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Preoperative and postoperative care in cardio surgery from the patient's point of view
Votava, Adam ; Klokočková, Šárka (advisor) ; Zámečníková, Kateřina (referee)
Preoperative and postoperative care in cardiac surgery from the patient's point of view - Adam Votava ABSTRACT The bachelor's thesis "Preoperative and postoperative care in cardiac surgery from the patient's point of view" investigated, evaluated and compared the views of patients who underwent cardiac surgery on the health care provided. The aim of the work was to map problematic areas in the provided information on the course of planned care and other areas connected with this topic. In the theoretical part of the thesis, the field of cardiac surgery itself, the process of hospitalization in the cardiac surgery department and specific information about the surgical procedure that the interviewees went through were presented. She also dealt with the role of the patient in healthcare. It presents the legal and ethical aspects of the patient in the Czech Republic and explained the factors affecting the patient's access to the provided health care. In conclusion, this section explains the need for information and possible resources that the cardiac surgery patient can use to his advantage. The empirical part contains the results of our own exploratory investigation and a comparison of the results with the results of other similar works. Method: Qualitative research - semi-structured interview. Results: Eight...
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lmportance of epicardial fat in heart diseases: new mechanism of action and their therapeutic implication
Matloch, Zdeněk ; Haluzík, Martin (advisor) ; Maruna, Pavel (referee) ; Lipš, Michal (referee)
It was documented earlier that epicardial fat is a source of pro-inflammatory mediators under basal conditions (Mazurek, Zhang et al. 2003, Baker, Silva et al. 2006). It was also found that during cardiac surgery there is an increased expression of mRNA for pro- inflammatory cytokines in both epicardial and subcutaneous adipose tissue (Kremen, Dolinkova et al. 2006). During advanced heart failure, an inflammation of adipose tissue and resistance to adiponectin was also discovered (Khan, Kato et al. 2012). As part of the project, we tested the hypothesis that changes in levels of pro-inflammatory and anti-inflammatory cytokines, including their expression in adipose, muscle and heart tissue, as well as changes in insulin resistance and lipid profile parameters, are dependent on the type of underlying disease of patients, either the presence of CAD or valve degeneration. The aim of our project was to investigate metabolic changes in various fat tissues, insulin resistance, pro-inflammatory and anti-inflammatory cytokines plasmatic levels and their mRNA expressions in patients with coronary artery disease (CAD) undergoing either elective coronary artery bypass surgery (CABG) or isolated valve replacement. Our patients underwent several blood tests and measurements like anthropometric, biochemical, and...
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Nursing Perioperative Care in the Cardiac Surgery Department
VÍTKOVÁ, Aneta
The incidence of civilisation diseases is rising not only in the Czech Republic but also worldwide. The incidence of cardiovascular diseases is widely represented in the population. To ensure proper and continuous development in the field of cardiac surgery, seamless interdisciplinary cooperation is necessary, which includes also perioperative nurses. The aim of this thesis is to identify the specifics of nursing care provided by perioperative nurses in the cardiac surgery department and to determine whether these nurses are motivated in the area of lifelong education. The empirical part consisted of both qualitative and quantitative research. Qualitative research was conducted through semi-structured interviews with perioperative nurses working in cardiac surgery operating theatres. Nurses were deliberately selected from three different healthcare facilities. The interviews were transcribed verbatim, processed using the "pen and paper" method, and categorized. For the quantitative research was used a non-standardized questionnaire which consisted of 18 questions and was distributed among perioperative nurses working in cardiac surgery operation theatres throughout the Czech Republic. Distribution was also carried out through NCO NZO (National Centre of Nursing and Non-medical Healthcare fields) and the Faculty of Health Studies in Pardubice. A total of 62 respondents participated in the questionnaire survey. The resulting data was processed using MS Excel and the Realstatistics add-on, with the help of graphs, contingency tables, and statistical calculations. The results of the qualitative research allowed us to map the activities performed by perioperative nurses in the role of a scrub or circulating nurse in cardiac surgery operating theatres. Perioperative nurses carry out a wide range of tasks which include care before, during and after the surgery. Communication and proper functioning of the entire surgical team are also essential. By carefully preparing for the procedure, complying with all duties and fulfilling good workplace relationships, they can provide the best possible care to patients. The results of the quantitative part of the research showed that there is no correlation between years of experience and the motivation of perioperative nurses in cardiac surgery departments for lifelong education, or between the highest level of education attained and their motivation for lifelong education. Despite this, the research had positive results. We found that all perioperative nurses in our research sample are sufficiently motivated for lifelong education. This thesis and its results can be valuable by newly employed perioperative nurses. They can learn basic information about the work of perioperative nurses in the cardiac surgery department and about opportunities for specialization or lifelong education. The section of lifelong education may also be supportive for all other nursing fields.
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Treatment-rehabilitation procedure in a patient after cardiac surgery
TŮMOVÁ, Jitka
The main aim of this bachelor´s thesis is to describe the treatment-rehabilitation procedure of patients after cardiac surgery complicated by stroke. In the theoretical part, I describe cardiac surgery in general, operative approaches, complications related to cardiac surgery, including stroke. I also focus on the rehabilitation of patients after heart surgery in a hospital facility. The second half of the theoretical part is dedicated ischemic and haemorrhagic strokes, symptoms, methods of treatment. At the very end, the thesis is dedicated to the rehabilitation of patients after a stroke. The practical part is processed in the form of qualitative research. In this part, I describe the medical rehabilitation procedure of two probands. The practical part is processed in the form of qualitative research. In this part, I describe the medical rehabilitation procedure of two probands.
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Preoperative physiotherapy in patients with planned cardiac surgery
KRONESOVÁ, Karolína
The bachelor thesis investigates preoperative physiotherapy options for patients with upcoming cardiac surgery. The thesis examines physiotherapeutic options before the cardiac surgery, which aim to be beneficial in the postoperative phase. The first goal is to map physiotherapeutic methods available for patients with upcoming cardiac surgery. The second goal is to compile educational material for patients who are planning to undergo a cardiac operation. I formulate two following research questions to achieve these goals: 1. Which physiotherapeutic methods are available for patients with upcoming cardiac surgery? 2. What effect has the educational material for patients with upcoming cardiac surgery? The theoretical part focuses on the following areas: anatomy of thorax and heart, physiology of bloodstream and heart, and on respiratory system. The next topic is a description of basic concepts of cardiac surgery and physiotherapeutic methods, which we can use in cardiac rehabilitation. The practical part of the work is based on qualitative research - case studies of four probands with planned cardiac surgery. Before the surgery, the input examination was performed to set starting values. The output examination took place right before the patient's release to home care for final evaluation. Probands were found thanks to the department of cardiac and chest surgery in České Budějovice hospital. The research was held during proband's hospitalization, and the whole therapy process was monitored. Based on kinesiological analysis input and output, I evaluated the effect of preoperative physiotherapy as positive for three out of four probands. Proband 1 had a significant extension of maximal respiratory mouth pressures; her thorax increased its volume and duration of inhaling and exhale. Despite lowered expectations, Proband 2 improved her maximal inspiratory and expiratory mouth pressures. Chest volume of Proband 3 increased during measurements. Due to the health condition of Proband 4, I could not perform her output examination.
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Methods for detection of impaired immune response in cardiac-surgical patients
Kormundová, Nikola ; Koláčková, Martina (advisor) ; Filipp, Dominik (referee)
In patients after cardiac surgery, there is an increase in the level of molecules with both pro-inflammatory and anti-inflammatory effects. This increase is influenced by the patient's clinical condition, but also by the nature of the operation itself, which uses conventional extracorporeal circulation. This technique leads to damage to blood elements by direct contact with air and parts of the extracorporeal circulation, as well as to ischemia-reperfusion injury. The specifics of cardiac surgery then affect possible postoperative complications such as multiorgan failure or septic shock. The diploma thesis is divided into a theoretical and a practical part. The theoretical part describes the principle and influence of cardiopulmonary bypass on the human body and the complications that are associated with its use. Furthermore, IFN-γ is described herein as a potential marker of septic conditions that could reflect the clinical postoperative condition of patients. The practical part of the diploma thesis monitored the percentage change of selected cell populations and the production of IFN-γ in the peripheral blood of patients before and after cardiac surgery. Furthermore, the response of individual isolated populations of healthy volunteers to selected stimulators was investigated. The percentage of...
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Methods for detection of impaired immune response in cardiac-surgical patients
Kormundová, Nikola ; Koláčková, Martina (advisor) ; Hrdý, Jiří (referee)
In patients after cardiac surgery, there is an increase in the level of molecules with both pro-inflammatory and anti-inflammatory effects. This increase is influenced by the patient's clinical condition, but also by the nature of the operation itself, which uses conventional extracorporeal circulation. This technique leads to damage to blood elements by direct contact with air and parts of the extracorporeal circulation, as well as to ischemia-reperfusion injury. The specifics of cardiac surgery then affect possible postoperative complications such as multiorgan failure or septic shock. The diploma thesis is divided into a theoretical and a practical part. The theoretical part describes the principle and influence of cardiopulmonary bypass on the human body and the complications that are associated with its use. Furthermore, IFN-γ is described herein as a potential marker of septic conditions that could reflect the clinical postoperative condition of patients. The practical part of the diploma thesis monitored the percentage change of selected cell populations and the production of IFN-γ in the peripheral blood of patients before and after cardiac surgery. Furthermore, the response of individual isolated populations of healthy volunteers to selected stimulators was investigated. The percentage of...
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Oxygen consumption in awake cardiac surgical patients
Pořízka, Michal ; Stříteský, Martin (advisor) ; Szárszoi, Ondrej (referee) ; Šetina, Marek (referee)
OBJECTIVES: Standard blood flow rates for cardiopulmonary bypass have been assumed to be the same for awake cardiac surgery with thoracic epidural anesthesia as for general anesthesia. However, compared to general anesthesia, awake cardiac surgery with epidural anesthesia may be associated with higher oxygen consumption due to missing effect of general anesthetics. This may result in insufficient oxygen delivery and lactic acidosis when standard blood flow rates were used. The primary aim of our study was to investigate if standard blood flow rates are adequate in awake cardiac surgery. The secondary aim was to evaluate postoperative clinical outcomes of patients undergoing awake cardiac surgery. METHODS: Forty-seven patients undergoing elective on-pump cardiac surgery were assigned to receive either epidural (Group TEA, n=17), combined (Group TEA-GA, n=15) or general (Group GA, n=15) anesthesia. To monitor adequacy of standard blood flow rates, arterial lactate, acid base parameters, central venous and jugular bulb saturation were measured at six time points during in all groups. Blood flow rates were adjusted when needed. Subsequently, early and late postoperative outcome data including hospital and 3-year mortality was recorded and compared among the study groups RESULTS: No lactic acidosis has...
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Factors affecting glucose metabolism and inflammatory response in critically ill patients
Kotulák, Tomáš ; Haluzík, Martin (advisor) ; Maruna, Pavel (referee) ; Šenolt, Ladislav (referee)
Hyperglycemia in critically ill patients was considered for many years an adaptive response to stress conditions being present in both patients with and without previous history of diabetes. Hyperglycemia is caused mainly by peripheral insulin resistance induced by the factors acting counteracting insulin signalling at the postreceptor level. Furthermore, hyperglycemia itself can then increase serum levels of pro-inflammatory cytokines such as tumor necrosis factor alpha (TNF-α), interleukin-6 (Il-6) and interleukin-8 (Il- 8) and others. On the contrary, peripheral insulin resistance induced by pro- inflammatory cytokines may further potentiate hyperglycemia. White adipose tissue represents in addition to its energy storage function also a very active endocrine active organ. In addition to regulation of a number of metabolic processes it also significantly modulates the inflammatory response. In critically ill patients, adipose tissue changes its morphology, i.e. the adipocytes are shrinking and adipose tissue is abundantly infiltrated by macrophages. Paradoxically, overweight and obese critically ill patients have lower mortality than underweight, lean and morbidly obese subjects. In our studies, we selected population of the patients undergoing elective major cardiac surgery with extracorporeal...
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Haemolysis and other biochemical evaluations of vacuum-assisted venous drainage in cardiac surgery
Škorpil, Jiří ; Tošovský, Jan (advisor) ; Lonský, Vladimír (referee) ; Semrád, Michal (referee)
Haemolysis and other biochemical evaluations of vacuum-assisted venous drainage in cardiac surgery Aims of the study: Vacuum-assisted venous drainage (VAVD) improves the quality of venous return in procedures using extracorporeal circulation systems (ECC). Nevertheless, there is not an evidence that such high negative pressure applied to ECC in combination with selective bicaval cannulation due to open heart surgery cause a trauma to blood elements and deteriorates organ function. A prospective randomised study was designed to demonstrate that negative pressure of -20 mm Hg to -80 mm Hg does not cause a significant haemolysis and organ deterioration in such procedures. Materials and methods: 85 consecutive patients undergoing combined cardiac surgery procedure with two separate venous cannulas were randomised in three groups A, B and C. VAVD with negative pressure of -20 to -45 mm Hg was applied to 28 patients in group A and negative pressure of -45 mm Hg to -80 mmHg was applied to 28 patients in group B. There was zero negative pressure applied to 29 patients in group C. Six blood samples were taken from each patient and examinated for haemolysis and other indicators of organ deterioration such as hemoblobin, platelet count, free hemoglobin, aptoglobin, lactate-dehydrogenase, aspartate-amino-transferase,...
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