RESUMEN
BACKGROUND: Coronary artery bypass graft (CABG) surgery with the use of mammary arteries is associated with severe alteration of lung function parameters. The purpose of the present study was to compare the effect on lung function tests of conventional physiotherapy using incentive spirometry (IS) with non-invasive ventilation on continuous positive airway pressure (CPAP) and with non-invasive ventilation on bilevel positive airway pressure (BiPAP or NIV-2P), METHODS: Ninety-six patients were randomly assigned to 1 of 3 groups: NIV-2P (1 h/3 h), CPAP (1 h/3 h) and IS (20/2 h). Pulmonary function tests and arterial blood gases analyses were obtained before surgery. On the 1st and 2nd postoperative days, these parameters were collected together with cardiac output and calculation of venous admixture. RESULTS: For the 3 groups a severe restrictive pulmonary defect was observed during the 1st postoperative day. On the 2nd postoperative day, in opposition to IS, intensive use of CPAP and NIV-2P reduced significantly the venous admixture (P<0.001) and improved VC, FEV1 and PaO2 (P<0.01). CONCLUSION: We conclude that preventive use of NIV can be considered as an effective means to decrease the negative effect of coronary surgery on pulmonary function.
Asunto(s)
Puente de Arteria Coronaria/rehabilitación , Modalidades de Fisioterapia , Respiración con Presión Positiva/métodos , Anciano , Análisis de los Gases de la Sangre , Femenino , Volumen Espiratorio Forzado , Humanos , Masculino , Persona de Mediana Edad , Cuidados Posoperatorios , Circulación PulmonarRESUMEN
OBJECTIVE: To evaluate the accuracy of cardiac output measurement obtained by a new continuous thermodilution cardiac output (CCO) pulmonary artery catheter compared to intermittent thermodilution (TCO) and the direct Fick method. DESIGN: Prospective open trial. SETTING: University hospital, intensive care unit. PATIENTS: 23 patients (15 surgical, 8 non-surgical) were monitored with the Intellicath pulmonary catheter. Cardiac output was evaluated by the three methods every 4 to 6h as long as the pulmonary artery catheter was necessary (8-96 h). RESULTS: The correlation coefficient between CCO and TCO was 0.92, no systematic bias was observed, and the relative error increased from 13.9% for a cardiac output of 21/min to 23.7% for an output of 101/min. When comparing CCO and Fick, the correlation coefficient was 0.89, no bias was detected, and the relative error increased from 20.4% for outputs of 21/min to 27.2% for outputs of 101/min. CONCLUSIONS: CCO provides clinically acceptable measurements. At high cardiac outputs, the difference with other methods increases and the results must be cautiously interpreted.