scholarly journals Neurological dysfunction after cardiac surgery and cardiac intensive care admission: A narrative review part 2: Cognitive dysfunction after critical illness; potential contributors in surgery and intensive care; pathogenesis; and therapies to prevent/treat perioperative neurological dysfunction

2020 ◽  
Vol 23 (4) ◽  
pp. 391
Author(s):  
MukulC Kapoor
Keyword(s):  
Cardiac Surgery ◽  
Intensive Care ◽  
Critical Illness ◽  
Cognitive Dysfunction ◽  
Narrative Review ◽  
Neurological Dysfunction ◽  
Intensive Care Admission ◽  
Cardiac Intensive Care

scholarly journals P.054 The use of robotic technology to define post-operative neurological dysfunction in patients undergoing coronary bypass surgery: a feasibility study

2016 ◽  
Vol 43 (S2) ◽  
pp. S33-S34
Author(s):  
AL Venters ◽  
T Saha ◽  
A Hamilton ◽  
D Petsikas ◽  
S Scott ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Cognitive Dysfunction ◽  
Bypass Surgery ◽  
Near Infrared ◽  
Artery Bypass ◽  
Quantitative Description ◽  
Coronary Bypass ◽  
Neurological Dysfunction ◽  
Prior History ◽  
Operative Assessment

Background: Cognitive dysfunction following coronary artery bypass surgery is a regular occurrence, but its cause is still unknown. In order to devise strategies to mitigate this acquired disability, a precise and quantitative description of the post-operative neurocognitive phenotype is necessary. This study is designed to assess the feasibility of using the KINARM robot to quantify the changes in the neurological function after cardaic surgery. Methods: Patients without prior history of cognitive dysfunction were recruited from the pre-operative cardiac surgery clinic, and underwent pre-operative assessment with the KINARM. The KINARM provides a quantitative assessment of the neurocognitive control of the upper limbs. During bypass surgery, brain tissue oxygen levels were measured with near-infrared spectroscopy. Patients were reassessed with the KINARM post-operatively at 3 months. Results: To date, 12 participants have been recruited (mean age = 65 years, all male). On straightforward tasks, such as visually guided reaching, the majority of patients scored within the normal range, both pre- and post-operatively. In more complex tasks, required visuospatial and executive functioning, post-operative deficits were more pronounced. Conclusions: It is feasible to use the KINARM robot to provide a quantitative measurement of the neurocognitive phenotype of patients after cardiac surgery.

Postoperative Delirium is Associated with Postoperative Cognitive Dysfunction at One Week after Cardiac Surgery with Cardiopulmonary Bypass

2009 ◽  
Vol 105 (3) ◽  
pp. 921-932 ◽  
Author(s):  
Judith A. Hudetz ◽  
Alison J. Byrne ◽  
Kathleen M. Patterson ◽  
Paul S. Pagel ◽  
David C. Warltier
Keyword(s):  
Cardiac Surgery ◽  
Intensive Care ◽  
Cognitive Impairment ◽  
Cardiopulmonary Bypass ◽  
Cognitive Dysfunction ◽  
Postoperative Delirium ◽  
Postoperative Cognitive Dysfunction ◽  
Surgical Patients ◽  
Nonverbal Memory ◽  
Surgery Group

Postoperative delirium with cognitive impairment frequently occurs after cardiac surgery. It was hypothesized that delirium is associated with residual postoperative cognitive dysfunction in patients after surgery using cardiopulmonary bypass. Male cardiac surgical patients ( M age = 66 yr., SD = 8; M education = 13 yr., SD = 2) and nonsurgical controls ( M age = 62, SD = 7; M education = 12, SD = 2) 55 years of age or older were balanced on age and education. Delirium was assessed by the Intensive Care Delirium Screening Checklist preoperatively and for up to 5 days postoperatively. Recent verbal and nonverbal memory and executive functions were assessed (as scores on particular tests) before and 1 wk. after surgery. In 56 patients studied ( n = 28 Surgery; n=28 Nonsurgery), nine patients from the Surgery group developed delirium. In the Surgery group, the proportion of patients having postoperative cognitive dysfunction was significantly greater in those who experienced delirium (89%) compared with those who did not (37%). The odds of developing this dysfunction in patients with delirium were 14 times greater than those who did not. Postoperative delirium is associated with scores for residual postoperative cognitive dysfunction 1 wk. after cardiac surgery.

The Impact of Dedicated Cardiac Intensive Care Units on Outcomes in Pediatric Cardiac Surgery: A Virtual Pediatric Systems Database Analysis

2020 ◽  
Author(s):  
Dayanand N. Bagdure ◽  
Jason W. Custer ◽  
Cortney B. Foster ◽  
William C. Blackwelder ◽  
Vladimir Mishcherkin ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Intensive Care ◽  
Mortality Rate ◽  
Intensive Care Units ◽  
Risk Category ◽  
Database Analysis ◽  
Cardiac Intensive Care ◽  
Outcomes For Children ◽  
The Impact ◽  
Risk Categories

AbstractCare of children undergoing cardiac surgery occurs in dedicated cardiac intensive care units (CICU) or mixed intensive care units. We analyzed data from Virtual Pediatric Systems (VPS, LLC) database (2009–2014) for children < 18 years of age undergoing cardiac surgery, classified according to Society of Thoracic Surgery–European Association of Cardiothoracic Surgery (STS-EACTS) risk category. We had 25,052 (52%) patients in 53 mixed units (mortality rate, 2.99%), and 22,762 (48%) patients in 19 dedicated CICUs (mortality rate, 2.62%). There was a direct relationship between STS-EACTS risk category and death rate in both units. By multivariable logistic and linear regression, there was no difference in mortality between mixed unit and CICU death rates within STS-EACTS risk categories. We found no difference in outcomes for children undergoing cardiac surgery based on the unit type (dedicated CICU or mixed unit).

Free and total catecholamines in critical illness

1988 ◽  
Vol 254 (3) ◽  
pp. E287-E291 ◽  
Author(s):  
P. D. Woolf ◽  
R. W. Hamill ◽  
L. A. Lee ◽  
J. V. McDonald
Keyword(s):  
Intensive Care Unit ◽  
Traumatic Brain Injury ◽  
Intensive Care ◽  
Brain Injury ◽  
Critical Illness ◽  
Glasgow Coma Score ◽  
Neurological Dysfunction ◽  
Surgical Patients ◽  
Range Of Values ◽  
Catecholamine Concentration

The magnitude of circulating free and total (free plus conjugated) catecholamine responses to a strong and sustained stimulus was investigated in four groups of patients: traumatic brain injury (n = 24), vascular brain injury (n = 10), polysystem trauma (n = 7) and medical/surgical patients in an intensive care unit (n = 29). Despite significant three- to sevenfold elevations in both free and total norepinephrine (NE) and epinephrine (E), the ratio of free to total NE and E remained constant over a very broad range of values. The proportion of free E was twice normal (30.1-33.5 vs. 16.2%) in all but patients with polytrauma, whereas the percentage of free NE was unchanged in all patients (43.0%). All dopamine (DA) parameters remained generally normal. In the patients with traumatic or vascular brain injury, significant inverse correlations were present between the degree of neurological dysfunction, as indicated by the concomitant Glasgow coma score, and free NE, E, and DA and total NE and DA levels. Thus, during conditions of intense and prolonged catecholamine release, the proportion of free catecholamine remains constant and the total as well as free catecholamine concentration is proportional to the Glasgow coma score.

Abstract NS5: Implementing NICE (Neurological Intensive Care Evaluation) in the CVICU to Identify Neurological Dysfunction More Rapidly in Post-Operative Cardiac Surgery Patients

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Taylor Esdale ◽  
Grace Davis ◽  
Brooke Harvey ◽  
Heather Lachiewicz ◽  
Jennifer Brecher ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Intensive Care ◽  
Assessment Tool ◽  
Artery Bypass ◽  
Standard Of Care ◽  
Ease Of Use ◽  
Neurological Dysfunction ◽  
Fiscal Year ◽  
Neurological Intensive Care ◽  
Care Evaluation

Background: Piedmont Atlanta Hospital identified cardiothoracic surgical (CTS) outcome metrics that were not meeting benchmarks established by the Society for Thoracic Surgeons (STS). Post-operative permanent stroke occurred in 1.303% (8 out of 616 cases) of coronary artery bypass-only patients at Piedmont Atlanta Hospital (PAH) during Fiscal Year 2015. The STS benchmark for all hospitals is 1.3%. Initially, the goal was to reduce the number of post-operative strokes to the standard of care but while reviewing this data, it was noted that there was significant delay in discovering the occurrence of stroke in this patient population. Traditional neurological assessments and stroke scales are difficult to apply to post-operative open heart patients due to intubation, variation in anesthesia recovery times, and the effects of pain management medications. To improve patient outcomes, PAH researched alternatives to standard post-operative neurological assessments to rapidly identify strokes and potential interventional candidates, ultimately reducing the frequency of disabling stroke. Method: A CTS Stroke Pathway was created that included the Neurologic Intensive Care Evaluation (NICE), a novel assessment tool performed by the critical care nurse. NICE was chosen because of the ease of use on post-anesthesia patients. Neurological state was assessed based on the ability to complete one-step commands up to six hours post-op. Results: Prior to NICE being implemented, stroke symptoms were discovered on average 40 hours from last known time well (LKTW). After NICE being implemented, Code Strokes (notification of neurological dysfunction) were initiated on average four hours from patients LKTW. In the first month of utilizing the NICE tool, one of three post-operative stroke patients was able to be transferred to a comprehensive stroke center for a mechanical thrombectomy. Conclusion: Implementing NICE as the standard neurological assessment for immediate post-operative cardiac surgery patients significantly reduced the time to identify neurological changes indicating a stroke. This may lead to more rapid treatment or intervention, reducing the post-operative rate of permanent stroke.

The Effect of Dexamethasone on Symptoms of Posttraumatic Stress Disorder and Depression After Cardiac Surgery and Intensive Care Admission

2016 ◽  
Vol 60 (6) ◽  
pp. 227
Author(s):  
Lotte Kok ◽  
Manon H. Hillegers ◽  
Dieuwke S. Veldhuijzen ◽  
Sandra Cornelisse ◽  
Arno P. Nierich ◽  
...  
Keyword(s):  
Posttraumatic Stress Disorder ◽  
Cardiac Surgery ◽  
Intensive Care ◽  
Posttraumatic Stress ◽  
Stress Disorder ◽  
Intensive Care Admission

scholarly journals A score to estimate 30-day mortality after intensive care admission after cardiac surgery

2017 ◽  
Vol 153 (5) ◽  
pp. 1118-1125.e4 ◽  
Author(s):  
Yoan Lamarche ◽  
Mahsa Elmi-Sarabi ◽  
Lillian Ding ◽  
James G. Abel ◽  
Demetrios Sirounis ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Intensive Care ◽  
Intensive Care Admission
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