Carrillo ER, Vladimir Contreras DV

Language: Spanish
References: 30
Page: 60-68
PDF size: 123.69 Kb.

ABSTRACT

The pulmonary changes during inflammation include acute respiratory distress syndrome (ARDS) as the most severe manifestation. Other entities associated are acute pulmonary injury and ventilator-induced injury. The final consequence of these inflammatory changes is the progressive alveolar collapse that is manifested as hypoxia, hemoglobin desaturation of oxygen and reduction of the pulmonary volumes in the x-rays and computed tomography. The mechanical ventilatory strategies in the ARDS include pulmonary protection strategy with low tidal volume (5 mL/kg) and high positive end espiratory pressure (PEEP) in order to maintain open (recruited) the pulmonary alveoli previously collapsed. The recruitment maneuvers are also other useful techniques. They provide a high and sustained airway pressure. The most commonly used techniques include: high and sustained positive pressure, intermittent sighs and prone position. PEEP is an important contributor in all of these maneuvers to maintain the benefical effect of the alveolar recruitment maneuver and prevent the mechanical ventilation complications, including atelectrauma.

REFERENCES

1. Marini JJ, Gattinoni L. Ventilatory management of acute respiratory distress syndrome: a consensus of two. Crit Care Med 2004;32:250-5.

2. Hess DR, Bigatello LM. Lung recruitment: the role of recruitment maneuvers. Respir Care 2002;47:308-17.

3. Habashi NM, et al. New directions in ventilatory management. In: Franco KL, Putman JB, editors. Advanced therapy in thoracic surgery. 1998;pp:24-35.

4. Tusman G, Böhm SH, Vázquez de Anda GF, et al. Alveolar recruitment strategy improves arterial oxigenation during general anesthesia. Br J Anaesth 1999;82:8-13.

5. Valente BS. Lung recruitment maneuvers in acute respiratory distress syndrome and facilitating resolution. Crit Care Med 2003;31:S265-71.

6. Amato MBP, Barbas CSV, Medeiros DM, et al. Effect of prospective-ventilation strategy on mortality in the acute respiratory distress syndrome. N Engl J Med 1998;338:347-54.

7. Pelosi P, Goldner M, McKibben A, et al. Recruitment and derecruitment during acute respiratory failure: an experimental study. Am J Respir Crit Care Med 2001;164:122-30.

8. Crotti S, Mascheroni D, Caironi P, et al. Recruitment and desrecruitment during acute respiratory failure: a clinical study. Am J Respir Crit Care Med 2001;164:131-40.

9. Grasso S, Mascia L, Del Turco M, et al. Effects of recruitment maneuvers in patients with acute respiratory distress syndrome ventilated with protective ventilatory strategy. Anesthesiology 2002;96:795-802.

10. Pelosi P, Cadringher P, Bottino N, et al. Sigh in acute distress respiratory syndrome. Am J Respir Crit Care Med 1999;159:872-80.

11. Barbas CSV, Silva E, Garrido A, et al. Recruitment maneuvers with different pressure control levels in ARDS patients. Am J Respir Crit Care 2001;163:A163.

12. Pelosi P, Caironi P, Taccone P, et al. Pathophysiology of prone position in the healthy lung and in ALI/ARDS. Minerva Anestesiol 2001;67:238-47.

13. Mure M, Lindahl SGE. Prone position improves gas exchange–but how? Acta Anaesthesiol Scand 2001;45:150-9.

14. Brazzi L, Ravagnan I, Pelosi P, et al. Prone position in anaesthesia and intensive care. Care Crit Ill 1999;15:5-10.

15. Mutoh T, Guest RJ, Lamm WJE, et al. Prone position alters the effect of volume overload on regional pleural pressures and improves hypoxemia in pigs in vivo. Am J Respir Crit Care Med 1992;146:300-6.

16. Ranieri VM, Brienza N, Santostasi S, et al. Impairment of lung and chest wall mechanics in patients with acute respiratory distress syndrome: role of abdominal distension. Am J Respir Crit Care Med 1997;156:1082-91.

17. Pelosi P, Croci M, Calappi E, et al. The prone positioning during general anestesia minimally affects respiratory mechanics while improving functional residual capacity and increasing oxygen tension. Anesth Analg 1995;80:955-60.

18. Rothen HU, Sporre B, Engberg G, et al. Airway closure, atelectasis and gas exchange during general anesthesia. Br J Anaesth 1998;81:681-6.

19. Messerole E, Peine P, Wittkopp S, et al. The pragmatics of prone positioning. Am J Respir Crit Care Med 2002;165:1359-63.

20. Rowe C. Development of clinical guidelines for prone positioning in critically ill adults. Nurs Crit Care 2004;9:50-57.

21. Chatte G, Sab J, Dubois J, et al. Prone position in mechanically ventilated patients with severe acute respiratory failure. Am J Respir Crit Care Med 1997;155:473-8.

22. Gattinoni L, Tognoni G, Brazzi L, et al. Ventilation in the prone position. Lancet 1997;350:815-20.

23. Jolliet P, Bulpe P, Chevrolet J, et al. Effects of the prone position on gas exchange and haemodynamics in severe acute respiratory distress syndrome. Crit Care Med 1998;26:1977-85.

24. Canter C. Nursing mechanically ventilated patients in the prone position. Care Crit Ill 1989;3:3-4.

25. Trottier S. Prone position in acute respiratory distress syndrome: turning over an old idea. Crit Care Med 1998;26:1934-5.

26. Blanch L, Mancebo J, Pérez M, et al. Short-term effects of prone position in critically ill patients with acute distress respiratory syndrome. Intensive Care Med 1997;23:1033-9.

27. Gosheron M, Leaver G, Forester A, et al. Prone lying–a nursing perspective. Care Critically 1998;14:89-92.

28. Pelosi P, Masheroni TD, et al. Effects of the prone position on respiratory mechanics and gas exchange during acute lung injury. Am J Respir Crit Care Med 1998;157:387-93.

29. Ball C. Use of the prone position in the management of acute respiratory distress syndrome. Intensive Crit Care Nurs 1999;15:192-203.

30. Carrillo Esper R, Hernández Rayón A. Posición prona para el manejo del paciente con SIRA. Rev Fac Med UNAM 2003;46:6-11.