{"id":1729,"date":"2021-03-29T17:00:00","date_gmt":"2021-03-29T20:00:00","guid":{"rendered":"http:\/\/nave.vet.br\/?p=1729"},"modified":"2024-03-02T19:38:50","modified_gmt":"2024-03-02T22:38:50","slug":"oximetria-de-pulso","status":"publish","type":"post","link":"https:\/\/nave.vet.br\/en\/video-aulas\/naveondas\/oximetria-de-pulso\/","title":{"rendered":"Oximetria de pulso (Onda Pletismogr\u00e1fica) &#8211; NAVE Ondas #2"},"content":{"rendered":"<div id=\"advads-1516432938\" class=\"advads-antes-do-post advads-entity-placement\" style=\"margin-bottom: 30px;margin-left: auto;margin-right: auto;text-align: center;\"><div class=\"advads-antes-do-post advads-entity-placement\" style=\"text-align: center;\" id=\"advads-2927714824\"><div id=\"advads-4171871835\"><a href=\"https:\/\/rb.gy\/brmhh3\" aria-label=\"WhatsApp Image 2024-04-11 at 10.31.52\"><img src=\"https:\/\/i0.wp.com\/nave.vet.br\/wp-content\/uploads\/2024\/04\/WhatsApp-Image-2024-04-11-at-10.31.52.jpeg?fit=1000%2C137&#038;ssl=1\" alt=\"\"  srcset=\"https:\/\/i0.wp.com\/nave.vet.br\/wp-content\/uploads\/2024\/04\/WhatsApp-Image-2024-04-11-at-10.31.52.jpeg?w=1000&ssl=1 1000w, https:\/\/i0.wp.com\/nave.vet.br\/wp-content\/uploads\/2024\/04\/WhatsApp-Image-2024-04-11-at-10.31.52.jpeg?resize=300%2C41&ssl=1 300w, https:\/\/i0.wp.com\/nave.vet.br\/wp-content\/uploads\/2024\/04\/WhatsApp-Image-2024-04-11-at-10.31.52.jpeg?resize=768%2C105&ssl=1 768w, https:\/\/i0.wp.com\/nave.vet.br\/wp-content\/uploads\/2024\/04\/WhatsApp-Image-2024-04-11-at-10.31.52.jpeg?resize=18%2C2&ssl=1 18w\" sizes=\"(max-width: 800px) 100vw, 800px\" width=\"1000\" height=\"137\"   \/><\/a><\/div><\/div><\/div>\n<figure class=\"wp-block-embed is-type-video is-provider-youtube wp-block-embed-youtube wp-embed-aspect-16-9 wp-has-aspect-ratio\"><div class=\"wp-block-embed__wrapper\">\n<iframe title=\"\ud83d\udd34  OXIMETRIA DE PULSO (PLETISMOGRAFIA) | NAVE Ondas #2\" width=\"800\" height=\"450\" src=\"https:\/\/www.youtube.com\/embed\/yBc2K8yd6eo?feature=oembed\" frameborder=\"0\" allow=\"accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture\" allowfullscreen><\/iframe>\n<\/div><\/figure>\n\n\n\n<p>A oximetria de pulso \u00e9 certamente <a href=\"http:\/\/nave.vet.br\/en\/video-aulas\/basico\/monitoracao-anestesica-anestesia-e-o-basico-13\/\" class=\"rank-math-link\">a monitora\u00e7\u00e3o<\/a> mais difundida no mundo. A principal fun\u00e7\u00e3o do ox\u00edmetro \u00e9 nos dar a satura\u00e7\u00e3o perif\u00e9rica de oxihemoglobina (SpO<sub>2<\/sub>), que tem certa rela\u00e7\u00e3o com a satura\u00e7\u00e3o arterial de O<sub>2<\/sub> (SaO<sub>2<\/sub>). O objetivo \u00e9 sempre termos SpO<sub>2<\/sub> acima de 95%, pois valores acima disso nos garante que a PaO<sub>2<\/sub> est\u00e1 acima de 80mmHg, considerado norm\u00f3xia. Outra informa\u00e7\u00e3o importante \u00e9 a avalia\u00e7\u00e3o da frequ\u00eancia card\u00edaca, pois ele detecta o pulso perif\u00e9rico. Por\u00e9m, a curva pletismogr\u00e1fica \u00e9 obtida apenas com ox\u00edmetros de melhor qualidade. <\/p>\n\n\n\n<h4 class=\"wp-block-heading\" id=\"onda-padrao\">Onda padr\u00e3o<\/h4>\n\n\n\n<p>A pletismografia tem uma onda bem caracter\u00edstica, com um primeiro ramo ascendente bem pronunciado, que representa a s\u00edstole ventricular e um ramo descendente, representando a di\u00e1stole. H\u00e1 um entalhe no ramo descendente, que \u00e9 chamado de incisura dicr\u00f3tica ou n\u00f3 dicr\u00f3tico, e  representa o fechamento da v\u00e1lvula a\u00f3rtica. A por\u00e7\u00e3o final da onda tamb\u00e9m \u00e9 chamada de \u201conda dicr\u00f3tica\u201d. Em teoria, qualquer altera\u00e7\u00e3o de pulso vai alterar a onda pletismogr\u00e1fica tamb\u00e9m. Ent\u00e3o, se o paciente apresentar vasodila\u00e7\u00e3o, vasoconstri\u00e7\u00e3o, hemorragia, altera\u00e7\u00f5es na for\u00e7a de contra\u00e7\u00e3o card\u00edaca ou no retorno venoso a curva poder\u00e1 mudar. <\/p>\n\n\n\n<figure class=\"wp-block-image aligncenter size-large is-resized\"><img data-recalc-dims=\"1\" fetchpriority=\"high\" decoding=\"async\" width=\"678\" height=\"561\" src=\"https:\/\/i0.wp.com\/nave.vet.br\/wp-content\/uploads\/2021\/03\/onda-pletismogra%CC%81fica.png?resize=678%2C561\" alt=\"\" class=\"wp-image-1740\" style=\"width:485px;height:401px\" srcset=\"https:\/\/i0.wp.com\/nave.vet.br\/wp-content\/uploads\/2021\/03\/onda-pletismogra%CC%81fica.png?w=678&amp;ssl=1 678w, https:\/\/i0.wp.com\/nave.vet.br\/wp-content\/uploads\/2021\/03\/onda-pletismogra%CC%81fica.png?resize=300%2C248&amp;ssl=1 300w, https:\/\/i0.wp.com\/nave.vet.br\/wp-content\/uploads\/2021\/03\/onda-pletismogra%CC%81fica.png?resize=16%2C12&amp;ssl=1 16w\" sizes=\"(max-width: 678px) 100vw, 678px\" \/><figcaption class=\"wp-element-caption\"><br>Caracter\u00edstica padr\u00e3o da curva pletismogr\u00e1fica obtida com a oximetria de pulso. Nela podemos ver a fase sist\u00f3lica (em azul) e diast\u00f3lica (em vermelho). Destaque para a incisura dicr\u00f3tica, representando o fechamento da v\u00e1lvula a\u00f3rtica. <a href=\"https:\/\/fundanest.org.ar\/wp-content\/uploads\/2016\/07\/Advanced-uses-of-pulsed-oxymeter.pdf\" class=\"rank-math-link\" target=\"_blank\" rel=\"noopener\">Fonte: Tusman et al, 2017.<\/a><\/figcaption><\/figure>\n\n\n\n<hr class=\"wp-block-separator aligncenter has-css-opacity\"\/>\n\n\n<div id=\"advads-1259759722\"><a href=\"https:\/\/www.sdamed.com\/\" aria-label=\"Banner-SDAMed NAVE\" target=\"_blank\" rel=\"noopener\"><img decoding=\"async\" src=\"https:\/\/i0.wp.com\/nave.vet.br\/wp-content\/uploads\/2021\/04\/Banner-SDAMed-NAVE-1.gif?fit=496%2C68&#038;ssl=1\" alt=\"\"  width=\"1000\" height=\"137\"   \/><\/a><\/div>\n\n\n<hr class=\"wp-block-separator aligncenter has-alpha-channel-opacity\"\/>\n\n\n\n<h4 class=\"wp-block-heading\" id=\"alteracoes-na-onda-pletismografica\">Altera\u00e7\u00f5es na Onda Pletismogr\u00e1fica<\/h4>\n\n\n\n<p>As altera\u00e7\u00f5es da onda pletismogr\u00e1fica est\u00e3o relacionadas \u00e0 altura, largura da onda e tamb\u00e9m a posi\u00e7\u00e3o da incisura dicr\u00f3tica. N\u00f3s podemos ver na figura abaixo que, quanto mais vasodilatado estiver o paciente, mais alta \u00e9 a onda e mais estreita ela \u00e9. Podemos ver tamb\u00e9m que a incisura dicr\u00f3tica muda de posi\u00e7\u00e3o. Quanto mais vasodilatado, mais perto da linha de base ela fica. Por outro lado, quanto mais intensa for a vasoconstri\u00e7\u00e3o, mais baixa e alongada a onda \u00e9, com a incisura dicr\u00f3tica ficando a parte superior do ramo descendente e \u00e0s vezes at\u00e9 sumindo no pico da onda.<\/p><div id=\"advads-2754357022\" class=\"advads-adsense-in-article advads-entity-placement\"><script async src=\"\/\/pagead2.googlesyndication.com\/pagead\/js\/adsbygoogle.js?client=ca-pub-9687921986569993\" crossorigin=\"anonymous\"><\/script><ins class=\"adsbygoogle\" style=\"display:block; text-align:center;\" data-ad-client=\"ca-pub-9687921986569993\" \ndata-ad-slot=\"1211285291\" \ndata-ad-layout=\"in-article\"\ndata-ad-format=\"fluid\"><\/ins>\n<script> \n(adsbygoogle = window.adsbygoogle || []).push({}); \n<\/script>\n<\/div>\n\n\n\n<figure class=\"wp-block-image aligncenter size-large is-resized\"><img data-recalc-dims=\"1\" decoding=\"async\" width=\"800\" height=\"348\" src=\"https:\/\/i0.wp.com\/nave.vet.br\/wp-content\/uploads\/2021\/03\/alterac%CC%A7o%CC%83es-na-onda-pletismogra%CC%81fica.png?resize=800%2C348\" alt=\"\" class=\"wp-image-1741\" style=\"width:805px;height:350px\" srcset=\"https:\/\/i0.wp.com\/nave.vet.br\/wp-content\/uploads\/2021\/03\/alterac%CC%A7o%CC%83es-na-onda-pletismogra%CC%81fica.png?resize=1024%2C446&amp;ssl=1 1024w, https:\/\/i0.wp.com\/nave.vet.br\/wp-content\/uploads\/2021\/03\/alterac%CC%A7o%CC%83es-na-onda-pletismogra%CC%81fica.png?resize=300%2C131&amp;ssl=1 300w, https:\/\/i0.wp.com\/nave.vet.br\/wp-content\/uploads\/2021\/03\/alterac%CC%A7o%CC%83es-na-onda-pletismogra%CC%81fica.png?resize=768%2C334&amp;ssl=1 768w, https:\/\/i0.wp.com\/nave.vet.br\/wp-content\/uploads\/2021\/03\/alterac%CC%A7o%CC%83es-na-onda-pletismogra%CC%81fica.png?resize=16%2C7&amp;ssl=1 16w, https:\/\/i0.wp.com\/nave.vet.br\/wp-content\/uploads\/2021\/03\/alterac%CC%A7o%CC%83es-na-onda-pletismogra%CC%81fica.png?w=1220&amp;ssl=1 1220w\" sizes=\"(max-width: 800px) 100vw, 800px\" \/><figcaption class=\"wp-element-caption\">Classifica\u00e7\u00e3o dos diferentes padr\u00f5es de onda pletismogr\u00e1fica, de acordo com situa\u00e7\u00f5es de vasodilata\u00e7\u00e3o e vasoconstri\u00e7\u00e3o. <a href=\"https:\/\/fundanest.org.ar\/wp-content\/uploads\/2016\/07\/Advanced-uses-of-pulsed-oxymeter.pdf\" class=\"rank-math-link\" target=\"_blank\" rel=\"noopener\">Fonte: Tusman et al., 2017.<\/a><\/figcaption><\/figure>\n\n\n\n<hr class=\"wp-block-separator aligncenter has-css-opacity\"\/>\n\n\n\n<h4 class=\"wp-block-heading\" id=\"possiveis-interferencias-na-obtencao-da-onda\">Poss\u00edveis interfer\u00eancias na obten\u00e7\u00e3o da onda<\/h4>\n\n\n\n<p>Por\u00e9m, s\u00f3 \u00e9 poss\u00edvel correlacionar essas altera\u00e7\u00f5es durante a anestesia se a leitura for de boa qualidade, com ondas bem delineadas. Nesse aspecto, n\u00f3s temos que entender as limita\u00e7\u00f5es dessa an\u00e1lise e saber que v\u00e1rios detalhes podem influenciar a leitura:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Tipo de sensor: A maioria dos equipamentos bons ainda s\u00e3o feitos num padr\u00e3o humano. Ent\u00e3o, a maioria deles segue anatomia para tal. Os sensores que se encaixam no dedo humano s\u00e3o muito ruins para o uso em animais, pois s\u00e3o c\u00f4ncavos na parte interna (para acomodar o dedo) e nem sempre encaixam bem. Os sensores veterin\u00e1rios geralmente s\u00e3o de presilha.<\/li>\n\n\n\n<li>Local de leitura: Geralmente utilizamos o sensor na l\u00edngua ou orelha. Mas podemos colocar tamb\u00e9m nos l\u00e1bios, teto, interd\u00edgito ou qualquer outra regi\u00e3o que seja sem pelos, livre de pigmenta\u00e7\u00e3o e que tenha fluxo sangu\u00edneo adequado.<\/li>\n\n\n\n<li>Altera\u00e7\u00e3o na colora\u00e7\u00e3o de mucosa: N\u00e3o s\u00f3 a pigmenta\u00e7\u00e3o vai atrapalhar a leitura. Situa\u00e7\u00f5es como icter\u00edcia, anemia severa, metahemoglobinemia e carboxihemoglobinemia podem alterar a absor\u00e7\u00e3o de luz e, com isso, confundirem a leitura do ox\u00edmetro.<\/li>\n\n\n\n<li>Altera\u00e7\u00e3o na perfus\u00e3o perif\u00e9rica: Diminui\u00e7\u00e3o de contratilidade card\u00edaca, hipotens\u00e3o severa e vasoconstri\u00e7\u00e3o intensa podem diminuir tanto a perfus\u00e3o perif\u00e9rica que alguns sensores n\u00e3o detectam a onda pletismogr\u00e1fica. Isso, por exemplo acontece quando administramos <a href=\"http:\/\/nave.vet.br\/en\/video-aulas\/basico\/mpa-2-anestesia-e-o-basico\/\" class=\"rank-math-link\">agonistas alfa<sub>2<\/sub> adren\u00e9rgicos<\/a>. A vasoconstri\u00e7\u00e3o pode ser t\u00e3o intensa que o ox\u00edmetro n\u00e3o vai conseguir identificar o pulso.<\/li>\n\n\n\n<li>Mal posicionamento do sensor: Alguns ox\u00edmetros menos precisos d\u00e3o uma certa bugada quando n\u00e3o est\u00e3o bem posicionados. Eles acabam \u201creconhecendo\u201d pulso devido \u00e0 luz ambiente. Isso pode acontecer em ambientes mais claros, por exemplo. Nesse caso, todo o sensor deve estar bem posicionado no local de leitura.<\/li>\n\n\n\n<li>Padroniza\u00e7\u00e3o: A leitura idealizada na onda pletismogr\u00e1fica tem sido idealizada segundo a fisiologia humana. Ainda que ela seja \u00fatil para mam\u00edferos, h\u00e1 diferen\u00e7as entre as esp\u00e9cies e isso deve ser compreendido.<\/li>\n<\/ul>\n\n\n\n<p><br>Diante disso, temos que relativizar a monitora\u00e7\u00e3o com oximetria de pulso. Particularmente, a oximetria de pulso tem sua relev\u00e2ncia, principalmente no p\u00f3s-operat\u00f3rio imediato, para analisarmos se o animal est\u00e1 conseguindo saturar bem, pois epis\u00f3dios de hipoxemia no p\u00f3s-anest\u00e9sico imediato s\u00e3o comuns. A onda pletismogr\u00e1fica tamb\u00e9m \u00e9 interessante, sem d\u00favidas, mas desde que analisada em conjunto com outros par\u00e2metros, como a onda de press\u00e3o arterial invasiva e com a cl\u00ednica do paciente.<\/p>\n\n\n\n<hr class=\"wp-block-separator has-css-opacity\"\/>\n\n\n\n<h6 class=\"wp-block-heading\" id=\"leia-tambem\">Read also about:<\/h6>\n\n\n\n<ul class=\"wp-block-list\">\n<li><a href=\"http:\/\/nave.vet.br\/en\/video-aulas\/naveondas\/capnografia\/\">Interpretando as ondas de Capnografia \u2013 NAVE Ondas #1<\/a><\/li>\n\n\n\n<li><a href=\"http:\/\/nave.vet.br\/en\/video-aulas\/naveondas\/onda-de-pressao-arterial\/\">Evaluating Arterial Blood Pressure Waveform - NAVE Waves #3<\/a><\/li>\n\n\n\n<li><a href=\"http:\/\/nave.vet.br\/en\/video-aulas\/ecg-na-anestesia\/\">ECG na Anestesia \u2013 NAVE Ondas #4<\/a><\/li>\n<\/ul>\n\n\n\n<hr class=\"wp-block-separator has-css-opacity\"\/>\n\n\n\n<p class=\"has-small-font-size\"><em>Find out more:<\/em><\/p>\n\n\n\n<p class=\"has-small-font-size\"><a href=\"https:\/\/doi.org\/10.1088\/1361-6579\/aaf433\" class=\"rank-math-link\" target=\"_blank\" rel=\"noopener\">&#8211; Cugmas B et al. Photoplethysmography in dogs and cats: a selection of alternative measurement sites for a pet monitor. <em>Physiol Meas<\/em>, 40:01NT02, 2019.<\/a><br><a href=\"https:\/\/doi.org\/10.1016\/j.vaa.2019.08.050\" class=\"rank-math-link\" target=\"_blank\" rel=\"noopener\">&#8211; Mair A et al. Appraisal of the \u2018penumbra effect\u2019 using lingual pulse oximetry in anaesthetized dogs and cats. <em>Vet Anaesth Analg<\/em>, 47:177-182, 2019.<\/a><br><a href=\"http:\/\/10.1080\/17415349.2016.1248636\" class=\"rank-math-link\">&#8211; McMillan M. Pitfalls and common errors of anaesthetic monitoring devices. Part 1: Pulse oximetry. <em>Vet Nurs J<\/em>, 31:297-302, 2016.<\/a><br><a href=\"https:\/\/doi.org\/10.1002\/14651858.CD002013.pub3\" class=\"rank-math-link\" target=\"_blank\" rel=\"noopener\">&#8211; Pedersen T et al. Pulse oximetry for perioperative monitoring. <em>Cochrane Database of Syst Rev<\/em>, 3:CD002013, 2014.<\/a> <br><a href=\"https:\/\/link.springer.com\/article\/10.1007\/s10877-018-0235-z\" class=\"rank-math-link\" target=\"_blank\" rel=\"noopener\">&#8211; Tusman G et al. Photoplethysmographic characterization of vascular tone mediated changes in arterial pressure: an observational study. <em>J Clin Monit and Comput<\/em>, 33:815-824, 2019.<\/a><br><a href=\"https:\/\/fundanest.org.ar\/wp-content\/uploads\/2016\/07\/Advanced-uses-of-pulsed-oxymeter.pdf\" class=\"rank-math-link\" target=\"_blank\" rel=\"noopener\">&#8211; Tusman G et al. Advanced uses of pulse oximetry for monitoring. <em>Anesth Analg<\/em>, 124:62-71, 2017.<\/a><\/p>\n\n\n\n<hr class=\"wp-block-separator has-css-opacity\"\/>\n\n\n\n<p><strong>Suggestions? Thoughts? Comments? Share!<\/strong><\/p>","protected":false},"excerpt":{"rendered":"<p>A oximetria de pulso \u00e9 certamente a monitora\u00e7\u00e3o mais difundido no mundo. Nesse v\u00eddeo n\u00f3s vamos conversar sobre o ox\u00edmetro avalia, analisar a onda pletismogr\u00e1fica e destacar os pr\u00f3s e contras dessa monitora\u00e7\u00e3o. A principal fun\u00e7\u00e3o do ox\u00edmetro \u00e9 nos dar a satura\u00e7\u00e3o perif\u00e9rica de oxihemoglobina (SpO2), que tem certa rela\u00e7\u00e3o com a&#8230;<\/p>","protected":false},"author":2,"featured_media":1731,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"video","meta":{"give_campaign_id":0,"colormag_page_layout":"default_layout","_monsterinsights_skip_tracking":false,"_monsterinsights_sitenote_active":false,"_monsterinsights_sitenote_note":"","_monsterinsights_sitenote_category":0,"_jetpack_memberships_contains_paid_content":false,"footnotes":""},"categories":[711,2],"tags":[786,797,794,796,780,527,793,787,364,781,798,790,791,795,779,785,784,783,788,782,792,789],"class_list":["post-1729","post","type-post","status-publish","format-video","has-post-thumbnail","hentry","category-naveondas","category-video-aulas","tag-anesthesia-monitoring-for-veterinary-technicians","tag-curva-de-oximetria","tag-dicrotic-notch","tag-monitoracao-anestesica-nao-invasiva","tag-monitoracao-veterinaria","tag-monitorizacao-anestesica","tag-monitorizacao-veterinaria","tag-monitorizacion-veterinaria","tag-nave-anestesia","tag-naveabc","tag-no-dicrotico","tag-onda-de-oximetria","tag-onda-oximetria","tag-onda-pletismografica","tag-oximetria-de-pulso","tag-oximetria-o-que-e","tag-oximetro","tag-oximetro-de-pulso-como-funciona","tag-pletismografia","tag-pulse-oximeter-waveform-analysis","tag-pulsioximetria","tag-spo2","post_format-post-format-video"],"jetpack_featured_media_url":"https:\/\/i0.wp.com\/nave.vet.br\/wp-content\/uploads\/2021\/03\/oximetria-de-pulso-1.jpg?fit=1280%2C720&ssl=1","jetpack_sharing_enabled":true,"_links":{"self":[{"href":"https:\/\/nave.vet.br\/en\/wp-json\/wp\/v2\/posts\/1729","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/nave.vet.br\/en\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/nave.vet.br\/en\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/nave.vet.br\/en\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/nave.vet.br\/en\/wp-json\/wp\/v2\/comments?post=1729"}],"version-history":[{"count":19,"href":"https:\/\/nave.vet.br\/en\/wp-json\/wp\/v2\/posts\/1729\/revisions"}],"predecessor-version":[{"id":3429,"href":"https:\/\/nave.vet.br\/en\/wp-json\/wp\/v2\/posts\/1729\/revisions\/3429"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/nave.vet.br\/en\/wp-json\/wp\/v2\/media\/1731"}],"wp:attachment":[{"href":"https:\/\/nave.vet.br\/en\/wp-json\/wp\/v2\/media?parent=1729"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/nave.vet.br\/en\/wp-json\/wp\/v2\/categories?post=1729"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/nave.vet.br\/en\/wp-json\/wp\/v2\/tags?post=1729"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}