The effects of recruitment maneuver during noninvasive ventilation after coronary bypass grafting: A randomized trial

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dc.contributor Sistema FMUSP-HC: Faculdade de Medicina da Universidade de São Paulo (FMUSP) e Hospital das Clínicas da FMUSP
dc.contributor.author MIURA, Mieko Claudia FMUSP-HC
CARVALHO, Carlos Roberto Ribeiro de FMUSP-HC
SILVEIRA, Leda Tomiko Yamada da FMUSP-HC
REGENGA, Marisa de Moraes
DAMIANI, Lucas Petri
FU, Carolina FMUSP-HC
dc.date.issued 2018
dc.identifier.citation JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY, v.156, n.6, p.2170-2177.e1, 2018
dc.identifier.issn 0022-5223
dc.identifier.uri http://observatorio.fm.usp.br/handle/OPI/29844
dc.description.abstract Objective: Pulmonary 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. Methods: Thirty-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. Results: Arterial 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). Conclusions: Noninvasive ventilation with recruitment maneuvers is safe, improves oxygenation, and reduces atelectasis in patients undergoing coronary artery bypass.
dc.language.iso eng
dc.publisher MOSBY-ELSEVIER
dc.relation.ispartof Journal of Thoracic and Cardiovascular Surgery
dc.rights restrictedAccess
dc.subject noninvasive ventilation; myocardial revascularization; coronary artery bypass grafting; pulmonary atelectasis; hypoxia; positive end-expiratory pressure; cardiopulmonary bypass
dc.subject.other positive airway pressure; end-expiratory pressure; cardiac-surgery; pulmonary complications; strategy; atelectasis; extubation; mortality; volume; care
dc.title The effects of recruitment maneuver during noninvasive ventilation after coronary bypass grafting: A randomized trial
dc.type article
dc.rights.holder Copyright MOSBY-ELSEVIER
dc.description.group LIM/09
dc.description.group LIM/34
dc.identifier.doi 10.1016/j.jtcvs.2018.05.004
dc.identifier.pmid 29945735
dc.type.category original article
dc.type.version publishedVersion
hcfmusp.author MIURA, Mieko Claudia:FM:
hcfmusp.author CARVALHO, Carlos Roberto Ribeiro de:FM:MCP
hcfmusp.author SILVEIRA, Leda Tomiko Yamada da:FM:MFT
hcfmusp.author FU, Carolina:FM:MFT
hcfmusp.author.external · REGENGA, Marisa de Moraes:Hosp Coracao, Sao Paulo, SP, Brazil
· DAMIANI, Lucas Petri:Hosp Coracao, HCor Res Inst, Sao Paulo, Brazil
hcfmusp.origem.id WOS:000450355500041
hcfmusp.origem.id 2-s2.0-85048882131
hcfmusp.publisher.city NEW YORK
hcfmusp.publisher.country USA
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dc.description.index MEDLINE
dc.identifier.eissn 1097-685X
hcfmusp.citation.scopus 3
hcfmusp.citation.wos 2
hcfmusp.affiliation.country Brasil


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