Eduesley Santana-Santos

High dose of N-acetylcystein prevents acute kidney injury in chronic kidney disease patients undergoing myocardial revascularization.

BACKGROUND The renoprotective effect of N-acetylcystein in patients undergoing coronary artery bypass graft surgery is controversial. METHODS We assessed the renoprotective effect of the highest dose of N-acetylcystein sanctioned for clinical use in a prospective, double-blind, placebo-controlled study including 70 chronic kidney disease patients, stage 3 or 4, who underwent coronary artery bypass graft surgery, on cardiopulmonary bypass (CPB) and off CPB, and were randomly allocated to receive either N-acetylcystein 150 mg/kg followed by 50 mg/kg for 6 hours in 0.9% saline or only 0.9% saline. Acute kidney injury was defined by the Acute Kidney Injury Network classification. RESULTS The incidence of kidney injury was reduced in the N-acetylcystein group (57.1% versus 28.6%, p=0.016). Nonuse of N-acetylcystein (relative risk 3.58, 95% confidence interval: 1.04 to 12.33, p=0.04) and cardiopulmonary bypass (relative risk 4.55, 95% confidence interval: 1.28 to 16.15, p=0.02) were independent predictors of kidney injury. In patients treated with CPB, N-acetylcystein reduced the incidence of kidney injury from 63% to 46%. Oxidative stress was increased in control subjects (p=0.01) and abolished in patients receiving N-acetylcystein. CONCLUSIONS Maximum intravenous doses of N-acetylcystein reduce the incidence of acute kidney injury in patients with kidney disease undergoing coronary artery bypass graft surgery, abolish oxidative stress, and mitigate the negative effect of CPB on renal function.

Avaliação da carga de trabalho no pós-operatório de cirurgia cardíaca segundo o Nursing Activities Score

Objetivo Identificar los factores asociados con la carga de trabajo de enfermeria en el cuidado de los pacientes despues de la cirugia cardiaca. Metodo Estudio prospectivo de cohorte, realizado con 187 pacientes de la Unidad Quirurgica de Cuidados Intensivos (UCI) del Instituto do Coracao. Los datos fueron recogidos en las primeras 24 y 72 horas el paciente en la UCI. La variable dependiente fue la carga de trabajo calculada por el Nursing Activities Score (NAS) y eran independientes de la naturaleza y de mortalidad puntajes demograficas y clinicas. Para el analisis de los datos se utilizo la prueba de Wilcoxon-Mann-Whitney y Spearman correlacion y de regresion lineal con el modelo de efectos mixtos. Resultados La mayoria de los pacientes eran varones (59,4%) con una edad media de 61 anos (±12,7) y 43,9% desarrollaron algun tipo de complicacion en el postoperatorio. Dentro de 24 horas, la carga de trabajo fue 82,4% (±3,4) y 58,1% (±3,4) en 72 horas. Los factores asociados con el aumento de NAS fueron: longitud del paciente de la estancia en la UCI (p=0,036) y la presencia de complicaciones (p<0,001). Conclusion La gravedad de la paciente dentro de 24 horas, a diferencia de numerosos estudios, no afecto a la mayor carga de trabajo, que se asocio a la duracion de la estancia y complicaciones.

Assessment of workload in the postoperative period of cardiac surgery according to the Nursing Activities Score

Objetivo Identificar los factores asociados con la carga de trabajo de enfermeria en el cuidado de los pacientes despues de la cirugia cardiaca. Metodo Estudio prospectivo de cohorte, realizado con 187 pacientes de la Unidad Quirurgica de Cuidados Intensivos (UCI) del Instituto do Coracao. Los datos fueron recogidos en las primeras 24 y 72 horas el paciente en la UCI. La variable dependiente fue la carga de trabajo calculada por el Nursing Activities Score (NAS) y eran independientes de la naturaleza y de mortalidad puntajes demograficas y clinicas. Para el analisis de los datos se utilizo la prueba de Wilcoxon-Mann-Whitney y Spearman correlacion y de regresion lineal con el modelo de efectos mixtos. Resultados La mayoria de los pacientes eran varones (59,4%) con una edad media de 61 anos (±12,7) y 43,9% desarrollaron algun tipo de complicacion en el postoperatorio. Dentro de 24 horas, la carga de trabajo fue 82,4% (±3,4) y 58,1% (±3,4) en 72 horas. Los factores asociados con el aumento de NAS fueron: longitud del paciente de la estancia en la UCI (p=0,036) y la presencia de complicaciones (p<0,001). Conclusion La gravedad de la paciente dentro de 24 horas, a diferencia de numerosos estudios, no afecto a la mayor carga de trabajo, que se asocio a la duracion de la estancia y complicaciones.

Long-Term Follow-Up Evaluation of Renal Function in Patients with Chronic Kidney Disease Undergoing Cardiac Surgery.

Background. Acute kidney injury (AKI) is a common complication of cardiac surgery but its long-term consequences, in patients with chronic kidney disease (CKD), are not known. Methods. We compared the long-term prognoses of CKD patients who developed (n = 23) and did not develop (n = 35) AKI during the period of hospitalization after undergoing coronary artery bypass graft (CABG). Fifty-eight patients who survived (69.6 ± 8.4 years old, 72% males, 83% Whites, 52% diabetics, baseline GFR: 46 ± 16 mL/min) were followed up for 47.8 ± 16.4 months and treated for secondary prevention of events. Results. There were 6 deaths, 4 in the AKI+ and 2 in the AKI− group (Log-rank = 0.218), two attributed to CV causes. At the end of the study, renal function was similar in the two groups. One AKI− patient was started on dialysis. Only 4 patients had an increase in serum creatinine ≥ 0.5 mg/dL during follow-up. Conclusion. CKD patients developing AKI that survived the early perioperative period of coronary intervention present good renal and nonrenal long-term prognosis, compared to patients who did not develop AKI.

Estratégias de prevenção da lesão renal aguda em cirurgia cardíaca: revisão integrativa

Acute kidney injury is a common complication after cardiac surgery and is associated with increased morbidity and mortality and increased length of stay in the intensive care unit. Considering the high prevalence of acute kidney injury and its association with worsened prognosis, the development of strategies for renal protection in hospitals is essential to reduce the associated high morbidity and mortality, especially for patients at high risk of developing acute kidney injury, such as patients who undergo cardiac surgery. This integrative review sought to assess the evidence available in the literature regarding the most effective interventions for the prevention of acute kidney injury in patients undergoing cardiac surgery. To select the articles, we used the CINAHL and MedLine databases. The sample of this review consisted of 16 articles. After analyzing the articles included in the review, the results of the studies showed that only hydration with saline has noteworthy results in the prevention of acute kidney injury. The other strategies are controversial and require further research to prove their effectiveness.

Desfechos clínicos de pacientes pediátricos tratados com oxigenação por membrana extracorpórea

Objective To identify factors related to mortality, and evaluate the survival of pediatric patients treated with extracorporeal membrane oxygenation. Methods A retrospective cohort study that included pediatric patients using the device in the last five years. The groups were divided into those who survived after therapy, and those who did not. Multivariate logistic regression was used for assessing the predictive factors of death, and the Kaplan-Meier and log-rank for assessing survival. Results Left ventricular ejection fraction was higher in the group of survivors (74% + 14.6% vs 56.2% + 22%, p = 0.038), and the number of patients who required dialysis was higher in the group of non-survivors (52.4% vs. 12.5%, p = 0.039), showing significantly lower survival in this group (log-rank = 0.020). Conclusion Previous ventricular dysfunction, evidenced by a left ventricular ejection fraction <55%, and requirement of concomitant renal replacement therapy, increased the risk of death.

Insuficiência cardíaca como preditor de dependência funcional em idosos hospitalizados

OBJECTIVEIdentify whether Heart Failure (HF) is a predictor of functional dependence for Basic Activities of Daily Living (BADL) in hospitalized elderly.METHODSWe investigated medical records and assessed dependence to BADL (by the Katz Index) of 100 elderly admitted to a geriatric ward of a university hospital. In order to verify if HF is a predictor of functional dependence, linear regression analyzes were performed.RESULTSThe prevalence of HF was 21%; 95% of them were dependent for BADLs. Bathing was the most committed ADL. HF is a predictor of dependence in hospitalized elderlies, increasing the chance of functional decline by 5 times (95% CI, 0.94-94.48), the chance of functional deterioration by 3.5 times (95% CI, 1.28-11.66; p <0.02) and reducing 0.79 points in the Katz Index score (p <0.05).CONCLUSIONHF is a dependency predictor of ADL in hospitalized elderly, who tend to be more dependent, especially for bathing.OBJECTIVE Identify whether Heart Failure (HF) is a predictor of functional dependence for Basic Activities of Daily Living (BADL) in hospitalized elderly. METHODS We investigated medical records and assessed dependence to BADL (by the Katz Index) of 100 elderly admitted to a geriatric ward of a university hospital. In order to verify if HF is a predictor of functional dependence, linear regression analyzes were performed. RESULTS The prevalence of HF was 21%; 95% of them were dependent for BADLs. Bathing was the most committed ADL. HF is a predictor of dependence in hospitalized elderlies, increasing the chance of functional decline by 5 times (95% CI, 0.94-94.48), the chance of functional deterioration by 3.5 times (95% CI, 1.28-11.66; p <0.02) and reducing 0.79 points in the Katz Index score (p <0.05). CONCLUSION HF is a dependency predictor of ADL in hospitalized elderly, who tend to be more dependent, especially for bathing.

Insuficiencia cardiaca como pronosticador de dependencia funcional en ancianos hospitalizados

OBJECTIVEIdentify whether Heart Failure (HF) is a predictor of functional dependence for Basic Activities of Daily Living (BADL) in hospitalized elderly.METHODSWe investigated medical records and assessed dependence to BADL (by the Katz Index) of 100 elderly admitted to a geriatric ward of a university hospital. In order to verify if HF is a predictor of functional dependence, linear regression analyzes were performed.RESULTSThe prevalence of HF was 21%; 95% of them were dependent for BADLs. Bathing was the most committed ADL. HF is a predictor of dependence in hospitalized elderlies, increasing the chance of functional decline by 5 times (95% CI, 0.94-94.48), the chance of functional deterioration by 3.5 times (95% CI, 1.28-11.66; p <0.02) and reducing 0.79 points in the Katz Index score (p <0.05).CONCLUSIONHF is a dependency predictor of ADL in hospitalized elderly, who tend to be more dependent, especially for bathing.OBJECTIVE Identify whether Heart Failure (HF) is a predictor of functional dependence for Basic Activities of Daily Living (BADL) in hospitalized elderly. METHODS We investigated medical records and assessed dependence to BADL (by the Katz Index) of 100 elderly admitted to a geriatric ward of a university hospital. In order to verify if HF is a predictor of functional dependence, linear regression analyzes were performed. RESULTS The prevalence of HF was 21%; 95% of them were dependent for BADLs. Bathing was the most committed ADL. HF is a predictor of dependence in hospitalized elderlies, increasing the chance of functional decline by 5 times (95% CI, 0.94-94.48), the chance of functional deterioration by 3.5 times (95% CI, 1.28-11.66; p <0.02) and reducing 0.79 points in the Katz Index score (p <0.05). CONCLUSION HF is a dependency predictor of ADL in hospitalized elderly, who tend to be more dependent, especially for bathing.

Heart failure as a predictor of functional dependence in hospitalized elderly

OBJECTIVEIdentify whether Heart Failure (HF) is a predictor of functional dependence for Basic Activities of Daily Living (BADL) in hospitalized elderly.METHODSWe investigated medical records and assessed dependence to BADL (by the Katz Index) of 100 elderly admitted to a geriatric ward of a university hospital. In order to verify if HF is a predictor of functional dependence, linear regression analyzes were performed.RESULTSThe prevalence of HF was 21%; 95% of them were dependent for BADLs. Bathing was the most committed ADL. HF is a predictor of dependence in hospitalized elderlies, increasing the chance of functional decline by 5 times (95% CI, 0.94-94.48), the chance of functional deterioration by 3.5 times (95% CI, 1.28-11.66; p <0.02) and reducing 0.79 points in the Katz Index score (p <0.05).CONCLUSIONHF is a dependency predictor of ADL in hospitalized elderly, who tend to be more dependent, especially for bathing.OBJECTIVE Identify whether Heart Failure (HF) is a predictor of functional dependence for Basic Activities of Daily Living (BADL) in hospitalized elderly. METHODS We investigated medical records and assessed dependence to BADL (by the Katz Index) of 100 elderly admitted to a geriatric ward of a university hospital. In order to verify if HF is a predictor of functional dependence, linear regression analyzes were performed. RESULTS The prevalence of HF was 21%; 95% of them were dependent for BADLs. Bathing was the most committed ADL. HF is a predictor of dependence in hospitalized elderlies, increasing the chance of functional decline by 5 times (95% CI, 0.94-94.48), the chance of functional deterioration by 3.5 times (95% CI, 1.28-11.66; p <0.02) and reducing 0.79 points in the Katz Index score (p <0.05). CONCLUSION HF is a dependency predictor of ADL in hospitalized elderly, who tend to be more dependent, especially for bathing.