Is Frailty Syndrome a Predictor of Morbimortality in Postoperative Cardiac Surgery? - A Retrospective Cohort Study

Abstract Background Frailty is a biological syndrome suggested as a better predictor of morbimortality than chronological age. Objective To assess associations between frailty and morbimortality outcomes in postoperative cardiac surgery. Methods A retrospective cohort study was conducted with cardiac surgery patients. Frailty and maximal inspiratory pressure (MIP) were assessed before surgery. Postoperative outcomes were: extracorporeal circulation time; use of vasopressor; mean arterial pressure (MAP); red blood cell (RBC) transfusion; cardiac arrhythmia and/or heart arrest; presence of intra-aortic balloon pump; antibiotic use; extubation time; length of stay in the intensive care unit (ICU); length of postoperative stay; mortality. One-way ANOVA was used to compare postoperative variables between frailty categories; Spearman was used to evaluate the correlations between frailty and postoperative variables. Age, sex, and MIP were introduced into multiple regression models to find the independent association between postoperative variables and frailty. A significance level of p < 0.05 was adopted. Results The medical records of 200 patients were analyzed (65.7±7.2 years; 68.5% men; 63.5% non-frail, 22.5% pre-frail, 14% frail). Frailty was not a predictor of postoperative outcomes. Age was an independent predictor for alterations in MAP (PR: 1.028, 95% CI: 1.003-1.053, p=0.025), need for RBC transfusion (PR: 1.034, 95% CI: 1.007-1.062, p=0.014), longer extubation time (PR: 1.052, 95% CI: 1.023-1.083, p<0.001), length of stay in the ICU (ß: 0.031, 95% CI: 0.010-0.053, p=0.005), length of postoperative stay (ß: 0.017, 95% CI: 0.003-0.031, p=0.015). Conclusions Frailty was not a predictor of morbimortality following cardiac surgery in middle-aged and older adults; however, age did predict morbidities in this setting.

Avaliação da Força de Preensão Palmar e Qualidade de Vida de Crianças com Câncer Submetidas à Quimioterapia com Vincristina / Evaluation of Handgrip Strength and Children's Quality of Life with Cancer Submitted to Chemotherapy with Vincristine / Evaluación de la fuerza de Asimiento Palmar y Calidad de Vida de Niños con Cáncer Sometidos a la quimioterapia con Vincristina

Introdução: com a quimioterapia, os pacientes podem apresentar diversas alterações; entre elas, polineuropatia e mudança na qualidade de vida, tanto à criança como aos familiares. Objetivo: avaliar a força de preensão palmar e a qualidade de vida de crianças e adolescentes com câncer submetidos à quimioterapia com vincristina. Método:trata-se de um estudo, no qual os pacientes responderam aos questionários de anamnese e PedsQLTM 3.0 Câncer Module, em três momentos diferentes do tratamento. um dos seus responsáveis foi convidado a responder ao mesmo questionário. a força de preensão palmar foi aferida por meio de um dinamômetro, nos mesmos momentos. Resultados: a amostra foi composta por sete pacientes com mediana 7 (5-15 anos); com predomínio de meninas, residentes em Porto alegre, rs, e diagnóstico prevalente de leucemia linfoide aguda, internados na primeira semana após o diagnóstico de câncer. a força de preensão palmar apresentou redução significativa para ambos os membros (p=0,018, membro superior direito; p=0,030, membro superior esquerdo). apesar de não apresentar resultado significativo, na maioria dos domínios do questionário de qualidade de vida, ocorreu declínio nas respostas, principalmente nas dos pais. Conclusão: a quimioterapia com vincristina reduz a força muscular periférica em pacientes com câncer, nos 30 primeiros dias. em relação à qualidade de vida, não foi apresentada diferença significativa. Porém, dentro dos domínios, pôde-se perceber algumas alterações. sendo assim, fica clara a importância do acompanhamento contínuo da fisioterapia junto a uma equipe preparada para esses pacientes e seus familiares

Introduction: With chemotherapy, patients may have several changes. among them: polyneuropathy and change in the quality of life, both the children and the family. Objective: to evaluate the handgrip's power and the life quality in these children and teens with cancer undergoing to chemotherapy with vincristine. Method: This is a study in which patients responded the questionaries of anamnsis and PedsQLTM 3.0 Cancer Modulein three different moments of the treatment. one of your responsible was invited to answer separately the same questionarie. The handgrip's power was measured by dynamometer, in the same moments. Results: The sample was composed for seven patients with average 7 (5-15 years); The most of them were girls, residing in Porto alegre-rs, with a prevalent diagnostic of acute lymphoid leukemia and who were hospitalized in the first week after the diagnosis of cancer. The handgrip's strength show significant reduction for all of the limbs (p=0,0018, right upper limb; p=0,0030, left upper limb). although of not show significant results, in most areas of the questionnaire of quality of life ocurred decline in the answers, mainly in the parents awnsers. Conclusion: The chemotherapy with vincristine, decrease in the peripheral muscle strength in the patients with cancer, in the first 30 days. in relationship of quality of life, there was no significant diference, however we could perceive some trends. Therefore, it is clear the importance of the continuous monitoring of physiotherapy with a team prepared for these patients and their families

Introducción: con la quimioterapia, los pacientes pueden presentar varias modificaciones. entre ellas: polineuropatía y cambio en la calidad de vida, tanto del niño y de los familiares. Objetivo: evaluar la fuerza de asimiento palmar y la calidad de vida de niños y adolescentes con cáncer sometidos a la quimioterapia con vincristina. Método: se trata de un estudio, en el cual los pacientes respondieron a los cuestionarios de anamnesis y PedsQltM 3.0 cáncer Module, en tres momentos diferentes del tratamiento. uno de sus responsables fue invitado a responder el mismo cuestionario. la fuerza de asimiento palmar fue evaluada por medio de un dinamómetro, en los mismos momentos. Resultados: la muestra fue compuesta por siete pacientes con mediana 7 (5-15 años); teniendo más niñas, residentes en Porto alegre-rs, con diagnóstico prevalente de leucemia linfoide aguda y que estaban internadas en la primera semana después del diagnóstico de câncer. la fuerza de asimiento palmar presentó una reducción significativa para ambos miembros (p=0,018, miembro superior derecho, p=0,030, miembro superior izquierdo). a pesar de no presentar resultados significativos, en la mayoría de los dominios del cuestionario de calidad de vida ocurrió declinación en las respuestas, principalmente en la respuesta de los padres. Conclusión: la quimioterapia con vincristina reduce la fuerza muscular periférica en pacientes con cáncer, en los 30 primeros días. en cuanto a la calidad de vida, no se presentó una diferencia significativa. sin embargo, dentro de los dominios se pode percibir algunos cambios. Por lo tanto, queda claro la importancia del acompañamiento continuo de la fisioterapia junto a un equipo preparado para esos pacientes y sus familiares

Hemodynamic changes and autonomic nervous system after acute myocardial infarction in rats submitted to left coronary artery ligation

Introduction: Heart failure is a clinical syndrome characterized by sympathetic/ renin-angiotensin system activation, besides parasympathetic activity attenuation. In the initial phase of HF, following a myocardial infarction, there is impairment of the ventricular function and this can be influenced by the myocardium ischemia area in addition to alteration in the autonomic control of the heart. The aim of this study is to evaluate the hemodynamic responses and autonomic nervous system and its associations in infarcted rats by left coronary artery ligation. Methods: Forty male rats were submitted to left coronary artery ligation: infarcted animals with fifteen days from cardiac surgery (I15), infarcted animals with thirty days from cardiac surgery (I30) and sham-operated groups (S15 and S30), with 10 animals in each group. Basal hemodynamic data and heart rate variability (spectral analysis) were evaluated. Results: Compared to control groups, the infarcted rats demonstrated the following complications: a) cardiac hypertrophy (I30); b) pulmonary congestion (I30); c) mean arterial pressure (MAP), systolic arterial pressure (SAP) and diastolic arterial pressure (DAP) reduction; d) left ventricular systolic pressure (LVSP) reduction and left ventricular end-diastolic pressure (LVEDP) rise; e) contractile (+dP/dt) and relaxation derivatives (-dP/dt) reduction; f) sympathetic cardiac activity increase, and parasympathetic cardiac activity reduction (I30). Conclusion: Our study shows that the infarcted animals presented left ventricular dysfunction, which was influenced by the infarct size. In addition, impairment of autonomic control was present only in the animals belonging to the I30 group, probably due to the degree of cardiac decompensation and disease progression. (AU)

Efeitos do treinamento muscular inspiratório nos pacientes em hemodiálise / Effects of inspiratory muscle training in hemodialysis patients

INTRODUÇÃO: A doença renal crônica associada ao tratamento hemodialítico pode apresentar uma diversidade de complicações músculo-esqueléticas, além de trazer repercussões à função pulmonar. OBJETIVO: Avaliar os efeitos do treinamento muscular inspiratório na força muscular inspiratória, função pulmonar e capacidade funcional em pacientes com insuficiência renal crônica submetidos à hemodiálise. MÉTODO: Ensaio clínico não controlado, composto por 15 indivíduos com diagnóstico médico de insuficiência renal crônica, submetidos à hemodiálise. Foram avaliados pressões inspiratória máxima (PImáx) e expiratória máxima (PEmáx) através da manovacuometria; função pulmonar pela espirometria e a capacidade funcional através da distância percorrida e consumo de oxigênio obtido no teste da caminhada dos seis minutos (TC6M). No período de oito semanas, foi aplicado o protocolo de treinamento muscular respiratório (TMI) durante a sessão de hemodiálise, com carga estabelecida de 40 por cento da PImáx e uma frequência semanal de três dias alternados. RESULTADOS: Houve um aumento significativo na variável distância percorrida após o treinamento (455 ± 98 versus 558 ± 121; p = 0,003). Não foram encontradas diferenças estatísticas na comparação antes e após treinamento nas demais variáveis do estudo. CONCLUSÃO: O estudo não apresentou diferença estatística na força muscular respiratória, na função pulmonar e no consumo de oxigênio. Observou-se apenas um aumento na distância do TC6M.

INTRODUCTION: Chronic kidney disease associated with hemodialysis can have a variety of musculoskeletal complications, in addition to repercussions in pulmonary function. OBJECTIVE: To evaluate the effects of inspiratory muscle training on inspiratory muscle strength, pulmonary function, and functional capacity in patients with chronic kidney failure undergoing hemodialysis. METHOD: Non-controlled clinical trial, comprising 15 individuals diagnosed with chronic kidney failure and undergoing hemodialysis. Maximum inspiratory (PImax) and expiratory (PEmax) pressures were assessed by use of pressure vacuum meter reading. Pulmonary function was assessed by use of spirometry. Functional capacity was assessed by use of walked distance and oxygen consumption obtained in the six-minute walk test (6MWT). For eight weeks, the inspiratory muscle training (IMT) protocol was applied during hemodialysis sessions, with load set to 40 percent of PImax and weekly frequency of three alternate days. RESULTS: A significant increase in the walked distance was observed after training (455.5 ± 98 versus 557.8 ± 121.0; p = 0.003). No statistically significant difference was observed in the other variables when comparing their pre- and posttraining values. CONCLUSION: The study showed no statistically significant difference in respiratory muscle strength, pulmonary function, and oxygen consumption. An increase in the walked distance was observed in the 6MWT.