional area (CSA) of the internal jugular vein (IJV) makes catheterization easier and the Trendelenburg position is used to achieve this. Unfortunately, it is not comfortable for conscious patients. The aim was to evaluate the impact of alternative manoeuvres on the enlargement of the CSA of the IJV and to compare these manoeuvres with the Trendelenburg position. Materials and methods. A prospective study of 63 healthy volunteers was conducted. Two-dimensional ultrasound images of right IJV (RIJV) and left IJV (LIJV) were recorded at the level of the cricoid cartilage in the supine position with and without head rotation by 30 degrees during various manoeuvres. Results. The CSA of the RIJV and the LIJV significantly increased using hold of deep breath (mean size (cm2) RIJV 1.59 ± 0.82, LIJV 1.07 ± 0.64; both p < 0.001) and the Trendelenburg position (mean size (cm2) RIJV 1.5 ± 0.68, LIJV 0.99 ± 0.54; both p < 0.001). The 45-degree passive leg raise increased the CSA of only the RIJV (mean size (cm2) 1.17 ± 0.61, p = 0.024). These manoeuvres were compared with the Trendelenburg position. There was no significant difference in the size of the CSA using hold of deep breath on the LIJV (p = 0.08) and the RIJV (p = 0.203). The passive leg raise had a significantly weaker impact on the size of the CSA (p < 0.001 for both sides). Conclusions. Hold of deep breath and 45-degree passive leg raise (the latter limited for the right side only) are alternative manoeuvres to improve visualization of internal jugular veins for conscious patients. Hold of deep breath was as effective as the Trendelenburg position