Título:
Evaluación del ayuno en el comportamiento perioperatorio en cirugía cardíaca del Hospital de Clínicas. Período de Abril a Octubre 2019
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Autor:
Abreu Placeres, Fabrizio
López Reich, Octavio
Maglione González, Sebastián
Martino Mesa, Doroteo
Ormaechea Fossati, Lucía
Riverón Antunez, Nara
López Reich, Octavio
Maglione González, Sebastián
Martino Mesa, Doroteo
Ormaechea Fossati, Lucía
Riverón Antunez, Nara
Tutor:
Dayan, Victor
Turconi, Leticia
Turconi, Leticia
Tipo de documento:
Monografía
Editor:
Palabras clave:
Cirugía cardíaca
ERAS
Ayuno prolongado
Maltodextrina
Noradrenalina
Seguimiento perioperatorio
Cardiac Surgery
Maltodextrin
Norepinephrine
Perioperative management
Prolonged fast
ERAS
Ayuno prolongado
Maltodextrina
Noradrenalina
Seguimiento perioperatorio
Cardiac Surgery
Maltodextrin
Norepinephrine
Perioperative management
Prolonged fast
Descriptores:
Año de publicación:
2019
Contenido:
Resumen:
Hasta la actualidad se realiza un protocolo de ayuno prolongado de 12 hs para sólidos y líquidos en pacientes intervenidos en el Hospital de Clínicas Dr Manuel Quintela. Globalmente, existe un protocolo ERAS (Enhanced recovery after surgery) que pretende lograr una rápida recuperación, reducir la morbimortalidad, la necesidad de volumen, la internación hospitalaria y mejorar el bienestar del paciente; en base a ciertas medidas perioperatorias aplicadas sobre el paciente por parte del equipo de salud. En 2005 el protocolo comenzó a aplicarse en el norte de Europa para las cirugías de colon obteniendo buenos resultados. En base a esto, se comienzan a aplicar ciertas recomendaciones de dicho protocolo en los pacientes intervenidos en cirugía cardiaca esperando resultados similares.
Metodología: se incluyeron 62 pacientes, 35 intervenidos entre abril y julio del 2019 contaron con un plan de ayuno convencional, de 12 horas, y 27 pacientes operados entre julio y octubre recibieron el nuevo plan de ayuno, 6 horas de ayuno para sólidos y 2 horas para líquidos junto a carbohidratos complejos. Se compararon 35 variables de la población.
Resultados: Se observó una correlación inversa entre el requerimiento de noradrenalina (NA) intraoperatoria y las horas de ayuno de líquidos (R= -0,46, p= 0,01). No se encontraron diferencias significativas en el requerimiento de intubación ni en los días de internación en Unidad de Cuidado Intensivos (UCI) de acuerdo a los tiempos de ayuno. La sed en pacientes con ayuno convencional fue de 39,1% con una p= 0,036 mientras que en el nuevo protocolo fue de 14,7%. Ante la presencia de maltodextrina la sed se redujo de 31% a 6,3% con una p= 0,045.
Conclusiones: Se comprueba que el nuevo protocolo mejora el bienestar del paciente en el preoperatorio. Igualmente, se considera necesario ampliar las investigaciones en cirugía cardíaca dado que se encontraron resultados discordantes a los esperados.
Background: Up until now, 12-hours fasting protocol for solids and liquids has been applied in patients operated at the “Hospital de Clínicas Dr Manuel Quintela”. Globally, there is an ERAS (Enhanced recovery after surgery) program that aims to achieve an earlier recovery, a reduction in morbidity and mortality, a reduction in the requirement of intravenous fluids, in the length of hospital stay and an improvement in patient experience. It is based on various perioperative care practices applied to patients. This protocol began to be used in 2005 in northern Europe for colonic surgeries, obtaining positive results. Because of these results, ERAS started to be applied in patients undergoing cardiac surgery, expecting to obtain similar results. Methods: 62 patients were included, 35 of which were intervened between April and July 2019 and had a conventional fasting plan (12 hours), and 27 patients operated between July and October who received the new fasting protocol (6 hours of fasting for solids and 2 hours for liquids and complex carbohydrates). 35 different population variables were compared. Results: For intraoperative norepinephrine requirement and the fluids fasting hours, an inverse correlation was observed (R = -0.46, p = 0.01). No significant differences were found in intubation time nor in ICU days between the two fasting plans. Thirst was found in 39.1% of patients with the conventional fasting (p= 0.036), while in the newest protocol this was reduced to 14.7%. Maltodextrin use was linked to a reduction of thirst from 31% to 6.3% (p= 0.045). Conclusions: The new protocol implementation improved patients’ experiences in preoperative period. Further protocol implementation studies are needed in cardiac surgery since results did not concluded as expected.
Background: Up until now, 12-hours fasting protocol for solids and liquids has been applied in patients operated at the “Hospital de Clínicas Dr Manuel Quintela”. Globally, there is an ERAS (Enhanced recovery after surgery) program that aims to achieve an earlier recovery, a reduction in morbidity and mortality, a reduction in the requirement of intravenous fluids, in the length of hospital stay and an improvement in patient experience. It is based on various perioperative care practices applied to patients. This protocol began to be used in 2005 in northern Europe for colonic surgeries, obtaining positive results. Because of these results, ERAS started to be applied in patients undergoing cardiac surgery, expecting to obtain similar results. Methods: 62 patients were included, 35 of which were intervened between April and July 2019 and had a conventional fasting plan (12 hours), and 27 patients operated between July and October who received the new fasting protocol (6 hours of fasting for solids and 2 hours for liquids and complex carbohydrates). 35 different population variables were compared. Results: For intraoperative norepinephrine requirement and the fluids fasting hours, an inverse correlation was observed (R = -0.46, p = 0.01). No significant differences were found in intubation time nor in ICU days between the two fasting plans. Thirst was found in 39.1% of patients with the conventional fasting (p= 0.036), while in the newest protocol this was reduced to 14.7%. Maltodextrin use was linked to a reduction of thirst from 31% to 6.3% (p= 0.045). Conclusions: The new protocol implementation improved patients’ experiences in preoperative period. Further protocol implementation studies are needed in cardiac surgery since results did not concluded as expected.
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Udelar.FM
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Citación:
Abreu Placeres F, López Reich O, Maglione González S y otros. Evaluación del ayuno en el comportamiento perioperatorio en cirugía cardíaca del Hospital de Clínicas. Período de Abril a Octubre 2019 [en línea]. Monografía de Pre Grado. Montevideo: Udelar. FM, 2019. 33 p.
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https://hdl.handle.net/20.500.12008/33623
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Licencia Creative Commons Atribución - No Comercial - Sin Derivadas (CC - By-NC-ND 4.0)
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URUGUAY
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| Ficheros | Descripción | Tamaño | Formato | ||
|---|---|---|---|---|---|
| MCII_2019_G40.pdf | Evaluación del ayuno en el comportamiento perioperatorio en cirugía cardíaca del Hospital de Clínicas. Período de Abril a Octubre 2019 | 1.04 MB | Adobe PDF |