BACKGROUND: Anxiety after acute myocardial infarction influences both short- and long-term recovery. Therefore, determining specific subgroups of patients who have relatively higher anxiety levels is important. Published findings about gender differences in anxiety after acute myocardial infarction are conflicting. OBJECTIVES: To determine whether gender differences in anxiety after acute myocardial infarction exist and whether any of the sociodemographic and clinical variables that often differ between men and women with acute myocardial infarction interact with gender to influence anxiety. METHODS: A total of 424 patients with confirmed acute myocardial infarction were enrolled in this multicenter prospective study. Patients' anxiety level was measured within 72 hours of their arrival at the hospital by using the State Anxiety Inventory and the Brief Symptom Inventory. RESULTS: Women had significantly higher anxiety than did men according to both the State Anxiety Inventory (42 +/- 12.9 vs 37.7 +/- 12.5; P = .001) and the Brief Symptom Inventory (0.83 +/- 0.97 vs 0.63 +/- 0.71; P = .02). Of the sociodemographic and clinical variables examined, only marital status and income significantly interacted with gender to influence anxiety. Married women had higher anxiety than did single and widowed women, and married men had lower anxiety than did single men. Women with lower income had higher anxiety than did women with higher income; income was not related to anxiety in men. CONCLUSION: Women report significantly greater anxiety early after acute myocardial infarction than men do. Women's greater anxiety may be partially explained by marital status and lower income at the time of the infarction.

OBJECTIVE: To identify preoperative, intraoperative, and postoperative predictors of early (6 hours or less after surgery) and delayed (more than 6 hours) extubation after coronary artery bypass graft surgery. METHODS: The sample for this prospective nonrandomized study consisted of 116 consecutive patients in a 12-bed cardiothoracic ICU who had coronary artery bypass graft surgery in a 6-month period and were followed up prospectively until transfer to an observation unit. RESULTS: Age and the presence of early hemodynamic instability (within the first 3 hours after ICU admission) were independent predictors of intubation times of more than 6 hours when each was considered in separate multivariate models of preoperative, intraoperative, and postoperative variables. In a combined model, when considered with age and ejection fraction, the presence of early hemodynamic instability increased the odds by 4.7 times that extubation would occur more than 6 hours after surgery. For every 1 year increase in age, the odds of extubation occurring more than 6 hours after surgery increased by 6.5%. CONCLUSIONS: Older age and the presence of early hemodynamic instability are associated with postoperative intubation periods of more than 6 hours after coronary artery bypass graft surgery. Clinicians should evaluate extubation goals in older patients carefully. Clinical management of hemodynamic instability should be aimed at prompt optimization of myocardial oxygen supply to limit ischemia and its sequelae.

Positioning of critically ill patients affects hemodynamic and cardiopulmonary outcomes. A review of clinical studies indicates that backrest elevations up to 60 degrees do not affect measurement of intracardiac pressures or cardiac output, but PaO2 may diminish in sitting positions following surgical procedures. In lateral positions, measurement of intracardiac pressures and cardiac output is not recommended, since a uniform reference point has not been identified for lateral positions. In patients with unilateral lung disease, PaO2 increases with the unaffected lung in the dependent position. Despite widespread use, the Trendelenburg position has not been shown to provide consistent beneficial effects. Prone positioning may be beneficial in adult respiratory distress syndrome and in weaning of mechanically ventilated patients. When planning positioning maneuvers, critical care nurses should consider these effects in relation to the specific needs of each patient. Hemodynamic and cardiopulmonary responses to positioning should be evaluated in conjunction with other therapeutic modalities such as those designed to preserve skin integrity and improve comfort.