Effects of positive end-expiratory pressure on cardiac hemodynamic and autonomic balance in patients on invasive mechanical ventilation: a clinical trial
DOI:
https://doi.org/10.33448/rsd-v10i11.19622Keywords:
Artificial breathing; Positive intrinsic pressure breathing; Heart rate; Nervous system.Abstract
Objective: To evaluate the effect of increasing positive end-expiratory pressure (PEEP) on hemodynamics and cardiac autonomic balance in patients using invasive mechanical ventilation (IMV). Methodology: This is a non-probabilistic study, where patients are their own controls, in critically ill patients hospitalized after 24 hours, submitted to increasing levels of PEEP (8, 12 and 15 cmH2O) 15 min per increment. Results: Thirty patients were included in the study. No changes were found in hemodynamic variables and cardiac autonomic balance among patients who underwent increasing levels of PEEP (8, 12 and 15 cmH2O). Conclusion: In the present study, PEEP levels of 8, 12 and 15 cmH2O did not promote changes in hemodynamic responses and cardiac autonomic balance in patients on invasive mechanical ventilation.
References
Araújo, J. N. M., Dutra, J. I. S., Silva, C. S. S., Macedo, H. K. S., Melo, J. J. S., Lopes, J. V. & Medeiros, M. L. O. (2020). Orientações para o Uso da Ventilação Mecânica – Geral e em Pacientes Acometidos pela Covid-19. Santa Cruz – RN. https://wp-sites.info.ufrn.br/admin/wp-content/uploads/sites/4/2020/05/Material_educativo_VM_Monitora_Media_e_Alta_complexidade_FACISA_UFRN.pdf
Associação de Medicina Intensiva Brasileira. Sociedade Brasileira de Pneumologia e Tisiologia (2013). Diretrizes Brasileira de Ventilação Mecânica. São Paulo: AMIB/SBPT.
Akker, J. P. C., Egal M. & Groeneveld A. B. (2013). Invasive mechanical ventilation as a risk fator for acute kidney injury in the critically ill: a systematic review and meta-analysis. Revista Critical Care, 17 (3). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3706893/
Azevedo, J. C. M., Carvalho, E. R. M., Feijó, L. A., Oliveira, F. P., Menezes, S. L. S., & Murad, H. (2010). Effects of the Continuous Positive Airway Pressure on the Airways of Patients with Chronic Heart Failure. Arquivos Brasileiro de Cardiologia, 95(1). https://www.scielo.br/j/abc/a/n4dBLCdftvR3y4fL6cpF7pb/?lang=en
Barbas, C. S., Ísola, A. M., Farias, A. M., Cavalcanti, A. B., Gama, A. M., Duarte, A. C. & Amado, V. M. (2014). Recomendações brasileiras de ventilação mecânica 2013. Parte I. Revista Brasileira de Terapia Intensiva, 26(2), 89-121. https://www.scielo.br/j/rbti/a/Whwrm75h6MJwr5C6JmJg73Q/
Brasil. Ministério da Saúde. Conselho Nacional de Saúde. (2013). Resolução n° 466, de 12 de dezembro de 2012. Ministério da Saúde.
Brasil. Ministério da Saúde. Conselho Nacional de Saúde. (2016). Resolução nº 510 de 7 de abril de 2016. Ministério da Saúde.
Choi, Y. S., Bae, M. K., Kim, S. H., Park, J., Kim, S. Y., & Oh, Y. J. (2015). Effects of Alveolar Recruitment and Positive End-Expiratory Pressure on Oxygenation during One-Lung Ventilation in the Supine Position. Yonsei Med Journal, 56(5), 1421-1427. https://eymj.org/DOIx.php?id=10.3349/ymj.2015.56.5.1421
Forgiarini, L. A. J., Rezende, J. C. & Forgiarini, S. G. I. (2013). Manobra de recrutamento alveolar e suporte ventilatório perioperatório em pacientes obesos submetidos à cirurgia abdominal. Revista Brasileira de Terapia Intensiva, 25(4), 312-318. http://rbti.org.br/artigo/detalhes/0103507X-25-4-9
França, E. E. T., Ferrari, F., Fernandes, P., Cavalcanti, R., Duarte, A., Martinez, B. P. & Damasceno, M. C. P. (2012). Physical therapy in critically ill adult patients: recommendations from the Brazilian Association of Intensive Care Medicine. Revista Brasileira de Terapia Intensiva, 24(1), 6-22. http://rbti.org.br/artigo/detalhes/0103507X-24-1-3
Giustiniano, E., Cancellieri, F., Battistini, G. M., Dominoni, C., Brancato, G., & Spoto, M. R. (2009). Positive end-expiratory pressure during infrarenal aortic clamping limits hemodynamic impairment risk. Journal of Cardiovascular Medicine, 10(3), 282–287. https://europepmc.org/article/MED/19262219
Karsten, J., Luepschen, H., Grossherr, M., Bruch, H. P., Leonhardt, S., Gehring, H., & Meier, G. T. (2011) Effect of PEEP on regional ventilation during laparoscopic surgery monitored by electrical impedance tomography. Acta Anaesthesiol Scand, 55(7), 878-886. https://onlinelibrary.wiley.com/doi/10.1111/j.1399-6576.2011.02467.x
Kemerci, P. U., Demir, A., Aydınlı, B., Güçlü, Ç. Y., Karadeniz, Ü., Çiçek, Ö. F. & Özgök, A. (2016). 10 cm H2O PEEP application in laparoscopic surgery and cerebral oxygenation: a comparative study with INVOS and FORESIGHT. Surg Endosc, 30, 971-978. doi: https://link.springer.com/article/10.1007/s00464-015-4277-8
Köche, J. C. (2011). Fundamentos de Metodologia Científica: Teoria da ciência e iniciação à pesquisa. Editora Vozes.
Kwak, H. J., Park, S. K., Lee, K. C., Lee, D. C. & Kim, J. Y. (2013). High positive end-expiratory pressure preserves cerebral oxygen saturation during laparoscopic cholecystectomy under propofol anesthesia. Surg Endosc, 27, 415-420. https://link.springer.com/article/10.1007%2Fs00464-012-2447-5
Louw, A. V., Médigue, C., Papelier, Y. & Cottin, F. (2010). Positive end-expiratory pressure may alter breathing cardiovascular variability and baroreflex gain in mechanically ventilated patients. Respiratory Research, 26, 89-121. https://doaj.org/article/fb30a40f72114717b32388e74773684c
Machado, F. D., Eder, G. L., Dulius, C. R., Baldisseroto, S. (2018). Ventilação Mecânica: Como Iniciar. https://docs.bvsalud.org/biblio ref/2018/04/882901/ventilacao-mecanica-como-iniciar.pdf
Pereira, S. M., Tucci, M. R., Morais, C. C. A., Simões, C. M., Tonelotto, B. F. F., Pompeo, M. S. & Amato, M. B. P. (2018). Individual Positive End-expiratory Pressure Settings Optimize Intraoperative Mechanical Ventilation and Reduce Postoperative Atelectasis. Anesthesiology, 129(6), 1070-1081. https://utsouthwestern.pure.elsevier.com/en/publications/individual-positive-end-expiratory-pressure-settings-optimize-int
Ribeiro, C., Vieira, A. L., Pamplona, P., Drummond, M., Seabra, B., Ferreira, D. & Nunes, R. (2021). Práticas Atuais em Ventilação Mecânica Domiciliar para Doença Pulmonar Obstrutiva Crônica: Um Estudo Transversal Multicêntrico da Vida Real. Jornal Internacional de Doença Pulmonar Obstrutiva Crônica, 16, 2217-2226. https://www.dovepress.com/getfile.php?fileID=72156
Sem, O., Doventas, Y. E. (2017). Efeitos de diferentes níveis de pressão expiratória final sobre a hemodinâmica, mecânica respiratória e resposta sistêmica ao estresse durante colecistectomia laparoscópica. Campinas, SP: Revista Brasileira de Anestesiologia. https://www.scielo.br/j/rba/a/PYNHbxWJgYCBLymXmHc4wbn/abstract/?lang=pt
Vinhal, G. S. (2015). Efetitos hemodinâmicos da pressão positiva continua nas vias aéreas avaliados pelo ecodoppler cardiograma. (Dissertação de Mestrado). Universidade Federal de Uberlândia, Uberlândia. Brasil.
Tafner, P. F. A., Chen, F. K., Rabello, R. F., Corrêa, T. D., Chaves, R. C. F. & Serpa, A. N. (2017) Recent advances in bedside microcirculation assessment in critically ill patients. Revista Brasileira de Terapia Intensiva, 29(2), 238-247. http://rbti.org.br/artigo/detalhes/0103507X-29-2-16
Tachon, G., Harrois, A., Tanaka, S., Kato, H., Huet, O., Pottecher, J. & Duranteau, J. (2014). Microcirculatory Alterations in Traumatic Hemorrhagic Shock. Critical Care Medicine, 42(6), 1433–1441. https://neuro.unboundmedicine.com/medline/citation/24561562/Microcirculatory_alteratio ns_in_traumatic_hemorrhagic_shock_
Wang, T., Zhang, L., Luo, K., He, J., Ma, Y., Li, Z. & Yu, X. (2016). Noninvasive versus invasive mechanical ventilation for immunocompromised patients with acute respiratory failure: a systematic review and meta-analysis. BMC Pulmonary Medicine, 16(1), 129. http://europepmc.org/article/PMC/5002326
Zhiling, Z., Hong, C., Qin, C., Nan, L., Shuisheng, Z., Qinggang, G. & Gaiqi, M. (2021) Efeito da ventilação com pressão positiva não invasiva e oxigenoterapia nasal de alto fluxo na eficácia clínica de pacientes com nova pneumonia por coronavírus complicada por SDRA. Chinese Critical Care Medicine. 33(6), 708-713. http://rs.yiigle.com/CN121430202106/1331726.htm
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