There is compelling evidence that preconditioning occurs in humans. Experimental studies with potential clinical implications as well as clinical studies evaluating ischaemic, pharmacological and anaesthetic cardiac preconditioning in the perioperative setting are reviewed. These studies reveal promising results. However, there are conflicting reports on the efficacy of preconditioning in the diseased and aged myocardium. In addition, many anaesthetics and a significant number of perioperatively administered drugs affect the activity of cardiac sarcolemmal and mitochondrial K(ATP) channels, the end-effectors of cardiac preconditioning, and thereby markedly modulate preconditioning effects in myocardial tissue. Although these modulatory effects on K(ATP) channels have been investigated almost exclusively in laboratory investigations, they may have potential implications in clinical medicine. Important questions regarding the clinical utility and applicability of perioperative cardiac preconditioning remain unresolved and need more experimental work and randomized controlled clinical trials.

British Anaesthetics and cardiac preconditioning. Part II. Clinical implications.

OBJETIVO: Comparar o efeito da aplicacao da pressao positiva intermitente e continua em pacientes no pos-operatorio de cirurgia de revascularizacao do miocardio. METODOS: Neste estudo foram considerados quarenta pacientes, divididos em dois grupos: um submetido a pressao positiva continua (Grupo CPAP), e outro submetido a pressao intermitente (Grupo Reanimador de Muller). Os pacientes foram avaliados nos momentos: pre-operatorio, 3a, 24a e 48a horas, em relacao as diversas variaveis do estudo. RESULTADOS: Os grupos de pacientes eram homogeneos em relacao a diversas variaveis demograficas e clinicas. Os valores gasometricos de PO2, PCO2 e SO2 estiveram dentro dos parâmetros de normalidade e nao foram encontradas diferencas significantes entre os grupos. Na ventilometria os grupos apresentaram diferencas significativas no volume corrente e frequencia respiratoria no pos-operatorio de 48 horas. A dispneia e a participacao da musculatura acessoria, nas avaliacoes do pos-operatorio, foram encontradas com frequencia significativamente maior nos pacientes submetidos ao CPAP. Pacientes submetidos ao Reanimador de Muller apresentaram radiografia de torax normal com maior frequencia do que pacientes submetidos ao CPAP. CONCLUSAO: Observou-se que ambos os recursos foram capazes de manter valores de PO2, PCO2 e SO2 dentro da normalidade. Porem, quando se busca a reexpansao pulmonar, com menor carga de trabalho imposta, o Reanimador de Muller foi mais efetivo pela forma mais rapida de acao e, consequentemente, apresentou menores indices de dispneia, frequencia respiratoria (FR) e atividade de musculatura acessoria.

/pdf/comparative-study-between-intermittent-muller-reanimator-and-3bvvefj4um.pdf

Comparative study between intermittent (Müller Reanimator) and continuous positive airway pressure in the postoperative period of coronary artery bypass grafting

INTRODUCTION: Hypoxemia is a frequent pulmonary complication in the postoperative coronary artery bypass graft. Detection of factors associated with their occurrence may indicate patients at risk for this complication, which allows tracing specific therapeutic and consequently reduce morbidity and mortality. OBJECTIVE: To identify related factors to hypoxemia occurrence in immediate coronary artery bypass graft postoperative. METHODS: In this retrospective cohort study, we studied 100 patients submitted to elective om-pump artery bypass graft , between April 2010 and December 2011, at a reference university hospital for cardiac surgery in the state of Maranhao. It was considered hypoxemia gas exchange ratio less than or equal to 300 mmHg. Associated variables with perioperative hypoxemia were defined by the Student T test, G or Mann-Whitney tests, Chi-square, or Fisher's exact test and multiple linear regression. RESULTS: Among studied variables, high body mass index (P=0.036) and smoking (P=0.024) were significantly associated with hypoxemia in the immediate coronary artery bypass graft postoperative. Hypoxemia incidence in this period was 55% and did not affects mechanical ventilation duration and Intensive Care Unit lengh of stay. CONCLUSION: In this sample, body mass index and smoking were associated to hypoxemia. These data reinforce the importance of clinical assessment to identify patients at risk for this complication, considering its high incidence in immediate postoperative period.

Factors associated to hypoxemia in patients undergoing coronary artery bypass grafting

INTRODUCTION: Characteristics of the patient and the coronary artery bypass grafting may predispose individuals to prolonged hospitalization, increasing costs and morbidity and mortality. OBJECTIVE: The objective of this study was to evaluate individual and perioperative risk factors of prolonged hospitalization in intensive care units and wards. METHODS: We conducted a case-control study of 104 patients undergoing isolated coronary artery bypass grafting with cardiopulmonary bypass. Patients hospitalized >3 days in the intensive care unit or >7 days in the ward were considered for the study. The association between variables was estimated by the chi-square test, odds ratio and logistic regression; P 3 days in the intensive care unit occurred for 22.1% of patients and >7 days in the ward for 27.9%. Among preoperative factors, diabetes (OR=3.17) and smoking (OR=4.07) were predictors of prolonged intensive care unit stay. Combining the pre-, intra-and postoperative variables, only mechanical ventilation for more than 24 hours (OR=6.10) was predictive of intensive care unit outcome. For the ward outcome, the preoperative predictor was left ventricular ejection fraction 24 hours for the intensive care unit and presence of infection for the ward.

Risk factors for prolonged hospital stay after isolated coronary artery bypass grafting

| The aim of this study was to verify the influence of physical therapists on the mechanical ventilation process of patients who underwent non-complicated cardiac surgery admitted to the Cardiac ICU overnight. Documentary and retrospective study with adult patients who underwent cardiac surgery admitted to the ICU overnight from November 2010 to October 2011 with physiotherapeutic care for 12 hours (n=51), and from November 2011 to October 2012 with physiotherapeutic care for 24 hours (n=43), at the University Hospital of the Federal University of Maranhao. For statistical analysis, we used Chi-square, Student’s t, and G tests; data were considered statistically significant when p<0.05. The duration of the mechanical ventilation was lower when physiotherapeutic care occurred at night (6.7±3.7 h vs. 8.7±3.1 h, p=0.02). In this same period, the number of patients extubated in less than 6 hours was also significantly higher (53.4% vs. 27.4%, p=0.0182), as well as the number of scheduled extubations (79% vs. 43.1%, p=0.009). The physiotherapeutic practice influenced the mechanical ventilation process of patients who underwent non-complicated cardiac surgery admitted to the ICU overnight, reducing the time of mechanical ventilation and increasing the number of extubations in less than 6 hours, as well as the number of extubations scheduled during the night.

/pdf/influence-of-physiotherapeutic-practice-in-mechanical-4rdycm1g5u.pdf

Influence of physiotherapeutic practice in mechanical ventilation process of patients admitted to the ICU overnight after non-complicated cardiac surgery

.Fatores, como idadeavancada, sexo feminino, tempo de circulacao extracorpo-rea, disfuncao cardiaca e baixo debito cardiaco podem levaro paciente a ventilacao mecânica prolongada 5-8. No entan-to, ha poucos relatos sobre a utilizacao conjunta de parâ-metros de mecânica respiratoria, oxigenacao e de alteracoescardiovasculares, como fatores envolvidos no sucesso dodesmame de pacientes submetidos a cirurgia cardiaca sobventilacao mecânica prolongada.Pacientes em pos-operatorio de cirurgia cardiaca sao,geralmente, extubados tao logo cesse o efeito anestesico,tendo a modalidade ventilatoria pouco impacto na decisaoda extubacao

/pdf/avaliacao-de-fatores-que-influenciam-no-desmame-de-pacientes-jk94qmj6zc.pdf

Avaliação de Fatores que Influenciam no Desmame de Pacientes em Ventilação Mecânica Prolongada após Cirurgia Cardíaca

SUMMARY Szeles TF, Yoshinaga EM, Alencar W, Brudniewski M, Ferreira FS,Auler Jr JOC, Carmona MJC, Malbouisson LMS — Hypoxemia afterMyocardial Revascularization: Analysis of Risk Factors. BACKGROUND AND OBJECTIVES: Severe hypoxemia iscomplication frequently seen in the immediate postoperative periodof myocardial revascularization (MR), increasing the duration ofmechanical ventilation, the incidence of pulmonary infections, hos-pital costs, and mortality. The objective of this study was to identifypredictive factors of severe hypoxemia in patients undergoing MR. METHODS: Four-hundred and eighty-one adult patients undergoingelective MR between October 2003 and March 2004 were enrolledin this study. Severe hypoxemia was defined as PaO 2 /FiO 2 0.2 was required to exclude the para-meter from the LR model, and a p < 0.1 was considered significant.

Hipoxemia após Revascularização Miocárdica: Análise dos Fatores de Risco* Hypoxemia after Myocardial Revascularization: Analysis of Risk Factors

Transplante Cardíaco no Neonato e na Infância. Resultados a Médio Prazo

Changes in the Pulmonary Glucocorticoid Receptor Content in the Course of Interstitial Disease

JUSTIFICATIVA E OBJETIVOS: A disfuncao renal perioperatoria e importante causa de aumento de morbimortalidade. Com o aumento da expectativa de vida, pacientes mais idosos e com maior numeros de co-morbidades estao sendo submetidos a procedimentos cirurgicos de alto risco, o que torna as praticas da protecao orgânica possiveis modificadoras de prognostico a curto e longo prazo. Nesse contexto, esta revisao sobre a protecao renal na unidade de terapia intensiva cirurgica objetivou destacar os fatores de riscos peri-operatorios e discutir as atuais evidencias cientificas direcionadas para a dimi nuicao da disfuncao renal peri-operatoria. CONTEUDO: Apesar da baixa extracao e adequada reserva renal de oxigenio, o rim e extremamente sensivel

Proteção Renal na Unidade de Terapia Intensiva Cirúrgica* Renal Protection in a Surgical Intensive Care Unit

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