RESUMO
Postoperative pain after cardiac surgery plays an important role in the patient's recovery process. In particular, pain at the chest tube site can negatively affect the comfort and recovery of these patients. Effective pain control minimizes the risk of many complications. Oral and intravenous analgesics, epidural anesthesia, paravertebral block, and intercostal nerve blockade are used in chest tube pain control. We routinely use the surgical cryoablation method in the presence of atrial fibrillation in the preoperative period of cardiac surgery in our clinic. Here we aimed to describe our method of using the cryoablation catheter for intercostal nerve blockade.
Assuntos
Fibrilação Atrial , Tubos Torácicos , Criocirurgia , Dor Pós-Operatória , Humanos , Fibrilação Atrial/cirurgia , Dor Pós-Operatória/prevenção & controle , Dor Pós-Operatória/etiologia , Criocirurgia/métodos , Criocirurgia/instrumentação , Bloqueio Nervoso/métodos , Procedimentos Cirúrgicos Cardíacos/métodos , Nervos Intercostais , Resultado do Tratamento , CatéteresRESUMO
ABSTRACT Postoperative pain after cardiac surgery plays an important role in the patient's recovery process. In particular, pain at the chest tube site can negatively affect the comfort and recovery of these patients. Effective pain control minimizes the risk of many complications. Oral and intravenous analgesics, epidural anesthesia, paravertebral block, and intercostal nerve blockade are used in chest tube pain control. We routinely use the surgical cryoablation method in the presence of atrial fibrillation in the preoperative period of cardiac surgery in our clinic. Here we aimed to describe our method of using the cryoablation catheter for intercostal nerve blockade.
RESUMO
OBJECTIVE: In this study, we aimed to determine whether plasma calcium level and C-reactive protein albumin ratio (CAR) as well as other demographic and hematological markers are related in predicting severe bleeding after coronary artery bypass grafting (CABG). METHODS: A total of 227 adult patients who underwent CABG at our hospital between December 2021 and June 2022 were prospectively studied. Total amount of chest tube drainage was evaluated within the first 24 hours postoperatively or until the patient was re-explored for bleeding. The patients were divided into two groups - Group 1, patients with low amount of bleeding (n=174), and Group 2, patients with severe bleeding (n=53). Univariate and multivariate regression analyzes were performed to determine independent parameters related to severe bleeding within the first 24 hours after surgery. RESULTS: When the groups were compared in terms of demographic, clinical, and preoperative blood parameters; cardiopulmonary bypass time and serum C-reactive protein (CRP) levels were found to be significantly higher in Group 2 compared to the low bleeding group. In addition, lymphocytes, hemoglobin, calcium, albumin, and CAR were found to be significantly lower in Group 2. In multivariate analysis, calcium, albumin, CRP, and CAR were found to be independent predictors of significant association with excessive bleeding. A cut-off value of 8.7 (94.3% sensitivity and 94.8% specificity) for calcium and 0.155 (75.4% sensitivity and 80.4% specificity) for CAR predicted excessive bleeding. CONCLUSION: Plasma calcium level, CRP, albumin, and CAR can be used to predict severe bleeding after CABG.
Assuntos
Proteína C-Reativa , Cálcio , Adulto , Humanos , Proteína C-Reativa/análise , Ponte de Artéria Coronária/efeitos adversos , Hemorragia , LinfócitosRESUMO
OBJETIVO: mapear os cuidados de enfermagem empregados aos pacientes adultos com drenagem torácica internados em terapia intensiva. MÉTODO: scoping review a ser conduzida conforme o Joanna Briggs Institute, com a seguinte questão de pesquisa: "quais são os cuidados de enfermagem indicados aos pacientes adultos com drenagem torácica internados em terapia intensiva?". A busca será desenvolvida em cinco bases de dados: Pubmed, Scopus, Embase, BVS e Web of Science, e os achados serão geridos com o auxílio do software Rayyan. Serão incluídos estudos quantitativos e qualitativos, artigos de revisão, dissertações, teses, diretrizes clínicas e protocolos terapêuticos sobre a temática, incluindo a literatura cinzenta. Será descrito o número total de fontes de evidência encontradas e selecionadas. Através de uma narrativa, será detalhado o processo de decisão da inclusão dos estudos. Os principais achados deverão estar descritos em consonância com o objetivo e os resultados relacionados à questão de pesquisa.
OBJECTIVE: to map nursing care employed to adult patients with chest drainage admitted to intensive care. METHOD: scoping review to be conducted according to the Joanna Briggs Institute, with the following research question: "What are the nursing cares indicated to adult patients with chest drainage admitted to intensive care?". The search will be developed in five databases: Pubmed, Scopus, Embase, BVS and Web of Science, and the findings will be managed with the support of Rayyan software. Quantitative and qualitative studies, review articles, dissertations, theses, clinical guidelines and therapeutic protocols on the subject will be included, including gray literature. The total number of sources of evidence found and selected will be described. Through a narrative, the decision-making process of the inclusion of the studies will be detailed. The main findings must be described in line with the objective and the results related to the research question.
Assuntos
Humanos , Adulto , Drenagem/enfermagem , Procedimentos Cirúrgicos Torácicos , Cavidade Pleural , Unidades de Terapia Intensiva , Cuidados de EnfermagemRESUMO
ABSTRACT Objective: In this study, we aimed to determine whether plasma calcium level and C-reactive protein albumin ratio (CAR) as well as other demographic and hematological markers are related in predicting severe bleeding after coronary artery bypass grafting (CABG). Methods: A total of 227 adult patients who underwent CABG at our hospital between December 2021 and June 2022 were prospectively studied. Total amount of chest tube drainage was evaluated within the first 24 hours postoperatively or until the patient was re-explored for bleeding. The patients were divided into two groups - Group 1, patients with low amount of bleeding (n=174), and Group 2, patients with severe bleeding (n=53). Univariate and multivariate regression analyzes were performed to determine independent parameters related to severe bleeding within the first 24 hours after surgery. Results: When the groups were compared in terms of demographic, clinical, and preoperative blood parameters; cardiopulmonary bypass time and serum C-reactive protein (CRP) levels were found to be significantly higher in Group 2 compared to the low bleeding group. In addition, lymphocytes, hemoglobin, calcium, albumin, and CAR were found to be significantly lower in Group 2. In multivariate analysis, calcium, albumin, CRP, and CAR were found to be independent predictors of significant association with excessive bleeding. A cut-off value of 8.7 (94.3% sensitivity and 94.8% specificity) for calcium and 0.155 (75.4% sensitivity and 80.4% specificity) for CAR predicted excessive bleeding. Conclusion: Plasma calcium level, CRP, albumin, and CAR can be used to predict severe bleeding after CABG.
RESUMO
Definitive management of hemodynamically stable patients with penetrating cardiac injuries remains controversial between those who propose aggressive invasive care versus those who opt for a less invasive or non-operative approach. This controversy even extends to cases of hemodynamically unstable patients in which damage control surgery is thought to be useful and effective. The aim of this article is to delineate our experience in the surgical management of penetrating cardiac injuries via the creation of a clear and practical algorithm that includes basic principles of damage control surgery. We recommend that all patients with precordial penetrating injuries undergo trans-thoracic ultrasound screening as an integral component of their initial evaluation. In those patients who arrive hemodynamically stable but have a positive ultrasound, a pericardial window with lavage and drainage should follow. We want to emphasize the importance of the pericardial lavage and drainage in the surgical management algorithm of these patients. Before this concept, all positive pericardial windows ended up in an open chest exploration. With the coming of the pericardial lavage and drainage procedure, the reported literature and our experience have shown that 25% of positive pericardial windows do not benefit and/or require further invasive procedures. However, in hemodynamically unstable patients, damage control surgery may still be required to control ongoing bleeding. For this purpose, we propose a surgical management algorithm that includes all of these essential clinical aspects in the care of these patients.
El manejo definitivo de los pacientes hemodinámicamente estables con heridas cardíacas penetrantes continúa siendo controversial con abordajes invasivos versus manejos conservadores. Estas posiciones contrarias se extienden hasta aquellos casos de pacientes hemodinámicamente inestables donde se ha descrito y considerado la cirugía de control de daños como un procedimiento útil y efectivo. El objetivo de este artículo es presentar la experiencia en el manejo quirúrgico de heridas cardíacas penetrantes con la creación de un algoritmo práctico que incluye los principios básicos del control de daños. Se recomienda que a todos los pacientes con heridas precordiales penetrantes se les debe realizar un ultrasonido torácico como componente integral de la evaluación inicial. Aquellos que presenten un ultrasonido torácico positivo y se encuentren hemodinámicamente estables se les debe realizar una ventana pericárdica con posterior lavado. Se ha demostrado que el 25% de las ventanas pericárdicas positivas no se benefician ni requieren de posteriores abordajes quirúrgicos invasivos. Antes de este concepto, todos los pacientes con ventana pericárdica positiva terminaban en una exploración abierta del tórax y del pericárdico.Los pacientes hemodinámicamente inestables requieren de una cirugía de control de daños para un adecuado y oportuno control del sangrado. Con este propósito, se propone un algoritmo de manejo quirúrgico que incluye todos estos aspectos esenciales en el abordaje de este grupo de pacientes.
Assuntos
Algoritmos , Traumatismos Cardíacos/cirurgia , Técnicas de Janela Pericárdica , Ferimentos Penetrantes/cirurgia , Colômbia/epidemiologia , Drenagem , Traumatismos Cardíacos/diagnóstico , Traumatismos Cardíacos/diagnóstico por imagem , Traumatismos Cardíacos/epidemiologia , Hemorragia/terapia , Técnicas Hemostáticas , Humanos , Ilustração Médica , Complicações Pós-Operatórias , Irrigação Terapêutica , Ultrassonografia/métodos , Ferimentos Penetrantes/diagnóstico , Ferimentos Penetrantes/diagnóstico por imagem , Ferimentos Penetrantes/epidemiologiaRESUMO
Damage control techniques applied to the management of thoracic injuries have evolved over the last 15 years. Despite the limited number of publications, information is sufficient to scatter some fears and establish management principles. The severity of the anatomical injury justifies the procedure of damage control in only few selected cases. In most cases, the magnitude of the physiological derangement and the presence of other sources of bleeding within the thoracic cavity or in other body compartments constitutes the indication for the abbreviated procedure. The classification of lung injuries as peripheral, transfixing, and central or multiple, provides a guideline for the transient bleeding control and for the definitive management of the injury: pneumorraphy, wedge resection, tractotomy or anatomical resection, respectively. Identification of specific patterns such as the need for resuscitative thoracotomy, or aortic occlusion, the existence of massive hemothorax, a central lung injury, a tracheobronchial injury, a major vascular injury, multiple bleeding sites as well as the recognition of hypothermia, acidosis or coagulopathy, constitute the indication for a damage control thoracotomy. In these cases, the surgeon executes an abbreviated procedure with packing of the bleeding surfaces, primary management with packing of some selected peripheral or transfixing lung injuries, and the postponement of lung resection, clamping of the pulmonary hilum in the most selective way possible. The abbreviation of the thoracotomy closure is achieved by suturing the skin over the wound packed, or by installing a vacuum system. The management of the patient in the intensive care unit will allow identification of those who require urgent reintervention and the correction of the physiological derangement in the remaining patients for their scheduled reintervention and definitive management.
Las técnicas de control de daños aplicadas al manejo de lesiones torácicas han evolucionado en los últimos 15 años. A pesar de que el número de publicaciones es limitado, la información es suficiente para desvirtuar algunos temores y establecer los principios de manejo. La severidad del compromiso anatómico justifica el procedimiento de control de daños solamente en algunos casos. En la mayoría, la magnitud del deterioro fisiológico y la presencia de otras fuentes de sangrado dentro del tórax o en otros compartimientos corporales constituyen la indicación del procedimiento abreviado. La clasificación de la lesión pulmonar como periférica, transfixiante y central o múltiple, proporciona una pauta para el control transitorio del sangrado y para el manejo definitivo de la lesión: neumorrafía, resección en cuña, tractotomía o resecciones anatómicas, respectivamente. La identificación de ciertos patrones como la necesidad de toracotomía de reanimación o de oclusión aórtica, la existencia de un hemotórax masivo, de una lesión pulmonar central, una lesión traqueobronquial o una lesión vascular mayor, así como el reconocimiento de hipotermia, acidosis o coagulopatía, constituyen la indicación de una toracotomía de control de daños. En estos casos, el cirujano concluye de manera abreviada los procedimientos con empaquetamiento de las superficies sangrantes, el manejo primario con empaquetamiento de algunas lesiones pulmonares periféricas o transfixiante seleccionadas y el aplazamiento de la resección pulmonar, pinzando el hilio de la manera más selectiva posible. La abreviación del cierre de la toracotomía se logra con la sutura de la piel sobre el empaquetamiento de la herida, o mediante la instalación de un sistema de presión negativa. El manejo del paciente en cuidados intensivos permitirá identificar aquellos que requieren reintervención urgente y corregir la alteración fisiológica de los restantes para su reoperación programada y manejo definitivo.
Assuntos
Hemorragia/terapia , Técnicas Hemostáticas , Lesão Pulmonar/cirurgia , Toracotomia/métodos , Acidose/diagnóstico , Aorta , Transtornos da Coagulação Sanguínea/diagnóstico , Hemorragia/etiologia , Humanos , Hipotermia/diagnóstico , Lesão Pulmonar/classificação , Lesão Pulmonar/complicações , Lesão Pulmonar/epidemiologia , Ilustração Médica , Fotografação , Oclusão Terapêutica , Técnicas de Fechamento de FerimentosRESUMO
Abstract Definitive management of hemodynamically stable patients with penetrating cardiac injuries remains controversial between those who propose aggressive invasive care versus those who opt for a less invasive or non-operative approach. This controversy even extends to cases of hemodynamically unstable patients in which damage control surgery is thought to be useful and effective. The aim of this article is to delineate our experience in the surgical management of penetrating cardiac injuries via the creation of a clear and practical algorithm that includes basic principles of damage control surgery. We recommend that all patients with precordial penetrating injuries undergo trans-thoracic ultrasound screening as an integral component of their initial evaluation. In those patients who arrive hemodynamically stable but have a positive ultrasound, a pericardial window with lavage and drainage should follow. We want to emphasize the importance of the pericardial lavage and drainage in the surgical management algorithm of these patients. Before this concept, all positive pericardial windows ended up in an open chest exploration. With the coming of the pericardial lavage and drainage procedure, the reported literature and our experience have shown that 25% of positive pericardial windows do not benefit and/or require further invasive procedures. However, in hemodynamically unstable patients, damage control surgery may still be required to control ongoing bleeding. For this purpose, we propose a surgical management algorithm that includes all of these essential clinical aspects in the care of these patients.
Resumen El manejo definitivo de los pacientes hemodinámicamente estables con heridas cardíacas penetrantes continúa siendo controversial con abordajes invasivos versus manejos conservadores. Estas posiciones contrarias se extienden hasta aquellos casos de pacientes hemodinámicamente inestables donde se ha descrito y considerado la cirugía de control de daños como un procedimiento útil y efectivo. El objetivo de este artículo es presentar la experiencia en el manejo quirúrgico de heridas cardíacas penetrantes con la creación de un algoritmo práctico que incluye los principios básicos del control de daños. Se recomienda que a todos los pacientes con heridas precordiales penetrantes se les debe realizar un ultrasonido torácico como componente integral de la evaluación inicial. Aquellos que presenten un ultrasonido torácico positivo y se encuentren hemodinámicamente estables se les debe realizar una ventana pericárdica con posterior lavado. Se ha demostrado que el 25% de las ventanas pericárdicas positivas no se benefician ni requieren de posteriores abordajes quirúrgicos invasivos. Antes de este concepto, todos los pacientes con ventana pericárdica positiva terminaban en una exploración abierta del tórax y del pericárdico. Los pacientes hemodinámicamente inestables requieren de una cirugía de control de daños para un adecuado y oportuno control del sangrado. Con este propósito, se propone un algoritmo de manejo quirúrgico que incluye todos estos aspectos esenciales en el abordaje de este grupo de pacientes.
RESUMO
Abstract Damage control techniques applied to the management of thoracic injuries have evolved over the last 15 years. Despite the limited number of publications, information is sufficient to scatter some fears and establish management principles. The severity of the anatomical injury justifies the procedure of damage control in only few selected cases. In most cases, the magnitude of the physiological derangement and the presence of other sources of bleeding within the thoracic cavity or in other body compartments constitutes the indication for the abbreviated procedure. The classification of lung injuries as peripheral, transfixing, and central or multiple, provides a guideline for the transient bleeding control and for the definitive management of the injury: pneumorraphy, wedge resection, tractotomy or anatomical resection, respectively. Identification of specific patterns such as the need for resuscitative thoracotomy, or aortic occlusion, the existence of massive hemothorax, a central lung injury, a tracheobronchial injury, a major vascular injury, multiple bleeding sites as well as the recognition of hypothermia, acidosis or coagulopathy, constitute the indication for a damage control thoracotomy. In these cases, the surgeon executes an abbreviated procedure with packing of the bleeding surfaces, primary management with packing of some selected peripheral or transfixing lung injuries, and the postponement of lung resection, clamping of the pulmonary hilum in the most selective way possible. The abbreviation of the thoracotomy closure is achieved by suturing the skin over the wound packed, or by installing a vacuum system. The management of the patient in the intensive care unit will allow identification of those who require urgent reintervention and the correction of the physiological derangement in the remaining patients for their scheduled reintervention and definitive management.
Resumen Las técnicas de control de daños aplicadas al manejo de lesiones torácicas han evolucionado en los últimos 15 años. A pesar de que el número de publicaciones es limitado, la información es suficiente para desvirtuar algunos temores y establecer los principios de manejo. La severidad del compromiso anatómico justifica el procedimiento de control de daños solamente en algunos casos. En la mayoría, la magnitud del deterioro fisiológico y la presencia de otras fuentes de sangrado dentro del tórax o en otros compartimientos corporales constituyen la indicación del procedimiento abreviado. La clasificación de la lesión pulmonar como periférica, transfixiante y central o múltiple, proporciona una pauta para el control transitorio del sangrado y para el manejo definitivo de la lesión: neumorrafía, resección en cuña, tractotomía o resecciones anatómicas, respectivamente. La identificación de ciertos patrones como la necesidad de toracotomía de reanimación o de oclusión aórtica, la existencia de un hemotórax masivo, de una lesión pulmonar central, una lesión traqueobronquial o una lesión vascular mayor, así como el reconocimiento de hipotermia, acidosis o coagulopatía, constituyen la indicación de una toracotomía de control de daños. En estos casos, el cirujano concluye de manera abreviada los procedimientos con empaquetamiento de las superficies sangrantes, el manejo primario con empaquetamiento de algunas lesiones pulmonares periféricas o transfixiante seleccionadas y el aplazamiento de la resección pulmonar, pinzando el hilio de la manera más selectiva posible. La abreviación del cierre de la toracotomía se logra con la sutura de la piel sobre el empaquetamiento de la herida, o mediante la instalación de un sistema de presión negativa. El manejo del paciente en cuidados intensivos permitirá identificar aquellos que requieren reintervención urgente y corregir la alteración fisiológica de los restantes para su reoperación programada y manejo definitivo.
RESUMO
INTRODUCTION: To determine predictors of length of stay (LOS) in the intensive care unit (ICU) after coronary artery bypass grafting (CABG) and to develop a risk scoring system were the objectives of this study. METHODS: In this retrospective study, 1202 patients' medical records after CABG were evaluated by a research-made checklist. Tarone-Ware test was used to determine the predictors of patients' LOS in the ICU. Cox regression model was used to determine the risk factors and risk ratios associated with ICU LOS. RESULTS: The mean ICU LOS after CABG was 55.27±17.33 hours. Cox regression model showed that having more than two chest tubes (95% confidence interval [CI] 1.005-1.287, Relative Risk [RR]=1.138), occurrence of atelectasis (95% CI 1.000-3.007, RR=1.734), and occurrence of atrial fibrillation after CABG (95% CI 1.428-2.424, RR=1.861) were risk factors associated with longer ICU LOS. The discrimination power of this set of predictors was demonstrated with an area under the receiver operating characteristic curve and it was 0.69. A simple risk scoring system was developed based on three identified predictors that can raise ICU LOS. CONCLUSION: The simple risk scoring system developed based on three identified predictors can help to plan more accurately a patient's LOS in hospital for CABG and can be useful in managing human and financial resources.
Assuntos
Ponte de Artéria Coronária , Unidades de Terapia Intensiva , Humanos , Tempo de Internação , Estudos Retrospectivos , Fatores de RiscoRESUMO
Abstract Introduction: To determine predictors of length of stay (LOS) in the intensive care unit (ICU) after coronary artery bypass grafting (CABG) and to develop a risk scoring system were the objectives of this study. Methods: In this retrospective study, 1202 patients' medical records after CABG were evaluated by a research-made checklist. Tarone-Ware test was used to determine the predictors of patients' LOS in the ICU. Cox regression model was used to determine the risk factors and risk ratios associated with ICU LOS. Results: The mean ICU LOS after CABG was 55.27±17.33 hours. Cox regression model showed that having more than two chest tubes (95% confidence interval [CI] 1.005-1.287, Relative Risk [RR]=1.138), occurrence of atelectasis (95% CI 1.000-3.007, RR=1.734), and occurrence of atrial fibrillation after CABG (95% CI 1.428-2.424, RR=1.861) were risk factors associated with longer ICU LOS. The discrimination power of this set of predictors was demonstrated with an area under the receiver operating characteristic curve and it was 0.69. A simple risk scoring system was developed based on three identified predictors that can raise ICU LOS. Conclusion: The simple risk scoring system developed based on three identified predictors can help to plan more accurately a patient's LOS in hospital for CABG and can be useful in managing human and financial resources.
Assuntos
Humanos , Ponte de Artéria Coronária , Unidades de Terapia Intensiva , Estudos Retrospectivos , Fatores de Risco , Tempo de InternaçãoRESUMO
SUMMARY INTRODUCTION What has been published so far regarding safe methods to deal with chest tube insertion during COVID-19. METHODS A descriptive study of the literature available in the Medline/PubMed, Lilacs, Scopus databases and specialized books. The search was carried out using the terms "infectious diseases"; "COVID-19"; "Chest tubes". RESULTS This paper aggregates and consolidates some old concepts to new tactics to minimize the contamination of teams who deal with chest tubes, before, during, and after the procedure. CONCLUSIONS Health officials are under increasing pressure to control the spread of COVID-19, which is a very virulent disease. Our analysis brought together old rules against contamination along with new tactics for professionals who deal with chest drains in order to minimize the contamination of teams during the Pandemic.
Assuntos
Humanos , Pneumonia Viral/prevenção & controle , Tubos Torácicos/efeitos adversos , Transmissão de Doença Infecciosa do Profissional para o Paciente/prevenção & controle , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Infecções por Coronavirus/prevenção & controle , Equipamento de Proteção Individual , Pneumonia Viral/epidemiologia , Infecções por Coronavirus , Infecções por Coronavirus/epidemiologia , Pandemias , BetacoronavirusAssuntos
Países em Desenvolvimento , Acessibilidade aos Serviços de Saúde , Pneumotórax/terapia , Padrões de Prática Médica , Procedimentos Cirúrgicos Torácicos/efeitos adversos , Colômbia , Fidelidade a Diretrizes , Acessibilidade aos Serviços de Saúde/normas , Disparidades em Assistência à Saúde , Humanos , Pneumotórax/diagnóstico , Pneumotórax/etiologia , Guias de Prática Clínica como Assunto , Padrões de Prática Médica/normas , Resultado do TratamentoRESUMO
RESUMO Objetivo: criar, em impressora 3D, um simulador de baixo custo de caixa torácica humana que permita a reprodução da técnica de drenagem fechada de tórax (DFT) comparando sua eficácia com a do modelo animal. Métodos: foi realizada impressão 3D do arcabouço ósseo de um tórax humano a partir de uma tomografia de tórax. Após a impressão das costelas, foram realizados testes com diversos materiais que contribuíram para formar a simulação da caixa torácica e da pleura. Foi, então, realizado um estudo experimental, randomizado e controlado comparando sua eficácia ao modelo animal no ensino da DFT para estudantes de medicina, que foram divididos em dois grupos: Grupo Modelo Animal e Grupo Modelo Simulador, que treinaram DFT em animais e no modelo simulador, respectivamente. Resultados: a reconstrução do tórax exigiu o conhecimento anatômico para análise da tomografia e para edição fiel da superfície 3D. Não houve diferença significativa quanto à segurança de realizar o procedimento entre os grupos (7,61 vs. 7,73; p=0,398). Foi observada maior pontuação no grupo modelo simulador para uso como material didático e aprendizado da técnica de drenagem torácica quando comparado ao grupo modelo animal (p<0,05). Conclusão: o custo final para a confecção do modelo foi inferior ao de um simulador comercial, o que demonstra a viabilidade do uso da impressão 3D para esse fim. Além disso, o simulador desenvolvido se mostrou equivalente ao modelo animal quanto à simulação da técnica de drenagem para aprendizado prático e houve preferência pelo modelo simulador como material didático.
ABSTRACT Objective: by using a 3D printer, to create a low-cost human chest cavity simulator that allows the reproduction of the closed chest drainage technique (CCD), comparing its effectiveness with that of the animal model. Methods: it was made a 3D printing of the bony framework of a human thorax from a chest computerized tomography scan. After printing the ribs, we performed tests with several materials that contributed to form the simulation of the thoracic cavity and pleura. An experimental, randomized, and controlled study, comparing the efficacy of the simulator to the efficacy of the animal model, was then carried out in the teaching of CCD technique for medical students, who were divided into two groups: animal model group and simulator model group, that trained CCD technique in animals and in the simulator model, respectively. Results: the chest reconstruction required anatomical knowledge for tomography analysis and for faithful 3D surface editing. There was no significant difference in the safety of performing the procedure in both groups (7.61 vs. 7.73; p=0.398). A higher score was observed in the simulator model group for "use as didactic material" and "learning of the chest drainage technique", when compared to the animal model group (p<0.05). Conclusion: the final cost for producing the model was lower than that of a commercial simulator, what demonstrates the feasibility of using 3D printing for this purpose. In addition, the developed simulator was shown to be equivalent to the animal model in relation to the simulation of the drainage technique for practical learning, and there was preference for the simulator model as didactic material.
Assuntos
Humanos , Masculino , Feminino , Adulto , Adulto Jovem , Tubos Torácicos , Desenho Assistido por Computador/instrumentação , Procedimentos Neurocirúrgicos/educação , Procedimentos Neurocirúrgicos/instrumentação , Educação Médica/métodos , Desenho de Equipamento/instrumentação , Treinamento por Simulação/métodos , Modelos Anatômicos , Médicos , Estudantes de Medicina , Simulação por Computador , Competência Clínica , Desenho Assistido por Computador/economia , Procedimentos Neurocirúrgicos/economia , Custos e Análise de Custo , Educação Médica/economia , Desenho de Equipamento/economia , Treinamento por Simulação/economiaRESUMO
The purpose of chest drainage is to allow lung re-expansion and the reestablishment of the subatmospheric pressure in the pleural space. Properly managing the drainage system minimizes procedure -related complications. This prospective observational study evaluated adult patients undergoing water-seal chest drainage, admitted to our hospital and accompanied by residents and tutors, aiming to check their care. One hundred chest drainages were monitored. The average age was 38.8 years old. The average drainage time was 6.7 days. Trauma was the prevalent cause (72%) for the indication of pleural drainage. The obstruction of the system occurred in 6% of the cases; 5% subcutaneous emphysema, 1% infection around the drain; 5% accidental dislodgement of the drain, and in 5% of the patients, there were some complications when removing the drain. Failures in chest drainage technique and management were present, and reflected in some complications that are inherent to the procedure, although it is known that there are intrinsic complications. This study aimed to assess the management of closed chest drainage systems and standardize the care provided in such procedure.
O objetivo da drenagem torácica é possibilitar a reexpansão pulmonar e o restabelecimento da pressão subatmosférica no espaço pleural. O manejo adequado do sistema de drenagem minimiza as complicações relacionadas ao procedimento. O presente estudo observacional prospectivo avaliou pacientes adultos submetidos à drenagem torácica em selo d'água, internados em nosso hospital e acompanhados por médicos residentes e preceptores, com o objetivo de verificar o manejo com eles. Foram observadas 100 drenagens torácicas. A faixa etária média foi de 38,8 anos. O tempo médio de drenagem foi de 6,7 dias. Houve predomínio da causa traumática (72%) na indicação de drenagem pleural. A obstrução do sistema esteve presente em 6% dos casos; em 5%, houve enfisema subcutâneo; em 1%, infecção peridreno; em 5%, deslocamento acidental do dreno e, em 5% dos pacientes, houve complicação na retirada do dreno. Falhas na técnica e no manejo de drenagem torácica estão presentes em nosso serviço, refletidas em algumas complicações inerentes ao procedimento, embora saibamos que haja complicações que lhe são intrínsecas. O objetivo do estudo foi avaliar o manejo dos sistemas de drenagem torácica fechada e padronizar o protocolo para os cuidados com esse procedimento.
Assuntos
Humanos , Masculino , Feminino , Tórax , Toracostomia , Tubos Torácicos , DrenagemRESUMO
Tracheobronchial stenosis is common in the thoracic surgery service, and iatrogenic injury of the airway after manipulation is not infrequent. When a digital thoracic drainage system came onto the market, many advantages were evident. A 24-year-old woman with critical right main bronchial stenosis underwent airway dilation that was complicated by a tear with a massive air leak, resulting in a total right pneumothorax. We employed a pleural drain connected to a digital thoracic drainage system. The drain was removed 2 days after successful resolution of the air leak.
Assuntos
Obstrução das Vias Respiratórias/terapia , Brônquios/lesões , Broncopatias/terapia , Dilatação/efeitos adversos , Drenagem/instrumentação , Pneumotórax/terapia , Obstrução das Vias Respiratórias/diagnóstico , Broncopatias/diagnóstico , Drenagem/métodos , Desenho de Equipamento , Feminino , Humanos , Pneumotórax/diagnóstico , Pneumotórax/etiologia , Resultado do Tratamento , Adulto JovemRESUMO
Objective: to assess the analgesic efficacy of subcutaneous lidocaine and multimodal analgesia for chest tube removal following heart surgery. Methods: sixty volunteers were randomly allocated in two groups; 30 participants in the experimental group were given 1% subcutaneous lidocaine, and 30 controls were given a multimodal analgesia regime comprising systemic anti-inflammatory agents and opioids. The intensity and quality of pain and trait and state anxiety were assessed. The association between independent variables and final outcome was assessed by means of the Chi-squared test with Yates' correction and Fisher's exact test. Results: the groups did not exhibit significant difference with respect to the intensity of pain upon chest tube removal (p= 0.47). The most frequent descriptors of pain reported by the participants were pressing, sharp, pricking, burning and unbearable. Conclusion: the present study suggests that the analgesic effect of the subcutaneous administration of 1% lidocaine combined with multimodal analgesia is most efficacious.
Objetivo: avaliar a eficiência analgésica de lidocaína subcutânea e analgesia multimodal na remoção do dreno torácico após cirurgia cardíaca. Método: sessenta voluntários foram alocados aleatoriamente em dois grupos; 30 participantes no grupo experimental receberam lidocaína subcutânea 1%, e outros 30 do grupo controle receberam o regime de analgesia multimodal compreendendo agentes anti-inflamatórios e opióides sistêmicos. A intensidade e qualidade da dor e Ansiedade Traço Estado foram avaliados. A associação entre variáveis independentes e desfecho final foi avaliada através do Teste Qui-quadrado com correção de Yates e o Teste exato de Fisher. Resultados: os grupos não apresentaram diferenças significante, no que diz respeito à intensidade da dor na remoção do dreno torácico (p= 0,47). Os descritores de dor mais comuns relatados pelos participantes foram dor: de pressão, aguda, como uma picada, queimar/arder e intolerável. Conclusão: o presente estudo sugere que o efeito analgésico da administração de lidocaína 1% combinada com a analgesia multimodal é mais eficiente.
Objetivo: evaluar la eficacia analgésica de la lidocaína subcutánea y la analgesia multimodal para la remoción del tubo torácico después de la cirugía cardíaca. Métodos: sesenta voluntarios fueron asignados aleatoriamente en dos grupos; 30 participantes en el grupo experimental recibieron lidocaína subcutánea al 1%, y 30 controlos recibieron un régimen de analgesia multimodal que comprende agentes antiinflamatorios sistémicos y opioides. La intensidad y calidad del dolor y rasgo y estado de ansiedad se evaluaron. La asociación entre las variables independientes y el resultado final han sido evaluados por medio de la prueba de Chi-cuadrado con corrección de Yates y la prueba exacta de Fisher. Resultados: los grupos no mostraron diferencias significativas con respecto a la intensidad del dolor después de la retirada del tubo torácico (p= 0,47). Los descriptores de dolor más frecuentes informados por los participantes fueron apretado, agudo, punzante, ardiente e insoportable. Conclusión: el presente estudio sugiere que el efecto analgésico de la administración subcutánea de lidocaína al 1% combinada con la analgesia multimodal es eficaz.
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Tubos Torácicos , Remoção de Dispositivo/efeitos adversos , Dor Processual/tratamento farmacológico , Analgesia , Anestésicos Locais/uso terapêutico , Lidocaína/uso terapêutico , Dor Pós-Operatória/tratamento farmacológico , Medição da DorRESUMO
JUSTIFICATIVA E OBJETIVOS: Estudo longitudinal, prospectivo, aleatório e encoberto para avaliar a influência do local de inserção do dreno pleural, de PVC atóxico, na função pulmonar e na dor pós-operatória dos pacientes submetidos à revascularização do miocárdio nos três primeiros dias pós-cirúrgicos e logo após a retirada do dreno. PACIENTES E MÉTODOS: Trinta e seis pacientes escalados para cirurgia eletiva de revascularização do miocárdio, com uso de circulação extracorpórea (CEC), em dois grupos: grupo SX (dreno subxifoide) e grupo IC (dreno intercostal). Feitos registros espirométricos, da gasometria arterial e da dor. RESULTADOS: Trinta e um pacientes analisados, 16 no grupo SX e 15 no grupo IC. O grupo SX apresentou valores espirométricos maiores do que o grupo IC (p < 0,05) no pós-operatório (PO), denotando menor influência do local do dreno na respiração. A PaO2 arterial no segundo PO aumentou significantemente no grupo SX quando comparada com o grupo IC (p < 0,0188). A intensidade da dor no grupo SX, antes e após a espirometria, era menor do que no grupo IC (p < 0,005). Houve aumento significativo dos valores espirométricos em ambos os grupos após a retirada do dreno pleural. CONCLUSÃO: A inserção do dreno na região subxifoide altera menos a função pulmonar, provoca menos desconforto e possibilita uma melhor recuperação dos parâmetros respiratórios.
BACKGROUND AND OBJECTIVES: Longitudinal, prospective, randomized, blinded Trial to assess the influence of pleural drain (non-toxic PVC) site of insertion on lung function and postoperative pain of patients undergoing coronary artery bypass grafting in the first three days post-surgery and immediately after chest tube removal. METHOD: Thirty six patients scheduled for elective myocardial revascularization with cardiopulmonary bypass (CPB) were randomly allocated into two groups: SX group (subxiphoid) and IC group (intercostal drain). Spirometry, arterial blood gases, and pain tests were recorded. RESULTS: Thirty one patients were selected, 16 in SX group and 15 in IC group. Postoperative (PO) spirometric values were higher in SX than in IC group (p < 0.05), showing less influence of pleural drain location on breathing. PaO2 on the second PO increased significantly in SX group compared with IC group (p < 0.0188). The intensity of pain before and after spirometry was lower in SX group than in IC group (p < 0.005). Spirometric values were significantly increased in both groups after chest tube removal. CONCLUSION: Drain with insertion in the subxiphoid region causes less change in lung function and discomfort, allowing better recovery of respiratory parameters.
JUSTIFICATIVA Y OBJETIVOS: Estudio longitudinal, prospectivo, randomizado y encubierto para evaluar la influencia del local de inserción del drenaje pleural, de PVC atóxico, en la función pulmonar y en el dolor postoperatorio de los pacientes sometidos a la revascularización del miocardio en los tres primeros días postquirúrgicos e inmediatamente después de la retirada del drenaje. PACIENTES Y MÉTODOS: Treinta y seis pacientes seleccionados para la cirugía electiva de revascularización del miocardio, con el uso de circulación extracorpórea (CEC), en dos grupos: grupo SX (drenaje subxifoide) y grupo IC (drenaje intercostal). Se realizaron los registros espirométricos de la gasometría arterial y del dolor. RESULTADOS: Treinta y un pacientes analizados, 16 en el grupo SX y 15 en el grupo IC. El grupo SX presentó valores espirométricos mayores que el grupo IC (p < 0,05) en el postoperatorio (PO), denotando una menor influencia de la región del drenaje en la respiración. La PaO2 arterial en el segundo PO aumentó significantemente en el grupo SX cuando se comparó con el grupo IC (p < 0,0188). La intensidad del dolor en el grupo SX, antes y después de la espirometría, era menor que en el grupo IC (p < 0,005). Se registró el aumento significativo de los valores espirométricos en ambos grupos después de la retirada del drenaje pleural. CONCLUSIONES: La inserción del drenaje en la región subxifoide altera menos la función pulmonar, provoca menos incomodidad y facilita una mejor recuperación de los parámetros respiratorios.
Assuntos
Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Tubos Torácicos , Ponte de Artéria Coronária , Drenagem/instrumentação , Cuidados Pós-Operatórios/instrumentação , Tubos Torácicos/efeitos adversos , Volume Expiratório Forçado , Pleura , Estudos Prospectivos , Método Simples-Cego , Espirometria , Capacidade VitalRESUMO
Objetivo - A expansibilidade torácica é definida como o movimento observado no tórax durante uma incursão inspiratória e expiratória, este movimento pode facilmente ser alterado após alguns procedimentos cirúrgicos que exijam a presença de drenos torácicos. O objetivo do presente trabalho foi avaliar cirtometria torácica em pacientes com drenos torácicos que realizam fisioterapia convencional ou associadas a diagonais de membros superiores. Método - Os pacientes que possuíam drenos torácicos foram divididos em dois grupos, o grupo controle realizava somente fisioterapia convencional e o grupo tratado realizava fisioterapia convencional associada a diagonais de membros superiores, após a execução dos procedimentos a cirtometria era avaliada em ambos os grupos. Resultados - A expansibilidade obtida após a realização de ambas as técnicas não foram estatisticamente significante em relação às medidas pré-terapêutica. Conclusão - Não houve diferença estatisticamente significante entre os dois métodos realizados para a reexpansão torácica em pacientes com dreno de tórax. Sugere-se que esta pesquisa seja posteriormente estendida para um número maior de sessões, para que possivelmente obtenha uma diferença estatisticamente significante. Recomenda-se também que se realizem trabalhos utilizando outras variáveis tais como força muscular respiratória,volumes e capacidades pulmonares.
Objective - The chest expansion is defined as the movement observed in the chest during an incursion into inspiratory and expiratory, this movement can easily be changed after some surgical procedures that require the presence of chest drains. The objective of this study was to evaluate thoracic expansion in patients with chest tubes or performing physiotherapy associated with the upper diagonal. Method - Patients who had chest tubes were divided into two groups, the control group performed only conventional physiotherapy and treatment group performed physical therapy associated with the upper diagonal, after performing the procedures cirtometry was evaluated in both groups. Results - The expansion obtained after performing both techniques were not statistically significantly higher than the pre-therapy. Conclusion - There was no statistically significant difference between the two methods performed to reexpansion in patients with chest tube. It is suggested that this research is subsequently extended to a larger number of sessions to possibly get a statistically significant difference. It is also recommended that work is carried out using other variables such as respiratory muscle strength, lung volumes and capacities.
Assuntos
Humanos , Masculino , Feminino , Adulto , Cinesiologia Aplicada , Modalidades de Fisioterapia , Tubos TorácicosRESUMO
Avaliou- se, prospectivamente, o manejo dos sistemas de drenagem torácica fechada em pacientes adultos no Hospital Universitário de Maringá, Estado do Paraná, no período de dez meses. Foram acompanhadas 90 drenagens em 75 pacientes. Predominou a causa traumática em pacientes jovens como determinante de indicação da drenagem pleural (61/90, 68%). A falta do curativo em meso e contrameso, como fixação complementar do dreno, foi a ocorrência isolada mais comum no manejo, sendo encontrado rotineiramente em 20% (18/90). A presença de obstrução (por dobramento, sifonagem, coágulo ou fibrina) esteve presente em 12% das drenagens (11/90) e complicações (enfisema subcutâneo, infecção, deslocamento acidental, pneumotórax na retirada do dreno) em 21% (20/90). O manejo apropriado da drenagem torácica reduz a morbidade associada ao método. Esta pesquisa ressalta a importância do treinamento continuado e do estabelecimento de manuais que padronizem condutas para os profissionais da saúde que manejam o sistema de drenagem torácica.
The handling of adults' closed thoracic drainage systems at the University Hospital of Maringá, Maringá, Paraná State, Brazil during a 10-month period was prospectively evaluated. Ninety thoracic drainages in 75 patients were analyzed. Traumatic causes in young patients determined pleural drainage (61/90, 68%). The absence of an omental tag of tape as a complementary tube fixation was the most common, albeit isolated case, occurrence in the procedure. In fact, it has been routinely found in 20% (18/90) of cases. Whereas tube obstruction (due to kinking, siphoning, clotting or fibrin) was detected in 12% (11/90) of drainage cases, drainage complications (subcutaneous emphysema, infection, accidental dislodgement, pneumothorax following chest tube removal) occurred in 21% (20/90) of cases. Adequate handling of tube thoracostomy reduces morbidity related to this procedure. Current research enhances the importance of continuous training and of textbooks that would standardize procedures for health teams whose role involves interventions in the thoracic drainage system.