Use of positive pressure in the bariatric surgery and effects on pulmonary function and prevalence of atelectasis: randomized and blinded clinical trial

ABCD. Arquivos Brasileiros de Cirurgia Digestiva (São Paulo)

Letícia Baltieri¹  Laisa Antonela Santos¹  Irineu Rasera-junior¹  Maria Imaculada Lima Montebelo¹  Eli Maria Pazzianotto-forti¹ 

关键词: Obesity;    morbid;    Bariatric surgery;    Pulmonary atelectasis;    Continuous positive airway pressure;    Physical therapy specialty;    Obesidade mórbida;    Cirurgia bariátrica;    Atelectasia pulmonar;    Pressão positiva contínua nas vias aéreas;    Fisioterapia;   

DOI  :  10.1590/S0102-6720201400S100007

来源: SciELO

【 摘 要 】

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.

【 授权许可】

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