Fisioterapia pré-operatória na prevenção das complicações pulmonares em cirurgia cardíaca pediátrica (original) (raw)
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Preoperative physiotherapy in prevention of pulmonary complications in pediatric cardiac surgery
Preoperative physiotherapy in prevention of pulmonary complications in pediatric cardiac surgery Abstract Objective: To evaluate the occurrence and risk of pulmonary complications in children who underwent preand postoperative physiotherapeutic intervention in cardiac surgeries, as well as to compare these patients to those who underwent only postoperative physiotherapeutic intervention.
2014
BACKGROUND Postoperative disorders of the respiratory system in infants after cardiac surgical procedures entail significant clinical problems, both because they are life threatening and due to their potential adverse effect on the final outcome of the treatment. The main causes of postoperative complications include significant changes in the vascular system, intrathoracic manipulation, potentially leading to the damage of anatomical structures, drainage of the pleural cavities, postoperative immobilization, mechanical respiration and post-perfusion syndrome. The basic clinical symptoms include changes in the pulmonary parenchyma and fluid in the pleural space. The identification of the type of changes and the risk factors related to postoperative pulmonary complications enables optimal adjustment of postoperative care strategies, including directed respiratory physiotherapy[1, 9]. The aim of the study was to identify the most common respiratory complications in patients after pediatric cardiac surgical procedures, to carry out a separate analysis of the group of infants with heart defects associated with Down syndrome and to evaluate the effect of extracorporeal circulation (ECC) time and aortic cross-clamp (ACC) time on pulmonary complications.
Arch Med Sci, 2008
A b s t r a c t Introduction: We aimed to draw a profile of young children undergoing surgical repair for congenital heart disease (CHD), who have prolonged postoperative recovery, and compared this profile with the profile of a shorter postoperative recovery time group. Material and methods: Data of 147 consecutive patients aged younger than 36 months undergoing cardiac surgery for CHD were reviewed, and they were allocated to two groups based on the duration of intensive care unit (ICU) stay equal to or less than 7 days (group I, n=114), and more than 7 days (group II, n=33). R Re es su ul lt ts s: : The patients in group II were significantly younger (10.2±3.9 months vs. 19.9±5.8 months; P<0.001). Aortic cross-clamp times were 39.1±3.6 min in group I, and 50.4±8.7 min in group II (P<0.05). Extubation failures (more than 48 hours) occurred in 3 cases in group I, compared to 29 patients in group II (P<0.0001). A total of 28 patients (7 in group I, and 21 in group II) developed pulmonary complications. These patients contributed to the majority of total ventilator days (69%) as well as ICU stay (58%). Fourteen percent of patients underwent staged operations in group I, compared to 48.5% in group II (P<0.002). Conclusions: Pulmonary complications seem to be one of the most important causes of delayed recovery following cardiac surgery in young children. We suggest that extubation time is a crucial factor for development of pulmonary problems. This factor might be more important for infants who undergo staged operations. Key words: congenital heart disease, infant, postoperative care, surgery.
Archives of Medical Science, 2008
I In nt tr ro od du uc ct ti io on n: : We aimed to draw a profile of young children undergoing surgical repair for congenital heart disease (CHD), who have prolonged postoperative recovery, and compared this profile with the profile of a shorter postoperative recovery time group. M Ma at te er ri ia al l a an nd d m me et th ho od ds s: : Data of 147 consecutive patients aged younger than 36 months undergoing cardiac surgery for CHD were reviewed, and they were allocated to two groups based on the duration of intensive care unit (ICU) stay equal to or less than 7 days (group I, n=114), and more than 7 days (group II, n=33). R Re es su ul lt ts s: : The patients in group II were significantly younger (10.2±3.9 months vs. 19.9±5.8 months; P<0.001). Aortic cross-clamp times were 39.1±3.6 min in group I, and 50.4±8.7 min in group II (P<0.05). Extubation failures (more than 48 hours) occurred in 3 cases in group I, compared to 29 patients in group II (P<0.0001). A total of 28 patients (7 in group I, and 21 in group II) developed pulmonary complications. These patients contributed to the majority of total ventilator days (69%) as well as ICU stay (58%). Fourteen percent of patients underwent staged operations in group I, compared to 48.5% in group II (P<0.002). C Co on nc cl lu us si io on ns s: : Pulmonary complications seem to be one of the most important causes of delayed recovery following cardiac surgery in young children. We suggest that extubation time is a crucial factor for development of pulmonary problems. This factor might be more important for infants who undergo staged operations. K Ke ey y w wo or rd ds s: : congenital heart disease, infant, postoperative care, surgery.
Pulmonary Functions Before and After Pediatric Cardiac Surgery
Pediatric Cardiology, 2014
This study aimed to assess pulmonary functions before and after cardiac surgery in infants with congenital heart diseases and pulmonary overflow and to clarify which echocardiographic parameter correlates best with lung mechanics. Between 2008 and 2009, 30 infants with leftto-right shunt congenital acyanotic heart diseases who had indications for reparative surgery of these lesions were assessed by echocardiography and infant pulmonary function tests before the operation and 6 months afterward. Tests using baby body plethysmography were performed to assess the following infant pulmonary functions: tidal volume, respiratory rate, respiratory system compliance (C rs ) and respiratory system resistance, functional residual capacity (FRC), and airway resistance. The mean age of the patients was 10.47 ± 3.38 months, and their mean weight was 6.81 ± 1.67 kg. Ventricular septal defect and combined lesions were the predominant cardiac diseases (26.7 %). Comparison of the infant pulmonary function tests showed a highly significant improvement in all the parameters between the preoperative and 6-month postoperative visits (p \ 0.0001). Systolic pulmonary artery pressure had a statistically significant negative correlation with C rs (r = -0.493, p = 0.006) and a positive correlation with FRC (r = 0.450, p = 0.013). The findings showed that C rs had a statistically significant negative correlation with the pulmonary artery size (r = -0.398, p = 0.029) and the left atrium size (r = -0.395, p = 0.031), whereas the pulmonary artery size had a statistically positive correlation with effective resistance (r = 0.416, p = 0.022) and specific effective resistance (r = 0.604, p = 0.0001). Surgical correction of left-toright shunt congenital heart diseases had a positive impact on lung compliance, airway resistance, and FRC. Noninvasive echocardiographic parameters assessing pulmonary vascular engorgement and pulmonary artery pressure were closely related to these infant pulmonary function test indexes.
Pediatric Critical Care Medicine, 2002
arly diagnosis of congenital heart disease by fetal echocardiography, improved perinatal care, innovations in surgical technique and myocardial protection, and better perioperative care have led to more young children surviving cardiac surgery for their underlying congenital heart disease (1, 2). The demand on resources for postoperative cardiac care is expected to increase with the increasing complexity of surgery performed at an earlier age. Among other risk factors, duration of mechanical ventilation is an important factor that determines postoperative recovery and outcome (3). Prolonged ventilation is well documented to be associated with major complications and mortality, hence early extubation after cardiac operations in neonates and children is highly desirable (4-6). Risk factors associated with prolonged mechanical ventilation after cardiac surgery in young children included a high preoperative pulmonary vascular resistance, the need for preoperative ventilation, longer cardiopulmonary bypass and aortic cross-clamp durations, and need for additional surgical interventions (6, 7). Furthermore, ventilator-associated pneumonia had also been shown recently to account for a major delay in extubation after pediatric cardiac surgery (8, 9). Although noninfectious pulmonary complications are also a common occurrence in young children after cardiac surgery and are associated with prolonged stay in the intensive care unit (10), there is a paucity