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Revista Brasileira de Anestesiologia
On-line version ISSN 1806-907X
AULER JUNIOR, José Otávio Costa et al. Alveolar recruitment maneuver to reverse hypoxemia in the immediate postoperative period of cardiac surgery. Rev. Bras. Anestesiol. [online]. 2007, vol.57, n.5, pp. 476-488. ISSN 1806-907X. http://dx.doi.org/10.1590/S0034-70942007000500003.
BACKGROUND AND OBJECTIVES: To evaluate the effects of the alveolar recruitment maneuver on oxygenation and exhaled tidal volume, in patients with hypoxemia, in the immediate postoperative period of cardiac surgery. METHODS: This is a prospective, consecutive study. Among the 469 cardiac surgeries performed from February to April 2006, 40 patients (8.5%) who, at the time of admission to the surgical intensive care unit, presented PaO2/FIO2 < 200, were included in the protocol. A standard prospective protocol of alveolar recruitment maneuvers with pressure of 20 cmH2O in the upper airways in the presence of the ratio PaO2/FIO2 < 200, 30 cmH2O with PaO2/FIO2 < 150, and 40 cmH2O when Pa2O2/FIO2 remained below 150 after recruitment maneuver with pressure of 30 cmH2O, was applied to this group of patients. Continuous positive pressure was applied to the airways with a mechanical ventilator, 3 times, for approximately 30 seconds each. Parameters of oxygenation and exhaled tidal volume were compared before and immediately after the recruitment maneuvers. RESULTS: Of the 40 patients in the study, 30 showed good responses to recruitment maneuvers with 20 cmH2O, and 10 cases required 30 cmH2O. It was not necessary to apply pressure of 40 cmH2O. There was a significant improvement in oxygenation after the recruitment maneuvers, demonstrated by an increase in PaO2/FIO2 (p = 0.001), peripheral oxygen saturation (p = 0.004), and exhaled tidal volume (p = 0.038). CONCLUSIONS: Alveolar recruitment maneuvers were successful on correcting hypoxemia and increasing the exhaled tidal volume in patients on mechanical ventilation in the immediate postoperative period of cardiac surgery.
Keywords : COMPLICATIONS [hypoxemia]; SURGERY, Cardiac; VENTILATION [mechanic, positive pressure, alveolar recruitment maneuver].