Expiratory positive airway pressure on oxygenation and hemodynamics in patients submitted to coronary artery bypass grafting
DOI:
https://doi.org/10.33233/fb.v22i6.4940Keywords:
myocardial revascularization; respiratory function tests; intrinsic positive-pressure respirationAbstract
Introduction: Expiratory Positive Airway Pressure (EPAP) is the application of an expiratory resistance to maintain positive airway pressure and has been widely used to prevent possible complications in the postoperative period of cardiac surgery. Objective: To describe the behavior of oxygenation and hemodynamics during the use of EPAP in patients undergoing coronary artery bypass grafting (CABG). Methods: This was a cross-sectional study that evaluated peripheral oxygen saturation (SpO2), heart rate (HR), respiratory rate (RR), systolic (SBP), diastolic (DBP) and mean (MAP) blood pressure, arterial oxygen pressure (PaO2), arterial carbon dioxide pressure (PaCO2) and oxygenation index that was calculated by dividing PaO2 by inspired oxygen fraction (FiO2), patients were evaluated at rest and in the first postoperative day. The EPAP was performed with the patient in the armchair sedation, and an arterial blood gas analysis was collected and analyzed to verify the PaO2, PaCO2, SaO2 and PaO2/FiO2 values. The mask on the patient's face was verbally stimulated to breathe normally while applying an expiratory resistance of 12 cmH2O for ten minutes. Immediately after the application of EPAP, the patients had new blood gas analysis performed and the hemodynamics analyzed. Results: We evaluated 58 patients for research, 41 (71%) male and with a mean age of 54 ± 8 years. The use of EPAP in the postoperative period led to improvement of all blood gas variables except PaCO2. There was an improvement in SaO2 (%) pre-EPAP 94 ± 3 and post-EPAP 98 ± 2, PaO2/FiO2 pre-EPAP 279 ± 10 and post-EPAP 346 ± 8, PaO2 (mmHg) pre-EPAP 78 ± 8 and post-EPAP 97 ± 7. Conclusion: We concluded that the application of EPAP had a positive impact on oxygenation in patients undergoing CABG without generating adverse effects on hemodynamics.
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