Vaidas Vicka

Impact of malnutrition on postoperative delirium development after on pump coronary artery bypass grafting.

Background & aimsEven though malnutrition is frequently observed in cardiac population outcome data after cardiac surgery in malnourished patients is very rare. No thorough research was done concerning the impact of malnutrition on neuropsychological outcomes after cardiac surgery. The aim of our study was to analyze the incidence of postoperative delirium development in malnourished patients undergoing on pump bypass grafting.MethodsWe performed a cohort study of adults admitted to Vilnius University Hospital Santariskiu Clinics for elective coronary artery bypass grafting. The nutritional status of the patients was assessed by Nutritional Risk Screening 2002 (NRS-2002) questionnaire the day before surgery. Patients were considered as having no risk of malnutrition when NRS-2002 score was less than 3 and at risk of malnutrition when NRS-2002 score was ≥3. During ICU stay patients were screened for postoperative delirium development using the CAM-ICU method. and divided into two groups: delirium and non delirium. The statistical analysis was preformed to evaluate the differences between the two independent groups. The logistic regression model was used to evaluate the potential preoperative and intraoperative risk factors of postoperative delirium.ResultsNinety-nine patients were enrolled in the study. Preoperative risk of malnutrition was detected in 24 % (n = 24) of the patients. The incidence of early postoperative delirium in overall study population was 8.0 % (n = 8). The incidence of the patients at risk of malnutrition was significantly higher in the delirium group (5 (62.5 %) vs 19 (20.9 %), p <0.0191). In multivariate logistic regression analysis risk of malnutrition defined by NRS 2002 was an independent preoperative and intraoperative risk factor of postoperative delirium after coronary artery bypass grafting (OR: 6.316, 95 % CI: 1.384-28.819 p = 0.0173).ConclusionsPreoperative malnutrition is common in patients undergoing elective coronary artery bypass grafting. Nutrition deprivation is associated with early postoperative delirium after on pump coronary artery bypass grafting.

Impact of pre‐operative health‐related quality of life on outcomes after heart surgery

Long‐term improvement in health‐related quality of life (HRQOL) is one of the most important outcomes of cardiac surgery. The aim of this study is to define the impact of perioperative patient and procedural variables on HRQOL dynamics, a year after cardiac surgery.

Preoperative risk factors of malnutrition for cardiac surgery patients

Background. Malnutrition (MN) is prevalent in cardiac surgery, but there are no specific preoperative risk factors of MN. The aim of this study is to assess the clinically relevant risk factors of MN for cardiac surgery patients. Materials and methods. The nutritional state of the patients was evaluated one day prior to surgery using a bioelectrical impedance analysis phase angle (PA). Two groups of patients were generated according to low PA: malnourished and well nourished. Risk factors of MN were divided into three clinically relevant groups: psychosocial and lifestyle factors, laboratory findings and disease-associated factors. Variables in each different group were entered into separate multivariate logistic regression models. Results. A total of 712 patients were included in the study. The majority of them were 65-year old men after a CABG procedure. Low PA was present in 22.9% (163) of patients. The analysis of disease-related factors of MN revealed the importance of heart functions (NYHA IV class OR: 3.073, CI95%: 1.416–6.668, p = 0.007), valve pathology (OR: 1.825, CI95%: 1.182–2.819, p = 0.007), renal insufficiency (OR: 4.091, CI95%: 1.995–8.389, p < 0.001) and body mass index (OR: 0.928, CI95%: 0.890–0.968, p < 0.001). Laboratory values related to MN were levels of haemoglobin (OR: 0.967, CI95%: 0.951–0.983, p < 0.001) and C-reactive protein (OR: 1.015, CI95%: 1.002–1.028, p = 0.0279). The lifestyle variables that qualified as risk factors concerned the intake of food (OR: 3.030, CI95%: 1.353–6.757, p = 0.007) and mobility (OR: 2.770, CI95%: 1.067–7.194, p = 0.036). Conclusions. MN risk factors comprise three different clinical groups: psychosocial and lifestyle factors, laboratory findings and disease-associated factors. The patients who are most likely to be malnourished are those with valve pathology, severe imparted heart function, insufficient renal function and high inflammatory markers. Also these patients have decreased mobility and food intake.

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.

OS 19-09 Bioelectrical impedance phase angle as intradialytic hypotension predictor.

Objective: Water balance and blood pressure (BP) alterations are strongly associated in haemodialysis (HD) patients. Aim of this study was to determine whether bioelectrical impedance analysis (BIA) parameters can be used as predictors of intradialytic hypotension (IDH). Design and Method: We conducted an observational study of chronic HD patients. BIA was measured before the HD procedure using InBody S10 (Biospace, Seoul, Korea) body composition analyzer. Intracellular water (ICW), extracellular water (ECW), total body water (TBW), ECW/TBW ratio and phase angle (PhA) were selected as markers of hydration state and thus possible predictors of IDH. Patients had their BP registered during the HD. NKF KDOQI guidelines were used to define the IDH group. These patients had SBP drop of ≥ 20 mmHg or MAP drop of 10 mmHg or more. The BIA parameters and other IDH predictors were entered into multivariate logistic regression analysis with forward model selection process. Results: 99 patients were enrolled into the study. More than a half were male patients 51.5 % (n = 51), on dialysis for 4.5 [2.0–8.5] years with mean Charlson co-morbidity index of 5.76 ± 2.23. The rate of IDH was 40.4 % (n = 40). The mean values of the BIA parameters were as follows: ICW (23.11 ± 5.20), ECW (15.45 ± 3.474), TBW (38.56 ± 8.59), ECW/TBW ratio (0.40 ± 0.013) and PhA (4.49 ± 0.98). Multivariate analysis of IDH predictors revealed the lower PhA (OR = 1.70 CI95% 1.07–2.68 p = 0,024) and higher SBP prior the procedure (OR = 1.03 CI95% 1.01–1.05 p = 0,011) as the risk factors. Conclusions: In our study, we report that nearly half of HD patients experience IHD episode. We conclude that BIA PhA can be used to evaluate the risk of IHD, providing basis for HD adjustment.

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.

Use of ringer's lactate solution does not eliminate the risk of strong ion difference related metabolic acidosis following on pump cardiac surgery

Perioperative use of Normal Saline is linked to hyperchloraemic or Strong Ion Difference (SID) related acidosis. It has been suggested, that this can be avoided by the use of balanced crystalloid solutions including Ringers Lactate (RL). Significant changes in SID were noted previously in cardiac surgery, however recent publication disproved the link between SID and hydrogen ion concentration[1].

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).