André Luiz Lisboa Cordeiro

Correlation between Length of Hospital Stay and Gait Speed in Patients Submitted to Cardiac Surgery

Fundamento: As doencas cardiovasculares tem aumentado em todo o mundo nas ultimas decadas devido ao aumento na ocorrencia de fatores desencadeantes. No periodo pos-operatorio de cirurgia cardiovascular, os pacientes experimentam um declinio funcional, que pode ser potencializado pelo tempo de internacao hospitalar. Portanto, e importante avaliar a capacidade funcional destes pacientes. Objetivo: Comparar o tempo de internacao hospitalar com a velocidade da marcha em pacientes submetidos a cirurgia cardiaca. Metodo: Estudo de coorte prospectivo, realizado no Instituto Nobre de Cardiologia (Incardio) da Santa Casa de Misericordia (Feira de Santana, Bahia). Na alta hospitalar, todos os pacientes foram avaliados com o teste de caminhada de 6 minutos (TC6). O tempo de internacao hospitalar no periodo pos-operatorio foi tambem registrado no momento da avaliacao e correlacionado com a velocidade da marcha. Utilizamos o teste de Kolmogorov-Smirnov para avaliar a suposicao de normalidade e a correlacao de Spearman para correlacionar a velocidade da marcha com a idade, tempo de hospitalizacao e com a duracao da circulacao extracorporea (CEC) e da ventilacao mecânica invasiva (VMI). Todas as conclusoes foram baseadas em um nivel de significância de 5%. Resultados: Ao todo, 64 pacientes foram incluidos (33 homens [51,5%], idade media 57,2 ± 14,06 anos). A distância media percorrida pelos pacientes foi de 375,8 ± 197,6 metros, a media da velocidade da marcha foi de 0,98 ± 0,53 m/s e a media de permanencia hospitalar foi de 8,2 ± 2,3 dias. Foi observada uma fraca correlacao entre o tempo de internacao hospitalar e a velocidade da marcha (r = 0,27 e p = 0,02). Conclusao: A duracao da hospitalizacao mostrou uma fraca correlacao com a velocidade da marcha na alta hospitalar em uma amostra de pacientes submetidos a cirurgia cardiaca. Registro do estudo: Registrado no CAAE (41151214.5.0000.5654) em 26 de junho de 2015.

Inspiratory Muscle Training and Functional Capacity in Patients Undergoing Cardiac Surgery

Introduction Cardiac surgery is a highly complex procedure which generates worsening of lung function and decreased inspiratory muscle strength. The inspiratory muscle training becomes effective for muscle strengthening and can improve functional capacity. Objective To investigate the effect of inspiratory muscle training on functional capacity submaximal and inspiratory muscle strength in patients undergoing cardiac surgery. Methods This is a clinical randomized controlled trial with patients undergoing cardiac surgery at Instituto Nobre de Cardiologia. Patients were divided into two groups: control group and training. Preoperatively, were assessed the maximum inspiratory pressure and the distance covered in a 6-minute walk test. From the third postoperative day, the control group was managed according to the routine of the unit while the training group underwent daily protocol of respiratory muscle training until the day of discharge. Results 50 patients, 27 (54%) males were included, with a mean age of 56.7±13.9 years. After the analysis, the training group had significant increase in maximum inspiratory pressure (69.5±14.9 vs. 83.1±19.1 cmH2O, P=0.0073) and 6-minute walk test (422.4±102.8 vs. 502.4±112.8 m, P=0.0031). Conclusion We conclude that inspiratory muscle training was effective in improving functional capacity submaximal and inspiratory muscle strength in this sample of patients undergoing cardiac surgery.

Time influence of mechanical ventilation on functional independence in patients submitted to cardiac surgery: literature review

Introduction: Patients submitted to cardiovascular surgery present motor and respiratory complications mainly due to high surgery manipulation and the use of mechanical ventilation. Reducing the weaning start time and disconnecting patients ventilation system prematurely can decrease the pulmonary complications and hospitalization time. Motor complications are the most relevant as they have a direct effect on functional independence provoked by immobility time. Objectives : Identify if mechanical ventilation time has an impact on functional capacity on patients submitted to cardiac surgery in order to contribute to the establishment of reliable evidence to practice through this patients profile. Materials and methods : Original articles were analyzed, published between 2000 and 2014, which focused on the influence of mechanical ventilation time concerning the functional independence on patients submitted to cardiac surgery, contained in the following electronic database: Scielo, BIREME (LILACS), PubMed e CAPES. Results : It was observed that the length of stay in the intensive care unit in cardiac surgery was influenced directly by CPB, VM and pulmonary dysfunction. Functional independence was compromised in patients with longer duration of mechanical ventilation, postoperative pain and prolonged bed rest. It was also found that there is no consensus on the protocol for improved functional capacity. Conclusion : There is a functional decline in patients undergoing cardiac surgery, especially those at increased length of stay in mechanical ventilation, reflecting a direct and negative impact on their functional independence and quality of life.

Behavior of Pulmonary Function after Hospital Discharge in Patients Submitted to Myocardial Revascularization

Mailing Address: André Luiz Lisboa Cordeiro Rua Japão, 94. Postal Code: 44052-022, Caseb, Feira de Santana, BA Brazil. E-mail: andrelisboacordeiro@gmail.com Behavior of Pulmonary Function after Hospital Discharge in Patients Submitted to Myocardial Revascularization André Luiz Lisboa Cordeiro,1,2 Letícia Gardênia Romualdo da Silva,2 Milena Oliveira Pinto,2 Jaclene da Silva Araújo,2 André Raimundo Guimarães,3 Jefferson Petto1,4,5,6 Escola Bahiana de Medicina e Saúde Pública,1 BA Brazil Faculdade Nobre,2 BA Brasil Instituto Nobre de Cardiologia,3 BA Brasil Universidade Salvador,4 BA Brasil Faculdade Adventista da Bahia,5 BA Brasil Faculdade Social da Bahia,6 BA Brasil

Association of Respiratory Mechanics with Oxygenation and Duration of Mechanical Ventilation After Cardiac Surgery

Mailing Address: André Luiz Lisboa Cordeiro Rua Japão, 94. Postal Code: 44052-022, Caseb, Feira de Santana, BA Brazil. E-mail: andrelisboacordeiro@gmail.com Association of Respiratory Mechanics with Oxygenation and Duration of Mechanical Ventilation After Cardiac Surgery André Luiz Lisboa Cordeiro,1 Livia Freire de Lima Oliveira,2 Thaynã Caribé Queiroz,2 Verena Lourranne Lima de Santana,2 Thiago Araújo de Melo,3 André Raimundo Guimarães,4 Bruno Prata Martinez5 Escola Bahiana de Medicina e Saúde Pública;1 Salvador, BA Brazil Faculdade Nobre;2 Feira de Santana, BA Brazil Universidade Salvador;3 Salvador, BA Brazil Incardio Instituto Nobre de Cardiologia;4 Feira de Santana, BA Brazil Universidade do Estado da Bahia (UNEB);5 Salvador, BA Brazil

Effect of Different Levels of Peep on Oxygenation during Non-InvasiveVentilation in Patients Submitted to CABG Surgery: Randomized ClinicalTrial

Introduction During and after coronary artery bypass grafting, a decline in multifactor lung function is observed. Due to this fact, some patients may benefit from non-invasive ventilation after extubation targeting lung expansion and consequently improved oxygenation. Objective To test the hypothesis that higher levels of positive end expiration pressure during non-invasive ventilation improves oxygenation in patients undergoing coronary artery bypass grafting. Methods A randomized clinical trial was conducted at Instituto Nobre de Cardiologia in Feira de Santana. On the first day after surgery, the patients were randomized: Group PEEP 10, Group PEEP 12 and Group PEEP 15 who underwent non-invasive ventilation with positive end expiration pressure level. All patients were submitted to analysis blood pressure oxygen (PaO2), arterial oxygen saturation (SaO2) and oxygenation index (PaO2/FiO2). Results Thirty patients were analyzed, 10 in each group, with 63.3% men with a mean age of 61.1±12.2 years. Mean pulmonary expansion pre-therapy PaO2 was generally 121.9±21.6 to 136.1±17.6 without statistical significance in the evaluation among the groups. This was also present in PaO2/FiO2 and SaO2. Statistical significance was only present in pre and post PEEP 15 when assessing the PaO2 and SaO2 (P=0.02). Conclusion Based on the findings of this study, non-invasive ventilation with PEEP 15 represented an improvement in oxygenation levels of patients undergoing coronary artery bypass grafting.

AB0581 Two years existence of reuma.pt/vasculitis – the portuguese registry of vasculitis

Background The vasculitides are a group of relatively rare diseases with different manifestations and outcomes. New therapeutic options have led to the need for long-term registries. The Rheumatic Diseases Portuguese Register, Reuma.pt, is an electronic clinical record, created in 2008, which currently includes specific protocols for 11 diseases and >16000 patients registered from 79 national and international rheumatology centres. Since October 2014, a dedicated protocol to vasculitis has been created as part of the European Vasculitis Society initiative of having compatible European registries. Objectives To describe the structure of Reuma.pt/Vasculitis and characterize the patients registered over the last two years. Methods We developed a dedicated web-based software to enable prospective collection and central storage of anonymised data from patients with vasculitis. All Portuguese rheumatology centres were invited to participate. Data regarding demographics, diagnosis, classification criteria, imaging and laboratory tests, outcome measures of prognosis, damage, disease activity and quality of life, and treatment were collected. We performed a cross-sectional descriptive analysis of all patients registered up to January 2017. Results A total of 492 patients, with 1114 visits, from 11 centres were registered in Reuma.pt/Vasculitis. The mean age was 53±20 years at last visit; 68% were females. The diagnoses followed the 2012 Chapel Hill Consensus nomenclature (Table 1). The most common diagnoses were Behçets disease (BD) (39%) and giant cell arteritis (GCA) (20%). Patients with BD met the International Study Group 1990 criteria, the International Criteria for BD 2006 and 2013 in 84%, 95% and 95% of cases, respectively. Patients with GCA met the 1990 American College of Rheumatology criteria in 95% of cases. Data on vascular ultrasound was available in 74% of patients; 73% compatible with the diagnosis. Assessment of the Birmingham Vasculitis Activity Score (BVAS) and Vasculitis Damage Index (VDI) was available for all vasculitides and the Five Factor Score calculation of survival rate for ANCA associated vasculitis (AAV) and polyarteritis nodosa (PAN). The mean BVAS at first visit was 18±7 for AAV and 15±9 for PAN; the mean VDI at last visit was 3±2 for AAV and 2±2 for PAN. Health related quality of life assessments (SF-36, EQD5, FACIT and HADS) were also collected. Treatment registry with the disease assessment variables shown in graphics was available for all patients; only 6% were under biologic treatment. Conclusions Reuma.pt/Vasculitis is a registry adapted for routine care, allowing an efficient data repository at a national level with the potential to link with other international databases. It facilitates research, trials recruitment, service planning and benchmarking. Disclosure of Interest None declared

Surgical Risk and Functionality in Patients Undergoing Heart Surgery

Mailing Address: André Luiz Lisboa Cordeiro Av. Dom João VI, 275, Acupe de Brotas, Postal Code: 40290-000. Salvador, BA – Brazil E-mail: andrelisboacordeiro@gmail.com Surgical Risk and Functionality in Patients Undergoing Heart Surgery André Luiz Lisboa Cordeiro1, Alina Ávila Oliveira Ribeiro Brito2, Isabela Carvalho2, Jessielle Oliveira2, André Raimundo Guimarães3, Thiago Melo de Araújo4, Giulliano Gardenghi5 Escola Bahiana de Medicina e Saúde Pública1, Liga de Pesquisa em Fisioterapia Cardiorrespiratória2, Instituto Nobre de Cardiologia da Santa Casa de Misericórdia3, Universidade Salvador4, Hospital ENCORE5, Aparecida de Goiânia, GO − Brazil

SAT0559 Reuma.Pt/LES: the Experience of Two Central Hospitals in Lisbon

Background Reuma.pt, the Rheumatic Diseases Register from the Portuguese Society of Rheumatology has recently expanded its coverage to Systemic Lupus Erythematous (SLE) patients, the Reuma.pt/LES. Reuma.pt/LES is a web-based platform launched in September 2012 that simultaneously serves as a nationwide registry and as an electronic medical record. Its aim is to register all patients with SLE and follow them up in a standard manner in order to improve the monitoring and clinical care for patients with SLE while simultaneously increase the knowledge of this disease. Methods The authors present the structure and the functioning of this national project, giving as an example the subpopulation of patients with SLE from two centres in Lisbon (Hospital Santa Maria and Hospital Garcia de Orta) included in Reuma.pt/LES. Results 878 patients from all the country with the clinical diagnosis of SLE were registered in the database Reuma.pt/LES until January 2013. Recorded information includes demographics, work status, life-styles, ACR and SLICC 2012 classification criteria, thrombotic and obstetric manifestations, SLE disease activity at each visit, fatigue scale, health related quality of life measures (SF-36 and EQD5), irreversible damage, comorbid conditions, medication and adverse events. Hospital Santa Maria (Lisbon) and the Hospital Garcia de Orta (Almada) contributed to Reuma.pt/LES with 305 patients, 95,1% females, 80% Caucasians with a mean age of 45.5 ±14.9y. The mean age at diagnosis was 35.9 ±14.9y and the mean disease duration was 10.3 ± 7.3y. SLE Disease Activity Index (SLEDAI) at the first evaluation was 3,4 ± 3,8 and current accrual damage assessed by the Systemic Lupus International Collaborating Clinics (SLICC) was 0,7 ± 1,1. Hypertension was reported in 24% of the patients, diabetes in 8.8% and cardiovascular diseases in 11%. The vast majority of patients was treated with hydroxychloroquine (93.9%) and corticosteroids (prednisolone 44.6%, prednisone 12.4%, deflazacort 18.%). Immunosuppressive drugs were used in about half of the cases (azathioprine in 27%, methotrexate in 15.5%, cyclophosphamide in 7.4%, micophenolate in 5%) and to a lesser extent biological therapies (rituximab in 5.9% and belimumab in 0.98% of the patients). Conclusions Reuma.pt, is a very useful tool, that allows a more efficient patient follow-up, and standardized data collection, storage and analysis, with the ultimate objective of improving patient care and simultaneously scientific research in the field of SLE. Disclosure of Interest None Declared