Effect of manual hyperinflation with versus without positive end-expiratory pressure on dynamic compliance in pediatric patients following congenital heart surgery: A randomized controlled trial.

BACKGROUND: We aimed to compare the effect of manual hyperinflation with versus without positive end-expiratory pressure (PEEP) on dynamic compliance of the respiratory system in pediatric patients undergoing congenital heart surgery; to assess the safety of the technique in this population. METHODS: This was a randomized controlled trial conducted at the pediatric intensive care unit (PICU) of a tertiary-care hospital. Patients admitted to the PICU following cardiac surgery and receiving postoperative mechanical ventilation were randomized to the experimental or control group. Patients in the experimental group (n = 14) underwent manual hyperinflation with a PEEP valve set at 5 cm H2O, once daily, during the first 48 hours after surgery. Patients allocated to the control group (n = 16) underwent manual hyperinflation without PEEP, at the same time points. Lung mechanics was assessed before (T0) and 5 minutes (T5) after manual hyperinflation. The primary endpoint was dynamic compliance. Secondary outcomes included oxygen saturation index, duration of mechanical ventilation, length of stay, 28-day mortality and safety. RESULTS: Demographic and clinical characteristics were comparable in both groups. There was no significant difference in dynamic compliance between times in each group (Day 1: (mean) 0.78 vs 0.81 and 0.70 vs 0.77; Day 2: 0.85 vs 0.78 and 0.67 vs 0.68 mL/kg/cm H2O, in experimental and control groups, respectively; P > .05). Mean deltas of dynamic compliance were not significantly different between groups. The proportion of patients extubated <72 hours after surgery was similar in experimental and control groups (43% vs 50%, respectively; P = .73). Oxygen saturation index, length of stay, and 28-day mortality were not significantly different between groups. None of the patients had hemodynamic instability. CONCLUSIONS: Manual hyperinflation was safe and well tolerated in pediatric patients following surgery for congenital heart disease. No significant change in dynamic compliance of the respiratory system or in oxygenation was observed with the use of manual hyperinflation with or without PEEP in this population.

Protocolos de desmame ventilatório em pediatria e pós-operatório de cardiopatia congênita-Revisão Bibliográfica / Ventilatory weaning protocols in pediatrics and postoperative of congenital heart disease-Bibliographic Review

A cardiopatia congênita é uma alteração na normalidade da estrutura ou função cardiocirculatória que acontece desde o parto, mesmo que posteriormente seja diagnosticada. A abordagem cirúrgica na cardiopatia congênita busca resolução dos defeitos, sendo de forma paliativa ou corretiva. Com o procedimento cirúrgico cardíaco é necessário suporte ventilatório e posteriormente o desmame com a diminuição gradual deste suporte. Sendo os protocolos de desmame uma importante chave para facilitar o reconhecimento da capacidade de respiração espontânea e adequação do paciente. Objetivo: Identificar a aplicabilidade de protocolos de desmame ventilatório em pediatria e pós-operatório de cardiopatia congênita. Metodologia: Revisão bibliográfica, com pesquisas na Biblioteca Virtual de Saúde (BVS) e PubMed de registros publicados entre 2007 a 2017. Resultados: A partir das pesquisas sete artigos foram relevantes frente ao objetivo proposto do estudo. Quatro estudos abordaram sobre Teste de Respiração Espontânea (TRE), um estudo avaliou os preditores perioperatórios...