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Use of positive pressure in the bariatric surgery and effects on pulmonary function and prevalence of atelectasis: randomized and blinded clinical trial.
Baltieri, Letícia; Santos, Laisa Antonela; Rasera, Irineu; Montebelo, Maria Imaculada Lima; Pazzianotto-Forti, Eli Maria.
Afiliação
  • Baltieri L; Universidade Metodista de Piracicaba, Piracicaba, SP, Brazil.
  • Santos LA; Universidade Metodista de Piracicaba, Piracicaba, SP, Brazil.
  • Rasera I; Universidade Metodista de Piracicaba, Piracicaba, SP, Brazil.
  • Montebelo MI; Universidade Metodista de Piracicaba, Piracicaba, SP, Brazil.
  • Pazzianotto-Forti EM; Universidade Metodista de Piracicaba, Piracicaba, SP, Brazil.
Arq Bras Cir Dig ; 27 Suppl 1: 26-30, 2014.
Article em En, Pt | MEDLINE | ID: mdl-25409961
BACKGROUND: In surgical procedures, obesity is a risk factor for the onset of intra and postoperative respiratory complications. AIM: Determine what moment of application of positive pressure brings better benefits on lung function, incidence of atelectasis and diaphragmatic excursion, in the preoperative, intraoperative or immediate postoperative period. METHOD: Randomized, controlled, blinded study, conducted in a hospital and included subjects with BMI between 40 and 55 kg/m2, 25 and 55 years, underwent bariatric surgery by laparotomy. They were underwent preoperative and postoperative evaluations. They were allocated into four different groups: 1) Gpre: treated with positive pressure in the BiPAP mode (Bi-Level Positive Airway Pressure) before surgery for one hour; 2) Gpos: BIPAP after surgery for one hour; 3) Gintra: PEEP (Positive End Expiratory Pressure) at 10 cmH2O during the surgery; 4) Gcontrol: only conventional respiratory physiotherapy. The evaluation consisted of anthropometric data, pulmonary function tests and chest radiography. RESULTS: Were allocated 40 patients, 10 in each group. There were significant differences for the expiratory reserve volume and percentage of the predicted expiratory reserve volume, in which the groups that received treatment showed a smaller loss in expiratory reserve volume from the preoperative to postoperative stages. The postoperative radiographic analysis showed a 25% prevalence of atelectasis for Gcontrol, 11.1% for Gintra, 10% for Gpre, and 0% for Gpos. There was no significant difference in diaphragmatic mobility amongst the groups. CONCLUSION: The optimal time of application of positive pressure is in the immediate postoperative period, immediately after extubation, because it reduces the incidence of atelectasis and there is reduction of loss of expiratory reserve volume.
Assuntos

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Atelectasia Pulmonar / Respiração com Pressão Positiva / Assistência Perioperatória / Cirurgia Bariátrica / Pulmão Tipo de estudo: Clinical_trials / Prevalence_studies / Prognostic_studies / Risk_factors_studies Limite: Adult / Female / Humans / Male Idioma: En / Pt Revista: Arq Bras Cir Dig Ano de publicação: 2014 Tipo de documento: Article País de afiliação: Brasil País de publicação: Brasil

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Atelectasia Pulmonar / Respiração com Pressão Positiva / Assistência Perioperatória / Cirurgia Bariátrica / Pulmão Tipo de estudo: Clinical_trials / Prevalence_studies / Prognostic_studies / Risk_factors_studies Limite: Adult / Female / Humans / Male Idioma: En / Pt Revista: Arq Bras Cir Dig Ano de publicação: 2014 Tipo de documento: Article País de afiliação: Brasil País de publicação: Brasil