Efeitos da manobra de recrutamento alveolar na prevenção de complicações pulmonares no pós-operatório imediato de cirurgias cardíacas pediátricas: estudo preeliminar

Abstract

Background: Pediatric cardiac surgery is an invasive procidation that can generate postoperative, pulmonary and systemic complications. Pulmonary complications may hinder ventilatory weaning, upsing the time of mechanical ventilation and hospitalization in the intensive care unit. The alveolar recruitment maneuver recruits collapsed areas, improving oxygenation and decreasing the risk of pulmonary complications. Objective: To identify whether the prophylactic Alveo1ar Recruitment Maneuver is effective in preventing pulmonary complications in the immediate postoperative period of pediatric cardiac surgeries in non hypoxemic patients. Methods: Randomized clinical trial with patients in the postoperative period of corrective pediatric cardiac surgery with pulmonary extracorporeal circulation, within the age range of 6 months to 6 years. All patients who met the inclusion criteria were ranomized between the control gupo and the intervention group. The control group (CG) received the standard treatment of the physiotherapy service. The intervention group (IG), in addition to standard care, received additionally the prophylactic alveolar recruitment maneuver (MRA). Data on gas exchange (PaO2/FiO2 Ratio) were collected from both groups at admission, 60 minutes and 6 hours after admission, mechanical ventilation time and total icu stay time. Results: The study showed no significant difference in the reduction of pulmonary complications between the control group and the intervention group (47.4% and 17.6% respectively with p=0.06). No patient presented complications during MRA. No differences were observed in mv time in hours (p=0.50), icu stay in days (p=0.52) and need for postoperative reintubation (p=0.66) between the intervention and control groups. Conclusions: Prophylactic MRA did not reduce the incidence of pulmonary complications in the postoperative period of pediatric cardiac surgery in non-hypoxemic patients. Mra was not shown to be effective in improving gas exchange, reducing MV time, reintubation and reducing the time of hospitalization in the cardiac ICU. However, it was safe and well tolerated in patients in the immediate postoperative period of pediatric cardiac surgery