RESUMO
Patients undergoing neurosurgery are predisposed to a variety of complications related to mechanical ventilation (MV). There is an increased incidence of extubation failure, pneumonia, and prolonged MV among such patients. The aim of the present study was to assess the influence of extubation failure and prolonged MV on the following variables: postoperative pulmonary complications (PPC), mortality, reoperation, tracheostomy, and duration of postoperative hospitalization following elective intra-cranial surgery. The study involved a prospective observational cohort of 317 patients submitted to elective intracranial surgery for tumors, aneurysms and arteriovenous malformation. Preoperative assessment was performed and patients were followed up for the determination of extubation failure and prolonged MV (>48 h) until discharge from the hospital or death. The occurrence of PPC, incidence of death, the need for reoperation and tracheostomy, and the length of hospitalization were assessed during the postoperative period. Twenty-six patients (8.2 percent) experienced extubation failure and 30 (9.5 percent) needed prolonged MV after surgery. Multivariate analysis showed that extubation failure was significant for the occurrence of death (OR = 8.05 [1.88; 34.36]), PPC (OR = 11.18 [2.27; 55.02]) and tracheostomy (OR = 7.8 [1.12; 55.07]). Prolonged MV was significant only for the occurrence of PPC (OR = 4.87 [1.3; 18.18]). Elective intracranial surgery patients who experienced extubation failure or required prolonged MV had a higher incidence of PPC, reoperation and tracheostomy and required a longer period of time in the ICU. Level of consciousness and extubation failure were associated with death and PPC. Patients who required prolonged MV had a higher incidence of extubation failure.
Assuntos
Adulto , Feminino , Humanos , Pessoa de Meia-Idade , Extubação/efeitos adversos , Encefalopatias/cirurgia , Malformações Arteriovenosas Intracranianas/cirurgia , Desmame do Respirador/efeitos adversos , Estudos de Coortes , Procedimentos Cirúrgicos Eletivos , Complicações Pós-Operatórias , Estudos Prospectivos , Respiração Artificial , Fatores de Risco , Fatores de TempoRESUMO
Patients undergoing neurosurgery are predisposed to a variety of complications related to mechanical ventilation (MV). There is an increased incidence of extubation failure, pneumonia, and prolonged MV among such patients. The aim of the present study was to assess the influence of extubation failure and prolonged MV on the following variables: postoperative pulmonary complications (PPC), mortality, reoperation, tracheostomy, and duration of postoperative hospitalization following elective intra-cranial surgery. The study involved a prospective observational cohort of 317 patients submitted to elective intracranial surgery for tumors, aneurysms and arteriovenous malformation. Preoperative assessment was performed and patients were followed up for the determination of extubation failure and prolonged MV (>48 h) until discharge from the hospital or death. The occurrence of PPC, incidence of death, the need for reoperation and tracheostomy, and the length of hospitalization were assessed during the postoperative period. Twenty-six patients (8.2%) experienced extubation failure and 30 (9.5%) needed prolonged MV after surgery. Multivariate analysis showed that extubation failure was significant for the occurrence of death (OR = 8.05 [1.88; 34.36]), PPC (OR = 11.18 [2.27; 55.02]) and tracheostomy (OR = 7.8 [1.12; 55.07]). Prolonged MV was significant only for the occurrence of PPC (OR = 4.87 [1.3; 18.18]). Elective intracranial surgery patients who experienced extubation failure or required prolonged MV had a higher incidence of PPC, reoperation and tracheostomy and required a longer period of time in the ICU. Level of consciousness and extubation failure were associated with death and PPC. Patients who required prolonged MV had a higher incidence of extubation failure.
Assuntos
Extubação/efeitos adversos , Encefalopatias/cirurgia , Malformações Arteriovenosas Intracranianas/cirurgia , Desmame do Respirador/efeitos adversos , Adulto , Estudos de Coortes , Procedimentos Cirúrgicos Eletivos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Estudos Prospectivos , Respiração Artificial , Fatores de Risco , Fatores de TempoRESUMO
AIMS: To assess the vital capacity (VC), tidal volume, minute volume and respiratory rate during the first four postoperative days of elective craniotomy and how they are correlated with smoking, associated diseases and respiratory symptoms. PATIENTS AND METHODS: Ninety-four patients were initially evaluated for elective craniotomy and they were included in this study only if they presented normal consciousness level and spontaneous breathing at the first postoperative. The preoperative and postoperative evaluations comprised physical examination and ventilometry up to the fourth postoperative. The repeated measures analysis of variance was used to the ventilation measurements. The significance level adopted for all the statistical tests was p = 0.05. RESULTS: Sixty-two patients were included in this study. There was a 20% fall in the VC from the first to the third postoperative (p = 0.001). Patients with systemic arterial hypertension presented in the preoperative period a lower mean VC (2.59 L) than the patients without (3.28 L) (p = 0.045). Smokers presented a lower mean VC (2.65 and 1.95 L) than the nonsmokers (3.13 and 2.43 L), both in the preoperative and in the postoperative, but with no statistic significance (p = 0.090). CONCLUSION: After elective craniotomy, there is a significant decrease in VC immediately after surgery, improving gradually thereafter; there was no difference in VC between the smoking and nonsmoking patients in the pre- and postoperative as well.