Segredo MY, Cartaya IJM, Bilbao GK, Rovira RLE, Álvarez GI, Acevedo RY

Language: Spanish
References: 20
Page: 1-17
PDF size: 265.42 Kb.

ABSTRACT

Introduction: The impact of mechanical ventilation in patients with acute respiratory distress syndrome has been extensively investigated in the last decade, both experimentally and clinically. It represents one of the greatest advances made in the field of critical patient respiratory care.
Objective: To determine the effectiveness of alveolar recruitment in paediatric patients with acute respiratory distress syndrome.
Method: A descriptive, longitudinal and prospective study was conducted from January 2005 to December 2014, at José Luis Miranda University Pediatric Hospital. The sample consisted of 55 patients who underwent alveolar recruitment as the main therapy. Gasometry was indicated and oxygenation rates were calculated before and after the maneuver. Basically, the mean and standard deviation, the Pearson correlation coefficient and the Chi-square test were used for statistical analysis.
Results: Highly significant values were obtained in relation to the recruitment of the first three days, since the levels of positive pressure, at the end of the optimal required expiration, were much higher after their titration by the decremental method. In addition, positive changes were obtained in the Kirby index, in specific dynamic compliance and in tidal volume at the same control pressure value.
Conclusions: Alveolar recruitment, together with the use of protective ventilation parameters, constitutes an effective therapy in the treatment applied to the pediatric patient with acute respiratory distress syndrome in the early stage.

REFERENCES

1. Ashbaugh DG, Petty TL, Bigelow DB. Acute respiratory distress in adults. Lancet. 1967;2:319-23.

2. Suárez-Sipmann F, Böhm S, Tusman G. Use of dynamic compliance for open lung positive end-expiratory pressure titration in an experimental study. Crit Care Med. 2007;35:214-21.

3. Suárez-Sipmann F. Utilidad de las maniobras de reclutamiento (PRO). Med Intensiva. 2009;33(3):134-8.

4. Donoso FA, Arriagada SD, Díaz RF, Cruces RP. Estrategias ventilatorias ante el niño con síndrome de distress respiratorio agudo e hipoxemia grave. Gac Med Mex. 2015;151:75-84.

5. Matthay MA, Ware LB, Zimmerman GA. The acute respiratory distress syndrome. J Clin Invest. 2012;122:2731-40.

6. Cardinal-Fernández P, Esteban A, Thompson BT, Lorente JA. ARDS: lessons learned from the heart. Chest. 2015;147:7-8.

7. Cardinal Fernández P, Correger E, Villanueva J, Rios F. Acute Respiratory Distress: from syndrome to disease. Med Intensiva. 2016;40:169-75.

8. Janz DR, Ware LB. Approach to the patient with the acute respiratory distress syndrome. Clin Chest Med. 2014;35:685-96.

9. Algaba Á, Nin N, GT-IRA de la SEMICYUC. Maniobras de reclutamiento alveolar en el síndrome de distrés respiratorio agudo. Med Intensiva. 2013;37(5):355-62.

10. Amato MB, Barbas CS, Medeiros DM, Magaldi RB, Schettino GP, Lorenzi-Filho G, et al. Effect of a protective-ventilation strategy on mortality in the acute respiratory distress syndrome. N Engl J Med. 1998;338:347-54.

11. Acute Respiratory Distress Syndrome Network; Brower RG, Matthay MA, Morris A, Schoenfeld D, Thompson BT, et al. The Acute Respiratory Distress Network. Ventilation with Lower Tidal Volumes as compared with Traditional Tidal Volumes for Acute Lung Injury and The Acute Respiratory Distress Syndrome. N Engel J Med. 2000;342(18):1301-8.

12. Meade MO, Cook DJ, Guyatt GH, Slutsky AS, Arabi YM, Cooper DJ, et al; Lung Open Ventilation Study Investigators. Ventilation strategy using low tidal volumes, recruitment maneuvers, and high positive end-expiratory pressure for acute lung injury and acute respiratory distress syndrome: a randomized controlled trial. JAMA. 2008;299:637-45.

13. Suzumura EA, Figueiró M, Normilio-Silva K. Effects of alveolar recruitment maneuvers on clinical outcomes in patients with acute respiratory distress syndrome: a systematic review and meta-analysis. Intensive Care Med. 2014;40:1227-40.

14. Gattinoni L, Caironi P, Cressoni M, Chiumello D, Ranieri VM, Quintel M, et al. Lung recruitment in patients with the acute respiratory distress syndrome. N Engl J Med. 2006;354:1775-86.

15. Hickling KG. Best compliance during a decremental, but not incremental, positive end-expiratory pressure trial is related to open-lung positive end-expiratory pressure: a mathematical model of acute respiratory distress syndrome lungs. Am J Respir Crit Care Med. 2001;163:69-78.

16. Amato MB, Barbas CS, Medeiros DM, Schettino G, Lorenzi Filho G, Kairalla RA, et al. Beneficial effects of the "open lung approach" with low distending pressures in acute respiratory distress syndrome. A prospective randomized study on mechanical ventilation. Am J Respir Crit Care Med. 1995;152(12):1835-46.

17. San Román JE, Giannasi SE, Ávila R, Saldarini F, Perman M, Butera M, et al. Efectos fisiológicos de una maniobra de reclutamiento alveolar escalonada en pacientes con SDRA en etapa precoz. Med Intensiva. 2003;27(10):662-822.

18. Rothen HU, Sporre B, Engberg G, Wegenius G, Hogman M, Hedenstierna G. Influence of gas composition on recurrence of atelectasis after a reexpansion maneuver during general anesthesia. Anesthesiology. 1995;82:832-42.

19. Gordo Vidal F, Delgado Arnaiz C, Calvo Herranz E. Lesión pulmonar inducida por la ventilación mecánica. Med Intensiva. 2007;31(1):18-26.

20. Tagarro García A, Moreno Pérez D, Andrés Martín A, Moreno Galdó A. ¡Atención!, el oxígeno solo es maquillaje. Respuestas de los autores. An Pediatr (Barc). 2016;84(6):353-54.