BackgroundThe early postoperative period is critical for surgical patients. SOFA, SAPS 3 and APACHE II are prognostic scores widely used to predict mortality in ICU patients. This study aimed to evaluate these index tests for their prognostic accuracy for intra-ICU and in-hospital mortalities as target conditions in patients admitted to ICU after urgent or elective surgeries and to test whether they aid in decision-making. The process comprised the assessment of discrimination through analysis of the areas under the receiver operating characteristic curves and calibration of the prognostic models for the target conditions. After, the clinical relevance of applying them was evaluated through the measurement of the net benefit of their use in the clinical decision.ResultsIndex tests were found to discriminate regular for both target conditions with a poor calibration (C statistics—intra-ICU mortality AUROCs: APACHE II 0.808, SAPS 3 0.821 and SOFA 0.797/in-hospital mortality AUROCs: APACHE II 0.772, SAPS 3 0.790 and SOFA 0.742). Calibration assessment revealed a weak correlation between the observed and expected number of cases in several thresholds of risk, calculated by each model, for both tested outcomes. The net benefit analysis showed that all score’s aggregate value in the clinical decision when the calculated probabilities of death ranged between 10 and 40%.ConclusionsIn this study, we observed that the tested ICU prognostic scores are fair tools for intra-ICU and in-hospital mortality prediction in a cohort of postoperative surgical patients. Also, they may have some potential to be used as ancillary data to support decision-making by physicians and families regarding the level of therapeutic investment and palliative care.Electronic supplementary materialThe online version of this article (10.1186/s13613-019-0488-9) contains supplementary material, which is available to authorized users.

We conclude that ARM is a safe and effective technique when used for prevention of pulmonary complications in patients undergoing bariatric surgery, resulting in more favorable radiological and spirometric findings in the experimental group compared to the control group in the PO.

BackgroundProlonged use of mechanical ventilation (MV) leads to weakening of the respiratory muscles, especially in patients subjected to sedation, but this effect seems to be preventable or more quickly reversible using respiratory muscle training. The aims of the study were to assess variations in respiratory and hemodinamic parameters with electronic inspiratory muscle training (EIMT) in tracheostomized patients requiring MV and to compare these variations with those in a group of patients subjected to an intermittent nebulization program (INP).MethodsThis was a pilot, prospective, randomized study of tracheostomized patients requiring MV in one intensive care unit (ICU). Twenty-one patients were randomized: 11 into the INP group and 10 into the EIMT group. Two patients were excluded in experimental group because of hemodynamic instability.ResultsIn the EIMT group, maximal inspiratory pressure (MIP) after training was significantly higher than that before (P = 0.017), there were no hemodynamic changes, and the total weaning time was shorter than in the INP group (P = 0.0192).ConclusionThe EIMT device is safe, promotes an increase in MIP, and leads to a shorter ventilator weaning time than that seen in patients treated using INP.

A dor interfere na função respiratória após cirurgias cardíacas?Does the pain disturb the respiratory function after heart surgeries? Abstract Objective: The postoperative pain after heart surgeries had been often reported. Meager reports about respiratory function and pain correlation had been reported. The aim of this study is to assess the pain intensity and location during hospital stay and its effect on respiratory function in patients undergone elective heart surgery.Methods: Respiratory function (lung volumes, respiratory muscle strength and peak expiratory flow) was assessed at the preoperative and postoperative times (1, 3 and 5 days) by ventilometer, manovacuometer and peak flow meter measurements. The assessment of pain intensity was performed with a visual analogue scale for pain.Results: The majority of pain site was on sternotomy incision (50% of patients) and the intensity was higher at the first postoperative day (8.32 by visual scale measurement). All respiratory variables remained lower than to preoperative period at fifth postoperative time (P > 0.05), with exception for respiratory rate. The pain and maximal inspiratory pressure showed a negative correlation at the first postoperative day (P = 0.019).Conclusion: Postoperative pain decreased respiratory function in patients precluding deep inspirations, in special, at the first postoperative day. Descriptors: Pain. Cardiovascular surgical procedures. Respiratory function tests. ResumoObjetivo: A dor no pós-operatório de cirurgia cardíaca é frequente. Poucos relatos existem sobre a sua relação com a função respiratória e o local mais frequentemente relatado. O objetivo é avaliar a intensidade e a localização da dor durante o período de internação e suas repercussões na função respiratória de pacientes submetidos à cirurgia cardíaca eletiva. PhD in Surgery at

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Summary: Remístico PPJ, Araújo S, Figueiredo LC, Aquim EE, Gomes LM, Sombrio ML, Ambiel SDF -Impact of Alveolar Recruitment Maneuver in the Postoperative Period of Videolaparoscopic Bariatric Surgery. Background and objectives:Pulmonary complications in bariatric surgery are common and, therefore, alveolar recruitment maneuvers (ARM) have been used to prevent or reduce them in the postoperative period (POP). The aim of this study was to evaluate the impact of ARM performed intraoperatively in patients undergoing bariatric surgery by videolaparoscopy in the incidence of postoperative pulmonary complications.

The time of mechanical ventilation, orotracheal reintubation, and the mortality given by APACHE II were the variables that best predicted death in this study.