Influência das diferentes inclinações de cabeceiras na monitorização hemodinâmica do paciente crítico

Abstract

Introduction: The management of patients in intensive care service requires monitoring of hemodynamic parameters, ensuring optimization and control of blood volume. Studies indicate that the correct horizontal positioning is unnecessary to invasive measurement of pressures. However there are few comparisons between the effect of the inclinations of 0°, 30° and 60° on the different types of hemodynamic measurements. Objectives: To investigate the effects of different backrest inclinations on measures of variation in pulse pressure (ΔPP), central venous pressure (CVP), distensibility index of the vena cava (IDVI), cardiac output (CO) and mean arterial pressure (MAP). Compare the predictive value for indicating volume using CVP and ΔPP as a predictor of IDVI. Methods: A prospective study of 31 patients admitted to the intensive care unit of the HCU-UFU. Patients were positioned with backrest inclination of 0°, 30° and 60°. For each inclination, measures ΔPP, CVP, IDVI, CO and MAP were obtained. For comparison of the results between groups was used analysis of variance. Results: There were no significant differences between the measurements obtained on the inclination 0° and 30°. In the inclination of 60°, significant variations in measures of ΔPP and CO were found. Referring to IDVI variable as a predictor of blood volume, when correlated with the CVP and ΔPP variables, the latter showed a strong correlation with the IDVI. Conclusion: The results suggest that the patient can be maintained with the backrest inclination of 30° to measurement of hemodynamic variables. The authors suggest the inclusion of assessments of ΔPP in daily use as a predictor of blood volume, in intensive care units.