Intraoperative effects of an alveolar recruitment manoeuvre in patients undergoing laparoscopic colon surgery.

INTRODUCTION: Pulmonary atelectasis is common in patients undergoing laparoscopic abdominal surgery under general anaesthesia, which increases the risk of perioperative respiratory complications. Alveolar recruitment manoeuvres (ARM) are used to open up the lung parenchyma with atelectasis, although the duration of their benefit has not been clearly established. The aim of this study was to determine the effectiveness of an ARM in laparoscopic colon surgery, the duration of response over time, and its haemodynamic impact. METHODS: Twenty-five patients undergoing laparoscopic colon surgery were included. After anaesthetic induction and initiation of surgery with pneumoperitoneum, an ARM was performed, and then optimal PEEP determined. Respiratory mechanics and gas exchange variables, and haemodynamic parameters, were analysed before the manoeuvre and periodically over the following 90 min. RESULTS: Three patients were excluded for surgical reasons. The alveolar arterial oxygen gradient went from 94.3 (62.3-117.8) mmHg before to 60.7 (29.6-91.0) mmHg after the manoeuvre (P < .05). This difference was maintained during the 90 min of the study. Dynamic compliance of the respiratory system went from 31.3 ml/cmH2O (26.1-39.2) before the manoeuvre to 46.1 ml/cmH2O (37.5-53.5) after the manoeuvre (P < .05). This difference was maintained for 60 min. No significant changes were identified in any of the haemodynamic variables studied. CONCLUSION: In patients undergoing laparoscopic colon surgery, performing an intraoperative ARM improves the mechanics of the respiratory system and oxygenation, without associated haemodynamic compromise. The benefit of these manoeuvres lasts for at least one hour.

Efectos intraoperatorios de una maniobra de reclutamiento alveolar en pacientes sometidos a cirugía laparoscópica de colon / Intraoperative effects of an alveolar recruitment manoeuvre in patients undergoing laparoscopic colon surgery

Introducción: Las atelectasias pulmonares son habituales en pacientes sometidos a cirugía abdominal laparoscópica bajo anestesia general, aumentando el riesgo de complicaciones respiratorias perioperatorias. Las maniobras de reclutamiento alveolar (MRA) permiten la reexpansión del parénquima atelectasiado, aunque no está claramente establecida la duración de su beneficio. El objetivo de este estudio fue determinar la efectividad de una MRA en cirugía de colon laparoscópica, la duración de la respuesta en el tiempo y su repercusión hemodinámica. Métodos: Se incluyeron 25 pacientes sometidos a cirugía de colon laparoscópica. Tras la inducción anestésica e inicio de la cirugía con neumoperitoneo, se realizó una MRA y determinación posterior de la PEEP óptima. Se analizaron variables de mecánica respiratoria y de intercambio gaseoso, así como parámetros hemodinámicos, antes de la maniobra y periódicamente durante los 90 min siguientes. Resultados: Tres pacientes fueron excluidos por causas quirúrgicas. El gradiente alveoloarterial de oxígeno pasó de 94,3 (62,3-117,8) mmHg antes a 60,7 (29,6-91,0) mmHg después de la maniobra (p < 0,05). Esta diferencia se mantuvo durante los 90 min del estudio. La compliance dinámica del sistema respiratorio pasó de 31,3 mL/cmH2O (26,1-39,2) antes de la maniobra, a 46,1 mL/cmH2O (37,5-53,5) tras la misma (p < 0,05). Esta diferencia se mantuvo durante 60 min. No se identificaron cambios significativos en ninguna de las variables hemodinámicas estudiadas. Conclusión: En pacientes sometidos a cirugía laparoscópica de colon, la realización de una MRA intraoperatoria mejora la mecánica del sistema respiratorio y la oxigenación, sin apreciarse un compromiso hemodinámico asociado. El beneficio de estas maniobras se extiende al menos durante una hora.(AU)

Introduction: Pulmonary atelectasis is common in patients undergoing laparoscopic abdominal surgery under general anaesthesia, which increases the risk of perioperative respiratory complications. Alveolar recruitment manoeuvres (ARM) are used to open up the lung parenchyma with atelectasis, although the duration of their benefit has not been clearly established. The aim of this study was to determine the effectiveness of an ARM in laparoscopic colon surgery, the duration of response over time, and its haemodynamic impact. Methods: Twenty-five patients undergoing laparoscopic colon surgery were included. After anaesthetic induction and initiation of surgery with pneumoperitoneum, an ARM was performed, and then optimal PEEP determined. Respiratory mechanics and gas exchange variables, and haemodynamic parameters, were analysed before the manoeuvre and periodically over the following 90 minutes. Results: Three patients were excluded for surgical reasons. The alveolar arterial oxygen gradient went from 94.3 (62.3-117.8) mmHg before to 60.7 (29.6-91.0) mmHg after the manoeuvre (P < .05). This difference was maintained during the 90 minutes of the study. Dynamic compliance of the respiratory system went from 31.3 ml/cmH2O (26.1-39.2) before the manoeuvre to 46.1 ml/cmH2O (37.5-53.5) after the manoeuvre (P < .05). This difference was maintained for 60 minutes. No significant changes were identified in any of the haemodynamic variables studied. Conclusion: In patients undergoing laparoscopic colon surgery, performing an intraoperative ARM improves the mechanics of the respiratory system and oxygenation, without associated haemodynamic compromise. The benefit of these manoeuvres lasts for at least one hour.(AU)

Perfil de pacientes evaluados con el Test de Capacidad de Difusión de Monóxido de Carbono: Una experiencia chilena

Antecedentes: La prueba de capacidad de difusión de monóxido de carbono (DLCO) es una evaluación de función pulmonar rutinaria y no invasiva clínicamente útil para determinar el estado de la función pulmonar en pacientes con trastornos crónicos como la enfermedad pulmonar intersticial difusa (EPID). Objetivo: Describir el perfil sociodemográfico y clínico de usuarios de la prueba DLCO en Valdivia, Chile. Materiales y Métodos: Estudio observacional, retrospectivo, de base documental. A partir de registros de 490 pacientes que se realizaron la prueba DLCO entre 2017 y 2019, se describen características sociodemográficas, clínicas y reporte de consumo de cigarrillo como cigarrillos/d e índice paquetes/año (IPA), comparando por sexo. Resultados: La mayor proporción de evaluados fueron mujeres (61%), con una edad mediana de 65 años, mayor en mujeres (66 vs 64 años; p = 0,0361). La mayoría consultaron por EPID (54,5%). Según estado nutricional, 38% presentó preobesidad y 24,7% obesidad I (24,7%), destacando que 40,5% de las mujeres y 33% de los hombres se encontraron en alguna categoría de obesidad. Entre quienes reportaron información de consumo de cigarrillos (n = 346, 70,6%), 14,7% (n = 51) eran consumidores actuales, con un consumo mediano de 10 cigarrillos/d, sin diferencias por sexo. Entre exfumadores (n = 144; 50% hombres/mujeres) hubo significativamente menor consumo diario (5 vs 15; p = 0,0300) y de IPA (7 vs 18; p = 0,0083) en mujeres. Conclusiones: En usuarios de DLCO el principal diagnóstico de consulta fue EPID. Destacó alta frecuencia de obesidad y tabaquismo, sin diferencia de consumo por sexo en fumadores actuales, pero sí en exfumadores.

Background: The carbon monoxide diffusion capacity test (DLCO) is a clinically useful, routine, non-invasive lung function assessment to determine the status of lung function in patients with chronic disorders such as interstitial lung disease (ILD). Aim: To describe the sociodemographic and clinical profile of users of the DLCO test in Valdivia, Chile. Materials and Methods: Observational, retrospective, documentary-based study. From the records of 490 patients who underwent the DLCO test between 2017 and 2019, sociodemographic and clinical characteristics and reports of cigarette consumption are described, such as cigarettes/d and pack-year index (PYI), comparing by sex. Results: The highest proportion of those evaluated were women (61%), with a median age of 65 years, higher in women (66 vs. 64 years; p = 0.0361). The majority consulted for ILD (54.5%). According to nutritional status, 38% presented pre-obesity and 24.7% obesity I (24.7%), highlighting that 40.5% of women and 33% of men were in some category of obesity. Among those who reported information on cigarette consumption (n = 346, 70.6%), 14.7% (n = 51) were current consumers, with a median consumption of 10 cigarettes/d, without differences by sex. Among exsmokers (n = 144; 50% men/women) there was significantly less daily (5 vs 15; p = 0.0300) and IPA (7 vs 18; p = 0.0083) consumption in women. Conclusions: In DLCO users, the main consultation diagnosis was ILD. High frequency of obesity and smoking stood out, with no difference in consumption by sex in current smokers, but yes in ex-smokers.

Efecto del uso del recuperador celular en el intercambio gaseoso en pacientes sometidos a cirugía cardíaca / Effect of the use of operative blood salvage on the pulmonary gas exchange in patients undergoing cardiac surgery

Resumen: Introducción: Se ha sugerido que el recuperador celular reduce el contenido de citocinas proinflamatorias después de la cirugía cardíaca mejorando su equilibrio en la circulación sistémica, lo que puede minimizar la respuesta inflamatoria que contribuye a la disfunción pulmonar postoperatoria. Objetivo: Comparar el intercambio gaseoso postoperatorio de pacientes sometidos a cirugía cardíaca con y sin el uso de recuperador celular. Material y métodos: Se realizó un estudio de cohortes prospectivo que incluyó 253 pacientes sometidos a cirugía cardíaca bajo circulación extracorpórea. Los pacientes se asignaron a cada uno de los grupos de estudio dependiendo de si usaron o no recuperador celular: grupo I (sin recuperador) y grupo II (con recuperador), estimándose la PaO2/FiO2 y la morbilidad respiratoria postoperatoria. Para el análisis se utilizó estadística descriptiva e inferencial mediante t de Student o U de Mann-Whitney. Una p < 0.05 fue significativa. Los datos se procesaron con SPSS v. 24.0. Resultados: 59.29% usaron recuperador celular. La PaO2/FiO2 fue menor en el grupo II (p = 0.018). No hubo diferencias entre ambos grupos en la morbilidad respiratoria a los 30 días de postoperados (p = 0.943). Conclusión: El intercambio gaseoso postoperatorio de pacientes sometidos a cirugía cardíaca es menor con el uso de recuperador celular que sin él.

Abstract: Introduction: It has been suggested that the use of a cell saver reduces the content of proinflammatory cytokines after cardiac surgery, improving the balance of these cytokines in the systemic circulation, which in turn could minimize the inflammatory response that contributes to postoperative pulmonary dysfunction. Objective: To compare the postoperative gas exchange in patients undergoing cardiac surgery with the use of cell saver and without it. Material and methods: A prospective cohort study that included 253 patients undergoing cardiac surgery under cardiopulmonary bypass. The patients were assigned to two study groups depending on whether a cell saver was used: group I (without cell saver) and group II (with cell saver). The PaO2/FiO2 ratio and the postoperative respiratory morbidity were then estimated. The analysis was done using descriptive and inferential statistics by means of the Student t test and Mann-Whitney U test. A p < 0.05 was considered significant. The data were processed using SPSS v. 24.0. Results: 59.29% of patients underwent surgery with the use of a cell saver. The PaO2/FiO2 ratio was lower in group II (p = 0.018). There were no differences between groups in respiratory morbidity 30 days after surgery (p = 0.943). Conclusion: The postoperative gas exchange is lower in patients undergoing cardiac surgery with the use of a cell saver than without it.

Content analysis of clinical indicators for Impaired gas exchange / Análisis de contenido de indicadores clínicos para Deterioro del intercambio gaseoso / Análise de conteúdo dos indicadores clínicos para Troca de gases prejudicada

ABSTRACT Objective To analyze the relevance of clinical indicators and the clarity and precision of conceptual and operational definitions of the diagnosis Impaired gas exchange. Methods Content analysis, by 39 nurse judges, divided into the phases of conceptual definition of the phenomenon of interest, construction of the structure of the phenomenon of interest and analysis of the judges on the built structure. Results From the 22 indicators, 21 were considered relevant Impaired gas exchange. The indicators that obtained absolute relevance were Cyanosis, Hypercapnia, Hypoxemia and Tachycardia. The indicator Headache upon waking did not show any statistically significant relevance for the diagnosis. All conceptual and operational definitions were clear and precise. Conclusion The indicators listed for Impaired gas exchange were relevant to the phenomenon, except Headache upon waking because it does not correspond to a safe manifestation to identify the diagnosis, according to the analysis of the judges. Each conceptual and operational definition was adequate for its indicator.

RESUMEN Objetivo Analizar la relevancia de los indicadores clínicos y la claridad y precisión de las definiciones conceptuales y operativas del diagnóstico Deterioro del intercambio gaseoso. Métodos Análisis de contenido, realizado por 39 jueces enfermeros, dividido en las fases de definición conceptual del fenómeno de interés, construcción de la estructura del fenómeno de interés y análisis de los jueces sobre la estructura construida. Resultados De los 22 indicadores, 21 fueron considerados relevantes Deterioro del intercambio gaseoso. Los indicadores que obtuvieron relevancia absoluta fueron Cianosis, Hipercapnia, Hipoxemia y Taquicardia. El indicador Cefalea al despertar no mostró relevancia estadísticamente significativa para el diagnóstico. Todas las definiciones conceptuales y operativas fueron claras y precisas. Conclusión Los indicadores enumerados para Deterioro del intercambio gaseoso fueron relevantes para el fenómeno, excepto Cefalea al despertar porque no corresponde a una manifestación segura para identificar el diagnóstico, según el análisis de los jueces. Cada definición conceptual y operativa fue adecuada para su indicador.

RESUMO Objetivo Analisar a relevância dos indicadores clínicos e a clareza e precisão das definições conceituais e operacionais do diagnóstico Troca de gases prejudicada. Métodos Análise de conteúdo, por 39 juízes enfermeiros, dividida nas fases de definição conceitual do fenômeno de interesse, construção da estrutura do fenômeno de interesse e análise dos juízes sobre a estrutura construída. Resultados Dos 22 indicadores, 21 foram considerados relevantes Troca de gases prejudicada. Os indicadores que obtiveram relevância absoluta foram Cianose, Hipercapnia, Hipoxemia e Taquicardia. O indicador Cefaleia ao acordar não apresentou relevância estatisticamente significante para o diagnóstico. Todas as definições conceituais e operacionais foram claras e precisas. Conclusão Os indicadores elencados para Troca de gases prejudicada foram relevantes ao fenômeno, exceto Cefaleia ao acordar pois não corresponde a uma manifestação segura para identificar o diagnóstico, conforme a análise dos juízes. Cada definição conceitual e operacional foi adequada para seu referido indicador.

Troca de gases prejudicada: análise em pacientes com infarto agudo do miocárdio / Impaired gas exchange: analysis in patients with acute myocardial infarction

O emprego do diagnóstico de enfermagem troca de gases prejudicada na assistência ao infartado requer aprofundamento e validação. Objetivamos analisar a ocorrência do diagnóstico troca de gases prejudicada em portadores de infarto agudo do miocárdio, caracterizando o grau de comprometimento do seu estado de saúde. Estudo transversal, descritivo-exploratório, realizado entre setembro e dezembro de 2007, com 32 pacientes infartados, internados em um hospital especializado em cardiologia da cidade de Fortaleza-CE. Os dados foram obtidos mediante entrevista, exame físico e consulta ao prontuário. O diagnóstico troca de gases prejudicada foi ausente em nossa amostra, entretanto, as variáveis índice de massa corpórea, porcentagens de massa gorda e massa magra, relação cintura-quadril e freqüência respiratória estiveram comprometidas, indicando risco potencial de agravamento. Os resultados mantêm alguma relação com o estilo de vida dos pacientes avaliados, o que indica a importância da modificação dos hábitos em prol de um melhor prognóstico.

The use of the nursing diagnosis impaired gas exchange in the assistance to patient with infarction requires further exploration and validation. We aim both at analyzing the occurrence of the diagnosis impaired gas exchange in bearers of acute myocardial infarction and at characterizing the extent to which their health condition is compromised. A cross-sectional study with descriptive-exploratory character, performed with 32 bearers of infarction interned in a hospital specialized in cardiology in Fortaleza-CE, Brazil, developed between September and December, 2007. The data were obtained through interview, physical exam, and consultation records. The diagnosis impaired gas exchange was absent in our sample; however, the variables body mass index, fat mass, and thin mass percentages, waist-hip relation, and respiratory frequency were compromised, fact which indicates potential risk of aggravation. Results keep some relation with patients' lifestyle, fact which shows the importance of modification of habits on behalf of a better prognosis.

El empleo del diagnóstico de enfermería cambio de gases perjudicado en la asistencia al infartado requiere ahondamiento y validación. Nuestro objetivo fue analizar la ocurrencia del diagnóstico cambio de gases perjudicado en portadores de infarto agudo del miocardio, caracterizando el grado de comprometimiento de su estado de salud. Estudio transversal, descriptivo-exploratorio, realizado entre septiembre y diciembre de 2007, con 32 pacientes infartados, internados en un hospital especializado en cardiología de Fortaleza-CE-Brasil. Los datos fueron obtenidos a través de entrevista, examen físico y consulta al prontuario. El diagnóstico estudiado estuvo ausente en nuestra muestra, mientras, las variables índice de masa corpórea, porcentajes de masa gorda y masa delgada, relación cintura-cadera y frecuencia respiratoria estuvieron comprometidas, lo que indica riesgo potencial de agravación. Los resultados mantienen alguna relación con el estilo de vida de los pacientes evaluados, lo que indica la importancia de la modificación de los hábitos para un mejor pronóstico.