Prolonged ventilation post cardiac surgery - tips and pitfalls of the prediction game

<p>Abstract</p> <p>Background</p> <p>Few available models aim to identify patients at risk of prolonged ventilation after cardiac surgery. We compared prediction models developed in ICU in two adjacent periods of time, when significant changes were observed both in population characteristics and the perioperative management.</p> <p>Methods</p> <p>We performed a retrospective review of two cohorts of patients in our department in two subsequent time periods (July 2007 - December 2008, n = 2165; January 2009 - July 2010, n = 2192). The study was approved by the Institutional Ethics Committee and the individual patient consent was not required. Patients were divided with regard to ventilation time of more or less than 48 hours. Preoperative and procedure-related variables for prolonged ventilation were identified and multivariate logistic regression analysis was performed separately for each cohort.</p> <p>Results</p> <p>Most recent patients were older, with more co-morbidities, more frequently undergoing off-pump surgery. At the beginning of 2009 we also changed the technique of postoperative ventilation. Percentage of patients with prolonged ventilation decreased from 5.7% to 2.4% (p < 0.0001).Preoperative and procedure-related variables for prolonged ventilation were identified. Prediction models for prolonged ventilation were different for each cohort. Most recent significant predictors were: aortic aneurysm surgery (OR 12.9), emergency surgery (OR 5.3), combined procedures (OR 5.1), valve procedures (OR 3.2), preoperative renal dysfunction (OR 2.9) and preoperative stroke or TIA (OR 2.8).</p> <p>Conclusions</p> <p>Prediction models for postoperative ventilation should be regularly updated, particularly when major changes are noted in patients' demographics and surgical or anaesthetic technique.</p

Człowiek i wartości : tematy filozoficzne we wczesnych studiach Floriana Znanieckiego

Analiza myśli Znanieckiego ujawnia zawierający się w niej obraz człowieka jako istoty twórczej. Humanizm, który był głoszony przez Uczonego zakładał, uznanie twórczej indywidualności człowieka, jako najwyższej wartości. Idąc nieco dalej można powiedzieć, iż to właśnie możliwość swobodnej twórczość jest tym szczególnym pierwiastkiem, który niejako konstytuuje człowieka jako człowieka. To właśnie ów przymiot umożliwia konkretnemu człowiekowi tworzenie rzeczywistości specyficznie ludzkiej czyli świata kultury wraz z istniejącymi w tym świecie wartościami. Może ona być wprawdzie rozpatrywana jako całość względnie izolowana, lecz jeśli chcemy ją rzeczywiście zrozumieć nie można negować innych, równie istotnych sfer kultury, na które składają się także ideały, nauka, sztuka, religia, a także wszelkie formy działalności podejmowanej przez człowieka. W tym znaczeniu twórczość filozoficzna jest również specyficznym rodzajem działalności intelektualnej zespolonej z innymi obszarami kultury. Co istotne, tworzenie świata specyficznie ludzkiego, różniącego się od tego, co składa się na świat przyrody, nadaje sens oraz znaczenie ludzkiemu życiu. w biografii Znanieckiego można bez trudu doszukać się takich wyjątkowych i niepowtarzalnych momentów, które wyzwalały w nim najbardziej twórcze możliwości, a także uzmysławiały to, co jest autentycznym powołaniem człowieka – filozofa. W przypadku Uczonego powołaniem tym była nieustanna twórcza praca intelektualna z myślą o człowieku i dla jego dobra. W dziele, które po sobie pozostawił szczególne miejsce zajmuje człowiek oraz wartości. Natomiast od tego jakim wartościom służyć będzie ludzka istota uzależniał to, czy dana cywilizacja jest w stanie przezwyciężać nawiedzające ją kryzysy. W tym też zakresie podejmował starania zmierzające do opracowania systemu filozoficznego rozwijającego się w procesie twórczej ewolucji. Dlatego znaczną część swojego życia poświecił badaniom nad wartościami. Celem autora Zagadnienia wartości w filozofii, w tym zakresie, było dokonanie syntezy wszystkich dotychczasowych systemów wartości. Rezultatem owej syntezy miał być jeden ogólnoludzki system wartości. Dodać należy, że dynamizm i otwartość, to cechy które charakteryzują projektowany system. Dlatego nie należy zapominać, że w tak zaprojektowanej konstrukcji należy pozostawić miejsce dla tych wartości, które dopiero zostaną odkryte i poznane

Implantacja Andrastentu XL u osoby dorosłej z zaawansowaną niewydolnością serca w przebiegu koarktacji aorty

We report the case of a 49 year-old-man with congenital coarctation of the aorta (CoA), admitted in a critical clinical condition due to advanced secondary cardiomyopathy and chronic heart failure. An Andrastent XL was implanted successfully in the CoA. The procedure resulted in an almost completely resolved CoA and prompt clinical improvement in the patient. Kardiol Pol 2011; 69, 9: 983&#8211;98

Coronary artery bypass graft in a patient with Von Willebrand disease type 1

Von Willebrand disease (VWD), is the most common hereditary bleeding disorder (HBD) and affects approximately 1–2% of the population. Type 1 accounts for 70–80% of all cases and involves partially reduced levels of functional VWF. It is usually manifested by mild to moderate mucocutaneous bleeding. A 63-yearold patient with multivessel coronary artery disease and diagnosed with Von Willebrand’s disease type 1 after a previous NSTEMI infarction (10 days earlier) was admitted to the cardiac surgery department for a planned CABG procedure. The coagulation factor values on admission to the ward were successively (VIII 15%; VWF: Ag 12%). Coronary angiography revealed MV CAD. The patient was consulted with the HEART Team. The decision was made to qualify the patient for CABG using the OPCAB technique. A detailed plan for securing the haemostasis was established. Haemate P 500/1200 and 1000/2400, a lyophilized concentrate of humans VIII and von Willebrand Factors, were secured. During surgery, LITA- LAD and Ao- RCA bridges were performed using Medtronic Starfish® Heart Positioners. In the post-operation period, no complications were noted. Plasma levels of VIII and VW factors were measured daily and antihemorrhagic prophylaxis was given accordingly to measured values. The patient was discharged on the eighth day after surgery in good condition, with the haematological recommendations. Currently, there are no guidelines for the management of patients with Von Willebrand’s disease undergoing cardiac surgery. Incorrectly conducted pharmacotherapy may result in an elevated level of VW factor and additional exposure to the occurrence of acute coronary syndromes and heart attacks

Analysis of the nature of injuries in victims of fall from height

Aim of study: To assess the types and extent of injuries sustained by victims of fall from height depending on the height of fall. Material and methods: The study included 338 bodies of victims of fatal falls from different heights (from the 1st to 10th floors) who were subjected to medico-legal autopsy at the Department of Forensic Medicine, Jagiellonian University Medical College, between 1995 and 2014. For each individual, selected data were collected including gender, age, body height, injury types and presence of alcohol or other intoxicants in blood. The analysis comprised injuries to the brain, thoracic and abdominal organs, fractures of the skull, extremities, ribs and spine, and fractures of the scapula, clavicle and sternum (considered together). The study focused on determining the frequency of occurrence of different injuries in relation to one another and depending on the height of fall. Results : The number and extent of injuries was found to increase along with the height of fall. Three injury types, including injuries to the mesentery and both kidneys and fractures of upper extremity small bones, were shown to occur from the threshold heights of the 3rd, 4th and 6th floors. Eleven injuries demonstrated a statistically significant correlation with the height of fall. The study also revealed a number of correlations between the frequencies of occurrence of different injuries. Conclusions : Injuries found from the threshold value may suggest the minimal height of fall. The presence of injuries which correlate with increasing height, and the overall number of injuries observed in victims of fall from height, may be useful for inferring the height of the fall

Ultrasound imaging of abdominal muscles activity among women with stress urinary incontinence: case-control study in Poland

Objectives: The aim of the present study is the assessment of thickness and percentage change in thickness of the musculus obliquus externus abdominis (OE), musculus obliquus internus abdominis (OI) and musculus transversus abdominis (TrA) among women suffering from stress urinary incontinence (SUI) in comparison with healthy controls. Material and methods: The thickness and its percentage changes of the OE, OI and TrA among women with and without SUI were assessed. We observed the reactions of the abdominal muscles among 84 women by means of ultrasound imaging. Results: The thickness of the OE was significantly greater in the SUI group during rest and tension of the lower part of the abdomen. Significant changes were found in the OI for the controls during isometric tension of the abdominal muscles, tension of the lower part of the abdomen, and ASLR (active straight leg raise) test of right leg. The thickness changes in the TrA were significant for the controls during isometric tension of the abdominal muscles. Conclusions: Our results suggest interactions of the pelvic floor and the abdominal muscles during pelvic floor activity, differing in the women with SUI and controls

On-Pump vs Off-Pump coronary artery bypass surgery in atrial fibrillation : analysis from the polish national registry of cardiac surgery procedures (KROK)

BackgroundNo single randomized study has ever before addressed the safety of On-Pump coronary artery bypass grafting (CABG) vs Off-Pump CABG in the setting of atrial fibrillation (AF) and data from small observational samples remain inconclusive.Methods and findingsProcedural data from KROK (Polish National Registry of Cardiac Surgery Procedures) were retrospectively collected. Of initial 188,972 patients undergoing CABG, 7,913 presented with baseline AF (76.0% men, mean age 69.1±8.2) and underwent CABG without concomitant valve surgery between 2006-2019 in 37 reference centers across Poland. Mean follow-up was 4.7±3.5 years (median 4.3 IQR 1.7-7.4). Cox proportional hazards models were used for computations. Of included patients, 3,681 underwent On-Pump- (46.52%) as compared to 4,232 (53.48%) who underwent Off-Pump CABG. Patients in the latter group less frequently were candidates for complete revascularization (PConclusionsOff-Pump CABG offered 30-day survival benefit to patients undergoing CABG surgery and presenting with underlying AF. On-Pump CABG was associated with significantly improved survival at long term

Zastosowanie utleniania pozaustrojowego (ECMO) w leczeniu ostrej niewydolności oddechowej wywołanej infekcją wirusem grypy pandemicznej

Pandemic influenza particularly often is associated with symptoms of acute respiratory failure, and in case of refractory hypoxemia patients may have indications for the extracorporeal membrane oxygenation (ECMO). The paper presents a case of a pandemic influenza virus infection, where classical indications for veno-venous ECMO occured. Practical aspects of this kind of treatment in the intensive care unit are discussed. Kardiol Pol 2011; 69, 4: 416-42