Resumo
JUSTIFICATIVA E OBJETIVO: Avaliar se manobra de hiperinsuflação manual (HM) pode propiciar aspiração das secreções orofaríngeas em paciente sob ventilação mecânica. MÉTODOS: Participaram do estudo pacientes adultos sob ventilação mecânica nos quais foi injetado corante na cavidade orofaríngea e aspirada secreção traqueal após 30 minutos (min). Na ocorrência de deslizamento do corante, o paciente foi eliminado. Os demais foram alocados em Grupo Controle: pacientes em que se aspiravam secreções traqueais após 30, 60, 120 e 180 min e Grupo Experimental: após 30 min, foram realizadas manobras de HM e aspirada secreção nos intervalos estabelecidos. RESULTADOS: Estudaram-se 43 pacientes. Em 13, ocorreu deslizamento do corante após 30 min antes da alocação dos grupos. Os demais 29 pacientes forneceram 226 amostras de secreções. Houve presença de secreções coradas em apenas duas amostras, após realização de HM, em pacientes do grupo experimental. CONCLUSÃO: A manobra de hiperinflação manual não propiciou aspiração de secreções orofaríngeas em paciente sob ventilação mecânica.
Palavras-chave
CIRURGIA, COMPLICAÇÕES, INTUBAÇÃO TRAQUEAL
Abstract
BACKGROUND AND OBJECTIVES: To evaluate whether manual hyperinflation maneuvers can cause aspiration of oropharyngeal secretions in patients under mechanical ventilation. METHODS: Adult patients under mechanical ventilation in whom a dye was injected in the oropharyngeal cavity and had their tracheal secretion aspirated after 30 minutes (min) participated in this study. In the event of dye slid, the patient was eliminated. The other patients were divided in Control Group: patients in whom tracheal secretions were aspirated after 30, 60, 120, and 180 min, and Experimental Group: after 30 min, manual hyperventilation maneuvers were performed and secretions were aspirated on the established intervals. RESULTS: Forty-three patients were enrolled in this study. In 13, dye slippage was observed after 30 min, before allocating them into two groups. In the remaining 29 patients, 226 secretion samples were collected. In only two samples the presence of dye in the secretion was observed after manual hyperinflation maneuvers in the experimental group. CONCLUSION: Manual hyperinflation maneuvers did not cause aspiration of oropharyngeal secretions in patients under mechanical ventilation.
Keywords
Respiratory Aspiration, Respiration, Artificial, Intensive Care, Critical Care, Physical Therapy (Specialty)
Referencias
Bouza E, Pérez MJ, Muñoz P. Continuous aspiration of subglottic secretions in the prevention of ventilator-associated pneumonia in the postoperative period of major heart surgery. Chest. 2008;134:938-946.
Denehy L. The use of manual hyperinflation in airway clearance. Eur Respir. 1999;14:958-965.
Suh-Hwa M, Tzong-Jen H, Kuang-Hung H. Manual hyperinflation improves alveolar recruitment in difficult-to-wean patients. Chest. 2005;128:2714-2721.
Rumbak MJ. The pathogenesis of ventilator-associated pneumonia. Semin Respir Crit Care Med. 2002;23:427-434.
Maloney JP, Halbower AC, Fouty BF. Systemic absorption of food dye in patients with sepsis. N Engl J Med. 2000;343:1046-1047.
Sills MR, Zinkhan WH. Methylene blue-induced heinz body hemolytic anemia. Arch Pediatr Adolesc Med. 1994;148:306-10.
Griscom NT, Wohl ME. Tracheal size and shape: effects of change in intraluminal pressure. Radiology. 1983;149:27.
Young PJ, Burchett K, Blunt MC. The protective effect of cuff lubrication in critically ill patients with tracheotomies. Br J Anaesth. 2000;84.
Greene R, Thompson S, Jantsch HS. Detection of pooled secretions above endotracheal-tube cuffs: value of plain radiographs in sheep cadavers and patients. Am J Roentgenol. 1994;163:1333-1337.
Ciesla ND. Chest physical therapy for patients in the intensive care unit. Physical Therapy. 1996;76:609-625.
Facebook
Google+
Twitter
LinkedIn
Mendeley
StumbleUpon
CiteULike
Reddit
Email