Estudo comparativo de dois metodos de ventilação mecanica : hipercapnia permissiva em volume controlado e hipercapnia permissiva em pressão controlada, em pacientes com a sindrome da angustia respiratoria aguda

AUTOR(ES)
DATA DE PUBLICAÇÃO

2002

RESUMO

The main goal of this study was to compare two methods of mechanical ventilation associated to the Permissive Hypercapnia, applied on patients with ARDS, since there is not a preceding consensus concerning the best ventilation . modality associated to the adoption of small flowing volumes, in regard to the minimal of pulmonary aggression to the preexistent lesion and alteration in the mortality of these patients. The adoption of low tidal volumes are due to the consensus that the adoption of high volumes, around 10 to 15 ml/kg weight, is harmful to the respiratory system having relation with the raise of mortality in patients with ARDS. The Volume-Controlled Ventilation (VCV) was compared with the Pressure-Controlled Ventilation (PCV) in relation to respiratory and hemodynamics, also the evolution of these parameters was analyzed during three following days and verified the influence of the evolution of the same parameters in the death. This study was prospective and randomized, with seven patients ventilated at VCV and nine at PCV, with a tidal volume variation between 6 and 8 ml/kg weight, with consequent Permissive Hypercapnia, has being calculated the ideal-PEEP. The patients presented the PaO2/FiO2 inclusion under 200 , with initial evaluation of the gravity through the MURRA Y scale with LIS _ 2.5, of the SOFA and of APACHE 11 scale. Hemodynamic and respiratory monitoring was carried out with Swan-Ganz catheter, gasometry (arterial and venous) and capnometry sampling, twice a day during three following days. There was not significative difference between the two groups with relation to: VC, FR, PEEP, PaO2, FiO2, PaO2/FiO2, Cst, shunt, PaCO2, ETCO2, difference between PaCO2 e ETCO2, pH, IC, RVS, RVP, DO2 and VO2. Significative differences were found for the two groups, from the first to the second day of study with relation to: pH increase , reduction of PaCO2, and RVP reduction. As well as FiO2 reductions, from the first to the second and from the second to the third day of study. Ali studied patients with AROS when ventilated with low tidal volumes (6,7-8 ml/kg weight), as well in VCV as in PCV, did not presented differences neither of oxygenation nor of the hemodynamic, being that the present alterations, for both modalities, were compensated in the second day of study. In spite of the small respiratory volumes, the hypercapnia was not important, contrary to the expected, ocurring drop of PaCO2 in the evolution. The ventilatory modalities did not present differences in the evolution of the patients in relation to the mortality

ASSUNTO(S)

insuficiencia respiratoria septicemia acidose surfactante pulmonar mortalidade

ACESSO AO ARTIGO

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