Liberação de pressão de vias aéreas em pacientes pediátricos submetidos à cirurgia cardíaca

OBJECTIVE: Comparison of three modes of MV: intermittent mandatory ventilation with positive end expiratory pressure (IMV+PEEP), APRV and continuous positive airway pressure (CPAP) in children during cardiac surgery post operative with pulmonary hypertension and mild or moderate pulmonary lesion. METHODS: Ten patients were studied with respiratory monitoring (Bear Neonatal Volume Monitor-1O) in MV with a continuos flow, time cycled and pressure limited ventilator. The cardiocirculatory variables analyzed were central venous pressure (CVP), oxygen extraction ratio, cardiac rate, systolic arterial pressure, and arterial- mixed venous CO2 difference. Friedman's test (non-parametric) was used to compare the variables in three modalities of ventilation and the Wilcoxon test was used for the variables obtained in two of the modalities. RESULTS: The mean airway pressure (MAP) showed a significant increasing during APRV compared to IMV+PEEP (p=0,012). The positive inspiratory pressure (PIP), the minute volume and the ratio of oxygen arterial pressure to oxygen inspired fraction (PaO2/FiO2) didn't show statistical difference. During APRV there was a significant decrease in respiratory rate (p= 0,004) and an increase in tidal volume (p=0,045) when compared to CPAP and IMV+PEEP. In the cardiocirculatory system only CVP showed a significant increased (p=0,019) during APRV. CONCLUSION: Due to the methodology utilized MAP was higher with APRV resulting in an increased tidal volume without respiratory or cardiocirculatory adverse effects when the three modes were compared. Our results suggest that APRV is a simple and safe method of ventilation.

[1]  R. Sahni,et al.  Continuous positive airway pressure (CPAP) , 1998, Indian journal of pediatrics.

[2]  M. Lamy,et al.  The American-European Consensus Conference on ARDS. Definitions, mechanisms, relevant outcomes, and clinical trial coordination. , 1994, American journal of respiratory and critical care medicine.

[3]  K. Sykes.  Mechanical ventilation in acute respiratory failure. , 1994, European journal of anaesthesiology.

[4]  R. Branson,et al.  Airway Pressure Release Ventilation , 1993 .

[5]  C. Putensen,et al.  EFFECT OF RELEASE TIME ON GAS EXCHANGE AND HEMODYNAMICS DURING AIRWAY PRESSURE RELEASE VENTILATION , 1993 .

[6]  T. Reilley,et al.  Improvement in cardiac output during airway pressure release ventilation. , 1992, Critical care medicine.

[7]  R. Kirby,et al.  Airway pressure release ventilation during acute lung injury: A prospective multicenter trial , 1991, Critical care medicine.

[8]  W. Peruzzi,et al.  Airway pressure release ventilation in severe acute respiratory failure. , 1991, Chest.

[9]  W. R. Sims,et al.  Distribution of ventilation and perfusion with different modes of mechanical ventilation. , 1991, The American review of respiratory disease.

[10]  R. Wetzel,et al.  Airway pressure release ventilation in a neonatal lamb model of acute lung injury , 1991, Critical care medicine.

[11]  M. Elliott,et al.  Non-invasive mechanical ventilation for acute respiratory failure. , 1990, BMJ.

[12]  R. Kirby,et al.  AIRWAY PRESSURE RELEASE VENTILATION: A MULTICENTER TRIAL , 1989 .

[13]  R. Kirby,et al.  Airway pressure release ventilation in a patient with acute pulmonary injury. , 1989, Chest.

[14]  J. Räsänen,et al.  Airway pressure release ventilation (APRV). A human trial. , 1988, Chest.

[15]  J. Räsänen,et al.  Cardiovascular effects of conventional positive pressure ventilation and airway pressure release ventilation. , 1988, Chest.

[16]  M. C. Stock,et al.  Airway pressure release ventilation. , 1987, Critical care medicine.

[17]  M. C. Stock,et al.  Airway pressure release ventilation: A new approach to ventilatory support during acute lung injury , 1987 .

[18]  M. C. Stock,et al.  AIRWAY PRESSURE RELEASE VENTILATION (APRV): A NEW VENTILATORY SUPPORT MODE DURING ACUTE LUNG INJURY (ALI) , 1986 .

[19]  W. Mitzner,et al.  A re‐evaluation of the hemodynamic consequences of intermittent positive pressure ventilation , 1983, Critical care medicine.

[20]  R. Wilson,et al.  Comparison of work of breathing on high gas flow and demand valve continuous positive airway pressure systems. , 1982, Chest.

[21]  W. Hunter,et al.  The contractile behavior of the heart and its functional coupling to the circulation. , 1982, Progress in cardiovascular diseases.

[22]  J. Marini,et al.  Mechanical effect of lung distention with positive pressure on cardiac function. , 2015, The American review of respiratory disease.

[23]  D. Shannon,et al.  The relationship of bronchopulmonary dysplasia to the occurrence of alveolar rupture during positive pressure ventilation , 1978, Critical care medicine.

[24]  W. Stanford,et al.  Ventilatory pattern, intrapleural pressure, and cardiac output. , 1977, Anesthesia and analgesia.

[25]  G. Barat,et al.  Positive end‐expiratory pressure , 1975, Anaesthesia.

[26]  M. Becklake,et al.  "Closing volume" and its relationship to gas exchange in seated and supine positions. , 1971, Journal of applied physiology.

[27]  J. Kitterman,et al.  Treatment of the idiopathic respiratory-distress syndrome with continuous positive airway pressure. , 1971, The New England journal of medicine.