ABSTRACT
Introducción: Los protocolos de recuperación mejorada o precoz, hoy en día, constituyen un eslabón fundamental cuando se habla de mejorar la calidad de la atención perioperatoria que se brinda a los enfermos en aras de disminuir la incidencia de complicaciones. Un acápite fundamental en ellos está en relación con la evaluación, optimización y el apoyo nutricional oportuno. Objetivo: Demostrar la importancia de una adecuada valoración y un oportuno apoyo nutricional perioperatorio en los enfermos programados para procedimientos quirúrgicos cardiacos, así como exponer los aspectos esenciales a considerar en relación a esta temática. Métodos: Se realizó una revisión de la literatura relacionada con el tema. Desarrollo: La desnutrición es uno de los problemas más importantes, así se evidencia en una serie de publicaciones que datan desde 1976 hasta la actualidad. La evaluación del estado nutricional se debe realizar durante todo el período perioperatorio. En sus diferentes fases se describen una serie de factores de riesgos que, cuando están presentes, obligan a instaurar un apoyo nutricional precoz e intensivo por vía parenteral y/o enteral. Conclusiones: La evaluación y la optimización preoperatoria del estado nutricional es vital para una adecuada evolución perioperatoria de los enfermos, por lo que debe constituir parte indispensable de la consulta anestesiológica. El apoyo nutricional debe de ser instaurado de forma precoz una vez identificados los indicadores de riesgo en aras de disminuir la incidencia de complicaciones perioperatorias(AU)
Introduction: Enhanced or fast-track recovery protocols, nowadays, constitute a fundamental link when it comes to improving the quality of perioperative care provided to patients for reducing the incidence of complications. A fundamental section in them is related to the evaluation, optimization and timely nutritional support. Objective: To demonstrate the importance of adequate evaluation and timely perioperative nutritional support in patients scheduled for cardiac surgical procedures. Methods: We carried out a review of the literature related to the subject. Development: Malnutrition is one of the most important problems, as evidenced by a series of publications dating from 1976 to date. The evaluation of nutritional status must be carried out throughout the perioperative period. In its different phases, a series of risk factors are described and, when present, require the introduction of early and intensive parenteral and/or enteral nutritional support. Conclusions: The evaluation and preoperative optimization of the nutritional status is vital for an adequate perioperative evolution of patients, so it must be an indispensable part of the anesthesiological consultation. Nutritional support should be established early once the risk indicators have been identified, in order to reduce the incidence of perioperative complications(AU)
Subject(s)
Humans , Male , Female , Thoracic Surgery/methods , Nutrition Assessment , Perioperative Care/education , Perioperative Care/methods , Review , /methodsABSTRACT
@#Objective To evaluate the feasibility and safety of improving chest drainage procedure by applying postoperative chest drainage with central venous catheter for uniportal video-assisted thoracoscopic surgery (VATS) lobectomy in fast track recovery. Methods Between July 2016 and March 2018, a total of 150 patients who underwent uniportal VATS lobectomy by the same chief surgeon were recruited. All patients were randomly divided into two groups including a trial group and a control group. In the trial group, there were 44 males and 28 females with an average age of 47±11 years. Central venous catheter and 26F silicone rubber tuber were used and chest tube was removed when drainage volume less than 300 ml/d. Chest X ray was conducted three days after discharge from hospital and the central venous catheter was removed after thoracentesis. In the control group, there were 40 males and 29 females with an average ages of 52±13 years, 26 F silicone rubber tuber and chest tube were removed when drainage volume less than 100 ml/d. The clinical effectiveness was compared between the two groups. Results No statistically significant difference was observed between the trial group and the control group in the date of preoperative general information, the occurrence of postoperative complications and the visual analogue score on Day1 after the operation. However, the visual analogue score, intubation time, post-operative length of stay, the frequency of using tramadol were all significantly shorter or lower in the trial group when compared with the control group (P<0.05). Seven patients of the trial group suffered moderate pleural effusion after intubation, which was significantly more than that of the control group (P<0.05). Six patients recovered after thoracentes through central venous catheter. The average amount of pleural effusions before removing the central venous catheter was 74.8 ml. Conclusion The use of central venous catheter and 26 F silicone rubber tuber after uniportal VATS lobectomy is safe and feasible for the early removal of chest tube. It is beneficial to fast track recovery.
ABSTRACT
Objective:To investigate the impact of active cycle of breathing technique(ACBT) and conventional air way clearance therapy(percussion and vibration) on fast track recovery after pulmonary lobectomy for non-small cell lung cancer.Method:A total of 78 lung cancer patient were chosen from 106 lung cancer patient admitted to Guangdong general hospital between January 2016 and January 2017.During study period,two patients dropped out in each group and 74 patients were included in the analysis finally.They were randomly allocated into experimental group (experimental group,37 patients including 23 males and 14 females with their average age of 56.05± 10.57 years)and control group (control group,37 patients including 21 males and 16 females with their average age of 59.35±10.57 years).There was no statistical difference in preoperative clinical characteristics.Patients in the control group had routine postoperative percussive and vibration chest physiotherapy ten minutes for every time,twice a day.Participants in the ACBT group received ACBT treatment for twice a day,6-8 cycle every time after surgery.The total hospital stay,postoperative hospital stay,length of chest tube removal and recovery level of cardiopulmonary function were compared between the 2 groups.Result:The length of chest tube removal of experiment group were significantly less than that of control group (1.41±0.60 vs 2.84±1.07 P＜0.05).Patients in the ACBT group showed significant improvement in cardiopulmonary function assessed by 6MWD and the less change in pulmonary function(FEVI and FVC) relative to the preoperation on the fourth day after surgery (377.46±67.95 vs 328.48±89.17,0.55±0.38 vs 1.03±0.45,0.84±0.20 vs 1.22±0.48,P＜0.05).Although the total hospital stay and postoperative hospital stay of experiment group were less than the control group(11.76±3.56 vs 13.73±4.90,5.56±2.64 vs 6.16±2.40,P＞0.05,there was no statistical difference.Conclusion:Compared with conventional air way clearance therapy(percussion and vibration),the ACBT can shorten the length of chest tube removal and promote the recovery of postoperative cardiopulmonary function,which is helpful for fast track recovery of NSCL patient after pulmonary lobectomy.
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Objective To analyze the risk factors impeding early extubation after off-pump coronary artery bypass grafting (OPCAB) in Chinese patients, so that to identify the applicable patients for "fast track recovery". Methods Clinical data of 680 consecutive patients who had received OPCAB were analyzed retrospectively. The patients were divided into two groups according to the time of extubation (group Ⅰ,n=333, extubation was performed within 12 h postoperation; group Ⅱ,n=347, extubation failed in 12 h). Univariate and multivariate analyses were used to determine risk factors prolonging mechanical ventilation. Results Univariate analyses showed significant difference between the two groups in the percentages of patients over 70 years [25% (84/333) vs 39% (136/347), ?2=15.148, P=0.000], with history of stroke [14% (46/333) vs 22% (75/347), ?2=7.068, P=0.008], with LVEF70 (OR=2.003), LVEF70, severe coronary artery lesion, emergency operation, and poor cardiac function are risk factors impeding early extubation. "Fast track recovery" protocol is applicable to young patients who have good cardiac function without left main lesion and do not need IABP during perioperative period.