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Aplicação da ventilação mecânica não-invasiva no pós-operatório de cirurgias torácicas e abdominais

Noninvasive Mechanical Ventilation in Postoperative Thoracic and Abdominal Surgeries

Roberta Weber Werle, Alana Piccoli, Alessandra Preisig Werlang, Samanta Pezzi Gomes, Fernando Nataniel Vieira

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Resumo

Introdução: A ventilação mecânica não invasiva (VNI) é uma estratégia usada para prevenir as complicações pulmonares que ocorrem no pós-operatório de pacientes submetidos a cirurgias abdominais e torácicas. Essa técnica pode ser usada na insuficiência respiratória estabelecida no pós-operatório ou como forma profilática. Objetivos: Avaliar a aplicação e desfechos do uso da VNI nos pacientes de pós-operatório de cirurgias torácicas e abdominais no período de junho 2010 a julho 2011. Método: estudo retrospectivo, descritivo transversal, realizado na Unidade de Terapia Intensiva (UTI) de um hospital público de Porto Alegre-RS, em pacientes de pós-operatório de cirurgia torácica ou abdominal. Os dados foram coletados a partir de um formulário específico, utilizado de rotina para todos os pacientes que faziam uso da VNI. Resultados: A amostra foi composta por 67 pacientes com média de idade de 63±12 anos, sendo 35(52%) do gênero feminino. O uso mais frequente ocorreu em pacientes submetidos a cirurgias intratorácicas (67%) e, em 60% dos pacientes do estudo, a VNI foi instalada nos três primeiros dias de pós-operatório. As causas mais comuns da aplicação da VNI foram a congestão pulmonar (51%) e a falência respiratória pós-extubação (resgate) (31%). O sucesso no uso da VNI ocorreu em 52 (77,6%) pacientes e falha em 15 (22,3%), sendo a piora clínica a principal causa para interrupção da VNI e reintubação orotraqueal (66%). Houve menor tempo de hospitalização (p=0,017), permanência na UTI (p<0,001) e menor mortalidade (p=0,04) nos pacientes que obtiveram sucesso no uso da VNI, quando comparado aos pacientes que falharam e retornaram à ventilação mecânica invasiva. Conclusão: A maioria dos pacientes que utilizou a VNI evoluiu sem a necessidade de suporte ventilatório invasivo. O uso precoce da VNI apresentou relação com o sucesso da técnica e os pacientes que falharam na VNI apresentaram maior tempo de internação e mortalidade.

Palavras-chave

Cirurgia torácica; Ventilação não invasiva; Unidade de Terapia Intensiva.

Abstract

Introduction: Noninvasive mechanical ventilation (NIV) is a strategy used to prevent pulmonary complications that occur postoperative in patients undergoing abdominal and thoracic surgeries. This technique can be used in postoperative established respiratory failure or as a manner to avoid this complication. Objectives: To evaluate the implementation and outcomes of the use of NIV in patients with postoperative abdominal and thoracic surgery from June 2010 to July 2011. Method: Retrospective, cross-sectional, conducted in the Intensive Care Unit (ICU) of a public hospital in Porto Alegre, in patients with postoperative abdominal or thoracic surgery. Data were collected from a specific form, used routinely for all patients using NIV. Results: The sample consisted of 67 patients with a mean age of 63 ± 12 years old, 35 (52%) were female. The highest frequency occurred in patients undergoing intrathoracic surgery (67%) and in 60% of study patients, NIV was installed in the first three days after surgery. The most common causes of application of NIV were pulmonary congestion (51%) and due to respiratory failure after extubation (rescue) (31%). The successful use of NIV occurred in 52 (77.6%) patients and failed in 15 (22.3%), with clinical deterioration leading cause for discontinuation of NIV and re-intubation (66%). There was a shorter hospital stay (p = 0.017), ICU stay (p <0.001) and lower mortality (p = 0.04) in patients who were treated successfully using NIV compared to patients who failed and returned to invasive mechanical ventilation. Conclusion: The majority of patients who used NIV progressed without needing invasive ventilatory support. The early use of NIV was correlated with the success of the technique and the patients who failed with NIV had higher rates of hospitalization and mortality.

Keywords

Thoracic surgery; Noninvasive ventilation; Intensive Care Units.

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