Aplicação da ventilação não-invasiva em insuficiência respiratória aguda após cirurgia cardiovascular

Coimbra, Vera Regina de Morais; Lara, Rodrigo De Almeida; Flores, Ériko Gonçalves; Nozawa, Emı́lia; Júnior, José Octávio Costa Auler; Feltrim, Maria Ignêz Z.

doi:10.1590/s0066-782x2007001700004

Cited by 20 publications

(11 citation statements)

References 25 publications

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“…One report was translated from Mandarin [20] and one from German [21] into English to access eligibility. Of 68 potentially eligible studies, three were excluded because they were not RCTs, 55 studies did not match the ALI or ARDS criteria, 4 trials were excluded due to fluids comparison [20,22-24], and 3 studies did not report the outcome investigated by this review [25-27]. Detailed information on the excluded articles is listed in the Additional file 2.…”

Section: Resultsmentioning

confidence: 99%

Albumin versus crystalloid solutions in patients with the acute respiratory distress syndrome: a systematic review and meta-analysis

et al. 2014

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IntroductionIn patients with acute respiratory distress syndrome (ARDS) fluid therapy might be necessary. The aim of this systematic review and meta-analysis is to determine the effects of colloid therapy compared to crystalloids on mortality and oxygenation in adults with ARDS.MethodsRandomized controlled trials (RCTs) were identified through a systematic literature search of MEDLINE, EMBASE, CENTRAL and LILACS. Articles published up to 15th February 2013 were independently screened, abstracted, and assessed (Cochrane Risk of Bias Tool) to provide evidence-based therapy recommendations. RCTs were eligible if they compared colloid versus crystalloid therapy on lung function, inflammation, damage or mortality in adults with ARDS. Primary outcome parameters were respiratory mechanics, gas exchange lung inflammation and damage as well as hospital mortality. Kidney function, need for renal replacement therapy, hemodynamic stabilization and intensive care unit (ICU) length of stay served as secondary outcomes.ResultsA total of 3 RCTs out of 4130 potential trials found in the databases were selected for qualitative and quantitative analysis totaling 206 patients who received either albumin or saline. Overall risk of bias was unclear to high in the identified trials. Calculated pooled risk of death was not statistically significant (albumin 34 of 100 (34.0%) versus 40 of 104 (38.5%), relative risk (RR) = 0.89, 95% confidence interval (CI) 0.62 to 1.28, P = 0.539). Weighted mean difference (WMD) in PaO2/FiO2 (mmHg) improved in the first 48 hours (WMD = 62, 95% CI 47 to 77, P <0.001, I2 = 0%) after therapy start and remained stable after 7 days (WMD = 20, 95% CI 4 to 36, P = 0.017, I2 = 0%).ConclusionsThere is a high need for RCTs investigating the effects of colloids in ARDS patients. Based on the findings of this review, colloid therapy with albumin improved oxygenation but did not affect mortality.

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Section: Resultsmentioning

confidence: 99%

Albumin versus crystalloid solutions in patients with the acute respiratory distress syndrome: a systematic review and meta-analysis

et al. 2014

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“…However, the positive intrathoracic pressure offered by NIV influences the patient's hemodynamic condition, with the decrease of cardiac preload and afterload due to the reduced transmural pressure. 33 …”

Section: Discussionmentioning

confidence: 99%

Non-Invasive Ventilation in Patients with Heart Failure: A Systematic Review and Meta-Analysis

Bittencourt¹,

Reis²,

Lima³

et al. 2017

Arquivos Brasileiros De Cardiologia

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Non-invasive ventilation (NIV) may perfect respiratory and cardiac performance in patients with heart failure (HF).The objective of the study to establish, through systematic review and meta-analysis, NIV influence on functional capacity of HF patients.A systematic review with meta-analysis of randomized studies was carried out through research of databases of Cochrane Library, SciELO, Pubmed and PEDro, using the key-words: heart failure, non-invasive ventilation, exercise tolerance; and the free terms: bi-level positive airway pressure (BIPAP), continuous positive airway pressure (CPAP), and functional capacity (terms were searched for in English and Portuguese) using the Boolean operators AND and OR. Methodological quality was ensured through PEDro scale. Weighted averages and a 95% confidence interval (CI) were calculated. The meta-analysis was done thorugh the software Review Manager, version 5.3 (Cochrane Collaboration).Four randomized clinical trials were included. Individual studies suggest NIV improved functional capacity. NIV resulted in improvement in the distance of the six-minute walk test (6MWT) (68.7m 95%CI: 52.6 to 84.9) in comparison to the control group.We conclude that the NIV is an intervention that promotes important effects in the improvement of functional capacity of HF patients. However, there is a gap in literature on which are the most adequate parameters for the application of this technique.

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“…Mazullo et al 18 também observou que, os pacientes em PO imediato de cirurgia cardíaca que foram extubados e imediatamente submetidos de forma profilática à VMNI tipo Binível, não apresentaram sinais de insuficiência respiratória aguda e consequentemente nenhum deles retornou para a ventilação mecânica invasiva. Coimbra constatou que a VMNI foi uma estratégia ventilatória eficaz na maioria dos casos, evitando a instalação de ventilação mecânica invasiva, porém fatores como idade, freqüência cardíaca e freqüência respiratória prévias podem comprometer a eficácia do suporte ventilatório 19 .…”

Section: Fisioterapiaunclassified

Efeitos da ventilação mecânica não invasiva sobre a função pulmonar em pacientes no pós-operatório de cirurgia de revascularização do miocárdio

Ataide¹,

Ferraz²,

Rocha³

et al. 2017

PRMJ

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Este é um artigo publicado em acesso aberto (Open Access) sob a licença Creative Commons Attribution, que permite uso, distribuição e reprodução em qualquer meio, sem restrições desde que o trabalho original seja corretamente citado. Resumo Introdução: A cirurgia cardíaca é responsável por diminuir os quadros sintomáticos e promover qualidade de vida dos pacientes com doença arterial coronariana. No entanto, complicações pulmonares são observadas com frequência e representam importante causa de morbidade e mortalidade para pacientes no pós-operatório imediato de cirurgia cardíaca, fato que pode ser minimizado pela fisioterapia com a utilização da ventilação mecânica não invasiva (VMNI). Objetivo: Verificar os efeitos da ventilação mecânica não invasiva sobre valores espirométricos em pacientes no pós-operatório de cirurgia de revascularização do miocárdio. Metodologia: Participaram 27 pacientes no primeiro pós operatório de cirurgia de revascularização do miocárdio. Foi realizada a espirometria antes e após aplicação em sessão única da ventilação mecânica não invasiva na modalidade BIPAP com pressão inspiratória de 15 cmH2O e pressão expiratória de 5 cmH2O. Resultados: Houve aumento do VEF 1 (p<0,0001) e do CVF (p<0,0001) após aplicação da VMNI, no entanto quanto ao Índice de Tiffeneau não houve diferença estatística em relação aos valores encontrados antes e após aplicação da VMNI (p=0,1455). Conclusão: O uso da VMNI no pós-operatório de cirurgia de revascularização do miocárdio melhorou a função pulmonar. Efeitos da ventilação mecânica não invasivaDescritores: cirurgia cardíaca; fisioterapia; ventilação mecânica.Summary Introduction: Cardiac surgery is responsible for decreasing the symptoms and promoting the quality of life of patients with coronary artery disease. However, pulmonary complications are frequently observed and represent an important cause of morbidity and mortality for patients in the immediate postoperative period of cardiac surgery, a fact that can be minimized by physiotherapy with the use of non-invasive mechanical ventilation (NIMV). Objective: To verify the effects of non-invasive mechanical ventilation on spirometric values in patients in the postoperative period of myocardial revascularization surgery. Methods: 27 patients participated in the first postoperative period of myocardial revascularization surgery. Spirometry was performed before and after a single session of noninvasive mechanical ventilation in the BIPAP modality with inspiratory pressure of 15 cmH2O and expiratory pressure of 5 cmH2O. Results: There was an increase in FEV1 (p <0.0001) and FVC (p <0.0001) after application of NIMV; however, there was no statistically significant difference between the Tiffeneau index and the NIMV values (p = 0.1455). Conclusion: The use of NIMV in the postoperative period of myocardial revascularization surgery improved pulmonary function.

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Aplicação da ventilação não-invasiva em insuficiência respiratória aguda após cirurgia cardiovascular

Cited by 20 publications

References 25 publications

Albumin versus crystalloid solutions in patients with the acute respiratory distress syndrome: a systematic review and meta-analysis

Albumin versus crystalloid solutions in patients with the acute respiratory distress syndrome: a systematic review and meta-analysis

Non-Invasive Ventilation in Patients with Heart Failure: A Systematic Review and Meta-Analysis

Efeitos da ventilação mecânica não invasiva sobre a função pulmonar em pacientes no pós-operatório de cirurgia de revascularização do miocárdio

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