Pericardial effusion after pediatric cardiac surgery: A single-center study.

BACKGROUND: Postoperative pericardial effusion (pPE) still remains a frequent complication after congenital heart surgery and it usually leads to an increased morbidity and re-hospitalization rate. There are only few published papers about pPE clinical course or large randomized studies that analyze its prevalence or preoperative risk factors. In this regard, we report a single-center 10-years retrospective analysis of prevalence, outcomes and risk factors of postoperative pericardial effusion after congenital heart surgery. METHODS: A retrospective analysis was carried out on 624 patients who underwent congenital heart surgery from January 2010 to December 2019. Study population was divided in two groups basing of the presence of pPE during the first 30 days after the surgery and their perioperative data were compared. Univariate and multivariate analysis were used to find possible risk factors for pPE developing. RESULTS: Ninety-four patients were enrolled in pPE group and 530 in ¬ pPE group. Pericardial effusion was assessed as "mild" in 57 patients (60,6%), as "moderate" in 25 (26,6%), and as "severe" in 12 patients (12,8%). Total correction of Tetralogy of Fallot/Pulmonary atresia seems to be associated with a higher prevalence of pPE in the "Infant" subgroup, while atrial septal defect showed to be a risk factor among "Toddler". In addition, pPE was proved to be much more frequent in Fontan patients in all studied subgroups. Univariate and multivariate analysis revealed that total drain amount, Fontan procedure, postoperative Warfarin therapy, Redo-operations and surgical correction of Tetralogy of Fallot/Pulmonary atresia seem to be risk factors for pPE. Postoperative pericardial effusion was diagnosed between the 4th and the 28th postoperative day but in 88,3% of the cases (83/94) it occurred before the 14th day after the operation. In 58 patients, pPE was clinically silent. CONCLUSIONS: Postoperative pericardial effusion was detected in 88.3% of cases within the first 14 days after the operation. About 69% of these patients were asymptomatic therefore it suggests that routinely echocardiogram after intensive care unit discharge could be a useful tool to screen clinically silent pPE at an early stage, especially in high-risk or unstable patients.

Delirium in ICU patients following cardiac surgery: An observational study.

AIMS AND OBJECTIVES: To observe the clinical and structural factors that can be associated with the post-operative onset of delirium in patients who have undergone heart surgery. BACKGROUND: Several risk factors could contribute to the development of delirium, such as the use of some sedative drugs and a patient's history with certain types of acute chronic disease. However, in the literature, there is little knowledge about the association between delirium in patients who have undergone cardiac surgical intervention and their clinical and environmental predictors. DESIGN: We used an observational design. METHODS: We enrolled 89 hospitalised patients in the ICU. Patients were first evaluated using the Richmond Agitation Sedation Scale and subsequently using the Confusion Assessment Method for the ICU. A linear model of regression was used to identify the predictors of delirium in patients. RESULTS: The patients had an average age of 89 years (SD = 6.9), were predominantly male (84.3%) and were mostly married (79.8%). The majority of patients had been subjected to bypass (80.9%), while 19.1% had undergone the intervention of endoprosthesis. The logistic regression model showed that patient age, the duration of mechanically assisted ventilation, continuous exposure to artificial light and the presence of sleep disorders were predictors of the onset of delirium. CONCLUSION: This study further confirms that clinical aspects such as insomnia and one's circadian rhythm as well as structural elements such as exposure to artificial light are variables that should be monitored in order to prevent and treat the onset of severe post-operative delirium. RELEVANCE TO CLINICAL PRACTICE: Identifying the possible factors that predispose a patient to the onset of delirium during intensive therapy following cardiac surgery, it is fundamental to implement interventions to prevent this syndrome.