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Silva ACSSD, Stipp MAC, Paes GO, Knupp VMDAO, Góes FGB, Sá Neto JAD. Tools for managing childcare in the postoperative period of cardiac surgery: an integrative review. Rev Bras Enferm 2021; 74:e20200073. [PMID: 33909809 DOI: 10.1590/0034-7167-2020-0073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 12/21/2020] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To analyze the scientific literature on the application of management tools in the postoperative period of pediatric cardiac surgery. METHODS integrative review including studies published between 2004 and 2018 in the following databases: LILACS, BDENF, coleciona SUS, MEDLINE/PUBMED, CINAHL and SCOPUS, via Portal de Periódicos da Capes, Scientific Electronic Library Online (SciELO) and Academic Google research. RESULTS Twelve articles that met the inclusion criteria were analyzed. The studies demonstrated that strategies such as extracorporeal membrane oxygenation, renal replacement therapy and the risk scores for Risk Adjustment for Congenital Heart Surgery 1 and Aristotle Basic Score favored the stratification the demand for care and predicted the risk for mortality. FINAL CONSIDERATIONS The applicability of risk scores and emerging strategies for the management of childcare in the postoperative period of cardiac surgery was described by the evaluation of possibilities of performance and/or efficiency of the treatments developed.
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Rezende RQ, Ricachinevsky CP, Botta A, Angeli VR, Nogueira AJDS. Assessment of PIM-2 performance among surgical patients with heart disease and correlation of results with RACHS-1. Rev Bras Ter Intensiva 2018; 29:453-459. [PMID: 29340536 PMCID: PMC5764557 DOI: 10.5935/0103-507x.20170069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Accepted: 06/22/2017] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE To assess the performance of the Pediatric Index of Mortality (PIM) 2 and the Risk Adjustment for Congenital Heart Surgery (RACHS) in the postoperative period of congenital heart disease patients. METHODS Retrospective cross-sectional study. Data were collected from patient records to generate the scores and predictions using recommended techniques, demographic data and outcomes. The Mann-Whitney test, Hosmer-Lemeshow test, standardized mortality rate, area under the receiver operating characteristic (ROC) curve, chi square test, Poisson regression with robust variance and Spearman's test were used for statistical analysis. RESULTS A total of 263 patients were evaluated, and 72 died (27.4%). These patients presented significantly higher PIM-2 values than survivors (p < 0.001). In the RACHS-1 classification, mortality was progressively higher according to the complexity of the procedure, with a 3.24-fold increase in the comparison between groups 6 and 2. The area under the ROC curve for PIM-2 was 0.81 (95%CI 0.75 - 0.87), while for RACHS-1, it was 0.70 (95%CI 0.63 - 0.77). The RACHS presented better calibration power in the sample analyzed. A significantly positive correlation was found between the results of both scores (rs = 0.532; p < 0.001). CONCLUSION RACHS presented good calibration power, and RACHS-1 and PIM-2 demonstrated good performance with regard to their discriminating capacities between survivors and non-survivors. Moreover, a positive correlation was found between the results of the two risk scores.
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Affiliation(s)
- Raíssa Queiroz Rezende
- Hospital da Criança Santo Antônio, Irmandade Santa Casa de Misericórdia de Porto Alegre - Porto Alegre (RS), Brasil
| | - Cláudia Pires Ricachinevsky
- Hospital da Criança Santo Antônio, Irmandade Santa Casa de Misericórdia de Porto Alegre - Porto Alegre (RS), Brasil
| | - Aline Botta
- Hospital da Criança Santo Antônio, Irmandade Santa Casa de Misericórdia de Porto Alegre - Porto Alegre (RS), Brasil
| | - Viviane Rampon Angeli
- Hospital da Criança Santo Antônio, Irmandade Santa Casa de Misericórdia de Porto Alegre - Porto Alegre (RS), Brasil
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Nutritional Status Based on Body Mass Index Is Associated With Morbidity and Mortality in Mechanically Ventilated Critically Ill Children in the PICU. Crit Care Med 2017; 44:1530-7. [PMID: 26985636 DOI: 10.1097/ccm.0000000000001713] [Citation(s) in RCA: 95] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To determine the influence of admission anthropometry on clinical outcomes in mechanically ventilated children in the PICU. DESIGN Data from two multicenter cohort studies were compiled to examine the unique contribution of nutritional status, defined by body mass index z score, to 60-day mortality, hospital-acquired infections, length of hospital stay, and ventilator-free days, using multivariate analysis. SETTING Ninety PICUs from 16 countries with eight or more beds. PATIENTS Children aged 1 month to 18 years, admitted to each participating PICU and requiring mechanical ventilation for more than 48 hours. MEASUREMENTS AND MAIN RESULTS Data from 1,622 eligible patients, 54.8% men and mean (SD) age 4.5 years (5.1), were analyzed. Subjects were classified as underweight (17.9%), normal weight (54.2%), overweight (14.5%), and obese (13.4%) based on body mass index z score at admission. After adjusting for severity of illness and site, the odds of 60-day mortality were higher in underweight (odds ratio, 1.53; p < 0.001) children. The odds of hospital-acquired infections were higher in underweight (odds ratio, 1.88; p = 0.008) and obese (odds ratio, 1.64; p < 0.001) children. Hazard ratios for hospital discharge were lower among underweight (hazard ratio, 0.71; p < 0.001) and obese (hazard ratio, 0.82; p = 0.04) children. Underweight was associated with 1.3 (p = 0.001) and 1.6 (p < 0.001) fewer ventilator-free days than normal weight and overweight, respectively. CONCLUSIONS Malnutrition is prevalent in mechanically ventilated children on admission to PICUs worldwide. Classification as underweight or obese was associated with higher risk of hospital-acquired infections and lower likelihood of hospital discharge. Underweight children had a higher risk of mortality and fewer ventilator-free days.
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Cavalcante CTDMB, de Souza NMG, Pinto Júnior VC, Branco KMPC, Pompeu RG, Teles ACDO, Cavalcante RC, de Andrade GV. Analysis of Surgical Mortality for Congenital Heart Defects Using RACHS-1 Risk Score in a Brazilian Single Center. Braz J Cardiovasc Surg 2016; 31:219-225. [PMID: 27737404 PMCID: PMC5062711 DOI: 10.5935/1678-9741.20160022] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Accepted: 02/11/2016] [Indexed: 11/29/2022] Open
Abstract
Introduction Risk Adjustment for Congenital Heart Surgery 1 (RACHS-1) score is a simple model that can be easily applied and has been widely used for mortality comparison among pediatric cardiovascular services. It is based on the categorization of several surgical palliative or corrective procedures, which have similar mortality in the treatment of congenital heart disease. Objective To analyze the in-hospital mortality in pediatric patients (<18 years) submitted to cardiac surgery for congenital heart disease based on RACHS-1 score, during a 12-year period. Methods A retrospective date analysis was performed from January 2003 to December 2014. The survey was divided in two periods of six years long each, to check for any improvement in the results. We evaluated the numbers of procedures performed, complexity of surgery and hospital mortality. Results Three thousand and two hundred and one surgeries were performed. Of these, 3071 were able to be classified according to the score RACHS-1. Among the patients, 51.7% were male and 47.5% were younger than one year of age. The most common RACHS-1 category was 3 (35.5%). The mortality was 1.8%, 5.5%, 14.9%, 32.5% and 68.6% for category 1, 2, 3, 4 and 6, respectively. There was a significant increase in the number of surgeries (48%) and a significant reduction in the mortality in the last period analysed (13.3% in period I and 10.4% in period II; P=0.014). Conclusion RACHS-1 score was a useful score for mortality risk in our service, although we are aware that other factors have an impact on the total mortality.
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Mattos SDS, Hazin SMV, Regis CT, Soares de Araújo JS, Albuquerque FCDL, Moser LRDN, Hatem TDP, Gomes de Freitas CP, Mourato FA, Tavares TR, Gomes RGS, Severi R, Santos CR, Ferreira da Silva J, Rezende JL, Vieira PC, de Lima Filho JL. A telemedicine network for remote paediatric cardiology services in north-east Brazil. Bull World Health Organ 2015; 93:881-7. [PMID: 26668441 PMCID: PMC4669725 DOI: 10.2471/blt.14.148874] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Revised: 06/16/2015] [Accepted: 06/19/2015] [Indexed: 12/21/2022] Open
Abstract
Problem Providing health care for children with congenital heart diseases remains a major challenge in low- and middle-income countries. Approach In October 2011, the Government of Paraíba, Brazil, established a paediatric cardiology network in partnership with the nongovernmental organization Círculo do Coração. A cardiology team supervised all network activities, using the Internet to keep in contact with remote health facilities. The network developed protocols for screening heart defects. Echocardiograms were performed by physicians under direct online supervision of a cardiologist; alternatively, a video recording of the examination was subsequently reviewed by a cardiologist. Cardiovascular surgeons came to a paediatric hospital in the state capital once a week to perform heart surgeries. Local setting Until 2011, the State of Paraíba had no structured programme to care for children with heart disease. This often resulted in missed or late diagnosis, with adverse health consequences for the children. Relevant changes From 2012 to 2014, 73 751 babies were screened for heart defects and 857 abnormalities were identified. Detection of congenital heart diseases increased from 4.09 to 11.62 per 1000 live births (P < 0.001). Over 6000 consultations and echocardiograms were supervised via the Internet. Time to diagnosis, transfers and hospital stays were greatly reduced. A total of 330 operations were carried out with 6.7% (22/330) mortality. Lessons learnt Access to an echocardiography machine with remote supervision by a cardiologist improves the detection of congenital heart disease by neonatologists; virtual outpatient clinics facilitate clinical management; the use of Internet technology with simple screening techniques allows resources to be allocated more efficiently.
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Affiliation(s)
- Sandra da Silva Mattos
- Círculo do Coração de Pernambuco, Av. Portugal, 163 Paissandu, Recife PE, CEP 52010-010, Brazil
| | | | - Cláudio Teixeira Regis
- Círculo do Coração de Pernambuco, Av. Portugal, 163 Paissandu, Recife PE, CEP 52010-010, Brazil
| | | | | | | | - Thamine de Paula Hatem
- Círculo do Coração de Pernambuco, Av. Portugal, 163 Paissandu, Recife PE, CEP 52010-010, Brazil
| | | | - Felipe Alves Mourato
- Círculo do Coração de Pernambuco, Av. Portugal, 163 Paissandu, Recife PE, CEP 52010-010, Brazil
| | - Thiago Ribeiro Tavares
- Círculo do Coração de Pernambuco, Av. Portugal, 163 Paissandu, Recife PE, CEP 52010-010, Brazil
| | | | - Rossana Severi
- Círculo do Coração de Pernambuco, Av. Portugal, 163 Paissandu, Recife PE, CEP 52010-010, Brazil
| | - Cícera Rocha Santos
- Círculo do Coração de Pernambuco, Av. Portugal, 163 Paissandu, Recife PE, CEP 52010-010, Brazil
| | | | - Juliana Landim Rezende
- Círculo do Coração de Pernambuco, Av. Portugal, 163 Paissandu, Recife PE, CEP 52010-010, Brazil
| | - Paulo Coelho Vieira
- Círculo do Coração de Pernambuco, Av. Portugal, 163 Paissandu, Recife PE, CEP 52010-010, Brazil
| | - José Luiz de Lima Filho
- Laboratório de Imunopatologia Keiso Asami, Universidade Federal de Pernambuco, Recife, Brazil
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Cavalcanti PEF, Sá MPBDO, dos Santos CA, Esmeraldo IM, Chaves ML, Lins RFDA, Lima RDC. Stratification of complexity in congenital heart surgery: comparative study of the Risk Adjustment for Congenital Heart Surgery (RACHS-1) method, Aristotle basic score and Society of Thoracic Surgeons-European Association for Cardio- Thoracic Surgery (STS-EACTS) mortality score. Braz J Cardiovasc Surg 2015; 30:148-58. [PMID: 26107445 PMCID: PMC4462959 DOI: 10.5935/1678-9741.20150001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Accepted: 01/13/2015] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE To determine whether stratification of complexity models in congenital heart surgery (RACHS-1, Aristotle basic score and STS-EACTS mortality score) fit to our center and determine the best method of discriminating hospital mortality. METHODS Surgical procedures in congenital heart diseases in patients under 18 years of age were allocated to the categories proposed by the stratification of complexity methods currently available. The outcome hospital mortality was calculated for each category from the three models. Statistical analysis was performed to verify whether the categories presented different mortalities. The discriminatory ability of the models was determined by calculating the area under the ROC curve and a comparison between the curves of the three models was performed. RESULTS 360 patients were allocated according to the three methods. There was a statistically significant difference between the mortality categories: RACHS-1 (1) - 1.3%, (2) - 11.4%, (3)-27.3%, (4) - 50 %, (P<0.001); Aristotle basic score (1) - 1.1%, (2) - 12.2%, (3) - 34%, (4) - 64.7%, (P<0.001); and STS-EACTS mortality score (1) - 5.5 %, (2) - 13.6%, (3) - 18.7%, (4) - 35.8%, (P<0.001). The three models had similar accuracy by calculating the area under the ROC curve: RACHS-1- 0.738; STS-EACTS-0.739; Aristotle- 0.766. CONCLUSION The three models of stratification of complexity currently available in the literature are useful with different mortalities between the proposed categories with similar discriminatory capacity for hospital mortality.
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Affiliation(s)
- Paulo Ernando Ferraz Cavalcanti
- Division of Cardiovascular Surgery of Pronto Socorro
Cardiológico de Pernambuco (PROCAPE) and Universidade de Pernambuco (UPE),
Recife, PE, Brazil
| | - Michel Pompeu Barros de Oliveira Sá
- Division of Cardiovascular Surgery of Pronto Socorro
Cardiológico de Pernambuco (PROCAPE) and Universidade de Pernambuco (UPE),
Recife, PE, Brazil
| | - Cecília Andrade dos Santos
- Division of Cardiovascular Surgery of Pronto Socorro
Cardiológico de Pernambuco (PROCAPE) and Universidade de Pernambuco (UPE),
Recife, PE, Brazil
| | - Isaac Melo Esmeraldo
- Division of Cardiovascular Surgery of Pronto Socorro
Cardiológico de Pernambuco (PROCAPE) and Universidade de Pernambuco (UPE),
Recife, PE, Brazil
| | - Mariana Leal Chaves
- Division of Cardiovascular Surgery of Pronto Socorro
Cardiológico de Pernambuco (PROCAPE) and Universidade de Pernambuco (UPE),
Recife, PE, Brazil
| | - Ricardo Felipe de Albuquerque Lins
- Division of Cardiovascular Surgery of Pronto Socorro
Cardiológico de Pernambuco (PROCAPE) and Universidade de Pernambuco (UPE),
Recife, PE, Brazil
| | - Ricardo de Carvalho Lima
- Division of Cardiovascular Surgery of Pronto Socorro
Cardiológico de Pernambuco (PROCAPE), Universidade de Pernambuco (UPE),
Recife, PE, Brazil and Escola Paulista de Medicina da Universidade Federal de
São Paulo (EPM/Unifesp), São Paulo, SP, Brazil
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The Importance of Extreme Weight Percentile in Postoperative Morbidity in Children. J Am Coll Surg 2014; 218:988-96. [DOI: 10.1016/j.jamcollsurg.2013.12.051] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2013] [Revised: 12/30/2013] [Accepted: 12/30/2013] [Indexed: 11/18/2022]
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Durandy YD, Younes M, Mahut B. Pediatric warm open heart surgery and prolonged cross-clamp time. Ann Thorac Surg 2009; 86:1941-7. [PMID: 19022013 DOI: 10.1016/j.athoracsur.2008.08.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2008] [Revised: 08/01/2008] [Accepted: 08/04/2008] [Indexed: 12/13/2022]
Abstract
BACKGROUND The safety of normothermic pediatric cardiac surgery remains controversial. This study evaluated the performance of normothermic cardiopulmonary bypass (CPB) associated with intermittent warm blood cardioplegia during prolonged aortic cross-clamp time (CCT). METHODS This retrospective study included 234 consecutive patients weighing less than 10 kg operated under CPB from August 2006 to November 2007. Patients were divided into two groups: group 1 contained 38 patients with CCT exceeding 90 minutes, and group 2 had 196 patients with shorter CCT. Classic factors were used to analyze outcomes, and outcomes were compared with those from the Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery database. RESULTS Results, expressed as values for group 1 vs those for group 2, were mortality rate, 5.3% vs 2%; length of hospital stay exceeding 21 days, 5% vs 0.5%; delayed chest closure, 21% vs 2.6%; epinephrine infusion, 45% vs 11%; organ failure, 13% vs 2%; reoperation due to bleeding, 3% vs 0.5%; heart block, 3% vs 1%; time to extubation, in hours, 64 +/- 94 vs 19 +/- 48; plasma lactate concentrations after bypass, 2.6 vs 1.9 mmol/L; length of stay in intensive care, in hours, 100 +/- 105 vs 52 +/- 48. CONCLUSIONS Despite expected differences between the two groups, our results were within the range of values described in the literature. This led us to conclude that warm pediatric cardiac surgery with a long CCT is safe. A large, multicenter, randomized prospective study comparing normothermic and hypothermic pediatric cardiac surgery is underway.
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Affiliation(s)
- Yves D Durandy
- Department of Perfusion and Intensive Care, Institut Hospitalier Jacques Cartier, Massy, France
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