Navegando por Palavras-chave "pressão positiva no final da expiração"

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    Influência da pressão expiratória final positiva na microcirculação de pacientes com choque distributivo
    (Universidade Federal de São Paulo (UNIFESP), 2013-11-27) Nunes, Nathaly Fonseca [UNIFESP]; Machado, Flavia Ribeiro Machado [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    This study aims to evaluate the impact of increased positive end expiratory pressure (PEEP) on the sublingual microcirculation in patients with distributive shock and acute respiratory distress syndrome. This is a prospective observational study conducted including patients with distributive shock and ARDS, with invasive arterial pressure and pulmonary artery catheter monitoring and in whom an increase in PEEP levels was requested by the attending physician. PEEP was increased to reach a plateau pressure of 30cmH20. The microcirculation was assessed using sidestream darkfield technology. All variables were recorded before and after the increase in PEEP. We included 12 patients. The median increase in PEEP was 7.5 (6.0 - 10.0) cmH2O. The microcirculation variables did not change significantly after increasing PEEP. However, the subgroup of patients with a decrease of mean arterial pressure ≥ 10% (n = 5) trended to have a decrease in perfused vascular density (p = .08). There was a weak positive correlation between the change in mean arterial pressure and the change in perfused vascular density (R2 = 0.387, p = 0.031). When the microcirculatory variables variation was compared between the subgroups, a significant reduction of perfused vascular density (p = 0.01) was found only in the subgroup of patients with a decrease of mean arterial pressure ≥ 10%. There was no difference in the microcirculation variables when patients were stratified according to the decrease in cardiac index and the amount of PEEP increment. We concluded that the increase in PEEP levels did not significantly change the microcirculation. However, in those patients who had a decrease in mean arterial pressure ≥ 10% after the increment in PEEP, also had a decreased in perfused vascular density.