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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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Changes in Expression of Membrane Molecules CD200R, CD95, CD95L, and Soluble CD200R Regulating inflammatory Responses in Patients Undergoing Cardiac Surgery
Holmannová, Drahomíra ; Krejsek, Jan (advisor) ; Brát, Radim (referee) ; Turánek, Jaroslav (referee)
Cardiac surgery is known to initiate a complex physiological response with the immune system activation (SIRS), neurohormonal response, metabolic changes, coagulopathies etc. SIRS is triggered by tissue injury, myocardial ischemia, reperfusion, use of anaesthesia, cardioplegia, extracorporeal circuit etc. Excessive immune system activation is associated with progression of SIRS, life-threatening multi-organ dysfunction (MOD), and increased morbidity/mortality in the postoperative period. The immune system response is regulated and terminated by both cellular and humoral regulatory and inhibitory mechanisms including changes in expression of in our study monitored molecules: CD200/CD200R, sCD200R and CD95/CD95L. Methods: The study included the measurement the expression of CD95, CD95L, CD200R, and sCD200R molecules in granulocyte and monocyte populations in blood samples of 30 patients who underwent heart surgery using CPB. Samples collected before surgery, after surgery, and in the postoperative period (1st , 3rd , 7th day) were analysed by flow cytometry and sCD200R by ELISA. Results: We discovered a significant increase in the percentage of granulocytes expressing inhibitory molecule CD200R (from 5% to 17.8%) instantly after surgery. It might be presumed that these cells are less susceptible to...
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Healing of the surgical wound after cardiac surgery
Mrkvičková, Petra ; Gigalová, Veronika (advisor) ; Votroubková, Michaela (referee)
ANOTATION Autor: Petra Mrkvičková Institution: Charles University, Faculty of Medicine in Hradec Kralove, Department of Social Medicine, Division of Nursing Title: Healing of the surgical wound after cardiac surgery Supervisor: Mgr. Veronika Gigalová Number of pages: 136 Number of attachments: 8 Year of defense: 2019 Keywords: patient, cardiac surgery, sternotomy, healing of the surgical wound, nursing care The bachelor thesis deals with healing of surgical wound after cardiac surgery. Theoretical part of the thesis deals with facts from the area of cardiac surgery, the most common cardiac diseases, which are indicated for cardiac surgery and appropriate surgical approaches. It points out to risk groups of patients who may have complications within the healing wound. This thesis focuses mainly on nursing care of sternotomy with sternotomy healing and potential complications. It points out to the importance of regular inspection of sternotomy, regular changing of wound dressing under aseptic conditions, education and care of patients' mental health. In the empirical part, the thesis focuses on quantitative and qualitative research. Quantitative research was conducted by a non-standardized questionnaire and qualitative research by a semi-structured interview. The aim of the research was to find out some...
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Changes in Expression of Membrane Molecules CD200R, CD95, CD95L, and Soluble CD200R Regulating inflammatory Responses in Patients Undergoing Cardiac Surgery
Holmannová, Drahomíra ; Krejsek, Jan (advisor) ; Brát, Radim (referee) ; Turánek, Jaroslav (referee)
Cardiac surgery is known to initiate a complex physiological response with the immune system activation (SIRS), neurohormonal response, metabolic changes, coagulopathies etc. SIRS is triggered by tissue injury, myocardial ischemia, reperfusion, use of anaesthesia, cardioplegia, extracorporeal circuit etc. Excessive immune system activation is associated with progression of SIRS, life-threatening multi-organ dysfunction (MOD), and increased morbidity/mortality in the postoperative period. The immune system response is regulated and terminated by both cellular and humoral regulatory and inhibitory mechanisms including changes in expression of in our study monitored molecules: CD200/CD200R, sCD200R and CD95/CD95L. Methods: The study included the measurement the expression of CD95, CD95L, CD200R, and sCD200R molecules in granulocyte and monocyte populations in blood samples of 30 patients who underwent heart surgery using CPB. Samples collected before surgery, after surgery, and in the postoperative period (1st , 3rd , 7th day) were analysed by flow cytometry and sCD200R by ELISA. Results: We discovered a significant increase in the percentage of granulocytes expressing inhibitory molecule CD200R (from 5% to 17.8%) instantly after surgery. It might be presumed that these cells are less susceptible to...
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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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The Immune response in critically ill patients
Melichová, Jana ; Průcha, Miroslav (advisor) ; Zazula, Roman (referee)
Cardiosurgery is a potent activator of the immune response similar to sepsis in critically ill patients. Therefore the differential diagnostics of infectious and non-infectious etiology plays an important role. The aim of the study was to compare the biomarkers in the diagnostics of patients after cardiosurgery and in septic patients. 24 patients fulfilling criteria of sepsis and 8 patients after cardio surgery were involved in the study. We demonstrated higher specificity and sensitivity of PCT in comparison with CRP at diagnostics of sepsis. sTREM-1, expression of TREM-1 on monocytes, TREM-1 on granulocytes and the number of FoxP3+T regulatory lymphocytes do not provide a reliable differential diagnostics of infectious and non-infectious etiology of examined group of the patients. The number of lymphocytes in patients with sepsis is a useful parameter at this diagnostics. Cardiosurgery represent a significant impulse for the evocation of the systemic inflammatory response of non-infectious etiology.
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Cardio-Surgery Operation from the Patient´s Point of View
CHMELÍKOVÁ, Petra
With the hectic time of today, the number of people with cardio-vascular disorder increases continuously. A whole range of factors are the cause of this disorder. Among others, it is stress which people are mostly exposed to, due to the modern bustling style of life. Further, it is improper food, obesity, diabetes mellitus, smoking and many other reasons increasing the risk of this illness. In connection with cardio {--} vascular disorder, the patients may be confronted with the decision, whether to undergo a cardiac {--} surgery operation or not. The patients quite understandably go a whole range of emotions, anxiety and feelings in connection with the cardio-surgery operation. In our thesis, we determined 3 aims. In the first aim, we concentrated our attention on the cardio-surgery patient´s perceiving him himself, his family and his future in connection with the cardio-surgery operation. The aim was carried out. Four hypotheses refer to this aim. Hypothesis number 1: The cardio-surgery patient perceives the cardio-surgery operation as the result of his life style. Hypothesis number 2: After the heart operation, the cardio-surgery patient feels to have failed in the eye of his family. Hypothesis number 3: The psychic wellbeing of the cardio-surgery patient depends on the help and assistance of his family (background) during the time of his convalescence. Hypothesis number 4: The cardio-surgery patient believes to be able to join in a normal life, the same as before his health problem leading to the cardio-surgery operation has started. The second aim has to do with the most frequent anxieties the cardio-surgery patient must cope with in connection with the heart operation. The aim was carried out. To this aim, the hypothesis number 5 related: Highly specialized nursing care of a cardio-surgery patient is concentrated on the most frequent anxieties of these patients. The third aim was directed at non-saturated needs of the cardio-surgery patient during the time of his hospitalization after the operation. To this aim, the hypothesis number 6 applied: In the nursing care of a cardio-surgery patient, the problems arising from dissatisfying the psychic needs prevail over dissatisfying the basic needs. The dates for the purpose of the research examination were collected in the form of an anonymous questionnaire consisting of 32 questions. The question used here were both opened and closed. The questionnaires were given to hospitalized patients before and after the heart operation in 6 cardio-centers. The research complex was produced by 185 respondents. The results were graphically worked into column graphs and tables. In the research examination, 4 of 6 hypotheses were confirmed. The results of this work will be applicable with the work of the nurses at the cardio-surgery for the purpose of improving the nursing care of cardio-surgery patients.
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