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1.
Braz J Cardiovasc Surg ; 35(1): 82-90, 2020 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-32270964

RESUMO

OBJECTIVE: To analyze the profile and outcomes of patients who underwent valve heart surgery in Brazil, using information retrieved from the Brazilian Registry of Cardiovascular Surgeries in Adults (BYPASS Registry) database. METHODS: This is a multicenter cohort study, evaluating 920 patients submitted to heart valve surgery. Demographics and postoperative clinical outcomes were assessed and compared to estimate mortality risk using the European System for Cardiac Operative Risk Evaluation (EuroSCORE). RESULTS: Isolated aortic valve replacement was the most frequently performed surgery (34%), followed by isolated mitral valve replacement (24.9%). Valve repair was performed in 21% of mitral procedures. Minimally invasive access was performed in 1.6% and the most frequent postoperative complications were arrhythmias (22.6%), infections (5.7%), and low-output syndrome (5.1%). Operations covered by the public health system accounted for 80.8% and the hospital mortality rate was 7.3%. CONCLUSION: The most frequent isolated valve surgery in Brazil is the aortic valve replacement by conventional open access and the rheumatic disease is still the main etiology for valve surgery. The BYPASS Registry has a fundamental role to provide information on the profile of patients with valve heart disease in our country in order to delineate adequate strategies for health promotion and resource allocation for cardiac surgery.

2.
Enferm Clin ; 2020 Apr 06.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-32273168

RESUMO

OBJECTIVE: To assess levels of medication adherence to antiplatelet and statins therapy among Acute Coronary Syndrome (ACS) patients 30 days after hospital discharge and identify the main barriers to medication adherence and the main sociodemographic and clinical variables associated with treatment adherence. METHOD: This was a quantitative longitudinal study. Patients admitted to hospital with Acute Coronary Syndrome were included. Initially, data collection was conducted using a semi-structured interview during the hospital stay. Thirty days after hospital discharge, the Brief Medication Questionnaire was applied by phone to assess treatment adherence. Descriptive statistics were used and tests were applied to analyze the association between medication adherence and clinical and sociodemographic data. RESULTS: One hundred and sixty-two patients were assessed. The Brief Medication Questionnaire test showed that 49.3% presented probable low adherence to treatment. Marital status, household income and alcohol intake showed an association with medication adherence. CONCLUSIONS: The findings of the present study indicate high rates of probable nonadherence to medication among Acute Coronary Syndrome patients 30 days after hospital discharge, this information could help nurses to choose specific nursing interventions that could improve adherence in patients' daily routines.

3.
Rev. bras. cir. cardiovasc ; 35(1): 82-90, Jan.-Feb. 2020. tab, graf
Artigo em Inglês | LILACS-Express | ID: biblio-1092463

RESUMO

Abstract Objective: To analyze the profile and outcomes of patients who underwent valve heart surgery in Brazil, using information retrieved from the Brazilian Registry of Cardiovascular Surgeries in Adults (BYPASS Registry) database. Methods: This is a multicenter cohort study, evaluating 920 patients submitted to heart valve surgery. Demographics and postoperative clinical outcomes were assessed and compared to estimate mortality risk using the European System for Cardiac Operative Risk Evaluation (EuroSCORE). Results: Isolated aortic valve replacement was the most frequently performed surgery (34%), followed by isolated mitral valve replacement (24.9%). Valve repair was performed in 21% of mitral procedures. Minimally invasive access was performed in 1.6% and the most frequent postoperative complications were arrhythmias (22.6%), infections (5.7%), and low-output syndrome (5.1%). Operations covered by the public health system accounted for 80.8% and the hospital mortality rate was 7.3%. Conclusion: The most frequent isolated valve surgery in Brazil is the aortic valve replacement by conventional open access and the rheumatic disease is still the main etiology for valve surgery. The BYPASS Registry has a fundamental role to provide information on the profile of patients with valve heart disease in our country in order to delineate adequate strategies for health promotion and resource allocation for cardiac surgery.

4.
Braz J Cardiovasc Surg ; 34(4): 484-487, 2019 08 27.
Artigo em Inglês | MEDLINE | ID: mdl-31454204

RESUMO

Placement of a mediastinal drain is a routine procedure following heart surgery. Postoperative bed rest is often imposed due to the fear of potential risk of drain displacement and cardiac injury. We developed an encapsulating stitch as a feasible, effective and low-cost technique, which does not require advanced surgical skills for placement. This simple, novel approach compartmentalizes the drain allowing for safe early mobilization following cardiac surgery.


Assuntos
Ponte de Artéria Coronária , Drenagem/instrumentação , Monitorização Neurofisiológica Intraoperatória/métodos , Mediastino/cirurgia , Complicações Pós-Operatórias/prevenção & controle , Drenagem/métodos , Estudos de Viabilidade , Ventrículos do Coração/lesões , Humanos , Derrame Pericárdico/prevenção & controle
5.
Rev. bras. cir. cardiovasc ; 34(4): 484-487, July-Aug. 2019. tab, graf
Artigo em Inglês | LILACS-Express | ID: biblio-1020488

RESUMO

Abstract Placement of a mediastinal drain is a routine procedure following heart surgery. Postoperative bed rest is often imposed due to the fear of potential risk of drain displacement and cardiac injury. We developed an encapsulating stitch as a feasible, effective and low-cost technique, which does not require advanced surgical skills for placement. This simple, novel approach compartmentalizes the drain allowing for safe early mobilization following cardiac surgery.

6.
J Sports Sci ; 37(12): 1420-1428, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30595098

RESUMO

Aim was to identify critical load (CL) in young and elderly apparently healthy male cohorts. To contrast the metabolic, cardiovascular and perceptual responses on CL according to age. We evaluated 12 young (23 ± 3 years) and 10 elderly (70 ± 2 years) apparently healthy active males, who underwent: (1) 1 repetition maximum (1RM) test on a 45° Leg Press; (2) on different days, three high-intensity resistance exercise constant load tests (60%, 75% and 90% 1RM) until fatigue (Tlim). Absolute values of both the CL asymptote and curvature constant (kg) were significantly lower in elderly subjects (P < 0.05). In contrast, elderly subjects demonstrated a significantly higher number of repetitions at CL when compared with young subjects (P < 0.05). As expected, oxygen uptake (VO2) and heart rate (HR) during maximal aerobic exercise testing were significantly reduced in older subjects. However, percent-predicted aerobic capacity were higher in older subjects (P < 0.05). In addition, blood lactate ([La-]) corrected to Tlim and rating of perceived exertion values were greater in younger subjects at all intensities (P < 0.05). These findings, despite reduced force production in older subjects, endurance-related parameters are well preserved according to age-adjusted percent-predicted values in apparently healthy males.


Assuntos
Envelhecimento , Exercício Físico/fisiologia , Treinamento de Resistência , Adulto , Idoso , Teste de Esforço , Frequência Cardíaca , Humanos , Ácido Láctico/sangue , Masculino , Fadiga Muscular , Consumo de Oxigênio , Esforço Físico , Adulto Jovem
7.
Disabil Rehabil ; 41(5): 534-540, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-29279000

RESUMO

PURPOSE: We aimed to investigate the ability of oxygen uptake kinetics to predict short-term outcomes after off-pump coronary artery bypass grafting. METHODS: Fifty-two patients aged 60.9 ± 7.8 years waiting for off-pump coronary artery bypass surgery were evaluated. The 6-min walk test distance was performed pre-operatively, while simultaneously using a portable cardiopulmonary testing device. The transition of oxygen uptake kinetics from rest to exercise was recorded to calculate oxygen uptake kinetics fitting a monoexponential regression model. Oxygen uptake at steady state, constant time, and mean response time corrected by work rate were analysed. Short-term clinical outcomes were evaluated during the early post-operative of off-pump coronary artery bypass surgery. RESULTS: Multivariate analysis showed body mass index, surgery time, and mean response time corrected by work rate as independent predictors for short-term outcomes. The optimal mean response time corrected by work rate cut-off to estimate short-term clinical outcomes was 1.51 × 10-3 min2/ml. Patients with slower mean response time corrected by work rate demonstrated higher rates of hypertension, diabetes, EuroSCOREII, left ventricular dysfunction, and impaired 6-min walk test parameters. The per cent-predicted distance threshold of 66% in the pre-operative was associated with delayed oxygen uptake kinetics. CONCLUSIONS: Pre-operative oxygen uptake kinetics during 6-min walk test predicts short-term clinical outcomes after off-pump coronary artery bypass surgery. From a clinically applicable perspective, a threshold of 66% of pre-operative predicted 6-min walk test distance indicated slower kinetics, which leads to longer intensive care unit and post-surgery hospital length of stay. Implications for rehabilitation Coronary artery bypass grafting is a treatment aimed to improve expectancy of life and prevent disability due to the disease progression; The use of pre-operative submaximal functional capacity test enabled the identification of patients with high risk of complications, where patients with delayed oxygen uptake kinetics exhibited worse short-term outcomes; Our findings suggest the importance of the rehabilitation in the pre-operative in order to "pre-habilitate" the patients to the surgical procedure; Faster oxygen uptake on-kinetics could be achieved by improving the oxidative capacity of muscles and cardiovascular conditioning through rehabilitation, adding better results following cardiac surgery.


Assuntos
Ponte de Artéria Coronária sem Circulação Extracorpórea/reabilitação , Doença da Artéria Coronariana , Esforço Físico , Teste de Caminhada/métodos , Idoso , Reabilitação Cardíaca/métodos , Ponte de Artéria Coronária sem Circulação Extracorpórea/métodos , Doença da Artéria Coronariana/metabolismo , Doença da Artéria Coronariana/fisiopatologia , Doença da Artéria Coronariana/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Consumo de Oxigênio , Período Perioperatório/métodos , Resultado do Tratamento
8.
Braz J Cardiovasc Surg ; 33(5): 469-475, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30517255

RESUMO

OBJECTIVE: To evaluate the sequential changes of hemodynamic and metabolic parameters in patients who underwent aorta no-touch off-pump coronary artery bypass surgery (OPCAB). METHODS: Prospective study involving twenty-seven consecutive patients who underwent aorta no-touch OPCAB. The FloTrac/PreSep/Vigileo™ system (Edwards Lifesciences) was used to continuously record heart rate (HR), mean arterial blood pressure (MABP), central venous pressure (CVP), continuous cardiac index (FCI), stroke volume (SV), stroke volume variation (SVV), and central venous oxygen saturation (ScvO2). The parameters were assessed 5 min before, during and 5 min after each anastomosis (left anterior descending [LAD], posterior descending [PD], obtuse marginal [OM] and diagonal [Dg]). Postoperative lactate was also evaluated. RESULTS: There was no significant change in HR and MABP for all anastomoses, except for MABP during PD grafting (-10.1±2.7 mmHg, P=0.03). There was a significant decrease in ScvO2 only during PD and OM anastomoses (-9.4±0.4, P=0.03; -4.4±0.4, P=0.02; respectively). CVP drop after PD manipulation was strongly associated with a higher lactate during the first hours after surgery (r=-0.82; P=0.001). These hemodynamic changes were transient and entirely recovered after the heart was returned to its anatomical position. No significant differences were observed in FCI, SVV, or the systemic vascular resistance index (SVRI) during all anastomoses, except for a drop in SVRI during PD grafting (-8.03±2.3, P=0.007). SV tended to decrease during the procedure in all territories, but with statistically significant drop only in PD and OM grafting (-10.4±1.2, P=0.02; -13.6±5.1, P=0.007; respectively). CONCLUSION: Heart displacement for performing aorta no-touch OPCAB is well tolerated, with transient and endurable hemodynamic variations.


Assuntos
Anastomose Cirúrgica/métodos , Pressão Sanguínea/fisiologia , Ponte de Artéria Coronária sem Circulação Extracorpórea , Doença das Coronárias/cirurgia , Volume Sistólico/fisiologia , Doença das Coronárias/fisiopatologia , Feminino , Hemodinâmica , Humanos , Masculino , Pessoa de Meia-Idade , Monitorização Intraoperatória , Projetos Piloto , Estudos Prospectivos , Resultado do Tratamento
9.
Rev. bras. cir. cardiovasc ; 33(5): 469-475, Sept.-Oct. 2018. tab, graf
Artigo em Inglês | LILACS-Express | ID: biblio-977461

RESUMO

Abstract Objective: To evaluate the sequential changes of hemodynamic and metabolic parameters in patients who underwent aorta no-touch off-pump coronary artery bypass surgery (OPCAB). Methods: Prospective study involving twenty-seven consecutive patients who underwent aorta no-touch OPCAB. The FloTrac/PreSep/Vigileo™ system (Edwards Lifesciences) was used to continuously record heart rate (HR), mean arterial blood pressure (MABP), central venous pressure (CVP), continuous cardiac index (FCI), stroke volume (SV), stroke volume variation (SVV), and central venous oxygen saturation (ScvO2). The parameters were assessed 5 min before, during and 5 min after each anastomosis (left anterior descending [LAD], posterior descending [PD], obtuse marginal [OM] and diagonal [Dg]). Postoperative lactate was also evaluated. Results: There was no significant change in HR and MABP for all anastomoses, except for MABP during PD grafting (-10.1±2.7 mmHg, P=0.03). There was a significant decrease in ScvO2 only during PD and OM anastomoses (-9.4±0.4, P=0.03; -4.4±0.4, P=0.02; respectively). CVP drop after PD manipulation was strongly associated with a higher lactate during the first hours after surgery (r=-0.82; P=0.001). These hemodynamic changes were transient and entirely recovered after the heart was returned to its anatomical position. No significant differences were observed in FCI, SVV, or the systemic vascular resistance index (SVRI) during all anastomoses, except for a drop in SVRI during PD grafting (-8.03±2.3, P=0.007). SV tended to decrease during the procedure in all territories, but with statistically significant drop only in PD and OM grafting (-10.4±1.2, P=0.02; -13.6±5.1, P=0.007; respectively). Conclusion: Heart displacement for performing aorta no-touch OPCAB is well tolerated, with transient and endurable hemodynamic variations.

10.
Braz J Cardiovasc Surg ; 33(3): 250-257, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30043917

RESUMO

OBJECTIVE: To compare the effects of extended- versus short-time noninvasive positive pressure ventilation on pulmonary function, tissue perfusion, and clinical outcomes in the early postoperative period following coronary artery bypass surgery in patients with preserved left ventricular function. METHODS: Patients were randomized into two groups according to noninvasive positive pressure ventilation intensity: short-time noninvasive positive pressure ventilation n=20 (S-NPPV) and extended-time noninvasive positive pressure ventilation n=21 (E-NPPV). S-NPPV was applied for 60 minutes during immediate postoperative period and 10 minutes, twice daily, from postoperative days 1-5. E-NPPV was performed for at least six hours during immediate postoperative period and 60 minutes, twice daily, from postoperative days 1-5. As a primary outcome, tissue perfusion was determined by central venous oxygen saturation and blood lactate level measured after anesthetic induction, immediately after extubation and following noninvasive positive pressure ventilation protocols. As a secondary outcome, pulmonary function tests were performed preoperatively and in the postoperative days 1, 3, and 5; clinical outcomes were recorded. RESULTS: Significant drop in blood lactate levels and an improvement in central venous oxygen saturation values in the E-NPPV group were observed when compared with S-NPPV group after study protocol (P<0.01). The E-NPPV group presented higher preservation of postoperative pulmonary function as well as lower incidence of respiratory events and shorter postoperative hospital stay (P<0.05). CONCLUSION: Prophylactic E-NPPV administered in the early postoperative period of coronary artery bypass surgery resulted in greater improvements in tissue perfusion, pulmonary function and clinical outcomes than S-NPPV, in patients with preserved left ventricular function. TRIAL REGISTRATION: Brazilian Registry of Clinical trial - RBR7sqj78 - http://www.ensaiosclinicos.gov.br.


Assuntos
Ponte de Artéria Coronária/métodos , Pneumopatias/prevenção & controle , Ventilação não Invasiva/métodos , Respiração com Pressão Positiva/métodos , Idoso , Análise de Variância , Ponte de Artéria Coronária/efeitos adversos , Feminino , Volume Expiratório Forçado , Humanos , Ácido Láctico/sangue , Tempo de Internação , Pneumopatias/sangue , Pneumopatias/etiologia , Masculino , Pessoa de Meia-Idade , Oxigênio/sangue , Complicações Pós-Operatórias/sangue , Complicações Pós-Operatórias/prevenção & controle , Fatores de Risco , Estatísticas não Paramétricas , Fatores de Tempo , Resultado do Tratamento , Capacidade Vital
11.
Respir Care ; 63(7): 879-885, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-29895702

RESUMO

BACKGROUND: The use of noninvasive ventilation in patients with left-ventricular dysfunction may increase cardiac performance by decreasing inspiratory effort and left-ventricular afterload. The aim of the present study was to evaluate the acute effects of noninvasive ventilation on central-venous oxygen saturation (Scv̄O2 ) and blood lactate in subjects with left-ventricular dysfunction during the early postoperative phase of coronary artery bypass grafting. METHODS: This study included 100 subjects during the postoperative phase of elective coronary artery bypass grafting. Blood samples, at 5 time points, were collected to assess tissue perfusion markers (ie, Scv̄O2 and blood lactate) as follows: (1) the intraoperative period (after anesthesia induction); (2) 20 min after ICU arrival, under intermittent mandatory ventilation; (3) 20 min after extubation with spontaneous breathing; (4) after 1 h of noninvasive ventilation; and (5) 20 min after discontinuation of noninvasive ventilation. RESULTS: A significant increase in the blood lactate and a drop in the Scv̄O2 were observed on arrival to the ICU compared with intraoperative values (P < .001). After extubation, during spontaneous breathing, the Scv̄O2 significantly decreased (P = .02), whereas the blood lactate increased, although not significantly (P = .21) compared with intermittent mandatory ventilation on arrival to the ICU. During the application of noninvasive ventilation, the Scv̄O2 significantly increased (P = .048) and the blood lactate significantly decreased (P = .008) compared with spontaneous breathing values after extubation. After noninvasive ventilation discontinuation, the Scv̄O2 and blood lactate did not change compared with measures taken during noninvasive ventilation; higher values of Scv̄O2 were maintained compared with those obtained after extubation (P < .001). CONCLUSIONS: The acute application of noninvasive ventilation improved Scv̄O2 and decreased the blood lactate in subjects with left-ventricular dysfunction during the early postoperative phase after coronary artery bypass grafting. (ClinicalTrials.gov registration NCT02767687.).


Assuntos
Ponte de Artéria Coronária/efeitos adversos , Ventilação não Invasiva , Complicações Pós-Operatórias/terapia , Disfunção Ventricular Esquerda/terapia , Adulto , Idoso , Gasometria , Feminino , Humanos , Ácido Láctico/sangue , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/sangue , Complicações Pós-Operatórias/etiologia , Período Pós-Operatório , Troca Gasosa Pulmonar , Resultado do Tratamento , Disfunção Ventricular Esquerda/sangue , Disfunção Ventricular Esquerda/etiologia
12.
Braz J Cardiovasc Surg ; 33(2): 176-182, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29898148

RESUMO

OBJECTIVE: The aim of this study is to characterize the presence of exercise oscillatory ventilation (EOV) and to relate it with other cardiopulmonary exercise test (CET) responses and clinical variables. METHODS: Forty-six male patients (age: 53.1±13.6 years old; left ventricular ejection fraction [LVEF]: 30±8%) with heart failure were recruited to perform a maximal CET and to correlate the CET responses with clinical variables. The EOV was obtained according to Leite et al. criteria and VE/VCO2 > 34 and peak VO2 < 14 ml/kg/min were used to assess patients' severity. RESULTS: The EOV was observed in 16 of 24 patients who performed the CET, as well as VE/VCO2 > 34 and peak VO2 < 14 ml/kg/min in 14 and 10 patients, respectively. There was no difference in clinical and CET variables of the patients who presented EOV in CET when compared to non-EOV patients. Also, there was no difference in CET and clinical variables when comparing patients who presented EOV and had a VE/VCO2 slope > 34 to patients who just had one of these responses either. CONCLUSION: The present study showed that there was an incidence of patients with EOV and lower peak VO2 and higher VE/VCO2 slope values, but they showed no difference on other prognostic variables. As well, there was no influence of the presence of EOV on other parameters of CET in this population, suggesting that this variable may be an independent marker of worst prognosis in HF patients.


Assuntos
Teste de Esforço/métodos , Exercício Físico/fisiologia , Insuficiência Cardíaca/fisiopatologia , Ventilação Pulmonar/fisiologia , Adulto , Idoso , Antropometria , Estudos Transversais , Volume Expiratório Forçado/fisiologia , Humanos , Masculino , Pessoa de Meia-Idade , Consumo de Oxigênio/fisiologia , Prognóstico , Valores de Referência , Índice de Gravidade de Doença , Estatísticas não Paramétricas , Volume Sistólico/fisiologia , Capacidade Vital/fisiologia
13.
Rev. bras. cir. cardiovasc ; 33(3): 250-257, May-June 2018. tab, graf
Artigo em Inglês | LILACS-Express | ID: biblio-958414

RESUMO

Abstract Objective: To compare the effects of extended- versus short-time noninvasive positive pressure ventilation on pulmonary function, tissue perfusion, and clinical outcomes in the early postoperative period following coronary artery bypass surgery in patients with preserved left ventricular function. Methods: Patients were randomized into two groups according to noninvasive positive pressure ventilation intensity: short-time noninvasive positive pressure ventilation n=20 (S-NPPV) and extended-time noninvasive positive pressure ventilation n=21 (E-NPPV). S-NPPV was applied for 60 minutes during immediate postoperative period and 10 minutes, twice daily, from postoperative days 1-5. E-NPPV was performed for at least six hours during immediate postoperative period and 60 minutes, twice daily, from postoperative days 1-5. As a primary outcome, tissue perfusion was determined by central venous oxygen saturation and blood lactate level measured after anesthetic induction, immediately after extubation and following noninvasive positive pressure ventilation protocols. As a secondary outcome, pulmonary function tests were performed preoperatively and in the postoperative days 1, 3, and 5; clinical outcomes were recorded. Results: Significant drop in blood lactate levels and an improvement in central venous oxygen saturation values in the E-NPPV group were observed when compared with S-NPPV group after study protocol (P<0.01). The E-NPPV group presented higher preservation of postoperative pulmonary function as well as lower incidence of respiratory events and shorter postoperative hospital stay (P<0.05). Conclusion: Prophylactic E-NPPV administered in the early postoperative period of coronary artery bypass surgery resulted in greater improvements in tissue perfusion, pulmonary function and clinical outcomes than S-NPPV, in patients with preserved left ventricular function. Trial Registration: Brazilian Registry of Clinical trial - RBR7sqj78 - http://www.ensaiosclinicos.gov.br

14.
J Thorac Cardiovasc Surg ; 156(4): 1554-1561, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-29803370

RESUMO

OBJECTIVE: To analyze the impact and severity of chronic obstructive pulmonary disease (COPD) on pulmonary function and postoperative clinical outcome based on the Global Initiative for Obstructive Lung Disease criteria in patients undergoing off-pump coronary artery bypass grafting (CABG). METHODS: Patients were allocated into 3 groups according to presence and severity of COPD: no or mild COPD (n = 144); moderate COPD (n = 77); and severe COPD (n = 30). Spirometry values were obtained preoperatively and on postoperative days (PODs) 2 and 5. The incidences of pneumonia and reintubation, time of mechanical ventilation, and length of postoperative hospital stay were recorded. RESULTS: Significant impairment in pulmonary function was observed in all groups on PODs 2 and 5 (P < .001). However, postoperative pulmonary dysfunction was significantly higher in the moderate and severe COPD groups compared with the no or mild COPD group (P < .05). On multivariable analysis, severe COPD was associated with an elevated risk for composite outcomes (odds ratio, 1.37; 95% confidence interval, 1.20-1.57; P < .001). A preoperative forced expiratory volume in 1 second (FEV1) <50% of the predicted value was associated with poor outcome. A significant negative correlation was found between FEV1 at POD 5 and postoperative length of stay (r = -0.5; P < .001). CONCLUSIONS: More severe COPD was associated with greater impairment in pulmonary function and worse clinical outcomes after off-pump CABG surgery. A preoperative FEV1 <50% of predicted value appears to be an important predictor of postoperative complications.


Assuntos
Ponte de Artéria Coronária sem Circulação Extracorpórea/efeitos adversos , Doença Pulmonar Obstrutiva Crônica/complicações , Feminino , Volume Expiratório Forçado , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Estudos Prospectivos , Índice de Gravidade de Doença , Capacidade Vital
15.
Rev. bras. cir. cardiovasc ; 33(2): 176-182, Mar.-Apr. 2018. tab, graf
Artigo em Inglês | LILACS-Express | ID: biblio-958398

RESUMO

Abstract Objective: The aim of this study is to characterize the presence of exercise oscillatory ventilation (EOV) and to relate it with other cardiopulmonary exercise test (CET) responses and clinical variables. Methods: Forty-six male patients (age: 53.1±13.6 years old; left ventricular ejection fraction [LVEF]: 30±8%) with heart failure were recruited to perform a maximal CET and to correlate the CET responses with clinical variables. The EOV was obtained according to Leite et al. criteria and VE/VCO2 > 34 and peak VO2 < 14 ml/kg/min were used to assess patients' severity. Results: The EOV was observed in 16 of 24 patients who performed the CET, as well as VE/VCO2 > 34 and peak VO2 < 14 ml/kg/min in 14 and 10 patients, respectively. There was no difference in clinical and CET variables of the patients who presented EOV in CET when compared to non-EOV patients. Also, there was no difference in CET and clinical variables when comparing patients who presented EOV and had a VE/VCO2 slope > 34 to patients who just had one of these responses either. Conclusion: The present study showed that there was an incidence of patients with EOV and lower peak VO2 and higher VE/VCO2 slope values, but they showed no difference on other prognostic variables. As well, there was no influence of the presence of EOV on other parameters of CET in this population, suggesting that this variable may be an independent marker of worst prognosis in HF patients.

16.
Clin Rehabil ; 32(1): 66-74, 2018 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-28633534

RESUMO

OBJECTIVE: To evaluate the impact of a short-term neuromuscular electrical stimulation program on exercise tolerance in hospitalized patients with advanced heart failure who have suffered an acute decompensation and are under continuous intravenous inotropic support. DESIGN: A randomized controlled study. SUBJECTS: Initially, 195 patients hospitalized for decompensated heart failure were recruited, but 70 were randomized. INTERVENTION: Patients were randomized into two groups: control group subject to the usual care ( n = 35); neuromuscular electrical stimulation group ( n = 35) received daily training sessions to both lower extremities for around two weeks. MAIN MEASURES: The baseline 6-minute walk test to determine functional capacity was performed 24 hours after hospital admission, and intravenous inotropic support dose was daily checked in all patients. The outcomes were measured in two weeks or at the discharge if the patients were sent back home earlier than two weeks. RESULTS: After losses of follow-up, a total of 49 patients were included and considered for final analysis (control group, n = 25 and neuromuscular electrical stimulation group, n = 24). The neuromuscular electrical stimulation group presented with a higher 6-minute walk test distance compared to the control group after the study protocol (293 ± 34.78 m vs. 265.8 ± 48.53 m, P < 0.001, respectively). Neuromuscular electrical stimulation group also demonstrated a significantly higher dose reduction of dobutamine compared to control group after the study protocol (2.72 ± 1.72 µg/kg/min vs. 3.86 ± 1.61 µg/kg/min, P = 0.001, respectively). CONCLUSION: A short-term inpatient neuromuscular electrical stimulation rehabilitation protocol improved exercise tolerance and reduced intravenous inotropic support necessity in patients with advanced heart failure suffering a decompensation episode.


Assuntos
Cardiotônicos/administração & dosagem , Terapia por Estimulação Elétrica , Tolerância ao Exercício/fisiologia , Insuficiência Cardíaca/fisiopatologia , Insuficiência Cardíaca/terapia , Adulto , Idoso , Feminino , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento , Teste de Caminhada
17.
Can J Cardiol ; 33(6): 785-791, 2017 06.
Artigo em Inglês | MEDLINE | ID: mdl-28545625

RESUMO

BACKGROUND: The purpose of this study was to evaluate respiratory muscle strength and endurance in the inpatient period in patients who recently experienced myocardial infarction (MI) and investigate the effects of a home-based walking program on respiratory strength and endurance in low-risk patients after MI. METHODS: Patients were randomized into a usual-care group (UCG) entailing regular care (n = 23) and an intervention group (IG) entailing an outpatient home-based walking program (n = 31). Healthy sex- and age-matched participants served as a control group for respiratory endurance variables. Respiratory muscle strength was evaluated through maximal inspiratory pressure (MIP) and endurance during the inpatient period, at 15 days, and at 60 days after MI. Submaximal functional capacity was determined by a 6-minute walk test (6MWT) at hospital discharge and 60 days after MI. RESULTS: Both groups showed impaired inspiratory muscle strength at hospital discharge. When compared with healthy individuals, after MI, patients had worse respiratory muscle endurance pressure (PTHmax = 73.02 ± 8.40 vs 44.47 ± 16.32; P < 0.05) and time (Tlim = 324.1 ± 12.2 vs 58.7 ± 93.3; P < 0.05). Only the IG showed a significant improvement in MIP and PTHmax at 15 days and 60 days after MI (P < 0.05). When comparing groups, the IG achieved higher values for MIP, PTHmax, and Tlim 15 and 60 days after MI (P < 0.01). The 60-day assessment revealed that the 6MWT distance and level of physical activity was significantly higher in the IG compared with the UCG. CONCLUSIONS: Low-risk patients recently experiencing MI demonstrate impaired MIP and respiratory endurance compared with healthy participants. A home-based walking program improved respiratory endurance and functional capacity.


Assuntos
Terapia por Exercício/métodos , Exercício Físico/fisiologia , Infarto do Miocárdio/reabilitação , Resistência Física/fisiologia , Caminhada/fisiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Força Muscular , Infarto do Miocárdio/fisiopatologia , Músculos Respiratórios/fisiopatologia , Estudos Retrospectivos , Resultado do Tratamento
18.
Cogitare enferm ; 22(1): 01-09, jan.-mar.2017.
Artigo em Inglês, Português | LILACS, BDENF - Enfermagem | ID: biblio-859812

RESUMO

Objetivou-se avaliar o nível de neuropatia periférica em pacientes diabéticos com síndrome coronariana aguda e sua associação com a intensidade dos sinais clínicos. Estudo prospectivo, transversal e quantitativo. Os dados foram coletados de novembro de 2015 a fevereiro de 2016 em um hospital na cidade de São Paulo. Foram analisados os sinais clínicos apresentados pelos pacientes com síndrome coronariana aguda portadores de diabetes mellitus e o nível de neuropatia periférica pela Escala de Sintomas Neuropáticos. Foram avaliados 50 pacientes, apresentaram dor precordial em aperto em 33 (66%) participantes, além da sudorese e dispneia. Sintomas neuropáticos foram identificados em 33 (66%) pacientes, não observada associação entre o nível de neuropatia e a intensidade dos sinais clínicos da síndrome coronariana aguda. A avaliação clínica realizada pelo enfermeiro em pacientes diabéticos com síndrome coronariana aguda deve ser feita de forma rigorosa, principalmente nos pacientes que podem apresentar sinais clínicos atípicos dependendo do grau de neuropatia periférica (AU).


This study aimed to assess the severity of peripheral neuropathy in diabetic patients with acute coronary syndrome and its association with the severity of clinical signs. Prospective, cross-sectional and quantitative study. Data were collected from November 2015 to February 2016 in a hospital in the city of São Paulo. The clinical signs of diabetic patients with acute coronary syndrome were analyzed and the intensity of peripheral neuropathy was assessed using the Neuropathic Symptom Score (NSS). Fifty patients were assessed, and 33 (66%) participants had precordial catch syndrome, as well as sweating and dyspnea. Neuropathic symptoms were also identified in 33 (66%) patients, and there was no association between intensity of neuropathy and intensity of clinical signs of acute coronary syndrome. The clinical assessment of diabetic patients with acute coronary syndrome by nurses should be very careful, especially in patients with atypical clinical signs, depending onthe degree of peripheral neuropathy (AU).


El objetivo fue evaluar el nivel de la neuropatía periférica en los pacientes diabéticos con síndrome coronario agudo y su asociación con la gravedad de los signos clínicos. Un estudio prospectivo, transversal y cuantitativo. Los datos fueron recolectados a partir de noviembre 2015 a febrero 2016 en un hospital de Sao Paulo. Se analizaron los signos clínicos observados en pacientes con síndrome coronario agudo, diabetes mellitus y el nivel de los síntomas Neuropatía periférica Neuropatía Scale. Se analizaron 50 pacientes tenían dolor en el pecho en 33 (66%) participantes, así como la sudoración y la disnea. síntomas neuropáticos se identificaron en 33 (66%) pacientes, y no hay asociación entre neuropatía y el nivel de intensidad de los signos clínicos de síndrome coronario agudo. La evaluación clínica llevada a cabo por la enfermera en pacientes diabéticos con síndrome coronario agudo debe realizarse con precisión, en particular en pacientes que pueden tener signos clínicos atípicos en función del grado de la neuropatía periférica (AU).


Assuntos
Humanos , Dor no Peito , Diabetes Mellitus , Neuropatias Diabéticas , Síndrome Coronariana Aguda , Infarto
19.
Int J Cardiol ; 231: 110-114, 2017 Mar 15.
Artigo em Inglês | MEDLINE | ID: mdl-28082094

RESUMO

BACKGROUND: Eisenmenger syndrome (ES) precipitates the extreme manifestation of pulmonary hypertension, which leads to severe functional limitation and poor quality of life. The propose of the current study was: 1) examined the acute effects of 40% oxygen supplementation during the 6-minute walk test (6MWT); and 2) evaluate the relation between exercise capacity and clinical cardiac parameters in patients with ES. METHODS: Thirty subjects were prospectively included; all were submitted to a 6MWT with compressed air and with 40% of oxygen. Heart rate recovery at the first minute (HRR1) and perceived effort Borg scale for dyspnea and lower limb fatigue were recorded in both tests scenarios. RESULTS: The 6MWT distance was modestly, negatively associated with pulmonary vascular resistance (PVR) [r=0.46, p=0.02]. Patients improved 6MWT distance (p<0.001) and exhibited a faster HRR1 (p<0.001) with 40% supplemental oxygen compared to compressed air. With 40% supplemental oxygen, subjects revealed lower dyspnea and lower limb fatigue compared to 6MWT without oxygen supplementation (p<0.001). The amount of change in the 6MWT distance from air to oxygen was moderate, positively associated with tricuspid annular plane systolic excursion (TAPSE) and right ventricular fractional area change (RVFAC) [r=0.50, p=0.03; r=0.64, p<0.001, respectively]. CONCLUSION: Acute 40% oxygen supplementation in patients with Eisenmenger syndrome led to an improvement in 6MWT distance, faster HRR1 and lower dyspnea and lower limb fatigue perception. Moreover, functional capacity was positively associated with right ventricular parameters.


Assuntos
Complexo de Eisenmenger/terapia , Tolerância ao Exercício/fisiologia , Frequência Cardíaca/fisiologia , Oxigenoterapia/métodos , Recuperação de Função Fisiológica/fisiologia , Resistência Vascular/fisiologia , Função Ventricular Direita/fisiologia , Adulto , Ecocardiografia , Complexo de Eisenmenger/fisiopatologia , Teste de Esforço , Feminino , Frequência Cardíaca/efeitos dos fármacos , Humanos , Masculino , Estudos Prospectivos
20.
Braz J Cardiovasc Surg ; 31(5): 358-364, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27982344

RESUMO

Objective: To compare pulmonary function, functional capacity and clinical outcomes amongst three groups of patients with left ventricular dysfunction following off-pump coronary artery bypass, namely: 1) conventional mechanical ventilation (CMV); 2) late open lung strategy (L-OLS); and 3) early open lung strategy (E-OLS). Methods: Sixty-one patients were randomized into 3 groups: 1) CMV (n=21); 2) L-OLS (n=20) initiated after intensive care unit arrival; and 3) E-OLS (n=20) initiated after intubation. Spirometry was performed at bedside on preoperative and postoperative days (PODs) 1, 3, and 5. Partial pressure of arterial oxygen (PaO2) and pulmonary shunt fraction were evaluated preoperatively and on POD1. The 6-minute walk test was applied on the day before the operation and on POD5. Results: Both the open lung groups demonstrated higher forced vital capacity and forced expiratory volume in 1 second on PODs 1, 3 and 5 when compared to the CMV group (P<0.05). The 6-minute walk test distance was more preserved, shunt fraction was lower, and PaO2 was higher in both open-lung groups (P<0.05). Open-lung groups had shorter intubation time and hospital stay and also fewer respiratory events (P<0.05). Key measures were significantly more favorable in the E-OLS group compared to the L-OLS group. Conclusion: Both OLSs (L-OLS and E-OLS) were able to promote higher preservation of pulmonary function, greater recovery of functional capacity and better clinical outcomes following off-pump coronary artery bypass when compared to conventional mechanical ventilation. However, in this group of patients with reduced left ventricular function, initiation of the OLS intra-operatively was found to be more beneficial and optimal when compared to OLS initiation after intensive care unit arrival.


Assuntos
Ponte de Artéria Coronária sem Circulação Extracorpórea , Doença da Artéria Coronariana/cirurgia , Volume Expiratório Forçado/fisiologia , Respiração Artificial/métodos , Disfunção Ventricular Esquerda/cirurgia , Capacidade Vital/fisiologia , Doença da Artéria Coronariana/fisiopatologia , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Espirometria , Resultado do Tratamento , Disfunção Ventricular Esquerda/fisiopatologia
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