Impacto da manobra de recrutamento alveolar profilática e ventilação protetora nas complicações pulmonares pós-cirurgia cardíaca: um ensaio clínico randomizado.

Abstract

Introduction: The alveolar recruitment maneuver (ARM) combined with protective mechanical ventilation may improve oxygenation and reduce pulmonary complications in the postoperative period of cardiac surgery (POCC). However, evidence regarding its efficacy is limited. Objectives: To investigate the effects of prophylactic ARM and protective ventilation on pulmonary complications (PCs) and gas exchange in POCC. Methods: A randomized clinical trial was conducted with 240 patients undergoing cardiac surgery (CS). Participants were randomly allocated into two groups: Control Group (CG), which received protective ventilation, and Intervention Group (IG), which received protective ventilation and prophylactic ARM. Primary outcomes included the incidence of PCs, improvement in gas exchange, and secondary outcomes such as mechanical ventilation (MV) time, reintubation, and length of hospital stay. Randomization and Blinding: Allocation was performed using a computer-generated random sequence, and blinding was applied to the physicians responsible for assessing hemodynamic outcomes and to patients at all stages of the research. Results: The incidence of PCs in the IG was 20.8% (95% CI: 13.4% to 28.2%) compared to 25% (95% CI: 17.3% to 32.7%) in the CG (p = 0.51). Improvement in gas exchange did not show a significant difference between the groups (p = 0.18). The mean duration of MV was 6.8 days in the IG and 7.2 days in the CG (p = 0.72). Reintubation was required in 10% of patients in the IG and 11% in the CG (p = 0.65). Conclusions: The addition of prophylactic ARM to protective ventilation did not significantly reduce the incidence of PCs, improve gas exchange, or reduce the MV time or the need for reintubation in POCC patients. Future studies should explore the combination of ARM with other physiotherapeutic interventions and ventilation strategies to identify subgroups of patients who may benefit more from this approach. Trial Registration: RBR- 9y6qvx. Universal Trial Number (UTN): U1111-1227-8525. Funding: Self-funded.