Aplicação da ventilação não invasiva no pós-operatório de transplante hepático pediátrico

• Autor(a) principal: Silva, Thiago Luciano Rodrigues Da [UNIFESP]
• Data de Publicação: 2018
• Tipo de documento: Dissertação
• Idioma: por
• Título da fonte: Repositório Institucional da UNIFESP
• Texto Completo: https://sucupira.capes.gov.br/sucupira/public/consultas/coleta/trabalhoConclusao/viewTrabalhoConclusao.jsf?popup=true&id_trabalho=6370607; https://repositorio.unifesp.br/handle/11600/52427
• topic: Non-Invasive ventilation; Acute ventilatory failure; Postoperative liver transplantation; Ventilação não evasiva; Insuficiência ventilatória aguda; Pós-operatório de transplante hepático

Objective: To describe the use of noninvasive mechanical ventilation (NIV) in pediatric patients in the postoperative period of liver transplantation. Method: Prospective study (carried out from June / 2008 to June / 2016) in the Pediatric Intensive Care Unit of a university hospital. Inclusion criteria: pediatric patients (018 years old) undergoing liver transplantation, who developed acute ventilatory failure after (AVF) extubation. Protocol: Ventilatory mode used in NIV: two levels of pressure (bilevel) with the initial parameters: Positive Inspiratory Pressure (PIP) 812 Centimeters of Water (cmH2O); Positive Expiratory Positive Pressure (EPAP) 35cmH2O; respiratory rate (RR) backup 812 cpm). Variables collected before and 2 hours after the initiation of NIV: arterial gases; vital signs (HR, heart rate (HR) and oxygen pulse saturation (SpO2));(PIP, EPAP, RR and inspired fraction of oxygen (FiO2)) and PaO2 / FiO2 and SpO2 / FiO2 ratios, oxygenation index (IO2) and HACOR scale were calculated. Study approved by the Ethics and Research Committee of the institution (CEP 0370/09). Statistical analysis: the failure and success groups of NIV were compared to the variables collected before and after 2h of their institution. A descriptive analysis was performed where the data were presented in mean and standard deviation, median and amplitude. The variables that met the normality assumption, we used Student's test for independent samples and ttest for paired samples, and were used for the nonparametric MannWhitney and Wilcoxon tests as alternatives for the comparisons between the success and with a significance level of 5%. Results: Fifteen children who evolved with AVF were included and submitted to NIV. Demographic characteristics of the sample: age 9.1 (7.1168.0) months; weight 6.9 (4.68.0) kilogram (kg); Arterial blood gas analysis 2hs after NIV (success vs failure): pH 7,40 ± 0,05 vs 7,32 ± 0,09 (p=0,07); PaCO2 38,5 ± 16,24 vs 42,2 ± 10,76mmHg (p=0,162); PaO2 98,16 ± 21,65 vs 93,08 ± 53mmHg (p=0,801); Vital signs 2h after NIV (success vs failure): RR 36,1 ± 12,1 vs 47 ± 20,89ipm (p=0.247); HR 126,11 ± 20,9 vs 122,2 ± 10,85bpm (p=0.706); 267.45 ± 90.6 vs 219.4 ± 31.6 p=581; HACOR Scale 2,3 ± 2,11 vs 7,80 ± 3,03 (p=0.001). Conclusions: In this sample there was no statistical difference regarding the parameters of NIV, arterial blood gases and oxygenation indices between groups. The HACOR scale after the second hour showed association with NIV failure and need for reintubation (p=0.001).