Background/Introduction: Recently, malnutrition has been shown to be related with worse clinical outcomes in patients with heart failure.However, the association between nutritional status and clinical outcomes in patients with coronary artery disease (CAD) remains unclear.Purpose: To investigate the prognostic value of malnutrition assessed by the Controlling Nutritional Status (CONUT, range 0-12, higher=worse, consisting of serum albumin, cholesterol and lymphocytes) in patients with CAD.Methods: The CONUT score was measured on admission in a total of 1,987 patients with CAD who underwent elective percutaneous coronary intervention (PCI) between 2000 and 2011.Patients were divided into two groups according to the CONUT score (0-1 vs. 2≤).The incidence of major adverse cardiac events (MACE), including all-cause death and non-fatal myocardial infarction, was evaluated.Results: The median CONUT score was 1 (interquartile range: 0 to 2).During the median follow-up of 7.4 years, 342 events occurred (17.2%).Kaplan-Meier curves revealed that the patients with high CONUT score had higher events rate for MACE (Log-rank p<0.0001).Higher CONUT score showed significant increase in the incidence of MACE compared with low CONUT score, even after adjustment for confounding factors (HR 1.64, 95% CI 1.30-2.07,p<0.0001).Adding CONUT score to a baseline model with established risk factors improved the C-index (p=0.02),net reclassification improvement (p=0.004), and integrated discrimination improvement (p=0.0003). Kaplan-Meier curves for MACEConclusions: Nutritional status assessed by CONUT score was significantly associated with long-term clinical outcomes in patients with CAD.Pre PCI assessment of CONUT score may provide useful prognostic information.

Despite all the evidence underlining the benefits of early mobilisation in the ICU, barriers are still common in clinical situations. Participants of two roundtable conferences were asked to identify the strengths and weaknesses of early mobilisation in four domains pre-identified by experts in the field. For successfully implementing early mobilisation, there seemed to be a need for a driving force on the ward, a patient-coordinator at the patient's bedside, modern equipment and a good work environment. Barriers to early mobilisation are identifiable on two levels: institution-related barriers and patient-related barriers. Successful implementation requires locally adapted tailored strategies.

The principles of extracorporeal life support started with the first experimental efforts of Jean Baptiste Denis who circa 1693 performed a cross-transfusion of the blood of a human with the "gentle humors of a lamb" to determine whether living blood could be transmitted between two creatures [1]. However, clinical efforts to provide extracorporeal support began around 1930 with the work of John and Mary Gibbon. They developed a freestanding roller pump device for extracorporeal support after the death of a patient from a pulmonary embolus. Sixteen years later, the first human use of the device was performed in the operating room to assist during repair of an atrial septal defect in 1953. After some years, the use of the silicone membrane oxygenator, which was developed to allow recovery outside the operating room, led to the use of the term extracorporeal membrane oxygenation (ECMO). In the 1960s, with the development of gas-exchange devices, a silicone rubbermembrane was interposed between the blood and the oxygen. This modification (and others) allowed the use of a heart-lung machine for days or weeks [3] reducing the threshold for their use. In 1972, Dr Bartlett successfully provided ECMO support to a two-year old boy following a Mustard procedure for correction of transposition of the great vessels with subsequent cardiac failure. The patient underwent ECMO support for 36 h until recovery. In 1975, the first neonate (Esperanza) with respiratory failure underwent ECMO support for 72 h and was successfully decannulated.

Pulmonary vascular resistance (PVR) has been used to assess right ventricular afterload; however, this is considered meaningless due to several physiologic shortcomings. Echocardiography has often been used to assess right ventricular (RV) afterload, but this has never been validated as an index of RV afterload. The purpose of this study is to evaluate echocardiographic indices of RV afterload in an experimental, open-pericardium pig model with induced, variable main pulmonary artery stenosis.

Cardiac surgery is associated with a pulmonary and systemic inflammatory response. The pulmonary effects of this inflammatory reaction are often modest: decreased lung compliance, pulmonary edema, increased intrapulmonary shunt fraction and decreased functional residual capacity (FRC) [1]. Less than 2% of patients undergoing cardiac surgery develop full blown respiratory failure, the acute respiratory distress syndrome (ARDS) [1]. For example, after cardiac surgery, FRC is reduced up to 40–50% during the first 24 hours after extubation [2]. However, after general anesthesia, FRC is only decreased by 20–30% [3]. This exaggerated disturbance of pulmonary function is not yet fully understood. It has been suggested that this impaired pulmonary function is the result of pulmonary inflammation, triggered by cardiopulmonary bypass (CPB), ischemia-reperfusion injury, the surgical procedure itself, or by mechanical ventilation.

Objective. To identify objective trends of the course of illness that might be used as benchmarks in the auditing of the organization/performance of Intensive Care Units (ICU).

A pilot-study was done to investigate the applicability of the sickness impact profile (SIP) in ex-ICU patients. For this study 221 consecutively admitted patients were reviewed retrospectively after excluding children, deceased patients and readmissions. SIP was assessed in these patients by either interview or questionnaire. These were divided into three groups: i) Patients interviewed at home (n = 26). ii) Patients receiving the SIP-questionnaire by mail (n = 93). iii) As for group ii, but after receiving a telephone invitation to participate (n = 102). Highest mean SIP-score was found in group i (16.3). Groups ii and iii scored 10.2 and 7.9 respectively. Analysis of variance demonstrated overall SIP-scores of these groups to be significantly different. The response in group iii (77%) was significantly higher compared to group ii (56%). Data collection in Group i appeared to be most expensive costing $13.20 per patient, followed by group iii ($3.79) and group ii ($2.56). It is concluded that the self-administered SIP is suitable for measuring outcome in ICU-patients and is much cheaper than the direct interview technique. The 3 different approaches should be considered as independent methods of which individual results cannot be compared. The response can be improved significantly by calling the patients before sending the questionnaire.