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Optimal blood pressure (BP) for patients with coronary artery disease (CAD) undergoing percutaneous coronary intervention (PCI) remains unclear. This study aims to identify the optimal BP by investigating the association between average office BP and future clinical events in patients undergoing PCI. Consecutive patients undergoing PCI from 2012 to 2016 were included. They were divided into five groups according to the average follow-up BP after discharge. The co-primary outcomes were net adverse clinical events (NACE) and major adverse cardiac and cerebrovascular events (MACCE) up to 5 years. NACE was defined as a composite of MACCE (all-cause death, non-fatal myocardial infarction (MI), non-fatal stroke, or any revascularization) or major bleeding. A total of 2845 patients were included, and among them, 787 (27.7%) experienced the NACE during the follow-up period. Patients in the highest SBP group (adjusted hazard ratio [HR] 1.495, confidence interval [CI] 1.189–1.880) and lowest SBP group (adjusted HR 1.625, CI 1.214–2.176) had a significantly higher risk of 5-year NACE. Similar associations were observed between SBP and the risk of MACCE, and similar results based on DBP categories were also observed. There was a J-curve relationship between SBP and DBP with respect to 5-year NACE and MACCE. The nadir point of risk for NACE and MACCE was found at 121.4/74.8 and 120.4/73.7 mmHg. In patients underwent PCI, there is a significant correlation between office BP level and clinical events, indicates the importance of efforts for optimal BP control to reduce ischemic and bleeding events. Trial registration: HanYang University Medical Center (HYUMC) Registry, NCT05935397. [ABSTRACT FROM AUTHOR]

There has been an evolution in the disease severity and complexity of patients presenting to the cardiac intensive care unit (CICU). There are limited data evaluating the role of palliative care in contemporary CICU practice. PubMed Central, CINAHL, EMBASE, Medline, Cochrane Library, Scopus, and Web of Science databases were evaluated for studies on palliative care in adults (≥18 years) admitted with acute cardiovascular conditions – acute myocardial infarction, cardiogenic shock, cardiac arrest, advanced heart failure, post-cardiac surgery, spontaneous coronary artery dissection, Takotsubo cardiomyopathy, and pulmonary embolism – admitted to the CICU, coronary care unit or cardiovascular intensive care unit from 1/1/2000 to 8/8/2022. The primary outcome of interest was the utilization of palliative care services. Secondary outcomes of included studies were also addressed. Meta-analysis was not performed due to heterogeneity. Of 5711 citations, 30 studies were included. All studies were published in the last seven years and 90 % originated in the United States. Twenty-seven studies (90 %) were retrospective analyses, with a majority from the National Inpatient Sample database. Heart failure was the most frequent diagnosis (47 %), and in-hospital mortality was reported in 67 % of studies. There was heterogeneity in the timing, frequency, and background of the care team that determined palliative care consultation. In two randomized trials, there appeared to be improvement in quality of life without an impact on mortality. Despite the growing recognition of the role of palliative care, there are limited data on palliative care consultation in the CICU. • Palliative care has been studied infrequently in the cardiac intensive care unit (CICU). • The CICU population has undergone a significant shift in disease severity and complexity. • Multiple barriers to palliative care utilization exist in contemporary literature. [ABSTRACT FROM AUTHOR]

Background: Family‐centred care (FCC), while a core value of paediatric hospitals, has not been well‐studied in the paediatric cardiac intensive care unit (PCICU). Aim: To describe parents' perceptions of FCC provided by nurses in the PCICU during their infant's recovery from neonatal cardiac surgery and explore associations of perceptions of FCC on parent post‐traumatic stress (PTS) 4 months post‐discharge. Study Design: Data obtained from a previously conducted randomized clinical trial (RCT) on telehealth home monitoring after neonatal cardiac surgery at three free‐standing paediatric hospitals were analysed from a subset of 164 parents who completed the FCC Scale at hospital discharge, which measures a parent's experience of nursing care that embodies core principles of FCC. The RCT intervention was provided after hospital discharge, having no influence on parent's perception of FCC. The intervention also had no effect on PTS. Results: Perceived FCC was lowest for items 'nurses helped me feel welcomed' and 'nurses helped me feel important in my child's care'. Having 12%–19% points lower perception of FCC at hospital discharge was associated with parent experience of six or more PTS symptoms, at least moderate PTS symptom severity, or PTS disorder diagnosis at 4‐month follow‐up. Every 10% increase in parental perceptions of FCC was associated with less PTS symptoms (β = −0.29, SE = 0.12; p =.02) and lower PTS symptom cluster scores of arousal (β = −0.18, SE = 0.08; p =.02). Conclusions: Parents who perceived lower FCC during their infants' hospitalization were at increased risk for the development of PTS symptoms, more PTS symptom severity and PTS disorder diagnosis 4‐months post‐discharge. Relevance to Clinical Practice: Nurses have a prominent role to support the implementation of FCC for infants with cardiac defects and their parents. FCC may positively influence overall parent mental health and well‐being, reducing the trauma and distress of the PCICU experience. [ABSTRACT FROM AUTHOR]

Rationale: Cardiac monitoring has often been identified as an area of overutilization and remains a limited resource in many hospitals. With the aim of reducing telemetry overuse, we added clinical decision support to our health system's telemetry order with guidance on appropriate indications for monitoring. The new order requires selection of an appropriate clinical indication. Aims and Objectives: In this study, we aimed to understand provider engagement with this tool by assessing concordance between selected indications within the order and the clinical presence of those conditions as documented within the patient chart. Methods: We randomly selected 100 telemetry orders from July to October 2022 across four different hospitals at NYU Langone Health. Two independent, blinded reviewers used a structured protocol to identify documentation of actual indications for telemetry in each selected chart. We calculated the rate of concordance between indications selected in the order and indications that were determined to be clinically present on chart review. Results: There were 30,839 telemetry orders placed during the study timeframe. Overall concordance between the selection within the order and the actual indication was 48% (95% confidence interval [CI], 38.21%−57.79%). We observed especially low concordance rates for vague indications, such as 'Other', and for 'Confirmed Stroke', which was the only indication allowing for indefinite telemetry. Conclusion: The overall low concordance suggests a disconnect between the support tool and clinical practice. Providers are more likely to select an indication that reduces downstream work regardless of a patient's true clinical indication. [ABSTRACT FROM AUTHOR]

Background: Promoting bonding and neurodevelopmental care is an important element in the cardiovascular intensive care unit (CICU); however, holding of infants by family members is inconsistently practiced. Objectives: This quality improvement study aimed to safely increase the holding of medically complex infants in the CICU by developing a holding guideline and offering simulation-based staff education. Methods: Using consensus methodology and high-fidelity simulation, an expert work group created a holding guideline and training to increase staff confidence and competence in holding critically ill infants in the CICU. The effectiveness of the intervention was tested via a postintervention survey used to assess participants' confidence in and comfort with holding critically ill infants and elicit suggestions for further support. Participants who engaged with the mannequin were surveyed to assess the validity of the simulation trainer. Results: After the intervention, participants (N = 130) reported increased confidence with infant holding (76%) and greater confidence in preparing families to hold their infants. Participants (95%) strongly agreed that the simulation enabled realistic, safe practice in holding a medically complex infant with catheters and tubes. More years of experience and engagement with the simulation trainer were associated with increased posttraining confidence. Participants cited increased resources, practice, and adherence monitoring as key supports for infant holding. Conclusions: Expert group consensus with high-fidelity simulation training is a feasible, safe, and reliable method for teaching higher risk skills and guiding protocol development. [ABSTRACT FROM AUTHOR]

This article explores the use of mechanical circulatory supports (MCS), specifically left ventricular assist devices (LVADs), in the treatment of advanced heart failure. It highlights the high mortality rates associated with heart failure, particularly among younger individuals, and the increasing incidence of cardiogenic shock. The article discusses the variation in LVAD implantation rates across European countries and the impact of the COVID-19 pandemic on implantation activity. It also addresses factors that may contribute to the lack of global implementation of LVADs, including concerns about the percutaneous power cable and the risk of infection. The article suggests that improving the network structure, educating practitioners, and redefining the role of LVADs in accessing transplantation are necessary to reduce mortality among young heart failure patients. [Extracted from the article]

Background: Electrocardiography (ECG) is a noninvasive diagnostic method used to examine electrical and muscular cardiac activity. It is usually the first-line diagnostic tool for patients with chest pain. Late recognition of electrocardiography abnormalities can cause in-hospital cardiac arrest, further complicate care, increase the cost of health care, and prolong admission. Hence, the objective of this study was to determine the knowledge, practice, and associated factors of nurses regarding the interpretation of electrocardiography. Methods: A cross-sectional study was carried out on 334 nurses working at randomly selected public hospitals from March 06, 2023, to April 05, 2023. Since our study populations were less than the calculated sample size, all nurses who fulfilled the inclusion criteria were included. The collected data were coded and cleaned using EpiData version 4.2 and analysed using Statistical Package for the Social Sciences (SPSS) version 25. Both bivariate and multivariate logistic regression was run to find an association between dependent and independent variables. Odds ratios (ORs) with 95% confidence levels were used to measure the strength of associations. Results: A total of 334 nurses responded to the survey, yielding a 93% response rate. Only 15.4% and 9% of them had satisfactory knowledge and good practice, respectively. Nurses who had 2–4 years of experience in the current unit were 3.13 times more likely (AOR = 3.13 (1.23, 7.92) to have sufficient knowledge. Nurses working in cardiac care units were 3.45 times more likely to have good practices than those working in intensive care units (AOR = 3.45 (1.02, 13.73)). Conclusion: The study revealed that educational qualifications, in-service training, and current working units were significantly associated with nurses' knowledge and practice of electrocardiography interpretation. The concerned body must provide continuous on-the-job training related to ECG interpretation to all nurses working in adult emergency and critical care unit. [ABSTRACT FROM AUTHOR]

Objectives: While significant evidence supports the benefits of normothermic cardiopulmonary bypass (NCPB) over hypothermic techniques, many institutions in developing countries, including ours, continue to employ hypothermic methods. This study aimed to assess the early postoperative outcomes of normothermic cardiopulmonary bypass (NCPB) for complete surgical repair via the Tetralogy of Fallot (TOF) within our national context. Methods: We conducted this study in the Pediatric Cardiac Intensive Care Unit (PCICU) at the University Children's Hospital. One hundred patients who underwent complete TOF repair were enrolled and categorized into two groups: the normothermic group (n = 50, temperature 35–37 °C) and the moderate hypothermic group (n = 50, temperature 28–32 °C). We evaluated mortality, morbidity, and postoperative complications in the PCICU as outcome measures. Results: The demographic characteristics were similar between the two groups. However, the cardiopulmonary bypass (CPB) time and aortic cross-clamp (ACC) time were notably longer in the hypothermic group. The study recorded seven deaths, yielding an overall mortality rate of 7%. No significant differences were observed between the two groups concerning mortality, morbidity, or postoperative complications in the PCICU. Conclusions: Our findings suggest that normothermic procedures, while not demonstrably effective, are safe for pediatric cardiac surgery. Further research is warranted to substantiate and endorse the adoption of this technique. [ABSTRACT FROM AUTHOR]

Following new concepts by Bichat in the early 19th century, of organic and animal life centered around the ganglionic nervous system, over 100 years of anatomic studies and physiologic experimentation eventually resulted in Gaskell's 1916 book entitled "The Involuntary Nervous System" and Langley's 1921 book entitled "The Autonomic Nervous System." Neurology and cardiology emerged as specialties of medicine in the early 20th century. Although neurology made several prominent discoveries in neurophysiology during the first half of the 20th century, cardiology developed coronary care units and cardiac catheterization in the 1960s. Programmed electrical stimulation of the heart and noninvasive ambulatory monitoring provided new methodologies to study clinical cardiac arrhythmias. Experimentally, direct cardiac nerve stimulation of sympathetic nerve endings, as well as parasympathetic control of the atrioventricular node, provided the background to new detailed autonomic studies of the heart. Neurocardiology, perhaps initially more directed towards our understanding of sudden cardiac death, ultimately embraced an even significantly more complex scheme of local circuit neurons and near‐endless loops of interconnecting neurons in the heart. Intrathoracic extracardiac and intracardiac ganglia have been recharacterized, both anatomically and physiologically, laying the groundwork for potential new therapies of cardiac neuromodulation. [ABSTRACT FROM AUTHOR]

Introduction: Despite advances in treatment of children with critical heart disease, cardiac arrest (CA) remains a common occurrence. We provided virtual support to bedside teams (BTs) from a tele-critical care (TCC) unit in a pediatric cardiac intensive care unit (CICU) and focused on early detection of concerning trends (CT) and avoidance of CA. Virtual surveillance workflows included a review of remote monitoring, video feed from patient room cameras, medical records, and artificial intelligence tools. We present our initial experience with a focus on critical communications (CCs) to BTs. Methods: A retrospective, descriptive review of TCC activities was conducted from January 2019 to December 2022, involving electronic databases and electronic medical records of patients in the CICU, including related CCs to BTs, responses from BTs, and related CA. Results: We conducted 18,171 TCC activities, including 2,678 non-CCs and 248 CCs. Over time, there was a significant increase in the proportion of CCs related with CT (p = 0.002), respiratory concerns (<0.001), and abnormalities in cardiac rhythm (p = 0.04). Among a sample of 244 CCs, subsequent interventions by BTs resulted in adjustment of medical treatment (127), respiratory support (68), surgery or intervention (19), cardiac rhythm control (17), imaging study (14), early resuscitation (9), and others (10). Conclusions: CCs from a TCC unit in a pediatric CICU changed over time with an increased focus on CT and resulted in early interventions, potentially contributing to avoiding CA. This model of care in pediatric cardiac critical care has the potential to improve patient safety. [ABSTRACT FROM AUTHOR]

Background: Despite implementation of central catheter bundles, central line [catheter]–associated bloodstream infections (CLABSIs) remain a preventable hospital-acquired infection. Local Problem: A new population of patients with pulmonary artery catheters was introduced to the cardiac progressive care unit, increasing central catheter days, device use, and CLABSI rate. Methods: A quality improvement project was conducted. Nursing staff implemented a standardized central catheter rounding process 3 days a week to critically assess all central catheter dressings, deter-mine the necessity of each central catheter, and educate patients on the importance of keeping central catheter dressings clean, dry, and intact. Data were collected during central catheter rounds for each patient, entered in an electronic survey tool via mobile devices, and analyzed. Results: From July 2019 through June 2022, a total of 2692 rounds were conducted for 707 individual patients with 3064 central catheters. Main interventions were dressing management, monitoring insertion site bleeding that extended beyond edges of the chlorhexidine gluconate pad, treating patients' allergies to products, and maintaining sustainability within the unit. Central catheter rounds decreased the CLABSI rate from 1.86 to 0.0 despite the continued increase in central catheter days. Conclusions: Central catheter dressing assessment, intervention, and education help reduce CLABSIs. Central catheter rounds are an important adjunct to the CLABSI bundle. A central catheter dressing management algorithm helps nurses decide when to change a dressing and which type of dressing to use. [ABSTRACT FROM AUTHOR]

This article provides a summary of a guideline developed by the Society of Critical Care Medicine and the American Society of Health-System Pharmacists on the prevention of stress-related gastrointestinal bleeding in critically ill adults. The guideline offers evidence-based recommendations on the use of stress ulcer prophylaxis (SUP) in the ICU. The recommendations include administering enteral nutrition, providing SUP to patients with risk factors for gastrointestinal bleeding, and using proton pump inhibitors or histamine-2 receptor antagonists as first-line agents for SUP. The article also discusses the results of a meta-analysis on SUP in critically ill patients, which found that proton pump inhibitors were associated with a reduced risk of upper gastrointestinal bleeding compared to histamine-2 receptor antagonists, but there may be an increased risk of mortality. Sucralfate was found to be associated with a lower risk of pneumonia compared to proton pump inhibitors and histamine-2 receptor antagonists. However, there is no evidence supporting the concurrent use of sucralfate and acid suppressants for SUP. The article includes information about the authors and their affiliations, as well as disclosures of potential conflicts of interest. [Extracted from the article]

Cardiac point-of-care ultrasound (POCUS) has the ability to rapidly assess function and identify systolic heart failure (HF), an often-missed diagnosis. POCUS has the potential to expedite medical intervention, improving overall outcomes. There have been limited studies describing pediatric emergency center (EC) utilization of cardiac POCUS and its impact on outcomes in pediatric patients. Authors performed a retrospective chart review at a tertiary children's hospital to identify all patients admitted from the EC to the Cardiac Intensive Care Unit (CICU) with acute systolic HF between January 2017 and August 2019. Outcome measures included EC length of stay (LOS), CICU LOS, and time until first IV HF medicine was administered. A total of 21 patients and 24 encounters meeting criteria were identified. Cardiac POCUS agreed with standard echocardiography in 8 of 9 cases. Patients who had a cardiac POCUS in the EC seemed more likely to receive their first dose of intravenous heart failure medication while in the Emergency Center (70% vs 43%). There was a trend toward significance, but it did not reach statistical significance (p = 0.1). EC and CICU LOS were not significantly different between POCUS and non-POCUS groups. Cardiac POCUS has the potential to have a valuable role in the early diagnosis of acute systolic HF in children. However, early diagnosis by POCUS did not translate into shorter EC or CICU LOS. This pilot data serves as a baseline for efforts to promote earlier clinical recognition of acute HF and more efficient collaboration between clinical services. [ABSTRACT FROM AUTHOR]

The primary objective of this study was to determine whether or not hemodynamic parameters and laboratory values at the time of admission to the pediatric cardiac intensive care unit after the Norwood operation were associated with a composite outcome of either need for extracorporeal membrane oxygenation or inpatient mortality. This was a single-center retrospective study of infants with functionally univentricular hearts admitted to intensive care after the Norwood procedure from January 2011 to January 2020. Data were obtained at a single point (after a Norwood procedure) and then compared between two subsets of patients based on the presence or not of the composite outcome of interest. In univariate and multiple regression analyses, a series of receiver operator curves were generated to assess the relationship between the variables of interest and the composite outcome. Eight (7.6%) experienced the composite outcome out of a total of 104 patients. Those who experienced the composite endpoint had significantly higher oxygen extraction ratio (0.43 vs. 0.31, p = 0.01), lower systemic blood flow (2.5 L/min versus 3.1 L/min, p = 0.01), and higher systemic vascular resistance (20.2 indexed woods units versus 14.8 indexed woods units, p = 0.01). Those with systemic blood flow of less than 2.5 L/min/m2 had a 17% risk of experiencing the composite endpoint AUC = 0.79. Those with systemic vascular resistance of greater than 19 indexed woods units had a 22% risk of experiencing the composite endpoint AUC 0.80. Systemic blood flow and systemic vascular resistance are independently associated with this composite outcome. [ABSTRACT FROM AUTHOR]

Accurate diagnosis in the Emergency Department (ED) is critical for appropriate, timely treatment. Discrepancies between admission diagnosis by the ED team and discharge diagnosis by the admission team may lead to suboptimal care and have important implications on patient outcomes, resource utilization and hospital quality measures. This study aimed to explore the extent of such discrepancies in a tertiary center in Saudi Arabia and their impact on patient outcomes. This retrospective study at a tertiary medical center in Riyadh, Saudi Arabia (July--August 2019), using electronic medical record (EMR) review, included patients aged ≥14 years old admitted through the adult emergency department. Patients admitted to the intensive care unit (ICU) or cardiac care unit (CCU), or triaged to the obstetrics and gynaecology (OBGYN) or psychiatric areas of the emergency department were excluded from the study. ED and discharge diagnoses were checked by three physicians and classified into three categories: full, partial and mismatch. A partial match was defined when the ED diagnosis correlated with the final diagnosis to a certain extent and the final diagnosis could not be revealed in the ED setting. Of 771 patients, 692 (89.8%) had matched initial and final diagnoses, 52 (6.7%) had a partially matched diagnosis, and 27 (3.5%) had a complete mismatch between their ED diagnosis and discharge diagnosis. Among partial matches (n = 52), the most frequently observed reason was Magentic Resonance Imaging (MRI) performed during admission (48.08%) and endoscopy/colonoscopy (15.39%). Duration of hospital stay was not significantly associated with diagnosis mismatch. Although the discrepancy between admission and discharge diagnoses was relatively low, careful evaluation of patient complaints, medical history and laboratory and imaging results is critical for accurate diagnosis and management. Future research is needed to explore the impact of discrepancies in diagnosis on patient outcomes and to identify strategies to minimize them. [ABSTRACT FROM AUTHOR]

Background: Various postoperative sedation protocols with different anaesthetics lead to profound effects on the outcomes for post‐cardiac surgery patients. However, a comprehensive analysis of optimal postoperative sedation strategies for patients in the intensive care unit (ICU) after cardiac surgery is lacking. Methods: We systematically searched for randomized controlled trials (RCTs) in databases including PubMed and Embase. The primary outcome measured the duration of mechanical ventilation (MV) in the ICU, and the secondary outcome encompassed the length of stay (LOS) in the ICU and hospital and the monitoring adverse events. Results: The literature included 18 RCTs (1652 patients) with 13 sedation regimens. Dexmedetomidine plus ketamine and sevoflurane were associated with a significantly reduced duration of MV when compared with propofol. Our results also suggested that dexmedetomidine plus ketamine may associated with a shorter LOS in ICU, and sevoflurane associated with a shorter LOS in the hospital, respectively. Conclusions: The combination of dexmedetomidine and ketamine seems to be a better option for adult patients needing sedation after cardiac surgery, and the incidence of side effects is lower with dexmedetomidine. These findings have potential implications for medication management in the perioperative pharmacotherapy of cardiac surgery patients. [ABSTRACT FROM AUTHOR]

Background: High doses of long-acting opioids were used to facilitate off-pump coronary artery bypass grafting procedure, which may result in opioid-related adverse events after surgery. Transcutaneous electrical acupoint stimulation (TEAS) had been reported to be effective in reducing intraoperative opioids consumption during surgery. The aim of this study is to assess whether TEAS with difference acupoints can reduce the doses of opioid analgesics. Methods: This was a multicenter, randomized, controlled, double-blind trial. Patients underwent off-pump coronary artery bypass grafting under general anesthesia were enrolled. Eligible patients were randomly and equally grouped into sham acupuncture group (n = 105), regional acupoints combination group (n = 105), or distal–proximal acupoints combination group (n = 105) using a centralized computer-generated randomization system. Transcutaneous electrical acupoint stimulation was applied for 30 min before anesthesia induction. The primary outcome was the doses of sufentanil during anesthesia. Secondary outcomes included the highest postoperative vasoactive-inotropic scores within 24 h, intraoperative propofol consumption, length of mechanical ventilation, duration of cardiac care unit and postoperative hospital stay, incidence of postoperative complications, and mortality within 30 days after surgery. Results: Of the 315 randomized patients, 313 completed the trial. In the modified intention-to-treat analysis, the doses of sufentanil were 303.9 (10.8) μg in the distal–proximal acupoints group, significantly lower than the sham group, and the mean difference was − 34.9 (− 64.9 to − 4.9) μg, p = 0.023. The consumption of sufentanil was lower in distal–proximal group than regional group (303.9 vs. 339.5), and mean difference was − 35.5 (− 65.6 to − 5.5) μg, p = 0.020. The distal–proximal group showed 10% reduction in opioids consumption comparing to both regional and sham groups. Secondary outcomes were comparable among three groups. Conclusion: Transcutaneous electrical acupoint stimulation with distal–proximal acupoints combination, compared to regional acupoints combination and sham acupuncture, significantly reduced sufentanil consumption in patients who underwent off-pump coronary artery bypass grafting surgery. [ABSTRACT FROM AUTHOR]

Background: Patients experience emotional distress and hold cardiac misconceptions following ST-elevation myocardial infarction. These issues informed the co-production of Cardiac Brief Intervention with patients and clinicians. The current study will establish a knowledge base for the feasibility of delivering this intervention to patients following ST-elevation myocardial infarction, with a preliminary exploration of impact on associated outcomes (ClinicalTrials.gov: NCT05848674). Methods: A pilot randomised controlled trial incorporating a mixed-methods design will be conducted. Patients with ST-elevation myocardial infarction (number = 40) will be recruited from coronary care units at two hospital centres in Northern Ireland, with participants randomised (1:1) to the intervention or control group. Cardiac Brief Intervention constitutes a nurse-led, short (20 minutes) emotional and educational support discussion with a patient, with a leaflet that serves as a memory-aid. It will be delivered to the intervention group prior to discharge from a coronary care unit. The control group will receive standard care information. Data will be collected at baseline, post-intervention, 4 weeks from diagnosis, and 14 weeks from diagnosis. Feasibility measurements and process evaluation (quantitative and qualitative) will assess the viability of the research design and intervention delivery. Cardiac rehabilitation attendance data will be collected, and participants will complete questionnaires related to associated outcomes. Quantitative data will be reported with descriptive statistics and qualitative data will be analysed using framework analysis, with data integrated to achieve triangulation of findings. Discussion: Educational and emotional difficulties following ST-elevation myocardial infarction may impede patient outcomes and cardiac rehabilitation participation. These issues informed the co-production of Cardiac Brief Intervention with patients and clinicians. This study will evaluate the feasibility of delivering Cardiac Brief Intervention to patients. These results will inform large-scale definitive testing of the intervention, which may lead to adoption in clinical practice to improve cardiac rehabilitation uptake and patient outcomes. [ABSTRACT FROM AUTHOR]

Cardiogenic shock (CS) is a heterogeneous clinical syndrome characterized by low cardiac output leading to end-organ hypoperfusion. Organ dysoxia ranging from transient organ injury to irreversible organ failure and death occurs across all CS etiologies but differing by incidence and type. Herein, we review the recognition and management of respiratory, renal and hepatic failure complicating CS. We also discuss unmet needs in the CS care pathway and future research priorities for generating evidence-based best practices for the management of extra-cardiac sequelae. The complexity of CS admitted to the contemporary cardiac intensive care unit demands a workforce skilled to care for these extra-cardiac critical illness complications with an appreciation for how cardio-systemic interactions influence critical illness outcomes in afflicted patients. [ABSTRACT FROM AUTHOR]

The article provides information on a process improvement project which aimed to determine if the implementation of a multimodal education program would result in decreased catheter-associated urinary tract infection (CAUTI) rates in a large healthcare system. Topics include CAUTI rates per 1,000 patient days, CAUTI prevention practices, and primary outcome of the initiative.

The article discusses the use of left atrial venting as a technique to unload the left ventricle in patients with cardiogenic shock undergoing extracorporeal life support (ECLS). Two recent trials, EARLY-UNLOAD and EVOLVE-ECMO, found no significant differences in 30-day mortality rates between early unloading through active left atrial venting and a rescue unloading strategy. The article acknowledges the challenges of interpreting the results due to sample size limitations and the complexity of intention-to-treat analysis. The authors suggest that further investigation is needed to determine the effectiveness and timing of left heart decompression techniques. The text also provides an overview of past and present mechanical circulatory support unloading trials in cardiogenic shock, highlighting the ongoing REMAP-ECMO and UNLOAD-ECMO trials that aim to determine the optimal timing of left heart decompression initiation. The article emphasizes the need for further research comparing different devices and timing of left heart decompression initiation, and suggests that decisions should be made on a case-by-case basis guided by local expertise and available strategies. [Extracted from the article]

Background: Infections caused by multidrug-resistant organisms (MDROs) have been increasingly reported from healthcare facilities. The spread of MDROs in hospitals further increases the financial burden on healthcare facility due to prolonged hospital stays and the need for more expensive investigations and treatment. Methicillin Resistant Staphylococcus aureus (MRSA) is known to be widely distributed in the healthcare facilities and accounts for a substantial proportion of the infectious disease burden. Hence, active surveillance for MRSA is carried out to identify colonized patients or Healthcare workers (HCWs) in a facility. This prospective study was conducted to study and compare the carriage of MRSA among doctors, nurses, General Duty Attendants (GDA) and Houseman/ House woman (HM/HW) working in cardiac unit of a tertiary care hospital. Screening was done by collecting swabs from hands and anterior nares. These specimens were processed by standard procedures for the isolation of Staphylococcus aureus and resistance to methicillin was determined using cefoxitin, 30µg disks as per Clinical and Laboratory Standards Institute (CLSI) guidelines. The carriage rate of MRSA was found to be highest among HM/HW (13%) followed by nurses (8%) and GDA (7%). Out of 11 doctors screened, none was found to carry MRSA. A higher percentage carriage in HM/HW can probably be accounted to their close and prolonged contact with infected patients and involvement in activities like emptying urinary bags, floor mopping and other activities of environmental cleaning. Management of MRSA carriers include applying stringent hand hygiene, contact precautions and core strategies including isolating and cohorting patients, increased environmental cleaning, dedicated patient equipment and decolonization. Active surveillance including screening of HCWs can help in decreased risk of spread to their close contacts and further reduction of MRSA prevalence among patients. [ABSTRACT FROM AUTHOR]

Objectives: To determine the effect of elevated supine position with back support on back pain, anxiety and comfort in patients undergoing coronary angiography. Methods: This randomized-controlled, experimental study was conducted in the Coronary Intensive Care Unit between September 2021 and January 2022, with an intervention group of 51 patients and a control group of 53 patients. Data were collected using a patient information form, a visual analog scale, the anxiety state inventory and the immobilization comfort questionnaire. Following angiography, the intervention group received pillow support to the back and the bedhead was elevated to 30 degrees. Routine Original Article nursing care was applied to the control group. In both groups, the severity of back pain was measured at 0, 2, and 4 hours, and anxiety and comfort at 0 and 4 hours. Results: The pain severity at 2 and 4 hours after the procedure was determined to be significantly lower in the intervention group than in the control group (p<0.001, p<0.001). At 4 hours, the anxiety levels were similar in both groups (p<0.05), and the comfort level was higher in the intervention group (p<0.001). The mean pain value was 6.003 points lower and the comfort level was 20.499 points higher in the intervention group than in the control group. Conclusion: The elevated supine position with back support was seen to reduce back pain, increase comfort, and did not change anxiety levels. [ABSTRACT FROM AUTHOR]

Background: The purpose of this study was to assess the prevalence of coma among patients in critical care units in Chile. We also aimed to provide insight into the demographic characteristics, etiologies, and complications associated with coma. Methods: A single day cross-sectional study was conducted through a national survey of public and private hospitals with critical and intensive cardiac care units across Chile. Data were collected using an online questionnaire that contained questions regarding critically ill patients' information, demographic characteristics, etiology and duration of coma, medical complications, and support requirements. Results: A total of 84% of all health facilities answered, accounting for a total of 2,708 patients. The overall coma prevalence was 2.9%. The median age of the comatose patients was 61 years (interquartile range 50–72) and 66.2% were male. The median coma duration was five days (interquartile range 2–9). Cerebral hemorrhage was the most common etiology, followed by severe hypoxic-ischemic encephalopathy, acute ischemic stroke, and traumatic brain injury. A total of 48.1% of coma patients experienced acute and ongoing treatment complications, with pneumonia being the most common complication, and 97.4% required support during comatose management. Conclusions: This study provides an overview of the prevalence of coma in Chilean critical and cardiac care units. Coma is a common condition. Comatose patients frequently experience medical complications during their hospitalization. [ABSTRACT FROM AUTHOR]

Background: Cardiovascular (CVS) conditions remain the main etiology of death in individuals with chronic kidney disease (CKD) even after control of classic risk factors of cardiovascular disease (CVD). Aim: This study is to detect the sequalae of serum phosphorus and calcium level abnormalities in individuals with CKD and their relation to occurrence of acute coronary syndrome (ACS) in those cases. Methods: A cross-sectional work involved 100 individuals with CKD managed with or without dialysis. They were admitted to Internal Medicine Department, Coronary Care Unit of Sohag University Hospital. Each participant had been subjected to full history taking, clinical assessment, and investigations including serum calcium, phosphorus, creatinine, blood urea, parathyroid hormone level, lipid profile, troponin, CK-MB, electrocardiogram, and echocardiography. Results: A substantial elevation in serum calcium and phosphorus levels was existed in individuals with CKD with ACS group compared to patients with CKD without ACS group (p = 0.026 and 0.001 respectively). The mean calcium/phosphorus ratio was 3.04 ± 2.14 in patients with CKD with ACS group, while it was 2.31 ± 1.17 in patients with CKD without ACS group. A substantial raise in calcium/phosphorus ratio was existed in CKD with ACS group as compared to patients with CKD without ACS group (p = 0.047). ROC curve analysis shows that calcium/phosphorus ratio can predict acute coronary syndrome at cutoff 1.94 with area under the curve 0.652 with sensitivity and specificity that were 77.8% and 52.1% correspondingly (p = 0.007). Conclusion: A substantial raise in calcium and phosphorus levels was existed in individuals with CKD with ACS group contrasted to individuals with CKD without ACS group. Calcium/phosphorus ratio can predict acute coronary syndrome at cutoff 1.94. Clinical trial registration number: NCT05134220. [ABSTRACT FROM AUTHOR]

OBJECTIVE The Society of Critical Care Medicine released the first guideline for the prevention and management of pain, agitation, neuromuscular blockade, and delirium in critically ill pediatric patients but offered conditional recommendations for sedation practices and monitoring during neuromuscular blockade. This study aimed to characterize sedation practices, patient awareness, and depth of blockade with neuromuscular blocking agent (NMBA) infusion administration in a single pediatric and cardiac intensive care unit. METHODS This retrospective chart review of critically ill pediatric patients queried orders for continuous infusion NMBA. Analgosedation agent(s), dose, and dose changes were assessed, along with depth of blockade monitoring via Train of Four (TOF) and awareness via Richmond Agitation and Sedation Scale (RASS). RESULTS Thirty-one patients were included, of which 27 (87%) had a documented sedation agent infusing at time of NMBA initiation and 17 patients (54%) were receiving analgesia. The most common agents used were rocuronium (n = 28), dexmedetomidine (n = 23), and morphine (n = 14). RASS scores were captured in all patients; however, 9 patients (29%) had recorded positive scores and 1 patient (3%) never achieved negative scores. TOF was only captured for 11 patients (35%), with majority of the scores being 0 or 4. CONCLUSIONS Majority of the study population did not receive recommended depth of blockade monitoring via TOF. Similarly, RASS scores were not consistent with deep sedation in half of the patients. The common use of dexmedetomidine as a single sedation agent calls into question the appropriateness of current sedation practices during NMBA continuous infusions. [ABSTRACT FROM AUTHOR]

Coronary artery vasospasm plays a crucial role in the prevalence of unstable angina. Despite common misdiagnosis, there is limited evidence on this topic. Here, we present a rare case of unstable vasospastic angina in a female with severe thyrotoxicosis. Case Report: A 62-year-old female patient was admitted to the cardiac intensive care unit due to crushing chest pain at rest. The patient exhibited ischemic changes on the ECG with a normal troponin I level. Recurrent chest pain prompted urgent coronary angiography, revealing generalized vasospasm of all coronary artery branches including the left main coronary artery. Intracoronary nitroglycerin injection partially alleviated the vasospasm; however, there was a persistent stenosis in the left main artery. Subsequent intravascular ultrasound demonstrated an anatomically normal left main artery. Post-procedure, laboratory tests revealed undetectable levels of thyroid-stimulating hormone and thyroid hormones above the detectable level. The patient was initiated on methimazole and discharged symptom-free, expecting a good prognosis under conservative management. Conclusions: Clinically significant coronary vasospasm triggered by thyrotoxicosis remains a rarity in clinical practice, often posing diagnostic challenges. This case emphasizes the significance of intracoronary nitroglycerin and intravascular ultrasound in discerning the etiology of coronary lesions seen on angiography. We advocate for these techniques to optimize invasive coronary artery diagnostics, enabling the selection of the appropriate treatment strategies and improving long-term prognosis. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the association between frailty and postoperative delirium (POD) in elderly cardiac surgery patients. Methods: A retrospective study was conducted of older patients admitted to the intensive care unit after cardiac surgery at a tertiary academic medical center in Boston from 2008 to 2019. Frailty was measured using the Modified Frailty Index (MFI), which categorized patients into frail (MFI ≥3) and non‐frail (MFI = 0–2) groups. Delirium was identified using the confusion assessment method for the intensive care unit and nursing notes. Logistic regression models were used to examine the association between frailty and POD, and odds ratios (OR) with 95% confidence intervals (CI) were calculated. Results: Of the 2080 patients included (median age approximately 74 years, 30.9% female), 614 were frail and 1466 were non‐frail. The incidence of delirium was significantly higher in the frail group (29.2% vs. 16.4%, p < 0.05). After adjustment for age, sex, race, marital status, Acute Physiology Score III (APSIII), sequential organ failure assessment (SOFA), albumin, creatinine, hemoglobin, white blood cell count, type of surgery, alcohol use, smoking, cerebrovascular disease, use of benzodiazepines, and mechanical ventilation, multivariate logistic regression indicated a significantly increased risk of delirium in frail patients (adjusted OR: 1.61, 95% CI: 1.23–2.10, p < 0.001, E‐value: 1.85). Conclusions: Frailty is an independent risk factor for POD in older patients after cardiac surgery. Further research should focus on frailty assessment and tailored interventions to improve outcomes. [ABSTRACT FROM AUTHOR]

Moral distress has emerged as a significant concern for critical care nurses, particularly due to the complex and demanding care provided to critically ill patients in critical care units. The ongoing COVID-19 pandemic has introduced new ethical challenges and changes in clinical practice, further exacerbating the experience of moral distress among these nurses. This systematic review compares the factors influencing moral distress among critical care nurses before and during the COVID-19 pandemic to gain a comprehensive understanding of the impact of the pandemic on moral distress. For this systematic review, PubMed, Scopus, ProQuest, Web of Science, medRxiv, bioRxiv, Embase, and Google Scholar were all utilized in the search. The search covered articles published from 2012 to December 2022, encompassing a 10-year timeframe to capture relevant research on moral distress among critical care nurses. In total, 52 articles were included in this systematic review. The findings indicate that personal, caring-related, and organizational factors can influence nurses' moral distress. Before the pandemic, factors including futile and end-of-life care, conflicts with physicians, nurse performance and authority, poor teamwork, decision-making regarding treatment processes and patient care, limited human resources and equipment, medical errors, patient restraints, and nurses' age and work experience affect critical care nurses' moral distress. Similarly, during the COVID-19 pandemic, factors contributing to moral distress include futile and end-of-life care, fear of contracting and spreading COVID-19, decision-making about treatment processes, poor teamwork, and being female. This study revealed that the factors contributing to moral distress were approximately similar in both periods. Futile care and end-of-life issues were critical care nurses' primary causes of moral distress. Implementing prevention strategies and reducing these underlying factors could decrease this major issue and improve the quality of care. [ABSTRACT FROM AUTHOR]

Background and Aims: There is significant potential to streamline the clinical pathway for patients undergoing transcatheter aortic valve implantation (TAVI). The purpose of this study was to evaluate the effect of implementing BENCHMARK best practices on the efficiency and safety of TAVI in 28 sites in 7 European countries. Methods: This was a study of patients with severe symptomatic aortic stenosis (AS) undergoing TAVI with balloon-expandable valves before and after implementation of BENCHMARK best practices. Principal objectives were to reduce hospital length of stay (LoS) and duration of intensive care stay. Secondary objective was to document patient safety. Results: Between January 2020 and March 2023, 897 patients were documented prior to and 1491 patients after the implementation of BENCHMARK practices. Patient characteristics were consistent with a known older TAVI population and only minor differences. Mean LoS was reduced from 7.7 ± 7.0 to 5.8 ± 5.6 days (median 6 vs. 4 days; P <.001). Duration of intensive care was reduced from 1.8 to 1.3 days (median 1.1 vs. 0.9 days; P <.001). Adoption of peri-procedure best practices led to increased use of local anaesthesia (96.1% vs. 84.3%; P <.001) and decreased procedure (median 47 vs. 60 min; P <.001) and intervention times (85 vs. 95 min; P <.001). Thirty-day patient safety did not appear to be compromised with no differences in all-cause mortality (0.6% in both groups combined), stroke/transient ischaemic attack (1.4%), life-threatening bleeding (1.3%), stage 2/3 acute kidney injury (0.7%), and valve-related readmission (1.2%). Conclusions: Broad implementation of BENCHMARK practices contributes to improving efficiency of TAVI pathway reducing LoS and costs without compromising patient safety. Structured Graphical Abstract BENCHMARK: streamlined transcatheter aortic valve implantation (TAVI) pathway with retained safety. CCU, coronary care unit; ICU, intensive care unit; GW, general ward; IMC, intermediate care; PPM, permanent pacemaker. *Includes patients with available data on LoS only. [ABSTRACT FROM AUTHOR]

Brugada syndrome (BrS) is a rare yet serious condition that can lead to death if not properly managed. Consequently, anesthesiologists must exercise special caution during the perioperative period. This report shares our experience with a patient diagnosed with type 3 BrS. We managed the intraoperative anesthesia in a 27-year-old patient scheduled for elective lumbar discectomy surgery. The patient had no additional comorbidities apart from BrS. After making the necessary preparations, the patient underwent surgery. Throughout the operation, the patient's hemodynamics remained stable. During the postoperative follow-up in the coronary intensive care unit, the patient reported experiencing chest pain and palpitations. However, no arrhythmia was detected, except for tachycardia. The patient was discharged after 48 h once clinical stability was achieved. In contrast to our case, patients who exhibit symptoms such as syncope, palpitations, and a family history indicative of cardiac diseases but have not been diagnosed with BrS should be thoroughly evaluated. It is crucial to ensure appropriate physiological and pharmacological conditions for these patients. : [ABSTRACT FROM AUTHOR]

Cardiac complications are a rare but potentially serious consequence of hyperbaric oxygen treatment (HBOT), resulting from increased blood pressure and decreased heart rate and cardiac output associated with treatment. These physiologic changes are generally well-tolerated by patients without preexisting cardiac conditions, although those with known or undetected cardiac disease may be more vulnerable to treatment complications. Currently, there are no universally accepted guidelines for pre-HBOT cardiac screening to identify these patients at heightened risk, leading to variability in practice patterns. In the absence of HBOT-specific evidence, screening protocols might be adapted from the diving medicine community; however, given the important differences in physiological stressors, these may not be entirely applicable to patients undergoing HBOT. Traditional cardiac investigations such as electro- and echo-cardiograms are limited in their ability to detect relevant risk modifying states in the pre-HBOT patient, stymieing their cost-effectiveness as routine tests. In the absence of strong evidence to support routine cardiac investigation, we argue that a comprehensive history and physical exam - tailored to identify high-risk patients based on clinical parameters - may serve as a more practical screening tool. While certain unique patient groups such as those undergoing dialysis or with implanted cardiac devices may warrant specialised assessment, thorough evaluation may be sufficient to identify many patients unlikely to benefit from cardiac investigation in the pre- HBOT setting. A clinical decision-making tool based on suggested low-risk and high-risk features is offered to guide the use of targeted cardiac investigation prior to HBOT. [ABSTRACT FROM AUTHOR]

Background/Objectives: Patient care in Cardiac Intensive Care Units (CICU) has evolved but data on patient characteristics and outcomes are sparse. This retrospective observational study aimed to define clinical characteristics and risk factors of CICU patients, their in-hospital and 30-day mortality, and compare it with established risk scores. Methods: Consecutive patients (n = 294, mean age 70 years, 74% males) hospitalized within 15 months were studied; APACHE II, EHMRG, GWTG-HF, and GRACE II were calculated on admission. Results: Most patients were admitted for ACS (48.3%) and acute decompensated heart failure (ADHF) (31.3%). Median duration of hospitalization was 2 days (IQR = 1, 4). In-hospital infection occurred in 20%, 18% needed mechanical ventilation, 10% renal replacement therapy and 4% percutaneous ventricular assist devices (33%, 29%, 20% and 4%, respectively, for ADHF). In-hospital and 30-day mortality was 18% and 11% for all patients (29% and 23%, respectively, for ADHF). Established scores (especially APACHE II) had a good diagnostic accuracy (area under the curve-AUC). In univariate and multivariate analyses in-hospital intubation and infection, history of coronary artery disease, hypotension, uremia and hypoxemia on admission were the most important risk factors. Based on these, a proposed new score showed a diagnostic accuracy of 0.954 (AUC) for in-hospital mortality, outperforming previous scores. Conclusions: Patients are admitted mainly with ACS or ADHF, the latter with worse prognosis. Several patients need advanced support; intubation and infections adversely affect prognosis. Established scores predict mortality satisfactorily, but larger studies are needed to develop CICU-directed scores to identify risk factors, improve prediction, guide treatment and staff training. [ABSTRACT FROM AUTHOR]

Implementing and sustaining technological innovations in healthcare is a complex process. Commonly, innovations are abandoned due to unsuccessful attempts to sustain and scale-up post implementation. Limited information is available on what characterizes successful e-health innovations and the enabling factors that can lead to their sustainability in complex hospital environments. We present a successful implementation, sustainability and scale-up of a virtual care program consisting of three e-health applications (telemedicine, telehome monitoring, and interactive voice response) in a major cardiac care hospital in Canada. We describe their evolution and adaptation over time, present the innovative approach for their "business case" and funding that supported their implementation, and identify key factors that enabled their sustainability and success, which may inform future research and serve as a benchmark for other health care organizations. Despite resource constraints, e-health innovations can be deployed and successfully sustained in complex healthcare settings contingent key considerations: simplifying technology to make it intuitive for patients; providing significant value proposition that is research supported to influence policy changes; involving early supporters of adoption from administrative and clinical staff; engaging patients throughout the innovation cycle; and partnering with industry/technology providers. [ABSTRACT FROM AUTHOR]

OBJECTIVES: In 2018, CMS established reimbursement for the first Medicare-covered artificial intelligence (AI)--enabled clinical software: CT fractional flow reserve (FFRCT) to assist in the diagnosis of coronary artery disease. This study quantified Medicare utilization of and spending on FFRCT from 2018 through 2022 and characterized adopting hospitals, clinicians, and patients. STUDY DESIGN: Analysis, using 100% Medicare fee-for-service claims data, of the hospitals, clinicians, and patients who performed or received coronary CT angiography with or without FFRCT. METHODS: We measured annual trends in utilization of and spending on FFRCT among hospitals and clinicians from 2018 through 2022. Characteristics of FFRCT-adopting and nonadopting hospitals and clinicians were compared, as well as the characteristics of patients who received FFRCT vs those who did not. RESULTS: From 2018 to 2022, FFRCT billing volume in Medicare increased more than 11-fold (from 1083 to 12,363 claims). Compared with nonbilling hospitals, FFRCT-billing hospitals were more likely to be larger, part of a health system, nonprofit, and financially profitable. FFRCT-billing clinicians worked in larger group practices and were more likely to be cardiac specialists. FFRCT-receiving patients were more likely to be male and White and less likely to be dually enrolled in Medicaid or receiving disability benefits. CONCLUSIONS: In the initial 5 years of Medicare reimbursement for FFRCT, growth was concentrated among well-resourced hospitals and clinicians. As Medicare begins to reimburse clinicians for the use of AI-enabled clinical software such as FFRCT, it is crucial to monitor the diffusion of these services to ensure equal access. [ABSTRACT FROM AUTHOR]

Background: Calcium-free (Ca-free) solutions are theoretically the most ideal for regional citrate anticoagulation (RCA) in continuous renal replacement therapy (CRRT). However, the majority of medical centers in China had to make a compromise of using commercially available calcium-containing (Ca-containing) solutions instead of Ca-free ones due to their scarcity. This study was designed to probe into the potential of Ca-containing solution as a secure and efficient substitution for Ca-free solutions. Methods: In this prospective, randomized single-center trial, 99 patients scheduled for CRRT were randomly assigned in a 1:1:1 ratio to one of three treatment groups: continuous veno-venous hemodialysis Ca-free dialysate (CVVHD Ca-free) group, continuous veno-venous hemodiafiltration calcium-free dialysate (CVVHDF Ca-free) group, and continuous veno-venous hemodiafiltration Ca-containing dialysate (CVVHDF Ca-containing) group at cardiac intensive care unit (CICU). The primary endpoint was the incidence of metabolic complications. The secondary endpoints included premature termination of treatment, thrombus of filter, and bubble trap after the process. Results: The incidence of citrate accumulation (18.2% vs. 12.1% vs. 21.2%) and metabolic alkalosis (12.1% vs. 0% vs. 9.1%) did not significantly differ among three groups (p > 0.05 for both). The incidence of premature termination was comparable among the groups (18.2% vs. 9.1% vs. 9.1%, p = 0.582). The thrombus level of the filter and bubble trap was similar in the three groups (p > 0.05 for all). Conclusions: In RCA-CRRT for CICU population, RCA-CVVHDF with Ca-containing solutions and traditional RCA with Ca-free solutions had a comparable safety and feasibility. Trial Registration: ChiCTR2100048238 in the Chinese Clinical Trial Registry. [ABSTRACT FROM AUTHOR]

Background: The off-label use of contrast-enhanced ultrasound has been increasingly used for pediatric patients. Objective: The purpose of this retrospective study is to report any observed clinical changes associated with the intravenous (IV) administration of ultrasound contrast to critically ill neonates, infants, children, and adolescents. Materials and methods: All critically ill patients who had 1 or more contrast-enhanced ultrasound scans while being closely monitored in the neonatal, pediatric, or pediatric cardiac intensive care units were identified. Subjective and objective data concerning cardiopulmonary, neurological, and hemodynamic monitoring were extracted from the patient's electronic medical records. Vital signs and laboratory values before, during, and after administration of ultrasound contrast were obtained. Statistical analyses were performed using JMP Pro, version 15. Results were accepted as statistically significant for P-value<0.05. Results: Forty-seven contrast-enhanced ultrasound scans were performed on 38 critically ill patients, 2 days to 17 years old, 19 of which were female (50%), and 19 had history of prematurity (50%). At the time of the contrast-enhanced ultrasound scans, 15 patients had cardiac shunts or a patent ductus arteriosus, 25 had respiratory failure requiring invasive mechanical oxygenation and ventilation, 19 were hemodynamically unstable requiring continual vasoactive infusions, and 8 were receiving inhaled nitric oxide. In all cases, no significant respiratory, neurologic, cardiac, perfusion, or vital sign changes associated with IV ultrasound contrast were identified. Conclusion: This study did not retrospectively identify any adverse clinical effects associated with the IV administration of ultrasound contrast to critically ill neonates, infants, children, and adolescents. [ABSTRACT FROM AUTHOR]

BACKGROUND: We aimed to observe the dynamic changes in glucose metabolic reprogramming- related parameters and their ability to predict neurological prognosis and all-cause mortality in cardiac arrest patients after the restoration of spontaneous circulation (ROSC). METHODS: Adult cardiac arrest patients after ROSC who were admitted to the emergency or cardiac intensive care unit of the First Affiliated Hospital of Dalian Medical University from August 1, 2017, to May 30, 2021, were enrolled. According to 28-day survival, the patients were divided into a non-survival group (n=82) and a survival group (n=38). Healthy adult volunteers (n=40) of similar ages and sexes were selected as controls. The serum levels of glucose metabolic reprogramming- related parameters (lactate dehydrogenase [LDH], lactate and pyruvate), neuron-specific enolase (NSE) and interleukin 6 (IL-6) were measured on days 1, 3, and 7 after ROSC. The Acute Physiology and Chronic Health Evaluation II (APACHE II) score and Sequential Organ Failure Assessment (SOFA) score were calculated. The Cerebral Performance Category (CPC) score was recorded on day 28 after ROSC. RESULTS: Following ROSC, the serum LDH (607.0 U/L vs. 286.5 U/L), lactate (5.0 mmol/L vs. 2.0 mmol/L), pyruvate (178.0 μmol/L vs. 70.9 μmol/L), and lactate/pyruvate ratio (34.1 vs. 22.1) significantly increased and were higher in the non-survivors than in the survivors on admission (all P<0.05). Moreover, the serum LDH, pyruvate, IL-6, APACHE II score, and SOFA score on days 1, 3 and 7 after ROSC were significantly associated with 28-day poor neurological prognosis and 28- day all-cause mortality (all P<0.05). The serum LDH concentration on day 1 after ROSC had an area under the receiver operating characteristic curve (AUC) of 0.904 [95% confidence interval [95% CI]: 0.851-0.957]) with 96.8% specificity for predicting 28-day neurological prognosis and an AUC of 0.950 (95% CI: 0.911-0.989) with 94.7% specificity for predicting 28-day all-cause mortality, which was the highest among the glucose metabolic reprogramming-related parameters tested. CONCLUSION: Serum parameters related to glucose metabolic reprogramming were significantly increased after ROSC. Increased serum LDH and pyruvate levels, and lactate/pyruvate ratio may be associated with 28-day poor neurological prognosis and all-cause mortality after ROSC, and the predictive efficacy of LDH during the first week was superior to others. [ABSTRACT FROM AUTHOR]

Context: It is not clear if an oral hygiene protocol to control biofilm applied before cardiac surgery can reduce infection rates. Objective: We aim to verify the effectiveness of an oral hygiene protocol in reducing postoperative infections when compared to usual practices, in patients admitted to a cardiology unit, prior to cardiac surgery. Design, Setting and Participants: Randomized, blind, controlled clinical trial, with 107 participants who expected to undergo cardiac surgery, randomized into two groups: Experimental Group (EG) standardized oral hygiene protocol (54) and Control Group (CG), usual practices performed in patients admitted (53). Intervention: a standardized oral hygiene protocol, 1 day before surgery: professional prophylaxis with a portable ultrasound device, tooth brushing and flossing plus a 0.12% chlorhexidine gluconate solution (0.12% CHX) mouth rinsing. When applicable, removable prostheses cleaning. Primary outcome: the presence of infection. Results: The occurrence of postoperative infection was higher in CG = 7 (13.2%) than in EG = 5 (9.3%); but no statistical difference was found between protocols (p = 0.518). The length of stayed from surgery to discharge presented a statistical difference (p = 0.047; RR = 4.9; CI = 1.01–24.33); the percentage of postoperative infection was almost five times higher in those participants who stayed 11 or more days. Conclusion: The standardized oral hygiene protocol with mechanical and chemical cleaning, 1 day before cardiac surgery, was not more effective than the usual practices performed regarding the reduction of postoperative infections. Other interventions regarding oral hygiene procedures before cardiac surgery must be studied to contribute to the reduction of adverse post‐surgical events. Clinical Trial Registration: Site Ensaclinicos.gov.br number U1111‐1214‐2862. Descriptors Healthcare Associated Infections, Cardiovascular Diseases, Periodontal Diseases, Dental Biofilm, Cardiovascular Surgery. [ABSTRACT FROM AUTHOR]

Background: Cardiovascular discharge diagnoses may serve as endpoints in epidemiological studies if they have a high validity. Aim was to study if diagnoses-specific characteristics like type, sub-categories, and position of cardiovascular diagnoses affected diagnostic accuracy. Methods: Patients (n = 7,164) with a discharge diagnosis of acute myocardial infarction, heart failure or cerebrovascular disease were included. Data were presented as positive predictive values (PPV) and sensitivity. Results: PPV was high (≥88%) for acute myocardial infarction (n = 2,189) (except for outpatients). For heart failure (n = 4,026) PPV was 67% overall, but higher (>99%) when etiology or echocardiography was included. For hemorrhagic (n = 257) and ischemic (n = 1,034) strokes PPVs were 87% and 80%, respectively, with sensitivity of 79% and 75%. Transient ischemic attacks (n = 926) had PPV 56%, but sensitivity 86%. Primary diagnoses showed higher validity than subsequent diagnoses and inpatient diagnoses were more valid than outpatient diagnoses (except for transient ischemic attack). The diagnoses of acute myocardial infarction and heart failure where most valid when placed at cardiology units, while ischemic stroke when discharged from an internal medicine unit. Conclusions: The diagnoses of acute myocardial infarction and stroke had excellent validity when placed during hospital stays. Similarly, heart failure diagnoses had excellent validity when echocardiography was performed before placing the diagnosis, while overall the diagnoses of heart failure and transient ischemic attack were less valid. In conclusion, the results indicate that cardiovascular diagnoses based on objective findings such as acute myocardial infarction and stroke have excellent validity and may be used as endpoints in clinical epidemiological studies with less rigid validation. [ABSTRACT FROM AUTHOR]

Background: An elevated shock index (SI) predicts worse outcomes in multiple clinical arenas. We aimed to determine whether the SI can aid in mortality risk stratification in unselected cardiac intensive care unit patients. Methods: We included admissions to the Mayo Clinic from 2007 to 2015 and stratified them based on admission SI. The primary outcome was in-hospital mortality, and predictors of in-hospital mortality were analyzed using multivariable logistic regression. Results: We included 9,939 unique cardiac intensive care unit patients with available data for SI. Patients were grouped by SI as follows: < 0.6, 3,973 (40%); 0.6–0.99, 4,810 (48%); and ≥ 1.0, 1,156 (12%). After multivariable adjustment, both heart rate (adjusted OR 1.06 per 10 beats per minute higher; CI 1.02–1.10; p-value 0.005) and systolic blood pressure (adjusted OR 0.94 per 10 mmHg higher; CI 0.90–0.97; p-value < 0.001) remained associated with higher in-hospital mortality. As SI increased there was an incremental increase in in-hospital mortality (adjusted OR 1.07 per 0.1 beats per minute/mmHg higher, CI 1.04–1.10, p-Value < 0.001). A higher SI was associated with increased mortality across all examined admission diagnoses. Conclusion: The SI is a simple and universally available bedside marker that can be used at the time of admission to predict in-hospital mortality in cardiac intensive care unit patients. [ABSTRACT FROM AUTHOR]

Background: Cardiovascular Disease (CVD) commonly known as disease of heart blood vessels and is typically composed of fatty deposits. The WHO estimates that approximately 17.3 million people worldwide die each year from CVD. Purpose: To identify DRPs, and assess the Health Related Quality of Life in the study population. Materials and Methods: A Prospective observational study was carried out on 210 patients in the cardiology department over 6 months. DRPs were identified by using the PCNE tool 9.1 version. The Health-Related Quality of Life was measured by using the SF-36 questionnaire in cardiac patients. Results: Among 210 subjects, 205 subject profiles were identified with 520 DRPs, which included 166 drug interactions, 37 problems related, and 147 causes related, a total of 50 interventions were found and accepted, so the outcome of the intervention is 50. significant correlation was observed in the physical function domain of HRQoL, age in Physical functioning, Role limitation due to physical health, and General health and also reported significant correlation of age in Energy/fatigue, Emotional well-being and Role limitation due to emotional problems. [ABSTRACT FROM AUTHOR]

Background: Cardiovascular diseases are the major non-communicable disease causing increased mortality and morbidity worldwide. Among cardiovascular diseases, coronary artery disease is one of the life-threatening diseases. The majority of patients, after the acute event of coronary artery disease, suffer from mental stress, depression, and cognitive impairments. Therefore, this study mainly focuses on the effect of the Cognitive and Emotional Impairment Management Bundle (CEIMB) among patients with coronary artery disease. Methods: This randomized, controlled, double-blinded trial was conducted in a tertiary care center among patients with coronary artery disease. The samples were recruited from the coronary intensive care unit through purposive sampling technique. After the sample selection, they were allotted to control (n1 = 55) and intervention (n2 = 56) groups through block randomization. The intervention was provided through three sessions. The study was registered under the Clinical Trial registry of the country. The statistical analysis was done using the SPSS ver. 25. The analysis was done by mean, standard deviation, frequency, percentage, and two-way repeated measures ANOVA. Results: The mean age of the participants in the control group was 56.6 ± 6.1 years, and in the experimental group was 57.6 ± 6.4 years. The majority of the participants (39.3%) in the intervention group had severe depression, moderate levels of stress (30.4%), and medication adherence (96.4%). In the experimental group, depression, stress, medication adherence, and cognition had a statistically significant difference at different periods (<0.05). Conclusion: The impaired mental status and cognitive level of the patients after the cardiac event negatively influences the patient's prognosis, contributing to readmission and premature death. [ABSTRACT FROM AUTHOR]

Aim: To assess and compare the metabolic and vascular effectiveness of sodium‐glucose cotransporter 2 inhibitors (SGLT‐2i) and dipeptidyl peptidase‐4 inhibitors (DPP‐4i) in the clinical practice of patients with type 2 diabetes in Italy. Materials and Methods: GIOIA is a 2‐year prospective, multicentre, quasi‐experimental study that enrolled patients with type 2 diabetes initiating SGLT‐2i or DPP‐4i for inadequate glycaemic control [glycated haemoglobin (HbA1c) >7%] between March 2018 and March 2021. The primary endpoints were changes in markers of organ damage [carotid intima‐media thickness (CIMT), albuminuria, myocardial function] and HbA1c from baseline to year 2. Results: In total, 1150 patients were enrolled in the study (SGLT‐2i n = 580, DPP‐4i n = 570). Patients initiated on SGLT‐2i were younger (about 6 years) and heavier (about 11 kg), had higher HbA1c level (1% more), more albuminuria and cardiovascular events (16% more) than patients initiated on DPP‐4i. CIMT and echocardiographic parameters were not significantly different. Propensity score matching yielded two groups, each consisting of 155 patients with diabetes with similar baseline characteristics. Despite a significant similar reduction in HbA1c levels in both groups (−0.8%), more patients on SGLT‐2i had regression of CIMT and albuminuria (22% and 10%, respectively, p <.001 vs. DPP‐4i); more patients on DPP‐4i had progression of CIMT and albuminuria (23% and 28%, respectively, p <.001 vs. SGLT‐2i). Left ventricular ejection fraction improved slightly (3%, p =.043) on SGLT‐2i only. Conclusions: In a real‐world setting, both SGLT‐2i and DPP‐4i improve glycaemic control persisting after 2 years of treatment, with a robust effect on both CIMT and albuminuria regression for SGLT‐2i as compared with DPP‐4i in the propensity score matching. [ABSTRACT FROM AUTHOR]

The article highlights the transformative journey of a nurse-turned-activist who founded a not-for-profit organization, Her Heart, dedicated to addressing the alarming statistics and barriers faced by women in heart health. Topics include her diverse career trajectory, challenges in setting up the organization, and innovative solutions such as an online directory to connect women with female cardiologists and Australia's first online risk assessment tool tailored for women.

Background: Uropathogenic Escherichia coli (UPEC) is the most common cause of urinary tract infection in humans including cystitis and pyelonephritis. Antimicrobial resistance (AMR) in UPEC is one of the global public challenges that is due to prevalent use of antibiotics in healthcare setting. Therefore, the purpose of this study is to investigate the frequency and antibiotic resistance pattern of UPEC isolated from patients admitted to Modares Hospital in Saveh, Iran. Methods: In this study, in total 633 isolates were evaluated. UPEC isolates were obtained from patients with urinary tract infection and identified using conventional microbiological protocols. Antibiotic resistance pattern of UPEC against different antibiotic were determined using disk diffusion method. SPSSTM software was used for statistical analysis. Results: In this study, the most sample was related to outpatients and the lowest sample was related to the CCU wards. The highest antibiotic resistance showed against cephalothin (63.8%) and nalidixic acid (62.2%) antibiotics. The highest effective antibiotics for the tested UPEC was nitrofurantoin (90.7%) and gentamicin (77.3%). Cephalothin and nalidixic acid in hospitalized patients in ICU and emergency wards, respectively, showed the highest antibiotic resistance. Out of 633 UPEC, the rate of Multi Drug Resistant (MDR) isolates were 343 (54.2%). Conclusion: The result of this study highlighted the role of UPEC as one of the important cause of UTI in individuals. Also, nitrofurantoin then gentamicin are the most effective antibiotics against UPEC infections. Logical prescription of antibiotics and infection control strategies are needed for prevention and control of nosocomial infections especially urinary tract infection [ABSTRACT FROM AUTHOR]

Objectives: This study aims to evaluate the knowledge and proficiency of nurses in managing thrombolytic therapy for myocardial infarction. Methodology: A cross-sectional research design was adopted and conducted in a public teaching hospital from May 2020 to September 2020. Registered professional nurses (n=52) working in the emergency department (ED) and cardiac care unit (CCU) were invited to participate. A structured, pre-validated questionnaire was used for data collection. The study received approval from the institutional review board and ethics committee. Data were analyzed using SPSS version 25.0. Results: Fifty ED nurses participated in the study, predominantly male, aged = 34 years, with = 3 years of experience. The overall knowledge score of nurses regarding thrombolytic therapy was 71%, while the practice score was 79%. The lowest level of knowledge was related to contraindications (65%) and treatment protocols (66%), while the highest was for therapy considerations (85.2%). The lowest task performance (47.8%) was observed in the pre - administration phase. There was a negative correlation (r = -0.226) between knowledge and practice. Knowledge levels were higher among male nurses, while task performance was better among those with cardiac certification. Conclusion: The study revealed that while nurses had a favorable level of knowledge about thrombolytic therapy, their practical implementation was poor. This gap highlights the need for targeted educational programs and the establishment of efficient documentation systems to enhance clinical practice. [ABSTRACT FROM AUTHOR]

Objectives: The prevalence and clinical significance of carotid artery stenosis (CAS) in acute myocardial infarction (AMI) patients remain uncertain. This study aims to evaluate CAS prevalence and its association with coronary artery disease (CAD) severity in AMI patients admitted to a coronary care unit (CCU). Methodology: In this cross-sectional study, 100 consecutively selected AMI patients underwent ultrasound Doppler carotid artery assessments, including measurements of carotid intima-media thickness (cIMT), identification of plaque (stenosis >0%), and calculation of internal carotid artery/common carotid artery (ICA/CCA) peak systolic velocity ratio. Angiographic findings, including the number of diseased vessels and Syntax score (SS), were also recorded. Results: Among the study cohort (mean age 55.1±11.2 years, 78 males), 32 patients exhibited CAS, with 8 having cIMT>1.2mm, 3 showing ICA/CCA PSV ratio>2, and 25 presenting plaque. CAS prevalence did not significantly correlate with CAD severity, regardless of the number of diseased vessels or SS. Similarly, CAS rates did not significantly differ based on SS categories (low, intermediate, high). While CAS prevalence trended higher in patients with conventional atherosclerotic risk factors (diabetes, hypertension, smoking, obesity), these associations were not statistically significant. Conclusion: CAS was prevalent in approximately one-third of AMI patients, yet it did not demonstrate a significant association with CAD severity or SS. However, CAS rates tended to increase with the presence of conventional atherosclerotic risk factors. Further research is warranted to elucidate the clinical implications of CAS in AMI patients and its relationship with CAD severity. [ABSTRACT FROM AUTHOR]