Ventilación mecánica protectiva/Protective mechanical ventilation

No. 2056                                                                                  Agosto 16, 2015

Ventilación protectiva intraoperatoria y riesgo de complicaciones respiratorias postoperatorias. Intraoperative protective mechanical ventilation and risk of postoperative respiratory complications: hospital based registry study. Ladha K, Vidal Melo MF, McLean DJ, Wanderer JP, Grabitz SD, Kurth T, Eikermann M. BMJ. 2015 Jul 14;351:h3646. doi: 10.1136/bmj.h3646. PDF Ventilación protectiva vs convencional en cirugía. Protective versus Conventional Ventilation for Surgery: A Systematic Review and Individual Patient Data Meta-analysis Ary Serpa Neto, M.D., M.Sc., Ph.D.; Sabrine N. T. Hemmes, M.D.; Carmen S. V.  et al Anesthesiology. 2015 May 15. [Epub ahead of print] Abstract This individual patient meta-analysis of 2,127 patients ventilated under general anesthesia for surgery from 15 randomized controlled trials shows that intraoperative ventilation with low tidal volume protects against postoperative pulmonary complications, but further trials are necessary to define the role of intraoperative higher positive end-expiratory pressure to prevent postoperative pulmonary complications after major abdominal surgery. PDF  Ventilación pulmonar protectiva en pacientes obesos Perioperative lung protective ventilation in obese patients. Fernandez-Bustamante A, Hashimoto , Serpa Neto A, Moine P, Vidal Melo MF, Repine JE. BMC Anesthesiol. 2015 May 6;15:56. doi: 10.1186/s12871-015-0032-x. Abstract The perioperative use and relevance of protective ventilation in surgical patients is being increasingly recognized. Obesity poses particular challenges to adequate mechanical ventilation in addition to surgical constraints, primarily by restricted lung mechanics due to excessive adiposity, frequent respiratory comorbidities (i.e. sleep apnea, asthma), and concerns of postoperative respiratory depression and other pulmonary complications. The number of surgical patients with obesity is increasing, and facing these challenges is common in the operating rooms and critical care units worldwide. In this review we summarize the existing literature which supports the following recommendations for the perioperative ventilation in obese patients: (1) the use of protective ventilation with low tidal volumes (approximately 8 mL/kg, calculated based on predicted -not actual- body weight) to avoid volutrauma; (2) a focus on lung recruitment by utilizing PEEP (8-15 cmH2O) in addition to recruitment maneuvers during the intraoperative period, as well as incentivized deep breathing and noninvasive ventilation early in the postoperative period, to avoid atelectasis, hypoxemia and atelectrauma; and (3) a judicious oxygen use (ideally less than 0.8) to avoid hypoxemia but also possible reabsorption atelectasis. Obesity poses an additional challenge for achieving adequate protective ventilation during one-lung ventilation, but different lung isolation techniques have been adequately performed in obese patients by experienced providers. Postoperative efforts should be directed to avoid hypoventilation, atelectasis and hypoxemia. Further studies are needed to better define optimum protective ventilation strategies and analyze their impact on the perioperative outcomes of surgical patients with obesity. PDF  Efecto de la ventilación protectiva sobre las complicaciones pulmonares en pacientes bajo anestesia general Effect of protective ventilation on postoperative pulmonary complications in patients undergoing general anaesthesia: a meta-analysis of randomised controlled trials. Tao T, Bo L, Chen F, Xie Q, Zou Y, Hu B, Li J, Deng X. BMJ Open. 2014 Jun 24;4(6):e005208. doi: 10.1136/bmjopen-2014-005208.   CONCLUSIONS: Intraoperative use of protective ventilation strategies has the potential to reduce the incidence of postoperative pulmonary complications in patients undergoing general anaesthesia. Prospective, well-designed clinical trials are warranted to confirm the beneficial effects of protective ventilation strategies in surgical patients. PDF

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