Navegando por Palavras-chave "Saturação Venosa Central De Oxigênio"

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    Efeito de diferentes valores de pressão positiva expiratória final (PEEP) nos parâmetros de perfusão tecidual, função pulmonar e resultados clinicos no pós-operatório de cirurgia revascularização do miocárdio com circulação extracorpórea
    (Universidade Federal de São Paulo (UNIFESP), 2021) Ferreira, Vanessa Marques [UNIFESP]; Guizilini, Solange [UNIFESP]; Universidade Federal de São Paulo
    Background: Central-venous oxygen saturation (Scv̄ O2) and blood lactate are markers of tissue oxygenation and independent predictors of morbidity and mortality after coronary artery bypass graft surgery (CABG). Objective: Therefore, the aim of the present study was to compare the levels of Scv̄ O2 and arterial blood lactate, pulmonary function and clinical outcomes among different positive end-expiratory pressure (PEEP) values in subjects during the early postoperative of CABG. Methods: Forty-eight participants who underwent elective first-time on-pump CABG, after ICU admission were allocated into either of the 3 groups according to PEEP titration: 1) Control Group: PEEP=5 cmH2O, 2) PEEP10 Group: PEEP=10 cmH2O and 3) PEEP15 Group: PEEP=15 cmH2O. Blood samples were collected at 3 time points to assess tissue perfusion markers (Scv̄ O2 and arterial blood lactate) and pulmonary function as follows: (1) 30 min after ICU arrival (baseline); (2) 30 min after PEEP titration; (3) 30 min after return of PEEP to baseline value. In these 3 times, the arterio-venous oxygen content difference (C(a - v)O2) ; PO2, PO2/ FIO2 and clinical outcome were also calculated. Results: PEEP10 group presented reduction of the Scv̄ O2 after PEEP titration but not reaching statistically significant difference compared to baseline; however, the PEEP15 group presented significant decrease of the Scv̄ O2 after PEEP titration (P < 0.01). The PEEP 10 group showed an elevation in lactate levels, but without significant difference after returning to PEEP of 5 cmH2O. However, the PEEP15 group exhibited a significant increase in arterial lactate levels (P = 0.014) and after the return to PEEP of 5 cmH2O maintained a significant difference (P = 0.002). The groups with PEEP increment presented a16 statistically significant increase of the PO2 and PO2/ FIO2 compared to control group (P < 0.01). Higher values of C(a-v)O2 was observed in the group PEEP15 compared to PEEP10 and control groups (P<000). The PEEP10 and PEEP15 groups presented a significantly shorter mechanical ventilation time and ICU stay, compared to control group. Conclusion: The PEEP application of 10 cmH2O for a short period of time improved pulmonary function, reduced mechanical ventilation time and ICU stay without significant influence on tissue perfusion markers (Scv̄ O2 and arterial blood lactate) in the early postoperative period after CABG.