PEEP-ZEEP technique: cardiorespiratory repercussions in mechanically ventilated patients submitted to a coronary artery bypass graft surgery

Journal of Cardiothoracic Surgery

Maria Ignez Zanetti Feltrim¹  José Otávio Costa Auler²  Vitor Oliveira Carvalho³  Marcus Vinicius Herbst-Rodrigues¹ 

[1] Physiotherapy Division, Heart Institute (InCor), University of Sao Paulo Medical School, Sao Paulo, Brazil;Anesthesiology Division, Heart Institute (InCor), University of Sao Paulo Medical School, Sao Paulo, Brazil;Laboratório de Insuficiência Cardíaca e Transplante, Heart Institute (InCor), University of Sao Paulo Medical School, Sao Paulo, Brazil

关键词: cardiovascular surgical procedures;    pulmonary gas exchange;    artificial respiration;    respiratory mechanics;    physical therapy modalities;   

Others  :  1153917
DOI  :  10.1186/1749-8090-6-108

 received in 2011-02-28, accepted in 2011-09-13,  发布年份 2011

【 摘 要 】

Background

The PEEP-ZEEP technique is previously described as a lung inflation through a positive pressure enhancement at the end of expiration (PEEP), followed by rapid lung deflation with an abrupt reduction in the PEEP to 0 cmH₂O (ZEEP), associated to a manual bilateral thoracic compression.

Aim

To analyze PEEP-ZEEP technique's repercussions on the cardio-respiratory system in immediate postoperative artery graft bypass patients.

Methods

15 patients submitted to a coronary artery bypass graft surgery (CABG) were enrolled prospectively, before, 10 minutes and 30 minutes after the technique. Patients were curarized, intubated, and mechanically ventilated. To perform PEEP-ZEEP technique, saline solution was instilled into their orotracheal tube than the patient was reconnected to the ventilator. Afterwards, the PEEP was increased to 15 cmH₂O throughout 5 ventilatory cycles and than the PEEP was rapidly reduced to 0 cmH₂O along with manual bilateral thoracic compression. At the end of the procedure, tracheal suction was accomplished.

Results

The inspiratory peak and plateau pressures increased during the procedure (p < 0.001) compared with other pressures during the assessment periods; however, they were within lung safe limits. The expiratory flow before the procedure were 33 ± 7.87 L/min, increasing significantly during the procedure to 60 ± 6.54 L/min (p < 0.001), diminishing to 35 ± 8.17 L/min at 10 minutes and to 36 ± 8.48 L/min at 30 minutes. Hemodynamic and oxygenation variables were not altered.

Conclusion

The PEEP-ZEEP technique seems to be safe, without alterations on hemodynamic variables, produces elevated expiratory flow and seems to be an alternative technique for the removal of bronchial secretions in patients submitted to a CABG.

【 授权许可】

   
2011 Herbst-Rodrigues et al; licensee BioMed Central Ltd.

【 图 表 】

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