Estudo preliminar sobre a utilidade da tonometria gástrica durante a retirada da ventilação pulmonar mecânica em crianças
Autor(a) principal: | |
---|---|
Data de Publicação: | 2002 |
Outros Autores: | |
Tipo de documento: | Artigo |
Idioma: | por |
Título da fonte: | Repositório Institucional da UNIFESP |
Texto Completo: | http://dx.doi.org/10.1590/S0104-42302002000100035 http://repositorio.unifesp.br/handle/11600/1381 |
Resumo: | OBJECTIVE: The intramucosal pHi measurement has been studied and evaluated as a minimally invasive method able to offer information about the tissue oxygenation. It's most important advantage is to be a regional not systemic measurement in a place with early changes of blood flow, even in the compensated states of shock, as the gastrointestinal tract. The weaning from mechanical ventilation may cause cardiac output changes as well as redistribution of blood flow to the respiratory muscles. Our aim was to test the hypothesis that the splanchnic blood flow decreases may occur after patients extubation, detected by pHi reduction, and to verify if pHi can be a good predictive index for weaning from mechanical ventilation. METHODS:Clinical prospective non-ran domized , uncontrolled study, realized in a University Hospital PICU. Assesment of pHi (gastric) in 15 children in the post-operative of elective cardiac surgery with cardiopulmonary bypass. A tonometer with saline solution was used and measurements were made one hour before and after extubation. The patients were divided into two groups with pHi <= or > 7.32. The Wilcoxon test was used for statistical analysis. RESULTS: The pHi decreased after extubation in 10 patients (66.7%). The overall mean before extubation was 7.32 ± 0.10 and after extubation was 7.27 ± 0.10 (p=0.096). In the group with pHi <= 7.32 and > 7.32 the means were 7.25 ± 0.05 to 7.32 ± 0.10 (p=0.72) and 7.41± 0.07 to 7.31±0.10 (p=0.059), before and after extubation respectively. None of the patients presented complications due to the procedure; no deaths or development of multiple organ failure occurred. All of the patients were successfuly weaned. CONCLUSIONS: Our results show pHi decreasing confirming splanchnic blood flow reduction after extubation, however in despite of this circulatory change the patients were weaned from mechanical ventilation and successfully extubated. In this trial the pHi was not a good predictive index. The pHi monitoring seems to be useful and reliable, but it requires further studies to evaluate its sensivity. |
id |
UFSP_e24d5e2b7c73d9f96f783d53c3b8b374 |
---|---|
oai_identifier_str |
oai:repositorio.unifesp.br/:11600/1381 |
network_acronym_str |
UFSP |
network_name_str |
Repositório Institucional da UNIFESP |
repository_id_str |
3465 |
spelling |
Estudo preliminar sobre a utilidade da tonometria gástrica durante a retirada da ventilação pulmonar mecânica em criançasPreliminary study about gastric tonometry usefulness, during weaning from mechanical ventilation in childrenIntramucosal pHSplanchnic circulationMechanical ventilation and cardiac surgerypH intramucosoCirculação esplâncnicaVentilação mecânica e cirurgia cardíacaOBJECTIVE: The intramucosal pHi measurement has been studied and evaluated as a minimally invasive method able to offer information about the tissue oxygenation. It's most important advantage is to be a regional not systemic measurement in a place with early changes of blood flow, even in the compensated states of shock, as the gastrointestinal tract. The weaning from mechanical ventilation may cause cardiac output changes as well as redistribution of blood flow to the respiratory muscles. Our aim was to test the hypothesis that the splanchnic blood flow decreases may occur after patients extubation, detected by pHi reduction, and to verify if pHi can be a good predictive index for weaning from mechanical ventilation. METHODS:Clinical prospective non-ran domized , uncontrolled study, realized in a University Hospital PICU. Assesment of pHi (gastric) in 15 children in the post-operative of elective cardiac surgery with cardiopulmonary bypass. A tonometer with saline solution was used and measurements were made one hour before and after extubation. The patients were divided into two groups with pHi <= or > 7.32. The Wilcoxon test was used for statistical analysis. RESULTS: The pHi decreased after extubation in 10 patients (66.7%). The overall mean before extubation was 7.32 ± 0.10 and after extubation was 7.27 ± 0.10 (p=0.096). In the group with pHi <= 7.32 and > 7.32 the means were 7.25 ± 0.05 to 7.32 ± 0.10 (p=0.72) and 7.41± 0.07 to 7.31±0.10 (p=0.059), before and after extubation respectively. None of the patients presented complications due to the procedure; no deaths or development of multiple organ failure occurred. All of the patients were successfuly weaned. CONCLUSIONS: Our results show pHi decreasing confirming splanchnic blood flow reduction after extubation, however in despite of this circulatory change the patients were weaned from mechanical ventilation and successfully extubated. In this trial the pHi was not a good predictive index. The pHi monitoring seems to be useful and reliable, but it requires further studies to evaluate its sensivity.OBJETIVO: A medida do pH intramucoso (pHi) está sendo estudada e avaliada como um método minimamente invasivo capaz de fornecer informações sobre a oxigenação tecidual, além de apresentar como principal vantagem uma medida regional e não sistêmica, num local com alterações precoces de fluxo sangüíneo mesmo nos estados compensados do choque, como o trato gastrointestinal. A retirada da ventilação pulmonar mecânica pode ocasionar alteração do débito cardíaco, assim como provocar uma redistribuição do fluxo sangüíneo para a musculatura respiratória. O objetivo do nosso estudo foi testar a hipótese de ocorrer diminuição do fluxo esplâncnico, detectado pela redução do pHi, após extubação dos pacientes e verificar a possibilidade do pHi ser um bom índice preditivo para a retirada da ventilação pulmonar mecânica.MÉTODOS: Estudo clínico prospectivo, não randomizado, não controlado, realizado na unidade de cuidados intensivos de hospital universitário. Avaliação do pHi (gástrico), com um tonômetro com solução salina, em 15 crianças no pós-operatório de cirurgia cardíaca eletiva com circulação extra-corpórea, realizadas medidas 1 hora antes e após extubação. Foi feita divisão dos pacientes em dois grupos com pHi <= ou > 7,32. Utilizado para análise estatística o Teste de Wilcoxon.RESULTADOS: Dez pacientes (66,7%) apresentaram queda do pHi após extubação. A média geral do pHi antes da extubação foi de 7,32±0,10 e pós-extubação foi de 7,27±0,10 (p= 0,096). No grupo com pHi <= 7,32 e > 7,32 as médias foram 7,25±0,05 para 7,23±0,10 (p=0,72) e 7,41±0,07 para 7,31±0,10 (p=0,059), antes e após extubação, respectivamente. Nenhum paciente apresentou complicações devido ao procedimento, não tivemos nenhum óbito ou desenvolvimento de síndrome da disfunção de múltiplos orgãos. Todos os pacientes foram extubados com sucesso.CONCLUSÕES: Nossos resultados mostram uma diminuição do pHi confirmando uma redução do fluxo esplâncnico após extubação, entretanto, apesar desta alteração circulatória, os pacientes foram retirados da ventilação pulmonar mecânica e extubados com sucesso. Em nossa amostra o pHi não se mostrou um bom índice preditivo para o desmame. A monitorização do pHi parece ser útil e de fácil execução, porém necessita maiores estudos para avaliar a sensibilidade do método.Universidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Hospital São PauloUNIFESP, EPM, Hospital São PauloSciELOAssociação Médica BrasileiraUniversidade Federal de São Paulo (UNIFESP)Souza, Renato Lopez de [UNIFESP]Carvalho, Werther Brunow de [UNIFESP]2015-06-14T13:29:38Z2015-06-14T13:29:38Z2002-03-01info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersion66-72application/pdfhttp://dx.doi.org/10.1590/S0104-42302002000100035Revista da Associação Médica Brasileira. Associação Médica Brasileira, v. 48, n. 1, p. 66-72, 2002.10.1590/S0104-42302002000100035S0104-42302002000100035.pdf0104-4230S0104-42302002000100035http://repositorio.unifesp.br/handle/11600/1381porRevista da Associação Médica Brasileirainfo:eu-repo/semantics/openAccessreponame:Repositório Institucional da UNIFESPinstname:Universidade Federal de São Paulo (UNIFESP)instacron:UNIFESP2024-08-06T03:38:40Zoai:repositorio.unifesp.br/:11600/1381Repositório InstitucionalPUBhttp://www.repositorio.unifesp.br/oai/requestbiblioteca.csp@unifesp.bropendoar:34652024-08-06T03:38:40Repositório Institucional da UNIFESP - Universidade Federal de São Paulo (UNIFESP)false |
dc.title.none.fl_str_mv |
Estudo preliminar sobre a utilidade da tonometria gástrica durante a retirada da ventilação pulmonar mecânica em crianças Preliminary study about gastric tonometry usefulness, during weaning from mechanical ventilation in children |
title |
Estudo preliminar sobre a utilidade da tonometria gástrica durante a retirada da ventilação pulmonar mecânica em crianças |
spellingShingle |
Estudo preliminar sobre a utilidade da tonometria gástrica durante a retirada da ventilação pulmonar mecânica em crianças Souza, Renato Lopez de [UNIFESP] Intramucosal pH Splanchnic circulation Mechanical ventilation and cardiac surgery pH intramucoso Circulação esplâncnica Ventilação mecânica e cirurgia cardíaca |
title_short |
Estudo preliminar sobre a utilidade da tonometria gástrica durante a retirada da ventilação pulmonar mecânica em crianças |
title_full |
Estudo preliminar sobre a utilidade da tonometria gástrica durante a retirada da ventilação pulmonar mecânica em crianças |
title_fullStr |
Estudo preliminar sobre a utilidade da tonometria gástrica durante a retirada da ventilação pulmonar mecânica em crianças |
title_full_unstemmed |
Estudo preliminar sobre a utilidade da tonometria gástrica durante a retirada da ventilação pulmonar mecânica em crianças |
title_sort |
Estudo preliminar sobre a utilidade da tonometria gástrica durante a retirada da ventilação pulmonar mecânica em crianças |
author |
Souza, Renato Lopez de [UNIFESP] |
author_facet |
Souza, Renato Lopez de [UNIFESP] Carvalho, Werther Brunow de [UNIFESP] |
author_role |
author |
author2 |
Carvalho, Werther Brunow de [UNIFESP] |
author2_role |
author |
dc.contributor.none.fl_str_mv |
Universidade Federal de São Paulo (UNIFESP) |
dc.contributor.author.fl_str_mv |
Souza, Renato Lopez de [UNIFESP] Carvalho, Werther Brunow de [UNIFESP] |
dc.subject.por.fl_str_mv |
Intramucosal pH Splanchnic circulation Mechanical ventilation and cardiac surgery pH intramucoso Circulação esplâncnica Ventilação mecânica e cirurgia cardíaca |
topic |
Intramucosal pH Splanchnic circulation Mechanical ventilation and cardiac surgery pH intramucoso Circulação esplâncnica Ventilação mecânica e cirurgia cardíaca |
description |
OBJECTIVE: The intramucosal pHi measurement has been studied and evaluated as a minimally invasive method able to offer information about the tissue oxygenation. It's most important advantage is to be a regional not systemic measurement in a place with early changes of blood flow, even in the compensated states of shock, as the gastrointestinal tract. The weaning from mechanical ventilation may cause cardiac output changes as well as redistribution of blood flow to the respiratory muscles. Our aim was to test the hypothesis that the splanchnic blood flow decreases may occur after patients extubation, detected by pHi reduction, and to verify if pHi can be a good predictive index for weaning from mechanical ventilation. METHODS:Clinical prospective non-ran domized , uncontrolled study, realized in a University Hospital PICU. Assesment of pHi (gastric) in 15 children in the post-operative of elective cardiac surgery with cardiopulmonary bypass. A tonometer with saline solution was used and measurements were made one hour before and after extubation. The patients were divided into two groups with pHi <= or > 7.32. The Wilcoxon test was used for statistical analysis. RESULTS: The pHi decreased after extubation in 10 patients (66.7%). The overall mean before extubation was 7.32 ± 0.10 and after extubation was 7.27 ± 0.10 (p=0.096). In the group with pHi <= 7.32 and > 7.32 the means were 7.25 ± 0.05 to 7.32 ± 0.10 (p=0.72) and 7.41± 0.07 to 7.31±0.10 (p=0.059), before and after extubation respectively. None of the patients presented complications due to the procedure; no deaths or development of multiple organ failure occurred. All of the patients were successfuly weaned. CONCLUSIONS: Our results show pHi decreasing confirming splanchnic blood flow reduction after extubation, however in despite of this circulatory change the patients were weaned from mechanical ventilation and successfully extubated. In this trial the pHi was not a good predictive index. The pHi monitoring seems to be useful and reliable, but it requires further studies to evaluate its sensivity. |
publishDate |
2002 |
dc.date.none.fl_str_mv |
2002-03-01 2015-06-14T13:29:38Z 2015-06-14T13:29:38Z |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/article |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
format |
article |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
http://dx.doi.org/10.1590/S0104-42302002000100035 Revista da Associação Médica Brasileira. Associação Médica Brasileira, v. 48, n. 1, p. 66-72, 2002. 10.1590/S0104-42302002000100035 S0104-42302002000100035.pdf 0104-4230 S0104-42302002000100035 http://repositorio.unifesp.br/handle/11600/1381 |
url |
http://dx.doi.org/10.1590/S0104-42302002000100035 http://repositorio.unifesp.br/handle/11600/1381 |
identifier_str_mv |
Revista da Associação Médica Brasileira. Associação Médica Brasileira, v. 48, n. 1, p. 66-72, 2002. 10.1590/S0104-42302002000100035 S0104-42302002000100035.pdf 0104-4230 S0104-42302002000100035 |
dc.language.iso.fl_str_mv |
por |
language |
por |
dc.relation.none.fl_str_mv |
Revista da Associação Médica Brasileira |
dc.rights.driver.fl_str_mv |
info:eu-repo/semantics/openAccess |
eu_rights_str_mv |
openAccess |
dc.format.none.fl_str_mv |
66-72 application/pdf |
dc.publisher.none.fl_str_mv |
Associação Médica Brasileira |
publisher.none.fl_str_mv |
Associação Médica Brasileira |
dc.source.none.fl_str_mv |
reponame:Repositório Institucional da UNIFESP instname:Universidade Federal de São Paulo (UNIFESP) instacron:UNIFESP |
instname_str |
Universidade Federal de São Paulo (UNIFESP) |
instacron_str |
UNIFESP |
institution |
UNIFESP |
reponame_str |
Repositório Institucional da UNIFESP |
collection |
Repositório Institucional da UNIFESP |
repository.name.fl_str_mv |
Repositório Institucional da UNIFESP - Universidade Federal de São Paulo (UNIFESP) |
repository.mail.fl_str_mv |
biblioteca.csp@unifesp.br |
_version_ |
1814268457615622144 |