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Incidence, risk factors and clinical outcome of multidrug-resistant organisms after heart transplantation

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World Journal of Transplantation 2024年第2期14卷 107-118页

作者： Sophia Hatzianastasiou Paraskevas Vlachos Georgios Stravopodis Dimitrios Elaiopoulos Afentra Koukousli Josef Papaparaskevas Themistoklis Chamogeorgakis Kyrillos Papadopoulos Theodora Soulele Despoina Chilidou Kyriaki Kolovou Aggeliki Gkouziouta Michail Bonios Stamatios Adamopoulos Stavros Dimopoulos Microbiology Department and Infection Control Office Onassis Cardiac Surgery CenterAthens 17674Greece Heart Transplantation Unit Onassis Cardiac Surgery CenterAthens 17674Greece cardiac surgery Intensive Care Unit Onassis Cardiac Surgery CenterAthens 17674Greece

BACKGROUND Transplant recipients commonly harbor multidrug-resistant organisms(MDROs),as a result of frequent hospital admissions and increased exposure to antimi-crobials and invasive *** To investigate the impact of patient demographic and clinical characteristics on MDRO acquisition,as well as the impact of MDRO acquisition on intensive care unit(icu)and hospital length of stay,and on icu mortality and 1-year mortality post heart *** This retrospective cohort study analyzed 98 consecutive heart transplant patients over a ten-year period(2013-2022)in a single transplantation *** was collected regarding MDROs commonly encountered in critical *** Among the 98 transplanted patients(70%male),about a third(32%)acquired or already harbored MDROs upon transplantation(MDRO group),while two thirds did not(MDRO-free group).The prevalent MDROs were Acinetobacter baumannii(14%),Pseudomonas aeruginosa(12%)and Klebsiella pneumoniae(11%).Compared to MDRO-free patients,the MDRO group was characterized by higher body mass index(P=0.002),higher rates of renal failure(P=0.017),primary graft dysfunction(10%vs 4.5%,P=0.001),surgical re-exploration(34%vs 14%,P=0.017),mechanical circulatory support(47%vs 26%P=0.037)and renal replacement therapy(28%vs 9%,P=0.014),as well as longer extracorporeal circulation time(median 210 vs 161 min,P=0.003).The median length of stay was longer in the MDRO group,namely icu stay was 16 vs 9 d in the MDRO-free group(P=0.001),and hospital stay was 38 vs 28 d(P=0.006),while 1-year mortality was higher(28%vs 7.6%,log-rank-χ2:7.34).CONCLUSION Following heart transplantation,a predominance of Gram-negative MDROs was *** acquisition was associated with higher complication rates,prolonged icu and total hospital stay,and higher post-transplantation mortality.

关键词： Heart transplantation Multi drug resistant organisms Transplantation complications Transplantation outcome

Effects of combined aerobic,resistance and inspiratory training in patients with pulmonary hypertension:A systematic review

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World Journal of Critical Care Medicine 2024年第2期13卷 168-179页

作者： Christos Kourek Antonia Zachariou Eleftherios Karatzanos Michalis Antonopoulos Theodora Soulele Andreas Karabinis Serafim Nanas Stavros Dimopoulos Department of Clinical Ergospirometry Exercise and Rehabilitation Laboratory1^(st)Department of Critical Care MedicineEvangelismos HospitalNational and Kapodistrian University of AthensAthens 10676Greece Department of Cardiology 417 Army Share Fund Hospital of AthensAthens 11521Greece cardiac surgery icu Onassis Cardiac Surgery centerAthens 17674AtticaGreece cardiac surgery icu Onassis Cardiac Surgery CenterAthens 17674Greece cardiac surgery Intensive Care Unit Onassis Cardiac Surgery CenterAthens 17674Greece Department of Clinical Ergospirometry Exercise and Rehabilitation LaboratoryNational and Kapodistrian University of AthensAthens 10676Greece

BACKGROUND Pulmonary hypertension(PH)is a serious progressive disorder of the modern world,characterized by endothelial dysfunction and impaired *** with PH usually present exercise intolerance from the very early stages and reduced exercise *** training has been shown to have beneficial effects in patients with cardiovascular ***,data regarding the effects of combined exercise training programs in patients with PH still remains *** To investigate the effects of combined exercise training programs on exercise capacity and quality of life in patients with *** Our search included all available randomized controlled trials(RCTs)regarding combined aerobic,resistance and inspiratory training programs in patients with PH in 4 databases(Pubmed,PEDro,Embase,CINAHL)from 2012 to *** RCTs were included in the final *** capacity,assessed by peak VO_(2)or 6-min walking test(6MWT),as well as quality of life,assessed by the SF-36 questionnaire,were set as the primary outcomes in our *** Peak VO_(2)was measured in 4 out of the 5 RCTs while 6MWT was measured in all *** indices of functional capacity were significantly increased in patients with PH who underwent combined exercise training compared to the controls in all of the included RCTs(P<0.05).Quality of life was measured in 4 out of 5 *** patients improved their quality of life in each group,however,only 2 RCTs demonstrated further improvement in patients performing combined training compared to *** By this systematic review,we have demonstrated that combined aerobic,resistance and inspiratory exercise training is safe and has beneficial effects on aerobic capacity and quality of life in patients with *** exercise training regimen may be part of the therapeutic strategy of the syndrome.

关键词： Pulmonary hypertension Exercise training Peak VO2 Functional capacity Quality of life

Increasing role of post-intensive care syndrome in quality of life of intensive care unit survivors

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World Journal of Critical Care Medicine 2024年第2期13卷 7-10页

作者： Irini Patsaki Stavros Dimopoulos Department of Physiotherapy University of West AttikaAthens 12243Greece cardiac surgery Intensive Care Unit Onassis Cardiac Surgery CentreAthens 17674Greece

In this editorial we comment on the detrimental consequences that post-intensive care syndrome(PICS)has in the quality of life of intensive care unit(icu)survivors,highlighting the importance of early onset of multidisciplinary rehabilitation from within the ***,the syndrome was identified and well described early in 2012,more awareness has been raised on the long-term PICS related health problems by the increased number of coronavirus disease 2019 icu *** is well outlined that the syndrome affects both the patient and the family and is described as the appearance or worsening of impairment in physical,cognitive,or mental health as consequence of critical *** was described in order:(1)To raise awareness among clinicians,researchers,even the society;(2)to highlight the need for a multilevel screening of these patients that starts from within the icu and continues after discharge;(3)to present preventive strategies;and(4)to offer guidelines in terms of *** early multidisci-plinary approach is the key element form minimizing the incidence of PICS and its consequences in health related quality of life of both survivors and their families.

关键词： Intensive care unit acquired weakness Physical impairment Quality of life Mental Cognitive function

Implications of Elevated Serum Cortisol in the Onset of Postoperative Delirium Following Off-Pump Coronary Artery Bypass Grafting: Insights from a Bangladesh-Based Single Center Experience

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World Journal of Cardiovascular Diseases 2024年第4期14卷 252-267页

作者： Vivek Kumar Jha Md Abir Tazim Chowdhury Munama Magdum Manoj Tiwari Md Abul Bashar Maruf Md Saiful Islam Khan Priyanka Sinha Rajesh Naryan Kapar Md. Rezwanul Hoque Department of Cardiothoracic and Vascular surgery BP Koirala Institute of Health Sciences Dharan Nepal Department of Cardiothoracic and Vascular surgery Evercare Hospital Dhaka Dhaka Bangladesh Department of Preventive and Social Medicine National Institute of Preventive and Social Medicine Dhaka Bangladesh Department of Thoracic surgery BP Koirala Memorial Cancer Hospital Bharatpur Nepal Department of cardiac surgery United Hospital Limited Dhaka Bangladesh Department of Cardiothoracic Anesthesia Evercare Hospital Dhaka Dhaka Bangladesh Department of Microbiology Kathmandu Medical College Kathmandu Nepal Department of Nephrology Bangabandhu Sheikh Mujib Medical University Dhaka Bangladesh Department of cardiac surgery Bangabandhu Sheikh Mujib Medical University Dhaka Bangladesh

Background: Following coronary artery bypass grafting (CABG), delirium emerges as a prevalent complication. This study aimed to assess the correlation between elevated serum cortisol levels and the occurrence of postoperative delirium subsequent to off-pump CABG. Methods: Conducted in the Department of cardiac surgery at BSMMU from October 2020 to September 2022, this comparative cross-sectional study included a total of 44 participants. Subjects, meeting specific criteria, were purposefully assigned to two groups based on off-pump CABG. Group A (n = 22) consisted of patients with normal serum cortisol levels, while Group B (n = 22) comprised individuals with high serum cortisol levels on the first postoperative day. Delirium onset was assessed at the bedside in the icu on the 1st, 2nd, 3rd, 4th, and 5th postoperative days using standard tools, namely the Richmond Agitation Sedation score (RASS) and The Confusion Assessment Method (CAM-icu). Data were collected based on the presence or absence of delirium. Statistical analysis utilized SPSS version 26.0, employing an independent Student’s t-test for continuous data and chi-square and Fischer’s exact test for categorical data. A p-value ≤ 0.05 was considered statistically significant. Results: Group-A had a mean age of 54.50 ± 17.97, and Group-B had a mean age of 55.22 ± 15.45, both with a male predominance (81.81% and 86.36% respectively). The mean serum cortisol level was significantly higher in Group B (829.71 ± vs. 389.98 ± 68.77). Postoperative delirium occurred in 27.3% of Group B patients, statistically significant compared to the 4.5% in Group A. However, patients in Group B who developed delirium experienced significantly longer postoperative icu and hospital stays (79.29 ± 12.27 vs. 11.44 ± 2.85, p ≤ 0.05). There was one mortality in Group B, which was statistically not significant. Conclusion: This study observed a significant association between elevated serum cortisol levels in the postoperative period a

关键词： Coronary Artery Bypass Grafting (CABG) Serum Cortisol Postoperative Delirium Bangladesh

cardiac rehabilitation after cardiac surgery:An important underutilized treatment strategy

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World Journal of Cardiology 2024年第2期16卷 67-72页

作者： Christos Kourek Stavros Dimopoulos Medical School of Athens National and Kapodistrian University of AthensAthens 15772Greece cardiac surgery Intensive Care Unit Onassis Cardiac Surgery CenterAthens 17674Greece Clinical Ergospirometry Exercise&Rehabilitation Laboratory1st Critical Care Medicine DepartmentEvangelismos HospitalNational and Kapodistrian University of AthensAthens 10676Greece

Physical inactivity remains in high levels after cardiac surgery,reaching up to 50%.Patients present a significant loss of functional capacity,with prominent muscle weakness after cardiac surgery due to anesthesia,surgical incision,duration of cardiopulmonary bypass,and mechanical ventilation that affects their quality of *** complications,along with pulmonary complications after surgery,lead to extended intensive care unit(icu)and hospital length of stay and significant mortality *** the well-known beneficial effects of cardiac rehabilitation,this treatment strategy still remains broadly underutilized in patients after cardiac *** and icu early mobilization have been both showed to be valid methods to improve exercise tolerance and muscle *** mobilization should be adjusted to each patient’s functional capacity with progressive exercise training,from passive mobilization to more active range of motion and resistance *** exercise testing remains the gold standard for exercise capacity assessment and optimal prescription of aerobic exercise *** the last decade,recent advances in healthcare technology have changed cardiac rehabilitation perspectives,leading to the future of cardiac *** incorporating artificial intelligence,simulation,telemedicine and virtual cardiac rehabilitation,cardiac surgery patients may improve adherence and compliance,targeting to reduced hospital readmissions and decreased healthcare costs.

关键词： cardiac rehabilitation cardiac surgery Cardiopulmonary exercise testing Early mobilization Treatment Technology

Effect of programmed comprehensive nursing on delirium incidence in intensive care unit children following severe cardiac surgery

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World Journal of Psychiatry 2024年第9期14卷 1301-1307页

作者： Qiu-Yue Wang Xiang Wang Ming-Xiong Li Department of Cardiothoracic surgery Children’s Hospital of Nanjing Medical UniversityNanjing 210000Jiangsu ProvinceChina

BACKGROUND Programmed comprehensive nursing was adopted for intensive care unit(icu)children following severe cardiac surgery to improve respiratory function and delirium *** To explore how programmed comprehensive nursing impacts respiratory func-tion and delirium incidence in icu children post cardiac *** Between January 2022 and January 2024,180 pediatric patients from the Chil-dren’s Hospital of Nanjing were admitted to the icu after cardiac surgery and randomly *** control group comprised 90 patients and received routine nursing *** observation group comprised 90 patients and received program-med comprehensive *** groups received continuous nursing care until *** respiratory function,incidence of delirium,and clinical outcomes were *** memory state and sleep quality of both groups were *** The incidence of delirium was 5.56%in the observation group when admitted to icu,which was lower than that in the control group(20.00%;Picu compared with the control ***,the observation group showed higher sleep depth,sleep latency,night awakening,return to sleep,and sleep quality com-pared with the control group(Picu patients following severe cardiac surgery can reduce the impact on respiratory function,improve sleep quality,and alleviate postoperative delirium,showing significant promise for clinical application.

关键词： Programmed comprehensive nursing Intensive care unit cardiac surgery Respiratory function Delirium

Sonographic muscle mass assessment in patients after cardiac surgery

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World Journal of Cardiology 2020年第7期12卷 351-361页

作者： Stavros Dimopoulos Vasiliki Raidou Dimitrios Elaiopoulos Foteini Chatzivasiloglou Despoina Markantonaki Efterpi Lyberopoulou Ioannis Vasileiadis Katerina Marathias Serafeim Nanas Andreas Karabinis Department of cardiac surgery icu Onassis Cardiac Surgery CenterAthens 17674Greece Clinical Ergospirometry Exercise and Rehabilitation LaboratoryNational and Kapodistrian University of AthensAthens 10676Greece

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 *** mass wasting seems to play important role in prolonged mechanical ventilation(MV)and consequently in intensive care unit(icu)and hospital *** 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 *** In this observational study,we enrolled consecutively all patients,following their admission in the cardiac surgery icu within 24 h of cardiac *** ultrasound scans,for the assessment of quadriceps muscle thickness,were performed at baseline and every 48 h for seven days or until icu *** strength was also evaluated in parallel,using the Medical Research Council(MRC)*** Of the total 221 patients enrolled,ultrasound scans and muscle strength assessment were finally performed in 165 patients(patients excluded if icu stayicu(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 prolong

关键词： Intensive care unit-acquired weakness cardiac surgery Skeletal muscle wasting Muscle ultrasound Quadriceps femoris Muscle mass

Risk factor analysis of perioperative mortality after ruptured bleeding in hepatocellular carcinoma

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World Journal of Gastroenterology 2014年第40期20卷 14921-14926页

作者： Hao-Ming Lin Li-Ming Lei Jie Zhu Guo-Lin Li Jun Min Department of Hepatobiliary surgery Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University icu of cardiac surgery Guangdong General Hospital Department of Emergency surgery Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University

AIM: To discuss strategies and prognosis for the emergency treatment of ruptured bleeding in primary hepatocellular carcinoma.

关键词： Hepatocellular carcinoma Spontaneous rupture Liver resection

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早期康复护理在心脏搭桥术后的应用效果

中国城乡企业卫生 2024年第1期39卷 201-203页

作者：胡楠楠天津市胸科医院icu 天津300202

目的分析早期康复护理在心脏搭桥术后的应用效果,为提高临床护理水平提供参考借鉴。方法选取2021年8月—2022年8月在天津市胸科医院接受治疗的86例行心脏搭桥术患者作为研究对象,按照随机数字表法分为观察组和对照组,每组各43例。对照... 详细信息

目的分析早期康复护理在心脏搭桥术后的应用效果,为提高临床护理水平提供参考借鉴。方法选取2021年8月—2022年8月在天津市胸科医院接受治疗的86例行心脏搭桥术患者作为研究对象,按照随机数字表法分为观察组和对照组,每组各43例。对照组行常规护理,即按照医嘱开展各项基础护理工作;观察组行早期康复护理,包括观察患者病情变化,重视细节护理,进行早期功能锻炼等。比较两组的生活质量评分及术后恢复情况。结果观察组躯体功能(95.68±5.79)分、肌体疼痛(93.46±5.46)分、情绪功能(94.24±4.35)分和社会功能(92.24±6.79)分,均明显高于对照组的(82.11±6.35)分、(86.35±5.71)分、(84.13±5.32)分和(85.57±7.13)分,差异均有统计学意义(P<0.05)。观察组的6MWT明显长于对照组,住院时间、排气时间和下床时间均明显短于对照组,差异均有统计学意义(P<0.05)。结论给予心脏搭桥术患者早期康复护理能够缩短疾病恢复时间,提升生活质量,值得临床推广应用。

关键词：早期康复护理心脏搭桥术住院时间