A temperatura da pele pode ser um indicador para hemorragia grave no pós-operatório?

Abstract

A temperatura da pele pode ser um indicador para hemorragia grave no pós-operatório?Can skin temperature be a clue for predicting excessive postoperative bleeding? Abstract Objective: The purpose of this study was to investigate whether postoperative hypothermia evaluated by skin temperature can be a clue of excessive bleeding requiring re-exploration.Methods: In this retrospective study, the records of 12 patients who needed re-exploration due to bleeding in the postoperative period were reviewed and the time from the first minute in the intensive care unit until the skin temperature reached 36.5ºC was measured. Cardiopulmonary bypass (CPB) durations were noted as were preoperative and postoperative Activated Clotting Times (ACT) and the lowest body temperatures during the operation. A control group was formed of 16 randomly chosen patients who did not need reexploration with CPB times similar to the study group. All parameters were compared between the two groups using the SPSS software version 10.0.Results: The length of time from the first minute in the intensive care unit until skin temperatures reached 36.5ºC were significantly longer in the study group (p=0.0001). Preoperative and postoperative ACT were not significantly different (p=0.312 and p=0.576 respectively). The lowest body temperatures were also not significantly different (p=0.157).Conclusions: Our findings show that skin temperature is an important indicator of excessive bleeding with a need for re-exploration. Hypothermia may be a reason for this or may be a result of the bleeding. Braz J Cardiovasc Surg 2006; 21(4): 429-432 INTRODUCTION Postoperative bleeding is a serious problem for all patients undergoing heart surgery. Bleeding is increased in patients exposed to cardiopulmonary bypasses [1]. There are many causes for bleeding in patients who are exposed to cardiopulmonary bypasses, which include coagulation factor loss, hemodilution, platelet loss and platelet function deficiency, hypothermia, immune response of host to the effects of heparin and protamine and inadequate surgical homeostasis [2]. Because of inadequate re-warming of body temperature, patients who undergo heart surgery associated with hypothermia are often still hypothermic after admission to the intensive care unit [3]. Some patients require re-exploration because of bleeding in the early postoperative period. Frequently the surgical source of bleeding can not be identified [1][2][3][4]. These re-explored patients may only be effectively offered control of bleeding [4]. The purpose of this study is to evaluate residual hypothermia and its duration and whether delayed hypothermia might be associated to excessive bleeding. Descriptors METHOD PatientsThis is a retrospective review of 721 patients undergoing elective heart surgery involving coronary artery bypass, valve surgery and combined procedures. Records of patients treated from March 1995 to March 2005 in our clinic were reviewed with the approval of the Research Ethics Commission of Cumhuriyet University. A total o...