NUTRITION SUPPORT COMPLICATIONS IN PATIENT WHO UNDERWENT CARDIAC SURGERY

Background: The nutrition support complications after cardiac surgery should be detected and treated on time. Aim: To show the incidence and type of nutritional support complication in patients after cardiac surgery. Methods: The prospective study included 415 patients who underwent cardiac surgery between 2010 and 2013 in Clinic for Cardiovascular Disease of University Clinical Center Tuzla. Complications of the delivery system for nutrition support (NS) and nutrition itself were analyzed. Results: The analysis showed that 95 (22.80%) patients received enteral nutrition (EN) and 47 (11.30%) total parenteral support (TPN). 41.54% patients who received EN had complications and 33.09% of those who received TPN had complications with no significant difference per support. The complications with highest incidence in group with EN were associated with gastrointestinal (GiT) tract dysfunction with diarrhea (14.04%) and high gastric residuals in (10.56%). The most significant complications in patients with TPN were hyperglycemia (16.90%) and catheter-related infection (11.97%). Complications in EN group were associated with commercial solutions (p<0.05). Conclusion: Complications of NS in Cardiac Surgery Intensive Care Unit are very frequent, diarrhea and hyperglycemia presenting the highest incidence. NS careful monitoring and strict protocols could decrease incidence of complications in patients underwent cardiac surgery and realize benefits of NS

Changes in activated partial thromboplastin time and international normalised ratio after on-pump and off-pump surgical revascularization of the heart

Surgical revascularization of the heart (CABG - coronary artery bypass grafting) is one way of treating coronary heart disease. Bleeding is one of the serious and frequent complications of heart surgery and can result in increased mortality and morbidity. Hemostasis disorder may be secondary consequences of surgical bleeding, preoperative anticoagulant therapy, and the use of cardiopulmonary bypass. Tests used for routine evaluation of the coagulation system are activated partial thromboplastin time (APTT) and international normalized ratio (INR). The study encountered 60 patients who were hospitalized at the Clinic for Cardiovascular Diseases, University Clinical Center Tuzla. Patients underwent elective coronary artery bypass heart surgery either with cardiopulmonary bypass (on-pump CABG) or without it (off-pumpCABG). The aim of this study was to compare the changes in coagulation tests (APTT, INR) in patients who were operated on-pump and patients operated off-pump. Our study showed that the values of APTT and INR tend to increase immediately after surgery. Twenty-four hours after surgery these values are declining and they are approaching the preoperative values in all observed patients (p <0.05). Comparing APTT between the groups we found that postoperative APTT levels are significantly higher in the group of patients who underwent surgery with cardiopulmonary bypass (p <0.05). Changes in coagulation tests after surgical revascularization of the heart are more pronounced in patients who were operated with on-pump technique compared to patients operated off-pump technique