Estimation of lung vital capacity before and after coronary artery bypass grafting surgery: a comparison of incentive spirometer and ventilometry

<p>Abstract</p> <p>Background</p> <p>Measurement of vital capacity (VC) by spirometry is the most widely used technique for lung function evaluation, however, this form of assessment is costly and further investigation of other reliable methods at lower cost is necessary. Objective: To analyze the correlation between direct vital capacity measured with ventilometer and with incentive inspirometer in patients in pre and post cardiac surgery.</p> <p>Methodology</p> <p>Cross-sectional comparative study with patients undergoing cardiac surgery. Respiratory parameters were evaluated through the measurement of VC performed by ventilometer and inspirometer. To analyze data normality the Kolmogorov-Smirnov test was applied, for correlation the Pearson correlation coefficient was used and for comparison of variables in pre and post operative period Student's t test was adopted. We established a level of ignificance of 5%. Data was presented as an average, standard deviation and relative frequency when needed. The significance level was set at 5%.</p> <p>Results</p> <p>We studied 52 patients undergoing cardiac surgery, 20 patients in preoperative with VC-ventilometer: 32.95 ± 11.4 ml/kg and VC-inspirometer: 28.9 ± 11 ml/Kg, r = 0.7 p < 0.001. In the post operatory, 32 patients were evaluated with VC-ventilometer: 28.27 ± 12.48 ml/kg and VC-inspirometer: 26.98 ± 11 ml/Kg, r = 0.95 p < 0.001. Presenting a very high correlation between the evaluation forms studied.</p> <p>Conclusion</p> <p>There was a high correlation between DVC measures with ventilometer and incentive spirometer in pre and post CABG surgery. Despite this, arises the necessity of further studies to evaluate the repercussion of this method in lowering costs at hospitals.</p

Estudo de vigilância epidemiológica da profilaxia do tromboembolismo venoso em especialidades cirúrgicas de um hospital universitário de nível terciário Study of epidemiological surveillance of venous thromboembolism prophylaxis in surgical specialties of a school tertiary referral hospital

CONTEXTO: O tromboembolismo venoso pós-operatório é uma entidade frequente e grave, que pode levar à embolia pulmonar e à síndrome pós-trombótica. Apesar dos benefícios comprovados pela profilaxia, nota-se uma inadequação na sua indicação. OBJETIVO: Verificar a indicação de heparina profilática entre pacientes de diferentes clínicas cirúrgicas de um hospital universitário de nível terciário. MÉTODOS: Realizou-se avaliação prospectiva, através de busca ativa, por 10 dias seguidos, em cada mês, no período de setembro a dezembro de 2005, de pacientes operados nas clínicas: cirurgia geral (aparelho digestório e proctologia), ginecologia, neurocirurgia, ortopedia e traumatologia, urologia e angiologia e cirurgia vascular, com identificação dos fatores de risco para tromboembolismo venoso e o uso profilático de heparina, de acordo com as normas da Sociedade Brasileira de Angiologia e Cirurgia Vascular. RESULTADOS: Foram avaliados 357 pacientes, 24 (6,7%) classificados como de baixo risco para tromboembolismo venoso, 128 (35,9%) de risco moderado, e a maioria, 205 (57,4%) de alto risco. Do total de pacientes, 184 (51,5%) receberam heparina profilática. A heparina foi utilizada em 73,3% dos pacientes da cirurgia geral, em 16,7% da ginecologia, em 50,0% da neurologia, em 32,5% da ortopedia e traumatologia, em 37,3% da urologia e em 97,7% da clínica de angiologia e cirurgia vascular. Das clínicas avaliadas, apenas 38,3% dos pacientes de risco moderado e 64,4% dos de alto risco receberam heparina profilática. Esta foi utilizada de forma adequada em 77,6% dos pacientes de risco moderado e em 63,6% dos de alto risco. Trombocitopenia, sangramento menor e maior, foram identificados em 3 (1,6%), 12 (6,5%) e 2 (1,1%) pacientes que receberam heparina, respectivamente. Foram diagnosticados clinicamente seis (1,7%) episódios de tromboembolismo venoso. CONCLUSÃO:Apesar das indicações bem definidas da heparina na profilaxia do tromboembolismo venoso, verifica-se adesão incompleta por parte dos profissionais médicos da especialidade, expondo os pacientes a complicações graves.<br>CONTEXT: Postoperative venous thromboembolism is a frequent and severe disease that can lead to pulmonary embolism and post thrombotic syndrome. Although the venous thromboembolism prophylaxis is a proven strategy, an unsuitable indication is observed. OBJECTIVE: To verify the indication of prophylaxis with heparin among patients of several surgical specialties of a School Tertiary Referral Hospital. METHODS: It was accomplished a prospective study during 10 consecutive days in each month, from September to December of 2005, with 360 patients surgically treated in the specialties: General Surgery, Gynecology, Neurosurgery, Ortopedy and Traumatology, Urology and Angiology and Vascular Surgery, identifying risk factors for the development of venous thromboembolism (VTE) and the use of heparin prophylaxis according to the recommendations of the Brazilian Society of Angiology and Vascular Surgery. RESULTS: Three hundred and fifty seven patients were evaluated, 24 (6,7%), 128 (35,9%) and 205 (57,4%) were included in low risk, medium risk and high risk for venous thromboembolism, respectively. One hundred and eighty four patients (51,5%) of the sample received prophylactic heparin. Heparin was used in 73,3% of the patients of General Surgery, 16,7% of Gynecology, 50,0% of Neurosurgery, 32,5% of Ortopedy and Traumatology, 37,3% of Urology and 97,7% of Angiology and Vascular Surgery. Only 38,3% of medium risk and 64,4% of high risk patients received prophylactic heparin. Heparin was suitably used in 77,6% of medium risk and in 63,6% of high risk patients. Thrombocytopenia, minor bleeding and major bleeding occurred in 3 (1,6%), 12 (6,5%) and 2 (1,1%) of the patients, respectively. Thromboembolic complications occurred in 6 (1,7%) cases. CONCLUSION: Although the indications of prophylactic heparin to venous thromboembolism are well known, we verify an incomplete adhesion of medical professionals, exposing patients to severe complications