Desempeño profesional de enfermería en la atención al paciente quirúrgico séptico / Nursing Professional Performance in the Care of the Septic Surgical Patient

Introducción: Las unidades de cuidados intensivos quirúrgicas muestran, en los últimos tiempos, un incremento en la incidencia de casos sépticos. La actuación del profesional de enfermería es fundamental en la atención a estos pacientes. Objetivo: Caracterizar el desempeño profesional de enfermería en la atención al paciente quirúrgico séptico. Métodos: Estudio descriptivo, observacional en la Unidad de Cuidados Intensivos del Centro Nacional de Cirugía de Mínimo Acceso en La Habana, de enero a agosto de 2020. En el universo de 17 enfermeras, se realizó un muestreo no probabilístico intencional de 12 profesionales. Se realizó prueba de desempeño, con análisis de tres dimensiones: actitud, dominio asistencial y superación profesional, se evaluaron con un rango de puntuación entre 0-8, se calculó media, desviación estándar y porcentajes con la siguiente valoración: inadecuado (<30 por ciento), poco adecuado (30 por ciento -49 por ciento), medio adecuado (50 por ciento-69 por ciento), adecuado (70 por ciento-89 por ciento) y muy adecuado (90 por ciento-100 por ciento). Resultados: De los profesionales estudiados, 66,66 por ciento obtuvieron un desempeño adecuado y 33,33 por ciento medio adecuado. En la puntuación general, la dimensión actitud se calificó de adecuada con 85,41 por ciento; sin embargo, las dimensiones dominio asistencial y superación profesional fueron calificadas de medio adecuada, con 67,08 por ciento y 52,08 por ciento, respectivamente. Conclusiones: Los profesionales muestran una actitud adecuada en la atención a los pacientes quirúrgicos sépticos, el dominio asistencial y la superación profesional fue medio adecuado, las deficiencias más significativas fueron en el dominio de las nuevas tecnologías y escasa participación en las alternativas de superación posgraduada(AU)

Introduction: Surgical intensive care units show, in recent times, an increase in the incidence of septic cases. The nursing professional's performance is essential for the care of these patients. Objective: To characterize the nursing professional's performance in the care of the septic surgical patient. Methods: Descriptive and observational study carried out in the intensive care unit of the National Center for Minimal Access Surgery in Havana, from January to August 2020. In the universe of seventeen nurses, a nonprobabilistic intentional sampling of twelve professionals was done. A performance test was performed, in which three dimensions were analyzed: attitude, care provision skills and professional improvement, evaluated. The three dimensions were evaluated with a score range of 0-8. Mean, standard deviation and percentages were calculated under the following scale: inadequate (<30 percent), little adequate (30 percent-49 percent), partially adequate (50 percent-69 percent), adequate (70 percent-89 percent) and very adequate (90 percent-100 percent). Results: Of the studied professionals, 66.66 percent performed adequately and 33.33 percent performed partially adequately. In the overall score, the dimension of attitude was rated as adequate, with 85.41 percent; however, the dimensions of care provision skills and professional improvement were rated as partially adequate, with 67.08 percent and 52.08 percent, respectively. Conclusions: The professionals show an adequate attitude in the care of septic surgical patients. Care provision skills and professional improvement were partially adequate. The most significant deficiencies were found in the competent usage of new technologies, apart from the scarce participation in postgraduate alternatives for professional improvement(AU)

Superfícies de suporte para prevenção de lesão por pressão no período intraoperatório: revisão sistemática com metanálise / Support surfaces for prevention of pressure ulcer in the intraoperative period: Systematic review with meta-analysis

No período intraoperatório, a lesão por pressão é um evento adverso que pode acometer o paciente cirúrgico. O planejamento e a implementação de cuidados para prevenção deste tipo de lesão são cruciais para a melhoria da qualidade da assistência prestada e da segurança do paciente. As superfícies de suporte são medidas que redistribuem a pressão e controlam o microclima e podem ser utilizadas para prevenção de lesão por pressão. O objetivo do estudo foi avaliar as evidências disponíveis na literatura sobre superfícies de suporte efetivas para prevenção de lesão por pressão em pacientes, no período intraoperatório. Trata-se de revisão sistemática conduzida pautada nas recomendações da Colaboração Cochrane. A busca dos estudos primários foi realizada nas seguintes bases de dados: PubMed; Cumulative Index to Nursing and Allied Health Literature; Cochrane Central Register of Controlled Trials, Embase, Literatura Latino-Americana e do Caribe em Ciências da Saúde, Scopus e Web of Science. A amostra da revisão sistemática foi composta por 10 estudos primários, sendo seis ensaios clínicos randomizados e quatro estudos não randomizados. A síntese dos resultados da revisão foi realizada na forma descritiva e por meio de metanálise. Para análise do risco de viés dos ensaios clínicos randomizados foi empregada a ferramenta gratuita denominada Revised Cochrane risk-of-bias tool for randomized trials (RoB 2). Para avaliar a qualidade metodológica dos estudos não randomizados foi adotada a ferramenta para estudo quase experimental, denominada JBI Critical Appraisal Checklist for Quasi-Experimental Studies. A qualidade das evidências foi avaliada por meio do Grading of Recommendations Assessment, Development and Evaluation (GRADE). Na comparação das superfícies de suporte de baixa tecnologia com o cuidado usual (colchão padrão de mesa cirúrgica), a metanálise demonstrou que não existe diferença estatisticamente significante entre as intervenções investigadas (RR = 0,88; IC95%: 0,30-2,39). Nesta comparação houve a inclusão de dois ensaios clínicos randomizados, sendo que o teste estatístico de inconsistência de Higgins indicou alta heterogeneidade entre os estudos (I2 = 83%). Além disso, a qualidade das evidências, por meio do sistema GRADE, foi considerada muito baixa (confiança muito limitada na estimativa do efeito), indicando que provavelmente a condução de outras pesquisas poderá alterar a estimativa do efeito. Na comparação das superfícies de suporte de alta tecnologia com as superfícies de baixa tecnologia, a metanálise evidenciou que existe diferença estatisticamente significante entre as intervenções investigadas, sendo as superfícies de suporte de alta tecnologia as mais efetivas (RR = 0,17; IC95%: 0,05-0,53). Nesta comparação houve a inclusão de três ensaios clínicos randomizados, sendo que a heterogeneidade entre os estudos foi leve (I2 = 0%). A qualidade das evidências foi considerada moderada (confiança moderada no efeito estimado), uma vez que dois ensaios clínicos randomizados foram avaliados com alto risco de viés. Frente ao exposto, recomenda-se a condução de ensaios clínicos bem delineados para testar superfícies de suporte para prevenção de lesão por pressão, principalmente as de alta tecnologia, no período intraoperatório.

In the intraoperative period, pressure ulcer is an adverse event that can affect the surgical patient. The planning and implementation of care to prevent this type of injury is crucial for improving the quality of care provided and for patient safety. Support surfaces are measures that redistribute pressure and control the microclimate and can be used to prevent pressure ulcer. This study aimed to evaluate the evidence available in literature on effective support surfaces for prevention of pressure ulcer in patients, during the intraoperative period. This is a systematic review conducted based on the recommendations of the Cochrane Collaboration. The search for primary studies was performed in the following databases: PubMed; Cumulative Index to Nursing and Allied Health Literature; Cochrane Central Register of Controlled Trials, Embase, Latin American and Caribbean Literature in Health Sciences, Scopus and Web of Science. The systematic review sample consisted of 10 primary studies, with six randomized clinical trials and four non-randomized studies. The synthesis of results was performed through descriptive meta-analysis. The free tool called Revised Cochrane risk-of-bias tool for randomized trials (RoB 2) was used to analyze the risk of bias in randomized clinical trials. A tool for quasi-experimental study, called JBI Critical Appraisal Checklist for Quasi-Experimental Studies, was adopted to assess the methodological quality of non-randomized studies. The quality of the evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE). When comparing low-tech support surfaces with the usual care (standard operating table mattress), the meta-analysis demonstrated that there is no statistically significant difference between the investigated interventions (RR=0.88; 95%CI: 0.30-2.39). In this comparison, two randomized clinical trials were included and the Higgins inconsistency statistical test indicated high heterogeneity between studies (I2 = 83%). In addition, the quality of the evidence, through the GRADE system, was considered to be very low (limited confidence in the estimate of the effect), indicating that the conduct of further research is likely to alter the estimate of the effect. When comparing high-tech support surfaces with low-tech surfaces, the meta-analysis showed that there is a statistically significant difference between the investigated interventions, with high-tech support surfaces being the most effective (RR=0.17; 95%CI: 0.05-0.53). In this comparison, three randomized clinical trials were included and the heterogeneity between the studies was mild (I2 = 0%). The quality of the evidence was considered moderate (moderate confidence in the estimated effect), since two randomized clinical trials were evaluated with a high risk of bias. In view of the above, it is recommended to conduct well-designed clinical trials to test support surfaces for the prevention of pressure ulcer, especially high-tech ones, during the intraoperative period.

Seguridad anestésica ¿Dónde estamos y qué nos queda? / Anesthetic safety. Where are we and what do we have?

Introducción: En la actualidad, la seguridad en el paciente quirúrgico constituye un problema de salud pública debido a su elevado y creciente uso dentro de la atención sanitaria, el alto potencial de daño asociado y la demostración de que, la mayor parte de los efectos adversos, relacionados con los procedimientos anestésicos-quirúrgicos, son prevenibles. Objetivo: Analizar los elementos deficientes en la práctica anestésica actual en materia de seguridad para el paciente y brindar posibles soluciones para el perfeccionamiento de la calidad asistencial. Desarrollo: La cultura de seguridad se define como un patrón integrado de comportamiento individual y de la organización, basado en creencias y valores compartidos, que busca continuamente reducir al mínimo el daño que podría sufrir el paciente como consecuencia de los procesos y prestaciones. Conclusiones: El anestesiólogo es una pieza clave del equipo quirúrgico en lo referente a la seguridad del paciente, por lo cual una práctica reflexiva, ajustada a los estándares de tratamiento actuales, en el marco de un sistema de atención capaz de aprender de sus errores, redundará en una mejor calidad de atención y una disminución de la incidencia de eventos adversos(AU)

Introduction: Surgical-patient safety is nowadays a public health concern for its high and growing usage in healthcare, the high potential for associated damage, and the demonstration that most of the adverse effects associated with anesthetic-surgical procedures are preventable. Objective: To analyze the deficient elements in the current anesthetic practice in terms of patient safety and to provide possible solutions for improving the quality of care. Development: Safety culture is defined as an integrated pattern of individual and organizational behavior, based on shared beliefs and values, which continuously aims at minimizing the harm the patient could suffer as a consequence of the processes and general provision of healthcare. Conclusions: The anesthesiologist is a key part within the surgical team in terms of patient safety, so a reflective practice, one that is adjusted to current treatment standards, within the framework of a care system capable of learning from its mistakes, will result in better quality of care and decrease in the incidence of adverse events(AU)

Conocimiento e Implementación de la seguridad del paciente quirúrgico en una institución pediátrica del sureste de México / Knowledge and Implementation of safety in Surgical patients' in a pediatric institution in southeastern Mexico / Conhecimento e Implementaçâo de segurança dos pacientes cirúrgicos numa instituiçâo pediátrica no sudeste do México / Connaissance et mise en œuvre de la sécurité des patients chirurgicaux dans un établissement pédiatrique du sud-est du Mexique

Resumen: Objetivo: Evaluar el nivel de conocimiento e implementación de la seguridad del paciente quirúrgico en una institución pediátrica. Materials and methods: Estudio observacional, descriptivo y de corte transversal, en el periodo comprendido de abril 2014-diciembre 2015. La muestra de 78 profesionales de salud del equipo quirúrgico del Hospital Regional de Alta Especialidad del Niño "Dr. Rodolfo Nieto Padrón" de los diversos turnos laborales, los instrumentos de recolección de datos fueron 1) Cuestionario de conocimiento de seguridad del paciente quirúrgico y 2) Cuestionario de cumplimiento de seguridad quirúrgica. Resultados: El nivel de conocimiento del equipo quirúrgico acerca de la seguridad quirurgica fue bueno en 77% de los participantes. En la evaluación del cumplimiento se sumaron las puntuaciones del total de ítems del instrumento y se dividieron entre el total de las medidas para estimar las medias. Se encontró un promedio de 85.6 % en la fase 1 antes de la anestesia que corresponde a un cumplimiento bueno, en la fase 2 antes de la incisión de la piel 79.86% o cumplimiento regular y en los factores del entorno interno y externo del área quirúrgica que influyen en la seguridad del paciente quirúrgico de la fase 3, antes que el paciente abandone el quirófano 85.2% o cumplimiento bueno. Conclusión: Las evaluaciones de las tres etapas de la verificación de la seguridad quirúrgica en el paciente pediátrico permitieron identificar las áreas de oportunidades para mejorar su implementación, disminuir el número de complicaciones, muertes evitables y avanzar sobre una cultura de seguridad del paciente quirúrgico.

Abstract: Objective: To evaluate the level of knowledge and implementation of the safety of surgical patients in a pediatric institution. Materials and methods: Observational, descriptive and cross-sectional study in the period April 2014- December 2015. The sample of 78 health professionals who are members of the surgical team Regional High Specialty Hospital del Niño "Dr. Rodolfo Nieto Padrón "of various work shifts, using 2 assessment instruments. 1) Knowledge Questionnaire safety of surgical patients and 2) Compliance Questionnaire surgical safety. Results: The level of knowledge of the surgical team regarding surgical safety was good with 77% in study participants. In compliance assessment scores of all instrument items were added and divided by the total of measures to estimate the means. an average of 85.6 was found in phase 1 before anesthesia corresponding to a good compliance in phase 2 before the skin incision 79.86 or regular compliance and factors internal and external environment of the surgical area that influence in the safety of the surgical patient phase 3 before the patient leaves the operating room or 85.2 good compliance. Conclusions: Evaluations of the three stages of verification of surgical safety in pediatric patients helped identify areas of opportunities to improve their implementation, reduce the number of complications, avoidable and advance a culture of safety of the surgical patient deaths.

Resumo: Objetivo: Avaliar o nível de conhecimento e implementação da segurança dos pacientes cirúrgicos numa instituição pediátrica. Materiais e métodos: Estudo de observação, descritivo e transversal no período de abril 2014 a Dezembro de 2015. A amostra foi constituída por 78 profissionais de saúde que são membros da equipe cirúrgica do Hospital Regional de Alta Especialidade del Niño "Dr. Rodolfo Nieto Padrón" e incluiu vários turnos de trabalho. Foram usados dois instrumentos de avaliação: 1) questionário de conhecimento de segurança do paciente cirúrgico e 2) questionário de cumprimento de segurança cirúrgica. Resultados: O nível de conhecimento da equipe cirúrgica em relação à segurança cirúrgica foi bom, com 77% dos participantes do estudo. Na avaliação do cumprimento de todos os itens do instrumento foram sumadas as pontuações do total de itens e foram divididas pelo total de medidas para estimar as médias. Foi encontrada uma média de 85,6% na fase 1 antes da anestesia, correspondendo a um bom cumprimento. Na fase 2, antes da incisão na pele, 79,86% manifestaram um cumprimento regular e fatores de ambiente interno e externo da área cirúrgica influenciaram na segurança do paciente cirúrgico da fase 3, antes de o paciente sair da sala de operação, com 85,2% de boa adesão. Conclusão: As avaliações das três fases de verificação de segurança cirúrgica em pacientes pediátricos ajudou a identificar áreas de oportunidade para melhorar a sua aplicação, reduzir o número de complicações evitáveis e promover uma cultura de segurança das mortes cirúrgicas de pacientes.

Résumé: Objectif: Évaluer le niveau de connaissances et de mise en œuvre de la sécurité des patients chirurgicaux dans un établissement pédiatrique. Matériel et méthodes: Étude observationnelle, descriptive et transversale, réalisée entre avril 2014 et décembre 2015. L'échantillon est constitué de 78 professionnels de santé, de différents horaires de travail, de l'équipe chirurgicale de l'Hospital Regional de Alta Especialidad del Niño Dr. Rodolfo Nieto Padrón". Les instruments de collecte de données utilisés sont: 1) Questionnaire de connaissance sur la sécurité des patients chirurgicaux et 2) Questionnaire sur le respect de la sécurité chirurgicale. Résultats: Le niveau de connaissance de l'équipe chirurgicale sur la sécurité chirurgicale s'est montré bon pour 77% des participants. Pour l'évaluation du respect de la sécurité, le total des scores de tous les items de l'instrument a été divisé par le nombre de mesures contenues dans le questionnaire. Les moyennes suivantes ont été calculées: 85,6% pour la phase 1 pré-anesthésique (considéré comme une bonne observance); 79,86% pour la phase 2 antérieur à l'incision cutanée (observance régulière) et 85,2% pour les facteurs de l'environnement interne et externe du bloc opératoire qui influent sur la sécurité du patient dans la phase 3, avant qu'il ne quitte la salle d'opération (bonne observance). Conclusion: Les évaluations des trois étapes de vérification de la sécurité chirurgicale envers les patients pédiatriques ont permis d'identifier les domaines susceptibles d'amélioration de leur mise en œuvre pour réduire le nombre de complications, de décès évitables, et progresser dans la culture de la sécurité des patients chirurgicaux.

Adherence to guidelines for surgical antibiotic prophylaxis: a review

ABSTRACTCONTEXT AND OBJECTIVES: The appropriate use of antibiotic prophylaxis in the perioperative period may reduce the rate of infection in the surgical site. The purpose of this review was to evaluate adherence to guidelines for surgical antibiotic prophylaxis.METHODS:The present systematic review was performed according to the Cochrane Collaboration methodology. The databases selected for this review were: Medline (via PubMed), Scopus and Portal (BVS) with selection of articles published in the 2004-2014 period from the Lilacs and Cochrane databases.RESULTS:The search recovered 859 articles at the databases, with a total of 18 studies selected for synthesis. The outcomes of interest analyzed in the articles were as follows: appropriate indication of antibiotic prophylaxis (ranging from 70.3% to 95%), inappropriate indication (ranging from 2.3% to 100%), administration of antibiotic at the correct time (ranging from 12.73% to 100%), correct antibiotic choice (ranging from 22% to 95%), adequate discontinuation of antibiotic (ranging from 5.8% to 91.4%), and adequate antibiotic prophylaxis (ranging from 0.3% to 84.5%).CONCLUSIONS:Significant variations were observed in all the outcomes assessed, and all the studies indicated a need for greater adherence to guidelines for surgical antibiotic prophylaxis.

Aspectos emocionais do paciente cardíaco cirúrgico no período pré-operatório / Emotional aspects of the cardiac surgical patient during the preoperative period

As doenças cardiovasculares são a principal causa de óbitos no Brasil. A intervenção cardíaca traz consigo grande carga emocional e anseios característicos naquele que se submeterá a ela, o que pode ser minimizado através do apoio psicológico nesta situação de crise. Para tanto, faz-se necessário investigar como se caracterizam os aspectos emocionais de tal paciente, sendo esse o objetivo dessa pesquisa qualitativa. O estudo contou com a participação de quatro pacientes cardíacos cirúrgicos, no período pré-operatório, de um hospital geral de Porto Alegre - RS. Na avaliação desses pacientes foram utilizadas uma entrevista e duas escalas, uma de ansiedade e outra de depressão. Os dados foram tratados por análise de conteúdo e descritivas. Os resultados indicaram que a metade dos pacientes apresentava um nível de ansiedade grave. Algumas emoções verbalizadas foram: dificuldade de aceitação, medo da ineficácia cirúrgica, de sentir dor, de ficar incapacitado para o trabalho e de morrer

Cardiovascular diseases are the leading cause of death in Brazil. Cardiac intervention brings great emotional burden and characteristic anxities in the person who will be submitted to it, which can be minimized through psychological support in this crisis situation. Therefore, it is necessary to investigate how to characterize the emotional aspects of such a patient, which is the purpose of this qualitative research. The study involved the participation of four cardiac surgical patients in the preoperative period in a general hospital in Porto Alegre-RS. An interview and two scales were used in the evaluation of these patients: one for anxiety and another for depression. The data were analyzed through content and descriptive analysis. The results indicated that half of the patients had a severe anxiety level. Some verbalized emotions were: difficulty of acceptance, fear of surgery ineffectiveness, of experiencing pain, of being unable to work and of dying

Caracterización de pacientes quirúrgicos de alto riesgo ingresados en terapia intensiva / Characteristics of the high risk surgical patients in the intensive care unit

Introducción: en los pacientes quirúrgicos de alto riesgo, es indiscutible la necesidad de la asistencia médica intensiva. Objetivo: caracterizar a los pacientes quirúrgicos de alto riesgo según variables demográficas, diagnósticos al ingreso y mortalidad. Métodos: se realizó un estudio descriptivo, prospectivo y de corte longitudinal, con 394 pacientes quirúrgicos de alto riesgo ingresados en la Unidad de Cuidados Intensivos del Hospital Docente Clínico Quirúrgico Joaquín Albarrán Domínguez en La Habana, durante los años 2012 y 2013. Resultados: el 98 por ciento de los pacientes quirúrgicos ingresados fueron de alto riesgo. La letalidad fue del 19,2 por ciento. El 31,5 por ciento de los fallecimientos pertenecían el grupo de 80 a 89 años de edad, no se encontró asociación significativa en cuanto a la edad y fallecimiento. El sexo masculino constituyó el 52,7 por ciento y el sexo femenino el 47,2 por ciento, predominó este último entre los fallecidos, se encontró asociación significativa. La peritonitis secundaria estuvo presente en el 30,3 por ciento de los fallecidos, las enfermedades neoplásicas del sistema digestivo en el 19,2 por ciento, y se encontró asociación significativa. La primera causa de muerte fue el fallo múltiple de órganos con 44,7 por ciento. Conclusiones: la mortalidad en los pacientes quirúrgicos de alto riesgo es adecuada, predominaron las pacientes femeninas de edades avanzadas; prevalecieron las peritonitis secundarias y las enfermedades neoplásicas, responsables posteriormente del fallo múltiple de órganos, por lo que se hace necesario estratificar el riesgo de cada paciente para intensificar o diferenciar la acción terapéutica(AU)

Introduction: the need of intensive care for high risk surgical patients is out of discussion. Objective: to characterize the high risk surgical patients by demographic features, diagnosis on admission and mortality. Methods: descriptive, prospective and longitudinal ofn394 high risk surgical patients admitted to the intensive care unit of Joaquín Albarrán Domínguez Hospital during 2012 and 2013. Results: ninety eight percent of the hospitalized surgical patients were classified as high risk. The fatality rate was 19. 2 percent. In this group, 31.5 percent of the dead people was in the 80 to 89 year age group, no significant association between age and mortality was found. Male sex prevail (52.7 percent) over female (47.2 percent), being females prevalent in mortality and there was significant association. Secondary peritonitis was present in 30.3 percent of the deceased people and neoplastic digestive system diseases in 19.2 percent with significant statistical association. The first cause of death was the multi-organ failure with 44. 7 percent. Conclusions: the mortality rate in the high risk surgical patients was acceptable; aged females prevailed; secondary peritonitis and neoplastic diseases predominated and led to multi-organ failure. It is therefore necessary to stratify the risk of every patient to intensify or customize the treatment intervention(AU)

Mecanismos de enfrentamento desencadeados por pacientes em situações estressoras: cirurgia ambulatorial / Coping mecanism by surgical patients in stress situations: ambulatory surgery / Mecanismos de enfrentamiento presentados por pacientes en situanciones de estrés: quirurgia ambulatorial

Estudo descritivo analítico com abordagem quantitativa e qualitativa, visando identificar os mecanismos de enfrentamento (coping) mais utilizados por pacientes e seus sentimentos diante do procedimento cirúrgico. A pesquisa foi realizada em uma unidade de cirurgia ambulatorial, no município do Rio de Janeiro, no período de junho a dezembro de 2012, com entrevista semiestruturada. Participaram do estudo 12 pacientes, cujas idades variam entre 16 e 74 anos. Mediante a análise de conteúdo dos depoimentos, foram elaboradas duas categorias que ressaltaram a religião e o apoio da família como mecanismos adaptadores no período cirúrgico; e a falta de orientação sobre a cirurgia, sentimentos de medo e falta de confiança. A maioria não estava adequadamente esclarecida sobre a cirurgia e os possíveis cuidados pré-operatórios. Conclui-se que, para superar tais carências, deve ser criada estratégia para fornecer aos clientes as orientações de enfermagem no período pré-operatório.

Analytic, descriptive study with a quantitative and qualitative approach, that identify the most used coping mechanisms and the feelings of the surgical patients by the analysis of their responses before the surgery. The research was developed in Ambulatorial Surgery Unit in the county of Rio de Janeiro, between June and December of 2012, with a semistructured interview. Participated on this study 12 patients between 16 and 74 years old. Through the analysis of the data, 2 cathegories were elaborated, emphasizing the religion and the family’s support as adaptive mechanisms during the surgical period. Most of the patients that undergo ambulatorial surgeries were not well informed about the procedure and the pré-operatory care. Therefore, an strategy must be created to give the nursing orientation of the pré-operatory.

Estudio descriptivo analítico con abordaje cuantitativo y cualitativo, visando identificar los mecanismos de enfrentamiento (coping) más utilizados y los sentimientos de los pacientes quirúrgicos a través de sus respuestas antes de la cirugía. La pesquisa fue realizada en una unidad de cirugía ambulatorial, en el município de Rio de Janeiro-RJ-Brasil, en el período de junio a diciembre de 2012, con entrevista semiestructurada. Participaron del estudio 12 pacientes, cuya edad varió entre 16 y 74 años. Mediante el análise de contenido de los datos, fueron elaboradas dos categorías que resaltaron la religión y el apoyo de la família como mecanismos adaptadores en el período quirúrgico, y que la mayoría de los pacientes sometidos a la cirugía ambulatorial, no estavan adecuadamente esclarecidos sobre la cirugía y los posibles cuidados pré-operatorios. Se concluye que, para superar tales carencias, se debe adoptar una estrategia para fornecer a los clientes las orientaciones de enfermería em el pre-operatorio.

Pautas transfusionales en el paciente quirúrgico / Transfusional standards in the surgical patient

Introducción: con el fin de promover la seguridad sanguínea la Organización Mundial de la Salud desarrolla estrategias para reducir las transfusiones innecesarias a través del uso clínico apropiado de la sangre. Diversas sociedades científicas auspician guías de prácticas clínicas sobre las indicaciones de la transfusión. Objetivo: profundizar los conocimientos que sobre los principios básicos para la utilización adecuada de la sangre y sus componentes que se vinculan a la atención del paciente quirúrgico. Desarrollo: los pacientes quirúrgicos son altos consumidores de transfusiones sanguíneas. A pesar de la existencia de guías clínicas se publican en la actualidad transfusiones innecesarias y gran variabilidad en los criterios para determinar la necesidad de una transfusión, que suelen ser complejos y de difícil aplicación. El empleo de los diferentes componentes sanguíneos deben ser guiados por políticas y pautas transfusionales. El cumplimiento de protocolos y la existencia de guías clínicas para su uso adecuado, de seguro contribuirán a reducir las transfusiones innecesarias y la gran variabilidad en los criterios para decidir la administración de este producto biológico que deben sustentarse en parámetros clínicos y exámenes complementarios. Conclusiones: tras revisar diversas propuestas de pautas transfusionales realizadas por especialistas vinculados con la transfusión sanguínea y en especial los de nuestra Comisión Nacional de Sangre (ABC de la Medicina Transfusional: Guías Clínicas) se propone contribuir modestamente a profundizar los conocimientos que sobre los principios básicos para la utilización adecuada de la sangre y sus componentes debemos poseer todos aquellos que estamos vinculados a la atención del paciente quirúrgico.

Introduction: with the objective of promoting blood safety, the World Health Organization develops strategies to reduce unnecessary transfusions through the appropriate clinical use of blood. Different scientific societies sponsor clinical practice guides about transfusion indications. Objective: to deepen into the knowledge about the basic principles for the proper use of blood and its components that is linked to surgical patient care. Development: surgical patients are high blood transfusion consumers. In spite of the existence of clinical guides, unnecessary transfusions are used and there is a great variability of criteria to determine the need for transfusion, which are often complex and of difficult application. The use of the different blood components must be guided by transfusional policies and guidelines. The fulfillment of protocols and the existence of clinical guides for their proper use will indeed help to reduce unnecessary transfusions and the great variability in the criteria to decide the biological drug administration that should be based on clinical parameters and complementary examinations. Conclusions: after reviewing different transfusional guideline proposals made by specialists linked to blood transfusion and especially, the ones belonging to our National Blood Commission (ABC of Transfusion Medicine: Clinical Guidelines), it is intended to contribute modestly to deepen into the knowledge about the basic principles for the proper use of blood and its components that everyone involved in the surgical patient care should have.

Sistemas de puntuación en sepsis / Scoring systems in sepsis

Introducción: el paciente quirúrgico se enfrenta inexorablemente al reto de la infección posoperatoria. Los sistemas de puntuación en sepsis resultan herramientas de utilidad para la toma de decisiones con estos pacientes de difícil evaluación. Objetivo: exponer algunos conceptos relacionados con la fisiopatología del paciente quirúrgico y con la sepsis posoperatoria, así como las ventajas y limitaciones de los principales sistemas de puntuación desarrollados para la valoración de este paciente en las salas de terapia intensiva. Métodos: se realizó una revisión narrativa de los principales aspectos relacionados con la respuesta del paciente quirúrgico a la infección apoyado en una búsqueda en la base de datos Pubmed/MEDLINE y LILACS con los términos del Mesh: peritonitis, sepsis, scores entre otros, mediante búsqueda manual, se identificaron revistas médicas relevantes y artículos derivados de conferencias internacionales. Resultados: se entregan definiciones y conceptos esenciales acerca del paciente séptico así como elementos relacionados con la fisiopatología de la sepsis del paciente quirúrgico y su respuesta inmune. Se describen los principales sistemas de puntuación en sepsis utilizados en salas de terapia intensiva, sus bondades y limitaciones. Conclusiones: los sistemas de puntuación son herramientas de indudable valor en apoyo al método clínico, su integración a la práctica médica asistencial permite disminuir los errores y optimizar el proceso de toma de decisiones en situaciones de gran estrés organizacional, además, mejoran la calidad y la seguridad del paciente.

Introduction: the surgical patient inevitably faces the challenge of postoperative infection. Scoring systems in sepsis are useful tools for decision-making with patients who are difficult to evaluate. Objective: to present some concepts related to the pathophysiology of surgical patients, and postoperative sepsis, as well as the advantages and limitations of the main scoring systems developed for assessing this patient in intensive care units. Methods: A narrative review of the main aspects of the surgical patient response to infection was conducted supported by a search in Pubmed/MEDLINE, and LILACS with MeSH terms: peritonitis, sepsis, and scores, among others, by manual search. Relevant medical journals and articles from international conferences were identified. Results: Definitions and key concepts are given about the septic patient as well as elements related to the pathophysiology of surgical patient sepsis and their immune response. The main sepsis scoring systems used in intensive care units, their advantages and limitations were described. Conclusions: scoring systems are tools of great value in supporting clinical method, its integration into the medical assistance can reduce errors and optimize the process of decision-making in situations of major organizational stress; it also improves the quality and patient safety.

Anticoagulantes y antiplaquetarios: consideraciones en el paciente quirúrgico / Anticoagulant and antiplatelet agents: considerations in the patient operated on

Introducción: Los fármacos modificadores de la hemostasia tienen múltiples indicaciones en las enfermedades cardiovasculares, por lo que con frecuencia el anestesiólogo se enfrenta a un paciente con éste tratamiento que requiere intervención quirúrgica. Objetivo: Actualizar la información sobre la conducta perioperatoria de los pacientes tratados con fármacos anticoagulantes y antiagregantes. Desarrollo: Para ello, se consultó la bibliografía relacionada con el tema a través de la red nacional de información médica y sus enlaces. El perioperatorio es un período de alto riesgo trombótico. Un paciente con riesgo y sin la adecuada cobertura antiagregante ó anticoagulante se enfrenta a un mayor riesgo de complicaciones cardíacas, cerebrales o vasculares periféricas. El concepto que el antiagregante se debe siempre suprimir, debe ser analizado, así como aquel que descarta la práctica de la anestesia regional en pacientes que requieren tromboprofilaxis, Toda estrategia debe ser individualizada y no sistematizada. Conclusiones: El anestesiólogo y el cirujano deben evaluar detalladamente el riesgo hemorrágico de la intervención quirúrgica, así como el riesgo trombótico de la supresión del fármaco anticoagulante ó antiagregante, siempre en el contexto particular de cada paciente en su circunstancia específica.

The modifying drugs of the hemostasis have many indications in cardiovascular diseases, thus the anesthesiologist confronts a patient with this treatment requiring a surgical intervention. Objective: To update the information on perioperative behavior of patients treated with anticoagulant and antiaggregant drugs. Development: For that reason, the bibliography related to this subject through the Nation Network of Medical Information and its links. The perioperative is a period of high thrombotic risk. A patient at risk and without the proper antiaggregant or anticoagulant coverage faced a great risk of cardiac, cerebral or peripheral vascular complications. The concept that the antiaggregant drug must to be suppressed always must to be analyzed as well as those rule out the practice of the regional anesthesia in patients requiring thromboprophylaxis. All strategy must to be individualized and not systematized. Conclusions: The anesthesiologist and the surgeon must to assess in detail the hemorrhagic risk of the surgical intervention, as well as the thrombotic risk of the anticoagulant and antiaggregant drug suppression always in the particular context of each patient in its specific circumstance.

Doses baixas de dobutamina e fluidos no pós-operatório de pacientes de alto risco: efeitos sobre a oxigenação tecidual, resposta inflamatória e morbidade / Low-doses dobutamine and fluids in high-risk surgical patients: effects on tissue oxygenation, inflammatory response and morbidity

JUSTIFICATIVA E OBJETIVOS: A dobutamina é um agente inotrópico com propriedade adrenérgica beta-1 predominante e freqüentemente usado para aumentar o fluxo sanguíneo em pacientes críticos. Dobutamina pode ter um papel no aumento da perfusão esplâncnica, desse modo protegendo esta área de lesão isquêmica. O objetivo deste estudo foi investigar os efeitos de baixas doses de dobutamina (5 mig/kg/min) sobre a oxigenação tecidual, resposta inflamatória e complicações pós-operatória em pacientes de alto risco. MÉTODO: Estudo prospectivo, aleatório, encoberto e placebo-controlado. Cem pacientes cirúrgicos admitidos em Unidade Semi-Intensiva foram avaliados e 82 pacientes foram incluídos, 42 pacientes no grupo controle (solução fisiológica) e 40 no grupo tratamento (5 mig/kg/min) de dobutamina por 24 horas). Os mesmos procedimentos terapêuticos foram usados nos dois grupos. A infusão de líquidos deveria ser realizada em caso de taquicardia ou hipotensão após a infusão de dobutamina, pela possibilidade de hipovolemia. RESULTADOS: O volume total de fluidos administrado foi significativamente maior no grupo dobutamina do que no grupo controle (7351 ± 2082 mL versus 6074 ± 2386 mL, respectivamente, p < 0,05). Saturação venosa central de oxigênio (SvcO2), lactato sérico e proteína C-reativa foram similares em ambos os grupos. Complicações ocorreram em 35 por cento e 50 por cento dos pacientes nos grupos dobutamina e controle, respectivamente (RR 0,70 IC 95 por cento 0,41 - 1,17; NS). CONCLUSÕES: Baixas doses de dobutamina e fluidos após trauma cirúrgico não tiveram efeitos na prevalência de complicações pós-operatória em pacientes cirúrgicos de alto risco.

BACKGROUND AND OBJECTIVES: Dobutamine is an inotropic agent with predominant beta1- adrenergic properties frequently used to increase blood flow in critically ill patients. Dobutamine may have a role in increasing splanchnic perfusion, thereby protecting this area from further injury. We investigated the effects of low doses dobutamine (5 mug/kg/min) on tissue oxygenation, inflammatory response and postoperative complications in high-risk surgical patients. METHODS: Prospective, randomized, blinded and placebo-controlled study. One hundred surgical patients admitted in a step-down unit were evaluated and 82 patients were enrolled, 42 in the control group (saline) and 40 in the treatment group (5 mug/kg/h) during 24 hours. Similar therapeutic goals were applied to both groups. Fluids were given whenever tachycardia or hypotension developed after study drug infusion. RESULTS: The total volume of fluids given was significantly higher in treatment than in control group (7351 ± 2082 mL versus 6074 ± 2386 mL, respectively, p < 0.05). Central venous oxygen saturation (ScvO2), serum lactate and C-reactive protein were similar in both groups. Complications occurred in 35 percent and 50 percent of the patients in the treatment and control groups, respectively (RR 0, 70 IC 95 percent 0.41 - 1.17; NS). CONCLUSIONS: Low-doses dobutamine and fluids after surgical trauma has no effects on the prevalence of postoperative complications in high-risk surgical patients.

The study on free hemoglobin concentrations in surgical patients with massive blood transfusion

Background: Hemoglobin is a composition of erythrocyte. They are released from the lysis of erythrocyte. Objectives: to study free hemoglobin concentrations in surgical patients received massive blood transfusion (MBT). Subject and methods: 48 adult patients (male: 31 (64.6%), female: 17 (35.4%), mean age: 36 \xb1 16) with more than 3000ml of storage blood were tested for plasma free hemoglobin. The major reason for MBT were severe trauma (45.8%), the remainder were non - trauma. The change of Hb free was followed in 16 patients at the times of 1500 ml, 2000 ml, 3000 ml storage blood transfused (9 \xb1 3 days). Results: Plasma free hemoglobin was detected after 2,000ml of red cell transfusion and during the first 24h post MBT in 100% cases. Plasma free hemoglobin concentration trended to increase with quantity of transfused blood (0.56 \xb1 0.3 g/dl after 2000 ml, 0.76 \xb1 0.47 g/dl after 3000 ml, and 0.93 \xb1 0.41 g/dl after 5000 ml). There was no correlation between free hemoglobin concentration in plasma of patients with the storage time of blood transfused, and no difference of plasma free hemoglobin concentration between in trauma and non trauma patients. Conclusion: The blood with short time of storage is recommended after 1500ml blood transfusion in these patients. \r\n', u'\r\n', u'

Cuidados de enfermagem realizados ao paciente cirúrgico no período pré-operatório / Nursing care given to the surgical patient in the postoperative period

Este estudo objetivou caracterizar os cuidados de enfermagem realizados no período préoperatório de cirurgias eletivas. Trata-se de uma pesquisa de caráter quantitativo, com delineamento transversal, classificada como descritiva. Foi realizada em unidades cirúrgicas de dois hospitais do município de Ponta Grossa. A população foi selecionada por meio de amostra de conveniência e constitui-se de 129 pacientes no período pré-operatório de cirurgias eletivas, na faixa etária de 18 a 70 anos, e 10 enfermeiros que atuam em unidades nas quais internam pacientes cirúrgicos no período pré-operatório. Para coleta de dados, foi utilizada com os pacientes a entrevista estruturada, e para a população de enfermeiros um questionário. Os resultados evidenciaram que 50 % (metade) dos pacientes internaram no dia da realização da cirurgia, os cuidados realizados pela enfermagem estão relacionados ao preparo físico do paciente, sendo que a maioria dos pacientes não recebeu orientação em relação ao procedimento cirúrgico, e poucos receberam orientações sobre os cuidados de enfermagem efetuados, portanto, tinham limitado conhecimento do motivo da realização destes. Os cuidados que deixaram os pacientes constrangidos foram a colocação da camisola cirúrgica, retirada de roupa íntima e prótese dentária. Os enfermeiros têm conhecimento da importância da sistematização da assistência, da orientação pré-operatória, para prestar uma assistência com qualidade, porém 90% referem que a prática não viabiliza a assistência de enfermagem ideal, para 60% deles é devido à falta de profissionais, para 40% pelo grande número de pacientes internados. Da mesma maneira, os profissionais têm conhecimento do motivo dos cuidados realizados, porém autores referem que alguns destes ainda não possuem evidências científicas. Em suma, entende-se que existem profissionais buscando continuamente o aperfeiçoamento do processo de cuidar. Assim, com este estudo, espera-se que os enfermeiros procurem o aprimoramento de sua prática, dedicando mais atenção ao paciente, utilizando a sistematização da assistência de enfermagem como ferramenta para conseguir o planejamento de cuidados individualizados para o paciente cirúrgico no período pré-operatório de acordo com cada realidade.

The main objective of this study was to characterize the nursing care carried out in the preoperative period of elective surgeries. This study was a quantitative research with transversal delineation, classified as descriptive. The research was done in two hospitals of Ponta Grossa city, Paraná state. The population was selected through a convenience sample and it was consisted of 129 pre-operative period patients of elective surgeries, in the 18 to 70 age group and 10 nurses who act in units that receive surgical patients in the pre-operative period. The data was got by structuralized interview, used as a tool, and a questionnaire was used to the nursing group. The results showed that 50% (half) of the patients get in the hospital in the surgery day, and the nursing care is related to the physical preparation of the patient and most of the patients did not receive any orientation about the surgical procedure and few of them received guidelines on the effected nursing care, so they had little knowledge of the reason of the accomplishment of these procedures. In relation to the procedures concerning the nursing care, the patients got more uncomfortable in wearing the surgical nightgown, the underpants and dentures removal. The nurses has knowledge about the importance of assistance systematization, of the pre-operative orientation to give a qualitative assistance, however, 90% of the nurses related that the nursing practice do not make possible the ideal nursing care, 60% said that the current nursing care is due to lack of professionals and 40 % of the nurses said that there are many patients in the hospitals every day. It also showed that the nursing professionals have knowledge about the nursing care necessity with the patients, but some authors related that some researchers didn't showed scientific evidences concerning this problem. To sum up, this study showed that there are professionals looking for continuous caring process improvement. Thus, we want that this study could bring the nursing practice improvement and more attention of the nurses with their patients, using the nursing care systematization as a tool to achieve the individual care planning to the surgical patient in the pre-operative period in relation to each single reality.

Serum HBV-DNA Level in HBsAg Positive Patients Before and after Operation and Their Infectious Risk in Hospital / 中华医院感染学杂志

OBJECTIVE To investigate the changes in serum HBV-DNA level in HBsAg positive patients before and after operation and their infectious risk in hospital.METHODS HBV markers(HBV-M) in serum was detected in 58 HBsAg positive patients by time-resolved fluoroimmunometric assay before operation.HBV-DNA level in serum of them before operation and at 3rd,and 7th day after operation was detected by real time fluorescent quantitative polymerase chain reaction.We also detected HBV-DNA in gastric drainage juice and abdominal drainage after operation.RESULTS HBV-DNA was detected in 27 of 58 HBsAg positive patients' serum,the positive rate was 46.1%.After operation,serum HBV-DNA was increased remarkably at 3rd and 7th day compared with before operation in these patients respectively(P

Ansiedade do paciente no período pré-operatório de revascularização do miocárdio como fator de risco de infecção da ferida cirúrgica / Patient's anxiety in the pre-operative period of myocardial revascularization as risk factor of infection in the surgical site

Este estudo teve a finalidade de avaliar a influência da ansiedade na incidência de infecção do sítio cirúrgico dos pacientes submetidos à revascularização do miocárdio e apresentou como objetivos: identificar no período pré-operatório o estado de ansiedade de pacientes com indicação de revascularizaçao do miocárdio; verificar a ocorrência de infecção do sítio cirúrgico nos pacientes submetidos à revascularização do miocárdio; relacionar estado de ansiedade no período pré-operatório à ocorrência de infecção do sítio cirúrgico no período pós-operatório. A amostra foi composta por 127 pacientes internados no Instituto Dante Pazzanese de Cardiologia. Para a coleta, foram utilizados além do questionário estado de ansiedade proposto por SPIELBERG, GORSUCH, LUSHENE, (1997), o formulário contendo dados pertinentes ao período intra-operatório e pós-operatório. Os dados foram coletados nos períodos referidos. Os resultados encontrados demonstraram com relação à ansiedade uma amostra caracterizada por 65 pacientes (51,2%) com médio estado de ansiedade. No que se refere a infecção no período pós-operatório, foram obtidos 116 pacientes sem infecção (91,3%) e 11 pacientes (8,7%) apresentaram infecção do sítio cirúrgico. Conclui-se que não houve diferenças estatisticamente significantes (p = 0,120) entre ansiedade e infecção do sítio cirúrgico.

This study has the aim to evaluate the influence of anxiety on the infection incidence in the surgical site of patients submitted to myocardial revascularization, and presented as purpose: to identify during the pre-surgical period the anxiety state of patients with indication for myocardial revascularization; to verify the occurrence of infection in the surgical site of patients submitted to myocardial revascularization; to inscribe the anxiety state during the pre-surgical period with the occurrence of infection of the surgical site during the post-surgical period. The sampling was composed by interned patients at Instituto Dante Pazzanese de Cardiologia. To the collection, it was used besides the questionaire to evaluate the anxiety state proposed by SPIELBERG, GORSUCH, LUSHENE (1997), a form containing data pertained to the intra - and post-surgical periods. Data were collected in the mentioned periods. Results found show that related to the anxiety, a sampling characterized a medium anxiety state 65 (51.2%). As to infection during the post-surgical period, it was obtained 116 patients without infection, and 11 patients (8.7%) presented infection in the surgical site. It was concluded that there were no statistically significant diferences (P = 0.120) between anxiety and infection in the surgical site.

A Study on the Effect of Supportive Nursing Care to Anxiety Reduction of the Patient Immediately Before Surgery in the Operating Room / 성인간호학회지

PURPOSE: This study was to examine the effects of supportive nursing care on surgical patients in the operating room. METHOD: This study was nonequivalent control group none-synchronized design. The data were collected during the period of July 26 through October 8, 1999 at K hospital in Kwangju. The subjects for the study were selected from those patients who were admitted to K hospital for abdominal surgery. Forty-eight adult subjects were selected and evenly divided into two groups: 24 for the experimental group and the other 24 for the control group, respectively. The tool used for measuring state and trait anxiety was the one originally worked out by Spilberger(1976), and translated by Kim Jung-Taek and Shin Dong-Kyun(1978) for suitable application for Koreans. Data were analyzed by x2-test, t-test, Chronbach's alpha coefficient using SAS/PC+. RESULT: Results were as follows: 1. The degree of State anxiety was found to be lower in the experimental group who received supportive nursing care in the operating room immediately before an operation than the control group who did not."(p.05). CONCLUSION: Results of the above study reveals that the supportive nursing care in the operating room is effective in alleviating the anxiety of patients. I suggest that it is highly desirable to apply supportive nursing care for those patients who are waiting for immediate surgery.

Effect fo glutamine-supplemented total parenteral nutrition on surgical patients / 肠外与肠内营养

Objectives:To observe the influence of glutamine supplemented TPN on surgical patients. Methods:Thirty cases were randomly divided into two groups.One was glutamine supplemented TPN group(Gln TPN) and another group was standard TPN group (S TPN). Results:①Total lymphocyte count(TLC) was raised significantly in Gln TPN than in S TPN.②There were no differences in hepatic function,Hb and ALB between two groups.③There was no difference in recorery of intestinal function between two groups.④The patients recovered more rapidly from POF in Gln TPN group than in S TPN group. Conclusions:Glutamine supplemented TPN could increase TLC of surgical patients and remit POF more rapidly.

Application of parenteral nutrition with fructose-1,6-diphosphate in elder abdominal operative patients / 肠外与肠内营养

Objectives:To study the value of fructose-1,6-diphosphate-supplemented parenteral nutrition in elder abdominal surgical patients.Methods:thirty-two patients were randomly allocated into study group and control group,receiving isocaloric(83.6 kJ/kg?d~(-1)) and isonitrogenous(0.2 g/kg?d~(-1)) PN from post-operation day 1 to post-operation day 6.The study group received 10g of FDP every day and did not receive Glycophos.Plasma albumin,pre-albumin and phosphate lever were measured and EKG was examined before surgery and days 1 and 7 after surgery.The level of 3-methylhistidine(3-MH) in urine was measured and nitrogen balances were calculated postoperatively on day 1,3,5 and 7.Results:The blood phosphate levels were normal in two groups before and after surgery.Compared with preoperation,plasma albumin and pre-albumin levels were both decreased in two groups and pre-albumin level was markedly decreased in the control group(P