Estudo comparativo dos efeitos hemodinâmicos e ventilatórios da ventilação controlada a volume ou a pressão, em cães submetidos ao pneumoperitônio

Antonio Roberto Carraretto; Pedro Thadeu Galvão Vianna; Armando Vieira de Almeida; Eliana Marisa Ganem

doi:10.1590/S0034-70942005000600007

Scientific Article

Estudo comparativo dos efeitos hemodinâmicos e ventilatórios da ventilação controlada a volume ou a pressão, em cães submetidos ao pneumoperitônio

Hemodynamic and ventilatory effects of volume or pressure controlled ventilation in dogs submitted to pneumoperitoneum. Comparative study

Antonio Roberto Carraretto; Pedro Thadeu Galvão Vianna; Armando Vieira de Almeida; Eliana Marisa Ganem

http://dx.doi.org/10.1590/S0034-70942005000600007 Braz J Anesthesiol, vol.55, n6, p.639-654, 2005

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Resumo

JUSTIFICATIVA E OBJETIVOS: A ventilação com pressão controlada (PCV) está disponível em aparelhos de anestesia, mas não existem estudos sobre o seu uso, durante o pneumoperitônio com o CO2 (PPC). O objetivo deste estudo foi avaliar a ventilação controlada a pressão bem como as alterações hemodinâmicas e ventilatórias durante o PPC, comparando-a com a ventilação controlada a volume (VCV) convencionalmente utilizada. MÉTODO: Dezesseis cães anestesiados com tiopental sódico, citrato de fentanil e brometo de pancurônio, foram divididos aleatoriamente em dois grupos: VC - ventilação controlada a volume (n = 8) e PC - ventilação controlada a pressão (n = 8) Os parâmetros hemodinâmicos e ventilatórios foram monitorizados e registrados em 4 momentos: M1 (antes do PPC), M2 (30 minutos após PPC = 10 mmHg), M3 (30 minutos após PPC = 15 mmHg) e M4 (30 minutos após a deflação do PPC). RESULTADOS: Com a aplicação do PPC ocorreu um aumento do volume corrente no grupo PC, aumento das pressões inspiratórias (máxima e de platô), diminuição da complacência proporcional ao aumento do PPC, aumento da freqüência cardíaca, manutenção da pressão arterial média com valores maiores no grupo VC em todos os momentos, aumento da pressão de átrio direito com diminuição significativa após a deflação, diminuição do pH sangüíneo durante o PPC com menor variação no grupo PC, maior estabilidade da pressão parcial do CO2 no sangue arterial no grupo PC, sem alterações da pressão parcial do O2 no sangue arterial. CONCLUSÕES: Apesar das diferenças de alguns parâmetros hemodinâmicos e ventilatórios, entre os dois modos de controle da ventilação, nas condições estudadas foi possível a utilização da ventilação controlada a pressão para procedimentos com a aplicação do PPC. É fundamental observar o controle rigoroso da ventilação alveolar, ajustando a pressão inspiratória para manter eliminação adequada do CO2 e garantir oxigenação.

Palavras-chave

ANIMAL, CIRURGIA, Abdominal, VENTILAÇÃO

Abstract

BACKGROUND AND OBJECTIVES: Pressure controlled ventilation (PCV) is available in anesthesia machines, but there are no studies on its use during CO2 pneumoperitoneum (CPP). This study aimed at evaluating pressure-controlled ventilation and hemodynamic and ventilatory changes during CPP, as compared to conventional volume controlled ventilation (VCV). METHODS: This study involved 16 dogs anesthetized with thiopental, fentanyl and pancuronium, which were randomly assigned to two groups: VC - volume controlled ventilation (n=8) and PC - pressure controlled ventilation (n=8). Hemodynamic and ventilatory parameters were monitored and recorded in 4 moments: M1 (before CPP), M2 (30 minutes after CPP = 10 mmHg), M3 (30 minutes after CPP=15 mmHg) and M4 (30 minutes after deflation). RESULTS: With CPP, there has been significant increase in tidal volume in PC group; there has been increase in airway pressures (peak and plateau), decrease in compliance with increase in CPP pressure, increase in heart rate, maintenance of mean blood pressure with higher values in the VC group in all stages; there was also increase in right atrium pressure with significant decrease after deflation, decrease in arterial pH with minor variations in PC group, greater arterial pCO2 stability in PC group, and no significant changes in arterial pO2. CONCLUSIONS: There were some differences in hemodynamic and ventilatory data between both ventilation control modes (VC and PC). It is possible to use pressure controlled ventilation during CPP, but the anesthesiologist must monitor and take a close look at alveolar ventilation, adjusting inspiratory pressure to ensure proper CO2 elimination and oxygenation.

Keywords

ANIMAL, SURGERY, Abdominal, VENTILATION

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Estudo comparativo dos efeitos hemodinâmicos e ventilatórios da ventilação controlada a volume ou a pressão, em cães submetidos ao pneumoperitônio

Hemodynamic and ventilatory effects of volume or pressure controlled ventilation in dogs submitted to pneumoperitoneum. Comparative study

Antonio Roberto Carraretto; Pedro Thadeu Galvão Vianna; Armando Vieira de Almeida; Eliana Marisa Ganem

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