ABSTRACT
OBJECTIVES: Patients after cardiac surgery with cardiopulmonary bypass (CPB) require a stay in the ICU postoperatively. This study aimed to investigate the incidence of prolonged length of stay (LOS) in the ICU after cardiac surgery with CPB and identify associated risk factors. METHODS: The current investigation was an observational, retrospective study that included 395 ICU patients who underwent cardiac surgery with CPB at a tertiary hospital in Guangzhou from June 2015 to June 2017. Data were obtained from the hospital database. Binary logistic regression modeling was used to analyze risk factors for prolonged ICU LOS. RESULTS: Of 395 patients, 137 (34.7%) had a prolonged ICU LOS (>72.0 h), and the median ICU LOS was 50.9 h. Several variables were found associated with prolonged ICU LOS: duration of CPB, prolonged mechanical ventilation and non-invasive assisted ventilation use, PaO2/FiO2 ratios within 6 h after surgery, type of surgery, red blood cell infusion during surgery, postoperative atrial arrhythmia, postoperative ventricular arrhythmia (all P < 0.05). CONCLUSIONS: These findings are clinically relevant for identifying patients with an estimated prolonged ICU LOS, enabling clinicians to facilitate earlier intervention to reduce the risk and prevent resulting delayed recovery.
ABSTRACT
BACKGROUND: Independent decision-making is one of the basic rights of patients. However, in clinical practice, most older cancer patients' treatment decisions are made by family members. OBJECTIVE: This study attempted to analyze the treatment decision-making process and formation mechanism for older cancer patients within the special cultural context of Chinese medical practice. METHOD: A qualitative study was conducted. With the sample saturation principle, data collected by in-depth interviews with 17 family members and 12 patients were subjected to thematic analysis. ETHICAL CONSIDERATIONS: The study was approved by the ethics committees of Sun Yat-sen University. All participants provided verbal informed consent after being told their rights of confidentiality, anonymity, and voluntary participation. They had the right to refuse to answer questions and could withdraw at any time. RESULTS: Three themes emerged: (1) complex process; (2) transformation of family decision-making power; and (3) individual compromise. Family members inevitably had different opinions during the long process of treatment decision-making for older cancer patients. The direction of this process could be regarded as an extension of the family power relationship. The patient usually compromised the decision to survive, which was made by family members. CONCLUSION: This study describes the treatment decision-making process of older cancer patients in the context of Chinese culture. The reasons underlying this process are related to the views on life and death and family values. An individual is a part of the family, which is often seen as the minimal interpersonal unit in Chinese society. It is significant that while emphasizing patient autonomy in the decision-making process, health professionals should also pay attention to the important roles of culture and family.
Subject(s)
Decision Making , Neoplasms , Aged , Family , Humans , Informed Consent , Neoplasms/therapy , Qualitative ResearchABSTRACT
BACKGROUND: Postoperative hyperglycaemia has been shown to have adverse effects on patients after coronary artery bypass grafting surgery (CABG). However, whether glucose variability has an effect on patients' outcomes is still uncertain. The aim of this study is to explore the effects of glucose variability on short-term outcomes in non-diabetic patients undergoing coronary artery bypass grafting. METHODS: This is a retrospective observational study utilising data collected after patients had left the hospital. This study was performed on 137 non-diabetic patients undergoing coronary artery bypass grafting from January 2011 to June 2013. Blood glucose at 72hours post operation was obtained and glucose variability was measured by mean postoperative blood glucose and mean of daily difference (MODD). Short-term outcomes included duration of intensive care unit (ICU) stay, mechanical ventilation time, length of hospital stay, and occurrence of arrhythmia. Patients with mean postoperative blood glucose ≥7.00mmol/L were defined as hyperglycaemic, and patients with MODD ≥1.40mmol/L were considered to be abnormal. Outcome variables were compared between patients in euglycaemic and hyperglycaemic groups, and between patients in normal and abnormal groups. RESULTS: In our study, patients with hyperglycaemia spent more time staying in ICU (p<0.01), and patients with large glucose variability (abnormal MODD) had higher incidences of arrhythmia (23% vs 4.2%, p<0.05). Regression analysis showed that MODD can affect occurrence of arrhythmia (p=0.004) and that mean postoperative blood glucose levels can affect duration of ICU stay (p<0.001). CONCLUSIONS: Patients' postoperative glucose variability after CABG is an important predictor of the negative outcomes regarding duration of ICU stay and occurrence of arrhythmia. Large glucose variability can have negative effects on short-term outcomes in patients.
