Impacto da manobra de recrutamento alveolar sobre a função pulmonar e mecânica respiratória em pacientes submetidos a cirurgia bariátrica avaliados pela tomografia de impedância elétrica: ensaio clínico controlado randomizado
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Data
2020-08-28
Autores
Gonçalves, Antonio Christian Evangelista
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Editor
Universidade Estadual Paulista (Unesp)
Resumo
Introdução: Os pacientes obesos quando submetidos a cirurgias de abdome sob videolaparoscopia sofrem alterações ventilatórias que comprometem a aeração pulmonar, a dinâmica da mecânica ventilatória e a função pulmonar, aumentando assim os riscos de complicações pulmonares no pós-operatório. Uma forma de minimizar essas alterações ventilatórias é combinar ventilação protetora associada à manobra de recrutamento alveolar (MRA). Assim, a hipótese deste estudo é que a MRA ao final da cirurgia otimizaria a distribuição da ventilação, a aeração pulmonar e promoveria dessa forma melhora da função pulmonar. Metodologia: Trinta e um pacientes obesos, sexo feminino, com idade média de 37 7,46 anos, submetidos a cirurgia de gastroplastia videolaparoscópica foram estudados durante o procedimento cirúrgico e nas primeiras 24h. Foram randomizados para o grupo PEEP5 (16 pacientes) ventilados com PEEP de 5 cmH2O sem manobra de recrutamento alveolar (MRA) ou grupo PEEP5-MRA (15 pacientes) com PEEP 5 cmH2O com MRA. Os pacientes foram acompanhados nos períodos pré-operatório, intraoperatório e pós-operatório, submetidos ao teste de função pulmonar e avaliados pela tomografia de impedância elétrica em todos os momentos. Resultados: Pelo modelo linear misto, a aeração pulmonar diminuiu ao longo do tempo, em ambos os grupos (p<0,001), e não houve diferença entre os grupos: aeração da região ventral (p=0,98) e região dorsal (p=0,79). Houve diminuição da ventilação na região dorsal em cada grupo sem diferença entre os grupos (p=0,32). Não foi observado diferença na complacência pulmonar entre os grupos durante o intraoperatório (p=0,33). Não houve diferença na função pulmonar nos dois grupos, no tempo de permanência hospitalar, tempo de anestesia e cirurgia. Conclusão: A aplicação da MRA em pacientes obesos ao final da cirurgia de gastroplastia videolaparoscópica não otimiza a ventilação e aeração pulmonar, assim como não há ganho na mecânica e função pulmonar.
Introduction: Obese patients when submitted to abdominal surgeries under laparoscopy undergo ventilatory changes that compromise pulmonary aeration, the dynamics of ventilatory mechanics and pulmonary function, thus increasing the risks of pulmonary complications in the postoperative period. One way to minimize these ventilatory changes is to combine protective ventilation associated with the alveolar recruitment maneuver (ARM). Thus, this study hypothesizes that ARM at the end of the surgery would optimize the distribution of ventilation, pulmonary aeration and thus promote improvement in lung function. Methodology: Thirty-one obese female patients, with an average age of 37 ± 7.46 years, who underwent laparoscopic gastroplasty surgery were studied during the surgical procedure and in the first 24 hours. They were randomized to the PEEP5 group (16 patients) ventilated with PEEP of 5 cmH2O without alveolar recruitment maneuver (ARM) or PEEP5-ARM group (15 patients) with PEEP 5 cmH2O with ARM. Patients were followed up in the preoperative, intraoperative, and postoperative periods submitted to the pulmonary function test and evaluated by electrical impedance tomography at all times. Results: By the mixed linear model, pulmonary aeration decreased over time in both groups (p<0.001) and there was no difference between the groups: aeration of the ventral region (p=0.98) and dorsal region (p=0.79). There was a decrease in ventilation in the dorsal region in each group with no difference between groups (p=0.32). There was no difference in lung compliance between groups during the intraoperative period (P=0.33). There was no difference in lung function in the two groups, length of hospital stay, anesthesia and surgery. Conclusion: The application of ARM in obese patients at the end of laparoscopic gastroplasty surgery does not optimize pulmonary ventilation and aeration, as well as there is no gain in pulmonary mechanics and function.
Introduction: Obese patients when submitted to abdominal surgeries under laparoscopy undergo ventilatory changes that compromise pulmonary aeration, the dynamics of ventilatory mechanics and pulmonary function, thus increasing the risks of pulmonary complications in the postoperative period. One way to minimize these ventilatory changes is to combine protective ventilation associated with the alveolar recruitment maneuver (ARM). Thus, this study hypothesizes that ARM at the end of the surgery would optimize the distribution of ventilation, pulmonary aeration and thus promote improvement in lung function. Methodology: Thirty-one obese female patients, with an average age of 37 ± 7.46 years, who underwent laparoscopic gastroplasty surgery were studied during the surgical procedure and in the first 24 hours. They were randomized to the PEEP5 group (16 patients) ventilated with PEEP of 5 cmH2O without alveolar recruitment maneuver (ARM) or PEEP5-ARM group (15 patients) with PEEP 5 cmH2O with ARM. Patients were followed up in the preoperative, intraoperative, and postoperative periods submitted to the pulmonary function test and evaluated by electrical impedance tomography at all times. Results: By the mixed linear model, pulmonary aeration decreased over time in both groups (p<0.001) and there was no difference between the groups: aeration of the ventral region (p=0.98) and dorsal region (p=0.79). There was a decrease in ventilation in the dorsal region in each group with no difference between groups (p=0.32). There was no difference in lung compliance between groups during the intraoperative period (P=0.33). There was no difference in lung function in the two groups, length of hospital stay, anesthesia and surgery. Conclusion: The application of ARM in obese patients at the end of laparoscopic gastroplasty surgery does not optimize pulmonary ventilation and aeration, as well as there is no gain in pulmonary mechanics and function.
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Palavras-chave
Cirurgia bariátrica, Obesidade, Manobra de recrutamento alveolar, Tomografia de impedância elétrica, Bariatric surgery, Obesity, Alveolar recruitment maneuver, Electrical impedance tomography