Mecânica respiratória de pacientes com obesidade mórbida

Sant'Anna, Mauricio de; Carvalhal, Renata Ferreira; Oliveira, Fernando da Franca Bastos de; Zin, Walter A.; Lopes, Agnaldo José; Lugon, Jocemir Ronaldo; Guimarães, Fernando Silva

doi:10.1590/1806-3713/e20180311

Cited by 15 publications

(8 citation statements)

References 27 publications

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“…Some conditions, such as obesity (Sant’Anna Jr et al., 2019), sedation (Gelb et al., 1983) and respiratory diseases (Ceriana et al., 2017), can impact respiratory mechanics, which could change the response of those patients to the MCCD maneuver. However, in this study, the MCCD maneuver promoted the same effect on iV t in patients with obesity, sedation, and respiratory comorbidity compared to those without these conditions, showing that this maneuver can benefit both groups of patients.…”

Section: Discussionmentioning

confidence: 99%

Immediate and long‐term effects of manual chest compression and decompression maneuver on patients receiving invasive mechanical ventilation

Biarzi

Severo

Baptistella

2022

Physiotherapy Res Intl

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Background It has been reported that the manual chest compression and decompression (MCCD) maneuver can increase lung volume in patients receiving invasive mechanical ventilation (IMV), but some important questions related to this maneuver require answers: how long the effects of MCCD on lung volume remain, and whether there are effects on other respiratory and hemodynamic variables. Methods Patients receiving IMV support in an intensive care unit (ICU) with signs of hypoventilation, hypoexpansion, or atelectasis were eligible to receive the MCCD maneuver. Immediately before the maneuver, respiratory and hemodynamic parameters were collected. Then, 20 MCCD maneuvers were performed while measured the same parameters. After 10 min, all parameters were measured again. The primary outcome was the tidal volume (Vt) during the MCCD maneuver and after 10 min compared to the previous Vt. Results Of the 255 patients who were mechanically ventilated in the study period, 105 patients composed the final cohort. The MCCD increased inspiratory tidal volume (iVt), expiratory tidal volume (eVt), and chest dynamic compliance (Cdyn) during the application of the maneuver, but after 10 min, these parameters returned to their basal levels. The MCCD maneuver did not change the peak pressure, respiratory rate, peripheral oxygen saturation (SpO2), heart rate, or blood pressure. There was no difference in increased iVt in patients with sedation, respiratory comorbidity, or obesity. Further, there was no association between the iVt response to the MCCD and the admission diagnosis, and no correlation with the ICU length of stay, IMV duration, or APACHE II score. Implications of Physiotherapy Practice We concluded that MCCD increased iVt, eVt, and Cdyn during the application of the maneuver, but this effect was not observed after 10 min. Randomized controlled trials should be performed in the future to investigate the mechanism involved in increasing Vt and the possible impact of the MCCD maneuver on ICU outcomes.

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Section: Discussionmentioning

confidence: 99%

Immediate and long‐term effects of manual chest compression and decompression maneuver on patients receiving invasive mechanical ventilation

Biarzi

Severo

Baptistella

2022

Physiotherapy Res Intl

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“…Increased BMI is known to cause substantial detrimental changes to the volumes, capacities, and mechanics of the lungs and chest wall. Increased BMI can induce decreases in forced vital capacity (FVC), forced exhaled volume in 1 s (FEV 1 ), increases in total airway, peripheral, and tissue respiratory system resistances and decreases in lung compliance [ 26 – 28 ]. Any decline in lung mechanics, volumes, or capacities resulting from higher BMI will lead to using higher intraoperative mechanical ventilation intensity and MPs to maintain oxygenation, ventilation, and acid–base balance [ 8 ] but not necessarily into using higher or stressful intraoperative V T , RR, PIP, P plateau , or ΔP.…”

Section: Discussionmentioning

confidence: 99%

Intraoperative mechanical power and postoperative pulmonary complications in low-risk surgical patients: a prospective observational cohort study

El-Khatib,

Zeeni,

Shebbo

et al. 2024

BMC Anesthesiol

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Background Inadequate intraoperative mechanical ventilation (MV) can lead to ventilator-induced lung injury and increased risk for postoperative pulmonary complications (PPCs). Mechanical power (MP) was shown to be a valuable indicator for MV outcomes in critical care patients. The aim of this study is to assess the association between intraoperative MP in low-risk surgical patients undergoing general anesthesia and PPCs. Methods Two-hundred eighteen low-risk surgical patients undergoing general anesthesia for elective surgery were included in the study. Intraoperative mechanical ventilatory support parameters were collected for all patients. Postoperatively, patients were followed throughout their hospital stay and up to seven days post discharge for the occurrence of any PPCs. Results Out of 218 patients, 35% exhibited PPCs. The average body mass index, tidal volume per ideal body weight, peak inspiratory pressure, and MP were significantly higher in the patients with PPCs than in the patients without PPCs (30.3 ± 8.1 kg/m2 vs. 26.8 ± 4.9 kg.m2, p < 0.001; 9.1 ± 1.9 ml/kg vs. 8.6 ± 1.4 ml/kg, p = 0.02; 20 ± 4.9 cmH2O vs. 18 ± 3.7 cmH2O, p = 0.001; 12.9 ± 4.5 J/min vs. 11.1 ± 3.7 J/min, p = 0.002). A multivariable regression analysis revealed MP as the sole significant predictor for the risk of postoperative pulmonary complications [OR 1.1 (95% CI 1.0–1.2, p = 0.036]. Conclusions High intraoperative mechanical power is a risk factor for developing postoperative pulmonary complications. Furthermore, intraoperative mechanical power is superior to other traditional mechanical ventilation variables in identifying surgical patients who are at risk for developing postoperative pulmonary complications. Clinical trial registration NCT03551899; 24/02/2017.

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“…The increase in respiratory complications resulting from COVID-19, the need for ICU admission, and the use of mechanical ventilation appear to be associated with increased BMI [ 90 ]. Physiologically, increased body weight increases the mechanical pressure on the chest and abdomen, thus compromising lung function [ 91 ]. Thus, oxygen consumption decreases and, consequently, causes a decrease in expiratory reserve volume, functional capacity, and lung compliance [ 92 , 93 ].…”

Section: Discussionmentioning

confidence: 99%

Obesity as a Risk Factor for Complications and Mortality in Individuals with SARS-CoV-2: A Systematic Review

de Paula Silva-Lalucci,

Marques,

Valdés-Badilla

et al. 2024

Nutrients

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This systematic review aimed to analyze the available studies that identified overweight and/or obesity as a risk factor for mortality, use of respiratory support, and changes in biochemical markers in adults hospitalized with SARS-CoV-2. The PubMed, Web of Science, and Scopus databases were searched using PRISMA guidelines until January 2024. The protocol was registered with PROSPERO (code: CRD42024501551). Of the 473 articles, only 8 met the inclusion criteria (e.g., adult individuals aged 18 or over diagnosed with COVID-19 individuals with overweight and/or obesity). In addition, the Downs and Black tool was used to assess the quality of the studies. The studies analyzed totaled 9782 adults hospitalized for COVID-19, indicating that overweight and obesity are present in more than half of adults. Diseases such as diabetes mellitus and hypertension are more prevalent in adults with obesity. The systematic review also highlighted that a higher incidence of respiratory support is related to a higher incidence of hospitalization in intensive care units and that adults with overweight and obesity have a higher risk of mortality from COVID-19. Biochemical markers such as procalcitinin, C-reactive protein, and interleukin-6 are associated with the severity of COVID-19 infection. This systematic review exposed overweight and/or obesity as a risk factor for worse COVID-19 disease, as well as for the need for intensive care, respiratory support, mortality, and changes in essential blood markers.

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Mecânica respiratória de pacientes com obesidade mórbida

Cited by 15 publications

References 27 publications

Immediate and long‐term effects of manual chest compression and decompression maneuver on patients receiving invasive mechanical ventilation

Immediate and long‐term effects of manual chest compression and decompression maneuver on patients receiving invasive mechanical ventilation

Intraoperative mechanical power and postoperative pulmonary complications in low-risk surgical patients: a prospective observational cohort study

Obesity as a Risk Factor for Complications and Mortality in Individuals with SARS-CoV-2: A Systematic Review

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