Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1590/S0034-70942008000200005
Brazilian Journal of Anesthesiology
Scientific Article

Hipoxemia após revascularização miocárdica: análise dos fatores de risco

Hypoxemia after myocardial revascularization: analysis of risk factors

Tais Felix Szeles; Eduardo Muracca Yoshinaga; Wellington Alencar; Marcio Brudniewski; Flávio Silva Ferreira; José Otavio Costa Auler Jr; Maria José Carvalho Carmona; Luiz Marcelo Sá Malbouisson

http://dx.doi.org/10.1590/S0034-70942008000200005 Braz J Anesthesiol, vol.58, n2, p.124-136, 2008
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Resumo

JUSTIFICATIVA E OBJETIVOS: Hipoxemia grave é uma complicação freqüente no pós-operatório imediato de revascularização do miocárdio (RM), promovendo aumento da duração da ventilação mecânica, da incidência de infecções pulmonares, dos custos e da mortalidade. O objetivo desse estudo foi identificar fatores preditivos de hipoxemia grave em pacientes submetidos à RM. MÉTODO: Foram estudados 481 pacientes adultos submetidos à RM eletiva entre outubro de 2003 e março de 2004. Considerou-se hipoxemia grave uma relação PaO2/FiO2 < 150 na admissão à UTI. A análise estatística foi realizada por meio de teste de Qui-quadrado, t de Student ou Wilcoxon, seguida de análise multivariada por meio de regressão logística (RL) para variáveis com valor p < 0,25 na análise univariada. Considerou-se valor de p > 0,2 para exclusão da variável do modelo de RL e p < 0,1 como sendo significativo. RESULTADOS: O tempo para extubação dos pacientes com hipoxemia grave foi maior que nos outros pacientes (p < 0,001). Na análise multivariada, as variáveis idade (p = 0,081), peso (p = 0,001), necessidade de CEC prolongada (p = 0,033) e disfunção ventricular esquerda (p = 0,082) foram identificadas como preditores independentes para hipoxemia grave. CONCLUSÕES: Pacientes com idade e peso elevados, disfunção ventricular esquerda e necessidade de CEC apresentaram risco aumentado para hipoxemia grave após RM. Nesses pacientes, o uso de estratégias ventilatórias perioperatória com pressões positivas expiratórias mais elevadas e manobra de recrutamento alveolar devem ser consideradas tendo como objetivo a prevenção da disfunção pulmonar pós-operatória.

Palavras-chave

CIRURGIA, Cardíaca, COMPLICAÇÕES: hipoxemia, RISCO

Abstract

BACKGROUND AND OBJECTIVES: Severe hypoxemia is complication frequently seen in the immediate postoperative period of myocardial revascularization (MR), increasing the duration of mechanical ventilation, the incidence of pulmonary infections, hospital costs, and mortality. The objective of this study was to identify predictive factors of severe hypoxemia in patients undergoing MR. METHODS: Four-hundred and eighty-one adult patients undergoing elective MR between October 2003 and March 2004 were enrolled in this study. Severe hypoxemia was defined as PaO2/FiO2 < 150 upon admission to the ICU. The Chi-square test, Student's t or Wilcoxon test, followed by multivariate analysis and logistic regression (LR) for parameters with p < 0.25 in the univariate analysis, were used for the statistical analysis. A p > 0.2 was required to exclude the parameter from the LR model, and a p < 0.1 was considered significant. RESULTS: Time for extubation was greater in patients with severe hypoxemia (p < 0.001). Multivariate analysis identified age (p = 0.081), weight (p = 0.001), need of prolonged CBP (p = 0.033), and left ventricular dysfunction (p = 0.082) as independent predictors of severe hypoxemia. CONCLUSIONS: Older and overweighted patients, those with left ventricular dysfunction, and those who needed CPB presented an increased risk of severe hypoxemia after MR. In those patients, the use of perioperative ventilatory strategies, with elevated positive expiratory pressures and alveolar recruitment maneuver should be considered to prevent postoperative pulmonary dysfunction.

Keywords

COMPLICATIONS, RISK, factors, SURGERY, Cardiac

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