Preditores clínicos de complicações em cirurgia cardíaca e os principais padrões de enfermagem na assistência / Clinical predictors of complications in heart surgery and the main nursing patterns in carepredictores clínicos de complicaciones en / Predictores clínicos de complicaciones en cirugía cardiaca y principales patrones de enfermería en la atención

OBJETIVO: Descrever o perfil e preditores de complicações no pós-operatório de revascularização do miocárdio de pacientes internados em unidade de terapia intensiva (UTI) e os principais diagnósticos, metas e intervenções de enfermagem. MÉTODO: Trata-se de uma pesquisa transversal e retrospectiva, realizada de agosto de 2019 a dezembro de 2020. Realizada em hospital especializado em cardiologia, participaram 300 elegíveis. Sob aprovação CAAE 26535819.5.0000.5462. RESULTADO: Das complicações foi sangramento (11,7%), Fibrilação atrial de alta resposta (11,6%) acidose metabólica (4,4%), congestão pulmonar (3,4%), derrame pleural (4,1%), óbito após 72h (3,7%). Identificou-se que o diagnóstico, meta e intervenção predominante foram (75,7%) Risco de Sangramento, (30,3%) Recuperação Cirúrgica pós-operatório imediato e (26%) Controle de Infecção. CONCLUSÃO: É imprescindível que o enfermeiro conheça os preditores de complicações no pós-operatório cardíaco e garanta a continuidade da assistência segura e de qualidade através do processo de enfermagem e raciocínio clínico (AU)

OBJECTIVE: To describe the profile and predictors of complications in the postoperative period of myocardial revascularization in ICU patients and the main diagnoses, goals and nursing interventions. METHOD: This is a cross-sectional and retrospective research held from August 2019 to December 2020. Performed in a hospital specializing in cardiology, 300 eligible participants. Under CAAE approval 26535819.5.0000.5462. RESULT: Complications were bleeding (11.7%), High-response atrial fibrillation (11.6%), metabolic acidosis (4.4%), pulmonary congestion (3.4%), pleural effusion (4.1%), death after 72h (3 .7%). It was identified that the diagnosis, goal and predominant intervention were (75.7%) Risk of Bleeding, (30.3%) Immediate Postoperative Surgical Recovery and (26%) Infection Control. CONCLUSION: It is essential that nurses know predictors of complications in the cardiac postoperative period and ensure the continuity of safe and quality care through the nursing process and clinical reasoning. (AU)

OBJETIVO: Describir el perfil y predictores de complicaciones en el postoperatorio de revascularización miocárdica em pacientes de UCI y los principales diagnósticos, objetivos e intervenciones de enfermería. MÉTODO: Se trata de uma investigación transversal y retrospectiva, celebrada de agosto de 2019 a diciembre de 2020. Realizado en un hospital especializado em cardiología, participaron 300 participantes elegibles. Bajo aprobación CAAE 26535819.5.0000.5462. RESULTADO: Las complicaciones fueron sangrado (11,7%), Fibrilación auricular de alta respuesta (11,6%), acidosis metabólica (4,4%), congestión pulmonar (3,4%), derrame pleural (4,1%), muerte a las 72h (3,7%). Se identificó que el diagnóstico, objetivo e intervención predominante fueron (75,7%) Riesgo de Sangrado, (30,3%) Recuperación Quirúrgica Postoperatoria Inmediata y (26%) Control de Infecciones. CONCLUSIÓN: Es fundamental que los enfermeiros conozcan predictores de complicaciones en el posoperatorio cardíaco y aseguren la continuidad de un cuidado seguro y de calidad a través del proceso de enfermeira y el raciocinio clínico. (AU)

Efecto de una intervención educativa de enfermería para reducir el dolor en el paciente con revascularización miocárdica durante el posoperatorio ambulatorio / Effect of an educational nursing intervention to reduce pain in patients with myocardial revascularization during the outpatient postoperative period

Introducción: Las necesidades que experimentan los pacientes en el postoperatorio de cirugía cardiaca van desde lo fisiológico hasta la esfera emocional. A nivel fisiológico el dolor es una necesidad insatisfecha, que repercute en otras necesidades como el sueño y la actividad física, el estado de ánimo, la adherencia terapéutica y la calidad de vida. Objetivo: Determinar el efecto de una intervención educativa de Enfermería comparada con el cuidado de enfermería convencional, para reducir el dolor del paciente de cirugía cardiaca en el posoperatorio ambulatorio en una Institución de alta complejidad en Cúcuta durante el II semestre del año 2020 y el I semestre del año 2021. Metodología: Estudio cuantitativo, cuasi experimental, con medición preprueba en el control posoperatorio realizado al tercer día y posprueba, con grupo de comparación, en pacientes con revascularización miocárdica de una institución de alta complejidad en Cúcuta, con muestreo probabilístico, aleatorio simple, con una muestra estimada de 40 pacientes para cada grupo. Para la recolección de la información se utilizó el cuestionario del dolor McGill (índice de valoración del dolor) (Cibersam, 1994) y el Inventario de la Ansiedad Rasgo, IDARE, previo diligenciamiento del consentimiento informado, se realizaron mediciones del dolor al tercer día de posoperatorio ambulatorio, a los 15 y 30 días de entrega de la intervención educativa, para determinar el efecto de la intervención entre grupos e intragrupo frente al cuidado convencional. Resultados: El grupo experimental exhibió una reducción estadísticamente significativa de los niveles del dolor para cada una de las dimensiones y a nivel general luego de la intervención educativa (p< 0.05) mientras que en el grupo de comparación no hubo cambios importantes en los niveles de dolor entre ambas mediciones (p > 0.05). También se pudo establecer que el grupo experimental exhibió una reducción estadísticamente significativa de los niveles de ansiedad para cada una de las dimensiones y a nivel general luego de la intervención educativa (p< 0.05) contrario al grupo de comparación, donde se evidenció un aumento en el nivel de ansiedad, aunque sin diferencias importantes respecto de la medición inicial (p > 0.05). (AU)

Manual educativo de cuidados no pós-operatório de revascularização miocárdica: uma ferramenta para pacientes e familiares / Educational manual for the care of patients in the post-operative period of myocardial revascularization: a tool for patients and families

Elaborou-se um manual educativo para o autocuidado de pacientes revascularizados após a alta hospitalar. Trata-se de um estudo metodológico cuja coleta ocorreu entre fevereiro e abril de 2012 junto a oito peritos em cardiologia e 35 pacientes/familiares. Realizou-se a validação de conteúdo e de face junto a oito pacientes/familiares e oito peritos. Dos 46 itens propostos, os pacientes/familiares classificaram 26 itens (57%) como muito importante (concordância entre 91,4% e 100%) e os peritos 29 itens (63%) como muito importante (concordância igual ou superior a 75%). Selecionaram-se 36 itens distribuídos em 26 categoriais para o manual final. Houve 100% de concordância de pacientes/familiares e peritos quanto ao conteúdo, linguagem e ilustrações. A ferramenta apresentou validade semântica e adequação de conteúdo para a população, sendo capaz de reduzir complicações decorrentes do despreparo para o autocuidado, reduzindo o número de reinternações e os custos hospitalares, além de sistematizar o ensino pós-operatório.

An educational manual for the self-care of revascularized patients after hospital discharge was created. It is a methodological study whose data collection occurred between February and April, 2012, with eight cardiology experts and 35 patients/families. Content and face validation were conducted with eight patients/families and eight experts. Of the proposed 46 items, patients/families rated 26 items (57%) as very important (agreement between 91.4% and 100%) and experts rated 29 items (63%) as very important (agreement equal to or over 75%). Thirty-six items, distributed in 26 categories, were selected for the final manual. There was 100% agreement between patients/families regarding content, language, and illustrations. The tool presented semantic validity and content adequacy for the population, because it was able to reduce complications resulting from lack of training for self-care, thus reducing the number of readmissions and hospital costs, in addition to systematizing post-operative teaching.

O processo de viver a cirurgia de revascularização cardíaca: uma análise de gênero / The process of experiencing the coronary revascularization surgery: an analysis of gender

Objetivo: Analisar as vivências de homens e mulheres sobre a cirurgia de revascularização miocárdica na perspectiva de gênero. Métodos: Utilizou-se a Teoria Fundamentada nos Dados, através de entrevista com 17 participantes (pacientes e familiares) em um hospital referência em cardiologia no Sul do Brasil. Resultados: Homens e mulheres vivenciam de forma diferente a espera pela cirurgia, bem como o lazer e as relações sociais. Familiares são considerados um importante suporte para superar as mudanças na sexualidade após a cirurgia e a necessidade de se adaptar aos novos hábitos alimentares e à nova ocupação profissional. Conclusões: Percebe-se que há significativa diferença na forma como os gêneros lidam com as experiências vinculadas ao processo de viver a cirurgia de revascularização cardíaca, e que enfermeiros podem melhor planejar as orientações e cuidados de acordo com as peculiaridades de gênero.

Objetivo: Analizar las vivencias de hombres y mujeres con respecto a la cirugía de revascularización miocárdica en la perspectiva de género. Métodos: Se utilizó la Teoría Fundamentada de Datos, a través de entrevistas con 17 participantes (pacientes y familiares) en un hospital de referencia en cardiología en el sur de Brasil. Resultados: Hombres y mujeres sienten de manera diferente la espera por la cirugía, así como el tiempo libre y relaciones en sociedad. Los parientes son considerados un importante apoyo para superar los cambios en la sexualidad después de la cirugía y la necesidad de adaptarse a los nuevos hábitos alimentares y la nueva profesión. Conclusiones: Se observa una diferencia significante en la forma en que los géneros son afectados con la experiencia relacionada con el proceso de vivir la cirugía de revascularización cardíaca, y que los enfermeros pueden planificar mejor las orientaciones y cuidados según las peculiaridades de género.

Objective: To analyze the experiences of men and women on myocardial revascularization surgery in the perspective of gender. Methods: The Grounded Theory was used, including interviews with 17 participants (patients and families) in a referral hospital in cardiology in southern Brazil. Results: Men and women experience the wait for surgery, leisure and social relations differently. The family is considered as an important support to overcome the changes in sexuality after surgery and the need to adapt to new eating habits and a new occupation. Conclusions: It could be noted that there is a significant difference in how the genders deal with the experience of undergoing the process of myocardial revascularization surgery, and nurses can better plan the guidelines and care according to gender peculiarities.

Caracterización de pacientes en posoperatorio de revascularización miocárdica según eventos clínicos de cuidado de enfermería / Characterization of patients in postoperative period of myocardial revascularization according to clinical nursing care events", "_e": "n

Antecedentes: las enfermedades cardiovasculares constituyen la primera causa de morbimortalidad a nivel mundial y nacional; sobresale la enfermedad coronaria. Esto ha contribuido para que el tratamiento quirúrgico de revascularización miocárdica sea considerado como un procedimiento de rutina. Éste es uno de los avances más importantes de la medicina durante el siglo XX. En Bogotá, los registros estadísticos muestran que más del 50% del total de cirugías cardiovasculares corresponde a ella. Objetivo: realizar la caracterización de pacientes que se encuentran en posoperatorio temprano de revascularización miocárdica, quienes presentan cambios fisiológicos en su esfera biológica, secundarios al procedimiento, a nivel neurológico, cardiovascular, respiratorio, gastrointestinal, de eliminación y de la piel. Metodología: se realizó un estudio descriptivo, de seguimiento prospectivo. Se observaron y revisaron las historias clínicas de 151 pacientes en posoperatorio de 48 a 96 horas. La revisión de la historia clínica se realizó por el investigador. Se consignó la información en una hoja de registro de información y se procesó mediante métodos de análisis exploratorio multidimensional: análisis factorial de correspondencias múltiples combinado con el Método Cluster de Clasificación. Resultados: estuvieron relacionados con clases de pacientes de acuerdo con los eventos clínicos presentes en cada uno de los sistemas estudiados donde se evidencia que presentan alteración de los sistemas neurológico, cardiovascular, respiratorio y de la piel. Conclusión: la caracterización de los pacientes en posoperatorio de una revascularización miocárdica permite que el cuidado de enfermería sea enfocado hacia la solución de problemas de los sistemas antes mencionados.

Background: cardiovascular diseases are the leading cause of morbidity and mortality at global and national level; stands out coronary disease. This has contributed to make the surgical treatment of coronary artery bypass grafting being considered a routine procedure. This is one of the most important advances in medicine during the twentieth century. In Bogota, statistical records show that more than 50% of all cardiovascular surgeries corresponds to it. Objective: to characterize patients who are in early postoperative myocardial revascularization, who present physiological changes secondary to procedure, in the biological area at neurological, cardiovascular, respiratory, and gastrointestinal level, elimination system and skin. Methodology: a descriptive study was performed and followed prospectively. The medical records of 151 patients in postoperative 48 to 96 hours were seen and reviewed. The review of the medical history was performed by the researcher. The information was collected on a recording sheet and then recorded and processed by methods of multidimensional exploratory analysis: Multiple correspondence analysis combined with Cluster Classification Method. Results: they were related to the kind of patient according to clinical events present in each of the studied systems where there is evidence of alteration of the neurological, cardiovascular and respiratory systems, and skin. Conclusion: the characterization of patients in postoperative of myocardial revascularization allows nursing care to be focused on solving problems of the aforementioned systems.

Expectativas de pacientes submetidos à cirurgia de revascularização do miocárdio no momento da alta hospitalar / Expectativas de los pacientes sometidos a cirugía de revascularización miocárdica en el momento del alta hospitalaria / Expectations of patients submitted to myocardial revascularization surgery at the time of hospital discharge

Objective: recognizing the expectations of patients submitted to myocardium revascularization surgery at the time of hospital discharge. Method: a descriptive-exploratory study of aqualitative approach carried out with ten patients in post-operative myocardium revascularization surgery of a university hospital in the south of Brazil. The data were collected from July to August, 2012, through a semi-structured interview and were analyzed based on content analysis. Results: the results were grouped into a category that focuses on patients ' expectations facing the recovery process and returning to daily activities. It was found out that this phase is challenging for the subjects, in special with feelings of anxiety and worry about the future, besides having weaknesses in relation to the knowledge about changes of habits imposed by the process of illness. Conclusions: surgery causes a significant impact on the patients’ lives, thus being necessary the effective intervention by the nursing staff, in order to optimizing the recovery process.

Objetivo: conhecer as expectativas de pacientes submetidos à cirurgia de revascularização do miocárdio no momento da alta hospitalar. Método:estudo descritivo-exploratório de abordagem qualitativa, realizado com dez pacientes pós-cirúrgicos de revascularização miocárdica de um hospital universitário do sul do Brasil. Os dados foram coletados de julho a agosto de 2012, utilizando-se entrevista semiestruturada e analisados por meio de análise de conteúdo. Resultados: os resultados foram agrupados em uma categoria que versa sobre as expectativas dos pacientes frente ao processo de recuperação e retorno às atividades diárias. Evidenciou-se que essa fase mostra-se desafiadora para os sujeitos, sobressaindo-se sentimentos de ansiedade e preocupação com o futuro, além de terem fragilidades em relação ao conhecimento sobre as mudanças de hábitos impostas pelo processo de adoecimento. Conclusões: a cirurgia provoca um impacto significativo na vida dos pacientes, sendo necessária a intervenção efetiva da enfermagem, a fim de otimizar o processo de recuperação.

Manejo no farmacológico del dolor en pacientes en posoperatorio de revascularización miocárdica en UCI / Non-pharmacological pain management in postoperative myocardial revascularization patients in the ICU

Este es un estudio descriptivo, que tuvo como objetivo principal documentar y describir el manejo no farmacológico que le dan los enfermeros a los pacientes en PORVM en la UCI, determinar los métodos que utilizan y las características de la aplicación de las terapias no farmacológicas en este tipo de pacientes. Los principales resultados documentan que las técnicas no farmacológicas para el manejo del dolor en pacientes en posoperatorio de revascularización miocárdica, son utilizadas de forma poco frecuente y con limitaciones tales como: la falta de formación y educación en el tema, la falta de indicación terapéutica, las múltiples actividades en el horario laboral y por supuesto la falta de protocolos institucionales y guías de manejo donde se incluyan técnicas no farmacológicas, que estandaricen el manejo del dolor en el paciente en PORVM.

This is a descriptive study 's main objective was to document and describe the nonpharmacological management that give nurses to patients in the ICU PORVM determine the methods used and the characteristics of the implementation of non-pharmacological therapies in this patients. The main results documented that non -pharmacological pain management in patients with postoperative myocardial revascularization techniques are used infrequently and limitations such as lack of training and education on the subject, the lack of therapeutic indication, multiple activities in working hours and of course the lack of institutional management protocols and guidelines where no pharmacological techniques, to standardize the management of pain in patients in PORVM included.

O cotidiano de adultos e idosos após a revascularização miocárdica / El cotidiano de adultos y ancianos después de la revascularización miocárdica / The daily life of adults and elderly after myocardial revascularization

Objective: To describe the evidences on care needs and factors those influence the daily life of patients after myocardial revascularization surgery. Method: An integrative review of literature, with data collection at the database Latin American and Caribbean Literature in Health Sciences and Medical Literature Analysis and Retrieval System Online using the keywords "myocardial revascularization" and "patient discharge" or "everyday activities" or "rehabilitation" or "social adjustment" in January 2013. There were analyzed 12 articles those constituted the corpus of the study. Results: The results indicate that the day-to-day after surgery includes the need for changes in lifestyle. The negative repercussions of myocardial revascularization include anxiety, depression and medical monitoring and the positive factors the decrease of anginal symptoms. Conclusion: It was concluded that there is a lack of assistance from nursing professionals who contribute to the quality of life of revascularized patients by encouraging autonomy in the reconstruction of identity.

Objetivo: Descrever as evidências sobre as necessidades de cuidado e fatores que influenciam no cotidiano dos pacientes após a cirurgia de revascularização miocárdica. Método: Revisão integrativa da literatura, com coleta dos dados nas bases Literatura Latino-Americana e do Caribe em Ciências da Saúde e Medical Literature Analysis and Retrieval System Online utilizando os descritores "revascularização miocárdica” and “alta do paciente” or “atividades cotidianas” or “reabilitação” or “ajustamento social”, em janeiro de 2013. Foram analisados 12 artigos que constituíram o corpus do estudo. Resultados: Os resultados apontam que o dia-a-dia após cirurgia inclui a necessidade de mudanças no estilo de vida. As repercussões negativas da revascularização miocárdica incluem a ansiedade, depressão e acompanhamento médico e os fatores positivos a diminuição dos sintomas anginosos. Conclusão: Conclui-se que há carência de intervenções dos profissionais de enfermagem que contribuam na qualidade de vida dos indivíduos revascularizados, incentivando a autonomia na reconstrução da identidade.

Objetivo: Describir las evidencias sobre las necesidades de atención y los factores que influyen en la vida diaria de los pacientes después de la cirugía de revascularización miocárdica. Método: Revisión integrada de la literatura, con la recopilación de datos en las bases de Literatura Latina Americana y del Caribe en Ciencias de la Salud y Medical Literature Analysis and Retrieval System Online utilizando las palabras clave "revascularización miocárdica" and "descarga de paciente" or "actividades cotidianas" or "rehabilitación" or "ajuste social" en enero de 2013. Se analizaron 12 artículos que constituyen el corpus del estudio. Resultados: Los resultados indican que el día a día después de la cirugía incluye la necesidad de cambios en el estilo de vida. Los efectos negativos de la revascularización miocárdica son la ansiedad, la depresión y la vigilancia médica y los factores positivos son la disminución de los síntomas anginosos. Conclusión: Se concluye que existe una falta de asistencia de los profesionales de enfermería que contribuyan a la calidad de vida de los pacientes revascularizados mediante el fomento de la autonomía en la reconstrucción de la identidad.

Effectiveness of theory-based invitations to improve attendance at cardiac rehabilitation: a randomized controlled trial.

BACKGROUND: Despite well-established evidence of benefit from cardiac rehabilitation, typically fewer than 35% of eligible patients attend. OBJECTIVE: The purpose of this study was to evaluate whether theory-based invitations increase attendance at cardiac rehabilitation. METHOD: The study was a randomized controlled trial (RCT) with two by two factorial design. A total of 375 participants with acute myocardial infarction or coronary revascularization was recruited from medical and surgical cardiac wards at Aberdeen Royal Infirmary (ARI). They were randomly assigned to receive either the standard invitation letter or a letter with wording based on the 'theory of planned behavior (TPB)' and the 'common sense model of illness perception', and either a supportive leaflet with motivational messages or not. The primary outcome was one or more attendances at cardiac rehabilitation. RESULTS: The theory-based letter increased attendance at cardiac rehabilitation compared to the standard letter (84% versus 74%, odds ratio (OR) 2.93, 95% confidence interval (CI) 1.54-5.56), independent of age, gender, working status, hypertension, identity and TPB constructs. The number needed to treat (NNT) was 9 (95% CI 7-12). The motivational leaflet had no significant effect on attendance at rehabilitation (OR 1.02, 95% CI 0.57-1.83). CONCLUSIONS: The use of theory-based wording in invitation letters is a simple method to improve attendance at cardiac rehabilitation. Our letter, reproduced in this paper, could provide a template for practitioners and researchers.

Acidente vascular cerebral em paciente de pós operatório de cirurgia cardíaca de Revascularização do miocárdio: avaliação diagnóstica preditiva

O objeto deste estudo está pautado na avaliação diagnóstica de enfermagem na predição para o acometimento do acidente vascular cerebral no cliente em pós-operatório de Revascularização do Miocárdio. Os objetivos são estratificar os sinais e sintomas sugestivos do Acidente Vascular Cerebral em clientes de pós-operatório de Revascularização do Miocárdio descritos em prontuário; Analisar a aproximação entre a descrição dos sinais e sintomas sugestivos do Acidente Vascular Cerebral em clientes pós-operatório de Revascularização do Miocárdio e os diagnósticos de enfermagem com suas respectivas características definidoras segundo a Taxonomia NANDA II; Discutir a avaliação diagnóstica na predição para o acometimento de acidente vascular cerebral no cliente em pós-operatório de revascularização do miocárdio. Trata-se de um estudo Epidemiológico, transversal, de prevalência, tipo retrospectivo. O cenário institucional deste estudo foi constituído por um hospital público universitário. Os clientes que foram submetidos à revascularização do miocárdio e selecionados para a pesquisa corresponderam a um total de 76 prontuários, num recorte temporal de 2009 a 2010...

The object of this study is guided by the diagnostic evaluation of nursing in the prediction forthe onset of stroke on the client in the postoperative period of myocardial revascularization.The objectives are stratifying suggestive signs and symptoms of stroke in patients inpostoperative period of myocardial revascularization described in medical records; analyzethe rapprochement between the description of the suggestive signs and symptoms of stroke inclients in post-operative myocardial revascularization and nursing diagnoses with theirdefining characteristics according to NANDA Taxonomy II; discuss the diagnostic evaluationfor predicting the onset of stroke on the client in the postoperative period of CABG. This is anepidemiological study, cross-sectional prevalence, retrospective type. The institutional settingof this study consisted of a public hospital. Patients who underwent CABG and selected forthe study corresponded to a total of 76 records in a time frame from 2009 to 2010...

L'objet de cette étude est guidée par l'évaluation diagnostique des soins infirmiers dans laprédiction de la survenue de l'AVC sur le client dans la période post-opératoire de larevascularisation myocardique. Les objectifs sont de stratifier les signes et symptômesévocateurs d'AVC chez les patients en période postopératoire de la revascularisationmyocardique décrit dans les dossiers médicaux, d'analyser le rapprochement entre ladescription des signes et des symptômes évocateurs d'un AVC dans les clients post-opératoireet une revascularisation myocardique diagnostics infirmiers avec leurs caractéristiques quidéfinissent en fonction de la taxonomie NANDA II, discuter de l'évaluation diagnostique pourprédire la survenue de l'AVC sur le client dans la période post-opératoire de pontageaortocoronarien. Il s'agit d'une étude épidémiologique, la prévalence transversale, de typerétrospectif. Le cadre institutionnel de cette étude consistait en un hôpital public. Les clientsqui ont subi un PC et sélectionnés pour l'étude correspondait à un total de 76 dossiers dans unlaps de temps de 2009 à 2010...

Cirurgia robótica de revascularização miocárdica: em busca de evidência científica no uso da tecnologia do século XXI / Robotic surgery myocardial revascularization: in search of scientific evidence on using technology of the XXI century

Trata-se de uma revisão sistemática da literatura, que objetivou identificar evidências científicas relacionadas ao emprego de sistemas robóticos em cirurgias de revascularização do miocárdio. A busca foi realizada nas bases de dados LILACS, BDENF, MEDLINE E CINAHL, nos idiomas Inglês, Português e Espanhol, com recorte temporal de dez anos, utilizando-se os descritores: Robótica, procedimentos cirúrgicos cardíacos e Procedimentos cirúrgicos minimamente invasivos; na classificação do nível de evidência, foram considerados os níveis I a IV...

Evaluación del dolor postoperatorio agudo tras cirugía cardiaca / Evaluation of the postoperative acute pain after heart surgery

El dolor es uno de los principales síntomas referidos por los pacientes sometidos a cirugía cardiaca. Objetivos Describir el dolor y explicar la posible asociación entre determinadas variables sociodemográficas, psicológicas y biológicas de los pacientes sometidos a cirugía cardiaca con la intensidad de dolor durante el postoperatorio en UCI. Pacientes y método Estudio descriptivo longitudinal entre febrero de 2008 y enero de 2009 sobre pacientes sometidos a cirugía cardiaca con ingreso en la UCI del Hospital de Navarra previo consentimiento informado. Entrevista preoperatoria con registro de variables sociodemográficas, biológicas, psicológicas y de morbilidad. Dolor monitorizado durante las primeras 48 horas de estancia en UCI a través de la Escala Verbal Numérica (EVN) del dolor. Nivel de significación aceptado p<0,05.ResultadosMuestra de 69 pacientes con media de edad de 62 años; el 74%, hombres y el 26%, mujeres. Encontramos asociación estadística entre niveles de dolor postoperatorio superiores para las variables edad < 65 años, cirugía de revascularización con injerto de arteria mamaria interna y ansiedad preoperatoria. Existió un aumento significativo en el consumo analgésico para las variables renta > 1.400 euros/mes, cirugía de revascularización con injerto de arteria mamaria y ansiedad preoperatoria. Conclusiones El dolor postoperatorio tras cirugía cardiaca está sujeto a una gran variabilidad individual. En nuestro estudio, edad, cirugía de revascularización con injerto de arteria mamaria y ansiedad preoperatoria se mostraron como variables predictivas del dolor postoperatorio de los pacientes sometidos a cirugía cardiaca

Pain is one of the main symptoms reported by patients who have had heart surgery. Objectives To describe the pain and explain the possible association among demographics, psychological and biological variables of the patients subjected to heart surgery with pain intensity during the postoperative in the ICU. Patients and method A descriptive, longitudinal study conducted between February 2008 and January 2009 on patients subjected to heart surgery with admission to the ICU of the Hospital of Navarra was conducted. A preoperatory interview was made with registration of sociodemographic, biological and psychological variables. Pain intensity was monitored during the first 48hours of ICU stay with the Verbal Numeric Scale (VNS) of pain. Accepted level of significance was p<0.05.ResultsA sample of 69 patients with mean age of 62, 26% women and 74% men was included. A superior statistical association was found between postoperative pain levels for age<65 years, bypass grafting with internal mammary artery and preoperatory anxiety variables. There was a significant increase in analgesic consumption for incomes > 1400 €/month, bypass grafting with internal mammary artery and preoperatory anxiety. Conclusions Postoperative pain after heart surgery show significant individual variability. In our study, age, bypass grafting with internal mammary artery and preoperatory anxiety were shown as predictive variables of postoperative pain in patients undergoing heart surgery

Meta-analysis of long-term outcomes of drug-eluting stent implantations for chronic total coronary occlusions.

BACKGROUND: In the treatment of chronic total occlusions (CTOs), some uncertainty exists regarding the effect of drug-eluting stents (DESs) compared with the effects of bare mental stents (BMSs). We reviewed outcomes of DES vs. BMS implantation for CTO lesions, to evaluate the risk-benefit ratio of DES implantation. METHODS: Relevant studies of long-term clinical outcomes or angiographic outcomes of both BMS and DES implantation were examined. The primary endpoint comprised major adverse cardiovascular events (MACEs), including all-cause deaths, myocardial infarctions (MIs), and target lesion revascularizations (TLRs). A fixed-effect model and random-effect model were used to analyze the pooling results. RESULTS: Ten studies were included according to the selection criteria. Eight were nonrandomized controlled trials, and two consisted of a randomized controlled comparison between DES and BMS implantation. No significant difference was evident for in-hospital MACE rates between the two groups (odds ratio [OR], 1.07; 95% confidence interval [CI], .53 to 2.13), but the long-term MACE rates in the DES group were significantly lower than in the BMS group (OR, .22; 95% CI, .13 to .38; P < .00001). The rates of stent restenosis and reocclusions were also significantly lower in the DES group (OR, .14; 95% CI, .09 to .20; and OR, .23; 95% CI, .12 to .41, respectively). CONCLUSION: Implantation of the DES improves long-term angiographic and clinical outcomes compared with BMS in the treatment of CTO lesions.

[Third phase of cardiac rehabilitation: a nurse-based "home-control" model]. / Terza fase della riabilitazione: sperimentazione di un modello gestionale "home-control".

BACKGROUND: Phase 3 is a critical point for cardiac rehabilitation: many problems don't allow achieving a correct secondary prevention, in particular regarding the relationship between patient and cardiologist. Aiming at ensuring continuity of care of phase 3 cardiac rehabilitation patients, we have developed a telemetric educational program to stimulate in them the will and capacity to become active comanagers of their disease. METHODS: Nurses specialized in cardiac rehabilitation, with the collaboration of the general practitioners, contact the patients by scheduled phone calls to collect questionnaires about their health status and the result of biochemistry. All the results are analyzed by the nurses and discussed with each patient (educational reinforcement). The effects of this program of comanagement of cardiac disease and secondary prevention are analyzed comparing each patient data at the discharge with data after one year and those coming from our archive (retrospective analysis). RESULTS: The patients enrolled in this study pay much more attention to the amount of food they eat; they tend not to gain weight, and they restart smoking in a reduced proportion compared to patients not enrolled in the study. However, despite having received better information on their cardiac disease, their compliance to physical training, consumption of healthy food, and pharmacological therapy is not improved. CONCLUSIONS: This study focuses on the role of a continuous educational program of a cardiac rehabilitation unit after the patient's discharge. This home control program conducted by nurses specialized in cardiac rehabilitation, with the assistance of cardiologists, psychologists and physiotherapists, and in collaboration with the general practitioner, was quite cheap, and helped maximizing the knowledge of the disease and reinforcing correct life style in the patients. The results are not as good as expected, probably because one year does not represent a sufficient time, or because the educational intervention needs to be improved.

Translation and validation study of the Japanese versions of the Coronary Revascularisation Outcome Questionnaire (CROQ-J).

BACKGROUND AND AIMS: Assessing the health related quality of life (HRQOL) in patients with a disease specific scale is essential. The purpose of this study was to develop the Japanese version of the coronary revascularisation outcome questionnaire (CROQ), a disease-specific scale to measure HRQOL before and after coronary revascularisation. METHODS: The English version of the questionnaire was translated into Japanese; some terms were revised, and some items were eliminated to suit the Japanese medical environment. Eight patients filled out the questionnaire, which was then analyzed for face validity. In the field study, subjects were recruited from a university hospital in Tokyo, and questionnaires were given to fill out. In terms of statistical analysis, factor analysis, internal consistency, known-groups validity, concurrent validity with using Short-Form36 (SF-36) and Seattle Angina Questionnaire-Japanese version (SAQ-J), and test-retest reliability were assessed. RESULTS: Informed consents were obtained from 356 patients, and out of 325 patients responded in the field study (91.3%). The factor structure of CROQ-Japanese version (CROQ-J) was similar to that of the original version. Cronbach's α ranged from 0.78 to 0.92. The concurrent validity was mostly supported by the pattern of association between CROQ-J, SAQ-J, and SF-36. Patients without chest symptoms had significantly higher scores of CROQ-J than those with chest symptoms. On the basis of analysis of the test-retest reliability, intra-class correlation coefficients were close to 0.70. CONCLUSIONS: The Japanese translation of CROQ is a valid and reliable scale for assessing the patient's HRQOL in CAD.

Consulta de enfermagem: espaço para criação e utilização de protocolo para pacientes após revascularização miocárdica / Consulta de enfermería: espacio para la creación y utilización de protocolo para pacientes después de la revascularización del miocardio / Nursing consultation: space for creation and use of protocol for patients after myocardial revascularization

Estudo descritivo com objetivo de descrever um protocolo de consultas de enfermagem testado para pacientes após revascularização miocárdica. O protocolo, aplicado em uma unidade de cardiologia hospitalar, possui metas que devem ser atingidas no decorrer da consulta ou no período entre elas. Para o alcance de cada meta, foram estabelecidas as ações de enfermagem que devem ser executadas pelo enfermeiro, expostas em três quadros: Estratégias de consulta de enfermagem referente ao primeiro atendimento; Estratégias de consultas de enfermagem referente aos atendimentos nº 2, nº 3 e nº 4; Estratégias de consultas de enfermagem referente ao atendimento nº 5 referente ao sexto mês após a cirurgia. A partir da aplicação do protocolo foi possível realizar uma avaliação sistemática do paciente, levantando seus reais problemas para planejar e realizar intervenções de enfermagem, principalmente as relacionadas às mudanças comportamentais.

Estudio descriptivo con objetivo de describir un protocolo de consultas de enfermería testado para pacientes después de la revascularización del miocardio. El protocolo fue aplicado en unidad de cardiología hospitalaria, el cual posee metas que deben ser alcanzadas en el transcurso de la consulta o en el periodo entre ellas. Para el alcance de cada meta se establecieron las acciones de enfermería que deben ser ejecutadas por la enfermera, expuestos en tres cuadros: Estrategias de consulta de enfermería referentes al primer atendimiento; Estrategias de consultas de enfermería referentes a los atendimientos nº 2, nº 3 y nº 4; Estrategias referente al atendimiento nº 5 referente al sexto mes después de la cirugía. Se cree que la aplicación del protocolo posibilitará una evaluación sistemática del paciente, identificando sus reales problemas para la planificación y realización de intervenciones de enfermería, principalmente las relacionadas a los cambios de comportamiento.

A descriptive study aiming to describe a protocol for nursing consultation tested for patients after myocardial revascularization. The protocol is implemented in a hospital cardiac unit, has goals that must be achieved during the consultation period or in between. For reaching each goal have been established that nursing actions should be implemented by the nurse, displayed in three tables: Strategies for nursing consultation relating to the first care; Strategies for nursing consultations regarding the nursing visits nº 2, 3 and 4; Strategies for nursing consultations regarding the nursing visit nº 5 referring to the sixth month after surgery. It is believed that the implementation of the protocol allow a systematic evaluation of the patient, raising their real problems, for planning and implementation of nursing interventions, especially those related to behavioral changes.

Coronary revascularisation in chronic kidney disease. Part II: acute coronary syndromes.

Chronic kidney disease (CKD) is associated with a high burden of coronary artery disease, myocardial infarction and cardiovascular death. Management of patients with CKD presenting with acute coronary syndromes is more complex than in the general population, due to greater diagnostic uncertainty and the lack of direct evidence for therapeutic interventions in this specific population, coupled with concerns about therapy-related adverse effects. However, these patients potentially have much to gain from conventional revascularisation strategies used in the general population. This review summarises the current evidence regarding the treatment of patients with CKD presenting with acute coronary syndromes, in particular with respect to coronary revascularisation strategies.

[Nursing consultation: space for creation and use of protocol for patients after myocardial revascularization]. / Consulta de enfermagem: espaço para criação e utilização de protocolo para pacientes após revascularização miocárdica.

A descriptive study aiming to describe a nursing consultation protocol tested for patients after myocardial revascularization. The protocol is implemented in a hospital cardiac unit, has goals that must be achieved during the consultation period or in between. For reaching each goal, it has been established that nursing actions should be implemented by the nurse, displayed in three tables: Strategies for nursing consultation related to the first care; Strategies for nursing consultations related to the second, third and forth nursing visits; Strategies for nursing consultations related to the fifth nursing visit, referring to the sixth month after surgery. It is believed that the implementation of the protocol allows a systematic evaluation of the patient, raising their real problems, for planning and implementation of nursing interventions, especially those related to behavioral changes.