title: Use of positive pressure in the bariatric surgery and effects on pulmonary function and prevalence of atelectasis: randomized and blinded clinical trial.
abstract: BACKGROUND
  In surgical procedures, obesity is a risk factor for the onset of intra and postoperative respiratory complications.
  
  
  OBJECTIVE
  Determine what moment of application of positive pressure brings better benefits on lung function, incidence of atelectasis and diaphragmatic excursion, in the preoperative, intraoperative or immediate postoperative period.
  
  
  METHODS
  Randomized, controlled, blinded study, conducted in a hospital and included subjects with BMI between 40 and 55 kg/m2, 25 and 55 years, underwent bariatric surgery by laparotomy. They were underwent preoperative and postoperative evaluations. They were allocated into four different groups: 1) Gpre: treated with positive pressure in the BiPAP mode (Bi-Level Positive Airway Pressure) before surgery for one hour; 2) Gpos: BIPAP after surgery for one hour; 3) Gintra: PEEP (Positive End Expiratory Pressure) at 10 cmH2O during the surgery; 4) Gcontrol: only conventional respiratory physiotherapy. The evaluation consisted of anthropometric data, pulmonary function tests and chest radiography.
  
  
  RESULTS
  Were allocated 40 patients, 10 in each group. There were significant differences for the expiratory reserve volume and percentage of the predicted expiratory reserve volume, in which the groups that received treatment showed a smaller loss in expiratory reserve volume from the preoperative to postoperative stages. The postoperative radiographic analysis showed a 25% prevalence of atelectasis for Gcontrol, 11.1% for Gintra, 10% for Gpre, and 0% for Gpos. There was no significant difference in diaphragmatic mobility amongst the groups.
  
  
  CONCLUSIONS
  The optimal time of application of positive pressure is in the immediate postoperative period, immediately after extubation, because it reduces the incidence of atelectasis and there is reduction of loss of expiratory reserve volume.
authors.affiliation: Universidade Metodista de Piracicaba, Piracicaba, SP, Brazil.
authors.forename: Letícia
authors.initials: L
authors.lastname: Baltieri
authors.affiliation: Universidade Metodista de Piracicaba, Piracicaba, SP, Brazil.
authors.forename: Laisa Antonela
authors.initials: LA
authors.lastname: Santos
authors.affiliation: Universidade Metodista de Piracicaba, Piracicaba, SP, Brazil.
authors.forename: Irineu
authors.initials: I
authors.lastname: Rasera
authors.affiliation: Universidade Metodista de Piracicaba, Piracicaba, SP, Brazil.
authors.forename: Maria Imaculada Lima
authors.initials: MI
authors.lastname: Montebelo
authors.affiliation: Universidade Metodista de Piracicaba, Piracicaba, SP, Brazil.
authors.forename: Eli Maria
authors.initials: EM
authors.lastname: Pazzianotto-Forti
mesh_terms: D000328:Adult; D050110:Bariatric Surgery; D005260:Female; D006801:Humans; D008168:Lung / Q000502:physiology*; D008297:Male; D019990:Perioperative Care / Q000379:methods*; D011175:Positive-Pressure Respiration; D011184:Postoperative Period; D015995:Prevalence; D001261:Pulmonary Atelectasis / Q000453:epidemiology* / Q000517:prevention & control*; D012129:Respiratory Function Tests; D016037:Single-Blind Method