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

Self-esteem and the value of body in people who exercise regularly at the gym - the results of pilot studies

Wstęp. Ćwiczenie na siłowni staje się coraz bardziej popularne, zarówno wśród kobiet, jak i wśród mężczyzn. Regularne treningi, poza zmianami morfologicznymi oraz funkcjonalnymi mogą mieć wpływ na zmiany pewnych aspektów psychologicznych, szczególnie dotyczących poczucia własnej wartości oraz postrzegania własnego ciała. Cel. Postanowiono określić poziom poczucia własnej wartości oraz poczucia wartości własnego ciała u osób ćwiczących na siłowni. Ponadto celem badań było zbadanie wzajemnych zależności między tymi rodzajami samooceny oraz ocena wpływu wieku i stażu treningowego na ich poziom u kobiet i u mężczyzn. Materiał i metody. Zbadano 73 osoby regularnie ćwiczące na siłowni: 23 kobiety i 50 mężczyzn. Narzędziem badawczym był kwestionariusz, zawierający Skalę Samooceny Rosenberga (SES) oraz Skalę Poczucia Wartości  Własnego Ciała (BES). Wyniki. Zarówno kobiety, jak i mężczyźni ocenili poczucie własnej wartości na poziomie 59% możliwych do uzyskania punktów. Również poczucie wartości własnego ciała i jego składowe były powyżej połowy możliwych do uzyskania punktów. Nie znaleziono korelacji poczucia własnej wartości z poczuciem wartości własnego ciała. Odnotowano silne wzajemne korelacje między składowymi skali BES. Wśród kobiet odnotowano korelację wieku z wynikami SES. Wnioski. Osoby ćwiczące na siłowni mają dobry poziom globalnej samooceny oraz poczucia wartości własnego ciała. Badane rodzaje samooceny nie są wzajemnymi korelatami. Aspekty poczucia wartości własnego ciała są ze sobą skorelowane. Wśród kobiet wiek wpływa dodatnio na poczucie własnej wartości

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

Long-term survival following surgical ablation for atrial fibrillation concomitant to isolated and combined coronary artery bypass surgery-analysis from the polish national registry of cardiac surgery procedures (KROK)

The current investigation aimed to evaluate long-term survival in patients undergoing isolated and combined coronary artery bypass grafting (CABG) with concomitant surgical ablation for atrial fibrillation (AF). Procedural data from KROK (Polish National Registry of Cardiac Surgery Procedures) were retrospectively collected. Eleven thousand three hundred sixteen patients with baseline AF (72.4% men, mean age 69.6 ± 7.9) undergoing isolated and combined CABG surgery between 2006–2019 in 37 reference centers across Poland and included in the registry were analyzed. The median follow-up was four years (3.7 IQR 1.3–6.8). Over a 12-year study period, there was a significant survival benefit (Hazard Ratio (HR) 0.83; (95% Confidence Interval (CI): 0.73–0.95); p = 0.005) with concomitant ablation as compared to no concomitant ablation. After rigorous propensity matching (LOGIT model, 432 pairs), concomitant surgical ablation was associated with over 25% improved survival in the overall analysis: HR 0.74; (95% CIs: 0.56–0.98); p = 0.036. The benefit of concomitant ablation was maintained in the subgroups, yet the most benefit was appraised in low-risk patients (EuroSCORE < 2, p = 0.003) with the three-vessel disease (p < 0.001) and without other comorbidities. Ablation was further associated with significantly improved survival in patients undergoing CABG with mitral valve surgery (HR 0.62; (95% CIs: 0.52–0.74); p < 0.001) and in patients in whom complete revascularization was not achieved: HR 0.43; (95% CIs: 0.24–0.79); p = 0.006. View Full-Text

The Use of Supplementation Among People Practicing Powerlifting and its Connections with their Self – esteem and Body Value

Supplementation is one of the forms of powerlifting training support. It may have an influence on physical parameters of the contenders and may also have an impact on perception of the body and self – esteem. The aim of the study was to assess relationships between age, BMI, data concerning training, supplementation, self – assurance and body value among the contenders practising powerlifting.51 people who regularly practise powerlifting: 11 women aged 23.5 ±3.6 and 40 men aged 23.9 ±8.5 have been examined using self – esteem (SES) and body – esteem (BES) questionnaires. Data concerning age, BMI, training variables and supplementation have been also gathered.Supplementation is used by 91% of women and 85% of men. Men use more types of supplements than women (p &lt; 0.05). Among women SES does not correlate with any other variables. Among men SES negatively correlates with the number of used supplements, as well as with all of the BES domains.Using supplementation among people who train powerlifting is rather common. Among women, SES in not related in any way with training or supplementation. Among men, lower self – esteem (SES) is significantly counterbalanced with BES

Off-pump versus on-pump coronary artery surgery in octogenarians (from the KROK Registry)

BackgroundAccording to the medical literature, both on-pump and off-pump coronary artery surgery is safe and effective in octogenarians.ObjectivesThe aim of our study was to examine the epidemiology, in-hospital outcomes and long-term follow-up results in octogenarians undergoing off-pump and on-pump coronary artery surgery utilizing nationwide registry data.MethodsAll octogenarians (≥ 80 years) enrolled in the Polish National Registry of Cardiac Surgical Procedures (KROK Registry), who underwent isolated coronary surgery between January 2006 and September 2017 were identified. Preoperative data, perioperative complications, hospital mortality and long-term mortality were analyzed. Unadjusted and propensity-matched comparisons were performed between octogenarians undergoing off-pump and on-pump coronary artery bypass surgery.ResultsOctogenarians accounted for 4.1% of the total population undergoing coronary artery surgery in Poland during the analyzed period (n = 152,631) and this percentage is increasing. Among 6,006 analyzed patients, 2,744 (45.7%) were operated on-pump and 3,262 (54.3%) were operated off-pump. Propensity-matched analysis revealed that patients operated on-pump were more often reoperated due to postoperative bleeding and their in-hospital mortality was higher (6.6% vs 4.5%, p = 0.006 and 8.7% vs 5.8%, p = 0.001, respectively). Long-term all-cause mortality was lower among patients operated off-pump (p = 0.013).ConclusionOn the basis of our findings we suggest that off pump technique should be considered as perfectly acceptable in octogenarians

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