Lígia dos Santos Roceto

Continuous positive airway pressure (CPAP) after lung resection: a randomized clinical trial

CONTEXT AND OBJECTIVE Noninvasive mechanical ventilation during the postoperative period (PO) following lung resection can restore residual functional capacity, improve oxygenation and spare the inspiratory muscles. The objective of this study was to assess the efficacy of continuous positive airway pressure (CPAP) associated with physiotherapy, compared with physiotherapy alone after lung resection. DESIGN AND SETTING Open randomized clinical trial conducted in the clinical hospital of Universidade Estadual de Campinas. METHOD Sessions were held in the immediate postoperative period (POi) and on the first and second postoperative days (PO1 and PO2), and the patients were reassessed on the discharge day. CPAP was applied for two hours and the pressure adjustment was set between 7 and 8.5 cmH2O. The oxygenation index (OI), Borg scale, pain scale and presence of thoracic drains and air losses were evaluated. RESULTS There was a significant increase in the OI in the CPAP group in the POi compared to the Chest Physiotherapy (CP) group, P = 0.024. In the CP group the OI was significantly lower on PO1 (P = 0,042), than CPAP group. The air losses were significantly greater in the CPAP group in the POi and on PO1 (P = 0.001, P = 0.028), but there was no significant difference between the groups on PO2 and PO3. There was a statistically significant difference between the groups regarding the Borg scale in the POi (P < 0.001), but there were no statistically significant differences between the groups regarding the pain score. CONCLUSION CPAP after lung resection is safe and improves oxygenation, without increasing the air losses through the drains. CLINICAL TRIAL REGISTRATION NCT01285648.

Análise da correlação do índice de Helkimo com a função respiratória no pré e pós-operatório de pacientes submetidos à cirurgia cardíaca: estudo piloto

Avaliar a articulacao temporomandibular (ATM) e a funcao respiratoria no pre e pos-operatorio de pacientes submetidos a cirurgia cardiaca eletiva, com intubacao orotraqueal (IOT) e verificar se ha correlacao entre o Indice de disfuncao clinica craniomandibular (IDCCM) com a funcao respiratoria. Foram avaliados pacientes no pre, primeiro e segundo dias de pos-operatorio (PO1, PO2) de cirurgia cardiaca com ate 24 horas IOT. Na avaliacao da ATM foi utilizado o IDCCM e para a avaliacao respiratoria foram utilizados a cirtometria axilar, xifoideana e umbilical, ventilometria, incluindo capacidade vital (CV), volume minuto (VM) e frequencia respiratoria (FR). Completaram o estudo 13 pacientes. Nao foi encontrada diferenca estatistica entre o IDCCM nos diferentes periodos de avaliacao. Houve diminuicao significativa dos valores de cirtometria nas tres medidas e da CV com p<0, 001. A FR apresentou aumento significativo, com p=0,01. Foi encontrada correlacao negativa entre o IDCCM no PO1 e a cirtometria axilar no PO1; correlacao negativa entre o IDCCM no PO2 e a cirtometria xifoideana no PO2, e correlacao positiva entre o IDCCM no PO2 e FR no PO2. Pode-se concluir que o IDCCM nao se alterou significativamente apos intubacao orotraqueal ao longo dos tempos estudados. A funcao respiratoria apresentou diminuicao dos volumes e capacidades pulmonares. A cirtometria axilar e xifoideana, assim como a FR apresentaram correlacao com o IDCCM em diferentes tempos.