Auler Junior José Otávio Costa, Nozawa Emília, Toma Eliane Kobayashi, Degaki Karin Lika, Feltrim Maria Ignêz Zanetti, Malbouisson Luiz Marcelo Sá
Serviço de Anestesiologia, Unidade de Terapia Intensiva Cirúrgica, InCor.
Rev Bras Anestesiol. 2007 Oct;57(5):476-88. doi: 10.1590/s0034-70942007000500003.
To evaluate the effects of the alveolar recruitment maneuver on oxygenation and exhaled tidal volume, in patients with hypoxemia, in the immediate postoperative period of cardiac surgery.
This is a prospective, consecutive study. Among the 469 cardiac surgeries performed from February to April 2006, 40 patients (8.5%) who, at the time of admission to the surgical intensive care unit, presented PaO2/FIO2 < 200, were included in the protocol. A standard prospective protocol of alveolar recruitment maneuvers with pressure of 20 cmH2O in the upper airways in the presence of the ratio PaO2/FIO2 < 200, 30 cmH2O with PaO2/FIO2 < 150, and 40 cmH2O when Pa2O2/FIO2 remained below 150 after recruitment maneuver with pressure of 30 cmH2O, was applied to this group of patients. Continuous positive pressure was applied to the airways with a mechanical ventilator, 3 times, for approximately 30 seconds each. Parameters of oxygenation and exhaled tidal volume were compared before and immediately after the recruitment maneuvers.
Of the 40 patients in the study, 30 showed good responses to recruitment maneuvers with 20 cmH2O, and 10 cases required 30 cmH2O. It was not necessary to apply pressure of 40 cmH2O. There was a significant improvement in oxygenation after the recruitment maneuvers, demonstrated by an increase in PaO2/FIO2 (p = 0.001), peripheral oxygen saturation (p = 0.004), and exhaled tidal volume (p = 0.038).
Alveolar recruitment maneuvers were successful on correcting hypoxemia and increasing the exhaled tidal volume in patients on mechanical ventilation in the immediate postoperative period of cardiac surgery.
评估肺泡复张手法对心脏手术后即刻低氧血症患者氧合及呼出潮气量的影响。
这是一项前瞻性、连续性研究。在2006年2月至4月进行的469例心脏手术中，40例患者（8.5%）在入住外科重症监护病房时，动脉血氧分压/吸入氧分数值（PaO2/FIO2）<200，被纳入本研究方案。对于PaO2/FIO2<200的患者，采用气道压力为20 cmH2O的标准前瞻性肺泡复张手法方案；PaO2/FIO2<150时，压力为30 cmH2O；当用30 cmH2O压力进行复张手法后Pa2O2/FIO2仍低于150时，压力为40 cmH2O。使用机械通气对气道持续施加正压，共3次，每次约30秒。比较复张手法前后的氧合参数及呼出潮气量。
研究中的40例患者中，30例对20 cmH2O的复张手法反应良好，10例需要30 cmH2O。无需施加40 cmH2O的压力。复张手法后氧合有显著改善，表现为PaO2/FIO2升高（p = 0.001）、外周血氧饱和度升高（p = 0.004）及呼出潮气量增加（p = 0.038）。
肺泡复张手法成功纠正了心脏手术后即刻机械通气患者的低氧血症并增加了呼出潮气量。
