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Monitoring of protein catabolism in neonates and young infants post-cardiac surgery

TEIXEIRA-CINTRA, Monica Akissue Camargo; MONTEIRO, Jacqueline Pontes; TREMESCHIN, Marina; TREVILATO, Tania Maria Beltramini; HALPERIN, Mitchell Lewis; CARLOTTI, Ana Paula de Carvalho Panzeri
Fonte: WILEY-BLACKWELL Publicador: WILEY-BLACKWELL
Tipo: Artigo de Revista Científica
ENG
Relevância na Pesquisa
66.2%
Aims: To evaluate cell catabolism by balance of nitrogen and phosphate, and creatinine excretion in children post-cardiac surgery; to establish protein and energy requirements to minimize catabolism; and to assess nutritional therapy by following these parameters and serial anthropometric measurements. Methods: A prospective observational study of children with congenital heart disease undergoing cardiac surgery. Blood samples and 24-h urine collections were obtained postoperatively for creatinine measurement and nitrogen and phosphate balance. Anthropometric measurements (weight, mid-arm muscle circumference and triceps skinfold thickness) were obtained preoperatively and at paediatric intensive care unit and hospital discharge. Results: Eleven children were studied for 3-10 postoperative days. Anabolism was associated with higher protein and energy intakes compared to catabolism (1.1 vs. 0.1 g/kg/day and 54 vs. 17 kcal/kg/day, respectively). On days with anabolism, phosphate balance was greater compared with that on days with catabolism. Daily creatinine excretion did not correlate with protein balance. Anthropometric measurements did not change significantly over time. Conclusions: Children with congenital heart disease undergoing cardiac surgery achieved anabolism with > 55 kcal/kg/day and > 1 g/kg/day of protein. Balance of phosphate was useful to monitor cell breakdown. Anthropometric measurements were not valuable to evaluate nutritional therapy in this population.; CAPES (Coordenacao de Aperfeicoamento de Pessoal de Nivel Superior[1309/06-4]; FAEPA (Fundacao de Apoio ao Ensino...

Incidência, fatores preditores e consequências do delirium no pós-operatório de cirurgia cardíaca em idosos; Incidence, predictive factors and complications of delirium in postoperative cardiac surgery elderly patients

Oliveira, Fatima Rosane de Almeida
Fonte: Biblioteca Digitais de Teses e Dissertações da USP Publicador: Biblioteca Digitais de Teses e Dissertações da USP
Tipo: Tese de Doutorado Formato: application/pdf
Publicado em 18/06/2015 PT
Relevância na Pesquisa
66.24%
Delirium é um estado confusional agudo caracterizado por um distúrbio de consciência, alteração na cognição e curso flutuante ao longo do dia. É a complicação mais comum observada em idosos hospitalizados. É freqüente no pós-operatório de cirurgia cardíaca, e pode chegar a taxas tão altas quanto 73% em pacientes mais idosos. Pacientes com delirium apresentam maior risco de morte, demência e institucionalização, aumento do tempo de internação hospitalar e dos custos. Os objetivos deste estudo foram: 1) determinar a incidência do delirium no pós-operatório de cirurgia cardíaca em idosos; 2) identificar fatores predisponentes e precipitantes neste contexto; 3) avaliar a relação entre delirium e morbimortalidade por até 18 meses de seguimento. Este estudo foi observacional, prospectivo, tipo coorte, realizado no Hospital de Messejana no período de Setembro/2011 à Dezembro/2013. Foram estudados 173 pacientes com idade > 60 anos. Antes da cirurgia, os pacientes foram avaliados quanto à função cognitiva através do MEEM e TFV, e pelo CAM, para determinar a presença de delirium pré-operatório, motivo de exclusão do estudo. Foram registradas variáveis referentes aos dados demográficos, doenças prévias...

Comportamento dos marcadores inflamatórios e de injúria miocárdica na cirurgia cardíaca : correlação laboratorial com quadro clínico de síndrome pós-pericardiotomia; Behavior of inflammatory markers of myocardial injury in cardiac surgery : laboratory correlation with the clinical picture of potpericardiotomy syndrome

Kohler, Ilmar; Saraiva, Paulo Jaconi; Wender, Orlando Carlos Belmonte; Zago, Alcides José
Fonte: Universidade Federal do Rio Grande do Sul Publicador: Universidade Federal do Rio Grande do Sul
Tipo: Artigo de Revista Científica Formato: application/pdf
POR
Relevância na Pesquisa
66.2%
Objective- To verify the association of serum markers of myocardial injury, such as troponin I, creatinine kinase, and creatinine kinase isoenzyme MB, and inflammatory markers, such as tumor necrosis factor alpha (TNF-alpha), C-reactive protein, and the erythrocyte sedimentation rate in the perioperative period of cardiac surgery, with the occurrence of possible postpericardiotomy syndrome. Methods- This was a cohort study with 96 patients undergoing cardiac surgery assessed at the following 4 different time periods: the day before surgery (D0); the 3rd postoperative day (D3); between the 7th and 10th postoperative days (D7-10); and the 30th postoperative day (D30). During each period, we evaluated demo- graphic variables (sex and age), surgical variables (type and duration , extracorporeal circulation), and serum dosages of the markers of myocardial injury and inflam- matory response. Results - Of all patients, 12 (12.5%) met the clinical criteria for a diagnosis of postpericardiotomy syndrome, and their mean age was 10.3 years lower than the age of the others (P=0.02). The results of the serum markers for tissue injury and inflammatory response were not signifi- cantly different between the 2 assessed groups. No signifi- cant difference existed regarding either surgery duration or extracorporeal circulation. Conclusio- The patients who met the clinical criteria for postpericardiotomy syndrome were significan- tly younger than the others were. Serum markers for tissue injury and inflammatory response were not different in the clinically affected group...

Intraoperative lactate levels and postoperative complications of pediatric cardiac surgery

Alves, Rodrigo Leal; Aragao e Silva, Andre Luiz; de Castro Kraychete, Nadja Cecilia; Campos, Guilherme Oliveira; Martins, Marcelo de Jesus; Pinheiro Modolo, Norma Sueli
Fonte: Wiley-Blackwell Publicador: Wiley-Blackwell
Tipo: Artigo de Revista Científica Formato: 812-817
ENG
Relevância na Pesquisa
66.2%
Objectives: Correlate arterial lactate levels during the intraoperative period of children undergoing cardiac surgery and the occurrence of complications in the postoperative period. Aim: Arterial lactate levels can indicate hypoperfusion states, serving as prognostic markers of morbidity and mortality in this population. Background: Anesthesia for cardiac pediatric surgery is frequently performed on patients with serious abnormal physiological conditions. During the intraoperative period, there are significant variations of blood volume, body temperature, plasma composition, and tissue blood flow, as well as the activation of inflammation, with important pathophysiological consequences. Methods/Materials: Chart data relating to the procedures and perioperative conditions of the patients were collected on a standardized form. Comparisons of arterial lactate values at the end of the intraoperative period of the patients that presented, or not, with postoperative complications and frequencies related to perioperative conditions were established by odds ratio and nonparametric univariate analysis. Results: After surgeries without cardiopulmonary bypass (CPB), higher levels of arterial lactate upon ICU admission were observed in patients who had renal complications (2.96 vs 1.31 mm) and those who died (2.93 vs 1.40 mm). For surgeries with CPB...

Disfunção transitória da troca gasosa no pós-operatório de cirurgia cardíaca e procedimentos cardíacos = : Transitory dysfunction in gas exchange in the postoperative period of cardiac surgery and cardiac procedures; Transitory dysfunction in gas exchange in the postoperative period of cardiac surgery and cardiac procedures

Cristiane Delgado Alves Rodrigues
Fonte: Biblioteca Digital da Unicamp Publicador: Biblioteca Digital da Unicamp
Tipo: Tese de Doutorado Formato: application/pdf
Publicado em 25/02/2015 PT
Relevância na Pesquisa
66.3%
OBJETIVO: Estudo de coorte retrospectivo realizado com o objetivo de verificar a presença de Disfunção Transitória da Troca Gasosa (DTTG) no pós-operatório de cirurgia cardíaca e determinar se esse transtorno está relacionado a eventos cardiorrespiratórios. MÉTODOS: Foram incluídos 942 pacientes consecutivos submetidos à cirurgia cardíaca e procedimentos cardíacos, encaminhados para a UTI, entre junho de 2007 e novembro de 2011. RESULTADOS: A Síndrome do Desconforto Respiratório Agudo (SDRA) foi observada em 15 pacientes (2%), apresentaram Disfunção Transitória da Troca Gasosa (DTTG) leve 199 (27.75%) pacientes, DTTG moderada em 402 (56.1%) pacientes e DTTG grave em 39 (5.4%) pacientes. A presença de hipertensão arterial e choque cardiogênico foram associadas ao surgimento de DTTG moderada no período pós-operatório (p=0.02 e p=0.019, respectivamente) e foram considerados fatores de risco para esta disfunção (p=0.0023 e p=0.0017, respectivamente). A presença de diabetes mellitus também foi considerada um fator de risco para DTTG (p=0.03). Houve correlação entre a presença de pneumonia e a presença de DTTG moderada em 8.9% dos casos (p = 0.001). A presença de DTTG grave foi associada a pacientes que necessitaram de terapia de substituição renal (p=0.0005)...

Invasive hemodynamic monitoring in the postoperative period of cardiac surgery

Dragosavac,Desanka; Araújo,Sebastião; Carieli,Maria do Carmo Monteiro; Terzi,Renato G. G.; Dragosavac,Sanja; Vieira,Reinaldo Wilson
Fonte: Sociedade Brasileira de Cardiologia - SBC Publicador: Sociedade Brasileira de Cardiologia - SBC
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/08/1999 EN
Relevância na Pesquisa
66.24%
OBJETIVE: To assess the hemodynamic profile of cardiac surgery patients with circulatory instability in the early postoperative period (POP). METHODS: Over a two-year period, 306 patients underwent cardiac surgery. Thirty had hemodynamic instability in the early POP and were monitored with the Swan-Ganz catheter. The following parameters were evaluated: cardiac index (CI), systemic and pulmonary vascular resistance, pulmonary shunt, central venous pressure (CVP), pulmonary capillary wedge pressure (PCWP), oxygen delivery and consumption, use of vasoactive drugs and of circulatory support. RESULTS: Twenty patients had low cardiac index (CI), and 10 had normal or high CI. Systemic vascular resistance was decreased in 11 patients. There was no correlation between oxygen delivery (DO2) and consumption (VO2), p=0.42, and no correlation between CVP and PCWP, p=0.065. Pulmonary vascular resistance was decreased in 15 patients and the pulmonary shunt was increased in 19. Two patients with CI < 2L/min/m² received circulatory support. CONCLUSION: Patients in the POP of cardiac surgery frequently have a mixed shock due to the systemic inflammatory response syndrome (SIRS). Therefore, invasive hemodynamic monitoring is useful in handling blood volume...

Outcome of acute renal failure associated with cardiac surgery in infants

Romão Jr,João Egídio; Fuzissima,Miguel G.; Vidonho Jr,Armando F.; Noronha,Irene L.; Quintaes,Paulo Sérgio L.; Abensur,Hugo; Araújo,Maria Regina T.; Freitas Jr,Ivanir; Marcondes,Marcello
Fonte: Sociedade Brasileira de Cardiologia - SBC Publicador: Sociedade Brasileira de Cardiologia - SBC
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/10/2000 EN
Relevância na Pesquisa
66.28%
OBJECTIVE: To analyze the impact of acute renal failure (ARF) on the evolution of infants undergoing cardiac surgery. METHODS: We assessed 15 infants undergoing cardiac surgery who developed (ARF). Their demographic, clinical and surgical data, and evolution were analyzed. RESULTS: Their mean age was 4.4±4.0 months (8 days to 24 months). Twelve infants were males, and 4 patients already had ARF at surgery. The primary cause of ARF was immediate acute cardiac dysfunction in 10 infants, cardiac dysfunction associated with sepsis in 2 infants, and isolated sepsis in 3 infants. All children depended on mechanical ventilation during their postoperative period, 14 infants used vasoactive drugs, and 11 had an infectious process associated with ARF. Thirteen infants required dialytic treatment. Eleven infants developed oluguric ARF, and all had to undergo peritoneal dialysis; of the 4 patients with non-oliguric, 2 required dialysis, the main indication being hypervolemia. Of these 13 dialyzed infants, 4 died in the first 24 hours because of the severity of the underlying cardiac disease (mean urea level of 49±20 mg/dl). The mortality rate for the entire group was 60% , and it was higher among the patients with oliguria ARF (73% vs 25%, p<0.001). The cause of death was acute cardiac dysfunction in 6 infants (early type-1ARF) and sepsis in the 3 remaining infants (late type-2 ARF). CONCLUSION: The mortality rate of ARF associated with cardiac surgery in infants was hight...

Assessment of splanchnic perfusion with gastric tonometry in the immediate postoperative period of cardiac surgery in children

Souza,Renato Lopes de; Carvalho,Werther Brunow de; Maluf,Miguel Angel; Carvalho,Antonio Carlos
Fonte: Sociedade Brasileira de Cardiologia - SBC Publicador: Sociedade Brasileira de Cardiologia - SBC
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/12/2001 EN
Relevância na Pesquisa
66.2%
OBJECTIVE - A prospective, nonrandomized clinical study to assess splanchnic perfusion based on intramucosal pH in the postoperative period of cardiac surgery and to check the evolution of patients during hospitalization. METHODS - We studied 10 children, during the immediate postoperative period after elective cardiac surgery. Sequential intramucosal pH measurements were taken, without dobutamine (T0) and with 5mcg/kg/min (T1) and 10 (T2) mcg/kg/min. In the pediatric intensive care unit, intramucosal pH measurements were made on admission and 4, 8, 12, and 24 hours thereafter. RESULTS - The patients had an increase in intramucosal pH values with dobutamine 10mcg/kg/min [7.19± 0.09 (T0), 7.16±0.13(T1), and 7.32±0.16(T2)], (p=0.103). During the hospitalization period, the intramucosal pH values were the following: 7.20±0.13 (upon admission), 7.27±0.16 (after 4 hours), 7.26±0.07 (after 8 hours), 7.32±0.12 (after 12 hours), and 7.38±0.08 (after 24 hours), (p=0.045). No deaths occurred, and none of the patients developed multiple organ and systems dysfunction. CONCLUSION - An increase in and normalization of intramucosal pH was observed after dobutamine use. Measurement of intramucosal pH is a type of monitoring that is easy to perform and free of complications in children during the postoperative period of cardiac surgery.

Assessment of factors that influence weaning from long-term mechanical ventilation after cardiac surgery

Nozawa,Emília; Kobayashi,Eliane; Matsumoto,Marta Erika; Feltrim,Maria Ignêz Zanetti; Carmona,Maria José Carvalho; Auler Júnior,José Otávio Costa
Fonte: Sociedade Brasileira de Cardiologia - SBC Publicador: Sociedade Brasileira de Cardiologia - SBC
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/03/2003 EN
Relevância na Pesquisa
66.21%
OBJECTIVE: To analyze parameters of respiratory system mechanics and oxygenation and cardiovascular alterations involved in weaning tracheostomized patients from long-term mechanical ventilation after cardiac surgery. METHODS: We studied 45 patients in their postoperative period of cardiac surgery, who required long-term mechanical ventilation for more than 10 days and had to undergo tracheostomy due to unsuccessful weaning from mechanical ventilation. The parameters of respiratory system mechanics, oxigenation and the following factors were analyzed: type of surgical procedure, presence of cardiac dysfunction, time of extracorporeal circulation, and presence of neurologic lesions. RESULTS: Of the 45 patients studied, successful weaning from mechanical ventilation was achieved in 22 patients, while the procedure was unsuccessful in 23 patients. No statistically significant difference was observed between the groups in regard to static pulmonary compliance (p=0.23), airway resistance (p=0.21), and the dead space/tidal volume ratio (p=0.54). No difference was also observed in regard to the variables PaO2/FiO2 ratio (p=0.86), rapid and superficial respiration index (p=0.48), and carbon dioxide arterial pressure (p=0.86). Cardiac dysfunction and time of extracorporeal circulation showed a significant difference. CONCLUSION: Data on respiratory system mechanics and oxygenation were not parameters for assessing the success or failure. Cardiac dysfunction and time of cardiopulmonary bypass...

Oral triiodothyronine for the prevention of thyroid hormone reduction in adult valvular cardiac surgery

Magalhães,A.P.A.; Gus,M.; Silva,L.B.; Schaan,B.D.
Fonte: Associação Brasileira de Divulgação Científica Publicador: Associação Brasileira de Divulgação Científica
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/07/2006 EN
Relevância na Pesquisa
66.26%
Treatment of non-thyroidal illness by intravenous triiodothyronine (T3) after cardiac surgery causes a disproportional elevation of hormone levels. The administration of oral T3, which has never been studied in this context, could cause physiological hormone levels. The aim of this study was to test oral T3 for the prevention of T3 reduction during the postoperative period of valvular cardiac surgery in adults. Eighteen patients who underwent cardiac surgery for valvular disease with invasive hemodynamic monitoring were randomly assigned to 2 groups: the T group received oral T3 (N = 8), 25 µg three times/day, initiated 24 h before surgery and maintained for 48 h and the NT group (N = 10) received placebo. Serum T3, thyroxine and thyrotropin were determined at baseline, 1 h before surgery, within 30 min of cardiopulmonary bypass and 6, 12, 24, and 48 h after removal of the aortic cross-clamp. Baseline T3 was similar in both groups (T: 119 ± 13; NT: 131 ± 9 ng/dL). Serum T3 increased during the first 24 h in the T group compared to the NT group (232 ± 18 vs 151 ± 13 ng/dL; P < 0.001). In the NT group, T3 was reduced by 24% (P = 0.007) 6 h after removal of the aortic cross-clamp, confirming the non-thyroidal illness syndrome. There were no differences in clinical or hemodynamic parameters between groups. Administration of oral T3 prevented its serum reduction after valvular cardiac surgery in adults...

High levels of B-type natriuretic peptide predict weaning failure from mechanical ventilation in adult patients after cardiac surgery

Lara,Thiago Martins; Hajjar,Ludhmila Abrahao; Almeida,Juliano Pinheiro de; Fukushima,Julia Tizue; Barbas,Carmem Silvia Valente; Rodrigues,Adriano Rogerio Baldacin; Nozawa,Emilia; Feltrim,Maria Ignes Zanetti; Almeida,Elisangela; Coimbra,Vera; Osawa,Eduardo
Fonte: Faculdade de Medicina / USP Publicador: Faculdade de Medicina / USP
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/01/2013 EN
Relevância na Pesquisa
66.22%
OBJECTIVE: The failure to wean from mechanical ventilation is related to worse outcomes after cardiac surgery. The aim of this study was to evaluate whether the serum level of B-type natriuretic peptide is a predictor of weaning failure from mechanical ventilation after cardiac surgery. METHODS: We conducted a prospective, observational cohort study of 101 patients who underwent on-pump coronary artery bypass grafting. B-type natriuretic peptide was measured postoperatively after intensive care unit admission and at the end of a 60-min spontaneous breathing test. The demographic data, hemodynamic and respiratory parameters, fluid balance, need for vasopressor or inotropic support, and length of the intensive care unit and hospital stays were recorded. Weaning failure was considered as either the inability to sustain spontaneous breathing after 60 min or the need for reintubation within 48 h. RESULTS: Of the 101 patients studied, 12 patients failed the weaning trial. There were no differences between the groups in the baseline or intraoperative characteristics, including left ventricular function, EuroSCORE and lengths of the cardiac procedure and cardiopulmonary bypass. The B-type natriuretic peptide levels were significantly higher at intensive care unit admission and at the end of the breathing test in the patients with weaning failure compared with the patients who were successfully weaned. In a multivariate model...

Customized Prediction of Short Length of Stay Following Elective Cardiac Surgery in Elderly Patients Using a Genetic Algorithm

Lee, Joon; Govindan, Sapna; Celi, Leo A.; Khabbaz, Kamal R.; Subramaniam, Balachundhar
Fonte: Harvard University Publicador: Harvard University
Tipo: Artigo de Revista Científica
EN_US
Relevância na Pesquisa
66.28%
Objective: To develop a customized short LOS (<6 days) prediction model for geriatric patients receiving cardiac surgery, using local data and a computational feature selection algorithm. Design: Utilization of a machine learning algorithm in a prospectively collected STS database consisting of patients who received cardiac surgery between January 2002 and June 2011. Setting: Urban tertiary-care center. Participants: Geriatric patients aged 70 years or older at the time of cardiac surgery. Interventions None. Measurements and Main Results Predefined morbidity and mortality events were collected from the STS database. 23 clinically relevant predictors were investigated for short LOS prediction with a genetic algorithm (GenAlg) in 1426 patients. Due to the absence of an STS model for their particular surgery type, STS risk scores were unavailable for 771 patients. STS prediction achieved an AUC of 0.629 while the GenAlg achieved AUCs of 0.573 (in those with STS scores) and 0.691 (in those without STS scores). Among the patients with STS scores, the GenAlg features significantly associated with shorter LOS were absence of congestive heart failure (CHF) (OR = 0.59, p = 0.04), aortic valve procedure (OR = 1.54, p = 0.04), and shorter cross clamp time (OR = 0.99...

Use of rFVlla for critical bleeding in cardiac surgery: dose variation and patient outcomes

Willis, C.; Bird, R.; Mullany, D.; Cameron, P.; Phillips, L.
Fonte: Karger Publicador: Karger
Tipo: Artigo de Revista Científica
Publicado em //2010 EN
Relevância na Pesquisa
66.24%
Background and Objectives: Recombinant activated factor VIIa (rFVIIa) is increasingly being used in non-haemophiliac patients for the treatment of severe bleeding refractory to standard interventions. Optimal dosing regimens remain debated in cardiac surgery. Therefore, this study investigated the use of different rFVIIa dosing practices on response to bleeding and patient outcomes in cardiac surgery patients using data from the Haemostasis Registry. Methods: Data were extracted from the Haemostasis Registry that records cases of off-licence rFVIIa use in participating institutions. Univariate analyses compared patients receiving ≤40 μg/kg, 41–60 μg/kg, 61–80 μg/kg, 81–100 μg/kg and >100 μg/kg of rFVIIa on key parameters. Logistic regression models investigated the relationship between independent variables and 28-day mortality. Results: Complete data was available on 804 cardiac surgery patients who received rFVIIa. Of these, 42 (5·2%) were treated with doses ≤40 μg/kg, while the dose group containing the most patients was 81–100 μg/kg (368, 45·77%). Results demonstrated no significant differences in the rate of thromboembolic adverse events, response to bleeding or 28-day mortality. Conclusions: These findings raise the important question of whether lower doses of rFVIIa may be as effective as higher doses in the treatment of severe bleeding in cardiac surgery patients.; C. Willis...

Depression, anxiety and morbidity outcomes after cardiac surgery.

Tully, Phillip John
Fonte: Universidade de Adelaide Publicador: Universidade de Adelaide
Tipo: Tese de Doutorado
Publicado em //2011
Relevância na Pesquisa
66.39%
Depression and heart disease are among the top ten causes of an estimated 56 million deaths throughout the world (Lopez, Mathers, Ezzati, Jamison, & Murray, 2006). Projections by the World Health Organisation indicate that depression and cardiac disorders will indeed remain among the top ten leading causes of disease burden by the year 2020 (Lopez et al., 2006; Murray & Lopez, 1997). The extant literature describes a prognostic association between depressive symptoms and adverse coronary artery disease (CAD) outcomes (Barth, Schumacher, & Herrmann-Lingen, 2004; Rugulies, 2002; Suls & Bunde, 2005; Van der Kooy et al., 2007). These findings extend to persons having undergone cardiac revascularisation surgery (Connerney, Shapiro, McLaughlin, Bagiella, & Sloan, 2001) and have prompted various consensus panels to call for routine depression assessment among heart disease patients (Ballenger et al., 2001; Davidson et al., 2006; Lichtman et al., 2008). By comparison to depression, anxiety has attracted a smaller share of empirical investigation and consensus panel support with respect to heart disease morbidity outcomes. This is particularly the case with regard to heart disease patients who have undergone cardiac surgery. In fact, one unanswered question to date is whether or not anxiety is related to morbidity after cardiac surgery to the same degree as has been described for depression. Notwithstanding substantial interrelation...

Cognitive impairment before and six months after cardiac surgery increase mortality risk at median 11 year follow-up: a cohort study

Tully, P.; Baune, B.; Baker, R.
Fonte: Elsevier Sci Ireland Ltd Publicador: Elsevier Sci Ireland Ltd
Tipo: Artigo de Revista Científica
Publicado em //2013 EN
Relevância na Pesquisa
66.24%
BACKGROUND: The additive effects of cognitive impairment and depression on mortality risk after cardiac surgery are unknown. METHODS: Patients were assessed on a battery of six neurocognitive measures before cardiac surgery (N = 521) and at six month follow up (N = 377/521, 72.4%). Cognitive impairment classification was based on cognitive test scores 1 SD below age and sex matched normative data, and classified according to amnestic, non-amnestic and mixed cognitive impairment subtypes. Survival analyses entered cognitive impairment subtypes and depression interactions terms adjusted for 12 common risk factors. RESULTS: There were 5407 person years for analysis (median 11.1 year survival, interquartile range of 7.9 to 13.1) and 176 deaths (33.8%) by the census date. Before cardiac surgery, patients with a mixed-cognitive impairment (adjusted hazard ratio (HR) = 2.53; 95% confidence interval (CI), 1.57-4.06, p<.001) and non-amnestic cognitive impairment (adjusted HR = 1.51; 95%, 1.00-2.32, p = .05) were at greater mortality risk. Six month analyses corroborated that the mixed-cognitive impairment group were at higher mortality risk (adjusted HR = 2.35; 95% CI, 1.30-4.25, p = .005). When change in neurocognitive functioning over time was analyzed...

Efeitos do suporte ventilatorio com pressão controlada e volume controlado na função pulmonar dos pacientes submetidos a cirurgia cardiaca com circulação extra-corporea; Effects of pressure controlled ventilation and volume controlled ventilation on pulmonary function in cardiac surgery patients with cardiopulmonary bypass

Cristiane Delgado Alves Rodrigues
Fonte: Biblioteca Digital da Unicamp Publicador: Biblioteca Digital da Unicamp
Tipo: Dissertação de Mestrado Formato: application/pdf
Publicado em 26/02/2009 PT
Relevância na Pesquisa
66.29%
A insuficiência respiratória após a cirurgia cardíaca com utilização da circulação extracorpórea (CEC) é resultante de inúmeros fatores relacionados à Síndrome de Resposta Inflamatória Sistêmica (SIRS). Grande número desses pacientes desenvolve Lesão Pulmonar Aguda (LPA) e alguns até Síndrome da Angústia Respiratória no Adulto (SARA). Há inúmeros fatores que podem influenciar direta e/ou indiretamente a lesão pulmonar observada no pós-operatório de pacientes submetidos à cirurgia cardíaca com CEC. A própria ventilação mecânica (VM) pode causar lesão pulmonar induzida pela ventilação (LPIV). Discutem-se técnicas e métodos ventilatórios que visam prevenir e corrigir a hipoxemia freqüentemente observada nessa condição. No entanto, ainda não há na literatura consenso sobre qual a melhor modalidade ventilatória a ser empregada. As propostas gerais de suporte ventilatório com baixos volumes, pressão limitada, fluxo decrescente e PEEP (pressão positiva no final de expiração), além de evitar a transfusão desnecessária, devem ser usadas para minimizar a lesão pulmonar em cirurgia cardíaca. O objetivo principal deste trabalho foi comparar o efeito das modalidades ventilatórias pressão controlada e volume controlado na função respiratória e reações inflamatórias de pacientes submetidos à cirurgia cardíaca eletiva com circulação extracorpórea. Participaram deste estudo 22 pacientes submetidos à cirurgia cardíaca com circulação extracorpórea. Onze foram submetidos à ventilação com pressão controlada...

Oral triiodothyronine for the prevention of thyroid hormone reduction in adult valvular cardiac surgery

Magalhães, A.P.A.; Gus, Miguel; Silva Neto, Luís Beck da; Schaan, Beatriz D'Agord
Fonte: Universidade Federal do Rio Grande do Sul Publicador: Universidade Federal do Rio Grande do Sul
Tipo: Artigo de Revista Científica Formato: application/pdf
ENG
Relevância na Pesquisa
66.26%
Treatment of non-thyroidal illness by intravenous triiodothyronine (T3) after cardiac surgery causes a disproportional elevation of hormone levels. The administration of oral T3, which has never been studied in this context, could cause physiological hormone levels. The aim of this study was to test oral T3 for the prevention of T3 reduction during the postoperative period of valvular cardiac surgery in adults. Eighteen patients who underwent cardiac surgery for valvular disease with invasive hemodynamic monitoring were randomly assigned to 2 groups: the T group received oral T3 (N = 8), 25 μg three times/day, initiated 24 h before surgery and maintained for 48 h and the NT group (N = 10) received placebo. Serum T3, thyroxine and thyrotropin were determined at baseline, 1 h before surgery, within 30 min of cardiopulmonary bypass and 6, 12, 24, and 48 h after removal of the aortic cross-clamp. Baseline T3 was similar in both groups (T: 119 ± 13; NT: 131 ± 9 ng/dL). Serum T3 increased during the first 24 h in the T group compared to the NT group (232 ± 18 vs 151 ± 13 ng/dL; P < 0.001). In the NT group, T3 was reduced by 24% (P = 0.007) 6 h after removal of the aortic cross-clamp, confirming the non-thyroidal illness syndrome. There were no differences in clinical or hemodynamic parameters between groups. Administration of oral T3 prevented its serum reduction after valvular cardiac surgery in adults...

O enfermeiro no pós-operatório de cirurgia cardíaca: competências profissionais e estratégias da organização; The nurse in the postoperative cardiac surgery: professional competences and strategies of the organization

Santos, Ana Paula Azevedo
Fonte: Biblioteca Digitais de Teses e Dissertações da USP Publicador: Biblioteca Digitais de Teses e Dissertações da USP
Tipo: Dissertação de Mestrado Formato: application/pdf
Publicado em 10/08/2015 PT
Relevância na Pesquisa
66.29%
Ao longo dos anos o tema competência profissional tem se constituído foco de atenção de enfermeiros e organizações hospitalares, visto que a equipe de enfermagem representa uma parcela significativa dos recursos humanos alocados nas instituições, interferindo diretamente na eficácia, qualidade e custo da assistência à saúde prestada. O ambiente de trabalho em unidades de pós-operatório de cirurgia cardíaca coloca o enfermeiro diante do desafio de exercer funções e atividades complexas, visando assistência de enfermagem holística e qualificada ao paciente hospitalizado. E para que isso seja possível é necessário desenvolver competências específicas nesses profissionais, tendo em vista o cenário de alta complexidade e que a mobilização de competências poderá refletir significativamente nos resultados obtidos na assistência. Esta pesquisa teve como objetivo analisar as competências dos enfermeiros para atuarem no pós-operatório de cirurgia cardíaca e as estratégias para a mobilização destas competências. Trata-se de um estudo exploratório, de abordagem qualitativa, tendo como desenho metodológico o estudo de caso coletivo. A investigação foi realizada em três unidades de alta complexidade que prestam assistência a pacientes no pós-operatório de cirurgias cardíacas e os participantes foram 18 enfermeiros. Para a coleta de dados utilizou-se duas fontes de evidência...

High levels of B-type natriuretic peptide predict weaning failure from mechanical ventilation in adult patients after cardiac surgery

Lara, Thiago Martins; Hajjar, Ludhmila Abrahao; Almeida, Juliano Pinheiro de; Fukushima, Julia Tizue; Barbas, Carmem Silvia Valente; Rodrigues, Adriano Rogerio Baldacin; Nozawa, Emilia; Feltrim, Maria Ignes Zanetti; Almeida, Elisangela; Coimbra, Vera; Osa
Fonte: Universidade de São Paulo. Faculdade de Medicina Publicador: Universidade de São Paulo. Faculdade de Medicina
Tipo: info:eu-repo/semantics/article; info:eu-repo/semantics/publishedVersion; ; ; ; ; ; Formato: application/pdf
Publicado em 01/01/2013 ENG
Relevância na Pesquisa
66.22%
OBJECTIVE: The failure to wean from mechanical ventilation is related to worse outcomes after cardiac surgery. The aim of this study was to evaluate whether the serum level of B-type natriuretic peptide is a predictor of weaning failure from mechanical ventilation after cardiac surgery. METHODS: We conducted a prospective, observational cohort study of 101 patients who underwent on-pump coronary artery bypass grafting. B-type natriuretic peptide was measured postoperatively after intensive care unit admission and at the end of a 60-min spontaneous breathing test. The demographic data, hemodynamic and respiratory parameters, fluid balance, need for vasopressor or inotropic support, and length of the intensive care unit and hospital stays were recorded. Weaning failure was considered as either the inability to sustain spontaneous breathing after 60 min or the need for reintubation within 48 h. RESULTS: Of the 101 patients studied, 12 patients failed the weaning trial. There were no differences between the groups in the baseline or intraoperative characteristics, including left ventricular function, EuroSCORE and lengths of the cardiac procedure and cardiopulmonary bypass. The B-type natriuretic peptide levels were significantly higher at intensive care unit admission and at the end of the breathing test in the patients with weaning failure compared with the patients who were successfully weaned. In a multivariate model...

Nursing care in the immediate postoperative period of cardiac surgery. Systematized Review of Literature

Souza, Carine Santos; Fluminense Federal University; Cruz, Isabel CF da; Fluminense Federal University
Fonte: Universidade Federal Fluminense Publicador: Universidade Federal Fluminense
Tipo: Peer-reviewed Article; systematic review Formato: text/html
Publicado em 31/01/2013 POR
Relevância na Pesquisa
66.28%
This study aimed to know the nursing care of patients undergoing cardiac surgery in their immediate postoperative, what is the importance of nursing prescription prevention and management of postoperative complications of surgery cardiac. Observed intensify the need nursing care in immediate postoperative period of cardiac surgery because of cardiovascular complications in the postoperative period are associated with high morbidity and mortality, postoperative pain e nausea and to avoid pain, the nursing staff should evaluate if possible the patient regarding their level of pain does not only in the immediate postoperative period, but also in the long term. Thus, this study proposes a reflection on the importance of using themselves as the nursing staff must be able to perform a careful evaluation of cardiac risk after surgery, postoperative handling, location and intensity of postoperative care and detection early cardiac complications, in order to prevent complications to the patient in the immediate postoperative cardiac surgery.