Pressão expiratória positiva na via aérea por máscara facial na hemodinâmica de pós-operatórios cardíacos

Sena, Ana Claudia Borges dos Santos; Ribeiro, Sérgio Pinto; Condessa, Robledo Leal; Vieira, Sílvia Regina Rios

doi:10.1590/s0066-782x2010005000128

Cited by 3 publications

(3 citation statements)

References 30 publications

(29 reference statements)

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“…Similar results were also found by Sena et al [16] , but safety was demonstrated with patients already extubated and receiving the application of positive expiratory pressure (EPAP) of 10 cmH 2 O, generating a discrete impact on heart rate.…”

Section: Discussionsupporting

confidence: 83%

Impact of Lung Expansion Therapy Using Positive End-Expiratory Pressure in Mechanically Ventilated Patients Submitted to Coronary Artery Bypass Grafting

Cordeiro¹,

Carvalho²,

Leite³

et al. 2019

Braz J Cardiovasc Surg

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ObjectiveTo evaluate the impact of different levels of positive end-expiratory pressure (PEEP) on gas exchange in patients undergoing coronary artery bypass grafting (CABG).MethodsA randomized clinical trial was conducted with patients undergoing CABG surgery. Patients were randomized into three groups: Group 10, PEEP of 10 cmH2O; Group 12, PEEP of 12 cmH2O; and Group 15, PEEP of 15 cmH2O. After the randomization, all patients underwent gas analysis at three moments: (1) before lung expansion therapy (LET); (2) 30 minutes after LET; and (3) one hour after extubation.ResultsSixty-six patients were studied, of which 61.7% were men, with mean age of 64 ± 8.9 years. Patients allocated to Group 15 showed a significant improvement in gas exchange comparing pre- and post-expansion values (239±21 vs. 301±19, P<0,001) and the increase was maintained after extubation (278±26). Despite the use of high levels of PEEP, no significant hemodynamic change was evidenced.ConclusionIt is concluded that high levels of PEEP (15 cmH2O) are beneficial for the improvement of gas exchange in patients undergoing CABG.

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Section: Discussionsupporting

confidence: 83%

Impact of Lung Expansion Therapy Using Positive End-Expiratory Pressure in Mechanically Ventilated Patients Submitted to Coronary Artery Bypass Grafting

Cordeiro¹,

Carvalho²,

Leite³

et al. 2019

Braz J Cardiovasc Surg

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“…In postoperative cardiac surgery patients, it was found that the application of a 10 cmH2O EPAP was associated with a small increase in mean and pulmonary arterial pressures, pulmonary artery occlusion pressure and central venous pressure [15]. In our study there was an increase in heart rate, while SBP, DBP and MAP decreased, but without significance even with the use of higher pressures.…”

Section: Discussioncontrasting

confidence: 48%

Pressão positiva expiratória das vias aéreas sobre a oxigenação e hemodinâmica em pacientes submetidos a revascularização do miocárdio

Cordeiro¹,

Andrade²,

Santos³

et al. 2022

Fisioter Bras

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Introdução: A pressão positiva expiratória nas vias aéreas (EPAP) é a aplicação de uma resistência expiratória para manter a pressão positiva nas vias aéreas e também tem sido amplamente utilizada para prevenir possíveis complicações no pós-operatório de cirurgia cardíaca. Objetivo: Descrever o comportamento da oxigenação e hemodinâmica durante o uso de EPAP em pacientes submetidos à cirurgia de revascularização do miocárdio (RM). Métodos: Estudo transversal que avaliou saturação periférica de oxigênio (SpO2), frequência cardíaca (FC), frequência respiratória (FR), pressão arterial sistólica (PAS), diastólica (PAD) e média (PAM), pressão arterial de oxigênio (PaO2), pressão arterial de dióxido de carbono (PaCO2) e índice de oxigenação calculado dividindo a PaO2 pela fração inspirada de oxigênio (FiO2), os pacientes foram avaliados em repouso, no primeiro dia de pós-operatório. A EPAP foi realizada com o paciente na sedestração da poltrona e uma gasometria arterial foi coletada e analisada para verificar os valores de PaO2, PaCO2, SaO2 e PaO2/FiO2. Foi aplicada uma resistência expiratória de 12 cmH2O por dez minutos. Imediatamente após a aplicação do EPAP, os pacientes tiveram nova análise gasométrica e a hemodinâmica analisada. Resultados: 58 pacientes, 41 (71%) do sexo masculino e com idade média de 54 ± 8 anos foram avaliados. O uso de EPAP no pós-operatório levou à melhora de todas as variáveis gasométricas, exceto PaCO2. Houve uma melhora na SaO2 (%) pré-EPAP 94 ± 3 e pós-EPAP 98 ± 2, PaO2/FiO2 pré-EPAP 279 ± 10 e pós-EPAP 346 ± 8, PaO2 (mmHg) pré-EPAP 78 ± 8 e pós-EPAP 97 ± 7. Conclusão: Concluiu-se que a aplicação do EPAP teve um impacto positivo na oxigenação em pacientes submetidos à RM sem gerar efeitos adversos na hemodinâmica.

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“…Indeed, positive expiratory pressure might provide several benefits to patients, such as lung re-expansion and airway clearance optimization. (20,21) In similar studies, increased PaO 2 and SaO 2 with decreased PaCO 2 were observed. An improvement in respiratory mechanics and bronchial clearance was correlated with this effect.…”

Section: Discussionmentioning

confidence: 62%

Acute bag-valve breathing maneuvers plus manual chest compression is safe during stable septic shock: a randomized clinical trial

Blattner¹,

Santos²,

Dias³

et al. 2017

Revista Brasileira De Terapia Intensiva

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ObjectiveTo evaluate the effects of bag-valve breathing maneuvers combined with standard manual chest compression techniques on safety, hemodynamics and oxygenation in stable septic shock patients.DesignA parallel, assessor-blinded, randomized trial of two groups. A computer-generated list of random numbers was prepared by an independent researcher to allocate treatments.SettingThe Intensive Care Unit at Hospital São Lucas, Pontifícia Universidade Católica do Rio Grande do Sul.ParticipantsFifty-two subjects were assessed for eligibility, and 32 were included. All included subjects (n = 32) received the allocated intervention (n = 19 for the Experimental Group and n = 13 for the Control Group).InterventionTwenty minutes of bag-valve breathing maneuvers combined with manual chest compression techniques (Experimental Group) or chest compression, as routinely used at our intensive care unit (Control Group). Follow-up was performed immediately after and at 30 minutes after the intervention.Main outcome measureMean artery pressure.ResultsAll included subjects completed the trial (N = 32). We found no relevant effects on mean artery pressure (p = 0.17), heart rate (p = 0.50) or mean pulmonary artery pressure (p = 0.89) after adjusting for subject age and weight. Both groups were identical regarding oxygen consumption after the data adjustment (p = 0.84). Peripheral oxygen saturation tended to increase over time in both groups (p = 0.05), and there was no significant association between cardiac output and venous oxygen saturation (p = 0.813). No clinical deterioration was observed.ConclusionA single session of bag-valve breathing maneuvers combined with manual chest compression is hemodynamically safe for stable septic-shocked subjects over the short-term.

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Pressão expiratória positiva na via aérea por máscara facial na hemodinâmica de pós-operatórios cardíacos

Abstract: Background: Expiratory positive airway pressure (EPAP) is used in after cardiac surgeries. However, its hemodynamic effects have not been clearly studied.

Cited by 3 publications

References 30 publications

Impact of Lung Expansion Therapy Using Positive End-Expiratory Pressure in Mechanically Ventilated Patients Submitted to Coronary Artery Bypass Grafting

Impact of Lung Expansion Therapy Using Positive End-Expiratory Pressure in Mechanically Ventilated Patients Submitted to Coronary Artery Bypass Grafting

Pressão positiva expiratória das vias aéreas sobre a oxigenação e hemodinâmica em pacientes submetidos a revascularização do miocárdio

Acute bag-valve breathing maneuvers plus manual chest compression is safe during stable septic shock: a randomized clinical trial

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