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Abstract Background Prolonged mechanical ventilation (MV) after cardiac surgery imposes a significant burden on the patient in terms of morbidity and financial hospital costs. Objective To develop a risk score model to predict prolonged MV in patients undergoing coronary artery bypass grafting (CABG) surgery. Methods This was a historical cohort study of 4165 adult patients undergoing CABG between January 1996 and December 2016. MV for periods ≥ 12 hours was considered prolonged. Logistic regression was used to examine the relationship between risk predictors and prolonged MV. The variables were scored according to the odds ratio. To build the risk score, the database was randomly divided into 2 parts: development data set (2/3) with 2746 patients and internal validation data set (1/3) with 1419 patients. The final score was validated in the total database and the model's accuracy was tested by performance statistics. Significance was established at p < 0.05. Results Prolonged MV was observed in 783 (18.8%) patients. Predictors of risk were age ≥ 65 years, urgent/emergency surgery, body mass index ≥ 30 kg/m2, chronic kidney disease, chronic obstructive pulmonary disease, and cardiopulmonary bypass time ≥ 120 minutes. The area under the ROC curve was 0.66 (95% CI, 0.64-0.68; p<0.001), the Hosmer-Lemeshow chi-square test was χ2: 3.38 (p=0.642), and Pearson's correlation was r = 0.99 (p<0.001), indicating the model's satisfactory ability to predict the occurrence of prolonged MV. Conclusion Selected variables allowed the construction of a simplified risk score for daily practice, which may classify the patients as having low, moderate, high, and very high risk. (Int J Cardiovasc Sci. 2020; [online].ahead print, PP.0-0

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BACKGROUND: Aerobic exercise and CPAP benefit patients in the postoperative period of cardiac surgery. To our knowledge, the association of aerobic exercise on an exercise bicycle with CPAP has not yet been demonstrated. Therefore, we aimed to evaluate the effectiveness of physical exercise on a cycle ergometer combined with CPAP in the postoperative period after coronary artery bypass graft surgery. METHODS: This was a randomized clinical trial, with recruitment from May 2017 to December 2017 (registered in the Brazilian Clinical Trials Registry: RBR-69CDYF). The step group (n = 16 subjects) started rehabilitation in the immediate postoperative period with breathing exercises and passive mobilization in the sitting position, progressing to active exercises, ambulation, and stair training. For the intervention group (n = 15 subjects), dynamic exercises on a cycle ergometer combined with CPAP were added to the step program from the second to the fourth postoperative day in a single daily session. RESULTS: Functional capacity decreased in both groups, but this reduction was not significant in the intervention group (P = .11). The length of stay in ICU was lower in the intervention group (P = .050). In both groups there was a decrease in maximum inspiratory and expiratory pressure, as well as in the 1-min sit-to-stand test on the fourth postoperative day compared to the preoperative period. CONCLUSIONS: Physical exercise combined with CPAP promoted the maintenance of functional capacity and reduced the length of stay in the ICU.

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Antecedentes: el aumento de la incidencia y prevalencia de las enfermedades cardiovasculares debido a los malos estilos de vida, disminución de ejercicio, un déficit de dieta balanceada, acompañada del estrés, alto consumo de alcohol y tabaco han sido responsables de que las afecciones cardiacas se incrementen. Gracias a la tecnología y avances científicos han surgido procedimientos cuyo objetivo ha sido prolongar y mejorar la calidad de vida; en este caso, la revascularización miocárdica (RVM) es un evento quirúrgico con denotación de ser una cirugía mayor, que tiene serias connotaciones a nivel físico, mental y emocional. Esta cirugía tiene unos periodos de recuperación, este estudio se enfatizó en el tardío periodo después del alta hospitalario, en el cual el individuo continúa su recuperación enfrentándose a su realidad. Desde este punto de vista, fue posible explorar cuáles son las vivencias de los pacientes que cursaron con un postoperatorio tardío de RVM, cuál fue su sentir respecto a su estado de salud, su relación con el personal de salud, cuáles son sus problemas y sus dudas. Estos conocimientos de los significados de vivir de esta población pueden generar posteriormente teorías de mediano rango que permita individualizar los cuidados a estos individuos, y nuevas estrategias que estén en la vanguardia de desarrollo tecnológico para modernizar el cuidado, sin perder la esencia del ser humano. Objetivo: comprender los significados que le atribuyen los pacientes a la experiencia vivida de la revascularización miocárdica en el postoperatorio tardío, atendidos durante el año 2017 y 2018 en la Clínica Mediláser en la ciudad Neiva (Huila). Metodología: investigación cualitativa con enfoque fenomenológico interpretativo o hermenéutico. La población de estudio fueron los pacientes que se encontraron entre el cuarto mes del postoperatorio tardío de RVM de la Clínica Mediláser. Se seleccionaron mediante un muestreo teórico; el tamaño de la muestra fue definido mediante el criterio de saturación de la información. La información fue obtenida mediante entrevistas a profundidad y los datos se analizaron con la propuesta de Heidegger, Diekelman, Allen y Tanner; en secuencia simultánea. Resultados: para los participantes del estudio, el significado de la experiencia de la postoperatorio de RVM está enmarcado en cuatro grandes temas: "Afrontando la recuperación", "Asumiendo cambios y complicaciones", "Retomando de nuevo mi vida" y "Fortalezas para vencer esta travesía". Conclusiones: en este estudio, las narraciones de las personas que viven un postoperatorio tardío de RVM permite un desplazamiento de la mirada puramente biológica ­ fisiológica y farmacológica del postoperatorio tardío hacia una comprensión de la experiencia humana que subyace y resulta de la experiencia misma, atravesando otras dimensiones. Los resultados aportan a la comprensión del fenómeno desde la mirada particular de los pacientes revascularizados, exaltando la importancia del acompañamiento multidisciplinario, incluyendo a Enfermería para continuar con su cuidado después del alta médica.

Introduction: the increase in the incidence and prevalence of cardiovascular diseases due to poor lifestyles, decreased exercise, a balanced diet deficit, accompanied by stress, high consumption of alcohol and tobacco; It has been responsible for heart conditions to increase. Thanks to technology and scientific advances have emerged procedures whose goal has been to prolong and improve the quality of life, in this case myocardial revascularization (RVM) is a surgical event with denoting major surgery, which has serious connotations at the physical level, mental and emotional. This surgery has a period of recovery, this study was emphasized in the late period after hospital discharge in which the individual continued his recovery facing his reality. From this point of view, it was possible to explore the experiences of the patients who attended a late post-operative period of MVR, what their feelings were with regard to their health status, their relationship with health personnel, their problems and their Doubts. This knowledge of the meanings of living of this population can later generate mid-range theories that allow individualizing the care of these individuals, and new strategies that are at the forefront of technological development to modernize care without losing the essence of the human being. Objective: to understand the meanings attributed by patients to the experience of myocardial revascularization in the late postoperative period, attended during 2017 and 2018 at the Mediláser Clinic in the city of Neiva (Huila). Methodology: qualitative research with interpretive or hermeneutical phenomenological approach. The study population was the patients who were between the fourth month of the late postoperative period of MVR of the Mediláser Clinic. They were selected by means of a theoretical sampling. The size of the sample was defined by the criterion of saturation of the information. The information was obtained through in-depth interviews and the data was analyzed with the proposal of Heidegger, Diekelman, Allen and Tanner, in simultaneous sequence. Results: For the participants of the study, the meaning of the post-operative experience of RVM is framed in 4 major themes: "Coping with recovery", "Assuming changes and complications", "Taking up my life again" and "Strengths for overcome this journey." Conclusions: In this study, the narratives of people who live a late postoperative period of MVR allow a shift from the purely biological - physiological and pharmacological look of the late postoperative to an understanding of the human experience that underlies and results from the experience itself. crossing other dimensions, the results contribute to the understanding of the phenomenon from the particular view of revascularized patients extolling the importance of multidisciplinary accompaniment, including nursing to continue with their care after medical discharge.

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Objetivo: analisar as mudanças provocadas pela Cirurgia de Revascularização Miocárdica (CRM) e o cuidado de si de indivíduos revascularizados. Método: pesquisa qualitativa realizada com dez indivíduos pós CRM, em um hospital escola do Sul do Brasil. Os dados foram coletados em 2013, por meio de entrevista narrativa e submetidos à análise temática. Projeto aprovado por Comitê de Ética e Pesquisa Resultados: da análise emergiu a categoria, mudanças provocadas pela CRM e o cuidado de si de indivíduos revascularizados com as subcategorias: agora eu me cuido; a mão dupla do cuidado; a imposição do cuidado; a valorização da vida; mudança de atitude nos relacionamentos; e, a família mais próxima. Conclusão: após a cirurgia, os indivíduos passam a repensar suas atitudes consigo e com as outras pessoas, valorizando sua vida, a saúde e a família. Os bens materiais e problemas que permeiam o cotidiano tornam-se menos relevantes, procurando assumir atitudes que lhe tragam prazer e bem-estar.

Objective: to examine changes brought about by myocardial revascularization surgery (coronary artery bypass graft, CABG) and self-care by revascularized individuals. Method: in this qualitative study of ten individuals post-CABG at a teaching hospital in southern Brazil, data were collected by narrative interview and submitted to thematic analysis. Results: analysis revealed the category "changes caused by CABG, and revascularized individuals self-care" with the subcategories "now I take care of myself"; "care as two-way process"; "care as imposition"; "valuing life"; "changed attitude in relationships"; and "closest relatives". Conclusion: after surgery, individuals begin to rethink their attitudes to themselves and other people, valuing their life, health and family. Material possessions and everyday problems become less relevant, and individuals endeavor to act in ways that bring pleasure and well-being.

Objetivo: analizar los cambios producidos por la cirugía de revascularización miocárdica (CRM) y el cuidado de sí de los individuos revascularizados. Método: investigación cualitativa realizada con diez individuos después de CRM, en un hospital universitario en el sur de Brasil. Los datos fueron recolectados por medio de una entrevista narrativa y sometidos al análisis temático. Resultados: del análisis surgió la categoría cambios causados por el CRM y el cuidado de sí de los pacientes revascularizados con subcategorías: ahora me cuido; la doble vía del cuidado; la imposición del cuidado; la valorización de la vida; la actitud en los relacionamientos y la familia más cerca. Conclusión: Después de la cirugía, las personas comienzan a replantearse sus actitudes con usted y otras personas, valorando su vida, la salud y la familia. Materiales y mercancías temas que permean la vida cotidiana se vuelve menos relevante, buscando tomar acciones que dan placer y bienestar.

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A doença arterial coronariana (DAC) é a principal causa de mortalidade e morbidade entre os portadores de diabetes mellitus (DM). O DM aumenta o risco de DAC e é um preditor independente dos piores resultados após qualquer método de revascularização coronária: intervenção coronária percutânea (ICP) ou cirurgia de revascularização miocárdica (CRM). O tratamento da DAC em diabéticos possui características importantes e sua respectiva presença deve ser utilizada na escolha do método de intervenção, especialmente nos pacientes multiarteriais e/ou com lesão de tronco de coronária esquerda. Além da terapia medicamentosa rigorosa ser um dos pilares fundamentais, a decisão sobre a estratégia de revascularização deve ser tomada por uma equipe multiprofissional e multidisciplinar ("Heart Team"), baseando-se em elementos do quadro clínico, da anatomia coronária, carga isquêmica, função ventricular esquerda, risco cirúrgico hospitalar e do próprio paciente.

Coronary artery disease (CAD) is the leading cause of mortality and morbidity among patients with Diabetes Mellitus (DM). DM increases the risk of CAD and is an independent predictor of poorer outcomes after any method of coronary revascularization: percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG). The treatment of CAD in diabetics has important characteristics, and its presence should not be used in the choice of intervention method, especially in multiarterial patients and/or patients with unprotected left main stem disease. In addition to rigorous drug therapy being one of the fundamental pillars, the decision on the type of revascularization strategy should be made by a multiprofessional and multidisciplinary team ("Heart Team"), based on the clinical presentation, coronary anatomy, ischemic burden, left ventricular function, in-hospital surgical risk and individual patient risk.

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Resumen: Introducción: La rehabilitación cardiovascular ha demostrado tener efectos beneficiosos en pacientes con antecedentes de patología coronaria. Objetivos: Identificar los factores que determinan el resultado de un programa de rehabilitación cardiovascular (PRC) aplicado a pacientes coronarios revascularizados. Métodos: 67 pacientes sometidos a cirugía de bypass o angioplastia fueron evaluados en su capacidad funcional mediante el test de marcha de 6 minutos (TM) al inicio y al completar el programa de rehabilitación cardiovascular. La distancia recorrida en el test de marcha fue correlacionada con la edad, capacidad funcional previa al PRC, tiempo en completar el pro-grama, tiempo que media entre la intervención y el inicio del programa, duración del programa y tipo de revascularización. Además, se comparó el incremento de la capacidad funcional entre los pacientes que fueron derivados a 36 sesiones con los referidos a solo 12. Resultados: 67 pacientes cumplieron los criterios para evaluación del PRC. Globalmente, se observó una mejoría de 12% (511,4 a 573,4 m) en la distancia del TM (p<0.001)). El mayor beneficio, en términos de distancia en el TM se obtuvo al efectuar un programa con más sesiones (36 vs 12) con valores de 20% y 8%, respectivamente (p<0.002). El poder terminar el PRC de 36 sesiones más rápidamente (entre 10 y 13 semanas vs entre 14 y 24 semanas se asoció a una mayor incremente en el TM con valores de 19% vs 10%, respectivamente (p<0,003). El incremento en el TM no difirió entre 3 grupos de edad (desde 49 a 85 años); en el tiempo que transcurre entre la intervención y el inicio del PRC (antes vs después de la 8a semana post revascularización), al tipo de revascularización a la que fue sometido el paciente (cirugía o angioplastía) y a la capacidad funcional previa que estos presentan al inicio del PRC. Conclusión: El PRC es efectivo en mejorar significativamente la capacidad funcional de pacientes revascularizados, especialmente cuando el número de sesiones del programa es mayor y cuando se realiza con una frecuencia de al menos 3 veces por semana. El PRC es igualmente efectivo en pacientes enviados a rehabilitación en forma más precoz, como también lo es en sujetos más añosos. Estos efectos fueron independientes del tipo de revascularización.

Abstracts: Introduction : Background: Cardiovascular Rehabilitation Programs (CRP) have been shown to produce be-neficial effects in patients with coronary artery disease. Aim: to identify factors associated to CRP success in patients who underwent myocardial revascularization Methods: 67 patients who underwent coronary artery bypass surgery (CABG) or percutaneous coronary artery angioplasty (PTCA) were evaluated for functional capacity by means of a standard 6 min walking test (6mWT), before and after completion of the CRP. Distance covered during the test was correlated with age, prior functional class, time employed to complete CRP, time from coronary intervention and CRP initiation, CRP duration and type of revascularization. In addition, patients referred for a 36 sessions CRP were compared to those referred to only 12 sessions. Results: 67 patients met inclusion criteria. Overall, there was a 12% increase (511,4 to 573,4 m) in 6mWT distance (p<0.001). The greatest benefit was obtained with the 36 session CRP as compared to a 12 session CRP (20 vs 8% (p<0.002). Also, completion of a 36 session CRP between 10 and 13 weeks compared to 14 to 24 weeks revealed a greater benefit in the former group (19% vs 10%, respectively (p<0.003). There was no difference in 6minWT distance in 3 groups of age (extending from 49 to 85 years-old); In addition, time from intervention to initiation of CRP (before vs after 8 weeks), type of revascularization or functional capacity at the beginning of CRP showed any difference in 6mWT distance. Conclusion: CRP is a highly effective intervention to improve functional capacity in patients following myocardial revascularization, more so when more sessions are employed and when at least 3 sessions per week are implemented. The program is equally effective in patients starting CRP early after revascularization, and benefit is independent from patient age.

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OBJECTIVE: to evaluate the quality of life of patients who underwent revascularization surgery. METHOD: a descriptive, cross sectional study, with quantitative approach carried out with 75 patients. The questionnaire WHOQOL-Bref was used to evaluate the quality of life (QOL). RESULTS: patients' QOL evaluation presented a moderate result, with need of improvement of all domains. Low income patients had the worst evaluation of QOL in the domain environment (p=0,021), and the ones from Recife/metropolitan area, in the domain social relationship (p=0,021). Smoker (p=0,047), diabetic (p=0,002) and alcohol consumption (p=0,035) patients presented the worst evaluation of the physical domain. Renal patients presented the worst evaluation of QOL in the physical (P=0,037), psychological (p=0,008), social relationship (p=0,006) domains and total score (p=0,009). CONCLUSION: the improvement of QOL depends on the individual's process of behavioral change and the participation of health professionals is essential to formulate strategies to approach these patients, especially concerning health education.

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ABSTRACT Objective: to evaluate the quality of life of patients who underwent revascularization surgery. Method: a descriptive, cross sectional study, with quantitative approach carried out with 75 patients. The questionnaire WHOQOL-Bref was used to evaluate the quality of life (QOL). Results: patients' QOL evaluation presented a moderate result, with need of improvement of all domains. Low income patients had the worst evaluation of QOL in the domain environment (p=0,021), and the ones from Recife/metropolitan area, in the domain social relationship (p=0,021). Smoker (p=0,047), diabetic (p=0,002) and alcohol consumption (p=0,035) patients presented the worst evaluation of the physical domain. Renal patients presented the worst evaluation of QOL in the physical (P=0,037), psychological (p=0,008), social relationship (p=0,006) domains and total score (p=0,009). Conclusion: the improvement of QOL depends on the individual's process of behavioral change and the participation of health professionals is essential to formulate strategies to approach these patients, especially concerning health education.

RESUMEN Objetivo: evaluar la calidad de vida de los pacientes sometidos a cirugía de revascularización. Método: estudio descriptivo, transversal, con abordaje cuantitativo llevado a cabo con 75 pacientes. Se empleó el cuestionario WHOQOL-Bref para evaluar la calidad de vida (CV). Resultados: Los pacientes tuvieron CV regular, necesitando mejoras en todos los dominios. Los pacientes de baja renta presentaron peores índices de CV en el dominio medioambiental (p=0,021), así como presentaron los provenientes de la ciudad de Recife y región en el dominio relaciones sociales (p=0,021). Los pacientes fumadores (p=0,047), diabéticos (p=0,002) y de la clase alta (p=0,035) tuvieron peores valores de CV en el dominio físico. Los pacientes con problemas renales presentaron peores índices de CV en los dominios físico (p=0,037), psicológico (p=0,008), relaciones sociales (p=0,006) y en el puntaje total (p=0,009). Conclusión: para mejorar la CV hay que cambiar la conducta individual, y es muy importante la participación de los profesionales de salud en la planificación de estrategias de abordaje a estos pacientes, en especial en la educación en salud.

RESUMO Objetivo: avaliar a qualidade de vida de pacientes submetidos à cirurgia de revascularização. Método: estudo descritivo, transversal, com abordagem quantitativa realizado com 75 pacientes. Foi utilizado o questionário WHOQOL-Bref para avaliação da qualidade de vida (QV). Resultados: Pacientes apresentaram avaliação da QV regular, com necessidade de melhora em todos os domínios. Pacientes de baixa renda tiveram pior avaliação da QV no domínio meio ambiente (p=0,021), e os procedentes de Recife/região metropolitana, no domínio relações sociais (p=0,021). Pacientes tabagistas (p=0,047), diabéticos (p=0,002) e etilistas (p=0,035) apresentaram pior avaliação da QV no domínio físico. Pacientes renais apresentaram pior avaliação da QV nos domínios físico (P=0,037), psicológico (p=0,008), relações sociais (p=0,006) e no escore total (p=0,009). Conclusão: a melhoria da QV depende de um processo de mudança de comportamento individual e a participação dos profissionais de saúde é essencial para elaborar estratégias de abordagem desses pacientes, principalmente no tocante à educação em saúde.

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Introduction: Coronary artery bypass grafting (CABG) does not have an effect on the etiopathogenic factors of atherosclerosis, thus, it is crucial to control risk factors. Objective: To analyze the effect of a cardiac rehabilitation (CR) program on cardiovascular risk factors, the Framingham risk score (FRS) and levels of C-reactive protein (CRP) of patients undergoing CABG. Methods: A descriptive, cross-sectional and retrospective study was conducted with a sample of 49 patients, who were participating in a program (24 weeks). Body mass index (BMI), waist circumference (WC), FRS, risk (%) of developing coronary artery disease in 10 years (CAD risk), serum levels of LDL-c, triglycerides (TG) and CRP were assessed. Results: The variables BMI, WC, LDL-c, TG, CRP levels, FRS and CAD risk showed significant reductions (p<0,001). Conclusion: The program was effective in reducing cardiovascular risk factors, FRS, as well as the decrease in CRP levels.

Introdução: A cirurgia de revascularização do miocárdio (CRM) não atua nos fatores etiopatogênicos da aterosclerose, dessa forma o controle destes fatores torna-se crucial. Objetivo: Analisar o efeito de um programa de reabilitação cardíaca (RC) sobre fatores de risco cardiovasculares, Escore de Framingham (EF) e níveis de proteína C reativa (PCR) de pacientes submetidos à CRM. Métodos: Trata-se de um estudo transversal e retrospectivo com uma amostra 49 pacientes participantes de um programa de RC (24 semanas). Índice de massa corporal (IMC), circunferência da cintura (CC), EF, risco de desenvolvimento de doença arterial coronariana em 10 anos (risco DAC), níveis séricos de LDL-c, triglicerídeos (TG) e PCR foram avaliados. Resultados: As variáveis IMC, CC, LDL-c, TG, PCR, Pontuação no EF e o risco DAC apresentaram reduções significativas (p<0,001). Conclusão: O programa foi eficaz na redução de fatores de risco cardiovascular, no EF, bem como na diminuição dos níveis de PCR.

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