Soporte ventilatorio no invasivo como puente hacia el trasplante pulmonar: reporte de un caso / Bridging to lung transplant using noninvasive ventilatory support: a case report

El soporte ventilatorio no invasivo es una herramienta que ha demostrado mejorar la sobrevida de pacientes con falla muscular de la bomba respiratoria y el manejo de enfermedades pulmonares crónicas, incluso la ventilación no invasiva nocturna ha servido de puente hacia el trasplante pulmonar. Se presenta el caso de una adolescente de 14 años con enfermedad pulmonar crónica hipoxémica severa y falla ventilatoria secundaria, que requirió ventilación prolongada y traqueostomía en espera de trasplante pulmonar. Luego de reevaluar indemnidad de la vía aérea fue decanulada a soporte ventilatorio no invasivo, con uso alternado de mascarilla nasal nocturna y pieza bucal diurna, permitiendo descanso muscular respiratorio eficiente, y mejoría de flujo de tos con técnicas de apilamiento de aire. Este plan permitió una decanulación segura y realizar soporte continuo ventilatorio no invasivo con un programa de rehabilitación cardiorrespiratorio. Generalmente, el soporte ventilatorio no invasivo se utiliza en trastornos primarios de la bomba respiratoria. En este caso, se indicó para enfermedad pulmonar crónica hipoxémica, mostrando claros beneficios con oxigenación adecuada, buen rendimiento cardiovascular con mejor tolerancia al ejercicio y entrenamiento en el escenario de preparación al trasplante pulmonar.

Noninvasive Ventilatory Support has demonstrated to improve survival of patients with ventilatory pump muscle failure and nocturnal noninvasive ventilation is useful in chronic lung disease, even bridging to lung transplant. We present a 14 years old girl with severe hypoxemic chronic lung disease and secondary ventilatory failure, who required continuous long-term ventilation and underwent a tracheostomy waiting for lung transplant. After reevaluated the airway patency the patient was decannulated to Noninvasive Ventilation Support, alternating nocturnal nasal mask with diurnal mouth piece in order to provide efficient respiratory muscle rest, made air stacking and improved cough flow. This plan allows safe decannulation to continuous Noninvasive Ventilatory Support tailoring a rehabilitation cardiorespiratory program. Usually, Noninvasive Ventilation Support is prescribed for primary respiratory pump muscles failure, but in this case, it was applied for a hypoxemic chronic lung disease. Clear benefits were observed leading to appropriate oxygenation, good cardiovascular performance with better tolerance to exercise for training in the preparatory scenario of a lung transplant.

An easy and reliable way to prevent electrocardiographic deteriorations of patients undergoing off-pump coronary artery bypass surgery: preoperative anxiolytic treatment

Abstract Objective: To investigate the effects of preoperative anxiety relieving on electrophysiological changes in patients undergoing off-pump coronary artery bypass surgery. Methods: A total of 61 patients at ASA III risk group in the age range of 18-65 years were enrolled in the present study. Patients were randomly divided into two groups. Group S (Sedation group) was administered 0.04 mg/kg lorazepam per os (PO) twice before the operation. Group C (control group) was not administered with any anxiolytic premedication. State Trait Anxiety Inventory (STAI-I) and Beck Anxiety Inventory (BAI) were used to evaluate the level of anxiety. Electrocardiography (ECG), pulse oximeter and standard monitoring were performed for each patient. QT and P dispersions in each derivation of all ECGs were calculated. Results: Preoperative STAI-I scores were significantly lower in sedation group compared to the controls. Mean values of QT dispersion measured before induction, at the 1st minute of induction, 30th second of intubation and 4th minute of intubation in sedation group were significantly reduced compared to controls (P=0.024; P=0.027; P=0.001; P=0.033, respectively). The mean values of P dispersion measured before induction, at the 3rd minute of induction, 30th second of intubation and 4th minute of intubation in sedation group were significantly reduced compared to controls (P=0.001; P=0.020; P=0.023; P=0.005, respectively). Conclusion: Elevated anxiety levels in patients undergoing coronary bypass surgery have a negative effect through prolonged QT and P-wave dispersion times. Anxiolytic treatment before surgery may be useful to prevent ventricular and atrial arrhythmias and associated complications through decreasing the QT and P-wave dispersion duration.

Physiotherapeutic approaches and the effects on inspiratory muscle force in patients with chronic obstructive pulmonary disease in the pre-operative preparation for abdominal surgical procedures / Abordagens fisioterapêuticas e os efeitos na força muscular inspiratória em pacientes com doença pulmonar obstrutiva crônica no preparo para procedimentos cirúrgicos abdominais

ABSTRACT Background: Abdominal disorders can alter respiratory function and increase the morbidity and mortality of patients with chronic obstructive pulmonary disease. Aim: To improve the physiotherapeutic and muscular capacity in chronic obstructive pulmonary muscular inspiration in the preoperative preparation in abdominal surgeries. Method: Retrospective and documentary study using SINPE © , clinical database software of patients with chronic obstructive pulmonary disease and candidates to abdominal operation. The sample consisted of 100 men aged 55-70 years, all with chronic obstructive pulmonary disease who underwent preoperative physiotherapeutic treatment. They were divided into two groups of 50 individuals (group A and group B). In group A the patients were treated with modern mobility techniques for bronchial clearance and the strengthening of the respiratory muscles was performed with IMT ® Threshold. In group B the treatment performed for bronchial obstruction was with classic maneuvers and for the strengthening of the respiratory muscles for flow incentive was used Respiron ® . Results: Both groups obtained improvement in the values ​​of the PiMáx after the different treatments. Group A obtained greater change in the intervals and a more significant increase of the values of the PiMax in relation to the average pre and post-treatment. However, when analyzing the variance and the standard deviation of the samples, group B presented the best results showing more homogeneity. Conclusions: The modern and traditional bronchial clearance techniques associated with inspiratory muscle training were equally effective in gaining inspiratory muscle strength with increased Pmax. In this way, the two can be used in the preoperative preparation of patients with chronic obstructive pulmonary disease and referred to abdominal operations.

RESUMO Racional: As operações abdominais podem alterar a função respiratória e aumentar a morbimortalidade dos operados com doença pulmonar obstrutiva crônica. Objetivo: Avaliar que técnica fisioterapêutica apresenta melhor efeito na força muscular inspiratória dos pacientes com doença pulmonar obstrutiva crônica no preparo pré-operatório em operações abdominais. Método: Estudo retrospectivo e documental usando o SINPE©, software de banco de dados clínicos de pacientes portadores de doença pulmonar obstrutiva crônica e candidatos a operações abdominais. A amostra foi composta de 100 homens com idade entre 55-70 anos, todos com DPOC com indicação para operação abdominal e que realizaram tratamento fisioterapêutico pré-operatório. Foram divididos em dois grupos de 50 indivíduos (grupo A e grupo B). No grupo A o tratamento realizado para a desobstrução brônquica foi com técnicas modernas e para fortalecimento dos músculos respiratórios foi realizado o Threshold IMT®. No grupo B o tratamento realizado para desobstrução brônquica foi com técnicas tradicionais e para fortalecimento dos músculos respiratórios foi realizado incentivador a fluxo Respiron®. Resultados: Ambos os grupos obtiveram melhora dos valores da PiMáx (Pressão inspiratória Máxima) após o tratamento com abordagens diferentes com melhora também nos intervalos da PiMáx. O grupo A obteve maior mudança nos intervalos e aumento mais significativo dos valores da PiMáx em relação à média pré e pós tratamento. Porém, ao analisar a variância e o desvio-padrão das amostras, o grupo B apresentou melhor distribuição que o grupo A mostrando que seus resultados na amostra foram mais homogêneos. Conclusões: As técnicas modernas e tradicionais de desobstrução brônquica associadas ao treinamento muscular inspiratório mostraram-se igualmente eficazes no ganho de força dos músculos inspiratórios com aumento da PiMáx. Dessa forma as duas podem ser utilizadas no preparo pré-operatório de pacientes com DPOC e encaminhados para operações abdominais.

Being-patient-waiting-for-cardiac-surgery: the preoperative period under the Heideggerian perspective / Ser-paciente-a-espera-de-cirugía-cardiaca: el período preoperatorio en la perspectiva heideggeriana / Ser-paciente-à-espera-da-cirurgia-cardíaca: o período pré-operatório na perspectiva heideggeriana

ABSTRACT Objective: to investigate the patients' experience in the cardiac surgery preoperative period under the Heideggerian perspective. Method: exploratory qualitative research. Twelve patients were interviewed, from March to April, 2016, while they waited for myocardial revascularization surgery or valve replacement surgery. Results: the analysis of the speeches allowed finding two dimensions of the being-there-patient-waiting-for-cardiac surgery, two meanings of the beingness: being-there-in-a-reduced-world and being-there-in-a-unknown-world. Conclusion: the experiences were related to alterations and limitations coming from the surgery, potential generators of anxiety, depression and existential conflicts in the cardiac surgery preoperative period. Reinforcing the care as being-with-the-other is suggested, considering the dimensions referred to and the patient's integrality.

RESUMEN Objetivo: investigar la vivencia de los pacientes en el período preoperatorio de la cirugía cardíaca en la perspectiva heideggeriana. Método: estudio de naturaleza exploratoria, cualitativa. Se entrevistaron a doce pacientes, en los meses de abril y marzo de 2016, mientras aguardaban cirugías de revascularización miocárdica o cambio de válvulas. Resultados: el análisis de las hablas facilitó el encuentro con dos dimensiones del ser-ahí-paciente-aguardando-cirugía-cardiaca, dos significados de los existenciales que surgieron: ser-ahí-en-un-mundo-reducido y ser-ahí-en-un-mundo-desconocido. Conclusión: las vivencias estaban relacionadas con los cambios y limitaciones provenientes de la cirugía, potenciales generadoras de ansiedad, depresión y conflictos existenciales en el período preoperatorio de la cirugía cardíaca. Se sugiere reforzar el cuidado como ser-con-el-otro, considerando las dimensiones referidas y la integralidad del paciente.

RESUMO Objetivo: investigar a vivência dos pacientes no período pré-operatório da cirurgia cardíaca na perspectiva heideggeriana. Método: estudo de natureza exploratória, qualitativo. Foram entrevistados doze pacientes, nos meses de abril e março de 2016, enquanto aguardavam cirurgias de revascularização miocárdica ou troca de válvulas. Resultados: a análise das falas facultou o encontro com duas dimensões do ser-aí-paciente-aguardando-cirurgia-cardíaca, dois significados dos existenciais que emergiram: ser-aí-num-mundo-reduzido e ser-aí-num-mundo-desconhecido. Conclusão: as vivências estavam relacionadas às mudanças e limitações advindas da cirurgia, potenciais geradoras de ansiedade, depressão e conflitos existenciais no período pré-operatório da cirurgia cardíaca. Sugere-se reforçar o cuidado como ser-com-o-outro, considerando as dimensões referidas e a integralidade do paciente.

Use of 3d printing in preoperative planning and training for aortic endovascular repair and aortic valve disease

Abstract Introduction: Three-dimensional (3D) printing has become an affordable tool for assisting heart surgeons in the aorta endovascular field, both in surgical planning, education and training of residents and students. This technique permits the construction of physical prototypes from conventional medical images by converting the anatomical information into computer aided design (CAD) files. Objective: To present the 3D printing feature on developing prototypes leading to improved aortic endovascular surgical planning, as well as transcatheter aortic valve implantation, and mainly enabling training of the surgical procedure to be performed on patient's specific condition. Methods: Six 3D printed real scale prototypes were built representing different aortic diseases, taken from real patients, to simulate the correction of the disease with endoprosthesis deployment. Results: In the hybrid room, the 3D prototypes were examined under fluoroscopy, making it possible to obtain images that clearly delimited the walls of the aorta and its details. The endovascular simulation was then able to be performed, by correctly positioning the endoprosthesis, followed by its deployment. Conclusion: The 3D printing allowed the construction of aortic diseases realistic prototypes, offering a 3D view from the two-dimensional image of computed tomography (CT) angiography, allowing better surgical planning and surgeon training in the specific case beforehand.

CANG and preoperative use of beta-blockers in patients with stable angina are associated with better cardiovascular survival

Abstract Objective: In contrast to unstable angina, optimal therapy in patients with stable angina is debated. Our aim was to evaluate the outcomes of patients with stable angina scheduled for isolated coronary artery bypass grafts and the effect of preoperative use of beta-blockers. Overall and cardiovascular survivals were our primary outcome. Operative mortality and postoperative complications along with subgroup analysis of diabetic patients were our secondary outcomes. Methods: Retrospective evaluation of patients with stable angina scheduled for isolated coronary artery bypass grafts was included. Pre- and postoperative variables were extracted from the institution database. Survival was obtained from the National Registry. Results: We included 282 patients with stable angina, with a mean age of 65.6±9.5 years. 26.6% were female and 38.7% had diabetes. Three-vessel disease was present in 76.6% of patients. Previous beta-blocker treatment was evident in 69.9% of patients. 10-year overall survival in the whole population was 60.5% (95% confidence interval [CI]: 50.3-70.7%). Operative mortality during the study period was 3.5%. Patients with preoperative use of beta-blocker therapy had better overall survival (9.0 years, 95%CI: 8.6-9.5) than those without treatment (7.9 years, 95%CI: 7.1-8.8 years; P=0.048). Predictors for overall survival were: hypertension, diabetes, and age. Predictors for cardiovascular survival in diabetic patients were: beta-blocker use, gender, and age. Conclusion: Coronary artery bypass grafts surgery in patients with stable angina carries low operative mortality, postoperative complications, and excellent long-term cardiovascular survival. The preoperative use of beta-blockers in diabetic patients is associated with better cardiovascular survival after coronary artery bypass grafts.

Combination of preoperative pulmonary and nutritional preparation for esophagectomy

Abstract Purpose: To compare pulmonary and nutritional parameters before and after inspiratory muscle training (IMT) and enteral feeding support in patients with esophageal disease undergoing preoperative outpatient follow-up. Methods: Thirty patients with a mean age of 55.83 years, 16 men and 14 women, were included. Pulmonary assessment consisted of the measurement of MIP, MEP, and spirometry. Anthropometric measurements and laboratory tests were performed for nutritional assessment. After preoperative evaluation, inspiratory muscle training and enteral nutrition support were started. A p<0.05 was considered statistically significant. Results: After an outpatient follow-up period of 4 weeks, a significant increase in MIP (-62.20 ± 25.78 to -81.53 ± 23.09), MEP (73.4 ± 31.95 to 90.33 ± 28.39), and FVC (94.86 ± 16.77 to 98.56 ± 17.44) was observed. Regarding the anthropometric variables, a significant increase was also observed in BMI (20.18 ± 5.04 to 20.40 ± 4.69), arm circumference (23.38 ± 3.28 to 25.08 ± 4.55), arm muscle circumference (21.48 ± 3.00 to 22.07 ± 3.36), and triceps skinfold thickness (5.62 ± 2.68 to 8.33 ± 6.59). Conclusion: Pulmonary and nutritional preparation can improve respiratory muscle strength, FVC and anthropometric parameters. However, further studies are needed to confirm the effectiveness of this preoperative preparation.

Preoperative treatment with 5α-reductase inhibitors and the risk of hemorrhagic events in patients undergoing transurethral resection of the prostate - A population-based cohort study

OBJECTIVES: To assess the associations between preoperative treatment with 5-alpha reductase inhibitors and the risks of blood transfusion during transurethral resection of the prostate and blood clot evacuation or emergency department visits for hematuria within 1 month after surgery. METHODS: We used data from the Taiwan National Health Insurance Research Database in this population-based cohort study. A total of 3,126 patients who underwent first-time transurethral resection of the prostate from 2004 to 2013 were identified. Adjusted odds ratios estimated by multiple logistic regression models were used to assess the independent effects of the preoperative use of 5-alpha reductase inhibitors on the risks of perioperative hemorrhagic events after adjustment for potential confounders. RESULTS: Two hundred and ninety-seven (9.4%) patients were treated with 5-alpha reductase inhibitors for <3 months, and 65 (2.1%) patients were treated for ≥3 months prior to undergoing transurethral resection of the prostate. The blood transfusion rates for patients who were not treated with 5-alpha reductase inhibitors (controls), patients who were treated with 5-alpha reductase inhibitors for <3 months, and patients who were treated with 5-alpha reductase inhibitors ≥3 months were 9.5%, 8.8%, and 3.1%, respectively. 5-alpha reductase inhibitors tended to decrease the risk of blood transfusion; however, this association was not statistically significant (adjusted odds ratio=0.14, 95% confidence interval: 0.02-1.01). Age ≥80 years, coagulopathy, and a resected prostate tissue weight >50 g were associated with significantly higher risks of blood transfusion than other parameters. CONCLUSIONS: This nationwide study did not show that significant associations exist between 5-alpha reductase inhibitor use before transurethral resection of the prostate and the risks of blood transfusion and blood clot evacuation or emergency visits for hematuria.

Reducción de la morbilidad postoperatoria en el cáncer colorrectal programado: inmunonutrición oral preoperatoria / Reduction of postoperative morbidity in programmed colorectal cancer: Preoperative oral immunonutrition

Resumen Objetivo: Valorar la eficacia de la administración preoperatoria de inmunonutrición oral en pacientes con cáncer colorrectal resecable, en términos de reducción de la incidencia de complicaciones infecciosas posquirúrgicas. Material y métodos: Estudio prospectivo y aleatorizado. Se reclutaron 84 pacientes. En el grupo inmunonutrido (SÍ IN) se administró de forma preoperatoria Impact© Oral durante 8 días (3 envases al día), con respecto del grupo no inmunonutrido (NO IN), que únicamente recibió dieta normal, sin suplementos. Resultados: Del total de pacientes, el 40,5% (17) de los NO IN presentaron complicaciones infecciosas frente a un 33,3% (14) de los SÍ IN. En los pacientes con cáncer rectal NO IN, un 50% (8) tuvieron complicaciones infecciosas menores frente a un 13,6% (3) de los SÍ IN, (p = 0,028). En la regresión logística, la variable proteínas totales en el quinto día posquirúrgico (OR: 2,8 [IC 95%: 1,3-6,3], p = 0,012) fue independiente en relación con la aparición de complicaciones infecciosas. Específicamente, la variable fuga anastomótica se comportó como factor de riesgo en el desarrollo de infección de herida, con una OR de 4,5 (IC 95%: 1,3-16,1) (p = 0,033). Discusión: La desnutrición en los pacientes oncológicos susceptibles de cirugía se traduce en un incremento en la morbimortalidad postoperatoria de los mismos. La utilización de fórmulas enterales con inmunonutrientes en estos sujetos puede atenuar dicha morbilidad, a expensas de la disminución de complicaciones infecciosas. Conclusión: En nuestro análisis, los pacientes NO IN presentaron con mayor frecuencia complicaciones infecciosas posquirúrgicas, sobre todo el subgrupo de pacientes con cáncer rectal.

Abstract Purpose: Assess the efficacy of preoperative administration of oral immunonutrition in patients with resectable colorectal cancer, in terms of reducing the incidence of postoperative infectious complications. Material and methods: Prospective randomized study. A total of 84 patients were recruited. To the group YES IN, Impact© Oral was preoperatively administered for 8 days (3 bricks a day), whereas the NOT IN group only received normal diet, without supplements. Results: Of all patients, 40.5% (17) in the NOT IN group suffered infectious complications against 33.3% (14) in the YES IN group. Among patients with rectal cancer in the NOT IN group, 50% (8) suffered minor infectious complications, compared with 13.6% (3) among those in the YES IN group (P = .028). Using logistic regression, the variable total protein on the fifth postoperative day [OR: 2.8 (95% CI: 1.3 to 6.3) (P = .012)] showed a statistically significant relationship with the occurrence of infectious complications. Specifically, anastomotic leak variable behaved as a risk factor in the development of surgical site infection, with an OR of 4.5 (95% CI: 1.3 to 16.1) (P = .033). Discussion: Malnutrition in cancer patients suitable for surgery results in an increase in postoperative morbidity and mortality. The use of enteral formulas with immunonutrients in these subjects can attenuate this morbidity, decreasing infectious complications. Conclusion: In our analysis, the NOT IN group suffered more postoperative infectious complications, particularly the subset of patients with rectal cancer.

Utility of Ultraportable Echocardiography in the Preoperative Evaluation of Noncardiac Surgery / Utilidade do Ecocardiograma Ultraportátil Direcionado na Avaliação Pré-Operatória de Cirurgia Não Cardíaca

Abstract Background: The ultraportable echocardiogram machine, with relevant portability and easiness in performing diagnoses, when in experienced hands, may contribute to the reliability of preoperative evaluation in noncardiac surgeries. Objectives: To assess cardiac function parameters in patients aged older than 60 years, candidates of elective noncardiac surgeries, classified as ASA1 or ASA 2 according to surgical risk. Methods: A total of 211 patients referred for elective surgeries, without suspicion of previous heart diseases, were included in the study. Assessment of patients was conducted by conventional echocardiogram using the ultraportable V Scan (GE) device right after the pre-anesthetic clinical evaluation. We assessed the clinical impact of echocardiography results by using a questionnaire addressed to the anesthetist. Results: Mean age of patients was 68.9 ± 7.0 years, 154 were women. The most frequent surgeries were: a) facectomy - cataract - 18; b) inguinal hernia surgery - 18; c) Cholecystectomy - 16. We found 58 normal tests (27.5%), 70 (33.2%) with mild valve reflux, and 83 (39.3%) with relevant abnormality, such as increase in heart chamber size, global and/or segmental contractile dysfunction, significant valve dysfunction or other unspecified. Test results caused delay of surgical procedure for a more detailed cardiac evaluation in 20 (9.5%) patients, and change in anesthetic management in 7 (3.3%). Conclusion: There was a considerable clinical impact with the use of the ultraportable echocardiography, since one out of every ten patients evaluated had their clinical management changed due to the detection of previously unsuspected, significant heart diseases, with the potential for severe complications.

Resumo Fundamento: O ecocardiógrafo ultraportátil, com importante mobilidade e facilidade diagnóstica em mãos experientes pode contribuir para a segurança na avaliação pré-operatória em cirurgias não cardíacas. Objetivo: Avaliar os parâmetros de função cardíaca nos pacientes com mais de 60 anos de idade, candidatos a cirurgias não-cardíacas eletivas, classificados como ASA 1 ou ASA 2 na classificação de risco cirúrgico. Métodos: Foram incluídos 211 pacientes direcionados para cirurgias eletivas diversas e sem suspeita prévia de cardiopatia. Os pacientes foram avaliados por técnica ecocardiográfica convencional, usando o aparelho ultraportátil V Scan (GE) logo após a avaliação clínica pré-anestésica. Avaliamos o impacto clínico dos resultados da ecocardiografia por um questionário dirigido ao anestesista. Resultados: A idade média dos pacientes foi 68,9 ± 7,0 anos, 154 do sexo feminino. As cirurgias mais frequentes foram: a) Facectomia-catarata - 18; b) Herniorrafia inguinal - 18; c) Colecistectomia - 16. No total, foram observados 58 exames normais (27,5%), 70 (33,2%) exames que apresentavam leves refluxos valvares e 83 (39,3%) exames com alguma anormalidade relevante, como aumento de câmara cardíaca, disfunção contrátil global e/ou segmentar, disfunção valvar mais significativa ou outra não especificada. Os resultados determinaram que 20 (9,5%) pacientes tivessem seus procedimentos cirúrgicos adiados até avaliação cardiológica mais detalhada e em 7 (3,3%) houve mudança na conduta anestésica. Conclusão: Houve um impacto clínico considerável com o uso da ecocardiografia ultraportátil, pois um em cada dez pacientes avaliados sofreu modificação na conduta clínica, em função da detecção de cardiopatias significativas, não suspeitadas previamente, e com potencial para complicações graves.

A avaliação pré-anestésica para cirurgia oftalmológica em idosos é realmente necessária? A realidade de um hospital público / The pre-anesthetic evaluation for ophthalmic surgery in the elderly is really necessary? The reality of a public hospital

RESUMO Objetivos: A avaliação pré-anestésica (APA) e a realização de exames laboratoriais são questionadas para cirurgias oftalmológicas ambulatoriais por acrescentarem custos e retardarem a cirurgia. Estas são de baixo risco, mas os pacientes são idosos e com várias comorbidades. O objetivo deste estudo foi determinar se a APA é realmente necessária nestes pacientes em um hospital público. Métodos: Foi conduzido um estudo retrospectivo em 297 prontuários contendo a APA de pacientes para cirurgias oftalmológicas em um hospital público. Foram avaliados através da história, exame clínico e exames complementares, a proporção de pacientes que apresentaram na APA doenças desconhecidas ou não controladas e alterações dos exames complementares. Resultados: A média de idade dos pacientes foi de 71,5 anos, com 95,28% tendo pelo menos uma doença crônica. A doença mais prevalente foi hipertensão arterial sistêmica (62,96%), que em 7,7% dos pacientes estavam sem controle adequado; 2.3% não tinham diagnóstico de HAS. O diabetes mellitus tipo 2 apareceu em segundo (22,22%), com 5,3% sem controle adequado. Glicemia acima de 100 mg.dl-1 foi encontrada em 25,92%, sem diagnóstico conhecido. Do total, 84,8% tomavam pelo menos um medicamento. Somente 73,4% dos pacientes foram liberados para a cirurgia na primeira consulta. Conclusão: A APA em oftalmologia é capaz de detectar doenças não diagnosticadas, ou condições clínicas instáveis, e exerce um papel não só de otimização do paciente para a cirurgia como de atendimento primário, desempenhando papel importante na saúde global da população e, portanto, considerada necessária nos pacientes idosos do sistema público de saúde.

ABSTRACT Objectives: Pre-anesthetic assessment (PAA) and laboratory tests are questioned for ophthalmic procedures due to their additional costs and surgery delays. These are lower risks, nonetheless, patients are elderly and suffer from multiple comorbidities. The aim of this study was to determinate if it is really necessary in a public hospital. Method: a retrospective study on 297 medical records containing the pre-anesthetic questionary from ophthalmic surgery patients in a public hospital was leaded. By the anamnesis, clinical examination and laboratory tests, the rate of patients who came up with unknown or uncontrolled diseases for the pre-anesthetic evaluation among with unsettled lab tests were analyzed. Results: The patients's mean age was 71.5 years old. 95.28% of them suffer from at least one chronic disease. The most prevailer illness was systemic arterial hypertension (SAH) (62.96%), which in 7.7% of were uncontroled. Also 2.3% had no diagnosis of SAH. The DM2 appeared in second (22.22%), with 5.3% without proper management. Glycaemia above 100 mg.dl1 was found in 25.92%, undiagnosed; 84.8% of the total were taking at least one medication. Only 73.4% of patients were released for surgery in the first moment. Discussion: To sum up, PAA in ophthalmology surgery is able to bring up undiagnosed diseases, or unstable medical conditions, and it plays a role not only in optimize the patient for surgery, but also as primary care. It can be an important deal to improve population's health, therefore, considered necessary in elderly patients in the public health system.

Idoso e a cirurgia: um estudo sobre construção de indicadores de cuidados de enfermagem para segurança no processo operatório / Elderly and surgery: a study on construction of nursing care indicators for safety in the operative process

Não consta

Preoperative therapy restores ventilatory parameters and reduces length of stay in patients undergoing myocardial revascularization / Fisioterapia pré-operatória restabelece parâmetros ventilatórios e reduz tempo de internação após revascularização do miocárdio

Introduction: The frequency of surgical procedures has increased steadily in recent decades, including the myocardial revascularization. Objectives: To demonstrate the importance of physiotherapy in the preoperative period of cardiac surgery in relation to the reduction of hospital stay, changes in lung volumes and respiratory muscle strength. Methods: We conducted a prospective study with patients undergoing myocardial revascularization, the Hospital das Clínicas da Universidade Estadual Paulista (UNESP)/Botucatu - SP. We evaluated 70 patients of both genders, aged between 40 and 75 years, subdivided into two groups: group I - 35 patients of both genders, who received a written protocol guidance, breathing exercises and respiratory muscle training in the preoperative period and group II - 35 patients of both genders, who received only orientation of the ward on the day of surgery. This study was approved by the Ethics Committee of UNESP / Botucatu - SP. Results: Maximal inspiratory pressure in third postoperative day and fifth postoperative day and significant difference between groups, being better for the intervention group. Expiratory pressure was significant in fifth postoperative day in the intervention group compared to controls. The difference of length of hospital stay in the postoperative was found between the groups with shorter hospital stay in the group receiving preoperative therapy. Conclusion: Physical therapy plays an important role in the preoperative period, so that individuals in the intervention group more readily restored the parameters evaluated before surgery, in addition, there was a decrease in the time of the postoperative hospital stay. Thus, it is thought the cost-effectiveness of a program of preoperative physiotherapy. .

Introdução: Procedimentos cirúrgicos aumentaram progressivamente nas últimas décadas, inclusive a revascularização do miocárdio(RM). Objetivos: Demonstrar a importância da fisioterapia no préoperatório de cirurgia cardíaca, em relação à redução do tempo de internação hospitalar, alteração de volumes pulmonares e força muscular respiratória. Métodos: Foi realizado estudo clínico prospectivo, com pacientes submetidos à revascularização do miocárdio, no Hospital das Clínicas da Universidade Estadual PaulistaUNESP / Botucatu - SP. Foram avaliados 70 pacientes de ambos os gêneros, com faixa etária entre 40 a 75 anos, randomizados por meio programa computadorizado em dois grupos: Grupo I - 35 pacientes de ambos os sexos, que receberam um protocolo de orientação por escrito, exercícios respiratórios e treinamento muscular respiratório no pré-operatório e Grupo II - 35 pacientes de ambos os gêneros, que receberam apenas orientação de rotina da enfermaria no dia da cirurgia. Trabalho foi aprovado pelo Comitê de Ética da Universidade Estadual PaulistaUNESP / Botucatu - SP. Resultados: A avaliação das pressões inspiratórias máximas evidenciou aumento significativo no terceiro dia pós-operatório e quinto dia pós-operatório para o grupo de intervenção e análise das pressões expiratórias máximas apresentou valores significativos apenas no quinto dia pós-operatório para o grupo intervenção em relação ao grupo controle, observando-se ainda que o grupo submetido ao protocolo de tratamento fisioterapêutico pré-operatório apresentou menor tempo de internação hospitalar. Conclusão: A fisioterapia ...

Estrategia de tratamiento de las fracturas de la cadera, 2010 / Treatment strategy of hip fractures, 2010

Objetivo: mostrar la influencia de los factores preoperatorio y posoperatorio en el resultado final del tratamiento rehabilitador de las fracturas de cadera en el Hospital General Universitario Dr. Gustavo Aldereguía Lima de Cienfuegos. Métodos: se hizo un estudio observacional, descriptivo, longitudinal prospectivo, en el cual se trabajó con 68 casos de ingreso por fractura de cadera en el período enero-junio de 2010, operados o no, y que residieron en el municipio de Cienfuegos. Las principales variables evaluadas desde el momento de la fractura hasta 1 año después fueron: edad, sexo, validismo, comorbilidad, complicaciones preoperatorio y posoperatorio, resultado final. Todos se recopilaron en el período estudiado y se registraron en un formulario de datos creados al efecto; además de las hojas de chequeo anestésico, evaluación geriátrica y expedientes clínicos. Resultados: dentro del conjunto de resultados resalta el grupo de edades de 80 a 89 años que predomina en 50 porciento de los pacientes estudiados, así como el sexo femenino con 72 porciento las fracturas extracapsulares resultaron las más frecuentes en 63 porciento del total. Las complicaciones ortopédicas se presentaron en 23 porciento de los casos, se le realizó rehabilitación preoperatoria a 76 porciento, posoperatoria mediante 1 a 7 d a 96 y 86 porciento a los pacientes valorados en consulta especializada de cadera; 89 porciento de los pacientes lograron deambular libremente con algún tipo de ayuda. Conclusiones: los resultados demuestran la experiencia alcanzada por los especialistas en el empleo de las nuevas tecnologías en la realización del acto quirúrgico. Las valoraciones preoperatorias tanto por geriatría o anestesia y la realización de una rehabilitación precoz, a partir de medidas higiénicas sanitarias, psicológicas con seguimiento ambulatorio estricto, y controlando el cumplimiento del entrenamiento familiar en el cuidado de estos pacientes

Objective: to demonstrate the influence of preoperative and postoperative factors in the final result of rehabilitation treatment of hip fractures in patients admitted in the Gustavo Aldereguía Lima University Hospital of Cienfuegos municipality. Methods: a prospective, longitudinal, descriptive and observational study was conducted in 68 cases admitted due to hip fracture from January to June, 2010, operated on or not residents of this municipality. The main variables assessed from the moment of fracture up to one year after were: age, sex, validity, comorbid disease, preoperative and postoperative complications, final result. All were collected in the study period and were registered in a data form created to that end, in addition to the anesthetic checkup sheets, the geriatric assessment and the clinical records. Results: in the group of results is highlighted the age group of 80 to 89 years with predominance in the 50 percent of study patients, as well as the female sex with the 72 percent the extracapsular fractures were the more frequent in the 63 percent of total. The orthopedic complications were present in the 23 percent of cases, preoperative rehabilitation in the 76 percent , postoperative over 1 to 7 days in the 96 and the 86 percent of patients assessed in hip specialized consultation, the 89 percent of patients achieved to walk freely with some type of help. Conclusions: results demonstrate the experience obtained by specialists in the use of new technologies during the surgical act. The preoperative assessments by Geriatric or Anesthesia and the performing of an early rehabilitation, from the health and psychological measures with an strict outpatient follow-up and controlling the fulfillment of family training in the care of these patients

Manejo analgésico y anestésico en la mastocitosis sistémica: a propósito de un caso / Analgesic and anesthetic management in systemic mastocytosis: a case report

Las mastocitosis son un grupo heterogéneo de enfermedades que se caracterizan por la proliferación de mastocitos en uno o más órganos o tejidos. Se denomina mastocitosis sistémica (MS) cuando hay afectación de un tejido distinto a la piel. La MS es una enfermedad poco frecuente, cuya incidencia y prevalencia se desconocen. El manejo anestésico de estos pacientes debe considerar que muchos de los fármacos empleados pueden causar una liberación masiva de mediadores químicos mastocitarios. Se presenta el caso de una mujer con MS programada para una histerectomía total, valorando la importancia del correcto estudio preoperatorio así como la técnica anestésica y el tipo de analgesia elegida en este caso. Se presenta nuestro protocolo de actuación de cara a la cirugía en estos pacientes.

Mastocytoses are a heterogeneous group of entities characterized by mast cell proliferation in one or more organs or tissues. When tissues other than the skin are involved, the disease is called systemic mastocytosis (SM). SM is a highly infrequent disease, whose incidence and prevalence are unknown. The anesthetic management of these patients must consider the fact that many drugs can trigger massive release of chemical mediators of mast cells. We report the case of a patient diagnosed with SM who underwent total hysterectomy and discuss the importance of thorough preoperative study, as well as the anesthetic technique and type of analgesia chosen. We also report our protocol for anesthetic management in this disease.

Avaliação dos fatores de risco cardiovascular e alteração eletrocardiográfica pré-operatória no idoso longevo / Evaluation of cardiovascular risk factors and pre-operative electrocardiogram alterations in the extreme elderly

Fundamentos: Fatores de risco cardiovascular (FRCV) e alterações eletrocardiográficas (AE) do idoso longevo (IL)representam importante informação com finalidade de avaliação pré-operatória. Objetivo: Determinar a prevalência de FRCV (hipertensão arterial (HA) e diabetes mellitus (DM) tipo 2) e de AE (fibrilação atrial (FA), extrassístole ventricular (EV) e bloqueio do ramo esquerdo (BRE)) em IL encaminhados à cirurgia eletiva. Métodos: Estudo com 100 indivíduos idosos longevos de ambos os sexos (54% mulheres) com idade ≥70 anos,que coletaram sangue em jejum para dosagem de glicose e realizaram medidas de pressão arterial e eletrocardiograma de 12 derivações em repouso. Resultados: Os pacientes apresentaram FRCV: 48%; AE:25%; HA: 31%; DM: 5%; DM+HA: 12%; FA: 9%; EV: 8%;BRE: 8%. Todos os pacientes com BRE apresentaram antecedentes de HA. Estes resultados diferem dos relatados na literatura para adultos jovens.Conclusão: Na população estudada observou-se uma maior prevalência de FRCV, quando comparada às AE.O BRE parece ser uma característica importante em idosos longevos com HA.

Clinical benefits after the implementation of a multimodal perioperative protocol in elderly patients / Benefícios clínicos após a implementação de um protocolo multimodal perioperatório em paciente idosos

CONTEXT: Multimodal protocol of perioperative care may enhance recovery after surgery. Based on evidence these new routines of perioperative care changed conventional prescriptions in surgery. OBJECTIVE: To evaluate the results of a multimodal protocol (ACERTO protocol) in elderly patients. METHODS: Non-randomized historical cohort study was performed at the surgical ward of a tertiary university hospital. One hundred seventeen patients aged 60 and older were submitted to elective abdominal operations under either conventional (n = 42; conventional group, January 2004-June 2005) or a fast-track perioperative protocol named ACERTO (n = 75; ACERTO group, July 2005-December 2007). Main endpoints were preoperative fasting time, postoperative day of re-feeding, volume of intravenous fluids, length of hospital stay and morbidity. RESULTS: The implantation of the ACERTO protocol was followed by a decrease in both preoperative fasting (15 [8-20] vs 4 [2-20] hours, P<0.001) and postoperative day of refeeding (1st [1st-10th] vs 0 [0-5th] PO day; P<0.01), and intravenous fluids (10.7 [2.5-57.5] vs 2.5 [0.5-82] L, P<0.001). The changing of protocols reduced the mean length of hospital stay by 4 days (6[1-43] vs 2[1-97] days; P = 0.002) and surgical site infection rate by 85.7 percent (19 percent; 8/42 vs 2.7 percent; 2/75, P<0.001; relative risk = 1.20; 95 percent confidence interval = 1.03-1.39). Per-protocol analysis showed that hospital stay in major operations diminished only in patients who completed the protocol (P<0.01). CONCLUSION: The implementation of multidisciplinary routines of the ACERTO protocol diminished both hospitalization and surgical site infection in elderly patients submitted to abdominal operations.

CONTEXTO: Protocolos multimodais de cuidados perioperatórios podem acelerar a recuperação pós-operatória. Fundamentadas na medicina baseada em evidência, essas novas rotinas mudam as prescrições convencionais em cirurgia. OBJETIVO: Avaliar os resultados de um protocolo multimodal (protocolo ACERTO) em pacientes idosos. MÉTODOS: Estudo de coorte histórica não aleatório realizado na enfermaria de cirurgia de um hospital universitário terciário. Cento e dezessete pacientes com idade igual ou superior a 60 anos foram submetidos a operações abdominais eletivas sob um protocolo convencional (n = 42; grupo convencional, janeiro 2004-junho 2005) ou um protocolo multimodal denominado ACERTO (n = 75; grupo ACERTO, julho 2005-dezembro 2007). As principais variáveis de resultado foram: tempo de jejum pré-operatório, tempo de realimentação pós-operatória, volume de fluidos intravenosos, tempo de internação e morbidade. RESULTADOS: A implantação do protocolo ACERTO foi acompanhada de queda do tempo de jejum pré-operatório (15 [8-20] vs 4 [2-20] horas, P<0.001), do dia de realimentação pós-operatória (1º [1º-10º] vs 0 [0-5º] dia de pós-operatório; P<0,01) e do volume de fluídos intravenosos (10,7 [2,5-57,5] vs 2,5 [0,5-82] L, P<0,001). A mudança de protocolo reduziu o tempo médio de internação hospitalar em quatro dias (6[1-43] vs 2[1-97] dias; P = 0,002) e a taxa de infecção do sítio cirúrgico em 85,7 por cento (19 por cento; 8/42 vs 2,7 por cento; 2/75, P<0,001; risco relativo = 1,20; 95 por cento intervalo de confiança = 1,03-1,39). Análise per-protocolo mostrou que a permanência hospitalar em operações de grande porte diminuiu apenas no subgrupo de pacientes nos quais o protocolo foi completo (P<0,01). CONCLUSÃO: A implantação de rotinas multidisciplinares do protocolo ACERTO diminuiu a hospitalização e a infecção de sitio cirúrgico em pacientes idosos submetidos a operações abdominais.

Proposta de escore de risco pré-operatório para pacientes candidatos à cirurgia cardíaca valvar / Proposed preoperative risk score for patients candidate to cardiac valve surgery

FUNDAMENTO: Estabelecer escore de risco para cirurgias cardíacas permite avaliar risco pré-operatório, informar o paciente e definir cuidados durante a intervenção. OBJETIVO: Pesquisar fatores de risco pré-operatórios para óbito em cirurgia cardíaca valvar e construir um modelo de risco simples (escore) para mortalidade hospitalar para os pacientes candidatos à cirurgia no Hospital São Lucas da Pontifícia Universidade Católica do Rio Grande do Sul (HSL-PUCRS). MÉTODOS: A amostra do estudo inclui 1.086 pacientes adultos que realizaram cirurgia cardíaca valvar entre Janeiro de 1996 a Dezembro de 2007 no HSL-PUCRS. Regressão logística foi usada para identificar fatores de risco e mortalidade hospitalar. O modelo foi desenvolvido em 699 pacientes e seu desempenho foi testado nos dados restantes (n = 387). O modelo final foi criado com a análise da amostra total (n = 1.086). RESULTADOS: A mortalidade global foi 11,8 por cento: 8,8 por cento casos eletivos e 63,8 por cento cirurgia de emergência. Na análise multivariada, 9 variáveis permaneceram preditores independentes para o desfecho: idade avançada, prioridade cirúrgica, sexo feminino, fração de ejeção < 45 por cento, cirurgia de revascularização miocárdica (CRM) concomitante, hipertensão pulmonar, classe funcional III ou IV da NYHA, creatinina (1,5 a 2,49 mg/dl e > 2,5 mg/dl ou diálise). A área sob a curva ROC foi 0,83 (IC: 95 por cento, 0,78 - 0,86). O modelo de risco mostrou boa habilidade para mortalidade observada/prevista: teste Hosmer-Lemeshow foi x² = 5,61; p = 0,691 e r = 0,98 (coeficiente de Pearson). CONCLUSÃO: As variáveis preditoras de mortalidade hospitalar permitiram construir um escore de risco simplificado para a prática diária, que classifica o paciente de baixo, médio, elevado, muito elevado e extremamente elevado risco pré-operatório.

BACKGROUND: To establish a risk score for heart surgery allows the assessment of preoperative risk, informing the patient and defining care during the intervention. OBJECTIVE: To assess preoperative risk factors for death in cardiac valve surgery and construct a simple risk model (score) for in-hospital mortality of patients candidate to surgery at Hospital São Lucas of Pontifícia Universidade Católica do Rio Grande do Sul (HSL-PUCRS). METHODS: The study sample included 1,086 adult patients that underwent cardiac valve surgery between January 1996 and December 2007 at HSL-PUCRS. Logistic regression was used to identify risk and in-hospital mortality factors. The model was developed in 699 patients and its performance was tested in the remaining data (n = 387). The final model was created using the total study sample (n = 1,086). RESULTS: Global mortality was 11.8 percent: 8.8 percent of elective cases and 63.8 percent of emergency cases. At the multivariate analysis, 9 variables remained independent predictors for the outcome: advanced age, surgical priority, female sex, ejection fraction < 45 percent, concomitant myocardial revascularization (CABG), pulmonary hypertension, NYHA functional class III or IV, creatinine levels (1.5 to 2.49 mg/dl and > 2.5 mg/dl or undergoing dialysis). The area under the ROC curve was 0.83 (95 percent CI: 0.78-0.86). The risk model showed good capacity for observed/predicted mortality: the Hosmer-Lemeshow test was x² = 5.61; p = 0.691 and r = 0.98 (Pearson's coefficient). CONCLUSION: The variables predictive of in-hospital mortality allowed the construction of a simplified risk score for daily practice, which classifies the patient as having low, moderate, high, very high and extremely high preoperative risk.

Aplicabilidade do escore fisiológico agudo simplificado (SAPS 3) em hospitais brasileiros / Aplicabilidad de la puntuación fisiológica aguda simplificada (SAPS 3) en hospitales brasileños / Applicability of the simplified acute physiology score (SAPS 3) in brazilian hospitals

Justificativa e objetivos: O sistema prognóstico SAPS 3 (Simplified Acute Physiology Score 3) é composto de 20 variáveis, representadas por escore fisiológico agudo e avaliação do estado prévio, visando estabelecer índice preditivo de mortalidade para pacientes admitidos em unidades de terapia intensiva (UTI). O estudo teve objetivo de validar este sistema e verificar o poder discriminatório deste índice em pacientes cirúrgicos do Brasil. Método: Estudo prospectivo, realizado em duas UTI especializadas em pacientes cirúrgicos de dois diferentes hospitais, no período de um ano, excluiuse pacientes com idade inferior a 16 anos, que permaneceram tempo inferior a 24 horas na UTI, readmitidos e aqueles admitidos para procedimento dialítico. A habilidade preditiva do índice SAPS 3 em diferenciar sobreviventes e não sobreviventes foi verificada utilizando curva ROC e a calibração pelo teste Hosmer-Lemeshow goodness-of-fit. Resultados: Foram incluídos no estudo 1.310 pacientes. Operações gastrintestinais foram predominantes (34,9 por cento). O menor valor do índice SAPS 3 foi 18 e o maior 154, média de 48,5 ± 18,1. A mortalidade hospitalar prevista e real foi de 10,3 por cento e de 10,8 por cento, respectivamente, razão de mortalidade padronizada (SMR) foi 1,04 (IC95 por cento = 1,03-1,07). A calibração pelo método Hosmer e Lemeshow mostrou X² = 10,47 p = 0,234. O valor do escore SAPS 3 que melhor discriminou sobreviventes e não sobreviventes foi 57, com sensibilidade de 75,8 por cento e especificidade de 86 por cento. Dos pacientes com índice SAPS 3 maior que 57, 73,5 por cento não sobreviveram versus 26,5 por cento de sobreviventes (OR = 1,32 IC95 por cento 1,23 - 1,42, p < 0,0001). Conclusões: O sistema SAPS 3 é válido na população brasileira de pacientes cirúrgicos, sendo útil para indicar pacientes graves e determinar maiores cuidados neste grupo.

Background and objectives: The SAPS 3 (Simplified Acute Physiology Score 3) prognostic system is composed of 20 parameters, represented by an acute physiology score and assessment of the previous status, aimed at establishing a predictive mortality index for patients admitted to intensive care units (ICU). The objective of this study was to validate this system and determine its discriminatory power in surgical patients in Brazil. Methods: This is a prospective study undertaken in two surgical ICUs of two different hospitals over a one-year period; patients younger than 16 years, who stay at the ICU for less than 24 hours, readmitted to the unit, and those admitted for dialysis were excluded from the study. The predictive ability of the SAPS 3 index to differentiate survivors and non-survivors was determined by the ROC curve and calibration by the Hosmer-Lemeshow goodness-of-fit test. Results: One thousand three-hundred and ten patients were included in the study. Gastrointestinal surgeries predominated (34.9 percent). Eighteen was the lower SAPS 3 index and the highest was 154, with a mean of 48.5 ± 18.1. The predicted and real hospital mortality was 10.3 percent and 10.8 percent, respectively; the standardized mortality ratio (SMR) was 1.04 (95 percentCI = 1.03-1.07). Calibration by the Hosmer and Lemeshow method showed X² = 10.47 p = 0.234. The SAPS 3 score that better discriminated survivors and non-survivors was 57, with sensitivity of 75.8 percent and specificity 86 percent. Among the patients with SAPS 3 index higher than 57, 73.5 percent did not survive versus 26.5 percent who survived (OR= 1.32, 95 percentCI 1.23-1.42, p < 0.0001). Conclusions: The SAPS 3 system is valid for the Brazilian population of surgical patients, being a useful indicator of critical patients and to determine greater care in this group.

Justificativa y objetivos: El sistema de pronóstico SAPS 3 (Simplified Acute Physiology Score 3), se compone de 20 variables, representadas por una puntuación fisiológica aguda y por una evaluación del estado previo, con el fin de establecer el índice predictivo de mortalidad para los pacientes admitidos en las unidades de cuidados intensivos (UCI). El estudio quiso validar ese sistema y verificar el poder discriminatorio de ese índice en pacientes quirúrgicos de Brasil. Método: Estudio prospectivo, realizado en dos UCIs especializadas en pacientes quirúrgicos de dos hospitales diferentes, en el período de un año, donde quedaron excluidos pacientes con edad inferior a los 16 años, que permanecieron un tiempo inferior a 24 horas en la UCI, los readmitidos y los que fueron admitidos para el procedimiento de diálisis. La habilidad predictiva del índice SAPS 3 para diferenciar a los sobrevivientes y a los no sobrevivientes, se constató utilizando la curva ROC y la calibración a través del test Hosmer-Lemeshow goodness-of-fit. Resultados: Se incluyeron en el estudio 1310 pacientes. Las operaciones gastrointestinales fueron predominantes (34,9 por ciento). El menor valor del índice SAPS 3 fue 18 y el mayor 154, un promedio de 48,5 ± 18,1. La mortalidad hospitalaria prevista y real alcanzó los 10,3 por ciento y 10,8 por ciento respectivamente, la razón de mortalidad estandarizada (SMR) fue 1,04 (IC95 por ciento = 1,03-1,07). La calibración por el método Hosmer y Lemeshow mostró X2 = 10,47 p = 0,234. El valor de la puntuación SAPS 3 que desglosó mejor a los sobrevivientes y a los no sobrevivientes fue 57, con una sensibilidad de un 75,8 por ciento y una especificidad de un 86 por ciento. De los pacientes con el índice SAPS 3 mayor que 57, un 73,5 por ciento no sobrevivieron contra un 26,5 por ciento de sobrevivientes (OR = 1,32 IC95 por ciento 1,23 – 1,42, p < 0,0001). Conclusiones: El sistema SAPS 3 es valido en la población brasileña...

Effects of massage therapy on sleep quality after coronary artery bypass graft surgery

INTRODUCTION: Having poor sleep quality is common among patients following cardiopulmonary artery bypass graft surgery. Pain, stress, anxiety and poor sleep quality may be improved by massage therapy. OBJECTIVE: This study evaluated whether massage therapy is an effective technique for improving sleep quality in patients following cardiopulmonary artery bypass graft surgery. METHOD: Participants included cardiopulmonary artery bypass graft surgery patients who were randomized into a control group and a massage therapy group following discharge from the intensive care unit (Day 0), during the postoperative period. The control group and the massage therapy group comprised participants who were subjected to three nights without massage and three nights with massage therapy, respectively. The patients were evaluated on the following mornings (i.e., Day 1 to Day 3) using a visual analogue scale for pain in the chest, back and shoulders, in addition to fatigue and sleep. Participants kept a sleep diary during the study period. RESULTS: Fifty-seven cardiopulmonary artery bypass graft surgery patients were enrolled in the study during the preoperative period, 17 of whom were excluded due to postoperative complications. The remaining 40 participants (male: 67.5 percent, age: 61.9 years ± 8.9 years, body mass index: 27.2 kg/m² ± 3.7 kg/m²) were randomized into control (n = 20) and massage therapy (n = 20) groups. Pain in the chest, shoulders, and back decreased significantly in both groups from Day 1 to Day 3. The participants in the massage therapy group had fewer complaints of fatigue on Day 1 (p=0.006) and Day 2 (p=0.028) in addition, they reported a more effective sleep during all three days (p=0.019) when compared with the participants in the control group. CONCLUSION: Massage therapy is an effective technique for improving patient recovery from cardiopulmonary artery bypass graft surgery because it reduces fatigue and improves sleep.