Variação da pressão sistólica como método diagnóstico da hipovolemia durante anestesia para cirurgia cardíaca

Ricardo Vieira Carlos; Cristina Salvadori Bittar; Marcel Rezende Lopes; José Otávio Costa Auler Júnior

doi:10.1590/S0034-70942005000100002

Scientific Article

Variação da pressão sistólica como método diagnóstico da hipovolemia durante anestesia para cirurgia cardíaca

Systolic pressure variation as diagnostic method for hypovolemia during anesthesia for cardiac surgery

Ricardo Vieira Carlos; Cristina Salvadori Bittar; Marcel Rezende Lopes; José Otávio Costa Auler Júnior

http://dx.doi.org/10.1590/S0034-70942005000100002 Braz J Anesthesiol, vol.55, n1, p.3-18, 2005

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Resumo

JUSTIFICATIVA E OBJETIVOS: A estimativa acurada do volume intravascular efetivo é de grande importância em pacientes submetidos a procedimentos cirúrgicos de grande porte. A avaliação da volemia, baseada na variação da pressão sistólica (VPS), (diferença entre os valores sistólicos máximos e mínimos durante um ciclo respiratório controlado mecanicamente) e sua variável delta down (dDown) tem se mostrado um indicador sensível da pré-carga, quando cotejados com parâmetros hemodinâmicos convencionais. Como a VPS não é um parâmetro utilizado rotineiramente para avaliação da volemia, este trabalho teve como objetivo introduzir a técnica da medida da VPS e verificar sua validade em pacientes submetidos à anestesia para cirurgia cardíaca. MÉTODO: A partir de programa de computador especialmente desenvolvido, transmitiu-se em tempo real a variação da pressão arterial a partir do monitor da sala cirúrgica para microcomputador conectado em rede. Após a adaptação deste sistema, foram estudadas as variações da pressão sistólica em nove pacientes submetidos à revascularização do miocárdio. As variáveis foram registradas em dois momentos, utilizando-se a expansão volêmica como indicador: M0 (antes da expansão volêmica) e M1 (após a expansão volêmica). Também foram estudados alguns parâmetros hemodinâmicos convencionais, confrontados com a variação da pressão sistólica. RESULTADOS: Os principais resultados deste estudo mostram que a VPS, em seu componente dDown, é a que apresenta maior consistência de variação após a expansão volêmica com amido.Os demais parâmetros hemodinâmicos estudados, embora apontem para nítida melhora cardiovascular após a expansão, possuem alta variabilidade entre os pacientes e mesmo quanto à resposta ao expansor. CONCLUSÕES: Os resultados obtidos mostram que a VPS se comporta como um sensível indicador da volemia, em pacientes sob ventilação mecânica, quando correlacionada às variações da pressão venosa central, pressão capilar pulmonar e índice sistólico.

Palavras-chave

CIRURGIA, MONITORIZAÇÃO, MONITORIZAÇÃO, MONITORIZAÇÃO, MONITORIZAÇÃO, MONITORIZAÇÃO, VOLEMIA

Abstract

BACKGROUND AND OBJECTIVES: An accurate predictor of effective intravascular volume is of paramount importance for patients submitted to major surgical procedures. A new method to evaluate intravascular volume based on systolic blood pressure variations (SPV), (difference between the maximum and minimum systolic values during controlled respiratory cycle) and its variable delta down (dDown) has shown to be a sensitive indicator of ventricular preload. As SPV is not routinely used in clinical practice our purpose was to evaluate the accuracy of this parameter in evaluating volume status of patients submitted to cardiac surgery. METHODS: As from specially developed software, blood pressure variation was transmitted in real time from operating room monitor to a network-connected computer. After the adaptation of this system, nine patients submitted to cardiac surgery were evaluated. Variables were recorded in two moments: T0 (before volume replacement) and TP (after volume replacement). At the same time, conventional hemodynamic parameters were also studied and compared to systolic pressure variation. RESULTS: Primary study results have shown that SPV (systolic pressure variation), in its dDown component, presents the best variation consistency after volume replacement with starch. Remaining hemodynamic parameters evaluated, although pointing to clear cardiovascular improvement after replacement, are highly variable among the patients and even on expander's response. CONCLUSIONS: Results have shown that SPV is a sensitive method to evaluate intravascular volume status in patients under mechanical ventilation, when correlated to central venous pressure, pulmonary capillary wedge pressure and systolic index variations.

Keywords

MONITORING, MONITORING, MONITORING, MONITORING, MONITORING, SURGERY, VOLEMIA

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Variação da pressão sistólica como método diagnóstico da hipovolemia durante anestesia para cirurgia cardíaca

Systolic pressure variation as diagnostic method for hypovolemia during anesthesia for cardiac surgery

Ricardo Vieira Carlos; Cristina Salvadori Bittar; Marcel Rezende Lopes; José Otávio Costa Auler Júnior

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