AVALIAÇÃO NÃO-INVASIVA DA PRESSÃO INTRACRANIANA EM PACIENTES SUBMETIDOS A CIRURGIA DE REVASCULARIZAÇÃO DO MIOCÁRDIO COM CIRCULAÇÃO EXTRACORPÓREA

Abstract

Currently, cardiovascular disease is classified as the main cause of morbidity and mortality worldwide and within cardiac surgeries, myocardial revascularization is one of the most frequent interventions, and cardiopulmonary bypass is most commonly used as a standard procedure. With regard to adverse effects, neurological disorders represent the most serious postoperative complication of cardiac surgeries, being attributed in large part to the effects of CPB in the brain. The main neurological changes include: ischemic and hemorrhagic stroke, cognitive dysfunction and delirium. Thus, the recognition of these complications may help in the prevention or early treatment of patients. The strong relationship between systemic blood pressure, intracranial pressure (ICP) and stroke is well founded in the literature. Therefore, ICP monitoring in individuals undergoing cardiac surgery may be important to predict risks in these patients and a potential strategy to detect complications. Recently, researchers from the Institute of Advanced Studies of São Carlos / USP developed a totally non-invasive PIC monitoring system. The objective of this study was to evaluate, by means of non-invasive equipment, whether the intracranial pressure of individuals undergoing coronary artery bypass grafting with cardiopulmonary bypass changed. Patients from high complexity hospitals in cardiac surgery were selected, who had the PIC monitor at the following moments: 12 hours before surgery, throughout the surgery and 48 hours after surgery. In total, 20 patients were evaluated, 16 men and 4 women. 3 of the patients monitored died. In addition, more than 80% of the individuals had decreased hematocrit and hemoglobin in all samples collected. Individuals undergoing coronary artery bypass grafting with CPB less than 80 minutes presented more changes in ICP. This result may indicate that cardiac lesions and the choice of surgery may alter ICP more than CPB as expected. The three individuals who died had an alteration in ICP throughout the surgery and 48 hours after surgery, which may indicate that the evolution of the patient may be related to the change in ICP. In addition, two individuals suffered stroke, after which they died.