Análise das alterações ventilatórias e hemodinâmicas com utilização de ventilação mecânica não-invasiva com binível pressórico em pacientes com insuficiência cardíaca congestiva

Abstract

Objective: To observe in practice how noninvasive bilevel positive pressure, applied at different levels, may interfere with systolic arterial pressure (SAP), diastolic arterial pressure (DAP), mean arterial pressure (MAP), heart rate (HR), respiratory rate (RR), and peripheral oxygen saturation (SpO2), in patients with congestive heart failure (CHF).Methods: Fourteen CHF patients (mean age 62.85 years) were treated with noninvasive bilevel mechanical ventilation. Patients were consecutively treated with an expiratory positive airway pressure (EPAP) of 5 cmH2O, 10 cmH2O, 15 cmH2O, the expiratory pressure (EPAP). Ventilation and hemodynamic data were collected at these time points, as well as 5 minutes before the beginning of the protocol and 5 minutes after its completion.Results: A statistically significant difference was observed in the respiratory rate between the moment just before the beginning of the protocol and 5 minutes after positive pressure mask placement (p=0.022), and in oxygen saturation, between the final minute of EPAP at 5 cmH2O and after the removal of the mask (p=0.05). Conclusion:Noninvasive bilevel mechanical ventilation improves oxygenation and reduces respiratory work, thus being beneficial for patients with congestive heart failure. It was not possible to observe statistically significant changes in the hemodynamic data due to the small number of patients and to other associated heart diseases.

Nursing process according the model of self-care in a cardiac bedridden patient

“…A study published in 2007 shows that the mechanical ventilator support installed as therapeutic measure decreases the degree of Dyspnea installation, in addition to increasing the participation of the individual in self-care activities. 9 Such therapeutic measure is maintained through an artificial tracheal prosthesis, whose distal portion contains a cuff, which has the function to seal the airway, preventing the escape of air, thereby maintaining proper ventilation and decreasing the incidence of pulmonary aspiration. It is known, however, that due to the presence of tracheal prosthesis together with an excessive production of mucus, there is usually an accumulation of secretions in the full extent of the respiratory tract.…”