Navegando por Palavras-chave "postoperative care"
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- ItemSomente MetadadadosCough Impairment and Risk of Postoperative Pulmonary Complications After Open Upper Abdominal Surgery(Daedalus Enterprises Inc, 2015-05-01) Bonfim Colucci, Daniela B. [UNIFESP]; Fiore, Julio F.; Paisani, Denise M.; Risso, Thais Telles; Colucci, Marcelo; Chiavegato, Luciana Dias; Faresin, Sonia Maria [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); McGill Univ; Universidade de São Paulo (USP); Univ Ctr Vila Velha; Nove de Julho Univ; Univ City São Paulo UNICIDBACKGROUND: Cough impairment is often described as part of the pathophysiological basis of postoperative pulmonary complications (PPCs). However, there have been few studies examining cough effectiveness and its relationship with PPCs following open upper abdominal surgery. the goal of this study was to estimate (1) changes in cough efficacy after upper abdominal surgery through the assessment of peak cough flow and (2) the extent to which cough impairment is associated with postoperative pain, FVC, and risk of PPCs. METHODS: This prospective cohort study assessed 101 subjects (45% male, 56 +/- 16 y old) admitted for elective upper abdominal surgery. Measurements of peak cough flow and FVC were performed on the day before surgery and repeated on postoperative days 1, 3, and 5. PPCs were assessed daily by a pulmonologist blinded to the cough measurement results. RESULTS: Peak cough flow dropped to 54% of the preoperative value on postoperative day 1 and gradually increased on postoperative days 3 (65%) and 5 (72%) (P < .05). On all postoperative days, peak cough flow was strongly correlated with FVC (P < .001) and weakly correlated with pain (P = .006). Six subjects (6%) developed PPCs. the association between peak cough flow and risk of PPCs was not statistically significant (unadjusted odds ratio of 0.80, 95% CI 0.45-1.40, P = .44; adjusted odds ratio of 0.66, 95% CI 0.32-1.38, P = .41). CONCLUSIONS: Cough effectiveness is impaired after upper abdominal surgery. Postoperative restrictive lung dysfunction seems to be associated with this impairment. There is no significant association between peak cough flow and PPCs; however, cough impairment might result in clinically important consequences in a high-risk population. (C) 2015 Daedalus Enterprises
- ItemAcesso aberto (Open Access)Cuidados intensivos para pacientes em pós-operatório de cirurgia bariátrica(Associação de Medicina Intensiva Brasileira - AMIB, 2007-06-01) Sanches, Giselle Domingues [UNIFESP]; Gazoni, Fernanda M. [UNIFESP]; Konishi, Renata Koda [UNIFESP]; Guimarães, Hélio Penna [UNIFESP]; Vendrame, Letícia Sandre [UNIFESP]; Lopes, Renato Delascio [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); AMIB-AMB; Instituto Dante Pazzanese de CardiologiaBACKGROUND AND OBJECTIVES: Obesity is an epidemic disease reaching more than 300 million people all over the world. Its prevalence has increased during the past few years and according to some studies its mortality in the critically ill patient seems to be much higher, especially among patients who were submitted to surgery. This study has as objective to discuss some particularities of managing obese patients in the intensive care unit after bariatric surgery. CONTENTS: The rate of obese patient in the ICU ranges from 9% to 26% and the increase in the number of bariatric surgeries has raised the number of obese patients in the ICU. It is important to know the physiopathology of obesity and to treat its particularities during the postoperative care. Such as pulmonary restriction, that causes an increase in pulmonary complications, coronary artery disease and thromboembolic events. CONCLUSIONS: The number of patients that undergo to bariatric surgery has increased; therefore, the number of obese patients in the ICU has also risen. Different physiological events and complications in obese patients are challenges to clinical practice. The knowledge of obese physiopathology helps in the managing routine procedures and complications after bariatric surgery.
- ItemSomente MetadadadosDo Directed Cough Maneuvers Improve Cough Effectiveness in the Early Period After Open Heart Surgery? Effect of Thoracic Support and Maximal Inspiration on Cough Peak Expiratory Flow, Cough Expiratory Volume, and Thoracic Pain(Daedalus Enterprises Inc, 2008-08-01) Fiore Junior, Julio Flavio [UNIFESP]; Chiavegato, Luciana Dias [UNIFESP]; Denehy, Linda; Paisani, Denise de Moraes [UNIFESP]; Faresin, Sonia Maria [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Univ MelbourneBACKGROUND: Directed cough maneuvers are often included in physiotherapy management aimed at preventing postoperative pulmonary complications after open heart surgery, but there is little scientific evidence of the effectiveness of directed cough maneuvers. METHODS: We conducted a randomized intra-subject crossover trial to evaluate the effect of thoracic support (patient holds his or her hands over the incision) and maximal inspiration on cough peak expiratory flow (CPEF), cough expiratory volume (CEV), and incision pain during cough in the early period after open heart surgery. Cough evaluation was undertaken on the first and second morning after surgery. On both measurement days the subject did a baseline cough (baseline cough 1) then, in a random sequence, performed 3 cough conditions: an additional baseline cough (baseline cough 2), supported cough, and supported cough preceded by maximal inspiration. In these test conditions a P < .008 was deemed to indicate a statistically significant difference. RESULTS: Twenty-one subjects participated. Thoracic support alone did not significantly affect CPEF or CEV (Bonferroni adjusted P > .008). With a maximal inspiration and thoracic support, CPEF and CPEV were significantly higher than in all other cough conditions (Bonferroni adjusted P < .008). Pain during cough was not influenced by the different cough conditions (P > .05). There was no significant difference in the cough variables or pain during the different cough conditions on the first day versus the second measurement day. CONCLUSIONS: Maximal inspiration increased CPEF and CEV, but the method of thoracic support we used did not reduce pain during cough or influence the cough values we measured.
- ItemAcesso aberto (Open Access)Dor pós-operatória em craniotomia(Escola de Enfermagem de Ribeirão Preto / Universidade de São Paulo, 2005-08-01) Peón, Andréa Ungaro; Diccini, Solange [UNIFESP]; Hospital Israelita Albert Einstein; Universidade Federal de São Paulo (UNIFESP)In the postoperative period, 47% to 75% of the patients report some degree of pain. This study aimed to evaluate pain in the pre and postoperative period of patients submitted to craniotomy. This prospective research was carried out at the neurosurgery unit of a large Brazilian hospital. For a quantitative evaluation of pain, the verbal numeric 0 - 10 rating scale was used. Forty patients with a mean age of 36 years were evaluated. In the preoperative period, 34 (85%) patients indicated headache as the main cause of pain. In the postoperative period, 37 (93%) patients complained of pain while three (7%) reported absence of pain. Pain peaks were observed on the 2nd postoperative day, when 12 (32%) of the patients reported severe pain and 10 (27%) moderate pain. Absence of severe pain occurred after the 8th postoperative day. It was concluded that protocols of analgesia in craniotomy are needed, such as training nurses to better evaluate and handle pain.
- ItemAcesso aberto (Open Access)Manejo do paciente no período perioperatório em neurocirurgia pediátrica(Associação Médica Brasileira, 2012-06-01) Mekitarian Filho, Eduardo [UNIFESP]; Carvalho, Werther Brunow de [UNIFESP]; Cavalheiro, Sergio [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Universidade de São Paulo (USP); UPA Hospital Israelita Albert Einstein; Hospital Santa Catarina; Hospital Santa Catarina Unidade de Terapia Intensiva PediátricaOBJECTIVES: To describe the main pathophysiological differences in neurosurgical procedures between children and adults; the main complications and adverse events resulting from pediatric neurosurgery reported in studies; the singularities in anesthetic and intraoperative management in several neurosurgical diseases; the more specific and common complications and their management in the most frequent pediatric neurosurgical procedures, as well as causes and treatment for the main complications found in children undergoing neurosurgery. METHODS: A non-systematic review in literature databases PubMed, EMBASE, and SciELO was performed by using the keywords pediatrics, children, neurosurgery, risk factors, intraoperative complications, and postoperative period, as well as their matches in Portuguese and Spanish from January 2001 to January 2011, in addition to using important references from the selected material over any period of time. RESULTS: The three procedures most commonly performed in children are hydrocephalus, craniostenosis repair, and brain tumor resection. Complications as fever, bleeding, metabolic disturbances (hyponatremia and hyperglycemia), brain swelling, and transient focal deficits (limb weakness, speech and swallowing disorders) are frequent, but their course is often towards prompt improvement. Up to 50% of children may have an uneventful evolution over the postoperative period. Special attention must be given to the prevention of postoperative infections and seizures with the use of a drug therapy that suits each case. CONCLUSION: The complexity of neurosurgical procedures in children is increasing, and observation and recognition of complications in pediatric intensive care units are fundamental. Anticipating complications in order to achieve an early treatment and adverse event prophylaxis can contribute to reduced morbidity and mortality and increased patients' safety.
- ItemAcesso aberto (Open Access)Parâmetros nutricionais pré-operatórios para pacientes após cirurgia bariátrica(Universidade Federal de São Paulo (UNIFESP), 2019) Jamil, Liliane Carvalho [UNIFESP]; Ferreira, Lydia Masako [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Introduction: Surgical outcomes in post bariatric patients are strongly influenced by the patient's nutritional status. Despite the extensive literature, in practice, follow-up management and nutritional preparation for bariatric patients undergoing subsequent surgeries present great variation. There is a need to standardize and summarize post bariatric nutritional recommendations in order to optimize preparation of patients for following surgeries. Objective: To define the preoperative nutritional parameters for post bariatric patients and create an assessment tool based on the current recommendations. Method: A review of the literature was carried out in the Health Information databases of the National Library of Medicine (MEDLINE), the electronic library of the Electronic On-line Library (SciELO) in Latin American and Caribbean Literature in Health Sciences (LILACS and Embase from January 2008 to October 2018 with use of the following terms: bariatric surgery, nutritional status, trace elements, nutritional physiological phenomena, postoperative care, postoperative period. The agreement between two examiners was evaluated using the Kappa coefficient. The content of the selected articles was submitted to the thematic analysis. Recommendations found in this review were organized to create an assessment tool. Results: Recommendations regarding routine testing, prophylactic and therapeutic supplementation and multidisciplinary follow-up for post-bariatric patients were identified in the literature. Conclusion: Preoperative nutritional parameters for post bariatric patients were defined and organized in an assessment tool.
- ItemSomente MetadadadosSepsis in the Postoperative Period of Cardiac Surgery: Problem Description(Arquivos Brasileiros Cardiologia, 2010-03-01) Oliveira, Dinaldo Cavalcanti de [UNIFESP]; Oliveira Filho, Joao Bosco de; Silva, Rogerio Ferreira; Moura, Simone Soares; Silva, Diego Janstk; Egito, Enilton Sergio Tabosa do; Martins, Stevan Krieger; Souza, Luis Carlos Bento; Jatene, Adib Domingos; Piegas, Leopoldo Soares [UNIFESP]; Universidade Federal de Pernambuco (UFPE); Hosp Coracao; Universidade Federal de São Paulo (UNIFESP)Background: In spite of the advances in sepsis diagnosis and treatment in the last years, the morbidity and mortality are still high.Objective: To assess the prevalence, in-hospital evolution and prognosis of patients that presented sepsis in the postoperative period of cardiac surgery.Methods: This is a prospective study that included patients (n = 7,332) submitted to cardiac surgery (valvular or coronary) between January 1995 and December 2007. The classic criteria of sepsis diagnosis were used to identify the patients that developed such condition and the preoperative comorbidities, in-hospital evolution and prognosis were evaluated.Results: Sepsis occurred in 29 patients (prevalence = 0.39%). There was a predominance of the male when compared to the female sex (79% vs. 21%). Mean age was 69 +/- 6.5 years. The main preoperative comorbidities were: systemic arterial hypertension (79%), dyslipidemia (48%) and family history of coronary artery disease (38%). The mean Apache score was 18 7, whereas the Sofa score was 14.2 +/- 3.8. The primary infectious focus was pulmonary in 19 patients (55%). There were 19 positive cultures and the mean IV hydration during the first 24 hours was 1,016 +/- 803 ml. The main complications were acute renal failure (65%), low cardiac output syndrome (55%) and malignant ventricular arrhythmia (55%). Mortality was 79% (23 patients).Conclusion: The occurrence of sepsis after cardiac surgery was a rare event; however, its occurrence showed catastrophic clinical outcomes. The high morbidity and mortality showed the need to improve treatment, aiming at patients' better clinical evolution. (Arq Bras Cardiol 2010; 94(3):332-336)