Postoperative Period Of Cardiac Surgery Research Articles

Predictors for prescription of noninvasive ventilation in the postoperative period of cardiac surgery: a systematic review

Introduction The postoperative (PO) period after cardiac surgery is associated with the occurrence of respiratory complications. Noninvasive positive pressure ventilation (NIPPV) is largely used as a ventilatory support strategy after the interruption of invasive mechanical ventilation. However, the variables associated with NIPPV prescription are unclear. Objective To describe the literature on predictors of NIPPV prescription in patients during the PO period of cardiac surgery. Materials and methods This systematic review was registered on the International Prospective Register of Systematic Reviews (PROSPERO) platform in December 2021 (CRD42021291973). Bibliographic searches were performed in February 2022 using the PubMed, Lilacs, Embase and PEDro databases, with no year or language restrictions. The Predictors for the prescription of NIPPV were considered among patients who achieved curative NIPPV. Results A total of 349 articles were identified, of which four were deemed eligible and were included in this review. Three studies were retrospective studies, and one was a prospective safety pilot study. The total sample size in each study ranged from 109 to 1657 subjects, with a total of 3456 participants, of whom 283 realized NIPPV. Curative NIPPV was the only form of NIPPV in 75% of the studies, which presented this form of prescription in 5–9% of the total sample size, with men around 65 years old being the majority of the participants receiving curative NIPPV. The main indication for curative NIPPV was acute respiratory failure. Only one study realized prophylactic NIPPV (28% of 32 participants). The main predictors for the prescription of curative NIPPV in the PO period of cardiac surgery observed in this study were elevated body mass index (BMI), hypercapnia, PO lung injury, cardiogenic oedema and pneumonia. Conclusions BMI and lung alterations related to gas exchange disturbances are major predictors for NIPPV prescription in patients during the PO period of cardiac surgery. The identification of these predictors can benefit clinical decision-making regarding the prescription of NIPPV and help conserve human and material resources, thereby preventing the indiscriminate use of NIPPV.

Complications in the Postoperative Period of Cardiac Surgery – A Scoping Review

Complications in the Postoperative Period of Cardiac Surgery – A Scoping Review

Factors associated with vasoplegic shock in the postoperative period of cardiac surgery and influence on morbidity and mortality of the use of arginine vasopressin as rescue therapy

ObjectivesAnalyzing associated factors with vasoplegic shock in the postoperative period of Cardiac Surgery. Analyzing the influence of vasopressin as rescue therapy to first-line treatment with norepinephrine. DesignCohort, prospective and observational study. SettingMain hospital Postoperative Cardiac ICU. PatientsPatients undergoing cardiac surgery with subsequent ICU admission from January 2021 to December 2022. InterventionsRecord of presurgical, perioperative and ICU discharge clinical variables. Main variables of interestchronic treatment, presence of vasoplegic shock, need for vasopressin, cardiopulmonary bypass time, mortality. Results773 patients met the inclusion criteria. The average age was 67.3, with predominance of males (65.7%). Post-CPB vasoplegia was documented in 94 patients (12.2%). In multivariate analysis, vasoplegia was associated with age, female sex, presurgical creatinine levels, cardiopulmonary bypass time, lactate level upon admission to the ICU, and need for prothrombin complex transfusion. Of the patients who developed vasoplegia, 18 (19%) required rescue vasopressin, associated with pre-surgical intake of ACEIs/ARBs, worse Euroscore score and longer cardiopulmonary bypass time. Refractory vasoplegia with vasopressin requirement was associated with increased morbidity and mortality. ConclusionsPostcardiopulmonary bypass vasoplegia is associated with increased mortality and morbidity. Shortening cardiopulmonary bypass times and minimizing products blood transfusion could reduce its development. Removing ACEIs and ARBs prior to surgery could reduce the incidence of refractory vasoplegia requiring rescue with vasopressin. The first-line treatment is norepinephrine and rescue treatment with VSP is a good choice in refractory situations. The first-line treatment of this syndrome is norepinephrine, although rescue with vasopressin is a good complement in refractory situations.

NURSING CARE FOR PATIENTS UNDERGOING HEART SURGERY

INTRODUCTION: Nursing care for patients undergoing heart surgery is extremely important, as it is possible to avoid risks, as well as the manifestation of various complications. With regard to cardiac surgeries, surgical interventions have the possibility of reducing mortality and thus improving the quality of life of patients, as it favors the development and improvement of assistance itself. OBJECTIVE: To identify nursing care for patients undergoing cardiac surgery in the literature. METHODOLOGY: this study is an integrative review of the literature, based on the following guiding question: what is the nursing care provided to patients undergoing cardiac surgery? Data collection took place between the months of January and February 2024 through the databases Scientific Electronic Library Online (SCIELO), Latin American and Caribbean Literature in Health Sciences (LILACS), Nursing Databases (BDENF), making use of the descriptors in health sciences (DeCS): nursing, cardiac surgery and patient. For the inclusion criteria, the following were adopted: articles published between the years 2019 and 2023, articles available in Portuguese for free, which addressed the topic and which were available in full, duplicate articles were excluded, that is, those present in more of a database, incomplete articles, and those that deviated from the study proposal. RESULTS AND DISCUSSIONS: It is worth noting that the postoperative period of cardiac surgeries, a period during which the patient recovers from post-anesthetic and post-surgical stress, is marked by the destabilization of the patient’s clinical condition, and is therefore , full of specificities, and critical care. Therefore, the postoperative period of cardiac surgery requires continued attention, resoluteness, and highly complex care from the nursing team. Therefore, it is possible to minimize various complications, such as changes in blood pressure levels, as well as compensation of organic systems. CONCLUSION: It is concluded, therefore, that the assistance of the nursing team to patients undergoing cardiac surgery is essential, as it makes it possible to carry out a continuous investigation, as well as to determine human responses, as well as to elaborate possible nursing diagnoses.

Relationship between Static Lung Compliance and Extubation Failure in Postoperative Cardiac Surgery Patients.

Static lung compliance, which is seriously affected during surgery, can lead to respiratory failure and extubation failure, which is little explored in the decision to extubate after cardiac surgery. To evaluate static lung compliance in the postoperative period of cardiac surgery and relate its possible reduction to cases of extubation failure in patients submitted to the fast-track method of extubation. Patients undergoing cardiac surgery using cardiopulmonary bypass (CPB) at a state university hospital admitted to the ICU under sedation and residual block were included. Their static lung compliance was assessed on the mechanical ventilator using software that uses least squares fitting (LSF) for measurement. Within 48 hours of extubation, the patients were observed for the need for reintubation due to respiratory failure. The level of significance adopted for the statistical tests was 5%, i.e., p<0.05. 77 patients (75.49%) achieved successful extubation and 25 (24.51%) failed extubation. Patients who failed extubation had lower static lung compliance compared to those who succeeded (p<0.001). We identified the cut-off point for compliance through analysis of the Receiver Operating Characteristic Curve (ROC), with the cut-off point being compliance <41ml/cmH2O associated with a higher probability of extubation failure (p<0.001). In the multiple regression analysis, the influence of lung compliance (divided by the ROC curve cut-off point) was found to be 9.1 times greater for patients with compliance <41ml/cmH2O (p< 0.003). Static lung compliance <41ml/cmH2O is a factor that compromises the success of extubation in the postoperative period of cardiac surgery.

Assessment of quadriceps muscle mass by ultrasound in the postoperative period of cardiac surgery

BackgroundPatients undergoing cardiac surgery are exposed to many factors that activate catabolic and inflammatory pathways, which affect skeletal muscle and are, therefore, related to unfavorable hospital outcomes. Given the limited information on the behavior of muscle mass in critically ill patients, the objective of this study was to evaluate the impact on quantitative and qualitative measurements of quadriceps muscle mass using ultrasound after cardiac surgery. To accomplish this, a prospective, descriptive, and correlational study was conducted at a tertiary care hospital. Quadriceps muscle mass was evaluated via ultrasound in 31 adult patients in the postoperative period of cardiac surgery, with daily follow-up until postoperative day 7, as well as an assessment of associations with negative outcomes at 28 days.ResultsA 16% reduction in the cross-sectional area of the rectus femoris was found (95% CI 4.2–3.5 cm2; p 0.002), as well as a 24% reduction in the pennation angle of the rectus femoris (95% CI 11.1–8.4 degrees; p: 0.025). However, changes in the thickness of the rectus femoris, vastus internus, vastus lateralis, the length of the fascicle of the vastus lateralis, the pennation angle of the vastus lateralis, the sarcopenia index, and the Hekmat score were not statistically significant. There was no significant association between quadriceps muscle mass measurements and Intensive Care Unit (ICU) length stay or 28-day mortality.ConclusionsPatients in the postoperative period of cardiac surgery evaluated by ultrasound exhibit both quantitative and qualitative changes in quadriceps muscle mass. A significant reduction in muscle mass is observed but this is not associated with unfavorable outcomes.

Efficacy of Respiratory Muscle Training in the Immediate Postoperative Period of Cardiac Surgery: A Systematic Review and Meta-Analysis.

This study aimed to evaluate the efficacy of respiratory muscle training during the immediate postoperative period of cardiac surgery on respiratory muscle strength, pulmonary function, functional capacity, and length of hospital stay. This is a systematic review and meta-analysis. A comprehensive search on PubMed®, Excerpta Medica Database (or Embase), Cumulative Index of Nursing and Allied Health Literature (or CINAHL), Latin American and Caribbean Health Sciences Literature (or LILACS), Scientific Electronic Library Online (or SciELO), Physiotherapy Evidence Database (or PEDro), and Cochrane Central Register of Controlled Trials databases was performed. A combination of free-text words and indexed terms referring to cardiac surgery, coronary artery bypass grafting, respiratory muscle training, and clinical trials was used. A total of 792 studies were identified; after careful selection, six studies were evaluated. The studies found significant improvement after inspiratory muscle training (IMT) (n = 165, 95% confidence interval [CI] 9.68, 21.99) and expiratory muscle training (EMT) (n = 135, 95% CI 8.59, 27.07) of maximal inspiratory pressure and maximal expiratory pressure, respectively. Also, IMT increased significantly (95% CI 19.59, 349.82, n = 85) the tidal volume. However, no differences were found in the peak expiratory flow, functional capacity, and length of hospital stay after EMT and IMT. IMT and EMT demonstrated efficacy in improving respiratory muscle strength during the immediate postoperative period of cardiac surgery. There was no evidence indicating the efficacy of IMT for pulmonary function and length of hospital stay and the efficacy of EMT for functional capacity.

Nursing diagnoses in the postoperative period of cardiac surgery

Nursing diagnoses in the postoperative period of cardiac surgery

Uso del catéter de arteria pulmonar en las primeras horas posoperatorias de cirugía cardiovascular de alto riesgo

IntroductionInformation on physiological phenomena in the postoperative period of cardiac surgery, pulmonary artery catheter (PAC) use, and medical behaviors derived from its measurement, is limited. ObjectiveTo describe the patterns of PAC use and therapeutic behaviors derived from it in the first postoperative hours of high-risk cardiovascular surgery. Materials and methodsRetrospective cohort study of high-risk cardiovascular surgery patients, managed with PAC in the intensive care unit of the Hospital Universitario San Ignacio in Bogotá D.C. (Colombia). The therapeutic interventions derived from the hemodynamic evaluation with this catheter were evaluated, taking into account the patterns of use and therapeutic behaviors according to the postoperative moment. ResultsForty-two patients were included. Median age 65 years, 59.5% men, 57.1% with EuroSCORE≥6. Median time of PAC use was 63 h (RIC 45–80). The number of PAC measurements per 12 h decreased from 2.16±0.53 in the first 12 h to 1.30±0.82 after 48 h (p: 0.0003). The number of behaviors taken from each measurement decreased from 1.48±0.45 to 0.71±0.51 (p: 0.0001) in the same period. There was significant reduction in number of behaviors associated with fluid, vasoactive, and vasodilator administration over time. ConclusionsOur data suggest that with the passage of hours the number of PAC measurements is decreasing, as well as the number of behaviors taken based on these measurements. These data suggest that many of the patients who maintained the pulmonary artery catheter for up to 48–72 h no longer required it. Further studies will be needed to clarify which patients benefit from pulmonary artery catheterization beyond 48 h.

Improvement of microcirculatory vessel density in the early post-operative period of heart valve surgery: an observational study

Abstract Introduction Cardiac surgery with cardiopulmonary bypass (CPB) is associated with microcirculatory perfusion disturbances that persist after the surgery and that can cause multiple organ dysfunction. Little is known about the effects of heart surgery on the microcirculation of patients in the postoperative period of heart valve surgery. Purpose The purpose of the study is to identify the alterations that occur in the sublingual microcirculation of patients submitted to heart valve surgery using cardiopulmonary bypass. Such findings may guide future implementation of routine microcirculation assessment in the postoperative period of cardiac surgery. Methods This was a single-center cross-sectional observational study that included thirty patients aged 52 ± 14 years and enrolled during a period of four months, scheduled for heart valve surgery with CPB at a quaternary public hospital. Sublingual microcirculatory density and perfusion were assessed using a handheld camera based on incident dark-field (IDF) imaging. Each recruited patient was evaluated in two stages: 1) during hospitalization, in the preoperative period of cardiac surgery to be performed within the next 48 hours; 2) in the early postoperative phase of cardiac surgery, within the first four hours of the patient's arrival at the intensive care unit. At least three videos of 5 seconds each were obtained in both stages. Images were analyzed using automated software as well as visual analysis. For analysis purposes, we considered vessels as capillaries if diameter ranges between 6.04-15.9 µm and non-capillaries if diameter ranges between 16-50 µm. Results We observed a statistically significant increase in the total number of vessels (TVN) after surgery (1076 ± 156) compared to values obtained before surgery (943 ± 117, P=0.0004). In addition, the total number of capillaries vessels (TNCV) was also greater after surgery (998 ± 132) compared to the preoperative period (877 ± 106; P=0.0001), the same being observed in the total length of capillaries vessels (TLCV) after surgery (28.7 ± 3.3 mm) compared to before surgery (25.8 ± 3.0 mm; P=0.0005) and capillary vessel density (CVD) (16.4 ± 1.9 and 14.8 ± 1.7 mm/mm2) after and before surgery, respectively (P=0.0005). With regard to non-capillary vessels, no difference was observed in total number of non-capillary vessels (TNNCV) after [68 (49-104)] and before surgery [69 (49-78)] (P=0.21), as well as in total length of non-capillary vessels (TLNCV) after [1.6 (1.2-2.4)] mm and before [1.5 (1.1-1.8.)] mm (P=0.25) surgery. Finally, non-capillary vessel density (NCVD) was also similar after [0.89 (0.67-1.36)] mm/mm2 and before surgery [0.83 (0.66-1.06)] mm/mm2 (P=0.34). Conclusion In patients undergoing heart valve surgery, there was a significant increase in postoperative microvessel number, mainly due to the increase in the density of capillaries vessels.

Clues of incomplete reversal of heparin in cardiac surgery.

In our center, an unusual rate of patients had abnormalities of hemostasis in immediate postoperative period of cardiac surgery. Our objectives were to identify the cause of these sudden hemostasis abnormalities and to evaluate the performances of point of care coagulation testing. In this prospective and descriptive study, we included 33 consecutive patients undergoing elective cardiac surgery for 1month. Heparin-induced anticoagulation and calculation of the protamine dose were tested by the Hemostasis Management System Plus device (Medtronic, Minneapolis, MN, USA). Fifteen minutes after the end of the protamine infusion, activated clotting time (ACT), activated partial thromboplastin time and anti Xa activity were measured. In case of unusual clinical bleeding, a Quantra analysis (Stago, HemoSonics LLC, Charlottesville, VA) was added. Residual antiXa activity >0.2 IU/mL after neutralization was present in 44% of patients. Our investigation concluded incomplete heparin reversal. There was no association between cellular reinfusate and the presence of heparin. The unusual rate of hemostasis abnormalities was explained by a less efficient protamine reversal of heparin. ACT and Clot Time Ratio (CTR, Quantra system) correlated with AntiXa with Spearman's coefficients of 0.85 (p < .0001) and 0.95 (p = .0012), respectively. About ACT, a threshold of 150 seconds had a sensitivity of 85% [58-97] and a specificity of 85% [58-97%] for detection of AntiXa>0.2. For CTR, a threshold of 1.4 had a sensitivity of 67% [30-94] and a specificity of 100% [18-100]. The use of point of care coagulation testing is effective in detecting incomplete reversal of heparin.

Venous-arterial oxygen saturation and serum lactate in the postoperative period of cardiac surgery

Venous-arterial oxygen saturation and serum lactate in the postoperative period of cardiac surgery

Construction and validation of an educational booklet for patients in the postoperative period of cardiac surgery: a methodological study.

to construct and validate an educational booklet for self-care of patients in the postoperative period of cardiac surgery. methodological study, including bibliographic survey, construction of the booklet and validation with judges and the target audience. For validation with judges, the Health Educational Content Validation Instrument was used, and with the target audience, an instrument was used with questions related to organization, writing style, appearance and motivation. To analyze the judges' answers, the content validation index was used. the booklet was prepared with 14 topics. The content validation index among the eight judges was 1 and the concordance index among the ten patients was above 80%. The final version of the material was made available in printed format. the educational booklet was developed and validated by judges and the target audience, serving as an educational support tool for self-care of patients in the postoperative period of cardiac surgery.

Adverse events in the postoperative period of cardiac surgery in a pediatric intensive care unit: the contribution of the VIS score and the RACHS-1.

To evaluate the occurrence of adverse events in the postoperative period of cardiac surgery in a pediatric intensive care unit and to find any patient characteristics that can predict such events. This was a historical cohort study of patients recovering in the pediatric intensive care unit for the first 7 days after cardiac surgery between April and December 2019, by reviewing the medical records. The following were reviewed: demographic, clinical, and laboratory characteristics; patient severity scores; and selected adverse events, grouped into device-related, surgical, and nonsurgical. A total of 238 medical records were included. At least one adverse event occurred in 110 postoperative patients (46.2%). The total number of adverse events was 193 (81%). Vascular catheters were the most common cause, followed by cardiac arrest, bleeding, and surgical reexploration. In the univariate analysis, the vasoactive-inotropic score (VIS), Risk Adjustment in Congenital Heart Surgery (RACHS-1) score, age, Pediatric Index of Mortality (PIM-2), cardiopulmonary bypass and aortic clamping duration were significantly associated with adverse events. In the multivariate analysis, VIS ≥ 20 (OR 2.90; p = 0.004) and RACHS-1 ≥ 3 (OR 2.11; p = 0.019) were significant predictors, while age and delayed sternal closure showed only trends toward significance. To predict the occurrence of adverse events from VIS and RACHS-1, the area under the curve was 0.73 (95%CI 0.66 - 0.79). Adverse events were quite frequent in children after cardiac surgery, especially those related to devices. The VIS and RACHS-1, used together, predicted the occurrence of adverse events well in this pediatric sample.

Adverse events in the postoperative period of cardiac surgery in a pediatric intensive care unit: the contribution of the VIS score and the RACHS-1

Adverse events in the postoperative period of cardiac surgery in a pediatric intensive care unit: the contribution of the VIS score and the RACHS-1

Risk Factors Associated with Ischemic Stroke in the Immediate Postoperative Period of Cardiac Surgery.

Stroke remains a major complication of cardiac surgery. Despite all efforts, the incidence of postoperative stroke remains as high as 6%. We aimed to investigate risk factors for ischemic stroke in a contemporary cohort of patients undergoing cardiac surgery. This is a retrospective cohort study of 678 consecutive adult patients who underwent cardiac surgery requiring cardiopulmonary bypass in a tertiary hospital in Brazil between July 1, 2011, and December 31, 2018. The primary outcome was the rate of early (perioperative and seven-day postoperative) stroke, defined as the occurrence of the outcome during the index admission. We developed a predictive model of stroke using the Poisson regression analysis with robust variance. Postoperative stroke occurred in 24 patients (3.5%), 23 (3.3%) were ischemic, and 21 (3.0%) were diagnosed in the first 72 hours after surgical procedure. After multivariate analysis, the following factors were significantly associated with stroke: previous stroke/transient ischemic attack (relative risk [RR]=2.75; 95% confidence interval [CI], 1.11-6.82), carotid artery disease (RR=4.0; 95% CI, 1.43-11.0), previous atrial fibrillation (RR=3.26, 95% CI, 1.31-8.1), and postoperative platelets > 200,000/mm3 (RR=2.26; 95% CI, 1.01-5.1). We developed a contemporary model to determine risk predictors for stroke after cardiac surgery. This model may help clinicians to identify patients at risk and could be useful in clinical practice.

Construction and validation of an educational booklet for patients in the postoperative period of cardiac surgery: a methodological study

RESUMO Objetivo: construir e validar uma cartilha educativa para o autocuidado de pacientes no pós-operatório de cirurgia cardíaca. Métodos: estudo metodológico, incluindo levantamento bibliográfico, construção da cartilha e validação com juízes e com o público-alvo. Para validação com juízes, utilizou-se o Instrumento de Validação de Conteúdo Educativo em saúde e com o público-alvo utilizou-se um instrumento com questões relacionadas à organização, estilo da escrita, aparência e motivação. Para análise das respostas dos juízes foi utilizado o índice de validação de conteúdo. Resultados: a cartilha foi elaborada com 14 tópicos. O índice de validação de conteúdo entre os oito juízes foi de 1 e o índice de concordância entre os dez pacientes acima de 80%. A versão final do material foi disponibilizada no formato impresso. Conclusão: a cartilha educativa foi desenvolvida e validada por juízes e público-alvo, servindo como uma ferramenta educativa de apoio para o autocuidado de pacientes no pós-operatório de cirurgia cardíaca.

Delirium and pain in patients in the immediate postoperative period of cardiac surgery: prevalence and associated risk factors

Delirium and pain in patients in the immediate postoperative period of cardiac surgery: prevalence and associated risk factors

Effect of the alveolar recruitment manoeuvre on pulmonary complications in the immediate postoperative period of cardiac surgery

Introdução: dada a grande variabilidade nos protocolos de ventilação, manejo pós-operatório, características da manobra de recrutamento alveolar (MRA) (frequência, duração e intensidade) e tolerabilidade em pacientes submetidos à cirurgia cardíaca (CC), este estudo investiga se a MRA é benéfica nesta área, a fim de padronizar seu uso. Objetivo: investigou-se a eficácia da MRA contra complicações pulmonares (CPs) imediatamente após a CC. Metodologia: este ensaio clínico randomizado incluiu 134 pacientes com idade &gt; 18 anos submetidos à cirurgia de revascularização do miocárdio ou cirurgia de substituição valvar em nossa instituição entre fevereiro e setembro de 2019. Os participantes foram alocados para receber fisioterapia padrão (grupo controle [GC], n=67) ou fisioterapia padrão com adição da MRA (grupo intervenção [GI], n=67). Resultados: não houve diferença estatisticamente significativa na incidência de CPs entre os grupos GC e GI (p=0,85). A MRA não melhorou as trocas gasosas ou reduziu o tempo total de ventilação mecânica, necessidade de reintubação na unidade de terapia intensiva e internação hospitalar. Conclusão: a MRA profilática não diminui a incidência de CPs no pós-operatório de CC, não melhora as trocas gasosas, nem reduziu o tempo de VM. A MRA foi associada a um risco aumentado de instabilidade hemodinâmica. Os pacientes devem ser avaliados antes de realizar MRA

Analgesic control with blockade of the thoracic transverse muscle plane in the postoperative period of cardiac surgery. Case report

Cardiac surgery with sternotomy is related to a mechanism of intense trauma with the use of a large amount of opioids, which does not always provide good analgesic control, in addition to generating chemical dependence. The persistence of pain in the thoracic region in the postoperative period is common with conventional analgesia performed only with opioids, which slows the recovery, increasing costs and morbidity. New approaches to the analgesic control of these surgeries become important as they may be related to a better response to physiotherapy and cardiopulmonary rehabilitation and, consequently, a shorter hospital stay, which would reduce the costs of the surgery in addition to ensuring a more comfortable postoperative period for patients. Blocking the thoracic transverse muscle plane has become a promising pioneering technique for analgesic control in the postoperative period of cardiac surgery. We describe a case report in which this block gave better postoperative analgesic control, compared to the usual care in the intensive care unit.