BACKGROUND: Respiratory complications remain a major cause of morbidity in cardiac surgery patients. This study aimed to determine the prognostic parameters associated with the application of noninvasive ventilation (NIV) for the treatment of acute respiratory failure, along with the possible predictors associated with NIV failure, among the subjects who underwent cardiac surgery. METHODS: This was a retrospective cohort study. Data on all adult patients who underwent cardiac surgery in a single center between May 2012 and December 2016 were analyzed. Multivariate regression analysis with bootstrapping was used to identify which baseline and intraoperative parameters were associated with the application of NIV to treat acute postoperative respiratory failure. A univariate analysis was also applied to identify potential variables associated with NIV failure. P < .05 was considered significant. RESULTS: A total of 1,657 subjects (mean ± SD age 65.2 ± 10.7 y; 21.7% females) constituted the study population, 145 (8.8%) of whom were treated with NIV due to acute postoperative respiratory failure. Body mass index adjusted odds ratio 1.02, bias-corrected 95% CI 1.01–1.04), EuroSCORE (European System for Cardiac Operative Risk Evaluation) II (adjusted odds ratio 1.11, bias-corrected 95% CI 1.02–1.32), COPD (adjusted odds ratio 4.004, bias-corrected 95% CI 2.53–8.93), and preoperative estimated glomerular filtration rate (adjusted odds ratio 0.99, bias-corrected 95% CI 0.98–0.99) independently predicted NIV application. NIV treatment failed in 16 of the 145 subjects (11%) and age, EuroSCORE II, COPD, heart failure, renal replacement therapy, and postoperative stroke were all univariately associated with the outcome. CONCLUSIONS: NIV successfully treated acute respiratory failure in the vast majority of cardiac surgery subjects and COPD, EuroSCORE II, body mass index, and preoperative renal function were independently associated with its application.
Lipomatous hypertrophy of atrial septum (LHAS) is a rare benign cardiac condition characterized by fatty tissue infiltration located in the atrial septum. We presented a rare case of LHAS resulting in recurrent syncopal attacks.
Background: Postoperative thrombocytopenia is a frequent finding after cardiac surgery, affecting approximately 10–40% of patients. The early decline in platelet count, typically observed within the first 48–72 h, is usually explained by hemodilution, perioperative platelet consumption, and the inflammatory or mechanical impact of cardiopulmonary bypass (CPB). However, a secondary decrease occurring beyond postoperative day 5 should raise suspicion for more serious causes, the most important being heparin-induced thrombocytopenia (HIT), a rare but potentially life-threatening complication. Objectives: This review aims to outline the characteristic patterns of postoperative thrombocytopenia in cardiac surgery, provide a practical framework for differential diagnosis, and summarize up-to-date evidence on the diagnosis and management of HIT. Methods: A narrative review was conducted through searches in PubMed, Scopus, and Embase up to September 2025. Conclusions: Recognizing platelet count trends early and applying a stepwise diagnostic approach can help distinguish benign postoperative thrombocytopenia from HIT and other critical causes. The combination of clinical assessment using the 4Ts score and appropriate confirmatory testing remains central to accurate diagnosis. Tailoring anticoagulant therapy to individual patient requirements—including surgical procedure, renal and hepatic function, and bleeding risk—is essential for reducing thrombotic events and improving postoperative outcomes.
Abdominal compartment syndrome is associated with severe dysfunction of intra-abdominal and intrathoracic organs. Medical therapy, with the goal of reducing intra-abdominal pressure, leads to improvement in organ perfusion.
Tracheal rupture is a very rare but life-threatening complication of endotracheal intubation. It is more common in women and patients older than 50 years old. Overinflation of endotracheal tube cuff and tracheal wall weakening are the most important pathogenetic mechanisms. Laceration sites are located in the posterior membranous wall in most cases. Subcutaneous and mediastinal emphysema and respiratory distress are the most common manifestations. A 55-year-old female presented with postoperative subcutaneous and mediastinal emphysema without dyspnea because of a tear in the posterior tracheal wall. The diagnosis was based on clinical manifestation, chest computer tomography scans (CT), and endoscopic findings. A conservative approach by broad-spectrum antibiotic therapy was decided because of patients’ vital signs stability and the absence of esophageal injury. The follow-up showed that there was no lesion in the posterior tracheal wall. Our case showed that in clinically stable patients without mediastinitis and with spontaneous breathing, conservative management of tracheal tears is a safe procedure.
About Me
Pneumonologist Intensivist
ICU Director
George Papnikolaou General Hospital
Thessaloniki Greece
Pneumonologist Intensivist
ICU Director
George Papnikolaou General Hospital
Thessaloniki Greece