Lesão pulmonar e ventilação mecânica em cirurgia cardíaca: revisão

Rodrigues, Cristiane Delgado Alves; Oliveira, Rosmari Aparecida Rosa Almeida de; Soares, Silvia Maria de Toledo Piza; Figueirêdo, Luciana Castilho de; Araújo, Sebastião; Dragosavac, Desanka

doi:10.1590/s0103-507x2010000400011

Cited by 14 publications

(19 citation statements)

References 39 publications

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“…Several studies have focused on injury to the lung parenchyma, which then causes deteriorated gas exchange in ARDS (16–18). In contrast, changes in homeostasis of coagulation and fibrinolysis have been sparsely investigated despite that their role in the evolution of this disease is beyond doubt.…”

Section: Introductionmentioning

confidence: 99%

Activation of Coagulation and Fibrinolysis in Acute Respiratory Distress Syndrome: A Prospective Pilot Study

et al. 2016

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IntroductionCoagulation and fibrinolysis remain sparsely addressed with regards to acute respiratory distress syndrome (ARDS). We hypothesized that ARDS development might be associated with changes in plasma coagulation and fibrinolysis. Our aim was to investigate the relationships between ARDS diagnosis and plasma concentrations of tissue factor (TF), tissue plasminogen activator (t-PA), and plasminogen activator inhibitor-1 (PAI-1) in mechanically ventilated patients at increased risk of developing ARDS.Materials and methodsWe performed an ethically approved prospective observational pilot study. Inclusion criteria were patients with PaO2/FiO2 < 300 mmHg admitted to the intensive care unit (ICU) for mechanical ventilation for 24 h, or more, because of one or more disease conditions associated with increased risk of developing ARDS. Exclusion criteria were age below 18 years; cardiac disease. We sampled plasma prospectively and compared patients who developed ARDS with those who did not using descriptive statistics and chi-square analysis of baseline demographical and clinical data. We also analyzed plasma concentrations of TF, t-PA, and PAI-1 at inclusion (T0) and on third (T3) and seventh day (T7) of the ICU stay with non-parametric statistics inclusive their sensitivity and specificity associated with the development of ARDS using receiver operating characteristic curve analysis. Statistical significance: p < 0.05.ResultsOf 24 patients at risk, 6 developed mild ARDS and 4 of each moderate or severe ARDS, respectively, 3 ± 2 (mean ± SD) days after inclusion. Median plasma concentrations of TF and PAI-1 were significantly higher at T7 in patients with ARDS, as compared to non-ARDS. Simultaneously, we found moderate correlations between plasma concentrations of TF and PAI-1, TF and PaO2/FiO2, and positive end-expiratory pressure and TF. TF plasma concentration was associated with ARDS with 71% sensitivity and 100% specificity, a cut off level of 145 pg/ml and AUC 0.78, p = 0.02. PAI-1 displayed 64% sensitivity and 100% specificity with a cut off concentration of 117.5 pg/ml and AUC 0.77, p = 0.02. t-PA did not change significantly during the observation time.ConclusionThis pilot study showed that increased plasma concentrations of TF and PAI-1 might support ARDS diagnoses in mechanically ventilated patients after 7 days in ICU.

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Section: Introductionmentioning

confidence: 99%

Activation of Coagulation and Fibrinolysis in Acute Respiratory Distress Syndrome: A Prospective Pilot Study

et al. 2016

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“…Respiratory failure after heart surgery is an important factor of postoperative morbidity and mortality [ 4 ] . In this study, 15 (2%) patients had ARDS, 27.7% mild TDGE, 56.1% moderate TDGE, and 5.4% severe TDGE.…”

Section: Discussionmentioning

confidence: 99%

“…ARDS was present in 0.4% to 1.32% of the patients [ 4 ] . ARDS was first described by Ashbaugh & Petty, in 1967, with these common characteristics: tachypnea, hypoxemia, persistent opacification on chest X-ray, decreased complacency, and high mortality.…”

Section: Discussionmentioning

confidence: 99%

“…Respiratory complications after cardiac surgery have been described in the literature since 1965 [ 1 ] . Respiratory system dysfunction can occur due to general anesthesia, median sternotomy (which leads to instability of the upper chest), cardiopulmonary bypass (CPB), prolonged myocardial ischemia, manipulation during surgery, and number of chest tubes [ 1 - 4 ] . Changes in pulmonary function occurring in the postoperative period of cardiac surgery with CPB are secondary to the reaction of heparin with protamine complex, edema, congestion, and lung damage, in addition to microatelectasis.…”

Section: Introductionmentioning

confidence: 99%

“…Due to the occurrence of transient dysfunction of gas exchange (called TDGE in this study) after surgery, the terms acute respiratory distress syndrome (ARDS) and acute lung injury (ALI) have been widely used in patients after cardiac surgery with CPB in recent decades. According to the criteria of the first consensus definitions of ARDS and ALI (1994), several studies reported the incidence of these disorders after such a procedure [ 4 ] .…”

Section: Introductionmentioning

confidence: 99%

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Risk factors for transient dysfunction of gas exchange after cardiac surgery

Rodrigues¹,

Moreira²,

Lima³

et al. 2014

Revista Brasileira De Cirurgia Cardiovascular

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ObjectiveA retrospective cohort study was preformed aiming to verify the presence of transient dysfunction of gas exchange in the postoperative period of cardiac surgery and determine if this disorder is linked to cardiorespiratory events.MethodsWe included 942 consecutive patients undergoing cardiac surgery and cardiac procedures who were referred to the Intensive Care Unit between June 2007 and November 2011.ResultsFifteen patients had acute respiratory distress syndrome (2%), 199 (27.75%) had mild transient dysfunction of gas exchange, 402 (56.1%) had moderate transient dysfunction of gas exchange, and 39 (5.4%) had severe transient dysfunction of gas exchange. Hypertension and cardiogenic shock were associated with the emergence of moderate transient dysfunction of gas exchange postoperatively (P=0.02 and P=0.019, respectively) and were risk factors for this dysfunction (P=0.0023 and P=0.0017, respectively). Diabetes mellitus was also a risk factor for transient dysfunction of gas exchange (P=0.03). Pneumonia was present in 8.9% of cases and correlated with the presence of moderate transient dysfunction of gas exchange (P=0.001). Severe transient dysfunction of gas exchange was associated with patients who had renal replacement therapy (P=0.0005), hemotherapy (P=0.0001), enteral nutrition (P=0.0012), or cardiac arrhythmia (P=0.0451).ConclusionPreoperative hypertension and cardiogenic shock were associated with the occurrence of postoperative transient dysfunction of gas exchange. The preoperative risk factors included hypertension, cardiogenic shock, and diabetes. Postoperatively, pneumonia, ventilator-associated pneumonia, renal replacement therapy, hemotherapy, and cardiac arrhythmia were associated with the appearance of some degree of transient dysfunction of gas exchange, which was a risk factor for reintubation, pneumonia, ventilator-associated pneumonia, and renal replacement therapy in the postoperative period of cardiac surgery and cardiac procedures.

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Comparison of intraoperative volume and pressure-controlled ventilation modes in patients who undergo open heart surgery

Hoşten

Kuş

Gümüş

et al. 2016

J Clin Monit Comput

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Respiratory problems occur more frequently in patients who undergo open heart surgery. Intraoperative and postoperative ventilation strategies can prevent these complications and reduce mortality. We hypothesized that PCV would have better effects on gas exchange, lung mechanics and hemodynamics compared to VCV in CABG surgery. Our primary outcome was to compare the PaO/FiO ratio. Patients were randomized into two groups, (VCV, PCV) consisting of 30 individuals each. Two patients were excluded from the study. I/E ratio was adjusted to 1:2 and, RR:10/min fresh air gas flow was set at 3L/min in all patients. In the VCV group TV was set at 8 mL/kg of the predicted body weight. In the PCV group, peak inspiratory pressure was adjusted to the same tidal volume with the VCV group. PaO2/FiO2 was found to be higher with PCV at the end of the surgery. Time to extubation and ICU length of stay was shorter with PCV. Ppeak was similar in both groups. Pplateau was lower and Pmean was higher at the and of the surgery with PCV compared to VCV. The hemodynamic effects of both ventilation modes were found to be similar. PVC may be preferable to VCV in patients who undergo open heart surgery. However, it would be convenient if our findings are supported by similar studies.

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Lesão pulmonar e ventilação mecânica em cirurgia cardíaca: revisão

Cited by 14 publications

References 39 publications

Activation of Coagulation and Fibrinolysis in Acute Respiratory Distress Syndrome: A Prospective Pilot Study

Activation of Coagulation and Fibrinolysis in Acute Respiratory Distress Syndrome: A Prospective Pilot Study

Risk factors for transient dysfunction of gas exchange after cardiac surgery

Comparison of intraoperative volume and pressure-controlled ventilation modes in patients who undergo open heart surgery

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