Search

Objective: This study was planned to evaluate effectiveness of cardiac surgery score (CASUS) system used for the prediction of mortality after the cardiac surgery and to compare it with EuroSCORE, a tested and approved method. Method: Fifty patients over the age of 18 who came to the intensive care unit (ICU) after open heart surgery and stayed in the ICU for more than 48 hours were prospectively included in the study. After the preoperative EuroSCORE evaluation of the patients, CASUS scoring systems were used for risk scoring from postoperative 0 day to the service or up to the 6th postoperative day (or possible mortality) in patients whose stay in ICU was prolonged. We evaluated the place of both models in the prediction of ICU mortality. Results: The study was conducted with 50 patients- 21 female, 29 male-, aged between 19 and 79 years (mean age: 60.38±12.50). Five (10%) cases exited.The areas under the ROC curve were estimated as follows: EuroSCORE, 45.3%; and for CASUS 0,1, and 2. day scores AUCs of ROC curve were 66,9%, 64,7%, and 79,8%, respectively. The CASUS 2nd day score was found to be valuable in predicting mortality (p<0.01). A statistically significant relationship was observed between the days of stay in the ICU and mortality. Conclusion: Our results show that the rate of the accurate prediction of mortality of CASUS is insufficient on postop 0th and 1st day; however CASUS score on postoperative 2nd day has sufficient.predictive accuracy EuroSCORE is not found effective in the prediction of mortality. It is observed that if the duration of stay in ICU is prolonged, it statistically significantly increases the risk of mortality. [ABSTRACT FROM AUTHOR]

Objective: Ventilator-associated pneumonia (VAP) are among common infections encountered in intensive care units. The high mortality rate is important due to prolonged hospital stay and increased hospital costs. In this study, we aimed to determine the risk factors associated with VAP in patients who had undergone open heart surgery. Method: In this study, a total of 599 patients (178 female, and 421 male) who underwent elective open heart surgery were prospectively included in this study. Patients who could not be extubated after 48 hours were divided into two groups. Group 1: Patients with clinical suspicion of VAP and bacterial growth in their endotracheal aspirates (ETA) (n=29) Group 2: Control group (n=570). Results: In univariate analysis, age, Chronic Obstructive Pulmonary Disease (COPD) Pulmonary Hypertension (PHT), history of myocardial infarction (MI), low ejection fraction (EF), prolonged cross- clamp and pump times, inotropic support, presnce of intra-aortic balloon pump (IABP) and use of hemofiltration, atrial fibrillation, reintubation, enteral nutrition with nasogastric tube, reoperation, neurologic dysfunction, steroid use, blood and blood product use, hypoalbuminemia and presence of decubitus ulcer were detected as risk factors for VIP. According to logistic regression analysis duration of intubation longer than 72 hours, reintubation, COPD, previous MI, steroid use, AF neurologic dysfunction were determined as independent risk factors for VAP. Conclusion: In the patient population consisting of patients with cardiac surgery, keeping the invasive mechanical ventilator support as short as possible, reducing the need for reintubation by extubation in optimal time, ensuring complete haemodynamic stability, preoperative preparation of the patient preoperatively, prevention of postoperative haemodynamic instability during surgery, and reduction of VAP. [ABSTRACT FROM AUTHOR]