Calidad del sueño en pacientes sometidos a cirugía cardiaca durante el postoperatorio en cuidados intensivos / Quality of sleep in patients undergoing cardiac surgery during the postoperative period in intensive care

Objetivos: Describir la calidad del sueño de los pacientes sometidos a cirugía cardiaca durante las dos primeras noches de postoperatorio e identificar algunos de los factores condicionantes del descanso nocturno de estos pacientes en la Unidad de Cuidados Intensivos. Método: Estudio descriptivo observacional basado en la aplicación del Cuestionario del Sueño de Richards-Campbell mediante un muestreo consecutivo de pacientes sometidos a cirugía cardiaca con ingreso en Unidad de Cuidados Intensivos. Simultáneamente se aplicó un cuestionario que evaluaba diferentes factores ambientales existentes en la unidad como posibles condicionantes del descanso nocturno. Se estudió la asociación entre el consumo de opiáceos y la calidad del sueño. Resultados: Muestra de 66 pacientes con edad media de 65±11,57 años, de los cuales el 73% eran hombres (N=48). El Cuestionario del Sueño de Richards-Campbell obtuvo una puntuación media de 50,33mm (1.a noche) y 53,30mm (2.a noche). Los principales factores perturbadores del sueño fueron el malestar con los diferentes dispositivos 30,91mm y el dolor 30,18mm. Los problemas generados por el ruido ambiental 27,5mm o bien a través de las voces de los profesionales 26,53mm también resultaron elementos de molestia nocturna. No se encontró asociación estadística entre el sueño y la distancia del box del paciente respecto al control de enfermería ni en relación con el consumo de analgésicos opiáceos. Conclusiones: La calidad del sueño durante las dos primeras noches de ingreso en Unidad de Cuidados Intensivos fue ‘regular’. Los factores ambientales que más condicionaron el descanso nocturno de los pacientes fueron el malestar, el dolor y el ruido ambiental (AU)

Objectives: To describe the quality of sleep of patients undergoing cardiac surgery during the first two nights following surgery and identify some of the factors conditioning the nightly rest of these patients in the Intensive Care Unit. Method: Observational descriptive study based on applying the Richards-Campbell Sleep Questionnaire through a consecutive sample of patients undergoing cardiac surgery with Intensive Care Unit admission. Simultaneously, a questionnaire assessing different environmental factors existing in the unit as possible conditioning of the night's rest was applied. The association between consumption of opioid and sleep quality was studied. Results: Sample of 66 patients with a mean age of 65±11.57 years, of which 73% were men (N=48). The Richards-Campbell sleep questionnaire garnered average scores of 50.33mm (1.st night) and 53.30mm (2.nd night). The main sleep disturbing factors were discomfort with the different devices, 30.91mm and pain, 30.18mm. The problems caused by environmental noise, 27.5mm or through the voices of the professionals, 26.53mm were also elements of nocturnal discomfort. No statistical association was found between sleep and the distance of the patient with respect to the nursing control area or related to opioid analgesics. Conclusions: The quality of sleep during the first two nights of Intensive Care Unit admission was ‘regular’. The environmental factors that conditioned the night-time rest of patients were discomfort, pain and ambient noise (AU)

Quality of sleep in patients undergoing cardiac surgery during the postoperative period in intensive care. / Calidad del sueño en pacientes sometidos a cirugía cardiaca durante el postoperatorio en cuidados intensivos.

OBJECTIVES: To describe the quality of sleep of patients undergoing cardiac surgery during the first two nights following surgery and identify some of the factors conditioning the nightly rest of these patients in the Intensive Care Unit. METHOD: Observational descriptive study based on applying the Richards-Campbell Sleep Questionnaire through a consecutive sample of patients undergoing cardiac surgery with Intensive Care Unit admission. Simultaneously, a questionnaire assessing different environmental factors existing in the unit as possible conditioning of the night's rest was applied. The association between consumption of opioid and sleep quality was studied. RESULTS: Sample of 66 patients with a mean age of 65±11.57 years, of which 73% were men (N=48). The Richards-Campbell sleep questionnaire garnered average scores of 50.33mm (1.st night) and 53.30mm (2.nd night). The main sleep disturbing factors were discomfort with the different devices, 30.91mm and pain, 30.18mm. The problems caused by environmental noise, 27.5mm or through the voices of the professionals, 26.53mm were also elements of nocturnal discomfort. No statistical association was found between sleep and the distance of the patient with respect to the nursing control area or related to opioid analgesics. CONCLUSIONS: The quality of sleep during the first two nights of Intensive Care Unit admission was "regular". The environmental factors that conditioned the night-time rest of patients were discomfort, pain and ambient noise.

Evaluación del dolor postoperatorio agudo tras cirugía cardiaca / Evaluation of the postoperative acute pain after heart surgery

El dolor es uno de los principales síntomas referidos por los pacientes sometidos a cirugía cardiaca. Objetivos Describir el dolor y explicar la posible asociación entre determinadas variables sociodemográficas, psicológicas y biológicas de los pacientes sometidos a cirugía cardiaca con la intensidad de dolor durante el postoperatorio en UCI. Pacientes y método Estudio descriptivo longitudinal entre febrero de 2008 y enero de 2009 sobre pacientes sometidos a cirugía cardiaca con ingreso en la UCI del Hospital de Navarra previo consentimiento informado. Entrevista preoperatoria con registro de variables sociodemográficas, biológicas, psicológicas y de morbilidad. Dolor monitorizado durante las primeras 48 horas de estancia en UCI a través de la Escala Verbal Numérica (EVN) del dolor. Nivel de significación aceptado p<0,05.ResultadosMuestra de 69 pacientes con media de edad de 62 años; el 74%, hombres y el 26%, mujeres. Encontramos asociación estadística entre niveles de dolor postoperatorio superiores para las variables edad < 65 años, cirugía de revascularización con injerto de arteria mamaria interna y ansiedad preoperatoria. Existió un aumento significativo en el consumo analgésico para las variables renta > 1.400 euros/mes, cirugía de revascularización con injerto de arteria mamaria y ansiedad preoperatoria. Conclusiones El dolor postoperatorio tras cirugía cardiaca está sujeto a una gran variabilidad individual. En nuestro estudio, edad, cirugía de revascularización con injerto de arteria mamaria y ansiedad preoperatoria se mostraron como variables predictivas del dolor postoperatorio de los pacientes sometidos a cirugía cardiaca

Pain is one of the main symptoms reported by patients who have had heart surgery. Objectives To describe the pain and explain the possible association among demographics, psychological and biological variables of the patients subjected to heart surgery with pain intensity during the postoperative in the ICU. Patients and method A descriptive, longitudinal study conducted between February 2008 and January 2009 on patients subjected to heart surgery with admission to the ICU of the Hospital of Navarra was conducted. A preoperatory interview was made with registration of sociodemographic, biological and psychological variables. Pain intensity was monitored during the first 48hours of ICU stay with the Verbal Numeric Scale (VNS) of pain. Accepted level of significance was p<0.05.ResultsA sample of 69 patients with mean age of 62, 26% women and 74% men was included. A superior statistical association was found between postoperative pain levels for age<65 years, bypass grafting with internal mammary artery and preoperatory anxiety variables. There was a significant increase in analgesic consumption for incomes > 1400 €/month, bypass grafting with internal mammary artery and preoperatory anxiety. Conclusions Postoperative pain after heart surgery show significant individual variability. In our study, age, bypass grafting with internal mammary artery and preoperatory anxiety were shown as predictive variables of postoperative pain in patients undergoing heart surgery

[Evaluation of the postoperative acute pain after heart surgery]. / Evaluación del dolor postoperatorio agudo tras cirugía cardiaca.

INTRODUCTION: Pain is one of the main symptoms reported by patients who have had heart surgery. OBJECTIVES: To describe the pain and explain the possible association among demographics, psychological and biological variables of the patients subjected to heart surgery with pain intensity during the postoperative in the ICU. PATIENTS AND METHOD: A descriptive, longitudinal study conducted between February 2008 and January 2009 on patients subjected to heart surgery with admission to the ICU of the Hospital of Navarra was conducted. A preoperatory interview was made with registration of sociodemographic, biological and psychological variables. Pain intensity was monitored during the first 48 hours of ICU stay with the Verbal Numeric Scale (VNS) of pain. Accepted level of significance was p<0.05. RESULTS: A sample of 69 patients with mean age of 62, 26% women and 74% men was included. A superior statistical association was found between postoperative pain levels for age<65 years, bypass grafting with internal mammary artery and preoperatory anxiety variables. There was a significant increase in analgesic consumption for incomes>1400 €/month, bypass grafting with internal mammary artery and preoperatory anxiety. CONCLUSIONS: Postoperative pain after heart surgery show significant individual variability. In our study, age, bypass grafting with internal mammary artery and preoperatory anxiety were shown as predictive variables of postoperative pain in patients undergoing heart surgery.

Spectrum of pulmonary aspergillosis: histologic, clinical, and radiologic findings.

Aspergillosis is a serious pathologic condition caused by Aspergillus organisms and is frequently seen in immunocompromised patients. At computed tomography (CT), saprophytic aspergillosis (aspergilloma) is characterized by a mass with soft-tissue attenuation within a lung cavity. The mass is typically separated from the cavity wall by an airspace ("air crescent" sign) and is often associated with thickening of the wall and adjacent pleura. CT findings in allergic bronchopulmonary aspergillosis consist primarily of mucoid impaction and bronchiectasis involving predominantly the segmental and subsegmental bronchi of the upper lobes. Aspergillus necrotizing bronchitis may manifest as an endobronchial mass, obstructive pneumonitis or collapse, or a hilar mass. Bronchiolitis is characterized by centrilobular nodules and branching linear or nodular areas of increased attenuation ("tree-in-bud" pattern). Obstructing bronchopulmonary aspergillosis mimics allergic bronchopulmonary aspergillosis at CT and manifests as bilateral bronchial and bronchiolar dilatation, large mucoid impactions, and diffuse lower lobe consolidation caused by postobstructive atelectasis. Characteristic CT findings in angioinvasive aspergillosis consist of nodules surrounded by a halo of ground-glass attenuation ("halo sign") or pleura-based, wedge-shaped areas of consolidation. Although imaging findings in pulmonary aspergillosis may be nonspecific, in the appropriate clinical setting, familiarity with the CT findings may suggest or even help establish the diagnosis.

Lung nodular lesions in heart transplant recipients.

To describe the characteristics and etiology of lung nodules after heart transplantation (HT). During a 6-year period 147 patients received HT and 130 survived more than 1 week. Nodular lesions were demonstrated after HT in 13 patients (10%). Median age was 53 years, and all patients were male. Nodules were detected 23 to 158 days after HT (median, 66 days). An etiologic diagnosis was made in all but 1 case: Aspergillus (5), Nocardia-Rhodococcus (4), and cytomegalovirus (CMV) (3). Previous severe infection was present in 50% of the patients and rejection in 33% (75% with nocardiosis). Initially all patients with Nocardia but only 1 patient with aspergillosis were asymptomatic. The most common symptoms were fever (67%) and cough (50%). Central nervous system (CNS) involvement appeared in only one Aspergillus-infected patient. An average of 1.8 diagnostic procedures per patient were performed. Median time to establish a diagnosis was 8 days (0 to 24). Median hospital stay was 36 days and reached 60 in patients with Aspergillus. No patient died, although aspergillosis, which must be suspected in the presence of dyspnea, pleuritic pain, and CNS symptoms, caused the highest morbidity. Overall diagnostic yield was 60% for transtracheal aspiration, 70% for bronchoalveolar lavage, and 75% for transthoracic aspiration. Ten percent of HT patients developed lung nodules that were mainly caused by Aspergillus, Nocardia, and CMV. The time of appearance and some clinical manifestations may suggest the etiology and may help in the empirical treatment.

Localized right upper lobe edema.

One of the lesser known atypical forms of radiographic presentation of pulmonary edema is the isolated or predominant affection of the upper right lobe in patients with mitral valve insufficiency. As a possible cause of this distribution, it has been established that the regurgitation jet during the ventricular systole may be directed selectively toward the orifice of the right upper lobe vein, locally accentuating the forces responsible for edema formation. There are few cases with these characteristics in the literature reviewed. We present an additional three cases, concluding that localized pulmonary edema secondary to mitral insufficiency should be suspected in the presence of any type of airspace consolidation in the right upper lobe, with or without associated affection of the middle lobe, in patients with a history of mitral valve insufficiency, especially when there are radiologic signs of left heart failure.

Ultrasound diagnosis of ruptured hydatid cyst of the liver with biliary obstruction.

Communication between a hydatid cyst of the liver and biliary tract results in a clinical picture of obstructive jaundice because of occupation of the extrahepatic biliary tract by intracystic material. Five cases of this complication are presented. Ultrasound criteria for diagnosis are analyzed, based on previous publications as well as our own experience.