Delirium, an acute alteration in attention and cognition, is the most common neurological complication after cardiac surgery in older patients, and it has been shown to be associated with multiple negative outcomes, such as mortality, morbidity, increased length of hospital stay, functional and cognitive decline, increased medical costs, and reduced health-related quality of life [1][2][3][4][5][6][7]. The incidence of delirium greatly increases with age [8-10], and it is expected to continue to increase as the population ages, especially in an aging society such as that in Japan.The rate of physical frailty and cognitive impairment also increases with age, and they are well-known risk factors for the incidence of delirium after surgery [11][12][13][14][15][16]. As delirium is thought to result from acute stress on the "vulnerable" body and brain, attention should be paid to both physical and cognitive functions for better perioperative care in older patients. Further, in a previous study, mild cognitive impairment (MCI), the transitional state between cognitive change associated with normal aging and dementia, has also been detected as a risk factor for delirium [17]. Therefore, close attention should be paid to patients who show even mild decline in cognitive function.Several cross-sectional studies have reported an association between physical frailty and cognitive function [18,19]. In addition,

Preoperative CKD stage correlated significantly with the progress of early postoperative CR after cardiac surgery. Independent determinants of achieving JCS early postoperative CR guideline goal were postoperative AKI in patients with or without CKD, and POFB/PBW only in patients without CKD.

Cardiopulmonary exercise testing (CPX) is a useful clinical tool for evaluating the severity of disease and the limitations of activities of daily life in cardiac patients. 9 As described by the Fick's equation, O2 uptake (V O2) is the product of cardiac output and the arteriovenous O2 difference. Among the parameters obtained from CPX, the peak V O2 is traditionally considered as the gold standard for identifying patients with a poor prognosis and selecting candidates for cardiac transplantation. 10 The slope of the increase in ventilation (V E) to the increase in CO2 output (V CO2) (V E-V CO2 slope) is also an established index reflecting cardiopulmonary dysfunction during exercise. 9 scillatory breathing, alternating between hyperpnea and hypopnea during sleep and commonly referred to as central sleep apnea or Cheyne-Stokes respiration, has long been recognized in cardiac patients. An instability of the ventilatory control system, 1 long circulation time, 2-4 high sensitivity of ventilation to changes in CO2, 5 a decrease in the PaCO2 regulatory set point, 5,6 or fluctuations in the pulmonary blood flow 7,8 have been proposed as possible mechanisms underlying this abnormal breathing. A similar breathing pattern has also been recognized during waking hours in cardiac patients, especially those with heart failure. The mechanisms underlying oscillatory breathing while awake are assumed to overlap, at least in part, with those of central sleep apnea. However, reports on the mechanisms of oscillatory breathing while awake are limited. The relation between the magnitude of oscillatory breathing while awake and the severity of heart failure has not Relation Between Oscillatory Breathing and Cardiopulmonary Function During Exercise in Cardiac PatientsJo Kato, MD; Akira Koike, MD; Masayo Hoshimoto-Iwamoto, PhD; Osamu Nagayama, BSc; Koji Sakurada; Akira Sato, MD; Takeshi Yamashita, MD; Karlman Wasserman, MD, PhD; Kazutaka Aonuma, MD Background: Oscillatory breathing, alternating between hyperpnea and hypopnea, has been recognized in cardiac patients, especially in those with heart failure. We evaluated whether the cycle length and amplitude of oscillatory breathing correlate with impaired cardiopulmonary function during exercise.

Postoperative atrial fibrillation (POAF) is a common complication after cardiac surgery. The aim of this multicenter study was to determine the relationship between POAF and patients' progress in early rehabilitation after heart valve surgery. Methods: We enrolled 302 patients (mean age, 69 10 years) who had undergone heart valve surgery. POAF was monitored using continuous electrocardiogram telemetry, and the Short Physical Performance Battery (SPPB) was used to assess lower-extremity function before surgery and at the time of discharge. Progress in early rehabilitation was evaluated by the duration from the surgery to independent walking. We determined factors associated delayed early rehabilitation and evaluated the interplay of POAF and delayed early rehabilitation in increasing the risk of decline in lower-extremity function from preoperatively to hospital discharge. Results: Multivariate analysis determined POAF to be independent predictors of delayed early rehabilitation after heart valve surgery (OR: 3.906, P = .01). The association between delayed early rehabilitation and decline in lower extremity function was stronger in patients with POAF (OR: 2.73, P = .041) than in those without (OR: 2.22, P = .052). Conclusions: POAF was clinical predictors of delayed early rehabilitation in patients undergoing heart valve surgery. The combination of POAF with delayed early rehabilitation conferred a high risk of decline in lowerextremity function during hospitalization.

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