Brazilian Journal of Anesthesiology
https://app.periodikos.com.br/journal/rba/article/doi/10.1590/S0034-70942004000300005
Brazilian Journal of Anesthesiology
Scientific Article

Comparação entre a medida contínua do débito cardíaco e por termodiluição em bolus durante a revascularização miocárdica sem circulação extracorpórea

Continuous and bolus thermodilution cardiac output measurement during off-pump coronary artery bypass surgery

Sílvia M. Kim; Sílvia D. S. Oliveira; Ubirajara S. Fonseca; Luiz Marcelo Sá Malbouisson; José Otávio Costa Auler Júnior; Maria José Carvalho Carmona

http://dx.doi.org/10.1590/S0034-70942004000300005 Braz J Anesthesiol, vol.54, n3, p.319-324, 2004
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Resumo

JUSTIFICATIVA E OBJETIVOS: A cirurgia de revascularização miocárdica sem o uso de circulação extracorpórea (CEC) relaciona-se a importantes alterações hemodinâmicas bruscas, que podem não ser prontamente detectadas pela medida contínua de débito cardíaco. Este estudo compara resultados obtidos pela medida do índice cardíaco com o cateter de artéria pulmonar com filamento térmico (Baxter Edwards Critical Care, Irvine, CA) com o método padrão por termodiluição com solução, durante a anastomose coronariana distal. MÉTODO: Dez pacientes submetidos à cirurgia de revascularização miocárdica sem CEC foram monitorizados com o cateter de artéria pulmonar com filamento térmico. As medidas de índice cardíaco foram obtidas em quatro momentos: no início da anestesia, enquanto o tórax ainda estava fechado (M1), após a esternotomia (M2), após a estabilização do coração com o aparelho octopus (M3) e ao final da anastomose coronariana distal (M4). RESULTADOS: Houve diminuição significativa (p < 0,05) do índice cardíaco durante a anastomose coronariana, detectada pela medida com termodiluição com bolus de solução. O índice cardíaco variou de 2,8 ± 0,7 para 2,3 ± 0,8 l.min.m-2 no início da anastomose e 2,5 ± 0,8 l.min.m-2 ao final da mesma. Essa variação não foi detectada pela medida contínua (de 3 ± 0,6 para 3,2 ± 0,5 e 3,1 ± 0,6 l.min.m-2 durante a anastomose coronariana). CONCLUSÕES: A medida de débito cardíaco contínuo utilizando o cateter de artéria pulmonar com filamento térmico apresentou atraso na detecção das alterações hemodinâmicas agudas relacionadas à mudança do posicionamento do coração na cirurgia de revascularização miocárdica sem CEC.

Palavras-chave

CIRURGIA, CIRURGIA, MONITORIZAÇÃO, TÉCNICAS DE MEDIÇÃO

Abstract

BACKGROUND AND OBJECTIVES: Off-pump CABG surgery is related to major and abrupt hemodynamic changes that may not be immediately detected by continuous cardiac output measurement (CCO). This study aimed at comparing results of cardiac index measurement with pulmonary artery catheter (PAC) with thermal filament (Baxter Edwards Critical Care, Irvine, CA) versus standard bolus thermodilution method during distal coronary anastomosis. METHODS: Participated in this study 10 patients undergoing off-pump CABG who were monitored with PAC with thermal filament. Measurements of cardiac index were obtained in four moments: at anesthetic induction with the chest still closed (M1), after sternotomy (M2), after heart stabilization with the octopus device (M3) and at distal anastomosis completion (M4). RESULTS: There has been significant cardiac index decrease (p < 0.05) during coronary anastomosis, detected when measurements were taken with bolus thermodilution method. Cardiac index has varied 2.8 ± 0.7 to 2.3 ± 0.8 L.min.m-2 in the beginning and 2.5 ± 0.8 L.min.m-2 at the end of anastomosis. This variation was not detected by the continuous method (from 3 ± 0.6 to 3.2 ± 0.5 to 3.1 ± 0.6 L.min.m-2 during anastomosis). CONCLUSIONS: CCO measurement with PAC was late in detecting acute hemodynamic changes due to changes in heart position during off-pump CABG.

Keywords

MEASUREMENT TECHNIQUES, MONITORING, SURGERY, SURGERY

Referências

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