Blood-urea-nitrogen-to-serum-albumin ratio in predicting the value of patients with contrast-induced nephropathy for coronary heart disease.

BACKGROUND: The blood-urea-nitrogen (BUN)-to-serum-albumin (ALB) ratio (BAR) has been identified as a novel indicator of both inflammatory and nutritional status, exhibiting a correlation with adverse cardiovascular outcomes. This study aims to investigate the potential predictive value of BAR levels at admission for the development of CIN in patients undergoing coronary angiography (CAG) or percutaneous coronary intervention (PCI). METHODS: Retrospective data were collected from patients who were admitted and underwent CAG or PCI between January 2018 and December 2022 at the Cardiac Medical Center of Union Hospital of Fujian Medical University, and the patients were divided into CIN and non-CIN groups. The BAR was computed by dividing the BUN count by the ALB count. Using multiple variable logistic regression, risk variables associated with the development of CIN were found. RESULTS: A total of 156 patients developed CIN (7.78%). The development of CIN was predicted by a BAR ratio > 4.340 with a sensitivity of 84.0% and a specificity of 70.2%, according to receiver operating characteristic (ROC) analysis. BAR, female gender, diuretic use, and statin medication use were found to be independent predictors of CIN using multifactorial analysis. CONCLUSIONS: When patients are receiving CAG/PCI, BAR is a simple-to-use marker that can be used independently to predict the presence of CIN.

Association Between Remnant Cholesterol and Contrast-Induced Nephropathy in Patients Undergoing Coronary Angiography and/or Percutaneous Coronary Intervention.

Contrast-induced nephropathy (CIN) is an acute renal complication that can occur after the use of iodinated contrast media. Remnant cholesterol (RC) is one of the markers of atherosclerotic cardiovascular disease risk. We evaluated the impact of RC on CIN and clinical outcomes after coronary angiography (CAG) and/or percutaneous coronary intervention (PCI). Consecutive patients (n = 3332) undergoing CAG and/or PCI were assessed in this retrospective study. Patients were divided into four groups based on baseline RC levels. In the quartile analysis, RC were associated with a higher risk of CIN, especially when RC ≤0.20 or ≥0.38 mmol/L (P < .05). However, after adjustment, the association of RC with CIN was not significant. There was a significant correlation between RC and repeated revascularization in patients undergoing PCI (P < .001) and driven primarily by the highest quartile level. After adjustment, this remained statistically significant (adjusted odds ratio (aOR) 4.06; 95% CI 2.10-7.87; P < .001). This is the first large study to show a possible association between RC and the risk of CIN after CAG and/or PCI; however, this finding was not further confirmed after adjustment. The complex clinical risk profile of patients, rather than RC itself, may contribute to the risk of CIN in this high-risk subgroup.

A family intervention to prevent postoperative delirium in patients undergoing cardiac valve surgery: A randomized controlled study.

BACKGROUND: Multiple guidelines recommend that families be involved in the care of ICU patients, which has been widely used in ICU delirium management in recent years. Postoperative delirium (POD) occurs frequently after cardiac surgery and is associated with poor outcomes; however, the effects of family intervention on this group are rarely studied. OBJECTIVES: This study aimed to investigate the effects of family intervention on the incidence of POD and the ICU prognoses of patients undergoing cardiac valve surgery. METHODS: This was a two-group, single-blind, randomized controlled trial involving 80 patients undergoing cardiac valve surgery, with 40 patients in each group. The control group received routine ICU visits, and the experimental group implemented a family intervention that instructed family caregivers to participate in delirium management during ICU visits. The occurrence of POD, ICU stay, mechanical ventilation time of patients; as well as the anxiety, depression, and satisfaction levels of family caregivers were compared between the two groups. RESULTS: The incidence of POD and ICU stay of patients were significantly lower in the experimental group compared to the control group (P < 0.05). The anxiety and depression incidence of family caregivers in the experimental group was lower than those of the control group (P < 0.05), and satisfaction scores were higher than those of the control group (P < 0.05). CONCLUSIONS: Family intervention has the potential to reduce the incidence of POD in patients undergoing cardiac valve surgery, shorten ICU stays, reduce the incidence of anxiety and depression in family caregivers, and improve their satisfaction. These findings suggest that family intervention could be incorporated into routine nursing practice.

Mediating effects of general self-efficacy on social support and quality of life in patients after surgical aortic valve replacement.

AIM: To explore whether general self-efficacy can mediate the relationship between social support and quality of life in patients after surgical aortic valve replacement. DESIGN: A cross-sectional design. METHODS: The final analysis included 283 patients who underwent surgical aortic valve replacement from May 2021 to September 2021. They completed a set of questionnaires, including the Chinese version of the General Self-Efficacy Scale, the Chinese Questionnaire of Quality of life in Patients with Cardiovascular Diseases and the Social Support Rating Scale. The PROCESS Macro in SPSS was used to analyse the mediating effect. RESULTS: Quality of life and all of its dimensions were significantly related to social support and general self-efficacy. A significant indirect effect of social support existed through general self-efficacy in relation to quality of life with the mediation effect ratio of 32.82%.

Preoperative slow-wave sleep is associated with postoperative delirium after heart valve surgery: A prospective pilot study.

Postoperative delirium (POD) is a very common neurological complication after valve surgery. Some studies have shown that preoperative sleep disorder is associated with POD, but the correlation between preoperative slow wave sleep (SWS) and POD remains unclear. Therefore, this study aims to identify the correlation between preoperative slow wave sleep and postoperative delirium in patients with heart valve disease. This was a prospective, observational study of elective valve surgery patients admitted to the Heart Medical Center between November 2021 and July 2022. Polysomnography (PSG) was used to monitor sleep architecture from 9:30 p.m. for 1 night before surgery to 6:30 a.m. on the day of surgery. Patients were assessed for postoperative delirium from postoperative day 1 to extubation or day 5 by using the Richmond Agitation/Sedation Scale (RASS) and the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). A total of 60 elective valve surgery patients were enrolled in this study. Prolonged N1 (11.44%) and N2 (58.62%) sleep, decreased N3 sleep (8.75%) and REM sleep (18.24%) within normal limits were the overall sleep architecture. Compared with patients without POD, patients with POD had less slow wave sleep 1 night before surgery (5.77% vs 10.88%, p < 0.001). After adjusting for confounding factors, slow wave sleep (OR: 0.647, 95% CI 0.493-0.851, p = 0.002) was found to be a protective factor for postoperative delirium. The preoperative SWS is a predictive factor of the POD in patients undergoing valve surgery. But further studies with larger sample sizes are still needed to elucidate the relationship between preoperative slow wave sleep and postoperative delirium.

Early goal-directed mobilization in patients with acute type A aortic dissection: A randomized controlled trial.

OBJECTIVE: To determine the safety and efficacy of early postoperative mobilization in patients who have undergone surgical repair of acute type A aortic dissection. DESIGN: Randomized controlled trial. SETTING: Heart Medical Center. SUBJECTS: Seventy-seven patients with acute type A aortic dissection were assessed. INTERVENTION: Patients were randomly allocated into: (1) the control group (usual care) (n = 38) and (2) the intervention group (early goal-directed mobilization) (n = 39). MAIN MEASURES: The primary outcome was the patient's functional status. The secondary outcomes included vital signs, serious adverse events, muscle strength, intensive care unit-acquired weakness, grip strength, duration of mechanical ventilation, length of stay, readmission rate, and health-related quality of life after 3 months. RESULTS: The vital signs of the patients were within the tolerable ranges during the entire intervention. No serious exercise-related adverse events were observed in the intervention group. The Barthel Index score (P = 0.013), Medical Research Council score (P = 0.001), grip strength (P = 0.001), and health-related quality of life (P = 0.001) were higher in the intervention group. Intensive care unit acquired weakness (P = 0.019), duration of mechanical ventilation (P = 0.002), intensive care unit stay (P = 0.002), and total length of stay (P = 0.010) were lower in the intervention group. Patients in the intervention group had a higher physical health-related quality of life (P = 0.015) at 3 months post-surgery. There was no difference in readmission rates. CONCLUSIONS: Delivery of early goal-directed mobilization in acute type A aortic dissection was safe and facilitated the recovery of daily living ability, shorter hospital stay, and improved quality of life after discharge.

Outcomes of postoperative delirium in patients undergoing cardiac surgery: A systematic review and meta-analysis.

Background: Postoperative delirium (POD) is an acute brain dysfunction that is frequently observed in patients undergoing cardiac surgery. Increasing evidence indicates POD is related to higher mortality among cardiac surgical patients, but the results remain controversial. Moreover, a quantitative evaluation of the influence of POD on hospital days, intensive care unit (ICU) time, and mechanical ventilation (MV) time has not been performed. Objective: This study aimed to evaluate the correlation between POD and outcomes in patients undergoing cardiac surgery by a systematic review and meta-analysis. Materials and methods: A total of 7 electronic databases (Cochrane Library, PubMed, EMBASE, CINAHL Complete, MEDLINE, Wan-fang database, and China National Knowledge Infrastructure) were searched from January 1980 to July 20, 2021, with language restrictions to English and Chinese, to estimate the impact of the POD on outcome in patients who underwent cardiac surgery. The meta-analysis was registered with PROSPERO (Registration: CRD42021228767). Results: Forty-two eligible studies with 19785 patients were identified. 3368 (17.0%) patients were in the delirium group and 16417 (83%) were in the non-delirium group. The meta-analysis showed that compared to patients without POD, patients with POD had 2.77-fold higher mortality (OR = 2.77, 95% CI 1.86-4.11, P < 0.001), 5.70-fold higher MV (>24h) rate (OR = 5.70, 95% CI 2.93-11.09, P < 0.001); and longer MV time (SMD = 0.83, 95% CI 0.57-1.09, P < 0.001), ICU time (SMD = 0.91, 95% CI 0.60-1.22, P < 0.001), hospital days (SMD = 0.62, 95% CI 0.48-0.76, P < 0.001). Conclusion: The synthesized evidence suggests that POD is causally related to the increased risk of mortality, prolonged length of ICU and hospital stay, and a longer duration of MV time. Future research should focus on the interventions for POD, to reduce the incidence. Systematic review registration: [www.crd.york.ac.uk/PROSPERO], identifier [CRD42021228767].

A Study of the Nursing Intervention Based on Self-Efficacy Theory for Patients After Mechanical Heart Valve Replacement: A Randomized Controlled Trial.

Aim: To explore the practicability and efficiency of self-efficacy intervention on the nursing for patients after mechanical heart valve replacement (MHVR), so as to provide a theoretical and data foundation for the implementation of self-efficacy intervention in clinical practice. Methods: This study adopted a randomized controlled trial (RCT). A total of 140 patients undergoing MHVR were randomly divided into the experimental group (normal nursing + self-efficacy intervention) or the control group (normal nursing only) based on a random number table. The primary goal was to evaluate the effect of self-efficacy theory on the self-efficacy of postoperative MHVR patients by General Self-Efficacy Scale (GSES). The secondary goal was to assess the improvement of mental health of postoperative patients as well as their pain through Symptom Checklist 90 (SCL-90) and the visual analogue scale (VAS). The incidence of infection during hospitalization was analyzed, as well as the medication compliance of patients during 3-month follow-up after discharge. Results: Finally, 136 patients completed the whole trial. The GSES score of the experimental group was notably superior over the control group (p < 0.001), and the SCL-90 scores were lower over the control group. The VAS score of the experimental group was remarkably lower than that of the control group (p < 0.001). The incidence of infection in the experimental group was lower than that in the control group (p = 0.026). The medication compliance of the experimental group was superior to that of the control group (p = 0.030). Conclusion: Self-efficacy intervention for patients after MHVR could mobilize their self-efficacy, enhance their postoperative medication compliance, and improve their postoperative recovery. This study provides evidence-based medicine (EBM) evidence for the application of self-efficacy theory to postoperative nursing for patients receiving MHVR.

Family-centred care interventions to reduce the delirium prevalence in critically ill patients: A systematic review and meta-analysis.

AIM: This study aimed to determine whether family-centred care (FCC) intervention reduces the ICU delirium prevalence. DESIGN: A systematic review and meta-analysis. METHODS: The databases, including PubMed, Cochrane Central Register of Controlled Trials, Web of Science, CINAHL Complete, China National Knowledge Infrastructure (CNKI), China Biology Medicine disc (CBMdisc), WANFANG Data and VIP Information, were systematically searched up to 30 November 2021. The search term includes keywords related to intensive care units, delirium and family-centred care. Meta-analyses were performed and presented by risk ratio (RR), mean difference (MD) and corresponding 95% confidence intervals (CIs). RESULTS: The meta-analysis results showed that compared with the usual care, FCC intervention has positive effects on reducing ICU delirium prevalence [RR = 0.54, 95% CIs (0.36, 0.81), p < .05]. However, no effect was observed on ICU stays, mechanical ventilation duration and ICU-acquired infection between the two groups. CONCLUSIONS: Family-centred care is an effective intervention to reduce the ICU delirium prevalence. But the result should be treated cautiously as the high levels of heterogeneity, further high-quality studies are required to determine the effectiveness of FCC intervention in the ICU setting.

Relationship Between Family Functioning and Medication Adherence in Chinese Patients With Mechanical Heart Valve Replacement: A Moderated Mediation Model.

Background: Medication adherence is crucial for patients with mechanical heart valve replacement. Although families functioning is positively associated with medication adherence, little is known about the underlying mechanisms. Objective: To test whether family functioning affects medication adherence through illness perceptions and whether this mediating effect was moderated by medication literacy. Methods: 319 patients after mechanical heart valve replacement were included in this cross-sectional study from June 2021 to October 2021. Data regarding family functioning, illness perceptions, medication adherence, and medication literacy were collected through questionnaires. The moderated mediation model was examined by Hayes's PROCESS macro, based on the bootstrapping method. Results: The results revealed illness perceptions partially mediated the association of family functioning on medication adherence [ß = 0.08, 95% confidence intervals: (0.04, 0.12)], and this effect was stronger for patients with low medication literacy than those with high literacy [ß = -0.36, 95% CI: (-0.50, -0.22)]. Furthermore, the relationship between family functioning and medication adherence was only significant in patients with low medication literacy [ß = 0.36, 95% CI: (0.23, 0.50)]. Conclusion: The mediating effect of illness perceptions between family functioning and medication adherence was moderated by medication literacy. Efforts to improve medication adherence by targeting at improving family functioning may be more effective when considering illness perceptions, especially for patients with limited medication literacy.

Admission Hyperglycemia in Acute Type A Aortic Dissection Predicts for a Prolonged Duration of Mechanical Ventilation.

Previous studies have demonstrated that admission hyperglycemia is a predictor of mortality and poor prognosis in patients with cardiovascular diseases, such as acute myocardial infarction. However, the prognostic value of admission hyperglycemia in patients with acute type A aortic dissection (AAAD) has never been explored. To clarify the association between hyperglycemia and in-hospital outcomes, we retrospectively analyzed 734 patients with AAAD. The interest endpoints were in-hospital mortality rate, the duration of intensive care unit and hospital stays, the occurrence of prolonged mechanical ventilation (PMV), and other complications. All patients were divided into the normal blood glucose group (≤ 140 mg/dL) and hyperglycemia group (> 140 mg/dL), to compare the in-hospital outcomes rate in the two groups. There were 531 (72.3%) patients with normal blood glucose levels and 203 (27.7%) patients with hyperglycemia. The in-hospital mortality rate was 21.1%, and no statistically significant differences were found between the two groups (20.3% versus 23.2%, P = 0.403). PMV is the most frequent postoperative complication, the incidence of which was significantly higher in the hyperglycemia group than in the normal blood glucose group (59.6% versus 50.8%, P = 0.040). The logistic regression analysis revealed that hyperglycemia (odds ratio (OR): 1.492; 95% CI: 1.014 to 2.197; P = 0.042) was an independent risk factor for PMV after adjusting for confounding factors. Age (OR: 1.021; 95% CI: 1.006-1.037; P = 0.007) and body mass index (OR: 1.101; 95% CI: 1.051-1.153; P < 0.001) were also associated with PMV. In conclusion, our study showed for the first time that a strong correlation between admission hyperglycemia and increased postoperative PMV in patients with AAAD, but not with in-hospital mortality rate.

Effects of neuromuscular electrical stimulation on functional capacity and quality of life among patients after cardiac surgery: A systematic review and meta-analysis.

BACKGROUND: Neuromuscular electrical stimulation (NMES) is a possible adjunctive therapy applied to cardiac surgery patients to improve physical function, but the results are still controversial. A systematic review and meta-analysis was conducted to investigate the effects of NMES on functional capacity and quality of life (QoL) in cardiac surgery patients. METHODS: The following databases PubMed, Embase, Medicine, CINAHL, and the Cochrane Central Register of Controlled Trials were searched for the English language from inception up to March 2021. A systematic targeted literature search evaluating the effects of NMES on physical function and QoL in cardiac surgery patients. The effect size of NMES was presented as the mean difference (MD)/standardized mean difference (SMD) and its 95% confidence interval using fixed/random effect models according to heterogeneity. Two reviewers independently screened and appraised each study by using the Cochrane Risk of Bias Tool. RESULTS: Six studies were included involving 400 cardiac surgery patients. The meta-analysis showed that NMES had effect on knee extensor strength (SMD=1.68; p=0.05), but had no effects on 6-minute walking distance (MD=44.08; p=0.22), walking speed (MD=0.05; p=0.24), grip strength (MD=3.01; p=0.39), or QoL (SMD=0.53; p=0.19). CONCLUSIONS: NMES use in cardiac surgery patients is limited by low to moderate quality. Existing evidence shows that NMES is safe and effective for improving knee extensor strength.

Association between glucose variability and postoperative delirium in acute aortic dissection patients: an observational study.

BACKGROUND: Blood glucose variability is associated with poor prognosis after cardiac surgery, but the relationship between glucose variability and postoperative delirium in patients with acute aortic dissection is unclear. The study aims to investigate the association of blood glucose variability with postoperative delirium in acute aortic dissection patients. METHODS: We prospectively analyzed 257 patients including 103 patients with delirium. The patients were divided into two groups according to whether delirium was present. The outcome measures were postoperative delirium, the length of the Intensive Care Unit stay, and the duration of hospital stay. Multivariable Cox competing risk survival models was used to assess. RESULTS: A total of 257 subjects were enrolled, including 103 patients with delirium. There were statistically significant differences between the two groups in body mass index, history of cardiac surgery, first admission blood glucose, white blood cell counts, Acute Physiology and Chronic Health Evaluation II score, hypoxemia, mechanical ventilation duration, and the length of Intensive Care Unit stay(P < 0.05). The delirium group exhibited significantly higher values of the mean of blood glucose (MBG) and the standard deviation of blood glucose (SDBG) than in the non-delirium group(P < 0.05). In model 1, the adjusted hazard ratio (AHR) of the standard deviation of blood glucose was 1.436(P < 0.05). In Model 2, the standard deviation of blood glucose (AHR = 1.418, 95%CI = 1.195-1.681, P < 0.05) remained significant after adjusting for confounders. The area under the curve of the SDBG was 0.763(95%CI = 0.704-0.821, P < 0.01). The sensitivity was 81.6%, and the specificity was 57.8%. CONCLUSIONS: Glucose variability is associated with the risk of delirium in patients after aortic dissection surgery, and high glycemic variability increases the risk of postoperative delirium.

Association of body mass index with in-hospital major adverse outcomes in acute type A aortic dissection patients in Fujian Province, China: a retrospective study.

BACKGROUND: Abnormal body mass index (BMI) has been related to a higher risk of adverse outcomes in patients undergoing cardiac surgery. However, the effects of BMI in patients with acute type A aortic dissection (AAAD) on postoperative outcomes remain unclear. This study aimed to explore the relationships between BMI and in-hospital major adverse outcomes (MAO) in AAAD patients. METHODS: Patients who underwent AAAD surgery at Cardiac Medical Center of Fujian Province from June 2013 to March 2020 were retrospectively evaluated. They were divided into three groups on the basis of Chinese BMI classification established by the World Health Organization: normal weight group (BMI 18.5-23.9 kg/m2), overweight group (BMI 24-27.9 kg/m2), and obese group (BMI >28 kg/m2). Patients' baseline characteristics, preoperative, operative, and postoperative data were collected. A multivariable logistic regression analysis model was performed to identify the association between BMI and MAO in AAAD patients. RESULTS: Of 777 cases, 31.9% were normal weight, 52.5% were overweight, and 15.6% were obese. A total of 160(20.6%) patients died in-hospital. There was a significant difference between the three groups for MAO (62.9% vs 72.1% vs 77.7%, respectively, P = 0.006). The incidence of postoperative complications did not differ among the three groups, except for postoperative bleeding, and prolonged mechanical ventilation, the proportion of which were higher in the overweight and obese groups. Besides, multivariable logistic regression analysis demonstrated that a higher risk of MAO in the overweight [odds ratios (ORs):1.475, 95%CI:1.006-2.162], and obese patients (ORs:2.147, 95%CI:1.219-3.782) with reference to the normal weight patients, and age, white blood cell, prior stroke and cardiopulmonary bypass time were also associated with in-hospital MAO (P<0.05). CONCLUSIONS: BMI is independently associated with higher in-hospital MAO in patients who underwent AAAD surgery.

Symptoms of post-traumatic stress disorder and associated risk factors in type A aortic dissection.

BACKGROUND: Surgery is the primary option of acute type A aortic dissection (AAAD) treatment. However, the unique traumatic stress of cardiovascular disease and surgery brings physical and psychological suffering to the patients and causes post-traumatic stress disorder (PTSD). The aim of this study was to investigate the rate of PTSD in AAAD patients after surgery and identify the risk factors of this complication. METHODS: A prospective cohort design was used. All patients who underwent AAAD surgery from September 2017 to June 2019 were included. Resilience, anxiety, and depression level were assessed before patients discharged from the hospital. Additionally, the PTSD symptoms were assessed three months after discharge from hospital. The data were analyzed by SPSS 24.0 (IBM, Armonk, NY, USA) and P<0.05 was considered as statistically significant. RESULTS: Two hundred and twenty-four patients were included in this study. The incidence of PTSD was 21.4%. Symptoms were highly prevalent with reexperience and increased alertness. "Primary or below" AAAD patients had a significantly higher score in "increased alertness" (P<0.05). Depressive symptoms (B=1.621, ß=0.398, P<0.001), female gender (B=-7.539, ß=-0.311, P<0.001) were the risk factors associated with PTSD, while optimism (B=-0.920, ß=-0.169, P=0.012) was the protective factor in AAAD patients. CONCLUSIONS: AAAD patients exhibited high prevalence of PTSD, which was highly prevalent with reexperience and increased alertness. Higher depressive level, female gender, and lower optimism were associated with higher risk of PTSD. The findings suggest that medical staff should assess the psychological health status of AAAD patients timely and identify high-risk patients early to improve the outcome.

Prognostic nutritional index predicts in-hospital mortality in patients with acute type A aortic dissection.

BACKGROUND: The prognostic nutritional index (PNI) has recently been reported to associate with the surgical prognosis of patients with some cardiovascular diseases. However, the prognosis significance of the preoperative PNI in patients with acute type A aortic dissection (AAAD) remains unclear. OBJECTIVES: The present study aimed to explore the relationship between PNI and postoperative in-hospital mortality in patients with AAAD. METHODS: Between June 2013 and December 2019, we retrospectively reviewed the clinical data of 651 patients undergoing AAAD surgery. Patients were divided into two groups according to the median PNI. The risk factors of postoperative in-hospital mortality were identified by univariate and multivariate logistic regression analysis. RESULTS: In-hospital mortality was significantly more common in the low group (24.8% vs 16.3%: P = .007). The percentage of prolonged mechanical ventilation (58.9% vs 49.8%: P = .020) and the median duration of intensive care unit stays (7.0 vs 6.0 days: P = .003) were also higher and longer in the low group. Multivariate logistic regression analysis showed that the PNI, age, hypertension, and operation time independently predicted in-hospital mortality. Besides, compared with patients with a history of hypertension, the low PNI affected in-hospital mortality more than those without (odds ratio [OR]: 2.07; 95% confidence interval [CI]: 1.20-3.56; P = .009). CONCLUSIONS: Lower PNI may be independently associated with in-hospital mortality of patients after AAAD surgery.

Atypical Sleep and Postoperative Delirium in the Cardiothoracic Surgical Intensive Care Unit: A Pilot Prospective Study.

PURPOSE: Postoperative delirium (POD) is a very common and serious neurological complication in patients admitted to the cardiothoracic surgical intensive care unit (CSICU). We aimed to identify a novel potential sleep-based marker for POD and investigate the relevance between atypical sleep and POD. PATIENTS AND METHODS: This was a prospective, observational study of patients admitted to the CSICU between December 2019 and February 2020 at our center. Sleep characteristics from 21:00 on postoperative day 1 to 07:00 on postoperative day 2 were assessed using polysomnography (PSG). POD from the end of PSG monitoring until postoperative day 5 was evaluated using the Confusion Assessment Method for the Intensive Care Unit. RESULTS: This analysis included 20 patients admitted to the CSICU. The incidence of atypical sleep was 45.0%. Compared to patients without delirium, those with delirium had less delta power, less percentage REM sleep, and a higher proportion of atypical sleep and REM sleep loss (P < 0.05). CONCLUSION: The presence of atypical sleep and the absence of REM sleep were associated with POD in patients admitted to the CSICU.

Effect of Oral Glucose Water Administration 1 Hour Preoperatively in Children with Cyanotic Congenital Heart Disease: A Randomized Controlled Trial.

BACKGROUND Guidelines recommend a clear liquid fasting time of 2 h before surgery, which is often exceeded, leading to adverse reactions (ARs) such as discomfort, thirst, and dehydration. We assessed the gastric contents and ARs after oral glucose water administration 1 h prior to surgery in children with cyanotic congenital heart disease (CCHD). MATERIAL AND METHODS This was a non-inferiority randomized controlled trial of children with CCHD enrolled at the Fujian Medical University Union Hospital from 09/2014 to 05/2017 and randomized to receive oral glucose water (10 g of glucose in 100 ml of warm water, 5 ml/kg) 2 h (2-h group, n=174) or 1 h (1-h group, n=170) before surgery. The primary endpoint was gastric volume. Secondary endpoints included pH of gastric content, preoperative blood glucose, and risk factors for aspiration pneumonia. Pre- and intraoperative ARs were recorded. RESULTS The 1-h group showed smaller gastric content volumes (0.34±0.35 (95% CI: 0.29-0.39) vs. 0.43±0.33 (95% CI: 0.38-0.48) ml/kg, t=2.55, P<0.05) and higher blood glucose (6.21±0.78 (95% CI: 6.09-6.33) vs. 5.59±1.11 (95% CI: 5.43-5.76) mmol/L, t=-5.91, P<0.001). The 95% confidence interval of the volume difference between the 2 groups was 0.017-0.163, the upper limit value was 0.163

Risk factors for postoperative delirium in patients with triple-branched stent graft implantation.

BACKGROUND: Neurological complications is a common complication following novel triple-branched stent graft implantation in patients with Stanford type A aortic dissection (AAD). But the incidence and risk factors of postoperative delirium (POD) are not completely clear. The aim of this study was to investigate the incidence and risk factors of POD after novel triple-branched stent graft implantation. METHODS: An observational study of AAD patients who underwent novel triple-branched stent graft implantation between January 2017 and July 2019 were followed up after surgery. Patients' delirium was screened by the Richmond Agitation-Sedation Scale and the Confusion Assessment Method for the intensive care unit from the first day after the operation, lasted 5 days. The risk factors of POD were analyzed by the Cox proportional hazard models. RESULTS: A total of 280 AAD patients were enrolled in this research, the incidence of POD was 37.86%. Adjusting for age, body mass index, and mechanical ventilation duration, multivariate Cox regression analysis model revealed that non-manual work (adjusted hazard ratio [AHR] = .554; 95% CI: 0.335-0.915; P = .021), Acute Physiology and Chronic Health Evaluation II (APACHE-II) scores > 20 (AHR = 3.359, 95% CI: 1.707-6.609, P < .001), hypoxemia (AHR = 1.846, 95% CI: 1.118-3.048, P = .017), and more than two types of analgesics and sedatives were independently associated with POD. CONCLUSIONS: This study showed that risk factors independently associated with POD were APACHE-II score > 20, hypoxemia, and more types of analgesics and sedatives, and non-manual work was the protective factor. TRIAL REGISTRATION: This study was retrospectively registered in the Chinese Clinical Trial Registry (Registration number: ChiCTR1900022408 ; Date: 2019/4/10).

Relationship of Platelet Counts and Inflammatory Markers to 30-Day Mortality Risk in Patients with Acute Type A Aortic Dissection.

Markers of prothrombotic state and inflammation are associated with the prognosis of patients with acute type A aortic dissection (AAAD). However, it is unclear that the relationship between these biomarkers and their combined impact on risk stratification. The present study evaluated the prognostic value of platelet counts, lymphocyte to neutrophil ratio (LNR), and lymphocyte to monocyte ratio (LMR), alone and in combination. A retrospective analysis of clinical data of 744 AAAD patients was conducted to identify whether these biomarkers were related to the 30-day mortality risk. A Kaplan-Meier analysis and log-rank test were used to compare survival between groups. A Cox hazard regression multivariable analysis was performed for 30-day mortality. Individual biomarker (platelet count, LNR, or LMR) was unable to predict 30-day mortality. However, combinations of all three biomarkers provided additive predictive value over either marker alone, the receiver operating characteristic (ROC) model had a prediction probability of 0.739 when platelet counts, LNR, and LMR were included. Cox hazard regression multivariable analysis showed that combinations of all three biomarkers were the strongest predictor of 30-day mortality (p < 0.021). Combined with these three easily measurable biomarkers at admission, they could help identify AAAD patients with a high risk of 30-day mortality.