PEEP-ZEEP technique: cardiorespiratory repercussions in mechanically ventilated patients submitted to a coronary artery bypass graft surgery

Marcus Vinicius Herbst-Rodrigues, Vitor Oliveira Carvalho, José Otávio Costa Auler Jr, Maria Ignez Zanetti Feltrim, Marcus Vinicius Herbst-Rodrigues, Vitor Oliveira Carvalho, José Otávio Costa Auler Jr, Maria Ignez Zanetti Feltrim

Abstract

Background: The PEEP-ZEEP technique is previously described as a lung inflation through a positive pressure enhancement at the end of expiration (PEEP), followed by rapid lung deflation with an abrupt reduction in the PEEP to 0 cmH2O (ZEEP), associated to a manual bilateral thoracic compression.

Aim: To analyze PEEP-ZEEP technique's repercussions on the cardio-respiratory system in immediate postoperative artery graft bypass patients.

Methods: 15 patients submitted to a coronary artery bypass graft surgery (CABG) were enrolled prospectively, before, 10 minutes and 30 minutes after the technique. Patients were curarized, intubated, and mechanically ventilated. To perform PEEP-ZEEP technique, saline solution was instilled into their orotracheal tube than the patient was reconnected to the ventilator. Afterwards, the PEEP was increased to 15 cmH2O throughout 5 ventilatory cycles and than the PEEP was rapidly reduced to 0 cmH2O along with manual bilateral thoracic compression. At the end of the procedure, tracheal suction was accomplished.

Results: The inspiratory peak and plateau pressures increased during the procedure (p < 0.001) compared with other pressures during the assessment periods; however, they were within lung safe limits. The expiratory flow before the procedure were 33 ± 7.87 L/min, increasing significantly during the procedure to 60 ± 6.54 L/min (p < 0.001), diminishing to 35 ± 8.17 L/min at 10 minutes and to 36 ± 8.48 L/min at 30 minutes. Hemodynamic and oxygenation variables were not altered.

Conclusion: The PEEP-ZEEP technique seems to be safe, without alterations on hemodynamic variables, produces elevated expiratory flow and seems to be an alternative technique for the removal of bronchial secretions in patients submitted to a CABG.

Figures

Figure 1
Figure 1
Patient's flow and study design.
Figure 2
Figure 2
Flow and pressure curves recorded during the PEEP-ZEEP technique, in circles, the moment of depressurization associated with manual bilateral thoracic compression.
Figure 3
Figure 3
Pressures before, at the 5 cycles, 10 and 30 minutes after the procedure.
Figure 4
Figure 4
Flows before, at the 5 cycles, 10 and 30 minutes after the procedure.

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