ABSTRACT
In cardiac surgery patients with pre-extubation PaO2/inspired oxygen fraction (FiO2) < 200 mmHg, the possible benefits and optimal level of high-flow nasal cannula (HFNC) support are still unclear; therefore, we compared HFNC support with an initial gas flow of 60 or 40 L/min and conventional oxygen therapy. Ninety nine patients were randomly allocated (respective ratio: 1:1:1) to I = intervention group 1 (HFNC initial flow = 60 L/min, FiO2 = 0.6), intervention group 2 (HFNC initial flow = 40 L/min, FiO2 = 0.6), or control group (Venturi mask, FiO2 = 0.6). The primary outcome was occurrence of treatment failure. The baseline characteristics were similar. The hazard for treatment failure was lower in intervention group 1 vs. control (hazard ratio (HR): 0.11, 95% CI: 0.03-0.34) and intervention group 2 vs. control (HR: 0.30, 95% CI: 0.12-0.77). During follow-up, the probability of peripheral oxygen saturation (SpO2) > 92% and respiratory rate within 12-20 breaths/min was 2.4-3.9 times higher in intervention group 1 vs. the other 2 groups. There was no difference in PaO2/FiO2, patient comfort, intensive care unit or hospital stay, or clinical course complications or adverse events. In hypoxemic cardiac surgery patients, postextubation HFNC with an initial gas flow of 60 or 40 L/min resulted in less frequent treatment failure vs. conventional therapy. The results in terms of SpO2/respiratory rate targets favored an initial HFNC flow of 60 L/min.
ABSTRACT
BACKGROUND: Life-long anticoagulant therapy is mandatory for patients who undergo heart valve replacement with implantation of a mechanical prosthesis. The aim of this study was to investigate the effects of a nurse-led patient educational program concerning oral anticoagulant therapy intake after heart valve replacement surgery on patients' knowledge of important parameters of anticoagulant administration. METHODS: In this single-center study, 200 patients who underwent surgical implantation of a mechanical prosthesis were divided into 2 groups. The control group received the basic education concerning oral anticoagulants, while the intervention group received a personalized educational program. RESULTS: Personalized education was correlated with a better regulation of therapeutic international normalized ratio (INR) levels and adequate knowledge among patients. Therapeutic levels of INR were achieved in 45% of the patients during the first month, 71% in the third month, and 89% in the sixth month after discharge in the intervention group, compared to 25%, 47%, and 76% in the control group, respectively. Patients' satisfaction with the information was higher in the intervention group than in the control group. The percentage of satisfaction reached 80% for the intervention group versus 37% for the patients of the control group. CONCLUSION: The implementation of the nurse-led educational programs was associated with improved clinical results and increased adherence to oral anticoagulant treatment.
ABSTRACT
INTRODUCTION: The impact of cardiac myxomas on the immune response is still indefinite, although laboratory tests and histological findings suggest that there is a correlation between myxomas and inflammatory reaction. OBJECTIVES: Our study speculates that cardiac myxomas are associated with inflammatory response and investigates potential elements of inflammation in the histopathological examination and biomarkers from laboratory tests. METHODS: It is a retrospective study and data were collected from a single center between May 2010 to May 2018. Autopsies and laboratory tests of 54 cases were analyzed. RESULTS: In 20,4% of the autopsies, inflammatory elements were identified. The neutrophil/lymphocyte ratio (NLR) preoperatively is elevated in patients suffering from cardiac myxoma while its value is correlated to the tumor size. CONCLUSIONS: Cardiac myxoma is an entity that affects the immune response of patients. The biomarker NLR could be utilized as a prognostic factor regarding enlarged cardiac myxomas. Future studies still need to be conducted in order to confirm the usefulness of this biomarker on cardiac myxomas.
ABSTRACT
OBJECTIVES: To investigate the effects of postoperative intensive glycemic control on patient outcomes. BACKGROUND: Ineffective perioperative glycemic control has been associated with high mortality and morbidity rates among cardiac surgery patients. METHODS: 212 cardiac surgery patients were allocated by a quasi-experimental design to: a) a control group (n = 107) with targeted blood glucose levels 161-200 mg/dl or b) a therapy group (n = 105) with blood glucose target 120-160 mg/dl. We compared the two groups on their mortality, length of stay, duration of intubation, incidence of severe hypoglycemia and frequency of postoperative infections. RESULTS: The mean postoperative blood glucose levels were significantly lower for the therapy group compared with the control group (153.9 mg/dl vs. 173.9 md/dl, p < 0.001). The intensive glycemic control was strongly associated with decreased in-hospital mortality (7 deaths/105 patients for the control group vs. 1 death/105 patients for the therapy group; p = 0.033). We did not identify any statistically significant associations regarding the other patient outcomes. CONCLUSIONS: This randomized quasi-experimental trial found lower in-hospital mortality with more intense blood glucose control. Effective postoperative glycemic control did not affect the other studied patient outcomes.
