Andrejaitienė, Judita
Item type:Publication, research article[2026][S1][M001,T010][8]; ; ; ; ; ; Perfusion, 2026-04-30, vol. 41, no. 4, p. 462-469Introduction Postoperative delirium affects up to 60% of cardiac surgical patients. No reliable gold standard method exists for preventing delirium after cardiac surgery. An example of patient-personal monitoring is cerebral autoregulation (CA). This study aims to highlight the personal monitoring of patients' cerebral autoregulation and to determine its relationship with postoperative delirium. Additionally, it seeks to test the hypothesis that the duration of CA impairment influences the onset of postoperative delirium. Methods A prospective study was conducted in 2021-2023. After approval of the Ethics Committee and with the patient's written consent, 104 adult patients undergoing elective coronary artery bypass graft (CABG) with cardiopulmonary bypass (CPB) surgery were enrolled. To diagnose possible delirium, all patients underwent a Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) test. CA monitoring using transcranial Doppler was performed. CA status index - Mx was recorded. Results Our study found that 12.5% of patients were diagnosed with delirium after on-pump CABG surgery. The total duration of cerebral autoregulation impairment (TCAI) was longer in the delirium group, 4783.0 seconds versus 4204.5 seconds (p = .047), with a cut-off at 4380 s. Longer cardiopulmonary bypass (CPB) leads to prolonged CA impairment (p < .001). The mean arterial pressure (MAP) during CPB was 69.67 mmHg in the non-delirium group and 74.91 mmHg in the delirium group (p = .001), with a cutoff at 73.669 mmHg. Conclusions CA impairment is crucial for delirium development after cardiac surgery. The duration of the TCAI event increases the risk of delirium.
36 Item type:Publication, research article[2026][S1][M001][11]; ; Medicina, 2026-01-01, vol. 62, no. 1, p. 1-11Background and Objectives: Coronary artery bypass grafting (CABG) is one of the most common cardiac surgeries worldwide. However, postoperative cognitive decline (POCD) remains a significant concern, affecting a substantial proportion of patients. One of the pathogenic mechanisms underlying POCD involves inflammatory responses and oxidative stress. Dexamethasone, a corticosteroid with potent anti-inflammatory properties, has been proposed as a potential neuroprotective agent. This study aimed to assess the effect of a single perioperative dose of dexamethasone on postoperative cognitive function in patients undergoing CABG surgery. Materials and Methods: This retrospective cohort study was conducted at the Hospital of Lithuania. Inclusion criteria: elective CABG surgery, non-neurocognitive anamnesis, Minimal Mental State Examination score ≥25 before surgery, and age >50. Patients were divided into two groups: DEXA (those who received preoperative dexamethasone 0.1 mg/kg) and non-DEXA (those who did not). Cognitive functions were assessed with the Addenbrooke’s Cognitive Examination test (ACE-III) 7 days post operation. Results: The study enrolled 60 patients (DEXA = 30, non-DEXA = 30): male (85%), female (15%). The mean age of the study was 66.1 ± 8.1 and the education was 12 (12–30) years. The groups were similar in the evaluated preoperative characteristics (sex, age, education) (p > 0.05). Cognitive impairment (ACE-III score cut–off 88 points) was identified in 40% (n = 12) of participants in the DEXA and 69.3% (n = 21) in the non-DEXA group, with no statistically significant difference between groups (p = 0.073). However, the DEXA group had significantly better cognitive scores in attention (Z = 3.145, p = 0.002), fluency (Z = 2.25, p = 0.024), and spatial ability (Z = 4.444, p < 0.001) while language (Z = 1.167, p = 0.243) and memory scores (Z = 1.906, p = 0.057) showed no significant differences. Conclusions: These findings suggest that dexamethasone may provide neuroprotective benefit, reducing postoperative cognitive function domains, such as attention, fluency, and spatial ability, after CABG surgery. Further prospective studies are needed to confirm these findings.
30 Item type:Publication, book[2025][K2d][M005][35]; ; ; ; ; ; ; ; ; Kaunas : LSMU Akademinė leidyba, 2025-12-316 Item type:Publication, [Askorbo rūgšties poveikis endotelio glikokaliksui širdies operacijų metu]journal article[2025][S4][M001][5]Cardiac surgery is associated with oxidative stress and systemic inflammation, which both contribute to postoperative organ dysfunction. Vitamin C is a pleiotropic, antioxidant, and potentially organ–protective micronutrient. It also influences coagulation and inflammation, and its application might prevent organ damage. Complications after heart surgery have received considerable attention because of their influence on clinical outcomes. This review explores the role of vitamin C in protecting the endothelial glycocalyx during cardiac surgery. Endothelial glycocalyx is a delicate, gel–like layer lining the blood vessels, vital for vascular stability and microcirculation. Cardiac surgery induces oxidative stress and systemic inflammation, leading to its degradation and increased risk of organ dysfunction. Vitamin C, with its potent antioxidant and anti-inflammatory properties, helps to preserve endothelial glycocalyx integrity. Perioperative vitamin C supplementation improves microcirculation, reduces biomarkers of endothelial glycocalyx damage, and may shorten recovery time after cardiac operations. The evidence supports considering vitamin C as a cost– effective adjunct to improve postoperative outcomes in cardiac patients.
24 Item type:Publication, [Daugiarūšis neuromonitoringas širdies chirurgijoje: dėmesys elektroencefalografijos metodui]journal article[2025][S4][M001][6]Neurological complications after cardiac surgery, ranging from temporary cognitive issues to severe strokes, are a major concern, especially for elderly patients. Many individuals over 70 already have a history of neurological conditions, which increases their risk of complications and long-term effects. Serious neurological events, such as strokes, occur in up to 6% of cardiac surgery patients. Given the vulnerability of these patients, prevention is crucial. Several factors can contribute to neurological damage during surgery, including embolism, inflammation, anemia, and arterial disease, however hypoperfusion is usually the main cause. Over the years, various systems have been developed to monitor brain oxygen levels and help doctors maintain proper cerebral perfusion. Neuromonitoring during cardiac surgery utilizes multiple techniques to assess cerebral perfusion and oxygenation, such as near infrared spectroscopy, transcranial Doppler, and jugular venous bulb saturation monitoring – as well as cerebral function, monitored through both processed and raw electroencephalography. Electroencephalography in cardiac surgery is used to assess cerebral function, depth of anesthesia, and detect signs of neurological damage. It can help guide anesthetic management, ensuring adequate brain protection during surgery.
21 - conference paper[2025][T2][M001][1]
; ; BaltAnestIC 2025 : 13th International Baltic Congress of Anaesthesiology and Intensive Care : September 18-20, 2025 Kaunas, Lithuania : Abstract book, 2025-09-18, p. 17-17Introduction: Refractory vasoplegic shock affects 5 – 25% of patients after cardiac surgery with cardiopulmonary bypass (CPB) and is often resistant to conventional therapies for shock therefore increasing the risk of complications associated with prolonged ICU hospitalization and mortality (1, 2). Norepinephrine and epinephrine have been the standard of care for vasoplegic shock, but unique pharmacology and its lack of inotropic activity suggests vasopressin as the first line drug for patients with vasoplegic shock (3). Objectives: analyze the case for better understanding of vasoplegic shock and its clinical manifestation in the patient; evaluate vasopressin and non-vasopressin alternatives on the clinical and patient-centered outcomes of vasoplegic shock in adult intensive care unit patients. Materials and methods: The study analyzes a case in which vasopressin was used to treat refractory vasoplegic shock in the early postoperative period after cardiopulmonary bypass surgery. All available data are analyzed: disease and nursing histories, test results and other medical documentation. The results of the clinical case are compared with the latest scientific literature. Results: Norepinephrine and epinephrine, used as fist line treatment, did not give the expected effect. Extracorporeal membrane oxygenation and a left ventricular replacement device were supportive measures used in this patient to stabilize hemodynamics and temporarily replace cardiac output; vasopressin was the drug that started to improve patient’s condition Conclusions: this case report study concludes that vasoplegic shock after cardiopulmonary bypass surgery is a complex pathology that may cause a bad outcome for the patient and a lot of challenges for the physicians. Standard of care drugs such as norepinephrine and epinephrin play a role in the treatment of it, but vasopressin is crucial for the managing of refractory vasoplegic shock and improve patient's outcome.
17 Item type:Publication, research article[2025][S1][M001,T010,T001][10]; ; ; ; ; ; ; Background: Postoperative cognitive dysfunction (POCD) occurs in 20% to 80% of patients following cardiac surgical interventions. The incidence of delirium is from 20% to 50%. Impaired cerebral autoregulation (CA) during cardiopulmonary bypass (CPB) contributes to these issues. We investigated a novel method for real-time monitoring of CA during CPB. The study aimed to obtain real-time CA impairment data to demonstrate the timely arterial blood pressure (ABP) management for immediate restoration of intact CA and, potentially, to reduce the incidences of POCD and delirium. Methods: An observational pilot clinical trial involved 108 elective on-pump surgery patients of whom 78 were included in the final analysis. All patients were evaluated for cognitive function on the 7th to 10th postoperative day. A rectangular blood flow modulation technique was proposed and applied to facilitate real-time detection of CA status impairment by using CA(t) transient response analysis. Results: A single CA impairment event lasting longer than 241 seconds was statistically significantly associated with POCD (P=0.0178), while impairments exceeding 262 seconds were related to delirium (P=0.0315). It was demonstrated that CA impairment events and patient-specific lower and upper limits of CA can be identified with sub-minute delays during cardiac surgery. Conclusions: The study demonstrated the feasibility of a novel heart and lung machine operation mode with rectangular blood flow modulation. Precise personal ABP(t) management can be performed during CPB to restore patient-specific optimal brain perfusion with sub-minute time resolution and, potentially, to reduce incidences of POCD and delirium.
50WOS© Citations 2 Item type:Publication, conference paper[2024][T1a][M001][2]; ; ; ; ; ; Objective Cardiac surgery is associated with various durations of cerebral autoregulation impairment and can have a significant impact on cognitive function, with short-term and long-term memory being particularly vulnerable. Therefore, it is crucial to take measures to protect and preserve these cognitive functions throughout the recovery process. There is a lack of a definitive gold-standard monitoring method to avert post-operative neurological complications following cardiac surgery. However, the potential of multimodal physiological real-time monitoring, which includes cerebral autoregulation monitoring, to be applied during cardiac surgery is promising. This approach could personally prevent postoperative neurologic complications in individual patients during cardiac surgery. This study was designed to determine the role of cerebral autoregulation dysfunction in the incidence of postoperative memory impairment and to test the hypothesis that the development of postoperative neurological complications depends on the duration of the cerebral autoregulation impairment. Design and method A prospective, pilot observational study was conducted in 2021 - 2023. The study was approved by the Kaunas Regional Biomedical Research Ethics Committee (No. P1-BE-2-64/2021, date: 2021-12-15), and participants provided written informed consent, according to the Declaration of Helsinki. The study enrolled 83 patients undergoing elective on-pump coronary artery bypass graft surgery with cardiopulmonary bypass (CPB) at the Department of Cardiothoracic and Vascular Surgery in the Hospital of Lithuanian University of Health Sciences Kaunas Clinics. All patients signed the written consent form and met the inclusion criteria: elective heart surgery with CPB, age 55 – 90 years, no anamnesis of neurocognitive diseases, no using agents affecting the central nervous system (CNS), and carotid artery atherosclerosis < 50%. Patients with anamnesis of neurological disorders and uncontrolled diabetes were excluded from the study. All patients were assessed for cognitive function 1 day before surgery using the Mini-Mental state examination test as a screening tool and the Hopkins Verbal Learning Test-Revised to assess memory specifically. To diagnose possible memory impairment, all patients underwent a repeat assessment of cognitive functions on the 7th-10th postoperative day. Cerebral autoregulation monitoring using transcranial Doppler was performed. The cerebral autoregulation status index—Mx—was recorded in real-time using Intensive Care Brain Monitoring System software (Cambridge, U.K.). Results and conclusions The study analyzed patients’ memory pre- post-surgery. The results showed that despite an overall postoperative memory impairment rate of 30.1% (based on a set cut-off point of 36), 49.4% of patients scored a lower recognition discriminant index after surgery than before, p<0.001 (Table 1). We performed non–invasive monitoring of cerebral autoregulation for all patients. Our data have shown that temporary cerebral autoregulation impairment occurs in all patients undergoing elective on-pump CABG surgery. Duration of the single longest cerebral autoregulation impairment event in seconds (445.5 vs. 794.5, p=0.006) was higher in patients with postoperative memory impairment (Table 2). The predictive factor associated with delayed recovery of neurocognitive functions is the duration of the single longest cerebral autoregulation impairment event. Cognitive assessments should aim to detect changes in specific cognitive domains, such as memory, in patients who have undergone cardiac surgery.
17 Item type:Publication, conference paper[2024][T1a][M001][2]; ; ; ; Journal of Cardiothoracic and Vascular Anesthesia : 39th EACTAIC Annual Congress FREIBURG (GERMANY), 23/10/2024 - 25/10/2024, 2024-10-25, vol. 38, no. 12, Suppl., p. 52-53Objective Postoperative chylothorax described as an accumulation of chyle in the pleural space. The most common reason is the accidental surgical damage of thoracic duct. Its prevalence in cardiothoracic surgeries is about 1,5% and in thoracic surgeries about 4% of cases. Often the diagnosis takes time, but untreated chylothorax is associated with management difficulties, poor patient outcomes and increased mortality. Design and method The case report of a rare case of chylothorax after coronary artery bypass surgery (CABG) is presented. Results and conclusions A 62-year-old female patient, with a triple vessel disease underwent an elective CABG under standard hospital protocols. After the surgery the patient was transferred to the intensive care unit and treated according to the standard hospital protocols. The drainage was within normal limits during postop days 1 and 2. Oral feeding was started the next morning after surgery. On the 3rd postop day, pleural drainage consisted of 1 liter of a yellowish-white, serous-like milky fluid. It was suspected that the fluid might be a chyle. The main challenge was to differentiate chylothorax from pyothorax. To identify the fluid, tests and a culture were taken from the pleural punctate (Tab. 1). A negative punctate culture, absence of fever and normal results of serum inflammatory markers rejected the pyothorax. Diagnosis of chylothorax sin was made. It was necessary to reduce intestinal triglyceride and protein intake to reduce lymphatic secretion, so oral nutrition was stopped and switched to full parenteral nutrition (PN) via central line and the pleural drainage was continued. This resulted in reduced intestinal activity, intestinal absorption of triglycerides and proteins and consequently reduced lymphatic flow. On the 3rd day of PN(6th postop day), the amount of chyla decreased to 250 ml per day. Conclusion Chylothorax is a rear complication after CABG, which is more often if the left internal mammary artery is used. Early recognition and management of chylothorax is crucial for a patient's recovery. It is known, that injury over the thoracic plane (Th 4-6) injury results in a left-sided chylothorax. Chyle is formed in the small intestine, long-chain triglycerides connect with cholesterol and phospholipids in order to create chylomicrons which will be transported as a chyle in thoracic duct, so due to the damage of the thoracic duct, chyle leaks to pleural space, resulting in chylothorax. Different approaches of deal with chylothorax, sometimes even a surgical intervention are used since no management guidelines have been created yet. There are many discussions, that conservative methods for treatment that chyle production can be slowed with a diet consisting of medium-chain triglycerides as it will be absorbed by the portal system and there PN is more extreme option.
25 Item type:Publication, research article[2024][S1][M001,T010][8]; ; ; ; ; ; ; Background and Objectives: Cardiac surgery is associated with various durations of cerebral autoregulation (CA) impairment and can significantly impact cognitive function. Cognitive functions such as memory, psychomotor speed, and attention are significantly impacted after cardiac surgery, necessitating prioritization of these areas in cognitive function tests. There is a lack of research connecting cerebral autoregulation impairment to specific cognitive function domains after cardiac surgery. This study aimed to determine if impaired cerebral autoregulation is associated with postoperative memory impairment and to test the hypothesis that the duration of this impairment affects the development of postoperative memory issues. Materials and Methods: A prospective study was conducted in 2021–2023. After approval of the Ethics Committee and with patient’s written consent, 83 adult patients undergoing elective on-pump coronary artery bypass graft (CABG) surgery were enrolled. All patients were assessed for cognitive function 1 day before surgery using the Mini-Mental state examination (MMSE-2) test as a screening tool and the Hopkins Verbal Learning Test-Revised (HVLT-R) to assess memory specifically. To diagnose possible memory impairment (IM), all patients underwent a repeat assessment of cognitive function on the 7th–10th postoperative day. Cerebral autoregulation monitoring using transcranial Doppler was performed. Cerebral autoregulation status index (Mx) was recorded using Intensive Care Brain Monitoring System software, 9.1.5.23 (Cambridge, UK). Results: According to our research, the incidence of postoperative memory impairment is 30.1%. Temporary cerebral autoregulation impairment occurs in all patients undergoing elective in-pump CABG surgery. The duration of the single longest CA impairment event in seconds (LCAI) and the LCAI dose were higher in patients with postoperative memory impairment, p = 0.006 and p < 0.007, respectively. Conclusions: Cerebral autoregulation impairment is important in developing memory loss after cardiac surgery. The duration and dose of the LCAI event are predictive of postoperative memory impairment.
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