Fisioterapia em pré e pós-operatório de cirurgia valvar / Physical therapy preoperative and postoperative of valve surgery

O aparelho valvar é uma estrutura complexa que pode sofrer alterações morfológicas que resultarão em disfunção; sendo, muitas vezes, necessário intervenção cirúrgica. As valvas mais comumente acometidas e passíveis de correção cirúrgica são as valvas mitral e aórtica. A função pulmonar de pacientes com valvopatia mitral está diretamente ligada ao grau de disfunção. Quando não há limitações nas atividades...

Avaliaçäo de fatores que influenciam no desmame de pacientes em ventilaçäo mecânica prolongada após cirurgia cardíaca / Assessment of factors that influence weaning from long-term mechanical ventilation after cardiac surgery

OBJECTIVE: To analyze parameters of respiratory system mechanics and oxygenation and cardiovascular alterations involved in weaning tracheostomized patients from long-term mechanical ventilation after cardiac surgery. METHODS: We studied 45 patients in their postoperative period of cardiac surgery, who required long-term mechanical ventilation for more than 10 days and had to undergo tracheostomy due to unsuccessful weaning from mechanical ventilation. The parameters of respiratory system mechanics, oxigenation and the following factors were analyzed: type of surgical procedure, presence of cardiac dysfunction, time of extracorporeal circulation, and presence of neurologic lesions. RESULTS: Of the 45 patients studied, successful weaning from mechanical ventilation was achieved in 22 patients, while the procedure was unsuccessful in 23 patients. No statistically significant difference was observed between the groups in regard to static pulmonary compliance (p=0.23), airway resistance (p=0.21), and the dead space/tidal volume ratio (p=0.54). No difference was also observed in regard to the variables PaO2/FiO2 ratio (p=0.86), rapid and superficial respiration index (p=0.48), and carbon dioxide arterial pressure (p=0.86). Cardiac dysfunction and time of extracorporeal circulation showed a significant difference. CONCLUSION: Data on respiratory system mechanics and oxygenation were not parameters for assessing the success or failure. Cardiac dysfunction and time of cardiopulmonary bypass, however, significantly interfered with the success in weaning patients from mechanical ventilation