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1.
Rev. bras. cir. cardiovasc ; 37(4): 488-492, Jul.-Aug. 2022. tab
Article in English | LILACS-Express | LILACS | ID: biblio-1394726

ABSTRACT

Abstract Introduction: There are several approaches for pericardiocentesis. However, there is no definite suggestion about puncture location after cardiac surgery. The purpose of this study is to examine whether there is any difference regarding puncture location during pericardiocentesis in postoperative cardiac tamponade comparing to nonsurgical cardiac tamponade. Methods: We retrospectively analyzed patients who had undergone pericardiocentesis from August 2011 to December 2019. Patients were examined in two groups, nonsurgical and postsurgical, based on the etiology of pericardial tamponade. Clinical profiles, echocardiographic findings, and procedural outcomes were identified and compared. Results: Sixty-eight pericardiocenteses were performed in this period. The etiology of pericardial effusion was cardiac surgery in 27 cases and nonsurgical medical conditions in 41 cases. Baseline demographic variables were similar between the surgical and nonsurgical groups. Loculated effusion was more common in the postsurgical group (48.1% vs. 4.9%, P<0.001). Maximal fluid locations were different between the groups; right ventricular location was more common in the nonsurgical group (36.6% vs. 11.1%, P=0.02), while lateral location was more common in the postsurgical group (12.2% vs. 40.7%, P=0.007). Apical drainage was more frequently performed in the postsurgical group compared to the nonsurgical group (77.8% vs. 53.7%, P=0.044). Conclusion: Apical approach as a puncture location can be used more frequently than subxiphoid approach for effusions occurred after cardiac surgery compared to nonsurgical effusions. Procedural success is prominent in this group and can be the first choice of treatment.

2.
Rev. argent. radiol ; 86(2): 115-123, jun. 2022. graf
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1387609

ABSTRACT

Resumen Para la reconstrucción y el tratamiento de anomalías que comprometen la aorta torácica pueden emplearse diversas técnicas quirúrgicas abiertas, las cuales estarán determinadas por la patología que presente el paciente. La angiotomografía computada multicorte (ATCMC) es el método de elección para su control y seguimiento. El médico radiólogo debe estar familiarizado con las técnicas quirúrgicas empleadas (Wheat, Bentall de Bono, Cabrol, entre otras), con las reparaciones estructurales que se realizan y con los materiales protésicos utilizados con el fin de evitar una interpretación errónea de las imágenes. El fieltro espontáneamente hiperdenso, los conductos protésicos y sus anastomosis, tanto con la aorta como con los grandes vasos, puede generar errores en el informe final y en el diagnóstico.


Abstract Multiple surgical techniques can be used for the reconstruction and treatment of abnormalities that compromise the thoracic aorta, which will be determined by the patient’s pathology. Multislice computed tomography angiography is the method of choice for their control and monitoring. The radiologist should be familiar with the surgical techniques used (Wheat, Bentall de Bono, and Cabrol, among others), as well as with the structural repairs that are performed and the prosthetic materials used in order to avoid an erroneous interpretation of the images. Spontaneously hyperdense felt, the prosthetic ducts and their anastomosis, both with the aorta and the large vessels, can generate pitfalls in the final report and error in the diagnosis.

3.
Rev. bras. cir. cardiovasc ; 37(2): 176-184, Apr. 2022. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1376522

ABSTRACT

ABSTRACT Introduction: The objectives of this study are to experimentally evaluate the haemostatic effects of two organic substances, a membrane of chitosan and a collagen sponge coated with thrombin and human fibrinogen (TachoSil®), in sealing 7-0 needle stitches holes on the femoral arteries of rats as well as to evaluate local histological reactions. Methods: Twenty-four rats were included, and four holes were made in each common femoral artery. In the control group, haemostasis was achieved only by compression with gauze sponge; and in the two other groups, haemostasis was achieved with application of one of these two substances. Results: Membrane of chitosan and TachoSil® showed a power to reduce the time to achieve haemostasis compared with the control group (P=0.001), and the haemostatic effects of these two substances were comparable. There was lower blood loss in the groups where these two substances were used when compared with the control group, but no difference was found comparing the two substances. Conclusion: The use of these sealants did not promote more adhesion or local histological reactions when compared to the control group. Since chitosan is easy to find in nature, has a positive effect to promote haemostasis, and did not bring considerable local reactions, it might be used as a sealant in cardiovascular surgery.

4.
Rev. bras. cir. cardiovasc ; 37(1): 128-130, Jan.-Feb. 2022. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1365535

ABSTRACT

ABSTRACT Although technically simple, surgical correction of patent ductus arteriosus can have serious complications. In this context, acute ventricular failure must be remembered, as its prompt diagnosis and proper management can change clinical outcomes.

6.
Enferm. foco (Brasília) ; 12(5): 998-1004, dez. 2021. tab
Article in Portuguese | LILACS, BDENF | ID: biblio-1367329

ABSTRACT

Objetivo: Mapear os diagnósticos de enfermagem levantados pelos enfermeiros, com o uso da Taxonomia NANDA-I, para pacientes internados em um Centro de Terapia Intensiva Cardiovascular, na perspectiva da Teoria Adaptativa de Callista Roy. Métodos: Trata-se de uma pesquisa documental, exploratória, descritiva e de abordagem quantitativa, mediante análise retrospectiva dos registros de enfermagem em prontuários eletrônicos de pacientes com o uso do mapeamento cruzado. Resultados: Foram identificados 677 termos e expressões que se referiam a 28 diagnósticos de enfermagem diferentes da Taxonomia da NANDA-I e 09 necessidades do modo fisiológico da Teoria Adaptativa de Callista Roy. Conclusão: A utilização do modelo adaptativo de Callista Roy possibilitou a identificação das necessidades do modo fisiológico, a partir de 28 diagnósticos de enfermagem diferentes, dos pacientes internados no Centro de Terapia Intensiva Cardiovascular em pós-operatório de cirurgia cardiovascular. Esse estudo é útil como reflexão sobre quais necessidades, vulnerabilidades e suscetibilidades os pacientes apresentam após serem submetidos a procedimentos cardiovasculares, assim como, organizar a assistência de enfermagem visando à melhoria clínica do paciente e consequentemente a qualidade da assistência. (AU)


Objective: To map the nursing diagnoses raised by nurses, using the NANDA-I Taxonomy, for patients admitted to a Cardiovascular Intensive Care Center, from the perspective of Callista Roy's Adaptive Theory. Methods: This is a documentary, exploratory, descriptive and quantitative approach, through a retrospective analysis of nursing records in electronic medical records of patients using cross-mapping. Results: 677 terms and expressions were identified that referred to 28 nursing diagnoses different from NANDA-I Taxonomy and 09 needs in the physiological mode of Callista Roy's Adaptive Theory. Conclusion: The use of Callista Roy's adaptive model made it possible to identify the needs in the physiological way, based on 28 different nursing diagnoses, of patients admitted to the Cardiovascular Intensive Care Center in the postoperative period of cardiovascular surgery. This study is useful as a reflection on what needs, vulnerabilities and susceptibilities patients have after undergoing cardiovascular procedures, as well as organizing nursing care aimed at the clinical improvement of the patient and, consequently, the quality of care. (AU)


Objetivo: Mapear los diagnósticos de enfermería planteados por enfermeras, utilizando la Taxonomía NANDA-I, para pacientes ingresados en un Centro de Cuidados Intensivos Cardiovasculares, desde la perspectiva de la Teoría Adaptativa de Callista Roy. Métodos: Se trata de un abordaje documental, exploratorio, descriptivo y cuantitativo, mediante un análisis retrospectivo de los registros de enfermería en los registros médicos electrónicos de los pacientes mediante mapeo cruzado. Resultados: Se identificaron 677 términos y expresiones que se referían a 28 diagnósticos de enfermería diferentes de la Taxonomía NANDA-I y 09 necesidades en la modalidad fisiológica de la Teoría Adaptativa de Callista Roy. Conclusión: El uso del modelo adaptativo de Callista Roy permitió identificar de forma fisiológica, a partir de 28 diagnósticos de enfermería diferentes, las necesidades de los pacientes ingresados en el Centro de Cuidados Intensivos Cardiovasculares en el postoperatorio de cirugía cardiovascular. Este estudio es útil como reflexión sobre qué necesidades, vulnerabilidades y susceptibilidades tienen los pacientes luego de ser sometidos a procedimientos cardiovasculares, así como para organizar cuidados de enfermería orientados a la mejora clínica del paciente y, en consecuencia, la calidad de la atención. (AU)


Subject(s)
Nursing , Cardiovascular Surgical Procedures , Nursing Diagnosis , Intensive Care Units
7.
Rev. bras. cir. cardiovasc ; 36(6): 822-824, Nov.-Dec. 2021. tab
Article in English | LILACS | ID: biblio-1351667

ABSTRACT

Abstract The coronavirus disease 2019 (COVID-19) pandemic brings numerous challenges to the health ecosystem, including the safe resumption of elective cardiac surgery. In the pre-pandemic period, rapid recovery protocols demonstrated, through strategies focused on the multidisciplinary approach, reduction of hospital length of stay, infection rates and, consequently, costs. Even with several studies proving the benefits of these protocols, their acceptance and implementation have been slow. It is believed that the resumption of surgeries in the current context requires the use of rapid recovery protocols combined with the use of a mobile application promoting greater engagement between patients, caregivers and care teams.


Subject(s)
Humans , Technology , COVID-19 , Cardiac Surgical Procedures , Patient Care Team , Elective Surgical Procedures , Mobile Applications , Enhanced Recovery After Surgery
8.
Rev. bras. ter. intensiva ; 33(3): 469-476, jul.-set. 2021. graf
Article in English, Portuguese | LILACS | ID: biblio-1347303

ABSTRACT

RESUMO Desde a instituição da circulação extracorpórea, há cinco décadas, a lesão cerebral decorrente desse procedimento durante cirurgias cardiovasculares tem sido uma complicação frequente. Não existe uma causa única de lesão cerebral pelo uso de circulação extracorpórea, porém se sabe que acomete cerca de 70% dos pacientes submetidos a esse procedimento. A avaliação da pressão intracraniana é um dos métodos que podem orientar os cuidados com os pacientes submetidos a procedimentos associados com distúrbios neurológicos. Este artigo descreve dois casos de pacientes submetidos à cirurgia cardiovascular com circulação extracorpórea, para os quais os procedimentos de neuroproteção na fase pós-operatória foram guiados pelos achados relacionados ao formato das ondas de pressão intracraniana, obtidos por meio de um método não invasivo de monitoramento.


ABSTRACT Brain injury caused by extracorporeal circulation during cardiovascular surgical procedures has been a recurring complication since the implementation of extracorporeal circulation five decades ago. There is no unique cause of brain injury due to the use of extracorporeal circulation, but it is known that brain injury affects about 70% of patients who undergo this procedure. Intracranial pressure assessment is one method that can guide the management of patients undergoing procedures associated with neurological disturbances. This study describes two cases of patients who underwent cardiovascular surgery with extracorporeal circulation in whom clinical protocols for neuroprotection in the postoperative phase were guided by intracranial pressure waveform findings obtained with a novel noninvasive intracranial pressure monitoring method.


Subject(s)
Humans , Intracranial Pressure , Cardiac Surgical Procedures/adverse effects , Extracorporeal Circulation , Neuroprotection , Intensive Care Units
9.
Rev. méd. Chile ; 149(8)ago. 2021.
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1389582

ABSTRACT

Recent randomized controlled trials confirmed the beneficial outcomes with coronary artery bypass grafting (CABG) compared with percutaneous coronary intervention (PCI) in patients with severe three-vessel coronary artery and left main disease. An increased long-term survival after CABG is associated with a reduction in spontaneous myocardial infarction and repeat revascularization rates. While PCI treats only flow-limiting lesions, CABG treats the whole coronary artery, preventing events in the future. Due to different clinical and anatomic factors affecting the outcomes, the heart team should formulate treatment assignment recommendations.

10.
Arq. bras. cardiol ; 116(6): 1080-1088, Jun. 2021. tab, graf
Article in English, Portuguese | LILACS | ID: biblio-1278337

ABSTRACT

Resumo Fundamento Houve aumento expressivo na incidência de infecções relacionadas a dispositivos cardíacos eletrônicos implantáveis (DCEI) nos últimos anos, com impacto na mortalidade. Objetivos Verificar a proporção de pacientes com infecção de DCEI e analisar seu perfil clínico, as variáveis relacionadas com a infecção e sua evolução. Método Estudo retrospectivo, observacional e longitudinal com 123 pacientes com infecção de DCEI entre 6.406 procedimentos. Foram usados os testes paramétricos, e o nível de significância adotado na análise estatística foi de 5%. Resultados A idade média dos pacientes foi de 60,1 anos, e 71 eram homens. A média de internação foi de 35,3 dias, e houve remoção total do sistema em 105 pacientes. Identificaram-se endocardite infecciosa (EI) e sepse em 71 e 23 pacientes, respectivamente. A mortalidade intra-hospitalar foi 19,5%. Houve associação entre EI e extrusão do gerador (17,0% vs. 19,5% nos grupos com e sem EI, respectivamente, p = 0,04; associação inversa) e sepse (15,4% vs. 3,2%, p = 0,01). Houve associação entre morte intra-hospitalar e EI (83,3% vs. 52,0% com e sem morte, respectivamente, p = 0,005) e sepse (62,5% vs. 8,1%, p < 0,0001). Foi dada alta hospitalar a 99 pacientes. Durante a média de seguimento clínico de 43,8 meses, a taxa de mortalidade foi de 43%, e 65,2% dos pacientes com sepse faleceram (p < 0,0001). A curva de sobrevida de Kaplan-Meier não indicou associação significante com sexo, agente etiológico, fração de ejeção, EI e modalidade de tratamento. A taxa de mortalidade foi de 32,8% entre os pacientes submetidos a reimplante de eletrodos por via endocárdica e 52,2% entre aqueles por via epicárdica (p = 0,04). Não houve influência da etiologia chagásica, a qual correspondeu a 44,7% das cardiopatias de base, quanto às variáveis clínicas e laboratoriais ou à evolução. Conclusões A taxa de infecção foi de 1,9%, com predomínio em homens. Houve associação entre mortalidade intra-hospitalar e EI e sepse. Após a alta hospitalar, a taxa de mortalidade anual foi de 11,8%, com influência de sepse durante a internação e o implante epicárdico. (Arq Bras Cardiol. 2021; [online].ahead print, PP.0-0)


Abstract Background In recent years, the incidence of infections related to cardiac implantable electronic devices (CIED) has increased sharply, impacting mortality. Objective To verify the proportion of patients with CIED infection; to analyze their clinical profile and the variables related to the infection and its progression. Methods Retrospective and longitudinal observational study including 123 patients with CIED infection among 6406 procedures. Parametric tests and a level of significance of 5% were used in the statistical analyses Results The mean age of patients was 60.1 years and mean length of stay in hospital was 35.3 days; most (71) patients were male, and the system was completely removed in 105 cases. Infectious endocarditis (IE) and sepsis were observed in 71 and 23 patients, respectively. Intra-hospital mortality was 19.5%. IE was associated with extrusion of the generator (17.0% vs 19.5% with and without IE, respectively, p = 0.04, inverse association) and sepsis (15.4% vs 3.2%, p = 0.01). Intra-hospital death was associated with IE (83.3% vs 52.0% with and without intra-hospital death, respectively, p = 0.005) and sepsis (62.5% vs 8.1%, p < 0.0001). Ninety-nine patients were discharged. During a mean follow-up of 43.8 months, mortality rate was 43%; among patients with sepsis, it was 65.2% (p < 0.0001). By applying a Kaplan-Meier survival curve, we did not indicate significant associations with sex, etiologic agent, ejection fraction, IE, or treatment modality. The death rate was 32.8% for patients subjected to endocardial electrode reimplantation and 52.2% for epicardial reimplantation (p = 0.04). Chagasic etiology (44.7% of the baseline heart diseases) did not influence clinical and laboratory variables or disease progression. Conclusion The infection rate was 1.9%, mostly in men. We observed an association of intra-hospital mortality with IE and sepsis. After discharge, the annual mortality rate was 11.8%, influenced by sepsis during hospitalization and epicardial implantation. (Arq Bras Cardiol. 2021; [online].ahead print, PP.0-0)


Subject(s)
Humans , Male , Female , Pacemaker, Artificial , Surgical Procedures, Operative , Endocarditis , Infections , Clinical Evolution , Hospital Mortality , Sepsis
11.
Rev. bras. cir. cardiovasc ; 36(2): 244-252, Mar.-Apr. 2021. graf., tab.
Article in English | LILACS, SES-SP, CONASS, SESSP-IDPCPROD, SES-SP | ID: biblio-1251100

ABSTRACT

Abstract Objective: To investigate whether hybrid repair has supremacy over conventional open repair in aortic arch diseases. Methods: A comprehensive search was undertaken in two major databases (PubMed and MEDLINE) to identify all studies comparing the two surgical techniques in five years, up to December 2018, that met the established criteria in this study. The search returned 310 papers, and 305 were selected after removing duplicates. The abstracts of the remaining articles were assessed, resulting in 15 studies that went to full-text analysis. After application of the inclusion and exclusion criteria, 8 papers remained for the final revision. Results: Eight studies met the criteria, with the inclusion of 1,837 patients. From a short-term perspective, hybrid repair and conventional open repair had similar outcomes in terms of postoperative mortality and acute neurological events. Hybrid repair was associated with less respiratory complications and risk of new intervention, as well as reduced hospital length of stay. Conventional open repair showed better mid- and long-term outcomes. Conclusion: Hybrid repair should be used in selected patients, with a high risk or very high-risk profile for conventional surgery. Finally, since most of the current data were obtained from limited to large samples, with narrow follow-up and had great heterogeneity, the best approach to the aortic arch is still variable. Therefore, the decision of the approach should be individualized and evaluated by the whole Heart Team, considering the expertise of the surgical team.


Subject(s)
Humans , Aorta, Thoracic/surgery , Postoperative Complications , Retrospective Studies , Blood Vessel Prosthesis Implantation , Treatment Outcome
12.
Rev. bras. enferm ; 74(2): e20200163, 2021.
Article in English | LILACS-Express | LILACS, BDENF | ID: biblio-1251147

ABSTRACT

ABSTRACT Objective: To investigate the critical nodes related to nursing care for patients in the postoperative period of cardiac surgery. Methods: Exploratory study with a qualitative approach. Data collected through semi-structured interviews with 27 members of the nursing team working in the Intensive Care Unit. Material submitted to thematic analysis. Results: Three categories emerged: Flaws in the professional qualification for patient care in the postoperative period of cardiac surgery; Team challenges concerning specific patient care in the postoperative period of cardiac surgery; and (dis) organization of work in the Intensive Care Unit and its impact on nursing care for patients in the postoperative period of cardiac surgery. Final considerations: Given the identification of the critical nodes, the professionals presented suggestions to overcome daily difficulties: investments in strategies for Permanent Education in Health; creation of tools to guide patient assistance in the postoperative of cardiac surgery; and provision of adequate human resources.


RESUMEN Objetivo: Investigar nudos críticos relacionados al cuidado de enfermería al paciente en postoperatorio de cirugía cardíaca. Métodos: Estudio exploratorio con abordaje cualitativo. Datos recogidos por medio de entrevista semiestructurada con 27 integrantes del equipo de enfermería, actuantes en Unidad de Cuidados Intensivos. Material sometido al análisis temático. Resultados: Emergieron tres categorías: Fragilidades en cualificación profesional para el cuidado al paciente en postoperatorio de cirugía cardíaca; Desafíos del equipo en relación a los cuidados específicos al paciente en postoperatorio de cirugía cardíaca; y La (des)organización del trabajo en Unidad de Cuidados Intensivos y su repercusión en el cuidado de enfermería al paciente en postoperatorio de cirugía cardíaca. Consideraciones finales: Delante la identificación de nudos críticos, los profesionales presentaron sugestiones para suplir dificultades cotidianas: inversiones en estrategias de Educación Permanente en Salud; creación de instrumentos que orienten la asistencia al paciente en postoperatorio de cirugía cardíaca; y provisión de recursos humanos adecuados.


RESUMO Objetivo: Investigar os nós críticos relacionados ao cuidado de enfermagem ao paciente no pósoperatório de cirurgia cardíaca. Métodos: Estudo exploratório com abordagem qualitativa. Dados coletados por meio de entrevista semiestruturada com 27 integrantes da equipe de enfermagem, atuantes na Unidade de Terapia Intensiva. Material submetido à análise temática. Resultados: Emergiram três categorias: Fragilidades na qualificação profissional para o cuidado ao paciente no pós-operatório de cirurgia cardíaca; Desafios da equipe em relação aos cuidados específicos ao paciente no pós-operatório de cirurgia cardíaca; e A (des)organização do trabalho na Unidade de Terapia Intensiva e sua repercussão no cuidado de enfermagem ao paciente no pósoperatório de cirurgia cardíaca. Considerações finais: Diante da identificação dos nós críticos, os profissionais apresentaram sugestões para suprir dificuldades cotidianas: investimentos em estratégias de Educação Permanente em Saúde; criação de instrumentos que orientem a assistência ao paciente em pós-operatório de cirurgia cardíaca; e provisão de recursos humanos adequados.

13.
Rev. baiana enferm ; 35: e42203, 2021. tab, graf
Article in Portuguese | LILACS, BDENF | ID: biblio-1279760

ABSTRACT

Objetivo identificar a prevalência de delirium em idosos internados em Unidade de Terapia Intensiva que estejam em pós-operatório de cirurgia cardiovascular e verificar associação entre o delirium e as variáveis sociodemográficas e clínicas. Método estudo transversal, analítico, realizado em um centro cardiológico do Distrito Federal, Brasília, Brasil. Foram analisados idosos internados entre junho e outubro de 2018. A triagem para delirium foi realizada utilizando o Confusion Assessment Method for Intensive Care Unit. Resultados o sexo masculino teve incidência de 65% e a hipertensão arterial sistêmica (75%) foi a doença crônica mais relatada; 30% apresentaram Infarto Agudo do Miocárdio e maior tempo em circulação extracorpórea, além de terem permanecido mais tempo internados; e 30% dos delirantes evoluíram a óbito. Conclusão a prevalência encontrada foi de 40% e estava associada ao mais idoso, ao sexo masculino, ao nível significativo de escolaridade, ao uso de tabaco, à apresentação de comorbidades prévias; estes, permaneceram mais tempo internados e morreram mais quando comparados ao outro grupo.


Objetivo identificar la prevalencia del delirium en ancianos hospitalizados en una Unidad de Cuidados Intensivos en el periodo postoperatorio de la cirugía cardiovascular y verificar una asociación entre el delirium y las variables sociodemográficas y clínicas. Método transversal, estudio analítico, realizado en un centro de cardiología. Se analizaron los ancianos hospitalizados entre junio y octubre de 2018. La detección del delirium se realizó utilizando el Confusion Assessment Method for Intensive Care Unit. Resultados los hombres tenían una incidencia del 65% y la hipertensión arterial sistémica (75%) fue la enfermedad crónica más notificada; El 30% tenía infarto agudo de miocardio y más tiempo en circulación extracorpórea, además de haber permanecido hospitalizado más tiempo; y el 30% de los delirantes murieron. Conclusión la prevalencia encontrada fue del 40% y se asoció con los ancianos, con el sexo masculino, con el nivel significativo de educación, con el uso del tabaco, con la presentación de comorbilidades anteriores; estos permanecieron hospitalizados más tiempo y murieron más en comparación con el otro grupo.


Objective to identify the prevalence of delirium in elderly inpatients from an Intensive Care Unit in the postoperative period of cardiovascular surgery and to verify an association between delirium and sociodemographic and clinical variables. Method cross-sectional, analytical study, carried out in a cardiology center. Elderly inpatients between June and October 2018 were analyzed. Screening for delirium was performed using the Confusion Assessment Method for Intensive Care Unit. Results males had an incidence of 65% and systemic arterial hypertension (75%) was the most reported chronic disease; 30% had acute myocardial infarction and longer time in cardiopulmonary bypass, in addition to having remained hospitalized longer; and 30% of the delusional ones died. Conclusion the prevalence found was 40% and was associated with the elderly, with the male sex, with the significant level of education, use of tobacco, previous comorbidities; these remained hospitalized longer and died more when compared to the other group.


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Aged, 80 and over , Cardiovascular Surgical Procedures/adverse effects , Delirium/etiology , Intensive Care Units , Postoperative Period , Prevalence , Cross-Sectional Studies , Risk Factors
14.
Article in Portuguese | LILACS-Express | LILACS, BDENF | ID: biblio-1384359

ABSTRACT

RESUMO Objetivo: Mapear as principais complicações no pós-operatório de cirurgias cardíacas em pacientes adultos. Material e Método: Revisão de escopo desenvolvida com base na seguinte questão: quais são as principais complicações que ocorrem no pós-operatório nos pacientes adultos submetidos a cirurgia cardíaca? A revisão seguiu as orientações do guia Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR). A busca foi realizada nos meses de dezembro 2019 e janeiro 2020 nas fontes de dados: CINAHL, PubMed, Web of Science, Scopus e LILACS, Catálogo de Teses e Dissertações da CAPES, Repositório Científico de Acesso Aberto de Portugal (RCAAP), National Library of Australia (Trove), Europe E-Theses Portal (DART), Electronic Theses Online Service (EThOS), National Electronic Theses and Dissertations (ETD portal), e Theses Canada. Resultados: O processo de busca resultou em 25.237 documentos. Foram selecionadas 150 publicações para pré-análise e a amostra final foi composta por 21 estudos. Os pacientes adultos dos estudos foram submetidos à revascularização miocárdica isolada (21; 100%), cirurgia valvar isolada (16; 76,19%), revascularização miocárdica combinada com cirurgia valvar (8; 38,10%) e cirurgia para correção de doenças congênitas (6; 28,57%). Identificaram-se complicações infecciosas, neurológicas, cardiovasculares, renais e urinárias, respiratórias, digestivas, hidroeletrolíticas, dentre outras. Conclusões: As complicações apresentaram incidências diferentes nos estudos analisados. Elas devem ser consideradas e estudadas pela equipe de enfermagem, para melhor compreensão dos fatores que podem estar relacionados ao seu surgimento, assim como auxiliar na prevenção e controle das mesmas.


ABSTRACT Objective: To assess the main complications in the postoperative period of cardiac surgery in adult patients. Materials and Methods: Scoping review based on the following research question: what are the main complications that occur postoperatively in adult patients undergoing cardiac surgery? The review followed the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) checklist. The search was conducted in the months of December 2019 and January 2020 in the following data sources: CINAHL, PubMed, Web of Science, Scopus and LILACS, CAPES Catalogue for Theses and Dissertations, Portugal Open Access Scientific Repository (RCAAP), National Library of Australia (Trove), Europe E-Theses Portal (DART), Electronic Theses Online Service (EThOS), National Electronic Theses and Dissertations (ETD portal), and Theses Canada. Results: The search process resulted in 25,237 documents. 150 publications were selected for pre-analysis and the final sample consisted of 21 studies. Adult patients underwent isolated myocardial revascularization (21; 100%), isolated valve surgery (16; 76.19%), myocardial revascularization combined with valve surgery (8; 38.10%) and surgery to correct congenital diseases (6; 28.57%). Infectious, neurological, cardiovascular, renal and urinary, respiratory, digestive and hydroelectrolytic complications, among others, were identified. Conclusions: The analyzed studies showed different incidence rates regarding complications. Complications should be considered and studied by the nursing team in order to better understand the factors related to their occurrence, as well as to help prevent and control them.


RESUMEN Objetivo: Mapear las principales complicaciones com el postoperatorio de cirugía cardíaca con pacientes adultos. Material y Método: Revisión de alcance desarrollada a partir de la siguiente pregunta: ¿Cuáles son las principales complicaciones en el postoperatorio de pacientes adultos sometidos a cirugía cardíaca? La revisión siguió las pautas de la Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR). La búsqueda se realizó entre diciembre 2019 y enero 2020 en las siguientes bases de datos: CINAHL, PubMed, Web of Science, Scopus, LILACS, Catálogo de Teses e Dissertações de la CAPES, Repositório Científico de Acesso Aberto de Portugal (RCAAP), National Library of Australia (Trove), Europe E-Theses Portal (DART), Electronic Theses Online Service (EThOS), National Electronic Theses and Dissertations (ETDportal) y Theses Canada. Resultados: El proceso de búsqueda arrojó 25.237 documentos. Se seleccionaron 150 publicaciones para el preanálisis y la muestra final fue de 21 estudios. Los pacientes adultos fueron sometidos a revascularización miocárdica aislada (21; 100%), cirugía valvular aislada (16; 76,19%), revascularización miocárdica combinada com cirugía valvular (8; 38,10%) y cirugía para corregir anomalías congénitas (6; 28,57%). Se identificaron complicaciones infecciosas, neurológicas, cardiovasculares, renales y urinarias, respiratorias, digestivas, hidroelectrolíticas, entre otras. Conclusiones: Las complicaciones tuvieron incidencias diferentes en los estudios analizados; deben ser considerados y estudiados por el equipo de enfermería, para una mejor comprensión de los factores que pueden estar relacionados con su aparición, así como ayudar a prevenirlos y controlarlos.

15.
Rev. bras. cir. cardiovasc ; 35(3): 249-253, May-June 2020. tab, graf
Article in English | LILACS, SES-SP | ID: biblio-1137252

ABSTRACT

Abstract Objective: To compare the incidence of postoperative complications (PC) between diabetic and nondiabetic patients undergoing cardiovascular surgeries (CS). Methods: This is a retrospective cross-sectional study, based on the analysis of 288 medical records. Patients aged ≥ 18 years, admitted to the intensive care unit (ICU) between January 2012 and January 2013, and undergoing coronary artery bypass grafting (CABG) or vascular surgeries were included. The population was divided into those with and without type 2 diabetes mellitus (T2DM), and then it was evaluated the incidence of PC between the groups. Results: The sample included 288 patients, most of them being elderly (67 [60-75] years old) male (64%) subjects. Regarding to surgical procedures, 60.4% of them were undergoing vascular surgeries and 39.6% were in the postoperative period of CABG. The incidence of T2DM in this population was 40% (115), just behind hypertension, with 72% (208). Other risk factors were also observed, such as smoking in 95 (33%) patients, dyslipidemias in 54 (19%) patients, and previous myocardial infarction in 55 (19%) patients. No significant difference in relation to PC (bleeding, atrial fibrillation, cardiorespiratory arrest, and respiratory complications) between the groups was observed (P>0.05). Conclusion: T2DM has a high incidence rate in the population of critically ill patients submitted to CS, especially in the elderly. However, in this small retrospectively analyzed study, there was no significant increase in PC related to diabetes for patients undergoing CS.


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Postoperative Complications/etiology , Postoperative Complications/epidemiology , Cardiovascular Surgical Procedures/adverse effects , Diabetes Mellitus, Type 2/complications , Coronary Artery Bypass/adverse effects , Cross-Sectional Studies , Retrospective Studies , Risk Factors
17.
Arq. bras. cardiol ; 114(4): 603-612, Abr. 2020. tab, graf
Article in English, Portuguese | LILACS, SES-SP | ID: biblio-1131198

ABSTRACT

Abstract Background: The current challenge of cardiovascular surgery (CVS) is to improve the outcomes in increasingly severe patients. In this respect, continuous quality improvement (CQI) programs have had an impact on outcomes. Objective: To assess the evolution of the incidence and mortality due to CVS, as well as the current outcomes of the Hospital das Clínicas Heart Institute of the University of São Paulo Medical School (InCor-HCFMUSP). Methods: An outcome analysis of CVSs performed at the InCor, between January 1984 and June 2019. We observed the surgical volume and mortality rates in 5 time periods: 1st (1984-1989), 2nd (1990-1999), 3rd (2000-2007), 4th (2008-2015) and 5th (2016-2019). The CQI program was implemented between 2015 and 2016. The analysis included the total number of surgeries and the evolution of the most frequent procedures. Results: A total of 105,599 CCVs were performed, with an annual mean of 2,964 procedures and mortality of 5,63%. When comparing the 4th and the 5th periods, the average global volume of surgeries was increased from 2,943 to 3,139 (p = 0.368), bypass graft (CABG), from 638 to 597 (p = 0.214), heart valve surgery, from 372 to 465 (p = 0.201), and congenital heart disease surgery, from 530 to 615 (p = 0.125). The average global mortality went from 7.8% to 5% (p < 0.0001); in CABG surgery, from 5.8% to 3.1% (p < 0.0001); in heart valve surgery, from 14% to 7.5% (p < 0.0001) and in congenital heart disease surgery, from 12.1% to 9.6% (p < 0.0001). Conclusion: In spite of a recent trend towards increased surgical volume, there was a significant decrease in operative mortality in the groups studied. After the implementation of the CQI program, the mortality rates were closer to international standards.


Resumo Fundamento: O desafio atual da cirurgia cardiovascular (CCV) é melhorar resultados em pacientes cada vez mais graves. Nesse sentido, Programas de Melhoria Contínua da Qualidade (PMCQ) tem impactado os resultados. Objetivo: Avaliar a evolução da incidência e mortalidade das CCV, assim como os resultados atuais do Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor). Métodos: Análise dos resultados das CCV realizadas no InCor entre jan-1984 e jun-2019. Foram observadas as tendências dos volumes cirúrgicos e da mortalidade em 5 períodos 1º (1984-1989), 2º (1990-1999), 3º (2000-2007), 4º (2008-2015) e 5º (2016-2019). O PMCQ foi estabelecido entre 2015-2016. A análise incluiu o total de cirurgias e a evolução dos procedimentos mais frequentes. Resultados: Foram realizadas 105.599 CCV, com uma média anual de 2.964 procedimentos e mortalidade de 5,63%. Comparando o 4º com o 5º período, o volume global médio de cirurgias foi de 2.943 para 3.139 (p = 0,368), cirurgias de revascularização miocárdica (CRM) de 638 para 597 (p = 0,214), valvas cardíacas de 372 para 465 (p = 0,201) e cardiopatias congênitas de 530 para 615 (p = 0,125). A mortalidade média global passou de 7,8% para 5% (p < 0,0001), nas cirurgias de revascularização miocárdica de 5,8% para 3,1% (p < 0,0001), nas cirurgias valvares de 14% para 7,5% (p < 0,0001) e nas cirurgias de cardiopatias congênitas de 12,1% para 9,6% (p < 0,0001). Conclusão: Embora haja uma tendência recente ao aumento dos volumes cirúrgicos, houve uma diminuição significativa da mortalidade cirúrgica nos grupos analisados. Após o estabelecimento do PMCQ, as taxas de mortalidade se aproximaram a dos padrões internacionais.


Subject(s)
Heart Defects, Congenital , Cardiac Surgical Procedures , Vascular Surgical Procedures , Incidence , Treatment Outcome , Hospital Mortality
18.
Arq. bras. cardiol ; 114(3): 518-524, mar. 2020. tab, graf
Article in Portuguese | LILACS | ID: biblio-1088892

ABSTRACT

Resumo Fundamento Escores de risco estão disponíveis para uso na prática clínica diária, mas saber qual deles escolher é ainda incerto. Objetivos Avaliar o EuroSCORE logístico, o EuroSCORE II e os escores específicos para endocardite infecciosa STS-IE, PALSUSE, AEPEI, EndoSCORE e RISK-E na predição de mortalidade hospitalar de pacientes submetidos à cirurgia cardíaca por endocardite ativa em um hospital terciário de ensino do sul do Brasil. Métodos Estudo de coorte retrospectivo incluindo todos os pacientes com idade ≥ 18 anos submetidos à cirurgia cardíaca por endocardite ativa no centro do estudo entre 2007 e 2016. Foram realizadas análises de calibração (razão de mortalidade observada/esperada, O/E) e de discriminação (área sob a curva ROC, ASC), sendo a comparação das ASC realizada pelo teste de DeLong. P < 0,05 foi considerado estatisticamente significativo Resultados Foram incluídos 107 pacientes, sendo a mortalidade hospitalar de 29,0% (IC95%: 20.4-37.6%). A melhor razão de mortalidade O/E foi obtida pelo escore PALSUSE (1,01, IC95%: 0,70-1,42), seguido pelo EuroSCORE logístico (1,3, IC95%: 0,92-1,87). O EuroSCORE logístico apresentou o maior poder discriminatório (ASC 0,77), significativamente superior ao EuroSCORE II (p = 0,03), STS-IE (p = 0,03), PALSUSE (p = 0,03), AEPEI (p = 0,03) e RISK-E (p = 0,02). Conclusões Apesar da disponibilidade dos recentes escores específicos, o EuroSCORE logístico foi o melhor preditor de mortalidade em nossa coorte, considerando-se análise de calibração (mortalidade O/E: 1,3) e de discriminação (ASC 0,77). A validação local dos escores específicos é necessária para uma melhor avaliação do risco cirúrgico. (Arq Bras Cardiol. 2020; 114(3):518-524)


Abstract Background Risk scores are available for use in daily clinical practice, but knowing which one to choose is still fraught with uncertainty. Objectives To assess the logistic EuroSCORE, EuroSCORE II, and the infective endocarditis (IE)-specific scores STS-IE, PALSUSE, AEPEI, EndoSCORE and RISK-E, as predictors of hospital mortality in patients undergoing cardiac surgery for active IE at a tertiary teaching hospital in Southern Brazil. Methods Retrospective cohort study including all patients aged ≥ 18 years who underwent cardiac surgery for active IE at the study facility from 2007-2016. The scores were assessed by calibration evaluation (observed/expected [O/E] mortality ratio) and discrimination (area under the ROC curve [AUC]). Comparison of AUC was performed by the DeLong test. A p < 0.05 was considered statistically significant. Results A total of 107 patients were included. Overall hospital mortality was 29.0% (95%CI: 20.4-37.6%). The best O/E mortality ratio was achieved by the PALSUSE score (1.01, 95%CI: 0.70-1.42), followed by the logistic EuroSCORE (1.3, 95%CI: 0.92-1.87). The logistic EuroSCORE had the highest discriminatory power (AUC 0.77), which was significantly superior to EuroSCORE II (p = 0.03), STS-IE (p = 0.03), PALSUSE (p = 0.03), AEPEI (p = 0.03), and RISK-E (p = 0.02). Conclusions Despite the availability of recent IE-specific scores, and considering the trade-off between the indexes, the logistic EuroSCORE seemed to be the best predictor of mortality risk in our cohort, taking calibration (O/E mortality ratio: 1.3) and discrimination (AUC 0.77) into account. Local validation of IE-specific scores is needed to better assess preoperative surgical risk. (Arq Bras Cardiol. 2020; 114(3):518-524)


Subject(s)
Humans , Endocarditis/surgery , Cardiac Surgical Procedures , Brazil , Retrospective Studies , Risk Factors , ROC Curve , Hospital Mortality , Risk Assessment
19.
Rev. Pesqui. Fisioter ; 10(1): 25-32, Fev. 2020. tab
Article in English, Portuguese | LILACS | ID: biblio-1151944

ABSTRACT

INTRODUÇÃO: Pacientes submetidos à cirurgia cardíaca necessitam de ventilação mecânica invasiva após o procedimento cirúrgico. A extubação no pós-operatório quando bem-sucedida, está relacionada com menor tempo de internação, redução de custos e recursos utilizados e diminuição das taxas de morbimortalidade. OBJETIVO: Identificar o perfil e o número de reintubações de pacientes submetidos a cirurgias cardíacas. MATERIAIS E MÉTODOS: Estudo quantitativo, transversal retrospectivo, com coleta de dados secundários obtidos de prontuários eletrônicos em um Hospital Municipal da Região Metropolitana de Porto Alegre/RS. Foram incluídos 57 prontuários de pacientes submetidos a cirurgia cardíaca entre janeiro e dezembro de 2017 e excluídos aqueles com idade menor que 18 anos e/ou extubados previamente no bloco cirúrgico. RESULTADOS: A amostra foi composta por 22 mulheres (38,6%) e 35 homens (61,4%), com média de idade 61,60±12,33 anos. Foram realizadas 37 cirurgias de revascularização do miocárdio (64,9%), sendo sete destas associadas a troca valvar. Em relação ao desmame, 96,5% dos pacientes obtiveram sucesso na extubação, 77,2% ficaram um período menor que 24 horas em ventilação mecânica invasiva e 15,8% foram reintubados. A média de tempo de internação hospitalar foi de 22,77±17 dias e na Unidade de Terapia Intensiva de 8,53 dias, sendo que 80,7% dos pacientes tiveram alta desta unidade. CONCLUSÃO: A caracterização clínica, sociodemográfica e cirúrgica dos pacientes submetidos a cirurgia cardíaca se assemelha aos achados na literatura, uma prevalência de pacientes idosos e do sexo masculino e baixa taxa de reintubação.


INTRODUCTION: Patients undergoing cardiac surgery require invasive mechanical ventilation after the surgical procedure. Postoperative extubation, when successful, is related to shorter hospital stay, reduced costs and resources used and decreased morbidity and mortality rates. AIM: To identify the profile and number of reintubations of patients undergoing cardiac surgery. MATERIALS AND METHODS: Quantitative, cross-sectional retrospective study, with collection of secondary data obtained from electronic medical records at a Municipal Hospital in the Metropolitan Region of Porto Alegre/ RS. Were included 57 medical records of patients who underwent cardiac surgery between January and December 2017 and excluded those under the age of 18 and / or previously extubated in the surgery block. RESULTS: The sample consisted of 22 women (38.6%) and 35 men (61.4%), with a mean age of 61.60 ± 12.33 years. 37 myocardial revascularization surgeries were performed (64.9%), seven of which were associated with valve replacement. Regarding weaning, 96.5% of the patients were successful in extubation, 77.2% spent less than 24 hours on invasive mechanical ventilation and 15.8% were reintubated. The average length of hospital internment was 22.77 ± 17 days and in the Intensive Care Unit was 8.53 days, being that 80.7% of patients discharged from this unit. CONCLUSION: The clinical, sociodemographic and surgical characterization of patients undergoing cardiac surgery is similar to the findings in the literature, a prevalence of elderly and male patients and a low rate of reintubation.


Subject(s)
Airway Extubation , Cardiovascular Surgical Procedures , Intensive Care Units
20.
Int. j. cardiovasc. sci. (Impr.) ; 33(1): 24-33, Jan.-Feb. 2020. tab, graf
Article in English | LILACS | ID: biblio-1090645

ABSTRACT

Abstract Background: Treatment of postoperative (PO) pain is essential after surgery, as it contributes to a faster rehabilitation. Assessment of PO pain after minimally invasive (MI) surgery has not been regularly addressed, especially when compared with median sternotomy (MS). Objective: This study aims to evaluate the intensity of thoracic pain in the PO period in patients subjected to MI surgery and MS. Methods: This study compared the intensity of thoracic pain in 34 patients subjected to minimally invasive (MI; n = 17) and median sternotomy (MS; n = 17) from June 2015 to June 2016. The intensity and sites of pain in the PO period, assessed using the visual numeric pain scale, and the need for pain medications were analyzed using the Student's t-test and the z test, with confidence level of 95% (p < 0.05). Results: Almost all patients reported pain on the third PO day (MS = 94.1% and MI = 88.2%; p = 0.5410). On the seventh PO day, there were significantly more patients free of pain in the group of patients subjected to the MI procedure (MS = 94.1% and MI = 64.7%; p = 0.0341). also, these patients reported fewer pain sites (3rd PO day: MS = 3.2 ± 1.5; MI = 1.5 ± 1.2; p = 0.001; 7th PO day: MS = 3.1 ± 1.4; MI = 0.9 ± 0.9; p = 0.000). Patients undergoing MS reported higher pain intensity and longer lasting pain (3rd PO: MS = 4.8 ± 2.2; MI = 3.0 ± 1.6; 7th PO: MS = 5.3 ± 2.0; MI = 1.2 ± 1.3; p = 0.001), with no difference in pain intensity between the third and the seventh PO days (p = 0.4931). In addition, patients subjected to MI procedure had a significant decrease in pain intensity from the third to the seventh PO days (p = 0.001). Conclusion: According to these results, we concluded that a MI procedure leads to lower intensity of pain in the PO period (from the third PO day on) when compared to a MS; also, patients undergoing MI patients reported fewer pain sites.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Pain, Postoperative , Minimally Invasive Surgical Procedures , Sternotomy , Postoperative Care , Thoracic Surgery , Pain Measurement
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