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Background: Cardiac rehabilitation is recommended for patients undergoing open‐heart surgery (OHS). During the hospital admission, these patients suffer from reduced cardiopulmonary performance and decreased psychological health, leading to poor physical function, depression, and morbidity. To prevent post‐operative pulmonary complications, a pre and post‐operative physical therapy intervention is recommended for patients undergoing heart surgery. Virtual reality (VR) promotes the health status of healthy individuals and those with health conditions. However, few studies have reported the beneficial effects of VR exercise programs on the pulmonary performance and mental health status of patients undergoing OHS. Objectives: To determine whether by using training enhanced by VR, patients who have undergone OHS can more effectively attain cardiopulmonary performance and improve depression than through conventional physical therapy. Method: 60 participants were randomly assigned to a conventional physical therapy and VR exercise program. Each session was conducted once daily until discharge from the hospital. Cardiorespiratory performance and depression were evaluated before surgery and at the time of discharge from the hospital. A two‐way mixed ANOVA was performed to compare within (i.e., pre and post‐operation) and between (i.e., VR and conventional physical therapy) groups. Results: No significant cardiopulmonary performance gains were detected in patients receiving the VR exercise program when compared with those who participated in conventional physical therapy prior to post‐operative OHS (p > 0.05). However, the conventional physical therapy group showed significantly higher depression scores than the VR group (∆4.00 ± 0.98 vs. ∆1.68 ± 0.92). However, cardiopulmonary performance did not differ in both VR exercise and conventional physical therapy. [ABSTRACT FROM AUTHOR]

Objective: Surgical site infections (SSIs) are a major source of morbidity after cardiac surgery, involving prolonged hospitalisation. Among the numerous techniques of skin closure and dressings available, the optimal method remains undetermined. The DERMABOND-PRINEO (PRINEO) (PRINEO, Ethicon, J&J) is the only skin closure system which combines a topical skin adhesive with a mesh. Other surgical disciplines have highlighted remarkable results with PRINEO. The aim of this study was to evaluate the effects of PRINEO, used as the final layer in sternotomy closure, in the incidence of postoperative SSIs. Method: This was a retrospective single-centre cohort study including adult patients who underwent cardiac surgery between January 2015 and December 2018. Patients who had undergone heart transplantation or ventricular assist surgery were excluded. Included patients were divided into two groups depending on the type of post-operative wound care technique used. Group 1 consisted of patients who had their sternotomy closed with a standard dressing and group 2 consisted of patients who were treated with PRINEO. The primary endpoint of our study was the occurrence of SSIs and secondary outcomes were the length of hospitalisation and mortality. Results: A total of 1603 patients were reviewed with the occurrence of 44 SSIs. Both groups were homogeneous in terms of risk factors. The incidence of SSIs was significantly lower in group 2 (PRINEO) than in group 1 (standard dressing) (n=29, 3.8% vs n=15, 1.8%, respectively; p=0.042). However, there was no significant difference in the duration of hospitalisation and mortality. Conclusion: In our practice, PRINEO has proven to be a safe wound closure system after sternotomy, with a reduced SSI rate compared to conventional wound care techniques. [ABSTRACT FROM AUTHOR]

Mobilisation is recommended following cardiac surgery, but much less is known about its effects on physiological parameters. This study aimed to determine the effect of mobilisation on cardiorespiratory physiological parameters, and to establish the relationship between physiological parameters and physical function following cardiac surgery. Participants requiring physiotherapy following cardiac surgery were recruited. Mobilisation involved ground-based walking, while physical function was assessed using the short physical performance battery (SPPB) test. During both procedures, physiological measures of heart rate (HR), respiratory rate (RR) and percutaneous oxygen saturation (SpO2) were periodically recorded. Participant perception of breathlessness and perceived exertion were recorded pre and post mobilisation and the SPPB test. Forty-five participants (mean [SD] age 69[7] years) completed the study. HR (mean difference 10[95% CI 8 to 12] bpm) and RR (13[10 to 17] br/min) significantly increased following mobilisation, while SpO2 significantly decreased (baseline median [IQR] 95% [95%–97%] vs nadir 94% [91% to 96%], p < 0.002). There was a significant increase in dyspnoea and perceived exertion (both p < 0.001). There was a moderate relationship between total SPPB score and SpO2 during mobilisation (rs=0.45). Mobilisation following cardiac surgery increases exertion and dyspnoea and alters physiological parameters. Greater physical function is linked to maintaining a higher oxygen saturation during mobilisation. [ABSTRACT FROM AUTHOR]

Objective: to identify the necessary health guidelines, so that the patient in the postoperative period of cardiac surgery can perform self-care behaviors after hospital discharge. Method: integrative review, following the steps proposed by Whittemore, limited to the Portuguese, English and Spanish languages, and publication between 2007 and 2018. The databases used were available on the virtual libraries PubMed and Virtual Health Library and the Ursi instrument for data extraction. The articles were classified according to the level of evidence. Results: six articles were included. The findings allowed creating nine categories that group the health guidelines for self-care performance after hospital discharge from cardiac surgery. Conclusion: activities of daily living, diet, physical activity and exercise, psychological symptoms, control of risk factors, complications, drug therapy, management of symptoms and skin were health guidelines identified for the performance of self-care after hospital discharge of patients undergoing cardiac surgery. [ABSTRACT FROM AUTHOR]

Aim: To examine the intensive care unit experiences and anxiety of patients following their referral to the clinic. Patients and Methods: A descriptive study involving 93 patients who had been in a cardiovascular surgery intensive care unit and then transferred to the clinic. The patients' socio-demographic characteristics, and intensive care unit experiences and anxiety levels were evaluated using a questionnaire and scales (intensive care unit experiences scale and hospital anxiety and depression scale-anxiety section). Results: We found that the intensive care experiences of the patients were positive. It was apparent that the patients' satisfaction regarding the care service they had received was high but awareness of their surroundings and anxiety levels were low. Their transfer anxiety levels was found low. Conclusion: Regular explanation of the conducted processes, treatments, and surrounding atmosphere, responding to the questions of the patients, and maintenance of effective communication with the patients and their relatives likely benefit the patients' awareness. [ABSTRACT FROM AUTHOR]

Background: Following adult cardiac surgery, often difficult to detect fluctuations in regional cerebral perfusion can contribute to strokes. Optimal cerebral perfusion remains elusive and traditional monitoring strategies do not consistently identify acute changes. Non-invasive cerebral oximetry may detect perfusion variations. Objective: To assess the feasibility of postoperative non-invasive cerebral oximetry monitoring. Methods: Non-invasive cerebral oximetry was performed on adult aortic valve surgery patients in a cardiac surgical intensive care unit. Monitoring feasibility was assessed using an investigatordeveloped, data extraction tool. Results: Non-invasive cerebral oximetry was completed in 94% of patients. Sixty percent had values that fell below pre-set ischemic threshold. Nurses reported monitoring was feasible and they perceived identifying deleterious cerebral perfusion trends may improve patient care. Conclusions: Prevalence of low cerebral oximetry values underscores the importance of increasing sensitivity of monitoring tools. Further evaluation is required to assess this modality and the role of nurses in optimizing neurocognitive outcomes. Impact statement: Cerebral oximetry monitoring may help identify adult patients at risk of neurological complications after cardiac surgery and as a consequence initiate definitive therapeutic strategies. [ABSTRACT FROM AUTHOR]

Background: Previous studies have shown that hyperglycaemia is associated with postoperative complications in cardiac surgical patients. Conversely, well-controlled glucose levels are said to reduce major infectious complications in diabetic patients. Aim/Objectives: The purpose of this clinical audit was to evaluate the blood glucose levels of diabetic patients undergoing cardiac surgery and to determine the effectiveness of postoperative glycaemic control. Methods: A group of 150 patients from a large Irish cardiac surgery centre was selected by convenience sampling. An audit tool was designed to capture the patients' blood glucose levels, treatment regimes and postoperative complications. Findings: The findings showed major variations between ‘high’, ‘good’ and ‘borderline’ blood glucose levels in the pre- and postoperative phase. Although blood glucose testing practices seemed inconsistent, mean levels measured ‘borderline’. Furthermore, the treatment regimes varied greatly and suggest a lack of consensus regarding the management of postoperative hyperglycaemia. A total of 52% ( n = 78) patients developed 114 complications with a level of 21·4% ( n = 32) postoperative wound infections. Conclusion: The findings from this audit highlight the importance of regular blood glucose testing to enable early detection of hyperglycaemia and timely initiation of appropriate treatments regimes for diabetic patients undergoing cardiac surgery. Findings also show that hyperglycaemia derangement may make a difference in the recovery phase. While patients will benefit from lesser wound infections, hospitals might save costs involved with treating postoperative complications. Relevance to practice: More consistent blood glucose testing might be achieved through the use of evidence-based protocols. However, the education of staff is as important as it develops knowledge on the complex metabolic interactions of diabetic patients undergoing cardiac surgery. While this means investing in staff education and policy development, costs for daily care and expensive treatments for complications will be saved as patient recovery will be speedier and less eventful. [ABSTRACT FROM AUTHOR]

OBJETIVO: Apresentar uma rotina de atendimento para crianças submetidas à cirurgia cardíaca. FONTES DOS DADOS: Realizada revisão bibliográfica através de bancos de dados (Medline, Mdconsult, PubMed), analisando as condutas sugeridas por diversos serviços fora do Brasil e comparando com a rotina de atendimento no Hospital Infantil Pequeno Príncipe, de Curitiba, onde foram realizadas cerca de 8.000 cirurgias cardíacas desde 1977 até abril de 2003. SÍNTESE DOS DADOS: O serviço citado é referência em cardiologia e cirurgia cardíaca no estado do Paraná e estados vizinhos. A evolução das condições de diagnóstico, preparo da equipe clínica e cirúrgica, unidade de terapia intensiva (UTI) melhor equipada com monitorização mais avançada, equipe da UTI com pessoal treinado em todas as áreas para fazer pós-operatório de cirurgia cardíaca, estrutura hospitalar adequada, oferecendo atendimento avançado em todas as especialidades pediátricas e paramédicas, fazem com que o resultado das intervenções cirúrgicas realizadas em crianças com cardiopatias congênitas ou adquiridas, principalmente nos recém-nascidos e lactentes jovens com cardiopatias complexas, apresente sensível melhora quando comparado com anos anteriores. CONCLUSÃO: As crianças com cardiopatias, principalmente as complexas, devem ser encaminhadas para um local que seja centro de referência, onde haja condições para um atendimento global no pré, per e pós-operatório.OBJECTIVE: To present a care routine for children submitted to heart surgery. SOURCE OF DATA: Literature review of Medscape, MD Consult and PubMed. Analysis of the suggested conducts adopted by various services from different countries and comparison with the care routine at the Pequeno Príncipe Children's Hospital (Curitiba, state of Paraná), where approximately 8,000 heart surgeries were performed in children from 1977 to April 2003. SUMMARY OF THE FINDINGS: Our hospital is a reference center for Cardiology and Heart Surgery in the state of Paraná and neighboring states. The improvement of conditions for diagnosis, training of the clinical and surgical teams, better equipped ICU with more modern monitoring, training of ICU personnel from all areas to handle the post-operative requirements of patients submitted to heart surgery, an adequate hospital structure with advanced care in all pediatric and paramedic specialties have resulted in marked improvement in relation to previous years in terms of the results of surgical interventions in children with congenital or acquired heart disease, especially newborns and young babies with complex heart problems. CONCLUSION: Children with heart diseases, especially complex conditions, should be receive care at reference centers that can provide global care before, during and after the surgery.

Children undergoing congenital heart surgery require postoperative mechanical ventilation. Despite recent advances, prolonged mechanical ventilation (PMV) 1.5 necessary in some patients and may increase the risk of post-operative complications. The purpose of this study was to identify incidence and risk factors for PMV. The authors performed a retrospective chart review. They defined PMV as ventilation longer than 48 hours. Mixed-effects linear regression models were used to assess the relationship between each factor and duration of mechanical ventilation. Separate models were developed for preoperative, intraoperative, and postoperative periods. To determine the extent to which a combination of risk factors would predict PMV, the most significant variables were adopted to fit a model using number of risk factors to predict PMV. Two hundred twelve children ≤ 36 months were included. Eleven (5.2%) children died perioperatively. Of the patients, 72.6% (143/197) were extubated by 48 hours. Age <6 months, perioperative infection, inotrope use > 48 hours, total parenteral nutrition use, and failed extubation were associated with PMV. PMV occurred in 28% of the patients in this study. The presence of 2 risk factors predicted PMV with a sensitivity of 86% and a specificity of 94%. [ABSTRACT FROM AUTHOR]

Summary: In order to move toward a program of reliable and routine ambulatory cardiac surgery there must be a paradigm change in the attitude of both patients and caregivers. The status quo must be abandoned and replaced by the pioneering attitude of the early practitioners who formed our specialty. [Copyright &y& Elsevier]