Perfil clínico e sucesso na extubação de pacientes pós cirurgia cardíaca / Clinical profile and success in patient extubation after cardiac surgery

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.

Tidal Flow-Volume Loop Enveloping at Rest in Advanced COPD.

BACKGROUND: Expiratory flow limitation (EFL) is a key physiological abnormality in COPD. Comparing tidal-to-maximum flow-volume (F-V) loops is a simple and widely available method to assess EFL in patients with COPD. We aimed to investigate whether subjects with COPD showing significant resting tidal F-V enveloping (ie, > 50% tidal volume) would present with higher exertional operating lung volumes, which would lead to greater burden of dyspnea and poorer exercise tolerance compared to their counterparts. METHODS: 37 subjects with COPD (21 males; 63.1 ± 9.2 years old; FEV1 = 37 ± 12% predicted) and 9 paired controls (3 males; 55.9 ± 11.7 y old) performed an incremental cardiopulmonary exercise testing on a cycle ergometer. Dyspnea perception, inspiratory capacity maneuvers after 3-4 sequential tidal F-V loops, and esophageal and gastric pressures were measured during exercise. RESULTS: Most subjects (31 of 37, 84%) presented with significant tidal F-V enveloping. Critical inspiratory constraints and upward dyspnea inflection points (as a function of both work rate and ventilation) were reached earlier in these subjects, thereby leading to poorer exercise tolerance compared to their counterparts (P = .01). Abdominal muscle recruitment (ie, increase in gastric pressure ≥ 15%) during tidal expiration was significantly higher in the EFL+ group. However, this did not bear an influence on the operating lung volumes, inspiratory constraints, dyspnea, cardiocirculatory responses, or exercise tolerance (P > .05). CONCLUSIONS: Tidal F-V loop enveloping at rest should be valued as it is related to relevant clinical outcomes, such as dyspnea burden and exercise tolerance in subjects with COPD.

Exercise capacity in adolescent and adult patients with post infectious bronchiolitis obliterans.

BACKGROUND: Post-infectious bronchiolitis obliterans (PBO) is a chronic lung disease characterized by the persistence of continuous obstructive respiratory symptoms following an acute and severe respiratory infection in children under 3 years old. The purpose of the present study was to investigate if adolescents and adults with diagnosis of PBO have reduced aerobic capacity and identify factors related with exercise performance. METHODS: A convenience sample of 16 patients (10-23 years) that have consulted with established diagnosis of PBO in a tertiary care clinic were studied. Fourteen healthy matched subjects were selected from the community to serve as controls. They performed resting lung function tests and cycle incremental cardiopulmonary exercise tests. RESULTS: Peak aerobic capacity (peak V˙O(2)) was significantly lower in patients compared to controls (84 ± 15 vs. 101 ± 17% pred; P < 0.01). Peak V˙O(2) was correlated with rest inspiratory capacity (IC) (r = 0.60; P = 0.02) and marginally with forced expiratory volume in the first second (FEV(1)) (r = 0.45; P = 0.09). Additionally, FEV(1) was correlated with IC (r = 0.83; P < 0.01) and residual volume/total lung capacity (r = -0.91, P < 0.01). CONCLUSIONS: Adolescent and adult patients with PBO had reduced peak V˙O(2) compared to healthy controls. Peak V˙O(2) was correlated with parameters of airflow limitation and rest hyperinflation. The greater the air flow limitation (lower FEV(1)) the greater the hyperinflation, air trapping, and aerobic capacity reduction.