Safety and feasibility of early mobilization in patients submitted to cardiac surgery using subxiphoid drain.

INTRODUCTION: Patients submitted to heart surgery are restricted to the bed of the Intensive Care Units (ICUs), due to this period of immobility the individual is likely to present clinical and functional alterations. These complications can be avoided by early mobilization; however, in some hospitals, this is not feasible due to the use of subxiphoid drain in the immediate postoperative period. OBJECTIVE: To verify the safety and feasibility of mobilizing patients after cardiac surgery using subxiphoid drain. METHODS: This was a prospective cohort study. On the first day the patient was positioned in sedestration in bed, then transferred from sitting to orthostasis, gait training and sedestration in an armchair. On the second postoperative day the same activities were performed, but with walking through the ICU with a progressive increase in distance. At all these moments, the patient was using the subxiphoid and intercostal drain. The patients were seen three times a day, but physical rehabilitation was performed twice. The adverse events considered were drain obstruction, accidental removal or displacement, total atrioventricular block, postoperative low output syndrome, cardiorespiratory arrest, pneumomediastinum, infection, and pericardial or myocardial damage. RESULTS: 176 patients were evaluated. Only 2 (0.4 %) of the patients had complications during or after mobilization, 1 (0.2 %) due to drain obstruction and 1 (0.2 %) due to accidental removal or displacement. CONCLUSION: Based on the data observed in the results, we found that the application of early mobilization in patients using subxiphoid drain after cardiac surgery is a safe and feasible conduct.

Clinical and functional outcomes associated with pulmonary complications after coronary artery bypass grafting.

INTRODUCTION: Coronary artery bypass grafting(CABG) is a surgical treatment for coronary artery disease aiming at improving symptoms and life expectancy. Despite this, there are pulmonary and functional complications that may arise during the postoperative period due to invasive mechanical ventilation(IMV), cardiopulmonary bypass and immobility, leading to longer hospital stays. OBJECTIVE: To evaluate the clinical and functional outcomes related to pulmonary complications in the postoperative period of CABG. METHODS: Prospective cohort. During the ICU stay the patients were divided into: Non Complicated Group(NCG) who did not present complications and Complicated Group(CG) who presented complication. Functional variables were applied as the six-minute walk test(6MWT), gait speed, sit up and stand up test, Timed Up and Go, peripheral muscle strength, ventilatory, pulmonary function and Functional Independence Measure. These tests were applied preoperatively, at ICU discharge, hospital discharge and six months after surgery. RESULTS: The study evaluated 90 patients, 59 in the NCG and 31 CG. In the 6MWT there was a 2%(p = 0.43) decrease in the NCG, while the decrease was 13%(p < 0.01) in the CG. In the MRC the drop was 2%(p = < 0.01) in the CNG, while in the CG the drop was 14%(p = < 0.01). In MIP the NCG had a 6%(p = 0.67) decrease, while the CG had a 16%(p = < 0.01) decrease. CONCLUSION: Patients with postoperative complications of CABG may have reduced functional performance, muscle strength, and pulmonary function at hospital discharge and after six months.

Ventilatory Muscle Strength Six Months After Coronary Artery Bypass Grafting in Patients Submitted to Inspiratory Muscular Training Based on Anaerobioc Threshold: A Clinical Trial

Abstract Introduction Coronary artery bypass grafting (CABG) surgery is associated with a decline in ventilatory muscle strength and lung function. Inspiratory muscle training (IMT) based on anaerobic threshold (AT) has been used to minimize the impact of CABG on these parameters, but the long-term impact is unknown. Objective To test the hypothesis that AT-based IMT improves inspiratory muscle strength and lung function even six months after CABG. Methods This is a randomized controlled clinical trial. In the preoperative period, maximum inspiratory pressure (MIP), maximum expiratory pressure (MEP), vital capacity (VC) and peak expiratory flow (PEF) rate were assessed. On the first postoperative day, patients were randomized into two groups: AT-based IMT (IMT-AT) (n=21) where the load was prescribed based on glycemic threshold and conventional IMT (IMT-C) (n=21), with load of 40% of MIP. Patients were trained during hospitalization until the day of discharge and were assessed at discharge and six months later. For within-group comparison, paired Student's t-test or Wilcoxon test was used, and independent Student's t-test or the Mann-Whitney test was used to analyze the different time points. A p<0.05 was considered significant. Results At six months after CABG surgery, statistical difference was found between the IMT-AT and the IMT-C groups in MIP (difference between the means of -5cmH2; 95% CI=- 8.21to-1.79) and VC (difference between the means of -2ml/kg;95%CI=-3.87to-0.13). No difference was found between groups in the other variables analyzed. Conclusion IMT-AT promoted greater recovery of inspiratory muscle strength and VC after six months of CABG when compared to conventional training.

Inspiratory muscle training and functional capacity following coronary artery bypass grafting in high-risk patients: A pilot randomized and controlled trial.

Background: Coronary artery bypass graft (CABG) surgery is associated with worsened functional capacity, pulmonary complications, and increased length of hospital stay. These negative effects are exacerbated in patients who are at high risk of post-operative (PO) pulmonary complications before CABG. Inspiratory muscle training (IMT) has been shown to benefit CABG patients in their recovery process. However, in high-risk patients, there is little evidence to support the post-operative implementation of IMT for purposes of faster recovery. Aim: The aim of the study was to test the hypothesis that IMT improves the functional capacity, pulmonary complications, and length of hospital stay in patients prone to pulmonary complications who had undergone CABG. Methods: This is a pilot clinical trial carried out with patients at high risk for pulmonary complications in the PO phase. In the pre-operative period, maximal inspiratory pressure (MIP), maximal expiratory pressure (MEP), and 6-min walk test (6MWT) were determined and administered. On the first PO day, patients were divided into two groups: A control group (CG) that received routine intervention and an IMT group that, in addition to routine care, was subjected to an IMT protocol until hospital discharge. On the day of discharge, the patients were reassessed with respect to ventilatory muscle strength, functional capacity, PO complications, and length of stay. Results: Twenty-nine patients were evaluated, 15 in the CG and 14 in the IMT group. No significant differences were observed in relation to MIP (difference between the mean of -7 cmH2O; 95% CI = -16.52-2.52), MEP (difference between the mean of -7cm H2O; 95% CI = -15.39-1.39), and in the 6MWT (difference between the mean of -9 m; 95% CI = -43.71-25.71). There was a decrease in the length of stay in the IMT group compared to the CG (9 ± 3 vs. 12 ± 4 days; P = 0.04). The IMT group had a lower rate of atelectasis and pneumonia. Conclusion: IMT does not minimize the loss of functional capacity, but it reduces pulmonary complications and the length of stay of patients undergoing CABG who are preoperatively at a high risk of pulmonary complications. Relevance for Patients: The increase in ventilatory muscle strength, associated with IMT, can reduce PO pulmonary complications, resulting in shorter hospital stays, and improved quality of life.

Impact of early mobilization on clinical and functional outcomes in patients submitted to coronary artery bypass grafting.

INTRODUCTION: Heart surgery is a feature that has grown a lot in recent years. Due to the complications that can be generated, the importance of prevention emerges, thus seeking effective protocols that generate improvement in clinical and functional outcomes to promote a shorter hospital stay and readmission. OBJECTIVE: To evaluate the impact of early mobilization on clinical and functional outcomes in patients undergoing coronary artery bypass grafting. METHODOLOGY: This was a prospective cohort study. Patients were evaluated preoperatively through the Medical Research Council (MRC), Functional Independence Measurement (FIM), Six-Minute Walk Test (6MWT). After the surgery they were divided into two groups: the mobilized group (MG) where patients performed bed transfer to armchair on the 1st postoperative day and ambulated on the 2nd day, and the non-mobilized group (NMG) who underwent passive kinesiotherapy in bed. At ICU discharge, mechanical ventilation (MV) time, intensive care unit stay (ICU) and mortality were compared. At hospital discharge, preoperative tests were repeated to compare with admission. RESULTS: A total of 103 patients were admitted, 59 (57.3%) males, mean age 64 ± 8 years. Time of MV it was 6 ± 2 (MG) vs 10 ± 3 (NMG) hours, P = 0.02, ICU stay it was 2 ± 2 (MG) vs 4 ± 3 (NMG) days (P ≤ 0.001), length of stay hospital was 8 ± 4 (MG) vs 14 ± 5 (NMG) days (P ≤ 0.001), FIM -4 ± 2 (MG) vs -11 ± 4 (NMG) points (P ≤ 0.001) and distance traveled 37 ± 10 (MG) vs 78 ± 11 (NMG) meters (P < 0.001). CONCLUSION: Early mobilization is associated with improvement in clinical outcomes such as MV time, ICU stay, hospital and functional outcomes, on the FIM scale and distance traveled.

Pressão positiva expiratória das vias aéreas sobre a oxigenação e hemodinâmica em pacientes submetidos a revascularização do miocárdio / Expiratory positive airway pressure on oxygenation and hemodynamics in patients submitted to coronary artery bypass grafting

)Introdução: A pressão positiva expiratória nas vias aéreas (EPAP) é a aplicação de uma resistência expiratória para manter a pressão positiva nas vias aéreas e também tem sido amplamente utilizada para prevenir possíveis complicações no pós-operatório de cirurgia cardíaca. Objetivo: Descrever o comportamento da oxigenação e hemodinâmica durante o uso de EPAP em pacientes submetidos à cirurgia de revascularização do miocárdio (RM). Métodos: Estudo transversal que avaliou saturação periférica de oxigênio (SpO2), frequência cardíaca (FC), frequência respiratória (FR), pressão arterial sistólica (PAS), diastólica (PAD) e média (PAM), pressão arterial de oxigênio (PaO2), pressão arterial de dióxido de carbono (PaCO2) e índice de oxigenação calculado dividindo a PaO2 pela fração inspirada de oxigênio (FiO2), os pacientes foram avaliados em repouso, no primeiro dia de pós-operatório. A EPAP foi realizada com o paciente em sedestação na poltrona e uma gasometria arterial foi coletada e analisada para verificar os valores de PaO2, PaCO2, SaO2 e PaO2/FiO2. Foi aplicada uma resistência expiratória de 12 cmH2O por dez minutos. Imediatamente após a aplicação do EPAP, os pacientes tiveram nova análise gasométrica e a hemodinâmica analisada. Resultados: 58 pacientes, 41 (71%) do sexo masculino e com idade média de 54 ± 8 anos foram avaliados. O uso de EPAP no pós-operatório levou à melhora de todas as variáveis gasométricas, exceto PaCO2. Houve uma melhora na SaO2 (%) pré-EPAP 94 ± 3 e pós-EPAP 98 ± 2, PaO2/FiO2 pré-EPAP 279 ± 10 e pós-EPAP 346 ± 8, PaO2 (mmHg) pré-EPAP 78 ± 8 e pós-EPAP 97 ± 7. Conclusão: Concluiu-se que a aplicação do EPAP teve um impacto positivo na oxigenação em pacientes submetidos à RM sem gerar efeitos adversos na hemodinâmica. (AU)

Impact of drains positioning on pulmonary function after coronary artery bypass grafting: an observational study.

INTRODUCTION: Coronary artery bypass grafting (CABG) is a procedure associated with a decline in pulmonary function. Among the main causes is the presence of the drain that is usually positioned in the intercostal or subxiphoid region. OBJECTIVE: To measure the interference of drains positioning on pulmonary function in patients undergoing CABG. METHODS: Observational study that assessed preoperative pulmonary function through vital capacity (VC), maximal inspiratory pressure (MIP), maximal expiratory pressure (MEP), and peak expiratory flow (PEF). These variables were evaluated in three different moments: in the presence of two drains, when removing one, and after removing all drains. RESULTS: We evaluated 45 patients with a mean age of 62 ± 7 years with male prevalence of 29 (64%) individuals. The insertion of drains caused a decline in pulmonary function after surgery by reducing MIP by 48%, MEP by 11%, VC by 39%, and PEF by 6%. CONCLUSION: This study has demonstrated that drains positioning after CABG surgery may produce weakness of the respiratory muscles, change ventilatory mechanics, and impair normal pulmonary function postoperatively.

Clinical and Surgical Characteristics of Patients Undergoing Valve Replacement / Características Clínicas e Cirúrgicas de Pacientes Submetidos a Troca Valvar

Abstract Cardiovascular diseases have been the leading the causes of hospital admissions, being one of the main public health problems in Brazil, and one of the forms of treatment is cardiac surgery, being more prevalent in older people who have several other comorbidities associated. This study aimed to describe the clinical and surgical profile of patients undergoing valve replacement. Thus, an ambispective study was carried out with patients admitted to the Intensive Care Unit of Instituto Nobre de Cardiologia. An analysis was carried out in the patients' medical records in search of data related to their clinical and surgical profile. During the research period, 55 patients underwent valve replacement, 10 of which were excluded. Thus, 45 patients were evaluated, with 28 (62%) male participants with a mean age of 43 ± 6 years, hypertension and sedentary lifestyle were the most common comorbidities (49% and 56% respectively) and 60% with the Body Mass Index within the normal range. Regarding the surgical characteristics, the extracorporeal circulation time was 211 ± 22 minutes and the Mechanical Ventilation time was 6 ± 2 hours. Based on the findings, it can be characterized that patients undergoing cardiac valve replacement surgery are over 40 years old, male, sedentary, hypertensive. (AU)

Resumo As doenças cardiovasculares têm liderado as causas de internação hospitalar, sendo um dos principais problemas de saúde publica no Brasil, sendo que umas das formas de tratamento é a cirurgia cardíaca, sendo mais prevalente em pessoas com idade mais avançada, e que possuem várias outras comorbidades associadas. O presente estudo teve como objetivo descrever o perfil clínico e cirúrgico de pacientes submetidos à troca valvar. Para isso foi realizado um estudo ambispectivo com os pacientes internados na Unidade de Terapia Intensiva do Instituto Nobre de Cardiologia. Foi feita uma análise no prontuário dos pacientes na busca de dados relacionados ao seu perfil clinico e cirúrgico. Durante o período da pesquisa foram submetidos a troca valvar 55 pacientes sendo que 10 foram excluídos. Desse modo foram avaliados 45 pacientes, com 28 (62%) participantes do sexo masculino com idade média de 43 ± 6 anos, hipertensão e sedentarismo as comorbidades mais encontradas (49% e 56% respectivamente) e 60% com o Índice de Massa Corpórea dentro da normalidade. Em relação às características cirúrgicas o tempo da circulação extracorpórea 211 ± 22 minutos e o tempo de Ventilação Mecânica 6 ± 2 horas. Com base nos achados podese caracterizar que os pacientes submetidos à cirurgia cardíaca de troca de válvulas têm mais de 40 anos, do gênero masculino, sedentários, hipertensos. (AU)

Pilates method on pulmonary function and range of motion after coronary artery bypass grafting: A clinical trial.

INTRODUCTION: Coronary artery bypass grafting (CABG) can compromise pulmonary function and range of motion (ROM) of the shoulder and knee joints due to median sternotomy and saphenectomy, the Pilates method being a strategy for reducing loss. OBJECTIVE: To evaluate the effect of applying the Pilates method on pulmonary function and ROM in patients undergoing CABG. METHOD: ology: This is a clinical trial. Patients were evaluated preoperatively at discharge from the hospital for shoulder flexion and abduction and knee flexion-extension. In addition, vital capacity(VC), maximum inspiratory pressure(MIP), expiratory pressure(MEP) and peak expiratory flow(PEF) were evaluated. Upon discharge from the Intensive Care Unit (ICU), they were divided into a control group(CG) that received conventional assistance and Pilates(PG) was increased with Pilates method techniques. RESULTS: 40 patients were analyzed, 25 were men(61%), with a mean age of 66 ± 7 years. At the end, the left shoulder abduction in the CG was 105±9vs115 ± 8 in the PG(p = 0.03), the right shoulder abduction in the CG 104 ± 11vs116 ± 10 in the PG(p < 0.001) and right knee flexion in the CG 78 ± 13vs92 ± 9 in the PG(0.002). In relation to MIP, the CG had a loss of 32 ± 8 while the PG 18 ± 10cmH2O(p < 0.001), the worsening MEP was 31 ± 9(CG)vs29 ± 11cmH2O(PG)(p = 0.53), the VC in the CG reduced 8±9vs6±8 in the PG(p = 0.23) and the PEF reduced 107 ± 5 in the GCvs83 ± 88 in the PG(p = 0.09). CONCLUSION: It is concluded that the Pilates method decreased the loss of ROM and maximum inspiratory pressure in patients undergoing coronary artery bypass grafting.

Factors associated with pulmonary complacence in patients submitted to coronary artery bypass grafting: cross-sectional study.

BACKGROUND: Coronary artery bypass grafting (CABG) is one of the most studied surgical procedures worldwide and is associated with deleterious effects on respiratory function in the postoperative period, corroborating the incidence of factors that can cause a decrease in lung compliance, generating possible respiratory complications. OBJECTIVE: To identify factors associated with low pulmonary compliance in patients submitted to coronary artery bypass grafting. METHODS: This is a cross-sectional study. After admission to the Intensive Care Unit (ICU), the static compliance calculation was performed and the patients were divided into two groups: Low Compliance Group (LCG) and Normal Compliance Group (NCG), to verify which factors were associated with low compliance. RESULTS: The final sample consisted of 62 patients, with male prevalence, with a mean age of 60 ± 9.5 years. Clinical variables body mass index (BMI) (P=0.04), smoking (P=0.05), chronic obstructive pulmonary disease (P < 0.001) and ejection fraction (P=0.03) were associated with reduced static pulmonary compliance. CONCLUSION: It is concluded that factors such as age, COPD, smoking, BMI and ejection fraction may be associated with worsening pulmonary compliance after CABG.

Two types of inspiratory muscle training on muscle strength in patients submitted to coronary artery bypass grafting: clinical trial / Dois tipos de treinamento muscular inspiratório sobre a força muscular de pacientes após revascularização do miocárdio: ensaio clínico

Introduction: Coronary artery bypass grafting (CABG) causes changes in the respiratory musculature that affects functional capacity and postoperative complications (POC). Inspiratory muscle training (IMT) is a tool used for these patients, but it is not known what the best form is to increase strength. Objective: To investigate whether IMT with a linear pressure load device is superior to the inspiratory incentive on functional capacity and muscle strength of patients undergoing CABG. Methods: This is a clinical trial. Patients were assessed preoperatively for inspiratory muscle pressure (MIP), expiratory pressure (MEP), peak expiratory flow (PEF), six-minute walk test (6MWT) and functional independence measure (FIM). After surgery, they were divided into three groups: control group (CG), training group with linear pressure load (IMT) and inspiratory incentive group (IG). On the day of discharge, all patients had their previous variables reassessed. Results: The study included 56 patients, 31 (55.4%) were male and an average age of 55 ± 12 years. There was a significant reduction in all variables, in relation to MIP, the IMT showed a higher value in the postoperative period 83 ± 19 cmH2O, against 70 ± 15 cmH2O in the CG and 80 ± 15 cmH2O in the IG (p < 0.001). The same behavior was observed in MEP, 77 ± 12 cm H2O in IMT, 67 ± 14 cmH2O in CG and 75 ± 10 cmH2O in IG (p < 0.001). Regarding the 6 MWT, there was a lesser loss in the IMT from 434 ± 15 m to 398 ± 20 m in IG (p < 0.001). Conclusion: It is concluded that muscle training with a linear pressure load device is superior to training with incentive on functional capacity and muscle strength in patients undergoing CABG. (AU)

Introdução: A cirurgia de revascularização do miocárdio (CRM) causa alterações na musculatura respiratória que afetam a capacidade funcional e complicações pós-operatórias (DCP). O treinamento muscular inspiratório (TMI) é uma ferramenta utilizada por esses pacientes, mas não se sabe qual é a melhor forma de aumentar a força. Objetivo: Investigar se o TMI com dispositivo de carga de pressão linear é superior ao incentivo inspiratório na capacidade funcional e força muscular de pacientes submetidos à CRM. Métodos: Este é um ensaio clínico. Os pacientes foram avaliados no pré-operatório para pressão muscular inspiratória (PImáx), pressão expiratória (PEF), pico de fluxo expiratório (PFE), teste de caminhada de seis minutos (TC6) e medida de independência funcional (MIF). Após a cirurgia, eles foram divididos em três grupos: grupo controle (GC), grupo treinamento com carga linear de pressão (IMT) e grupo incentivo inspiratório (GI). No dia da alta, todos os pacientes tiveram suas variáveis anteriores reavaliadas. Resultados: O estudo incluiu 56 pacientes, 31 (55,4%) eram do sexo masculino e idade média de 55 ± 12 anos. Houve redução significativa em todas as variáveis, em relação à PImáx, o IMT apresentou valor maior no pós-operatório 83 ± 19 cmH2O, contra 70 ± 15 cmH2O no GC e 80 ± 15 cmH2O no GI (p < 0,001). O mesmo comportamento foi observado na PEmáx, 77 ± 12 cmH2O no IMT, 67 ± 14 cmH2O no GC e 75 ± 10 cmH2O no GI (p < 0,001). Em relação ao TC6, houve menor perda no TMI de 434 ± 15 metros para 398 ± 20 metros no GI (p < 0,001). Conclusão: Conclui-se que o treinamento muscular com dispositivo de carga pressórica linear é superior ao treinamento com incentivo inspiratório na capacidade funcional e da força muscular em pacientes submetidos à CRM. (AU)

Correlation between Surgical Risk Scales with Respiratory Muscle Strength and Functional Independence in Patients Submitted to Coronary Artery Bypass Grafting

Abstract Background The European Heart Surgery Risk Assessment System (EuroSCORE) and InsCor have been used to predict complications of cardiac surgery. However, their application to predict lung function and functionality is still uncertain. Objective To correlate surgical risk scales with functional independence and pulmonary function in patients undergoing coronary artery bypass grafting. Methods This was a prospective cohort study. In the preoperative period, the two surgical scales were applied, the maximal inspiratory pressure (MIP), maximal expiratory pressure (MEP), and peak expiratory flow (PEF) were measured, and functionality was assessed using the functional independence measure (FIM). On the seventh postoperative day, the pulmonary function and functionality variables were reevaluated, compared with the preoperative values (delta) and correlated with the risk scales. Correlations of pulmonary function, functional independence and muscle strength variables with the surgical scales were made by Pearson correlation test. The significance level adopted was 5%. Results Thirty-one patients were studied; most were male (77%), with a mean age of 56±8 years. Mean EuroSCORE was 2.3±0.5 and mean InsCOR was 1.2±0.5. MIP, MEP, and PEF reduced 30% (p<0.001), 33% (p<0.001) and 10% (p=0.23), respectively. The EuroSCORE correlated with MIP (r-0.78; p = 0.02) and FIM (r-0.79; p <0.01), and the InsCor correlated with MIP (r-0.77), MEP (r-0.73) and MIF (r-0.89; p=0.02). Conclusion The EuroSCORE showed a strong negative correlation with MIP and FIM, while InsCor had a strong negative correlation with MIP, MEP and FIM. (Int J Cardiovasc Sci. 2020; [online].ahead print, PP.0-0)

Qualidade do sono em pacientes pós-cirurgia cardíaca com diferentes índices de massa corporal / Sleep quality in patients in patients submitted to coronary artery bypass grafting with different body mass indexes

INTRODUÇÃO: Evidências mostram que existe correlação positiva entre o Índice de Massa Corpórea (IMC) e a qualidade do sono. A avaliação de como o IMC pode influenciar a qualidade do sono de pacientes no pós-operatório pode ser útil para tomada de decisão relacionada ao tratamento fisioterapêutico. OBJETIVO: Comparar a qualidade do sono em pacientes pós-cirurgia cardíaca em diferentes IMC. MÉTODOS: Trata-se de um estudo transversal. Pacientes de ambos os sexos, com idade superior a 18 anos e submetidos a revascularização do miocárdio via esternotomia mediana e circulação extracorpórea foram incluídos. O Questionário do Índice de Qualidade do Sono de Pittsburgh, que mede a qualidade retrospectiva do sono, foi aplicado, na alta da Unidade de Terapia Intensiva (UTI), em pacientes de ambos os sexos agrupados por IMC em grupos eutrófico, sobrepeso e obesidade, para investigar as alterações no comportamento do sono pós-cirurgia cardíaca desses grupos. Pontuações de 0-4 indicam boa qualidade do sono e de 5-10 indicam qualidade ruim. Os dados foram expressos em média e desvio padrão. Para comparação entre os grupos o teste de ANOVA foi usado. Foi considerado como significativo um p<0,05. RESULTADOS: O estudo foi composto por 120 pacientes, com uma predominância do sexo masculino num total de 79 (65,83%) pacientes e idade em torno de 60,22 ± 1,34 anos. As pontuações das variáveis desse questionário como Duração do sono (Grupo eutrófico:0, sobrepeso:0, obesidade:2, p=0,02), Distúrbio do sono (Grupo eutrófico:1, sobrepeso:1, obesidade:2, p=0,01) e Disfunção diurna (Grupo eutrófico:1, sobrepeso:1, obesidade:2, p=0,04) foram estatisticamente significativos. Comparando a pontuação geral entre os grupos eutrófico:2, sobrepeso:5 e obesidade:10 identificou-se que a qualidade do sono tende a piorar à medida que o IMC aumenta. CONCLUSÃO: Os pacientes que apresentavam um IMC maior, como do grupo obesidade, apresentaram pior qualidade do sono, enquanto os pacientes do grupo eutrófico possuíram melhor qualidade do sono.

INTRODUCTION: Evidence shows that there is a positive correlation between the Body Mass Index (BMI) and sleep quality. The assessment of how the BMI can influence the sleep quality of patients in the postoperative period can be useful for decision making related to physiotherapeutic treatment. OBJECTIVES: To compare the sleep quality in patients undergoing CABG at different BMI. METHODS: Patients of both sexes, aged 18 years or over and submitted to coronary artery bypass grafting via median sternotomy and cardiopulmonary bypass (CPB) were included. This is an observational study. The Pittsburgh Sleep Quality Index Questionnaire, which measures the retrospective sleep quality, was applied, upon discharge from the Intensive Care Unit (ICU), in patients of both sexes grouped by BMI into eutrophic, overweight, and obesity groups to investigate changes in sleep behavior post-cardiac surgery in these groups. The data were expressed as means and standard deviations. For comparison between groups, the ANOVA test was used. P <0.05 was considered significant. RESULTS: The study consisted of 120 patients, with a predominance of males in a total of 79 (65.83%) patients and age around 60,22 ± 1,34 years. The scores of the variables in this questionnaire such as Sleep Duration (Eutrophic Group:0, Overweight:0, Obesity:2, p=0.02), Sleep Disturbances (Eutrophic Group:1, Overweight:1, Obesity:2, p=0.01) and Daytime Dysfunction (Eutrophic Group:1, Overweight:1, Obesity:2, p=0.04) were statistically significant. Comparing the total score between the groups eutrophic:2, overweight:5, and obesity:10, it was found that sleep quality tends to worsen as the BMI increases. CONCLUSION: Patients with a higher BMI, as in the obesity group, had worse sleep quality, while patients in the eutrophic group had better sleep quality.

Impact of early ambulation on functionality in patients undergoing valve replacement surgery.

BACKGROUND: Cardiac surgery is a highly complex procedure that aims to increase and prolong the quality of life of patients. The role of physiotherapy in early mobilization after cardiac surgery has shown several benefits to the patient when he presents impairments in terms of functionality. AIM: To evaluate the impact of early ambulation on the functionality of patients undergoing cardiac valve replacement surgery. MATERIALS AND METHODS: Prospective cohort study in patients undergoing cardiac valve replacement surgery. Patients had their functionality assessed preoperatively using the Functional Independence Measurement (FIM) and Perme Intensive Care Unit (ICU) Mobility Score scales. At ICU discharge, they were divided into two groups: walking group (WG) and non-WG (NWG). At discharge, the two functional scales were reapplied in these patients. Pre- and postoperative values were assessed using the independent Student's t-test. It was considered statistically significant when P<0.05. RESULTS: One hundred and seventy patients were evaluated, 110 (65%) male, with a mean age of 48±2 years. In relation to Perme Score, the WG had a decrease of 11±2 and the NWG had a decrease of 13±2 (P=0.34). Regarding FIM, those who walked had a decrease of 27±3 against those who did not walk, which showed a reduction of 36±5, with a significance level of P<0.001. CONCLUSION: Based on the FIM data found, patients undergoing cardiac valve replacement surgery who underwent early mobilization had less decrease of functionality compared to patients who did not ambulate. RELEVANCE FOR PATIENTS: Based on this article, we can demonstrate that walking while still in the ICU environment favors less loss of functionality for patients after valve replacement surgery.

Repercussões da Pandemia de COVID-19 na Prática Assistencial de um Hospital Terciário / Repercussions of the COVID-19 Pandemic on the Care Practices of a Tertiary Hospital

Resumo Fundamento Ainda não temos informações acerca do impacto da pandemia da COVID-19 sobre a atividade médica assistencial no Brasil. Objetivo Descrever as repercussões da pandemia da COVID-19 na rotina de atendimentos em um hospital terciário, referência regional em cardiologia e oncologia. Métodos Estudo de corte transversal. Foi realizado levantamento dos atendimentos no período de 23/03/2020 (fechamento do comércio local) até 23/04/2020 (P20) e comparado com o mesmo período em 2019 (P19).Resultados: Detectamos redução no número de consultas cardiológicas, teste ergométrico, Holter, monitorização ambulatorial da pressão arterial, eletrocardiograma e ecocardiograma (90%, 84%, 94%, 92%, 94% e 81%, respectivamente). Em relação à cirurgia cardíaca e cateterismo cardíaco, houve redução de 48% e 60%, respectivamente. Aumento no número de angioplastia transluminal coronária (33%) e de implante de marca-passo definitivo (29%). Houve 97 internamentos na UTI em P19, contra 78 em P20, redução de 20%. Diminuição dos atendimentos no pronto-socorro cardiológico (45%) e nos internamentos na enfermaria de cardiologia (36%). Houve diminuição nas consultas oncológicas de 30%. Sessões de quimioterapia reduziram de 1.944 para 1.066 (45%). Sessões de radioterapia diminuíram 19%. Conclusão A COVID-19 provocou redução considerável no número de consultas nos ambulatórios de cardiologia, oncologia e demais especialidades. Houve uma preocupante diminuição no número de cirurgias cardíacas e nas sessões de quimioterapia e radioterapia nas semanas iniciais da pandemia. A procura por atendimento no pronto-socorro cardiológico, assim como as internações na UTI e enfermaria cardiológicas, também reduziram, gerando preocupação acerca da evolução e prognóstico destes pacientes portadores de outras patologias, que não a COVID-19, nestes tempos de pandemia. (Arq Bras Cardiol. 2020; [online].ahead print, PP.0-0)

Abstract Background We still do not have information regarding the impact of the COVID-19 pandemic on medical care activity in Brazil. Objective To describe the repercussions of the COVID-19 pandemic on the care routine of a tertiary hospital, which is a regional reference in cardiology and oncology. Methods Cross-sectional cohort study. We conducted a survey of medical visits from March 23, 2020 (when local commerce was closed) to April 23, 2020 (P20), in comparison with the same period in 2019 (P19). Results We found decreases in the number of cardiology consultations, exercise tests, Holter, ambulatory blood pressure monitoring, electrocardiogram, and echocardiogram (90%, 84%, 94%, 92%, 94%, and 81%, respectively). In relation to cardiac surgery and cardiac catheterization, there were 48% and 60% decreases, respectively. There was an increase in the number of percutaneous transluminal coronary angioplasties (33%) and definitive pacemaker implantations (29%). There were 97 admissions to the ICU during P19, in contrast with 78 during P20, a 20% decrease. Visits to the cardiac emergency room (45%) and admissions to the cardiology ward (36%) also decreased. The decrease in oncology consultations was 30%. Chemotherapy sessions decreased from 1,944 to 1,066 (45%), and radiotherapy sessions decreased by 19%. Conclusion COVID-19 has led to a considerable decrease in the number of consultations in outpatient clinics for cardiology, oncology, and other specialties. There was a concerning decrease in the number of cardiac surgeries, chemotherapy sessions, and radiotherapy sessions during the initial weeks of the pandemic. The number of people seeking care in the cardiac emergency room and the number of admissions to the cardiology ward and ICU also decreased, generating concern regarding the evolution and prognosis of these patients with pathologies other than COVID-19 during this pandemic time. (Arq Bras Cardiol. 2020; [online].ahead print, PP.0-0)

Repercussions of the COVID-19 Pandemic on the Care Practices of a Tertiary Hospital. / Repercussões da Pandemia de COVID-19 na Prática Assistencial de um Hospital Terciário.

BACKGROUND: We still do not have information regarding the impact of the COVID-19 pandemic on medical care activity in Brazil. OBJECTIVE: To describe the repercussions of the COVID-19 pandemic on the care routine of a tertiary hospital, which is a regional reference in cardiology and oncology. METHODS: Cross-sectional cohort study. We conducted a survey of medical visits from March 23, 2020 (when local commerce was closed) to April 23, 2020 (P20), in comparison with the same period in 2019 (P19). RESULTS: We found decreases in the number of cardiology consultations, exercise tests, Holter, ambulatory blood pressure monitoring, electrocardiogram, and echocardiogram (90%, 84%, 94%, 92%, 94%, and 81%, respectively). In relation to cardiac surgery and cardiac catheterization, there were 48% and 60% decreases, respectively. There was an increase in the number of percutaneous transluminal coronary angioplasties (33%) and definitive pacemaker implantations (29%). There were 97 admissions to the ICU during P19, in contrast with 78 during P20, a 20% decrease. Visits to the cardiac emergency room (45%) and admissions to the cardiology ward (36%) also decreased. The decrease in oncology consultations was 30%. Chemotherapy sessions decreased from 1,944 to 1,066 (45%), and radiotherapy sessions decreased by 19%. CONCLUSION: COVID-19 has led to a considerable decrease in the number of consultations in outpatient clinics for cardiology, oncology, and other specialties. There was a concerning decrease in the number of cardiac surgeries, chemotherapy sessions, and radiotherapy sessions during the initial weeks of the pandemic. The number of people seeking care in the cardiac emergency room and the number of admissions to the cardiology ward and ICU also decreased, generating concern regarding the evolution and prognosis of these patients with pathologies other than COVID-19 during this pandemic time. (Arq Bras Cardiol. 2020; [online].ahead print, PP.0-0).

FUNDAMENTO: Ainda não temos informações acerca do impacto da pandemia da COVID-19 sobre a atividade médica assistencial no Brasil. OBJETIVO: Descrever as repercussões da pandemia da COVID-19 na rotina de atendimentos em um hospital terciário, referência regional em cardiologia e oncologia. MÉTODOS: Estudo de corte transversal. Foi realizado levantamento dos atendimentos no período de 23/03/2020 (fechamento do comércio local) até 23/04/2020 (P20) e comparado com o mesmo período em 2019 (P19).Resultados: Detectamos redução no número de consultas cardiológicas, teste ergométrico, Holter, monitorização ambulatorial da pressão arterial, eletrocardiograma e ecocardiograma (90%, 84%, 94%, 92%, 94% e 81%, respectivamente). Em relação à cirurgia cardíaca e cateterismo cardíaco, houve redução de 48% e 60%, respectivamente. Aumento no número de angioplastia transluminal coronária (33%) e de implante de marca-passo definitivo (29%). Houve 97 internamentos na UTI em P19, contra 78 em P20, redução de 20%. Diminuição dos atendimentos no pronto-socorro cardiológico (45%) e nos internamentos na enfermaria de cardiologia (36%). Houve diminuição nas consultas oncológicas de 30%. Sessões de quimioterapia reduziram de 1.944 para 1.066 (45%). Sessões de radioterapia diminuíram 19%. CONCLUSÃO: A COVID-19 provocou redução considerável no número de consultas nos ambulatórios de cardiologia, oncologia e demais especialidades. Houve uma preocupante diminuição no número de cirurgias cardíacas e nas sessões de quimioterapia e radioterapia nas semanas iniciais da pandemia. A procura por atendimento no pronto-socorro cardiológico, assim como as internações na UTI e enfermaria cardiológicas, também reduziram, gerando preocupação acerca da evolução e prognóstico destes pacientes portadores de outras patologias, que não a COVID-19, nestes tempos de pandemia. (Arq Bras Cardiol. 2020; [online].ahead print, PP.0-0).

Impact of lung expansion therapy using positive end-expiratory pressure in mechanically ventilated patients submitted to coronary artery bypass grafting

Abstract Objective: To evaluate the impact of different levels of positive end-expiratory pressure (PEEP) on gas exchange in patients undergoing coronary artery bypass grafting (CABG). Methods: A randomized clinical trial was conducted with patients undergoing CABG surgery. Patients were randomized into three groups: Group 10, PEEP of 10 cmH2O; Group 12, PEEP of 12 cmH2O; and Group 15, PEEP of 15 cmH2O. After the randomization, all patients underwent gas analysis at three moments: (1) before lung expansion therapy (LET); (2) 30 minutes after LET; and (3) one hour after extubation. Results: Sixty-six patients were studied, of which 61.7% were men, with mean age of 64 ± 8.9 years. Patients allocated to Group 15 showed a significant improvement in gas exchange comparing pre- and post-expansion values (239±21 vs. 301±19, P<0,001) and the increase was maintained after extubation (278±26). Despite the use of high levels of PEEP, no significant hemodynamic change was evidenced. Conclusion: It is concluded that high levels of PEEP (15 cmH2O) are beneficial for the improvement of gas exchange in patients undergoing CABG.

Impact of Lung Expansion Therapy Using Positive End-Expiratory Pressure in Mechanically Ventilated Patients Submitted to Coronary Artery Bypass Grafting.

OBJECTIVE: To evaluate the impact of different levels of positive end-expiratory pressure (PEEP) on gas exchange in patients undergoing coronary artery bypass grafting (CABG). METHODS: A randomized clinical trial was conducted with patients undergoing CABG surgery. Patients were randomized into three groups: Group 10, PEEP of 10 cmH2O; Group 12, PEEP of 12 cmH2O; and Group 15, PEEP of 15 cmH2O. After the randomization, all patients underwent gas analysis at three moments: (1) before lung expansion therapy (LET); (2) 30 minutes after LET; and (3) one hour after extubation. RESULTS: Sixty-six patients were studied, of which 61.7% were men, with mean age of 64 ± 8.9 years. Patients allocated to Group 15 showed a significant improvement in gas exchange comparing pre- and post-expansion values (239±21 vs. 301±19, P<0,001) and the increase was maintained after extubation (278±26). Despite the use of high levels of PEEP, no significant hemodynamic change was evidenced. CONCLUSION: It is concluded that high levels of PEEP (15 cmH2O) are beneficial for the improvement of gas exchange in patients undergoing CABG.

Behavior of pulmonary function after discharge in patients submitted to myocardial revascularization / Comportamento da função pulmonar após a alta em pacientes submetidos à revascularização do miocárdio

Background: Coronary artery bypass grafting (CABG) is a type of surgery where there is a compromise in one or more coronary arteries, with the objective of restoring function to the areas that have been compromised in the heart, possibly leading to respiratory compromise and postoperative complications. The return time of the pulmonary function to the preoperative condition is still indeterminate in the literature. Objective: To describe the behavior of pulmonary function after hospital discharge in patients submitted to CABG. Methods: This is a prospective cohort study. Only patients undergoing MRI, whose lung function was evaluated preoperatively, at hospital discharge and 30 days after surgery, were evaluated. This evaluation consisted of maximum inspiratory pressure (MIP) and expiratory (MEP), vital capacity (VC) and expiratory flow peak (EFP). Results: A total of 30 patients were evaluated, of which 18 (60%) were males, mean age 62 ± 9 years. A reduction in lung function from preoperative time to hospital discharge was observed in all variables. There was improvement in MIP (88 ± 9 vs 109 ± 5, p < 0.001), MEP (67 ± 10 for 90 ± 8, p < 0.001) and EFP (310 ± 59 for 390 ± 32, p < 0.001), high for review. At the time of the review, no variables returned to their preoperative value: MIP (116 ± 5 for 109 ± 5, p = 0.43), MEP (111 ± 8 for 90 ± 8, p < 0.001), VC (45 ± 12 for 39 ± 7, p = 0.33) and EFP (430 ± 40 for 390 ± 32, p < 0.001). Conclusion: It is concluded that MRI surgery reduces lung function and is not reestablished after 30 days of the procedure. Being the expiratory muscular force and the peak of expiratory flow the most affected

Associação da mecânica respiratória com a oxigenação e duração da ventilação mecânica no pós-operatório de cirurgia cardíaca / Association of respiratory mechanics with oxygenation and duration of mechanical ventilation after cardiac surgery

Fundamentos: A ventilação mecânica (VM) e a circulação extracorpórea (CEC) estão associadas a um declínio da mecânica pulmonar que pode impactar as trocas gasosas. Objetivo: Avaliar o impacto da mecânica pulmonar sobre a duração da VM e trocas gasosas no pós-operatório de cirurgia cardíaca. Métodos: Estudo de coorte realizado com pacientes submetidos a cirurgia cardíaca. Todos os pacientes foram submetidos a avaliação da mecânica pulmonar (complacência estática e resistência das vias aéreas) e gasometria arterial assim que admitidos à unidade de terapia intensiva (UTI) e foram acompanhados até o momento da extubação e, em seguida, até a alta hospitalar. Para correlacionar as variáveis preditoras com o desfecho, foi utilizado o teste de Pearson. Valores de p < 0,05 foram considerados significativos. Resultados: O estudo incluiu 50 pacientes (46 mulheres, 52%), com idade média de 57,5 ± 13,5 anos. A duração da VM foi de 7,7 ± 3,0 horas, a complacência estática foi de 35,5 ± 9,1 cm H2O, a resistência foi de 6,0 ± 2,3 cm H2O, a duração média de estadia na UTI foi de 2,9 ± 1,1 dias e o índice de oxigenação foi de 228,0 ± 33,4 mmHg. Não houve uma correlação significativa entre a duração da VM e a complacência estática (p = 0,73), porém houve uma forte correlação entre a complacência estática e as trocas gasosas (r = 0,8, p < 0,001). Conclusão: A mecânica pulmonar apresenta forte correlação com as trocas gasosas e fraca correlação com a duração da VM no pós-operatório de cirurgia cardíaca

Background: Mechanical ventilation (MV) and extracorporeal circulation (ECC) are associated with a decline in pulmonary mechanics that may affect gas exchange. Objective: To evaluate the impact of pulmonary mechanics on MV duration and gas exchange in the postoperative period of cardiac surgery. Methods: This was a cohort study in patients undergoing cardiac surgery. All patients underwent evaluation of pulmonary mechanics (static compliance and airway resistance) and arterial blood gas analysis upon admission to the intensive care unit (ICU) and were followed up until extubation and hospital discharge. Results: The study included 50 patients (46 women, 52%) with a mean age of 57.5 ± 13.5 years. The MV duration was 7.7 ± 3.0 hours, static compliance was 35.5 ± 9.1 cm H2O, resistance was 6.0 ± 2.3 cm H2O, mean length of ICU stay was 2.9 ± 1.1 days, and oxygenation index was 228.0 ± 33.4 mmHg. No significant correlation was found between MV duration and static compliance (p = 0.73), but a strong correlation was found between static compliance and gas exchange (r = 0.8 and p < 0.001). Conclusion: Pulmonary mechanics have a strong correlation with gas exchange and a weak correlation with MV duration after cardiac surgery