Resumen

DUSSICH, Alejandro  y  VANEGAS, María Victoria. Predictive Factors of Medical Bleeding in Adult Patients Undergoing Cardiac Surgery. Rev. Cienc. Salud [online]. 2005, vol.3, n.1, pp.25-36. ISSN 1692-7273.

A percentage of post surgery bleedings that leads to mediastinal reintervention do not have a surgical cause, and therefore the reintervention was not indicated. The objective of the study was to determine predictive factors to recognize the bleeding that does not require surgery. Methodology: retrospective study with 560 patients, from whom 50 required reintervention for bleeding. The patients were divided in three groups: patients with not intervention, patients with reintervention and an anatomic lesion susceptible of surgical reparation (surgical bleeding), and patients with reintervention in whom a bleeding area could not be identify. (medical bleeding). Results: Mortality and time of permanence in ICU was higher in the patients with medical bleeding than in the other groups. Medical bleeding was associated with long time of extracorporeal circulation (p = 0,03), with circulatory arrest of any duration (p <0,001) and with surgery procedure category 3, according to Hardy's classification (p = 0,033). The use of ultrafiltartion techniques was statistically related with a reduction in the medical bleeding. Conclusion: bleedings that need reintervention after surgery are related with a high increase in mortality and time of permanence in ICU. Patients in whom a high risk of medical bleeding is predicted can be benefited from the prophylactic use of aprotinina or any other agent that help in the reduction of bleedings. It is clear that patients with medical bleeding are worse of if they go to surgery.

Palabras clave : Thoracic Surgery; postoperative hemorrhage; extracorporeal circulation; disseminated intravascular coagulation; ultrafiltration.

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