Avaliação do gradiente pressórico aorto-radial em pacientes submetidos à intervenção cirúrgica com circulação extracorpórea

Maria José Carvalho Carmona; Luiz Carlos de Melo Barboza Júnior; Roberto Yara Buscatti; Fábio Antônio Gaiotto; Alexandre Ciappina Hueb; Luiz Marcelo Sá Malbouisson

doi:10.1590/S0034-70942007000600004

Scientific Article

Avaliação do gradiente pressórico aorto-radial em pacientes submetidos à intervenção cirúrgica com circulação extracorpórea

Evaluation of the aorta-to-radial artery pressure gradient in patients undergoing surgery with cardiopulmonary bypass

Maria José Carvalho Carmona; Luiz Carlos de Melo Barboza Júnior; Roberto Yara Buscatti; Fábio Antônio Gaiotto; Alexandre Ciappina Hueb; Luiz Marcelo Sá Malbouisson

http://dx.doi.org/10.1590/S0034-70942007000600004 Braz J Anesthesiol, vol.57, n6, p.618-629, 2007

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JUSTIFICATIVA E OBJETIVOS: Diversos estudos têm demonstrado diferença significativa entre a pressão aórtica e a pressão radial em pacientes submetidos à circulação extracorpórea (CEC). Os objetivos deste estudo foram avaliar o comportamento da diferença entre pressão arterial radial e a pressão aórtica durante revascularização do miocárdio (RM) com CEC e sua correlação com resistência vascular sistêmica. MÉTODO: Após aprovação pelo Comitê de Ética Hospitalar, 16 pacientes submetidos à RM com CEC hipotérmica foram estudados. Pressões sistólica, diastólica e média foram obtidas na raiz da aorta e na artéria radial, através de cateteres específicos. Débito cardíaco foi obtido com o uso de cateter de artéria pulmonar ou diretamente da máquina de CEC e resistência vascular sistêmica indexada (RVSi) foi calculada nos momentos pré-CEC, início da CEC, após a última RM, no fim da CEC e pós-CEC. A análise estatística foi realizada por meio de Análise de Variância para medidas repetidas e correlação de ordem de Spearman e o nível de significância foi fixado em 0,05. RESULTADOS: Após o início da CEC, a pressão arterial radial foi sistematicamente menor que a pressão aórtica em 3 a 5 mmHg. Foi observada correlação significativa entre o gradiente médio de pressão aorto-radial e a RVSi somente após a última RM, correspondendo ao aquecimento do paciente (Rho = 0,67, p = 0,009). CONCLUSÕES: A medida de pressão na arterial radial subestimou sistematicamente a pressão arterial na raiz da aorta após a CEC e a RVSi não forneceu estimativa acurada da magnitude do gradiente de pressão aorto-radial.

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CIRURGIA, Cardíaca, MONITORAÇÃO

Abstract

BACKGROUND AND OBJECTIVES: Several studies have demonstrated a significant difference between the aortic and radial artery pressures in patients on cardiopulmonary bypass (CPB). The objectives of this study were to evaluate the behavior of the aorta-to-radial artery pressure gradient during myocardial revascularization (MR) with CPB and its correlation with the systemic vascular resistance. METHODS: After approval by the Ethics Committee of the hospital, 16 patients undergoing MR with hypothermic CPB were studied. Systolic, diastolic and mean blood pressures were obtained at the root of the aorta and in the radial artery by using specific catheters. The cardiac output was obtained using a pulmonary artery catheter or from the CPB equipment, and the systemic vascular resistance index (SVRI) pre-CPB, at the beginning of CPB, after the last MR, at the end of the CPB, and post-CPB was calculated. Statistical analysis was done with Analysis of Variance for repeated measurements and Spearman correlation, and a level of significance of 0.05 was established. RESULTS: After beginning CPB, the radial artery pressure was systematically lower than the aortic pressure by 3 to 5 mmHg. A significant correlation between the mean aorta-to-radial artery pressure gradient and SVRI was observed only in the last MR, corresponding to the rewarming of the patient (Rho = 0.67, p = 0.009). CONCLUSIONS: Measurement of the radial artery pressure underestimated, systematically, the arterial pressure at the root of the aorta after CPB and the SVRI did not provide an accurate estimate of the magnitude of the aorta-to-radial artery pressure gradient.

Keywords

MONITORING, SURGERY, Cardiac

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Avaliação do gradiente pressórico aorto-radial em pacientes submetidos à intervenção cirúrgica com circulação extracorpórea

Evaluation of the aorta-to-radial artery pressure gradient in patients undergoing surgery with cardiopulmonary bypass

Maria José Carvalho Carmona; Luiz Carlos de Melo Barboza Júnior; Roberto Yara Buscatti; Fábio Antônio Gaiotto; Alexandre Ciappina Hueb; Luiz Marcelo Sá Malbouisson

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