1
|
Breel JS, de Klerk ES, Strypet M, de Heer F, Hermanns H, Hollmann MW, Eberl S. What Really Matters to Survivors of Acute Type A Aortic Dissection-A Survey of Patient-Reported Outcomes in the Dutch National Aortic Dissection Advocacy Group. J Clin Med 2023; 12:6584. [PMID: 37892723 PMCID: PMC10607692 DOI: 10.3390/jcm12206584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 10/09/2023] [Accepted: 10/13/2023] [Indexed: 10/29/2023] Open
Abstract
(1) Background: Type A acute aortic dissection (TAAAD) almost always requires emergency surgery, and postoperative complications are common. Quality assurance systems tend to measure only the hard outcomes, e.g., complications and mortality. Our aim was to assess the health-related quality of life of TAAAD survivors. (2) Methods: An anonymized, Dutch language, web-based survey was sent out to all of the participants of the 2022 Annual Meeting of the Dutch National Aortic Dissection (DNAD) advocacy group via their own representatives. The survey was divided into five sections: patient information, global satisfaction, surgery, including complications, and the recovery period. (3) Results: Ninety members of the DNAD group attended the meeting. Seventy-five (83%) participated in the survey, and the responses from 61 (81%) were available for analysis. Despite hindrances in their daily life (complications, changes in physical, cognitive, and social functioning), patients were satisfied with their treatment, and all would undergo the procedure again. In addition they requested better post-discharge guidance and communication (4) Conclusion: The emphasis lies in equipping patients with knowledge about potential outcomes and effective coping strategies. This underscores the importance of communication and expectation management, in line with established literature.
Collapse
Affiliation(s)
- Jennifer S. Breel
- Department of Anesthesiology, Amsterdam University Medical Centers, Location Meibergdreef, 1105 AZ Amsterdam, The Netherlands; (J.S.B.); (E.S.d.K.); (M.S.); (H.H.); (S.E.)
| | - Eline S. de Klerk
- Department of Anesthesiology, Amsterdam University Medical Centers, Location Meibergdreef, 1105 AZ Amsterdam, The Netherlands; (J.S.B.); (E.S.d.K.); (M.S.); (H.H.); (S.E.)
| | - Magnus Strypet
- Department of Anesthesiology, Amsterdam University Medical Centers, Location Meibergdreef, 1105 AZ Amsterdam, The Netherlands; (J.S.B.); (E.S.d.K.); (M.S.); (H.H.); (S.E.)
| | - Frederiek de Heer
- Department of Cardiac Surgery, Amsterdam University Medical Centers, Location Meibergdreef, 1105 AZ Amsterdam, The Netherlands;
| | - Henning Hermanns
- Department of Anesthesiology, Amsterdam University Medical Centers, Location Meibergdreef, 1105 AZ Amsterdam, The Netherlands; (J.S.B.); (E.S.d.K.); (M.S.); (H.H.); (S.E.)
| | - Markus W. Hollmann
- Department of Anesthesiology, Amsterdam University Medical Centers, Location Meibergdreef, 1105 AZ Amsterdam, The Netherlands; (J.S.B.); (E.S.d.K.); (M.S.); (H.H.); (S.E.)
| | - Susanne Eberl
- Department of Anesthesiology, Amsterdam University Medical Centers, Location Meibergdreef, 1105 AZ Amsterdam, The Netherlands; (J.S.B.); (E.S.d.K.); (M.S.); (H.H.); (S.E.)
| |
Collapse
|
2
|
Valenza G. Depression as a cardiovascular disorder: central-autonomic network, brain-heart axis, and vagal perspectives of low mood. FRONTIERS IN NETWORK PHYSIOLOGY 2023; 3:1125495. [PMID: 37260560 PMCID: PMC10228690 DOI: 10.3389/fnetp.2023.1125495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 05/04/2023] [Indexed: 06/02/2023]
Abstract
If depressive symptoms are not caused by the physiological effects of a substance or other medical or neurological conditions, they are generally classified as mental disorders that target the central nervous system. However, recent evidence suggests that peripheral neural dynamics on cardiovascular control play a causal role in regulating and processing emotions. In this perspective, we explore the dynamics of the Central-Autonomic Network (CAN) and related brain-heart interplay (BHI), highlighting their psychophysiological correlates and clinical symptoms of depression. Thus, we suggest that depression may arise from dysregulated cardiac vagal and sympathovagal dynamics that lead to CAN and BHI dysfunctions. Therefore, treatments for depression should target the nervous system as a whole, with particular emphasis on regulating vagal and BHI dynamics.
Collapse
|
3
|
Rousseaux F, Dardenne N, Massion PB, Ledoux D, Bicego A, Donneau AF, Faymonville ME, Nyssen AS, Vanhaudenhuyse A. Virtual reality and hypnosis for anxiety and pain management in intensive care units: A prospective randomised trial among cardiac surgery patients. Eur J Anaesthesiol 2022; 39:58-66. [PMID: 34783683 PMCID: PMC8654253 DOI: 10.1097/eja.0000000000001633] [Citation(s) in RCA: 36] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Virtual reality and hypnosis are little studied in complex contexts, such as intensive care, where patients need significant physical and psychological assistance. OBJECTIVES To compare and combine hypnosis and virtual reality benefits on anxiety and pain on patients before and after cardiac surgery. DESIGN Prospective randomised controlled clinical trial. SETTING The study was conducted in the University Hospital of Liege (Belgium) from October 2018 to January 2020. PATIENTS One hundred patients (66 ± 11.5 years; 24 women, 76 men) were included. Participants were adults undergoing cardiac surgery. Exclusion criteria: psychiatric diseases, claustrophobia, acrophobia, hearing loss, visual impairment, extreme fatigue, confusion surgery cancelled. INTERVENTIONS Patients were randomly assigned to four arms (control; hypnosis; virtual reality; virtual reality hypnosis) and had 20 min of one of the techniques the day before and the day after surgery. MAIN OUTCOMES MEASURES Anxiety, pain, fatigue, relaxation, physiological parameters, and opioid use were evaluated before and after each session. RESULTS The main results did not show any significant differences between the groups. In all groups, anxiety decreased and pain increased from baseline to the postoperative day. Relaxation increased in all groups in the pre-operative (P < 0.0001) and postoperative period (P = 0.03). There were no significant differences for fatigue, physiological measures, or opioid use. CONCLUSION As there were no significant differences between groups for the measured variables, we cannot affirm that one technique is better than another. Additional studies are required to compare and evaluate the cost-effectiveness of these techniques for critical care patients and caregivers. TRIAL REGISTRATION ClinicalTrials.gov: NCT03820700. https://clinicaltrials.gov/ct2/show/NCT03820700. Retrospectively registered on 29 January 2019.
Collapse
Affiliation(s)
- Floriane Rousseaux
- From the Laboratory of Cognitive Ergonomics and Work Intervention, University of Liege, ULiege (B32), Quartier Agora - Place des Orateurs (FR, AB, ASN), Algology Department, University Hospital of Liege, CHU Sart Tilman, Domaine Universitaire du Sart Tilman (MEF, AV), Sensation & Perception Research Group, GIGA Consciousness, University of Liege, GIGA (B34) (FR, AB, MEF, ASN, AV), Intensive Care Units, University Hospital of Liege (B35) (PBM, DL), Public Health Department, Biostatistics, University of Liege, CHU (B35) (ND, AFD) and Anesthesia & Intensive care, GIGA Consciousness, University of Liege, GIGA (B34), Quartier Hopital - Avenue de l'Hopital, Liege, Belgium (DL)
| | | | | | | | | | | | | | | | | |
Collapse
|
4
|
Vu T, Smith JA. An Update on Postoperative Cognitive Dysfunction Following Cardiac Surgery. Front Psychiatry 2022; 13:884907. [PMID: 35782418 PMCID: PMC9240195 DOI: 10.3389/fpsyt.2022.884907] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 05/23/2022] [Indexed: 12/14/2022] Open
Abstract
Postoperative cognitive dysfunction is extremely prevalent following cardiac surgery. The increasing patient age and comorbidity profile increases their susceptibility to cognitive impairment. The underlying pathophysiological mechanisms leading to cognitive impairment are not clearly elucidated. Using the contemporary literature (2015-present), this narrative review has three aims. Firstly, to provide an overview of postoperative cognitive impairment. Secondly, to analyse the predominant pathophysiological mechanisms leading to cognitive dysfunction following cardiac surgery such as inflammation, cerebral hypoperfusion, cerebral microemboli, glycaemic control and anaesthesia induced neurotoxicity. Lastly, to assess the current therapeutic strategies of interest to address these pathophysiological mechanisms, including the administration of dexamethasone, the prevention of prolonged cerebral desaturations and the monitoring of cerebral perfusion using near-infrared spectroscopy, surgical management strategies to reduce the neurological effects of microemboli, intraoperative glycaemic control strategies, the effect of volatile vs. intravenous anaesthesia, and the efficacy of dexmedetomidine.
Collapse
Affiliation(s)
- Tony Vu
- Department of Cardiothoracic Surgery, Monash Health, Melbourne, VIC, Australia.,Department of Surgery, School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC, Australia
| | - Julian A Smith
- Department of Cardiothoracic Surgery, Monash Health, Melbourne, VIC, Australia.,Department of Surgery, School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC, Australia
| |
Collapse
|
5
|
Kotani T, Inoue S, Uemura K, Kawaguchi M. Radiating pain during epidural needle insertion and catheter placement cannot be associated with postoperative persistent paresthesia: a retrospective review. JA Clin Rep 2021; 7:64. [PMID: 34410552 PMCID: PMC8377104 DOI: 10.1186/s40981-021-00460-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 05/15/2021] [Accepted: 07/06/2021] [Indexed: 12/01/2022] Open
Abstract
Background It has been suggested that radiating pain during spinal or epidural needle insertion and catheter placement can be an indicator of needle-related nerve injury. In this study, using a historical cohort, we investigated what factors could be associated with postoperative persistent paresthesia. In addition, we focused on radiating pain during epidural needle insertion and catheterization. Methods This was a retrospective review of an institutional registry containing 21,606 anesthesia cases. We conducted multivariate logistic analysis in 2736 patients, who underwent epidural anesthesia, using the incidence of postoperative persistent paresthesia as a dependent variable and other covariates, including items of the anesthesia registry and the postoperative questionnaire, as independent variables in order to investigate the factors that were significantly associated with the risk of persistent paresthesia. Results One hundred and seventy-six patients (6.44%) were found to have persistent paresthesia. Multivariate analysis revealed that surgical site at the extremities (odds ratio (OR), 12.5; 95% confidence interval (CI), 2.77–56.4; the reference was set at abdominal surgery), duration of general anesthesia (per 10 min) (OR, 1.02; 95% CI, 1.01–1.03), postoperative headache (OR, 1.78; 95% CI, 1.04–2.95), and days taken to visit the consultation clinic (OR, 1.03; 95% CI, 1.01–1.06) were independently associated with persistent paresthesia. Radiating pain was not significantly associated with persistent paresthesia (OR, 1.56; 95% CI, 0.69–3.54). Conclusion Radiating pain during epidural procedure was not statistically significantly associated with persistent paresthesia, which may imply that this radiating pain worked as a warning of nerve injury.
Collapse
Affiliation(s)
- Taichi Kotani
- Department of Anesthesiology and Division of Intensive Care, Nara Medical University, 840 Shijo-cho Kashihara, Nara, 634-8522, Japan
| | - Satoki Inoue
- Department of Anesthesiology, Fukushima Medical University, 1 Hikarigaoka, Fukushima, Fukushima, 960-1295, Japan.
| | - Keiko Uemura
- Department of Anesthesiology and Division of Intensive Care, Nara Medical University, 840 Shijo-cho Kashihara, Nara, 634-8522, Japan
| | - Masahiko Kawaguchi
- Department of Anesthesiology and Division of Intensive Care, Nara Medical University, 840 Shijo-cho Kashihara, Nara, 634-8522, Japan
| |
Collapse
|
6
|
Catrambone V, Messerotti Benvenuti S, Gentili C, Valenza G. Intensification of functional neural control on heartbeat dynamics in subclinical depression. Transl Psychiatry 2021; 11:221. [PMID: 33854037 PMCID: PMC8046790 DOI: 10.1038/s41398-021-01336-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 03/30/2021] [Indexed: 01/06/2023] Open
Abstract
Subclinical depression (dysphoria) is a common condition that may increase the risk of major depression and leads to impaired quality of life and severe comorbid somatic diseases. Despite its prevalence, specific biological markers are unknown; consequently, the identification of dysphoria currently relies exclusively on subjective clinical scores and structured interviews. Based on recent neurocardiology studies that link brain and cardiovascular disorders, it was hypothesized that multi-system biomarkers of brain-body interplay may effectively characterize dysphoria. Thus, an ad hoc computational technique was developed to quantify the functional bidirectional brain-heart interplay. Accordingly, 32-channel electroencephalographic and heart rate variability series were obtained from 24 young dysphoric adults and 36 healthy controls. All participants were females of a similar age, and results were obtained during a 5-min resting state. The experimental results suggest that a specific feature of dysphoria is linked to an augmented functional central-autonomic control to the heart, which originates from central, frontopolar, and occipital oscillations and acts through cardiovascular sympathovagal activity. These results enable further development of a large set of novel biomarkers for mood disorders based on comprehensive brain-body measurements.
Collapse
Affiliation(s)
- Vincenzo Catrambone
- Research Center E. Piaggio & Department of Information Engineering, School of Engineering, University of Pisa, 56126, Pisa, Italy.
| | | | - Claudio Gentili
- grid.5608.b0000 0004 1757 3470Department of General Psychology, University of Padua, 35131 Padua, Italy
| | - Gaetano Valenza
- grid.5395.a0000 0004 1757 3729Research Center E. Piaggio & Department of Information Engineering, School of Engineering, University of Pisa, 56126 Pisa, Italy
| |
Collapse
|
7
|
Assessing mood symptoms through heartbeat dynamics: An HRV study on cardiosurgical patients. J Psychiatr Res 2017; 95:179-188. [PMID: 28865333 DOI: 10.1016/j.jpsychires.2017.08.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 08/20/2017] [Accepted: 08/25/2017] [Indexed: 12/18/2022]
Abstract
BACKGROUND Heart Rate Variability (HRV) is reduced both in depression and in coronary heart disease (CHD) suggesting common pathophysiological mechanisms for the two disorders. Within CHD, cardiac surgery patients (CSP) with postoperative depression are at greater risk of adverse cardiac events. Therefore, CSP would especially benefit from depression early diagnosis. Here we tested whether HRV-multi-feature analysis discriminates CSP with or without depression and provides an effective estimation of symptoms severity. METHODS Thirty-one patients admitted to cardiac rehabilitation after first-time cardiac surgery were recruited. Depressive symptoms were assessed with the Center for Epidemiologic Studies Depression Scale (CES-D). HRV features in time, frequency, and nonlinear domains were extracted from 5-min-ECG recordings at rest and used as predictors of "least absolute shrinkage and selection" (LASSO) operator regression model to estimate patients' CES-D score and to predict depressive state. RESULTS The model significantly predicted the CES-D score in all subjects (the total explained variance of CES-D score was 89.93%). Also it discriminated depressed and non-depressed CSP with 86.75% accuracy. Seven of the ten most informative metrics belonged to non-linear-domain. LIMITATIONS A higher number of patients evaluated also with a structured clinical interview would help to generalize the present findings. DISCUSSION To our knowledge this is the first study using a multi-feature approach to evaluate depression in CSP. The high informative power of HRV-nonlinear metrics suggests their possible pathophysiological role both in depression and in CHD. The high-accuracy of the algorithm at single-subject level opens to its translational use as screening tool in clinical practice.
Collapse
|
8
|
Gentili C, Valenza G, Nardelli M, Lanatà A, Bertschy G, Weiner L, Mauri M, Scilingo EP, Pietrini P. Longitudinal monitoring of heartbeat dynamics predicts mood changes in bipolar patients: A pilot study. J Affect Disord 2017; 209:30-38. [PMID: 27870943 DOI: 10.1016/j.jad.2016.11.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Revised: 10/23/2016] [Accepted: 11/07/2016] [Indexed: 12/12/2022]
Abstract
OBJECTIVES Recent research indicates that Heart Rate Variability (HRV) is affected in Bipolar Disorders (BD) patients. To determine whether such alterations are a mere expression of the current mood state or rather contain longitudinal information on BD course, we examined the potential influence of states adjacent in time upon HRV features measured in a target mood state. METHODS Longitudinal evaluation of HRV was obtained in eight BD patients by using a wearable monitoring system developed within the PSYCHE project. We extracted time-domain, frequency-domain and non-linear HRV-features and trained a Support Vector Machine (SVM) to classify HRV-features according to mood state. To evaluate the influence of adjacent mood states, we trained SVM with different HRV-feature sets: 1) belonging to each mood state considered alone; 2) belonging to each mood state and normalized using information from the preceding mood state; 3) belonging to each mood state and normalized using information from the preceding and subsequent mood states; 4) belonging to each mood state and normalized using information from two randomly chosen states. RESULTS SVM classification accuracy within a target state was significantly greater when HRV-features from the previous and subsequent mood states were considered. CONCLUSIONS Although preliminary and in need of replications our results suggest for the first time that psychophysiological states in BD contain information related to the subsequent ones. Such characteristic may be used to improve clinical management and to develop algorithms to predict clinical course and mood switches in individual patients.
Collapse
Affiliation(s)
- Claudio Gentili
- Department of General Psychology, University of Padua, Via Venezia 8, 35139 Padua, Italy.
| | - Gaetano Valenza
- Department of Information Engineering & Research Centre "E. Piaggio", School of Engineering, University of Pisa, Italy
| | - Mimma Nardelli
- Department of Information Engineering & Research Centre "E. Piaggio", School of Engineering, University of Pisa, Italy
| | - Antonio Lanatà
- Department of Information Engineering & Research Centre "E. Piaggio", School of Engineering, University of Pisa, Italy
| | - Gilles Bertschy
- INSERM U1114, Fédération de Médecine Translationnelle de Strasbourg, Université de Strasbourg, Pôle de Psychiatrie et Santé Mentale des Hôpitaux Universitaires de Strasbourg, France
| | - Luisa Weiner
- INSERM U1114, Fédération de Médecine Translationnelle de Strasbourg, Université de Strasbourg, Pôle de Psychiatrie et Santé Mentale des Hôpitaux Universitaires de Strasbourg, France
| | - Mauro Mauri
- Section of Psychiatry, Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - Enzo Pasquale Scilingo
- Department of Information Engineering & Research Centre "E. Piaggio", School of Engineering, University of Pisa, Italy
| | - Pietro Pietrini
- IMT School for Advanced Studies, Piazza San Ponziano, 6 - 55100 Lucca, Italy.
| |
Collapse
|