Reclutamiento pulmonar / Lung recruitment

Marzo 25, 2016. No. 2276

¨De los ensayos a la clínica¨. Recrutamiento y maniobras de reclutamiento Bench-to-bedside review: Recruitment and recruiting maneuvers. Lapinsky SE, Mehta S. Crit Care. 2005 Feb;9(1):60-5. Epub 2004 Aug 18. Abstract In patients with acute respiratory distress syndrome (ARDS), the lung comprises areas of aeration and areas of alveolar collapse, the latter producing intrapulmonary shunt and hypoxemia. The currently suggested strategy of ventilation with low lung volumes can aggravate lung collapse and potentially produce lung injury through shear stress at the interface between aerated and collapsed lung, and as a result of repetitive opening and closing of alveoli. An 'open lung strategy' focused on alveolar patency has therefore been recommended. While positive end-expiratory pressure prevents alveolar collapse, recruitment maneuvers can be used to achieve alveolar recruitment. Various recruitment maneuvers exist, including sustained inflation to high pressures, intermittent sighs, and stepwise increases in positive end-expiratory pressure or peak inspiratory pressure. In animal studies, recruitment maneuvers clearly reverse the derecruitment associated with low tidal volume ventilation, improve gas exchange, and reduce lung injury. Data regarding the use of recruitment maneuvers in patients with ARDS show mixed results, with increased efficacy in those with short duration of ARDS, good compliance of the chest wall, and in extrapulmonary ARDS. In this review we discuss the pathophysiologic basis for the use of recruitment maneuvers and recent evidence, as well as the practical application of the technique. PDF Comparación entre dos maniobras diferentes de reclutamiento en pacientes con síndrome de dificultad respiratoria aguda A comparison between two different alveolar recruitment maneuvers in patients with acute respiratory distress syndrome. Mahmoud KM, Ammar AS. Int J Crit Illn Inj Sci. 2011 Jul;1(2):114-20. doi: 10.4103/2229-5151.84795. Abstract BACKGROUND:Alveolar recruitment is a physiological process that denotes the reopening of previously gasless lung units exposed to positive pressure ventilation. The current study was aimed to compare two recruitment maneuvers, a high continuous positive airway pressure (CPAP), and an extended sigh in patients with ARDS. MATERIALS AND METHODS: Forty patients with acute respiratory distress syndrome were randomly divided into two groups, 20 patients each. Group I received a CPAP of 40 cm H(2)O for 40 seconds and group II received extended sigh (providing a sufficient recruiting pressure × time). In our study, we assessed the effects of both recruitment maneuvers on respiratory mechanics, gas exchange, and hemodynamics. These data were analyzed using two-way analysis of variance (ANOVA) followed by a Student--Newman--Keuls post hoc comparison test. P < 0.05 was considered statistically significant. RESULTS: Both methods improved the compliance, increased arterial oxygenation (PaO(2)), increased the PaO(2)/FiO(2) ratio, and reduced the pulmonary shunt fraction (Q(s)/Q(t)). However, the extended sigh improved both PaO(2) and PaO(2)/FiO(2) ratios more than continuous positive airway pressure. Also the hemodynamic parameters were better maintained during the extended sigh. CONCLUSION: Alveolar recruitment maneuvers are effective in management of mechanically ventilated ARDS patients. We conclude that extended sigh is more effective than continuous positive airway pressure as a recruitment maneuver. KEYWORDS: Alveolar recruitment; acute respiratory distress syndrome; continuous positive airway pressure; extended sigh PDF La mejor forma de reclutar el pulmón lesionado? How best to recruit the injured lung? Marini JJ. Crit Care. 2008;12(3):159. doi: 10.1186/cc6910. Epub 2008 Jun 20. Abstract Sustained re-opening of collapsed lung tissue (recruitment) requires the application of airway pressures that exceed those of the tidal cycle. The post-maneuver PEEP as well as the duration of high pressure application are also key factors in its success, with their accompanying potential for hemodynamic compromise. Although a wide variety of recruiting maneuvers have been described, the technique that strikes the best balance between efficacy and risk may well vary among patients with differing right heart loading status and lung properties. PDF Maniobras de reclutamiento pulmonar con o sin albuterol nebulizado en daño pulmonar agudo. Estudio aleatorizado y controlado Lung recruitment maneuver with and without nebulized albuterol for acute lung injury: a randomized, controlled study. Asida SM, Badawy MS. Res Opin Anesth Intensive Care 2015;2:126-31 Abstract Background. β2-Adrenoceptor agonists accelerate the resolution of pulmonary edema in experimental and clinical studies. We tested the hypothesis that combining nebulized albuterol with lung recruitment maneuver (RM) during mechanical ventilation would improve oxygenation and accelerate the resolution of pulmonary edema more than would RM alone in patients with acute lung injury (ALI) and/or acute respiratory distress syndrome (ARDS). Materials and methods. In this randomized, controlled, single-blinded study, 60 patients admitted to the ICU of Qena University Hospitals and suffering from ALI and/or ARDS were recruited. All patients were subjected to the lung RM. They were assigned to two equal groups: the albuterol group (30 patients), in which patients were medicated with nebulized albuterol 1 mg diluted in 10 ml saline; and the control group (30 patients), in which patients were given 10 ml nebulized saline instead of albuterol. This regimen was repeated every 8 h for 3 days. Alveolar fluid samples were withdrawn before and 1 h after the lung recruitment for protein concentration measurement in the alveolar fluid. Results. We found a significant difference between the two groups regarding PaO2 (P = 0.003) and PaO2/FiO2 (P = 0.023) before and after RM ± albuterol. No significant difference between the two groups was found regarding alveolar fluid clearance and alveolar protein concentration. Conclusion. RM with nebulized albuterol improved oxygenation but the addition of albuterol was not beneficial regarding alveolar fluid clearance in terms of lowering alveolar protein concentration in ALI/ARDS patients. Keywords: acute lung injury, albuterol, recruitment maneuver PDF

Anestesiología y Medicina del Dolor 52 664 6848905 vwhizar@anestesia-dolor.org anestesia-dolor.org Copyright © 2015

Tromboembolismo venoso en UCI / Venous thromboembolism in the ICU

Marzo 17, 2016. No. 2268

Heparina de bajo peso molecular y compresión neumática intermitente para tromboprofilaxis en pacientes graves Low-molecular-weight heparin and intermittent pneumatic compression for thromboprophylaxis in critical patients. Wan B, Fu HY, Yin JT, Ren GQ. Exp Ther Med. 2015 Dec;10(6):2331-2336. Epub 2015 Oct 13. Abstract The efficacy and safety of physiotherapeutic prophylaxis for venous thromboembolism in critically ill patients with heparin contraindication remains unclear. In the present study it was hypothesized that physiotherapy prophylaxis with intermittent pneumatic compression (IPC) would be safe and effective for patients unable to receive low-molecular-weight heparin (LMWH). In addition, this study investigated whether a combined therapy of IPC with LMWH would be more effective for the prophylaxis of deep vein thrombosis (DVT) in critical patients. A total of 500 patients were divided into four groups according to the prophylaxis of DVT. The IPC group consisted of 95 patients with heparin contraindication that received IPC treatment; the LMWH group consisted of 185 patients that received an LMWH injection; the LMWH + IPC group consisted of 75 patients that received IPC treatment and LMWH injection; and the control group consisted of 145 patients that received no IPC treatment or injection of LMWH. Each patient was evaluated clinically for development of DVT and the diagnosis was confirmed by Doppler study. Venous thromboembolism was a common complication among the trauma patients with severe injuries. Patients responded positively to the treatment used in the intervention groups. Patients exhibited an improved response to LMWH + ICP compared with IPC or LMWH alone, while no significant difference was detected between the IPC and LMWH groups. These results were applicable to patients that had a Wells score of ≥3; however, no significant differences in DVT incidence were observed among the patients who had a Wells score of <3. In this observational study, LMWH + ICP appeared to be more effective than either treatment alone in treating critically ill trauma patients with severe injuries that are at high risk for VTE and bleeding simultaneously. KEYWORDS: deep venous thrombosis; intermittent pneumatic compression; low-molecular-weight heparin PDF Tromboembolismo venoso en UCI. Principales características, diagnóstico y tromboprofilaxis Venous thromboembolism in the ICU: main characteristics, diagnosis and thromboprophylaxis. Minet C, Potton L, Bonadona A, Hamidfar-Roy R, Somohano CA, Lugosi M, Cartier JC, Ferretti G, Schwebel C, Timsit JF. Crit Care. 2015 Aug 18;19:287. doi: 10.1186/s13054-015-1003-9. Abstract Venous thromboembolism (VTE), including pulmonary embolism (PE) and deep venous thrombosis (DVT), is a common and severe complication ofcritical illness. Although well documented in the general population, the prevalence of PE is less known in the ICU, where it is more difficult to diagnose and to treat. Critically ill patients are at high risk of VTE because they combine both general risk factors together with specific ICU risk factors of VTE, like sedation, immobilization, vasopressors or central venous catheter. Compression ultrasonography and computed tomography (CT) scan are the primary tools to diagnose DVT and PE, respectively, in the ICU. CT scan, as well as transesophageal echography, are good for evaluating the severity of PE. Thromboprophylaxis is needed in all ICU patients, mainly with low molecular weight heparin, such as fragmine, which can be used even in cases of non-severe renal failure. Mechanical thromboprophylaxis has to be used if anticoagulation is not possible. Nevertheless, VTE can occur despite well-conducted thromboprophylaxis. PDF

Anestesiología y Medicina del Dolor 52 664 6848905 vwhizar@anestesia-dolor.org anestesia-dolor.org Copyright © 2015

Libros de neumología / E-books on pulmonology

Marzo 19, 2016. No. 2270

Perspectivas clínicas en Enfermedad Pulmonar Obstructiva Crónica COPD Clinical Perspectives Edited by Ralph J. Panos, ISBN 978-953-51-1624-0, 206 pages, Publisher: InTech, Chapters published July 16, 2014 under CC BY 3.0 license DOI: 10.5772/57036 Libro / Book Inflamación pulmonar Lung Inflammation Edited by Kian Chung Ong, ISBN 978-953-51-1373-7, 118 pages, Publisher: InTech, Chapters published May 14, 2014 under CC BY 3.0 license DOI: 10.5772/57068 Libro / Book Enfermedades respiratorias e infecciones. Una nueva visión Respiratory Disease and Infection - A New Insight Edited by Bassam H. Mahboub, ISBN 978-953-51-0968-6, 260 pages, Publisher: InTech, Chapters published February 06, 2013 under CC BY 3.0 license DOI: 10.5772/46040 Libro / Book Perspectiva global sobre broncoscopía Global Perspectives on Bronchoscopy Edited by Sai Praveen Haranath and Samiya Razvi, ISBN 978-953-51-0642-5, 252 pages, Publisher: InTech, Chapters published June 13, 2012 under CC BY 3.0 license DOI: 10.5772/1452 Libro / Book Enfisema Emphysema Edited by Ravi Mahadeva, ISBN 978-953-51-0433-9, 142 pages, Publisher: InTech, Chapters published March 30, 2012 under CC BY 3.0 license DOI: 10.5772/1189 Libro / Book Embolismo pulmonar Pulmonary Embolism Edited by Ufuk Çobanoğlu, ISBN 978-953-51-0233-5, 246 pages, Publisher: InTech, Chapters published March 14, 2012 under CC BY 3.0 license DOI: 10.5772/1493 Libro / Book

Anestesiología y Medicina del Dolor 52 664 6848905 vwhizar@anestesia-dolor.org anestesia-dolor.org Copyright © 2015