PetCO2, VCO2 and CorPP values in the successful prediction of the return of spontaneous circulation : an experimental study on not assisted cardiopulmonary arrest

Orientadores: Marcos Mello Moreira, Luiz Claudio MartinsDissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências MédicasResumo: Introdução: Durante a parada cardiorrespiratória (PCR) os níveis da pressão expiratória final de CO2 (PetCO2), produção de CO2 (VCO2) e a pressão de perfusão coronariana (PPCor) caem abruptamente e tendem a se normalizar após o retorno da circulação espontânea (RCE). Estas variáveis fisiológicas têm sido utilizadas para avaliar a eficácia das manobras de ressuscitação cardiopulmonar (RCP), as taxas de RCE e até mesmo a sobrevivência de curto prazo das vítimas de PCR. Sendo assim, a monitorização da PetCO2 e da VCO2 por meio da capnografia é uma ferramenta valiosa durante o manejo clínico de pacientes em PCR, já que seus valores estão relacionados com o desempenho dos esforços da RCP e à utilização de drogas vasopressoras. Objetivo: Avaliar se a PetCO2, VCO e PPCor são úteis na predição de sucesso da RCE em um modelo animal submetido à PCR/RCP em que foram utilizadas medicações vasopressoras.Material e Método: 42 porcas, Large White, imaturas, divididas em quatro grupos, foram anestesiadas, intubadas e ventiladas (PEEP=0cmH2O e FIO2=0,21). Sob monitorizações respiratória e hemodinâmica contínuas, foram submetidas à PCR por fibrilação ventricular (FV) não assistida por 10min, após o qual se iniciou RCP manual (100 CTE contínuas/10 ventilações/min). No 2ºmin de RCP cada grupo recebeu: Adrenalina (ADR) (45ug/kg-1); Salina-Placebo (SAL) (10mL); Terlipressina (TP) (20ug/kg-1) ou TP (20ug/kg-1) + ADR (45ug/kg-1). No 4º min de RCP os animais foram desfibrilados e os sobreviventes observados por um período adicional de 30min. As variáveis de interesse foram anotadas nos períodos basal, 10min de FV, 2ºmin de RCP, 4ºmin de RCP e 30min após a RCE (sobreviventes).Resultados: Os valores da PetCO2 e da VCO2, tanto no 2º quanto no 4º min de RCP, não se correlacionaram com as taxas de RCE em nenhum dos grupos estudados. Por outro lado, valores mais elevados da PPCor no 4ºmin de RCP estiveram associados a uma maior taxa de RCE nos grupos ADR e ADR+TP.Conclusões: Embora valores mais elevados de PPCor aos 4min de RCP tenham se associados a maiores taxas de RCE nos animais que receberam ADR ou ADR+TP, a PetCO2 e a VCO2 mensuradas aos 2min e aos 4min de RCP, contrariando alguns estudos e recomendações da literatura, não se mostraram preditores úteis das taxas de RCE neste modelo de PCR/RCP (PEEP=0 cmH2O e FIO2=0,21)Abstract: Introduction: During cardiac arrest (CA) end-tidal CO2 (EtCO2), CO2 production (VCO2) and coronary perfusion pressure (CorPP) fall abruptly and tend to return to normal levels after an effective return of spontaneous circulation (ROSC). These physiologic variables have been used to evaluate the efficacy of cardiopulmonary resuscitation (CPR) maneuvers, ROSC rates and eventually short term survival of CA victims. Therefore, PetCO2 and VCO2 monitoring by capnography is a useful tool during clinical management of CA patients, since their values are related to the performance of CPR maneuvers and the use of vasopressor drugs.Objective: To evaluate if PetCO2, VCO2 and CorPP are useful for ROSC prediction in an animal model of CA/CPR treated with vasopressor drugs.Methods: 42 female, Large-White, immature swines, divided into four groups, were anesthetized with ketamine/thiopental, orotracheally intubated and mechanically ventilated (FIO2=0.21; RR=10ipm and TV adjusted to keep PetCO2 around 40mmHg). The animals were kept under continuously respiratory and hemodynamic monitoring. Ventricular fibrillation (VF) was induced and after a 10min non-assisted CA manual closed-chest CPR was initiated (100 continuous ECC/10 ventilations/min). After 2min of basic CPR, each group received: Adrenaline (ADR) (45ug/kg-1); Saline-Placebo (SAL) (10mL); Terlipressin (TP) (20ug/kg-1) or TP (20ug/kg-1) + ADR (45ug/kg-1). Two minutes later (4th min CPR) the animals were defibrillated and the survival ones were observed for an additional 30min period. The variables of interest were recorded at basal period, 10min of VF, 2nd min CPR, 4th min CPR and 30min after ROSC and statistically analyzed.Results: EtCO2 and VCO2 values, both as recorded at 2min and 4min CPR, did not correlate with ROSC rates in any group. On the other hand, higher values of CorPP at the 4th min CPR have been associated with increased ROSC rates in ADR and ADR+TP groups.Conclusion: Although higher values of CorPP at the 4th min CPR have been associated with increased ROSC rates in animals that received ADR or ADR+TP, EtCO2 and VCO2, both as recorded at the 2nd and the 4th min CPR, contrary to some studies and the literature recommendation, have not been shown useful for predicting ROSC rates in this porcine model of fibrillatory CA/CPRMestradoFisiopatologia CirúrgicaMestra em Ciências01-P-1744/2016CAPE

Petco(2), Vco2 And Corpp Values In The Successful Prediction Of The Return Of Spontaneous Circulation: An Experimental Study On Unassisted Induced Cardiopulmonary Arrest

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)During cardiac arrest, end-tidal CO2 (PetCO(2)), VCO2 and coronary perfusion pressure fall abruptly and tend to return to normal levels after an effective return of spontaneous circulation. Therefore, the monitoring of PetCO(2) and VCO2 by capnography is a useful tool during clinical management of cardiac arrest patients. Objective: To assess if PetCO(2), VCO2 and coronary perfusion pressure are useful for the prediction of return of spontaneous circulation in an animal model of cardiac arrest/cardiopulmonary resuscitation treated with vasopressor agents. Methods: 42 swine were mechanically ventilated (FiO(2)=0.21). Ventricular fibrillation was induced and, after 10 min, unassisted cardiac arrest was initiated, followed by compressions. After 2 min of basic cardiopulmonary resuscitation, each group received: Adrenaline, Saline-Placebo, Terlipressin or Terlipressin + Adrenaline. Two minutes later (4th min of cardiopulmonary resuscitation), the animals were defibrillated and the ones that survived were observed for an additional 30 min period. The variables of interest were recorded at the baseline period, 10 min of ventricular fibrillation, 2nd min of cardiopulmonary resuscitation, 4th min of cardiopulmonary resuscitation, and 30 min after return of spontaneous circulation. Results: PetCO(2) and VCO2 values, both recorded at 2 min and 4 min of cardiopulmonary resuscitation, have no correlation with the return of spontaneous circulation rates in any group. On the other hand, higher values of coronary perfusion pressure at the 4th min of cardiopulmonary resuscitation have been associated with increased return of spontaneous circulation rates in the adrenaline and adrenaline + terlipressin groups. Conclusion: Although higher values of coronary perfusion pressure at the 4th min of cardiopulmonary resuscitation have been associated with increased return of spontaneous circulation rates in the animals that received adrenaline or adrenaline + terlipressin, PetCO(2) and VCO2 have not been shown to be useful for predicting return of spontaneous circulation rates in this porcine model.316468473Fundacao de Amparo a Pesquisa do Estado de Sao Paulo (Fapesp) [07/08315-0]Fundo de Apoio ao Ensino, Pesquisa e Extensao (Faepex)-Unicamp [17809]Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP

Petco2, Vco2 And Corpp Values In The Successful Prediction Of The Return Of Spontaneous Circulation: An Experimental Study On Unassisted Induced Cardiopulmonary Arrest

31646847

Petco(2), Vco2 and corpp values in the successful prediction of the return of spontaneous circulation: an experimental study on unassisted induced cardiopulmonary arrest

During cardiac arrest, end-tidal CO2 (PetCO(2)), VCO2 and coronary perfusion pressure fall abruptly and tend to return to normal levels after an effective return of spontaneous circulation. Therefore, the monitoring of PetCO(2) and VCO2 by capnography is a useful tool during clinical management of cardiac arrest patients. To assess if PetCO(2), VCO2 and coronary perfusion pressure are useful for the prediction of return of spontaneous circulation in an animal model of cardiac arrest/cardiopulmonary resuscitation treated with vasopressor agents. 42 swine were mechanically ventilated (FiO(2)=0.21). Ventricular fibrillation was induced and, after 10 min, unassisted cardiac arrest was initiated, followed by compressions. After 2 min of basic cardiopulmonary resuscitation, each group received: Adrenaline, Saline-Placebo, Terlipressin or Terlipressin + Adrenaline. Two minutes later (4th min of cardiopulmonary resuscitation), the animals were defibrillated and the ones that survived were observed for an additional 30 min period. The variables of interest were recorded at the baseline period, 10 min of ventricular fibrillation, 2nd min of cardiopulmonary resuscitation, 4th min of cardiopulmonary resuscitation, and 30 min after return of spontaneous circulation. PetCO(2) and VCO2 values, both recorded at 2 min and 4 min of cardiopulmonary resuscitation, have no correlation with the return of spontaneous circulation rates in any group. On the other hand, higher values of coronary perfusion pressure at the 4th min of cardiopulmonary resuscitation have been associated with increased return of spontaneous circulation rates in the adrenaline and adrenaline + terlipressin groups. Although higher values of coronary perfusion pressure at the 4th min of cardiopulmonary resuscitation have been associated with increased return of spontaneous circulation rates in the animals that received adrenaline or adrenaline + terlipressin, PetCO(2) and VCO2 have not been shown to be useful for predicting return of spontaneous circulation rates in this porcine model316468473FUNDAÇÃO DE AMPARO À PESQUISA DO ESTADO DE SÃO PAULO - FAPESP07/08315-0Fundo de Apoio ao Ensino, Pesquisa e Extensao (Faepex)-Unicam

Postoperative Period of Myocardial Revascularization Surgery: Retrospective Cohort Study of a Single Center

ABSTRACT Introduction: Risk factors and postoperative complications can worsen the condition of patients undergoing coronary artery bypass grafting; some of these factors and complications are closely related to mortality rate. Objective: To describe clinical factors and outcomes related to mortality of patients undergoing coronary artery bypass grafting and on invasive mechanical ventilation. Methods: This is a single-center retrospective data analysis of patients who underwent coronary artery bypass grafting on invasive mechanical ventilation between 2013 and 2019. Data regarding clinical characteristics, postoperative complications, intensive care unit and mechanical ventilation time, and their relationship with mortality were analyzed. Results: Four hundred seventy-two patients who underwent coronary artery bypass grafting entered the study. Their mean age was 62.3 years, and mean body mass index was 27.3. The mortality rate was 4%. Fifty percent of the patients who had ventilator-associated pneumonia died. Considering the patients who underwent hemotherapy and hemodialysis, 20% and 33% died, respectively. Days of intensive care unit stay and high Acute Physiology and Chronic Health Evaluation score and Simplified Acute Physiology Score were significantly related to death. Conclusion: Factors and clinical conditions such as the patients’ age, associated comorbidities, the occurrence of ventilator-associated pneumonia, length of stay in the intensive care unit, and mechanical ventilation time are related to higher mortality in patients undergoing coronary artery bypass grafting