Resultados clínicos e metabólicos da abreviação do jejum com carboidratos na revascularização cirúrgica do miocárdio

Feguri, Gibran Roder; Lima, Paulo Ruiz Lúcio de; Lopes, Andréa Mazoni; Roledo, Andréa; Marchese, M Verdugo; Trevisan, Mônica de Souza; Ahmad, Haitham; Freitas, Bruno Baranhuk de; Aguilar-Nascimento, José Eduardo de

doi:10.5935/1678-9741.20120004

Cited by 30 publications

(33 citation statements)

References 36 publications

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“…These results are in agreement with two previous studies that document speedy recovery and less need of vasoactive drugs, if oral CHO loading is done prior to cardiac surgery [7, 8]. Curtailing of preoperative fasting, with CHO loading, is no longer a novelty approach [9].…”

Section: Discussionsupporting

confidence: 91%

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Preoperative carbohydrate load and intraoperatively infused omega-3 polyunsaturated fatty acids positively impact nosocomial morbidity after coronary artery bypass grafting: a double-blind controlled randomized trial

Feguri

Lima

Borges

et al. 2017

Nutr J

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BackgroundA strategy of limited preoperative fasting, with carbohydrate (CHO) loading and intraoperative infusion of omega-3 polyunsaturated fatty acids (ω-3 PUFA), has seldom been tried in cardiovascular surgery. Brief fasting, followed by CHO intake 2 h before anesthesia, may improve recovery from CABG procedures and lower perioperative vasoactive drug requirements. Infusion of ω-3 PUFA may reduce occurrences of postoperative atrial fibrillation (POAF) and shorten hospital stays. The aim of this study was to assess morbidity (especially POAF) in ICU patients after coronary artery bypass grafting (CABG)/cardiopulmonary bypass (CPB) in combination, if preoperative fasts are curtailed in favor of CHO loading, and ω-3 PUFA are infused intraoperatively.MethodsFifty-seven patients undergoing CABG were randomly assigned to receive 12.5% maltodextrin (200 ml, 2 h before anesthesia), without infusing ω-3 PUFA (CHO, n = 14); water (200 ml, 2 h before anesthesia), without infusing ω-3 PUFA (controls, n = 14); 12.5% maltodextrin (200 ml, 2 h before anesthesia) plus intraoperative ω-3 PUFA (0.2 mcg/kg) (CHO + W3, n = 15); or water (200 ml, 2 h before anesthesia) plus intraoperative ω-3 PUFA (0.2 mcg/kg) (W3, n = 14). Perioperative clinical variables and mortality were analyzed, examining the incidence of POAF, as well as the need for inotropic vasoactive drugs during surgery and in ICU.ResultsTwo deaths occurred (3.5%), but there were no instances of bronchoaspiration and mediastinitis. Neither ICU stays nor total postoperative stays differed by group (P > 0.05). Patients given preoperative CHO loads (CHO and CHO + W3 groups) experienced fewer instances of hospital infection (RR = 0.29, 95%CI 0.09–0.94; P = 0.023) and were less reliant on vasoactive amines during surgery (RR = 0.60, 95% CI 0.38–0.94; P = 0.020). Similarly, the number of patients requiring vasoactive drugs while recovering in ICU differed significantly by group (P = 0.008), showing benefits in patients given CHO loads. The overall incidence of POAF was 29.8% (17/57), differing significantly by group (P = 0.009). Groups given ω-3 PUFA (W3 and CHO + W3 groups) experienced significantly fewer instances of POAF (RR = 4.83, 95% CI 1.56–15.02; P = 0.001).ConclusionPreoperative curtailment of fasting was safe in this cohort. When implemented in conjunction with CHO loading and infusion of ω-3 PUFA during surgery, expedited recovery from CABG with CPB was observed.Trial registrationNCT: 03017001

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Section: Discussionsupporting

confidence: 91%

“…In cardiac surgery specifically, some randomized trials have shown that CHO loading 2 h before inducing anesthesia will reduce ICU and hospital stays while reducing the need for perioperative vasoactive drug delivery [7, 8]. …”

Section: Introductionmentioning

confidence: 99%

Preoperative carbohydrate load and intraoperatively infused omega-3 polyunsaturated fatty acids positively impact nosocomial morbidity after coronary artery bypass grafting: a double-blind controlled randomized trial

Feguri

Lima

Borges

et al. 2017

Nutr J

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“…Although adherence to protocol fasting abbreviation was not high, the results showed that, when the shorter fasting was prescribed, length of stay decreased. This association between reduced fasting and accelerated postoperative recovery has been reported by several authors 6,8,10,11 . This change of routine fasting is safe and is recommended by anesthesia societies 12,13 , and revisions made on the subject 14 .…”

Section: Results Results Results Resultsmentioning

confidence: 74%

Resultados clínicos antes e após a implantação do protocolo ACERTO

Costa¹,

Santos²,

Aguilar-Nascimento

2013

Rev. Col. Bras. Cir.

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OBJETIVO: Comparar os resultados clínicos pós-operatórios de pacientes submetidos à cirurgia oncológica no Hospital de Câncer de Mato Grosso antes e após a implantação do protocolo ACERTO. MÉTODOS: Foram prospectivamente observados 271 pacientes durante dois períodos: o primeiro, entre abril e maio de 2010 (n=101) formado por pacientes submetidos a condutas convencionais (Fase 1) e o segundo, entre setembro a outubro de 2010 (n=171), formado por pacientes submetidos a um novo protocolo de condutas peri-operatórias estabelecidas pelo projeto ACERTO (Fase 2). As variáveis observadas foram: tempo de jejum pré-operatório, reintrodução da dieta no período pós-operatório, volume de hidratação e tempo de internação. RESULTADOS: Na comparação entre os dois períodos, na Fase 2 houve uma queda de aproximadamente 50% do tempo de jejum pré-operatório (14,7 [4-48] horas vs 7,2 [1-48] horas, p<0,001), houve redução de aproximadamente 35% do volume de fluidos intravenosos no pós-operatório imediato (p<0,001), de 47% no 1º PO (p<0,001) e de 28% no 2º PO (p=0,04), sendo a redução global de 23% (p<0,001). Não houve diferença no tempo de internação pós-operatória entre as duas fases (3,9 [0-51] vs. 3,2 [0-15] dias; p=0.52). Entretanto, nos pacientes cujo tempo de jejum pré-operatório foi de até 5 horas houve redução de um dia de internação (3.8 [0-51] vs 2.5 [0-15] dias, p=0,03). CONCLUSÃO: A adoção das medidas do projeto ACERTO é factível e segura em doentes oncológicos. Após a implantação do protocolo ACERTO reduziu-se o volume de fluidos intravenosos e quando o jejum pré-operatório foi reduzido o tempo de internação foi menor.

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“…The increased research in the field of cardiac surgery such as the article written by Feguri et al [11], "Results of clinical and metabolic effects of fasting with carbohydrate in coronary artery bypass grafting," and the deepening of the concepts briefly described have great therapeutic potential due to the low cost and easy implementation in daily practice. …”

Section: See Also Original Article On Pages 7-17mentioning

confidence: 99%

Jejum pré-operatório

Machado¹

2012

Rev Bras Cir Cardiovasc

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Resultados clínicos e metabólicos da abreviação do jejum com carboidratos na revascularização cirúrgica do miocárdio

Abstract: Resultados clínicos e metabólicos da abreviação do jejum com carboidratos na revascularização cirúrgica do miocárdioClinical and metabolic results of fasting abbreviation with carbohydrates in coronary artery bypass graft surgery Rev Bras Cir Cardiovasc 2012;27(1):7-17

Cited by 30 publications

References 36 publications

Preoperative carbohydrate load and intraoperatively infused omega-3 polyunsaturated fatty acids positively impact nosocomial morbidity after coronary artery bypass grafting: a double-blind controlled randomized trial

Preoperative carbohydrate load and intraoperatively infused omega-3 polyunsaturated fatty acids positively impact nosocomial morbidity after coronary artery bypass grafting: a double-blind controlled randomized trial

Resultados clínicos antes e após a implantação do protocolo ACERTO

Jejum pré-operatório

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