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1.
Enferm. actual Costa Rica (Online) ; (38): 75-88, Jan.-Jun. 2020. tab
Artigo em Português | LILACS, BDENF - Enfermagem | ID: biblio-1090088

RESUMO

Resumo Identificar o conhecimento de profissionais da saúde sobre a Lista de Verificação para Segurança Cirúrgica, os desafios e estratégias para sua implantação em uma instituição pública hospitalar. Trata-se de uma pesquisa quantitativa, de caráter descritivo, transversal. Realizada entre abril e maio de 2017, compreendeu o preenchimento de um questionário sobre o conhecimento e percepções do Protocolo de Cirurgia Segura por profissionais que atuam no centro cirúrgico. Os dados foram analisados considerando a estatística descritiva. 72 profissionais participaram do estudo, entre técnicos de enfermagem, enfermeiros, médicos e instrumentadores, a maioria conhecia o Protocolo e objetivos. A falta de adesão da equipe foi o principal desafio encontrado por esta equipe para utilização deste protocolo. Apontaram estratégias importantes que possivelmente subsidiariam a implantação da ferramenta na instituição. A hipótese do estudo foi confirmada, pois se constatou que os profissionais possuem conhecimento sobre a Lista de Verificação e a reconhecem como uma ferramenta que assegura a qualidade da assistência durante o período perioperatório, além de elencarem os principais desafíos para sua implantação.


Abstract The aim of this study was to identify the knowledge of health professionals about the Surgical Safety Checklist, the challenges and strategies for its implementation in a public hospital. This is a quantitative, descriptive, crosssectional research. Held between April and May 2017, it comprised the completion of a questionnaire about the knowledge and perceptions of the Safe Surgery Protocol by professionals working in the operating room. Data were analyzed considering descriptive statistics. 72 professionals participated in the study, including nursing technicians, nurses, doctors and instructors, most knew the Protocol and objectives. The lack of adherence of the team was the main challenge encountered by this team to use this protocol. They pointed out important strategies that could possibly subsidize the implementation of the tool in the institution. The study hypothesis was confirmed, as it was found that professionals have knowledge about the Checklist and recognize it as a tool that ensures the quality of care during the perioperative period, and list the main challenges for its implementation.


Resumen El objetivo de este artículo fue identificar el conocimiento de los profesionales de la salud sobre la Lista de verificación de seguridad quirúrgica, los desafíos y las estrategias para su implementación en un hospital público. Esta es una investigación cuantitativa, descriptiva, transversal. Realizada entre abril y mayo de 2017, incluyó la realización de un cuestionario sobre el conocimiento y las percepciones del Protocolo de cirugía segura por parte de los profesionales que trabajan en el quirófano. Los datos fueron analizados considerando estadística descriptiva. 72 profesionales participaron en el estudio, incluidos técnicos de enfermería, enfermeras, médicos e instructores, la mayoría conocía el Protocolo y los objetivos. La falta de adherencia del equipo fue el principal desafío que encontraron para usar este protocolo. Señalaron estrategias importantes que posiblemente podrían subsidiar la implementación de la herramienta en la institución. Se confirmó la hipótesis del estudio, ya que se descubrió que los profesionales tienen conocimiento sobre la Lista de verificación y la reconocen como una herramienta que garantiza la calidad de la atención durante el período perioperatorio, y enumeran los principales desafíos para su implementación.


Assuntos
Humanos , Enfermagem de Centro Cirúrgico , Salas Cirúrgicas , Enfermagem Perioperatória , Brasil , Lista de Checagem , Segurança do Paciente
2.
Ann R Coll Surg Engl ; 102(5): 323-332, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32352836

RESUMO

INTRODUCTION: Several articles have been published about the reorganisation of surgical activity during the COVID-19 pandemic but few, if any, have focused on the impact that this has had on emergency and trauma surgery. Our aim was to review the most current data on COVID-19 to provide essential suggestions on how to manage the acute abdomen during the pandemic. METHODS: A systematic review was conducted of the most relevant English language articles on COVID-19 and surgery published between 15 December 2019 and 30 March 2020. FINDINGS: Access to the operating theatre is almost exclusively restricted to emergencies and oncological procedures. The use of laparoscopy in COVID-19 positive patients should be cautiously considered. The main risk lies in the presence of the virus in the pneumoperitoneum: the aerosol released in the operating theatre could contaminate both staff and the environment. CONCLUSIONS: During the COVID-19 pandemic, all efforts should be deployed in order to evaluate the feasibility of postponing surgery until the patient is no longer considered potentially infectious or at risk of perioperative complications. If surgery is deemed necessary, the emergency surgeon must minimise the risk of exposure to the virus by involving a minimal number of healthcare staff and shortening the occupation of the operating theatre. In case of a lack of security measures to enable safe laparoscopy, open surgery should be considered.


Assuntos
Abdome Agudo/cirurgia , Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/complicações , Salas Cirúrgicas/organização & administração , Pandemias , Pneumonia Viral/complicações , Procedimentos Cirúrgicos Operatórios/efeitos adversos , Abdome Agudo/complicações , Aerossóis/efeitos adversos , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/transmissão , Humanos , Controle de Infecções/métodos , Laparoscopia/efeitos adversos , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Pneumonia Viral/transmissão , Pneumoperitônio Artificial/efeitos adversos , Prática Profissional/organização & administração , Procedimentos Cirúrgicos Operatórios/métodos
3.
Clinics (Sao Paulo) ; 75: e1923, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32428115

RESUMO

The coronavirus disease (COVID-19) outbreak started in Wuhan, China, in December 2019, and evolved into a global problem in a short period. The pandemic has led to many social and health-care challenges. In this context, surgery is an area that is facing the need for many adaptations. In this systematic literature review, we analyzed different perspectives concerning this situation, aiming to provide recommendations that could guide surgeons and entities toward screening, elective and emergency surgeries, decision making, and operating room management. A computerized search in PubMed, Scopus, and Scientific Electronic Library Online (SciELO) for relevant literature up to April 4, 2020, was performed. Articles were included if they were related to surgery dynamics in the context of the COVID-19 pandemic. Of the 281 articles found in our initial search and 15 articles from alternative sources, 39 were included in our review after a systematic evaluation. Concerning preoperative testing for severe acute respiratory syndrome coronavirus 2 infection, 29 (74.4%) articles recommended some kind of screening. Another major suggestion was postponing all (or at least selected) elective operations (29 articles, 74.4%). Several additional recommendations with respect to surgical practice or surgical staff were also assessed and discussed, such as performing laparoscopic surgeries and avoiding the use of electrocauterization. On the basis of the current literature, we concluded that any surgery that can be delayed should be postponed. COVID-19 screening is strongly recommended for all surgical cases. Moreover, surgical staff should be reduced to the essential members and provided with institutional psychological support.


Assuntos
Betacoronavirus , Infecções por Coronavirus/prevenção & controle , Tomada de Decisões , Salas Cirúrgicas/organização & administração , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Procedimentos Cirúrgicos Operatórios/normas , Infecções por Coronavirus/epidemiologia , Humanos , Pneumonia Viral/epidemiologia , Procedimentos Cirúrgicos Operatórios/estatística & dados numéricos , Triagem/métodos
8.
Can J Anaesth ; 67(6): 732-745, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32162212

RESUMO

The coronavirus disease 2019 (COVID-19) outbreak has been designated a public health emergency of international concern. To prepare for a pandemic, hospitals need a strategy to manage their space, staff, and supplies so that optimum care is provided to patients. In addition, infection prevention measures need to be implemented to reduce in-hospital transmission. In the operating room, these preparations involve multiple stakeholders and can present a significant challenge. Here, we describe the outbreak response measures of the anesthetic department staffing the largest (1,700-bed) academic tertiary level acute care hospital in Singapore (Singapore General Hospital) and a smaller regional hospital (Sengkang General Hospital). These include engineering controls such as identification and preparation of an isolation operating room, administrative measures such as modification of workflow and processes, introduction of personal protective equipment for staff, and formulation of clinical guidelines for anesthetic management. Simulation was valuable in evaluating the feasibility of new operating room set-ups or workflow. We also discuss how the hierarchy of controls can be used as a framework to plan the necessary measures during each phase of a pandemic, and review the evidence for the measures taken. These containment measures are necessary to optimize the quality of care provided to COVID-19 patients and to reduce the risk of viral transmission to other patients or healthcare workers.


Assuntos
Infecções por Coronavirus/transmissão , Transmissão de Doença Infecciosa/prevenção & controle , Controle de Infecções/normas , Salas Cirúrgicas/normas , Pandemias , Pneumonia Viral/transmissão , Centros de Atenção Terciária/normas , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Surtos de Doenças/prevenção & controle , Humanos , Pandemias/prevenção & controle , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Singapura/epidemiologia
9.
J Cardiothorac Vasc Anesth ; 34(5): 1125-1131, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32178954

RESUMO

OBJECTIVES: The aim of the present study was to prevent cross-infection in the operating room during emergency procedures for patients with confirmed or suspected 2019 novel coronavirus (2019-nCoV) by following anesthesia management protocols, and to document clinical- and anesthesia-related characteristics of these patients. DESIGN: This was a retrospective, multicenter clinical study. SETTING: This study used a multicenter dataset from 4 hospitals in Wuhan, China. PARTICIPANTS: Patients and health care providers with confirmed or suspected 2019-nCoV from January 23 to 31, 2020, at the Wuhan Union Hospital, the Wuhan Children's Hospital, The Central Hospital of Wuhan, and the Wuhan Fourth Hospital in Wuhan, China. INTERVENTIONS: Anesthetic management and infection control guidelines for emergency procedures for patients with suspected 2019-nCoV were drafted and applied in 4 hospitals in Wuhan. MEASUREMENTS AND MAIN RESULTS: Cross-infection in the operating rooms of the 4 hospitals was effectively reduced by implementing the new measures and procedures. The majority of patients with laboratory-confirmed 2019-nCoV infection or suspected infection were female (23 [62%] of 37), and the mean age was 41.0 years old (standard deviation 19.6; range 4-78). 10 (27%) patients had chronic medical illnesses, including 4 (11%) with diabetes, 8 (22%) with hypertension, and 8 (22%) with digestive system disease. Twenty-five (68%) patients presented with lymphopenia, and 23 (62%) patients exhibited multiple mottling and ground-glass opacity on computed tomography scanning. CONCLUSIONS: The present study indicates that COVID 19-specific guidelines for emergency procedures for patients with confirmed or suspected 2019-nCoV may effectively prevent cross-infection in the operating room. Most patients with confirmed or suspected COVID 19 presented with fever and dry cough and demonstrated bilateral multiple mottling and ground-glass opacity on chest computed tomography scans.


Assuntos
Anestesia , Infecções por Coronavirus , Infecção Hospitalar , Serviços Médicos de Emergência , Controle de Infecções , Pandemias , Pneumonia Viral , Adolescente , Adulto , Idoso , Anestesia/métodos , Anestesia/normas , Betacoronavirus , Criança , Pré-Escolar , China , Doença Crônica , Comorbidade , Infecções por Coronavirus/complicações , Infecção Hospitalar/prevenção & controle , Serviços Médicos de Emergência/normas , Feminino , Humanos , Controle de Infecções/normas , Masculino , Pessoa de Meia-Idade , Salas Cirúrgicas , Pneumonia Viral/complicações , Guias de Prática Clínica como Assunto , Estudos Retrospectivos , Adulto Jovem
10.
Anaesthesist ; 69(4): 225-235, 2020 04.
Artigo em Alemão | MEDLINE | ID: mdl-32189015

RESUMO

The current outbreak of coronavirus disease (COVID-19) has reached Germany. The majority of people infected present with mild disease, but there are severe cases that need intensive care. Unlike other acute infectious diseases progressing to sepsis, the severe courses of COVID19 seemingly show prolonged progression from onset of first symptoms to life-threatening deterioration of (primarily) lung function. Diagnosis relies on PCR using specimens from the respiratory tract. Severe ARDS reflects the hallmark of a critical course of the disease. Preventing nosocomial infections (primarily by correct use of personal protective equipment) and maintenance of hospitals' operational capability are of utmost importance. Departments of Anaesthesia, Intensive Care and emergency medicine will envisage major challenges.


Assuntos
Anestesia Geral/métodos , Anestesiologistas , Infecções por Coronavirus , Cuidados Críticos/normas , Infecção Hospitalar , Controle de Infecções , Pandemias , Pneumonia Viral , Anestesia Geral/normas , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/transmissão , Infecção Hospitalar/prevenção & controle , Surtos de Doenças , Alemanha , Humanos , Controle de Infecções/métodos , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Salas Cirúrgicas , Pandemias/prevenção & controle , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Pneumonia Viral/transmissão
12.
Eur J Vasc Endovasc Surg ; 59(4): 654-660, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32061447

RESUMO

OBJECTIVE: To quantify the effects of different imaging settings on radiation exposure to the operator and surgical team in a hybrid operating room (OR). METHODS: Measurements to determine scatter radiation in different imaging and geometry settings using an anthropomorphic phantom were performed in a hybrid OR equipped with a robotic C arm interventional angiography system (Artis Zeego; Siemens Healthcare, Erlangen, Germany). The radiation dose (RD) was measured with seven calibrated Philips DoseAware active electronic dosimeters and a Raysafe Xi survey detector, which were placed at different locations in the hybrid OR. The evaluated set ups included low dose, medium dose, and high dose fluoroscopy for abdomen; fluoroscopy fade; roadmap; and digital subtraction angiography (DSA), all using 20 s exposures. The effect of magnification, tube angulation, field size, source to skin distance, and RADPAD protection shields were assessed. Finally RD during cone beam computed tomography (CBCT) was obtained. RESULTS: In the operator position the initial settings with low dose fluoroscopy caused a RD of 1.03 µGy. The use of fluorofade did not increase the radiation dose (1.02 µGy), whereas the roadmap increased it threefold (2.84 µGy). The RD with "normal fluoro" was 4.13 µGy and increased to 6.44 µGy when high dose fluoroscopy mode was used. Magnification or field size varying from 42 cm to 11 cm led the RD to change from 0.86 µGy to 2.10 µGy. Decreasing the field of view to 25% of the initial size halved the RD (0.48 µGy). The RDs for the left anterior oblique 30° and right anterior oblique 30° were 3.26 µGy and 1.63 µGy, respectively. DSA increased the cumulative dose 33 fold but the RADPAD shield decreased the DSA RD to 4.92 µGy. The RD for CBCT was 47.2 µGy. CONCLUSION: Radiation exposure to operator and personnel can be significantly reduced during hybrid procedures with proper radiation protection and dose optimisation. A set of six behavioural rules were established.


Assuntos
Exposição Ocupacional/prevenção & controle , Doses de Radiação , Dosímetros de Radiação , Proteção Radiológica , Angiografia Digital/métodos , Procedimentos Endovasculares/métodos , Humanos , Salas Cirúrgicas , Exposição à Radiação/prevenção & controle , Radiografia Intervencionista/métodos
13.
BMC Health Serv Res ; 20(1): 111, 2020 Feb 12.
Artigo em Inglês | MEDLINE | ID: mdl-32050960

RESUMO

BACKGROUND: The World Health Organization (WHO) Surgical Safety Checklist (SSC) has demonstrated beneficial impacts on a range of patient- and team outcomes, though variation in SSC implementation and staff's perception of it remain challenging. Precisely how frontline personnel integrate the SSC with pre-existing perioperative clinical risk management remains underexplored - yet likely an impactful factor on how SSC is being used and its potential to improve clinical safety. This study aimed to explore how members of the multidisciplinary perioperative team integrate the SSC within their risk management strategies. METHODS: An ethnographic case study including observations (40 h) in operating theatres and in-depth interviews of 17 perioperative team members was carried out at two hospitals in 2016. Data were analysed using content analysis. RESULTS: We identified three themes reflecting the integration of the SSC in daily surgical practice: 1) Perceived usefullness; implying an intuitive advantage assessment of the SSC's practical utility in relation to relevant work; 2) Modification of implementation; reflecting performance variability of SSC on confirmation of items due to precence of team members; barriers of performance; and definition of SSC as performance indicator, and 3) Communication outside of the checklist; including formal- and informal micro-team formations where detailed, specific risk communication unfolded. CONCLUSION: When the SSC is not integrated within existing risk management strategies, but perceived as an "add on", its fidelity is compromised, hence limiting its potential clinical effectiveness. Implementation strategies for the SSC should thus integrate it as a risk-management tool and include it as part of risk-management education and training. This can improve team learning around risk comunication, foster mutual understanding of safety perspectives and enhance SSC implementation.


Assuntos
Lista de Checagem , Assistência Perioperatória , Gestão de Riscos/organização & administração , Especialidades Cirúrgicas , Antropologia Cultural , Feminino , Pesquisa sobre Serviços de Saúde , Humanos , Masculino , Observação , Salas Cirúrgicas , Estudos Prospectivos , Pesquisa Qualitativa , Gestão de Riscos/métodos , Organização Mundial da Saúde
14.
Mutat Res ; 849: 503131, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-32087852

RESUMO

We have assessed chromosome-type aberrations and micronuclei in the peripheral lymphocytes of personnel working with C-arm fluoroscopy, multi-slice CT-scan, lithotripsy, and digital radiology medical procedures. The study population comprised of 46 exposed workers and 35 controls matched for age, gender, and other confounding factors. Chromosome-type aberrations and micronuclei were analyzed and compared with occupational dosimetry data. The highest frequency of both chromosome aberrations (1.62 CA/100 cells) and MN (MN = 7.47 ± 2.55) was observed in the operating room group. According to occupational dosimetry, surgeons and medical staff received 0-2.99 mSv over the previous year, well below the limit established by the International Committee on Radiation Protection. An increased level of chromosomal aberrations was observed among workers exposed in the operating rooms. We recommend that operating room radiation safety programs be improved and better supervised, in particular for orthopedic surgeons and personnel performing fluoroscopically guided procedures.


Assuntos
Aberrações Cromossômicas/efeitos da radiação , Fluoroscopia/efeitos adversos , Litotripsia/efeitos adversos , Micronúcleos com Defeito Cromossômico/efeitos da radiação , Exposição Ocupacional/análise , Tomografia Computadorizada por Raios X/efeitos adversos , Adulto , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Corpo Clínico Hospitalar , Pessoa de Meia-Idade , Salas Cirúrgicas , Doses de Radiação
16.
Br J Anaesth ; 124(3): e148-e154, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32000976

RESUMO

Modern healthcare is delivered by interprofessional teams, and good leadership of these teams is integral to safe patient care. Good leadership in the operating theatre has traditionally been considered as authoritative, confident and directive, and stereotypically associated with men. We argue that this may not be the best model for team-based patient care and promote the concept of inclusive leadership as a valid alternative. Inclusive leadership encourages all team members to contribute to decision-making, thus engendering more team cohesion, information sharing and speaking up, and ultimately enhancing team effectiveness. However, the relational behaviours associated with inclusive leadership are stereotypically associated with women and may not in fact be recognised as leadership. In this article we provide evidence on the advantages of inclusive leadership over authoritative leadership and explore gender stereotypes and obstacles that limit the recognition of inclusive leadership. We propose that operating teams rise above gender stereotypes of leadership. Inclusive leadership can elicit maximum performance of every team member, thus realising the full potential of interprofessional healthcare teams to provide the best care for patients.


Assuntos
Liderança , Salas Cirúrgicas , Equipe de Assistência ao Paciente , Estereotipagem , Humanos , Incerteza
18.
Revista de Enfermagem Referência ; 5(1): e19053, 01-01-2020. tab
Artigo em Português | BDENF - Enfermagem | ID: biblio-1095755

RESUMO

ENQUADRAMENTO: A qualidade em saúde é uma responsabilidade crescente, designadamente no bloco operatório, e está associada ao investimento de cada profissão, entre eles os enfermeiros. OBJETIVO: Avaliar a perceção dos enfermeiros sobre a qualidade em saúde, no bloco operatório, no âmbito da estrutura, processo e resultado. METODOLOGIA: Estudo descritivo, com uma amostra de 748 enfermeiros com pelo menos 2 anos de atividade no bloco operatório. Através de um questionário eletrónico foram aplicadas as escalas - Indicadores de Estrutura no Bloco Operatório (IEBO), Processos de Qualidade Assistencial no Bloco Operatório (PQABO) e Resultados de Qualidade no Bloco Operatório (RQBO). RESULTADOS: As melhores avaliações recaem sobre o resultado, em oposição, as avaliações mais baixas recaem sobre as dimensões da estrutura designadamente Circuitos no bloco operatório, Continuidade na assistência de enfermagem e Especificidades dos grupos profissionais. CONCLUSÃO: A avaliação da qualidade do bloco operatório assume real importância pelo papel preponderante que o enfermeiro pode desempenhar a este nível, designadamente planeando ações de correção e melhoria para a qualidade e segurança dos cuidados.


BACKGROUND: Quality in health is an emergent concern, particularly in surgical settings, and is associated with the investment of each profession, including nurses. OBJECTIVE: To evaluate nurses' perceptions of the quality in health in the operating room as regards structure, process, and outcome. METHODOLOGY: A descriptive study was conducted in a sample of 478 nurses working for at least 2 years in an operating room. An electronic questionnaire was applied, including the scales - Structure Indicators in the Operating Room (IEBO), Quality Care Processes in the Operating Room (PQABO), and Quality Outcomes in the Operating Room (RQBO). RESULTS: The highest evaluations occurred in outcomes. However, the structure dimensions, namely Circuits in the operating room, Continuity in nursing care, and Specificities of professional groups, had the lowest ratings. CONCLUSION: The evaluation of quality is essential because of the important role that nurses can play in these settings, namely in planning corrections and improvements for the quality and safety of care.


MARCO CONTEXTUAL: La calidad en la salud es una responsabilidad creciente, sobre todo en el quirófano, y está asociada a la inversión de cada profesión, incluido el personal de enfermería. OBJETIVO: Evaluar la percepción de los enfermeros sobre la calidad de la salud en el quirófano, en el ámbito de la estructura, el proceso y el resultado. METODOLOGÍA: Estudio descriptivo, con una muestra de 748 enfermeros con, por lo menos, 2 años de actividad en el quirófano. A través de un cuestionario electrónico se aplicaron las escalas - Indicadores de Estructura en el Quirófano (IEBO en portugués), Procesos de Calidad Asistencial en el Quirófano (PQABO) y Resultados de la Calidad en el Quirófano (RQBO). RESULTADOS: Las mejores evaluaciones se refieren al resultado, mientras que las evaluaciones más bajas se refieren a las dimensiones de la estructura, a saber, los Circuitos en el quirófano, la Continuidad en los cuidados de enfermería y las Especificidades de los grupos profesionales. CONCLUSIÓN: La evaluación de la calidad del quirófano tiene una importancia real debido al papel preponderante que puede desempeñar el enfermero en este nivel, en concreto, la planificación de acciones de corrección y mejora de la calidad y la seguridad de los cuidados.


Assuntos
Salas Cirúrgicas , Qualidade da Assistência à Saúde , Avaliação em Saúde , Enfermagem
19.
J Cardiothorac Surg ; 15(1): 1, 2020 Jan 06.
Artigo em Inglês | MEDLINE | ID: mdl-31906990

RESUMO

BACKGROUND: In pediatric cardiac anesthesiology, there is increased focus on minimizing morbidity, ensuring optimal functional status, and using health care resources sparingly. One aspect of care that has potential to affect all of the above is postoperative mechanical ventilation. Historically, postoperative ventilation was considered a must for maintaining patient stability. Ironically, it is recognized that mechanical ventilation may increase risk of adverse outcomes in the postoperative period. Hence, many institutions have advocated for immediate extubation or early extubation after many congenital heart surgeries which was first reported decades ago. METHODS: 637 consecutive patient charts were reviewed for pediatric patients undergoing cardiac surgery with cardiopulmonary bypass. Patients were placed into three groups. Those that were extubated in the operating room (OR) at the conclusion of surgery (Immediate Extubation or IE), those that were extubated within six hours of admission to the ICU (Early Extubation or EE) and those that were extubated sometime after six hours (Delayed Extubation or DE). Multiple variables were then recorded to see which factors correlated with successful Immediate or Early Extubation. RESULTS: Overall, 338 patients (53.1%) had IE), 273 (42.8%) had DE while only 26 patients (4.1%) had EE. The median age was 1174 days for the IE patients, 39 days for the DE patients, whereas 194 days for EE patients (p < 0.001). Weight and length were also significantly different in at least one extubation group from the other two (p < 0.001). The median ICU LOS was 3 and 4 days for IE and EE patients respectively, whereas it was 9.5 days for DE patients (p < 0.001). DE group had a significant longer median anesthesia time and cardiopulmonary bypass time than the other two extubation groups (p > 63,826.88 < 0.001). Regional low flow perfusion, deep hypothermia, deep hypothermic circulatory arrest, redo sternotomy, use of other sedatives, furosemide, epinephrine, vasopressin, open chest, cardiopulmonary support, pulmonary edema, syndrome, as well as difficult intubation were significantly associated with delayed extubation (IE, EE or DE). CONCLUSIONS: Immediate and early extubation was significantly associated with several factors, including patient age and size, duration of CPB, use of certain anesthetic drugs, and the amount of blood loss and blood replacement. IE can be successfully accomplished in a majority of pediatric patients undergoing surgery for congenital heart disease, including in a minority of infants.


Assuntos
Extubação/métodos , Procedimentos Cirúrgicos Cardíacos , Ponte Cardiopulmonar , Cardiopatias Congênitas/cirurgia , Intubação Intratraqueal/estatística & dados numéricos , Complicações Pós-Operatórias/epidemiologia , Anestesia/métodos , Criança , Pré-Escolar , Parada Circulatória Induzida por Hipotermia Profunda/estatística & dados numéricos , Diuréticos/uso terapêutico , Feminino , Furosemida/uso terapêutico , Humanos , Hipnóticos e Sedativos/uso terapêutico , Lactente , Unidades de Terapia Intensiva Pediátrica , Tempo de Internação/estatística & dados numéricos , Masculino , Salas Cirúrgicas , Período Pós-Operatório , Edema Pulmonar/epidemiologia , Respiração Artificial , Fatores de Risco , Esternotomia , Fatores de Tempo , Vasoconstritores/uso terapêutico
20.
Unfallchirurg ; 123(2): 134-142, 2020 Feb.
Artigo em Alemão | MEDLINE | ID: mdl-31041476

RESUMO

BACKGROUND: For some years now, more and more hospitals in Germany have acquired so-called hybrid operating rooms. In these operating rooms it is possible to produce three-dimensional imaging during the operation. Originally developed for cardiovascular surgery, these rooms are increasingly being used for interdisciplinary purposes. Previous experiences in the use for trauma surgery and orthopedics has shown that three-dimensional imaging can have a positive effect on the success of surgery. OBJECTIVE: Can minimally invasive operations on the spine benefit intraoperatively from three-dimensional imaging with respect to operating times and results? METHODS: Minimally invasive operations on the spine performed at the UKSH Campus Kiel between 2015 and 2018 in the hybrid operating room were considered. These were compared to minimally invasive spinal surgery performed in conventional operating rooms. RESULTS: As is usual with the establishment of a new procedure, there are initially longer operating times. With regular use and appropriate training and experience of the personnel, the processes can be optimized. CONCLUSION: Due to the accuracy of the three-dimensional imaging, errors can be detected and eliminated at an early stage during the operation. Revisions are less frequent. In contrast, there is increased radiation exposure and sometimes longer operation and anesthesia times.


Assuntos
Salas Cirúrgicas , Procedimentos Ortopédicos , Ortopedia , Exposição à Radiação , Alemanha , Humanos
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