Postoperative Period Of Cardiac Surgery Research Articles

Physical Exercise Combined With CPAP in Subjects Who Underwent Surgical Myocardial Revascularization: A Randomized Clinical Trial.

Aerobic exercise and CPAP benefit patients in the postoperative period of cardiac surgery. To our knowledge, the association of aerobic exercise on an exercise bicycle with CPAP has not yet been demonstrated. Therefore, we aimed to evaluate the effectiveness of physical exercise on a cycle ergometer combined with CPAP in the postoperative period after coronary artery bypass graft surgery. This was a randomized clinical trial, with recruitment from May 2017 to December 2017 (registered in the Brazilian Clinical Trials Registry: RBR-69CDYF). The step group (n = 16 subjects) started rehabilitation in the immediate postoperative period with breathing exercises and passive mobilization in the sitting position, progressing to active exercises, ambulation, and stair training. For the intervention group (n = 15 subjects), dynamic exercises on a cycle ergometer combined with CPAP were added to the step program from the second to the fourth postoperative day in a single daily session. Functional capacity decreased in both groups, but this reduction was not significant in the intervention group (P = .11). The length of stay in ICU was lower in the intervention group (P = .050). In both groups there was a decrease in maximum inspiratory and expiratory pressure, as well as in the 1-min sit-to-stand test on the fourth postoperative day compared to the preoperative period. Physical exercise combined with CPAP promoted the maintenance of functional capacity and reduced the length of stay in the ICU.

Cuidado de enfermagem no pós-operatório de cirurgia cardíaca pediátrica: revisão integrativa

OBJETIVO: Identificar a atuação do enfermeiro no pós-operatório de cirurgia cardíaca no paciente pediátrico. METODOLOGIA: Trata-se de uma revisão integrativa através da execução de seis etapas, com amostragem realizada por meio de levantamento e análise bibliográfica, após busca dos artigos no sítio da BVS, nas bases LILACS, MEDLINE, BDENF entre 2009 a 2018, com combinação dos descritores selecionados. RESULTADOS: A partir dos dados emergiram dois eixos temáticos: o enfermeiro e sua própria percepção no cuidado ao paciente pediátrico no pós-operatório, no qual ele se torna num ser-com que assume a responsabilidade de assegurar à criança um cuidado completo, providenciando insumos, monitorando-a constantemente e propiciando um cuidado integral; e os principais diagnósticos e intervenções de enfermagem, que variam de diagnósticos de risco a diagnósticos reais, orientando o enfermeiro para condutas de prevenção, de avaliação e de recuperação ou reabilitação. CONCLUSÃO: A atuação do enfermeiro se traduz por meio de uma condução sistemática, complexa e minuciosa, que assume a responsabilidade de assegurar à criança um cuidado completo, providenciando insumos, monitorando-a constantemente e propiciando um cuidado integral orientado pelos diagnósticos e intervenções de enfermagem.

Brain Computed Tomography Scan Findings in Children with Neurological Impairment During the Early Postoperative Period of Open-Heart Surgery for Congenital Heart Disease

Objectives: We evaluated the brain computed tomography (CT) scan findings of children with abnormal neurologic recovery during the postoperative period for corrective/palliative congenital heart surgery. Methods: This study was conducted at a referral educational pediatric hospital from May 2015 to May 2016. We included patients with congenital heart disease (CHD) who underwent corrective/palliative cardiac surgery presenting with abnormal neurologic recovery in the early postoperative period. We recorded the demographic data, past medical history, surgery details, type of neurological disorders leading to a brain CT scan, and postoperative coagulopathy. Results: From among 734 cardiac surgeries from May 2015 to May 2016, 40 (5.44) patients with abnormal neurologic recovery were assessed by brain CT scans. Among them, 55 were male and 45 were female with a mean age of 14.6 months. The most frequent heart anomaly was the transposition of great arteries (27.5), which is known as the most common cause of cardiac surgery in the first month of life. Seizure (67.5) was the most common neurologic manifestation and had the highest predictive value for the presence of an abnormal finding in the brain CT scan (91.3). Intracranial hemorrhage, specifically subarachnoid hemorrhage, was the most frequent underlying pathology in brain CT scans of patients presenting with seizure. The most common findings in brain CT scans included subarachnoid hemorrhage (82.6), intraparenchymal hemorrhage (26.08), and ischemic infarction (17.39). Data showed that a bypass time of over 180 min could significantly increase the probability of abnormal brain CT scan findings (P value = 0.03), particularly intra-parenchymal hemorrhage (P value = 0.016). The presence of coagulopathy concomitant with seizure would significantly increase the possibility of abnormal brain CT scan findings due to an acute neurologic event (P value = 0.049). Conclusions: This study showed seizure as the most common neurologic manifestation in the early postoperative period of cardiac surgery and the intracranial hemorrhage as the most common underlying pathology in patients with neurologic symptoms. Seizure in patients with coagulopathy should be considered as a great concern for physicians to evaluate acute neurologic events more precisely. © 2020, Author(s).

Understanding Health Professionals about Preservation of Silence in the Intensive Care Unit During the Post-Heart Surgery Surgery: a Systematic Review

Introduction: Through studies in the scientific literature about the measurement of sounds in the Intensive Care Unit environment, it is clear that the noise, continuous sound of equipment and those caused by the health team itself is excessive and above 85dB (decibels), favors increased sensitivity of patients to pain, irritation, post-traumatic stress and may cause psychomotor agitation, delirium, changes in heart rate and sleep. A peaceful environment can bring countless benefits to restoring the health of patients, as well as reducing the stress of professionals. Objective: To analyze some research and studies published in Brazil about the noise in an Intensive Care Unit and the perception that professionals have about this topic. Methods: A systematic literature review was performed with electronic search of articles indexed in PePSIC and SciELO databases, published from 2009 to 2019, in which the inclusion and exclusion criteria were considered. Results: indicate that the noise in this type of place often presents with an oscillating intensity of moderate to intense. It is verified that there is from the professionals a certain level of understanding of the existence of noise in the ICU. Considerations: Despite the finding by professionals about noise, it is also observed that there are few current publications about the awareness of health professionals regarding the importance of preserving a quieter environment and criteria that reinforce effective humanization interventions during the study. postoperative period of cardiac surgery in this type of environment.

Correlation of the sit-to-stand test, the walk test and waist circumference before cardiac surgery

The postoperative period of cardiac surgery interferes with peripheral muscle strength, which can be assessed by a 1-minute sit-to-stand test (STST). Our objective was to correlate STST and preoperative physical-functional variables and secondarily to correlate with gender, clinical and surgical variables, comorbidities, risk factors and postoperative complications. Cross-sectional and analytical study of patients undergoing elective cardiac surgery between 2010 and 2017. On the day before surgery, an evaluation was performed to quantify performance of the STST and the functional physical variables (six-minute walk test - 6MWT, respiratory muscle strength assessed by maximal inspiratory (MIP) and expiratory (MEP) pressure and waist circumference). Clinical and surgical variables (ejection fraction, time on mechanical ventilation, length of stay in the intensive care unit and total length of stay), comorbidities and risk factors (hypertension, diabetes mellitus, chronic obstructive pulmonary disease, acute myocardial infarction, smoking, alcoholism, physical inactivity and stress) and postoperative complications were collected from patient’s medical records. A population of 154 individuals obtained a mean of 17.32±5.02 repetitions in STST. There was a direct correlation with the 6MWT (r= 0.330; p= 0.004), the percentage of MIP (r= 0.115; p= 0.001) and MEP (r= 0.212; p= 0.004) and an inverse correlation with waist circumference (r= -0.238; p= 0.003) and age (r= -0.294; p= 0.001). There was a better performance of STST correlated with males (p= 0.032) and those with lower stress levels (p= 0.012). It is concluded that there is a correlation between the STST and the 6MWT, respiratory muscle strength and waist circumference, as well as male gender and stress.

Predicción de aparición de injuria renal aguda después de cirugía cardiovascular en la unidad de cuidados intensivos del Hospital Universitario San Ignacio

*Trabajo ganador del Premio al "Mejor Trabajo de Investigación Clínica" otorgado por el XXI Congreso Colombiano de Medicina Interna, Cali, 14 al 17 de octubre de 2010
 
 Objetivo: identificar pacientes de alto riesgo de presentar injuria renal aguda en el posoperatorio de cirugía cardiovascular en la unidad de cuidados intensivos del Hospital Universitario San Ignacio.
 
 Contexto y tipo de estudio: la población de referencia estuvo conformada por aquellos pacientes atendidos en el Hospital San Ignacio de la ciudad de Bogotá, institución de IV nivel de complejidad, con una población estudio conformada por aquellos pacientes que ingresaron a la unidad de cuidados intensivos en posoperatorio inmediato de cirugía cardiovascular.
 
 Material y métodos: estudio observacional descriptivo, retrospectivo, tipo serie de casos. La información fue recolectada por los investigadores a partir de la revisión de las historias clínicas, es decir, a partir de una fuente secundaria. Dicha recolección se realizó teniendo en cuenta un formulario diseñado para ese fin, el cual incluye datos generales y datos de las variables de la escala de predicción, registrando los datos generales de cada uno de los pacientes, incluyendo antecedentes personales y las variables de la escala de predicción.
 
 Durante la recolección de información se fue conformando la base de datos, la cual fue debidamente revisada y depurada, y posteriormente analizada utilizando el programa Epi Info 2000.
 
 Resultados: se analizaron 213 pacientes que ingresaron a la unidad de cuidado intensivo del Hospital Universitario San Ignacio en el posoperatorio inmediato de CVC. Entre los pacientes analizados la incidencia de IRA fue 3.3% (n=7) los cuales fueron sometidos a TRR. Estos pacientes tuvieron una creatinina posterior al procedimiento significativamente más alta (p=0.000). Entre los pacientes que requirieron TRR se encontró una proporción significativamente mayor de casos con una FEVI menor a 40% (71.4% vs 14.1%). Otra diferencia significativa fue el porcentaje de pacientes en quienes se utilizó el balón intraaórtico, el cual fue mucho mayor entre los pacientes que recibieron TRR (p=0.000). En cuanto a la relación entre la IRA y los procedimientos realizados a los pacientes se evidenció una mayor proporción de casos manejados con CEC dentro del grupo de pacientes que requirieron TRR; así mismo, la proporción de pacientes a quienes se les colocó balón intraaórtico fue significativamente mayor (p=0.000). Al aplicar la escala de riesgo en los pacientes analizados se evidenció que existían cuatro pacientes con alto riesgo de IRA cuyo puntaje fue mayor a cuatro. De estos pacientes solamente dos (50%) terminaron en TRR.
 
 Conclusiones: la aparición de lesión renal aguda en pacientes que son llevados a cirugía cardiovascular se ha demostrado como factor independiente de mortalidad en los pacientes en las unidades de cuidado intensivo. Los modelos predictivos para determinar la aparición de IRA en el posoperatorio de CVC han facilitado la toma de decisiones y la evaluación y estratificación del riesgo, abriendo la posibilidad de realizar intervenciones más tempranas y efectivas en pro de la recuperación, disminución de complicaciones y descenso de la morbimortalidad en estos pacientes

Perfil clínico-cirúrgico de pacientes com mediastinite pós-cirurgia cardíaca: estudo transversal retrospectivo

Objetivo: Descrever o perfil dos pacientes que desenvolveram mediastinite no pós-operatório de cirurgia cardíaca em um hospital de alta complexidade, analisando o desfecho, relacionado ao tempo de internação, à necessidade de reinternação, à antibioticoterapia instituída e a óbito. Método: Estudo transversal, com coleta de dados retrospectiva, por meio de consulta a 86 prontuários de pacientes que desenvolveram mediastinite no ano de 2015. Os dados foram coletados desde o pré-operatório até 90 dias após a alta hospitalar, o diagnóstico de mediastinite ou o óbito. Resultados: O diagnóstico de mediastinite ocorreu em 45,3% dos casos durante a internação e 54,7% após a alta hospitalar, dos quais 14,9% foram tratados ambulatorialmente e 85,1% necessitaram de reinternação. O tempo médio de internação foi de 31,8 dias. O tempo médio para o diagnóstico de mediastinite foi de 21,2 dias (desvio padrão — DP±11,48). O tratamento foi baseado principalmente em quinolonas (43%) e glicopeptídeos (39,5%). Conclusão: Considerando a frequência de identificação de casos após a alta hospitalar, a vigilância pós-alta de infecções do sítio cirúrgico entre pacientes submetidos a cirurgias cardíacas deve ser um objetivo compartilhado pela equipe multiprofissional

Effect of opioid-free anaesthesia on post-operative period in cardiac surgery: a retrospective matched case-control study

BackgroundNo study has been conducted to demonstrate the feasibility of an opioid-free anesthesia (OFA) protocol in cardiac surgery to improve patient care. The aim of the present study was to evaluate the effect of OFA on post-operative morphine consumption and the post-operative course.MethodsAfter retrospectively registering to clinicaltrial.gov (NCT03816592), we performed a retrospective matched cohort study (1:1) on cardiac surgery patients with cardiopulmonary bypass between 2018 and 2019. Patients were divided into two groups: OFA (lidocaine, dexamethasone and ketamine) or opioid anaesthesia (OA) (sufentanil). The main outcome was the total postoperative morphine consumption in the 48 h after surgery. Secondary outcomes were rescue analgesic use, a major adverse event composite endpoint, and ICU and hospital length of stay (LOS).ResultsOne hundred ten patients were matched (OFA: n = 55; OA: n = 55). On inclusion, demographic and surgical data for the OFA and OA groups were comparable. The total morphine consumption was higher in the OA group than in the OFA group (15 (6–34) vs 5 mg (2–18), p = 0.001). The pain score during the first 48 post-operative hours did not differ between the two groups. Creatinine values did not differ on the first post-operative day (80 (IQR: 66–115) vs 77 mmol/l (IQR: 69–95), p = 0.284). Incidence of the composite endpoint was lower in the OFA group (25 patients (43%) vs 38 patients (68%), p = 0.021). The time to extubation and the ICU stays were shorter in the OFA group (3 (1–5) vs 5 (3–6) hours, p = 0.001 and 2 (1–3) vs 3 (2–5) days, p = 0.037).ConclusionThe use of OFA was associated with lower morphine consumption. OFA might be associated with shorter intubation time and ICU stays. Further randomized studies are needed to confirm these results.Trial registrationThis study was retrospectively registered to ct2 (identifier: NCT03816592) on January 25, 2019.

Incidence and aetiological mechanism of stroke in cardiac surgery

ObjectiveWe studied patients who had experienced a stroke in the postoperative period of cardiac surgery, aiming to analyse their progression and determine the factors that may influence prognosis and treatment. MethodsWe established a protocol for early detection of stroke after cardiac surgery and collected data on stroke onset and a number of clinical, surgical, and prognostic variables in order to perform a descriptive analysis. ResultsOver the 15-month study period we recorded 16 strokes, which represent 2.5% of the patients who underwent cardiac surgery. Mean age in our sample was 69±8 years; 63% of patients were men. The incidence of stroke in patients aged 80 and older was 5.1%. Five patients (31%) underwent emergency surgery. By type of cardiac surgery, 7% of patients underwent mitral valve surgery, 6.5% combined surgery, 3% aortic valve surgery, and 2.24% coronary surgery. Most cases of stroke (44%) were due to embolism, followed by hypoperfusion (25%). Stroke occurred within 2 days of surgery in 69% of cases. The mean NIHSS score in our sample of stroke patients was 9; code stroke was activated in 10 cases (62%); one patient (14%) underwent thrombectomy. Most patients progressed favourably: 13 (80%) scored≤2 on the modified Rankin Scale at 3 months. None of the patients died during the postoperative hospital stay. ConclusionIn our setting, strokes occurring after cardiac surgery are usually small and have a good long-term prognosis. Most of them occur within 2 days, and they are mostly embolic in origin. The incidence of stroke in patients aged 80 and older and undergoing cardiac surgery is twice as high as that of the general population.

Pre-operative and peri operative predictors of acute renal failure after cardiac surgery

Background: Acute kidney injury (AKI) is one of the most serious complications during the postoperative period of cardiac surgery. Multiple variables predict the ARF after cardiac surgery. Objective of this study was to evaluate the significance of pre and peri-operative variables which may help in predicting the chances of developing ARF after cardiac surgery.Methods: This study was an observational, prospective study conducted among patients who were scheduled to undergo open heart surgery under cardiopulmonary bypass.Results: In total, 50 patients who underwent open-heart surgery, ARF was seen in 5 patients, with the incidence rate of 10%. Acute renal failure was present in one patient with ejection fraction <35, 2 patients had ejection fraction between 35 to 50 and 2 patients with ejection fraction >50. It was seen in 4 patients with 1-2 hrs of cardiopulmonary bypass and in 1 patient with >2 hrs of cardiopulmonary bypass. ARF was also seen in 4 patients with hematocrit between 22-26% and in 1 patient with >26%.Conclusions: The study provided a clinical variable score that can predict ARF after open-heart surgery. The score enhances the accuracy of prediction by accounting for the effect of all major risk factors of ARF.

Pilot study of viability in the use of cycle ergometer for upper limbs in the immediate postoperative period of cardiac surgery

INTRODUCTION: The use of a cycle ergometer for the upper limbs may contribute to maintain the functional capacity in patients after heart surgery (HS). OBJECTIVES: To investigate the cardiorespiratory responses of HS patients receiving or not vasoactive drugs (VADs) during the realizations of cycle ergometer for upper limbs, verifying the incidence of loss of radial arterial catheter or of steel wire fractures in the sternum. MATERIAL AND METHODS: A pilot study involving 26 patients divided in 2 groups. Group CO: no use of VADs (13 patients, age: 57±12 years, 09 male) and VAD group: (13 patients, age: 61±10 years, 07 male), submitted to HS, which on the first postoperative day (1stPO) performed the cycle ergometer for upper limbs. The parameters evaluated during the exercise were heart rate (HR), oxygen saturation (SpO2), dyspnea, fatigue of upper limbs and mean arterial pressure (MAP). The incidence of losses of the radial artery catheter and of steel wire fractures in the sternum was calculated. Statistical analysis adopted one-way or two-way analysis of variance, with post hoc from Newman Kauls or Scheffé, when necessary. The significance level was 0.05%. RESULTS: HR increased in both groups at the end of the exercise (p=0.00), with no difference between them (p=0.97); SpO2, dyspnea and MAP did not change from rest to the end of exercise (p=0.49; p=0.78 and p=0.25, respectively); The fatigue in the upper limbs increased in both groups (p=0.04), without difference between groups (p=0.79); There was no event of loss of radial artery catheter or steel wire fractures in the sternum. CONCLUSION: The adoption of the cycle ergometer for upper limbs was safe in the 1stPO of HS, even in the individuals using VADs. There was no relationship between the use of the upper limbs cycle ergometer and losses of arterial catheters or steel wire fractures in the sternum.

Chinese consensus guideline for cerebral protection in the perioperative period of cardiac surgery (2019)

Cerebral complication in the postoperative period of cardiac surgery is one of the most important elements for the prognosis and rehabilitation. It is significant for the clinicians to recognize, comprehend, prevent and ameliorate the complications of cerebral nervous system. For the purpose of down-regulating brain injury and cerebral complications after cardiac surgery, promoting nosocomial rehabilitation, Cerebral Protection in Cardiac Intensive Care Group, Neural Regeneration and Repair Committee, Chinese Research Hospital Association organizes Chinese medical experts who specialize in cardiac surgery, critical care medicine, extracorporeal circulation, anesthesiology and emergency medicine cooperatively draft Chinese consensus guideline for cerebral protection in the perioperative period of cardiac surgery (2019). Its content includes brain injury classifying risk factors recognizing, treatment protocols formulating, intra-operative cerebral function monitoring, brain protection in intensive care unit (ICU) and drug administration in order to guide the clinical practice.

Neuromuscular Electrical Stimulation on Hemodynamic and Respiratory Response in Patients Submitted to Cardiac Surgery: Pilot Randomized Clinical Trial

Abstract Background: Neuromuscular electrical stimulation seems to be a promising option to intensify the rehabilitation and improve the exercise capacity of patients in the immediate postoperative period of cardiac surgery. Objective: This study aimed to evaluate the hemodynamic (heart rate, systolic blood pressure, diastolic blood pressure, and mean blood pressure) and respiratory (respiratory rate and oxygen saturation) responses to neuromuscular electrical stimulation in the immediate postoperative period in patients submitted to cardiac surgery and to verify its feasibility and safety. Methods: This is a pilot randomized controlled trial, wherein critical patients in the immediate postoperative period of cardiac surgery were randomly assigned to a control group, using sham neuromuscular electrical stimulation, or an experimental group, submitted to neuromuscular electrical stimulation sessions (FES), for 60 min, with a 50-Hz frequency, 200-µs pulse duration, time on: 3 s, and time off: 9 s. Data distribution was evaluated by the Shapiro-Wilk test. The analysis of variance was used and a p-value < 0.05 was considered significant. Results: Thirty patients were included in the study. The neuromuscular electrical stimulation was applied within the first 23.13 ± 5.24 h after cardiac surgery, and no changes were found regarding the hemodynamic and respiratory variables between the patients who underwent neuromuscular electrical stimulation, and those in the control group. Conclusions: In the present study, neuromuscular electrical stimulation did not promote changes in hemodynamic and respiratory responses of patients in the immediate postoperative period of cardiac surgery.

About efficiency of the pharmacological scores as a predictors of outcomes after cardiac surgery

Pharmacological scores, such as inotropic score (IS) and vasoactive-inotropic score (VIS) were created to quantify doses of vasoactive and inotropic drugs. The number of studies where IS and VIS were used for evaluation of postoperative period of adult patients after cardiac surgery is small. Objective: to estimate IS and VIS as an approach for monitoring of the hemodynamic profile and clinical outcomes in the early postoperative period of cardiac surgery. Methods. The study involved 144 patients older than 18 years who underwent cardiac surgery under cardiopulmonary bypass (CPB). In perioperative period we measured cardiac output using a Swan-Ganz catheter with the calculation of central hemodynamic parameters, and also VIS and IS wcre calculated. We evaluated the prognostic value of these pharmacological scores in the development of complications of the early postoperative period, as well as their correlation with the duration of respiratory support, the length of stay in the ICU, and total hospital time. Results. IS ≥ 10 significantly associated with prolonged respiratory support, a long stay in the ICU and with a mortality rate of 28.6 %. Patients with IS ≥ 10 are characterized by a violation of tissue perfusion, main cause of which may be a low cardiac output syndrome. IS ≥ 10 can be used as criteria for the low cardiac output syndrome with impaired organ perfusion. The use of this pharmacological score as a predictor of adverse clinical outcomes and increased mortality is justified. The hemodynamic profile of patients with VIS ≥ 10 is characterized by the absence of signs of cardiac output decrease and normal organ perfusion. It has low prognostic significance for the adverse postoperative clinical outcomes and should not be used as perioperative criteria for low cardiac output. In addition, VIS ≥ 10 requires careful use as a predictor of adverse postoperative outcomes and mortality.

Determinants of pacemaker dependency after cardiac surgery

Conduction disorders in the postoperative period of cardiac surgery impedes prompt clinical recovery and prolongs hospitalization. The aim of this study was to identify the predictive factors of pace maker dependency in patients with high grade atrioventricular block (AVB) after cardiac surgery. A 25 patients’ descriptive retrospective study carried out in the-cardiology department of Charles Nicolle's Hospital in Tunis (Tunisia) between 1997 and 2014. We included all patients with a high-grade AVB requiring definitive pacemaker implantation following cardiac surgery. We investigated the pacemaker dependency of each patient during his last follow-up. The mean age was 44 years and 9 months. Our population was made of 14 men (56%) and 11 women. Correction of acquired heart disease was the dominant indication of operation (68%). Preoperatively, 14 patients (56%) were in sinus rhythm. A pacemaker implantation was indicted for a complete AV block in 23 patients (92%). Postoperatively, 10 patients (40%) had an immediate complete AV block. After pacemaker implantation and at the last follow-up, 9 patients were dependent of their pacemaker. The immediate occurrence of AV block is the only factor significantly correlated to the pacemaker dependency ( P = 0.041). This study highlights the importance of a regular and pronged screening of conduction disorders in patients undergoing cardiac surgery since immediate postoperative period.

Dressings used to prevent surgical site infection in the postoperative period of cardiac surgery: integrative review.

To identify and describe which dressings are recommended to prevent surgical site infection in hospitalized adult patients after cardiac surgeries. Integrative review carried out in the databases MEDLINE, LILACS, CINAHL, Web of Science, Cochrane and Scopus. Studies related to dressing in the postoperative period of cardiac surgery were selected. Seven articles were included, with the following dressings: negative pressure wound therapy, silver nylon dressing, transdermal delivery of continuous oxygen and impermeable adhesive drape. The dressings that led to reduction of infection were negative pressure and silver nylon dressings. It was not possible to identify which dressing is most recommended, however, some studies show that certain types of dressings were related to the reduction of infection. Clinical trials with a rigorous methodological design and representative samples able to minimize the risk of bias should be conducted to evaluate the effectiveness of dressings in the prevention of surgical site infection.

Post esophagectomy diaphragmatic hernia: a case report of a rare cause of acute respiratory distress

BackgroundDiaphragmatic hernia is frequent among the elderly and is usually associated with mild chronic digestive and respiratory symptoms.Case presentationAn elderly post-esophagectomy male patient, in the early postoperative period of cardiac surgery, presented with acute respiratory distress. An emergent surgery was performed to reduce a giant diaphragmatic herniation.ConclusionsAn acute transhiatal herniation can cause serious respiratory impairment; surgical repair should be considered in select patients of cardiac surgery.

Estresse gravitacional no pós-operatório de cirurgia cardíaca

INTRODUÇÃO: Após a cirurgia cardíaca, a mobilização precoce busca o ganho funcional e um melhor condicionamento para as próximas fases da reabilitação cardiovascular, tendo o estresse gravitacional(EG)um importante papel para o retorno destas atividades, através da integridade dos mecanismos compensatórios cardiovasculares. OBJETIVO: verificar o comportamento de variáveis circulatórias e respiratórias durante o EG no pós-operatório de cirurgia cardíaca. MÉTODOS E MATERIAIS: Estudo observacional, transversal e analítico, composto por 83 indivíduos adultos clinicamente estáveis, submetidos a cirurgia de revascularização do miocárdio ou abordagem valvar. Excluídos aqueles com dificuldade de compreensão das atividades realizadas, além de comprometimento motor e/ou neurológico que impossibilitassem a realização do EG, de forma adaptada. Foram coletados os dados circulatórios e respiratórios no 1° minuto para cada etapa através do monitor multiparamétrico Gemedical Systems@. RESULTADOS: As frequências cardíaca e respiratória apresentaram um aumento com significância estatística (p ? 0,01), quando analisado seus valores de variação de decúbito dorsal para sedestação e decúbito dorsal para ortostase. CONCLUSÃO: As variáveis hemodinâmicas e respiratórias se comportam de acordo com a resposta fisiológica durante o EG, sugerindo que esse procedimento é seguro no ambiente da terapia intensiva, mesmo se tratando de um pós-operatório de alta complexidade.

Factors associated with the increased bleeding in the postoperative period of cardiac surgery: A cohort study.

To identify factors associated with the increased bleeding in patients during the postoperative period after cardiac surgery. Bleeding is among the most frequent complications that occur in the postoperative period after cardiac surgery, representing one of the major factors in morbidity and mortality. Understanding the factors associated with the increased bleeding may allow nurses to anticipate and prioritise care, thus reducing the mortality associated with this complication. Prospective cohort study. Adult patients in a cardiac hospital who were in the postoperative period following cardiac surgery were included. Factors associated with the increased bleeding were investigated by means of linear regression, considering time intervals of 6 and 12hr. The sample comprised 391 participants. The factors associated with the increased bleeding in the first 6hr were male sex, body mass index, cardiopulmonary bypass duration, anoxia duration, metabolic acidosis, higher heart rate, platelets and the activated partial thromboplastin time in the postoperative period. Predictors in the first 12hr were body mass index, cardiopulmonary bypass duration, metabolic acidosis, higher heart rate, platelets and the activated partial thromboplastin time in the postoperative. This study identified factors associated with the increased postoperative bleeding from cardiac surgery that have not been reported in previous studies. The nurse is important in the vigilance, evaluation and registry of chest tube drainage and modifiable factors associated with the increased bleeding, such as metabolic acidosis and postoperative heart rate, and in discussions with the multiprofessional team. Knowledge of the factors associated with the increased bleeding is critical for nurses so they can provide prophylactic interventions and early postoperative treatment when needed.

Hemodynamic impact of the connection to continuous renal replacement therapy in critically ill children

BackgroundContinuous renal replacement therapy (CRRT) is the treatment of choice for critically ill children with acute kidney injury. Hypotension after starting CRRT is frequent but very few studies have analyzed its incidence and clinical relevance.MethodsA prospective, observational study was performed including critically ill children treated with CRRT between 2010 and 2014. Hemodynamic data and connection characteristics were collected before, during, and 60 min after CRRT circuit connection. Hypotension with the connection was defined as a decrease in > 20% of the mean arterial pressure from baseline or when intravenous fluid resuscitation or an increase in vasopressors was required.ResultsOne hundred sixty-one connections in 36 children (median age 18.8 months) were analyzed. Twenty-eight patients (77.8%) were in the postoperative period of cardiac surgery, 94% had mechanical ventilation, and 86.1% had vasopressors. The heparinized circuit priming solution was discarded in 8.7% and infused to the patient in 18% of the connections. The circuit was re-primed in the remaining 73.3% using albumin (79.3%), red blood cells (4.5%), or another crystalloid solution without heparin (16.2%). Hypotension occurred in 49.7% of the connections a median of 5 min after the beginning of the therapy. Fluid resuscitation was required in 38.5% and the dose of vasopressors was increased in 12.4% of the connections. There was no relationship between hypotension and age or weight. Re-priming the circuit with albumin reduced the incidence of hypotension from 71.4 to 44.6% (p = 0.004).ConclusionsHypotension after the connection to CRRT is very frequent in critically ill children. Re-priming the circuit with albumin could improve hemodynamics during connection.