Brazilian Journal of Anesthesiology
https://app.periodikos.com.br/journal/rba/article/doi/10.1590/S0034-70942002000600005
Brazilian Journal of Anesthesiology
Artigo Científico

Avaliação da função pulmonar em pacientes submetidos à cirurgia cardíaca com circulação extracorpórea

Evaluation of pulmonary function in patients undergoing cardiac surgery with cardiopulmonary bypass

Ricardo Antonio Guimarães Barbosa; Maria José Carvalho Carmona

http://dx.doi.org/10.1590/S0034-70942002000600005 Braz J Anesthesiol, vol.52, n6, p.689-699, 2002
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Resumo

JUSTIFICATIVA E OBJETIVOS: As complicações pulmonares permanecem como um grande problema no pós-operatório de cirurgia cardíaca com circulação extracorpórea (CEC). O objetivo do presente estudo foi avaliar as alterações da função pulmonar ocorridas em pacientes submetidos à cirurgia cardíaca de revascularização miocárdica, comparando-os àqueles submetidos à cirurgia cardíaca de troca valvar. MÉTODO: Quinze pacientes submetidos à revascularização (Grupo RM) e 15 pacientes submetidos à troca valvar (Grupo TV) foram avaliados através da relação entre a pressão arterial de oxigênio e sua fração inspirada (PaO2/FiO2), do gradiente alvéolo-arterial de oxigênio (GA-aO2), do shunt pulmonar, da PEEP de melhor complacência e da complacência estática, avaliados no pré-operatório, após a indução da anestesia, 1, 3 e 6 horas de pós-operatório e no 1º e 2º dias de pós-operatório. Os dados foram analisados através da análise de variância para medidas repetidas (p < 0,05). RESULTADOS: Os resultados mostraram valores de gradiente alvéolo-arterial de oxigênio e shunt pulmonar significativamente maiores para o grupo RM em relação ao grupo TV. A relação PaO2/FiO2 foi significativamente maior no grupo TV. Os grupos não diferiram quanto à complacência estática. No grupo RM, a PEEP de melhor complacência obtida no pós-operatório foi significativamente maior que no grupo TV. CONCLUSÕES: No presente estudo observamos que os pacientes submetidos à cirurgia cardíaca de revascularização miocárdica apresentam alterações da função pulmonar diferentes daqueles submetidos à cirurgia cardíaca de troca valvar

Palavras-chave

CIRURGIA, CIRURGIA

Abstract

BACKGROUND AND OBJECTIVES: Pulmonary complications are still a major postoperative problem for cardiac surgeries with cardiopulmonary bypass (CPB). This study aimed at evaluating pulmonary function changes in patients undergoing myocardial revascularization, as compared to those submitted to valve replacement. METHODS: Participated in this study patients undergoing myocardial revascularization (MR Group, n=15) and valve replacement (VR Group, n=15) who were evaluated by the ratio between oxygen blood pressure and its inspired fraction (PaO2/FiO2), oxygen alveolar-arterial gradient (GA-aO2), pulmonary shunt, best compliance PEEP and static PEEP, evaluated in the preoperative period, after anesthetic induction, 1, 3 and 6 postoperative hours and 1st and 2nd postoperative days. Data were analyzed by analysis of variance for repeated measures (p < 0.05). RESULTS: Alveolar-arterial gradient and pulmonary shunt results were significantly higher for the MR group as compared to the VR group. PaO2/FiO2 ratio was significantly higher in the VR group. There were no differences between groups in static compliance. Postoperative best compliance PEEP was significantly higher in the MR group as compared to the VR group. CONCLUSIONS: Our study has shown that patients submitted to myocardial revascularization presented pulmonary function changes different from those submitted to valve replacement.

Keywords

SURGERY, SURGERY

Referências

Brasil LA, Gomes WJ, Salomão R. Inflammatory response after myocardial revascularization with or without cardiopulmonary bypass. Ann Thoracic Surg. 1998;66:56-59.

Magnusson L, Zemgulis V, Wicky S. Atelectasis is a mayor cause of hypoxemia and shunt after cardiopulmonary bypass. Anesthesiology. 1997;87:1153-1163.

Higgins TL, Estafanous FG, Loop FD. Stratification of morbidity and mortality outcome by preoperative risk factors coronary artery bypass patients. JAMA. 1992;267:2344-2348.

Timm NH. Multivariate Analysis with Applications. Reeducation and Psychology. 1975:444-455.

Cary NC. Statistic, User’s Guide Fourth Edition. SAS Institute Inc. 1989;6:68-72.

Johnson D, Hurst T, Thomson D. Respiratory function after cardiac surgery. J Cardiothoracic Vasc Anesth. 1996;10:571-577.

Cox CM, Ascione R, Cohen AM. Effect of cardiopulmonary bypass on pulmonary gas exchange. Ann Thorac Surg. 2000;69(1):140-145.

Johnmarker C, Nordstrom L, Werner O. Change in functional residual capacity during cardiac surgery. Br J Anaesth. 1986;58.

Locke TJ, Griffiths TL, Mould H. Rib cage mechanics after median sternotomy. Thorax. 1990;45:465-468.

Van Belle AF, Wesseling GJ, Wouters EFM. Postoperative pulmonary function abnormalities after coronary artery bypass surgery. Respiratory Medicine. 1992;86:195-199.

Shapira N, Zabatino SM, Ahmed S. Determinants of pulmonary function in patients undergoing coronary bypass operations. Ann Thorac Surg. 1990;50:268-273.

Chandler KW, Rozas CJ, Kory RC. Bilateral diaphragmatic paralysis complicating local cardiac hypothermia during open heart surgery. Am J Med. 1984;77:243-249.

Kollef MH, Wragge T, Pasque C. Determinants of mortality and multiorgan dysfunction in cardiac surgery patients requiring prolonged mechanical. Chest. 1995;107:1395-1401.

Wilcox P, Baile EM , Hards J. Phrenic nerve function and its relationship to atelectasis after coronary artery bypass surgery. Chest. 1988;93:693-698.

Tisi GM. Preoperative evaluation of pulmonary function. Am Rev Respir Dis. 1979;119:293-310.

Hammermeister KE, Burchfiel C, Johnson R. Identification of patients at greatest risk for development of major complications at cardiac surgery. Circulation. 1990;82(^s2):380-389.

Kollef MH, Peller T, Knodel MA. Delayed pleuropulmonary complications following coronary artery revascularization with the internal mammary artery. Chest. 1988:68-71.

Bendixen HH, Hedley WJ. Impaired oxygenation in the surgical patients during general anesthesia with controlled ventilation: a concept of atelectasis. New Engl Med. 1963;269:991-996.

Hedenstierna G, Tokics L, Strandberg A. Correlation of gas exchange impairment to development of atelectasis during anaesthesia and muscle paralysis. Acta Anaesthesiol Scand. 1986;30:183-191.

Michel L, Mcmichan JC. Measurement of ventilatory reserve as an indication for early extubation after cardiac operation. J Thoracic Cardiov Surgery. 1979;78:761-765.

Wolf G, Brunner JX, Ing DE. Gas exchange during mechanical ventilation and spontaneous breathing: intermittent mandatory ventilation after open heart surgery. Chest. 1986;90:11-17.

Auler Jr JOC, Ruiz Neto PP. Alterações pulmonares da anestesia. Rev Bras Anestesiol. 1992;42(^s14):15-24.

Brtko M, Lonsky V, Kunes P. The post-perfusion syndrome after operation performed with extracorporeal circulation. Acta Medic. 1999;42(^s1):13-16.

Auler Jr JOC, Zin WA, Caldeira MPR. Pre and postoperative inspiratory mechanics in ischemic valvular heart disease. Chest. 1987;92:984-990.

Loeckinger A, Kleinsasser A, Lindner KH. Continuous positive airway pressure at 10 cmH2O during cardiopulmonary bypass improves postoperative gas exchange. Anesth Analg. 2000;91:522-527.

Massoudy P, Zahler S, Becker BF. Evidence for inflammatory responses of the lungs during coronary artery bypass grafting with cardiopulmonary bypass. Chest. 2001;119:2-4.

Kirklin JK. Prospects for understanding and eliminating the deleterious effects of cardiopulmonary bypass. Ann Thorac Surg. 1991;51:529-531.

Singh NP, Vargas FS, Cukier A. Arterial blood gases after coronary artery bypass surgery. Chest. 1992;102:1337-1441.

Hachenberg T, Tenling A, Tyden H. Ventilation perfusion relationship in mitral valve disease and coronary artery disease. Anesthesiology. 1997;86:809-817.

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