Tools for managing childcare in the postoperative period of cardiac surgery: an integrative review

Silva, Aline Cerqueira Santos Santana da; Stipp, Marluci Andrade Conceição; Paes, Graciele Oroski; Knupp, Virgínia Maria de Azevedo Oliveira; Góes, Fernanda Garcia Bezerra; Sá Neto, José Antônio de

doi:10.1590/0034-7167-2020-0073

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Sumário

REVIEW • Rev. Bras. Enferm. 74 (suppl 4) • 2021 • https://doi.org/10.1590/0034-7167-2020-0073 copy

Tools for managing childcare in the postoperative period of cardiac surgery: an integrative review

Herramientas para la gestión del cuidado infantil en el postoperatorio de cirugía cardíaca: una revisión integradora

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

To analyze the scientific literature on the application of management tools in the postoperative period of pediatric cardiac surgery.

Methods:

integrative review including studies published between 2004 and 2018 in the following databases: LILACS, BDENF, coleciona SUS, MEDLINE/PUBMED, CINAHL and SCOPUS, via Portal de Periódicos da Capes, Scientific Electronic Library Online (SciELO) and Academic Google research.

Results:

Twelve articles that met the inclusion criteria were analyzed. The studies demonstrated that strategies such as extracorporeal membrane oxygenation, renal replacement therapy and the risk scores for Risk Adjustment for Congenital Heart Surgery 1 and Aristotle Basic Score favored the stratification the demand for care and predicted the risk for mortality.

Final considerations:

The applicability of risk scores and emerging strategies for the management of childcare in the postoperative period of cardiac surgery was described by the evaluation of possibilities of performance and/or efficiency of the treatments developed.

Descriptors:
Pediatric Nursing; Organization and Administration; Critical Care; Thoracic Surgery; Postoperative Period

Database	Descriptors (combination)
Portal Regional da BVS (LILACS, BDENF)	tw:((gerencia OR gerenciamento OR gestao OR "ferramentas administrativas" OR administração) cuidado* AND ("cirurgia toracica" OR "cirugia toracica" OR "cirurgia cardiaca" OR "cirurgia do coraçao") AND ("recem-nascido" OR "recien nacido" OR "recem-nascida" OR "recem nascidas" OR "recem-nascido" OR "recem-nascidos" OR neonato OR neonato OR criança OR crianças OR nino)) AND (instance:"regional") AND ( db:("LILACS" OR "IBECS" OR "BINACIS" OR "BDENF" OR "SES-SP" OR "CUMED" OR "colecionaSUS") AND year_cluster:("2004" OR "2016" OR "2009" OR "2006" OR "2015" OR "2008" OR "2005" OR "2013" OR "2011" OR "2014" OR "2010" OR "2012" OR "2017"))
Portal Regional da BVS (LILACS, BDENF)	tw:(("Score de Risco" OR "instrumento de classificação de risco" OR "instrumento de classificação" OR "escala de risco" OR escore* OR administraçao OR gerencia OR gerenciamento OR gestao OR "ferramentas administrativas" OR administração) cuidado* AND ("cardiopatias congenitas" OR "cardiopatias congenitas" OR "malformação cardiovascular" OR "defeitos cardiovasculares congenitos" OR "anormalidades cardiacas")) AND (instance:"regional") AND ( db:("LILACS" OR "IBECS" OR "BINACIS" OR "BDENF" OR "CUMED" OR "SES-SP" OR "colecionaSUS") AND la:("es" OR "pt" OR "en") AND year_cluster:("2009" OR "2014" OR "2015" OR "2005" OR "2012" OR "2013" OR "2008" OR "2011" OR "2017" OR "2016") AND type:("article"))
CINAHL	( "Infant Newborn" OR "Infants, Newborn" OR "Newborn Infant" OR "Newborn Infants" OR Newborns OR Newborn OR Neonate OR Neonates OR Child OR Children OR "Child Institutionalized" OR "Institutionalized Child" OR "Children, Institutionalized" OR "Institutionalized Children" OR Adolescents OR Adolescence OR Teens OR Teen OR Teenagers OR Teenager OR Youth OR Youths ) AND "Thoracic Surgery" AND Management
PUBMED	(((((((("Infant Newborn"[MeSH Terms]) OR "Child Institutionalized"[MeSH Terms]) OR Child[MeSH Terms]) OR ("Infant Newborn"[Title/Abstract] OR "nfants, Newborn"[Title/Abstract] OR "Newborn Infant"[Title/Abstract] OR "Newborn Infants"[Title/Abstract] OR Newborns[Title/Abstract] OR Newborn[Title/Abstract] OR Neonate[Title/Abstract] OR Neonates[Title/Abstract] OR Child[Title/Abstract] OR Children[Title/Abstract] OR "Child Institutionalized"[Title/Abstract] OR "Institutionalized Child"[Title/Abstract] OR "Children, Institutionalized"[Title/Abstract] OR "Institutionalized Children"[Title/Abstract])) OR (Adolescents Adolescence[Title/Abstract] OR Teens[Title/Abstract] OR Teen[Title/Abstract] OR Teenagers[Title/Abstract] OR Teenager[Title/Abstract] OR Youth[Title/Abstract] OR Youths[Title/Abstract])) OR Adolescent[MeSH Terms])) AND (("Thoracic Surgery"[Title/Abstract]) OR "Thoracic Surgery"[MeSH Terms])) AND (((((((management[Title/Abstract]) AND care[Title/Abstract])) OR ("care management"[Title/Abstract] AND ( ( "2004/01/01"[PDat] : "3000/12/31"[PDat] ) AND ( English[lang] OR Portuguese[lang] OR Spanish[lang] ) ))) AND ( ( "2004/01/01"[PDat] : "3000/12/31"[PDat] ) AND ( English[lang] OR Portuguese[lang] OR Spanish[lang] ) ))) AND ( ( "2004/01/01"[PDat] : "3000/12/31"[PDat] ) AND ( English[lang] OR Portuguese[lang] OR Spanish[lang] ) ))
SCOPUS	( ( TITLE-ABS-KEY ( "Infant Newborn" OR "Infants,Newborn" OR "Newborn Infant" OR "Newborn Infants" OR newborns OR newborn OR neonate OR neonates OR child OR children ) OR TITLE-ABS-KEY ( "Child Institutionalized" OR "Institutionalized Child" OR "Children,Institutionalized" OR "Institutionalized Children" OR adolescents OR adolescence OR teens OR teen OR teenagers OR teenager OR youth OR youths ) ) ) AND ( TITLE-ABS-KEY ( "Thoracic Surgery" ) ) AND ( TITLE-ABS-KEY ( "care management" ) ) AND ( LIMIT-TO ( PUBYEAR , 2014 ) OR LIMIT-TO ( PUBYEAR , 2007 ) ) AND ( LIMIT-TO ( LANGUAGE , "English" ) )
SCIELO	((("recem-nascido" OR "recien nacido" OR "recem-nascida" OR "recem nascidas" OR "recem-nascido" OR "recem-nascidos" OR neonato OR neonato OR criança OR crianças OR nino OR "criança institucionalizada" OR "nino institucionalizado" OR "infant newborn" OR "nfants, newborn" OR "newborn infant" OR "newborn infants" OR newborns OR newborn OR neonate OR neonates OR child OR children OR "child institutionalized" OR "institutionalized child" OR "children, institutionalized" OR "institutionalized children" OR adolescents OR adolescence OR teens OR teen OR teenagers OR teenager OR youth OR youths) AND (cardiopatias OR cardiovascular OR cardiovasculares OR cardiacas))) AND (cirurgia) AND la:("en" OR "pt" OR "es") AND year_cluster:("2014" OR "2010" OR "2008" OR "2011" OR "2012" OR "2013" OR "2007" OR "2006" OR "2009" OR "2015" OR "2018" OR "2004" OR "2016") AND type:("research-article" OR "case-report" OR "review-article")

Title/Database	Journal/Year/Authors	Design/ Objective/ Level of Evidence	Results/Outcome
The RACHS-1 risk categories reflect mortality and length of hospital stay in a large German pediatric cardiac surgery population MEDLINE	Eur J Cardio-Thorac Surg 2004 Boethig D, Jenkins KJ, Hecker H, ThiesWR, Breymann T⁽¹⁶16 Boething D, Jenkins KJ, Hecker H, Thies WR, Breymann T. The RACHS-1 risk categories reflect mortality and length of hospital stay in a large German pediatric cardiac surgery population. Eur J Cardiothorac Surg. 2004;26(1):12-7. https://doi.org/10.1016/j.ejcts.2004.03.039 https://doi.org/10.1016/j.ejcts.2004.03.... ⁾.	Descriptive study Application of the RACHS 1 score and analysis of its relation to mortality and length of hospital stay. Level: V	Both in-hospital mortality and length of stay in the ICU were associated with the RACHS-1 categories. In addition, mortality in each RACHS-1 category was equivalent to that reported in larger institutions in America and Europe.
An index for evaluating results in pediatric cardiac intensive care. PUBMED	Cardiol Young 2006 Mattos SS, Neves JR, Costa MC, Hatem TP, Luna CF⁽¹⁷17 Mattos SS, Neves JR, Costa MC, Hatem TP, Luna CF. An index for evaluating results in paediatric cardiac intensive care. Cardiol Young. 2006;16(4):369-77. https://doi.org/10.1017/S1047951106000357 https://doi.org/10.1017/S104795110600035... ⁾.	Retrospective cohort study To determine if in-hospital mortality after cardiac surgery can be predicted, in children, using a new clinical and surgical index. Level: IV	Accomplishment of an international work to generate a universally applicable index to measure mortality and morbidity in children undergoing cardiac surgery.
Is the RACHS-1 (Risk adjustment in congenital heart surgery) a useful tool in our scenario?? SCIELO	Rev Bras Cir Cardiovasc 2007 Nina RVAH, Gama MEA, Santos MAS, Nina VJS, Neto JAF, Mendes VGG, Lamy ZC, Brito LMO⁽¹⁸18 Nina RVAH, Gama MEA, Santos AMS, Nina VJS, Figueiredo Neto JAF, Mendes VGG, et al. O escore de risco ajustado para cirurgia em cardiopatias congênitas (RACHS-1) pode ser aplicado em nosso meio? Rev Bras Cir Cardiovasc. 2007;22(4):425-31. https://doi.org/10.1590/S0102-76382007000400008 https://doi.org/10.1590/S0102-7638200700... ⁾.	Retrospective cohort study To evaluate the applicability of the RACHS-1 as a predictor of mortality in the pediatric population of a public hospital in the Northeast Region of Brazil. Level: IV	Although the RACHS-1 is easily applicable, it can not be applied in our scenario because it does not include variables that are present in our scenario and that could interfere in the final surgical outcome.
Accuracy of the Aristotle Basic Complexity Score for Classifying the Mortality and Morbidity Potential of Congenital Heart Surgery Operations PUBMED	Ann Thorac Surg 2007 O'Brien SM, Jacobs JP, Clarke DR, Maruszewski B, Jacobs ML, Walters HL⁽¹⁹19 O'Brien SM, Jacobs JP, Clarke DR, Maruszewski B, Jacobs ML, Walters HL, et al. Accuracy of the aristotle basic complexity score for classifying the mortality and morbidity potential of congenital heart surgery operations. Ann Thorac Surg. 2007;84(6):2027-37. https://doi.org/10.1016/j.athoracsur.2007.06.031 https://doi.org/10.1016/j.athoracsur.200... ⁾.	Exploratory study through retrospective data analysis To assess how well the Aristotle Basic Complexity Index (ACB score) predicts the actual morbidity and mortality potential of 131 congenital heart surgery procedures. Level: VI	The ABC score generally discriminates between low-risk and high-risk procedures, making it a potentially useful covariate for case-mix adjustment in congenital heart surgery outcomes analysis.
Post-operative chylothorax in children: an evidence-based management algorithm CINAHL	Journal of Paediatrics & Child Health 2008 Panthongviriyakul C, Bines JE⁽²⁰20 Panthongviriyakul C, Bines JE. Post-operative chylothorax in children: an evidence-based management algorithm. J Paediatr Child Health. 2008;44(12):716-21. https://doi.org/10.1111/j.1440-1754.2008.01412.x https://doi.org/10.1111/j.1440-1754.2008... ⁾.	Review study To develop an evidence-based algorithm for the management of chylothorax in the postoperative period of cardiothoracic, esophageal, mediastinal, diaphragmatic and pleuropulmonary surgery in children. Level:VI	Post‐operative chylothorax is associated with significant morbidity and prolonged hospitalization. An evidence based algorithm to guide the therapeutic approach to management of post‐operative chylothorax is proposed.
Pediatric cardiac intensive care unit: current setting and organization in 2010 PUBMED	Arch Cardiovasc Dis 2010 Fraisse A, Le Bel S, Mas B, Macrae D⁽²¹21 Fraise AL, Le Bel S, Mas B, Macrae D. Pediatric cardiac intensive care unit: current setting and organization in 2010. Arch Cardiovasc Dis. 2010;103(10):546-51. https://doi.org/10.1016/j.acvd.2010.05.004 https://doi.org/10.1016/j.acvd.2010.05.0... ⁾.	Review study To evaluate different elements for the development of a pediatric cardiac intensive care program based on clinical experience. Level:VI	Seriously ill cardiac patients are best managed in the ICUs designed for them, which should include a multidisciplinary team, a specialized nursing team and perioperative risk stratification.
Evaluation of pediatric cardio surgical model in Croatia by using the Aristoteles basic complexity score and the risk adjustment for congenital cardiac surgery- 1 method PUBMED	Cardiol Young 2010 Dilber D, Malcic I⁽²²22 Dilber D, Malcic I. Evalution of paediatric cardiosurgical mode in Croatia by using the Aristotele basic complexity escore and the risk adjustment for congenital cardiac surgery- 1 method. Cardiol Young. 2010;20(4):433-40. https://doi.org/10.1017/S1047951110000193 https://doi.org/10.1017/S104795111000019... ⁾.	Review study To compare the use of the Aristotle basic complexity score and the risk adjustment in congenital cardiac surgery-1 method in centers that perform pediatric cardiac surgery. Level:VI	Both, the Aristotle basic complexity score and the risk adjustment in congenital cardiac surgery-1 method were predictive of in-hospital mortality as well as prolonged length of hospital stay.
Twenty-four hour in-hospital congenital cardiac surgical coverage improves perioperative ECMO support outcomes PUBMED	Ann Thorac Surg 2014 Peer SM, Costello JP, Klein JC, Engle AM, Zurakowski D, Berger JT, Jonas RA, Nath DS⁽²³23 Peer SM, Costello JP, Klein JC, Engle AM, Zurakowski D, Berger JT. Twenty-four hour in-hospital congenital cardiac surgical coverage improves perioperative ECMO support outcomes. Ann Thorac Surg. 2014;98(6):2152-7. https://doi.org/10.1016/j.athoracsur.2014.07.042 https://doi.org/10.1016/j.athoracsur.201... ⁾.	Exploratory study through retrospective data analysis To evaluate the effect of 24 hours coverage on ECMO in congenital heart surgery children in the perioperative period. Level: VI	The implementation of 24-hour coverage on ECMO significantly decreases the mortality rate, pulmonary complications, and cardiac arrhythmias in congenital heart surgery children in the perioperative period. It demonstrates that congenital heart disease programs would benefit from this coverage in the care of this unsafe population.
Renal replacement therapy after cardiac surgery with extracorporeal circulation LILACS	Rev Chil Pediatr 2012 Ovalle P, Vogel A, Córdova G, Cerda J, Cavagnaro SM F⁽²⁴24 Ovalle P, Vogel A, Córdova G, Cerda J, Cavagnaro F. Reemplazo renal en el post-operatorio de niños sometidos a cirugía cardíaca con circulación extracorpórea. Rev Chil Pediatr. 2012;83(1):24-32. https://doi.org/10.4067/S0370-41062012000100003 https://doi.org/10.4067/S0370-4106201200... ⁾.	Retrospective, descriptive study. To determine the incidence of Renal Replacement Therapy (RRT) in children undergoing surgical correction of congenital heart disease and to identify risk factors for RRT. Level:VI	In this study, the incidence of RRT was 1.6%. Severe hypotension and low cardiac output were significant risk factors for RRT requirement. Renal function should be closely evaluated in patients with surgical events.
Heart defects treatment in Sergipe: propose of resources' rationalization to improve care LILACS	Ver Bras Cir Cardiovasc 2012 Leite DCF, Mendonça JT, Cipolotti R, Viera EM⁽²⁵25 Leite DCF, Mendonça JT, Cipolotti R, Melo EV. Tratamento das cardiopatias congênitas em Sergipe: proposta de racionalização dos recursos para melhorar a assistência. Rev Bras Cir Cardiovasc. 2014;27(2):224-30. https://doi.org/10.5935/1678-9741.20120038 https://doi.org/10.5935/1678-9741.201200... ⁾.	Descriptive quantitative study To evaluate the treatment of congenital heart diseases from 2000-2009. Level:VI	The evaluation of RACHS-1 as a predictor of hospital mortality showed it was significant. The results indicate that the centralization and organization of existing resources are necessary to improve the performance of surgical corrections for congenital heart diseases.
Principles of shared decision-making within teams PUBMED	Cardiol Young 2015 Jacobs JP, Wernovsky G, Cooper DS, Karl TR⁽²⁶26 Jacobs JP, Wernovsky G, Cooper DS, Karl TR. Principles of shared decision-making within teams. Cardiol Young. 2015;25(8):1631-6. https://doi.org/10.1017/S1047951115000311 https://doi.org/10.1017/S104795111500031... ⁾.	Expert consensus. Analyze the mortality risk model used by the Society Thoracic Surgeons (STS) to publicly report the outcomes of congenital heart surgery. Level:VII	In an environment of strong disagreement, the use of the mortality risk model (STS) serves to estimate the number of expected deaths among patients, enabling true teamwork and shared decision-making, which are fundamental to obtain excellent health outcomes.
Stratification of complexity in congenital heart surgery: comparative study of the Risk Adjustment for Congenital Heart Surgery (RACHS-1) method, Aristotle basic score and Society of Thoracic Surgeons-European Association for Cardio- Thoracic Surgery (STS-EACTS) mortality score LILACS	Rev Bras Cir Cardiovasc 2015 Cavalcanti PEF, Sá MPBO, Santos CA, Esmeraldo IM, Chaves ML, Lins RFA, Lima RC⁽⁶6 Cavalcanti PEF, Sá MPBO, Santos CA, Esmeraldo IM, Chaves ML, Lins RFA, et al. Stratification of complexity in congenital heart surgery: comparative study of the Risk Adjustment for Congenital Heart Surgery (RACHS-1) method, Aristotle basic score and Society of Thoracic Surgeons-European Association for Cardio- Thoracic Surgery (STS-EACTS) mortality score. Rev Bras Cir Cardiovasc. 2015;30(2):148-58. https://doi.org/10.5935/1678-9741.20150001 https://doi.org/10.5935/1678-9741.201500... ⁾.	Descriptive quantitative study To determine whether stratification of complexity models in congenital heart surgery (RACHS-1, Aristotle basic score and STS-EACTS mortality score) fit to our center and determine the best method of discriminating hospital mortality.Level: VI	The three models of stratification of complexity currently available in the literature are useful even with different mortality rates between the categories proposed. With similar discriminatory capacity for hospital mortality outcome, it was not possible to determine the superiority of one method over another in the sample.

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[1] Corresponding author: Aline Cerqueira Santos Santana da Silva. E-mail: alinecer2014@gmail.com