Brazilian Journal of Anesthesiology
https://app.periodikos.com.br/journal/rba/article/doi/10.1590/S0034-70942010000400008
Brazilian Journal of Anesthesiology
Scientific Article

Estratégias ventilatórias frente à hipoxemia em cirurgia cardíaca: validação de questionário para anestesiologistas no Brasil

Ventilatory strategies for hypoxemia during cardiac surgery: survey validation for anesthesiologists in Brazil

Celso Augusto Martins Parra; Maria José Carvalho Carmona; José Otávio Costa Auler Junior; Luiz Marcelo Sá Malbouisson

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Resumo

JUSTIFICATIVA E OBJETIVOS: A hipoxemia perioperatória ocorre frequentemente em cirurgia cardíaca e a atelectasia é sua principal causa. Além disso, podemos citar como causas circulação extracorpórea (CEC), dissecção de artérias torácicas internas, status clínico prévio do paciente, entre outras. O presente estudo elaborou um questionário anônimo para observar as estratégias ventilatórias frente à hipoxemia em cirurgia cardía ca adotadas por cinco mil anestesiologistas distribuídos no país. MÉTODO: Foram enviados questionários por e-mail a cinco mil anestesiologistas do Brasil. RESULTADOS: Dos questionários enviados, foram recebidas 81 respostas válidas. Dentre as respostas, 65 (80%) anestesiologistas fazem uso da ventilação controlada a volume (VCV) frente a 16 (20%) que preferem ventilação controlada à pressão (PCV). O volume (Vt) corrente utilizado é inferior a 10 mL.kg-1 para 46 (61%) contra 29 (39%) que adotam um Vt maior que 10 mL.kg-1. Quarenta e sete (58%) usam PEEP e 17 (21%) utilizam FiO2 acima de 60%. No caso de hipoxemia intraoperatória, 20,9% aumentam ou introduzem PEEP, 70,3% aumentam a FiO2, 19,7% realizam manobra de recrutamento alveolar, 13,5% aumentam o volume-corrente e 20,9% realizam checagem de falhas no aparelho de anestesia. As respostas foram enviadas de 15 estados. CONCLUSÕES: As condutas descritas nos questionários respondidos são compatíveis com a literatura internacional. Com ajuste no formato do questionário e na abordagem aos anestesiologistas, novos estudos poderão ser realizados.

Palavras-chave

ANESTESIOLOGIA, COMPLICAÇÕES, CIRURGIA, Cardíaca

Abstract

BACKGROUND AND OBJECTIVES: Perioperative hypoxemia is common in cardiac surgeries, and atelectasis is the main cause. Besides, we can mention extracorporeal circulation (ECC), dissection of internal thoracic arteries, and previous clinical status of the patient among others as its causes. The present study elaborated an anonymous questionnaire to observe ventilatory strategies for hypoxemia in cardiac surgeries adopted by five thousand anesthesiologists all over the country. METHODS: Questionnaires were sent via e-mail for five thousand anesthesiologists in Brazil. RESULTS: Out of the questionnaires sent, 81 valid responses were received. Among the answers, 65 (80%) anesthesiologists use volume-controlled ventilation (VCV), while 16 (20%) prefer pressure-controlled ventilation (PCV). The tidal volume (Vt) used is lower than 10 mL.kg-1, for 46 (61%) versus 20 (30%) who adopt a Vt greater than 10 mL.kg-1. Forty-seven (58%) use PEEP and 15 (21%) use FiO2 above 60%. In the case of intraoperative hypoxemia, 20.9% increase or introduce PEEP, 70.3% increase the FiO2, 19.7% use alveolar recruitment maneuvers, 13.5% increase the tidal volume, and 20.9% check for the presence of failures in the anesthesia equipment. Responses were sent from 15 states. CONCLUSIONS: The conducts described in the questionnaires are compatible with those of the international literature. Adjusting the questionnaires format and the way to approach anesthesiologists, new studies could be undertaken.

Keywords

ANESTHESIOLOGY, COMPLICATIONS, SURGERY, Cardiac

References

Singh NP, Vargas FS, Cukier A. Arterial blood gases after coronary artery bypass surgery. Chest. 1992;102:1337-1341.

Yende S, Wunderink R. Causes of prolonged mechanical ventilation after coronary artery bypass surgery. Chest. 2002;122:245-252.

Brooks-Brunn JA. Postoperative atelectasis and pneumonia. Heart Lung. 1995;24:94-115.

Hedenstierna G, Rothen HU. Atelectasis formation during anesthesia: causes and measures to prevent it. J Clin Monit Comput. 2000;16:329-35.

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

Jacka MJ. Survey of Monitoring Practice of Anesthesiologists During Cardiovascular Surgery. .

Supply, distribution and migration of Canadian physicians. 2000.

, . Ventilation with lower tidal volumes as compared with traditionaltidal volumes for acute lung injury and the acute respiratory distress syndrome: The Acute Respiratory Distress Syndrome Network. N Engl J Med. 2000;342:1301-1308.

Schultz MJ. Lung-protective mechanical ventilation with lower tidal volumes in patients not suffering from acute lung injury: a review of clinical studies. Med Sci Monit. 2008;14:RA22-26.

Donahoe M. Basic ventilator management: lung protective strategies. Surg Clin North Am. 2006;86:1389-1408.

Davis WB, Rennard SI, Bitterman PB. Pulmonary oxygen toxicity: Early reversible changes in human alveolar structures induced by hyperoxia. N Engl J Med. 1983;309:878-883.

Aboab J, Jonson B, Kouatchet A. Effect of inspired oxygen fraction on alveolar de recruitment in acute respiratory distress syndrome. Intensive Care Med. 2006;32:1979-1986.

Oczenski W, Schwarz S, Fitzgerald RD. Vital capacity manoeuvre in general anaesthesia: useful or useless?. Eur J Anaesthesiol. 2004;21:253-259.

Myers JA, Good ML, Andrews JJ. Comparison of tests for detecting leaks in the low-pressure system of anesthesia gas machines. Anesth Analg. 1997;84:179-184.

Short JA, van der Walt JH. Oxygen in neonatal and infant anesthesia: current practice in the UK. Pediatr Anesth. 2008;18:378-387.

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