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A1831 - Safety of Respiratory Physiotherapy in Mechanically Ventilated Patients After Cardiac Surgery
Author Block: M. L. Sousa, C. C. Melo, M. T. Takei, V. R. Coimbra, F. R. Galas, L. A. Hajjar, M. I. Feltrim, E. Nozawa; Instituto do Coracao, Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil.
RATIONALE: Respiratory physiotherapy intervention practice in intubated patients after cardiac surgery reduces the duration of mechanical ventilation, but the safety of such interventions needs more investigation. Our objectives were to address the incidence of adverse events during interventions of respiratory physiotherapy in postoperative cardiac surgery patients undergoing mechanical ventilation, and to analyze clinical characteristics associated with these events. METHODS: We conducted a prospective, observational study of patients admitted to surgical ICU, aged > 18 years, and undergoing mechanical ventilation. We excluded patients with neurological and cognitive impairment. Physiotherapy interventions were observed, performed by physiotherapists outside of the protocol. We recorded the occurrence of adverse events or physiological abnormality, classifying them according to the symptomatic consequences for the patient, from grade 1 (“near miss”, additional intervention not required) to grade 5 (death). We collected clinical characteristics of patients, such as sequential organ failure assessment (SOFA) score, comorbidities and PaO2/FIO2. We calculate 95 % confidence interval (95%CI) for incidences, and used the T test, Mann-Whitney test and chi-square test to analyze differences between patients with and without adverse events or physiological abnormality. RESULTS: We included 117 patients, and observed 249 interventions. Median age was 62 years old (IQR, 52-71), the most prevalent diagnostic was coronary artery bypass graft (44%), and median time of mechanical ventilation was 10 hours (IQR, 7-20). Adverse events occurred in all types of observed interventions: 75% of alveolar recruitments (95%CI: 53-89%), 44% of endotracheal suctioning (95%CI: 53-89%), and 19% of manual hyperinflations (95%CI: 13-27%), with the most common being hemodynamic abnormalities (7 to 87%). Only 12 occurrences (10%) required minimal additional treatment or cost (grades 2 or 3). Patients characteristics associated with adverse events were high SOFA (7, IQR:6-9 vs. 9, IQR:9-11; p=0.003) and arterial hypertension (47% vs. 73%; p=0.009). CONCLUSION: In this observational study, we found that, during postoperative period, 57% of mechanically ventilated patients have adverse events or physiological abnormality during respiratory physiotherapy, but the most part did not require minimal additional treatment or cost. We also found that higher SOFA and arterial hypertension was associated with the occurrence of adverse events.