Navegando por Palavras-chave "Ponte De Artéria Coronária"

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    Efetividade da manta de ar forçado aquecido na redução de complicações da hipotermia após cirurgia de revascularização do miocárdio: ensaio clínico randomizado
    (Universidade Federal de São Paulo (UNIFESP), 2019-12-18) Bezerra, Amanda Silva De Macedo [UNIFESP]; Barros, Alba Lucia Bottura Leite De [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Introduction: Despite intraoperative re-warming of patients undergoing induced hypothermia during on-pump coronary artery bypass grafting (CABG), patients remain hypothermic in the intensive care unit. Postoperative hypothermia in these patients is associated with excessive bleeding, need for blood components transfusion, respiratory failure, unplanned subsequent surgeries, increased length of hospitalization, of mechanical ventilation, and mortality. Objectives: To determine the effectiveness of postoperative use of forced air warming blanket on the reduction of excessive bleeding, arrhythmias, acute myocardial infarction (AMI) and blood product transfusion in hypothermic patients following on-pump CABG and to compare the pattern of the tympanic temperature associated with heated forced air or woolen blanket. Methods: A randomized clinical trial conducted in a public Cardiovascular hospital from January to November 2018. Two hundred patients undergoing isolated on-pump CABG were randomized to the Intervention Group (IG, submitted to postoperative warming with forced air blanket, n=100) and the Control Group (CG, submitted to postoperative warming with a sheet and a blanket, n=100). The tympanic temperature was measured over 24 hours in all participants. The primary outcome was excessive bleeding and the secondary outcomes were cardiac arrhythmias, acute myocardial infarction (AMI), blood component transfusion and the temperature patterns along time. The relationship between the intervention and the outcomes was assessed by means of bivariate logistic regression, with p<0.05 considered significant. Results: Starting two hours postoperatively, the IG had mean temperatures significantly higher than CG, maintaining this trend up to 15 hours. The IG had a 79% lower chance of bleeding compared to the GC (OR=0.21, 95% CI 0.12-0.39, p<0.001). The chance of AMI in was 94% lower in the IG compared to the CG (OR=0.06, 95% CI 0.01-0.48, p<0.001). The IG had a 77% lower chance of arrhythmias compared to the CG (OR=0.23, 95% CI=0.12-0.47, p<0.001). There was no difference between groups regarding blood product transfusion (p<0.279). Conclusions: Postoperative forced air warming decreased the incidence of excessive bleeding, AMI and arrhythmias, but did not alter the incidence of transfusion of blood components. These results indicate that forced air warming can be used after CABG until patients reach normothermia to avoid undesirable clinical outcomes.