Comparação entre dois metodos de retirada do suporte ventilatorio em pacientes no pos-operatorio de cirurgia cardiaca

AUTOR(ES)
DATA DE PUBLICAÇÃO

2001

RESUMO

NTRODUCTION. Usually, there is no weaning difficulty in mechanical ventilated post-operative coronary artery bypass grafting (CABG) patients, but the literature is not consensual in relation to the best weaning method and the ideal moment for extubation. OBJECTIVE. To compare two weaning methods in uncomplicated CABG post-operative patients by evaluating clinical, ventilatory and pulmonary gas exchange parameters. SETTING. A general adult intensive care unit of a teaching hospital at Campinas State University. DESIGN. a prospective, randomized, interventional study. METHODOLOGY. Forty eight adult, both sexes, post-operative CABG patients were included in this trial, and randomly divided in: 1) study group (N = 24): patients were submitted to direct extubation; and 2) control group (n = 24): patients were extubated after a 30min breathing period on a ?T? piece. Some clinical, ventilatory and pulmonary gas exchange parameters were measured and registered at the end of the weaning process (initial values) and 30min after extubation (final values). RESULTS. Values are expressed as (mean ? SD). The vast majority of patients were male (70.8% in the study group and 66.7% in the control group; p = NS), aging aroud 60 years (56.7 ? 8.8 years in the study goup and 55.8 ? 10.7 years in the control group). P0.1 (3.0 ? 1.3 versus 2.6 ? 1.0 cmH2O), Tobin Index (31.4 ? 10.6 versus 36.5 ? 12.9) and Pimax (-34.4 ? 12.9 versus -31.8 ? 10.2 cmH2O) were similar in the study and control group before extubation (p = NS). Time-to-wean was 6.8 ? 1.9h in the study group and 7.3 ? 2.5h in the control group (p = NS). In relation to mechanical respiratory parameters, respiratory rate (RR ? ipm) increased in both groups (from 15.4 ? 3.3 to 18.2 ? 3.4 in the study group, and from 16.9 ? 3.7 to 18.9 ? 3.9 in the control group; p = 0.0001) as did Tidal Volume (TV ? ml) (from 529.2 ? 146.4 to 612.5 ? 159.6 in the study group, and from 502.1 ? 147.1 to 581.2 ? 192.7 in the control group; p = 0.0001), when considering the initial and the final moments of measurements. On the contrary, a small but significant decreases in Pimax (cmH2O) were observed in both groups (from ?34.4 ? 12.9 to ?30.2 ? 10.5 in the study group, and from ?31.8 ? 10.2 to ?29.7 ? 10.7 in the control group; p = 0.0356). In relation to pulmonary gas exchange parameters, both groups were comparable, without differences between them (p = NS). However, in the control group, some kind of worsening in these parameters were observed when the values obtained at the final moment were compared to those of the initial moment. These data were statistically significant in relation to PaO2 (112.3 ? 30.5, initial versus 103.3 ? 33.1 mmHg, final; p = 0.0159), SaO2 (97.8 ? 1.6, initial versus 97.0 ? 2.3 %, final; p = 0.0171); PaO2/FiO2 (280.8 ? 76.2, initial versus 258.3 ? 82.7, final; p = 0.0340). Respiratory Index has also shown this same tendency (1.28 ? 0.65, initial versus 1.54 ? 0.89, final; p = 0.0106). CONCLUSIONS. Both weaning methods were comparable in relation to the time-to-wean and clinical safety in these post-operative CABG patients. However, some kind of worsening in pulmonary gas exchange parameters was observed in the ?T? piece weaning group. Thus, our data suggest that uncomplicated post-operative CABG patients may be directly extubated according to a step-by-step weaning protocol, without needing to spent a time in a ?T? piece, since this method has shown to be useless and potentially deleterious to pulmonary gas exchange

ASSUNTO(S)

fisioterapia - problemas coração - cirurgia pulmões tratamento intensivo etc exercicios

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