ObjectivesTo analyze patients after cardiac surgery that needed endotracheal reintubation and identify factors associated with death and its relation with the severity scores.MethodsRetrospective analysis of information of 1,640 patients in the postoperative period of cardiac surgery between 2007 and 2015.ResultsThe reintubation rate was 7.26%. Of those who were reintubated, 36 (30.3%) underwent coronary artery bypass surgery, 27 (22.7%) underwent valve replacement, 25 (21.0%) underwent correction of an aneurysm, and 8 (6.7%) underwent a heart transplant. Among those with comorbidities, 54 (51.9%) were hypertensive, 22 (21.2%) were diabetic, and 10 (9.6%) had lung diseases. Among those who had complications, 61 (52.6%) had pneumonia, 50 (42.4%) developed renal failure, and 49 (51.0%) had a moderate form of the transient disturbance of gas exchange. Noninvasive ventilation was performed in 53 (44.5%) patients. The death rate was 40.3%, and mortality was higher in the group that did not receive noninvasive ventilation before reintubation (53.5%). Within the reintubated patients who died, the SOFA and APACHE II values were 7.9 ± 3.0 and 16.9 ± 4.5, respectively. Most of the reintubated patients (47.5%) belonged to the high-risk group, EuroSCORE (> 6 points).ConclusionThe reintubation rate was high, and it was related to worse SOFA, APACHE II and EuroSCORE scores. Mortality was higher in the group that did not receive noninvasive ventilation before reintubation.
RESUMOA osteoartrose é uma doença degenerativa comum, em que a articulação do joelho sofre um desgaste de seus componentes, a tíbia, o fêmur, a patela e os meniscos, provocando, assim, um quadro de dor, deformidade e rigidez articular. A artroplastia total de joelho (ATJ) apresenta-se como um tratamento eficaz para os casos mais avançados de osteoartrose. A técnica consiste na substituição dos componentes danificados da articulação por próteses inorgânicas, constituídas de bases metálicas e polietileno. A fisioterapia no paciente pós-ATJ tem a finalidade de restabelecer a função articular, melhorando a qualidade de vida e devolvendo a independência funcional ao paciente. Palavras-chave: artroplastia do joelho; joelho; reabilitação; fisioterapia. ABSTRACTOsteoarthritis is a degenerative joint disease, where the knee joint undergoes wear of its components; the tibia, the femur, the patella and the menisci, thus causing a painful condition, deformity and joint stiffness. Total knee arthroplasty (TKA) presents itself as an effective treatment for advanced cases of osteoarthritis. The technique involves replacing the damaged components of the joint inorganic prostheses, made of metal and polyethylene bases. Physical therapy in the post TKA patients, aims to restore joint function, improving the quality of life and functional independence returning to the patient. Keywords: arthroplasty, replacement, knee; knee; rehabilitation; physical therapy specialty. INTRODUÇÃOOs ossos que formam a articulação do joelho são: fêmur, tíbia e patela, estruturas ósseas que formam duas articulações distintas, a femoropatelar e a tibiofemoral; todavia, funcionalmente, essas duas articulações não podem ser sempre consideradas separadamente, pois existe uma relação mecânica entre elas, e são articulações que proporcionam sustentação ao corpo e podem, com o tempo, sofrer grande desgaste e degeneração, sendo assim necessário um procedimento cirúrgico em que se faz a troca da articulação degenerada por uma artificial.1 A artroplastia total de joelho (ATJ) é uma técnica que vem sido utilizada desde o final dos anos 1950 e o começo dos anos 1960, a qual visa substituir a articulação do joelho por uma prótese metálica. É dividida, de acordo com os componentes articulares a serem substituídos, em dois tipos: a artroplastia total, em que são substituídos todos os três compartimentos articulares (femorotibial medial, femorotibial lateral e o femoropatelar), e a unicompartimental, em que apenas um dos compartimentos, seja o femorotibial medial, seja o lateral, é substituído. A técnica tem indicação em pacientes com dor intensa e comprometimento das habilidades funcionais, destruição das superfícies articulares do joelho, instabilidade e diminuição de amplitude de movimento e vem ajudando no tratamento da osteoartrose e da artrite reumatoide, melhorando a qualidade de vida, a dor, a incapacidade e a rigidez causadas por essas doenças. 2A fisioterapia tem sido de fundamental importância para a reabilitação do pós-cirúrgico da ATJ, principalmente por...
ObjectiveA retrospective cohort study was preformed aiming to verify the presence of transient dysfunction of gas exchange in the postoperative period of cardiac surgery and determine if this disorder is linked to cardiorespiratory events.MethodsWe included 942 consecutive patients undergoing cardiac surgery and cardiac procedures who were referred to the Intensive Care Unit between June 2007 and November 2011.ResultsFifteen patients had acute respiratory distress syndrome (2%), 199 (27.75%) had mild transient dysfunction of gas exchange, 402 (56.1%) had moderate transient dysfunction of gas exchange, and 39 (5.4%) had severe transient dysfunction of gas exchange. Hypertension and cardiogenic shock were associated with the emergence of moderate transient dysfunction of gas exchange postoperatively (P=0.02 and P=0.019, respectively) and were risk factors for this dysfunction (P=0.0023 and P=0.0017, respectively). Diabetes mellitus was also a risk factor for transient dysfunction of gas exchange (P=0.03). Pneumonia was present in 8.9% of cases and correlated with the presence of moderate transient dysfunction of gas exchange (P=0.001). Severe transient dysfunction of gas exchange was associated with patients who had renal replacement therapy (P=0.0005), hemotherapy (P=0.0001), enteral nutrition (P=0.0012), or cardiac arrhythmia (P=0.0451).ConclusionPreoperative hypertension and cardiogenic shock were associated with the occurrence of postoperative transient dysfunction of gas exchange. The preoperative risk factors included hypertension, cardiogenic shock, and diabetes. Postoperatively, pneumonia, ventilator-associated pneumonia, renal replacement therapy, hemotherapy, and cardiac arrhythmia were associated with the appearance of some degree of transient dysfunction of gas exchange, which was a risk factor for reintubation, pneumonia, ventilator-associated pneumonia, and renal replacement therapy in the postoperative period of cardiac surgery and cardiac procedures.
RESUMOA compreensão da influência do membro superior na marcha de indivíduos hemiparéticos é de extrema importância. Sendo assim, o trabalho objetivou-se no estudo da importância que o membro superior tem na marcha de pacientes após acidente vascular encefálico (AVE). Foi realizada uma revisão bibliográfica na qual buscou-se artigos científicos nas bases de dados, LILACS, BIREME, SciELO e Cochrane. A pesquisa levou em consideração trabalhos publicados no período de 2002 a 2014. De acordo com os artigos encontrados, concluiu-se que a biomecânica da marcha está diretamente relacionada ao membro superior, sendo assim, qualquer disfunção poderá alterar a marcha de pacientes após AVE. Palavras-chave: marcha; extremidade superior; paresia; acidente vascular cerebral. ABSTRACTThe understanding the influence of the upper limb in the gait of hemiparetic subjects is of utmost importance. Thus, the work aimed to study the importance of the upper limb in the gait of post-encephalic vascular accident (EVA) patients. We conducted a brief literature review of scientific articles in the databases LILACS, BIREME, SciELO, and Cochrane. The research took into account articles published between 2002 and 2014. According to the articles studied, it was concluded that the gait biomechanics is directly related to the upper limb, thus, any dysfunction can change the gait of patients after EVA. Keywords: gait; upper extremity; paresis; stroke. INTRODUÇÃOA biomecânica é o estudo do comportamento de sistemas biológicos, sendo relevantes os conceitos e as leis da mecânica, baseadas nas três leis de Isaac Newton, as quais são bases importantes para locomoção, lei do movimento e da gravidade: a primeira é a Lei da Inércia, a segunda é a Lei do Princípio Fundamental da Dinâmica, e a terceira é a Lei é a da Ação e Reação. Torna-se assim possível analisar e descrever qualquer tipo de movimento realizado pelo corpo humano.O andar é uma das principais habilidades do indivíduo e, apesar de sua complexidade, esse se caracteriza por movimentos suaves, regulares e repetitivos, com surpreendente eficiên-cia do ponto de vista neuro-músculo-esquelético.¹ A marcha é composta de movimentos compassados e alternados dos membros, e também do tronco, que desloca o centro de gravidade do corpo. No desenvolvimento infantil, quando a criança começar a ter os reflexos de proteção, esses reflexos passam a ser integrados e ter funcionalidade. Entre 11 e 12 meses ela começa a se segurar em móveis, passando sozinha por todas as posições, já realiza transferência de peso e permanece em pé, e marcha em blocos com a base alargada. A partir dos 12 meses a marcha se torna uma atividade automática, acontecendo devido à ação de muitas articulações e grupos musculares, descarga de peso, reações de equilíbrio e busca pelo centro de gravidade.Quando um indivíduo realiza o movimento de marcha, há todo um conjunto sequencial de movimentos, que se repetem ao longo do tempo (ciclo da marcha). 2Este trabalho teve como objetivo analisar a biomecâ-nica da marcha normal e patológica, o...
Introduction: Malocclusion can be defined as an imbalance between the masticatory system and neuromuscular Temporomandibular joint. It is considered as a result of the sum of genetic, environmental and postural elements therefore of multifactorial origin. Objective: To review the existing literature if malocclusion influence in posture and balance of the subject. Methods: This is a systematic review, which searched up clinical studies, published between 2009 and 2014 in English, Portuguese and Spanish, in the databases SciELO, PubMed, Lilacs and Sience Direct, using the keywords malocclusion/posture and malocclusion/body balance. Studies were included that had to evaluate the posture and/or balance in patients with malocclusion, were excluded systematic reviews and studies that did not correspond to the proposed theme. Results: In addition to the articles found in all databases, the corpus generated by the literature consisted of 828 records; 13 of them responded to the proposed theme. About the selected literature, eight studies showed significant results regarding the relationship between malocclusion and posture, and two as malocclusion and body balance. Conclusion: it was concluded that malocclusion is associated with the posture of the changes, since the balance, only two studies presented this outcome and was in a considered positive for the worsening of static equilibrium, but with no clinical application, and another positive for improves dynamic balance.
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