Expertos Invitados





ESTRATEGIAS ATUAIS DE VENTILAÇAO MECANICA NA SINDROME DA ANGUSTIA RESPIRATORIA AGUDA (SARA)

(especial para SIIC © Derechos reservados)
O emprego de volume corrente reduzido, minimizando a hiperdistensão alveolar, parece ser o maior avanço relacionado a ventilação mecânica desde o advento do PEEP, há mais de duas décadas, e o único com comprovado impacto na taxas de mortalidade.
coimbra.jpg Autor:
Raul Coimbra
Columnista Experto de SIIC
Artículos publicados por Raul Coimbra
Recepción del artículo
25 de Junio, 2003 		Primera edición
7 de Abril, 2004 		Segunda edición, ampliada y corregida
7 de Junio, 2021

ESTRATEGIAS ATUAIS DE VENTILAÇAO MECANICA NA SINDROME DA ANGUSTIA RESPIRATORIA AGUDA (SARA)

Resumen
Nos últimos anos ocorreram avanços significativos na compreensão da fisiopatologia da Lesão Pulmonar Aguda (LPA) e da Síndrome da Angústia Respiratória Aguda (SARA), bem como novas estratégias de ventilação mecânica visando o recrutamento alveolar e a proteção pulmonar foram desenvolvidas. O presente artigo tem por objetivo fazer uma revisão das estratégias atuais de ventilação mecânica na SARA incluindo o uso de volume corrente reduzido (4-8 mL/kg), hipercapnia permissiva, e ventilação em pronação.

Palabras clave
Insuficiência Respiratória Aguda, Síndrome da Angústia Respiratória Aguda, Lesão Pulmonar Aguda, Ventilação Mecânica


Artículo completo
(castellano)
Extensión:  +/-4.87 páginas impresas en papel A4
Exclusivo para suscriptores/assinantes

MECHANICAL VENTILATION STRATEGIES IN THE MANAGEMENT OF ACUTE RESPIRATORY DISTRESS SYNDROME (ARDS)

Abstract
In recent years, significant advances in the pathophysiology and ventilatory management of Acute Lung Injury (ALI) and Acute Respiratory Distress Syndrome (ARDS) occurred. These new ventilatory strategies aim to protect the lung against the deleterious effects of conventional mechanical ventilation, as well as to promote alveolar recruitment.In the present article current ventilatory strategies including the use of low tidal volumes (4-8 mL/kg), permissive hypercapnia, and prone ventilation are reviewed.

Key words
Insuficiência Respiratória Aguda, Síndrome da Angústia Respiratória Aguda, Lesão Pulmonar Aguda, Ventilação Mecânica

Clasificación en siicsalud
Artículos originales > Expertos del Mundo >
página   www.siicsalud.com/des/expertocompleto.php/

Especialidades
Principal: Cuidados Intensivos
Relacionadas: Emergentología, Neumonología



Comprar este artículo
Extensión: 4.87 páginas impresas en papel A4

file05.gif (1491 bytes) Artículos seleccionados para su compra



Bibliografía del artículo
  1. Bernard GR, Artigas A, Brigham KL, et al. The American-European Consensus Conference on ARDS: definition, mechanisms, relevant outcomes, and clinical trial coordination. Am J Respir Crit Care Med 149: 818-824, 1994
  2. Parker JC, Hernandez LA, Peevy KJ. Mechanisms of ventilator-induced lung injury. Crit Care Med 21:131-143, 1993.
  3. Dreyfuss D, Saumon G. Ventilator-induced lung injury. Lessons from experimental studies. Am J Respir Crit Care Med 157:294-323, 1998.
  4. Marcy TW, Marini JJ. Inverse Ratio Ventilation in ARDS. Rationale and Implementation. Chest 100: 494-504, 1991.
  5. Argiras EP, Blakeley CR, Dunnill MS, et al. High PEEP decreases hyaline membrane formation in surfactant deficient lungs. Br J Anaesth 59:1278-1285, 1987.
  6. Webb, HH, Tierney DF. Experimental pulmonary edema due to intermittent positive pressure ventilation with high inflation pressures:protection by positive end-expiratory pressure. Am Rev Respir Dis 110:556-565, 1974.
  7. International Consensus Conferences in Intensive Care Medicine: Ventilator- associated Lung Injury in ARDS. Am J Respir Crit Care Med 160:2118-2124, 1999.
  8. Richard JC, Maggiore SM, Jonson B, et al. Influence of tidal volume on alveolar recruitment: respective role of PEEP and a recruitment maneuver. Am J Respir Crit Care Med 2001; 163:1609-1613.
  9. Grasso S, Mascia L, Del Turco M, et al. Effects of recruiting maneuvers in patients with acute respiratory distress syndrome ventilated with protective ventilatory strategy. Anesthesiology 2002; 96:795-802.
  10. Lapinsky SE, Aubin M, Mehta S, et al. Safety and efficacy of a sustained inflation for alveolar recruitment in adults with respiratory failure. Intensive Care Med 1999; 25:1297-1301.
  11. Amato MB, Barbas CS, Medeiros DM, et al. Effect of a protective-ventilation strategy on mortality in the acute respiratory distress syndrome. N Engl J Med 338:347-354, 1998.
  12. Hickling KG, Walsh J, Henderson S, et al. Low mortality rate in adult respiratory distress syndrome using low-volume, pressure-limited ventilation with permission hypercapnia: a prospective study. Crit Care Med 22:1568-1578, 1994.
  13. Bidani A, Tzounakis AE, Cardenas VJ, et al. Permissive hypercapnia in acute respiratory failure. JAMA 272:957-962, 1994.
  14. Roupie E, Dambrosio M, Servillo G. Titration of tidal volume and induced hypercapnia in acute respiratory distress syndrome. Am J Respir Crit Care Med 152:121-128, 1995.
  15. Guinard N, Beloucif S, Gatecel C, et al. Interest of a therapeutic optimization strategy in severe ARDS. Chest 111:1000-1007, 1997.
  16. Stewart TE, Meade MO, Cook DJ, et al. Evaluation of a ventilation strategy to prevent barotrauma in patients at high risk for acute respiratory distress syndrome. N Engl J Med 338:355-361, 1998.
  17. Bulger EM, Jurkovich GJ, Gentilello LM, et al. Current clinical options for the treatment and management of acute respiratory distress syndrome. J Trauma 48:562-572, 2000.
  18. Hirvela ER. Advances in the management of acute respiratory distress syndrome. Protective ventilation. Arch Surg 135:126-135, 2000.
  19. Gurevitch MJ, Dyke JV, Young ES, Jackson K. Improved Oxygenation and Lower Peak Airway Pressure in Severe Adult Respiratory Distress Syndrome. Treatment with Inverse Ratio Ventilation. Chest 89: 211-213, 1986.
  20. Lain DC, DiBenedetto R, Morris SL, et al. Pressure Control Inverse Ratio Ventilation as a Method to Reduce Peak Inspiratory Pressure and Provide Adequate Ventilation and Oxigenation. Chest 95: 1081-1088, 1989.
  21. Abraham E, Yoshihara G. Cardiorespiratory Effects of Pressure Controlled Inverse Ratio Ventilation in Severe Respiratory Failure. Chest 96: 1356-1359, 1989.
  22. Tharratt RS, Allen RP, Albertson TE. Pressure Controlled Inverse Ratio Ventilation in Severe Adult Respiratory Failure. Chest 94: 755-762, 1988.
  23. Lessard MR, Guerot E, Lorino H, et al. Effects of pressure-controlled with different I:E ratios versus volume-controlled ventilation on respiratory mechanics, gas exchange, and hemodynamics in patients with adult respiratory distress syndrome. Anesthesiology 80: 983-991, 1994.
  24. Gattinoni L, Pelosi P, Vitale G et al. Body position changes redistribute lung computed-tomographic density in patients with acute respiratory failure. Anesthesiology 1991; 74:15-23.
  25. Stocker R, Neff T, Stein S, et al. Prone positioning and low-volume pressure-limited ventilation improve survival in aptients with severe ARDS. Chest 111: 1008-1017, 1997.
  26. Jolliet P, Bulpa P, Chevrolet JC. Effects of the prone position on gas exchange and hemodynamics in severe acure respiratory distress syndrome. Crit Care Med 26:1977-1985, 1998.
  27. Mure M, Martling CR, Lindahl SGE. Dramatic effect on oxygenation in patients with severe acute lung insufficiency treated in the prone position. Crit Care Med 25:1539-1544, 1997.
  28. Blanch L, Mancebo J, Perez M, et al. Short-term effects of prone position in critically ill patients with acute respiratory distress syndrome. Intensive Care Med 23:1033-1039, 1997.
  29. Servillo G, Roupie E, De Robertis E, et al. Effects of ventilation in ventral decubitus position on respiratory mechanics in adult respiratory distress syndrome. Intensive Care Med 23:1219-1224, 1997.
  30. Dries DJ. Prone Positioning in Acute Lung Injury. J Trauma 45: 849-852, 1998.
  31. Curley MAQ. Prone Positioning of Patients with Acute Respiratory Distress Syndrome: A Systematic Review. Am J Crit Care 8: 397-405, 1999.
  32. Amato MB, Barbas CS, Medeiros DM, 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. 152:1835-1846, 1995.
  33. Ventilation with Lower Tidal Volumes as Compared with Traditional Tidal Volumes for Acute Lung Injury and The Acute Respiratory Distress Syndrome. The Acute Respiratory Distress Syndrome Network. N Engl J Med 342: 1301-1308, 2000.
  34. Gattinoni L, Tognoni G, Pesenti A, et al. Effect of prone positioning on the survival of patients with acute respiratory failure. N Engl J Med 2001; 345:568-573.
  35. Gattinoni L, Chiumello D, Russo R. Reduced tidal volumes and lung protective ventilatory strategies: where do we go from here Curr Opinion Crit Care 2002; 8:45-50.
Título español
Resumen
 Palabras clave
 Bibliografía
 Artículo completo
(exclusivo a suscriptores)
 Autoevaluación
  Tema principal en SIIC Data Bases
 Especialidades

 English title
 Abstract
 Key words
Full text
(exclusivo a suscriptores)

Autor 
Artículos
Correspondencia

Patrocinio y reconocimiento
Imprimir esta página
 
 
 
 
 
 
 
 
 
 
 
 
Está expresamente prohibida la redistribución y la redifusión de todo o parte de los contenidos de la Sociedad Iberoamericana de Información Científica (SIIC) S.A. sin previo y expreso consentimiento de SIIC.
ua31618
Home

Copyright siicsalud © 1997-2024 ISSN siicsalud: 1667-9008