ABSTRACT The study is designed to evaluate the influence of remifentanil/propofol anesthesia on ventilator-associated pneumonia (VAP) occurrence and respiratory support (RS) time after major cardiac surgery. Material and methods: In retrospective-prospective study we investigated the respiratory support time and VAP occurrence in group of 47 patients with remifentanil/propofol and 35 patients with fentanil/midazolam anesthesia after major cardiac surgery in period June 2009–December 2011. Groups are divided in subgroups depending of who underwent cardiac surgery with or without cardiopulmonary by pass (CPB). Results: The time of respiratory support (RS) was the shortest in remifentanil group without CPB (R/Off 63min ± 44.3 vs R/On 94min ± 49.2 p=0,22), but was longer in fentanil group (F/Off 142 min ± 102.2 vs F/On 212 min ± 102.2 p=0.0014). The duration of RS of ON pump remifentanil group was shorter than in ON pump fentanil group (R/On 94 min vs F/On 212 min p=0.0011). The time of RS of OFF pump remifentanil group was lower than in Off pump entangle group (R/Off 63min ± 44,3 vs F/Off 142min ± 102.2 p=0,021) with statistically significance. Ventilator–associated pneumonia was detected in 7 patients (8.5 %). Six patients (17.1%) were from entangle group and one patient (2.1%) from remifentanil group. The most common isolates were Pseudomonas aeruginosa in all patients and both Pseudomonas aeruginosa and Klebsiella pneumonia in one patient. Conclusion: The remifentanil anesthesia regimen in cardiac surgery decreases length of respiratory support duration and can prevent development of VAP. The role of remifentanil anesthesia in preventing VAP, as one of the most important risk factor of in-hospital mortality after cardiac surgery is still incompletely understood and should be investigated further.

The incidence of postoperative death has changed little in recent years. Most deaths occur in older patients with coexisting medical diseases who undergo major surgery. The objective of our research was to investigate the significance of demographic factors (age, gender, preoperational physiological status) and type of surgery on the outcome of treatment. This study included 288 patients older than 18 years of age that were treated in the intensive care unit (ICU) for at least 24 hours after a surgical procedure (both elective and emergency) between 1st January 2010 and 31st March 2011. The average age of patients included in the survey was 68 (range 19-88). APACHE II score was between 2.9 and 83.1 points, with an average value of 12.90 points. In this study, male gender (n=186) was much more common than female gender (n=102). Age of patients who died in the ICU was higher than the age of those who were discharged but it was not a statistically significant predictor of patient death. APACHE II score is associated with increased age of patients, neurosurgical operations and incidence of nosocomial infections. Patients’ age and female gender had a strong negative correlation with nosocomial infection. Actual mortality rate for patients was 21%. Ratio between actual and predicted mortality was 1.4.