Showing papers by "Ludhmila Abrahão Hajjar published in 2013"

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

Abstract: Background: 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. Methods: 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. Results: 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. Conclusion: 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.

Volume Replacement Therapy during Hip Arthroplasty using Hydroxyethyl Starch (130/0.4) Compared to Lactated Ringer Decreases Allogeneic Blood Transfusion and Postoperative Infection

Abstract: Background and objectives: Hydroxyethyl starch (HES) 130/0.4 is considered an effective plasma expander when compared to crystalloids. There is controversy around its superiority regarding hemodynamic optimization and about possible detrimental effects on coagulation. The aim of this study was to compare the effects of HES 130/0.4 to lactated Ringer solution during hip arthroplasty in adult patients under spinal anesthesia regarding intraoperative bleeding, hemodynamic parameters, coagulation profi le, transfusion requirements and clinical outcomes. Methods: In this randomized, controlled trial, 48 patients scheduled for hip arthroplasty with spinal anesthesia were randomized into two groups: 24 patients were allocated to receive a preload of 15 mL.kg -1 of HES 130/0.4 and 24 patients received a preload of 30 mL.kg -1

Bronchial injury and pneumothorax after reintubation using an airway exchange catheter.

Abstract: Background and objectives : We report a case of pneumothorax caused by a bronchial perforation during a reintubation using an airway exchange catheter (AEC) in a patient with a head and neck cancer. Case report : A 53 year old man with oropharynx carcinoma was admitted to ICU for severe pneumonia and severe acute respiratory distress syndrome (ARDS). The patient was recognized as a difficult-to-intubate patient and an endotracheal tube (ETT) was inserted through a bronchoscope. After one week of treatment, it was observed an endotracheal cuff perforation. Exchanging the endotracheal tube was necessary to achieve satisfactory pulmonary ventilation. An AEC Cook 14 was used to perform the reintubation. After reintubation, the patient presented a worsening in oxygen saturation and a chest radiography (CXR) revealed a large pneumothorax. A chest tube was inserted and we observed immediate improvement in oxygen saturation. A repeat CXR confirmed correct positioning of the chest tube and reexpansion of the right lung. A bronchoscopy performed showed a posterior laceration in the right main bronchus. The patient was extubated the following day. After four days, the chest tube was removed. A CXR performed a day after chest tube removal revealed a small right upper pneumothorax, but the patient remained asymptomatic. Conclusions : Airway exchange catheter is a valuable tool to handle with difficult-to-intubate patients. Although the physicians generally focus their attention in avoid barotrauma - caused by oxygen supplement or jet ventilation through AEC - concern for insertion technique can minimize life threatening complications and increase the safety of AEC.

Prognostic value of coronary and microvascular flow reserve in patients with nonischemic dilated cardiomyopathy.

Abstract: Background Coronary and microvascular blood flow reserve have been established as important predictors of prognosis in patients with cardiovascular disease. The aim of this study was to assess the value of coronary flow velocity reserve (CFVR) and real-time myocardial perfusion echocardiography (RTMPE) for predicting events in patients with nonischemic dilated cardiomyopathy. Methods One hundred ninety-five patients (mean age 54 ± 12 years; 66% men) with dilated cardiomyopathy (left ventricular ejection fraction A N ), and myocardial blood flow reserve were obtained from RTMPE. Results Mean CFVR was 2.07 ± 0.52, mean A N reserve was 1.05 ± 0.09, mean β reserve was 2.05 ± 0.39, and mean myocardial blood flow reserve ( A N × β) was 2.15 ± 0.48. During a median follow-up period of 29 months, 45 patients had events (43 deaths and two urgent transplantations). Independent predictors of events were left atrial diameter (relative risk, 1.16; 95% confidence interval, 1.08–1.26; P P 2 = 36.8–58.5, P 2 = 70.2, P Conclusions Increased left atrial diameter and depressed β reserve were independent predictors of cardiac death and transplantation in patients with nonischemic dilated cardiomyopathy. Beta reserve by RTMPE provided incremental predictive value beyond that provided by current known prognostic clinical and echocardiographic factors.

Terapia de reposición volémica durante la artroplastia de cadera usando hidroxietilalmidón (130/0,4) : comparado con lactato de Ringer reduce la transfusión de sangre alogénica y la infección posoperatoria

Abstract: Resumen Justificativa y objetivos : El hidroxietilalmidon 130/0,4 (HES 130/0,4) esta considerado como un expansivo plasmatico efectivo cuando se le compara con los cristaloides Existen controversias sobre su superioridad con relacion a la optimizacion hemodinamica y sobre posibles efectos perjudiciales en la coagulacion El objetivo de este estudio, fue comparar los efectos del HES 130/0,4 con los de la solucion de lactato de Ringer durante la artroplastia de cadera en pacientes adultos bajo raquianestesia, considerando el sangramiento intraoperatorio, los parametros hemodinamicos, el coagulograma, la necesidad de transfusion y los resultados clinicos Metodos : En este estudio aleatorio y controlado, 48 pacientes citados para la artroplastia de cadera con raquianestesia fueron aleatoriamente divididos en dos grupos: 24 pacientes fueron ubicados para recibir una pre-carga de HES 130/0,4 (15 mLkg-1) y 24 pacientes recibieron una pre-carga de solucion de lactato de Ringer (30 mLkg-1) antes de la cirugia Las medidas hemodinamicas, concentracion de hemoglobina, parametros bioquimicos y los test de coagulacion fueron evaluados en tres periodos durante el procedimiento quirurgico Los pacientes recibieron un acompanamiento medico durante el ingreso y de 30 dias en el periodo del postoperatorio El principal factor fue la necesidad de transfusion de hematies entre los grupos durante el ingreso Los factores secundarios fueron los parametros hemodinamicos, tiempo de ingreso, mortalidad y aparecimiento de complicaciones clinicas Resultados : La transfusion de hematies fue necesaria en un 17% de los pacientes del grupo HES y en un 46% de los pacientes del grupo lactato de Ringer (p = 0,029) Las infecciones postoperatorias fueron observadas con mas frecuencia en el grupo lactato de Ringer (17%) en comparacion con el grupo HES (0), p = 0,037 No hubo diferencias significativas entre los grupos con relacion a la mortalidad, tiempo de ingreso y complicaciones clinicas, excepto en la infeccion Conclusiones : Durante la artroplastia de cadera, los pacientes tratados con hemodilucion hipervolemica normal con hidroxietilalmidon 130/04 necesitaron menos transfusion y presentaron un indice menor de infeccion en comparacion con los pacientes que recibieron lactato de Ringer

Terapia de reposição volêmica durante artroplastia de quadril usando hidroxietilamido (130/0,4) comparado com Ringer lactato diminui transfusão de sangue alogênico e infecção pós-operatória

Abstract: JUSTIFICATIVA E OBJETIVOS: O hidroxietilamido 130/0,4 (HES 130/0,4) e considerado um expansor plasmatico efetivo quando comparado com cristaloides. Ha controversia sobre sua superioridade em relacao a otimizacao hemodinâmica e sobre possiveis efeitos prejudiciais na coagulacao. O objetivo deste estudo foi comparar os efeitos do HES 130/0,4 com os da solucao de Ringer lactato durante artroplastia de quadril em pacientes adultos sob raquianestesia e levou em consideracao sangramento intraoperatorio, parâmetros hemodinâmicos, coagulograma, necessidade de transfusao e desfechos clinicos. METODOS: Neste estudo randomico e controlado, 48 pacientes agendados para artroplastia de quadril com raquianestesia foram alocados em dois grupos: 24 receberam uma pre-carga de HES 130/0,4 (15 mL.kg-1) e 24 receberam uma pre-carga de solucao de Ringer lactato (30 mL. kg-1) antes da cirurgia. Mensuracoes hemodinâmicas, concentracao de hemoglobina, parâmetros bioquimicos e testes de coagulacao foram avaliados em tres periodos durante o procedimento cirurgico. Os pacientes receberam acompanhamento medico durante a internacao e ate 30 dias no periodo pos-operatorio. O principal fator foi a necessidade de transfusao de hemacias entre os grupos durante a internacao. Os fatores secundarios foram parâmetros hemodinâmicos, tempo de internacao, mortalidade e ocorrencia de complicacoes clinicas. no periodo pos-operatorio. O principal fator foi a necessidade de transfusao de hemacias entre os grupos durante a internacao. Os fatores secundarios foram parâmetros hemodinâmicos, tempo de internacao, mortalidade e ocorrencia de complicacoes clinicas. RESULTADOS: A transfusao de hemacias foi necessaria em 17% dos pacientes do grupo HES e em 46% dos pacientes do grupo Ringer lactato (p = 0,029). Infeccoes pos-operatorias foram observadas com mais frequencia no grupo de Ringer lactato (17%) em comparacao com o grupo HES (0), p = 0,037. Nao houve diferencas significativas entre os grupos em relacao a mortalidade, ao tempo de internacao e as complicacoes clinicas, exceto infeccao. CONCLUSOES: Durante a artroplastia de quadril, os pacientes tratados com hemodiluicao hipervolemica normal com hidroxietilamido 130/0,4 precisaram de menos transfusao e apresentaram indice menor de infeccao em comparacao com os pacientes que receberam Ringer lactato.

Lesión brónquica y neumotórax posterior a la reintubación usando un catéter para el cambio de la vía aérea

Abstract: Resumen Justificativa y objetivos: Relatamos aqui un caso de neumotorax causado por perforacion bronquica durante una reintubacion usando un cateter para el cambio de la via aerea (CTVA) en una paciente con cancer de cabeza y cuello Relato de caso: Paciente del sexo masculino, 53 anos, con carcinoma de orofaringe, que fue ingresado en la UTI con neumonia grave y el sindrome de la angustia respiratoria aguda (SARA) El paciente fue identificado como siendo de dificil intubacion y con un broncoscopio se le inserto una sonda endotraqueal (SET) Despues de una semana de tratamiento, vimos una ruptura del manguito endotraqueal El cambio de la sonda endotraqueal se hizo necesario para obtener una ventilacion pulmonar satisfactoria Un cateter para el cambio de la via aerea (Cook, tamano 14) se uso para realizar la reintubacion Despues de la reintubacion, el paciente tuvo un empeoramiento en la saturacion de oxigeno y una radiografia revelo un fuerte neumotorax Un dreno toracico se inserto observando una mejoria inmediata en la saturacion de oxigeno La repeticion de la radiografia confirmo el posicionamiento correcto del dreno toracico y la re-expansion del pulmon derecho La broncoscopia realizada arrojo una laceracion posterior del bronquio principal derecho El paciente se desentubo al dia siguiente Despues de cuatro dias, el dreno toracico se retiro La radiografia realizada un dia despues de la retirada del dreno revelo un pequeno neumotorax en el lobulo superior derecho, pero el paciente permanecio asintomatico Conclusiones: El cateter para el cambio de la via aerea es una herramienta valiosa para lidiar con los pacientes dificiles de intubar Aunque los medicos generalmente concentren su atencion en evitar un barotrauma causado por el suplemento de oxigeno o ventilacion a chorro por medio del CTVA, la preocupacion con la tecnica de insercion puede minimizar las complicaciones que amenazan la vida y aumentar la seguridad del CTVA