Luciana Castilho de Figueiredo

Does the pain disturb the respiratory function after open heart surgery

OBJECTIVE The post operative pain after open heart surgeries had been often reported. Meager reports about respiratory function and pain correlation had been reported. The aim of this article is to assess the pain intensity and location during hospital admittance and its effect on pulmonary function in patients underwent elective cardiac surgery. METHODS Pulmonary function (lung volumes, respiratory pressures and peak expiratory flow) was assessed at the preoperative and post-operative time (1, 3 and 5 days) by ventilometer, manovacuometer and peak flow meter measurements. The assessment of pain intensity was carried out with a visual analogue scale for pain. RESULTS The majority of pain site was on sternotomy incision (50% of patients) and the intensity was higher at the first postoperative day (8.32 by visual scale measurement). All pulmonary variables decreased on post-operative time when compared to baseline values. All respiratory variables remained lower than to pre-operative time at fifth postoperative time (P > 0.05), with exception for respiratory rate. The pain and maximal inspiratory pressure showed a negative correlation at the first postoperative day (P = 0.019). CONCLUSION Postoperative pain decreased lung function in patients precluding deep inspirations, in special, at the first post-operative day.

Impact of alveolar recruitment maneuver in the postoperative period of videolaparoscopic bariatric surgery

BACKGROUND AND OBJECTIVES Pulmonary complications in bariatric surgery are common and, therefore, alveolar recruitment maneuvers (ARM) have been used to prevent or reduce them in the postoperative period (POP). The aim of this study was to evaluate the impact of ARM performed intraoperatively in patients undergoing bariatric surgery by videolaparoscopy in the incidence of postoperative pulmonary complications. METHODS Randomized clinical trial with 30 patients divided into control group (CG) and experimental group (EG), with analysis of spirometric, ventilatory, hemodynamic, and radiographic variables. ARM was performed in EG with positive end expiratory pressure of 30 cmH₂O and inspiratory plateau pressure of 45 cmH₂O for 2 minutes after pneumoperitoneum deflation. RESULTS We observed a significant decrease in spirometric values (p ≤ 0.001) and higher incidence of pulmonary complications on chest radiograph (p=0.02) in CG, as well as significant improvement in dyspnoea Borg scale (p ≤ 0.001) in EG. CONCLUSIONS We conclude that ARM is a safe and effective technique when used for prevention of pulmonary complications in patients undergoing bariatric surgery, resulting in more favorable radiological and spirometric findings in the experimental group compared to the control group in the PO.

Lesão pulmonar e ventilação mecânica em cirurgia cardíaca: revisão

Respiratory failure after cardiopulmonary bypass heart surgery can result from many pre-, intra- or postoperative respiratory system-related factors. This review was aimed to discuss some factors related to acute lung injury observed during the postoperative period of cardiac surgery and the mechanical ventilation modalities which should be considered to prevent hypoxemia.

Plasmatic vasopressin in patients undergoing conventional infra-renal abdominal aorta aneurysm repair.

OBJECTIVES To evaluate plasmatic arginine vasopressin (AVP) levels in patients undergoing scheduled conventional abdominal aortic aneurysm (AAA) repair. METHODS Plasmatic AVP concentrations were measured by radioimmunoassay in 22 non-consecutive adult patients undergoing infra-renal AAA repair. They were under combined general and epidural anesthesia at the following time frames: 1--pre-operative (T0); 2--2h (T1) and 6h (T2) after the surgical procedure; 3--in the morning at the first (T3), second (T4) and third (T5) post-operative days. Some clinical and laboratory variables were also recorded. RESULTS The mean age of patients was 68 ± 10 years; 17 were males. Plasmatic AVP (mean ± SD; pg/mL) was within the normal range at T0 (1.4 ± 0.7; baseline), increasing significantly at T1 (62.6 ± 62.9; P<0.001) and at T2 (31.5 ± 49.7; P<0.001), with a progressive fall, returning to basal levels at T5 (2.1 ± 3.8; P = NS). Positive and statistically significant correlations were found between AVP and glycemia, serum lactate and white blood cells counts, but not with systemic arterial pressure or plasma osmolarity during the postoperative period. CONCLUSIONS Considering that no correlations were found between AVP levels and hemodynamic or plasmatic osmolarity variations in AAA repair, it seems that stress response is mainly secondary to noxious stimulation mediated by the autonomic nervous system that is not completely blocked by anesthetics.Objectives: To evaluate plasmatic arginine vasopressin (AVP) levels in patients undergoing scheduled conventional abdominal aortic aneurysm (AAA) repair. Methods: Plasmatic AVP concentrations were measured by radioimmunoassay in 22 non-consecutive adult patients undergoing infra-renal AAA repair. They were under combined general and epidural anesthesia at the following time frames: 1 - pre-operative (T0); 2 - 2h (T1) and 6h (T2) after the surgical procedure; 3 - in the morning at the first (T3), second (T4) and third (T5) post-operative days. Some clinical and laboratory variables were also recorded. Results: The mean age of patients was 68±10 years; 17 were males. Plasmatic AVP (mean±SD; pg/mL) was within the normal range at T0 (1.4±0.7; baseline), increasing significantly at T1 (62.6±62.9; P<0.001) and at T2 (31.5±49.7; P<0.001), with a progressive fall, returning to basal levels at T5 (2.1±3.8; P=NS). Positive and statistically significant correlations were found between AVP and glycemia, serum lactate and white blood cells counts, but not with systemic arterial pressure or plasma osmolarity during the postoperative period. Conclusions: Considering that no correlations were found between AVP levels and hemodynamic or plasmatic osmolarity variations in AAA repair, it seems that stress

Inspiratory Muscle Training in the Intensive Care Unit: A New Perspective

Background Prolonged use of mechanical ventilation (MV) leads to weakening of the respiratory muscles, especially in patients subjected to sedation, but this effect seems to be preventable or more quickly reversible using respiratory muscle training. The aims of the study were to assess variations in respiratory and hemodinamic parameters with electronic inspiratory muscle training (EIMT) in tracheostomized patients requiring MV and to compare these variations with those in a group of patients subjected to an intermittent nebulization program (INP). Methods This was a pilot, prospective, randomized study of tracheostomized patients requiring MV in one intensive care unit (ICU). Twenty-one patients were randomized: 11 into the INP group and 10 into the EIMT group. Two patients were excluded in experimental group because of hemodynamic instability. Results In the EIMT group, maximal inspiratory pressure (MIP) after training was significantly higher than that before (P = 0.017), there were no hemodynamic changes, and the total weaning time was shorter than in the INP group (P = 0.0192). Conclusion The EIMT device is safe, promotes an increase in MIP, and leads to a shorter ventilator weaning time than that seen in patients treated using INP.

Risk factors for transient dysfunction of gas exchange after cardiac surgery

Objective A retrospective cohort study was preformed aiming to verify the presence of transient dysfunction of gas exchange in the postoperative period of cardiac surgery and determine if this disorder is linked to cardiorespiratory events. Methods We included 942 consecutive patients undergoing cardiac surgery and cardiac procedures who were referred to the Intensive Care Unit between June 2007 and November 2011. Results Fifteen patients had acute respiratory distress syndrome (2%), 199 (27.75%) had mild transient dysfunction of gas exchange, 402 (56.1%) had moderate transient dysfunction of gas exchange, and 39 (5.4%) had severe transient dysfunction of gas exchange. Hypertension and cardiogenic shock were associated with the emergence of moderate transient dysfunction of gas exchange postoperatively (P=0.02 and P=0.019, respectively) and were risk factors for this dysfunction (P=0.0023 and P=0.0017, respectively). Diabetes mellitus was also a risk factor for transient dysfunction of gas exchange (P=0.03). Pneumonia was present in 8.9% of cases and correlated with the presence of moderate transient dysfunction of gas exchange (P=0.001). Severe transient dysfunction of gas exchange was associated with patients who had renal replacement therapy (P=0.0005), hemotherapy (P=0.0001), enteral nutrition (P=0.0012), or cardiac arrhythmia (P=0.0451). Conclusion Preoperative hypertension and cardiogenic shock were associated with the occurrence of postoperative transient dysfunction of gas exchange. The preoperative risk factors included hypertension, cardiogenic shock, and diabetes. Postoperatively, pneumonia, ventilator-associated pneumonia, renal replacement therapy, hemotherapy, and cardiac arrhythmia were associated with the appearance of some degree of transient dysfunction of gas exchange, which was a risk factor for reintubation, pneumonia, ventilator-associated pneumonia, and renal replacement therapy in the postoperative period of cardiac surgery and cardiac procedures.

Impacto da manobra de recrutamento alveolar no pós-operatório de cirurgia bariátrica videolaparoscópica

JUSTIFICATIVA E OBJETIVOS: Complicacoes pulmonares em cirurgias bariatricas sao frequentes, e, por isso, manobras de recrutamento alveolar (MRA) tem sido utilizadas para preveni-las ou reduzi-las no pos-operatorio (PO) imediato. O objetivo do estudo foi avaliar o impacto da MRA executada no intraoperatorio de pacientes submetidos a cirurgia bariatrica por videolaparoscopia na incidencia de complicacoes pulmonares no pos-operatorio. METODO: Ensaio clinico aleatorio com 30 pacientes alocados em Grupo Controle (GC) e Grupo Experimental (GE), sendo analisadas variaveis espirometricas, ventilatorias, hemodinâmicas e radiograficas. A MRA foi realizada no GE com pressao positiva expiratoria final de 30 cmH2O e pressao de plato inspiratoria de 45 cmH2O por 2 minutos apos a desinsuflacao do pneumoperitoneo. RESULTADOS: Observaram-se queda significativa nos valores espirometricos (p < 0,001) e maior incidencia de complicacoes pulmonares na radiografia toracica (p = 0,02) no GC, bem como melhora significativa da escala de BORG dispneia (p < 0,001) no GE. CONCLUSOES: Concluiu-se que a MRA e uma tecnica segura e eficaz quando utilizada para a prevencao de complicacoes pulmonares em pacientes submetidos a cirurgia bariatrica, resultando em achados espirometricos e radiologicos mais favoraveis no Grupo Experimental em relacao ao Grupo Controle no PO.

Teste de permeabilidade de vias aéreas pré-extubação: comparação entre três métodos em ventilação espontânea.

BACKGROUND AND OBJECTIVES: The cuff leak test aims to evaluate the presence of airway obstruction and normally is carried through in the controlled mode of mechanical ventilation. The objective of this study was to evaluate the cuff leak in patients breathing spontaneously, across three different methods, and to compare them. METHODS: Twenty intubated patients had been submitted to three different forms of cuff leak test, all of them in spontaneous respiration: measuring air leak buy using a ventilometer and with the patient connected to the mechanical ventilator (test 1); through the display of the mechanical ventilator (test 2); and with ventilometer and the patient detached from the mechanical ventilator (test 3). The air leak around the tracheal tube (TT) was defined as the percentage difference between the inspired tidal volume (insufflated cuff) and exhaled (deflated cuff). The air leak differences between the three tests were evaluated, as well as their correlations to three variables: cuff pressure, TT diameter and intubation time. RESULTS: Statistically significant (p < 0.05) air leak difference was observed between the tests 1 and 2 in relation to the test 3 in the general and regarding time intubation below 48h and cuff pressure below 20 cmH2O. Regarding the tube diameter, it had been difference only between tests 2 and 3 for 8.5 mm tubes. CONCLUSIONS: The cuff leak test in spontaneous ventilation seems to be more accurate when the patient is connected to the mechanical ventilator, and that additional studies are needed to determine the real contribution of the test in this ventilation mode to predict laryngeal edema.

Comparação entre o uso de bocal e máscara facial na avaliação de volumes pulmonares e capacidade vital em indivíduos saudáveis

Testes de funcao pulmonar sao usados para determinar a gravidade, as consequencias funcionais e o progresso de disfuncoes pulmonares e neuromusculares. As variacoes metodologicas com o bocal e a mascara facial e a cooperacao do paciente podem interferir no desempenho das manobras e afetar as medidas. O objetivo deste estudo foi comparar os valores de volumes pulmonares (volume corrente [Vc], volume-minuto [Vm]), frequencia respiratoria (FR) e capacidade vital (CV) em individuos saudaveis quando avaliados por meio do bocal e da mascara facial. Participaram do estudo 60 voluntarios saudaveis, 14 homens e 46 mulheres, com media de idade de 22,9±7,1 anos. Para a avaliacao com bocal, utilizou-se uma peca semirrigida descartavel e clipe nasal; a mascara usada foi facial plastica com borda pneumatica inflavel. As medidas obtidas foram comparadas estatisticamente (nivel de significância 5%). Os valores obtidos com o bocal e com a mascara facial foram, respectivamente: FR, 15 rpm x 13 rpm (p<0,01); Vm, 14,87 l/min x 10,02 l/min (p<0,01); Vc, 0,93 l x 0,8 l (p<0,01); CV, 3,85 l x 3,52 l (p<0,01). Os valores de volumes pulmonares e capacidade vital mostraram-se pois significativamente inferiores quando avaliados com a mascara facial em comparacao ao bocal.

Análise comparativa da função respiratória de indivíduos hígidos em solo e na água

Measuring respiratory function provides essential information to assess pulmonary changes. Effects of water hydrostatic pressure on the submerged chest cause changes in the respiratory system. The purpose here was to compare respiratory function variables - minute volume (MV), tidal volume (TV), vital capacity (Vitalc), and respiratory rate (RR) - on the ground and with chest submerged in water. Respiratory function of 30 healthy female volunteers (mean age 20.93 ± 2.11; weight 58.8±9.2 kg; body mass index 21.78±2.63 kg/m²) was assessed by spirometry on the ground, and 1 and 20 minutes after immersion in warm water at shoulder level in the sitting position. As compared to ground levels, statistically significant increases were found in MV (p=0.015) and TV (p=0.027) 20 minutes after immersion, as well as a significant decrease (p=0.016) in Vitalc one minute after immersion. Longer time immersion has thus altered values obtained on ground, except for Vitalc, which showed significant reduction on the first minute after chest immersion. Comparison between variable values obtained 1 and 20 minutes in water showed no significant difference. It may thus be said that chest submersion in warm water caused an increase in MV and VT and a decrease in Vitalc of healthy subjects.