Donata Ringaitiene

Incidence and precipitating factors of delirium after coronary artery bypass grafting

Objective. To analyze large contemporary patient population, undergoing on-pump coronary artery bypass grafting at our institution, and identify the prevalence and precipitating factors of delirium development. Design. Baseline demographics, operative data and postoperative outcomes of 1367 consecutive patients were recorded prospectively and analysed using multivariate logistic regression analysis, to determine independent predictors of postoperative delirium development. Results. Delirium was detected in 42 (3.07%) patients. Eight factors: age more than 65 years, peripheral vascular disease, Euroscore≥5, preoperative IABP support, postoperative blood product usage and postoperative low cardiac output syndrome were independently predicting delirium development after coronary artery bypass procedures. Postoperative delirium was associated with significantly higher mortality rate (16.6% vs. 3.9%, p=0.013), prolonged mechanical ventilation time (9.2±3.1 vs. 5.05±7.6, p=0.04) and increased length of intensive care unit stay (6.8±4.9 vs. 2.0±2.7 days, p=0.001). Conclusions. Delirium is a dangerous complication, prolonging intensive care unit stay and postoperative mortality. Factors associated with delirium development are advanced age, peripheral vascular disease, diminished cardiac function and blood product usage.

Successful Treatment of Right Heart Thrombi and Acute Massive Pulmonary Embolism by Repeated Thrombolysis

We present the case of a 19 year old female who underwent a massive pulmonary embolism with thrombus in right ventricle (RV) and acute RV failure. Thrombolytic treatment had failed and repeated thrombolysis was given after 24 hours. Treatment was successful and on the eleventh day of hospitalization the patient was discharged. The current guidelines do not give clear directions for the management of patients with acute massive pulmonary embolism who do not respond to fibrinolytic therapy. A repeated thrombolysis could be an alternative treatment over surgical embolectomy for these patients.

Bioelectrical Impedance Phase Angle—Predictor of Blood Transfusion in Cardiac Surgery

OBJECTIVE To determine whether bioelectrical impedance-derived phase angle (PA) can be a predictor of red blood cell (RBC) transfusion in patients undergoing cardiac surgery. DESIGN An observational retrospective study of prospectively collected data. SETTING Single center, tertiary referral university hospital. PARTICIPANTS The study sample comprised 642 adult patients undergoing elective cardiac surgery. INTERVENTIONS Patient demographic and clinical variables were collected. The body composition of the patients was evaluated by bioelectrical impedance analysis (BIA) the day prior to surgery. The rates of postoperative RBC transfusion were recorded. MEASUREMENTS AND MAIN RESULTS Among the 642 patients (67.8% men, median age of 66 [range 59-73]) included in the present study, 210 (32.7%) received at least 1 RBC unit postoperatively. Hypertension, preoperative stroke, renal failure, preoperative hemoglobin and hematocrit values, BIA-derived PA, aortic crossclamp time, and cardiopulmonary bypass (CPB) time were associated with the risk of RBC transfusion in the univariate analysis, and were included in the final multivariate regression model. Preoperative stroke (odds ratio [OR] 0.394; 95% confidence interval [CI]: 0.183-0.848; p = 0.017), preoperative hemoglobin values (OR 0.943; 95% CI: 0.928-0.960; p < 0.001), PA <15th percentile (OR 2.326; 95% CI: 1.351-4.000; p = 0.002), and CPB time (OR 1.013; 95% CI: 1.008-1.018; p < 0.001) were identified as independent predictors of RBC transfusion. CONCLUSION Several factors were identified to be associated significantly with postoperative RBC transfusion in patients undergoing cardiac surgery. Among the conventional predictors, the value of the BIA-derived PA was indicated as a potent prognostic tool.

Prolonged vasopressors therapy is associated with glucose variability after cardiac surgery

Stress hyperglycemia in the ICU environment is a highly regarded study subject since Lueven collaborators publications in 2001. Current research focused on variability of blood glucose levels suggests it being an independed predictor of bad clinical outcome. Despite the importance of the subject the genesis of the variability of the glycemia is not fully understood.

SUN-PP070: Postoperative Glucose Variability: Association with Clinical Outcome After Cardiac Surgery

Rationale: ESPEN guidelines recommend using equations based on the BW before acute illness because of fluid retention, with questionable accuracy of this BW. The aim of this study is to ascertain the accuracy of the ESPEN equation using different BW vs. EE measured by IC, in ventilated patients and to determine the most suitable BW Methods: All mechanically ventilated patients staying >72 h in ICU, with FiO2 < 60%, PEEP< 9 cmH2O, no pulmonary fistula or lung multi-resistant bacteria were included and had IC measurement. We calculated EE with the ESPEN equation (20 25 kcal/kg acute phase and 25 30 kcal/kg post-acute phase), using several BW: anamnestic (BWAN), measured (BWMES), adjusted for water balance (BWADJ) and ideal BW calculated for a body mass index of 22.5 and 25 kg/m2. Results are presented as mean±SD. Calculated EE was compared to EE measured by IC, with ANOVA repeated measure and Bonferroni post-hoc test, as well as Bland Altman analysis Results: We included 85 patients (57±19 y, 61 men, SAPS II 50±14), including 47 in acute phase. EE calculated with BWAN, BWADJ and BWMES significantly overestimated measured EE by IC (1910±458 kcal/d; p < 0.0001). Differences of calculated EE were statistically significant between the various BW used (p < 0.0001).