Aplicação da ventilação mecânica não-invasiva no pós-operatório de cirurgias torácicas e abdominais
Noninvasive Mechanical Ventilation in Postoperative Thoracic and Abdominal Surgeries
Roberta Weber Werle, Alana Piccoli, Alessandra Preisig Werlang, Samanta Pezzi Gomes, Fernando Nataniel Vieira
Resumo
Introdução: A ventilação mecânica não invasiva (VNI) é uma estratégia usada para prevenir as complicações pulmonares que ocorrem no pós-operatório de pacientes submetidos a cirurgias abdominais e torácicas. Essa técnica pode ser usada na insuficiência respiratória estabelecida no pós-operatório ou como forma profilática. Objetivos: Avaliar a aplicação e desfechos do uso da VNI nos pacientes de pós-operatório de cirurgias torácicas e abdominais no período de junho 2010 a julho 2011. Método: estudo retrospectivo, descritivo transversal, realizado na Unidade de Terapia Intensiva (UTI) de um hospital público de Porto Alegre-RS, em pacientes de pós-operatório de cirurgia torácica ou abdominal. Os dados foram coletados a partir de um formulário específico, utilizado de rotina para todos os pacientes que faziam uso da VNI. Resultados: A amostra foi composta por 67 pacientes com média de idade de 63±12 anos, sendo 35(52%) do gênero feminino. O uso mais frequente ocorreu em pacientes submetidos a cirurgias intratorácicas (67%) e, em 60% dos pacientes do estudo, a VNI foi instalada nos três primeiros dias de pós-operatório. As causas mais comuns da aplicação da VNI foram a congestão pulmonar (51%) e a falência respiratória pós-extubação (resgate) (31%). O sucesso no uso da VNI ocorreu em 52 (77,6%) pacientes e falha em 15 (22,3%), sendo a piora clínica a principal causa para interrupção da VNI e reintubação orotraqueal (66%). Houve menor tempo de hospitalização (p=0,017), permanência na UTI (p<0,001) e menor mortalidade (p=0,04) nos pacientes que obtiveram sucesso no uso da VNI, quando comparado aos pacientes que falharam e retornaram à ventilação mecânica invasiva. Conclusão: A maioria dos pacientes que utilizou a VNI evoluiu sem a necessidade de suporte ventilatório invasivo. O uso precoce da VNI apresentou relação com o sucesso da técnica e os pacientes que falharam na VNI apresentaram maior tempo de internação e mortalidade.
Palavras-chave
Abstract
Introduction: Noninvasive mechanical ventilation (NIV) is a strategy used to prevent pulmonary complications that occur postoperative in patients undergoing abdominal and thoracic surgeries. This technique can be used in postoperative established respiratory failure or as a manner to avoid this complication. Objectives: To evaluate the implementation and outcomes of the use of NIV in patients with postoperative abdominal and thoracic surgery from June 2010 to July 2011. Method: Retrospective, cross-sectional, conducted in the Intensive Care Unit (ICU) of a public hospital in Porto Alegre, in patients with postoperative abdominal or thoracic surgery. Data were collected from a specific form, used routinely for all patients using NIV. Results: The sample consisted of 67 patients with a mean age of 63 ± 12 years old, 35 (52%) were female. The highest frequency occurred in patients undergoing intrathoracic surgery (67%) and in 60% of study patients, NIV was installed in the first three days after surgery. The most common causes of application of NIV were pulmonary congestion (51%) and due to respiratory failure after extubation (rescue) (31%). The successful use of NIV occurred in 52 (77.6%) patients and failed in 15 (22.3%), with clinical deterioration leading cause for discontinuation of NIV and re-intubation (66%). There was a shorter hospital stay (p = 0.017), ICU stay (p <0.001) and lower mortality (p = 0.04) in patients who were treated successfully using NIV compared to patients who failed and returned to invasive mechanical ventilation. Conclusion: The majority of patients who used NIV progressed without needing invasive ventilatory support. The early use of NIV was correlated with the success of the technique and the patients who failed with NIV had higher rates of hospitalization and mortality.
Keywords
References
1. O’donohue WJJ. Postoperative pulmonary complications. When are preventive and therapeutic measures necessary? Postgrad Med. 1992 Feb 15; 91(3):167-175.
2. Gardner B, Palasti S. A comparison of hospital costs and morbidity between octogenarians and other patients undergoing general surgical operations. Surg Gynecol Obstet. 1990 Oct;171(4):299-304.
3. Weiser TG, Regenbogen SE, Thompson KD, Haynes AB, Lipsitz SR, Berry WR, Gawande AA. An estimation of the global volume of surgery: a modelling strategy based on available data. Lancet. 2008 Jul 12; 372:139-44.
4. Chawla G, Drummond GB. Fentanyl decreases end-expiratory lung volume in patients anaesthetized with sevoflurane. Br J Anaesth. 2008 Mar;100(3):411-4.
5. Ferreyra G, Squadrone V, Ranieri VM. Acute respiratory failure after abdominal surgery. In: Yearbook of intensive care and emergency medicine. Berlin: Springer Berlin Heidelberg; 2005. pp. 10-8.
6. Dureuil B, Cantineau JP, Desmonts JM. Effects of upper or lower abdominal surgery on diaphragmatic function. Br J Anaesth. 1987 Oct;59(10):1230-5.
7. Warner DO. Preventing postoperative pulmonary complications: the role of the anesthesiologist. Anesthesiology. 2000 May; 92(5):1467-72.
8. Ingwersen UM, Larsen KR , Bertelsen MT, Nielsen KK, Laub M, Sandermann J et al. Three different mask physiotherapy regimens for prevention of post-operative pulmonary complications after heart and pulmonary surgery. Intensive Care Med. 1993;19(5):294-8.
9. Stock MC, Downs JB, Gauer PK, Alster JM, Imrey PB. Prevention of postoperative pulmonary complications with CPAP, incentive spirometry, and conservative therapy. Chest 1985 Feb;87(2):151-7.
10. Evans TW. International Consensus Conferences in Intensive Care Medicine: non-invasive positive pressure ventilation in acute respiratory failure. Organised jointly by the American Thoracic Society, the European Respiratory Society, the European Society of Intensive Care Medicine, and the Societe de Reanimation de Langue Francaise, and approved by the ATS Board of Directors, December 2000. Intensive Care Med. 2001 Jan;27(1):166-78.
11. Nava S, Hill N. Non-invasive ventilation in acute respiratory failure. Lancet. 2009 Jul 18;374(9685):250-9.
12. Nava S, Navalesi P, Carlucci A. Non-invasive ventilation. Minerva Anestesiol. 2009 JanFeb;75(1-2):31-6.
13. Jaber S, Chanques G, Jung B. Postoperative non-invasive ventilation. Intensive Care Med.. 2008; 310-9.
14. Pennock BE, Kaplan PD, Carlin BW, Sabangan JS, Magovern JA. Pressure support ventilation with simplified ventilatory support system administered with a nasal mask in patients with respiratory failure. Chest. 1991 Nov;100(5):1371-6.
15. Kindgen-Milles D, Buhl R, Gabriel A, Böhner H, Müller E. Nasal continuous positive airway pressure: a method to avoid endotracheal reintubation in postoperative high-risk patients with severe nonhypercapnic oxygenation failure. Chest. 2000 Apr;117(4):1106-11.
16. Gust R, Gottschalk A, Schmidt H, Böttiger BW, Böhrer H, Martin E. Effects of continuous (CPAP) and bi-level positive airway pressure (BiPAP) on extravascular lung water after extubation of the trachea in patients following coronary artery bypass grafting. Intensive Care Med. 1996 Dec;22(12):1345-50.
17. Principi T, Pantanetti P, Catani F, Elisei D, Gabbanelli V, Pelaia P, Leoni P. Noninvasive continuous positive airway pressure delivered by helmet in hematological malignancy patients with hypoxemic acute respiratory failure. Intensive Care Med. 2004 Jan;30(1):147-50.
18. Delclaux C, L’Her E, Alberti C, Mancebo J, Abroug F, Conti, G et al. Treatment of acute hypoxemic nonhypercapnic respiratory insufficiency with continuous positive airway pressure delivered by a face mask: a randomized controlled trial. JAMA. 2000 Nov 8;284(18):2352-60.
19. L’Her E, Deye N, Lellouche F, Taille S, Demoule A, Fraticelli A et al. Physiologic effects of noninvasive ventilation during acute lung injury. Am J Respir Crit Care Med. 2005 Nov 1;172(9):1112- 8.
20. Pankow W, Hijjeh N, Schuttler F, Penzel T, Becker HF, Peter JH, von Wichert P. Influence of noninvasive positive pressure ventilation on inspiratory muscles activity in obese subjects. Eur Respir J. 1997 Dec;10(12):2847-52.
21. Nava S, Navalesi P, Gregoretti C. Interfaces and Humidification for Noninvasive Mechanical Ventilation. Respir Care. 2009 Jan;54(1):71-84.
22. Holanda MA, Reis RC, Winkeler GFP, Fortaleza SCB, Lima JWO, Pereira EDB. Influence of total face, facial and nasal masks on short-term adverse effects during noninvasive ventilation. J Bras Pneumol. 2009 Feb;35(2):164-73.
23. Pasquina, P; Merlani, P; Granier, JM; Ricou, B. Continuous Positive Airway Pressure Versus Noninvasive Pressure Support Ventilation to Treat Atelectasis After Cardiac Surgery. Anesth Analg. 2004 Oct;99(4):1001-8.
24. Michelet P, D’Journo XB, Seinaye F, Forel JM, Papazian L, Thomas P. Non-invasive ventilation for treatment of postoperative respiratory failure after oesophagectomy. Br J Surg. 2009 Jan;96(1):54-60.
25. Schettino GPP. III Consenso Brasileiro de Ventilação Mecânica. J Bras Pneumol. 2007;33(Supl 2):S92-S105.
26. Squadrone V, Coha M, Cerutti E, Schellino MM, Biolino P, Occella P et al. Continuous positive airway pressure for treatment of postoperative hypoxemia: a randomized controlled trial. JAMA. 2005 Feb 2;293(5):589-95.
27. Auriant I, Jallot A, Hervé P, Cerrina J, Ladurie FLR, Fournier JL et al. Noninvasive ventilation reduces mortality in acute respiratory failure following lung resection. Am J Respir Crit Care Med. 2001 Oct 1;164(7):1231-5.
28. Böhner H, Kindgen-Milles D, Grust A, Buhl R, Lillotte WC, Müller BT et al. Prophylactic nasal continuous positive airway pressure after major vascular surgery: results of a prospective randomized trial. Langenbecks Arch Surg. 2002 Apr;387(1):21-6.
29. Esteban A, Frutos-Vivar F, Ferguson ND, Arabi Y, Apezteguía C, Gonzaléz M et al. Noninvasive Positive-Pressure Ventilation for Respiratory Failure after Extubation. N Engl J Med. 2004 Jun 10;350(24):2452-60.
30. Landoni G, Zangrillo A, Cabrini L. Noninvasive Ventilation After Cardiac and Thoracic Surgery in Adult Patients: A Review. J Cardiothorac Vasc Anesth. 2012 Oct;26(5):917-22.
Facebook
Google+
Twitter
LinkedIn
Mendeley
StumbleUpon
CiteULike
Reddit
Email