ISSN 1305-5550 | e-ISSN 2548-0669
Journal of Cardio-Vascular-Thoracic Anaesthesia and Intensive Care Society - GKD Anest Yoğ Bak Dern Derg: 29 (2)
Volume: 29  Issue: 2 - 2023
1.Full Issue

Page I (111 accesses)

2.Perioperative Transesophageal Echocardiography in Heart Transplantation
Büşra Tezcan, Eda Macit Aydın
doi: 10.14744/GKDAD.2023.26214  Pages 57 - 67 (159 accesses)
In recent years, perioperative transesophageal echocardiography has become well estab-lished and widely used in several heart surgical operations. Heart transplantation, which is the treatment of choice for patients with end-stage heart failure, may benefit from transe-sophageal echocardiography. It can be adopted for assessing donor organs in addition to the perioperative monitoring of heart transplant patients. In this review, the perioperative use of transesophageal echocardiography is discussed in heart transplantation.

3.Use of Endotracheal Tubes with Subglottic Drainage Reduces Ventilator-associated Pneumonia in Chronic Obstructive Pulmonary Disease Patients After Coronary Surgery
İpek Yakın Düzyol, Nurgül Yurtseven, Çağrı Düzyol, Abbas Köse
doi: 10.14744/GKDAD.2023.03360  Pages 68 - 73 (133 accesses)
Objectives: We investigated the effects of endotracheal tubes with subglottic drainage (SGAETT) on the incidence of ventilator-associated pneumonia (VAP) in patients with chronic obstructive pulmonary disease (COPD) undergoing coronary artery bypass grafting (CABG).
Methods: The patients were assigned to one of two groups. Group 1 patients used a SGAETT (n=94); Group 2 controls received standard endotracheal tubes (n=100). The demographic data, number of coronary bypasses performed, and cross clamp (CC) and cardiopulmonary bypass (CPB) durations were recorded. Endotracheal aspiration samples were obtained from patients with suspected VAP in the intensive care unit (ICU). Intubation time, length of ICU and hospital stays, erythrocyte transfusion volume, enteral nutrition needs, transportation needs, and reintubation and sedation needs were recorded.
Results: The VAP rate was 6.8% in Group 1 and 19% in Group 2 (p<0.05). Group 1 patients had lower body weight, smoking, and transportation needs; Group 1 patients also had shorter ICU and hospital stays but demonstrated a greater average body surface area, higher mean pulmonary arterial pressure, more-frequent peptic ulcers, higher mean pulmonary arterial pressure, and Group 1 patients were more likely to have ejection fractions (EFs) less than 40% (p<0.05). A logistic regression analyses found SGAETT independently reduced VAP independently (OR: 0.037) (p<0.05).
Conclusion: SGAETT reduces the incidence of VAP in patients with COPD undergoing cardiac surgery.

4.Effect of Emotional Status on Early Morbidity after Coronary Artery Bypass Graft Surgery
Alper Can, Günseli Abay
doi: 10.14744/GKDAD.2023.83723  Pages 74 - 79 (121 accesses)
Objectives: We investigated whether anxiety and/or depression increased the risk of morbidity in the early postoperative period following coronary artery bypass graft surgery (CABG). Additionally, we evaluated the effects of emotional state on recovery.
Methods: We studied 81 patients undergoing CABG. Their emotional status was measured using the Hospital Anxiety and Depression Scale (HADS), Hamilton Anxiety Rating Scale, and Hamilton Depression Rating Scale on the day before surgery and on day 5 after surgery. Then, we compared the rate of postoperative cardiac, respiratory, neurological, and renal complications between the patients with mild to moderate anxiety and/or depression symptoms with those who showed no emotional distress.
Results: Prior to surgery, 18 patients showed mild to moderate anxiety and/or depression symptoms (emotional disorder group1), while the remainder (group 2, n=63) showed no emotional disorder. There was no significant difference between the preoperative and postoperative periods in both groups for all anxiety and depression test scales except for the HADS anxiety subgroup, where the results in both groups were significantly lower postoperatively than preoperatively. In the group with preoperative emotional distress, the incidence of postoperative atelectasis and pneumonia was higher than in the group with no preoperative emotional distress. Furthermore, the duration of mechanical ventilation, stay in the intensive care unit stay, and overall hospital stay was significantly longer in the emotional disorder group.
Conclusion: Emotional distress is an important risk factor that increases morbidity and delays the recovery period by increasing respiratory complications in the early postoperative period following CABG.

5.Effect of Preoperative and Postoperative Erector Spinae Plane Block on Perioperative Hemodynamics and Postoperative Analgesia in Video-assisted Thoracoscopic Surgery: A Randomized Controlled Study
Emine Nilgün Zengin, Hilal Sazak, Sumru Şekerci, Musa Zengin, Hülya Yiğit, Ali Alagöz
doi: 10.14744/GKDAD.2023.70298  Pages 80 - 87 (158 accesses)
Objectives: To compare the hemodynamic and analgesic effects of pre-/postoperative erector spinae plane block (ESPB) application in patients undergoing video-assisted thoracoscopic surgery (VATS).
Methods: This was a prospective, randomized multicenter study. Patients were assigned to preoperative ESPB (Group-Pre; n=32) or postoperative ESPB (Group-Post; n=33) groups. Ultrasound-guided block applications were performed under general anesthesia with single-needle insertion. Pain scores were assessed by visual analog scale (VAS). Demographic characteristics and surgical procedure data of the patients were recorded. In addition, perioperative mean arterial pressure (MAP), peripheral oxygen saturation (SpO2), heart rate (HR), and bispectral index (BIS) values were recorded. MAP, SpO2, HR, VAS scores (while resting/coughing), additional analgesic use, morphine consumption, and side effects were recorded 24 hours postoperatively.
Results: The groups were statistically similar in terms of MAP, HR, and SpO2 in the intraoperative and postoperative periods. VAS resting and coughing values were statistically significantly higher at the 1st, 2nd, 4th, and 12th hours in Group-Post compared with Group-Pre (p<0.05). There was no statistically significant difference between the groups in terms of 24-hour VAS at rest (p=0.258) or VAS at cough (p=0.189). The amount of remifentanil requirement, morphine consumption, and additional analgesic use in Group-Post was statistically significantly higher than in Group-Pre (p<0.05).
Conclusion: ESPB applied in the preoperative period is more effective in suppressing the surgical response in VATS, as it limits intraoperative opioid consumption and provides more effective analgesia in the postoperative period.

6.Comparison of Ultrasonography Guidance Versus Direct Palpation Technique for Central Venous Catheterization in Children Undergoing Cardiac Surgery
Esra Aktiz Bıçak, Deniz Elmastaş, Fikret Salık, Yiğit Kılıç, Cem Kıvılcım Kaçar, Mustafa Bıçak
doi: 10.14744/GKDAD.2023.84755  Pages 88 - 94 (131 accesses)
Objectives: We aimed to compare the success rates, procedure times, and complication rates of the Landmark technique with ultrasonography-guided (USG) central venous catheterization (CVC) in children undergoing cardiac surgery.
Methods: This study included 52 patients divided into two equal groups: the CVC with Landmark technique group (Group-1) and the USG CVC group (Group-2). Demographic and clinical characteristics of the patients, internal jugular vein (IJV) diameters, and central venous pressures were measured. Each needle penetration of the skin, defined as one “attempt,” was recorded. The success rate, number of first-attempt successful cannulations, number of cannulas used, successful cannulation time, and all observed complications were recorded.
Results: The groups had similar age, weight, height, sex, and diagnosis. There were no differences in IJV diameter, IJV intervention history, and basal central venous pressure between the groups. The successful cannulation time was short, and the number of attempts was low in Group-2. The number of successful cannulations and first-attempt success rate were high in Group-2. The number of cannulas was lower in Group-2 than in Group-1. Failed cannulations occurred in no patients in Group-2 and in seven patients in Group-1. The failed cannulations in five of the patients in Group-1 were subsequently successfully achieved with USG. The complication rates were high in Group-1.
Conclusion: USG CVC catheterization increased the number of successful cannulations and chance of first-attempt success on the, shortened the procedure time, and reduced the incidence rate of complications.

7.Systemic Inflammatory Response Syndrome in Pediatric Patients Undergoing Cardiac Surgery
Feride Karacaer, Ebru Biricik
doi: 10.14744/GKDAD.2023.10438  Pages 95 - 101 (128 accesses)
Objectives: Cardiac surgery with cardiopulmonary bypass is a primary activator of the systemic inflammatory response syndrome (SIRS). To assess the association of SIRS with intraoperative variables and early postoperative outcomes, we compared SIRS incidence after cardiac surgery between cyanotic and acyanotic children.
Methods: Using binary logistic regression models, we evaluated the incidence of SIRS between cyanotic and acyanotic children and the effect of intraoperative variables on SIRS occurrence and the effects of SIRS on postoperative complications.
Results: A total of 175 children (69 cyanotic, 106 acyanotic) were included. Based on Mantel–Haenszel–Cochran analysis, considering the Risk Adjusted Classification for Congenital Heart Surgery score, the SIRS rate was higher at operation end in cyanotic children (p<0.001; 95% confidence interval: 1.94–10.61). An association was detected between SIRS incidence and consumption of red blood cells intraoperatively and fresh frozen plasma postoperatively. Lactate levels were higher in cyanotic than in acyanotic children at the end of the operation and at the postoperative 6th and 24th hours (p=0.008, 0.007, and 0.016, respectively). Lactate levels were higher in cyanotic children diagnosed with SIRS than in acyanotic children without SIRS at the end of the operation and the 6th postoperative hour (p=0.024 and 0.011, respectively). Vasoactive inotropic scores were higher in children with SIRS in the 6th and 24th postoperative hours (p=0.018 and 0.029, respectively).
Conclusion: The incidence of SIRS is higher in children with complex cyanotic heart disease. Perioperative consumption of blood products increases SIRS occurrence.

8.Evaluation of Surgical Procedures with Technological Limitations for Diagnosis and Staging of Lung Cancers
Fatoş Kozanlı, Ahmet Karslıgil
doi: 10.14744/GKDAD.2023.25593  Pages 102 - 107 (100 accesses)
Objectives: Early diagnosis of lung cancer increases survival. However, advanced technological capabilities for diagnosis and staging may not be available in every hospital. This study evaluated the use of surgical procedures with technological limitations to provide relevant information to similar institutions worldwide.
Methods: Sixty patients, 49 males (84.2%) and 11 females (15.8%), who underwent diagnostic and curative surgery for lung cancer between January 2011 and January 2021were enrolled and analyzed retrospectively. Diagnostic surgery and curative surgery were performed in 23 (38.3%) and 37 (61.7%) patients, respectively. Age, sex, smoking, diagnostic methods, tumor cell type, staging, radiological localization of the lesion, treatment received, and survival were recorded.
Results: The predicted survival for patients >65 years old was 35 (range: 22.6–49.2) months, significantly lower than the 69.4 (range: 51.5–87.4) months for patients ≤65 years (p>0.05). Predicted survival was significantly lower for diagnostic surgery than for curative surgery group (19.5 vs. 76.4 months; p<0.05) and for small-cell lung cancer (n=5, 8.3%) than for non-small-cell lung cancer (9.9, range: 5.6–14.3 months vs. 60, range: 46.6–73.4 months; p<0.05). SCLC was significantly associated with mortality (p<0.05) but did not differ among patients with adenocarcinoma or squamous cell or sarcomatoid carcinoma.
Conclusion: Early diagnosis found to significantly improve survival. The most appropriate treatment was radical resection with early diagnosis, which can increase survival in treatable patients with early-stage lung cancer in any center with a thoracic surgeon.

9.Risk Factors for Pressure Ulcers in the Intensive Care Unit in the Cardiac Center
Bedih Balkan, Gülferen Turan Gevrek, Zahide Özlem Ulubay, Mustafa Can Kaplan, Ali Osman Balkan
doi: 10.14744/GKDAD.2023.49360  Pages 108 - 116 (162 accesses)
Objectives: Pressure ulcers (PUs) can negatively affect quality of life, prolong hospital stays, and increase the costs of health care. In this study, we evaluate the risk factors for the development of PUs in patients admitted to the cardiac intensive care units (ICUs) in our hospital.
Methods: We studied 229 patients who developed PUs in the ICUs between January 1, 2020, and August 30, 2021. We obtained patient data retrospectively from physician and nurse follow-up records. We recorded patient demographic and clinical characteristics, scores from Braden Scale for Predicting Pressure Sore Risk and from the Glasgow Coma Scale (GCS), percentage of ejection fraction (EF), body mass index (BMI), operation type, indication for hospitalization, and laboratory examinations during the stages of PU formation and on which day they occurred during ICU follow-up.
Results: Patient BMI, age, and gender did not significantly differ between the groups with and without PUs (p>0.05). However, the percentage of EF and GCS values were significantly lower (p<0.05), whereas glucose, urea, creatinine, C-reactive protein (CRP) values, and mortality rate were significantly higher (p<0.05) in the PU group.
Conclusion: We found that the rates of PU formation and transition from Stage I to Stage II significantly increased in patients with low EF and high CRP, urea, creatinine, and glucose levels.

10.The Relationship between Acinetobacter Pneumonia Rale Scores and Mortality
Onur Bayrakçı
doi: 10.14744/GKDAD.2023.59932  Pages 117 - 122 (95 accesses)
Objectives: Acinetobacter baumannii is an opportunistic pathogen that is frequently detected in intensive care unit (ICU) patients. It is a cause of ventilator-associated pneumonia (VAP). The severity of lung involvement can be determined using Radiographic Assessment of Lung Edema (RALE) scores, which are determined based on data from chest X-rays. This study aimed to investigate the relationship between the RALE scores of patients with Acinetobacter VAP and mortality.
Methods: The study was conducted in ICUs between 2020 and 2021. All ICU inpatients older than 18 years with a diagnosis of Acinetobacter baumannii pneumonia were included in the study. Patients infected with other bacteria or viruses, those with immunodeficiency, and those younger than 18 years of age were excluded from the study. Chi-square tests were used for all statistical analyses.
Results: The cohort had a mean age of 68.1 years and 56% were males. The incidence of comorbidities was 85%. Treatment was empirical antibiotics in 42% of patients and antibiotics specific to the causative agent in 58%. RALE scores were 25–36 in 50%, 37–48 in 32%, and 13–24 in 18% of the patients. The mortality rate was 65%.
Conclusion: RALE scores in the 13–24 range were correlated with persistent pneumonia using combined antibiotics. RALE scores in the 25–36 and 37–48 ranges were correlated with mortality.

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