Marina S. Grekova

Aim. To identify biomarkers for prediction and early diagnosis of infectious and inflammatory complications in patients after aortic surgery.Materials and methods. The study included 57 patients who underwent surgical procedures on the aorta and its branches under cardiopulmonary bypass and myocardial ischemia. The cohort was divided into two groups: patients with an uneventful postoperative period (group 1, N=35) and patients with local infectious and inflammatory complications after surgery (group 2, N=22). Serum levels of procalcitonin (PCT), interleukins (IL-6 and IL-10), and aromatic microbial metabolites (AMM) were measured before surgery, upon admission, and six hours after admission to the ICU. On postoperative days 3 and 6 neutrophil, lymphocyte, and platelet counts were assessed, and neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) were calculated.Results. There were no significant differences in sex, age, or comorbidities between groups 1 and 2. Patients in group 2 had a more severe intraoperative period and required a longer ICU stay. Predictive markers of complications included IL-6143.35 pg/mL at ICU admission (sensitivity 42.9%, specificity 90.9%, AUC 0.789, 95% CI 0.669–0.909, P0.001); PCT0.12 ng/mL 6 hours after ICU admission (sensitivity 90.9%, specificity 54.3%, AUC 0.762, 95% CI 0.634–0.891, P0. 001); NLR 7.8 on postoperative day 3 (sensitivity 72.7%, specificity 68.6%, AUC 0.710, 95% CI 0.571–0.850, P=0.003); and AMM (before and after surgery) 0.185 (sensitivity 77.3%, specificity 71.4%, AUC 0.780, 95% CI 0.651–0.909, P0.001).Conclusion. Values of IL-6, PCT, NLR, and AMM reflect different features of the inflammation and can be used for prediction and early diagnosis of infectious and inflammatory complications in cardiac surgery patients.

INTRODUCTION: Respiratory rehabilitation used for cardiac surgery patients with impaired sputum evacuation, is an important aspect of the prevention of postoperative pulmonary complications. OBJECTIVE: To compare the effectiveness of the external percussion and vibroacoustic chest massage, against of the planned incentive spirometry in the early postoperative period of cardiosurgery patients. MATERIALS AND METHODS: A randomized prospective study included 90 patients who underwent elective cardiac surgery. Vibroacoustic lung massage (VLM) was performed with “VibroLUNG”in the 1st group (30 patients), high-frequency percussion of the chest followed by the intermittent airway pressure (HFP+IP) with “Comfort Cough Plus” devise was performed in the 2nd group (30 patients). Procedures started 10–12 hours after trachea extubation and were performed 3 times a day during 3 days after surgery. A control group included 30 patients in whom incentive spirometry was used. The following parameters were measured on the 1st and 3rd days: SpO2 (on room air) and volumetric parameters using bedside spirometry. RESULTS: VLM improved sputum clearance, increased mean SpO2 by 4 % (p < 0.001), reduces the number of patients with low MIC (maximal inspiratory capacity < 1200 ml) by 3.6 times (p = 0.004) and increase mean VC (Vital Capacity) by 432 ml (p = 0.034). HFP-IP increased mean SpO2 by 4.5 % (p < 0.001), decreased the number of patients with MIC ≤ 1200 ml by 5.7 times (p = 0.002), and increase mean VC by 574 ml (p = 0.016). In the control group no significant changes were noted. Respiratory rehabilitation decreased the number of the patients with radiological signs of hypoventilation: in the group of VLM by 7.33 times (p < 0.001), and in the group of HFP+IP by 6.48 times (p = 0.001). СONCLUSIONS: Methods of mechanical impact on the chest wall during postoperative rehabilitation of cardiosurgical patients are safe. They have a positive effect on the bronchopulmonary clearance and significant advantages over the control in their effect of sputum clearance, gas exchange, respiratory function and Xray signs of hypoventilation.

INTRODUCTION: Microbiota metabolism disturbance, assessed by the dynamics of clinically significant aromatic metabolites in the blood, plays an important role in the development of complications after cardiac surgery, which is the basis for the search for a new prevention strategy. OBJECTIVES: To evaluate the feasibility of microbial metabolism modulation using antibiotics-inhibitors of protein synthesis in bacterial cell for prevention of infectious-inflammatory complications after cardiac surgery. MATERIAL AND METHODS: A randomized prospective interventional study was conducted, including patients (n = 58) who underwent planned surgical intervention on the heart and main vessels under artificial circulation and were divided into group I — main group — patients with microbial metabolism modulation using antibiotics-inhibitors of protein synthesis (n = 30), group II — control group — patients without microbial metabolism modulation (n = 28). Blood serum samples from patients were taken before surgery, on the 3rd and 6th days of the postoperative period, in which clinical blood parameters, biomarkers, and concentrations of clinically significant aromatic acids were determined. RESULTS: In groups I and II postoperative complications were observed in 6 and 8 patients, respectively. Groups I and II differed significantly in the frequency of pneumonia (0 vs. 5 patients, respectively, p = 0.016). The spectrum of microorganisms determined in group II was significantly wider. In group I there was a more significant decrease in 4-hydroxyphenylacetic acid (p-HPhAA) concentration between baseline and postoperative values on the 3rd and 6th day, compared to group II (p = 0.016 and p = 0.005, respectively). The sum of aromatic metabolites on the 3rd day and p-HPhAA on the 6th day had a good predictor significance in relation to the complication development (sensitivity 100 % in both cases; specificity 81.5 % and 92.6 %, respectively). CONCLUSIONS: Prophylactic use of antibiotics-inhibitors of microbial protein synthesis allows to reliably reduce the degree of microbiota metabolism dysfunction and the frequency of pneumonia development in the early postoperative period.

INTRODUCTION: Hematological indices are available, universal predictors and markers of infectious and non-infectious pathological conditions. OBJECTIVE: To determine the predictive ability of hematological indices in relation to the development of postoperative complications in patients undergoing reconstructive interventions on the aorta. MATERIALS AND METHODS: A prospective, observational, single-center study included 79 patients who underwent elective aortic surgery under cardiopulmonary bypass. Age of participants 57 (46.5; 64) years, Charlson comorbidity index 4 (2; 5), cardiopulmonary bypass duration 123 (101; 160) minutes, myocardial ischemia 91 (66; 115) minutes. The patients were divided into two groups: I — without complications, II — with complications. RESULTS: Neutrophil to lymphocyte ratio (NLR) on day 3 in group I was 6.17 (4.1; 8.7), in group II — 9.56 (6.68; 12.46), p = 0.002. NLR on day 6 in group I was 3.79 (2.77; 5.1), in group II — 6.0 (4.3; 9.1), p = 0.001. NLR > 7.5 on day 3 was a predictor of complications in the postoperative period, OR = 4.6 (95 % CI 1.8–11.9, p = 0.002). NLR on day 6 > 5.0 also showed a predictive ability: OR = 4.9 (95 % CI 1.9–12.7, p = 0.001). Platelet to lymphocyte ratio (PLR) on day 3 in group I was 103.88 (78.87; 133.57), by day 6 it increased to 117.5 (104.63; 160.78); in group II, there was practically no increase in PLR: from 122 (88.46; 160.25) to 127.06 (108.40; 154.14). Differences between the indicators in groups were not statistically significant. CONCLUSIONS: Hematological indices can be used as predictors of complications in patients after surgery on the aorta and its branches. Patients with NLR > 7.5 on day 3 and > 5.0 on day 6, regardless of comorbidities and age, may represent a previously unrecognized subgroup of patients with an increased risk of postoperative complications.

Postoperative complications in cardiovascular surgery remain an important unresolved problem, in particular in patients with aortic aneurysm. The role of the altered microbiota in such patients is of great interest. The aim of this pilot study was to determine whether the development of postoperative complications in patients with aortic aneurysm is related with initial or acquired disorders of microbiota metabolism by monitoring the level of some aromatic microbial metabolites (AMMs) circulating in the blood before the surgery and in the early postoperative period. The study comprised patients with aortic aneurysm (n = 79), including patients without complications (n = 36) and patients with all types of complications (n = 43). The serum samples from the patients were collected before and 6 h after the end of the surgery. The most significant results were obtained for the sum of three sepsis-associated AMMs. This level was higher before the surgery in comparison with that of healthy volunteers (n = 48), p < 0.001, and it was also higher in the early postoperative period in patients with all types of complications compared to those without complications, p = 0.001; the area under the ROC curve, the cut-off value, and the odds ratio were 0.7; 2.9 µmol/L, and 5.5, respectively. Impaired microbiota metabolism is important in the development of complications after complex reconstructive aortic surgery, which is the basis for the search for a new prevention strategy.

Postoperative pulmonary complications in cardiac surgery patients occur in 10-35% of cases, depending on differences in their definition, patient characteristics and type of surgical intervention, most of them are associated with ineffective coughing and evacuation of bronchial secretions. OBJECTIVE To determine the effectiveness of stimulating the evacuation of bronchial secretions with the help of oscillating PEP therapy carried out during the first three days. MATERIAL AND METHODS A randomized prospective study of 60 adult patients after elective cardiac surgery was performed (Clinical Trials.gov. protocol number NCT05159401). Oscillatory PEP-therapy was performed in 30 patients using Acapella DHGreen device (SmithMedicalASD, USA) 10—12 hours after tracheal extubation 3 times a day for 3 days after surgery. The control group (30 patients). The inclusion criteria: age over 18 years, spontaneous breathing after tracheal extubation, clear consciousness and productive contact with the patient, the ability to maintain adequate gas exchange on the low-flow oxygen inhalation, adequate analgesia (10), shocks syndrome of various etiologies, the use of any extracorporeal support, any neuromuscular disorders, pneumothorax, hydro-or hemothorax. Before each session and 20 minutes after its end, when breathing air, blood oxygen saturation was recorded using a pulse oximeter (SpO₂), the maximum inspiratory capacity (MIC) was measured using a Coach-2 incentive spirometer from SmithsMedical and spirometry with a portable ultrasonic spirometer Spiro Scout (Schiller, Switzerland). For the purposes of this work, the total index of the spirometry maximum inspiratory capacity (SMIC) was used — the sum of the respiratory volume and the reserve volume of inspiration in ml. RESULTS Difficulties in evacuation of sputum were noted in 90% of patients. Three-day sessions of oscillating PEP- therapy are accompanied by a significant improvement in the passage of sputum, as evidenced by a 3-fold increase in the number of patients with productive cough. The increase in MIC in the main group was 46.9% and 21.3%, respectively (p=0.042), and the number of patients with values greater than MICo. 1500 ml increased from 23.3% to 7.6% (pp2≤92%) decreased by 8.6 times after completion of all PEP- therapy sessions (p=0.001), however, without statistically significant difference with the control group. CONCLUSIONS Oscillatory PEP- therapy in cardiac surgery patients has a positive effect on sputum passage, ventilation parameters and oxygenating lung function. The procedure was well tolerated and there were no complications associated with it.

Коррекция эндотоксемии и профилактика шока с помощью многократной сорбции липополисахарида: описание клинического случая и анализ данных литературы