Pressão positiva de duplo nível em via aérea melhora o balanço autonômico no pós-operatório de cirurgia cardiaca ensaio randomizado
DOI:
https://doi.org/10.1590/1809-2950/19023129012022ENPalavras-chave:
Cirurgia Cardíaca, Pós Operatório, Ventilação Não Invasiva, Sistema Nervoso Autônomo, Ensaio Clínico Controlado AleatórioResumo
The use of bilevel positive airway pressure (BiPAP) has repercussions on the cardiorespiratory outcomes. However, the influence of the BiPAP on the modulation of the autonomic nervous system in the postoperative period of cardiac surgery has not been explored. This study aimed to evaluate the effects of BiPAP on the peripheral oxygen saturation, vital signs and autonomic balance in the period of hospitalization after cardiac surgery. This randomized controlled trial evaluated 36 patients in the preoperative period and hospital discharge. The BiPAP group was treated since the 18h after surgery until hospital discharge, in two daily sessions of 20 minutes associated with routine physiotherapy. The control group received routine physiotherapy during the same period. The primary outcome was peripheral oxygen saturation. Secondary outcomes were vital signs and autonomic balance evaluated by heart rate variability. It was observed that peripheral oxygen saturation and blood pressure did not change at the hospital discharge. There was a similar increase in heart rate and respiratory rate in both groups. The BiPAP group had a reduction of the Low Frequency component (sympathetic) in -27.1 n.u. (95% CI -39 to -15.2), increase of High Frequency (parasympathetic) in 27.0 n.u. (95% CI 15.2 to 39) and improves the LF/HF ratio in -2.5 (95% CI -3.8 to -1.2) compared with the control group. BIPAP attenuated the sympathetic activity, improved the vagal modulation and the autonomic balance in the hospital discharge. These findings evidence that BiPAP enable more efficient autonomic mechanisms during hospitalization after cardiac surgery
Downloads
Referências
Ortiz LD, Schaan CW, Leguisamo CP, et al. Incidence of pulmonary complications in myocardial revascularization. Arq Bras Cardiol. 2010;95:441-6. https://doi.org/10.1590/s0066-782x2010005000115
Ranucci M, Ballotta A, La Rovere MT, et al. Surgical and Clinical Outcome Research (SCORE) Group. Postoperative hypoxia and length of intensive care unit stay after cardiac surgery: the underweight paradox? PLoS One. 2014;9:e93992. https://doi.org/10.1371/journal.pone.0093992
Guizilini S, Gomes WJ, Faresin SM, et al. Avaliação da função pulmonar em pacientes submetidos à cirurgia de revascularização do miocárdio com e sem circulação extracorpórea. Braz J Cardiovasc Surg. 2005;20:310-6. https://doi.org/10.1590/S0102-76382005000300013
Lopes CR, Brandão CMA, Nozawa E, et al. Benefícios da ventilação não-invasiva após extubação no pós-operatório de cirurgia cardíaca. Braz J Cardiovasc Surg. 2008;23:344-50. https://doi.org/10.1590/S0102-76382008000300010
Franco AM, Torres FCC, Simon ISL, et al. Assessment of noninvasive ventilation with two levels of positive airway pressure in patients after cardiac surgery. Braz J Cardiovasc Surg. 2011;26:582-90. https://doi.org/10.5935/1678-9741.20110048
Liao G, Chen R, He J. Prophylactic use of noninvasive positive pressure ventilation in postthoracic surgery patients: A prospective randomised control study. J Thorac Dis. 2010;2:205-9. https://doi.org/10.3978/j.issn.2072-1439.2010.02.04.4
Frazier SK, Moser DK, Stone KS. Heart rate variability and hemodynamic alterations in canines with normal cardiac function during exposure to pressure support, continuous positive airway pressure, and a combination of pressure support and continuous positive airway pressure. Biol Res Nurs. 2001;2:167-74. https://doi.org/10.1177/109980040100200302
American Heart Association and European Society of Cardiology. Heart rate variability. Standards of measurement, physiological interpretation, and clinical use. Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. Eur Heart J. 1996;17:354-81. https://doi.org/10.1161/01.CIR.93.5.1043
Montano N, Porta A, Cogliati C, et al. Heart rate variability explored in the frequency domain: a tool to investigate the link between heart and behavior. Neurosci Biobehav Rev. 2009;33:71–80. https://doi.org/10.1016/j.neubiorev.2008.07.006
Lombardi F. Clinical implications of present physiological understanding of HRV components. Card Electrophysiol Rev. 2002;6:245-9. https://doi.org/10.1023/a:1016329008921
Novais LD, Sakabe DI, Takahashi ACM, et al. Avaliação da variabilidade da frequência cardíaca em repouso de homens saudáveis sedentários e de hipertensos e coronariopatas em treinamento físico. Rev Bras Fisioter. 2004;8:207-13.
Günther A, Witte OW, Hoyer D. Autonomic Dysfunction and Risk Stratification Assessed from Heart Rate Pattern. Open Neurol J. 2010;15:39-49. https://doi.org/10.2174/1874205x01004010039
Hilz MJ, Moeller S, Akhundova A, et al. High NIHSS values predict impairment of cardiovascular autonomic control. Stroke. 2011;42:1528-33. https://doi.org/10.1161/strokeaha.110.607721
Pantoni CB, Di Thommazo L, Mendes RG, et al. Effects of different levels of positive airway pressure on breathing pattern and heart rate variability after coronary artery bypass grafting surgery. Braz J Med Biol Res. 2011;44:38-45. https://doi.org/10.1590/s0100-879x2010007500129
Soares PP, Moreno AM, Cravo SL, et al. Coronary artery bypass surgery and longitudinal evaluation of the autonomic cardiovascular function. Crit Care. 2005;9:R124-31. https://doi.org/10.1186/cc3042
Bauernschmitt R, Malberg H, Wessel N, et al. Impairment of cardiovascular autonomic control in patients early after cardiac surgery. Eur J Cardiothorac Sur. 2004;25:320-6. https://doi.org/10.1016/j.ejcts.2003.12.019
Lakusic N, Slivnjak V, Baborski F, et al. Heart rate variability in patients after cardiac valve surgery. Cent Eur J Med. 2008;3:65-70. https://doi.org/10.2478/s11536-007-0070-y
Philip-Joët FF, Paganelli FF, Dutau HL, et al. Hemodynamic effects of bilevel nasal positive airway pressure ventilation in patients with heart failure. Respiration. 1999;66:136-43. https://doi.org/10.1159/000029355
Gamelin FX, Berthoin S, Bosquet L. Validity of the polar S810 heart rate monitor to measure R-R intervals at rest. Med Sci Sports Exerc. 2006;38:887-93. https://doi.org/10.1249/01.mss.0000218135.79476.9c
Nardi AT, Hauck M, Franco OS, et al. Different frequencies of transcutaneous electrical nerve stimulation on sympatho-vagal balance. Acta Scient Health Sci. 2017; 39:9-16. http://dx.doi.org/10.4025/actascihealthsci.v39i1.32854
Lacerda D, Costa D, Reis M, et al. Influence of bilevel positive airway pressure on autonomic tone in hospitalized patients with decompensated heart failure. J Phys Ther Sci. 2016;28:1-6. https://doi.org/10.1589/jpts.28.1
Colucci WS, Sawyer DB, Singh K, et al. Adrenergic overload and apoptosis in heart failure: implications for therapy. J Card Fail. 2000;6:1-7. https://europepmc.org/article/MED/10908092
La Rovere MT, Bigger JT Jr, Marcus FI, et al. Baroreflex sensitivity and heart rate variability in prediction of total cardiac mortality after myocardial infarction. Lancet. 1998;351:478-84. https://doi.org/10.1016/s0140-6736(97)11144-8
Huikuri HV, Makikallio TH, Peng CK, et al. Fractal correlation properties of R-R interval dynamics and mortality in patients with depressed left ventricular function after an acute myocardial infarction. Circulation. 2000;101:47-53. https://doi.org/10.1161/01.cir.101.1.47
Kalisnik JM, Avbelj V, Trobec R, et al. Effects of beating- versus arrested-heart revascularization on cardiac autonomic regulation and arrhythmias. Heart Surg Forum. 2007;10:E279–87. https://doi.org/10.1532/hsf98.20071055
Laitio TT, Huikuri HV, Kentala ES, et al. Correlation properties and complexity of perioperative RR-interval dynamics in coronary artery bypass surgery patients. Anesthesiology. 2000;93:69-80. https://doi.org/10.1097/00000542-200007000-00015
Stéphan F, Barrucand B, Petit P, et al. High-flow nasal oxygen vs noninvasive positive airway pressure in hypoxemic patients after cardiothoracic surgery: a randomised clinical trial. JAMA. 2015;313:2331-9. https://doi.org/10.1001/jama.2015.5213
Haruki N, Takeuchi M, Kaku K, et al. Comparison of acute and chronic impact of adaptive servo-ventilation on left chamber geometry and function in patients with chronic heart failure. Eur J Heart Fail. 2011;13:1140-6. https://doi.org/10.1093/eurjhf/hfr103
Westerdahl E, Lindmark B, Eriksson T, et al. The immediate effects of deep breathing exercises on atelectasis and oxygenation after cardiac surgery. Scand Cardiocasc J. 2003;37:363-7. https://doi.org/10.1080/14017430310014984
Selke FW. Vascular changes after cardiopulmonary bypass and ischemic cardiac arrest: roles of nitric oxide synthase and cyclooxygenase. Braz J Med Biol Res. 1999;32:1345-52. https://doi.org/10.1590/s0100-879x1999001100004
Downloads
Publicado
Edição
Seção
Licença
Copyright (c) 2022 Silva AMV, Nardi AT, Righi GA, Nascimento JR, Lima RM, Signori LU
Este trabalho está licenciado sob uma licença Creative Commons Attribution-ShareAlike 4.0 International License.
