Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1590/S0034-70942009000200005
Brazilian Journal of Anesthesiology
Scientific Article

Análise dos efeitos da manobra de recrutamento alveolar na oxigenação sanguínea durante procedimento bariátrico

Analysis of the effects of the alveolar recruitment maneuver on blood oxygenation during bariatric surgery

Alda Paiva de Souza; Márcia Buschpigel; Ligia Andrade Silva Telles Mathias; Carlos Alberto Malheiros; Vera Lucia dos Santos Alves

http://dx.doi.org/10.1590/S0034-70942009000200005 Braz J Anesthesiol, vol.59, n2, p.177-186, 2009
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Resumo

JUSTIFICATIVAS E OBJETIVOS: A manobra de recrutamento alveolar (MRA) é indicada no tratamento de atelectasias intraoperatórias. O objetivo do presente estudo foi comparar duas técnicas de MRA por meio da resposta da relação PaO2/FiO2 e da soma [PaO2+PaCO2], em pacientes obesos grau III. MÉTODO: Estudo prospectivo aberto em pacientes adultos, obesos grau III, submetidos a procedimento cirúrgico bariátrico em ventilação controlada a volume, pressão positiva no final da expiração (PEEP) de 5 cmH2O e divididos em três grupos: G CONT: PEEP de 5 cmH2O; G MRA10/15/20 após sutura da aponeurose: aumento progressivo da PEEP para 10,15 e 20 cmH2O, pausa de 40 segundos e manutenção de cada valor da PEEP por 2 minutos; G MRA30: após sutura da aponeurose: aumento súbito da PEEP para 30 cmH2O, 40 segundos de pausa e manutenção da PEEP em 30 cmH2O por dois minutos. Foram analisadas as variáveis frequência cardíaca, pressão arterial média, sistólica, diastólica, pressão média das vias aéreas (P MVA) e de platô (P PLAT), pressão arterial de oxigênio (PaO2), pressão arterial de CO2 (PaCO2), relação PaO2/FiO2 (fração inspiratória de oxigênio) e soma [PaO2+PaCO2]. RESULTADOS: As variáveis que apresentaram diferença estatística significativa entre os três grupos foram: P PLAT, P MVA, PaO2, relação PaO2/FiO2 e soma [PaO2+PaCO2] (p < 0,0001). Na comparação dos grupos dois a dois, verificou-se diferença estatística significativa para as variáveis P PLAT e P MVA: G CONT X G MRA10/15/20 e G CONT X G MRA30 e para as variáveis relação PaO2/FiO2 e soma [PaO2+PaCO2]: G CONT X G MRA30. CONCLUSÕES: A técnica de MRA com aumento súbito da PEEP para 30 cm H2O mostrou a melhor resposta da relação PaO2/FiO2.

Palavras-chave

CIRURGIA, COMPLICAÇÕES, VENTILAÇÃO, VENTILAÇÃO

Abstract

BACKGROUND AND METHDS: Alveolar recruitment maneuver (ARM) is indicated in the treatment of intraoperative atelectasis. The objective of the present study was to compare two techniques of ARM using the response of the PaO2/FiO2 ratio and [PaO2 + PaCO2] in patients with grade III obesity. METHODS: This was an open prospective study with adult patients with grade III obesity who underwent bariatric surgery under volume-controlled mechanical ventilation with positive end-expiratory pressure (PEEP) of 5 cmH2O, divided in three groups: G CONT: PEEP of 5 cmH2O; G ARM10/15/20 after suture of the aponeurosis: progressive increase in PEEP to 10, 15, and 20 cmH2O with a 40-second pause and maintaining each level of PEEP for 2 minutes; and G ARM30 after suture of the aponeurosis: sudden increase in PEEP to 30 cmH2O with a 40-second pause and maintaining a PEEP of 30 for 2 minutes. Heart rate, mean arterial pressure, systolic and diastolic blood pressure, mean (P AW) and plateau (P PLAT) airways pressure, partial pressure of oxygen (PaO2), partial pressure of carbon dioxide (PaCO2), PaO2/FiO2 ratio (inspired fraction of oxygen), and [PaO2 + PaCO2] were analyzed. RESULTS: The following parameters showed statistically significant differences among the study groups: P PLAT, P AW, PaO2, PaO2/FiO2 ratio, and [PaO2 + PaCO2] (p < 0.0001). Comparing the groups two by two, the following parameters showed statistically significant differences: for P PLAT and P AW: G CONT x G2ARM10/15/20 and G CONT x G ARM30; and for PaO2/FiO2 ratio and [PaO2 + PaCO2]: G CONT x G ARM30. CONCLUSIONS: Alveolar recruitment maneuver with sudden increase of PEEP to 30 cmH2O showed a better response of the PaO2/FiO2 ratio.

Keywords

COMPLICATIONS, SURGERY, VENTILATION, VENTILATION

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