Ewa Kucewicz-Czech

It is time for enhanced recovery after surgery in cardiac surgery

Łukasz Krzych, MD, PhD is an associate professor of anaesthesiology and intensive care medicine, head of the Department of Anaesthesiology and Intensive Care, Medical University of Silesia in Katowice. Member of the Board of ‘Club 30’ of the Polish Cardiac Society. General Secretary of the Polish Society of Anaesthesiology and Intensive Therapy and Chairman of its scientific section, cardiac and thoracic anaesthesia. His scientific activity encompasses the methodology of scientific research, mainly within the field of cardiac anaesthesia and intensive care of cardiovascular diseases and perioperative medicine, in particular prediction and consequences of complications in cardiac surgery, and some major issues associated with interdisciplinary intensive therapy.

Silesian Registry of Intensive Care Units

To the Editor: The Silesian Registry of Intensive Care Units (hereafter called ‘the Registry’) is an Internet platform which gathers medical data regarding hospitalisations of patients in Silesian intensive care units (ICUs). The Registry has been functioning since September 2010 and is available for all multi-profile ICUs for adults. The owner and administrator of the Registry is the Silesian Section of the Polish Society of Anaesthesiology and Intensive Care PSAIT). The initiators of this project were Prof. Ewa Karpel (then Regional Consultant in anaesthesiology and intensive care for the Silesian region) and Prof. Piotr Knapik (Chairman of the Silesian section). The registration of hospitalisations in the Registry is voluntary. The platform is accessible exclusively for registered users, namely physicians employed in Silesian ICUs. The database contains information regarding hospitalisations of adult patients treated in ICUs cooperating with the Registry. To enter the data to the Registry, the user has to log on to the system (for verification). When a particular patient is discharged from or dies in an ICU (completion of hospitalisation), the attending physician or physician on duty logs on (individual login and password) and enters the strictly defined data concerning hospitalisation to the Registry. On entering the data, the hospitalisation is assigned an individual number in the Registry. No data enabling identification of patients are entered (e.g. full name, first name or Universal Electronic System for Registration of the Population UESRP – PESEL in Polish) [1]. On 11.01.2017 the Registry contained data regarding 20,049 hospitalisations. The data from the entire region are accessible to the Regional Consultant in anaesthesiology and intensive care, the Chairman of the Silesian Section, as well as the administrators of the Registry. Each Senior Registrar of an ICU or those authorised have a continuous access to the data concerning their unit (moreover, they can compare the data about their Unit with the mean characterising all ICUs in the Silesian Region). The registry does not contain any information enabling identification of individual patients or hospitalisations; all units were asked to note the individual Registry number assigned in their internal ICU documentation. Thus, each ICU in the Silesian region can create its own database containing information on its hospitalisations, provided that all hospitalisations are regularly reported to the Registry. The system gathers data regarding patients’ conditions before admission and on admission, the course of ICU treatment, treatment outcomes (according to the questionnaire provided) (Table 1). The entered data were previously defined (thus, they can be entered only by marking the appropriate box); in some cases, the data can be entered in a descriptive manner (only non-standard data). In answering a particular question, several boxes can be marked. The obtained information is used to plan and accomplish intensive care therapies at an appropriate level, to improve the quality of services, to prepare multi-centre scientific studies and to promote cooperation of individual ICUs in the Silesian region. Therefore, the Registry is a scientific and educational undertaking and an important tool for the evaluation of the quality of treatment of patients hospitalised in Silesian ICUs. The data from the entire region are also available for analyses and scientific studies by physicians working in the ICUs participating in the Project [2–15], once approved by the Regional consultant or Chairman of the Silesian section of the PSAIT. The use of Registry data for scientific purposes was approved by the Bioethics Committee of the Medical University of Silesia in Katowice. The Registry’s functioning (IT services, hosting services, protection, software) is supported from the funds of the Silesian Section of the PSAIT. All data are verified by the administrator of the database as for their internal coherence in order to eliminate errors during their entering (i.e. conflicting data regarding the same hospitalisation. The entered data, however, are not audited by the Registry administrators as to their conformity with medical records. It was assumed that such verification should be conducted at the Unit level. According to the opinion of the Legal Department of the Ministry of Health, the statistical-scientific platform operated in the way described above does not fall into the category of registries requiring the Directive of the Minister of Health pursuant to the Health Information Protection Act. This means that the Silesian Section can freely carry on with its database and the information included in it can be used for research purposes by physicians employed in the therapeutic units participating in the Project [16].

Levosimendan in patients with low ejection fraction undergoing cardiac surgery

Introduction Significant impairment of left ventricular function causes low cardiac output syndrome in the immediate postoperative period in 3–14% of patients undergoing surgery, increasing the mortality 15-fold. Aim To assess the use of levosimendan in patients undergoing cardiac surgery in 2016. Material and methods The analysis included 14 patients: 3 (21.4%) women and 11 (78.6%) men aged 65.4 ±11.8 years. The mean value of left ventricular ejection fraction amounted to 20 ±6.25%. In 11 patients, levosimendan infusion was started immediately after the induction of anesthesia. Three patients received the agent during the early postoperative period due to low cardiac output syndrome refractory to conventional therapy. The dosage was modified within the range of 0.05–0.2 μg/kg/min. On the day of the surgery, all patients received continuous infusion of adrenaline and levonor. Results The cardiac index amounted to 2.8 ±0.71 l/m2 after several hours of infusion and 2.9 ±0.1 l/m2 the next morning. The first examination showed that the mean systemic vascular resistance was 1010 dyn/s–5 and the second: 940 ±100 dyn/s–5; mixed venous blood saturation amounted to 66 ±7.5% and 65.5 ±8%, respectively. Respectively, the mean concentration of lactates was 2.0 ±0.96 mmol/l and 1.8 ±0.24 mmol/l. Mechanical lung ventilation lasting more than 48 hours was required in 50% of the patients. Two patients with chronic kidney disease required bedside renal replacement therapy before the procedure. Two (14.3%) patients died. Nine (64.3%) patients were discharged home, and three were transferred to cardiac wards. Conclusions Levosimendan therapy proved safe in the study group. The nature of the study and the small sample size preclude the formulation of detailed conclusions.

Perioperative haemodynamic optimisation in patients undergoing non-cardiac surgery — a position statement from the Cardiac and Thoracic Anaesthesia Section of the Polish Society of Anaesthesiology and Intensive Therapy. Part 1

Należy cytować anglojęzyczną wersję: Kucewicz-Czech E, Krzych ŁJ, Marcin Ligowski M. Perioperative haemodynamic optimisation in patients undergoing non-cardiac surgery — a position statement from the Cardiac and Thoracic Anaesthesia Section of the Polish Society of Anaesthesiology and Intensive Therapy. Part 1. Anaesthesiol Intensive Ther. 2017, vol. 49, no 1, 6–15. doi: 10.5603/AIT.2017.0006. Optymalizacja funkcji układu krążenia w okresie okołooperacyjnym u chorych poddawanych operacjom niekardiochirurgicznym — stanowisko Sekcji Kardiotorakoanestezjologii Polskiego Towarzystwa Anestezjologii i Intensywnej Terapii. Część 1

Perioperative care in elderly cardiac surgery patients

Introduction Surgery is an extreme physiological stress for the elderly. Aging is inevitably associated with irreversible and progressive cellular degeneration. Patients above 75 years of age are characterized by impaired responses to operative stress and a very narrow safety margin. Aim To evaluate perioperative complications in patients aged ≥ 75 years who underwent cardiac surgery in comparison to outcomes in younger patients. Material and methods The study was conducted at the Silesian Centre for Heart Diseases in Zabrze in 2009–2014 after a standard of perioperative care in seniors was implemented to reduce complications, in particular to decrease the duration of mechanical ventilation and reduce postoperative delirium. The study group included 1446 patients. Results The mean duration of mechanical ventilation was 13.8 h in patients aged ≥ 75 years and did not differ significantly compared to younger patients. In-hospital mortality among seniors was 3.8%, a value significantly higher than that observed among patients younger than 75 years of age. Patients aged ≥ 75 years undergoing cardiac surgery have significantly more concomitant conditions involving other organs, which affects treatment outcomes (duration of hospital stay, mortality). Conclusions The implementation of a standard of perioperative care in this age group reduced the duration of mechanical ventilation and lowered the rate of postoperative delirium.