Vinicius Batista Santos

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.

Neuromuscular electrical stimulation improves exercise tolerance in patients with advanced heart failure on continuous intravenous inotropic support use—randomized controlled trial:

Objective: To evaluate the impact of a short-term neuromuscular electrical stimulation program on exercise tolerance in hospitalized patients with advanced heart failure who have suffered an acute decompensation and are under continuous intravenous inotropic support. Design: A randomized controlled study. Subjects: Initially, 195 patients hospitalized for decompensated heart failure were recruited, but 70 were randomized. Intervention: Patients were randomized into two groups: control group subject to the usual care (n = 35); neuromuscular electrical stimulation group (n = 35) received daily training sessions to both lower extremities for around two weeks. Main measures: The baseline 6-minute walk test to determine functional capacity was performed 24 hours after hospital admission, and intravenous inotropic support dose was daily checked in all patients. The outcomes were measured in two weeks or at the discharge if the patients were sent back home earlier than two weeks. Results: After losses of follow-up, a total of 49 patients were included and considered for final analysis (control group, n = 25 and neuromuscular electrical stimulation group, n = 24). The neuromuscular electrical stimulation group presented with a higher 6-minute walk test distance compared to the control group after the study protocol (293 ± 34.78 m vs. 265.8 ± 48.53 m, P < 0.001, respectively). Neuromuscular electrical stimulation group also demonstrated a significantly higher dose reduction of dobutamine compared to control group after the study protocol (2.72 ± 1.72 µg/kg/min vs. 3.86 ± 1.61 µg/kg/min, P = 0.001, respectively). Conclusion: A short-term inpatient neuromuscular electrical stimulation rehabilitation protocol improved exercise tolerance and reduced intravenous inotropic support necessity in patients with advanced heart failure suffering a decompensation episode.

Conceptual and Operational Definitions of the Defining Characteristics and Related Factors of the Diagnosis Ineffective Health Management in People With Heart Failure

OBJECTIVE To construct conceptual and operational definitions for the defining characteristics (DCs) and related factors (RFs) of the nursing diagnosis (ND) ineffective health management for people with chronic heart failure. METHOD Conceptual and operational definitions for the DC and RF were based on studies found in an integrative literature review in the databases Latin American Literature in Health Sciences, Cumulative Index to Nursing and Allied Health Literature, and MEDLINE by using the key words Nursing diagnosis, Heart Failure, and Patient Cooperation in different combinations. RESULTS Conceptual and operational definitions for all the DCs and RFs were constructed. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE The definitions will facilitate in the identification of ND in clinical practice in patients with heart failure, future research on ND validation, and education in undergraduate courses.Objective To construct conceptual and operational definitions for the defining characteristics (DCs) and related factors (RFs) of the nursing diagnosis (ND) ineffective health management for people with chronic heart failure. Method Conceptual and operational definitions for the DC and RF were based on studies found in an integrative literature review in the databases Latin American Literature in Health Sciences, Cumulative Index to Nursing and Allied Health Literature, and MEDLINE by using the key words Nursing diagnosis, Heart Failure, and Patient Cooperation in different combinations. Results Conceptual and operational definitions for all the DCs and RFs were constructed. Conclusions and Implications for Practice The definitions will facilitate in the identification of ND in clinical practice in patients with heart failure, future research on ND validation, and education in undergraduate courses.

Effects of acute oxygen supplementation on functional capacity and heart rate recovery in Eisenmenger syndrome

BACKGROUND Eisenmenger syndrome (ES) precipitates the extreme manifestation of pulmonary hypertension, which leads to severe functional limitation and poor quality of life. The propose of the current study was: 1) examined the acute effects of 40% oxygen supplementation during the 6-minute walk test (6MWT); and 2) evaluate the relation between exercise capacity and clinical cardiac parameters in patients with ES. METHODS Thirty subjects were prospectively included; all were submitted to a 6MWT with compressed air and with 40% of oxygen. Heart rate recovery at the first minute (HRR1) and perceived effort Borg scale for dyspnea and lower limb fatigue were recorded in both tests scenarios. RESULTS The 6MWT distance was modestly, negatively associated with pulmonary vascular resistance (PVR) [r=0.46, p=0.02]. Patients improved 6MWT distance (p<0.001) and exhibited a faster HRR1 (p<0.001) with 40% supplemental oxygen compared to compressed air. With 40% supplemental oxygen, subjects revealed lower dyspnea and lower limb fatigue compared to 6MWT without oxygen supplementation (p<0.001). The amount of change in the 6MWT distance from air to oxygen was moderate, positively associated with tricuspid annular plane systolic excursion (TAPSE) and right ventricular fractional area change (RVFAC) [r=0.50, p=0.03; r=0.64, p<0.001, respectively]. CONCLUSION Acute 40% oxygen supplementation in patients with Eisenmenger syndrome led to an improvement in 6MWT distance, faster HRR1 and lower dyspnea and lower limb fatigue perception. Moreover, functional capacity was positively associated with right ventricular parameters.

Defining Characteristics and Related Factors of Decreased Cardiac Tissue Perfusion: Proposal of a New Nursing Diagnosis

PURPOSE To identify the possible defining characteristics (DCs) and related factors of the nursing diagnosis (ND) decreased cardiac tissue perfusion. METHODS Cross-sectional study using medical charts of adults admitted to an emergency department with the chief complaint of chest pain in a hospital in São Paulo, Brazil. FINDINGS DCs identified: crushing chest pain, elevated markers of myocardial necrosis, ischemic electrocardiogram changes, sweating, nausea, and vomiting. Related factors identified: interruption of arterial blood flow and coronary spasm. CONCLUSION This ND was clinically identified due to significant differences in the DCs of patients with and without the diagnosis. PRACTICE IMPLICATIONS The clinical indicators identified in this study can be the starting point for the DCs for this ND.

Validation of a novel sleep-quality questionnaire to assess sleep in the coronary care unit: a polysomnography study

INTRODUCTION The sleep of patients admitted to coronary care unit (CCU) may be compromised. A feasible and cost-effective tool to evaluate sleep in this scenario could provide important data. The aim of this study was to evaluate sleep with a questionnaire developed specifically for the CCU and to validate it with polysomnography (PSG). METHODS Ninety-nine patients (68% male; 56 ± 10 years old) with acute coronary syndrome were included. PSG was performed within 36 h of admission. A specific 18-question questionnaire (CCU questionnaire) was developed and applied after the PSG. Cronbachs alpha test was used to validate the questionnaire. The Spearman test was used to analyze the correlation between the PSG variables and the questionnaire, and the Kruskal-Wallis test was used to compare the PSG variables among patients with good, regular, or poor sleep. RESULTS The total sleep time was 265 ± 81 min, sleep efficiency 62 ± 18%, REM sleep 10 ± 7%, apnea/hypopnea index 15 ± 23, and the arousal index 24 ± 15. Cronbachs alpha test was 0.69. The CCU questionnaire showed correlation with the sleep efficiency evaluated by PSG (r: 0.52; p < 0.001). Sleep quality was divided into three categories according to the CCU questionnaire: patients with good sleep had a sleep efficiency of 72 ± 9%, better than those with a regular or poor sleep (60 ± 16% and 53 ± 20%, respectively; p < 0.01). CONCLUSION The CCU questionnaire is a feasible and reliable tool to evaluate sleep in the CCU, showing correlation with the PSG sleep efficiency.

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.

Nursing diagnoses validated in cardiology in Brazil: integrative literature review

Objective: To identify nursing diagnoses (ND) currently appearing in the NANDA-I taxonomy, validated in the area of cardiology in Brazil. Methods: An integrative literature review, guided by the following question: what nursing diagnoses were validated in Brazil? Eleven works were analyzed: three content validations and eight clinical validations. Results: The NDs validated were: activity intolerance, decreased cardiac output, spiritual distress, deficient knowledge, excessive fluid volume, ineffective airway clearance, ineffective peripheral tissue perfusion, fear, anxiety, and pain. The highlights were the production of the graduate programs in public institutions, the validation of defining characteristics, models of validation and the modified Fehring criteria for selection of experts . The clinical validation model was used for NDs of the psychobiological sphere; the content validation model was used mainly for NDs in the psychosocial and psychospiritual spheres. Conclusion: The knowledge produced can provide a basis for future studies on the relevance of the content of nursing outcomes in the evaluation of the effectiveness of nursing interventions in the country.

Ineffective Health Management in People With Heart Failure: A Pilot Study: Ineffective Health Management in People With Heart Failure

OBJETIVO Investigar a aplicabilidade clínica das definiçõs conceituais e operacionais das características definidoras (CD) e fatores relacionados (FR) de Controle ineficaz da saúde em pessoas com insuficiência cardíaca. MÉTHODS: Estudo piloto transversal. A presença das CD e FRfoi investigada com base nas definiçõses conceituais e operacionais. As frequênciasforam utilizadas para análise. RESULTADOS Dos 33 participantes, 32 (97%) tinham Controle ineficaz da saúde.A principal CD foi Escolhas na vida diária ineficazes para atingir as meta de saúde, e oprincipal FR foi Impotência CONCLUSÂO: As definições conceituais e operacionais foram aplicáveis à prática clínica, com exceçâo de Benefício percebido, Suscetibilidade percebida e Gravidade da condiçâo percebida, as quais devem ser modificadas.OBJETIVO Investigar a aplicabilidade clinica das definicos conceituais e operacionais das caracteristicas definidoras (CD) e fatores relacionados (FR) de Controle ineficaz da saude em pessoas com insuficiencia cardiaca. METHODS Estudo piloto transversal. A presenca das CD e FRfoi investigada com base nas definicoses conceituais e operacionais. As frequenciasforam utilizadas para analise. RESULTADOS Dos 33 participantes, 32 (97%) tinham Controle ineficaz da saude.A principal CD foi Escolhas na vida diaria ineficazes para atingir as meta de saude, e oprincipal FR foi Impotencia CONCLUSÂO As definicoes conceituais e operacionais foram aplicaveis a pratica clinica, com excecâo de Beneficio percebido, Suscetibilidade percebida e Gravidade da condicâo percebida, as quais devem ser modificadas.