ABSTRACT
Abstract Objective: To evaluate the impact of different levels of positive end-expiratory pressure (PEEP) on gas exchange in patients undergoing coronary artery bypass grafting (CABG). Methods: A randomized clinical trial was conducted with patients undergoing CABG surgery. Patients were randomized into three groups: Group 10, PEEP of 10 cmH2O; Group 12, PEEP of 12 cmH2O; and Group 15, PEEP of 15 cmH2O. After the randomization, all patients underwent gas analysis at three moments: (1) before lung expansion therapy (LET); (2) 30 minutes after LET; and (3) one hour after extubation. Results: Sixty-six patients were studied, of which 61.7% were men, with mean age of 64 ± 8.9 years. Patients allocated to Group 15 showed a significant improvement in gas exchange comparing pre- and post-expansion values (239±21 vs. 301±19, P<0,001) and the increase was maintained after extubation (278±26). Despite the use of high levels of PEEP, no significant hemodynamic change was evidenced. Conclusion: It is concluded that high levels of PEEP (15 cmH2O) are beneficial for the improvement of gas exchange in patients undergoing CABG.
Subject(s)
Humans , Male , Female , Middle Aged , Aged , Coronary Artery Bypass/rehabilitation , Positive-Pressure Respiration/methods , Blood Gas Analysis , Respiratory Mechanics , Pulmonary Gas Exchange , Airway Extubation , HemodynamicsABSTRACT
Introdução: A cirurgia cardíaca aberta de revascularização domiocárdio (RM) por ser um procedimento muito invasivo e degrande porte, predispõe o paciente a muitas complicações pulmonaresas quais causam impacto na função pulmonar. Objetivo:Avaliar e comparar a função pulmonar no pré e pós-operatório depacientes submetidos à cirurgia cardíaca aberta de revascularizaçãodo miocárdio de um hospital filantrópico de Feira de Santana/Bahia. Material e métodos: Foi realizado um estudo de caráter coorteprospectivo na Unidade de Terapia Intensiva e no ambulatório deum hospital filantrópico de Feira de Santana. Foram avaliados 9pacientes com média de idade 62,44 ± 10,69 anos, peso 62,55 ±12,5 kg, altura 161,4 ± 1,075 cm, IMC 23,41 ± 3,55, no períodopré-operatório e no 1º DPO. Foi realizada avaliação clínica e funcionalcom anamnese e testes espirométricos, de ventilometria e deforça muscular. Resultados: Os resultados demonstraram que houveperda significativa, com redução do VEF1, da CVF e da CV (p <0,0005) quando comparados os valores pré-operatórios com os do1º DPO, enquanto que as demais variáveis de força muscular, VEe VT não apresentaram diferença estatística significativa no períodoavaliado. Conclusão: A cirurgia de RM associa-se a um decréscimona função pulmonar em todos os pacientes, apresentando reduçãoimportante nos valores de VEF1, da CVF e da CV.
Introduction: Open heart surgery and myocardial revascularization(MR) is a very invasive procedure that predisposes patients tomany pulmonary complications and causes impact on lung function.Objective: To evaluate and compare the pre and postsurgicalpulmonary function in patients undergoing open heart surgery ofmyocardial revascularization in a philanthropic hospital in Feira deSantana/BA. Methods: Was performed a prospective cohort study inthe Intensive Care Unit and ambulatory of a philanthropic hospitalin Feira de Santana. We evaluated 9 patients with mean age 62.44 ±10.69 years, weight 12.5 ± 62.55 kg, height 161.4 ± 1.075 cm, BMI23.41 ± 3.55 kg/m2 in the preoperative period and the 1st DPO.Clinical and functional evaluation was performed with anamneseand spirometry tests (pulmonary and muscle strength). Results: Theresults showed that there was significant loss, with reduced FEV1,FVC and VC (p < 0.0005) when compared to preoperative valueswith the 1st POD, while the other variables of muscle strength, VEand VT showed no statistically significant difference in the studyperiod. Conclusion: MR surgery is associated with decrease in lungfunction in all patients, showing significant reduction in FEV1,FVC and VC.