Predictors of Acute Kidney Injury Associated with Cardiopulmonary Bypass.

OBJECTIVES: To study the incidence of acute kidney injury (AKI) in the postoperative period of cardiac surgery in patients without preoperative renal insufficiency who underwent cardiac surgery with cardiopulmonary bypass (CPB), and to explore the association between the incidence of AKI and predictors related to CPB. METHODS: Observational, cross-sectional study. Participants were divided in two groups, those who developed AKI in the postoperative period and those who did not develop AKI. Kidney Disease: Improving Global Outcomes - Clinical Practice Guideline for Acute Kidney Injury (KDIGO) classification was used to characterize AKI. The analysis included preoperative variables (anthropometric data, cardiovascular risk factors and blood parameters), as well as the type of surgery, intraoperative variables related to CPB, and postoperative creatinine variation. Association between variables was studied with binary logistic regression. RESULTS: We have included 329 patients, of which 62 (19%), developed AKI. There were statistically significant differences between the groups in age (p<0.001; OR (95%)-1.075 (1.037-1.114)), duration of CPB (p=0.011; 1.008 (1.002-1.014)), urine output during CPB (p=0.038; 0.998 (0.996-0.999)), mannitol and furosemide administration during CPB, (respectively, p=0.032; 2.293 (1.075-4.890) and p=0.013; 2.535 (1.214-5.296)). CONCLUSIONS: A significant number of patients developed AKI in the postoperative period of cardiac surgery and this incidence was influenced by factors related to CPB, namely: age, duration of CPB, urine output during CPB, mannitol and furosemide administration during CPB.

Predictors of Acute Kidney Injury in the Postoperative Period of Cardiac Surgery Associated with Cardiopulmonary Bypass.

INTRODUCTION: Acute kidney injury (AKI) in the postoperative period of cardiac surgery occurs in 1 to 30% of the patients, mainly caused by ischemia secondary to renal hypoperfusion. Cardiopulmonary bypass (CPB) has a deleterious effect on renal function, constituting an aggression to the patient's homeostasis. AIM: To evaluate the incidence of AKI in the postoperative period of cardiac surgery in patients without preoperative renal insufficiency who underwent cardiac surgery with CPB, and explore the association between incidence of AKI and predictors related to CPB. METHODS: Observational, retrospective, cross-sectional study. Participants were divided in two groups, those who developed AKI in the postoperative period and those who did not develop AKI. KDIGO Clinical Practice Guideline for Acute Kidney Injury classification was used to characterize AKI. The preoperative variables analysed were anthropometric data, cardiovascular risk factors and blood parameters. The type of surgery, intraoperative variables related to CPB and postoperative creatinine variation were also analysed. The association between variables was studied using binary logistic regression. RESULTS: Of the 329 patients included, 62 (18.8%), developed AKI. There were statistically significant differences between the groups in age (p<0.001), CPB time (p=0.011), diuresis during CPB (p=0.038) and mannitol and furosemide administration during CPB (respectively, p=0.032 and p=0.013). Odds ratio showed a significant positive association between AKI and age (OR (95%)- 1.08 (1.04-1.11)), CPB time (OR (95%)-1.01 (1.00-1.01)), mannitol and furosemide administration during CPB (respectively, OR (95%)-2.29 (1.08-4.89) and OR (95%)-2.54 (1.21-5.30)). CONCLUSIONS: This study shows that a significant number of patients developed AKI in the postoperative period of cardiac surgery and this incidence was influenced by factors related to CPB.

[Incidence of atrial fibrillation after cardiac surgery: Influence of the type of surgery, cardiopulmonary bypass and preoperative and perioperative predictive factors]. / Incidência De Fibrilação Auricular Pós Cirurgia Cardíaca: Influência Do Tipo De Cirurgia, Da circulação Extracorporal E De Fatores Pré E Intraoperatórios.

BACKGROUND: Atrial fibrillation (AF) is the arrhythmia with higher incidence in postoperative period after cardiac surgery. In individuals undergoing valve replacement surgeries (VRS) it occurs in about 64% and in individuals undergoing coronary artery bypass grafting (CABG) it can occurs in about 30-40%. Its incidence in postoperative period can still be influenced by pre and perioperative risk factors. AIM: To study the incidence of AF after cardiac surgery, its association with the type of surgery, cardiopulmonary bypass (CPB), and with the main pre and perioperative risk/predictive factors. METHODS: Longitudinal retrospective observational study of individuals undergoing CABG and VRS in 2014, in a central hospital in the northern region. Cardiac rhythm was evaluated in four moments of postoperative period (end of CPB, Intensive Care Unit (ICU)/hospitalization, pre-hospital discharge, follow-up). The association of cardiac rhythm and preoperative risk/predictive factors (size of the atria, cardiomegaly, left ventricular hypertrophy (LVH)) and intraoperative risk factors (type of surgery, duration of CPB, aortic clamping time and cardioplegia administration) were explored through Odds ratio (OR). RESULTS: We studied 416 individuals, 73.6 % male, mean age 66.8±10.5 years old. VRS showed incidence values of AF in all evaluation moments, and CABG only in ICU/internment and pre-hospital discharge. The incidence of AF was higher in ICU/internment in all types of surgery, ranging from 3.7% (CABG with CPB) to 71.4% (mitral VRS). Preoperative predictive factors with an OR>1 were age upper 65 years old (2.51 end of CPB, 10.62 pre-hospital discharge), dilation of the right atrium (RA) (1.08 follow-up, 3.41 pre-hospital discharge), and LVH (1.68 end of CPB, 2.78 pre-hospital discharge). Perioperative predictive factors with an OR>1 were CPB (2.74 ICU/interment, 3.37 pre-hospital discharge), and cardioplegia (2.93 ICU/internment, 5.40 pre-hospital discharge). CONCLUSIONS: VRS were the type of surgery with higher incidence of AF. CABG had a higher incidence of AF in surgeries without CPB. Age upper 65 years old, RA dilation and LVH were the preoperative predictive factors with positive association with AF incidence in all evaluation moments.

Effects of aging on lung function. A comparison of lung function in healthy adults and the elderly.

INTRODUCTION: The respiratory system changes with age and understanding these changes helps detect and prevent respiratory dysfunctions in the elderly. AIMS: This study compares the respiratory pattern in healthy non-smoker adults and the elderly, using lung function testing and expansion of the chest to confirm the effects of aging on lung function. METHODOLOGY: We used lung function testing to measure forced vital capacity, forced expiratory volume in one second, peak expiratory flow rate and maximum voluntary ventilation. We also measured expansion of the chest. Measurements were taken with subjects resting in the dorsal recumbent position with upper body elevated to 45 masculine. Statistical analysis consisted of the Student T test for independent samples, the non-parametric Mann-Whitney test with a p <0.05 level, and linear regression analysis, also with a p <0.05 level, to assess correlation between variables studied and age. Our population consisted of 35 elderly subjects and 35 adults. 15 of the elderly subjects were male (43%) and 20 female (57%). 16 of the adult group were male (46%) and 19 female (54%). The sample was mapped in terms of age, weight, height, abdominal girth and clinical data, to exclude factors which could distort the results. RESULTS: The difference between the two study groups attained statistical significance for all parameters measured. The linear relationship was also significant between age and all parameters and a negative and significant correlation was seen. Expansion of the chest in females was the parameter most inversely correlated with age (60.37%). The lung function testing variable with the greatest difference between the groups was peak expiratory flow rate (35.77% in females and 36.17% in males). CONCLUSIONS: Our results show differences in the respiratory patterns of healthy adults and the elderly, suggesting that age impacts on lung function. Both male and female elderly subjects had lower lung function testing scores than the adult subjects, with this difference more marked in females.

Imunoterapia específica - avaliação dinâmica e cinética in vivo do extrato terapêutico em doentes alérgicos / Specific immunotherapy - in vivo dinamic and kinetic evaluation of a therapeutic extract in allergic patients

Introdução: A imunoterapia específica (IT) é uma forma comum de tratamento da doença alérgica. O mecanismo preciso desta terapêutica não é conhecido, embora a eficácia clínica esteja plenamente documentada. O objetivo deste estudo foi avaliar a cinética da IT , aplicando uma técnica de Medicina Nuclear, marcação de leucócitos com 99mTc-HMPAO, em doentes em fase de manutenção e com excelente eficácia clínica à terapêutica.Pacientes e métodos: Foram estudados 14 doentes alérgicos agrupados de acordo com o tipo de extrato e via de administração: extratos aquosos subcutâneos (látex= 4 doentes; veneno de abelha= 2 doentes), extrato depot subcutâneo (ácaros= 2 doentes; gramíneas= 2 doentes); extrato modificado subcutâneo (gramíneas= 1 doente; Parietária= 1 doente) extrato sublingual (ácaros= 2 doentes). O grupo controle foi constituído por dois doentes alérgicos a ácaros, submetidos respectivamente a: injecção subcutânea de soluto salino e injecção de extrato bacteriano por via subcutânea (controle positivo).Simultaneamente à administração do extrato alergênico terapêutico, procedeu-se à re-injecção de leucócitos marcados com 99mTc-HMPAO, em veia periférica contralateral. A aquisição dinâmica decorreu durante 60 minutos, com matriz de 64x64, 2 imagens/ minuto em projeção torácica anterior. As aquisições estáticas, com matrizes 256x256, durante 5 minutos cada foram adquiridas aos 60, 90, 120, 180, 240, 300 e 360 minutos, em projeção torácica (anterior e posterior) e abdominal (anterior).Resultados: A atividade inflamatória no ocal de administração da IT para os extratos subcutâneos aquosos e depot iniciou-se na primeira hora e manteve um aumento ao longo do tempo de estudo. Para os extratos sublinguais a atividade inflamatória foi observada logo nos primeiros minutos. Todos os estratos subcutâneos condicionaram dreanagem linfática ascendente para áreas axilares homolaterais nos primeiros minutos após a adminstração do extrato e, posteriormente, para tecido linfóide do mediastino superior e anterior, e áreas cervicais. As focalizações torácicas estiveram presentes em todos os doentes estudados, o mesmo não acontecendo para a atividade de intestinal. A via sublingual não induziu focalizações axilares ou instetinais, mesmo tendo havido deglutição do alérgeno. Foram calculados coeficientes corrigidos de captação em áreas individualizadas (ROIs- region of interest) em relação aos coeficientes de captação das áreas de background.