Analysis of epidemiological profile and ventilator parameters of puerperas submitted to mechanical ventilation by electrical impedance tomography
Main Article Content
Abstract
Introduction: Pregnancy-related diseases have aggravated the situation of postpartum women, who end up using Mechanical Ventilation (MV) when admitted to Intensive Care Units (ICU). Although VM has benefits, it is associated with deleterious effects that can be minimized with the use of Electrical Impedance Tomography (EIT). Objective: The aim was analyze the epidemiological profile and ventilatory parameters of mothers, which developed HELLP Syndrome, Sepsis and/or Acute Respiratory Distress Syndrome (ARDS), under MV and monitored with EIT. Methods: The study was observational, retrospective and prospective cross-sectional, conducted between March and September 2018, using data collection forms filled from a sociodemographic, obstetric and ventilatory database of postpartum women admitted to an adult ICU. Results: Sample consisting of 13 puerperal women, 8 with sepsis (61.5%), 7 with HELLP syndrome (53.8%) and 4 with ARDS (30.8%), demonstrating that 5 patients (38.5%) evolved with more than one of these pathologies. Regarding the ventilatory parameters evaluated, VT 378.9 (± 103.9) were observed and mean values found for PEEP 9.8 (±1.9) and driving pressure 11.1 (±1.4) are below those recommended by the literature, predicting lower mortality and morbidity index. Conclusion: The relevance of the driving pressure assessment in the MV setting was demonstrated, a parameter assessed by the EIT and directly related to Cstat, PEEP, VT and optimization of regional pulmonary ventilation. We highlight the need for future research that presents greater clinical significance regarding the profile of postpartum women in relation to the increasingly frequent diseases in this population.
Downloads
Article Details
Authors who publish with this journal agree to the following terms:
Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License (CC BY) that allows others to share and adapt the work with an acknowledgement of the work's authorship and initial publication in this journal.
Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.References
Brasil. Ministério da Saúde. Secretaria de Atenção à Saúde. Departamento de Ações Programáticas Estratégicas. Manual dos Comitês de mortalidade materna. Brasília: Ministério da Saúde, 2009.
Burti JS, Cruz JPS, Silva AC, Moreira IL. Assistência ao puerpério imediato: o papel da fisioterapia. Rev Fac Ciênc Méd Sorocaba. 2016;18(4):193-8. https://doi.org/10.5327/Z1984-4840201625440
Cruz AFN, Vieira BDG, Alves VH, Rodrigues DP, Queiroz ABA, Santos KM. Morbidade materna pela doença hipertensiva específica da gestação: estudo descritivo com abordagem quantitativa. J Res Fundam Care Online. 2016; 8(2):4290-9. http://dx.doi.org/10.9789/2175-5361.2016.v8i2.4290-4299
Miranda FK, Klemann D, Castro JAA, Souza SJP, Weigert SP, Piemonte MR. Atuação da enfermagem na síndrome de hellp: uma revisão de literatura. Rev Gestão Saúde. 2016;15(1):39-45.
Leonhardt S, Lachmann B. Electrical impedance tomography: the holy grail of ventilation and perfusion monitoring? Intensive Care Med. 2012;38(12):1917-29. https://doi.org/10.1007/s00134-012-2684-z
Matthay MA, Ware LB, Zimmerman GA. The acute respiratory distress syndrome. J Clin Invest. 2012;122(8):2731-40. https://doi.org/10.1172/JCI60331
Lisboa DDAJ, Medeiros EF, Alegretti LG, Badalotto D, Maraschin R. Perfil de pacientes em ventilação mecânica invasiva em uma unidade de terapia intensiva. J Biotec Biodivers. 2012;3(1):18-24.
Loring SH, Malhotra A. Driving pressure and respiratory mechanics in ARDS. N Engl J Med. 2015;372(8):776-7. https://doi.org/10.1056/NEJMe1414218
Amato MBP, Meade MO, Slutsky AS, Brochard L, Costa ELV, Schoenfeld DA, et al. Driving Pressure and survival in the acute respiratory distress syndrome. N Engl J Med. 2015;372(8):747-55. https://doi.org/10.1056/NEJMsa1410639
Guérin C, Papazian L, Reignier J, Ayzac L, Loundou A, Forel JM. Effect of driving pressure on mortality in ARDS patients during lung protective mechanical ventilation in two randomized controlled trials. Crit Care. 2016;20(1):384. https://doi.org/10.1186/s13054-016-1556-2
Marinho LS, Magalhães CBA, Vasconcelos RS, Nogueira IC, Nogueira ANC, Holanda MA. Tomografia de Impedância Elétrica: novo método de avaliação pulmonar. Rev Fisioter Saúde Fun. 2013;2(2):4-6.
Cinnella G, Grasso S, Raimondo P, D'Antini D, Mirabella L, Rauseo M, et al. Physiological effects of the open lung approach in patients with early, mild, diffuse acute respiratory distress syndrome: an Electrical impedance tomography study. Anesthesiology. 2015;123(5):1113-21. https://doi.org/10.1097/ALN.0000000000000862
Rosa RG, Rutzen W, Madeira L, Ascoli AM, Dexheimer Neto FL, Maccari JG, et al. Uso da tomografia por impedância elétrica torácica como ferramenta de auxílio às manobras de recrutamento alveolar na síndrome do desconforto respiratório agudo: relato de caso e breve revisão da literatura. Rev Bras Ter Intensiva. 2015;27(4):406-11. https://doi.org/10.5935/0103-507X.20150068
Annoni R, Silva WR, Mariano MS. Análise de parâmetros funcionais pulmonares e da qualidade de vida na revascularização do miocárdio. Fisioter Mov. 2013;26(3):525-36. http://dx.doi.org/10.1590/S0103-51502013000300006
Nery IS, Viana LS, Viana LMM, Araújo TME, Feitosa VC, Pereira VF. Perfil epidemiológico e obstétrico de gestantes com síndrome HELLP. Cogitare Enferm. 2014;19(1):147-52. http://dx.doi.org/10.5380/ce.v19i1.35973
Guimarães JP, Medeiros LGS, Oliveira FCS, Oliveira SF. A prevalência de gestantes portadoras de SHEG que evoluíram para síndrome HELLP. Rev Bras Educ Saúde. 2014;4(1):1-17.
Saintrain SV, Oliveira JGR, Saintrain MVL, Bruno ZV, Borges JLN, Daher EF, et al. Fatores associados à morte materna em unidade de terapia intensiva. Rev Bras Ter Intensiva. 2016;28(4):397-404. http://dx.doi.org/10.5935/0103-507x.20160073
Cordioli RL, Cordioli E, Negrini R, Silva E. Sepse e gravidez: sabemos tratar? Rev Bras Ter Intensiva. 2013;25(4):334-44. http://dx.doi.org/10.5935/0103-507X.20130056
Santos AM, Souza GRB, Oliveira AML. Sepse em adultos na unidade de terapia intensiva: características clínicas. Arq Med Hosp Fac Cienc Med Santa Casa São Paulo. 2016;61:3-7.
Fonseca NM, Martins AVC, Fonseca GG. Ventilação mecânica protetora, utilizar para todos? Rev Med. 2014;24(8):67-72. http://dx.doi.org/10.5935/2238-3182.20140129
Bugedo G, Retamal J, Bruhn A. O uso de níveis altos de PEEP previne a lesão pulmonar induzida pelo ventilador?. Rev Bras Ter Intensiva. 2017;29(2):231-7. http://dx.doi.org/10.5935/0103-507x.20170032
Chiumello D, Carlesso E, Brioni M, Cressoni M. Airway driving pressure and lung stress in ARDS patients. Crit Care. 2016;20:276. https://doi.org/10.1186/s13054-016-1446-7
Karsten J, Heinze H, Meier T. Impact of PEEP during laparoscopic surgery on early postoperative ventilation distribution visualized by electrical impedance tomography. Minerva Anestesiol. 2014;158-66.
Keenan JC, Formenti P, Marini JJ. Lung recruitment in acute respiratory distress syndrome: what is the best strategy?. Crurr Opin Crit Care. 2014;20(1):63-8. https://doi.org/10.1097/MCC.0000000000000054
Nebuya S, Koyke T, Imai H, Iwashita Y, Brown BH, Soma K. Feasibility of using ‘lung density’ values estimated from EIT images for clinical diagnosis of lung abnormalities in mechanically ventilated ICU patients. Physiol Meas. 2015;36(6):1261-71. https://doi.org/10.1088/0967-3334/36/6/1261
Marinho LS, Sousa NP, Barros CABS, Matias MS, Monteiro LT, Beraldo MA, et al. Assessment of regional lung ventilation by electrical impedance tomography in a patient with unilateral bronchial stenosis and a history of tuberculosis. J Bras Pneumol. 2013;39(6):742-6. https://dx.doi.org/10.1590/S1806-37132013000600013
Frerichs I, Amato MBP, van Kaam AH, Tingay DG, Zhao Z, Grychtol B, et al. Chest electrical impedance tomography examination, data analysis, terminology, clinical use and recommendations: consensus statement of the translational EIT development study group. Thorax. 2017;72(1):83-93. https://doi.org/10.1136/thoraxjnl-2016-208357
Barriento L, Ratti L, Tonella R, Faez D, Anjos APR, Figueiredo LC. Monitorização da expansão pulmonar após manobra de fisioterapia respiratória por meio do tomógrafo de impedância elétrica. J Health Sci. 2016;18(3):201-5. http://dx.doi.org/10.17921/2447-8938.2016v18n3p201-5