Effects of different PEEP levels on respiratory mechanics and oxygenation after coronary artery bypass grafting Efeitos de diferentes níveis de PEEP na mecânica respiratória e oxigenação após revascularização do miocárdio

Effects of different PEEP levels on respiratory mechanics and oxygenation after coronary artery bypass grafting Revista Brasileira de Cirurgia Cardiovascular/Brazilian Journal of Cardiovascular Surgery, vol. 28, núm. 3, julio-septiembre, 2013, pp. 380-385 Sociedade Brasileira de Cirurgia Cardiovascular São José do Rio Preto, Brasil Rev Bras Cir Cardiovasc 2013;28(3):380-

CARACTERÍSTICAS CLÍNICAS E DEMOGRÁFICAS DE PACIENTES SUBMETIDOS À REVASCULARIZAÇÃO DO MIOCÁRDIO EM UM HOSPITAL UNIVERSITÁRIO / DEMOGRAPHIC AND CLINICAL CHARACTERISTICS OF PATIENTS UNDERGOING CORONARY ARTERY BYPASS GRAFT IN A UNIVERSITARY HOSPITAL

Introdução: A avaliação pré-operatória da revascularização do miocárdio, com identificação de características clínicas e demográficas associadas aos fatores de risco cirúrgico e o desenvolvimento de medidas capazes de reduzi-los, reflete na diminuição da morbimortalidade. Objetivo: Identificar o perfil clínico e demográfico dos pacientes submetidos à cirurgia de revascularização do miocárdio. Métodos: Os dados foram obtidos por meio das fichas de evolução fisioterapêutica de 121 pacientes submetidos à cirurgia de revascularização do miocárdio no Hospital Universitário Presidente Dutra, São Luís (MA), no período de janeiro de 2011 a fevereiro de 2012. Resultados: A idade média dos pacientes foi 60,7 ± 9,1 anos, com predominância de idosos (53,7%), do sexo masculino (71,1%), procedentes de municípios do interior do Estado do Maranhão (57,9%) e com sobrepeso (44,6%). A hipertensão arterial sistêmica foi a comorbidade mais prevalente (76,9%), seguida por diabetes mellitus (46,3%) e tabagismo (31,4%). Conclusão: A maioria dos pacientes submetidos à cirurgia de revascularização do miocárdio foram homens, idosos, procedentes do interior do Estado, com fatores de risco clássicos para cardiopatia isquêmica. O conhecimento do perfil clínico e demográfico é importante para o planejamento de cuidados pós-operatórios pela equipe multiprofissional, visto que pacientes com risco aumentado de complicações podem ser beneficiados pela assistência fisioterapêutica no período pré-operatório.Palavras-chave: Perfil epidemiológico. Comorbidade. Coronariopatia. Cirurgia Cardíaca.AbstractIntroduction: The preoperative evaluation of myocardial revascularization with identification of clinical and demographic characteristics associated with surgical risk factors, as well as the development of measures that are able to reduce them may reflect in decreased morbidity and mortality. Objective: To identify clinical and demographic profile of patients undergoing coronary artery bypass graft. Methods: Data were obtained from Physical Therapy evolution forms of one hundred twenty-one patients undergoing coronary artery bypass graft at the University Hospital Presidente Dutra, from January 2011 to February 2012. Results: The mean age of patients was 60.7 ± 9.1 years old and predominance of elderly people (53.7%). Most individuals were males (71.1%), lived in the countryside (57.9%) and overweight (44.6%). Hypertension was the most prevalent comorbidity (76.9%), followed by diabetes mellitus (46.3%). Conclusion: Patients undergoing coronary artery bypass graft are mostly men. Most individuals were males living in the countryside and being overweight as well as having classical risk factors for ischemic heart disease. Thus, knowing the clinical and demographic profiles of these patients may assist in planning postoperative care by the multidisciplinary team, whereas patients with increased risk of complications may benefit from physical therapy assistance in the preoperative period.Keywords: Health profile. Comorbidity. Coronary disease. Cardiac surgery

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

En este estudio se propone a verificar si la presencia del fisioterapeuta influencia en el proceso de ventilación mecánica en pacientes sometidos a cirugía cardiaca no complicada e internados en el sector cardiaco de una UCI durante el periodo nocturno. Estudio de carácter documental retrospectivo con pacientes adultos sometidos a cirugía cardiaca e internados en una UCI en el periodo nocturno de noviembre de 2010 hasta octubre de 2011, con cuidados fisioterapéuticos de 12 horas (n=51), y entre noviembre de 2011 hasta octubre de 2012, periodo con cuidados fisioterapéuticos de 24 horas (n=43), en el Hospital Universitario de la Universidade Federal do Maranhão, en Brasil. Para el análisis estadístico, se emplearon las pruebas chi-cuadrado, t de Student y G, siendo los datos considerados significativos estadísticamente cuando pThe 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 Maranhão. For statistical analysis, we used Chi-square, Student's t, and G tests; data were considered statistically significant when pEste estudo pretendeu verificar se a presença do fisioterapeuta influencia no processo de ventilação mecânica de pacientes submetidos à cirurgia cardíaca não complicada e admitidos em UTI cardiológica no período noturno. Trata-se de estudo documental retrospectivo com pacientes adultos submetidos a cirurgia cardíaca e admitidos na UTI no período noturno nos meses de novembro de 2010 a outubro de 2011, com assistência fisioterapêutica por 12 horas (n=51) e entre novembro de 2011 e outubro de 2012, período com assistência fisioterapêutica por 24 horas (n=43), no Hospital Universitário da Universidade Federal do Maranhão. Para análise estatística, foram utilizados os testes qui-quadrado, t de Student e G, sendo os dados considerados estatisticamente significantes quando

INVESTIGAÇÃO DA USINABILIDADE DE AÇOS E LIGAS NÃO-FERROSAS.

A usinabilidade interessa não somente aos fabricantes dos metais, bem como aos consumidores, aos fabricantes de ferramentas, enfim, a todos que se envolvem na produção de peças, por meio da formação do cavaco. A usinabilidade é uma propriedade que depende da interação entre o processo de fabricação e as características do material da peça. Tem uma grande influência na produtividade de uma empresa, razão pela qual existe um enorme interesse em se estabelecer métodos de ensaio. Este trabalho procurou comprovar experimentalmente o efeito da velocidade, profundidade de corte e raio de ponta sobre as componentes da força de usinagem no torneamento. Os ensaios cobriram condições de corte recomendadas pelo fabricante das ferramentas e alguns testes utilizaram um fluido de corte comercialmente disponível, além de utilizar ferramentas de metal duro com e sem recobrimento. Os resultados obtidos revelam concordância com as descrições da literatura

Factors associated to hypoxemia in patients undergoing 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 Maranhão. 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

Effects of different PEEP levels on respiratory mechanics and oxygenation after coronary artery bypass grafting

OBJECTIVE: To compare the effects of different levels of positive end-expiratory pressure on respiratory mechanics and oxygenation indexes in the immediate postoperative period of coronary artery bypass grafting. METHODS: Randomized clinical trial in which 136 patients underwent coronary artery bypass grafting between January 2011 and March 2012 were divided into three groups and admitted to mechanical ventilation with different positive end-expiratory pressure levels: Group A, 5 cmH2O (n=44), Group B, 8 cmH2O (n=47) and Group C, 10 cmH2O (n=45). Data about respiratory mechanics were obtained from mechanical ventilator monitor and oxygenation indexes from arterial blood gas samples, collected twenty minutes after intensive care unit admission. Patients with chronic obstructive pulmonary disease and patients submitted to off-pump, emergency or combined operations were not included. For statistical analysis, we used Kruskal-Wallis, G and Chi-square tests, considering results significant when P<0.05. RESULTS: Groups were homogeneous in terms of demographic, clinical and surgical variables. Patients ventilated with positive end-expiratory pressure of 10 cmH2O (Group C) had best compliance (P=0.04) and airway resistance values, this, however, without statistical significance. They also had best oxygenation indexes, with statistical difference in all analyzed variables, and lower frequency of hypoxemia (P=0.03). CONCLUSION: Higher levels of positive end-expiratory pressure in immediate postoperative period of coronary artery bypass grafting improved pulmonary compliance values and increased oxygenation indexes, resulting in lower frequency of hypoxemia

Relationship between pre-extubation positive end-expiratory pressure and oxygenation after coronary artery bypass grafting

Abstract Introduction After removal of endotracheal tube and artificial ventilation, ventilatory support should be continued, offering oxygen supply to ensure an arterial oxygen saturation close to physiological. Objective: The aim of this study was to investigate the effects of positive-end expiratory pressure before extubation on the oxygenation indices of patients undergoing coronary artery bypass grafting. Methods: A randomized clinical trial with seventy-eight patients undergoing coronary artery bypass grafting divided into three groups and ventilated with different positive-end expiratory pressure levels prior to extubation: Group A, 5 cmH2O (n=32); Group B, 8 cmH2O (n=26); and Group C, 10 cmH2O (n=20). Oxygenation index data were obtained from arterial blood gas samples collected at 1, 3, and 6 h after extubation. Patients with chronic pulmonary disease and those who underwent off-pump, emergency, or combined surgeries were excluded. For statistical analysis, we used Shapiro-Wilk, G, Kruskal-Wallis, and analysis of variance tests and set the level of significance at P<0.05. Results Groups were homogenous with regard to demographic, clinical, and surgical variables. There were no statistically significant differences between groups in the first 6 h after extubation with regard to oxygenation indices and oxygen therapy utilization. Conclusion: In this sample of patients undergoing coronary artery bypass grafting, the use of different positive-end expiratory pressure levels before extubation did not affect gas exchange or oxygen therapy utilization in the first 6 h after endotracheal tube removal