Méndez Vanessa Marques Ferreira, Oliveira Mayron F, Baião Adriana do Nascimento, Xavier Patrícia Andrade, Gun Carlos, Sperandio Priscila A, Umeda Iracema I K
Physiotherapy Unit, Dante Pazzanese Institute of Cardiology, Avenida Dr Dante Pazzanese, 500, CEP: 04012-180, Vila Mariana, São Paulo, SP Brazil.
Physiotherapy Unit, Division of anesthesiology and intensive care unit - Federal University of São Paulo (UNIFESP), São Paulo, SP Brazil.
Arch Physiother. 2017 Jan 11;7:2. doi: 10.1186/s40945-016-0030-4. eCollection 2017.
Cardiac surgery is widely used in the treatment of cardiovascular diseases. However, several complications can be observed during the postoperative period. Positive end expiratory pressure (PEEP) improves gas exchange, but it might be related to decreased cardiac output and possible impairment of tissue oxygenation. The aim of this study was to investigate the hemodynamic effects and oxygen saturation of central venous blood (ScvO) after increasing PEEP in hypoxemic patients after coronary artery bypass (CAB) surgery.
Seventy post-cardiac surgery patients (CAB), 61 ± 7 years, without ventricular dysfunction (left ventricular ejection fraction 57 ± 2%), with hypoxemia (PaO/FiO ratio <200) were enrolled. Heart rate, mean arterial pressure, arterial and venous blood samples were measured at intensive care unit and PEEP was increased to 12 cmHO for 30 min.
As expected, PEEP12 improved arterial oxygenation and PaO/FiO ratio ( 0.0001). Reduction in ScvO was observed between PEEP5 (63 ± 2%) and PEEP12 (57 ± 1%; = 0.01) with higher values of blood lactate in PEEP12 ( 0.01). No hemodynamic effects (heart rate, mean arterial pressure, SpO; 0.05) were related.
Increased PEEP after cardiac surgery decreased ScvO and increased blood lactate, even with higher O delivery. PEEP did not interfere in hemodynamics status in CAB patients, suggesting that peripheral parameters must be controlled and measured during procedures involving increased PEEP in post-cardiac surgery patients in the intensive care unit.
心脏手术广泛应用于心血管疾病的治疗。然而，术后可能会出现多种并发症。呼气末正压通气（PEEP）可改善气体交换，但可能与心输出量降低及组织氧合可能受损有关。本研究的目的是探讨冠状动脉搭桥（CAB）手术后低氧血症患者增加PEEP后对血流动力学的影响以及中心静脉血氧饱和度（ScvO）。
纳入70例心脏手术后患者（CAB），年龄61±7岁，无心室功能障碍（左心室射血分数57±2%），伴有低氧血症（动脉血氧分压/吸入氧分数值<200）。在重症监护病房测量心率、平均动脉压、动脉血和静脉血样本，并将PEEP增加至12 cmH₂O持续30分钟。
正如预期的那样，PEEP12改善了动脉氧合和动脉血氧分压/吸入氧分数值（P<0.0001）。在PEEP5（63±2%）和PEEP12（57±1%；P = 0.01）之间观察到ScvO降低，且PEEP12时血乳酸值更高（P = 0.01）。未观察到血流动力学影响（心率、平均动脉压、SpO₂；P>0.05）。
心脏手术后增加PEEP会降低ScvO并增加血乳酸，即使氧输送增加。PEEP对CAB患者的血流动力学状态无干扰，这表明在重症监护病房对心脏手术后患者进行涉及增加PEEP的操作时，必须控制和测量外周参数。
