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2012, Number 4

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Rev Hosp Jua Mex 2012; 79 (4)

Posición prono, más que una estrategia en el manejo de pacientes con síndrome de insuficiencia respiratoria aguda

Hernández-López GD, Mondragón-Labelle T, Torres-López L, Magdaleno-Lara G

Language: Spanish
References: 35
Page: 263-270
PDF size: 459.98 Kb.


ABSTRACT

At present, in the management of acute respiratory distress syndrome (ARDS) mechanical ventilation is employed with lower tidal volumes and positive end expiratory pressure (PEEP). However, despite this, there are patients who remain hypoxemic and make us look alternative therapies to improve arterial oxygenation, prone position (PP) is one of them. In the initial stadium, ARDS is characterized by diffuse and homogeneous alteration of vascular permeability, edema and increase lung weight, which favors the development of atelectasis by vertical transmission of gravitational forces (hydrostatic) to compress more dependent lung zones. In mechanically ventilated patients, stress and lung distension are the major determinants of lung injury induced by mechanical ventilation (VILI). In early severe ARDS, during mechanical ventilation with PEEP optimization, the PP decrease lung stress and strain, and reduces the risk of VILI. During the management of patients on mechanical respiratory assistance placed in PP improve the gas exchange secondary at three phenomena: ventilation deviation, blood flow deviation and weakening of the chest wall. The PP promotes alveolar recruitment of collapsed areas.


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