RELATION BETWEEN STRESSORS AND HEMODYNAMIC INSTABILITY IN THE POSTOPERATIVE PERIOD AFTER CARDIAC SURGERY

Dessotte, Carina Aparecida Marosti; Furuya, Rejane Kiyomi; Rodrigues, Hélen Francine; Rossi, Lidia Aparecida; Dantas, Rosana Aparecida Spadoti

doi:10.1590/0104-070720180004530017

Brasil

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Original Article • Texto contexto - enferm. 27 (3) • 2018 • https://doi.org/10.1590/0104-070720180004530017 linkcopy

RELATION BETWEEN STRESSORS AND HEMODYNAMIC INSTABILITY IN THE POSTOPERATIVE PERIOD AFTER CARDIAC SURGERY¹

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective: assess the relation between the perceived stressors at the Intensive Care Unit and hemodynamic instability in the postoperative period of patients submitted to the first cardiac surgery.

Method: observational analytic prospective cohort study, developed at a university hospital in the interior of São Paulo State. A consecutive and non-probabilistic sample was constituted, consisting of patients submitted to the first coronary artery bypass graft or heart valve disease correction. The Environmental Stressor Questionnaire (range 0-200, with higher scores indicating greater stress) and tissue perfusion markers were used to assess the research variables.

Results: 150 patients participated in the study. The average score for the assessment of stressors was 75.6 for patients with hemodynamic instability (n=91) and 72.8 for patients without hemodynamic instability, without a statistically significant difference (p=0.398; Student’s t-test).

Conclusion: in the study sample, we found no relation between perceived stressors at the Intensive Care Unit and hemodynamic instability in the postoperative period of cardiac surgery.

Variables	With hemodynamic instability (n=91)		No hemodynamic instability (n=59)		p
	% (n)	Mean (SD)^* * coefficient resulting from Chi-square test;	% (n)	Mean (SD)^* * coefficient resulting from Chi-square test;	p
Genger
Male	63.7 (58)		67.8 (40)		0.610^* * coefficient resulting from Chi-square test;
Female	36.3 (33)		32.2 (19)		0.610^* * coefficient resulting from Chi-square test;
Marital situation
With partner	69.2 (63)		78.0 (46)		0.241^* * coefficient resulting from Chi-square test;
No partner	30.8 (28)		22.0 (13)		0.241^* * coefficient resulting from Chi-square test;
Employment situation
Inactive	72.5 (66)		64.4 (38)		0.292^* * coefficient resulting from Chi-square test;
Active	27.5 (25)		35.6 (21)		0.292^* * coefficient resulting from Chi-square test;
Age (in years)		58.6 (12.0)		58.4 (12.6)	0.901^† † p-value resulting from Student's t-test for independent samples
Education (full years)		5.34 (4.2)		4.90 (3.7)	0.500^† † p-value resulting from Student's t-test for independent samples
Monthly family income (in reais)		2,471.00 (2,694.00)		2,139.00 (1,524.00)	0.370^† † p-value resulting from Student's t-test for independent samples

Variables	With hemodynamic instability (n=91) % (n)	Without hemodynamic instability (n=59) % (n)
Main diagnosis
Coronary artery disease	50.5 (46)	47.5 (28)
Heart valve disease	40.7 (37)	45.8 (27)
Coronary artery + heart valve disease	8.8 (8)	6.8 (4)
Presence of comorbidities
Systemic Arterial Hypertension	78.0 (71)	67.8 (40)
Overweight/obesity	68.1 (62)	52.5 (31)
Dyslipidemia	50.5 (46)	47.5 (28)
Diabetes mellitus	45.1 (41)	40.7 (24)
Atrial Fibrillation	12.1 (11)	5.1 (3)
Left Ventricular Ejection Fraction
Preserved	67.0 (61)^* * no results were found for five patients;	69.5 (41)^† † no results were found for three patients.
Reduced	27.5 (25)	25.4 (15)
Smoking
Past	41.7 (38)	39.0 (23)
Current	12.1 (11)	25.4 (15)
Surgery performed
Coronary artery bypass graft	50.5 (46)	45.8 (27)
Valvulopathy correction	42.9 (39)	47.4 (28)
Coronary artery bypass graft + valvulopathy correction	6.6 (6)	6.8 (4)

Scale items	With hemodynamic instability (n=91)		Without hemodynamic instability (n=59)
Scale items	Mean (SD)^* * (SD)=Standard deviation	Rank	Mean (SD)^* * (SD)=Standard deviation	Rank
Being thirsty	2.7 (1.0)	1^st	2.6 (1.0)	1^st
Having tubes inside your nose and/or mouth	2.3 (1.2)	2^nd	2.1 (1.1)	3^rd
Being unable to sleep	2.2 (1.2)	3^rd	2.2 (1.1)	2^nd
Being strapped to tubes and drains	2.1 (1.1)	4^th	2.2 (1.0)	2^nd
Being unable to perform your role within the family	2.1 (1.2)	4^th	2.1 (1.1)	3^rd
Having to look up at the details in the ceiling	2.0 (1.0)	5^th	2.1 (1.0)	3^rd
Feeling pain	2.0 (1.3)	5^th	2.1 (1.3)	3^rd
Missing your spouse or partner	1.9 (1.2)	6^th	2.2 (1.0)	2^nd
Not having control over yourself	1.9 (1.1)	6^th	1.7 (1.0)	5^th
Being afraid of dying	1.9 (1.4)	6^th	1.5 (1.0)	7^th
Not knowing the length of the ICU stay	1.9 (1.0)	6^th	1.7 (0.9)	5^th
Being unable to move your hands or arms due to intravenous serum or medication	1.8 (1.0)	7^th	1.9 (1.0)	4^th
Having the lights constantly on	1.8 (1.1)	7^th	1.9 (0.9)	4^th
Not being able to communicate	1.8 (1.1)	7^th	1.9 (1.0)	4^th
Seeing your family and friends only for a few minutes every day	1.7 (1.0)	8^th	1.6 (1.0)	6^th
Having an uncomfortable bed and/or pillows	1.6 (1.0)	9^th	1.5 (1.0)	7^th
Not knowing when the procedures will be performed on you	1.6 (0.9)	9^th	1.4 (0.8)	8^th
Being pierced by needles	1.6 (1.0)	9^th	1.5 (0.8)	7^th
Not knowing what day today is	1.6 (1.0)	9^th	1.2 (0.9)	10^th
Not knowing what time it is	1.5 (1.1)	10^th	1.4 (1.0)	8^th
Not knowing exactly where you are	1.5 (1.0)	10^th	1.1 (0.7)	11^th
Feeling annoyed	1.5 (1.2)	10^th	1.2 (0.7)	10tn
Not having privacy	1.5 (0.9)	10^th	1.3 (0.7)	9^th
Listening to the noise and alarms of the medical devices	1.4 (0.8)	11^th	1.4 (0.7)	8^th
Having to use oxygen	1.4 (0.8)	11^th	1.4 (0.8)	8^th
Listening to unknown sounds and noises	1.4 (0.9)	11^th	1.4 (0.8)	8^th
Having financial concerns	1.4 (1.1)	11^th	1.4 (0.8)	8^th
Being afraid of catching AIDS	1.4 (0.9)	11^th	1.3 (0.9)	9^th
Feeling pressured to agree to the treatment	1.1 (0.7)	11^th	0.9 (0.6)	13^th
Having strange devices around you	1.3 (0.7)	12^th	1.4 (0.8)	8^th
Listening to your heart monitor go off	1.3 (0.7)	12^th	1.1 (0.6)	11^th
Being awakened by the nursing staff	1.3 (0.7)	12^th	1.2 (0.7)	10^th
Hearing the nursing team speak with terms that you do not understand	1.3 (0.8)	12^th	1.1 (0.6)	11^th
Being in a very warm or very cold room	1.3 (0.9)	12^th	1.4 (0.9)	8^th
Feeling that the nursing staff is in a hurry	1.2 (0.7)	13^th	1.2 (0.9)	10^th
Not receiving explanations about your treatment	1.2 (0.9)	13^th	0.9 (0.7)	13^th
Having the nursing staff constantly doing tasks around your bed	1.2 (0.7)	13^th	1.3 (0.7)	9^th
Listening to other patients moaning	1.2 (1.0)	13^th	1.2 (0.9)	10^th
Having men and women in the same room	1.2 (0.7)	13^th	1.2 (0.6)	10^th
Seeing serum bags hanging over your head	1.2 (0.8)	13^th	1.1 (0.4)	11^th
Listening to people talking about your	1.2 (0.8)	13^th	1.2 (0.8)	10^th
Having your blood pressure checked several times a day	1.1 (0.6)	14^th	1.1 (0.4)	11^th
Listening to the telephone ringing	1.1 (0.6)	14^th	1.2 (0.6)	10^th
Feeling that the nursing staff pays more attention to the devices than to you	1.1 (0.8)	14^th	1.0 (0.6)	12^th
Observing treatments being administered to other patients	1.1 (0.7)	14^th	1.2 (0.9)	10^th
Smelling strange smells around you	1.1 (0.8)	14^th	1.2 (0.9)	10^th
Receiving care from doctors that you do not know	1.1 (0.4)	14^th	1.0 (0.3)	12^th
The nursing staff member does not introduce himself/herself by the name	1.0 (0.8)	15^th	0.9 (0.8)	13^th
Being examined frequently by the medical and the nursing staff	1.0 (0.2)	15^th	1.1 (0.5)	11^th
Nurses and doctors speaking too loudly	1.0 (0.6)	15^th	1.0 (0.7)	12^th
Mean score of scale items	1.5 (0.5)		1.4 (0.3)

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