Effect of mechanical ventilation during cardiopulmonary bypass on oxidative stress: a randomized clinical trial
Efeito da ventilação mecânica durante a circulação extracorpórea no estresse oxidativo: um ensaio clínico randomizado
Yavuz Orak; Filiz Alkan Baylan; Aydemir Kocaslan; Erdinc Eroglu; Mehmet Acipayam; Mehmet Kirisci; Omer Faruk Boran; Adem Doganer
Abstract
Keywords
Resumo
Introdução: A circulação extracorpórea (CEC) causa resposta ao estresse oxidativo sistêmico e dano endotelial em órgãos sistêmicos. Nós investigamos os efeitos das aplicações de pressão expiratória final positiva (PEEP) e ventilação mecânica (VM) sobre o estresse oxidativo em CEC.
Métodos: Setenta e um pacientes foram recrutados e 60 completaram o estudo. Grupos randomizados: VM desligada (Grupo 1); VM ligada, volume corrente (VC) de 3 a 4 mL.kg-1 (Grupo 2); VM ligada, TV de 3 a 4 mL.kg-1, PEEP de 5 cmH2O (Grupo 3), n = 20 em cada grupo. Como marcadores de estresse oxidativo, usamos glutationa peroxidase (GPx), estado antioxidante total (EAT), estado oxidante total (TOS), tiol total e nativo (TT, TN), malondialdeído (MDA) e catalase. Também investigamos a correlação entre o estresse oxidativo e o tempo de intubação pós-operatória.
Resultados: Os níveis de GPx pós-operatório no Grupo 2 foram maiores do que no Grupo 3 (p = 0,017). Nos grupos 2 e 3, os níveis de TAS foram maiores no pós-operatório do que no intraoperatório (p = 0,001, p = 0,019, respectivamente). No Grupo 2, os níveis de TT foram maiores no pós-operatório do que no pré-operatório e intraoperatório (p = 0,008). No Grupo 3, os níveis de MDA pós-operatório foram maiores do que no pré-operatório (p = 0,001) e foram maiores do que ambos os níveis pós-operatórios do Grupo 1 e 2 (p = 0,043, p = 0,003). À medida que a EAT pré-operatória (Grupo 2) diminuiu e a TN pós-operatória (Grupo 2) e a catalase (Grupo 3) aumentaram, o tempo de intubação pós-operatório aumentou.
Conclusão: A VM (3-4 mL.kg-1) isolada parece ser a estratégia mais vantajosa. O tempo prolongado de intubação pós-operatória foi associado ao aumento dos níveis de TN e catalase.
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References
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Submitted date:
12/03/2019
Accepted date:
06/26/2021