Índice de fragilidade na avaliação pré-operatória do paciente idoso

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Clinical recommendations for postoperative care after heart transplantation in children: 21 years of a single-center experience

Heart transplantation is an option for children with complex congenital heart disease and cardiomyopathies. A patient's quality of life and long-term survival depend on successful management of the surgical complications and adverse side effects of immunosuppression. The purpose of this review was to summarize the practical management of postoperative care in this patient population and to make recommendations for the future

Effect of hypertonic saline treatment on the inflammatory response after hydrochloric acid-induced lung injury in pigs

OBJECTIVES: Hypertonic saline has been proposed to modulate the inflammatory cascade in certain experimental conditions, including pulmonary inflammation caused by inhaled gastric contents. The present study aimed to assess the potential anti-inflammatory effects of administering a single intravenous dose of 7.5% hypertonic saline in an experimental model of acute lung injury induced by hydrochloric acid. METHODS: Thirty-two pigs were anesthetized and randomly allocated into the following four groups: Sham, which received anesthesia and were observed; HS, which received intravenous 7.5% hypertonic saline solution (4 ml/kg); acute lung injury, which were subjected to acute lung injury with intratracheal hydrochloric acid; and acute lung injury + hypertonic saline, which were subjected to acute lung injury with hydrochloric acid and treated with hypertonic saline. Hemodynamic and ventilatory parameters were recorded over four hours. Subsequently, bronchoalveolar lavage samples were collected at the end of the observation period to measure cytokine levels using an oxidative burst analysis, and lung tissue was collected for a histological analysis. RESULTS: Hydrochloric acid instillation caused marked changes in respiratory mechanics as well as blood gas and lung parenchyma parameters. Despite the absence of a significant difference between the acute lung injury and acute lung injury + hypertonic saline groups, the acute lung injury animals presented higher neutrophil and tumor necrosis factor alpha (TNF-α), interleukin (IL)-6 and IL-8 levels in the bronchoalveolar lavage analysis. The histopathological analysis revealed pulmonary edema, congestion and alveolar collapse in both groups; however, the differences between groups were not significant. Despite the lower cytokine and neutrophil levels observed in the acute lung injury + hypertonic saline group, significant differences were not observed among the treated and non-treated groups. CONCLUSIONS: Hypertonic saline infusion after intratracheal hydrochloric acid instillation does not have an effect on inflammatory biomarkers or respiratory gas exchange

Cytokine levels evaluation during acute isovolemic anemia

Trabalho apresentado ao 30º International Symposium on Intensive Care and Emergency Medicine, 2010, Bruxelas

Blood transfusion in cardiac surgery is a risk factor for increased hospital length of stay in adult patients

Abstract\ud \ud \ud \ud Background\ud \ud Allogeneic red blood cell (RBC) transfusion has been proposed as a negative indicator of quality in cardiac surgery. Hospital length of stay (LOS) may be a surrogate of poor outcome in transfused patients.\ud \ud \ud \ud Methods\ud \ud Data from 502 patients included in Transfusion Requirements After Cardiac Surgery (TRACS) study were analyzed to assess the relationship between RBC transfusion and hospital LOS in patients undergoing cardiac surgery and enrolled in the TRACS study.\ud \ud \ud \ud Results\ud \ud According to the status of RBC transfusion, patients were categorized into the following three groups: 1) 199 patients (40%) who did not receive RBC, 2) 241 patients (48%) who received 3 RBC units or fewer (low transfusion requirement group), and 3) 62 patients (12%) who received more than 3 RBC units (high transfusion requirement group). In a multivariable Cox proportional hazards model, the following factors were predictive of a prolonged hospital length of stay: age higher than 65 years, EuroSCORE, valvular surgery, combined procedure, LVEF lower than 40% and RBC transfusion of > 3 units.\ud \ud \ud \ud Conclusion\ud \ud RBC transfusion is an independent risk factor for increased LOS in patients undergoing cardiac surgery. This finding highlights the adequacy of a restrictive transfusion therapy in patients undergoing cardiac surgery.\ud \ud \ud \ud Trial registration\ud \ud Clinicaltrials.gov identifier: http://NCT01021631.The authors would like to thank Suelly Zeferino and Lígia Camara for their assistance with data extraction. There was no external funding source for this research.This work was supported by the Department of Anaesthesiology, InCor, University of Sao Paulo

Statement of Second Brazilian Congress of Mechanical Ventilarion : part I

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aluation of respiratory function before and after cardiac surgery with extracorporeal circulation in anesthetized, intubated and curarized patients. Study of respiratory mechanics with a new method based on constant inspiratory flow. Study of lung ventilation and oxygenation

O presente trabalho teve por finalidade estudar as alterações do sistema circulatório provocadas pela cirurgia cardíaca sob circulação extracorpórea, 12 pacientes adultos, anestesiados e curarizados, selecionados aleatoriamente, sendo 6 deles valvopatas e 6 coronariopatas. As alterações respiratórias foram verificadas por medidas da mecânica respiratória e da ventilação-oxigenação pulmonar. Do ponto de vista mecânico, o sistema respiratório foi analisado como um todo e individualizando os seus componentes - pulmões e parede torácica, tanto do ponto de vista elástico como também fluxo-resistivo. A análise das propriedades resistivas do sistema respiratório foi feita através de um método que se utiliza da insuflação pulmonar com fluxo constante, seguida de uma oclusão súbita das vias aéreas. Esta análise permite que tanto para o sistema respiratório como também para os pulmões e parede torácica, obtenha-se o valor resistivo máximo (Rmax) bem como o valor mínimo da resistência (Rmin) ao lado das resistências geradas pelas desigualdades do sistema (Ru). Este estudo foi feito graças a estimativa das diferentes respostas de frequência de cada um destes componentes. As medidas de ventilação-oxigenação foram aferidas pelo cálculo do \"shunt\" pulmonar (Qs/Q) e gradiente alvéolo-arterial de oxigenio P(A-a)O2. Tanto as medidas mecânicas como as de ventilação-oxigenação foram feitas na vigência de uma fração inspirada de O2 de 100% e realizadas de 15 a 30 minutos após a entubação traqueal, sendo repetidas logo após o fechamento do tórax. [...]The aim of this work was to study the respiratory alterations caused by cardiac surgery under cardiopulmonary bypass in 12 randomly selected anesthetized paralyzed adult patients; 6 with acquired valvar disease and 6 with ischmic cardiopathy. Respiratory alterations were assessed by respiratory mechanics and lung ventilation-oxygenation measurements. Respiratory mechanics analyzed the respiratory system as a whole and partitioned into its components: lung and chest wall, measuring both the elastic and resistive properties were measured using a constant inflation flow followed bu a sudden occlusion. This analysis provides the maximum resistance value (Rmax), the minimum resistance value (Rmin), and the resistance caused by the uneven distribution of mechanical properties within the system (Ru), for respiratory system, lung and chest wall. This analysis is based on the frequency dependence differences of each component of respiratory system. The ventilation-oxygenation evaluation was done by the calculation of pulmonary shunt and the alveolar arterial oxygen gradient (P (A-a)O2). Both mechanical and ventilation-oxygenation measurement were done with a oxygen inspired fraction of 1 and performed 15 to 30 minutes after tracheal intubation and repeated just after thorax closure. [...