Predictors of outcomes of patients ≥ 80 years old admitted to intensive care units in Poland - a post-hoc analysis of the VIP2 prospective observational study.

INTRODUCTION: Elderly patients pose a significant challenge to intensive care unit (ICU) clinicians. In this study we attempted to characterise the population of patients over 80 years old admitted to ICUs in Poland and identify associations between clinical features and short-term outcomes. MATERIAL AND METHODS: The study is a post-hoc analysis of the Polish cohort of the VIP2 European prospective observational study enrolling patients > 80 years old admitted to ICUs over a 6-month period. Data including clinical features, clinical frailty scale (CFS), geriatric scales, interventions within the ICU, and outcomes (30-day and ICU mortality and length of stay) were gathered. Univariate analyses comparing frail (CFS > 4) to non-frail patients and survivors to non-survivors were performed. Multivariable models with CFS, activities of daily living score (ADL), and the cognitive decline questionnaire IQCODE as predictors and ICU or 30-day mortality as outcomes were formed. RESULTS: A total of 371 patients from 27 ICUs were enrolled. Frail patients had significantly higher ICU (58% vs. 44.45%, P = 0.03) and 30-day (65.61% vs. 54.14%, P = 0.01) mortality compared to non-frail counterparts. The survivors had significantly lower SOFA score, CFS, ADL, and IQCODE than non-survivors. In multivariable analysis CFS (OR 1.15, 95% CI: 1.00-1.34) and SOFA score (OR 1.29, 95% CI: 1.19-1.41) were identified as significant predictors for ICU mortality; however, CFS was not a predictor for 30-day mortality ( P = 0.07). No statistical significance was found for ADL, IQCODE, polypharmacy, or comorbidities. CONCLUSIONS: We found a positive correlation between CFS and ICU mortality, which might point to the value of assessing the score for every patient admitted to the ICU. The older Polish ICU patients were characterised by higher mortality compared to the other European countries.

Treatment of Esophago-Airway Fistula after Esophageal Resection.

(1) Background: Esophago-airway fistula after esophageal resection is a rare, life-threatening complication associated with a high postoperative mortality rate. Managing this condition is challenging, and the prognosis for patients is uncertain. The results and our own approach to treatment are presented. (2) Material and Methods: We present a retrospective analysis of a group of 22 patients treated for an esophago-airway fistula between 2012 and 2022, with 21 cases after esophageal resection and one during the course of Hodgkin's disease. (3) Results: Twenty-two patients were treated for an esophago-airway fistula. Among them, a tracheobronchial fistula occurred in 21 (95.4%) patients during the postoperative period, while 1 (4.5%) was treated for Hodgkin's disease. Of these cases, 17 (70.7%) patients underwent esophageal diversion with various treatments, including intercostal flap in most cases, greater omentum in one (4.5%), latissimus dorsi muscle in two (9%), and greater pectoral muscle in one (4.5%). Esophageal stenting was performed in two patients (9.0%), and one (4.5%) was treated conservatively. Unfortunately, one patient (4.5%) died after being treated with bronchial stenting, and two (9.5%) experienced a recurrence of the fistula. (4) Conclusions: The occurrence of an esophago-airway fistula after esophagectomy is a rare but life-threatening complication with an uncertain prognosis that results in several serious perioperative sequelae.

Tension pneumothorax as a severe complication of endobronchial ultrasound-guided transbronchial fine needle aspiration of mediastinal lymph nodes.

This article presents a case report of a patient suffering from bullous emphysema and chronic obstructive pulmonary disease, who was diagnosed with tension pneumothorax after undergoing endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA). Tension pneumothorax is a severe but rare complication of EBUS-TBNA. It can result from lung injury caused by the biopsy needle or, in patients suffering from bullous emphysema, from spontaneous rupture of an emphysematous bulla resulting from increased pressure in the chest cavity during cough caused by bronchofiberoscope insertion. The authors emphasize that patients should be carefully monitored after the biopsy, and, in the case of complications, provided with treatment immediately in proper hospital conditions. Patients burdened with a high risk of complications should be identified before the procedure and monitored with extreme care after its completion.

Beta-thromboglobulin as a marker of perioperative myocardial infarction in patients undergoing coronary artery bypass grafting following aspirin discontinuation.

Perioperative myocardial infarction (PMI) following coronary artery bypass grafting (CABG) is associated with significant morbidity and mortality. The aim of this study was to assess platelet activation and oxidative stress in the setting of PMI in patients undergoing CABG. We studied 108 consecutive patients who stopped taking low-dose aspirin 7-10 days prior to elective isolated on- or off-pump CABG. ß-thromboglobulin (ß-TG), thromboxane B2 (TXB2) and 8-iso-prostaglandin F2α (8-iso-PGF2α), a marker of oxidative stress, were measured at the baseline and 5-7 days postoperatively. Aspirin (150 mg/d) was administered every morning since 12 hours after CABG. Mean baseline ß-TG was 58.5 ± 10.3 IU/ml, TXB2 was 143.6 ± 28.5 ng/ml and 8-iso-PGF2α was 355.2 ± 40.7 pg/ml. Postoperatively, after administration of 4-6 doses of aspirin, ß-TG increased by 16.7% and 8-iso-PGF2α increased by 17.2% 5-7 days after surgery (p = 0.005 and p < 0.001, respectively). TXB2 decreased by 99.7% to 410.3 ± 52.1 pg/ml (p < 0.001). Nine patients (8.3%) developed PMI. Baseline ß-TG and TXB2, together with postoperative ß-TG and 8-iso-PGF2α were higher in PMI patients than in the remaining subjects (all, p < 0.05). Multivariate analysis showed that baseline ß-TG (OR: 1.28; 95% CI: 1.05-1.57, p = 0.015) was the only independent predictor of PMI. In conclusion, we demonstrated that increased platelet activation and thromboxane production, observed in patients not taking aspirin till the day of CABG, contribute to the occurrence of PMI in early postoperative period.

Factors influencing the occurence of nosocomial bloodstream infections observed in thoracic and cardiosurgical postoperative care units.

BACKGROUND: The aim of this study was to analyse the epidemiology and aetiology of laboratoryconfirmed bloodstream infections (LC-BSI) and central line-associated bloodstream infections (CLABSI) after pulmonary and coronary surgery, in postoperative intensive care units in 2009. METHODS: Sources of infections were identified by the hospital Infection Control Team in cooperation with ITU personnel using the CDC definitions. RESULTS: A total of 37 LC-BSI and 21 CLA-BSI cases in 3.096 patients were detected. Central line device utilization ratio was 0.50. The total cumulative LC-BSI incidence rate was 1.2% and CLA-BSI rate 8.7 per 1,000 central line days. The most common causes of LC-BSI were Gram-positive cocci (Staphylococcus aureus - 5.9%, CNS - 50.0%, Enterococcus faecium - 5.9%). CONCLUSIONS: We found that in those units in which surveillance of CLA-BSI had been conducted since 2002, BSI incidence rates were higher than those reported in the NHSN programme.

[Surgical revascularization in patients with acute coronary syndromes: early outcome]. / Chirurgiczna rewaskularyzacja serca u chorych z ostrymi zespolami wiencowymi: wyniki wczesne.

OBJECTIVE: Between January 1 2001 and June 30 2002, 2204 CABG procedures were performed in our institution. 110 patients underwent urgency CABG within six hours of ACS. We analyzed their short-term results. METHODS: 55 patients underwent CABG for UAP, 31 for STEMI and 24 for NSTEMI. In the control group, 55 patients underwent elective revascularization. Preoperative, intraoperative, and postoperative data were analyzed. RESULTS: Hospital mortality was 12.9%, 8.3%, 7.3% and 1.9% for groups with STEMI, NSTEMI, UAP and stable angina, respectively. Independent predictors of early mortality, in order of decreasing importance, were: preoperative extracardiac arteriopathy (p = 0.0002), cardiac arrest befor CABG (p = 0.0003), preoperative shock (p = 0.003), STEMI (p = 0.03) and LVEF < 40% (p = 0.03). CONCLUSIONS: CABG procedures should be a standard part of ACS treatment. Patients with UAP and NSTEMI can be safely operated during the early course of ACS. CABG can be performed with acceptable early-term risk in patients with STEMI and hemodynamic instability.

[Fibrinolysis activation after cardiac surgery--role of thromboelastography in the diagnosis and treatment]. / Aktywacja fibrynolizy po zabiegach kardiochirurgicznych--rola tromboelastografii w diagnostyce i leczeniu.

Use of cardiopulmonary bypass in cardiac surgery strongly influences haemostatic system, activating fibrinolysis as well. The widespread use of antiplatelet and fibrinolytic drugs creates haemostatic disturbances in the perioperative period. Thromboelastography seems to be a useful tool in the assessment of this complex process, particularly in the early postoperative period.