Evelise Helena Fadini Reis Brunori

Excessive bleeding predictors after cardiac surgery in adults: integrative review.

AIMS AND OBJECTIVES To integrate literature data on the predictors of excessive bleeding after cardiac surgery in adults. BACKGROUND Perioperative nursing care requires awareness of the risk factors for excessive bleeding after cardiac surgery to assure vigilance prioritising and early correction of those that are modifiable. DESIGN Integrative literature review. METHODS Articles were searched in seven databases. Seventeen studies investigating predictive factors for excessive bleeding after open-heart surgery from 2004-2014 were included. RESULTS Predictors of excessive bleeding after cardiac surgery were: Patient-related: male gender, higher preoperative haemoglobin levels, lower body mass index, diabetes mellitus, impaired left ventricular function, lower amount of prebypass thrombin generation, lower preoperative platelet counts, decreased preoperative platelet aggregation, preoperative platelet inhibition level >20%, preoperative thrombocytopenia and lower preoperative fibrinogen concentration. Procedure-related: the operating surgeon, coronary artery bypass surgery with three or more bypasses, use of the internal mammary artery, duration of surgery, increased cross-clamp time, increased cardiopulmonary bypass time, lower intraoperative core body temperature and bypass-induced haemostatic disorders. Postoperative: fibrinogen levels and metabolic acidosis. CONCLUSIONS Patient-related, procedure-related and postoperative predictors of excessive bleeding after cardiac surgery were identified. RELEVANCE TO CLINICAL PRACTICE The predictors summarised in this review can be used for risk stratification of excessive bleeding after cardiac surgery. Assessment, documentation and case reporting can be guided by awareness of these factors, so that postoperative vigilance can be prioritised. Timely identification and correction of the modifiable factors can be facilitated.

Nursing diagnoses and interventions for a child after cardiac surgery in an intensive care unit

OBJECTIVE To describe the nursing clinical judgment as a basis for ND identification and development of a NIC treatment plan for a child after cardiac surgery under intensive care. METHOD A case study with data retrospectively collected from charts. RESULTS Three nurses identified NANDA-I diagnoses and NIC interventions. A 6-month-old child submitted to cardiac surgery, requiring extracorporeal membrane oxygenation in the postoperative period. Four main nursing diagnoses were identified, towards which ten interventions were directed. The proposal of interventions to respond to the priority human responses of the child was optimized by the use of standard terminologies. Every nursing diagnosis was supported by diagnostic indicators; every intervention was scientifically supported. CONCLUSION There must be an expectation that nurses address not only physiological responses, but also those within psychosocial domains.

Predictive factors for bleeding-related re-exploration after cardiac surgery: A prospective cohort study

Background: Bleeding-related re-exploration is a life-threatening complication after cardiac surgery. Nurses must be aware of important risk factors for this complication so that their assessment, monitoring and evaluation activities can be prioritized, focused and anticipated. Aims: To identify the predictive factors for bleeding-related re-exploration after cardiac surgery and to describe the sources of postoperative bleeding. Methods: This is a prospective cohort study at a tertiary cardiac school-hospital in São Paulo/SP, Brazil. Adult patients (n=323) submitted to surgical correction of acquired cardiac diseases were included. Potential risk factors for bleeding-related re-exploration within the 24 hours following admission to the intensive care unit were investigated in the patients’ charts. A univariate analysis and a multiple analysis through logistic regression were conducted to identify the outcome predictors. The area under the receiver-operating characteristic curve was calculated as a measure of accuracy considering the cut-off points with the highest sensitivity and specificity. Results: The univariate factors significantly associated with bleeding-related re-exploration were a lower preoperative platelet count, a lower number of bypasses in coronary artery bypass surgery and postoperatively, a lower body temperature, infusion of lower intravenous volume, a higher positive end-expiratory pressure during mechanical ventilation and transfusion of blood products. The independent predictors of bleeding-related re-exploration included postoperative red blood cell transfusion, and transfusion of fresh frozen plasma, platelet or cryoprecipitate units. These predictors had a sensitivity of 87.5%, a specificity of 99.28% and an accuracy of 97.93%. Conclusions: Blood product transfusion postoperatively is an independent predictor of bleeding-related re-exploration. Surgical errors prevailed as sources of bleeding.

Factors associated with excessive bleeding after cardiac surgery: A prospective cohort study

OBJECTIVE To identify factors associated with excessive bleeding (ExB) after cardiac surgery in adults. BACKGROUND Excessive bleeding after cardiac surgery must be anticipated for implementation of timely interventions. METHODS A prospective cohort study with 323 adults requiring open-chest cardiac surgery. Potential factors associated with ExB were investigated through univariate analysis and logistic regression. The accuracy of the relationship between the independent variables and the outcome was depicted through the receiver-operating characteristic (ROC) curve. RESULTS The factors associated with ExB included gender, body mass index (BMI), preoperative platelet count, intraoperative heparin doses and intraoperative platelet transfusion. The ROC curve cut-off points were 26.35 for the BMI; 214,000 for the preoperative platelet count, and 6.25 for intraoperative heparin dose. This model had an accuracy = 77.3%, a sensitivity = 81%, and a specificity = 62%. CONCLUSIONS Male gender, BMI, preoperative platelet count, dose of intraoperative heparin >312.5 mg without subsequent platelet transfusion, are factors associated with ExB.

Association of cardiovascular risk factors with the different presentations of acute coronary syndrome

Objetivo: identificar la relacion de las diferentes presentaciones del sindrome coronario agudo con factores de riesgo cardiovasculares entre individuos hospitalizados. Metodo: estudio transversal realizado en un hospital escuela de Sao Paulo-SP. Los datos sociodemograficos, clinicos y antropometricos de 150 individuos hospitalizados por sindrome coronario agudo fueron recolectados por medio de entrevista y revision de fichas medicas. Fue verificada la asociacion de esos datos con la presentacion del sindrome. Resultados: hubo predominio de infarto agudo del miocardio con deflexion positiva del segmento ST; hubo asociacion significativa de hipertension arterial sistemica con angina inestable y altos valores de lipoproteina de baja densidad con infarto, sin influencia de caracteristicas sociodemograficas. Conclusion: la hipertension arterial y los niveles de lipoproteina de baja densidad elevados se asociaron a diferentes presentaciones del sindrome coronario. Los resultados pueden ofrecer subsidios a los profesionales de salud para planificar programas de prevencion secundaria que objetiven el cambio de comportamiento.OBJECTIVE: to identify the relationship between different presentations of acute coronary syndrome and cardiovascular risk factors among hospitalized individuals. METHOD: cross-sectional study performed in a teaching hospital in São Paulo, in the State of São Paulo (SP). Socio-demographic, clinical and anthropometric data of 150 individuals hospitalized due to acute coronary syndrome were collected through interviews and review of clinical charts. Association between these data and the presentation of the syndrome were investigated. RESULTS: there was a predominance of ST segment elevation acute myocardial infarction. There was significant association of systemic hypertension with unstable angina and high values of low density lipoprotein with infarction, without influence from socio-demographic characteristics. CONCLUSION: arterial hypertension and high levels of low-density lipoprotein were associated with different presentations of coronary syndrome. The results can provide support for health professionals for secondary prevention programs aimed at behavioural changing.

Associação de fatores de risco cardiovasculares com as diferentes apresentações da síndrome coronariana aguda

Objetivo: identificar la relacion de las diferentes presentaciones del sindrome coronario agudo con factores de riesgo cardiovasculares entre individuos hospitalizados. Metodo: estudio transversal realizado en un hospital escuela de Sao Paulo-SP. Los datos sociodemograficos, clinicos y antropometricos de 150 individuos hospitalizados por sindrome coronario agudo fueron recolectados por medio de entrevista y revision de fichas medicas. Fue verificada la asociacion de esos datos con la presentacion del sindrome. Resultados: hubo predominio de infarto agudo del miocardio con deflexion positiva del segmento ST; hubo asociacion significativa de hipertension arterial sistemica con angina inestable y altos valores de lipoproteina de baja densidad con infarto, sin influencia de caracteristicas sociodemograficas. Conclusion: la hipertension arterial y los niveles de lipoproteina de baja densidad elevados se asociaron a diferentes presentaciones del sindrome coronario. Los resultados pueden ofrecer subsidios a los profesionales de salud para planificar programas de prevencion secundaria que objetiven el cambio de comportamiento.OBJECTIVE: to identify the relationship between different presentations of acute coronary syndrome and cardiovascular risk factors among hospitalized individuals. METHOD: cross-sectional study performed in a teaching hospital in São Paulo, in the State of São Paulo (SP). Socio-demographic, clinical and anthropometric data of 150 individuals hospitalized due to acute coronary syndrome were collected through interviews and review of clinical charts. Association between these data and the presentation of the syndrome were investigated. RESULTS: there was a predominance of ST segment elevation acute myocardial infarction. There was significant association of systemic hypertension with unstable angina and high values of low density lipoprotein with infarction, without influence from socio-demographic characteristics. CONCLUSION: arterial hypertension and high levels of low-density lipoprotein were associated with different presentations of coronary syndrome. The results can provide support for health professionals for secondary prevention programs aimed at behavioural changing.

Self-Care Behaviors in Heart Failure: Self-Care Management in Heart Failure

OBJECTIVE To identify self-care behaviors, instruments, techniques, parameters for the assessment of self-care behaviors in people with heart failure, compare these behaviors with the indicators of the Nursing Outcomes Classification outcome, Self Management: Cardiac Disease. METHOD Integrative literature review performed in Lilacs, Medline, CINAHL, and Cochrane, including publications from 2009 to 2015. One thousand six hundred ninety-one articles were retrieved from the search, of which 165 were selected for analysis. RESULTS Ten self-care behaviors and several different assessment instruments, techniques, and parameters were identified. The addition and removal of some indicators are proposed, based on this review. The data provide substrate for the development of conceptual and operational definitions of the indicators, making the outcome more applicable for use in clinical practice.OBJECTIVE To identify self-care behaviors, instruments, techniques, parameters for the assessment of self-care behaviors in people with heart failure, compare these behaviors with the indicators of the Nursing Outcomes Classification outcome, Self Management: Cardiac Disease. METHOD Integrative literature review performed in Lilacs, Medline, CINAHL, and Cochrane, including publications from 2009 to 2015. One thousand six hundred ninety-one articles were retrieved from the search, of which 165 were selected for analysis. RESULTS Ten self-care behaviors and several different assessment instruments, techniques, and parameters were identified. The addition and removal of some indicators are proposed, based on this review. The data provide substrate for the development of conceptual and operational definitions of the indicators, making the outcome more applicable for use in clinical practice.

Self‐Care Behaviors in Heart Failure

OBJECTIVE To identify self-care behaviors, instruments, techniques, parameters for the assessment of self-care behaviors in people with heart failure, compare these behaviors with the indicators of the Nursing Outcomes Classification outcome, Self Management: Cardiac Disease. METHOD Integrative literature review performed in Lilacs, Medline, CINAHL, and Cochrane, including publications from 2009 to 2015. One thousand six hundred ninety-one articles were retrieved from the search, of which 165 were selected for analysis. RESULTS Ten self-care behaviors and several different assessment instruments, techniques, and parameters were identified. The addition and removal of some indicators are proposed, based on this review. The data provide substrate for the development of conceptual and operational definitions of the indicators, making the outcome more applicable for use in clinical practice.OBJECTIVE To identify self-care behaviors, instruments, techniques, parameters for the assessment of self-care behaviors in people with heart failure, compare these behaviors with the indicators of the Nursing Outcomes Classification outcome, Self Management: Cardiac Disease. METHOD Integrative literature review performed in Lilacs, Medline, CINAHL, and Cochrane, including publications from 2009 to 2015. One thousand six hundred ninety-one articles were retrieved from the search, of which 165 were selected for analysis. RESULTS Ten self-care behaviors and several different assessment instruments, techniques, and parameters were identified. The addition and removal of some indicators are proposed, based on this review. The data provide substrate for the development of conceptual and operational definitions of the indicators, making the outcome more applicable for use in clinical practice.

Fatores preditores de transfusão de concentrado de hemácias após cirurgia cardíaca: um estudo coorte prospectivo

OBJECTIVE To identify predictors of red blood cell transfusion (RBCT) after cardiac surgery. METHOD A prospective cohort study performed with 323 adults after cardiac surgery, from April to December of 2013. A data collection instrument was constructed by the researchers containing factors associated with excessive bleeding after cardiac surgery, as found in the literature, for investigation in the immediate postoperative period. The relationship between risk factors and the outcome was assessed by univariate analysis and logistic regression. RESULTS The factors associated with RBCT in the immediate postoperative period included lower height and weight, decreased platelet count, lower hemoglobin level, higher prevalence of platelet count <150x10 3/mm3, lower volume of protamine, longer duration of anesthesia, higher prevalence of intraoperative RBCT, lower body temperature, higher heart rate and higher positive end-expiratory pressure. The independent predictor was weight <66.5Kg. CONCLUSION Factors associated with RBCT in the immediate postoperative period of cardiac surgery were found. The independent predictor was weight.OBJECTIVE To identify predictors of red blood cell transfusion (RBCT) after cardiac surgery. METHOD A prospective cohort study performed with 323 adults after cardiac surgery, from April to December of 2013. A data collection instrument was constructed by the researchers containing factors associated with excessive bleeding after cardiac surgery, as found in the literature, for investigation in the immediate postoperative period. The relationship between risk factors and the outcome was assessed by univariate analysis and logistic regression. RESULTS The factors associated with RBCT in the immediate postoperative period included lower height and weight, decreased platelet count, lower hemoglobin level, higher prevalence of platelet count <150x10(3)/mm (3), lower volume of protamine, longer duration of anesthesia, higher prevalence of intraoperative RBCT, lower body temperature, higher heart rate and higher positive end-expiratory pressure. The independent predictor was weight <66.5Kg. CONCLUSION Factors associated with RBCT in the immediate postoperative period of cardiac surgery were found. The independent predictor was weight.

Predictors of red blood cell transfusion after cardiac surgery: a prospective cohort study

OBJECTIVE To identify predictors of red blood cell transfusion (RBCT) after cardiac surgery. METHOD A prospective cohort study performed with 323 adults after cardiac surgery, from April to December of 2013. A data collection instrument was constructed by the researchers containing factors associated with excessive bleeding after cardiac surgery, as found in the literature, for investigation in the immediate postoperative period. The relationship between risk factors and the outcome was assessed by univariate analysis and logistic regression. RESULTS The factors associated with RBCT in the immediate postoperative period included lower height and weight, decreased platelet count, lower hemoglobin level, higher prevalence of platelet count <150x10 3/mm3, lower volume of protamine, longer duration of anesthesia, higher prevalence of intraoperative RBCT, lower body temperature, higher heart rate and higher positive end-expiratory pressure. The independent predictor was weight <66.5Kg. CONCLUSION Factors associated with RBCT in the immediate postoperative period of cardiac surgery were found. The independent predictor was weight.OBJECTIVE To identify predictors of red blood cell transfusion (RBCT) after cardiac surgery. METHOD A prospective cohort study performed with 323 adults after cardiac surgery, from April to December of 2013. A data collection instrument was constructed by the researchers containing factors associated with excessive bleeding after cardiac surgery, as found in the literature, for investigation in the immediate postoperative period. The relationship between risk factors and the outcome was assessed by univariate analysis and logistic regression. RESULTS The factors associated with RBCT in the immediate postoperative period included lower height and weight, decreased platelet count, lower hemoglobin level, higher prevalence of platelet count <150x10(3)/mm (3), lower volume of protamine, longer duration of anesthesia, higher prevalence of intraoperative RBCT, lower body temperature, higher heart rate and higher positive end-expiratory pressure. The independent predictor was weight <66.5Kg. CONCLUSION Factors associated with RBCT in the immediate postoperative period of cardiac surgery were found. The independent predictor was weight.