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      Complicações que aumentam o tempo de permanência na unidade de terapia intensiva na cirurgia cardíaca Translated title: Complications that increase the time of Hospitalization at ICU of patients submitted to cardiac surgery

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          Abstract

          OBJETIVO: Apresentar as complicações que aumentam a permanência na Unidade de Terapia Intensiva (UTI) dos pacientes submetidos à cirurgia cardíaca. MÉTODOS: Foram analisados, retrospectivamente, 85 prontuários de pacientes submetidos à cirurgia cardíaca, no período de março a maio de 2009, na Santa Casa de Misericórdia de Juiz de Fora (MG) e, destes pacientes, foram estudados 14 (16,47%) que permaneceram por mais de 5 dias na UTI. Dentre os 85 pacientes, houve três óbitos, sendo dois pacientes operados em caráter de urgência, o que aumenta a morbidade, e um paciente que permaneceu internado e em ventilação mecânica (VM) por 21 dias. RESULTADOS: O estudo demonstrou que as complicações que aumentaram o tempo de internação na UTI foram respiratórias e metabólicas, de acordo com a literatura. CONCLUSÃO: As complicações que aumentam o tempo de permanência na UTI são as relacionadas à função respiratória, doença pulmonar obstrutiva crônica, tabagismo, congestão pulmonar, desmame da VM prolongado, diabetes, infecções, insuficiência renal, acidente vascular encefálico e instabilidade hemodinâmica.

          Translated abstract

          OBJECTIVE: To show the complications that increase the permanence at intensive care unit (ICU) of the patients submitted to cardiac surgery. METHODS: Eighty-five handbooks of patients submitted to cardiac surgery had been analyzed, retrospectively, from March to May 2009 at Santa Casa de Misericórdia de Juiz de Fora (MG) - Brazil - and 14 (16.47%) patients had been studied. They remained more than 5 days at ICU. In 85 patients occurred three deaths: two patients operated in urgency character and this increases the morbidity; one patient who remained in mechanical ventilation (MV) by 21 days. RESULTS: Complications that had increased the time of hospitalization at ICU had been respiratory and metabolic in accordance with literature. CONCLUSION: Complications that increase the time of permanence at ICU are those related to respiratory function, chronic obstructive pulmonary disease, tabagism, pulmonary congestion, time of permanence under MV, diabetes, infections, renal insufficiency, stroke and hemodynamic instability.

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          Most cited references42

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          Corticosteroids for the prevention of atrial fibrillation after cardiac surgery: a randomized controlled trial.

          Atrial fibrillation (AF) is the most common arrhythmia to occur after cardiac surgery. An exaggerated inflammatory response has been proposed to be one etiological factor. To test whether intravenous corticosteroid administration after cardiac surgery prevents AF after cardiac surgery. A double-blind, randomized multicenter trial (study enrollment August 2005-June 2006) in 3 university hospitals in Finland of 241 consecutive patients without prior AF or flutter and scheduled to undergo first on-pump coronary artery bypass graft (CABG) surgery, aortic valve replacement, or combined CABG surgery and aortic valve replacement. Patients were randomized to receive either 100-mg hydrocortisone or matching placebo as follows: the first dose in the evening of the operative day, then 1 dose every 8 hours during the next 3 days. In addition, all patients received oral metoprolol (50-150 mg/d) titrated to heart rate. Occurrence of AF during the first 84 hours after cardiac surgery. The incidence of postoperative AF was significantly lower in the hydrocortisone group (36/120 [30%]) than in the placebo group (58/121 [48%]; adjusted hazard ratio, 0.54; 95% confidence interval, 0.35-0.83; P = .004; number needed to treat, 5.6). Compared with placebo, patients receiving hydrocortisone did not have higher rates of superficial or deep wound infections, or other major complications. Intravenous hydrocortisone reduced the incidence of AF after cardiac surgery. clinicaltrials.gov Identifier: NCT00442494.
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            Risk factors for 5-year mortality in older adults: the Cardiovascular Health Study.

            Multiple factors contribute to mortality in older adults, but the extent to which subclinical disease and other factors contribute independently to mortality risk is not known. To determine the disease, functional, and personal characteristics that jointly predict mortality in community-dwelling men and women aged 65 years or older. Prospective population-based cohort study with 5 years of follow-up and a validation cohort of African Americans with 4.25-year follow-up. Four US communities. A total of 5201 and 685 men and women aged 65 years or older in the original and African American cohorts, respectively. Five-year mortality. In the main cohort, 646 deaths (12%) occurred within 5 years. Using Cox proportional hazards models, 20 characteristics (of 78 assessed) were each significantly (P 169 mm Hg) and low tibial ( 7.2 mmol/L [130 mg/dL]), low albumin level ( or = 106 micromol/L [1.2 mg/dL]), low forced vital capacity (< or = 2.06 mL), aortic stenosis (moderate or severe) and abnormal left ventricular ejection fraction (by echocardiography), major electrocardiographic abnormality, stenosis of internal carotid artery (by ultrasound), congestive heart failure, difficulty in any instrumental activity of daily living, and low cognitive function by Digit Symbol Substitution test score. Neither high-density lipoprotein cholesterol nor low-density lipoprotein cholesterol was associated with mortality. After adjustment for other factors, the association between age and mortality diminished, but the reduction in mortality with female sex persisted. Finally, the risk of mortality was validated in the second cohort; quintiles of risk ranged from 2% to 39% and 0% to 26% for the 2 cohorts. Objective measures of subclinical disease and disease severity were independent and joint predictors of 5-year mortality in older adults, along with male sex, relative poverty, physical activity, smoking, indicators of frailty, and disability. Except for history of congestive heart failure, objective, quantitative measures of disease were better predictors of mortality than was clinical history of disease.
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              Impact of preoperative statin therapy on adverse postoperative outcomes in patients undergoing cardiac surgery: a meta-analysis of over 30,000 patients.

              To determine the strength of evidence for preoperative statin use for prevention of adverse postoperative outcomes in patients undergoing cardiac surgery. After literature search in major databases, 19 studies were identified [three RCT (randomized prospective clinical trials), 16 observational] that reported outcomes of 31 725 cardiac surgery patients with (n = 17 201; 54%) or without (n = 14 524; 46%) preoperative statin therapy. Outcomes that were analysed included early all-cause mortality (30-day mortality), myocardial infarction (MI), atrial fibrillation (AF), stroke and renal failure. Odds ratio (OR) with 95% confidence intervals (95%CI) were reported using fixed or random effect models and publication bias was assessed. Preoperative statin therapy resulted in a 1.5% absolute risk reduction (2.2 vs. 3.7%; P < 0.0001) and 43% odds reduction for early all-cause mortality (OR 0.57; 95%CI: 0.49-0.67). A significant reduction (P < 0.01) in statin pretreated patients was also observed for AF (24.9 vs. 29.3%; OR 0.67, 95%CI: 0.51-0.88), stroke (2.1 vs. 2.9%, OR 0.74, 95%CI: 0.60-0.91), but not for MI (OR 1.11; 95%CI: 0.93-1.33) or renal failure (OR 0.78, 95%CI: 0.46-1.31). Funnel plot and Egger's regression analysis (P = 0.60) excluded relevant publication bias. Our meta-analysis provides evidence that preoperative statin therapy exerts substantial clinical benefit on early postoperative adverse outcomes in cardiac surgery patients, but underscores the need for RCT trials.
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                Author and article information

                Journal
                rbccv
                Brazilian Journal of Cardiovascular Surgery
                Braz. J. Cardiovasc. Surg.
                Sociedade Brasileira de Cirurgia Cardiovascular (São Paulo, SP, Brazil )
                0102-7638
                1678-9741
                June 2010
                : 25
                : 2
                : 166-171
                Affiliations
                [01] Juiz de Fora orgnameUniversidade Presidente Antônio Carlos
                Article
                S0102-76382010000200007 S0102-7638(10)02500207
                f6bc9c97-d236-4175-ae5c-1262aee50339

                This work is licensed under a Creative Commons Attribution 4.0 International License.

                History
                : 26 April 2010
                : 17 December 2009
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 42, Pages: 6
                Product

                SciELO Brazil

                Categories
                Artigos Originais

                Intensive care units,Length of stay,Complicações pós-operatórias,Procedimentos cirúrgicos cardiovasculares,Tempo de internação,Unidades de terapia intensiva,Postoperative complications,Cardiovascular surgical procedures

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