Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1590/S0034-70942007000500003
Brazilian Journal of Anesthesiology
Scientific Article

Manobra de recrutamento alveolar na reversão da hipoxemia no pós-operatório imediato em cirurgia cardíaca

Alveolar recruitment maneuver to reverse hypoxemia in the immediate postoperative period of cardiac surgery

José Otávio Costa Auler Junior; Emília Nozawa; Eliane Kobayashi Toma; Karin Lika Degaki; Maria Ignêz Zanetti Feltrim; Luiz Marcelo Sá Malbouisson

http://dx.doi.org/10.1590/S0034-70942007000500003 Braz J Anesthesiol, vol.57, n5, p.476-488, 2007
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Resumo

OBJETIVO: Avaliar os efeitos da manobra de recrutamento alveolar na oxigenação e volume corrente exalado em pacientes com hipoxemia no pós-operatório imediato de intervenção cirúrgica cardíaca. MÉTODO: Estudo prospectivo, consecutivo. Dentre 469 intervenções cirúrgicas cardíacas no período de fevereiro a abril de 2006, foram incluídos no protocolo 40 pacientes (8,5%), que na primeira avaliação na admissão da unidade de terapia intensiva cirúrgica apresentavam relação PaO2/FiO2 < 200. Nesse grupo de pacientes aplicou-se prospectivamente protocolo padronizado de manobras de recrutamento alveolar com pressão nas vias aéreas de 20 cmH2O na vigência de relação PaO2/FiO2 < 200, 30 cmH2O na relação PaO2/FiO2 < 150 e 40 cmH2O quando a relação PaO2/FiO2 persistisse inferior a 150 após manobra de recrutamento com pressão nas vias aéreas de 30 cmH2O. A pressão aplicada por meio do ventilador mecânico foi na modalidade pressão positiva contínua nas vias aéreas, por três vezes, com duração média de 30 segundos cada uma. Os parâmetros de oxigenação e volume corrente exalado foram comparados antes e imediatamente após as manobras de recrutamento. RESULTADOS: Dos 40 pacientes estudados, 30 responderam de modo favorável à manobra de recrutamento com pressão de 20 cmH2O e em 10 houve necessidade de 30 cmH2O. Nenhuma vez foi necessário aplicar manobra de recrutamento com pressão de 40 cmH2O. Após aplicação da manobra de recrutamento houve melhora significativa da oxigenação caracterizada por aumento da relação PaO2/FiO2 (p = 0,001), saturação periférica de oxigênio (p = 0,004) e do volume corrente exalado (p = 0,038). CONCLUSÃO: As manobras de recrutamento alveolar foram efetivas na correção da hipoxemia e aumento do volume corrente exalado em pacientes sob ventilação mecânica no pós-operatório imediato de intervenção cirúrgica cardíaca.

Palavras-chave

CIRURGIA, Cardíaca, COMPLICAÇÕES, VENTILAÇÃO

Abstract

BACKGROUND AND OBJECTIVES: To evaluate the effects of the alveolar recruitment maneuver on oxygenation and exhaled tidal volume, in patients with hypoxemia, in the immediate postoperative period of cardiac surgery. METHODS: This is a prospective, consecutive study. Among the 469 cardiac surgeries performed from February to April 2006, 40 patients (8.5%) who, at the time of admission to the surgical intensive care unit, presented PaO2/FIO2 < 200, were included in the protocol. A standard prospective protocol of alveolar recruitment maneuvers with pressure of 20 cmH2O in the upper airways in the presence of the ratio PaO2/FIO2 < 200, 30 cmH2O with PaO2/FIO2 < 150, and 40 cmH2O when Pa2O2/FIO2 remained below 150 after recruitment maneuver with pressure of 30 cmH2O, was applied to this group of patients. Continuous positive pressure was applied to the airways with a mechanical ventilator, 3 times, for approximately 30 seconds each. Parameters of oxygenation and exhaled tidal volume were compared before and immediately after the recruitment maneuvers. RESULTS: Of the 40 patients in the study, 30 showed good responses to recruitment maneuvers with 20 cmH2O, and 10 cases required 30 cmH2O. It was not necessary to apply pressure of 40 cmH2O. There was a significant improvement in oxygenation after the recruitment maneuvers, demonstrated by an increase in PaO2/FIO2 (p = 0.001), peripheral oxygen saturation (p = 0.004), and exhaled tidal volume (p = 0.038). CONCLUSIONS: Alveolar recruitment maneuvers were successful on correcting hypoxemia and increasing the exhaled tidal volume in patients on mechanical ventilation in the immediate postoperative period of cardiac surgery.

Keywords

COMPLICATIONS, SURGERY, Cardiac, VENTILATION

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