NON-INVASIVE PREVENTIVE VENTILATION WITH TWO PRESSURE LEVELS IN THE POSTOPERATIVE PERIOD OF ROUX-EN-Y GASTRIC BYPASS: RANDOMIZED TRIAL.

Mabelle Gomes De Oliveira Cavalcanti,Lívia Barboza Andrade,Leandro Ricardo Rodrigues Lucena,Patrícia Clara Pereira Dos Santos

doi:10.1590/0102-672020180001e1361

Mabelle Gomes De Oliveira Cavalcanti, Lívia Barboza Andrade + Show 2 more

Open Access

https://doi.org/10.1590/0102-672020180001e1361

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Abstract

ABSTRACTBackground:Obesity is characterized by excessive accumulation of body fat, which causes damage to the health of individuals, such as breathing difficulties. Aim:To verify the results of non-invasive ventilation as a preventive strategy on the decline of respiratory function and postoperative complications in patients undergoing Roux-en-Y gastric bypass. Methods:This is a randomized trial, according to CONSORT standards, with obese adults aged 18-40 years. Randomized control group (n=25) only received guidelines regarding posture, early ambulation and cough stimuli, and in the NIV group (n=25), in addition to the aforementioned group, non-invasive ventilation was performed with two pressure levels, once day for 60 min, from the 1st to the 3rd postoperative day (POD). Both groups were evaluated in the preoperative period and in the 1st and 3rd POD for respiratory function, which were: slow vital capacity (VC), inspiratory capacity (IC), minute volume (MV), tidal volume maximal inspiratory muscle strength (Pimax) and peak expiratory flow (PEF). The length of hospital stay and the episodes of postoperative complications were recorded. Results:Of the 50 patients the majority were young adults with degrees of obesity between III and IV. In the intergroup analysis, there was an improvement in the CVL and MV only in the 1st POD in the NIV group, CI in the three moments evaluated in the NIV group and the PFE in the 1st and 3rd PDO also in this group. The most frequent complications were pneumonia, followed by operative wound infection and atelectasis. There was a significant difference between groups, showing a higher occurrence in pneumonia and atelectasis in the control group. The days of hospitalization and intensive care unit were similar. Conclusion:It was observed a faster recovery until the 3rd POD in the IC and PEF variables in the NIV group; in addition, there were fewer complications in this group.

Highlights

Obesity is characterized by excessive accumulation of body fat to such an extent that it impairs the health of individuals
In Brazil, the formal indications for gastric operations are: 18 to 65 years of age, BMI greater than 40 kg/m2 or 35 kg/m2 with one or more serious comorbidities related to obesity, and Roux-en-Y gastric bypass correspond to 75% of the procedures performed
The objective of this study was to verify the effectiveness of non-invasive ventilation (NIV) as a preventive strategy on the decline of respiratory function and postoperative complications in patients undergoing Rouxen-Y gastric bypass

Summary

Introduction

Obesity is characterized by excessive accumulation of body fat to such an extent that it impairs the health of individuals. Patients with BMI greater than or equal to 45 kg/m2 present a decrease in life expectancy and an increase in cardiovascular mortality, which may reach 190%. In this context, bariatric surgery is a consistent resource in cases of severe obesity with documented failure of clinical treatment, providing patients with reduced mortality rates and improved quality of life[19]. According to a new balance sheet of the Brazilian Society of Bariatric and Metabolic Surgery, in 2015 93.5 thousand people were submitted to the procedure, an increase of 6.25% in relation to the previous year[23]

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