Quality of life and functional capacity in patients after cardiac surgery intensive care unit

Coronary heart disease and aortic stenosis are prevalent cardiovascular diseases worldwide,leading to morbidity and mortality.Coronary artery bypass grafting(CABG)and surgical aortic valve replacement(SAVR)have therapeutic benefits,including improved postoperative quality of life(QoL)and enhanced patient functional capacity which are key indicators of cardiac surgery outcome.In this article,we review the latest studies of QoL outcomes and functional capacity in patients who underwent cardiac surgery.Many standardized instruments are used to evaluate QoL and functional conditions.Preoperative health status,age,length of intensive care unit stay,operative risk,type of procedure,and other pre-,intra-,and postoperative factors affect postoperative QoL.Elderly patients experience impaired physical status soon after cardiac surgery,but it improves in the following period.CABG and SAVR are associated with increases of physical and mental health and functional capacity in the immediate postoperative and the long long-term.Cardiac rehabilitation improves patient functional capacity,QoL,and frailty following cardiac surgery.

Sonographic muscle mass assessment in patients after cardiac surgery

BACKGROUND Patients undergoing cardiac surgery particularly those with comorbidities and frailty,experience frequently higher rates of post-operative morbidity,mortality and prolonged hospital length of stay.Muscle mass wasting seems to play important role in prolonged mechanical ventilation(MV)and consequently in intensive care unit(ICU)and hospital stay.AIM To investigate the clinical value of skeletal muscle mass assessed by ultrasound early after cardiac surgery in terms of duration of MV and ICU length of stay.METHODS In this observational study,we enrolled consecutively all patients,following their admission in the Cardiac Surgery ICU within 24 h of cardiac surgery.Bedside ultrasound scans,for the assessment of quadriceps muscle thickness,were performed at baseline and every 48 h for seven days or until ICU discharge.Muscle strength was also evaluated in parallel,using the Medical Research Council(MRC)scale.RESULTS Of the total 221 patients enrolled,ultrasound scans and muscle strength assessment were finally performed in 165 patients(patients excluded if ICU stay<24 h).The muscle thickness of rectus femoris(RF),was slightly decreased by 2.2%[(95%confidence interval(CI):-0.21 to 0.15),n=9;P=0.729]and the combined muscle thickness of the vastus intermedius(VI)and RF decreased by 3.5%[(95%CI:-0.4 to 0.22),n=9;P=0.530].Patients whose combined VI and RF muscle thickness was below the recorded median values(2.5 cm)on day 1(n=80),stayed longer in the ICU(47±74 h vs 28±45 h,P=0.02)and remained mechanically ventilated more(17±9 h vs 14±9 h,P=0.05).Moreover,patients with MRC score≤48 on day 3(n=7),required prolonged MV support compared to patients with MRC score≥49(n=33),(44±14 h vs 19±9 h,P=0.006)and had a longer duration of extracorporeal circulation was(159±91 min vs 112±71 min,P=0.025).CONCLUSION Skeletal quadriceps muscle thickness assessed by ultrasound shows a trend to a decrease in patients after cardiac surgery post-ICU admission and is associated with prolonged duration of MV and ICU length of stay.

Incidence and peri-operative risk factors for development of acute kidney injury in patients after cardiac surgery:A prospective observational study

BACKGROUND Patients admitted to intensive care unit(ICU) after cardiac surgery develop acute kidney injury(AKI) immediately post-operation. We hypothesized that AKI occurs mainly due to perioperative risk factors and may affect outcome.AIM To assess peri-operative risk factors for AKI post cardiac surgery and its relationship with clinical outcome.METHODS This was an observational single center, tertiary care setting study, which enrolled 206 consecutive patients, admitted to ICU after cardiac surgery. Patients were followed-up until ICU discharge or death, in order to determine the incidence of AKI, perioperative risk factors for AKI and its association with outcome.Univariate and multivariate logistic regression analysis was performed to assess predictor variables for AKI development.RESULTS After ICU admission, 55 patients(26.7%) developed AKI within 48 h. From the logistic regression analysis performed, high EuroScore Ⅱ(OR: 1.18;95%CI: 1.06-1.31, P = 0.003), white blood cells(WBC) pre-operatively(OR: 1.0;95%CI: 1.0-1.0, P = 0.002) and history of chronic kidney disease(OR: 2.82;95%CI: 1.195-6.65, P = 0.018) emerged as independent predictors of AKI among univariate predictors. AKI that developed AKI had longer duration of mechanical ventilation [1113(777–2195) vs 714(511–1020) min, P = 0.0001] and ICU length of stay [70(28–129) vs 26(21–51) h, P = 0.0001], higher rate of ICU-acquired weakness(16.4% vs 5.3%, P =0.015), reintubation(10.9% vs 1.3%, P = 0.005), dialysis(7% vs 0%, P = 0.005), delirium(36.4% vs 23.8%, P = 0.001) and mortality(3.6% vs 0.7%, P = 0.046).CONCLUSION Patients present frequently with AKI after cardiac surgery. EuroScore Ⅱ, WBC count and chronic kidney disease are independent predictors of AKI development. The occurrence of AKI is associated with poor outcome.

Interval exercise training improves tissue oxygenation in patients with chronic heart failure

Aim: Aim of our study was to evaluate the effects of interval exercise training (IT) programs, regarding whole body oxygen uptake and peripheral tissue oxygenation, in Chronic Heart Failure (CHF) patients during recovery. Methods: Twenty-six CHF patients (21 males/5 females), mean age of 49 ± 12 years, participated in the study. Fifteen patients were assigned to IT and 11 patients were assigned to IT followed by strength training. All patients were trained for 40 minutes per session, 3 times per week, for 12 weeks. They performed a symptom-limited cardiopulmonary exercise testing (CPET), before and after the completion of the program. Muscle tissue oxygen saturation (StO2) of quadriceps femoris was continuously measured by Near Infrared Spectroscopy (NIRS) during CPET and during the recovery period after the end of exercise. Results: No differences were noted between the two patient groups regarding whole body and peripheral tissue oxygenation indices and, therefore, data from all patients were pooled. After training, an increase in peak oxygen uptake (17 ± 4.5 to 19 ± 5.5 ml/kg/min, p < 0.05), gas exchange threshold (11 ± 3.5 to 12.5 ± 3.5 ml/kg/min, p < 0.05), peak work rate achieved (105 ± 29 to 124 ± 37 Watt, p < 0.05) and the first degree slope of VO2 at the first minute of recovery (0.45 ± 0.2 to 0.61 ±0.3 L/min2, p ) was noted. In addition, tissue re-oxygenation time constant was decreased (65 ± 25 to 52 ± 28 sec, p < 0.001). Conclusion: In conclusion, interval exercise training accelerates oxygen uptake and peripheral tissue oxygenation during recovery from exercise in CHF patients.

Interval exercise training improves tissue oxygenation in patients with chronic heart failure

Aim: Aim of our study was to evaluate the effects of interval exercise training (IT) programs, regarding whole body oxygen uptake and peripheral tissue oxygenation, in Chronic Heart Failure (CHF) patients during recovery. Methods: Twenty-six CHF patients (21 males/5 females), mean age of 49 ± 12 years, participated in the study. Fifteen patients were assigned to IT and 11 patients were assigned to IT followed by strength training. All patients were trained for 40 minutes per session, 3 times per week, for 12 weeks. They performed a symptom-limited cardiopulmonary exercise testing (CPET), before and after the completion of the program. Muscle tissue oxygen saturation (StO2) of quadriceps femoris was continuously measured by Near Infrared Spectroscopy (NIRS) during CPET and during the recovery period after the end of exercise. Results: No differences were noted between the two patient groups regarding whole body and peripheral tissue oxygenation indices and, therefore, data from all patients were pooled. After training, an increase in peak oxygen uptake (17 ± 4.5 to 19 ± 5.5 ml/kg/min, p 2 at the first minute of recovery (0.45 ± 0.2 to 0.61 ±0.3 L/min2, p ), was noted. In addition, tissue re-oxygenation time constant was decreased (65 ± 25 to 52 ± 28 sec,