Ventilatory Strategies for Hypoxemia During Cardiac Surgery: Survey Validation for Anesthesiologists in Brazil

• Published in: Revista brasileira de anestesiologia 2010-07, Vol.60 (4), p.406-414
• Main Authors: Parra, Celso Augusto Martins, Carmona, Maria José Carvalho, Junior, José Otávio Costa Auler, Malbouisson, Luiz Marcelo Sá
• Format: Article
• Language: English
• Subjects: ANESTESIOLOGIA: Condutas na Prática Médica; Anesthesiology; ANESTHESIOLOGY: medical practice; Brazil; CIRURGIA, Cardíaca: circulação extracorpórea; COMPLICATIONS: atelectasis, hypoxemia; COMPLICAÇÕES: atelectasia, hipoxemia; Humans; Hypoxia - therapy; Intraoperative Complications - therapy; Practice Patterns, Physicians; SURGERY, Cardiac: extracorporeal circulation; Surveys and Questionnaires
• ISSN: 0034-7094; 1806-907X
• DOI: 10.1016/S0034-7094(10)70050-7

Perioperative hypoxemia is common in cardiac surgeries, and atelectasis is the main cause. Besides, we can mention extracorporeal circulation (ECC), dissection of internal thoracic arteries, and previous clinical status of the patient among others as its causes. The present study elaborated an anonymous questionnaire to observe ventilatory strategies for hypoxemia in cardiac surgeries adopted by five thousand anesthesiologists all over the country. Questionnaires were sent via e-mail for five thousand anesthesiologists in Brazil. Out of the questionnaires sent, 81 valid responses were received. Among the answers, 65 (80%) anesthesiologists use volume-controlled ventilation (VCV), while 16 (20%) prefer pressure-controlled ventilation (PCV). The tidal volume (Vt) used is lower than 10 mL.kg-1, for 46 (61%) versus 20 (30%) who adopt a Vt greater than 10 mL.kg-1. Forty-seven (58%) use PEEP and 15 (21%) use FiO2 above 60%. In the case of intraoperative hypoxemia, 20.9% increase or introduce PEEP, 70.3% increase the FiO2, 19.7% use alveolar recruitment maneuvers, 13.5% increase the tidal volume, and 20.9% check for the presence of failures in the anesthesia equipment. Responses were sent from 15 states. The conducts described in the questionnaires are compatible with those of the international literature. Adjusting the questionnaires format and the way to approach anesthesiologists, new studies could be undertaken. A hipoxemia perioperatória ocorre frequentemente em cirurgia cardíaca e a atelectasia é sua principal causa. Além disso, podemos citar como causas circulação extracorpórea (CEC), dissecção de artérias torácicas internas, status clínico prévio do paciente, entre outras. O presente estudo elaborou um questionário anônimo para observar as estratégias ventilatórias frente à hipoxemia em cirurgia cardíaca adotadas por cinco mil anestesiologistas distribuídos no país. Foram enviados questionários por e-mail a cinco mil anestesiologistas do Brasil. Dos questionários enviados, foram recebidas 81 respostas válidas. Dentre as respostas, 65 (80%) anestesiologistas fazem uso da ventilação controlada a volume (VCV) frente a 16 (20%) que preferem ventilação controlada à pressão (PCV). O volume (Vt) corrente utilizado é inferior a 10 mL.kg-1 para 46 (61%) contra 29 (39%) que adotam um Vt maior que 10 mL.kg-1. Quarenta e sete (58%) usam PEEP e 17 (21%) utilizam FiO2 acima de 60%. No caso de hipoxemia intraoperatória, 20,9% aumentam ou introduzem PEEP, 70,3% aumentam