Relación de los niveles séricos de ácido úrico, con la mortalidad y morbilidad en pacientes graves con ventilación mecánica

RESUMEN Introducción: Los procesos oxidativos en el paciente clínico grave con ventilación mecánica, justifican investigar la posible asociación de los niveles del ácido úrico sérico, con la mortalidad y morbilidad. Objetivo: Identificar la posible asociación del ácido úrico sérico al ingreso, con la mortalidad y morbilidad de pacientes clínicos graves, con ventilación mecánica invasiva. Métodos: Se realizó estudio descriptivo longitudinal y prospectivo, en 89 pacientes clínicos graves con ventilación mecánica, ingresados en cuidados intensivos del hospital "Dr. Luís Díaz Soto" de enero del 2000 a agosto del 2007. Al ingreso y por 72 horas se determinó el ácido úrico sérico, cuyo valor medio se contrastó con la mortalidad, la morbilidad y el tiempo de ventilación mecánica. Las variables cuantitativas se expresaron como media con una desviación estándar; las cualitativas, como frecuencias absolutas o porcentajes. La comparación de medias se realizó con la t de Student. La asociación entre variables cualitativas se evaluó con el ji cuadrado. Resultados: Predominó el sexo masculino (58,4 %), edad media de 51,2 años y como mayor diagnóstico al ingreso, la sepsis (47,1 %). Se asociaron los valores elevados del ácido úrico a la mortalidad hospitalaria, la presencia del síndrome de daño múltiple de órganos (316,8 ± 165 mmol/L, p = 0,04) y al mayor tiempo de ventilación mecánica (307,3 ± 157 mmol/L, p = 0,016). Conclusiones: La asociación del ácido úrico sérico con la mortalidad y morbilidad, es evidente, en pacientes con afecciones clínicas graves y ventilación mecánica.

ABSTRACT Introduction: The oxidative process in severe clinically ill patient with mechanical ventilation, base the possible association of serum uric acid with mortality and morbidity. Objectives: To identify the possible association of serum uric acid with the mortality and morbidity of severe clinically ill patients with invasive mechanical ventilation. Methods: A longitudinal and prospective observational study was carried out in 89 patients with invasive mechanical ventilation, admitted to the intensive care unit of the Hospital "Dr. Luís Díaz Soto", from January 2000 to August 2007. On admission and for three consecutive days, the serum uric acid was determined with a Hitachi 902 microprocessor. The mean value was contrasted with mortality, morbidity, and mechanical ventilation time. Quantitative variables were expressed as mean and standard deviation; the comparison of means was made with Student's t test. Qualitative variables were expressed with absolute frequencies and percentages; the association was evaluated with the chi square. Results: Male sex predominated (58,4 %) and mean age of 51,2 ± 14,9 years. The most frequent diagnosis on admission was sepsis (47,1 %). The mortality was 59,6 % and 66,3% in the hospital. The higher value of uric acid was associated to hospital mortality, the multiple organ damage syndrome (316,8 ± 165 mmol/l p=0,04) and the longer mechanical ventilation time (307,3 ± 157 mmol/l p=0,016). Conclusions: The association of mortality and morbidity, with serum uric acid on admission, was evident in severe clinical patients with mechanical ventilation.

Evolución del paciente quirúrgico grave con ventilación mecánica en cuidados intensivos, según valor de creatininuria / Evolution of critically ill surgical patient with mechanical ventilation in intensive care, according the urine creatinine value

Introducción: El estado nutricional al ingreso influye en la evolución del paciente quirúrgico grave. La creatininuria, indicador de este estado, podría mostrar su posible asociación con la evolución de estos pacientes. Objetivos: Identificar la evolución de los pacientes quirúrgicos graves, con ventilación mecánica invasiva y su posible asociación con la creatininuria al ingreso. Métodos: Se realizó un estudio observacional descriptivo y longitudinal, en 85 pacientes quirúrgicos con ventilación mecánica invasiva, ingresados en la sala de cuidados intensivos, desde enero del 2000 a agosto del 2007. Se evaluó el índice APACHE II al ingreso y la creatininuria en la orina de 24 horas durante 3 días seguidos, con un equipo microprocesador Hitachi 902. El valor medio se contrastó con la mortalidad, morbilidad, estadía en cuidados intensivos y tiempo de ventilación mecánica. Las variables cuantitativas se expresaron como media, con desviación estándar y las cualitativas, como frecuencias absolutas o porcentajes. La comparación de medias se realizó con la t de Student. La asociación entre variables cualitativas se evaluó con ji cuadrado. Resultados: La edad media fue de 52,3 ± 15,8 años; el 54,1 por ciento correspondió al sexo masculino y el índice de APACHE II fue 20,4 ± 6 puntos. El diagnóstico más frecuente fue la peritonitis secundaria (49,4 por ciento). Los valores inferiores de creatininuria se asociaron a la mortalidad, presencia de complicaciones, mayor estadía en cuidados intensivos y del tiempo de ventilación mecánica. Conclusiones: La creatininuria al ingreso está asociada a la evolución de los pacientes quirúrgicos con ventilación mecánica invasiva(AU)

Introduction: The nutritional status at admission influences the evolution of the severely ill surgical patient. Urine creatinine, an indicator of this state, could show its possible association with the evolution of these patients. Objectives: To identify the evolution of critically ill surgical patients with invasive mechanical ventilation and its possible association with urine creatinine on admission. Methods: A descriptive and longitudinal observational study was carried out in 85 surgical patients with invasive mechanical ventilation, admitted to the Intensive Care Unit, from January 2000 to August 2007. The APACHE II index on admission and urine creatinine in the 24-hour urine for 3 consecutive days, with a Hitachi 902 microprocessor equipment. The mean value was contrasted with mortality, morbidity, stay in intensive care and time on mechanical ventilation. Quantitative variables were expressed as mean, with standard deviation, and qualitative variables, as absolute frequencies or percentages. The comparison of means was carried out with Student's t test. The association between qualitative variables was evaluated with chi square. Results: The mean age was 52,3 ± 15,8 years; 54,1 percent corresponded to the male sex and the APACHE II index was 20,4 ± 6 points. The most frequent diagnosis was secondary peritonitis (49,4 percent). Lower urine creatinine values ​​were associated with mortality, the presence of complications, a longer stay in intensive care and the time on mechanical ventilation. Conclusions: Urine creatinine on admission is associated with the evolution of surgical patients with invasive mechanical ventilation(AU)

Impact of the Covid-19 pandemic on colorectal cancer surgery in Madrid

Introduction: The Covid-19 pandemic has had an important impact on colorectal cancer surgery, for hospital resources had to be redistributed in favour of Covid-19 patients. The aim of the present study is to analyze our results in colorectal oncologic surgery during the Covid-19 pandemic in patients with and without perioperative SARSCoV- 2 infection. Methods: In total, 32 patients (19 male and 13 female patients), with a mean age of 64 years (range: 57.2 to 69.5 years) with colorectal cancer underwent surgery under the recommendations of surgical societies included in a protocol. Data collection included clinical characteristics (gender, age, body mass index, American Society of Anesthesiologists score, tumor location, preoperative staging, lymphopenia), data related to SARS-CoV-2 infection (postoperative symptoms, diagnostic tests), operative details (surgical procedure, approach, duration, stoma), pathological outcomes (tumor stage, number of lymph nodes harvested, distal and circumferential radial margins, quality of the total mesorectal excision), and surgical outcomes (morbidity, mortality, hospital stay, and the rates of reoperation and readmission). Results: A total of 3 (9.4%) patients who underwent colorectal surgery during the Covid-19 pandemic were infected by SARS-CoV-2 in the postoperative period. Chronic obstructive pulmonary disease was associated with Covid-19 (6.2% versus 33.3%; p=0.042), and surgical morbidity was higher among Covid-19 patients (100% versus 37.9%; p=0.039). There were not significant differences between COVID-19 patients and non-COVID-19 patients in relation to the rest of the analyzed outcomes. Conclusion: During the Covid-19 pandemic, colorectal cancer surgery should be performed according to the recommendations of surgical societies. However, Covid- 19 patients could present a higher morbidity rate. (AU)

Comparison of two health literacy measurement tools in surgical patients / 中国实用护理杂志

Objective:To explore the operability of the Chinese version of the All Aspects of Health Literacy Scale (C-AAHLS) and the Brief Health Literacy Screening (BHLS) for assessing the health literacy level of surgical patients.Methods:A total of 202 surgical patients were recruited in an acute care hospital. C-AAHLS and BHLS were used simultaneously to measure the health literacy of patients, and the consistency of their measurement results was compared.Results:The total health literacy scores of 202 surgical patients measured by C-AAHLS and BHLS were respectively (23.16±2.94) and (7.50±3.58), both were at a medium level, and they are consistent in differences in the health literacy levels of different ages, occupations, and educational levels, with statistical significance; the Bland-Altman graph shows that the maximum difference between the measurement results of the two tools is 1.68 <1.824 (average value), the average value of the difference is close to 0, and the results are highly consistent (P < 0.0001).Conclusions:The results of C-AAHLS and BHLS in measuring health literacy are consistent, and clinical medical staff can choose the suitable measurement tool according to the appropriate situation.

The Effect Of Direct Eye Contact On Preoperative Surgical Patients And Counseling Intervention On Postoperative Anxiety, Depression And Posttraumatic Stress Disorder

To the study the effect of direct eye contact counseling method on pre-operative surgical patients and counseling intervention along with the medical follow-up of post-operative surgical patients. Methodology : 60 pre-operative surgical patients who had been identify with major or minor need of surgical assistance were consulted by two different method such as ( 30 patients with direct eye contact consultation) and (30 patients with non-direct eye contact consultation) and assessed by Peer assessment of outpatient consultation Rating Scale (2007) by Keely et al 1. Followed by the consulting session we compared the willingness and acceptance of surgical procedure by the number of participants and found that the direct eye contact method is more effective than non-direct eye contact. During the surgical treatment follow-up, we have categorized 30 patients in to two groups such as Group A - Control group: 15 patients who have undergone medical treatment alone and Group B - Experimental group: 15 patients who have undergone medical treatment and counseling intervention. Both groups were assessed by using Hamilton Anxiety Rating Scale (1959) 2, Beck’s Depression Inventory (1996) 3 and PTSD Check List Civilian Version (PCL-C) (1994) 4. Result: The findings indicate that the direct eye contact consultation method is more effective than non-direct eye contact consultation. The post-operative surgical patients treated with counseling intervention along with the medical treatment found to be less subjected to anxiety, depression and Posttraumatic stress disorder. Implications: The results obtained from this study can be helpful in designing better counseling technique for the post-operative surgical patients to reduce their anxiety and depression level.

Impacto do estado nutricional e do tempo de jejum nas complicações gastrointestinais e no tempo de hospitalização em pacientes cirúrgicos / Impact of the nutritional status and fasting time in gastrointestinal complications and hospitalization time in surgical patients

Introdução: O estado nutricional e o tempo de jejum pré e pós-cirúrgico impactam na morbimortalidade de pacientes submetidos a cirurgias eletivas. No Brasil, o tempo de jejum prolongado e a elevada prevalência de desnutrição são comuns nos hospitais terciários. Objetivo: Realizar levantamento do tempo de jejum médio praticado em hospital terciário e avaliar o impacto do jejum pré e pós-cirúrgico e do estado nutricional nas complicações gastrointestinais imediatas e no tempo de hospitalização em pacientes cirúrgicos. Material e métodos: Estudo prospectivo, realizado no Hospital Universitário Walter Cantídio, em Fortaleza. Foram avaliados 173 indivíduos submetidos a cirurgias eletivas de médio e grande porte entre agosto de 2016 a janeiro de 2017. Foram coletadas medidas antropométricas, hemograma e informações como tempo de jejum pré e pós-cirúrgico, permanência hospitalar e complicações gastrointestinais. As análises de correlação e associação foram realizadas no Software SPSS®, com nível de significância fixado em p< 0,05. Resultados: A maioria dos pacientes (71,1%) foi submetida à cirurgia de porte II (grande porte). Houve correlação negativa entre tempo de permanência hospitalar e índice de massa corporal [r= -0,223; p= 0,003], circunferência braquial [r= -0,335; p< 0,001], dobra cutânea tricipital [r= -0,320; p< 0,001], área muscular do braço corrigida [r= -0,253; p= 0,001], contagem total de linfócitos [r= -0,223; p= 0,008], hemoglobina [r= -0,243; p= 0,004] e relação linfócito/monócito [r= -0,308; p< 0,001]. Adicionalmente, houve correlação positiva entre tempo de permanência hospitalar com o tempo de jejum pós-cirúrgico [r= 0,456; p< 0,001]. Ausência de complicações gastrointestinais foi associada a valores de triagem (Nutritional Risk Screenin-2002) < 3 (p= 0,034) e entre menor tempo de jejum pós-cirúrgico (p= 0,033). Conclusão: Pacientes desnutridos, com maior risco nutricional e os que se submeteram a um tempo de jejum pós-cirúrgico elevado apresentaram maior tempo de permanência hospitalar e maior incidência de complicações gastrointestinais.

Introduction: The nutritional status and pre and postoperative fasting time impact the morbidity and mortality of patients undergo to elective surgeries. In Brazil, prolonged fasting time and high prevalence of malnutrition are common in tertiary hospitals. Objective: To evaluate the mean preoperative and postoperative fasting time and the impact of fasting, and nutritional status on gastrointestinal complications and on length of hospital stay in surgical patients. Material and methods: A prospective study, conducted at Walter Cantídio University Hospital, in Fortaleza. One hundred and seventy three surgery patients were evaluated between August 2016 and January 2017. The subjects were divided in two groups (medium and large size). Anthropometric measurements, blood count and information about pre and postoperative fasting time, hospital stay and gastrointestinal complications data were collected. Correlation and association test were performed by Software SPSS®. P<0.05 was considered significant. Results: The majority of the patients (71,1%) were included in size II (large) surgery. There was a negative correlation between length of stay in hospital and body mass index [r= -0,223; p= 0,003], brachial circumference [r= -0,335; p<0,001], triceps skinfold thickness [r= -0,320; p<0,001], arm muscle area [r= -0,253; p= 0,001], total lymphocyte count [r= -0,223; p= 0,008], hemoglobin [r= -0,243; p= 0,004] and lymphocyte/monocyte ratio [r= -0,308; p<0,001]. In addition, there was a positive correlation between length of stay in hospital and postoperative fasting time [r= 0,456; p<0,001]. Absence of gastrointestinal complications was associated with Nutrition Risk Screening-2002 <3 (p= 0,034) and shorter post-operative fasting time (p= 0,033). Conclusion: Malnourished patients, higher nutritional risk and higher postoperative fasting time were associated to longer hospital stay and a higher incidence of gastrointestinal complications.

Identification of surgical patients at high risk of OSAS using the Berlin Questionnaire to detect potential high risk of adverse respiratory events in post anesthesia care unit / 医学前沿

Obstructive sleep apnea syndrome (OSAS) increases the risk of post-surgery complications. This study uses Berlin Questionnaire (BQ) to identify Chinese adult surgical patients who are at a high risk of OSAS and to determine if the BQ could be used to detect potential high risk of adverse respiratory events in the post anesthesia care unit (PACU). Results indicated that only 11.4% of the patients were considered at a high risk of OSAS. Age and body mass index are the key factors for the risk of OSAS prevalence in China and also gender specific. Furthermore, the incidence of adverse respiratory events in the PACU was higher in patients with high risk of OSAS than others (6.8% vs. 0.9%, P < 0.001). They also stayed longer than others in the PACU (95 ± 28 min vs. 62 ± 19 min, P < 0.001). Age, high risk for OSAS, and smoking were independent risk factors for the occurrence of adverse respiratory events in the PACU. The BQ may be adopted as a screening tool for anesthesiologists in China to identify patients who are at high risk of OSAS and determine the potential risk of developing postoperative respiratory complications in the PACU.

Effects of sevoflurane combined anesthesia on early cognitive function in elderly patients / 中国生化药物杂志

Objective To investigate the effects of sevoflurane combined anesthesia on the early cognitive function of the elderly patients.Methods 120 patients underwent laparoscopic surgery in our hospital from August 2014 to August 2016 were selected and randomly divided into two groups:sevoflurane group 60 cases, sevoflurane anesthesia during operation and propofol anesthesia 60 cases, propofol anesthesia during operation.MMSE was used to detect the cognitive function at one day before operation, one day, three days and seven days after surgery respectively.The blood samples were taken from the patients of the two groups at the time of one day before operation, one hour after operation and one day after operation, the levels of serum TNF-αand IL-6 were measured by enzyme-linked immunosorbent assay ( ELISA ) . The recovery time and adverse reactions were observed after operation.Results The average recovery time was (18.94 ±3.32) min in the propofol group and (10.62 ±2.31) min in the sevoflurane group, the sevoflurane group was better than the propofol group, the difference was statistically significant (P<0.05).The scores of MMSE were significantly lower in the sevoflurane group one day after operation than those in the one day before operation, the difference was statistically significant (P<0.05).The scores returned to the preoperative level three days and seven days after operation.In the propofol group, the MMSE score was significantly lower at one day after operation than that before operation, the difference was statistically significant (P<0.05), but increased three days after operation but did not reach the preoperative level, and sevoflurane group, the difference was statistically significant.After treatment, the levels of TNF-and IL-6 in serum of two groups increased, the level of TNF-αand IL-6 in the propofol group one hour after operation and one day after operation were significantly higher than those in the sevoflurane group, the difference between the two groups was statistically significant ( P <0.05 ).Conclusion The sevoflurane compound anesthesia in patients after surgery, the recovery of cognitive ability faster, fewer side effects in patients.

A prospective observational study on nutritional status of patients with pancreatic tumor / 中华临床营养杂志

Objective To investigate the rates of undernutrition and nutritional risks of surgical pa-tients with pancreatic tumors .Methods Totally 121 surgical patients with pancreatic tumors from Depart-ment of Surgery Beijing Hospital were enrolled in a prospective study during January 2014 to December 2015 . Patients were divided into two groups:the pancreatic cancer group ( n=90 ) and other pancreatic tumor group ( n=31 ) .Nutritional Risk Screening 2002 was used to assess the nutritional status .Other data including an-thropometric measure, body composition, blood biochemistry and clinical outcome were collected and ana-lyzed.Results Among 121 patients, the mean age was ( 61.9 ±13.6 ) years, the mean body mass index was ( 23.20 ±2.95) kg/m2 , the mean mid-upper circumference was ( 28.8 ±3.5 ) cm, the mean muscle weight was (44.6 ±7.4) kg, and the mean fat mass was (16.8 ±7.6) kg .There was no significantly differ-ence in anthropometric measurement results and body compositions between two groups ( all P>0.05 ) .In the pancreatic cancer group, albumin [ (39.0 ±4.7) g/L vs. (42.3 ±2.9) g/L, P<0.001], total protein [ (62.8 ±6.2) g/L vs.(66.3 ±2.9) g/L, P<0.001], and prealbumin [ (136.1 ±85.4) mg/L vs. (197.8 ±112.6 ) mg/L, P=0.011 ] were significantly lower than those in the other pancreatic tumor group and a higher fasting blood-glucose [ (6.45 ±2.47) mmol/L vs.(4.95 ±0.79) mmol/L, P<0.011] was found.Among all patients , the rates of undernutrition and nutritional risk were 4.1% and 78.5%, and the pancreatic cancer group had a higher rate of nutritional risk (91.1% vs.38.7%,χ2 =36.525, P<0.001). Conclusion In this prospective study , surgical patients with pancreatic cancer have a high incidence of nutri -tional risk, with low protein level and abnormal glucose metabolism .

Demanda de informações de pacientes cirúrgicos hospitalizados: estudo descritivo e prospectivo / Demand of hospitalized surgical patients information: a descriptive and prospective study / Demanda de informaciones de pacientes quirúrgicos hospitalizados: estudio descriptivo y prospectivo

OBJETIVOS: identificar as complicações pós-operatórias apresentadas por pacientes submetidos aos procedimentos cirúrgicos, em um hospital de média complexidade, as dificuldades vivenciadas no autocuidado durante o período pós-operatório e as orientações fornecidas no processo de alta hospitalar. MÉTODOS: estudo descritivo, prospectivo quantitativo, empreendido em pacientes que realizaram tratamentos cirúrgicos em um hospital do Paraná. RESULTADOS: de 110 pacientes, 70 (64%) participaram, sendo que destes, 57 (87%) apresentaram algum tipo de complicação e 67 (95%) afirmaram ter recebido orientações para a alta hospitalar. Apesar de 38 (54%) informarem não ter tido dúvidas quanto ao autocuidado, 26 (37%) relataram dúvidas quanto a realizar o curativo, e seis (9%) sobre o uso correto da medicação. Quanto ao profissional orientador, 45 (64%) foram orientados por enfermeiro, 40 (58%) por médico e quatro (5%) por outros profissionais. CONCLUSÃO: evidenciou-se a necessidade de ações educativas mais eficientes pelos profissionais da saúde no perioperatório.

AIM: to identify post-operative complications in patients undergoing surgical procedures in a hospital of medium complexity, the difficulties experienced in self-care during the post-operative period and the guidance provided in the discharge process. METHOD: a descriptive study, quantitative prospective undertaken in patients who underwent surgical treatment in a hospital of Paraná. RESULTS: in a total of 110 patients, 70 (64%) participated, and of these, 57 (87%) had some type of complication and 67 (95%) said they had received instructions for discharge. Although 38 (54%) inquiries did not have doubts about self-care, 26 (37%) reported doubts about changing the dressing and 6 (9%) about the correct use of medication. As for the professional advisor, 45 (64%) were instructed by nurses, 40 (58%) by doctors and 4 (5%) by other professionals. CONCLUSION: It showed the need for more efficient educational actions by health professionals in the peri-operative period.

OBJETIVOS: identificar las complicaciones pos operatorias presentadas por pacientes sometidos a los procedimientos quirúrgicos, en un hospital de media complejidad, las dificultades experimentadas en el autocuidado durante el período pos-operatorio y las orientaciones ofrecidas en el proceso de alta hospitalaria. MÉTODOS: estudio descriptivo, prospectivo cuantitativo, emprendido en pacientes que realizaron tratamientos quirúrgicos en un hospital de Paraná. RESULTADOS: de 110 pacientes, 70 (64%) participaron, siendo que de estos, 57 (87%) presentaron algún tipo de complicaciones y 67 (95%) afirmaron haber recibido orientaciones para la alta hospitalaria. A pesar de 38 (54%) informar no haber tenido dudas cuanto al autocuidado, 26 (37%) relataron dudas cuanto a realizar el curativo, y seis (9%) sobre el uso correcto de la medicación. Cuanto al profesional orientador, 45 (64%) fueron orientados por enfermero, 40 (58%) por médico y cuatro (5%) por otros profesionales. CONCLUSIÓN: se evidenció la necesidad de acciones educativas más eficientes por los profesionales de la salud en el peri operatorio.

Correlation between the risk of falling and nutritional status in elderly surgical patients / 中华临床营养杂志

Objective To investigate the risk of falling and nutritional status in elderly surgical patients,and to assess the correlation between them.Methods Patients aged ≥65 in Department of General Surgery of Beijing Hospital between January and June 2015 were enrolled in this study.The Morse Fall Scale was used to evaluate the risk of falling.Anthropometrics,body composition,and Nutritional Risk Screening 2002 (NRS 2002) scores were collected to evaluate the nutritional status of the patients.The correlation between risk of falling and nutritional status was analyzed.Results A total of 383 patients were included,including 314 cases under 80 (65-79 years) and 69 cases ≥ 80.Patients ≥ 80 years showed significantly lower grip [(24.53 ± 8.09)kgvs.(30.57 ±8.48)kg,P＜0.05] and4-meter gait speed [(0.66 ±0.19)m/s vs.(0.84 ± 0.20) m/s,P ＜ 0.05],but significantly increased undemutrition [15.9％ (11/69) vs.7.0％ (22/314),P ＜ 0.05] and nutritional risk [56.5％ (39/69) vs.38.2％ (120/314),P ＜0.05].Altogether 33.9％ of the patients (130/383) were at high risk of falling,and the prevalence was significantly higher in patients ≥80 than in patients ＜ 80 [44.9％ (31/69) vs.31.5％ (99/314),P =0.036].Compared with patients not at high risk of falling,high-risk patients had lower body mass index [(22.33 ± 1.82) kg/m2 vs.(23.76 ± 3.26) kg/m2] and grip [(24.95 ± 8.56) kg vs.(30.72 ± 8.39) kg],but higher prevalence of nutritional risk [46.9％ (61/130) vs.38.7％ (98/253)] (all P＜0.05).Conclusions Eldedy surgical patients have a high risk of falling,which may be related with their nutritional status.Nursing and nutrition intervention should be emphasized in there patients to prevent falling and improve clinical outcome.

Complicaciones pulmonares posoperatorias en pacientes ingresados en Unidad de Cuidados Intensivos / Posoperative pulmonary complications in patients admitted to the intensive care service

Introducción: la cirugía y la anestesia provocan el aumento del riesgo de sufrir complicaciones pulmonares. Objetivo: evaluar el comportamiento delas complicaciones respiratorias en pacientes quirúrgicos. Métodos: estudio de cohorte, prospectivo, longitudinal, con 526 pacientes quirúrgicos que ingresaron en la Unidad de Cuidados Intensivos del Hospital Universitario Joaquín Albarrán Domínguez desde el 1ro. de enero de 2012 hasta el 31 de diciembre de 2014. La muestra quedó conformada por 127 pacientes operados que presentaron complicaciones de índole respiratoria. Resultados: 24,1 por ciento de los pacientes quirúrgicos presentaron complicaciones respiratorias. El mayor porcentaje de fallecidos estuvo dentro del grupo de 71 a 80 años (9,4 por ciento), seguidos por los de 61 a 70 (6,2 por ciento). Esto resultados fueron significativos (p≤ 0,05). El 18,8 por ciento de los fallecidos fue en operaciones de urgencia, y de ellos, con tiempo quirúrgico mayor de 2 horas 12,5 por ciento, con asociación significativa entre el tiempo quirúrgico y la mortalidad (p≤ 0,05). No hubo asociación entre el número de reintervenciones y la mortalidad (p= 3,721). El 35,4 por ciento, presentó bronconeumonía bacteriana nosocomial, seguido por la insuficiencia respiratoria aguda con 22,8 por ciento. El 50 por ciento falleció por fallo múltiple de órganos, seguido de 13,8 por ciento porinfarto pulmonar. Conclusiones: las principales complicaciones respiratorias en pacientes quirúrgicos fueron las infecciones de origen nosocomial, favorecidas por la edad avanzada, operaciones de urgencia y tiempo quirúrgico mayor de 2 horas con elevada frecuencia y letalidad. La bronconeumonía bacteriana nosocomial es la principal causa de muerte asociada al fallo multiorgánico(AU)

Introduction: surgery and anesthesia cause the increase of risk of suffering pulmonary complications. Objective: to evaluate the behavior of respiratory complications in surgical patients. Methods: prospective, longitudinal and cohort study of 526 surgical patients who were admitted to the intensive care service of Joaquin Albarrán Dominguez university hospital from January 1st 2012 to December 31st 2014. The sample was made up of 127 surgical patients who presented with respiratory complications. Results: in this group, 24.1 percent of patients suffered respiratory complications. The highest percentage of deaths occurred in the 71-80 year age group (9.4 percent) followed by the 61-70 y group (6.2 percent). These results were significant (p≤0.05). Of the number of deaths, 18.8 percent occurred in emergency surgeries, with over 2-hour surgical time in 12.5 percent of cases. There was significant association between the surgical time and mortality (p≤0.05). The number of reoperations and mortality were not related (p=3.721). In the sample, 35.4 percent had nosocomial bacterial bronchopneumonia followed by acute respiratory failure (22.8 percent). The main cause of death in 50 percent of patients was multiple organ failure followed by pulmonary infarction in 13.8 percent. Conclusions: the main respiratory complications in surgical patients were nosocomial infections prompted by the older age, emergency operations and surgical times over 2 hours with high frequency and lethality. Nosocomial bacterial bronchopneumonia is the main cause of death associated to multiple organ failure(AU)

“Manifestos do Coração”: Significados Atribuídos à Doença por Pacientes Cardíacos Pré-cirúrgicos / “Manifestations of the Heart”: Meanings Attributed to the Disease by Pre-surgical Cardiac Patients

RESUMOEste estudo objetivou explorar os significados atribuídos à doença cardíaca por pacientes cardíacos pré-cirúrgicos em tratamento ambulatorial no sul do Brasil. É um estudo clínico-qualitativo, de caráter exploratório e descritivo, cuja coleta de dados aconteceu por meio de entrevistas semiestruturadas e da autofotografia, propostas a 15 indivíduos. Foi realizada análise de conteúdo temática, emergindo as categorias: Confrontação com a doença: os saberes em questão, Negação da doença, Doença e trabalho e Sexualidade rompida. Os resultados destacaram as dificuldades dos participantes relacionadas à apropriação do quadro da doença e à aceitação dessa condição. Salienta-se a premência de ações de saúde, que possam ser coadjuvantes na reestruturação das possibilidades de vida para os pacientes cardíacos pré-cirúrgicos.

ABSTRACTThis study aimed to explore the meanings attributed to the cardiac disease by pre-surgical outpatients in the South of Brazil. It is a clinical and qualitative study, characterized as exploratory and descriptive. Data was collected through semi-structured interviews and auto-photography, proposed to 15 individuals. The use of thematic analysis resulted in the following categories which emerged: Confrontation with the disease: questioning existing knowledge, denial of the disease, disease and work, and ruptured sexuality. Results highlighted difficulties of the participants in regards to the appropriation of the disease condition as well as its acceptance. This result points out the need for health care actions that may help cardiac pre-surgical patients to restructure their possibilities of life.

Determinants of Malnutrition and Post-operative Complications in Hospitalized Surgical Patients.

The study aimed to determine the nutritional status (NS) of hospitalized surgical patients and investigate a possible association between NS and type of disease, type of surgery and post-operative complications. The gender, age, disease, surgery, complications, length of hospital stay, number of medications, laboratory test results, and energy intake of 388 hospitalized surgical patients were recorded. NS was determined by classical anthropometry. The inclusion criteria were: nutritional status assessment done within the first 24 hours of admission, age ≥20 years, and complete medical history. Univariate and multiple Cox’s regression analyses were employed to determine which variables were possible risk factors of malnutrition and complications. Malnutrition was more common in males (p=0.017), individuals aged 70 to 79 years (p=0.000), and individuals with neoplasms and digestive tract diseases (p=0.000). Malnourished individuals had longer hospital stays (p=0.013) and required more medications (p=0.001). The risk of malnutrition was associated with age and disease. Individuals aged 70 years or more had a two-fold increased risk of malnutrition (p=0.014; RR=2.207; 95% CI 1.169-4.165); those with neoplasms (p=0.008; RR=14.950; 95% CI 2.011-111.151) and those having digestive tract diseases (p=0.009; RR=14.826; 95% CI 1.939-113.362) had a 14-fold increased risk of malnutrition. Complications prevailed in older individuals (p=0.016), individuals with longer hospital stays (p=0.007), and individuals who died (p=0.002). The risk of complications was associated with age and BMI. In the present study, the risk of malnutrition was associated with age and type of disease; old age and low BMI may increase complications.

Increasing utilization of abdominal CT in the Emergency Department of a secondary care center: does it produce better outcomes in caring for pediatric surgical patients?

PURPOSE: The use of abdominal computed tomography (ACT) utilization is increasing to a remarkable extent in the pediatric Emergency Department (ED), but the clinical benefit of increased use of ACT for pediatric surgical patients remains uncertain. METHODS: A retrospective review was conducted to investigate if, for patients who had visited pediatric ED during the last 5 years, increasing utilization of ACT would increase the detection rate of acute appendicitis, increase the detection rate of surgical conditions other than appendicitis, and decrease the hospital admission rate for surgical conditions. RESULTS: During the study period, there were 37,918 ED visits; of these, 3,274 (8.6%) were for abdominal pain, 844 (2.2%) had ACT performed. The annual proportional increase of the ACT was statistically significant (1.56% to 2.46%, P = 0.00), but the detection rate of acute appendicitis (3.3% to 5.1%) or other surgical conditions (1.7% to 2.8%) showed no statistically significant changes. Hospital admission rates (5.6% to 6.8%) also showed no significant changes during the study period. CONCLUSION: Increasing utilization of ACT does not lead to the improved outcomes in caring for pediatric surgical patients visiting the pediatric ED. Careful evaluation for the indication for ACT is needed in the pediatric ED.

Effects of comfort nursing on emotions and comfort of surgical patients / 现代临床护理

Objective To explore effects of comfort nursing on anxiety, depression and comfort of surgical patients.Methods Comfort nursing was done to 128 surgical patients, including physical comfort, psychological comfort and social comfort and self-designed questionnaire was made to investigate the comfort of patients during operation. When the patients were hospitalized and after operation, patients’physical states were evaluated with self-rating depression scale(SDS)and self-rating anxiety scale(SAS).Results The score of patients’comfort was (6.5±0.2)and the SDS and SAS were lower than that of patients when hospitalized with statistical difference(P<0.05).Conclusion Comfort nursing can reduce anxiety, depression and increase comfort of surgical patients.

Influência do estado nutricional e da composição corporal na morbimortalidade de doentes candidatos à cirurgia major / Influence of nutritional status and body composition in morbidity and mortality of patients eligible for major surgery

Malnutrition is an important risk factor for operative morbidity and mortality. The aim of this study was to evaluate prevalence of nutritional risk and malnutrition in patients eligible for major surgery and correlate them with clinical outcome. Nutritional screening was performed using the index ?Malnutrition Universal Screening Tool?. Nutritional status was assessed by anthropometric (Garrow, McWhirter and Blackburn), analytical (pre-albumin, transferrin, albumin and lymphocyte count) and functional (grip strength) parameters and body composition was evaluated by bioelectrical impedance. We studied 71 patients, 63.4% male, with mean age of 60.4±12.8 (30-91) years and oncologic pathology in 81.7% of cases. Mortality and morbidity rates were 7 and 31%, respectively. Postoperative hospitalization was 12.4±10.5 (1-61) days. Sixtyfour patients (90.1%) were considered of high nutritional risk and MUST score was 2.46±1.29 (0-6); 36.5% reported weight loss exceeding 5% and 16.9% of cases exceeded 10%. Only four patients (5.6%) presented BMI below 20kg/m2 while 72% showed BMI over 25kg/m2. Fat-free mass index (FFMI) was normal for only 11.3% of cases. Weight loss greater than 10% and ideal weight percentage were predictors of operative mortality (p=0.040, p=0.043). Morbidity related significantly to MUST, Buzby index, BMI, FFMI and albumin. We found high percentage of surgical patients at nutritional risk and high prevalence of excess weight or obesity. A systematic pre-operative nutritional assessment is needed for prognosis optimization.

La desnutrición es un importante factor de riesgo para la mortalidad y la morbilidad operatoria. El objetivo de este estudio fue evaluar la prevalencia de riesgo nutricional y desnutrición en pacientes candidatos a cirugía major electiva y correlacionarlos con su evolución clínica. El examen nutricional se realizó mediante la herramienta ?Malnutrition Universal Screening Tool? (MUST). El estado nutricional se evaluó mediante parámetros antropométricos (criterios de Garrow, McWhirter y Blackburn), analíticas (prealbuminemia, transferrinemia, albuminemia y recuento total de linfocitos), funcionales (dinamometría) y la composición corporal por bioimpedancia. Se estudiaron 71 pacientes, 63,4% varones, con una edad media de 60,4±12,8 años (30-91) y con patología oncológica en el 81,7% de los casos. Las tasas de mortalidad y morbilidad fueron de 7 y 31%, respectivamente. La internación hospitalaria postoperatoria fue de 12,4±10,5 (1-61) días. Sesenta y cuatro pacientes (90,1%) fueron considerados de alto riesgo nutricional y su puntuación MUST fue de 2,46±1,29 (0-6), el 16,9% de los casos reportaron pérdida de peso superior al 10%. Sólo cuatro pacientes (5,6%) tenían un IMC (índice de masa corporal) inferior a 20kg/m2 y un 72% más de 25. El índice de masa sin grasa (IMSG) fue bajo en sólo el 4,2% de los casos. La pérdida de peso mayor que 10% y el porcentaje del peso corporal ideal fueron predictores de mortalidad operatoria (p=0,040, p=0,043). La morbilidad se relacionó significativamente con la suma de MUST, índice de Buzby, IMC, IMSG y albuminemia. Se evidenciaun alto porcentaje de pacientes quirúrgicos con riesgo nutricional y una alta prevalencia de exceso de peso u obesidad. A fin de optimizar el pronóstico, es necesaria una evaluación nutricional preoperatoria sistemática.

A má nutrição constitui um importante fator de risco de mortalidade e morbilidade operatória. O estudo teve como objetivos avaliar a prevalência do risco nutricional e da má nutrição em doentes candidatos à cirurgia eletiva major, e correlacioná-los com a evolução clínica. O rastreio nutricional foi efetuado por meio do Malnutrition Universal Screening Tool (MUST). O estado nutricional foi avaliado por parâmetros antropométricos (critérios de Garrow, McWhirter e Blackburn), analíticos (pré-albuminemia, transferrinemia, albuminemia e contagem de linfócitos) e funcionais (dinamometria); a composição corporal foi avaliada por bioimpedância. Foram estudados 71 pacientes, sendo 63,4% do gênero masculino, com idade média de 60,4±12,8 (30-91) anos e diagnóstico de patologia oncológica em 81,7% dos casos. As taxas de mortalidade e morbilidade foram de 7 e 31%, respectivamente. O internamento pós-operatório foi de 12,4±10,5 (1-61) dias. Um número de 64 doentes (90,1%) foi considerado em risco nutricional elevado e a pontuação MUST foi de 2,46±1,29 (0-6); 16,9% dos casos referiram perda de peso superior a 10%. Somente quatro pacientes (5,6%) apresentavam um IMC inferior a 20kg/m2 e 72%, superior a 25. O índice de massa não gorda (IMNG) foi baixo em apenas 4,2% dos casos. A perda ponderal superior a 10% e a percentagem de peso ideal constituíram fatores preditivos de mortalidade operatória (p=0,040; p=0,043). A morbilidade relacionouse significativamente com o somatório de MUST, Índice de Buzby, IMC, IMNG e albuminemia. Salienta-se uma elevada percentagem de doentes cirúrgicos em risco nutricional e uma alta prevalência de excesso ponderal ou obesidade. É necessária uma avaliação nutricional pré-operatória sistemática para uma otimização do prognóstico.

The success rate and safety of internal jugular vein cannulation using anatomical landmark technique in patients undergoing cardiothoracic surgery.

Aims and objectives: Landmark-guided internal jugular vein (IJV) cannulation is a basic procedure, which every anesthetist is expected to acquire. A successful first attempt is desirable as each attempt increases the risk of complications. The present study is an analysis of 976 IJV cannulations performed in adults undergoing cardiothoracic surgery. Materials and Methods: The IJV was cannulated with a triple lumen catheter using the anatomical landmarks. The following data were recorded: Patient demographics, age, sex, body mass index, diagnosis, operative procedure, operator (resident/consultant), site of cannulation (central approach, right IJV, left IJV, external jugular vein), number of attempts and duration of cannulation, length of insertion of the catheter, number of correct placements on X-ray and any complications. Results: The success rate of IJV cannulation was 100%. In 809 (82.9%) patients, cannulation was performed in the first attempt. Residents performed 792 cannulations and the consultants performed 184 cannulations. In 767 patients, the residents were successful in inserting the catheter and in 25 they failed after 5 attempts, hence, they were cannulated by the consultant. The time taken for insertion of the catheter was 6.89 ± 3.2 minutes. Carotid artery puncture was the most common complication, it occurred in 22 (2.3%) patients. Conclusion: IJV cannulation with landmark technique is highly successful with minimal complications in the adult patients undergoing cardiothoracic surgery. Basic training of cannulating the IJV by landmark technique should be imparted to all the traines as ultrasound may not be available in all locations.

Optimization of surgical patients’handover procedures using tracking methodology / 现代临床护理

Objective To evaluate the effect of optimizing surgerical patients’handover procedures using tracking methodology.Methods Two hundred patients hospitalized between July 2011 and May 2012 were assigned in the control group,in which their handover was conduced conventionally.Another 200 patients between April 2012 to February 2012 were assigned in the observation group,where their handover was done by tracking methodology.The two groups were compared in terms of incidence of adverse events at handover,time for handover and satisfaction of medical staff.Result Compared with the control group,the study group showed significantly lower incidence of adverse events,shorter surgical handover time and higher satisfaction degree of medical staff(P<0.05).Conclusion The tracking methodology can help to optimize handover procedures and quality control management, reduce the incidence of adverse events and improve working efficiency.

Adequação calórico-proteica da terapia nutricional enteral em pacientes cirúrgicos / Protein-calorie adequacy of enteral nutrition therapy in surgical patients

OBJETIVO: Avaliar a adequação calórico-proteica da terapia nutricional enteral (TNE) empregada em pacientes cirúrgicos. MÉTODOS: Estudo prospectivo, realizado em pacientes cirúrgicos que receberam TNE de março a outubro de 2011. Os pacientes foram avaliados antropometricamente e pela avaliação subjetiva global (ASG). Os valores de calorias e proteínas prescritos e administrados e as causas de interrupção da dieta foram registrados diariamente. O valor de 90% foi utilizado como referencial de adequação. A diferença entre o prescrito e o administrado foi verificada pelo teste t de Student. RESULTADOS: Uma amostra de 32 pacientes, com idade de 55,8 ± 14,9 anos, apresentou 40,6 a 71,9% de desnutrição dependendo da ferramenta utilizada. A neoplasia gástrica e as gastrectomias foram o diagnóstico e as cirurgias mais frequentes. Dos pacientes, 50% conseguiram atingir suas necessidades calórico-proteicas. A adequação da dieta recebida em relação à prescrita foi de 88,9 ± 12,1% e de 87,9 ± 12,2% para calorias e proteínas, respectivamente, com um déficit significativo (p < 0,0001) de 105,9 Kcal/dia e de 5,5 g de proteína/dia. Dos pacientes, 59,4% estavam adequados quanto a calorias e 56,2% quanto a proteínas. As causas de suspensão da dieta ocorreram em 81,3%, sendo o jejum para procedimentos (84,6%) e náuseas/vômitos (38,5%) as causas mais observadas no pré e no pós-operatório, respectivamente. CONCLUSÃO: A inadequação calórico-proteica foi frequente, podendo ser atribuída às intercorrências e suspensões da dieta durante a TNE, o que pode ter dificultado que a amostra atingisse suas necessidades nutricionais. Isto pode contribuir para o declínio do estado nutricional do paciente cirúrgico, que frequentemente já está comprometido, conforme observado neste estudo.

OBJECTIVE: To evaluate the protein-calorie adequacy of enteral nutrition therapy (ENT) in surgical patients. METHODS: A prospective study was performed in surgical patients who received ENT from March to October 2011. Patients were evaluated anthropometrically and by subjective global assessment (SGA). The amount of calories and protein prescribed and administered were recorded daily, as well as the causes of discontinuation of the diet. A 90% value was used as the adequacy reference. The difference between the prescribed and administered amount was verified by Student's t-test. RESULTS: A sample of 32 patients, aged 55.8 ± 14.9 years, showed a malnutrition rate of 40.6% to 71.9%, depending on the assessment tool used. Gastric cancer and gastrectomy were the most common diagnosis and surgery, respectively. Of the patients, 50% were able to meet their caloric and protein needs. The adequacy of the received diet in relation to the prescribed one was 88.9 ± 12.1% and 87.9 ± 12.2% for calories and proteins, respectively, with a significant difference (p < 0.0001) of 105.9 kcal/day and 5.5 g protein/day. 59.4% of the patients had adequate caloric intake and 56.2% had adequate protein intake. Causes of diet suspension occurred in 81.3%, with fasting for procedures (84.6%) and nausea/vomiting (38.5%) being the most frequently observed causes in pre- and postoperative periods, respectively. CONCLUSION: Inadequate caloric and protein intake was common, which can be attributed to complications and diet suspensions during ENT, which may have hampered the sample reached their nutritional needs. This may contribute to the decline in the nutritional status of surgical patients, who often have impaired nutrition, as observed in this study.