RESUMO
BACKGROUND: The Trendelenburg position (TP) has been empirically used to increase preload and thus cardiac output (CO). Transthoracic echocardiogram (TTE) is a noninvasive technique that estimates CO. We aimed to describe if the TP can improve CO. MATERIALS AND METHODS: We conducted a descriptive study in healthy subjects (ASA I), with TTE measurements of CO and the End-Diastolic Volume of the Left Ventricle (EDVLV) in supine and after 5 minutes in TP. RESULTS: There showed no significant changes in blood pressure, heart rate and pulse oximetry in 0° and after 5 minutes in 45°. The mean CO without inclination was 4.2 l/min ± 0.6, tat is the same results after 5 minutes in PT (p > 0.6). The EDVLV was 95 ± 12 ml at 0° and 101 ± 15 ml after 5 minutes in PT (p > 0.8). CONCLUSION: Trendelenburg position doesn't improve CO or preload in healthy subjects.
INTRODUCCIÓN: Empíricamente se ha utilizado la posición de Trendelenburg (PT) para aumentar la precarga y posteriormente el gasto cardiaco (GC). La ecografía transtorácica (ETT) es una técnica no invasiva que puede estimar el GC. Realizamos un estudio descriptivo para evaluar si la PT afecta el CG. MATERIALES Y MÉTODOS: Examinamos pacientes ASA I, se hicieron mediciones del GC y del volumen de fin de diástole (VDFVI) en posición supina y luego de cinco minutos en PT. RESULTADOS: No se observaron cambios significativos en la presión arterial, frecuencia cardíaca y saturometría en los voluntarios a 0º y a 45º. El GC sin inclinación fue en promedio 4,2 l/min ± 0,6, el mismo resultado tras cinco minutos en PT, sin ser estadísticamente significativo (p > 0,6). El VDFVI a 0º fue en promedio 95 ± 12 ml y tras cinco minutos en PT 101 ± 15 ml, que tampoco alcanzó diferencia estadísticamente significativa (p > 0,8). CONCLUSIÓN: La posición de Trendelenburg no varía el gasto cardiaco ni la precarga en voluntarios sanos.
Assuntos
Humanos , Masculino , Feminino , Adulto , Adulto Jovem , Ecocardiografia/métodos , Débito Cardíaco/fisiologia , Decúbito Inclinado com Rebaixamento da Cabeça , Volume Sistólico/fisiologia , Posicionamento do Paciente , Pressão Arterial/fisiologia , Saturação de Oxigênio/fisiologia , Frequência Cardíaca/fisiologiaRESUMO
BACKGROUND: Transesophageal echocardiography allows a semi-invasive hemodynamic monitoring, during cardiac and non cardiac surgery. The benefits of such surveillance must be assessed, since it may help to change patient management. AIM: To assess the usefulness of transesophageal echocardiography during surgical procedures in critical patients. MATERIAL AND METHODS: Based on the indications of the North American Societies of Cardiology and Anesthesiology, 264 patients were monitored using a multiplanar transducer. The type of surgery, insertion difficulties, quality of visualization, complications and usefulness of the method were recorded. RESULTS: One hundred eleven cardiac and 153 non cardiac surgical procedures were monitored. In 97% of cases, visualization was good. In 2 cases, it was impossible to obtain a transgastric axis. No complications of the procedure were recorded. The method was useless in nine patients, helpful to change drug and volume management in 126 (48%) patients, helpful to change perioperative management in 49 (19%) patients and was a substitute for pulmonary artery catheterization in 79 (30%) patients. CONCLUSIONS: Intraoperative transesophageal echocardiography is a safe technique that renders high quality images, with a low incidence of complications and that, when well indicated, orients therapeutic changes in 98% of patients.