Med Intensiva. Algaba a , N. Todos los derechos reservados. Alveolar recruitment maneuvers in respiratory distress syndrome Abstract In patients with acute respiratory distress syndrome, heterogeneity in filling of the lung parenchyma results in collapsed or distended lung areas. Protective ventilation strategies based on the use of low volumes have been shown to increase survival in this context. For opening the lung, and in addition to PEEP, recruitment maneuvers are usedthis practice remaining the subject of debate.
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In this review we try to define the pulmonary lesions caused by mechanical ventilation that may benefit from the main recruitment strategies proposed, both in the case of intensive respiratory care patients as in patients under anesthesia. The most common pulmonary lesions caused by mechanical ventilation are: barotrauma, volutrauma, atelectrauma and biotrauma.
There are strategies for alveolar recruitment, some of which are recruitment maneuvers in themselves according to the pressure values used , such as: an increase in PEEP values, sustained insufflation, sighing, resorting to the benefits of spontaneous breathing, high frequency oscillating ventilation, ventilation with biological variability maintaining constant minute volume, prone position, differential ventilation, partial liquid ventilation and inhaled nitric oxi- de.
Monitoring of alveolar acinus recruitment: oximetry arterial and pulse saturation measurement , PaCO 2, arterial pressure, computerized axial tomography CAT , dynamic CAT done during the recruitment maneuver.
Conclusions: In spite of their mechanical origin, mechanical ventilation lesions occur due to changes in biochemical elements such as the surfactant, the action of inflammatory mediators, etc. The lack of large casuistic that supports the success of maneuvers as regards healing and the duration of the benefits of the maneuvers especially in the immediate postoperative period , as well as those concerning survival and morbi-mortality leads us to state that, as yet, there is no evidence about the degree of success of such maneuvers.
There is an improvement in reported monitoring that leads, with certainty, to the frequent use of these strategies, with the pertinent safeguards that allow achieving the specified beneficial repercussions. El flujo de O2 el edema del espacio alveolar. Por lo tanto, se pueden observar regiones superiores creando espacio muerto sobre la zonas relativamente normales y otras con gran colapso zona 1 de West 36, Re- cm de agua cm H2O vs. En contraste, en un estudio de distensibilidad.
Por ejemplo, un pH de 7,,20 equivale a PaCO2 de 80 mmHg, valores de los que se recomienda mantenerse alejados Los diferentes contextos Fig. En pacientes con dad vital.
Maniobras de reclutamiento alveolar
MANIOBRAS DE RECLUTAMIENTO ALVEOLAR. REVISIÓN SISTEMÁTICA
Maniobras de reclutamiento alveolar en el síndrome de distrés