Oxigenoterapia posquirúrgica de alto flujo aplicada mediante cánula nasal bilateral en dos caninos sometidos a procedimientos de tórax: un reporte de caso

Jefferson Jaimes Salcedo, Alejandra Uribe Rendón, David Alzate Velásquez, Luis Adolfo Vergara Saldarriaga, Nathalia María Correa-Valencia

Resumen


Las terapias convencionales para el aporte de oxígeno usadas en la clínica veterinaria pueden ser ineficientes al momento de ofrecer una recuperación satisfactoria de los pacientes posquirúrgicos bajo procedimientos a tórax con falla respiratoria hipoxémica, requiriendo estrategias que mejoren los indicadores de oxigenación. El presente trabajo describe el uso de cánulas nasales de alto flujo en dos pacientes sometidos a cirugías de tórax bajo anestesia general. El paciente #1 fue sometido a pericardiectomía subfrénica por toracoscopía y el paciente #2 fue sometido a una reducción percutánea de fractura de costillas con tubo a tórax. Ambos pacientes fueron recuperados en el posquirúrgico con oxigenoterapia de alto flujo a caudales de 600 y 1.071 mL/kg/minuto, respectivamente. El oxígeno fue entregado a través de un dispositivo comercial de humidificación activa, tubuladura no condensable con sistema de calefacción y cánula nasal bilateral, ofreciendo una temperatura del aire de 37 ºC, humedad del 98% y fracción inspirada de oxígeno de 50%. Se realizó gasometría percutánea (arteria dorsal metatarsiana) tras 15 minutos de ser extubado el paciente y una segunda muestra arterial fue colectada 60 minutos luego de la instalación del dispositivo de alto flujo. Se observó un aumento de la presión parcial de oxígeno (PaO2) sin cambios en la presión parcial de dióxido de carbono (PaCO2). Adicionalmente, se reportó tolerancia satisfactoria al dispositivo por parte de ambos pacientes. Las cánulas de alto flujo deben ser consideradas dentro de las estrategias de soporte ventilatorio no invasivo durante la posextubación en pacientes sometidos a cirugías de tórax.

 

High-flow post-surgical oxygen therapy applied through bilateral nasal cannula in two canines undergoing thoracic procedures: a case report

Conventional therapies for oxygen supply used in the veterinary clinic may be inefficient when offering a satisfactory recovery to post-surgical patients under chest surgical procedures with hypoxemic respiratory failure, demanding strategies to improve oxygenation indicators. The present work describes the use of high-flow nasal cannulas in two patients submitted to chest surgeries and under general anesthesia. Patient #1 was submitted to a subphrenic pericardiectomy by thoracoscopy, and patient #2 was submitted to a percutaneous rib fracture reduction by a chest tube. Both patients were recovered with a high-flow oxygen therapy in the post-surgical phase at flow rates of 600 and 1,071 mL/kg/minute, respectively. The oxygen was delivered using a commercial device of active humidification, non-condensable suction with heating system and bilateral nasal cannula, offering an air temperature of 37 ºC, humidity of 98% and inspired fraction of oxygen of 50%. A percutaneous gasometry was performed (dorsal metatarsal artery) after 15 minutes of extubating of the patient, and a second arterial sample was collected 60 minutes after the installation of the high-flow device. An increase in the partial pressure of oxygen (PaO2) was observed without an increase in the partial pressure of carbon dioxide (PaCO2). Additionally, both patients reported satisfactory tolerance to the device. High-flow nasal cannulas should be considered within non-invasive ventilatory support strategies during post-extubating in patients submitted to chest surgeries.

Keywords: high flow, hypoxemia, oxygen therapy, thoracoscopy.

 

Oxigeno terapia pós-cirúrgica de alto fluxo aplicada através de cânula nasal bilateral em dois cães submetidos a procedimentos torácicos: um relato de caso

As terapias convencionais para oxigênio usado na clínica veterinária podem ser ineficientes quando oferecendo uma recuperação satisfatória dos pacientes póscirúrgicos sob procedimentos peito insuficiência respiratória hipoxêmica exigindo estratégias para melhorar os indicadores de oxigenação. O presente trabalho descreve o uso de cânulas nasais de alto fluxo em dois pacientes submetidos a cirurgias torácicas sob anestesia geral. Paciente #1 foi submetida a pericardiectomia subfrênica por toracoscopia e paciente #2 foi submetida a uma redução percutânea da fratura de costela com tubo torácico. Ambos os pacientes foram recuperados no pós-operatório com oxigeno terapia de alta vazão nas vazões de 600 e 1.071 mL/kg/ minuto, respectivamente. O oxigênio foi entregue através de um dispositivo comercial de umidificação ativa, tubuladura não condensável com sistema de aquecimento e cânula nasal bilateral, oferecendo temperatura do ar de 37 ºC, umidade de 98% e fração inspirada de oxigênio de 50%. A análise gasométrica percutânea (artéria metatarsal dorsal) foi realizada 15 minutos após a extubação do paciente e uma segunda amostra arterial foi coletada 60 minutos após a instalação do dispositivo de alto fluxo. Um aumento na pressão parcial de oxigênio (PaO2) foi observado sem alterações na pressão parcial de dióxido de carbono (PaCO2). Além disso, tolerância satisfatória ao dispositivo foi relatada por ambos os pacientes. Cânulas de alto fluxo devem ser consideradas dentro das estratégias de suporte ventilatório não invasivo durante a pós-extubação em pacientes submetidos a cirurgias torácicas.

Palavras-chave: alto fluxo, hipoxemia, oxigenoterapia, toracoscopia.


Palabras clave


alto flujo, hipoxemia, oxigenoterapia, toracoscopia.

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