VERA REGINA DE MORAIS COIMBRA

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Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina

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  • article 1 Citação(ões) na Scopus
    Physiological abnormalities and adverse events during physical therapy in the intensive care unit after cardiac surgery: A prospective observational study
    (2021) SOUSA, Mayson Laercio de Araujo; COIMBRA, Vera Regina de Moraes; TAKEI, Mauro Tadashi; MELO, Cyalme Cristina de Almeida; FELTRIM, Maria Ignez Zaneti; NOZAWA, Emilia
    Background: After cardiac surgery, physiological abnormalities or adverse events might occur in patients in the intensive care unit (ICU) during physical therapy care. Identifying these events may help improve patient safety and care. Objectives: To estimate the incidence and the degree of severity of physiological abnormalities or adverse events during physical therapy interventions provided in the ICU after cardiac surgery. To explore the relationship between these events and patients' characteristics and clinical outcomes. Methods: Prospective observational study of adult patients in the postoperative period of cardiac surgery admitted to the ICU of a referenced university hospital. Physical therapy interventions were observed by a team trained to evaluate and register the occurrence of physiological abnormalities or adverse events and grading their consequences. We compared baseline characteristics and outcomes of patients with versus without these events. Results: We observed 935 physical therapy interventions in 323 patients, of which 189 (20%, 95% confidence interval: 18, 23%) resulted in physiological abnormalities or adverse events. The highest incidences of these events were observed during endotracheal suctioning (44%), walking (40%), and noninvasive ventilation (37%). Hemodynamic changes were the most frequent events accounting for 74% of all events. Only 2% of interventions resulted in mild harm and 0.2% in moderate harm. The presence of comorbidities was associated (p = 0.03) with the occurrence of these events. Conclusion: Physiological abnormalities or adverse events occurred in 20% of physical therapy interventions in patients in the ICU after cardiac surgery, with 10% of those resulting in negative effects. Only the presence of comorbidities was associated with the occurrence of these events.
  • conferenceObject
    Safety of Respiratory Physiotherapy in Mechanically Ventilated Patients After Cardiac Surgery
    (2018) SOUSA, M. L.; MELO, C. C.; TAKEI, M. T.; COIMBRA, V. R.; GALAS, F. R.; HAJJAR, L. A.; FELTRIM, M. I.; NOZAWA, E.
  • conferenceObject
    LATE-BREAKING ABSTRACT: Early mobilization optimizing fluid of mediastinal and thoracic tube in the postoperative patients after coronary artery bypass surgery
    (2015) NOZAWA, Emilia; COIMBRA, Vera Regina Moraes; CRUZ, Fernanda Carolina Silva G.; SILVA, Sara Herculano Souza; FRANCA, Paula Fernanda B. D.; GALAS, Filomena Regina Gomes; HAJJAR, Ludmilla Abhao; FELTRIM, Maria Ignez Zanetti
  • article 22 Citação(ões) na Scopus
    High levels of B-type natriuretic peptide predict weaning failure from mechanical ventilation in adult patients after cardiac surgery
    (2013) LARA, Thiago Martins; HAJJAR, Ludhmila Abrahao; ALMEIDA, Juliano Pinheiro de; FUKUSHIMA, Julia Tizue; BARBAS, Carmem Silvia Valente; RODRIGUES, Adriano Rogerio Baldacin; NOZAWA, Emilia; FELTRIM, Maria Ignes Zanetti; ALMEIDA, Elisangela; COIMBRA, Vera; OSAWA, Eduardo; IANOTTI, Rafael de Moraes; LEME, Alcino Costa; JATENE, Fabio Biscegli; AULER- JR., Jose Otavio Costa; GALAS, Filomena Regina Barbosa Gomes
    OBJECTIVE: The failure to wean from mechanical ventilation is related to worse outcomes after cardiac surgery. The aim of this study was to evaluate whether the serum level of B-type natriuretic peptide is a predictor of weaning failure from mechanical ventilation after cardiac surgery. METHODS: We conducted a prospective, observational cohort study of 101 patients who underwent on-pump coronary artery bypass grafting. B-type natriuretic peptide was measured postoperatively after intensive care unit admission and at the end of a 60-min spontaneous breathing test. The demographic data, hemodynamic and respiratory parameters, fluid balance, need for vasopressor or inotropic support, and length of the intensive care unit and hospital stays were recorded. Weaning failure was considered as either the inability to sustain spontaneous breathing after 60 min or the need for reintubation within 48 h. RESULTS: Of the 101 patients studied, 12 patients failed the weaning trial. There were no differences between the groups in the baseline or intraoperative characteristics, including left ventricular function, EuroSCORE and lengths of the cardiac procedure and cardiopulmonary bypass. The B-type natriuretic peptide levels were significantly higher at intensive care unit admission and at the end of the breathing test in the patients with weaning failure compared with the patients who were successfully weaned. In a multivariate model, a high B-type natriuretic peptide level at the end of a spontaneous breathing trial was the only independent predictor of weaning failure from mechanical ventilation. CONCLUSIONS: A high B-type natriuretic peptide level is a predictive factor for the failure to wean from mechanical ventilation after cardiac surgery. These findings suggest that optimizing ventricular function should be a goal during the perioperative period.