• Mieko Claudia Miura, Ribeiro de Carvalho Carlos Roberto CR University Hospital, Universidade de São Paulo, São Paulo, Brazil., Yamada da Silveira Leda Tomiko LT Cardio-Pulmonary Department-Respiratory ICU, Pulmonary Division, Heart Institute, Hospital das Clínicas da FMUSP, University of Sao Paul, de Moraes Regenga Marisa M Hospital do Coração, São Paulo-SP, Brazil., Petri Damiani Lucas L HCor Research Institute, Hospital do Coração, São Paulo, Brazil., and Carolina Fu.
• Hospital do Coração, São Paulo-SP, Brazil; Department of Physiotherapy, Communication Science & Disorders, Occupational Therapy, Medical School of the University of São Paulo, São Paulo, Brazil; Cardio-Pulmonary Department-Respiratory ICU, Pulmonary Division, Heart Institute, Hospital das Clínicas da FMUSP, University of Sao Paulo, São Paulo, Brazil. Electronic address: claumiura@hotmail.com.
• J. Thorac. Cardiovasc. Surg. 2018 Dec 1; 156 (6): 2170-2177.e1.

ObjectivePulmonary impairment is a common complication after coronary artery bypass graft procedure and may be prevented or treated by noninvasive ventilation. Recruitment maneuvers include sustained airway pressure with high levels of positive end-expiratory pressure in patients with hypoxemia, favoring homogeneous pulmonary ventilation and oxygenation. This study aimed to evaluate whether noninvasive ventilation with recruitment maneuver could safely improve oxygenation in patients with atelectasis and hypoxemia who underwent a coronary artery bypass grafting procedure.MethodsThirty-four patients admitted to our intensive care unit undergoing mechanical ventilation after surgery, with ratio of arterial oxygen partial pressure to fraction of inspired oxygen < 300 and radiologic atelectasis score ≥2, were included. The control group consisted of 16 randomized patients and the recruitment group consisted of 18 patients. After extubation, noninvasive ventilation was applied for 30 minutes 3 times a day with positive end-expiratory pressure of 8 cm H2O. The recruitment group received recruitment maneuver with positive end-expiratory pressure of 15 cm H2O and 20 cm H2O for 2 minutes each during noninvasive ventilation. We analyzed the arterial oxygen partial pressure in room air, radiologic atelectasis score, hemodynamic stability, and adverse events from extubation until discharge.ResultsArterial oxygen partial pressure increased 12.6% ± 6.8% in the control group and 23.3% ± 8.5% in the recruitment group (P < .001). The radiologic atelectasis score was completely improved for 94.4% of the recruitment group with no adverse events, whereas 87.5% of the control group presented some atelectasis (P < .001).ConclusionsNoninvasive ventilation with recruitment maneuvers is safe, improves oxygenation, and reduces atelectasis in patients undergoing coronary artery bypass.Copyright © 2018 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

40 keywords...

hide…