Benefícios da ventilação não-invasiva após extubação no pós-operatório de cirurgia cardíaca

Abstract

Benefícios da ventilação não-invasiva após extubação no pós-operatório de cirurgia cardíacaBenefits of non-invasive ventilation after extubation in the postoperative period of heart surgery Abstract Objective: to show the benefits of the use of non-invasive positive pressure ventilation (NPPV) in the process of weaning from mechanical ventilation in the immediate postoperative period of heart surgery.Methods: A prospective, randomized and controlled study was performed involving 100 consecutive patients submitted to coronary artery bypass grafting or valve surgery. The subjects were admitted into the Intensive Care Unit (ICU) under mechanical ventilation and randomized in a study group (n=50), which used NPPV with bilevel pressure for 30 minutes after extubation, and a control group (n=50) which only used a nasal O 2 catheter. Anthropometric variables and the times of the intra-operative periods corresponding to anesthesia, surgery and cardiopulmonary bypass, as well as the time required for weaning from invasive mechanical ventilation were analysed. The arterial blood gases and hemodynamic variables were also assessed before and after extubation.Results: The evolution was similar for the control and study groups without statistically significant differences of the variables analyzed except for the PaO 2 . On comparing the groups, the PaO 2 improved significantly (p = 0.0009) with the use of NPPV for 30 minutes after extubation, but there was no statistically significant difference in the PaCO 2 (p = 0.557).Conclusion: The use of NPPV for 30 minutes after extubation improved oxygenation in the immediate postoperative period of heart surgery. Descriptors 345LOPES, CR ET AL -Benefits of non-invasive ventilation after extubation in the postoperative period of heart surgery Bras Cir Cardiovasc 2008; 23(3): 344-350 Rev

Perfil ventilatório dos pacientes submetidos a cirurgia de revascularização do miocárdio

“…The incidence of pulmonary complications of patients on the preoperative period can be noted on the 1 st postoperative day and on the 6th postoperative day. A greater number of radiographs changed on the 6 th postoperative day was found (78%) compared to the 1st postoperative day (40%), occurring on intubation, decrease of respiratory complications and thus resulting in reduced length of hospital stay associated with the reduction in hospital costs [5,8,10,20,21].…”

“…Lopes et al [21] showed in their study improvement in oxygenation of the patients in the immediate postoperative period of heart surgery, using noninvasive ventilation for 30 minutes after extubation when compared to the control group with nasal oxygen catheter.…”

Complicações que aumentam o tempo de permanência na unidade de terapia intensiva na cirurgia cardíaca

“…Cardiac surgeries are major surgeries broadcasted worldwide, among them stands out mostly coronary artery bypass (CABG) and valve replacement [1][2][3][4].…”

“…The morbidity and mortality in the postoperative of cardiac surgeries is of great interest, prompting several protocols for postoperative management [1][2][3][4]. The ischemic asymptomatic episodes are very frequent and seem to imply a worse prognosis [11,12].…”

“…The patient undergoing cardiac surgery shall remain on mechanical ventilation (MV) in the immediate postoperative period until he covers total lucidity, in some cases for even longer, and should remain in bed for three to six weeks [3,[12][13][14]. Because of hemodynamic instability that can happen in the immediate postoperative period, the patient may need inotropic support (VAD) and must remain in the Intensive Care Unit (ICU) while there is need [15][16][17].…”