Más de ventilación perioperatoria / More on perioperative ventilation

Septiembre 7, 2017. No. 2804

Efectos de la ventilación mecánica intraoperatoria y de la ventilación de protección pulmonar en el paciente quirúrgico adulto Peris-Montalt R, Cruz-García-Dihinx I, Errando C, Granell M. MÉD.UIS. 2015;28(1):65-78. PDF Conceptos actuales de ventilación protectora durante la anestesia general. Current concepts of protective ventilation during general anaesthesia. Serpa Neto A1, Schultz MJ2, Slutsky AS3. Author information Swiss Med Wkly. 2015 Nov 12;145:w14211. doi: 10.4414/smw.2015.14211. eCollection 2015. Abstract Mechanical ventilation with high tidal volumes (VT) has been common practice in operating theatres because this strategy recruits collapsed lung tissue and improves ventilation-perfusion mismatch, thus decreasing the need for high inspired oxygen concentrations. Positive end-expiratory pressure (PEEP) was not used routinely because it was thought to impair cardiovascular function. Over the past two decades there have been advances in our understanding of the causes and importance of ventilation-induced lung injury based on studies in animals with healthy lungs, and trials in critically ill patients with and without acute respiratory distress syndrome. Recent data from randomised controlled trials in patients receiving ventilation during general anaesthesia for surgery have demonstrated that lung-protective strategies (use of low VT, use of PEEP if indicated, and avoidance of excessive oxygen concentrations) are also of importance during intraoperative ventilation. PDF XIV Congreso Virtual Mexicano de Anestesiología 2017 Octubre 1-Diciembre 31, 2017 Información / Information Video informativo Convocatoria para el Curso de Posgrado en Medicina del Dolor y Paliativa 2018 para Mexicanos y extranjeros. Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán Informes (52) 55 5487 0900 ext. 5011 de lunes a viernes de 9.00 a 14 h (hora de Ciudad de México).  Informes / Information California Society of Anesthesiologists Reuniones / Events Informacion / Information

Anestesiología y Medicina del Dolor 52 664 6848905 vwhizar@anestesia-dolor.org anestesia-dolor.org

Ventilación perioperatoria / Perioperative ventilation

Septiembre 6, 2017. No. 2803

Epidemiología, práctica de ventilación y resultado en pacientes con mayor riesgo de complicaciones pulmonares postoperatorias: LAS VEGAS - un estudio observacional en 29 países. Epidemiology, practice of ventilation and outcome for patients at increased risk of postoperative pulmonary complications: LAS VEGAS - an observational study in 29 countries. LAS VEGAS investigators. Collaborators (492) Eur J Anaesthesiol. 2017 Aug;34(8):492-507. doi: 10.1097/EJA.0000000000000646. Abstract BACKGROUND: Limited information exists about the epidemiology and outcome of surgical patients at increased risk of postoperative pulmonary complications (PPCs), and how intraoperative ventilation was managed in these patients. OBJECTIVES: To determine the incidence of surgical patients at increased risk of PPCs, and to compare the intraoperative ventilation management and postoperative outcomes with patients at low risk of PPCs.  CONCLUSION: The incidence of patients with a predicted increased risk of PPCs is high. A large proportion of patients receive high VT and low PEEP levels. PPCs occur frequently in patients at increased risk, with worse clinical outcome. TRIAL REGISTRATION: The study was registered at Clinicaltrials.gov, number NCT01601223. PDF Ventilación intraoperatoria protectora con niveles más altos o más bajos de presión positiva de expiración final en pacientes obesos (PROBESE): protocolo de estudio para un ensayo controlado aleatorio. Protective intraoperative ventilation with higher versus lower levels of positive end-expiratory pressure in obese patients (PROBESE): study protocol for a randomized controlled trial. Bluth T1, Teichmann R1, Kiss T1, Bobek I2, Canet J3, Cinnella G4, De Baerdemaeker L5, Gregoretti C6, Hedenstierna G7, Hemmes SN8,9, Hiesmayr M10,11,12,13, Hollmann MW8,9, Jaber S14, Laffey JG15,16,17,18, Licker MJ19, Markstaller K13, Matot I20, Müller G21, Mills GH22, Mulier JP23, Putensen C24, Rossaint R25, Schmitt J21, Senturk M26, Serpa Neto A27,28, Severgnini P29, Sprung J30, Vidal Melo MF31, Wrigge H32, Schultz MJ9,33, Pelosi P34, Gama de Abreu M35; PROBESE investigators; and the PROtective VEntilation Network (PROVEnet); Clinical Trial Network of the European Society of Anaesthesiology (ESA). Collaborators (157) Author information Trials. 2017 Apr 28;18(1):202. doi: 10.1186/s13063-017-1929-0. Erratum to Protective intraoperative ventilation with higher versus lower levels of positive end-expiratory pressure in obese patients (PROBESE): study protocol for a randomized controlled trial. [Trials. 2017] Abstract BACKGROUND: Postoperative pulmonary complications (PPCs) increase the morbidity and mortality of surgery in obese patients. High levels of positive end-expiratory pressure (PEEP) with lung recruitment maneuvers may improve intraoperative respiratory function, but they can also compromise hemodynamics, and the effects on PPCs are uncertain. We hypothesized that intraoperative mechanical ventilation using high PEEP with periodic recruitment maneuvers, as compared with low PEEP without recruitment maneuvers, prevents PPCs in obese patients. METHODS/DESIGN: The PRotective Ventilation with Higher versus Lower PEEP during General Anesthesia for Surgery in OBESE Patients (PROBESE) study is a multicenter, two-arm, international randomized controlled trial. In total, 2013 obese patients with body mass index ≥35 kg/m2 scheduled for at least 2 h of surgery under general anesthesia and at intermediate to high risk for PPCs will be included. Patients are ventilated intraoperatively with a low tidal volume of 7 ml/kg (predicted body weight) and randomly assigned to PEEP of 12 cmH2O with lung recruitment maneuvers (high PEEP) or PEEP of 4 cmH2O without recruitment maneuvers (low PEEP). The occurrence of PPCs will be recorded as collapsed composite of single adverse pulmonary events and represents the primary endpoint. DISCUSSION: To our knowledge, the PROBESE trial is the first multicenter, international randomized controlled trial to compare the effects of two different levels of intraoperative PEEP during protective low tidal volume ventilation on PPCs in obese patients. The results of the PROBESE trial will support anesthesiologists in their decision to choose a certain PEEP level during general anesthesia for surgery in obese patients in an attempt to prevent PPCs. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT02148692. Registered on 23 May 2014; last updated 7 June 2016. KEYWORDS: Mechanical ventilation; Obesity; Positive end-expiratory pressure; Postoperative pulmonary complication; Recruitment maneuver PDF XIV Congreso Virtual Mexicano de Anestesiología 2017 Octubre 1-Diciembre 31, 2017 Información / Information Video informativo Convocatoria para el Curso de Posgrado en Medicina del Dolor y Paliativa 2018 para Mexicanos y extranjeros. Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán Informes (52) 55 5487 0900 ext. 5011 de lunes a viernes de 9.00 a 14 h (hora de Ciudad de México).  Informes / Information California Society of Anesthesiologists Reuniones / Events Informacion / Information

Anestesiología y Medicina del Dolor 52 664 6848905 vwhizar@anestesia-dolor.org anestesia-dolor.org

Falla pulmonar aguda perioperatoria / Perioperative acute lung injury

Agosto 21, 2017. No. 2787

Lesión pulmonar aguda "remota" perioperatoria: actualización reciente Perioperative "remote" acute lung injury: recent update. Jin Z1, Chun Suen K1, Ma D1. Author information J Biomed Res. 2017 Jan 19;31(3):197-212. doi: 10.7555/JBR.31.20160053. Abstract Perioperative acute lung injury (ALI) is a syndrome characterised by hypoxia and chest radiograph changes. It is a serious post-operative complication, associated with considerable mortality and morbidity. In addition to mechanical ventilation, remote organ insult could also trigger systemic responses which induce ALI. Currently, there are limited treatment options available beyond conservative respiratory support. However, increasing understanding of the pathophysiology of ALI and the biochemical pathways involved will aid the development of novel treatments and help to improve patient outcome as well as to reduce cost to the health service. In this review we will discuss the epidemiology of peri-operative ALI; the cellular and molecular mechanisms involved on the pathological process; the clinical considerations in preventing and managing perioperative ALI and the potential future treatment options. La lesión pulmonar aguda perioperatoria (ALI) es un síndrome caracterizado por hipoxia y cambios en la radiografía de tórax. Se trata de una complicación postoperatoria grave, asociada a una mortalidad y morbilidad considerables. Además de la ventilación mecánica, el insulto a órganos remotos también podría desencadenar respuestas sistémicas que inducen ALI. Actualmente, existen limitadas opciones de tratamiento disponibles más allá del apoyo respiratorio conservador. Sin embargo, el aumento de la comprensión de la fisiopatología de ALI y las vías bioquímicas implicadas ayudará al desarrollo de nuevos tratamientos y a mejorar el resultado del paciente, así como reducir los costos para el servicio de salud. En esta revisión se discutirá la epidemiología de la ALI perioperatoria, los mecanismos celulares y moleculares implicados en el proceso patológico, las consideraciones clínicas en la prevención y manejo de ALI perioperatoria y las posibles opciones de tratamiento en el futuro. PDF XIV Congreso Virtual Mexicano de Anestesiología 2017 Octubre 1-Diciembre 31, 2017 Información/Information Videoclip

Anestesiología y Medicina del Dolor 52 664 6848905 vwhizar@anestesia-dolor.org anestesia-dolor.org