Impacto hemodinâmico de manobra de recrutamento alveolar em pacientes evoluindo com choque cardiogênico no pós-operatório imediato de revascularização do miocárdio

Abstract

In patients who evolved to cardiogenic shock and hypoxemia after MR, ARM improved oxygenation and was well tolerated hemodynamically.

Pulmonary complications in patients undergoing coronary artery bypass grafting at a hospital in Maceio, Brazil

“…The use of CEC and the absence of pulmonary ventilation during this period are also determining factors in the development of pulmonary complications after cardiac surgery, likely due to alterations in the mechanical properties of the respiratory system caused by changes in complacency and pulmonary resistance (7,8,9).…”

Recrutamento alveolar em pacientes no pós-operatório imediato de cirurgia cardíaca

“…for 30 to 40 seconds [10,14,19]. Although alveolar recruitment in pressure controlled ventilation mode is employed less frequently, they are also observed in some studies.…”

“…These factors are: cephalic displacement of the diaphragm caused by anesthetics and neuromuscular blockers, the compression of the lung by mediastinal structures, sternotomy, the surgical management of pleural cavity, the inactivity of the lungs during EC and mechanical ventilation with high inspired oxygen fraction during the intraoperative period [13,14].…”

“…In patients undergoing cardiac surgery intervention with EC, the increase in extravascular lung water and changing the normal activity of the surfactant system, secondary to inflammatory cascade activation and coagulation by blood contact with non-endothelial surfaces, contributes to the weight gain of the lung parenchyma and alveolar unit collapses, decreasing the efficiency of gas exchange [14,15]. These changes reverberate in ventilation-perfusion ratio, causing a decrease in functional residual capacity, increase of intrapulmonary shunt and hypoxemia development [10.16].…”

“…By promoting better distribution of ventilation to previously collapsed areas, the possibility of volutrauma and pulmonary vascular resistance associated with hypoxia can be reduced, improving the right ventricular performance and reducing the need for mechanical ventilation in the postoperative period [14,27].…”